NCM 3155 Community Health Nursing 2 LEC (Population Groups & Community as Clients) SY 2024-2025 PDF

CHN 2 LEC: Prelims NCM 3155 SY 2024-2025 NCM 3155: COMMUNITY HEALTH NURSING 2 LEC (POPULATION...

CHN 2 LEC: Prelims NCM 3155 SY 2024-2025 NCM 3155: COMMUNITY HEALTH NURSING 2 LEC (POPULATION 1ST SEMESTER GROUPS AND COMMUNITY AS CLIENTS) MA’AM MELBA IRENE GABUYA a. Allender - A collection of people who interact OUTLINE with one another and whose common I Introduction and Overview of Community Health interests or characteristics form the basis for a Nursing A. Definitions sense of unity or belonging. a. Terminologies b. Lundy and Janes - A group of people who B. Public Health Nursing C. Community-Based Nursing share something in common and interact with D. Determinants of Health one another, who may exhibit a commitment E. Indicators of Health and Illness with one another and may share geographic F. Definition and Focus of Public Health and Community Health boundary. G. 9 Essential Public Health Functions According to WHO c. Clark - A group of people who share common Regional Office for the Western Pacific H. Health Promotion and Levels of Preventions interests, who interact with each other, and a. Leavell and Clark’s Three Levels of who function collectively within a defined Prevention I. 6 Building Blocks social structure to address common concerns. a. Organization of Health Services d. Shuster and Goeppinger - A locality-based J. Human Resources for Health entity, composed of systems of formal a. Health Worker Migration organizations reflecting society’s institutions, II Community Organizing and COPAR informal groups and aggregates. III Philippine Healthcare Delivery System e. Maurer and Smith (2009) - Two main types of communities: IV Primary Healthcare 1. Geopolitical communities - Also called territorial communities. V Community Health Nurse Specialized Field in - Most traditionally recognized. Community and Public Health Nursing - Defined or formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, INTRODUCTION AND OVERVIEW OF COMMUNITY regions and nations. HEALTH NURSING 2. Phenomenological communities Definition of HEALTH according to: - Also called functional communities. a. WHO - A state of complete physical, mental - Refer to relational, interactive groups, in which and social well-being and not merely the the place or setting is more abstract, and absence of disease or infirmity. people share a group perspective or identity b. Murray - A state of well-being in which the based on culture, values, history, interest and person is able to use purposeful, adaptive goals. responses and processes physically, mentally, emotionally, spiritually, and socially. Community/Public Health Nursing is the synthesis of c. Pender - Actualization of inherent and nursing practice and public health practice. acquired human potential through goal- Major goal of CHN - Preserve the health of directed behavior, competent self-care, and the community and surrounding population by satisfying relationship with others. focusing on health promotion and health d. Orem - A state of person that is characterized maintenance of individual, family and group by soundness or wholeness of developed within community. human structures and of bodily and mental Thus CHN/ PHN is associated with health and functioning. identification of population at risks rather than with an episodic response to patient demand. Definition of COMMUNITY according to: ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 1  Mission of Public Health - Is social justice measures for evaluation or control of threats that entitles all people to basic necessities, to health, for health education of the public such as adequate income and health and for the mobilization of the public for health action. protection, and accepts collective burdens to make possible. PUBLIC HEALTH NURSING TERMINOLOGIES PHC according to ANA (1996): Social - The practice of promoting and protecting the - Of or relating to living together in organized health of populations using knowledge from groups or similar close aggregates. nursing, social and public health sciences. Social Health - Population-focused,with the goals of - Connotes community vitality and is a result of promoting health and preventing disease and positive interaction among groups within the disability for all people through the creation of community with an emphasis on health conditions in which people can be healthy. promotion and illness prevention. COMMUNITY-BASED NURSING Community - Is seen as a group or collection of Application of the nursing process in caring locality-based individuals, interacting in social for individuals, families and groups where they units and sharing common interests, live, work go to go school or they move characteristics, values, and/ or goals. through the healthcare system. Population Setting - Specific, and the emphasis is on - Is typically used to denote a group of people acute and chronic care and includes practice having common personal or environmental areas such as home health nursing and characteristics. nursing in outpatient or ambulatory setting. Aggregates CHN vs. Community-Based Nursing - Are subgroups or subpopulations that have - CHN emphasizes preservation and protection some common characteristics or concerns. of health - the primary client is the community. Community Health Nursing - Global or umbrella term; broader and more DETERMINANTS OF HEALTH general specialty area that encompasses subspecialties that include public health 1. Income and Social Status - Higher income and nursing, school nursing, occupational health social status are linked to better health. The nursing, and other developing fields of greater the gap between the richest and poor practice, such as home health, hospice care, health, the greater differences in health. and independent nurse practice. - The synthesis of nursing practice and public 2. Education - Low education levels are linked with health practice applied to promoting and poor health, more stress and lower self- preserving health of the populations (ANA, confidence. 1980). Public Health Nursing 3. Physical Environment - Safe water and clean - A component or subset of CHN. air, healthy workplaces, safe houses - The synthesis of public health and nursing communities and roads all contribute to good practice. health. PHC according to FREEMAN (1963) 4. Employment and Working Conditions - People - Public Health Nursing may be defined as the in employment are healthier, particularly those field of professional practice in nursing and in who have control over their working conditions. public health in which technical nursing, interpersonal, analytical, and organizational 5. Social Support Networks - Greater support skills are applied to problems of health as they from families, friends and communities is linked affect the community. to better health. - These skills are applied in concert with those of other persons engaged in health care, 6. Culture - Customs and traditions, and the beliefs through comprehensive nursing care of of the family and community all affect health. families and other groups and through ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 2 7. Genetics - Inheritance plays a part in prolonging life and promoting health through determining lifespan, healthiness and the the organized efforts of society. likelihood of developing illnesses. c. Public health - Key phrase definition: Through 8. Personal Behavior and Coping Skills - organized community effort. Balanced eating, keeping active, smoking, d. Connotes organized, legislated, and drinking and how we deal with life’s stresses and tax-supported efforts that serve all people challenges all affect health. through health departments or related governmental agencies. 9. Health Services - Access and use of services that prevent and treat disease influences health. SIDE NOTE: 10. Gender - Men and women suffer from different types of diseases at different ages. PHILIPPINE NATIONAL HEALTH SITUATION As of 22 June 2022, a total of 3,708,271 COVID-19 cases had been recorded in the Philippines since INDICATORS OF HEALTH AND ILLNESS the beginning of the COVID-19 pandemic. There were 7,398 new cases (6.71 cases per National Epidemiology Center of DOH, PSA 100,000 population) reported in week 26 (27 and local health centers/ offices/ June—3 July 2022), that is 59.65% higher than the departments- provide morbidity, mortality and previous week (20 - 26 June 2022: 4,634 new other health status related data. cases, 4.20 cases per 100,000 population. Local health centers/ offices/ departments- In week 26, the following regions recorded the are responsible for collecting morbidity and highest case counts: National Capital Region mortality data and forwarding the information (3,634 cases), Region IV-A: CALABARZON (1,388 to the higher lever of health, such as cases), and Region VI: Western Visayas (608 cases). Provincial Health office. Nurses should participate in investigative efforts to determine what is precipitating the 9 ESSENTIAL PUBLIC HEALTH FUNCTIONS increased disease rate and work to remedy ACCORDING TO WHO REGIONAL OFFICE FOR the identified threats or risks. THE WESTERN PACIFIC DEFINITION AND FOCUS OF PUBLIC HEALTH AND 1. Health situation monitoring and analysis COMMUNITY HEALTH 2. Epidemiological surveillance/ disease prevention and control Definition of PUBLIC HEALTH according to: 3. Development of policies and planning in a. CE Winslow - Public health is the science and public health art of preventing disease (1), prolonging life 4. Strategic management of health systems and (2), and promoting health and efficiency services for population health gain through organized community effort for: 5. Regulation and enforcement to protect public - Sanitation of the environment, health - Control communicable infections, 6. Human resources development and planning - Education of the individual in persocal in public health hygiene, 7. Health promotion, social participation and - Organization of medical and nursing services empowerment for the early diagnosis and preventive 8. Ensuring the quality of personal and treatment of disease, and population-based health service - Development of the social machinery to 9. Research, development, and implementation ensure everyone a standard of living adequate of innovative public health solution for the maintenance of health, so organizing these benefits as to enable every citizen to SIDE NOTE: realize his birthright of health and longevity (Hanlon). Community health- Extends the realm of public health b. Acheson (1988) - Public Health is defined as to include organized health efforts at the community level through both government and private efforts. the art and science of preventing disease, ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 3  HEALTH PROMOTION AND LEVELS OF PREVENTIONS Health Promotion - Activities enhance resources directed at improving well-being. Disease Prevention - Activities protect people from disease and effects of disease. LEAVELL AND CLARK’S THREE LEVELS OF PREVENTION 1. Primary Prevention - Relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. ORGANIZATION OF HEALTH SERVICES 2. Secondary Prevention - Early detection and prompt intervention during the period of early Public-Private Sector Imbalance disease pathogenesis. - Highly resourced private sector servicing - Implemented after a problem has begun but 20-30% of population. before signs and symptoms appear and - Health promotion/Disease prevention lag behind curative service provision. targets populations who have risk factors Fragmentation of Services (Keller). - Overspecialization of curative services. 3. Tertiary Prevention - Targets populations that - Devolution of health services - National and have experienced disease or injury and Local focuses on limitations of disability and - Weak regulatory mechanisms. rehabilitation. - AIM: Reduce the effects of disease and injury SIDE NOTE: and to restore individuals to their optimum level of functioning. PhilHealth Article 2, Section 2, R.A. 7875 as amended: 6 BUILDING BLOCKS Compulsory Coverage - All citizens of the Philippines shall be required to enroll in the National Health Insurance Program in order to avoid adverse selection and social inequity. HUMAN RESOURCES FOR HEALTH HEALTH WORKER MIGRATION Overproduction Maldistribution High Out-Migration Nil In-Migration Low Return Migration NOTE: It is estimated that 70% of all health workers are employed in a private health sector that serves only the 30% of the population that can afford to pay for their health care. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 4  COMMUNITY ORGANIZING AND COPAR 2. Internal organizational consolidation is a prerequisite to external expansion. Community Organization - A process by which 3. Social movement first before the technical people, health services, and agencies of the change. community are brought together in common 4. Health reforms occurring within the context of self-interest. broader social transformation. Community organizing as a process consists of steps or activities that instill and reinforce the people’s self-confidence in their own collective CORE PRINCIPLES IN COMMUNITY ORGANIZING strengths and capabilities (Manalili, 1990). It is the development of the community’s collective Anchored on the basic values of human rights, capacity to solve its own problems and aspire for social justice, and social responsibility, the development through its own efforts. following are the core principles and grounds for Community organizing is a continuous process of the practice of community organizing. educating the community to develop its capacity to assess and analyze the situation (which usually 1. Community organizing is people-centered. involves the process of consciousness-raising), 2. Community organizing is participative. plan and implement interventions (mobilization), 3. Community organizing is democratic. and evaluate them. 4. Community organizing is developmental. Community Organizing is a process of educating 5. Community organizing is process-oriented. and mobilizing members of the community to Community Organizers - Create social enable them to resolve community problems. movements by building a base of concerned It is a means to build the community’s capacity people, mobilizing these community members to to work for the common good in general and act, and developing leadership from and health goals. relationships among the people involved. Community Organizing is a process of educating and mobilizing members of the community to BENEFITS OF COMMUNITY ORGANIZATION enable them to resolve community problems. It is a means to build the community’s capacity 1. Learn common problems. to work for the common good in general and 2. Identify those problems as your own. health goals. 3. Plan the kind of action needed to solve these Community organizing and community health problems. nursing practice have common goals: 4. Act on this basis. - People empowerment, development of CRITICAL STEPS - ACTIVITIES IN BUILDING self-reliant community, and improved quality PEOPLE’S ORGANIZATION of life. - As a result, they become the health care COMMUNITY DIAGNOSIS OR PROFILING professionals’ partners in health care delivery and overall community development. ❖ A community diagnosis is a summary Community development is the end goal of statement resulting from an analysis of the community organizing and all efforts toward data collected from a community health needs uplifting the status of the poor and marginalized. assessment. Community development – entails a process of ❖ A clear statement of the problem, as well as assessment of the current situation, the the causes of the problem, should be identification of needs, deciding on appropriate included. courses of action or response, mobilization of ❖ A community diagnosis may also address a resources to address these needs, and need for increased wellness in the community. monitoring and evaluation by the people. Community diagnoses should include these Community development means improved four parts: access to resources (including health resources) 1. The problem that will enable people to improve their standards 2. The population or vulnerable group of living and overall quality of life. 3. The effects of the problem on the The emphasis of community organizing in population/vulnerable group primary health care are the following: 4. The indicators of the problem in this 1. People from the community work together to community solve their own problems. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 5  EXAMPLE OF COMMUNITY DIAGNOSIS SOCIAL INVESTIGATION Assessment data: Fifty percent of residents A systematic process of collecting, collating, of an assisted living facility were found to have analyzing data to draw a clear picture of the blood pressure readings higher than 130/80 community. mmHg during a health fair last week at the Also known as the COMMUNITY STUDY. facility. Pointers for the conduct of SOCIAL Community diagnosis: Increased need for INVESTIGATION. education about exercise and diet and - Use of surveys or questionnaires is referrals to primary care doctors for residents discouraged. of an assisted living facility due to increased - Community leaders can be trained to risk for mortality related to high blood initially assist the community pressure, as evidenced by a high number of worker/organizer in SI. residents with high blood pressure during a - Data can be more effectively and health fair. efficiently collected through informal methods-house visits, participating in OUTCOMES IDENTIFICATION conversations in jeepneys, and others. - Secondary data should be thoroughly Healthy People objectives are classified by these five examined because much of the categories: information might already be 1. Health Conditions available. 2. Health Behaviors - SI is facilitated if the CO/ community 3. Populations worker is properly integrated and has 4. Settings and Systems acquired the trust of the people. 5. Social Determinants of Health - Confirmation and validation of INTEGRATION community data should be done regularly. A CO becoming a par with the people in order to: - Immerse himself in the poor TENTATIVE PROGRAM PLANNING community. CO chooses one issue to work on in order to - Understand deeply the culture, begin organizing the people. leaders, history, rhythms and lifestyle in the community. GROUNDWORK Methods of Integration include: - Participation in direct production Going around and motivating the people on a activities of the people. one-on-one basis to do something on the - Conduct of house visits. issue that has been chosen. - Participation in activities like birthdays, fiestas, wakes, etc. THE MEETING - Conversing with people where they People collectively ratifying what they have usually gather such as stores, water, already decided individually. walls, washing streams, or The meeting gives the people the collective churchyards. power and confidence. - Helping out in household chores like Problems and issues are discussed. cooking, ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 6  ROLE PLAY ➔ A continuous and sustained process of educating the people to understand and This means to act out the meeting that will develop their critical awareness of their take place between the leaders of the people existing condition, working with the people and government representatives. collectively and efficiently on their immediate It is a way of training the people to participate and long-term problems, and mobilizing the what will happen and prepare themselves. people to develop their capability and readiness to respond and take action on their ROLE PLAY immediate needs towards solving their long-term problems (CO: A manual of Actual experience of the people in confronting experience, PCPD). the powerful and the actual exercise of the people power. IMPORTANCE OF COPAR REFLECTION 1. COPAR is an important tool for community development and people empowerment as Dealing with deeper, on going concerns to this helps community workers to generate look at the positive values CO is trying to build community participation in development in the organization. activities. It gives the people time to reflect on the stark 2. COPAR prepares people/clients to eventually reality of life compared to the ideal. take over the management of development ORGANIZATION programs in the future. 3. COPAR maximizes community participation The people’s organization is the result of many and involvement; community resources are successive and similar actions of the people. mobilized for community services. A final organizational structure is set up with elected officers and supporting members. COPAR PRINCIPLES COPAR People, especially the most oppressed, exploited, and deprived sectors are open to Definition: change, have the capacity to change, and are ➔ A social development approach that aims to able to bring about change. transform the apathetic, individualistic and COPAR should be based on the interest of the voiceless poor into dynamic, participatory and poorest sectors of society. politically responsive community. COPAR should lead to a self-reliant ➔ A collective, participatory, transformative, community and society. liberative, sustained and systematic process of building people’s organizations by COPAR PROCESS mobilizing and enhancing the capabilities and resources of the people for the resolution of ❖ A progressive cycle of action-reflection their issues and concerns towards effecting action which begins with small, local, and change in their existing oppressive and concrete issues identified by the people and exploitative conditions. the evaluation and reflection of and on the ➔ A process by which a community identifies its action taken by them. needs and objectives, develops confidence to ❖ Consciousness-raising through experimental take action in respect to them and in doing so, learning is central to the COPAR process extends and develops cooperative and because it places emphasis on learning that collaborative attitudes and practices in the emerges from concrete action and which community (Ross 1967). enriches succeeding action. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 7 ❖ COPAR is participatory and mass-based because it is primarily directed towards and 4. COMMUNITY ACTION PHASE biased in favor of the poor, the powerless and - Organization and training of the community oppressed. health workers (CHW’s) ❖ COPAR is group-centered and not - Development of criteria for the selection of leader-oriented. Leaders are identified, CHW’s emerge and are tested. - Selection of CHW’s - Training of CHW’s PHASES OF COPAR - Setting up of linkages/network referral systems 1. PRE-ENTRY - Initial identification and implementation of - Pre-entry involves preparation one the part of resource mobilization schemes the organizer and choosing a community for partnership. 5. SUSTENANCE AND STRENGTHENING - Preparation includes knowing the goals of the PHASE community organizing activity or experience. It - Occurs when the community organization has also necessary to delineate criteria or already been established and the community guidelines for site selection. members are already actively participating in - Making a list of sources of information and community-wide undertakings. possible facility resources, both government - Strategies used may include: and private, is recommended. a. Education and training b. Networking and linkages 2. ENTRY c. Conduct of mobilization on health and - Entry into the community: development concerns - Entry into the community formalizes the start d. Implementation of livelihood projects of the organizing process. This is the stage e. Developing secondary leaders where the organizer gets to know the community and the community likewise gets 6. PHASE-OUT/EXIT to know the organizer. - The Community Organizer (CO) turns over the - An important point to remember in this phase project to the community. is to make courtesy calls to local formal - The community leaders will now handle the leaders (barangay chairperson, council management of the project and all its logistics members). - An ideal number of years for COPAR is 5 years 3. COMMUNITY STUDY/DIAGNOSIS PHASE (RESEARCH PHASE) SIDE NOTE: - Selection of the research team - Training on the data collection methods and Equally crucial but often overlooked is a visit to informal leaders recognized in the community, like elders, local techniques; capability-building (includes health workers, traditional healers, church leaders, and development of data collection tools) local neighborhood association leaders. - Planning for the actual gathering of the data - Data gathering CONSIDERATIONS IN THE ENTRY PHASE - Training on data validation (includes tabulation and preliminary analysis of data) The community organizer’s responsibility to - Community validation clearly introduce themselves and their - Presentation of the community institution to the community. A clear study/diagnosis/recommendations explanation of the vision and mission, goals, - Prioritization of community needs/problems programs, and activities must be given in all for action. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 8  initial meetings and contacts with the community. Preparation for the initial visit includes gathering basic information on socioeconomic conditions, traditions including religious practices, overall physical environment, general health resources. the community organizer must keep in mind that the goal of the process is to build up the confidence and DEPARTMENT OF HEALTH capacities of people. It is the national government’s biggest health Manalili describe two strategies for gaining care provider. entry into a community: It exercises regulatory powers over health - Padrino – a patron, usually barangay facilities and products. or some other local government It provides the Local Government Units (LGUs) official. The padrino, in an effort to the necessary support in managing their local boost the organizer’s image, tends to health system (EO 102). preset the intended. - Project output, thereby creating false hopes. - Bongga – as the easiest way to catch the attention and gain the “approval” of the community. This strategy exploits the people’s weaknesses and usually involves doles-out, such free medicines. PHILIPPINE HEALTH CARE DELIVERY SYSTEM Health Care Delivery Systems - Is the totality of all policies, infrastructures, facilities, equipment, products, human resources, and services that address the health needs, problems and concerns of all people. Philippine Health Care Delivery System - It is a complex set of organizations interacting to provide an array of health services. LOCAL HEALTH SYSTEM Under the Local Government Code, all structures, personnel and budgetary allocations from provincial health level down ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 9  to the barangays were devolved to the local - It includes many things such as government units to facilitate health service beliefs, values, and customs or delivery. practices. INTER-LOCAL HEALTH SYSTEM 3. Environmental Influences on Health - This system ID being espoused by the - Environment plays a direct role and is DOH in order to ensure quality of one of the extrinsic factors which health care service at the local level. influence health and wellness of - Clustering municipalities into human beings. INTER-LOCAL HEALTH ZONE (with a MICRO ENVIRONMENT – it defined population within a defined refers to the personal geographical area). environments. IMPORTANCE: There is a need to re-integrate MACRO ENVIRONMENT – it hospital and public health service for a holistic refers to the external delivery of health services. environment which is outside COMPOSITION: the home environment. 1. People – ideal health district 4. Ethical Influences on Health population 100k – 500k - The commitment to place the interests 2. Boundaries of clients above all else is one of the 3. Health facilities – Secondary hallmarks of professionalism. Hospitals, RHUs, BHSs - Public health ethics focuses on the 4. Health workers design and implementation of measures to monitor and improve the health of broader populations. 5. Political Influences on Health - The political system has a very strong role in health promotion of people. - Health policies include National Blood Services Act, National Diabetes Act, and Salt Iodization Act. - Many do not have full access to basic health goods and services because of the severely limited health care financing. - The severely limited health budget is INFLUENCES IN THE DIMENSIONS OF HEALTH the biggest hindrance to the 1. Socioeconomic Influences on Health implementation of well-meaning - Socioeconomic conditions have policies such as Magna Carta for significant influence on the community Public Health Workers, National health. Insurance Act, Senior Citizens Act. - Most of the leading causes of morbidity and mortality are associated LEVELS OF CLIENTELE with factors that could be attributed to Target Population POVERTY ❖ Individual 2. Cultural Influences on Health - The PHN deals with INDIVIDUALS – - Culture is a way of life. sick or well – on a daily basis. - Endures over time and is passed on - They are the people who consult at from one generation to the next. the health center and receive health services, they are clients with chronic illnesses ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 10  - “Entry point” in working with the g. Participation by citizens in whole family. decision making ❖ Family h. High degree of wellness - It is a very important social institution among its members performing two major functions: (1) reproduction and (2) socialization. LEVELS OF HEALTH CARE - Basic unit of care in the community health nursing. - Health Tasks of a Family (Freeman, 1981): a. Recognizing interruptions of health or development b. Seeking health care c. Managing health and non-health crises d. Providing nursing care to the sick, disabled and dependent family member e. Maintaining a home environment conducive to good health f. Maintaining a reciprocal relationship with the community and health institutions. ❖ Population group - A population group or “aggregate” is a group of people who share common characteristics, developmental stage or common exposure to particular environmental factors, and consequently common health problems. ❖ Community - Is a group of people sharing common geographic boundaries and common values and interests. - Characteristics of a “Healthy Community”: a. Awareness that “we are community” b. Conservation of natural resources c. Recognition and respect for existence of subgroups d. Resources available to all PREVENTION e. Preparation to meet crises As it relates to health, is really about avoiding disease f. Setting of dispute through before it starts. It has been defined as the plans for, legitimate mechanisms ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 11 and the measures taken, to prevent the onset of a disease or other health problem before the occurrence of the undesirable health event. LEVELS OF PREVENTION PHC was declared in Sept. 6-12, 1978 in Alma-Ata Kazahkstan Adopted in the Philippines through LOI 949 by then President Marcos “Underlying theme of “Health in the hands of the People by 2020” PHC entails three inter-related and synergistic components, including: a. comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces; b. multi-sectoral policies and actions to address the upstream and wider determinants of health; and c. engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health HEALTH INTERVENTIONS Education and Information measures Service measures Technologic measures Legislative and Regulatory measures Economic measures PRIMARY HEALTHCARE Essential health care made universally accessible to individuals and families in the community by ELEMENTS OF PHC means acceptable to them through their full participation and at a cost that the community Environmental sanitation and country can afford at every stage of Control of Communicable Diseases development. Immunization Health education Maternal and Child Health and Family Planning Adequate food and proper nutrition Provision of medical care and Emergency Treatment ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 12  Treatment of Locally Endemic Diseases Provision of Essential Drugs PRIMARY HEALTHCARE WORKERS LEVELS OF REFERRAL SYSTEM CLASSIFICATION OF COMMUNITY Rural or Open Lands Urban or City Suburban or the Capitals DEVELOPMENT OF THE COMMUNITY Every human community has institutions for the socialization of its members. Development of community requires sanction of group members. A community is a reflection of all the functional relationships that occur among its individual members. A community or a group can change because of conflict among members. Family is the primary group. Peer groups help youth to establish norms of behavior and assist in the rites of passage from the family group to society. Group membership helps individuals achieve goals that are not attainable through individual effort. Type of leadership in a group depends on the needs of group members as well as the personality of the leader. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 13  FAMILY - The mother on the hand is considered be the light of the house (“ilaw ng tahanan”). A basic social unit consisting of parents and - She is responsible in all housekeeping their children, considered as a group, whether activities, taking care of the children, planning dwelling together or not. of meals, and budgeting the income of the - While this definition is a good starting family. point, there are several modern family structures that are excluded by this CHILD definition, such as childless couples or other variations on the family unit. - The role of the child may depend on whether Two or more people who share goals and he is the eldest, middle, the youngest or the values, have long-term commitments to one only child. another and reside usually in the same - The eldest takes charge in helping mothers dwelling. take care of his siblings. - The middle child may assume the role of the FILIPINO FAMILY eldest child. - The youngest is often the most loved although Filipino family is a family of Philippine origin. he is also expected to have his own share in Philippine families exhibit Filipino cultures, doing some household chores. The youngest customs, traits and values, of which the most always gets the special treatment from his important value is family closeness. parents. STRUCTURE OF THE FILIPINO FAMILY The typical Filipino family consists of a husband, wife and children, extending to include grandparents, aunts, uncles and cousins. This circle is often enlarged with the selection of a child's godparents. FATHER BLOOD KINSHIP is very important in the - The father is acknowledged head of the Filipino family. family. Family alliance is further extended by the - The father commands full authority in the compadre system. family. The Filipino family is said to be patriarchal in MOTHER authority. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 14  However, studies by other sociologists reveal your home and living out the values you that the Filipino family is not "patriarchal" but acquired within the family. is egalitarian. The Filipino family has values that have been treasured and passed on for many THE FILIPINO FAMILY generations already. These values are believed to be beneficial as it fulfil some of the basic The Filipinos practice endogamy, the custom needs of people. of marrying only within the limits of a local community, clan, or tribe. PAGGALANG In marriage, monogamy is the norm. Although polygamy is allowed among the Muslims. ➔ It means being respectful or giving due Right from childhood Filipino child is made to respect for a person. Filipinos are accustomed believe that he belongs to the family. to using the words “po,” “opo,” and “ho” when Since childhood, a Filipino is encouraged to they are conversing with older people or tell all of his thoughts to his parents and sometimes to people with higher position or submit to his parents’ direction, counsel and status in the society. advice. ➔ Using these words is customary in the He is advised to be good because any Philippines and it shows sign of respect. disgrace that he commits is a disgrace to the Paggalang can also be given to the elders by family. In times of misfortune, he is assured of virtue of kissing their hands before leaving and his family’s support, sympathy and love. upon arrival. Younger member of the family Even after finishing school, Filipino children gives due respect to older siblings by calling are not obliged to get out of their homes them kuya (older brother) or ate (older sister). unless they want to. In fact, most of them keep their close PAKIKISAMA relationship to their parents by staying at least ➔ “Pakikisama” or Getting along well with before they get married. people – The yearning of the Filipinos to be Filipino Families are Hospitable. accepted and well liked by his friends, Traditional Filipino families often consult each colleagues, boss and even relatives steers other about when making important decisions them perform pakikisama. such as Going to college, taking a job ➔ The word pakikisama means helping others. overseas, and getting married may sometimes This trait usually fosters cooperation and be individual decisions, but quite often they doing good deeds which are favorable to are family decisions. other people. Actual family involvement in personal decision making has decreased for most of those UTANG NA LOOB surveyed. ➔ “Utang na Loob” or Debt of Gratitude – THE FILIPINO FAMILY VALUES Usually a system of obligation, when applied it All happy families resemble one another, but gives duty and responsibility on the part of the each unhappy family is unhappy in its own young siblings to serve and repay the favors way. - Leo Tolstoy done to them sooner or later. Values formation which is vital to the PAGPAPAHALAGA SA PAMILYA socialization skills of an individual can be developed and nurtured in the family, school ➔ “Pagpapahalaga sa Pamilya” or Putting and environment. importance to family - This implies that a Values may include obtaining knowledge, person will put a high regards and concerns wisdom and necessary skills, using them in over the family before anything else. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 15 ➔ This is one of the reasons why a father or a During the morning, it is also customary for mother in a Filipino family will seek Filipino people to open their east window. This employment abroad just to earn decent is said to bring God’s grace inside the house earnings for their family, to meet the family’s through the sun. basic needs and want. It is also very important to make sure that there are statues of Jesus or Mary in the HIYA house. It is also important that they are facing the direction of the front door. This is because ➔ “Hiya” or Shame – This controls the social they will be greeting the visitors of the house behaviour of Filipino. It is a value that makes a and anyone who comes in. Filipino be obedient and be respectful to When building a house with stairs, make sure parents, older siblings and authorities. It is to count them that they are not 13. It is said also a key ingredient to the loyalty of one’s that 13 is the number of Judas and this will family. bring bad luck to the household and the FILIPINO FAMILY: CUSTOMS AND TRADITIONS people who will come in. The Filipino family are very traditional people. They believe in many different kinds of COMMUNITY HEALTH NURSE SPECIALIZED FIELD customs and follow lots of various traditions. IN COMMUNITY AND PUBLIC HEALTH NURSING The Filipino people are known to have close ROLES AND FUNCTIONS OF COMMUNITY family ties. This is why you may notice that the HEALTH NURSE people in a vicinity most of the time know 1. CARE PROVIDER each other. Actually, they are likely related to - Provides a continuous and each other. Whether short or long and distant, comprehensive area to the family, the Filipino family will choose to live close to group of people, and community at large. each other. - Emphasize more on promotive and If they would have to move out to a new preventive health care, influencing house, the homeowner will be asked to throw communities to implement these some coins when he opens the front door. measures. This is said to bring good luck and prosperity - Provides care during illness for which to the household. usually the family members come forward to seek help. The first things one should carry into a new 2. HEALTH EDUCATOR home on the day they will transfer are rice and - Educates the individual, family, salt. groups of people and the community The number of people sleeping in a new at large. house the first night should be the same for - Conducts planned health education nine consecutive days. Otherwise, death will sessions for organized community occur in that house. groups e.g., school children, antenatal mothers, eligible couples, elderly etc. When doves and pigeons leave a house, it is a - Involved in giving sign that there is no harmony there, because incidental/casual/spontaneous health its owners quarrel all the time. education according to the situation. If you wish to rid your home of unwanted (washing of hands before a child visitors, secretly sprinkle salt around the eats). house and they will soon depart. 3. COUNSELLOR The Filipino people are very religious as well. - Helps individual, families and the community at large to recognize and Therefore, there are quite a lot of Filipino understand their problems to be culture, customs and traditions for the home solved, find solutions with-in and family that is based on religious beliefs. resources and implement feasible and acceptable solutions. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 16 4. RESOURCE PERSON c. Provide standard functional - Explores community resources in facilities. terms of money, manpower, material, d. Provide opportunities for agencies etc. continuing education and - Makes use of these resources in training for nursing personnel helping individual, family groups and e. Doing research that is community to meet their health and connected to nursing care. nursing needs. f. Reinforce connections with 5. SENSITIVE OBSERVER government/non-government - Makes observations of any untoward organizations for school changes in health behavior health work. - Includes observations on health - Functions of a School Nurse status, unusual occurrences, diseases a. Health and Nutrition Survey - Takes action accordingly b. Functional School Clinic 6. ADVISOR c. Health Assessment - Can give suggestions on practical d. Standard Vision Testing for situations that require immediate Students actions. e. Ear Examination 7. PLANNER f. Height and Weight - Makes a plan on the basis of Measurement, Nutritional identified health problems Status Determination - Plans with other team members to g. Medical Referrals provide appropriate care h. Attendance to Emergency 8. CARE MANAGER Cases - Directly provides care with active i. Student Health Counseling participation of family and community j. Health and Nutrition members Education Activities - Guides family and community and k. School-Community Health refers when required Evaluates and Nutrition Councils effectiveness of care given l. Communicable Disease 9. MEDICAL ASSISTANT ROLE Control - Assists physicians and coordinates m. Establishment of Data bank in with other team members in the School health community health care team n. Home Visitation - Obtains orders from physicians and explains it clearly to clients 2. OCCUPATIONAL HEALTH NURSING - It is a specialized method focusing on SPECIALIZED FIELDS IN COMMUNITY AND health promotion, prevention, and PUBLIC HEALTH NURSING restoration within a safe and healthy environment. 1. School Health Nursing - Prevention of adverse health effects - Focuses on promoting the health, and from occupational and environmental wellness of the school population hazards is also included. (students, teachers, non-teaching - It provides clients with occupational personnel). and environmental health and safety - Prevent health problems that can programs and services. affect learning process and - It is in the best position to assess the performance of development tasks. health needs of the used - Specific Objectives: interventions. a. Provide quality nursing - Duties and Function: service to schools. a. In the absence of a physician, b. Create awareness on health organizing and administering aspects (promotive, a health service program is preventive) through health essential and integrates education among the school safety. populace. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 17  b. It provides nursing care to ill e. In Preventive Control - workers. Recognize mental health c. Participates in the health hazards and stressful maintenance of workers. situations such as d. Participates as well in unemployment, divorce or maintaining occupational abandonment of children, health and safety. vices, and long-standing e. It maintains the record system physical illness, all of which of the physician and, if not may make heavy demands on available, should have the emotional resources of the prescribed form to the person concern employer as required. f. Be aware of the potential causes of breakdown and 3. COMMUNITY MENTAL HEALTH NURSING when necessary take some - It is a unique clinical process which possible prevention action includes an integration of concepts of g. Help the family to understand nursing, mental health, social and accept the patient's psychology, psychology, community health status and behavior so networks, and the basic science. that all its members may offer - Provide education regarding mental as much support in the illness, physical health concerns, readjustments to home and chronic disease management, community wellness, relapse prevention and h. Help the patient assess medications to patients, families, care his/her capacities and his/her givers and team members. handicaps in working towards - The focus of community mental health a solution on his/her problem. nursing is on mental health promotion. i. Encourage the feeling of There is no need to identify the achievement by setting health disease as it aims to increase mental goals that patients can attain wellness of people. This is different j. Encourage the patient to from psychiatric nursing where it is express his/her anxieties so focused on mental illness prevention that fears and misconceptions which aims to identify psychiatric can be cleared up. conditions and shortens the disease k. Impart information and process. guidance about the treatment - Responsibilities and Functions scheme of the patients, the a. In Mental Health Promotion desired and undesirable - Participate in the promotion effects of the tranquilizers, of mental health among psychiatric emergency families and the community. management, and other basic b. Utilize opportunities in their nursing care everyday contacts with other l. In Rehabilitation - Initiate members of the community to patient participation in extend the general knowledge occupational activities best on mental hygiene. suited to patient's c. Helps people in the capabilities, education, community understand the experience and training, basic emotional needs and capacities, and interest. the factors that promote m. Encourage and initiate mental well-being. patients to partake in d. Teach parents the importance activities of CVIC organization of providing emotional in the community through the support to their children cooperation of the patient's during critical periods in their family. lives such as first day in school, graduation etc. ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 18  n. Advise the family about the prevention. This prevention reduces or importance of regular eliminates current or potential occupational follow-up at the clinic. exposure to risk factors. o. Make regular home visits to SECONDARY PREVENTION - This aims for observe patient's condition early detection, early intervention, and during conversation and follow-up of medication. attempts to limit impairment. Its main goal is p. In Research and to identify employees' health needs. Epidemiology - Participate TERTIARY PREVENTION - This focuses on actively in epidemiological the worker's rehabilitation and restoration to survey to be aware of the size an optimal level of functioning. and extent of mental health problems of the community REFERENCES and organize a program for better preventive, curative and Notes from the discussion/learning mats by: rehabilitative measures. MA’AM MELBA IRENE GABUYA LEVELS OF PREVENTIVE CARE AND OCCUPATIONAL HEALTH NURSING PRIMARY PREVENTION - Occupational health nursing (OHN) is involved in health promotion and disease prevention in primary ENRICUSO, ZOEXANDRA ANDREA D. | BSN 3A 19