COMMUNITY AND PUBLIC HEALTH

FOR MEDICAL LABORATORY SCIENCE

MODULE 3 | THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
Prepared by: A. Dumlao, RMT
 Module 3.4
THE HEALTH CARE
PROCESS
Module 3.4
THE HEALTH CARE PROCESS
Topics covered: Learning objectives:
• Principle of Health Care process • Define the health care
• Concepts of family
• Types of Family
1 •
process
Describe the roles of each
• Roles and Responsibilities of family member of the family
members • Differentiate families
• Health Care Process for a Family
according to their structure
• Apply health care process in
family setting
• Formulate health care
objectives for a family care
Public Health is the science and
art of preventing disease,
prolonging life, and promoting
physical health and efficiency
through organized community
efforts.
TWO-WAY REFERRAL SYSTEM

2nd 3rd
Barangay Health Public Health Nurse H H
P
Worker (BHW) E E
O
P A A
U L L
L Barangay Health RHU T T
A Physician H H
Stations (BHS) Midwife
T
I F F
O A A
N BHS Midwife Sanitary C C
Inspector I I
L L
I I
T T
Y Y
The Health Care Process

Donabedian was an early

proponent of the use of the
process concept in
healthcare. He identified the
importance of looking at the
organizational structure and
the processes involved in
producing outcomes for the
patients.
The Health Care Process

The citizen should be looked upon as

a cocreator of value and
improvement of these processes.
The Health Care Process
FIVE MAIN PROCESSES OF HEALTH CARE

Detecting Providing
Keeping Diagnosing Treating
health for a good
healthy diseases diseases
problems end of life

Bo Bergman et al. BMJ Qual Saf 2011;20:i41-i42

The Health Care Process
Keeping healthy (prevention)
• The use of personal
improvement projects is a
mechanism to improve health
at the individual level.

• However, the healthcare

system also has to engage in
proactive prevention of future
illness.
The Health Care Process
Detecting health problems
• Proactive outreach on the
part of the healthcare
system is important.
The Health Care Process
Diagnosing diseases
• This is the process needed
to trigger the next process
of treatment.

• Timeliness of diagnosis is
critical for many disease
paths. The healthcare
system provides the
knowledge and methods
for this process.
The Health Care Process
Treating diseases
• Through self-management, the
citizen can work as a stronger
partner with the healthcare
system to improve this process.
The Health Care Process
Providing for a good end of life
• The medical specialties are
divided by organ/symptom
area: the heart, eyes, hearing,
mental health, etc.

• A holistic point of view is

required
What is a Family?

• The basic unit of society

• A primary entity of health care or

institution responsible for the physical,
emotional and social support of its
members.

• Its foundation is marriage

Types of Family
Family of orientation
• the family into which you are
born, and where one is reared
and socialized

Family of procreation
• created when you marry or form
a significant and lasting bond
with another adult
Roles and responsibilities of family members
• A family role is an expected set of behaviors associated with a
particular family position that can be formal or informal.
• Formal roles - recognized by expectations associated with roles
• Informal roles - those that are casually acquired within the family

• A family consists of the interactions between the mother and

father, parents and children, and siblings, in their respective roles.

• These roles, guided by culturally prescribed norms, are made up

of specific tasks and responsibilities.
Roles and responsibilities of family members

Tatay - “Haligi ng tahanan”

• being the head in authority, his wisdom
is well respected

• he's the breadwinner so the family

depends on him for financial support

• he earns the money so that he can

provide for the basic needs of the family
including the children's education.
Roles and responsibilities of family members

Nanay - “Ilaw ng tahanan”

• the keeper of the home and children

• she serves as mother and teacher,

managing the family resources with care

• she shares the financial struggles of the

father, doing jobs to earn additional income
Roles and responsibilities of family members

Ate, Kuya, Bunso

• Children are expected
to show respect to
elders and care for their
parents up to their old
age and unto death.
Roles and responsibilities of family members

• A family is composed of two or more people who are

emotionally involved with each other and live in close
geographical proximity.

• Emotional connection is established

through caring and a commitment to a
common purpose
• Parent - child relationships influence a
person's concept of self-worth and
capacity to form later relationships.
Roles and responsibilities of family members

Tahanan
root word:
Tahan
v. magtahan, tumahan (mag-:-um-) to cease or stop crying.

✓ Home: a place of love, comfort, and rest.

✓ The Filipino family serves as a source of refuge.
Family Structure
Family structure refers to the characteristics and the
demographics (age, sex, number) of individual members who
make up family units. As a structure, it may be classified as:

• Traditional Family
• Nuclear/Conjugal
• Extended/Consanguineous

• Single Parent Families

• Alternate Family Structure

Family Structure
Traditional Family
• Nuclear/Conjugal Family
• consists of a husband and wife, and their children (natural or
adopted) who live in a common household.

• referred to as “mag-anak”, the primary unit and building block in

Filipino Christian family structure.

• Polygamous Family - when nuclear families are united through

the extension of the husband-wife bond as a result of plural
marriages
Family Structure
Traditional Family
• Extended/Consanguineous Family
• a form of combining nuclear units into larger units through the
parent-child relationships.

• composed of two or more residential units of three or more

generations.

• part of the extended family are relatives such as aunts, uncles,

cousins, and grandparents.
Family Structure
Single-Parent Families
• Single parents may be never-married, separated, divorced, or
widowed.

Alternate Family Structure

• Cohabitating Families
• includes those individuals who choose to live together
• Single persons not living with others - he or she is a part of a family of
origin, usually has a social network with significant others.
• independent young adults who have entered the work force
• the elderly left alone through death of a spouse
Family Stages and Tasks
Family with
Beginning Family
teenagers

Childbearing Launching center

Family Family

Family with pre- Middle-aged

school children Family

Family with school-

Aging Family
age children
Family Stages and Tasks
Beginning Family
• covers the start of marriage to the birth of the first child, including
establishment of a new household and the beginning of a
nuclear family

Childbearing Family
• begins with the birth of the first child and lasts
until the child is 30 months of age

Family with pre-school children

• covers the years from the time the oldest child is
2½ years old until the youngest child is 5 years
old
Family Stages and Tasks
Family with school-age children
• the oldest child is 6 years of age until the child turns
13 years of age

Family with teenagers

• begins when the oldest child is 13 years of age and
ends when the youngest child is 20 years of age or
leaves home

Launching Center Family

• covers between the time the first child leaves home
and the last child leaves home
Family Stages and Tasks
Middle-aged Family
• this stage refers to the years from the time
the last child leaves home to the retirement
or death of one of the spouses

Aging Family
• this stage lasts form the retirement of one or
both members of the couple through the
death of one of the spouses, ending with
the death of the remaining spouse
Family Functions
1. Affective
• promotes the stability of family members be meeting psychological
needs.

2. Socialization and social placement

• these will facilitate in the life-long process of learning for the growth
and development of the individual; social control; and transmission of
culture.
Family Functions
3. Reproduction
• the family provides recruits for society to ensure the continuity of the
intergenerational family and society through procreation.

4. Economic
• allows the family to acquire and allocate adequate financial
resources to meet their needs.

5. Health Care and Physical Necessities

• Physical care is the provision of basic needs such as food, clothing
and shelter.
• Family health care includes family health and lifestyle practices
Health Care Process for a Family
The family as a unit of care
and service has been the domain in
community health care, in context
with a larger goal - facilitating the
health of the community.

The family is viewed as an

aggregate of persons of different
ages, their family development,
dynamics, interaction and the health
of the family as a whole.
Family Functions
Characteristics of Family as a Patient
1. The family is a product of time and place
• the ways in which a family is organized and the societal tasks which are
assigned to it will vary

2. The family develops its own lifestyle

• each family develops its own set of values, its own patterns of behavior, and
its own style of life.

3. The family operates as a whole/group.

• a family may have developed a pattern of facing the problem as a group,
deciding together what they will do.
Family Functions
Characteristics of Family as a Patient
4. The family accommodates to the needs of the individual.
› Each member of the family is functioning as a unique human being, with
his own destiny to fulfill. Each member must assert himself in a way that
allows him to grow and to develop.

5. The family relates to the community.

› the family develops a characteristic stance with respect to the
community.
Health Care Process for a Family
Family based health care process is a client-oriented, systematic and dynamic
approach to scientific problem solving involving a series of dynamic actions for
the purpose of facilitating optimum family functioning:

Relating/Establishing a Good Working Relationship with the Family

Assessment

Planning

Implementing

Evaluating
Health Care Process for a Family

Relating/Establishing a Good Working Relationship with the Family

• the foundation or all subsequent actions

• facilitate and maintaining a two-way communication in

gaining the family’s trust and confidence

• the health care worker initiates contact, shows interest and

concern, demonstrates a helpful attitude, sincerity and
sensitivity
Health Care Process for a Family
Family Assessment
Purpose:
• to determine the level of family functioning
• to clarify family interaction patterns
• to identify strengths and weaknesses
• to describe the health status of the family and its
individual members (Logan & Dawkins, 1986).
Health Care Process for a Family
Family Assessment
The health worker must first assess all components of family
functioning:
1. Family dynamics
2. Health status of each family member
3. Socio-economic-cultural factors
4. Home living and environmental condition
5. Preventive health practices

The health worker must then formulate conclusions about the family
needs as he categorizes the health problems and determine the
various levels of family functioning, to assess why there is a need for
care and supervision.
Health Care Process for a Family
Family Assessment
Characteristics of Healthy Families who are Functioning Well in Society
(Hanson 2001)
The family:
• tends to communicate well and listen to all members
• affirms and supports all of its members
• values teaching respect for others
• members have a sense of trust
• plays together and humor is present
• members interact with each other, and a balance in the
interactions is noted among the members
Health Care Process for a Family
Family Assessment
Characteristics of Healthy Families who are Functioning Well in Society
(Hanson 2001)
The family:
• shares leisure time together
• has a shared sense of responsibility
• has traditions and rituals
• shares religious core
• honors the privacy of its members
• opens its boundaries to admit and seek help with problems
Health Care Process for a Family
Family Assessment
Tools:
• Genogram
displays pertinent family information in a family tree
format that shows family members and their relationships
over at least three generations (McGoldrick, et al, 1999).
44
45
Health Care Process for a Family
Family Assessment
Tools:
• Ecomap
The ecomap is a visual diagram of the family unit in
relation to other units or subsystems in the community.
The ecomap presents the nature of relationship among
family members, and between families and the
community.
Health Care Process for a Family
Family Assessment
Tools:
• Family APGAR
A family unit is considered by Smilkstein to be a nurturing
unit that demonstrates integrity in the five components:
Adaptability, Partnership, Growth, Affection and Resolve.
This tool is useful in suggesting areas to be assessed
relative to family functioning and potential areas of
family strengths and resources.
Health Care Process for a Family
Family Assessment
Tools:
• Family Coping Index
The purpose of this is to provide a basis for estimating the
needs of a particular family
Health Care Process for a Family
Planning
This involves the formulation of desired family outcomes and
identification of actions to achieve goals. Careful planning builds
on the data collection and diagnosis of the family-based health
care process and increase the probability of successful
implementation and evaluation.

Essential components of the plan

1. Problem definition
2. Goals and objectives of care
3. Plan intervention
4. Plan for evaluating care
Health Care Process for a Family
Planning
✓ Goal setting for a family must be realistic and in accordance
to the needs of the majority of the family members.
✓ Mutual goal setting in which the client and the family are
included is the cornerstone of effective planning.
Health Care Process for a Family
Implementing/Intervention
It is a systematic approach to actions used in partnership with the
family to achieve desired family outcomes.
Three levels of Family functioning:
• Cognitive interventions
pertains to the act of knowing, perceiving, or
understanding
• Affective interventions
related to feelings, attitudes and values
• Behavioral interventions
refers to skills and behavior modification
Health Care Process for a Family
Implementing/Intervention
Three types of interventions (Freeman and Heinrich,
1981):
• Supplemental intervention
doing things that the target client cannot do.
• Facultative intervention
minimizing, if not removing the obstructions to
health care.
• Behavioral/developmental intervention
allows the health care provider to motivate
families to make responsible decisions for
themselves
Health Care Process for a Family
Evaluation
It is a mutual continuous process that incorporates
reassessment, and modification of the care plan to
determine whether goals and outcome criteria were
stated correctly to permit modification as
circumstances change, and met effectively.
Health Care Process for a Family
Evaluation
Three approaches to evaluating the quality of health care rendered:
• Structure
refers to settings in which care occurs. This approach to
evaluation is based on the assumption that, given a proper
setting with good equipment, good care will follow
• Process
refers to whether the care that was given was competent or
preferred
• Outcome
refers to the results of client care and restoration of function and
survival
Health Care Process for a Family
Evaluation
 References

• Ebuen B. U., et al. (2019). Health Information System for Medical Laboratory Science
• David, E. S., Rodolfo, M. J. L. D., Serraon-Claudio, V., Jamorabo-Ruiz, (2007). Community Health Nursing: An Approach to Families
ad Population Groups
• Gyuchan Thomas Jun, James Ward, Zoe Morris, John Clarkson, Health care process modelling: which method when?, International
Journal for Quality in Health Care, Volume 21, Issue 3, June 2009, Pages 214–224, https://doi.org/10.1093/intqhc/mzp016
• Bergman B, Neuhauser D, Provost L (2011). Five main processes in healthcare: a citizen perspective BMJ Quality & Safety
2011;20:i41-i42.
• Resource Manual for Health Care I and Health Care II

• https://www.who.int/gender-equity-rights/knowledge/right-to-health-factsheet/en/
• https://www.who.int/health-topics/primary-health-care#tab=tab_1
• https://www.who.int/news-room/fact-sheets/detail/primary-health-care
• https://openi.nlm.nih.gov/detailedresult?img=PMC2738304_IJCCM-12-67-g001&query=&req=4
• https://qualitysafety.bmj.com/content/qhc/20/Suppl_1/i41.full.pdf
• http://3.bp.blogspot.com/-z9hNqZzeucc/TZKsQ3eYtJI/AAAAAAAAABQ/X8eyIijRZEs/s1600/genogram+1.jpg
• https://i.ytimg.com/vi/ED0WWi67bpM/maxresdefault.jpg
• https://ferrisintroductiontosocialwork.pressbooks.com/app/uploads/sites/64471/2017/08/image-1-2.png
• https://image2.slideserve.com/4581670/filipino-family-apgar-part-i-l.jpg
• https://imgv2-1-f.scribdassets.com/img/document/47339664/original/735bc9c61a/1486516131
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638.jpg?cb=1441979220