POINTS IN COMMUNITY HEALTH NURSING Definitions of CHN by:
WHO – Combination of Nursing Skills, Sociology and Public Health Freeman – a service rendered by a professional professional nurse with communities, communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work for promotion of health, prevention of illness, illness, care of the sick at home home and rehabilitation. Jacobson – Achievement of Optimum level of functioning through teaching and delivery of care Bailon-Reyes – It is a field of nursing practice where services are delivered outside of purely curative institution, but In community settings such as home, the school, place of work health centers and clinics. Maglaya – Utilization of nursing process to benefit the Individual, Family and Community Hanlon – attainment of highest level of physical, mental, and social well-being and longevity consistent with available Knowledge and resources at a given place and time. Philosophy Goal
– Based on worth and dignity of man (Shetland) ( Shetland) – Raise the level of citizenry (Nisce)
PUBLIC HEALTH
Winslow – Science and art of preventing disease, prolonging life, promoting health and efficiency. Knowing your birthrights, health and longevity Purdom – Survival of Human Species Hanlon – most effective total development of life of individual and society
DEPARTMENT OF HEALTH – PHILIPPINES Vision – The DOH is the leader, staunch advocate and model in promoting Health
for All in the Philippines. Mission – guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health.
Goal – Health Sector Reform Agenda (HSRA) PRIMARY HEALTH CARE
~ It is essential health care car e 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. ~1st International Conference was on Septemb September er 6 to 12, 1978 at Alma Ata, USSR sponsored by WHO ~ Adopted in the Philippines on October 19, 1979 through Letter of Instruction 949 singed by Pres. Marcos Goal: Health for all Filipinos and Health in the Hands of the People by the year
2020. Mission: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. Elements/components of PHC
1. Environmental Sanitation Food and Proper nutrition 2. Control of Communicable Diseases Medical Care and Emergency Treatment 3. Immunization Endemic Disease 4. Health Education of Essential Drugs 5. Maternal and Child and Family Planning
6. Adequate 7. Provision of 8. Treatment of locally 9. Provision
Four Cornerstones/ Pillars of PHC
1. Active Community Participation Technology 2. Intra and Inter-sectoral Linkages made available
HOME VISIT
3. Use of Appropriate 4. Support mechanism
~ It is nurse-family contact which allows health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. PURPOSES OF HOME VISIT
1. To give nursing care to sick, post partum mother and her newborn. 2. To assess the living condition of the patient and his family and their health practices. 3. To give Health teaching regarding the prevention and control of diseases. 4. To establish close relationship n> between the agencies and the public for the promotion of health. 5. To make use of the inter-referral system and to promote the utilization of community services PRINCIPLES OF HOME VISIT
1. Home Visit must have a Purpose or Objective 2. Home Visit must use all available information about the patient and his family 3. Home Visits’ planning must give priority to the essential needs of the family 4. Home Visits’ planning and delivery must involve the individual and family 5. Home Visit must be flexible 7 STEPS IN CONDUCTING HOME VISIT
1. Greet the Patient and Introduce elf 2. State the purpose of the visit 3. Observe the patient and determine the health needs 4. Put the bag in a convenient place and proceed to perform the bag technique 5. Perform the nursing care needed and give health teachings 6. Record all important, observation and care rendered r endered 7. Make appointment for a return visit
BAG TECHNIQUE
~ It is a TOOLTOOL n> making use of a public health bag through which the nurse, during his/her home visit, can perform nursing procedure with ease and deftness, saving time and effort with the end in view of rendering effective nursing care. PHN Bag – essential and indispensable equipment of a PHN Principles of Bag Technique
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Minimize, if not prevent spread of any infection Saves time and effort in the performance of nursing procedure Show the effectiveness of total care to the the individual and family Variety of way should be performed depending on the agency’s policy
Important points in Bag Technique
The Bag should be: ¶ Contain all the necessary article, supplies and equipments ¶ Cleaned very often, supplies replaced and ready for use anytime ¶ Consider the bag and its contents clean and sterile ¶ Collection of article article should should Convenient Convenient to the the user, to facilitate facilitate efficiency and avoid confusion
COMMUNITY DIAGNOSIS
Ü A process in which the PHN and the community community are identifying community problems that will serve as basis in formulating community program Ü It is derived and will become become the bases for developing developing and implementing implementing Community Health Nursing intervention and strategies. Steps in Conducting Community Diagnosis
1.
1.
Determining Objectives
2. Defining the study population 3. Determining the data to be collected
4. Colle Collecting cting Data 5. Developing the instruments 6. Actua Actuall Data Data gatherin gatheringg 7. Data Colla Collation tion 8. Data Prese Presentati ntation on 9. Data Analy Analysis sis 10.Identifying CHN problems 11.Priority Setting
Two types of Community Diagnosis
1. Comprehensive – Obtaining general information about community Elements:
- Demographic Variables - Socio-economic and Cultural Variables - Health and Illness Patterns - Health Resources - Political Leadership Patterns
2. Problem-oriented or Specific – Obtaining particular information about the community
3 Types of Team in Community Health Nursing 1. Nursing Team – Part of health team and is
responsible for planning and implementation of nursing services
to individual, families, groups and community as a whole. It is a single disciplinary team whose leaders is a nurse with the highest educational attainment or work experience. 2. Health Team – Composed of people from various disciplines in health filed that work together- Typical Rural Health Team. 3. Intersectoral – Consist of professional workers from various disciplines outside of health field but whose work have relevance to the impact on continuity of care. ~Elements£ An attitude of mutual trust, confidence and respect £ Commonly agreed and understood goal and plan of action £ Effective leadership £ A clear division of labor and and appropriate allocation of responsibilities among members £ Supportive, Collaborative and Cooperative relationship among the members of the team £ Open and Honest Communication £ Recognition of Responsibility of each professional group £ Appropriate use of available resources so as to achieve the goals goals of the team team £ Provision for periodic evaluation of teams functioning £ Continuous education for the members of the group Commonly Used Records and Reports in Community Health Nursing Practice
þ Individual Clinical Clinical Records – these are health records of clients/ patients patients who were served by the health agency. They include a child Health record includingImmunization Card , for infants and children, a Prenatal Record for pregnant women. þ Family Folder Folder – itit is large envelope whose whose face sheets contain information about family. It also contains clinical records of members who have utilized the health agency’s services. þ Administrative Records – These comprise records which are being maintained for administrative purposes, such as planning the health agency’s budget, requisitioning equipment, drugs and other supplies, evaluating programs and staff performance. (Example: Record of daily clinic attendance, outreach services, registers)
þ Periodic reports reports on health status status of the community, community, activities activities and services delivered by the health agency. REPRODUCTIVE HEALTH Prenatal Visits
1st Visit - As early in pregnancy as possible before four months or during the 1st trimester 2nd Visit - During the 2nd trimester 3rd Visit - During the 3rd trimester Every 2 weeks - After 8th moth of pregnancy Recommended Schedule of Post Partum Care Visits:
1st Visit - 1st week post partum preferably 3 to 5 days 2nd Visit - 6 weeks post partum
Tetanus Toxoid Immunization Schedule for Women
(Given intramuscularly at the Deltoid region of the upper arm) TT1 As early as possible during pregnancy TT2 At least 4 weeks later 80% ~Infants born to the mother will be protected from neonatal tetanus ~ Gives 3 years protection for the mother TT3 At least 6 months later 95% ~Infant born to mother will be protected from neonatal tetanus ~ Gives 5 years protection for the mother
TT4 At least one year 99% ~Infants born to the mother will be protected from neonatal tetanus ~ Gives 10 years protection for the mother TT5 At least one year later 99% ~ gives life time protection for the mother ~ All infants born to that mother will be protected The strategic thrust for 2005-2010 includes:
~ Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH, The BEMOC strategy in coordination with the DOH. The BEMOC strategy entails the establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically. The strategy calls for families and communities to plan for childbirth and the upgrading of technical capabilities of local health providers. ~ Improve the quality of prenatal and postnatal care. Pregnant women should have at least four prenatal visits with time for adequate evaluation and management of disease and conditions that may but put the pregnancy at risk. Postpartum care should extend to more women after childbirth, after a miscarriage or after an unsafe abortion. ~ Reduce women’s exposure to health risks through the institutionalism of responsible parenthood and provision of appropriate health care package to all women of reproductive age, women with low educational and financial resources, women with unmanaged chronic illness and women who had just given birth in the last 18 months. ~ LGUs, NGOs and other stakeholders must advocate for health through resource generation and allocation for health services to be provided for the mother and the unborn. Home Deliveries Need to Remember!
Clean Hands Clean Surface Clean Cord
Expanded Program on Immunization
Children need not die young if they receive complete and timely immunization. Children who are not fully immunized are more susceptible to common childhood diseases. The Expanded Program on Immunization i s one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region. r egion. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of six (6) immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles) Special campaigns have been undertaken to improve further program implementation, notably the National Immunization Days (NID), K Knock nock Out Polio (KOP) and Garantisadong Pambata (GP) since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and improved surveillance system. Cold Chain ~ It is scheme used to preserve the potency of a vaccine. An appropriate storage of vaccine from the time it was manufactured till the time it has to be given to the child or the mother. ~ Vaccines’ lifespan is determined by where it is stored or kept
6 months – Regional Hospital 3 months – Provincial Hospital 1 month – Main Health Centers 5 days – RHU and BHS ~ In transporting, use cold dogs