NCM 104 Community Health Nursing 1 Notes PDF

Hiiii, Student Nurse! As a senior who have walked the same path you’re on now, it’s a privilege to share these review materials with you, hoping they will assist you in passing your classes and reach your academic goals. Reflect on the reasons you chose this noble profession – the lives you want t...

Hiiii, Student Nurse! As a senior who have walked the same path you’re on now, it’s a privilege to share these review materials with you, hoping they will assist you in passing your classes and reach your academic goals. Reflect on the reasons you chose this noble profession – the lives you want to impact, the difference you aim to make, and the passion that drives you forward. Hold onto these reasons. Let these motivations be your guiding light through every challenge you face. Also a quick note: if you decide to print these materials, please handle them responsibly and avoid leaving them anywhere. Study hard, stay focused, and keep that fire burning. I believe in you and your potential to become amazing nurses. With my sincerest encouragement, Kisha Jayn A. Tulio, SN. NCM 104 COMMUNITY HEALTH NURSING 1: CARE ▪ and/or common values and interest. Community functions within a socio-cultural OF INDIVIDUALS AND FAMILIES AS CLIENT context in that the people share the same cultural heritage, making each community unique from others. The physical characteristics of the environment also vary, and this affects the economic production of the people. 1. It is defined by geographic boundaries within a The practice of nursing particularly the CHN certain identifiable characteristic. differs from one geographical area to another. 2. It is made up of institutions organized into a It is influenced by the number of factors social system, with the institutions and primarily the scope of practice as defined by organizations linked in a complex network, nursing law, policies, standard of WHO and having formal and informal power structures other organizations where CHN’s work and the and a communication system. health needs and problems of an individual, 3. It has a common or shared interest that binds family, group, or in a community. the member together. 2 Major fields of Nursing in the Philippines: 4. It has an area of fluid boundaries within which o Community Health Nursing problem can be identified or solve. ▪ A field of nursing practice 5. It has a population aggregate concept. where services are delivered outside the hospital in community settings. o Hospital Nursing LOCATION o The health of the community is affected by this CHN and PHN can be used interchangeably, location, every physical community carries out its daily however CHN is broader in scope; it includes existence in a specific geographical location. PHN, occupational health nursing and school POPULATION nursing. o consists of specialized aggregates, but all of the The utilization of NURSING PROCESS in the various people who live within the boundary of the community. DIFFERENT LEVELS OF CLIENTELE, SOCIAL SYSTEM concerned w/ the PROMOTION OF HEALTH, o the various parts of communities’ social system that PREVENTION OF DISEASE, DISABILITY & interact and include the health system, family system, REHABILITATION. (Dr. Araceli Maglaya, et al.) economic system and educational system. 1. INDIVIDUAL NURSING - CHN deals with individual (sick or well) on a o Assisting sick individual to become healthy daily basis. and healthy individual to achieve optimum  Why? Since health problem of individuals are intertwined with those of other members of the family wellness. and community. o Nursing is defined as the science and art of  (Ex: Covid infected family member); considered as an caring. entry point in working with these clients ▪ Nursing as an art is reflected in the nurses’ 2. FAMILY interactions and communication with clients that are geared towards the improvement - is defined as a collection of people who are not just of their health but as well as their integrated, interacting and interdependent. ability to deal with the determinants and Family members interact with each other and consequences of their health problems. the action of one affects the other members. COMMUNITY HEALTH NURSING 3. POPULATION o Clark defines community health nursing as - is a group of people who share common a “synthesis of nursing knowledge and characteristics, developmental stage (Ex: practice of public health, implemented via a school age, adolescents, adults) or common systematic use of nursing process and exposure to particular environmental factors, other processes to promote health and and consequently common health problems, prevent illness in population groups”. issues and concerns. o CHN is the totality of its philosophy and 4. COMMUNITY beliefs, principles and processes and - a group of people sharing common geographic standards. boundaries and common values and interests COMMUNITY within a specific social system, which includes o A group of people with common health, family, economic, educational, religious, characteristics or interest living together welfare, political, recreational, legal and within a territory or geographical communication system. boundaries  services to people w/ mental illness and/or addiction. COMMUNITY-BASED NURSING SCHOOL HEALTH NURSING o Focused on illness care for individuals o Works in school and families both acute and chronic o A specialized practice of professional diseases. nursing that advances the well-being, o Examples: Home health nurse performing academic success, and lifelong wound care to one of the members of the achievement of students. family. Another one is a school nurse taking care of all student’s medical needs COMMUNITY-ORIENTED NURSING o Focused on population and community as a whole. Health promotion and disease prevention activities are done to help improve the health of the community and population. This is essentially known Public Health Nursing. o It is the art and science of (1) prolonging life, (2) promoting health and (3) preventing disease through organization of community efforts. Public health nursing refers to composition of nursing services and health promotion of the population. There is a strong link between a society’s health o It aimed to: and its economic development which in turn is ▪ Improve sanitation. determined by its social, political structures and ▪ Control of community epidemics. processes. ▪ Prevent the transmission of Culture and environment which impact of infection. people’s health are also affected by the ▪ Provide education about the basic country’s politics and economy. principles of personal hygiene. TO BE HEALTHY, WE NEED: ▪ Organize medical and nursing o HAPPINESS: aim for a positive attitude services for early diagnosis, o SLEEP: get 7-8 hours of sleep daily prevention and treatment of o WATER: drink plenty of water diseases. o GOOD DIET: the right balance of carbs, proteins, fats, vitamins, and minerals o EXERCISE: do exercise, walk, 1. The community is the patient in CHN, the gardening, use the stairs, and move family is the unit of care and there are four about. levels of clientele: individual, family, Health: The state of absolute physical, mental, population group and community. and social well-being. It is more than just the 2. In CHN, the client is considered an ACTIVE absence of disease or infirmity (WHO, 1995) partner not PASSIVE recipient of care. Health is a basic human right. The enjoyment of 3. CHN practice is affected by developments in the highest standard of health is one of the health technology, in particular, changes in fundamental rights of every human being. society, in general. Health is viewed as a continuum (continuity, 4. The goal of Community Health Nursing is sequence), is considered as the goal of public achieved through multi-sectorial efforts. health in general, and community health 5. Community Health Nursing is part of Health nursing in particular. Care System and the larger human services system. is a lifestyle aimed at achieving physical, OCCUPATIONAL HEALTH NURSING emotional, intellectual, spiritual, and o Works in a company environmental well-being. It can increase o Specialty nursing practice that provides stamina, energy, and self-esteem, then health care services to workers & enhance quality of life. o The concept of wellness also allows for individual worker populations. variability. Wellness can be thought of a balance COMMUNITY MENTAL HEALTH NURSING of the physical, emotional, psychological, social o Works in mental hospital and spiritual aspects of a person’s life. Wellness o The primary function is to collaborate behavior are those that promote healthy functioning and help prevent illness. w/ a community-based support  The social determinants of health are the POVERTY AND HEALTH conditions in which we are born, we grow o Poor health because they don’t have the resources to afford the basic requisites of health and age, and in which we live and work. The (no health insurance). factors below impact on our health and well- o They don’t have the capacity to transact or being: negotiate with health care system. o Childhood Experiences o Poverty is an indication of the continuing social ▪ Early life experiences shape physical, injustice and failure of a country’s developmental cognitive, and emotional development, efforts. influencing long-term health outcomes. o The poor have poor health because they do not ▪ Example: a child exposed to violence have the resources to afford the basic requisites at home may develop chronic stress, of health; they are not covered by health leading to mental health issues later in insurance. life. o Housing CULTURE AND HEALTH ▪ Safe, stable, and affordable housing is o Include many things such as beliefs, values and crucial for health, as poor housing customs or practices. conditions can lead to illnesses and o Culture is, broadly speaking, a way of life; it is the injuries. totality of who we are as a people. It is stable, ▪ Example: Living in a damp, moldy which means that it endures over time and is housing can cause or exacerbate passed on from one generation to the next. As respiratory conditions like asthma. such, it is obviously an important influence on o Education people’s health. ▪ Higher education levels are associated o Culture includes beliefs, values and customs or with better health outcomes due to practices- how we socialize or interact with increased health literacy and job others, how we relax and spend our free time, the opportunities. food that we eat or do not eat, how we prepare ▪ Example: Someone with a college our food, how we treat others, how we cope with degree may have better access to our problems, how and when we seek help information about health lifestyles and among many others and a lot more. preventive care. o Social Support ENVIRONMENT AND HEALTH ▪ Strong social networks provide o Plays a direct influence on the health of people. emotional support, reduce stress, and o Ex: The increase in carbon dioxide, methane and encourage healthy behaviors. nitrous oxide (among other gases) in the earth’s ▪ Example: A person with a supportive atmosphere has depleted the ozone layer. The family is more likely to recover quickly denudation of our forest has directly or indirectly from an illness due to emotional and resulted in many health problems. Rivers have practical support. dried up or are extremely polluted, therefore o Family Income depriving many people of their major source of ▪ Higher income allows for access to dietary protein, calcium, iodine, etc. nutritious food, healthcare, and safe living conditions, promoting better POLITICS AND HEALTH health. o Health budget is the most concrete expression of ▪ Example: A family with a higher the government’s political will. income can afford regular medical o Many Filipinos do not have full access to basic check-ups, preventing serious health health goods and services because of the issues. severely limited health care financing. o Employment ▪ Employment provides income, health benefits, and social connections, all HOW THE JUSTICE SYSTEM WORKS IN THE contributing to better health. PHILIPPINES (FOR CROOKED POLITICIANS) ▪ Example: An individual with a stable job has access to employer-sponsored health insurance, reducing financial barriers to healthcare. o Our communities ▪ Community environments impact health through access to resources, safety, and social cohesion. ▪ Example: A neighborhood with parks, clean air, and community centers promotes physical activity and social interaction, enhancing overall health. o Access to health services ▪ Timely and affordable access to healthcare services is essential for maintaining and improving health. ▪ Example: Someone living in a rural area with limited healthcare facilities may suffer from untreated medical conditions due to lack of access.  2. Knowledge and understanding of the objectives and policies of the agency It is part of the larger public health effort that is facilities goal achievement. The mission concerned with preserving and promoting the statement commits Community Health Nurses health of specific populations and communities. 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 1. PROMOTION OF HEALTH the degree to which it can deal with its own - It includes all efforts that seek to move people problems. Therefore, the family is an effective closer to optimal well-being or higher level of and available channel for the most of the CHN wellness. It is the combination of educational efforts. and environmental supports for action and 4. Respect for the values, customs and beliefs condition of living conducive to health. of the clients contribute to the effectiveness of care to the client. CHN services must be 2. PREVENTION OF HEALTH PROBLEMS available sustainable and affordable to all - The action of stopping something from regardless of race, creed, color or happening or arising. socioeconomic status. 5. CHN integrated health education and 3. TREATMENT OF DISORDERS counseling as vital parts of functions. These - It focuses on the illness end of continuum and encourage and support community efforts in the is the remedial aspects of community health discussion of issues to improve the people’s practice. health. - This is practiced by: 6. Collaborative work relationships with the o A. Direct Service to people with co-workers and members of the health team health problems. facilities accomplishments of goals. Each ▪ e.g. home visit for elderly, member is helped to see how his/her work those with chronic illness. benefits the whole enterprise. o B. Indirect Service to people with 7. Periodic and continuing evaluation provides health problems. the means for assessing the degree to ▪ e.g. assisting people with which CHN goals and objectives are being health problem to obtain attained. Clients are involved in the appraisal treatment and referral. of their health program through consultations, o C. Development of program to observations and accurate recording. correct unhealthy condition. 8. Continuing staff education program quality ▪ e.g. alcoholism, drug services to client and are essential to abuse, etc upgrade and maintain sound nursing 4. REHABILITATION practices in their setting. Professional - It involves efforts which seek to reduce interest and needs of Community Health disabilities, as much as possible, and restore Nurses are considered in planning staff functions; e.g. stroke rehabilitation. development programs of the agency. 9. Utilization of indigenous and existing 5. EVALUATION community resources maximizing the - It is the process by which the practice is success of the efforts of the Community analyzed, judged, and improved according to Health Nurses. The use of local available established goals and standards. It helps to ailments. Linkages with existing community solve problems and provides direction for future resources, both public and private, increase the health care planning. awareness of what care they need what are entitled. 6. RESEARCH 10. Active participation of the individual, family - It is a systematic investigation which helps to and community in planning and making discover facts affecting community health and decisions for their health care needs, community health practices, solve problems, determine, to a large extent, the success of and explore improved methods of health the CHN programs. Organized community services. 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 1. The recognized need of individuals, families and communities provides the basis for direction to the work to be done. Potentials CHN practice. Its primary purpose is to further of employees for effective and efficient work are developed. apply public health measures within the 12. Accurate recording and reporting serve as framework of the total CHN effort. the basis for evaluation of the progress of  planned programs and activities and as a someone to explain what services to expect guide for the future actions. Maintenance of and which services they ought to receive. accurate records is a vital responsibility of community as these are utilized in studies and 4. MANAGERIAL ROLE researches and as legal documents. - As a manager the nurse exercises administrative direction towards the accomplishment of specified goals by assessing clients’ needs, planning and organizing to meet those needs, directing and controlling and evaluating the progress to assure that goals are met. Nurses serve as managers when they oversee client care, supervise ancillary staff, do case management, manage caseloads, run clinics or conduct community health needs assessment projects. 1. Participates in the development of an overall health plan. 5. COLLABORATOR ROLE 2. Provides quality nursing services. - The community health nurse assumes the role 3. Maintains coordination/linkages w/other health of collaborator, which means to work jointly in a team members. common endeavor, to co-operate as partners. 4. Initiates & conducts research relevant to CHN To whom does a nurse needs to collaborate? services. They must work with many people including 5. Initiate & provides opportunities for professional clients, other nurses, physicians, social workers growth. and community leaders, therapists, nutritionists, occupational therapists, psychologists, epidemiologists, biostatisticians, legislators, etc. as a member of the health team 1. CLINICIAN ROLE /DIRECT CARE PROVIDER (Fairly 1993, Williams, 1986). - ensures that health services are provided, not just to individuals and families but also to 6. LEADER ROLE groups and population. For community health - Community health nurses are becoming nurses, the clinician role involves certain increasingly active in the leader role. As a emphasis different from basic nursing, i.e. – leader, the nurse directs, influences, or Holism, health promotion, and skill expansion. persuades others to effect change that will positively affect people’s health. The leadership 2. EDUCATOR ROLE role’s primary function is to effect change; thus, - Health teaching is a part of good nursing the community health nurse becomes an agent practice and one of the major functions of a of change. They also seek to influence people community health nurse (Brown, 1988). to think and behave differently about their - The educator role is especially useful in health and the factors contributing to it. promoting the public’s health for two reasons. o Has the potential for finding greater 7. RESEARCH ROLE receptivity and providing higher yield - In the researcher role community health nurses results. engage in systematic investigation, collection o Is significant because wider audience and analysis of data for the purpose of solving can be reached. The emphasis problems and enhancing community health throughout the health teaching process practice. Research literally means to search continues to be placed on illness and/or to investigate, discover, and interpret prevention and health promotion. facts. All researches in community health from the simplest inquiry to the most epidemiological 3. ADVOCATE ROLE study uses the same fundamental process. - The issue of clients’ rights is important in health - The research process involves the following care today. Every patient or client has the right steps: to receive just equal and humane treatment. o Identifying an area of interest However, our present health care system is o Specify the research question or statement often characterized by fragmented and o Review of literature depersonalized services. This approach o Identifying the conceptual framework particularly affected the poor and the o Select research design disadvantaged. The community health nurse o Collect and analyze data often must act as advocate for clients pleading o Interpret the result the cause or acting on behalf of the client group. o Communicate the findings There are times when health care clients need  PRIMARY PREVENTION o refers to the prevention of an illness before it has a chance to occur. o Reduction of risk factors before occurrence of disease, condition, or PRIMARY CARE LEVEL injury. o This is the usual entry point for clients of the o Primary preventive measures apply health care delivery system. It is oriented before a disease manifests with sign towards the promotion and maintenance of and symptoms. health, the prevention of disease, the o Aims: management of common episodic disease ▪ Health promotion and the monitoring of stable or chronic ▪ Protection against illness conditions. o Examples: ▪ Eating well balanced diet SECONDARY CARE LEVEL ▪ Regular exercise program o It involves the provision of specialized ▪ Maintaining weight medical services by physician or a hospital ▪ No smoking on a referral by the primary care provider. ▪ Moderation of alcohol o A patient has developed a recognizable ▪ Information on alcohol sign and symptoms that are either substance definitively diagnosed or require further ▪ Nutritional counselling diagnosis. ▪ Environmental control o It is oriented towards clients with more ▪ Safe water Supply severe acute illnesses or chronic illnesses ▪ Good food hygiene that are exacerbated. If hospitalization ▪ Safe waste management occurs it is usually in a community (district) ▪ Vector and animal reservoir hospital. control o Most individuals who enter this level of care ▪ Good living and working are referred by primary care worker, condition although some are self-referred. The ▪ Stress management physicians who provide secondary care are usually specialists and general SECONDARY PREVENTION practitioners. o Includes the early detection of actual or potential health hazards. This allows TERTIARY CARE LEVEL for prompt intervention and possibly a o It is a level of care that is specialized and cure of a disease or condition. highly technical in diagnosing and treating o Early detection of the potential for complicated or unusually health problems. development of a disease or condition, o Patients requiring this level often present in or existence of a disease while extensive and complicated pathological aymptomatic. conditions. o It is directed forwards health o It is the most complex level of care. maintenance for patients experiencing o The illness may be life-threatening, and the health problems. care ordinarily takes place in a major o SECONDARY PREVENTION HAS hospital affiliated by a medical school. TWO SUB-LEVELS: o Clients are referred by workers from ▪ A. Early Detection primary or secondary settings. The health (diagnosis) of disease professionals, including physicians and ▪ B. Prompt Treatment. e.g. nurses tend to be highly specialized, and hypertension screen and acute they focus on their area of specialization in care. the delivery of care. o SECONDARY PREVENTION INCREASES AWARENESS OF: ▪ Breast Self Examination ▪ testicular self-examination ▪ mammography ▪ Pap smear ▪ BP screening ▪ Blood glucose screening ▪ Teaching breast self – examination ▪ Antibiotic treatment of streptococcal pharyngitis  aimed at preventing rheumatic ▪ To assess living conditions of the fever patient and his family and their ▪ “Caution” of cancer health practices. ▪ To give health teachings regarding TERTIARY PREVENTION prevention and control of diseases. o Is aimed at avoiding further ▪ To establish close relationships deterioration of an already existing between the health agencies and problem. the public. o This level of prevention occurs after a ▪ To make use of the inter-referral disease caused extensive damage. system and to promote the o Treatment of existing symptomatic utilization of community services. disease process to ameliorate its o PRINCIPLES effects, or delay or prevent its progress. ▪ Must have a purpose or objective. o Rehabilitative efforts are sometimes ▪ Should make use of all available tertiary preventive measures. It deals information about the patient. with rehabilitation and return of client to ▪ Should consider and give priority to a status of maximum function within the needs of clients. limit posed by the disease or disability ▪ Should involve the clients. and preventing further decline in ▪ Should be flexible. health. o PURPOSE OF THE VISIT o Examples: ▪ Assess health needs. ▪ Rehabilitation after stroke ▪ Perform the bag technique. ▪ smoking cessation program ▪ Perform nursing care and give with emphysema health teachings. ▪ Record all data, observation and care rendered ▪ Make appointment for a return visit. ▪ Newborn Pre-visit – initiate contact with family. ▪ Postpartum In-home ▪ Pregnant Mothers Post visit ▪ Morbid Cases GROUP CONFERENCE TELEPHONE CONTACT o If resources are available use of communication services. WRITTEN COMMUNICATION Needs of the client. o Use to give specific information such as Acceptance of the family. o instructions given to parents however the Policy of the specific agency. nurse cannot be certain that the information Other health agencies and personnel involved will reach the intended recipient if given in care of family. through the schoolchildren requiring Past services given to the families. literacy and interest. Ability of clients to recognize own needs. Greet the client and introduce self. HOME VISIT o Professional interaction that takes place in the family’s residence where instead the family going to the nurse the nurse goes to the family. o Family nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. CLINIC VISIT o Patient visits the health center to avail of the services offered by the facility primarily for the consultation on matters that ailed them physically. o PURPOSE: ▪ To give nursing care to the clients.  CORE VALUES OF DOH Integrity Excellence WORLD HEALTH ORGANIZATION Compassion and Respect for human dignity Attainment by all peoples of the highest Commitment possible of health (WHO, 2006) Professionalism CORE FUNCTIONS: Teamwork 1. Providing leadership on matters critical Stewardship of the health of the people to health and engaging in partnerships where joint action is needed. In the Philippines the components of the health care 2. Shaping the research agenda and delivery system as mandate of the Department of stimulating the generation, translation Health (DOH) is to be responsible for the following: and and dissemination valuable Formulation and development of national health knowledge. policies, guidelines, standards and manual of 3. Setting norms and promoting and operations for health services and programs. monitoring their implementation. Issuance of rules and regulations, licenses and 4. Articulating ethical and evidence-based accreditations; promulgation of national health policy options standards, goals, priorities and indicators. 5. Providing technical support, catalyzing Development of special health programs and change and building sustainable projects and advocacy for legislation on health institutional capacity. policies and programs. Known as health center. Primary level health facility in the municipality First contact health care facility that offers basic services at the barangay level. A satellite station of the RHU Manned by volunteer Barangay Health workers Department of Health (BHWs) under the supervision of the Rural mandated as the lead agency for health. Health Midwife. it has a regional office in every region and maintains specialty, regional hospitals and DOH Recommendations for Human Resource for medical centers. Health and Health Facilities Ratio to Population maintains health teams made up of DOH 1 RHU/HC Physician 20,000 population ratio representatives to local health boards and 1 Public Health Nurse 10,000 population ratio personnel. 1 Public Health Midwife 5,000 population ratio 1 Public Health Dentist 50,000 population ratio DOH VISION AND MISSION 1 RHU 20,000 population ratio VISION BY 2030: A global leader for attaining 1 BHS 5,000 population ratio better health outcomes, competitive and responsive health care system, and equitable health financing. - heads the health services at the municipal level and MISSION: To guarantee equitable, sustainable carries out the following roles and functions: and quality health for all Filipinos, especially the 1. Administrator of the RHU poor, and to lead the quest for excellence in 2. Community physician health. 3. Medico-legal officer of the municipality THE DEPARTMENT OF HEALTH DOH VISION: Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040. 1. Supervises and guides all RHMs in the municipality. Mission Statement: Lead the country in the 2. Prepares the FHSIS quarterly and annual reports of development of a productive, resilient, the municipality for submission to the Provincial equitable, and people-centered health system. Health Office Major Roles: 3. Utilizes the nursing process in responding to health 1. Leader in health care needs, including needs for health education 2. Enabler and capacity builder and promotion, of individuals, families and 3. Administrator of specific services catchment community 4. Collaborates with the other members of the health Republic Act No. 9439 An act prohibiting the team, govt agencies, private businesses, NGOs detention of patients in and people’s organization to address the hospitals and medical community’s health problems clinics on grounds of nonpayment of hospital DOH launched Nurse Deployment Project bills or medical expenses (NDP) to augment efforts of PHNs in their areas Republic Act No. 9502 An act providing for of jurisdiction. cheaper and quality medicines, amending for the purpose Republic Act 1. Manages the BHS and supervises and trains the No. 8293 or the BHW intellectual property 2. Provides midwifery services and executes health code, Republic Act No. care programs and activities for women of 6675 or the Generics Act reproductive age including family planning of 1988, and Republic counseling and services. Act No. 5921 or the 3. Conducts patient assessment and diagnosis for Pharmacy Law, and for referral or further management. other purposes Republic Act No. 8293 The intellectual property code Republic Act No. 6675 The Generics Act Republic Act 5921 Pharmacy Law HEALTHCARE DELIVERY SYSTEM Republic Act 11223 Universal Health Care The totality of “societal services and activities Law designed to protect or restore the health of President Rodrigo individuals, families, groups, and communities. Duterte has signed a It includes both government and non- Universal Health government health facilities, programs, Care (UHC) Bill into services, and activities (preventive, promotive, law. curative, and rehabilitative) Objective of UHC: to provide all Filipinos access to comprehensive and cost-effective health care that covers all spectrums of services  Generally regarded as a responsibility of the government.  Universal access to basic health services must be ensured.  The epidemiological shift from infection to degenerative must be managed.  The performance of the health sector must be enhanced.  The health and nutrition of vulnerable groups must be prioritized.  largely market-oriented and health care is paid through user fees at the point of service PREVENTIVE HEALTHCARE is a major concern  its involvement in maintaining the people’s of the government-owned health centers; while health includes providing health insurance, CURATIVE HEALTHCARE is provided by manufacture of medicines, vaccines, medical hospitals both gov't and private. supplies, equipment and other health and nutrition products, research and development,  human resource development and other health related services.  “science and art of preventing disease, prolonging life and promoting physical and mental health and well-being.” DOH leads in the efforts to improve the health of Filipinos, in partnerships with other gov't agencies, the private sector, NGOs and communities. The direction pursued by the DOH is guided by the: o Philippine Development Plan o Fourmula 1 plus The FOURmula One Plus with the tagline, “Boosting o Health Sector Reform Agenda Universal Health Care via FOURmula One Plus or F1 o Universal Healthcare Plus” hints a health reforms to a more transparent, o National Objectives for Health inclusive, coordinative and synergistic agenda with the o All for health, Health for all efforts of both the public and private sector partners especially the local government. a summary measure for assessing long-term progress in three basic dimensions of human development: a long and healthy life, access to knowledge and a decent standard of living," the UNDP defined in its country report. Department's strategic thrust for the Philippine Health Agenda. The F1+ model is composed of five pillars: o Financing o Regulation o Service Delivery o Governance and Performance o Accountability 1. Better health outcomes with no major disparity among population groups. 2. Financial risk protection for all especially the poor, marginalized and vulnerable. - UNIVERSAL HEALTH CARE LAW 3. Responsive health system which makes - President Rodrigo Duterte has signed a Universal Filipinos feel respected, valued and Health Care (UHC) Bill into law. empowered. - Objective of UHC: to provide all Filipinos access to comprehensive and cost-effective health care that covers all spectrums of services - Universal Health Coverage (UHC) - means that all individuals and communities receive the health services they need without suffering financial hardship - It automatically enrolls all Filipino citizens in the National Health Insurance Program and prescribes complementary reforms in the health system.  Persistent Inequalities in Health Outcomes Restrictive and Impoverishing Healthcare Costs Poor quality and undignified care synonymous with public clinics and hospitals  WHY IS SOLIDARITY IMPORTANT IN THE FAMILY? Solidarity is the principle that inspires action for others. It's a value that makes our lives more FAMILY meaningful, and it's a practice that strengthens a group of persons united by ties of marriage, communities. The more human solidarity we blood or adoption, constituting a single have with each other as a human family, the household, interacting and communicating with more united we're in the struggle for justice and each other, in their respective social roles, of peace. husband and wife, mother and father, son and daughter, brother and sister, creating and maintaining a common culture. CULTURE It is the foundation of social life for most this encompasses the social behavior and Filipinos. norms found in human societies as well as the WHO characterizes the family as “primary knowledge, beliefs, customs, habits, of the social agent in the promotion of health and well- individuals in these groups. being.” HOUSEHOLD – A group of persons living TRAITS under one roof and sharing the same kitchen, A distinguishing quality or characteristic and housekeeping arrangements. typically one belonging to a person. Not related by marriage, blood or adoption Not engaged in the performance of familial VALUES roles, standards or ideals that with which we evaluate actions, people, things, or situations. Nuclear family is the traditional type of family PRACTICE structure you might think of. This family type it is a way of doing something. consists of two parents and at least one child. Single-parent family consists of one parent raising one or more children on their own. This family unit Hospitable may include a single mother with her children, a o One of the popular traits of the Filipinos; It single dad with his kids, or a single person with their is the trait that refers to the warm welcome, kids. that Filipinos gives to visitors, who come to Extended family structure consists of two or more his/ her home, especially strangers and adults who are related, either by blood or marriage, foreigners. living in the same home. This family includes many relatives living together and working toward Respect to the Elderly common goals. Many extended families include o This Filipino trait as the respect accorded to cousins, aunts or uncles, and grandparents living people such as in authority, and the elderly. together. o Filipinos show the utmost respect for the Grandparent family unit, also known as a skipped- elderly with great consideration and care. generation family, is sometimes due to parents' death, addiction, abandonment, or being deemed Helpfulness/Bayanihan unfit parents. o this involve cooperation and bonding with Blended Family/Stepfamily a family where one or people. both parents have children from a previous relation o Bayanihan is the Filipino value that denotes Cohabiting Family lives together in an intimate and camaraderie among people in the committed relationship, who are not married to each community and helping one another in other and not in a civil partnership. times of need. Family Orientation/Family Ties o possess a genuine and deep love for family o It is very evident in the Philippines, that closely knit families demonstrate their deep love, for each member such as the spouse, children, parents, siblings, grand parents, and other relatives. Persons in the family feel loyal and protective of one o One’s family is the source of personal another when they invoke solidarity. They have each identity, emotional and material support, other's interests at heart and protect the family against and one’s main commitment and threats. responsibility.  EXAMPLES OF COMMON FILIPINO SUPERSTITIOUS BELIEFS: Filipino older adults tend to cope with illness with 1. By showing fondness or affection when meeting a the help of family and friends and by faith in God. baby for the first time, you may cause the baby to Complete cure or even the slightest improvement in feel uneasy or make the baby cry non-stop which is malady or illness is viewed as a miracle. commonly referred to as "na-usog. Filipino families greatly influence patient’s decision 2. Get rid of a hiccup by placing a short thread wet with about health care. saliva on the forehead. Patients subjugate personal needs and tend to go 3. Going to bed right after a shower is believed to along with the demands of a more authoritative cause blindness and insanity. family figure in order to maintain group harmony. 4. Stepping over a child will stunt his or her growth Before seeking professional help, Filipino older adults tend to manage their illnesses by self- monitoring of symptoms, ascertaining possible causes. FILIAL PIETY- is an important concept in Filipino Determining the severity and threat to functional culture. It is understood as essential in order to capacity and considering the financial and maintain the collective face of the family and to emotional burden to the family. avoid experiencing hiya. May even resort to utilizing traditional home Many Filipinos hold the belief that each family remedies such as alternative or complimentary member has several duties and responsibilities they means of treatment. must uphold. Seeking medical advice from family members or Observing one’s duties and responsibilities is friends who are health professionals is also a important in order to correctly respect others and to common practice among Filipino older adults, and ensure harmony among family members. their family members especially if severe somatic Family members are required to show respect to symptoms arise. their elders at all times. The opinions of younger family members and children’s opinions are considered to be secondary to their superior. MYSTICAL CAUSES o Are often attributed or experiences or behavior such as ancestral retribution for Patience and endurance (Tiyaga) unfinished tasks or obligations. o the ability to tolerate uncertain situations o Example: Bangungot Flexibility ▪ Some believe that the soul goes o lakas ng loob out of the body and wanders. o being respectful and honest with one self. ▪ Or having nightmares after a heavy Humor meal may result in death. o tatawanan ang problema PERSONALISTIC CAUSES o the capacity to laugh at oneself in times of o Associated with social punishment or adversity retribution from supernatural forces such as Fatalistic Resignation (Bahalana) evil spirit or witch or sorcerer o the view that illness and suffering are (mangkukulam). unavoidable and pre destined will of God in o These forces cast these spells on people if which the patient, family members and they feel jealous or feel disliked. even the physician should not interfere. o A faith healer, or an “albularyo or Conceding to the wishes of the collective herbularyo” or priests are asked to (Pakikisama) counteract and cast out these evil forces, o to maintain group harmony through the use of prayers, incantations, Camaraderie (Pakikisama or Kapwa Tao) medicinal herbs and plants. For protection, o a representative trait of the Filipinos; traits the healer may recommend using holy oils, which is shown to close friends and or wearing religious objects, amulets, or relatives; talisman (anting-anting). o This trait is translated as “companionship or NATURALISTIC CAUSES ( comrade). o includes a host of factors ranging from o This basic value expresses the Filipinos natural forces to excessive stress, food and desire to be treated equally. drug incompatibility, infection and familial o This trait is born as a result of the Filipinos susceptibility. sense of camaraderie, friendship, neighborliness, or empathy towards others. o This also refers to the expectation of being together, to make effort not to displease  others and to conform to the majority of the group. Debt of Gratitude (Utang na Loob) o still persists in the Filipino psyche, You give a Filipino a favor and he will surely remember it even if the favor has already returned the favor. o This dictates that the recipient of the good act or deed behaves generously towards his benefactor as long as he or she lives. Amor Propio o According to Carson-Arenas (2004), amor propio represents the need of the Filipino to be treated as a person, not as an object. o This word is also defined as a Spanish word, which literally means self-love, because of Amor propio, Filipinos in organization, strongly wish to be recognized, as a person who is valuable to the organization. They want to be someone the organization needs, even someone the organization cannot survive without. Objectives: Demonstrate caring as the core of nursing, love of God, love of country and love of people manifest professionalism, integrity and excellence. Project the positive professional image of a Filipino nurse. Mission: The National League for Nursing promotes excellence in nursing education to build a strong and diverse nursing workforce to advance the health of our nation and the global community. CORE VALUES (National League for Nursing) CARING: promoting health, healing and hope in response to the human condition INTEGRITY: respecting the dignity and moral wholeness of every person without conditions or limitation. DIVERSITY: affirming the uniqueness of and differences among persons, ideas, values, and ethnicities. EXCELLENCE: co-creating and implementing transformative strategies with daring ingenuity The promotion of breastmilk as the ideal food for healthy growth and development of infants; and of exclusive breastfeeding for the first 6 months of life as the means to achieve optimal growth, development, and health of newborns. Reduce allergic reactions Emotional bonding Always available Digestible Safe/maintains the stool soft Promotes immunity Temperature is always right Nutritious GIT disorders are decreased Overall Goal: To reduce the morbidity and mortality among - BCG, MMR Vaccine, Pentavalent Vaccine, Measles children against the common vaccine- Vaccine, and Hepatitis-B vaccine (+2 to +8℃ body) preventable diseases. Vaccine Dosage Age Given # of Route/Site Diseases Doses Prevented Specific Goals: BCG (Bacillus 0.05 ml At birth (90 1 ID Tuberculosis To immunize all infants/children against the Calmette Guerin) Hepa B 0.5 ml min after) At birth 1 R Deltoid IM Hepatitis B most common vaccine-preventable diseases. R Thigh To sustain polio-free status of the Philippines. Penta HIB 0.5 ml 6 weeks 3 IM Diphtheria, 10 weeks R Thigh Tetanus, 14 weeks Pertussis, To eliminate measles infection. Hepatitis B, Haemophilus To eliminate maternal and neonatal tetanus. Influenzae type b (Hib) To control diphtheria, pertussis, hepatitis B, and MMR (Measles, 0.5 ml 9 months 2 SQ diseases Measles, German measles. Mumps, Rubella) 12 months R Deltoid Mumps, Rubella To prevent extra pulmonary tuberculosis Rota virus 0.1 ml 6 weeks 10 weeks 2 Oral Rota virus among children. TD (Tetanus 0.5 ml Pregnant 5 IM Tetanus Diphtheria) Deltoid Diphtheria TD (Tetanus 0.5 ml Grade 1 2 IM Tetanus Diphtheria) Grade 7 Deltoid Diphtheria OPV (Oral Polio 2 QTTS 6 weeks 3 Oral Polio Mandatory Infants and Children Health vaccine) 10 weeks 14 weeks Immunization Act of 2011 IPV (Inactivated Polio 0.5 ml 14 weeks 1 IM Polio Vaccine) (given on 3rd L Thigh Requires that all children under five years old dose of OPV) be given basic immunization against vaccine- PCV (Pneumococcal 0.5 ml 6 weeks 3 IM Pneumonia Conjugated Vaccine) 10 weeks L Thigh preventable diseases. Specifically, this bill 14 weeks provides for all infants to be given birth dose of Hepatitis-B vaccine within 24 hours of birth. - Protects against five major diseases. - Diphtheria: Corynebacterium diphteriae is a - Is a system for storing and transporting vaccines in bacterium which can cause myocarditis good condition from the manufacturer to the person (inflammation of the heart muscle), inflammation of being immunized. nerves and kidney problems. - Oral Polio Vaccine = -15 to -25℃ freezer - Tetanus: Caused by Clostridium tetani bacterium, which is commonly found in soil, saliva, dust and manure, the infection is characterized by muscle - Is a thermochromics label put on vials containing spasms. vaccines which gives a visual indication of whether - Pertussis (Whooping Cough): Pertussis or the vaccine has been kept at a temperature which whooping cough is a highly infectious airborne preserve its potency.  bacterial disease. It spreads easily from infected Mission: persons and is fatal cases among infants. The state shall ensure quality, affordable, - Haemophilus influenzae type b: Haemophilus accessible and available oral health care influenzae type b (Hib) is a deadly bacterium which delivery. can cause meningitis, pneumonia and septicemia. - Hepatitis B: The hepatitis B (hepB) virus is the Goal: leading cause of liver cancer and is 50 times more infectious than HIV. While infections occur mostly in Attainment of improved quality of life through promotion of oral health and quality oral health young children, the deadly consequences of the care. virus usually strike later in life in the form of liver disease, including cirrhosis and liver cancer. Objectives: To increase proportion of Orally Fit Children (OFC) under 6 years old to 12% by 20% by Malnutrition continues to be the public health concerns 2020. in the country. The common nutritional deficiencies are: 1. Vitamin A To control oral health risks among the young 2. Iron people. 3. Iodine To improve the oral health conditions of pregnant women by 20% and older persons by Goal: 10% every year till 2016. To improve the quality of life of Filipinos through better nutrition, improved health, and increased productivity. regular visits to the dentist for early diagnosis and preventive care; professionally applied fluorides & sealants; 1. Food based interventions improvements is nutritional status for sustained well balanced diet; 2. Life-cycle approach with strategic attention to 0-3 minimize eating sugary foods and years old children, adolescent females and good plaque control through regular tooth pregnant/lactating women. brushing and flossing. 3. Effective complementation of nutrition interventions with other services 4. Geographical focus to needier areas regular visits to the dentist for early detection and treatment; 1. Micronutrient Supplementation regular and proper tooth brushing and 2. Food Fortification healthy lifestyle such as avoidance of tobacco 3. Essential Maternal and Child Health Services smoking, drugs and excessive alcohol-intake Package 4. Nutrition information, communication and education 5. Home, School and Community Food Production 6. Food Assistance includes center based complementary feeding for wasted/stunted children and pregnant women 7. Livelihood Assistance is done by provision of credit and livelihood opportunities to poor Dental Caries (tooth decay) and Periodontal Diseases (gum diseases) are the two most common oral health diseases affecting the Filipinos. 87.4% Filipinos are suffering from dental caries while 48.3% have gum disease (based on the 2011 National Monitoring and Evaluation Dental Survey) Vision: Empowered and responsible Filipino citizens taking care of their own personal oral health for an enhanced quality of life.  Under Section 4 of RA 11469, the law grants the President 30 special powers to address the COVID-19 According to World Health Organization (WHO), Mental outbreak in the country: Health is a “state of well-being in which an individual realizes his or her own abilities, can cope with the 1. Adopt and implement these measures to prevent normal stressors of life and can work productively and further spread of the coronavirus, following the able to make a contribution to his or her community” World Health Organization (WHO) guidelines; 2. Expedite and streamline the accreditation of testing kits and facilitate the testing of PUIs and Poverty and its associated psychosocial PUMs by public and private hospitals, as well as stressors (e.g. violence, unemployment, social the immediate isolation and treatment of patients; exclusion like quarantine isolation, insecurity) 3. Ensure that all local government units (LGUs) are acting according to the regulations and directives low education issued by the national government while inequality within communities implementing the standards of the community quarantine to their respective locales. The LGUs are still allowed to exercise their autonomy in Mental, neurological and substance use situations not defined by the national government; disorders are common in all regions of the 4. The authority to give 18 million low-income world, affecting every community and age families P5,000 to P8,000 a month in emergency group across all income countries. cash aid — depending on the prevailing minimum wage in the region— for two months; 14% of the global burden of disease is 5. Give health workers a special risk allowance on attributed to mental, neurological and top of their regular hazard pay; substance use disorders. 6. Direct PhilHealth to shoulder all medical costs of 75% in low-income countries do not have workers exposed to the coronavirus for the access to the treatment they need. duration of the emergency; 7. Mandate that public and private health workers who contract the virus will be given P100,000, and P1 million for the families of health workers who Scaling up services for mental, neurological succumbed to the virus while in the line of duty; and substance use disorders for countries with 8. Take over private medical facilities; low and middle-income. 9. Discontinue appropriated programs or activities of The program asserts that with proper care, agencies of the executive branch —including psychosocial assistance and medication, tens government-owned and controlled corporations of millions could be treated for depression, — to save money. The savings will then be schizophrenia and epilepsy, prevention from allocated for support operations and response suicide and begin to lead normal lives, even measures in the fight against Covid 19; where resources are scarce. 10. Enforce protective measures against hoarding and profiteering of commodities such as food, fuel, medicine, and medical supplies; World Mental Health Forum, held at Geneva 11. Ensure that donation, acceptance, and last October 14-15, 2019 distribution of health products are not delayed; 12. Secure goods such as protective laboratory and The World Mental Health Forum 2019 medical equipment, medical supplies, tools, (previously “mhGAP Forum”) has provided an testing kits, facilities and venues, and others in an opportunity for diverse stakeholders to discuss efficient manner; progress on WHO’s Mental Health Action Plan 13. Partner with the Philippine Red Cross as the in countries. The theme was “Enhancing primary humanitarian agency; Country Action on Mental Health,” reflecting the 14. Engage temporary Human Resources for Health vision of WHO’s Thirteenth General (HRH) to complement or supplement the current Programme of Work, 2019-2023. workforce in hospitals and other facilities; 15. Ensure the availability of credit to the productive sectors of the economy by lowering the lending Originally Published: March 23, 2020 interest rates and reserve requirements of lending institutions; Signed: March 24, 2020 16. Ease up grant incentives for the manufacture or Effectivity: March 25, 2020 importation of much needed equipment or Signed: President Rodrigo Duterte supplies, including medical equipment and supplies; Territorial Extent: Philippines 17. Ensure the availability of essential goods through a comprehensive air recognizing the primary quality management responsibility of local measures that will reduce interference to the policy and program which government units to deal supply chain; aims to achieve and with environmental maintain healthy air for all problems. 18. Require businesses to prioritize and accept Filipinos. contracts for services and materials necessary to RA 6675 Generics Act of 1988 -To ensure that affordable promote the law; and effective drugs are -an act to promote, require made available to all 19. Regulate and limit the operation of land, sea and and ensure the production Filipinos air transportation, private or public; of an adequate supply, -To ensure the adequate distribution, use and supply of drugs with 20. Regulate traffic on all roads, streets, bridges, et al; acceptance of drugs and generic names at the 21. Continue to authorize alternative working medicines identified by lowest possible cost their generic names. arrangements for employees and workers in the RA 7875 National Health Insurance provide all citizens of the executive branch, and if necessary, other Act of 1995 Philippines with the independent branches of government and the mechanism to gain Republic of the Philippines financial access to health private sector; declares that the State shall services; adopt an integrated and 22. Regulate the distribution and use of energy, fuel, comprehensive approach to and water, and ensure sufficient supply of these; health development which shall endeavor to make 23. Use unutilized funds to fight against the essential goods, health and other social services available coronavirus. Any unutilized funds shall be to all the people at affordable considered abandoned during the State of cost. Priority for the needs of the underprivileged, sick, Emergency; elderly, disabled, women, and 24. Authorize to allocate funds — including unutilized children shall be recognized. Likewise, it shall be the policy or unreleased subsidiaries held by GOCCs — to of the State to provide free medical care to paupers address the COVID-19 emergency; RA 7719 National Blood Services promotes voluntary blood 25. Move the deadline and timeline for the submission Act donation to provide sufficient supply of safe and filing of documents, taxes, fees, and others An act promoting blood and to regulate blood while in community quarantine; voluntary blood donation, banks providing for an adequate 26. Direct banks and other financial institutions — supply of safe blood, including GSIS, SSS and Pag-IBIG Fund — to regulating blood banks. implement a 30-day grace period for payments of RA 11332 LAW OF NOTIFIABLE continuously develop and DISEASE (Mandatory upgrade the list of loans and credit card bills; Reporting of Notifiable nationally notifiable 27. Provide a 30-day grace period on residential rents Diseases and Health diseases and health events Events of Public Health of public health concern within the period of the ECQ without incurring Concern Act) with their corresponding interests, penalties, et al; case definitions and An act providing policies laboratory confirmation. 28. Implement an expanded Pantawid Pamilya and prescribing Pilipino Program to include persons working in procedures on informal economy (self-employed, construction, surveillance and response to notifiable diseases, etc.) and those who are not recipients of the epidemics, and health current Pantawid Pamilya Pilipino Program; events of public health concern. 29. Lift the 30-percent cap on the amount RA 7432 SENIOR CITIZEN ACT (a) to motivate and encourage appropriated for the quick response fund; and (Act to Maximize the the senior citizens to contribute Contribution of Senior to nation building; 30. Undertake other reasonable and necessary Citizens to Nation (b) to encourage their families