Community Health Nursing

Community Defined by geographic boundaries With common interests/values Made up by institutions Primary client in CHN

Community Health Nursing The goal of CHN is promotion of OLOF(Optimum Level of Functioning)through the teaching and delivery of care to raise the level of health of the citizentry. Philisophy: according to Dr. Margaret Shetland, the philosophy of CHN is based on the WORTH and DIGNITY of man. Concept of Community Health Nursing

Primary FOCUS is Health Promotion Nurses are GENERALISTS in terms of their practice through lifes continuum Nature of CHN Practice requires that current knowledge derived from a. Bilogical and social sciences b. Ecology c. Clinical nursing d. Community health organizations

Principles Based on recognized needs of communities, families, groups, and individuals Family is the unit of service Health Teaching is the primary responsibility of the community Health Nurse Nurses work as a members of the health team

Health Principles

Modern concept of Health: focuses on the Optimum Level of Functioning of individuals, families, and communities Families from the lower income groups are the ones mostly served Goal of Public Health: to contribute to the most effective total development and life of the individual and his society Ecosystem influences the Optimum Level of Functioning(OLOF) Factors: Political Health Care Delivery Behavioral Environment Heredity Socioeconomic Influence

Categories of Health Problems Health Threaths conditions that are conducive to disease, accident, failure to realize ones health potential. The family may be healthy but there is a risk of developing a problem Examples: Malnutrition Familiy History of Ilness Poor Home environment Cross-infection Inadequate or lack of immunization Family size larger than what family can provide Health deficits instances of failure in health maintenance(disease, disability, developmental lag). Diseases: all illnesses are considered health deficits Disability: blindness, deafness, physical impairment due to polio, etc.

Developmental(physical and mental)lag: Mongoliod,Dwarfism/Gigantism due to hormonal problems

Foreseable Crisis anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources such as: Examples:

School entrance Adolescence Circumcision Courtship and Marriage Pregnancy and Delivery Death of a family member Illegitimacy Migration

Five Fold Mission of of Community Health Nursing 1. 2. 3. 4. 5. Health Promotion Health Protection Health Balance Social Justice Disease prevention a. Primary Prevention generalized health promotion and specific protection against disease. It precede disease or dysfunction and is applied to generally healthy individuals or groups. Secondary Prevention early disease prompt intervention to halt pathological process to shorten duration, severity and return to normal function at earliest possible time(Acute) Tertiary Prevention begins after an illness, when a defect or disability is fixed, stabilized, or determined to be irreversible

b.

c.

Duties and Responsibilities of Community Health Nurse According to Jacobson, community health nursing is a disciplne with the ultimate goal of contributing to the promotion of the clients optimum level of functioning through teaching and delivery of care Roles:

Clinician - who is a health care provider, taking care of the sick people at home or inthe RHU Health Advocator speaks on behalf of the client Advocator act on behalf of the client Supervisor - who monitors and supervises the performance of midwives Facilitator - who establishes multi-sectoral linkages by referral system Collaborator working with other health team member

Home Visit Professional face-to-face contact made by a nurse to a patient or the family to provide necessary health care activities and to further attain an objective of the agency Should have a purpose/objective Planning for a home visit should make use of all available information about the patient and his/her family

Bag Technique Tool making use of the public health bag through which the nurse during the visit can perform nursing procedures with ease and deftness, saving time and effort at the end in view of rendering effective nursing care Public Health Bag essential and indespensable equipment Principles : Minimize the spread of infection Save time and effort

Not overshadow concern of the patient Practice in a variety of way

Special Consideration: Handwashing Contents of the Bag: BP apparatus and stethoscope are carried separately; medicines include betadine, 70% alcohol, benedicts solution, place waste paper bag outside of work area to prevent contamination of clean area Community Organizing Participatory Action Research (COPAR) The COPAR process COPAR - is a social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

Participatory action research is an investigation on problems and issues concerning life and environment of the underprivileged. The underprivileged through their representatives, research themselves with the technical assistance of professional researchers. PAR is a community directed process of gathering and analyzing information on an issue for the process of taking actions and making changes.

Phases -

Pre entry phase

Entry phase

Community study/diagnosis phase (Research phase) Community Organization and Capability Building Phase -

Activities Community consultations/dialogues Setting of issues/considerations related to site selection Development of criteria for site selection Site selection Preliminary social investigation (PSI) Networking with local government units (LGUs), NGOs, and government agencies. Integration with the community Sensitization of the community/information campaigns Continuing social investigation Core group (CG) formation o Development of criteria for selection of CG members o Defining the roles/functions/tasks of the CG Coordination/dialogue/consultation with other community organizations Self-awareness and leadership training (SALT)/action planning Selection of the research team Training on data collection methods and techniques/capabilitybuilding (includes development of data collection tools) Planning for the actual gathering of data Data gathering Training on data validation (includes tabulation and preliminary analysis of data) Community validation Presentation of the community study/diagnosis and recommendations Prioritization of community needs/problems for action Community meetings to draw up guidelines for the organization of the community health organization (CHO). Election of officers Development of management systems and procedures, including delineation of the roles, functions and tasks of officers and members of the CHO Team building/Action-Reflection-Action (ARA) Working out legal requirements for the establishment of the CHO Organization of working committees/task groups (e.g., education and training, membership of committees) Training of the CHO officers/community leaders

Community Action Phase

- Organization and training of community health workers (CHWs) o Development of criteria for the selection of CHWs o Selection of CHWs o Training of CHWs - Setting up of linkage/network referral systems - PIME (planning, implementation, monitoring and evaluation) of health services/intervention schemes and community development projects - Initial identification and implementation of resource mobilization schemes

- Formulation and ratification of constitution and by-laws - Identification and development of secondary leaders - Setting up and institutionalization of financing scheme for community health program/activities Sustenance and strengthening phase - Formalizing and institutionalization of linkages, networks and referral systems - Development and implementation of viable management systems and procedures, committees, continuing education/training of leaders, community health workers, community residents Source: Jimenez, Sr. Carmen, (2005), Community Organizing Participatory Action Research (CO-PAR) for Community Health Development (1st ed), Paranaque, Philippines by the Author. pp.53 -56

Department of Health Vision Health for all Filipinos (OLD) The Leader of health for all in the Philippines (NEW) Mission Enhance accessibility and quality of health care to improve the quality of life for all Filipinos, especially the poor (OLD) Guarantee equitable, sustainable and quality health for all Filipinos,especially the poor and to lead the quest for exellence in health (NEW) Basic Principles

Roles of DOH

Ensured universal access to basic health services Health and nutrition of vulnerable groups must be prioritized

Leadership Enabler Administrator

Framework: Formula one for Health

Financing equitable/secured Service delivery available/accesible Regulation affordable/quality Good governance

Healthcare Delivery System

Totality of all policies, infrastructures,facilities, equipment, products, human resources and services that address the health needs problem and concern of all people

Primary Health Care Essential health care made universally accessible to individuals and families in the community by means acceptable to them GOAL: Health for all Filipinos and health in the hands of the people by the year 2020 MISSION: to strenghten the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care Core Strategy: Partnership and empowerment towards Self-Reliance 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.

Components/Elements of PHC

Education for health Locally endemic disease treatment and control Expanded Program on Immunization Maternal and Child Health Nursing Essential Drugs and Herbal Plants Nutritional Health Services Treatment of Communicable and Non-communicable diseases Sanitation of the environment Dental Health Access to hospitals Mental Health

Principles of Primary Health Care 1. 4 A's

Accessibility, Availability, Affordability Acceptability, Appropriateness of health services

2. Community Participation 3.People are the center, object and subject of development. 4. Self-reliance 5. Partnership between the community and the health agencies in the provision of quality of life. 6. Recognition of interrelationship between the health and development 7. Social Mobilization 8. Decentralization Four Cornerstone/Pillars of PHC 1. 2. 3. 4. Active Community Participation Intra and Inter-sectoral Linkages Use of Appropriate Technology Support mechanism made available

Primary Health Workers: The higher the level the more qualified the health personnel and the more sophisticated the health equipment Concept : Teamwork Two Levels of Primary Health Workers 1. 2. Village/BHWs trained community health workers, health auxilliary volunteers, traditional birth attendants, healers Intermediatte Level professional group which include the Public Health Nurse, Rural Sanitary Inspector and midwives.

ALTERNATIVE THERAPIES HERBAL MEDICINES 10 Herbal Medicines being advocated by DOH Lagundi Vitex Negundo treat cough, colds and fever. It is also used as a relief for asthma & pharyngitis, rheumatism, dyspepsia, boils, and diarrhea. effective in fighting arthritis and gout. The leaves can be eaten fresh as salad or like tea. For the decoction, boil a cup of clean chopped leaves in 2 cups of water. Boil for 15 to 20 minutes. Strain, let cool and drink a cup after meals (3 times day). mainly reduces cholesterol in the blood and helps control blood pressure. an antiseptic to disinfect wounds also, it can be used as a mouth wash to treat tooth decay and gum infection. an analgesic to relive body aches and pain. It can be taken internally as a decoction or externally by pounding the leaves and applied directly on the afflicted area. a diuretic which helps in the excretion of urinary stones and for edema effective in the treatment of diabetes (diabetes mellitus), hemorrhoids, coughs, burns and scalds, and being studied for anti-cancer properties. elimination of intestinal worms, particularly the Ascaris and Trichina effective in treating intestinal motility and also used as a mouth wash since the leaves of this shrub has high fluoride content treat tinea infections, insect bites, ringworms, eczema, scabies and itchiness.

Ulasimang Bato

Peperonia pellucida Allium Sativum Psidium quajava Mentha Cordifelia Blumea Balsanifera Mamordica Charantia Quisqualis Indica Carmona Resuta Cassia Alata

Bawang Bayabas Yerba Buena Sambong Ampalaya Niyog-Niyogan Tsaang-Gubat Akapulko

Public Health Programs Dental Health Program Osteoporosis Prevention Health Education and Community Organization Primary Health Care Reproductive Health Older Persons Health Services Guidelines for Good Nutrition Respiratory Infection Control Accupressures Maternal and Child Care

Family Planning A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. Vision: Empowered men and women living healthy, productive and fulfilling lives and exercising the right to regulate their own fertility through legally and acceptable family planning services. Mission The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the availability of FP information and services to men and women who need them. Program Goals: To provide universal access to FP information, education and services whenever and wherever these are needed.

Importance of Family Planning

For the health of the mother For the health of the newborn For the health of the entire providing

Family Planning Methods 1.Reversible A. Natural method

Cervical Mucus Method/Billings Ovulation Method - As you get closer to ovulation, your cervical mucus will become thinner and stickier. When ovulation is about to occur, your cervical mucus will be clear, slippery and very stretchy, similar to a raw egg white. This type of mucus is ideal for sperm to swim in and helps the sperm swim up to your uterus. While this is great for women who are trying to conceive, women who are trying to avoid pregnancy will want to abstain from sex or use another form of birth control, like condoms or the sponge, during this time. Basal Body Temperature - Also known as the sympto-thermal method, this birth control method involves charting your core body temperaturethroughout your menstrual cycle. Since your temperature rises slightly around the time of ovulation, finding the sustained spike in your core temperature will alert you as to when you are most fertile during your monthly cycle. Symptothermal Method Combination of Billings and BBT.Fertile and infertile days are determined after having established an accurate record of sex immediately preceding menstrual cycles then watching out for BBT fluctuations Lactational Amenorrhea Method - natural postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding. LAM is 98% - 99.5% effective during the first six months postpartum.

B. Social Method Coitus interruptus also known as the withdrawal method, least effective due to premature ejaculation Coitus Reservatus sex without ejaculation, popular among sex workers Coitus interfemura - penis rubbed in between the femur Coitus Intramammas penis is rubbed between the breasts

C. Biological Method also known as the Calendar Method wherein the couple abstains from intercourse on days that the women is fertile

Rhythm Method effective if the mother has a regular cycle. The first step is to determine the cycle then subtract 14 days from the beginning of the next cycle.From ovulation day, subtract 4-5 days and add 4-5 days then the result will be the unsafe days and abstinence is advised. Procedure: Origoknause formula for women with irregular menstrual cycle. The women charts her menstrual cycles for 12 continous months in order to determine the shortest and the longest cycles. The first fertile day is determined by subtracting 18 from the shortest menstrual cycle.

D.Physiological Method Pills combined oral contraceptives prevent ovulation by inhibiting the APG production of FSH and LH which are essential for the maturartion and rupture of follicle,99.9% effective. Depomedroxy Progesterone Acetate or Depo Provera given intramuscularly every 3 months; never massage injection site as this can shorten the duration of effectivity. Norplant 6 match sticks like capsule and rod which is implanted subdermally and contains progesterone that inhibits ovulation. Good for 5 years.

E.Mechanical Method Intrauterine Device(IUD) affects motility of sperm and ovum, usually inserted during menstruation or after delivery,99.7% effective. Condom made of latex inserted to the erected penis or lubricated vagina to prevent sperm to enter to the vagina. Diaphragm made of rubberized material,reusable and dome shaped inserted to the cervix to prevent sperm to get inside the uterus. It must be refitted especially if there is weight gain or loss of 1-5lbs.Must be kept in place for 6 hours after sexual intercourse Cervical Cap more durable than diaphragm that fits to the cervix. It can stay in place for 24 hours and no need to reapply spermicide.

2.Irreversible Bilateral Tubal Ligation(BTL) surgical technique whereby both fallopian tubes are identified, cut and tied. It is safe and highly effective(almost 100%). Vasectomy removal of vas deferens. It has no immediate sterility.After the procedure Father must be taught that he should have atleast 30 ejaculations or 0 sperm count before considering a safe sex.

VITALSTATISTICS t h e a p p l i c a t i o n o f s t a t i s t i c a l m e a s u r e s t o v i t a l e v e n t s ( b i r t h s , d e a t h s a n d c o m m o n illnesses) that is utilized to gauge the levels of health, illness and health services of a community. TYPES: FERTILITY RATE A.CRUDE BIRTH RATE total # of livebirths in a given calendar year X 1000 estimated population as of July 1 of the same given year B.GENERAL FERTILITY RATE total # of livebirths in a given calendar year Total number of reproductive age

X 1000

MORTALITYRATE A. CRUDE DEATH RATE Total # of death in a given calendar year X 1000 Estimated population as of July 1 of the same calendar year B.INFANTMORTALITYRATE Total # of death below 1 yr in a given calendar year X 1000 Estimated population as of July 1 of the same calendar year C.MATERNALMORTALITYRATE

D Total # of death among all maternal cases in a given calendar year X 1000 Estimated population as of July 1 of the same calendar year MORBIDITY RATE A.PREVALENCERATE Total # of new & old cases in a given calendar year X 100 Estimated population as of July 1 of the same calendar year B. INCIDENCE RATE Total # of new cases in a given calendar year X 100 Estimated population as of July 1 of the same calendar year C. ATTACKRATE Total # of person who are exposed to the disease X 100 Estimated population as of July 1 of the same calendar year

Epidemiology the study of distribution of disease or physiologic condition among human population sand the factors affecting such distribution the study of the occurrence and distribution of health conditions such as disease, death,deformities or disabilities on human populations Patterns of disease occurrence Epidemic -a situation when there is a high incidence of new cases of a specific disease inexcess of the expected. -when the proportion of the susceptibles are high compared to the proportion of the immunes Epidemic potential -an area becomes vulnerable to a disease upsurge due to causal factors such asclimatic changes, ecologic changes, or socio-economic changes Endemic -habitual presence of a disease in a given geographic location accounting for thelow number of both immunes and susceptiblese.g. Malaria is a disease endemic at Palawan. -the causative factor of the disease is constantly available or present to the area. Sporadic -Disease o c c u r s e v e r y n o w a n d t h e n affecting only a small number of people relative to the total population -intermittent Pandemic -global occurrence of a disease STEPS IN EPIDEMIOLOGICAL IVESTIGATION: 1.Establish fact of presence of epidemic 2.Establish time and space relationship of the disease 3.Relate to characteristics of the group in the community 4.Correlate all data obtained