THE HEALTH REFERRAL SYSTEM INTER – LOCAL HEALTH ZONE

REFERRAL – is a set of activities undertaken by a An ILHZ is defined to be:

health care provider intervention or facility in
• Any form or organized arrangement for
response to its inability to provide the necessary
health intervention to satisfy patient’s need.
REFERRAL SYSTEM – is one that ensure the
continuity and complementation of health and
medical services. – is comprehensive, encompassing
promotive, preventive, curative and rehabilitative
care. – It engages all health facilities from the lowest
to the highest level.
TWO – WAY REFERRAL – it involves movement of a
• ILHZ, as a form of inter – LGU cooperation is
patient from the health center of first contact and
the hospital at first level referral. When hospital
intervention has been completed, the patient is
referred back to the health center.
TYPES OF REFERRAL
1. Internal Referral – occur within the health
facility, from one health personnel to another.
• ILHZ provides a means for consolidating health
2. External Referral – is a movement of a patient
from a health facility to another
a. Vertical referral – where the patient
referral may be from a lower to a higher
level of health facility or the other way
around
b. Horizontal referral – where the patient is
referred between similar facilities in
1.
different catchments areas
2.
3.
4.
coordinating the operations of an array and
hierarchy of health providers and facilities which
typically include
o Primary health providers
o Core referral hospital and
o End – referral hospital, jointly serving a
common population within a local
geographic area under the jurisdiction of
more than one local government.
established in order to better protect the public
or collective health of their community, assure
the constituents access to a range of services
necessary to meet health care needs of
individuals, and to manage their limited
resources for health more efficiently and
equitably.
care efforts. It does not only cover government
health services but includes all other sectors
involve in the delivery of health services like
community based NGO’s and the private sector
both local and foreign.
COMPONENTS OF INTER-LOCAL HEALTH ZONE
People – WHO has described the ideal
population size of a health district is between
100,000 – 500,000. However the number of
people may vary from zone to zone especially
when taking in to consideration the number of
LGYs that will decide to cooperate and cluster
Boundaries – clear boundaries ILHZ establish
accountability and responsibility of health
service providers
Health Facilities – RHUs, BHS and other health
facilities that decide to work together as an
integrated health system. – District or Provincial
Hospital serving as the central referral hospital,
make-up the health facilities.
Health Workers – who delivers comprehensive
services
• DOH personnel’s
• District and Provincial Hospital
• Rural Health Units
• Barangay Health units
• Private Clinics
• Volunteer Health Workers from NGOs
• Community Based Organizations
 through the Center for Health Dev. In each 17
regions.
Mission – Guarantee equitable, sustainable, and
quality health for all Filipinos
Vision – A global leader for attaining better health
outcomes, competitive and responsive health care
system, and equitable heal financing
Levels of Health Care Delivery
– Primary
– Secondary
– Tertiary

THE HEALTH CARE DELIVERY SYSTEM Classification of Hospitals

Health System – consist of all organizations, people,
and actions whose primary intent is to promote,
restore, or maintain health.
Six Building Block or Components of a Health System
a) Health Service
b) Health Workforce
c) Information
d) Medical products, vaccines and technologies
e) Financing
f) Leadership & governance or stewardship
1. Category A – Primary Care Facility
PHILIPPINES HEALTH CARE DELIVERY SYSTEM
WHO – specialized agency of the United Nations
(UN) provides global leadership on health matters
Government {
Private Sectors – for profit {provide health services
NGOs – nonprofit {
National Level: Roger’s Theory of Unitary Human Be
DOH – set direction by virtue of the mandate of
Local Government {R.A. 7160}
Local Government Units (LGUs) should have an
2. Category B: Custodial Care Facility
operating mechanism to meet the priority needs
and service requirements of their communities.
Nurse – is an essential member of the health
workforce in the country. – should have an
understanding of the dynamic relationships among
its components in order to work efficiently within
the health delivery system. – its role provide
motivation to work despite overwhelming odds.
DOH – serves as the main governing body of health
service in the country. – is the national agency
3. Category C: Diagnostic/Therapeutic Facility
mandated to lead the health sector towards
assuring health quality health care for all Filipinos.
Provides guidance & technical assistance to LGUs
A. General Hospital – provides services for all
kinds of illness, injuries or deformities.
Services offered.
– Level 1
– Level 2
– Level 3
B. Specialty Hospital – offers services for a
specific disease or condition or type of
patient such as children, elderly or women.
Classification of other Health Facilities
• First contact health care facility that offers
basic services including emergency services
and provision for normal deliveries
a) Without in-patient beds like health
centers, out-patient clinics, and dental
clinics.
b) With in-patient beds – a short stay
facility where the patient spends on the
average of one or two days before
discharge, like infirmaries and birthing
{lying in} facilities.
- A health facility that provides long term care,
including basic services like food and shelter, to
patients with chronic conditions requiring
ongoing health and nursing care due to
impairment and a reduced degree of
independence in activities of daily living, and
patient in need of rehabilitation.
Examples: Psychiatric facilities, Leprosaria,
nursing homes
- A facility for the examination of the human
body, specimens of the human body for the
diagnosis, sometimes treatment of disease, or
 water for drinking water analysis. The test
covers the pre-analytical, analytical, and post-
analytical phases of the examination.
- This category is further classified into:
a. Laboratory Facility:
- Clinical Laboratory
- HIV testing laboratory
- Newborn screening Lab
- Blood service facility
- Drug testing laboratory
- Drinking water analysis
b. Radiologic Facility providing services
such as : X-ray, CT scan, MRI,
Mammography & ultrasonography
c. Nuclear Medicine Facility: a facility
regulated by the Phil. Nuclear Research
Institute utilizing applications of
radioactive materials in the diagnosis,
treatment, or medical research, with the
exception of the use of sealed radiation
sources in radiotherapy as in internal
radiation therapy
4. Category D: Specialized Outpatient Facility
– A facility that performs highly specialized
procedures on an outpatient basis
Ex. Dialysis clinic, ambulatory surgical
clinic, cancer chemotherapeutic
center/clinic, cancer radiation facility,
physical medicine, rehabilitation
center/clinic
RURAL HEALTH UNIT
o Commonly known as a health center is a primary
level health facility in the municipality
o Its focus is preventive and promotive services
and the supervision of BHSs (Barangay Health
Station) under DOH. Ratio of RHU is to 20,000
population
o Find a combination of the two methods list
BARANGAY HEALTH STATION
• Is the first contact health care facility that offers
basic services at the barangay level; a satellite
station of RHU {DOH}; manned by volunteer
barangay. Health workers under the supervision
of Rural Health Midwife.
RURAL HEALTH UNIT PERSONNEL
1. Municipal Health Officer or Rural Health
Physician
2. Public Health Nurse
3. Rural Health Midwife
4. Rural Sanitation Inspector
ENVIRONMENTAL THEORY
Florence Nightingale
– Is the founder of Modern Nursing
– Born on May 12 1820, in Florence, Italy and was
named after her birthplace
– She is well-educated, affluent and belong to an
Aristocrastic family
– Her father educated her more broadly than
other girls.
– She was tutored in mathematics, languages,
religion and philosophy
– She developed the sense that her life should
become more useful
– She had a calling from God to his service.
– She became a nurse after completing her
nursing training in 1851 at Kaiserwerth,
Germany, a Protestant religious community with
a hospital facility
– She trained as a nurse for approximately 3
months
– In her return to England, Nightingale was
employed to examine hospital facilities,
reformatories and charitable institutions
– She became the superintendent of the Hospital
for Invalid Gentlewomen in London
– Traveled to Scutari Turkey with a group of nurses
to care for wounded British soldiers.
– She addressed the environmental problems that
existed in that place:
o Lack of sanitation
o Exposure to frostbite
o House infestations
o Wound infections
o Opportunistic diseases from battle
wounds
o Presence of filth
▪ Few chamber pots
▪ Contaminated water
▪ Contaminated bed linens
▪ Overflowing cesspools
– She was called “The Lady of the Lamp”
o Made ward round during the night
o Provide emotional comfort to the
soldiers
– She was ill with Crimean Fever {Typhus or
Brucellosis} which affected her physical
condition for years
– She was awarded with funds in recognition of
her works and used it to establish schools for
nursing training at St. Thomas Hospital and Kings
College Hospital in London.
METAPARADIGM/ MAJOR ASSUMPTIONS IN
NURSING
A. Nursing
• She believed that every woman, at one time
in life, would be a nurse
• Is having the responsibility for someone
else’s health
• In her Notes on Nursing to provide women
with guidelines for providing nursing care
and to give advice on how to “think like a
nurse”
B. Person
• She referred to the person as a patient
• Nurses performed task to and for the patient
and controlled the patient’s environment to
enhance recovery
• Ask the patient about his or her preferences
and saw the patient as individual
• In control of some personal choices and
behavior
• Has respect for persons of various
background and was not judgmental about
social worth and religious beliefs
C. Health
• Being well and using power that the person
has to the fullest extent in living life
• She envisioned the maintenance of health
through the prevention of disease via
environmental control
D. Environment
• Are those elements external to and which
affect the health of the sick and health
person and included everything from the
patient’s food and flowers to the patient’s
verbal and nonverbal interaction with the
patient
• She believed that the sick, poor people
would benefit from environmental
improvements that addressed both their
bodies and minds.
• Nightingale’s definition of environment as
“All the external conditions and influences
affecting the life and development of an
organism and capable of preventing,
suppressing or contributing to disease,
accidents and death.’
• Components of environment are:
Ventilation, Warmth, Light, Cleanliness, Diet,
Noise
o Proper Ventilation : keep the air he
breathes as pure as the external air
without chilling him
o Concept of Light: position patients to
expose them to sunlight because of
its benefits
o Cleanliness: daily bath of the patient,
frequent hand washing, provision of
clean clothing, adequate sewage,
access to pure H2O
o Warmth: maintain room
temperature, provide blankets when
patient is chilling
o Quiet Place: avoid/control
unnecessary noise
o Diet: meeting patient’s nutritional
needs
14 BASIC HUMAN NEEDS
Virginia Henderson
Nurse – is temporarily the consciousness of the
unconscious, the love for the suicidal, the leg of the
amputee, the eyes of the newly blind, a means for
locomotion of the infant, knowledge of confidence
for the mother, the mouthpiece for those too weak
or withdrawn to speak and so on.
Henderson was called the “First Lady of Nursing”
and the “First Truly International Nurse”
Her writing, presentations, research and contacts
with nurses have profoundly affected nursing and
gave an impression on the recipient of care by
nurses throughout the world.
Began her career in public health nursing in the
Henry Street Settlement and in the visiting nurse
service in Washington D.C.
She was the first full-time instructor in nursing in
Virginia when she was at Norfolk Protestant
Hospital
An early advocate for the introduction of Psychiatric
Nursing in the curriculum and served in the
committee to develop such a course at Eastern State
Hospital in Williamsburg, Virginia in 1929
Nurses through the US studied with her without
ever leaving their home schools when her revision
of Bertha Harmers’ textbook of the Principles and
Practice of Nursing became widely used.
Other important publications grew out of
Henderson’s years at Yale University including
Nursing Research; A Survey and Assessment
She also directed a twelve-year project entitled
Nursing Studies Index, four volumes recognized as
an essential reference for many years
Nature Nursing, this book expressed for belief about
the essence of nursing and influenced the hearts
and minds of those who read it
At 75 years old, she directed her career to
international teaching and speaking. Another
generation harvested the benefits of contact with
this outstanding nurse of 20th century
Numerous honors bestowed on Henderson
• Honorary degrees from 13
universities
• Selected to the American Nurse
Association Hall of Fame
Sigma Theta Tau International Library named her
honor
Historical Nurse Leadership Award was presented to
her by the Virginia Nurses in 1988
Recognized Henderson as one of the 51 Pioneer
Nurses in Virginia Nurses Association in 2000
Halloran, a nurse theorist write “Henderson was to
the 20th century as Nightingale was 19th century.
Both wrote extensive works that have influenced
the world
METAPARADIGM IN NURSING
Person – the person is an individual who requires
assistance to achieve health and independence in
some cases, a peaceful death
– Introduced the concept of mind and
body of a person as inseparable. For a
person to function to the utmost, he
must be able to maintain physiological
and emotional balance.
Health – viewed health as a quality of life and is very
basic for a person to function fully
– As a vital need, health requires
independence and interdependence
– Gave emphasis in prioritizing health
promotion
Environment – it is important for a healthy
individual to control the environment but as illness
occur, this ability is diminished and affected
– In caring for the sick, the
responsibility of the nurse to help
the patient manage his
surroundings to protect him from
harm or mechanical injury.
– Nurses must provide physicians
data about the safety needs of
the patient
Nursing – she asserted that nurse function
independently from the physician but they must
promote the treatment prescribed by the physician.
– Special role of the nurse is to help both
the sick and well individuals. Care must
include people from all walks of life from
the well to the sides’ newborn to the
dying.
– Role of the nurse as a health care
provider
– The nurse must be
knowledgeable in both biological
and social sciences
– Must have the ability to assess
basic human needs
– Her definition of nursing was
considered as the signature of
the profession
14 BASIC NEEDS
1. Breathing Normally – one needs to take care of
one’s respiratory system
2. Eating and Drinking adequately – eat a
balanced diet and drink water regularly
3. Eliminating Body Wastes – urinate and bowel
movement to eliminate toxins out of the body
4. Moving “maintaining a desired position” –
5. Sleeping and rest –
6. Selecting suitable clothes –
7. Maintaining normal body temperature by
adjusting clothes in modifying the environment
8. Keeping the body clean and well-groomed to
promote integument (skin)
9. Avoiding dangers in the environment and
avoiding injury to others
10. Communicating with others in expressing
emotions, needs, fears with opinions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of
accomplishment
13. Playing or participating in various forms of
recreation
14. Learning, discovering, or satisfying the curiosity
that leads to normal development a health, or
using available health facilities
A. 3 LEVELS OF NURSE-PATIENT RELATIONSHIP
1. The nurse as a substitute for the patient:
– Provide knowledge, will and strength in
order to make him complete, whole and
independent once again
2. The nurse as a helper to the patient:
– Nurse focuses her attention in assisting
the patient meet these needs so as to
regain independence as quickly as
possible
3. The nurse as partner with the following:
– As partners, formulates the plan of care
together
– Both an advocate or as a resource
person, the nurse can empower the
patient to make effective decisions
regarding his care plans
– As partners, their interest are the same
having the patient achieve health and
independence
B. THE NURSE-PHYSICIANS RELATIONSHIP
– Though the nurse and patient are partners, the
plan of care must be implemented in such a way
that will promote the physicians prescribed
therapeutic plan
– She insisted that nurse do not follow doctor’s
orders to patients or other health care team
members
C. NURSE AS A MEMBR OF THE HEALTH CARE
TEAM
– As a member the team, the nurse works and
contributes in carrying out the total program of
care
ACCEPTANCE BY THE NURSING COMMUNITY
1. Practice
– Henderson’s approach focuses on
decision making
A. Assessment Phase
– She gathers data by observing,
smelling, feeling and hearing
– The nurses use critical thinking and
analysis of the condition of the
patient
B. Planning Phase
– Plan of care to meet the needs and
personality
– To make the plan same with the goals
of the health care team, the notes
and responsibilities of each
professional member must be
included and integrated to the care
of plan
C. Implementation Phase
– Nurses uses the 14 basic needs in
answering the factors that are
contributing to the illness state of
the patient
– Interventions are focused on:
o Maintaining health
o To recover from illness
o To aid in peaceful death
– She performs activities that are
directed in helping the patient attain
his independence as fast possible
D. Evaluating phase
– Nurse-patient reviews the
relationship and decides whether
the goals are met or not.
– Assess if the patient attained
independence and if health is
achieved
2. Education
• Developed 3 phases of curriculum
development
A. First Phase
• Emphasis is made on helping the
patient perform ADL
• Priorities are given on the
fundamental needs of the patient
and planning of nursing care
B. Second Phase
• Importance is placed on assisting
patients achieve their needs in times
of mark body disturbance
• The approach becomes more
medical and the nurse understand
the rationale behind the prescribed
therapeutic plans made by the
doctor
C. Third Phase
• Centered on the patient and his
family together with dynamics
affecting the relationship in the side
unit
RESEARCH
• Henderson supported the use of research in
improving the practice of nursing
• The nurse responsibility is to identify
problems, continuously validates her
practice, improving the methods used, a
reassuring the effectiveness of the care
 21 NURSING PROBLEMS
THEORY OF FAYE GLENN ABDELLAH
• Born in March 13, 1919 in New York City.
• Finished her Basic Nursing Education as Magna Cum
Laude in 1942 from Fitkin Memorial Hospital School
of Nursing in Neptune, New Jersey.
• Obtained her BSN degree in 1945, Master of Arts in
1947, Doctor of Education in 1955 at Teachers
College of Columbia University.
• The first nurse and first woman to serve as DEPUTY
SURGEON GENERAL of the US.
• Inducted into the US National Women’s Hall of Fame
in 2000 due to her contribution in the field of
Education and Nursing Research.
• A Fellow and beneficiary of both National and
International Awards.
• As retiree, she has written and discussed more than
100 publications related to nursing care, education
for advanced practice in nursing or nursing research.
• In 1960, she was profoundly influenced by the desire
to promote client-centered all-inclusive nursing care,
thus making the idea of nursing as a true
humanitarian service to individuals, families and to
society.
• Nursing is grounded as an art and science that molds
the attitude, intellectual capabilities, technical know-
how of the individual nurse into the desire and
capacity to assist people, sick or well, and to deal
with their needs.
• Nursing as a complete humanitarian service, it
includes the following:
o Be acquainted with the nursing problems of
the patient.
o Choose the definite courses of action to
make in the scope of relevant nursing
principles.
o Make available continuous care of the
individual’s entire health needs.
o Give continuous care to relieve pain and
discomfort and provide immediate security
for the individual.
o Regulate the total nursing care plan to meet
the patient’s tailored needs.
o Serving the individual to become more self-
determining in achieving maintaining a
heathy state of mind and body.
o Informing nursing personnel, family and
support system to provide the individual act
for oneself within perceived limitations.
o Facilitate the individual to adapt to limits
and emotional problems.
o Team up with different allied health
professions in working with the diagram for
optimum health on local, state, national and
international levels.
o Engaging in non-stop evaluation and
research to develop nursing techniques and
to create new techniques to serve the health
needs of different people.
o Provision of continuous care of the
individual’s total health needs was
eliminated in 1973. The words continuous
and total are impossible to provide.
METAPARADIGM IN NURSING:
PERSON:
• Classifies the beneficiary of care as individuals.
• Does not set standard limits on the nature and
essence of human beings.
• The 21 nursing problems relate with biological,
psychological and social aspects of individuals.
HEALTH:
• The center and purpose of nursing services.
• Healthy state of mind and body. She speaks to a
“Total health needs.”
ENVIRONMENT:
– The idea of environment is included in “planning
for optimum health on local, state, national, and
international levels” She elaborates her idea, the
apex of nursing service is the individual.
NURSING:
– Is an all-inclusive service that is based on the
disciplines of art and science that serves
individuals, sick or well, cope with their health
needs.
ABDELLAH’S WORK UTILIZES THREE CHIEF CONCEPTS:
1. Health Needs are seen as problems, which
maybe:
a. Overt – which is obvious or can be seen
condition.
b. Covert – which is an unseen or masked
one.
- sometimes attributed with
emotions and relationship in nature and
often seen incorrectly.
- in many instances covert
problems may solve the overt problems
as well.
2. Nursing Problems is more in tune with “Nursing
goals” and “Nursing functions”. Therefore the
focus of the theory is more nursing-centered
than client-centered. She re-focused the role of
the nurse from the disease orientation to
nursing orientation, but maintaining the client
as the main concern.
– all medicines and nursing practices help the
client, but the nurse must know where she can
 excel well, and that is, on caring for the overall The 21 Nursing Problems as an extensive collection
needs of the patient. would give confidence to the simplification of principles
and a result, would:
3. PROBLEM SOLVING:
• Guide care.
o medium for nursing problems as the
• Promote the development of the nurse’s
client is geared in the direction of health,
judgmental ability.
which is the outcome.
• Increase ability to use the theory in
– This process includes:
clinical practice.
a. Identifying the problem
• Strengthen the usefulness of the nursing
b. Selecting relevant data
problems
c. Devising hypotheses
d. Testing hypotheses through the This 21 Nursing Problems is one of the forerunners of the
assortment of data Nursing Diagnosis as compiled by the North American
e. Revising hypotheses when necessary on Nursing Diagnosis Association {NANDA}
the basis of conclusion obtained from
the data.

TYPOLOGY OF TWENTY ONE NURSING PROBLEMS

1. To maintain good hygiene and physical comfort.

2. To promote optimal activity, exercise, rest, sleep.
3. To promote safely through prevention of accidents,
injury or others.
4. To maintain good body mechanics, prevent and
correct deformity.
5. To facilitate the maintenance of a supply of oxygen
to all body cells.
6. To facilitate the maintenance of nutrition of all body
cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and
electrolytes balance.
9. To recognize the physiologic responses of the body
to disease conditions – pathological, physiological,
and compensatory.
10. To facilitate the maintenance of sensory function.
11. To facilitate the maintenance of regulatory
mechanism and function.
12. To identify and accept positive and negative
expression, feelings and reactions.
13. To identify and accept interrelatedness of emotions
and organic illness.
14. To facilitate the maintenance of effective verbal and
non-verbal communication.
15. To promote the development of productive IPRs.
16. To create or maintain a therapeutic environment.
17. To facilitate progress toward achievement and
personal spiritual goals.
18. To facilitate awareness of self as an individual with
varying physical, emotional, and developmental
needs.
19. To accept the optimum possible goals in the light of
limitations, physical and emotional.
20. To used community resources as an aid in resolving
problems arising from illness.
21. To understand the role of social problems as
influencing factors in the cause of illness.