The College of Maasin

Nisi Dominus Frustra

College of Nursing
Maasin City, Southern Leyte

SUPPLEMENTAL REVIEW

KEY POINTS IN COMMUNITY HEALTH NURSING

(Prepared by Rhenier S. Ilado RN)

Some test taking techniques:

A-ssimilate essential principles in the care of patients in the

community
These principles may include:
1. have a purpose or objective when conducting home visit
2. plan ahead
3. priority should be given to the recognized needs of the family
4. there is no definite rule as to the frequency of a home visit
5. frequency of home visit should take into account, the physical,
psychological and educational needs of the individual and family
6. the initial step in conducting a home visit is to GREET the client and
introduce yourself
7. soiled articles with discharge should be boiled in water 30 minutes before
laundering

B- ag Technique
- steps which are carried out by the nurse to facilitate the
performance of nursing procedures with ease and deafness
Remember the:
Bag and its contents must be protected from any possible contamination
Always wash your hands to prevent the spread of infection
Gather all necessary articles and supplies to answer emergency needs
Note: blood pressure apparatus and stethoscope are carried
separately

Consider the following principles:

1. prevention of contamination
Note: place waste paper bag outside the work areas
2. protection of the caregiver
Note: clean and alcoholize all articles after use
3. make articles readily accessible
Note: place the articles in one corner of the work area
4. make follow-up care
Note: set the date and time for the next visit
 C- ommunity Based Rehabilitation Program
• the goal of this program is the improvement of quality of life and
productivity of disabled persons
• R.A 7277, Magna Carta for Disabled Persons, serves as the legal basis of
the program
• The components of the program include: social preparations, services
preparation, training, information, education and communication and
monitoring, supervision and evaluation
• The VISION of the Department of Health is: health for all Filipinos
• The MISSION of the Department of Health is: Ensure accessibility of
health care to improve the quality of life of all Filipinos especially the
poor
• The basic principles to achieve improvement in health include:
E – nsure universal access to basic health services
E – pidemiological shift from infectious to degenerative disease must
be managed
E – nhance the performance of health sector
E – nsure the priotization of health and nutrition of vulnerable groups
• The primary strategies to achieve health goals include:
S – upport for frontline health workers and to local system
development
A – ssurance of health care
I – ncreasing investment for primary health care
D – evelopment of national standard and objectives for health
• Primary health Care (PHC), according to the World Health organization
is an essential health care made universally accessible to individuals and
families in the community by means acceptable to them through their full
participation and at a cost that the community and country can afford at
every stage of development
• The goal of PHC is health for all Filipinos and Health in the hands of
the people by the year 2020
• Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of
PHC
• The first international conference on primary health care was held in
Alma, Ata, USSR on September 6-12, 1978 sponsored by the WHO and
UNICEF
• The framework for meeting the goal of primary health care is
organizational strategy, it calls for among communities, private and
government agencies with the end view of health development
• The four cornerstone/pillars in primary health care includes:
1. active community participation
2. intra and inter sectoral linkages
3. use of appropriate technology
4. support mechanism made available
• The expanded program on immunization aims to reduce the morbidity
and mortality among infants and children caused by the six childhood
immunizable diseases. It was launched in July 1976.
 P.D. 996 (September 16, 1976) provides for compulsory basic
immunization for infants and children below 8 years of age. The EPI
program is based on epidemiological situations.
Presidential proclamation no. 147 (March 3, 1993) declares April 21
and May 19, 1993 and every third Wednesday of January and February
thereafter for two years as National Immunization Days.
R.A. 7846 (December 30, 1994) requires compulsory immunization
against hepatitis B for infants and children below 8 years old
• the ultimate goal of promotion of reproductive health is “QUALITY OF
LIFE”. The focus of the Philippine framework of the program is
Reproductive Health status in terms of, its elements. The ten elements
of Reproductive Health includes:
1. maternal and child health and nutrition
2. family planning
3. prevention and management of abortion complications
4. prevention and treatment of reproductive tract infection (RTI’s)
including STD’s, HIV and AIDS
5. education and counseling on sexuality and sexual health
6. breast and reproductive tract cancers and other gynecological
conditions
7. men’s reproductive health
8. violence against women
9. prevention and treatment of infertility and sexual disorders
10. adolescent reproductive
• the goal of the 2000 Nutritional Guidance for Filipinos is the
improvement of nutritional status, productivity and quality of life of the
population through adoption of desirable dietary practices and healthy
lifestyle. An example is the exclusive breastfeeding of infants from
birth to 4-6 months and the use of iodized salt.
• The use of fluoride in the prevention of tooth decay is carried out by
making four application of fluoride about a week apart among children
who are aged 3, 7, 10 and 13 because at these ages new teeth have
erupted
• The goal for health care and services for older persons is to provide a
longer disability-free life. This is carried out through a holistic care
approach
• To reduce the blindness prevalence rate in the Philippines, the prevention
of blindness program was conceived. It is subdivided into four programs
namely, cataract program, primary eye care, vitamin A deficiency program
and other eye care program
• The goals of the mental health program include: promotion of mental
health, decreased health-related effects of stressful lifestyle and
reduction of prevalence of mental ill health and disorders in the
Philippines
• The Sentrong sigla movement aims to promote availability of quality
health services in health centers and hospitals and to make these
services accessible to every Filipino
• “Sang Milyong Sepilyo” is a strategy for social mobilization of Dental
health program. It aims to emphasize the importance of oral health in
relation to total body health to increase public awareness on the
prevention of common dental diseases

D- OH PROGRAMS

D - ental health Program

O- steoporosis prevention
H- ealth education and Community Organization

P- rimary Health Care

R- eproductive health
O- lder Persons health Services
G- uidelines for Good Nutrition
R- espiratory Infection control
A- ccupressures
M- aternal and Child care
S- entrong Sigla Movement

E- pidemiology

• Systematic and scientific study of the distribution patterns and

determinants of health, disease and condition for the purpose of
promoting wellness and preventing disease conditions
• Basic concepts that guide epidemiological study include: biostatistics,
aggregate at risk, the natural life history of a disease, levels of
prevention, host-agent-environment relationships, multiple causation,
person-place-time-relationships
• When monitoring incidence of infectious disease, the term used to
distinguish relative frequency in time and space include the following:
Sporadic – presence of occasional cases of the disease
Endemic – constant long-term presence of the disease
Epidemic – presence of the disease at a much higher frequency over a short
period of time
Pandemic – presence of a disease in many countries in a relatively short
period of time
• Effective implementation of the epidemiological process requires a
multi disciplinary approach
• A community health nurse must apply the principles of epidemiology in
order to provide preventive services to the community
• Community health nurses participate in may epidemiological activities
like: case finding, health teaching, counseling and follow up essential
to the prevention of diseases and other conditions
 F- ormulas for Mortality and Morbidity Statistics

CRUDE BIRTH RATE (CBR) – a measure of one characteristics of the

natural growth or increase of a population

CBR= total number of live births registered in a given calendar year x 1000
Estimated population as July 1 of same year

CRUDE DEATH RATE (CDR) – a measure of one mortality from all causes
which may result in a decrease of population

CDR= total number of deaths registered in a given calendar year x 1000

Estimated population as of July 1 of same year

INFANT MORTALITY RATE (IMR) –measure the risk of dying during the
1st year if life

IMR= total number of deaths under 1 year of age registered

in a given calendar year x 1000
total number of registered live births of same calendar year

MATERNAL MORTALITY RATE (MMR) – it measures the risk of dying

from causes related to pregnancy, childbirth and puerperum

MMR= total number of deaths from maternal causes registered

For a given year x 1000
total number of live births registered of same year

INCIDENCE RATE (IR) –measures the frequency of occurrence of the

phenomenon during a given period of time. Deals only with new cases

IR= no of new cases of a particular disease registered

During a specified period of time x 100, 000
Estimated population as of July of same year

PREVALENCE RATE (PR) –measures the proportion of the population which

exhibits a particular disease at a particular time. Deals with total (old and
new) number cases

PR= no of new and old cases of a certain disease registered

At a given time x 100
Total no of persons examined at same year given time
 K- ey Points to EPI

• A fully immunized child should have received one (1) dose of BCG,
three (3) doses of DPT, three (3) doses of OP, three (3) doses of
hepatitis B and one (1) dose of measles, before the child’s birthday
• Moderate fever, malnutrition, mild respiratory infection, cough,
diarrhea and vomiting are not contraindications to vaccination
• DPT2 or DPT3 is not given to a child who has had convulsion or shock
within 3 days of the pervious dose
• BCG vaccine is not given to a child with clinical AIDS
• Measles and polio vaccines are most sensitive to heat

ADMNISTRATION OF VACCINES
Vaccine Dose Route of Site of
Administration administration

BCG Infant- Intradermal Right deltoid

region of the arm

School age Intradermal Left deltoid

entrance- region of the arm
DPT, 0.5 ML Intramuscular Upper, outer
HEPATITIS B portion of the
thigh
POLIO 2 drops, or Oral Mouth
depending on
manufacturer’s
instructions
MEASLES 0.5 ml Subcutaneous Outer Part of the
Upper arm
TETANUS 0.5 ml Deep Deltoid region of
TOXOID Intramuscular the upper arm

K- ey Points in Vaccine Administration

• BCG- lay the syringe and needle almost flat along the child’s arm
- if the vaccine is injected correctly into the skin, a flat wheal
with the surface pitted like an orange peer will appear at the injection
site

• OPV – if necessary open the child’s mouth by squeezing the cheeks

gently between your fingers to make lips point upwards
- put drops of vaccine straight from the dropper onto the child’s
tongue but do not let the dropper touch the child’s tongue
- if the child spit out the vaccine, give another dose
• HEPA and DPT – the best injection site is the outer part of the
child’s midthigh
- ask the mother of the child to hold the child’s legs

• MEASLES –the best injection site is on the outer side of the upper
arm

• TETANUS TOXOID –the best injection site for a woman is the outer
side of the left upper arm

Vaccine Dose Timing of Vaccination

TT1 5-6 months of pregnancy
TT2 1 month/ 4 weeks after TT1
TT3 at least 6 months later
TT4 at least 1 year later
TT5 at least 1 year later

Note: TT1 gives initial protection, TT2 provides 3 years protection for
the mother, TT3 provides 5 years protection, TT4 provides 10 years
protection and TT5 provides lifetime protection of the mother

M- edicinal Plants

Herbal Plant Use/s

Akapulko Anti-fungal

Ampalaya Diabetes Mellitus

Bawang Hypertension (to lower cholesterol levels in

the blood)
Toothache
Remember:
BawHaT (Bawang for Hypertension, toothache)

Bayabas/ Guavas Diarrhea

Washing of wounds
Gargle to relieve toothache

Lagundi S-kin diseases

H-eadache
A-sthma, cough and fever
R-heumatism, sprain, insect bites
E-czema
Dysentery
Niyug-niyogan Anti helminthic
Sambong Anti-edema
Diuretic
Anti-urolithiasis

Tsaang Gubat Remember:

Stomach ache
Tsaang gubat
Diarrhea

Yerba Buena S-wollen gums

P-ain
I-nsect bites
T-oothache
M-enstrual and gas pain
A-rthritis
N-ausea and fainting
D-iarrhea

Ulasimang bato Uric acid excretion

(pansit pansitan) Remember:
Ulasimang bato, uric acid

REVIEW BULLETS FOR CHN

• Acupressure
- traditional Chinese medicine believes that life is the result of QI or
life energy
- when there is an imbalance of YIN and YANG forces, there is illness
- YIN is the yielding negative and feminine force: YIN principle: give
Chinese cold deserts after surgery
- Yang is the dominating, positive and masculine force
- posture: lying down or sitting up
-foods to avoid; iced food/drinks, sour food, alcohol drink, pepper and
spices, seafood, peanuts, salty foods
- TSUN measurement- method of locating points in the body using the
patient’s own hands or fingers as a base for measurement
- contraindications: pregnancy, full stomach and cardiac illness

• Acupuncture
- stimulating specific anatomic points called HSUEH
- goal: manipulation of energy flow throughout the body following as
thorough assessment by a practitioner
- indication: acute and chronic pain and motion disabilities
- contraindications: pregnancy, hemophlia, acute CVD

• Aromatherapy
 - based on olfactory stimuli used to help balance the DOSHAS, the
mediators between physiologic and psychologic process
- done often at night to induce sleep
- use of essential oils of plants to treat symptoms

• Bag Technique
- a tool making use of the public health bag through which the nurse
during the visit can perform nursing procedures with ease and deftness,
saving time and effort at the end in view of rendering effective nursing
care
- PUBLIC HEALTH BAG –essential and indispensable equipment of the
public health nurse
- principles: should minimize if not totally prevent the spread of
infection: should save time and effort
- special consideration: hand washing
- content of the bag: Bp apparatus and stethoscope are carried
separately; medicines also include – betadine, 70% alcohol, benedict’s
solution
- place waste paper bag outside of work area to prevent contamination of
clean area

Sample Questions:
1. this is the tool trough which the nurse, during home visit can perform
nursing procedures with ease and deftness, saving time and effort with
the end of view of rendering effective nursing care:
a. public health bag
b. bag technique
c. home visit
d. all of the above
2 the public health bag contains basic medications and articles which are
necessary for giving care during home visits. Its contents are he
following EXCEPT:
a. soap, adhesive plaster and tape measure
b. betadine, acetic acid and benedict’s solution
c. surgical scissors and forceps
d. stethoscope and sphygmomanometer

CARE OF THE OLDER PERSON

- first cause of morbidity among the 50+ years old: influenza
- top cause of mortality among the 60+ years old: Diseases of the heart
- common health problems: difficulty in walking, difficulty in chewing,
impaired vision in at least one eye, hearing problem
- goal: “A longer disability free life’
- Resolution 46: the UN principle for older persons to add life to years
that have been added to life
COMMUNITY HEALTH NURSING:
- Goal: promotion of the client’s optimum level of functioning through
teaching and delivery of care
- Philosophy: based on the worth and dignity of man
- the primary focus of CHN practice is HEALTH PROMOTION
- community health nurse are generalists in terms of their practice
- family is the unit of service
- HEALTH TEACHING is the primary responsibility of the community
health nurse

Sample Question:
1. the key role for the community health nurse in dealing with
communities is to:
a. make sure that people in the community are empowered and able to
participate
b. provide incentives for community members to follow the protocols of
any study or drug trial
c. establish project teams that will collect and analyze data
d. closely direct community members so that the community assessments
are done appropriately

CHN ROLES OF THE NURSE:

- Clinician: focus on the health of individuals in the larger context of the
community
- Advocate: advocates self-care, people’s ability to be active participants
in their own health, and self-determination, the right to make their own
decisions
- Collaborator: brings together strengths and resources of people
involved toward a common goal
- Counselor; key tasks include listening and providing feedback and
information
- Educator: provides skills, knowledge and attitudes that the people need
to make appropriate choices or decisions
_ Hospice care: providing care skills in a home or other setting and
balancing the client’s needs

Sample questions:
1. the community health nurse acting in the role of clinician would be
more likely to:
a. work to participate the special needs of a population such as homeless
people
b. focus on reducing the incidence of disease in a population
c. address the spiritual needs of a group without performing any
screening or treatment
d. coordinate the various components of care to different areas of thr
health system
2. the CHN acting in the role of advocate would be most likely to
promote;
a. self-care and self-determination for the population
b. telling the people in a community that the medical experts know what is
best for them
c. smoking cessation
d. that health care options should be pursued without the influence of
friends or families
3. which of the following is not a role for the community health nurse
providing hospice or end of life care?
a. providing resources for caregivers to prevent burnout
b. ensuring that the client is given every reasonable chance to extend life
and is encouraged not to give up too easily
c. working as part of a multidisciplinary team to meet client’s, family and
community needs
d. promoting and coordinating palliative care and services

COMMUNITY ASSESSMENT:
- process of examining the community in collaboration with the community
members to develop strategies that improve health and quality of life for
the community
- community competence refers to the community’s ability to identify
needs, achieve working consequence and agree and work together to meet
goals
- three dimensions include: status, structure and process
- status- information about morbidity and mortality, life expectancy,
crime rates and education
- structure – socioeconomic, age, gender, resources
- process – how the community operates and functions as a whole

Sample questions:
1. a community is best described as:
a. people living in the same place
b. organizations, family groups and friend groups that interact
c. groups that have common interest or needs
d. all of the above
2. a community that is described as having community competence has
which of the following characteristics?
a. the ability to perform their own cross-sectional epidemiological studies
b. the ability to delegate any community processes to an outside expert
such as community health nurse
c. the ability to identify their own needs, achieve consensus, plan and
implement goals
d. the ability to predict morbidity and mortality rates for the population
3. all of the following are part of the community assessment process,
EXCEPT:
a. identifying available resources such as time, money and team skills
b. collecting and analyzing information
c. withholding results from the community until they can be statistically
confirmed, to avoid alarming people
d. setting action priorities based on the needs of the community and
available resources
4. a valid way to collect data for a community assessment is:
a. using a library database for literative review
b. reading government documents to find out about previous data
c. using surveys or questionnaires to gather information from the
community members
d. all of the above

CHN CLINIC VISIT:

- PRE-CONSUATION VISIT: clinical history taking, vital sings, physical
assessments, laboratory exams and documentation
- MEDICAL EXAMINATION: ensure privacy, safety and comfort of the
patient throughout procedure
- POST-CONSULATION: explain findings and needed care, refer as
needed, make appointment for nest clinic/ home visit

Sample questions:
1. during clinic visits, all of the following are done in the consultation
conference, EXCEPT:
a. take clinical history after greeting and making client at ease
b. refer client to other related staff or agency if necessary
c. take temperature, BP, height and weight
d. perform physical assessment and selective laboratory examination

COMMUNITY ORGANIZING:
- a continuous of awareness building, organizing and mobilizing community
members towards community development
- phases of activities:
PRE-ENTRY- preparation of the staff
- site selection
ENTRY PHASE – integration with the community
- courtesy calls, information campaigns, identification
of potential leaders
CORE-GROUP FORMATION AND MOBILIZING
- integration with the core group
ORGANIZATIO- BUILDING
- organizing barrio health committee, setting up the community
organization
CONSOLIDATION AND EXPANSION PHASE
- networking and establishing linkages, implementation of
livelihood-projects and developing secondary leaders

Sample questions;
1. one of the primary tasks of the community health nurses during the
pre-entry phase is the selection of the barangay to become the initial
site for their organizing efforts. The following are the steps in the
selection of the project site by the team, EXCEPT:
a. developing criteria for site selection
b. identifying potential barangays and choosing the final project village
c. identification of potential leaders
d. identification of the host family
2. it is during this period that one member of the team formed was given
the ole of a community organizer:
a. organizing-building phase
b. core stoup formation phase
c. consolidation phase
d. expansion phase
3. for potential leaders to perform their roles effectively, they have to
possess certain characteristics. Among these are the following, EXCEPT:
a. they must belong to the poor sector
b. they must be respected members of the community
c. preferably informal leaders
d. formal leaders with many community responsibilities
4. this phase signals the start of community self-management of any
development program:
a. consolidation and expansion phase
b. core group formation
c. entry phase
d. organization building phase
5. under this phase of the education and training process, the conduct of
training, monitoring and documentation of training are included in:
a. implementation phase
b. planning phase
c. evaluation phase
d. post-training phase

DENTAL HEALTH PROGRAM:

- vision: a lifetime oral health and no tooth decay for the nest
generations
-objective: to prevent and control dental diseases and conditions
- “Sang milyong Sepilyo”- project for social mobilization of dental health
program

DEPARTMENT OF HEALTH:
- Vision: health for all filipinos
- mission: enhance accessibility and quality of health care to improve the
quality of life of all Filipinos, especially the poor
- basic principles to achieve improvement of health
1. ensured universal access to basic health services
2. health and nutrition of vulnerable groups must be prioritized
 3. epidemiological shift from infection to degenerative diseases must
be managed
4. performance of the health sector must be enhanced
- primary strategies:
1. assurance of health care
2. increased investment for primary health care
3. development of national standards and objectives for health
4. support to local health system development and frontline health
workers

Sample questions:
Situation: the department of health formulated plan, programs and
projects with the vision, “health for all Filpinos’
1. which of the following is the mission of the department of health?
a. promote healthy lifestyle
b. ensure accessibility and quality of health care
c. reduce morbidity and mortality
d. improve general health status of the people
2. which of the following is not a basic principle in the achievement of
improved health?
a. health and nutrition priorities
b. universal access to health service
c. enhancement of performance of health sector
d. investment for primary health care
3. which of the following is not a primary strategies to achieve health
goals?
a. support of local health system
b. development of national standards for health
c. assurance of health care for all
d. funding from non-government organization