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 efforts
CHN 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 necessary

HEALTH EDUCATOR
Utilizes 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

SUPERVISOR
Monitors and supervises the performance of midwives and other auxiliary
health workers
Also 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 unit
As 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

COMMUNITY

PRIMARY LEVEL OF CARE

Devolved to the cities and the municipalities and is the first contact
between the community people and the different levels of health facility
Refers 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 Facilities

PRIMARY 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
Individual
Family
Community
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 interests

POPULATION GROUPS
A 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 groups
It 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 CARE

PRIMARY 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
Health
Health
Health

is a fundamental Human Right

is both and individual and collective responsibility
should be an equal opportunity for all
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 UNICEF
Legal 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 Philippines

Health in the Hands of the people by the year 2020

PRIMARY HEALTH CARE

5 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 provision
Treatment of emergency cases and provision of Medical Care

TEN HERBAL PLANTS RECOMMENDED BY

THE DOH

LAGUNDI

Indications: Cough, Asthma, Fever, Muscle Pain

Decoction or Syrup

ULASIMANG BATO (PANSITPANSITAN)

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 Pain

Decoction

SAMBONG

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

Decoction

AMPALAYA

Indications: For Diabetes Melitus or non-Insulin dependent Diabetes

Decoction or Steamed

NIYUG-NIYOGAN

Indications: For intestinal infestation with Ascaris Lumbricoides

Prepare dried, mature Niyug-niyogan seeds

TSAANG 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 recommended
Use 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 PROCESS

INITIAL 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 Crisis

Preventive 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

Health Deficit

Health Threat

Foreseeable Crisis

MODIFIABILITY OF THE PROBLEM

Easily Modifiable

Partially Modifiable

Not Modifiable

PREVENTIVE POTENTIAL

High

Moderate

Low

SALIENCE

A condition needing immediate attention

A condition not needing immediate

attention

Not perceived as needing change

COMMUNITY 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
change
COPAR 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

PROCESS
Pre-entry Phase
Entry Phase
Organization-Building Phase
Sustenance and Strengthening Phase

PRE-ENTRY PHASE
At the NGO level

Formulation of Institutional Goals, Objectives and Targets for the Program

Revision of Curriculum
Training of Faculty of COPAR
Coordinate participation of other departments within the institution

At the community level

Community 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 level
Area 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 activities

Imbibe 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 Leaders
Characteristics 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 Organization

Representing 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 Officers

Training 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)

Manpower
Machine
Method
Material
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 Plans
Formalizing Linkages, Networks and Referral Systems

TURNOVER PHASE / PHASE OUT

Transfer of community organizer roles and responsibilities and documents
Subsequent follow-up
COPARs 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 1000
Midyear 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 1000
Midyear 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
--------------------------------------------------Midyear Population of women age
(x) years

x1000

MORTALITY RATES
Crude Death Rate
Specific Mortality Rate
Cause-of-death Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Perinatal Mortality Rate
Proportionate Mortality Rate
Swaroops Index
Case Fatality Rate

CRUDE DEATH RATE

Crude because death is affected by different factors
Widely used because of the availability of data
Number of Deaths in a year
---------------------------------------- x1000
Midyear Population, same year

SPECIFIC MORTALITY RATE

Made specific according to:

Age
Sex
Occupation
Education
Exposure to Risk Factors
Combination of the above

More valid than CDR when comparing mortality experiences within a group
Number of Deaths in specified Group
------------------------------------------------------Midyear Population, Same Year

x1000

CAUSE-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
------------------------------------------------------ x1000
Midyear Population, same year

INFANT MORTALITY RATE

Sensitive index of level of health in a community
High 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
------------------------------------------------Number of live births, same year

x1000

NEONATAL MORTALITY RATE

Number of Deaths among those under 28 years of age
-------------------------------------------------------------------------------- x1000
Number of Live Births, Same year

MATERNAL 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
--------------------------------------------------------------------------------------------- x1000
Number of Live Births

PROPORTIONATE MORTALITY
RATE
Used in ranking the cause of death by magnitude of frequency
Expressed in Percentage
Number of Deaths from particular cause
----------------------------------------------------------Total Deaths from all cause, same year

x1000

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

------------------------------------------------------------Number of cases from the same disease

x100

MORBIDITY 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
----------------------------------------------------------------------------------------- x100,000
Population 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
----------------------------------------------------------------------------------------- x100
Population at risk for developing the disease during the same
period 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 levels
Point prevalence
No of existing (old and new) cases of a disease at a given time
------------------------------------------------------------------------------------------population examined during that time

x100

Period prevalence
No of existing (old and new) cases of a disease at a given interval
-------------------------------------------------------------------------------------------- x100
Population examined during that interval time

ENVIRONMENTAL SANITATION

ENVIRONMENTAL 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 densely

Level 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 FACILITY
Pit 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 wastes
REFUSE 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 management
Red tide control and monitoring
Integrated pest management and sustainable agriculture
Pasig River rehabilitation Management