MODULE-1-CHN-2.pdf

COMMUNITY HEALTH NURSING 2 (Population Groups and Community as Clients) SHEELA MAE N. BAGACINA, MAN Clinical Instructor  MODULE 1: COMMUNITY HEALTH NURSING CONCEPT A. Definition B. Philosophy and principles C. Features of CHN D. Theoretical Models/ A...

COMMUNITY HEALTH NURSING 2 (Population Groups and Community as Clients) SHEELA MAE N. BAGACINA, MAN Clinical Instructor  MODULE 1: COMMUNITY HEALTH NURSING CONCEPT A. Definition B. Philosophy and principles C. Features of CHN D. Theoretical Models/ Approaches 1. Health Belief Model (HBM) 2. Milio’s Framework for prevention 3. Nola Pender’s Health Promotion 4. Lawrence Green’s PRECEDE-PROCEED MODEL (PRECEDE=Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation) 5. (PROCEED=Policy, Regulatory and Organizational Constructs in Educational and Environmental Development E. Different Fields 1. School Health Nursing 2. Occupational Health Nursing 3. Community Mental Health Nursing  INTRODUCTION ❑The role of the nurse in the Community is multifaceted and brings many challenges. ❑ In this course, deals with the concepts, philosophy and practices, principles, theories and techniques in the provision of basic care in terms of health promotion, disease prevention, restoration and maintenance and rehabilitation at the individual and family level. ❑ It includes the study of the Different Fields like School Health Nursing, Occupational and Mental Health Nursing. ❑The learners are expected to provide safe, appropriate and holistic nursing care to individual and family as clients in community setting utilizing the nursing process.  LEARNING OBJECTIVES: Upon completion of this course, you will be able to: 1. Define and Discuss the Community Health Nursing Concepts. 2. Discuss the philosophy, practices and principles of community health nursing. 3. Discuss the various theoretical models and approaches that can be applied in community health nursing. 4. Discuss application of different models and approaches in community health nursing. 5. Discuss how to implement models/approaches in community health nursing. 6. Discuss the importance of school, occupational and mental health nursing and services. DEFINITION: WHAT IS COMMUNITY HEALTH NURSING? According to American Nursing Association ❖ “Community health nursing is a synthesis of nursing practice and public health practice applied in promoting and preserving the health of populations. ❖ The nature of this practice is general and comprehensive. ❖ It is not limited to a particular age or diagnostic group. ❖ It is continuous and not episodic. ❖ The dominant responsibility is the population as a whole. ❖ Therefore Nursing directed to individuals, families, or groups contributes to the health of the total population. Health promotion, health maintenance, health education, coordination and continuity of care are utilized in a holistic approach to the management of the individual, family group and community. The nurse’s actions acknowledge the need for comprehensive health planning, recognize the influences of social and ecological issues, give attention to populations at risk and utilize dynamic forces which influence change.”  Community service project proposal infographics According to Maglaya, et al. “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.”  Philosophy and Practices 1. Philosophy of Individual’s 3. Philosophy that People in the Right of being Health Community have the Potential for Continual Development and are 2. Philosophy of Working Capable of Dealing with their own Together Under a Problems if Educated and Helped Competent Leader for the Common Good 4. Philosophy of Socialism 1. Philosophy of Individual’s Right of being Health Health is believed to be one of the rights of all human beings nationally and internationally according to the WHO charter. Goal of Health for all is based on the philosophy of Individual’s right of being healthy. This philosophy encompasses all the aspects of the society i.e socio- cultural, economic aspects, so that there is no hindrance of any kind to attain these rights. 2. Philosophy of Working Together Under a Competent Leader for the Common Good It is from the primitive ages of human ages, man has learnt to live together to meet their needs. The basis of modern community health nursing is to share responsibility of helping each other. When it comes to considering an organization, equal participation of the people working through the community groups people with the people, for the people for their mutual benefit, change in behavior and health practices. A democratic team functioning is essential for effective delivery of health care services. 3. Philosophy that People in the Community have the Potential for Contiual Development and are Capapble of Dealing with their own Problems if Educated and Helped An individual with average intelligence can learn and deal with his/her own needs. Modify his/her lifestyles adjust to his or her changing environment i.e he can learn to solve his or her problems. On the basis of this philosophy, emphasis is placed on health education projected towards individuals in home, health center, place of work, school, community places or hospital. This helps to modify their behaviors respective to health.  4. Philosophy of Socialism Socialism as one of the social system in the community has control over production and distribution eg: food. Housing, material production of all kinds, education, transportation, etc. should be shared with all people.  12 Principles of Community Health Nurisng 1. The recognized need of individuals, families and communities provides the basis for CHN practice. Its primary purpose is to further apply public health measures within the framework of the total CHN effort. 2. Knowledge and understanding of the objectives and policies of the agency facilities goal achievement. The mission statement commits Community Health Nurses to positively actualize their service to this end. 3. CHN considers the family as the unit of service. Its level of functioning is influenced by the degree to which it can deal with its own problems. Therefore, the family is an effective and available channel for the most of the CHN efforts. 4. Respect for the values, customs and beliefs of the clients contribute to the effectiveness of care to the client. CHN services must be available sustainable and affordable to all regardless of race, creed, color or socio-economic status. 5. CHN integrated health education and counseling as vital parts of functions. These encourage and support community efforts in the discussion of issues to improve the people’s health. 6. Collaborative work relationships with the co-workers and members of the health team facilities accomplishments of goals. Each member is helped to see how his/her work benefits the whole enterprise. 7. Periodic and continuing evaluation provides the means for assessing the degree to which CHN goals and objectives are being attained. Clients are involved in the appraisal of their health program through consultations, observations and accurate recording. 8. Continuing staff education program quality services to client and are essential to upgrade and maintain sound nursing practices in their setting. Professional interest and needs of Community Health Nurses are considered in planning staff development programs of the agency. 9. Utilization of indigenous and existing community resources maximizing the success of the efforts of the Community Health Nurses. The use of local available ailments. Linkages with existing community resources, both public and private, increase the awareness of what care they need what are entitled. 10. Active participation of the individual, family and community in planning and making decisions for their health care needs, determine, to a large extent, the success of the CHN programs. Organized community groups are encouraged to participate in the activities that will meet community needs and interests. 11. Supervision of nursing services by qualified by CHN personnel provides guidance and direction to the work to be done. Potentials of employees for effective and efficient work are developed. 12. Accurate recording and reporting serve as the basis for evaluation of the progress of planned programs and activities and as a guide for the future actions. Maintenance of accurate records is a vital responsibility of community as these are utilized in studies and researches and as legal documents. Features of Community Health Nursing Theoretical Models/Approaches  Theoretical Models/Approaches WHAT IS THE IMPORTANCE OF THEORETICAL MODELS OR APPROACHES TO NURSING PARTICULARLY IN THE COMMUNITY?  Theoretical Models/Approaches Community Nursing Theories The model or theories which are applicable to the educator in Community Health Nursing are as follows: ❑ Health Belief Model ❑ Milio’s Framework for Prevention Model ❑ Nola Pender: Health Promotion Model ❑ Lawrence Green’s PRECEDE-PROCEED Model  WHAT IS HEALTH BELIEF MODEL FRAMEWORK? The health belief model framework is a psychological theoretical framework designed to guide the promotion of healthy behavioral decisions and disease prevention. The Health Belief Model states that people's beliefs influence their health- related actions or behaviors. Individuals will likely take action when experiencing a personal threat or risk, but only if the benefits of taking action outweigh the barriers, whether real or perceived.  Who developed the Health Belief Model? The Health Belief Model was created by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal during the 1950s. It was developed for the U.S. Public Health Services to understand why people fail to engage in healthy behaviors.  Health Belief Model How does the health belief model work? What are the strengths of the Health Belief Model? The health belief model (HBM) utilizes the six constructs of the HBM framework to One of the main benefits of the Health Belief understand the failure of people to adopt Model is that it simplifies health-related disease prevention strategies or screening for constructs so they can be more readily the early detection of illness or disease. tested and implemented in public health settings. Because it emphasizes some of the prerequisites for health behaviors, it can be helpful for addressing the things that need to happen before a person can successfully implement a behavior change.  Health Belief Model A person takes a health care decision based on the following six factors: 1. Perceived Susceptibility: This refers to how vulnerable a person feels about getting afflicted by a disease. There are fears that one is more prone to an illness compared to others. 2. Perceived Severity: This refers to the serious repercussions that could follow as a result of not adopting a recommended health behavior. This could range from becoming bedridden, dying, to even social consequences in terms of the extent to which it affects a family, inability to work, etc.  Health Belief Model 3. Perceived Benefits: The person evaluates the value of getting medical treatment by comparing the cost and side effects of the treatment with the expected consequences of being struck by an illness. 4. Perceived Barriers: This includes the cost of the treatment, complexity of adopting a new dietary/health regimen, lack of belief that one has the ability to change, side effects and length of treatment  Health Belief Model 5. Desired Behavior/Health Value: This refers to the physical and emotional costs of undergoing treatment. One has to value his/her health to be motivated enough to make the necessary changes. 6. Cues to Action: These are signals that prompt the person to take the initiative to treat illness. These can range from being exposed to health reports and messages in the mass media, watching a friend or relative suffer from the disease, reading a health pamphlet to even the onset of symptoms in one’s body.  Health Belief Model EXAMPLE: HIV/AIDS PROGRAM BENEFITS/BARRIERS PERCEIVED PERCEIVED ▪ Condoms are easy to use, one can SUSCEPTIBILITY THREAT feel safe. ▪ Condoms not readily available or Young man has been Young man believes costly. engaging in sex with that he is at risk multiple partners. because friend is ill. DESIRED BEHAVIOR/HEALTH VALUE Young man buys and uses condoms PERCEIVED regularly. SEVERITY CUES TO ACTION Nurse in the BHS Young man believes conducted Health that AIDS is a death Teaching explaining the SELF-EFFICACY sentence since there is need for safe sex and Young man has practice using no cure. how to prevent such condoms and feels confident to use illness. Peer education on them. safe sex and HIV.  Health Belief Model Failure to Change Behaviors The main reasons for the failure to change one’s lifestyle behavior are perceived susceptibility and barriers to change. A person, who feels that he is highly vulnerable to being afflicted by diseases, is more likely to pay attention to any health message. But barriers, like social pressure, may stop various changes even if the person is highly motivated.  Application of the Model Breast and Cervical Cancer: The model has been used to find ways in which women can be encouraged to go in for cancer screening. Diet Change: The model has been used to predict the likelihood of people adopting a healthier diet. Smoking: The model is used to identify if a person is likely to quit smoking by taking into account various factors like peer pressure, threat of cancer, onset of symptoms like breathing problems, etc. Milio’s Framework for Prevention Model NANCY MILIO DEFINITION MILIO’S PREPOSITIONS MILIO’S PREPOSITIONS MILIO’S PREPOSITIONS MILIO’S PREPOSITIONS Nola Pender: Health Promotion Model  Nola Pender: Health Promotion Model ❑ Developed by Dr. Nola Pender ❑ She is a nurse and a professor of nursing at University of Michigan. ❑ The theory emphasizes the importance of proactive health promotion and individual empowerment.  Nola Pender: Health Promotion Model The model suggests that health-promoting behaviors are influenced by three main factors: 1. Individual characteristics and experiences: this factor looks at an individual’s personal characteristics including knowledge, beliefs, attitudes, and past experiences. 2. Behavior-specific cognitions and affect: this component focuses on an individual’s cognitive processes, including their perceptions of self-efficacy, perceived barriers, and benefits related to adopting health-promoting behaviors. 3. Situational influences: This factor centers around an individual’s immediate environment, including their social and physical surroundings.  Strategies for promoting health and preventing illness: 1. Enhancing positive motivations 2. Building self-efficacy 3. Creating supportive environments 4. Strengthening social support  Nola Pender: Health * Promotion Model ❑ Overall, Nola Pender’s Health Promotion Model provides valuable insights into the complex interaction between individual characteristics, behavior-specific cognitions and situational influences in health promotion. ❑ This model serves as a guide for healthcare professionals to promote wellness, prevent illness, and empower individuals to lead healthy lives. Lawrence Green’s PRECEDE-PROCEED Model  Lawrence Green’s PRECEDE-PROCEED Model ❑ The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W. Green that can help health program planners, policy makers and other evaluators, analyze situations and design health programs efficiently. ❑ It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs.  Purpose of PRECEDE/PROCEED model: ❑ It provides structural framework for developing behavior change intervention. ❑ This model is also used for monitoring and evaluating the intervention program. ❑ It is participatory model and involves community participation. ❑ Content, methods/media for a particular program is selected according to need.  Lawrence Green’s PRECEDE-PROCEED Model PRECEDE provides the structure for PROCEED provides the structure for planning a targeted and focused public implementing and evaluating the public health program. health program. PRECEDE stands for: PROCEED Stands for: P – Predisposing, P – Policy, R- Reinforcing, R – Regulatory, E – Enabling, O – Organizational, C – Construct in, C – Construct in, E – Educational and E- Educational, E – Environmental, D – Diagnosis and D – Development E – Evaluation.  PRECEDE It involves assessing the following community factors: ❑ SOCIAL ASSESSMENT: Determine the social Identify administrative and policy factors that problems and needs of a given population and influence implementation and MATCH identify desired results. (Ex. Poverty, unemployment, APPROPRIATE INTERVENTIONS that unequal opportunity, racism and malnutrition. Also, substandard housing, employment discrimination, child abuse and neglect.) encourage desired and expected changes. ❑ EPIDEMIOLOGICAL ASSESSMENT: Identify the health determinants of identified problems and set priorities and goals. ❑ ECOLOGICAL ASSESSMENT: Analyze behavioral and environmental determinants that predispose, IMPLEMENTATION of interventions reinforce and enable the behaviors and lifestyles are identified.  PROCEED It involves the identification of desired outcomes and program implementation: ❑ IMPLEMENTATION: design intervention, assess availability of resources, and implement program. ❑ PROCESS EVALUATION: determine if program is reaching the targeted population and achieving desired goals. ❑ IMPACT EVALUATION: evaluate the change in behavior. ❑ OUTCOME EVALUATION: identify if there is a decrease in the incidence or prevalence of the identified negative behavior or an increase in identified positive behavior.  Module 1: Part 2-Different Fields COMMUNITY HEALTH NURSING CONCEPT different fields  SCHOOL HEALTH NURSING DEFINITION: School Nursing is a specialized field of nursing that focuses on promoting the health and well- being of students in educational setting. School nurses play a critical role in ensuring the physical, mental and social health of students, creating a safe and healthy environment that supports responsibilities, benefits, and importance of school nursing.  Examples of Prevention and the Role of the Nurse in the School Setting Examples Nurse’s Role Primary Prevention Nutrition Education Provide education to children and parent; consult with dietary staff. Immunizations Provide for or refer to source(s) for immunizations; offer consultation for immunization in special circumstances. Safety Provide safety education; inspect playgrounds and buildings for safety hazards. Health Education Facilitate healthy lifestyle education programs; develop health education curriculum for appropriate grade levels; provide health education to parents, faculty, and staff; develop suicide prevention programs and sex education materials.  Examples of Prevention and the Role of the Nurse in the School Setting Examples Nurse’s Role Secondary Prevention Screening Schedule routine screenings for scoliosis, vision and hearing problems, eating disorders, obesity, depression, anger, dental problems, and abuse. Case Finding Identify at-risk students. Treatment Administer medications; develop individualized health plan; implement procedures and tasks necessary for student with special health needs; administer first aid. Home Visits Assist with family counseling and assess special and at-risk students.  Examples of Prevention and the Role of the Nurse in the School Setting Examples Nurse’s Role Tertiary Prevention Referral of student for substance Serve as an advocate; assist with resource referrals; assist parent, faculty, and abuse or behavior problems staff; consult with neighborhood and law enforcement officials; initiate outreach programs. Prevention of complications and Follow-up and referral for student with eating disorders and obesity; participate adverse effects with faculty and staff to reduce recurrence and risk factors; serve as a case manager. Faculty and staff monitoring Follow-up for faculty and staff experiencing chronic or serious illness; follow-up of work-related injuries and accidents.  Standards of School Health Nursing Practice Standards of Practice Standard 1: Assessment The school nurse collects comprehensive data pertinent to the client’s health or situation. Standard 2: Diagnosis The school nurse analyzes the assessment data to determine diagnoses or issues. Standard 3: Outcomes The school nurse identifies expected outcomes for a plan individualized to the client or Identification situation. Standard 4: Planning The school nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. Standard 5: The school nurse implements identified pln. Implementation Standard 5A: The school nurse coordinates care delivery. Coordination of Care  Cont. Standards of Practice Standard 5B: Health The school nurse provides health education and employs strategies to promote Teaching and health health and a safe environment. promotion Standard 6: Evaluation The school nurse evaluates the client’s progress towards attainment of outcomes.  Standards of Professional Performance Standard 7: Quality of Practice The school nurse systematically enhances the quality and effectiveness of nursing practice. Standard 8: Education The school nurse attains knowledge and competency that reflects current school nursing practice. Standard 9: Profession practice The school nurse evaluates one’s own nursing practice in relation to professional evaluation standards and guidelines, relevant statutes, rules, and regulations. Standard 10: Collegiality The school nurse interacts with, and contributes to the professional development of, peers and school nursing practice. Standard 11: Collaboration The school collaborates with the client, family, school staff, and others in the conduct of school nursing practice.  Cont. Standard 12: Ethics The school nurse integrates ethical provisions in all areas of practice. Standard 13: Research The school nurse integrates research findings into practice. Standard 14: Resource The school nurse considers factors related to safety, effectiveness, cost, and impact utilization on practice in the planning and delivery of school nursing services. Standard 15: Leadership The school nurse provides leadership in the professional practice setting and the profession. Standard 16: Program The school nurse manages school health services. management Source: American Nurses Association and National Association of School Nurses, 2005. school nursing: Scope and standards of practice. Silver spring, MD, nursesbooks.org OCCUPATIONAL HEALTH NURSING  Occupational Health Nursing: A Public Health Perspective ✓ In the Philippines, the health of people in the workplace is another important focus for community health nursing practice. ✓ The public health nurse can be an occupational health nurse who is in a prime position to assess the health needs of the working population and design healthful working interventions. ✓ The integration of public health theory and principles with the roles of occupational health nurses, increase its effectiveness in serving the working population.  Occupational Health Nursing History in the Philippines ❑ Occupational Health Nursing in the Philippines traces its roots to Ms. Magdalena Valenzuela of the Department of Health who founded the Industrial Nursing Unit (INU) of the Philippine Nurses Association on November 11, 1950. ❑ INU is an organization of nurses working in the industry as company nurse. ❑ The Industrial Nursing Unit was changed to Occupational Health Nurses Association of the Philippines, Inc. OHNAP) on September 10, 1960 and September 25, 1979, the Constitution and By-Laws created a Specialty Board that granted its first Certified Occupational Health Nurse Title to its first graduate.  Functions of Public Health Nurse as an Occupational Health Nurse *(Referred from the PD 856, Chapter VII-Industrial Hygiene of the Sanitation Code of the Philippines) 1. Work with the occupational health team to lead the sanitary and industrial hygiene of all industrial establishments including hospitals to determine their compliance with the sanitation code and its implementing rules and regulations. 2. Recommends to Local Health Authority the issuance of license/business permits and suspensions or revocation of the same for any violation of the condition upon which said licenses or permits had been issued, pursuant to existing rules and regulations. 3. Coordinates with other government agencies relative to the implementation of the implementing rules and regulations.  Functions of Public Health Nurse as an Occupational Health Nurse 4. Attends to complaints of all establishments in the area of assignment related to industrial hygiene and recommends appropriate measures for immediate compliance. 5. Participate to provide, install and maintains in good condition all control facilities and protective barriers for potential and actual hazards. 6. Informs all affected workers regarding the nature of hazards and the reasons for the control measures and protective equipment. 7. Makes a periodic testing for physical examination of the workers and other health examinations related to worker’s exposure to potential or actual hazards in the workplace.  Leadership roles of the nurse utilizing public health skills includes the following: 8. Provides control measures to reduce noise, dust, health and other hazards. 9. Ensure strict compliance on the regular use and proper maintenance of Personal Protective Equipment (PPE). 10. Provide employees/workers can occupational health services and facilities. 11. Refers or elevates to higher authority all unsolved issues in relation to occupational and environmental health problems. 12. Prepares and submit yearly reports to the Local and National Government.  Issues in Occupational Health Nursing Categories of workplace hazards affecting worker health and safety: Physical Hazards: 1. Physical hazards are agents within the work environment that may cause tissue damage or other physical harm. 2. Physical hazards include radiation, temperature extremes, noise, electric and magnetic fields, lasers, microwaves, and vibration. 3. Health effects may be acute or chronic, depending on the dose and the body part affected. Examples: a. Acute: acoustic trauma from excessive noise; heat stress or stroke; skin rashes; eye injuries from infrared radiation; skin burns, cuts, or contusions. b. Chronic: Noise-induced hearing loss (NIHL); multiple myeloma and leukemia rom exposure to ionizing radiation; teratogenic or genetic effects induced by certain types of radiation.  Issues in Occupational Health Nursing Chemical Hazards: 1. Various forms of either synthetic or naturally occurring chemicals in the work environment may be potentially toxic or irritating to the body system through inhalation, skin absorption, ingestion, or accidental injection. 2. Chemical hazards include solution, mists, vapors, aerosols, gases, medications, particulate matter (fumes and dust), solvents, metals, oils synthetic textiles, pesticides, explosives, and pharmaceuticals. Specifically, health care workers are exposed to chemical hazards such as the anesthetics gases, chemotherapeutic and antineoplastic agents, tissue fixatives and reagents, disinfectants and detergents, sterilizing agents, solvents, latex, and mercury.  CONT. 1. Health effects may be acute or chronic and can affect the pulmonary, reproductive, urologic, cardiovascular, neurologic, and immune systems: Examples: a. Acute: respiratory irritation due to smoke; poisoning from accidental ingestion, metal-fume fever; chemical burns; contact dermatitis and other dermatoses b. Chronic: cancers (e.g mesothelioma, bronchogenic and gastrointestinal carcinomas); pleural disease; occupational asthma; hypersensitivity pneumonitis; birth defects; neurological disorders  Issues in Occupational Health Nursing Biological Hazards: 1. Biological agents such as viruses, bacteria, fungi, mold, or parasites may cause infectious disease via direct contact with infected individuals/animals, contaminated body fluids, or contaminated objects/surfaces. 2. Workers in certain occupations (e.g., health care, biologic research, animal handling) have a high incidence of infectious disease. 3. Health effects may be acute or chronic, depending on the nature of the organism. Examples: a. Acute: self-limiting infections such as colds and influenzas; measles; skin and parasitic infections. b. Chronic: tuberculosis; chronic hepatitis B; human immunodeficiency virus (HIV) infection, progressing to acquired immunodeficiency syndrome (AIDS).  Issues in Occupational Health Nursing Mechanical Hazards: 1. Mechanical agents may cause stress on the musculoskeletal or other body systems. 2. Hazards include inadequate work-station and tool design, frequent repetition of a limited movement, repeated awkward movements with hand-held tools, local vibrations. 3. Health effects may be acute or chronic; they may result in a permanently disabling health effect. Examples: a. Acute: neck strain and other muscular fatigue from forceful exertion or awkward positioning; visual fatigue. b. Chronic: Raynaud’s syndrome from use of vibrating power tools; carpal tunnel syndrome and other work- related musculoskeletal disorders; back injury. Psychosocial Hazards: 1. Psychosocial hazards are often related to the nature of the job, the job content, the organizational structure and culture, insufficient training and education regarding job requirements, and the physical conditions in the workplace; leadership and management styles can also contribute to psychosocial hazards. 2. Psychosocial hazards include interpersonal conflict, unsafe working conditions, overtime, sexual harassment, racial inequality, role conflict, shift work, limited autonomy, poorly defined expectations and work instructions, and absent or limited job reward.  CONT. 3. Health acute may be acute or chronic, including temporary and permanent disabilities; the occurrence of accidents and injuries may be a secondary effect of these hazards. Examples: a. Acute: Increased heart rate; increase blood pressure; sleep disturbances; fatigue; depression; substance abuse; worksite violence b. Chronic: hypertension, alcoholism; coronary artery disease; mental illness; gastrointestinal disorder The Program Strategies/Key Result Areas are as follows: 1. Establish/institutionalize Regional Occupational Toxicology (wherein Mercury Surveillance is incorporated) and Poison Control Center. 2. Integration of Occupational Health Services as part of the Primary Health Care Approach. 3. Upgrade manpower capability of health personnel and existing facilities/laboratory to respond to occupational health related concerns. 4. Preventive and primitive Occupational Health Strategies. 5. Toxicovigilance activities. 6. Advocacy Campaign thru the “Healthy Workplace” Initiative. 7. Research 8. Multi-agency Linkages. COMMUNITY MENTAL HEALTH NURSING DEFINITON OF TERMS