COMMUNITY

HEALTH
2020 - 2021

NURSING1
MODULE
 MODULE

COMMUNITY HEALTH NURSING

(NUR211)

OVERVIEW/INTRODUCTION:

This course covers the concepts and principles in the provision of basic
care in terms of health promotion, health maintenance and disease prevention
at the individuals, family, community level and special population groups.

It includes the study of the Philippine Health Care Delivery System and the
global context of public health Nursing is in the context of the Philippine Health
Care Delivery System, and in Community development.

LEARNING OUTCOMES AND OBJECTIVES:

At the end of the course, the students should be able to:

1. Apply concepts and principles of Community Health.
2. Utilizes Nursing Process in the care of Communities and population
groups.
3. Ensure well organized recording and reporting system.
4. Share leadership/relate effectively with others with others in works
situations related to nursing and health.

LEARNING CONTENT/ TOPICS

UNIVERSITY VISION
Isabela State University as a vibrant comprehensive and research university
in the country and ASEAN region.

UNIVERSITY MISSION
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 “The Isabela State University is committed to develop highly trained and
globally competent professionals; generate innovative and cutting edge
knowledge and technologies for people empowerment and sustainable
development; engage in viable resource generation programs; and maintain
and enhance stronger partnership under good governance to advance to
advance the interest of national international communities.

VISION AND MISSION OF THE COLLEGE OF NURSING

VISION

The college of Nursing Envisions a nursing envisions a nursing student as

innovative, competent and scientifically equipped with skills to face the
demands of nursing profession in promoting and maintaining health.

MISSION

The Isabela State University – College of Nursing, Ilagan Campus commits

to:
Provide nursing students with the beginning nursing skills competency
based in order to produce quality nursing graduates who are professionally
knowledgeable, competent and dedicated to serve.

OBJECTIVES

1. Provide quality education to Nursing Student for them to be equipped

with necessary skills and values in the delivery of health care services.
2. Develop students a solid foundation in humanistic, spiritual and moral
values which will serve their guide when confronted with decision on
human life;
3. Develop students a sense of caring by reaching our people in the
community through extension and various outreach programs;
4. Provide graduates with good leadership qualities, self-discipline and
caring attitudes in applying their nursing skills and serving man, his
family and community: and
5. To provide profession growth and advancement of nursing knowledge
through research studies and continuing education.

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OVERVIEW OF COMMUNITY HEALTH NURSING, CONCEPTS
AND PRINCIPLES
- Is one of the two major fields of nursing in the Philippines. The
other is the Hospital Nursing. We generally use the terms
community health nursing and public health nursing and
community and public health nursing interchangeably.
- The American Nurses Association wrote that: Community health
nursing practice promotes and preserves the health populations
by integrating the skills and knowledge relevant to both nursing
and public health.
- The practice is comprehensive and general, and is limited to a
particular age or diagnostic group.
- It is continual and is not limited to episodic care… while
community health nursing practice includes nursing directed to
individuals, families, and groups, the dominant responsibility is to
the population as a whole.

Community Health Nursing Defined

-refers to the services rendered by a professional nurse with the
communities, groups, families, individuals at home, in health care centers, in
clinics, in schools, in places of work for the promotion of health, prevention of
illness, care of the sick at home and rehabilitation(RUTH FREEMAN).

This definition is also true to public health nursing if one goes back to the
definition given by the WHO Expert committee on Nursing.
-nursing practice in a wide variety of community services and consumer
advocate areas, and in a variety of roles, at times including independent
practice. This definition of JACOSON means community health nursing is
certainly not confined to public health nursing agencies.

-The American nurses association wrote that: community health nursing

practice promotes and preserves the health populations by integrating skills
and knowledge relevant to both nursing and public health. The practice is
comprehensive and general, and is not limited to episodic care…while
community health nursing practice includes nursing directed to individuals,
families and groups, the dominant responsibility is to the population as a
whole .

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HIGHLIGHTS OF CHN
The goal of professional practice is the promotion and preservation of the
health of populations.
1. The nature of practice is comprehensive, general, continual, and not
episodic.
2. The knowledge comes from nursing and public health.
3. The different levels of clientele- individual, families and group.
4. The practitioner’s recognition of the primacy of the population as a
whole.

IMPORTANT CONCEPT FROM SCIENCE OF PUBLIC HEALTH

1. Emphasis on the importance of the “greatest good for the greatest
number”.
2. Assessing health needs, planning, implementing, and evaluating the
impact of health services on population groups.
3. Priority of health promotive and disease preventive strategies over
curative interventions.
4. Tools for measuring and analyzing community health nursing.
5. Application of principles of management and organization in the delivery
of health services to the community.

OTHER IMPORTANT CONCEPTS:

1. HEALTH
-Is considered as the goal of public health in general, and CHN, in
particular.
Is a state of complete physical, mental and social wellbeing and merely
the absence of disease or infirmity, by WHO.
- An integrated method of functioning which is oriented toward
maximizing the potential which the individual is capable, DUNN,
who emphasize high level of functioning.
- It requires that the individual maintain the continuum of balance
and purposeful direction within the environment where he is
functioning.
- A state characterized by soundness and wholeness of human
structures and bodily and mental functions, by OREM, theorist.
- It must be noted that these definitions are focused on the
individual.

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2. RIGHT TO AND RESPONSIBILITY FOR HEALTH
- Health is a basic human right.
- The universal declaration of human rights article 25, section 1
that: “everyone has the right to a standard living adequate for the
health and wellbeing of himself and his family, including food,
clothing, housing and medical care and necessary social services,
and the right to security in the event of unemployment, sickness,
disability, widowhood, old age, or other lack of livelihood in
circumstances beyond his control.
- The WHO believes (1995) that “the government has the
responsibility for the health of their people which can be fulfilled
only by the provision of adequate health and social measures.”
- According to the congressional commission on Health (1993), “AS
A Fundamental Right, Health Deserves to be a TOP NATIONAL
PRIORITY”.
- In addition to the state or government, individuals, families and
communities share the responsibility for health.

3. PUBLIC HEALTH
-‘Public Health is the science and the art of preventing disease,
prolonging life and promoting health and efficiency through organized
community effort, for the sanitation of the environment.

The control of communicable infections, the education of the

individual in personal hygiene, the organization of medical and nursing
services for the early diagnosis and preventive treatment of disease and
the development of the socials machinery to ensure4 everyone a
standard of living for the maintenance of health, so organizing these
benefits as to enable every citizen this birth right of health longevity, by
WINSLOW, (1920).

4. PRIMARY HEALTH CARE – is “essential health care based on practical,

scientifically sound and socially acceptable methods and technology
made universally accessible to individuals, families in the community can
afford to maintain at every stage of their development in the spirit of
self-reliance and self-determination.”
(WHO/UNICEF 1978, in STANLOPE and LANCASTER).

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 5. Public health nursing defined
-World HEALTH Organization Expert Committee of Nursing defined
this as a special field in nursing that combines skills of nursing, public
health and some phases of social assistance and functions as part of the
total public health programme for the promotion of health, the
improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.
(use their nursing skills in the application of public health functions and
social assistance within the context of public health programs designed
to promote health and prevent diseases).

COMMUNITY HEALTH NURSING

-The utilization of the Nursing Process in the different levels of nursing
clientele-individuals, families, population group, and communities concerned
with the promotion of health, prevention of disease and disability and
rehabilitation. (Araceli Maglaya)

GOAL:
To raise level of citizenry by helping communities and families to cope
with the discontinuities and treats to health in such a way as to maximize their
potential for high level wellness.
Is the promotion and preservation of health of its different clienteles –
individual, family, population and community.

BASIC PRINCIPLES OF COMMUNITY HEALTH NURSING:

1. The community is the patient in CHN, the family is the unit of care and
there are four levels of clientele.
2. In CHN, the clientele is considered as an active partner not passive
recipient of care.
3. CHN practice is affected by development in which technology, in
particular, changes in society, in general.
4. The goal of CHN is achieved through multi-sectorial efforts.
5. CHN is a part of health care system and the larger human system.

OTHER PRINCIPLES OF CHN:

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 1. The recognized needs of individuals, families, and communities provides
the basis for CHN practice.
2. Knowledge and understanding of the objectives and policies of the
agency facilities goal achieved.
3. CHN considers the family as the unit of service.
4. Respect for values, customs and beliefs of the clients contribute to the
effectiveness of care to the client.
5. CHN integrated health education and counselling as vital parts of
functions.
6. Collaborative work relationships with the co-workers and members of
the health team facilities accomplishments of goals.
7. Periodic and continuing evaluation provides the means for assessing the
degree to which CHN goals and objectives are being attained.
8. Continuing staff education program quality services to attain and are
essential to upgrade and maintain sound nursing practices in their
setting.
9. Utilization of indigenous and existing community resources maximizing
the success of the efforts of community health nurses.
10.Active participation of the individual, family, and community in planning
and making decisions for the health care needs, determine to a large
extent, the success of the CHN programs.
11.Supervision of nursing services by qualities CHN personnel provides
guidance and direction for the work to be done.
12.Accurate recording and reporting serve as the basis for evaluation of the
degree of planned programs and activities and as a guide for the future
actions.

OTHER DISTINGUISHING ATTRIBUTES OF CHN

-Greater control for both the nurse and the client in making decisions
related to health care
- collaboration between nurse and client as equals
- recognition of the impact of different factors on health
- nurses’ greater AWARENESS of their clients’ lives and situations.
**therefore, CHN obviously has broader perspective than institutional or
hospital nursing.

- CHN’s basic knowledge and skills are anchored on nursing

theories and important concepts from the science of public
health such as:

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 1. Emphasis on the importance of the “greatest good for the
greatest number”
2. Assessing health needs, planning, planning, implementing and
evaluating the impact of health services on population groups
3. Priority of health-promotive and disease-preventive strategies
over curative interventions
4. Tools for measuring and analyzing community health problems
5. Application of principles of management and organization in
the delivery of health services to the community
- CHN’s practice is enhanced by the bodies of knowledge of other
academic disciplines like sociology, psychology, anthropology,
economics and political science to help nurses understand the health
care delivery system and their clients, and thus perform their roles and
functions better.

FRAMEWORK FOR COMMUNITY HEALTH NURSING

 COMMUNITY Health Nursing is the totality of its philosophy and
beliefs, principles, and processes.
 CHN is influenced by its immediate context – the HEALTH CARE
DELIVERY SYSTEM – and the overall economic, political, socio-
cultural and environmental factors.
 The primary goal of CHN is the promotion and preservation of
health of its different clients.
 CHN responds the health needs of its client. In recognition of the
fact health is greatly affected by the health care delivery system
and the economic, socio-cultural, political and environmental
factors.

CLIENTS OF THE COMMUNITY HEALTH NURSE

There are different levels of clientele in Community Health Nursing – the
INDIVIDUAL, FAMILY, POPULATION GROUP AND COMMUNITY.

INDIVIDUAL – the PHN deals with individuals – sick or well on daily basis, these
are the people who consult at the health center and receive health services
such as pre-natal supervision, well child follow ups and morbidity services.
These also include clients with chronic illness such as DM and HPN who go
to health center for blood sugar and blood pressure monitoring. The individual
client will be considered as the “entry point” in working with the whole family.

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FAMILY – The family is a very important social institution that performs two
major functions – Reproduction and socialization. It is generally considered as
the basic unit of care in CHN for many reasons. It performs health promoting,
health maintaining and disease preventing activities.
The family is the focus of decision making on health matters. It is the
source of the most solid support and the care to its members, particularly to
the young, the elderly, the disabled and the chronologically ill.

POPULATION GROUP – or “aggregate” is a group of people who share

common characteristics, developmental stage or common exposure to
particular environmental factors, and subsequently common health problems.
Some of these groups are children, men, women and elderly.

COMMUNITY – is a group sharing common geographic boundaries and/or

common values and interest? It functions within a particular socio-cultural
context, which means that no two communities are alike. The physical
environment varies, and so with the people’s way of behaving and coping. The
people are different from each other, this, the dynamics in one community
differs from the other.

CHARACTRISTICS:
1. It is defined by its geographical boundaries within certain identifiable
characteristics.
2. It is made up of institutions organized into s social system with the
institutions and organizations linked in a complex network having a
formal and informal power structure and a communication system.
3. A common or shared interest that binds the members together exists.
4. It has an area with fluid boundaries within which a problem can be
identified and solved.

In the Philippines, there is a big difference between rural and urban

communities. These communities differs in terms of number of characteristics
such as physical environment, population size, and availability and accessibility
of health resources.

A “HEALTHY COMMUNITY”, be it rural or urban, has the following

characteristics:
1. Awareness that “we are a community”.
2. Conservation of natural resources.
3. Recognition of, and respect for, the existence of subgroups.
4. Participation of subgroups in community affairs.
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 5. Preparation to meet crisis.
6. Ability to problem solve.
7. Communication through open channels.
8. Resources available to all.
9. Setting of disputes through legitimate mechanisms.
10.Participation by citizen in decision making.
11.Wellness of a high degree among its members.

OTHER IMPORTANT CONCEPTS

1. Community (client)
2. Health (goal)
3. Nursing ( the means)

FACTORS AFFECTING THE LEVEL OF FUNCTIONING OF CHN

A. POLITICAL
-this factor pertains to the power and authority to regulate the
environment.
Examples:
Safety

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 Oppression
People empowerment

B. HEALTH CARE DELIVERY SYSTEM

-One component of this factor is the primary health care which is a
partnership approach.
GOAL: Effective provision Of health services that are community
based and accessible
COMPONENTS:
Promotive
Preventive
Curative
Rehabilitative

C. BEHAVIORAl
COMPONENTS
Culture
Habits
Ethnic customs
Example: smoking, intake of alcoholic drinks, substance abuse,
lack of exercise

D. SOCIOECONOMIC INFLUENCES
COMPONENTS
Employment
Education
Housing

E. ENVIRONMENTAL INFLUENCES
COMPONETS
Air
Food
Water waste
Urban/rural noise
Radiation
Pollution

F. HEREDITY
COMPONENTS
Genetic endowment

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 Defects
Strengths
Risk:
Familial
Ethnic
Racial

ROLES, FUNCTIONS OF and COMPETENCIES REQUIRED BY A

COMMUNITY HEALTH NURSE
Role – refers to a set of behavior patterns that are deemed
appropriate for a person by virtue of his/ her status in society and/or
a position he/she occupies in an organization.

Function - is a set of activities and task expected of a person to

perform by virtue of his position or role in society.

Competency – the quality of being functionally adequate in

performing the task and assuming the role of a specific position.

 CLINICIAN – who is the health care provider, taking care of the sick
people at home or in the RHU?
 HEALTH EDUCATOR – who aims towards health promotion and illness
prevention through dissemination of correct information?
 FACILITATOR – who establishes multi-sectorial linkages by referral
system?
 SUPERVISOR – who monitors and supervises the performance of
midwives in the event that the municipality/city health officer is unable
to perform his/her duties and responsibilities or is not available, the
public health nurse will take charge of the CHO’s responsibilities.
 Case manager
 Advocates
 Health planner
 Case finder
 Statistician
 Community leader

OTHER SPECIFIC RESPONSIBILITIES – R.A. 7164 (Phil. Nursing Act of 1991)

includes:

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  Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…..etc.
 Provide families with primary health care services
 Provide developmental utilization of family nursing care plan I provision
of care for the family
 Community organizing, mobilization, community development and
people empowerment
 Case finding and epidemiological investigation
 Influencing executive and legislative individuals and bodies concerning
health and development

RESPONSIBILITIES OF COMMUNITY HEALTH NURSE

 Be a part in developing an overall health plan, its implementation and
evaluation for communities.
 Provide quality nursing services to the three levels of clientele.
 Maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health services.
 Provide opportunities for professional growth and continuing education
for staff development.

11 CORE COMPETENCIES
 Safe and quality nursing care
 Management of resources and environment
 Health education
 Legal responsibility
 Ethico-moral responsibility
 Personal and professional development
 Research
 Record management
 Communication
 Collaboration and teamwork

HISTORY OF COMMUNITY HEALTH NURSING PRACTICE IN

THE PHILIPPINES

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1577 – Franciscan Friar Juan Clemente opened a medical dispensary in
Intramuros (the old walled city of Manila) for the indigent.

1690 – Dominican Father Juan de Pergero worked toward installing a water

system in San Juan del Monte (now San Juan City, Metro Manila) and Manila
small pox vaccination was introduced by Dr. Francisco de Balmis, the personal
physician of King Charles IV of Spain, who came to the Philippines in 1805.

1876 – the first medicos titulares (provincial health officers) were appointed by
the Spanish government.

1888 – a 2 year course consisting of fundamental medical and dental subjects

was first offered in the University of Sto. Tomas

Graduates of this course known as “cirujanos ministrantes” served as male

nurses and sanitation inspectors.

1901
 Act # 157 (Board of Health of the Philippines); Act # 309 (Provincial and
Municipal Boards of Health) were created.

– The United States Philippine Commission, through Act 157, created the board
of Health of the Philippine Islands, with a commissioner of Public Health as its
executive officer, it eventually evolved into what is now the Department of
Health. Subsequently the provincial and municipal boards of health were
formed.

1905
 Board of Health was abolished; functions were transferred to the Bureau
of Health.
1905
– puericulture center nurses carried out health education activities and
home visits to follow up cases and invite client to consult at the center.
Founded by the Asociacion Feminista Filipina.

La Gota de Leche – was the first center dedicated to the service of mothers
and babies.

1912
 Act # 2156 or Fajardo Act

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 The Fajardo Act of 1912 – created sanitary divisions made of one to four
municipalities, each sanitary divisions had a “president”, who had to be a
physician
.
1915
– The Philippine General Hospital began to extend public health nursing
services in the homes of patient by organizing a unit called social and home
care service, with two nurses as staff.

1919
 Act # 2808 (Nurses Law was created) – Carmen del Rosario, 1st Filipino
Nurse supervisor under Bureau of Health
Oct. 22, 1922
 Filipino Nurses Organization (Philippine Nurses’ Organization) was
organized.
1923
 Zamboanga General Hospital School of Nursing & Baguio General Hospital
were established; other government schools of nursing were organized
several years after.
1928
 1st Nursing convention was held

1940
 Manila Health Department was created.
1941
 Dr. Mariano Icasiano became the first city health officer; Office of Nursing
was created through the effort of Vicenta Ponce (chief nurse) and Rosario
Ordiz (assistant chief nurse)
Dec. 8, 1941
 Victims of World War II were treated by the nurses of Manila.

July 1942
 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31
Filipino nurses in Bilibid Prison as prisoners of war by the Japanese.
1947
– the Department of Health was reorganized into bureau: quarantine
hospitals that took charge of the municipal and charity clinics, and health with
the sanitary divisions under it.

Feb. 1946

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 Number of nurses decreased from 556 – 308.
1948
 First training center of the Bureau of Health was organized by the Pasay
City Health Department. Trinidad Gomez, Marcela Gabatin, Costancia
Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training
staff.
1950
 Rural Health Demonstration and Training Center was created.
1953
 The first 81 rural health units were organized.
1957
 RA 1891 amended some sections of RA 1082 and created the eight
categories of rural health unit causing an increase in the demand for the
community health personnel.
1958-1965
 Division of Nursing was abolished (RA 977) and Reorganization Act (EO
288)
1961
 Annie Sand organized the National League of Nurses of DOH.
1967
 Zenaida Nisce became the nursing program supervisor and consultant on
the six special diseases (TB, leprosy, V.D., cancer, filariasis, and mental
health illness).
1975
 Scope of responsibility of nurses and midwives became wider due to
restructuring of the health care delivery system.
1976-1986
 The need for Rural Health Practice Program was implemented.
1990- 1992
 Local Government Code of 1991 (RA 7160)

1993-1998
 Office of Nursing did not materialize in spite of persistent recommendation
of the officers, board members, and advisers of the National League of
Nurses Inc.
Jan. 1999
 Nelia Hizon was positioned as the nursing adviser at the Office of Public
Health Services through Department Order # 29.
May 24, 1999

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 EO # 102, which redirects the functions and operations of DOH, was signed
by former President Joseph Estrada.

**EO – Executive Order; RA- Republic Act)

PRIMARY HEALTH CARE HISTORY

HISTORY
MAY 1977 – the 30th World Health Assembly adopted resolution WHO
30:43, this resolution decided that the main social target of governments
and of WHO should be the attainment by all the people of the world by
the year 2000 a level of health that will permit them to lead a socially
and economically productive life.
September 12, 1978 - international conference on Primary Health Care
was held in this year at Alma ata, USSR.
October 19,1979 – the president of the Philippines (Ferdinand Marcos)
issued a letter of Instruction (LOI) 949 which mandated the Ministry of
Health to adopt PHC as an approach towards design, development and
implementation of progress which focus health development at the
community ; level.

SUBSPECIALTIES OF CHN

I. OCCUPATIONAL HEALTH NURSING

A. DEFINITION
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 - nursing in the workplace, it is focused on people, on their places
of work, which of course is part of the bigger community.
- the specialty practice that provides for and delivers health care
services to workers and worker populations.
-it is autonomous, and occupational health nurses make
independent nursing judgements in providing occupational health
services.
- the foundation is research-based with an emphasis on optimizing
health, preventing illness and injury, and reducing health hazards.

B. OBJECTIVES
-focuses on promotion, protection, and restoration of workers’
health within the context of a safe and healthy work environment
-it aims to assists workers in all occupations to cope with actual
and potential stresses in relation to their work and work
environment.
-it is primarily geared at helping workers attain and maintain
optimum level of physical and psychological functioning.

A. C. MAJOR ACTIVITIES
-Assessment and control of environmental hazards
-Assessment of capcity of employees for work
- Maintenance of health of the employee
- organized and manage the health programs.

II. SCHOOL HEALTH NURSING

A. DEFINITION
-is the application of nursing theories and principles in the care of
the school population.

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B. OBJECTIVES
-aims at promoting the health problems that would hinder their
learning and performance of their developmental task. It also aims to
promote and maintain the health of the school populace by providing
comprehensive and quality nursing care. Specifically, it aims to
achieve the following objectives:
 Provide quality services to school population
 Create awareness among school children, personnel, and
administration the importance of promotive and preventive
aspects of health through health educations.
 Encourage the provision of standard functional facilities.
 Provide nursing personnel with opportunities for continuing
education and training.
 Conduct and participate in researches related to nursing care.
 Establish/ strengthen linkages with government and NGO’s for
school community health work.

B. PHASES
1. Health Instructions – giving health education, group
counselling, personal hygiene, immunization, nutrition,
dental care, environmental sanitation.
2. Health services – attending to emergency cases, physical
examinations (PE) of students, teachers. Making referrals
for laboratory exams.
3. Health School Living – coordinate with other agencies like
the insect and vermin control, identify health hazards,
participates in maintaining cleanliness.

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 4. School and Community Coordination – initiates projecs to
promote health in the environment.

C. DETERMINANTS OF SCHOOL HEALTH NURSING

 characteristics of their clientele- their age, developmental
stage and their common health problems and concerns.
 -POLICIES OF THE Department of education.
 Programs of the Department of Health
 Standard of the nursing profession
-health problems of school children are the result of economic and
environmental (particularly their home and immediate environment)
factors.

C. Components of School Health Nursing

1.School Services- Maintain school, clinic, screening all children-
visual, hearing, scoliosis.
2. Health instructions- as health educator/ counselor
3. health monitoring
a. mental health- substance abuse, sexual health
b. environmental health- food sanitation, water supply, safe
environment, safe toilet.
c. school community linkage – as community organizer

COMMUNITY ORGANIZING
- Is a process whereby the community members develop the
capability to assess in their health needs and problems, plan and
implement actions to solve this problems, put up and sustain
organizational structures which will be support and monitor
implementation of health initiatives by the people?

CORE PRINCIPLES OF COMMUNITY ORGANIZING:

1. Community Organizing is People-Centered
- The basic premises of any community organizing endeavor is that
the people are the means and ends of development, and
community empowerment is the process and outcome.

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 - It is people centered in the sense that the process of critical
inquiry is informed by and responds to the experiences and needs
of the marginalized sectors/people.
- Over all, the development is concerned with improving quality of
life in the different dimensions of community-social, political,
economic, environmental, cultural and spiritual.
- Community organizing is a process that promotes the
development of people’s autonomy and self-reliance, leading to
people empowerment.

2. Community Organizing is Participative

- The participation of a community in the entire process-
assessment, planning, implementation, and evaluation-should be
ensured.
- The community is considered as the prime mover and
determinant, rather than beneficiaries and recipients, of
development efforts, including health care.
3. Community Organizing is Democratic
- Community organizing should empower the disadvantaged
population.
- It is a process that allows the majority of people to recognize and
critically analyze their difficulties and articulate their aspirations.
- Their decisions must reflect the will of the whole, more so the will
the common people, than that of the leaders and the elite.
4. Community Organizing is Developmental
- Community organizing should be directed towards changing
current undesirable conditions.
- The organizers desires changes for the betterment of the
community and believes that the community shares that these
changes can be achieved.
5. Community Organizing is Process Oriented
- The community organizing goals of empowerment is dynamic.
With the evolving community situation, monitoring and periodic
review of plans are necessary.
- The community may initially face simple barangay problems.

PHILOSOPHY OF COMMUNITY ORGANIZING:

- People have the capability to change and influence conditions in
their environment which oppress and affect their lives.

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 Organizations facilitates this capability by promoting self-
awareness, self-determination and collective effort among the
people.

BASIC PRINCIPLES OF COMMUNITY ORGANIZING (Quesada):

1. Principle of Felt Needs

- Are problems/issues the people recognize
- Conditions which disturb people and are causing general
discontent
- They are differentiated from needs which health providers and
other groups and agencies have determined based on their
perception
- Co-tasks:
*to discover what these felt needs are
*to channel these and the people’s discontent into organization
and action
2. Principle of Leadership
- Leadership is a key to successful CO
- It is important that the leader is accepted, well respected, has charisma or
influence to a number of people, demonstrated capability of making things
work.
3. Principle of Participation
- Genuine CO aims to enable people to be in control in management of
projects or programs designed to address their problems in which they
were involved in the decision making process
- Co must be away from token participation such as information giving
consultation and placation efforts
4. Principle of Communication
- Open lines of communication must be established and maintain among
community organizers, local leaders and community members.
5. Principle of Structure
- CO should develop the organizational structure that is simple and
functional based on the needs of the organization
- it need not follow the structure of formal organization, instead, the CO’s
mat set up working committees that would address the need for:
*information, education, research
*ways and means and logistics
*Membership and mobilization

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 *Liaison/mobilization
6. Principle of Evaluation
- Assessment in on-going process of CO
- Efforts should be made to assess and to sum up the lessons learned
-the process is referred to as ARA or action-reflection-action

PHASES OF COMMUNITY ORGANIZING

1. PREPARATORY PHASE – activities include area selection, community
profiling, entry i8n the community and integration with the people.

GUIDELINES IN CONDUCTING INTEGRATION:

- Recognize the role and position of the authorities
- Adapt a lifestyle in keeping with that of the community
- Choose a modest dwelling which the people, especially the
economical disadvantaged will not hesitate to enter
- Avoid raising expectation of the people
- Be clear with your objectives and limitations
- Participate directly in production process
- Make house calls and seek out people where they usually gather
- Participate in some social activities

2. ORGANIZATIONAL PHASE – consists of activities leading to the

formation of people’s organization.
a. Social Preparation
b. Spotting and developing potential leaders
c. Core Group Formation – develop leaders in :
- Democratic and collective leadership
- Planning and assuming task for the formation of a community
wide-organization
- Handling and resolving group conflicts
- Critical thinking and decision making process
d. Setting up the community organization – these should be maximum
participation of and control by the members in all activities.

3. EDUCATION AND TRAINING PHASE – to strengthen the organization and

develop its capability to attend to the community’s basic health care
needs.

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 - Can be achieved by conducting the community diagnosis, training
of community health workers, undertaking health services and
mobilization and leadership skills training.
a. Conducting community diagnosis – assist the people in
developing a plan and in the actual conduct of community
diagnosis, help identify, analyze and understand the
implications of the data.
b. Training the community health workers
c. Health services and mobilization
d. Leadership formation activities:
- Intersectoral collaboration phase – the need for turnover of work
and develops a plan for monitoring and subsequent follow up of
the organization’s activities until the community is ready for full
disengagement and phase out.

PARTNERSHIP AND COLLABORATION

 They must work with other people or groups to increase the probability
of accomplishing the goals that they set.
 The nurse must plan to establish and maintain valuable working
relationship with people such as people’s organizations, health
organizations, the LGU’s, financial institutions, religious groups, socio-
civic organizations, sectorial groups and the like.
 The aim of partnership and collaboration is to get people to work
together in order to address problems or concerns that affect them.

WAYS to enable organizations to accomplish their goals:

1. Networking – is a relationship among organizations that consist of
changing information about each other’s goals and objectives,
services or facilities.
2. Coordination – is a relationship where organizations modify their
activities in order to provide better service to the target beneficiary.
3. Cooperation – is a relationship where organizations share
information and resources and make adjustments in one’s own
agenda.
4. Collaboration – is the level of organizational relationship where
organizations help each other enhance their capabilities in
performing their tasks as well as in the provision of services.
5. Coalition or Multi-sector collaboration – is the level of relationship
where organizations and citizens form a partnership.

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GENERAL IDEAS ON HOW TO GET STARTED IN PARTNERSHIP AND
COLLABORATION WORK?
1. It is imperative for the nurse to all the stakeholders in the process of
forging partnership and collaboration with the community.
2. In working together, the nurse and the community face risks together. It
is important therefore, that they need to know and trust each other.
3. Determine how each organization views the problem, how it is proposes
to solve the problem and how it perceives an organizational relationship
can help solve the problem.
4. Organizations should agree on the kind or level of relationship that will
best accomplish the group goals considering the needs and available
resources.
5. When organizations have agree on the type of organizational
relationship. Formulate ground rules that will become the bases for
decision making.

ADVOCACY
- One way the nurse can promote active community participation.
- The nurse helps the people attain optimal degree of
independence in decision making.

Advocacy Works Involves:

- Informing the people about rightness of the course
- Thoroughly discussing with the people the nature of the
alternatives, their content possible consequences
- Supporting people’s right to make a choice and on their choice
- Influencing public opinion

SUPERVISION
 Is a developmental and enabling process whereby the nurse supervisor
ensures that work is done effectively and efficiently by the person being
supervised and at the same time keeps the person satisfied and
motivated with his work
 Also seen as facilitating process that consists of inspecting and
evaluating the work of another in order to remedy rather than punish
poor performance.

OBJECTIVES
 Identify the supervisory needs of the worker

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  Determine ways meeting the needs of the worker
 Develop the capability of the worker to solve own problems and to meet
own needs by providing continuing personal guidance and professional
development
 Evaluate the performance of the worker as it becomes the basis for
providing help or guidance
 Supervisory is seen more as coaching function rather than a function of
control
 In the community, most of the supervisory functions of the nurse are
directed towards lower level health workers
 The nurse as a coach to health workers uses persuasion, exhortation and
judicious mixture of reward and punishment to motivate the players
higher levels of performance

SUPERVISORY PLAN
 The nurse supervisory plan is written document in how to organize and
systemize supervisory activities
 It includes objectives, strategies, resources and timetable of activities to
meet the identified needs of the person being supervised
 Supervisory needs arises from:
- Inadequate knowledge, skills and attitude
- Conflict between organizational and individual goals
- Work and personal situation
- Lack of motivation

MAKING A SUPERVISORY PLAN

 The nurse conducts a situational analysis focusing on supervisory needs
assessment, information regarding supervisory needs of the workers can
be taken from the following:
- Review of records and report
- Observation of the person at work
- Interview of the worker
- Interview of co-worker and clients of the workers in the
community
 Supervisory needs and problems may be prioritized based on the
following criteria:
- Degree of importance or urgency of the problem need
- Activities/strategies needed to meet identified needs
- Magnitude and extent of the problem/need
- Time frame to carry out actions

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  Set objectives
 Select activities, strategies and resources needed to meet identified
objectives
 Identify indicators for evaluation
- Meet the needs
- Performance increased
- Improved quality of service

METHODS AND TOOLS FOR SUPERVISION

1. Analysis of record and report
- PDS of the worker
- Client records
- Performance evaluation
- DTR
- Reports submitted
- Accomplishment reports
- Target client list
2. Actual observation of worker’s performance in various situations:
- Clinic
- Home visit
- Conduct of individual or group classes
- Nursing references
- Organization/implementation of community projects and
activities
- Observation guide:
*questionnaire
*checklist

3. Individual/group conferences and meetings

- Anecdotal report
- Critical incident report
- Performance evaluation form
- Minutes of meetings
- Manuals/handbooks
- Modules/case studies
- Nursing audit
- Supervisory logbook

CONDUCTING A SUPERVISORY VISIT

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  All supervisory clinic must be planned
 The actual conduct of the visit is divided into three parts:
a. Opening – creates a warm environment, open and friendly
atmosphere. Discuss the objectives of the visit, expected outcomes,
the process and the time frame.
b. Body – nurse discusses the following points with the worker
- Results and recommendations of the last visit

- New areas of concern of the health worker

- Actions to address concerns
- Review objectives and extent to which they attained
c. Closure – nurse expresses appreciation and support extended during
the visit together with the worker, she plans for the subsequent visit

THE COPAR PROCESS: THE FOUR PHASES OF COPAR

1. THE PRE-ENTRY PHASE
- Initial phase, simplest phase of CO process in terms of actual
output, activities and strategies
- Also includes designing a plan for community development
including all activities and strategies for care and development
- Takes one to two months to complete
2 Main Activities:
a. Selection of project site (Site Selection) – selections of barangay to
become the initial sites of HRDP services and organizing activities
b. Entails the sequential implementation of the sub-activities to ensure
the project sites to be selected will be responsive to whatever health
development interventions the team would initiate later on
c. It is important to solicit the active participation of the entire project
team.

CRITERIA FOR INITIAL SITE SELECTION:

A.1. the site must be depressed rural community with the majority of the
population belonging to the poor sector (100-200 families).
Indicators:
- Percentage of households having income below the national and
regional poverty thresholds
- Lack of income opportunities for the community residents
A.2. Health services in the site are accessible or inadequate to meet the
needs of the majority of community residents.

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Indicators:
- Absence of barangay health station, or if one exists, it is
unmanned most of the time or visited irregularly by a DOH staff
- Lack of primary or secondary hospital within 30 minutes ride
A.3. Poor health status of the community in general
Indicators:
- High incidence of CD
- High malnutrition rate
- High infant mortality rate
- Lack of sanitary toilets
- Prevalence should be worse than the national and regional
incidence rate for them to be considered high
A.5. There must be no strong resistance from the community regarding the
HRDP being initiated
A.6. the area must be relatively free of similar agencies or programs to avoid
competition and duplication of services.

CONDUCT OF PRELIMINARY SOCIAL INVSTIGATION

Methods:
1. Use of secondary data from government offices (PHO) and/or the RHU.
2. Use of secondary data from other community based health programs.
3. Conduct of ocular observations, noting accessibility, geography, terrain,
settlement patterns and available physical resources.
4. Coordination with extension workers from both government and non-
government agencies.

*using the information gathered in the PSI, the NGO-HRDP team then rates the
brgy. According to how they approximate the criteria site.

THE STRATEGIES FOR SHORTLISTING COMMUNITIES

a. Review the secondary data about the barangays in the community.
b. Meetings with the municipal technical or development staff.
c. Consultation with the development workers from NGO’s in the
municipality to thresh out points of coordination, expansion areas and
possible areas with HRDP by doing ocular surveys and interviews with
barangay leaders and community residents.
*process of eliminations is followed in coming up with a shortlist of potential
barangays.

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GUIDELINES FOR CHOOSING THE FINAL BARANGAY
A. Conduct informal interviews with community residents’ especially key
person or informants in the barangays included in the shortlist.
B. Take note of political undertones among the formal and informal leaders
because these may affect organizing activities or may become a political
resource or organizational conflicts.

IDENTIFICATION OF THE HOST FAMILY

A. In general, community workers are the most effective if they live with
the people in the area where they intend to work
B. By living in the area, they will acquire deeper knowledge of the
objectives of their community, it ensures round the clock integration and
more importantly, experiencing the life of community residents.
C. Before actual community entry, a host family should have been
identified and could be done while doing actual community visits before
the project site is finalized.
D. As a general rule, a maximum of 2 persons should stay in one host family
to eliminate putting unnecessary burden on the host family.

CRITERIA IN CHOOSING A HOST FAMILY

a. The house of the host family should be strategically located in the
barangay to enable the project staff, especially the CO, to reach out
more efficient and effectively to community residents.
b. The host family should not belong to the risk segment of the community
whose house has the best facilities.
c. The family should be respected by both the formal and informal leaders
and community residents.
d. The family should be respected by both the formal and informal leaders
and community residents.
e. No member of the host family should be displaced once the staff moved
in.

SELECTING A STAFF HOUSE

- Location must be strategic, so as to facilitate their integration with
the community.

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GUIDELINES:
A. It must be located in a cluster of houses where most of the primary
beneficiaries are.
B. It must be located in a sitio where it would be easy for the project staff
to move to other sitios.
*despite choosing to live in a staff house, the team should be consciously
planned for overnight stay with selected community residents, especially with
potential leaders and community health workers, later on.
*it also includes designing a plan for community development including all its
activities and strategies for core development.

LIST OF ACTIVITES IN THE PRE-ENTRY PHASE

1. Train faculty and students in COPAR.
2. Formulate plan for institutionalizing COPAR.
3. Revise/enrich curriculum and immersion program.
4. Coordinate participants of other departments.
5. Formulate criteria and guidelines for site selection.
6. Do initial networking with local government
7. Conduct PSI
8. Make long list/shortlist of potential communities
9. Interview barangay officials, leaders and key informants
10.Choose sites/community profiles for secondary data
11.Coordinate with local government/NGO for assistance
12.Develop community profiles for secondary data
13.Develop survey tools
14.Pay courtesy call to community leaders
15.Choose foster families based on guidelines

1. ENTRY PHASE (Integration phase or Social Preparation Phase)

- Includes the sensitization of the people on the critical events in
their life, motivating them to share their dreams and ideas on how
to manage their concerns and eventually mobilizing them to take
collection action on these
- signals the actual entry of the CO
- the longest process
- crucial in determining which strategies for organizing would still
be best especially where the community organizers is a stranger
to the community

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GUIDELINES:
1. The team should recognize the role of local authorities by paying their
visits to inform them of their presence and to orient them of the project.
2. Adapt a lifestyle in your personal appearance, speech and behavior in
keeping with the community.
3. Choose a modest dwelling which is open to the majority of the poor.
4. Avoid raising expectations by adopting a low-key approach and profile.

5 CRITICAL ACTIVITIES IN ENTRY PHASE

1. Integration with the community – the process of establishing rapport
with the people in a continuing effort to imbibe community life by living
with them and undergoing the same experiences, sharing their own
dream, aspirations and hardship toward building mutual trust and
cooperation.
2. Conduct of information campaign about HRDP making the community
aware of the program, the objectives and the activities.
WAYS ON HOW TO CONDUCT INFORMATION ACTIVITIES:
a. Discussion during house discussions
b. Small group discussions
c. Purok meetings and assemblies
d. Community wide meetings and assemblies
3. Conduct of community study and deepening social investigation – verify
the accurateness of prior baseline data.
4. Provision of Basic Health Services – to respond to the health problems of
the residents and by doing so, the stress of prevention aspects of health
care.
5. Identification of Potential Leaders/Criteria of Potential Leaders
a. Belong to the poor sectors and classes and is directly engaged in
production
b. Well respected by members of the community and has relatively
wide influence
c. Desirous for change and is willing to work for change
d. Can find time, conscientious and resourceful in his work
e. Must be able communities effectively

TECHNIQUES IN IDENTFYING POTENTIAL LEADERS:

a. Ask the residents to name out 3-5 persons whom they consider as
community leaders during informal discussions
b. Observe the people who are active in small mobilization activites

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 c. Observe who in the community readily responds to community
problems and emergencies and those concern for people are very well
manifested in their actions
d. Observe the people in their natural environment

LEADERS SPOTTING THRU SOCIOGRAM

- The systematic process identifying indigenous leadership in the
community who can help facilitate the change process.
1. KEY PERSON (KP) – the star of sociogram, the person who is
approachable by most people.
2. OPINION LEADER (OP) – the person who is approach by the key
person and is therefore behind the key person’s opinion and
ideas
3. ISOLATE – person who is never or hardly approached

CORE GROUP FORMATION

- The laying down of the foundation of a strong people’s
organization brought about by bringing together several of the
most advanced indigenous leaders to exchange knowledge and
insights towards a deeper understanding of the dynamics of the
community.

FORMATION PHASE:
a. Form the core group
b. Define the roles and functions of the core
c. Conduct team building of core group members
d. Informal education of core members
e. Consult community to organize (community health
organizations, community researchers)

THE CORE GROUP

- Is a group of individuals/community residents who possess
leadership potentials formed/organized in a cohesive unit?
- It assist the NGO-HRDP team in generating community
participation
*members of the core group may eventually be elected as
officers/leaders in the CHO

FUNCTIONS OF THE CORE GROUP

1. Serves as training ground for democratic and collective leadership

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 2. Helps the organizers gather data for deeper community studies, spotting
other potential leaders and prospective members for the community
wide organization
3. Help in laying out plans and tasks for the formation and maintenance of
a community wide organization with working committee and officers to
ensure them democratic and collective leadership.

QUALIFICATION OF COMMUNITY RESEARCHERS:

1. Preferably can read and write
2. Can give time for training and actual research
3. Can emphasize with the people because he/she also owns the problem
4. Willing to go around the community, literally to hike
5. Has skill in getting information without hurting the one being
ask/questioned
6. Trusted by community, credible

3. ORGANIZATION BUILDING PHASE

- Entails the formation of more formal structures and the inclusion
of more formal procedures of planning, implementing,
monitoring, and evaluating community wide activities.

2 SUB-PHASES:
1. Pre-Organization Sub Phase – basic requirement is the establishment of
an organization
2. Organization Sub-Phase – the setting-up of formal structure to
systematize the health services of the community

4 CRITICAL STEPS IN OB PHASE:

1. Preparing the community for organization building
- Present the purpose and structure of organization
- Present the roles and functions of the leaders in the CHO
- Can be done thru ground working
- Methods of ground working:
*conduct dialogues with community residents regarding the
rationale and objectives of the proposed organization.
*conduct of meetings among the core group members to prepare
for the general community meeting,
- Listing of main facilities/speakers and their back-up if
necessary
- The tasks of the core group members

34
 - The possible issue that may arise and how the core group
members plan to them
2. Organizing the CHO
3. Training and Education for the CHO – development and enhancement of
the capabilities of community leaders in HRDP
4. Setting up the Community Organization
- The formation of a community wide organization requires preparation in
two equal important aspects:
a. Legal Requirement – organization’s constitution and by-laws
- Organization’s regulation papers if necessary
- Guidelines for the election of officers
- Board of incorporators and financial statements if the organization
Plans to go into livelihood
b. Technical Aspects of the CHO – related to the CHO operations which
concern the community leaders (health committee, education and
training committee, membership committee)

SUMMARY OF ACTIVITES IN OB PHASE:

1. Elect CHO officers
2. Organize/train community health workers and second liners
3. Conduct PAR
4. Consolidate community diagnosis and PAR results
5. Formulate community health plan
6. Organize working committees
7. Link with LGU’S/NGO’S for financial and technical assistance
8. Implement/ monitor/evaluate health projects

4. SUSTENANCE AND STRENGTHENING PHASE

- Monitoring and evaluating takes place (weakness and strength)

- CO’s are now about to withdraw themselves from the community

Activities include:
1. Education and training
2. Networking and linkaging
3. Conduct of mobilization on health and evaluation of the development
concerns
4. Introducing/implementing different livelihood programs
5. Developing secondary leaders

35
COMMUNITY HEALTH NURSING PROCESS
-refers to systematic series of steps which are followed by public health
nurse in the community health and nursing problems using community
approaches and resources.
- it is an effective tool to help people solve their health problems and
meet their health and nursing needs.
- The central to all nursing actions.
- It is the very essence of nursing, applicable in any setting, in any
frame of reference, and within any philosophy.
- Is a systematic, scientific, dynamic, on-going interpersonal process
in which the nurses and the clients are viewed as a system with
each affecting the other and both being affected by the factors
within the behavior?
- It is a series of actions that lead toward a particular result.

36
STEPS OF COMMUNITY HEALTH NURSING PROCESS AND ITS
ACTIVITIES:
1. ASSESSMENT
- Initiate contact
- Demonstrate caring attitudes
- Mutual trust and confidence
- Collect data from all possible sources
- Identify health problems
- Assess coping ability
- Analyze and interpret data
2. NURSING DIAGNOSIS
3. PLANNING
- Prioritize needs
- Establish goal based on needs and capabilities of staff
- Construct action and operation plan
- Develop evaluation parameters
- Revise plan as needed

4. IMPLEMENTATION
- Put nursing plan to action
- Coordinate care/services
- Utilize community resources
- Delegate
- Supervise/monitor health services provided
- Provide health education and training
- Document responses to nursing action
5. EVALUATION
- Nursing audit
- Care outcomes
- Performance appraisal
- Estimate cost benefit ratio
- Assessment of problems
- Identify needed alterations
- Revise plans as necessary

37
a) ASSESSMENT
- Assessment is “the act of reviewing a human situation from a data
base in order to affirm the wellness state and diagnose potential
client problems; to affirm an illness state, diagnosing the client’s
prevailing problems, determining the potential for problems and
identifying the wellness aspects of the ill client”.
- Determination of a client’s health problem. Identification of
strengths and weaknesses and the clients state of health

38
- Provides an estimate of the degree to which a family, group or
community is achieving the level of health possible for them,
identifies specific deficiencies or guidance needed and estimates
the possible effects of the nursing interventions.
- Involves the following steps which are taken with the active
participation of the clients especially in decision made.

 COLLECTION OF DATA, are collected on the health status of the

family, groups and community:
 demographic data, (location and its boundaries, area,
population ,location of health services, geographic
features, climate)
 vital health statistics, (common illnesses, mortality,
morbidity rates, vaccination programmes)
 community dynamics including power structure, studies of
disease surveillance, economic, cultural and environmental
characteristics,condition of the houses, saniataion, water
supply
 utilization of health services by the population; and on
individuals and families (opportunity for recreation, health
services, ambulance, birthing centers)
 health status, education,
 socio-cultural, religious and occupational background
(values and beliefs)
 family dynamics, environment and patterns of coping.

 HOW TO COLLECT DATA?

 community survey: interview to individuals, families,
groups and significant others:
o Informants interviews - Interviewing community
residents: -
 Key informants: Individuals in power position,
such as leaders in local government, schools,
religion…… etc
 General public: random residents in the
community.  Random telephone or face to
face
 Street interviews

39
  Constructed survey - A set of prepared specific questions
given to a random sample in the community. It is time
consuming and expensive
 observation of health related behaviors of individuals,
families, groups and environmental factors;
 review of statistics ,epidemiological and relevant studies
 individual and family health records: laboratory and
screening tests and physical examinations of individuals.
 Physical examination,
 Review of records, Diagnostic reports,
 Collaboration with colleagues

- These data are collected systematically and continuously, then are

recorded in an appropriate forms and kept systematically so that
retrieval of information is facilitated. Collected data are treated
confidentially.

b) NURSING DIAGNOSIS
- After assessment of the health situation of the community, the CHN
was able to identify the health needs and problems of the community as she
explores the community.
- It is a statement of a potential or actual altered status of a patient
which is derived from nursing assessment and which requires intervention
from the domain of nursing practices.
- A nursing diagnosis is a clinical judgment about individual, family, or
community responses to actual or potential health problems/life
processes.
- Nursing diagnoses provide the basis for selection of nursing
interventions to achieve outcomes for which the nurse is accountable.

-The problems could be a large family size, malnutrition in children,

incomplete immunization, anaemia in pregnant and nursing mothers, several
morbidity conditons-TB, malaria, diarhoea etc.,

EXAMPLE OF COMMUNITY NURSING DIAGNOSIS

1. Knowledge deficit r/t to small family norms as evidenced by

large family.
2. Potential health hazards related to breeding of mosquitoes
as evidenced by presence of stagnant water

40
 3. Health seeking behavior regarding immunization.
4. Ineffective health maintenance
5. Impaired social interaction
6. Ineffective Infant Feeding Pattern

CATEGORIES OF HEALTH PROBLEMS:

1. HEALTH DEFICITS –
- occurs when there is a gap between actual and achievable health
status.
- possible precursors of health deficits
o history of repeated infections or miscarriages
o No regular health checkup (diabetes, CVA)

2. HEALTH THREATS – are conditions that promote disease or injury and

prevent people from realizing their health potential.
- example
o inadequately immunized population against preventable
diseases.
o Family history of hereditary disease
o Poor environmental condition
o Unhealthy lifestyle

3. FORESEEABLE CRISIS/STRESS POINTS – includes stressful occurrence

such as death and illness of family member, loss of job, marriage,
divorce, pregnancy, menopause, etc..

- A health need exists when there is a health problem that can be

alleviated with medical or social technology.
- A health problem is a situation in which there is a demonstrated
health need combined with actual or potential resources to apply
remedial measures and a commitment to act on the part of the
provider or the client.

The Process of ASSESSMENT in community health nursing includes: intensive

fact finding, the application of professional judgment in estimating the
meaning and importance of these facts to the family and the community, the
availability of nursing resources that can be provided, and the degree of
change which nursing intervention can be expected to effect.

41
c) PLANNING NURSING ACTIONS/CARE
- Is based on the actual and potential problems that were identified
and prioritized. It includes the following steps
(After obtaining the list of health needs and problems, the community health
nurse needs to prioritize the problems, as all the problems cannot be dealt with
simultaneously.)

a. GOAL SETTING – a goal is a declaration of purpose or intent

that gives essential direction to action.
- These objectives are stated in behavioral terms: specific,
measurable, attainable, and realistic and time bounded. The
nurse prioritizes these objectives.

b. CONSTRUCTING A PLAN OF ACTION – is concerned with

choosing from among the possible courses of action, selecting
the appropriate types of nursing intervention, identifying
appropriate and available resources for care and developing an
operational plan.
- May have positive/negative effects. The positive consequences
must be weighed against those with negative aspects. The ability
of the family to cope or solve its own problems and make
decisions on health matters should be considered.
- The appropriate resources are identified which include the family,
the neighborhood, the schools, the industrial population: the
whole medical system of hospitals, clinics, public and private
practitioners of medicine, health units of welfare departments,
voluntary health agencies, and other health related agencies: non-
health facilities such as social, educational and counseling
agencies.

c. DEVELOPING AN OPERATIONAL PLAN – the public health

nurse must establish priorities, phase and coordinate activities.
- Are prioritized in order of urgency to determine those that need
the earliest action or attention such as those that actually
threaten the health of the client (individual, family, community).
These plans are broken down to manageable units and properly
sequenced.
- Periodic evaluation and modification of the plan is necessary. The
plan and activities should be coordinated with the various services
so that it would synchronized with the total health program of the
community.
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 - Development of evaluation parameters is done in the planning
stage and based on standards set by the nursing services,
problems identified, goals and priorities as reflected in the plan or
program of nursing care for the clients.

d) IMPLEMENTATION OF PLANNED CARE/ NURSING

INTERVENTIONS
– involves various nursing interventions which may have determined
by the goals/objectives that have been previously set.
- Putting the plan into action and doing all the activities included in
the plan Collaborative implementation by nurse, other professionals or
clients.
TYPES OF NURSING INTERVENTION
i. DEPENDENT INTERVENTION :
- It is related to implementation of medical orders.
 Eg: discuss about the medicine regimen with the
patient as prescribed by doctor.

ii. INTERDEPENDENT INTERVENTION:

1. Describe the activities that nurse carries out in
cooperation with other health team members.
a. Example: sterile instruments to be used Takes
out the record Gets the clinic personnel to
arrange the clinic

iii. INDEPENDENT INTERVENTION :

a. These are the activities performed by the nurse
without direct doctor’s order.
i. Example Community health nurse will
Give group teaching and health
education Assist the patient to identify
potential hazards at home
4. The Public Health Nurses carry out nursing procedures which are
consistent with the nursing care plan, are adopted to present situations
which promote a safe and therapeutic environment.
5. Public Health Nurses involve the patient and his/her family in the care
provided in order to motivate them to assume responsibility for
his/their care, and to be able to teach and maintain a desired level of
function, explaining and answering questions to clarify doubts, to

43
 maximize the client’s confidence and ability to care for
himself/themselves.
6. Thus, the role of the community health nurse shift from direct care
giver to that of a teacher.
7. The Public Health Nurse monitor the health services provided, make
proper referrals as necessary and supervises midwives and barangay
health workers. The knowledge and skills of the midwives and barangay
health workers are continuously updated through planned education
programs.
8. Documentation is an important function of the public health nurses.
This provides data which is needed to plan the clients received and their
response to it. They are legal reports to protect the agency and the
health care providers or the client himself/themselves. They also
provide data for research and education.

e) EVALUATION OF CARE AND SERVICES PROVIDED

- The last phase of the nursing process.
- follows implementation of the plan of care
- it’s the judgment of the effectiveness of nursing care to meet
client goals based on the client’s behavioral responses.
- Process of Evaluating Client Responses Collecting data related to
the desired outcomes Comparing the data with outcomes Relating
nursing activities to outcomes
- Drawing conclusions about problem status Continuing, modifying,
or terminating the nursing care plan. Relationship of Evaluation to
Nursing Process

HOME VISIT
 A nursing home visit is a family-nurse contact which allows the
health worker to assess the home and family situations in order to
provide the necessary nursing care and health related activities.
 In performing  home visits, it is essential to prepare a plan of visit
to meet the needs of the client and achieve the best results of
desired outcomes.
PURPOSE:
1. To give care to the sick, to a postpartum mother and her newborn with
the view teach a responsible family member to give the subsequent
care.
2. To assess the living condition of the patient and his family and their
health  practices in order to provide the appropriate health teaching.
44
 3. To give health teachings regarding the prevention and control of
diseases.
4. To establish close relationship between the health agencies and the
public for the promotion of health.
5. To make use of the inter-referral system and to promote the utilization
of community services
PRINCIPLES:
The following principles are involved when performing a home visit:
1. A home visit must have a purpose or objective.
2. Planning for a home visit should make use of all available information
about the patient and his family through family records.
3. In planning for a home visit, we should consider and give priority to the
essential needs if the individual and his family.
4. Planning and delivery of care should involve the individual and family.
5. The plan should be flexible.

GUIDELINES:
The following guidelines are to be considered regarding the
frequency of home visits:
1. The physical needs psychological needs and educational needs
of the individual and family.
2. The acceptance of the family for the services to be rendered,
their interest and the willingness to cooperate.
3. The policy of a specific agency and the emphasis given towards
their health programs.
4. Take into account other health agencies and the number of
health personnel already involved in the care of a specific
family.
5. Careful evaluation of past services given to the family and how
the family avails of the nursing services.
6. The ability of the patient and his family to recognize their own
needs, their knowledge of available resources and their ability
to make use of their resources for their benefits.

STEPS:
1. Greet the patient and introduce yourself.

45
 2. State the purpose of the visit
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place and then proceed
to perform the bag technique.
5. Perform the nursing care needed and give health teachings.
6. Record all important date, observation and care rendered.
7. Make appointment for a return visit.

BAG TECHNIQUE
Definition
 Bag technique-a tool making use of public health bag through which the
nurse, during his/her home visit, can perform nursing procedures with
ease and deftness, saving time and effort with the end in view of
rendering effective nursing care.

 Public health bag – is an essential and indispensable equipment of the

public health nurse which he/she has to carry along when he/she goes
out home visiting. It contains basic medications and articles which are
necessary for giving care.

 Rationale
To render effective nursing care to clients and /or members of the family
during home visit.

 Principles
 The use of the bag technique should minimize if not totally prevent
the spread of infection from individuals to families, hence, to the
community.
 Bag technique should save time and effort on the part of the nurse in
the performance of nursing procedures.
 Bag technique should not overshadow concern for the patient rather
should show the effectiveness of total care given to an individual or
family.
 Bag technique can be performed in a variety of ways depending upon
agency policies, actual home situation, etc., as long as principles of
avoiding transfer of infection is carried out.

 Special Considerations in the Use of the Bag

46
  The bag should contain all necessary articles, supplies and equipment
which may be used to answer emergency needs.
 The bag and its contents should be cleaned as often as possible, supplies
replaced and ready for use at any time.
 The bag and its contents should be well protected from contact with any
article in the home of the patients. Consider the bag and it’s contents
clean and /or sterile while any article belonging to the patient as dirty
and contaminated.
 The arrangement of the contents of the bag should be the one most
convenient to the user to facilitate the efficiency and avoid confusion.
 Hand washing is done as frequently as the situation calls for, helps in
minimizing or avoiding contamination of the bag and its contents.
 The bag when used for a communicable case should be thoroughly
cleaned and disinfected before keeping and re-using.

 Contents of the Bag

Paper lining
Extra paper for making bag for waste materials (paper bag)
Plastic linen/lining
Apron
Hand towel in plastic bag
Soap in soap dish
Thermometers in case [one oral and rectal]
2 pairs of scissors [1 surgical and 1 bandage]
2 pairs of forceps [ curved and straight]
Syringes [5 ml and 2 ml]
Hypodermic needles g. 19, 22, 23, 25
Sterile dressings [OS, C.B]
Sterile Cord Tie
Adhesive Plaster
Dressing [OS, cotton ball]
Alcohol lamp
Tape Measure
Baby’s scale
1 pair of rubber gloves
2 test tubes
Test tube holder
Medicines
betadine
70% alcohol

47
 ophthalmic ointment (antibiotic)
zephiran solution
hydrogen peroxide
spirit of ammonia
acetic acid
benedict’s solution
Note: Blood Pressure Apparatus and Stethoscope are carried separately.

• Steps/Procedures
Actions Rationale
1. Upon arriving at the client’s home, place the bag on
the table or any flat surface lined with paper lining, clean
side out (folded part touching the table). Put the bag’s
handles or strap beneath the bag. To protect the bag from contamination.

2. Ask for a basin of water and a glass of water if faucet is To be used for handwashing.
not available. Place these outside the work area. To protect the work field from being wet.

3. Open the bag, take the linen/plastic lining and spread

over work field or area. The paper lining, clean side out
(folded part out). To make a non-contaminated work field or area.

4. Take out hand towel, soap dish and apron and the
place them at one corner of the work area (within the
confines of the linen/plastic lining). To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel. Leave the Handwashing prevents possible infection from one care provider to
plastic wrappers of the towel in a soap dish in the bag. the client.

6. Put on apron right side out and wrong side with crease
touching the body, sliding the head into the neck strap. To protect the nurses’ uniform. Keeping the crease creates aesthetic
Neatly tie the straps at the back. appearance.

7. Put out things most needed for the specific case (e.g.)
thermometer, kidney basin, cotton ball, waste paper
bag) and place at one corner of the work area. To make them readily accessible.

8. Place waste paper bag outside of work area. To prevent contamination of clean area.

To give comfort and security, maintain personal hygiene and hasten

9. Close the bag. recovery.

10. Proceed to the specific nursing care or treatment. To prevent contamination of bag and contents.

11. After completing nursing care or treatment, clean

and alcoholize the things used. To protect caregiver and prevent spread of infection to others.

12. Do handwashing again.

13. Open the bag and put back all articles in their proper
places.

48
14. Remove apron folding away from the body, with
soiled sidefolded inwards, and the clean side out. Place it
in the bag.

15. Fold the linen/plastic lining, clean; place it in the bag

and close the bag.

16. Make post-visit conference on matters relevant to

health care, taking anecdotal notes preparatory to final
reporting. To be used as reference for future visit.

17. Make appointment for the next visit (either home or

clinic), taking note of the date, time and purpose. For follow-up care.

THE HEALTH CARE DELIVERY SYSTEM

“ the totality of all policies, facilities, equipment, products, human

resource and services which address the health needs, problems and
concern of the people. It is large, complex, multi-level and multi-
disciplinary.”

SYSTEM – a set of interrelated and independent parts that form a complex

whole and each of those parts can be viewed as a subsystem with each own
set of interrelated and independent parts.

HEALTH SYSTEM – is the interrelated ways in which a country organizes

available resources for the maintenance and improvement of the health of its
citizens and commitments. It consists of interrelated components in homes,
educational institutions, workplaces, communities, health sector and other
related sectors.

HEALTH CARE DELIVERY SYSTEM – the network of health facilities and

personnel which carry out the task of rendering health care of the people.

THE WORLD HEALTH ORGANIZATION

49
WHO- specialized agency of the United Nations provides global leadership on
health matters. In the Philippines, health services are providrd by the
government and the private sectors- for the profit as well as non profit, with
the latter frequently referred to us nongovernmental organizations or NGOs .

On the national level, direction is set by the DOH. By virtue of the mandate of
the Local Government Code (R.A. 7160), local govt units (LGUs) should have
operating mechanisms to meet the priority needs and service requirements of
their community.

April 7 each year- world health day

CORE FUNCTIONS OF WHO

 Providing leadership on matters critical to health and engaging in
partnerships where joint action is needed.
 Shaping the reseach agebda and stimulating generation, translation and
disseminating valuable knowledge.
 Setting orms and standars and promoting and monitoring their
implementations
 Articulating ethical and evidence-based policy options.
 Providing technical support, catalyzing change and building sustainable
institutional capacity.

THE PHILPPINE HEALTH CARE DELIVERY SYSTEM

 The DOH serves as the main governing body of health services in the
country.
 DOH provides guidance and technical assistance to LGUs through the
Center for Health Development in each of the 17 regions.
 Provincial governments are responsible for administration of provincial
and district hospitals.
 Municipal and city governments are in charge of primary care through
Rural health Units (RHUs) or health centers.

50
  Satellite outposts known as barangay health stations (BHSs) provide
health services in the periphery of the municipality or City

DEPARTMENT OF HEALTH
The Department of Health (abbreviated as DOH; Filipino: Kagawaran ng
Kalusugan) is the executive department of the Government of the Philippines
responsible for ensuring access to basic public health services by all Filipinos
through the provision of quality health care and the regulation of all health
services and products. It is the government's over-all technical authority on
health.
It has its headquarters at the San Lazaro Compound, along Rizal Avenue
in Manila.

The head of the department is led by the Secretary of Health, currently

Francisco Duque, nominated by the President of the Philippines and confirmed
by the Commission on Appointments. The Health Secretary is a member of the
Cabinet.

VISION BY 2030
“A global leader for attaining better health outcomes, competitive and
responsive health care system, and equitable health financing.”

MISSION

51
 “To guarantee equitable, sustainable and quality health for all people in
the Cordillera Region, especially the poor, and to lead the quest for excellence
in health.”

QUALITY POLICY
The Department of Health, as the nation’s leader in health, is committed to
guarantee equitable, accessible and quality health services for all Filipinos.

We at the DOH, together with our partners, shall ensure the highest standards
of health care in compliance with statutory and regulatory requirements

And shall continually improve our quality management systems to the

satisfaction of our citizens.

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MAJOR FUNCTIONS
 Ensure equal access to basic health services
 Ensure formulation of national policies for proper division of labor and
proper coordination of operations among the government agency
jurisdiction
 Ensure a minimum level of implementation nationwide of services
regarded as public health goods
 Plan and establish arrangements for the public health system to achieve
economic scale
 Maintain a medium of regulation and standards to protect consumers
and guide providers

NATIONAL HEALTH OBJECTIVES

 improve the general health status of the population.
 reduce the morbidity, mortality, disability and complications
 eliminate the following diseases as public health problems
(schistosomiasis, malaria, filariasis, leprosy, rabies, measles, tetanus,
diptheria, pertussis, vitamin A deficiency, iodine deficiency
 eradicate poliomyelitis
 promote healthy lifestyle
 promote health and nutrition of families and special populations
 promote environmental health and sustainable development

BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT OF HEALTH

 ensure universal access to basic health services (equity and accessibility)
 Epidemiological shift from infectious to degenerative disease must be
managed.
 Enhance the performance of the health sector (Quality vs. Quantity)
 Ensure the prioritization of the health and nutrition of vulnerable groups
PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS
 Support for the frontline health workers and local system
development
 Assurance of health care
 Increasing investment for primary health care
 Development of national standards and objectives for health
 Dental health program
 Osteoporosis prevention
 Health education and community organizing

 Primary health care

53
  Reproductive health
 Older person health services
 Guidelines for good nutrition
 Respiratory Infection Control
 Alternative Health care
 Maternal and Child care
 Sentrong sigla movement

AGENCIES ATTACHED TO DOH

Philippine Institute of Traditional and Alternative Health Care
Philippine Health Insurance Corporation
Philippine National AIDS Council
Commission on Population
National Nutrition Council

DOH Hospitals Specialty Hospitals

 Amang Rodriguez Medical Center

 Dr. Jose Fabella Memorial Hospital
 Corazon Locsin Montelibano Memorial Regional
Hospital
 East Avenue Medical Center  Lung Center of the Philippines
 José R. Reyes Memorial Medical Center  National Kidney and Transplant
 National Center for Mental Health Institute
 National Children's Hospital  Philippine Children's Medical Center
 Philippine Orthopedic Center  Philippine Heart Center
 Quirino Memorial Medical Center  Reproductive Health Clinic (9
 Research Institute for Tropical Medicine branches)
 Rizal Medical Center
 San Lazaro Hospital
 Tondo Medical Center
 Baguio General Hospital and Medical Center

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SENTRONG SIGLA MOVEMENT (SSM

SENTRONG SIGLA MOVEMENT

 (SSM)was established by DOH with LGUs having a logo of a Sun with 8
Rays and composed of 4 Pillars:
o Health Promotion
o Granted Facilities
o Technical Assistance
o Awards: Cash, plaque, certificate
 is a quality improvement initiative through a certification/recognition
program.
 Health facilities are certified based on a set of standards
 SS also promotes continuous quality improvement as a complementing
strategy

55
56
CHARACTERISTICS OF HEALTH CARE SYSTEM BASED ON PHC:
1. The system should encompasses the entire population on the basis of
equality and responsibility.
2. It should include components from the health sector and from the
sectors whose interrelated actions contribute to health.
3. The essential elements of PHC should be delivered at the first point of
contact between individuals and health system.
4. The other levels of system should support the first contact level to
permit it to provide the aforementioned essential elements on a
continuing basis.
5. An intermediate levels made complex problems should be dealt with
more skilled and specialized care as well as logistic support.
6. The central level should coordinate all parts of the system and provide
planning and manage expertise; highly specialized care, teaching for
specialized staff.

LEVELS OF HEALTH CARE FACILITIES

1. PRIMARY LEVEL FACILITIES – health services at this level are offered to
individuals in fair health and clients with diseases in the early
symptomatic stages.
- Prevention of illness or promotion of health
- Include the RHU, CHO, sub centers, chest clinics, malaria
medication units, etc.

2. SECONDARY LEVEL FACILITIES – offer services to clients with

symptomatic stages of the disease which require moderately specialized
knowledge and technical resources for adequate treatment.
- curative
- Include emergency district hospitals, provincial city health
services.

3. TERTIARY LEVEL FACILITIES – include the high technological and

sophisticated services offered by medical centers and large hospitals.
These are the specialized Hospitals/ Institutions.
- Services offered in this level are for clients afflicted with diseases
which seriously threaten their health and which require highly
technical and specialized knowledge facilities and personnel to
treat effectively.
- rehabilitative

57
58
59
 Rational
And Regional
Health and Service
Medical Center
Teaching & Training
Hospitals

Provincial City Health Services, Hospitals,

Emergency, and District Hospitals.

RHU’s Communication and center Private Practitioner,

Periculture, centers and barangay. Health centers.

THE RURAL HEALTH UNIT(RHU)

-commonly known as a health center , is a primary level health facility in
the municipality . the focus of the rhu is promotive and preventive health
services and the supervision of BHSs under its jurisdiction.
- recommended ratio of RHU to catchment population – 1RHU:20,000
population

BARANGAY HEALTH SERVICES

- the first contact health care facility that offers basic services t the
barangay level.
- Satellite station od RHU and manned by volunteer barangay
health workers (BHWs) under the supervision of Rural Health
Midwife (RHW).

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REFERRAL SYSTEM in LEVEL OF HEALTH CARE
 Barangay Health Stations (BHS) is under the management
of Rural Health Midwife (RHM)
 Rural Health Unit (RHU) is under the management or
supervision of Public Health Nurse (PHN)
 Public Health Nurse (PHN) caters to 1:10,000 population,
acts as managers in the implementation of the policies
and activities of RHU, directly under the supervision of
MHO (municipal Health Officer) who acts as
administrator.

PUBLIC HEALTH WORKERS (PHW)/RURAL HEALTH UNIT PERSONNEL

 Municipal Health Officer(MHO) or Rural health Physician
- Heads the health services at the municipal leveland
carries out the following roles:
o Administrator of the RHU
 Prepares municipal health plans and budget

61
  Monitors the implementation of basic health
services
 Management of the RHU staffs.
o Community Physician
 Conducts epidemiological studies
 Formulates health rducation campaigns on
disease prevention
 Prepares and implements control measures
or rehabilitation plans
o Medico legal Officer

 Public Health Nurse (PHN) – Registered Nurse

- Supervises and guides all RHM in the municipality
- Prepares annual report of the municipality for submission
to Provincial Health Office
- Utilizes nursing process in responding to health needs for
health education and promotion of individuals, families
and community
- Collaborates with the other members of the health team,
government agencies, private business, NGOs, and
peoples organization to address the community’s health
problems.

 Rural Health Midwife (RHM) – Registered midwife

- Manages the BHS and supervises and trains the BHWs
- Provides midwifery services and executes health care
programs and activities for women of reproductive age,
including family planning counseling and services
- Conducts patient assessment and diagnosis for referral or
further management.
- Performs health information, education, and
communication services
- Organized community
- Facilitates batrangay health planning and other
community health services.

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  Rural Sanitary inspector – must be a sanitary engineer
- Ensuring healthy physical environment in the
municipality.
- This entails advocacy, monitoring , and regulatory
activities such as inspection of water supply and
unhygienic household conditions.

 Dentist
 Nutritionist
 Medical Technologist
 Pharmacist

HEALTH AS MULTIFACTORIAL PHENOMENON

1. HEALTHY WORKPLACES – clean, orderly, well ventilated, adequately
lighted, and smoke free and adequately secured.
2. HEALTHY BARRIOS – people work together towards attaining
sustainable improvement in their lives and aspirations.
3. HEALTHY PRISON – clean and safe detection with adequate facilities and
service address the physical, mental, spiritual, and social and economic
needs for inmates.
4. HEALTHY HOMES – where responsible parents provide household
members with the sanitary environmental where GOD reigns supreme.
5. HEALTHY CITIES – promote safety, order and cleanliness through
structural and man power support.
6. HEALTHY RESORT – a place providing rest, recreation, relaxation and
wholesome entertainment that is clean, safe, accessible and affordable.
7. HEALTHY HOSPITALS – one that provides comprehensive care.
8. HEALTHY VEHICLES – clean, safe, comfortable, well ventilated and in
good running condition manned by reliable and dependable licensed
operators who are physically and mentally fit.
9. HEALTHY STREETS – shed have: well-maintained roads and public
waiting area, well-marked traffic signs and pedestrian crossing lane,
clean and obstruction free sidewalks, free or has minimal traffic
problems, fight air production by being a part of the clean and green
initiative, proper and visible street names, fight air production by being
part of the clean and green initiative and with adequate and strict law
enforcement.

63
 10.HEALTHY HOTELS – clean and pleasant place that provides comfort,
security, conforms to a set guidelines and promotes a healthy lifestyle.
11.HEALTHY SCHOOLS – one that provides health instructional through
classroom learning non curricular activities and maintain adequate
services.
12.HEALTHY EATING PLACE – should comply with sanitary standard.
13.HEALTHY MOVIE HOUSES – safe/has competent and friendly employees;
comply sanitary standards.
14.HEALTHY PORTS – clean, spacious, and secure with facilities for public
waiting area, passenger terminals, sanitary food shops and public toilets,
etc.
15.HEALTHY MARKETS – there is enough water supply, drainage and
maintained toilet facilities; quality food are sold within reach of the
common people; market vendors, buyers, supervisory team and sanitary
inspectors are working together for a well-organized and honest market
system.

Factors Affecting Health

1. Political Factors – refers to one’s leadership which include
a. Political Will – determination to pursue something that is in the
interest of the majority.
b. Empowerment – the ability of the person to do something.
2. Economic Factor – refers to production, distribution and consumption of
goods, services and how these affect health and development.
3. Socio-economic Factor – influences a client’s health practices.
4. Environment – refers to sum totals of all conditions and elements that
make up the surroundings and influences the health.
5. Genetic Heredity
6. Health Care Delivery

DOH thinks link and bring health messages to where the people are
and build supportive environment through
a. Advocacy
b. Networking
c. Community Action

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 PHC (Primary Health Care)
DEFINITION
Is the essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible
to individuals and families in the communities through their full
participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of self-
reliance and self-determination, (Alma Ata Declaration, 1978).

The WHO defines Primary Health Care an essential health care made

universally acceptable to individuals and families in the community by
means acceptable to them through their full participation and at a cost
that the community and country and afford at every stage of
development.

An essential health care made universally acceptable to individuals and

families in the community by means acceptable to them through their
full participation and at a cost at every stage of development.

The Declaration of Alma-Ata was adopted at the International

Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata),
Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6-12 September
1978

GOAL
 Health to all Filipinos and Health in the hands of the people by the year
2020.
MISSION
 To strengthen the health care system wherein people will manage their
own health care.
CONCEPT
 Partnership and empowerment to people
LEGAL BASIS
 Letter of instruction (LOI) 949
 President Ferdinand Marcos
 October 19, 1979
 First International Conference on Primary Health Care
o Alma Ata, USSR

65
 o September 6-12, 1978
o Sponsored by WHO and UNICEF

Health begins at home, in schools and in the workplace because it is

there where people live and work that health is made or broken.
It also means that people will use better approaches than they do now
for preventing diseases and alleviating unavoidable disease and disability
and have better ways of growing up, growing old, and dying gracefully.
It also means that there will be even distribution among the population
of whatever resources for health are available.
It means that services will be accessible to all individuals and families in
an acceptable and affordable way.
The World health organization (WHO) has identified five key elements to
achieving goals of “Health for all”

8 ESSENTIAL HEALTH SERVICES IN PHC (ELEMENTS) BASED ON

ALMA ATA
An essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally,
accessible to individuals and families in the community by means of
acceptable to them, through their full participation and at a cost that
community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination.

E – Education for health

L – Locally endemic disease control
E – Expanded program for Immunization
M – Maternal and Child Health including responsible parenthood
E – Essential Drugs
N – Nutrition
T- Treatment of Communicable and non-communicable diseases
S – Safe water and Sanitation

Goals
The ultimate goal of primary health care is better health for all.

WHO has identified five key elements to achieving that goal:

66
 1. Reducing exclusion and social disparities in health (universal coverage
reforms);
2. Organizing health services around people’s needs and expectations
(service delivery reforms);
3. Integrating health into all sectors (public policy reforms);
4. Pursuing collaborative models of policy dialogue (leadership reforms);
and
5. Increasing stakeholder participation.

History
A brief history of Primary Health Care is outlined below:

 May 1977. The 30th World Health Assembly adopted resolution

which decided that the main social target of governments and of
WHO should be the attainment by all the people of the world by the
year 2000 a level of health that will permit them to lead a socially and
economically productive life.
 September 6-12, 1978. International Conference in PHC was held in
this year at Alma Ata, USSR (Russia)
 October 19, 1979. The President of the Philippines (Ferdinand
Marcos) issued Letter of Instruction (LOI) 949 which mandated the
then Ministry of Health to adopt PHC as an approach towards design,
development, and implementation of programs which focus health
development at the community level.

Rationale
Adopting primary health care has the following rationales:

1. Magnitude of Health Problems

2. Inadequate and unequal distribution of health resources
3. Increasing cost of medical care
4. Isolation of health care activities from other development activities

Objectives

67
 1. Improvement in the level of health care of the community
2. Favorable population growth structure
3. Reduction in the prevalence of preventable, communicable and other
disease.
4. Reduction in morbidity and mortality rates especially among infants
and children.
5. Extension of essential health services with priority given to the
underserved sectors.
6. Improvement in basic sanitation
7. Development of the capability of the community aimed at self-
reliance.
8. Maximizing the contribution of the other sectors for the social and
economic development of the community.

THREE STRATEGIES IN DELIVERING HEALTH SERVICES (ELEMENTS )

1. Creation of Restructured Health Care Delivery System (RHCDS) regulated
by PD 568 (1976)
 Regional Health Office (National Health Agency)
Or existing national agencies like PGH or specialized
agencies like Heart Center for Asia, National Kidney
Institute, Lung Center of the Philippines

 MHO & PHO (Municipal Health Office/ Provincial Health

Office

 BHS & RHU (Barangay Health Station/Rural Health Unit)

2. Management of information System regulated by RA 3753: Vital health

Statistics Law
- Law on reporting communicable diseases. (incidence rate,
morbidity rate, mortality rate)

3. Primary health care (PHC) regulated by LOI 949 (1979): legalization of

implementation of PHC in the Philippines

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Major Strategies
1) Elevating health to a comprehensive and sustained national effort
- Attaining health for all Filipinos will require expanding
participation in health and health-related programs whether as
service provider or beneficiary. Empowerment to parents, families
and communities to make decisions of their health is the desired
outcome.
- Advocacy must be directed to national and local policy making to
elicit support and commitment to major health concerns through
legislations, budgetary and logistical considerations.

2) Promoting and supporting community managed health care

- The health in the hands of the people brings the government
closest to the people. It necessitates a process of capacity building
of communities and organization to plan, implement and evaluate
health programs at their levels.

3) Increasing efficiency in health sector

- Using appropriate technology will make services and resources
required for their delivery, effective, affordable, accessible and
culturally acceptable.
- The development of human resources must correspond to the
actual needs of the nation and the policies it upholds such as PHC.
- The Department of Health (DOH) continue to support and assist
both public and private institutions particularly in faculty
development, enhancement of relevant curricula and
development of standard teaching materials.

4) Advancing essential national health research

o Essential National Health Research (ENHR) is an integrated
strategy for organizing and managing research using
intersectoral, multi-disciplinary and scientific approach to
health programming and delivery.

PRINCIPLES AND STRATEGIES:

1. ACCESSIBILITY, Availability, Affordability and Acceptability of health
services:

69
 a. Accessibility- refers to the physical distance of a health facility or
the travel time required for prople to get the needed or desired
health services.
b. Affordability – is not only in consideration of the individual of
family’s capacity to pay for basic health services but a matter of
whether the community or government can afford theses
services.
c. Acceptability – means the health care offered is in consonance
with the prevailing culture and traditions of the population.
d. Availability – is a question of whether the basic health services
required by the people are offered in the health care facilities or is
provided on a regular or organized manner.
Strategies:
a. Health services delivered where the people are
b. Use of indigenous/resident volunteer health worker as a health
care provider with a ratio of one community health worker per 10-
20 households
c. Use of traditional herbal medicine with essential drugs

2. Provision of quality, basic and essential health services.

Strategies:
a) Training design and curriculum based on community needs and
priorities
b) Attitudes, knowledge and skills developed are on promotive,
preventive, curative and rehabilitative health care
c) Regular monitoring and periodic evaluation of community health
workers performance by the community and health staff
3. Community Participation
Strategies:
a) Awareness, building and consciousness raising on health and
health related issues
b) Planning, implementation, monitoring and evaluation done
through small groups meetings (10-20households).
c) Selection of community health workers by the community
d) Formation of health committees
e) Establishment of a community health organization at the parish or
municipal level
f) Mass health campaigns and mobilization to combat health
problems

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 4. Self-reliance
Strategies:
a) Community generates support (clean, labor) for health programs
b) Use of local resources to human, financial and material
c) Training of community in leadership and management skills
d) Incorporation of income generating projects, cooperatives and
small scale industries

5. Recognition of interrelationship of health and development

Strategies:
a) Convergence of health, food, nutrition, water, sanitation and
population services.
b) Integration of PHC into, national, regional, provincial, municipal, and
barangay development plans.
c) Coordination of activities with economic planning, education,
agriculture, industry, housing, public works, communication, and
social services.
d) Establishment of an effective health referral system

6. Social Mobilization
Strategies:
a) Establishment of an effective health referral system
b) Multi-sectorial and interdisciplinary linkage
c) Information, education, communication support using multi-
media
d) Collaboration between government and non-governmental
organizations

7. Decentralization
Strategies:
a) Relocation of budgetary resources
b) Reorientation of health professional and PHC
c) Advocacy for political and political and support from the national
leadership down to the barangay

8 ESSENTIAL HEALTH SERVICES IN PHC

E – Education for health

71
L – Locally endemic disease control
E – Expanded program for Immunization
M – Maternal and Child Health including responsible
parenthood
E – Essential Drugs
N – Nutrition
T- Treatment of Communicable and non-communicable
diseases
S – Safe water and Sanitation

I. EDUCATION FOR HEALTH

 This is one of the potent methodologies for information dissemination. It
promotes the partnership of both the family members and health
workers in the promotion of health as well as prevention of illness.
 -The sum of activities in which agencies engage to influence the thinking,
motivation, judgment and action of the people
 -Consist of techniques that stimulate, arouse and guide people to live
healthfully.
 -Process whereby knowledge, attitude and practice of the people are
changed to improve individual, family and community.

STEPS IN HEALTH EDUCATION

1. Creative Awareness
2. Motivation
3. Decision

3 Elements in Health Education

 INFORMATION: to share ideas to keep population group knowledgeable
and aware.
 EDUCATION : Change within individual
3 key Elements of Education
 Knowledge
 Attitude
 Skills

 COMMUNICATION : Interaction involving 2 or more persons or agencies.

Exchange of information

72
 3 Elements of Communication
 Message
 Sender
 Receiver

II. LOCALLY ENDEMIC DISEASE CONTROL

-The control of endemic disease focuses on the prevention of its
occurrence to reduce morbidity rate. Example Malaria control and
Schistosomiasis control.
-The nature of this public health program is to prevent the
transmission of endemic disease through vector control and detection
and early treatment to reduce case and prevent deaths.

*ENDEMIC - (of a disease or condition) regularly found among particular people

or in a certain area.

MALARIA
 A systematic protozoan infection with fever, chills, sweats,
headaches
 The protozoans plastidium vivax, P. malariae, P. falcifarum and P.
ovale
 Transmitted through bite an infective female anopheles mosquito
 Common in forested, mountain areas

PROTECTIVE AND PREVENTIVE MEASURES:

C – Chemically treated mosquito nets
L – Larva eating fish
E – environmental cleanup for stagnant water, cutting of vegetation
over hanging along stream banks
A – anti-mosquito soap/Fidel soap
N – neem tree or other herbal plants zoopyrophylaxis

OTHERS:
 Fumigation of House Spraying
 Avoid outdoor night activities

Early diagnosis identification of cases through signs and symptoms and

microscopic method done by a medical technologist or microscopic at the
Main Health Center or City Health Officer.

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LEPROSY – is a chronic disease of the skin and peripheral nerves caused by
mycobacterium leprae or Hansen’s bacillus

Early Signs and Symptoms

 Change in skin color
 Loss of sensation on the skin lesion
 Decrease/loss of sweating and hair growth over the wound
 Thickened or painful nerves
 Muscle weakness or paralysis
 Pain and reduces of the eye
 Ulcers (wound) that do not heal

Late signs and symptoms

 Loss of eyebrows
 Inability to close eyelids
 Clawing of finger toes
 Sinking of the nose bridges
 Enlargement of the breast in males

Prevention:
1. BCG vaccination
2. Adequate Nutrition
3. Health Education
LEPTOSPIROSIS – disease caused by bacteria leptospirosis, leptopira
interrogans
f) Occur in all seasons and develops during rainy seasons
g) Rat is the main host
h) Transmitted through contact of the skin especially open wounds, moist
soil or vegetation contaminated with urine of infected host.
i) Affects farmers, veterinarians, miners, sewer workers, abattoir workers

Signs and Symptoms

j) Presence of leptospirosis in the blood cerebrospinal fluid
k) Fever
l) Headache
m) Nausea
n) Vomiting
o) Cough
p) Chest pain

74
 q) Painful muscles

Prevention
r) Improve education of people who are at risk. Example farmers, miners,
children wading in muddy water
s) Use of protect6ive clothing, booths and gloves
t) Community – wide eradication program through proper disposal
u) Segregate domestic animals potentially infected from man’s working and
infected areas
v) Isolation of patients and disinfection of soiled articles

III. EXPANDED PROGRAM FOR IMMUNIZATION

-This program exists to control the occurrence of preventable illnesses

especially of children below 6 years old.
- Immunizations on poliomyelitis, measles, tetanus, diphtheria and other
preventable disease are given for free by the government and ongoing
program of the DOH
What is immunization?
Immunization is the process whereby a person is made immune or
resistant to an infectious disease, typically by the administration of a vaccine.
Vaccines stimulate the body's own immune system to protect the person
against subsequent infection or disease.
Process by which the vaccine is introduced to the body before infection
sets in.

Republic Act No. 10152“MandatoryInfants and Children Health

Immunization Act of 2011Signed by President Benigno Aquino III in July 26,
2010. The mandatory includes basic immunization for children under 5
including other types that will be determined by the Secretary of Health.

Specific Goals:
1. To immunize all infants/children against the most common vaccine-
preventable diseases.

2. To sustain the polio-free status of the Philippines.

3. To eliminate measles infection.

4. To eliminate maternal and neonatal tetanus

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5. To control diphtheria, pertussis, hepatitis b and German measles.

6. To prevent extra pulmonary tuberculosis among childre

  MCV1 (monovalent measles)  at 9-11 months old    

                           MCV2 (MMR) at 12-15 months old.

76
 - In 2012, two new vaccines were introduced as part of EPI
1. ROTAVIRUS VACCINE (Againts rotavirus). Rotavirus is
a disease affecting large intestine and causes severe
diarrhea in infanta and children(6 months-2years)
2. Hib Vaccine (against meningitis and pneumonia
affecting children younger than 5 yrs old with those
between 4 and 18 months)

SIDE EFFECTS OF VACCINATION and VACCINATION AND their

MANAGEMENT

VACCINES SIDE EFFECTS MANAGEMENT

BCG Koch’s phenomenon; an acute No management needed
inflammatory reaction, within 2-4
days after previous exposure to
tuberculosis

Deep abscess at vaccination site; Refer to physician for

77
 almost inviably due to subcutaneous incision and drainage
or deeper injection.

Indolent ulceration; an ulcer which Treat with INH powder

persist after 12 weeks from
vaccination date.

Glandular enlargement: enlargement

of lymph glands draining the injection
site.

Local soreness at the injection site If suppuration occurs, treat

as deep abscess

HEPATITIS B Local soreness at the injection site. No treatment necessary

VACCINE

DPT-HepB-Hib Fever that usually last for only 1 day. Parents to give antipyretic
(Pentavalent Fever beyond 24 hrs is not due to the
vaccine) vaccine but to other causes.

Locl soreness at the injection site Reassure parents that

soreness disappear after 3-4
Local soreness at the injection site days

Abscess after a week or more usually Incision and drainage may be

indicates that the injection was not required
deep enough or the needle was not
sterile

Convulsions: although very rare, may Proper management of

occur in children older than 3 months convulsions; pertussis
caused by pertussis vaccine. vaccine should not be given
anymore

OPV NONE NONE

ANTI-MEASLES Fever 5-7 days after vaccination in Antipyretic, reassurance

VACCINE some children; mild rash sometimes

MMR Local soreness, fever, irritability and Antipyretic, reassurance

malaise

ROTAVIRUS Some children develop mild vomiting

78
 and diarrhea, fever, irritability antipyretic, ORESOL,
reassurance

TETANUS TOXOID Local soreness in the injection site cold compress at the site.

ABSOLUTE CONTRAINDICATION TO EPI VACCINES

 Pentavalent vaccine/DPT to children over 5 yrs of age

 Pentavalent vaccine/DPT to chills with current convulsions or another
active neurological disease of central nervous system.
 Pentavalent vaccine 2 or 32 or 3/DPT to child who has had convulsions
or shock within 3 days of the most recent dose.
 Rotavirus vaccine when the child has history to hypersensitivity to a
previous dose of the vaccine, intussusception or intestinal malformation
or acute gastroenteritis
 BCG to a child who has signs and symptoms of AIDS or other immune
deficiency conditions or who are immunosuppressed.
Note: malnutrition, low grade fever, mild respiratory infections are not
contraindications. Diarrhea- children who are due for OPV should
receive the a dose during the visit. However, the dose is not counted.
The child should return when the next dose of the OPV is due.

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80
IV. MATERNAL AND CHILD HEALTH
 Maternal and Infant morbidity and rates area among the indicators of
health of a particular community. Protection of the mother and child
against illness and other risk would ensure a good health for the
community. This is the goal of the maternal and child program.

 WHO Philippines MCH Program works with local public health

departments, community based organizations, statewide organizations
and other providers to provide and/or assure quality health services are
delivered to mothers, children, and families in the country.

 OBJECTIVE:
-To improve the survival, health and well being of mothers and
unborn child.

The primary areas of work focus are:

 Increasing healthy birth outcomes;
 Promoting and assuring comprehensive primary care for children, from
birth to 21 year olds, including children with special health care needs
 Promoting healthy lifestyles among school-age youth, ages 6-21,
including children with special health care needs
 Promoting access to safe, healthy child care, including children with
special health care needs

A. MATERNAL HEALTH SERVICES:

Antenatal Registration - pregnant women can avail the free prenatal
services at their respective health center.

81
Tetanus Toxoid Immunization - A series of 2 doses of tetanus toxoid
vaccination must be received by a pregnant women one month before
delivery and 3 booster doses after childbirth .

82
 Micronutrient Supplementation - Vitamin A and Iron supplement for
the prevention of anemia and Vit. A deficiency.
Treatment of diseases and other conditions - These is for the women
who is diagnosed as under the high risk

B. CHILD HEALTH PROGRAM

 Newborns, infants and children are vulnerable age group for common
childhood diseases.
 To address problems, child health programs have been created and
available in all health facilities which includes:
o Infant and Young Child Feeding
o Newborn Screening (NBS)
o Expanded Program on Immunization (EPI)
o Management of Childhood Illnesses
o Micronutrient Supplementation
o Dental Health
o Early Child Development
o Child Health Injuries
GOAL: Reduce morbidity and mortality rates for children 0 – 9 years with the
strategies necessary for program

a. INFANT AND YOUNG CHILD FEEDING

 There is global evidence that good nutrition in the early
months and years of life plays a very significant role,
affecting not only the health and survival of infants and
children but also their intellectual and social development,
resulting in life-long impact on school performance and
overall productivity.
 Breastfeeding, especially exclusive breastfeeding during the
first half-year of life is an important factor that can prevent
infant and childhood morbidity and mortality.
 Timely, adequate, safe and proper complementary feeding
will prevent childhood malnutrition.

83
Laws that protects infant and young child feeding:
 Milk code (EO 51)
- Products covered by milk code consist of breast milk
substitute, e.g. infant formula, other milk products,
bottlefed complementary foods
 Rooming-In Breastfeeding Act of 1992 (RA 7600)
- Requires both public and private institution to promote
rooming-in, it encourage and support the practice of
breastfeeding
 Food Fortification Law (RA 8976)
- An act establishing the Philippine food fortification
Program and for other purpose
-
b. FOOD FORTIFICATION
- Food fortification law is vital in the promotion of optimal
health and to compensate for the loss of nutrients during
processing and storage of food.
- The law requires a mandatory food fortification of staple
foods – rice, flour, edible oil, and sugar and voluntary food
fortification of processed food and food products. (Vitamin
A, Iron, Iodine)
- Fortification is “the addition of one or more essential
nutrients to food, whether or not it is normally contained in
the food, for the purpose of preventing or correcting a
demonstrated deficiency of one or more nutrients in the
population or specific population groups”

84
c. NEWBORN SCREENING
 Newborn screening is ideally done on the 48th – 72nd hour
of life. However, it may also be done after 24 hours from
birth.
 A few drops of blood are taken from the baby’s heel,
blotted on a special absorbent filter card and then sent to
Newborn Screening Center (NSC).
 Newborn Screening Act of 2004 (RA 9288).
o Newborn screening (NBS) is a public health program
aimed at the early identification of infants who are
affected by certain genetic/ metabolic/ infectious
conditions.
o Early identification and timely intervention can lead
to significant reduction of morbidity, mortality, and
associated disabilities in affected infants.

85
86
 d. Micronutrient supplementation
- Short term intervention for correcting high level of
micronutrient deficiency.
MICRONUTRIENT TARGET POPULATION SCHEDULE
Vitamin A capsule Infants 6-11 months 100,000 IU only
Children 12-71 months old
Iron
Infants 2-6 months with low birth 0.3 ml once a day to start 2
(<2,500 g) months until 6 months when
complementary foods are
given. Preparation is 15mg
elemental iron/0.6 ml

Anemic children 2-59 months old 1 tsp once a day for 3

months or 30 mg once a
week for 6 months with
supervised administration.

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 e. Deworming
- Deworming of children aged 1-12 years is done every 6
months.
- Children aged 12-24 months are given ALBENDAZOLE
200mg or half tablet or MEBENDAZOLE 500mg tablet.
- Children older than 2 years are give ALBENDAZOLE 400 mg
or MEBENDAZOLE 500 mg tablet.
- Needs full stomach

V. ESSENTIAL DRUGS
 The program focuses on the information campaign in the proper
utilization and acquisition of drugs.
 The Generic Act of the Philippines is in response to this campaign.
 This focuses on the information campaign on the utilization and
acquisition of drugs.
 GENERIC ACT of the Philippines is enacted. It includes the following
drugs:
o Cotrimoxazole,
o Paracetamol,
o Amoxycillin,
o Oresol,
o Nifedipine,
o Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,
o Albendazole,
o Quinine

AN ACT TO PROMOTE, REQUIRE AND ENSURE THE PRODUCTION OF AN

ADEQUATE SUPPLY, DISTRIBUTION, USE AND ACCEPTANCE OF DRUGS
AND MEDICINES IDENTIFIED BY THEIR GENERIC NAMES. Section. - This
Act shall be known as the "Generics Act of 1988.

REPUBLIC ACT 6675 (RA 6675)

An Act to Promote, Require and Ensure the Production of an Adequate
Supply, Distribution, Use and Acceptance of Drugs and Medicines Identified by
their Generic Names.

VI. NUTRITION and Promotion of Adequate Food Supply

88
  One basic need of the family is food. And if food is properly
prepared then one may be assured healthy family.
 There are many food resources found in the communities but
because of faulty preparation and lack of knowledge regarding
proper food planning,
 Malnutrition continues to be a public health concerns in the
country.
 The common nutritional deficiencies are Vitamin A, Iron and
Iodine.
GOAL:
-To improve quality of life of Filipinos through better nutrition, improved
health and increased productivity.

Programs and projects

 Micronutrient supplementation
 food fortification,
 nutrition information
 communication and education
 home, school and community food production and food assistance.

MICRONUTRIENT SUPPLEMENTATION
- It is one of the interventions to address the health and
nutritional need of infants and children and improve their
growth and survival.
- The twice-a-year distribution of Vitamin A capsules through
the “Araw ng Sangkap Pinoy” (ASAP), known as
Garantisadong Pambata or Child Health Week is the
approach adopted to provide micronutrient supplements
to 6-71 months old preschoolers on a nationwide scale.

VII. TREATMENT OF COMMUNICABLE DISEASES

 The diseases spread through direct contact pose a great risk to those
who can be infected.
 Tuberculosis is one of the communicable diseases continuously occupies
the top ten causes of death.
 Most communicable diseases are also preventable.
 The Government focuses on the prevention, control and treatment of
these illnesses.
 The diseases spread by direct contact pose a great to those who can be
infected. Communicable diseases, like tuberculosis, continuously

89
 occupies the Top Ten causes of illness and death in the country. Thus,
the government’s focus on the prevention, control and treatment of
these illnesses.

General Functions OF DISEASE PREVENTION AND CONTROL

BUREAU (DPCB)

 Develop plans, policies, programs, projects and strategies for

disease prevention and control and health protection.
 Provides coordination, technical assistance, capability building,
consultancy and advisory services related to disease prevention
and control and health protection.

VIII. SAFE WATER AND SANITATION

 Environmental Sanitation is defined as the study of all factors in the
man’s environment, which exercise or may exercise deleterious effect on
his well-being and survival.
 Water is a basic need for life and one factor in man’s environment.
Water is necessary for the maintenance of healthy lifestyle.
 Safe Water and Sanitation is necessary for basic promotion of health.

90
  The environment plays a very important role in the promotion and
maintenance of good health. However, problems affecting sanitation of
the environment and still affects the Filipino people.
 The government recognizes that assisting the client provide and
maintain an environment conducive to health is a basic service it has to
offer.
 Programs to promote the development the development and use of
potable drinking water, sanitary toilet facility, drainage and sewerage
area made accessible everyone.

ENVIRONMENTAL HEALTH PROGRAMS

Vision
- Environmental Health (EH) related diseases are prevented
and no longer a public health problem in the Philippines
(based on on-going Strategic Plan 2019-2022)

Mission
- To guarantee sustainable Environmental Sanitation (ES)
services in every community

Objectives
a) Expand and strengthen delivery of quality ES services
b) Institute supportive organizational, policy and management systems
c) Increase financing and investment in ES
d) Enforce regulation policy and standards
e) Establish performance accountability mechanism at all levels

Program Components

 Drinking-water supply, Sanitation (e.g excreta, sewage and septage

management),
 Zero Open Defecation Program (ZODP),
 Food Sanitation,
 Air Pollution (indoor and ambient),
 Chemical Safety,
 WASH in Emergency situations,
 Climate Change for Health and Health Impact Assessment (HIA)

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DENTAL HEALTH
 Oral disease continues to be a serious public health problem in the
Philippines.
 The prevalence of dental caries on permanent teeth has generally
remained above 90% throughout the years.
 About 92.4% of Filipinos have tooth decay (dental caries) and 78% have
gum diseases (periodontal diseases)
 Although preventable, these diseases affect almost every Filipino at one
point or another in his or her lifetime.

Goal: Attainment of improved quality of life through promotion of oral

health and quality

Objectives:
 The prevalence of dental caries is reduce
 The prevalence of periodontal disease is reduced
 Dental caries experience is reduced 
 The proportion of Orally Fit Children (OFC) 12-71 months old is
increased

NATIONAL HEALTH SITUATION

The national health situation gives us an idea of the health situation in the
communities where nurses works. Because of the different conditions
prevailing these communities, their health picture expectedly varies. For
example, goiter is highly prevalent in the Mountain province while
schistosomiasis is pandemic in Leyte. The local health situation, therefore,
needs to be established for each province, city and municipality.

I. DEMOGRAPHIC PROFILE

 The current population of the Philippines is 109,910,032 as of

Wednesday, September 23, 2020, based on Worldometer elaboration of
the latest United Nations data.
 The Philippines 2020 population is estimated at 109,581,078 people at
mid year according to UN data.
 The Philippines population is equivalent to 1.41% of the total world
population.
 The Philippines ranks number 13 in the list of countries (and
dependencies) by population.
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  The population density in the Philippines is 368 per Km2 (952 people
per mi2).
 The total land area is 298,170 Km2 (115,124 sq. miles)
 47.5 % of the population is urban (52,008,603 people in 2020)
 The median age in the Philippines is 25.7 years.

Life Expectancy in the Philippines

 BOTH SEXES
71.7 years
(life expectancy at birth, both sexes combined)
 FEMALES
75.9 years
(life expectancy at birth, females)
 MALES
67.7 years
(life expectancy at birth, males)

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Fertility in the Philippines
 A Total Fertility Rate (TFR) of 2.1 represents the Replacement-Level
Fertility:
 Replacement-Level Fertility:the average number of children per woman
needed for each generation to exactly replace itself without needing
international immigration.
 A value below 2.1 will cause the native population to decline
pregnant_woman

TOTAL FERTILIY RATE (TFR)

2.6
(Live Births per Woman, 2020)

II. HEALTH PROFILE

 One of the issues raised about health statistics in the country is their
accuracy, completeness and reliability. Different sources sometimes
quote different figures. Nonetheless, the intention of the paper is to give
very exact picture of filipinos.
 These statistics can provide students and practitioners a general idea of
the major health needs, problems and concerns of our people.
 The leading causes of death (ADULT)are
1. diseases of the heart,
2. diseases of the vascular system,
3. pneumonias,
4. malignant neoplasms/cancers,
5. all forms of tuberculosis,
6. accidents,
7. COPD and allied conditions,
8. diabetes mellitus,
9. nephritis/nephritic syndrome and
10. other diseases of respiratory system.
 Among these diseases, six are non-communicable and four are the major
NCDs such as CVD, cancers, COPD and diabetes mellitus.

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TEN LEADING CAUSE OF INFANT DEATH
 In 2013, although the infant mortality rate slightly increased, the
number of registered infant deaths slightly decreased by more than one
percent, from last year’s 22,254 cases to 21,992 cases.
 It comprised of 4.1 percent of the total deaths (531,280) reported
during the year.
 This represented a daily average of 60 infant deaths and was equivalent
to an Infant Mortality Rate (IMR) of 12.5 deaths per thousand live
births.
 The top three leading causes of infant mortality were Pneumonia (3,146;
14.3%); Bacterial sepsis of newborn (2,731; 12.4%); and Respiratory
distress of newborn (2,347; 10.7%). The listed top ten leading causes of
infant mortality in 2013 were the same with what was recorded in 2012
which only differ in ranks

 Infant Mortality Rate

 -is one of the most sensitive indicators of health status of a
country or community.
 infants death results from poor maternal condition, unhealthy
environment and inadequate health care delivery system
 it reflects of how the society ensures the health of the future
generation.

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  Maternal Mortality
 major indicator of a womans health status.
 WHO defines it as the death of a woman while pregnant or within 42
days of termination of pregnancy irrespective of the duration and the
site of pregnancy fron any cause related to, or aggravated by the
pregnancy or its management, but not from accidental or incidental
causes.

Philippines maternal mortality rate for 2017 was 121.00, a 2.42% decline
from 2016.
Philippines maternal mortality rate for 2016 was 124.00, a 2.36% decline
from 2015.
Philippines maternal mortality rate for 2015 was 127.00, a 3.05% decline
from 2014.
Philippines maternal mortality rate for 2014 was 131.00, a 3.68% decline
from 2013.

HEALTH INDICATORS

Fertility
 Crude Birth Rate (CBR)Overall total reported births

96
 Morbidity-Illnesses affecting the population group.
 Incidence Rate (IR)-reported new cases affecting the population
group.

new cases of disease

------------------------------------ x 100
Population

  Prevalence Rate (PR)-determine sum total of new + old cases of

diseases per percent population

new cases + old cases

-------------------------------------- x 100
Population
Mortality-Reports causes of deaths
 Crude Death Rate (CDR)-overall total reported death

overall total deaths x 1000

Population

 Maternal Mortality Rate (MMR)-maternal deaths due to maternal

causes

# of maternal deaths
---------------------------------------x 1000
RLB

  Infant Mortality Rate (IMR)-# of infant deaths (0-12 months) or less

than 1 year old
# of infant deaths
---------------------------x1000

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 RLB
 Neonatal Mortality Rate (NMR)-# of deaths among neonates (newborn
0-28 days, < 1 month)
# of neonatal deaths
-------------------------------------X1000
RLB
  Swaroops Index (SI)-deaths among individual in the age group of 50 and
above

 The Philippines has made significant investments and advances in health

in recent years.
 Rapid economic growth and strong country capacity have
contributed to Filipinos living longer and healthier. However, not all the
benefits of this growth have reached the most vulnerable groups, and the
health system remains fragmented.
 Health insurance now covers 92% of the population.
 Maternal and child health services have improved, with more children
living beyond infancy, a higher number of women delivering at health
facilities and more births being attended by professional service
providers than ever before.
 Access to and provision of preventive, diagnostic and treatment services
for communicable diseases have improved, while there are several
initiatives to reduce illness and death due to noncommunicable diseases
(NCDs).
 Despite substantial progress in improving the lives and health of people
inthe Philippines, achievements have not been uniform and challenges
remain.
 Deep inequities persist between regions, rich and the poor, and different
population groups.
 Many Filipinos continue to die or suffer from illnesses that have well-
proven, cost-effective interventions, such tuberculosis, HIV and dengue,
or diseases affecting mothers and children.
 Many people lack sufficient knowledge to make informed decisions
about their own health.
 Rapid economic development,urbanization, escalating climate change,
and widening exposure to diseases and pathogens in an increasingly
global world increase the risks associated with disasters, environmental
threats, and emerging and re-emerging infections.

Most Common Health Issues

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  Physical Activity and Nutrition
 Overweight and Obesity
 Substance Abuse
 HIV/AIDS
 Mental Health
 Environmental Quality
 Immunization
 Access to Health Care

Physical Activity and Nutrition

 Research indicates that staying physically active can help prevent or
delay certain diseases, including some cancers, heart disease and
diabetes, and also relieve depression and improve mood.
 Inactivity often accompanies advancing age, but it doesn't have to.
 Check with your local churches or synagogues, senior centers, and
shopping malls for exercise and walking programs.
 Like exercise, your eating habits are often not good if you live and eat
alone. It's important for successful aging to eat foods rich in nutrients
and avoid the empty calories in candy and sweets.

Overweight and Obesity

 Being overweight or obese increases your chances of dying from
hypertension, type 2 diabetes, coronary heart disease, stroke,
gallbladder disease, osteoarthritis, sleep apnea, respiratory problems,
dyslipidemia and endometrial, breast, prostate, and colon cancers.
 In-depth guides and practical advice about obesity are available from
the National Heart Lung and Blood Institute of the National Institutes of
Health.

Substance Abuse
 Substance abuse usually means drugs and alcohol.
 These are two areas we don't often associate with seniors, but seniors,
like young people, may self-medicate using legal and illegal drugs and
alcohol, which can lead to serious health consequences.
 In addition, seniors may deliberately or unknowingly mix medications
and use alcohol.
 Because of our stereotypes about senior citizens, many medical people
fail to ask seniors about possible substance abuse.

HIV/AIDS

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Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between
1991 and 1996, AIDS in adults over 50 rose more than twice as fast as in
younger adults. Seniors are unlikely to use condoms, have immune systems
that naturally weaken with age, and HIV symptoms (fatigue, weight loss,
dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can
accompany old age. Again, stereotypes about aging in terms of sexual activity
and drug use keep this problem largely unrecognized. That's why seniors are
not well represented in research, clinical drug trials, prevention programs and
efforts at intervention.

Mental Health
Dementia is not part of aging. Dementia can be caused by disease, reactions to
medications, vision and hearing problems, infections, nutritional imbalances,
diabetes, and renal failure. There are many forms of dementia (including
Alzheimer's Disease) and some can be temporary. With accurate diagnosis
comes management and help. The most common late-in-life mental health
condition is depression. If left untreated, depression in the elderly can lead to
suicide. Here's a surprising fact: The rate of suicide is higher for elderly white
men than for any other age group, including adolescents.

Environmental Quality
Even though pollution affects all of us, government studies have indicated that
low-income, racial and ethnic minorities are more likely to live in areas where
they face environmental risks. Compared to the general population, a higher
proportion of elderly are living just over the poverty threshold.

Immunization
Influenza and pneumonia and are among the top 10 causes of death for older
adults. Emphasis on Influenza vaccination for seniors has helped. Pneumonia
remains one of the most serious infections, especially among women and the
very old.

Access to Health Care

Seniors frequently don't monitor their health as seriously as they should. While
a shortage of geriatricians has been noted nationwide, URMC has one of the
largest groups of geriatricians and geriatric specialists of any medical
community in the country.

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Philippines: Health Situation Snapshot (as of 25 October
2019)
(FormatInfographic Source OCHA Posted 24 Oct 2019 Originally published 25
Oct 2019)

DENGUE

On 6 August, the Department of Health declared a dengue epidemic. With

nearly 361,000 dengue cases recorded and 1,373 deaths, the current dengue
epidemic is the largest in the last ten years, or since the disease has been
monitored in the Philippines.

DIPHTHERIA

Almost 200 cases of diphtheria were reported by the Department of Health for
the period from 1 January to 5 October 2019, an increase of 47 per cent
compared to the same period in 2018. A significant number of diphtheria cases
were reported in the National Capital Region, Region IV-A and Cordillera
Autonomous Region.

MEASLES

In February 2019, the Department of Health declared a measles outbreak in

five regions in the country, including Metro Manila. From 1 January to 12
October 2019, over 42,400 cases were reported by DOH. Severe complications
from measles have also claimed the lives of over 560 people. As of 25 October,
the reported cases of measles are declining as well as the case fatality rate.

POLIO

On 19 September, the Department of Health confirmed the re-emergence of

polio in the Philippines and declared a national polio outbreak. As of 25
October, thirteen environmental samples and three human samples of
vaccine-derived polio virus have been confirmed. Between October 2019 and
January 2020, 4.4 million children under 5 years of age will be vaccinated
through vaccination campaigns.

EPIDEMIOLOGY

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Epidemiology
 The study of distribution of disease or physiologic condition among
human population s and the factors affecting such distribution ›
 The study of the occurrence and distribution of health conditions such
as disease, death, deformities or disabilities on human populations

What are the roles of epidemiology in public health?

Epidemiological methods are used for disease surveillance to identify which
hazards are the most important. Epidemiological studies are also used to
identify risk factors which may represent critical control points in the food
production system.

PATTERN OF DISEASE OCCURRENCE

A. Epidemic ›

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  a situation when there is a high incidence of new cases of a
specific disease in excess of the expected.
 when the proportion of the susceptible are high compared
to the proportion of the immunes
B. Epidemic potential ›
 an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes
C. Endemic ›
 habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible
o e.g. Malaria is a disease endemic at Palawan. ›
 the causative factor of the disease is constantly
available or present to the area.
D. Sporadic
 disease occurs every now and then affecting only a small number
of people relative to the total population
 intermittent
E. Pandemic ›
 global occurrence of a disease

4 CONTRIBUTIONS OF PHC TO DOH &ECONOMY

1. Training of Health Workers
2. Creation of Botika sa Baryo & Botika sa Health Center
3. Herbal Plants
4.  Oresol
5.
1. TRAINING OF HEALTH WORKERS
 3 Levels of Training:
o Grassroot/Village
 Includes Barangay Health Volunteers (BHV) and
Barangay Health Workers (BHW)
 Non professionals, didn’t undergo formal training,
receive no salary but are given incentive in the form
of honorarium from the local government since 1993
o Intermediate - these are professionals including the 8
members of the PHWs
o First Line Personnel - the specialist

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2. CREATION OF “BOTIKA SA BARYO & BOTIKA SA HEALTH CENTER”RA
6675: Generics Act of 1988:
o Implementing“Oplan Walang Reseta Program”-solution to the
absence of a medical officer who prescribed the medicines so PHN
are given the responsibility to prescribe generic medicines and
o “Walong Wastong Gamot Program”- available generics in “Botika
sa Baryo” & Health Center
o Father of Generics Act: Dr. Alfredo Bengzon

8 COMMONLY AVAILABLE GENERICS (CARIPPON)

1. Co-Trimoxazole:
  it’s a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
 Has a bacteriostatic action that stops/inhibits multiplication of
bacteria
  For GUT, GIT & URTI (TMP combined with SMX
2. Sulfamethoxazole (SMX)
 Has bactericidal action that kills bacteria
  For GUT, GIT, URTI & Skin Infections
3. Amoxicillin/Ampicillin
  An antibacterial drug that comes from the Penicillin family
  Effect is generally bacteriostatic (when source of infection is
bacterial)
 These 2 drugs provide the least sensitivity reaction (rashes & GI)
and the adverse effect of other antibiotics is anaphylactic shock
4. TB DRUGS
Rifampicin (RIF), Isoniazid (INH), Pyrazinamide (PZA)
5. Paracetamol
 Has an analgesic & anti-pyretic effect
 Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the “Botika”
because of its effects:
o  Anticoagulant-highly dangerous to Dengue patients that’s
why it’s not available in “Botika” & Health Center
6. Oresol
 :a management for diarrhea to prevent dehydration under
the Control of Diarrheal Diseases (CDD) Program
7. Nifedipine
  An anti-hypertensive drug
 According to DOH, 16% of population belonging to 25 years
old & above in the community are hypertensive

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 3. HERBAL PLANTS
RA 8423: Alternative Traditional Medicine Law
a program where patient may opt to use herbal plants especially
for drugs that are not available in dosage form or patients has no
financial means to buy the drug
Traditional Medicine :Use of herbal plants

10 ADVOCATED HERBAL PLANTS BY DOH:

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106
107
Procedures/Preparations:
 Decoction
   Gather leaves & wash thoroughly, place in a container the
washed leaves & add water
 Let it boil without cover to vaporize/steam to release toxic
substance & undesirable taste
 Use extracts for washing
 Poultice
 Done by pounding or chewing leaves used by herbolaryo
 Example: Akapulko leaves-when pounded, it releases extracts
coming out from the leaves contains enzyme (serves as anti-
inflammatory) then apply on affected skin or spewed it over skin
 For treatment of skin diseases
 Infusion
 To prepare a tea (use lipton bag), keep standingfor 15 minutes in a
cup of warm water where a brown solution is collected, pectin
which serves as an adsorbent and astringent
 Juice/Syrup
 To prepare a papaya juice, use ripe papaya &mechanically mashed
then put inside a blender& add water
 To produce it into a syrup, add sugar then heat to
 dissolve sugar & mix it
 Cream/Ointment
 Start with poultice (pound leaves) to turn it semi-solid
 Add flour to keep preparation pasty & make it adhere to skin
lesions
 To make it into an ointment: add oil (mineral, baby or any oil-
serves as moisturizer) to the prepared cream to keep it lubricated
while being massage on the affected area.

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4. ORESOL

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FOURmula One Plus for Health

Pillars of the FOURmula One Plus for Health

 Health Service Delivery Ensure the accessibility of essential quality

health products and services at appropriate levels of care.
1. Increase access to quality essential health products and services.
2. Ensure equitable access to quality health facilities.
3. Ensure Equitable Distribution of human resources for health.
4. Engage Service Delivery Networks to delivery comprehensive package
of health services.

 Fourmula one for Health engages the entire health sector, including the
public and private sectors, national agencies and local government units,
external development agencies, and civil society to get involved in the
implementation of health reforms

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  FOURmula ONE for Health Goals
 Better Health Outcomes
 More responsive health systems
 Equitable health care financing

 Four Elements of the Strategy

o Health Financing
 To foster greater, better & sustained investments in health.
o Health Regulation
 To ensure the quality & affordability of health goods &
services.
o Health Service Delivery
 To improve & ensure the accessibility &
availability of basic & essential health care.
o Good Governance
 To enhance health system performance at the
national and local levels.

DOH NATIONAL FAMILY PLANNING PROGRAM

GOALS:
A. Safe Pregnancy
 Right age to be pregnant=20-35 years old, not less than 20 & not more
than 35
 Right interval of pregnancy=once in 2 or 3 yearsü
 Home Base Mother’s Record (HBMR): the record used for care of
mothers in CHN

POLICIES:
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all Curricular
 Program:LOI 47 DECS states that Family Planning is to be
integrated in all school curricular programs, either
baccalaureates or non- baccalaureates, enrolled separately
as one unit
3. Multi-Sectoral Approach: establish relationship with other
agencies which can either be
4.  Intrasectoral
5.  Intersectoral-Local or International (WHO, Unicef, USAID,
Japhiego)

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A. Basal Body Temperature (BBT)
 Get the temperature early morning before waking up which should be
monitored daily at the same time
 There should be a sudden drop of temperature between 0.3-0.6°C
followed by an increase of temperature by 0.3-0.6°C which means that
the woman is fertile

Sympto-thermal
C. Cervical Mucus Test
  Billing’s Method by Dr. Billing Spinnbarkheit (came from a German word
Spinner which means to play with the cervical mucus with the finger) or
Wet & Dry Method:
o Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
o Dry Cervical Mucus (Safe & Not fertile): whitish, pasty & adhesive
D. Calendar (Rhythm)
  Deleted already since 1998 because it’s not recommended for irregular
cycle of menstruation
 Menstrual cycle should be regular; obtain 4-6 months cycle

E. Lactation Amenorrhea Method (LAM):

 RA 7600-Breastfeeding & Rooming In Law
  DOH organized Maternal & Child Family Health Institute (MCFHI) with
the following members:
o All government hospitals
o  Private hospitals (volunteer)
 Normal involution (uterus goes back to normal) of the uterus:
o after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding
  Frozen breast milk is to be put out of the freezer 2 hours before feeding
( Body of Ref: 2-3 days / Freezer: 3-4 months)
 Left over milk should be discarded & should not be re-preserved or re-
frozen because it is already contaminated

F. Chemical
 Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
inhibits ovulation
 Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women amenorrheic;1991, DMPA
was found to be causing cancer of the cervix1994, DMPA is given IM
4x a year every 3 months (90 days interval)

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 G. Implants:
 Norplant-it inhibits ovulation effective for 5 years but seldom advocated
for use because it is usually expensive;
 the client buys the device (consists of 5 capsules) & have it implanted at
the health center by minor surgical incision
o in upper inner arm because it is nearest to the brain
o external oblique thigh
o  gluteal muscles

G. Mechanical:
 IUD (intrauterine device)
 Up to 10 years protection
 Cervical cap & Diaphragmü
o Prevent the sperm to pass the cervix
o Works better with spermicideü
o Wore 30 minutes before coitus and keep up to 6 hours after coitus
 CondoM  Most effective way to prevent STD’s / STI’s

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 H. Behavioral
 Abstinence
 Withdrawal

I. Permanent 
 Vasectomy (reversible)-since year 2000 in the Philippines
  bilateral tubal ligation

THE FAMILY AND FAMILY HEALTH

Concept/ Definition of Family

Family
- Basic to social institution and the primary group in society.
- Social group characterized by common residence, economic cooperation
and reproduction
- Group of persons united by ties at marriage, blood or adoption
constituting a single household, interacting and communicating with
each other in their respective social roles in creating and maintaining a
common culture.
-

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F – Father
A – and
M – Mother
I – implying the presence of children where
L – Love most prevail between Me and
Y – You

Structure/ Functions of Family

1. The family regulates sexual behavior and reproduction also strives to
provide legitimate children with a status.
2. Biological Maintainance Function – human infant is born helpless and
parents presents all the roles as protector, provider and guardian.
3. Socialization Function – family transmits culture/ways of living through
teaching and indoctrination.
4. The family gives its members status.
5. Social Control Function – each member has its own conformity and
desires behavior.
6. Economic Function – provides economic needs of the members.

Characteristics:
 The family as a social group is universal and is significant element in the
mans’ social life.
 It is the first social group to which the individual is exposed.
 Family contact and relationship are repetitive and continuous.
 The family is very close and intimate group.
 It is the setting of the most intense, emotional experiences during the
lifetime of the individual.
 The family affects the individuals social values, disposition and outlook
in life.
 The family has the unique position at serving as a link between the
individual and the larger society.
 The family is also unique in providing continuity or social life.

STAGES OF FAMILY/ TASKS

1. Baginning – establishing a mutually satisfying marriage/planning to have
or not to have children.
2. Childbearing Family – having and adjusting to infant and supporting the
needs of the members renegotiating marriages.
3. Family with Pre-school Children – adjusting to cost of family life.

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 4. Family with School Age Children – adjusting to activities of growing
children.
5. Family with Teen-Agers and Young Adults – balancing freedom with
responsibilities of teen-agers; maintaining open communication among
members; supporting ethical moral values within the family.
6. Post-Parental Family – strengthening marital relationship, maintains
supportive home base.
7. Aging Family – preparing for retirement; maintaining ties with younger
and older generation.

CLASSIFICATION OF FAMILY STRUCTURE

A. Based on Internal Organization and Membership

1. Nuclear – also known as primary or elementary family; composed of
father, mother and the children.
2. Extended - composed of 1 or more nuclear families related to each
other economically or socially.

B. Based on Place of Residence

1. Patrilocal – newly wed couple to live with the family of bridegroom or
near the residence of the parents of bridegroom.
2. Matrilocal – newly wed couple to live with the family or near the
residence of the brides parents.
3. Bilocal – provides the newly wed couple the choice of staying with
either the grooms parents or the brides parents.
4. Neolocal – permits the couple te reside independently and decide on
their own.
5. Avuncolocal – prescribe the newly wed couple with or near the
maternal uncle of the groom.

C. Based on Descent
1. Patrilineal – affiliates a person with a group of relatives through his or
her father.
2. Matrilineal – affiliates a person with a group of relatives related
through his or her mother.
3. Bilateral – affiliates a person with a group of relatives related through
both his or her parents.

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 D. Based on Authority
1. Patriarchal – authority is vested on the eldest male on the family,
usually the father.
2. Matriarchal – authority is vested on the mother or mothers kin.
3. Egalitarian – the husband and wife exercise a more or less equal
amount of authority.
4. Matricentric – prolonged absence of the father gives the mother a
dominant position in the family.

Levels of Prevention in Family Health

1. Primary – by measures designed to promote positive general health.
2. Secondary – consist of early diagnosis to prompt treatment of the
disease in order to arrest the disease/problem and to prevent its spread
to other people.
3. Tertiary – consist of such activities as consistent and appropriate
administration of needs to optimize therapeutic effects, moving and
positioning to prevent complications/disability; intensive/periodic
follow-up and treatment to prevent relapses in certain diseases.

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Family Health Care Process
ASSESSMENT
PLANNING
IMPLEMENTATION
EVALUATION PHASE

Nursing Assessment in Family Nursing Practice

ASSESSMENT PHASE

 First major phase of nursing process in family health nursing

 Involves a set of action by which the nurse measures the status of the
family as a client. Its ability to maintain wellness, prevent, control or
resolve problems in order to achieve health and wellness among its
members
 Data about present condition or status of the family are compared
against the norms and standards of personal , social, and environmental
health, system integrity and ability to resolve social problems.
 The norms and standards are derived from values, beliefs, principles,
rules or expectation.

Nursing Assessment includes:

 Data collection or gathering

 Data analysis or interpretation
 Problem definition or nursing diagnosis –end result of two major types
of nursing assessment in family health nursing practice.

Steps in Family Nursing Assessment

Data collection
Data analysis

1.Data Collection – gathering of five types of data which will generate the
categories of health conditions or problems of the family.

OUTPUT IN THIS STAGE: completely filled up Family Nursing Assessment Tool

forming the Initial Data Base containing the Five Sets of Data.

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Five Sets Of Data:

6. Family Structure, Characteristics &Dynamics

– include the composition and demographic data of the members of the
family/household, their relationship to the head and place of residence; the
type of, and family interaction/communication and decision-making patterns
and dynamics.

7. Socio-Economic & Cultural Characteristics

– include occupation, place of work, and income of each working member;
educational attainment of each family member; ethnic background and
religious affiliation; significant others and the other role(s) they play in the
family’s life; and, the relationship of the family to the larger community

8. Home And Environment

– include information on housing and sanitation facilities; kind of
neighborhood and availability of social, health, communication and
transportation facilities in the community.

9. Health Status Of Each Member

–includes current and past significant illness; beliefs and practices conducive to
health and illness; nutritional and developmental status; physical assessment
findings and significant results of laboratory/diagnostic tests/screening
procedures.

10.Values And Practices On Health Promotion/Maintenance &

Disease Prevention
– include use of preventive services; adequacy of rest/sleep, exercise,
relaxation activities, stress management or other healthy lifestyle activities,
and immunization status of at-risk a.

DATA COLLECTION METHODS AND TOOLS: SELECT APPROPRIATE METHOD

OBSERVATION

 done through use of sensory capacities

 The nurse gathers information about the family’s state of being and
behavioral responses
 the family’s health status can be inferred from the s/sx of problem areas

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  communication and interaction patterns expected ,used, and tolerated
by family members
 role perception / task assumption by each member including decision
making patterns
 conditions in the home and environment
 ** Data gathered through this method have the advantage of being
subjected to validation and reliability testing by other observers

PHYSICAL EXAMINATION

 significant data about the health status of individual members can be

obtained through direct examination through IPPA, Measurement of
specific body parts and reviewing the body systems
 data gathered from P.A form substantive part of first level assessment
which may indicate presence of health deficits (illness state )

INTERVIEW

 Productivity of interview process depends upon the use effective

communication techniques to elicit needed response PROBLEMS
ENCOUNTERED:
 How to ascertain where the client is in terms of perception of health
condition or problems and the patterns of coping utilized to resolve
them
 Tendency of community health worker to readily give out advice, health
teachings or solutions once they have identified the health condition or
problems.
 Provisions of models for phrasing interview questions utilization of
deliberately chosen communication techniques for an adequate nursing
assessment.
 confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question
that aim to explore, validate, clarify, offer feedback, encourage
verbalization of thought and feelings and offer needed support or
reassurance.
 TYPES:
 Completing health history of each family member
 Health history determines current health status based on significant

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  PAST HEALTH HISTORY e.g. developmental accomplishment, known
illnesses, allergies, restorative treatment, residence in endemic areas
for certain diseases or sources of communicable diseases.
 FAMILY HISTORY e.g. genetic history in relation to health and illness.
 SOCIAL HISTORY e.g. intra-personal and inter-personal factors
affecting the family member social adjustment or vulnerability to
stress and crisis
 Collecting data by personally asking significant family members or relatives
questions regarding health, family life experiences and home environment
to generate data on what wellness condition and health problem exist in
the family ( first level assessment) and the corresponding nursing problems
for each health condition or problem ( 2nd level assessment)

RECORDS REVIEW

 Gather information through reviewing existing records and reports

pertinent to the client
 Individual clinical records of the family members, laboratory and diagnostic
reports, immunization records reports about home and environmental
conditions
 
2. DATA ANALYSIS
OUTPUT IN THIS STAGE: Come up with Health Needs and Problems of the
Family

 A situation which interferes with the promotion and / or maintenance of

health (1st level results or list of family conditions/ problems in 4 categories)
 It is a health problem when it started as the family’s failure to perform
adequately specific health task to enhance the wellness state or manage a
health problem (2nd Level Ax results or list of Nursing Diagnosis)
 
TWO MAJOR TYPES
 FIRST LEVEL ASSESSMENT- a process whereby existing and potential health
conditions or problems of the family are determined (Wellness Situation,
Health Threat, Health Deficit, Stress Points or Foreseeable Crisis)
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
 SORTING OF DATA
 CLUSTERING OF RELATED CUES
 DISTINGUISHING RELEVANT FROM IRRELEVANT CUES
 IDENTIFYING PATTERNS

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 COMPARING PATTERNS
 INTERPRETING RESULTS OF COMPARISON
 MAKING INFERENCES AND DRAWING CONCLUSIONS

Wellness Potential

– stated as potential or Readiness-a clinical or nursing judgment about a client

in transition from a specific level of wellness or capability to a higher level.
Wellness potential is a nursing judgment on wellness state or condition based
on client’s performance, current competencies, or performance, clinical data
or explicit expression of desire to achieve a higher level of state or function in a
specific area on health promotion and maintenance.

Health Threat

– conditions that are conducive to disease and accident, or may result to

failure to maintain wellness or realize health potential

Health Deficit

– instances of failure in health maintenance

Stress Points or Foreseeable Crisis

– anticipated periods of unusual demand on the   individual or family in terms

of adjustment/family resources.

TOOL: A Typology of Nursing Problems in Family Nursing Practice

(CONDITIONS OR PROBLEMS PART)

First Level Assessment

I. Presence of Wellness Condition
-stated as potential or Readiness-a clinical or nursing judgment about a client in
transition from a specific level of wellness or capability to a higher level. Wellness
potential is a nursing judgment on wellness state or condition based on client’s
performance, current competencies, or performance, clinical data or explicit
expression of desire to achieve a higher level of state or function in a specific area on

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health promotion and maintenance. Examples of this are the following

A. Potential for Enhanced Capability for:

1.     Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2.     Healthy maintenance/health management
3.     Parenting
4.     Breastfeeding
5.     Spiritual well-being-process of client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
(NANDA 2001)

6.     Others. Specify.

B. Readiness for Enhanced Capability for:

1.     Healthy lifestyle

2.     Health maintenance/health management
3.     Parenting
4.     Breastfeeding
5.     Spiritual well-being
6.     Others. Specify.
II. Presence of Health Threats
-conditions that are conducive to disease and accident, or may result to failure to
maintain wellness or realize health potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic

syndrome)

B. Threat of cross infection from communicable disease case

C. Family size beyond what family resources can adequately provide

D. Accident hazards specify.

1.     Broken stairs

2.     Pointed /sharp objects, poisons and medicines improperly kept
3.     Fire hazards
4.     Fall hazards

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5.     Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices.

Specify.
1.     Inadequate food intake both in quality and quantity
2.     Excessive intake of certain nutrients
3.     Faulty eating habits
4.     Ineffective breastfeeding
5.     Faulty feeding techniques

F. Stress Provoking Factors. Specify.

1.     Strained marital relationship

2.     Strained parent-sibling relationship
3.     Interpersonal conflicts between family members
4.     Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify.

1.     Inadequate living space

   Lack of food storage facilities
3.     Polluted water supply
4.     Presence of breeding or resting sights of vectors of diseases
5.     Improper garbage/refuse disposal
6.     Unsanitary waste disposal
7.     Improper drainage system
8.     Poor lightning and ventilation
9.     Noise pollution
10.  Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
1.     Alcohol drinking
2.     Cigarette/tobacco smoking
3.     Walking barefooted or inadequate footwear
4.     Eating raw meat or fish
5.     Poor personal hygiene
6.     Self medication/substance abuse
7.     Sexual promiscuity

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8.     Engaging in dangerous sports
9.     Inadequate rest or sleep
10.  Lack of /inadequate exercise/physical activity
11.  Lack of/relaxation activities
12.  Non use of self-protection measures (e.g. non use of bed nets in malaria and
filariasis endemic areas).

J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the Occurrence of Health Deficit,

e.g. previous history of difficult labor.

L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not
assuming his role.

M. Lack of Immunization/Inadequate Immunization Status Specially of Children

N. Family Disunity-e.g.
1.     Self-oriented behavior of member(s)
2.     Unresolved conflicts of member(s)
3.     Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits

–instances of failure in health maintenance.
Examples include:

A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical

practitioner.

B. Failure to thrive/develop according to normal rate

C. Disability-whether congenital or arising from illness; transient/temporary (e.g.

aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation
secondary to diabetes, blindness from measles, lameness from     polio)

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IV. Presence of stress points/foreseeable crisis situations
–anticipated periods of unusual demand on the   individual or family in terms of
adjustment/family resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________

 SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that
family encounters in performing health task with respect to given health
condition or problem and etiology or barriers to the family’s assumption of the
task
*Second level assessment can be adequately done for each wellness state, health
threat, health deficit or crisis situation by going through the following procedures:

1. Determine if the family recognizes the existence of the condition or problem. If

the family does not recognize the presence of the condition or problem, explore
the reasons why.
2. If the family recognizes the presence of the condition or problem, determine if
something has be end one to maintain the wellness state or resolve the problem.
If the family has not done anything about it, determine the reasons why. If the
family has done something about the problem or condition, determine if the
solution is effective.
3. Determine if the family encounters other problems in implementing interventions
for the wellness state/potential, health threat, health deficit or crisis. What are
these problems?
4. Determine how all the other members are affected by the wellness
state/potential, health threat deficit or stress point.

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Five Family Health Tasks:
– these are the tasks a family needs to do
given the different Health Conditions or SECOND-LEVEL ASSESSMENT
Problems found in the First Level –               present when the family health
Assessment tasks is not fulfilled by the family;
I.               Inability to recognize the
1. Recognize the presence of the presence of the condition or problem.
condition or problem. II.              Inability to make decisions with
 2. Make decisions with respect to taking respect to taking appropriate health
appropriate health action. action.
 3. Provide adequate nursing care to the III.            Inability to provide adequate
sick, disabled, dependent or nursing careto the sick, disabled,
vulnerable/at risk member of the family. dependent or vulnerable/at-risk member
4. Provide a home environment of the family.
conducive to health maintenance and IV.           Inability to provide a home
personal development. environment conducive to health
 5. Utilize community resources for maintenance and personal development.
health care. V.            Failure to utilize community
resources for health care.

TOOL: A Typology of Nursing Problems in Family Nursing Practice (NURSING

DIAGNOSIS PART)

Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge

B. Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem, specifically:

1.     Social-stigma, loss of respect of peer/significant others

2.     Economic/cost implications

3.     Physical consequences
4.     Emotional/psychological issues/concerns

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C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem

II. Inability to make decisions with respect to taking appropriate health action due
to:
A. Failure to comprehend the nature/magnitude of the problem/condition

B. Low salience of the problem/condition

C. Feeling of confusion, helplessness and/or resignation brought about by perceive
magnitude/severity of the  situation or problem, i.e. failure to breakdown problems
into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to
them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action to
take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1.     Social consequences
2.     Economic consequences
3.     Physical consequences
4.     Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is
meant one that interferes with  rational decision-making.

J. In accessibility of appropriate resources for care, specifically:

1.     Physical Inaccessibility

2.     Costs constraints or economic/financial inaccessibility

K. Lack of trust/confidence in the health personnel/agency

L. Misconceptions or erroneous information about proposed course(s) of action

III. Inability to provide adequate nursing care to the sick, disabled, dependent or

vulnerable/at risk  member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature,

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severity, complications, prognosis and management)

B. Lack of/inadequate knowledge about child development and care

C. Lack of/inadequate knowledge of the nature or extent of nursing care needed

D. Lack of the necessary facilities, equipment and supplies of care

E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or

treatment/procedure of care  (i.e. complex therapeutic regimen or healthy lifestyle
program).

F. Inadequate family resources of care specifically:

1.     Absence of responsible member

2.     Financial constraints

3.     Limitation of luck/lack of physical resources

G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety,

despair, rejection) which his/her capacities to provide care.

H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable/at risk member

I. Member’s preoccupation with on concerns/interests

J. Prolonged disease or disabilities, which exhaust supportive capacity of family

members.

K. Altered role performance, specify.

1.  Role denials or ambivalence

2.     Role strain
3.     Role dissatisfaction

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4.     Role conflict
5.     Role confusion
.     Role overload

IV. Inability to provide a home environment conducive to health maintenance and

personal development due to:
A. Inadequate family resources specifically:

1.     Financial constraints/limited financial resources

2.     Limited physical resources-e.i. lack of space to construct facility

B. Failure to see benefits (specifically long term ones) of investments in home

environment improvement

C. Lack of/inadequate knowledge of importance of hygiene and sanitation

D. Lack of/inadequate knowledge of preventive measures

E. Lack of skill in carrying out measures to improve home environment

F. Ineffective communication pattern within the family

G. Lack of supportive relationship among family members

H. Negative attitudes/philosophy in life which is not conducive to health maintenance

and personal development

I. Lack of/inadequate competencies in relating to each other for mutual growth and
maturation (e.g. reduced ability to meet the physical and psychological needs of
other members as a result of family’s preoccupation with    current problem or
condition.

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V. Failure to utilize community resources for health care due to:
A. Lack of/inadequate knowledge of community resources for health care

B. Failure to perceive the benefits of health care/services

C. Lack of trust/confidence in the agency/personnel

D. Previous unpleasant experience with health worker

E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative)

specifically :

1.     Physical/psychological consequences

2.     Financial consequences
3.     Social consequences
F. Unavailability of required care/services

G. Inaccessibility of required services due to:

1.     Cost constrains

2.     Physical inaccessibility

H. Lack of or inadequate family resources, specifically

1.     Manpower resources, e.g. baby sitter

2.     Financial resources, cost of medicines prescribe

I. Feeling of alienation to/lack of support from the community, e.g. stigma due to
mental illness, AIDS, etc.

J. Negative attitude/ philosophy in life which hinders effective/maximum utilization

of community resources for health care

K. Others, specify __________

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From Nursing Practice in the Community -Maglaya, 5th Edition

P– DEVELOPING THE NURSING CARE PLAN

THE FAMILY CARE PLAN

– is 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 ( goals and objectives) and deliberately chosen of
interventions, resources and evaluation criteria, standards, methods and tools.

DESIRABLE QUALITIES OF A NURSING CARE PLAN

1. It should be based on clear, explicit definition of the problems. A good nursing
plan is based on a comprehensive analysis of the problem situation.
2. A good plan is realistic.
3.The nursing care plan is prepared jointly with the family. The nurse involves the
family in determining health needs and problems, in establishing priorities, in
selecting appropriate courses of action, implementing them and evaluating
outcomes.
4.The nursing care plan is most useful in written form.

THE IMPORTANCE OF PLANNING CARE

1.They individualize care to clients.
2.The nursing care plan helps in setting priorities by providing information about the
client as well as the nature of his problems.
3.The nursing care plan promotes systematic communication among those involved
in the health care effort.
4.Continuity of care is facilitated through the use of nursing care plans. Gaps and
duplications in the services provided are minimized, if not totally eliminated.
5.Nursing care plans, facilitate the coordination of care by making known to other
members of the health team what the nurse is doing.

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133
RISK AND HEALTH

RISK – the probability that a specific event will occur in a given time frame.
RISK FACTOR – is an exposure that is associated with a disease.

THREE CRITERIA FOR ESTABLISHING A RISK FACTOR:

1. The frequency of the disease varies by category, or amount of the factor.
Cigarette smokers are more likely to develop lung cancer than
nonsmokers, and those who smoke heavily are more likely to develop
lung cancer than those who smoke little.
2. The risk factor must precede the onset of the disease. Cigarette smokers
have lung cancer before starting to smoke, this would cast doubt on
smoking as a risk factor for lung cancer.
3. The association of concern must not be due to any course of error. In
any research study (especially one involving human behavior), there are
many sources of error such as study design, data collection methods,
and data analysis.

- A risk assessment is a systematic way of distinguishing the risks

posed by potentially harmful exposures.
- The four main steps of s risk assessment are hazard identification,
risk description, exposure assessment, and risk estimation.

RELATIONSHIP BETWEEN RISK FACTORS AND LEADING CAUSES OF DEATH IN

THE PHILIPPINES IN 2009
Cause of % of smok High Seden Highbl Elevate obes diabe Alco
death tota ing fat,l tary ood d ity tes hol
l ow lifestyl pressu cholest abus
dae fibe e re erol e
ths r
diet
Heath dse. 21.0 X X X X X X X X
Cerebrova 11.8 X X x x X X
scular
diseases
Malignant 9.9 X X X x X
neoplasm
Pnuemoni 8.9 X X
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a
Tuberculo 5.3 X X x
si,all forms
Chronic 4.7 X
lower
respirator
diseases
DM 4.6 x x x x
Nephritis, 2.9 X x x x x x
nephrotic
syndrome,
and
nephrosis
assault 2.5
Certain 2.4 x x x x X
conditions
originatio
n in the
perinatal
period

- To improve the nutritional status of the population, nutrition

education is essential.
- The 10 Nutritional Guidelines for Filipinos were developed to
facilitate disseminating simple and practical messages to
encourage a healthy diet and lifestyle.

NUTRITIONAL GUIDELINES FOR FILIPINOS

1. Eat a variety of foods every day.
2. Breast feed infants exclusively from birth to 4-6 months and then give
appropriate foods while continuing breast feeding.
3. Maintain children’s normal growth through proper diet and monitor
their growth regularly.
4. Consume fish, lean, eat, poultry, or dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat food cooked in edible/cooking oil daily.
7. Consume milk, milk products, and other calcium rich foods such as small
fish and dark green leafy vegetables every day.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe food.

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 10.For a healthy lifestyle and good nutrition, exercise regularly, do not
smoke, and avoid drinking alcoholic beverages.

- Special populations such as pregnant or lactating women, infants,

children, older adults, and adolescents have differing nutritional
needs. Specific recommendations for these individuals can be
accessed at the website for the recommended energy and
nutrient intakes for Filipinos:
http://www.fnri.dost.gov.ph/index.php?
- The daily nutritional guide pyramid provides Filipinos an eating
plan for healthy living.
- What about eating away from home for many people, eating at
home all of the time is impossible or impractical, and food is
central to many social interactions. In order to consume fewer
calories when eating out, one may:
 Patronize establishments that offer a variety of food
choices and are willing to make substitutions or changes.
 Order low fat steamed, broiled, baked, roasted or poached
items, or ask that an item be prepared in a low calorie way,
such as grilled rather than fried.
 Choose lower calorie sauces or condiments, or do without
them altogether.
 Substitute colorful vegetables for other side dishes (such as
French fries).
 Ask for half of the meal to be boxed to take home before
the meal is brought to the table.
 Share an entrée with someone.
 Order a vegetarian meal.
 Select a fruit for dessert.

To decrease reliance on away from home foods, plan ahead carefully and:
 Pack healthy snacks.
 Cook a healthful dinner at home, and make extra to pack for lunch, such
as fresh fruits and vegetables.
 Bring along nutritious foods for travel or longer excursions that will not
spoil, such as fresh fruits and vegetables, or pack a cooler with healthy
foods.

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One’s surrounding’s also impact whether one will choose to exercise. Clean air
Asia has develop a tool to rate Asian cities for suitability for walking. The
parameters applied in the walkability survey are the following:
Walking path modal conflict: the extent of conflict between pedestrians
and other modes on the road, such as bicycles, motorcycles and cars.
Availability of walking paths: the need, availability and condition of
walking paths.
Availability of crossings: the availability and length of crossings to
describe whether pedestrians tends to jaywalk when there are no
crossings or when crossings are too far apart.
Grade crossing safety: the exposure to other modes when crossing
roads, time spent waiting and crossing the street and the amount of
time given to pedestrians to cross interactions with signals.
Motorist behavior: the behavior of motorists toward pedestrians as an
indication of the kind of pedestrian environment.
Amenities: the availability of pedestrian amenities, such as benches,
street lights, public toilets, and trees, which greatly enhance the
attractiveness and convenience of the pedestrian environment, and in
turn, the surrounding area.
Disability Infrastructure: the availability of, positioning of and
maintenance of infrastructure for the disabled.
Obstructions: the presence of permanent and temporary obstructions
on pedestrian pathways.
Security form crime: the general feeling of security from crime on a
certain stretch of road (walkability Asia, 2012).

Research has found that one’s environment is a significant factor in

health promotion. Adults and adolescents living in a neighborhoods with high
walkability engage in significantly more walking and cycling than those living in
neighborhoods with low walkability (Frank, 2005; saelens et al., 2003).

How much exercise do I need? What counts an exercise? Nurses in the

community hear these questions commonly as they educate the public on the
need to increase physical activity. The answer to this questions will depend on
the age, physical condition, and gender of the client.
People may feel overwhelmed by the idea that they must add one more
demand to an already busy schedule, and some think, “I’m in such bad shape,
I’ll never be able to exercise.” The most important idea is that one must take a
first step to try exercise. Walking, biking, taking the stairs, swimming-there is
something for everyone, and any exercise is better than none.

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 Exercise may also be broken down into smaller blocks of time during the
day if it is not possible or convenient to do it all at once. Physical activity can
also be a family affair, with the entire family using the time to reconnect and
have fun together. Of course, persons with health problems, as cardiovascular
conditions, should seek guidance from a health worker.

SLEEP
- Sleep is an essential component of chronic disease prevention and
health promotion, yet 74% of adults report having a sleep
problem one or more nights per week. Insufficient sleep is
associated with diabetes, heart disease, obesity, depression, and
motor vehicle accidents.
- Sleep requirements change as people age and depending on life
circumstances, one may require more than the minimum hours
listed. If a person is so tired and sleepy that it interferes with his
or her daily activities, that person probably needs more sleep?
- As we age, sleep is often interrupted by pain, trips to the
bathroom, medications, medical conditions, and sleep disorders.
This means that we are awaken naturally without an alarm clock,
ensuring adequate rest.
- The need for sleep is regulated by two processes. One is the
number of hours we are awake. The longer we are awake, the
stronger is the desire to sleep. The other process is the circadian
biological clock in the brain, the suprachiasmatic nucleus, which
responds to light. This makes us tend to be sleepy at night when it
is dark and active during the day when it is light. The circadian
rhythm is why we are sleepiest between 2:00 and 4:00 AM and in
the afternoon between 1:00 to 3:00 PM.
- The circadian rhythm also regulates the 24 hour cycle of the body.
While we sleep, important hormone are released, memory is
consolidated, blood pressure is decreased, and kidney function
changes (National Sleep Foundation, 2010).
- Practicing sleep hygiene will help achieve optimum sleep (National
Sleep Foundation, 2010).
1. Avoid caffeine and nicotine close to bedtime.
2. Avoid alcohol as it can cause sleep disruptions.
3. Retire and get up at the same time every day.
4. Exercise regularly, finish all exercise and vigorous activity at
least 3 hours before bedtime.

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 5. Establish a regular, relaxing bedtime routine (a warm bath,
reading a books).
6. Create a dark, quiet, cool sleep environment.
7. As much as circumstances allow, have comfortable beddings.
8. Use of the bed for sleep only; do not read, listen to the music,
or watch TV in bed.
9. Avoid large meals before bedtime.

Sleep assessment is an important nursing function. If patient report snoring,

apnea, restlessness, or insomnia, they may have sleep disorders. Recommend
keeping a sleep log detailing how many hours are spent in each night and any
problems with sleep. If insufficient sleep is causing trouble concentrating or
completing daily activities, recommend consulting a doctor, as a sleep disorder
may be to blame.
Smoking cessation is an important step in achieving optimum health.
Based on the result of the Global Adult Tobacco Survey (2009), it is estimated
that more than half of the world’s smokers live in 14 countries, the Philippines
among them. In 2009, among the 10 leading causes of death in the Philippines,
8 were associated with smoking.

The American Cancer Society recommends the following steps to quit smoking:
1. Make the decision to quit. Any change is scary, and smoking cessation is
a big change requiring a long-term commitment.
2. Set a date to quit and choose a plan.
 Mark the date on your calendar.
 Tell your family and friends about the date, and ask for their
support.
 Get rid of all tobacco products, ashtrays, and lighters in your
environment.
 Stock up on oral substitutes such as sugarless gum, hard candy,
fruit and carrot sticks.
 Decide on a [plan, and prepare to implement it; register for the
stop smoking class, or see your doctor about nicotine replacement
therapy or pharmaceutical alternatives.
 Practice saying, “No, thank you, I don’t smoke.”
 Think back to your previous attempts to quit, and see what
worked and what did not work.
 If you are taking bupropion or verenicline, take your medication
each day of the week leading up to your quit day.
3. Deal with withdrawal through:
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  Avoiding temptation.
 Changing your habits. Walk when you are stressed or during
breaks. Use hard candy, carrot sticks, or gum to satisfy the need to
put something in your mouth. If you feel the urge light up, tell
yourself that you are going to wait 10 minutes before giving in.
usually the urge will pass within the time.
4. Staying off to tobacco is a lifelong process. Many former smokers state
that they experienced strong desires to smoke after weeks, months,
even years of smoking cessation. These unexpected cravings can be
difficult to deal with.
 Remind yourself of the reasons you quit.
 Wait out the craving. There is no such thing as just one cigarette
or just one puff.
 Avoid alcohol.
 Begin an exercise program and work on having a healthy diet to
avoid gaining weight.

ALCOHOL CONSUMPTION AND HEALTH

Alcohol use is very common in our society, and serving alcoholic beverages
is considered customary in social gatherings.
A drink is the amount of any alcoholic beverage that delivers a half ounce
(around 15 ml) of pure ethanol, which is equivalent to the following.
 4 -5 ounces (around 120-150 ml) of wine
 10 ounces (around 300 ml) of wine cooler
 12 ounces (around 360 ml) of beer
 1.25 ounces (around 40 ml) of distilled liquor (80 proof of whisky, scotch,
rum or vodka.)
Health authorities have defined moderation as not more than two drinks a
day for the average sized man and more than one drink a day for the average
sized woman. But still, the exact amount of moderate alcohol intake per day
cannot be defined because people have different tolerances to alcohol.
Thus, the amount of alcohol a person can drink safely is highly
individualized, depending on genetics, health conditions, sex, weight, age and
family history. In addition, the liver can process about half ounce ethanol per
hour (the amount in a typical drink, depending on the person’s body size,
previous drinking experience, food intake, and general health.
Heavy drinking is defined as consuming more than two drinks per day for
women.

140
 Binge drinking five or more drinks on a single occasion for men, or more
drinks on a single occasion for women.
Excessive drinking can take the form of heavy drinking, binge drinking or
both.

THOSE WHO WOULD NOT DRINK AT ALL INCLUDE:

 Pregnant or trying to become pregnant women.
 People taking prescription or over- the-counter medications that may
cause harmful reactions when mixed with alcohol.
 People younger than 21.
 People recovering from alcoholism or are unable to control the amount
that they drink.
 People suffering from a medical condition that may be worsened by
alcohol.
 Anyone driving, planning to drive, or participating in other activites
requiring skill, coordination, and alertness.

TEN TARGET AREAS FOR NATIONAL ACTION TO REDUCE THE HARMFUL USE OF
ALCOHOL:
1. Leadership, awareness, commitment
2. Health service response
3. Community action
4. Drink-driving policies and countermeasures
5. Availability of alcohol
6. Marketing of alcoholic beverages
7. Pricing policies
8. Reducing the negative consequences of intoxication
9. Reducing the public health impact of unrecorded alcohol
10.Monitoring and surveillance

Pre-requisites for Health

The fundamental conditions and resources for health are:
 Peace
 Shelter
 Education
 Food
 Income
 A stable ecosystem
 Sustainable resources
 Social justice and equity and equity

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HEALTH EDUCATION
- Health promotion, health protection, and risk reduction entails’
client deliberate performance or avoidance of particular actions.
- Is the process of changing people’s knowledge, skills and attitudes
for health promotion and risk reduction? The nurse participates in
health education by empowering people so that they are able to
achieve optimum health and prevent disease by bringing about
lifestyle changes and reducing exposure to health risks in the
environment.
- It includes risk communication. Teaching pregnant woman on the
need for regular prenatal consultations, instructing a family on
methods of water purification that can be done at home in
instances when water sanitation is uncertain, holding a class on
breastfeeding for first time pregnant woman, and the use of mass
media-newspaper, radio and television- on prevention of dengue
fever are examples of health education activities.
- Patient Education – usually refers to a series of planned teaching-
learning activities designed for individuals, families, or groups with
an identified alteration in health. Its purposes are to aid the client
in coping with the event, to prevent complications or
deterioration of the client’s condition, and in cases of
communicable diseases, to prevent transmission of the disease.

THE EFFECTIVE NURSE EDUCATOR

BASED ON Knowles’ THEORY on adult learning, Stanhope and Lancaster
(2010) listed the following basic principles that guide the effective nurse
educator:
1. Message – send a clear message to the learner. Information must be
presented in a manner that is understandable to the learner. The4 nurse
needs to consider factors that may affects that the learners’ ability to
receive and retain the information.
2. Format – select the most appropriate learning format or strategy. The
strategy must watch the objectives of the learning activity and the
characteristics of the learner. For example, a demonstration of the
procedure will be helpful in teaching a first time mother how to prepare
solid foods for her 6 months old baby.
3. Environment – create the best possible learning environment. This must
be applied from the start, that is, from the time the nurse composes the
invitation to the learning activity. Aside from having a physical

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 environment conducive to learning, the nurse must create a therapeutic
and supportive relationship with the learner. In a group setting, the
nurse should foster positive interpersonal relationships among the
learners to allow them to contribute to the attainment of learning
objectives.
4. Experience – organize positive and meaningful learning experiences.
Sequencing of materials in a logical manner from simple to more
complex concepts allows building on previous learning.
5. Participation – engage the learner in participatory learning. The nurse
encourages learner’s participation by involving them in discussions and
other group activites, soliciting feedback, role playing, and return
demonstration after a demonstration are some methods of participatory
learning. Depending on the objectives of the learning session, the nurse
applies methods such as these, knowing that active involvement
provides for better learning.
6. Evaluation – evaluate and give objective feedback to the learner. Using
tools such as quizzes, individual conferences, and return
demonstrations, the nurse may monitor and evaluate learning
outcomes. Knowing the degree of attainment of learning objectives
motivates motivates learners to go on. At the same time, the nurse is
able to identify areas of instruction that may need to be modified.

PARTNERSHIP AND COLLABORATION

Health and related problems in the community are varied. Most

often, the problems are complicated and too many for the nurse and the
people or their organization to handle. They cannot solve the problems
alone. They must work with other people or groups to increase the
probability of accomplishing the goals that they have set.

The nurse must plan to establish and maintain valuable working

relationships with people such as people’s organizations,health
organizations, educational institutions, the local government units,
financial institutions, religious groups, socio-civic organizations, sectoral
groups and the like.

The aim of partnership and collaboration is to get people to work

together in order to address problems or concerns that affect man.

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 Working together enables organizations to accomplish their goals
much quicker because resources, skills and views are pooled together.
Organizations can commit and work together in different ways.

A. NETWORKING – is a relationship among organizations that consists of

exchanging information about each other’s goals and objectives,
services or facilities.
B. COORDINATION – is a relationship where organizations modify their
activities in order to provide better service to the target beneficiary.
To a certain extent, this level of organizational relationships becomes
time consuming as it requires more involvement and trust on the part
of the committed organization. Modification of activites that are
more responsive to community’s needs may significantly improve
people’s lives.
C. COOPERATION – is a relationship where organizations share
information and resources and make adjustments in one’s own
agenda to accommodate the other organization’s agenda.
D. COLLABORATION – is the level of organizational relationship where
organizations help each other enhance their capabilities in
performing their tasks as well as in the provision of services. At this
point, the people become partners rather than competitors.
Collaboration entails a lot of work but the potential for change can be
great.
E. COALITION OR MULTI-SECTOR COLLABORATION – is the level of
relationship where organizations and citizens form a partnership. All
parties give priority to the good of the community. It requires great
investment in terms of effort, time, trust and the will to make a
change.

THE FOLLOWING ARE GENERAL IDEAS FOR THE NURSE ON HOW TO GET
STARTED IN PARTNERSHIP AND COLLABORATION WORK:
1. It is imperative for the nurse to involve all the stakeholders in the
process of forging partnership and collaboration with the community.
2. In working together, the nurse and the community face risks together. It
is important therefore, that they need to know and trust each other.
3. Determine how each organization views the problem, how it proposes to
solve the problem and how it perceives an organizational relationship
can help solve the problem.

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 4. Organizations should agree on the kind or level of relationship that will
help best accomplish the group goals considering needs and available
resources.
5. When organization have agreed on the type of organizational
relationship, formulate ground rules that will become the bases for
decision making. The following are the most important points:
- Listen to what each has to say. Points of agreement can only be
reached if there is an exchange of information.
- Take time to listen to people who voice different opinions or
concerns. Keep an open mind. Try to identify points of unity from
diverse opinions.
- Don’t force organizations to give up their identities. Remember,
organizations work together just so they can outdo each other.

THE PARTNERSHIP APPROACH TO COMMUNITY HEALTH PRACTICE

Community health practice aims to ensure optimum use of these

resources through partnership between professional health workers or
change agents, members of the community and representatives of
organizations involved with development programs. This partnership
focuses on mutual responsibilities and joint efforts at minimizing or
overcoming risk and problems to achieve health development goals.
Through partnership, health programs or projects become more
effective and relevant because those who are directly affected by these
programs participate in the development, implementation and
evaluation.
Community take active roles as partners of health professionals and
other change agents in determining needs and problems which become
the bases of planning, implementing, and evaluating health programs,
projects or activities.
In community health program work, the health worker or change
agent has to channel her resources in developing characteristics for
partnership.
Her vital role, therefore centers around development of human
resources. She becomes a catalyst of a slow process of reorienting or
reformulating values in order to change modes of behavior from
autocratic, authoritative, self-centers ways or submissive, subservient
tendencies to those characterized by open mindedness, dynamism, and
egalitarianism.

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 THE ESSENTIAL INGRIDIENT OF PARTNERSHIP
Partnership is a type of relationship characterized by a close
cooperation between parties having specified and joint rights and
specified as they try to work on a common venture. It is egalitarian
relationship where partners consider each other as co-equals in so far
are concerned
They participate equally in assuming responsibilities to achieve the
objectives and goals jointly identified. Such a genuine participation is not
common. Health workers are often faced with the reality that
participants in community health development work of the community,
representatives of agency resources, and the health need to learn how
to work together as real partners.
In order to engage in partnership that is characterized as a mutually
growth-promoting relationship relationship, the partners need to
internalize the following essential ingredients:
a. Belief in egalitarian relationship;
b. Open-mindedness;
c. Respect and trust; and,
d. Commitment to enhance others capabilities for partnership

BELIEF IN EGALITARIAN RELATIONSHIP

- Partnership cannot be a reality unless an egalitarian relationship is
considered vital by the identified partners in health development.
The health worker must firmly believe that in order to achieve
personal, professional or organizational goals and objectives,
she/he must engage in an egalitarian relationship with members
of the community and others involved with development work.

OPEN-MINDEDNESS
- Individuals who are gathered together to do partnership on a
common venture carry with them their past experiences which
affect the way they see, analyze and understand things, events,
and people. As practical beings with limited functions and duties
to perform, they are inclined to feel intensely the importance of
these duties and the significance of these situations that call these
forth.
- Partnership requires that participants learn to be open-minded in
order to see and understand things, events and people without

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 limitations imposed by prejudices and idiosyncrasies. Partners are
expected to possess the skill to view things and experiences from
each other’s perspective to arrive at a more relevant and
appropriate solution to any problem that concerns them both.

RESPECT AND TRUST

For person to be able to engage in an egalitarian relationship they need
to have respect for each other’s worth and trust on the potentialities and
capabilities of each one despite differences in beliefs, values and experiences.
Partners may come from all sectors representing a cross-section of socio-
economic, cultural, educational or political backgrounds. These backgrounds
may affect the partners’ expectations and perceptions of each other.
The professional will expect the poor and the less educated members will
naturally to be passive, submissive, and subservient members. These
expectations become such a self-fulfilling prophecy that the designated
partners could not learn to have respect for the capabilities and potentialities
of each other.
Respect and trust also form the basic ingredients of a relationship where
each partner does not use the other to get the honor or reward only for
himself. Many health professionals and the organizations they represent are
not too encouraged to engage in partnership because past experiences proved
that others get the recognition for the success of an endeavor, the efforts and
investments of which had been a shared activity in the first place.

ADVOCACY
- Advocacy work is one way the nurse can promote active
community participation. The nurse helps the people attain
optimal degree of independence in decision-making in asserting
their rights to a safe and better community.
- The nurse as advocate places the client’s rights as priority. She is
responsible for providing mechanisms for people to participate in
activivties that aim to improve the conditions and carry out
actions that have the potential to better their lives.

ADVOCACY WORK INVOLVES

A. Informing the people about the rightness of the cause. The nurse
conveys the problem to the people shows how it affects them and
describes what possible actions they can take.
B. Thoroughly discussing with the people the nature of the alternative,
their content and possible consequences. While discussing the

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 alternatives, the community needs and problems are implied and
eventually become the basis for decision-making. It is through this
process that the nurse and the people come to agree on the relevance
and appropriateness of the actions to be taken to solve the problem.
C. Supporting people’s right to make a choice and to act on their choice.
The nurse puts emphasis on the people’s right to decide on actions that
they think should benefit the community. It is also the nurse’s
responsibility to facilitate the process of weighing the benefits and
losses of the alternatives. Whatever the outcome of the decision making
process, the nurse assures the people that they do not have to change
their decisions because of others’ objections or pressure.
D. Influencing public opinion. The nurse affirms the decision made by the
people by getting powerful individuals and groups to listen, support and
make substantial changes to solve the problem.

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

 A. Family Structure, Characteristics, and Dynamics

1. Members of the household and relationship to the head of the family.
2. Demographic Data – age, sex, civil status, position in the family.
3. Place of residence of each member – whether living with the family or
elsewhere.
4. Type of Family structure – e.g. matriarchal or patriarchal, nuclear or
extended.

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