COMMUNITY HEALTH 2020 - 2021 NURSING1, Exams of Nursing

Download COMMUNITY HEALTH 2020 - 2021 NURSING1 and more Exams Nursing in PDF only on Docsity! 2020 - 2021 COMMUNITY HEALTH NURSING1 MODULE ELEANOR R. ATIENZA, BSN, RN, MAN FACULTY NAME: COLLEGE: College of Nursing PROGRAM: Nursing SPECIALIZATION: Community Health Nursing! COURSE GUIDE WEE K 1 2 3 4 5 DATE TOPICS VMGO, Quality Policy, College Goals I. Overview of community health nursing, concepts and principles a. Definition b. Highlights c. Concepts and principles d. Attributes e. Frameworks II. Clients of Community health nurse III. Factors Affecting the Level of Functioning of CHN IV. Roles, Responsibilities, Functions and competencies of Community Health Nurse V. History of CHN Practice in the Philippines VI. Subspecialties of CHN a. Occupational Health nursing b. School Nursing VII. Community Organizing a. Principles b. Philosophy c. Phases VIII. The COPAR Process IX. Community Health Nursing Process A. Steps a. Assessment b. Planning c. Implementation d. Evaluation B. Home visit C. Bag Technique* GC (Assignment ) Zoom lecture Quiz Handout for Printing via email Quiz Zoom with Handout for Printing via email Quiz Handouts Quiz 1 ROWENA VENI S. MANUS, MSN Approved By: BEVERLY D. TAGUINOD, MSN MODULE COMMUNITY HEALTH NURSING (NUR211) OVERVIEW/INTRODUCTION: This course covers the concepts and principles in the provision of basic care in terms of health promotion, health maintenance and disease prevention at the individuals, family, community level and special population groups. It includes the study of the Philippine Health Care Delivery System and the global context of public health Nursing is in the context of the Philippine Health Care Delivery System, and in Community development. LEARNING OUTCOMES AND OBJECTIVES: At the end of the course, the students should be able to: 1. Apply concepts and principles of Community Health. 2. Utilizes Nursing Process in the care of Communities and population groups. 3. Ensure well organized recording and reporting system. 4. Share leadership/relate effectively with others with others in works situations related to nursing and health. LEARNING CONTENT/ TOPICS UNIVERSITY VISION Isabela State University as a vibrant comprehensive and research university in the country and ASEAN region. 4 UNIVERSITY MISSION “The Isabela State University is committed to develop highly trained and globally competent professionals; generate innovative and cutting edge knowledge and technologies for people empowerment and sustainable development; engage in viable resource generation programs; and maintain and enhance stronger partnership under good governance to advance to advance the interest of national international communities. VISION AND MISSION OF THE COLLEGE OF NURSING VISION The college of Nursing Envisions a nursing envisions a nursing student as innovative, competent and scientifically equipped with skills to face the demands of nursing profession in promoting and maintaining health. MISSION The Isabela State University – College of Nursing, Ilagan Campus commits to: Provide nursing students with the beginning nursing skills competency based in order to produce quality nursing graduates who are professionally knowledgeable, competent and dedicated to serve. OBJECTIVES 1. Provide quality education to Nursing Student for them to be equipped with necessary skills and values in the delivery of health care services. 2. Develop students a solid foundation in humanistic, spiritual and moral values which will serve their guide when confronted with decision on human life; 3. Develop students a sense of caring by reaching our people in the community through extension and various outreach programs; 5 4. Provide graduates with good leadership qualities, self-discipline and caring attitudes in applying their nursing skills and serving man, his family and community: and 5. To provide profession growth and advancement of nursing knowledge through research studies and continuing education. 6 - A state characterized by soundness and wholeness of human structures and bodily and mental functions, by OREM, theorist. - It must be noted that these definitions are focused on the individual. 2. RIGHT TO AND RESPONSIBILITY FOR HEALTH - Health is a basic human right. - The universal declaration of human rights article 25, section 1 that: “everyone has the right to a standard living adequate for the health and wellbeing of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control. - The WHO believes (1995) that “the government has the responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures.” - According to the congressional commission on Health (1993), “AS A Fundamental Right, Health Deserves to be a TOP NATIONAL PRIORITY”. - In addition to the state or government, individuals, families and communities share the responsibility for health. 3. PUBLIC HEALTH -‘Public Health is the science and the art of preventing disease, prolonging life and promoting health and efficiency through organized community effort, for the sanitation of the environment. The control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the socials machinery to ensure4 everyone a standard of living for the maintenance of health, so organizing these benefits as to enable every citizen this birth right of health longevity, by WINSLOW, (1920). 4. PRIMARY HEALTH CARE – is “essential health care based on practical, scientifically sound and socially acceptable methods and technology 9 made universally accessible to individuals, families in the community can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.” (WHO/UNICEF 1978, in STANLOPE and LANCASTER). 5. Public health nursing defined -World HEALTH Organization Expert Committee of Nursing defined this as a special field in nursing that combines skills of nursing, public health and some phases of social assistance and functions as part of the total public health programme for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability. (use their nursing skills in the application of public health functions and social assistance within the context of public health programs designed to promote health and prevent diseases). COMMUNITY HEALTH NURSING -The utilization of the Nursing Process in the different levels of nursing clientele-individuals, families, population group, and communities concerned with the promotion of health, prevention of disease and disability and rehabilitation. (Araceli Maglaya) GOAL: To raise level of citizenry by helping communities and families to cope with the discontinuities and treats to health in such a way as to maximize their potential for high level wellness. Is the promotion and preservation of health of its different clienteles – individual, family, population and community. BASIC PRINCIPLES OF COMMUNITY HEALTH NURSING: 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele. 2. In CHN, the clientele is considered as an active partner not passive recipient of care. 3. CHN practice is affected by development in which technology, in particular, changes in society, in general. 4. The goal of CHN is achieved through multi-sectorial efforts. 5. CHN is a part of health care system and the larger human system. 10 OTHER PRINCIPLES OF CHN: 1. The recognized needs of individuals, families, and communities provides the basis for CHN practice. 2. Knowledge and understanding of the objectives and policies of the agency facilities goal achieved. 3. CHN considers the family as the unit of service. 4. Respect for values, customs and beliefs of the clients contribute to the effectiveness of care to the client. 5. CHN integrated health education and counselling as vital parts of functions. 6. Collaborative work relationships with the co-workers and members of the health team facilities accomplishments of goals. 7. Periodic and continuing evaluation provides the means for assessing the degree to which CHN goals and objectives are being attained. 8. Continuing staff education program quality services to attain and are essential to upgrade and maintain sound nursing practices in their setting. 9. Utilization of indigenous and existing community resources maximizing the success of the efforts of community health nurses. 10.Active participation of the individual, family, and community in planning and making decisions for the health care needs, determine to a large extent, the success of the CHN programs. 11.Supervision of nursing services by qualities CHN personnel provides guidance and direction for the work to be done. 12.Accurate recording and reporting serve as the basis for evaluation of the degree of planned programs and activities and as a guide for the future actions. OTHER DISTINGUISHING ATTRIBUTES OF CHN -Greater control for both the nurse and the client in making decisions related to health care - collaboration between nurse and client as equals - recognition of the impact of different factors on health - nurses’ greater AWARENESS of their clients’ lives and situations. 11 A “HEALTHY COMMUNITY”, be it rural or urban, has the following characteristics: 1. Awareness that “we are a community”. 2. Conservation of natural resources. 3. Recognition of, and respect for, the existence of subgroups. 4. Participation of subgroups in community affairs. 5. Preparation to meet crisis. 6. Ability to problem solve. 7. Communication through open channels. 8. Resources available to all. 9. Setting of disputes through legitimate mechanisms. 10.Participation by citizen in decision making. 11.Wellness of a high degree among its members. OTHER IMPORTANT CONCEPTS 1. Community (client) 2. Health (goal) 3. Nursing ( the means) 14 FACTORS AFFECTING THE LEVEL OF FUNCTIONING OF CHN A. POLITICAL -this factor pertains to the power and authority to regulate the environment. Examples: Safety Oppression People empowerment B. HEALTH CARE DELIVERY SYSTEM -One component of this factor is the primary health care which is a partnership approach. GOAL: Effective provision Of health services that are community based and accessible COMPONENTS: Promotive Preventive Curative Rehabilitative C. BEHAVIORAl COMPONENTS Culture Habits Ethnic customs Example: smoking, intake of alcoholic drinks, substance abuse, lack of exercise D. SOCIOECONOMIC INFLUENCES COMPONENTS Employment Education Housing E. ENVIRONMENTAL INFLUENCES COMPONETS Air Food Water waste Urban/rural noise 15 Radiation Pollution F. HEREDITY COMPONENTS Genetic endowment Defects Strengths Risk: Familial Ethnic Racial ROLES, FUNCTIONS OF and COMPETENCIES REQUIRED BY A COMMUNITY HEALTH NURSE Role – refers to a set of behavior patterns that are deemed appropriate for a person by virtue of his/ her status in society and/or a position he/she occupies in an organization. Function - is a set of activities and task expected of a person to perform by virtue of his position or role in society. Competency – the quality of being functionally adequate in performing the task and assuming the role of a specific position.  CLINICIAN – who is the 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?  FACILITATOR – who establishes multi-sectorial linkages by referral system?  SUPERVISOR – who monitors and supervises the performance of midwives in the event that the municipality/city health officer is unable to perform his/her duties and responsibilities or is not available, the public health nurse will take charge of the CHO’s responsibilities.  Case manager  Advocates  Health planner 16 La Gota de Leche – was the first center dedicated to the service of mothers and babies. 1912  Act # 2156 or Fajardo Act The Fajardo Act of 1912 – created sanitary divisions made of one to four municipalities, each sanitary divisions had a “president”, who had to be a physician . 1915 – The Philippine General Hospital began to extend public health nursing services in the homes of patient by organizing a unit called social and home care service, with two nurses as staff. 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. 1947 19 – the Department of Health was reorganized into bureau: quarantine hospitals that took charge of the municipal and charity clinics, and health with the sanitary divisions under it. 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. 20 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. **EO – Executive Order; RA- Republic Act) PRIMARY HEALTH CARE HISTORY HISTORY  MAY 1977 – the 30th World Health Assembly adopted resolution WHO 30:43, this resolution decided that the main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life.  September 12, 1978 - international conference on Primary Health Care was held in this year at Alma ata, USSR.  October 19,1979 – the president of the Philippines (Ferdinand Marcos) issued a letter of Instruction (LOI) 949 which mandated the Ministry of Health to adopt PHC as an approach towards design, development and implementation of progress which focus health development at the community ; level. 21 3. Health School Living – coordinate with other agencies like the insect and vermin control, identify health hazards, participates in maintaining cleanliness. 4. School and Community Coordination – initiates projecs to promote health in the environment. C. DETERMINANTS OF SCHOOL HEALTH NURSING  characteristics of their clientele- their age, developmental stage and their common health problems and concerns.  -POLICIES OF THE Department of education.  Programs of the Department of Health  Standard of the nursing profession -health problems of school children are the result of economic and environmental (particularly their home and immediate environment) factors. C. Components of School Health Nursing 1.School Services- Maintain school, clinic, screening all children- visual, hearing, scoliosis. 2. Health instructions- as health educator/ counselor 3. health monitoring a. mental health- substance abuse, sexual health b. environmental health- food sanitation, water supply, safe environment, safe toilet. c. school community linkage – as community organizer COMMUNITY ORGANIZING - Is a process whereby the community members develop the capability to assess in their health needs and problems, plan and implement actions to solve this problems, put up and sustain organizational structures which will be support and monitor implementation of health initiatives by the people? CORE PRINCIPLES OF COMMUNITY ORGANIZING: 1. Community Organizing is People-Centered 24 - The basic premises of any community organizing endeavor is that the people are the means and ends of development, and community empowerment is the process and outcome. - It is people centered in the sense that the process of critical inquiry is informed by and responds to the experiences and needs of the marginalized sectors/people. - Over all, the development is concerned with improving quality of life in the different dimensions of community-social, political, economic, environmental, cultural and spiritual. - Community organizing is a process that promotes the development of people’s autonomy and self-reliance, leading to people empowerment. 2. Community Organizing is Participative - The participation of a community in the entire process- assessment, planning, implementation, and evaluation-should be ensured. - The community is considered as the prime mover and determinant, rather than beneficiaries and recipients, of development efforts, including health care. 3. Community Organizing is Democratic - Community organizing should empower the disadvantaged population. - It is a process that allows the majority of people to recognize and critically analyze their difficulties and articulate their aspirations. - Their decisions must reflect the will of the whole, more so the will the common people, than that of the leaders and the elite. 4. Community Organizing is Developmental - Community organizing should be directed towards changing current undesirable conditions. - The organizers desires changes for the betterment of the community and believes that the community shares that these changes can be achieved. 5. Community Organizing is Process Oriented - The community organizing goals of empowerment is dynamic. With the evolving community situation, monitoring and periodic review of plans are necessary. - The community may initially face simple barangay problems. 25 PHILOSOPHY OF COMMUNITY ORGANIZING: - People have the capability to change and influence conditions in their environment which oppress and affect their lives. Organizations facilitates this capability by promoting self- awareness, self-determination and collective effort among the people. BASIC PRINCIPLES OF COMMUNITY ORGANIZING (Quesada): 1. Principle of Felt Needs - Are problems/issues the people recognize - Conditions which disturb people and are causing general discontent - They are differentiated from needs which health providers and other groups and agencies have determined based on their perception - Co-tasks: *to discover what these felt needs are *to channel these and the people’s discontent into organization and action 2. Principle of Leadership - Leadership is a key to successful CO - It is important that the leader is accepted, well respected, has charisma or influence to a number of people, demonstrated capability of making things work. 3. Principle of Participation - Genuine CO aims to enable people to be in control in management of projects or programs designed to address their problems in which they were involved in the decision making process - Co must be away from token participation such as information giving consultation and placation efforts 4. Principle of Communication - Open lines of communication must be established and maintain among community organizers, local leaders and community members. 5. Principle of Structure - CO should develop the organizational structure that is simple and functional based on the needs of the organization - it need not follow the structure of formal organization, instead, the CO’s mat set up working committees that would address the need for: 26 5. Coalition or Multi-sector collaboration – is the level of relationship where organizations and citizens form a partnership. GENERAL IDEAS ON HOW TO GET STARTED IN PARTNERSHIP AND COLLABORATION WORK? 1. It is imperative for the nurse to all the stakeholders in the process of forging partnership and collaboration with the community. 2. In working together, the nurse and the community face risks together. It is important therefore, that they need to know and trust each other. 3. Determine how each organization views the problem, how it is proposes to solve the problem and how it perceives an organizational relationship can help solve the problem. 4. Organizations should agree on the kind or level of relationship that will best accomplish the group goals considering the needs and available resources. 5. When organizations have agree on the type of organizational relationship. Formulate ground rules that will become the bases for decision making. ADVOCACY - One way the nurse can promote active community participation. - The nurse helps the people attain optimal degree of independence in decision making. Advocacy Works Involves: - Informing the people about rightness of the course - Thoroughly discussing with the people the nature of the alternatives, their content possible consequences - Supporting people’s right to make a choice and on their choice - Influencing public opinion SUPERVISION  Is a developmental and enabling process whereby the nurse supervisor ensures that work is done effectively and efficiently by the person being supervised and at the same time keeps the person satisfied and motivated with his work  Also seen as facilitating process that consists of inspecting and evaluating the work of another in order to remedy rather than punish poor performance. 29 OBJECTIVES  Identify the supervisory needs of the worker  Determine ways meeting the needs of the worker  Develop the capability of the worker to solve own problems and to meet own needs by providing continuing personal guidance and professional development  Evaluate the performance of the worker as it becomes the basis for providing help or guidance  Supervisory is seen more as coaching function rather than a function of control  In the community, most of the supervisory functions of the nurse are directed towards lower level health workers  The nurse as a coach to health workers uses persuasion, exhortation and judicious mixture of reward and punishment to motivate the players higher levels of performance SUPERVISORY PLAN  The nurse supervisory plan is written document in how to organize and systemize supervisory activities  It includes objectives, strategies, resources and timetable of activities to meet the identified needs of the person being supervised  Supervisory needs arises from: - Inadequate knowledge, skills and attitude - Conflict between organizational and individual goals - Work and personal situation - Lack of motivation MAKING A SUPERVISORY PLAN  The nurse conducts a situational analysis focusing on supervisory needs assessment, information regarding supervisory needs of the workers can be taken from the following: - Review of records and report - Observation of the person at work - Interview of the worker - Interview of co-worker and clients of the workers in the community  Supervisory needs and problems may be prioritized based on the following criteria: - Degree of importance or urgency of the problem need 30 - Activities/strategies needed to meet identified needs - Magnitude and extent of the problem/need - Time frame to carry out actions  Set objectives  Select activities, strategies and resources needed to meet identified objectives  Identify indicators for evaluation - Meet the needs - Performance increased - Improved quality of service METHODS AND TOOLS FOR SUPERVISION 1. Analysis of record and report - PDS of the worker - Client records - Performance evaluation - DTR - Reports submitted - Accomplishment reports - Target client list 2. Actual observation of worker’s performance in various situations: - Clinic - Home visit - Conduct of individual or group classes - Nursing references - Organization/implementation of community projects and activities - Observation guide: *questionnaire *checklist 3. Individual/group conferences and meetings - Anecdotal report - Critical incident report - Performance evaluation form - Minutes of meetings - Manuals/handbooks - Modules/case studies - Nursing audit - Supervisory logbook 31 *process of eliminations is followed in coming up with a shortlist of potential barangays. GUIDELINES FOR CHOOSING THE FINAL BARANGAY A. Conduct informal interviews with community residents’ especially key person or informants in the barangays included in the shortlist. B. Take note of political undertones among the formal and informal leaders because these may affect organizing activities or may become a political resource or organizational conflicts. IDENTIFICATION OF THE HOST FAMILY A. In general, community workers are the most effective if they live with the people in the area where they intend to work B. By living in the area, they will acquire deeper knowledge of the objectives of their community, it ensures round the clock integration and more importantly, experiencing the life of community residents. C. Before actual community entry, a host family should have been identified and could be done while doing actual community visits before the project site is finalized. D. As a general rule, a maximum of 2 persons should stay in one host family to eliminate putting unnecessary burden on the host family. CRITERIA IN CHOOSING A HOST FAMILY a. The house of the host family should be strategically located in the barangay to enable the project staff, especially the CO, to reach out more efficient and effectively to community residents. b. The host family should not belong to the risk segment of the community whose house has the best facilities. c. The family should be respected by both the formal and informal leaders and community residents. d. The family should be respected by both the formal and informal leaders and community residents. e. No member of the host family should be displaced once the staff moved in. SELECTING A STAFF HOUSE 34 - Location must be strategic, so as to facilitate their integration with the community. GUIDELINES: A. It must be located in a cluster of houses where most of the primary beneficiaries are. B. It must be located in a sitio where it would be easy for the project staff to move to other sitios. *despite choosing to live in a staff house, the team should be consciously planned for overnight stay with selected community residents, especially with potential leaders and community health workers, later on. *it also includes designing a plan for community development including all its activities and strategies for core development. LIST OF ACTIVITES IN THE PRE-ENTRY PHASE 1. Train faculty and students in COPAR. 2. Formulate plan for institutionalizing COPAR. 3. Revise/enrich curriculum and immersion program. 4. Coordinate participants of other departments. 5. Formulate criteria and guidelines for site selection. 6. Do initial networking with local government 7. Conduct PSI 8. Make long list/shortlist of potential communities 9. Interview barangay officials, leaders and key informants 10.Choose sites/community profiles for secondary data 11.Coordinate with local government/NGO for assistance 12.Develop community profiles for secondary data 13.Develop survey tools 14.Pay courtesy call to community leaders 15.Choose foster families based on guidelines 1. ENTRY PHASE (Integration phase or Social Preparation Phase) - Includes the sensitization of the people on the critical events in their life, motivating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collection action on these - signals the actual entry of the CO - the longest process 35 - crucial in determining which strategies for organizing would still be best especially where the community organizers is a stranger to the community GUIDELINES: 1. The team should recognize the role of local authorities by paying their visits to inform them of their presence and to orient them of the project. 2. Adapt a lifestyle in your personal appearance, speech and behavior in keeping with the community. 3. Choose a modest dwelling which is open to the majority of the poor. 4. Avoid raising expectations by adopting a low-key approach and profile. 5 CRITICAL ACTIVITIES IN ENTRY PHASE 1. Integration with the community – the process of establishing rapport with the people in a continuing effort to imbibe community life by living with them and undergoing the same experiences, sharing their own dream, aspirations and hardship toward building mutual trust and cooperation. 2. Conduct of information campaign about HRDP making the community aware of the program, the objectives and the activities. WAYS ON HOW TO CONDUCT INFORMATION ACTIVITIES: a. Discussion during house discussions b. Small group discussions c. Purok meetings and assemblies d. Community wide meetings and assemblies 3. Conduct of community study and deepening social investigation – verify the accurateness of prior baseline data. 4. Provision of Basic Health Services – to respond to the health problems of the residents and by doing so, the stress of prevention aspects of health care. 5. Identification of Potential Leaders/Criteria of Potential Leaders a. Belong to the poor sectors and classes and is directly engaged in production b. Well respected by members of the community and has relatively wide influence c. Desirous for change and is willing to work for change d. Can find time, conscientious and resourceful in his work e. Must be able communities effectively 36 - Listing of main facilities/speakers and their back-up if necessary - The tasks of the core group members - The possible issue that may arise and how the core group members plan to them 2. Organizing the CHO 3. Training and Education for the CHO – development and enhancement of the capabilities of community leaders in HRDP 4. Setting up the Community Organization - The formation of a community wide organization requires preparation in two equal important aspects: a. Legal Requirement – organization’s constitution and by-laws - Organization’s regulation papers if necessary - Guidelines for the election of officers - Board of incorporators and financial statements if the organization Plans to go into livelihood b. Technical Aspects of the CHO – related to the CHO operations which concern the community leaders (health committee, education and training committee, membership committee) SUMMARY OF ACTIVITES IN OB PHASE: 1. Elect CHO officers 2. Organize/train community health workers and second liners 3. Conduct PAR 4. Consolidate community diagnosis and PAR results 5. Formulate community health plan 6. Organize working committees 7. Link with LGU’S/NGO’S for financial and technical assistance 8. Implement/ monitor/evaluate health projects 4. SUSTENANCE AND STRENGTHENING PHASE - Monitoring and evaluating takes place (weakness and strength) - CO’s are now about to withdraw themselves from the community Activities include: 1. Education and training 2. Networking and linkaging 3. Conduct of mobilization on health and evaluation of the development concerns 39 4. Introducing/implementing different livelihood programs 5. Developing secondary leaders COMMUNITY HEALTH NURSING PROCESS -refers to systematic series of steps which are followed by public health nurse in the community health and nursing problems using community approaches and resources. - it is an effective tool to help people solve their health problems and meet their health and nursing needs. - The central to all nursing actions. - It is the very essence of nursing, applicable in any setting, in any frame of reference, and within any philosophy. - Is a systematic, scientific, dynamic, on-going interpersonal process in which the nurses and the clients are viewed as a system with each affecting the other and both being affected by the factors within the behavior? - It is a series of actions that lead toward a particular result. 40 STEPS OF COMMUNITY HEALTH NURSING PROCESS AND ITS ACTIVITIES: 1. ASSESSMENT - Initiate contact - Demonstrate caring attitudes - Mutual trust and confidence - Collect data from all possible sources - Identify health problems - Assess coping ability - Analyze and interpret data 2. NURSING DIAGNOSIS 3. PLANNING - Prioritize needs - Establish goal based on needs and capabilities of staff - Construct action and operation plan - Develop evaluation parameters - Revise plan as needed 4. IMPLEMENTATION - Put nursing plan to action - Coordinate care/services - Utilize community resources - Delegate - Supervise/monitor health services provided - Provide health education and training - Document responses to nursing action 5. EVALUATION - Nursing audit - Care outcomes - Performance appraisal - Estimate cost benefit ratio - Assessment of problems - Identify needed alterations - Revise plans as necessary 41  Constructed survey - A set of prepared specific questions given to a random sample in the community. It is time consuming and expensive  observation of health related behaviors of individuals, families, groups and environmental factors;  review of statistics ,epidemiological and relevant studies  individual and family health records: laboratory and screening tests and physical examinations of individuals.  Physical examination,  Review of records, Diagnostic reports,  Collaboration with colleagues - These data are collected systematically and continuously, then are recorded in an appropriate forms and kept systematically so that retrieval of information is facilitated. Collected data are treated confidentially. b) NURSING DIAGNOSIS - After assessment of the health situation of the community, the CHN was able to identify the health needs and problems of the community as she explores the community. - It is a statement of a potential or actual altered status of a patient which is derived from nursing assessment and which requires intervention from the domain of nursing practices. - A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. - Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. -The problems could be a large family size, malnutrition in children, incomplete immunization, anaemia in pregnant and nursing mothers, several morbidity conditons-TB, malaria, diarhoea etc., EXAMPLE OF COMMUNITY NURSING DIAGNOSIS 1. Knowledge deficit r/t to small family norms as evidenced by large family. 2. Potential health hazards related to breeding of mosquitoes as evidenced by presence of stagnant water 44 3. Health seeking behavior regarding immunization. 4. Ineffective health maintenance 5. Impaired social interaction 6. Ineffective Infant Feeding Pattern CATEGORIES OF HEALTH PROBLEMS: 1. HEALTH DEFICITS – - occurs when there is a gap between actual and achievable health status. - possible precursors of health deficits o history of repeated infections or miscarriages o No regular health checkup (diabetes, CVA) 2. HEALTH THREATS – are conditions that promote disease or injury and prevent people from realizing their health potential. - example o inadequately immunized population against preventable diseases. o Family history of hereditary disease o Poor environmental condition o Unhealthy lifestyle 3. FORESEEABLE CRISIS/STRESS POINTS – includes stressful occurrence such as death and illness of family member, loss of job, marriage, divorce, pregnancy, menopause, etc.. - A health need exists when there is a health problem that can be alleviated with medical or social technology. - A health problem is a situation in which there is a demonstrated health need combined with actual or potential resources to apply remedial measures and a commitment to act on the part of the provider or the client. The Process of ASSESSMENT in community health nursing includes: intensive fact finding, the application of professional judgment in estimating the meaning and importance of these facts to the family and the community, the availability of nursing resources that can be provided, and the degree of change which nursing intervention can be expected to effect. 45 c) PLANNING NURSING ACTIONS/CARE - Is based on the actual and potential problems that were identified and prioritized. It includes the following steps ( After obtaining the list of health needs and problems, the community health nurse needs to prioritize the problems, as all the problems cannot be dealt with simultaneously.) a. GOAL SETTING – a goal is a declaration of purpose or intent that gives essential direction to action. - These objectives are stated in behavioral terms: specific, measurable, attainable, and realistic and time bounded. The nurse prioritizes these objectives. b. CONSTRUCTING A PLAN OF ACTION – is concerned with choosing from among the possible courses of action, selecting the appropriate types of nursing intervention, identifying appropriate and available resources for care and developing an operational plan. - May have positive/negative effects. The positive consequences must be weighed against those with negative aspects. The ability of the family to cope or solve its own problems and make decisions on health matters should be considered. - The appropriate resources are identified which include the family, the neighborhood, the schools, the industrial population: the whole medical system of hospitals, clinics, public and private practitioners of medicine, health units of welfare departments, voluntary health agencies, and other health related agencies: non- health facilities such as social, educational and counseling agencies. c. DEVELOPING AN OPERATIONAL PLAN – the public health nurse must establish priorities, phase and coordinate activities. - Are prioritized in order of urgency to determine those that need the earliest action or attention such as those that actually threaten the health of the client (individual, family, community). These plans are broken down to manageable units and properly sequenced. - Periodic evaluation and modification of the plan is necessary. The plan and activities should be coordinated with the various services 46 2. To assess the living condition of the patient and his family and their health practices in order to provide the appropriate health teaching. 3. To give health teachings regarding the prevention and control of diseases. 4. To establish close relationship between the health agencies and the public for the promotion of health. 5. To make use of the inter-referral system and to promote the utilization of community services PRINCIPLES: The following principles are involved when performing a home visit: 1. A home visit must have a purpose or objective. 2. Planning for a home visit should make use of all available information about the patient and his family through family records. 3. In planning for a home visit, we should consider and give priority to the essential needs if the individual and his family. 4. Planning and delivery of care should involve the individual and family. 5. The plan should be flexible. GUIDELINES: The following guidelines are to be considered regarding the frequency of home visits: 1. The physical needs psychological needs and educational needs of the individual and family. 2. The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate. 3. The policy of a specific agency and the emphasis given towards their health programs. 4. Take into account other health agencies and the number of health personnel already involved in the care of a specific family. 5. Careful evaluation of past services given to the family and how the family avails of the nursing services. 6. The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits. 49 STEPS: 1. Greet the patient and introduce yourself. 2. State the purpose of the visit 3. Observe the patient and determine the health needs. 4. Put the bag in a convenient place and then proceed to perform the bag technique. 5. Perform the nursing care needed and give health teachings. 6. Record all important date, observation and care rendered. 7. Make appointment for a return visit. BAG TECHNIQUE Definition  Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care.  Public health bag – is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.  Rationale To render effective nursing care to clients and /or members of the family during home visit.  Principles  The use of the bag technique should minimize if not totally prevent the spread of infection from individuals to families, hence, to the community.  Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures.  Bag technique should not overshadow concern for the patient rather should show the effectiveness of total care given to an individual or family.  Bag technique can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding transfer of infection is carried out. 50  Special Considerations in the Use of the Bag  The bag should contain all necessary articles, supplies and equipment which may be used to answer emergency needs.  The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use at any time.  The bag and its contents should be well protected from contact with any article in the home of the patients. Consider the bag and it’s contents clean and /or sterile while any article belonging to the patient as dirty and contaminated.  The arrangement of the contents of the bag should be the one most convenient to the user to facilitate the efficiency and avoid confusion.  Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the bag and its contents.  The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using.  Contents of the Bag Paper lining Extra paper for making bag for waste materials (paper bag) Plastic linen/lining Apron Hand towel in plastic bag Soap in soap dish Thermometers in case [one oral and rectal] 2 pairs of scissors [1 surgical and 1 bandage] 2 pairs of forceps [ curved and straight] Syringes [5 ml and 2 ml] Hypodermic needles g. 19, 22, 23, 25 Sterile dressings [OS, C.B] Sterile Cord Tie Adhesive Plaster Dressing [OS, cotton ball] Alcohol lamp Tape Measure Baby’s scale 1 pair of rubber gloves 2 test tubes Test tube holder Medicines betadine 51 WHO- specialized agency of the United Nations provides global leadership on health matters. In the Philippines, health services are providrd by the government and the private sectors- for the profit as well as non profit, with the latter frequently referred to us nongovernmental organizations or NGOs . On the national level, direction is set by the DOH. By virtue of the mandate of the Local Government Code (R.A. 7160), local govt units (LGUs) should have operating mechanisms to meet the priority needs and service requirements of their community. April 7 each year- world health day CORE FUNCTIONS OF WHO  Providing leadership on matters critical to health and engaging in partnerships where joint action is needed.  Shaping the reseach agebda and stimulating generation, translation and disseminating valuable knowledge.  Setting orms and standars and promoting and monitoring their implementations  Articulating ethical and evidence-based policy options.  Providing technical support, catalyzing change and building sustainable institutional capacity. THE PHILPPINE HEALTH CARE DELIVERY SYSTEM  The DOH serves as the main governing body of health services in the country.  DOH provides guidance and technical assistance to LGUs through the Center for Health Development in each of the 17 regions.  Provincial governments are responsible for administration of provincial and district hospitals.  Municipal and city governments are in charge of primary care through Rural health Units (RHUs) or health centers. 54  Satellite outposts known as barangay health stations (BHSs) provide health services in the periphery of the municipality or City DEPARTMENT OF HEALTH The Department of Health (abbreviated as DOH; Filipino: Kagawaran ng Kalusugan) is the executive department of the Government of the Philippines responsible for ensuring access to basic public health services by all Filipinos through the provision of quality health care and the regulation of all health services and products. It is the government's over-all technical authority on health. It has its headquarters at the San Lazaro Compound, along Rizal Avenue in Manila. The head of the department is led by the Secretary of Health, currently Francisco Duque, nominated by the President of the Philippines and confirmed by the Commission on Appointments. The Health Secretary is a member of the Cabinet. VISION BY 2030 “A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable health financing.” MISSION 55 “To guarantee equitable, sustainable and quality health for all people in the Cordillera Region, especially the poor, and to lead the quest for excellence in health.” QUALITY POLICY The Department of Health, as the nation’s leader in health, is committed to guarantee equitable, accessible and quality health services for all Filipinos. We at the DOH, together with our partners, shall ensure the highest standards of health care in compliance with statutory and regulatory requirements And shall continually improve our quality management systems to the satisfaction of our citizens. 56 SENTRONG SIGLA MOVEMENT (SSM SENTRONG SIGLA MOVEMENT  (SSM)was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars: o Health Promotion o Granted Facilities o Technical Assistance o Awards: Cash, plaque, certificate  is a quality improvement initiative through a certification/recognition program.  Health facilities are certified based on a set of standards  SS also promotes continuous quality improvement as a complementing strategy 59 ©@ DOH Milestones O: Before 1898 1898 1899 Hospital system wih Department of Pubic Abolshment of Board Insular Board of Health _Abalishment of the District heath 13 hospitals Works, Education, of Health Insular Board of Heath offcers, instead of seh Provincial and munipal ae Central Board of Vaccination dal Registration of births, health boards Establishment een & Board of Health and Charity Board of Health deaths, and marriages of the Bureau of Health forthe City of Medicos Titvares he 1950 1947 1941 1932 1915 1912 Second and Formaized the Office of the Commissioner Bureau of Health Fejardo Act renaming ofthe Department Department of Heath of Health and Pubic _ renamed and became ne ofthe Department of Health and Public ‘and Public Wetare Wetare Philippine Health Service eerie Weare into Department of Health selkay chtcions) 1958 1969 1970 1972 creat 82. {886-1987 Decentralization Philippine Medical © -Restrucured Health Care Renamed of health services Care Act of 1969 ‘Service Delivery: Ministry of Health iegaedPre Cente Creation of eight regional mesons] % Adkitional four regional Heath Education and —-‘éeional three heal offices heath offces anpower Development Tesi fies (NCR, CAR, & ARMM) National Health Facies 2005 2003 200! 2000 1999 1991-1993 FOURmia ONE One Script Systems Guidelines on the HRA as the major Health Sector Office of Health Facies, forHeath (F1)as_Improvement Progam —_HSRAimplementafon framework forheath Reform Agenda (HSRA) Standards, and Burnt ofrfom 68 DOHetaned hosp plan win T3conergence polcesandinesnens oe Pipes 1209-200 Reglaten Provided wih fecal Inational Objectives for Intensified programs: ay Health 1999-2004 Doctors to the Barrios, National Micronutrient ‘Campaign, & “Lets DOH it” 2006 2007 2008 National and intemational One-stop shop Maternal, , recognitions fromthe system forhasptals Child Health and Nutriton. Presidential Anti-Graf ‘Strategy (MNCHN) Commission and Guinness Sector-ide World Records Limited Approach forHealth Universally Accessible ‘Cheaper and | Medicines Act of 2008, 2017 2016 Philippine National Philippine Health Agenda ‘Standards for Drinking 2016-2002 Water of 2017 “All for Health towards nae Health for All” Framework 2010 2011 2012 covmoyeeste new Framawekon Hed Sin Ta Reto aw Etre Deel to Terrorism National Policy on Climate Repauce oa ae 2015 2014 2013 Universal Health Graphic Health Food Satefy Act Care-High Impact Wamings Law siera Elrination Five (HLS) Strategy Senice Delnery Hubs {for Hospitals Networks for Kalusugan DOH Academy Pangkalahatan CHARACTERISTICS OF HEALTH CARE SYSTEM BASED ON PHC: 1. The system should encompasses the entire population on the basis of equality and responsibility. 2. It should include components from the health sector and from the sectors whose interrelated actions contribute to health. 3. The essential elements of PHC should be delivered at the first point of contact between individuals and health system. 4. The other levels of system should support the first contact level to permit it to provide the aforementioned essential elements on a continuing basis. 5. An intermediate levels made complex problems should be dealt with more skilled and specialized care as well as logistic support. 6. The central level should coordinate all parts of the system and provide planning and manage expertise; highly specialized care, teaching for specialized staff. LEVELS OF HEALTH CARE FACILITIES 1. PRIMARY LEVEL FACILITIES – health services at this level are offered to individuals in fair health and clients with diseases in the early symptomatic stages. - Prevention of illness or promotion of health - Include the RHU, CHO, sub centers, chest clinics, malaria medication units, etc. 2. SECONDARY LEVEL FACILITIES – offer services to clients with symptomatic stages of the disease which require moderately specialized knowledge and technical resources for adequate treatment. - curative - Include emergency district hospitals, provincial city health services. 3. TERTIARY LEVEL FACILITIES – include the high technological and sophisticated services offered by medical centers and large hospitals. These are the specialized Hospitals/ Institutions. - Services offered in this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge facilities and personnel to treat effectively. - rehabilitative 61 Rational And Regional Health and Service Medical Center Teaching & Training Hospitals Provincial City Health Services, Hospitals, Emergency, and District Hospitals. RHU’s Communication and center Private Practitioner, Periculture, centers and barangay. Health centers. THE RURAL HEALTH UNIT(RHU) -commonly known as a health center , is a primary level health facility in the municipality . the focus of the rhu is promotive and preventive health services and the supervision of BHSs under its jurisdiction. - recommended ratio of RHU to catchment population – 1RHU:20,000 population BARANGAY HEALTH SERVICES - the first contact health care facility that offers basic services t the barangay level. - Satellite station od RHU and manned by volunteer barangay health workers (BHWs) under the supervision of Rural Health Midwife (RHW). 64 REFERRAL SYSTEM in LEVEL OF HEALTH CARE  Barangay Health Stations (BHS) is under the management of Rural Health Midwife (RHM)  Rural Health Unit (RHU) is under the management or supervision of Public Health Nurse (PHN)  Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the implementation of the policies and activities of RHU, directly under the supervision of MHO (municipal Health Officer) who acts as administrator. PUBLIC HEALTH WORKERS (PHW)/RURAL HEALTH UNIT PERSONNEL  Municipal Health Officer(MHO) or Rural health Physician - Heads the health services at the municipal leveland carries out the following roles: o Administrator of the RHU  Prepares municipal health plans and budget  Monitors the implementation of basic health services 65  Management of the RHU staffs. o Community Physician  Conducts epidemiological studies  Formulates health rducation campaigns on disease prevention  Prepares and implements control measures or rehabilitation plans o Medico legal Officer  Public Health Nurse (PHN) – Registered Nurse - Supervises and guides all RHM in the municipality - Prepares annual report of the municipality for submission to Provincial Health Office - Utilizes nursing process in responding to health needs for health education and promotion of individuals, families and community - Collaborates with the other members of the health team, government agencies, private business, NGOs, and peoples organization to address the community’s health problems.  Rural Health Midwife (RHM) – Registered midwife - Manages the BHS and supervises and trains the BHWs - Provides midwifery services and executes health care programs and activities for women of reproductive age, including family planning counseling and services - Conducts patient assessment and diagnosis for referral or further management. - Performs health information, education, and communication services - Organized community - Facilitates batrangay health planning and other community health services.  Rural Sanitary inspector – must be a sanitary engineer - Ensuring healthy physical environment in the municipality. 66 to individuals and families in the communities through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self- reliance and self-determination, (Alma Ata Declaration, 1978).  The WHO defines Primary Health Care an essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country and afford at every stage of development.  An essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost at every stage of development.  The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6-12 September 1978 GOAL  Health to all Filipinos and Health in the hands of the people by the year 2020. MISSION  To strengthen the health care system wherein people will manage their own health care. CONCEPT  Partnership and empowerment to people LEGAL BASIS  Letter of instruction (LOI) 949  President Ferdinand Marcos  October 19, 1979  First International Conference on Primary Health Care o Alma Ata, USSR o September 6-12, 1978 o Sponsored by WHO and UNICEF  Health begins at home, in schools and in the workplace because it is there where people live and work that health is made or broken. 69  It also means that people will use better approaches than they do now for preventing diseases and alleviating unavoidable disease and disability and have better ways of growing up, growing old, and dying gracefully.  It also means that there will be even distribution among the population of whatever resources for health are available.  It means that services will be accessible to all individuals and families in an acceptable and affordable way.  The World health organization (WHO) has identified five key elements to achieving goals of “Health for all” 8 ESSENTIAL HEALTH SERVICES IN PHC (ELEMENTS) BASED ON ALMA ATA An essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally, accessible to individuals and families in the community by means of acceptable to them, through their full participation and at a cost that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. E – Education for health L – Locally endemic disease control E – Expanded program for Immunization M – Maternal and Child Health including responsible parenthood E – Essential Drugs N – Nutrition T- Treatment of Communicable and non-communicable diseases S – Safe water and Sanitation Goals  The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal: 1. Reducing exclusion and social disparities in health (universal coverage reforms); 2. Organizing health services around people’s needs and expectations (service delivery reforms); 3. Integrating health into all sectors (public policy reforms); 70 4. Pursuing collaborative models of policy dialogue (leadership reforms); and 5. Increasing stakeholder participation. History A brief history of Primary Health Care is outlined below:  May 1977. The 30th World Health Assembly adopted resolution which decided that the main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life.  September 6-12, 1978. International Conference in PHC was held in this year at Alma Ata, USSR (Russia)  October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued Letter of Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an approach towards design, development, and implementation of programs which focus health development at the community level. Rationale Adopting primary health care has the following rationales: 1. Magnitude of Health Problems 2. Inadequate and unequal distribution of health resources 3. Increasing cost of medical care 4. Isolation of health care activities from other development activities Objectives 1. Improvement in the level of health care of the community 2. Favorable population growth structure 3. Reduction in the prevalence of preventable, communicable and other disease. 71 o 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. PRINCIPLES AND STRATEGIES: 1. ACCESSIBILITY, Availability, Affordability and Acceptability of health services: a. Accessibility- refers to the physical distance of a health facility or the travel time required for prople to get the needed or desired health services. b. Affordability – is not only in consideration of the individual of family’s capacity to pay for basic health services but a matter of whether the community or government can afford theses services. c. Acceptability – means the health care offered is in consonance with the prevailing culture and traditions of the population. d. Availability – is a question of whether the basic health services required by the people are offered in the health care facilities or is provided on a regular or organized manner. Strategies: a. Health services delivered where the people are b. Use of indigenous/resident volunteer health worker as a health care provider with a ratio of one community health worker per 10- 20 households c. Use of traditional herbal medicine with essential drugs 2. Provision of quality, basic and essential health services. Strategies: a) Training design and curriculum based on community needs and priorities b) Attitudes, knowledge and skills developed are on promotive, preventive, curative and rehabilitative health care c) Regular monitoring and periodic evaluation of community health workers performance by the community and health staff 3. Community Participation Strategies: a) Awareness, building and consciousness raising on health and health related issues b) Planning, implementation, monitoring and evaluation done through small groups meetings (10-20households). 74 c) Selection of community health workers by the community d) Formation of health committees e) Establishment of a community health organization at the parish or municipal level f) Mass health campaigns and mobilization to combat health problems 4. Self-reliance Strategies: a) Community generates support (clean, labor) for health programs b) Use of local resources to human, financial and material c) Training of community in leadership and management skills d) Incorporation of income generating projects, cooperatives and small scale industries 5. Recognition of interrelationship of health and development Strategies: a) Convergence of health, food, nutrition, water, sanitation and population services. b) Integration of PHC into, national, regional, provincial, municipal, and barangay development plans. c) Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication, and social services. d) Establishment of an effective health referral system 6. Social Mobilization Strategies: a) Establishment of an effective health referral system b) Multi-sectorial and interdisciplinary linkage c) Information, education, communication support using multi-media d) Collaboration between government and non-governmental organizations 7. Decentralization Strategies: a) Relocation of budgetary resources b) Reorientation of health professional and PHC c) Advocacy for political and political and support from the national leadership down to the barangay 75 8 ESSENTIAL HEALTH SERVICES IN PHC E – Education for health L – Locally endemic disease control E – Expanded program for Immunization M – Maternal and Child Health including responsible parenthood E – Essential Drugs N – Nutrition T- Treatment of Communicable and non-communicable diseases S – Safe water and Sanitation I. EDUCATION FOR HEALTH  This is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.  -The sum of activities in which agencies engage to influence the thinking, motivation, judgment and action of the people  -Consist of techniques that stimulate, arouse and guide people to live healthfully.  -Process whereby knowledge, attitude and practice of the people are changed to improve individual, family and community. STEPS IN HEALTH EDUCATION 1. Creative Awareness 2. Motivation 3. Decision 3 Elements in Health Education  INFORMATION: to share ideas to keep population group knowledgeable and aware.  EDUCATION : Change within individual 3 key Elements of Education 76 k) Fever l) Headache m) Nausea n) Vomiting o) Cough p) Chest pain q) Painful muscles Prevention r) Improve education of people who are at risk. Example farmers, miners, children wading in muddy water s) Use of protect6ive clothing, booths and gloves t) Community – wide eradication program through proper disposal u) Segregate domestic animals potentially infected from man’s working and infected areas v) Isolation of patients and disinfection of soiled articles III. EXPANDED PROGRAM FOR 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 What is immunization? Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body's own immune system to protect the person against subsequent infection or disease. Process by which the vaccine is introduced to the body before infection sets in. Republic Act No. 10152“MandatoryInfants and Children Health Immunization Act of 2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health. Specific Goals: 1. To immunize all infants/children against the most common vaccine- preventable diseases. 79 2. To sustain the polio-free status of the Philippines. 3. To eliminate measles infection. 4. To eliminate maternal and neonatal tetanus 5. To control diphtheria, pertussis, hepatitis b and German measles. 6. To prevent extra pulmonary tuberculosis among childre MCV1 (monovalent measles) at 9-11 months old MCV2 (MMR) at 12-15 months old. 80 - In 2012, two new vaccines were introduced as part of EPI 81 f EXPANDED PROGRAM ON IMMUNIZATION Vea ypeironm ot vaccine Storage Temperate: Most Sensitive to Oral Polio (live -15% to -25 C ( at the aad Heat attenuated ) freezer) Measles ( Freeze -15% to -25C ( at the dried) freezer) Least Sensitive to DPT/Hep B +2 °C to + 8% (in the Heat body of refrigerator) D'toxoidisa Hepatitis B +2 °C to + 8C (inthe v body of refrigerator) BCG (freeze dried) +2 °C to+ 8% (in the body of refrigerator) Tetanus toxoid +2 °C to + 8 (in the body of refrigerator) weakened toxin | ‘A EXPANDED PROGRAM ON A IMMUNIZATION -— eueines a « Itis safe and immunologically effective to administer all EP! vaccines onthe same day at different sites of the body. + Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination. « DPT2 and DPT3 are contraindicated to a child who has had convulsion or shock within 3 days the previous dose. « Live vaccines like BCG must not be given to individuals who are immunosuppressed due to malignant disease, therapy with immunosuppressive agents or irradiation. « It is safe and effective with mild side effects after vaccination. (Ex: Local reaction, fever) « Repeat BCG vaccination if the child does not develop a scar after the first injection. e BCG immunization shall be given to all school entrants both in private and public schools regardless of the presence or absence of BGG scar. 84 IV. MATERNAL AND CHILD HEALTH  Maternal and Infant morbidity and rates area among the indicators of health of a particular community. Protection of the mother and child against illness and other risk would ensure a good health for the community. This is the goal of the maternal and child program.  WHO Philippines MCH Program works with local public health departments, community based organizations, statewide organizations and other providers to provide and/or assure quality health services are delivered to mothers, children, and families in the country.  OBJECTIVE: -To improve the survival, health and well being of mothers and unborn child. The primary areas of work focus are:  Increasing healthy birth outcomes;  Promoting and assuring comprehensive primary care for children, from birth to 21 year olds, including children with special health care needs  Promoting healthy lifestyles among school-age youth, ages 6-21, including children with special health care needs  Promoting access to safe, healthy child care, including children with special health care needs A. MATERNAL HEALTH SERVICES:  Antenatal Registration - pregnant women can avail the free prenatal services at their respective health center. 85  Tetanus Toxoid Immunization - A series of 2 doses of tetanus toxoid vaccination must be received by a pregnant women one month before delivery and 3 booster doses after childbirth . 86 c. NEWBORN SCREENING  Newborn screening is ideally done on the 48th – 72nd hour of life. However, it may also be done after 24 hours from birth.  A few drops of blood are taken from the baby’s heel, blotted on a special absorbent filter card and then sent to Newborn Screening Center (NSC).  Newborn Screening Act of 2004 (RA 9288). o Newborn screening (NBS) is a public health program aimed at the early identification of infants who are affected by certain genetic/ metabolic/ infectious conditions. o Early identification and timely intervention can lead to significant reduction of morbidity, mortality, and associated disabilities in affected infants. 89 iA DISORDERS TESTED FOR Voy NEWBORN SCREENING C4 » CH — results from lack or absence of thyroid hormone = which is essential for the physical and mental development of a child. » CAH - is an endocrine disorder that causes severe salt loss, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies with CAH may die within 7-14 days. » GAL - is a condition in which babies are unable to process galactose, the sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts. {| DISORDERS TESTED FOR VA NEWBORN SCREENING CS * PKU - is a rare condition in which the baby cannot ~~ properly use one of the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the blood causes brain damage. « G6PD - is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency may have hemolytic anemia resulting from exposure to oxidative substances found in drugs, foods and chemicals. d. Micronutrient supplementation - Short term intervention for correcting high level of micronutrient deficiency. MICRONUTRIENT TARGET POPULATION SCHEDULE Vitamin A capsule Iron Infants 6-11 months Children 12-71 months old Infants 2-6 months with low birth (<2,500 g) Anemic children 2-59 months old 100,000 IU only 0.3 ml once a day to start 2 months until 6 months when complementary foods are given. Preparation is 15mg elemental iron/0.6 ml 1 tsp once a day for 3 months or 30 mg once a week for 6 months with supervised administration. 91 occupies the Top Ten causes of illness and death in the country. Thus, the government’s focus on the prevention, control and treatment of these illnesses. General Functions OF DISEASE PREVENTION AND CONTROL BUREAU (DPCB)  Develop plans, policies, programs, projects and strategies for disease prevention and control and health protection.  Provides coordination, technical assistance, capability building, consultancy and advisory services related to disease prevention and control and health protection. VIII. SAFE WATER AND SANITATION  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. 94  The environment plays a very important role in the promotion and maintenance of good health. However, problems affecting sanitation of the environment and still affects the Filipino people.  The government recognizes that assisting the client provide and maintain an environment conducive to health is a basic service it has to offer.  Programs to promote the development the development and use of potable drinking water, sanitary toilet facility, drainage and sewerage area made accessible everyone. ENVIRONMENTAL HEALTH PROGRAMS Vision - Environmental Health (EH) related diseases are prevented and no longer a public health problem in the Philippines (based on on-going Strategic Plan 2019-2022) Mission - To guarantee sustainable Environmental Sanitation (ES) services in every community Objectives a) Expand and strengthen delivery of quality ES services b) Institute supportive organizational, policy and management systems c) Increase financing and investment in ES d) Enforce regulation policy and standards e) Establish performance accountability mechanism at all levels Program Components  Drinking-water supply, Sanitation (e.g excreta, sewage and septage management),  Zero Open Defecation Program (ZODP),  Food Sanitation,  Air Pollution (indoor and ambient),  Chemical Safety,  WASH in Emergency situations,  Climate Change for Health and Health Impact Assessment (HIA) 95 DENTAL HEALTH  Oral disease continues to be a serious public health problem in the Philippines.  The prevalence of dental caries on permanent teeth has generally remained above 90% throughout the years.  About 92.4% of Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases)  Although preventable, these diseases affect almost every Filipino at one point or another in his or her lifetime. Goal: Attainment of improved quality of life through promotion of oral health and quality Objectives:  The prevalence of dental caries is reduce  The prevalence of periodontal disease is reduced  Dental caries experience is reduced   The proportion of Orally Fit Children (OFC) 12-71 months old is increased NATIONAL HEALTH SITUATION The national health situation gives us an idea of the health situation in the communities where nurses works. Because of the different conditions prevailing these communities, their health picture expectedly varies. For example, goiter is highly prevalent in the Mountain province while schistosomiasis is pandemic in Leyte. The local health situation, therefore, needs to be established for each province, city and municipality. I. DEMOGRAPHIC PROFILE  The current population of the Philippines is 109,910,032 as of Wednesday, September 23, 2020, based on Worldometer elaboration of the latest United Nations data.  The Philippines 2020 population is estimated at 109,581,078 people at mid year according to UN data.  The Philippines population is equivalent to 1.41% of the total world population.  The Philippines ranks number 13 in the list of countries (and dependencies) by population. 96