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COMMUNITY HEALTH NURSINGProf. Michael Bryann Sta.Maria-Flores BSN, RN, RM, MAN(c)

Roles of the DOH:1. Leadership in health

Serve as the national policy and regulatory institution Provide leadership in the formulation, monitoring and evaluation of the national health policies, plans and programs Serve as advocate in the adoption of health policies, plans and programs

2. Enabler and capacity builder Innovate new strategies in health Exercise oversight functions and monitoring and evaluation of national health plans, program and policies Ensure the highest achievable standards of quality health care, promotion and protection

3. Administrator of specific services Manage selected national health facilities and hospitals with modern and advanced facilities Administer direct services for emergent health concerns that require new complicated technologies

Vision: The DOH is the leader, staunch advocate and model in promoting Health for All in the PhilippinesMission: Guarantee equitable, sustainable quality health for all Filipinos, especially the poor and shall lead the quest for excellence in Health.Goal: Health Sector reform Agenda (HSRA)

Rationale for HSRA: Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates Persistence of large variations in health status across population groups and geographic areas High burden from infectious diseases Rising burden from chronic and degenerative diseases Unattended emerging health risks from environmental and work related factors Burden of disease is heaviest on the poor

Framework for the Implementation of HSRA: FOURmula One for HealthGoals of FOURmula ONE for Health:

1. Better health outcomes2. More responsive health systems3. Equitable health care financing

Elements of the Strategy:1. Health financing – to foster greater, better and sustained investments in health2. Health regulation – to ensure quality and affordability of health goods and services3. Health service delivery – to improve and ensure the accessibility and availability of basic and essential health care in both public and

private facilities and services4. Good governance – to enhance health system performance at the national and local levels

Roadmap for All Stakeholders in Health: National Objectives for Health 2005 – 2010National Objective for Health: sets the target and the critical indicators, current strategies based on field experience, and laying down new avenues for improved interventions. Objectives of the Health Sector:

Improve general health status of the population Reduce morbidity and mortality from certain diseases Eliminate certain diseases as public health problems Promote healthy lifestyle and environmental health Protect vulnerable groups with special health and nutrition needs Strengthen national and local health systems to ensure better health service delivery Pursue public health and hospital reforms Reduce the cost and sure the quality of essential drugs Institute health regulatory reforms Strengthen health governance and management support systems Institute safety nets for the vulnerable and marginalized groups Expand the coverage of social health insurance Mobilize more resources for health Improve efficiency in the allocation, production and utilization of resources for health

PRIMARY HEALTH CARELOI 949 – signed by President Marcos with an underlying theme: “Health in the Hands of the People by 2020”

Concept of PHC - characterized by partnership and empowerment of the people that shall permeate as the core strategy in the effective provision of essential health service that are community based, accessible, acceptable and sustainable at a cost which the community and the government can afford

Elements/Components of Primary Health Care:Education for HealthLocally Endemic and Communicable Disease Control and TreatmentExpanded Program on ImmunizationMaternal and Child Health and Family PlanningEssential drugsNutritionTreatment (Medical care and Emergency treatment)Sanitation of the Environment

Strategies of Primary Health Care1. Reorientation and reorganization of the national health care system

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2. Effective preparation and enabling process for health action at all levels3. Mobilization of the people to know their communities and identifying their basic health needs4. Development and utilization of appropriate technology 5. Organization of communities6. Increase opportunities for community participation 7. Development of intra-sectoral linkages 8. Emphasizing partnership

Four Cornerstones/Pillars in Primary Health Care1. Active community participation2. Intra-intersectoral linkages3. Use of appropriate technology4. Support mechanism made available

Types of Primary Health Care workers depend upon: Available health manpower resources Local health needs and problems Political and financial feasibility

Two levels of primary health care workers:1. Village or Barangay Health workers2. Intermediate level health workers

Levels of Health Care and Referral System1. Primary level of Care – health care provided by center physicians, PHN, Rural Health Midwives, barangay health workers and others at the

barangay health station and rural health units2. Secondary level of care – given by physicians with basic health training; given in health facilities which are privately owned or government

operated such as infirmaries, municipal and district hospitals and OPD of provincial hospitals; serves as the referral center for primary health facilities

3. Tertiary level of care – care rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals and specialized hospitals

Functions of the PHN:1. Management function2. Training Function3. Supervisory function4. Health care provider/ Nursing care function5. Health promotion and education function6. Collaborating and coordinating function7. research function

COMMUNITY HEALTH NURSING PROCESSAssessment

Initiate contact Demonstrate caring attitudes Mutual trust and confidence Collect data from all possible sources Identify health problems Assess coping ability Analyze and interpret data

Planning Nursing Action Prioritize needs Establish goals based on needs Construct action and operation plan Develop evaluation parameters Revise plan as needed

Implementation of planned care Put nursing care plan to action Coordinate care/ services Utilize community resources Delegate Supervise/monitor health services provided Provide health education and training Document responses

Evaluation of Care and Services Rendered Nursing audit Care outcomes Performance appraisal Estimate cost benefit ratio Re-assessment of problems Identify needed alterations Revise plans as necessary

NURSING PROCEDURES

Clinic visit – patient visits the Health center to avail of the services thereto offered by the facility primarily for consultation on matters that ailed them physically

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Standard procedures performed during clinic visits:I. Registration/ Admission

1. Greet client and establish rapport2. Prepare the family record or retrieve records of old clients3. Elicit and record the client’s chief complaint and clinical history4. Perform physical examination on the client and record it accordingly

II. Waiting time1. Give priority numbers to clients2. Implement the “first come, first served” policy except for emergency cases

III. Triaging1. Manage program-based cases (like the IMCI)2. Refer all non-program based cases to the physician3. Provide first aid treatment to emergency cases and refer to the next level when necessary

IV. Clinical evaluation1. Validate clinical history and physical exam2. Nurse arrives at evidence-based diagnosis and provides rational treatment based on DOH programs3. Inform the client on the nature of the illness, appropriate treatment and prevention and control measures

V. Laboratory and other diagnostic examinations1. Identify a designated referral laboratory when needed

VI. Referral system1. Refer patient if he needs further management following the 2-way referral system2. Accompany the patient when an emergency referral is needed

VII. Prescription/dispensing1. Give proper instructions on drug intake

VIII. Health education1. Conduct one-on-one counseling with the patient2. Reinforce health education and counseling messages3. Give appointments for the next visit

Blood pressure measurementProcedure:

1. Preparatory phase Introduce self to client Make sure client is relaxed and has rested for at least 5 minutes Explain the procedure Assist to a seated or supine position

2. Applying the BP cuff and stethoscope Bare client’s arm Apply cuff around upper arm 2-3 cm above brachial artery Keep manometer at eye level Keep arm level with his heart by placing it on a table or a chair arm or by supporting it Palpate brachial pulse correctly just below or slightly medial to the antecubital area3. Obtaining the BP reading by using palpatory method While palpating the brachial or radial pulse, close valve or pressure bulb and inflate cuff until pulse disappears Note point at which pulse disappeared – palpated systolic BP Deflate cuff fully Wait 1-2 minutes before inflating cuff again

Obtaining the BP reading by auscultation Place earpieces of stethoscope in ears and stethoscope head over the brachial pulse Use the bell of the stethoscope to auscultate pulse Watching the manometer, inflate the cuff rapidly by pumping the bulb until the column reaches 30 mmHg above the palpatd SBP Deflate the cuff slowly at a rate of 2-3 mmHg per beat While the cuff is deflating, listen for pulse sounds (Korotkoff sounds) (1st clear tapping sound – Systolic BP and disappearance of sound –

Diastolic BP4. Recording BP and other guidelines For every visit, take the mean of 2 reading, obtained at least 2 minutes apart If first visit, repeat procedure with other arm. Subsequent BP readings should be performed on the arm, with a higher BP reading

Home visit – family nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities

Purpose of Home Visit:1. To give nursing care to the clients2. To assess living conditions of the patient and his family and their health practices3. To give health teachings regarding prevention and control of diseases4. To establish close relationships between the health agencies and the public 5. To make use of the inter-referral system and to promote the utilization of community services

Principles involve in Preparing for a Home visit:1. Must have a purpose or objective

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2. Should make use of all available information about a patient3. Should consider and give priority to needs of clients4. Should involve the clients5. Should be flexible

Guidelines to consider regarding the Frequency of Home Visits1. Needs of the client2. Acceptance of the family3. Policy of a specific agency4. Other health agencies and personnel involved in care of family5. Past services given to families6. Ability of clients to recognize own needs

Steps in conducting home visits

1. Greet the patient and introduce yourself2. State the purpose of the visit3. Observe the patient and determine the health needs4. Put the bag in a convenient place then proceed to perform the bag technique5. Perform nursing care needed and give health teachings6. Record all important data, observation and care rendered7. Make an appointment for a return visit

Bag Technique: too by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort

Public Health Bag: an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits

Principles of Bag Technique:1. Minimize, if not prevent the spread of infection2. Saves time and effort of the nurse3. Should show effectiveness of total care given to an individual or family4. Can be performed in a variety of ways

Important points to consider in the use of the bag technique:1. The bag should contain all necessary articles, supplies and equipments that will be used2. The bag and its contents should be cleaned very often, supplies replaced and ready for use anytime3. The bag and its contents should be well-protected from contact with any article in the paitent’s home.4. The arrangement of the contents of the bag should be the one most convenient for the user, to facilitate efficiency and avoid confusion

Nursing care in the Home

Principles in Nursing Care:1. Nursing care utilizes a medical plan of care and treatment2. Performance of nursing care utilizes skills that would give maximum comfort and security to the individual3. Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family4. Performance of nursing care should recognize dangers in the patient’s over-prolonged acceptance of support and comfort5. Nursing care is a good opportunity for detecting abnormal signs and symptoms, observing patients attitude towards care given and the

progress of the patient

COMMUNITY ORGANIZINGMaglaya DOH1. Preparatory Phase Community Analysis2. Organizational Phase Design and Initiation3. Education and training Implementation 4. Collaboration Phase Program Maintenance-

Consolidation 5. Phase Out Dissemination

Reassessment

1. Community analysis5 components

Demographic, social and economic profile of the community derived from secondary data Health risk profile Health/wellness outcome profile Survey of current health promotion programs Studies conducted in certain target groups

Steps in community analysis Define the community Collect data Assess community capacity Assess community barriers Assess readiness for change Synthesis of data and set priorities

2. Design and initiation Establish a core planning group and select a local organizer Choose an organizational structure Identify, select and recruit organizational members Define the organization mission and goals Clarify roles and responsibilities of people involved in the organization

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Provide trainings and recognition

3. Implementation Generate broad citizen participation Develop a sequential work plan Use comprehensive integrated strategies Integrate community values

4. Program maintenance – consolidation Integrate intervention activities into community networks Establish a positive organizational structure Establish an ongoing recruitment plan Disseminate results

5. Dissemination – reassessment Update the community analysis Assess effectiveness of interventions/programs Chart future directories and modifications Summarize and disseminate results

GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS

Community Diagnosis: an in-depth process of finding out the profiles, health status of the community and the factors affecting the present status

Contents:1. Introduction

1.1 Rationale – accurate, valid, timely and relevant information on the community profile and health problems are essential so that resources can be maximized

1.2 Purpose – to analyze the data in order to develop responsive intervention strategies that address the root cause of the problem1.3 Statement of Objective – what are to be accomplished to attain the study1.4 Methodology and tool used – a description of the adoption, construction and administration of instruments1.5 Limitation of the study – state any limitations that exist in the reference or given population or area of assignment

2. Target Community Profile2.1 Geographical Identifiers – historical background, location, boundaries, population, physical features, climate, spot map2.2 Population Profile – Total estimated population of Barangay, Population Density, 2.3 Socio-demographic Profile – total population of families surveyed, number of households, age and sex distribution, sex ratio,

dependency ratio, civil status, types of families, religious distribution, place of origin, length of residency2.4 Socio-economic indicators – educational attainment, literacy rate, occupation, income, housing, ventilation2.5 Environmental indicators – Water supply, excreta disposal, garbage disposal, pet ownership, domestic animals2.6 Health profile – food storage, infant feeding practices, immunization, community facilities, health seeking behaviors, communication

resource and family planning2.7 Morbidity and mortality data – leading cause of morbidity, mortality, infant mortality and maternal mortality

3. Analysis of Data3.1 Identification of health problems3.2 Prioritized problems identified

4. Action plan based from prioritized problem identified4.1 Intervention strategies

5. Conclusion

6. Recommendation

Community Diagnosis1. Preparation of Community Diagnosis

a. Identify barangay to survey or required by the health centerb. Ocular surveyc. Community assembly

2. Conduct of survey proper using the format/survey forma. Random sampling or saturationb. Guidelines in filling survey formc. Data collection techniques

3. Make graph or chart of each data gathered4. Data analysis and interpretation5. Preparation of action plan /project planHEALTH PROMOTION AND EDUCATION

Ottawa charter for Health Promotion

Health promotion – process of enabling people to increase control over and to improve their health

Prerequisite for Health: Peace Shelter Education Food Income A stable eco-system

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Sustainable resources Social justice Equity

To Operationalize concept of health promotion, the Charter recommended the following action ares: Build Health Public policy Create supportive environment Strengthen community action Develop personal skills Reorient health services

WHO Principles of Health Promotion:1. Involves the population as whole in the context of their everyday life2. It is directed towards actions on the determinants or causes of health3. It combines diverse, but complementary methods or approaches4. It aims particularly at effective and concrete public participation5. It is primarily a societal and political venture and not a medical service

Health Education – any combination of learning experience designed to facilitate voluntary adoptions of behaviors conducive to health

EPIDEMIOLOGYEpidemiology: study of occurrences and distribution of diseases as well as the distribution and determinants of health state or events in a specified population, and the application of this study to the control of health problems

Uses of Epidemiology:1. Study the history of the health population and the rise and fall of diseases and changes in their character2. Diagnose the health of the community3. Study the work of health services with a view of improving them4. Estimate the risk of disease, accident, defects and the chances of avoiding them5. Identify syndromes by describing the distribution and association of clinical phenomena in the population6. Complete the clinical picture of chronic disease and describe their natural history7. Search for causes of health and disease by comparing the experience of groups

Epidemiologic triangle: Agent, Host and EnvironmentAgents of disease:

Nutritive elements in excess or in deficiencies Chemical agents Physical agents Infectious agents

Host Factors (intrinsic factors) – influence exposure, susceptibility or response to agents Genetics Age Sex Ethnic group Physiologic functioning Immunologic experience Inter-current or pre-existing disease Human behavior

Environmental factors (extrinsic factors) - influence existence of the agent, exposure or susceptibility to agents Physical environment Biologic environment Socio-economic environment

Preventive strategies :1. Change the people’s behavior to manipulate the environment and reduce their exposure to biological and non-biological disease agents2. manipulate the environment and prevent production or presence of disease agents3. Increase man’s resistance or immunity to disease agentsPatterns of Occurrence and Distribution of Disease:1. Sporadic occurrence – intermittent occurrence of a few isolated and unrelated cases in a given locality2. Endemic occurrence – continuous occurrence throughout a period of time3. Epidemic occurrence – unusually large number of cases in a relatively short period of time4. Pandemic – simultaneous occurrence of epidemic of the same disease in several countriesOutline of Plan for Epidemiological Investigation:1. Establish fact of presence of epidemic2. Establish time and space relationship of the disease3. Relations to characteristic of the group of community4. Correlation of all data obtainedSteps in Outbreak Investigation:1. Prepare for field work2. Establish existence of an outbreak3. Verify diagnosis4. Define and Identify cases5. Perform descriptive epidemiology6. Developing hypotheses7. Evaluate hypotheses8. Refine hypotheses and execute additional studies9. implement control and prevention measures10. Communicate findings

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11. Follow-up RecommendationsNational Epidemic Sentinel Surveillance System (NESSS)

Hospital based information system that monitors the occurrence of infectious diseases with outbreak potential Serves as a supplemental information system of the Dept of HealthObjectives:

To provide early warning on occurrence of outbreaks To provide program managers, policy makers, and public administrators, rapid, accurate and timely information so that inventive and

control measures can be institutedNESS DATA shows:

Trends of cases across time Demographic characteristics of cases Estimates of case fatality ratio Clustering of cases in a geographical area Information to formulate hypotheses for disease causation

Diseases under surveillance (NESSS)Laboratory diagnosed

Cholera Hepatitis A Hepatitis B Malaria Typhoid fever

Clinically diagnosed Dengue Hemorrhagic fever Diphtheria Measles Meningococcal disease Neonatal tetanus Non-neonatal tetanus Pertussis Rabies Leptospirosis Poliomyelitis

Under surveillance system:1. Acute flaccid paralysis2. Measles3. Maternal and neonatal tetanus4. Paralytic shellfish poisoning5. Fireworks and related injury6. HIV/AIDS

Importance of outbreak investigation: Control and prevention measure Severity and risk to others Research oppurtunities Public, political or legal concerns Program consideration Training

Sources: Surveillance data Medical practitioner Affected persons/ groups Concerned citizens Media

Functions of the Epidemiology Nurse:1. Implement public health surveillance2. Monitor local health personnel conducting disease surveillance3. Conduct and/ or assist other health personnel in outbreak investigation4. Assist in the conduct of rapid surveys and surveillance during disasters5. Assist in the conduct of surveys, program evaluations and other epidemiologic studies6. Assist in the conduct of training course in epidemiology7. Assist the epidemiologist in preparing the annual report and financial plan8. Responsible for inventory and maintenance of epidemiology and surveillance unit equipment

VITAL STATISTICS Systematic study of vital events such as births, illnesses, marriages, divorces, separation and deathsUse of Vital Statistics: Indices of the health and illness status of a community Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and servicesSources of Data: Population census Registration of vital data Health survey Studies and researchRate – shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specified unit of timeRatio – used to describe the relationship between 2 numerical quantities or measures of events without taking particular considerations to the time of placeCrude or general rates – referred to the total living populationSpecific rate – the relationship is for a specific population class or groupPresentation of Data:

Line or curved graphs – shows peaks, valleys and seasonal trends

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Bar graphs – for comparison of data Area diagram or pie charts – shows relative importance of parts to the whole

Functions of the Nurse: Collects data Tabulates data Analyzes and interprets data Evaluates data Recommends redirection and or strengthening of specific areas of health programs as needed

FIELD HEALTH SERVICES AND INFORMATION SYSTEMObjectives:

To provide summary of data on health service delivery and selected programs To provide data which can be used for program monitoring and evaluation purposes To provide a standardized, facility level data base which can be accessed for a more in-depth study To ensure that the data reported are useful and accurate To minimize recording and reporting burden at the service delivery level

Components:1. Family treatment record – fundamental building block or foundation of the FHSIS2. Target client list – second building block3. Reporting forms4. Output reports

Reporting Units: Barangay Health Stations/ Barangay Health Centers Rural Health Units or Main Health Center Provincial hospital or City Health Office Regional Hospital

SCHOOL NURSINGObjectives: To promote and maintain the health of the school populace by providing comprehensive and quality nursing careFunctions:

1. School Health and Nutrition Survey2. Putting up a functional School Clinic3. Health assessment4. Standard vision testing for school children5. Ear examination6. Ht and wt measurement and nutritional status determination7. Medical referrals8. Attendance to emergency cases9. Student health counseling10. Health and nutrition education activities11. Organization of School-Community Health and Nutrition Councils12. Communicable disease control13. Establishment of Data bank on school health and nutrition activities14. School plant inspection15. Rapid classroom inspection16. Home visitation

OCCUPATIONAL HEALTH NURSINGPrimary focus: Mission of occupational health and safety is “to assure every working man and woman in the country is safe and in healthful working conditions”Essential Components:

1. Health promotion and prevention2. Worker and workplace health hazard assessment and surveillance3. Injury and illness investigation4. Primary care 5. Case management6. counseling7. Management administration8. Legal/ethical monitoring9. Research10. Community orientation

Issues in Occupational Health NursingA. Categories of Workplace Hazards

Physical hazards Chemical hazards Biologic hazards Mechanical hazards Psychosocial hazards

B. Work-related Injuries and IllnessesC. Worker’s compensation

PUBLIC HEALTH PROGRAMSFAMILY HEALTHAims to:1. Improve the survival, health and well-being of mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal and postnatal packages.2. Reduce morbidity and mortality rates for children 0-9 years.3. Reduce mortality from preventable causes among adolescents and young people.4. Reduce mortality and morbidity among Filipino adults and improve their quality of life.5. Reduce morbidity and mortality of older persons and improve their quality of lifeMaternal Health ProgramStrategic thrusts for 2005-2010

Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH. Improve the quality of prenatal and postnatal care

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Reduce women’s exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health care package to all women of reproductive age

LGUs, NGOs and other stakeholders must advocate for heatlh through resource generation and allocation for health services to be provided for the mother and the unborn

A. Antenatal RegistrationPrenatal Visits Period of Pregnancy1st visit As early as possible before 4 months

or during the 1st trimester2nd visit During the 2nd trimester3rd visit During the 3rd trimesterEvery 2 weeks After 8th month until delivery

B. Tetanus Toxoid Immunization A series of 2 doses of TT vaccination must be received by a woman one month before delivery to protect the baby from neonatal tetanus 3 booster dose shots are needed to complete the five doses following the recommended schedule to provide full protection for both mother

and child mother is then called as a “fully immunized mother”

C. Micronutrient supplementation:Vit A: 10,000 IU 2x a week starting on 4th month of pregnancyIron: 600mg/400ug tablet dailyD. Treatment of Diseases and other conditionsE. Clean and Safe Delivery1. Do a quick check upon admission for emergency signs.2. Make the woman comfortable/3. Assess the woman in labor.4. Determine the stage of labor.5. Decide if the woman can safely deliver.6. Give supportive care throughout labor.7. Monitor and manage labor. 8. Monitor closely within one hour after delivery and give supportive care.9. Continue care after one hour postpartum.10. Educate and counsel on Family Planning and provide Family Planning Method if available and decisions made by the woman.11. Inform, teach and counsel the woman on important MCH messages:

birth registration importance of breastfeeding Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth Schedule when to return for consultation for post partum visits

1st visit 1st week post partum preferably 3-5 days2nd visit 6 weeks post partum

FAMILY PLANNINGGoal: Provide universal access to family planning information and services wherever and whenever these re needed

FP Aims to contribute to: Reduced infant deaths Neonatal deaths Under-five deaths Maternal deaths

Objectives: Addresses the need to help couples and individuals

achieve their desired family size within the context of responsible parenthood and improve their reproductive health to attain sustainable development

Ensure that quality FP services are available in DOH retained hospitals, LGU managed health facilities, NGOs and private sector

Strategies: Focus service delivery to urban and rural poor Reestablish the FP outreach program Strengthen FP provision in regions with high unmet needs Promote frontline participation of hospitals Mainstream modern natural family planning Promote and implement CSR strategy

Different Family Planning Methods:1. Female sterilization2. Male sterilization3. Pills4. Male condom5. Injectibles6. Lactational amenorrhea method (LAM)7. Mucus/ Billings Method8. Basal Body temperature9. Two-day method10. Symptothermal method11. Standard days methodMisconceptions about Family Planning Methods:

Some family planning methods cause abortion Using contraceptives will render couples sterile

Vaccine

Minimum age at 1st dose

# of Doses

Minimum interval between doses

Route, Dosage, Site

Storage temp

Type/ form of vaccine

BCG Birth or anytime after birth

1 ID0.05 mlRight arm

2-8 C in body of ref

Freeze dried, live attenuated bacteria

DPT 6 weeks

3 4 weeks IM0.5 mlThigh (vastus lateralis)

2-8 C in body of ref

D – weakened toxinP – killed bacteriaT – toxin

OPV 6 weeks

3 4 weeks Oral2 dropsMouth

-15 to -25C (freezer)

Live attenuated virus

Hepa B

At birth

3 6 wks interval from 1st dose to 2nd dose, 8 wks interval from 2nd

to 3rd dose

IM0.5 mlThigh (vastus lateralis)

2-8 C in body of ref

RNA recombinant

Measles

9 months

1 SQ0.5 mlOuter part of upper arm

-15 to -25C (freezer)

Freeze dried, live attenuated virus

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Using contraceptive methods will results to loss of sexual desireCHILD HEALTH PROGRAMS

Infant and young child feeding Newborn screening Expanded program on immunization Management of childhood illnesses Micronutrient supplementation Dental health Early child development Child health injuries

National Plan iof Action for 2005-2010 for Infant and Young Child Feeding

Goal: Reduce child mortality rate by 2/3 by 2015Objective: To improve health and nutrition status of infants and young childrenOutcome: To improve exclusive and extended breastfeeding and complementary feedingKey messages on infant and young child feeding

Initiate breastfeeding within 1 hour after birth Exclusive for the first 6 months of life Complemented at 6 months with appropriate foods, excluding milk supplements Extend breastfeeding up to 2 years and beyond.

Breastfeeding benefitsTo Infants:

Provides a nutritional complete food for the young infant Strengthens infants’ immune system Safely rehydrates and provides essential nutrients Reduces infants exposure to infection Increase IQ points

To Mother: Reduces woman’s risk of excessive blood loss after birth Provides natural methods of delaying pregnancies Reduces the risk of ovarian and breast cancers and osteoporosis

To Household and the Community: Conserve funds that would be spent on breastmilk substitute Saves medical cost to families

EPI

Principles in Vaccinating Children: It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body. Measles vaccine should be given as soon as the child is 9m/o. Vaccination schedule should not be restarted from beginning even if interval exceeds recommended interval. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination. Absolute contraindications: DPT 2 or DPT3 to a child who had convulsions or shock within 3 days after DPT administration; BCG to

immunosuppressed clients Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen antibody response False contraindications: malnutrition, low-grade fever, mild respiratory infections, and other minor illnesses and diarrheaManagement of CHILDHOOD ILLNESSES

Methods: Assess the patient Classify the disease Treat the patient Counsel the patient

Color Presentation Classification of Disease Level of Management Green Mild Home CareYellow Moderate Managed at the RHUPink Severe Urgent Referral in Hospital

NUTRITION PROGRAMGoal: Improve the quality of life of Filipinos through better nutrition, improved health and increased productivityStrategies:

1. Food based interventions for sustained improvements in nutritional status2. Life-cycle approach with strategic attention to 0-3 year old children, adolescent females and pregnant/lactating women3. Geographical focus to needier areas

Programs and projects:1. Micronutrient Supplementation – “Araw ng Sangkap Pinoy”2. Food Fortification3. Essential maternal and child health service package4. Nutrition information, communication and education5. Home, school and community food production6. Food assistance includes center based complementary feeding for wasted/stunted children and pregnant women7. Livelihood assistance

ORAL HEALTH PROGRAMGoal: Reduce the prevalence rate of dental caries and periodontal diseases by the end of 2010 among general populationObjectives:

Increase proportion of Orally Fit Children under 6 y/o to 80% by 2010

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Control oral health risks among the young people Improve the oral health conditions of pregnant women by 20% and older persons by 10% every year until 2010

Classification of Oral Interventions: Preventive services Curative/treatment services Promotive services

ADOLESCENT HEALTH PROGRAM

Essential health care package for the Adolescent and Youth:1. Management of illness2. Counseling on substance abuse, sexuality and Reproductive tract infections3. Nutrition and diet counseling4. Mental health5. Family planning and responsible sexual behavior6. Dental care

ADULT MEN AND WOMEN

Essential health care package for the Adult Male and Female:1. Management of illness2. Counseling on substance abuse, sexuality and Reproductive tract infections3. Nutrition and diet counseling4. Mental health5. Family planning and responsible sexual behavior6. Dental care7. Screening and management of lifestyle related and other degenerative diseases

PHILIPPINE REPRODUCTIVE HEALTH

Main objectives: Reducing maternal mortality rate Reducing child mortality rate Halting and reversing spread of HIV/AIDS Increasing access to reproductive health information and services

10 Element of RH:1. Family planning2. Maternal and Child Health and Nutrition3. Prevention and Management of Reproductive Tract Infections4. Adolescent Reproductive Health5. Prevention and Management of Abortion and its complications6. Prevention and Management of Breast and Reproductive Tract Cancers and other gynecologic principles7. Education and counseling on Sexuality and Sexual Health8. Violence against Women and Children9. Prevention and management of Infertility and Sexual Dysfunction10. Men’s Reproductive Health

FAMILY NURSING ASSESSMENT:Steps:

1. Data Collection2. Data Analysis3. Family Nursing Diagnoses

Criteria for Prioritization of Family health problems:1. Nature of the problem2. Modifiability of the problem3. Preventive potential4. Salience

Family Nursing Care Plan: Blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problemsFeatures:

1. Focuses on actions to solve or minimize existing problems2. Product of a deliberate systematic process3. Relates to the future4. Based upon health and nursing problems5. Means to an end6. Continuous proess

Qualities:1. Based on a problem2. Realistic3. Prepared jointly with the family4. In written form

Steps in Developing FNCP1. Prioritize the Health Conditions and Problems2. Define Goals and Objectives of Care3. Select Appropriate Nursing Interventions4. Develop Evaluation Plan

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NON-COMMUNICABLE DISEASE PREVENTION AND CONTROLGoal: Reduce the toll of morbidity, disability and premature deaths due to chronic, non-communicable lifestyle related diseaseKey intervention Strategies:

1. Establishing program direction and infrastructure2. Changing environments3. Changing lifestyle4. Reorienting health services

4 Major non-communicable diseases: Cardiovascular diseases Cancer Chronic obstructive pulmonary disease Diabetes mellitus

Role of the PHN in NCD prevention and control: Health advocate – PHN promotes active community participation in NCD prevention and control; helps people towards optimal degree of

independence in decision making and in asserting their right to a safer and better community Health educator – concerned with promoting health as well as reducing behavior-induced disease, focuses on establishing or inducing

changes in personal and group attitudes and behavior that promote healthier living Health care provider Community organizer – community health development and empowerment of the people by raising their levels of awareness regarding non

communicable diseases Health trainer – provides technical assistance in the assessment of the skills of auxiliary health workers in NCD prevention and control Researcher – provides valuable information for prevention and control

Risk factor Cardio-vascular dse

Diabetes Cancer Respiratory conditions

Smoking Diet Physical inactivity

Obesity Alcohol Increased BP

Bld glucose Bld lipids

Risk Factor Key area for PreventionElevated blood lipidHigh intake of fatty foodsInadequate intake of dietary fiber

Promote proper nutrition: limit intake of fatty, salty and

preserved foods increase intake of vegetables and

fruits avoid high calorie low nutrient value

food start developing healthy habits in

childrenOverweight and obesitySedentary lifestyle

Encourage more physical activity and exercise: Moderate physical activity of at least

39 minutes for most days Integrate physical inactivity and

exercise into regular activities Encourage walking as exercise

Smoking Promote smoke-free environment: Smoking cessation for active smokers Prohibit smoking inside living areas Avoid smoke-filled places Advocate for implementation of

policies and Clean Air Act Support Policies that limit access of

youth to cigarettesExcessive use of alcohol

Discourage excessive drinking of alcoholic beverages

Hyperlipidemia, HPN, DM

Early diagnosis and prompt treatment

NATIONAL PREVENTION OF BLINDNESS PROGRAMVISION 2020: Right to Sight is global initiative to eliminate avoidable blindness by year 2020Vision: All Fililpinos enjoy the right to sight by year 2020Mission: The DOH, Local Health Units, partners and stakeholders commit to:

1. Strengthen partnership among and with stakeholders to eliminate avoidable blindness in the Philippines2. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness3. Provide access to quality eye care services for all4. Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos

Goal: Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care5 preventable/treatable conditions causing blindness:

Cataract Refractive errors and low vision Trachoma

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Onchocerciasis Childhood blindness

MENTAL HEALTH AND MENTAL DISORDERSFour Facets as public health burden:

Defined burden – burden currently affecting persons with mental disorders and is measured in terms of prevalence and other indicators such as quality of life

Undefined burden – portion of the burden relating to the impact of mental health problems to persons other than the individual directly affected

Hidden burden – refers to the stigma and violations of human rights Future burden – refers to the burden in the future relating from the aging of the population, increasing social problems and unrest inherited

from the existing burdenPointers for Having Mental Health:

Maintain good physical health Undergo annual medical exam Develop and maintain a wholesome lifestyle Avoid smoking, substance abuse and excessive alcohol Have a realistic goal in life Have a friend whom you can confide and ventilate your problems Don’t live in the past and avoid worrying about the future Live one-day at a time Avoid excessive stress Develop and sustain solid spiritual values

COMMUNITY DIAGNOSISTypes:

1. Comprehensive Community diagnosis2. Problem Oriented Community diagnosis

Steps:1. Determining Objectives2. Defining Study Population3. Determining Data to be Collected4. Data Collecting Methods5. Developing the Instrument6. Actual Data Gathering7. Data Collation8. Data Presentation9. Data Analysis10. Identifying Community Health Nursing Problems11. Priority-SettingCriteria for prioritization of COMMUNITY Problems:1. Nature of the problem2. Magnitude of the Problem3. Modifiability of the Problem4. Preventive Potential5. Social concernEnvironmental Sanitation: study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and survivalApproved types of water facilities:Level I – Point sourceLevel II – Communal faucet system or stand-postsLevel III – Waterworks System or Individual House connectionsApproved types of Toilet facilities:Level I – non-water carriages (pit latrines, reed odorless earth closet) and with water (pour flush toilets and aqua privies)Level II – on site toilet facilities water sealed and flush type with septic vault/tank disposal facilitiesLevel III – toilet facilities connected to septic tanks and/or to sewerage system to treatment plantFOOD SANITATION PROGRAMFour rights in Food Safety:

Right source Right preparation Right cooking Right storage

HOSPITAL WASTE MANAGEMENT PROGRAMPolicies:

All newly constructed/authorized and existing government and private hospitals shall prepare and implement a Hospital Waste Management (HWM) program as a requirement for registration/renewal of licenses

Use of appropriate technology and indigenous materials for HWM system shall be adopted Training of all hospital personnel involved in waste management shall be part of hospital training program Public information campaign on health and environmental hazards arising from mismanagement of hospital shall be the responsibility

of hospital administration DOH HWM guidelines/policies shall be guided by existing legislative health and environmental protection laws policies on waste

management Local ordinances regarding the collection and disposal techniques shall be institutionalized

SENTRONG SIGLA Joint effort of the DOH and LGU Aims to promote availability of quality health services in health centers and hospitals and to make these services accessible to every

Filipino Main component is the certification recognition program that develops and promotes standards for health facilities

Guiding Principles Recognition for achieving good quality shall be the main incentive in SS certification Quality improvement is an unending process Focus shall be on core public health programs that are most beneficial to the people

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Quality improvement is a partnership that empowers all stakeholders DOH shall give purposive technical assistance to targeted health facilities Assessment for certification shall involve other stakeholders in order to provide objectivity and varying perspective into the process

GOALS:Long-term: Institutionalize within the health sector the leadership, processes, knowledge, attitudes and skills and organizations to generate continuous quality improvement in health careIntermediate: To improve quality of health care in outpatient health facilities, hospitals and public health services in communitiesSpecific goal: To improve the quality of out-patient health care and of public health services in communitiesLevel and Scope of Certification:

1. Basic SS certification – minimum input, process and output standards2. Specialty awards – second level quality standards3. Award for Excellence – highest level quality standards

4 Pillars of SSM1. Quality Assurance Pillar2. Grants and Technical Assistance Pillar3. Health Promotion Pillar4. Award Pillar HERBAL MEDICINE

Herbal plant Uses Sambong Anti-edema, diuretic, anti-urolithiasisAkapulko Anti-fungal, Ringworm, athlete’s foot, scabies,

Tinea FlavaNiyug-niyogan Anti-helminthicTsaang Gubat For Diarrhea and StomachacheAmpalaya Lower blood sugar levelsLagundi For cough, fever, asthma, dysentery, colds

and pain, skin diseases, headache, rheumatism, sprain, insect bites, aromatic bath for sick patients

Ulasimang bato Lowers uric acidBayabas Washing wounds, diarrhea, toothachebawang For hypertension and toothacheYerba buena For pain, rheumatism, arthritis, cough and

cold, swollen gums, toothache, menstrual and gas pain, nausea and fainting, insect bites and pruritus

Reminders on the Use of Herbal Medicine:1. Avoid the use of insecticides2. Use a clay pot and remove cover while boiling at low heat.3. Use only the part being advocated4. follow accurate dose of suggested preparation.5. Use only one kind of herbal plant for each type of symptom or sickness.6. Stop giving the herbal medication in cases of untoward reactions.7. If signs and symptoms are not relieved after 2-3 doses, consult a doctor.

HEALTH EMERGENCY PREPAREDNESS AND RESPONSE PROGRAM

Legal mandate: Presidential Decree no. 1566. Strengthening the Philippine Disaster Control Capability and Establishing the National Program on Community Disaster Preparedness

Disaster – serious disruption of the functioning of a society, causing wide spread human, material or environmental losses which exceed the ability of the affected society to copeEmergency – as any occurrence, which requires an immediate responseHazards – any phenomenon, which has the potential to cause disruption or damage to humans and their environmentRisk – the level of loss or damage that can be predicted from a particular hazard affecting a particular place at a particular time from the point of view of the community

Classifications of disaster according to its cause:1. Natural disaster – force of nature2. Human generated/manmade disaster

Classification of disasters according to onset:1. Acute or sudden impact events2. Slow or chronic genesis

Contributing Factors to disaster occurrence and severity:1. Human vulnerability resulting from poverty and social inequality2. environmental degradation resulting from poor land use3. Rapid population growth especially among the poor

General Principles of Disaster Management1. The first priority – protection of people who are at risk2. Second priority – protection of critical resources and systems on which communities depend3. Disaster management must be an integral function of national development plans and objectives4. Disaster management relies upon an understanding of hazard risks5. Capabilities must be developed prior to impact of a hazard.6. Disaster management must be based upon interdisciplinary collaboration7. Disaster management will only be as effective as the extent to which commitment, knowledge and capabilities can be applied.

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Principles of Emergency Preparedness:1. It is the responsibility of all2. Should be woven into the community and administrative levels of both government and non-government organizations3. Emergency preparedness is an important aspect of emergency management4. Emergency preparedness is connected to other aspects of emergency management5. Should concentrate on process and people rather than documentation6. Emergency preparedness should not be done in isolation7. Emergency preparedness should not concentrate only on disasters but integrate prevention and response strategies for any scale of

emergency8. Hospitals play a very vital role in the management of emergencies9. Main objective is to decrease mortality, morbidity and to prevent disability10. Every hospital should have a regularly updated disaster plan

Purpose of the Disaster Plan:1. To Provide policy for effective response to both internal and external disaster situations2. Identify hospital capability to handle mass casualty3. Identify responsibilities of individuals and departments in the event of a disaster situation4. Identify standard operating guidelines for emergency activities and responses

NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM

RA 7719 – Blood Services Act of 1994

Objectives: To promote and encourage voluntary blood donation by the citizenry To provide adequate, safe, affordable and equitable distribution of supply of blood and blood products To mobilize all sectors of the community to participate in mechanisms for voluntary and non-profit collection of blood

Vision: Envision network of modernized national and regional blood centers operating on a fully, voluntary, non-remunerated blood donation system

Mission: Ensure adequate, safe and accessible blood supply by:a. promoting voluntary blood donation as a way of lifeb. establishing new blood service facilities and upgrading existing onesc. organizing association of blood donors and training medical practitioners on national blood use

Eligible Blood Donors must: Weigh more than 45 kg for 250ml of donated blood; 50 kg for 450ml of donated blood Be in good health Be aged 16-5 yrs of age Have BP in safe range 90-160 mmHg systolic and 60-100 mmHg diastolic Have HGB at least 12.5g/dL

BOTIKA NG BARANGAYGoal: To promote equity in health by ensuring the availability and accessibility of affordable, safe and effective quality essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas.Objectives:

To Rationalize the distribution of common drugs and medicines among intended beneficiaries To serve as mechanism for the DOH to establish partnership with LGU and Community Organizations Optimize involvement of the Barangay Health workers addressing the Health needs of the community

STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES 2006

Public health nursing – practice of nursing in local/national health departments; community health nursing practiced in the public sectorCommunity health nursing – broader than public health nursing because it encompasses “nursing practice in a wide variety of community services and consumer advocate areas and in a variety of rolesPublic health nurses – refers to nurses in the local health departments whether their official position is Public Health Nurse or Nurse or School NurseNursing service – separate and distinct unit of the local health agency which is composed of nurses, midwives and auxiliaries such as barangay health workers, nursing aides and volunteersStandard – desired and achievable level of performance against which actual practice is comparedCriterion – objective, measurable, relevant and flexible indicator related to performance, behavior, circumstances or clinical status

I. Organization and ManagementA. A nursing service is organized in a local health agency to ensure the effective delivery of nursing services and nursing component of public health programsB. The nursing service is headed by a qualified chief nurse (RA 9173)C. The nursing service has a written vision, mission, philosophy, goals and objectives.D. The nursing service formulates/reviews and implements the nursing service plan, manual of policies and nursing standards.E. The nursing service participates in planning for the health agency’s physical facilities, equipment and supplies and in monitoring their use.F. The nursing service participates in the official recruitment, selection, promotion and discharge process at all levels involving nursing personnel and in making decisions involving nurses and midwives and nursing practice.G. The Nursing service initiates/ strengthens mechanisms within the agency that enhance nursing and midwifery contribution to the overall community health goals.

II. Qualifications and Functions of the PHNA. The PHN has the professional, personal and other qualifications that are appropriate to his job responsibilities ( a graduate of BSN and a registered Nurse,RN)

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B. The PHN performs functions and activities in accordance with the dominant values of Public health nurses, within the profession’s ethicolegal framework and in accordance with the needs of the client and available resources for health care.C. The PHN, in coordination with the faculty of colleges of nursing, participates in teaching, guidance and supervision of students in nursing and midwifery for their related learning experiences (RLE) in the community setting.D. The PHN participates in the conduct or research and utilizes research findings in his/her nursing practice

III. SupervisionA. The PHN supervises midwives within her catchment area in accordance with the agency’s policies and in a manner that improves performance and promotes job satisfaction

1. The PHN formulates a supervisory plan.2. The PHN conducts supervisory visits to implement the supervisory plan3. The PHN regularly monitors and evaluates midwives and nursing auxiliaries’ performance in the implementation of public health

programs.4. The PHN initiates and participates in activities to promote his/her supervisees’ personal and professional growth.5. The PHN initiates and participates in developing policies and guidelines that promote good performance in nursing and midwifery

services.

IV. Interdisciplinary and Intersectoral CollaborationA. The PHN establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector (businesses) non-government organizations and people’s organizations to address the community’s health problemsB. The PHN collaborates with other health care providers, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health.

V. Nursing ProcessA. The PHN establishes a working relationship to help ensure good quality data and to facilitate on enhance partnership in addressing identified health needs and problems.B. The PHN systematically collects data that are appropriate and accurate.C. The PHN recognizes the broad impact of certain factors on the client’s health and nursing problems and their readiness or willingness to do something about their problems.D. The PHN analyzes data collected about the community, family and individual to determine the diagnoses.E. the PHN formulates a nursing/ community diagnosis/F. The PHN develops jointly with the client a nursing care plan or program plan for the priority nursing problems.G. The PHN implements the nursing care plan/program plan to promote, maintain or restore health, to prevent illness, to effect rehabilitation and to improve the capability of clients.H. The PHN evaluates the responses of his clients to interventions in order to revise data base, diagnose and plan and to formulate recommendations.

VI. Health promotion and Health educationA. The PHN recognizes the role of a healthy lifestyle in the different health programs.B. The PHN plans, conducts and evaluates health promotion and health education activities properly.C. The PHN demonstrates knowledge and skills on how to advocate for healthy public policy, creating supportive environment, strengthening community action and developing client’s personal skillsD. The PHN actively works to build capacity for health promotion among the midwives, volunteer health workers and community partners.

VII. Demonstrating Professional Responsibility and AccountabilityA. The PHN recognizes that her/his personal attitudes, beliefs, assumptions, feelings and values about health have potential effects on his professional actions and interventions.B. The PHN accepts accountability for his actions and engages in nursing practice that is ethical, safe, acceptable and evidence-based.C. The PHN protects his professional autonomy, assumes responsibility for professional development and contribute to the professional development of thers.D. The PHN institutes changes/ improvements in service delivery and management of health facility to improve client’s access and use of public health nursing services.E. The PHN maintains links and collaboration with other professional nurses and nursing groups to strengthen his/her nursing practiceF. The PHN maintains links and collaboration with government agencies and non-government organizations. G. The PHN conducts and/or facilitates in various training activities for public health nurses, midwives, barangay health workers, nursing aide and volunteers.