FAMILY

• Basic unit of the community

• A group of people related by blood, marriage, or adoption living together (US Census Bureau, 2000)

• 2 or more people who live in the same household, share a common emotional bond, and perform certain interrelated social task (Spradley and Allender , 2000)

Nuclear family, defined as "the family of marriage, parenthood, or procreation; composed of a husband, wife, and their immediate children— natural, adopted or both".

Dyad, consisting only of husband and wife, such as newly married couples and “empty nesters”

Extended family, consisting of three generations, which may include married siblings and their families and/or grandparents.

Blended family, which results from a union where one or both spouses bring a child or children from a previous marriage into a new living arrangement;

Compound family, where a man has more than one spouse; approved by Philippine authorities only among Muslims by virtue of Presidential Decree No. 1083, also known as the Code of Muslim Personal Laws of the Philippines (Office of the President, 1977)

Cohabiting family, which is commonly described as a “live-in” arrangement between an unmarried couple who are called common-law spouses and their child or children from such an arrangement; and

Single parent, which results from the death of a spouse or both parents, separation, or pregnancy outside of wedlock.

Gay or lesbian family is made up of a cohabiting couple of the same sex who have a sexual relationship. The homosexual family may or may not have children. o Because the Family Code of the Philippines (Executive Order No. 209) expressly states that marriage is a special contract of permanent union between a man and a woman entered into in accordance with law for the establishment of conjugal and family life, same-sex marriage is not legally acceptable.

Family as a Client

• Community health nursing has long viewed the family as an important unit of health care, with awareness that the individual can be best understood within the social context of the family. • Observing and inquiring about family interaction enables the nurse in the community to assess the influence of family members on each other.

FAMILY OF ORIENTATION - The family one is born into (self, mother, father, and siblings if any)

FAMILY OF PROCREATION - The family one establishes (self, spouse/significant other and children)

Stages and Task of the Family Life Cycle

I. Marriage: joining of families –

a. Formation of identity as a couple –

b. Inclusion of spouse in realignment of relationships with extended families –

c. Parenthood: making decisions

II. Families with young children – a. Formation of identity as a couple – b. Inclusion of spouse in realignment of relationships with extended families – c. Parenthood: making decisions

III. Families with adolescents – a. Development of increasing autonomy for adolescents – b. Midlife reexamination of marital and career issues – c. Initial shift toward concern for the older generation

VI. Families as launching centers – a. Establishment of independent identities for parents and grown children – b. Renegotiation of marital relationship – c. Readjustment of relationships to include in-laws and grandchildren – d. Dealing with disabilities and death of older generation

V. Aging families – a. Maintenance of couple and individual functioning while adapting to the aging process – b. Support role of middle generation – c. Support and autonomy of older generation – d. Preparation for own death and dealing with the loss of spouse and/or siblings and other peers

Family Health Task (from Friedman and Heinrich, 1981)

1. Recognizing interruptions of health or development.

2. Seeking health care.

3. Managing health and non-health crises.

4. Providing nursing care to sick, disabled or dependent members of the family.

5. Maintaining a home environment conducive to good health and personal development.

6. Maintaining a reciprocal relationship with the community and its health institutions.

COMMUNITY - Refers to a group of people who live in close proximity to each other and share common interests, values and goals. vary widely in size, from small rural barangays (villages) to cities. Have a strong sense of identity and may be based on factors such as geographical location, cultural heritage or common activities.

Determinants of Health and Disease

•Income & social status - •Health services •gender

•education - •Personal behavior and coping skills

•Culture •Genetics - •Social support networks

•Employment and work conditions - •Physical environment

Community health nursing - The   utilization   of   the   nursing process  in  the  different  levels  of clientele   -   individuals,   families, population groups and communities, concerned  with  the  promotion  of health,  prevention  of  disease  and disability and rehabilitation.

Public Health Nursing - The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences -ANA/APHA, 1996

Public health nursing may be defined as a field of professional practice in nursing and in public health in which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they affect the community. -Freeman, 1963

POPULATION OR AGGREGATE FOCUSED - community   health   nurses   work   with   groups, communities or populations as a whole. helps address public health issues, promote healthy behaviors   and   improve   overall   well-being   of communities

FAMILY NURSING ASSESSMENT

-          Deliberate and systematic process

-          First major phase of nursing process

-          Data collection, analysis, interpretation

FIRST LEVEL ASSESSMENT

-          Gathering data that generates problems

-          process where data about the current health status are compared against norms within the family system

Socio-economic and Cultural Characteristics

-          income and expenses

-          educational attainment

-          ethnic background and religious affiliation

-          family traditions

-          significant others

-          relationship of fam to the community

HOME AND ENVIRONMENT

-          housing

-          kinds of neighborhood

-          social and health facilities available

-          communication and transportation

HEALTH STATUS OF EACH FAMILY MEMBERS

-          medical and nursing history

-          nutritional assessment

a.       ANTHROPOMETRIC DATA – measures of nutritional status of children- weight, height, mid-upper arm circumference

b.       OBESITY – WHR equal to or greater than 1.0 cm in men and 0.85 in women

c.       BMI – weight in kgs. divided by height in meters²)

-          Dietary history

-          Eating/feeding habits

SECOND LEVEL ASSESSMENT

-          family’s realities, perceptions about and attitudes related to the assumption or performance of family health task during the first level assessment

-          nursing problems that the family encounters in performing health tasks

DATA- GATHERING METHODS AND TOOLS

-          Used to ensure quality assessment data.

OBSERVATION – use of sensory capacities

PHYSICAL EXAMINATION – inspection, palpation, percussion, auscultation

INTERVIEW – Questions and communication techniques

RECORD REVIEW – Review of existing records and reports

LABORATORY OR DIAGNOSTIC TEST – Performing tests, diagnostic procedures

FAMILY HEALTH TASK

-          recognize the presence of wellness state

-          make decisions about taking appropriate health action

-          provide nursing care to the sick members

-          maintain a home environment conducive to health maintenance and personal development

-          utilize community resources for health care

FAMILY COPING INDEX

-           alternative for nursing diagnosis

-          provides a system of identifying areas

-          Has nine areas of assessment

a.       Physical independence –mobility and ability to perform ADL’s

b.       Therapeutic competence – ability to comply with prescribed or recommended procedures or treatments to be done

c.       Knowledge of health condition – understanding of health condition

d.       Application of principles of personal and general hygiene – practice of general health promotion

e.       Health care attitudes – family’s perception of health care in general.

f.        Emotional competence – degree of maturity of family members.

g.       Family living patterns – interpersonal relationships among family members.

h.       Physical environment – environment that may influence the health of the family members

i.         Use of community facilities – ability to seek and utilize, as needed, both government-run and private health services.

WELLNESS STATE – potential readiness; a clinical judgement about a client

WELLNESS POTENTIAL – a nursing judgement based on client’s performance

READINESS FOR ENHANCED WELLNESS STATE – based on client’s current competencies

HEALTH THREATS – conditions that are conducive to disease and accident,

HEALTH DEFICITS – instances of failure in health maintenance

FORESEEABLE CRISIS/ STRESS POINTS – anticipated periods of unusual demand

a.       Marriage

b.       Pregnancy

c.       Loss of job

d.       Abortion

e.       Adolescence

SPIRITUAL WELL-BEING – process of a client’s developing

COMMUNITY

-          group of people who live in close proximity

-          have a strong sense of identity

ATTRIBUTES OF A COMMUNITY

-          Geographical location

-          Shared interest and identity

-          Social interaction

-          Mutual support

-          Collective activities

-          Governance and rules

-          Shared resources

-          Common goals

-          Sense of belonging

-          Cultural and historical significance

TYPES OF COMMUNITIES

-          Geographic

-          Cultural or Ethnic

-          Religious

-          Virtual or Online

-          Professional or Occupational

-          Interest-based

-          Academic or educational

-          Health care

-          Residential

-          Environmental or sustainability

-           Support or Self-help

-           Neighborhood watch or safety

DETERMINANTS OF HEALTH AND DISEASE

-          Income and social status (health services, gender)

-          Education (personal behavior and coping skills)

-          Culture & Genetics (social support networks)

-          Employment and work conditions (physical environment)

COMMUNITY HEALTH NURSING

-          utilization   of   the   nursing process in the different levels of clientele  

PUBLIC HEALTH NURSING

-          field of professional practice in nursing and in public health

-          practice of promoting and protecting the health of populations

COMMUNITY HEALTH NURSING AS A FIELD OF NURSING PRACTICE

-          Focuses on providing healthcare services to individuals, families and communities within their own environments

-          emphasizes prevention, health promotion and community involvement

FUNDAMENTAL CONCEPTS AND PRINCIPLES OF CHN

-          population-focused

-          primary prevention

-          health promotion

-          cultural competence

-          collaboration

-          community assessment

-          advocacy

-          holistic care

-          empowerment

-          evidence-based practice

STANDARDS IN COMMUNITY HEALTH NURSING

-          Population Diagnosis and Priorities

-          Outcomes identification

-          Planning

-          Implementation

-          Evaluation

-          Ethics

-          Education

-          Evidence-Based Practice and Research

-          Quality practice

-          Communication

-          Leadership

-          Collaboration

-          Professional practice evaluation

-          Resource utilization

-          Environmental health

-          Advocacy

La Gota de Leche – the first center dedicated to the service of mothers and babies

Health Sector Reform Agenda – direct government efforts towards comprehensive reforms.

FOURmula One (F1) – provide an implementation framework to the reform agenda

Universal Health Care – provide the necessary revisions to the F1 framework.

Regional Health Offices – result of decentralization efforts

1577 – Friar Juan Clemente

1690 – Dominican Father Juan de Pergero

1805 – Dr. Francisco de Balmis

1876 – The first medicos titulares

1888 – UST opens cirujanos ministrantes

1901 – The Board of Health of the Philippine Islands

1905 – Asociacion de Feminista Filipina founded La Gota de Leche

1912 – The Fajardo Act

1947 – The DOH was reorganized

1954 – The congress passed R.A. 1082 or the RHU Act

1957 – R.A. 1891 was enacted

1958 – Regional health offices were created

1970 – Philippine health care delivery system was restructured

1991 – R.A.7160 or the Local Government Code

1999 – Health Sector Reform Agenda was launched

2005 – FOURmula One (F1)

2010 – Universal Health Care

 HEALTH CARE DELIVERY SYSTEM - refers to the network of institutions, services, professionals, and other resources aimed at delivering health care services to individuals and communities

 Public Sector:

§Government-funded services (e.g., national health programs, public hospitals)

§Focus on public health, disease prevention, and health promotion

Private Sector:

§Privately funded services (e.g., private clinics, hospitals, insurance-based care)

§Provides specialized and quicker access to health services

Community Health Services:

§Grassroots programs, local health centers, and community outreach

§Emphasis on preventive care, health education, and immunization

Primary Care:

§First point of contact for patients (e.g., general practitioners, family doctors)

§Focus on comprehensive, continuous, and patient-centered care

Secondary Care:

§Specialized care provided by specialists after referral from primary care providers

§Includes outpatient services and specialist consultations

Tertiary Care:

§Advanced medical care such as surgery, intensive care, and treatment of severe illnesses

§Usually provided in larger hospitals and medical centers

World Health Organization -

§Established on April 7, 1948 & is headquartered at Geneva, Switzerland

§Created in response to the need for global organization to coordinate and lead efforts to improve health and combat diseases worldwide

§Has 194 member states

§Funded through combination of assessed & voluntary contributions

Sustainable Development Goals - §A set of 17 global goals established by the United Nations in 2015 as part of the 2030 Agenda for Sustainable Development. These goals are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity by 2030.

The main goals focus on the 5 Ps

üPeople: the well-being of all people

üPlanet: protection of the earth’s ecosystems

üProsperity: continued economic & technological growth

üPeace: securing peace

üPartnership: improving international cooperation

17 SDGs

1.  No Poverty: End poverty in all its forms everywhere.

2.  Zero Hunger: End hunger, achieve food security, improve nutrition, and promote sustainable agriculture.

3.  Good Health and Well-Being: Ensure healthy lives and promote well-being for all at all ages (SDG 3).

4.  Quality Education: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

5.  Gender Equality: Achieve gender equality and empower all women and girls.

6. Clean Water and Sanitation: Ensure availability and sustainable management of water and sanitation for all.

7.Affordable and Clean Energy §Ensure access to affordable, reliable, sustainable, and modern energy for all.

8.Decent Work and Economic Growth §Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all.

9.Industry, Innovation, and Infrastructure: §Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.

10.  Reduced Inequality: Reduce inequality within and among countries.

11. Sustainable Cities and Communities: Make cities and human settlements inclusive, safe, resilient, and sustainable.

12.  Responsible Consumption and Production: Ensure sustainable consumption and production patterns.

13.  Climate Action: Take urgent action to combat climate change and its impacts.

14.  Life Below Water: Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.

15.  Life on Land: Protect, restore, and promote sustainable use of terrestrial ecosystems, manage forests sustainably, combat desertification, and halt biodiversity loss.

16.  Peace, Justice, and Strong Institutions: Promote peaceful and inclusive societies, provide access to justice for all, and build effective, accountable institutions.

17.  Partnerships for the Goals: Strengthen the means of implementation and revitalize global partnerships for sustainable development.

Focus is on SDG 3:  Good Health & Well-being

Goal: Ensure healthy lives and promote well-being for all at all ages.

Key Targets:

•  Reduce global maternal mortality rates.

•  End the epidemics of AIDS, tuberculosis, malaria, and other diseases.

•  Ensure universal access to sexual and reproductive health care.

•  Achieve universal health coverage (UHC), including access to essential health services and medicines.

•  Strengthen the capacity of all countries in early warning, risk reduction, and management of national and global health risks.

vSDG 3 is particularly relevant in the context of health care delivery systems, as it emphasizes universal health coverage and access to quality health services without financial hardship.

Philippine Department of Health - §is the principal health agency in the Philippines responsible for ensuring access to basic public health services, regulating all health services and products, and promoting public health and well-being §plays a crucial role in the country's health care delivery system by leading efforts in policy-making, service provision, and health program management

§The devolution of health services in the Philippines refers to the transfer of responsibility for health care delivery from the national government (through the Department of Health) to local government units (LGUs) under the Local Government Code of 1991 (Republic Act No. 7160). §This process is part of a broader decentralization policy designed to bring services closer to the people by empowering local authorities.

§According to scope of services

1.General – provides services for all kinds of illnesses, injuries or deformities

2.Specialty -  specializes in a particular disease or condition

1.  Barangay Health Stations (BHS):

  -  Small, community-level facilities located in barangays (villages).

Functional Capacity:

§Basic preventive services such as immunization, maternal and child care, family planning, and health education.

§Minor treatments like first aid and basic wound care.

§Screening and referral of patients to higher-level facilities for more advanced care.

Staffing: Barangay Health Workers (BHWs) and midwives.

2. Rural Health Units (RHUs):

-  Located in municipalities and managed by the local government unit (LGU).

Functional Capacity:

§Comprehensive primary care services, including immunizations, nutrition programs, disease prevention, family planning, and sanitation.

§Basic outpatient care and treatment of common illnesses like respiratory infections and diarrhea.

§Health promotion and education services.

§Management of uncomplicated childbirth, prenatal and postnatal care.

§Referral services to district or provincial hospitals for more complex cases.

Staffing: Physicians, nurses, midwives, public health officers, and other allied health professionals.

1.District Hospitals

  -  Located at the provincial or municipal level

Functional Capacity:

§Provide secondary care including emergency services, inpatient care, and basic surgical procedures.

§Specialized outpatient services such as pediatrics, obstetrics, gynecology, and internal medicine.

§Diagnostic services like X-rays, laboratory tests, and ultrasound.

§Management of more complex cases that cannot be handled at the primary care level, such as childbirth complications, pneumonia, and minor surgeries.

2.Provincial Hospitals

  -  Larger than district hospitals, usually serving as referral centers for multiple district hospitals within a province.

  -  Offer specialized inpatient and outpatient care, including surgery, pediatrics, internal medicine, and emergency services.

Regional Hospitals §Serve as the highest level of referral centers in a region, offering tertiary care with specialized departments like cardiology, oncology, neurology, orthopedics, and nephrology. §Advanced diagnostic and treatment services such as MRIs, dialysis, chemotherapy, cardiac surgeries, and organ transplants. §Comprehensive emergency care, including trauma centers and intensive care units (ICUs) for critical care.

Medical Centers and National Specialty Hospitals

Functional Capacity:

§National referral centers providing highly specialized care such as heart surgery, cancer treatment, kidney transplants, and rehabilitation.

§Specialized departments with state-of-the-art medical technology (e.g., robotic surgery, nuclear medicine).

4.  Specialized Health Facility - -  These cater to specific health care needs or patient populations.

6.  Infirmaries - §Provide short-term care for minor illnesses or injuries, typically for patients who do not need prolonged hospitalization. §Basic diagnostic services and limited inpatient care, often catering to rural areas with no full-service hospitals.

Marcos Health Agenda - §President Ferdinand Marcos Jr.'s health agenda focuses on expanding access to healthcare and improving the quality of health services across the Philippines.

Regional Specialty Centers Act -  This act aims to decentralize specialized healthcare services by establishing health centers across various regions in the country

2.Doctors to the Barangays Program

  -  A program designed to deploy more physicians to rural and underserved areas to improve local access to healthcare.

Strengthening Primary Healthcare

  -  Focus on enhancing basic healthcare services, including preventive measures and immunization programs.

Empathy and Understanding: Demonstrate genuine care and concern for individuals and communities

PRIMARY HEALTH CARE - an essential health care made universally acceptable 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.

1.PRIMARY PREVENTION 

§Aims to prevent the occurrence of a disease or health issue before it even begins.

§Examples:  vaccination programs, health education campaigns, promotion of healthy lifestyles

2.SECONDARY PREVENTION

–focuses on early detection and intervention to prevent the progression of a disease or condition

–It is often aimed at identifying and treating a condition in its early stages when it is more manageable and before it causes severe complications. –Examples:  regular screenings, diagnostic tests, early medical treatment

3.TERTIARY PREVENTION

§geared toward managing and limiting the impact of an already established disease or condition

§Its goal is to prevent further complications, disability, and reduce the overall burden of the disease

Examples:  rehabilitation programs for stroke survivors

§Republic Act 11223 - signed into law in 2019, aimed to provide all Filipinos with access to a comprehensive set of healthcare services