CHAPTER I INTRODUCTION A.

BACKGROUND OF THE STUDY Community health nursing is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of community health nursing practice is the community as a whole, with nursing care of individuals, families and groups being involved within the context of promoting and preserving the health of the community. The principles of Community Health Nursing in Relation to the Integrated Management of Childhood Illness Practice are:

The recognized need of individuals, families and communities provides the basis for CHN practice. Its primary purpose is to further apply public health measures within the framework of the total Ch effort. Knowledge and understanding of the objectives and policies of the agency facilities goal achievement. The mission statement commits Community Health Nurses of positively actualize their service to this end. CHN considers the family as the unit of service. Its level of functioning is influenced by the degree to which it can deal with its own problems. Therefore the family is an effective and available channel for the most of the CHN efforts. Respect for the values, customs and beliefs of the clients contribute to the effectiveness of care to the client. CHN services must be available sustainable and affordable to all regardless of race, creed, color or socio-economic status. CHN integrated health education and counseling as vital parts of functions. These encourage and support community efforts in the discussion of issues to improve the peoples health.

Collaborative work relationships with the co-workers and members of the health team facilities accomplishments of goals. Each member is helped to see how his/her work benefits the whole enterprise. Periodic and continuing evaluation provides the means for assessing the degree to which CHN goals and objectives are being attained. Clients are involved in the appraisal of their health program through consultations, observations and accurate recording. Continuing staff education program quality services to client and are essential to upgrade and maintain sound nursing practices in their setting. Professional interest and needs of Community Health Nurses are considered in planning staff development programs of the agency. Utilization of indigenous and existing community resources maximizing the success of the efforts of the Community Health Nurses. The use of local available ailments. Linkages with existing community resources, both public and private, increase the awareness of what care they need what are entitled. Active participation of the individual, family and community in planning and making decisions for their health care needs, determine, to a large extent, the success of the CHN programs. Organized community groups are encouraged to participate in the activities that will meet community needs and interests. Supervision of nursing services by qualified by CHN personnel provides guidance and direction to the work to be done. Potentials of employees for effective and efficient work are developed. Accurate recording and reporting serve as the basis for evaluation of the progress of planned programs and activities and as a guide for the future actions. Maintenance of accurate records is a vital responsibility of community as these are utilized in studies and researches and as legal documents.

Integrated case management relies on case detection using simple clinical signs and empirical treatment. As few clinical signs as possible are used. The signs are based on expert clinical opinion and research results, and strike a careful balance between sensitivity and

specificity. The treatments are developed according to action-oriented classifications rather than exact diagnosis. They cover the most likely diseases represented by each classification. The IMCI process can be used by doctors, nurses and other health professionals who see sick infants and children aged from 1 week up to five years. It is a case management process for a first-level facility such as a clinic, a health centre or an outpatient department of a hospital. The IMCI guidelines describe how to care for a child who is brought to a clinic with an illness, or for a scheduled follow up visit to check the childs progress. The guidelines give instructions for how to routinely assess a child for general danger signs (or possible bacterial infection in a young infant), common illnesses, malnutrition and anemia, and to look for other problems. In addition to treatment, the guidelines incorporate basic activities for illness prevention. The complete IMCI case management process involves the following elements: Assess a child by checking first for danger signs (or possible bacterial infection in a young infant), asking questions about common conditions, examining the child, and checking nutrition and immunization status. Assessment includes checking the child for other health problems. Classify a childs illnesses using a color-coded triage system. Because many children have more than one condition, each illness is classified according to whether it requires: urgent pre-referral treatment and referral (red), or specific medical treatment and advice (yellow), or simple advice on home management (green). After classifying all conditions, identify specific treatments for the child. If a child requires urgent referral, give essential treatment before the patient is transferred. If a child needs

treatment at home, develop an integrated treatment plan for the child and give the first dose of drugs in the clinic. If a child should be immunized, give immunizations. Provide practical treatment instructions, including teaching the caretaker how to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at home. Ask the caretaker to return for follow-up on a specific date, and teach her how to recognize signs that indicate the child should return immediately to the health facility. Assess feeding, including assessment of breastfeeding practices, and counsel to solve any feeding problems found. Then counsel the mother about her own health. When a child is brought back to the clinic as requested, give follow-up care and, if necessary, reassess the child for new problems. The IMCI guidelines address most, but not all, of the major reasons a sick child is brought to a clinic. A child returning with chronic problems or less common illnesses may require special care which is not described in this handbook. The guidelines do not describe the management of trauma or other acute emergencies due to accidents or injuries. Although AIDS is not addressed specifically, the case management guidelines address the most common reasons children with HIV seek care: diarrhea and respiratory infections. When a child, who is believed to have HIV, presents with any of these common illnesses, he or she can be treated the same as any child presenting with an illness. If a childs illness does not respond to the standard treatments described in this handbook, or if a child becomes severely malnourished, or returns to the clinic repeatedly, the child is referred to a hospital for special care. Case management can only be effective to the extent that families bring their sick children to a trained health worker for care in a timely way. If a family waits to bring a child to a clinic until the child is extremely sick, or takes the child to an untrained provider, the child is more likely to die from the illness. Therefore, teaching families when to seek care for a sick child is an important part of the case management process.

The case management process is presented on two different sets of charts: one for children age 2 months up to five years, and one for children age 1 week up to 2 months. B. STATEMENT OF OBJECTIVES B.1 General Objectives After a week of our community exposure in Sito Oriole,Mambugan, Antipolo city: 1. To discover and appraise health problems. 2. To serve as a guide in familys understanding and acceptance of problems 3. To provide nursing services that the family needs and cannot provide itself 4. To contribute to personal and social development of individuals and families through health activities B.2 Specific Objectives: After a week of our community exposure in Sito Oriole, Knowledge:
1. The families will determine the presence of any health problems in their children.

2. They will develop a common feeling of solidarity and become aware about the treatment needed for the illness of the child.
3. The families will determine priorities among the list health problems.

Skills:
1. The families will actively participate in the promotion and maintenance of the health of

their children. 2. Help their community to attain their optimum level of functioning. 3. Demonstrate the things they learned about the prevention and promotion of the childrens health status on their community.

Attitude: 1. They initiate contact and communicate interest in the prevention, and promotion of health of their children. 2. Develop trust and rapport between the families and the health care provider. 3. Show willingness to listen to the topics being presented about their childrens health status.

C. SIGNIFICANCE OF THE STUDY

Since Integrated Management of Childhood Illness (IMCI) aims to significantly reduce the morbidity and mortality associated with major cause of disease in children and to contribute to healthy growth and development of children, we utilized this as a strategy to deal with common childhood illnesses in an integrated manner. We believe that this will benefit the following:

Individuals: For them to be aware of the different diseases that they may encounter and also for them to be knowledgeable about the following treatment in which they should comply with.

Families: For them to be able to learn the different home care management and be provided with information about the importance of complying in various treatments available.

Community: For them to know the different risk factors present in their community and reduce the major causes of increasing morbidity and mortality.

Health Sectors/Health Personnel: For them to be constantly provide proper and timely management towards childhood illnesses, in accordance to the IMCI process.

Nursing Students: For them to be guided accordingly on how to perform management and most importantly, to be able to assess a sick child and young infant; guided by the IMCI chart.

D. SCOPE AND LIMITATION OF THE STUDY The community has 12 houses. The collection of data is limited to 6 families consisting of children; with whom we conducted our interview. This compilation of data is focused to the assessment, classifying the illness, identifying the treatment, and evaluating the children health status residing in Sitio Oriole, Mambugan Antipolo city. The respondent are 0-5 years old and we focus on diseases such as Pneumonia, Diarrhea, Fever, Ear problem, Malnutrition, Anemia, Local infection and Jaundice. We had our courtesy call at the Barangay of the community for Mrs. Pedrozas permission. We conducted the first day of community exposure on November 14, 2011, we get the census and all information gathered directly to the family in the community.