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Community

Health Nursing
Mr. Jhessie L. Abella RN,RM,MAN

Course Content
I. Overview of Community Health Nursing II. Community Health and Development Concepts, Principles and Strategies III. The Community Health Nursing Process IV. Implementing the Community Health Nursing Services V. Evaluating Community Health Nursing Services VI. Recording and Reporting

Course Description: This course focuses on the care of population groups and community as clients utilizing concepts and principles in community health development. It also describes problems, trends and issues in the Philippine and global health care systems affecting community health nursing practice. Course Objectives: At the end of the course the student will be able to:
1. Apply concepts and principles of community health development in the care of communities and population groups. 2. Utilizes the nursing process in the care of communities and population groups. a. Assess the health status of communities and population groups to identify existing and potential problems. b. Plans relevant and comprehensive interventions and programs based on identified priority problems. c. Implements appropriate plan of care to improve the health status of the communities and population groups. d. Evaluates the progress and outcomes of community health nursing interventions and programs. 3. Ensure a well-organized recording and reporting system. 4. Share leadership/relate effectively with others in work situations related to nursing and health.

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An Overview of the Community


What is a Community?
Community is the object or locus (area) of service in Community Health Nursing (CHN) Community is a group of people living in a specific geographical area that have a health interest and needs which they can identify or be helped to identify. Different types of structure exist in the community. The level of community health is influenced by many factors such as physical, biological, socio cultural and economic factors. Community is like an individual and family that have characteristic sets of values, relationship and ways of behaving that may have a great effect in their health. a group of people with common characteristics or interests living together within a territory or geographical boundary place where people under usual conditions are found The community is the object or focus of care in CHN, with the family as the unit of service.

Characteristics of COMMUNITY
It is defined by its geographical boundaries within certain identifiable characteristics It is made up of institution organized into a social system with the institution and organizations linked in a complex network A common or shared interest that binds the member together Population aggregated concept

A Healthy Community
Awareness that we are a community Conservation of the natural resources Recognition and respect Participation of subgroups in community affairs Preparation to meet crisis Ability to problem-solve Community through open channels Resource available to all Settings of disputes through legitimate mechanism Participation of citizen in decision making Wellness of a high degree among its members

FAMILY is

the basic unit of care in the community


1. Religious Groups 2. Socio economic group and voluntary organization 3. Government structure

Community Structure:

FACTS of CHN
Focus : Area of Content: promotion and preservation of health skills and knowledge relevant to both nursing and public health general populations (individuals, families, communities) continual, not limited to episodic care
comprehensive and general, not limited to a particular age or group
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Clients: Time: Scope :


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2. What Is Health?

A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity (WHO, 1995).
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What is Health?
It carries the mandate that health is a basic human right. It is seen as a spectrum or a continuum The modern concept of health refers to Optimum Level of Functioning (OLOF) of individuals, families, and communities, which is influenced by the ecosystem through a myriad of factors.

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3. What is Nursing?
The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980). Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele individuals, families or groups, and communities

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It operates within the realm of health care both independently and interdependently. The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson)

Community Health Nursing is one of the two major fields of nursing in the Philippines: the other is hospital nursing. Those who work in the RHU or health centers are Community Health Nurses and are official called PUBLIC HEALTH NURSES. Occupational health nurse and school nurses are classified as CHN. According to ANA: Community Health Nursing practice

promotes and preserve the health of population by


integrating the skills and knowledge relevant to both nursing and public health. The practice is comprehensive and general, and is not limited to a particular age or diagnostic group, it is continual and is not limited to episodic careCHN practice includes nursing directed to individual, families and groups, the dominant responsibility is to the

population as a whole.

Concepts on Community Health Nursing


CLIENTS of Community Health Nurse Composed of different levels of clientele: Individual, family, population group, and community Community as a SETTING for CHN PRACTICE School Health Nursing- School Occupational Health NursingWorkplace Public Health Nursing-Home

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Concepts on Community Health Nursing


1. The primary focus of CHN practice is on health promotion, thru health teaching and education.
Three major aspect of heath education:
1. Information 2. Education 3. Communication

*Create awareness thru motivation Three domains of learning of a client:


1. Cognitive 2. Affective 3. Psychomotor
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Concepts on Community Health Nursing


CHN practice is extended to benefit the whole family (community and family) CHN contact with the family and community may continue over a long period of time. CHN utilizes the dynamic process
( dynamic process practice of service)
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Concepts on Community Health Nursing


What would you consider when doing health education?
Emotional, maturational, educational level of client.

What is the sign that the client understand the health teaching?
When client practices the health teaching that was shared, which can be confirmed through home visit.
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Concepts on Community Health Nursing


Community Health Nursing Emphasized The importance of the greatest good for the greatest number Assessing health needs, planning, implementing and evaluating the impact of health services on population groups Priority of health-promotive and diseaseprevention strategies over curative intervention Tool for measuring and analyzing community health problems Application of principles of management and organization in the delivery of health services in the community

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Essential Public Health Functions


Health situation monitoring and analysis Epidemiological surveillance/disease prevention and control Development of policies and planning in public health Strategic management of health system and services for population health gain Regulation and enforcement to protect public health Human resources development and planning Health promotion, social participation and empowerment Ensuring the quality of personal and population based services Research, development and implementation of innovative public health solutions
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The National Health Situation


INDICATOR Population Population Density Projected Population Growth Rate Projected Life Expectancies at Birth Males Females Infant Mortality Rate Simple Literacy Rate School Participation Rate Elementary Secondary Average Annual Family Income Average Annual Family Expenditures Poverty Threshold Poverty Incidence LATEST 88.57 million As of 01 Aug 2007 255 persons per sq. km As of 01 May 2000 2.05% 2000-2005 PREVIOUS 76.5 million As of 01 May 2000 246 persons per sq. km. As of 01 Sept 1995 2.31% 1990-2000

66.1 yrs.(2005) 71.6 yrs.(2005)

67.53 yrs.(2004) 72.78 yrs.(2004)

30 per 1,000 36 per 1,000 livebirths livebirths 2003 (official estimate)1998 (official estimate)
93.4% (2003) 88.84% SY 2007-2008 61.91% SY 2007-2008 P173,000 (2006) P147,000 (2006) P15,057 (2006) 26.9% of total families 2006 92.3% (2000) 83.22% SY 2006-2007 58.59% SY 2006-2007 P148,616 (2003) P124,377 (2003) P14,196 (2005) 24.4% of total families 2003

POPULATION: 101,833,938 CAPITAL WITH POPULATION: Manila - 1,654,761 LARGEST CITY WITH POPULATION: Quezon City - 2,173,831
INDICATOR Underemployment Rate LATEST 17.8% Apr 2010 8.0% Apr 2010 YEAR-AGO 18.9% Apr 2009 7.5% Apr 2009 PREVIOUS 19.7% Jan 2010 7.3% Jan 2010

Unemployment Rate

2006 Contraceptive preva lence rate (Based on currently married women aged 15-49 years)

2005

2004

50.6%

49.3%

49.3%

Modern method Traditional method

35.9%
14.8%

36.0%
13.2%

35.1%
14.2%

MORBIDITY: 10 Leading Causes, Number and Rate* 5-Year Average (2000-2004) & 2005 5-Year Average (20002004) Number 1. Acute Lower Respiratory Tract Infection and Pneumonia** 2. Bronchitis/Bronchiolitis 3. Acute watery diarrhea 4. Influenza 5. Hypertension 6. TB Respiratory 7. Diseases of the Heart 8. Malaria 9. Chicken Pox 10. Dengue fever * ** per 100,000 population Does not include ALRI, Pneumonia cases only from 2000-2002 Rate

Diseases

2005 Number Rate

694,209
669,800 726,211 459,624 314,175 109,369 43,945 35,970 79,236 15,383

884.6
854.7 928.3 587.0 400.5 139.7 56.1 46.1 41.1 19.6

690,566
616,041 603,287 406,237 382,662 114,360 43,898 36,090 30,063 20,107

809.9
722.5 707.6 476.5 448.8 134.1 51.5 42.3 36.3 23.6

MORTALITY: TEN (10) LEADING CAUSES NUMBER AND RATE/100,000 POPULATION Philippines 5-Year Average (2000-2004) & 2005 CAUSES
1. Diseases of the Heart 2. Diseases of the Vascular System 3. Malignant Neoplasms 4. Pneumonia 5. Accidents** 6. Tuberculosis 7. Chronic lower respiratory diseases 5-Year Average (2000-2004) Number Rate 66,412 83.3 50,886 63.9 38,578 48.4 32,989 41.4 33,455 42.0 27,211 34.2 18,015 22.6

2005*
Number 77,060 54,372 41,697 36,510 33,327 26,588 20,951 18,441 12,368 11,056 Rate 90.4 63.8 48.9 42.8 39.1 31.2 24.6 21.6 14.5 13.0

8. Diabetes Mellitus 13,584 17.0 9.Certain conditions originating in the 14,477 18.2 perinatal period 10. Nephritis, nephrotic syndrome 9,166 11.5 and nephrosis Note: Excludes ill-defined and unknown causes of mortality *reference year ** External Causes of Mortality

Item Hospitals Government Private Doctors Dentists

1999 1,794 648 1,146 2,948 2,027

2000 1,712 623 1,089 2,943 1,943

2001 1,708 640 1,068 2,957 1,958

2002 1,739 662 1,077 3,021 1,871

2003 1,719 662 1,057 3,064 1,946

2004 1,725 657 1,068 2,969 1,929

2005 1,838 702 1,136 2,967 1,946

2006 1,921 719 1,202 2,955 1,930

2007 1,781 701 1,080 3,047 1,894

2008 1,784 711 1,073 2,838 1,891

2009 1,795 721 1,074 ... ...

Government Health Manpower

Nurses
Midwives

4,945

4,724

4,819

4,720

4,735

4,435

4,519

4,374

4,577

4,576

...
... ...

16,173 16,451 16,612 16,534 17,196 16,967 17,300 16,857 16,821 17,437

Barangay 14,416 15,204 15,107 15,283 14,490 15,099 15,436 16,191 16,219 17,018 Health Stations Rural Health Units a/ 2,212 2,218 1,773 1,974 2,259 2,258 2,266

...

Ethico-legal Aspects of Nursing in the Community


The practice of a profession is guided by a number of legal and ethical principle that are primarily on the welfare of clients and protection of their rights. Professional practice is legal if the practitioner works in accordance with the law or does not violates its provisions.

Ethico-legal Aspects of Nursing in the Community


1. Restrict for person applying the principles of autonomy (self autonomy, self determination) 2. Beneficence do good for everybody 3. Nonmaleficence avoid harm 4. Justice treating clients equally; give client what is due to them; support the right of the person.

Public health nurses in the Philippines have made a great contribution to the improvement of the health of the people for more than a century now. In the light of the changing national and global health situation and the acknowledgement that nursing is a significant contributor to health, the PHN is strategically positioned to make difference in the health outcomes of individuals, families and communities cared for.

PUBLIC HEALTH NURSING IN THE PHILIPPINES

GLOBAL AND COUNTRY HEALTH IMPERATIVES


Public heath system are operating within a context of ongoing changes, which exert a number of pressures on the public health system. 1. Shifts to demographic and epidemiological trends in diseases, including the emergence and reemergence of new diseases and in the prevalence of risk and protective factors. 2. Ne technologies for health care, communication and information 3. Existing and emerging environmental hazards some associated with globalization 4. Health reforms

MILLENIUM DEVELOPMENT GOALS Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop a global partnership for development

Determinants of Health
Employment

Social Support Networks

Culture
Genetics

and Working Condition

Physical Environme nt

Personal Behavior and Coping Skills

Education

Health Services

Income and Social Status

HEALTH

Gender

ECO SYSTEM INFLUENCES ON OLOF


Political
Behavior Culture, Habits, Mores, Ethnic Customs

Safety, Oppression,
People Empowerment

Socio Economic Employment, Education, Housing

Heredity Genetic Endowment

Environmental

Air, Food, Water, Waste, Rural, Urban, Noise, Radiation, Pollution

OLOF

Health Care Delivery System Promotive Preventive, Curative, Rehabilitative

Board Question
Isolation of a child with measles belongs to what level of prevention? A. Primary B. Secondary C. Intermediate D. Tertiary

Board Question
On the other hand, Operation Timbang is_____ prevention? A. Primary B. Secondary C. Intermediate D. Tertiary

Board Question
RA 7160 mandates devolution of basic services from the national government to local government units. Which of the following is the major goal of devolution?

A. To strengthen local government units B. To allow greater autonomy to local government units. C. To empower the people and promote their selfreliance D. To make basic services more accessible to the people

Board Question
"Public health services are given free of charge". Is this statement true or false? A. The statement is true; it is the responsibility of government to provide haste services B. The statement is false; people pay indirectly for public health services C. The statement may be true or false; depending on the Specific service required D. The statement may be true or false; depending on policies of the government concerned.

The Philippine Health Care Delivery System


The Philippine HCDS is composed of two sectors: Public Sector- largely financed through a tax based
budgeting system at both national and local levels and where health care is generally given free at the point of service. With the devolution of health services, the local health system is now run by the LGU.

Private Sectors- includes for profit and non profit health


providers their involvement in maintaining peoples health is enormous.

Board Question
Who is the Chairman of the Municipal Health Board? A. Mayor B. Municipal Health Officer C. Public Health Nurse D. Any qualified physician

Board Question
Which level of health facility is the usual point of entry of a client into the health care delivery system? A. Primary B. Secondary C. Intermediate D. Tertiary

Republic Act 7160


AN ACT PROVIDING FOR A LOCAL GOVERNMENT CODE OF 1991 SECTION 1. Title. This act shall be known and cited as the Local Government Code of 1991.

SECTION 2. Declaration of Policy. (a) It is hereby declared the policy of the State that the territorial and political subdivisions of the State shall enjoy genuine and meaningful local autonomy to enable them to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals. Toward this end, the State shall provide for a mare responsive and accountable local government structure instituted through a system of decentralization whereby local government units shall be given more powers, authority, responsibilities and resources. The process of decentralization shall proceed from the national government to the local government units.
(b) It is also the policy of the state to ensure the accountability of local government units through the institution of effective mechanisms of recall, initiative and referendum. (c) It is likewise the policy of the State to require all national agencies and offices to conduct periodic consultations with appropriate local government units, nongovernmental and peoples organizations, and other concerned sectors of the community before any project or program is implemented in their respective jurisdictions.

Local Health System


Who is the Chairman of the Municipal Health Board? A. Mayor B. Municipal Health Officer C. Public Health Nurse D. Any qualified physician If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the: A. Rural Health Unit B. District Health Office C. Provincial Health Office D. Municipal Health Board

The DEVOLUTION made local government executives responsible to operate Each center controls a portion of the health care system as part of its political and administrative Provincial City/Municipal Government Government mandate
District Hospital Provincial Hospital

HC/RHU

BHS

Function of the MHO or CHO


MHO- municipal health officer CHO - city health officer
1. Administrative and monitoring the health programs and services within the city or municipality or their catchments area.
In the year 1991 a law was passed RA 7160 (Devolution Code) - this law transfers the programs and powers of the DOH to the local government unit to be the lead implementer. The local health board - are responsible in improving the health of the constituent. Chairperson of the Local Health Board is the Governor if regional or Mayor if city.

2. They recommend to the mayor or governor in hiring the health staff.

Composition of the Local Health Zone


1. People- According to WHO the ideal health district would have a population size between 100,000 and 500,00 for optimum efficiency and effectiveness. 2. Boundaries- clear boundaries between Loc al Health Zone determine the accountability and responsibility of health providers, geographical location and access to referral such as district hospital are the usual basic in forming the boundaries. 3. Health facilities 4. Health Workers

Board Question
Which of the following government agency is the sole provider of technical and other resources assistance to concerned group as mandated by the EC 102? A. Department of Interior and Local Government B. DOJ C. DOH D. DPWH

Department of Health
Executive Order 102 identified the DOH as the national authority on health providing technical and other resource assistance to concerned group. EO 102 mandates the DOH to provide assistance to local government units, peoples organization, and other member of civic society in effectively implementing programs, projects and services that will promote the health and well being of every Filipino; prevent and control diseases among population at risk; protect individual, families and communities exposed to

Department of Health
All but which of the following is not the general functions/role of the health sector? 1. provides leadership in the formulation, monitoring and evaluating of national health policies, plans, and programs 2. Innovate new strategies in health to improve the effectiveness of health programs, initiate public discussion on health issues 3. Manage selected national health facilities and hospitals with modern and advanced facilities that shall serve as national referral centers.

Department of Health
Role and Functions of the DOH Leadership in Health Enabler and Capacity Builder Administrator of Specific Services Vision: The DOH is the leader of health, staunch advocate and model in promoting Health for ALL in the Philippines. Goal: HSRA

Board Question
Which of the following is not the rationale of the Health Sector Reform? A. Burden of diseases is heaviest on the Class A society B. Slowing of IMR and MMR C. Persistent large variations in health status across population group and high burden from infectious diseases D. Rising burden from chronic and degenerative disease

Board Question
There has been a significant improvement in the health status of Filipinos for the last 50 years. But failing health condition is still emerging problem of the DOH. The following are the reason why these condition still emerge except; A. Inappropriate health delivery system B. Inadequate regulatory mechanism for health services resulting to poor quality of health C. Poor health care financing and inefficient sourcing or generation of funds fro

FOURmula One for Health


Health Financing Health Regulation Health Service Delivery Good Governance

Board Question
What is the priority program of the DOH? A. Reproductive Health B. Maternal and Child Health C. Nutrition Programs D. Environmental sanitation

D ental Health

Programs of DOH

O perations for Environmental Sanitation H ealth Education and Community Organizing P revention and Control of Communicable Diseases R eproductive Health O lder Persons Health Services G uidelines for Nutrition

R ehabilitation and Management of Noncommunicable Dse.


A lternative Health Care Practices (HerbalMeds/Acupressure)

Board Question
You are working in the RHU which is staff with 1 RHM. Who is the direct supervisor of the RHM? A. Physician B. Mayor C. RHN D. BHW

You are the public health nurse in a municipality with a total population of about 20,000. There are 3 health midwives among the RHU personnel. How many more midwife items will the RHU need? A. 1 B. 2 C. 3 D. 4

Main Features of DOH Programs


1. Establishment of additional Barangay health station this is manned by the Rural Health Midwife (RHM). 2. Staffing of the Barangay health station. 3. Redistribution of the roles and relationship of the Rural Health Unit (RHU) personnel.

Ideally:
For every 5 000 population there should be I RHM (Rural Health Midwife) For every 20 000 population there should be 1 RHN (Rural Health Nurse) For every 20 000 population there should be 1 RHP (Rural Health Physician)

The RHP (Rural Health Physician) - is the manager or chairman and administrative supervisor of the rural health unit.

The technical supervisor of the RHM (Rural Health Midwife) is the RHN (Rural Health Nurse) The head of the RSI (Rural Sanitary Inspector) is the

Sanitary Engineer.

Board Question
What is the legal basis of Primary Health Care approach in the Philippines? A. Alma Ata Declaration of PHC B. Letter of Instruction No 949 C. Presidential Decree No. 147 D. Presidential Decree 996

Primary Health Care


CommunityBased

Affordable

Accessible

PHC
Acceptable

Sustainable

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Framework
People Empowerment

Health for All Filipinos by the Year 2000 and Health in the Hands of the People by 2020

Partnership

Primary Health Care


In Sep. 6-12,1978, a conference was held at Alma Atta, Russia The conference was sponsored by the World Health Organization and the UNICEF The purpose of the conference was to develop a new approach to health care delivery system that would make possible the global goal of WHO Health for ALL The output of the conference was entitled Alma Atta Declaration on PHC LOI 949 issued by the them Pres. Marcos mandated the DOH to use PHC as an approach in planning and implementing health programs LOI 949 is the legal basis of PHC in the country and has an underlying theme Health in the Hands of the People by 2020

Primary Health Care


WHO define PHC as an essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford every stage of development. The concept of PHC is characterized by partnership and empowerment of the people. accessible, acceptable and

sustainable
It is a strategy, which focuses responsibility for health on the individual, families and the communities. full participation

and active involvement of the community

Primary Health Care


How can PHC be POSSIBLE?
Control of Communicable Diseases Offers Health Education Maternal and Child Care Provision of Medical Care and Emergency Treatment Offers Immunization Nutrition and Food Supply Environmental Sanitation N Family Planning Treatment of Locally Endemic Diseases Supply and Proper Use of Essential Drugs

Primary Health Care


E L E M E N T S H O M E Education for health (priority) Locally endemic disease prevention and control Essential drug provision Maternal and child health and family planning Expanded program on immunization Nutrition (adequate food and proper nutrition) Treatment of communicable disease Safe water and environmental sanitation Hospital as a center of wellness Oral and dental health Mental health Elderly care

C O M M U N I T Y P A R T I C I P A T I O N

I N T R A A N D I N T E R SEC L I N K

A P P R O P R I A T E

S U P P O R T M E C H A N I S M

T E C H N O L O G Y

Four Cornerstone of PHC


1. Active community participation and involvement 2. Intra and inter sectoral linkages *Intra sectoral - within the health system / facilities: Primary - rural health unit, local government unit, health center, Brgy. health station. Secondary - regional health sector Tertiary - national level headed by the Department of Health 3. Use of appropriate technology *provide social and environmental service that is acceptable to all level and has a quality of product with the least cost. Criteria for selection of technology (S.A.F.E.S.A.C) 1. efficacy and safety 2. complexity and simplicity 3. the cost 4. acceptability 5. scope of technology 6. visibility 4. Support mechanism made available *the primary health care, as a nurse one must try to determine the needs of the community (ex. teach income generating program (IGP) such as basket weaving, candle making, soap making etc.)

Types of PH Care Workers


What consist the PHC team?
Physician Nurses Midwives Nurse Auxiliaries TBA BHW

Two Levels of PHC Workers


1. Primary Level Barangay Health Worker (BHW) Trained Hilot Traditional Birth Attendant (TBA) Grassroots leader in the community 2. Intermediate Level Midwives Public Health Nurse (PHN) Rural Health Physician (RHP) Private practitioner

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.
REPUBLIC ACT NO. 8423 - AN ACT CREATING THE PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND AND FOR OTHER PURPOSES

Section 1. Short Title This Act shall be known as the Traditional and Alternative Medicine Act (TAMA) of 1997.
Section 2. Declaration of Policy It is hereby declared the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system.

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.
It shall also be the policy of the State to seek a legally workable basis by which indigenous societies would own their knowledge of traditional medicine. When such knowledge is used by outsiders, the indigenous societies can require the permitted users to acknowledge its source and can demand a share of any financial return that may come from its authorized commercial use.

In promoting herbal medicines:


Encourage client to backyard gardening. When using herbal medicines, advise the client never to use insecticides or pesticides Use one herbal medicine at a time When cooking the herb, use clay pat and remove the cover to prevent over cook. If there is a reaction to the herbal medicine, advice client to go to the nearest health center.

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.

1) Bawang-anti cholesterol

2) Ulasimang-Bato-lowers uric
acid

3) Bayabas- antiseptic; diarrhea 4) Lagundi-cough, asthma, and


colds

5) Yerba Buena- toothache, pain,


and arthritis

6) Sambong- renal calculi 7) Ampalaya- diabetes mellitus 8) Niyog-niyogan- anti-helminthic

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997. 1. Bayabas (Psidium Guajava) - for washing of wounds, for those with diarrhea, can be use as gargle for toothache.

Uses of Bayabas: Antiseptic, astringent, & anti helmintic Kills bacteria, fungi, and ameba Used to treat diarrhea in children For hypertension, diabetes and Asthma Promotes menstruation

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.

2, Lagundi (Vitex Negunda) - for cough and fever, asthma, dysentery (blood in the stool) headache, aromatic bath for sick patients, occasionally for patient with rheumatism, treat skin disease. Benefits:
Relief of asthma & pharyngitis Recommended relief of rheumatism, dyspepsia, boils, diarrhea Treatment of coughs, colds, fever and flu

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.

3. Yerba Buena (Clinopodium douglasii) for rheumatism, cough and cold, aromatic herb that can be use for body ache and pain.
Benefits & Treatment of:
Arthritis Headaches Toothaches Mouth wash Relief of intestinal gas Stomach aches Indigestion Drink as tea for general good health

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.

4. Sambong (Blumea balsamifera) anti - edema diuretic, anti-lithiasis (stone) Benefits:


Good as diuretic agent Effective in dissolving kidney stones Aids in treating hypertension & rheumatism Treatment of colds and fever Anti diarrheic & Anti gastralgic properties Helps remove worms, boils Treats dysentery, sore throat

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997. 5. Akapulko (Cassia alata) anti fungal, ringworm, scabies, athletes foot. Uses of Akapulko:
Treatment of skin diseases: Tinea infection, insects bites, ringworms, eczema, scabies and itchiness. Internal: Expectorant for bronchitis and dyspnoea, mouthwash in stomatitis, alleviation of asthma symptoms, used as diuretic and purgative, for cough and fever, as a laxative to expel intestinal parasites and other

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.
6. Ampalaya (Momordica Charantia) - for those with non-insulin diabetes mellitus, non-ketosis prone diabetes, maturity onset or juvenile diabetes. Herbal Benefits of Ampalaya:
Good for rheumatism and gout And diseases of the spleen and liver Aids in lowering blood sugar levels Helps in lowering blood pressure Relieves headaches Disinfects and heals wounds and burns Can be used as a cough & fever remedy Treatment of intestinal worms, diarrhea Helps prevent some type of cancer Enhance immune system to fight infection

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997. 7. Bawang (Allium sativum) - for those with hypertension, toothache, it also lowers cholesterol
Benefits of Bawang:
Good for the heart Helps lower bad cholesterol levels (LDL) Aids in lowering blood pressure Remedy for arterioclorosis May help prevent certain types of cancer Boosts immune system to fight infection With anti oxidant properties Cough and cold remedy Relieves sore throat, toothache Aids in treatment of tuberculosis

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.
8. Niyog-niyogan (Quisqualis indica L.)

- anti helmintic 9. Tsaang Gubat (Ehretia microphylla Lam.) - for those with diarrhea, stomach ache, can be used as mouthwash because it is rich in fluoride.
Benefits and Treatment of: Stomach pains Gastroenteritis Intestinal motility Dysentery Diarrhea or Loose Bowel Movement

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997. 10. Ulasimang bato / pansit-pansitan (Peperomia peliucida) - lowers uric acid, rheumatism, gout, tophi (buko - bukol) Pansit pansitan is used as an herbal medicine for the treatment of:
Arthritis Gout Skin boils, abscesses, pimples Headache Abdominal pains Kidney problems

REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997.
Tips on Handling Medical Plants / Herbs: If possible, buy herbs that are grown organically without pesticides. Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall. Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts.

After harvesting, if drying is required, it is advisable to dry the plant parts either in the oven or air-dried on screens above ground and never on concrete floors.
Store plant parts in sealed plastic bags or brown

The Public Health Nurse


A PHN can perform his/her function effectively if all of the following is met except; a. Has the necessary knowledge, skills and attitudes towards with the health needs of the client b. He/she is a graduate nurse or should be a professional nurse alone c. Familiar with the structure and dynamics of the health care system d. Is knowledgeable of laws and policies affecting the health care delivery system

What is the law that govern the practice of nursing and PHN in the Philippines? a. RA 8423 b. RA 7160 c. RA 9173 d. RA 7164

RA 9173 Nursing Act of 20


Section 28 of RA 9173 specifies the scope of nursing A person shall be deemed to be practicing nursing when he/she singularly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood and old age. As independent practitioner nurse are primary responsible for the promotion and prevention illness. It shall be the duty of the nurse to; a. Provide nursing care through the utilization of the nursing process b. Establishing linkages with the community resources and coordination with the health team. c. Provide health education to individuals, families and communities d. Teach guide and supervise the students in nursing education programs, including administration of nursing services in varied setting e. Undertake nursing and health human resource development

The National League of Philippine Government Nurse in 2005 describe the qualification and function of a PHN. The PHN must be professionally qualified and licensed to practice in the arena of PHN just like any other professional health worker.

PHN must posses the following qualities; Personal qualities and people skills Resourcefulness Creativity Honesty Integrity Interest and willingness to work with the people

Role and Functions of a PHN


The PHN has various role and functions: Manager, Planner, Implementer, Monitor, Evaluator, Educator, Facilitator and Coordinator. As a Manager: Plans and organizes the nursing service of the unit Participate in the preparation of the municipal health plan Implements the nursing service Monitor and evaluate the implementation of the nursing service Initiates changes for the improvement of services Manages the RHU in the absence of the RHP

Role and Functions of a PHN


The PHN has various role and functions: Manager, Planner, Implementer, Monitor, Evaluator, Educator, Facilitator and Coordinator. As a Trainor: Participates in meeting the training needs of the midwives, student affiliates and other trainees As a Supervisor: Supervises the RHM Implements supervisory plan Monitors and evaluates the performance of the midwifes Maintain records and reports

Role and Functions of a PHN


Provider of Health and Nursing Care Collaborating and Coordinating Function Health promotion and Education Function Research Function

When the patient came in to the clinic the nurse should do which of the following first? a. Ask the patient his/her name for registration b. Greet the client upon entry c. Perform first level assessment d. Give priority number to clients

Clinic Visit the patient visit the Health Center to avail the services thereto offered by the facility primarily for consultation that ailed them physically. The nurse plays a very important role in building a closer ties with the patient to gain their trust and confidence. Pre-Consultation Conference is usually conducted prior to the admission of patients, which is one way of providing

Standard Procedure During Clinic Visit


I. Registration and Admission Greet the client upon entry and establish rapport Prepare the family record of new patient or retrieve record of the old client Elicit record the clients CC and Hx Perform PE II. Waiting Time Give priority number to the client first come first served III. Triaging Manage program based case Refer the non program based cases to the physician Provide first aid treatment to emergency cases and refer when necessary IV. Clinical Evaluation V. Laboratory and other Diagnostic Exams VI. Referral System VII. Prescription and Dispensing VIII. Health Education

It is a family nurse contact which allows the health worker to assess the home and family situation in order to provide necessary nursing care and health related activities? a. Clinic Visit b. Nursing Visit c. Home Visit d. Pre Consultation Visit

Purpose of Home Visit


To give nursing care to the sick, to a post partum mother and her newborn with the view to teach a responsible family member to give the subsequent care To assess the living condition of the patient and his family and their health practices in order to provide the appropriate health teaching To give health teaching regarding the prevention and control of disease To establish close relationship between the health agencies and the public for the promotion of health

When planning a home visit it is necessary to ; 1. Have a purpose and objective 2. Home visit should make use of all available information abput the patient and his family 3. Plan should be flexible 4. Consider and give priority to the essential needs of thr individual in his family A. 1,2,4 B. 1,2 C. 1,2,3,4 D. 2,3,4

Nurse Mila knows that the most important consideration in the frequency of the home visit is; a. Acceptance of the family and their interest to cooperate b. The weather c. The distance of the RHU d. Availability of medicines and other supply

Guidelines to Consider Regarding the Frequency of Home Visit


The physical needs, psychological needs and educational needs of the individual and family The acceptance of the family for the services to be rendered, their interest and willingness to cooperate Careful evaluation of past services given to a family and how the family avail of the nursing service The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resource for their benefits

Nurse Kimi a PHN of Barangay Sugbo is about to visit a mother who is in her 5th day post partum. Nurse Kimi is correct if she will perform which of the following first? a. Put the bag in a convenient place to prevent microbial contamination b. State the purpose of the visit c. Make sure you have an ID d. Greet the patient and introduce yourself

Steps in Conducting a Home Visit


1. 2. 3. 4. Greet the patient and introduce yourself State the purpose of the visit Observe the patient and determine the health needs Put the bag in a convenient place and then proceed to perform the bag technique 5. Perform the nursing care needed and give health teaching 6. Record all important data, observation and care rendered 7. Make appointment for a return visit

It is an essential and indispensible equipment of a public health nurse which she carry along during her home visit. a. PHN Bag b. Bag technique c. Bag and bag technique d. Sphygmomanometer and Stethoscope

It is a tool by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness; a. Bag Technique b. PHN Bag c. Bag and bag technique d. Sphygmomanometer and Stethoscope

Bag technique a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care.

Public health bag - is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.

What is the rationale of performing appropriate bag technique? a. To save time and effort with the end view of rendering effective nursing care to client b. To practice aseptic technique c. Nursing is an art d. Because the bag is essential equipment

Principles of Bag Technique


The use of the bag technique should minimize if not totally prevent the spread of infection from individuals to families, hence, to the community. Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures. Bag technique should not overshadow concern for the patient rather should show the effectiveness of total care given to an individual or family. Bag technique can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding transfer of infection is carried out.

Special Considerations in the Use of the Bag


The bag should contain all necessary articles, supplies and equipment which may be used to answer emergency needs. The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use at any time. The bag and its contents should be well protected from contact with any article in the home of the patients. Consider the bag and its contents clean and /or sterile while any article belonging to the patient as dirty and contaminated. The arrangement of the contents of the bag should be the one most convenient to the user to facilitate the efficiency and avoid confusion.

Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the bag and its contents.
The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using.

Contents of the Bag


Paper lining Extra paper for making bag for waste materials (paper bag) Plastic linen/lining Apron Hand towel in plastic bag Soap in soap dish Thermometers in case [one oral and rectal] 2 pairs of scissors [1 surgical and 1 bandage] 2 pairs of forceps [ curved and straight] Syringes [5 ml and 2 ml] Hypodermic needles g. 19, 22, 23, 25 Sterile dressings [OS, C.B] Sterile Cord Tie Adhesive Plaster Dressing [OS, cotton ball] Alcohol lamp Tape Measure

Babys scale 1 pair of rubber gloves 2 test tubes Test tube holder Medicines
betadine 70% alcohol ophthalmic ointment (antibiotic) zephiran solution hydrogen peroxide spirit of ammonia acetic acid benedicts solution

Steps in Performing the Bag Technique


Actions 1. Upon arriving at the clients home, place the bag on the table or any flat surface lined with paper lining, clean side out (folded part touching the table). Put the bags handles or strap beneath the bag. 2. Ask for a basin of water and a glass of water if faucet is not available. Place these outside the work area. 3. Open the bag, take the linen/plastic lining and spread over work field or area. The paper lining, clean side out (folded part out). 4. Take out hand towel, soap dish and apron and the place them at one corner of the work area (within the confines of the linen/plastic lining). Rationale To protect the bag from contamination.

To be used for handwashing. To protect the work field from being wet. To make a non-contaminated work field or area.

To prepare for hand washing.

Actions 5. Do handwashing. Wipe, dry with towel. Leave the plastic wrappers of the towel in a soap dish in the bag. 6. Put on apron right side out and wrong side with crease touching the body, sliding the head into the neck strap. Neatly tie the straps at the back. 7. Put out things most needed for the specific case (e.g.) thermometer, kidney basin, cotton ball, waste paper bag) and place at one corner of the work area. 8. Place waste paper bag outside of work area. 9. Close the bag. 10. Proceed to the specific nursing care or treatment. 11. After completing nursing care or treatment, clean and alcoholize the things used. 12. Do handwashing again.

Rationale Handwashing prevents possible infection from one care provider to the client.

To protect the nurses uniform. Keeping the crease creates aesthetic appearance.

To make them readily accessible.

To prevent contamination of clean area.


To give comfort and security, maintain personal hygiene and hasten recovery. To prevent contamination of bag and contents. To protect caregiver and prevent spread of infection to others.

Actions Rationale 13. Open the bag and put back all articles in their proper places. 14. Remove apron folding away from the body, with soiled sidefolded inwards, and the clean side out. Place it in the bag. 15. Fold the linen/plastic lining, clean; place it in the bag and close the bag. 16. Make post-visit conference on matters To be used as reference for future visit. relevant to health care, taking anecdotal notes preparatory to final reporting. 17. Make appointment for the next visit ( For follow-up care. either home or clinic), taking note of the date, time and purpose.

Nursing Care in the HOME


Isolation Technique in the Home
Generally, strict isolation technique is difficult to carry out in the homes where houses are small and occupy a large number of people.

o All articles used by the patient should not be mixed with the articles used by the rest of the members of the households. o Frequent hand washing and airing of beddings and other articles and disinfection of rooms are imperative. Abundant use of soap, water, sunlight and some chemical disinfectants is necessary. o The one who is caring for the sick should be provided with a protective gown that should be used only within the room of the sick o All discharges, especially from the nose and throat of a communicable disease patient should be carefully discarded o Articles soiled with discharges should first be boiled in water 30 minutes before laundering.

Nursing Assessment in Family Nursing Practice


Nursing Assessment is the first major phase of the nursing process. In the family health nursing practice, this involves a set of actions by which the nurse measures the status of the family as a client. Nursing Assessment includes Data Collection, Data Analysis or Data Interpretation and Problem Definition or Nursing Diagnosis. Nursing Diagnosis is the end result of two major types of nursing assessment in family nursing practice;
o FIRST LEVEL ASSESSMENT is the process whereby existing and potential health condition or problems are categorized;
o o o o WELLNESS STATE HEALTH THREATS HEALTH DEFECITS FORESEEABLE CRISIS SITUATION

o SECOND LEVEL ASSESSMENT define the nature or type of nursing problems that the family encounters in performing the health task with respect to a given health condition or problems, and the etiology or barriers to the familys assumptions of these tasks.

Steps in Family Nursing Assessment


There are three major steps in assessment as applied to family nursing practice. I. Data Collection
i. ii. iii. iv. v. Family Structure, characteristics and dynamics Socio economic and cultural characteristics Home and environment Health status of each member Values and practices on health promotion/maintenance and disease prevention

II. Data Analysis


i. ii. iii. iv. Sorting of the data Clustering of related cues to determine relationships bet data Distinguished relevant from irrelevant data Identifying patterns such as physiological, developmental, nutritional, coping and lifestyle v. Comparing with norms or standards vi. Interpreting results vii. Making inferences and drawing conclusion about the reason for the existence of a problem

Steps in Family Nursing Assessment


There are three major steps in assessment as applied to family nursing practice.

III. Making a Diagnosis


o The family nursing problem is stated as an inability to perform a specific health task and the reasons (etiology) why the family cannot perform such task.

Data Collection
1. Family structure, characteristics and dynamics includes the composition and demographic data of the family/household, their relationship to the head and place of residence, the type of and family interaction/communication and decision making patterns and dynamics 2. Socio economic and cultural characteristics includes occupation, place of work, and income of each working member, educational attainment pf each family member, ethnic background and religious affiliations, significant roles they play in the familys life and the relationship of the family to the larger community.

Steps in Family Nursing Assessment


Data Collection
3. Home and environment includes information on housing and sanitation facilities kind of neighborhood and availability of social, health, communication and transportation facilities in the community. 4. Health status of each member includes current and past significant illness, beliefs and practices conducive to health and illness, nutritional and developmental status, physical assessment findings and significant results of laboratory/diagnostic test/ screening procedures 5. Values and practices on health promotion/maintenance and disease prevention includes use of preventive services adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities and immunization status at risk family members.

Data Gathering Methods and Tools


o o o o o Observation Physical Examination Interview Record Review Laboratory/Diagnostic Test

Steps in Family Nursing Assessment


Data Analysis
Wellness Condition is a judgment on wellness state or condition based o clients performance, current competencies or clinical data. Is a situation or condition which interferes with the promotion and / or maintenance of health and recovery from illness and injury. Health Threats condition that are conducive to disease and accident or may result to failure to maintain wellness or realize health potentials. Are situations that are conducive to disease or accident or failure to realize ones health potential. (ex houses along the railroad tracks can cause accidents) Health Deficits instances of failure in health maintenance Presence of Stress Points/Foreseeable Crisis anticipated periods or unusual demand on the individual or family. More on economic situation (ex head of the family becomes paralyzed can no anger support his family) The nurse can now proceed to SECOND LEVEL ASSESSMENT

Steps in Family Nursing Assessment


Sample Data
Cues/Data Family Nursing Problems
37 year old mother of seven at 21 Inability to recognize presence weeks AOG, with BP of 140/90 and of a possible complication of slight pedal edema; Weight 118 pregnancy due to lack of pounds

knowledge

Rina contracted scabies is due to Inability to provide adequate weather condition nursing care to preschooler

with scabies due to ..


Family income is Php.400 a day to they have to feed 12 members of the family
Three preschooler members usually are left to the care of 8 year old sister when parents are working and other children are at the school

Inadequate family resources specifically.


Inability to provide adequate nursing care to a member of family due to.

Scale for Ranking Health Condition and Problems According to Priorities


Criteria
1. Nature and condition or problem presented Scale: WELLNESS STATE HEALTH DEFICIT HEALTH THREAT FORESEEABLE CRISIS 2. Modifiability of the condition or problem Scale: EASILY MODIFIABLE PARTIALLY MODIFIABLE NOT MODIFIABLE 3. Preventive Potential Scale: HIGH MODERATE LOW 4. Salience Scale: Needs immediate attention Not needing immediate attention Not perceive as a problem or condition needing change 3 3 2 1 2 1 0 3 2 1 2 1 0

Weight
1

Divide the score by the highest possible score and multiply by the weight.

COPAR: Community Organizing Participatory Action Research


o Is a social development approach that aims to transforms the apathetic, individuals and voiceless poor into dynamic, participatory and politically responsive community o Collective, participatory, transformative, liberative, sustained and systematic process of building people organization by mobilizing and enhancing their capabilities, and resources of the people o Process by which the community identifies its needs and objectives, develops confidence to take action in respect to them o A continuous process of educating the people to understand and develop their critical awareness

COPAR: Community Organizing Participatory Action Research


What is the importance of COPAR?
COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. COPAR prepares people to eventually take over management of a development programs in the future. COPAR maximizes community participation and involvement; community resources are mobilized for health development services.

COPAR: Community Organizing Participatory Action Research


Principles of COPAR o People especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change o COPAR should be based on the interest of the poorest sectors of society o COPAR should lead to a self reliant community and society

Process and Methods Used in COPAR


PROGRESSIVE CYCLE OF ACTION-REFLECTION-ACTION CONCIOUSNESS RAISING PARTICIPATORY AND MASS BASED COPAR IS GROUPED CENTERED

CRITICAL STEPS IN COPAR


I. PRE ENTRY PHASE 1. Site Selection i. Population size ii. Socio economic status iii. Peace and order situation iv. Accessibility of the site v. Willingness of the people to organized vi. Inadequacy of health service in the area II. ENTRY PHASE 2. Entry 3. Integration III. ACTIVITY PHASE 4. Community Study 5. Identification of the potential leaders 6. Core group formation 7. Formation of the community organization 8. Mobilization 9. Evaluation IV. SUSTAINANCE PHASE 10. Follow Up/Extension/Expansion

CRITICAL STEPS IN COPAR


1) 2) 3) Integration the health worker becomes one with the people Social Investigation otherwise known as the community study Tentative Program Planning choose one issue to work on in order to begin organizing the people 4) Groundwork going around and motivating the people on a one on one basis to do something on the issues that has been chosen 5) Meeting people collectively ratify what they have already decided individually. 6) Role Play means acting out 7) Mobilization or actual experience of the people in confronting the powerful and the actual exercise of people power 8) Evaluation reviewing the step 1 to 7 9) Reflection dealing with deeper on going concerns to look at the positive values 10) Organization the peoples organization is the result of many successive and similar action of the people.

CARE ENHANCEMENT QUALITIES OF HEALTH WORKERS IN THE COMMUNITY SETTING


COMMUNITY HEALTH WORKER

_______________

is one who provides basic community health care services for promotion of health, prevention of illness, simple treatment and rehabilitation. The service utilizes the philosophy, content, method and skills of a public health care.

Qualities of Health Worker: OPEN 1. Accepts needs for joint planning and decision relative to health 2. TACTFUL Does not embarrass people but gives constructive criticism 3. OBJECTIVE Unbiased and fair 4. GOOD LISTENER Always available and attentive to the clients 5. EFFICIENT Produces the expected output with consideration to cost and time 6. FLEXIBLE Adapts easily and makes necessary adjustment appropriately 7. CRITICAL THINKER Decides on what has been analyzed

Functions of a Health Worker


o Community Health Service Provider o Facilitator o Health Counselor o Change Agent o Co-Researcher o Team Member o Health Educator
o Information provision of knowledge o Education change in the knowledge and attitude o Communication exchange of information

Traits and Qualities of Health Educator


o o o o o o o o Efficient Good Communicator Keen Observer Systematic Creative and Resourceful Knowledgeable Open With Sense of Humor

Health Promotion and Education


The first term health promotion occurred in 1945 when Henry Sigerist, the great medical historian defined the four major task of medicine promotion health, prevention of illness, restoration of the sick and rehabilitation In 1986 the WHO, Health and Welfare Canada and the Canadian Public Health Association organized an ICHP (Ottawa Charter for Health Promotion) The OCHP is broadly defined as the process of enabling people to incrase control over and improve their health Prerequisite of Health: Peace, Shelter, Education, Food, Income, Stable Eco system, Sustainable resources, Social Justice and Equity In order to operationalize the concept of health promotion they recommend the ff areas of action:
Build Healthy Public Policy Create Supportive Environments Strengthen Community Action Develop Personal Skills Reorient Heath Serrvices

Health Education
any combination of learning experiences designed to facilitate voluntary adoptions of behaviors conducive to health the process of assisting individuals, acting separately or collectively, to make informed decisions about matters affecting the personal health and that of others Health education can take place in various setting, either formally or informally/incidentally.

Epidemiology
Is the study of the occurrence and distribution of diseases as well as the distribution and determinants of health state or events in specified population, and the application of this study to the control of health problems Backbone of the prevention of the disease Uses of Epidemiology 1. Study the history of the health of the population 2. To diagnose the health of the community 3. Study the work of the health services 4. Estimate the risk of disease, accident and the chances of avoiding them 5. Complete the clinical picture of chronic disease 6. Search for causes of health and disease

Epidemiologic Triangle

HOST

AGENT

ENVIRONMENT

For the purpose of analyzing epidemiology data, it has been found helpful to organize the data according to the following variables

TIME

refers to both to the period during the cases of the disease being studied were exposed to the source of infection and the period during which the illness occurred. EPIDEMIC PERIOD YEAR PERIOD OF CONSECUTIVE YEARS

PERSON

refers to the characteristics of individual who were exposed and who contracted the infections
AGE SEX AND OCCUPATION

PLACE

refers to the features or factors or conditions which existed in or described the environment
URBAN/RURAL SOCIO ECONOMIC AREA

Pattern of Occurrence and Distribution


1. Sporadic occurrence is the intermittent occurrence of a
few isolated and unrelated cases in a given locality.

2. Endemic occurrence is the continuous occurrence


throughout a period of time of the usual number of cases in a given locality.

3. Epidemic occurrence is of unusually large number of


cases in a relatively short period of time. 4. Pandemic is the simultaneous occurrence of epidemics of the same disease in several countries . A pattern of occurrence in an international perspective.

Public Health Surveillance PHS is an on-going systematic, collection ,analysis , interpretation


and dissemination of health data. What is the Role of the Nurse in SURVEILLANCE? Nurse function as a Researcher.

Branches of Epidemiology
Descriptive Epidemiology concerned with the disease frequency and distribution Analytic Epidemiology analysis of the causes or determinants of disease Intervention Epidemiology study the effectiveness of new methods of prevention/treatment of disease Evaluation Epidemiology measurement of the effectiveness of different health programs

Types of the Epidemiologic Data


Demographic Vital Statistics Environmental Data Health Services

Vital Statistics
Statistics refers to the systematic approach of obtaining, organizing and analyzing numerical facts so that conclusion may be drawn from them Vital Statistics refers to the systematic study of vital events in the community Uses if Vital Statistics Indices of the health and illness status of a community Serves as bases for planning, implementing, monitoring and evaluating health nursing programs and services Sources of Data
Population Census Registration of vital Data Health Survey Studies and Researches

Vital Statistics
Rate shows the relationship between a vital event and those persons
exposed to the occurrence of said event , within a given area and during specified unit in time

Ratio used to describe the relationship of two numerical quantities or


measures of event without taking particular consideration to the time and place.

Crude or General Rates refers to the total living population . It must


be presumed that the population was exposed to the risk of the occurrence of the event.

Specific Rate

the relationship is for a specific population class or group.

Vital Statistics
A. Fertility Rate 1. CBR measure of one characteristics of the natural growth or increase of a population. CBR=Total Number of live birth registered in a given calendar year X 1000 Estimated Population as of July 1 of the same year

Factors that can affect the crude birth rate: 1. Accuracy of registered live birth. 2. Influence of the fertility status of the female population. 3 Number of female in the child bearing stage 4. The cultural or social practice (ex family planning practices)
Menarche- time or onset when a female can conceive.

2. General Fertility Rate

GFR =

Number of registered live birth x 1,000 Number of women 15-44 years

*The General Fertility Rate relates birth to the segment of population who are actually at risk of giving birth. *MACRA - marriageable couple of reproductive age (15 to 44 years old)
B. Mortality Rate Morbidity
The state of being disease or ill (Latin morbidus: sick, unhealthy) The degree or severity of a disease. The prevalence of a disease: the total number of cases in a particular population at a particular point in time. The incidence of a disease: the number of new cases in a particular population during a particular time interval. Disability in respect of cause (e.g. disability caused by accidents).

Types of MORBIDITY RATES:


1. Incidence Rate measures the frequency of occurrence of the phenomenon during given period of time IR = Number of New Cases at a Given Time x 100,000 Estimated Population 2. Prevalence Rate measures the proportion of the population which exhibit a particular disease at a particular time (deals with total new and old cases) PR = Number of New and Old Cases at a Given Time x 100 Estimated Population of that time

3. Attack Rate more accurate measure of the risk of exposure AR = Number of person acquiring a disease registered in given year Number of exposed to the same disease in the same year

x 100

C. Mortality Rates
Kinds of Mortality Rate:
1. Crude Death Rate a measure of one mortality from all causes which may result in a decrease population.

CDR = Total number of deaths in a given year x 1,000 Estimated mid year population for the same year
2. Specific Death Rate determines the specific cause of death. Describes more accurately the risk of exposure of certain classes or groups to particular disease. Deaths in specific class/group in a given year x 100,000 Estimated mid year population for the same year specified class/group Age Specific Death Rate Sex Specific Death Rate Cause Specific Death Rate 3. Proportionate Mortality Rate shows the numerical relationship between death from all causes (group of causes),age etc..and the total death from all causes in all ages taken together SDR =

PMR=

No. of death from specific cause/age x 100 No. of registration death from all causes/all ages

Swaroopss Index

Swaroops Index = Number of death among 50 years old and above x 100 Total deaths for all causes *If there is an increase in the result of the Swaroops index, this indicates a better health status.

Other type of Mortality where LB is the denominator


1. Infant Mortality Rate measures the risk of dying during the 1st year of life. IMR = Number of deaths under 1 year of age in a year x 1,000 Number of registered Iive birth during the same year

2. Neonatal Mortality Rate NMR = Number deaths less than 1 month age x 1,000 Number of registered live birth during the same year

3. Maternal Mortality Rate measure the risk of dying from causes related to pregnancy childbirth and puerperium. MMR = Number deaths from causes related to pregnancyU Number of registered have birth during the same year x1,000

4. Fetal Death Rate measure pregnancy wastage.

Thats all for This Afternoon..

Thank YOU!