CHN-Reviewer-Chap-1-Nheo.docx

**Overview of Public Health Nursing in the Philippines** **(Global and National Health Situations)** **Global Health Situations** - Public health is operating within a context on-going change, which exert a number of pressures on the public system. These changes include 1. Shills in d...

**Overview of Public Health Nursing in the Philippines** **(Global and National Health Situations)** **Global Health Situations** - Public health is operating within a context on-going change, which exert a number of pressures on the public system. These changes include 1. Shills in demographic and epidemiological trends in diseases, including the emergence and re e-emergence of new diseases and in the prevalence of risks and protective factors. 2. New technologies for health care, communication and information. 3. Existing and emerging environmental hazards some associated with globalization. 4. Health reforms. **National health Situations** - The health problems of our country remain the same over the past 30 years, the leading causes of death are preventable. Added to the situation is the emergence of life style diseases A. **Positive aspect** 1. Filipinos are healthier today. 2. Life expectancy rises (Male 68:81: Female = 74.43). 3. Decline in mortality rate. 4. Certain diseases (Poliomyelitis and Neonatal Tetanus) are nearing eradication due to immunization. 5. Increase awareness of the families and community in health and disease. 6. Use of herbal medicine is slowly gaining ground. 7. Increase access to safe water. 8. Improve child survival and development service including the establishment of baby friendly hospital and breast-feeding promotion. 9. Fast growing number of health initiative to solve equitable distribution of health facilities and human resources. 10. DOH has become responsive in providing quality health services. 11. Multi-sectoral and multidisciplinary participation in health care development. B. **Negative Aspect** 1. Fast growing population**.** 2. Urban dwellers exposed to risk factors e.g. Smoking, stress, high risk living associated with more dominated lifestyle related illness**.** 3. Increasing mortality rate from cancer, cardiovascular disease, accidents and chronic degenerative diseases**.** 4. Slow reduction in fertility and close spacing of birth. 5. Many infants and children still suffer and die from communicable diseases (diarrhea and pneumonia which are preventable). 6. Death related to pregnancy and childbirth remains to be leading causes of female death. 7. High level malnutrition. 8. Malaria, Schistosomiasis and goiter are still endemic. 9. Incidence of HIV infection and AIDS is slowly increasing not only in males and females but in infant and children. 10. High rate of disability. 11. Poor environmental sanitation and new threat of degradation. 12. Under-funding/overspending for health care by individual, family and government. 13. Low coverage and support level existing compulsory national insurance system. 14. Rising and prohibitive cost of drugs and hospitalization. 15. Rapid turnover and mal-distribution of health and human resources. 16. Inadequate basic service coverage in many areas exacerbate by the occurrence of natural and manmade disaster. - According to Philippine Health Statistics total population in 2015 is 100, 979, 303. There was a 47% increase in the population from 1995-2015. **10 Leading Causes of Mortality (2016)** 1. Ischemic Heart Disease 2. Neoplasms 3. Pneumonia 4. Cerebrovascular Disease 5. Hypertensive Diseases 6. Diabetes Mellitus 7. Other Heart Diseases 8. Respiratory Tuberculosis 9. Chronic Lower RTI\'s 10. Diseases of the Genitourinary system **10 leading Causes of Morbidity (2015)** 1. Acute Respiratory Infection 2. Hypertension 3. Pneumonia 4. Urinary Tract Infection 5. Bronchitis 6. Influenza 7. Acute Watery Diarrheal 8. TB Respiratory 9. Dengue Fever 10. TB other Forms **Definition and Focus** **Nursing** - Is a profession aimed at helping the population achieve better health thru their own hands. - **As a science**, it relies heavily on an understanding that the key towards genuine development is investing on health and healthcare of the people regardless of age, sex, gender, religion and color. **Health** - Is a shared reality. - It enables the people to achieve their full potential. - Is a complex reality. - A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. **Social** - Means relating to living together in organized groups or similar close aggregates. - Refers to units of people in communities who interact with one another. **Social health** - Connotes community vitality and is a result of positive interaction among groups within the community, with emphasis on health promotion and illness prevention. In the mid 1980\'s WHO defines health as the extent to which an individual or group is able on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources and physical capacities. **Dimensions of Health** 1. Physical structure and function 2. Social 3. Role 4. Mental (emotional & mental) 5. General perceptions of health status **Health as Human Right** - The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic and social conditions. - It is grounded in the Universal Declaration of Human Rights proclaimed in Paris on Dec 10, 1948, UDHR Article 25 1 declares. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services. **Components of the right to health:** 1. Availability 2. Acceptability 3. Accessibility 4. Quality **Models of Health** 1. **Clinical Model / Medical Model** - Health is the absence of signs and symptoms of disease and illness refers to its presence. 2. **Role Performance Model** - The individuals\' ability to perform societal roles. 3. **Adaptive Model** - Health is a dynamic state. 4. **Eudaimonistic Model** - An elevated level of wellness suggests optimal health and illness is reflected by a lack of vitality (Exuberant wellbeing). 5. **Health Illness Continuum Model** 6. **High Level Wellness Model** 7. **Health Belief Model** 8. **Needs Fulfillment Model** **Determinants of Health and Disease** 1. **Biology** - Is the individual\'s genetic make-up, family history, and any physical and mental health problems developed in the course of life 2. **Behavior** - Are the individual\'s responses to internal stimuli and external conditions 3. **Social environment** - Include interactions and relationships with family, friends, co-workers and others in the community 4. **Physical environment** - Is what is experienced by the senses 5. **Policies and interventions** - Can have a profound effect on the health of individuals, groups, and communities. **Social Determinants of Health** - Are conditions in which people are born, grow, live, work and age, might also be circumstantial elements such as housing, work conditions and access to recreational activities, circumstances that influence how an individual will develop sickness, what risk factors they are exposed to, how they access services, and is shaped by the distribution of money, power and resources at global, national and local levels. 1. Health care access 2. Economic conditions 3. Social and environmental issues 4. Cultural practices - A framework for Community and Public Health Nursing is **ONE HEALTH CONCEPT.** **Public Health (Dr. Charles Edward Winslow)** - The **science** and **art** of preventing disease, prolonging life, promoting health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birth right of health and longevity. **According to WHO**: - Public health is the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number. **Community Health (Stanhope and Lancaster, 1992)** - The meeting of collective needs through identifying problems and managing interactions within the community itself and between the community and large society. - Is part of paramedical and medical intervention / approach which is concerned on the health of the whole population. **Aims:** 1. Health promotion 2. Disease prevention 3. Management of factors affecting health **3 common characteristics / dimensions of community health:** 1. **Status** - The physical component, frequently measured by mortality and morbidity rates, life expectancy rates and risk factors profile. - Vital statistics - live births, neonatal deaths, infant deaths, maternal deaths. - Disease incidence and prevalence of leading causes of mortality and morbidity. - Health risk profiles of selected aggregates. - Functional ability levels. 2. **Structure** - Community health services and resources. - Health facilities such as hospitals, nursing homes. - Health-related planning groups - Health manpower such as physicians, dentists, nurses. - Health resource utilization patterns such as bed occupancy rate and patient/ provider visits. 3. **Process** - Effective community functioning or problem solving, promotion of effective community action or wellness. - Commitment, Articulateness, Effective communication, Participation, Conflict containment and accommodation, machinery for facilitating participant interaction. **Public Health Nursing** - According to the **World Health Organization Expert Committee of Nursing,** Public Health Nursing is a special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health programmed for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability. **Community** - **Hanchett**, 1979 in Stanhope and Lancaster, 1992 defines community as a group of people in relationship with each other. - T**he World Health Organization Expert Committee of Nursing Public Health Nursing (1974)** defines community as a social group determined by geographic boundaries and / or common values and interests. Its members know and interact with one another. It functions within a particular social structure and exhibits and create norms, values and social interactions. **Dimensions of Community**: **1. People**- the community residents **2. Place**- the spatial and time dimensions **3. Functions**- the aims and activities of the community **Place** - Geopolitical boundaries - Local or folk name for area - Size in square miles, blocks or census tracts Transportation avenues - History - Physical environment such as land use patterns and condition of housing **People or Person** - Number and density - Demographic structure - Informal groups - Formal group - Linking structures **Function** - Production, distribution and consumption of goods and services - Socialization of new members - Maintenance of social control - Adapting to on-going and expected change - Provision of mutual aid **Community Health Nursing** - According to **Ruth B. Freeman** it refers to a service rendered by a professional nurse with communities, groups, families, individuals at home, in health centers, in clinics, in schools, in place of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation. - Is a unique blend of nursing and public health practice aimed at developing and enhancing the health capabilities of people, either singly as individuals or collectively as families, special population or communities. It involves in the entire spectrum of health services for the community. **According to American Nurses Association (1973**) - CHN is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. The nature of this practice is general and comprehensive. It is not limited to a particular age or diagnostic groups. The dominant responsibility is to the population as a whole. Therefore, nursing directed to individuals, families or groups contributes to the health of the total population **According to Tinkham and Voorhies (1972)** - CHN is that field of nursing in which the family and community are patients. Its primary focus is on the prevention of disease and the promotion and maintenance of the highest level of health and well-being. - **Community Health Nursing** is the synthesis of nursing and public health practice applied to promote and protect the health of the population. It combines all the basic elements of professional, clinical nursing with public health and community practice. **Characteristics and Features of Community and Public Health Nursing (CPHN)** 1. CPHN is developmental. 2. CPHN promotes social justice. 3. CPHN values consumer involvement. 4. CPHN uses prepayment mechanism. 5. CPHN focuses on preventive services. 6. CPHN offers comprehensive care. 7. CPHN is multidisciplinary. 8. CPHN is ecology oriented. **Philosophical and Ethical Underpinnings** a. **Philosophical** 1. Worth and dignity of man **(Margaret Shetland).** 2. Caring is the moral ideal of nursing whereby the end is protection, enhancement, and preservation of human dignity **(Jean Watson)** 3. Responsibility for health rest primarily on people and not on agencies or professionals **(Aristotle).** 4. Social justice b. **Ethical** 1. Beneficence and nonmaleficence 2. Veracity 3. Fidelity 4. Autonomy **Standards of Public Health Nursing in the Philippines** - Was founded by the National League of Philippine Government Nurses in 2005. - Differentiated public health nursing and community health nursing in one area (**setting of work as dictated by funding).** - The government is the employer of public health nurses both the national and local health agencies. - The position title or designation was given by the Civil Service Commission (Public Health Nurse). **According to standards of Public Health Nursing in the Philippines:** - **Public Health Nurse** refers to the nurses in the local / national health departments or public schools. - **Public Health Nursing** refers to the practice of nursing in national and local government health departments (health centers & RHU\'s) and public schools. It is community health nursing practiced in the public sector. **Evolution of Public Health Nursing in the Philippines** - The history of public health nursing in the Philippines is embedded in the history of DOH which was first established as **Department of Public Works, Education and Hygiene in 1898.** **Republic Act No. 1082 or the Rural Health Law.** - It created the first **81 RHU\'s.** Each unit had a physician, a public health nurse, a midwife, a sanitary inspector and a clerk driver. **Roles and Responsibilities of a Community and Public Health Nurse** 1. **Health Monitor** - Detects deviations from health by individuals, families, groups, or the community through her contact / visit with them and with the use of systematic and objective observation and other forms of data gathering. 2. **Provider of Nursing Care to the sick or disabled / Health Care Provider** - Provides nursing care to the sick / disabled in the home, clinic, school or place of work. - develops the family's capability to take care of its sick, disabled or dependent members. 3. **Health Teacher / Counselor / Trainer / Health Educator** - Is one of the most frequently used interventions of the nurse. - Every contact of the client, be it in the home, clinic, school or place of work must be seen as an opportunity for teaching about health promotion, disease prevention, care of the sick at home and rehabilitation. 4. **Coordinator of Services to the individuals and family** - With the nurse holistic view of the family and her prolonged contact with it, she is in a position to coordinate health services provided by various members of the health team so that they are delivered and received as a meaningful whole / package based on needs, not as fragmented bits and pieces. 5. **Community Organizer** - Takes active participation in stimulating and enhancing community participation in planning, organizing, implementing and evaluating health programs and services and initiating community development activities. 6. **Change Agent** - This involves individual, family, groups and community\'s health behavior, including lifestyles in order to promote and maintain health. (Client Advocate) 7. **Role Model** - The nurse is expected to provide a good example or model of healthful living to the public / community. 8. **Supervisor / Manager/ Leader** - The nurse functions as trainer and supervisor to lower Leader level health personnel in the health agency as well as community health workers and manager / administrator of a unit / program of the agency. 9. **Supervisor / Manager** - The nurse also participates in the planning and evaluation of the total program of the health agency. 10. **Planner / Programmer** - The nurse identifies needs, priorities and problems; formulates nursing component of health plans; interprets and implements nursing plan, program policies; and provide technical assistance to midwives in health matters. 11. **Recorder /Reporter / Statistician** - The nurse prepares and submits required reports and records; maintains adequate, accurate recording and reporting; reviews, validates, consolidates, analyzes and interprets all records and reports; prepares statistical data for presentation or display. 12. **Researcher / Epidemiologist** - Participates / assists in the conduct of surveys and studies on nursing and health related subjects; and coordinates with government and non-government organizations in the implementation of studies / research. 13. **Program Implementer** - Requires that programs initiated by the national government thru the DOH are executed at all levels **The Health Care Delivery System** 1. **World Health Organization** **Millennium Development Goals:** 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development **The 17 Sustainable Development Goals for the period 2016-2030 are:** 1. End poverty in all its forms everywhere. 2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. 3. Ensure healthy lives and promote well-being for all at all ages. 4. Ensure inclusive and equitable quality education and promote life-long learning opportunities for all. 5. Achieve gender equality and empower all women and girls. 6. Ensure availability and sustainable management of water and sanitation for all. 7. Ensure access to affordable, reliable, sustainable, and modern energy for all. 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all. 9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation. 10. Reduce inequality within and among countries. 11. Make cities and human settlements inclusive, safe, resilient and sustainable. 12. Ensure sustainable consumption and production patterns. 13. Take urgent action to combat climate change and its impacts (in line with the United Nations Framework Convention on Climate Change). 14. Conserve and sustainably use the oceans, seas and marine resources for sustainable development. 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss. 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels. 17. Strengthen the means of implementation and revitalize the global partnership. **Philippine Department of Health** **Vision**: - The DOH is the leader, staunch advocate and model in promoting Health for all in the Philippines. **Mission**: - Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health. - DOH is a government agency that is responsible for the health problems of the Filipino people under the virtue of **Executive Order (EO) 119.** - The DOH is responsible for the promotion, protection, preservation and restoration of health of the people. **RA 7160** - **The Local Autonomy Code -** devolution of the health services, the local government units were granted more power, authority and resources. **EO 503** - Transfer of personnel assets and liabilities and records of devolved government agencies. **Responsibilities of the DOH** 1\. Formulation and Development of National Health Policies, Guidelines Standards and Manuals of Operations for health service programs. 2\. Issuance of rules and regulations, licenses and accreditation. 3\. Promulgation of National Health Standards, Goals, Priorities and indicators 4\. Development of special program and projects. 5\. Advocacy for legislation on health policies and programs. **Objectives of the DOH** 1\. Improve the general health status of the people. 2.Reduce morbidity, mortality, disability and complications from diseases. 3.Eliminate the public health problems of schistosomiasis, malaria, filariasis, leprosy, rabies, measles, tetanus, diptheria & pertussis, goiter and Vit. A deficiency. 4\. Eradicate polio. 5\. Promote healthy lifestyle thru diet, exercise, personal hygiene and mental health. **DOH Administrative Order No. 2012-0012 Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines** (Streamlining of Licensure and Accreditation of Hospitals)    **Classification of Hospitals** According to Ownership: **A. Government** Created by law. May be under DOH, DND, DOJ, PNP, LGU, SUCS, GOCC and others. **B. Private** May be a single proprietorship, partnership, corporation, cooperative, foundation, religious, non-government organization and others. A.O. No. 2012 - 0012 Rule V. B. 1, a.. p. 6 Classification of Hospitals According to Functional Capacity: **A. General Hospital** Provides medical and surgical care to the sick and injured and maternity care and shall have as minimum, the following clinical services: medicine, pediatrics, obstetrics and gynecology, surgery and anesthesia, emergency services, out-patient and ancillary services. **B. Specialty Hospital** Specializes in a particular disease or condition or in one type of patient. A.O. No. 2012 - 0012 Rule V. B. 1. b.. p. 6