Healthcare Delivery System PDF

THE HEALTHCARE DELIVERY SYSTEM HEALTH SYSTEM “The combination of resources, organization, financing, and management that culminate in the delivery of health services to the population” The institution that caters to our health It cannot be a health system without the resources...

THE HEALTHCARE DELIVERY SYSTEM HEALTH SYSTEM “The combination of resources, organization, financing, and management that culminate in the delivery of health services to the population” The institution that caters to our health It cannot be a health system without the resources (san ka kukuha o sino ang pagkukuahanan mo?), organization (mga group or people or institution with relation in the health system), financing (kanino manggagaling yung pera or sino management of money) It is important to function or give services with these parameters like resources, organization, financing, and management; without these, it won’t be called a health system HEALTHCARE DELIVERY SYSTEM An organization that provides resources and treatments that help people when sick or injured and helps them stay healthy through preventive care ○ When you are sick, the mode of delivery of health services is the health care delivery system; they cater to your health It includes all the institutions, organizations, people, and resources that help a particular group of people stay healthy ○ The main target or objective is with regards to your health: to cure you, to prevent sickness ○ Not only hospitals WORLD HEALTH ORGANIZATION (WHO) Specialized agency of the united nations (UN) Provides global leadership on health matters ○ This was proven, and one example was during the pandemic, where through media, may kinakausap or ini-interview ang mga scientists. They are working and creating ways to find cures for COVID-19 or vaccines WHO constitution ○ Its objective is the attainment by all people of the highest possible level of health Core functions: ○ Providing leadership on matters critical to health and engaging in partnerships where joint actions are needed Ex. During COVID-19, protocols and policies came from WHO to DOH to the 17 regions Ex. the vaccines did not only come from the Philippines. Some were formulated from other countries ○ Shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge Ex. vaccines came through research  ○ Setting norms and standards and promoting and monitoring their implementation Ex. dengvaxia. When a new vaccine is coming out from the market, the WHO should be the ones to monitor these vaccinations ○ Articulating ethical and evidence-based policy options Hindi lang puro research It should also have something to do with the ethical aspect ○ Providing technical support, catalyzing change, and building sustainable institutional capacity Ang WHO and nage-empower, nagpapa-train, and nagsusuporta sa mga 3rd world countries In the past decade, WHO with DOH ○ Energy, environment, and social justice ○ Development and provisions of services towards the attainment of health-related Millennium Development Goals (MDGs) Bago mag SDGs merong MDGs. these MDGs (12 goals) would be for global problems Yung mga MDGs, after the reign of Nonoy, napaltan into SDG by Duterte ○ 2016 — Sustainable Development Goals or SDGs (more detailed than MDGs; 17 goals) that are now incorporated into the law The SDGs cover a broad range of social and economic development issues. These include poverty, hunger, health, education, climate change, gender equality, water, and sanitation When we talk about the SDGs, these are the issues or problems that need to be addressed and solved SDG Goal 3: Ensure healthy lives and promote well-being for all at all ages Aim: achieve universal health coverage and provide access to safe and affordable medicines and vaccines for all. Supporting research and development for vaccines is an essential part of this We don’t have a healthy population in the Philippines, but the community is doing something One way to do this is to provide services and give health programs to the people (which can be done by the barangays) Prevention and treatment, education, immunization campaigns, and sexual and reproductive healthcare ○ There are vaccines for senior citizens, adults, and children ○ Education: there are health teaching classes or organizations that have created different classes like mother’s class Commitment to end the epidemics of AIDS, tuberculosis, malaria, and other communicable diseases by 2030 Process as well THE PHILIPPINE HEALTHCARE DELIVERY SYSTEM DUAL HEALTH SYSTEM Public sector: headed by DOH Private sector: headed/governed by the DOH. Without any guidelines, they cannot go with any program PUBLIC SECTOR Largely financed through a tax-based budgeting system, where government facilities deliver health services under the national and local governments Both cater to the national (manila) and local (ating mga boards sa province)governments Department of Health (DOH) ○ Government corporate hospitals, specialty and regional hospitals ○ The main governing body of health services in the country ○ Provides guidance and technical assistance to LGUs (local government unit; tayo yan) through the Center for Health Development in each of the 17 regions ○ Holds the overall technical authority on health as it is a national health-policy maker and regulatory institution Hindi tayo magkakaroon ng kahit ano without the DOH when it comes to health concerns; all concerns, policies, and guidelines come from the DOH ○ Basically, the DOH has three major roles in the health sector: Leadership in health Enabler and capacity builder The administrator of specific services ○ Its mandate is to develop national plans, technical standards, and guidelines on health ○ Aside from being the regulator of all health services and products, the DOH is the provider of special tertiary health care services and technical assistance to health providers and stakeholders Department of National Defense ○ Military hospitals PRIVATE SECTOR May bayad Binabayaran ung services To be able to utilize their services, you need to pay Composed of for-profit and nonprofit agencies Market-oriented, where health is generally paid for through Ex. private hospital, health insurance, diagnostic or laboratory centers, private clinics Financing of health services (3 major groups): ○ Government (national and local) ○ Private sources ○ Social health insurance  Philippine Health Insurance Corporation (PhilHealth) ○ National Health Insurance Act of 1995 ○ RA 7875 – creation of PhilHealth ○ Way of helping the patient: during hospitalization, kapag nagda-dialysis, kapag na-confine (zero billing) ○ Tax-exempt government corporation attached to the DOH for policy coordination and guidance ○ Aims for universal health coverage for all Filipino citizen ○ The majority of the hospitals are PhilHealth-accredited PHILIPPINE HEALTH SECTOR BY THE NUMBERS Infrastructures ○ 1224 hospitals ○ 2587 city/rural health centers ○ 20,216 village health stations ○ 64% level 1 hospitals ○ 10% level 3 medical centers and teaching hospitals ○ ⅔ hospital beds in Luzon, including NCR ○ 23:10,000 (hospital beds to people) NCR ○ 8.2:10,000 (LUZON) ○ 7.8:10,000 (VISAYAS) ○ 8.3:10,000 (MINDANAO) Health human resources ○ Records from the Professional Regulation Commission as of March 2024 showed there are 951,105 registered nurses (RNs), but only 509,297 are active (only 53.5 percent), and 159,283 doctors, but only 95,039 are practicing (59.7) ○ In short, 441,808 RNs are not practicing, and 64,244 doctors are not active ○ Yung iba raw hindi rito sa Phillipines nagpra-practice kundi sa abroad Health human resources (in the public sector) ○ Ideal ratio 1:10,000 doctors to patient 1:12 nurses to patient ○ Reality 1:26,000 doctors to patient 1:50 (and above) nurses to patient LEVELS OF HEALTHCARE DELIVERY DOH Administrative Order 2012-0012 ○ Rules and regulations governing the new classification of hospitals and other health facilities in the Philippines  HOSPITALS OTHER HEALTH FACILITIES Definition: Primary care facilities Lahat kine-cater, lahat ng sakit, injuries, and deformities First-contact health care Provides services for all kinds of illnesses, injuries or deformities facility that offers basic services, including General emergency services and Level 1 provision for normal ○ Most basic (need to cater to all general services like ER, deliveries DR, etc.) ○ Cater to patients who need minor care and supervision Custodial care facilities ○ Must include: Provides long-term care to Operating room patients with chronic Post-operative recovery room conditions requiring Maternity facilities ongoing health and ○ Facilities nursing care due to Isolation facilities impairment and a reduced Dental Clinic degree of independence in Blood station ADLs, and patients in need Clinical Laboratory of rehabilitation Level 1 imaging facility (X-ray) Ex. orphanages, nursing Pharmacy centers, houses for elderly, Level 2 rehabilitation ○ If a patient needs something that cannot be found in Level 1, they can find it here in Level 2 Diagnostic/therapeutic facilities ○ Need for a referral (from level 1) For the examination of the ○ Contains all available facilities in level 1 and additional human body, specimens facilities: (blood, semen, urine) from ICU for critically ill patients the human body for the NICU diagnosis, sometimes HRPU (high-risk pregnancy unit) treatment of disease, or Respiratory therapy services water for drinking water Specialist doctors for OB-Gyne, pediatric services, analysis medicine, surgery, their subspecialty and ancillary services Clinical Laboratory Level 2 imaging facility (mobile X-ray and contrast examinations; mas malinaw ung imaging ng dye x-ray) Level 3 (are teaching or training hospitals) ○ Teaching and/or training hospital ○ It contains all the facilities of Level 2 ○ Specialized facilities Physical medicine and rehabilitation unit Ambulatory surgical clinic Dialysis facility Respiratory therapy services Blood blank Clinical Laboratory Level 3 imaging facility (interventional radiology) Specialty Specialized outpatient facilities Performs highly Definition: specialized procedures on Caters few or special cases an outpatient basis Offers services for a specific disease or condition or type of Mga clinics (private), may patient (children, elderly, or women) ginagawa silang procedures like debridement (ung sa mga Specialty hospitals sugat), circumcision a. Treatment of a particular type of illness i. Ex. Benavides Cancer Institute b. Treatment of patients suffering from diseases of a particular organ or group of organs i. Ex. Philippine Heart Center c. Treatment of patients belonging to a particular group i. Ex. National Children's Hospital LOCAL HEALTH BOARD Devolution ○ Act by which the national government confers power and authority upon the various LGUs to perform specific functions and responsibilities ○ Decision-making and accountability on basic government services closer to the people All health services were under their control ○ Advantage: allowed local leaders to have a greater hand in the future of communities ○ Disadvantage: fragmentation of the health care delivery system in the Philippines Nahati kasi from the national government to the local government RA 7160 (Local Government Code) ○ Genuine and meaningful local autonomy ○ This will enable local government to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals Makakatayo ang mga community or local government on their own; hindi na sila aasa sa national government pero they are still partners with them with accordance to their national goals ○ Creation of the: Provincial Health Board City/Municipal Health Boards Provincial governments ○ Responsible for the administration of provincial and district hospitals Municipal and city governments ○ In charge of the Primary Care Rural Health Centers (RHU)/Health Center - under the mayor Satellite Ourposts - Barangay Health Stations (BHS) THE MANILA HEALTH DEPARTMENT The department is concerned mainly with the promotion of health and prevention of diseases to the Manila constituents, with a special focus on poor families Kapag ikaw ay pinanganak and resident ng manila, ikaw ang priority Parang DOH ng mga taga-manila Health Centers Thrust Program ○ Maternal and child health (may kinalaman sa mom and anak) Maternal care Safe motherhood and women’s health Expanded program on immunization Control of acute respiratory infections Control of diarrheal diseases Under five clinic/growth monitoring Breastfeeding promotion Nutrition  ○ Communicable disease control Tuberculosis Leprosy Sexually transmitted diseases Dengue prevention and control program ○ Non-communicable disease control Cardiovascular disease Cancer control Primary eye care National voluntary blood donation Diabetes mellitus control RURAL HEALTH UNIT Another government sector Commonly known as a health center Primary-level healthcare facility in the municipality Focus: preventive and promotive health services and the supervision of Barangay Health Stations (BHSs) under its jurisdiction They also cater for minor diseases 1 RHU: 20,000 population THE HEALTH REFERRAL SYSTEM Referral ○ Set of activities undertaken by a healthcare provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient’s need ○ We are nagre-refer kasi may mga services na not available in our health systems, so we can be referred from one institution to another Functional referral system ○ Ensures the continuity and complementation of health and medical services ○ Comprehensive, encompassing, promotive, preventive, curative, and rehabilitative care ○ Engages all health facilities from the lowest to highest level For example, you went to the health center to take BP. The nurse in RHU takes the BP, it happens that you have a record already tapos nakalagay na laging borderline or hindi bumababa BP mo, kaya you will be referred now to a level 1 hospital Two-way referral system ○ Movement of a patient from the health center of first contact and the hospital at the first referral level ○ When hospital intervention has been completed, the patient is referred back to the health center Ex. binalik ka sa health center after pumunta sa level 1 hosp. Sabi ng doctor na magpa bp ka for 1 month sa health center tas gawa diary and then balik sa doc again  Internal referral ○ Occurs within the health facility, from one health personnel to another External referral ○ Movement of a patient from one health facility to another ○ Vertical - patient referral may be from lower to a higher level of health facilities or other way around ○ Horizontal - patient is referred between similar facilities in different catchment areas OTHER HEALTHCARE SETTING Community immersion ○ Implementation of an intervention program to the identified problems in the community setting Rehabilitation setting ○ UST-CRS Speech-Language Pathology LAB The world-class slate of art laboratory and classroom are designed for Speech-Language Pathology Education and Research Located inside the UST Central Laboratory Building  PATIENT’S BILL OF RIGHTS PATIENT’S BILL OF RIGHTS This acknowledges a client’s right to participate in their healthcare, emphasizing autonomy and the right to choose their care All healthcare agencies must post this in a visible area 1. Right to appropriate medical care and humane (humane: tender or caring) treatment a. Access to good quality health and medical care without discrimination, based on available resources, staff, and expertise b. Treat patients equally and fairly despite differences c. In emergencies, patients must be referred for treatment if immediate care isn’t possible, without requiring any upfront payment or guarantee d. Render special and critical conditions first before asking for payment 2. Right to informed consent a. Patients have the right to a clear and understandable explanation (considering their level of knowledge and language of choice) of the following: i. The proposed medical procedures (diagnostic, preventive, curative, rehabilitative, or therapeutic) ii. The name and credentials of the person performing the procedure iii. Potential risks, including mortality or serious side effects iv. Recovery challenges, chances of success, and any reasonable risks involve b. When you undergo a procedure, you need to lay your cards to the patient c. Written consent is a form of paper that requires you to get a patient's permission. Informed consent is a way how to explain what is written in the written consent d. A patient won’t undergo any procedure without written informed consent, except in these cases: i. In emergencies, where delaying treatment risks serious injury or death ii. When a mass health program is needed to control an epidemic iii. When the law mandates the procedure for everyone iv. When the patient is a minor or legally incompetent, requiring third-party consent v. When sharing information with the patient could jeopardize the treatment's success, requiring third-party consent vi. When the patient waives their right to writing e. Informed consent should be obtained from the patient if they are of legal age and have a sound mind. If the patient is unable to give consent, the following people can give consent in this order: i. Spouse ii. An adult son or daughter iii. Either parent iv. Adult brother or sister v. Guardian 3. Right to privacy and confidentiality a. Patients have the right to freedom from unnecessary public exposure, except in these cases: i. When the court orders a physical or mental examination due to a legal dispute ii. When public health and safety require it (it can cause harm to others if hindi sinunod) iii. When the patient waives this right in writing b. Information can be disclosed under the following conditions: i. To benefit public health and safety ii. When required by a court for justice iii. If the patient waives confidentiality in writing iv. For ongoing medical treatment or medical research, provided the patient’s identity is protected and confidentiality is maintained 4. Right to information a. Disease evaluation: summary of the illness and its severity b. Treatments: any planned medical or surgical procedures c. Medications: new meds, their generic names, and potential side effects d. Relevant information: key facts and research about the illness e. Care plan changes: review any updates to the care plan before implementation f. Participation: the person’s role in the care plan and any required changes before starting (who’s the doctor) g. Payment: expected coverage from PhilHealth or other payers and any out-of-pocket costs i. Ex. a patient was operated and kailangang mag cash out daw siya kasi hindi kaya ma-cover with the use of card, so need ito malaman ng patient h. Care team: the healthcare professionals involved and how often services will be provided i. Itemized bill: right to review and receive a detailed hospital and medical services i. Your bill statement is malaki tas may sugat ka raw kahit wala, so pwede mo ito pa-delete sa kanila j. Post-discharge care: information on ongoing health care needs after leaving the hospital k. Illness summary: right to a brief written summary of the illness and treatment i. Para proof na you were hospitalized 5. Right to choose healthcare provider and facility a. Choice of provider: the patient can choose their healthcare provider and facility unless they are in a service facility, public health and safety require otherwise, or they waive this right in writing b. Specialist consultation: the patient has the right to discuss their condition with a specialist if requested and paid for by the patient c. Second opinions: right to seek additional opinions from other healthcare providers, if needed 6. Right to self-determination a. Diagnostic and treatment procedures: right to access recommended diagnostic and treatment procedures i. Ikaw lang ang pwede magdesisyon para sa sarili mo b. Advance directive: adults of sound mind can create a written directive for terminal care if they are in the final stages of a terminal illness i. Kunwari unconscious ka, kahit gustuhin ng relative mong buhayin ka, hindi pwede kasi may DNR (do not resusciate) ka and you have the right to self-determination 7. Right to religious belief a. Refusal of treatment: i. Right to refuse medical treatments that go against religious beliefs, with the exception that parents cannot impose this refusal on their minor children in life-threatening situations, as determined by the attending physician or facility director ii. Right to practice your religious belief if it will not jeopardize or affect your condition iii. Right to refuse a treatment you don’t want to do iv. Ex. Jehovah's Witness cannot receive blood v. If patient is bata at wala syang kakayang mag-sign ng consent, they are under the care of their parents and the parents have no right to refuse kasi if ang need ng bata yung treatment, need ibigay ‘yun 8. Right to medical records a. Medical summary: right to receive a summary of medical history and condition i. Should not exceed 130 or 140 days ii. Dapat makuha ng patient within the said date b. Record access: right to view medical records (excluding psychiatric notes and incriminating information about others), with explanations from the attending physician c. Medical certificate: The institution must provide a medical certificate upon request d. Insurance documents: any required documents for insurance claims must be available within 45 days of request 9. Right to leave a. When the patient wants to go home and leave, they can leave the hospital or healthcare facilities regardless of their physical condition, as long as: i. Informed: they are informed of the medical risks of leaving ii. Release: they release the care providers from responsibility for the consequences iii. Public safety: their departure does not harm public health and safety b. You can leave, but you need to sign a waiver where it is said that the medical practitioners are not responsible for whatever will happen when discharged c. You cannot leave when your sickness can be nakakahawa sa public 10. Right to refuse participation in medical research  a. Research participation: right to be informed if involved in medical research or experiments, which requires the patient’s written informed consent 11. Right to correspondence and receive visitors a. You must follow the regulations and guidelines when visiting, such as the visiting hours, special areas, etc. b. Communication and visitors: right to communicate with relatives and others and to receive visitors within the reasonable limits set by the healthcare institution’s rules and regulations 12. Right to express grievances a. Complaints and grievances: the right to express complaints about care and services without fear of discrimination or retaliation and to be informed about how these complaints are handled. The system should provide a fair opportunity to resolve grievances amicably i. Dapat pwede pang mapag-usapan kung ano ang problema THERAPEUTIC COMMUNICATION When patients say that they don’t want to live anymore, there are techniques we can do or say to them COMMUNICATION The term communication has various meanings, depending on the context in which it is used To some, communication is the interchange of information between two or more people; in other words, the exchange of ideas and thoughts ○ Two-way process Thoughts are expressed to others not only by spoken or written words but also by gestures or bodily actions It can be a transmission of feeling or a more personal and social interaction between people Any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including health professions and other disciplines ○ When we deal with our patients, we exchange our information, feelings, or ideas (making kwento ganon) We need to be able to establish a ___ to have a relationship with the patient COMMUNICATION PROCESS Face-to-face communication involves a sender, a message, a receiver, and a response or feedback Sender  ○ A person or group who wishes to communicate a message to another person Message ○ Said or written ○ Body language that accompanies the words and how the message is transmitted ○ The method used to convey the message can target any of the receiver’s senses Receiver ○ 3rd component of the communication process ○ Listener ○ The decoder must perceive what the sender intended Feedback ○ Verbal, nonverbal, or both. Non-verbal examples: nod or yawn ○ Either way, feedback allows the sender to correct or reword a message MODES OF COMMUNICATION Verbal communications ○ It uses the spoken or written words Nonverbal communication ○ Sometimes called body language ○ It uses other forms, such as gestures, body movements, physical appearance (including adornment) facial expressions, and touch Personal appearance Clothing and adornments can be sources of information about a person Although the choice of apparel is highly personal, it may convey social and financial status, culture, religion, group association, and self-concept Posture and gait The way people walk and carry themselves are often reliable indicators of self-concept, current mood, and health Facial expression No part of the body is as expressive as the face. Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expressions Although the face may express the person’s genuine emotions, it is also possible to control these muscles so the emotion expressed does not reflect what the person is feeling ○ There are times that you should not show your facial expressions or emotions because it won’t be therapeutic anymore Gestures  Hand and body gestures may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign Ex. a father awaiting info abt his son in surgery may wring his hands, tap his foot, pick his nails, or pace back and forth ○ To observe nonverbal behavior efficiently requires a systematic assessment of the person’s overall physical appearance, posture, gait, facial expression, and gestures THERAPEUTIC COMMUNICATION Therapeutic touch is considered to be a form of communication It requires the use of verbal and nonverbal techniques that are focused on the client's needs and not the needs of the healthcare provider ○ nonverbal communication: therapeutic touch It requires the avoidance of unhelpful or non-therapeutic techniques Promotes understanding and can help establish a constructive relationship between the HCP and the client Unlike a social relationship, where there may not be a specific purpose or direction, the therapeutic helping relationship is client and goal-directed (may object for the patient) ○ The difference with ordinary communication is that there is no purpose or direction THERAPEUTIC COMMUNICATION TECHNIQUES Using silence ○ Description Accepting pauses or silences that may extend or several seconds or minutes without interjecting any verbal response Nanduon ka lang at wala kang sasabihin ○ Example Sitting quietly (or walking with the client) and waiting attentively until the client can put thoughts and feelings into words Providing general leads  ○ Description Using statements or questions that Encourage the client to verbalize Choose a topic of conversation Facilitate continued verbalization Gumagawa ka ng paraan ng pag-uusapan ○ Example “Can you tell me how it is for you? “Perhaps you would like to talk about… “Would it help to discuss your feelings? “Where would you like to begin? “And then what? Using open-ended questions ○ Description Asking broad questions that lead or invite the client to explore (elaborate, clarify, describe, compare, or illustrate) thoughts or feelings. Open-ended questions specify only the topic to be discussed and invite answers that are longer than one or two words Closes-ended: yes or no; open-ended: can clarify, elaborate, describe, illustrate Pwede ka magkwento ○ Example “I’d like to hear more about that.” “Tell me more…” “How have you been feeling lately?” “What brought you to the hospital?” “What is your opinion?” “You said you were frightened yesterday. How do you feel now?” Using touch ○ Description Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals, families, and cultures, the HCP must be sensitive to the differences in attitudes and practices of clients and self Should be careful because other nationalities and cultures that think badly of touch ○ Example Putting arm over the shoulder/Rubbing shoulder Placing your hand over the hand of the client Restating or paraphrasing ○ Description Actively listening for the client’s basic message and then repeating those thoughts and/or feelings in similar words  This conveys that HCP has listened and understood the client’s basic message and also offers clients a clearer idea of what they have said ○ Examples Client: “I couldn’t manage to eat any dinner last night—not even the dessert.” HCP: “you had difficulty eating yesterday” Client: “yes, i was very upset after my family left” Seeking clarification ○ Description A method of making the client’s broad overall meaning of the message more understandable. It is used when paraphrasing is difficult or when the communication is rambling or garbled To clarify the message, the HCP can restate the basic message or confess confusion and ask the client to repeat or restate the message HCP can also clarify the message with statements Parang nakikinig ka kasi nagcla-clarify ka ○ Example “I’m puzzled.” ‘I’m not sure I understand that.” “Would you please say that again?” “Would you tell me more?” “I meant this rather than that” “I’m sorry that wasn’t very clear. Let me try to explain it another way” Offering self ○ Description Suggesting one’s presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the HCP’s attention Nagvo-volunteer ka ○ Example “I’ll stay with you until your daughter arrives.” “We can sit here quietly for a while; we don’t need to talk unless you would like to.” “I’ll help you to dress to go home, if you like.” Giving information ○ Description Providing, in a simple and direct manner, specific factual information the clien may or may not request. When the information is not know, the HCP states this and indicates who has it or when the HCP will obtain it ○ Example “Your surgery is scheduled for 11am tomorrow.” “You will feel a pulling sensation when the tube is removed from your abdomen.”  “I do not know the answer to that, but I will find out from Dr. King, the resident in charge.” Acknowledging ○ Description Giving recognition, in a non-judgmental way, of a change in behavior, an effort the client has made, or a contribution to a communication Acknowledgment may be with or without understanding, verbal or nonverbal It is also to boost the morale of the patient ○ Example “You trimmed your beard and mustache and washed your hair.” “I noticed you keep squinting your eyes. Are you having difficulty seeing?” “You walked twice as far today with your walker.” Presenting reality ○ Description Helping the client to differentiate the real from the unreal For the aged, iba na interpretation nila sa bagay-bagay kaya you need to present them reality or tell them factual things ○ Example “That telephone ring came from the program on television.” “Your magazine is here in the drawer. It has not been stolen.” Focusing ○ Description Helping the client expand on and develop a topic of importance, it is important for the HCP to wait until the client finishes stating the main concerns before attempting to focus The focus may be an idea or a feeling; however, the HCP often emphasizes a feeling to help the client recognize an emotion disguised behind words ○ Examples Client: “my wife says she will look after me, but I don't think she can, what with the children to take care of, and they’re always after her about something—clothes, homework, what’s for dinner tonight” HCP: “sounds like you are worried about how well she can manage” Reflecting ○ Description Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation ○ Examples Client: “what can I do?” HCP: “what do you think would be helpful?” Client: “do you think i should tell my husband?” HCP: “you seem unsure about telling your husband.”  Summarizing and planning ○ Description Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview or to review a health teaching session. It often acts as an introduction to future care planning ○ Example During the past half hr we’ve talked about Tom afternoon we may explore this further In a few days ill review what you ve learned about the action and effects of your insulin Tom, i will look at your feeling journal BARRIERS TO COMMUNICATIONS Leads us to nontherapeutic communication It wont be good to us ang not goal directed Stereotyping ○ Description Telling general statements that have no basis or explanation Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid These responses categorize clients and negate their uniqueness as individuals ○ Examples “Two-year-olds are brats.” “Women are complaining.” “Men don’t cry.” “Most people don’t have any pain after this type of surgery.” Agreeing and disagreeing ○ Description Hindi dapat tayo maging judgmental kasi it may belittle the feeling of the patient and client might be defensive Similar to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the HCP is in a position to judge this These responses deter clients from thinning through their position and may cause a client to become defensive ○ Examples Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his clients.” HCP: “Dr. Broad is the head of the department of surgery and is an excellent surgeon.”  Being defensive responses ○ Description You need to welcome all the complains and hear out all the patient is verbalizing Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns The HCP is saying, “You have no right to complain.” Defensive responses protect the HCP from admitting weaknesses in the health care services, including personal weaknesses. ○ Examples Client: “Those night nurses must just sit around and talk all night. They didn’t answer my light for over an hour.” HCP: “I’ll have you know we literally run around on nights. You’re not the only client, you know” Challenging ○ Description Giving a response that makes clients prove their statement or point of view These responses indicate that the HCP is failing to consider the client’s feelings, making the client feel it necessary to defend a position ○ Example Client: “I felt nauseated after that red pill.” HCP: “Surely you don’t think I gave you the wrong pill?” Client: “I feel as if I am dying.” HCP: “How can you feel that when your pulse is 60?” Probing ○ Description Out of curiosity rather than helping the client Asking for information chiefly out of curiosity rather than with the intent to assist the client These responses are considered prying and violate the client’s privacy Asking “why” is often probing and places the client in a defensive position ○ Example Client: “I was speeding along the street and didn’t see the stop sign.” HCP: “Why were you speeding?” Client: “I didn’t ask the doctor when he was here.” HCP: “Why didn’t you”  Testing ○ Description Asking questions that make the client admit to something. These responses permit the client only limited answers and often meet the HCP’s needs rather than the client’s Sinusubukan mo siya Gusto mong mapatunayan na may specific siyang sasabihin You’re not doing something for th eclient Ikaw may gusto na yun ung gawin niya or sabihin ○ Example “Who do you think you are?” (forces people to admit their status is only that of client) “Do you think I am not busy?” (forces the client to admit that the HCP really is busy) Rejecting ○ Description Refusing to discuss certain topics with the client These responses often make clients feel that the HCP is rejecting not only their communication but also the clients themselves ○ Examples “I don’t want to discuss that. Let’s talk about…” “Let’s discuss other areas of interest to you rather than the two problems you keep mentioning.” Changing topics and subjects ○ Description Directing the communication into areas of self-interest rather than considering the client’s concerns is often a self-protective response to a topic that causes anxiety. These responses imply that what the HCP considers important will be discussed and that clients should not discuss certain topics ○ Examples “I can’t talk now. I’m on my way for coffee break.” Client: “I’m separated from my wife. Do you think I should have sexual relations with another woman?” HCP: “I see that you’re 36 and like gardening. This sunshine is good for my roses. I have a beautiful rose garden” Unwanted reassurance ○ Description Using cliches or comforting statements of advice as a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client ○ Example “You’ll feel better soon” “I’m sure everything will turn out all right”  “Don’t worry.” Passing judgment ○ Description Giving opinions and approving or disapproving responses, moralizing or implying one’s own values. These responses imply that the client must think as the HCP thinks, fostering client dependence Nagiging dependent sya sa’yo Nawawala ung pagka-independent ng pasyente ○ Example “That’s good (bad).” “You shouldn’t do that.” “That’s not good enough.” “What you did was wrong (right).” Giving common advice ○ Description Telling the client what to do. These responses deny the client’s right to be an equal partner Note that getting an advice from an expert rather than common advice is therapeutic ○ Example Client: “Should I move from my home to a nursing home?” HCP: “If I were you, I’d go to a nursing home, where you’ll get your meals cooked for you.” PHASES OF HELPING RELATIONSHIP HCP can identify the progress of a relationship by understanding these phases: Pre interaction phase ○ Similar to the planning stage before an interview ○ In most situations, the HCP has information about the client before the first face-to-face meeting ○ Such information may include the client’s name, address, age, medical history, and/or social history Introductory phase ○ Also referred to as the orientation phase ○ Important because it sets the tone for the rest of the relationship ○ During this initial encounter, the client and HCP closely observe each other and form judgments about the other’s behavior Working (maintaining) phase ○ During the 8 hrs siya na ung healthcare provider mo ○ During the working phase of a helping helping relationship, the HCP and the client begin to view each other as unique individuals ○ They begin to appreciate this uniqueness and care about each other. Caring is sharing deep and genuine concern about the welfare of anothe person  ○ Once caring develops, the potential for empathy increases ○ Has two major parts Termination phase ○ This is often expected to be difficult and filled with ambivalence. However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems independently ○ Many methods can be used to terminate relationships. Summarizing or reviewing the process can produce a sense of accomplishment. This may include sharing reminiscences of how things were at the beginning of the relationship and comparing them to how they are now PROFESSIONALISM Professionalism is defined by who you are (inner character), what you do (behavior exhibited) and how others perceive you (image projected) WORK ETHICS A set of standards and rules that are required by an individual for satisfactory work performance This involves attitude, behavior, respect, communication, and interaction, and how one gets along with others TWO TYPES OF WORK ETHICS Professional - general Specific to a work situation - specific to your profession only CHARACTERISTICS OF WORK ETHICS 1. Attendance a. Attendance often has a large impact on individual and team success b. Absenteeism can also profoundly impact job performance and retention c. How do you maintain good attendance? i. Make work a high priority ii. Know your schedule iii. Make use of an alarm clock iv. Get enough sleep v. Arrange your transportation vi. Inform your supervisor of an absence 2. Character a. You need to have all of these in your character to be able to survive hardships and difficulties you’ll be encountering, especially when working i. Loyalty ii. Honesty iii. Trustworthiness  iv. Dependability v. Reliability vi. Initiative vii. Self-discipline viii. Self-responsibility 3. Teamwork a. You can’t always be alone, or you alone only know something b. Ex. hindi dapat ikaw lang ang may alam tungkol sa patient dahil mangangailangan ka rin ng ibang healthcare department para sa needs ng patient, kaya need mo maging cooperative and maki-collaborate with them. c. Respecting the rights of others d. Being a team worker e. Being cooperative f. Being assertive g. Displaying a customer service attitude h. Seeking opportunities for continuous learning (kahit ayaw mo duon sa role na yun) i. Demonstrating mannerly behavior (you know how to behave accordingly) j. Respecting confidentiality 4. Appearance a. Dress appropriately b. Personal hygiene c. Good manners 5. Attitude a. Demonstrating a positive attitude (para maganda ung itsura mo sa career mo) i. Avoid negative thoughts b. Appearing self confident (alam mo kaya mo. wag daw sobra) c. Having realistic expectations for self (you need to be realistic and do something) 6. Productivity a. Following safety procedures b. Conserving materials c. Keeping the work area neat and clean d. Following directions properly 7. Organizational Skills a. Preparing for assignments at home b. Prioritize what’s the most important c. Set timetables - list what you have achieved and what is still pending d. Spend time wisely 8. Communication a. Verbal or nonverbal must be clear b. Be emphatic c. We must always treat others as we would like others to treat us 9. Cooperation a. Developing good working relationships  b. Following the chain of command c. Good at conflict management d. Being a good problem solver 10. Respect a. Work to the best of your ability b. Do what’s asked the first time c. Accept and acknowledge an individual's talents and knowledge GOOD WORK ETHICS WILL ACCOMPLISH THE FOLLOWING GOALS 1. Positive work ethics skill make for more employable and valuable employees 2. Employers will have workers with desirable work habits 3. More motivated and attentive workers VALUES TO BE ADOPTED BY PUBLIC HEALTH WORKERS 1. The public health worker shall be humane 2. The public health worker shall uphold his/her personal integrity and that of his/her profession 3. The public health worker shall be just 4. The public health worker shall be generous in spirit deed 5. The public health worker shall exercise courage to protect the interest of public health DUTIES AND OBLIGATIONS To his/her Clientele: The public health worker shall attend to his/her client faithfully and conscientiously. he/she shall strive to provide them with all possible benefits from his/her knowledge and skills ○ The public health worker shall serve at any time all people in his/her area of jurisdiction without discrimination The public health worker shall exercise good faith and strict honesty in the discharge of his/her duties and responsibilities, especially in disseminating information to clients and their families ○ Dapat factual information, hindi opinions The public health worker shall guard as sacred trust anything confidential or private in nature that is discovered or relayed to him/her by the clients. He/she shall not divulge confidential information that may reflect on the clients, except, when required by law, in the interest of public health and safety, or upon the client’s consent The public health worker shall provide his/her clients with the best quality service at the least cost ○ The public health worker shall serve the needs of his/her clients throughout the duration of the client’s treatment or make the necessary referral until the treatment is complete (this includes all required follow-up treatment) ○ The public health worker shall act and respond to any call for his/her services at any time  The public health worker shall at all times maintain quality and prompt delivery of health services without discrimination ○ The public health worker shall maintain a cordial professional relationship with his/her clients at all times To the community The public health worker shall fully cooperate with local authorities in the performance of his/her duties and responsibilities ○ The public health worker shall assist in the administration of justice when called upon to provide expert opinion on health public safety and medico-legal cases The public health worker shall provide correct and accurate information on the risk and injury to health and life existing in the community ○ The public health worker shall take the initiative to organize the community to become self-reliant for their health and medical needs to maintain their health facilities and to mobilize resources for health The public health worker shall make himself/herself available to the community anytime his/her services are needed, especially in emergencies and calamities To coworkers: The public health worker shall maintain a harmonious relationship with his/her co-worker and shall avoid destructive competition with them ○ The public health worker shall seek assistance through consultations with his/her colleagues whenever necessary for the benefit of the client and the community To the government: The public health worker shall ensure that services are delivered to the intended population The public health worker shall help improve and maintain a healthy population which contributes to socio-economic development of the country The public health worker shall pay all taxes due to the government The public health worker shall wisely and efficiently use all equipment and facilities provided to him/her for the effective delivery of health services The public health worker shall strive as much as he/she can about the programs of the government, especially those related to health, such that he/she is able to discuss them intelligently at any given time The public health worker shall strive for excellence in the performance of his/her duties and responsibilities as a public servant  INTRODUCTION TO FIRST AID FIRST AID It is immediate help provided to a sick or injured person until professional medical help arrives or becomes available Immediate intervention can be done It is a way of preparing an individual to respond to emergency situations quickly Administering first aid techniques before medical help arrives Initial assistance or treatment given to a person who is injured or suddenly ill OBJECTIVES OF FIRST AID Preserve life Prevent further harm and complications Seek immediate medical help Provide reassurance ○ Remember that your patient is in a matter of life and death situation, para maalis ung iniisip ng patient, we need to provide reassurance (we need to tell something about the condition of the patient) to lessen the fear and anxiety MANAGING AN INCIDENT In any emergency, it is important that you follow a clear plan of action ○ Dapat may plan hindi ung bigla-bigla for you can prioritize the demands This will enable you to prioritize the demands that may be made upon you, and help you decide on your best response Assessing the situation ○ Evaluating the scene accurately is one of the most important factors in the management of an incident ○ You should stay calm ○ State that you have first aid training, and if there are no medical personnel in attendance, calmly take charge ○ All incidents should be managed similarly. Considering the following? Safety: what are the dangers and do they still exist? Are you wearing protective equipment? Is it safe for you to approach? Scene: what factors are involved in the incident? What are the mechanisms of the injuries? How many casualties are there? What are the potential injuries? Situation: what happened? How many people are involved and what ages are they? Are any of them children or elderly? Making an area safe ○ The conditions that give rise to an incident may still present a danger and must be eliminated if possible ○ Usually, specialist help and equipment are required for this. When approaching a casualty, make sure you protect yourself: wear high-visibility clothing, gloves, and head protection if you have them  Giving emergency help ○ Once an area has been made safe, use the primary survey to quickly carry out an initial assessment of the casualty or casualties to establish treatment priorities ○ If there is more than one casualty, attend to those with life-threatening conditions first ○ If possible, treat casualties in the position in which you find them; move them only if they are in immediate danger or if it is necessary to provide life-saving treatment QUALITIES OF A GOOD FIRST AIDER: (GORTEC) GENTLE - minimize pain OBSERVANT - observe other possible injuries (ex. ung fractures di naman ganon nakikita) RESOURCEFUL - make use of hand or other things in his/her surrounding TACTFUL - should be careful in using words (reassure them that immediate care will be given) EMPATHY - you should be caring, putting yourself into the patient/victim's condition CAREFUL - not to add injury or pain for the victim/patient PROTECTION FROM INFECTION: When you give first aid, it is important to protect yourself (and the patient) from infection as well as injury Take steps to avoid cross-contamination—transmitting germs or infection to a casualty or contracting an infection from a casualty Be cautious and conscious of everything HOW TO PROTECT YOURSELF? With the use of Personal Protective Equipment (PPE) — nonetheless, proper hand-washing is the most effective way of eliminating of acquiring/passing different diseases COMMON EMERGENCIES Wound ○ A break in the skin or the internal body surfaces is known as a wound ○ Wounds can be daunting, particularly if there is a lot of bleeding; prompt action reduces the amount of blood loss and minimizes shock ○ Closed wound Where the outer layer of the skin is intact, and the damage lies below the surface  First aid management Apply an ice pack Elevate the injured part Do not assume that all closed wounds are minor injuries Help the person to rest Provide comfort and reassure the person ○ Open wound The outer layer of the skin is broken The break in the skin can be as minor as a scrape of the surface layers or as sever as a deep penetration Types: Simple laceration ○ This is caused by a clean surface cut from a sharp-edged object such as a razor ○ Blood vessels are cut straight across, so bleeding may be profuse ○ Structures such as tendons or nerves may be damaged ○ Ex. nahiwa ng any sharped edge object Complex laceration ○ Blunt (matalim) or ripping with forces that results in tears or laceration ○ These wounds may bleed less than clean surface cuts, but deep tissue damage may occur. These lacerations are often contaminated with germs, so the risk of infection is high ○ Give anti-tetanoustoxoid (ATS) Abrasion (scrape) ○ This is a superficial wound in which the topmost layers of skin are scraped off, leaving a raw, tender area. Abrasions are often caused by a sliding fall or a friction burn ○ They can contain embedded foreign particles that may cause infection Contusion (bruise) ○ Kapag nabugbog ○ A blunt blow can rupture capillaries beneath the skin, causing blood to leak into the tissues ○ This process results in bruising. Extensive contusion and swelling may indicate deeper damage, such as a fracture or an internal injury ○ Blue-ish discoloration  Puncture wound ○ Natusok ○ An injury such as standing on a nail or being pricked by a needle will result in a puncture wound ○ It has a small entry site but a deep track of internal damage ○ Since germs and dirt can be carried far into the body, the infection risk with this kind of wound is high Stab wound ○ This is a deep incision caused by a long or bladed instrument, usually a knife, penetrating the body ○ Stab wounds to the trunk must always be treated as serious because of the danger of injury to vital organs and life-threatening internal bleeding Gunshot wound ○ This type of wound is caused by a bullet or missile being driven into the body, causing serious internal injury as well as infection caused by clothing and contaminants from the air being sucked into the wound First aid management Control bleeding Clean with soap and water Cover the wound Consult physician  Burns ○ The three layers of skin can be involved which can be very serious TYPES OF BURNS AND POSSIBLE CAUSES TYPE OF BURN CAUSES Dry burn Flames Contract with hot objects, such as domestic appliances or cigarettes Scald Stem Hot liquids, such as tea and coffee, or hot oil Electrical burn Low-voltage current, as used by domestic appliances High-voltage currents, as carried in overhead or underground cables Lightning strikes Radiation burn Sunburn Overexposure to UV rays from a sunlamp Exposure to a radioactive source, such as an X-ray Chemical burn Industrial chemicals, including inhaled fumes and corrosive gases Domestic chemicals and agents, such as paint stripper, caustic soda, weed killers, bleach, oven cleaner, or any other strong acid or alkali chemical Cold injury Frostbite Contact with freezing metals Contact with freezing vapors, such as liquid oxygen or liquid nitrogen ○ Depth burns Gaano kalalim Burns are classified according to the depth of skin damage There are three depths: Superficial ○ First aid Soaking the wound in cool water for 5 minutes or longer Taking acetaminophen or ibuprofen for pain relief Applying lidocaine (a local anesthetic) with aloe vera gel or cream to soothe the skin Using an antibiotic ointment and loose gauze to protect the affected area  Partial-thickness ○ Very painful ○ They destroy the epidermis and cause the skin to become red and blistered ○ They usually heal well, but if they affect more than 20% of the body in adults and 10% in a child, they can be life-threatening ○ Total body area (TBA) - using the rule of 9 ○ First aid Running the skin under cool water for 15 minutes or longer Taking over-the-counter pain medication (acetaminophen or ibuprofen) Applying antibiotic cream to blisters (do not prick the blister) Full-thickness ○ Pain sensation is lost, which masks the severity of the injury Nasira na ung nerves kaya wala nang pain nararamdaman ○ The skin may look waxy, pale, or charred (sunog) and needs urgent medical attention ○ First aid May need more intensive treatments such as intravenous (IV) antibiotics to prevent infection or IV fluids to replace fluids lost when skin was burned They may also need skin grafting (getting tissues in the body mostly sa pwet daw kumukuha) or the use of synthetic skin A casualty may suffer one or more depths of burn in a single incident  MEDICAL CONDITIONS STROKE A condition that occurs when the blood flow to the brain is long enough to cause damage Occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures) First aid management ○ Check the patient's ABC ○ Have the patient rest in a comfortable position ○ Seek immediate medical help ○ Do not give anything by mouth ○ If the patient becomes unconscious, turn on his side ○ Continue monitor ABC ○ Care for shock SEIZURE Sudden involuntary muscle contraction, due to uncontrolled electrical activity in the brain, caused by many different conditions First aid management ○ Asses ABC’s ○ Protect patient for further injury ○ Transport if necessary Aura is the warning signal that a seizure will occur (something unusual will happen seeing stars, masakit yung tummy) ASTHMA Lung disease in which there is intermittent narrowing of the bronchi (airways), causing shortness of breath What to do? ○ Keep your inhalers or puff beside you incase you’ll have the attack HYPOGLYCEMIA This condition occurs when the blood sugar level falls below normal Characterized by a rapidly deteriorating level of response What to do? ○ Offer something sweet ○ After some time, quickly give food and eat NOSEBLEED Bleeding from the nose most commonly occurs when tiny blood vessels inside the nostrils are ruptured, either by a bloc to the nose or as a result of sneezing, pinking, or blowing the nose First aid in nose bleeding ○ Sit down ○ Dati, sabi nila dapat daw pataas ung position ng neck. Pero NAUR dapat naka-forward kasi papasok ung dugo sa loob ○ Pinch the bridge of the nose strills and then leave in 10 mins (3 times mo pwede gagawin)