Time Frame

Functional Objectives Planned Activities Responsible Resources (per week) Expected Output
Area Person Manpowe Materia 1 2 3 4 5 6 7 8 9 1 1 1 1
r ls 0 1 2 3
COCD
Pre-entry Orient self to the  Attended community practicum BSN 36th -BSN dep’t bond / Service leave plan
Phase activities to be orientation to conducted by BSN students chair paper
undertaken Department Chair Prof. Carmen N. -Clinical and pen
during the Firmo and CP @ UPMSHS on Dec. Instructor /
community 15, 2016. -BSN 36th
practicum.  Formulate Service Leave Plan for batch
Community Practicum Immersion. students / Documentation on
Entry Phase meetings with LGU
Baluso, LGU officials, RHU staff of
Establish rapport Raffy officials, / Carmen and key
and a good  Conduct courtesy call to LGU RHU staff leaders of Poblacion
working Officials and RHU Staff of Carmen, and Brgy. Sur catchment and
relationship with Key Leaders of Poblacion Sur Official OSCA president
the community. catchment and OSCA President. Brgy. /
Baluso, Officials
Assessment  Conduct meetings with key Raffy Attendan
barangay officials to orient them ce sheet,
practicum objectives and activities ballpen
Assess the health and leveling expectations. Brgy. and /
status of the Baluso, Officials pencil
community and  Conduct entrance assembly to Raffy
the catchment barangay. BHWs Documentation of
implementation RHU staff entrance assembly
status of  Conduct occular survey in
responsive DOH catchment barangay. / Accomplished health
programs. data review forms
 Do socio demographic health data
review. Accomplished
Planning / program review
  Do program review. Baluso, forms
Identify priority Raffy
health and other  Accomplish Worksheets 1.1, 1.2 / 0utput on
community and 2.1. WS 1.1, Worksheets 1.1, 1.2
health problems. Baluso, 1.2 and and 2.1
Raffy 2.1 /
Implementatio Facilitate List of priority health
n formulation of an  Listing of priority health and health Baluso, and health related
operational plan related problems. Raffy bond / problems
to meet  Analysis/prioritization of RHU staff paper
community community problems and Brgy. and pen
needs or  Formulate CDx Officials
problems and Output on
meet health assessment results
program targets.  Preparation of assessment reports Brgy. and plan of
and working paper for planning Officials bond / appropriate
paper interventions and
 Present assessment results to and and pen / documentation of
Facilitate plan appropriate interventions with Catchm presentation.
implementation RHU Nursing team. Baluso, ent /
of the Raffy Health Documentation of
Evaluation operational plan.  Present relevant data from plan to Plan presentation of data
key leaders of Catchment barangay Baluso, to the key leaders of
for action and support. Raffy Catchment brgy.
PROVISION Monitor / Operational plan
OF HEALTH  Action planning with local leaders ing form List of group
CARE membership or task
Monitor the  Organize individuals and groups for
implementation action. Baluso, / Catchment health
of programs or Raffy Attendan plan
projects.  Organize the older persons in the LGU ce sheet,
community where no organization Baluso, officials,
Evaluate the exists. Raffy RHU staff Attendan /
ce sheet,
implementation and Brgy. Updated monitoring
 of activities.  Start implementation of catchment Officials forms
health plan Bond
paper
 Keep monitoring form updated. key and pen / / Evaluation tool and
leaders evaluation results
and the
Provide nursing health / Documentation of
care to sick and  Wrap up/preparation for team presentation of
well individuals evaluation evaluation results
and develop their BHW
potential for self-  Conduct final evaluation of plans at /
care. the end of fielding utilizing Bond
appropriate forms. paper Dispensary Record
and pen
To come up a list  In the exit assembly, inform the /
of older persons community of evaluation results.
living in the
community. / Masterlist of elderly
 Perform nursing care functions to in the community.
MANAGERIAL clients (high risk or otherwise) in Identified case load
ROLE their homes, BHS and RHU (a of elderly clients
minimum of two caseloads of Completed
elderly clients). Referral assessment of
form caseload
 Conduct barangay clinics.
/ Nursing Care Plan for
 Conduct masterlisting of older Elderly client
persons living in the community. Schedule of
Institute health orientation meeting
RECORDING promotive and  Identify case load of care for / Wellness promotion
AND disease elderly Diary program
REPORTING preventive noteboo Progress report on
measures. k activities
 Do initial nursing assessment on Notebo /
 elderly case load. ok and Documentation of
Utilize the pen activities
referral system  Conduct home visit of elderly and
effectively. high risk client. RHU staff
/ / /
Acquaint self  Coordinate with DSWD/OSCA for Dispensary record
with the an orientation for Senior Citizen Act Bond and list of referred
management of and Program/Services for the paper cases
the RHU and the elderly and pen
functions of the
personnel  Formulate a wellness promotion
especially of the program for the elderly. /
PHN.
With the  Start implementing the wellness /
PROFESSIONA supervision of promotion program
L GROWTH the PHN or CP
AND perform selected  Do bench conferences as needed /
DEVELOPMEN function of the
T PHN.  Conduct relevant activities for the Bond
elderly. paper
Keep and and pen Dispensary record
maintain an  Manage referred cases from BHW /
organized and or RHM.
updated health Updated weekly plan
records.  Make referrals as need arises. / / of activities

 Follow-up all referrals made.

/
 Be oriented to RHU set-up, Bond
personnel, routines, policies, RHU staff paper
activities and work schedule of the and pen
RHU. /
 Be oriented to the various Attendan
 responsibilities of the RHU ce sheet,
personnel especially of the PHN. /

 Participate in the delivery of basic

services of the DOH. List of target groups
Develop skill on  RHU Rotation / / / Training needs
formulating and LGU assessment
implementing a officials, / / Task analysis
training program RHU staff Training design
to enhance the and Brgy. Documentation on
community or Officials / / training activities
group’s ability to
cope with health
problems.  Keep a diary of health and health Minutes of the
related activities. / / / meeting

To facilitate  Maintain a dispensary notebook Documentation or

professional where health care services / / / reports
development of rendered are recorded.
self and others.
 Update weekly plan of activities.

 Review existing secondary data. / /

 Make written reports utilizing

appropriate forms. / /
-dispensary record
-monitoring scheme
- program review form
- HDR form
-WS 1.1, 1.2 & 2.1 / / /
-weekly plan
-accomplishment report / / /
 Submit final reports utilizing
appropriate forms.

 Identify target group for training.

 Conduct training needs

assessment. / / / /

 Drafting of task analysis.

/ / / /
 Formulate training design.

 Conduct the training. / / / /

 Conduct informal conferences with /

barangay officials, key leaders and
health team.

/ / /
 Attend community meetings or
conferences. / / /

 Hold exit assemblies / /

(Barangay/Municipal)
/

/ /

/ /
/ /
 /

University of the Philippines-Manila

 School of Health Sciences

Palo, Leyte

Service Leave Plan

(January 23- April 23, 2017)

Submitted by:

Baluso, Raffy A.

BSN 36th batch student