Community Health Nursing

COMMUNITY HEALTH
NURSING
Your Subtitle Goes Here
COMMUNITY
BLACK
A group of people living in
the same area with the same
government.

WHO
Social Structure that exhibits
& creates norms & values that
establishes social institution
4 aspects:
1. Social
2. Political
3. Cultural
4. Geographical
5 types of community
1. Urban
2. Rural
3. Rurban
4. Suburban
5. Metropolitan
HEALTH
CONCEPT in determinant of
Health: OLOF

Factors that affect OLOF:
1. Behavioral
2. Political
3. Socio-economical
4. Heredity
5. Environmental
6. Health Care Delivery System
CONCEPT OF CHN
Your Text Here
I. Philosophy of CHN
Based on the worth and dignity of
man

II. Ultimate Goal
Increase level of wellness of the
people

III. Primary Goal
Enhance peoples capabilities
IV. OBJECTIVES
1. Provide a quality Service
Education
Research
2. Participate in Development
Implementation
Evaluation of
overall health plan

3. Coordinate Nursing Services
V. Emphasis/ Focus
Health Promotion and Disease
Prevention

PRIMARY FOCUS:
HEALTH PROMOTION

Health Promotion: process of
enabling people to increase control
over and improve health
Disease prevention: Identification of
possible hx problems that can be
minimized & eradicate possible
disability
LEVELS OF PREVENTION
1. Primary:
-directed to HEALTHY
POPULATION
-elimination of risk factors
-specific protection
Ex: immunization, handwashing
1. Secondary:
Treating & identifying of health
problems at the earliest possible
time
a. case finding
b. contact tracing
c. prompt treatment
d. early diagnosis and
detection
3. Tertiary
Limits disability progression
Occurs during the disease
VI. PRINCIPLE
1. Made for all (Generalist)
2. Existing active groups (women)
3. Existing indigenous resources
(Herbal meds)
4. Implementation of health
programs & services
5. Health education: MOST
IMPORTANT PRINCIPLE
VII. CLIENT IN CHN
1. Individual: point of entry
2. Family: Focus of nursing care
Center in delivery of care
3. Group: point of specific care
4. community: point of entire care
Nursing Process in Family
Nursing Practice
1. ASSESSMENT
a. Characteristics, structures
& dynamics
b. Home environment
c. Socio-economic & cultural
characteristics
d. Health Status of each
member
e. Values toward health
practices
Nursing Practice
2. Family Nsg Diagnosis
Typology:
a. Wellness condition
b. Health deficit
c. Health threat
d. Forseable crisis/ stress point
Nursing Practice
3. NCP
a. Nature of the problem
b. Modifiability
c. Preventive potential
d. salience of the problem
4. Implementation of NCP
5. Data Validation & Plan
Modification
6. Conclusion
VIII. Places in CHN
a. Public Health Nursing-
combination of the ff:
1. skills in nursing
2. some phases of social
assistance
3. Function of all public
health programs
VIII. Places in CHN
FUNCTION of PHN in city health
office:
PHN II: frontline health worker
PHN III: Nurse in charge
(Supervisor/manager)
PHN V: Nurse supervisor
(MHC/RHU)
PHN VI: Nurse Program Supervisor
(CHO)
PHN VII: Chief nurse
IX. Activities in CHN
1. Clinic Visit
A. Two programs
-Program based
-Non Program based
B. Std Procedure
1. Registration/admission
2. Waiting time
3. Triaging
4. Medical Investigation
5. Laboratory
6. Referral note
7. Prescription
8. Education
2. Home Visit
A. Principles in Home Visit
Involve the family/ individual
Prioritize essential needs
LAST: client with sickness
client with Communicable disease
Plan should be flexible
Use of available information
There should be a purpose & obj.
B. Factors affecting frequency in Home
Visit
Delivered past Hx service
Acceptance of the family
Manpower
Policy of a given agency
Other agency involved
The needs are recognized
C. Resources in Conducting Home Visit
1
st
to see in the bag: soap in
soapdish with hand towel
2
nd
: apron

PH bag: essential indispensable
equipment in rendering care in the
community

Solutions:
Acetic acid: presence of CHON in urine
(HPN)
Benedicts soln: presence of glucose in
urine (DM)
Zephiran soln: Antiseptic soln
Acetic Acid Findings:
(-) clear
(+) cloudy

Benedicts soln:
(-) Blue
(+1) green
(+2) yellow
(+3) orange
Bag Technique: tool being used in
rendering effective & efficient care with
ease and deftness

Principles:
1. Minimize the spread of disease
2. Save time and effort
3. Show effectiveness of total care
4. Can be performed in variety of ways
X. Research in CHN
Epidemiology: study of occurrence &
distribution of a dse or factors affecting the
disease occurrence & distribution

1. Phases of epidemiologic approach
Descriptive
Analytical
Experimental
Evaluative
2. Patterns of occurrence & distribution
Sporadic
Epidemic
Endemic
Pandemic
X. Research in CHN
3. Disease Surveillance and registration
National Epidemic Sentinel
Surveillance System: Monitoring of all
infectious diseases with outbreak potential
Field Health Services &
Information System: Recording &
Reporting of cases in the Health sector

4. Vital Statistics: study of vital events &
indices of health status of a community
Two Vital events: MORBIDITY &
MORTALITY Indicate hx condition of
the people whether it is successful or
failure in hx work
X. Research in CHN
CBR:

CDR:

MMR:

IMR:

NDR:

FDR:

SDR:
X. Research in CHN
CSDR:

ASDR:

SSDR:
DEPARTMENT OF HEALTH
Vision: The Leader, staunch advocate &
model in promoting Health for all in the
Philippines

GOAL: HSRA

FRAMEWORK for IMPLEMENTATION of
HSRA: FOURmula 1 for Health

Elements of the strategy:
1. Health financing
2. Health regulation
3. Health Service Delivery
4. Good Governance
PRIMARY HEALTH CARE
4 As:
1. Accessible
2. Available
3. Affordable
4. Acceptable

3 core concepts:
1. Self reliance
2. Empowerment
3. partnership
PRIMARY HEALTH CARE
4 Pillars/ Cornerstone
Support mechanism made available
Active Community participation
Intra & Inter Sectoral linkages
Use of appropriate technology

Elements of PHC
Provide medical care & surgical Tx
Render essential drugs
Immunization
Maternal & child health & family planning
Adequate Nutrition
Render health education & sanitation
Yes to control CD & local endemic diseases
PRIMARY HEALTH CARE
Millenium Developmental Goals
Promote gender equality & empower women
Achieve universal primary education
Reduce child mortality: 4
Eradicate extreme poverty and hunger: 1
Combat HIV & other problems
Ensure environmental sustainability
Develop global partnership
Improve maternal health: 5
ORAL HEALTH PROGRAM
2 most common oral health problems:
Tooth decay
Gum disease
Vision: Lifetime oral health & tooth decay
Goal: Reduce prevalence of dental carries &
periodontal diseases
Objectives:
increase proportion of orally fit children
control oral health risk among young people
Improve oral health among pregnant women
Program: Sang Milyong Sipilyo
Strategy: 1. capability building
2. linkages & networks
3. Social Mobilization
Environmental Health &
Sanitation
Laws & policies:
PD 856: Environmental Sanitation Code
PD 825: Improper Garbage Disposal
RA 9003: Ecological Solid Waste Management
RA 9275: Clean water act
RA 8749: Clean Air act
RA 6969: Toxic hazardous Nuclear Waste
Control

Sanitation
WATER SANITATION

3 unapproved water source facility:
1. Open dug wells
2. Unimproved springs
3. Well that needs priming (repair)
deep: 100 ft below
shallow: 60 ft

Sanitation
WATER SANITATION
3 levels of approved water source facility:
I. Point source
-without pipe distribution
-Distance: 250 m away from the
houses
-distribution: 40-140 L/min
-Households: 15-25
II. Communal faucet or stand posts
-with pipe distribution; protected well
-Distance: 25 m away from septic
tanks, sewage, poultry
-distribution: 40-80 L/capital/day
-Households: 100
III. Waterworks system: Own Connection

Sanitation
EXCRETA DISPOSAL
2 unapproved secreta disposal:
1. Open pit privy
2. Overhung latrine

3 levels of approved Excreta disposal
1. Non water carriage
Negative Minimal
-reed odorless earth closet -pour flush
-closed pit privy
-pit latrines
-bucket latrines
-ventilated improvised pit
Sanitation

3 levels of approved Excreta disposal

2. Water carriage septic tank/vault
3. Water carriage septic tank sewerage
system treatment
PUBLIC PLACES
SANITATION

DORMANT CONTROL
most effective method & economical:
Search & Destroy

4S in dengue control:
1. Search & destroy: 4pm-8pm / 4am-8am
2. Self protection
3. Seek early consultation
4. Say no to indiscriminate fogging

NEW: Enrique T. Ona
Aksyon Barangay Kontra Dengue
FOOD SANITATION
Rule: When in doubt, throw it out!

3 classification of food establishments
A- Excellent
B- Very satisfactory
C- Satisfactory

4 Rights:
1. source
2. storage
3. Preparation
4. cooking
NON COMMUNICABLE
DISEASE PREVENTION &
CONTROL

1. Physical inactivity
2. Smoking
3. Hypercholesterolemia
4. Hypertension
5. Obesity
6. DM

GOAL: Reduce disability, morbidity &
premature death due to chronic non
communicable lifestyle diseases
NON COMMUNICABLE
DISEASE PREVENTION &
CONTROL

1. Physical activity: 30 mins/day
2. Maintain ideal weight
BMI= wt. (kg)/ ht (m2)
N: 22.9
Overweight: 23
underweight: 18.6
Waist circumference
M: less than 35 inches
F: less than 31.5 inches
equal or greater than even the BMI is
normal = at risk for obesity
3. Smoking cessation
4. Alcohol intake
beer= 350 ml/day; wine= 100 ml/day
National Prevention of
blindness
Most common eye problem: Cataract
Vision: Every Filipino enjoy right to sight by
year 2020

Mission:
Access to quality eye care
Yes to eliminate poverty
Empower community to promote eye
health
Strengthened political partnership

Objectives:
1. Increase cataract surgical rate
2. Reduce visual impairment
3. Reduce visual disability
Nutrition Program
Three most common deficiencies:
-Iron
-Vit. A
-Iodine
GOAL: Improve quality life among Filipinos
through better nutrition & increase productivity

Guidelines in Good nutrition:
1. Eat variety of foods everyday
2. Breastfeeding (<6 mos.)
3. Maintain ideal weight through proper diet
4. Eat lots of fruits & vegetables
5. Eat lean meat
Nutrition Program
BREASTFEEDING

4 signs of good attachment:
1. Chin touching the breast
2. Mouth wide open
3. Lower lip turned outward
4. More areola visible above than below

Good sucking
Slow, deep sucks, sometimes pausing

RA 8976: Food fortification Act
All staple foods should contain
micronutrients
PROOF: sangkap pinoy seal
REPRODUCTIVE HEALTH
LAW: RA 10354 (Reproductive health act)
FOCUS: men & women
Factor: Health Care Delivery system

4 main objectives:
1. Reduce maternal deaths
2. Reduce child mortality
3. Increase access to information & services
4. Halting the spread of HIV

4 priority elements:
1. Family planning
2. MCH & Nutrition
3. Adolescent reproductive health
4. Prevention of STI/HIV

REPRODUCTIVE HEALTH
METHODS OF FAMILY PLANNING
1. Female sterilization: tubal ligation
2. Male sterilization: vasectomy (3 mos)
3. Pill
4. Injectables
5. Condom
6. Lactational amenorrhea method: 6 mos
7. Billings method
8. BBT
9. Symptothermal
10. Two-day method
11. Standard days method
-menstrual cycle is 26 & 32, abstain on
sexual intercourse on days 8 to 19

MATERNAL HEALTH
PROGRAM
3 major cause of maternal deaths:
1. Hypertension
2. Bleeding
3. Abortion

GOAL: improve survival, health & well-being
among mother & unborn

Objectives of prenatal care:
1. Reach out all pregnant women
2. Ensure a safe & healthy delivery
MATERNAL HEALTH
PROGRAM
HIGH RISK FACTORS:
1. Age
N: 18-35
HR: <17 & >36
2. Height
N: 410
HR: <49
3. Gravida
N: G1 to G4
HR: >G5
4. History
5. Present condition

HR: for close monitoring
BEST ACTION: home visit
MATERNAL HEALTH
PROGRAM
HBMR (Home-Based Mother Record)
Purpose:
1. Identify risk factors
2. Recognize danger signs
3. Implement appropriate nursing care

MATERNAL HEALTH SERVICES:
ENCOURAGE & SUPPORT
BREASTFEEDING
1. Benefits of BF to mothers:
Prevents post partum bleeding
Prevent unplanned pregnancy
Prevent occurrence of cancer
MATERNAL HEALTH
PROGRAM
MATERNAL HEALTH SERVICES:
ENCOURAGE & SUPPORT
BREASTFEEDING
2. Benefits of BF to infants
Provide complete nutrition
Prevent infection
Rehydrates the child
Increase IQ points

MICRONUTRIENT SUPPLEMENTATION
Pregnant: 10,000 IU/ 4
th
-9
th
month/ 2x per
week
Post partum: 20,000 IU/ one dose within 4
weeks post partum
MATERNAL HEALTH
PROGRAM
MICRONUTRIENT SUPPLEMENTATION

IRON & FOLIC
1
st
trimester: 60 mg El/day for 6 mos
2
nd
/ 3
rd
tri: 120 mg el/day for entire
pregnancy
Post partum: 60 mg el/day for 3 mos.
MATERNAL HEALTH
PROGRAM
TETANUS TOXOID

TT1 ASAP 0 0%
TT2 1 month 3 80%
TT3 6 mos 5 95%
TT4 1 year 10 99%
TT5 1 year lifetime 99%
MATERNAL HEALTH
PROGRAM
SOLUTIONS TO OTHER PROBLEMS/
CONDITION

1. Complication

EMOC
BEMOC CEMOC
1:125,000 population 1: 500,000
30 mins travel time 1 hour
-delivery services all bemoc services
-IV +BT
-IV anticonvulsants +CS
-D/C
MATERNAL HEALTH
PROGRAM
SOLUTIONS TO OTHER PROBLEMS/
CONDITION

2. Parasitism
-Mebendazole 500 mg/tab
-one dose
-4
th
to 9
th
month of pregnancy
MATERNAL HEALTH
PROGRAM
Home care delivery

2 persons:
Licensed health professional
Trained birth attendant

3 priorities
Clean hands
Clean cord
Clean surface
MATERNAL HEALTH
PROGRAM
Home care delivery

Qualifications/ criteria:
Full term
G1-G4
Cephalic presentation
No history of complications
No history of prolonged labor
No history of infections
Adequate pelvis
No PROM
Enlargement of the abdomen is equal to
AOG
Imminent delivery
MATERNAL HEALTH
PROGRAM
POST PARTUM CARE

1
st
post partum care visit: w/in 2 week (3 to 5
days)

3 cardinal signs of post partum infection
1. Boardlike abdomen
2. Fever
3. Foul smelling vaginal discharge

2
nd
post partum care visit: 6 weeks post partum
1
st
PPHV: within 24 hrs
2
nd
PPHV: within a week
CHILD HEALTH CARE
LAWS:

RA 9288: NBS
RA 7600: Breastfeeding
EO 51: milk

*IMCI (discuss soon)
*expanded program of immunization

LAWS:
PD 996: immunization
RA 7846: Hepa B vaccination
RA 1066: Tetanus elimination campaign
CHILD HEALTH CARE
expanded program of immunization

Elements:
1. Target population
infant: pop x 3%
pregnant: pop x 3.5%
reproductive age: pop x 13.5-14%
2. Cold chain management
A. transport mgt*
B. Storage Management
Most sensitive to heat (-15 to -25 C)
AMV (measles)
OPV
freezer
CHILD HEALTH CARE

Storage Management
Most sensitive to freezing (2 to 8 C)
BCG, DPT, Hepa B, TT
Body
cold box: 5-8 mins

3. Information, Education, Communication
Campaign
4. Assessment & evaluation
5. Surveillance & research

CHILD HEALTH CARE

RA 10152: mandatory infant and child
immunization

*TABLE

CONTRAINDICATIONS:
X BCG: immunocompromised
X DPT I: active neurological diseases
X DPT 2: convulsion within 3 days after DPT 1

ADOLESCENT HEALTH CARE
WHO:
Adolescent: 10-20 y.o
Youth: 15-24 y.o
Young people: 10-24 y.o

Major cause of morbidity: Injury & accidents
Nursing Responsibilities in mental hx:
Maintain good physical hx
Express feelings to a friend
Never live in the past
To have a wholesome life
Avoid substance abuse
Live one day at a time
OLDER PERSON HEALTH
CARE
Characteristics of an older person:
Financially disadvantaged
Housebound
May not report illness

Common cause of morbidity: influenza
Common cause of mortality: heart diseases
Most common problem: difficulty in walking
Common cause of fall: poor vision

Goal: reduce morbidity and mortality
improve quality life among older persons

LAWS: RA 7432: senior citizen act
RA 9994: expanded senior citizen act
ALTERNATIVE MEDICATION
RA 8423: traditional & medicinal act

LAGUNDI: cough, fever
ULASIMANG BATO: uric acid
BAWANG: HPN, toothache
BAYABAS: wound cleaning
YERBA BUENA: body pain
SAMBONG: loop diuertic
AKAPULKO: anti fungal
NIYUG-NIYOGAN: parasitism
TSAANG-GUBAT:diarrhea
AMPALAYA: DM

ALTERNATIVE MEDICATION
Guidelines:

1. Avoid pesticides
2. Use clay pot
3. Use one part per symptom
4. Use part of the plant being advocated
5. If allergy occur STOP
COPAR
Your Text Here
Community Organizing
Participatory Action
Research (COPAR)

COPAR or Community Organizing
Participatory Action Research is a vital part of
public health nursing. COPAR aims to
transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and
politically responsive community.
Research (COPAR)

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).
Research (COPAR)

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).
Research (COPAR)

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)
Research (COPAR)

Emphasis

Community working to solve its own
problem.
Direction is established internally and
externally.
Development and implementation of a
specific project less important than the
development of the capacity of the
community to establish the project.
Consciousness raising involves perceiving
health and medical care within the total
structure of society.
Research (COPAR)
Importance

1. COPAR is an important tool for community
development and people empowerment as this
helps the community workers to generate
community participation in development
activities.
2. COPAR prepares people/clients to
eventually take over the management of a
development programs in the future.
3. COPAR maximizes community participation
and involvement; community resources are
mobilized for community services.
Research (COPAR)

Principles

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.
COPAR should be based on the interest of
the poorest sector of the community.
COPAR should lead to a self-reliant
community and society.
Research (COPAR)

Phases of COPAR

1. Pre-Entry Phase

Is the initial phase of the organizing process
where the community organizer looks for
communities to serve and help. Activities
include:

Research (COPAR)

Preparation of the Institution

Train faculty and students in COPAR.
Formulate plans for institutionalizing
COPAR.
Revise/enrich curriculum and immersion
program.
Coordinate participants of other
departments.
Research (COPAR)

Site Selection

Initial networking with local government.
Conduct preliminary special investigation.
Make long/short list of potential
communities.
Do ocular survey of listed communities.
Research (COPAR)

Criteria for Initial Site Selection

Must have a population of 100-200 families.
Economically depressed. No strong
resistance from the community.
No serious peace and order problem.
No similar group or organization holding the
same program.
Research (COPAR)
I
dentifying Potential Municipalities

Make long/short list of potential
municipalities

Identifying Potential Community

Do the same process as in selecting
municipality.
Consult key informants and residents.
Coordinate with local government and
NGOs for future activities.
Research (COPAR)

Choosing Final Community

Conduct informal interviews with
community residents and key informants.
Determine the need of the program in the
community.
Take note of political development.
Develop community profiles for
secondary data.
Develop survey tools.
Pay courtesy call to community leaders.
Choose foster families based on
guidelines
Research (COPAR)

Identifying Host Family

House is strategically located in the
community.
Should not belong to the rich segment.
Respected by both formal and informal
leaders.
Neighbors are not hesitant to enter the
house.
No member of the host family should be
moving out in the community.
Research (COPAR)

2. Entry Phase

sometimes called the social preparation
phase. Is crucial in determining which
strategies for organizing would suit the
chosen community. Success of the activities
depend on how much the community
organizers has integrated with the
community.
Research (COPAR)

Guidelines for Entry

Recognize the role of local authorities by
paying them visits to inform their
presence and activities.
Her appearance, speech, behavior and
lifestyle should be in keeping with those
of the community residents without
disregard of their being role model.
Avoid raising the consciousness of the
community residents; adopt a low-key
profile.
Research (COPAR)
Activities in the Entry Phase

Integration. Establishing rapport with the people
in continuing effort to imbibe community life.
living with the community
seek out to converse with people where they
usually congregate
lend a hand in household chores
avoid gambling and drinking
Deepening social investigation/community
study
verification and enrichment of data collected
from initial survey
conduct baseline survey by students, results
relayed through community assembly
Research (COPAR)

Core Group Formation
Leader spotting through sociogram.

Key Persons. Approached by most
people
Opinion Leader. Approached by key
persons
Isolates. Never or hardly consulted
Research (COPAR)

3. Organization-building Phase

Entails the formation of more formal
structure and the inclusion of more formal
procedure of planning, implementing, and
evaluating community-wise activities. It is at
this phase where the organized leaders or
groups are being given training (formal,
informal, OJT) to develop their style in
managing their own concerns/programs.
Research (COPAR)

Key Activities

Community Health Organization (CHO)
preparation of legal requirements
guidelines in the organization of the CHO
by the core group
election of officers
Research Team Committee
Planning Committee
Health Committee Organization
Others
Formation of by-laws by the CHO
Research (COPAR)

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
committees 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.
Research (COPAR)

Key Activities

Training of CHO for monitoring and
implementing of community health
program.
Identification of secondary leaders.
Linkaging and networking.
Conduct of mobilization on health and
development concerns.
Implementation of livelihood projects.
Health Sector Reform
Agenda
-describes the major SOP
Strategies
Operational & policy changes
Public investments
-needed to improve the way health care is
delivered, financed & regulated
-RATIONALE:
Burden of disease is heaviest
among the poor
Emerging health risk factors are
unattended
Slowing down in the reduction of
IMR & MMR
The population groups

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