NCM(104)CHN-finals

ELOJA, EDWARD ANTIPAS G.

POINTERS IN CHN accessible, acceptable, and sustainable, at a cost, which the

community and the government can afford.
❖ PRIMARY HEALTH CARE
❖ FAMILY GOAL OF PRIMARY HEALTH CARE:
❖ TYPOLOGY OF NURSING PROBLEMS HEALTH FOR ALL FILIPINOS by the year AND 2000 HEALTH IN THE
❖ NEWBORN SCREENING HANDS OF THE PEOPLE by the year 2020.
❖ VACCINES STORAGE
❖ TRADITIONAL HERBAL MEDICINES An improved state of health and quality of life for all people attained
through SELF-RELIANCE
❖ LAWS KEY TO THE GOAL:
Partnership with and Empowerment of the people
(100 ITEMS) • permeate as the core strategy in the effective provision of
essential health services that are community based,
BONUS: PLEASE STUDY AGAIN THE NATIONAL
accessible, acceptable, and sustainable, at a cost, which the
IMMUNIZATION PROGRAM (AN TABLE) community and the government can afford.

TYPE OF EXAM:

- MULTIPLE CHOICE PRINCIPLES OF PRIMARY HEALTH CARE

- IDENTIFICATION
- TRUE OR FALSE
PRIMARY HEALTH CARE
• Basic health care and is a whole of society approach to
healthy well-being. Focused on needs and priorities of
individuals, families and communities (WHO)
• “An essential health care made universally accessible 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 can afford at every
stage of development in the spirit of self-reliance and self-
determination.”
HISTORY OF PRIMARY HEALTH CARE
• Before 1978, globally, existing health services were failing to
provide quality health care to the people.
• Considering these issues, a joint WHO-UNICEF international
conference was held in 1978 in Alma Ata (USSR), commonly
known as ALMA-ATA CONFERENCE
• The conference jointly called for a revolutionary approach to
the health care.
• The Alma-Ata conference called for acceptance of WHO
goal of “Health for All”
• It proclaimed PRIMARY HEALTH CARE (PHC) as a way to
achieve “Health for All”
• In this way, the concept of PHC came into existence
globally in 1978 from Alma-Ata Conference
GOAL OF PRIMARY HEALTH CARE
HEALTH FOR ALL FILIPINOS by the year 2000 and HEALTH IN THE
HANDS OF THE PEOPLE by the year 2020.
1. 4 A’s
▪ Accessibility – The health services are delivered
where people live & work.
▪ Availability – Development of indigenous/resident
volunteer health worker to provide health care. { 1
CHW:10-20 households)
▪ Affordability & Acceptability – Use of low cost,
appropriate technologies sustainable by the
community.
▪ Appropriateness of health services – Combined
utilization of traditional medicine and essential
drugs.
2. Community Participation – heart and soul of PHC
A. Awareness building & consciousness raising on
health & development issues.
B. Community building & community organizing
C. Planning, implementation, & evaluation by the
community
D. Community discussion done thru small group
discussions
E. Selection of CHW by the community
F. Formation of health committees & health
organizations
G. Mass health campaigns
H. Campaigns & community mobilizations.
I. CHW are given competency based trainings.
J. Training curriculum of CHW are based on
community health needs & problems.
K. KSA developed by CHW are on promotive,
preventive, curative, rehabilitative health care
L. Regular supervision & periodic evaluation of CHW
performance.
M. Recognition of the roles of the traditional healers in
the delivery of health services.

An improved state of health and quality of life for all people attained
through SELF-RELIANCE
KEY TO THE GOAL:
Partnership with and Empowerment of the people
• permeate as the core strategy in the effective provision of
essential health services that are community based,
People are the center, object and subject of development.
• Thus, the success of any undertaking that aims at serving
the people is dependent on people’s participation at all levels
of decision-making; planning, implementing, monitoring and
evaluating. Any undertaking must also be based on the
people’s needs and problems (PCF, 1990)
 • Part of the people’s participation is the partnership between • Advocacy for political will & support from the
the community and the agencies found in the community; national leadership to the Barangay level
social mobilization and decentralization. • re-orientation of health professional & other
• In general, health work should start from where the people sectors regarding PHC.
are and building on what they have. MAJOR STRATEGIES OF PRIMARY HEALTH CARE
• Example: Scheduling of Barangay Health Workers in the
Health center
A. HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL
EFFORTS

• Attaining Health for all Filipino will require expanding

participation in health and health related programs whether
BARRIERS OF COMMUNITY INVOLVEMENT
as service provider or beneficiary.
• Lack of motivation
• Empowerment to parents, families and communities to make
• Attitude
decisions of their health is really the desired outcome.
• Resistance to change
• Advocacy must be directed to National and Local policy
• Dependence on the part of community people
making to elicit support and commitment to major health
• Lack of managerial skills
concerns through legislations, budgetary and logistical
considerations.
3. PARTNERSHIP BETWEEN THE COMMUNITY & HEALTH
B. PROMOTING AND SUPPORTING COMMUNITY MANAGED
AGENCIES IN THE PROVISION OF QUALITY, BASIC, &
HEALTH CARE
ESSENTIAL HEALTH SERVICES.
• The health in the hands of the people brings the closest to
▪ the community needs and priorities are the bases
the people.
for planning health services and activities.
• It necessitates a process of capacity building of communities
▪ Providing linkages between the government and
and organization to plan, implement and evaluate health
the non-government organization & people’s
programs at their levels.
organization
C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR
4. SELF-RELIANCE
• Using appropriate technology will make services and
▪ The community generates support for health care.
resources required for their delivery, effective, affordable,
▪ Mobilization of local resources
accessible and culturally acceptable.
▪ Training of community leaders on leadership &
• The development of human resources must correspond to
management skill
the actual needs of the nation and the policies it upholds
▪ Launching of income generating projects,
such as PHC.
cooperatives, family production & small-scale
• The DOH will continue to support and assist both public and
industries.
private institutions particularly in faculty development,
5. Recognition of interrelationship between the health and
enhancement of relevant curricula and development of
development
standard teaching materials.
HEALTH
D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH
▪ is not merely the absence of disease.
• Essential National Health Research (ENHR)
▪ Neither it is only state of physical and mental well-
o is an integrated strategy for organizing and
being.
managing research using intersectoral, multi-
▪ Health being a social phenomenon recognizes the
disciplinary and scientific approach to health
interplay of political, socio-cultural and economic
programming and delivery.
factors as its determinant.
▪ Good Health therefore, is manifested by the
FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE
progressive improvements in the living conditions
1. Active Community Participation
and quality of life enjoyed by the community
▪ People must take active involvement in community
residents.
affairs.
▪ People must want to be healthy to keep healthy.
DEVELOPMENT
▪ Fundamental to primary health care.
▪ is the quest for an improved quality of life for all
2. Intra and Inter-sectoral Linkages
Development is multi-dimensional
▪ Unifying efforts within the health organization.
▪ It has a political, social, cultural, institutional and
▪ Sectors most related to health:
environmental dimensions (Gonzales 1994).
o agriculture
▪ It is measured by the ability of people to satisfy
o population control
their basic needs.
o education
6. SOCIAL MOBILIZATION
o private sectors
It enhances people participation or governance, support
system provided by the government, networking and o Public works
developing secondary leaders. o social welfare
▪ Establishment of an effective health referral o local government
system 3. Use of Appropriate Technology
▪ multi-sectoral & interdisciplinary linkages ▪ The use of methods, procedures, techniques,
▪ Information, education & communication support equipment’s/materials that are not only
using multi-media channels scientifically sound but also suitable to the
▪ Collaboration among government agencies, NGO, community.
& community groups. ▪ A method of technique which provides a socially &
7. DECENTRALIZATION environmentally acceptable level of services or
• Reallocation of budgetary resources. quality product at the least economic cost.
4. Support mechanism made available
▪ Reorientation & reorganization of national health care
system with devolution.
▪ Effective preparation & enabling process for health action at
all levels.
▪ Utilization of appropriate technology.
▪ Mobilization of people to self-reliance
• Community organization for development
• Community participation
• Intra-inter-sectoral linkages with gov’t & non- gov’t agencies
• Partnership of health workers & community leaders
8 ESSENTIAL HEALTH SERVICES (ELEMENTS)
• Education for Health
• Locally endemic disease
• Expanded Program of Immunization/National Immunization
Program
• Maternal and child health and family planning
• Essential drugs
• Nutrition
• Treatment of locally endemic diseases
• Safe water and sanitation.
CHARACTERISTICS OF PHC ESSENTIAL SERVICES
• Community based – health services should be delivered
where the people are.
• Accessible – can be reached by majority of the population.
• Acceptable – the people agree and are satisfied with the
health care services.
• Sustainable – active participation and involvement of the
community members.
• Affordable – utilize traditional herbal medicines and other
alternative forms of healing must be used.
PHC SUMMARY
• WHAT
o An approach/partnership/concept
o Community based
o Knowledgeable response to the inter-related
needs of the community
• WHY
o Making health care accessible, affordable,
sustainable on health for all
o Towards self-reliance, development and social
transformation
• HOW
o Partnership and community participation
o Linkages: intra & inter-sectoral collaboration
o Provision of community services
o Use of appropriate technology and organizing
OBSTACLES OF PHC NURSING
• Role Complexity – the CHN is mandated to perform a high
level of nursing care.
• Special Responsibilities – the CHN focuses not only to the
clients but also in the promotion of health and prevention of
diseases.
• Role Confusion – difficulties can emerge over role
boundaries and over the care provided by the team.
• Lack of skills training – there is a need to changes nurses’
attitudes to enable them to work better with groups in the
community.
FAMILY
• is the basic unit of society
• It is a unity of interacting persons related by ties of marriage,
birth or adoption, whose central purpose is to create and
maintain a common culture which promotes the physical,
mental, emotional and social development of each of its
members (Duval).
• Is defined as composed of two or more people who are
emotionally involved with each other and live in close
geographical proximity. (Friedman)
• is a separate entity with its own structure, functions and
needs, the most basic unit of society (Kristjanson and
Chalmers)
• Means two or more individuals who share a residence or live
near one another, possess some common emotional bonds,
engage in social positions that are interrelated, roles, and
tasks, and share a sense of affection and belonging. (Murray
and Zentner 1997; Friedman 1998)
4 MAJOR FUNCTIONS OF A FAMILY:
(FRIEDMAN,1981) PRODUCTION
• Physical Function
▪ Family members carry out this function by
providing a safe, comfortable environment
necessary for growth, development and
rest/recuperation of each family member.
• Economic Function
▪ The family should be the one to provide financial
aid for members, as well as, meeting monetary
needs of society.
• Reproductive Function
▪ It is met by the birth of children. We all come from
a family by virtue of birth.
• Socialization Function
▪ It is from our own family that we are taught to
socialize with others.
TYPES AND FORMS OF FAMILY
1. On the basis of marriage: Family has been classified into
three major types:
a. Polygamous or polygynous family
b. Polyandrous family
c. Monogamous family
2. One basis of the nature of residence family can be
classified into three main forms.
a. Family of matrilocal residence
b. Family of patrilocal residence
c. Changing Residence
3. On the basis of ancestry or descent family can be
classified into two main types:
a. Matrilineal family
b. Patrilineal family
4. On the basis of the nature of relations among the family
members the family can be classified into two main types.
a. Conjugal family which consists of adult members
among there exists sex relationship.
b. Consanguine family which consists of members
among whom there exists blood relationship-
brother and sister, father and son etc.
Regardless of Family structure and configuration there are four famous
types of a family structure;
1. Nuclear
2. Single Parent
3. Extended
4. Childless
UNIVERSAL CHRACTERISTICS OF FAMILIES
• Universality
▪ Family is the basic unit structure of a society and
is found in every culture and almost all
geographical locations and at all times.
• Emotional Basis
▪ Emotional attachment between father-mother,
parent-children and between siblings, keeps the
family members together as a unit.
• Limited Size:
▪ Since family is a group of people related to each
other by the bonds of blood, adoption or marriage;
the number of members in each group is limited
thus restricting the size of the family.
• Nuclear position in the social structure:
▪ Family is like a unit block in the formation of a
social set-up and it performs various functions.
Although today many of its functions are taken
upon by the various social institutions, yet the
central status of family is indispensable.
• Responsibility of Members:
▪ Each member of the family has a responsibility
towards other family members, towards family and
towards society.
• Social Regulations:
▪ Family is bound to run by certain family and social
regulations. These various rules called taboos,
customs, laws etc., vary in different cultures.
▪ An individual is not free to overlook these (family
and social) regulations which were rather more
strict in olden days as compared to the present-
day society.
• Permanent and Temporary Nature:
▪ Family as an association is temporary in nature.
▪ When one of the partners in a marriage dies, the
association ends; thus the association is
temporary in nature. On the other hand, family as
an institution keeps changing its members and has
permanent existence.
CHARACTERISTICS OF A HEALTHY FAMILY
• Quality time – Family members who have healthy
relationships spend time with one another.
• Communication – Ideas will be exchanged in families with
good communication skills.
• Trust – Healthy families have family members who trust one
another.
• Fulfilling Needs – Individual family members can go
through times of duress and need. During these times, other
family members step up to provide support in a healthy
family.
• Family Goals – Healthy families not only talk about family
goals, further enhancing the channels of communication,
they work together to achieve family goals.
• Boundaries – Parents and grandparents must accept the
duties of managers and teachers, and children must
understand that the family depends upon their abilities to
learn and perform maintenance tasks.
Mutual Respect – When people follow through on their obligations, an
atmosphere of mutual respect is created.
STAGES OF FAMILY
• It is the duty of the health care practitioner to assess whether
the family performs the family task in accordance to what
stage the family undergoes.
• Family health tasks will also be the guide of the care
practitioner in performing the role of the nurse as a health
care educator and counsellor towards making a family
healthy and functional thus achieving the highest possible
level of functioning of family members moreover towards
family and societal development.
STAGES TASK
Beginning Family • establishing a mutually satisfying
marriage
• planning to have or not have children
Child – bearing • having and adjusting to infant
Family • supporting the needs of all the
members
• renegotiating marital relationship
Family with Pre- • adjusting to costs of family life
school Children • adapting to needs of pre-school
children to simulate growth and
development
• coping with parental loss of energy
and privacy
Family with School • adjusting to the motility of growing
Age Children Children
• promoting joint decisions between
children and parents
• encouraging and supporting
children's educational achievements
Family with • maintaining open communication
Teenagers and among members
Young Adults • supporting ethical and moral values
within the family
• balancing freedom with responsibility
for teenagers
• releasing young adults with
appropriate ritual and assistance
• strengthening marital relationship
• maintaining supportive home base
Post- Parental Family • preparing for retirement
• maintaining ties with older and
younger generations
Aging Family • adjusting to retirement
• adjusting to loss of spouse
• closing family house
FAMILY
• Two or more individuals who share a residence or live near
one another, possess some common emotional bands,
engage in social positions that are interrelated, roles, and
tasks, and share a sense of affection and belonging.
o (Murray and Zentner 1997; Friedman 1998)
• A separate entity with its own structure, functions and needs,
the most basic unit of society
o (Kristjanson and Chalmers 1997)
TYPES OF FAMILY
• NUCLEAR FAMILY
o a household consisting of a father, mother and
their children all in one household.
• EXTENDED FAMILY
o a family that includes parents and children and
other relatives in the same household.
o includes aunts, uncles, grandparents, cousins or
other relatives
• THREE-GENERATION FAMILY
o multigenerational family households where two or
more adult generations live together under the
same roof
o includes a grandparent, parent and child.
• DYAD FAMILY
o the smallest unit of a family group
o It is comprised of two people
o include a married couple or parent-child
• SINGLE PARENT
o comprised of a parent/caregiver and one or more
dependent children without the support of a
spouse or adult partner
• STEP PARENT/STEP FAMILY
o family where at least one parent has children who
are not biologically related to their spouse
o a stepfamily forms when one or both in a new
couple bring their children from previous
relationship.
• BLENDED OR RECONSTITUTED FAMILY / STEP FAMILY
o two or more families join together after one or both
partners have divorced their previous partners.
• SINGLE ADULT LIVING ALONE
o one person household, using the census definition
of household, where the householder lives by
himself or herself in an owned or rented place of
residence.
• COHABITING/LIVING-IN
o a living arrangement whereby a couple who is not
married or couple who is in a civil partnership lie
together in the same household.
o The FASTEST GROWING family type.
• NO KIN
o people who are not one’s kin
o those who are not members of one’s family or
related by blood
o such as boarders and lodgers
• COMPOUND FAMILY
o a unit consisting of three or spouses and their
children
o consists of three or more spouses and their
children
• LESBIAN/GAY FAMILY
o a homosexual couple living together with children
• COMMUNE
o a group of families or single people who live and
work together sharing possessions and
responsibilities; a bunch of people with similar
beliefs might all decide to get a big house and live
communally, sharing the cooking, bills and
everything else. ( ex. Women’s Commune)
o their relationship to each other is motivated by
social or religious values rather than kinship
STAGES OF FAMILY LIFE CYCLE
• NEWLY MARRIED COUPLE – couples who recently gotten
married.
• CHILDBEARING – from the birth of the first child until child is
22 years old.
• Family with PRE-SCHOOL children – 3 to 5 years off
• Family with SCHOOL AGE children -6 to 12 years old
• Family with TEENAGERS 13 to 17 years old
• Launching – when children have grown up into adults and
are ready to leave the family home and ends with “empty
nest”. (YOUNG ADULTS and ADULTS)
• MIDDLE-AGED (EMPTY NEST/ PREPARATION FOR
RETIREMENT)
o between the ages of 40 and 60; children begin
establishing families of their own and leave the
family home
• PERIOD OF RETIREMENT or DEATH OF BOTH SPOUSE-
closing family house
TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING
PRACTICE
FIRST LEVEL ASSESSMENT
• The process of determining existing and potential health
conditions or problems.
• This health conditions are categorized as:
o Wellness state
o Health Threat
o Health deficit
o Foreseeable crisis
Categorized Health Problems into:
1. Presence of Wellness Condition
o stated as “Potential or Readiness”
o a clinical or nursing judgment about a client in
transition from a specific level of wellness or
capability to a higher level.
• WELLNESS POTENTIAL
o Is a nursing judgment on wellness state or
condition based on client’s performance,
current competencies or clinical data but no
explicit expression of client desire.
• Examples of POTENTIAL for ENHANCED CAPABILITY
are the following:
o Healthy lifestyle – e.g. nutrition/diet, exercise/
o Activity
o Health Maintenance
o Parenting
o Breastfeeding
o Spiritual Well-being
• process of a client’s unfolding of mystery
through harmonious interconnectedness
that comes from inner strength/sacred
source/GOD (NANDA 2001)
WELLNESS SUPPORTING CUES
CONDITION
POTENTIAL for “Ha amon pamilya kaurugan utan an amun
enhanced capability ginkakaun. Sugad han marigoso,
for health karubasa, sayote, ganas, malunggay ngan
nutrition/lifestyle iba pa. Ginpapahinumdum ko pirmi ha
akun mga anak an pag inum hin sakto nga
kadamo hin tubig.”
READINESS for “Sige po, tikang yana diri na ako makaun
enhanced capability hin noodles primi, ngan magtitikang tikang
for health na ako pag exercise. Aghatun ko gihap ak
nutrition/lifestyle sulod balay nga mag exercise gihap ngan
uminom hin sakto nga kadamu na tubig.”
 POTENTIAL HEALTH THREATS
• conditions that are conducive to disease, accident or failure
to realize one’s health potential.
• Example:
o Family history of hereditary condition, e.g.
diabetes
o Threat of cross infection from a communicable
disease case.
o Family size beyond what family resources can
adequately provide
o Accidental hazards
▪ Broken stairs
▪ Sharp objects, poison, and medicines
improperly kept
o Fire hazards
o Faulty nutritional habits or feeding practices.
▪ Inadequate food intake both in quality &
quantity
▪ Excessive intake of certain nutrients
▪ Faulty eating habits
▪ Ineffective breastfeeding
▪ Faulty feeding practices
o Stress-provoking factors-
▪ Strained marital relationship
▪ Strained parent-sibling relationship
▪ Interpersonal conflicts between family
members
▪ Care-giving burden
o Poor home condition-
▪ Polluted water supply
▪ Presence of breeding sites of vectors of
disease
▪ Improper garbage
▪ Inadequate living space
▪ Lack of food storage facilities
▪ Unsanitary waste disposal
▪ Improper drainage system
▪ Poor ventilation
▪ Noise pollution
▪ Air pollution
o Unsanitary food handling and preparation
o Unhealthful lifestyles and personal habits-
▪ Alcohol drinking
▪ Sexual promiscuity
▪ Cigarette smoking
▪ Engaging in dangerous sports
▪ Inadequate footwear
▪ Inadequate rest
▪ Eating raw meat
▪ Lack of inadequate exercise
▪ Poor personal hygiene
▪ Lack of relaxation activities
▪ Self-medication
▪ Non-use of self protection measures
o Inherent personal characteristics – E.g. poor
impulse control
o Health history which induce the occurrence of a
health deficit, e.g. previous history of difficult labor
o Inappropriate role assumption
▪ e.g. child assuming mother’s role, father
not assuming his role
o Lack of immunization/ inadequate immunization
status specially of children
o Family disunity
▪ Self-oriented behavior of member(s)
▪ Unresolved conflicts of member(s)
▪ Intolerable disagreement
▪ Other
o OTHERS
PRESENCE OF HEALTH DEFICITS
• instances of failure in health maintenance
• Example:
o Illness states, regardless of whether it is
diagnosed or by medical practitioner
o Failure to thrive/ develop according to normal rate
o Disability – whether congenital or arising from
illness; temporary
PRESENCE OF STRESS POINTS/ FORESEEABLT CRISIS
• anticipated periods of unusual demand of the individual or
family in terms of family resources
• Example
o Marriage
o Pregnancy
o Parenthood
o Additional member
o Abortion
o Entrance at school
o Adolescence
o Divorce
o Menopause
o Loss of job
o Hospitalization of a family member
o Death of a manner
o Resettlement in a new community
o Illegitimacy
SECOND LEVEL OF ASSESSMENT
• include those that specify or describe the family’s realities,
perceptions about and attitudes related to the assumption or
performance of family health tasks on each health condition
or problem identified during the first level assessment
• Focus on determining family’s capacity to perform the health
tasks
I. Inability to recognize the presence of the condition or problem
a. Lack of or inadequate knowledge
b. Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem
o Social-stigma, loss of respect of peer/S.O.
o Physical consequences
o Economic/cost implications
o Emotional/psychological
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 break down problems into
manageable units of attack
d. Lack of/inadequate knowledge/insight as to alternative
courses of action open to them
e. Attitude/Philosophy in life, which hinders
recognition/acceptance of a problem
f. Inability to decide which action to take from among a list of
alternatives
g. Conflicting options among family/significant others regarding
action to take
h. Lack of/inadequate knowledge of community resources for
care
 i. Fear of consequences of action, specifically: Social
consequences, economic consequences, physical
consequences, emotional/psychological consequences
j. Negative attitude towards the health condition or problem-by
negative attitude is meant one that interferes with rational
decision- making
k. In accessibility of appropriate resources for care, specifically:
physical inaccessibility, costs constraint/economic/ financial
inaccessibility
l. Lack of trust/confidence in the health personnel/agency
m. Misconception or erroneous information about proposed
course(s) of action
III. Inability to provide adequate nursing care to the sick, disabled,
dependent or vulnerable member of the family due to:
a. Lack of/inadequate knowledge about the disease/health
condition
▪ nature, 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:
▪ absence of responsible member
▪ financial constraints
▪ limitation of/lack of physical resources
g. Significant persons unexpressed feelings which his/her
capacities to provide care
▪ ex. Hostility/anger, guilt, fear/anxiety, despair,
rejection
h. Philosophy in life which negates/hinder caring for the sick,
disabled, dependent, vulnerable risk member
i. Member’s preoccupation with on concerns/interest
j. Prolonged disease or disabilities, which exhaust supportive
capacity of family member
k. Altered role performance, specially:
▪ Role conflict
▪ Role confusion
▪ Role denial
▪ Role dissatisfaction
▪ Role overload
▪ Role strain
IV. Inability to provide a home environment conducive to health
maintenance or personal development due to:
a. Inadequate family resources specifically:
▪ financial constraints/limited financial resources
▪ limited physical resources – e.i. lack of space to
construct facility
b. Failure to see benefits of investments in home environment
improvement
▪ specifically long-term ones
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 supportive relationship among family members
h. Negative attitudes/philosophy in life is not conducive to
health maintenance and personal development
i. Lack of adequate competencies in relating to each other for
mutual growth and maturation
▪ ex: reduced ability to meet the physical and
psychological needs of other members as a result
of family’s preoccupation with current problem or
condition
V. Failure to utilize community resources for health care
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 – physical, financial and
social consequences
f. Unavailability of required care/services
g. Inaccessibility of required services due to:
▪ Cost constraint and physical inaccessibility
h. Lack of or inadequate family resources, specifically:
▪ manpower resources and financial resources
i. Feeling of alienation to/lack of support from the community
▪ Ex. Stigma due to mental illness, AIDS, etc..
j. Negative attitude/philosophy in life which hinders
effective/maximum utilization of community resources for
health care
DATA GATHERING METHODS
• Validity, reliability, adequacy of assessment data
▪ Observation
▪ Physical Exam
▪ Interview
▪ Record review
▪ Laboratory diagnostic test
DATA ANALYSIS
Involves several sub-steps:
1. Sorting of data for broad categories such as those related
with the health status or practices of family members or data
about home and environment
2. Clustering of related cues to determine relationships
between and among data
3. Distinguishing from relevant to irrelevant data to decide
what information is immaterial
4. Identifying patterns such as physiologic function,
developmental, nutritional/dietary, coping/adaptation or
communication patterns and lifestyles
5. Comparing patterns with norms or standards of health, family
functioning and assumptions of health tasks
6. Interpreting results of comparisons to determine signs,
symptoms or cues of specific wellness state/s, health
deficit/s, health threat/s or foreseeable crisis/stress point/s
and their underlying causes or associated factors, and
7. Making inferences or drawing conclusions about the reasons
for the existence of the health condition, problem, risk
factor/s related to non-maintenance of wellness state/s which
can be attributed to non- performance of family health tasks
MAKING DIAGNOSIS
Includes two (2) types:
• Definition of Health Problems
▪ Definition of wellness state/potential or health
condition or problems
▪ End product of 1st level assessment
• Definition of Family Nursing Problems
▪ End product of 2nd level assessment
HEALTH PROBLEM
• situation w/c interferes w/ the health promotion,
maintenance of health & recovery from illness/ injury.
 o The rooming-in and breastfeeding Act, etc.
FAMILY NURSING PROBLEM o Food Fortification Law
Arises when the family cannot effectively perform its health tasks:
• P – ability to recognize the presence of the problem CHARACTERISTICS OF EPI/NIP VACCINES
• A – ability to make decisions with respect to taking More sensitive to OPV -15°C to -25°C (at the
appropriate health action heat freezer)
• N – ability to provide adequate nursing care to the sick, Least sensitive DPT +2°C to +8°C
disabled, dependent or
to heat • D – weakened (in the refrigerator)
member of the family toxin
• E – ability to provide a home environment conducive to • P – killed
health maintenance or personal bacteria
development • T –weakened
• R – ability to utilize community resources for health care toxin

EXAMPLE Hep B
HEALTH PROBLEM: Unsanitary Food Handling and Preparation BCG
TT
FAMILY NURSING PROBLEM
Measles
• Inability to recognize the presence of the problem due to
inadequate knowledge OTHER ESSENTIAL PACKAGES FOR NEWBORN, INFANT AND
• Inability to provide a home environment conducive to health CHILD
maintenance due and personal development due to: • Newborn resuscitation
▪ Inadequate family resources • Newborn routine eye prophylaxis
▪ Lack of knowledge of importance of hygiene and • Prevention and management of hypothermia
sanitation • Newborn screening
▪ Lack of skill in carrying out measures to improve
• Immediate and exclusive breastfeeding
home environment
• Complementary feeding at 6 months
• Birth registration
NEWBORN SCREENING
• Birth weight & growth monitoring
• a simple procedure to find out if the newborn has a
• Full immunization
congenital metabolic disorder that may lead to mental
retardation. • Micronutrient supplementation
• is done on the 48 hour or at least 24 hrs from birth • Dental care
• It uses the heel prick method. • Nutritional screening Disability detection
o The blood is dried for 4 hours and sent to the • First aid
Newborn Screening Laboratory. • Management of common Childhood Illness
• The fee is P550-750.
EXPANDED PROGRAM FOR IMMUNIZATION
NEWBORN SCREENING PACKAGE VACCINE Minimum Age No. Minimum irbers between
at 1st Dose Dose doses
• Congenital Hypothyroidism – results from lack or absence of
BCG Birth or 1
thyroid hormone anytime after
• Congenital Adrenal Hyperplasia birth
o an endocrine disorder that causes severe salt DPT 6 weeks 3 4
loss, dehydration, and abnormally high levels of OPV 6 weeks 3 4
male sex hormones in both boys and girls. Hepa B At birth 3 6 wks from 1st dose & 8
• Galactosemia wks from 2nd dose to 3rd
dose
o a condition in which the body is unable to process
Measles 9 months
galactose, the sugar in milk.
• Phenylketonuria
o a metabolic disorder in which the body cannot
properly use one of the building blocks of protein
called phenylalanine.
• Glucose 6 Phosphate Dehydrogenase Deficiency
o a condition where the lacks the enzyme called
G6PD
o babies may have hemolytic anemia resulting from
exposure to certain drugs, foods and chemicals.

Other Relevant Child Health Programs

• Intensify health education and information campaigns at the
ground level
• Enhance medical, nursing and midwifery education with
cost-effective saving strategies such as the IMCI & BEMOC.
• Pursue the implementation of laws and policies for protection
of newborns, infants & children
o Early Childhood Development Act of 2000
o Newborn Screening Act of 2004
o EO 286 for the Bright Child Program
o EO 51 known as the Milk Code
 TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN EXPANDED PROGRAM FOR IMMUNIZATION
VACCINE MINIMUM PERCENT DURATION OF VACCINE Minimum Age No. Minimum irbers between
AGE PROTECTED PROTECTION at 1st Dose Dose doses
INTERVAL BCG Birth or 1
TT1 As early as 80% anytime after
possible birth
during DPT 6 weeks 3 4
pregnancy OPV 6 weeks 3 4
TT2 At least 4 80% • Infants born to Hepa B At birth 3 6 wks from 1st dose & 8
weeks later the mother will wks from 2nd dose to 3rd
be protected dose
from neonatal Measles 9 months
tetanus.

• Gives 3 years
protection for
the mother
from tetanus

TT3 At least 6 95% • Infants born to

months later the mother will
be protected
from neonatal
tetanus.
• Gives 5 years
protection for
the mother.

TT4 At least 1 99% Gives 10 years

year later protection for the
mother
TT5 At least 1 100% • Gives lifetime
year later protection for
the mother.
• All infants born
to that mother
will be
protected.

Dose: 0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks

TT IMMUNIZATION FOR WOMEN

VACCINE Minimum % Protected
Age/Interval
TT1 As early as possible
during pregnancy
TT2 At least 4 weeks later 80%
TT3 At least 6 months 95%
later
TT4 At least 1 year later 99%
TT5 At least 1 year later 99%

CHARACTERISTICS OF EPI/NIP VACCINES

More sensitive to OPV -15°C to -25°C (at the
heat freezer)
Least sensitive DPT +2°C to +8°C
to heat • D – weakened (in the refrigerator)
toxin
• P – killed
bacteria
• T –weakened
toxin

Hep B
BCG
TT
Measles
 HERBAL MEDICINES
• As part of PHC and because of the increasing cost of drugs,
the use of locally available medicinal plants has been
advocated by the Department of Health
• Many local plants and herbs in the Philippine backyard and
field have been found to be effective in the treatment of
common ailments as attested by the National Science
Development Board, other government and private
agencies/persons engaged in research.
• The DOH is advocating the use of the following ten (10)
herbal plants
o Sambong (Blumes balsamifera)
o Akapulko (Cassia, alata L. )
o Niyug Niyogan (Quisqualis indica L.)
o Tsaang Gubat (Carmona retusa)
o Ampalaya (Mamordica charantie)
o Lagundi (Vitex negundo )
o Ulasimang Bato (Peperonia pellucida)
o Bawang
o Bayabas/Guava (Psidium guajava L.)
o Yerba ( Hierba) Buena (Mentha cordelia)
SAMBONG (Blumea Balsamifera)
• Uses: ANTI-EDEMA, DIURETIC, ANTI-UROLITHIASIS
o Boil chopped leaves in water for 15 minutes until 1
glass full remans.
o Cool and strain
• Note: Sambong is not a medicine for kidney infection.
AKAPULKO (Cassia, Alata L.)
• Uses: ANTI-FUNGAL
o Fresh matured leaves are pounded.
o Apply as soap to the affected part 1 -2 times a
day.
NIYUG – NIYOGAN (Quisqualis indica L.)
• Uses: ANTI-HELMINTHIC (used to expel round worms
ascariasis)
o The seeds are taken 2 hours after supper.
o If no worms are expelled, the dose may be
repeated after one week.
• Caution: Not to be given to children below four years old
TSAANG GUBAT (Carmona Retusa)
• Uses:
o DIARRHEA
▪ Boil the following amount of chopped
leaves in 2 glasses of water for 15
minutes or until amount of water goes
down to 1 glass. Cool and strain
o STOMACHACHE
▪ Wash leaves and chop.
▪ Boil chopped leaves in 1 glass of water
for 15 minutes.
▪ Cool and filter/strain and drink
AMPALAYA (Mamordica Charantia)
• Uses: LOWER BLOOD SUGAR LEVELS (DIABETES
MELLLITUS)
o Gather and wash young leaves very well.
o Chop.
o Boil 6 tablespoons in two glassfuls of water for 15
minutes under low fire.
o Do not cover pot.
o Cool & strain.
o Take one third cup 3 times a day after meals.
• Note: Young leaves may be blanched/steamed and eaten½
glassful 2 times a day.
LAGUNDI (Vitex Negundo)
• Uses:
o ASTHMA, COUGH AND FEVER
▪ Boil chopped raw fruits or leaves in 2
glasses of water left for 15 min. until
water left in 1 glass. Strain.
o DESENTERY, COLDS, AND PAIN
▪ decoct a handful of leaves & flowers in
water
o SKIN DISEASE (scabies, ulcer, dermatitis,
eczema)
▪ decoct leaves, wash & clean the skin
o HEADACHE
▪ crushed leaves may be applied on the
forehead
o RHEUMATISM, SPRAIN, CONTUSIONS, INSECT
BITES
▪ Pound the leaves and apply on the
affected part
o AROMATIC BATH FOR SICK PATIENTS
▪ prepare leaf decoction for use in sick
and newly delivered patients.
ULASIMANG–BATO (Peperonia pellucida)
• Uses: LOWERS URIC ACID (RHEUMATISM AND GOUT)
o Wash the leaves well.
o One and a half cup leaves are boiled in two
glassfuls of water over low fire.
o Do not cover pot.
o Cool and strain.
o Divide into three parts and drink each part three
times a day after meals.
o May also be eaten as salad.
▪ Wash the leaves.
▪ Prepared 1 and ½ cups of leaves and
take it 3x a day.
BAWANG
• Uses: HYPERTENSION, TOOTHACHE AND TO LOWER
CHOLESTEROL LEVELS IN BLOOD
o May be fried, roasted, soaked in vinegar for 30
min. or blanched in boiled water for 5 minutes.
Take 2 pcs 3x a day after meals
• Toothache: pound a small pc and apply to affected part
• Caution: take on a full stomach to prevent stomach and
intestinal ulcers.
BAYABAS/Guava (Psidium guajava L.)
• Uses
o WASHING WOUNDS
▪ wash guava leaves & boil for 15 minutes
at low fire, do not cover pot, cool &
strain
▪ may be used twice a day
o DIARRHEA
▪ wash guava leaves & boil for 15 minutes
at low. fire, do not cover pot, cool &
strain
o TOOTHACHE
▪ warm decoction is used for gargle.
YERBA (Hierba) BUENA (Mentha cordifelia)
• Uses:
o FOR PAIN IN DIFFERENT PARTS OF THE
BODY AS HEADACHE, STOMACHACHE
▪ boil chopped leaves in 2 glasses of
water for 15 minutes. Cool and strain
 o NAUSEA AND FAINTING – crush leaves & apply
at nostrils of patient
o RHEUMATISM, ARTHRITIS AND HEADACHE
▪ crush the fresh leaves and squeeze sap.
▪ Massage sap on painful parts with
eucalyptus
o COUGH AND COLD
▪ Get about 10 fresh leaves and soak in a
glass of boiling water for 30 minutes.
Use solution to gargle.
o SWOLLEN GUMS
▪ Steep 6gms of fresh plant in a glass of
boiling water for 30 minutes.
▪ Use solution as gargle.
o TOOTHACHE
▪ Cut fresh plant and squeeze sap.
▪ Soak a piece to cotton in the sap and
insert this in aching tooth cavity.
▪ Mouth should be rinsed by gargling salt
solution before inserting the cotton.
▪ To prepare salt solution: add 5gms or 7
table salt to one glass of water.
o MENSTRUAL AND GAS PAIN
▪ Soak a handful of leaves in a glass of
boiling water.
▪ Drink infusion. It induces menstrual flow
and sweating.
o INSECT BITES
▪ Crush leaves and apply juice on affected
part or pound leaves until paste-like and
rub this on affected part.
o PRURITUS
▪ Boil plant alone or with eucalyptus in
water. Use decoction as a wash on
affected area.
REMINDERS ON THE USE OF HERBAL MEDICINES
• Avoid the use of insecticides as these may leave poison on
plants.
• In the preparation of herbal medicine, use a clay pot and
remove cover while boiling at low heat.
• Use only the part of the plant being advocated.
• Follow accurate dose of suggested preparation.
• Use only one kind of herbal plant for each type of symptoms
or sickness.
• Stop giving the herbal meds in case untoward reaction such
as allergy.
• Consult a doctor if symptoms are not relieved after 2 or 3
doses.
GUIDLEINES ON THE USE OF MEDICINAL PLANTS
• B – boiling: remove cover
• O – one kind of plant for each type of symptoms
• N – no insecticides
• U – use clay pot and plant part advocated
• S – stop in case of untoward reactions; seek consultation if
S/S are not relieved after 2-3 doses.
DECOCTION
Procedures/Preparations
• Gather leaves & wash thoroughly, place in a container the
washed leaves
• Let it boil without cover to vaporize/steam to release toxic
• Substance-add water
• Use extracts for washing undesirable taste
POULTICE
Procedures/Preparations for treatment of skin disease
• Example
o 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
o Done by pounding or chewing leaves used by
herbolaryo
INFUSION
Procedures/Preparations
• To prepare a tea (use lipton bag), keep standing for 15
minutes in a cup of warm water where a brown solution is
collected, pectin which serves as an adsorbent and
astringent
JUICE/SYRUP
Procedures/Preparations
• 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
Procedures/Preparations
• 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:
o 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
LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF
COMMUNITY HEALTH NURSING
• Acts – are laws passed by the congress of the Philippines.
• Decrees – are orders of the President in his capacity to act
as legislator.
• Orders – are issued by the Executive Department in order to
implement a Constitutional or statutory provision.
R.A. 7160 OR THE LOCAL GOVERNMENT CODE
• Involves the devolution of powers, functions and
responsibilities to the local government both rural & urban
• The code aims to transform local government units into self-
reliant communities and active partners in the attainment of
national goals thru a more responsive and accountable local
government structure instituted thru a system of
decentralization.
• Hence, each province, city and municipality has a lacal
health board (LHB) which is mandated to propose annual
budgetary allocations for the operation and maintenance of
their own health facilities.
o DETERMINANTS OF SUCCESS:
▪ LGU’s financial capability
▪ A dynamic and responsive political
leadership
▪ Community empowerment
R.A. 2382 – Philippine Medical Act.
• This act defines the practice of medicine in the country.
R.A. 1082 Rural Health Act. – created the 1st 81 Rural Health Units.
• amended by RA 1891; more physicians, dentists, nurses,
midwives and sanitary inspectors will live in the rural areas
where they are assigned in order to raise the health
conditions of barrio people, hence help decrease the high
incidence of preventable diseases
RA 2644 Philippine Midwifery Act
• Registered nurses may practice midwifery through passing
the midwifery exam and completed 20 actual deliveries.
RA 2382 Practice of Medicine by a Nurse
• during epidemics/national emergencies, whenever services
of doctor are not available.
R.A. 7305 Magna Carta for Public Health Workers.
• This act aims:
o to promote and improve the social and economic
well-being of health workers, their living and
working conditions and terms of employ aims
o to develop their skills and capabilities in order that
they will be more responsive and better equipped
to deliver health projects and programs
o to encourage those with proper qualifications and
excellent abilities to join and remain in government
service.
R.A. 6758
• standardizes the salary of government employees including
the nursing personnel.
R.A. 8423 – created the Philippine of Traditional and Alternative Health
Care (PITAHC).
R.A. 8344
• an act penalizing the refusal of hospitals and medical clinics
to administer appropriate initial treatment and support in
emergency cases.
R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials
and Employees.
• It is the policy of the state to promote high standards of
ethics in public office.
• Public officials & employees shall at all times be accountable
to the people and shall discharges their duties with utmost
responsibility, integrity, competence &loyalty, act with
patriotism and justice, modest lives uphold public interest
over personal interest
PD 626
• employee compensation and state insurance fund where
injury/death that is work-related is compensable.
PD 807 – Civil service law
• provides for recruitment and selection of employees in
government service,
EO 180 – guidelines on the right to organize government employees
Letter of Instruction No. 949 – legal basis of Primary Health Care dated
OCT. 19, 1979
• Promotes development of health programs on the
community level
PD 442 labor code of the Philippines
• provides for the rights, benefits/privileges of employees in
the private sector – vacation/sick leave, night shift
differentials (10%), overtime pay.
R.A. 7875 –National Health Insurance Act
RA 6675 – Generic Drug Act of 1988
• which promotes, requires and ensures the production of an
adequate supply, distribution, use and acceptance of drugs
and medicines identified by their generic name.
• generic/brand name, drug list
R.A. 9165 Comprehensive Dangerous Drug Act of 2002
• prohibited acts: sell, administer, deliver/distribute/transport
drugs, importation of prohibited drugs, maintenance of
den/drive, use and possession, & culture of plants.
R.A. 953 Narcotic Drug Act
• Registration and imposition of license on all persons who
deal in narcotic drugs and the control of the legal traffic in
narcotic drugs.
R.A. 6425 Dangerous Drug Act – Provision of S2
• code for selected doctors who can prescribe narcotic drugs.
R.A. 7877 Anti Sexual Harassment Law
• Authority, influence or moral ascendancy over another who
demands, requests or requires any sexual favors.
R.A. 9262 Anti Violence against Women and Their children physical,
sexual, psychological and economic abuse
R.A. 7610-anti – child abuse
R.A. 7658 – an act prohibiting the employment of children below 15
yrs. Old
R.A. 6809 – emancipation law lowered majority age from 21 to 18
years old
P.D. No. 965
• requires applicants for marriage license to receive
instructions on family planning and responsible parenthood.
P. D. 418 – promote the concept of family responsible parenthood and
family planning.
P.D. NO. 79 – defines, objectives, duties and functions of POPCÓM
EO 209 Family Code
P.D. No. 651
• requires that all health workers shall identify and encourage
the registration of all births within 30 days following delivery.
P. D. 603 – child and youth welfare code
• registration of births, child’s health, freedom of expression,
right to basic health services.
P.D. No. 996
• requires the compulsory immunization of all children below 8
yrs. Of age against the 6 childhood immunizable diseases.
Α. Ο. NO. 2005-0014- ΝΑΤIONAL POLICIES ON INFANT AND
YOUNG CHILD FEEDING:
• All newborns be breastfeed within 1 hr. after birth
• Infants be exclusively breastfeed for 6 mos.
• Infants be given timely, adequate and safe complementary
foods
• Breastfeeding be continued up to 2 years and beyond
E.O. 51 – Phil. Code of Marketing of Breast milk Substitutes
Α.Ο. No. 2006-0012
• specifies the Revised Implementing Rules and Regulations
of E.O. 51 or Milk Code, Relevant International Agreements,
Penalizing Violations thereof and for other purposes
R.A. 7600 – Rooming In and Breastfeeding Act of 1992
R.A. 8980 of 2000
• promulgates a comprehensive policy and a national system
for Early Childhood Care (ECCD)
• An act promulgating a comprehensive policy and a national
system for early childhood care and development (ECCD),
providing funds therefor and for other purposes
• It is hereby declared the policy of the State to promote the
rights of children to survival, development and special
protection with full recognition of the nature of childhood and
its special needs; and to support parents in their roles as
primary caregivers and as their children’s first teachers
Α.Ο. No. 2006-0015
• defines the Implementing guidelines on Hepatitis B
Immunization for Infants
R.A. 7846
• mandates Compulsory Hepatitis B Immunization among
infants and children less than 8 yrs. Old
R. A. 7719 National Blood Services Act
R.A. 8172 Salt lodization Act (ASIN LAW)
R.A. 8976 Food Fortification Law
R.A. 3573
• an act providing for the prevention and suppression of
dangerous Communicable Diseases
• requires reporting of all cases of communicable diseases
and administration of prophylaxis
Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease.
R.A. 4073 –advocates home treatment for leprosy
R.A. 2029 – mandates Liver Cancer and Hepatitis B Awareness Month
Act (February)
R.A. 8749 Philippine Clean Air Act of 1999
• right of people to a balanced and healthful ecology, promote
and protect the global environment.
P.D. No. 856 –Code on Sanitation.
• It provides for the control of all factors in man’s environment
that affect health including the quality of water, food, milk,
insects, animal carriers, transmitters of disease, sanitary and
recreation facilities, noise, pollution and control of nuisance.
P.D. No. 825 – Garbage disposal act
• Provides penalty for improper disposal of garbage
R.A. 7432 –Senior Citizens Act.
R. A. 7876
• an act establishing a senior citizens center in all cities and
municipalities of the Philippines, and appropriating funds
thereof.
R.A.7277 – Magna Carta for Persons with Disabilities (PWD’s)
• provides their rehabilitation, self-development and self-
reliance and integration into the mainstream of society