Community Health Nursing
mid-upper arm circumference (Malnourishment) 2 types of community: -
Lectured by: Z. Famorca, PhD, RN A Pre-test on Basic Concepts 1. D. 2. B. 3. B. 4. B. 5. A. 6. A. 7. C. 8. A. 9. C. 10. C. “Public health is supposed to be given for free” FALSE Financing of health services - Out of pocket - Health maintenance organization (Phil Health) - Free at the point of care Government—Taxes are paid ♥ Test taking technique - When choosing numbers choose the middle ground - Do not choose the extreme numbers CHN: Definition 1. Developmental Services - Development of health capability of Individual, Family, Group, Community Groups with common susceptibility ♥ Same working group ♥ - Enabling service self- reliance - Health education—done for health promotion Patient Education—Done when person ♥ is sick - Community organizing 2. Community-based -
Catchment
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Natural environment of people Home PHN School SHN Workplace OHN
-
Case-finding of CHN practice ♥
Geo political community Barangay ♥ City ♥ Province ♥ Phenomenological
GIDA- Geographically Isolated and Deprived Areas -
Cooperative Development Authority Under the office of the president
♥
-
Many are from Mindanao
-
Hospice home care
-
Parish Community Nursing
-
Faith community nursing
DOTS -
Treatment partner – follows up medication ♥
PHN appoints a treatment partner
♥
Another health worker that is accessible – BHW
3. Population/aggregate—focused -
“The greater good of the majority”
-
Community Diagnosis
-
♥
Vital Statistics
♥
Demography
Magnitude (prevalence) of a problem ♥
A criterion for priority setting
4. Promotive and preventive -
Preventive treatment, e.g. DOTS
-
Health Education
5. Pre-paid service -
Taxation (public and school health)
-
Passed on to consumer (occupational)
Transfer of Technology -
6. Generalist Practice Labor Code: Health, Safety and W elfare Benefits -
Book 4: Health, safety and welfare benefits
Number of workers 10-50 50-200
3 fields of CHN Practice -
Weighing Scale or tape measure for
♥
200-300
Direct Sputum Smear Microscopy (TB) >300
OH services Graduate first aider who may be one of the workers Non-hazardous: full-time first aider Hazardous workplace: OHN OHN, Part-time physician and dentist (at least 2hrs a day), emergency clinic (1 bed: 100 workers) or hospital within 5 km Full time DMD and MD
Margadi BSN 2013
RA 124—mandates all schools to have a school clinic for
Public Health (C.E.Winslow)
the treatment of minor ailments and attendance to
Philosophy of public heatlh
emergency cases (1947) -
School health physician reports to the board of health (DOH)
-
“Health and longevity” as “birth rights”
-
Premature death (*untimely death)
Objectives of public health
Functions of OHN and SHN
-
To prevent disease
1. Health care provider
-
To prolong life
-
-
To promote health and efficiency
-
Promotive and preventive services ♥
Health advocacy
Organized community efforts
♥
Health education and counseling
-
People
♥
Immunization, prenatal care
-
RHU
-
Private sector
Treatment of common ailments and emergency nursing care ♥
-
Philosophy of public health nursing (Margaret Shetland)
CD control
-
PHN is based on the worth and dignity of man
Screening for health problems: ♥
♥
School health and nutrition survey — st
Individual, Family and Community -
The family is the basic unit of service in PHN
every 3 years thereafter
-
Physical and emotional health are inseparable
Random/rapid classroom inspection
♥
Annual individual health inspection
♥
♥
Consider physical and emotional aspects of the needs of all the members
o
Interview
of the family
o
Height and weight
Public Health Nursing (WHO expert committee on
measurement
nursing)
Head to foot examination for
-
cleanliness, skin disease and other ♥
Contribute to the integrity of the
done on the 1 visit by the nurse and ♥
♥
Primary Health Care
PHN is a special field of nursing that combines the skills of:
obvious abnormalities
♥
Public health
Visual acuity test: a child with visual
♥
Nursing
acuity of 20/40 or poorer to be referred
♥
Some phases of social assistance –
Ear exam and hearing acuity test:
feeding program
otoscopy, whisper test, ballpen click
4P’s Pantawid pamilyang Pilipino Program
test or with the use of tuning fork
(CCT- conditional cash transfer)
(ototoxicity for Streptomycin)
-
Poverty alleviation
2. Environmental Manager -
Monitoring environmental conditions
-
Recognizing and reporting accident and health hazards in workplace/school
♥
-
MDG1: Eliminate hunger and poverty
th
5 Quintile and instrument to identify “True Poor”
Benefits:
-
Healthful school living
1. P500/month
-
Application of ergonomic principles (physical
2. For every qualified child (max of 4 up to 15yrs)
environment)
-
3. Health coordinator -
P300/month for 10 mos.
Conditions:
Making referrals to other agencies and health
1. 85% of class days, students should be present
personnel
2. Immunization up to the age of 4
Coordination with public health nurse, e.g. for
3. Children will be in the garantisadong pambata
immunization of school children
program
Margadi BSN 2013
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PHN functions as part of a total public health program
-
♥
Health team
♥
1 municipal health plan
Primary level -
Target population: well individuals, families, groups and communities
-
Aspects of prevention
Objectives of PHN ♥
Promotion of health
♥
Improvement of conditions in the
♥
General health promotion
♥
Specific disease prevention o
physical and social environment
♥
Specific protection
♥
Rehabilitation
o
Groups of people
♥
Prevention of illness and disability
o
ASIN Law- “An Act for Salt
Basic competencies of the Public Health Nurse -
Patient care competencies ♥
CHN process
♥
Nursing procedures during clinic and home visits
♥
Health promotion and education
-
Communication
-
Collaboration: community organizing
-
Empowering competencies
-
Target Population: Early sick + subclinical cases (asymptomatic)
-
Aspects of prevention ♥
Early diagnosis and prompt treatment
♥
Prevention of complications
Tertiary Level -
Target population: Late sick: convalescent, disabled, complicated case, terminal ill
Legal responsibility
Natural hx of disease
♥
Ethico-moral responsibilities
♥
Personal and professional development
PrePathogenesis Interaction
Enabling competencies
♥
Pathogenesis
Management of resources and environment Record management
Enhancing competencies ♥
Research
♥
Quality improvement
Pre-test
Pre-test 1. A 2. D 3. 3 4. 4 5. 1
1. 1
6. 2
2. 2
7. D
3. 1
8. A
4. 1
9. B
5. 2
10. D
6. 1
11. B.
7. 3
12. A
8. 2 9. C
Millennium Summit: September 6-8, 2000
10. B. Level of Prevention -
Secondary Level
♥
♥
-
Iodization Nationwide ”
Surveillance
-
-
Prevent from a single person
Target population: ♥
Beneficiaries (For whom?)
♥
Purpose of the nursing action: aspect of prevention (for what?)
1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce by2/3 the under 5 mortality rate (1990:80/1000 live births 2015: 26.7/1000) Margadi BSN 2013
5. Reduce by ¾ the maternal mortality rate (1990: 2.09/1000 live births 2015: 52/1000 live Universal Health Care (2010-2016)
births) 6. Combat HIV/AIDS, malaria and other disease 1993: eradication of
FOURmula One for Health (2005-2010)
1. Polio 2. Neonatal Tetanus
Health Sector Reform Agenda (1999-2004)
3. Measles 4. Rabies 7. Ensure environmental sustainability 8. Develop a global partnership for development World Health Organization (MDG4-6)
Priority Health Policy Directions of the Aquino Administration
The Department of Health Financial Risk Protection
Vision- Mission Vision
To staunch advocate, model and leader of health for all in the Philippines “A global leader for attaining better health
Achieving MDGmax
outcomes, competitive and responsive health care system, and equitable health financing. ”
Health facilities enhancement
Mission
“To guarantee equitable, sustainable and quality health
Universal Health Care
for all Filipinos, especially the poor, and to lead the
Strategies
quest for excellence in health. ”
1 Health Financing
2 Service Delivery
6 Health Human Resource
5 Health information
3 Policy and regulation 4 Governance for Health
Responsive health system
Equitable health financing
Roles and functions of the DOH 1. Leader a.
Planner and policy-maker
b. Regulator of health services c.
Advocate in the adoption of health policies, plans and programs
2. Enabler and capacity builder a.
and disseminate info on research outputs
Primary Level -
Promotion and prevention
protection and care (training)
-
Management of prevalent conditions
-
Out-patient services
Manage selected national health facilities
b. Administer direct services for emergent health concerns that require new c.
Health care delivery system of the Philippines
Ensure standards of health promotion,
3. Administrator of specific services a.
Better Health outcomes
Develop new strategies in health
b. Initiate public discussion on health issues c.
Goals
Secondary -
Hospitalization
Tertiary -
Specialized care
complicated technologies
♥
Specially trained personnel
Administer health emergency responses
♥
Highly departmentalized Margadi BSN 2013
♥
Sophisticated equipment
5. D 6. B
National hospitals/DOH national office/ medical
7. A
centers/ university hospitals/ special hospitals
8. B 9.
Center for health development
10. A Prove Health Board
Provincial hospital (PHO)
C
11. D
Chair: Governor Vice-chair: IPHO
District hospital (DHO) Municipal/city Health Board
RHU/CHC/CHO
Chair: Mayor Vice-chair: Municipal Health Officer
BHS RA 7160—devolution code Inter Local Health System -
To ensure quality of health care service at the local level integrate hospital and public health services holistic health care
-
Inter Local Health Zone (ILHZ) ♥
Clustered municipalities (defined population within a defined area)
♥
Primary level facilities (RHU’s and BHS’s)
♥
Central referral hospital
Components of the ILHZ -
People—may vary, according to WHO, between 100, 000 to 500, 000
-
Boundaries—to determine accountability of health service providers
-
Health facilities- secondary level hospital (district of provincial), RHU’s BHS’s and other
health facilities -
Health workers—both government and nongovernment
Two-way referral system -
Communication among facilities
The RHU team Epidemiology 1. B 2. B 3. B 4. D Margadi BSN 2013