[TR-C]: Community Health Nursing

Community Health Nursing

Prof. Jessie Daclis 

Community Health Nursing 

• Resides OUTSIDE of the (H)ospital 

  • Mostly (H)EALTHY clients 

  • Since our clients are healthy, we do mostly HEALTH EDUCATION [Primary Responsibility]

    • Bunganga ang capital, hind nonchalant 

FOCUS OF EDUCATION: 

• 2 types of Health Education:

• 1. Health Promotion

  • INCREASE the level of health (mas pinapataas, naglelevel up) 

  • “Healthy dapat healthIER” 

• 2. Illness Prevention

  • Desires to MAINTAIN health

    • Stays the same 

  • “Healthy PA RIN”

GOAL OF CHN

• Attain OLOF (Optimum Level of Functioning) / [High Level Wellness] 

FIELDS OF CHN:

1. School Nursing (Safety and Health Assessment)

• Focus: SAFETY of the children

  • Inside the classroom, playground 

• SAFETY against communicable disease

  • For ex: may chickenpox yung bata, hindi na pinapapasok sa school

• Next focus: HEALTH ASSESSMENT (health of the children, enrollees)

  • For ex: chinecheck ang bata for their health, naapektuhan ang PERFORMANCE IN SCHOOL

• Occurs ONCE A YEAR

  • Kapag naman mayaman ang school, twice a year

2. Occupational Health Nursing

• Aka COMPANY NURSING

  • Focus: HEALTH of the EMPLOYEES

    • Kapag may nararamdaman, nagiging less efficient sila sa trabaho

• You also ensure SAFETY of the employees of the workplace

• Remember ERGONOMICS – studies designing and arranging the workplace 

  • Mas nadadalian sa ginagawa

  • Deals with architecture, engineering, & health

    • For ex: tamang distance ng keyboard, monitor, upuan

      • For ex: adjustable table 

3. Mental Health Nursing

• Focus on the MENTAL HYGIENE

  • Having psychological disorders came from COMMUNITIES

• You also do RISK ASSESSMENT

  • To gauge the incidences or chances of developing into mental disorders

• You also help in TRANSITION

  • “Paglipat” for ex. Pts na nasa mental hospital, ay binabalik sa community

    • Dapat may nag eeducate sa mga tao tsaka may mga magwewelcome [para ma lessen anxiety ni patient]

• RA. 11036 (MENTAL HEALTH ACT)

• The first ever MENTAL HEALTH ACT

• (Si Juan at si Juana ay nawala sa sarili, nakikipag usap sa three [tree] at nakikipag sex pa (6) [11036]

PUBLIC HEALTH NURSING 

• The GOVERNMENT pays your salary

  • Mas mataas ang sahod

• Salary Grade 15 

  • Equates into Php 36,000 / month

    • Nakabase ang sahod mo sa SALARY GRADE, it also depends on the INFLATION

• PHN is under DOH (Department of Health)

  • DOH is known as the NATIONAL AUTHORITY FOR HEALTH

DEPARTMENT OF HEALTH

• The budget is around 275 BILLION

VISION: Filipinos will be HEALTHIEST in Southeast Asia in year 2022 and in Asia in 2040 

• Basis for HEALTHIEST:

  • 1. Life Expectancy

    • Kapag mas mahaba ang buhay, mas okay ang living 

    • Mas IMPORTANTE ang balanced diet

      • Ang naging HEALTHIEST nung 2022 ay SINGAPORE

        • Mahaba ang buhay ng Singaporeans kasi malinis ang bansa nila

• The Philippines is TOP 7 out of 11 Southeast Asian Countries (bottom half) in 2022

List of healthiest southeast countries

Top 1: Hong Kong

• Marami kasing pera, plus advanced ang cancer treatment na 

Top 2: Japan

• They do not overeat by eating bento meals [compartmentalized meals] 

Top 3: South Korea

• Nakakahaba ng buhay ang kpop kasi sayaw nang sayaw

Top 4: Polynesia

Top 5: Switzerland

Top 6: Australia

• Maganda ang healthcare, hindi masyadong racist 

Top 7: Italy

Top 8: Singapore

Top 9: Spain

Top 10: Reunion

Top 11: Malta

MISSION: [General] Develop PREP HEALTH SYSTEM 

• P - Productive 

  • (gagawa ng mas maraming health programs)  

• R - Resilient 

  • (kahit anong pagdadaanan, nalalagpasan natin)

• E - Equitable 

  • (pantay sa lahat)

  • For ex: Ang PhilHealth ay PARA SA LAHAT

    • Ang public hospital at health center ay PARA SA LAHAT

• P -  People-oriented 

3 MAIN FUNCTIONS OF THE DOH (E.O. 102) [Partner ni LEA, add ka lang ng L, LEO, tapos 1+0+2 + 3 functions]

• Remember LEA

  • 1. Leadership in Health

    • Sets POLICIES 

      • Rules and regulations

        • For ex: bawal magreseta ng gamot if walang prescription

• 2. Enabler & Capacity Builder

  • Assigns in NEW STRATEGIES and TRAINING for HEALTH

    • For ex: Does new programs [Unang Yakap, INCI etc]

      • For ex: Any position of comfort na ng nanay [dati naka Lithotomy] 

    • Inuupdate ang policy

• 3. Administrative Function

  • Manages TERTIARY FACILITY 

  • Level of PHC 

    • Primary 

    • Secondary

    • Tertiary (Hawak ng DOH)

PHILIPPINE HEALTH CARE DELIVERY SYSTEM

Divided into 3 sections: 

1. PRIMARY

• Unang papasok sa primary kapag may sakit

• The MOST ACCESSIBLE among the three

  • Within 3-5 km radius and within 30 mins 

• Limitation: It only offers BASIC HEALTH CARE SERVICES

• Patients: SIMPLE CASES

  • For ex: headache, stomachache, diarrhea 

• Example: BHS (Barangay Health Station)

  • Considered as the SMALLEST UNIT of healthcare facility

• Next, RHU (Rural Health Unit / Health Center)

  • Different ang BHS and RHU

DIFFERENCE BETWEEN BHS and RHU 

2. SECONDARY

• Could be found:

  • Common Diagnostic Procedures

    • Complete Blood Count

    • Creatinine Clearance

    • Cardiac Enzyme

• Common Medical Interventions

  • IVF

  • Antibiotics 

• Common Surgical Procedures 

  • Minor surgeries 

  • Major surgeries na common lang

    • C-Section 

    • Cholecystectomy

    • Appendectomy

• Example of secondary is: 

(1) EMERGENCY HOSPITAL / DISTRICT HOSPITAL and PROVINCIAL HOSPITAL

3. TERTIARY 

• Examples are (1) REGIONAL HOSPITAL / MEDICAL CENTER / 

(2) NATIONAL HOSPITAL (PGH) /  (3) NATIONAL MEDICAL CENTER (PRIVATE) / (4) SPECIALTY HOSPITAL (Heart Center, Kidney Institute, National Center on Mental Health, Orthopedics Hospital)

• Ang may hawak ng PRIMARY and SECONDARY ay LGU (Local Government Units) RA 7160 Local Government Code

  • Baligtarin ang 7, so L [Lee, sounds like L sa GU]

  • Ang GU ay parang 6 and 0 pag binigkas

  • Mnemonics: Ligo dede

• Decentralization (Transfer of power)

• Devolution (Transfer of power) 

DOH: FORMULATE

LGU: IMPLEMENT 

• Mas maganda na LGU na nag-iimplent ng program kasi sila ang MAS MALAPIT SA TAO 

• Nagpapatupad ng PROGRAMS 

Vice-chairmen

MHO

CHO 

PHO

GOAL OF DOH:

• NOH: (National Objectives of Health)

  • Nakalista ang mga objectives ni DOH

    • For ex: Mapababa ang incidences ng TB out of 1 out of 100,000 population in 5 years time

  • We evaluate NOH every 5 years to screen improvement 

  • It serves as the ROADMAP (Guide) FOR ALL STAKEHOLDERS OF HEALTH (may hawak ng pera)

    • Stakeholders for health:

      • DOH

      • LGU

HSRA (HEALTH SECTOR REFORM AGENDA)

• Serves as the OVERRIDING GOAL of DOH

• This serves as the SECOND GOAL of DOH

  • Health Sector Reform is known as F1 PLUS (FOURmula One for Health Plus) 

    • This serves as the implementation framework for health sector reform

      • Lahat dapat ng programs ni DOH, dapat chinecheck ni F1 Plus

      • Theme of F1 Plus is to BOOSTING UNIVERSAL HEALTH CARE

There are 5 pillars to consider in F1 Plus [Four Plus One = 5]:

1. HEALTH FINANCING

• Ensure BETTER INVESTMENT for health  

• Also known as NHIP (NATIONAL HEALTH INSURANCE PROGRAM)

  • In the concept of PhilHealth

    • Remember FIN that sounds like Phil

    • PhilHealth is also known as INVESTMENT in HEALTH

• RA 11223 Universal Health Care Act

  • It ensures that ALL Filipinos are automatically enrolled in PhilHealth 

  • In the Philippines, we practice CASE RATE METHOD

    • “Per diagnosis”

      • Dengue → 10k (kung ang bill mo sa hosp 50k, ambag ni PhilHealth ay 10k)

      • Severe Dengue → 16k  

2. HEALTH REGULATION

• Deals with AFFORDABLE and QUALITY health care services 

  • Hindi pwedeng MAHAL

  • Lahat ng gamit dapat may BIDDING 

    • For ex: bidding sa vaccine, between Pfizer and Sinovac, e mas mura ang Pfizer kaya dapat dun + mas effective

3. HEALTH SERVICE DELIVERY

• Deals with ACCESSIBLE and AVAILABLE health care services

  • SAC and SAV (Service Accessible)

    • SAC - Sakay (Accessible)

    • SAV - Sasakay sa Vas (Available)

• Kawawa ang mga malalayo, kasi walang MD and RN sa mga far flung areas, wala ring health center to begin with 

• Maraming buntis sa bundok pero maraming namamatay kasi walang nakakaattend 

• May mga SCHOLARSHIP programs like DOCTORS TO THE BARRIOS 

• Kailangan mong mag RSA (Return Service Agreement) [every year na pinapaaral ka, 2 years ang equivalent na RSA, so 5 yrs MD, 10 yrs kang service] 

4. GOOD GOVERNANCE

• Deals with STAKEHOLDERS, their characteristics must be, remember TAE

  • T - Transparent (pinapakita lahat)

    • They must submit their SALN (Statement Asset, Liabilities, and Net Worth) 

  • A - Accountable 

    • Ina-audit ng COA (Commission on Audit)

  • E - Efficient 

    • Mas napapaganda

5. PERFORMANCE ACCOUNTABILITY

• Deals with OUTCOME BASED APPROACH

  • For ex: sa COVID, due to vaccination, mas nababa ang cases

4 CLIENTS OF CHN:

1. Individual 

• Solo 

• For ex: pumasok ka may lagnat ka, pumasok ka may headache ka

2. Family

• Known as the BASIC UNIT of SERVICE

• And BASIC UNIT OF SOCIETY

• Assess RELATIONSHIP

TYPES OF FAMILY:

1. Single Parent

• Solo

2.  Nuclear Family  

• Father

• Mother

• Child 

  • Note: hindi counted as extended if yaya or tita-titahan na nakikitira lang

3. Extended Family

• Father

• Mother

• Child

• + Relatives 

4. Blended Family 

• 2 single parents that deal with living together and with other members

  • Pwede kang manirahan sa hindi mo rin kaconnect sa blood line, halo-halo na literal

5. Cohabitation or Common Law

• Also known as the LIVE IN 

3.) Population / Group / Aggregate

• Share common characteristics 

  • Same developmental milestones (pare-parehong infant / adolescent / adults / elderly etc)

    • Same or alike problems 

• They share the same vulnerabilities

4.) Community

• Considered as the PRIMARY CLIENT in COPAR

  • Kapag dinevelop ang community, uunlad ang lahat 

FAMILY

• Home Visit

• We usually use the FAMILY CARE PLAN

  • We use the NURSING PROCESS OF APIE

    • A - Assessment

      • The DATA COLLECTION

      • Which can be get in 

        • RECORD

        • OBSERVATION

        • INTERVIEW

 Two types of ASSESSMENT:

1. FIRST LEVEL

• Determine WHAT ARE the problems

  • Kapag nililista mo ang lahat ng problems 

• CATEGORIES OF HEALTH PROBLEMS:

• 1. WELLNESS STATE: Healthy Individuals

  • For ex: pwede pang magregular exercise et 

• 2. HEALTH DEFICIT:

(+) Disease and (+) Disability (Dududu) 

• For ex: (DISEASE) si tatay may high blood, si nanay may diabetes, si ate may galis, si bunso may rabies 

• For ex: (DISABILITY) [naiwan sayo pagkatapos ng sakit] naparalyze after stroke, nabulag after meningitis, aphasia dahil sa stroke

• 3. HEALTH THREAT

  • Situations that INCREASE the RISK level of ILLNESS and INJURY

    • For ex: palaging umiinom, palaging naninigarilyo, kulang sa tulog, stressed araw-araw

• For ex: sa bahay, wet floor, sharp objects scattered on the floor, broken stairs, octopus wires, pag madalim ang kwarto sa bahay baka kasi may mantusok 

• 4. FORESEEABLE CRISIS / STRESS POINTS:

  • Anticipated problems which are DEVELOPMENTAL or SOCIAL in nature 

  • The person needs to ADJUST

  • DEVELOPMENTAL - pinagdadaan sa buhay na need mag adjust

    • For ex: Mag-aasawa ka na

FORESEEABLE CRISIS - soon talaga na nangyayari

• For ex: Nabuntis ng asawa

• For ex: Namatay si lolo sa edad na 88 years old

• For ex: Si buntis ay magmamanerty leave

STRESS POINTS - Biglaan nangyari

• For ex: Nabuntis ka ng kakumpara mo

• For ex: Namatay si relative dahils aksidente 

• For ex: Nawalan ng trabaho

2. SECOND LEVEL

• Determines WHY there is a problem (the reason)

• Deals with the word INABILITY

  • For ex: bakit walang tsinelas si dudung kasi hindi kayang bumili

    • Nsg Dx: Inability to avail resources 

PLANNING:

• The first step: GOAL SETTING

  • Utilize SMART

• The second step: Constructing PLAN OF ACTION

  • You need to choose NURSING INTERVENTION

    • Pipili ka ng appropriate nursing intervention 

• The third step: Develop an OPERATIONAL PLAN

  • Prioritize 

    • We do not ABC (Airway, Breathing, Circulation) since majority sa kanila ay HEALTHY

    • We do not also use the MASLOW’S HIERARHCY OF NEEDS

    • We follow SOLVING (it has 4 criteria)

    • PRIORITIZATION: the HIGHEST SCORE, the HIGHEST PRIORITY AND VICE VERSA

4 CRITERIA [(NaMo) (Pre), nag (Sal) ka na naman]

1. NATURE OF PROBLEM [WEIGHT: 1]

2. MODIFIABILITY OF THE PROBLEM [WEIGHT: 2] [The greatest influence in the total score]

3. PREVENTIVE POTENTIAL [WEIGHT: 1]

4. SALIENCE [WEIGHT: 1]

• Perception of the clients

1. NATURE OF THE PROBLEM

• Pertains to the TYPE of nursing problem that we have

2. MODIFIABILITY OF THE PROBLEM

• Solution of the Problem

3. PREVENTIVE POTENTIAL

• Future recurrence of the problem

• Remember PP

  • (Paulit-ulit, paulit-ulit)

  • For ex: measles (isang beses ka lang nagkakatigas) [high preventable]

4. SALIENCE

• PERCEPTION of the CLIENT about the problem

• The PATIENT describes the PERCEPTION

FORMULA: 

Score / highest score x weight

For ex:

a.) Nature of the Problem: Father with (+) HPN: 3 / 3 x 1 = 1 

b.) Modifiability of the Problem: Father with (+) HPN: 1 /2 x 2 = 1

c.) Preventive Potential: 1 / 3 x 1 = 1 / 3

d.) Salience: 0 / 2 x 1 = 0

TOTAL: Father (+) HPN: 2 ⅓ 

If mother has diabetes: 3

IMPLEMENTATION 

• (RA 9173 – Sec 28 refers of SCOPE OF NURSING PRACTICE)

There are THREE types:

1. Dependent

• It needs to have a PRESCRIPTION / ORDER from a physician

  • For ex: Medication administration

2. Independent

• For ex: 

  • Positioning the patient

  • Educating the patient

  • Helping ADLs

3. Interdependent

• Aka COLLABORATIVE

• Refers to other professionals apart from the MD

  • For ex: RND, PT, MedTech etc

EVALUATION

• We try to check for the OUTCOME of CARE

• Remember QAE

  • Quality Assurance Elements 

    • It contains 3 elements

QUALITY ASSURANCE ELEMENTS

• Remember SOP 

1. Structural Element

• Lahat ng pwedeng mahawakan

• Physical settings

  • May hospital ba o wala, may health center ba o wala

    • Pag walang health center sa probinsya, problema to

• Manpower

  • For ex: walang MD

• Money

  • For ex: walang pera / walang financial support

• Materials / Equipment 

  • For ex: walang gamot o walang gamit

2. Outcome Element 

• Changes resulting from Nursing intervention

  • For ex: May lagnat 39 oC, tapos nagbigay ng paracetamol, tapos now 38 oC na lang

  • For ex: mataas ang BP 190/150 tapos binigyan ng Catapres, 130/110 na lang sya

3. Process Elements

• The steps of Nursing Process itself (PROcedure)

All those elements are there to ACHIEVE OUTCOME OF CARE

PRINCIPLES WE FOLLOW IN ORDER TO ACHIEVE OLOF

PRIMARY HEALTH CARE

VISION: HEALTH in the HANDS of the PEOPLE (known as self-reliance)

• At the end of time, sila na ang bahala sa sarili nila

MISSION: To INCREASE OPPORTUNITIES that people will manage their own health care

• Turuan ang mga tao kung paano alagaan ang sarili nila 

2 CORE PRINCIPLES OF PRIMARY HEALTH CARE:

• Remember PE (parang constipated)

1. P - Partnership with the people 

• We develop ACTIVE PARTNERSHIP with the people 

  • GOAL: INDEPENDENCE for the people

    • Hindi magiging dependent sayo anytime soon 

2. E - Empowerment

• We transfer knowledge, skills, and attitude 

  • Nililipat ang mga kaalaman natin from the nurse to client

  • Magiging SR (Self-reliance) 

4 PILLARS  

• Remember AIUS

1. A - Active community participation

• Ang mga tao dapat ang bida

2. I - Intra & Inter Sectoral Linkages 

• INTRA

  • Within the Healthcare Delivery System (HCDS)

    • TWO WAY REFERRAL SYSTEM (mula primary, ipapadala sa secondary, tapos from secondary irerefer sa tertiary)

    • For ex: ang buntis pinadala mo sa isang district hospital 

• INTER

  • Outside the healthcare delivery system

    • For ex: government organization, walang tablet ang bata, pwedeng refer to DepEd 

    • For ex: domestic abuse, DSWD

  • NGO (mga foundations)

    • For ex: kapamilya foundation etc

3. U - Use of Appropriate Technology

• Use of indigenous resources)

  • For ex: lagundi ang available edi yun ang gagamitin 

4. - Support

• Mechanism of support made available 

• Through LIVELihood PROJECTS

CHARACTERISTICS of PRIMARY HEALTH CARE (REMEMBER CASASA)

1. C - Community Based

• Kung ano ang problema, dun ka magfocus

• Kailangan natin pumunta ng community at tumira para mas maiintindihan natin ang health status

2. A - Accessible 

• Malapit (3-5km in 30 mins)

3. S - Sustainable

• Pang matagalan

  • For ex: herbal  

4. A - Affordable

• Karamihan ng tao ay poor

• Promote herbal 

• Hindi ka mamimigay ng sardinas at bigas

  • Magiging dependent sila kung bigay ka lang nang bigay

    • Aasa sila, hindi mo makakapat ang GOAL

5. S - Self Reliance

6. A - Available

• Depende sa lugar

ELEMENTS OF PRIMARY HEALTH CARE

• Ituturo lahat sa tao to achieve self-reliance:

1. Education

2. Locally Endemic Disease

3. Essential Drugs

4. Maternal Child Health

5. EPI (Expanded Program on Immunity)

6. Nutrition

7. Treatment of Communicable Disease, Non Communicable Disease, and Emergency Services

8. Sanitation 

EDUCATION:

There are 3 LEVELS OF EDUCATION

• We teach health education across ALL ELEMENTS 

• KNOW THE PURPOSE (technique to see if primary, secondary, or tertiary)

EXAMPLES

1. Teach - TSE (testicular scrotum exam) (secondary) [kasi screening e]

2. Daily insulin Diabetes

(tertiary) [purpose: maintenance]

3. Reg Insulin - DKA

(secondary) 

• Purpose of insulin: treatment

4. IMCI (tertiary) (secondary) [early screening]

5. Operation timbang (primary)

6. Chloroquine 1 wk before going to Palawan (primary) [prophylaxis]

7. Nitrogen for chest pain (secondary) [early treatment]

8. Daily beta blocker (tertiary) [maintenance]

9. Isolation - COVID 19 (Primary) [used to prevent illness]

10. Insecticide Treatment Mosquito Net (Primary) [prevention]

OPERATION TIMBANG

• To check if the child is overweight, normal, or underweight  

LOCALLY ENDEMIC DISEASE

EPIDEMIOLOGY

• Study of the OCCURRENCE & DISTRIBUTION of DISEASES

  • San uso ang sakit at paano kumakalat ang sakit 

    • For ex: If may trend na may STD sa Cebu, edi gagawa si Nurse ng STD management / control sa Cebu

• It is the BACKBONE of PREVENTING DISEASE

CLASSIFICATION OF EPIDEMIOLOGY

1. SPORADIC 

• Cases occur OCCASIONALLY

• Few cases

  • Marami ang immune, konti ang susceptible

• HERD IMMUNITY

  • >80% high proportion of the people in the community are IMMUNE

    • For ex: kapag pumasok ang measles sa isang HERD community, iisa lang ang mahahawahan or 2 lang 

2. ENDEMIC 

• ENDEka nya iniiwan 

• Cases are ALWAYS present

  • The # of immune = the # of susceptible 

• May specific area na uso na

  • For ex: sa Philippines, mga mountainous areas ang Malaria, same with Schistosomiasis 

• For ex: Tuberculosis, Dengue (hindi na lang sya rainy season)

3. EPIDEMIC 

• Aka OUTBREAK

• Sudden increase in cases in a short period of time 

  • Marami ang susceptible, konti lang ang immune

    • Bago pa lang yung sakit o wala pa syang bakuna 

    • Pwedeng kumalat kahit saan 

4. PANDEMIC

• Worldwide epidemic (several countries)

• For ex: COVID19 (2020), SARS (2002), Bird’s Flu (2005), Swine Flu (2009), MERS (2012)

• HIV is still a pandemic (tumataas ang cases all over the world, mabagal lang pero tumataas)

PD 651: REGISTRATION

• BIRTH: Within 30 days dapat registration na

• We register the BIRTH in CIVIL REGISTRAR and NOT PSA 

• Kung saan ka pinanganak, dun ka magreregister

  • Kung may alterations sa civil registrar ka pupunta

• ANG PSA is just a REPOSITORY of DATA (lahat ng original duplicates isesend sa PSA)

• The BIRTH ATTENDANT is the ONLY ONE who is ELIGIBLE to register

  • Kung sino lang ang nagpaanak lang sya dapat lang magpaparegister 

    • Kahit no read and no write, sya pa rin talaga

• DEATH: Within 48 hours 

  • Doctor lang ang pwedeng magregister 

VITAL STATISTICS:

Study of Vital Events 

The 100, 1000, 10,000 and 100,000 is called the FACTOR (for every)

• Always syang nag describe kay DENOMINATOR

• Ginagamit ang 100 

  • Uses as Percentage, Ratio, and Few Population 

• Ginagamit ang 1000

  • Uses as Standard factor

  • Mula number 1 to 6 ito gamit

• Ginagamit ang 10,000 and 100,000

  • Uses SELDOMLY 

DENOMINATOR

• Total population (1,2) 

• Total Live Birth (if the formula sounds OB) (3,4,5,6)

• Total Death (seldomly uses)

  • USES SWAROOP’S INDEX

  • And also PROPORTIONATE MORTALITY RATE

NUMERATOR (Kung ano ang title, sya ang numerator)