Community Health Nursing Lectured by: Z. Famorca, PhD, RN “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
Under the office of the president
♥
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Many are from Mindanao
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Hospice home care
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Parish Community Nursing
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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”
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Community Diagnosis
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♥
Vital Statistics
♥
Demography
Magnitude (prevalence) of a problem ♥
A criterion for priority setting
4. Promotive and preventive -
Preventive treatment, e.g. DOTS
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Health Education
5. Pre-paid service -
Taxation (public and school health)
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Passed on to consumer (occupational)
Transfer of Technology 6.
Generalist Practice
Labor Code: Health, Safety and Welfare Benefits 2. Community-based -
Catchment
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Natural environment of people
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Book 4: Health, safety and welfare benefits
Number of workers 10-50
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
Home PHN School SHN
50-200
Workplace OHN 3 fields of CHN Practice -
Case-finding of CHN practice ♥
Direct Sputum Smear Microscopy (TB)
♥
Weighing Scale or tape measure for mid-upper arm circumference (Malnourishment)
2 types of community: -
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Geo political community Barangay ♥ City ♥ Province ♥ Phenomenological
GIDA- Geographically Isolated and Deprived Areas -
200-300
Cooperative Development Authority
>300
RA 124—mandates all schools to have a school clinic for the treatment of minor ailments and attendance to emergency cases (1947) -
School health physician reports to the board of health (DOH)
Functions of OHN and SHN 1. Health care provider -
Promotive and preventive services ♥
Health advocacy
♥
Health education and counseling
♥
Immunization, prenatal care Margadi BSN 2013
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Treatment of common ailments and emergency nursing care ♥
-
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Private sector
Philosophy of public health nursing (Margaret S hetland)
CD control
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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
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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 ♥
♥
♥
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)
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Poverty alleviation
2. Environmental Manager -
Monitoring environmental conditions
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Recognizing and reporting accident and health hazards in workplace/school
♥
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MDG1: Eliminate hunger and poverty
th
5 Quintile and instrument to identify “True Poor”
Benefits:
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Healthful school living
1. P500/month
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Application of ergonomic principles (physical
2. For every qualified child (max of 4 up to 15yrs)
environment)
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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 -
Public Health (C.E.Winslow)
program
Philosophy of public heatlh -
“Health and longevity” as “birth rights”
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Premature death (*untimely death)
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Objectives of public health -
To prevent disease
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To prolong life
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To promote health and efficiency People
-
RHU
♥
Health team
♥
1 municipal health plan
Objectives of PHN ♥
Promotion of health
♥
Improvement of conditions in the physical and social environment
Organized community efforts -
PHN functions as part of a total public health
♥
Rehabilitation
♥
Prevention of illness and disability
Basic competencies of the Public Health Nurse
Primary Health Care
-
Patient care competencies Margadi BSN 2013
♥
CHN process
Natural hx of disease
♥
Nursing procedures during clinic and
PrePathogenesis Interaction
home visits ♥
Surveillance
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Health promotion and education
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Communication
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Collaboration: community organizing
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Empowering competencies
-
♥
Legal responsibility
♥
Ethico-moral responsibilities
♥
Personal and professional development
Enabling competencies ♥
Management of resources and environment
♥
-
Record management
Millennium Summit: September 6-8, 2000 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) 5. Reduce by ¾ the maternal mortality r ate (1990: 2.09/1000 live births 2015: 52/1000 live
Enhancing competencies ♥
Research
♥
Quality improvement
births) 6. Combat HIV/AIDS, malaria and other disease 1993: eradication of
Level of Prevention -
Beneficiaries (For whom?)
♥
Purpose of the nursing action: aspect of prevention (for what?)
Primary level -
Target population: well individuals, families, groups and communities
-
Aspects of prevention ♥
General health promotion
♥
Specific disease prevention o
♥
Prevent from a single person
Specific protection o
Groups of people
o
ASIN Law- “An Act for Salt Iodization Nationwide ”
Secondary Level -
2. Neonatal Tetanus 3. Measles 4. Rabies 7. Ensure environmental sustainability 8. Develop a global partnership for development World Health Organization (MDG4-6) The Department of Health Vision- Mission Vision
To staunch advocate, model and leader of health for all in the Philippines “A global leader for attaining better health
outcomes, competitive and responsive health care system, and equitable health financing. ”
Target Population: Early sick + subclinical cases
Mission
(asymptomatic)
“To guarantee equitable, sustainable and quality health
Aspects of prevention
for all Filipinos, especially the poor, and to lead t he
♥
Early diagnosis and prompt treatment
♥
Prevention of complications
Tertiary Level -
1. Polio
Target population: ♥
Pathogenesis
Target population: Late sick: convalescent, disabled, complicated case, terminal ill
quest for excellence in health.” 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 Margadi BSN 2013
2. Enabler and capacity builder a.
Develop new strategies in health
b. Initiate public discussion on health issues and disseminate info on research outputs c.
Ensure standards of health promotion,
Goals Better Health outcomes
Responsive health system
Equitable health financing
protection and care (training) Health care delivery system of the Philippines 3. Administrator of specific services a.
Manage selected national health facilities
b. Administer direct services for emergent health concerns that require new
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Promotion and prevention
-
Management of prevalent conditions
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Out-patient services
Secondary
complicated technologies c.
Primary Level
Administer health emergency responses
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Hospitalization
Tertiary Universal Health Care (2010-2016) FOURmula One for Health (2005-2010)
Specialized care ♥
Specially trained personnel
♥
Highly departmentalized
♥
Sophisticated equipment
National hospitals/DOH national office/ medical centers/ university hospitals/ special hospitals Health Sector Reform Agenda (1999-2004)
Center for health development Prove Health Board Provincial hospital (PHO) Priority Health Policy Directions of the Aquino
Chair: Governor Vice-chair: IPHO
District hospital (DHO)
Administration
Municipal/city Health Board
RHU/CHC/CHO Financial Risk Protection
Chair: Mayor Vice-chair: Municipal Health Office
BHS RA 7160—devolution code Achieving MDGmax
Health facilities enhancement
Inter Local Health System -
To ensure quality of health care service at the local level integrate hospital and public health services holistic health care
Universal Health Care
-
Strategies
Inter Local Health Zone (ILHZ) ♥
1 Health Financing
2 Service Delivery
6 Health Human Resource
5 Health information
3 Policy and regulation 4 Governance for Health
Clustered municipalities (defined population within a defined area)
♥
Primary level facilities (RHU’s and BHS’s)
♥
Central referral hospital
Margadi BSN 2013
Components of the ILHZ -
People—may vary, according to WHO, between 100, 000 to 500, 000
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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
Margadi BSN 2013
