Community Health Nursing 2 1st Sem Midterm Notes PDF

NURSING CARE MANAGEMENT 113J delivery of health services (Cecilia Estrada- (COMMUNITY HEALTH NURSING 2) Castro, 2012) § HANDOUT I: OVERVIEW of COMMUNITY Statements that ch...

NURSING CARE MANAGEMENT 113J delivery of health services (Cecilia Estrada- (COMMUNITY HEALTH NURSING 2) Castro, 2012) § HANDOUT I: OVERVIEW of COMMUNITY Statements that characterize COMMUNITY HEALTH NURSING IN THE PHILIPPINES HEALTH NURSING CHN (Philippines) 1. Promotion of health and prevention of 2 major fields of nursing disease are the goals of professional practice ü Community Health Nursing 2. Community health nursing practice is comprehensive, general, continual and § Public Health Nursing: Rural Health not episodic Units (RHUs) or Health Centers 3. There are different levels of clientele - § Community Mental Health Nursing individual, families and population groups and the practitioner recognizes ü Specialized Field of Community Health the primacy of the populations a s a Nursing whole § Occupational Health Nursing- 4. The nurse and the client have greater Company Nurse control in making decisions related to § School Health Nursing health care and they collaborate as equals ü Emerging Fields of Community Health 5. The nurse recognizes the impact of Nursing different factors on health and has a greater awareness of his/her clients' COMMUNITY HEALTH NURSING lives and situations (Clark, 2008: 10-13) § The utilization of the nursing process in the DIFFERENT LEVELS OF CLIENTELE- CHN: CHARACTERISTICS INDIVIDUALS, FAMILIES, POPULATION GROUPS & COMMUNITIES, concerned Goals of Professional Practice: with the PROMOTION OF HEALTH, ü Promotion of health PREVENTION OF DISEASE & DISABLITY ü Prevention of disease & REHABILITATION (Dr. Araceli Maglaya, et al) CHN practice is § A synthesis of nursing knowledge and ü Comprehensive practice and the science and practice of ü General public health, implemented via a systematic ü Continual and not Episodic use of the nursing process and other processes to promote health and prevent Nurse & the client illness in population groups (Clark, 2008) ü Greater control in making decisions r/t § Is a service rendered by a professional health care nurse with the community, groups, families ü Collaborate as equals and individuals at home, in Health centers, in clinics, in school, in places of work for the Nurse promotion of Health, prevention of illness, ü recognizes the impact of different care of the sick at home and rehabilitation factors on health (Ruth B. Freeman, 1979) ü greater awareness of his/her clients' § a learned practice discipline with the lives and situations (Clark, 2008: 10-13) ultimate goal of contributing as individuals and in collaboration with others to the Features of COMMUNITY HEALTH NURING promotion of the client's optimum level of Practice functioning through teaching and delivery of care (Jacobson, 1969) In addition to its preventive approach to § Nursing practice in a wide variety of health, CHN is characterized by: community services & consumer advocate ü Population- or aggregate-focused areas, & in a variety of roles, at times ü Developmental nature, & existence of a including independent practice.... prepayment mechanism for consumers Community nursing is certainly not confined of community health nursing services. to public health nursing agencies. ü Unlike nurses who work in the hospital (Jacobson, 1975) settings, CHNs care for different levels § A field that is a blend or synthesis of of clientele. nursing practice with public health using primary health care as the tool in the The essence of nursing is the same even if the individual, the family, the population practiced in different setting. group and the community. In CHN, the CLIENT is considered as an Nursing As An ART - reflected in the ACTIVE PARTNER, not a passive recipient nurses interaction & communication with of care. clients that are geared towards the CHN practice is AFFECTED BY improvement not just of their health but also DEVELOPMENTS IN HEALTH their ability to deal with the determinants TECHNOLOGY, in particular and and consequences of their health problems. CHANGES IN SOCIETY, in general. o Responsibility of nursing in society is The goal of CHN is achieved through to guide individuals and families "in MULTISECTORAL EFFORTS. choosing possibilities in changing the CHN is a part of HEALTH CARE SYSTEM health process which is and the LARGER HUMAN SERVICES accomplished by intersubjective SYSTEM. participation with people" (George, 2002:439) CONCEPTS o ART of nursing is demonstrated by The hallmark of CHN is that it is population nurses who can maintain the delicate or aggregate-focused. The whole balance between doing things for community is the patient/client. their clients and doing things with Emphasis on the importance of the them, thus co-creating a better or "greatest good for the greatest number" more meaningful reality. Assessing health needs, planning, o Practice of nursing, therefore, entails implementing & evaluating the impact of active interaction partnership health services on population groups between the nurse and the client. Priority of health-promotive & disease- Such partnership recognizes the preventive strategies over curative autonomy of both parties and the interventions potential of each one in enriching Tools for measuring & analyzing community their relationship. health problems Application of principles of management & Nursing As A Science - community health organization in the delivery of health nurses should use practice-based and services to the community evidenced-based methods and tools. They also need to engage in generating evidence OBJECTIVES to support their practice through research. To participate in the development of an over-all Health plan for the community and PHILOSOPHY OF COMMUNITY HEALTH in it's implementation and evaluation NURSING To provide quality Nursing Services to individuals, families and communities Is based on the worth & dignity of man (Dr. utilizing as basis, the standards set for Margaret Shetland) Community Health Nursing practice GOAL: To coordinate Nursing services with various members of the Health Team, Community raise the level of health of the citizenry by Leaders and SOs, GOs and NGOs in helping communities and families to cope achieving the aims of Public Health with the discontinuities in and threats to Services within the community health in such way as to maximize their potential for high level of wellness - Nisce, To Participate in and/or conduct researches Reyala, et al. relevant to community health & CHN services and disseminate their results for assist the individual, family and community improvement of health care in attaining their highest level of holistic health which is attained through To provide community health nursing multidisciplinary effort and to promote personnel with opportunities for continuing reciprocally supportive relationship between education and professional growth through people and their physical and social staff development. environment FRAMEWORK FOR COMMUNITY HEALTH BASIC PRINCIPLES NURSING 1. Health Care Delivery System (HCDS), with its CHN subsystem The COMMUNITY is the PATIENT in CHN; 2. The clients (individual, family, population the FAMILY is the UNIT OF CARE; and group and community there are FOUR LEVELS of CLIENTELE; 3. Health which is the goal of the health care PUBLIC HEALTH delivery system Is the science & art preventing disease, 4. The economic, sociocultural, political and prolonging life, promoting health & environmental factors that affect the HCDS, efficiency through organized community the practice of CHN and the people's health effort o sanitation of the environment o control COMMUNITY HEALTH of communicable infections Part of paramedical and medical o education of the individual in personal intervention/approach which is concerned hygiene on the health of the whole population o organization of medical & nursing Aims: services for the early diagnosis & 1. Health promotion preventive treatment of disease 2. Disease prevention o development of the social machinery 3. Management of factors affecting ü ensure everyone a standard of health living adequate for the maintenance of health, According to Maglaya, et al - CHN: Composed ü so organizing these benefits as to of 3 major concepts enable every citizen to realize his Community (client) birthright of health & longevity (Dr. Health (goal) C.E. Winslow) Nursing (the means) ART OF APPLYING SCIENCE IN THE COMMUNITY HEALTH NURSING IN THE CONTEXT OF POLITICS so as to reduce PHILIPPINES inequalities in health while ensuring the Most community health nurses in the best health for the greatest number (World Philippines work in health centers as public Health Organization) health nurses, industries/companies as THE SCIENCE AND ART OF occupational health nurses (company PREVENTING DISEASE, PROLONGING nurses) and school nurses LIFE, AND PROMOTING HEALTH and Roles and functions of nurses are defined efficiency through organized community by: effort for the sanitation of the environment, ü Philippine Nursing Act of 2002 control of communicable diseases, (RA 9173) education of individuals in personal o Through the board resolution hygiene, organization of medical and Number 425, Series of 2003, RULE nursing services for the early diagnosis and V, Nursing Practice, Section 28 preventive treatment of disease, and Scope of Nursing development of social machinery to ensure ü Standards developed by everyone a standard of living adequate for professional associations the maintenance of health, so organizing o Philippine Nurses Association (PNA) these benefits as TO ENABLE EVERY o Occupational Health Nurses CITIZEN TO REALIZE HIS BIRTHRIGHT Association of the Philippines TO HEALTH AND LONGEVITY (Dr. C.E. (OHNAP) Winslow) o National League of Philippine Government Nurses (NLPGN) PUBLIC HEALTH NURSING o Agencies - Department of Education The practice of nursing in national & (DepEd) local government health departments (HCs & RHUs), & public schools. It is Section 28. Scope of Nursing Community health nursing practiced in Singly or in collaboration with another, the public sector (Standards of Public initiates & performs nursing services to Health Nursing in the Philippines, 2005) individuals, families, & communities in any "a special field of nursing that combines health care setting the skills of nursing, public health and Primarily responsible for the promotion of some phases of social assistance and health, & preventions of illness functions as part of the total public Collaborate with other health care providers Health program for the promotion of o Curative, preventive, & rehabilitative Health, the improvement of the aspects of a care conditions in the social and physical o Restoration of health o alleviation of environment, rehabilitation of illness and suffering disability (WHO Expert Committee on o When recovery is not possible, towards Nursing) peaceful death OBJECTIVES OF PUBLIC HEALTH: CODES C. The nursing service has a written vision, mission, philosophy, goals & objectives C - Control of Communicable Diseases D. The nursing service formulates/reviews & O - Organization of Medical and Nursing implements the nursing service plan, Services manual of policies & nursing standards. D - Development of Social Machineries E. The Nursing Service participates in E - Education on personal Hygiene→ Health planning for the health agency's physical Education is the essential task of every health facilities, equipment & supplies & in worker monitoring their use S - Sanitation of the environment F. The nursing service participates in the official recruitment, selection, promotion, Community-based nursing & discharge process at all levels "application of the nursing process in caring involving nursing personnel (nurses & for individuals, families and groups where midwives) & in making decisions they live, work or go to school or as they involving nurses & midwives & nursing move through the health care system" practice. (McEwen and Pullis, 2008, p.6) G. The Nursing Service initiates / setting-specific, and the emphasis is on strengthens mechanisms within the acute and chronic care and includes agency that enhance nursing & midwifery practice areas such as home health nursing contribution to the overall community and nursing in outpatient or ambulatory health goals. settings. II. QUALIFICATIONS & FUNCTION of the STANDARDS OF PUBLIC HEALTH PUBLIC HEALTH NURSE NURSING IN THE PHILIPPINES 2006 Formulated by National League of A. The PHN has the professional, personal Philippine Government Nurses, Inc. & other qualifications that are appropriate (NLPGN) to her/his job responsibilities. More specific in focus, that is public health 1. Is a graduate of Bachelor of Science in nursing not community health nursing Nursing (BSN) & a registered nurse (RN) 1. ORGANIZATION & MANAGEMENT 2. Has the following personal qualities & professional competencies: A. A nursing service is organized in a local 3. Good physical & mental health health agency to ensure the effective 4. Interest & willingness to work in the delivery of nursing services & nursing community component of public health programs 5. Capacity & ability to: B. The nursing service is headed by a a) Relate the practice with ongoing qualified chief nurse community health & health a. Chief Nurse - Qualifications: related activities 1. BSN, RN b) Work cooperatively with other 2. 5 years' experience in general disciplines & members of the nursing service administration community 3. Master's degree in nursing, c) Accept & take actions needed to preferably in public health or improve self & service community health nursing d) Analyze combinations of factors 4. Member of good standing of the & conditions that influence accredited professional health of organization of nurses e) Apply nursin b. The supervising PHN who heads a f) Apply nursing process in nursing unit should have the ff: meeting the health & nursing 1. BSN, RN needs of the community 2. 5 years supervisory experience in g) Mobilize resources in the public health community 3. Master's degree in nursing, 6. With leadership potential preferably in public health or 7. Resourcefulness & creativity nursing (major in nursing 8. Honesty & Integrity administration 9. Active membership to professional 4. Member of good standing of the organizations accredited professional organization of nurses B. The PHN performs functions & activities Theoretical Models/Approaches in accordance with the dominant values of PHNs, within the profession's ethico-legal 1. The Health Belief Model framework & in accordance with the needs Developed by social psychologists to of the client & available resources for explain why the public failed to health care participate in screening for tuberculosis (Hochbaum, 1958). 1. The functions & activities of the PHN Model explains and predict individual which are related to management changes in health behaviors training, supervision, provision of o One of the most widely used nursing care, health promotion & models for understanding health education & coordination are consistent behaviors. with the Nursing Law (RA 9173) & Used to explain behavior change and program policies formulated by the maintenance of behavior change to Department of Health & the local health guide health promotion interventions agency (Janz et al., 2002) C. The PHN, in accordance with the faculty of colleges of nursing, participates in teaching, guidance & supervision of students in nursing & midwifery for their related learning experience (RLE) in the community setting. D. The PHN participates in the conduct of research & utilizes research findings in his/her nursing practice PHN CAN ONLY PERFORM HIS/HER FUNCTIONS EFFECTIVELY IF HE/SHE: Has the necessary KSA in dealing with the health needs & problems of his/her clients Familiar with the structure & dynamics 2. Nancy Milio of the health care system & its broader Framework for Prevention sociocultural, economic & political outlined Six propositions relating to context health promotion and disease Knowledgeable of laws & policies prevention. affecting the health care system in asserted that health deficits occur when general & nursing practice in particular there is an imbalance between a & of nursing & program standards community's health needs, and its health-sustaining resources. ETHICO-LEGAL ASPECTS OF NURSING All human beings make health choices PRACTICE IN THE COMMUNITY that are the easiest for them to make, Guided by a number of legal and ethical most of the time. principles that center on the welfare of clients & protection of their rights. Milio's Framework for Prevention CHNs are in the position to influence Model describes as neglected role of others to respect and protect these community health nursing to examine rights the determinants of a community's Nursing practice is legal if the health and attempt to influence those practitioner works within the bounds of determinants through public policy law; it is ethical if the nurse upholds Model includes concepts of community- ethical principle such as: oriented, population-focused care. o Autonomy Basic treatise was that behavioral o Beneficence/Nonmaleficence patterns of the populations and o Justice individuals who make up populations- o Fidelity are a result of habitual selection from o Veracity limited choices. Model challenged the common notion that a main determinant for unhealthful behavioral choice is lack of knowledge.  population can result in response to APPLICATION OF NANCY MILIO'S in social change organizational & FRAMEWORK IN PUBLIC HEALTH NURSING public policy mandates. Milio (1976): outlined the relationship of an individual's ability to have healthful Without concurrent Addressing persistent behavior and the society's ability to availability of health problems (e.g. provide accessible and affirming options alternative health- hypertension) is for healthy choices. promoting options for hindered because investment of most people are very Milio's Proposition Population Health personal choices, aware of what causes Summary Examples health education will the problem, but are Population health Individuals & families largely ineffective in reluctant to make deficits' living in poverty have changing behavior lifestyle changes to result from deprivation poorer health status patterns. prevent or reverse the and/or excess of compared with the condition. critical health middle; & upper-class Often "new" resources individuals and information (e.g. new families diet) or resources Behaviors of Positive & negative (e.g. new medication) populations result lifestyle choices (e.g. can assist in attracting from selection from smoking, alcohol use, attention & directing limited choices; these safe sex practices, positive behavior arise from actual & regular exercise, diet, changes perceived options seatbelt use) are avail a leas well as strongly dependent on beliefs & expectations culture, resulting from socioeconomic status, 2. (3) Nola Pender - Health Promotion Model socialization, & educational level. (HPM) education, & experience. Explores many biopsychosocial factors Organizational Health Insurance that influence individuals to pursue decisions & policies coverage & availability health promotion activities. (both governmental & are largely determined depicts the complex multidimensional nongovernmental) & financed by the factors with which people interact as dictate many of the government through they work to achieve optimum health. options the National Health health as a positive dynamic state rather Insurance Corporation than simply the absence of disease. (PhilHealth) & private focuses on helping people achieve insurance; the source higher levels of well-being & funding of insurance encourages health professionals to influences health provide positive resources to help provider choices & patients achieve behavior specific services changes. Focuses on three ares such as Individual choices Choices & behaviors individual characteristics and related to health of individuals are experiences, behavior-specific promotion or health strongly influenced by cognitions, affect and behavioral damaging behaviors desires, values, & outcomes. are influenced by beliefs. For example, efforts to maximize the use of illegal drugs values resources by adolescents is often dependent on peer pressure & the need for acceptance, love & belonging Alteration in patterns Some behaviors such of behavior resulting as tobacco use have from decision making become difficult to of significant number maintain in many of people in a settings or situations  Interpersonal influences Norms - expectations of significant others solaing - vicarious leaning through nos enco othere engaged in a particular behavior Primary sources of interpersonal influences are families, peers, and healthcare providers. Situational Influences Personal perceptions and cognitions of any given situation or context can facilitate or impede behavior. Include perceptions of options available, PERSONAL FACTORS demand characteristics, and aesthetic features of the environment in which biological factors given health-promoting is proposed to o age, gender, body mass index, pubertal take place. status, aerobic capacity, strength, Situational influences may have direct or agility, or balance. indirect influences on health behavior. psychological factors o self-esteem, self-motivation, personal Commitment to Plan of Action competence, perceived health status, & concept of intention and identification of definition of health. a planned strategy leads to the Personal socio-cultural factors implementation of health behavior. o race, ethnicity, acculturation, education, and socioeconomic status Immediate Competing Demands and Preferences Perceived Benefits of Action Competing demands are those Anticipated positive outcomes that will alternative behaviors over which occur from health behavior. individuals have low control because of environmental contingencies such as Perceived Barriers to Action work or family care responsibilities. Anticipated, imagined, or real blocks and Competing preferences are alternative personal costs of understanding a given behaviors over which individuals exert behavior. relatively high control, such as choice of ice cream or apple for a snack. Perceived Self-Efficacy The judgment of personal capability to Health-promoting behavior organize and execute a health-promoting is an endpoint or action-outcome behavior. directed toward attaining positive health Perceived self-efficacy influences perceived outcomes such as optimal wellbeing, barriers to action, so higher efficacy results personal fulfillment, and productive in lowered perceptions of barriers to the living. behavior's performance. 4. Lawrence Green's - Precede-Proceed Model Provide for community assessment, Activity-Related Affect health education planning, and Subjective positive or negative evaluation. feeling occurs before, during, and PRECEDE: which stands for following behavior based on the PREDIPOSING, REINFORCING and stimulus properties of the behavior itself. Enabling Constructs in educational Activity-related affect influences Diagnosis and Evaluation, is used for perceived self-efficacy, which means the community diagnosis. more positive the subjective feeling, the PROCEED: an ACRONYM for POLICY, greater its efficacy. In turn, increased REGULATORY, and feelings of efficacy can generate a ORGANIZATIONAL CONSTRUCT in further positive affect EDUCATIONAL and ENVIRONMENTAL  DEVELOPMENT, is a model for equipment; and maintenance of a safe implementing and evaluating health environment. programs based on PRECEDE. 3. Health education: Assessment of diet's learning needs; development of a health education plan and learning materials; and implementation and evaluation of the health education plan. 4. Legal responsibility: Adherence to the nursing law and other relevant laws as well as to national, local, and organizational policies, including documentation of care given to clients. 5. Ethicomoral responsibility: Respect for the rights of the client; responsibility and accountability for decisions and actions; and adherence to the international and national codes of ethics for nurses. 6. Personal and professional development: Identification of own learning needs; pursuit of continuing education; involvement in professional and civic activities; projection of a professional image; positive attitude toward change and criticism; and adherence to professional standards. 7. Quality improvement: Data gathering for quality improvement; participation in nursing audits and rounds; identification and reporting of variances in client care; and recommendation of solutions to identified problems related to client care. 8. Research: Research-based formulation of solutions to problems in client care and dissemination and application of research COMPETENCY STANDARDS IN findings. COMMUNITY HEALTH NURSING 9. Records management: Accurate and updated documentation of client care while ü The professional nurse, including the observing legal imperatives in record community health nurse, must demonstrate keeping. competence in 11 key areas of 10. Communication: During interactions with responsibility as determined by the clients and coworkers, uses therapeutic Committee on Core Competency Standards communication techniques for Development for the Board of Nursing establishment of rapport, identifies verbal Education (2005). The Nursing Core and nonverbal cues, and responds to Competency Standards were revised in clients' needs, while using formal and 2012, building on the same set of key areas informal channels of communication and of responsibility. Together with a brief appropriate information technology. description and example for each, the 11 11. Collaboration and teamwork: key areas of responsibility are the following: Establishment of collaborative relationships with colleagues and other members of the 1. Safe and quality nursing care: health team; collaborative planning with the Knowledge of health/ilness status of the other members of the health team. client; sound decision making; safety, comfort, and privacy of the client; priority setting based on client's needs; administration of medications and health therapeutics; and use of the nursing process. 2. Management of resources and environment: Organization of workload; use of financial resources for client care; mechanism to ensure proper functioning of HANDOUT II: SPECIALIZED FIELDS OF FUNCTIONS OF THE SCHOOL NURSE COMMUNITY HEALTH NURSING 1. School health & nutrition survey Actual survey should be done during the A. SCHOOL HEALTH NURSING first visit of the nurse to the school & Health & Nutrition Center (HNC) of the every year thereafter DepED o Mandated to safeguard the health & 2. Putting up a functional school clinic nutritional well-being of the total R.A. 124 mandates that all schools are school population to provide clinics for the treatment of School nurses in public schools a.k.a. minor ailments & attendance to Public Health Nurses emergency cases Every child deserves to be as fit & as healthy as possible to gain maximum 3. Health assessment benefits from his education Every child should be examined once a year & as the need arises like during PRIMARY ROLE OF THE SCHOOL NURSE epidemics To support student learning & ensure Aims to discover the signs if illness & that educational potential is not physical defects in order to correct hampered by unmet health needs them, check on the health habits of pupils & prevent the progress of those SCHOOL NURSES which cannot be corrected are the frontlines in the provisions of health & nutritional programs in the Important Reminders: school They are in unique position in the school o If the health personnel is of setting to assist the pupils in acquiring opposite sex, it must be done in health knowledge im developing the presence of other school attitudes & practices conducive to personnel preferably of the same healthy living ex It is based on the philosophy that the o Discuss with the teacher & the academic performance of the pupils & pupil concerned the results of the the instructional outcomes are also findings & what should be done determined by the quality of health of after the assessment is finished the school population & the community o Treat cases needing treatment where they come from during the special treatment School nursing is a type of public health periods & not during the nursing that focuses on the promotion of inspection except in case of health & wellness of the pupils/students, emergency teaching & non-teaching personnel of o Refer cases which cannot be the schools handled by the nurse promptly School nurses also assist young people o Parents must be informed of the in making choices for a healthy lifestyle, findings reduce risk taking behavior & focus on issues such as 4. Standard vision testing for school o prevention of drug & substance children abuse, 20/20 visual acuity for him to perform his o teenage pregnancy, visual task demand clearly & o sexually transmitted diseases, comfortably as far & near distances o malnutrition, & o communicable & non- 5. Ear examination communicable diseases Detect hearing difficulties as early as possible OBJECTIVE OF SCHOOL NURSING Through observation, examination by using penlight or otoscope and General: To promote & maintain the health of screening test like whisper test, the school populace by providing conversation voice test, ballpen click & comprehensive & quality nursing care through the use of the tuning fork 6. Height & weight measurement and nutritional status determination  In DepED weight-for-age & height-for- *(Referenced from PD 856, Chapter VII - age indicators for children below 10 Industrial Hygiene of the Sanitation Code of the years are used Philippines) Body Mass index (BMI) is used for children 1o years & above 1. Work with the occupational Health team to Done at the beginning & at the end of lead the sanitary and industrial hygiene of the school year all industrial establishments including Appropriate school feeding programs hospitals to determine their compliance with with rice, milk or fortified noodles are the sanitation code and its implementing given to children with below nutritional rules and regulations. status for 120 feeding days to overcome 2. Recommends to Local Health Authority the nutritional deficiencies issuance of license/business permits and suspensions or revocation of the same of 7. Medical referrals any violation of the condition upon which said licenses or permits had been issued, 8. Attendance to emergency cases pursuant to existing rules and regulations. 3. Coordinates with other government 9. Student health counseling agencies related to the implementation of the implementing rules and regulations. 10. Health & nutrition education activities 4. Attends to complaints of all establishments in the area of assignment related to 11. Organization of school-community industrial hygiene and recommends health & nutrition councils appropriate measures for immediate compliance. 12. Communicable disease control 5. Participates to provide, install and Encourage immunization requirements, maintains in good condition all control aids in early detection, help to provide facilities and protective barriers for potential parental notification & information, & and actual hazards. makes any medical referrals necessary 6. Informs all affected workers regarding the nature of hazards and the reasons for the 13. Establishment of data bank on school control measures and protective equipment. health & nutrition activities 7. Makes a periodic testing for physical examination of the workers and other health 14. School plant inspection for environment examinations related to worker's exposure to potential or actual hazards in the Particular attention shall focus on the workplace. provision & maintenance of toilets, 8. Provides control measures to reduce noise, school clinics, water supplies, sanitation dust, health and other hazards. of school canteens, & safety & nutrition 9. Ensure strict compliance on the regular use value of foods being served and proper maintenance of Personal Protective Equipment (PPE). 15. Rapid classroom inspection 10. Provide employees/workers an occupational health services and facilities. 16. Home visitation 11. Refers or elevates to higher authority all unsolved issues in relation to occupational B. OCCUPATIONAL HEALTH NURSING and environmental health problems. focus of this specialty is the preservation 12. Prepares and submit yearly reports to the and restoration of the health of workers Local and National Government. and working populations Application of Public Health Principles to is an autonomous practice requiring Occupational Health Nursing independent decisions and creative solutions to complex occupational and environmental health and safety Leadership roles of the nurse utilizing problems. public health skills includes the following: Occupational health nurses are assuming innovative roles and ü Community Assessment- Knows the increasing responsibilities as they strive community's demographic data on disease to respond to a changing and more trends including morbidity and mortality complex work environment. statistics, and social environmental. conditions that will provide pertinent Functions of Public Health Nurses as an information for the establishment of Occupational Health Nurse  priorities in planning and implementing professionals assesses, plans, implements occupational health programs. In addition, and evaluates health programs. A data on economic, cultural and multiplicity of data collected from a variety psychological factors that determine the of disciplines enhances the development of community's health attitudes and behavior. a comprehensive occupational health program. Ideally, collaboration among ü Work assessment - assess the workforce specialist such as safety engineer, to determine populations at risk for industrial hygienist, epidemiologist, medical occupationally related injury or illness. technologist, toxicologist, ergonomist, Classification of groups of occupational health physician, occupational workers/employees by age, sex, race, type health nurse and occupational health of work, and presence or absence of therapist produce appropriate, effective, disability provides the occupational health and efficient occupational health services. nurse with the data necessary for analysis For example, an occupational health nurse of health risks. of the government hospital notes an unusually frequent visit of hospital For instance, those fisher folks who maintenance workers visiting health service stopped fishing in Guimaras due to MT or employees clinic complaining of pain Solar I bunker oil spill, who eventually "pain in the wrist". An investigation because the clean up workers of the said establishes that these hospital maintenance exposure. The DOH-UP occupational workers experiencing tendonitis all have health team recommended that those similar jobs involving the splicing of cable. directly exposed clean-up workers must be Weeks previous to the onset of symptoms, protected from bunker oil spill and should the safety engineer consulted the be provided with proper personal protective ergonomist and developed and equipment such as proper masks, gloves, implemented the splicing technique. The boots and clothing. ergonomist studying the complaints found the procedures that involves considerable ü Application of the Epidemiology repetitive motion without loss of production Principles - To determine relationship of time or violation of safety principles. work and injury or illness, the occupational health nurse applies the epidemiological ü Program Planning and Implementation - method. Investigation of causation of illness The primary goal of the occupational health or injury through a description of its program is the promotion of wellness and occurrence. The pattern of occurrence prevention of illness and injury among permits identification of the population at workers. However, illness and injury do risk. Application of such sciences as occur, necessitating occupational health toxicology, pathology, and ergonomics, programs aimed at all levels of prevention: provides the basis for developing theories primary, secondary and tertiary. of causation. Approaches to prevention can then be tested to confirm or disprove ü Primary Prevention - A program to ensure theories. The conduct of medical the health of prospective surveillance by obtaining worker's biological employees/workers includes a history and samples such as blood, urine, hair, and physical examination to assess level of environmental samples such as air, water, wellness. Maintenance of that level is and soil results will confirm cause and provided through appropriate job effect of the illness or injury. placement. In Mindanao, the DOH-UP occupational For example, a potential staff nurse in the health team conducted a health ward, a wealthy young female of extremely assessment activities of the 52 workers in a small stature, is screened for ability to push cacao plantation in Davao del Sur including or lift heavy patients. She was able to push volunteers that were hospitalized at the heavy patients in wheelchair but cannot lift Digos Provincial hospital and nearby private patients. Assignment to the ward was given hospital and clinics due to pesticide except lifting heavy patients may prevent poisoning (Diazinon 600 EC). Findings on musculoskeletal injuries. RBC cholinesterase showed severe, moderate and mild depressions. The workplace is surveyed periodically to protect workers from potential health ü Team Approach - Occupational health hazards. Environmental conditions may be efforts, to be most effective, require team changed to prevent illness or injury. For work. A team of occupational health example, the occupational health nurse in  the hospital doing a walk through survey, involves careful analysis of the work, tools may notice a wet surface on a walkway or and workplace to ascertain necessary hallway. Correction will eliminate many falls modification. Communication with and and injuries. Dissemination of health and preparation of the employee's supervisor safety information and instruction are will promote successful placement. common prevention technique toward workers. One-to-one health counseling In the department of health, there were remains an effective motivator of safe and employed workers that were disabled by healthy behavior or lifestyle. stroke. Assessment of the individual's interest and capabilities, reveal that he is ü Secondary Prevention - Despite primary not a candidate for advance education. The prevention efforts in occupational health, management accommodates this worker diseases and disability continue to exist, and he was given a new job function and necessitating the development of successfully returned to work. secondary preventive services. Early detection and treatment of both work-and ü Referral to Community Resources - the non-work related health problems continues occupational health nurse enhance their a major portion of health services available practice through the development of a new to workers. network of appropriate community resources. Appropriate referral and follow- Screening and monitoring of workers up provide more comprehensive, cost exposed to potential hazards and the effective service to workers. For instance, affected community posed by the company occupational health nurse frequently deal policy and government regulations. with workers experiencing situational stress. In cases where more intense For example, exposure to lead, like in the intervention is needed, a referral to Marinduque's Marcopper Mining industry, community support group for divorced constitutes a threat to workers and the persons or single parents may be community and must be closely evaluated. appropriate to others. Additional sources may include services for career counseling, The health and environmental assessment vocational training, day care of children, conducted by the DOH-UP occupational emergency medical care, and child and health team includes 520 residents mostly women's protection unit. children were examined and results showed that 76 children have elevated blood lead ü Program Evaluation - Assessment of levels from Boac, Mogpog and Sta. Cruz. program to determine benefits in terms of Only 27 children were detoxified at the UP- decreasing loss of productivity related to PGH in Manila. Reporting and monitoring employee health problems is carried out. systems were developed and coordinated Cost-effectiveness is established for with the local government regarding the example when an occupational health issue brought about by chemical hazards program demonstrates an increase in posed by the Marcopper spill affecting the worker productivity. Occupational health communities and the intervention measures professionals are expected to justify their performed. program goals and cost. ü Tertiary prevention - primary and I. The Primary Focus secondary prevention programs in The mission of occupational health and occupational health decrease the number of safety is "to assure so far as possible every workers permanently disabled but do not working man and woman in the country is eliminate the need for tertiary prevention. safe and in healthful working conditions". Rehabilitation efforts are directed toward A. Occupational health and safety should be workers disabled by occupational and non considered an integral part of all health occupational problems. These efforts services. include evaluation of the current status, B. The occupational environment is complex enhancement of employability, and and multidimensional; the recognition of appropriate job placement of employees. occupational hazards requires an The services of such disciplines as appreciation of the social, cultural, political, physical, occupational and speech therapy, and economic context of work: vocational training, chronic pain clinics, and remedial reading and mathematics program Examples of factors that affect the work may be enlisted. Placement in a job environment are as follows:  used in manufacturing and other 1. Social: the meaning of work, the social work applications milieu of the worker, and the structure of iv. Ergonomists, who study, design, work and promote the healthy interface of 2. Cultural: beliefs, attitudes, and values humans, their tools, and their work related to work v. Health educators, who promote 3. Political: the prevalent ideology in a society, workers' healthy lifestyles and work the distribution of power, and government practice support for health safety of workers vi. Environmental engineers, who 4. Economic: level of unemployment, concentrate on environmental competition, wage regulation, and nature of controls limit environmental pollution local economy and achieve a healthy environment. C. Occupational health and safety affect not III. The Practice only the worker but also the worker's family and significant others, the worker's Occupational health nursing "is the community, and the larger society. specialty practice that provides for and D. Occupational health as a specialty within delivers health care services to workers and public health is a population-based practice. worker population". E. Occupational health sciences are in an a. Occupational health nurses focuses on early stage of development; much remains the "promotion, protection and to be known about the effect of the work restoration of worker' health within the environment on the health and safety of context of a safe and healthy work worker populations. environment" b. Autonomy and independent nursing II. Professional Goals judgments characterize the practice of occupational health nursing. Professionals from multiples disciplines c. With a research-based foundation, work cooperatively to achieve the goals of occupational health nursing's occupational health and safety: theoretical, conceptual, and factual A. Occupational health nurses' central framework is multidisciplinary. mission is to promote and maintain d. "Occupational health nurses advocated the health and safety of the workers for worker's and encourage and enable through a systematic process of individuals to make informed decisions assessment, planning, intervention, about health care concerns". and evaluation. e. Through collaborative practice with B. Occupational physicians focus on other occupational health and safety the prevention, detection, and professionals, occupational health treatment of work-related diseases nurses are "key to the coordination of a and injuries. holistic approach to the delivery of C. Industrial hygienists recognize, quality, comprehensive occupational evaluate, and control toxic health services. exposures and hazards in the work f. Occupational health nurses are environment. professionally accountable to workers D. Safety engineers and other safety (their primary responsibility) employers, professionals focus on the their own profession and themselves. prevention of occupational injuries g. The essential elements of occupational and the maintenance or creation of health and safety services are defined safe workplaces and safe work by the Standards of Occupation Health practices. Nursing Practice. E. Other professionals include: i. Epidemiologists, who study and COMMUNITY MENTAL HEALTH NURSING describe the natural history of Republic Act 11036 OR Mental Health occupational diseases and injuries Act in population groups o to enhance and integrate mental health ii. Toxicologists, who study and service delivery to Universal Health describe the toxic properties of Care through promotion and protection agents used in work applications to of the rights of persons using which workers may be exposed psychosocial health services and iii. Industrial engineers, who design the increasing investments in mental tools, equipment, and machines health. https://doh.gov.ph/health-programs/mental- - Recognizes spirituality as the core of his/her health-program practice - May be expected to lead or work as a National Mental Health Program (NMHP) member of the healing ministry o ensures the implementation of the law through the National Mental Health Strategic Plan (2019-2023) o affirms the basic right of all Filipinos to mental health as well as the fundamental rights of people who require mental health services. https://doh.gov.ph/health-programs/mental- health-program EMERGING FIELDS OF CHN IN THE PHILIPPINES HOME HEALTH CARE ü Practice involve providing nursing care to individuals & families in their own places of residence mainly to minimize the effects of illness & disability ü Allows a patient to remain at home & still receive care instead of staying in a hospital or health institution for recovery or rehabilitation Examples: chronically ill, convalescent, the elderly, the disabled who require custodial care & high-risk pregnant women HOSPICE HOME CARE ü Specifically rendered to the terminally ill ü Intended to provide comfort ü Improve his/her quality of life ü Provide support to patient & family as they go through the process of dying & grieving EntrepreNurse ü Project initiated by DOLE in collaboration with BON of the Phil., DOH & PNA ü To promote nurse entrepreneurship by introducing a home health care industry in the Phili. Faith CHN OR Parish Nursing ü Practice of the art & science of nursing combined with spiritual care ü Focuses on health promotion & provision of holistic care to members of the faith community ü Assume the roles of health educator, personal health counsellor, developer & coordinator of support groups in the faith community & integrator of health & healing ü As integrator of health & healing HANDOUT II: CONCEPT OF A COMMUNITY TWO MAIN TYPES OF COMMUNITIES: COMMUNITY Is a group of people sharing common 1. Geopolitical (Territorial) - Defined or geographic boundaries &/or common formed by both natural & manmade values & interests. It functions within a boundaries. particular sociocultural context, which means that no two communities are alike. Examples: barangays; municipalities; cities; The physical environment varies, & so with provinces; regions; nations; Congressional the people's way of behaving & coping. The districts & neighborhood people are different from each other, thus 2. Phenomenological - Relational, interactive the dynamics in one community differs from groups, in which the place or setting is that of the other. more abstract, & people share a group "a group of people who share common perspective or identity based on culture, interests, who interact with each other & values, history, interest & goals. Examples: who function collectively within a defined Schools; colleges & universities; Churches social structure to address common & mosques & various groups or concerns" (Clark, 2008) organizations "a collection of people who interact with one another & whose common interests or CLASSIFICATION: characteristics form the basis for a sense of unity or belonging" (Allender et al., 2009) 1. Rural - also known as open lands, often "a group of people who share something in agricultural in nature which is more common & interact with one another & may spacious and less densely populated share a geographic boundary. (Lundy and 2. Urban - often known as city or cities which Janes, 2000) are non-agricultural by nature, are densely "a locality-based entity, composed of populated, and marked by industrial systems of formal organizations reflecting products and technology society's institutions, informal groups & 3. Suburban / Rurban / the Capitals - aggregates" (Shuster and Goeppinger, usually the administrative capital of a 2008) province characterized by a unique mix of Maurer and Smith (2009) addressed the agriculture and industry. concept of community o Identified 4 defining attributes: TYPES OF COMMUNITY o People o Place 1. FORMAL COMMUNITIES - Engage in joint o Interaction activities and discussion, help each other, o Common characteristics, interest, or and share information with each other; they goals care about their standing with each other. CHARACTERISTICS: Examples: Ecovillages, Co-housing It is defined by geographic boundaries communities, Co-ops communities, within certain identifiable characteristics: Religious communities o It is made up of institutions organized into a social system with institutions & 2. INFORMAL COMMUNITIES- Consists of a organizations linked in a complex set of personal relations, social networks, network having a formal & informal common interest and emotional sources of power structure & a communication motivation. system o A common or shared interest that binds Example: Academic communities, the members together exists Recreation communities, Retirement o It has an area with fluid boundaries communities within which a problem can be identified & solved 3. URBAN COMMUNITIES- Large in terms of o It has a population aggregate concept and area & population, advanced in science & technology, with favorable physical A community is regarded as an environment and diverse cultures, and the "organism which has its own stages of people are engaged in various occupations. development (matures fast or slow) and responses to problems may be adequate, inadequate, inappropriate or delayed.  Characteristics of urban communities NGOs: Non-governmental organizations Advancement in science and technology Many business establishments, 7. SOCIAL SPACE COMMUNITIES recreational centers, educational and Based on social spaces religious institutions A social space is a physical or virtual People are crowded space Class extremes Physical: social center, gathering place, Many crimes are committed town squares, parks, pubs, shopping Limited space malls Greater impersonality among neighbors Higher standard of living 8. SOCIAL SPACE COMMUNITIES Informal settlers are rampant Virtual: online social media, websites Greater number of separation of spouses and live- in arrangements Characteristics of social spaces Major occupations are industrial, People gather at information grounds for administrative and professional a primary purpose other than information sharing Divisions of labor and occupational specialization are very much common Attended by different social types Social heterogeneity Social interaction is a primary activity Greater pollution Information occurs in many directions Family ties tend to be weak Information is used in alternative ways Shortage of employment Many sub-contexts exist; together they form grand context A lot of hazards and dangers References Ariola, M. (2017) as cited in Delgado, A.T. (2023) 4. RURAL COMMUNITIES - Usually produce their own food for subsistence CHARACTERISTICS OF A HEALTHY COMMUNITY Characteristics of rural communities Greater personal interaction 1. Awareness that "we are a community" Deep, long-term relationships 2. Conservation of natural resources Generally, peace and order exist 3. Recognition of and respect for the Mutual give and take affairs existence of subgroups Emphasis of shared values 4. Participation of subgroups in community Vernacular is usually spoken affairs Wider area & Influence of blood 5. Preparation to meet crises relationships in decision making 6. Ability to solve problems Homogenous type of culture 7. Communication through open channels Belief in supernatural and superstitious 8. Resources available to all beliefs 9. Settling of disputes through legitimate Relationship is more personal and mechanisms informal 10. Participation by citizens in decision-making Less pollution & Few establishments 11. Wellness of a high degree among its and institutions members 5. GLOBAL COMMUNITIES - It is the CHARACTERISTICS OF A HEALTHY international aggregate of nation-states. COMMUNITY Global communities “World Community” Common point of view towards issues of A shared sense being of a community human rights, global warming and based on history and values. climate change, peace and order, socio- A general feeling of empowerment and economic conditions as well as disputed control over matters that affect the issues such as territorial conflict. community as a whole. Existing structures that allow subgroups 6. SECTORAL COMMUNITIES - Include the within the community to participate in voluntary sector or non-profit sector decision-making in community matters. The ability to cope with change, solve Voluntary, non-profit and non- problems, and manage conflicts within governmental the community through acceptable Also called third sector (in contrast to means. public and private sector)  Open channels of communication and cooperation among members of the FACTORS AFFECTING HEALTH community. 1. Poverty Equitable and efficient use of community 2. Culture resources with view towards sustaining 3. Environment natural resources. 4. Politics FACTORS AFFECTING HEALTH OF THE ECOSYSTEM INFLUENCES ON OPTIMUM COMMUNITY LEVEL OF FUNCTIONING (OLOF) PEOPLE - Population variables that Modified from (Blum 1974:3) affect the health of the community: Further modified by the Community o Size Health Nursing Committee NLPGN, o Density 2000 o Composition Employment and working conditions o Growth rate or decline o Cultural characteristics Factors or things that make people healthy o Mobility or not, known as determinants of health: o Social class o Educational level Employment and working conditions People in employment are healthier, LOCATION particularly those who have more control o Natural & Man-made Variables r/t over their working conditions location. § Natural factors - geographic Income and social status features, climate, flora & Higher income and social status are fauna. linked to better health § Community boundaries - whether the community is Education urban or rural; presence of Low educational levels are linked with spaces; quality of the soil, air, poor health, more stress and lower self- and water; location of health confidence facilities; influence by human decisions & behavior Physical environment Safe water and clean air, healthy work SOCIAL SYSTEM places, safe houses, communities and o Patterned series of roads all contribute to good health. interrelationships existing between individuals, groups, & Social support networks institutions forming a coherent Greater support from families, friends whole. and communities is linked to better o Components: Family; Economic; health Educational; Communication; Political; Legal; Religious; Genetics Recreational & Health systems Inheritance place a part in determining Allender et al.,2009 life span, healthiness and the likelihood of developing certain illness HEALTH Viewed as a continuum, is considered Personal behavior and coping skills the goal of public health in general, and Balanced eating, keeping active, community health nursing in particular smoking, drinking, and how we deal with Important prerequisite (and life’s stresses and challenges all affect consequence) of development health. By promoting health and preventing diseases, CHNs therefore, contribute to Health services the country's economic and social Access and use of services that prevent development. and treat disease influence health Is a state of complete physical, mental and social well-being and not merely the Gender absence of disease or infirmity (WHO, Men and Women suffer from different 1995). types of disease at different ages 4 LEVELS OF CLIENTELE IN THE common exposure to particular COMMUNITY environmental factors, & consequently common health problems A. INDIVIDUAL Clark (1999:5) sick or well 1. children Consult the health center & receive 2. elderly health services indifferent forms 3. women Seen as both clients & patients during Allender and Spradley (2001) home visits, school clinic consultations, 1. Developmental Needs workplace clinic visits a. maternal, prenatal & newborn considered as the "entry point" in population working with the whole family b. infants, toddler and preschool population DIFFERENCES BETWEEN PATIENT & c. school-aged and adolescents CLIENT d. adults & working population e. older adult population CLIENT PATIENT may or may not be sick 2. Vulnerable sick a. Rural clients, the poor, migrant Greek word pathein - workers, minority pupation "to suffer" the patient experiencing health disparities, always suffers from an those with mental health issues, illness those living with addiction, those Collaborates with the Dependent on health in correctional facilities and those health professionals professionals for in long-term care settings when it comes to decisions & health his/her care care D. COMMUNITY Assumes an active Passive receiver of A group of people who occupy a common role in health care health services contiguous territory, possessed of a Health professionals Health professionals common set of traditions associated with perform health generally perform their living together in that territory, and promotion & disease disease prevention served by a set of local institutions in which preventions activities activities the people are conscious of their common interest (Delgado 2023) B. FAMILY From a systems perspective - a collection of people who are integrated, interacting and interdependent (Hunt, 1997: 126) 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 (Murray & Zentner, 1997) number of persons joined together by bonds of marriage, blood or adoption ( Burgess 1963, Friedman, 1992:8) two or more persons who are joined together by bonds of sharing & emotional closeness & who identify themselves as being part of the family (Friedman (1992) performs 2 major functions: reproduction & socialization C. POPULATION GROUP or "aggregate" is a group of people who share common characteristics, developmental stage or ROLES & ACTIVITIES OF A COMMUNITY a. Identifies health needs and problems of HEALTH NURSE individuals, families and communities b. Formulates individual, family and PUBLIC HEALTH NURSING FUNCTIONS community nursing/health care plan. AND ACTIVITIES c. Coordinates with individual groups and agencies for resource assistance in ü MANAGEMENT - Manager implementing the health care plan. 1. Plans and organizes the nursing service d. Implements health care plans for of the health unit individual, family and community o Identifies problems related to e. Evaluates nursing interventions and clients, resources, program other components of care provided to implementation and service individual, family and community delivery o Prepares the nursing service HEALTH EDUCATION - Health Educator plan 2. Participates in the preparation of the Conducts health education activities. municipal health plan 3. Participates in the implementation of the a. Identifies client's need for health municipal health plan education. 4. Implements the nursing service plan b. Conducts health education activities o Coordinates with the different c. Assesses the effects of health education health units and related activities on the capabilities of clients. agencies and facilities o Delegates the task to the COORDINATION - Coordinator & midwives, if necessary Collaborator 5. Monitors and evaluates the implementation of the nursing service a. Identifies persons, groups, organizations, plan other agencies and communities whose 6. Initiates changes for the improvement of resources are available within and services outside the community and which can be 7. Manages the RHU in the absence of the tapped in the implementation of rural health physician (RHP) individual, family and community health plan. ü TRAINING - Trainer b. Refers patients to other health personnel, Participates in meeting the training needs of health facility or government agencies. midwives, student affiliates and other trainees. LEADER & CHANGE AGENT 1. Priorities the identified needs of rural o Influences people to participate in health midwives (RHMs) that can be the overall process of community addressed by training development 2. Organizes a staff development program for RHMs RESEARCHER 3. Conducts a staff education program or o participates in the conduct of coaching session. research 4. Evaluates effects of training on work o utilizes research findings in performance practice ü SUPERVISION - Supervisor The Roles of CHNs are grouped by Clark Supervises the RHMs: (2008: 14-22) a. Formulates a supervisory plan b. Implements the supervisory plan Client-Oriented Roles c. Monitors and evaluates midwives o caregiver, educator, counselor, performance in the implementation of referral resource, role model & public health programs case manager d. Maintains records and reports Delivery-Oriented Roles o coordinator, collaborator, & PROVISION OF HEALTH AND NURSING liaison CARE - Clinician (Health Care Provider) Population-Oriented Roles o case finder, leader, change Provides health and nursing care to individuals, agent, community mobilizer, families and communities. coalition builder  o policy advocate, social marketer agency Cecilia Estrada-Castro. & researcher Community Health Nursing and Community Health Development RESPONSIBILITIES OF CHN Participates in the development of an PURPOSE overall health plan, its implementation, & evaluation for communities To give nursing care to the sick, to a Provides quality nursing services to the post-partum mother & her newborn with 4 levels of clientele the view to teach responsible family to Maintains coordination/linkages with give the subsequent care other health care team members, To assess the living condition of the NGOs/government agencies in the patient & his family & their practices in provision of public health services order to provide the appropriate health Initiates & conducts researches relevant teaching to CHN services to improve provision of To give health teachings regarding the health care prevention & control of diseases Initiates & provides opportunities for To establish close relationship between professional growth & continuing the health agencies & the public for the education for staff development promotion of health To make use of the inter-referral system NOTE: The Public Health Nurse will take & to promote the utilization of charge of the Municipal Health Officer's community services. responsibilities in the event that the MHO is unable to perform his duties/functions or is PRINCIPLES INVOLVED IN PREPARING not available FOR A HOME VISIT WHEN PLANNING - assemble the In the care of families: records of the patient & list the names to o Provision of primary health care be visited, study the case & have a services written nursing care plan o Development/Utilization of family 1. A home visit must have a purpose or nursing care plan in the provision objective of care. 2. Planning for a home visit should make In the care of the communities use of all available information about the o Community organizing, client & his family through family records mobilization, community 3. In planning for a visit, we should development, & people consider & give priority to the essential empowerment needs of the individual & family o Case finding & epidemiological 4. Planning & delivery of care should investigation involve the individual & family o Program planning, 5. The plan should be flexible. implementation & evaluation o Influencing executive & legislative GUIDELINES TO CONSIDER REGARDING individuals or bodies concerning THE FREQUENCY OF HOME VISIT health & development No definite rule to be followed on frequency of home visits. Schedule may vary according to the ACTIVITIES OF THE CHN NURSE need of the client or family for nursing care, but the following may be HOME VISIT / HOME VISITATION considered: o Family-nurse contact which allows the health worker to 1. The physical, psychological and assess the home & family educational needs of the individual and situations in order to provide the his family. necessary nursing care & health 2. The acceptance of the family for the related activities. services to be rendered, their interest § (Frances Prescilla I. Cuevas. Public Health and the willingness to cooperate. Nursing in the Philippines) 3. The policy of a specific agency & the o Professional face to face contact emphasis given towards their health made by a nurse to the patient or programs family in order to provide 4. Take into account other health agencies necessary health care activities & & the number of health personnel further attain an objective of the  already involved in the care of a specific H 02: SPECIALIZED FIELDS OF family COMMUNITY HEALTH NURSING 5. Careful evaluation of past services given to a family & how the family avail of the SCHOOL NURSING IN THE PHILIPPINES nursing services 6. The ability of the patient & his family to Education & health are interrelated recognize their own needs, their o WHO Expert Committee on knowledge of available resources & their School Health Services ability to make use of their resources for § "to learn effectively, their benefits. children need good health". Studies: nutritional deficiencies & poor health in school-aged children o low school enrolment, absenteeism, poor school performance, and early dropout o regular attendance in school - improving health Education o basic academic skills § specific KSA related to health aspect of education has lifelong effects (WHO, 1997). Generally: School Nurses visits 4 to 6 schools per month, with each visit lasting for 3 days or more, depending on the type of school & school location & population. Revisits may be done within the month for follow-up purposes