Community Health Nursing 1 Midterm

COMMUNITY HEALTH NURSING 1 The Philippine Public Healthcare Scenario (INDIVIDUAL AND FAMILY) The national budget allocation for health care is I.OUTLINE OF PUBLIC HEALTH NURSING IN...

COMMUNITY HEALTH NURSING 1 The Philippine Public Healthcare Scenario (INDIVIDUAL AND FAMILY) The national budget allocation for health care is I.OUTLINE OF PUBLIC HEALTH NURSING IN relatively small. Local government units augment THE PHILIPPINES the national budget to an undetermined extent. This scenario requires strategies that will allow HEALTHY FAMILIES are the maximization of limited resources: foundation for HEALTHY Health promotion COMMUNITIES, and through Disease prevention the Sustainable Development Goals, the PUBLIC HEALTH world has made a promise of UNIVERSAL HEALTH Is the science and art of preventing disease, COVERAGE AND HEALTH FOR prolonging life, and promoting physical health ALL. and efficiency through: - Organized community efforts for the sanitation I.A. Global and National Health Situation of the environment - Control of community infections ❖ The COVID-19 global outbreak is challenging - Education of the individual in principles of health systems worldwide, both the supply side personal hygiene (delivery) and the demand side (access) of - Organization of medical and nursing service for essential family planning and maternal/child the early diagnosis and preventive treatment of health services particularly in low income and disease middle income countries. - Development of the social machinery which will ensure to every individual in the community a ❖ The world has never seen a health crisis like standard of living adequate for the maintenance COVID-19. It has impacted communities of health everywhere in all aspects of our lives. There has never been a stronger, more urgent case for (Organizing these benefits in such fashion as to global cooperation because no one is safe until enable every citizen to realize his birth right of everyone is safe. health and longevity). ❖ Each year, more than 5.2 million children under AS A SCIENCE age 5 die from preventable causes, and over 800 Is concerned with the KNOWLEDGE and women and adolescent girls die due to SKILLS required of a NURSE to be able to complications during pregnancy and childbirth institute interventions for the WELFARE of every day. the PUBLIC. ❖ The number of children receiving life saving AS AN ART routine childhood immunization in Barangay Public Health requires creativity in Health Stations and Barangay Health Centers has executing the knowledge and skills for the decreased. A lot of children missed routine comfort of the People. vaccines during pandemic because of difficulty in transportation and fear of contracting COVID-19. THE MISSION OF PUBLIC HEALTH is Social Justice, which entitles all People to Basic ❖ Significant rise of unintended pregnancies Necessities such as adequate Income and because of disruption in the delivery and lack of Health Protection and accepts collective supply of modern FP commodities. burdens to make it possible. ❖ Increasing number of Home Deliveries handled Community/public health nursing by Hilots. is the synthesis of nursing practice and public health practice. ❖ Increasing number of malnourished children and pregnant women noted in every barangay. The major goal of community health nursing is to preserve the health of the community and surrounding populations by focusing on health promotion and  health maintenance of individuals, identify and solve health problems families, and groups within the community. 5. Develop policies and plans that support individual and community health efforts PUBLIC HEALTH EFFORTS 6. Enforce laws and regulations that protect health Focus on Prevention and Promotion of Population and ensure safety Health at the National Level and Local Levels. 7. Link people to needed personal health services National Level: Concentrate on providing and assure the provision of health support and advisory services to Public Health care when otherwise is unavailable Structures at the Local Level. 8. Assure a competent public health and personal Local Level: Provide direct services to health workforce communities through Two Avenues: 9. Evaluate effectiveness, accessibility and quality of 1. Community Health services which protect the personal and population based Public from hazards such as polluted water and health services air, tainted food and unsafe housing. 10. Research for new insights and innovative 2. Personal Health Care Services such as solutions to health problems. immunization and family planning services, well Public Health Nurses focus on the care of: infant care and sexually transmitted disease (STD) treatment. - Individuals - Groups CORE PUBLIC HEALTH FUNCTIONS - Aggregates - Populations in many settings including homes, clinics, worksites and schools 1. ASSESSMENT Regular collection, analysis and information sharing Public Health Nurses must be able also to assess a about health conditions, risks and resources in a Population’s health needs and resources and identify community. its values. 2. POLICY DEVELOPMENT Public Health Nurses must also work with the Use of information gathered during assessment to community to identify and implement programs that develop local and state health policies and to direct meet health needs and to evaluate the effectiveness resources toward those policies. of programs after implementation. 3. ASSURANCE Focuses on the availability of necessary health THE PUBLIC HEALTH INTERVENTION WHEEL services throughout the community. It includes maintaining the ability of both public health agencies The Intervention Wheel is a population-based and private providers to manage day to day practice model that encompasses three levels of operations and the capacity to respond to critical practice (community, systems, and individual/family) situations and emergencies. and 17 public health interventions. Each intervention and practice level contributes to improving ESSENTIAL PUBLIC HEALTH SERVICES population health. The Minnesota 1. Monitor health status to identify and solve Department of community health problems Health (MDH) introduced the 2. Diagnose and investigate health problems and color-coded health hazards in the community graphic illustration, once 3. Inform, educate and empower people about known as the health issues Public Health Intervention 4. Mobilize community partnerships and actions to Model, in 1998. Today, you may hear it called the Intervention similar than they are different; health teaching and Wheel, or simply, the Wheel. counseling are especially often paired. It Contains Three Levels of Practice Orange Three concentric circles inside the wheel name the The interventions in the orange wedge— levels of practice. They are identified, from the outer collaboration, coalition building, and community ring to the inner ring: Systems-focused, community- organizing—while distinct, are grouped together focused, and individual-focused. because they are all types of collective action and are most often carried out at systems or community 1. Systems-focused: Changes organizations, policies, levels of practice. laws, and power structures. The focus is not directly on individuals and communities but on the systems Yellow that impact health. Changing systems often impacts Similarly, advocacy, social marketing, and policy population health in a more effective and lasting way development and enforcement—the yellow than requiring change from every individual in a wedge—are often interrelated when implemented. community. In fact, advocacy is often viewed as a precursor to policy development; social marketing is seen by 2. Community-focused: Changes community norms, some as a method of carrying out advocacy. attitudes, awareness, practices, and behaviors. This practice level is directed at entire populations within the community or occasionally toward target groups PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS within those populations. Community-focused practice is measured in terms of what proportion of the population actually changes. 1. SURVEILLANCE Describes and monitors health events through 3.Individual/family-focused: Changes knowledge, ongoing and systematic collection, analysis and attitudes, beliefs, practices, and behaviors of interpretation of health data for the purpose of individuals and families. This practice level is directed planning, implementing and evaluating public health at individuals, alone or as part of a family, class, or interventions. group. Individuals receive services because they are identified as belonging to a population at risk. 2. DISEASE AND OTHER HEALTH INVESTIGATION Systematically gathers and analyses data regarding threats to the health of the populations, ascertains Interventions Are Actions the source of the threat, identifies cases and other at The interventions comprising the wheel’s outer ring risk and determines control measures. are grouped by color. 3. OUTREACH Red Locates populations of interest or populations at risk The five interventions in the red wedge are and provides information about the nature of the frequently implemented in conjunction with one concern, what can be done about it and how service another. Surveillance is often paired with disease can be obtained. and health event investigation, even though either can be implemented 4. SCREENING independently. Screening frequently follows either Identifies individuals with unrecognized health risk surveillance or disease and health event investigation factors or asymptomatic disease condition. and is often preceded by outreach activities in order to maximize the number of those at risk who actually 5. CASE FINDING get screened. Most often, screening leads to case Locates individuals and families with identified risk finding, but this intervention can also be carried out factors and connects them with resources independently. 6. REFERRAL AND FOLLOW UP Assists individuals, families groups, organizations, Green and/or communities to identify and access necessary The green wedge consists of referral and follow- resources to prevent or resolve problems or up, case management, and delegated functions— concerns. three interventions that, in practice, are often implemented together. 7. CASE MANAGEMENT Optimizes self care capabilities of individuals and Blue families and the capacity of systems and Similarly, health teaching, counseling, communities to coordinate and provide services. and consultation—the blue wedge—are more 8. DELEGATED FUNCTIONS 3 BASIC CONCEPTS OF COMMUNITY OR PUBLIC Carries out direct care tasks under the authority of a HEALTH health care practitioner as allowed by the law. - Community as a Client - Health as a Goal 9. HEALTH TEACHING - Nursing as the vehicle or means to achieve its aims Communicates facts, ideas and skills that change knowledge, attitudes, values, beliefs, behaviours and 1. COMMUNITY AS A CLIENT practices of individuals, families, systems and/or Community a group of people living in particular area communities. with common beliefs, values and traditions. 10. COUNSELLING Two Important Attributes of Community Establishes an interpersonal relationship with a 1. Having geographic boundaries community, a system and a family or individual, with 2. Shared belief system or culture intention of increasing or enhancing their capacity for self care and coping. GEOGRAPHIC BOUNDERIES Where people live is an important 11. CONSULTATION determinant of Human Behaviour and Seeks information and generates optional solutions Health. Whether humans settle near bodies to perceived problems or issues through interactive of water or on the mountain slopes, people problem solving with a community system and family uniquely adopt to their environment and or individual spell much of the choices they make in their life including healthcare. 12. COLLABORATION Commits two or more persons or organizations to SHARED BELIEF SYSTEM OR CULTURE achieve a common goal by enhancing the capacity of Bound by their location, people develop one or more of the members to promote and protect common beliefs and values that eventually health. evolve as culture. This set of beliefs acquired over time accounts for why people 13. COALITION BUILDING across the globe have similarities and Promotes and develops alliances among differences. Further, culture spells out organizations or constituencies for a common people’s primordial concept of health and purpose. illness and their health seeking behaviour. 14. COMMUNITY ORGANIZING Helps community groups to identify common (In the Philippines, the concept of health problems or goals, mobilize resources and develop and illness can be summed up in either and implement strategies for realizing the goals they presence or absence of signs and symptoms. collectively have set. Without physical manifestations of disease, people tend to cling to the false belief of 15. ADVOCACY being healthy. Such mindset breeds a fatal Pleads someone’s cause or acts on someone’s behalf, outcome. In this context, families only seek with a focus on developing the community, system healthcare when the condition is advanced and individual or family’s capacity to plead their own with full blown complications hence cause or act on their own behalf. requiring costly hospitalization in tertiary care.) 16. SOCIAL MARKETING Utilizes commercial marketing principles and 2. HEALTH AS A GOAL technologies for programs designed to influence the Health is more than a state of wellbeing, It is a knowledge, attitudes, values, beliefs, behaviours and multidimensional reality that includes socioeconomic, practices of the population of interest. environmental and even political factors. 17. POLICY DEVELOPMENT AND ENFORCEMENT With Health as a goal, healthcare needs to be holistic. Places health issues on decision maker’s agendas, This means that the Nurse in the community foster multi- acquires a plan of resolution and determines needed disciplinary efforts to address various core determinants resources, resulting in laws, rules, regulations, of health. ordinances and policies. Policy enforcement compels others to comply with laws, rules, regulations, Moreover, health is a shared reality. It is the common ordinances and policies. ground that connects all people regardless of age, sex, creed and religion. Thus, healthcare should be universal in order to achieve health as a human right. COMMUNITY HEALTH NURSING 3. NURSING AS THE VEHICLE OR MEANS TO ACHIEVE ITS Is defined as a specialized field of nursing practice that AIM renders care to individuals, families and communities; focusing on health promotion and disease prevention Nursing is traditionally defined as the art and science of through people empowerment. caring. CORE OF COMMUNITY HEALTH NURSING Nursing is a means of ensuring that people are placed in 1. Health Promotion: directed at improving the well- an optimum condition where nature can contribute to being healing and wellness—Florence Nightingale. Such 2. Disease Prevention: Protects people from disease assertion from Nightingale provides a powerful and the effects of disease description of what nurses do in community and public health work. Efforts to help people reduce their risks from developing disease and maintain their optimum functioning is a Ensuring safe water access and promoting sanitary priority in this field. conditions are part and parcel of promoting health and preventing diseases. Preventive measures like vaccination and screening activities for certain diseases for early detection and The unique function of the nurse is to assist the prompt treatment are packaged into health programs for individual, sick or well, in the performance of those communities. activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had Nurses in the Community strive to help people gain the necessary strength, will or knowledge. And to do this independence in health by sharing information to help in such a way as to help him gain independence as rapidly them manage their own healthcare needs. This is the as possible—Virginia Henderson essence of empowerment, that people enjoy health in their own hands. Defining Attributes of Communities - People - Place - Interaction - Common characteristics, interests or goals -Maurer and Smith, 2009 Determinants of Health and Disease - Income and social status - Education - Physical environment - Employment and work conditions - Social support networks - Culture - Genetics - Personal behavior and coping skills - Health services - Gender Level of Prevention 1. Primary: general health promotion and specific protection 2. Secondary: early detection and prompt intervention 3. Tertiary: reduce the effects of disease and injury, and restore individuals to their optimal level of functioning -Leavell and Clark, 1958  1888: The University of Santo Tomas opens a two-year, cirujanos ministrantes course to produce male nurses and sanitary inspectors. 1901: The Board of Health of the Philippine Islands was created through Act 157, which eventually evolved into the Department of Health (DOH) 1905: Asociacion de Feminista Filipina founded La Gota de Leche: the first center dedicated to the service of mothers and babies 1912: The Fajardo Act law created sanitary divisions made up one to four municipalities. 1947: The DOH was reorganized into bureaus and the administration of city health departments was placed at bureau level. 1954: The congress passed R.A. 1082 or the Rural Health Unit Act which provided an RHU in every municipality. 1957: R.A. 1891 was enacted to have a more equitable distribution of health personnel. 1958: Regional health offices were created as a result of decentralization efforts, thus creating the position: Regional Health Officer. 1970: the Philippine health care delivery system was restructured, paving the way for the health care system that exists to this day where health services are classified into primary, secondary and tertiary levels. 1991: R.A.7160 or the Local Government Code mandated the devolution of basic services, including health services, to local government units and the establishment of a local health board in every province and city or municipality. 1999: Health Sector Reform Agenda was launched to direct government efforts towards comprehensive reforms. 2005: FOURmula One (F1) for health was launched to provide an implementation framework to the reform agenda. 2010: Universal Health Care was launched to provide the necessary revisions to the F1 framework. 2016-2022: Healthy Philippines with ACHIEVE acronym strategy and with the F1 plus framework 2023-2028: Health Sector Strategy Impact for healthier Pilipinos ROLES OF A COMMUNITY AND PUBLIC HEALTH NURSE History of Public Health Nursing in the Philippines 1577: Friar Juan Clemente opened a medical dispensary in Intramuros for the indigent. 1690: Dominican Father Juan de Pergero worked towards installing a water system in San Juan del Monte (now San Juan City, Metro Manila) and Manila. 1805: Dr. Francisco de Balmis introduced Smallpox vaccination. 1876: The first medicos titulares were appointed and worked as provincial health officers. II. THE HEALTH CARE DELIVERY SYSTEM World Health Organization (WHO)- specialized agency in the United Nations (UN) provides global leadership on health matter in the Philippines. Health services are provided by the; - government and - private sector -for profit as well as non-profit to as Non- Government Organizations (NGO). On the national level, director is set by department of health (DOH) by virtue of mandate of the Local Government Code (R.A.7160) LGU’s should have operating mechanism to meet the priority needs and service requirements of their communities. Basic Health Services are regarded as priority services for which LGU’s are primary responsible. Health System consist of all organizations, people and actions whose primary intent is to promote, restore, or maintain health. 1. Service delivery 2. Health Workforce 3. Information 4. Medical Products, Vaccines, and technologies 5. Financing 6. Leadership and governance or stewardship The World Health Organization The WHO constitution came into force on April 7, 1948. Since then April 7 has been celebrated each year as World Health Day. Objective: attainment by all peoples of the highest possible level of health (WHO,2006) To attain its objective, WHO carries out the following core functions: - Providing leadership on matters critical to health and engaging partnerships where joint action is needed. WHO has 193 members of countries and 2 associate members. WHO and its members work with UN agencies, NGO’s and the private sector. The WHO country focus is directed toward providing technical collaboration with member states with accordance with each country’s needs and capacities. - Shaping the research agenda and stimulating the ensuring health and well being of populations. generation, translation, and disseminating valuable knowledge. The WHO strategy on research for health THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM has 5 goals: 1. Capacity- in reference to capacity-building to Components and Sectors of the Health Care Delivery strengthen the national health research system System: 2. Priorities – to focus research on priority health need particularly in low and middle income countries The Philippine health care delivery system is 3. Standards - to promote good research practice and composed of two sectors: enable the greater sharing of research evidence, tools, and materials (1) public sector- consists of the national and local 4. Translation - to ensure that quality evidence is turned government agencies providing health services. At the into products and policy national level, the Department of Health (DOH) is 5. Organization – to strengthen the research culture mandated as the lead agency for health. It has a regional within WHO and improve the management and office in every region and maintains specialty hospital, coordination of WHO research activities. regional hospitals and medical centers. The public sector is largely financed through a tax based budgeting system - Setting norms and standards and promoting and at both national and local levels. In here, health is monitoring their implementation. WHO develops norms generally free at the point of service. and standards for various health and health –related issues, such as pharmaceutical products including vaccines and other biological products used in (2) private sector - is a largely market oriented and immunization, practices in maternal and child care, and health care is rapid through users fee at the point of environmental conditions. service. Its involvement in maintain the people’s health include providing health insurance, manufacturer of medicines, vaccines, medical supplies, equipment and - Articulating ethical and evidence-based policy other health and nutrition products, research and options. Through its Department of Ethics and Social development, human resource and development and Determinants, WHO is evolved in various issues on health other health related services. ethics. In collaboration with other governmental and nongovernmental organizations, WHO has worked on bioethical concerns such as those related to human organ (The private sector is composed of for-profit and and tissue transplantation, reproductive technology and nonprofit agencies this sector provides all levels of public health response to threats of infectious diseases services and accounts for a large segment of health like AIDS, influenza, and tuberculosis. service providers in the country. About 30% of Filipinos utilize private health facilities. Estimated 60% of national health expenditure goes to the private sector which - Providing technical support, catalyzing change, and employs more than 70% of the health professionals in the building sustainable institutional capacity. WHO offers Philippines. technical support training to its member countries in the fields of maternal and child health, control of diseases, and environmental health services. WHO is involved in Financing of health services is provided by three monitoring the health situation and assessing health major groups: The government (national and local), trends. WHO has developed guidance and tools and private sources and social health insurance. The measurement, monitoring and evaluation. National Insurance Act of 1995 (R.A. 7875) created by the Philippine Health Insurance Corporation (PhilHealth). It is tax-exempt government corporation attached to the DOH WHO has worked as a partner of the Philippine for policy coordination and guidance, and aims for DOH in the Development and provision of services universal health coverage of all Filipino citizens.) towards the attainment of health-related Sustainable Development Goals (SDGs). The Sustainable Developmental Goals (SDGs) or Agenda 2030 aims to continue the gains achieved thru Millennium Development Goals (MDGs) implemented from 2000 to 2015. The SDGs contain 17 goals and 169 targets that will cover the period 2016 to 2030. In the Philippines, the Department of Health develops and aligns its programs to help achieve SDG 3 that focuses on The Millennium Development Goals On September 6 to 8, 2000, world leaders on UN General Assembly participate in Millennium Summit. The result of the summit was a resolution entitled United Nations Millennium Declaration. In this declaration, the world leaders recognized their collective responsibility to uphold the principles of human dignity, equality and equity at the global level. The declaration expressed the commitment of the 191 member states, including the Philippines, to reduce extreme poverty and achieve seven other targets - now called the Millennium Development Goals (MDG’s) by the year 2015. The following are the eight MDG’s and the targets corresponding to health-related MDG’s 4,5, and 6: 1. Eradicate extreme poverty and hunger. 2. Achieve universal primary education. 3. Promote gender equality and empower women. 4. Reduce child mortality. (Target: reduce by 2/3, between 1990 and 2015, the under-five mortality rate). 5. Improve maternal health. (Target: Reduce by three quarters the maternal mortality ratio & Achieve universal access to reproductive health) 6. Combat HIV/AIDS, malaria and other diseases. (Targets: Have halted by 2015 and begun to reverse the spread of HIV/AIDS, Achieve by 2010, universal access to treatment for all those who need it, Have halted by 2015, and begun to reverse the incidence of malaria and other major diseases) 7. Ensure environmental sustainability 8. Develop a global partnership for development The Sustainable Developmental Goals (SDGs) or Agenda 2030 aims to continue the gains achieved thru Millennium Development Goals (MDGs) implemented from 2000 to 2015. The SDGs contain 17 aspirational "Global Goals" and 169 targets that will cover the period 2016 to 2030.  The Sustainable Development Goals (SDGs), aims to “ ensure that all human beings can fulfill their potential in dignity and equality and in a healthy environment.” The SDGs, otherwise known as the Global Goals, build on the Millennium Development Goals (MDGs), eight anti-poverty targets that the world committed to achieving by 2015. The MDGs, adopted in 2000, aimed at an array of issues that included slashing poverty, hunger, disease, gender inequality, and access to water and sanitation. The new Global Goals, and the broader sustainability agenda, go much further than the MDGs, addressing the root causes of poverty and the universal need for development that works for all people.  The Philippine Department of Health The DOH is the national agency mandated to lead the health sector towards assuring quality health care for all Filipinos. DOH Vision: is to make “Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040” DOH Mission: “To Lead the country in the development of a productive, resilient, equitable, and people centered health system” (DOH,2019). DOH has the following major roles: - Leader in health - Enabler and capacity builder - Administrator of specific services The DOH core values (1.) Integrity (2.) Excellence (3.)Compassion and respect for human dignity (4.) Commitment (5.) Professionalism (6.)Teamwork (7.) Stewardship of the health of the people (DOH, 2013). Historical Background of DOH Local Health System and Devolution of Health Services R.A 7160 or Local Government Code was enacted to bring about genuine and meaningful local autonomy. This will enable local governments to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals. Devolution refers to the act by which the national government confers power and authority upon the various LGU’s to perform specific functions and responsibilities. R.A 7160 provided for the creation of the Provincial Health Board and the City/Municipal Health boards, or Local Health Boards. The chairman of the board is the local executive- the Provincial Governor/ Mayor. The Provincial/ City/ Municipal Health Officer serve as vice chairman. * With limitations of LGUs to finance health human resource, the DOH has launched Nurse Deployment Project (NDP) to augment efforts of PHNs in their areas of jurisdiction.  Classification of Health Facilities ( DOH AO – 2012-0012 ) The DOH issued Administrative Order 2012-0012 (Rules and Regulations Governing the new Classification of Hospitals and Other Health Facilities in the Philippines) that provides for a new classification scheme of health facilities. The Health Referral System A referral is a set of activities undertaken by a health care provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient’s need. A functional referral system is one that ensures the continuity and complementation of health and medical services.  It usually involves movement of a patient from the health center of first contact and the hospital at first referral level. When hospital intervention has been completed, the patient is referred back to the health center. This accounts for the term two-way referral system. Referrals may be internal or external ❖ Internal referrals – occur within the health facility; may be made to request for an opinion or suggestion, co- management, or further management or specialty care. ❖ External referral – is a movement of a patient from one health facility to another. It may be vertical, where the patient referral may be from a lower to a higher level of health facility or the other way round.