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THE DEPARTMENT OF

HEALTH
VISION: HEALTH FOR ALL FILIPINOS
MISSION: ENSURE ACCESSIBILITY &
QUALITY OF HEALTH CARE TO
IMPROVE THE QUALITY OF LIFE OF ALL
FILIPINOS, ESPECIALLY THE POOR.
NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality
of life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism, Sexually
Transmitted Diseases, Hepatitis B, Accident &
Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma
& Chronic Obstructive Pulmonary Diseases, Nephritis
& Chronic Kidney Diseases, Mental Disorders, Protein
Energy Malnutrition, Iron Deficiency Anemia &
Obesity.
3.Eliminate the ff. diseases as public health problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical
activity & fitness, personal hygiene, mental health & less stressful life
& prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families & special populations
through child, adolescent & youth, adult health, womens health,
health of older persons, health of indigenous people, health of
migrant workers and health of different disabled persons and of the
rural & urban poor.
7. Promote environmental health and sustainable development
through the promotion and maintenance of healthy homes,
schools, workplaces, establishments and communities towns
and cities.
Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health services must
be ensured.
2. The health and nutrition of vulnerable groups
must be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector must be
enhanced.
Primary Strategies to
Achieve Goals
1. Increasing investment for Primary Health Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
PHC as a Strategy
PRIMARY HEALTH CARE (PHC)

May 1977 -30th World Health Assembly decided that the main health
target of the government and WHO is the attainment of a level of
health that would permit them to lead a socially and economically
productive life by the year 2000.
September 6-12, 1978 - First International Conference on PHC in Alma
Ata, Russia (USSR) The Alma Ata Declaration stated that PHC was the
key to attain the health for all goal
October 19, 1979 - Letter of Instruction (LOI) 949),
the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos,
which adopted PHC as an approach towards
the design, development and implementation of
programs focusing on health development at
community level.
RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

Magnitude of Health Problems


Inadequate and unequal distribution of health resources
Increasing cost of medical care
Isolation of health care activities from other development
activities
GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE PEOPLE by
he year 2020.

An improved state of health and quality of life for all people attained
through SELF-RELIANCE.

KEY STRATEGY TO ACHIEVE 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, accessible, acceptable,
and sustainable, at a cost, which the community
and the government can afford.
OBJECTIVES OF PRIMARY HEALTH CARE
Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable
and other disease.
Reduction in morbidity and mortality rates especially among
infants and children.
Extension of essential health services with priority given to the
underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at
self-reliance.
Maximizing the contribution of the other sectors for the social
and economic development of the community.
MISSION:
To strengthen the health care system
by increasing opportunities and
supporting the conditions wherein
people will manage their own health
care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

1. Barangay Health Workers - trained community


health workers or health auxiliary volunteers or
traditional birth attendants or healers.
2. Intermediate level health workers include the
Public Health Nurse, Rural Sanitary Inspector and
midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A's = Accessibility, Availability,
Affordability & Acceptability, Appropriateness of health
services. The health services should be present where the supposed
recipients are. They should make use of the available resources
within the community, wherein the focus would be more on health
promotion and prevention of illness.

2. COMMUNITY PARTICIPATION
=heart and soul of PHC
3. People are the center, object and subject of development.
Thus, the success of any undertaking that aims at
serving the people is dependent on peoples
participation at all levels of decision-making;
planning, implementing, monitoring and
evaluating. Any undertaking must also be based
on the peoples needs and problems (PCF, 1990)
Part of the peoples participation is the
partnership between the community and the
agencies found in the community; social
mobilization and decentralization.
In general, health work should start from where
the people are and building on what they have.
Example: Scheduling of Barangay Health Workers
in the health center
BARRIERS OF COMMUNITY INVOLVEMENT

Lack of motivation
Attitude
Resistance to change
Dependence on the part of
community people
Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the
community and the health
agencies in the provision of quality
of life.
Providing linkages between the
government and the non-
government organization and
peoples organization.
6. Recognition of interrelationship between
the health and development
HEALTH
is not merely the absence of disease. Neither it is
only a state of physical and mental well-being.
Health being a social phenomenon recognizes
the interplay of political, socio-cultural and
economic factors as its determinant. Good
Health therefore, is manifested by the progressive
improvements in the living conditions and quality
of life enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved quality
of life for all. Development is multi-dimensional. It
has a political, social, cultural, institutional and
environmental dimensions(Gonzales 1994).
Therefore, it is measured by the ability of people
to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or
governance, support system
provided by the Government,
networking and developing
secondary leaders.

8. DECENTRALIZATION
MAJOR STRATEGIES OF PRIMARY HEALTH
CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND
SUSTAINED NATIONAL EFFORTS.
Attaining Health for all Filipino 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 really 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.
B. 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.
C. INCREASING EFFICIENCIES IN THE 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 DOH will continue to support and assist
both public and private institutions particularly in faculty
development, enhancement of relevant curricula and development
of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL HEALTH
RESEARCH
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.
FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH

Name Indications Dosage


1.Five-leaf 1. Asthma Divide the decoction
Chaste tree 2. Cough into 3 parts:
(Lagundi) 3. Body Pain For asthma and
4. Fever cough, drink 1 part 3
times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh-Mint; 1. Body pain Divide
Peppermint decoction into
(Yerba Buena) 2 parts and
drink 1 part
every 3 hours.

3. Sambong 1. Swelling Divide


2. Inducing decoction into
diuresis 3 parts and
( anti- drink 1 part 3
urolithiasis) times a day.
4. Tsaang 1. Stomachache Drink the warm
Gubat decoction. If it
persists, or if there is
no improvement an
hour after drinking the
decoction, consult a
doctor.
5. 1. Gouty Arthritis Divide the
Ulasimang decoction into 3
Bato/Pansit- parts and drink 1
Pansitan part 3 times a day
after meals.
6. Garlic 1. Hypertension Eat 6 cloves of
2. Htperlipidemia garlic together
with meals
7. Niyog- 1. Ascariasis Chew and swallow
only dried seeds 2
Niyogan hours after dinner
according to the
following:
ADULTS = 8-10
seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
8. Guava 1. Cleaning For wound cleaning,
wounds use decoction for
2. Mouth wash washing the wound 2
for mouth times a day
infection, For tooth decay and
sore gums & swelling of gums,
tooth decay gargle with warm
decoction 3 times a day
9. 1. Ring worm Apply the juice on the affected
Akapulko 2. Athletes area 1 to 2 times a day
foot If the person develops an allergy
3. Scabies while using the above preparation,
prepare the following:
oPut 1 cup of chopped fresh
leaves in an earthen jar. Pour in 2
glasses of water and cover it.
oBoil the mixture until the 2
glasses of water originally poured
have been reduced to 1 glass of
water
oStrain the mixture. Use it while it
is warm.
oApply the warm decoction on the
affected area 1 to 2 times a day.
10. 1. Mild Non- Drink cup
Bitter Gourd/ Insulin of cooled or
Melon Depende warm
(Ampalaya) nt decoction 3
Diabetes times a day
Mellitus after meals.
11. 1. Motion An abortifacient if taken
Ginger sickness, in large amounts; should
(Zingiber sore throat, not be used by persons
officinale) nausea & with cholelithiasis unless
vomiting, directed by the physician;
migraine may increase the risk of
headaches, bleeding when used
arthritis concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of
ginger root, and mix in a glass
of water
Boil the mixture
Drink the cooled or warm
decoction as needed.
ELEMENTS OF PRIMARY HEALTH CARE:

Education For Health


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.
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
Expanded Program on 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
Maternal and Child Health and
Family Planning
The mother and child are the most
delicate members of the community.
So the protection of the mother and
child to illness and other risks would
ensure good health for the
community. The goal of Family
Planning includes spacing of children
and responsible parenthood.
Environmental Sanitation and
Promotion of Safe Water Supply
Environmental Sanitation is defined as the study of all factors in the
mans 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 mans environment.
Water is necessary for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic promotion of
health.
Nutrition and Promotion of Adequate
Food Supply
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 is one of the
problems that we have in the country.
Treatment of Communicable Diseases
and Common Illness
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.
Supply of Essential Drugs
This focuses on the information campaign on the
utilization and acquisition of drugs.
In response to this campaign, the GENERIC ACT of the
Philippines is enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
FAMILY HEALTH NURSING
- that level of CHN practice directed to the FAMILY as the
unit of care with HEALTH as the goal and NURSING as the
medium, channel or provider of care
Family Case Load

- the no. and kind of families a nurse handles at


any given time
- variable for cases are added or dropped based
on the need for nursing care and supervision
Types of Families

1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
Types of Families

8. Single adult living alone


9. Cohabiting/ Living in
10. No- kin
11. Compound
12. Gay
14. Commune
Stages of Family Life Cycle

1. Newly married couple


2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest
retirement)
8. Period from retirement to Death of
both spouses
HEALTH TASKS OF THE
FAMILY( Freeman, 1981)
1. recognizing interruptions of health or
development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled
and dependent member of the family
5. maintaining a home environment
conducive to good health and personal
development
6. maintaining a reciprocal relationship with
the community and health institutions
Family Nursing Problem

Arises when the family cannot effectively perform


its health tasks
Nurses Roles in Family
Health Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR
FAMILY NURSING PRACTICE
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
5. Dominant family members in terms
of decision-making, especially in
matters of health care
6. General family
relationship/dynamics presence of
any readily observable conflict
between members; characteristics
communication patterns among
members
Socio-economic and Cultural
Characteristics
1. Income and Expenses
Occupation, place of work and
income of each working members
Adequacy to meet basic necessities
Who makes decisions about money
and how it is spent
2. Educational attainment of each
other
3. Ethnic background and religious
affiliation
4. Significant Others role(s)
they play in familys life
5. Relationship of the family
to larger community
Nature and extent of
participation of the family
in community activities
Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership, portability
Toilet facility type, ownership, sanitary condition
Drainage system type, sanitary condition
2. Kind of neighborhood, e.g.
congested, slum, etc.
3. Social and health facilities
available
4. Communication and
transportation facilities
available
Health Status of each Family
Member
1. Medical and nursing history indicating current or past
significant illnesses or beliefs and practices conducive to health
illness
2. Nutritional assessment
Anthropometric data: Measures of nutritional status of children,
weight, height, mid-upper arm circumference: Risk assessment
measures of obesity: body mass index, waist circumference, waist
hip ratio
Dietary history specifying quality and quantity of food/nutrient
intake per day
Eating/ feeding habits/ practices
3. Developmental assessments of infants, toddlers, and preschoolers
e.g., Metro Manila
4. Risk factor assessment indicating presence of major and
contributing modifiable risk factors for specific lifestyles, cigarette
smoking, elevated blood lipids, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking and other
substance abuse
5. Physical assessment
indicating presence of
illness state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
Values, Habits, Practices on Health
Promotion, Maintenance and
Disease Prevention.
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate footwear in parasite-
infested areas;
relaxation and other stress management activities
4. Use of promotive-preventive health services
A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
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 clients performance, current
competencies or clinical data but no
explicit expression of client desire.
Readiness for enhanced wellness state is a
nursing judgment on wellness state or
condition based on clients current
competencies or performance, clinical
data explicit expression of desire to achieve
a higher level of state or function in specific
area on health promotion and
maintenance.
Examples of these are the following:

1. Potential for Enhanced Capability for:


Healthy lifestyle e.g. nutrition/diet,
exercise/ activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a clients
unfolding of mystery through harmonious
interconnectedness that comes from
inner strength/sacred source/GOD
(NANDA 2001)
Others,
2. Readiness for Enhanced
Capability for:
Healthy Lifestyle
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being
Others,
I. Presence of Health Threats
conditions that are conducive to
disease, accident or failure top
realize ones health potential.
Examples of these are the following:
1. Family history of hereditary
condition, e.g. diabetes
2. Threat of cross infection from a
communicable disease case
3. Family size beyond what
family resources can
adequately provide
4. Accidental hazards
Broken stairs
Sharp objects, poison, and
medicines improperly kept
Fire hazards
5. 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
6. Stress-provoking factors
Strained marital relationship
Strained parent-sibling
relationship
Interpersonal conflicts
between family members
Care-giving burden
7. Poor home condition-
Inadequate living space
Lack of food storage facilities
Unsanitary
Polluted water supply waste disposal
Presence of breeding sites of Improper
vectors of disease
Improper garbage
drainage
system
Poor ventilation
Noise pollution
Air pollution
8. Unsanitary food handling and preparation
9. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
10. Inherent personal characteristics
e.g. poor impulse control
11. Health history which induce the
occurrence of a health deficit, e.g.
previous history of difficult labor
12. Inappropriate role assumption
e.g. child assuming mother's role,
father not assuming his role
13. Lack of immunization/ inadequate
immunization status specially of
children
14.Family disunity
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
15.Other
III. Presence of Health Deficits
instances of failure in health
maintenance.
Examples include:

1. Illness states, regardless of


whether it is diagnosed or by
medical practitioner
2. Failure to thrive/ develop
according to normal rate
3. Disability whether congenital or
arising from illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis
Situations anticipated periods of unusual
demand of the individual or family in terms of
family resources.
Examples of these include:
1. Marriage 9. Menopause
2. Pregnancy 10. Loss of job
3. Parenthood 11. Hospitalization of a
4. Additional member family member
5. Abortion 12. Death of a manner
6. Entrance at school 13. Resettlement in
a
7. Adolescence new community
8. Divorce 14. illegitimacy
Second Level Assessment

Focus on determining familys capacity to


perform the health tasks
Statements on family health nursing problem:
a. Inability to recognize the presence of the
condition or problem
b. Inability to make decisions with respect to
taking appropriate health action
c. Inability to provide adequate nursing care to
the sick, disabled , dependent or vulnerable
member of the family
d. Inability to provide a home environment
conducive to health maintenance or personal
development
e. Failure to utilize community resources for
health care
Scale for Ranking Health
Conditions and Problems
according to priorities
Criteria:
a. Nature of the condition or problem
presented
( wellness state, health deficit, health threat,
forseeable crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not
immediate, not perceived as a problem)
COMMUNITY HEALTH CARE
PROCESS
Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health of
the community people
Evaluation
Purpose : To determine the effectiveness of health care
programs
NURSING PROCEDURES
CLINIC VISIT
- process of checking the clients health
condition in a medical clinic
HOME VISIT
- a professional face to face contact made by
the nurse with a patient or the family to
provide necessary health care activities and
to further attain the objectives of the agency
BAG TECHNIQUE
-a tool making of the public health bag through
which the nurse during the home visit can
perform nursing procedures with ease and
deftness saving time and effort with the end in
view of rendering effective nursing care
THERMOMETER TECHNIQUE
-to assess the clients health condition through body temperature
reading
NURSING CARE IN THE HOME
- giving to the individual patient the nursing care required by his/her
specific illness or trauma to help him/her reach a level of
functioning at which he/she can maintain himself/herself or die
peacefully in dignity
ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client with communicable disease
to prevent the spread of infection:
2. frequent washing and airing of beddings and other articles and
disinfections of room
3. wearing a protective gown , to be used only within the room of the
sick member
4. discarding properly all nasal and throat discharges of any member
sick with communicable disease
5. burning all soiled articles if could be or contaminated articles be
boiled first in water 30 minutes before laundering
INTRAVENOUS THERAPY
- insertion of a needle or catheter into a vein to provide medication
and fluids based on physicians written prescription
- can be done only by nurses accredited by ANSAP
PRINCIPLES OF HEALTH
EDUCATION
It considers the health status of the people,
which is determined by the economic and
social conscience of the country.
It is a process whereby people learn to improve
their personal habits and attitudes, to work
responsibly for the improvement of health
conditions of the family, community, and
nation.
It involves motivation, experience,
and change in conduct and
thinking, while stimulating active
interest. It develops and provides
experience for change in peoples
attitudes, customs, and habits in
relation to health and everyday
living.
It should be recognized as the basic
function of all health workers.
It takes place in the home, in
the school, and in the
community.
It is a cooperative effort
requiring all categories of health
personnel to work together in
close teamwork with families,
groups, and the community.
It meets the needs, interests,
and problems of the people
affected.
It finds means and ways of
carrying out plans by
encouraging individual and
community participation.
It is a slow, continuous
process that involves
constant changes and
revisions until objectives are
achieved.
Makes use of supplementary
aids and devices to help with
the verbal instructions.
It utilizes community resources by
careful evaluation of the different
services and resources found in the
community.
It is a creative process requiring
methods and techniques with
various characteristics, not following
a rigid and flexible pattern.
It aims to help people make use of
their own efforts and education to
improve their conditions of living,
It makes careful evaluation of the
planning, organization, and
implementation of all health
education programs and activities.
THE COMMUNITY HEALTH
NURSE

Qualifications
1. Bachelor of
Science in Nursing
2. Registered Nurse
of the Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems of
individuals, families, and communities
2. Formulates municipal health plan in the
absence of a medical doctor
3. Interprets and implements nursing plan,
program policies, memoranda, and circular
for the concerned staff personnel
4. Provides technical assistance to rural health
midwives in health matters
Provider of Nursing
Care
1. Provides direct nursing care to sick
or disabled in the home, clinic,
school, or workplace
2. Develops the familys capability to
take care of the sick, disabled, or
dependent member
Manager/Supervisor
1. Formulates individual, family, group, and community-centered
plan
2. Interprets and implements programs, policies, memoranda, and
circulars
3. Organizes work force, resources, equipments, and supplies at
local level
4. Provides technical and administrative support to Rural Health
Midwives (RHM)
5. Conducts regular supervisory visits and meetings to different
RHMs and gives feedback on accomplishments
Community Organizer
1. Motivates and enhances
community participation in
terms of planning,
organizing, implementing,
and evaluating health
services
2. Initiates and participates in
community development
activities
Coordinator of Services
1. Coordinates with individuals,
families, and groups for health
related services provided by
various members of the health
team
2. Coordinates nursing program with
other health programs like
environmental sanitation, health
education, dental health, and
mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the RHMs, Barangay
Health Workers (BHW), and hilots
2. Conducts training for RHMs and hilots on promotion and disease
prevention
3. Conducts pre and post-consultation conferences for clinic
clients; acts as a resource speaker on health and health-related
services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print
ads) for health education purposes
5. Conducts pre-marital counseling
Health Monitor
1. Detects deviation from
health of individuals,
families, groups, and
communities through
contacts/visits with them
Role Model
1. Provides good
example of
healthful living to
the members of
the community
Change Agent
1. Motivates changes in
health behavior in
individuals, families,
groups, and communities
that also include lifestyle in
order to promote and
maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required
reports and records
2. Maintain adequate, accurate,
and complete recording and
reporting
3. Reviews, validates, consolidates,
analyzes, and interprets all records
and reports
4. Prepares statistical data/chart and
other data presentation
Researcher
1. Participates in the conduct of
survey studies and researches
on nursing and health-related
subjects
2. Coordinates with government
and non-government
organization in the
implementation of
studies/research
Community Organizing

Approaches to community devt.:


a. Welfare approach
b. Technological approach
c. Transformatory approah
Community Organizing

Principles of CO:
1. People esp. the oppressed, exploited and
deprived sectors are most open to change, have
the capacity to change and are able to bring
about change. Hence , CO is based on the ff:
A. Power must reside in the people
B. Devt. is from the people to the people
C. People participation
Principles of CO

2.-must be based on the poorest sectors of


society. The solutions of problems commonly
shared by these sectors must be focused on
collective organizations, planning and action
3. should lead to self-reliant communities
THE HRDP-COPAR
PROCESS
1. PRE-ENTRY PHASE
2. ENNTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4.COMMUNITY ORGANIZATION AND CAPABILITY-
BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING PHASE
Classify the ff. CO activities as
to phase of COPAR each
belong:
1.Conducts community meetings to
draw up guidelines for the
organization of CHO
2. Trains BHWs
3. Sets up of linkages/network and
referral systems
4. PIME of health services and or
community devt. Projects
5. Provides continuing education to
leaders or residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
Continued.

9. Develops criteria for site selection


10. Forms the core group
11.Conducts SALT
12.Selects members of the research team
13. Assists the research team in presenting
results during the general assembly
14. Helps the people identifying the
community needs and health problems
15. Facilitates for the formulation and
ratification of the constitution and by-
laws of the organization
Public Health Programs
COMPREHENSIVE MATERNAL
AND CHILD HEALTH PROGRAM

1. EPI (Expanded Program on


Immunization)
2. CDD (Control of Diarrheal
Diseases)
3. CARI (Control of Acute
Respiratory Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition Rehabilitation
Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency
Anemia)
10. FP (Family Planning)
EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
TARGET SETTING:
1. INFANTS 0-12 MONTHS
2. PREGNANT AND POST PARTUM WOMEN
3. SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD IMMUNIZABLE DISEASE
ELEMENTS OF EPI:
1. TARGET SETTING
2. COLDCHAIN LOGISTIC MANAGEMENT- Vaccine distribution through
cold chain is designed to ensure that the vaccine were maintained
under proper environmental condition until the time of
administration.
3. IEC
4. Assessment and evaluation of Over-all performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Numbe Minimum Reason
Age of 1st r of Interval
Dose Doses Between
Doses
1. BCG Birth or 1 BCG is given
(Bacillus at the earliest
anytime possible age
Calmette after protects
Guerin) against the
birth
possibility of
School
TB infection
entrants from the other
family
members
2. DPT 6 weeks 4 weeks An early start with
(Diphtheria 3 DPT reduces the
Pertusis
Tetanus)
chance of severe
pertussis

3. OPV 6 weeks 4 weeks The extent of


(Oral Polio 3 protection against
Vaccine)
polio is increased
the earlier OPV is
given.
4. 6 weeks 4 weeks An early start of
Hepatitis B 3 Hepatitis B reduces
the chance of being
infected and becoming
a carrier.
5. Measles 9 months At least 85% of measles
1 can be prevented by
immunization at this age.
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
DIARRHEA
A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not thirsty
Tears present
Skin pinch goes back quickly
TREATMENT PLAN A- HOME TTT.
THREE RULES FOR HOME
TREATMENT

1.Give the child more fluids


than usual
use home fluid such as
cereal gruel
give ORESOL, plain water
2. Give the child plenty of food to prevent
undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual milk
if child is less than 6 months and not yet taking solid food, dilute
milk for 2 days
if child is 6 months or older and already taking solid food, give
cereal or other starchy food mixed with vegetables, meat or fish; give
fresh fruit juice or mashed banana to provide potassium; feed child at
least 6 times a day. After diarrhea stops, give an extra meal each
day for two weeks.
3. Take the child to the health
worker if the child does not get better
in 3 days or develops any of the
following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
ORESOL TREATMENT
Age Amount of Amount of ORS to
ORS to give provide for use at
after each home
loose stool
< 50-100 500 ml./day
24 ml.
months
2 100-200 1000 ml./day
10 ml.
years
10 As much as 2000 ml./day
years wanted
up
B. SOME DEHYDRATION
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, TTT. PLAN B
APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS
AGE WEIGHT ORS
KG ML
4 MOS. 5 200-400

4-11MOS 5-7.9 400-600

12-23MOS 8-10.9 600-800

2-4YRS 11-15.9 800-1200

5-14YRS 16-29.9 1200-2200

15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed,
give 100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then continue
giving ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS , give
plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used
for dysentery and suspected
cholera
Antiparasitic drugs should only be
used for amoebiasis and
giardiasis
C. SEVERE DEHYDRATION
Condition lethargic or unconscious; floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to drink
Skin pinch goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE CONTROL
OF DIARRHEAL DISEASES PROGRAM

1.Two problems in CDD


1. High child mortality due to
diarrhea
2. High diarrhea incidence
among under fives
2. Highest incidence in age 6 23
months

3. Highest mortality in the first 2 years


of life

4. Main causes of death in diarrhea :


DEHYDRATION
MALNUTRITION
5. To prevent dehydration, give home fluids am as soon as
diarrhea starts and if dehydration is present, rehydrate early,
correctly and effectively by giving ORS

6. For undernutrition, continue feeding during diarrhea


especially breastfeeding.
7. Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
8. Risk of severe diarrhea 10-30x higher
in bottle fed infants than in breastfed
infants.
9. Advantages of breastfeeding in
relation to CDD
1.Breast milk is sterile
2.Presence of antibodies protection
against diarrhea
3.Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
10. Breastfeeding decreases
incidence rate by 8-20% and
mortality by 24-27% in infants
under 6 months of age.
11. When to wean?
4-6 months soft mashed foods 2x
a day
6 months variety of foods 4x a
day
12. Summary of WHO-CDD recommended strategies to prevent
diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months of life and partially for at
least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest source
- protecting water from contamination at the source and in the home
3.Good personal and domestic
hygiene
- handwashing
- use of latrines
- proper disposal of stools of young
children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12
mos. less than 50 per minute; 12 mos. 5 years
less than 40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for
assessment
2. Assess and treat ear problems/sore throat if
present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
1. Feed the child during illness
2. Increase feeding after illness
3. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
1. offer the child extra to drink
2. Increase breastfeeding
3. SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A SAFE
REMEDY
4. WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY OCCUR
1. Breathing becomes difficult
2. Breathing becomes fast
3. Child is not able to drink
4. Child becomes sicker
B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min or more ; 2-12 mos.
50/min or more; 12 mos. 5 years 40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the childs condition gets worst,refer urgently to hospital; if
improving, finish 5 days of antibiotic.
ANTIBIOTICS RECOMMENDED
BY WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
C. Severe Pneumonia

Chest indrawing
Nasal flaring
Grunting ( short sounds made with the voice)
Cyanosis
TTT.
1. Refer urgently to hospital
2. Treat fever ( paracetamol), wheezing (
salbutamol)
D. Very Severe Disease

Not able to drink


Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Severe undernutrition
TTT.
Refer urgently to hospital
ASSESSMENT OF RESPIRATORY
INFECTION
ASK THE MOTHER:
1. How old is the child?
2. Is the child coughing? For how long?
3. Age 2 months up to 5 years: Is the child able to drink?
Age less than 2 months: Has the young infant stopped feeding
well?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.

Age0 Fast Breathing


Less than 2 months 60/minute or more
2 months 12 months 50/minute or more
2. Look for chest in drawing.
12 months 5 years
3. Look and listen for stridor.
40/minute or more
Stridor occurs when there is a narrowing of the larynx, trachea or
epiglottis which interferes with air entering the lungs.
4. Look and listen for wheeze
Wheeze is a soft musical noise which
shows signs that breathing
out(exhale) is difficult.
5. See if the child is abnormally sleepy
or difficult to wake. (Suspect
meningitis)
6. Feel for fever or low body
temperature.
7. Check for severe under nutrition
MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS tender swelling behind the ear (in infants, swelling may
be above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION pus draining from the ear
for less than 2 weeks, ear pain, red, immobile ear
drum (Acute Otitis Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION pus draining from
the ear for more than 2 weeks (Chronic Otitis
Media)
TREATMENT
Most important & effective treatment: Keep the
ear dry by wicking.
Paracetamol maybe given for pain or high
fever.
Precautions for a child with a draining ear:
1. Do not leave anything in the ear such as cotton,
wool between wicking treatments.
2. Do not put oil or any other fluid into the ear.
3. Do not let the child go swimming or get water in
the ear.
Maternal and Child Health
Nursing
Philosophy
Pregnancy, labor and delivery and
puerperium are part of the continuum of the
total life cycle
Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy
for individuals and make each experience
unique
MCN is FAMILY CENTERED- the father is as
important as the mother
Goals
To ensure that expectant mother and nursing mother maintain
good health, learn the art of child care, has a normal delivery
and bear healthy children

That every child lives and grows up in a family unit with love and
security, in healthy surroundings, receives adequate nourishment,
health supervision and efficient medical attention and is taught
the elements of healthy living
Classification of pregnant
women
Normal healthy pregnancy
With mild complications- frequent home visits
With serious or potentially serious cx referred to
most skilled source of medical and hospital care
Home Based Mothers
Record ( HBMR )

Tool used when rendering prenatal care


containing risk factors and danger signs
*Risk Factors
145 cm tall ( 4 ft & 9 inches)
Below 18 yrs old, above 35 yrs old
Have had 4 pregnancies
With TB, goiter, heart disease, DM,
bronchial asthma, severe anemia
Last baby born was less than 2 years ago
Previous cesarian section delivery
History of 2 or more abortions, difficult
delivery, given birth to twins , 2 or more
babies born before EDD, stillbirth
Weighs less than 45 kgs. or more than 80 kgs.