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HEALTH NURSING
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Community Health Nursing:
The 3 Broad Concepts
1. What is a community?
– a group of people with
common characteristics or
interests living together within
a territory or geographical
boundary
• Community as a SETTING
for CHN PRACTICE
School Health
Nursing- School
Occupational
Health Nursing-
Workplace
Public Health Nursing-
Home
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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.
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I t operates within the realm of health
careboth independently and
interdependently.
T h e 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)
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The PHILOSOPHY of CHN
• is based on the
worth and
dignity of man
(Shetland)
• Concepts and
Principles pertaining
to CHN
Knowledge-base of CHN
• Biological and social sciences
• Ecology
• Clinical Nursing
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•Utilizes COMMUNITY
HEALTH ORGANIZATIONS
it is population-focused – “the greatest
good for the greatest number”
> Community diagnosis
> Vital statistics
> Priority setting
it is a promotive-preventive service
–adheres to Primary Health Care
> Health education
> Preventive treatment
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Principles of CHN
E – ducation as primary tool and responsibility
M – ade available to all regardless of race, creed and socio-economic status
P – olicies and objectives of the agency is fully understood by the nurse
O – rganizing for health, with the family as the unit of service
W – orks as a member of the health team (PHN)
E – xisting active organizations are utilized
R – ecording and reporting are accurate
M – onitoring and evaluation of services is periodically done
E – xisting indigenous resources of the community is used
N – eeds of clienteles is recognized and serves as basis for CHN
T – raining and development as opportunities for continuing staff education
programs
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REMEMBER that in CHN:
1. The patient in CHN is the Community which is composed of
different population groups and several families (the basic unit of
care), and In turn compose of individuals.
5. CHN is a part of health care system and the larger human services
system.
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Quick Review
Exercises
(QRX)
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QRX
In terms of CHN practice, the nurse in
the community is trained as
a. Certified in public health
b. Specialist in CHN
c. 4-year BSN graduate
d. Generalist in nursing
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Ans: d. Generalist in
nursing
QRX
The thrusts of CHN must be embodied in the
hearts of health care providers. Which one
strengthens the health care system?
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Ans:
c.Letting the people
manage their own
health
QRX
As a Public Health Nurse, what is your
primary function or responsibility?
a. Reporting of cases
b. Health Promotion
c. Community Diagnosis
d. Health Teaching
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• Ans:
d. Health
Teaching
QRX
The philosophy of CHN practice is based on
the belief that the family is the smallest unit
in a democratic society. Which age group
should be the priority of the nurses in the
community?
a. Older persons and terminally ill
b. Adolescents and adults
c. Infants and children
d. All ages regardless of status
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Ans:
d. All ages
regardless
of status
HIGHLIGHTS in CHN Concepts
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Objectives of Public Health
3 P’s:
Promote health
Prevent Disease
Prolong Life
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Basic Public Health Services
• Environmental Sanitation
• Health Education
• Prevention of Communicable Diseases
• Medical Services
• Nursing Services
• Vital Statistics
• Public Health Laboratories
• Maternal and Child Health Services
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Basic Competencies Needed by the
Public Health Nurse
• Teaching
• Management
• Critical Thinking
• Physical Caregiving
• Application of the Nursing Process
• Application of the Epidemiological
Process
• Documentation
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Functions of the PHN
Manager
> Planner, Programmer, Supervisor, Coordinator of services
Health Care Provider
> Direct nursing care
Researcher
> Epidemiologist, Health Monitor, Recorder, Statistician
Community Organizer
> Change Agent
Trainer
> Health Educator, Counselor
R o l e Model
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In the care of the families:
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In the care of the communities:
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Responsibilities of CHN:
– be a part in developing an overall health plan, its implementation
and evaluation for communities
– provide quality nursing services to the three levels of clientele,
the standards ser for CHN practice
– maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health
services
– conduct researches relevant to CHN services to improve
provision of health care
– provide opportunities for professional growth and continuing
education for personal growth thru staff development
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CHN Process
1. Establishing a working relationship with
the client
• Initiating contact
• Communicating interest in the
client’s welfare
• Showing willingness to help with
expressed need of the client
• Maintaining a two-way communication
with the client
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CHN Process
2. Assessment of needs, taking into consideration
personal, environmental and psycho-socio-
cultural factors influencing health
• Situation and trends revealed in personal, socio-
economic and environmental history
• Physical, emotional, intellectual ability to perform a
function
• Attitudes, knowledge and perceptions of health and
illness
• Health behavior and patterns of health care
• Resources available to meet own needs
• Other factors affecting health
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A. Collection of Data
A. Community
Demographic data
Vital statistics
Community Dynamics
Disease surveillance
Economic, cultural , and environmental characteristics
Health service utilization
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B. Categories of Health Problem
A. Wellness State
B. Health Deficit
C. Health Threat
D. Foreseeable Crisis
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CHN Process
3. Planning of care
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CHN Process
4. Implementation of care
• Monitoring of status
• Systematic documentation of
results
• Analysis of effectiveness of care
provided
(Structural elements, Process
Elements, and Outcome elements)
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Levels of Clientele
Individual
• Basic approaches in
looking at the
individual:
– Atomistic
– Holistic
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Family
Models:
Developmental
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Stage 4 – The Family with School Age Children
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Structural-Functional
Environmental Factors
Va l u e Placed on Prevention of
Disease
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First Level Assessment
Health threats:
conditions that are conducive to disease, accident or failure to realize
one’s health potential
Health deficits:
instances of failure in health maintenance (disease, disability,
developmental lag)
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Second Level Assessment:
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Problem Prioritization:
Preventive potential
High
Moderate
Low
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• Modifiability
Easily modifiable
Partially modifiable
Not modifiable
• Salience
High
Moderate
Low
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*Family Service and Progress Record
Population Group
• Vulnerable Groups:
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STEPS:
Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
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Implementation Phase
1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback
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Evaluation Phase
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CHN Process
Parts of Community Diagnosis:
A. Demographic Variables
• Total population and population density
• Age and sex composition, Population Pyramid
• Sex Ratio
• Civil Status
• Population movement/patterns of migration
• Growth Rate, Life Expectancy
12/05/12 • Crude Birth Rate, Crude Death Rate 59
CHN Process
Parts of Community Diagnosis:
B. Social Indicators
• Literacy Rate
• Educational attainment
• Communication network
• Transportation system
• Housing conditions (types, ownership,
lighting, ventilation, crowding/congestion)
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CHN Process
Parts of Community Diagnosis:
C. Economic Indicators
• Dependency Ratio
• Occupation
• Income
• Poverty index
• Unemployment Rate
• Underemployment Rate
• Types of industry present in the community
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CHN Process
Parts of Community Diagnosis:
D. Cultural Factors
• Ethnicity
• Race
• Language
• Religion
• Beliefs (superstitions and traditions)
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CHN Process
Parts of Community Diagnosis:
E. Environmental Indicators
• Topographical characteristics
• Water supply
• Garbage disposal/collection system
• Excreta disposal
• General sanitary condition
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CHN Process
Parts of Community Diagnosis:
F. Health Patterns
• Food storage
• Infant feeding practice
• Immunization status
• Health seeking behavior
• Source of health information
• Leading causes of mortality, morbidity, infant
mortality, infant morbidity, maternal mortality
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CHN Process
Parts of Community Diagnosis:
G. Health Resources
• manpower-population ratio
• manpower distribution
• manpower policies
• health budget and policies
• sources of health funding
• categories of health institutions available
12/05/12 • categories of health services available 65
CHN Process
Parts of Community Diagnosis:
H. Political and Leadership Patterns
• Power structures in the community
• Confidence of people to authority
• Conditions that cause developmental conflicts
• Prevailing issues
• Practices that are usually utilized in settling
concerns of the community
• Stakeholder Analysis
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CHN Process
Steps in Conducting Community Diagnosis:
1. Determining the objectives
2. Defining the study population
3. Determining the data to be collected
4. Developing an instrument
• survey questionnaire
• interview schedule
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CHN Process
Steps in Conducting Community Diagnosis:
5. Data gathering
• Records review
• Observation
• Surveys
• Interviews
6. Data collation
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CHN Process
Steps in Conducting Community Diagnosis:
7. Data presentation
8. Data analysis
9. Identification of CHN Problems
• Health status
• Health resources
• Health-related
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CHN Process
Steps in Conducting Community Diagnosis:
10. Prioritization of CHN Problems
• Nature
• Magnitude
• Modifiability
• Preventive potential
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• Social concern 70
Biostatistics
A. Demography
A study of population size, composition,
and spatial distribution as affected by
births, deaths, and migration
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SOURCES OF DEMOGRAPHIC
DATA:
1. Survey
1. Census- De jure or De facto
2. Sample Survey
2. Continuing Population Registers
3. Other Records and Registration Systems
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COMPONENTS:
Population Size
1. Natural increase
2. Net migration
3. Rate of natural increase
Population Composition
1. Age Distribution
2. Median Age
3. Dependency Ratio
4. Sex Ratio
5. Population Pyramid
6. Others: occupational groups, economic groups,
educational attainment, and ethnic groups
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Population Distribution
1. Urban-Rural
• Shows the proportion of people living in urban
compared to the rural areas
1. Crowding Index
• Indicates the ease by which a communicable
disease can be transmitted from 1 host to another
susceptible host
1. Population Density
• Determines the congestion of the place
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B. VITAL STATISTICS
The application of statistical measures to
vital events (births, deaths and common
illnesses) that is utilized to gauge the
levels of health, illness and health services
of a community.
• Fertility Rate
– Epidemiologic Triad
– Transmission
– Incubation period
– Herd immunity
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Factors affecting distribution:
• PERSON
– intrinsic characteristics
• PLACE
– extrinsic factors
• TIME
– temporal patterns
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Patterns of Disease Occurrence:
• Epidemic
– a situation when there is a high incidence of new cases of a
specific disease in excess of the expected.
– when the proportion of the susceptible are high compared to the
proportion of the immunes
• Epidemic potential
– an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes
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• Endemic
– habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible
e.g. Malaria is a disease endemic at Palawan.
– the causative factor of the disease is constantly available or
present to the area.
• Sporadic
– disease occurs every now and then affecting only a small
number of people relative to the total population
– intermittent
• Pandemic
– global occurrence of a disease
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THE NATIONAL HEALTH
SITUATION
Health Care Delivery System
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The Health
Sector
Department of Health
Vision: Leader and staunch advocate and model
in promoting Health for ALL in thePhilippines
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3 Major Functions:
1 . LEADERSHIP in health
National policy – formulation, monitoring and evaluation
Regulatory institution
Advocates adoption of health policies, plans and programs
S12–/05e/1n2trongSigla Movement 87
Local Government Units (LGU)
RA 7160 Local Government Code
Private Sector
Composed of both commercial and business
organizations, non-business organizations
Non-Government Organizations
Assumes the following roles:
Policy and Legislative Advocates
Organizers, Human Rights Advocates
Research and Documentation
Healt h Resource Development Personnel
Relief and Disaster Management
Networking
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PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Prevention of Prevention of
Illness Prevention Complications thru Disability, etc.
Early Dx and Tx
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Primary Health Care
WHO: PHC was declared in the ALMA ATA
CONFERENCE(USSR) in September 6-
12, 1978, as a strategy to community
health development.
Philippines: Adopted through LOI 949
signed by President Marcos on October
19, 1979 with the theme-
“Health in The Hands of the People by 2020”
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Primary Health Care
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Framework
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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
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S P S
C U
E R
O P
C O
M P
T P
M. O
O E
R R R
P T
A
A
L T
R M
E
T E
L C
I C
I H
P H
N N
A A
K O
T N
A L
I I
G O
O S
E G
N M
S Y
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PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private
sectors, social welfare, public service, enrironmental,
etc.)
B. Community Participation
e.g. Community Organizing
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C. Appropriate Technology
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10 Medicinal
Plants:
Bawang-anti cholesterol
Ulasimang-Bato-lowers uric acid
Bayabas- antiseptic; diarrhea
Lagundi-cough, asthma, and colds
Yerba Buena- toothache, pain, and arthritis
Sambong- renal calculi
Ampalaya- diabetes mellitus
Niyog-niyogan- anti-helminthic
Tsaang-Gubat- diarrhea
Akapulko- fungal infection RA 8423: utilization
of medicinal plants as
alternative for high cost
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D. Support mechanism made
available
TYPES OF PRIMARY HEALTH WORKERS
Village/Grassroots Intermediate Level Health Personnel of
Health Workers First-Line Hospitals