Community Health Nursing Past Paper PDF

COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Chapter 1 DEFINING ATTRIBUTES OF COMMUNITIES FUNDAMENTAL CONCEPTS OF COMMUNITY 1. Place HEALTH NURSING...

COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Chapter 1 DEFINING ATTRIBUTES OF COMMUNITIES FUNDAMENTAL CONCEPTS OF COMMUNITY 1. Place HEALTH NURSING 2. People 3. Interaction The Philippine Healthcare Scenario 4. Common characteristics, interests, or goals - The national budget allocation for health care is relatively small TYPES OF COMMUNITIES - LGUs augment the national budget to an Geopolitical Communities AKA Territorial undetermined extent Communities - This scenario requires strategies that will ▪ Most traditionally recognized. allow maximization of limited resources ▪ Defined or formed by both natural and man-made (Health promotion and Disease prevention) boundaries and include barangays, municipalities, cities, provinces, regions, and nations. Phenomenological Communities AKA Functional NURSES IN PUBLIC HEALTH CARE Communities ▪ Refer to relational, interactive groups, in which the place Community/Public Health Nursing – the synthesis of or setting is more abstract, and people share a group nursing practice and public health practice perspective or identity based on culture, values, history, MAJOR GOAL OF CHN interest, and goals. Preserve the health of the community and DETERMINANTS OF HEALTH AND DISEASE surrounding population by focusing on health 1. Income and Social Status promotion and health maintenance of Higher-income and social status are linked to better individual, family, and group within health. The greater the gap between the richest and poor community health, the greater differences in health. The mission of public health is social-justice 2. Education which entitles all people to basic necessities Low education levels are linked with poor health, more such as adequate income and health stress and lower self confidence. 3. Physical Environment protection and accepts collective burdens to Safe water and clean air, healthy workplaces, safe make this possible houses communities and roads all contribute to good health. CONCEPTS OF HEALTH 4. Employment and Working Conditions The variety of characterizations of the word illustrates People in employment are healthier, particularly difficulty in standardizing conceptualization of health. those who have control over their working conditions. 5. Social Support Networks CONCEPTS OF COMMUNITY Greater support from families, friends and ❖ Before 1996: definitions of community communities is linked to better health. focused on geographical boundaries, 6. Culture combined with social attributes of people. Customs and traditions, and the beliefs of the family ❖ Later part of the decade: geographical and community all affect health. location became a secondary characteristic in 7. Genetics the discussion of what defines a community. Inheritance plays a part in determining lifespan, healthiness, and the likelihood of developing illnesses. 8. Personal Behavior and Coping Skills COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Balanced eating, keeping active, smoking, drinking ❖ Targets populations that have experienced and how we deal with life’s stresses and challenges all disease or injury and focuses on limitations of affect health. disability and rehabilitation. 9. Health Services Access and use of services that prevent and treat DEFINITIONS OF PUBLIC HEALTH NURSING disease influences health. According to Freeman, 1963 10. Gender Public Health Nursing may be defined as the field of Men and women suffer from different types of professional practice in nursing and in public health in diseases at different ages. which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of HEALTH PROMOTION health as they affect the community. - Physical activity ❖ These skills are applied in concert with those - Walking for health of other persons engaged in health care, - Healthy eating through comprehensive nursing care of - Stop smoking families and other groups and through - Mental health measures for evaluation or control of threats - Sexual health to health, for health education of the public - Community development and for the mobilization of the public for health - Healthy schools action. - Health trainees According to ANA / APHA, 1996 “The practice of promoting and protecting the health HEALTH PROMOTION AND DISEASE PREVENTION of populations using knowledge from nursing, social Health Promotion: activities enhance resources and public health sciences” o directed at improving well-being Disease Prevention: ❖ “Population-focused, with the goals of the activities protect people from disease and the effects promoting health and preventing disease and of disease disability for all people through the creation of conditions in which people can be healthy.” LEVEL OF PREVENTION 1. Primary: general health promotion and specific COMMUNITY-BASED NURSING protection According to McEwen and Pullis, 2008 ❖ Relates to activities directed at preventing a Application of the nursing process in caring for problem before it occurs by altering individuals, families and group where they live, work susceptibility or reducing exposure for go to go school, or they move through the health care susceptible individuals. system 2. Secondary: early detection and prompt ❖ Setting-specific, and the emphasis is on acute intervention during the period of early disease and chronic care and includes practice areas pathogenesis such as home health nursing and nursing in ❖ Implemented after a problem has begun but outpatient or ambulatory setting. before signs and symptoms appear and targets populations who have risk factors (Keller). POPULATION-FOCUSED NURSING / POPULATION- 3. Tertiary: reduce the effects of disease and injury, FOCUSED APPROACH and restore individuals to their optimal level of Concentrates on specific groups of people and functioning focuses on health promotion and disease prevention, COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester regardless of geographical location (Baldwin et. al., functioning of equipment and maintenance of a safe 1998) environment 3. Health Education THE INTERVENTION WHEEL ▪ assessment of client’s learning needs; development Proposed in the late 1990s by nurses from the of health education plan and learning materials and Minnesota Department of Health, 2008 implementation and evaluation of health education - To describe the breadth and scope of public plan health nursing practice 4. Legal Responsibility - Recognized as a framework for community ▪ adherence to the nursing laws as well as to national, and public health practice local and organizational policies including documentation of care given to clients. 5. Ethicomoral Responsibility EMERGING FIELDS OF COMMUNITY HEALTH ▪ respect for the rights of the client; responsibility and NURSING IN THE PHILIPPINES accountability for own decisions and actions; and Home Health Care adherence to the international and national codes of This practice involves providing nursing care nursing ethics for nurses care to individuals and families in their own places of 6. Personal and Professional Development residence mainly to minimize the effects of illness and ▪ identification of own learning needs, pursuit of disability continuing education; involvement in professional image; positive attitude towards change and criticism Hospice Home Care 7. Quality Improvement Homecare rendered to the terminally ill. Palliative care ▪ data gathering for quality improvement; is particularly important participation in nursing rounds; identification and EntrepreNurse reporting of solutions to identifies problems related to A project initiated by the Department of Labor and client care. Employment (DOLE), in collaboration with the Board 8. Research of Nursing of the Philippines, Department of Health, ▪ research-based formulation of solutions to Philippines Nurses Association and other problems in client care and dissemination and stakeholders to promote nurse entrepreneurship by application of research findings introducing a home health care industry in the 9. Records Management Philippines. ▪ accurate and updated documentation of client care Main Purpose of Entreprenurse – To deliver home while observing legal imperatives and record keeping health care services 10. Communication Parish Nursing / Faith Community Nursing ▪ uses therapeutic communication techniques, identifies verbal and nonverbal cues, responds to COMPETENCY STANDARDS IN CHN client needs, while using formal and informal 1. Safe and Quality Nursing Care channels of communication and appropriate ▪ knowledge of health/illness status of the client, information technology sound decision making; safety, comfort, privacy, 11. Collaboration and Teamwork administration of meds and health therapeutics and ▪ establishment of collaborative relationship with nursing process. colleagues and other members of health team 2. Management of Resources and Environment ▪ organization of workload; use of financial resurces for client care; mechanism to ensure proper HISTORY OF PUBLIC HEALTH NURSING IN THE PHILIPPINES COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester 1577: Friar Juan Clemente opened a medical establishment of a local health board in every dispensary in Intramuros for the indigent. 1690: province and city or municipality. Dominican Father Juan de Pergero worked towards 1999: Health Sector Reform Agenda was launched to installing a water system in San Juan del Monte (now direct government efforts towards comprehensive San Juan City, Metro Manila) and Manila. reforms. 1805: Smallpox vaccination was introduced by 2005: FOURmula One (F1) for health was launched to Francisco de Balmis, the personal physician of King provide an implementation framework to the reform Charles IV of Spain agenda. 1876: The first medicos titulares were appointed and 2010: Universal Health Care was launched to provide worked as provincial health officers. the necessary revisions to the F1 framework. 1888: 2-year courses consisting of fundamental - Aims to achieve the health system goals of medical and dental subjects was first offered in the better health outcomes, sustained health University of Santo Tomas. Graduated were known as financing, and responsive health system that “cirujanos ministrantes” and serve as male nurses will provide equitable access to health care. and sanitation inspectors 1901: United States Philippines Commission, through Act 157, created the Board of Health of the Philippine CHAPTER 2 Islands with a Commissioner of the Public Health, as THEORETICAL FOUNDATIONS OF COMMUNITY its chief executive officer (now the Department of HEALTH NURSING Health Nursing Theories 1912: The Fajardo Act law Created sanitary divisions - Theories or parts of theoretical frameworks to made up of one to four municipalities. Each sanitary guide practice best achieves the goal of division had a president who had to be a physician improving nursing practice- including that of 1905: Asociacion de Feminista Filipina founded La public health Gota de Leche: the first center dedicated to the - A theory is like a map of a territory as opposed service of mothers and babies to an aeriel photograph. The map. The map 1947: The Department of Health was reorganized into does not give the full terrain (ie.: full picture); bureaus: quarantine, hospitals that took charge of the instead it picks out those parts that are municipal and charity clinics and health with the important for its given purpose. (Barnum, sanitary divisions under it. 1998) 1954: The congress passed R.A. 1082 or the Rural Health Unit Act which provided an RHU in every HISTORICAL PERSPECTIVES ON NURSING THEORY municipality. Era of Florence Nightingale 1957: R.A. 1891 was enacted to have a more equitable First nurse to formulate a conceptual distribution of health personnel. 1958: Regional foundation for nursing practice health offices were created as a result of Believed that clean water, cleanliness, access decentralization efforts, thus creating the position: to adequate sanitation, and quiet environment Regional Health Officer. 1970: the Philippine health would improve health outcomes, and she put care delivery system was restructured, paving the way these beliefs into practice during the Crimean for the health care system that exists to this day where War 1980 onwards health services are classified into primary, secondary Several nursing theorists, Dorothy Johnson, and tertiary levels. Sister Callista Roy, Imogene King, Betty 1991: R.A.7160 or the Local Government Code Neuman, and Jean Watson among them, have mandated the devolution of basic services, including included community perspectives in their health services, to local government units and the definition of health COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester General Systems Theory PENDER’S HEALTH PROMOTION MODEL Viewed as an “open system”, the client is Explores the many biopsychosocial factors considered as a set of interacting elements that influence individuals to pursue health that exchange energy, matter, or information promotion activities with the external environment to exist Contains variables related to health This concept is particularly useful when behaviors, as well as individual analyzing interrelationships of the elements characteristics that may influence behavioral within the client, as well as those of the client outcomes and the environment Does not include threat as a motivator, as Open Systems threat may not be a motivating factor for The basic structures of a family that are found clients in all age gaps. in all open systems: o Boundaries 7 VARIABLES OF PENDER’S HEALTH o Environment PROMOTION MODEL o Inputs 1. Prevention o Outputs 2. Lifestyle o Processing (throughput) 3. Preventive policies o Feedback 4. Policy maker education o Subsystems 5. Health education 6. Health protection HEALTH BELIEF MODEL 7. Policy support Provides the basis for much of the practice of health education and health promotion PUBLIC HEALTH NURSE Developed by a group of social psychologists What are the Roles of Public Health Nurse? to explain why the public failed to participate Public health nurses comprise the largest in screening for tuberculosis professional segment of the workplace in “Behavior is based on current dynamics public health and are involved in the confronting an individual rather than prior prevention, education, advocacy, activism, experiences” – Kurt Lewin assessment, and evaluation of public health They hold a vital role in the prevention of MILO’S FRAMEWORK FOR PREVENTION disease and help to promote community Provides a complement to the health belief health and safety model Provides a mechanism for directing attention Public Health Nurse “upstream” While most nurses care for one patient at a Provides for the inclusion of economic, time, public health nurses care for entire political, and environmental health populations determinants: therefore, the nurse is given a The main focus of community health nurse is broader range in the diagnosis and health promotion interpretation of health problems The recipient of care of community public Encourages the nurse to understand health health nursing practice is extended not only behaviors in the context of their social milieu the individual but also to benefit the whole family and community COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Roles and Responsibilities of a Public Health Nurse “essential health care based on practical, Programmer / Planner scientifically sound and socially acceptable methods Health Educator / Trainer / Counselor and technology made universally accessible to Community Organizer individuals and families in the community through Provider of Nursing Care their full participation and at a cost that the Health Monitor community and country can afford to maintain at Researcher every stage of their development in the spirit of self- Statistician reliance and self- determination” Change agent HEALTH FOR ALL: UNIVERSAL GOAL OF PHC Educational Qualifications of Public Health Nurse Health for all means an acceptable level of 1. The staff nurse employed in public health health for all the people of the world through should hold a baccalaureate degree from a community and individual self-reliance college or university which has met certain This policy agenda of “health for all by the year accreditation requirements having specific 2000” technically was a global strategy reference or the public health nursing field as employed in achieving 3 main objectives” stated in reference. 1. Promotion of healthy lifestyles, 2. She should hold a current license to practice 2. Prevention of diseases, and as a registered professional nurse. 3. Therapy for existing conditions 3. In a graduate program, the public health nurse would be expected to achieve an KEY PRINCIPLES OF PRIMARY HEALTH CARE understanding of the research process as well Accessibility, affordability, acceptability, and as first-hand knowledge of the contributions availability of the multidisciplinary group in the public Support mechanisms health field. Multisectoral approach Community participation CHAPTER 3 Equitable distribution of health resources PRIMARY HEALTH CARE Appropriate technology History of Primary Health Care - Alma Ata Conference of Sept. 6-12, 1978 ELEMENTS OF PRIMARY HEALTH CARE - Alma Ata Declarations of PHC Education about health problems & solutions o Health as Basic Fundamental Right Prevention & control of Locally endemic diseases o Global Burden of Health Inequalities Provision of Essential drugs o Economic and Social Development Maternal & child care; reproductive health o Government responsibility Expanded immunization against major diseases - LOI 949, PHC adopted in the Philippines Adequate food supply & Nutrition Treatment of common diseases & injuries HEALTH DEFINED BY THE WHO Safe water & basic Sanitation “a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or PRIMARY HEALTH CARE IS NOT PRIMARY CARE infirmity.” Point of PHC Primary Comparison Care DEFINITION OF PRIMARY HEALTH CARE (PHC) Outcome Self-reliance Reliance on Alma Ata Declaration : PHC is / self help health professional COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester to restore / - Community Integration regain health - Social Analysis Setting of Rural – based Mostly urban - Identifying Potential Leaders Services satellite based - Core Group Formation clinics, clinics and - Community Organization community hospitals - Action Phase health - Evaluation centers - Exit and Expansion Goal Development Absence of and disease preventive GOALS OF COMMUNITY ORGANIZING care - People’s Empowerment Focus Client Family and Individual - Building People’s Organization community - Improved quality of life Focus of Promotive / Curative Care Preventive PARTICIPATORY ACTION RESEARCH (PAR) Decision – Community – Health - Is an approach to research that aims at Making centered / Worker promoting change among participants Process consultative, Driven - Members of the group being studied participative participate as partners in all phases of the research, including design, data collection, analysis, and dissemination (Brown et. al., CHAPTER 4 2008) COMMUNITY ORGANIZING: ENSURING HEALTH IN THE HANDS OF PEOPLE COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) Core Principles of Community Organizing - Is a community development approach that - People centered allows the community (participatory) to - Participative systematically analyze the situation - Democratic (research), plan solution, and implement - Developmental projects/programs (action), utilizing the - Process-oriented process of community organizing WHAT IS COMMUNITY ORGANIZING? COPAR MODEL Community Organizing as a process consists of steps or activities that instill and reinforce the people’s self- confidence on their own collective strengths and capabilities (Manalili, 1990) BASIC VALUES IN COMMUNITY ORGANIZING 1. Human rights 2. Social Justice 3. Social Responsibility PHASES OF COMMUNITY ORGANIZING - Pre-entry - Entry COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester CHAPTER 5 HEALTH PROMOTION, RISK RISK ASSESSMENT REDUCTION, AND CAPACITY-BUILDING - A risk assessment is a systematic way of STRATEGIES distinguishing the risks posed by potentially harmful exposures RISK AND HEALTH Risk: the probability that a specific event will occur in The four main steps of a risk assessment are: a given time frame – Olockno, 2002 1. Hazard identification Risk Factor: an exposure that is associated with a 2. Risk description disease – Friis and Sellers, 2004 3. Exposure assessment 4. Risk estimation TWO TYPES OF RISKS Modifiable risk factors are those aspects of a RISK REDUCTION person’s health risk over which he or she has Risk reduction is a proactive process in which control individuals participate in behaviors that enable them - Examples include smoking, leading a to react to actual or potential threats to their health – sedentary or active lifestyle, type, and amount Pender, 1996 of food eaten, and the type of activities in Risk communication is the process through which which he or she engages the public receives information regarding possible or Nonmodifiable risk factors are those actual threats to health aspects of one’s health risk over which one has no or little control DIET - Examples include genetic makeup, gender, - One of the most modifiable of risk factors age, and environmental exposures - A healthy diet contributes to the prevention of such chronic disease as type 2 diabetes, 3 CRITERIA FOR ESTABLISHING A RISK FACTOR hypertension, heart diseases, and some 1. The frequency of the disease varies by cancers category or amount of the factor. Cigarette smokers are more likely to develop lung OBESITY cancer than nonsmokers and those who - Obesity affecting the Filipino adults is known smoke heavily are more likely to develop lung as android or apple-shaped type, where cancer than those who smoke little. abdominal fat accumulation is measured 2. The risk factor must precede the onset of the using waist-to-hip ratio (WHR) disease. Cigarette smokers have lung cancer - A person with WHR equal to or more than 1.0 after they have been smoking for a while. If in men or equal to or more than 0.85 in women smokers had lung cancer before starting to is considered android or apple-shaped obese smoke, this would cast doubt on smoking as a (FNRI, 2012) risk factor for lung cancer. - The WHR criterion recommended by the World 3. The association of concern must not be due to Health Organization is considered as a any source of error. In any research study, sensitive measure for risk to cardiovascular (especially one involving human behavior) diseases (CVD) there are many sources of error such as study - The relative risk associated with apple-type design, data collection methods, and data obesity among Filipinos was found to be more analysis. than twice the risk of developing coronary artery disease and almost thrice the risk of developing CVD including stroke. These COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester accounted for at least 37 000 deaths in 2008 - Pedestrian-centric designs: businesses are (FNRI, 2012) close to the street to encourage foot traffic with parking in back NUTRITIONAL GUIDELINES FOR FILIPINOS (FROM - Density: the city is compact enough to allow THE FNRI) businesses to flourish and for public 1. Eat a variety of foods every day. transportation to run frequently 2. Breast-feed infants exclusively from birth to 4- - Parks and public space: there are plenty of 6 months and then, give appropriate foods public areas in which to gather while continuing breast-feeding. - Nearby schools and workplace: schools and 3. Maintain children’s normal growth through workplaces are close enough that most proper diet and monitor their growth regularly. people can walk from home 4. Consume fish, lean meat, poultry or dried beans. SLEEP 5. Eat more vegetables, fruits, and root crops. - Is an essential component of chronic disease 6. Eat foods cooked in edible/ cooking daily. prevention and health promotion, yet 74% of 7. Consume milk, milk products and other adults report having a sleeping problem one or calcium-rich foods such as small fish and dark more nights per week green leafy vegetables every day. - Insufficient sleep is associated with diabetes, 8. Use iodized salt but avoid excessive intake of heart disease, obesity, depression, and motor salty foods. vehicle accidents 9. Eat clean and safe food. - As we age, sleep is often interrupted by pain, 10. For a healthy lifestyle and good nutrition, trips to the bathroom, medications, medical exercise regularly, do not smoke and avoid conditions, and sleep disorders drinking alcoholic beverages. SLEEP HYGIENE (FROM THE NATIONAL SLEEP INCREASING PHYSICAL ACTIVITY FOUNDATION) - Research has found that one’s environment is 1. Avoid caffeine and nicotine close to bedtime. a significant factor in health promotion 2. Avoid alcohol as it can cause sleep - Adults and adolescents living in disruptions. neighborhoods with high walkability engage in 3. Retire and get up at the same time every day. significantly more walking and cycling than 4. Exercise regularly, but finish all exercise and those living in neighborhoods with low vigorous activity at least 3 hours before walkability – Frank, 2005; Saelens et al., 2003 bedtime. - The Sightline Institute (2008) has formulated a 5. Establish a regular, relaxing bedtime routine (a walk score algorithm to rate US cities for warm bath, reading a book). suitability for walking 6. Create a dark, quiet, cool sleep environment. 7. Have a comfortable mattress and bedding. COMPONENTS FOR SUITABILITY OF A CITY FOR 8. Uset he bed for sleep only; do not read, listen WALKING (FROM THE SIGHTLINE INSTITUTE) to music, or watch TV in the bed. - A center: shopping center, park, or main 9. Avoid large meals before bedtime. street - Mixed use, mixed income: businesses are SLEEP ASSESSMENT located next to homes at all price points - Sleep assessment is an important nursing function. If a client reports snoring, apnea, COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester restlessness, or insomnia, he or she may have Enforce bans on tobacco advertising, promotion, a sleep disorder and sponsorship, and - Recommend keeping a sleep log detailing how Raise taxes on tobacco many hours are spent in sleep each night and May 31 – World No Tobacco Day any problems with sleep - If insufficient sleep is causing trouble RA 9211 – THE TOBACCO REGULATION ACT OF concentrating or completing daily activities, 2003 recommend consulting a doctor, as a sleep Prohibited Acts disorder may be to blame - Smoking in public places - Sale of tobacco products to persons below 18 TOBACCO AND HEALTH RISK years of age - Smoking cessation is an important step in - All forms of tobacco advertising in mass achieving optimum health media and regulates other forms of tobacco - More than half of the world’s smokers live in 14 promotions countries, the Philippines among them – The law requires a printed warning on Global Tobacco Survey, 2009 cigarette packages - In 2009, among the 10 leading causes of death Enjoins the Department of Health, in the Philippines, 8 are associated with together with other government agencies smoking such as the Department of Education to carry out a continuous information STEPS TO QUIT SMOKING (FROM THE AMERICAN program on the harmful effects of CANCER SOCIETY smoking, undertake a National Smoking 1. Make the decision to quit Cessation Program, and establish 2. Set a date to quit and choose a plan smoking withdrawal clinics - Mark the date on your calendar - Tell your family and friends about the date and ALCOHOL CONSUMPTION ask for support - In the Philippines, drinkers had a per capita - Rid the environment from all tobacco consumption of 17 liters, with male drinkers products and smoking paraphernalia consuming 19 liters and female drinkers, 10.9 - Stock-up on oral substitutes liters - Practice saying “No thank you, I don’t smoke” - Among students who ever had a drink of 3. Deal with withdrawal though alcohol other than a few sips, the percentage - Avoiding temptation who had their first drink of alcohol before age - Changing your habits 14 years was 61.5% among males and 51.1% 4. Staying off of tobacco is a lifelong process among females, for a combined proportion of 56.7% - WHO, 2011 TOBACCO CONTROL AT THE COUNTRY-LEVEL (FROM THE WORLD HEALTH ORGANIZATION, Heavy drinking having more than 2 drinks per 2012) day on average for men or MPOWER STRATEGY more than 1 drink per day for Monitor tobacco use and prevention policies, women Protect people from tobacco smoke, Binge drinking drinking 5 or more drinks on a Offer help to quit tobacco use, single occasion for men or 4 or Warn about the dangers of tobacco, more drinks in a single occasion for women COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Excessive heavy drinking, binge drinking - WHO, 1986 drinking or both CDC, October 28, 2011 5 PRIORITY ACTION AREAS TO SUPPORT THE BASIC STRATEGIES FOR HEALTH PROMOTION PERSONS WHO SHOULD NO DRINK (FROM CDC) 1. Build healthy public policies 1. Pregnant or trying to become pregnant 2. Create supportive environments 2. Taking prescription or over-the-counter 3. Strengthen community actions medications that may cause harmful 4. Develop personal skills reactions when mixed with alcohol 5. Reorient health services 3. Younger than age 21 - WHO, 1986 4. Recovering from alcoholism or are unable to control the amount that they drink HEALTH EDUCATION VS PATIENT EDUCATION 5. Suffering from a medical condition that may Health education is the process of changing people’s be worsened by alcohol knowledge, skills, and attitudes for health promotion 6. Driving, planning to drive, or participating in and risk reduction. other activities requiring skill, coordination, Patient education usually refers to a series of and alertness planned teaching-learning activities designed for individuals, families or groups with an identified OTTAWA CHARTER FOR HEALTH PROMOTION alteration in health. - Product of the first International Conference - Maurer and Smith (2009) on Health Promotion held at Ottawa, Canada on November 17 to 21, 1968 PRINCIPLES TO GUIDE THE EFFECTIVE NURSE - Organized by the World Health Organization EDUCATOR - The charter calls for a commitment to health 1. Message promotion to achieve the goal of Health for All 2. Format by the year 2000 and beyond 3. Environment 4. Experience Defines health promotion as: 5. Participation - The process of enabling people to increase 6. Evaluation control over, and to improve, their health, - From Stanhope and Lancaster, 2010 which requires that an individual or group must be able to identify and to realize REQUISITE COMPETENCIES OF BARANGAY aspirations, to satisfy needs, and to change or HEALTH WORKERS (BHW) cope with the environment Skills - Health promotion is t just the responsibility of - Communication the health sector, but goes beyond healthy - Interpersonal lifestyles to well-being - Teaching - Organizational 3 BASIC STRATEGIES FOR HEALTH PROMOTION - Advocacy 1. Advocacy for health to provide for the Knowledge conditions and resources essential for health; - Community 2. Enabling all people to attain their full health - Health issues (eg. Communicable and non potential; and communicable diseases) 3. Mediating among the different sectors of - Available community resources society in efforts to achieve health Proper attitude COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Related trainings - Observing and inquiring about family interaction enables the nurse in the CHAPTER 6 community to assess the influence of family FAMILY HEALTH NURSING members on each other. Basic Unit of Society: Family STAGES AND TASKS OF THE FAMILY LIFE CYCLE Definitions of Family I. Marriage: Joining of Families - The family is a group of persons usually living a. Formation of identity as a couple together and composed of the head and other b. Inclusion of spouse in realignment of persons related to the head by blood, relationships with extended families marriage, or adoption. Includes both the c. Parenthood: making decisions nuclear and extended family - A family is two or more persons who are joined II. Families with young children together by bonds of sharing and emotional a. Formation of identity as a couple closeness and who identify themselves as b. Inclusion of spouse in realignment of being part of the family relationships with extended families c. Parenthood: making decisions WHAT ARE THE DIFFERENT FAMILY FORMS? - Nuclear Family III. Families with Adolescents - Dyad a. Development of increasing autonomy for - Extended Family adolescents - Blended Family b. Midlife reexamination of marital and career - Compound Family issues - Cohabiting Family c. Initial shift toward concern for the older - Single Parent generation - Gay or Lesbian Family IV. Families with Launching Centers FUNCTIONS OF A FAMILY a. Establishment of independent identities for Functions that meet the needs of the society: parents and grown children - Procreation b. Readjustment of relationships to include in- - Socialization laws and grandchildren - Status Placement c. Dealing with disabilities and death of older - Economic Function generation Functions that meet the needs of individuals: V. Aging Families - Physical Maintenance (survival needs) a. Maintenance of couple and individual - Welfare and Protection functioning while adapting to the aging process FAMILY AS A CLIENT b. Support role of middle generation - Community health nursing has long viewed c. Support and autonomy of older generation the family as an important unit of health care, d. Preparation for own death and dealing with the with awareness that the individual can be best loss of spouse and/or siblings and other peers understood within the social context of the family. FAMILY HEALTH ASSESSMENT - Interviews COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester - Observation - Sterile Dressing - Physical Examination - Cotton Balls - Secondary Data - Cord Clamp - Micropore Plaster WHAT IS GENOGRAM? - Tape Measure - tool that helps the nurse outline the family’s - 1 pair of Sterile Gloves structure - Baby’s Scale Ex. Family Health Tree: Based on the genogram, the - Alcohol Lamp family health tree provides a mechanism for recording - 2 Test Tubes the family's medical and health histories - Test Tube Holders - Solutions of: Betadine, 70% Alcohol, Zephiran WHAT IS ECOMAP? Solution - tool that is used to depict a family’s linkages to other - Hydrogen Peroxide systems - Spirit of Ammonia - Ophthalmic Ointment OTHER SOURCES OF FAMILY HEALTH - Acetic Acid ASSESSMENT - Benedict’s Solution - Specific diagnoses as proposed by NANDA International (NANDA-I) serve as a common PRINCIPLES OF THE BAG TECHNIQUE framework of expressing human responses to actual - Should help the nurse in infection control and potential health problems. - Allows the nurse to give care efficiently - An alternative tool is the Family Coping Index. * this - Should not take away the nurse’s focus on the tool is based on the premise that nursing action may patient and the family help a family in providing for a health need or resolving - May be performed in different ways a health problem by promoting the family’s coping capacity. Family nurse contacts: Clinic Visit, Group CHAPTER 6 Conference, Telephone, Communication Nursing Process in the Care of the Community Principles of Community Health Nursing: HOME VISIT 1. Focus on community as unit of care. - A professional, having purposeful interaction that 2. Give priority to community needs. takes place in the family’s residence aimed at 3. Work with community as equal partner of promoting, maintaining or restoring the health of the health team. family or its members. 4. In selecting appropriate activities, focus on primary prevention. Phases of a Home Visit 5. Promote healthful physical and psychosocial - Pre-visit phase environment. - In-home Phase 6. Reach out to all who may benefit from specific - Post-visit phase service. 7. Promote optimum use of resources. THE PUBLIC HEALTH NURSING BAG 8. Collaborate with others working in Contents of a Public Health Nursing Bag: community. - 2 pairs of Forceps (curved and straight) - Disposable Syringes with Needles (g.23&25) - Hypodermic Needles (g.19,22,23,25) COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester Conditions in the Community Affecting Health - Ocular/Windshield Curvey 1. People: size, density, composition, rate of - Participant Observation growth/decline, cultural characteristics, Survey mobility, social class and educational level Informant Interview 2. Location: natural (geographic features, flora & Community Forum fauna) and man made variables Focus Group Discussion 3. Social System: family, economic, Secondary Data: already known; taken from existing educational. Communication, political, legal, sources religious, recreational, and health systems Vital Registries Health records and reports CHARACTERISTICS OF A HEALTHY COMMUNITY Disease Registries Open channels of communication and cooperation Publications among members of community - Print and electronic Equitable and efficient use of community resources, Census Data with view towards sustaining natural resources. A health community is in fact, “The process of PLANNING COMMUNITY HEALTH INTERVENTIONS enabling people to increase control over, and to Planning: logical process of decision-making, improve, their health” involving: Priority-Setting NURSING PROCESS IN COMMUNITY HEALTH CARE Formulating goals and objectives 1. Assessment: gather information about client’s Deciding on community interventions condition 2. Nursing Diagnosis: identify client’s problems Implementation 3. Planning: set goals of care and desired outcomes Implementation entails: and identify appropriate nursing actions Facilitating process 4. Implementing: perform nursing actions identified Coordinating plan with community in planning 5. Evaluating: determine if goals met and outcomes Collaboration with other sectors and agencies achieved Structure Process What is Community Health Nursing Process? Outcome Collect data on three categories of community health determinants: SUMMARY 1. Place Community health work required systematic 2. People process of ADPIE 3. Social System Ultimate goal of this process is healthy and empowered community Approaches: Nurse must work with community as equal 1. Comprehensive needs assessment: broad partner 2. Problem-oriented assessment: Focused Nurse overseas efficient use of resources through entire community health process TOOLS FOR COMMUNITY HEALTH ASSESSMENT Primary Data Collection: have not been gathered before and are collected by nurse Observation COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester CHAPTER 8 7. Ensure environmental sustainability THE HEALTH CARE DELIVERY SYSTEM 8. Develop a global partnership for development WHAT IS HEALTH SYSTEM PHILIPPINE HEALTHCARE DELIVERY SYSTEM A health system consists of all organizations, people, - Government: Department of Health and Local and actions whose primary intent is to promote, Government Units (LGU) restore or maintain health. - Local Government Code (R.A. 7160), Devolution: Six building blocks or components (WHO, 2007a): - Private: for-profit and non-profit agencies a) service delivery - Financing is provided by 3 major groups: b) health workforce government (national and local), private c) information sources, social health insurance d) medical products, vaccines, and - National Health Insurance Act of 1995 (R.A. technologies 7875) created the Philippine Health Insurance e) financing; Corporation (PhilHealth) f) leadership and governance or stewardship DEPARTMENT OF HEALTH (DOH) WORLD HEALTH ORGANIZATION National agency mandated to lead the health - WHO constitution came into force on April 7, sector towards assuring quality health care for all 1948 (World Health Day) Filipinos - Headquarters: Geneva, Switzerland Vision: to be a global leader for attaining - 147 country offices and 6 world regional better health outcomes, competitive and offices responsive health care system, and equitable health financing. WHO CORE FUNCTIONS Mission: to guarantee equitable, sustainable, Objective: the attainment by all peoples of the and quality health for all Filipinos, especially highest possible level of health (WHO, 2006) the poor, and to lead the quest for excellence 1. Provide leadership and engage in partnerships on in health. matters of health 3 major roles (DOH, 2013) 2. Shape research agenda and promote knowledge a. Leader in health - 5 goals: Capacity, Priorities, Standards, b. Enabler and capacity builder Translation and Organization c. Administrator of specific services 3. Set and monitor standards Levels of health care delivery (DOH issued 4. Provide technical support, catalyze change, and Administrative Order 2012-0012) build sustainable capacity. Board classification for hospitals: General – services for all kinds of illnesses, 8 MILLENIUM DEVELOPMENT GOALS injuries, or deformities 1. Eradicate extreme poverty and hunger Specialty – services for a particular disease or 2. Achieve universal primary education condition or in one type of patient 3. Promote gender equality and empower women HEALTHY FACILITY CLASSIFICATION 4. Reduce child mortality Category A: Primary Care Facility 5. Improve maternal health Category B: Custodial Care Facility 6. Combat HIV / AIDS, malaria and other Category C: Diagnostic / Therapeutic diseases Category D: Specialized Out-Patient COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester RURAL HEALTH UNIT - Improved access to quality hospitals and health care 'Health Center', primary level health facility facilities Focus: Preventive and Promotive - Attainment of the health related MDGs RHU to catchment population ratio - 1 RHU: 20,000 Population (DOH, 2009) PUBLIC HEALTH PROGRAMS Barangay Health Station (BHS) Reproductive and maternal health: Municipal Health Officer (MHO) - Pre-pregnancy services and care during pregnancy, Public Health Nurse (PHN) delivery, and the postpartum period; Rural Health Midwife Expanded Garantisadong Pambata (child health): - 1 RHM: 5,000 population - Advocacy for exclusive breastfeeding in the first 6 Rural Sanitation Inspector months of life, newborn screening program, Barangay Health Workers immunization, nutrition services, and integrated management of childhood illness; LOCAL HEALTH BOARDS Control of communicable diseases Chairman: Provincial Governor or Mayor Control of non-communicable or lifestyle diseases; Vice-Chairman: Provincial/City/Municipal Health Environmental health Officer Members: chairman of the committee on health of CHAPTER 9 PUBLIC HEALTH PROGRAMS the Sanggunian, a representative from the private sector or NGO, and the DOH THE CURRENT MATERNAL ANG CHILD HEALTH The functions of local health boards are: AND NUTRITION STATUS - Propose to the Sanggunian annual budgetary Pregnancy and childbirth still pose a great risk to allocations for the operation and maintenance of Filipino women of reproductive age Maternal mortality health facilities and services. rate is still high:162 per 100,000 live births (NSO, 2006) - Serve as an advisory committee on health matters; Complications include hypertension, post- partum and hemorrhage, severe infections, and other medical - Create committees which shall advise local health problems arising. agencies. Poor birth spacing, maternal malnutrition, unsafe abortions, and presence of concurrent infections. THE HEALTH REFERRAL SYSTEM A referral is a set of activities undertaken by a health THE MATERNAL, NEWBORN, AND CHILD HEALTH care provider or facility in response to its inability to AND NUTRITION (MNCHN) STRATEGY provide the necessary health intervention for a In its response to the maternal and child health patient. situation, the DOH takes into consideration the - May be: interrelatedness of: Internal a) direct threats to the life of mothers and children that External necessitate immediate health care and risk management. HEALTH SECTOR REFORM: UNIVERSAL HEALTH b) underlying socioeconomic conditions that hinder CARE the provision and utilization of maternal, newborn, Kalusugan Pangkalahatan / Aquino Health Agenda and child health and nutrition (MNCHN) core package (Administrative Order 2010-0036) of services. Goal and objectives 3 strategic thrusts FOUR KEY STRATEGIES OF MNCHN: - Financial risk protection 1. Ensuring universal access to and utilization of an COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester MNCHN Core Package of services and interventions. pregnancies, and measures of the TBA, BHW, 2. Establishment of a service delivery network at all or health professional levels of care to provide the package of services and Child-birth package interventions. Post-partum package 3. Organized use of instruments for health systems development to bring all localities to create and THE NEWBORN (FIRST WEEK OF LIFE) CARE sustain their service delivery networks. PACKAGE 4. Rapid build-up of institutional capacities of DOH 1. Interventions - Immediate and Thorough and PhilHealth, being the lead national agencies that within the first 90 Drying will provide support to local planning and minutes - Skin to skin contact development. between mother and newborn THE MNCHN STRATEGIES - Cord clamping 1-3 minutes Every pregnancy to be wanted, planned and after birth supported; - Early initiation of breastfeeding within an hour Every pregnancy to be adequately managed after birth throughout its course; - Non-separation of baby Every delivery to be facility-based and managed by from the mother, also known skilled birth attendants/skilled health professionals; as rooming in Every mother and newborn pair to secure proper 2. Essential - Vitamin K prophylaxis post-partum and newborn care with smooth newborn care after - Hepatitis B and BCG transitions to the women's health care package for the 90 minutes to 6 vaccination mother and child survival package for the newborn. hours - Examination of baby for birth injuries, THE MNCHN CORE PACKAGES OF SERVICES malformations, or defects, and - Additional care for a small baby (baby with birth weight 97%. 4. Phenylketonuria: inability to properly break down Must be in monogamous amino acid called “phenylalanine” relationship. 5. Glucose-6-phosphate-dehydrogenase Barrier Methods Is used during intercourse to keep sperm from travelling COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester (G6PD) Deficiency: red blood cells break down when 1. To immunize all infants/children against most body is exposed to certain drugs, foods, severe stress, common vaccine-preventable diseases or severe infection 2. To sustain polio-free status of the Philippines 6. Maple Syrup Urine Disease: inability to break down 3. To eliminate measles infection. Presidential amino acids: leucine, isoleucine, and valine; urine of Proclamation No.4, s. 1998 launched the Philippine affected personal smells like maple syrup Measles Elimination Campaign (Office of the President, 1998) Newborn Screening Procedure 4. To eliminate maternal and neonatal tetanus. - Using heel prick method, few drops of blood Presidential Proclamation No. 1066, S. 1997 declared are taken from baby’s heel and blotted on national neonatal tetanus elimination campaign special absorbent filter card. starting 1997 (Office of the President, 1997) - The blood is air dried for 4 hours and sent to 5. To control diphtheria, pertussis, hepatitis B, and the Newborn Screen Laboratory (NBS Lab) in German Measles Manila 6. To prevent extra pulmonary tuberculosis among children Newborn Hearing Screening - Performed 24-48 hours of age or before the IMMUNIZATION SCHEDULE baby leaves the hospital R.A. 9709: Universal Newborn Hearing Screening and Intervention Act of 2009 - Universal Newborn Hearing Screening Program (UNHSP) for early detection of congenital hearing loss and referral for early intervention for infants - Establishment of Newborn Hearing Screening Reference Center at the National Institutes of Health EXPANDED PROGRAM ON IMMUNIZATION (EPI) - Established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines - Reducing morbidity and mortality among children against most common vaccine- preventable diseases - Supporting Legislation: o R.A. 10152: also known as Mandatory Infants and Children Health Immunization Act of 2011 o R.A. 7846: provided for compulsory immunization against hepatitis B for PENTAVALENT VACCINE infants and children below 8years old Five-in-one pentavalent - Diphtheria Specific Goals of (EPI) - Pertussis - Tetanus COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester - Hepatitis B INFANT AND YOUNG CHILD FEEDING (IYCF): THE - Hib PHILIPPINE SITUATION  Optimal infant and young child feeding practices rank among the most effective interventions to improve child health  Administrative Order 2005-0014: National Policies on Infant and Young Child Feeding  Nutritional Assessment of the Infant and Young Child - nutritional assessment begins with history taking, describing feeding practices NUTRITIONAL ASSESSMENT OF THE INFANT AND YOUNG CHILD  Nutritional assessment begins with history taking, describing feeding practices: EPI RECORDING AND REPORTING Exclusive breastfeeding Accomplished using the Field Health Service Predominant breastfeeding Information System (FHSIS) Complimentary feeding 1. Fully immunized children (FIC) Bottle feeding a. BCG Early initiation of breastfeeding b. 3 doses of OPV c. 3 doses of DPT RECOMMENDED IYCF PRACTICES d. Hepatitis B vaccine or 3 doses of National Policies on Infant and Young Child Feeding Pentavalent vaccine advocate for the following practices (DOH, 2005): e. One dose of anti-measles vaccine before 1. Early initiation of breastfeeding; reaching one year of age 2. Exclusive breastfeeding for the first six months, which is possible, except for a 2. Completely Immunized Children few medical conditions - Completed their immunization schedule at 3. Extended breastfeeding up to two the age of 12 to 23 months years and beyond, which is recommended even if the infant’s 3. Child protected at Birth (CPAB) consumption of breast milk declines - Is a term used to describe a child whose as complementary foods are given; mother has received: 4. Appropriate complementary feeding a. 2 doses of tetanus toxoid during this with the use of locally available and pregnancy, provided that the second dose was culturally acceptable foods; given at least a month prior to delivery, OR 5. Micronutrient supplementation; b. At least 3 doses of tetanus toxoid anytime 6. Universal salt iodization prior to pregnancy with this child 7. Food fortification PROMOTE BREASTFEEDING  To promote the practice of breastfeeding, providing mothers and families with adequate, accurate and timely information and COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester opportunities for developing necessary skills Erratic worm migration – Pull out for good breastfeeding practices is essential. worms from mouth/nose or from other  The nurse then makes a health education plan body orifices. based on the mother’s needs Benefits of Breastfeeding MALNUTRITION IN CHILDREN Techniques of Breastfeeding Protein energy malnutrition (PEM) consists of underweight, stunting, wasting, and overweight MICRONUTRIENT SUPPLEMENTATION 1. Underweight  Purpose: add to the vitamins and minerals 2. Stunting provided by a normal diet 3. Wasting  Micronutrient supplementation is a short- 4. Overweight term intervention for correcting high levels of 5. Severe acute malnutrition (SAM) micronutrient deficiencies until more sustainable food-based approaches can be MICRONUTRIENT MALNUTRITION used effectively Micronutrients are so-called because they are  Recommended for 0-59 month-old children, needed only in very small amounts, i.e., they are in addition to pregnant and lactating women present in the human body in amounts less than and other women of reproductive age, or those 0.005% of body weight within the ages of 15-49 years old enable the body to produce enzymes, hormones and other substances essential for FOOD FORTIFICATION proper growth and development  Fortification is defined as the addition of Iodine, vitamin A and iron are most important micronutrients to staple food such as rice, in global public health terms; their lack sugar, cooking oil, flour and salt. represents a major threat to the health and  Addition of micronutrients to processed foods development of populations the world over, at levels above the natural state particularly children and pregnant women  Sangkap Pinoy seal is conferred by the DOH and affixed to the packaging of food products OVERVIEW OF INTEGRATED MANAGEMENT OF that have been certified as fortified either CHILDHOOD ILLNESS (IMCI) singly or in combination of the micronutrients IMCI process includes preventive as well as curative vitamin A, iron and iodine measures to address the most common conditions that affect young children DEWORMING  Deworming of children aged 1 to 12 years is IMCI CASE MANAGEMENT done every 6 months  IMCI clinical guidelines are meant to be used  Possible adverse effects of the antihelminthic by the health worker in the management of drugs and their respective management: sick children from age 1 week up to 5 years Local sensitivity or allergy – give an  IMCI case management process involves the antihistamine. following elements: ASSESS, CLASSIFY, Mild abdominal pain – give an IDENTIFY, TREAT, COUNSEL and FOLLOW-UP antispasmodic. Diarrhea – Give oral rehydrating solution. COMMUNITY HEALTH NURSING Nursing Care of the Community (Famorca et.al., 2013) 2nd Year | 1st Semester IMCI PROCESS