Definition of Terms

Community

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 Derived from a latin word comunicas which means a group of people.

Health

OLOF (Optimum Level of Functioning) Health-illness continuum High-level wellness Agent-host-environment Health belief Evolutionary-based Health promotion WHO definition

Community Health

Part of paramedical and medical intervention/approach which is concerned on the health of the whole population

Aims:

1. 2. 3. Nursing

Health promotion Disease prevention Management of factors affecting health

Both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

Community Health Nursing

The utilization of the nursing process in the different levels of clienteleindividuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. ( Maglaya, et al)

Goal: To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness ( Nisce, et al) Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability ( WHO Expert Committee of Nursing) A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the clients optimum level of functioning thru teaching and delivery of care (Jacobson) A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)

Public Health

Public Health is directed towards assisting every citizen to realize his birth rights and longevity.The science and art of preventing disease, prolonging life and efficiency through organized community effort for: 1. The sanitation of the environment 2. The control of communicable infections 3. The education of the individual in personal hygiene 4. The organization of medical and nursing services for the early diagnosis and preventive treatment of disease 5. The development of a social machinery to ensure every one a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity (Dr. C.EWinslow)

Mission of CHN
Health Promotion Health Protection Health Balance Disease prevention Social Justice

Philosophy of CHN
The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.(Dr. M. Shetland)

Basic Principles of CHN 1. The community is the patient in CHN, the family is the unit of care and

there are four levels of clientele:individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the community. 2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general 4. The goal of CHN is achieved through multi-sectoral efforts 5. CHN is a part of health care system and the larger human services system.

Roles of the PUBLIC HEALTH NURSE

Clinician, who is a health care provider, taking care of the sick people at home or in the RHU Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of midwives Health Advocator, who speaks on behalf of the client Advocator, who act on behalf of the client Collaborator, who working with other health team member

*In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or is not available, the Public Health Nurse will take charge of the MHOs responsibilities. Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:

Supervision and care of women during pregnancy, labor and puerperium Performance of internal examination and delivery of babies Suturing lacerations in the absence of a physician Provision of first aid measures and emergency care Recommending herbal and symptomatic medsetc.

In the care of the families:

Provision of primary health care services Developmental/Utilization of family nursing care plan in the provision of care

In the care of the communities:

Community organizing mobilization, community development and people empowerment Case finding and epidemiological investigation Program planning, implementation and evaluation Influencing executive and legislative individuals or bodies concerning health and development

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 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 staff development

Standards in CHN
1. Theory o Applies theoretical concepts as basis for decisions in practice 2. Data Collection o Gathers comprehensive, accurate data systematically 3. Diagnosis o Analyzes collected data to determine the needs/ health problems of IFC 4. Planning o At each level of prevention, develops plans that specify nursing actions unique to needs of clients 5. Intervention o Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation 6. Evaluation o Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan 7. Quality Assurance and Professional Development o Participates in peer review and other means of evaluation to assure quality of nursing practice o Assumes professional development o Contributes to development of others 8. Interdisciplinary Collaboration

Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health 9. Research o Indulges in research to contribute to theory and practice in community health nursing o

Definitions of COPAR
A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community. A collective, participatory, transformative, liberative, sustained and systematic process of building peoples organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference) 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 (Ross 1967) A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD)

Importance of COPAR 1. COPAR is an important tool for community development and people 2. 3.

empowerment as this helps the community workers to generate community participation in development activities. COPAR prepares people/clients to eventually take over the management of a development programs in the future. COPAR maximizes community participation and involvement; community resources are mobilized for community services.

Principles of COPAR
1. 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. 2. COPAR should be based on the interest of the poorest sectors of society

3. COPAR should lead to a self-reliant community and society. COPAR Process

A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.

COPAR Phases of Process

1. Pre-entry Phase

Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it Activities include:

o o o

Designing a plan for community development including all its activities and strategies for care development. Designing criteria for the selection of site Actually selecting the site for community care

2. Entry Phase

Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collective action on these. This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following guidelines however. o Recognizes the role of local authorities by paying them visits to inform them of their presence and activities.

The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role models. Avoid raising the consciousness of the community residents; adopt a low-key profile.

3. Organization Building Phase

Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and evaluating communitywide activities. It is at this phase where the organized leaders or groups are being given trainings (formal, informal, OJT) to develop their skills and in managing their own concerns/programs.

4. Sustenance and Strengthening Phase

Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different communities setup in the organization building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance from the community-wide organization. Strategies used may include:

o o o o o

Education and training Networking and linkaging Conduct of mobilization on health and development concerns Implementing of livelihood projects Developing secondary leaders

Community Assessment
Status Structure Process

Types of Community Assessment

1. Community Diagnosis

A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the

population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies. 2 Types:

Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis aims to obtain general information type of assessment responds to a about the community particular need
Steps: Preparatory Phase

1. 2. 3. 4. 5. 6. 7.

site selection preparation of the community statement of the objectives determine the data to be collected identify methods and instruments for data collection finalize sampling design and methods make a timetable

Implementation Phase

1. 2. 3. 4. 5. 6. 7. 8.

data collection data organization/collation data presentation data analysis identification of health problems prioritization of health problems development of a health plan validation and feedback

Evaluation Phase

Biostatistics
DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births, deaths and migration. Sources: Census complete enumeration of the population

2 Ways of Assigning People

1. De Jure - People were assigned to the place where assigned to the place they
usually live regardless of where they are at the time of census.

2. De Facto - People were assigned to the place where they are physically
present at are at the time of census regardless, of their usual place of residence. Components

1. Population size 2. Population composition o Age Distribution o Sex Ratio o Population Pyramid o Median age - age below which 50% of the population falls and above which 50% of the population falls. The lower the median age, the younger the population (high fertility, high death rates). o Age Dependency Ratio - used as an index of age-induced economic drain on human resources o Other characteristics: occupational groups economic groups educational attainment ethnic group 2. Population Distribution o o o Urban-Rural - shows the proportion of people living in urban compared to the rural areas Crowding Index - indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host. Population Density - determines congestion of the place

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.

Types of Vital Statistics Fertility Rate 1. Crude Birth Rate Total # of livebirths in a given calendar year Estimated population as of July 1 of the same given year 2. General Fertility Rate X 1000

Total # of livebirths in a given calendar year Total number of reproductive age Mortality Rate 1. Crude Death Rate _Total # of death in a given calendar year_ Estimated population as of July 1 of the same calendar year 2. Infant Mortality Rate Total # of death below 1 yr in a given calendar year Estimated population as of July 1 of the same calendar year 3. Maternal Mortality Rate

X 1000

X 1000

X 1000

Total # of death among all maternal cases in a given calendar year 1000 Estimated population as of July 1 of the same calendar year

Morbidity Rate 1. Prevalence Rate Total # of new & old cases in a given calendar year Estimated population as of July 1 of the same calendar year 2. Incidence Rate Total # of new cases in a given calendar year_ Estimated population as of July 1 of the same calendar year 3. Attack Rate Total # of person who are exposed to the disease Estimated population as of July 1 of the same calendar year X 100 X 100 X 100

Epidemiology
the study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations

1. 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

Endemic

habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles.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

Steps in Epidemiological Investigation:

1. 2. 3. 4.

Establish fact of presence of epidemic Establish time and space relationship of the disease Relate to characteristics of the group in the community Correlate all data obtained

2. Role of the Nurse

Case Finding Health Teaching Counseling Follow up visit

Qualifications
1. Bachelor of Science in Nursing 2. Registered Nurse of the Philippines

Planner/Programmer
1. Identifies needs, priorities, and problems of individuals, families, and communities 2. Formulates municipal health plan in the absence of a medical doctor 3. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 4. Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace 2. Develops the familys capability to take care of the sick, disabled, or dependent member

Community Organizer
1. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 2. Initiates and participates in community development activities

Coordinator of Services
1. Coordinates with individuals, families, and groups for health related services provided by various members of the health team 2. Coordinates nursing program with other health programs like environmental sanitation, health education, dental health, and mental health

Trainer/Health Educator
1. Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots

2. Conducts training for RHMs and hilots on promotion and disease prevention 3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and health related services 4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes 5. Conducts pre-marital counseling

Health Monitor
Detects deviation from health of individuals, families, groups, and communities through contacts/visits with them

Role Model
Provides good example of healthful living to the members of the community

Change Agent
Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health

Recorder/Reporter/Statistician
1. Prepares and submits required reports and records 2. Maintain adequate, accurate, and complete recording and reporting 3. Reviews, validates, consolidates, analyzes, and interprets all records and reports 4. Prepares statistical data/chart and other data presentation

Researcher
1. Participates in the conduct of survey studies and researches on nursing and health-related subjects 2. Coordinates with government and non-government organization in the implementation of studies/research

Principles of EPI

1.

Epidemiological situation 2. Mass approach 3. Basic Health Service

The 7 immunizable diseases

1. 2. 3. 4. 5. 6. 7. Tuberculosis Diptheria Pertussis Measles Poliomyelitis Tetanus Hepatitis B

Target Setting
Infants 0-12 months Pregnant and Post Partum Women School Entrants/ Grade 1 / 7 years old

Objectives of EPI
To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease

Elements of EPI
Target Setting Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were maintained under proper environmental condition until the time of administration.

Information, Education and Communication (IEC) Assessment and evaluation of Over-all performance of the program Surveillance and research studies

Administration of vaccines Vaccine BCG (Bacillus Calmette Guerin) Content Live attenuated bacteria Form & Dosage Freeze dried Infant- 0.05ml Preschool-0.1ml liquid-0.5ml # of Route Doses 1 ID

DPT (Diphtheria Pertussis Tetanus)

DT- weakened toxin P-killed bacteria weakened virus Plasma derivative Weakened virus

IM

OPV (Oral Polio Vaccine) Hepatitis B Measles

liquid-2drops Liquid-0.5ml Freeze dried0.5ml

3 3 1

Oral IM Subcutaneous

Schedule of Vaccines Vaccine Age at 1st dose BCG At birth Interval between dose Protection BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members An early start with DPT reduces the chance of severe pertussis 4weeks The extent of protection against polio is increased the earlier OPV is given. @birth,6th An early start of Hepatitis B week,14th week reduces the chance of being infected and becoming a carrier. 4 weeks

DPT OPV

6 weeks 6weeks

Hepa B @ birth

Measles 9m0s.-11m0s.

At least 85% of measles can be prevented by immunization at this age.

6 months earliest dose of measles given in case of outbreak 9months-11months- regular schedule of measles vaccine 15 months- latest dose of measles given 4-5 years old- catch up dose Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.

Tetanus Toxiod Immunization

Schedule for Women

Vaccine TT1 TT2 TT3 TT4 TT5

Minimum age interval As early as possible 4 weeks later 6 months later 1year later/during next pregnancy 1 year later/third pregnancy

% protected 0% 80% 95% 99% 99% 0

Duration of Protection

3 years 5 years 10 years Lifetime

There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children.

Cold Chain under EPI

Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. The allowable timeframes for the storage of vaccines at different levels are: o 6months- Regional Level o 3months- Provincial Level/District Level

o 1month-main health centers-with ref. o Not more than 5days- Health centers using transport boxes. Most sensitive to heat: Freezer (-15 to -25 degrees C) o OPV o Measles Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) o BCG o DPT o Hepa B o TT Use those that will expire first, mark X/ exposure, 3rd- discard, Transport-use cold bags let it stand in room temperature for a while before storing DPT. Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B. FEFO (first expiry and first out) - vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.