Discussed by: Prof.
Aida Garcia
Bachelor of Science in Nursing 2YA
CHNN211 LEC: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
Coverage for Prelim:
• Evolution PHN in the Phil
• National/ Global Health Situation
• Community Health Nursing
• Phil Health Care Delivery System
• Primary Health Care
• Rural Health Unit
• Family Health Nursing
• Herbal Medicine
• Family nursing care plan
EVOLUTION: PUBLIC HEALTH NURSING IN THE
PHILIPPINES
• 1577
- Franciscan Friar Juan Clemente (Priest) opened medical
dispensary in Intramuros for the indigent.
- This medical dispensary is now san Lazaro hospital
- Dispensary – nag bibibgay ng libreng gamot
• 1690
- Dominican Father Juan de Pergero (Priest) worked toward
installing water system in San Juan del Monte and Manila.
- They adopted the idea of john snow who find out that
cholera contaminates water so they put up water station.
• 1805
- Smallpox vaccination was introduced by Francisco de
Balmis, a personal physician of King Charles IV of Spain.
• 1876
- First medicos titulares (Certified doctor) were appointed
by the Spanish government.
- Dumarami na ang sakit dito sa pilipinas kaya nag padala
sila ng mga doctor pero maraming doc. ang ayaw
pumunta dito. Kaya gumawa sila ng 2yrs course sa UST↓
• 1888
- 2-year courses consisting of fundamental medical and
dental subjects - First offered UST.
- Graduates were “cirujanos ministrantes”.
- Serve as male nurses and sanitation inspectors. They are
the one who are given the responsibility when it comes to
sanitation of the community.
• 1901
- United States Philippine Commission
- Act 157, created Board of Health of Philippine Islands
with Commissioner of the Public Health (like duque), as
chief executive officer (now DOH)
• Fajardo Act of 1912
- created Sanitary Divisions made up of one to four
municipalities.
- Each sanitary division had a president who had to be
physician.
• 1915
- Philippine General Hospital began to extend public health
nursing services in homes by organizing unit called social
and home services.
• 1905 Asociacion Femenista Filipina
- La Gota de Leche was the first center dedicated to the
service of mother and babies.
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• Commonwealth Act No. 430
- Philippine government
- Under Philippine gov. they put up dep. Of health and
called it Department of Public Health and Welfare.
- Pinagsama ang 2 dep. Na to dhil they become the case of
mortality ung pag nag kasakit pwede mamatay at kumuha
ng needs so lalo hihirap.
- Modern times: department of health and DSWD
- DSWD – pinipili nila ung mga indigent, children.
- Hindi pa ito na fully implement nood dahil mahitap ang
ph kaya nung nag bago ang pres. nagpatupad ng↓
• EO No. 317 (1941)
- Full implementation of Commonwealth Act No. 430.
• Dr. Jose Fabella
- 1st Department Secretary of Health and Public Welfare.
• 1947 – Post war
- the Department of Health was reorganized into bureaus:
- Bureau of Hospitals and a Bureau of Quarantine were
created under DOH.
- Took charge of municipal and charity clinics.
- (DOH nagging 2 dept. kase lalong nag hirap ang ph
after nung war at maraming infectious diseases)
- Creation of Nursing Service Division.
1) Bureau of Health with the sanitary divisions under it.
- Originally male nurses handle sanitation during
Spain time
- Eventually nung nag karoon ng sanitary div. at
doctor na ang boss nila.
- After non ung sanitary division pinasok na nila
yung trabaho under DOH
- DOH responsible na ngayon sa disease
prevention and health promotion
2) Bureau of public welfare (became the Social Welfare
Administration, katumbas ng DSWD)
3) Bureau of hospitals – curative
4) Bureau of hospitals – preventive care services.
• 1951
- Sanitary district was converted into a Rural Health Unit.
- 81 selected provinces (ginawa lang sa mga probinsyang
Malaki ang problema).
- Vital statistics - bilang ng mga namatay, nag kasakit at
gumaling. Ang binibilang lang ay ung mga sakit na
mabilis kumalat.
- 7 Basic Health Services:
1. Maternal and Child Health
2. Environmental Health
3. Communicable Disease Control
4. Vital Statistics
5. Medical Care
6. Health Education
7. Public Health Nursing
• 1954 – R. A. 1082 or Rural Health Act
- Initially known as sanitary district/division.
- Creation of RHU in every municipality.
- Created post for Municipal Health Officer.
- Originally 81 provinces have this now lahat na ay meron.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
• 1957 – R. A. 1891
- amend certain provisions in Rural Health Act.
- Created 8 categories of rural health units corresponding to
the population size of the municipalities.
- Barangay Health Station – branch RHU; no dentist; main
stay midwife; barangay health worker.
- Rural Sanitary Inspector – siya na nagiinspect ng
sanitation.
• 1970
- Classification of health services into: Primary, Secondary
and Tertiary Levels of Care.
- PHN population ratio is 1: 20,000. (1-nurse)
- Primary Level of Care – for health promotion and disease
prevention. (Rural Health center formal na tawag sa
health center)
- Secondary Level of Care – pag may sakit, moderate
specialized care. District hospital
- Tertiary Level of Care – highly specialized care.
• RA 1891
- In 1957 amend certain provisions in rural health act
- Created 8 categories of rural health units corresponding to
the population size of the municipalities
- Ung mga lugar na hindi naabot ng health center ay
tinayuan ng barangay health station- branch of rural health
unit
- Barangay health station- no dental chair and no nurses and
doc available unlike in RHU.
- Rural sanitary inspector- inspects environment if it can
cause sickness.
• 1991 October, R. A. 7160 or Local Government Code
- Decentralization of entire government – all structures,
personnel, and budgetary allocations from the provincial
health level down to the barangays were devolved to the
local government unit (LGU) to facilitate health service
delivery.
- What happened in the health system in phil because of the
local government code? – decentralized kase nag hati-hati
na sa work.
- Delivery health services – now the responsibility of the
LGU
- DOH changes its role from one of implementation to one
of governance.
• 2000
- Millennium Development Goals
- adopted during world summit in September. Created
8 goals
- 1 – connected to poverty
- 4, 5, 6 – connected with health
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• 2005
- FOURmula One (F1) for health and Universal Health
Care in 2010 – agenda launched in 1999
- Health Service Delivery - Both the national government
and LGUs manage the delivery of promotive, preventive,
curative and rehabilitative health services.
- Health Financing – The National Health Insurance Act of
1995 created the Philippine Health Insurance Corporation
(PhilHealth) to provide health insurance coverage for all
Filipinos.
- Health governance and regulation – The enactment of
LGC in 1991 led to dual governance in health, with the
DOH governing at the national level and the LGUs at the
subnational level.
• 2010
- Agenda launched in 1999 Health Service Delivery. Both
the national government and LGUs manage the delivery
of primitive, preventive, curative and rehabilitative health
services.
Universal Health Care
- Aims to achieve the health system goals of better health
outcomes, sustained health financing, responsive health
system that will provide equitable access to health care.
Universal Health Care Act Kalusugan Pangkalahatan
(Republic Act No. 11223)
- automatically enrolls all Filipino citizens in the National
Health Insurance Program.
- Provide all Filipinos with access to affordable, quality, and
comprehensive health services.
NATIONAL OR GLOBAL HEALTH SITUATION
Population
- Demographic – yung bilang
- Population by gender = Male 50.5% and Female 49.5%
- Population by age = age 5-14 – 21% and age 15-24 – 20%
- Life expectancy – mas tumatagal ang buhay ng mga
kababaihan.
• M 68.8 & F 74.3 (2015-2020)
Annual Ave Pop Growth Rate (%)
2010 – 2015 1.73%
2015 – 2020 1.59 %
2020 - 2025 1.41 %
Projected Population / Total
Yr. 2020 109,947,900
Yr. 2025 117,959,400
Yr. 2030 125,337.500
- Using the annual average population growth rate, you will
compute for projected population.
- Ave fertility in the Philippines = 3
Natality
- Birth
- Live births by age of the mother
- Live births by sex and regions (NCR, CAR, REG 1…)
- Live births by attendance (M.D, Public health nurse, Midwife,
Traditional birth attendant, others)
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

- Infectious – microorganism (morbidity)

- Lifestyle – naninigarilyo, pagiinom ng alak (mortality)

- NCR has many facilities

In 2013
- 531,280 registered deaths from all causes and all ages.
- Males: 304,516 (57%) Females: 226,764 (43%)
- For every 1,000 population - More than 5 people die.

Notifiable Diseases
- Dengue 361,000 confirmed cases. 1, 373 deaths. January 1 to
October 25 (2018 – 2019)
- Diphtheria 197 confirmed cases, 47 deaths.
• January 1 to October 5 (2018 – 2019)
• Measles 42, 400 confirmed cases, 560 deaths.
• January 1 to October 12 (2018 – 2019). Most affected 1
year old.
- Pinagbabawalan na yung pagpapaanak sa bahay. • Polio 3 confirmed cases, 13 confirmed environmental
- Traditional birth attendant – manghihilot samples; 4.4 Million target immunization for children up
to 5 years old.
Morbidity or Mortality • October 2019 to January 2020
- Sickness and death
- Morbidity: ten leading causes (TB other forms, Dengue fever,
TB respiratory, Acute water diarrhea…)
- Mortality: all causes by age group

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 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
Global Health Situation
• April 10, 2020
- Coronavirus Disease 2019 (COVID-19) is an infectious
disease caused by a new coronavirus recently introduced
to humans for the first time”.
- WHO called it a pandemic.
- Virus spreads all over the world.
- About 80% of COVID-19 (+) have mild symptoms.
• September 2019
- Synchronized polio vaccination campaigns Nov to Dec
2019 in targeted regions reached a total of 1,404,517
(exceeding target) children below 5 years old in NCR and
2,937,327 (95%) children in Mindanao.”
• January 30, 2020
- Polio vaccination must intensify until last child is reached
and fully protected.
• April 7, 2020
- Urgent Need for Investment in Nursing.
- “In Philippines, shortfall of nurses at 249,843 by 2030.
Greater investment now to retain them in Philippine
health sector.”
COMMUNITY HEALTH NURSING
Community
- A group of people with common characteristics or interests
living together within a territory or geographical boundary
place where people under usual conditions are found (mass
approach).
- Common illness ang tinatarget
Health
- WHO: states of complete physical, mental and social –
wellbeing. Not merely an absence of disease or infirmity
(This should be complete so kapag malabo ang mata mo you
are not healthy dapat kase kumpleto)
- Modern definition: OLOF or Optimum Level of Functioning
- Generally, influences health  eco-system
• Political – safety, oppression, people, and empowerment.
• Behavior – culture, habits, ethnic customs.
• Heredity – generic endowment (defect, strengths, risk).
• Health care delivery system – promotive, preventive,
curative, rehabilitative.
• Environment – air, food, water waste, urban or rural,
noise, pollution, radiation.
• Socio-economic – employment, education, housing
- Determinants of health – is affected by combination of many
factors (using this malalaman mo kung ano ang tinatarget mo
sa isang community):
• Environment and circumstances
• Income and social status – (ang poverty could result to
infection and bad lifestyle)
• Employment and working conditions – (mas mabigat ang
trabaho ng mga males kumpara sa females)
• Education – (madalas mag kasakit ang mga less educated
kase may sarili silang beliefs at kulang ang pinag aralan
nila)
• Physical environment – (kung madumi tataas ang
infection)
• Health services – (walang resources)
• Social support networks – (para masustain ang health)
J.A.K.E 5 of 28
• Personal behavior and coping skills – (sa mga nag online
games dapat may social interaction pa din sila sa family
nila or friends)
• Genetics
• Gender
• Culture
Public health
- In tgaalog pangkalusugang pang kalahatan
Winslow
- A science and Art of Prevents Disease, promote
health/efficiency, Prolong life.
- Organized community effort for:
• Sanitation environment
• Control communicable disease
• Education personal hygiene
• Organization of medicine
• Nursing service.
- (↑ kapag naman nagawa ito lahat ng tao mag kakaroon ng ↓)
- For early detection and prevent treatment of disease.
- Development of social machinery to ensure a standard of
adequate living for maintenance of health.
(Social machinery- para malaman kung anong part ng govt.
ang tutulong)
- Enable every citizen to realize birth right of health and
longevity. (kaya mula noon hanggang ngayon bawal ang
abortion bcs we have the right to live and live long)
- Nung ginawa niya ito maraming sakit at nakita niya na
kapag nag tulong-tulongan ang mga tao na co-conquer
naman ito.
WHO
- Art of applying science in the context of politics.
(Madalas kausap ang politics kaya meron politics sa
meaning)
- Public health is a core element of government attempt to
improve citizens welfare (gov. dpat ang unang mangalaga sa
health ng kalahatan)
• Essential public health function. (ito dpat ang gawin ng
gov.)
• Development of policy in public health regulation to
protect public human resources.
• Surveillance (mga sakit na binibilang)
• Research, innovation solution.
• (↑ kapag nagawa ito lahat ng govt. mag kakaroon ng)
Ensure quality health service health promotion. (at para
ma bawasan ang hindi pag kakapantay pantay dahil
lagging nag kakasakit nag mga mahihirap ↓)
• Reduce inequalities; ensure best health for the greatest
number.
- DOST – to research (tuberculosis, dpaat gawan ng research
sa 4th year)
QUESTIONS:
1. Trabaho ng government – WHO
2. Kapag ginawa natin ito ay hahaba ang buhay natin –
Winslow
3. Dapat gumaw ng policy and rergulate ito – WHO
4. Kayo-kayo mag linis ng katawan/kapaligiran ninyo –
Winslow
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
Public Health Nursing
Lillian Wald
- Coined (made the word public health nursing)
- (orphanage) Director: Henry St. Settlement in New York
- Service that is available to all people or “public” 
government agency  care of poor people.
- Invented bag technique
- Since nurse in govt. she thought to take care of the public.
National League of Philippine Government Nurses
- Practice of nursing in local or national government health
department and public school.
- Position, title, designation (civil service commission)
- Public health nurse (nurse in local or national health
department or public school)
- Difference of Public health nursing and community health
nursing is only one area or setting of work as dictated by
funding. (gov. sa tax kumukuha ng sahod; CHN mas
malawak at lahat ng working sa community or hindi nag
wowork sa hospital are working here like health center.
PHN naman working in government hospitals)
- Another definition of public health na gumawa sa PH
- Samahan ng mga nurses na working in PH
- Working in public instituition either in public school, public
local dep, public national dept.
Community Health Nursing
Dr. Ruth Freeman
- A service rendered by professional nurse with the individual,
family, group, and community at home, health clinic, clinics,
schools, places of work for:
• The promotion of health (main emphasis, kapag ito ang
lumabas sa borad exam)
• Prevention of illness
• Care of sick at home
• Rehabilitation
- Ex. In hospitals 1 bed per nurse kaya individual, at kapag
nasa community ang nurse aalagaan niya ang family, group,
and community.
- Patient – may sakit na
- Client – walang sakit
- 4 level of client:
o Individual – unique, sick or well, the “entry point”.
o Family – group of people bound by blood. Marriage
and adoption, the “unit of service”. (Unit of service in
community are buong pamilya. In hospitals u can say
“pwede po mag pa BP pero uunahin ko muna po ang
mga patient ko balikan ko na lang po kayo” pero in
community “dpat each family have healthy status”)
o Group – population group or risk group.
a) Same age group – bata at matanda
b) Same characteristics – mga buntis
c) Exposed to same environmental factor –
sisilipin ang environment.
(Considered as one population group kaya sila
naka bukod-bukod)
o Community – group of person sharing the same culture
situated in same geographical location. Main patient
and main concern.
Jacobson
- Broader than PHN.
- Nursing practice in a wide variety of services and consumer
advocate areas, variety roles, including independent practice.
J.A.K.E 6 of 28
- Not confined in PHN.
Concept of Community Health Nursing
1. Focus of care – health promotion.
2. Duration of care – over a long period of time.
3. Coverage of care
• All ages
• All types of health care
• Care for all regardless of race
• Creed
• Nationality
• Socio-economic
• Nationality
4. Benefits – family and community.
5. Knowledge used – current, multi-disciplinary (biology,
ecology, social science).
• Generalist in terms of practice.
• Applies nursing process in taking action.
• Goal of CHN  raise level of health.
Principle of Community Health Nursing
• Must fully understand objectives and principles. (Orient ka
muna sa vision and mission)
• Primary Responsibility: health teaching.
• Care is based on recognized needs of Individual, Family, and
Community.
• Resources of community (GO & NGO) must be fully utilized.
• There should be Accurate Record & Reporting. (to know if
nag de-decrease or nag i-increase.
• Family (unit of service).
• Knowledge used - No Knowledge will be obsolete Current,
Updated.
• Evaluation: periodic.
• Part of health team. (Rural health sanitary inspector na ang
nangangalaga sa environment hindi na nurse)
• Philosophy: worth and dignity of man (Dr. Margaret Shetland)
The Public Health Nurses
- Professional qualifications: licensed
- Personal qualifications:
• People skills
• strength on physical, mental and emotional.
• Tested in leadership, resourcefulness, creative, honesty,
and integrity.
• Difference in interest, willingness (capacity to work with
people).
- Function consistent:
• Nursing law 2002 - Philippine nursing RA 9173
• Program policies of DOH (series of intervention ang ibig
sabihin ng program)
• Polices of local government health agency (Ex. Acc. To
rule bawal na mag paanak sa bahay)
- Competencies skill and knowledge:
1) Nursing Process
2) Nursing Procedure (vaccination, usually diagnosing
procedure and health education, home visit or clinic visit)
3) Community Organizing (for third year students)
4) Health Promotion and Education (first year subject)
5) Surveillance, records and reports
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
Functions of PHN
1. Nursing care function
- Based on Science and Art of caring
- Towards health promotion and disease prevention of
individual, family, and community.
- Uses nursing process and recognized needs of the client.
- Home visits or referral (other health provider,
environmental health, social services)
- Every Wednesday is bakuna day in Luzon, Visayas and
mindanao
2. Collaborating and coordinating functions
- Bring group of activity in harmony with each other.
- PHN care coordinator.
- Linkages with:
• Government agencies
• NGO
• Health professionals
• Private sector.
3. Research function
- Activity – Disease Surveillance Continuous collection and
analysis of data of cases and deaths.
- Purpose of Disease Surveillance: measure magnitude of
problem and measure effect of program to improve
strategies.
- Data will be used to improve care.
- CHN2- 10 family ang iinterviewhin = 120 people
4. Training function
- Initiate staff development and training program for
midwives and barangay health worker.
- Training Needs Assessment (TNA).
- Design, conducts training with resources person, and
evaluate training.
- Training of nursing and midwifery affiliates (RLE).
- Community organizing.
5. Health promotion and education function
- Health education
• Is part of our basic health service.
• Major components of health program that is done on
daily basis.
• Solid knowledge of principles of teaching or learning.
- As an educator that provides information (better choices)
- Uses skills in advocacy, influence for health promotion.
6. Supervisory function
- Supervisor of midwives and auxiliary health workers.
- Formulate supervisory plan and conducts supervisory visit
(supervisory checklist).
- Identifies with supervisee issue or problem.
- Breach of procedure or protocol  coaching stat 
training (needs further capacity enhancement).
7. Management function
- Organizes nursing service – implement nursing service
plan as part of the overall municipal health plan.
- 5 management functions:
1) Planning
2) Organizing
3) Staffing
4) Directing
5) Controlling (evaluation)
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Public Health Nursing
PHN II
- Frontline Health Worker.
- First Contact of patient (works in health center).
- Prime mover for all health programs and activities.
- Assist physician during consultation.
- Provides health education (pre or post clinic visit).
- Reaches out in community.
- Organizes community assemblies for health promotion.
- Performs Home Visits.
- Prepare, submit reports (W, M, Q, A).
PHN III
- Acts as nurse in charge.
- Supervises, guides, coordinates work of nurse.
- Interpret policies, participates in planning health program.
- Toward managerial
PHN V
- Supervising PHN.
- Assigned in health center with lying-in. (paanakan)
- Takes charge of staff and unit.
- Participates in program planning. (madalas nasa munisipyo to
supervise nurse 2 )
- Attends, meeting, conference for improvement of health
services.
- Aside form BSN kailangan nag masteral of science in nursing
ka tatanggalin na kase ung MAN
- Candidate for managerial nurse ang nag masteral.
PHN VI
- Nurse program supervisor.
- Conducts Program Orientation.
- Conducts pre-service and in-service orientation.
- Consolidate reports.
- Study ratings of PHN performance.
- Initiate meeting, conferences for joint planning.
- Nursing consultant on technical matters.
Laws Affecting PHN
• RA 6758 – Standardized salaries of government employees
- Nursing personnel.
• RA 7305 – Magna Carta of Public Health workers.
- Improved the social and economic well-being of health
workers.
- Higher basic salary, hazard allowance, laundry allowance,
subsistence allowance
• RA 6713 – Code of conduct and ethical standard for public
- Officials and employees. Utmost responsibilities, integrity,
competence, loyalty, lead modest lives and uphold public
interest over personal interest.
Levels of Care
Primary level of health care
1. Rural Health Unit (RHU)
2. Barangay Health Station (BHS)
3. Puericulture Center
4. Clinics of large Industrial firms – employee
5. Private practitioners or private clinics and others
• Basic level of health care.
• Promotion of health, early diagnosis of disease or
disability and prevention of disease.
• The FIRST CONTACT between community members
and other levels of health facility.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
Secondary level of health care
1. Emergency Hospital (pag aari ni mayor)
2. District Hospital (pag aari ni mayor)
3. Provincial Hospital (pag aari ni governor)
4. City/ Municipal Hospital (pag aari ni governor)
• Moderately specialized equipment and laboratory
facilities Capable of Minor surgeries Referral Center for
PHC.
• Kapag hindi kaya nito ipapadala sa ↓
Tertiary level of health care
1. Regional health service
2. Regional medical services and training hospital
3. National health services
4. Medical centers
5. Teaching and training hospital
• Ultimate highly specialized health personnel
• Highly specialized technical level
• Specialized ICU
• Advanced diagnostic services for:
o Diagnosis
o Treatment of disease and disability
QUESTIONS:
1. Emphasis of care – promotion
2. Primary responsibilities if maayos pakiramdam – health
teaching
3. Four levels of client – I, F, G, C
PHILIPPINE HEALTH CARE DELIVERY SYSTEM
The Philippines
- Paano yung sistema na pagbibigay serbisyo pagdating sa
kalusugan sa mga Pilipino.
- Archipelago with 7,100 islands.
- Geographically, divided into 3 main islands: Luzon, Visayas
and Mindanao.
- 17 regions, including the Autonomous Region of Muslim
Mindanao (ARMM).
- 82 provinces.
- 135 cities.
- 1,493 municipalities.
- 2 Sectors:
• Private Sector
- production and provision of health goods and
services (private clinics, hospitals and laboratories,
drugstores, and other facilities)
• Public Sector
- Decentralized health care system. Department of
Health (DOH). Local government units (LGUs).
- Devolving primary and secondary health services
delivery Local government units (LGUs)
RA 7160: Implementing Rules and Regulation (IRR) of the
local Government Code of 1991
- Devolution of hospital services.
- Decentralization of basic hospital services.
In public sector:
- Managed, coordinated, and regulated by the DOH.
o DOH
− Composed of Central Office (San Lazaro
Manila)
− 17 Regional Offices (ROs)
− Retained hospitals
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DOH – Specialty Hospital
• Lung Center of the Philippines
• National Kidney and Transplant Institute
• Philippine Children’s Medical Center
• Philippine Heart Center
DOH – Metro Manila Hospitals
• Amang Rodriguez Memorial Medical Center
• Dr. Jose Fabella Memorial Hospitals
• East Avenue Medical Center
• Jose R. Reyes Memorial Medical Center
• National Center for Mental Health
• National Children’s Hospital
• E. Rodriguez, Quezon City
• Philippine Orthopedic Center
• Quirino Memorial Medical Center
• Research Institute for Tropical Medicine
• Rizal Medical Center
• San Lazaro Hospital
• Tondo Medical Center
- These hospitals are considered as covid referral hospitals
DOH – Regional Hospital
Regional Hospital in Cagayan Valley
• Batanes General Hospital
• Cagayan Valley Medical Center
• Southern Isabela General Hospital
• Region II Trauma and Medical Center
Regional Hospitals on NCR
• Dr. Jose N. Rodriguez Memorial Hospital – Tala, Caloocan
City
• Las Piñas General Hospital and Satellite Trauma Center
• San Lorenzo Ruiz General Hospital
• Valenzuela Medical Center
- Regional hospital – governor, mas Malaki ang sahod dahil
galling sa DOH
- Health center – mayor
Levels of Health Care Delivery
- Section 8 “Minimum Standards and Construction of a
Hospital.” Republic Act No. 4226 (Hospital Licensure Law)
categorized based on “service capacities and compliance with
standards for manpower, equipment, construction and physical
activities.
1) Primary prevention – maintenance
2) Secondary prevention – referral hospitals
3) Tertiary prevention – highly skilled and technology
- Year 2015 bumagsak tayo sa no. 4, 5, 2
- So nag conduct ng self-evaluation ang Pilipinas at nalaman ito:
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

• NICU – critical care sa bata (Neonatal Intensive Care Unit)

• An organized staff of qualified and competent personnel
with Chief of Hospital or Medical Director and appropriate
board-certified Clinical Department Heads.
• Medical director – pinaka mataas
Level 3
• Level 2 plus
• Teaching or training with accredited residency training
program in 4 clinical services. (intern doctor – like student
nurses)
• Physical Medicine and rehabilitation unit.
- Maraming namatay sa region na ito pero marami naman • Ambulatory surgical clinic (can perform minor surgery)
palang hospital so they checked the hospital claiming that they • Dialysis clinic
are hospital but below the standard of RA 4226. • Teaching and/or training hospital with accredited residency
Millennium Development Goals: training program for physicians in the four (4) major
1) Eradicate extreme poverty and hunger. specialties, namely:
2) Achieve universal primary education. 1) Medicine
3) Promote gender equality and empower women. 2) Pediatrics
4) Reduce child mortality. 3) Obstetrics and Gynecology
5) Improve maternal health. 4) Surgery
6) Combat HIV/ Aids, Malaria, and other disease.
7) Ensure environmental sustainability. General Level 1 Level 2 Level 3
8) Global partnership for development.
- For sustainable development. Level 1 plus all: Level 2 plus all:

New Classification of Hospitals and Other Facilities Teaching or

Consulting
According to Ownership training with
specialists in:
- Government – created by law. May be under DOH, DND, accredited
Medicine Departmentaliz
DOJ, LGU, SUCs, GOCC, and others. residency
Pediatrics ed clinical
- Private – may be single proprietorship, partnership, training
OB-GYNE services
corporation, cooperative, foundation, religious, non- program in the
Surgery
government organization, and others. 4 major clinical
According to Scope of Services services
- General Hospitals – provides medical and surgical care to the Clinical
sick and injured and maternity care and shall have as services Emergency
minimum, the following clinical services: medicine, pediatrics, for in- and out- Physical
Respiratory unit
obstetrics, and gynecology, surgery and anesthesia, emergency patients patients medicine and
services, out-patient and ancillary services. services rehabilitation
- Specialty Hospitals – specializes in a particular disease or unit
Isolation
condition or in one type of patient. General ICU
facilities
Hospital classification scheme
General Hospital Surgical or
- Services for all types of illness, injuries or deformities. High risk Ambulatory
maternity
Level 1 Pregnancy unit surgical clinic
facilities
• You must be able to deliver the care of the general public.
• Consult: medicine, pedia, OB-Gynecology, surgery Dental clinic NICU Dialysis clinic
• ER and OPD
• Isolation Facility Secondary Tertiary lab
• Surgical or Maternity facilities Tertiary clinical
clinical with
• Dental clinic laboratory
laboratory histopathology
• A staff of qualified medical, allied medical and Ancillary
administrative personnel. (dapat may license) Blood station Blood station Blood bank
services
• Headed by a physician duly licensed by the Professional 1st level x-ray 2nd level x-ray 3rd level x-ray
Regulation Commission (PRC)
Level 2 Pharmacy
• Level 1 plus (lahat nasa lvl. 1 nandito)
• Departmentalized clinical services Specialty Hospital
• Respiratory unit (respiratory therapist works here) − for specific disease, condition or type of patient, particular
• General ICU – critical care sa matanda disease, particular organ or groups of organs, particular group
• High Risk Pregnancy Unit such as children, women, elderly and others

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Examples of Specialty Hospitals b) Trauma – receiving facility

- A DOH licensed hospital w/ in the trauma service area
Particular Particular Group
Particular Organ(s) which receives trauma pt. for transport to the point of care
Disease of Patients
or a trauma center
National Philippines - Open 24/7
Orthopedic Lung Center Children’s Medical Department of Health
Hospital Center - The Philippines’ Department of Health (DOH) (Filipino:
National Center Kagawaran ng Kalusugan) is the principal health agency in the
Philippine Heart National Children’s
for Mental ph.
Center Hospital
Health - It is the executive department of the Philippine Government
San Lazaro National Kidney and Dr. Jose Fabella responsible for ensuring access to basic public health services
Hospital Transplant Institute Memorial Hospital to all Filipinos through the provision of quality health care and
the regulation of providers of health goods and services
- Main governing body
Health Facilities Classification - Guidance / technical assistance to LGU
Category A – Primary Care Facility - Center for Health Development
- W/out in pt. Health charts, out pt. Clinic, dental clinics – first Provincial Government
contact health facility - Administration of provincial or district hospital
- W/ in-pt. – birthing (lying-in), infirmaries – first contact health Municipal or City Government
facility - In charge of PHC (RHU/Health Center)
Category B – Custodial Care Facility - BHS
- Long term care w/ food & shelter to chronic condition needing - Plan, implementation basic health services (health services)
ongoing health & nursing care due to impairment, reduce
independence in activities of daily living and rehabilitation. DOH Rules and Functions
- Ex. Custodial psychiatric facilities substance drug abuse Leadership in health:
therapy and rehab center, nursing homes, leprosaria/sanitaria - National Policy and regulatory institution
Category C – Diagnostic / Therapeutic Facility - Leader in formulation, monitoring, and evaluation of
- Lab facility national health policies
- Radiologic facility - Advocate adoption of health policies
- For cancer diagnosis facility Enabler and capacity builder:
Category D – Specialized Outpatient Facility - Taga turo
- Dialysis clinic - Innovate new strategies in health
- Ambulatory surgical - Oversight function & monitoring, evaluation of national
- Cancer chemotherapeutic health plan
- Center/ clinic - Ensure highest standard
- Radiation facility Administrator of specific services:
- Physical medicine - Manage selected national health facilities
- Rehab center/clinic - Administer direct service for emergent concern
- Administer health emergency response services
Attached Agencies
- The DOH – constituted of various central bureaus and services
in the Central Office, Centers for Health Development (CHD)
in every region, and DOH retained hospitals
- CHN - always updated kaya sa board exam dpt balikan ito
Filipinos – Vision, Mission, Core Values, & Strategic Goals
1) Vision
- Filipinos are among the healthies people in Sountheast
Asia by 2022, and Asia by 2040
2) Mission
- To lead the country in the development of a Productive,
Resilient, Equitable and People-centered health system for
Universal Health Care
3) Core Values
• Professionalism - DOH performs its functions in
accordance with highest ethical standards, principles of
Classification of Hospitals accountability, and full responsibility.
According to Trauma Capability: Guidelines formulated by PCS
a) Trauma – capable facility • Responsiveness
- A DOH licensed hospital designated as a trauma center. • Integrity - The Department believes in upholding truth &
- Open 24 /7 pursuing honesty, accountability & consistency in
- Tertiary hospital performing its functions

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• Compassion & Respect for Human Dignity - DOH 5) Performance Accountability – use management systems to
upholds quality of life, respect for human dignity is drive better execution of policies and programs in the DOH
encouraged by working w/ sympathy & benevolence for while ensuring responsibility to all stakeholders
people in need. • Cross-cutting pillar of F1 Plus for Health
• Excellence - DOH continuously strive for the best by - which is on performance accountability, it introduces
fostering innovation, effectiveness & efficiency, pro- evidence-based metrics in the health system to
action dynamism, and openness to change objectively monitor and ensure its responsiveness to
• Commitment – With all our hearts & minds, the Dept. addressing the healthcare needs of Filipinos.
commits to achieve its vision for health & development of - It supports the achievement of Ambisyon Natin 2040:
future generations Matatag, Maginhawa at Panatag na Buhay
• Teamwork – DOH employees work together with a result-
oriented mindset.
• Stewardship of the health of the people – Being stewards
of health for the people, the Dept shall pursue sustainable
development & care for environment since it impinges on
the health of Filipinos.
• Strategic Goals – Better Health Outcomes, More
Responsive Health System, More Equitable Healthcare
Financing, Financing, Service delivery, Regulation ,
Governance
4) Goal
- Formula 1 for Health – Pres. Gloria Macapagal Arroyo
- HSRA – health sector reform agenda
• Health financing
• Health regulation
• Local health system
• Public health programs
• Hospital system

Frameworks of HSRA – 4mula One for Health Plus (F1 Plus)

4 Pillars of F1 for Health
1) Health financing – secures sustainable investment to improve - Mas specific na ito kesa sa millenum developmental goal at
health outcomes and ensure efficient and equitable use of ang tawag na dito ngayon ay sustainable developmental goals.
health resources
2) Health regulation – ensure high quality and affordable health Health targets of Sustainable Development Goals (SDG) 2030
produts, devices, facilities, and services. RA 11223 Pang - Goal 3 “Good health & well-being” and other health-related
kalusugang pangkalhatan universal health care. targets in:
3) Health Service Delivery – ensure the accessibility of essential • Goal 1 “No poverty”,
quality health services at appropriate levels of care • Goal 2 “Zero hunger”
4) Good Governance – streghthen leadership and management • Goal 6 “Clean water and sanitation”
capacities, coordination and support mechanisms necessary to • Goal 7 “Clean energy”
ensure functional people-centered and participatory health • Goal 11 “Sustainable cities and communities”
systems • Goal 13 “Climate action”
• Goal 16 “Peace, justice”
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World Health Organization (WHO)
- A specialized agency of the United Nations (UN) provides
global leadership on health matters
- WHO constitution came into force on April 7, 1948.
- 1946 – natapos ang gera
5 Core Functions of WHO
1) Provide leadership on matters critical to health & engage
partnerships when joint action is needed
2) Shape research agenda. Stimulate generation, translation, &
dissemination of valuable knowledge.
3) Setting norms, standards. Promote & monitor implementation.
4) Articulating ethical and evidence-based policy options.
5) Provide technical support, catalyze change & build sustainable
institutional capacity.
PRIMARY HEALTH CARE
- Essential health care.
- Practical, significantly sound, and socially acceptable methods
and technology.
- Universally accessible to individual and family in community.
- Through full participation, At cost can afford to maintain; At
every stage of their development.
- In Spirit of self-reliance and self-determination.
PHC History
September 6 – 12, 1978
- First international Conference for Primary Health Care.
- Happened at: At Alma Ata and USSR (Russia)
- Organized by: WHO and UNICEF (United Nations
Children’s Fund)
- Concept: Health and development of workers for the
protection and promotion of health of all the people.
(kapag healthy daw ang tao madedevelop ang country
katulad ngayong pandemic kapag maraming may sakit
bumabagsak din ang ating ekonomiya)
- Alma Ata Declaration on Primary Health Care
- Health – fundamental right.
- Global burden of health inequalities exists.
- Economic and Social development – basic importance for
full attainment of health for all.
- Government has responsibility for health of people.
- President at this time is Ferdinand Marcos
Letter Of Instruction (LOI) 949 of 1979
- First Asian country. (na nagpatupad nito dahil kay
Ferdinand Marcos)
- Health – is a product of Socio and Economic development.
- What is the legal basis of primary health care – Letter of
instruction 949
- Legal basis of primary health care
- Hindi na dumaan s amga senado kundi nag bigay lang ng
instruction si president marcos
- Hindi nahirapan yung presidente na ipublish yan sa
pilipinas dahil bago pa mangyari yan, meron na tayong
mga RHU na pinatayo in 81 provinces.
Definition of Public Health Care
- Essential health care
- practical, significantly sound & socially acceptable methods &
technology
- Universally accessible to I & F in community (mga madaling
mapuntahan)
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- Accessible – means w/in 30 min narating na ung health center
at w/in 1 hr naman kapag hospital
- Through full participation of family – active participation
- At cost can afford to maintain – hindi na ilalabas yung pera.
- At every stage of their development
- In Spirit of self-reliance & self-determination
Universal Goal
- Health for all by year 2000. (hindi na attain)
- Acceptable level of health for all in the world.
- Through Individual and Community self – reliance.
- LOI theme: Health in the Hands of the people by 2020
- Primary health care:
1) Education for health. (using internet fb live)
2) Locally endemic disease treatment. (malaria etc)
3) EPI – NIP (National Immunization Program)
4) MCH with responsible parenthood (pagaalala sa buntis at bata
at pag bibigay contraceptives – maternal and child health)
5) Essential drugs (libreng gamut)
6) Nutrition. (vitamins, iron na libre)
7) Treatment of communicable disease and non-communicable
disease.
8) Safe water and sanitation.
Key Principle of PHC
1. Accessibility – within 30 mins narating
2. Affordability – wala silang gagastusin
3. Acceptability – within the culture.
4. Availability – available dapat resources natin
5. Support mechanism
6. Multi sectoral approach
- Intersectoral linkages – w/in the health system (hospital)
- Intersectoral linkages
- Philippines has a challenge when it comes to location.
- Geographically we are isolate w/ one another because
we are island.
- It needs bridges and roads to reach other people.
- DPWH ang dapat tumulong sa atin dito
- Personal hygiene reason kung bakit nagkaka infection
hanggang sa isinam a ito sa libro
7. Community participation
- Clients are not recipients of care but active partners.
- Dito tayo laging bumabagsak kay dapat tayong mag
scaling or rating, wag mag lagay ng mataas na score kung
alam namn hidni susunod ang community
8. Equitable distribution of health resources
- (DTTB) Doctors to The Barrio Program – if you want to
study medicine at have scholarship avail this but this have
return service. If you study on state and government
university hindi sila agad agad makakapag abroad.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

- RN Heals – ang munisipyo ang mag papasweldo sa - Health information, education, & communication
tauhan na nasa loob. Nung maraming pinagaawa ang - Organizes community
DOH na ang magbabayad to pay and hire these nurses but - Facilitate brgy health planning
ilalagay sa facility ni mayor. - Mga ginagawa dito is related with reproductive health
9. Appropriate technology RSI / Rural Sanitary Inspector
- Health technology – tools, drugs, methods, procedures - Ensures healthy environment
and techniques. - Through advocacy, monitoring, regulatory
- Criteria: - Ex. Inspect water supply
1) Safe - Community sanitation ay sa nurses dati pero ngayon hindi na
2) Effective BHW / Barangay Health Worker
3) Affordable - Interface between community & RHU
4) Simple - Trainings: preventive health care. FP,
5) Acceptable - MCH, Nut, San’tion, Rep’tive H.
6) Feasible or reliable - RA 7883 – Entitled to hazard & subsistence allowance
7) Ecological effects
8) Potential to contribute to individual and community Local Health Board
development - Chairman – mayor / prov. Governor → municipal health
- Lagundi and leopolds maneuver officer, doctor → sanggunian → rep. from the people
- Representative from the people – example representative ng
RURAL HEALTH UNIT mga matatanda = president of Senior Citizen; sa mga kabataan
- Main Health Centers = SK Sangguniang kabataan – usually this are the people who
- Primary level health facility in municipality has a capacity to decide and they can help in planning. These
- Focus: preventive, promotive health services are the people who have the capacity to decide and be part of
- Supervision of BHS the planning.
- 1 : 20,000 - Function:
Barangay Health Station • Prepares budget
- 1st contact health care facility • Advisory committee
- Basic services at brgy level • Advisor
- Satellite station of RHU
- Manned by volunteer BHW under the supervision of midwife Health Referral System
- Branch ito ng health center - Set of activities undertaken by health care provider in response
- Ang pagkakaiba dito sa main health center, ang BHS ay to its inability to provide necessary health intervention
kulang ng health care workers. - 2-way referral system:
- What facility of the government is considered as smallest? - • If the one health facility cannot provide the health service,
barangay health station. it will refer to the hospital. (hindi kakayanin ng health
center ang confinement ni patient so irerefer siya sa
Rural Health Unity – Personnel hospital and vice versa)
MHO / Municipal Health Officer • If the hospital cannot provide the health service, it will
- Or Rural Health Physician refer to the health facility.
- Head the health services
- Roles/ functions: Administrator of RHU – plan & budget Interlocal Health Zone - ILHZ
- Community physician Composition
- Mga mataas ang doctor dito sila ang tumatayong admin at - People – Ideal health district population size (100,000 &
humahawak ng pondo at medico legal 500,000) for optimum efficiency, effectiveness (WHO, 1986).
- Medico-legal officer of Municipality – pag mag dedemanda, - Population Vary - depending on number of LGUs decide to
may assessment from para ditto. cooperate & cluster
- Manager of health center: Nurses - Boundaries – Clear boundaries between Inter Local Health
PHN / Public Health Nurse Zones - determine accountability & respective health service
- RHM - Supervises/guides providers.
- Field Health Service Information System (FHSIS) – Prepares, - Geographical locations & access to referral facilities such as
report – main responsible in recording report district hospitals are usual basis in forming the boundaries
- Nursing Process – utilize when responding - Health Facilities – A district or provincial hospital (referral
• NCP – Nursing Care Process (one person) hospital for secondary level of health care), Rural Health Units
• FNCP – Family Nursing Care Plan (family) (RHU), Barangay health stations (BHS) & other health
services deciding to work together as an integrated health
• CNCP – nursing process for whole community
system.
- GO, NGO, private business, people – performing collaboration
- Health Workers – Right mix of health providers needed to
- Hospital one nursing process will be used while in community
deliver comprehensive health services.
three nursing process will be used
- Groups of health providers are:
PHM / Public Health Midwife
- Manages BHS, trains BHW barangay health worker • Department of Health
- Provides midwife services & program • District hospital
- Pt. assessment for referral • Rural Health Unit
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• Basic Health Unit Family Assessment

• Private clinics - The family interview:
• Volunteer health workers • Effective communication is essential in the 1st step to
• Non-Government Organization establish trusting relationship.
• Community-based organizations. • Same principles used in an effective interview with a
- They form LHZ team to plan joint strategies for district health client apply.
care. • Family assessment tools are available.
- Hindi pwedeng mag pagamot sa health center kapag hindi siya • Many agencies have a standard form.
sakop ng boundary dahil: • Tool: IDB or Initial Data Base
- Sa reporting and recording - NCP: vital signs and cephalo caudal assessment
- Mauubos ang pondo natin
- Mauubusan ang gamit tapos ung kabila madami pang
stock.
- Kapag lumagpas an sa 100, 000 kailangan ng isa pang health
center. Yun ang tinatawag na district 1, 2, 3
- Health facility, dpt ung district 1 kumpleto ang gamit may
health center, referral hospital at kumpletong health worker.
Kung anong meron sa isa ganun din dpt sa district 2. Bawal
ang hiraman ng health worker dito.

FAMILY HEALTH NURSING

National Statistical Coordination Board
- Family - a group of people usually living together and
• Components of Initial Data Base:
composed of the head by blood, marriage and legal adoption.
1) Family structure, characteristics and dynamics
(Community will not develop kapag nag ka-kanya-kanya)
2) Socio-economic and cultural characteristics (sahod, pinag
- Johnson – Social unit interacting with the larger society.
aralan, religion, saan sila nag mula)
- Allen – Characterized by people together because of birth,
3) Home and environment (malinis ba ung bahay, gawa ba
marriage, adoption, or choice. (he is foreigner and divorce in
saan)
their country is legal)
4) Health status of each member (sinong mga nag ka sakit,
- Executive Order 209 Family Code – Marriage is special
commonly respiratory diseases, mag banggit ng top 10
contract of permanent union between man and woman.
diseases)
(President ang nag sabi nito, in our society we accept a male
5) Values and practice on health promotion, maintenance
with a partner as one family pero kapag legalities they are not
and disease prevention (hand washing, sleeping pattern,
accepted. Kaya kapag namatay ang dalawang mag kasintahang
vaccination history – mga batang 5 years old and below
parehas na lalaki o babae pwedeng i-contest ng mga kamag
lang ang tanungin)
anak ang mga naiwang ari-arian)
- Friedman - two or more persons who are joined together by Family forms or family structure
bonds of sharing and emotional closeness and identify Based on Internal Organization and Membership or Components.
themselves as part of family. (hindi kailangan kasal; like live • Dyad
in partners) - Empty nester. (newlywed, or matgal ng kasal but do not
have a child)
• Cohabitating
- Live-in.

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- Common law spouses and children. (means live-in but • Neo-Local

this is what we should use in our form) - When a married couple sets up a home separate from
- Not married legally but they are married in terms of the either side of their families.
law of masses or common table. - Can stand on their own
- Medical professional should not use the word “live-in Based on Pattern of Lineage
verbally and by documenting - Kayamanan ang pag uusapan dito, usually happens in Chinese
• Compound family people
- Man has more than 1 wife. • Patrilineal Family
- Acceptable under Presidential Degree 1083. - This type of family occurs when property and title
- This is not acceptable for woman. inheritance pass down through the father’s side.
- Muslim relationship can do this • Matrilineal Family
• Blended - his is where the property and title inheritance pass through
- 1 or both spouses bring in child or children from previous the mother’s side.
marriage in their new living arrangement. Based on Amount of Mates
- parehas patay/hiwlay sa asawa at may anak at nag sama as • Monogamous Family
one family at nag ka sariling anak. Maraming challenge - In this instance, a husband only has one wife. This is the
dito western idea of a typical marriage.
• Nuclear • Polygamous Family
- Husband, wife, children, marriage, procreation. - In this case, the husband has more than one wife at the
• Extended same time. This type of family can be found mostly in
- 3 generations. Married sibling and their family with Saudi Arabia.
grandparents. • Polyandrous Family
• Single Parent - This family consists of a wife with more than one husband.
- Pregnancy outside of wedlock, separation, death of spouse. This can be found in the Todas of Southern India.
- usually sa babae napupunta ang anak
• Gay or Lesbian Family Genogram
- Cohabitating couple of same sex, not legal. - Known as McGoldrick–Gerson study, a Lapidus schematic or
- Acceptable as a family in society but not acceptable in the a family diagram.
legality - A pictorial display of a person's family relationships and
medical history.
Classification of family
Based on Authority MALE FEMALE
• Patriarchal
- Authority is vested on the oldest male in the family, often
the father.
- kung sino ung nag de-decide siya dpt ang interviewhin
• Matriarchal
- Authority is vested in the mother or mother’s kin. - Straight line signifies good relationship to each other, broken
lines broken family
• Matricentric
- Prolonged absence of the father gives the mother a
dominant position in the family, although the father may
also share with the mother in decision making.
- kapag nasa abroad ung asawa at humingi ng decision
making sa kanya, kung sino ung nasa bahay siya pa din
ang masusunod
• Patricentric
- Prolonged absence of the mother gives the father a
dominant position in the family, although the father may
also share with the mother in decision making.
- kabaliktaran nung matricentric
Based on Pattern of Residence
- Newly wed need assistance kase maraming bata at matandang
namamatay dito sa PH
- This would determine who are the supports person of the
family
• Patrilocal
- When a married couple lives with or near the husband’s
family.
• Matrilocal
- When a couple lives with or near the mother’s family.
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• Language spoken at home and in the community

• Health beliefs
• Crisis events (In PH umbilical cord are displayed in front
of the house)
• Holidays and special events
• Contact with cultural and religious institutions
• Values about education and work
• Values about family structure (power, hierarchy, rules,
subsystems, and boundaries)

Developmental Assessment
- Duvall (1977) theory of development stages of family life
- Stages within the life cycle of every family; each stage
includes distinct family developmental tasks.
Marriage
- For a family to function as a unit they should ↓
- Formation of identity as a couple.
- Inclusion of spouse in realignment of relationship with
extended families. (kapag kinasal tapos nakitira sa pamilya)
- Parenthood decision making.
Family with Young Children
- Integration of children into family unit. (reason why in the us
Culturagram naghihiwaly madalas ang mag asawa ay dahil parehas
- Develop a better understanding of the sociocultural context of workaholic so ung responsibilidad sa anak hindi na
the family as well as identify appropriate interventions for the nagagampanan)
family. (Congress & Kung, 2005) - Adjustment of tasks: Child rearing, financial and household.
- Most important because this causes hindrance, hindi mo - Accommodation of new parenting and grand parenting role.
maayos ang health niya if marami siyang pinaniniwalaan (parehas dapat tutulong)
• Reasons for relocation Family with Adolescent
• Legal status - Development of increasing autonomy for children. (children
• Time in the community practice independence)
- Midlife re-exam of marital and career issues.
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- Initial shift towards concern for older generation. (alam na - Start of first interaction in the family.
nilang tatanda na sila) • Status placement
- Consider children as blacksheep of the family kase makulit na - Family confers its social rank into the society.
but we have to explain na dumadaan lang tlga sa ganon. - Kung mahirap ang magulang un na rin ang classification
- Anong problema ng pamilya na may adolescent na anak ng mga bata
Family as Launching Centers • Economic function
- Establishment for different identities for parents and children. o Rural family – unit of production.
- Renegotiation of marital relationship. o Urban family – unit of consumption, enterprise.
- Re-adjustment of relationship to include in-laws and • Physical maintenance
grandchildren. (kung dati ung magulang lagi na susunod - Survival needs of dependents.
ngayon may asawa na dpt din iconsider ung kabilang pamilya) - Pinagkukuhanan ng mga kagamitan
- Dealing with disabilities and older generation. • Welfare and protection
- Ga-graduate na ang anak, mag kaka sariling pamilya, etc o Partners - companionship, affective, sex, socioeconomic.
Aging Family o Children - Emotional gratification, psychological
- Maintaining as couple or individual while adapting to aging security, motivation, morale.
process. Levels of Preventive Care
- Support role of middle generation. 1) Primary Prevention
- Support and autonomy of older generation. • Health promotion
- Preparation for own death; deal with loss of spouse, sibling, • Specific promotion
peers.
• Genetic counseling
- Highest stress is a death of a spouse tapos walang support ng
• Environmental change
pamilya hihina katawan niya at mamatay na din siya.
• Hearing conservation
Family according to Defrain and Montalvo • Immunization
Description of a healthy family working as a unit: • Prenatal care
- Interact with one another. • Vocal hygiene
- Can establish priorities. • Prevention of secondary communication disorder
- Support, respect, and affirm one another. 2) Secondary Prevention
- Members has flexible role. • Early diagnosis and prompt treatment
- Foster responsibility and value service to others. • Disability limitation
- Have sense of play. 3) Tertiary Prevention
- Ability to cope with stress. • Restoration and rehabilitation
Characteristics of a Healthy Family

HERBAL MEDICINE
- Republic Act 8423, known as the Traditional and Alternative
Medicine Act (TAMA) of 1997 - traditional medicine program.
- Traditional and Alternative Medicine Act (TAMA) Authored
by Senator Juan Flavier and approved on December 1997.
(dati siyang secretary of DOH)
- This gave rise to the creation of Philippine Institute of
Traditional and Alternative Health Care (PITAHC).
- Tasked to promote and advocates use of traditional and
Functions of Family alternative health care modalities through scientific research
• Procreation and product development.
- Universal accepted institution for reproductive - Philippine Department of Health (DOH) through its
functioning or child-rearing. "Traditional Health Program" has endorsed 10 medicinal
- Most Filipinos are catholic so we are mono type plants to be used as herbal medicine in Philippines due to its
relationship health benefits.
• Socialization of family members
- Family as a first teacher of societal rules.

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Traditional Health Program • Rheumatism, sprain, contusions, insect bites – Pound the
- 10 medicinal plants as herbal medicines in Philippines. leaves and apply on affected area.
- Attested by National Science and Development Board. Yerba Buena
- Sum total of knowledge, skills and practice on health care, not - Mentha cordifelia – scientific name
necessary explicable in the context of modern, scientific - Analgesic to relive body aches and
philosophical framework. pain due to rheumatism and gout. It is
- Recognized by people to help maintain and improve their also used to treat coughs, colds and
health towards the wholeness of their being, community and insect bites.
society and their interaction based on culture, history, heritage - Uses and preparation:
and consciousness. • Swollen gums – Steep 6 g. of fresh plant in a glass of
boiling water for 30 minutes. Use as a gargle solution.
Medical Plants Preparation
• Toothache – Cut fresh plant and squeeze sap. Soak a piece
• Decoction of cotton in the sap and insert this in aching tooth cavity.
- Boil recommended parts in water. (this is only for a remedy)
- Boiling time: 20 minutes.
• Menstrual and gas pain – Soak a handful of leaves in a
- Kapag maligam-gam na hatiin into equal parts into 3.
class of boiling water. Drink infusion.
- Inumin 3 times a day
• Nausea and Fainting – Crush leaves and apply at nostrils
- Pinapakuluan ng walang takip with minimal water para
of patients. (amoy nito ay pwede ibigay sa pt.)
mas concentrated
- Mas magandang gamitin ang palayok para mas • Insect bites – Crush leaves and apply juice on affected
makatasan ang dahon. area or pound leaves until like a paste, rub on affected
area.
• Infusion
- Plant part soaked in hot water like tea. • Pruritis – Boil plant alone or with eucalyptus in water.
- 10 – 15 minutes. Use decoction as a wash on affected area. (sa pangagati
ipanghuhugas natin ito)
• Poultice
- Directly apply recommended part on affected area. • Pain (headache, stomachache) – Boil chopped leaves in 2
- For bruises, wounds, rashes. glasses of water for 15 minutes. Divide decoction into 2
- Di-dik-dikin at ung katas ay ipapahid sa affected part. parts, drink one part every 3 hours.
• Tincture • Rheumatism, arthritis and headache – Crush the fresh
- Mix plant part in alcohol. leaves and squeeze sap. Massage sap on painful parts with
- May alcohol pang preserve at pang katas eucalyptus
Halamang Gamot • Cough and Cold – Soak 10 fresh leaves in a glass of hot
- Akapulko water, drink as tea (expectorant).
- Ampalaya Sambong
- Bawang - Blumea balsamifera – scientific name
- Bayabas - Treat kidney stones, gout (rich in
- Lagundi proteins).
- Niyog-niyugan - Uses and preparation:
- Sambong • Anti-edema, diuretic, anti-
- Tsaang gubat urolithiasis – Boil chopped leaves
- Pansit-pansitan in a glass of water for 15 minutes until one glassful
- Yerba Buena remains. Urolithiasis is a stone in the kidney.
Lagundi • Divide decoction into 3 parts, drink one part 3 times a day.
- Vitex negundo – scientific name • Diarrhea – Chopped leaves and boil in a glass of water for
- 5-leaved chaste tree – english name 15 minutes. Drink one part every 3 hours. (mas maiksi
- used in Philippine herbal interval kase ung m.o causing diarrhea mabilis mag
- Medicine to treat cough, colds and multiply)
fever. Tsaang Gubat
- Relief for asthma and pharyngitis. - Carmona retusa – scientific name
- Recommended for mild covid infection - Wild tea – english name
- Uses and preparation: - Taken as tea to treat diarrhea with
• Asthma, Cough and Fever – Decoction. Boil raw fruits or abdominal pain.
leaves in 2 glasses of water for 15 minutes. - Uses and preparation:
• Dysentery, Colds and Pain – Decoction. Boil a handful of • Diarrhea – Boil chopped leaves into 2 glasses of water for
leaves and flowers in water to produce a glass, three times 15 minutes. Divide decoction into 4 parts. Drink 1 part
a day. every 3 hours.
• Skin diseases (dermatitis, scabies, ulcer, eczema) - Wash • Stomachache – Boil chopped leaves in 1 glass of water for
and clean the skin or wound with the decoction. 15 minutes. Cool and strain.
• Headache – Crush leaves may be applied on the forehead.
(didik-dikin at ilalagay sa noon g patient na may bimpo)

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 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
Niyog-niyogan
- Quisqualis indica – scientific name
- Chinese honey suckles – english name
- To eliminate intestinal parasites.
- Uses and preparation:
• Anti-helmintic – The seeds are taken
2 hours after supper.
• If no worms are expelled, the dose may be repeated after
one week.
• Caution: Not to be given to children below 4 years old.
Bayabas
- Psidium guajava – scientific name
- Guava – english name
- As antiseptic, anti-inflammatory,
antispasmodic, antioxidant
hepatoprotective, anti-allergy,
antimicrobial, anti-plasmodial, anticough, antidiabetic, and
antigenotoxic in folkloric medicine.
- Uses and preparation:
• For washing wounds – Maybe use twice a day. (pang
langgas sa mga na circumcise)
• Diarrhea – May be taken 3-4 times a day.
• As gargle and for toothache – Warm decoction is used for
gargle. Freshly pounded leaves are used for toothache.
Boil chopped leaves for 15 minutes at low fire. Do not
cover and then let it cool and strain.
- Note: sa mga bagong panganak unang ligo ay dahon ng
lagundi o bayabas
Akapulko
- Cassia alata – scientific name
- Ringworm bush or schrub and Acapulco –
English name
- To treat tinea infections, insect bites,
ringworms, eczema, scabies and itchiness.
- Not native plant in the PH, it is from the
spain.
- To treat had-had, buni, alipunga. Takes several times to effect
- Uses and preparation:
• Anti-fungal (tinea flava, ringworm, athlete’s foot and
scabies) – Fresh, matured leaves are pounded.
• Apply soap to the affected area 1-2 times a day.
Ulasimang Bato or Pansit-Pansitan
- Peperonica pellucida – scientific name
- Effective in treating arthritis and gout.
- Uses and preparation:
• Lowers uric acid (rheumatism and
gout)
• One a half cup leaves is boiled in two glass of water over
low fire. Do not cover pot. (kapag sobrang kulo na hinaan
na)
• Divide into 3 parts and drink one part 3 times a day.
Bawang
- Allium sativum – scientific name
- Garlic – English name
- Treat infection with antibacterial,
anti-inflammatory, anti-cancer and
antihypertensive properties.
- To reduce cholesterol level in blood.
- Uses and preparation:
• Hypertension – Maybe fried, roasted, soaked in vinegar
for 30 minutes, or blanched in boiled water for 15 minutes.
J.A.K.E 19 of 28
Take 2 pieces 3 times a day after meals. (bawal kainin ng
deretsyo dahil mainit ito at baka mag ka ulcer ang patient;
dapat taken as maintenance para umepekto)
• Toothache – Pound a small piece and apply to affected
area.
Ampalaya
- Momordica charantia – scientific name
- Bitter melon or bitter ground. – English
name
- Treatment of diabetes (diabetes mellitus),
hemorrhoids, coughs, burns and scalds,
and being studied for anticancer
properties.
- Muarng dahon or ung batang dahon ang gagamitin dito
- Mild diabetes lang kaya lutasan
- Uses and preparation:
• Dependent – Chopped leaves then boil in a glass of water
for 15 minutes. Do not cover. Cool and strain. Take 1/3
cup 3 times a day after meals.
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticide as these may leave poison on
plants.
2. In the preparation of herbal medicine, use a clay pot and
remove cover while boiling at low heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms
or sickness. (bawal inumin ng sabay-sabay ang ibat ibang
dahon)
6. Stop giving the herbal medication in case untoward reaction
such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of
herbal medication, consult a doctor.
Alternative Health Care Modalities
- As defined by law.
- Other forms of non-allopathic, occasionally nonindigenous or
imported healing methods.
- Includes: reflexology, acupressure, chiropactics, and
nutritional therapy.
Acupressure
- Application of pressure on acupuncture points without
puncturing the skin. Acupressure stimulates the body at certain
meridians, or pressure points.
- Meron tayong meridian point at ang katapos-tapusan nun ay
CNS. From meridian point put pressure so that the body will
have natural healing.
Reflexology
- Application of therapeutic pressure on the body’s reflex points
to enhance body’s natural healing mechanisms and balance
body functions. Based on principle that internal glands and
organs can be influenced by properly applying pressure to the
corresponding reflex area on the body.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

states, pain syndromes and neurophysiological effects relieve

to static and dynamics of locomotors system, especially spine
and pelvis. Traditionally uses manipulation of the spine and
limbs.
- Ina-aligned ang mga buto
Herbal Medicine or Phytomedicine
- Finished, labeled, medicinal products that contain as active
ingredients, aerial or underground parts of the plant or other
materials or combination thereof, either in the crude state or as
plant preparations.

Nutritional Therapy
- Use of food as medicine and to improve health by enhancing
the nutritional value of food components that reduces risk of
disease. Synonymous with nutritional healing.
- Kapag nurse na inoorder ng doctor ang nutrition.
Pranic Healing
- Holistic approach of healing that follows the principle of
balancing energy.
- Ex. Hot and cold compress.

FAMILY NURSING PROCESS

− The blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified health and
family nursing problems through explicitly formulated
outcomes of care and deliberately chosen set.
− We always start after we get the trust of the client with
assessment and with our plan tsaka pa lang mag intervention
− Not all problems can be eliminated some will just be reduced or
minimize.
− FNCP considers two level of assessment:
- Health problem – first level of assessment
- Family nursing problem – second level of assessment

Nursing process
− A problem-solving approach that enables the nurse to provide
care in an organize and scientific manner. It is applicable to
individuals, families and community groups at any level of
health. It is adaptable to any practice setting or specialization
and the components may be used sequentially or concurrently.
Phase of nursing process
1. Assessment
2. Diagnosis
3. Planning
Acupuncture 4. Implementation
- Acupuncture points are anatomically defined areas on the skin 5. Evaluation
relative to certain landmarks on body. Indicated that there - Relating – rapie
were holes in the skin through which qi energy could flow. - Since we are taking care of the family inu-una dito ung relating
- Uses meridian point but doesn’t use pressure but rather - We also start with introducing our self during interview,
punctured. discussing the procedure.
Massage
- Superficial soft parts of the body are rubbed, stroked, kneaded Assessment
or tapped for remedial, aesthetic, hygienic or limited 1. Data collection
therapeutic purposes. 2. Data analysis
Chiropratic
- “kamusta po kayo? Ilan po ang anak niyo?”
- Concerned with pathogenesis, diagnosis, therapy and
prophylaxis of functional disturbances, patho-mechanical
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Data collection c. Place of residence of each member - whether living with or

Three sources of data elsewhere.
1. First source – health status of the family. d. Type of family structure-matriarchal, patriarchal, nuclear or
2. Second source – family’s status as functioning unit. extended.
(undergo some process and stages that is called e. Dominant family members in terms of decision making in
developmental stage. As they grow they should accomplish. matters of health care.
Each developmental stage they have to accomplish f. General family relationship - presence of obvious or ready
something. If they are dysfunctional and do not know how
observable conflict between members; communication
to work with one another then mag kaka gaps sa illnesses or
patterns among members.
health at hindi magiging successful ang isang pamilya)
3. Third source - family's environment (because they can live - This is the first data we ask.
to illnesses like infection) - Place of residence, hindi naman need ilagay minsan dahil
- Hospital nurse – collects data about past health pare-parehas naman sila ng tirahan
Methods of gathering data - Name, initial lang dapat ang ilagay
1. Direct observation - Address, wag ng masyadong kumpleto (st. brgy and city
- A method of data collection which is done through the pwede na magamit)
use of all sensory capacities. Household Age Sex Civil Position Place of
- The nurse gathers information about the family’s state of member status in the residence
being and behavioral responses. family
- Presence of s/s:
 Physical make up of each member. RD 24 Male Live-in Father Living
 Communication or language patterns expected and with
tolerated. JC 23 Female Live-in Mother Living
with
 Role perception/task assumption by each member,
AL 3 Male Son Son Living
including decision-making patterns.
with
 Conditions in home and environment
OJ 2 Female Daughter Daughter Living
− We should use our sensory (kung nakikita mo na wag
with
mo ng tanungin)
2. Socio-economic and cultural factors
2. Interviewing
a. Income and expense
- Productivity of interview process depends upon the use
- Occupation, place of work, income of each working
of effective communication techniques to elicit needed
member
responses.
- Adequacy to meet basic necessities (food, clothing,
- Encourage verbalization of thought and feelings and
shelter)
offer needed support or reassurance.
- Who makes decision about money and how it is spent
- Use the initial data base for you to be guided on how to
- We ask kung saan sila nag tatrabaho, mag kano ang
interview.
income for one month, para malaman kung ang pamilya
3. Physical examination
ay below the poverty line at kung tugma ba ung
- Done through inspection, palpation, percussion,
minimum wage na sinasabi sa PH.
auscultation measurement of specific body parts and
b. Educational attainment of its members (kapag bata pa
reviewing the body systems.
kinder ganun, student)
- They use their CHN Bag
c. Ethnic background and religious affiliation
4. Review of records
d. Significant others - roles they play in the family
- Reviewing existing records and reports pertinent to the
client. e. Relationship of family to community- what is the
participation of the family in community activities?
5. Laboratory or diagnostic test
- Performing laboratory tests, diagnostic procedures or
Educational
Occupation

So/ roles in
attainment
Household

the family
member

Place of

other test of integrity and function carried out by the

Income
work

nurse herself and /or health workers.

- Mga buntis at may t bang karaniwang meron nito.
5 types of data use as initial data base for family nursing
Rd Carpenter Qc P9000 High school Provider
1. Family structure and characteristics
/mos. grad
a. Members of the household; relationship to the head of the
family.
Jc Housewife - - College grad House
b. Demographic data- age, sex, civil status, position in the
keeper
family.
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Al Children - - - Member
Oj Baby - - - Member
3. Environmental factors
a. Housing
• Adequacy of living space.
• Sleeping arrangement.
• Presence of insects and rodents.
• Adequacy of the furniture.
• Food storage and cooking facilities.
• Presence of accidents hazards.
• Water supply-source, ownership, portability.
• Toilet facility-type, ownership, sanitary condition.
• Garbage/refuse disposal – type, sanitary condition.
• Drainage system – type and sanitary condition.
- Strong – pure cement
- Light – pure wood
- Mixed – wood and cement
b. Kind of neighborhood- congested, slum, etc.
c. Social and health facilities available
d. Communication and transportation
- May alaga bang hayop or halaman
- May toilet ba at maayos na tubig
- Example: housing
• The family lives in a small room
• Inadequate living space
• They do not have beds and used to sleep in their floors,
in a slanted position
• There is presence of breeding or resting sites of vectors
of disease as manifested by an open-canal found outside
their house.
• Presence of fire hazards due to the used of candle during
night/sleep time
• Presence of fall hazards due to dark surroundings and un
railed stairs
• They used to fetch water from the faucet of their
neighbor
• Poor environmental sanitation due to poor drainage
• Poor environmental condition due to dirty toilet bowl
and slippery toilet floor
• Poor environmental condition as manifested by pile of
garbage found in their hallway
4. Health assessment of each member
a. Medical and nursing history indicating past significant
illness, beliefs and practices conducive to illness.
• Anthropometric data- weight, height.
• Dietary history indicating quality and quantity of food
intake per day
• Eating/feeding habits and practices
b. Nutritional assessment (specifically for vulnerable or at risk
members)
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c. Current health status indicating presence of illness states
(diagnosed/undiagnosed by medical practitioner)
- Mahiyain ang pamilya kaya hindi sasabihin ang sakit.
Kaya dapat ikaw na ang mag sasabi banggitin mo ung top
10 diseases.
- Communicable at infectious diseases ang common
5. Value placed on preventive disease
a. Immunization status of children
b. Use of other preventive services
- We ask kung nag handwashing, napapaliguan ang mga
bata, at ngayong covid-19 maraming prevention na
ginagawa.
Data analysis
- Comparison of the gathered data to the standard or norms.
- Norm – means normal and it is called standard
- Q: what are you going to do in data analysis? Data analysis is
comparison with the norm.
- Ex. Temperature
• Three types of standards or norms
a. Normal health of individual members.
b. Home and environment conditions conducive to family
development. (normal na bahay means hindi nag dudulot ng
sakit ang bahay kaya it is conducive for the family
development)
c. Family characteristics, dynamic and level of functioning
conducive to family development. (each developmental task
dapat nagagawa natin ang responsibilidad natin kase kung
hidi natin nagagawa it can lead to illness)
• Health problem:
- Is defined as situation or condition which interferes with the
promotion and/ or maintenance of health and recovery from
illness and injury.
- A health problem becomes a nursing problem when it can
be modified through nursing interventions.
• Health need:
- Exist when there is a health problem that can be alleviated
with medical or social technology.
- Not all family have health need. Because one may know
how to solve or eliminate the problem but if they don’t
lalabas ang health need pupunta pa sila sa health center.
- Dapat natin silang maturuan para hindi sila umasa sa atin.
Diagnosis
Typology/ types of nursing problem
- The study or systematic classification of types. (we use first
level of assessment if it is health deficit, threat and foreseeable
crisis)
- A tool or classification of family nursing problems that reflects
the family status and capabilities as a functioning unit. (we use
second level of assessment which is family nursing problem)
- ”kailan po kayo nangupahan dito?”
First level
a. Health deficits
- Instances of failure in health maintenance and development.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

- Occurs when there is a gap between actual and achievable o Noise pollution
health status. o Air pollution
- Diagnosed/suspected illness states of family members. • Unsanitary food handling and preparation
- Sudden or premature or untimely death illness or disability • Personal habits/ practices
and failures to adapt reality of life emotional control and o Frequent drinking of alcohol
stability. o Excessive smoking
- Deviations in growth and development. o Walking barefooted
- Personality disorders. o Eating raw meat/fish
- Hindi na maintain ang kalusugan may sakit, disabled, hindi o Poor personal hygiene
lumalaki, at mental disorder o Self-medication
- Example: o Use of dangerous drugs or narcotics
• Illness regardless whether it is diagnosed. o Sexual promiscuity
• Failure to thrive or inability to develop according to o Engaging in dangerous sports
normal rate. • Inherent personal characteristics- short temper
• Disability arising from illness, whether • Health history which may precipitate the occurrence of
transient/temporary. health deficit-previous history of difficult labor.
− Temporary: aphasia or temporary paralysis after cva. • Improper role assumption-child assuming mother’s role,
− Permanent: leg amputation secondary to dm, blindness from father not assuming his role.
measles, paralysis from polio. • Lack of/ inadequate immunization status of children
b. Health threats • Family disunity
- Condition that are conducive to diseases, accidents or o Self-oriented behaviour of members
failure to realize one’s health potential. o Unresolved conflicts among members
- Walang sakit, magkakaroon palang dahil siguro may ganito o Intolerable disagreements
ng sakit ang pamilya c. Stress points/ foreseeable crisis situation
- Example: - Anticipated periods of unusual demand on the individual or
• Health history of specific condition/disease family in terms of adjustments/family resources.
o Family history of dm - Kailangan maraming period of assessment and adjustment
• Threat of gross infection of cd case dahil crucial period ito ng pamilya
• Family size beyond what resources can adequately - Example:
provide (madami ng anak hindi na ma provide ang • Marriage
needs) • Pregnancy, labor, puerperium
• Accident hazards • Parenthood
o Broken stairs • Additional member-newborn, lodger.
o Pointed sharp objects, poison and medicine • Abortion
improperly kept • Entrance at school
o Fire hazards • Adolescence
o Fall hazards. • Loss of job
• Inadequate food intake both in quantity and quality • Death of a spouse /member (pinaka mataas na stress
o Excessive intake of certain nutrients source kaya kapag hindi natin na suportahan ang tao
o Faulty eating habits hihina ang katawan niya at mamamatay na siya)
• Stress provoking factors • Resettlement in new community
o Strained marital relationship • Illegitimacy
o Strain parent-sibling relationship
Drill
o Interpersonal conflicts between family members.
• Wellness state – walang sakit o problema
• Poor environmental sanitation
• Deficit – may sakit na
o Inadequate living space
• Threat – mag kaka sakit pa lang, posibleng mag ka sakit
o Inadequate personal belongings/utensils
• Foreseeable crisis / stress point – stress ang buhay, maraming
o Lack of food storage facilities
adjustment
o Polluted water supply
Health Problem
o Presence of breeding places of insects and rodents
i. First Level of Assessment – Presence of health deficit,
o Improper garbage/refuse disposal
health threats, and foreseeable crisis/ stress points in the
o Unsanitary waste disposal
family.
o Improper drainage system
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 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)
• Subjective – from patients
• Objective – from nurses
• Maglaya framework – used table here in the Philippines
Second level of assessment
Family health task:
1. Inability to recognize presence of problem
2. Inability to make decisions with respect to taking
appropriate health action
3. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of the
family.
4. Inability to provide home conducive to health maintenance,
personal development
5. Failure to utilize community resources for health care
− Should use community health center
− Kapag may hindi nagawa dito there is inability
− Second level of assessment is considered as diagnosis
Two parts:
1. General
- The statement of the unhealthful response
- Family health task
- Nandito ung mga hindi niya nagawa or inabilities
2. Specific
- The statement of factors which are maintaining the
undesirable response and preventing the desired change
- Due to or related to
- Dahilan kung bakit hindi niya nagagawa
Example:
• General: inability to utilized the community resources for
health care due to
• Specific: lack of adequate family resources, specifically,
o Financial
o Manpower
o Time
J.A.K.E 24 of 28
Planning
- “hmmm, priority natin ang malnutrition tapos sumunod
scabies…”
Family nursing care plan (fncp)
- “a family nursing care plan is the set of actions the nurse
decides to implement to be able to resolve identified family
health and nursing problems.”
Characteristics family nursing care plan
1. Nursing care plan focuses on actions which are designed to
solve or minimize existing problem. (there are problems
that cannot be eliminated)
2. Nursing care plan is a product of deliberate systematic
process. (assessment to planning)
3. Nursing care plan, as with all other plans, relates to the
future. (based on their identified problem what should we
do for their future)
4. Nursing care plan is based upon identified health & nursing
problems.
5. Nursing care is a means to an end, not an end in itself. (it is
a continues process, isang fmily kase ito e maso-solve ung
isa tapos meron na naman)
6. Nursing care plan is a continuous process not a one-shot
deal.
Desirable qualities a nursing care plan
1. Based on clear definition of the problems.
2. Good plan is realistic.
3. Should be consistent with goals &philosophy of the health
agency.
4. Nursing care plan is drawn with the family. (dapat lahat ng
sinabi mong plano gusto din nila)
5. Nursing care plan is best kept in written form.
Importance of planning care
1. Individualized care to clients (iba iba ung plano kada
pamilya)
2. Nursing care plan helps in setting priorities by providing
information about client as well as nature if his problem.
3. Nursing care plan promotes systematic communication
among those involve in health care effort.
4. Continuity of care is facilitated through use of nursing care
5. Nursing care plans facilitate coordination of care by making
known to other members of the health team what nurse is
doing.
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

Priorities
1. Nature of condition or problem
- Categorized into wellness state/ potential, health threat,
health deficit of foreseeable crisis.
2. Modifiability of the problem
- Refers to the probability of success in minimizing,
alleviation or totally eradicating the problem through
nursing intervention
3. Preventive potential
- Refers to the nature and magnitude of future problems
that can be minimized or totally prevented if intervention
is done on the problem under consideration.
4. Salience
- Refers to the family’s perception and evaluation of the
problem in terms of seriousness an urgency attention
needed.
Scoring
• Decide on a score for each of the criteria.
• Divide the score by the highest possible score and multiply by
the weight.
Score/highest score x weight
• Sum up the scores for all the criteria. The highest score is
equivalent to the total weight.
Scale for ranking family health problems according to
priorities
Summary:
− The list of health problems ranked according to priorities is
presented:
• Malnutrition 5
• Scabies 4
• Improper refuse disposal 3.67
Goals and objectives
- Goals of care – titingnan health problem
- Objective of care – titingnan ay family health nursing problem
Formulation of goals and objectives of nursing care
Example 1:
- At the end of nursing intervention, the family will be able to
start a piggery business.
Example 2:
- At the end of nursing intervention, the family will be able to
start litigation proceedings against landlord.
Goals
- A cardinal principle in goal setting states that goals must be
set mutually with the family.
- Basic to the establishment of mutually acceptable goals is
the family’s recognition and acceptance of existing health
needs and problems.
- Goals set by the nurse and the family should be realistic or
attainable.
- Goals are best stated in terms of client’s outcomes, whether
at the individual, family, or community levels.
Barriers to joint goal setting between nurse and family
1. Failure on part of family to perceive existence of the
problem.
2. Family may realize existence of health condition/problem
but is too busy at the moment.

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3. Sometimes, family perceives existence of problem but does • recognize Example:

not see it as serious enough to warrant attention. • Decide • After the nursing
4. Family may perceive presence of problem & need to take • Care intervention, the family will
action. However refuse to face & do something about the • H&e be able to feed the mentally
situation. • Comm resources challenged prescribed
• Reasons to this kind of behaviour: quantity and quality of food.
- Fear of consequences of taking actions. • They will be able to teach
- Respect for tradition. the child simple skills
- Failure to perceive the benefits of action. related to activities of daily
- Failure to relate the proposed action to the family’s living and
goals. • The family will be able to
5. A big barrier to collaborative goal setting between nurse & apply measures taught to
the family is the working relationship. prevent infection in the
mentally challenged child.
Objectives
- Refer to more specific statements of the desired results or Objective time
outcomes of care." Short-term Medium-term Long-term
a) nurse-oriented based on activities of nurse or or immediate or intermediate or ultimate
b) client-oriented stated in terms of outcomes. objectives objectives objectives
Problem situations Are those which are Require several
Nurse-oriented Client-oriented which require not immediately nurse-family
Nurse-oriented objectives will Stating objectives in terms of immediate attention achieved and are encounters
not tell if the nurse’s activities client outcomes will indicate required to attain the
produced some beneficial during the evaluation phase long term ones.
results; they only indicate what whether the desired changes in Results can be The nature of the
the nurse did and in qualitative the problem situation resulted observed in a outcomes sought
evaluation, how well she from the nurse’s action. relatively short requires time to
performed them. period of time. demonstrate
Example: Example: They are Investment of more
• During the home visit, the • After the nursing accomplished with resources
nurse will discuss the intervention, the few nurse-family
importance of malnourished pre-school contacts and
immunization. member of the family will relatively less
increase their weights by at resources.
• During the second nurse- least one pound per month.
family contact, the nurse • After the nursing Example of nursing goal / objective
will show the different types intervention, there will be − The family will cope effectively with the threat of
of fertility-regulating improved relationship pulmonary tuberculosis.
methods. among family members. • Short term -the infant and preschool members of the family
• After the nurse’s visit, the will be immunized with bcg.
family will bring the pre- • Medium term -all members of the family will have a
school members to the well- complete physical check-up to rule out pulmonary
baby clinic the following tuberculosis.
day. • Long term -all members of the family will participate in the
care of the sick members and apply preventive measures
General objective Specific objective against the spread of infection.
After the nursing intervention, After the nursing intervention,
the family will utilize the family will bring the Implementation
community resources for health pregnant member to the health - “eto po ipapakita ko po sainyo paano niyo bubuhatin si indang.”
care. center regularly for check ups Selecting appropriate nursing actions
- The choice of nursing intervention is highly dependent on two
After the nursing intervention, The family will also consult the major variables:
the family will be able to take health center on every episode 1. The nature of the problem
care of the mentally challenged of illness among members. - Resolve around family’s assumption of the health tasks.
child competently. 2. Resource available to solve the problem
Define the criteria for - Aimed at minimizing or eliminating reasons for or
evaluation causes of family’s inability to do these tasks.

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Goals and objectives
• S – specific
• M – measurable
• A – attainable
• R – realistic
• T- time bound
Principles of nursing actions
- Stimulate recognition & acceptance of health needs/problems
- Work on the family’s failure to decide on taking appropriate
health actions
- Increase family’s confidence in providing nursing care to its
sick, disabled and dependent member through demonstrations
on nursing procedures utilizing supplies and equipment’s
available in the home.
- Involve patient & family in order to motivate them to assume
responsibility for their own care.
- Explain and clarify doubts thus the role of the nurse shifts direct
care giver to that of a teacher. (dapat may skills si nanay ituro
aht nung skills na naituro sa atin tuwing lab)
- Explore ways to minimize or prevent threats to the maintenance
of health & personal development among family members
- Utilize intervention measures involving environmental
manipulations through improvements on physical facilities in
home either by construction of needed ones or modifying
existing ones.
- Minimize or eliminate psychological threats in home
environment. Nurse can work closely with family to improve its
communication patterns, role assumptions & relationships &
interaction patterns.
Types of resources
• Family resources
- Physical & psycho-social strengths &assets of individual
members, financial capabilities, physical facilities &
support system provided by relatives and significant
others. (wag pagastusin ang pamilya)
• Nurse resources
- Knowledge about family health, her skills in helping
family manage them. These skills may range from simple
nursing procedure to complicated behavioral problems
such as marital disharmony. Availability of time
&logistical support are also part of resources of the nurse.
- (CHN Bag, IDB, Black Payong etc.)
• Community resources
- Include existing agencies, programs or activities for health
and related needs/problems and community organization
for health actions. (manpower ng health center etc.)
Methods of intervention
Family-nurse contact
• Home-visit
- Home visit is a professional, purposeful interaction that
takes place in the family’s residence aimed at promoting,
maintaining and restoring the health of the family or its
members.
• Clinic- visit
- Takes place in a private clinic health center, barangay
health station.
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- Major advantage is the fact that a family member takes
the initiative of visiting the professional health worker,
usually indicating the family readiness to participate in the
health care process.
- Because the nurse has greater control over the
environment, distractions are lessened and the family may
feel less confident to discuss family health concerns.
• Group approach
- Appropriate for developing cooperation, leadership, self-
reliance and or community awareness among group
members.
- The opportunity to share experiences and practical
solutions to common health concerns is strength of this
type of family-nurse contact.
• Telephone conference
• Written communication
- Used to give specific information to families, such as
instructions given to parents through school children.
• School visit or conference
• Industrial or job site visit
Implementation
The nursing bag
- Frequently called the phn bag is a tool used by the nurse
during home or community visits to be able to provide care
safely and efficiently.
- Serves as a reminder of the need for hand hygiene and other
measures to prevent the spread of infection.
- Nursing bag usually has the ff. Contents:
• Articles for infection control
• Articles for assessment of family members
• Note that the stethoscope and sphygmomanometer are
carried separately.
• Articles for nursing care
• Sterile items
• Clean articles
• Pieces of paper
- Bag technique helps the nurse in infection control.
- Bag technique allows the nurse to give care efficiently.
- It saves time and effort by ensuring that the articles needed
for nursing care are available.
- Bag technique should not take away the nurse’s focus on
the patient and the family.
- Bag technique may be performed in different ways,
principles of asepsis are of the essence and should be
practiced at all times.
Evaluation
- “nangyare ba ung dapat mangyare?
- “the determination of whether the objectives set were attained
or to what degree they were attained.”
- “evaluation is always related to objectives.”
- “evaluation when address to the result or outcome of care
answers the question “did the intended results occur?””
- “there is always an element of subjectivity in evaluation; the
process involves value judgement which is subjective”
- “evaluation also involves decision-making”
 COMMUNITY HEALTH NURSING 1 LEC – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 (MAM GARCIA)

Dimensions of evaluation
• Effectiveness – focus is attainment of the objectives
• Efficiency – relates to cost whether in terms of money, time,
effort, or materials. (mas maiksi mo na solve ang problema mas
efficient ka)
• Appropriateness- ability to solve or correct existing problem
situation, a question that involves professional judgement.
• Adequacy- pertains to its comprehensiveness whether all
necessary activities were performed in order to realize the
intended results. (lahat ba nagawa na natin?)
Criteria and standard
• Standard- once a value judgement is applied to a criterion; it
acquires the status of a standard.
• It refers to the desired level of performance corresponding with
a criterion against which actual performance is compared.
• It tells us what the acceptable level of performance or state of
affairs should be for us to say that the intervention was
successful.
• Criteria- refer to signs or indicators that tell us if the objective
has been achieved.
- They are names & description of variables that are relevant
indicators of having attained the objectives.
- They are free from any value judgement and are
independent to time frame.
Criteria and Standard
• Standard
- It refers to the desired level of performance corresponding
with a criterion against
• Criteria
- They are names & description of variables that are
relevant indicators of having attained the objectives.
Standard Criteria
Ex: infant nutrition With correct attachment
On demand in correct position
Breast feeding
Activities and Outcome
• Activities
- Are actions performed to accomplish an objective. They
are the things the nurse does in order to achieved a desired
result or outcome. Activities consume time and resources.
Examples are health teachings, demonstration and
referrals.
• Outcome
- Is the results produced by activities. Where activity is the
cause, outcome is the effect. They can also be immediate,
immediate or ultimate outcomes. Patient care outcomes
can be measured along three broad lines:
o Physical condition - decreased temperature or weight
and change in clinical manifestations
o Psychological or attitudinal status - decreased anxiety
and favourable attitude towards health care personnel.
o Knowledge on learning behavior - compliance of the
patient with instructions given by the nurse.

Mag Review maigiii!! Gooood luckkk 😊😊 – Aki

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