MODULE 1 CONCEPT OF PUBLIC HEALTH

AND COMMUNITY HEALTH

TEODORA T. MACALINCAG, RN, MPH

[email protected]
09178677690
Objectives
1. Define Health, Community and Public health.
2. Describe the different categories of community and its
characteristics.
3. Discuss the public health approaches, strategies, and it’s core ares.
4. Describe the community health nurse, its roles, responsibilities and
basic principles.
HEALTH
WHO : A state of complete physical , mental and
social well being not merely the absence of
disease or infirmity.
The extent to which an individual or group is able,
on the one hand , to realizes aspirations and
satisfy needs; and on other hand to change or
cope with the environment.
Health
• It is seen as a resource for everyday life , not the objective of living;
• It is a positive concept emphasizing social and personal resources, and
physical capacities.
(WHO, 1986, P 73)
• It is a human right with the following component:
• Availability
• Accessibility
• Acceptability
• Quality
What is a community?
• A community can be defined in many ways, it could be as simple as you and your
family, and the rest of the people living in your village – or it could be you and
your peers who belong in an organization
• Often, community is thought to be pertaining to a place or a specific location
where people live and do their socio-economic activities, like a ‘barangay’ or a
village, and ‘bayan’ or a town.
• However, community is a concept with a variety of meanings. The definitions of
community evolved in a confusing and messy fashion. In the past, the people
and groups with power look at their association favorably and degraded other
groups, to some point, created social divide even if the entire population share
one geographical space, under one government, and share the same national
identity.
💡 Community can be defined into three categories: common interest community; geographic
community; and, community of solution.

• Geographic community is defined by its geographic shared geographic

territory. People may share bonds, related experiences, common
attitude and values, but what makes them a geographic community is
the necessary condition that it has a geographic boundary (Poland and
Maré 2005).
• Common-interest community can be described by their shared belief,
goal, and interest. They may share or may not share a common
geographic boundary. Common-interest community is a collection of
people, even if they are scattered geographically, can have an interest
or goal that binds the members together (Allender, Rector and Warner
2010).
Community of Solution.

• Community is a group of people with common characteristics or

interests living together within a territory or geographical boundary;
it may also be a group of people coming together to respond to
common problem that affects them.
A type of community encountered frequently in community health
practice is a group of people who gathers to respond to common
problem. The share of this community varies with the nature of the
problem, the size of the geographic area affected and the number of
resources needed to address the problem (Allender, Rector and Warner
2010).
Public Health Key Term

• Clinical care – prevention, treatment and management and

preservation of physical, mental well being through services offered
by medical and allied health professions; also known as health care.
• Determinants – factors that contribute to the generation of a traits.
• Epidemics or outbreak – occurrence in a community or region of
cases of an illness, specific health related behavior or any health
related events clearly in excess of normal expectancy.
• Health outcome – result of medical condition that directly affects the
length or quality of person’s life.
What is Public Health?
• Charles-Edward Amory Winslow the father of Public health,
• Remember the 3 P’s
• Prevention of Disease
• Prolonging life
• Promotion of health and efficiency through organized community
effort and informed choices of society, organizations, public and
private communities, and individuals.”
GOAL & RESPONSIBLE PERSONS
• PROLONGING LIFE AND IMPROVING HEALTH

all sectors of society

health department
private sectors
NGO
international organization
community
PUBLIC HEALTH STRATEGY
• Identify and define public health problems
• Identify the determinants : risk factors;
deterrents
• Develop ant test intervention to control or
prevent the problems
• Assess the effectiveness of the intervention
CORE AREAS
I. PROTECTION
A. Control of infectious disease
B. Environmental hazard
C. Healthy work place
D. Managing health emergencies
II. PROMOTION
A. Promoting healthy lifestyle & behavior
B. Social determinant of health
 CORE AREAS
III. PREVENTION
A. Vaccination
B. Screening
Core areas to succeed:
1. Good governance
2. Advocacy to support
3. Capacity of trained health personnel
4. Information thru research, surveillance, monitoring & evaluation
COMMUNITY HEALTH NURSING
What is Community Health?

• Community health is defined as a multi-sector and multi-disciplinary

collaborative enterprise that uses public health science, evidence-
based strategies, and other approaches to engage and work with
communities, in a culturally appropriate manner, to optimize the
health and quality of life of all persons who live, work, or are
otherwise active in a defined community or communities (Goodman,
Bunnell, and Posner 2014).
What is community health?
• part of paramedical and medical
intervention/ approach which is concerned
on the health of the whole population
• Aims
1. health promotion
2. disease prevention
3. management of factors affecting health
What is nursing?
•It is an art and science of
assisting sick individuals to
become healthy and healthy
individuals achieve optimum
wellness
Concept of Community Health Nursing
• Community as a client

• Health as a goal

• Nursing as a vehicle or mean to

achieve its aim
COMMUNITY HEALTH NURSING (CHN):
• “The utilization of the nursing process in the
different levels of clientele-individuals,
families, population groups and communities,
concerned with the promotion of health,
prevention of disease and disability and
rehabilitation.”
- Maglaya, et al
COMMUNITY HEALTH NURSING (CHN):
• Community health nursing is population-focused, community-
oriented approach aimed at health promotion of an entire
population, and prevention of disease, disability and premature death
in a population (WHO-SEA 2010).
COMMUNITY HEALTH NURSING (CHN):

• a specialized field of nursing practice a

science of Public Health combined with
Public Health Nursing Skills and Social
Assistance with the goal of raising the level
of health of the citizenry, to raise optimum
level of functioning of the citizenry
BASIC PRINCIPLES OF CHN
1. The community is the patient in CHN, the family is
the unit of care and there are four levels of
clientele: individual, family, population group
(those who share common characteristics,
developmental stages and common exposure to
health problems – e.g. children, elderly), and the
community. "
2. In CHN, the client is considered as an ACTIVE
partner NOT PASSIVE recipient of care
BASIC PRINCIPLES OF CHN

3. CHN practice is affected by developments in health

technology, in particular, changes in society, in
general “
4. The goal of CHN is achieved through multi-sectoral
efforts “
5. CHN is a part of health care system and the larger
human services system.
BASIC PRINCIPLES OF CHN
6. Continuing staff education program quality services to client and are essential to
upgrade and maintain sound nursing practices in their setting. Professional interest
and needs of Community Health Nurses are considered in planning staff development
programs of the agency.
7. Utilization of indigenous and existing community resources maximizing the success of
the efforts of the Community Health Nurses. The use of local available ailments.
Linkages with existing community resources, both public and private, increase the
awareness of what care they need what are entitled.

8. Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the
CHN programs. Organized community groups are encouraged to participate in the
activities that will meet community needs and interests.
BASIC PRINCIPLES OF CHN
9.  CHN integrated health education and counseling as vital parts of
functions. These encourage and support community efforts in the
discussion of issues to improve the people’s health.
10. Supervision of nursing services by qualified by CHN personnel
provides guidance and direction to the work to be done. Potentials
of employees for effective and efficient work are developed.
11. Accurate recording and reporting serve as the basis for evaluation
of the progress of planned programs and activities and as a guide
for the future actions. Maintenance of accurate records is a vital
responsibility of community as these are utilized in studies and
researches and as legal documents.
Characteristics of CHN & PHN
• CPHN is developmental – right to health- self care – educate
• CPHN are multi disciplinary – collaborates w/ other professional
• CPHN promote social justice – health for all
• CPHN value consumer involvement – partners in health
• CPHN uses prepayment – taxes
• CPHN focus on preventive services
• CPHN offers comprehensive services – from womb to tomb
ROLES OF THE COMMUNITY HEALTH NURSE
Responsibilities of CHN
1. Be a part in developing an overall health plan, its
implementation and evaluation for communities
2. Provide quality nursing services to the three levels of clientele
3. Maintain coordination/linkages with other health team
members, NGO/government agencies in the provision of public
health services
4. Conduct researches relevant to CHN services to improve
provision of health care
5. Provide opportunities for professional growth and continuing
education for staff development
Standards in CHN

1. Theory
• Applies theoretical concepts as basis for decisions in practice
2. Data Collection/ Assessment
• Gathers comprehensive, accurate data systematically
3. Diagnosis
• Analyzes collected data to determine the needs/ health
problems of IFC
4. Planning
• At each level of prevention, develops plans that specify
nursing actions unique to needs of clients
Standards in CHN
5. Intervention
• Guided by the plan, intervenes to promote, maintain or restore health,
prevent illness and institute rehabilitation
6. Evaluation
• Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
• Participates in peer review and other means of evaluation to assure quality of
nursing practice
• Assumes professional development
• Contributes to development of others
Standards in CHN
8. Interdisciplinary Collaboration
• Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and evaluating
programs for community health
9. Research
• Indulges in research to contribute to theory and practice in community health
nursing
10. Education
PHN attains knowledge and competency that reflects current nursing and public
health practice
11. Collegiality and professional relationship
PHN stablishes collegial partnership while interacting with representatives of the
population, organizations, health & human services professionals and contribute to the
professional developments of peers, colleagues and others.
Standards in CHN
12. Ethics
PHN integrates ethical provisions in all areas of practices.
13. Resource Utilization Population
PHN considers factors related to safety, effectiveness, cost and impact on practice
and in the planning and delivery of nursing and public health programs, policies
and services.
14. Leadership
PHN provides leadership in nursing and public health.
15. Regulatory Activities
PHN identifies , interprets, and implements public health laws, regulations and
policies.
THEORIES
• Pender’s model focuses on three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral outcomes.
• The Health Promotion Model makes four assumptions:
1. Individuals seek to actively regulate their own behavior.
2. Individuals, in all their biopsychosocial complexity, interact with the
environment, progressively transforming the environment as well as being
transformed over time.
3. Health professionals, such as nurses, constitute a part of the interpersonal
environment, which exerts influence on people through their life span.
4. Self-initiated reconfiguration of the person-environment interactive patterns is
essential to changing behavior.
Milio’s Framework for Prevention

• Nancy Milio developed a framework for prevention that includes

concepts of community – oriented, population- focused care.
• Milio stated that behavioural patterns of the populations-and
individuals who make up populations – are a result of habitual selection
from limited choices.
• She challenged the common notion that a main determinant for
unhealthful  behavioural choice is lack of knowledge.
• Milio’s framework described a sometimes neglected role of community
health nursing to examine the determinants of a community’s health
and attempt to influence those determinants through public policy.
Dr. Lawrence W. Green
PRECEDE-PROCEED MODEL
The Transtheoretical Model
The Health Belief Model

• Health Belief Model focus on individual beliefs about health

conditions, which predict individual health-related behaviors.
The model defines the key factors that influence health
behaviors as an individual's perceived threat to sickness or
disease (perceived susceptibility), belief of consequence
(perceived severity), potential positive benefits of action
(perceived benefits), perceived barriers to action, exposure
to factors that prompt action (cues to action), and
confidence in ability to succeed (self-efficacy).
SOCIAL LEARNING THEORY
by Albert Bandura
A theory of learning process and social behavior
which proposes that new behaviors can be
acquired by observing and imitating others. ... In
addition to the observation of
behavior, learning also occurs through the
observation of rewards and punishments, a
process known as vicarious reinforcement.
General System Theory
by Ludwig von Bertalanffy -
• A system is a complex of interacting elements and that they are open
to, and interact with their environments. In addition, they can acquire
qualitatively new properties through emergence, thus they are in a
continual evolution. When referring to systems, it also generally
means that they are self-regulating (they self-correct through
feedback).
• System thinking is both part-to-whole and whole-to-part thinking
about making connections between the various elements so that they
fit together as a whole.
HISTORY OF PUBLIC HEALTH &
PUBLIC HEALTH NURSING

ENRICO SANTOS R.N., M.P.H. and Henry

Paul Santos RN, MAN, DMS
UNIVERSITYOF MAKATI
DEC.2004
http://www.authorstream.com/Presentation/geethujerald-1542374-history-public-health-n
ursing-1/
A. INFLUENCES OF ANCIENT
CULTURES ON PUBLIC HEALTH

1. EGYPTIAN CIVILIZATION (ca 3000 BC)

 Built irrigation canal and granaries for
storage of food
 Practice of prophylaxis by the medicine
man and high priest
 Emphasis on personal hygiene,
cleanliness within & outside the body
 Sanitation measures ( removal of refuse
and crude fumigation in times of
epidemics)
 Hebrews (c.a. 1400 BC)
 Founders of public hygiene
 Moses “father of Sanitation”
 Mosaic Health Code pertained to every
aspect of individual, family & community
hygiene, included:
a. Principles of personal hygiene (rest,

sleep, hours of work, cleanliness)

b. Environmental sanitation
1. Inspection of food
2. Methods of disposal of excreta
3. Detecting and reporting diseases
4. Practice of isolation, quarantine,
fumigation and disinfection
5. Detailed instructions on the correct way of
hand washing
 3. Greeks (ca. 600 BC)
Hippocrates – “Father of Medicine”
> exponent of the science of
preventive
medicine
> introduced the philosophy of the
interrelationship between physical and
mental health ( “A healthy mind dwells in
a healthy body”)
 4. Romans (ca. 50 BC)
* Contributed to the field of sanitation
(building of
Aqueducts, purification of water supply)
* Appointing of public health medical
officers
* Establishment of hospitals which
emphasized both preventive and curative
aspects of care
B. DEVELOPMENT OF PUBLIC HEALTH
NURSING AS A WORLD MOVEMENT

 1. Early Christian Period (1st century)

* order of Deaconesses- organized
visiting of the sick
- called visiting nurses
- forerunner of CHN
- endeavored to practice the corporal
works of mercy (feeding the hungry,
caring for the sick, burying the dead)
 Phoebe a friend of St Paul and the first
Deaconess and visiting nurse.
 2. Middle Ages (500-1500)
* Beguines of Flanders- worked as
nursing sister in the hospital, but
also gave care to the sick in their
homes, staying with the dying and
consoling the families of the
bereaved.
 3. Renaissance (1500-1700)
St Vincent De Paul- introduced modern
principles of visiting nurse and social services
* taught that indiscriminate giving was harmful
* emphasized the concept of helping people
help themselves
* organized the daughters of charity primarily
for the care of the sick at home
* maintained the family is the unit of the
service
* recognized the importance of supervision of
those who render service to the sick
 Early 19th century
 Pastor Theodor Fliedner- German Lutheran
pastor, went tour to raise funds when the main
industry of his community failed, came back
with money and ideas for a program social work.
 Fredericka Munster Fliedner- a wife pastor
organized women society for visiting nursing
the sick poor in their homes
 Couple recognized the need for preparing the
training those who care for the sick , organized
a hospital school of nursing in Germany
( Kaiserswerth Institute for the training of
Deaconesses)
C. Development of Modern PHN
 1 Characterized by clean-up measures in the
control of communicable dse
 Removal of refuse
 Clean-up campaign of prison and asylums

 Improvement of working conditions of women and

children
William Rathbone father of modern district nursing
with the encouragement of florence Nightingale,
organized a training school for nurses in the
liverpool Royal Infirmary which provided training
for hospital nurses, private duty nurses and
district nurse.
 2 Period of Scientific Control of
Communicable Diseases(1890-1910)
-Application of bacteriology and
immunology
3 Period of health education (1910-
present)
- Characterized by education for
prevention of diseases with active
cooperation of the individual in the
health action
D. PHN in USA
 1 Lillian Wald
 Conceived the idea of establishing a
neighborhood nursing service for the
sick poor in the lower east side of New
York
 To her “the home visit should be like
that of really interested friend, rather
than that of an impersonal paid visitors
2 Teacher College of University of
Columbia (1912)
-offered the first course of study of PHN
 3. National Organization PHN
 organized in 1912 to upgrade the
practice of PHN through standardization
of policies regarding the function and
qualification of PHN.
E. PHN in THE Philippines
 Pre- Spanish Era- no records
 Spanish Regime (1591-1898)
 Bro. Juan Climente (1577) – Started
Public Health Services though a
dispensary in Intramuros
 Started water sanitation
 Introduced small pox vaccine
 Creation of position of district,
provincial, national health officers
 3 American Regime (1898- 1942)
 1898 creation of board of the Health for
Physician
 1899 appointment of the first commissioner of
health
 1906 abolition of the board of health, creation
of bureau of health
 1912 PHN started in Cebu w/ 4 graduate
nurses who dealt primarily in MCH services
 1915 PHN began in Manila with 2 nurses who
offered follow-up care of OB patients and envt
sanitation services
 4. Japanese Regime (1942-1945)
 PHN services were interrupted
5. Era of the Republic of the Philippines
(1946 to present)
* 1947 DOH was divided into 3 bureaus
A Hospital
B Quarantine
C Health
 May 18, 1954 – RA 1082 (RHU Act) was
passed, implemented in July of the same
year, provided for the employment of
health personnel, including nurses, who
would man the RHUs and help raise the
health conditions of the rural population.
 June 1957 – RA 1891 (An Act
Strengthening Health and Dental Services
in the Rural Areas and Providing Funds
Thereof) was approved; created eight(8)
categories of RHUs corresponding to 8
population groups to be served.
 1975 – Formulation of the National Health
Plan and the restructured Health Care
Delivery System.
 1992- Devolution transferred authority to
LGU by virtue of the Local Government
Code. Appointments of RHU/City Health
Department personnel (including nursing
personnel) have to be approved by the
mayor. Material supplies of health center
have to be provided by the LGUs.
THE NATIONAL HEALTH
SITUATION

https://www.scribd.com/doc/11
534563/National-Health-Situat
ion
 THE NATIONAL HEALTH
SITUATION
Demographic profile

- Philippine is one of the populous countries in

the world.

- TP 2020= 109,581,078
- TP 2021= 110,962,170
- 1.35% yearly change
 THE NATIONAL HELATH
SITUATION
- Average life expectancy at birth was 71.66
years

* 77.9 for females

* 67.7 for males
- 368 people for every square kilometer of
Philippine territory.
 THE NATIONAL HELATH
SITUATION
- High population density
transmission of infectious and
communicable diseases.

- Greater need for social services such as:

decent housing education
transportation health services
communication
 THE NATIONAL HELATH
SITUATION
- High level of stress in congested areas
leads to:
disintegration of moral values and
social institutions and contributes to the
incidence of a number of health problems,
including mental health problems.
 THE NATIONAL HELATH
SITUATION
Health profile
Birth and deaths 2020
Crude Birth Rate (CBR) 12.8 per 1000
population
Crude Death Rate (CDR) 5.49 per 1000
population.
The rate of natural increase in the country’s
population for the same year was 7.31(12.8
minus 5.49) for every 1000 population
 THE NATIONAL HELATH
SITUATION
- Rural women have more children than
urban women.
- Uneducated women also have more
children than those who are with college
education.
- Those in the 25-29 age group have the
highest fertility rate (national demographic
and health survey, 1999)
 THE NATIONAL HEALTH
SITUATION
- In 2020, infant mortality rate (IMR) was
17.5 per 1000 live births, which is within
the WHO global goal for IMR of less than
50/1000 live births.

- Under-five mortality rate or deaths of

children below five years old in the same
year was 24.8/1000 live births.
 THE NATIONAL HEALTH
SITUAION
- Maternal mortality rate (MMR) was
12.1/1000 live births (DOH), 2017) or 121
maternal deaths for every 100,000 live
births.

- Death rate among males is higher than

females – referred as the “feminization” of
old age.
 THE NATIONAL HEALTH
SITUATION
10 Leading Causes of Mortality 2020
1. Ischemic Heart Disease =99,680
2. Malignant neoplasms =62,503
3. Cardio Vascular Disease =59,736
4. Diabetes Mellitus = 37,265
5. Pneumonias =32,574
6. Hypertension Disease = 29,511
7. COVID 19 = 19758
 THE NATIONAL HELATH
SITUATION
8. Chronic Lower Respiratory Infection =
19,463
9. Other Heart Diseases =19,298
10. Pulmonary TB =17,433
 THE NATIONAL HELATH
SITUATION
- Infant mortality rate is one of the most
sensitive indicators of health status of a
country or community.
Results from:
1. poor maternal conditions
2. unhealthy environment
3. inadequate health care delivery system
 THE NATIONAL HELATH
SITUATION
leading causes of infant mortality in 1997
were:
1. Respiratory conditions of the fetus and
newborn
2. Pneumonias
3. Congenital anomalies
4. Birth injury and difficult labor
5. Diarrheal diseases
 THE NATIONAL HELATH
SITUATION
6. Septicemia
7. Measles
8. Meningitis
9. Other diseases of the respiratory system
10. Aminovitaminosis and other nutritional
deficiency. (1997 Philippine health
statistics)
 THE NATIONAL HELATH
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Maternal mortality – major indicator of a
woman’s health status – define by WHO
as the death of a woman while pregnant or
within 42 days of termination of pregnancy
from any cause related to, or aggravated
by the pregnancy or its management, but
not from accidental or incidental causes.
 THE NATIONAL HEALTH
SITUATION
Leading causes of maternal mortality in
1997
1. Normal delivery and other complications
related to pregnancy occurring in the
course of labor, delivery and puerperium.
2. Hypertension complicating pregnancy,
childbirth and puerperium
3. Postpartum hemorrhage
 THE NATIOAL HEALTH
SITUATION
4. Pregnancy with abortive outcome
5. Hemorrhages related to pregnancy

Analysis of women’s poor health and

maternal mortality should consider the
overall social, cultural, and economic
environment. (poor, low educational
status, multipara, anemic)
 THE NATIONAL HEALTH
SITUATION
SARS – “scary” severe acute respiratory
syndrome. Transmission of infectious
diseases is facilitated by the increasing
mobility of people and ease in traveling
form one country to another.
 THE NATIONAL HEALTH
SITUATION
AIDS – major public health problem, (urban
areas)
- increase in STD’s (syphilis, & gonorrhea
due to unhampered prostitution in the
country.
- prostitution has always been identified as
a consequence of poverty.
 THE NATIONAL HEALTH
SITUATION
TUBERCULOSIS
- Number one cause of mortality about 50
years ago continue to be a major killer of
Filipinos.

LEPROSY
-MDT (multi-drug therapy) 1.7/10,000 (1995)
 THE NATIONAL EHALTH
SITUATION
SCHISTOSOMIASIS
- affect hundred of barangays in 24 endemic
provinces.
RABIES
- incidence in the Philippines is one of the highest
in the world.
HEPATITIS B
- 12% of the population are chronic carriers
(hepatitis B and hepatic sarcoma)
 THE NATIONAL HEALTH
SITUATION
*MOSQUITO*
- malaria
- filariasis
- dengue fever
 THE NATIONAL HEALTH
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POVERTY AND HEALTH
- illiteracy
- unfounded health beliefs
- harmful practices
- inadequate nutrition
- poor environmental sanitation
- inadequate source of potable water
supply
NATIONAL HEALTH SITUATION
- congested housing unit
- limited access to basic health services
- inability to make decisions on matters
which are important to health
 THE NATIONAL HEALTH
SITUATION
CULTURAL INFLUENCES ON HEALTH
- is a way of life
- passed on from one generation to the
next
- includes beliefs, values and customs or
practices
- traditional
 THE ANTIONAL HEALTH
SITUATION
ENVIRONMENTAL INFLUENCES ON
HEALTH
- unsanitary environment = major factor
- breeding ground of animals and insects
that harbor and transmit microorganisms.
- deterioration of the ecosystem
- exposure to chemicals and other air
pollutants (cancer & respiratory diseases)
 THE NATIONAL HEALTH
SITUATION
- industrialization
- government policies
- poverty and an uncaring attitude towards
the environment.
 THE NATIONAL HEALTH
SITUATION
POLITICAL INFLUENCES ON HEALTH
- politics affects health
- health policies emanate from congress,
the executive department (DOH)
- policies that affect health = health care
delivery system and the practice of nursing
in the Philippines
THE NATIONAL HELATH
SITUATION

- health budget is the most

concrete expression of the
government’s political will.

- health spending has always

 THE NATIONAL HELATH
SITUATION
policies that impact
on people’s health
directly
1. National blood
services Act (RA
7719)
2. National diabetes
Act (RA 8191)
3. Salt iodization Act
(RA 8172)
 THE NATIONAL HELATH
SITUATION
Policies that affect health indirectly
1. Family and social relationship
2. Environment
3. Access to education
4. Malnutrition
5. Mental health problems
6. Cancer
7. Other lifestyle-related diseases
 THE ANTIONAL HELATH
SITUATION
Laws that affect the delivery of health
services
1. Local government code
2. National health insurance Act
3. Professional practice acts of the different
professions
 THE NATIONAL HEALTH
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THE HEALTH CARE DELIVERY SYSTEM
- is the totality of all policies,
infrastructures, facilities, equipment,
products, human resources, and concerns
of all people
 THE NATIONAL HEALTH
SITUATION
- preventive health care = concern of the
government-owned health centers

- curative care = provided by hospitals,

both government and private
 THE NATIONAL HEALTH
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DEPARTMENT OF HEALTH
- national government’s biggest health
care provider

- used to have control and supervision

over all barangay health stations, rural
health units and hundreds of hospitals
throughout the country
 THE NATIONAL HELATH
SITUATION
- Bureau of local health development
- local health systems development
- health care financing programs
- quality improvement programs
- intersectoral (public-private)
coordination and local projects
 THE NATIONAL HELATH
SITUATION
DEVOLUTION OF HEALTH SERVICES
- RA 7160 = local government code
- the code aims to: transform local
government units into self-reliant
communities and active partners in the
attainment of national goals through a
more responsive and accountable local
government structure instituted through a
system of decentralization.
 THE NATIONAL HEALTH
SITUATION
- provincial, district and municipal hospitals
provincial governments

- rural health units (RHUs) and barangay

health stations (BHSs) municipal
governments
 THE NATIONAL HEALTH
SITUATION
- provincial level
> governor (chair)
> provincial health officer (vice chair)
> chairman of the Committee on Health
of the sangguniang panlalawigan
> DOH representative
 THE NATIONAL HELATH
SITUATION
- City and Municipal level
> mayor (chair)
> municipal health officer (vice chair)
> chair of the committee on health of the
sangguniang bayan
> DOH representative and NGO
representative
 THE NATIONAL HEALTH
SITUATION
HEALTH SECTOR REFORM AGENDA
AND NATIONAL OBJECTIVES FOR
HEALTH
- HSRA (1999-2004)
- NOH (1999-2004)
 THE NATIONAL HELATH
STITUATION
FIVE MAJOR REFORMS CONTAINED IN
THE HSRA
1. Provide fiscal autonomy to government
hospitals
2. Secure funding for priority public health
programs
3. Promote the development of local health
systems and ensure its effective
performance
 THE NATIONAL HEALTH
SITUATION
4. Strengthen the capacities of health
regulatory agencies
5. Expand the coverage of the National
Health Insurance program
NATIONAL OBJECTIVES FOR
HEALTH

Vision: Health for all Filipinos

NATIONAL OBJECTIVES FOR
HEALTH

Mission: Ensure accessibility and quality

of health care to improve the quality of life
of all Filipinos, especially the poor
 NATIONAL OBJECTIVES FOR
HEALTH
Principles
 universal access to basic health
services must be ensured.

 the health and nutrition of vulnerable

groups must be prioritized.
 NATIONAL OBJECTIVES FOR
HEALTH
 The epidemiologic shift from infectious to
degenerative diseases must be managed.

 The performance of the health sector must

be enhanced.
 NATIONAL OBJECTIVES FOR
HEALTH
 GOALS AND OBJECTIVES
1. Improve the general health status of the
population
- reduce infant mortality rate
- reduce child mortality rate
- reduce maternal mortality rate
- reduce total fertility rate
- increase the life expectancy and the quality of
life years
 NATIONAL OBJECTIVES FOR
HEALTH
2. Reduce morbidity, mortality, disability and
complications from the following diseases
and disorders
- pneumonias and acute respiratory
infections
- diarrheas and other food and water
borne diseases like typhoid, cholera, and
hepatitis A
 NATIONAL OBJECTIVES FOR
HEALTH
- Tuberculosis
- Dengue
- Intestinal parasitism
- STD’s, HIV-AIDS and other reproductive
tract infections
- Hepatitis B
- Asthma and chronic obstructive pulmonary
diseases
 NATIONAL OBJECTIVES FOR
HEALTH
- Nephritis and chronic diseases
- Dental caries and periodontal diseases
- Rheumatic heart disease and rheumatic
fever
- Coronary artery disease, hypertension and
hyperlipidemia
- Stroke
- Cancer
 NATIONAL OBJECTIVES FOR
HEALTH
- Diabetes
- Mental disorders
- Protein-energy malnutrition
- Iron-deficiency anemia
- Obesity
- Accidents, traumas and injuries
 NATIONAL OBJECTIVES FOR
HEALTH
3. Eliminate the following diseases as public health
problems

- Schistosomiasis
- malaria
- filariasis
- leprosy
- rabies
 NATIONAL OBJECTIVES FOR
HEALTH
- vaccine-preventable diseases: measles,
tetanus, diptheria, and pertussis

- Vitamin A deficiency

- Iodine deficiency disorders

 NATIONAL OBJECTIVES FOR
HEALTH
4. Eradicate poliomyelitis

5. Promote healthy lifestyle

- promote healthy diet and nutrition
- promote physical activity and fitness
- promote personal hygiene
 NATIONAL OBJECTIVES FOR
HEALTH
- promote mental health and less stressful
life

- Prevent smoking and substance abuse

- Prevent violent and risk-taking behaviors

 NATIONAL OBJECTIVES FOR
HEALTH
6. Promote the health and nutrition of
families and special populations
- neonatal and infant health
- health of indigenous peoples
- children's health
- adolescent and youth health
- adult health
- women's health
 NATIOANL OBJECTIVES FOR
HEALTH
- health of older persons
- health of overseas Filipino workers
- health of differently-abled persons
- health of the rural poor
- health of the urban poor
 NATIONAL OBJECTIVES FOR
HEALTH
7. Promote environmental health and
sustainable development
- healthy homes
- healthy workplace and establishments
- healthy schools
- healthy communities, towns and cities
DOH HEALTH PROGRAMS
TEODORA MACALINCAG RN MPH
  Maternal
 Prenatal care at least 1prenatal care visit per
trimester
 On first visit HBMR provision thorough
assessment including laboratory test, start of
MATERNAL tetanus immunization, health education on what
to observe for complication
AND CHILD  Referral for medical and dental assessment
HEALTH  2nd trimester provision of micronutrient
supplementation 2nd dose of TT immunization ,
health educ.
 3rd trimester preparation of delivery , health educ.
what to observe.
  Delivery : should be in lying in or clinic or hospital
with partograph, no home delivery
 Prevention of infection
 Close monitoring for 24 hour provision of Vit. A
and Ferrous.

MATERNAL  Provision of appropriate chosen Family Planning

method ( natural or artificial)
 Exclusive breast feeding.
 Health educ. Infant care, next visit.
 Mental Health
  Observance and accomplishing Unang Yakap
 Immunization
 Newborn screening
 Exclusive breast feeding
 Monitoring of growth and development
 The early recognition, management and prevention of
common childhood illness ( IMCI )
CHILD CARE  Prevention of malnutrition by provision of
Garantisadong Pambata at Sangkap Pinoy program.
 Dental Care - Fluoride Use
           - Tooth brushing
           - Other Preventive Measures
 Prevention of accidents and abuse.
  Ensure access and delivery of quality oral health
care services.
 Provide relevant, timely and accurate information
DENTAL HEALTH management system  for oral Health.
PROGRAM  Ensure financial access to essential public and
personal oral health services.
 Formulate  policy and regulations to ensure the full
implementation of OHP
 I. DENGUE – aedes egypti
 Program component:
1. Surveillance
2. Case Management and Diagnosis
3. Integrated Vector Management (IVM)
PREVENTION AND
4. Outbreak Response
MANAGEMENT OF
5. Health Promotion and Advocacy
ENDEMIC
6. Research
COMMUNICABLE
4 S Strategy
DISEASES
 S - earch and Destroy
 S - eek Early Consultation
 S - elf Protection Measures
 S - ay yes to fogging only during outbreaks
  Elephantiasis
 Causative organism:  parasites classified as nematodes
(roundworms),  Wuchereria bancrofti,  transmitted by
mosquito bite
 Diethylcarbamazine Citrate and Albendazole 5 yr
treatment as prophylaxis
II. FILARIASIS  “November as Filariasis Mass Treatment Month
ELIMINATIO  STRATEGIES, ACTION POINTS, AND TIMELINE
N  Mass Drug Administration

PROGRAM  Disability Management

 Monitoring thru Midterm Sentinel surveys and Evaluation
thru Transmission Assessment Survey
 Post Validation Surveillance
 Private-Public Partnership
  Caused by Plasmodium parasite through bite of
Anopheles mosquito

III. MALARIA  PROGRAM COMPONENTS

CONTROL 1.ProgramManagementandHealthSystem -
2.DiagnosisandTreatment
PROGRAM 3.VectorControl
4.AdvocacyandSocialMobilization
5. Surveillance, Outbreak Preparedness and
Response Monitoring and Evaluation
  Causative Organism Mycobacterium leprae
 Cardinal symptoms:
1. Skin patches / lesion
IV. NATIONAL
LEPROSY 2. Dryness / Numbness

CONTROL 3. Muscle weakness/ enlarge nerve

PROGRAM Diagnosis: skin slit smear

Treatment: MDT (multi drug therapy): dapsone

with rifampicin, and clofazimine 
  PROGRAM COMPONENTS
 Early diagnosis and treatment
 Integration of leprosy services
 Referral system
 Case detection and diagnosis
Hansen’s  Advocacy and IEC focusing on stigma
discrimination and reduction
Disease  Prevention of Deformity, self-care and
rehabilitation
 Recording and reporting
 Monitoring, supervision and evaluation
 Causative organism:
 Schistosoma haematobium.
 Schistosoma mansoni.
 Schistosoma japonicum.

V. Diagnosis : Fecal smear- Kato-Katz test

SCHISTOSOMI Component:
ASIS CONTROL 1. Preventive Chemotherapy -  praziquantel
PROGRAM 2. Intensified Case Management
3. Water, Sanitation and Hygiene (WASH)
4. Veterinary Public Health and the Promotion of
Animal Health under One Health Approach.
5. Effective Intermediate Host Control and
Surveillance
  Causative organism: Negri body
 Incubation period: week to a year depend on the site
of contamination
 PROGRAM COMPONENTS
 Post Exposure Prophylaxis
RABIES PREVENTION  Pre- Exposure Prophylaxis (PrEP)
AND CONTROL  Health Education and advocacy campaign
PROGRAM  Training/Capability Building
 Training on National Rabies Information System
(NaRIS)
 Establishment of ABTCs by Inter-Local Health Zone
 DOH-DA joint evaluation and declaration of Rabies-
free areas/provinces
 NATIONAL
TUBERCULOSIS TB https://www.philhealth.gov.ph/partners/providers/pdf
/NTCP_MoP2014.pdf
CONTROL PROGRAM
  PD 996
 To reduce the morbidity and mortality among infants and
children caused by 7 immunizable diseases.
 STRATEGIES
1. Sustaining 90% FIC coverage
2. Sustaining Polio Free country
(EPI) Expanded 3. Elimination of measles

Program on 4. Elimination of tetanus neo-natorum

ELEMENTS
Immunization Target settings- 3% of total population
IEC- Information, Education, Communication
Cold chain and logistic management
Assessment and evaluation of over all performance
Surveillance , studies and Research
 Essential  https://www.youtube.com/watch?v=AjcoR2tozyQ
Newborn Care
 INTEGRATED
MANAGEMENT  http://www.kznhealth.gov.za/chrp/documents/Guid
OF CHILDHOOD elines/Guidelines%20National/IMCI/IMCI%20Chart
%20Booklet.pdf
ILLNESS
  GARANTISADONG PAMBATA is to ensure children’s
survival by provision micronutrient
supplementation and deworming drugs every 6
month.
 April and October all children under 5 years of age
must be given Vitamin A 100,00 IU 6mos-11mos
GARANTISADON and 200,000 IU for 12 mos. to 59 mos. of age.
G PAMBATA AND  Iron or Ferrous syrup for those with anemia
SANGKAP PINOY  Deworming drugs
 Utilization of iodized salt
 SANGKAP PINOY- fortification of micronutrient on
food like milk, breads and other food commomnly
consumed by children.
 A SEMINAR
ON
FAMILY HEALTH
NURSING

Presentation By :
Mr.Kunal Jejurkar.
(First year, MSc.
Nursing.)
 INTRODUCTION
Family health care nursing is an art and a science
that has evolved over the last 20 years as a way of
thinking about and working with families. Family nursing
comprises a philosophy and a way of interacting with
clients that affects how nurses collect information,
intervenes with patients, advocate for patients, and
approach spiritual care with families. This philosophy and
practice incorporates the assumption that health affects all
members of families that health and illness are family
events, and that families influence the process and
outcome of health care.
 TERMINOLOGY

• Family:
Two or more individuals coming from the same or
different kinship groups who are involved in a continuous living
arrangement, usually residing in the same household,
experiencing common emotional bonds, and sharing certain
obligations toward each other and toward others.

• Family health: A condition including the promotion

and maintenance of physical, mental, spiritual, and
social health for the family unit and for individual
family members.
• Family process: The ongoing interaction between
family members through which they accomplish their
instrumental and expressive tasks. The nursing process
considers the family, not the individual, as the unit of
care.

• Family centered nursing: Nursing that considers

health of the family as a unit in addition to the health
of individual family members.
 FAMILY HEALTH NURSING
• Definition and meaning of family health
nursing
Family health nursing is a nursing aspect of
organized family health care services which are directed or
focused on family as the unit care with health as the goal. It is
thus synthesis of nursing care and health care. It helps to
develop self care abilities of the family and promote, protect
and maintain its health. Family health nursing is generalized,
well balanced and integrated comprehensive and continuous are
requiring comprehensive planning to accomplish its goal.
The goals of the family health nursing include
optimal functioning for the individual and for the family as a
unit.”
 OBJECTIVES OF FAMILY HEALTH
NURSING
• The broad objectives of family health nursing are as
under:
• To identify health & nursing needs and problems of each
family.
• To ensure family’s understanding and acceptance of
these needs and problems.
• To plan and provide health and nursing services with the
active participation of family members.
• To help families develop abilities to deal with their
health needs and health problems independently.
 OBJECTIVES OF FAMILY HEALTH
NURSING CONT….

• To contribute to family’s performance of developmental

functions and tasks.
• To help family make intelligent use of promotive,
preventive, therapeutic and rehabilitative health and
allied facilities and services in the community.
• To educate, counsel and guide family members to
cultivate good personal health habits, practice safe
cultural practices and maintain wholesome physical,
psychosocial, and spiritual environment.
PRINCIPLES OF FAMILY HEALTH
NURSING
1. Provide services without discrimination
2. Periodic and continuous appraisal and evaluation of family health
situation
3. Proper maintenance of record and reports.
4. Provide continuous services
5. Health education, guidance and supervision as integral part of family
health nursing.
6. Maintain good IPR.
7. Plan and provide family health nursing with active participation of
family.
8. Services should be realistic in terms of resources available.
9. Encourage family to contribute towards community health.
10.Active participation in making health care delivery system.
 ADVANTAGES OF FAMILY HEALTH
NURSING

• Family health nursing of patients saves hospital beds that can be

utilized for critical cases.
• Family health nursing is cheaper than hospital nursing.
• Patient under family health nursing enjoys privacy and emotional
support.
• Patients on family health nursing can continue with their routine
pursuits.
• If the patient resides in a sanitary house, family health nursing is
better than hospital nursing since he can control inimical
environmental influences better.
 DISADVANTAGES OF FAMILY HEALTH
NURSING

• Family health nursing requires the nurse to carry

portable laboratory machinery to the patent’s home.

• If the patient resides in a substandard house, family

health nursing could delay his recovery.
FAMILY CENTERED NURSING
APPROCH

•The four approaches included in the family

health nursing care views are:
1.Family as the context
2.Family as the client
3.Family as a system
4.Family as a component of society
1. Family as the context
When the nurse views the family as context, the primary focus
is on the health and development of an individual member existing within a
specific environment (i.e., the client’s family).Although the nurse focuses
the nursing process on the individual’s health status, the nurse also assesses
the extent to which the family provides the individual’s basic needs. These
needs vary, depending on the individual’s development level and situation.
Because families provide more than just material essentials, their ability to
help the client meet psychological needs must also be considered. Family
members may need direct interventions themselves.
2. Family as the client
The family is the foreground and individuals are in the background.
The family is seems as the sum of individuals family members. The focus is
concentrated on each and every individual as they affect the whole family.
From this perspective, a nurse might ask a family member who has just
become ill. Tell me about what has been going on with your own health and
how your perceive each family member responding to your mother’s recent
diagnosis of liver cancer.
3. Family as a system
The focus is on the family as a client and it is viewed as an
international system in which the whole is more than the sum of its parts.
This approach focuses on the individual and family members become the
target for nursing interventions. Eg: the direct interaction between the
parent and the child. The system approach to the family always implies
that when something happens to one affected.
It is important to understand that although theoretical and
practical distinctions can be made between the family as context and the
family as client, they are not necessarily mutually exclusive, and both are
often used simultaneously, such as with the perspective of the family as
system.
4.Family as a component of society
The family is seen as one of many institutions in society,
along with health, educational, religious, or economic institution. The
family is a basic or primary unit of society, as are all the other units and
they are all a part of the larger system of society. The family as a whole
interacts with other institutions to receive exchange or give
communications and services. Community health nursing has drawn
many of its clients from this perspective as it focuses on the interface
between families and communities.
Family health nursing practice like any nursing practice
begins with the nursing process. By using this process, the nurse
practicing with family perspectives is potentially able to effectively
intervene at any of the levels. After an assessment of the individuals,
family nit, and supra system, the nurse is ready to begin to identify areas
of concern or need.
 FAMILY HEALTH NURSING PROCESS

Definition Of Family Health Nursing Process

Family health nursing process is a orderly, systematic
steps to assess the health needs, plan, implement and evaluate the
services to achieve the health. It is the systematic steps to analyze
health problems and their solutions. It helps in achieving desire goals
of health prootion,prevention and control of health problems.
Family Nursing Process
The family nursing process, suggested by these authors,
consists of the following steps adapted specifically with family as the
focus group.
(Carnevali and Thomas, 1993)
 ELEMENTS OF FAMILY NURSING
PROCESS

a) Assessment of client’s problem

b)Diagnosis of client response needs that nurse
can deal with
c) Planning of client’s care
d)Implementation of care
e) Evaluation of the success of implemented care
a) Assessment (of client’s problem)
The home health nurse assesses not only the health care
demand of the client and family but also the home and community
environment. Assessment actually begins when the nurse contacts the
client for the initial home visit and reviews documents received from
the referral agency. The goal of the initial visit is to obtain a
comprehensive clinical picture of the client’s need.
During the initial home visit, the home health nurse
obtains a health history from the client, examines the client, observe
the relationship of the client and caregiver, and assess the home and
community environment. Parameters of assessment of the home
environment include client and caregiver mobility, client ability to
perform self care, the cleanliness of the environment, the availability
of caregiver support, safety, food preparation, financial supports and
the emotional status of the client and caregiver.
b) Diagnosis (of client response needs that nurse can deal
with)
As in other care environments, the nurse identifies both actual and
potential client problems. Examples of common nursing diagnoses for home care
include Deficient Knowledge, Impaired Home Maintenance, and Risks for
caregiver Role strain. Client education is considered a skill reimbursed by
Medicare and other commercial insurance carriers, it is important for the nurse to
include Deficient Knowledge in the plan of care .The deficit in knowledge may
relate to client’s lack of information about their disease process, medications, and
self- care skills and so on.

c)Planning (of client’s care)

During the planning phase the nurse needs to encourage and permit
client’s to make their own health management decisions. Alternatives may need
to be suggested for some decisions if the nurse identifies potential harm from a
chosen course of action. Strategies to meet the goals generally include teaching
the client family techniques of care and identifying appropriate resources to
assist the client and family maintaining self-sufficiency.
 d) Implementation (of care)
To implement the plan, the home health nurse performs
nursing interventions, including teaching, coordinates and uses
referrals and resources, provides and monitors all levels of technical
care; collaborates with other disciplines and providers; identifies
clinical problems and solutions from research and other health
literature, supervises ancillary personnel, and advocates for the
client’s right to self –determination. Technical skills commonly
performed by home health nurses include blood pressure
measurement; body fluid collection (blood, urine, stool, and sputum),
wound care, respiratory care, and all types of intravenous therapy,
eternal nutrition, urinary catheterization and renal dialysis.
e) Evaluation and Documenting (of the success of
implemented care)
Evaluation is carried out by the nurse on subsequent home
visits, observing the same parameters assessed on the initial home
visit and relating findings to the expected outcomes or goals. The
nurse can also teach caregivers parameters of evaluation so that
they can obtain professional intervention if needed.
Documentation of care given and the client’s progress toward goal
achievement at each visit is essential. Notes also may reflect plan
for subsequent visits and when the client may be sufficiently
prepared for self care and discharge from the agency.
 FAMILY HEALTH ASSESSMENT
1.Establishing a working relationship
The family and nurse maintain a working
relationship. It is relationship which is maintained while
working together by developing trust, confidentiality and
empathy. These are essential components or elements to
find out the facts from families and making correct
decisions. A working relationship must have scope of two
way communication. The family members must be given
equal opportunity to give their views and ideas and
express the feelings and vice versa. The nurse must have
enough interactions with family members to guide and
help them to solve the problem.
2. Assessment of Health Needs
Assessment is a continuous process which becomes more
accurate as knowledge of people deepens.
• Family structure, characteristics & dynamics:
Include the composition and demographic data of the
members of the family/household, their relationship to the head and
place of residence; the type of, and family interaction/communication
and decision-making patterns and dynamics.
• Socio-economic & cultural characteristics:
Include occupation, place of work, and income of each
working member; educational attainment of each family member;
ethnic background and religious affiliation; significant others and
the other role(s) they play in the family’s life; and, the relationship
of the family to the larger community.
• Home and environment:
Include information on housing and sanitation
facilities; kind of neighborhood and availability of social, health,
communication and transportation facilities in the community.
• Health status of each member:
Includes current and past significant illness; beliefs
and practices conducive to health and illness; nutritional and
developmental status; physical assessment findings and significant
results of laboratory/diagnostic tests/screening procedures.
• Values and practices on health promotion/maintenance &
disease prevention:
Include use of preventive services; adequacy of
rest/sleep, exercise, relaxation activities, stress management or other
healthy lifestyle activities, and immunization status of at-risk family
members.
 METHODS OF DATA COLLECTION
A)Observation:
Method of data collection through the use of sensory capacities, sight,
hearing, smell and touch. Data gathered through this method have the advantage
of being subjected to validation and reliability testing by other observers.
B) Physical Examination:
Done through inspection, palpation, percussion, auscultation,
measurement of specific body parts and reviewing the body systems.
C) Interview:
Completing the health history of each family member. The health
history determines current health status based on significant past health history.
The second type of interview is collecting data by personally asking
significant family members or relatives questions regarding health, family life
experiences and home environment to generate data on what wellness condition
and health problems exist in the family. Productivity of the interview process
depends upon the use of effective communication techniques to elicit the needed
responses.
 METHODS OF DATA COLLECTION CONT…
D) Record Review:
Reviewing existing records and reports pertinent to the
client. (Individual clinical records of the family members;
laboratory & diagnostic reports; immunization records; reports
about the home & environmental conditions.
E) Laboratory/Diagnostic Tests:
Performing laboratory tests, diagnostic procedures or
other tests of integrity and functions carried out by the nurse herself
and/or other health workers.
 ASSESSMENT OF HEALTH PROBLEMS

1)Health Deficits
• Health deficits refer to instances of failure in health maintenance
and development. Health deficits includes:-
• Diagnosed/ suspected illness states of family members
• Sudden or premature or untimely death illness or disability and
failures to adapt reality of life emotional control and stability.
• Deviations in growth and development
• Personality disorders.
 ASSESSMENT OF HEALTH PROBLEMS
CONT..

2)Health Threats Practices

Health threats refers to conditions which predispose to disease,
accident, poor or retarded growth and development and personality
disorder and a failure to realize one’s health potentials. These situations
are incomplete immunization among children, environmental hazards,
poverty, family history of chronic illness, eg., diabetes
3) Foreseeable Crisis or Stresses
Foreseeable crisis situations or stress points, refers to
anticipated periods of unusual demands on the individual or the family
in terms of adjustment or family resources. These demands may be
pregnancy, retirement from work and adolescence. Though these
conditions are expected but still lead to various types of crisis in
family.
ASSESSMENT OF FAMILIES

1. Assessment of environmental condition

2. Health status assessment
3. Family health practices
4. Family lifestyle
 ASSESSMENT OF FAMILIES CONT…
• Assessment of environmental condition:
The environment of the family home should be
examined carefully, the type of house, hygienic conditions,
facilities available and safety factors.
• Health status assessment:
The physical and emotional health status assessment
must be done for all family members by using the available
assessment tools. Each family member should be evaluated
even if she/he is not primary person whom you are seeing. Eg.,
name, age, sex, height, weight, immunization, developmental
stages; health history and current health history.
 ASSESSMENT OF FAMILIES CONT….
• Family health practices:
Finding out their practices towards healthy living of
nutritional status, sleeping pattern, exercises, rest and
alcoholism, smoking, etc. use of health facilities. The type and
ways in which a family uses health resources and providers
give the information about health, will make community health
nurse aware of their health practices about their strengths and
weaknesses.
• Family lifestyle:
Observe and describe family’s interrelationship and
communication pattern. Try to identify the role of each family
members, patterns of decision making and family’s attitude
towards health care.
ASSESSMENT OF HEALTH RISK FAMILIES

• Assessment of health risk families

Health risk families are those who experience a

particular event or other events of any disease repeatedly,
that make them more prone towards physical,
psychological and environmental response.
 ASSESSMENT THROUGH FAMILY
• Health records:
The family information can also be collected through family
records. Family records are important sources of all family members’ health
information. The previous family records and reports are important means to
gather information about family.
• Clinics:
The family members coming to health centers to attend the clinics
for medical care can also contribute to identify the health risk. Community
health nurse can make observation and relate to the present health situation.
• Observation:
In community health nursing, certain situations need direct
observation. It is important to get acquainted with family environment along
with patient, and many things can be learnt by observation, eg. In a family
how mother holds the infant.
• Physical health assessment:
Community health nurse may require to do physical examination of
each family member to find individual’s physical state of health. This may help
her early diagnosis and treatment and appropriate referral.
3.PLANNING FOR NURSING ACTION

• Goal setting and selection of appropriate

strategy
A good assessment will make the selection of
appropriate goals and strategies easier. Families determine the
degree of change required. Often people can easily identify
their own goals. However community health nurse has to assist
in making a clear goal statement by achievable means. Be sure
that neither community health nurse nor families are too
ambitious. Goal should be clear and concise statement. Clearly
written goals give a sense of direction in how to proceed in the
care of the family. This increases the self confidence and trust
and confidence of the family in you and your ability to provide
care.
 3.PLANNING FOR NURSING ACTION
CONT….
• Formulation of nursing diagnosis
Once assessment is complete, review all the data, compile the
risk factors and formulate nursing diagnosis. Since assessment is an ongoing
process, it should be periodically reviewed, deleted and revised as per need.
It is important to look at assessment data in totality and compile as overall
functioning and health of the family.
The final step of family assessment is formulation of nursing
diagnosis. The nurse, who practices in the community just like those
practicing in other health care settings, formulates nursing diagnosis based
on assessment data with complete data available. She can formulate more
accurate and scientific diagnosis. This forms the foundation for development
of a health care plan.
• Resources available
Availability of health related resources and financial resources
used by family members. Sometimes families need help in identifying these
resources; they may not define as broad as community health nurse can do.
Discussing the family’s financial status may be difficult initially, and family
may be reluctant to disclose their finances, to a stranger.
4.IMPLEMENTING THE PROGRAMME

Implementation of nursing process in family health care is

foundation of nursing practice. Nurse uses family health care process
to promote the health of families and differentiate from work with
individual events. Implementing the health care requires home visits,
working closely with families, community leaders, health workers,
and other related agencies like social welfare and educational
institution, etc. for comprehensive system to care.
As the implementation process goes on, it may be
necessary to change or omit certain strategies according to situation.
Nurse can also facilitate the growth of the well- planned programme.
Family’s satisfaction serves as the stimulus for adding further goal.
Sometimes nurse observes the family’s readiness and raises the
possibility of care.
5.EVALUATION OF PROGRAMME
ACTION

Evaluation is not an end to family health care programme,

it is continuing process integrated in the other phases. The ultimate
goal of community health nurse is for the family to be self- supporting
and independent in identifying the presence or absence of preventive
health behavior and skills in determining strategies and using
appropriate resources. The evaluation is based on the set objectives
for family. For success in evaluation, it is better to involve family in
setting the objectives to bring the desired changes in attitude.
The nurse should observe for change in attitude during and
after the intervention of care. If she notices the failure brings to the
desired change, then she needs to go back to reset the objective,
replan and reimplement the programming.
 THE NURSING CARE PLAN
 The family care plan –
Family care plan is the blueprint of the care that the nurse designs
to systematically minimize or eliminate the identified health and family
nursing problems through explicitly formulated outcomes of care ( goals
and objectives) and deliberately chosen of interventions, resources and
evaluation criteria, standards, methods and tools.
 Qualities of a nursing care plan
• It should be based on clear, explicit definition of the problems. A good
nursing plan is based on a comprehensive analysis of the problem situation.
• A good plan is realistic.
• The nursing care plan is prepared jointly with the family. The nurse
involves the family in determining health needs and problems, in
establishing priorities, in selecting appropriate courses of action,
implementing them and evaluating outcomes. The nursing care plan is most
useful in written form.
 NURSING CARE PLAN CONT…

 The importance of planning care

• They individualize care to clients.
• The nursing care plan helps in setting priorities by providing
information about the client as well as the nature of his problems.
• The nursing care plan promotes systematic communication among
those involved in the health care effort.
• Continuity of care is facilitated through the use of nursing care plans.
Gaps and duplications in the services provided are minimized, if not
totally eliminated.
• Nursing care plans, facilitate the coordination of care by making
known to other members of the health team what the nurse is doing.
NURSING CARE PLAN CONT…

 Steps in developing a family nursing care plan

• The prioritized condition/s or problems based on:
• nature of condition or problem
• modifiability
• preventive potential
• salience
NURSING CARE PLAN CONT…

• The goals and objectives of nursing care

• Expected Outcomes:
• Conditions to be observed to show problem is
prevented, controlled, resolved or eliminated.
• Client response/s or behavior
• Specific, Measurable, Client-centered
Statements/Competencies
 NURSING CARE PLAN CONT…

• The plan of interventions

• Decide on:
• Measures to help family eliminate:
• Barriers to performance of health tasks
• Underlying cause/s of non-performance of health tasks
• Family-centered alternatives to recognize/detect, monitor, control or
manage health condition or problems
• Determine Methods of Nurse-Family Contact
• Specify Resources Needed
• The plan for evaluating
• Criteria/Outcomes Based on Objectives of Care
• Methods/Tools
 ROLES OF FAMILY NURSING
The roles of health care nurses are evolving along with the
specialty. Each health care setting affects roles that nurses assume
with families, and many of these roles may occur in the same setting
as well.
• Health teacher:
The family nurse teaches about family wellness, illness,
relations, and parenting, to name a few. The teacher educator
function is ongoing in all settings in both formal and informal ways.
• Coordinator, collaborator, and liaison.
The family nurse coordinates the care that families receive,
collaborating with the family to plan care.
ROLES OF FAMILY NURSING CONT…

• Deliverer and supervisor of care and technical expert.

The family nurse either delivers or supervises the
care that families receive in various settings. To do this, the
nurse must be a technical expert in terms of both knowledge
and skill.
• Family advocate.
The family nurse advocates for families with whom
they work; the nurse empowers family members to speak with
their own voice or the nurse speaks out for the family.
ROLES OF FAMILY NURSING CONT…

• Consultant.
The family nurse serves as a consultant to families
whenever asked or whenever necessary. In some instances, he
or she consults with agencies to facilitate family centered care.
• Counselor.
The family nurse plays a therapeutic role in helping
individuals and families solve problems or change behavior.
• Case finder and epidemiologist.
The family nurse gets involved in case finding and
becomes a tracker of disease.
ROLES OF FAMILY NURSING CONT….

• Environmental modifier.
The family nurse consults with families and other health
care professionals to modify the environment.
• Clarifier and interpreter.
The family nurse clarifies and interprets data to families
in all settings.
• Surrogate.
The family nurse serves as a surrogate by substituting
for another person. For example, the nurse may stand in
temporarily as a loving parent to an adolescent who is giving
birth to a child by herself in the labor and delivery room.
ROLES OF FAMILY NURSING CONT….
• Researcher.
The family nurse should identify practice problems and find the
best solution for dealing with these problems through the process of
scientific investigation.
• Role model.
The family nurse is continually serving as a role model to
other people through his or her activities. A school nurse who
demonstrates the right kind of health in personal self-care serves as a
role model to parents and children alike.
• Case manager.
Although case manager is a contemporary name for this
role, it involves coordination and collaboration between a family and
the health care system. The case manager has been formally
empowered to be in charge of a case.
 SUMMARY
AND
CONCLUSION :
 REFRENCES
• Shirely May Harmon Hanson. Family Health Care Nursing- theory, practice
& research 3rd edition. New Delhi: Jaypee brothers; 2007
• BT Basavanthapa, “Community Health Nursing”, 2nd edition, chapter-6,
Family Health Nursing, published by Jaypee Brothers Medical publishers,
2008, page no.-108-136.
• Marcia Stanhope and Jeanette Lancaster, “Foundations of Nursing in the
Community” (community- Oriented Practice), 2nd edition, chapter-18,
Family Development and Family Nursing Assessment, published by Mosby
Elsevier, page no. - 321-339.
• Sunita Patney, “Textbook of Community Health Nursing”, First edition,
Chapter – 8, Family Health Care, published by Modern Publishers, 2005,
page no: 88-103.
• Krishna Kumari Gulani, “Community Health Nursing (Principles and
Practices)”, 1st Edition, Chapter-11, Maternal and Child Health, published by
Kumar Publishing House, 2005, page no.: 354 – 366.
Universal Health Care
The Philippine journey towards
accessing quality health services without financial hardship

Albert Francis Domingo, MD MSc

Consultant for Health Systems Strengthening
Office of the WHO Representative to the Philippines
Email: [email protected]

22 January 2019 | Manila, Philippines

What is Universal Health Coverage/Care?

• All people having access to quality health services*

without suffering the financial hardship associated
with paying for care
– All people (population coverage)
– having access to quality health services (service coverage)
– without suffering financial hardship associated with paying
for care (financial risk protection)

*including prevention, promotion, treatment, rehabilitation and palliation

22 January 2019 | Manila, Philippines

 Healthy population

Population at risk

Population with sickness

People needing
rehabilitation

Sick that need Sick

hospitalization
and
but have no
Hospitalized
Senate Committees on Health and Demography, Waysaccess
and Means, toandhospital
Finance
care
1 February 2018 | Cebu City, Philippines
The Continuum of Care Interventions

Primary Prevention:
Risk
Health Risk contact Reduce risk exposure
exposure

Financing, Stewardship
Resource Generation,
Secondary
Early Prevention:
Disease Latent
progression disease/ disease/injury Detect
injury and intervene early

Tertiary Prevention:
Chronic
Advanced Reduce progress or
Disease or Death complications of
disease/injury
impairment established disease

22 January 2019 | Manila, Philippines

 (Berman, 2012)

22 January 2019 | Manila, Philippines

 T? W
?
AT?
H A O TH
W H
SO

Across ALL conditions

Building blocks of health systems (especially the
linkages) are areas for adjustment of policy

People-Centred Health Care Services

Health Resource Essential Health
workforce generation and medicines, information
health commodities system
financing and
technologies
Good Governance

22 January 2019 | Manila, Philippines

What is your UHC road map?

Effective Services

Regulatory Environment
UHC Index, etc.

Incentives

22 January 2019 | Manila, Philippines

CORE CONSIDERATIONS FOR
THE PHILIPPINES
22 January 2019 | Manila, Philippines
What should be the roles and
responsibilities of the major institutions?

LGUs DOH PhilHealth

Private Sector Providers

22 January 2019 | Manila, Philippines
 How can we reduce out of pocket payments?
Financing Agents for Health Care Services (National Health Accounts)
Households PhilHealth DOH LGUs HMOs Other NGAs Private insurance GSIS, SSS
100% 1.3 1.8 …
2.5 2.8 2.4
7.8 5.3 5.4

7.1 6.8 7.1

Share in Health Expenditures

7.8 9.0 10.0

75%

16.0 17.9 17.4

50%

25%
55.7 54.8 54.2

0%
2014 2015 2016

22 January 2019 | Manila, Philippines

 Who does what to deliver health services?
State/government: per Sec. 17, RA 7160 – LGC; DOH standards
LGU Minimum Basic Health Services and Facilities
Barangay Health and social welfare services which include maintenance of
barangay health center and day-care center
Municipality Health services which include the implementation of programs and
projects on primary health care, maternal and child care, and
communicable and non-communicable disease control services,
access to secondary and tertiary health services; purchase of
medicines, medical supplies, and equipment needed to carry out
the services herein enumerated
Province health services which include hospitals and other tertiary health
services
City All the services and facilities of the municipality and province
Non-state: private facilities, regulated by the DOH (HFSRB, etc.)

22 January 2019 | Manila, Philippines

The mandate to consolidate
Local government units may group themselves, consolidate or
coordinate their efforts, services, and resources for purposes
commonly beneficial to them in accordance with law.
(Sec 13, Art X, 1987 Constitution)

The national government or the next higher level of local

government unit may provide or augment the basic services and
facilities assigned to a lower level of local government unit when
such services or facilities are not made available or, if made
available, are inadequate to meet the requirements of its
inhabitants.
(Sec 17f, Ch II, Title I, Book 1, Local Government Code)
22 January 2019 | Manila, Philippines
How can decentralization work for UHC?
• Need to clearly identify the role delineation between national
and local governments
• Need to consolidate local governments to reduce
inefficiencies and transactions cost in health: through referral
systems, pooling of resources, complementation with other
social services
• Need to adequately license, regulate, supervise and engage
private sector providers
• Need to support the devolution of powers and functions with
adequate financing (intergovernmental transfers)
• Need to institutionalize accountability mechanisms

22 January 2019 | Manila, Philippines

Moving forward: how to integrate at PHC level?

Financing

Taxes,
Including “Sin Tax”

Subsidy Premium Payments

DOH Local
Out of Pocket
Budget Government Population
Budget
PHC, Secondary,
Reimbursement Private Referral Care
Hospitals/Clinics
Pharmacies Essential Drugs
Capitation

Provincial Hospitals City Health Centers

District Hospitals Rural Health Units Primary
DOH Referral
Barangay Health Stations Health
Hospitals Care
Referral/Secondary Care

Service Delivery

15
15
Philippines: Universal Health Care legislation
(Current Situation)

• The Philippines has long instituted a National Health

Insurance Program (PhilHealth) to be the preferred single
payer for healthcare services for patients
• Essential public health functions (e.g. health promotion,
disease surveillance, quarantine) are funded by line-item
government budgets
• Service delivery is through a dual system composed of the
public sector and a strong private sector

22 January 2019 | Manila, Philippines

The Philippines uses Universal Health Care interchangeably with Universal
Health Coverage.
It has been an iterative process of health reform, ongoing for almost 50 years
and under different names:
Year Name of policy Focus area Type of
issuance
1969 Philippine Medical Care Act (Medicare) Financing Statute
1991 Local Government Code (devolution) Governance Statute
1995 National Health Insurance Act (PhilHealth) Financing Statute
1999 Health Sector Reform Agenda Policy framework Regulation
2005 FOURmula ONE (F1) for Health Strategy Regulation
2011 Kalusugan Pangkalahatan (KP/UHC) Strategy Regulation
2012 Sin Tax Reform Act of 2012 Revenue generation Statute
2013 Amendments to PhilHealth law Financing Statute
2016 Philippine Health Agenda Policy framework Regulation
2018 FOURmula ONE Plus Strategy Regulation

22 January 2019 | Manila, Philippines

 Legislative Process House of Representatives Senate
Highlighted by the President during
Preliminaries State of the Nation Address 2018
Introduction and 30 Jun 2016 – first bill (HB 225) 16 May 2017 – first bill (SB 60)
26 Jul 2016 – referred to committee 17 May 2017 – referred to committee
referral of bills
23 May 2017 – public hearing and 2 Aug 2017 – first public hearing
approval of substitute bill Feb, Mar 2018 – nationwide public
Committee level 30 May 2017 – committee report hearings
30 Jul 2018 – committee report
16, 22 Aug 2017 – sponsorship and 31 Jul 2018 – sponsorship
interpellation Aug, Sep 2018 – interpellation
22 Aug 2017 – approved on second reading 9 Oct 2018 – approved on second reading
6 Sep 2017 – approved on third 10 Oct 2018 – certified by the President for
Floor consideration immediate enactment
reading: HB 5784
10 Oct 2018 – approved on third
reading: SB 1896
Bicameral Conference Pre-bicam meetings: 23, 30 Oct 2018
Committee Bicameral Conference Committee Report ratified: 10 December 2018

Presidential action Anticipated this Q1 2019

*With direct WHO technical assistance

22 January 2019 | Manila, Philippines
Philippines: Universal Health Care legislation
(Objectives)
• The UHC bill seeks to realize universal health coverage through a systemic
approach and clear delineation of the roles of key agencies and stakeholders
• The major reforms seek to:
– consolidate existing yet fragmented financial flows
– increase the fiscal space for benefit delivery
– improve the governance and performance of devolved local health systems
– institutionalize support mechanisms such as health technology assessment
and health promotion

22 January 2019 | Manila, Philippines

22 January 2019 | Manila, Philippines
Challenges and Opportunities
• Expectations have to be managed, especially because of the upcoming
midterm elections
• Complementary bills to increase tobacco excise taxes and provide more
funds for UHC are still pending
• There are varied perspectives on the major reforms; strategic
communication is needed
• After the bill becomes law, next opportunity is to support drafting of
implementing rules and regulations

22 January 2019 | Manila, Philippines

Salient points of the UHC law

• (see Word file of the UHC law)

22 January 2019 | Manila, Philippines

 Albert Francis Domingo, MD MSc
Email: [email protected]

HEALTH AND THE

22 January ENVIRONMENT
2019 | Manila, Philippines
Division of Noncommunicable Diseases and Health through the Lifecourse
 A SEMINAR
ON
FAMILY HEALTH
NURSING

Presentation By :
Mr.Kunal Jejurkar.
(First year, MSc.
Nursing.)
 INTRODUCTION
Family health care nursing is an art and a science
that has evolved over the last 20 years as a way of
thinking about and working with families. Family nursing
comprises a philosophy and a way of interacting with
clients that affects how nurses collect information,
intervenes with patients, advocate for patients, and
approach spiritual care with families. This philosophy and
practice incorporates the assumption that health affects all
members of families that health and illness are family
events, and that families influence the process and
outcome of health care.
 TERMINOLOGY

• Family:
Two or more individuals coming from the same or
different kinship groups who are involved in a continuous living
arrangement, usually residing in the same household,
experiencing common emotional bonds, and sharing certain
obligations toward each other and toward others.

• Family health: A condition including the promotion

and maintenance of physical, mental, spiritual, and
social health for the family unit and for individual
family members.
• Family process: The ongoing interaction between
family members through which they accomplish their
instrumental and expressive tasks. The nursing process
considers the family, not the individual, as the unit of
care.

• Family centered nursing: Nursing that considers

health of the family as a unit in addition to the health
of individual family members.
 FAMILY HEALTH NURSING
• Definition and meaning of family health
nursing
Family health nursing is a nursing aspect of
organized family health care services which are directed or
focused on family as the unit care with health as the goal. It is
thus synthesis of nursing care and health care. It helps to
develop self care abilities of the family and promote, protect
and maintain its health. Family health nursing is generalized,
well balanced and integrated comprehensive and continuous are
requiring comprehensive planning to accomplish its goal.
The goals of the family health nursing include
optimal functioning for the individual and for the family as a
unit.”
 OBJECTIVES OF FAMILY HEALTH
NURSING
• The broad objectives of family health nursing are as
under:
• To identify health & nursing needs and problems of each
family.
• To ensure family’s understanding and acceptance of
these needs and problems.
• To plan and provide health and nursing services with the
active participation of family members.
• To help families develop abilities to deal with their
health needs and health problems independently.
 OBJECTIVES OF FAMILY HEALTH
NURSING CONT….

• To contribute to family’s performance of developmental

functions and tasks.
• To help family make intelligent use of promotive,
preventive, therapeutic and rehabilitative health and
allied facilities and services in the community.
• To educate, counsel and guide family members to
cultivate good personal health habits, practice safe
cultural practices and maintain wholesome physical,
psychosocial, and spiritual environment.
PRINCIPLES OF FAMILY HEALTH
NURSING
1. Provide services without discrimination
2. Periodic and continuous appraisal and evaluation of family health
situation
3. Proper maintenance of record and reports.
4. Provide continuous services
5. Health education, guidance and supervision as integral part of family
health nursing.
6. Maintain good IPR.
7. Plan and provide family health nursing with active participation of
family.
8. Services should be realistic in terms of resources available.
9. Encourage family to contribute towards community health.
10.Active participation in making health care delivery system.
 ADVANTAGES OF FAMILY HEALTH
NURSING

• Family health nursing of patients saves hospital beds that can be

utilized for critical cases.
• Family health nursing is cheaper than hospital nursing.
• Patient under family health nursing enjoys privacy and emotional
support.
• Patients on family health nursing can continue with their routine
pursuits.
• If the patient resides in a sanitary house, family health nursing is
better than hospital nursing since he can control inimical
environmental influences better.
 DISADVANTAGES OF FAMILY HEALTH
NURSING

• Family health nursing requires the nurse to carry

portable laboratory machinery to the patent’s home.

• If the patient resides in a substandard house, family

health nursing could delay his recovery.
FAMILY CENTERED NURSING
APPROCH

•The four approaches included in the family

health nursing care views are:
1.Family as the context
2.Family as the client
3.Family as a system
4.Family as a component of society
1. Family as the context
When the nurse views the family as context, the primary focus
is on the health and development of an individual member existing within a
specific environment (i.e., the client’s family).Although the nurse focuses
the nursing process on the individual’s health status, the nurse also assesses
the extent to which the family provides the individual’s basic needs. These
needs vary, depending on the individual’s development level and situation.
Because families provide more than just material essentials, their ability to
help the client meet psychological needs must also be considered. Family
members may need direct interventions themselves.
2. Family as the client
The family is the foreground and individuals are in the background.
The family is seems as the sum of individuals family members. The focus is
concentrated on each and every individual as they affect the whole family.
From this perspective, a nurse might ask a family member who has just
become ill. Tell me about what has been going on with your own health and
how your perceive each family member responding to your mother’s recent
diagnosis of liver cancer.
3. Family as a system
The focus is on the family as a client and it is viewed as an
international system in which the whole is more than the sum of its parts.
This approach focuses on the individual and family members become the
target for nursing interventions. Eg: the direct interaction between the
parent and the child. The system approach to the family always implies
that when something happens to one affected.
It is important to understand that although theoretical and
practical distinctions can be made between the family as context and the
family as client, they are not necessarily mutually exclusive, and both are
often used simultaneously, such as with the perspective of the family as
system.
4.Family as a component of society
The family is seen as one of many institutions in society,
along with health, educational, religious, or economic institution. The
family is a basic or primary unit of society, as are all the other units and
they are all a part of the larger system of society. The family as a whole
interacts with other institutions to receive exchange or give
communications and services. Community health nursing has drawn
many of its clients from this perspective as it focuses on the interface
between families and communities.
Family health nursing practice like any nursing practice
begins with the nursing process. By using this process, the nurse
practicing with family perspectives is potentially able to effectively
intervene at any of the levels. After an assessment of the individuals,
family nit, and supra system, the nurse is ready to begin to identify areas
of concern or need.
 FAMILY HEALTH NURSING PROCESS

Definition Of Family Health Nursing Process

Family health nursing process is a orderly, systematic
steps to assess the health needs, plan, implement and evaluate the
services to achieve the health. It is the systematic steps to analyze
health problems and their solutions. It helps in achieving desire goals
of health prootion,prevention and control of health problems.
Family Nursing Process
The family nursing process, suggested by these authors,
consists of the following steps adapted specifically with family as the
focus group.
(Carnevali and Thomas, 1993)
 ELEMENTS OF FAMILY NURSING
PROCESS

a) Assessment of client’s problem

b)Diagnosis of client response needs that nurse
can deal with
c) Planning of client’s care
d)Implementation of care
e) Evaluation of the success of implemented care
a) Assessment (of client’s problem)
The home health nurse assesses not only the health care
demand of the client and family but also the home and community
environment. Assessment actually begins when the nurse contacts the
client for the initial home visit and reviews documents received from
the referral agency. The goal of the initial visit is to obtain a
comprehensive clinical picture of the client’s need.
During the initial home visit, the home health nurse
obtains a health history from the client, examines the client, observe
the relationship of the client and caregiver, and assess the home and
community environment. Parameters of assessment of the home
environment include client and caregiver mobility, client ability to
perform self care, the cleanliness of the environment, the availability
of caregiver support, safety, food preparation, financial supports and
the emotional status of the client and caregiver.
b) Diagnosis (of client response needs that nurse can deal
with)
As in other care environments, the nurse identifies both actual and
potential client problems. Examples of common nursing diagnoses for home care
include Deficient Knowledge, Impaired Home Maintenance, and Risks for
caregiver Role strain. Client education is considered a skill reimbursed by
Medicare and other commercial insurance carriers, it is important for the nurse to
include Deficient Knowledge in the plan of care .The deficit in knowledge may
relate to client’s lack of information about their disease process, medications, and
self- care skills and so on.

c)Planning (of client’s care)

During the planning phase the nurse needs to encourage and permit
client’s to make their own health management decisions. Alternatives may need
to be suggested for some decisions if the nurse identifies potential harm from a
chosen course of action. Strategies to meet the goals generally include teaching
the client family techniques of care and identifying appropriate resources to
assist the client and family maintaining self-sufficiency.
 d) Implementation (of care)
To implement the plan, the home health nurse performs
nursing interventions, including teaching, coordinates and uses
referrals and resources, provides and monitors all levels of technical
care; collaborates with other disciplines and providers; identifies
clinical problems and solutions from research and other health
literature, supervises ancillary personnel, and advocates for the
client’s right to self –determination. Technical skills commonly
performed by home health nurses include blood pressure
measurement; body fluid collection (blood, urine, stool, and sputum),
wound care, respiratory care, and all types of intravenous therapy,
eternal nutrition, urinary catheterization and renal dialysis.
e) Evaluation and Documenting (of the success of
implemented care)
Evaluation is carried out by the nurse on subsequent home
visits, observing the same parameters assessed on the initial home
visit and relating findings to the expected outcomes or goals. The
nurse can also teach caregivers parameters of evaluation so that
they can obtain professional intervention if needed.
Documentation of care given and the client’s progress toward goal
achievement at each visit is essential. Notes also may reflect plan
for subsequent visits and when the client may be sufficiently
prepared for self care and discharge from the agency.
 FAMILY HEALTH ASSESSMENT
1.Establishing a working relationship
The family and nurse maintain a working
relationship. It is relationship which is maintained while
working together by developing trust, confidentiality and
empathy. These are essential components or elements to
find out the facts from families and making correct
decisions. A working relationship must have scope of two
way communication. The family members must be given
equal opportunity to give their views and ideas and
express the feelings and vice versa. The nurse must have
enough interactions with family members to guide and
help them to solve the problem.
2. Assessment of Health Needs
Assessment is a continuous process which becomes more
accurate as knowledge of people deepens.
• Family structure, characteristics & dynamics:
Include the composition and demographic data of the
members of the family/household, their relationship to the head and
place of residence; the type of, and family interaction/communication
and decision-making patterns and dynamics.
• Socio-economic & cultural characteristics:
Include occupation, place of work, and income of each
working member; educational attainment of each family member;
ethnic background and religious affiliation; significant others and
the other role(s) they play in the family’s life; and, the relationship
of the family to the larger community.
• Home and environment:
Include information on housing and sanitation
facilities; kind of neighborhood and availability of social, health,
communication and transportation facilities in the community.
• Health status of each member:
Includes current and past significant illness; beliefs
and practices conducive to health and illness; nutritional and
developmental status; physical assessment findings and significant
results of laboratory/diagnostic tests/screening procedures.
• Values and practices on health promotion/maintenance &
disease prevention:
Include use of preventive services; adequacy of
rest/sleep, exercise, relaxation activities, stress management or other
healthy lifestyle activities, and immunization status of at-risk family
members.
 METHODS OF DATA COLLECTION
A)Observation:
Method of data collection through the use of sensory capacities, sight,
hearing, smell and touch. Data gathered through this method have the advantage
of being subjected to validation and reliability testing by other observers.
B) Physical Examination:
Done through inspection, palpation, percussion, auscultation,
measurement of specific body parts and reviewing the body systems.
C) Interview:
Completing the health history of each family member. The health
history determines current health status based on significant past health history.
The second type of interview is collecting data by personally asking
significant family members or relatives questions regarding health, family life
experiences and home environment to generate data on what wellness condition
and health problems exist in the family. Productivity of the interview process
depends upon the use of effective communication techniques to elicit the needed
responses.
 METHODS OF DATA COLLECTION CONT…
D) Record Review:
Reviewing existing records and reports pertinent to the
client. (Individual clinical records of the family members;
laboratory & diagnostic reports; immunization records; reports
about the home & environmental conditions.
E) Laboratory/Diagnostic Tests:
Performing laboratory tests, diagnostic procedures or
other tests of integrity and functions carried out by the nurse herself
and/or other health workers.
 ASSESSMENT OF HEALTH PROBLEMS

1)Health Deficits
• Health deficits refer to instances of failure in health maintenance
and development. Health deficits includes:-
• Diagnosed/ suspected illness states of family members
• Sudden or premature or untimely death illness or disability and
failures to adapt reality of life emotional control and stability.
• Deviations in growth and development
• Personality disorders.
 ASSESSMENT OF HEALTH PROBLEMS
CONT..

2)Health Threats Practices

Health threats refers to conditions which predispose to disease,
accident, poor or retarded growth and development and personality
disorder and a failure to realize one’s health potentials. These situations
are incomplete immunization among children, environmental hazards,
poverty, family history of chronic illness, eg., diabetes
3) Foreseeable Crisis or Stresses
Foreseeable crisis situations or stress points, refers to
anticipated periods of unusual demands on the individual or the family
in terms of adjustment or family resources. These demands may be
pregnancy, retirement from work and adolescence. Though these
conditions are expected but still lead to various types of crisis in
family.
ASSESSMENT OF FAMILIES

1. Assessment of environmental condition

2. Health status assessment
3. Family health practices
4. Family lifestyle
 ASSESSMENT OF FAMILIES CONT…
• Assessment of environmental condition:
The environment of the family home should be
examined carefully, the type of house, hygienic conditions,
facilities available and safety factors.
• Health status assessment:
The physical and emotional health status assessment
must be done for all family members by using the available
assessment tools. Each family member should be evaluated
even if she/he is not primary person whom you are seeing. Eg.,
name, age, sex, height, weight, immunization, developmental
stages; health history and current health history.
 ASSESSMENT OF FAMILIES CONT….
• Family health practices:
Finding out their practices towards healthy living of
nutritional status, sleeping pattern, exercises, rest and
alcoholism, smoking, etc. use of health facilities. The type and
ways in which a family uses health resources and providers
give the information about health, will make community health
nurse aware of their health practices about their strengths and
weaknesses.
• Family lifestyle:
Observe and describe family’s interrelationship and
communication pattern. Try to identify the role of each family
members, patterns of decision making and family’s attitude
towards health care.
ASSESSMENT OF HEALTH RISK FAMILIES

• Assessment of health risk families

Health risk families are those who experience a

particular event or other events of any disease repeatedly,
that make them more prone towards physical,
psychological and environmental response.
 ASSESSMENT THROUGH FAMILY
• Health records:
The family information can also be collected through family
records. Family records are important sources of all family members’ health
information. The previous family records and reports are important means to
gather information about family.
• Clinics:
The family members coming to health centers to attend the clinics
for medical care can also contribute to identify the health risk. Community
health nurse can make observation and relate to the present health situation.
• Observation:
In community health nursing, certain situations need direct
observation. It is important to get acquainted with family environment along
with patient, and many things can be learnt by observation, eg. In a family
how mother holds the infant.
• Physical health assessment:
Community health nurse may require to do physical examination of
each family member to find individual’s physical state of health. This may help
her early diagnosis and treatment and appropriate referral.
3.PLANNING FOR NURSING ACTION

• Goal setting and selection of appropriate

strategy
A good assessment will make the selection of
appropriate goals and strategies easier. Families determine the
degree of change required. Often people can easily identify
their own goals. However community health nurse has to assist
in making a clear goal statement by achievable means. Be sure
that neither community health nurse nor families are too
ambitious. Goal should be clear and concise statement. Clearly
written goals give a sense of direction in how to proceed in the
care of the family. This increases the self confidence and trust
and confidence of the family in you and your ability to provide
care.
 3.PLANNING FOR NURSING ACTION
CONT….
• Formulation of nursing diagnosis
Once assessment is complete, review all the data, compile the
risk factors and formulate nursing diagnosis. Since assessment is an ongoing
process, it should be periodically reviewed, deleted and revised as per need.
It is important to look at assessment data in totality and compile as overall
functioning and health of the family.
The final step of family assessment is formulation of nursing
diagnosis. The nurse, who practices in the community just like those
practicing in other health care settings, formulates nursing diagnosis based
on assessment data with complete data available. She can formulate more
accurate and scientific diagnosis. This forms the foundation for development
of a health care plan.
• Resources available
Availability of health related resources and financial resources
used by family members. Sometimes families need help in identifying these
resources; they may not define as broad as community health nurse can do.
Discussing the family’s financial status may be difficult initially, and family
may be reluctant to disclose their finances, to a stranger.
4.IMPLEMENTING THE PROGRAMME

Implementation of nursing process in family health care is

foundation of nursing practice. Nurse uses family health care process
to promote the health of families and differentiate from work with
individual events. Implementing the health care requires home visits,
working closely with families, community leaders, health workers,
and other related agencies like social welfare and educational
institution, etc. for comprehensive system to care.
As the implementation process goes on, it may be
necessary to change or omit certain strategies according to situation.
Nurse can also facilitate the growth of the well- planned programme.
Family’s satisfaction serves as the stimulus for adding further goal.
Sometimes nurse observes the family’s readiness and raises the
possibility of care.
5.EVALUATION OF PROGRAMME
ACTION

Evaluation is not an end to family health care programme,

it is continuing process integrated in the other phases. The ultimate
goal of community health nurse is for the family to be self- supporting
and independent in identifying the presence or absence of preventive
health behavior and skills in determining strategies and using
appropriate resources. The evaluation is based on the set objectives
for family. For success in evaluation, it is better to involve family in
setting the objectives to bring the desired changes in attitude.
The nurse should observe for change in attitude during and
after the intervention of care. If she notices the failure brings to the
desired change, then she needs to go back to reset the objective,
replan and reimplement the programming.
 THE NURSING CARE PLAN
 The family care plan –
Family care plan is the blueprint of the care that the nurse designs
to systematically minimize or eliminate the identified health and family
nursing problems through explicitly formulated outcomes of care ( goals
and objectives) and deliberately chosen of interventions, resources and
evaluation criteria, standards, methods and tools.
 Qualities of a nursing care plan
• It should be based on clear, explicit definition of the problems. A good
nursing plan is based on a comprehensive analysis of the problem situation.
• A good plan is realistic.
• The nursing care plan is prepared jointly with the family. The nurse
involves the family in determining health needs and problems, in
establishing priorities, in selecting appropriate courses of action,
implementing them and evaluating outcomes. The nursing care plan is most
useful in written form.
 NURSING CARE PLAN CONT…

 The importance of planning care

• They individualize care to clients.
• The nursing care plan helps in setting priorities by providing
information about the client as well as the nature of his problems.
• The nursing care plan promotes systematic communication among
those involved in the health care effort.
• Continuity of care is facilitated through the use of nursing care plans.
Gaps and duplications in the services provided are minimized, if not
totally eliminated.
• Nursing care plans, facilitate the coordination of care by making
known to other members of the health team what the nurse is doing.
NURSING CARE PLAN CONT…

 Steps in developing a family nursing care plan

• The prioritized condition/s or problems based on:
• nature of condition or problem
• modifiability
• preventive potential
• salience
NURSING CARE PLAN CONT…

• The goals and objectives of nursing care

• Expected Outcomes:
• Conditions to be observed to show problem is
prevented, controlled, resolved or eliminated.
• Client response/s or behavior
• Specific, Measurable, Client-centered
Statements/Competencies
 NURSING CARE PLAN CONT…

• The plan of interventions

• Decide on:
• Measures to help family eliminate:
• Barriers to performance of health tasks
• Underlying cause/s of non-performance of health tasks
• Family-centered alternatives to recognize/detect, monitor, control or
manage health condition or problems
• Determine Methods of Nurse-Family Contact
• Specify Resources Needed
• The plan for evaluating
• Criteria/Outcomes Based on Objectives of Care
• Methods/Tools
 ROLES OF FAMILY NURSING
The roles of health care nurses are evolving along with the
specialty. Each health care setting affects roles that nurses assume
with families, and many of these roles may occur in the same setting
as well.
• Health teacher:
The family nurse teaches about family wellness, illness,
relations, and parenting, to name a few. The teacher educator
function is ongoing in all settings in both formal and informal ways.
• Coordinator, collaborator, and liaison.
The family nurse coordinates the care that families receive,
collaborating with the family to plan care.
ROLES OF FAMILY NURSING CONT…

• Deliverer and supervisor of care and technical expert.

The family nurse either delivers or supervises the
care that families receive in various settings. To do this, the
nurse must be a technical expert in terms of both knowledge
and skill.
• Family advocate.
The family nurse advocates for families with whom
they work; the nurse empowers family members to speak with
their own voice or the nurse speaks out for the family.
ROLES OF FAMILY NURSING CONT…

• Consultant.
The family nurse serves as a consultant to families
whenever asked or whenever necessary. In some instances, he
or she consults with agencies to facilitate family centered care.
• Counselor.
The family nurse plays a therapeutic role in helping
individuals and families solve problems or change behavior.
• Case finder and epidemiologist.
The family nurse gets involved in case finding and
becomes a tracker of disease.
ROLES OF FAMILY NURSING CONT….

• Environmental modifier.
The family nurse consults with families and other health
care professionals to modify the environment.
• Clarifier and interpreter.
The family nurse clarifies and interprets data to families
in all settings.
• Surrogate.
The family nurse serves as a surrogate by substituting
for another person. For example, the nurse may stand in
temporarily as a loving parent to an adolescent who is giving
birth to a child by herself in the labor and delivery room.
ROLES OF FAMILY NURSING CONT….
• Researcher.
The family nurse should identify practice problems and find the
best solution for dealing with these problems through the process of
scientific investigation.
• Role model.
The family nurse is continually serving as a role model to
other people through his or her activities. A school nurse who
demonstrates the right kind of health in personal self-care serves as a
role model to parents and children alike.
• Case manager.
Although case manager is a contemporary name for this
role, it involves coordination and collaboration between a family and
the health care system. The case manager has been formally
empowered to be in charge of a case.
 SUMMARY
AND
CONCLUSION :
 REFRENCES
• Shirely May Harmon Hanson. Family Health Care Nursing- theory, practice
& research 3rd edition. New Delhi: Jaypee brothers; 2007
• BT Basavanthapa, “Community Health Nursing”, 2nd edition, chapter-6,
Family Health Nursing, published by Jaypee Brothers Medical publishers,
2008, page no.-108-136.
• Marcia Stanhope and Jeanette Lancaster, “Foundations of Nursing in the
Community” (community- Oriented Practice), 2nd edition, chapter-18,
Family Development and Family Nursing Assessment, published by Mosby
Elsevier, page no. - 321-339.
• Sunita Patney, “Textbook of Community Health Nursing”, First edition,
Chapter – 8, Family Health Care, published by Modern Publishers, 2005,
page no: 88-103.
• Krishna Kumari Gulani, “Community Health Nursing (Principles and
Practices)”, 1st Edition, Chapter-11, Maternal and Child Health, published by
Kumar Publishing House, 2005, page no.: 354 – 366.