Notre Dame of Marbel University Nursing Department NCM-N 104A Community Health Nursing 1 PDF

NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) Overview to Community and Public Health Nursing ...

NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) Overview to Community and Public Health Nursing  B. CONCEPTS OF PUBLIC HEALTH AND COMMUNITY HEALTH NURSING Definition of Terms COMMUNITY - group of people sharing common geographic boundaries and/or common values and interests. (Dr. Araceli Maglaya) - a locality-based entity composed of systems of formal organizations reflecting society’s institutions, informal groups and aggregates. (Shuster and Goepingger) HEALTH - State of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. (World Health Organization) PHYSICAL MENTAL SOCIAL  COMMUNITY HEALTH NURSING Utilization of the nursing process in the different levels of clientele – individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. (Dr. Araceli Maglaya) –  COMMUNITY HEALTH NURSING The goal is to raise the level of health of the citizenry by helping communities and families cope with the discontinuities in and threats to health in such a way as to maximize their potential to high-level wellness. (Nisce, Reyala, et al)  PUBLIC HEALTH The science and art of preventing disease, prolonging life, and promoting health… to enable every citizen to realize his birthright to health and longevity. (Dr. C.E. Winslow) PUBLIC HEALTH The art of applying science in the context of politics as to reduce the inequalities in health while ensuring the best health for the greatest number. (WHO)  PUBLIC HEALTH NURSING It is community health nursing practiced in the public sector. The practice of nursing in national and local government health departments (which include health centers and rural health units) and public schools. (Standards of Public Health Nursing in the Philippines)  Special field of nursing that combines the skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation, and the prevention of illness and disability. (WHO Expert Committee in Nursing)  PHILOSOPHY OF COMMUNITY HEALTH PRACTICE Philosophy of Community Health Nursing Practice A philosophy is defined as “a system of beliefs that provides a basis for and guides action.” A philosophy provides the direction and describe the what's, the whys and the how's of activities within a profession. The Community Health Nursing is guided by the following beliefs: HUMANISTIC.  THINKING TIPS: HUMANISTIC H- Humanistic values of the nursing profession upheld U- Unique and distinct component of health care M- Multiple factors of health considered A- Active participation of clients encouraged N- Nurse considers availability of resources I- Interdependence among health team members practiced S - Scientific and up-to-date T- Tasks of Community Health Nurse vary with time and place I - Independence or self-reliance of the people is the end goal C - Connectedness of health and development regarded Basic Principles of Community Health Nursing 1. The COMMUNITY is the PATIENT in CHN; the FAMILY is the UNIT OF CARE; and there are FOUR LEVELS of CLIENTELE: INDIVIDUAL, FAMILY, POPULATION GROUPS, and the COMMUNITY. 2. In CHN, the CLIENT is considered as an ACTIVE PARTNER, not a passive recipient of care.  3. CHN practice is AFFECTED BY DEVELOPMENTS IN HEALTH TECHNOLOGY, in particular and CHANGES IN SOCIETY, in general. 4. The goal of CHN is achieved through MULTISECTORAL EFFORTS. 5. CHN is a PART of HEALTH CARE SYSTEM and the LARGER HUMAN SERVICES SYSTEM  Roles of Public Health Nurse CLINICIAN Utilizes the nursing process in the care of the client in the home setting and in public health care facilities; conducts referral of patients.  HEALTH EDUCATOR Utilizes the teaching skills to improve the health knowledge, skills and attitudes; conducts health information campaigns for the purpose of health promotion and disease prevention.  COORDINATOR and COLLABORATOR Establishes linkages and collaborative relationships with other health professionals, agencies and organizations to address health problems.  SUPERVISOR Monitors and supervises the performance of midwives and auxiliary health workers; initiates formulation of staff development and training programs. LEADER and CHANGE AGENT Influences people to participate in the overall process of community development. MANAGER Organizes the nursing service component of the local health agency or LGU; responsible for the delivery of package of services by the health program to target clientele. RESEARCHER Participates in the conduct of research and utilizes research findings in practice. Duties and Responsibilities of the Nurse In the Implementing Rules and Regulations of the Philippine Nursing Act of 2002 (RA 9173), Article VI, Nursing Practice, Section 28, Scope of Nursing as published in the Philippine Journal of Nursing, it is stated that: SEC. 28. Scope of Nursing.  A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age.  As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;  Establish linkages with community resources and coordination with the health team; Provide health education to individuals, families and communities  Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and, Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice; Responsibilities of Community Health Nurse Participates in the development of an overall health plan, its implementation, and evaluation for communities Provides quality nursing services to the four levels of clientele Maintains coordination/ linkages with other health team members, NGO/ government agencies in the provision of public health services  Initiates and conducts research relevant to CHN services to improve provision of health care Initiates and provides opportunities for professional growth and continuing education for staff development Note: ❑ The public health nurse will take charge of the Municipal Health Officer’s (MHO) responsibilities if the MHO is unable to perform his duties/ functions or is not available. ❑ In the care of families: ✓ Provision of primary health care services ✓ Development/ utilization of family nursing care plan in the provision of care. ❑ In the care of the communities: ✓ Community organizing, mobilization, community development, and people empowerment ✓ Case finding and epidemiological investigation o Program planning, implementation and evaluation ✓ Influencing executive and legislative individuals or bodies concerning health and development  Specialized Fields of Community Health Nursing Community Mental Health Nursing -A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences.  Occupational Health Nursing -The application of nursing principles and procedures in conserving the health of workers in all occupations.  School Health Nursing -The application of nursing theories and principles in the care of the school population. NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) The Health Care Delivery System  LOCAL HEALTH SYSTEM a. Devolution – refers to the act by which the National government confers power and authority upon the various local government units to perform specific functions and responsibilities, including the provision and delivery of basic health services. b. RA 7160 or the Local Government Code of 1991 – made possible the devolution of powers, functions and responsibilities to the local government, both provincial and municipal, as well as an autonomous regional government and a metropolitan authority. c. Objectives of the Local health System i. Establish local health systems for effective and efficient delivery of health care services. ii. Upgrade the health care management and service capabilities of local health facilities. iii. Promote inter-LGU linkages and cost sharing schemes including local health care financing systems for better utilization of local health resources. iv. Foster participation of the private sector, non-government organizations, and communities in local health systems development. v. Ensure the quality of health service delivery at the local level.  LOCAL HEALTH BOARD Each local government has local health board which proposes annual budgetary allocations for the operations of health services within the locality.  COMPARISON OF PROVINCIAL AND MUNICIPAL HEALTH BOARD PROVINCIAL LEVEL MUNICIPAL LEVEL  INTER-LOCAL HEALTH SYSTEM a. A system of health care similar to district health system in which individuals, communities and all other health care providers in a well-defined geographical area participate together in providing quality, equitable and accessible health care with Inter Local Government Unit (ILGU) partnerships as the basic framework b. Overall concept is the creation of ILHS by clustering municipalities into Inter Local Health Zone (ILHZ) c. Inter Local health Zone Unit of health system created for local health service management and delivery in the Philippines Responsibility for health has been decentralized from national to local health authorities Has defined population within a define geographical area and comprises a central or core referral hospital and a number of primary level facilities  ▪Provides quality, equitable and accessible health care Importance: ▪ re-integrate hospital and public health services for a holistic delivery of health services; ▪ identify areas for complementation of the stakeholders Composition: ▪ People ▪ Health Facilities ▪ Health Worker ▪ Boundaries Core referral hospital ▪ Main hospital for ILHZ and its catchment population ▪ Main point of referral for hospital services from the community, private medical practitioner and public health services at BHS and RHUs d. District Health System Smallest manageable unit in areas which are small enough to be managed without being bogged down by much bureaucracy, yet large enough to make it feasible. e. Two-way Referral System Needs to be established between each level of health facility. LEVELS OF THE HEALTH CARE SERVICES CLASSIFICATION OF HEALTH FACILITIES  HEALTH PROMOTION AND LEVELS OF DISEASE PREVENTION Health Promotion – directed towards healthy individuals or populations, focusing on the prevention of the emergence of risk factors such as unhealthy lifestyle behavior  LEVELS OF DISEASE PREVENTION 1. PRIMARY LEVEL Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. 2. SECONDARY LEVEL This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.  3. TERTIARY LEVEL While secondary prevention seeks to prevent the onset of illness, tertiary prevention aims to reduce the effects of the disease once established in an individual. Forms of tertiary prevention are commonly rehabilitation efforts PRIMARY HEALTH CARE a. Brief History Primary Health Care (PHC) was declared during the First International Conference on Primary health Care held in Alma Ata, USSR on September 6- 12, 1978 through the sponsorship of WHO and UNICEF. b. Legal Basis Letter of Instruction (LOI) 949 signed in October 19,1979 by President Ferdinand E. Marcos. C. Definition Essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development. d. Basic Concepts Health s related to social structures Health and development are interrelated People’s participation is essential Community organizing is the core in PHC Use of appropriate technology e. Goals i. To develop and maximize people potential and self-reliance of the community for the improvement of their own health. ii. To maximize the contributions of other sectors of health iii. To maximize the extension of effective health care services to the periphery. F. Principles 1. Accessibility, availability, and acceptability of health services 2. Provision of quality basic, and essential health services 3. Community participation 4. Self-reliance 5. Recognition of interrelationship between health and development 6. Social mobilization 7. Decentralization G. COMPARISON OF TRADITIONAL AND PHC APPROACH H. TYPES OF PRIMARY HEALTH CARE WORKER NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) The Health Care Delivery System With the thought that Health is our basic human right. A Health Care Delivery System is necessary as it comprises the policies, facilities, equipment, products, human resources, and services which helps in addressing the needs, problems and concerns of the people. Without these, quality health will not be attained. HEALTH CARE DELIVERY SYSTEM DEFINITION OF TERMS  Health System Interrelated system in which a country organizes available resources for the maintenance and improvement of health of its citizens and communities It comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health.  Health Care System An organized plan of health services.  Health Care Delivery Rendering health care services to the people.  Health Care Delivery System The network of health facilities and personnel which carries out the task of rendering health care to the people.  Philippine Health Care System a. Health as a basic human right b. Department of Health as the lead agency c. Local Government Code i. In 1991, the Philippine Government introduced major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991.  ii. The code devolved basic services for agricultural extension, forest management, health services, barangay roads and social welfare to Local Government Units. iii. In 1992, the Philippine government devolved the management and delivery of health services from the national Department of Health to locally elected provincial, city, and municipal governments. d. Access to health care is hampered by high cost, physical and socio-cultural barriers, and health workforce crisis.  Four Essential functions of Health System Service Provision Resource Generation Financing - It aims to strengthen the healthcare delivery system by providing people access to essential health services. But “ more that half of the health expenditures remain funded by out of pocket (OOP) payments despite increased resources in recent years. -To generate more fundings congress formulated sin taxes last 2013 which include Republic act 10351. this law increased taxes for both tobacco and alcohol to generate revenue for health care financing Stewardship  Health Care System Models a. Private Enterprise Health Care Model Usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care. b. Social Security Health Model Social welfare service concerned with social protection, or protection against socially recognized conditions, including poverty, old age, disability, unemployment, etc. c. Publicly Funded Health Model Health care that is financed entirely or in majority part by citizens’ tax payments instead of through private payments made to insurance companies or directly to health care providers. d. Social Health Insurance Method for financing health care costs through social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies.  Health Care Utilization a. Physical barriers Geographical location patterns of health care consumers in relation to health providers. b. Financial factors Economic status affects health seeking patterns of the Filipinos  Multisectoral Approach to Health a. The health status of the community is largely the result of a combination of factors. b. Health cannot work in isolation. Neither one sector or discipline claim monopoly to the solution of community health problems. c. Health has a multi-sectoral concern  GLOBAL AND NATIONAL HEALTH IMPERATIVES The United Nations have come up with different development goals which aims to address the pressures on the health system brought about by: a.) Shift in demographic and epidemiological trends in disease. b) new technologies for health care communication, and information. c.) existing and emerging environmental hazards some associated with globalization, and d.) health reform. This adopts a common vision of poverty reduction and sustainable development. The target of the eight Millennium Development Goals (MDGs) is to: reduce global poverty and hunger. After 15 years, the United Nations was able to come up with new set of goals naming it as – Sustainable Development Goals (SDGs). With the principle of leaving no one behind, for the year 2030 the goal is to fully include persons with disabilities. There are 17 Sustainable Development Goals which were formulated to transform the world These developmental goals influence health, and health influences these goals as well.  Sustainable Development Goal 3 The official wording is: "To ensure healthy lives and promote well-being for all at all ages." Sustainable Development Goal 3 seeks to ensure health and well-being for all, at every stage of life. The Goal addresses all major health priorities, including reproductive, maternal and child health; communicable, non- communicable and environmental diseases; universal health coverage  and access for all to safe, effective, quality and affordable medicines and vaccines. It also calls for more research and development, increased health financing, and strengthened capacity of all countries in health risk reduction and management. 3.1. Maternal mortality By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births. 3.2. Neonatal and child mortality By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3.3. Infectious diseases By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, and combat hepatitis, waterborne diseases and other communicable diseases. 3.4. Noncommunicable diseases By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well- being. 3.5. Substance abuse Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.6. Road traffic By 2020, halve the number of global deaths and injuries from road traffic accidents. 3.7. Sexual and reproductive health By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs. 3.8. Universal health coverage Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. 3.9. Environmental health By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. Goal 3 – Means of implementation for the targets 3.a. Tobacco control Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate. 3.b.Medicines and vaccines Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries. Provide access to affordable essential medicines and vaccines in accordance with the Doha Declaration on TRIPS and Public Health, which affirms the right of developing countries to the fullest use of the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS agreement) regarding flexibilities to protect public health and, in particular, provide access to medicines for all. 3.c. Health financing and workforce Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States. 3.d. Emergency preparedness Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.  PHILIPPINE DEPARTMENT OF HEALTH Principal agency in health in the Philippines Responsible for ensuring access to public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services. Policy and regulatory body for health  Withother health providers and stakeholders, the DOH pursue and assure the following:  Promotion of health and well-being for every Filipino; Prevention and control of diseases among population at risk. Protection of individuals, families, and communities exposed to health hazards and health risks. Treatment, management, and rehabilitation of individuals affected by diseases and disability.  Mission To guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health.  Vision A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable health financing.  Department of Health (DOH) a. The DOH is composed of about 17 central offices, 16 centers for health Development located in various regions, 70 hospitals and 4 attached agencies. b. Center for Health Development ▪ Responsible for field operations of the Department in its administrative region and for providing catchment area with efficient and effective medical services. ▪ Act as a main catalyst and organizer in the ILHZ formation c. DOH Hospitals Provides hospital-based care; specialized or general services, some conduct research on clinical properties and training hospitals for medical specialization.  d. Attached Agencies i. Philippine Health Insurance Corporation ii. Dangerous Drugs Board iii. Philippine Institute of Traditional and Alternative Health Care iv. Philippine national AIDS Council  Framework FOURmula ONE for Health is directed towards ensuring accessible and affordable quality heath care, especially for the more disadvantaged and vulnerable sectors of the population. This strategy has four elements: Good Governance, Health Financing, Health Regulation, and  Health Service Delivery  Philippine Health Agenda a. All for Health towards Health for All  b. Strategy (ACHIEVE) A-Advance quality, health promotion and primary care C-Cover all Filipinos against health-related financial risk H- Harness the power of strategic HRH development I- Invest in eHealth and data for decision-making E- Enforce standards, accountability and transparency V- Value all clients and patients, especially the poor, marginalized, and vulnerable E- Elicit multi-sectoral and multi-stakeholder support for health c. Goals  Financial Risk Protection  Better Health Outcomes  Responsiveness d. Values  Equity  Quality  Efficiency  Transparency  Accountability  Sustainability  Resilience NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) Levels of Clientele In the community setting, there are four levels of clientele: a. Individuals b. Families c. Population Groups d. Community A. INDIVIDUAL AS A CLIENT  The community health nurse deals with individuals sick or well daily.  Since the health needs of the individual are intertwined with the needs of other family members, the individual, being a family member himself, could be used as an “entry point” in working with the whole family. CLIENT AND PATIENT There are two ways of looking at man: ATOMISTIC APPROACH:  is based on the notion that events and their causes can be decomposed and individually quantified Views man as an organism of different organ systems, made up of tissues, made up of cells which are the basic unit of life. HOLISTIC APPROACH  in which man is seen as a unity of body, soul and spirit. According to the holistic approach to health, the human organism is not a sum of individual parts, but a complex interconnected and interdependent system of life processes. FIVE DIMENSIONS OF A MAN B. FAMILY AS A CLIENT As defined by Murray and Zentner (2007), the family is a social system and primary reference group made up of two or more persons living together who are related by blood, marriage, or adoption or who are living together by arrangement over a period of time. Types of Families NUCLEAR FAMILY - a family that is composed of a husband, wife and their immediate children- natural, adopted or both. DYAD FAMILY - a family consisting only of husband and wife. ( newly married couples) EXTENDED FAMILY - Consisting of three generations, which may include married siblings and their families or grandparents BLENDED FAMILY - Results from the union where one or both spouses brings a child or children from previous marriage into a new living arrangement. COMPOUND FAMILY - where a man has more than one spouse; approved by the Philippine authorities only among Muslims by virtue of Presidential Decree No. 1083, also know as the Code of Muslim Personal Law of the Philippines COHABITING FAMILY - It is commonly described as a “Live –in” arrangement between an unmarried couples who are called common- law spouses and their child or children. SINGLE PARENTING - Which results from the death of a spouse, separation, or pregnancy outside of wedlock GAY OR LESBIAN FAMILY - Is made up of a cohabiting couple of the same sex in a sexual relationship  Family Theories and Models FAMILY SYSTEMS MODEL Bowen family systems theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the unit's complex interactions. It is the nature of a family that its members are intensely connected emotionally. Developmental Stage Theory In psychology, developmental stage theories are theories that divide psychological development into distinct stages which are characterized by qualitative differences in behavior Structural-Functional Theory is an orientation that focuses on structure – the patterning of roles, the form of institutions, and the overall articulation of institutions in a society – and seeks to explain these structures in terms of their functions – contributions to the stability and persistence of societies Interactional Theory Interactionaltheory proposes that the fundamental or primary cause of delinquent behavior is a weakening of bonds to conventional society.  Role Theory refersto the cultural norms regarding psychological and interactional aspects of members of society, such as mothers, fathers, sons, daughters, and grandparents.  Crisis Theory  The application for treatment was defined as a crisis—a period of psychological disequilibrium and high anxiety—in that it is an application for a major role change affecting the core self. Crisis theory predicts that the closer the intervention is to the crisis, the greater the success of the intervention.  Theoretical Framework applicable to Families Kalish Hierarchy of Needs : - adapted Maslow’s hierarchy of needs  Kalish Hierarchy of Needs : suggested simulation needs as additional category – sex, activity, exploration, manipulation and novelty.  emphasized the importance of exploring and manipulating the environment so that the children could achieve optimum growth and development. Stages of Family Development Duvall's(1957) widely‐cited model defined family development in terms of eight developmental stages. Duvall's (1957) eight developmental stages:  (1) married couple without children,  (2) childbearing families with the oldest child between birth and 30 months,  (3) families with preschool children,  (4) families with school‐age children,  (5) families with adolescent children,  (6) launching families (first to last child is leaving home),  (7) middle‐age families (“empty nest” to retirement), and  (8) aging families (retirement to death of both spouses).  Functions of a Healthy Family  Physical maintenance ✓ A healthy family provides food, shelter, clothing, and health care for its members. Socialization of Family Members ✓ The family has an open communication system among family members and outward to the community.  Allocation of Resources ✓ In healthy families, there is justification, consistency, and fairness in the distribution. Resources include not only material goods but also affection and space.  Maintenance of order ✓ In healthy families, members know the family rules and respect and follow them.  Division of labor ✓ Healthy families evenly divide the work load among members and are flexible enough that they can change work loads as needed.  Reproduction, recruitment, and release of family members Placement of members into the larger society ✓ Healthy families realize that they do not have to operate alone but can reach out to other families or their community for help when needed.  Maintenance of motivation and Morale ✓ Healthy families are able to maintain a sense of unity and pride in the family. Roles and Responsibilities of a Family Member A. Physical functions: Families provide food, clothing, shelter, medical care and a safe environment for its members. B. Affectional functions:  Being warm, caring and affectionate with your child helps to build strong family relationships. Positive attention is also important for building strong relationships in your family C. Social functions: The family ideally serves several functions for society. It socializes children, provides practical and emotional support for its members, regulates sexual reproduction, and provides its members with a social identity  Family Health Tasks According to Maglaya, A. (2003), the following are the family health tasks and each of the family should have the ability to perform: ▪ Recognize the presence of a wellness state or health condition or problem; ▪ Make decisions about taking an appropriate health action to maintain wellness or manage the health problem; ▪ Provide nursing care to the sick, disabled, dependent, or at-risk member; ▪ Maintain a home environment conducive to health maintenance and personal development; and, ▪ Utilize community resources for health care. Note: it is the responsibility of the nurse to assess whether the family is able to attend to these family health tasks constitute the family nursing problems. C. THE POPULATION GROUP AS A CLIENT According to Clark (1999), a population or aggregate is a group of people sharing the same characteristics, developmental stage, or common exposure to particular environment environmental factors. Children ✓ In the Philippines, this population group is considered the most vulnerable to different types of diseases, especially those who are brought about by socio- economic factors. ✓ They deserve attention from health professionals, concerned group, and government agencies. ✓ These children include- street children, children abused and neglected in their own homes, special children, children suffering from disabilities, child laborers and the children of cultural minorities. Elderly ✓ Individuals who belongs to the age group 60 years and above. ✓ They are often stereotyped as ill, bald, hard of hearing, forgetful, rigid, grumpy, or boring, simply on the basis of their age and regardless of their competencies and individual characteristics. ✓ A major problem among poor older people is access to health care. Health care services for people are limited because these are intended for general population. D. COMMUNITY AS A CLIENT  The community is a group of people sharing common geographic boundaries and/or common values and interests (Maglaya, 2004). Elements : ✓ The geographical unit ✓ The social entity ✓ Psychocultural unit Characteristics: ✓ Defined by geographic boundaries within certain identifiable characteristics ✓ Made up of institutions organized into a social system ✓ A common or shared interest that binds the members together exists ✓ Has an area with fluid boundaries within which problem can be identified and solved ✓ Has a population aggregate concept Healthy Community Characteristics ✓ Awareness that ‘we are community’ ✓ Conservation of natural resources ✓ Recognition of, and respect for, the existence of subgroups ✓ Participation of subgroups in community affairs ✓ Preparation to meet crises ✓ Ability to problem-solve ✓ Communication through open channels ✓ Resources available to all ✓ Setting of disputes through legitimate mechanisms ✓ Participation by citizens in decision making ✓ Wellness of a high degree among its members NOTRE DAME OF MARBEL UNIVERSITY Nursing Department Alunan Avenue, Koronadal City South Cotabato, Philippines, 9506 NCM- N 104A COMMUNITY HEALTH NURSING 1 (Individual and Family as Clients) The Family Health and Family Nursing Process  Family Health Nursing and Family Nursing Process Definition of terms: Family Health Nursing – The practical science of preventative and remedial support to the family in order to help the family system unit independently and autonomously maintain and improve its family functions. (Hohashi, 2010) Definition of terms Family Nursing Process – Is an orderly, systematic steps to assess the health needs, plan, implement and evaluate the services to achieve health. It is the systematic steps to analyze health problems and solutions. It helps in achieving desired goals of health promotion, prevention and control of health problems. (Carenevali and Thomas, 1993)  Objectives and Principles of Family Health Nursing Family Health Nursing Objectives ✓To identify health & nursing needs and problems of each family. ✓To ensure family’s understanding and acceptance of these needs and problems. ✓To plan and provide health and nursing services with the active participation of family members. ✓To help families develop abilities to deal with their health needs and health problems independently. ✓To contribute to family’s performance of developmental functions and tasks. ✓To help family make intelligent use of promotive, preventive, therapeutic and rehabilitative health and allied facilities and services in the community. ✓ To educate, counsel and guide family members to cultivate good personal health habits, practice safe cultural practices and maintain wholesome physical, psychosocial, and spiritual environment.  Family Health Nursing Principles ✓Provide services without discrimination ✓Periodic and continuous appraisal and evaluation of family health situation ✓Proper maintenance of record and reports. ✓Provide continuous services ✓Health education, guidance and supervision as integral part of family health nursing. ✓Maintain good IPR. ✓Plan and provide family health nursing with active participation of family. ✓Services should be realistic in terms of resources available. ✓Encourage family to contribute towards community health. ✓Active participation in making health care delivery system. C. Steps of Family Health Nursing Process The family nursing process is the same nursing process utilized by the nurses as applied to the family, the unit of care in the community. It deals with the following phases: Assessment, Diagnosis, Planning, Implementation, and Evaluation. a. Assessment ✓ This involves sets of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a system and functioning unit, and its ability to maintain wellness, prevent, control, or resolve problems in order to achieve health and well-being among its members. ✓ It includes data collection, data analysis, or interpretation and problem definition or nursing diagnosis ▪ Tools for assessment ✓Initial Data Base A. Family Structure Characteristics and Dynamics 1.Members of the household and relationship to the head of the family. 2.Demographic data-age, sex, civil status, position in the family 3.Place of residence of each member-whether living with the family or elsewhere 4.Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended 5.Dominant family members in terms of decision making especially on matters of health care 6.General family relationship/dynamics-presence of any obvious/readily observable conflict between members; characteristics, communication/interaction patterns among members. B. Socio-economic and Cultural Characteristics 1.Income and expenses A. Occupation, place of work and income of each working member B. Adequacy to meet basic necessities (food, clothing, shelter) C. Who makes decision about money and how it is spent 2.Educational Attainment of each Member 3. Ethnic Background and Religious Affiliation 4. Significant others-role (s) they play in family’s life 5. Relationship of the family to larger community-nature and extent of participation of the family in community activities C. Home Environment 1.Housing a) Adequacy of living space b) Sleeping in arrangement c) Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.) d) Presence of accident hazard e) Food storage and cooking facilities f) Water supply-source, ownership, pot ability g) Toilet facilities-type, ownership, sanitary condition h) Garbage/refuse disposal-type, sanitary condition i) Drainage System-type, sanitary condition 2.Kind of Neighborhood, e.g. congested, slum etc. 3.Social and Health facilities available 4.Communication and transportation facilities available D. Health Status of Each Family Member 1.Medical Nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness 2.Nutritional assessment (especially for vulnerable or at risk members) Anthropometric data: measures of nutritional status of children-weight, height, mid-upper arm circumference; risk assessment measures for obesity : body mass index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC: greater than 90 cm. in men and greater than 80 cm. in women), waist hip ration (WHR=waist circumference in cm. divided by hip circumference in cm. Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women) dietary history specifying quality and quantity of food or nutrient per day Eating/ feeding habits/ practices 3.Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila Developmental Screening Test (MMDST). 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases-e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking, and other substance abuse. 5. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners ) 6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings. E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: 1.Immunization status of family members 2.Healthy lifestyle practices. Specify. 3.Adequacy of: ▪ Rest and sleep ▪ Exercise/activities ▪ Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of bed nets and protective clothing in malaria and filariasis endemic areas. ▪ Relaxation and other stress management activities 4.Use of promotive-preventive health services  Typology of Nursing Problems in Family Nursing Practice 1. FIRST LEVEL ASSESSMENT Presence of Wellness Condition – a clinical judgment about a client in transition from a specific wellness or capability to a higher level. A. Potential for Enhanced Capability for: -Healthy Lifestyle -Health Maintenance/Management -Parenting -Breastfeeding -Spiritual Well-being -Others B. Readiness for Enhanced Capability -Healthy Lifestyle -Health Maintenance/Management -Parenting -Breastfeeding -Spiritual Well-being -Others Presence of Health Threats – Conditions that are conducive to diseases and accidents, and or may result to failure to maintain wellness or realize health potential. A. Family history of hereditary diseases B. Threat of cross infection from communicable disease case C. Family size beyond what family resources can adequately provide D. Accidental hazards: -Broken stairs -Pointed/sharp objects, poison and medication improperly kept -Fire hazards -Others, specify E. Faulty/unhealthy nutrition/eating habits or feeding techniques/practices -Inadequate food intake both in quantity and quality -Excessive intake of certain nutrients -Faulty eating habits -Ineffective breastfeeding -Faulty feeding techniques F. Stress Provoking Factors -Strained marital relationship -Strained parent-sibling relationship -Interpersonal conflicts between family members -Care-giving burden G. Poor home/environment condition/sanitation -Inadequate living space - Lack of food storage facilities - Polluted water supply - Presence of breeding or resting sites of vectors of diseases - Improper garbage disposal - Unsanitary waste disposal - Improper drainage system - Poor lighting and ventilation - Noise pollution - Air pollution H. Unsanitary Food Handling and Preparation I. Unhealthful Lifestyle and Personal Habits - Alcohol drinking - Cigarette smoking - Walking barefoot or inadequate footwear - Eating raw fish or meat - Poor personal hygiene - Self-medication/substance abuse - Sexual promiscuity - Engaging in dangerous sports - Inadequate rest and sleep - Lack of exercise/physical activity - Lack of relaxation activity -Non-use of self-protection measures J. Inherent personal characteristic-poor impulse control K. Health history which may induce health deficit L. Inappropriate role assumption M. Lack of immunization N. Family disunity: -Self-oriented behavior -Unresolved conflicts -Intolerable disagreement O. Others, Specify: Presence of Health Deficits – instances of failure in health maintenance. ▪ illness states, regardless of whether it is diagnosed or by medical practitioner ▪ Failure to thrive/ develop according to normal rate ▪ Disability – whether congenital or arising from illness; temporary Presence of stress Points/ Foreseeable Crisis Situations – anticipated periods of unusual demand of the individual or family in terms of family resources. Marriage Menopause Pregnancy Loss of job Parenthood Hospitalization of a family member Additional member Abortion Death of a manner Entrance at school in a new community Resettlement Adolescence Divorce Illegitimacy 2. SECONDA- LEVEL ASSESMENT Defines the nature of the or type of nursing problems that the family encounters in performing the health task with respect to a given health condition or problem and the etiology or barriers to the families assumption of this task It explains the families problem related to maintaining health and wellness. It specified the measures that the family did not due to INABILITY ✓ Family Health Task ✓ Family Coping Index ✓ Genogram ✓ Ecomap ✓ Family Assessment Guide ▪ Data Collection Methods ✓ Observation ✓ Physical Examination ✓ Interview o Review of Records/ Reports and Laboratory results ✓ Assessment of Home and Environment ▪ Family Data Analysis ✓ Socio-economic and Cultural characteristics ✓ Home and Environment ✓ Family health status ✓ Family values and health practices B. Family Nursing Diagnosis - A classification system of family nursing problems was developed to facilitate the process of defining the family nursing problem. C. Developing Family Nursing Care Plan - The Family nursing care plan is the blueprint of care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools. ▪ Steps in developing the family nursing care plan ✓ The prioritized condition/s or problems ✓ The goals and objectives of nursing care ✓ The plan of interventions ✓ The plan for evaluating care ▪ Prioritizing health problems ✓ The use of Scale for Ranking Health Conditions and Problems according to Priorities to objectivize priority setting ▪ Formulating goals and objectives ✓ Goal – general statement of the condition or state to be brought about by specific courses of action. ✓ Objectives – refer to more specific statement of the desired result or outcome of care. ▪ Selecting appropriate family nursing intervention and strategies ✓ Analyze with the Family the Current Situation and determine choices and possibilities based on the lived experience of meanings and concerns ✓ Develop/enhance family’s competencies as thinker, doer and feeler ✓ Focus on interventions to help perform the health tasks ✓ Catalyze the behavior change through motivation and support