Community health nursing

Community health nursing Brief history of nursing The community is the patient in CHN. The family is the unit of care, In CHN, the client is considered as an Active Partner and not a passive recipient of care CHN practice is affected by the development of Health Technology, in particular; changes in the society in general. The goal of the CHN is achieved through Multi-Sectoral effortsCHN is part of the Health Care System and the larger Human Services System Roles and functions of the CHN Clinician or health care provider Utilizes the Nursing Process in the care of the clients in the home setting through hoe visits and in Public Health Care Facilities Conducts referral of patients to appropriate levels of care when necessaryHealth educatorUtilizes teaching skills to improve the health knowledge, skills and attitude of the individual, family and the community and conducts health information campaigns to various groups for the purpose of health promotion and disease prevention Coordinator and collaborator Establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations and peoples organizations to address health problems supervisorMonitors and supervises the performance of midwives and other auxiliary health workersAlso initiates the formulation of staff development and training programs as part of their training function as supervisors Leader and change agent Influences people to participate in the overall process of community development Manager Organizes the nursing service component of local health agencies or local government unitAs Program Manager, the PHN is responsible for the delivery of the package of services provided by the health program to the target clientele

Researcher Participates in the conduct of research and utilizes the findings of the research in practice Specialized fields of the CHN Community Mental Health Nursing Occupational Health Nursing School Health Nursing Levels of healthcare in the communityPrimary level of careDevolved to the cities and the municipalities and is the first contact between the community people and the different levels of health facilityRefers to health care provided by the health care center staff

Secondary level of care Rendered by Physicians with basic health training in district hospitals, provincial hospitals, and city hospitals These facilities are capable of basic surgical procedures and simple laboratory examinations and serves as referral centers of primary healthcare facilities Tertiary level of care Rendered by specialist in medical centers, regional hospitals and specialized hospitals like the Lung Center of the Philippines Serves as the referral centers of secondary Health Care FacilitiesPrimary health care workers Village or Barangay Health Worker Refers to trained community health workers or health auxiliary volunteers or Traditional Birth Attendants or healers Intermediate level Health Workers Refers to general medical practitioners or their assistants, public health nurse, rural sanitary inspectors and midwives Four levels of clientele in the community setting IndividualFamilyCommunity Population groups Individual Basic Approaches in looking at the Individual Atomic the whole is equal to the sum of its parts Holistic the whole is More than equal to the sum of its parts Family Is a small social system and primary reference group made up of two or more persons living together who are related by blood, marriage or adoption who are living together by arrangement over a period of time (Murray and Zentner) Community A group of people sharing common geographic boundaries and/or common values and interestsPopulation groupsA group of people sharing the same characteristics, developmental stage or common exposure to environmental factors thus resulting in common health problems(e.g. Vulnerable Groups) Infants and young children School Age Adolescents Mothers Males Older People Health care delivery system The department of health Executive order 102 has identified the DOH as the National Health Authority in providing technical and other resource assistance to concerned groupsIt has three specific roles in the Health Sector and several functions under each role. Leadership in Health Administrator of Specific Services Capacity Builder and Enabler Goal of the doh Implementation of the Health Sector Reform Agenda FOURmula ONE for health intends to implement Critical Interventions as a single package backed by effective management infrastructure and financing arrangements thru a sector-wide approach This is directed towards ensuring accessible, affordable, quality health care especially for the more disadvantaged and vulnerable sectors of the population FOURMULA ONE Good Governance to enhance health system performance at the national and the local levels Health Financing to foster greater, better and sustained investments in health Health Regulation to ensure the quality and affordability of health goods and services Health Service Delivery to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services

Objectives of the health sector Improve the Health Status of the Population Ensure quality Service Delivery Improve support system for the vulnerable and marginalized groups Implement proper Resource Management What is the role of the lgu in the healthcare delivery? The Local Governemnt Code of 1991 or RA 7160 transformed Local Government Units into Self-reliant communities and active partners in the attainment of national goals through a more responsive and accountable government structure instituted through a system of decentralization. Primary health carePrimary health care Is essential Health Care made universally accessible to individuals and families in the community by a means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development. Conceptual Framework Health is a fundamental Human Right Health is both and individual and collective responsibility Health should be an equal opportunity for all Health is an essential element of Socio-economic development Primary hEalth care PHC was declared in Alma Ata, Russia during the first International Conference on PHC held September 6-12 tnrough the sponsorship of WHO and UNICEFLegal basis of PHC in the Philippines Letter of Instruction (LOI) 949 signed in October 19, 1979 by President Ferdinand E. Marcos Theme of the implementation of PHC in the PhilippinesHealth in the Hands of the people by the year 2020Primary health care5 As of Health Care according to PHC Available Accessible Affordable Acceptable Attainable Four cornerstone or pillars of phc Use of Appropriate Technology Support Mechanisms Made Available Active Community Participation Intra and Inter Sector Linkages Elements and components of PHC Communicable Disease Control Health Education Expanded Program on Immunization Locally Endemic Disease Treatment Environmental Sanitation Maternal and Child Health and Family Planning Essential Drugs Provision Nutrition and Adequate food provisionTreatment of emergency cases and provision of Medical Care Ten herbal plants recommended by the dohLagundi

Indications: Cough, Asthma, Fever, Muscle Pain Decoction or SyrupUlasimang Bato (pansit-pansitan)

Indication: Lowers serum Uric Acid in cases of Gouty Arthritis Salad or Decoction Bawang

Indication: Lowers Serum Cholesterol May be roasted, soaked in Vinegar or used for sauting

Bayabas

Indication: Its anti-septic properties is best used for wound cleaning, as a mouthwash in cases of oral cavity and gingivitis Decoction Yerba Buena

Indications: For Muscle PainDecoction Sambong

Indication: Its Diuretic effect is good for edema and against Urolithiasis Decoction Ampalaya

Indications: For Diabetes Melitus or non-Insulin dependent DiabetesDecoction or Steamed Niyug-Niyogan

Indications: For intestinal infestation with Ascaris Lumbricoides Prepare dried, mature Niyug-niyogan seedsTsaang gubat

Indications: Stomach Ache Decoction

akapulko

Indication: Ringworm, Tinea flava, Athletes foot and other types of Fungi Poultice or ointment Guidelines for the use of herbal plants Chemical pesticides may leave toxic residues on the plants. These should not be used on Herbal Plants Use palayok or clay pots and wooden spoon when cooking herbal medicines Use only the plant part recommendedUse the appropriate Herbal Plant for each sign and symptom observed Watch out for allergic reactions Always keep the Herbal Medicine containers properly labeled Always keep the herbal preparations out of reach of children RA 8423 utilization of Medicinal Plants as an alternative to high cost of medications Family nursing processInitial database Family structure and Characteristics Socio-Economic and Cultural Factors Environmental Factors Health Assessment of Each Member Value placed on the prevention of the Disease

First level assessment Wellness Condition (stated as POTENTIAL or READINESS) a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher one Health Threats conditions that are conducive to a disease, accident or failure .to realize ones health potential Health Deficits instances of failure in ones health maintenance (disease, disability or developmental lag) Stress Points / Foreseeable Crisis Situations anticipated periods of unusual demand on the individual or family in terms of adjustment of family resources Second Level of assessment (based on freemans family health tasks) Ability to recognize the existence of a problem Ability to make decisions with respect to taking appropriate health actions Ability to provide nursing care to the affected family member Ability to provide a home environment that is conducive to health maintenance and personal development Ability to utilize community resources for healthcare Problem Prioritization Nature of the Problem Wellness Condition Health Deficits Health Threats Foreseeable CrisisPreventive Potential refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done Modifiability of the Condition refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating, or totally eradicating the problem through intervention Salience refers to the familys perception and evaluation of the problems in terms of seriousness and urgency of attention needed

Criteria Score Weight NATURE OF THE CONDITION Wellness State 31Health Deficit 3Health Threat 2Foreseeable Crisis1MODIFIABILITY OF THE PROBLEM Easily Modifiable 21Partially Modifiable 1Not Modifiable 0PREVENTIVE POTENTIAL High 21Moderate2Low1SALIENCE A condition needing immediate attention21A condition not needing immediate attention 1Not perceived as needing change 0Community organizing participatory action research (copar) Definitions of copar A social developmental approach that aims to transform the ,apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community Importance of copar As an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities Prepares people/client to eventually take over the management of a development program in the future Maximizes community participation and involvement; community resources are mobilized for community services Principles of Copar People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change ad are able to bring about changeCOPAR should be based on the interests of the poorest sectors of society COPA should lead to a self-reliant community and society Phases of the copar processPre-entry Phase Entry Phase Organization-Building Phase Sustenance and Strengthening Phase Pre-Entry phase At the NGO levelFormulation of Institutional Goals, Objectives and Targets for the Program Revision of Curriculum Training of Faculty of COPARCoordinate participation of other departments within the institutionAt the community levelCommunity Consultations and Dialogue Setting of Issues related to the site selection Development of the criteria for the site selection Depressed and Underserved Oppressed Poor Exploited Struggling Pre-Entry phase At the community levelArea must not have serious peace and order problem Willingness to be organized Community needing health assistance Check vital health statistic Malnutrition rate Lack of health facility / health care providers Counter-part of the Community (support, commitment, resources) Accessible to transport and communication Site selection Preliminary Social Investigation Identify Contact Person Gather overview of the demographic characteristics, health services and facilities of the community Networking with LGUs, NGOs and other departments Entry phase Integration with the Community main objective is to gain their TRUST First Task Courtesy Call to the Barangay Captain Establish Rapport Join social activitiesImbibe their lifestyle Immerse yourself Live with them Reside on the area Sensitization of the community social preparation Information campaign on health services Continuing deep social investigation Process of collecting, collating, analyzing data to draw the clear picture of the community Entry phase Core Group Formation Consists of Identified Potential LeadersCharacteristics of Potential Leaders Respected Community Members Responsible and Committed Willing to work for a desired change Has good communication skill Has a wide influence to elite and poor community members Self-awareness and Leadership Training (SALT)Coordination with the Community OrganizationRepresenting the different sectors of the community

Community diagnosis / study phase (research phase ) Selection of the Research Team Training on data collection Planning for the actual gathering of data Data Gathering Training on Data Validation Community Validation Presentation of the Community study/diagnosis and recommendations Prioritization of community needs and problems for action Community Organizing / capability building phase Community meetings to draw up guidelines for the organization Election of Officers Development of Management Systems Delineation of Roles, Functions and Task of OfficersTraining of Leaders Team-Building Exercises Action-Reflection-Action-Session Community action phase Organization and Training of BHWs village or Grassroots Workers Project Implementation/Monitoring and Evaluation (PIME) of health services Resource Mobilization (5 MS)ManpowerMachine MethodMaterial Money Space Setting up of Linkages/Network/Referral System Sustenance and Strengthening phase Formulation and Ratification of Constitution and By-laws Identification and Development of Secondary leaders Setting up a financing scheme Continuing Education and Training of the BHWs Development of Long-Term Community Health Development PlansFormalizing Linkages, Networks and Referral Systems Turnover Phase / phase out Transfer of community organizer roles and responsibilities and documents Subsequent follow-upCOPARs main goal is to attain Community Development where Basic needs are met Equal rights Self-reliance Active Participation Vital statistics The application of Statistical Measures to Vital Events that is utilized to gauge the levels of health, illness and health services of a community Health indicators A list of information which would determine the health of a particular community like the population, crude birth rate, crude death rate, infant and maternal death rates, neonatal death rate and tuberculosis death rate Health Indicators Birth Death Marriages Migration Common statistical indicators Fertility rates Crude Birth Rate General Fertility Rate Age-Specific Fertility Rate Crude birth rate Used often because of availability of data Measure how fast people are added to the population by birth Crude since it is related to the total population including Men, Children and Elderly who are not capable of giving birth

Number of Livebirths in a year -------------------------------------------x 1000Midyear Population, same year

General fertility rate More specific than CBR since births are related to the segment of the population capable of giving birth In some countries, reproductive age groups are 15-49 years of age

Number of Live Births in a year--------------------------------------------x 1000Midyear Population of women aged 15-44 years of age Age-specific fertility rate More accurate refinement in the study of fertility

Total Births to women age (x) years ---------------------------------------------------x1000Midyear Population of women age (x) yearsMortality rates Crude Death Rate Specific Mortality Rate Cause-of-death Rate Infant Mortality RateNeonatal Mortality Rate Post-neonatal Mortality Rate Maternal Mortality Rate Perinatal Mortality Rate Proportionate Mortality RateSwaroops Index Case Fatality RateCrude dEath rate Crude because death is affected by different factors Widely used because of the availability of data

Number of Deaths in a year ----------------------------------------x1000Midyear Population, same yearSpecific Mortality Rate Made specific according to:Age SexOccupationEducation Exposure to Risk Factors Combination of the aboveMore valid than CDR when comparing mortality experiences within a group Number of Deaths in specified Group-------------------------------------------------------x1000Midyear Population, Same YearCause-of-DEath rate Crude rate since the denominator indicates the entire population Could be made specific by relating the deaths from a specific cause and group to the midyear population of that specific group

Number of Deaths in specified cause ------------------------------------------------------x1000Midyear Population, same year Infant mortality rate Sensitive index of level of health in a communityHigh IMR means Low Levels of health standards secondary to poor maternal and child healthcare, malnutrition, poor environmental sanitation or deficient health service delivery May be artificially lowered by improving the registration of births

No of deaths under 1 year of age -------------------------------------------------x1000Number of live births, same yearNeonatal mortality rate Number of Deaths among those under 28 years of age --------------------------------------------------------------------------------x1000Number of Live Births, Same yearMaternal mortality rate Measures risk of dying from causes associated with Childbirth Affected by: Maternal health practices Diagnostic ascertainment of maternal condition or cause of death Completeness of Registration of Birth

Number of Deaths due to pregnancy, delivery and puerperium---------------------------------------------------------------------------------------------x1000Number of Live Births Proportionate mortality rate Used in ranking the cause of death by magnitude of frequencyExpressed in Percentage

Number of Deaths from particular cause -----------------------------------------------------------x1000Total Deaths from all cause, same year Swaroops index Low Index implies that life expectancy is short Directly proportional to the health status of a population where developed countries have higher Swaroops Index than Developing countries

Case fatality rate Measures the killing power of a disease or injury A high of CFR means a more fatal disease Rate depends on: Nature of the disease Diagnostic ascertainment Level of reporting in the population CFR from hospitals higher than from the community

Number of deaths from a specified cause -------------------------------------------------------------x100Number of cases from the same diseaseMorbidity rates Incidence Rate Attack Rate Prevalence Rate Incidence rate Measures the development of a disease in a group exposed to the risk of the disease in a period of time Can be made specific for age and sex

No of new cases of disease developing form a period of time -----------------------------------------------------------------------------------------x100,000Population in the area during the same period of time Attack rate Used for a limited population group and time period, usually during an outbreak or an epidemic

No of new cases of disease developing over a period of time -----------------------------------------------------------------------------------------x100Population at risk for developing the disease during the sameperiod of time Prevalence rate Useful in describing the occurrence of chronic conditions and as basis for making decisions in the administration of health services Useful also in computing for carrier rates and antibody levelsPoint prevalence No of existing (old and new) cases of a disease at a given time -------------------------------------------------------------------------------------------x100population examined during that time Period prevalence No of existing (old and new) cases of a disease at a given interval--------------------------------------------------------------------------------------------x100Population examined during that interval time Environmental sanitationEnvironmental sanitation Is defined as the study of all factors in mans physical environment which may exercise a deleterious effect on his health, well-being and survival GOAL: to eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all house holds COMPONENTS: Water supply and Sanitation Program Proper Excreta and Sewage Disposal program Insect and Rodent Control Food Sanitation Program Hospital Waste Management Program Strategies on Health Risk Minimization due to Environmental Pollution Water supply and sanitation program Level 1 POINT SOURCE A protected well or a developed spring with an outlet but without a distribution system for Rural areas where houses are thinly scattered Level 2 COMMON FAUCET SYSTEM OR STAND POSTS A system composed of a source, a reservoir, a piped distribution network and communal faucets, located not more than 25 meters from the farthest house in rural areas where houses are clustered denselyLevel 3 WATERWORKS SYSTEM OT INDIVIDUAL HOUSE CONNECTIONS A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas Proper excreta and sewage disposal system Level 1 NON-WATER CARRIAGE TOILET FACILITYPit Latrines, Reed Odorless Closet, Bored Hole, Ventilated Improved Pit Toilets requiring small amount of water to wash waste into receiving space Pour Flush Aqua Privies Level 2 on site toilet facilities of the WATER CARRIAGE TYPE with water sealed and flushed type with septic tank disposal facilities Level 3 Water Carriage types of toilet facilities connected to a sewerage or treatment plant Proper Solid waste management Refers to satisfactory methods of storage, collection and final disposal of solid wastesREFUSE is a general term applied to solid and semi-solid waste materials other than human excreta. Waste material in refuse may be divided into: GARBAGE refers to leftover vegetable, animal and fish material from kitchen and food establishments. These materials have a tendency to decay, giving off foul odor and sometimes also serve as food to rats and flies. RUBBISH refers to waste materials such as bottles, broken glass, tin cans, waste paper and discarded textile materials, porcelain wares, pieces of metal and other wrapping materials ASH are leftover from burning wood and coal. Ashes may become a nuisance because of the dust associated with them. STABLE MANURE is animal manure collected from stables DEAD ANIMALS include dead dogs, cats, rats, pigs and chickens that were killed by vehicles on streets and public highways Food sanitation program Policies:Food establishments are subject to inspection Comply with sanitary permit requirement for food establishments Comply with updated health certificates for food handlers, helpers and cooks Hospital waste management program GOAL: to prevent the risk of contracting nosocomial infection and other diseases from the disposal of infectious, pathological, and other hospital wastes Policies:The use of appropriate technology and indigenous material for HWM system shall be adopted Training of all hospital personnel involved in waste management shall be an essential part in the hospital training program Local ordinances regarding the collection and disposal techniques, especially incinerators shall be institutionalized Strategies in health risk minimization due to environmental pollution Anti-smoke belching campaign and air pollution campaign Zero solid waste management Toxic, chemical and hazardous waste managementRed tide control and monitoring Integrated pest management and sustainable agriculture Pasig River rehabilitation Management