COMMUNITY HEALTH NURSING by the program to the target

clientele
PUBLIC HEALTH NURSE e.g. National TB Program
- uses nursing process 2. Supervisory Function
- adept in documenting and - Supervisors of the midwives and
reporting accomplishments other auxiliary health workers
through records and reports - Formulates supervisory plan and
- technically competent in various conducts supervisory visits to
nursing procedures conducted in implement the plan
settings where she is assigned • Sentrong Sigla Program –
- functions in accordance with the developed a Supervisory
dominant values of public health Package complete with
nurses, within the ethico-legal supervisory checklists for
framework of the nursing various programs and proved
profession, and in accordance to be useful to supervisors
with the needs of the clients and - PHN identifies together with the
available resources for health supervisee the issue or problems
care encountered and addresses
Roles them accordingly
- Health advocate 3. Nurse Care Function
- Program manager - Based on science and art of
- Leader in planning, implementing caring
and evaluating health programs - Caring for individuals, families,
Qualifications and Functions and communities toward health
By National League of Philippine promotion and prevention
Government Nurses, 2005 - Assessment, plans and
- Must be qualified and licensed implements care and evaluates
- Possess personal qualities and outcomes
“people skills” e.g. home visits
- Has physical, mental and 4. Collaborating and Coordinating
emotional strength Function
- Leadership, resourcefulness, - Bring activities or group of
creativity, honesty and integrity activities systematically into
- Interest, willingness, and proper relation or harmony with
capacity to work with people each other
Functions (Nursing Law 2002) - Establishes linkages and
- r/t management, supervision, collaborative relationships with
and provision of nursing care, other health professionals,
collaboration and coordination, government agencies, the private
health promotion, and education sector, non-government
training and research organizations, people’s
1. Management Function organizations to address health
- Execution of five management problems
functions of planning, organizing, 5. Health Promotion and Education
staffing, directing, and controlling Function
- Organizes “nursing service” of - Understands the
the local health agency multidimensional nature of health
• Program manager – enables planning and
responsible for the delivery of implementing health promotion
package of services provided
 interventions for individuals and Community Health Nursing Process
communities - Systematic, scientific, dynamic,
- Uses skills in advocacy for the on-going interpersonal process in
creation of a supportive which the nurses and the clients
environment through policies and are viewed as a system with
reengineering of the physical each affecting the other and both
environment for healthier actions being affected by the factors
- Provides client information that within the behavior
allows them to make healthier A. Assessment
choices and practices - Estimate of the degree to which
6. Training Function a family, group or community is
- Initiates the formulation of staff achieving the level of health
development and training possible for them, identifies
programs for midwives and other specific deficiencies or guidance
auxiliary workers needed and estimates the
- Training needs assessment, possible effects of the nursing
designs training program and interventions
conducts in collaboration with 1. Collection of Data
other resource person; and - Data are collected systematically
evaluation and continuously. Then are
• Community Organizing – recorded in appropriate forms
mobilizing people to solve and kept systematically
their own problems; people Categories of Health Problems:
learn that their problems have PRIMARY
social causes and fighting 1. Health deficit – gap between
back is a more reasonable, actual and achievable health
dignified approach than status
passive acceptance and 2. Health threats – conditions
personal alienation that promote disease or injury
7. Research Function and prevent people from
- Participates in the conduct of realizing their health potential
research and utilizes research 3. Foreseeable crisis – stressful
finding in her practice occurrences such as death or
• Disease Surveillance – illness of a family member
research activity of the 4. Health need – health problem
nurses; continuous collection that can be alleviated with
and analysis of data of cases medical or social technology
and deaths 5. Health problem – health need
Purpose: combined with actual or
1. To measure the potential resources to apply
magnitude of the problem remedial measures and a
2. To measure the effect of commitment to act on the part
control program of the provider or the client
e.g. Poliomyelitis SECONDARY:
Eradication, Neonatal 1. Recognition of the problem
Tetanus Elimination, 2. Decision on health action
Measles Control, NCD risk 3. Care to affected family
factors, etc. member
Competencies, Skills, and 4. Provision of healthy home
Knowledge environment
 5. Utilization of community e.g. philosophy, objectives,
service for health care building, organizational
B. Planning Nursing Actions/ Care structure, financial resources
1. Goal Setting 2. Process elements – steps of
- Declaration of purposes or intent the nursing process itself
that gives essential direction to 3. Outcome elements – changes
action in the client’s health status
- SMART objectives that result from nursing
2. Constructing a Plan of Action intervention
- Choosing from among the • Evaluation based on
possible courses of action, professional practice
selecting the appropriate types of • Evaluation of structure
nursing intervention, identifying • Evaluation based on
appropriate and available information gathered
resources for care and NURSING PROCEDURES
developing an operational plan A. Clinic Visit
3. Developing an Operational Standard Procedures performed during
Plan clinic visits
- Prioritized in order of urgency to 1. Registration/ Admission
determine those that need the 2. Waiting time
earliest action or attention 3. Triaging
4. Development of evaluation 4. Clinical Evaluation
parameters 5. Laboratory and other diagnostic
C. Implementation of Planned Care examinations
• Documentation – provides 6. Referral System
data which is needed to plan 7. Prescription/ Dispensing
the client’s care and ensure 8. Heath Education
its continuity; serves as an B. Blood Pressure Measurement
important communication tool
for various team members, C. Home Visit
furnishes written evidence of
the quality of care that the - Allows the health worker to
clients receives and their assess home and family
response to it; whether situations in order to provide the
revisions were made in necessary nursing care and
his’her plan of care and health related activities
whether such has been Kinds:
effective 1. Case Finding
-legal records to protect the 2. Case Follow-up
agency and the health care Purpose:
providers or the client 1. To provide nursing care
himself/herself 2. To assess the living condition
D. Evaluation of Care and Services 3. To give health teachings
Provided 4. To establish close
1. Structural elements – relationship
physical settings, 5. To make use of inter-referral
instrumentalities and system and promote
conditions through which utilization of community
nursing care is given services
Principles:
 1. Must have a purpose or 3. Show the effectiveness of total
objectives care given to an individual or
2. Make use of all available family
information about the patient 4. Can be performed in a variety of
3. Give priority to essential ways depending on the agency’s
needs of the individual and policy, the home situation, or as
family long as principles of avoiding
4. Planning and delivery of care transfer of infection is always
should involve the individual observed
and family Contents of the PHN bag
5. Plan should be flexible • Paper lining
Guidelines in frequency of home • Extra paper for making waste
visit: bag
- There is no definite rule to be • Plastic/linen lining
followed • Apron
- May vary according to the need • Hand towel
of the client • Soap in a soap dish
1. Physical needs, psychological • Thermometers (oral and
needs and educational needs rectal)
2. Acceptance of the family for
• 2 pairs of scissors (surgical
the services rendered
and bandage)
3. Policy of a specific agency
• 2 pairs of forceps (curved and
4. Agencies and number of
straight)
health personnel already
involved • Disposable syringes with
5. Careful evaluation of past needles (g. 23 & 25)
services given • Hypodermic needles g. 19,
6. The ability of the client to 22, 23, 25
recognize their own needs, • Sterile Dressing
their knowledge and their • Cotton balls (dry and with
ability to make use of their alcohol)
resources • Cord clamp
THE BAG TECHNIQUE • Micropore plaster
- Tool that enables the nurse to • Tape measure
perform nursing procedure with • 2 pair of sterile gloves
ease and deftness, to save time • baby’s scale
and effort, with the end view of • alcohol lamp
rendering effective nursing care • 2 test tubes
to clients • test tube holders
• Public Health Bag – essential • Solutions of betadine,
and indispensable equipment Zephiran solution, spirit of
of a public health nurse which ammonia, acetic acid, 70%
she has to carry along during alcohol, hydrogen peroxide,
home visits ophthalmic ointment,
Principles of Bag Technique benedict’s solution
1. Minimize, if not prevent the • Sphygmomanometer and
spread of any infection stethoscope are carried
2. Saves time and effort in the separately
performance of nursing Important Points to consider
procedures
 1. Should contain all the necessary 4. Wash hands To prevent
articles, supplies, and equipment using soap infection from
that will be used to answer and water. the care
emergency needs Wipe to dry provider to
2. Should be cleaned very often, the client
the supplies replaced, and ready 5. Take out the To protect
for use anytime apron from the nurse’s
3. Should be well protected from the bag and uniform
contact with any article in the put it on the
patient’s home. Consider the bag right side
and its contents clean and out
sterile, while articles that belong 6. Put out all To have
to the patients as dirty and the them readily
contaminated necessary accessible
4. The arrangement of the contents articles
of the bag should be the one needed for
most convenient to the user, to the specific
facilitate efficiency and avoid care
confusion 7. Close the To prevent
STEPS IN PERFORMING THE BAG bag and put contaminatio
TECHNIQUE ACTIONS (with rationale) it in one n
1. Upon arrival To protect corner of the
at the the bag from working
patient’s getting area
home, place contaminated 8. Proceed in To give
the bag on performing comfort and
the table the security and
lined with a necessary hasten
clean paper. nursing care recovery
The clean and
side must be treatment
out and the 9. After giving To protect
folded part, the the caregiver
touching the treatment, and prevent
table clean all infection
things that
2. Ask for a To be used were used
basin of for and perform
water or a handwashing handwashin
glass of g
drinking 10. Open the
water if tap bag and
water is not return all
available things that
3. Open the To prepare were used in
bag and for their proper
take out the handwashing places after
towel and cleaning
soap them
 11. Remove Principles:
apron, 1. Nursing care utilizes a medical
folding away plan of care and treatment
from the 2. The performance of nursing care
person, the utilizes skills that would give
soiled side maximum comfort and security to
in and the the individual
clean side 3. Nursing care given at home
out. Place it should be used as a teaching
in the bag opportunity to the patient or to
12. Fold the any responsible member of the
lining, place family
it inside the 4. The performance of nursing care
bag and should recognize dangers in the
close the patient’s over-prolonged
bag acceptance of support and
13. Take the For reference comfort
record and in the next 5. Nursing care is a good
have a talk visit opportunity for detecting
with the abnormal signs and symptoms,
mother. observing the patient’s attitude
Write down towards care given and the
all the progress exhibited by the patient
necessary Isolation Technique in the Home
data that - Prevent cross-infection
were COMMUNITY ORGANIZING
gathered, - “empowerment” or building the
observations capacity of people for future
, nursing community action
care and Five Stages of Organizing: A
treatment Community Health Promotion Model
rendered. Stage 1: Community Analysis
Give - The process of assessing and
instructions defining needs, opportunities and
for care of resources involved in initiating
the patients community health action program
in the (Haglund)
absence of Five Components
the nurse 1. Demographic, social, and
14. Make For follow-up economic profile
appointment care 2. Health risk profile; behavioral risk
for the next assessment; social indicators of
visit (either risk
home or 3. Health/ wellness outcomes
clinic) taking profile
note of the 4. Survey of current health
date and promotion programs
time 5. Studies conducted in certain
target groups
NURSING CARE IN THE HOME Stage 2: Design and Initiation
1. Establish a core planning group 1. Update the community analysis
2. Choose an organizational 2. Assess effectiveness of
structure intervention/programs
• leadership board or council – 3. Chart future directories and
existing local leaders working modifications
for a common cause 4. Summarize and disseminate
• coalition- linking results
oraganizations and groups to HEALTH PROMOTION AND
work on community issues EDUCATION
• “lead” or official agency – a • Lifestyle – composite
single agency takes the expression of the social and
primary responsibility of a cultural circumstances that
liaison for health promotion condition and constrain
activities in the community behavior
• grass-roots – informal • The behavioral change that
structures in the community health education is able to
like the neighborhood effect can only be maintained
residents if supportive environment
• citizen panels – a group of were provided through the
citizens (5-10) emerge from a effort of other sectors-
partnership with a political, economic, social,
government agency biomedical, etc. (Green)
• networks and consortia – 4 Major Tasks of Medicine
network develop because of - Henry E. Sigerist
certain concerns - Health is promoted by ptoviding
3. Identify, select, and recruit decent standard of living, good
organizational members labor conditions, education,
4. Define the organization mission physical culture, means of rest
and goals and recreation
5. Clarify roles and objectives of 1. Promotion of health
people involved in the 2. Prevention of illness
organization 3. Restoration of the sick
6. Provide training and recognition 4. Rehabilitation
Stage 3: Implementation The Ottawa Charter for a Health
Stage 4: Program Maintenance – Promotion (WHO, Health and Welfare
Consolidation Canada, Canadian Public Health
1. Integrate intervention activities Association, 1986)
into community networks • Health promotion – the
2. Establish a positive process of enabling people to
organizational culture increase control over and to
3. Establish an ongoing recruitment improve their health
plan Prerequisites for Health
4. Disseminate results • Peace
Stage 5: Dissemination – • Shelter
Reassessment • Education
- Part of the monitoring aspect in • Food
the management of the program • Income
• Formative evaluation – done • A stable eco-system
to provide timely modification • Sustainable resources
of strategies and activities
 • Social justice 2. Health promotion is directed
• Equity towards action on the
Action Areas: determinants or cause health.
1. Build healthy public policy This requires a close cooperation
- Combines diverse but between sectors beyond health
complementary approaches care reflecting the diversity of
including legislation, fiscal conditions which influence health
measures, taxation, and 3. Health promotion combines
organizational change diverse, but complementary
- Joint action contributes to methods or approaches,
ensuring safer and healthier including communication,
goods and services, healthier education, legislation, fiscal
public services, and clear, more development, and spontaneous
enjoyable environments local activities against health
- Identification of obstacles and hazards
ways of removing them 4. Health promotion aims
2. Create supportive particularly at effective and
environments concrete public participation.
- The protection of the natural and This requires the further
built environments and the development of problem-defining
conservation of the natural and decision-making life skills,
resources must be addressed in both individually, and collectively,
any health promotion strategy and the promotion of effective
3. Strengthen community action participation mechanisms
- Empowerment of the people’s 5. Health promotion is primarily a
endeavors and destinies societal and political venture and
4. Develop personal skills not a medical service, although
- Providing information, education health professionals heave an
for health, and enhancing life important role in advocating and
skills enabling health promotion (WHO
5. Reorient health services Health Promotion Glossary 1990)
- The individual, community Health Promotion
groups, health professionals, - Mediating strategy between
health service institutions and people and their environments,
governments must work together synthesizing personal choice and
towards a health care system social responsibility in health
which contributes to the pursuit (WHO)
of health Health Education
- Role of health sector must move - Any combination of learning
increasingly in a health experience designed to facilitate
promotion direction, beyond its voluntary adoptions of behaviors
responsibility for providing conducive to health (Green et al,
clinical and curative services 1980)
Principles of Health Promotion (WHO) - The process of assisting
1. Health promotion involves the individuals, acting separately or
population as a whole in the collectively, to make informed
context of their everyday life, decisions about matters affecting
rather than focusing on people at the personal health and that of
risk from specific diseases others (National Task Force on
 the Preparation and Practice of that is transmitted from the
Health Educators, 1983) source of infection to the
EPIDEMIOLOGY susceptible body
- Study of occurrences and • Environment – sum total of all
distribution of diseases external condition and
- Backbone of the prevention of influences that affects the
the disease development of an organism
2 Main Areas: which can be biological,
1. Distribution of health status in social and physical
terms of age, gender, race, Three components of the environment:
geography, time and so on 1. Physical environment
2. Explanations of the patterns of 2. Biological environment
disease distribution 3. Socio-economic environment
Uses of Epidemiology (Morris) Disease Distribution
• Study the history of the health 1. Time
population 2. Persons
• Diagnose the health of the 3. Place
community and the condition Patterns of Occurrence and Distribution
of people to measure the 1. Sporadic Occurrence –
distribution and dimension of intermittent occurrence of a few
illness in terms of incidence, isolated and unrelated cases in a
prevalence, disability and given locality; seasonal
mortality 2. Endemic occurrence –continuous
• Study the work of health occurrence throughout a period
services with a view of of time, of the usual number of
improving them cases in a given locality; always
• Estimate the risk of disease, occurring in the locality and the
accident, defects and the level of occurrence is more or
chances of avoiding them less constant through a period of
• Identify syndromes time; long term
• Complete the clinical picture 3. Epidemic Occurrence –
of chronic disease unusually large number of cases
The Epidemiologic Triangle in a relatively short period of
- Consists of three components: time; disproportionate
host, environment and agent relationship between the number
- A change in any of the of cases and the period of
component will alter an existing occurrence; THE MORE ACUTE
equilibrium to increase or THE DISPROPORTION, THE
decrease the frequency of the MORE URGENT OR SERIOUS
disease IS THE PROBLEM; depends on
• Host – is any organism that the geographical location
harbors and provides 4. Pandemic – simultaneous
nourishment for another occurrence of epidemic of the
organism same disease in several
• Agent – intrinsic property of countries; international
microorganism to survive and perspective
multiply in the environment to Epidemics
produce disease - Demands immediate effective
action which includes
• Causative agent – infectious
epidemiological investigation
agent or its toxic component
Factors • Provides high quality services
1. Agent MILESTONES:
2. Host • Devolution
3. Environment • Use of generics
Outline of Plan for Epidemiological • Milk code
Investigation • PhilHealth (1995)
1. Establish fact of presence of • DOH resources to promote
epidemic local health system
• Verify diagnosis development
• Reporting • Fiscal autonomy for
• Is there unusual prevalence government hospitals
of the disease? • Good governance programs
2. Establish time and space • Funding for UHC
relationship of the disease Problems:
3. Relations to characteristic of the 1. Persistent inequities in health
group of community outcomes
4. Correlation of all data obtained 2. Restrictive and impoverishing
---- healthcare costs
PRIMARY HEALTH CARE 3. Poor quality and undignifies care
8 Essential elements: synonymous with the public
• Education about prevailing clinics and hospitals
health problems and how to 3 GUARANTEES
prevent and control them 1. All life stages & triple burden of
• Food supply and proper disease
nutrition 2. Service delivery network
• Adequate supply of water and 3. Universal health insurance
basic sanitation STRATEGY
• Maternal and child health, A achieve quality, health promotion
family planning and primary care
• Immunization against C Cover all Filipinos against health-
infectious diseases related financial risk
• Prevention and control of H Harness the power of strategic
endemic diseases HRH development
• Treatment of common I Invest in eHealth and data for
infections decision-making
• Essential drugs E Enforce standards, accountability
PHILIPPINE HEALTH AGENDA 2016- and transparency
2022 V Value all clients and patients,
“ALL FOR HEALTH TOWARDS especially the poor, marginalized,
HEALTH FOR ALL” and vulnerable
GOALS: The health system we aspire E Elicit multi-sectoral and multi-
for: stakeholder support for health
• Financial protection
• Better health outcomes,
responsiveness
VALUES:
• Equitable & inclusive to all
• Transparent & accountable
• Uses resources efficiently