Community Health Nursing 1 - Lecture Notes PDF

Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 1 LESSON TITLE: Orientation / N...

Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 1 LESSON TITLE: Orientation / Nursing Core Values as a Materials: Community Health Nurse. Filipino Culture, values and Pen, paper, index card, book, and class List practices in relation to Health Care of Individual and Family. Global and National Health Situations Reference: LEARNING OUTCOMES: Famorca, Z. U., Nies, M. A., & McEwen, M. At the end of the lesson, the nursing student can: (2013). Nursing Care of the Community. Elsevier 1. Demonstrate caring as the core of nursing, love of God, Gezondheidszorg. love of country and love of people in serving the community; Community Health Nursing Services in the 2. Enumerate the role and responsibilities of a community Department of Health Philippines (2000). health nurse; Community Health Nursing. 9th Edition. National 3. Exemplify love for country in the service of the Filipinos League of Government Nurses, Inc. and family; 4. Customize nursing interventions based on Philippine Culture and values; and, 5. Discuss appropriate the global and national health situation and actions holistically and comprehensively. SUBJECT ORIENTATION (15 minutes) Your classroom instructor for this subject Community Health Nursing 1 - Lecture, is ________________________. Listed below are the additional information vital in orientation: MAIN LESSON (20 minutes) The instructor should discuss the following topics. Instruct students to take down notes. Definition of Terms Community  Are social structures that exhibits and create norms and values that establish social institution (WHO) Health  A state of complete physical, mental and social being and not merely the absence of disease or infirmity (WHO) Community Health  Extends the realm of public health to include organized health efforts at the community level through both government and private sectors This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 13 Community Health Nursing  “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. ” (Maglaya, et al)  Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness” (Nisce, et al)  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 program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability (WHO Expert Committee of Nursing)  A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care (Jacobson)  A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, school’s workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman) Role and Responsibilities of Community Health Nurse “The main focus of community health nurse is health promotion.” 1. Programmer/Planner  Identifies the needs and concerns of individuals, groups, families, and the community  Formulates health plans, especially in the absence of a community physician  Interprets and implements nursing plans and programs  Assists other health team members in implementing health programs in the setting 2. Health Educator/Trainer/ Counsellor  Acts as resource speaker on health and health-related services  Advocate health programs in the community through dissemination of IEC or Information Education and Communication materials  Conducts advocacy educations concerning premarital, breastfeeding, and immunization counselling  Organizes orientation/ training of concerned groups like pregnant mothers  Identifies and interprets training needs of health team members and formulate appropriate training program for them  Conducts and facilitates necessary training or educational orientation to other health team members in the community “The recipient of care of community public health nursing practice is extended not only to the individual but also to benefit the whole family and community.” 3. Community Organizer  Promotes self- reliance of community and emphasizes their involvement and participation in planning, organizing, implementing and evaluating of health services  Initiates and implements community development activities 4. Coordinator of services  Coordinate’s health services with concerned individuals and families through the community health team members, government organizations and non- government organizations  Coordinate’s nursing plans and programs with other health programs “Community health nurses are generalists in terms of their practice through life’s continuum.” 5. Provider of Nursing Care  Renders direct care to various clients with different needs, may it be at home, in school, clinics or work settings  Involves the family in the care of the sick or dependent individual, i.e., sick child “Continuity of care with the client, family or and the community extends for a longer time involving individuals of all ages and health needs” 6. Health Monitor  Monitors and detects the presence of health concerns in the community through contacts or home visits.  Utilizes various effective data gathering techniques in keeping an eye on the health status of all recipients of care. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 13  Records and reports health status and presence of health problems in the community “The nature of nursing practice in the community needs the knowledge of biological and social sciences, ecology, clinical nursing, and community organizing, for it to be effective.” 7. Researcher  Follows a systematic process of monitoring the health status of the community through the conduct of surveys and home visits  Conducts researches concerning the health of the community  Coordinates with government and non- government organizations in the conduct and implementation of studies 8. Statistician  Records data systematically and ensures its validity through accurate and complete data gathering  Reports prepared reports to concerned organizations i.e. government organization for immediate necessary plans or programs  Consolidates and reviews reports efficiently.  Analyzes and interprets consolidated data for monitoring the development in the health matters of the whole community “This field of nursing practice utilizes a dynamic process (assessment, planning, implementation, and evaluation) in the provision of continuous care until termination is implicit.” 9. Change Agent  Promotes and motivates change in the community in their health practices and lifestyle behaviors for them to promote and maintain good health, be knowledgeable and has the initiative in accessing health services  Inculcates self- reliance to brought about development and improvement in the community Core Values of a Community Health Nurse 1. Integrity Skills attribute to integrity  Care Comes First – Communication is key. Listen to others, and provide information and advice clearly so every patient can understand. Make well-informed decisions that are best for the patient. Do not accept gifts for preferential treatment.  Confidentiality- states that anything said to nurses and other health-care providers by their patients must be held in the strictest confidence.  Veracity- requires nurses to be truthful. Truth is fundamental to building a trusting relationship.  Accountability- linked to fidelity and means accepting responsibility for one’s actions. Nurses are accountable to their patients and to their colleagues.  Respect Dignity – Protect patient privacy. Never give client information to an unauthorized person, and preserve anonymity when citing patient cases in coursework, research, or other public documents.  Honesty and Integrity – Do not plagiarize coursework or professional assessments. Compile an accurate CV to reflect your education and work experience. Always aspire to the highest levels of personal and professional conduct.  Uphold reputation – be aware that all actions—even outside of work—may have consequences. 2. Professionalism Skills attribute to professionalism  High Standards of Care – Be punctual. Acknowledge when a situation is beyond your professional scope. Don’t be afraid to ask for help.  Leadership – A sought-after attribute, leadership is founded on excellent communication skills, attention to detail, respect, and resourcefulness. Professionals commonly build leadership skills as they move on to more senior roles in which they can guide others to provide higher levels of care. 3. Competence  Conflict resolution – This involves a professional’s ability to de-escalate a problem. It requires the nurse to consider the needs of everyone involved in the conflict, while communicating possible solutions with respect. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 13   Ethical thinking – This skill enables nurses to make value-based judgments that align with professional standards and moral codes, prioritizing the needs of patients and colleagues ahead of their own.  Adaptability – This demonstrates the capacity to combine new information with education, experience, and professional guidelines to re-evaluate a situation and make changes that lead to more effective solutions. 4. Commitment  Fidelity- a promise that the individual will fulfill all commitments made to himself or herself and to others.  Accountability- linked to fidelity and means accepting responsibility for one’s actions. Nurses are accountable to their patients and to their colleagues. 5. Openness  We want our community to have confidence in their local health services.  We foster greater confidence and cooperation through open communication.  Our performance is open to public scrutiny through patient and employee surveys.  We welcome and use feedback as a tool to do better.  We encourage those around us to speak up and voice their ideas as well as their concerns by making it clear that speaking up is worthwhile and valued.  We communicate clearly and with integrity. 6. Teamwork  Collaboration -working with others and being able to communicate and cooperate is crucial to developing an efficient work environment that places patient needs at the forefront  Cooperate with team members and respect their contributions. Always treat everyone with respect.  Team Leader – excellent communication skills leadership skills as they move on to more senior roles in which they can guide others to provide higher levels of care. 7. Patriotism  National pride is the feeling of love, devotion and sense of attachment to a homeland and alliance with other citizens who share the same sentiment. Filipino Culture, Values and Practices in relation to Health Care of Individual and Family. Culture is socially transmitted behavior, patterns, rules of conduct, arts, values, beliefs, custom, rituals, lifeways, and products of existence that guide the worldwide and decision making. Madeleine Leininger recognized the need to focus on culture in nursing as she predicted that nursing and health care would become global. The major concepts of Leininger’s Theory is cultural diversity and goal of nursing is to provide patient with culturally specific nursing care. Key component of the nursing assessment process in order to plan in a manner that is sensitive and respectful of the individual needs of the client /significant others Cultural considerations  An individual may not necessary identify strongly with the specific group just because he/she was born into it.  An individual may identify with more than one group.  Client may choose to practice selected custom of a group while not honoring others.  How a client identifies with a culture, ethnic group, or religion may affect his/her health practices and care up to the end of life.  Rituals tend to become most important to individuals at times of significant life transitions  When ethical dilemmas arise, the leader of the spiritual or cultural group might be consulted. Assessment  Does the client identify strongly with a specific group or groups?  What are the beliefs, customs, practices and rules that are most important to the client?  How can the health care team support the client and plan of care that will address these needs? Are there special wishes/needs? This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 13  Is the client part of a community, congregation, or extended family structure? Does this play an important part in his/her life?  How do the identified culture(s) influence feelings about health and care? It is important to assess areas related to the situation (e.g., for a client newly diagnosed with AIDS? What gives the client’s life meaning? What does pain mean to this client? Selected examples of diverse cultures that might influence health care practices 1. Jehovah’s Witness  Urge members to refuse blood transfusion 2. Seventh-day Adventist  Prohibit consumption of pork, shellfish, alcohol, coffee and tea. 3. Hindus  Prohibit consumption of beef (all meat and alcohol are avoided by the most devout).  Food is eaten with right hand (regarded as clean) 4. Muslims  Prohibit consumption of pork and pork products and alcohol. Consumption of blood is forbidden; therefore, all meat and poultry ate cooked to well done.  Bread is required with each meal (a gift from God)  Food is eaten with the right hand (regarded as clean)  Beverages are not consumed until after the meal (some believe it unhealthy to eat and drink at the same time). Some Muslims do not mix hot and cold foods at the same time.  Fasting as the start of a remedy: prophet Mohammad said” stomach is the house of every disease”  High concern for ingredients in mouthwash, non-home- prepared food, medication (gelatin capsule derived from pig, insulin, etc.)  Special daily prayer times  Need basin of water to wash before praying  Bed or chair facing Mecca  Read or listen to the Qur’an  Death is God’s will and foreordained. The worldly life is preparation for eternal life.  Death rituals  Body washed three times by Muslim of the same gender and wrapped in white  Buried as soon as possible in brick-or cement grave with the body facing Mecca (no cremation and typically no autopsy) 5. Roman Catholic  Anointing of the sick (last rites) for the seriously Ill. This sacrament of healing discusses God’s grace and brings physical and spiritual strength  attending mass  praying the rosary and novena  expressing devotion to saints and the Virgin Mother  receiving the sacraments and holy communion  reconciliation  anointing the sick  observing religious holidays and rituals  going on pilgrimages Health Beliefs and Behaviors: Health Behaviors Response to Illness  Filipino older adults tend to cope with illness with the help of family and friends, and by faith in God.  Complete cure or even the slightest improvement in a malady or illness is viewed as a miracle.  Filipino families greatly influence patients’ decisions about health care.  Patients subjugate personal needs and tend to go along with the demands of a more authoritative family figure in order to maintain group harmony.  They may even resort to utilizing traditional home remedies such as alternative or complimentary means of treatment.  They may discuss their concern with a trusted family member, friend, spiritual counselor or healer (Yeo, 1998). This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 13  Seek medical advice from family members or friends who are health professionals is also a common practice among Filipino older adults and their family members, especially if severe somatic symptoms arise (Anderson, 1983). Responses to Mental Illness Indigenous traits common among elderly Filipino Americans when faced with illness related to mental conditions:  Devastating shame (Hiya)  Sensitivity to criticism (Amor Propio) Coping Styles Coping styles common among elderly Filipino Americans in times of illness or crisis include:  Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations  Flexibility (Lakas ng Loob): being respectful and honest with oneself  Humor (Tatawanan ang p\Problema): the capacity to laugh at oneself in times of adversity  Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable and predestined will of God, in which the patient, family members and even the physician should not interfere  Conceding to the wishes of the collective (Pakikisama) to maintain group harmony Cultural Values  Smooth Interpersonal Relationships are a core value for every Filipino community  They involve a shared identity, engagement on an equal basis with others  Give importance to the individual versus agencies or institutions. This cultural characteristic is also known as “Personalism.”  The high value placed on sensitivity and regard for others, respect and concern, understanding, helping out, and consideration for others’ limitations, often creates discord with American tendencies toward openness and frankness (Agoncillo & Guerrero, 1987; Enriquez, 1994).  Perceptions regarding physician preferences dictate who will provide care and how much trust is given. Two main concepts determine the interaction between a Filipino and a health care provider: 1. “One of Us” (Hindi ibang Tao) versus 2. “Not one of Us” (Ibang Tao) Health providers who are respectful, amenable and willing to accommodate the patient’s needs are considered to be Hindi ibang Tao. If the provider is considered Ibang Tao, Filipino Americans will be reluctant to express their feelings and emotions. They will designate a family member to mediate or advocate on their behalf while responding politely to the provider at a formal and superficial level. The concept “Not one of Us” involves The concept “One of Us” includes:  civility (Pakikitungo)  mutual trust/rapport (Pakikipagpalagayan ng loob)  mixing (Pakikisalamuha)  getting involved (Pakikisangkot)  joining/participating (Pakikilahok)  oneness/full trust (Pakiisa)  adjusting (Pakikisama) (Pasco, 2004; Enriquez, 1994; Pe Pua, 1990). Family and Filial Responsibility  Children are taught to show affection for older family members and respect for older adults and authority.  Seek the advice of and accept the decisions of their older adults.  They are obligated to care for older adults and aging parents, and maintain group harmony, loyalty, and emotional ties with parents and other family members across the life span (Chao & Tseng, 2002; Mc Bride, 2006; Miranda, Mc Bride & Anderson, 2000; Superio, 1993). Spiritual Life and Religiosity  Religion is deeply embedded in and intertwined with Filipino culture. It is central to people ’s lives and enables them to face life’s challenges and adversities with strength and optimism (Tompar-Tiu & Sustento- Seneriches, 1995).  Filipino use spirituality and religion as part of their coping practice, especially when dealing with illness. Global and National Health Situations. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 13  With the huge national debt, widespread poverty, high birth rate and growing population, the task of creating a healthy population in the Philippines as a prerequisite to national development lies in the hand of health sector. The department of health must undertake bold initiatives in health care services through innovate approaches 50 Facts: Global health situation and trends 1955-2025 Population Global Rural/Urban Birth /Death Age /employment Population Areas 2.8billion in 1955 In 1955, 68% of Every day in 1997, 1. Today's population is made up of 613 5.8 billion now the global about 365 000 million children under 5; 1.7 billion population lived in babies were born, children and adolescents aged 5-19; It will increase by rural areas and and about 140 000 3.1 billion adults aged 20-64;and 390 nearly 80 million 32% in urban people died, million over 65. people a year to areas. 2. The proportion of older people requiring reach about 8 In 1995 the ratio Giving a natural support from adults of working age will billion by the year was 55% rural and increase of about increase from 10.5% in 1955 and 2025. 45% urban; 220 000 people a 12.3% in 1995 to 17.2% in 2025 day. 3. In 1955, there were 12 people aged by 2025 it will be over 65 for every 100 aged under 20. 41% rural and By 1995, the old/young ratio was 59% urban. 16/100; by 2025 it will be 31/100. 4. The proportion of young people under 20 years will fall from 40% now to 32% of the total population by 2025, despite reaching 2.6 billion - an actual increase of 252 million. 5. The number of people aged over 65 will rise from 390 million now to 800 million by 2025 - reaching 10% of the total population. 6. By 2025, increases of up to 300% of the older population are expected in many developing countries, especially in Latin America and Asia. 7. Globally, the population of children under 5 will grow by just 0.25% annually between 1995-2025, while the population over 65 years will grow by 2.6%. 8. The average number of babies per woman of child-bearing age was 5.0 in 1955, falling to 2.9 in 1995 and reaching 2.3 in 2025. While only 3 countries were below the population replacement level of 2.1 babies in 1955, there will be 102 such countries by 2025. Life expectancy  Average life expectancy at birth in 1955 was just 48 years; in 1995 it was 65 years; in 2025 it will reach 73 years.  By the year 2025, it is expected that no country will have a life expectancy of less than 50 years.  More than 50 million people live today in countries with a life expectancy of less than 45 years.  Over 5 billion people in 120 countries today have life expectancy of more than 60 years.  About 300 million people live in 16 countries where life expectancy actually decreased between 1975 -1995. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 13  Many thousands of people born this year will live through the 21st century and see the advent of the 22nd century. For example, while there were only 200 centenarians in France in 1950, by the year 2050, the number is projected to reach 150 000 - a 750-fold increase in 100 years. Age Structure of Deaths  In 1955, 40% of all deaths were among children under 5 years, 10% were in 5–19-year-olds, 28% were among adults aged 20-64, and 21% were among the over-65s.  In 1995, only 21% of all deaths were among the under-5s, 7% among those 5-19, 29% among those 20-64, and 43% among the over-65s.  By 2025, 8% of all deaths will be in the under-5s, 3% among 5–19-year-olds, 27% among 20-64 year-olds and 63% among the over-65s. Leading causes of Global deaths In 1997, of a global total of 52.2 million deaths  17.3 million were due to infectious and parasitic diseases;  acute lower respiratory infections  chronic obstructive pulmonary disease  tuberculosis  diarrhea  HIV/AIDS  malaria  15.3 million were due to circulatory diseases;  coronary heart disease  cerebrovascular disease  other heart diseases  million were due to cancer;  Lung  Stomach  Colon and rectum  Liver  breast  3.6 million Were due to perinatal conditions. Health of infants and small children  Spectacular progress in reducing under 5 mortality achieved in the last few decades is projected to continue. There were about 10 million such deaths in 1997 compared to 21 million in 1955.  The infant mortality rate per 1000 live births was 148 in 1955; 59 in 1995; and is projected to be 29 in 2025. The under-5 mortality rates per 1000 live births for the same years are 210, 78 and 37 respectively.  By 2025 there will still be 5 million deaths among children under five - 97% of them in the developing world, and most of them due to infectious diseases such as pneumonia and diarrhoea, combined with malnutrition.  There are still 24 million low-birthweight babies born every year. They are more likely to die early, and those who survive may suffer illness, stunted growth or even problems into adult life.  In 1995, 27% (168 million) of all children under 5 were underweight. Mortality rates are 5 times higher among severely underweight children than those of normal weight.  About 50% of deaths among children under 5 are associated with malnutrition.  At least two million a year of the under-five deaths could be prevented by existing vaccines. Most of the rest are preventable by other means. Health of older children and adolescents  One of the biggest 21st century hazards to children will be the continuing spread of HIV/AIDS. In 1997, 59 0 000 children age under 15 became infected with HIV. The disease could reverse some of the major gains in child health in the last 50 years.  The transition from childhood to adulthood will be marked for many in the coming years by such potentially deadly "rites of passage" as violence, delinquency, drugs, alcohol, motor accidents and sexual hazards such as HIV and other sexually transmitted diseases. Those growing up in poor urban areas are more likelly to be most at risk.  The number of young women aged 15-19 will increase from 251 million in 1995 to 307 million in 2025. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 13  In 1995, young women aged 15-19 gave birth to 17 million babies. Because of population increase, that number is expected to drop only to 16 million in 2025. Pregnancy and childbirth in adolescence pose higher risks for both mother and child. Health of adults  Infectious diseases will still dominate in developing countries. As the economies of these countries grow, non- communicable diseases will become more prevalent. This will be due largely to the adoption of "western" lifestyles and their accompanying risk factors - smoking, high-fat diet, obesity and lack of exercise.  In developed countries, non-communicable diseases will remain dominant. Heart disease and stroke have declined as causes of death in recent decades, while death rates from some cancers have risen.  About 1.8 million adults died of AIDS in 1997 and the annual death toll is likely to continue to rise for some years.  Diabetes cases in adults will more than double globally from 143 million in 1997 to 300 million by 2025 largely because of dietary and other lifestyle factors.  Cancer will remain one of the leading causes of death worldwide. Only one-third of all cancers can be cured by earlier detection combined with effective treatment.  By 2025 the risk of cancer will continue to increase in developing countries, with stable if not declining rates in industrialized countries.  Cases and deaths of lung cancer and colorectal cancer will increase, largely due to smoking and unhealthy diet respectively. Lung cancer deaths among women will rise in virtually all industrialized countries, but stomach cancer will become less common generally, mainly because of improved food conservation, dietary changes and declining related infection.  Cervical cancer is expected to decrease further in industrialized countries due to screening. The incidence is almost four times greater in the developing world. The possible advent of a vaccine would greatly benefit both the developed and developing countries.  Liver cancer will decrease because of the results of current and future immunization against the hepatitis B virus in many countries.  In general, more than 15 million adults aged 20-64 are dying every year. Most of these deaths are premature and preventable.  Among the premature deaths are those of 585 000 young women who die each year in pregnancy or childbirth. Most of these deaths are preventable. Where women have many pregnancies the risk of related death over the course of a lifetime is compounded. While the risk in Europe is just one in 1 400, in Asia it is one in 65, and in Africa, one in 16.  Health of older people  Cancer and heart disease are more related to the 70-75 age group than any other; people over 75 become more prone to impairments of hearing, vision, mobility and mental function.  Over 80% of circulatory disease deaths occur in people over 65. Worldwide, circulatory disease is the leading cause of death and disability in people over 65 years.  Data from France and the United States show breast cancer on average deprives women of at least 10 years of life expectancy, while prostate cancer reduces male average life expectancy by only one year.  The risk of developing dementia rises steeply with age in people over 60 years. Women are more likely to suffer than men because of their greater longevity. CHECK FOR UNDERSTANDING (20 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 20 minutes for this activity: Multiple Choice 1. Filipino nurses are very religious people, there is a deep faith in God that is reflected in the expression of “bahala na” (it is up to God or leave it to God”.) Which cultural attitude still exist at present the” bahala” system. A. Incorrectly equated with an expression of fatalism and a passive acceptance of or resignation to fate. B. May also apply to acceptance of illness or malady. C. Operates psychologically to elevate one’s courage and conviction to persist in the face of adversity and improve D. All of the above ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 13 RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. An American nurse tries to speak with a Korean client who cannot understand the English language. To effectively communicate to a client with a different language, which of the following should the nurse implement? A. Have an interpreter to translate. B. Speak slowly. C. Speak loudly and closely to the client. D. Speak to the client and family together. ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 3. A nurse is caring for a Chinese client who is hospitalized due to pneumonia. Based on their culture, which of the following is believed to be the cause of the illness? A. An illness is cast by an enemy. B. An illness is a result of punishment for sins. C. An illness may be attributed to overexertion. D. An illness may be given by someone who did not want it. ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. Which of the following food items would be appropriate for a Seventh Day Adventist to be followed? A. Shrimp and mussels. B. Beef and pork. C. Tuna and salmon. D. Cheese and milk. ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. When assessing a patient from a different culture, what is the most important area to consider? A. Religious beliefs B. Language spoken C. Health Practices D. Social Organizations ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 6. Identification of health risk in the community is a step-in formulating community health diagnosis. Which of the following methods should be done by the public nurse to best facilitate the identification of health risk threatening this community? A. Review vital statistics available B. Study health center records and reports C. Assess community health resources and industries available D. Familiarize with prevalent lifestyle of the people within the community ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 7. You are the new public health nurse. To obtain 100% population count of the community, you should need to do a: This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 13  A. One to one interview B. Survey C. Sampling of the population D. Census ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 8. In order to raise people’s awareness on cancer prevention, the following danger signs of cancer need to be disseminated. A. Unexplained anemia and weight loss B. All these groups C. Indigestion and nagging cough D. Change in normal bowel habits and unusual bleeding or discharge ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 9. In the year 1995, 27% of all children under 5 were underweight and about 50% of deaths among children under 5 are associated with: A. Malnutrition B. Diarrhea C. Denque D. Malaria ANSWER: ________ RATIO:__________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________ 10. What government agency is responsible to undertake initiatives in health care services through innovative approaches? A. Department of Science and Technology B. Department of Local Government C. Department of Health D. Department of Education ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 3. ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 11 of 13  RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ ____________________________________________________________________________________________ _ _____________________________________________________________________ 6. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 7. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 8. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 9. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 10. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ LESSON WRAP-UP (5 minutes) Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students trac k how much work they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet. You are done with the session! Let’s track your progress. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AL Activity: CAT: 3-2-1 Instructions: 1. As an exit ticket at the end of the class period 2. Record three things you learned from the lesson. 3. Next, two things that you found interesting and that you’d like to learn more about. 4. Then, record one question you still have about the lesson. Three things you learned: 1. __________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 12 of 13 2. __________________________________________________________________________________ 3. __________________________________________________________________________________ Two things that you’d like to learn more about: 1. ____________________________________________________________________________ ______ 2. __________________________________________________________________________________ One question you still have: 1.___________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 13 of 13  Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 2 Materials: LESSON TITLE: Standards of Public Health Nursing in the Philippines and the Evolution of Public Health in the Pen, paper, index card, book, and class List Philippines. LEARNING OUTCOMES: Reference: At the end of the lesson, the nursing student can: Famorca, Z. U., Nies, M. A., & McEwen, M. 1. Apply the competency standards of nursing practice in the (2013). Nursing Care of the Community. Elsevier Philippines in community health nursing practice; Gezondheidszorg. 2. Integrate relevant principles of social, physical, natural and health sciences and humanities in a given health and nursing situation; 3. Discuss appropriate community health nursing concepts and actions holistically and comprehensively; and, 4. Outline the historical development of public health and public health nursing in the Philippines. LESSON PREVIEW/REVIEW (5 minutes) Instruction: In your own opinion, what is the most important role of a community health nurse? Explain. _________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ MAIN LESSON (30 minutes) Standards of Public Health Nursing in the Philippines. Nursing in the Philippines has been compliant to medicine since its birth. It is not only to actual nursing practice but also to laws regulating the nursing profession. The scope of nursing means the extend or range of activities which a nurse may perform pursuant to Law. Whether f or free or a fee, salary, rewards or compensation, it is legal nursing practice under section 28 of R.A No. 9173, when a licensed nurse initiates and performs: a. Nursing services wither singly or collaboratively to individuals, families and communities in any health care setting. b. Nursing care whether singly or collaboratively, during conception, labor, delivery, infancy, childhood, pre -school, school age, adolescence, adulthood and old age. c. Nursing action as independent practitioner for promotion of health and prevention of illness d. Collaborative work with other health-care professionals for curative, preventive and rehabilitative aspects of care, restoration of health, alleviation of suffering and when recovery is not possible, towards peaceful death Specifically, among nurse the duties of a nurse are: a. To provide nursing care using the nursing process. b. To establish linkages with community resources and coordination with health team c. To provide health education to individuals, families and communities d. To teach guide and supervise students in nursing education programs including administration of nursing services in varies setting such as hospitals and clinics, undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse e. Undertake nursing and health human resource development training and research, which shall include the development of advanced nursing practice. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 9  Standards of care The Public Health Nurse (PHN) collects comprehensive data pertinent to Standard 1. Assessment the health status of the populations. Standard 2. Population Diagnosis The PHN identifies expected outcomes for a plan that is based on and Priorities population diagnosis and priorities. The PHN identifies the expected outcomes for a plan that is based on Standard 3. Outcome Identification population diagnoses and priorities. The PHN develops a plan that reflects best practices by identifying Standard 4. Planning strategies, action plans, and alternatives to attain expected outcomes. Standard 5. Implementation The PHN implements the identified plan by partnering with others. Coordinates programs, services and other activities to implement the a. Coordination identified plan. b. Health Education and Enjoys multiple strategies to promote health, prevent disease, and ensure Health Promotion a safe environment for populations. Provides consultation to various community groups and officials to c. Consultation facilitate the implementation of programs and services. Identifies, interprets, and implements public health laws, regulations and d. Regulatory Activities policies. Standard 6. Evaluation The PHN evaluates the health status of the population. Standards of Professional Performance The PHN systematically enhances the quality and effectiveness of Standard 7. Quality of Practice nursing practice. The PHN attains knowledge and competency that reflects current nursing Standard 8. Education and public health practice. The PHN evaluates one’s own nursing practice in relation to professional Standard 9. Professional Practice practice standards and guidelines, relevant statutes, rules and evaluation regulations. The PHN establishes collegial partnerships while interacting with Standard 10. Collegiality and representatives of the population, organizations, and health and human Professional Relationships services professionals and contributes to the professional development of peers, students, colleagues and others. The PHN collaborates with the representatives of the population, Standard 11. Collaboration organizations, and health and human services professionals in providing for and promoting the health of the population. Standard 12. Ethics The PHN integrates ethical provisions in all areas of practice. Standard 13. Research The PHN integrates research findings in practice. The PHN considers factors related to safety, effectiveness, cost, and Standard 14. Resource Utilization impact in practice and in the planning and delivery of nursing and public Population health programs. Policies and services. Standard 15. Leadership The PHN nurse provides leadership in nursing and public health. Evolution of Public Health in the Philippines The history of public health nursing in the Philippines is embedded in the history of the Department of Health which was first established as the Department of Public Works, Education and Hygiene in 1898. Since then, various laws were enacted to organize and establish the various structures and activities of the health agency covering the entire country. The following, milestones marked the events when nurses and nursing were particularly mentioned in historical accounts: 1912  The Fajardo Act (Act No. 2156) created Sanitary Divisions. The President of the Sanitary Division took charge of two or three municipalities. Where there were no physicians available, male nurses were assigned to perform the duties of the President, Sanitary Division  Philippine General Hospital then under the Bureau of Health sent four nurses to Cebu to take care of mothers and their babies. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 9  St. Paul Hospital of Nursing in Intramuros assigned two nurses to do home visiting in Manila and gave nursing to mothers and newborn babies from the outpatient obstetrical service of the Philippines General Hospital 1914  School nursing was rendered by a nurse employed by the Bureau of Health in Tacloban, Leyte.  Reorganization Act No. 2462 created the office of General Inspection. This office is created due to increasing demands for nurses to work outside the hospital, the need for direction, supervision and guidance of public health nurses. Two graduate Filipino nurses, Mrs. Casilang Eustaquio and Mrs. Matilde Azurin were employed for maternal and child nursing health and sanitation in Manila under an American nurse, Mrs. G.D Schudder. 1916-1918  Ms. Perlita Clark took charge of the public health nursing work. Her staff was composed of one American nurse supervisor, one American dietician, 36 Filipino nurses working in the provinces and one nurse and one dietitian assigned in two sanitary division  1917 Four graduates paid by the City of Manila were employed to work in the City Schools. Provinces that could afford to carryout school health services were encouraged to employ a district nurse.  1918 The office of Ms. Clark was demolished due to lack of funds 1919  The first Filipino nurse supervisor under the Bureau of health, MS Carmen del Rosario was appointed. She succeeded Miss Mabel Dabbs. She had a staff of 84 public health nurses assigned in five health stations.  There was a gradual increase of public health nurses and expansion of services 1923  Two government schools of nursing were established: Zamboanga General Hospital School of Nursing in Mindanao and Baguio General Hospital in Northern Luzon. These schools were primarily intended to train on-Christian women and prepare them to render service among their people. In Later years, four more government schools of nursing were established: one in southern Luzon (Quezon Province) and three in the Visayan Island of Cebu, Bohol and Leyte) 1926  Miss Carmen Legardo resigned and Miss Genara S. Manongdo, a ranking supervisor of the American Red Cross, Philippine Chapter was appointed in her place. 1927  The office of District Nursing under the Office of General Inspection, Philippine Health Services was abolished and supplanted by the section of Public Health Nursing. Ms. Genara de Guzman acted as consultant to the Director of health on nursing matters. 1928  The first convention of nurses was held followed by yearly convention until the advent of World War II. Preservice training was initiated as pre- requisite for appointment 1930  The Section of Public health Nursing was converted into Section of Nursing due to pressing need for guidance not only in public nursing services but also in hospital nursing and nursing education. The Section of Nursing was transferred from the Office of General Services to the Division of Administration. This office covered the supervision and guidance of nurses in the provincial hospital s and two government schools of nursing. 1933  Reorganization Act No. 4007 transferred the Division of Maternal and Child Health of the Office of Public Welfare Commission to the Bureau of Health. Mrs. Soledad Buenafe, former Assistant Superintendent of Nurse of the Public Welfare Commission was appointed as Assistant Chief Nurse of the Section of Nursing, Bureau of Health. 1941  Activities and personnel including six public health members of the Metropolitan Division, Bureau of health were transferred to the new department. Dr. Mariano Icasiano became the first City health Officer of manila. An office of Nursing was organized with Mrs. Vicenta C. Ponce as Chief Nurse and Mrs. Rosario A. Ordiz as assistant Chief nurse. They occupied these positions until retirement. December 8, 1921 a group of public health nurses broke out; public health nurses in Manila were assigned to devastated areas to attend to the sick and the wounded. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 9 1942  A group of public health nurses, physicians and administrators from manila Health Department went to the internment Camp in Capas, Tarlac to receive sick prisoners of the war released by the Japanese army. They were confirmed at San Lazaro Hospital and sixty-eight National Public Health Nurses were assigned to help to the staff take care of them.  July 1942 - 31 nurses who were taken prisoners of war by the Japanese army and confined at the Bilibid Prison in manila were released to then Director of the Bureau of health, Dr. Eusebio Aguilar who acted as their guarantor.  Many public health nurses joined the guerillas or went to hide in the mountains during World War II. 1946  Post war records of the Bureau of health showed that there were 308 public health nurses and 38 supervisors compared to pr-war when there were 556 public health nurses and 38 supervisors. In the same year Mrs. Genera M. De Guzman, technical assistant: Miss Anne Sand for Nursing Education: Mrs. Magdalena C. Valenzuela for Public Health Nursing and Mrs. Patrocinio J. Montellano for Staff Education. 1947  October 8, 1947 Executive order No. 94 reorganized government offices and created the Division of Nursing under the Office of the Secretary of health so that nursing services can be availed of by the different bureaus and units to help carry out their health programs  At the Bureau of Health, the Section of Nursing Supervision tool over the functions of the former Section of Nursing. Mrs. Soledad Buenafe was appointed chief and Miss Marcela Gabatin , assistant Chief.  The newly created Section of Puerculture Center of the Bureau of Hospitals and Mrs. Teresa Malgapo as Chief. 1948  The first training center of the Bureau of Health was organized in cooperation with the Pasay City Health Department. This was housed at the Tabon Health Center located in marginalized part of the city. It was renamed as Dona Marta Health Center.  Physician and nurse undergoing pre-service and in-service training in public health /public health nursing as well as nursing students on affiliation were assigned to the above training center. 1950  The Rural health Demonstration and Training center (RHDTC) was established by the Department of Health through the initiatives of Dr. Hilarion Lara, Dean Institute of Hygiene, now college of Public health, University of the Philippines  The WHO and UNICEF assisted project used health centers of the Quezon City Health Department, which were located in the rural areas of the city.  The RHDTC was used as a medicine, nursing, health education, nutrition and social work. Health workers from other countries also came to observe in the training center.  The training staffs of RHDTC were nurses and had a major role in the organization and implementation of training activities. 1953  The Office of Health Education and Personnel Training were established with Dr. Trinidad Gomez as Chief.  Philippine Congress approved Republic Act No. 1082 or the Rural Health Law. It created the first 81 Rural Health units. Each Unit had a physician, a public health nurse, a midwife, a sanitary inspector and a clerk driver. They were provided with transportation (jeep) by the UNICEF.  Among the first public health nurses to undergo pre-service training prior to assignment in the rural health units were two graduates of Class 1952 of the Philippine General Hospital School of Nursing, Miss Florida B. Ramos (Mrs. Martinez) and Miss Lydia Amurao (Mrs. Cabugao). 1957  Republic Act 1891 was approved amending Sections, two, three, four, seven and eight of R.A 1082: strengthening Health and dental Services in the Rural Areas and providing Funds thereto.” This second rural health Act created 8 categories of rural health units based on populations. This resulted in additional number of positions for health workers including public health nurses and midwives. 1958-1965  Republic Act 977 passed by congress in 1954 was implemented. Division of Nursing was abolished. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 9  It created nursing position at different levels in health organization.  Reorganization Act with implementing details embodied in Executive Order 288, series o f 1959 de-centralized and integrated health services. It created 8 Regional Health Offices in the country, which were later increased to 11 and eventually seventeen.  At the regional level two supervising positions for nurses were created: Regional Nurse Supervisors and Regional Public health Nurse. They had the same salary grades and performed the same function and responsibilities.  Regional Health Office had a regional Training center, creating position for Regional Training Nurse and Nurse Instructors who took charge of training activities.  The supervising Public health Nurses at the Provincial Health once supervised at the Public health Nurses assigned at the Rural Health Units as well as the Chief Nurses of the District hospitals.  The reorganization of 1959 also merged two Bureaus in the Department of health. The Bureau of health (in charged in preventive programs- Maternal and Child Health, Dental Health Industrial or Occupational Health) was merged with Bureau of Hospitals (Curative and regulatory / licensing functions) to from the Bureau of Health and Medical Services. 1967  In the Bureau of Disease Control Mrs. Zenaida Panlilio-Nisce was appointed as Nursing Program Supervisor and served as consultant on the nursing aspects of the 5 special diseases: TB, Leprosy, Venereal Diseases, Cancer, Filariasis, and Mental Health. She was involved in program planning, monitoring and evaluation a nd research. 1971  Mrs. Josefina A. Mendoza, supervising Nurse Instructor, office of Health Education and personnel Training, succeeded Mrs. Annie Sand as Nursing Consultant  WHO Consultant on Pediatric Nursing was appointed Nursing Program Supervisor, Office of the Secretary of Health. 1974  The project Management Staff was organized as part of Population Loan II of the Philippine Government with Dr. Francisco Aguilar as Project Manager.  Expert form different fields of public health were recruited and Mrs. Nelida Castillo joined the PMS staff. Her position as Nursing supervisor, office of the Secretary of health was taken over by Mrs. Zenaida Nisce, Nursing Program Supervisor Bureau of Disease Control. 1975  As a result of the restructuring of the health care delivery system based on the findings of Operation Research (WHO assisted) conducted in the province of Rizal in the early 70’s, the function of the health team members (Municipal health Officer, Public Health Nurse, Rural health Midwifes and Rural Sanitary Inspector) were redefined. The role of the Public Health Nurse and the midwife were expanded. Two thousand midwives were recruited and trained to serve in the rural areas. 1976- 1986  The Nursing Consultant and Nursing Program Supervisor of the Office of the Secretary were involved in the Rural health Practice Program which required medical and nursing graduates to serve for two months in the rural areas of the country before their licenses could be issued by the Professional Regulatory Commission. When the number of nursing graduates reached over 12,000 per year, the program was stopped. By then the objectives of the program that health services be made available in the rural areas in the country, and that the young medical and nursing graduates develop a liking for working in these remote underserved areas were partially attained.  During the incumbency of President Ferdinand Marcos, Mrs. Josefina Mendoza as Nursing Consultant strongly and repeatedly recommend the creation of the Bureau of Nursing but unfortunately, the government was in the midst of streamlining its organization. The envisioned Bureau of Nursing did not materialize even of the President endorsed it to Mr. Armand Fabella who was in charge of the government reorganization. 1986  The reorganization of the Department of Health during this period placed the position of Nursing Consulant at the Bureau of Health and Medical Services. It ws then abolished when Mrs. Mendoza retired. 1987- 1989  Executive Order No. 119 reorganized the Department of health and created several offices and services within the Department of Health This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 9  The number of positions of Nursing Programs Supervisors (Nurse VI) was increased as there were three or more appointed in each service. In the Maternal and Child Nursing Health Services Mrs. Emilia Briones and Mrs. Ana Mallari were first appointed. Aside from the usual services og mother and children, these nurses were involved in the following programs: Expanded Program on Immunization, control of Diarrheal Diseases and Control of Acute Respiratory Infections.  Mrs. Gloria Temelo and Miss Gilda Estipona are Nursing Program Supervisors f Non- Communicable Disease Control Services  Miss Thelma Bermudez, Miss Frances Prescilla Cuevas and Mrs. Ma. Theresa Mendoza were involved in the development of public health programs for the prevention and control of cardiovascular diseases, cancer, diabetes and disabilities such as blindness and deafness, osteoporosis, asthma and smoking control.  The three nurses at the Communicable Disease Control Service, Mrs. Zenaida P. Nisce, Mrs. Carolina A. Ruzol and Mrs. Zenaida Recidoro participated in the planning, training, monitoring, supervision and evaluation of diseases as Leprosy, sexually transmitted diseases, rabies, filariasis and dengue hemorrhagic fever 1999  May 24, 1999, Executive Order No. 102 was signed by president Joseph Ejercito Estrada, redirecting the functions and operations of the Department of Health  Based on this Executive Order, most of the nursing positions at the Central Office were either transferred or devolved to the other offices and services. 2005-2006  The development of the rationalization Plan to streamline the bureaucracy further was started and is in the last stages of finalization. 2006- up to Present  During this period, the Philippine Nursing Act of 2002 was enacted under the Republic Act No. 9173 which entails changes on existing policies under Republic Act No. 7164. These changes underscore on the require ments for faculty and Dean of the Colleges of Nursing, as well as the conduct for Nursing Licensure Exam. CHECK FOR UNDERSTANDING (20 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 20 minutes for this activity: Multiple Choice 1. Which among the following is true to Public Health Nursing? (Select all that apply) A. Both are special field of nursing B. Both are combination of nursing and social skills C. PHN and CHN can be used interchangeably D. It is public service oriented ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. The PHNs’ responsible of care is the: A. Client B. Family C. Community D. All of these ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 3. The focus of the PHNs’ activities is: A. Primary prevention B. Curative This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 9 C. Rehabilitative D. All of these ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. Which of the following does not describe an urban community? A. Highly dense in population B. People are well-knit and having high degree of group feeling C. Complex international relationship D. Non-agricultural occupation ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5.What health sector aims to achieve the health system goals of better health outcomes in the Philippines? A. Philippine Health Insurance B. Universal Health Care C. Home health Care D. Department of Labor and Employment ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 6. In this year, the Fajardo Act (Act No. 2156) created Sanitary Divisions. A.1910 B.1911 C.1912 D. 1921 ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 7. These schools were primarily intended to train on-Christian women and prepare them to render service among their people. A. Philippine General Hospital and Chong Hua Hospital B. Cardinal Santos Medical Center and the Medical City C. University of Santo Tomas and Manila Doctor’s Hospital D. Zamboanga General Hospital School of Nursing and Baguio General Hospital ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 8. In what year did the Section of Public health Nursing was converted into Section of Nursing due to pressing need for guidance not only in public nursing services but also in hospital nursing and nursing education? A. 1930 B. 1940 C. 1942 D. 1944 ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 9 9. In what year did the office of Health Education and Personnel Training were established with Dr. Trinidad Gomez as Chief. A. 1952 B. 1953 C. 1955 D. 1962 ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 10. In what year did the Philippine Health Services was abolished? A.1967 B.1927 C. 1972 D.1976 ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 3. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 6. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 7. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 9 8. ANSWER: ________ RATIO:_______________________________________________________________________________________ _________________________________________________________________________ ____________________ _____________________________________________________________________ 9. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 10. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AL Activity: Minute Paper: 1) What was the most useful or the most meaningful thing you have learned this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2) What question(s) do you have as we end this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 9  Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 3 LESSON TITLE: Theoretical Foundation of Community Materials: Health Nursing Pen, paper, index card, book, and class List LEARNING OUTCOMES: At the end of the lesson, the nursing student can: Reference: 1. Integrate relevant principles and theory of social, Famorca, Z. U., Nies, M. A., & McEwen, M. physical, natural and health sciences and humanities in (2013). Nursing Care of the Community. Elsevier a given health and nursing situation in the community; Gezondheidszorg. and, 2. Compare the different theories in community health nursing. LESSON PREVIEW/REVIEW (5 minutes) Instruction: Discuss the duties of the nurse as mandated in section 28 of R.A No. 9173. _________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ MAIN LESSON (30 minutes) When the nurses work on a complex community health problem, they need to think strategically. They need to know where to focus their time, energy and programmatic resources. There are health problems that have existed for years with other layers of foundational problems that may have existed for generations. The nurses should use organizational resources in a focused manner, so that they will solve the problem and can’t create new problems along the way. The nursing profession has advanced and with it so has the need to develop nursing theories that formalize the scientific base of community health nursing. The richness of community health nursing comes from the challenge of conceptualizing and implementing strategies that will enhance the health of the people. There are several theoretical approaches that the community health nurse may apply in efforts to improve community health. 1. General System Theory  It is applicable to the different levels of the community health nurses’ clientele: individual, families, groups or aggregates and communities.  It is viewed as an open system; the client is considered a set of interacting elements that exchange energy, matter, or information with external environment to exist (Katz and Kahn 1966).  The family and the group are set of interrelated individuals. This concept is particularly useful when analyzing interrelationships of the elements within the client as well as those of the client.  The family home and the community and its institution make up its immediate environment and are therefore important aspects to be considered in the assessment of the family health status.  The nurse observes interpersonal relationships among the members and appraises the physical environmental conditions in the home.  An interview with the family members may reveal how the family relates to the larger system-the community and the structures in the community such as health agencies.  The family gets inputs of matter (e.g., food, water), energy (e.g., sunlight, and electricity), information (e.g., news on community events, health teaching, which resources are taken from its environment.  The outputs refer to material products, energy and information that results from the family ’s processing (throughput) of inputs. The health practices and the health status are examples of outputs.  Feedbacks is information from the environment directed back to the system, which allows the system to make the necessary adjustment for better functioning This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 10 2. Social Learning Theory  It is based on the belief that learning takes place in a social context, that is, people learn from one another and that learning is promoted by modeling or observing other people.  People can learn by observing the behavior of others. 3. The Health Belief Model  The health belief model provides the basis for much of the practice of health education and health promotion today.  The individuals must know what to do and how to do it before they can take action. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 10   The information must be related in some way to the individual’s needs. One of the most widely used conceptual frameworks in health behavior, the HBM, has been used to explain behavior change and maintenance of behavior change and to guide health promotion intervention. 4. Milio’s Framework for Prevention  The framework provides that the health status existing in the population occurs due to too little or excess critical health sustaining resources whereby people who are have enough and safe food, shelter, water and environment are vulnerable to infectious diseases which too much food will lead to obesity.  Population behavior patterns also affect health since knowledge and perception is influenced by informal and formal learning and also by experience (Milio, n.d).  Health is also influenced by organizational behavior which includes policy makers since they provide options available to thus influencing selections made by individuals.  Milio proposed that health deficits often result from the imbalance between a population’s health needs and its health- sustaining resources.  Personal and societal resources affect the range of health promoting or health damaging choices available to individual.  Personal resources include: Awareness Knowledge Beliefs Money Time The urgency of priorities  Societal: community and national conditions strongly influence societal resources. Availability and cost of health services Environmental protection Safe shelter Penalties for failure to select the given options Rewards  Milio challenged health education’ assumption that knowledge of health generating behaviors implies an act in accordance with that knowledge.  She proposed that most human beings professional or non-professional, provider or consumer make the easiest choices available to them most of the time.  Health promoting choices must be more readily available and less costly than health damaging options for individuals to gain health and for society to improve health status. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 10 5. Pender’s Health Promotion Model  Pender’s Health Promotion Model explores many biopsychosocial factors that influence individuals to pursue health promotion activities  The HPM depicts the complex multidimensional factors which people interact as they work to achieve optimum health. This model contains seven variables related to health behaviors as well as individual characteristics that may influence them  Pender’s model does not include threats as a motivator as threat nay not be a motivating factor for clients in all age groups. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 10 6. The Transtheoretical Model  The TTM combines several theories of intervention  It is based on the assumption that behavior change takes place over time, progressing through a sequence of stages.  It also assumes that each of the stages is both stable and open to change  One may stop in one stage progress to the next stage or return to the previous stage  Change is difficult even for the most motivated of individuals. People resist change for many reasons:  Be unpleasant  Require giving up pleasure  Be painful  Be stressful  Jeopardize social relationships  Not seem important any more  Require change of self-image 7. PRECEDE-PROCEED Model  It provides a model for community assessment, health education, planning, and evaluation.  PRECEDE stands for:  P- predisposing  R-reinforcing  E- enabling  C-construct  E- educational  D diagnosis  E- Evaluation  PROCEED  P- policy  R- regulatory  O- organizational  C-construct  E-educational  D- developmental  Predisposing factors refer to a people’s characteristic that motivate them towards health –related behavior This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 10 This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 10 CHECK FOR UNDERSTANDING (20 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 20 minutes for this activity: Multiple Choice 1. In preparing to review different theories, nurse Bobby reviews basic information to assist in understanding the material. Theories are defined as: A. Statements that describe concepts or connect concepts B. Mental formulations of objects or events C. Aspects of reality than can be consciously sensed D. Concepts or propositions that project a systematic view of phenomena ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. Kristy, a community health nurse is working with a variety of clients and decides to use a Systems theory approach to assist them to meet their health care needs. In using the Systems theory, nurse Kristy focuses on the: A. Client’s interaction with the environment B. Hierarchy of the client’s human needs C. Client’s attitudes toward health behaviors D. Response of the client to the process of growth and development ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 10 RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 3. When assessing the external variables that influence a client’s health beliefs and practices, nurse Mindy must consider his: A. Educational background B. Religious practices C. Income status D. Reaction to the heart disease ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. In the Health Belief Model, nurse Chiara recognizes that the focus is placed on the: A. Functioning of the individual in all dimensions B. Relation of perceptions and compliance with therapy C. Relation of perceptions and compliance with therapy D. Multidimensional nature of clients and their interaction with the environment ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Which of the following is the most basic type of health promotion activity? (Select all that apply). A. A billboard promoting abstinence to prevent sexually transmitted diseases and unplanned pregnancies B. A wellness assessment program C. An environment control program about pesticide uses D. A nurse who models healthy lifestyle behaviors E. A school of nursing that holds a blood pressure fair ANSWER: ________ RATIO:___________________________________________________________________________________________ ____________________________________________________________________________________________ ____ ________________________________________________________________________________________________ 6. Nurse Marco is providing health education about injury and poisoning prevention to a group of young mothers at a health fair. What type of prevention is the nurse conducting? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Limited prevention ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 7. Pender’s health promotion model would benefit which of the following clients? (Select all that apply) A. An active 23-year-old who does not smoke or drink alcohol B. A 49-year-old client who exercises four times a week C. A 35-year-old who has yearly breast exams and other routine health screenings D. An overweight 27-year-old who engages in risky behaviors ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 8. Client Clint reports that he believes he will "never lick the habit" of smoking because he has tried before and failed. Using the Transtheoretical model (TTM), what stage of health behavior is the client functioning in? A. Preparation stage This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 10 B. Contemplation stage C. Termination stage D. Action stage ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 9. Honey, a public health nurse compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is being implemented? A. Assurance B. Assessment C.Prevention D.Policy development ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 10. Nurse Glynnis performs activities to meet the primary goals of public health. Which of the following is nurse Glynnis most likely to complete? A. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication B. Finding home care for a 70-year-old client recuperating from a hip replacement C.Conducting an infant car seat safety check D.Contacting a local hospice to admit a terminally ill 60-year-old woman ANSWER: ________ RATIO:___________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 2. ANSWER: ________ RATIO:____________________________________________________________________