Global Health and Wellness Concepts

Overview of Public Health Nursing in the Philippines

• The World Health Organization (WHO) defined health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
• The health of all people is fundamental to the attainment of peace and security, and governments have a responsibility for the health of their people.

Global Health Situations

• The WHO identified 10 threats to global health: • Air pollution and climate change • Non-communicable diseases • Global influenza pandemic • Fragile and vulnerable settings • Antimicrobial resistance • Ebola and other high threat pathogens • Weak primary health care • Vaccine hesitancy • Dengue • HIV

National Health Situation in the Philippines

• The Philippines has made significant investments and advances in health, leading to a longer and healthier life for Filipinos.
• However, achievements have not been even, and challenges remain, including inequities between regions, rich and poor, and different population groups.

Public Health Nursing

• Public Health Nursing is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort.
• The standards of Public Health Nursing in the Philippines differentiate it from Community Health Nursing only in the setting of work, which is dictated by funding.

Community Health Nursing

• Community Health Nursing is a service rendered by a professional nurse to communities, groups, families, and individuals at home, in health centers, clinics, schools, and places of work.
• The goal of Community Health Nursing is to promote health, prevent illness, care for the sick, and rehabilitate, achieved through multi-sectoral efforts.
• The principles of Community Health Nursing include: • The community is the patient. • The family is the unit of care. • There are four levels of clientele: individual, family, population group, and community.

Roles and Responsibilities of a Community Health Nurse

• Healthcare Provider
• Health Educator
• Program Implementer
• Community Organizer
• Manager/Leader
• Researcher/Epidemiologist
• Client Advocate

Millennium Development Goals (MDGs)

• The MDGs were eight anti-poverty targets that the world committed to achieving by 2015.
• The Sustainable Development Goals (SDGs) build on the MDGs, aiming to end poverty, protect the planet, and ensure peace and prosperity for all.

Department of Health – Philippines

• The Department of Health is the country's principal health agency, responsible for ensuring access to basic public health services.
• Its vision is to be the leader, staunch advocate, and model in promoting health for all in the Philippines.
• Its mission is to guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor.

Local Health System and Devolution of Health Services

• The Local Government Code aims to transform local government units into self-reliant communities.
• Devolution of health services transferred responsibility from the Department of Health to local government units.
• Objectives of the Local Health System include: • Establishing a local health system for effective delivery of health care services. • Upgrading health care management and service capabilities. • Promoting inter-LGU linkages and community participation. • Ensuring quality of health service delivery at the local level.

Classification of Health Facilities

• Health facilities can be classified according to ownership, scope of services, and functional capacity.
• Examples of health facilities include: • Primary Care Facilities • Custodial Care Facilities • Diagnostic/Therapeutic Care Facilities • Specialized Out-Patient Facilities

Primary Health Care

• The World Health Organization defines Primary Health Care (PHC) as essential health care made universally accessible to individuals and families in the community.
• PHC was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on September 6-12, 1978.### Public Health Nursing in the Philippines
• The goal of "Health for All by the year 2000" was adopted in the Philippines through Letter of Instruction 949 signed by President Marcos on October 19, 1979.
• The underlying theme of "Health in the Hands of the People" was set to be achieved by 2020.

Strategies for Health Care

• Reorientation and reorganization of national health care systems with the establishment of functional support mechanisms.
• Effective preparation and enabling process for health in all levels.
• Mobilization of the people to know their communities and identifying their basic health needs.
• Development and utilization of appropriate technology focusing on local indigenous resources.
• Organization of communities arising from their expressed needs.
• Increase opportunities for community participation in local level planning, management, monitoring, and evaluation.
• Development of intra-sectoral linkages with other government and private agencies.
• Emphasizing partnership between health workers and the community leaders/members.

Primary Health Care (PHC) Team

• Physician
• Nurse auxiliaries
• Nurse
• Locally trained community health workers
• Midwives

Levels of Health Care Referral System

• Primary Level of Care: The first contact between the community members and the other levels of health facility.
• Secondary Level of Care: Given in health facilities either privately owned or government operated.
• Tertiary Level of Care: Rendering by specialist in health facilities, complicated cases, and intensive care.

Levels of Prevention

• Primary prevention: Aims to prevent disease or injury before it ever occurs.
  • Health education about healthy and safe practices.
  • Immunization.
• Secondary prevention: Aims to reduce the impact of a disease or injury that has already occurred.
  • Regular exams and screening tests.
  • Diet and exercise to prevent further attacks.
• Tertiary prevention: Aims to soften the impact of an ongoing illness or injury that has lasting effects.
  • Cardiac or stroke rehabilitation programs.
  • Vocational rehabilitation programs.
  • Support groups that allow members to share experiences.

Classification of Family According to Structure

• Nuclear Family: A father and mother with/without children living together but apart from both sets of parents and relatives.
• Extended Family: Two or more nuclear families economically and/or unilaterally/bilaterally extended.
• Single Parent Family: Children < 17 years of age, living in a family unit with a single parent, another relative, or non-relative.
• Blended/Reconstituted Family: Includes step-parents and step-children, resulting from divorce, annulment, and separation.
• Compound Family: One woman/man with several spouses.
• Communal Family: A group of individuals formed for specific ideological or societal purposes.
• Cohabitation/Live-in: Unmarried couple living together.
• No-Kin: A group of at least two people sharing a relationship and exchange support without legal or blood tie.
• Foster: Substitute family for children whose parents are unable to care for them.
• Gay/Lesbian: Homosexual couple living together with/without children.

Family as a System

• The focus is on the family as a client, viewed as an international system in which the whole is greater than the sum of its parts.
• The family accommodates the needs of individual members.

Family Developmental Stages

• 1. Beginning Family: From the marriage to the birth of the first child.
• 2. Childbearing Family: From the birth of the first child to the birth of the last child.
• 3. Family with Preschoolers: When the oldest child is between 2 1/2 and 6 years old.
• 4. Family with School-Age Children: When the oldest child is between 6 and 13 years old.
• 5. Family with Teenagers: When the oldest child is between 13 and 20 years old.
• 6. Launching: From the time the oldest child leaves the family for independent adult life till the time the last child leaves.
• 7. Empty Nest: From the time the children are gone till the marital couple retires from employment.
• 8. Aging Family: From retirement till the death of the surviving marriage partner.

Family Health Tasks

• 1. Physical maintenance: Provides food, shelter, clothing, and health care to its members.
• 2. Socialization of Family: Involves preparation of children to live in the community and interact with people outside the family.
• 3. Allocation of Resources: Determines which family needs will be met and their order of priority.
• 4. Maintenance of Order: Task includes opening an effective means of communication between family members, integrating family values, and enforcing common regulations.
• 5. Division of Labor: Who will fulfill certain roles, e.g., family provider, home manager, children's caregiver.
• 6. Reproduction, Recruitment, and Release of Family Members: Placement of members into larger society.
• 7. Placement of Members into Larger Society: Consists of selecting community activities that correlate with the family beliefs and values.
• 8. Maintenance of Motivation and Morale: Created when members serve as support people to each other.

Family Nursing Process

• Assessment and Diagnoses in Family Nursing Practice: Determining existing and potential health conditions or problems of the family.
• Two major types of assessment:
  1. First Level Assessment: The process of determining existing and potential health conditions or problems of the family.
  2. Second Level Assessment: Focuses on the family's ability to perform its functions.### Family Health Tasks
• Recognizing interruptions of health development, stated as potential or readiness
• Making decisions about seeking healthcare and taking action
• Dealing effectively with health and non-health situations
• Providing care to all members of the family
• Maintaining a home environment conducive to health maintenance

Characteristics of a Healthy Family

• Able to provide for physical, emotional, and spiritual needs of family members
• Able to be sensitive to the needs of family members

Health Threats

• Conditions that are conducive to disease and accident, or may result in failure to maintain wellness or realize health potential
• Examples include:
  • Presence of risk factors of specific diseases
  • Threat of cross-infection from a communicable disease case
  • Family size beyond what family resources can adequately provide
  • Accident/fire hazards
  • Faulty/unhealthful nutritional/eating habits or feeding techniques/practices
  • Stress-provoking factors
  • Poor home environmental condition/sanitation
  • Unsanitary food handling and preparation
  • Unhealthful lifestyle and personal habits/practices
  • Inherent personal characteristics
  • Health history which may participate/induce the occurrence of a health deficit

Health Deficits

• Instances of failure in health maintenance, including disease, disability, and developmental lag
• Data gathering methods include:
  • Observation
  • Physical examination
  • Interview
  • Review of records and laboratory and diagnostic procedures

Stress Points/Foreseeable Crisis

• Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources
• Examples include:
  • Marriage
  • Pregnancy, labor, puerperium
  • Parenthood
  • Additional member (e.g., newborn, lodger)
  • Abortion
  • Entrance at school
  • Adolescence
  • Divorce or separation
  • Menopause
  • Loss of job
  • Hospitalization of a family member
  • Death of a member
  • Resettlement in a new community
  • Illegitimacy

Five Main Types of Family Nursing Problems

• Inability to recognize the presence of a condition or problem
• Inability to make decisions with respect to taking appropriate health action
• Inability to provide adequate nursing care to the sick, disabled, dependent, or vulnerable/at-risk member of the family
• Inability to provide a home environment conducive to health maintenance and personal development
• Failure to utilize community resources for health care

Family Nursing Diagnosis

• Defines the nature or type of nursing problems that the family encounters in performing health tasks with respect to a given health condition or problem
• Includes the etiology or barriers to the family's assumption of these tasks

Planning, Implementing, and Evaluating in Family Nursing Practice

• Family Nursing Care Plan: a blueprint of nursing care designed to systematically enhance the family's capability to maintain wellness, manage health problems, and utilize community resources
• Steps in Developing a Family Nursing Care Plan:
  1. Prioritize Health Conditions or Problems
  2. Goal and Objectives of Nursing Care
  3. Intervention Plan
  4. Evaluation Plan

Health Problem

• Process whereby existing and potential health conditions or problems of the family are determined
• Derived from the First Level Assessment of the Typology of Nursing Problems
• Categorizes the presence of:
  • Wellness state
  • Health deficits
  • Health threats
  • Foreseeable crisis or stress point

Prioritizing Health Conditions

• Four Criteria:
  1. Nature of the Problem
  2. Modifiability of the Condition
  3. Preventive Potential
  4. Salience (family's perception and evaluation of the problem in terms of seriousness and urgency)

Implementing Nursing Activities

• Guidelines:
  • Nursing actions should be based on scientific knowledge, nursing research, and professional standards of care
  • Nursing actions should be adapted to the individual client
  • Nursing actions should always be safe
  • Nursing actions often require teaching, support, and comfort
  • Nursing actions should be holistic and respect the dignity of the client

Goal of Care

• A broad desired outcome toward which behavior is directed
• The Cardinal Principle: Goals must be jointly set with the family to ensure their commitment to their realization

Objectives of Care

• More specific statements of the desired results or outcomes of care
• Types of Objectives:
  1. Short-term/Immediate Objective
  2. Long-term/Ultimate Objective
  3. Medium-term/Intermediate Objective

Evaluation

• Specifies how the nurse will determine changes in health status, condition, and achievement of outcomes of care
• Components:
  • Ongoing Evaluation
  • Intermittent Evaluation
  • Terminal Evaluation