NCM 104: Community Health Nursing 1 PDF

NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris TOPICS economic disparities, public...

NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris TOPICS economic disparities, public policy, Module 1: Overview of Public Health Nursing in environmental factors, cultural studies, the Philippines etc. 1. Global and National Health Situations 2. Definition and Focus 10 THREATS TO GLOBAL HEALTH 3. Public Health (WHO) 4. Community Health 1. Air pollution and climate change – 5. Public Health Nursing considered as the greatest environmental 6. Community Health Nursing risk to health. 7. Standards of the Public Health Nursing in 2. Non-communicable diseases – driven the Philippines by tobacco use, physical inactivity, 8. Evolution of Public Health Nursing in the harmful use of alcohol, unhealthy diets Philippines and air pollution, metal health issues. 9. Roles and Responsibilities of a Community 3. Global influenza pandemic - Health Nurse 4. Fragile and vulnerable settings – drought, famine, conflict, population GLOBAL AND NATIONAL HEALTH displacement, and weak health services. SITUATIONS 5. Antimicrobial resistance – ability of WORLD HEALTH ORGANIZATION (WHO) bacteria, parasites, viruses and fungi to ▪ Defined health as a state of complete resist medicines. physical, mental and social well-being and - Drug Resistance – driven by the not merely the absence of disease or overuse of antimicrobials in people, and infirmity. animals used for food production as well as in the environment. ▪ The health of all people is fundamental to 6. Ebola and other high threat pathogens the attainment of peace and security and is – an epidemic of high threat pathogens is dependent on the critical. Hemorrhagic fevers, Zika, Mers- Cov, Sars ▪ Fullest cooperation of individuals and states 7. Weak primary health care - Primary Health Care – the first point of ▪ Governments have a responsibility for the contact people has with their care system health of their people which can be fulfilled and ideally should provide only by the provision of adequate health and comprehensive, affordable, community- social measures. based care throughout life. 8. Vaccine hesitancy – most cost-effective GLOBAL HEALTH ways of avoiding diseases. Some people ▪ Global Health is viewed in different ways, as have complex reason why they choose the institute of medicine- USA (1997) not to vaccinate. defined it as health problems, issues and 9. Dengue – mosquito-born disease, kill up concerns that transcends national to 20% of those with severe dengue. boundaries, which may be influenced by Spreading to less tropical and more circumstances or experiences in other temperate countries countries, and which are best addressed 10. HIV by cooperative actions and solutions. NATIONAL HEALTH ▪ Koplan et al. stated it as an area for study, ▪ In the recent years, the Philippines made research and practice that places a significant investments and advances in priority on improving health and health. Filipinos have been living longer achieving health equity for all people and healthier due to the rapid economic worldwide. growth and strong country capacity. ▪ Achievements have not been even, and ▪ Moreover, Kickbush defined global health challenges remains. Inequities persist as, those health issues that transcend between regions, rich and poor, and different national boundaries and governments population groups. and call for actions on the global forces ▪ Many Filipinos continue to die and suffer that determine the health of people from illnesses. ▪ Many people lack enough knowledge to ▪ Focus on people across the whole plane make informed decisions about their own rather than concerns of nation. health. ▪ Global health initiatives consider both INFANT MORTALITY RATE (IMR) - number of medical and non-medical disciplines, deaths per 1,000 live births under one year of such as epidemiology, sociology, age.  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris NEONATAL DEATHS (NT DEATHS) - deaths STANDARDS OF PUBLIC HEALTH NURSING among live births during the first 28 completed IN THE PHILIPPINES days of life. ▪ The standards differentiated public health nursing from community health nursing only PERINATAL DEATHS - refers to the number of in one area: setting of work as dictated by stillbirths and deaths in the first week of life (early funding. neonatal mortality). ▪ The government is the employer of Public Health Nurses both at the national and MATERNAL MORTALITY RATE - death of a local health agencies. woman while pregnant or within 42 days of termination of pregnancy, irrespective of the PRINCIPLES OF CHN duration and site of the pregnancy, from any The community is the patient in CHN, the family cause related to or aggravated by the pregnancy is the unit of care and there are four levels of or its management but not from accidental or clientele: incidental cause. 1. Individual CRUDE BIRTH RATE - the number of live births 2. Family occurring among the population of a given 3. Population group geographical area during a given year, per 1,000 4. Community mid-year total population of the given geographical area during the same year Population Group - those who share common characteristics, developmental stages and MORBIDITY RATE - the proportion of patients common exposure to health problems - e.g. with a disease during a given year per children, elderly, and the community. population. ▪ In CHN, the client is considered as an PUBLIC HEALTH ACTIVE partner NOT PASSIVE recipient "Science and art of preventing disease of care. prolonging life and promoting health and ▪ CHN practice is affected by developments efficiency through organized community in health technology, in particular, effort for the sanitation to ensure a living changes in society, in general adequate for the maintenance of health" ▪ The goal of CHN is achieved through multi- sectoral efforts. COMMUNITY HEALTH NURSING ▪ CHN is a part of health care system and the ▪ "Service rendered by a professional nurse to larger human services system communities, groups, families, and individuals at home, in health centers, in RESPONSIBILITIES OF THE COMMUNITY clinics, in schools, and in places of work for HEALTH NURSE the promotion of health, prevention of ▪ Participates in developing an overall illness, care of the sick at home, and health plan, its implementation and rehabilitation." evaluation for communities. ▪ "Nursing practice in a wide variety of ▪ Provide quality nursing services to the community services and consumer four levels of clientele. advocate areas, and in a variety of roles, at ▪ Maintain coordination/linkages with other times including independent practice... health team members, NGO/government Community nursing is certainly not confined agencies in the provision of public health to public health nursing agencies." services. ▪ The utilization of the nursing process in ▪ Initiates and conducts researches the different levels of clientele - relevant to CHN services to improve individuals, population groups and provision of health care. communities, concerned with the promotion ▪ Initiates and provides opportunities for of health, prevention of disease and professional growth and continuing disability and rehabilitation." education for staff development. ▪ “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" (GOAL)  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris statistical health trends and issues ROLES AND RESPONSIBILITIES OF A warnings about possible health problems. COMMUNITY HEALTH NURSE MILLENIUM DEVELOPMENT GOALS ▪ Healthcare Provider. In September 2000, leaders of 189 countries Caring is the essence of nursing and gathered at the United Nations headquarters has been widely accepted in all settings. and signed the historic Millennium Declaration, The use of the nursing process applied in in which they committed to achieving a set of the natural environment of the client eight measurable goals that range from pertains to this role. halving extreme poverty and hunger to ▪ Health Educator. promoting gender equality and reducing Communicating information to help child mortality, by the target date of 2015 patients make an informed choice regarding their health is a key activity in public health works. It is hoped that awareness will impact people’s behavior to achieve health in their own hands. ▪ Program Implementer. Nurses working under local government units deliver healthcare to the grassroots. This also requires that programs initiated by the national government thru the Philippine Department SUSTAINABLE DEVELOPMENT GOALS of Health (DOH) are executed at all levels The Sustainable Development Goals build on ▪ Community Organizer. MDGs, eight anti-poverty targets that the Working with people in communities world committed to achieving by 2015. and providing them ownership of their Enormous progress has been made on the healthcare needs and to act collectively on MDGs, showing the value of a unifying agenda their issues is best captured by this role of underpinned by goals and targets. The UN the nurse in public health. recognize that ending poverty and other ▪ Manager/Leader. deprivations must go hand-in-hand with Community and public health work deal strategies that improve health and with competing claims specifically on education, reduce inequality, and spur utilization of limited resources. Hence, the economic growth – all while tackling climate nurse employs principles of change and working to preserve our oceans management to maximize resources and forest effectively and efficiently ▪ Researcher/Epidemiologist. The nurse is regarded as the health monitor of the community. Together with the rural health midwife, they keep track of illnesses encountered in their areas of jurisdiction and submits reports to health authorities as required by law. ▪ Client Advocate. The community/public health nurse takes a proactive stance in ensuring that the right DEPARTMENT OF HEALTH – PHILIPPINES to health of the population he/she works Is the country’s principal health agency. It is with is realized and protected. To do this, responsible for ensuring access to basic he/she engages stakeholders in clamoring public health services through the provision and lobbying for policies that impact health of quality healthcare and the regulation of of communities. The nurse in the field also providers of health goods and services. The initiates organizing activities to form primary function is the promotion, coalitions and linkages to foster protection, preservation or restoration of awareness of people to various health- the health of the people through the provision related issues and delivery of health services and through the regulation and encouragement of providers of MODULE 2 health goods and services. World Health Organization (WHO) is the ▪ VISION: The DOH is the leader, directing and coordinating authority on staunch advocate and model in international health within the United promoting health for all in the Nations’ system. Its mission “is the attainment Philippines. by all peoples of the highest possible level of ▪ MISSION: Guarantee, equitable, health”. Moreover, it also performs charting sustainable, and quality health for all  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris Filipinos, especially the poor and shall lead the quest for excellence in health. CLASSIFICATION OF OTHER HEALTH FACILITIES LOCAL HEALTH SYSTEM AND A. Primary Care Facility- first contact care DEVOLUTION OF HEALTH SERVICES facility that offers basic services including Devolution made local government emergency service and provision for normal executives responsible to operate local health deliveries care services. 1. With in-patient beds- Infirmary, birthing RA 7160 Local Government Code aims to home transform local government units into self- 2. Without beds- medical out-patient clinic, reliant communities OFW clinic, dental clinic 1993 health services were devolved or transferred from Department of Health to the B. Custodial care facility-provides long term local government units care to patients with chronic/mental illness, in need of rehabilitation or requiring ongoing Objectives for Local Health Systems health and nursing care 1. Establish local health system for effective 1. Custodial psychiatric care facility and efficient delivery of health care services. 2. Substance abuse treatment and 2. Upgrade the health care management and rehabilitation center service capabilities of local health care 3. Sanitarium/leprosarium facilities. 4. Nursing home 3. Promote inter-LGU linkages 4. Foster participation of the private sector, C. Diagnostic/ Therapeutic Care Facility- NGOs and communities in local health system examines human body or specimens from the development. human body for diagnosis or treatment of 5. Ensure the quality of health service delivery diseases at local level 1.Laboratory facility- clinical lab, HIV testing center, Blood service facility, drug testing lab, CLASSIFICATION OF HEALTH FACILITIES Newborn screening lab To improve access to health facilities with the 2.Radiologic facility efficient use of government resources and 3.Nuclear medicine facility without compromising the quality of care. D. Specialized Out-Patient Facility- with CLASSIFICATION OF HOSPITALS highly competent and trained staff that According to ownership performs highly specialized procedures on an ✓ Government- created by law out-patient basis ✓ Private- owned and operated with funds 1. Dialysis clinic through donation, principal investment or other 2. Ambulatory surgical clinic means by any individual, corporation or 3. In-vitro fertilization center organization. 4. Stem cell facility According to scope of services 5. Oncology chemotherapeutic center 6. Radiation oncology facility ✓ General- services for all kinds of 7. Physical medicine and rehabilitation cent illnesses, diseases, injuries or deformities ✓ Specialty- specializes in particular PRIMARY HEALTH CARE condition or disease WHO defines PHC as an essential health According to functional capacity care made universally accessible to ✓ General individuals and families in the community by means acceptable to them to their full participation and at the cost that the community and country can afford at every stage of development Historical Background PHC was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on September 6- 12, 1978 by WHO. The goal was “Health for All by the year 2000” this was adopted in the Philippines through Letter of Instruction 949 signed by President Marcos on October 19,1979 and has an underlying theme of “Health in the Hands of the People” by 2020  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris ✓ Laws to mandate and enforce healthy and safe practices Secondary prevention- aims to reduce the impact of a disease or injury that has already occurred. ✓ Regular exams and screening tests ✓ Diet and exercise to prevent further attacks Tertiary prevention- aims to soften the impact of an ongoing illness or injury that has STRATEGIES lasting effects. ✓ Cardiac or stroke 1. Reorientation and reorganization of the rehabilitation programs national health care systems with the ✓ Vocational rehabilitation programs establishment of functional support ✓ Support groups that allow members to share mechanism. strategies for living well 2. Effective preparation and enabling process for health in all levels. UNIVERSAL HEALTH CARE (UHC), 3. Mobilization of the people to know their also referred to as Kalusugan communities and identifying their basic health Pangkalahatan (KP), is the “provision to needs with the end in view of providing every Filipino of the highest possible appropriate solutions. quality of health care that is accessible, 4. Develop and utilization of appropriate efficient, equitably distributed, adequately technology focusing on local indigenous funded, fairly financed, and appropriately resources available in and acceptable in the used by an informed and empowered community. public.” 5. Organization of communities arising from their expressed needs 6. Increase opportunities for community MODULE 3: FAMILY participation in local level planning, FAMILY AS BASIC UNIT OF SOCIETY management, monitoring and evaluation ✓ Genetic transmission unit 7. Development of intra-sectoral linkages with ✓ Matrix of personality of development and the other government and private agencies 8. Emphasizing partnership so that the health most intimate emotional unit of society workers and the community leaders/members ✓ Enduring social form in which a person is view each other as partners incorporated ✓ Lifelong involvement PHC TEAM ✓ Shared attributes Physician ✓ Genetics – physical and psychological Nurse auxiliaries ✓ Developmental – shared home, lifestyle, Nurse social activities Locally trained community health workers ✓ Sense of belonging Midwives ✓ Security/defense against a potentially hostile LEVELS OF HEALTH CARE REFERRAL environment SYSTEM ✓ Companionship 1.Primary Level of Care ✓ Societal expectations The first contact between the community ✓ Sense of responsibility towards members & members and the other levels of health facility others ✓ Basis of affection/care 2. Secondary Level of Care. ✓ Built-in problems Given in health facilities either privately owned or government operated. ✓ Generation gap 3. Tertiary Level of Care ✓ Dependence of members Tertiary care is rendered by specialist in ✓ Emotional attachment/involvement health facilities. Complicated cases and ✓ The family endures despite problems intensive car ✓ Resource utilization ✓ Authority LEVELS OF PREVENTION ✓ Individual sense Primary prevention- aims to prevent disease or injury before it ever occurs. ✓ Health education about healthy and safe measures ✓ Immunization  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris CLASSIFICATION ACCORDING TO The family is considered the natural and STRUCTURE fundamental unit of society. NUCLEAR FAMILY The family as a group generates, prevents, A father and mother with/without children living tolerates and corrects health problems within together but apart from both sets of parents and its membership. relatives The health problems of the family members Separate dwelling not shared with members of are interlocking. the family of origin / orientation of either spouse The family is the most frequent focus of Economically independent health decisions and action in personal care. The family is an effective and available EXTENDED FAMILY channel for much of the effort of the health Two or more nuclear families economically and worker. socially related to each other Unilaterally/ bilaterally extended TYPES OF FAMILY Includes 3 generations FAMILY AS A CLIENT Lives together as a group Single Parent Family The family is the foreground and individuals Children < 17 years of age, living in a family unit are in the background with a single parent, another relative or non- The focus is concentrated on each and every relative individual as they affect the whole family May result from: The focus is concentrated on how the family Loss of spouse by death, divorce, separation as a whole is reacting to an event when a family Out of wedlock birth of a child member experiences a health issue From adoption Migration (OFWs) Characteristics of Family as a Client: 1. The family is a product of time and place BLENDED/ RECONSTITUTED FAMILY ▪ A family is different from other family who Includes step-parents and step-children lives in another location in many ways. Caused by divorce, annulment with remarriage ▪ A family who lived in the past is different and separation from another family who lives at present in many ways. COMPOUND FAMILY 2. The family develops its own lifestyle One woman/ man with several spouses ▪ Develop its own patterns of behavior and its Communal family own style in life. Grouping of individuals which are formed for ▪ Develops their own power system which specific ideological or societal purposes either be: Considered as an alternative lifestyle for people ▪ Balance-the parents and children have their who feel alienated from the economically own areas of decisions and control. privileged society ▪ Strongly Bias-one member gains dominance Vary within social context over the others. 3. The family operates as a group COHABITATION/ LIVE-IN ▪ A family is a unit in which the action of any Unmarried couple living together member may set of a whole series of reaction within a group, and entity whose inner strength NO-KIN may be greatest single supportive factor when A group of at least two people sharing a one of its members is stricken with illness or relationship and exchange support who have no death legal or blood tie to each other 4. The family accommodates the needs of the individual members. FOSTER ▪ An individual is unique human being who needs Substitute family for children whose parents are to assert his or herself in a way that allows him to unable to care for them grow and develop. ▪ Sometimes, individual needs and group needs GAY/ LESBIAN seem to find a natural balance; Homosexual couple living together with/without 1. The need for self-expression does not children overshadow consideration for others. 2. Power is equitably distributed. Classification According to Function 3. Independence is permitted to flourish Family of Procreation- refers to the family you yourself created. FAMILY AS A SYSTEM Family of Orientation- refers to the family The focus is on the family as a client where you came Viewed as an international system in which the whole is greater than the sum of its parts FAMILY AS A UNIT OF CARE  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris Focuses on the individual and family 3. If applicable, engage in reproductive life members become the target for nursing planning interventions FUNCTIONS & DEVELOPMENTAL STAGE 2. CHILDBEARING FAMILY FUNCTIONS OF A FAMILY ❖ From the birth of the first child until that Biologic child is 2 1/2 years old. ✓ Reproduction ❖ Developmental Tasks: ✓ Child-rearing/Caring Adjusting to increased family size ✓ Nutrition Caring for an infant ✓ Health maintenance Providing a positive developmental environment ✓ Recreation 3. FAMILY WITH PRESCHOOLERS Economic ❖ When the oldest child is between the ages ✓ Provision of adequate financial resources of 2 1/2 and 6. ✓ Resource allocation ❖ Developmental Tasks: ✓ Ensure financial security ▪ Satisfying the needs and interests of preschool children Educational ▪ Coping with demands on energy and attention ✓ Teach skills, attitudes and skills relating to with less other functions 4. FAMILY WITH SCHOOL AGE CHILDREN Psychological/ Affection ❖ When the oldest child is between the ages ✓ Promotes the natural development of of 6 and 13. personalities ❖ Developmental Tasks: ✓ Offer optimum psychological protection ▪ Promoting educational achievement ✓ Promotes ability to form relationships with ▪ Fitting in with the community of families with people within the family circle school-age children. Socio-cultural 5. FAMILY WITH TEENAGERS ✓ Socialization of children ❖ When the oldest child is between the ages ✓ Promotion of status and legitimacy of 13 and 20. ❖ Developmental Tasks: DEVELOPMENTAL STAGES/ FAMILY LIFE ▪ Allowing and helping children to become CYCLE more independent Assess a patient and family developmental ▪ Coping with their independence concerns ▪ Developing new interests beyond child care. Identifies stages of family development that reflect the biological functions of raising children 6. LAUNCHING As the family system moves together through ❖ From the time the oldest child leaves the time, the individual life cycles intertwines with the family for independent adult life till the time life cycles of other family members the last child leaves. Families go through different stages for which ❖ Developmental Tasks: specific developmental tasks must be ▪ Releasing young adults and accepting new accomplished ways of relating to them Families who are not able to accomplish these ▪ Maintaining a supportive home base tasks may develop difficulties with subsequent ▪ Adapting to new living circumstances. family development. 7. EMPTY NEST 1. BEGINNING FAMILY ❖ From the time the children are gone till the ❖ Beginning Family: The couple establishes marital couple retires from employment. their home but do not yet have children. ❖ Developmental Tasks: ❖ Involves merging of values brought into the ▪ Renewing and redefining the marriage relationship from the families of orientation. relationship ❖ Includes adjustments to each other’s routines ▪ Maintaining ties with children and their families (sleeping, eating, chores, etc.), sexual and ▪ Preparing for retirement years. economic aspects. ❖ Members work to achieve 3 separate 8. AGING FAMILY identifiable tasks: ❖ From retirement till the death of the 1. Establish a mutually satisfying relationship surviving marriage partner. 2. Learn to relate well to their families of ❖ Developmental Tasks: orientation  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris ▪ Adjusting to retirement 3. Able to communicate thoughts and feelings ▪ Coping with the death of the marriage partner effectively and life alone 4. Able to provide support, security and encouragement FAMILY HEALTH TASK 5. Able to initiate and maintain growth producing Health task differ in degrees from family to relationship family 6. Maintain and create constructive and TASK- is a function, but with work or labor responsible community relationships overtures assigned or demanded of the person 7. Able to grow with and through children 8. Ability to perform family roles flexibly Family Health Tasks (Duvall & Niller) 9. Able to help oneself and to accept help when 1. Physical maintenance- provides food, appropriate shelter, clothing, and health care to its members 10. Demonstrate mutual respect for the being certain that a family has ample resources individuality of family members to provide 11. Ability to use a crisis experience as a means of growth 2. Socialization of Family- involves preparation 12. Demonstrate concern of family unity, loyalty of children to live in the community and and interfamily cooperation interact with people outside the family FAMILY NURSING PROCESS 3. Allocation of Resources- determines which FAMILY NURSING PROCESS: family needs will be met and their order of priority. - Includes data collection, data analysis or interpretation and problem definition or 4. Maintenance of Order- task includes nursing diagnosis opening an effective means of - The rationale for adopting this health tasks communication between family members, as the framework of the typology is the fact integrating family values and enforcing common that in community health nursing practice, regulations for all family members. one deals mostly with problems within the domain of human behavior or human 5. Division of Labor – who will fulfill certain response to health and illness. roles e.g., family provider, home manager, - A community health nurse works with and children’s caregiver through the family to improve its behavior related to health. 6. Reproduction, Recruitment, and Release of ASSESSMENT AND DIAGNOSES IN FAMILY family member NURSING PRACTICE 7. Placement of members into larger society – There are two major types in dealing with the consists of selecting community activities such assessment of the family according to nursing as church, school, politics that correlate with the practice: family beliefs and values 1. FIRST LEVEL ASSESSMENT - the process of 8. Maintenance of motivation and morale- determining existing and potential health conditions created when members serve as support or problems of the family. These health conditions people to each other are categorized as: A. WELLNESS CONDITION Family Health Tasks (Maglaya) 1. Recognizing interruptions of health - Stated as Potential or Readiness development - A clinical or nursing judgment about a client 2. Making decisions about seeking health care/ to in transition from a specific level of wellness take action or capability to a higher level 3. Dealing effectively health and non-health situations 4. Providing care to all members of the family 5. Maintaining a home environment conducive to health maintenance CHARACTERISTICS OF HEALTHY FAMILY 1. Able to provide for physical, emotional and spiritual needs of family members 2. Able to be sensitive to the needs of the family members B. HEALTH THREATS - Conditions that are conducive to disease and accident, or may result  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris to failure to maintain wellness or realize health potential A. Presence of risk factors of specific diseases B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident/ fire hazards E. Faulty/ unhealthful nutritional/ eating habits or feeding techniques or practices F. Stress provoking factors G. Poor home environmental condition/ sanitation H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices J. Inherent personal characteristics K. Health history which may participate/ induce the occurrence of a health deficit L. Inappropriate role assumption M. Lack of immunization/ inadequate immunization status specially of children N. Family disunity O. Others C. HEALTH DEFICITS - Instances of failure in Data gathering methods includes: Observation, health maintenance (disease - regardless of physical examination, interview, review of records whether it is diagnosed or undiagnosed by medical and laboratory and diagnostic procedures. practitioner, disability, (developmental lag) 2. SECOND LEVEL ASSESSMENT - identifies the D. STRESS POINTS / FORESEABLE CRISIS - Anticipated periods of unusual demand on the nature or type of nursing problems the family individual or family in terms of experiences in the performance of their health adjustment/family resources. tasks with respect to a certain health condition or - Examples of this include: health problem. A. Marriage B. Pregnancy, labor, puerperium FIVE MAIN TYPES OF FAMILY NURSING C. Parenthood PROBLEMS: D. Additional member-e.g. newborn, lodger I. Inability to recognize the presence of the E. Abortion condition or problem due to: F. Entrance at school a. Lack of or inadequate knowledge G. Adolescence b. Denial about its existence or severity as a result H. Divorce or separation of fear of consequences of diagnosis of problem, I. Menopause specifically: J. Loss of job i. Social-stigma, loss of respect of peer/significant K. Hospitalization of a family member others L. Death of a member ii. Economic/cost implications M. Resettlement in a new community iii. Physical consequences N. Illegitimacy iv. Emotional/psychological issues/concerns c. Attitude/ Philosophy in life, which hinders recognition / acceptance of a problem II. Inability to make decisions with respect to taking appropriate health action due to: a. Failure to comprehend the nature/magnitude of the problem/condition b. Low salience of the problem/condition c. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack. d. Lack of/inadequate knowledge/insight as to Data collection for first level assessment includes alternative courses of action open to them gathering the five types of data, namely:  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris e. Inability to decide which action to take from among a list of alternatives III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to: a. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management) b. Lack of/inadequate knowledge about child development and care c. Lack of/inadequate knowledge of the nature or extent of nursing care needed Note: d. Lack of the necessary facilities, equipment and Utilizing the data gathered from the Initial Data supplies of care Base (IDB), the nurse goes though the data e. Lack of/inadequate knowledge or skill in carrying analysis. The end-result of the analysis during the out the necessary first-level assessment is a conclusion or a intervention or treatment/procedure of care (i.e. statement of a health condition or problem complex therapeutic regimen classified as a wellness potential, health threat or healthy lifestyle program). f. Inadequate family and health deficit or stress point/ foreseeable resources of care specifically: crisis. i. Absence of responsible member The second - level of assessment ends with a ii. Financial constraints definition of family nursing problems, in terms iii. Limitation of luck/lack of physical resources of how the family handles it. IV. Inability to provide a home environment PLANNING, IMPLEMENTING AND conducive to health maintenance and personal EVALUATING IN FAMILY NURSING development due to: PRACTICE a. Inadequate family resources specifically: i. Financial constraints/limited financial resources FAMILY NURSING CARE PLAN - Is a blueprint of ii. Limited physical resources-e.i. lack of space to nursing care designed to systematically construct facility enhance the family’s capability to maintain b. Failure to see benefits (specifically long term wellness, manage health problems through ones) of investments in home explicitly formulated goals and objectives of care environment improvement and deliberately chosen set of nterventions, c. Lack of/inadequate knowledge of importance of resources, & evaluation criteria, standards, hygiene and sanitation methods/tools. d. Lack of/inadequate knowledge of preventive measure STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN V. Failure to utilize community resources for 1. Prioritize Health Conditions or Problems health care due to: 2. Goal and Objectives of Nursing Care a. Lack of/inadequate knowledge of community 3. Intervention Plan resources for health care 4. Evaluation Plan b. Failure to perceive the benefits of health care/services HEALTH PROBLEM - Process whereby existing c. Lack of trust/confidence in the agency/personnel and potential health conditions or problem of d. Previous unpleasant experience with health the families are determined. They reflect depth of worker data gathering and analysis on what health e. Fear of consequences of action (preventive, conditions or problems exists. diagnostic, therapeutic, rehabilitative) specifically: i. Physical/psychological consequences This is derived from the First Level Assessment of ii. Financial consequences the Typology of Nursing Problems. iii. Social consequences f. Unavailability of required care/services Which categorizes the presence of: ▪ Wellness state ▪ Health deficits ▪ Health threats ▪ Foreseeable crisis or stress point FAMILY NURSING DIAGNOSIS  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris - Defines the nature or type of nursing problems o Current Management – refers to the presence that the family encounters in performing the and appropriateness of intervention measures health tasks with respect to a given health instituted to enhance the wellness state or remedy condition or problem, and the etiology or barriers the problem. The institution of appropriate to the family’s assumption of these tasks. intervention increase the preventive potential - This is derived from the Second Level o Exposure of any vulnerable or high-risk Assessment of the Typology of Nursing group – Increases the preventive potential in Problems. determining the score for salience. The family’s - This includes those that specify or describe concerns, felt needs, or readiness increases the the family’s realities, perceptions about and salience attitudes related to the assumption or performance of family health tasks on each health 4. SALIENCE - Family’s perception & evaluation condition or problem identified during the first-level of the problem in terms of seriousness & urgency assessment. of attention needed or family readiness - The nurse should learn to prioritize the numerous family nursing problem considering the available resources of the nurse, the family and the community. FOUR CRITERIA IN PRIORITIZNG HEALTH CONDITIONS (Maglaya et. al., 2017) 1. NATURE OF THE PROBLEM - Is the problem a: a. Wellness condition b. Health deficit c. Health threat d. Foreseeable crisis 2. MODIFIABILITY OF THE CONDITION - Probability of success in enhancing wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. - Factors to consider in determining modifiability of the problem: o Current knowledge, technology and interventions to enhance wellness state or manage the problem o Resources of the family-physical, financial and manpower o Resources of the nurse-knowledge, skill and time o Resources of the community-facilities and community organization or support 3. PREVENTIVE POTENTIAL - Nature and magnitude of future problems that can be minimized or totally prevented if interventions are done on the problem. - Factors to consider in determining preventive potential: o Gravity or severity of the problem – refers to the progress of disease indicating extent of damage on the client. The more severe of advanced the problem, the lower is the preventive potential. o Duration of the problem – refers to the length of time the problem has been existing. Has a direct relationship to gravity & preventive potential.  NCM 104: COMMUNITY HEALTH NURSING 1 MODULE 2-4: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES TERM: PRELIMS I A.Y. 2023-2024 – FIRST SEMESTER I Krizia Rose S. Ferraris Focus on Interventions to Help the Family Performs Health Tasks - Help the family recognize the problem - Guide the family on how to decide on appropriate health actions to take. - Develop the family’s ability and commitment to provide nursing care to each member. - Enhance the capability of the family to provide home environment conducive to health maintenance and personal development. - Facilitate the family’s capability to utilize community resources for health care. Guidelines for Implementing Nursing Activities - Nursing actions should be based on scientific knowledge, nursing research and professional GOAL OF CARE standards of care. a broad desired outcome toward which behavior - Nurse should understand clearly the orders to be is directed. implemented and question any that are not The Cardinal Principle: Goals must be jointly set understood. with the family. This ensures the family - Nursing actions should be adapted to the commitment to their realization. individual client. Goals set by the nurse & family should be realistic - Nursing actions should always be safe. or attainable. - Nursing actions often require teaching, support Too high goals & their consequent failure frustrate and comfort. both the family & the nurse. - Nursing actions should be holistic. - Nursing actions should respect the dignity of the OBJECTIVES OF CARE client and enhance the client’s self esteem This refers to a more specific / more precise - - Clients should be encouraged to participate statements of the desired results or outcome of actively in implementing the nursing actions. care. The more specific the objective, the easier is the Implementation requires the following skills evaluation of their attainment. from the nurse: - Cognitive Skills – problem solving, decision TYPES OF OBJECTIVE: making, critical thinking and creative thinking. 1. Short term/ Immediate Objective - Interpersonal or communication skills Formulated for problem which require - Technical skills – hands on skills such as immediate attention and results observed is manipulating equipment, giving medications and short time period with few nurse family other contacts, use of less resources. 2. Long term/ Ultimate Objective EVALUATION Require several nurse-family encounters & - Specifies how the nurse will determine investment of more resources. Outcomes changes in health status, condition and sought require time to demonstrate achievement of outcomes of care specified in the 3. Medium term/ Intermediate Objective objectives of family nursing care plan Those which are not immediately achieved. Components of an objective Ongoing Evaluation – done while or (ABCD): immediately after implementing an order; 1. Actor / Subject – client, any part of the enables nurse to make on-the-spot modifications in client or some attributes of the client. an intervention. 2. Behavior / Verb – action of the client to perform. Intermittent Evaluation - performed at specific 3. Conditions / Modifiers - explain the time intervals to show the extent of progress circumstances under which the behavior is towards the goal and enables nurse to correct any to be performed, (what, where, when, how) deficiencies and modify care plan; also called 4. Determinant / Criterion of Desired PROCESS Evaluation. Performance - Level at which the client will perform the Terminal Evaluation – indicates client’s condition at the time of discharge; includes HEALTH CARE STRATEGIES - This involves status of goal achievement and an evaluation of selection of appropriate nursing interventions/ the client’s self-care abilities with regard to health care strategies based on the formulated goal follow-up care. and objective.