CHN (Galleto) Past Lecture Notes PDF

CHN (GALLETO) placement of the service, the geographical feature.  POPULATION: consists of spec...

CHN (GALLETO) placement of the service, the geographical feature.  POPULATION: consists of specialized The practice of nursing particularly the CHN differs from aggregates, but all of the various people one geographical area to another. It is influenced by the who live within the boundary of the number of factors primarily the scope of practice as community. defined by the nursing law, policies, standard of WHO  SOCIAL SYSTEM: the various parts of and other organizations where CHN’s work and the communities’ social system that interact and health needs and problems of an individual, family, include the health system, family system, group or in a community. economic system and educational system. COMMUNITY HEALTH NURSING NURSING  Community Health Nursing is one of the 2 major  Assisting sick individual to become healthy and fields of nursing in the Phil; the other is hospital healthy individual achieve optimum wellness. nursing  Nursing is defined as the science and art of  Clark defines community health nursing as a caring. “synthesis of nursing knowledge and practice and  Give me example where we can say that the science and practice of public health, Nursing as an art. Nursing as an art is implemented via a systematic use of nursing reflected in the nurses’ interactions and process and other processes to promote health and communication with clients that are geared prevent illness in population groups.” towards the improvement not just of their  CHN and PHN can be used interchangeably, health but as well as their ability to deal with however CHN is broader in scope; it includes PHN, the determinants and consequences of their occupational health nursing and school nursing health problems.  The utilization of NURSING PROCESS in the WHAT IS A COMMUNITY? DIFFERENT LEVELS OF CLIENTELE,  It is a group of people with common characteristics concerned w/ the PROMOTION OF HEALTH, or interest living together within a territory or PREVENTION OF DISEASE, DISABILITY & geographical boundaries and/or common values REHABILITATION. (Dr. Araceli Maglaya, et al.) and interest Community functions within a socio- cultural context in that the people share the same WHAT IS COMMUNITY HEALTH NURSING ? cultural heritage, making each community unique  A field of nursing practice where services are from others. The physical characteristics of the delivered outside the hospital/ in community environment also vary and this affects the economic settings production of the people. CHARACTERISTICS OF A COMMUNITY 4 LEVELS OF CLIENTELE 1. It is defined by geographic boundaries within  INDIVIDUAL- CHN deals with individual (sick or certain identifiable characteristics. well) on a daily basis. Why? Since health 2. It is made up of institutions organized into a social problem of individuals are intertwined with system, with the institutions and organizations those of other members of the family. And linked in a complex network, having formal and community. (Ex: Covid infected family informal power structures and a communication member); considered as an entry point in system. working with these clients 3. It has common or shared interest that binds the  FAMILY- is defined as a collection of people member together. who are integrated, interacting and 4. It has an area of fluid boundaries within which interdependent. Family members interact with problem can be identified or solve each other and the action of one affects the 5. It has a population aggregate concept. other members. FEATURES OF A COMMUNITY  POPULATION GROUP-is a group of people  A community has three features, location, who share common characteristics, population and social system. developmental stage(Ex: school age,  LOCATION: every physical community carries adolescents, adults) or common exposure to out its daily existence in a specific geographical particular environmental factors, and location. The health of the community is consequently common health problems, affected by this location, including the issues and concerns.  CHN (GALLETO)  COMMUNITY- a group of people sharing common Public health nursing refers to composition geographic boundaries and common values and of nursing services and health promotion of interests within a specific social system; which the population. It is aimed to: includes: health, family, economic, educational,  improve sanitation religious, welfare, political, recreational, legal and  control of community epidemics communication system  prevent the transmission of infection  provide education about the basic HISTORY OF COMMUNITY HEALTH NURSING principles of personal hygiene  The history of public health nursing in the Phil is  organize medical and nursing services embedded in the history of the Department of for early diagnosis, prevention and Health which was first established as the treatment of diseases. Department of Public Works, Education and Hygiene in 1898 Public health nursing (1900 – 1970) Focus: Public needs Nursing Orientation: Families Services: Preventive and Curative measures Agencies: Government and other Private Sector/Voluntary Community health nursing (1970) Focus: Total community Nursing orientation: Population Services: Health promotion and Illness prevention Agencies: Independent practice SPECIALIZED FIELD OF NURSING 1. COMMUNITY MENTAL HEALTH NURSING (CMHN)  The primary function is to collaborate w/ a community-based support services to people w/ mental illness and/or addiction. 2. OCCUPATIONAL HEALTH NURSING  Specialty nursing practice that provides health care services to workers & worker populations. 3. SCHOOL HEALTH NURSING  A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. COMMUNITY-SETTING NURSING CARE 1. COMMUNITY-BASED NURSING – focused on illness care for individuals and families both acute and chronic diseases.  Examples: Home health nurse performing wound care to one of the member of the family. Another one is a school nurse taking care of all student’s medical needs. 2. COMMUNITY–ORIENTED NURSING – focused on population and community as a whole. Health promotion and disease prevention activities are done to help improve the health of the community and population. This is essentially known Public Health Nursing.  It is the art and science of prolonging life, promoting health and preventing disease through organization of community efforts.  CHN (GALLETO)  Health promotion  Protection against illness  Primary preventive measures apply before a disease manifests with sign and symptoms.  Examples:  Eating well balanced diet  Regular exercise program  Maintaining weight  No smoking  Moderation of alcohol  Information on alcohol substance  Nutritional counselling  Environmental control  Safe water Supply 1. PRIMARY CARE LEVEL  Good food hygiene  This is the usual entry point for clients of the health  Safe waste management care delivery system. It is oriented towards the  Vector and animal reservoir control promotion and maintenance of health, the  Good living and working condition prevention of disease, the management of common  Stress management episodic disease and the monitoring of stable or 2. SECONDARY PREVENTION chronic conditions.  includes the early detection of actual or potential  It is oriented towards the promotion and health hazards. This allows for prompt maintenance of health intervention and possibly a cure of a disease or 2. SECONDARY CARE LEVEL condition. It is directed forwards health  It involves the provision of specialized medical maintenance for patients experiencing health services by physician or a hospital on a referral by problems. the primary care provider.  Secondary prevention has two sub-levels  A patient has developed a recognizable sign and  aearly detection (diagnosis) of disease symptoms that are either definitively diagnosed or  prompt treatment require further diagnosis. It is oriented towards  E.g. hypertension screen and acute care. clients with more severe acute illnesses or chronic  Secondary prevention increases awareness of: illnesses that are exacerbated. If hospitalization  Breast Self Examination occurs it is usually in a community (district) hospital.  testicular self-examination Most individuals who enter this level of care are  mammography referred by primary care worker, although some are  Pap smear self-referred. The physicians who provide  BP screening secondary care are usually specialists and general  Blood glucose screening practitioners.  Teaching breast self - examination 3. TERTIARY CARE LEVEL  Antibiotic treatment of streptococcal pharyngitis  It is a level of care that is specialized and highly aimed at preventing rheumatic fever technical in diagnosing and treating  “Caution” of cancer  Patients requiring this level often present in 3. TERTIARY PREVENTION extensive and complicated pathological conditions.  is aimed at avoiding further deterioration of an It is the most complex level of care. The illness may already existing problem. Rehabilitative efforts be life-threatening, and the care ordinarily takes are sometimes tertiary preventive measures. It place in a major hospital affiliated by a medical deals with rehabilitation and return of client to a school. Clients are referred by workers from primary status of maximum function within the limit or secondary settings. The health professionals, posed by the disease or disability and including physicians and nurses tend to be highly preventing further decline in health. This level of specialized, and they focus on their area of prevention occurs after a disease caused specialization in the delivery of care. extensive damage.  Examples: LEVELS OF PREVENTION:  Rehabilitation after stroke 1. PRIMARY PREVENTION: refers to the prevention of  smoking cessation program with emphysema an illness before it has a chance to occur.  Aims:  CHN (GALLETO) In the Philippines the components of the health care delivery system as mandate of the Department of Health care system is an organized plan of health Health (DOH) is to be responsible for the following: services. The rendering of health care services to the  Formulation and development of national health people is called health care delivery system. Thus, policies, guidelines, standards and manual of health care delivery system is the network of health operations for health services and programs. facilities and personnel which carries out the task of  Issuance of rules and regulations, licenses and rendering health care to the people. In the Philippines accreditations; promulgation of national health health care system is complex set of organizations standards, goals, priorities and indicators. interacting to provide an array of health services.  Development of special health programs and projects and advocacy for legislation on health PHILIPPINE HEALTH CARE DELIVERY SYSTEM BY policies and programs. DEPARTMENT OF HEALTH The primary function of the Department of Health is  VISION BY 2030 - A global leader for attaining the promotion, protection, preservation or restoration better health outcomes, competitive and responsive of the health of the people through the provision and health care system, and equitable health financing. delivery of health services and through the regulation  MISSION - To guarantee equitable, sustainable and and encouragement of providers of health goods and quality health for all Filipinos, especially the poor, services (E.O. No. 119, Sec. 3). and to lead the quest for excellence in health.  A Healthcare Delivery System is the totality of The DOH vision is "Health as a right. Health for All "societal services and activities designed to Filipinos by the year 2000 and Health in the Hands of protect or restore the health of individuals, the People by the year 2020." While its mission is "DOH, families, groups and communities. in partnership with the people to ensure equity, quality  It includes both government and non- and access to health care by: making services available; government health facilities, programs, services arousing community awareness; mobilizing resources; and activities (preventive, promotive, curative and promoting the means to better health. and rehabilitative)  Non government health facilities -.hospital, CORE VALUES OF DOH clinics, diagnostic centers, health centers  Integrity – The Department believes in upholding truth and pursuing honesty, accountability, and consistency in performing its functions.  Excellence – The DOH continuously strive for the best by fostering innovation, effectiveness and efficiency, pro-action, dynamism, and openness to change.  Compassion and respect for human dignity – Whilst DOH upholds the quality of life, respect for human dignity is encouraged by working with sympathy and benevolence for the people in need.  Commitment – With all our hearts and minds, the Department commits to achieve its vision for the health and development of future generations.  Professionalism – The DOH performs its functions in accordance with the highest ethical standards, principles of accountability, and full responsibility. PREVENTIVE HEALTHCARE is a major concern of  Teamwork – The DOH employees work together the government-owned health centers while with a result-oriented mindset. CURATIVE HEALTHCARE is provided by hospitals  Stewardship of the health of the people – Being both gov't and private stewards of health for the people, the Department shall pursue sustainable development and care for REPUBLIC ACT NO. 9502 the environment since it impinges on the health of  An act providing for cheaper and quality the Filipinos. medicines, amending for the purpose Republic Act No. 8293 or the intellectual property code, Republic Act No. 6675 or the Generics Act of  CHN (GALLETO) 1988, and Republic Act No. 5921 or the Pharmacy "The HUMAN DEVELOPMENT INDEX is a summary Law, and for other purposes. measure for assessing long-term progress in three REPUBLIC ACT NO. 9439 basic dimensions of human development: a long and  An act prohibiting the detentions of patients in healthy life, access to knowledge and a decent hospitals and medical clinics on grounds of standard of living," the UNDP defined in its country nonpayment or hospital bills or medical expenses. report. Three key dimensions are: PUBLIC HEALTH is generally regarded as a  long and healthy life measured by life responsibility of the government. expectancy  In Winslow's classic 1920 definition, public health is  Access of education the “science and art of preventing disease,  Standard of living prolonging life and promoting physical and HDR – 2019 = 0.718 w/ population of: 115, 559,009 mental health and well-being.” 2022 population rank 8th  BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT IN HEALTH DOH pipeline is FOURMULA ONE PLUS  Universal access to basic health services must  Department's strategic thrust for the Philippine be ensured Health Agenda.  The epidemiological to degenerative diseae must  The F1+ model is composed of five pillars: be managed Financing, Regulation, Service Delivery,  The performance of the health sector must be Governance and Performance Accountability enhanced The National Objectives for Health (NOH) 2017–  The health and nutrition of vulnerable groups 2022 serves as the medium-term roadmap of must be prioritized the Philippines towards achieving universal healthcare (UHC). It specifies the objectives, DOH leads in the efforts to improve the health of strategies and targets of the Department of Filipinos, in partnerships with other gov't agencies, the Health (DOH) FOURmula One Plus for Health private sector, NGOs and communities. (F1 Plus for Health) built along the health The direction pursued by the DOH is guided by the system pillars of financing, service delivery, Philippine Development Plan regulation, governance and performance Fourmula 1 plus accountability. Health Sector Reform Agenda It ultimately leads to the three major goals that Universal Healthcare the Philippine Health Agenda aspires for: (1) National Objectives for Health better health outcomes with no major disparity All for health, Health for all among population groups; (2) financial risk protection for all especially the poor, marginalized and vulnerable; and (3) a responsive health system which makes Filipinos feel respected, valued and empowered. 3 MAJOR GOALS OF THE PHILIPPINE HEALTH AGENDA: 1. Better health outcomes with no major disparity among population groups. 2. Financial risk protection for all especially the poor, marginalized and vulnerable. 3. Responsive health system which makes Filipinos feel respected, valued and empowered.  Poverty incidence declined from 25.2 percent in 2012 to 21.6 percent  CHN (GALLETO)  The FOURmula One Plus with the tagline, “Boosting Universal Health Care via FOURmula One Plus or F1 Plus” hints a health reforms to a more transparent, inclusive, coordinative and synergistic agenda with the efforts of both the public and private sector partners especially the local government  FOURmula ONE for Health (F1), a strategy for implementing health reforms, has been put into action by the different offices, bureaus, programs, and projects including attached agencies since 2005. Numerous efforts and resources have been poured for the operationalization. UNIVERSAL HEALTH CARE - RA 11223 BY FRANCISCO T. DUQUE III, MD, MSC  President Rodrigo Duterte has signed a Universal Health Care (UHC) Bill into law.  It automatically enrolls all Filipino citizens in the National Health Insurance Program and prescribes complementary reforms in the health system. The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable,  VISION OF F1 - Filipinos are among the healthiest available and accessible health care services people in Southeast Asia by 2022, and Asia by for all citizens of the Philippines. It shall serve 2040. as the means for the healthy to help pay for  MISSION OF F1 - To lead the country in the the care of the sick and for those who can development of a productive, resilient, equitable and afford medical care to subsidize those who people-centered health system.the executive cannot. It shall initially consist of Programs I department of the Government of the and II or Medicare and be expanded Philippines responsible for ensuring access to progressively to constitute one universal basic public health services by all Filipinos through health insurance program for the entire the provision of quality health care and the population. The program shall include a regulation of all health services and products. It is sustainable system of funds constitution, the government's over-all technical authority on collection, management and disbursement for health. financing the availment of a basic minimum package and other supplementary packages of health insurance benefits by a progressively expanding proportion of the population. The program shall be limited to paying for the utilization of health services by covered beneficiaries. It shall be prohibited from providing health care directly, from buying and dispensing drugs and pharmaceuticals, from employing physicians and other professionals for the purpose of directly rendering care, and from owning or investing in health care facilities. (Article III, Section 5 of RA 7875 as amended) Powers And Functions PhilHealth is a tax-exempt Government Corporation attached to the Department of  CHN (GALLETO) Health for policy coordination and guidance. (Article IV, Section 15 of RA 7875 as amended). It shall have the following powers and functions (Article IV, Section 16 of RA 7875 as amended by RA 10606): GOALS: ALL FOR HEALTH TOWARDS HEALTH FOR ALL  FINANCIAL PROTECTION – Filipinos are protected from high cost of healthcare  BETTER HEALTH OUTCOMES – Filipinos attain the best possible health outcomes with no disparity  RESPONSIVENESS – Filipinos feel respected, valued and empowered in all of their interaction with the health system ALL FOR HEALTH TOWARDS HEALTH FOR ALL VALUES:  Equity – The quality of being fair and impartial  Quality – standards of high quality of care  Efficiency – the ability to produce programs that are provided to all Filipinos  Transparency – the quality of being done in an open way without secrecy.  Accountability – the fact that their should be somebody who will be responsible.  Sustainability – the ability to maintain at a certain rate or level. Fulfilling the needs of the people.  Resilience – the capacity to recover quickly from difficulties.  CHN (GALLETO)  Adolescent Health – target ages are 10 – 19 years old, aims to provide adolescent with access to quality of healthcare services with adolescent friendly facilities and programs. Health promotion and behavior changes, strengthening partnership among adolescent groups and organizations.  Geriatric Health – promoting the health and wellness of senior citizens and alleviating the condition of who are encountering degenerative diseases, aims to promote quality of life among older persons. Free vaccinations and philhealth  First 1000 days- the time spanning roughly premium subsidies. between conception and one’s 2nd year. Period of  Health screening, promotion and information opportunity for optimum health, growth and neuro – newborn screening programs, seminars, development across the lifespan. Yet to frequently posters, announcements. in a developing country you can see poverty and  Triple burden disease: malnutrition leading to earlier mortality and  Communicable disease – tuberculosis (TB morbidities. DOTS Program), HIV AND AIDS (prevention  Reproductive and sexual Health – It is a state of programs such as early diagnosis, treatment physical, emotional, mental and social well being in and prevention of transmission), Rabies relation to sexuality. Sexual health requires a (Reducing risk of rabies exposure in positive and respectful approach to sexuality and partnership with animal welfare foundation, sexual relationships as well as the possibilty of and appropriate management for animal having pleasured and safe sexual experiences bites), Malaria (aims for a malaria free without coercion, discrimination and violence. For it Philippines in 2030, includes reliable to be attained the sexual rights of each person must treatment, along with vector control. be respected, protected and fulfilled.  Non communicable diseases – Disease of  Maternal, Newborn and child health – refers to the heart is the number 1 cause of mortality the services provided for women, mothers and rate in the country, provides free check up, children known appropriate clinical management early detection of heart disease, diabetes, including emergency obstetrics and newborn care in and hypertension, maintenance medications preventing direct causes of maternal and neonatal are available in health facilities to ensure deaths. compliance to medications and control of  Exclusive breastfeeding – giving only breastmilk diabetes. and no other liquids or solids not even water.  Disease of globalization and rapid Exclusive breastfeed for 6 months then continue urbanization – it was contributed by high breastfeeding combined with complementary foods population density and poverty in urban for up to year 2. areas that lead to unsafe environments and  Food and micronutrient supplementation – is the crime. In cooperation with the PNP the preparation of pharmaceutically prepared vitamins campaign against drugs and also services and minerals for treatment and prevention of fro treatment and rehabilitation of drug specific micronutrient deficiency and addition of dependents have been provided by the essential micronutrients to food products at levels DOH. above normal state. Iodine, iron, folic acid, vitamin a, b12, d and zinc. It is given to children to avoid malnutrition and also to pregnant mothers to avoid having a low birthweight baby. Scheduled deworming.  Immunization – National Immunization Program – aim is to reduce the morbidity and mortality among children against the most common diseases which includes, tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles.  CHN (GALLETO) queuing, guarantee decent accommodation and clean restrooms in all government hospitals,  E – Harness and align private sector in planning supply side investments, collaborate with other stakeholders on budget development, monitoring and evaluation, initiate large scale and high risk infrastructure projects.  A- Conducts visits for all poor families and special populations such as pwd, senior citizens, transform selected DOH hospitals with capabilities for multi- specialty training and teaching reference laboratory, support LGUS in advancement of resolutions and ordinances such as wide smoke free or speed limit ordinances, establish expert bodies for health promotion and surveillance and response.  C- Enhance and enforce philhealth contracting policies for better viability and sustainability, update costing of current philhealth case rate to ensure that it covers full cost of care and link payment to service quality.  H – Revise health professionals curriculum to be more primary care oriented and responsive to local and global needs. Update frontline staffing complement standards from profession-based to competency based. Make available fully funded scholarships and mandatory return of services for all health graduates.  I – mandate the use of medical electronic records in all health facilities, make online submissions of clinical and drug dispensing, streamline Information System and support efforts to improve local civil registration and statistics.  E- Publish Health Information that can trigger better performance and accountability, set up performance monitoring unit to track performance/ progress.  V- Prioritize the poorest 20million Filipinos in all health programs, make health services widely published to facilitate understanding, eliminate  CHN (GALLETO)  Complete cure or even the slightest THE FILIPINO FAMILY improvement in malady or illness is viewed as a  FAMILY - a group of persons united by ties of miracle. marriage, blood or adoption, constituting a single  Filipino families greatly influence patient’s household, interacting and communicating with decision about health care each other, in their respective social roles, of  Patient’s subjugate personal needs and tend to husband and wife, mother and father, son and go along with the demands of a more daughter, brother and sister, creating and authoritative family figure in order to maintain maintaining a common culture. group harmony.  FAMILY--It is the foundation of social life for most  Before seeking professional help, Filipino older Filipinos. adults tend to manage their illnesses by self  WHO characterizes the family as a….” primary monitoring of symptoms, ascertaining possible social agent in the promotion of health and well causes determining the severity and threat to being. functional capacity and considering the financial  HOUSEHOLD- A group of persons living under one and emotional burden to the family. roof and sharing the same kitchen, and  May even resort to utilizing traditional home housekeeping arrangements. remedies such as alternative or complimentary Not related by marriage, blood or adoption means of treatment Not engaged in the performance of familial roles,  Seeking medical advice from family members or friends who are health professionals is also a CLASSIFICATION OF FAMILY common practice among Filipino older adults,  Based on internal organization, or membership, and their family members especially if severe families maybe classified into two: somatic symptoms arise. 1. Nuclear family -consists typically of a married man and woman with their offspring. COPING STYLES Primary unit of all types of families, and is  Patience and endurance (Tiyaga)- the ability to considered the basic building block in family tolerate uncertain situations structure  Flexibility (lakas ng loob) - being respectful 2. Extended family - when a number of nuclear and honest with one self. families are linked, together by virtue of the kinship  Humor (tatawanan ang problema) - the bond, between parents and children, and between capacity to laugh at oneself in times of adversity siblings.  Fatalistic Resignation (Bahala na) - the view Kinship bond makes the extended family continuous that illness and suffering are unavoidable and generation after generation. pre destined will of God. in which the patient, family members and even the physician should FILIPINO CULTURE not interfere.  FILIAL PIETY-is an important concept in Filipino  Conceding to the wishes of the collective culture. It is understood as essential in order to (Pakikisama) - to maintain group harmony. maintain the collective face of the family and to avoid experiencing hiya. INDIGENOUS HEALTH BELIEFS: THE CONCEPT  Many Filipinos hold the belief that each family OF BALANCE member has several duties and responsibilities they  This concept is central to Filipino health care must uphold. practices and is applied to social relationships  Observing one’s duties and responsibilities is and encounters. important in order to correctly respect others and to  According to this principle, health is thought to ensure harmony among family members. be a result of balance while illness is due to  Family members are required to show respect to humoral pathology and stress is usually the their elders at all times. result of some imbalance:  The opinions of younger family members and  Rapid shifts from “ hot to cold “ lead to illness. children’s opinions are considered to be secondary  Warm environment is essential for maintaining to their superior optimal health.  Cold drinks or cooling foods should be avoided HEALTH BELIEFS AND BEHAVIORS: RESPONSE in the morning. TO ILLNESS  An overheated body is vulnerable to disease.  Filipino older adults tend to cope with illness with the help of family and friends and by faith in God.  CHN (GALLETO) INDIGENOUS HEALTH BELIEFS: THE CONCEPT OF BALANCE  A heated body can get “shocked”  When cooled quickly it can cause illness.  A layer of fat maintains warmth protecting the body’s vital energy.  Imbalance from worry and overwork create stress and illness.  Emotional restraint is a key element in restoring balance.  A sense of balance imparts increased body awareness. THEORIES OF ILLNESS:  MYSTICAL CAUSES - are often attributed to experiences or behavior such as ancestral retribution for unfinished tasks or obligations. Eg. bangungot- some believe that the soul goes out of the body and wanders. Or having nightmares after a heavy meal may result in death.  PERSONALISTIC CAUSES - Associated with social punishment or retribution from supernatural forces such as evil spirit or witch or sorcerer (mangkukulam). These forces cast these spells on people if they feel jealous or feel disliked. A faith healer, or an “ albularyo or herbularyo “or priests are asked to counteract and cast out these evil forces, through the use of prayers, incantations, medicinal herbs and plants. For protection, the healer may recommend using holy oils, or wearing religious objects, amulets, or talisman (anting-anting).  NATURALISTIC CAUSES - includes a host of factors ranging from natural forces( thunder, lightning, drafts, etc) to excessive stress, food and drug incompatibility, infection and familial susceptibility.