CHN Checked

COURSE TITLE COMMUNITY HEALTH NURSING

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Table of Contents Course Syllabus Course Outline I. Overview of Community Health Nursing A. Community Health Nursing as a Fiel of Nursing !ra"ti"e #. #asi" "on"e$ts an !rin"i$les of Community Health Nursing C. %efinitions %. Classifi"ations of Community '. %OH Con"e$ts of CHN F. #asi" !rin"i$les in CHN ).. !eo$le #ehin CHN H. *ission of CHN I. %eterminants of Health +. ,evels of Care .. /y$es of Clientele ,. /y$es of Family *. 0oles of a Community Health Nurse N. S$e"iali2e Fiel s in Community Health Nursing O. Histori"al ba"3groun of CHN in the !hili$$ines II. Community Health an %evelo$ment Con"e$ts5 !rin"i$les an Strategies A. !rimary Health Care A$$roa"h #. !rimary Health Care !rin"i$les an strategies C. !illars of !HC %. 16 Herbal !lants '. Health !romotion F. /he %e$artment of Health ).. Community Organi2ing !arti"i$ation an 0esear"h H. !hases of CO!A0 I. Health ' u"ation III. /he Community Health Nursing !ro"ess A. Assessment of Community Health Nee s #. Community %iagnosis

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C. /y$es of Community %iagnosis %. Ste$s in "on u"ting Community %iagnosis '. %ata Colle"tion /e"hni8ue F. CHN !ro"e ures an /ools ). Clini" 9isit H. Home 9isit I. #ag /e"hni8ue +. %emogra$hy .. Sour"es of %emogra$hi" ata ,. 9ital Statisti"s *. ,evels of isease $revention N. Health Care %elivery System I9. Im$lementing the Community Health Nursing Servi"es A. Family !lanning *etho s #. Chil Health !rogram C. ':$an e !rogram on Immuni2ation %. Integrate *anagement on Chil hoo Illnesses '. Nutrition !rogram F. Oral Health !rogram H. A oles"ent Health !rogram I. 'ssential Health Care !a"3age For the a oles"ent an youth +. A ult ;omen .. Ol er !erson ,. Control of Communi"able %iseases *. S$e"iali2e Fiel s of Community Health Nursing 9. 'valuating Community Health Nursing Servi"es A. %efinition of 'valuation 9I. 0e"or ing an 0e$orting A. Family Health Servi"e Information System #. Com$onents of FSHIS A$$en i"es #ibliogra$hy

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ROOSEVELT COLLEGE SYSTEM TERTIARY EDUCATION DIVISION INSTITUTE OF NURSING AND HEALTH EDUCATION COURSE SYLLABUS Course Name Course Co e Course %es"ri$tion CO**<NI/= H'A,/H N<0SIN) CHN /his "ourse fo"uses on the "are of $o$ulation grou$s an "ommunity as "lients utili2ing "on"e$ts an $rin"i$les in "ommunity health evelo$ment. It also es"ribes $roblems5 tren s an issues in the !hili$$ine an global health "are systems affe"ting "ommunity health nursing $ra"ti"e. 7 units le"ture5 2 units 0,' >6.& S3ills ,ab5 1.& Clini"als? &4 le"ture hoursA 162 0,' hours NC* 1665 /heoreti"al Foun ations of Nursing5 Health Assessment 2n year5 1st semester At the en of the "ourse5 the stu ent will be able toD 1. A$$ly "on"e$ts an $rin"i$les of "ommunity health evelo$ment in the "are of "ommunities an $o$ulation grou$s. 2. <tili2es the nursing $ro"ess in the "are of "ommunities an $o$ulation grou$s. a. Assess the health status of "ommunities an $o$ulation grou$s to i entify e:isting an $otential $roblems. b. !lan relevant an "om$rehensive interventions an $rograms base on i entifie $riority $roblems. ". Im$lement a$$ro$riate $lan of "are to im$rove the health status of the "ommunities an $o$ulation grou$s. . 'valuate the $rogress an out"omes of "ommunity health nursing interventions an $rograms. 7. 'nsure a wellBorgani2e re"or ing an re$orting system. 4. Share lea ershi$@relate effe"tively with others in wor3 situations relate to nursing an health.

Course Cre it Conta"t Hours@Semester !reBre8uisite !la"ement Course ObCe"tives >)eneral?

Course OutlineD Community Health Nursing I. Overview of Community Health Nursing A. Community Health Nursing as a Fiel of Nursing !ra"ti"e #. #asi" "on"e$ts an !rin"i$les of Community Health Nursing C. %efinitions %. Classifi"ations of Community
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'. %OH Con"e$ts of CHN F. #asi" !rin"i$les in CHN ). !eo$le #ehin CHN H. %eterminants of Health I. ,evels of Care +. /y$es of Clientele .. /y$es of Family ,. 0oles of a Community Health Nurse *. S$e"iali2e Fiel s in Community Health Nursing N. Histori"al ba"3groun of CHN in the !hili$$ines II. Community Health an %evelo$ment Con"e$ts5 !rin"i$les an Strategies A. !rimary Health Care A$$roa"h #. !rimary Health Care !rin"i$les an strategies C. !illars of !HC %. 16 Herbal !lants '. Health !romotion F. /he %e$artment of Health ). Community Organi2ing !arti"i$ation an 0esear"h H. !hases of CO!A0 I. Health ' u"ation III. /he Community Health Nursing !ro"ess A. Assessment of Community Health Nee s #. Community %iagnosis C. /y$es of Community %iagnosis %. Ste$s in "on u"ting Community %iagnosis '. %ata Colle"tion /e"hni8ue F. CHN !ro"e ures an /ools ). Clini" 9isit H. Home 9isit I. #ag /e"hni8ue +. %emogra$hy .. Sour"es of %emogra$hi" ata ,. 9ital Statisti"s *. ,evels of isease $revention N. Health Care %elivery System I9. Im$lementing the Community Health Nursing Servi"es A. Family !lanning *etho s #. Chil Health !rogram C. ':$an e !rogram on Immuni2ation %. Integrate *anagement on Chil hoo Illnesses '. Nutrition !rogram F. Oral Health !rogram
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). A oles"ent Health !rogram H. 'ssential Health Care !a"3age For the a oles"ent an youth I. A ult ;omen +. Ol er !erson .. Control of Communi"able %iseases ,. S$e"iali2e Fiel s of Community Health Nursing 9. 'valuating Community Health Nursing Servi"es A. %efinition of 'valuation 1. /y$es of evaluationD 8uantitative5 8ualitative 2. As$e"ts of evaluationD stru"tural5 $ro"ess5 an out"ome 7. *etho s an tools of evaluation 4. 'valuation in i"ators &. Euality Assuran"eD Sentrong Sigla *ovement 9I. 0e"or ing an 0e$orting A. Family Health Servi"e Information System #. Com$onents of FSHIS 1. Family /reatment 0e"or 2. /arget Client ,ist 7. 0e$orting Forms 4. Out$ut re$orts

I O!e"!#e$ of Co%%&n#t' Healt( N&"s#ng /he wor Community is erive from the ,atin wor FComuni"asF whi"h means a grou$ of $eo$le. Community Health Nursing is one of the two maCor fiel s of Nursing in the !hili$$inesA the other is Hos$ital Nursing. ;e use the term Community Health Nursing an !ubli" Health Nursing inter"hangeably. /hose who wor3 in 0ural Health <nits >0H<s? or health "enters are "ommunity health nurses an are offi"ially "alle !ubli" Health Nurses >!HNs?. O""u$ational health Nurses >"om$any nurses? an s"hool health nurses are "lassifie as "ommunity health nurses.
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!ubli" Health Nursing in the !hili$$ines evolve alongsi e the institutional evelo$ment of the %e$artment of Health5 the government agen"y man ate to $rote"t an $romote $eo$leGs health an the biggest em$loyees of health wor3ers in"lu ing $ubli" health nurses. Histori"al a""ounts show that as far as the 1466s5 Nurses wor3ing in the "ommunities were alrea y given the title !ubli" Health Nurses. a? Community Health Nursing as a Fiel of Nursing !ra"ti"e i. /he hallmar3 of "ommunity health nursing is that it is $o$ulationB or aggregateBfo"use . /he nature of the !ubli" Health !ra"ti"e is general an "om$rehensive. It is not limite to a $arti"ular age or iagnosti" grou$. It is "ontinuing an not e$iso i". /he ominant res$onsibility is the $o$ulation as a whole. /herefore5 Nursing is ire"te to in ivi uals5 families or a grou$ that "ontributes to the health of the total $o$ulation. ii. CHN is a synthesis of nursing an $ubli" health $ra"ti"e. CHN is a synthesis of Nursing an !ubli" Health !ra"ti"e a$$lie to the $romotion of the "lientGs o$timum level of fun"tioning an $reserving the health of the $o$ulation. 1. 'm$hasis on the im$ortan"e of the Fgreatest goo for the greatest numberF 2. Assessing health nee s $lanning5 im$lementing an evaluating the im$a"t of health servi"es on $o$ulation grou$s. 7. !riority of healthB$romotive an iseaseB$reventive strategies over "urative interventions. 4. /ools for measuring an analy2ing "ommunity health $roblemsA an &. A$$li"ation of $rin"i$les of management an organi2ation in the elivery of health servi"es to the "ommunity. iii. #asi" "on"e$ts an !rin"i$les of Community Health Nursing 1. /he family is the unit of "areA the "ommunity is the $atient an there are four levels of "lientele in "ommunity health nursing. 2. /he goal of im$roving "ommunity health is reali2e through multi is"i$linary effort. 7. /he "ommunity health nurse wor3s with an not for the in ivi ual $atient5 family5 grou$ or "ommunity. /he latter are a"tive $artners5 not $assive re"i$ients of "are. 4. /he $ra"ti"e of "ommunity health nursing is affe"te by "hanges in so"iety in general an by evelo$ments in the health fiel $arti"ular. &. Community health nursing is $art of the "ommunity health system5 whi"h in turn is $art of the larger human servi"es system.

Def#n#t#ons  Co%%&n#t') a grou$ of $eo$le with "ommon interest5 living together within a geogra$hi"al boun ary.  Healt() state of "om$lete $hysi"al5 mental an so"ial well being an not merely the absen"e of isease or infirmity>;HO?. It is HO,IS/IC. >Nightingale?

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 N&"s#ng) Assisting si"3 in ivi uals to be"ome healthy. An healthy in ivi uals to a"hieve o$timum level of fun"tioning.  Co%%&n#t' Healt(B $o$ulation. $ara@me i"al a$$roa"h "on"erne on the health

 Co%%&n#t' Healt( N&"s#ngB A""or ing to 0uth #. Freeman5 it refers to a Ha servi"e ren ere by $rofessional nurse with "ommunities5 grou$s5 families5 in ivi uals at home5 in health "enters5 in "lini"s5 in s"hool5 in $la"es of wor3 for the $romotion of health5 $revention of illness5 "are of the si"3 at home an rehabilitation. A""or ing to %r. *aglaya5 is the utili2ation of Nursing $ro"ess in the ifferent level of "liente >IF!)? for the $romotion of health5 $revention of iseases an ha2ar s5 "urative servi"es an rehabilitation servi"es.  P&bl#* Healt() /he Art an S"ien"e of Nursing so that every "iti2en may reali2e his birthright to health an longevity >!0'9'N/I9' A!!0OACH?.  P&bl#* Healt( N&"s#ng) A $rofessional $ra"ti"e in $ubli" health an Nursing in whi"h te"hni"al Nursing an Organi2ational s3ills are a$$lie to "ommunity health $roblems. Class#f#*at#ons of a Co%%&n#t'  0ural@O$en lan s B usually $la"es in the $rovin"ial areas where $eo$le ma3e earn their living by agri"ulture an things of sort. *ostly less ense an more s$a"ious.  <rban@City B a nonBagri"ultural ty$e of "ommunity. /he "ommunity is ense an mostly $o$ulating the whole "ommunity the maCor sour"e of in"ome are the in ustrial $ro u"ts an te"hnology.  Suburban@Ca$itals of Cities B usually the "a$ital of $rovin"es where there is a mi: of agri"ulture an in ustry. DOH Con*e+ts of CHN  Health $romotion BB$rimary fo"us of CHN $ra"ti"e  Health tea"hing BB$rimary res$onsibility of CHNurse  )eneralistsBBCHNurses through lifeIs "ontinuum of "lient  CHN Nursing !ro"ess >A!I'?BBim$li"it the $ra"ti"e of Nursing  )oal of !rofessional !ra"ti"eJ !romotion of health an !reservation of life  Nature of !ra"ti"eJ Com$rehensive5 general5 "ontinual5 not e$iso i"  .nowle ge #aseJ Nursing an !ubli" Health  ,evels of ClienteleJ in ivi ual5 families5 grou$s >aggregate?5 "ommunity5 si"3 or well in aily basis5 health tas3s5 "hil ren5 el erly5 youth  !ra"titionerIs re"ognitionJ !rima"y of $o$ulation as a whole greater "ontrol for both nurse an "lient in health "are e"ision "ollaboration between nurse an "lients as
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e8uals re"ognition of the im$a"t of ifferent fa"tors of their "lient lives an situation. Bas#* P"#n*#+les #n CHN  /he !hiloso$hy of Community Health Nursing is base on the worth an ignity of man.  <,/I*A/' )OA, OF CHND /o raise the health level of "iti2enry.  !rimary )oalD S',FB0',IANC'  Clients in CHND CO**<NI/=  #asi" <nit of CareD FA*I,=  4 levels of ClienteleD IF!)C >In ivi ual5 Family5 !o$ulation )rou$5 Community? Peo+le Be(#n, CHN  %r. C' ;inslow K CHN is the birthright of health an longetivity  +ohn Hanlon K $ro$onent of total evelo$ment  +a"obson K a"hievement of O,OF through health tea"hing  !ur om K survival of human s$e"ies  Ar"eli *aglaya K <tili2ation of the nursing $ro"ess for the benefit of I5 F5 !)5 C M#ss#on of CHN  Health !romotion  Health !rote"tion  Health #alan"e  %isease !revention  So"ial +usti"e Dete"%#nants of Healt( /he eterminants of health as a "on"e$t "an be further e:$laine . An this framewor3 refers to an o$timum level of fun"tioning >O,OF? of in ivi uals5 families5 an "ommunities being influen"e by several fa"tors in the e"osystem. /hese are fa"tors or things that ma3e $eo$le healthy or not.  In*o%e o" so*#al stat&s B Higher in"ome an so"ial status are lin3e to better health  E,&*at#on B ,ow e u"ation levels are lin3e with $oor health5 more stress an lower self "onfi en"e  P('s#*al en!#"on%ent B safe water an "lean air5 healthy wor3 $la"es5 safe houses5 "ommunities an roa s all "ontribute to goo health  E%+lo'%ent an, $o"-#ng *on,#t#ons B $eo$le in em$loyment are healthier $arti"ularly those who have more "ontrol
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over their wor3ing "on itions  So*#al s&++o"t net$o"-s B greater su$$ort from families5 frien s an "ommunities is lin3e to better health  C&lt&"e B "ustoms an tra itions5 an the beliefs of the families an "ommunity all affe"t health  Genet#*s B inheritan"e $lays a $art in etermining lifes$an5 healthiness an the li3elihoo of evelo$ing "ertain illness  Pe"sonal be(a!#o" an, *o+#ng s-#lls B balan"e eating5 3ee$ing a"tive5 smo3ing5 rin3ing an how we eal with lifeGs stresses an "hallenges all affe"t health.  Healt( se"!#*es B a""ess the use of servi"es that $revent an treat isease influen"e health  Gen,e" B men an women suffer from ifferent ty$es of iseases at ifferent ages. T'+es of Cl#entele 1.In ivi ual B si"3 or well B on a aily basis B who "onsult at the health "enter an re"eives servi"es a. $renatal b. wellBbaby follow u$ ". morbi ity . "hroni" illnessD iabetes5 hy$ertension e. "lients seen uring home follow u$ f. s"hool "onsultation g. wor3$la"e visitB "onferen"e h. other "ommunity base a"tivities 2. Family B unit of "are in CHN an $rimary referen"e grou$ 0ationaleD >*aglaya L #ailon? a? Natural an fun amental unit of so"ietyA im$ortant so"ial institution b? )enerates5 $revents5 tolerates an "onne"t healthy $roblems within its members "? Health $roblems of family members are interlo"3ing ? /he most fre8uent fo"us of health e"isions an a"tions in $ersonal "are. e? An effe"tive an available "hannel for mu"h of the "ommunity nursing effort. f? Servi"e of the most soli su$$ort to its members s$e"ially the young5 el erly an lessBfortunate.
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/y$es of Family i. Nu"lear FamilyB Com$ose of mother5 father5 "hil @"hil ren ii. ':ten e FamilyB father5 mother5 "hil ren5 relatives iii. SingleB$arent FamilyB single@se$arate with "hil iv. #iBnu"lear FamilyB %ivor"e@se$arate who share "onCugal rights with "hil ren v. Ste$ FamilyB ;i owe or se$arate >0eBmarriage? vi. Cohabitating FamilyB ,iveBin $artners vii. Homose:ual FamilyB femaleBfemale@maleBmale relationshi$ viii. Communal FamilyB Or$hanage@home for the age 7. !o$ulation )rou$ or Aggregate B $rominent grou$s that are vulnerable to Health $roblems. a. infants L "hil ren e. $risoners b. women f. farmers ". fa"tory wor3er g. el erly . males 4. Community B the most im$ortant "lient in CHN. Roles of a Co%%&n#t' Healt( N&"se 1. A vo"ate B $erson who s$ea3s or writes in su$$ort of a "ause. CHN see3s to $romote an un erstan ing of health $roblems loo3ing for benefi"ial $ubli" $oli"y an stimulating for the emergen"e of a su$$ortive "ommunity a"tion for health. 2. Case *anager B hel$ing "lients to ma3e e"isions about a$$ro$riate health "are servi"es. /o a"hieve servi"e elivery integration an "oor ination is a maCor tas3 in CHN. 7. Case Fin er B CHN loo3s for "lients at ris3 among the $o$ulation serve . 4. Counselor B Clients in the "ommunity health setting fre8uently fa"e iffi"ult an "om$le: health "on"erns an esire su$$ortive an $roblem solving assistan"e. /hey eal with stress relate to health "on"erns. &. Clini" Nurse B Clini" servi"es are in"reasingly e:$an ing to meet the nee s of aggregates at ris3. (. '$i emiologist B CHN uses the e$i emiologi"al metho to stu y isease an health among various $o$ulation grou$s an to eal with "ommunity wi e health $roblems. -. )rou$ ,ea er B CHN wor3s in grou$s in $ra"ti"e. 1. Health !lanner B $rovi es health $rograms for the "ommunity. 4. Home 9isitor B CHN enters the "lient setting. She@he assesses the environment an wor3s within it. )athers information about how a family system fun"tions within its own setting. /hey also $rovi e ire"t "are servi"es with "lients. 16. O""u$ational Health Nurse B CHN is also "on"erne with ris3 an $roblems in the wor3 environment of $eo$le at wor3. 11. 0esear"her B assist health "are $rofessionals in rea"hing their goals through resear"h.
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12. S"hool Nurse B wor3s with stu ents in the s"hool 17. /ea"her B fa"ilitates "hange in behavior among "lients whi"h is a basi" intervention strategy in "ommunity health. B"#ef H#sto"' of Co%%&n#t' (ealt(.+&bl#* n&"s#ng +"a*t#*e #n t(e P(#l#++#nes  1414 K *s. Carmen el 0osario is the first Fili$ino nurse su$ervisor who wor3s un er bureau of health  0A 1612 K 3nown as the 0ural Health <nit a"t in 14&4  ,OI 444 K ,egal basis of !rimary Health Care  0A 1141 K An a"t strengthening health an ental servi"es in the rural area. 0esulte also to a itional number of $ositions for health wor3ers in"lu ing $ubli" health nurses an mi wives.  *s. Annie San >14(1? K Foun er an 1st $resi ent an a viser of national league of nurses.  !% 44( K Com$ulsory immuni2ation of "hil ren below 1 years ol .  0A -1(6 K ,o"al government "o e. Hel in 1441.  144- K #ureau of $ubli" health was rename %e$artment of Health.  S$anish 0egime K 1st is$ensary starte uring S$anish regime. <se of herbs an rituals5 start of water sanitation an intro u"tion of small$o: va""ine.  S$anish regime K use of herbs an rituals5 start of water sanitation5 an intro u"tion of small $o: va""ine.  !reBS$anish era K no re"or s.  Ameri"an 0egime K Creation of boar of health for !hysi"ians  'ra of the 0e$ubli" of the !hili$$ines K reorgani2ation of government offi"es un er e:e"utive or er no. 44 series of 144-.  It was also this time that !ueri"ulture "enters was o$erate to ta3e "are of infants an mothers.  141- K Four gra uate nurses $ai by the City of *anila were em$loye to wor3 in the "ity s"hools.  1421 K First "onvention of nurses was hel followe by yearly "onventions  1412 K FaCar o A"t No. 21&( "reate Sanitary %ivision  0e$ubli" A"t -1(6 or lo"al government "o e resulte in the evolution of health servi"es transferring the $ower an authority from the national to the lo"al units.  144( K !rimary Health Care as a strategy to attain for all by year 2666 was in the fo"us su$$orte by the following slogan H27 in 47M5 Health for more in 1444M Five in H4&M5 si: in H4(M an (6 in H144-M  1444 K Creation of National Health !lanning Committee an the establishment of InterB,o"al Health Nones throughout the "ountry through ':e"utive Or er 26&.  2664 K Health Se"tor 0eform Agen a of the !hili$$ines was laun"he . /he reforms $rovi es a? fis"al autonomy to government hos$itals5 b? se"ure fun ing for $riority health $rograms "? $romote the evelo$ment of health system ? ensure the effe"tive $erforman"e strengthen the "a$a"ities of health regulatory agen"ies an e:$an
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"overage of the National Health Insuran"e Agen"y.  *rs. Annie San K was the foun er an the first $resi ent of the National ,eague of Nurses.  *s. Anasta"ia )eron /u$a2 K was the first Fili$ino nurse to hol the $osition of "hief nurse su$erinten ent.  *s. )enera e )u2man K was the first "hief nurse of the %ivision of nursing when the government offi"ers were reorgani2e in O"t. -5 144 /here were ninety $ubli" health nursing assigne in the ifferent $rovin"es. /his 2 s"hools were $rimarily inten e to train nonBChristian women an $re$are them to ren er nursing servi"e among their $eo$le.  1476 K Se"tion of !ubli" Health Nursing was "onverte into Se"tion of Nursing ue to free2ing for gui an"e not in !ubli" Health Servi"es but also in hos$ital nursing an nursing e u"ation.  1441 K !ubli" Health Nurses in *anila was sent to evastate areas to atten to the si"3 uring the outbrea3 of ;orl ;ar II.  14&4 K !hili$$ine Congress $asse an a$$rove 0e$ubli" A"t No. 1612 3nown as the 0ural Health <nit A"t.  *CNA! K is an asso"iation of nurses involve in the $ra"ti"e of *aternal an Chil Health Nursing  Catholi" Nurses )uil of the !hili$$ines K is an asso"iation of "atholi" nurses  !hili$$ine Nurses Asso"iation K is the national organi2ation of Fili$ino nurses a""re ite by !0C.  0eorgani2ation of government offi"e un er e:e"utive or er 44 series of 144- with transfer of the #ureau of !ubli" ;elfare to the offi"e of the !resi ent.  1442 K !ubli" health nursing servi"es were interru$te .  14&7 K /he Offi"e of Health ' u"ation an !ersonnel /raining was "reate with %r. /rini a )ome2 as Chief.  14-& K Formulation of the National Health !lan an the 0estru"ture Health Care %elivery System

Co%%&n#t' Healt( an, De!elo+%ent Con*e+ts/ P"#n*#+les an, St"ateg#es Community Health "an be fa"ilitate by the evelo$ment of the "ommunity an the a"tive $arti"i$ation of its members. /he "ommunity resour"es of the muni"i$ality an nonB governmental agen"ies "an hel$ in attaining "ommunity health. Community health evelo$ment is both a means an an en towar s a"hieving health as total wellBbeing an not Cust the absen"e of isease. CH% is base on the $rimary health "are an a$$roa"h. !rin"i$les B are rules or stan ar s Strategies B are the metho s or a"tivities to attain the $rin"i$les.

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!rimary Health Care A$$roa"h i. %efinitionA !HC as a $hiloso$hy5 a$$roa"h5 stru"ture an servi"es %efinition. !rimary Health Care is the essential health "are base on $ra"ti"al5 s"ientifi"ally soun an so"ially a""e$table metho s an te"hnology ma e universally a""essible to in ivi uals an families in the "ommunity by means a""e$table to them5 through their full $arti"i$ation at a "ost that the "ommunity "an affor to maintain their evelo$ment in the s$irit of selfBrelian"e an selfB etermination. ;HO efines !HC as an essential health "are ma e universally a""essible to in ivi uals an families in the "ommunity by means a""e$table to them5 through their full $arti"i$ation an at a "ost that the "ommunity an "ountry "an affor at every stage of evelo$ment. !hiloso$hy. !HC $hiloso$hy a$$roa"h stru"ture an servi"es. /he Alma Ata e"laration of 14-1 e"lare that the $ursuit of health is inse$arable from the struggle for a fairer an more "aring so"iety. /he e"laration was rafte at a global "onferen"e in Alma Ata5 0ussia an en orse by the worl Gs $eo$le es$e"ially those in evelo$ing "ountries. It e"lare health as a basi" human right an $ro$ose a Fra i"al an $otential revolutionary a$$roa"hF to meeting all $eo$leGs basi" nee s. /his a$$roa"h was "alle $rimary health "are with the )OA, of a"hieving H'A,/H FO0 A,, #= /H' ='A0 2626. !rimary Health Care was "on"eive as a "om$rehensive strategy that woul in"lu e a $eo$leB "entere a$$roa"h to health servi"es an that woul a ress the so"ial an $oliti"al fa"tors that influen"e health. It "alle for a strong "ommunity $arti"i$ation5 a""ountability of health wor3ers an heath ministries to the $eo$le an so"ial guarantees to ensure that the basi" nee s of all $eo$le were met. ii. ,egal basis of !HC in the !hili$$ines  ,etter of Instru"tion >,OI? 444 signe on O"tober 145 14-4 by then !resi ent Fer inan '. *ar"os B one year after the first International Conferen"e on !rimary Health Care was hel in Alma Ata5 <SS0 on Se$tember (B125 14-15 s$onsore by ;orl Health Organi2ation an <NIC'F.  )oalD Health for all Fili$inos by the year 2626 an health in the han s of $eo$le by the year 2626.  .ey StrategyD !eo$le em$owerment an $artnershi$.  !HC was e"lare in Alma Ata Conferen"e in Se$tember (B125 14-1. iii. 'lement@"om$onents of !HC 1. ' u"ation for health 2. ,o"ally en emi" isease "ontrol 7. ':$an e $rogram on immuni2ation 4. *aternal an "hil health an family $lanning &. 'ssential rugs
11

(. Nutrition -. /reatment of "ommuni"able an nonB"ommuni"able iseases 1. Safe water an sanitation 4. !rovision of me i"al "are an emergen"y treatment PHC P"#n*#+les an, St"ateg#es 1. A""essibility5 availability5 affor ability5 a""e$tability of health servi"es. 2. !rovision of 8uality5 basi" essential servi"es 7. Community $arti"i$ation 4. selfBrelian"e &. 0e"ognition of the interBrelationshi$ of health an evelo$ment (. So"ial mobili2ation -. %e"entrali2ation P#lla"s of PHC  /he four !illars of !HC on whi"h the A"tions For Health For All *ust be base D 4 !illars of !HC > *. A. !. S.? M&lt#se*to"al A++"oa*( 0 1)$a' "efe""al s'ste% 2#nte".#nt"ase*to"al3 OOOOInterBse"tor "oo$eration between the health se"tor an other evelo$ment se"tors su"h as e u"ation5 "ommuni"ation5 in ustry5 $ubli" wor3s5 trans$ortation an housing A++"ote*( 0 &se of (e"bal %e,#*#nes 4444!oliti"al an so"ietal "ommitment an etermination to move towar s health for all as the main so"ial target for the "oming e"a es. Pa"t#*#+at#on5 a*t#!e OOOOCommunity $arti"i$ationB the a"tive involvement of $eo$le an the mobili2ation of so"ietal for"es for health evelo$ment. S&++o"t S'ste%5 A!a#lable 2Sent"ong S#gla Mo!e%ent3 OOOOO System su$$ort to ensure that the essential health "are an s"ientifi"ally soun affor able health te"hnology are available to all $eo$le. He"bal Me,#*#ne As $art of $rimary health "are an be"ause of the in"reasing "ost of rugs5 the use of lo"ally available me i"inal $lants has been a vo"ate by the e$artment of health . *any lo"al $lants an herbs in the !hili$$inesG ba"3yar have been foun effe"tive in the treatment of "ommon ailments as atteste to by the National S"ien"e %evelo$ment boar 5 an other )overnment an $rivate agen"ies@$ersons engage in resear"h. /he %e$artment of Health is a vo"ating the use of the following 16 herbal $lants. Herbal *e i"ine In i"ation ,agun i >9ite: negun o? "ough L asthma =erba #uena >*entha "or ifelia? $ains of the bo y Sambong >#lumea balsamifera? Swelling5 iureti"5 AntiBurolithiasis
12

/saang )ubat >Carmona retusa? NiyugBNiyogan >Euis8ualis in i"a ,.? #ayabas >!si ium guaCava ,.? A3a$ul3o >Cassia alata ,.? <lasimang #ato >!e$eronia $ellu"i a? #awang >Allium sativum? Am$alaya >*amor i"a "harantia?

Stoma"h a"he As"aris For "leansing woun s5 *outh infe"tion5Swollen gums Infe"te s3in5 S3in irritation5 S"abies /o lower uri" a"i 5 For arthriti" gout /o lower "holesterol level %iabetis mellitus

Re%#n,e"s #n Us#ng He"bal Plants5  Avoi the use of inse"ti"i es as these may leave $oison on $lants.  In the $re$aration of herbal me i"ine5 use a "lay $ot an remove "over while boiling at low heat.  <se only the $art of the $lant being a vo"ate .  Follow a""urate ose of suggeste $re$aration.  <se only one 3in of herbal $lant for ea"h ty$e of sym$toms or si"3ness.  Sto$ giving the herbal me i"ation in "ase untowar rea"tion su"h as allergy o""urs.  If signs an sym$toms are not relieve after 2 or 7 oses of herbal me i"ation5 "onsult a o"tor.  /he $lanting site for herbal $lants is "alle HH'0#O,A0I<*M Healt( P"o%ot#on i. Con"e$t of health $romotion >as embo ie in the Ottawa Chartere A November 141(?  HEALTH PROMOTION begins with $eo$le who are basi"ally healthy an see3s the evelo$ment of "ommunity an in ivi ual measures whi"h "an hel$ them to evelo$ lifestyles that "an maintain an enhan"e the state of their wellBbeing.  OTTA6A CHARTER OF HEALTH PROMOTION efines Health !romotion as the $ro"ess of enabling $eo$le to in"rease "ontrol over the eterminants of health an thereby to im$rove their health.  /he first International "onferen"e on health $romotion was hel in O//A;A5 ON/A0IO CANA%A on November 1-B215 141(. /he $ro u"t of the "onferen"e was the O//A;A CHA0/'0 OF H'A,/H !0O*O/ION whi"h "reate the vision by "larifying the vision of health $romotion.  !rere8uisite of Health B $ea"e B shelter B e u"ation B foo B in"ome B a stable e"osystem
17

B sustainable resour"es B so"ial Custi"e B e8uity Healt( P"o%ot#on St"ateg#es5 1. #uil healthy $ubli" $oli"y Health $romotion involves not only health "are5 but most im$ortantly $oli"y a vo"a"y. It wor3s to ma3e $oli"y ma3ers in all se"tors an at all levels "on"erne an a""ountable to the $eo$le for the health "onse8uen"es of their $oli"ies5 or la"3 of $oli"ies. Health $romotion $oli"y lea s to im$rove health an in"ome5 greater e8uity5 safer an healthier goo s an servi"es5 healthier $ubli" servi"es an "leaner an more enCoyable environments. 2. Create su$$ortive environments Health $romotion generates living an wor3ing "on itions that are safe5 stimulating5 satisfying an enCoyable. It ensures that the way so"iety organi2es wor3 hel$ "reate a healthy so"iety. Health $romotion strives for the re"i$ro"al $rote"tion of the natural an built environments an the "onservation of natural resour"es. 7. Strengthen "ommunity a"tion Health $romotion wor3s through the em$owerment of the "ommunities5 ta3ing ownershi$ an "ontrol of their own en eavors5 in"lu ing matters in health. It enables the "ommunities to set $riorities5 ma3e e"isions5 $lan strategies an im$lement the to a"hieve better health. Community evelo$ment in"lu ing that on health5 re8uires human an material resour"es. Fle:ible systems for selfBhel$5 so"ial su$$ort an strong $ubli" $arti"i$ation. 4. %evelo$ $ersonal s3ills Health $romotion enables $eo$le throughout life5 e8ui$s them to "o$e with all of life stages in"lu ing "hroni" illness an inCuries an em$owers them with more o$tions@ "hoi"es to better "ontrol their own health an environments. !rovision of information5 e u"ation for health an enhan"ing life s3ills is fa"ilitate through health $romotions in $ursuit of $ersonal an so"ial evelo$ment. &. 0eorient health servi"es Health $romotion is a "ommon res$onsibility among in ivi uals an "ommunity grou$s5 the health se"tor as well as other se"tors in so"iety5 government an nonB government institutions ali3e. /he health se"tor must lea in health $romotion ire"te towar s health "are system that oes not $rovi e "lini"al an "urative servi"es but also res$on s to the nee s of ifferent "ultures5 in ivi uals an "ommunities an integra es broa er so"ial5 $oliti"al5 e"onomi" an $hysi"al environmental "om$onents into health "on"erns. ii. ':am$les of /heories@*o els of Health !romotionA !en er5 #an ura5 )reen /he Health !romotion *o el by !en er es"ribes the multiB imensional nature of $ersons as they intera"t within the environment to $ursue health. /he mo el fo"uses on the following areaD
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1. In ivi ual $er"e$tions >"lientGs "ognitive $er"e$tual fa"tors? 2. *o ifying fa"tors > emogra$hi" an so"ial fa"tors? 7. !arti"i$ation in health B $romoting behavior >li3elihoo of a"tions? /his mo el attem$ts to e:$lain the reasons why in ivi uals engage in health a"tivities. !en er a vo"ates that health $romotion involves a"tivities that are ire"te towar in"reasing the level of well being an selfBa"tuali2ation. ':am$les of Health !romotion a"tivities are routine e:er"ise an goo nutrition whi"h hel$ "lient maintain or enhan"e their $resent level of health.

T(e De+a"t%ent of Healt( 2D O H 3 9ISIOND Health for all Fili$inos >ol ?  ,ea er an staun"h a vo"ate an mo el in $romoting health for all in the !hili$$ines >new? *ISSIOND /o ensure a""essibility an 8uality of health "are to im$rove the 8uality of life of all Fili$inos es$e"ially the $oor. >ol ?  )uarantee e8uitable5 sustainable an 8uality health for all Fili$inos es$e"ially the $oor an shall lea the 8uest for e:"ellen"e in health. Health Servi"es in %.O.H.  Health ' u"arion  Oral Health Servi"es  *ental Health Servi"es  ' u"ation B Health information an "ommuni"ation  ,o"ally 'n emi" %iseases  ':$an e !rogram on Immun2ation  *aternal an Chil Health Care !rograms  'ssential %rugs  Nutrition !rograms  /reatment of Communi"able %iseases  Safe water an sanitation & *aCor Fun"tionsD 1. 'nsure e8ual a""ess to basi" health servi"es 2. 'nsure formulation of national $oli"ies for $ro$er ivision of labor an $ro$er "oor ination of o$erations among the government agen"y Curis i"tions 7. 'nsure a minimum level of im$lementation nationwi e of servi"es regar e as $ubli" health goo s 4. !lan an establish arrangements for the $ubli" health systems to a"hieve e"onomies of s"ale &. *aintain a me ium of regulations an stan ar s to $rote"t "onsumers an gui e $rovi ers
1&

Co%%&n#t' O"gan#7#ng to$a",s *o%%&n#t' +a"t#*#+at#on #n Healt( 1. %efinition of Community Organi2ing A "ontinuous an sustaine $ro"ess of e u"ating $eo$le to un erstan an evelo$ their "riti"al awareness on the e:isting "on itions5 wor3ing with the $eo$le effe"tively an effi"iently on their imme iate an long term $roblems5 an mobili2ing the $eo$le to evelo$ their "a$ability an rea iness to res$on an ta3e a"tion on thir imme iate nee s towar s solving their long term $roblems. i. CO "hara"teristi"s5 !hases an !ro"ess A P"e)Ent"' P(ase /he sim$lest $hase in terms of a"tual out$uts5 a"tivities an strategiesA /a3es only 1B 2 months to "om$lete. A"tivities in !reB'ntry !hase Site Sele"tion D %e$resse $oor "ommunity5 ina""essibility or ina e8ua"y of health servi"es5 $oor health status of the "ommunity5 with no serious $ea"e an or er $roblem5 no strong resistan"e from the "ommunity regar ing the $rogram5 no similar agen"ies or $rograms "urrently in the "ommunity to avoi "om$etition an u$li"ation of servi"es. Sele"tion of Host FamiliesD strategi"ally lo"ate in the barangay5 shoul not belong to the ri"h segment of the "ommunity5 res$e"te by both formal an informal lea ers an all "ommunity resi ents5 house where neighbors are not hesitant to enter. B Ent"' P(ase /he so"ial $re$aration $hase. /he su""ess of the entire CO greatly e$en s on this $hase. )ui elines for entry in the "ommunityD 0e"ogni2e the role of the lo"al authorities by $aying them visits an inform them of their $resen"e an orient them on the $roCe"t obCe"tives. /eam membersI s$ee"h5 a$$earan"e5 behavior an lifestyle shoul be in 3ee$ing with those of the "ommunity resi ents. Avoi raising the e:$e"tations of the "ommunity resi ents. .ee$ a lowB3ey $rofile an a$$roa"h. A"tivities in the 'ntry !haseD  Integration with the "ommunity  Con u"t of information "am$aigns about the $rogram  Con u"t of ee$ening so"ial investigations  !rovision of health servi"es  I entifi"ation of $otential lea ers @ Core )rou$ C O"gan#7at#on an, Ca+ab#l#t' B&#l,#ng P(ase 'ntails more formal $ro"e ure of $lanning5 im$lementing5 monitoring an evaluating "ommunityBwi e a"tivities. A"tivities in the Organi2ation L Ca$ability !haseD  !re$aring the "ommunity for organi2ation buil ing
1(

 Organi2ing "ommittees  /raining an evelo$ment of the "ommittees forme  SettingBu$ of the "ommunityBwi e organi2ation D S&stenan*e an, St"engt(en#ng P(ase /a3es $la"e when the "ommunity is a"tively $arti"i$ating in the "ommunityBwi e un erta3ings. A"tivities in the Sustenan"e L Strengthening !haseD  ' u"ation an training  Networ3ing an lin3aging  Con u"t of mobili2ation on health an evelo$ment "on"erns  Im$lementation of livelihoo $roCe"ts  I entifi"ation an evelo$ment se"on ary lea ers  %evelo$ment an im$lementation of viable management system an $r"e ures5 "ommittees5 "ontinuing e u"ation@ training of lea ers5 CH;s5 "ommunity resi en"e. '. P(ase)O&t /he "oreBgrou$ ta3es full res$onsibility on the $roCe"ts an they fa"ilitate "ontinuous $roblem i entifi"ation5 an $lan $rograms to meet the "ommunity nee s. Co%%&n#t' O"gan#7#ng as +a"t of Co%%&n#t' Healt( De!elo+%ent 2CHD3 Community Health %evelo$ment is both a means an an en towar s a"hieving health as total well being an not Cust the absen"e of isease. CH% is base on the !rimary Health Care >!HC? $hiloso$hy an a$$roa"h. /he mo ule on CH% !rin"i$les an !ra"ti"es in"lu es the efinition of !HC as efine in the Alma Ata %e"laration in 14-1. A most re"ent review of the !HC as a $hiloso$hy an strategy to attain health for all5 em$hasi2es these "on"e$ts of health "areD >;HO5 2662? P Health "are is not Cust about o"tors an rugsA it is about $eo$le a"ting for their own wellBbeing P Health "are is not Cust the obligation of governmentsA it is the res$onsibility of so"iety as a whole P Health "are is not Cust fighting iseaseA it is about ealing with the "onstant "hanges in so"ial systems an institutional stru"tures P Health "are is not Cust about elivering an using servi"esA it a resses all fa"tors affe"ting health status CH% is a $ro"ess of im$lementing !HC with "ommunity organi2ing as its maCor strategy an a$$roa"h. As a $ro"ess5 it aims to a"hieve "ommunityBmanage health "are. CH% as im$lemente in the ;HS*!B!C e:$erien"e5 in"or$orates gen er mainstreaming an the fo"us is womenIs health. /he CH% $ro"ess is shown in Anne: A an # >show the CH% $ro"ess w@ the 2B year timeframe?. Co%%&n#t' De!elo+%ent as en, goal of Co%%&n#t' O"gan#7#ng5 Community %evelo$ment >C%? is the en goal of "ommunity organi2ing an all other efforts towar s u$lifting the status of the $oor an marginali2e . Only when the $arti"i$ation of the
1-

basi" se"tor or sta3ehol ers is eli"ite "an evelo$ment be meaningful an sustaine by the basi" se"tors themselves. HCommunity evelo$mentM will have to be efine an visuali2e by the "ommunity members an their $arti"i$ation is im$ortant in the attainment of this vision. Community evelo$ment entails a $ro"ess of assessment of "urrent situation5 the i entifi"ation of nee s5 e"i ing on a$$ro$riate "ourses of a"tions or res$onses5 mobili2ation of resour"es to a ress these nee s5 an monitoring an evaluation by the $eo$le. ii. )oal of !HC  !eo$leIs em$owerment. Community organi2ing is aime at a"hieving effe"tive $ower for the $eo$le. /hrough the $ro"ess of CO5 $eo$le learn to over"ome their $owerlessness an evelo$ their "a$a"ity to ma:imi2e their "ontrol over their situation an start to $la"e the future in their own han s. It is their $rogressive reali2ation of the $ower that they $ossess an the ability to influen"e the "ourse of history that ramati"ally ero es the ehumani2ing effe"ts of $owerlessness.  #uil ing relatively $ermanent stru"tures an $eo$leIs organi2ations. Community organi2ing aims to establish an sustain relatively $ermanent organi2ational stru"tures whi"h best serve the nee s an as$irations of the $eo$le. /hese stru"tures ensure $eo$leIs ma:imum $arti"i$ation while5 at the same time5 they $rovi e the venue through whi"h the $eo$leIs organi2ations "an lin3 u$ with other grou$s an se"tors. It is also through these stru"tures that alternative ways of oing things "an be teste an a new system of values "an be internali2e so that lo"ali2e e:$erien"es be"ome the buil ing blo"3s u$on whi"h the blue$rint of a more esirable future is base .  Im$rove 8uality of life. Community organi2ing also see3s to se"ure short an longterm im$rovements in the 8uality of life of the $eo$le. Imme iately5 the $ro"ess of mobili2ation "an gain "on"essions for fulfilling basi" nee s for foo 5 "lothing5 shelter5 e u"ation an health. In the long term5 it shoul "reate a "on u"ive environment for the evelo$ment of human "reativity an soli arity through e8uitable istribution of $ower an resour"es. 2. Community $arti"i$ation in healthD levels of "ommunity $arti"i$ation5 fa"tors affe"ting "ommunity $arti"i$ation b? Ca$a"ityBbuil ing for sustainable "ommunity health evelo$ment towar s "ommunity "om$eten"e i. Con"e$ts of a sustainable "ommunity health evelo$mentD integrate 5 "ommunityB base 5 "om$rehensive /he %evelo$ment Con"e$t %evelo$ment B is a "ontinuous $ro"ess of "hange from goo to better or worse to worse5 to ba . /wo .in s of Change Negative Change B from goo to ba 5 human to inhuman "on ition !ositive Change B synonymous to $rogress

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.in s of %evelo$ment '"onomi" %evelo$ment. A evelo$ment base on the in"ome of an in ivi ual against his e"onomi" nee s to meet the stan ar s of living. So"ial %evelo$ment. So"ial awareness an relationshi$ of the $eo$le in "ommunity in meeting the eman s of the so"iety. !oliti"al %evelo$ment. /he $arti"i$ation of $eo$le in sha$ing u$ the estiny of the nation an their a"tion towar s the reali2ation of the "ommon goo of their fellowmen. !hysi"al %evelo$ment. /he $eo$leGs "ons"iousness an a"tion towar s the $reservation of their $hysi"al well being an their environment. Cultural %evelo$ment. S$iritual %evelo$ment. /he relationshi$ of man to his "reator. ii. Ca$a"ityBbuil ing strategiesD health e u"ation5 "om$eten"yBbase training for "ommunity health wor3ers5 su$ervision of lower level health wor3ers !eo$leGs $arti"i$ation shoul be observe in all $hases of "ommunity organi2ing even in the so"ial investigation $hase in $ro"ess "alle $arti"i$atory ata gathering. !arti"i$atory ata gathering5 it is the $ro"ess of involving the "ommunity resi en"e in the "olle"tion an "onsoli ation of ata or information5 thus be"oming the basis for $roblemGs i entifi"ation an strategy formulationA it is sim$ly 3nowing the answers why ata are gathere 5 what ata to gather5 how ata are to be gathere >sour"es?. Healt( E,&*at#on Health e u"ation is a $ro"ess whereby 3nowle ge5 attitu e an $ra"ti"e of $eo$le are "hange to im$rove in ivi ual5 family an "ommunity health. Health e u"ation is a basi" health servi"e an every member of the health team shares res$onsibility in $rovi ing health e u"ation. /he se8uen"e of ste$s in health e u"ation in"lu e "reating awareness5 motivation an e"ision ma3ing a"tion to $ra"ti"e health servi"es. A. Information B $rovision of 3nowle ge #. Communi"ation B e:"hange of information C. ' u"ation B "hange in 3nowle ge5 attitu e an s3ills. )reen efine health e u"ation as Fany "ombination of learning e:$erien"e esigne to fa"ilitate voluntary a o$tion of behaviors "on u"ive to health.F /he National tas3 for"e on the $re$aration an $rati"e of health e u"ators >1417? efine health e u"ation as Fthe $ro"ess of assisting in ivi uals5 a"ting se$arately or "olle"tively5 to ma3e informe e"isions about matters affe"ting the $ersonal health an that of others.F Health ' u"ation is one of the most im$ortant as$e"ts of the fun"tion of the "ommunity health Nurse. T(e S*o+e of Healt( E,&*at#on Health e u"ation "overs the "ontiuum of ,eavell "alls the level of $revention from health $romotion5 s$e"ifi" health $rote"tion5 early iagnosis an treatment5 isability
14

limitation to rehabilitation. In all levels of $revention5 health e u"ation $lays an im$ortant role. All the $rogram thrusts of the health "are elivery system have "orres$on ing health e u"ation@ $romotion "om$onent. /he various levels for health e u"ation $rogram an a"tivities su"h as issemination of health information5 "ommuni"ation5 so"ial mar3eting5 motivation $rogram5 behavior mo ifi"ation5 health "ounseling5 et". illustrate the s"o$e an boun aries of e u"ational a$$li"ation in health.

Health ' u"ation /ea"hing *etho s an Strategies  Interviewing  Counseling  ,e"ture is"ussion  O$en forum  ;or3sho$  Case stu y  0ole $lay  Sym$osium  )rou$ wor3 B bu22 sessions  Community assembly  Nominal )rou$ /e"hni8ue >N)/?  ,aboratory training  <se of I'C >information5 e u"ation an "ommuni"ation? materials as leaflets5 bro"hures5 "omi" han outs5 flyers. *3 Pa"tne"s(#+ b&#l,#ng an, *ollabo"at#on /he aim of $artnershi$ an "ollaboration is to get $eo$le to wor3 together in or er to a ress $roblem or "on"erns that affe"t them. It gives $eo$le the o$$ortunity to learn s3ills in grou$ relationshi$. ;or3ing together enables organi2ations to a""om$lish their goals mu"h 8ui"3er be"ause resour"es5 s3ills an views are $oole together. /hey must wor3 with other $eo$le or grou$s to in"rease the $robability of a""om$lishing the goals that they have set. As the saying says5 there is strength in numbers. /he Nurse must $lan to establish an maintain valuable wor3ing relationshi$s with $eo$le su"h as $eo$leGs organi2ation5 health organi2ations5 e u"ational institutions5 the ,o"al government units5 finan"ial institutions5 religious grou$s5 so"ioB"ivi" organi2ation5 se"toral grou$s an the li3e. i. Networ3ing B is a relationshi$ among organi2ations that "onsist of e:"hanging information about other goals an obCe"tives5 servi"es or fa"ilities. B the lin3ing of relate institutions an the resour"es to a"hieve "ommon obCe"tives. B the investigative $ro"ess of resear"hing $otential em$loyers begin with networ3ing at s"hool5 in the "ommunity an within stu ent Nurse organi2ations. One may 8uestion other Nurse5 em$loyees5 an former em$loyees5 es$e"ially alumni of oneGs own
26

s"hool who have wor3e in various settings. Fa"ulty will have $ertinent observations base on their e:$erien"es with their "lini"al sites in the "ommunity. ii. ,in3ageBbuil ing B the !HN establishes lin3ages an "ollaborative relationshi$s with other health $rofessionals5 government agen"ies5 $rivate se"tor >businesses? an nonBgovernment asso"iations to a ress the "ommunityGs health $roblems. iii. *ultiBse"toral "ollaboration an Inter is"i$linary "ollaboration Bthe !HN "ollaborates with the other health "are $rovi ers5 $rofessionals5 government agen"ies an "ommunity re$resentatives in assessing5 $lanning5 im$lementing an evaluating $rograms for "ommunity healthA Atten s multiB is"i$linary an multiB se"toral a"tivities an i entifies strategies to strengthen referral system. iv. A vo"a"y B is one way the Nurse "an $romote a"tive "ommunity $arti"i$ation. /he Nurse hel$s the $eo$le attain o$timal egree of in e$en ents in e"ision ma3ing in asserting the rights to a safe an better "ommunity. BA vo"a"y wor3 in Nursing has gone a long way who Cust a"ts on behalf or inter"e es for the "lient to one who assists $arties to un erstan ea"h other so that agreement is ri"h. /o ay5 the Nurse as an a vo"ate $la"es the "lientGs right as the fo"us of the $riority. B $ro"ess of $ersua ing or "onvin"ing a s$e"ifi" grou$ of $eo$le to the ne"essary a"tion of a s$e"ifi" goal. B the !HN uses her s3ills in a vo"a"y for the "reation of a su$$ortive environment through $oli"ies an reBengineering of the $hysi"al environment for healthier a"tions. T(e Co%%&n#t' Healt( N&"s#ng P"o*ess Nursing !ro"ess is a systemati"5 s"ientifi"5 ynami"5 ongoing inter$ersonal $ro"ess in whish the Nurses an the "lients are viewe as a system with ea"h affe"ting the other an both being affe"te by the fa"tors within the behavior. /his $ro"ess of e"ision ma3ing result in the o$timal health "are for the "lients to whom the Nurse a$$ly the $ro"ess. /here are s$e"ifi" "om$eten"ies an s3ills that the $ubli" health nurse shoul have. /hese are "ommunity health nursing $ro"ess. Nursing $ro"e ures uring "lini" an home visits5 "ommunity organi2ing5 health $romotion an e u"ation5 surveillan"e5 re"or s an re$orts. T(e Bas#* P(ases of N&"s#ng P"o*ess Bas#* +(ases of N&"s#ng +"o*ess Elabo"at#on of N&"s#ng P"o*ess Assessment 'stablishing a wor3ing relationshi$ OAssessment O%iagnosis !lanning !lanning out"omesO !lanning InterventionsO Im$lementation Im$lementationO 'valuation 'valuationO a? Assessment of the Community Health Nee s
21

Assessment is the $ro"ess of "olle"ting an $ro"essing ata information about the "lient. %iagnosis in the other han is the i entifi"ation of "lient nee s an $roblems base on an analysis of the ata@information gathere . /he analysis an inter$retation of ata "an vary from one Nurse to another. Nursing assessment is the first maCor $hase of the Nursing $ro"ess. In family health Nursing $ra"ti"e5 this involves a set of a"tion by whi"h the Nurse measures the status of the family as a "lient5 its ability to maintain itself as a system an fun"tioning unit an its ability to $revent5 "ontrol5 or resolve $roblems in or er to a"hieve health an well being among its members. /he first "onsi eration of assessment is the ata that nee to be "olle"te . S$ra ley >1446? em$hasi2es that the "ommunity is the $rimary "lient for two main reasonsD  /he "ommunity has a ire"t influen"e on the health of the in ivi ual5 families an subB $o$ulations.  It is at this level that most health servi"e $rovision o""urs. Nursing assessment in"lu es ata "olle"tion5 ata analysis or inter$retation an $roblem efinition or Nursing %iagnosis. Nursing aignosis is the en result of 2 maCor ty$es of Nursing assessment in the family Nursing $ro"ess base on the framewor3 use in this boo3. /hese are the 1st level an 2n level assessment. 1 Le!els of assess%ent5  8st le!el assess%ent B is a $ro"ess whereby e:isting an $otential health "on itions or $roblems of the family are etermine . B the health "on itions or $roblems are "ategori2e asD >1? ;ellness stateA >2? Health threatA >7? Health %efi"itA >4? Stress $oint@ Foreseeable "risis.  ;ellness state B $resen"e of wellness "on itionA wellness $otential is a Nursing +u gment on wellness state or "on ition base on "lientGs $erforman"e5 "urrent "om$eten"ies or "lini"al ata but no e:$li"it e:$ression of "lient esire. ':. Healthy lifestyle5 $arenting5 breastfee ing5 an s$iritual well being  Health threat B "on itions that are "on u"ive to isease5 a""i ents or failure to$ reali2e oneGs health $otential. ':. Family history of here itary "on itionsA threat of "ross infe"tion  Health %efi"it B instan"es of failure in health maintenan"e. ':. Illness state regar less or whether it is iagnose or un iagnose by me i"al $ra"titionerA failure to thrive or evelo$ a""or ing to normal rateA isability whether "ongenital or arising from illness.  Stress $oint or foreseeable "risisB anti"i$ate $erio s of unusual eman s on the in ivi ual or family in terms of a Custment5 family resour"es. ':. *arriage5 $regnan"y5 $arenthoo 5 abortion5 ivor"e or se$aration5 eath of a family member. n,  1 le!el assess%ent B efines the nature or ty$e of Nursing $roblems that the family en"ounters. B inability to re"ogni2e the $resen"e of "on ition ue to la"3 or ina e8uate 3nowle ge.
22

B inability to ma3e e"isions with res$e"t to ta3e a$$ro$riate a"tions ue toD failure to "om$rehen the nature magnitu e of the $roblem@ "on itionA low salien"e of the $roblem "on ition B inability to $rovi e a e8uate Nursing "are to the si"35 isable 5 e$en ent or vulnerable ris3 member of the family ue to la"3 of ina e8uate 3nowle ge about the isease. i. Com$onents of Community nee s assessment 1. Healt( stat&s Health status of the $o$ulation involves $eo$le an the environment. /he health status of the "ommunity is a $ro u"t of the various intera"ting elements su"h as $o$ulation5 $hysi"al an to$ogra$hi"al "hara"teristi"s5 so"ioBe"onomi" an "ultural fa"tors5 health an basi" interrelationshi$ of these elements will e:$lain the health an illness5 $roblems in the "ommunity. 2. Healt( "eso&"*es /he main health resour"e that are available in the "ommunity is an im$ortant element of the "ommunity iagnosis5 mainly be"ause they are the essential ingre ients in the elivery of basi" health servi"es. /he nurse nee s to etermine man $ower5 institutional an material resour"e $rovi e not only by the state but those whi"h are "ontribute by the $rivate se"tor an other nonBgovernmental organi2ations. B *an $ower resour"esD "ategories of health man $ower available5 geogra$hi"al istribution of health man $ower5 a""or ing to health fa"ilities >hos$itals5 0H<s5 health "enters an others?A istribution of health man $ower a""or ing to ty$e of organi2ation >government5 nonBgovernment5 health units5 $rivate? B *aterial resour"esD in"lu es health $roblems an e:$en itures5 sour"es of health fun ingA "ategories of health servi"es available. 9 Healt( a*t#on +otent#al Co%%&n#t' D#agnos#s 1. %efinition Community %iagnosis is an in e$th $ro"ess of fin ing out the $rofiles5 health status of the "ommunity an the fa"tors affe"ting the $resent status. Caring for the "ommunity as "lients starts with etermining the health status. /he Nurse "olle"ts ata about the "ommunity in or er to i entify the ifferent fa"tors that may ire"tly or in ire"tly influen"e the health of the $o$ulation. /hen she $ro"ee s to analy2e an see3 e:$lanations for the o""urren"e of health nee s an $roblems of the "ommunity. /he "ommunity health iagnosis are then erive an will be"ome the bases for evelo$ing an im$lementing "ommunity health Nursing Interventions an strategies. /his $ro"ess is "alle "ommunity iagnosis. Others "all it "ommunity assessment or situational analysis. 1 T'+es of Co%%&n#t' D#agnos#s5 A. Com$rehensive "ommunity iagnosis Aims to obtain general information about the "ommunity with the intent of etermining not only $revalent health "on itions an ris3 fa"tors but also the so"ioB e"onomi" "on ition >so"ioBe"onomi" a$$roa"h? an lifestyle behaviors an attitu es that have effe"t on health >behavioral a$$roa"h.
27

','*'N/SD  %emogra$hi" variables Btotal $o$ulation Btotal number of families surveye Btotal number of family members surveye Bse: istribution B$yrami of age Bage an se: istribution B"ivil status Bfamily si2e Bfemale re$ro u"tive age  So"io '"onomi" 9ariables Baverage in"ome Bo""u$ation table Bsour"e of in"ome  So"ioB"ultural 9ariables B e u"ational attainment B religion B $o$ulation movement . ,ength of resi en"y . /y$e of housing . House movement . 3in s of ventilation  'nvironmental 9ariables Bwater su$$ly Be:"reta is$osal Bgarbage is$osal  Health 9ariables Bfoo storage Binfant fee ing $ra"ti"e Bimmuni2ation status Bhealth see3ing behavior Bsour"e of health information B"ommonly a"8uire isease #. !roblemBoriente "ommunity iagnosis S$ra ley >1446? es"ribes the $roblemBoriente "ommunity iagnosis as the ty$e of assessment that res$on s to a $arti"ular nee . 7 Im$ortant !arts of Community %iagnosis  /he nurse "olle"ts ata about the "ommunity.  Analy2ing an see3ing e:$lanations for the o""urren"e of health nee s an $roblems of the "ommunity.
24

 <tili2ation of these assessment ata will be"ome the basis for evelo$ing an im$lementing "ommunity health nursing intervention an strategies. 1 Ste+s #n Con,&*t#ng t(e *o%%&n#t' ,#agnos#s  %etermining the obCe"tives  %efining the stu y $o$ulation  %etermining the ata to be "olle"te  Colle"ting the ata  %evelo$ing the instrument  A"tual ata gathering  %ata "ollation  %ata $resentation  %ata analysis  I entifying "ommunity health nursing $roblem 1? !re$aration of "ommunity iagnosis i entify the barangay to survey or re8uire by the health "enter. O"ular survey Courtesy "all for the barangay "a$tainA 3agawa for health. I entifi"ation 3ey of lea ers an barangay health wor3ers. Con u"t o"ular survey of a few househol s Start $re$aring for s$ot ma$. Community assembly Inform $eo$le of $ur$ose@$resen"e of the barangay to isseminate initial fin ings5 es$e"ially $resen"e of infe"tious iseases in the area5 e:$laining its mo e of transmission5 s@s:. 2? Con u"t of survey $ro$er using the format@survey form. 0an om sam$ling or saturation )ui elines in filling survey form %ata "olle"tion te"hni8ues 7? *a3e gra$h or "hart of ea"h ata gathere . 4? %ata analysis an inter$retation. &? !re$aration of a"tion $lan@$roCe"t $lan. NO/'D /he $roblem mostly en"ountere uring the "on u"t of the survey is un"oo$erative "ommunity. Data Colle*t#on Te*(n#:&e It is im$ortant that you must e"i e the nee e ata for your "ommunity analysis. %ata "an be "olle"te or obtaine from the muni"i$al health "enter5 NSO5 "ity or muni"i$al hall or other resour"es within the sai "ommunity. %ata Colle"tion /e"hni8ues In"lu e the FollowingD  .ey information a$$roa"h5 same as Hgra$eBvineM a$$roa"h K "ertain in ivi uals
2&

or 3ey informants by virtue of their e:$erien"e5 $rofession or ele"te offi"ers who "an "ontribute valuable information on issues $ertaining to health nee s of the "ommunity.  Ste$s in the $ro"essD  I entify the "hara"teristi"s of 3ey informants li3ely to have insights into issues un er stu y.  Sele"t $otential 3ey informants an ma3e initial "onta"t.  %etermine s$e"ifi" information you wish to obtain5 an s$e"ifi" 8uestions you to as3.  A minister instruments li3e interview5 mailing5 tele$hone et".  /abulate ata "olle"te an raw "on"lusions. CHN P"o*e,&"es an, Tools a? Cl#n#* V#s#t ) /he $atient visits the health "enter to avail of the servi"es thereto offer by the fa"ility $rimarily for CONS<,/A/ION on matters that aile them $hysi"ally. Servi"es that the health "enter offer su"h asD $renatal an $ost$artum "are5 well baby "he"3Bu$5 immuni2ation5 free me i"ine un er %O/S an other health "are.  Stan,a", P"o*e,&"e Pe"fo"%e, D&"#ng Cl#n#* V#s#t  0egistration@A mission  )reet the "lient u$on entry an establish ra$$ort  !re$are the family re"or  'li"it an re"or the "lientIs "hief "om$laints an history  !erform $hysi"al e:amination on the "lient an re"or it a""or ingly  ;aiting /ime  )ive $riority numbers to "lient  Im$lement the first "ome5 first serve $oli"y  Observe for emergen"y "ases  /riaging *anage $rogramBbase "ases 0efer all nonB$rogram base "ases to the $hysi"ian !rovi e firstBai treatment to emergen"y "ases Clini"al 'valuation  9ali ate "lini"al history an $hysi"al e:amination  /he nurse arrives at evi en"eBbase iagnosis an $rovi es rational treatment base on %OH $rograms.  Inform the "lient on the nature of the illness5 the a$$ro$riate treatment an $revention an "ontrol measures.  ,aboratory an other %iagnosti" ':amination  I entify a esignate referral laboratory when nee e .  0eferral System

2(

0efer the $atient if he nee s further management5 following the twoBway referral system. >#HS to 0H<5 0H< to 0H<5 0H< to hos$ital? A""om$any the $atient when an emergen"y referral is nee e .  !res"ri$tion@%is$ensing )ive $ro$er instru"tions on rug inta3e  Health ' u"ation Con u"t one on one "ounseling with the $atient 0einfor"e health e u"ation an "ounseling messages )ive a$$ointments for the ne:t visit

Ho%e V#s#t ) Is a familyBnurse "onta"t whi"h allows the health wor3er to assess the home an family situation in or er to $rovi e the ne"essary nursing "are an healthBrelate a"tivities.

 P&"+oses of Ho%e V#s#t  /o give nursing "are to the si"35 to a $ost$artum mother an her newborn with the view to tea"h a res$onsible family member to give the subse8uent "are.  /o assess the living "on ition of the $atient an his family an their health $ra"ti"es in or er to $rovi e the a$$ro$riate health tea"hing  /o give health tea"hing regar ing the $revention an "ontrol of iseases.  /o establish "lose relationshi$ between the health agen"ies an the $ubli" for the $romotion of health.  /o ma3e use of the inter referral system an to $romote the utili2ation of "ommunity servi"es. Bag Te*(n#:&e ) /he bag te"hni8ue is a tool by whi"h the nurse5 uring her visit will enable her to $erform a nursing $ro"e ure with ease an eftness5 to save time an effort5 with the en view of ren ering effe"tive nursing "are to "lients.  1. 2. 7. 4. P"#n*#+les Of Bag Te*(n#:&e !erforming the bag te"hni8ue will minimi2e5 if not $revent the s$rea of any infe"tion. It saves time an effort in the $erforman"e of nursing $ro"e ures. /he bag te"hni8ue shoul show the effe"tiveness of total "are given to an in ivi ual or family. /he bag te"hni8ue "an be $erforme in a variety of ways e$en ing on the agen"yIs $oli"y5 the home situation5 or as long as $rin"i$les of avoi ing transfer of infe"tion is always observe .

 Contents Of P&bl#* Healt( Bag  !a$er lining  ':tra $a$er for ma3ing waste bag
2-

                       

!lasti" @ linen lining A$ron Han towel Soa$ in a soa$ ish /hermometer > igital? 2 $airs of s"issors >surgi"al L ban age? 2 $airs of for"e$s >"urve L straight? %is$osable syringes with nee les >g. 27 L 2&? Hy$o ermi" nee les >g. 145 225 275 2&? Sterile ressing Cotton balls > ry L with al"ohol? Cor "lam$ *i"ro$ore $laster /a$e measure 1 or more $air of sterile gloves 1 or more $air of "lean gloves Fa"e mas3 #abyIs s"ale Al"ohol lam$ *at"h 2 test tubes /est tube hol ers /est tube ra"3 Solutions ofD #eta ine -6Q Al"ohol Ne$hiran solution Hy rogen !ero:i e S$irit of Ammonia O$thalmi" ointment A"eti" a"i #ene i"tIs solution  S$hygmomanometer an Stethos"o$e are "arrie se$arately.

 I%+o"tant Po#nts to Cons#,e" #n t(e Use of t(e Bag 1. /he bag shoul "ontain all the ne"essary arti"les5 su$$lies an e8ui$ments that will be use to answer emergen"y nee s. 2. /he bag an its "ontents shoul be "leane very often5 the su$$lies re$la"e 5 an rea y for use anytime. 7. /he bag an its "ontents shoul be well $rote"te from "onta"t with any arti"le in the $atientIs home. Consi er the bag an its "ontents "lean an sterile5 while arti"les that belong to the $atients as irty an "ontaminate . 4. /he arrangement of the "ontents of the bag shoul be the one most "onvenient to the user5 to fa"ilitate effi"ien"y an avoi "onfusion.

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Ste+s #n Pe"fo"%#ng t(e Bag Te*(n#:&e A*t#ons  <$on arrival at the $atientIs home5 $la"e the bag on the table line with a "lean $a$er. /he "lean si e must be out an the fol e $art5 tou"hing the table. BB /o $rote"t the bag from getting "ontaminate .  As3 for a basin of water or a glass of rin3ing water if ta$ water is not available. BB /o be use for han washing.  O$en the bag an ta3e out the towel an soa$. BB /o $re$are for han washing.  ;ash han s using soa$ an water. ;i$e to ry. BB /o $revent infe"tion from the "are $rovi er to the "lient.  /a3e out the a$ron from the bag an $ut it on with the right si e out. BB /o $rote"t the nurseIs uniform.  !ut out all the ne"essary arti"les nee e for the s$e"ifi" "are. BB /o have them rea ily a""essible.  Close the bag an $ut it in one "orner of the wor3ing area. BB /o $revent "ontamination.  !ro"ee in $erforming the ne"essary nursing "are an treatment. BB /o give "omfort an se"urity an hasten re"overy.  After giving the treatment5 "lean all things that were use an $erform han washing. BB /o $rote"t the "aregiver an $revent infe"tion.  O$en the bag an return all things that were use in their $ro$er $la"es after "leaning them.  0emove a$ron5 fol ing it away from the $erson5 the soile si e in an the "lean si e out. !la"e it in the bag.  Fol the lining5 $la"e it insi e the bag an "lose the bag.  /a3e the re"or an have a tal3 with the mother. ;rite own all the ne"essary ata that were gathere 5 observations5 nursing "are an treatment ren ere . )ive instru"tions for "are of $atients in the absen"e of the nurse. BB For referen"e in the ne:t visit. 1.*a3e a$$ointment for the ne:t visit >either home or "lini"? ta3ing note of the ate an time. BB For followBu$ "are. /ools use in "ommunity iagnosisD emogra$hy5 vital an health statisti"s5 e$i emiology De%og"a+(' a? %efinition an uses of emogra$hy %'*O)0A!H= is the s"ien"e whi"h eals with the stu y of the human $o$ulation si2e5 "om$osition an istribution in s$a"e. !o$ulation si2e sim$ly refers to the number of $eo$le in a given $la"e or area at a given time. ;hen the $o$ulation is "hara"teri2e in relation to "ertain variables su"h as age5 se:5 o""u$ation or e u"ational level5 then the $o$ulation "om$osition is being es"ribe . /he nurse also es"ribes how $eo$le are istribute in a s$e"ifi" geogra$hi" lo"ation. <ses of %emogra$hy  /o be aware of how large a $o$ulation is in a "ommunity
24

/o "om$rehen the "hara"teristi"s of the $o$ulation that ma3es them e:$ose to "ertain health "on ition. !tB !o  /o etermine the nature an tmagnitu e of e:isting an $otential "ommunity health nursing $roblems.  /o 3now about the $o$ulation si2e5 "om$osition an istribution an s$a"e. b? Com$onents of emogra$hy i. %es"ribing !o$ulation Si2e ;ays in *easuring $o$ulation si2e by etermining In"rease in $o$ulationD  Natural In"rease Natural In"rease R Number of births B Number of eaths >s$e"ifie year? >s$e"ifie year? >s$e"ifie year?  0ate of Natural In"rease 0ate of natural in"rease R Cru e birth rate BCru e %eath 0ate >s$e"ifie year? >s$e"ifie year? >s$e"ifie year? ;ays in *easuring $o$ulation si2e by etermining In"rease in $o$ulation using ata obtaine uring two "ensus $erio sD  Absolute in"rease $er year B measures the number of $eo$le that are a e to the $o$ulation $er year. Absolute in"rease $er year R BBBBBBBBBBBBBBBBBBBBBBBBBBBBB !t R $o$ulation si2e at a later time !o R $o$ulation si2e at an earlier time t R number of years between time 6 an time t  0elative In"rease 2 B is the a"tual ifferen"e between the 2 "ensus "ounts e:$resse in $er"ent5 relative to the $o$ulation si2e ma e uring an earlier "ensus. 

ii. %es"ribing $o$ulation "om$osition Se: "om$osition Se: ratio R >no. of males @ no. of females? : 166 OOOthe se: ratio re$resents the number of males for every 166 females in the $o$ulation Age "om$osition *e ian ageB ivi es the $o$ulation into 2 e8ual $arts. %e$en en"y 0ation B "om$ares the number of e"onomi"ally e$en ent with the e"onomi"ally $ro u"tive grou$ in the $o$ulation. %e$en ent belongs to 6B14 an (& L above age grou$s. !ro u"tive are those within 1&B(4. /he e$en en"y ratio re$resents the number of e"onomi"ally e$en ent for every 166 e"onomi"ally $ro u"tive. Age an se: "om$osition B the age an se: "om$osition of the $o$ulation "an be es"ribe at the same time using a $o$ulation $yrami . It is a gra$hi"al $resentation of the age an se: "om$osition of the $o$ulation
76

iii. %es"ribing s$atial istribution /he istribution of the $o$ulation an s$a"e "an be es"ribe in terms of urban rural istribution5 $o$ulation ensity an "row ing in e:. /he measures hel$ the Nurse e"i e how meager resour"es "an be Custifiably allo"ate base on "on"entration of $o$ulation in a "ertain $la"e. U"ban)"&"al ,#st"#b&t#on sim$ly illustrate the $ro$ortion of the $eo$le living in urban "om$are to the rural area. C"o$,#ng #n,e; will es"ribe the ease by whi"h a "ommuni"able isease will be istribute form one host to another sus"e$tible host. Po+&lat#on ,ens#t' will etermine how "ongeste a $la"e an has im$li"ations in terms of the a e8ua"y of basi" health servi"es $resent in the "ommunity. It "an be "om$ute by ivi ing the number of $eo$le living in a given lan area.

*3 So&"*es of ,e%og"a+(#* ,ata C'NS<S B an offi"ial an $erio i" enumeration of $o$ulation.  %e Cure metho Bis one when $eo$le are assigne to a $la"e where they usually live regar less of where they are at the time of the "ensus.  %e fa"to metho Buse when the $eo$le are assigne to a $la"e where they are $hysi"ally $resent at the time of "ensus regar less of their usual $la"e of resi en"e. SA*!,' S<09'= B emogra$hi" information "olle"te from a sam$le of a given $o$ulation. 0')IS/0A/ION S=S/'*S B re"or ing of vital events in the "ommunity. V#tal An, Healt( Stat#st#*s a? %efinition an uses of vital an health statisti"s Statisti"s refers to a systemati" a$$roa"h of obtaining5 organi2ing an analy2ing numeri"al fa"ts so that "on"lusion may be rawn from them. 9ital statisti"s refers to the systemati" stu y of vital events su"h as births5 illnesses5 marriages5 ivor"e5 se$aration an eaths. Statisti"s of isease >morbi ity? an eath >mortality? in i"ate the state of health of a "ommunity an the su""ess or failure of health wor3. #irths an eaths are registere in the offi"e of the lo"al "ivil registrar of the muni"i$ality or "ity. In "ities5 births an eaths are registere at the "ity health
71

e$artment. <ses of 9ital Statisti"sD • In i"es of the health an illness status of a "ommunity • Serves as bases for $lanning5 im$lementing5 monitoring an "ommunity health nursing $rograms an servi"es b? Common vital an health statisti"al in i"ators

evaluating

Fe"t#l#t' Rate a. Cru e #irth 0ate B a measure of oneGs "hara"teristi"s of the natural growth or in"rease of a $o$ulation. /otal S of live births in a given "alen ar year T 1666 'stimate $o$ulation as of +uly 1 of the same given year b. )eneral Fertility 0ate /otal S of live births in a given "alen ar year T 1666 /otal number of re$ro u"tive age Mo"tal#t' Rate a. Cru e %eath 0ate B a measure of one mortality from all "auses whi"h may result in a e"rease of $o$ulation. /otal S of eath in a given "alen ar year T 1666 'stimate $o$ulation as of +uly 1 of the same year b. Infant *ortality 0ate B measure the ris3 of ying uring the first year of life. /otal S of eath below 1 year in a given "alen ar year T 1666 'stimate $o$ulation as of +uly 1 of the same "alen ar year ". *aternal *ortality 0ate B measure the ris3 of ying from all "auses relate to $regnan"y5 "hil birth an $uer$erium. /otal S of eath among all maternal "ases in a given "alen ar year T 1666 'stimate $o$ulation as of +uly 1 of the same "alen ar year Mo"b#,#t' Rate a. !revalen"e 0ate B measures the $ro$ortion of the $o$ulation whi"h e:hibits a $arti"ular isease at a $arti"ular time. /otal S of new L ol "ases in a given "alen ar year T 166 'stimate $o$ulation as of +uly 1 of the same "alen ar year b. In"i en"e 0ate B measures the fre8uen"y of o""urren"e of the $henomenon uring a given $erio of time. /otal S new "ases in a given "alen ar year T 166 'stimate $o$ulation as of +uly 1 of the same "alen ar year ". Atta"3 0ate /otal S of $erson who are e:$ose to the isease T 166 'stimate $o$ulation as of +uly 1 of the same "alen ar year
72

1. '$i emiology a. %efinition an uses of e$i emiology '$i emiology is the stu y of o""urren"es an istribution of health "on ition su"h as isease5 eath5 eformities or isabilities on human $o$ulations. It is also "on"erne with the stu y of $robable fa"tors that influen"e the evelo$ment of this health "on itions. /he Nurse measures the fre8uen"y an istribution of health "on itions using vital statisti"al in i"es. '$i emiology however is use to analy2e the ifferent fa"tors that "ontribute to isease evelo$ment. <n erstan ing the isease "ausation hel$s the Nurse $lan an evelo$ strategies to $revent an "ontrol s$rea of isease se$e"ially for highBris3 grou$s. It is the ba"3bone of the $revention of the isease. b. '$i emiologi" "on"e$ts an $rin"i$les i. *ulti$le "ausation theory or e"ologi" "on"e$t of isease %isease evelo$ment oes not rest on a single "ause. Health "on itions result from a multitu e of fa"tors. /here are three mo els that e:$lain the multi$le "ausation theory B B B the wheel5 the web an the e"ologi" tria . Of the three5 the e"ologi" tria is the most hel$ful to the nurse be"ause it highlights not only the hostGs an agentGs roles in isease evelo$ment but also regar s the role of the environment as the im$ortant in isease "ausation.  Agent B Host B 'nvironment !athway of Health an %isease A)'N/. mi"roorganisms or to:i" "om$onents that is transmitte from the sour"e of infe"tion to the sus"e$tible bo y. !reB$athogeni" HOS/. any organism that harbors an $rovi es nourishment for re"overy another organism asym$tomati" 'N9I0ON*'N/. sum total of all e:ternal "on itionA affe"ts both the host an agent. isability  *o elsD ;eb5 wheel an tria ii. Natural history of isease Common "auses of iseaseD >1? biologi" eath agentA >2? inherite geneti" efe"tsA >7? evelo$mental efe"tsA >4? $hysi"al agentA >&? "hemi"al agentA >(? tissue res$onse to irritation or inCuryA >&? faulty "hemi"al@ metaboli" !rimary Se"on ary rea"tion to stress. /ertiary $ro"essA >1? emotional@$hysi"al iii. ,evels of isease $revention

77

P"#%a"' Le!el D#sease P"e!ent#on /hrough $ersons B immuni2ation B nutrition B "hemo$ro$hyla:is B $ersonality evelo$ment B $ersonal hygiene B res$onsible se:uality B fertility regulation B avoi an"e of allergens5 $oisons an "ar"inogens /hrough environmental "ontrol B safe water B foo hygiene B safe e:"reta is$osal B $ro$er refuse management B safe home environment B safe wor3$la"e  Se"on ary %isease !revention B *ass s"reening B CaseBfin ing B Conta"tBtra"ing B *ultiB$hasi" s"reening B Surveillan"e
74

iv. Con"e$t of "ausality an asso"iation ". '$i emiologi" a$$roa"h fo"using onD i. %es"ri$tive e$i emiology. Con"erne with isease istribution an fre8uen"y.  'n emi" K "onstant5 habitual5 "onsistent  S$ora i" K irregular istribution@ o""asional  '$i emi" K outbrea3s@ su en in"rease in in"i en"e  !an emi" K worl wi e istributions ii. Analyti"al e$i emiology. Attem$ts to analy2e the "auses or eterminant of isease through hy$othesis testing. b? !lanning of Community Health Nursing Servi"es !lanning is the se8uen"e of ste$s that nee to be ta3en. !lanning Nursing A"tions /he $lan for Nursing a"tion or "are is base on the a"tual an $otential $roblems that were i entifie an $rioriti2e . !lanning nursing a"tions in"lu e the followingD  )oal Setting >S*A0/B s$e"ifi"5 measurable5 attainable5 realisti"5 timeBboun ?  Constru"ting a $lan of a"tion  %evelo$ing an o$erational !lan i. !rin"i$les of Community health $lanning ii. #ases for evelo$ing a "ommunity health $lan 1. Health status 2. Health resour"es 7. Health a"tion $otential iii. Ste$s in ma3ing a $lanD the $lanning "y"le 1. /he $rioriti2e "on itions or $roblems 2. /he goals an obCe"tives of nursing "are 7. /he $lan of interventions 4. !lan for evaluating "are iv.Conte:t in evelo$ing the "ommunity health $lan P(#l#++#ne Healt( Ca"e Del#!e"' S'ste% B the totality of all $oli"ies5 e8ui$ment5 $ro u"ts5 human resour"es an servi"es whi"h a ress the health nee s of $eo$le. B /he !hili$$ine Health Care %elivery system is "om$ose of two se"torsD >1? !ubli" Se"tor whi"h is largely finan"e through a ta:Bbase bu geting system at both national an lo"al levels an where health "are is generally given F0'' at the $oint of servi"e >although so"iali2e user fees have been intro u"e in re"ent years for "ertain ty$es of servi"es?A >2? !rivate Se"tor >for $rofit an nonB$rofit $rovi ers?5 whi"h is largely mar3etBoriente an where health "are is $ai through user fees at the $oint of servi"e. ':. !hilhealth Categories of Health Care %elivery System
7&

a?

T'+e !rimary

Se"!#*es Common health $roblems Health ' u"ation !reventive Care *e i"al Servi"es Surgery

Le!el of P"e!ent#on Health $romotion Illness !revention %iagnosis /reatment Com$li"ation $revention %isability $revention 0ehabilitation

E;a%+le Health ' u"ation Immuni2ation

Lo*at#on 0H< Community Hos$ital !ueri"ulture %istri"t Hos$ital !rovin"ial@ "ity hos$itals

Se"on ary

/ertiary

A van"e an s$e"iali2e servi"es

!rom$t /reatment Conta"t /ra"ing Case Fin ing S"reening !/@O/ Fa"ility em$loyment

0egional5 S$e"iali2e 5 *e i"al an National Health Centers

b? /he National Health !lan 9ISIOND A longBterm ire"tional $lan for health. )OA,D /o enable the Fili$ino to a"hieve a level of health that is a""essible O#+'C/I9'SD E8uity5 $eo$le health status Health $roblemsD a resse A"tiveD !arti"i$ative "iti2enry "? Health Senarios 8< Lea,#ng Ca&ses of Mo"b#,#t' 21<<93 1. !neumonia (./uber"olosis 2. %iarrhea -.Heart %iseases 7. #ron"hitis 1.*alaria 4. Influen2a 4.Chi"3en !o: &. Hy$ertension 16. *easles 8< Lea,#ng Ca&ses of Mo"tal#t' 21<<93 1. Car ia" iseases (. /# 2. 9as"ular iseases -.N'C 7. Can"er 1.Chroni" ,ower 0es$iratory %iseases 4. A""i ents 4.%* &. !neumonia 16. !erinatal %iseases A E;e*&t#!e O",e" 8<1 2 T(e De+a"t%ent of Healt(3 /he ':e"utive Or er 162 F0e ire"ting the Fun"tions an O$erations of the %e$artment of HealthF by !resi ent +ose$h '. 'stra a grante the %OH to $ro"ee with its 0ationali2ation an Streaming $lan whi"h $res"ribes the "urrent organi2ational staffing an resour"e stru"ture "onsistent with its new man ate5 roles an fun"tions5 $ostB evolution.
7(

'O 162 man ates the %e$artment of Health to $rovi e assistan"e to lo"al government units5 $eo$leGs organi2ations an other members of "ivi" so"iety in effe"tively im$lementing $rograms5 $roCe"ts an servi"es that will $romote the health an well being of every Fili$inoA $revent an "ontrol iseases among $o$ulation at ris3A $rote"t in ivi uals5 families an "ommunities e:$ose to ha2ar s an ris3s that "oul affe"t their health an treat5 manage an rehabilitate in ivi uals affe"te by iseases an isability. B RA =8>< 2Lo*al Healt( S'ste%s3 -no$n as t(e Lo*al Go!e"n%ent Co,e O"t. 165 1441 F,o"al )overnment Co eF $rovi e for the e"entrali2ation of the entire government. /his brought about a maCor shift in the role an fun"tions of the %OH. <n er this law5 all stru"tures5 $ersonnel an bu getary allo"ations from the $rovin"ial health level own to the barangays were evolve to the lo"al governent units >,)<s? to fa"ilitate health "are elivery. As su"h5 elivery of basi" health servi"es is now the res$onsibility of the ,)<s. /he %OH "hange its role from one of im$lementation to one of governan"e. C Le!els of Healt( Ca"e an, Refe""al S'ste% Le!els of Ca"e  !rimary level of "are B "enters on health $romotion an $reventive measures  Se"on ary level of "are B "enters on iagnosis an $rom$t treatments  /ertiaty level of "areB "enters on isability $revention an rehabilitation 1. )lobal Health Situation >*illenium %evelo$ment )oals? In the light of the "hanging national an global health situation an the a"3nowle gment that Nursing is a signifi"ant "ontributor to health. /he !ubli" Health Nurse is strategi"ally $ositione to ma3e a ifferen"e in the health out"omes of in ivi uals5 families an "ommunities "are for. /he 1 *illenium %evelo$ment )oals are as followsD  'ra i"ate e:treme $overty an hunger  A"hieve universal $rimary e u"ation  !romote gen er e8uality an em$ower women  0e u"e "hil mortality  Im$rove maternal health  Combat HI9@AI%S5 malaria an other iseases  'nsure environmental sustainability  %evelo$ a global $artnershi$ for evelo$ment OOOe:"e$t for goals 2 an 75 all the *%)s are health or healthBrelate . Health is essential to the a"hievement of these goals an is a maCor "ontributor to the overar"hing goal of $overty re u"tion. 2. National Health Situation >FO<0mula One? Currently5 there are various "ountry initiatives to im$lement a more "auseB effe"tive health "are servi"es. /he Health Se"tor 0eform Agen a >HS0A? im$lemente through FO<0mula ON' an o$erationali2e in the National obCe"tives for health 266& B
7-

2616 s$ells out the $rogram im$eratives of the health se"tor. All these are in line with the *Illenium %evelo$ment )oals an the *e iumB/erm evelo$ment !lan of the "ountry. )oals of FO<0mula ON' for HealthD B better health out"omes B more res$onsible health systems B e8uitable health "are finan"ing 7. !rimary Health Care as an a$$roa"h to health "are elivery /he "on"e$t of !HC is "hara"teri2e by $artnershi$ an em$owerment of the $eo$le that shall $ermeate as t he "ore strategy in the effe"tive $rovision of essential healh servi"es that are "ommunity base 5 a""essible5 a""e$table5 an sustainable at a "ost whi"h the "ommunity an the government "an affor .

I%+le%ent#ng t(e Co%%&n#t' Healt( N&"s#ng Se"!#*es Im$lementationB /o "arry into effe"tA fulfill5 a""om$lish a $lan or an a"tivity formulate beforehan . It involves various interventions whi"h has been etermine by the goals@obCe"tives whi"h has been $reviously set. /he "ommunity health nurses "arry out nursing $ro"e ures whi"h are "onsistent with the nursing "are $lan5 are a o$te to $resent situations whi"h $romote a safe an thera$euti" environment. A. Com$onents of $rogram im$lementation i.Coor inating the health $rogram ii. *onitoring Health !rograms iii. Su$ervising the $rogram staff #. National Health $rograms of %OH i.Family Health Servi"es 8 Mate"nal Healt( P"og"a% B /he !hili$$ines is tas3e to re u"e maternal mortality rate >**0? by three 8uarters by 261& to a"hieve its millennium evelo$ment goal. 'ssential Health Servi"e !a"3age Available in the health Care fa"ilityD  Antenatal 0egistration  /etanus /o:oi Immuni2ation  *i"ronutrient Su$$lementation  /reatment of %isease an Other Con ition  Clean an Safe %elivery 1 Fa%#l' Plann#ng Family !lanning aims to "ontribute forD

71

 0e u"e infant eaths  Neonatal eaths  <n erBfive eaths  *aternal eaths Family !lanning *etho sD  Female sterili2ation  *ale sterili2ation  !ills  *ale "on om  InCe"tables  ,A* >,a"tating Amenorrhea *etho ?  *u"us #illings@Ovulation  ##/ >#asal #o y /em$erature? C(#l, Healt( P"og"a%s Newborns5 infants an "hil ren are vulnerable age grou$ for "ommon "hil hoo iseases. /he ris3 of infe"tion among "hil ren is higher when not s"reene for metaboli" isor er5 not e:"lusively breastfe 5 unva""inate 5 not $ro$erly manage when si"35 not given with vitamins su$$lementation an many others. A Infant an, 'o&ng *(#l, fee,#ng /here is a global evi en"e that goo nutrition in the early manGs an years of life $lays a very signifi"ant role5 affe"ting not only the health an survival of infants an "hil ren but also their intelle"tual an so"ial evelo$ment5 resulting in lifeBlong im$a"t on s"hool $erforman"e an over all $ro u"tivity. #reastfee ing es$e"ially e:"lusive breastfee ing uring the first year of life is an im$ortant fa"tor that "an $revent infant an "hil hoo morbi ity an mortality. /imely a e8uate5 safe an $ro$er "om$lementary fee ing will $revent "hil hoo malnutrition. /he strategy "alls for the $romotion of breastmil3 as the i eal foo for the healthy growth an evelo$ment in infantA an of e:"lusive breastfee ing for the first ( months of life as the means to a"hieve o$timal growth5 evelo$ment an health of newborns. /he overall obCe"tive is to im$rove the survival of infants an young "hil ren by im$roving their nutritional status5 growth an evelo$ment through o$timal fee ing. %efinition of ':"lusive #reastfee ing an "om$limentary fee ing E;*l&s#!e b"eastfee,#ng means giving a baby only breast mil35 an no other soli s or li8ui s5 not even water. %ro$s or syru$s "onsisting of vitamins5 minerals an su$$lements are $ermitte . Co%+l#%enta"' fee,#ng After ( months of age5 all babies re8uire other foo s to "om$liment breastmil3. ;e "all this "om$limentary foo s. ;hen "om$limentary foo s ar intro u"es5 breastfee ing shoul still "ontinue for u$to 2 years of age or beyon . E;+an,e, P"og"a% on I%%&n#7at#on

74

Immuni2ation among infants an newborns is essential be"ause they belong to the vulnerable age grou$ an their immune system are not yet fully evelo$e . )eneral !rin"i$les that A$$lies to 9a""inating Chil renD  It is safe an immunologi"ally effe"tive to a minister all '!I va""ine on the same ay at ifferent sites of the bo y  *easles va""ine shoul be given as soon as the "hil is 4 mos regar less the fa"t that he has not "om$lete the oses re8uire of other va""ines a ministere  9a""ination s"he ule shoul not be reBstarte from the beginning even if the interval between oses e:"ee e the re"ommen e interval  *o erate fever5 malnutrition5 mil res$iratory infe"tion5 "ough5 iarrhea an vomiting are not "ontrain i"ations  Absolute "ontrain i"ations B %!/ 2 an 7 to a "hil who ha "onvulsions or sho"3 within 7 ays the $revious ays B #C) must not be given to "hil who immuno"om$romise  ,o"al rea"tions an fever "an result as $art of normal immune res$onse  )iving oses of va""ine at less than the re"ommen e 4 wee3s interval may lessen the antibo y res$onse  <se one syringe one nee le $er "hil uring va""ination '!I /arget %iseasesD /uber"ulosis5 i$htheria5 $ertussis5 tetanus5 $oliomyelitis5 measles an he$atitis # 0outine Immuni2ation S"he ules For InfantsD

Integ"ate, Manage%ent of C(#l,(oo, Illness Integrate *anagement of Chil hoo Illness >I*CI? is a strategy for re u"ing mortality an morbi ity asso"iate with the maCor "auses of "hil hoo illnesses. /he "urrent fo"us is on im$roving 8uality of "are at 1st level health fa"ilities.
46

First level health fa"ilities U health "enter an out$atient servi"es in rural an urban $la"es. Fo"us on most "ommon lifeBthreatening "on itionD  %iarrhea  !neumonia  *easles L *alaria  *alnutrition *'/HO%S <S'% IN *ANA)IN) CHI,%HOO% I,,N'SS'S  Assess the $atient  Classify the isease  /reat the $atient  Counsel the $atient /o effe"tively manage "hil hoo illnesses5 a "olor "o e system has been utili2e D

)oal of I*CID #y 26265 to re u"e the infant un er & mortality rate. /o re u"e eath5 illness an isability an to $romote im$rove growth an evelo$ment un er & years of age. N&t"#t#on P"og"a% *A,N</0I/ION "ontinues to be the $ubli" health "on"ern in the "ountry. Common nutritional efi"ien"iesD B9itamin A BIron BIo ine OOO/he efi"ien"ies lea to a serious $hysi"al5 mental5 so"ial an e"onomi" "on itions among "hil ren an women. OOO/he goal of nutrition is to im$rove 8uality of life of Fili$inos thru better nutrition.  *i"ronutrient su$$lementation B to im$rove the growth an survival of infants an "hil ren. B ASA! >Araw ng Sang3a$ !inoy? or )arantisa ong !ambataD OOtwi"e a year OOvitamin A "a$s giving OOiron an vitamin su$$lementation >(B-1 mos ol ?  Foo fortifi"ation  'ssential maternal an "hil health servi"e $a"3age.  Nutrition I'C >Information5 ' u"ation5 Communi"ation?
41

 Home s"hool an "ommunity foo $ro u"tion.  Foo assistan"e  ,ivelihoo assistan"e. O"al Healt( P"og"a% *ain oral $roblem is %'N/A, CA0I'S L !'0I%ON/A, %IS'AS'V Classifi"ation of oral interventionD  !reventive  Curative  !romotive 7. 'ssential Health !a"3ages for the a oles"ent5 a ult men an women an ol er $ersons A,oles*ent Healt( P"og"a% A%O,'SC'NC' is efine by ;HO as the $erio of life between 16 an 26 years of age while the =O</H refers to those who are between 1& an 24 years ol . =O<N) !'O!,' refers to both age grou$s. >16B24 y@o?

Essent#al Healt( Ca"e Pa*-age Fo" T(e A,oles*ent An, Yo&t(  *anagement of illness  Counseling on substan"e abuse5 se:uality an re$ro u"tive tra"t infe"tion  Nutrition an iet "ounseling  *ental health  Family $lanning L res$onsible se:ual behavior  %ental "are

A,&lt 6o%en Car iovas"ular %iseases are the lea ing "auses of eath among a ult Fili$ino women. Followe by *alignant Neo$lasm. /he lea ing "auses of eath among females are mostly egenerative an lifestyleBrelate in nature. /b L !neumonia are the only infe"tious isease in"lu e in the lea ing "auses of mortality among Fili$ino females. )oiter is $revalent among females.

T(e Ol,e" Pe"son

42

!O!<,A/ION A)IN) is a emo"rati" $henomenon in i"ate by a stea y in"rease in the number an $ro$ortion of the el erly an a "orres$on ing e"line in the $ro$ortion of younger age grou$s. ,ea ing "auses of mortality are nonB"ommuni"able or egenerative iseaseD  %iseases of the heart  %iseases of the vas"ular system  Can"er ,ea ing "auses of morbi ity are infe"tious in natureD  Influen2a  !neumonia  /uber"ulosis Other $roblems of the el erlyD  In"ontinen"e  Arthritis  Osteo$orosis  %iffi"ulty of "hewing  %iffi"ulty of wal3ing  Hearing im$airment  9isual im$airment ii. Control of nonB"ommuni"able iseases 1. Integrate B"ommunityBbase nonB"ommuni"able isease $revention $rogram 2. !rograms for the $revention of other non "ommuni"able iseases A. National !revention of #lin ness #. *ental Health an *ental %isor ers C. 0enal %isease "ontrol $rogram %. CommunityB base rehabilitation $rogram Cont"ol of Co%%&n#*able D#seases 1. National /# !rogramB %ire"tly Observe /reatment5 shortB"ourse >N/!B%O/S? /uber"ulosis B is highly infe"tious an "hroni" isease "ause by /uber"le ba"illi. It is "onsi ere as the worl Gs ea liest isease an remains a maCor $ubli" health $roblem in the !hili$$ines. It is $rimarily a res$iratory isease but "an also affe"t other organs of the bo y an is "ommon among malnourishe in ivi uals living in a "row e area. It often o""urs in "hil ren of un er evelo$e an evelo$ing "ountries in the form of $rimary "om$le: es$e"ially after a bout of a ebilitating "hil hoo iseases su"h as measles. In the !hili$$ines5 /# ran3s si:th in the lea ing "ause of morbi ity >2662? an mortality >2662?. *o e of transmission is through airborne an ro$let through "oughing5 singing or snee2ing. !reventive *easuresD  !rom$t iagnosis an treatment of infe"tious "ases  #C) va""ination of newborn5 infants an gra es"hool entrants
47

 ' u"ate the $ubli" in mo e of s$rea an metho s of "ontrol an the im$ortan"e of early iagnosis  Im$rove so"ial "on ition whi"h in"rease the ris3 of be"oming infe"te su"h as over"row ing  *a3e available me i"al 5 laboratory an Tray fa"ilities for e:amination $atients5 "onta"ts an sus$e"ts5 an fa"lities for early treatment of "ases an $ersons at high ris3 of infe"tion an be s for those nee ing hos$itali2ation. 2. National ,e$rosy Control !rogram ,e$rosy B an an"ient isease an is the lea ing "ause of $ermanent $hysi"al isability among the "ommuni"able iseases. It is a "hroni" mil "ommuni"able isease that mainly affe"ts the s3in5 the $eri$heral nerve5 the eyes an mu"osa of the u$$er res$iratory tra"t. Infe"tious agent is my"oba"terium le$rae. *o e of transmission is airborne an $rolong s3inBtoBs3in "onta"t to an untreate le$rosy $atient. 7. S"histosomiasis Control !rogram S"histosomiasis has been one of the im$ortant tro$i"al iseases in our "ountry. It is "ause by a bloo flu3e. S"histosoma +a$oni"um that is transmitte by a tiny snail On"omalenia Eua rasi. It mostly affe"ts farmers in the rural areas. 4. Filariasis Control !rogram Filariasis B affli"ts Fili$inos living in the en emi" areas. &. *alaria Control !rogram *alaria "ontinues to be a maCor health $roblem in the "ountry having an annual $araiste in"i en"e of &.1@1666 $o$. In 14445 it was aime that there be a 26Q re u"tion in morbi ity annually. /he nature of *alaria as a $ubli" health $roblem re8uires sustaine ans systemati" efforts towar two maCor strategies5 namely $revention of transmission through ve"tor "ontrol an the ete"tion an early treatment of "ases to re u"e morbi ity an $revent mortality. (. 0abies Control !rogram 0abies@Hy ro$hobia is an a"ute viral en"e$halomyelitis "ause by the rabies virus BBB rhab ovirus of the genus lysavirus. It is fatal on"e signs an sym$toms a$$ear. *o e of transmission is through a bite of a rabie animal. -. %engue Control !rogram %engue is an a"ute febrile isease "ause by infe"tion with one of the seroty$es of engue virus whi"h is transmitte by mos8uito genus ae es. It refers to a benign form of isease with systemi" system5 fever5 an often5 rash asso"iate with $ain behin the eyes5 the Coints an bones. %engue Hemorrhagi" Fever is a severe5 sometimes5 fatal manifestations of engue virus infe"tion "hara"teri2e by a blee ing iathesis an hy$ovolemi" sho"3. 1. Se:uallyBtransmitte infe"tions an AI%S Control !rogram S/%s are ran3e as the 2n most im$ortant isease worl wi e5 for whi"h intervention is $ossible among women age between 1& an 44 years of age. iii. 'nvironmental health 'nvironmental sanitation is still a health $roblem in the "ountry. %iarrheal
44

iseases ran3e se"on in the lea ing "auses of morbi ity among the general $o$ulation. Other sanitationBrelate iseases are tuber"ulosis5 intestinal $arasitism5 s"histosomiasis5 malaria5infe"tious he$atitis5 filariasis an engue hemorrhagi" fever whi"h are "ontrolle an @or era i"ate by health $rograms with environmental sanitation "om$onents but still affli"ting a great number of the $o$ulation. 1. ;ater su$$ly sanitation A$$rove /y$e of ;ater Su$$ly Fa"ilitiesD  ,'9', I B !oint Sour"e  ,'9', II B Communal fau"et system  ,'9', III B ;ater wor3 system or in ivi ual house "onne"tion 2. !ro$er e:"reta is$osal A$$rove /y$es of /oilet Fa"ilitiesD  ,'9', I  ,'9', II  ,'9', III 7. Soli waste management 4. 9e"tor "ontrol &. Foo sanitation /he ra$i "hange in the eating habits of the Fili$inos in fastfoo establishments $arti"ularly those in the urban "enters in"reases the ris3 of the segment of $o$ulation to foo Bborne infe"tion ue to unsanitary han ling of $re$aration of foo . (. Air $ollution -. !ro$er housing S+e*#al#7e, F#el,s of Co%%&n#t' Healt( N&"s#ng i. S"hool Health Nursing K the a$$li"ation of nursing theories an $rin"i$les in the "are of the s"hool $o$ulation ii. O""u$ational Health Nursing K the a$$li"ation of nursing $rin"i$les an $ro"e ures in "onserving the health of wor3ers in all o""u$ations iii. Community *ental Health Nursing B a uni8ue $ro"ess whi"h in"lu es an integration of "on"e$ts from nursing5 mental health5 so"ial $sy"hology5 $sy"hology5 "ommunity networ3s5 an the basi" s"ien"es E!al&at#ng Co%%&n#t' Healt( N&"s#ng Se"!#*es Def#n#t#on of E!al&at#on 'valuation is the assessment of whether or not the $lanne $roCe"t a"tually wor3s in the fiel . 0evise $lans as ne"essary a$$raisal of effe"tiveness of Nursing intervention. i. /y$es of evaluationD 8uantitative5 8ualitative
4&

ii. As$e"ts of evaluationD stru"tural5 $ro"ess5 an out"ome S/0<C/<0A, ','*'N/S O Stru"ture "an be e:amine from the stan $oint of the whole "ommunity in whi"h "lient@ family lives an $ubli" health agen"y from whi"h they re"eives nursing "are assistan"e. !0OC'SS ','*'N/S O !ro"ess "an be e:amine by fo"using on the a"tions an e"isions of the "ommunity health nurse in $rovi ing "are O</CO*' ','*'N/S Hout"omeM K refers to the result of "are $rovi e an "lient@ families serve 5 "hanges in 3nowle ge5 s3ills an attitu e an satisfa"tion of those serve 5 in"lu ing members of the health team. iii. *etho s an tools of evaluation iv. 'valuation in i"ators A. Euality Assuran"eD Sentrong Sigla *ovement Re*o",#ng an, Re+o"t#ng

Fa%#l' Healt( Se"!#*e Info"%at#on S'ste% ObCe"tivesD B /o $rovi e summary of ata an health servi"es5 elivery an sele"te $rogram a""om$lishe in i"ators of the barangay5 muni"i$ality@"ity5 istri"t5 $rovin"ial5 regional an national level B /o $rovi e ata whi"h when "ombine with ata from other sour"es5 "an be use for $rogram monitoring an evaluation $ur$oses B /o $rovi e a stan ar i2e fa"ility level atabase whi"h "an be assesse for a more in e$th stu ies. B /o ensure that the ata re$orte to the FHSIS are useful an a""urate an are Family isseminate in /reatment timely an easy to use fashion. 0e"or s B /o minimi2e the re"or ing an re$orting bur en at the servi"e elivery level in or er to allow more time for $atient "are an $romotive a"tivities. /arget@ Client /ally@ 0e$orting Out$ut A Co%+onents of FSHIS ,ists Form /ables i. Family /reatment 0e"or B /he fun amental buil ing blo"3 or foun ation of the fiel health servi"e information Fa"ility base *eans of /ransmitting %ata %ata Out"ome

4(

system. /his is the o"ument5 form or $ie"es of $a$er u$on whi"h re"or e the $resenting sym$toms or "om$laints of the $atient on "onsultation an the iagnosis >if available5 treatment an the ate of treatment is re"or e ? /his re"or must be maintaine as $art of the system of re"or s of ea"h #HS@#HC@0H<@*HC5 or hos$ital out$atient by fa"ility on all $atients seen. B /he treatment re"or an its system of filing may vary from $rogram to $rogram an $la"e to $la"e. R; Re*o", Date Na%e Age.B#"t(,a' A,,"ess Co%+la#nts D#agnos#s 2#f a!a#lable3. T"eat%ent

ii. /arget Client ,ist B "onstitute the 2n buil ing blo"3 of the FSHIS an are inten e to serve four $ur$osesD 1. /o $lan an "arry out $atient "are an servi"e elivery. /o etermine the master list. 2. /o fa"ilitate the monitoring an su$ervision of servi"es. 7. /o re$ort servi"es elivere . 4. /o $rovi e a "lini"Blevel ata base whi"h "an be a""esse for further stu ies.

### Re+o"t#ng Fo"%s FSHIS re$orts "onstitute the only me"hanism through whi"h transmitte from one fa"ility to another in the revise FSHIS.

ata are routinely

#! O&t+&t "e+o"ts Out$ut re$orts or tables will be $ro u"e at the !HO ?alternate ata $ro"essing site in the $rovin"e? from the ata re$orte in FHSIS re$orting forms. /He obCe"tives in esigning the out$ut formats is to ma3e the re$orts useful for monitoring@ management $ur$oses of ea"h level of %OH management. /he use of the system re"or s an re$orts is relatively sim$le. All information relate to the "lient@ $atient history5 "om$laints5 iagnosis5 servi"e an @or treatment is "ontaine in 7 o"uments or re"or s. >1? the in ivi ual treatment re"or 5 >2? target "lient list >/C,? for the several $ubli" health $rograms an >7? the tally sheet or re$ort forms whi"h have a ual $ur$ose that is to tally events as they o""ur an the $ur$ose of re$orting $erio i"ally to higher levels.

4-

A!!'N%IC'S
41

B#bl#og"a+('  CHN5 the #asi"s of !ra"ti"eD Salva"ion ). #ailonB0eyes5 "o$yright 266(  Community Health Nursing Servi"es in the %OH 4th e ition by +ean !. 0eyala et.5 al. "o$yright 2666  Com$rehensive Communi"able Nursing Han boo3 by Aaron HCyM /ues"a <ntalan5 0N.5 &th e ition Co$yright 266&  Con"e$ts an gui elines in CO!A0 >C%:5 CO!A05 an Com %evIt? by Aaron HCyM /ues"a <ntalan5 0NA revise e ition5 "o$yright 266 CO!A0 for Community Health %evelo$ment5 1st e ition by Sr. Carmen '. +imene2  Han boo3 of Common Communi"able an Infe"tious %iseases by %ionisia *on eCar Navales 0N5 *A' 5 266( e ition  Nursing !ra"ti"e in the "ommunity5 4th e ition by Ara"eli S. *aglaya et.5 al. Co$yright 2664  !ubli" Health Nursing in the !hili$$ines by %OH5 "o$yright 26644

           

Health"are $ra"ti"e in the Community by 'rlin a Castro !alaganas5 0N5 !h%. www."an"er.orgA www. oh.gov.$hA www.aaron"yuntalan."om htt$D@@www.infobarrel."om@/heW#asi"W<nitWofWOurWSo"ietyWBWFamily htt$D@@nurseslabs."om@"ommunityBhealthBnursingB$rin"i$les@ htt$D@@www."hn"."a@nursingBstan ar sBofB$ra"ti"e."fm htt$D@@www.health.8l .gov.au@townsville@Community@i$ha"W"hnW"om$Ws3ls.$ f htt$D@@"urrentnursing."om@nursingWtheory@theoriesW"ommunityWhealthWnursing.html htt$D@@Cournals.lww."om@na8Cournal@Abstra"t@2664@16666@CaringWforWtheWCommunity.&.as$ : htt$D@@www.s"rib ."om@ o"@74114474@CommunityBHealthBNursingB!ro"ess htt$D@@www.sli eworl .org@sli eshow.as$:@CommunityBHealthBNursingB!ro"essB$$tB 214(461 htt$D@@www.euro.who.int@WW ata@assets@$ fWfile@6611@162244@'-7444.$ f htt$D@@www."hausa.org@AssessingWan WA ressingWCommunityWHealthWNee s.as$:

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