Community and Public Health for Medical Laboratory Science (MLS 1305) PDF

Community and Public Health for Medical Laboratory Science (MLS 1305) MODULE 3 (Part 2) THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM Prepared...

Community and Public Health for Medical Laboratory Science (MLS 1305) MODULE 3 (Part 2) THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM Prepared by: Angelique C. Dumlao, RMT Summer 2020 Module no. 3 | The Philippine Health Care Delivery System 1 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Course Topics: Module 3.3 - Primary Health Care  Rationale, Definition and Goal of PHC  Strategies of PHC  Elements of PHC  Traditional Medicines and Indigenous Resources Learning Objectives: At the end of the module, the learner must be able to:  Identify the strategies used in primary health care  Discuss the Elements of Primary Health Care  Categorize Primary Health Care Workers according to levels  Familiarize oneself with DOH's 10 Herbal Medicine Module 3.2 - The National Health Plan  Principle of Health Care process  Concepts of family  Types of Family  Roles and Responsibilities of family members  Health Care Process for a Family Learning Objectives: At the end of the module, the learner must be able to:  Define the health care process  Describe the roles of each member of the family  Differentiate families according to their structure  Apply health care process in family setting  Formulate health care objectives for a family care Module no. 3 | The Philippine Health Care Delivery System 2 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Module 3.3 - Primary Health Care Introduction Review: What is Health?  health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right.  the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. The Alma-Ata Declaration The Alma-Ata Declaration of 1978 affirms the crucial role of primary health care, which addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly. It stresses that access to primary health care is the key to attaining a level of health that will permit all individuals to lead a socially and economically productive life and to contributing to the realization of the highest attainable standard of health. PHC is usually the first point of contact people have with the health care system. Primary Health Care (PCH) - it deals with social policy which targets health equity - The Alma-Ata Declaration defines it as an important health care derived from scientifically sound and socially acceptable methods. It must be universally accessible to all individuals and is based on what the community and country can provide. Module no. 3 | The Philippine Health Care Delivery System 3 MLS 1305 (Community and Public Health for Medical Laboratory Science)  - According to WHO, PCH addresses the majority of a person’s health needs throughout their lifetime. This includes physical, mental and social well-being and it is people-centred rather than disease-centred. PHC is a whole-of-society approach that includes health promotion, disease prevention, treatment, rehabilitation and palliative care. Universal definition: “essential care based on scientifically sound and socially acceptable methods and technology made universally accessible to individuals, families, and communities through their full participation, at a cost they can afford at any given stage of development, and with the goal of self-reliance and self-determination” Primary Health Care Paradigm Made accessible, attainable, sustainable and affordable to the people towards a... Rationale for the Development of PHC 1. Magnitude of health problems 2. Inadequate and unusual distribution of health resources 3. Increasing cost of medical care 4. Isolation of health care activities from other development A health system based on primary health care will:  build on the Alma-Ata principles of equity, universal access, community participation, and intersectoral approaches;  take account of broader population health issues, reflecting and reinforcing public health functions;  create the conditions for effective provision of services to poor and excluded groups;  organize integrated and seamless care, linking prevention, acute care and chronic care across all components of the health system;  continuously evaluate and strive to improve performance Module no. 3 | The Philippine Health Care Delivery System 4 MLS 1305 (Community and Public Health for Medical Laboratory Science)  General Principles of Primary Health Care: 1. Health and development are interrelated Health is not merely the absence of disease. Neither it is only a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good health therefore, is maniested by the progrssive improvements in the living conditions and quality of lie enjoyed by the community residents. Development is a quest or an improved quality of life for all. Development is multi-dimensional. It has political, economic, social, cultural, institutional and environmental. Therefore, it is measured by the ability of people to satisfy their basic needs. Thus, the interrelationship of health and development. MAN AS A FACTOR OF PRODUCTION PRODUCTION HEALTH AND QUALITY OF LIFE GOODS AND SERVICES THE POVERTY AND ILLNESS CURVE LOW PRODUCTION INCAPACITY AND SHORTER LIFE EXPECTANCY LOW WAGES MORE ILLNESS LESS ENERGY AND HIGHER INCAPACITY LOW IVESTMENT IN SANITATION AND MALNUTRITION, POOR PREVENTION EDUCATION, HOUSING, ETC. HIGH EXPENSES IN CURATVE ACTIVITIES Module no. 3 | The Philippine Health Care Delivery System 5 MLS 1305 (Community and Public Health for Medical Laboratory Science)  2. Essential health services must be accessible, available, acceptable and affordable The health services should be present where the supposed recipients are. They should make use of the available resources that is found in the community, wherein the focus would be more on promotive of health and prevention of illness. 3. Genuine people's participation is essential People are the center, object, and subject of development. Thus, the success of any undertaking that aims at serving the people is dependent on the people's participation at all levels of decision-making: planning, implementing, monitoring, and evaluating. Any undertaking must also be based on the people's needs and problems (PCF 1990). Part of the people's participation is the partnership between the community and the agencies found in the community;social mobilization; and decentralization. In general, health work should start from where the people are building on what they have. Other Principles of Primary Health Care: 1. Improvement in the level of health care of the community. 2. Favorable population growth structure. 3. Reduction in the prevalence of preventable, communicable and other disease. 4. Reduction in morbidity and mortality rates especially among infants and children. 5. Extension of essential health services with priority given to the undeserved sectors. 6. Improvement in basic sanitation. 7. Development of the capability of the community aimed at self-reliance. 8. Maximizing the contribution of the other sectors for the social and economic development of the community. 9. Equitable distribution of health care according to this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, and caste, urban/rural and social class. 10. Community participation The desire to get involved must be generated from within the community. Its participation entails productive contact between the health service and the people for specific needs. Health actions must be a response of a community to problems that the people themselves perceived and carried out in a way that is acceptable to them. Module no. 3 | The Philippine Health Care Delivery System 6 MLS 1305 (Community and Public Health for Medical Laboratory Science)  11. Multi-sectional approach Multi-sectional approach-recognition that health cannot be improved by intervention within just the formal health sector 12. Use of appropriate technology Ultimate goal of PHC: SELF-RELIANCE - the ability to stand on their own; self - sufficiency Major Strategies of Primary Health Care: Based on Visions, Policies, and Strategies of the DOH, Philippines 1. Elevating Health to a Comprehensive and Sustained National Effort Advocacy must be directed to national and local policy makers to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations. 2. Promoting and Supporting Community-Managed Health Care The DOH, in promoting community-managed care as a cornerstone to health, must manifest support to community organizing and organizations, establish sustainable mechanisms or community-managed financial schemes and identify and develop indigenous health resources. 3. Increasing Efficiencies in the Health Sector The DOH will safeguard and strengthen the integration of health operations to maintain the quality o health care. It will make use of devolution and decentralization of organizations, appropriate technology, development of human resources, and provide support and assistance to public and private institutions for enhanced health education. 4. Advancing Essential National Health Research Essential National Heal Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery. Essential ELEMENTS of Primary Health Care: Education concerning prevailing health problems and the methods of identifying, preventing and controlling them. - promotes the partnership of both the family members and the health worker in the promotion of health as well as prevention of illness - a means of improving the health of the people Module no. 3 | The Philippine Health Care Delivery System 7 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Locally endemic disease prevention and control - Endemic diseases may have a low morbidity rate but since it is continually present in the community, prevention and control is necessary Expanded program of immunization against major infectious diseases - This program exists to control the occurance of preventable illness especially of children. - The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines. Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. They are given for free by the government and an on-going program of the DOH Maternal and child health care including family planning - the maternal and infant mortality and morbidity rates are among the indicators of health of a particular community. - the protection of the mother and child to illness and other risks would ensure a good health for the community. Essential drugs arrangement - focuses on the information campaign on the proper utilization and acquisition of drugs. Nutritional food supplement, an adequate supply of safe and basic nutrition - malnutrition is one of the problems that we have in the country. - if food is properly prepared, then one may be assured of a healthy family. Treatment of communicable and non-communicable disease and promotion of mental health - Most communicable diseases that affects the country are also preventable - Through a comprehensive mental health program, the DOH hopes to attain the highest possible level of health for the nation including mental health Safe water and sanitation - Presidential Decree No. 856/Code on Sanitation of the Philippines empower the Department of Health with the following powers and functions: Undertake the promotion and preservation of the health of the people and raise the health standards of individuals and communities throughout the Philippines. Module no. 3 | The Philippine Health Care Delivery System 8 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Management of PHC Planning Set a direction and determine what needs to be accomplished Setting priorities and determining performance targets Organizing Designing the organization or the specific division, unit, or service Determining positions, teamwork assignments, and distribution of authority and responsibility. Staffing Acquiring and retaining human resources Developing and maintaining the workforce through various strategies and tactics. Controlling Monitoring staff activities and performance and taking the appropriate actions for corrective action to increase performance. Directing Its focus is to initiate action in the organization through effective leadership and motivation of, and communication with, subordinates. PHC SUMMARY WHAT An approach/partnership/concept Community based Kowledgeable response to the interrelated needs of the community WHY Making health care accessible, affordable, sustainable on health for all Towards self-reliance Towards development and social transformation HOW Partnership and Community participation, Linkages: intra- and inter-sectoral collaboration Provision of community services Use of appropriate technology and organizing Module no. 3 | The Philippine Health Care Delivery System 9 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Levels of Primary Health Care Workers 1. Village or Grassroot Health Workers - Initial links of the community to health care - They provide preventive health care measurements and simple curatives to promote a healthy environment. - They encourage programs/activities such as food production programs to improve the socio-economic level of community. - the first contact of the community. - They work in liaison with the local health services. - They include: trained community health workers or health auxiliary volunteers, or a traditional birth attendant or healers, who provides elementary curative and health care and measurements that promote a healthy environment. 2. Intermediate Level Health Workers - First source of professional health care - They attend to health problems which are already beyond the competence of the village workers. - They provide supervision, training, supplies, and services that provide support to front-line health workers. - Thy include: General medical practitioners or residents, Public health nurse, Midwives, and Sanitary inspectors 3. First-Line Hospital Personnel - Serve as the backup health service providers when hospitalization is required - The intermediate level health workers or village health workers are in close contact with them. - They include: Physicians with specialty, Nurses, Dentists, Pharmacists, Other health professional DOH's 10 Herbal Medicines As part of the home elements of the PHC, the Philippine Department of Health endorsed 10 herbs for use in the community. Akapulko (Cassia alata/Herpetica alata) Uses: Anti-fungal: Tinea flava, ringworm, athletes foot, and scabies Preparation: Fresh, matured leaves are pounded. Apply sap to the affected part 1-2 times a day. Module no. 3 | The Philippine Health Care Delivery System 10 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Ampalaya (Mamordica charantia) Uses: Diabetes Mellitus (Mild Type 2) Preparation: Gather and wash young leaves very well. Chop. Boil 6 tablespoons in 2 glassfuls of water for 15 minutes under slow fire. Do not cover pot. Cool and strain. Take ⅓ cup, 3x a day after meals. Note: Young leaves may be blanched/steamed and eaten ½ glassfuls, 2x a day. Bawang (Allium sativum) Uses: To lower choloesterol levels in blood; for hypertension; toothache Preparation: May be fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled water for 5 minutes. Take 2 pieces, 3x a day after meals. For toothache: Pound a small piece and apply to affected part. Caution: Take on a full stomach to prevent stomach and intestinal ulcers Bayabas/Guavas (Psidium guajava L.) Uses: 1. For washing wounds - may be used twice a day. 2. For diarrhea - may be taken 3-4 times a day. 3. As gargle and to relieve toothache. Warm decoction is used or gargle. Freshly pounded leaves are used for toothache. Instruction: Guava leaves are to be washed well and chopped. Boil for 15 minutes at low fire. Do not cover pot. Cool and strain before use. Lagundi (Vitex negundo/V. leucoxylon) a shrub growing in vacant lots and waste land. Matured branches are planted. The flowers are blue and bell-shaped. The small fruits turn black when ripe. It is better to collect the leaves when flowers are in bloom. Uses: 1. Asthma, cough and fever - boil raw fruits or leaves in 2 glasses of water for 15 minutes until the water left is only 1 glass (decoction). Strain. Leaves should be chopped and the following dosages of the decoction are given according to age group: Dried leaves Fresh leaves Adult 4 tbsp. 6 tbsp. 7-12 yrs. 2 tbsp. 3 tbsp. 2-6 yrs. 1 tbsp. 1½ tbsp. 2. Dysentery, cold and pain in any part of the body as in influenza - boil a handful of leaves and lowers in water to produce a glassful of decoction. Adults and children may drink a glassful of decoction 3x a day. Module no. 3 | The Philippine Health Care Delivery System 11 MLS 1305 (Community and Public Health for Medical Laboratory Science)  3. Skin disease (dermatitis, scabies, ulcer, eczema) and wounds - prepare a decoction of leaves. Wash and clean the skin/wound with the decoction. 4. Headache - crushed leaves may be applied on the forehead. 5. Rheumatism, sprain, contusions, insect bites - pound the leaves and apply on affected part. 6. Aromatic bath for sick patients - prepare leaf decoction and use for bathing sick and newly delivered patients. Niyug-Niyogan (Quisqualis indica) a vine, which bears tiny fruit that grows wild in backyards. The seeds must come from mature, dried, but newly opened fruits. Propagates through stem cuttings about 20 cm in height. Use: Anti-helmintic - used to expel round worms, which cause ascariasis. The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated after one week. Adult 8-10 seeds 7-12 years 6-7 6-8 years 5-6 4-5 years 4-5 Caution: not to be given to children below four years old. Sambong (Blumea balsamiera/Conyza balsamifera) a plant that reaches 1½ to 3 meters in height with rough hairy leaves. Young plants around mother plant may be separated when they have three or more leaves. Uses: Anti-edema, diuretic, anti-urolithiasis - boil chopped leaves in a glassful of water for 15 minutes until one glassful remains. Cool and strain. Dried leaves Fresh leaves Adult 4 tbsp. 6 tbsp. 7-12 yrs. ½ of adult dose Divide decoction into 3 parts. Drink one part 3x a day. Note: Sambong is not a medicine for kidney infection. Tsaang Gubat (Carmona retusa) a shrub with small, shiny, nice-looking leaves that grows in wild, uncultivated areas anf orests. Mature stems are used for planting. Uses: 1. Diarrhea - boil following amount of chopped leaves in 2 glasses of water for 15 minutes until amount of water goes down to 1 glass. Cool and strain. Module no. 3 | The Philippine Health Care Delivery System 12 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Dried leaves Fresh leaves Adult 10 tbsp. 12 tbsp. 7-12 yrs. 5 tbsp. 6 tbsp. 2-6 yrs. 2½1 tbsp. 3 tbsp. Divide decoction into 4 parts. Let patient drink 1 part every 3 hours. 2. Stomachache - wash leaves and chop. Boil chopped leaves in 1 glass of water for 15 minutes. Cool and filter/strain. Dried leaves Fresh leaves Adult 2 tbsp. 3 tbsp. 7-12 yrs. 1 tbsp. 1½ tbsp. Ulasimang Bato/Pansit-Pansitan (Paperonia pellucida) a weed with heart-shaped leaves and grows in shady parts of the garden and yard Use: Lower uric acid (rheumatism and gout) Preparation: Wash the leaves well. One and a half leaves are boiled in two glassfuls of water over low fire. Do not cover pot. Cool and strain. Divide into three parts and drink each part three times a day after meals. May also be eaten as salad. Wash leaves well. Prepare one and a half cups of leaves (not closely packed). Divide into three parts and take as salad three times a day. Yerba Buena (Mentha cordifelia) a small multi-branching aromatic herb. The leaves are small, elliptical and with toothed margin. The stem creeps to the ground and develops roots. May also be propagated through cuttings. Uses: 1. For pain in different parts of the body as headache, stomachahe - boil chopped leaves in 2 glasses of water for 15 minutes. Cool and strain. Dried leaves Fresh leaves Adult 6 tbsp. 4 tbsp. 7-12 yrs. ½ of adult dose Divide decoction into 2 parts and drink 1 part every 3 hours. 2. Rheumatism, Arthritis and headache - crush the fresh leaves and squeeze sap. Massage sap on painful parts with eucalyptus. 3. Cough and colds - get about 10 fresh leaves and soak in a glass of hot water (expectorant). Drink as tea. 4. Swollen gums - steep 6 glasses of fresh plant in a glass of boiling water for 30 minutes. Use solution as gargle. 5. Toothaches -cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity. Mouth should be rinsed by gargling salt solution before inserting the cotton. To prepare salt solution: Add 5 g of table salt to one glass of water. Module no. 3 | The Philippine Health Care Delivery System 13 MLS 1305 (Community and Public Health for Medical Laboratory Science)  6. Menstrual and gas pains - soak a handful of leaves in a glass of boiling water. Drink infusion. It induces menstrual flow and sweating. 7. Nausea and fainting - crush leaves and apply at nostrils of patients. Reminders on the Use of Herbal Medicines: 1. Avoid the use of insecticides on plants. 2. Use clay pot and remove the cover while boiling at low heat in cooking the herbal medicine. 3. Use one kind of herbal plant as needed and prepare as instructed. 4. If ailments are not relieved, or if there is an untoward reaction, stop giving the herbal medicine and consult a doctor. Module no. 3 | The Philippine Health Care Delivery System 14 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Module 3.4 - The Health Care Process Introduction Review: What is Public Health?  the science and art of preventing disease,prolonging life, and promoting physical health and efficiency through organized community efforts In community involvement, the people in the community share the responsibility to participate in:  defining their health and health-related needs and problems  identifying realistic solutions organizing community or health action  mobilizing local resources  providing essential health services  evaluating the results of health actions Primary Health Care is usually the first point of contact people have with the health care system. The desire to get involved must be generated from within the community. Its participation entails productive contact between the health service and the people or specific needs. Health actions must be a response of community to problems that the people themselves perceives and carried out in a way that is acceptable to them. Module no. 3 | The Philippine Health Care Delivery System 15 MLS 1305 (Community and Public Health for Medical Laboratory Science)  The Health Care Process Donabedian was an early proponent of the use of the process concept in healthcare. He identified the importance of looking at the organisational structure and the processes involved in producing outcomes for the patients. According to Bergman, Neuhauser, and Provost, “a citizen point of view on the healthcare system, its processes and their improvement is emphasised. From this point of view, five main processes are identified: Keeping Healthy, Detecting Health Problems, Diagnosing Diseases, Treating Diseases and Providing for a Good End of Life. The citizen should be looked upon as a cocreator of value and improvement of these processes.” Keeping healthy (prevention)  The use of personal improvement projects is a mechanism to improve health at the individual level.  However, the healthcare system also has to engage in proactive prevention of future illness.  This includes physical fitness, bed nets against malaria, a good diet, clean drinking water and less use of tobacco; the list goes on. Detecting health problems  Proactive outreach on the part of the healthcare system is important Diagnosing diseases  This is the process needed to trigger the next process of treatment.  Timeliness of diagnosis is critical for many disease paths. The healthcare system provides the knowledge and methods for this process. Treating diseases  Curing and caring is at the core of most of today’s discourse on quality improvement in healthcare.  Through self-management, the citizen can work as a stronger partner with the healthcare system to improve this process. Providing for a good end of life  For many diseases, ageing is the root cause leading to the deterioration of all human systems, some slower, some faster.  The medical specialties are divided by organ/symptom area: the heart, eyes, hearing, mental health, etc. What is considered good care from a symptom area specialist may not create a good end of life.  A holistic point of view is required; therefore, there is a need for more physicians in the specialty of geriatric care. Module no. 3 | The Philippine Health Care Delivery System 16 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Concepts of Family What is a Family?  The basic unit of society  A primary entitiy of health care or institution responsible for the physical, emotional and social support of its members.  Its foundation is marriage (the group which ensures continuity through its reproductive function and socialization). Types of Family: Family of orientation the family into which you are born, and where one is reared and socialized Family of procreation created when you marry or form a significant and lasting bond with another adult Roles and responsibilities of family members According to Burgees and Locke (as cited by Medina, 2001), the family is a group of persons united by ties of marriage, blood, birth or adoptation. The family unit is incomplete without an adult to guide its members. It is made up of individuals who perform certain roles which contribute to the system's function as a whole. A family role is an expected set of behaviors associated with a particular family position that can be formal or informal. Formal roles - recognized by expectations associated with roles Informal roles - those that are casually acquired within the family A family consists of the interactions between the mother and father, parents and children, and siblings, in their respective roles. These roles, guided by culturally prescribed norms, are made up of specific tasks and responsibilities. Tatay - “Haligi ng tahanan”  being the head in authority, his wisdom is well respected  He’s the breadwinner so the family depends on him for financial support  he earns the money so that he can provide for the basic needs of the family including the children's education. Nanay - “Ilaw ng tahanan”  the keeper of the home and children  she serves as mother and teacher, managing the family resources with care  she shares the financial struggles of the father, doing jobs to earn additional income Module no. 3 | The Philippine Health Care Delivery System 17 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Ate, Kuya, Bunso  Children are expected to show respect to elders and care for their parents up to their old age and unto death. A family is composed of two or more people who are emotionally involved with each other and live in close geographical proximity. They depend on one another for emotional, physical, and/or financial support. Hence, emotional connection is established through caring and a commitments to a common purpose, as parent- child relationships influence a person's concept of self-worth and capacity to form later relationships. Tahanan root word: Tahan v. magtahan, tumahan (mag-:-um-) to cease or stop crying. Home: a place of love, comfort, and rest. The Filipino family serves as a source of refuge. Family Structure - refers to the characteristics and the demographics (age, sex, number) of individual members who make up family units. As a structure, it may be classified as: Traditional Family  Nuclear/Conjugal  Extended/Consanguineous Single Parent Families Alternate Family Structure Nuclear/Conjugal Family  consists of a husband and wife, and their children (natural or adopted) who live in a common household.  referred to as “mag-anak”, the primary unit and building block in Filipino Christian family structure.  Polygamous Family - when nuclear families are united through the extension of the husband-wife bond as a result of plural marriages Extended/Consanguineous Family  a form of combining nuclear units into larger units through the parent-child relationships.  composed of two or more residential units of three or more generations.  part of the extended family are relatives such as aunts, uncles, cousins, and grandparents.  the family is more organized with their assigned tasks and obligations, as relatives are available to give the needed assistance and guidance in childbearing. Module no. 3 | The Philippine Health Care Delivery System 18 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Single-Parent Families  Single parents may be never-married, separated, divorced, or widowed. Alternate Family Structure  Cohabitating Families - includes those individuals who choose to live together  Single persons not living with others - he or she is a part of a family of origin, usually has a social network with significant others.  independent young adults who have entered the work force  the elderly left alone through death of a spouse Family Stages and Tasks Beginning Family - covers the start of marriage to the birth of the first child, including establishment of a new household and the beginning of a nuclear family - establishing a mutually satisfying marriage - relating harmoniously to kin - making decisions regarding parenthood Childbearing Family - begins with the birth of the first child and lasts until the child is 30 months of age - integrate infants into a family unit - accommodate to new parenting and grandparenting roles - renegotioating marital relationship Family with pre-school children - covers the years from the time the oldest child is 2½ years old until the youngest child is 5 years old - adapting to critical needs and interests of pre-school children - meeting the needs of additional children while continuing to meet those of the firstborn - coping with parental energy depletion and lack of privacy Family with school-age children - the oldest child is 6 years of age until the child turns 13 years of age. - constructively fitting into the community of families with school-aged children - encouraging and supporting children's educational achievements - meeting the physical health needs of all family members - maintaining a satisfying marital relationship Module no. 3 | The Philippine Health Care Delivery System 19 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Family with teenagers - begins when the oldest child is 13 years of age and ends when the youngest child is 20 years of age or leaves home. - balancing teenager's freedom with responsibility as thy mature and emancipate from the family - parents refocus on midlife marital and career issues - parents begin a shift toward concern or the older generation Launching Center Family - covers between the time the first child leaves home and the last child leaves home - releasing young adults into lives of their own with appropriate rituals and assistance - maintaining a supportive home base - building a new life together as a couple - assisting with aging or ill parents Middle-aged Family - this stage refers to the years from the time the last child leaves home to the retirement or death of one of the spouses - reinvest in couple identity with concurrent development of independent interest - maintaining ties with older and younger generations - realigning relationships to include in-laws and grandchildren - deal with disabilities and death of older generation Aging Family - this stage lasts form the retirement of one or both members of the couple through the death of one of the spouses, ending with the death of the remaining spouse - shift from work to leisure and semi-retirement or full retirement - maintaining couple and individual functioning while adapting to the aging process - prepare or own death and dealing with the loss of spouse, and /or siblings, and other peers. Family Functions The family functions for the needs of its members and the requirements essential for the existence of society.They are essential for the biological and psychological preservation and protection of its members as they provide the basic needs of its members - food, clothing, shelter, and the needed love, affection and emotional security. Module no. 3 | The Philippine Health Care Delivery System 20 MLS 1305 (Community and Public Health for Medical Laboratory Science)  1. Affective - promotes the stability of famiy members be meeting psychological needs. 2. Socialization and social placement - these will facilitate in the life-long process of learning for the growth and development of the individual; social control; and transmission of culture. 3. Reproduction - the family provides recruits for society to ensure the continuity of the intergenerational family and society through procreation. 4. Economic - allows the family to acquire and allocate adequate financial resources to meet their needs. 5. Health Care and Physical Necessities - Physical care is the provision of basic needs such as food, clothing and shelter. - Family health care includes family health and lifestyle practices Health Care Process for a Family The family as a unit of care and service has been the domain in community health care, in context with a larger goal - facilitating the health of the community. The family is viewed as an aggregate of persons of different ages, their family development, dynamics, interaction and the health of the family as a whole. Characteristics of Family as a Patient 1. The family is a product of time and place Although some sort of family is virtually a universal phenomenon, the ways in which a family is organized and the societal tasks which are assigned to it will vary with time and place. 2. The family develops its own lifestyle Each family develops its own set of values, its own patterns of behavior, and its own style of life. 3. The family operates as a whole/group. In business of daily living, the family develops its own ways of operating. In dealing with common problems, one family may have developed a pattern of facing the problem as a group, deciding together what they will do. Module no. 3 | The Philippine Health Care Delivery System 21 MLS 1305 (Community and Public Health for Medical Laboratory Science)  4. The family accommodates to the needs of the individual. Each individual is functioning not only as a member of the group but also as a unique human being, with his own destiny to fulfill. By some means, each member must assert himself in a way that allows him to grow and to develop. 5. The family relates to the community. The family develops a characteristic stance with respect to the community. Family based health care process is a client-oriented, systematic and dynamic approach to scientific problem solving involving a series of dynamic actions for the purpose of facilitating optimum family functioning. The health care process for a family compose of the following: Relating /establishing a good working relationship with the family Assessment Planning Implementing Evaluating Relating/establishing a good working relationship with the family During this phase, the health care worker initiates contact, shows interest and concern, demonstrates a helpful attitude, sincerity and sensitivity that will facilitate in maintaining a two-way communication in gaining the family’s trust and confidence. The role of the community health worker is to act as the family’s advocate, supportive and understanding the family’s condition - their family health and illness patterns. Thus, the establishment of the good working relationship with the family becomes the foundation or all subsequent actions. Family Assessment Assessment is a systematic collection of data to determine the family’s status and to identify any actual or potential health problems. It includes the analysis of data to serve as a basis for planning and delivering heath care to the whole family. The purpose of family assessment is to determine the level of family functioning, to clarify family interaction patterns, to identify strengths and weaknesses, and to describe the health status of the family and its individual members (Logan & Dawkins, 1986). Module no. 3 | The Philippine Health Care Delivery System 22 MLS 1305 (Community and Public Health for Medical Laboratory Science)  The health worker must first assess all components of family functioning: 1. Family dynamics 2. Health status of each family member Can be obtained through direct 3. Socio-economic-cultural factors observation, interview, 4. Home living and environmental condition examination and records review 5. Preventive health practices Upon completion of the data, the health worker compares the information to documented norms of health and illness. Characteristics of Health Families who are Functioning Well in Society (Hanson 2001): The family…  Tends to communicate well and listen to all members  Affirms and supports all of its members  Values teaching respect for others  Members have a sense of trust  Plays together and humor is present  Members interact with each other, and a balance in the interactions is noted among the members  Shares leisure time together  Has a shared sense of responsibility  Has traditions and rituals  Shares religious core  Honors the privacy of its members  Opens its boundaries to admit and seek help with problems Family Assessment Tools: 1. Genogram - displays pertinent family information in a family tree format that shows family members and their relationships over at least three generations (McGoldrick, et al, 1999) 2. Ecomap - a visual diagram of the family unit in relation to other units or subsystems in the community. The ecomap presents the nature of relationship among family member, and between families and the community. 3. Family APGAR - a family unit is considered by Smilkstein to be a nurturing unit that demonstrates integrity in the five components: Adaptability, Partnership, Growth, Affection and Resolve.This tool is useful in suggesting areas to be assessed relative to family functioning and potential areas of family strengths and resources. Module no. 3 | The Philippine Health Care Delivery System 23 MLS 1305 (Community and Public Health for Medical Laboratory Science)  4. Family Coping Index - the purpose of this is to provide a basis for estimating the needs of a particular family. The health worker must then formulate conclusions about the family needs as he categorizes the health problems and determine the various levels of family functioning, to assess why there is a need for care and supervision. Planning Involves the formulation of desired family outcomes and identification of actions to achieve goals. Careful planning builds on the data collection and diagnosis of the family-based health care process and increase the probability of successful implementation and evaluation. Essential components of the plan (Bailon & Maglaya, 1990): 1. Problem definition 2. Goals and objectives of care 3. Plan intervention 4. Plan for evaluating care Mutual goal setting in which the client and the family are included is the cornerstone of effective planning. The family is more likely to work towards the goals they have chosen and support. Implementation/Intervention Implementing is a systematic approach to actions used in partnership with the family to achieve desired family outcomes. Implementation of a plan can be accomplished easily I the family agreed on the plan out o support or each other. Three levels of family functioning: Cognitive interventions - pertains to the act of knowing, perceiving, or understanding, e.g. teaching a client or family member about the importance of a diabetic diet Affective interventions - related to feelings, attitudes and values, e.g. helping family members to understand their fears about a loved one’s diagnosis of diabetes Behavioral interventions - refers to skills and behavior modification, e.g. teaching clients about giving themselves insulin injections and beginning a group exercise program or newly diagnosed diabetic clients. Module no. 3 | The Philippine Health Care Delivery System 24 MLS 1305 (Community and Public Health for Medical Laboratory Science)  Three types of interventions (Freeman and Heinrich (1981): Supplemental intervention - doing things that the target client cannot do. This may refer to giving therapeutic care to the sick or organizing a health care program. Facultative intervention - minimizing, if not removing the obstructions to health care. For instance, if the family has inadequate information about a particular health concern, the health care worker provides the needed information. Behavioral/developmental intervention - allows the nurse to motivate families to make responsible decisions for themselves. Evaluation Evaluation has a profound effect on the quality of care in family based nursing. It is a mutual continuous process that incorporates reassessment, and modification of the care plan to determine whether goals and outcome criteria were stated correctly to permit modification as circumstances change, and met effectively. Three approaches to evaluating the quality of health care rendered (Donabedian, 1982): Structure - refers to settings in which care occurs. It includes materials, equipment, qualification of staff, and organizational structure. This approach to evaluation is based on the assumption that, given a proper setting with good equipment, good care will follow. Process - refers to whether the care that was given was competent or preferred. It consists of review of records, focused on whether documentation was included in the clinical records. Outcome - refers to the results of client care and restoration of function and survival. It includes the sense of change in health status or changes in health-related knowledge, attitude and behavior. This can be expressed in terms of mortality, morbidity, and disability for a given population,specifically in health promotion behaviors such as weight control, exercise, abstinence from alcohol and tobacco smoking. Module no. 3 | The Philippine Health Care Delivery System 25 MLS 1305 (Community and Public Health for Medical Laboratory Science)  References: Ebuen B. U., et al. (2019). Health Information System for Medical Laboratory Science David, E. S., Rodolfo, M. J. L. D., Serraon-Claudio, V., Jamorabo-Ruiz, (2007). Community Health Nursing: An Approach to Families ad Population Groups Gyuchan Thomas Jun, James Ward, Zoe Morris, John Clarkson, Health care process modelling: which method when?, International Journal for Quality in Health Care, Volume 21, Issue 3, June 2009, Pages 214–224, https://doi.org/10.1093/intqhc/mzp016 Bergman B, Neuhauser D, Provost L (2011). Five main processes in healthcare: a citizen perspective BMJ Quality & Safety 2011;20:i41-i42. Resource Manual for Health Care I and Health Care II Online References: https://www.who.int/gender-equity-rights/knowledge/right-to-health-factsheet/en/ https://www.who.int/health-topics/primary-health-care#tab=tab_1 https://www.who.int/news-room/fact-sheets/detail/primary-health-care https://openi.nlm.nih.gov/detailedresult?img=PMC2738304_IJCCM-12-67-g001&query= &req=4 https://qualitysafety.bmj.com/content/qhc/20/Suppl_1/i41.full.pdf http://3.bp.blogspot.com/-z9hNqZzeucc/TZKsQ3eYtJI/AAAAAAAAABQ/X8eyIijRZEs/s1 600/genogram+1.jpg https://i.ytimg.com/vi/ED0WWi67bpM/maxresdefault.jpg https://ferrisintroductiontosocialwork.pressbooks.com/app/uploads/sites/64471/2017/08/i mage-1-2.png https://image2.slideserve.com/4581670/filipino-family-apgar-part-i-l.jpg https://imgv2-1-f.scribdassets.com/img/document/47339664/original/735bc9c61a/14865 16131 https://image.slidesharecdn.com/207528705-family-case-study-1-150911133137-lva1-a pp6892/95/207528705-familycasestudy1-14-638.jpg?cb=1441979220 Module no. 3 | The Philippine Health Care Delivery System 26 MLS 1305 (Community and Public Health for Medical Laboratory Science)