CHN
Content
HISTORY OF CHN DateEvent 1901 - Act # 157 ( Board of Health of the Philippines) ; Act # 309 ( ProvincialandMunicipal Boards of Health)were created. 1905 - Boardof Health was abolished; functions were transferred to theBureau of Health. 1912 – Act # 2156or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male nurses performs the functions of doctors 1919 – Act # 2808 (Nurses Law was created) - Carmen del Rosario , 1 Fil. Nurse supervisor under Bureau of Health Oct. 22, 1922 – Filipino Nurses Organization Philiine Nurses’ Or anization was 1923 – Zamboanga General Hospital School of Nursing & Baguio General Hospital were established; other government schools of nursing were organized several years after. •1928- 1 Nursing convention was held •1940 – Manila Health Department was created. •1941 – Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistant chief nurse) Dec. 8, 1941 – Victims of World War II were treated by the nurses of Manila. •July 1942 – Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses in Bilibid Prison as prisoners of war by the Japanese. •Feb. 1946 – Number of nurses decreased from 556 – 308. •1948 – First training center of the Bureau of Health was organized by the Pasay City Health Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training
staff. 1950 – Rural Health Demonstration and Training Center was created. •1953 – The first 81 rural health units were organized. •1957 – RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit causing an increase inthe demand for the community health personnel. •1958-1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 – Annie Sand organized the National League of Nurses of DOH. •1967 – Zenaida Nisce became the nursing program supervisor and consultant on the six specialdiseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness). •1975 – Scope of responsibility of nurses and midwives became wider due to restructuringof the health care delivery system. •1976-1986 – The need for Rural Health Practice Program was implemented. •1990- 1992- Local Government Code of 1991(RA 7160) 1993-1998 – Office of Nursing did not materialize in spite of persistent recommendation of the officers, board members, and advisers of the National League of Nurses Inc. •Jan. 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of PublicHealth Services through Department Order # 29. •May 24, 1999 – EO # 102, which redirects the functions and operations of DOH, was signed by former President Joseph Estrada LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING R.A. 7160 -or the Local Government Code. This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.The Code aims to transform
local government units into self-reliant communities and active partners in the attainment of national goals thru’ a more responsive and accountable local government structure instituted thru’ a system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their ownhealth facilities Composition of LHB Provincial Level 1.Governor- chair 2. Provincial Health Officer – vice chair 3. Chair , Committee on Health of Sangguniang Panlalawigan 4. DOH rep. 5. NGO rep. Composition of LHB City and Municipal Level 2.Mayor – chair 2. MHO – vice chair 3. Chair, Committee on Health of Sangguniang Bayan 4. DOH rep 5. NGO rep EFFECTIVE LHS DEPENDS ON: 1. the LGU’s financial capability 2. a dynamic and responsive political leadership 3. community empowerment R.A. 2382 – Philippine Medical Act. This act defines the practice of medicine in the country. R.A. 1082 – Rural Health Act. It created the 1 81 Rural Health Units. -amended by RA 1891 ; more physicians,
dentists, nurses, midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people ,hence help decrease thehigh incidence of preventable diseases R.A. 6425 – Dangerous Drugs Act. It stipulatesthat the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law. R.A. 9165 – the new Dangerous Drug Act of 2002 P.D. No. 651 – requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery. P.D. No. 996 – requires the compulsory immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases. P.D. No. 825 – provides penalty for improper disposal of garbage. R.A. 8749 – Clean Air Act of 2000 P.D. No. 856 – Code on Sanitation. It provides for the control of all factors in man’s environment that affect health including the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution. R.A. 6758 – standardizes the salary of government employees including the nursing personnel. R.A. 6675 – Generics Act of 1988 which promotes, requires and ensures the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by their generic name. R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. It is the policy of the state to promote high standards of ethics in public office. Public officials and employees shall at all
times be accountable to the people and shall discharges their duties with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives uphold public interest over personal interest R.A. 7305 – Magna Carta for Public Health Workers. This act aims: to promote and improve the social and economic well-being of health workers, their living and working conditions and terms of employment; to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and to encourage those with proper qualifications and excellent abilities to join and remain in government service. R.A. 8423 – created the Philippine Institute of Traditional and Alternative HealthCare P.D. No. 965 – requires applicants for marriage license to receive instructions onfamily planning and responsible parenthood. P.D. NO. 79 – defines , objectives, duties and functions of POPCOM RA 4073 – advocates home treatment for leprosy •Letter of Instruction No. 949 – legal basis of PHC dated OCT. 19, 1979 –- promotes development of health programs on the community level RA 3573 – requires reporting of all cases of communicable diseases and administration of prophylaxis •Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease R.A. 7875 – National Health Insurance Act R.A. 7432 – Senior Citizens Act R. A. 7719 -National Blood Services Act R.A. 8172 – Salt Iodization Act ( ASIN LAW) R.A.7277- Magna Carta for PWD’s,
provides their rehabilitation, selfdevelopment and self-reliance and integration into the mainstream of society A. O. No.2005-0014- National Policies on Infant and Young Child Feeding: 1.All newborns be breastfeed within 1 hr after birth 2. Infantsbe exclusively breastfeed for 6 mos. 3. Infants be given timely, adequate and safe complementary foods 4. Breastfeeding be continued up to 2 years and beyond EO 51- Phil. Code of Marketing of Breastmilk Substitutes •R.A.-7600 – Rooming In and Breastfeeding Act of1992 •R.A. 8976-Food Fortification Law •R.A. 8980- prolmulgates a comprehensive policy and a national system for ECCD A..O.No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunization for Infants •R.A.7846- mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old •R.A. 2029-madates Liver Cancer and Hepatitis B Awareness Month Act ( February) A.O. No. 2006-0012- specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and for other purposes Public Health •-” science and art of preventing diasease, prolonging life, promoting health and efficiency thru’ organizedcommunity effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing servicesfor the early diagnosis and preventive treatment of diseases and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing
these benefits as to enable every citizen to realize his birthright off birth and longevity” ( DR. C.E. Winslow) Community Health Nursing •- special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability ( WHO Expert Committee of Nursing ) CHN •- a learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care ( Jacobson ) •- a service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promtion of health, preventionof illness, care of the sick at home and rehabilitation(DR. Ruth B. Freeman) Concepts •The primary focus of community health nursing is health promotion. •Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. •Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is used. •Nursing process in community health nursing changes based on the needs of the community Goal •To elevate the level health of the multitude. •Worth and dignity of man. 1.The need of the community is the basis of community health nursing. 2.The community health nurse must understand fully the objectives and policies of the agency she represents 3. The family is the unit of service. 4. CHN must be available to all regardless of race,creed and socioeconomic status 5. The CHN works as a member of the health
team 6. There must be provision for periodic evaluation of community health nursing services 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN makes use of available 9. The CHN taps the already existing active organized groups in the community 10. There must be provision for educative supervision in community health nursing 11. There should be accuraterecording and reporting in community health nursing 12. Health teaching is the primary responsibility of the community health nurse Standards in CHN I. Theory Applies theoretical concepts as basis for decisions in practice II. Data Collection Gathers comprehensive , accurate data Systematically Standards III. Diagnosis Analyzes collected data to determine the needs/ health problems of IFC IV. Planning At each level of prevention, develops plans that specify nursing actions unique to needs of clients V. Intervention Guided by the plan, intervenes to promote,maintain or restore health, prevent illnessand institute rehabilitation VI. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan VII. Quality Assurance and Professional Development Participates in peerreview and other means of evaluation to assure quality of nursing practice Assumes professional development Contributes to development of others
VIII. Interdisciplinary Collaboration Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health I. Research Indulges in research to contribute to theory and practice incommunity health nursing LEVELS OF CARE/ PREVENTION
•1. Teaching and Training Hospitals •2. City Health Services •3. Emergency and District Hospitals •4. Private Practitioners •5. Heart Institutes •6. Puericulture Centers •7. RHU THE DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor NATIONAL OBJECTIVES 1.Improve the general health status of the population (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years). 2.Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity. 3.Eliminate the ff. diseases as public health problems: •Schistosomiasis •Malaria •Filariasis •Leprosy •Rabies •Measles
•1. PRIMARY
•2. SECONDARY
•3. TERTIARY Types of Clientele •1. INDIVIDUALS •2. FAMILIES •3. COMMUNITIES •4. POPULATION GROUPS - Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) e.g. children . elderly,women, workers etc. Phil.Health Care Delivery System
•1.PRIMARY LEVEL FACILITIES
•2. SECONDARYLEVEL FACILITIES
•3. TERTIARY LEVEL FACILITIES Classify as to what level the ff. belong
•Tetanus •Diphtheria & Pertussis •Vitamin A Deficiency & Iodine Deficiency Disorder 4. Eradicate Poliomyelitis 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life & prevent violent & risk-taking behaviors. 6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health, women’s health, health of older persons, health of indigenous people, health of migrant workers and health of different disabled persons and of the rural & urban poor. 7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes, schools, workplaces, establishments and communities towns and cities. Basic Principles to Achieve Improvement in Health 1.Universal access to basic health services must be ensured. 2.The health and nutrition of vulnerable groups must be prioritized. 3.The epidemiological shift from infection to degenerative diseases must be managed. 4.The performance of the health sector must be enhanced Primary Strategies to Achieve Goals 1.Increasing investment for Primary Health Care. 2.Development of national standards and objectives for health. 3.Assurance ofhealth care. 4.Support to the local system development. 5.Support for frontline health workers FAMILY HEALTH NURSING
•- that level ofCHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care Family Case Load •- the no. and kind of families a nurse handles at any given time •- variable for cases are added or dropped based on the need for nursing care and supervision
Family Case Load •- the no. and kind of families a nurse handles at any given time •- variable for cases are added or dropped based on the need for nursing care and supervision Types of Families •1. Nuclear •2. Extended •3. Three generational •4. Dyad •5. Single- Parent •6. Step- Parent •7. Blended or reconstituted 8. Single adult living alone •9. Cohabiting/ Living –in •10. No- kin •11. Compound •12. Gay •14. Commune HEALTH TASKS OF THE FAMILY( Freeman, 1981) •1. recognizing interruptions of health or development •2. seeking health care •3. managing health and non-health crises •4. providing nursing care to the sick, disabled and dependent member of the family •5. maintaining a home environment conducive to good health and personal development •6. maintaining a reciprocal relationship with the
community and health institutions Family Nursing Problem •Arises when the family cannot effectively perform its health tasks Nurse’s Roles in Family Health Nursing •1. HEALTH MONITOR •2. PROVIDER OF CARE TO A SICK FAMILY MEMBER •3. COORDINATOR OF FAMILY SERVICES •4. FACILITATOR •5. TEACHER •6. COUNSELOR INITIAL DATA BASE FOR FAMILY NURSING PRACTICE •Family structure, Characteristics, and Dynamics 2.Members of the household and relationship to the head of the family 3.Demographic data – age, sex, civil status, position in the family 4.Place of residence of each member – whether living with the family or elsewhere Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended 2.Dominant family members in terms ofdecisionmaking, especially in mattersof health care 3.General family relationship/dynamics – presence of any readily observable conflict between members; characteristics communication patterns among members Socio-economic and Cultural Characteristics 2.Income and Expenses –Occupation, place of work and income of each working members –Adequacy to meet basic necessities –Who makes decisions about money and how it is spent 3.Educational attainment of each other 4.Ethnic background and religious affiliation 1.Significant Others – role(s) they play in family’s life 2.Relationship of the family to larger community – Nature and extent of participation of
the family in community activities •Home and Environment 2. Housing –Adequacy of living peace –Sleeping arrangement –Presence of breeding or resting sites of vectors of diseases –Presence of accidents hazards –Food storage and cooking facilities –Water supply – source, ownership, portability –Toilet facility – type, ownership, sanitary condition –Drainage system – type, sanitary condition
1.Kind of neighborhood, e.g. congested, slum, etc. 2.Social and health facilities available 3.Communication and transportation facilities available •Health Status of each Family Member 2.Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness 3. Nutritional assessment –Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio –Dietary history specifying quality and quantity of food/nutrient intake per day –Eating/ feeding habits/ practices Developmental assessments of infants, toddlers, and preschoolers – e.g., Metro Manila 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse 5. Physical assessment indicating presence of illness state/s 6. Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. 3.Immunization status of family members 4.Healthy lifestyle practices. Specify. 5. Adequacy of: –rest and sleep –exercise –use of protective measures- e.g. adequate footwear in parasite-infested areas; –relaxation and other stress management activities 6.Useof promotive-preventive health services A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST-LEVEL ASSESSMENT Presence of Wellness Condition – stated as Potential or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance. Second Level Assessment • Focus on determining family’s capacity to perform the
health tasks • Statements on family health nursing problem: c.Inability to recognize the presence of the condition or problem d.Inability to make decisions with respect to taking appropriate health action e.Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family f.Inability to provide a home environment conducive to health maintenance or personal development g.Failure to utilize community resourcesfor health care Scale for Ranking Health Conditions and Problems according to priorities •Criteria: b.Nature of the condition or problem presented ( wellness state, health deficit,health threat, forseeable crisis) b. Modifiability of the condition or problem ( easily, partially, not modifiable) c. Preventive Potential (high, moderate , low) d. Salience ( needs immediate attention, not immediate, not perceived as a problem COMMUNITY HEALTH CARE PROCESS •Assessment Purpose : To identify the health needs of the people •Planning of nursing actions Purpose :To act on the determined needs of the community people •Implementation Purpose : To achieve the optimum level of health of the community people •Evaluation Purpose : To determine the effectiveness of health care programs
EDUCATION NURSING PROCEDURES •CLINIC VISIT - process of checking the client’s health condition in a medical clinic •HOME VISIT - a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency •BAG TECHNIQUE -a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort THERMOMETER TECHNIQUE -to assess the client’s health condition through body temperature reading •NURSING CARE IN THE HOME - giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity •ISOLATION TECHNIQUE IN THE HOME -done by : 1.separating the articles used by a client with communicable disease to prevent the spread of infection: 2. frequent washing and airing of beddings and other articles and disinfections of room 3. wearing a protective gown , to be used only within the room of the sick member 4. discarding properly all nasal and throat discharges of any member sick with communicable disease 5. burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering •INTRAVENOUS THERAPY -insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription - can be done only by nurses accredited by ANSAP PRINCIPLES OF HEALTH •It considers the health status of the people, which is determined by the economic and social conscience of the country. •It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly for the improvement of health conditions of the family, community, and nation. •It involves motivation, experience, and change in conduct and thinking, while stimulating active interest. It develops and provides experience for change in people’s attitudes, customs, and habits in relation to health and everyday living. •It should be recognized as the basic function of all health workers. •It takes place in the home, in the school, and in the community. •It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families, groups, and the community. It meets the needs, interests, and problems of the people affected. •It finds means and ways of carrying out plans by encouraging individual and community participation. •It is a slow, continuous process that involves constant changes and revisions until objectives are achieved. •Makes use of supplementaryaids and devices to help withthe verbal instructions. •It utilizes community resources by careful evaluation of the different
services and resources found in the community. •It is a creative process requiring methods and techniques with various characteristics, not following a rigid and flexible pattern. •It aims to help people make use of their own efforts and education to improve their conditions of living, •It makes careful evaluation of the planning, organization, and implementation of all health education programs and activities. THE COMMUNITY HEALTH NURSE •Qualifications 1.Bachelor of Science in Nursing 2.Registered Nurse of the Philippines •Planner/Programmer 2.Identifies needs, priorities, and problems of individuals, families, and communities 3.Formulates municipal health plan in the absence of a medical doctor 4.Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 5.Provides technical assistance to rural health midwives in health matters •Provider of Nursing Care 2.Provides direct nursing care to sick ordisabled in the home, clinic, school, orworkplace 3.Develops the family’s capability to take care of the sick, disabled, or dependent member •Manager/Supervisor 2.Formulates individual, family, group, and community-centered plan 3.Interprets and implements programs, policies, memoranda, and circulars 4.Organizes work force, resources, equipments, and supplies at local level 5.Provides technical and administrative
support to Rural Health Midwives (RHM) 6.Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments •Community Organizer 2. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 3. Initiates and participates in community development activities •Coordinator of Services 2. Coordinates with individuals, families, and groups for health related services provided by various members of the health team 3. Coordinates nursing program with other health programs like environmental sanitation, health education, dental health •Trainer/Health Educator 2.Identifies and interprets training needsof the RHMs, Barangay Health Workers(BHW), and hilots 3.Conducts training for RHMs and hilots on promotion and disease prevention 4.Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and healthrelated services 5.Initiates the use of tri-media (radio/TV,cinema plugs, and print ads) for healtheducation purposes 6.Conducts pre-marital counseling •Health Monitor 2.Detects deviation from health of individuals, families, groups, and communities through contacts/visits with them •Role Model 2.Provides good example of healthful living to the members of the community
•Change Agent 2.Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health
staff. 1950 – Rural Health Demonstration and Training Center was created. •1953 – The first 81 rural health units were organized. •1957 – RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit causing an increase inthe demand for the community health personnel. •1958-1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 – Annie Sand organized the National League of Nurses of DOH. •1967 – Zenaida Nisce became the nursing program supervisor and consultant on the six specialdiseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness). •1975 – Scope of responsibility of nurses and midwives became wider due to restructuringof the health care delivery system. •1976-1986 – The need for Rural Health Practice Program was implemented. •1990- 1992- Local Government Code of 1991(RA 7160) 1993-1998 – Office of Nursing did not materialize in spite of persistent recommendation of the officers, board members, and advisers of the National League of Nurses Inc. •Jan. 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of PublicHealth Services through Department Order # 29. •May 24, 1999 – EO # 102, which redirects the functions and operations of DOH, was signed by former President Joseph Estrada LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING R.A. 7160 -or the Local Government Code. This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.The Code aims to transform
local government units into self-reliant communities and active partners in the attainment of national goals thru’ a more responsive and accountable local government structure instituted thru’ a system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their ownhealth facilities Composition of LHB Provincial Level 1.Governor- chair 2. Provincial Health Officer – vice chair 3. Chair , Committee on Health of Sangguniang Panlalawigan 4. DOH rep. 5. NGO rep. Composition of LHB City and Municipal Level 2.Mayor – chair 2. MHO – vice chair 3. Chair, Committee on Health of Sangguniang Bayan 4. DOH rep 5. NGO rep EFFECTIVE LHS DEPENDS ON: 1. the LGU’s financial capability 2. a dynamic and responsive political leadership 3. community empowerment R.A. 2382 – Philippine Medical Act. This act defines the practice of medicine in the country. R.A. 1082 – Rural Health Act. It created the 1 81 Rural Health Units. -amended by RA 1891 ; more physicians,
dentists, nurses, midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people ,hence help decrease thehigh incidence of preventable diseases R.A. 6425 – Dangerous Drugs Act. It stipulatesthat the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law. R.A. 9165 – the new Dangerous Drug Act of 2002 P.D. No. 651 – requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery. P.D. No. 996 – requires the compulsory immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases. P.D. No. 825 – provides penalty for improper disposal of garbage. R.A. 8749 – Clean Air Act of 2000 P.D. No. 856 – Code on Sanitation. It provides for the control of all factors in man’s environment that affect health including the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution. R.A. 6758 – standardizes the salary of government employees including the nursing personnel. R.A. 6675 – Generics Act of 1988 which promotes, requires and ensures the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by their generic name. R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. It is the policy of the state to promote high standards of ethics in public office. Public officials and employees shall at all
times be accountable to the people and shall discharges their duties with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives uphold public interest over personal interest R.A. 7305 – Magna Carta for Public Health Workers. This act aims: to promote and improve the social and economic well-being of health workers, their living and working conditions and terms of employment; to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and to encourage those with proper qualifications and excellent abilities to join and remain in government service. R.A. 8423 – created the Philippine Institute of Traditional and Alternative HealthCare P.D. No. 965 – requires applicants for marriage license to receive instructions onfamily planning and responsible parenthood. P.D. NO. 79 – defines , objectives, duties and functions of POPCOM RA 4073 – advocates home treatment for leprosy •Letter of Instruction No. 949 – legal basis of PHC dated OCT. 19, 1979 –- promotes development of health programs on the community level RA 3573 – requires reporting of all cases of communicable diseases and administration of prophylaxis •Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease R.A. 7875 – National Health Insurance Act R.A. 7432 – Senior Citizens Act R. A. 7719 -National Blood Services Act R.A. 8172 – Salt Iodization Act ( ASIN LAW) R.A.7277- Magna Carta for PWD’s,
provides their rehabilitation, selfdevelopment and self-reliance and integration into the mainstream of society A. O. No.2005-0014- National Policies on Infant and Young Child Feeding: 1.All newborns be breastfeed within 1 hr after birth 2. Infantsbe exclusively breastfeed for 6 mos. 3. Infants be given timely, adequate and safe complementary foods 4. Breastfeeding be continued up to 2 years and beyond EO 51- Phil. Code of Marketing of Breastmilk Substitutes •R.A.-7600 – Rooming In and Breastfeeding Act of1992 •R.A. 8976-Food Fortification Law •R.A. 8980- prolmulgates a comprehensive policy and a national system for ECCD A..O.No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunization for Infants •R.A.7846- mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old •R.A. 2029-madates Liver Cancer and Hepatitis B Awareness Month Act ( February) A.O. No. 2006-0012- specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and for other purposes Public Health •-” science and art of preventing diasease, prolonging life, promoting health and efficiency thru’ organizedcommunity effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing servicesfor the early diagnosis and preventive treatment of diseases and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing
these benefits as to enable every citizen to realize his birthright off birth and longevity” ( DR. C.E. Winslow) Community Health Nursing •- special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability ( WHO Expert Committee of Nursing ) CHN •- a learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care ( Jacobson ) •- a service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promtion of health, preventionof illness, care of the sick at home and rehabilitation(DR. Ruth B. Freeman) Concepts •The primary focus of community health nursing is health promotion. •Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. •Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is used. •Nursing process in community health nursing changes based on the needs of the community Goal •To elevate the level health of the multitude. •Worth and dignity of man. 1.The need of the community is the basis of community health nursing. 2.The community health nurse must understand fully the objectives and policies of the agency she represents 3. The family is the unit of service. 4. CHN must be available to all regardless of race,creed and socioeconomic status 5. The CHN works as a member of the health
team 6. There must be provision for periodic evaluation of community health nursing services 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN makes use of available 9. The CHN taps the already existing active organized groups in the community 10. There must be provision for educative supervision in community health nursing 11. There should be accuraterecording and reporting in community health nursing 12. Health teaching is the primary responsibility of the community health nurse Standards in CHN I. Theory Applies theoretical concepts as basis for decisions in practice II. Data Collection Gathers comprehensive , accurate data Systematically Standards III. Diagnosis Analyzes collected data to determine the needs/ health problems of IFC IV. Planning At each level of prevention, develops plans that specify nursing actions unique to needs of clients V. Intervention Guided by the plan, intervenes to promote,maintain or restore health, prevent illnessand institute rehabilitation VI. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan VII. Quality Assurance and Professional Development Participates in peerreview and other means of evaluation to assure quality of nursing practice Assumes professional development Contributes to development of others
VIII. Interdisciplinary Collaboration Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health I. Research Indulges in research to contribute to theory and practice incommunity health nursing LEVELS OF CARE/ PREVENTION
•1. Teaching and Training Hospitals •2. City Health Services •3. Emergency and District Hospitals •4. Private Practitioners •5. Heart Institutes •6. Puericulture Centers •7. RHU THE DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor NATIONAL OBJECTIVES 1.Improve the general health status of the population (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years). 2.Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity. 3.Eliminate the ff. diseases as public health problems: •Schistosomiasis •Malaria •Filariasis •Leprosy •Rabies •Measles
•1. PRIMARY
•2. SECONDARY
•3. TERTIARY Types of Clientele •1. INDIVIDUALS •2. FAMILIES •3. COMMUNITIES •4. POPULATION GROUPS - Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) e.g. children . elderly,women, workers etc. Phil.Health Care Delivery System
•1.PRIMARY LEVEL FACILITIES
•2. SECONDARYLEVEL FACILITIES
•3. TERTIARY LEVEL FACILITIES Classify as to what level the ff. belong
•Tetanus •Diphtheria & Pertussis •Vitamin A Deficiency & Iodine Deficiency Disorder 4. Eradicate Poliomyelitis 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life & prevent violent & risk-taking behaviors. 6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health, women’s health, health of older persons, health of indigenous people, health of migrant workers and health of different disabled persons and of the rural & urban poor. 7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes, schools, workplaces, establishments and communities towns and cities. Basic Principles to Achieve Improvement in Health 1.Universal access to basic health services must be ensured. 2.The health and nutrition of vulnerable groups must be prioritized. 3.The epidemiological shift from infection to degenerative diseases must be managed. 4.The performance of the health sector must be enhanced Primary Strategies to Achieve Goals 1.Increasing investment for Primary Health Care. 2.Development of national standards and objectives for health. 3.Assurance ofhealth care. 4.Support to the local system development. 5.Support for frontline health workers FAMILY HEALTH NURSING
•- that level ofCHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care Family Case Load •- the no. and kind of families a nurse handles at any given time •- variable for cases are added or dropped based on the need for nursing care and supervision
Family Case Load •- the no. and kind of families a nurse handles at any given time •- variable for cases are added or dropped based on the need for nursing care and supervision Types of Families •1. Nuclear •2. Extended •3. Three generational •4. Dyad •5. Single- Parent •6. Step- Parent •7. Blended or reconstituted 8. Single adult living alone •9. Cohabiting/ Living –in •10. No- kin •11. Compound •12. Gay •14. Commune HEALTH TASKS OF THE FAMILY( Freeman, 1981) •1. recognizing interruptions of health or development •2. seeking health care •3. managing health and non-health crises •4. providing nursing care to the sick, disabled and dependent member of the family •5. maintaining a home environment conducive to good health and personal development •6. maintaining a reciprocal relationship with the
community and health institutions Family Nursing Problem •Arises when the family cannot effectively perform its health tasks Nurse’s Roles in Family Health Nursing •1. HEALTH MONITOR •2. PROVIDER OF CARE TO A SICK FAMILY MEMBER •3. COORDINATOR OF FAMILY SERVICES •4. FACILITATOR •5. TEACHER •6. COUNSELOR INITIAL DATA BASE FOR FAMILY NURSING PRACTICE •Family structure, Characteristics, and Dynamics 2.Members of the household and relationship to the head of the family 3.Demographic data – age, sex, civil status, position in the family 4.Place of residence of each member – whether living with the family or elsewhere Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended 2.Dominant family members in terms ofdecisionmaking, especially in mattersof health care 3.General family relationship/dynamics – presence of any readily observable conflict between members; characteristics communication patterns among members Socio-economic and Cultural Characteristics 2.Income and Expenses –Occupation, place of work and income of each working members –Adequacy to meet basic necessities –Who makes decisions about money and how it is spent 3.Educational attainment of each other 4.Ethnic background and religious affiliation 1.Significant Others – role(s) they play in family’s life 2.Relationship of the family to larger community – Nature and extent of participation of
the family in community activities •Home and Environment 2. Housing –Adequacy of living peace –Sleeping arrangement –Presence of breeding or resting sites of vectors of diseases –Presence of accidents hazards –Food storage and cooking facilities –Water supply – source, ownership, portability –Toilet facility – type, ownership, sanitary condition –Drainage system – type, sanitary condition
1.Kind of neighborhood, e.g. congested, slum, etc. 2.Social and health facilities available 3.Communication and transportation facilities available •Health Status of each Family Member 2.Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness 3. Nutritional assessment –Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio –Dietary history specifying quality and quantity of food/nutrient intake per day –Eating/ feeding habits/ practices Developmental assessments of infants, toddlers, and preschoolers – e.g., Metro Manila 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse 5. Physical assessment indicating presence of illness state/s 6. Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. 3.Immunization status of family members 4.Healthy lifestyle practices. Specify. 5. Adequacy of: –rest and sleep –exercise –use of protective measures- e.g. adequate footwear in parasite-infested areas; –relaxation and other stress management activities 6.Useof promotive-preventive health services A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST-LEVEL ASSESSMENT Presence of Wellness Condition – stated as Potential or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance. Second Level Assessment • Focus on determining family’s capacity to perform the
health tasks • Statements on family health nursing problem: c.Inability to recognize the presence of the condition or problem d.Inability to make decisions with respect to taking appropriate health action e.Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family f.Inability to provide a home environment conducive to health maintenance or personal development g.Failure to utilize community resourcesfor health care Scale for Ranking Health Conditions and Problems according to priorities •Criteria: b.Nature of the condition or problem presented ( wellness state, health deficit,health threat, forseeable crisis) b. Modifiability of the condition or problem ( easily, partially, not modifiable) c. Preventive Potential (high, moderate , low) d. Salience ( needs immediate attention, not immediate, not perceived as a problem COMMUNITY HEALTH CARE PROCESS •Assessment Purpose : To identify the health needs of the people •Planning of nursing actions Purpose :To act on the determined needs of the community people •Implementation Purpose : To achieve the optimum level of health of the community people •Evaluation Purpose : To determine the effectiveness of health care programs
EDUCATION NURSING PROCEDURES •CLINIC VISIT - process of checking the client’s health condition in a medical clinic •HOME VISIT - a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency •BAG TECHNIQUE -a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort THERMOMETER TECHNIQUE -to assess the client’s health condition through body temperature reading •NURSING CARE IN THE HOME - giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity •ISOLATION TECHNIQUE IN THE HOME -done by : 1.separating the articles used by a client with communicable disease to prevent the spread of infection: 2. frequent washing and airing of beddings and other articles and disinfections of room 3. wearing a protective gown , to be used only within the room of the sick member 4. discarding properly all nasal and throat discharges of any member sick with communicable disease 5. burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering •INTRAVENOUS THERAPY -insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription - can be done only by nurses accredited by ANSAP PRINCIPLES OF HEALTH •It considers the health status of the people, which is determined by the economic and social conscience of the country. •It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly for the improvement of health conditions of the family, community, and nation. •It involves motivation, experience, and change in conduct and thinking, while stimulating active interest. It develops and provides experience for change in people’s attitudes, customs, and habits in relation to health and everyday living. •It should be recognized as the basic function of all health workers. •It takes place in the home, in the school, and in the community. •It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families, groups, and the community. It meets the needs, interests, and problems of the people affected. •It finds means and ways of carrying out plans by encouraging individual and community participation. •It is a slow, continuous process that involves constant changes and revisions until objectives are achieved. •Makes use of supplementaryaids and devices to help withthe verbal instructions. •It utilizes community resources by careful evaluation of the different
services and resources found in the community. •It is a creative process requiring methods and techniques with various characteristics, not following a rigid and flexible pattern. •It aims to help people make use of their own efforts and education to improve their conditions of living, •It makes careful evaluation of the planning, organization, and implementation of all health education programs and activities. THE COMMUNITY HEALTH NURSE •Qualifications 1.Bachelor of Science in Nursing 2.Registered Nurse of the Philippines •Planner/Programmer 2.Identifies needs, priorities, and problems of individuals, families, and communities 3.Formulates municipal health plan in the absence of a medical doctor 4.Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 5.Provides technical assistance to rural health midwives in health matters •Provider of Nursing Care 2.Provides direct nursing care to sick ordisabled in the home, clinic, school, orworkplace 3.Develops the family’s capability to take care of the sick, disabled, or dependent member •Manager/Supervisor 2.Formulates individual, family, group, and community-centered plan 3.Interprets and implements programs, policies, memoranda, and circulars 4.Organizes work force, resources, equipments, and supplies at local level 5.Provides technical and administrative
support to Rural Health Midwives (RHM) 6.Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments •Community Organizer 2. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 3. Initiates and participates in community development activities •Coordinator of Services 2. Coordinates with individuals, families, and groups for health related services provided by various members of the health team 3. Coordinates nursing program with other health programs like environmental sanitation, health education, dental health •Trainer/Health Educator 2.Identifies and interprets training needsof the RHMs, Barangay Health Workers(BHW), and hilots 3.Conducts training for RHMs and hilots on promotion and disease prevention 4.Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and healthrelated services 5.Initiates the use of tri-media (radio/TV,cinema plugs, and print ads) for healtheducation purposes 6.Conducts pre-marital counseling •Health Monitor 2.Detects deviation from health of individuals, families, groups, and communities through contacts/visits with them •Role Model 2.Provides good example of healthful living to the members of the community
•Change Agent 2.Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health
