COMMUNITY HEALTH NURSING REVIEWER

I. PRIMARY HEALTH CARE T- TREATMENT OF COMMUNICABLE AND

September 6-12, 1978 NON-COMMUNICABLE DISEASES

 First International Conference for S- SAFE WATER AND SANITATION

PHC at Alma Ata, USSr Russia
KEY PRINCIPLES: 4 A’s
L.O.I 949
ACCESIBILITY- distance/travel time
- legal basis for PHC in the Philippines required, home must be w/in 30 mins away
- signed by Ferdinand Marcos (madali lang puntahan or ma access ganun)

Theme: Health in the hand of the people by AFFORDABILITY- can afford the services,
2020 government insurance covered through
philhealth (pasok sa bulsa ganon)
University Goal: Health for all by the year
2020 ACCEPTABILITY- compatible with the
culture and traditions of the population
5 KEY ELEMENTS:
AVAILABILITY- it is when the health services
1. UNIVERSAL COVERAGE- reducing
are offered in the health care clinics or
exclusion
(kung araw araw bang open at meron
2. HEALTH SERVICE REFORMS-
ganun)
organizing health
3. PUBLIC POLICY REFORMS- SUPPORT MECHANISM- 3 MAJOR
Integrating Health RESOURCES:
4. LEADERSHIP REFORMS- Pursuing
1. PEOPLE
collaborative
2. GOVERNMENT
5. Increasing Stakeholder Participation
3. PRIVATE SECTOR
8 ESSENTIAL HEALTH SERVICE:
MULTISECTORAL APPROACH:
E- EDUCATION FOR HEALTH
INTRASECTORAL LINKAGE
L- LOCALLY ENDEMIC DISEASE CONTROL
 Two-way referral
E- EXPANDED PROGRAM FOR  Communication, cooperation,
IMMUNIZATION collaboration within health sectors

M- MATERNAL AND CHILD HEALTH INTERSECTORAL APPROACH

INCLUDING RESPONSIBLE PARENTHOOD
 Between the health sector and other
E- ESSENTIAL DRUGS sectors.
 Education, agriculture, and local
N- NUTRITION
government officials.
COMMUNITY HEALTH NURSING REVIEWER

- Safety
- Effectiveness
COMMUNITY PARTICIPATION
- Affordability
 Process in which the people identify - Simplicity
the problem, needs and assumes - Acceptability
responsibilities to plan, manage and - Feasibility and reliability
control (parang nasa mindset nil ana - Ecological effects
kapag may problema, it is there - Potential to contribute to
responsibilities to think how they individual and community
can manage those problems) development

EQUITABLE DISTRIBUTION OF HEALTH R.A 8421- Traditional and Alternative

RESOURCES: Medicine act of 1997 (Juan Flavier)

2 DOH PROGRAMS: Medical plants:

 DOCTOR TO THE BARRIO (DTTB) 1. Lagundi

PROGRAM - Uses: asthma, cough, colds,
- Deployment of doctors to fever, dysentery pain, skin
municipalities that are with disease, wounds.
out doctors. - Preparation: decocting, wash
- For 2 years affected site with decocting.
 REGISTERED NURSE HEALTH 2. Yerba Buena
ENHANCEMENT AND LOCAL - Uses: headache,
SERVICE (RN HEALS) stomachache, cough, colds,
- Training and program for rheumatism, arthritis
unemployed nurses. - Preparations: Decoctin,
- For 1 year infusion, massage sap
3. Sambong
APPROPRIATE HEALTH TECHNOLOGY
- Uses:
INCLUDES:
Antiedema/antiurolithiasis
- Drugs - Preparation: decoctin
- Tools 4. Tsaang gubat
- Methods - Used: Diarrhea
- Procedures and techniques - Preparation: decoctin
- People’s technology 5. Niyog Niyogan
- Indigenous technology - Used: Anthelminthic
- Preparation: seeds are used
CRITERIA FOR APPROPRIATE HEALTH
6. Bayabas
TECHNOLOGY:
COMMUNITY HEALTH NURSING REVIEWER

- Used: Washing wounds , 1. ACUPRESSURE

gargle, toothache - Application of pressure on
- Preparation: decoctin acupuncture without
7. Akapulko puncturing the skin
- Used: antifungal 2. ACUPUNTURE
- Preparation: poultice - Uses of special needles to
8. Ulasimang puncture and stimulate the
- Used: lower blood uric acid specific part of the body
- Preparation: decoctine 3. AROMATHERAPHY
9. Bato/pancit pancitan - Combine essential aromatic
- Used: gout oil and apply to the body
- Preparation: eaten raw 4. NUTRITIONAL THERAPHY
10. Bawang - “Nutritional healing”
- Used: Hypertension, improves health by
toothache, lower blood enhancing the nutritional
cholesterol value to reduce risk of
- Preparation: eaten raw, disease.
apply on part 5. PRANIC HEALING
11. Ampalaya - Follows the principle of
- Used: diabetes mellitus balancing
- Preparation: decoctine, 6. REFLEXOLOGY
steamed - Application of pressure on
the body’s reflex joints to
MEDICAL PLANT PREPARATION:
enhance body’s natural
 DECOCTIN healing
- Boiling the plant material in
PRIMARY CARE (hospital/clinic)
water for 20mins
 INFUSION - includes health promotion
- Soaked in hot water for 10- - disease preventions
15mins - health maintenance
 POULTRICE - counseling
- Directly apply the herbal on - patient education
affected parts (wounds, - diagnosis and treatments
bruises, rashes) - refers to a first contact of a
 TINCTURE person with a professionals
- Mix the herbal with alcohol - nursing care is directed
towards meeting all the
ALTERNATIVE HEALTH CARE MODALITIES:
patients
COMMUNITY HEALTH NURSING REVIEWER

PHC PC

Focus of client family and community individual

Focus of care promotive and preventive
Decision-making process community-centered
Outcome self-reliance
Setting for services rural-based satellite clinics;
community health centers
Goal development and preventive
care
curative
health worker driven
reliance on health workers
mostly urban places; hospital,
clinics
absence of disease

II. COMMUNITY ORGANIZING:

ENSURING HEALTH IN THE
HANDS OF THE PEOPLE

COMMUNITY ORGANIZING

- a process of educating and

mobilizing members of the
community to enable them
to resolve community
problems.
- To build the community’s
capacity to work for the
common good in general and
health goals.

COMMON GOALS OF CHN AND

COMMUNITY ORGANIZING:

- People empowerment
- Development of self-reliant
community
- Improved quality of life
COMMUNITY HEALTH NURSING REVIEWER

COMMUNITY DEVELOPMENT - An offshoot of the ethical

principle of solidarity,
- Improvement access to
concerns of one another.
resources that will enable
the people to improve their CORE PRINCIPLES IN COMMUNIT
standards of living and ORGANIZING:
overall quality of life.
Anchored on basic values of human rights,
- Identification of needs
social justice, and social responsibility as the
- Deciding appropriate courses
following:
of actions
 COMMUNITY ORGANIZING IS
EMPHASESS OF COMMUNITY ORGANIZING
PEOPLE CENTERED
IN PRIMARY HEALTH CARE ARE THE:
- The learners (community)
1. People from the community working and the teacher (nurses)
together to solve their own  COMMUNITY ORGANIZING IS
problems. PARTICIPATIVE
2. Internal organization consolidation - Decisions are made not just
as prerequisite to external the elite but also the
expansion ordinary people
3. Social movement first before  COMMUNITY ORGANIZING IS
technical change DEMOCRATIVE
4. Health reforms occurring within the - It is the process that allows
context broader social most of the people to
transformation. recognize and critically
analyze their difficulties and
3 BASIC VALUES: LOCOA, 2005
articulate their aspirations.
1. HUMAN RIGHTS  COMMUNITY ORGANZIING IS
- Based on the worth and DEVELOPMENTAL
dignity inherent to all human - It should be directed towards
beings. Right to life, freedom changing current undesirable
to make decisions for conditions. Seeks authentic
oneself. human development
2. SOCIAL JUSTICE  COMMUNITY IS PROCESS-
- Entails fairness in the ORIENTED
distribution of resources to - Deal with other problems
satisfy basic needs and to leads to sustenance of the
maintain dignity as human community organizing efforts
beings.
3. SOCIAL RESPONSIBILITY
COMMUNITY HEALTH NURSING REVIEWER
PHASES OF COMMUNTY ORGANIZING:
PRE-ENTRY- involves preparation one the
part of the organizer and choosing a
community for partnership
- Preparation includes Knowing the
goal
- Making a list of sources
- Novice organizer, need to review
and study the basic concepts
- Proper selection of possible barriers,
threats, and strengths
ENTRY INTO THE COMMUNITY- formalizes
the start of the organizing process. Gets to
know the community and vice versa gets to
know the organizer.
- To make courtesy call to local formal
leaders (barangay chairperson,
council members)
CONSIDERATION IN THE ENTRY PHASE
- Introduce yourself and the intuition
to the community
- Clear explanation of the mission
vision and goals.
-
- Preparation of initial visits
- Keep in mind the goal of the process
is to build up the confidence and
capacities of people
MANALILI DESCRIBES 2 STRATEGIES FOR
GAINING ENTRY INTO A COMMUNITY:
1. PADRINO- a patron, usually
barangay pr some other local
government official.
2. BONGGA- easiest way to catch the
attention and gain the approval of
the community. This exploits the
weakness and usually involves doles-
out such as free medicines.
III. FAMILY DATA ANALYSIS
FAMILY DATA ANALYSIS
- It is done by comparing findings with
accepted standards for indiv family
members and for the family units.
(Collecting information within the
family)
SYSTEM OF ORGANIZING FAMILY DATA
Family structure and characteristics:
- Data on household membership
- Demographic characteristics
- Family members living outside the
household
- Family mobility
- Family dynamics (emotional
bonding, authority, power structure
autonomy of members etc.)
SOCIOECONOMIC CHARACTERISTICS:
- Data on social integration (ethnic
origin, language, dialects spoken and
social networks)
- Educational experiences and literacy
- Work history
- Financial resources
- Cultural influences
- Spirituality or religious affiliation
COMMUNITY HEALTH NURSING REVIEWER
FAMILY ENVIRONMENT: refers to the
physical environment inside the family’s
home/residence and its neighborhood.
FAMILY HEALTH AND HEALTH BEHAVIOUR:
- Family activities
- Self-care
- Risk behaviors
- Health history
- Current health status
- Health care resources (home
remedies and services)
Family Nursing Diagnosis
 Nursing diagnoses may be
formulated at several levels:
- As a Individual family members
- As a family unit
- As the family in relation to its
environment/community.
 International (NANDA-I, 2011)
- Serve as a common framework
of expressing human responses
to actual and potential health
problems.
 Family Coping Index
- This tool is based on premise
that nursing action may help a
family in providing for a health
need or resolving a health
problem by promoting the
family’s coping capacity.
Nine areas of assessment of the Family
Coping Index (Freeman and Heinrich, 1981):
 Physical Independence – Family
members’ mobility and ability to
perform activities of daily living
(personal hygiene)
 Therapeutic Competence – Ability
to comply with prescribed or
recommended procedures and
treatments to be done at home.
 Knowledge of Health Condition –
Understanding of the health
condition or essentials of care
according to the developmental
stages of family members.
 Application of principles of personal
and general hygiene – practice of
general health promotion and
recommended preventive measures.
 Health Care Attitudes – family’s
perception of health care in general.
 Emotional Competence – Degree of
emotional maturity of family
members according to their
developmental stage.
 Family living patterns –
Interpersonal relationships among
family members, management of
family finances, and the type of
discipline in the home.
 Physical Environment – includes
home, school, work, and community
environment that influence the
health of family members.
 Use of community facilities – ability
of the family to seek and utilize, as
needed, both environment-run and
private health.
FOMULATING PLAN OF CARE- involves
priority settings establishing goals and
COMMUNITY HEALTH NURSING REVIEWER
objectives and determining appropriate
interventions.
PRIORITY SETTINGS- determining the
sequences in dealing with identified family
needs and problems.
FAMILY SAFETY- a life threatening situation
is given top priority
FAMILY PERCEPTION- priority is given to
the need that the family recognizes as
urgent or important
PRACTICALITY- together with the family,
nurse investigates existing resources and
constraints
PROJECTED EFFECST- immediate resolutions
of a family concern gives the family a sense
of accomplishment and confidences in
themselves and the nurse.
ESTABLISHING GOALS AND OBJECTIVES:
GOAL: desired observable family response
to planned intervention in response to a
mutually identified family need
OBJECTIVES: the desired step by stepfamily
responses as they work toward a goal
Objectives should be SMART:
S- SPECIFIC
M-MEASURABLE
A-ATTAINABLE
R-RELEVANT
T-TIME BOUND
DETEMINING APPROPRIATE
INTERVENTIONS:
FREEMAN AND HEINRICH categorized
nursing intervention into THREE TYPES:
1. SUPLEMENTAL INTERVENTIONS
- Actions that nurse performs on
behalf of the family when it is
unable to do things for itself.
2. FACILITATIVE INTERVENTION
- Actions that remove barriers to
appropriate health actions
3. DEVELOPMENTAL INTERVENTIONS
- Aim to improve the capacity of
the family to provide for its
own health needs such as
guiding the family to make
responsible health decisions.
IMPLEMENTING THE PLAN OF CARE
- It is the step when the family
or the nurse execute the plan
of actions
EVALUATION
- To evaluate is to determine or
fix the value
FORMATIVE EVALUATION
- Judgement made about
effectiveness of nursing
interventions as they are
implemented
SUMMATIVE EVALUATION
- Determining the end results of
family nursing care and usually
involves measuring outcomes
COMMUNITY HEALTH NURSING REVIEWER

ASPECTS OF EVALUATION:  HOME VISIT

- Purposeful interaction that
EFFECTIVENESS
takes place in the family’s
- Determination of whether residence aimed in promoting
goals and objectives were the health of the family
attained
Advantages:
APPROPRIATENESS
1. It allows firsthand assessment of
- Suitability of the the home situation.
goals/objectives and 2. The nurse can seek out
interventions. previously unidentified needs.
3. It gives the nurse an opportunity
ADEQUACY
to adapt interventions according
- Degree of sufficiency of to family resources.
goals/objectives and 4. It promotes family participation
interventions and focuses on the family as a
EFFICIENCY unit.
5. Teaching family members in the
- Relationship of resources used home is made easier by the
to attain the desired outcomes familiar environment and the
FAMILY NURSE CONTACTS: recognition of the need to learn
as they are faced by the actual
Family nurse relationships develops through home situation.
family nurse contact, by the form of clinic 6. The personalized nature of home
visit, group conference, telephone contact visit gives family a sense of
or home visit confidence in themselves and in
 CLINIC VISITS the agency.
- Takes place in a private clinic Disadvantages:
health center, barangay health 1. The cost in terms of time and
clinics. effort.
 GROUP CONFERENCE 2. There are more distractions
- Opportunity to share because the nurse is unable
experiences and practical to control the environment.
solutions to common health 3. Nurse’s safety.
concerns.
 WRITTEN COMMUNICATIONS
- Used to give specific
information’s to families
COMMUNITY HEALTH NURSING REVIEWER

Phases of Home Visit  Implementation – Involves the

Pre-visit phase – Nurse contacts the family,
determines the willingness for a home visit,
and sets an appointment with them.
Purposes:
- To have a more accurate assessment
- To educate the family about
measures of health promotion
- To provide supplemental
interventions for the sick, disabled,
or dependent family member.
- To provide family with greater
access to health resources in the
community.
In-home phase: This phase begins as the
nurse seeks permission to enter and lasts
until he or she leaves the family’s home. It
consists of initiation, implementation, and
termination.
 Initiation – It is customary to knock
or ring the doorbell and at the same
time, in a reasonably loud but
nonthreatening voice say, “Tao po.
Si Jenny po ito, nurse sa health
center?”
- the nurse acknowledges the family
members
- Observes environment
- Establish rapport
- States the purpose of the visit the
source of information.
application of the nursing process,
assessment, provision of direct
nursing care as needed, and
evaluation.
 Termination – Consists of
summarizing with the family the
events during the home visit
- Use this time to record findings,
such as vital signs of family members
and body weight.
Post-visit phase- Takes place when the
nurse has returned to the health facility.
Includes documentations.
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
COMMUNITY HEALTH NURSING REVIEWER

- Pieces of paper 6. Do not put any of the family’s

articles on your paper lining/washable
Use of the Nursing Bag
protector.
• Bag technique helps the nurse in
7. Wash your articles before putting
infection control.
them back into you bag.
• Bag technique allows the nurse to
8. Confine the contaminated surface
give care efficiently.
by folding the contaminated side inward.
• It saves time and effort by ensuring
9. Wash the inner cloth lining of the
that the articles needed for nursing care are
bag as necessary.
available.
FAMILY DYNAMICS- some families naturally
• Bag technique should not take away
falling into multiple categories.
the nurse’s focus on the patient and the
family. Nuclear Family – family of marriage,
parenthood, or procreation; composed of
• Bag technique may be performed in
husband and wife and their children-
different ways; principles of asepsis are of
natural, adopted or both (Friedman)
the essence and should be always practiced.
Dyad Family – only husband and wife
For infection control the ff. activities
“empty nesters”
should be practiced during home visits:
Extended Family – consisting of 3
1. Remember to proceed from “clean”
generations or more
to “contaminated”.
Blended Family – results from a union
2. The bag and its contents should be
where one or both spouses bring a child or
well protected from contact with any article
children from a previous marriage
in the patient’s home.
Compound Family – where a man has more
3. Line the table/flat surface with
than one spouse (approved in the
paper/washable protector on which the bag
Philippines only among Muslims by virtue of
and all the articles to be used are placed.
Presidential Decree No. 1083)
4. Wash your hands before and after
Cohabiting Family – “live-in” arrangements
physical assessment and physical care of
each family member. Single Parent – single

5. Bring out only the articles needed.

COMMUNITY HEALTH NURSING REVIEWER

IV. HEALTH PROMOTION, RISK Risk factor- an exposure that is associated

REDUCTION AND CAPACITY with a disease
BUILDING STRATEGIES
3 Criteria for establishing a risk factor
HEALTH PROMOTION - any combination of
1. The frequency of the disease varies
health education and related organizational,
by category or amount of factor.
economic, and environmental supports for
2. The risk factor must precede the
behavior of individual, groups, or
communities conducive to health onset of the disease.

3. The association of concern must not

HEALTH PROTECTION- Parse (1990)
behaviors in which one engages with the be due to any source of error.

specific intent to prevent disease, detect Two types of Risks Factors:

disease in the early stages or to maximize
Modifiable Risk Factors- individual has
health within constraints of disease
some control
(nagpapacheck up ka ganun,
prinoprotektahan mo self mo ganun) Non- Modifiable Risk Factors- little or no
control. (Ex. genetic makeup, gender, age)
HEALTH RISK- The probability that a specific
event will occur in each time frame Risk Reduction – a proactive process in

(kunwari magkakasakit ako kakapayat, tas which individuals participate in behaviors

2weeks ng puyat ganun, basta kung gaano that enable them to react to actual or

katagal don at risk) potential threats to their health

Risk Assessment- conducted to determine Risk communication- process through

health risks to individuals and populations, which public receives information regarding

way of distinguishing the risks posed by possible threats to health

potentially harmful exposures. Sleep- is essential component of chronic

disease prevention and health promotion.
Steps of risk assessment- Hazard
Smoking Cessation- is an important step in
Identification, risk description, exposure
achieving optimum health. The American
assessment and risk estimation. Cancer society recommends the following
COMMUNITY HEALTH NURSING REVIEWER

Steps to Quit Smoking: 2. Create Supportive Environments

1. Make decision to quit. 3. Develop Personal Skills

2. Set a date to quit and choose a plan 4. Reorient Health Services

3. Deal with withdrawal through. Avoid 5. Moving into the Future

temptation
HEALTH EDUCATION- a process of changing
4. Staying off tobacco is a lifelong people’s knowledge, skills and attitudes for
process. Remind yourself of the reasons health promotion and risk reduction.
why you quit
Basic principles that guide the Effective
Alcohol Consumption - not more than 2 Nurse Educator (based on Knowles Theory
drinks a day for the average sized man and on adult learning)
not more than 1 drink a day for the average
1. Message – send a
size woman
clear/understandable message to the
Heavy Drinking- consuming more than 2 learner.
drinks/day on average for men and more
2. Format- strategy must match the
than 1 drink per day for women
objectives
Binge drinking- drinking 5 or more drinks on
3. Environment –conducive
a single occasion for men / 4 or more drinks
environment for learning, therapeutic and
on a single occasion for women
supportive relationship with the learner
Excessive Drinking- can take the form of
4. Experience – organize positive and
heavy drinking/ binge drinking/ both
meaningful learning experience
3 basic strategies for Health Promotion
5. Participation- engage learner in
1. Advocacy for health to provide for participatory learning by involving then in
the conditions and resources essential for the discussion, solicit feedback
health
6. Evaluation- use tools such as
2. Enabling all people to attain their full quizzes, individual conferences and return
health potential demonstration

3. Mediating among the different

sectors of society to achieve health

5 priority action areas provide support for

these 3 strategies:

1. Build Healthy Public Policy