University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
AN OVERVIEW OF COMMUNITY HEALTH
NURSING PRACTICE IN THE PHILIPPINES
• LEARNING OBJECTIVES
• Discuss the relationship between the
science of public health and community
health nursing practice.
• Critically appraise the fundamental
tenets of the concept of community.
• Describe the four levels of clientele in
the community.
• Describe family as the unit of care and
the community as the patient
• Identify the goal of CHN
• Roles of the nurse in caring for
communities and population groups
• Brief history of CHN/ PHN practice in
the Philippines
COMMUNITY HEALTH NURSING
As a distinct field of nursing, has been aptly
described as any of the following:
 A field of nursing that is a blend or
synthesis of using practice with public
health using primary health care as a
tool in the delivery of health services.
 A learned practice discipline with the
ultimate goal of contributing as
individuals and in collaboration with
others to the promotion of the client
optimum level of functioning thru
teaching and delivery of care (Jacobson,
1969).
 A service rendered by professional nurse
to individuals, families, schools and the
workplace in order to promote health,
prevent illness and provide care for the
sick at their respective homes, provide
effective rehabilitation (Freeman,
1970).
Philosophy of CHN
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
• The philosophy of CHN is based on the
worth and dignity of men (Shetland,
1958).
• The goal of Community Health Nursing
is to assist the individual, family and
community in attaining their highest
level of holistic health which is attained
through multidisciplinary effort to
promote reciprocally supportive
relationship between the people and
their physical and social environment
CONCEPTS AND PRINCIPLES
• FAMILY
• The primary unit of care or basic unit of
service in the Community Health Care
where primary prevention is given
priority.
▫ The client of CHN is the
community
Partnership
• The CHN works with, not for, the
individual patient, family, group or
community as active partners and not
passive recipients of care. These clients
are actively involved in the organizing,
planning, implementation, management
and evaluation phases of their care. All
processes must include partnering with
representatives of the people.
Change
• The practice of Community Health
Nursing is affected by changes in society
in general, and by developments in the
health field in particular. The
environment and socio- economic status
have been shown to affect the health of
the community.
Healthcare Delivery System
• Community Health Nursing is a part f
the community health system and of the
larger human services system. The CHN
shares with other members of the
health team and other sectors in the
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
community the responsibility of
delivering health care services.
• The CHN interacts, collaborates and
coordinates using the multidisciplinary
approach wit teamwork as the driving
force in the efficient, effective and
equitable delivery and utilization of the
services.
SALIENT FEATURES OF THE COMMUNITY
HEALTH NURSING
• Population or Aggregate- Focused
• The hallmark of CHN.
a. Priorities foe care when resources or
supplies are primarily allotted for the health
needs and problems of the individuals or
families as they impact or relate to the health of
the total population or community.
b. Population- based assessment, policy
development and assurance processes are
systematic and comprehensive.
• Greatest Good for the Greatest
Number
The emphasis of CHN
• When a particular situation is seen as a
risk or hazard to the heath of the total
community or can afflict a greater
number of individuals, this is now seen
as a community health problem which
needs community- wide intervention.
• Utilizes the Nursing Process
• CHN involves the assessment of health
needs, planning, implementation and
evaluation of the impact of health
services on population groups
• Promotive-preventive by Nature
• The priority o CHN is on health
promotion and disease prevention
strategies over curative interventions.
• The health center consultation is the
entry point to the health care system
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
and provides initial contact between the
nurse and client.
• Uses a variety of Instruments
• CHN makes use of tools for measuring
and analyzing community health
problems like public health statistics or
vital statistics.
• Community Map
• Interviews
• Schedule
• Survey forms
• Questionnaires
• Required Management Skills
• CHN applies the principle and
management especially during the
organization of the nursing service in
the local health agency and in activities
that require the effective management
of a certain program or health service.
RECIPIENTS OF CARE BY COMMUNITY
HEALTH NURSE
THE INDIVIDUAL
• Is a specific person or client in various
stages of nursing intervention by the
community health nurse and other
members of the health team as
condition warrants.
THE FAMILY
• Is a group of people affiliated by
consanguinity, affinity or co- residence.
The family is the principal institution for
the socialization of children.
TYPES OF FAMILIES
• Nuclear
• Conjugal
• Extended
• Single-Parent
• Blended
• Traditional
POPULATION GROUPS
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
Population groups are vulnerable groups
or those at risk of developing certain
health or heath-related problems. These
are group of people who share common
characteristics, developmental stage or
common exposure to particular
environmental factors, thus, resulting in
common health problems.
THE COMMUNITY
• Old french “communite” which is also
derived from Latin word “communitas” (
cum – “with/ together” + munus “gift”),
a broad term for fellowship or organized
society
A community can be described as:
1. A group of people sharing common
geographic boundaries and/or common
values and interest.
2. The group which functions within a
particular socio-cultural context ( no two
communities are alike) and varying
physical environment and the people’s
way of behaving and coping differ from
one group to another.
Classifications of a Community
• Rural Communities – open lands, often
agricultural in nature which is more
spacious and less densely populated
• Urban communities – non- agricultural
by nature, densely populated and
marked by industrial products and
technology
• Suburban or rurbal or the capitals –
usually the administrative capital of a
province characterized by a unique mix
of agriculture and industry.
CHARACTERISTICS OF HEALTHY
COMMUNITY
• Awareness that “we are a community”
• Conservation of natural resources
• Recognition of and respect for the
existence of subgroups
• Participation of subgroups in community
affairs
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
• Preparation to meet crises
• Characteristics of Healthy Community
• Ability to solve problems
• Communicat on through open channels
• Resources available to all
• Settling of disputes through legitimate
mechanisms
• Participation by citizens in decision-
making
• Wellness of a high degree among its
members
Definition of Health
• The definition of health is evolving. The
early, classic definition of health by
WHO set a trend toward describing
health in social terms, rather than
medical terms.
• WHO, 1958
• Is a state of complete physical,
mental and social well- being without
merely the absence of disease or
infirmity.
• WHO, 1986
• The extent to which an individual or
group is able, on the one hand, to
realize aspirations and satisfy needs;
and, on the other hand, to change or
cope with the environment. Health is,
therefore, seen as a resource for
everyday life, not the objective of living;
it is a positive concept emphasizing
social and personal resources, and
physical capacities.
• Saylor, 2004
• Pointed out that the WHO definition
considers several dimensions of health.
These include physical (structures/
function), social role, mental (emotional
and intellectual), and general
perceptions of health status. It also
conceptualizes health from macro
perspective, as a resource to be used
rather than a goal in and of itself
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

• For many years, community and public
health nurses have favored Dunn’s
classic concept of wellness, in which
family, community, society and
environment are interrelated and have
an impact on health.
▫ Illness, health and peak
wellness are on a continuum
▫ Within social environment, the
state of health depends on the
goals, potentials and
performance of individual,
families, communities and
societies.
FOUR DEFINING ATTRIBUTES OF THE
COMMUNITY (MAURER AND SMITH, 2009)
• People
• Place
• Interactions
• Common characteristics, interests or
goals
• Two Main Types of Communities
1. Geopolitical Communities
▫ Are most traditionally recognized or
imagined when considering the term
community
▫ Defined or formed by man -made
boundaries and include barangays,
municipalities, cities, provinces, regions
and nations.
• Schools, Colleges and Universities,
Churches and Mosques and various
groups or organizations.
POPULATION AND AGGREGATE
• Population is typically used to denote a
group of people having common,
personal or environmental
characteristics.
• Aggregate are subgroups or
subpopulations that have some common
characteristics or concerns may make
the member vulnerable to similar health
problems.
• Community ( Residents of small town)
• Population ( All elders in rural region)
• Aggregate ( Pregnant teens within a
school district)
• Determinants of Health and Disease
The WHO states that health or lack of
health of individuals depends on the context of
their lives.
- Social
- Economic
- Physical
- Individual Characteristics and behavior
• Income and Social Status
• Education
• Physical environment
• Employment and working conditions
• Social support network
• Culture
• Genetics
• Personal behavior and coping skills
• Health services
• Gender

▫ Other forms are congressional districts

and neighborhoods.

PHENOMENOLOGICAL COMMUNITIES

• Refers to the relational, interactive

groups, in which the place or setting is
more abstract, and people share a
group perspective or identity based on
culture, values, history, interests ad
goals.

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

 Tertiary health care

Primary health care

 The “first” level of contact between the

individual and the health system.
 Essential health care (PHC) is provided.
 A majority of prevailing health problems
can be satisfactorily managed.
 The closest to the people.
 Provided by the primary health centers.

Secondary health care

 More complex problems are dealt with.

 Comprises curative services
 Provided by the district hospitals
 The 1st referral level

Tertiary health care

 Offers super-specialist care

 Provided by regional/central level
institution.
 Provide training programs

 Primary health care (PHC) became a

core policy for the World Health
Organization with the Alma-Ata
Declaration in 1978 and the ‘Health-for-
All by the Year 2000’ Program.

The commitment to global

improvements in health, especially for
the most disadvantaged populations,
was renewed in 1998 by the World
PRIMARY HEALTH CARE (PHC) IN THE Health Assembly. This led to the
PHILIPPINES ‘Health-for-All for the twenty-first
Century’ policy and program, within
HEALTH FOR ALL which the commitment to PHC
development is restated.
 Attainment of a level of health that will
enable every individual lead a socially WHAT IS PRIMARY HEALTH CARE?
and economically productive life
 Primary health care is essential health
Levels of Care care made universally accessible to
individuals and acceptable to them,
 Primary health care through full participation and at a cost
 Secondary health care the community and country can afford

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 Primary Health Care  Promotion of Safe Water Supply
is different in each
community depending  upon:  
 Needs of the residents;
 Availability of health care
providers;
 The communities geographic
location; &
 Proximity to other health care
services in the area.
 ELEMENTS OF PRIMARY HEATH CARE
1. Education for Health
 This is one of the potent methodologies
for information dissemination. It
promotes the partnership of both the
family members and health workers in
the promotion of health as well as
prevention of illness.
2. Locally Endemic Disease Control
 The control of endemic disease focuses
on the prevention of its occurrence to
reduce morbidity rate.
Example Malaria control and
Schistosomiasis control.
3. Expanded Program on Immunization
This program exists to control the occurrence of
preventable illnesses especially of children below
6 years old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
preventable disease are given for free by the
government and ongoing program of the DOH.
4. Maternal and Child Health and FP
 The mother and child are the most
delicate members of the community. So
the protection of the mother and child
to illness and other risks would ensure
good health for the community. The
goal of FP includes spacing of children
and responsible parenthood.
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
5. Environmental Sanitation and
Environmental Sanitation is defined as
the study of all factors in the man’s
environment, which exercise or may
exercise deleterious effect on his well-
being and survival. Water is a basic
need for life and one factor in man’s
environment. Water is necessary for the
maintenance of healthy lifestyle. Safe
Water and Sanitation is necessary for
basic promotion of health.
6. Nutrition and Promotion of Adequate
Food Supply
 One basic need of the family is food.
And if food is properly prepared then
one may be assured healthy family.
There are many food resources found in
the communities but because of faulty
preparation and lack of knowledge
regarding proper food planning,
Malnutrition is one of the problems that
we have in the country.
7. Treatment of Communicable Diseases
and Common Illness
 The diseases spread through direct
contact pose a great risk to those who
can be infected. Most communicable
diseases are also preventable. The
Government focuses on the prevention,
control and treatment of these illnesses.
8. Supply of Essential Drugs
 This focuses on the information
campaign on the utilization and
acquisition of drugs. In response to this
campaign, the GENERIC ACT of the
Philippines is enacted. It includes the
following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol,
Nefidipine, Rifampicin, INH (isoniazid)
and Pyrazinamide, Ethambutol, Qunine,
Streptomycin, Albendazole
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A’s = Accessibility, Availability,
Affordability and Acceptability,
Appropriateness of health services
 The health services should be present
where the supposed recipients are. They
should make use of the available
resources within the community,
wherein the focus would be more on
health promotion and prevention of
illness.
2. Community Participation
 Community participation is the heart
and soul of primary health care.
3. People are the center, object and
subject of development.
 Thus, the success of any undertaking that
aims at serving the people is dependent on
people’s participation at all levels of
decision-making; planning, implementing,
monitoring and evaluating. Any undertaking
must also be based on the people’s needs
and problems (PCF, 1990)
Barriers of Community Involvement
 Lack of motivation
 Attitude
 Resistance to change
 Dependence on the part of community
people
 Lack of managerial skills
4. Self-reliance
 Through community participation and
cohesiveness of people’s organization they
can generate support for health care
through social mobilization, networking and
mobilization of local resources. Leadership
and management skills should be develop
among these people.
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
5. Partnership between the community
and the health agencies in the provision of
quality of life.
 Providing linkages between the
government and the non-government
organization and people’s organization.
6. Recognition of interrelationship
between the health and development
 Health is defined as not merely the
absence of disease. Neither is it only a state
of physical and mental well-being. Health
being a social phenomenon recognizes the
interplay of political, socio-cultural and
economic factors as its determinant. Good
Health therefore, is manifested by the
progressive improvements in the living
conditions and quality of life enjoyed by the
community residents
 Development is the quest for an improved
quality of life for all. Development is
multidimensional. It has political, social,
cultural, institutional and environmental
dimensions (Gonzales 1994). Therefore, it is
measured by the ability of people to satisfy
their basic needs.
7. Social Mobilization
 It enhances people’s participation or
governance, support system provided by
the government, networking and
developing secondary leaders.
8. Decentralization
 This ensures empowerment and that
empowerment can only be facilitated if the
administrative structure provides local level
political structures with more substantive
responsibilities for development initiators.
This also facilities proper allocation of
budgetary resources.
The Basic Requirements for Sound PHC
(the 8 A’s and the 3 C’s)
 Appropriateness
 Availability
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 Adequacy
 Accessibility
 Acceptability
 Affordability
 Assessability
 Accountability
 Completeness
 Comprehensiveness
 Continuity
 Strategies of PHC
1.Reducing excess mortality of poor
marginalized populations:
PHC must ensure access to health services
for the most disadvantaged populations, and
focus on interventions which will directly impact
on the major causes of mortality, morbidity and
disability for those populations.
2. Reducing the leading risk factors to
human health:
PHC, through its preventative and health
promotion roles, must address those known risk
factors, which are the major determinants of
health outcomes for local populations.
 Strategies contd.
3. Developing Sustainable Health Systems:
PHC as a component of health systems must
develop in ways, which are financially
sustainable, supported by political leaders, and
supported by the populations served.
4. Developing an enabling policy and
institutional environment:
PHC policy must be integrated with other
policy domains, and play its part in the pursuit
of wider social, economic, environmental and
development
policy.
 Evaluation of HFA : 1979-2006
 Reasons for slow progress:
 Insufficient political commitment
 Failure to achieve equity in acess
to all PHC components
 The continuing low status of
women
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
 Slow socio- economic
development
 Difficulty in achieving inter
sectoral action for Health
 Unbalanced distribution of
resources
 Reasons for slow progress
 Widespread inequity of health promotion
efforts
 Weak health information systems and lack
of baseline data
 Pollution, poor food safety, and lack of
water supply and sanitation
 Rapid demographic and epidemiological
changes
 Inappropriate use and allocation of
resources for high cost technology
 Natural and man made disasters
 Obstacles to the implementation of the
PHC strategy
 Misinterpretation of the PHC concept
 Misconception that PHC is a 2nd rate health
care for the poor.
 Selective PHC strategies
 Lack of political will
 Centralized planning and management
 The Challenges of changing World
 Unequal growth, unequal outcomes
 Adapting to new health challenges
 Trends that undermine the health
systems’ response
 Changing values and rising expectations
 PHC reforms: driven by demand
COMMUNITY ORGANIZING: ENSURING
HEALTH IN THE HANDS OF PEOPLE
Chapter Contents
 Definition of Community Organizing
 Core Principles of Community Organizing
 Phases of Community Organizing
 Goal of Community Organizing
 COPAR
Definition of Community Organizing
 Community Organizing as a process,
consist of steps or activities that instill
and reinforce the people’s self-
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
confidence on their own collective
strength and capabilities.
 It is the development of the
community’s collective capacities to
solve its own problems and aspire for
development through its own efforts.
 CO is a continuous process of organizing
of educating the community to develop
its capacity to assess and analyze the
situation (which raising), plan and
implement interventions (mobilization)
and evaluate the.
 CO is a process of educating and
mobilizing members of the community
to enable them to resolve community
problems.
 It is a means to build the
community’s capacity to work for
the common good in general and
health goals in particular.
 In the context, CO is teaching the
community to apply the nursing
process on its own, utilizing
resources that are available to it,
thereby allowing the community to
be active participant in the process
of development.
Common Goals of CO and Community
Health Nursing Practice
 People empowerment
 Development of self-reliant community
 Improve quality of life
The emphasis of CO in PHC:
 People from the community working
together to solve their own problems.
 Internal organizational consolidation as
a pre-requisite to external expansion.
 Social movement first before technical
change
 Health reforms occurring within the
context of broader social transformation
 Community development is the en
goal of community organizing and all
other efforts toward uplifting the status
of the poor and marginalized.
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
 Community development entails a
process of assessment of the current
situation, the identification of needs,
deciding the appropriate courses of
actions or responses, mobilization of
resources to address these needs, and
monitoring and evaluation by the
people.
3 BASIC VALUES
 Human Rights
 Social Justice
 Social responsibility
Human rights
 Are universally held principle anchored
mainly on the belief in the worth and
dignity of people; these includes the
right of life, self- determination and
development as persons and as a
people.
Social Justice
 Means equitable access to opportunities
for satisfying people’s basic needs and
dignity; it requires an equitable
distribution of resources and power
through people’s participation in their
own development.
Social responsibility
 Is premised on the belief that people as
social beings must not limit themselves
to their own concerns but should reach
out to and move jointly with others in
meeting common needs and problems;
society has the responsibility to ensure
an environment for the fullest
development of its members.
CORE PRINCIPLES OF CO
 CO is people- centered
 CO is participative
 CO is democratic
 CO is developmental
 CO id process- oriented
CO IS PEOPLE-CENTERED
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 The basic premise of any community
organizing endeavor is that the people
are the mean and ends of development,
and community empowerment is the
process and outcome.
 It is people- centered in the sense that
the process of critical inquiry is not
meant for a person-to-person
interaction, with only a few who will
benefit from any undertakings and
activities.
 Overall the development is concerned
withy improving quality of life in the
different dimensions of the community-
social, political, economic,
environmental, cultural and spiritual.
 Emphasis is on the development of
human resources necessitating
education.
 The educational processes are
interactive, empowering both the
learners and the teacher.
COMMUNITY ORGANIZING IS A PARTICIPATIVE
 The participation of the community in
the entire process should be ensured.
 The community is considered as the
prime mover and determinant, rather
than beneficiaries and recipients of
development efforts, including health
care.
 The people are well informed about the
community activities and are aware of
their potential contributions to the
common good.
 Decision making are in the hands of the
ordinary people, not just the elite.
 Distinction is not made among different
groups and different personalities.
 Community Organizing is Democratic
 Community Organizing should empower
the disadvantaged population. It is a
process that allows the majority of
people to recognize and critically
analyze their difficulties and articulate
their aspirations.
 Their decision must reflect the will of
the whole, more so the will of the
common people, than that of the
leaders and the elite.
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
 Conflicts are inevitable in group
dynamics. The organizer and the leader
must effectively process and manage
these conflicts.
 Efforts must be exerted to achieve a
consensus. This requires a participative
and consultative approach.
 CO is Developmental
 Co should be directed towards changing
current undesirable conditions.
 The organizer desires changes for the
betterment of the community and the
believes that the community shares and
their aspirations and that these changed
can be achieved.
 CO affords empowerment of the
marginalized people.
 Through the process, the community
gains insights, hones their capacities,
and develops their confidence in
themselves and in each other that will
allow them to take the lead in the
holistic improvement of their
communities.
 Thus, CO seek human development.
 CO is process- oriented
 The community organizing goals of
empowerment and development are
achieved through s process of change.
 Organizers should follow CO process to
achieve these goals. Allowing the
community to internalize an embrace
the process requires time.
 Monitoring and periodic review of plans
are necessary.
 Simple problems - > confidence of the
community members -> sustenance of
the community organizing efforts.
PHASES OF COMMUNITY ORGANIZING
  Pre- entry phase
◦ Preparation on the part of the
organizer and choosing the
community for partnership.
◦ Delineate criteria and guidelines
for site selection.
◦ Skills in CO are developed on
the job or experiential approach
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
so student nurses are not
unusual.
  Pre- entry phase
◦ For Novice organizers,
preparation includes a study or
review of the basic concepts of
CO.
◦ Self-examination is also
necessary both negative and
positive attitude.
  Pre- entry phase
◦ Site selection is often crucial.
 Identification of possible
barriers
 Threats
 Strengths
 Opportunities
 Communities may be identified through
different means:
 initial data gathered through ocular
survey
 review of records of a health facility
 Review of the barangay/municipal
profile
 Referral from other communities or
institutions o through series of meetings
 Consultation from the LGU
Essential questions should be answered:
 Does the community meet the GIDA?
Criterion of the DOH?
 Do the members of the community
perceive the need for assistance
 Does the community show signs of
willingness or hostility towards the
organizer or the organizing agency?
 Are the other individuals, groups or
agencies working I the area? If so, are
they using CO approach?
 Is partnership among all potential
stakeholders possible and feasible?
Entry in the Community (Entry Phase)
 Formalizes the start of organizing
process. This is the stage where the
organizer gets to know the community
and voce versa.
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
 Make courtesy calls to the local formed
leaders
 Equally crucial but overlooked often is a
visit of informal leaders.
 Considerations
 It is also important that the community
organizer introduce themselves and
their institutions to the community.
 A clear explanation of the VMGO and
activities must be given in all initial
meetings and contacts with the
community.
 Preparation of the initial visit includes
 Gathering basic information
socioeconomic conditions
 Traditions including religious practices
 Overall physical environment
 General heath and illness patterns
 Available health resources
 Informal meetings are also useful
 The community organizer must keep in
mind that the goal of the process is to
build up confidence and capacities of
the people.
2 strategies for gaining entry in the
community as described by Manalili
 Padrino entry
– patron or padrino usually a barangay
official
- the padrino boost the organizer’s image,
tends to present project output and thereby
creating false hopes.
 Bongga entry
- easiest way to catch the attention and
gain approval of the community.
- dole outs
- contradicts the essentiality of CO
Community Integration
 Pakikimabuhay
 A phase where the organizer may
actually live in the community in an
effort to understand the community
better and imbibe community life.
 Establishment of rapport – successful
integration
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 A gradual process – not a visitor or
guess
 Respect for the culture and traditions is
important
 Integration Styles (Manalili, 1990)
 Mow you see, now you don’t
 Boarder
 Elitist
 People-centered approach in Integration
 The organizers enter the community
with a well-conceived plan.
 The approach allows the organizers to
develop a deeper relationship with the
whole community through various
techniques.
 Manalili cited different techniques
 Pagbabahay-bahay or occassional home
visit
- the organizer observe the daily schedule of
activities of households to avoid inconvenience
on the part of the families
 Huntahan
- Informal conversations help a lot of integrating
with the community. It can be done in a variety
of venues such as village poso during laundry
time, basketball court and sari-sari store,
 Participation in the production process
- The organizer participates in the
livelihood activities such as farming in
agricultural community.
- The goal is to gain firsthand knowledge
as a basis for understanding the
production process and the economic
system which the community operates.
 Participation on social activities
- To get to know each other through face-
to-face encounters.
- Fiestas, wedding, baptismal, funeral
wakes and meetings
- The organizer remains a a role model
and must avoid activities and situations
that may undermine the reputation of
the community.
Social analysis
 A process of gathering, collating, and
analyzing data to gain extensive
understanding of community conditions,
help in the identification of problems of
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
the community and determine the root
causes of these problem
 Social Investigation, Community Study,
Community Analysis and Community
Needs Assessment
 It is also called as Community Diagnosis
 There should be a comprehensive
analysis of the ff factors:
- Demographic data
- Sociocultural data
- Economic Data
- Environmental Data
- Data on Health Patterns
- Data oh health resources
 Identifying potential leaders
 Since organizing is not a job of one
person, it is imperative that the
organizer identifies partners and
potential leaders who will help lead the
people.
 Desirable traits of potential leader
 They represent the target group/
community.
 They possess or display leadership
qualities.
 They have trust and confidence of the
community
 They express belief in the need to
change the current undesirable situation
in the community.
 Thy are willing to invest time
 They must have a potential
management skills
 Thus, one of the challenges of the
community organizer is to train and
prepare the potential leaders. This
requires consistency and persistence in
training, and giving them opportunities
to assume various roles in community
activities.
 The key is to allow time for them to
develop and gradually assume
leadership roles.
Core Group Formation
 As the community organizer prepares
the potential leaders, the membership of
the group is expanded, as necessary, by
asking them to invite one or two of their
neighbors or friends.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 Keeping the group size manageable, 8
to 12 members, facilitates arriving at a
consensus (common date and time for
meetings).
 A small group may be overwhelmed
with the task given to them.
 Initially, forming a single core group is
usually suggested. But as the
community gets better organized, the
first group may decide to have separate
core group or communities for specific
sector of the community.
 The formation of a viable, functioning
core group is the focal point of
community organizing. This requires a
series of training sessions to transfer the
technology of community organizing
,enabling the core group to take charge
of the subsequent organizing process.
 Since the core group will serve as the
foundation of community organization,
ay facilitative or negative factor not
properly harnessed or addressed during
core group formation may affect the
outcomes of community organizing
efforts.
COMMUNITY ORGANIZATION
 Through various information
dissemination, the core group, the core
group, with the assistance of the
community organizer, instills awareness
of common concerns among other
members of the community.
 Subsequently, on the initiative of the
core group, the community conducts the
assemblies, with the goals of arriving at
a common understanding of community
concerns ad formulating a plan of action
in dealing with these concerns.
 The organizer must remember that it is
their project to be done in their
community. The organizer must let
them decide.
 If the community decides t formalize the
organization, it must have the following
concerns:
- An organizational name and structure
- A set of officers recognized by the
members of the community
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LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
- Constitution and by laws stating the
VMG rules and regulations of the
organization and duties and
responsibilities of the officers and
members.
 The community may then decide to seek
legal recognition by registering the
organization with appropriate
government agency.
 The organization may also established
linkages and networks with other
government agencies, or other people’s
organizations that will further
strengthen and expand the organization,
facilitating the attainment of its goals
and organizations.
ACTION PHASE
 AKA Mobilization Phase
 Refers to the implementation of the
community’s planned projects and
programs
 Important Considerations
 Allow the community to determine the
pace and scope of project
implementation.
 The process is as important as the
output. A project may fail, but as long
as the community gins valuable
experience and learns from the process,
it is not a failure in itself.
 Regular monitoring and continuing
community formation program are
essential.
EVALUATION
 It is a systematic, critical analysis of the
current state of the organization and/or
projects compared to desired or planned
goals or objectives. Ideally, evaluation
is done periodically (formative) during
mobilization and at the end of the
prescribed project period(summative).
 In CO, there are 2 major areas of
evaluation:
1. Program-based evaluation
2. Organizational evaluation
 Exit an Expansion Phase
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

 The organizer must have a clear vision

and a general time frame in mind.
 s articulated by Manalili, “ the best entry
paln is an exit plan”.
INDICATIONS FOR READINESS FOR EXIT
 Attainment of the set of goals of the CO
efforts
 Demonstration of the capacity of the
people’s organization to lead the
community in dealing with common
problems
 People empowement
 During the exit phase, the organizer
may start exploring another community
to organize, that is, expanding to
another area but stays in touch with the
first community, periodically visiting.
Goals of CO
 People’s Empowerment
 Building relatively permanent structures
and people’s organization
 Improved quality of life
 Displays a charismatic personality that
draws people toward organizing work
and community activities.
 Adopts and enjoy working and living
with all types of community/ people.
 Can empathize with the people of the
community she/he is working with
 Believes on the vision of change,
empowerment and development
 Has a personal conviction consistent
with the values and principles being
advocated.
Participatory data-gathering methods for
COPAR
 Transect Walk
 Mapping
 Venn Diagram

COPAR

 PAR is an approach to research that

aims at promoting change among
participants.
 Members of the group being studied
participates as partners.
 It was introduces in mid 1990’s
 Both COPAR and traditional research
approach in nursing endeavor using
methods of scientific. However, they
differ in certain ways

Who is the Community Organizer?

 Has exemplary professional and moral

qualities
 Possesses good communication/
facilitation skills to be able to call and
lead small group discussions and
trainings and community meetings.
 Has the ability to set good leadership
examples for the community to emulate

Who is the Community Organizer?

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

Health Promotion, Risk Reduction  Risk and Health

and Capacity- Building Strategies  Risk – as the “probability that a specific
event will occur in a given time frame’.
A risk factor is an exposure that is
Objectives
associated with a disease”.
Upon completion of this chapter, the reader
3 CRITERIA FOR ESTABLISHING A
should be able to:
RISK FACTOR
1. Demonstrate understanding if the
I. The frequency of the disease varies by
difference between health promotion
category, or amount of the factor. Cigarette
and health protection
smokers are more likely to develop lung cancer
2. Define risk.
than nonsmokers and those who smoke heavily
3. Discuss the relationship of risk to health
are more likely to develop lung cancer than
and health promotion activities
those who smoke little.
Health Promotion and Community Health
II. The risk factor must precede the onset of
Nursing
disease.
 Nursing has focused on helping
III. The association of concern must not be due
individuals, groups, and communities
to any source of error.
maintain and protect their health
 Although people are responsible for
In order to determine health risks to individuals,
their health and medical care, they often
groups and populations, a risk assessment must
seek advice from nurses in the
be conducted
community regarding health promotion
and to help them make sense of the
 Risk Assessment is a systematic way of
many and often competing,
distinguishing the risk posed by potentially
recommendations that appear daily on
harmful exposure.
TV.

4 main steps of a Risk Assessment

Health Promotion

 Hazard Identification
 Any combination of health education
 Risk Description
and related organizational, economic,
 Exposure assessment
environmental supports for behavior of
 Risk Estimation
individuals, groups or communities
conducive to heath.
Relationship of Risk to Health and Health
 Parse stated that Health Promotion as
Promotion Activities
behavior as motivated by he desire to
increase the well-being and to reach the
 Health is directly related to the activities in
best possible health potential.
which we participate, the food we eat, and
substances to which we are exposed daily.
Health Protection
 Gender, Age, Genetic Makeup and
Environment in which we live also impact
 Refers to behaviors in which one
health.
engages with the specific intent to
prevent disease in the early stages or to
Two Types of Risks
maximize health within the constraints
1. Modifiable Risks
of disease.
2. Nonmodifiable Risks
 Immunization, cervical cancer screening
are examples of this.

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
Modifiable Risk factors
 Those aspects of health risk over which
an individual has some control.
 Examples: smoking, sedentary or active
lifestyles and etc
Nonmodifiable factors
 Those health risk factor in which an
individual has little or no control.
 Examples: Gender, age, environmental
exposure
Risk reduction
 Is a proactive process in which
individual participate in behaviors that
enable them to react to actual or
potential threat to their health.
 Risk Communication
 Is the process through which the public
receives information regarding possible
or actual threats to health.
 Health care personnel, Magazines,
Internet, radio, TV and etc.
 Risk Communication is affected by the
way individuals and communities
perceive, process, and act on their
understanding of risk.
 In 2009, about 52% of the deaths in the
Philippines were attributed to conditions
related to lifestyle factors.
Diet and Health
 Diet is one of the most modifiable of the
risk factors. A healthy diet contributes to
the prevention of chronic disease such
ad type 2 diabetes, hypertension, and
heart disease and some cancers.
 Statistics
 Obesity affects 7 out of 10 in women
and 1 out of 10 in men
 Obesity affecting Filipino adults is known
as the android or apple-shaped type,
where abdominal flat accumulation is
measured using waist-to-hip ratio
(WHR).
 A person with a WHR equal or more
than 1.0 in men or equal to more than
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
0.85 in women is considered as android
or apple-shaped obese.
Out of 5000 households, only 35% answered
that they read product labels when buying
processed food. It makes diet as an important
topic in health promotion.
 Although there are many contributing
factors to overweight and obesity,
controlling one’s weight is a matter of
balancing caloric intake with physical
activity.
 Too many calories in and few calories
out will eventually result in being
overweight.
10 Nutritional Guidelines for Filipinos
1. Eat a variety of foods everyday.
2. Breast feed infants exclusively from birth to
4-6 months and then give appropriate foods
while continuing breastfeeding.
3. Maintain children’s normal growth through
proper diet and monitor their growth
regularly.
4. Consume fish, lean meat and poultry or dried
beans.
5. Eat more vegetables, fruit and root crops.
6. Eat foods cooked in edible/ cooking or oil
daily
7. Consume milk, milk products and other
calcium-rich foods such as small fish and dark
green leafy vegetables ever day.
8. Use iodized salt, but avoid excessive intake of
salty food.
9. Eat clean and safe food.
10. Exercise regularly, avoid smoking and
drinking alcoholic beverages.
 Special populations such as pregnant
mothers or lactating women, infants,
children, older adults and adolescent
have differing nutritional needs.
 What is Portion Distortion?
 To avoid this, one may?
 To decrease the reliance on away-from-
home food, plan ahead carefully by?
 Physical activity and health
 There are many reasons people engage
in physical activity and exercise: Weight
management, increase energy, better
appearance and etc.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
 The physical activity of Filipino adults
aged 20 years and above is low. About
92.7% have low-leisure related physical
activity. About 94.5% have low travel
related physical activity like walking or
cycling. 75.4% have low non-work
related physical activity like household
chores and 76.3% have low related
physical activity.
 US data shows that men are little more
likely to engage in strength training than
women.
 18-24 years – leisure time activity is at
the peak
 Parameters developed by Clean Air Asia
 Walking path modal conflict
 Availability of walking paths
 Availability of crossings
 Grade crossing safety
 Motorist behavior
 Amenities
 Disability infrastructure
 Obstructions
 Security from crime
Sleep
 Sleep is an essential component of
chronic disease prevention and health
promotion, yet 745 of adults report
having a sleeping problem one or more
night per week.
 If the person is tired or sleepy, that it
interferes with his or hr daily activities,
that person needs probably more sleep.
 As we age, sleep is often interrupted by
pain, trips to the bathroom,
medications, medical conditions and
sleep disorders. In order to get enough
sleep, we must plan to set aside enough
time for sleep.
 Sleep is being regulated by two
processes:
 The number of hours we are awake, the
stronger the desire to sleep.
 Circadian biological click in the brain. It
makes us tend to sleepy at night when
it is dark and active when there is light.
 The circadian rhythm is why we are
sleepiest at 2am to 4m and 1pm to
3pm. While we are sleep, more
Prepared by:
LORRAINE T. ESTADILLA, RM, RN, MAN
CLINICAL INSTRUCTOR – PHC 1
hormones are being release, memory
consolidation , blood pressure is
decreased, and kidney functions
changes.
Sleep Hygiene
1. Avoid caffeine and nicotine close to
bedtime.
2. Avoid alcohol and it can cause sleep
disruptions.
3. Retire and get up at the same time ever day
4. Exercise regularly but finish exercise and
vigorous activity 3 hours before bedtime.
5. Establish regular, relaxing bedtime routine ( a
warm bath, reading a book).
6. Create a dark , quiet, cool, sleep
environment.
7. As much as circumstances allow, have a
comfortable beddings.
8. Use the bed for sleep only.
9. Avoid large meals before bedtime.
 Sleep assessment is an important
nursing function. If parents report
snoring, apnea, restlessness and
insomnia, they may have sleep
disorders.
Tobacco and Health Risk
 Smoking Cessation is an important step
in achieving optimum health.
 Based on the results of the Global Adult
Tobacco Survey, t is estimated that
more than half o the World’s smokers
lives in 14 countries and the Philippines
is among them.
 In 2009, 8 out of 10 leading mortality
cases is caused by smoking.
How to Quit Smoking?
1. Make decisions to quit smoking.
2. Set a date to quit smoking and choose a
plan.
- Mark the date in your calendar.
- Tell your family and friends about the date,
and ask for their support.
- Get rid of all tobacco products, ashtrays
and lighters.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
- Stock up on oral substitutes such as
sugarless gum, hard candy, fruit and carrot
sticks.
- Decide for a plan an prepare to implement
it.
 Think back on the previous attempts
you made to see what worked and what
di not.
 If you are taking bupropion or
verenicline, take your medication each
day of the week leading up to your quit
day.
 Deal with withdrawal through:
- Avoid temptation
- Changing your habits
 Staying off of tobacco is a lifelong
process.
- Remind yourself of the reasons you why
you quit.
- Wait out the craving.
- Avoid alcohol.
- Begin an exercise program
Only 4%-7% of smokers are able to quit
smoking on any attempt without pharmaceutical
or other interventions to help them, so nurses
must provide information and referrals to help
clients assess resources to help them to get off
and to stay off of tobacco.
 RA No. 9211 or the Tobacco Regulation
Act of 2003 prohibits smoking in public
places and sale of tobacco products to
minors.
 The ordinances of smoking ban had also
been passed to various cities and
provinces such as Davao City and
Provice of Albay.
Alcohol Consumption and Health
 Alcohol use is very common in our
society, and serving alcoholic beverages
is considered customary in social
gatherings.
 In 2003- 2005, consumption of alcohol
by Filipinos aged 15 years and older was
estimated 6.4 liters per capita.
 Drinkers had a per capita consumption
of 17 liters, with male drinkers
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CLINICAL INSTRUCTOR – PHC 1
consuming in 19 liters and female
drinkers, 10.9 liters..
 13 to 15 years old students showed that
18.7% of Filipino students drank at least
one drink containing alcohol on one or
more of the past 30 days before the
survey.
 First sip at 14 years was 61.5% among
males and 51.5% among females.
 A drink is the amount of any alcoholic
beverages that delivers v a half ounce
(around 15 ml) of pure ethanol, which is
equivalent to the following:
 4-5 ounces (around 120-150ml) of wine
 10 ounces of wine cooler
 12 ounces of beer
 1.25 ounces of distilled liquor
 Health authorities have defined
moderation as not more than two drinks
a day for the averaged-sized man and
not more than one drink a day for the
average-sized woman.
 Thus, the amount of alcohol a person
can drink safely is highly individualized,
depending on genetics, health
conditions, sex, weight, age and family
history.
 However, those who should not drink at
all include:
 Pregnant or trying to become pregnant
women
 People taking prescription or over-the-
counter medications that may cause
harmful reactions when mixed with
alcohol.
 People younger than 21 years
 People recovering from alcoholism or
are unable to control the amount that
they drink.
 People suffering from a medical
condition that may be worsened by
alcohol.
 Anyone driving, planning to drive, or
participating in other activities requiring
skill, coordination and alertness.
 Ten target areas for national action to
reduce the harmful use of alcohol
 Leadership, awareness, commitment
 Health service response
 Community action
 Drink- driving policies
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

 Availability of alcohol
 Marketing of alcoholic beverages
 Pricing policies
 Reducing the public health impact of
unrecorded alcohol
 Monitoring and surveillance

Health Education

 Health promotion, health protection and

risk reduction entails clients deliberate
performance or avoidance of particular
actions. This performance or avoidance
ensures that people be quipped with
certain SKA.
 Maurer and Smith distinguish Health
Education and Patient Education

Health Education

- is the process of changing SKA for health

promotion and risk reduction. The nurse
participates in health promotion by empowering
people so that they are able to achieve optimum
level of health an prevent disease by bringing
lifestyle changes and reducing the exposure to
health risks communication.

Patient education

- usually refers to a series of planned teaching-

learning activities designed for individuals,
families or groups with an identified alteration in
health.
Purpose: to aid the client in coping with the
event, to prevent complications or deteriorations
of client’s condition and in cases of CD to
prevent transmission of disease.

The Effective Nurse educator

1. Message
2. Format
3. Environment
4. Experience
5. Participation
6. Evaluation

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines
Philippine Traditional and Alternative
Medicine
Traditional medicine has been practiced since
ancient times in every culture throughout the
world and has been an integral part of human
evolution and development.
The evolution of Philippine traditional medicine
is an interesting study that is influenced by
religion, mysticism, magic, superstition, folkloric
herbalism and western medicine.
Philippine's common traditional medicine
practitioners include the following:
hilot or manghihilot acts as a midwife, a
chiropractor or massage therapist to promote
health and healing
Tawas or mangtatawas, this practitioner uses
alum, candles, smoke, paper, eggs and other
mediums to diagnose the cause of illness
associated by prayers and incanteations
albularyo, a general practitioner who uses a
combination of healing modalities that may
include prayers, incantations, mysticism and
herbalism. Albularyos claim to draw healing
powers from a supernatural source (shamanism)
Medico, a general practitioner similar to an
albularyo but integrates western medicine to
promote healing.
Faith healers, a practitioner who claims divine
power bestowed by the Holy Spirit or God. A
patient is required to have faith and believe in
divine powers to effect healing
The 10 Herbal Plant approved by the
Department of Health-DOH
1.Akapulko  (Cassia alata) - also known as
"bayabas-bayabasan" and "ringworm bush" in
English, this herbal medicine is used to treat
ringworms and skin fungal infections.
2. Ampalaya (Momordica charantia) - known as
"bitter gourd" or "bitter melon" in English, it
most known as a treatment of diabetes
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CLINICAL INSTRUCTOR – PHC 1
(diabetes mellitus), for the non-insulin
dependent patients.
3. Bawang (Allium sativum) - popularly known
as "garlic", it mainly reduces cholesterol in the
blood and hence, helps control blood pressure.
4. Bayabas (Psidium guajava) - "guava" in
English. It is primarily used as an antiseptic,
to disinfectwounds. Also, it can be used as a
mouth wash to treat tooth decay and gum
infection.
5. Lagundi(Vitex negundo) - known in English
as the "5-leaved chaste tree". It's main use is
for the relief of coughs and asthma.
6. Niyog-niyugan (Quisqualis indica L.) - is a
vine known as "Chinese honey suckle". It is
effective in the elimination of intestinal worms,
particularly the Ascaris and Trichina. Only the
dried matured seeds are medicinal -crack and
ingest the dried seeds two hours after eating (5
to 7 seeds for children & 8 to 10 seeds for
adults). If one dose does not eliminate the
worms, wait a week before repeating the dose.
7. Sambong (Blumea balsamifera)- English
name: Blumea camphora. A diuretic that helps
in the excretion of urinary stones. It can also be
used as an edema.
8. Tsaang Gubat(Ehretia microphylla Lam.) -
Prepared like tea, this herbal medicine is
effective in treating intestinal motility and also
used as a mouth wash since the leaves of this
shrub has high fluoride content.
9. Ulasimang Bato(Peperomia pellucida) - It is
effective in fighting arthritis and gout. The
leaves can be eaten fresh (about a cupful) as
salad or like tea. For the decoction, boil a cup of
clean chopped leaves in 2 cups of water. Boil for
15 to 20 minutes. Strain, let cool and drink a
cup after meals (3 times day).
10. Yerba Buena (Clinopodium douglasii) -
commonly known as Peppermint, this vine is
used as an analgesic to relive body aches and
pain. It can be taken internally as a decoction or
externally by pounding the leaves and applied
directly on the afflicted area.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

Tips on Handling Medicinal Plants / Herbs:

• If possible, buy herbs that are grown

organically - without pesticides.

• Medicinal parts of plants are best harvested on

sunny mornings. Avoid picking leaves, fruits or
nuts during and after heavy rainfall.

• Leaves, fruits, flowers or nuts must be mature

before harvesting. Less medicinal substances
are found on young parts.

• After harvesting, if drying is required, it is

advisable to dry the plant parts either in the
oven or air-dried on screens above ground and
never on concrete floors. 

• Store plant parts in sealed plastic bags or

brown bottles in a cool dry place without
sunlight preferably with a moisture absorbent
material like charcoal. Leaves and other plant
parts that are prepared properly, well-dried and
stored can be used up to six months.

Tips on Preparation for Intake of Herbal

Medicines:

• Use only half the dosage prescribed for fresh

parts like leaves when using dried parts.

• Do not use stainless steel utensils when boiling

decoctions. Only use earthen, enamelled, glass
or alike utensils.

• As a rule of thumb, when boiling leaves and

other plant parts, do not cover the pot, and boil
in low flame.

• Decoctions loose potency after some time.

Dispose of decoctions after one day. To keep
fresh during the day, keep lukewarm in
a flask or thermos.

• Always consult with a doctor if symptoms

persist or if any sign of allergic reaction
develops.

Prepared by:

LORRAINE T. ESTADILLA, RM, RN, MAN

CLINICAL INSTRUCTOR – PHC 1