COMMUNITY HEALTH

NURSING
 Public Health Nursing practice has been influenced by the changing
global and local health trends these brought PHN into new frontiers &
have positioned nurses to emerge as leaders in health promotion and
advocacy validated by WHO report acknowledging the significant
contribution of the nursing workforce to the achievement of health
outcomes, particularly MILLENIUM DEVELOPMENT GOALS
GLOBAL & COUNTRY HEALTH
IMPERATIVES
Changes exerting pressures on the Public Health Systems:

1. Shift in demographic & epidemiological trends in disease

2. New technologies for health care, communication &
information
3. Existing & emerging environmental hazards associated with
globalization
4. Health Reforms
• United Nations General Assembly adopted a common vision of
poverty reduction and sustainable development in September 2000
exemplified by the

Millennium Development Goals (MDG) based

on:freedom,equality,solidarity,tolerance,health respect for nature
and shared responsibility

8 Millennium Development Goals are as follows:

1. Eradicate extreme poverty & hunger

2. Achieve universal primary education
3. Promote gender equality& empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria & other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
• Health is essential to the achievement of this goal
• Participation of all members in the society both
developing and developed countries is required
• Achievement of these goals by 2015 is now the priority
• Country initiatives to implement a more cost-effective health care
services
• The Health Sector Reform Agenda (HSRA) implemented through
FOURmula ONE & operationalized in the National Objectives
for
Health 2005 to 2010-spells out the program imperatives of the
health sector in line with MDG & Medium-Term Dev’t Plan of
the country
 EVOLUTION OF PUBLIC HEALTH NURSING IN
THE PHIL.
• To have a better understanding we need to know certain concepts:
HEALTH-(WHO) as a “ state of complete physical,mental,and social
well being, not merely the absence of disease or infirmity.”
Determinants of Health as listed by WHO:
1.Income and social status
2.Education-low education are link to poor health
3.Physical Environment-safe water supply & clean air
4.Employment & working conditions
5.Social support network-greater family support better
6.Culture-customs & traditions
7.Genetics-inheritance
8.Personal behavior & coping skills-healthy lifestyle
9.Health Services-access & use
10. Gender-suffering from diff. diseases
• Public Health Nursing (Winslow)-”science and art of
preventing disease, prolonging life, promoting health and
efficiency through organized community effort for the
sanitation of the environment, control of communicable
disease, the education of individuals in personal hygiene, the
organization of medical and nursing services for the early
diagnosis and preventive treatment of disease & the
development of social machinery to ensure everyone a
standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize
his birthright of health and longevity.”
• WHO—”the art of applying science in the context of politics
so as to reduce inequalities in health while ensuring the best
health for the greatest number.”
 GAYLORD

•
is an organized community program
designed to prolong life , because it is
the duty of the Department of Health to
prevent unnecessary illness.
 HANLON
• Public health is dedicated to the highest level of physical, mental & social well-being
& longevity consistent with available knowledge and resources at a given time and
place. It holds this goal as its contribution to the most effective total development
and life of the individual and his society.
 JACOBSON

• a learned practice discipline with the

ultimate goal of contributing as
individuals & in collaboration with others,
to the promotion of the client’s optimum
level of functioning through teaching &
delivery of care.
 WHO
• Special field of nursing that combines the skills
of nursing, public health & some phases of socia
assistance & functions as part of the total public
health program for the promotion of health, the
improvement of the
conditions in the social & physical environment,
rehabilitation of illness and disability.
 RUTH FREEMAN
• Special field of nursing that combines skills in Public Health Nursing & some phases
of social assistance to further community health.
• Is a service rendered by a professional nurse with the community, groups, families
and individuals at home, in health centers, in clinics, in school, in places of work for
the promotion of health, prevention of illness, care of the sick at home &
rehabilitation
ECO-SYSTEMS INFLUENCES ON
OPTIMUM LEVEL OF
FUNCTIONING
(OLOF)
 POLITICAL
Safety
Oppression
SOCIO People Empowerment
ECONOMIC BEHAVIOR
Employment Culture
Education Mores
Housing OLOF
Ethnic Customs
Individuals
ENVIRONMENT Family Groups
Communities HEREDITY
Air, Food
Populations Generic Endowment
Water Waste
- Defects
Urban/Rural
HEALTH CARE -Strengths
Noise
DEL. SYSTEM -Risks
Radiation
Promotive Familial ,Ethnic
Pollution
Preventive Racial
Curative
Rehabilitative
Public health is a core element of governments’ attempts to
improve & promote the health & welfare of their citizens.
It further presented the core business of Public Health as:
1. Disease control
2. Injury prevention
3. Health protection
4. Healthy public policy including environmental hazards
in workplace,housing,food,water,etc.
5.Promotion of health and equitable health gain
 PHILOSOPHY
CHN-BASED ON WORTH & DIGNITY OF MAN

CONCEPTS
1.The primary focus of CHN practice is on health promotion
2.CHN practice is extended to benefit not only the individual but the whole
family and community
3.CHNurses are generalists in terms of their practice
4.Contact with client & family may continue over a long period of time
includes all ages & types of health care
5.The nature of CHN practice requires that current knowledge derived from
biological & social sciences, ecology, clinical nursing & community
organizing be utilized
6.The dynamic process of assessing, planning, intervening,
provide periodic measurements of progress , evaluation & a continuum of
the cycle until the termination of nursing problem.
 PRINCIPLES
1.CHN is based on the recognized needs of communities,
families. groups & individuals.
2.The CHNurse must understand fully the objectives & policies
of the agency she represents.
3.In CHNsg the family is the unit of service.
4.CHN must be available to all regardless of race, creed &
socio-economic status.
5.Health teaching is a primary responsibility of the CHNurse.
6.CHNurse works as a member of the health team.
7.There must be provision for periodic evaluation in CHN
services.
8.Opportunities for continuing staff education programs for nurses
must be provided by the CHN agency.
The CHN Nurse also has a responsibility for his/her own
professional growth.
9. The CHN Nurse makes use of available community health
resources.
10.The CHN Nurse utilizes the already existing active
organized groups in the community.
11.There must be provision for educative supervision in CHN.
12.There should be accurate recording & reporting in CHN.
QUALIFICATIONS OF A
PUBLIC HEALTH NURSE
Is a graduate of Bachelor of Science in Nursing
(BSN) and a registered nurse (RN).

• Good physical and mental health

• Interest and willingness to work in the community
• Capacity and ability to relate the practice with
ongoing community health and health related
activities.,
• Work cooperatively with other disciplines and
members of the community,
• Accept and take actions needed to improve self and
service
• Analyze combination of factors and conditions that
influence health of populations, 
 
•Apply nursing process in meeting the health and
nursing needs of the community and
•Mobilize resources in the community;
•With leadership potential;
•Resourcefulness and creativity;
Honesty and integrity and,
•Active membership to professional nursing
organizations.

The PHN performs functions and activities in

accordance with the dominant values of PHN,
within the profession’s ethico-legal framework and
in accordance with the needs of the client
and available resources for health care.
 The FUNCTIONS & ACTIVITES OF a PHN are :
management training, supervision, provision of nursing care,
health promotion and education and coordination are
consistent with the Nursing Law (RA 9173) and program
policies formulated by DOH and LGU

The PHN considers the needs of her/his clients and their

available resources for health and health care.

The PHN, in coordination with the faculty of colleges of

nursing, participates in teaching, guidance and
supervision of students in nursing and midwifery for
their related learning experiences (RLE) in the
community setting.

The PHN participates in the conduct of research and

utilizes research findings in his/her nursing practice.
SUPERVISION
•The PHN supervises midwives within her catchments area in
accordance with the agency’s policies
•The PHN formulates a supervisory plan.
•Identifies the factors that affect the midwives performance and
job satisfaction; and their need for supervision;
•Defines standards of performance & goals for health services
for each supervisee’s catchments area/s;
•Sets achievable performance targets in consultation with
his/her supervisees;
• Prioritizes problems and concerns using adequately defined
criteria;
•Formulates objectives and strategies to meet the midwives’ need
for supervision;
•Determines standards and criteria for evaluating supervisory
visits.
•conducts supervisory visits
 
•Reviews objectives, targets and norms with midwives and
nursing auxiliaries;

•Motivates the midwives and nursing auxiliaries to improve

performance;
•Provides technical supervision to midwives and nursing
auxiliaries and,

• Provides administrative support

(e.g., interpret policies, guidelines, memoranda and other
administrative issuances; assess supply of stock levels;
facilitate acquisition of logistic requirements; and, allocate and
distributes supplies).
•The PHN regularly monitors and evaluates midwives’ and
nursing auxiliaries’ performance in the implementation of
public health programs. He/she:

•Utilizes appropriate monitoring and evaluation tools;

Reviews clinic records and reports, validates their accuracy
and completeness, and compares actual performance with
program targets; and provides feedback to the municipal/city
health officers and midwives;

•Utilizes results of monitoring and evaluation to strengthen

supervision; and,
 
•Documents findings during monitoring and evaluation.
 
•Initiates and participates in activities to promote his/her
supervises personal and professional growth.
•Determines each supervisee’s specific needs for supervision
and development;

•Evaluates the effects of training and other staff development

programs/activities;
 
•Initiates and participates in developing policies and
guidelines that promote good performance in nursing and
midwifery services.
•Formulates policies and guidelines for nursing services and,
advocates for the approval/passage of
facilitative/supportive mechanisms of improving performance
conditions.
 INTERDISCIPLINARY
AND
INTERSECTORAL COLLABORATION
•The PHN establishes linkages and collaborative relationships
with other health professionals, GOs, NGO and POS to
address the community’s health problems.
 
•Identifies opportunities for establishing linkages with different
stakeholders in health maintaining communication

•Uses knowledge on the community to link with or refer to

appropriate community resources

•Attends multidisciplinary and multisectoral activities

•Identifies strategies to strengthen referral system.

Collaborates with health care providers, professionals,

• 

community representatives in ADPIE programs for community

health
 NURSING PROCESS
•Establishes a working relationship to help ensure good
quality data and to enhance partnership in addressing
identified health needs and problems.

•Establishes rapport with the client

• Collects data that are appropriate and accurate from

individual, family and community

Uses different data collection methods and sources such as

surveys, qualitative interviews, observation and review of
records and reports.
•Ensures community participation in data gathering

•Records data collected in appropriate forms and files them in a

manner that facilitates retrieval.
• The PHN recognizes the broad impact of certain factors on
the client’s health and nursing problems

• The PHN analyzes data collected to determine diagnosis

• Examines and interrelates data on the clients – individual,

family and community;
• Identifies actual and potential problems of the client;

• Validates interpretation with the client concerned

• Determines the possible causes of the identified nursing and

health problems and the factors that could facilitate or hinder
their resolution.

• The PHN formulates a nursing/community diagnoses.

•A nursing diagnosis contain a statement of an unhealthful
response or negative condition and the factors that
maintain it .
•A community diagnosis must focus on the community’s health
problems and capability to address these problems.

•The PHN ensures community participation in establishing

community diagnosis.

•The PHN develops jointly with the client an NCP

•Prioritizes the health problems and nursing problems identified

using criteria such as: nature of the problem, magnitude of
the problem, modifiability of the problem, preventive potential
and salience of the problem;

•Sets objectives of intervention/s that are SMART

•Ensures that interventions are culture-and gender-sensitive;

•Includes in the plan/program the three levels of prevention

•Includes strategies that enhance the client’s capacity for health

action;
•Specifies the criteria/indicators and process of evaluation.

•The PHN implements the NCP to promote, maintain, or restore

health, to prevent illness, to effect rehabilitation and to improve
the capability of clients.

•Carries out actions that are legally and ethically acceptable &
are in accordance with the NCP

•Involves the client in implementing the nursing care/program

plan;
•Collaborates with clients and assists them in taking
responsibility for maintaining, restoring their health by
increasing their knowledge, and control .

•Helps clients make informed choices about health issues

and interventions

•Maximizes the ability of their clients to take responsibility

for, and manage their health according to their resources
and personal skills.

•Supports the client in developing skills for self-advocacy.

•Assists clients in identifying their strengths and available
resources to address, their needs;
•Uses empowering strategies such as visioning and
facilitation
•Applies epidemiological strategies such as screening,
surveillance, vaccination CD response and
outbreak management and education.

•The PHN evaluates the responses of her/his clients to

interventions in order to revise data base, diagnoses and
plan, and to formulate recommendations.

•Analyzes the results of evaluation with the client;

•Uses reflective practice as an evaluation strategy;

•Uses the results of evaluation to revise the data

base,diagnoses and plan; and,
•Uses the results of evaluation to make recommendations to
decision makers/policymakers.
HEALTH PROMOTION & HEALTH EDUCATION
The PHN recognizes the role of healthy lifestyle in the
prevention of a number of health problems & integrates
healthy lifestyle in health programs.

The PHN plans, conducts, and evaluates health promotion

and health education activities properly.

The PHN demonstrates knowledge and skills on: (a) how to

advocate for healthy public policy, (b) creating
supportive environments, (c) strengthening community
action, and (d) developing client’s personal skills. He/

The PHN actively works to build capacity for health promotion

among the midwives, volunteer health workers and
community partners.
DEMONSTRATING PROFESSIONAL
RESPONSIBILITY AND
ACCOUNTABILITY
The PHN recognizes that her/his personal attitudes, beliefs,
assumptions, feelings and, values about health have
potential effects on his/her professional actions and
interventions.

The PHN accepts accountability for her/his actions and

engages in nursing practice that is ethical, safe, acceptable
and evidence-based. He/She

The PHN protects her/his professional autonomy, assumes

responsibility for professional development and contribute to
the professional development of others.

The PHN institutes changes/improvements in service

delivery and management of health facility to improve
client’s access and use of public health nursing services.
He/She
The PHN maintains links and collaboration with other
professional nurses and nursing groups to strengthen his/her
nursing practice.

The PHN Maintains links and collaboration with the

government agencies and non-government organizations
(including political, community and religious groups).

The PHN conducts and/or facilitates in various training

activities for public health nurses, midwives, barangay health
workers, nursing aide and volunteers.
 COMMUNITY HEALTH NURSING
PROCESS
• Is the central to all nursing actions-it is the very essence of
nursing, applicable in any setting, in any frame of reference,
and within any philosophy
• Is a systematic,scientific,dynamic,on-going
• Interpersonal process in which the nurses & the clients are
viewed as a system w/ each affecting the other & both being
affected by the factors w/n the behavior
• process of DM results in the optimal health care for the
clients to whom the nurse applies the process
 COMPONENTS OF NURSING
PROCESS
• Assessment: Initiate contact, Demonstrate a caring attitude, mutual trust &
confidence, Collect Data from all sources, ID health problems, assess coping
capability,analyze data

• Planning : prioritize needs, establish goals based on the needs &

capabilities of staff, construct action plan & operational plan, develop
evaluation parameters, revise plan as needed

• Implementation of planned Care: putting plan into action, coordinate

services, utilize resources, delegate ,supervise, monitor, HE, training,
document responses to action

• Evaluation of Care: Performance Appraisal, ID needed alterations,

revise plans as necessary
 SEQUENCE OF ACTIVITIES IN
FAMILY NURSING PRACTICE
• Establish a working relationship
• Conduct Initial Assessment
• Categorizes health problems
• Determine the nature & extent of the family’s performance
of the health tasks.
• Det. priorities among list of health problems
• Ranks health problems according to priorities
• Decide on what to tackle
• Make FNCP
• Implement the Plan
• Evaluate, re-define nursing problems & reformulate
objectives according to evaluation.
 FAMILY HEALTH TASK &
RESPONSIBILITIES
• Recognizing interruptions of health development
( Ability to recognize presence of health problems)
• Making decisions about taking appropriate health action.
• Providing nursing care to the sick, disabled & or
dependent members of the family.
• Maintaining a home environment conducive to health
maintenance & personal development.
• Maintaining a reciprocal relationship with the
community & its health institution.
 FAMILY-THE BASIC UNIT OF THE
COMMUNITY. ALL MEMBERS OF THE FAMILY
ARE EMPOWERED TO MAINTAIN THEIR
HEALTH STATUS. THEY MUST BE FREE FROM
DISEASE OR INFIRMITY WITH NO DISABILITIES

Family Health Office: is tasked to operationalize health programs geared

towards the health of the family.
It concerned with the health of the mother & the unborn, the newborn, infant,
child,the adolescent
& youth the adult men & women & older persons
FAMILY HEALTH: SPECIFICALLY IT AIMS TO:

1.Improve the survival & well being of mothers & the

unborn
2.Reduce morbidity & mortality rates for children 0-9
years
3.Reduce mortality from preventable causes among
adolescents & young people
4.Reduce morbidity & mortality among Filipino adults &
improve their quality of life
5.Reduce morbidity & mortality of older persons &
improve their quality of life
 STRATEGIC THRUST 2005-2010
1.Launch & implement the Basic Emergency Obstetric Care or BEMOC
strategy in coordination with the DOH
• BEMOC strategy entails the establishment of facilities that provide
emergency obstetric care for every 125,000 pop. & which are located
strategically
• It calls for planning for childbirth & upgrading of technical capabilities of
local health providers
2. Improve the quality of prenatal & postnatal care
• Pregnant women should have at least 4 prenatal visits
• Postpartum care should extend to more women after childbirth, miscarriage &
after unsafe abortion
3.Reduce women’s exposure to health risks through responsible parenthood &
health care packages
4.LGUs,NGOs & other stakeholders must advocate for health through resource
 ESSENTIAL HEALTH SERVICE PACKAGES
AVAILABLE IN THE HEALTH CARE
FACILITIES (EVERY WOMAN HAS TO
RECEIVE BEFORE & AFTER PREGNANCY &
OR DELIVERY OF A BABY.

1. Antenatal Registration
2. Tetanus Toxoid Immunization
3. Micronutrient Supplementation
4. Treatment of Diseases & other Conditions
5. Clean & Safe Delivery
 STANDARD PRENATAL VISITS THAT A
WOMAN HAS TO RECEIVE DURING
PREGNANCY
Prenatal Visits Period of Pregnancy

1st visit As early as possible before 4

mos. Or during 1st trimester
2nd visit During the second trimester

3rd visit During the third trimester

Every 2 weeks After 8th mo. until delivery

 TETANUS TOXOID IMMUNIZATION
SCHEDULE FOR WOMEN
Vaccine Min age % Duration of
interval protected protection
TT1 As early as
possible
TT2 At least 4 wks 80% Infant protected
later Mother 3 yrs

TT3 At least 6 mos. 95% Infant protected

later Mother 5 yrs

TT4 At least 1 yr. 99% Infant protected

later Mother 10 yrs.
 MICRONUTRIENT
SUPPLEMENTATION: TO
PREVENT ANEMIA ,VIT.A
DEFICIENCY & OTHER
NUTRITIONAL DISORDERS.
Vitamins Dose Sched. Of Remarks
giving
Twice a Do not give
Vitamin A 10,000 IU week Vit.A
starting 4th before
mo. of teratogenic
pregnancy
60mg/
Iron 400ug Daily`1
tablet
 TREATMENT OF DISEASES & OTHER
CONDITIONS
Conditions/Disease What To Do Do Not Give
Difficulty in Clear airway
breathing/obstruction Place in best position
of airway Refer to hospital
Keep on her back arms Don’t give ORS
at side
Unconscious Tilt Head unless trauma
IVF to prevent shock Do not give IVF if
Monitor bp, pulse& you are not trained
shortness of breath q to do so
15 minutes.
Monitor fluid given if
difficulty in breathing &
puffiness develops
STOP infusion
Monitor Urine output
Postpartum Massage Uterus & expel clots Do not give
Bleeding Place cupped palmed on uterine ergonometrine
fundus & feel for contraction, if woman has
massage fundus in circular motion eclampsia,
Apply bimanual compression if preeclampsia,
ergometrine txt done & PP bleeding HPN
persists
Give ergometrine 0.2 mg IM 7

another dose after 15 min

Intestinal Mebendazole 500mg tab single dose Do not give on

parasite From 4th -9 month if none was given the first
Infection for the past 6 months trimester

Malaria Sulfadoxin-pyrimethamine to
women fr. Malaria endemic areas in
1st to 2nd pregnancy
500mg-25mg tab,3 tabs at the
beginning of 2nd& 3rd tri not less than 1 month
interval
 CLEAN AND SAFE DELIVERY
1.Do a quick check upon admission for ER signs (vaginal bleeding,
severe abdominal pain, convulsion, unconscious , difficulty in
breathing, fever, severe vomiting, severe headache, very ill
2.Make her comfortable
3.Assess the woman in Labor( LMP,# of pregnancies, start
Of labor pains, age/height, danger signs of pregnancy
4.Determine the stage of Labor
5.Decide if the woman can safely deliver
6.Give supportive care throughout labor
7.Monitor & manage labor
8.Monitor closely within1 hour after delivery
9.Continue care after 1 hour PP. watch closely for 2 hrs.
10Educate & counsel on FP & provide methods available
11.Teach on birth registration, BF, NB screening 48hrs-2wks after birth,
schedule when to return for consultation PP visits
 RECOMMENDED SCHEDULE OF
POST PARTUM CARE VISITS:

First visit First week post partum

Preferably 3-5 days

Second Visit Six weeks Post Partum

 FAMILY PLANNING PROGRAM
Goal: Provide universal access to family planning information & services wherever &
whenever these are needed
Aims to : reduce infant deaths ,neonatal deaths, under-five deaths ,maternal deaths
Objectives: Address the need to help couples achieve their desired family size
Ensure that quality FP services
are available in DOH retained hospitals LGU managed health facilities , NGO, private
sector
 THE CHILD HEALTH PROGRAMS
(NEWBORN , INFANT AND CHILDREN )
• Vulnerable age group for common childhood diseases
• Goal: Reduce morbidity & mortality rates for children 0-9
years.
• Programs available in all Health Facilities:
1.Infant & Young Child Feeding
2.Newborn Screening
3.Expanded Program on Immunization
4.Management of Childhood Illness
5.Micronutrient Supplementation
6.Dental Health
7.Early Child Development
8.Child Health Injuries
 STRATEGIC THRUSTS FOR 2005-
2010
• Develop local capability to deliver the health package for
children
• Implement programs & projects that favor disadvantaged
population
• Apply Reaching Every Barangay (REB)
strategy for immunization
• Intensify HE at the ground level
• Enhance Med, Nursing & MW education w/ cost-effective
life saving strategies (IMCI)
• Pursue the implementation of Laws & policies (Early
Childhood Dev’t Act 2000,NB Act of 2004,EO 286 Bright
Child Program, EO 51 Milk Code, Rooming-In &
Breastfeeding Act)
 INFANT AND YOUNG CHILD
FEEDING
• Global Strategy for IYCF was jointly issued WHO and UNICEF in 2002
• Strategy calls for the promotion of breastmilk as the ideal food for the healthy
growth & development of infant
• & exclusive BF for the first 6 months of life for optimal growth
• Goal: Reduce Child Mortality by 2/3 by 2015
• Objective: To improve the health & nutritional status of infant & young children
 EXPANDED PROGRAM ON
IMMUNIZATION
• With the commitment of our country to Universal Child
Immunization Goal acceleration of EPI coverage had
began in 1986
• Hepatitis B immunization has been integrated in 1992
among 0-1 y.o. but 40% of the eligible targets were
prioritized.
• Western Regional Goal : Eliminate HB before 2012
• Fully immunized Child is a child who has received 1 dose
of BCG,3 doses of DPT, OPV, Hepatitis B and 1 dose of
AMV before his first birthday
 GENERAL PRINCIPLES IN VACCINATING
CHILDREN
• It is safe & immunologically effective to administer ALL EPI
vaccines on the same day at different sites of the body
• AMV is given as soon as the child is 9 months old regardless of
whether other
vaccines will be given on that day
• The vaccination schedule should not be restarted from the beginnin
even if the interval between doses exceeded the recommended
interval
• Moderate fever, malnutrition, mild respiratory infection, cough
diarrhea & vomiting are not contraindication to immunization,
unless the child is so sick that he needs to be hospitalized
• Absolute C/I: DPT2 & DPT3 to a child who has convulsion or shock within 3
days from previous dose
• Giving doses of a Vaccine at less than the recommended interval may lessen
the antibody response
• No extra doses must be given to children/mother who missed a dose of
DPT/TT/OPV, it must be continued as if no time had lapsed between doses
• Never reconstitute the freeze dried vaccines in anything other than the
diluents supplied with them
• False C/I, children w/ malnutrition, low grade fever, mild respiratory
infection diarrhea & minor illnesses are NOT C/I to OPV vaccination
• Repeat BCG vaccination if there is no scar after the first injection
• Use one syringe one needle per child during immunization
 EPI TARGET
DISEASES(TB,DIPHTHERIA,PERTUSSIS,TETA
NUS, POLIOMYELITIS,MEASLES &
HEPATITIS
• The EPI Routine Schedule on Immunization: Every Wednesday is designated as
immunization Day in all parts of the country
• In Barangay Health Station immunization is done monthly
• Far flung areas it is done quarterly
• Some areas adopted local practices to provide everyday vaccination in their areas to
cover all targets
 ROUTINE IMMUNIZATION SCHEDULE
Vaccines Min Age at No. of Min. Reason
1st Dose Doses Interval
Bet. Doses
Birth or BCG is given the earliest
BCG 1 possible age protects the
anytime
after birth possibility of TB meningitis
& other forms of TB
4 weeks An early start w/ DPT
DPT 6 weeks 3 reduces the chance of
severe pertussis
4 weeks The extent of protection
OPV 6 weeks 3 against polio is increased
the earlier OPV is given
6 wks Early start of Hep B reduces
Hep B At Birth 3 the chance of being infected
fr.1st dose
& becoming a carrier
8 wks fr
Prevent liver cirrhosis & CA
2nd dose
Measles At least 85% can be
9 mos 1 prevented,prevents deaths
malnutrition,pneumonia,diar
Vacc. Dose Route Site of admn Type/form Storage
Of vaccine Temp
BCG 0.05ml Right deltoid Live attenuated +2-+8
ID region of the Bacteria Degrees
arm Freeze dried centegrade

DPT 0.5 ml Upper outer D-WT +2=+8

IM portion of the P-Killed Bact.
thigh T-WT
OPV 2 drops/ ORAL Mouth Live attenuated -15 to -25
depending on Virus freezer
the
manufacturer
AMV 0.5ml subcu Outer part of Live attenuated -15 to -25
the upper virus
arm
Hep 0.5ml IM Upper outer RNA +2 to +8
B portion of the Recumbinant
thigh Plasma derived
TT 0.5ml IM Weakened toxin +2to +8
Deltoid
 TETANUS TOXOID IMMUNIZATION
SCHEDULE
Vacc. Min. age Percent Duration of
interval protected protection
as early as
TT1 possible during
pregnancy
As least 4 weeks Infant protected from
TT2 later
80% neonatal tetanus give 3 years
protection for the mother
At least 6 Infant protected from
TT3 months later
95% Neonatal tetanus, mother
protected for 5 years
At least 1 year Infant protected from
TT4 later
99% neonatal tetanus mother
protected for 10 years
At least 1 year Infants born is protected
TT5 later
99%
Mother protected for life
• When Handling, transporting and storing vaccines special
care must be given to provide quality potent vaccines among
the targets
• “First Expiry and First Out” FEFO vaccine is practiced to
assure that all vaccines are utilized before expiry date
• Temperature Monitoring of Vaccines is done in all levels of
Health Facilities to monitor vaccine temperature
• Done twice a day early morning & afternoon before going
Home
• Temperature is plotted every day in a temperature
Monitoring Chart to Monitor to monitor break in the cold
chain
 HOW TO CALCULATE VACCINE
NEEDS
Step 1: Det. Eligible Pop. (Total pop. X 3% 0r 3.5%)
Step 2: Det. The no. of Doses required in a year (Eligible pop. X
Doses)
Step 3: Det. The wastage rate of the antigen
( annual dose X wastage multiplier)
Step 4: Det. Annual vacc. In vials/amp. (divide annual dose with
the # of doses per vial/amp.
Step 5:Det Vacc./month or quarter ( total vials/ 12 months or
total vials / 4 quarters
Step 6:Det the reserve stock (ans.In#5 X 1.25)
 HOW TO CALCULATE NEEDLES &
SYRINGE REQUIREMENTS
Step 1: Det. Eligible Population ( total pop X 3.5 % or 3 % )
Step 2: Det. Monthly eligible pop. (E.P.diveded by 12 months )
Step 3: Det. Monthly injections ( monthly E.P. X doses )
Step 4: Det. Total requirement including allowance ( monthly injection X 1.25 for
syringe and 1.5 for needle )
 INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESS
• Has been established as an approach to strengthen the
provision of comprehensive & essential health packages to
the children

• Methods Utilized in managing childhood Illness: Assess the

patient, Classify the disease, Treat the patient, Counsel the
Patient
• Color Coded System has been Utilized:
• Green - Mild – Home Care
• Yellow – Moderate – Manage at the RHU
• Pink - Severe - Urgent Referral in Hospital
 NUTRITION PROGRAM
Goal: Improve the quality of life of Filipinos through better nutrition, improved health
and increased productivity
Programs and Projects:
1.Micronutirent Supplementation
2.Food Fortification
3.Essential MCH Services Package
4.Nutrition Information
5.Home school & community production
6.Food Assistance
7.Livelihood Assistance
NATIONAL GUIDELINES FOR MICRONUTRIENT
SUPPLEMENTATION

TABLE 1: UNIVERSAL SUPPLEMENTATION OF

VITAMIN A

Target Preparation Dose/Duration Remarks

One capsule is
Infants 100,00 1 dose given anytime
6-11 mos IU only during 6-11
mos but usually
at 9 mos w/
AMV

Children 200,00IU 1 capsule

21-71 every 6
Mos months
SUPPLEMENTATION FOR PREGNANT AND
POST PARTUM
Target Prepa Dose Duration Remarks
ration
Start form Not given to
the 4th mother taking
Pregnant 10,000 1 month of prenatal Vit or
cap/tab pregnancy multiple
2x a until micronutrient
week delivery tablets

1 dose Not given

Postpartum 200,000 w/n 4 wks
IU
1 cap from
To
delivery pregnant
 IRON SUPPLEMENTATION FOR
PREGNANT & LACTATING
Target Preparation Dose/Duration Remarks
Coated tablet 1 tab once A dose of
w/ /day for 6 800 mcg of
Pregnant
60mgelement mos or 180 folic acid is
women al iron w/ 400
days during still safe to
mg Folic Acid
pregnancy pregnant
period
Lactating same 1 tab/ day
for 3
months
 IODINE SUPPLEMENTATION

Target Preparation Dose/Duration

Women 15- Iodized oil 1 cap for 1
45 y.o. capsule w/ 200 year
mg Iodine
Children of Same Same
school age
Adult Males Same Same
 NURSING PROCEDURES
Clinic Visit
the patient visit the Health Center/clinic
to avail of the services offered by the facility
primarily for consultation on matters that aid them physically.
Services offered: Pre-natal and post partum care
Well baby check-up, immunizations,free medecines –DOTS & HE etc.
 STANDARD PROCEDURES
PERFORMED DURING CLINIC
VISITS
• Pre-Consultation conference is conducted prior to admission
1.Registration/Admission-GEPEP(Greet,Establish
Rapport, Prepare family record, Elicit & record complaint, PE
2.Waiting Time-first come first served according to priority
numbers
3.Triaging-
Managed program-based cases (IMCI)
Refer all non-program based cases to physician
Provide first-aid treatment to emergency cases & refer when
necessary
4.Clinical Evaluation
a. validate clinical history and PE
b .arrives at evidenced-based diagnosis &
provides rational treatment based on DOH program: ID
patients problem formulate nursing diagnosis, perform
nursing intervention, evaluate
c. Inform client on the nature of illness, treatment
prevention & control
5.Laboratory & other Diagnostic Examinations
6.Referral System-using two-way referral system
7.Prescription/dispensing-give proper instructions
8.Health Education-counseling, appointment for next visit
 HOME VISIT
• Is a family-nurse contact which allows the health worker to assess
the home & family situations in order to provide the necessary
nursing care & health related activities
• Important to have a Plan of Visit-to meet the needs of the client
and to achieve the best results of the desired outcome.

PURPOSE
1. Give nursing care to the sick, post partum& her NB.
2. Assess the living condition of the patient & his family
3. Give HE on prevention & control
4. Establish close relationship between agencies & public
5. Make use of the inter-referral system to promote the utilization
of community services.
 PRINCIPLES IN PREPARING FOR
HV (ASSEMBLE RECORDS ,LISTS OF PATIENTS TO BE VISITED
HAVE NCP)

• HV should have a purpose or objective

• Planning for HV should make use of all available information about the patient & his
family through family records
• In panning, priority should be given to the essential needs of the individual and his
family
• Planning & delivery of care should involve the individual and family
• Planning should be flexible
 GUIDELINES TO CONSIDER ON
THE FREQUENCY OF HOME
VISIT
No definite rule but may vary according to the need of patient
and family
1.The physical & psychological needs and educational needs
of individual and family
2.The acceptance of the family for the services to be rendered
3.Policy of the agency & program emphasis
4.Other health agencies & no. of health personnel involved in
the care
5.Careful evaluation of past services given to the family
6.Ability of the family to recognize their own needs,
knowledge of resources and their utilization
STEPS IN THE CONDUCT OF HOME VISIT

1.Greet and introduce yourself

2.State the purpose of the visit
3.Observe and determine the patient health needs
4.Put the bag in a convenient place & proceed to perform Bag Technique
5.Perform the nursing care needed ,HE
6.Record all important data, observation & care rendered
7.Make appointment for return visit
 BAG TECHNIQUE
• Is a tool by which the nurse, during her HV will enable her to perform a nursing
procedure with ease & deftness, to save time & effort w/ the end view of
rendering effective nursing care to clients
Principles of Bag Technique
1. It minimizes if not prevent the spread of infection
2. It saves time and effort
3. Should show effectiveness
4. Can be performed in a variety of ways
 PUBLIC HEALTH BAG
• Is an essential & indispensable equipment of a PHN which she has to carry along during
her HV

Important Considerations in the Use of the Bag

1. Bag should contain all the necessary articles, supplies
2. Contents should be cleaned often, supplies replaced
3. Contents should be well protected from contact with
any articles in the patient’s home
4. Arrangement of the contents should be the one most
convenient to the user.
 COMMUNITY ORGANIZING

• Empowerment or building the capability of people for future community action.

• Key ELEMENTS of the Community w/c maybe reactivated to bring social &
behavioral change
1.Organization( relationships, structure & resources)
2.Ideology (knowledge , beliefs & attitudes)
3.Change Agents
 FIVE STAGES OF ORGANIZING
A COMMUNITY HEALTH PROMOTION
MODEL
1.Community Analysis-assessing & defining needs, opportunities & resources involved
2.Design & Initiation (formation of Organization)
3.Implementation
4.Program Maintenance – Consolidation (strengthening)
5.Dissemination-Reassessment
• VITAL SATTISTICS
 PUBLIC HEALTH NURSING IN
SCHOOLS
The primary role of the school nurse is to support student
learning & ensure that educational potential is not hampered
or unmet health needs.
Assist the pupils in acquiring health knowledge in developing
attitudes & practices conducive to healthful living
Based on the philosophy that the academic performances of
the pupils & the instructional outcomes are also determined by
the quality of health of the school population & the
community where they come from.
OBJECTIVES OF SCHOOL NURSING: TO
PROMOTE & MAINTAIN THE HEALTH OF THE
SCHOOL POPULACE BY PROVING
COMPREHENSIVE& QUALITY NURSING CARE.
Duties & Responsibilities of the School Nurse:
1.Health advocacy
2.Health & nutrition assessment including vision & hearing
3.Supervision of the health & safety of the school plant
4.Treatment of common ailments & attending to emergency cases
5.Referrals and follow-up of the pupils & personnel
6.Home visit
7.Community outreach
8.Recording & reporting of accomplishments
9.Monitoring & evaluation of programs & projects
 NON-COMMUNICABLE DISEASES
Integrated Community Based Non-Communicable Diseases Prevention & Control
Program
• Aim at preventing the four major Non-CD/chronic/lifestyle related diseases ,
cardiovascular diseases , cancers , COPD , DM
• Through promotion of healthy lifestyle
Healthy Lifestyle is defined as a way of life that promotes & protects health and
well-being.
Includes practices that promote health as:
• Healthy diet & nutrition
• Regular & adequate physical activity & leisure
• Avoidance of substances that can be abused-tobacco, alcohol, addicting
substances,
• adequate stress mgt. relaxation
• Safe sex and immunization
 GOAL: REDUCE THE TOLL OF MORBIDITY,
DISABILITY AND PREMATURE DEATHS DUE
TO CHRONIC, NON COMMUNICABLE
LIFESTYLE RELATED DISEASE
Objectives:
1.Analyze the social & economic, political & behavioral determinants of NCD
2.Reduce exposure of individuals & pop. to major determinants of NCD
3.Strengthen health care for people with NCD through health sector reforms & cost
effective interventions.
 TO ACHIEVE THE GOAL THE FOLLOWING
APPROACHES SHOULD CHARACTERIZE THE
PROGRAM:
1.Comprehensive Approach Focused on Primary Prevention
• prevention of risk factors primordial prevention,removal of risk factors)
2.Community-based Approach
• involves people participation,recognizes people as the center of any health & dev’t
effort
3. Integrated Approach
 ROLE OF PUBLIC HEALTH NURSE IN
NON COMMUNICABLE
1.Health Advocate -help people towards optimal degree
of independence in DM & asserting the right to safer &
better community
2.Health Educator -inform ,motivate & guide the people into
action.
3.Health Care Provider- emphasizing on health
promotion & prevention
4.Community Organizer- community health development and
people empowerment
5.Health Trainer- provide technical assistance
6.Researcher- community assessment, epidemiological studies
& intervention studies
 PROMOTING STRESS MANAGEMENT
1.Spirituality-(Mediation,effectivce way of
relaxation)
2.Self-Awareness-increases sensitivity to inner self
3.Scheduling:Time Management( managing one’s self to optimize time
available to achieve gratifying results
4.Siesta-it relaxes the mind and body
5.Stretching-relaxes stress muscle & induces sleep
6.Sensation Techniques- massage
7.Sports-
8.Socials – dancing
9.Sounds & Songs- music provides a medium of for
thoughts & emotion expression
10.Speak to Me -talking to someone
11.Stress Debriefing-assist crisis worker deal positively with emotional
impact
12.Smile- people who smile are healthy people