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HEALTH NURSING
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4/10/15
FACTS of CHN
Focus : promotion and preservation of health
Area of Content: skills and knowledge
relevant to both nursing and
public
health
Clients : general populations (individuals,
families, communities)
Time
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2. What Is Health?
A state of complete
physical, mental,
and social wellbeing 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
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factors.
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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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 a promotive-preventive service
adheres to Primary Health Care
> Health education
> Preventive treatment
It is a generalist practice
with
all
cases
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deals
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RAISE
the level
of
health
of
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By:
help communities and
families cope with
discontinuities in
health and threats
Maximize their
potential for high level
wellness
Promote reciprocally
supportive relationship
between people and
their physical and
16
social environment
17
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
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for CHN
2.
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?
a. Supporting conditions for healthy habits
b. Increasing opportunities to be healthy
c. Letting the people manage their own
health
d. Financing health care program
Ans: c.Letting the people manage their own
health
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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:
All ages
regardless
status
d.
of
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30
3 Ps:
Promote health
Prevent Disease
Prolong Life
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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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Researcher
> Epidemiologist, Health Monitor, Recorder, Statistician
Community Organizer
> Change Agent
Trainer
> Health Educator, Counselor
Role Model
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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
clients 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
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Other factors affecting health
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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Wellness State
Health Deficit
Health Threat
Foreseeable Crisis
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CHN Process
3. Planning of care
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CHN Process
4. Implementation of care
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CHN Process
5.
Evaluation 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
Stages of Family Development
Stage 1 The Beginning Family
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Structural-Functional
Initial Data Base
Family structure and Characteristics
Socio-economic and Cultural Factors
Environmental Factors
Health Assessment of Each Member
Value Placed on Prevention of Disease
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Problem Prioritization:
Nature of the problem
Wellness State
Health deficit
Health threat
Foreseeable Crisis
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
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Population Group
Vulnerable Groups:
Infants and Young Children
School age
Adolescents
Mothers
Males
Old People
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CHN Process
Community Diagnosis
Determining the health status of the
populations in the community as
well as the factors that directly or
indirectly affect their health status
It is an integral part of the
assessment phase of the CHN
Process
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assessment or situational analysis
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STEPS:
Preparatory Phase
1.
2.
3.
4.
5.
site selection
preparation of the community
statement of the objectives
determine the data to be collected
identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
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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
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CHN Process
Parts of Community Diagnosis:
A. Demographic Variables
Sex Ratio
Civil Status
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CHN Process
Parts of Community Diagnosis:
B. Social Indicators
Literacy Rate
Educational attainment
Communication network
Transportation system
CHN Process
Parts of Community Diagnosis:
C. Economic Indicators
Dependency Ratio
Occupation
Income
Poverty index
Unemployment Rate
Underemployment Rate
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CHN Process
Parts of Community Diagnosis:
D.Cultural Factors
Ethnicity
Race
Language
Religion
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CHN Process
Parts of Community Diagnosis:
E. Environmental Indicators
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Topographical characteristics
Water supply
Excreta disposal
CHN Process
Parts of Community Diagnosis:
F. Health Patterns
Food storage
Immunization status
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CHN Process
Parts of Community Diagnosis:
G.Health Resources
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manpower-population ratio
manpower distribution
manpower policies
CHN Process
Parts of Community Diagnosis:
H.Political and Leadership Patterns
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Prevailing issues
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
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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
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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
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COMPONENTS:
Population Size
1. Natural increase
2. Net migration
3. Rate of natural increase
Population Composition
4.
5.
6.
7.
8.
9.
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Age Distribution
Median Age
Dependency Ratio
Sex Ratio
Population Pyramid
Others: occupational groups, economic groups,
educational attainment, and ethnic groups
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Population Distribution
1. Urban-Rural
2. Crowding Index
3. Population Density
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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
Crude Birth Rate
General Fertility Rate
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Mortality Rates
Crude Death Rate
Specific Mortality Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Proportionate Mortality Rate
Swaroops Index
Case Fatality Rate
Cause-of- Death Rate
Morbidity Rate
Prevalence
Incidence Rate
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C. 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
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Basic Concepts:
Epidemiologic Triad
Transmission
Incubation period
Herd immunity
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PLACE
extrinsic factors
TIME
temporal patterns
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Epidemic potential
an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socioeconomic 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
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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According to Increasing
Complexity of the Services
Provided
Type
Service
According to the
Type of Service
Type
Example
Primary
Health Promotion,
Preventive Care,
Continuing Care for
common health
problems, attention to
psychological and social
care, referrals
Health
Promotion
and illness
Prevention
Informatio
n
Dissemina
tion
Secondar
y
Surgery, Medical
services by Specialists
Diagnosis
and
Treatment
Screening
Tertiary
Advanced, specialized,
diagnostic, therapeutic
& rehabilitative care
Rehabilitati
on
PT/OT
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The
Healt
h
Secto
r
DOH
LGU
NGO/PS
84
The Health
Sector
Department of Health
Vision: Leader and staunch
advocate and model in promoting
Health for ALL in the Philippines
Mission: Guarantee equitable,
sustainable, and quality health for all
Filipinos, specially the poor and shall
lead the quest for excellence in
health
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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
2. Enabler and Capacity Builder
Innovate new strategies to improve health programs
Exercise oversight function
Ensure highest achievable standards
3. Administrator of Specific Services
Manage selected national health facilities and hospitals
Administer direct services for emergent health concerns
Administer health emergency response services
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DOH Programs
D ental Health
87
88
PRIMARY LEVEL
Health Promotion and
Illness Prevention
SECONDARY LEVEL
Prevention of
Complications thru Early
Dx and Tx
TERTIARY LEVEL
Prevention of Disability,
etc.
Provided at
Health care/RHU
Brgy. Health Stations
Main Health Center
Community Hospital
and Health Center
Private and Semiprivate agencies
When hospitalization
is
deemed
necessary and referral is
made to emergency
(now district), provincial
or regional or private
hospitals
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Accessible
Affordable
PHC
Acceptable
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Sustainable
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Framework
People
Empowerment
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C
O
M
M.
P
A
R
T
I
P
A
T
I
O
N
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S
E
C
T
O
R
A
L
L
I
N
K
A
G
E
S
P I L L A R S
P
R
O
P
E
R
S
U
P
P
O
R
T
T
E
C
H
N
O
L
O
G
Y
M
E
C
H
A
N
I
S
M
O F
P H 94C
PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private
sectors, social welfare, public service, enrironmental,
etc.)
Intrasectoral linkages (peoples empowerment;
within own system)
B. Community Participation
e.g. Community Organizing
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C. Appropriate Technology
- method used to provide a socially and environmentally acceptable
level of service or quality product at the least economic cost.
Criteria:
Safe
Acceptable
Feasible
Effective
Scope-wise
Affordable
Complex
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Example:
- ORS
- - Herbal Meds
- -Botica sa Baryo
- -Use of
Indigenous
Materials
96
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
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RA 8423:
utilization of medicinal
plants as alternative for
97 cost medications
high
Intermediate Level
Health Personnel of
First-Line Hospitals
Trained Community
Health worker; health
auxiliary volunteer;
Traditional Birth
Attendant
General Medical
Practitioners
Public Health Nurses
Midwives
Physicians with
specialty area
Nurses
Dentists
1st source of
professional healthcare
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Reproductive Health
Exercise of reproductive right &
responsibility
Vision: RH practice as a way of life for every
man and woman throughout life
Goals: 4 Es
> Every pregnancy should be intended
> Every birth should be healthy
> Every sex act should be free of coercion
> Every family should achieve its desired size
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