CENTRAL LUZON DOCTORS’ HOSPITAL

EDUCATIONAL INSTITUTION, INC.

Romulo Highway, San Pablo, Tarlac City
Department of Nursing

COURSE TITLE: NCM_104 – COMMUNITY HEALTH NURSING

COURSE CONTENT:

6. Evolution of Public Health Nursing in the Philippines

7. Roles and Responsibilities of a Community Health Nurse

The Health Care Delivery System

A. World Health Organization

1. Millennium Development Goals

2. Sustainable Development Goals

6. Evolution of Public Health Nursing in the Philippines

Historical Background

1. 1898

- The Department of Health was first established as the

Department of Public Works, Education and Hygiene.

- Since then various laws were enacted to organize and establish

the various structures and activities of the health agency covering
the entire country. The following milestones marked the events
when the nurses and nursing were particularly mentioned in
historical accounts:

2. 1912

- The Fajardo Act (Act No. 2156) created Sanitary Divisions.

- The President of the Sanitary Division took charge of two or

three municipalities. Where there are no physicians available,
male nurses were assigned to perform the duties of the President,
Sanitary Division.

- Philippine General Hospital (PGH), then under the Bureau of

 Health sent four nurses to Cebu to take care of mothers and their
babies.

- St. Paul’s Hospital School of Nursing in Intramuros, also

assigned two nurses to do home visiting in Manila and gave
nursing care to mothers and newborn babies from the outpatient
obstetrical service of the PGH.

3. 1914

- School nursing was rendered by a nurse employed by the

Bureau of Health in Tacloban, Leyte.

- Reorganization Act No. 2462 created the Office of General

Inspection.

- Dr. Rosario Pastor, a lady physician, headed the Office of District

Nursing.

- Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs.

Matilde Azurin were employed for Maternal and Child Health
and Sanitation in Manila under an American nurse, Mrs. G.D.
Schudder.

4. 1919
- The first Filipino Nurse Supervisor under the Bureau of Health,
Miss Carmen del Rosario wasappointed. She succeeded Miss
Mabel Dabbs.

5. 1923

- Two government Schools of Nursing were established:

Zamboanga General Hospital School of Nursing in Mindanao and
Baguio General Hospital in Northern Luzon. These schools were
primarily intended to train non-Christian women and prepare
them to render service among their people.

- Four more government School of Nursing were established:

one in Southern Luzon (Quezon Province) and three in the
Visayan Islands of Cebu, Bohol and Leyte.

6. 1927

- The Office of District Nursing under the Office of General

Inspection, Philippine Health Service was abolished and
 supplanted by the Section of Public Health Nursing. Mrs. Genara
de Guzman acted as consultant to the Director of Health on
nursing matters.

7. 1928

- First convention of nurses was held followed by yearly

conventions until the advent of World War II. Pre-service
training was initiated as a prerequisite for appointment.

8. 1930

- The Section of Public Health Nursing was converted into the

Section of Nursing. The Section of Nursing was transferred from
the Office of General Services to the Division of Administration.
This Office covered the supervision and guidance of nurses in the
provincial hospitals and the government schools of nursing.

9. 1933

- Reorganization Act No. 4007 transferred the Division of

Maternal and Child Health of the Office of Public Welfare
Commission to the Bureau of Health.

- Mrs. Soledad A. Buenafe, former Assistant Superintendent of

Nurses of the Public Welfare Commission was appointed as
Assistant Chief Nurse of the Section of Nursing, Bureau of
Health

10. 1941
- The Bureau of Health was transferred to the new department.

- Dr. Mariano Icasiano became the first City Health Officer of Manila.

- An office of Nursing was organized with Mrs. Vicenta C.

Ponce. As Chief Nurse and Mrs. Rosario A. Ordiz as Assistant
Chief Nurse.

11. Dec 8. 1941

- World War II broke out, public health nurses in Manila were

assigned to devastated areas to attend to the sick and the
wounded.

12. 1942

- A group of public health nurses, physicians and administrators

 from the Manila Health Department went to the internet camp in
Capas, Tarlac to receive sick prisoners of war released by the
Japanese Army.

- They were confined at San Lazaro Hospital and 68 Public

Health Nurses were assigned to help the hospital staff take care
of them.

13. July 1942

- 31 nurses who were taken prisoners of war by the Japanese army

and confined at the Bilibid Prison in Manila were released to the
Director of the Bureau of Health, Dr. Eusebio Aguilar who acted
as their guarantor.

- Many public health nurses joined the guerillas or went to hide

in the mountains during World War II.

14. February 1946

- Post war records of the Bureau of Health showed that there were
308 public health nurses and 38 supervisors compared to pre-war
when there were 556 public health nurses and 38 supervisors.

- Mrs. Genera M. de Guzman, Technical Assistant in Nursing of

the Department of Health and concurrent President of the Filipino
Nurses Association recommended the creation of a Nursing
Office in the Department of Health.

15. Oct. 7, 1947

- Executive Order No. 94 organized government offices and
created the Division of Nursing under the Office of the Secretary
of Health. This was implemented on December 16, 1947.

- Mrs. Genara de Guzman was appointed as Chief of the Division,

with three Assistant: Miss Annie Sand for Nursing Education;
Mrs. Magdalena C. Valenzuela for Public Health Nursing and
Mrs. Patrocinio J. Montellano for Staff Education.

- At the Bureau of Health, the Section of Nursing Supervision

took over the functions of the former Section of Nursing.

- Mrs. Soledad Buenafe was appointed Chief and Miss Marcela

Gabatin, Assistant Chief. 16. 1948

- The first training Center of the Bureau of Health was organized

 in cooperation with the Pasay City Health Department. This was
housed at the Tabon Health Center located in a marginalized part
of the city. It was later renamed as Doña Marta Health Center.

- Physicians and nurses undergoing pre-service and in-service

training in public health/public health nursing as well as nursing
students on affiliation were assigned to the above training center.

17. 1950

- The Rural Health Demonstration and Training Center (RHDTC)

was established by the Department of Health through the
initiative of Dr. Hilario Lara, Dean, institute of Hygiene, now
College of Public Health, University of the Philippines.

- The WHO/UNICEF assisted project used health centers of the

Quezon City Health Department, which were located in the rural
areas of the city.

- Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of

Public Health Graduate form Harvard was chosen to be the
Chief of the RHDTC.

- Dr. Antonio V. Acosta, former Physician of the Manila Health

Department was Medical Training Officer.

18. 1953

- The Office of Health Education and Personnel Training was

established with Dr. Trinidad Gomez as Chief
- Philippine Congress approved Republic Act No. 1082 or the
Rural Health Law. It created the first 81 Rural Health Units.

19. 1957

- Republic Act 1891 was approved amending Sections Two,

Three, Four, Seven and Eight of R.A. 1082 :Strengthening Health
and Dental Services in the Rural Areas and Providing Funds
thereto.”

20. 1958-1965

- Miss Annie Sand was appointed Nursing Consultant under the

Office of the Secretary of Health.

- The Department of Health National League of Nurses, Inc.

was founded by Miss Annie Sand in 1961. She became its first
 President and Adviser.

- The reorganization of 1959 also merged two Bureaus in the

Department of Health. The Bureau of Health was merged with
the Bureau of Hospitals to form the Bureau of Health and Medical
Services.

21. 1967

- In the Bureau of Disease Control, Mrs. Zenaida Panlilio – Nisce

was appointed as Nursing Program Supervisor and served as
consultant on the nursing aspects of the 5 special diseases: TB,
Leprosy, Venereal Disease, Cancer, Filariasis, and Mental
Health.

22. 1974

- The Project Management Staff was organized as part of

Population II of the Philippine Government with Dr. Francisco
Aguilar as Project Manager.

23. 1975

- The roles of the public health nurse and the midwife were
expanded. 2000 midwives were recruited and trained to serve in
the rural areas.

24. 1987-1989
- Executive Order No. 119 reorganized the Department of
Health and created several offices and services within the
Department of Health.

25. 1990-1992

- Department Order No. 29 designated Mrs. Neila F. Hizon, Nurse

VI, then President of the National League of Philippine
Government Nurses, as Nursing Adviser. She was detailed at the
Office Public Health Services. As Nursing Adviser, matters
affecting nurses and nursing are referred to her.

26. May 24, 1999

- Executive Order No. 102 was signed by President Joseph

Ejercito Estrada, redirecting the functions and operations of the
Department of Health.
27. 2005-2006
 - The development of the Rationalization Plan to streamline the
bureaucracy further was started and is in the last stages of
finalization.

7. Roles and Responsibilities of a Community Health Nurse

Roles and functions of the Community Health Nurse (CHN)

1. Clinicians – focus is on the health of the population or individuals on

the larger context of the community. Provides nursing care to the sick
and disabled in order to reduce disease, discomfort, disability, and
premature death, among others.

2. Advocate – speaks or acts for those who cannot speak/act for

themselves. Advocates for self care and self-determination.

3. Collaborator – brings together strength and weaknesses of people

involved toward a common goal. She works with people in the
community toward a common goal and relies on joint orshared decision
making.

4. Consultant – catalyst to bring change, helping people understand

processes and actions, and assisting them in decision-making.
5. Counselor – listens and provides feedback and information,
strengthens and guides people’s own decision making skills, and
explores feelings and attitudes for people to understand themselves and
their decisions.

6. Educator – acts as a health educator which is one of her most

important roles as CHN. The CHN provides knowledge, skills, and
attitudes needed by the community members for self efficacy in making
decisions and empowerment. Enables clients to make informed
decisions, identifies populations at risk, and explores learning strategies.

7. Researcher – utilizes data to predict future phenomena and modify

interventions. Reliable research foundation allows nurses to anticipate
potential health problems and interventions. Identifies research
problems, works with data, and conducts research.

8. Case manager – coordinates care in a system that is made up of many

different programs which have different policies, services and missions
in order to avoid gaps in services and breakdown in the care system.

Develops, implements, and reviews healthcare plans for patients that are
geriatric, recovering from serious injuries, or dealing with chronic
illnesses. Case managers work both within and outside of a hospital or
medical facility.

8. The health care delivery system

a. A health care delivery system is an organization of people,

institutions, and resources to deliver health care services to meet
the health needs of a target population.

A. World Health Organization

World Health Organization

When diplomats formed the UN in 1945, they also discussed the

creation of a global health organization. The World Health Organization
(WHO) was the outcome of these discussions. The WHO constitution
came into force on April 7, 1948. Since then, April 7 each year is
celebrated as World Health Day (WHO, 2013a). With its headquarters in
Geneva, Switzerland, WHO has 147 country offices and 6 world regional
offices for Africa, the Americas, Eastern Mediterranean, Europe,
Southeast Asia, and the Western Pacific. The Philippines is a member of
the Western Pacific region, which holds office in Manila (WHO, 2007b).

The WHO constitution states that its objective is attainment by all

peoples of the highest possible level of health (WHO, 2006). To attain
its objective, WHO carries out the following core functions (WHO,
2013b):
● Providing leadership on matters critical to health and engaging in
partnerships where joint action is needed. WHO has 193 member
countries and 2 associate members. WHO and its members work with
UN agencies, NGOs, and the private sector (WHO, 2006). The WHO
Country Focus is directed toward providing technical collaboration with
member states in accordance with each country’s needs and capacities.
(WHO, 2013g).

● Shaping the research agenda and stimulating the generation,

translation, and disseminating valuable knowledge. The WHO strategy
on research for health has five goals (WHO, 2013g):

o Capacity in reference to capacity-building to

strengthen national health research systems;

o Priorities to focus research on priority health needs

 particularly low- and middle income countries;

o Standards to promote good research practice and

enable the greater sharing of research evidence,
tools, and materials;

o Translation to ensure that quality evidence is turned into products and policy; and

o Organization to strengthen the research culture within

WHO and improve the management and coordination of
WHO research activities.

● Setting norms and standards and promoting and monitoring their

implementation. WHO develops norms and standards for various health
and health-related issues, such as pharmaceutical products including
vaccines and other biological products used in immunization, practices
in maternal and child care, and environmental conditions.

● Articulating ethical and evidence-based policy options. Through its

Department of Ethics and Social Determinants, WHO is involved in
various issues on health ethics (WHO, 2013d). In collaboration with
other governmental and non-governmental organizations, WHO is
involved in various issues on health ethics (WHO, 2013d). In
collaboration with other governmental and nongovernmental
organizations, WHO has worked on bioethical concerns such as those
related to human organ and tissue transplantation, reproductive
technology, and a public health response to threats of infectious diseases
such as AIDS, influenza, and tuberculosis (WHO, 2013f).
● Providing technical support, catalyzing change, and building
sustainable institutional capacity. WHO offers technical support and
training to its member countries in the fields of maternal and child health,
control of diseases, and environmental health services. WHO is involved
in monitoring health situations and assessing health trends. WHO has
developed guidance and tools on measurement, monitoring, and
evaluation (WHO, 2013f).

The Philippines is a member of a global system of nations interacting

with each other at different levels in different ways. Events that happen
in other countries can affect the health status of Filipinos. Ease of travel
from one part of the globe to another makes transmission of
communicable disease likewise easy. This has been proven byevents
such asthe emergence and spread of diseases like HIV/AIDS, SARS,
(Severe acute respiratory syndrome) and AH1N1 influenza (Swine flu)
to cite a few. In contrast, cooperation and sharing a few resources among
nations serve as the key in the solution of many human problems-health
and otherwise. WHO provides the environment that facilitates
cooperation and sharing of resources to promote and protect health and
to resolve health problems and alleviate their effects.

In the past decade, WHO has worked as a partner of the Philippine DOH
in the development and provision of services towards the attainment of
health-related Millennium Development Goals (MDGs).

Millennium Development Goals

The Millennium Development Goals

On September 6 to 8, 2000, world leaders in the UN General Assembly

participated in the Millennium Summit. The result of the Summit was a
resolution entitled United Nations Millennium Declaration (UN, 2013).
In this declaration, the world leaders recognized their collective
responsibility to uphold the principles of human dignity, equality and
equity at the global level. To uphold these principles is their duty to all
the people of the world, especially the most vulnerable and, in particular,
the children (UN General Assembly, 2000).

The declaration expressed the commitment of 191 member states,

including the Philippines, to reduce extreme poverty and achieve seven
other targets-now called the Millennium Development Goals (MDGs)-
by the year 2015 (UN, 2013).

The following are the eight MDGs and the targets corresponding to
health related MDGs 4, 5, and 6 (UN, 2008):

1. Eradicate extreme poverty and hunger.

- FAO focuses on poverty and hunger reduction through: improving

agricultural productivity and incomes and promoting better
nutritional practices at all levels and programmes that enhance
direct and immediate access to food by the neediest.
- FAO helps developing countries to improve agriculture, forestry and
fisheries practices, to sustainably manage their forest, fisheries
and natural resources and ensure good nutrition for all.

TARGET:

- achieve full and productive employment and decent work

for all, including women and young people.
 2. Achieve universal primary education.

- FAO also provides technical assistance to member countries for

implementing school gardens and school-feeding programmes,
which can encourage school attendance and bring direct
nutritional benefits to children.

- Food security and education need to be tackled simultaneously to

develop the capacity of rural people to feed themselves and
overcome poverty, hunger and illiteracy. Social protection
bridges the education and food security sectorial efforts towards
increased effectiveness.

TARGET:

- Ensure that, by 2015, children everywhere, boys and girls alike,

will be able to complete a full course of primary schooling

3. Promote gender equality and empower women.

- FAO recognizes the importance of encouraging women and men to

participate fully and equally in efforts to improve food security,
reduce poverty, and fuel sustainable rural development.
TARGET:

- Eliminate gender disparity in primary and secondary education,

preferably by 2005, and in all levels of education no later than
2015.

4. Reduce child mortality.

- Undernutrition is estimated to be an underlying cause in more than

one-third of all deaths in children under five.FAO programmes
assist poor households and communities to secure access to
nutritionally adequate diets and reduce child undernutrition.
Activities include: community-centred initiatives, training
materials, nutrition education programmes, training programmes
for national and local staff, and promotion of a forum on
household food security and community nutrition.
 Target:

● Reduce by two-thirds, between 1990 and 2015, the under-five mortality

rate.

5. Improve maternal health.

FAO contributes to improving maternal health through efforts to:

improve women’s access to productive resources and income; improve
women’s nutritional status; and empower women to obtain better health
care, education and social services.

Targets:

a. Reduce by three-quarters the maternal mortality ratio; and

b. Achieve universal access to reproductive health.

6. Combat HIV/AIDS, Malaria, and other diseases.

Aims to combat HIV/AIDS, malaria and other diseases. HIV, malaria and
other diseases have a direct and indirect impact on rural development,
agricultural productivity and food and nutrition security. At the same
time, food and nutrition insecurity and malnutrition can increase
vulnerability to disease. FAO supports policy makers and programme
planners to incorporate HIV, malaria and other disease considerations
into food, nutrition and agriculture policies and programmes.

FAO promotes awareness among key actors in the food and agriculture
sector on the impacts of HIV on food security and agriculture, while
advocating for multi sectoral responses to the epidemic.

Targets:

a. Have halted by 2015 and begun to reverse the spread of HIV/AIDS;

b. Achieve, by 2010, universal access to treatment for

HIV/AIDS for all those who need it, and

c. Have halted by 2015 and begun to reverse the incidence of

malaria and other major diseases.

7. Ensure environmental sustainability.

 - FAO advocates for sustainable natural resource management, which
includes agricultural water efficiency, land and soil productivity,
sustainable forest management, aquaculture and inland fisheries,
integrated crop and livestock systems, pesticide control, and
watershed management.

- 7 has four targets

Integrate the principles of sustainable development
into country policies and programmes and reverse
the loss of environmental resources

Reduce biodiversity loss, achieving, by 2010, a

significant reduction in the rate of loss

Halve, by 2015, the proportion of the population without

sustainable access to safe drinking water and basic
sanitation

Achieve, by 2020, a significant improvement in the

lives of at least 100 million slum dwellers

8. Developa global partnership for development.

- FAO supports governments, organizations, and rural communities

with guidance and technical assistance to help them improve their
skills in agricultural information management and the use of new
information and communication technology (ICT). This is
supported by capacity building initiatives such as the Information
Management Resource Kit (IMARK), the Agricultural
Information Management Standards (AIMS) community, and
World Summit on the Information Society follow-up activities
(WSIS).

- MDG8 has six targets

Develop further an open, rule-based, predictable, non-

discriminatory trading and financial system

Address the special needs of least developed countries

Address the special needs of landlocked developing

countries and small island developing States

Deal comprehensively with the debt problems of developing countries

 In cooperation with pharmaceutical companies,
provide access to affordable essential drugs in
developing countries

In cooperation with the private sector, make available

benefits of new technologies, especially information
and communications

Of the eight MGDs, five are not considered as strictly health issues.
However, these five MGDs are health-related issues because they are
goals towards upgrading socioeconomic conditions. These
socioeconomic conditions are, in themselves health

2. Sustainable Development Goals

1. NO POVERTY

- SDG Goal 1 objectives include, but are not limited to, ending
 extreme poverty (those living on less than $1.25 per day),
reducing poverty by half, implementing protection systems,
ensuring equal rights to economic resources and basic services,
reducing poverty-related vulnerability to climate change-induced
extreme weather events, mobilizing resources in developing
countries, and developing pro-poor and gender-sensitive policy
frameworks by 2030.

2. ZERO HUNGER

- SDG Goal 2 objectives include, but are not limited to, ending
hunger, ending all forms of malnutrition, doubling agricultural
productivity and small-scale food producer income, bringing
resilience to agricultural practices and establishing sustainable
food production systems, and preserving genetic food diversity.

3. GOOD HEALTH AND WELL BEING

- SDG Goal 3 objectives include, but are not limited to, reducing
maternal mortality, ending preventable newborn and child death,
ending multiple disease epidemics, reducing premature mortality,
preventing and treating substance abuse, halting traffic-related
deaths and injuries, ensuring universal health coverage and
access, and reducing pollution and contamination deaths.

4. QUALITY EDUCATION

- Ensure inclusive and equitable quality education and promote

lifelong learning opportunities for all

- Education liberates the intellect, unlocks the imagination and is

fundamental for self respect. It is the key to prosperity and opens
a world of opportunities, making it possible for each of us to
contribute to a progressive, healthy society. Learning benefits
every human being and should be available to all.

THE TARGETS

TARGET 4.1
By 2030, ensure that all girls and boys complete free, equitable and
quality primary and secondary education leading to relevant and
effective learning outcomes.

TARGET 4.2
By 2030, ensure that all girls and boys have access to quality early
childhood development, care and pre-primary education so that they are
ready for primary education.

TARGET 4.3

By 2030, ensure equal access for all women and men to affordable and
quality technical, vocational and tertiary education, including
university.

TARGET 4.4

By 2030,substantially increase the number of youth and adults who

have relevant skills, including technical and vocational skills, for
employment, decent jobs and entrepreneurship.

TARGET 4.5

By 2030, eliminate gender disparities in education and ensure equal

access to all levels of education and vocational training for the
vulnerable, including persons with disabilities, indigenous peoples and
children in vulnerable situations.

TARGET 4.6

By 2030, ensure that all youth and a substantial proportion of adults,

both men and women, achieve literacy and numeracy.

TARGET 4.7

By 2030, ensure that all learners acquire the knowledge and skills
needed to promote sustainable development, including, among others,
through education for sustainable development and
sustainable lifestyles, human rights, gender equality, promotion of a
culture of peace and non violence, global citizenship and appreciation of
cultural diversity and of culture’s contribution to sustainable
development
TARGET 4.8

Build and upgrade education facilities that are child, disability and
gender sensitive and provide safe, non-violent, inclusive and effective
learning environments for all.

TARGET 4.9

By 2020, substantially expand globally the number of scholarships

available to developing countries, in particular least developed countries,
small island developing States and African countries, for enrolment in
higher education, including vocational training and information and
communications technology, technical, engineering and scientific
programmes, in developed countries and other developing countries.

TARGET 4.A

By 2030, substantially increase the supply of qualified teachers,

including through internatio nal cooperation for teacher training in
developing countries, especially least developed countries and small
island developing States.

5. GENDER EQUALITY

Gender bias is undermining our social fabric and devalues all of us. It is
not just a human rights issue; it is a tremendous waste of the world’s
human potential. By denying women equal rights, we deny half the
population a chance to live life at its fullest. Political, economic and
social equality for women will benefit all the world’s citizens. Together
we can eradicate prejudice and work for equal rights and respect for all.

THE TARGETS
TARGET 5.1

End all forms of discrimination against all women and girls everywhere.

TARGET 5.2
Eliminate all forms of violence against all women and girls in the
public and private spheres, including trafficking and sexual and other
types of exploitation.

TARGET 5.3

Eliminate all harmful practices, such as child, early and forced marriage
and female genital mutilation.

TARGET 5.4

Recognize and value unpaid care and domestic work through the
provision of public services, infrastructure and social protection policies
and the promotion of shared responsibility within the household and the
family as nationally appropriate.

TARGET 5.5

Ensure women’s full and effective participation and equal opportunities

for leadership at all levels of decision-making in political, economic
and public life.

TARGET 5.6

Ensure universal access to sexual and reproductive health and

reproductive rights as agreed in accordance with the Programme of
Action of the International Conference on Population and Development
and the Beijing Platform for Action and the outcome documents of their
review conferences.

TARGET 5.7
Undertake reforms to give women equal rights to economic resources, as
well as access to ownership and control over land and other forms of
property, financial services, inheritance and natural resources, in
accordance with national laws.

TARGET 5.8
 Enhance the use of enabling technology, in particular information and
communications technology, to promote the empowerment of women.

TARGET 5.9

Adopt and strengthen sound policies and enforceable legislation for the
promotion of gender equality and the empowerment of all women and
girls at all levels.

6. CLEAN WATER AND SANITATION

One in three people live without sanitation. This is causing unnecessary

disease and death. Although huge strides have been made with access to
clean drinking water, lack of sanitation is undermining these advances.
If we provide affordable equipment and education in hygiene practices,
we can stop this senseless suffering and loss of life.

THE TARGETS

TARGET 6.1

By 2030, achieve universal and equitable access to safe and affordable drinking
water for all.

TARGET 6.2

By 2030, achieve access to adequate and equitable sanitation and hygiene

for all and end open defecation, paying special attention to the needs of
women and girls and those in vulnerable situations.

TARGET 6.3
By 2030, improve water quality by reducing pollution, eliminating
dumping and minimizing release of hazardous chemicals and materials,
halving the proportion of untreated wastewater and substantially
increasing recycling and safe reuse globally.

TARGET 6.4

By 2030, substantially increase water-use efficiency across all sectors

and ensure sustainable withdrawals and supply of freshwater to address
water scarcity and substantially reduce the number of people suffering
from water scarcity.

TARGET 6.5

By 2030, implement integrated water resources management at all

levels, including through transboundary cooperation as appropriate.

TARGET 6.6

By 2020, protect and restore water-related ecosystems, including

mountains, forests, wetlands, rivers, aquifers and lakes.

TARGET 6.7

By 2030, expand international cooperation and capacity-building support

to developing countries in water- and sanitation-related activities and
programmes, including water harvesting, desalination, water efficiency,
wastewater treatment, recycling and reuse technologies.

TARGET 6.8

Support and strengthen the participation of local communities in

improving water and sanitation management.

7. AFFORDABLE AND CLEAN ENERGY

● Modern forms of energy improve many areas of daily life. Better
sanitation systems, well functioning health care and education
services, and dependable transportation and telecommunications
all depend on reliable electricity.

● SDG 7 recognizes that expanding access to electricity and other

forms of energy is fundamental to improving people’s lives and
communities. It aims for efficient energy use and the promotion
of renewable sources of energy.
Targets:

● Target 7.1

By 2030, ensure universal access to affordable, reliable

and modern energy services ● Target 7.2

By 2030, increase substantially the share of renewable

energy in the global energy mix ● Target 7.3

By 2030, double the global rate of improvement in energy efficiency

● Target 7.A

By 2030, enhance international cooperation to facilitate access to

clean energy research and technology, including renewable
energy, energy efficiency and advanced and cleaner fossil-fuel
technology, and promote investment in energy infrastructure and
clean energy technology

● Target 7.B

By 2030, expand infrastructure and upgrade technology for

supplying modern and sustainable energy services for all in
developing countries, in particular least developed countries,
small island developing States, and land-locked developing
countries, in accordance with their respective programmes of
support

8. DECENT WORK AND ECONOMIC GROWTH

- Promote sustained, inclusive and sustainable economic

growth, full and productive employment and decent work
for all.
-

Targets:

Target 8.1

Sustain per capita economic growth in accordance with national

circumstances and, in particular, at least 7 per cent gross domestic
product growth per annum in the least developed countries.
Target 8.2

Achieve higher levels of economic productivity through diversification,

technological upgrading and innovation, including through a focus on
high-value added and labour-intensive sectors.

Target 8.3

Promote development-oriented policies that support productive

activities, decent job creation, entrepreneurship, creativity and
innovation, and encourage the formalization and growth of micro- ,
small- and medium-sized enterprises, including through access to
financial services.

Target 8.4

Improve progressively, through 2030, global resource efficiency in

consumption and production and endeavor to decouple economic growth
from environmental degradation, in accordance with the 10‑Year
Framework of Programmes on Sustainable Consumption and Production,
with developed countries taking the lead.

Target 8.5

By 2030, achieve full and productive employment and decent work for
all women and men, including for young people and persons with
disabilities, and equal pay for work of equal value.

Target 8.6

By 2020, substantially reduce the proportion of youth not in

employment, education or training. Target 8.7

Take immediate and effective measures to eradicate forced labour, end

modern slavery and human trafficking and secure the prohibition and
elimination of the worst forms of child labour, including recruitment and
use of child soldiers, and by 2025 end child labour in all its forms.

Target 8.8
Protect labor rights and promote safe and secure working environments
for all workers, including migrant workers, in particular women
migrants, and those in precarious employment.

Target 8.9

By 2030, devise and implement policies to promote sustainable tourism

that creates jobs and promotes local culture and products.

Target 8.A

Strengthen the capacity of domestic financial institutions to encourage

and expand access to banking, insurance and financial services for all.

Target 8.B

Increase Aid for Trade support for developing countries, in particular

least developed countries, including through the Enhanced Integrated
Framework for Trade-related Technical Assistance to Least Developed
Countries.

Target 8.C

By 2020, develop and operationalize a global strategy for youth

employment and implement the Global Jobs Pact of the International
Labor Organization.

9. INDUSTRY, INNOVATION, AND INFRASTRACTURES

- Build resilient infrastructure, promote inclusive and sustainable

industrialization and foster innovation.

TARGETS:

Target 9.1

Develop quality, reliable, sustainable and resilient infrastructure,

including regional and transborder infrastructure, to support economic
development and human well-being, with a focus on affordable and
equitable access for all.

Target 9.2
Promote inclusive and sustainable industrialization and, by 2030,
significantly raise industry’s share of employment and gross domestic
product, in line with national circumstances, and double its share in least
developed countries.

Target 9.3
Increase the access of small-scale industrial and other enterprises, in
particular in developing countries, to financial services, including
affordable credit, and their integration into value chains and markets.

Target 9.4

By 2030, upgrade infrastructure and retrofit industries to make them

sustainable, with increased resource-use efficiency and greater adoption
of clean and environmentally sound technologies and industrial
processes, with all countries taking action in accordance with their
respective capabilities.

Target 9.5

Enhance scientific research, upgrade the technological capabilities of

industrial sectors in all countries, in particular developing countries,
including, by 2030, encouraging innovation and substantially increasing
the number of research and development workers per 1 million people
and public and private research and development spending.

Target 9.6

Facilitate sustainable and resilient infrastructure development in

developing countries through enhanced financial, technological and
technical support to African countries, least developed countries,
landlocked developing countries and small island developing States.

Target 9.7
Support domestic technology development, research and innovation in
developing countries, including by ensuring a conducive policy
environment for, inter alia, industrial diversification and value addition
to commodities.

Target 9.8

Significantly increase access to information and communications

technology and strive to provide universal and affordable access to the
Internet in least developed countries by 2020.
 10. REDUCED INEQUALITIES

- Reduce inequality within and among countries

TARGETS:

Target 10.1

● By 2030, progressively achieve and sustain income growth of the

bottom 40 percent of the population at a rate higher than the
national average.

Target 10.2

● By 2030, empower and promote the social, economic and political

inclusion of all, irrespective of age, sex, disability, race, ethnicity,
origin, religion or economic or other status.

Target 10.3

● Ensure equal opportunity and reduce inequalities of outcome,

including by eliminating discriminatory laws, policies and
practices and promoting appropriate legislation, policies and
action in this regard.

Target 10.4
● Adopt policies, especially fiscal, wage and social protection
policies, and progressively achieve greater equality.

Target 10.5

● Improve the regulation and monitoring of global financial

markets and institutions and strengthen the implementation of
such regulations.

Target 10.6

● Ensure enhanced representation and voice for developing countries

 in decision-making in global international economic and financial
institutions in order to deliver more effective, credible,
accountable and legitimate institutions.

Target 10.7

● Facilitate orderly, safe, regular and responsible migration and

mobility of people, including through the implementation of
planned and well-managed migration policies.

Target 10.A

● Implement the principle of special and differential treatment for

developing countries, in particular least developed countries, in
accordance with World Trade Organization agreements.

Target 10.B

● Encourage official development assistance and financial flows,

including foreign direct investment, to States where the need is
greatest, in particular least developed countries, African
countries, Small Island developing States and landlocked
developing countries, in accordance with their national plans and
programmes.

Target 10.C
● By 2030, reduce to less than 3 per cent the transaction costs of
migrant remittances and eliminate remittance corridors with
costs higher than 5 per cent.

11. SUSTAINABLE CITIES AND COMMUNITIES

● Make cities and human settlements inclusive, safe, resilient and

sustainable.

TARGETS:
Target 11.1

● By 2030, ensure access for all to adequate, safe and affordable

housing and basic services and upgrade slums.

Target 11.2

● By 2030, provide access to safe, affordable, accessible and

sustainable transport systems for all, improving road safety,
notably by expanding public transport, with special attention to
the needs of those in vulnerable situations, women, children,
persons with disabilities and older persons.

Target 11.3

● By 2030, enhance inclusive and sustainable urbanization and

capacity for participatory, integrated and sustainable human
settlement planning and management in all countries.

Target 11.4

● Strengthen efforts to protect and safeguard the world’s

cultural and natural heritage. Target 11.5

● By 2030, significantly reduce the number of deaths and the number

of people affected and substantially decrease the direct economic
losses relative to global gross domestic product caused by
disasters, including water-related disasters, with a focus on
protecting the poor and people in vulnerable situations.

Target 11.6

● By 2030, reduce the adverse per capita environmental impact of

cities, including by paying special attention to air quality and
municipal and other waste management.
Target 11.7

● By 2030, provide universal access to safe, inclusive and

accessible, green and public spaces, in particular for women and
children, older persons and persons with disabilities.

Target 11.A

● Support positive economic, social and environmental links

between urban, peri-urban and rural areas by strengthening
national and regional development planning.

Target 11.B

● By 2020, substantially increase the number of cities and human

settlements adopting and implementing integrated policies and
plans towards inclusion, resource efficiency, mitigation and
adaptation to climate change, resilience to disasters, and develop
and implement, in line with the Sendai Framework for Disaster
Risk Reduction 2015-2030, holistic disaster risk management at
all levels.

Target 11.C

● Support least developed countries, including through financial

and technical assistance, in building sustainable and resilient
buildings utilizing local materials.
12. Responsible Consumption and Production

● Ensure sustainable consumption and production patterns

TARGETS:

Target 12.1

● Implement the 10-Year Framework of Programmes on Sustainable

Consumption and Production Patterns, all countries taking
action, with developed countries taking the lead, taking into
account the development and capabilities of developing
countries.
 Target 12.2

● By 2030, achieve the sustainable management and efficient use of natural

resources.

Target 12.3

● By 2030, halve per capita global food waste at the retail and
consumer levels and reduce food losses along production and
supply chains, including post-harvest losses.

Target 12.4

● By 2020, achieve the environmentally sound management of

chemicals and all wastes throughout their life cycle, in
accordance with agreed international frameworks, and
significantly reduce their release to air, water and soil in order to
minimize their adverse impacts on human health and the
environment.

Target 12.5

● By 2030, substantially reduce waste generation through

prevention, reduction, recycling and reuse.
Target 12.6

● Encourage companies, especially large and transnational

companies, to adopt sustainable practices and to integrate
sustainability information into their reporting cycle.

Target 12.7

● Promote public procurement practices that are sustainable, in

accordance with national policies and priorities.

Target 12.8

● By 2030, ensure that people everywhere have the relevant

information and awareness for sustainable development and
 lifestyles in harmony with nature.

Target 12.A

● Support developing countries to strengthen their scientific and

technological capacity to move towards more sustainable
patterns of consumption and production.

Target 12.B

● Develop and implement tools to monitor sustainable development

impacts for sustainable tourism that creates jobs and promotes
local culture and products.

Target 12.C

● Rationalize inefficient fossil-fuel subsidies that encourage wasteful

consumption by removing market distortions, in accordance with
national circumstances, including by restructuring taxation and
phasing out those harmful subsidies, where they exist, to reflect
their environmental impacts, taking fully into account the specific
needs and conditions of developing countries and minimizing the
possible adverse impacts on their development in a manner that
protects the poor and the affected communities.
13. Climate Action

- The increases in heatwaves, droughts and floods caused by

climate change are destroying the planet and affecting billions
of lives worldwide.

Targets

Target 13.1

Number of deaths, missing persons and directly affected persons

attributed to disasters per 100,000 population, Proportion of local
governments that adopt and implement local disaster risk reduction
strategies in line with national disaster risk reduction strategies.
Target 13.2

Number of countries with nationally determined contributions, long-term

strategies, national adaptation plans and adaptation communications, as
reported to the secretariat of the United Nations Framework Convention
on Climate Change, Total greenhouse gas emissions per year.

Target 13.3

Extent to which (i) global citizenship education and (ii) education for
sustainable development are mainstreamed in (a) national education
policies; (b) curricula; (c) teacher education; and (d) student assessment.

Target 13.a

Implement the commitment undertaken by developed-country parties to

the United Nations Framework Convention on Climate Change to a goal
of mobilizing jointly $100 billion annually by 2020 from all sources to
address the needs of developing countries in the context of meaningful
mitigation actions and transparency on implementation and fully
operationalize the Green Climate Fund through its capitalization as soon
as possible.

Target 13.b
Promote mechanisms for raising capacity for effective climate change-
related planning and management in least developed countries and small
island developing States, including focusing on women, youth and local
and marginalized communities.

14. Life Below Water

- conserve and sustainably use the oceans, seas and marine

resources for sustainable development.

Targets:

Target 14.1

By 2025, prevent and significantly reduce marine pollution of all kinds,

 in particular from land based activities, including marine debris and
nutrient pollution.

Target 14.2

By 2020, sustainably manage and protect marine and coastal ecosystems

to avoid significant adverse impacts, including by strengthening their
resilience, and take action for their restoration in order to achieve healthy
and productive oceans.

Target 14.3

Average marine acidity (pH) measured at agreed suite of representative sampling stations

Target 14.4

By 2020, effectively regulate harvesting and end overfishing, illegal,

unreported and unregulated fishing and destructive fishing practices and
implement science-based management plans, in order to restore fish
stocks in the shortest time possible, at least to levels that can produce
maximum sustainable yield as determined by their biological
characteristics
Target 14.5

By 2020, conserve at least 10 percent of coastal and marine areas,

consistent with national and international law and based on the best
available scientific information

Target 14.6

By 2020, prohibit certain forms of fisheries subsidies which contribute to

overcapacity and overfishing, eliminate subsidies that contribute to
illegal, unreported and unregulated fishing and refrain from introducing
new such subsidies, recognizing that appropriate and effective special
and differential treatment for developing and least developed countries
should be an integral part of the World Trade Organization fisheries
subsidies negotiation

Target 14.7
By 2030, increase the economic benefits to Small Island developing
States and least developed countries from the sustainable use of marine
resources, including through sustainable management of fisheries,
aquaculture and tourism

Target 14.a

Increase scientific knowledge, develop research capacity and transfer

marine technology, taking into account the Intergovernmental
Oceanographic Commission Criteria and Guidelines on the Transfer of
Marine Technology, in order to improve ocean health and to enhance the
contribution of marine biodiversity to the development of developing
countries, in particular small island developing States and least
developed countries

Target 14.b

Degree of application of a legal/regulatory/policy/institutional

framework which recognizes and protects access rights for small‐scale
fisheries

Target 14.c
Enhance the conservation and sustainable use of oceans and their
resources by implementing international law as reflected in United
Nations Convention on the Law of the Sea, which provides the legal
framework for the conservation and sustainable use of oceans and their
resources, as recalled in paragraph 158 of "The future we want"

15. Life on land

- Protect, restore and promote sustainable use of terrestrial

ecosystems, sustainably manage forests, combat desertification,
and halt and reverse land degradation and halt biodiversity loss

Targets

Target 15.1

By 2020, ensure the conservation, restoration and sustainable use of

terrestrial and inland freshwater ecosystems and their services, in
particular forests, wetlands, mountains and drylands, in line with
obligations under international agreements

Target 15.2

promote the implementation of sustainable management of all types of

forests, halt deforestation, restore degraded forests and substantially
increase afforestation and reforestation globally

Target 15.3

By 2030, combat desertification, restore degraded land and soil,

including land affected by desertification, drought and floods, and strive
to achieve a land degradation-neutral world

Target 15.4

By 2030, ensure the conservation of mountain ecosystems, including

their biodiversity, in order to enhance their capacity to provide benefits
that are essential for sustainable development
Target 15.5

Take urgent and significant action to reduce the degradation of natural

habitats, halt the loss of biodiversity and, by 2020, protect and prevent
the extinction of threatened species

Target 15.6

Promote fair and equitable sharing of the benefits arising from the
utilization of genetic resources and promote appropriate access to such
resources, as internationally agreed

Target 15.7

Take urgent action to end poaching and trafficking of protected species

of flora and fauna and address both demand and supply of illegal
wildlife products
Target 15.8

proportion of countries adopting relevant national legislation and

adequately resourcing the prevention or control of invasive alien species
by 2020, introduce measures to prevent the introduction and significantly
reduce the impact of invasive alien species on land and water ecosystems
and control or eradicate the priority species

Target 15.9

By 2020, integrate ecosystem and biodiversity values into national and

local planning, development processes, poverty reduction strategies and
accounts Number of countries that have established national targets in
accordance with or similar to Aichi Biodiversity Target 2 of the Strategic
Plan for Biodiversity 2011–2020 in their national biodiversity strategy
and action plans and the progress reported towards these targets; and (b)
integration of biodiversity into national accounting and reporting
systems, defined as implementation of the System of Environmental
Economic Accounting

Target 15.a
(a) Official development assistance on conservation and sustainable use
of biodiversity; and (b) revenue generated and finance mobilized from
biodiversity-relevant economic instruments

Target 15.b

Mobilize significant resources from all sources and at all levels to

finance sustainable forest management and provide adequate incentives
to developing countries to advance such management, including for
conservation and reforestation (a) Official development assistance on
conservation and sustainable use of biodiversity; and (b) revenue
generated and finance mobilized from biodiversity-relevant economic
instruments

Target 15.c

Enhance global support for efforts to combat poaching and trafficking of

protected species, including by increasing the capacity of local
communities to pursue sustainable livelihood opportunities
 16. Peace, Justice, and Strong Institutions

- Promote peaceful and inclusive societies for sustainable

development, provide access to justice for all and build effective,
accountable and inclusive institutions at all levels.

Targets

Target 16.1

Significantly reduce all forms of violence and

related death rates everywhere Target 16.2

End abuse, exploitation, trafficking and all forms of violence

against and torture of children Target 16.3

Promote the rule of law at the national and international levels and
ensure equal access to justice for all
Target 16.4

By 2030, significantly reduce illicit financial and arms flows,

strengthen the recovery and return of stolen assets and combat all forms
of organized crime

Target 16.5

Substantially reduce corruption and bribery in all their forms

Target 16.6

Develop effective, accountable and transparent institutions at all levels

Target 16.7

Ensure responsive, inclusive, participatory and representative

decision-making at all levels Target 16.8

Broaden and strengthen the participation of developing countries in the

institutions of global governance

Target 16.9

By 2030, provide legal identity for all, including birth registration

Target 16.10

Ensure public access to information and protect fundamental freedoms,

in accordance with national legislation and international agreements

Target 16.a

Strengthen relevant national institutions, including through international

cooperation, for building capacity at all levels, in particular in developing
countries, to prevent violence and combat terrorism and crime

Target 16.b

Promote and enforce non-discriminatory laws and policies

for sustainable development 17. Partnership for the

Goals

- Strengthen the means of implementation and revitalize the

Global Partnership for Sustainable Development

Targets

Target 17.1

Strengthen domestic resource mobilization, including through

international support to developing countries, to improve domestic
capacity for tax and other revenue collection

Target 17.2

Developed countries to implement fully their official development

assistance commitments, including the commitment by many developed
countries to achieve the target of 0.7 per cent of ODA/GNI to developing
countries and 0.15 to 0.20 per cent of ODA/GNI to least developed
countries; ODA providers are encouraged to consider setting a target to
provide at least 0.20 per cent of ODA/GNI to least developed countries

Target 17.3
Mobilize additional financial resources for developing

countries from multiple sources Target 17.4

Assist developing countries in attaining long-term debt sustainability

through coordinated policies aimed at fostering debt financing, debt
relief and debt restructuring, as appropriate, and address the external debt
of highly indebted poor countries to reduce debt distress

Target 17.5

Adopt and implement investment promotion regimes

for least developed countries Target 17.6

Enhance North-South, South-South and triangular regional and

international cooperation on and access to science, technology and
innovation and enhance knowledge sharing on mutually agreed terms,
including through improved coordination among existing mechanisms,
in particular at the United Nations level, and through a global technology
facilitation mechanism

Target 17.7
Promote the development, transfer, dissemination and diffusion of
environmentally sound technologies to developing countries on
favourable terms, including on concessional and preferential terms, as
mutually agreed

Target 17.8

Fully operationalize the technology bank and science, technology and

innovation capacity building mechanism for least developed countries by
2017 and enhance the use of enabling technology, in particular
information and communications technology

Target 17.9

Enhance international support for implementing effective and targeted

capacity-building in developing countries to support national plans to
implement all the Sustainable Development Goals, including through
North-South, South-South and triangular cooperation

Target 17.10

Promote a universal, rules-based, open, non-discriminatory and equitable

multilateral trading system under the World Trade Organization,
including through the conclusion of negotiations under its Doha
Development Agenda\

Target 17.11

Significantly increase the exports of developing countries, in particular

with a view to doubling the least developed countries’ share of global
exports by 2020

Target 17.12

Realize timely implementation of duty-free and quota-free market access

on a lasting basis for all least developed countries, consistent with World
Trade Organization decisions, including by ensuring that preferential
rules of origin applicable to imports from least developed countries are
transparent and simple, and contribute to facilitating market access

Target 17.13

Enhance global macroeconomic stability, including through policy

coordination and policy coherence

Target 17.14

Enhance policy coherence for sustainable development

Target 17.15
Respect each country’s policy space and leadership to establish and
implement policies for poverty eradication and sustainable development

Target 17.16

Enhance the Global Partnership for Sustainable Development,

complemented by multi-stakeholder partnerships that mobilize and share
knowledge, expertise, technology and financial resources, to support the
achievement of the Sustainable Development Goals in all countries, in
particular developing countries

Target 17.17

Encourage and promote effective public, public-private and civil

society partnerships, building on the experience and resourcing
strategies of partnerships

Target 17.18

By 2020, enhance capacity-building support to developing countries,

including for least developed countries and small island developing
States, to increase significantly the availability of high quality, timely
and reliable data disaggregated by income, gender, age, race, ethnicity,
migratory status, disability, geographic location and other characteristics
relevant in national contexts

Target 17.19

By 2030, build on existing initiatives to develop measurements of

progress on sustainable development that complement gross domestic
product, and support statistical capacity-building in developing countries

REFERENCES:

https://www.indeed.com/career-advice/finding-a-job/case-

manager-vs-care-manager

https://www.fao.org/sustainable-development-

goals/mdg/goal-5

https://sinay.ai/en/what-are-the-17-sustainable-development-goals-sdgs/
COURSE CONTENT:

B. Philippine Department of Health

1. Mission-Vision

2. Historical Background

3. Local Health System and Devolution of Health Services

4. Classification of Health Facilities (DOH AO-0012A)

5. Philippine Health Agenda 2010-2022

B. Philippine Department of Health

1. Mission-Vision

Vision

➢Is to be a global leader for attaining better health outcomes, competitive

and responsive health care system, and equitable health financing.

Mission

➢To guarantee equitable, sustainable and quality health for all Filipinos,

especially the poor, and to lead the quest for excellence in health.

2. Historical Background

June 23, 1898

- Creation of the Department of Public Works, Education and Hygiene (now

the Department of Public Works and Highways, Department of Education

Culture & Sports, and Department of Health) through the Proclamation of

President of Emilio Aguinaldo. September 29, 1898

- Establishment of the Board of Health for the City of Manila under General Orders
No. 15
- This order started the institutional development of the current DOH or it may
 consider as the stepping stone of DOH.

1899 – 1905

- Abolition of the Board of Health and appointment of Dr. Guy L. Edie as the

first Commissioner of Public Health.

Act No. 157 of the Philippine Commission

- Creation of the Board of Health for the Philippine Islands; it also acted as the

Board of Health for the city of Manila.

Acts Nos. 307, 308 and 309

- Establishment of the Provincial and Municipal Boards of Health, completing

the health organization in accordance with the territorial division of the

Islands.

Act No. 1407

- also, the Reorganization Act

- Abolition of the Board of Health and its functions and activities were taken

over by the Bureau of Health.

1915

- Changing of the name of the Bureau of the Health Service, which was later

on changed to its former name.

January 1, 1941

- Creation of the Department of Health and Public Welfare for in Executive

Order No. 317, series of 1941.

1947

- Reorganization of government offices under Executive EO no. 94, series of

1947 with the transfer of the Bureau of Public Welfare to the Office of the

President and the Department was renamed Department of Health (DOH).

1950

- Under E.O no. 392, s. 1950, the Department of Health gained additional

functions brought by the transfer of the Institute of Nutrition, together with

the Division of Biological Research and the Division of Food Technology

from the Institute of Science, and the Public Schools Medical and Dental

Services from the Office of the President of the Philippines and the Bureau

of Public School respectively to the DOH.

1958

- The creation of eight regional health offices and two Undersecretaries of

Health; the Undersecretary of Social Services.

1982

- Under E.O. No. 851, the Health Education and Manpower Development

Service was created, and the Bureau of Food and Drugs assumed the

functions of the Food and Drug Administration.

1986

- The Ministry of Health became Department of Health again.

1987

- Another re-organization under E.O. No. 119, which placed under the

Secretary of Health five offices headed by an undersecretary and an

assistant secretary.

1991

- Full implementation of R.A. No. 7160 or Local Government Code. The

DOH changed its role from one of the implementation to one of

governance.

What is Health System?

➢The combination of health care institutions, supporting human resources,

 financing mechanism, information system, organizational structures that

link institutions and

resources, and management structures that collectively culminate in the

delivery of health services to patients.

Fundamental Objectives of Health Systems

1. Improvement of health outcomes of the population they serve.

2. Providing financial protection against the costs of ill health

- The poor need it more

3. Responding to people’s expectations

- Public satisfaction in performance

Levels of Governance, Health Delivery Systems

1. Nation-wide Health System

2. Region-wide Health System

3. Local Health System (City, Province, Municipal, Barangay, Inter-Local

cooperation systems)

What are the Local Health System?

➢A health system at the sub-national level (Dorotan, et al)

➢The core element of local or district health system is the integrated

primary health care and the first referral hospital serving a well-defined

population (Segall, 2003). The Basic Framework of LHS

➢The basic framework of local health system is inter-LGU partnership. ➢

Inter-LGU coordination: The actions of two or more LGUs to joinly adapt

and implement in a coordinated manner a common set of policies,

programs, projects or activities in order to achieve common health goals

or purposes.
Devolution of Health Services

➢R.A. 7160 or Local Government Code was enacted to bring about

genuine and meaningful local autonomy. This will enable local

governments to attain their fullest

development as self-reliant communities and make them more effective

partners in the attainment of national goals. It mandates devolution of

basic services from the national government to LGUs. Devolution refers

to the act by which the national government confers power and

authority upon the various LGUs to perform specific functions and

responsibilities (Congress of the Republic of the Philippines, 1991).

➢R.A. 7160 provided for the creation of the Provincial Health Board and

the City/ Municipal Health Boards, or Local Health Boards. The

chairman of the board is the local executive-the Provincial Governor/

Mayor. The Provincial/City/Municipal

➢ Health Officer serves as vice chairman. Members of the board are

composed of the chairman of the committee on health of the

Sanggunian, a representative from the private sector or NGO involved

in health services, and a representative of the DOH (Congress of the

Republic of the Philippines, 1991).

Classification of Health Facilities (DOH AO-0012A)

The functions of Local Health boards are as follows:

1. Proposing to the Sanggunian annual budgetary allocations for the

operation and maintenance of health facilities and services within the

province/city/ municipality; 2. Serving as, an advisory committee to the

Sanggunian on health matters; and 3. Creating committee that shall advise

local health agencies on various matters related to heal.th service

 operations.

The Health Referral System

➢Implemented since 1992 devolution has brought decision making and

accountability on basic government services closer to the people. This

has allowed local leaders to have a greater hand in the future of

communities. However, it has brought about fragmentation of the health

care delivery system in the Philippines. It resulted in a three

level system where local and national governments are responsible for independent
services. Also, municipalities/cities began operating separately from

each other causing further segregation of public health services (DOH,

200I).

Two Referral System (DOH, 2001)

Referrals may be internal or external.

➢Internal Referrals occurs within the health facility, from one health

personnel to another ➢External Referrals is a movement of a patient from

one health facility to another. It may be vertical, where the patient referral

may be from a lower to a higher level of health facility or the other way

round.

The Inter Local Health Zone

➢As stated earlier, in the concept of health referral system, devolution

allows basic government services be close to its people resulted of

separation in health care delivery system based in municipality/ district

and its purpose is to be closer on the people within the community.

➢Inter local health zone is a concept based on the district health system, it

provided health services within the LGU or local government unit for

example here in Tarlac we have 17 municipalities and its goal is to focus

 on the health of the people within the community by making the health

services be closer to the people in the community.

Components of ILHZ

People

➢The ideal population of Health District is 100,000 to 500, 000 but this

can be also depending by the number of LGU.

Boundaries

➢This component provides responsibility and accountability of health

services provider Health facilities

➢RHU means rural health unit and BHS Baranggay Health Station are

examples of health facilities they serve as first referral hospital within

the community

Health Workers

➢This include the personnel of DOH, district or provincial hospitals,

RHU’s, BHS’s, private clinic, volunteer health workers from NGO’s

and community based organization

Universal Health Care

➢Universal Health care o Kalusugan Pangkalahatan ) gives assurance to the

the people in the state or country that they will be given access to the

quality health care, One of the example is the Garantisadong Pambata,

it is a package of giving health services or the needs of a child between

0 to 59 months old.

➢So Universal Health Care is directed toward ensuring the achievement of

the health system goals of first…. Their main goal is to evaluate a

healthy outcome, sustained health financing in the health system and

 ensuring people even at the disadvantage group or in the lower level

will support and access in the health services by making an affordable

health care.

Classification of Hospital

General Hospital

➢Provide services for all kinds of illnesses, injuries or deformities for

example the Philippine General Hospital

Specialty Hospital

➢Offers services for a specific disease or condition or type of patient such

as the children, elderly or woman for example Lying in clinic for

pregnant women and Psychiatric Hospital for individual who has

mental illness.

Other Health Facilities

Category A: Primary Care Facility

➢This facility offers normal deliveries and basic services within

the community TWO TYPES:

With in Patient Bed: patients who only stay in the facility for about one to two

days before discharge

Without in Patient Beds: patient who only undergo for checkup or follow up

care for example dental clinics and health center.

Category B: Custodial Care Facility

➢It is a facility that provides long term care for patient with chronic

condition. For example, an elderly who has a chronic condition that

need assistance with his/her adl or activities of daily living, this facility

help to reduce the dependency of a certain individual.

Category C: Diagnostic/ Therapeutic Facility

➢This facility if for examination of human body, specimens from human

body for diagnosis or to treat certain illness, the category is classified

into LABORATORY FACILITY for technological research

experiment, RADIOLOGIC FACILITY for Xray CT scan and MRI and

NUCLEAR MEDICINE FACILITY that uses radioactive material

inside the body to see how organs or tissue are functioning.

Category D: Specialized outpatient facility

➢a facility that performs highly specialized procedures on an outpatient basis.

➢It is a place that specializes in providing outpatient treatments in a variety

of medical specialties, including pain or wound management, urology,

optometry, urology, neurology, and cardiology. Chemotherapy and

radiation therapy are fundamentally also regarded as specialist

outpatient care facilities in a significant way for diseases like cancer.

Philippines Health Agenda 2010-2022

According to The Philippine Health Agenda 2016-2022

Not 2010-2022 Motto: All for Health towards Health

for All

➢Contrary to what is commonly believed, universal health care typically

serves as the foundation for health and development in the Philippines

under the slogan All for Health toward Health for All.

Goals: Attain Health-Related SDG Targets

➢Financial Risk Protection

➢Filipinos, especially the poor, marginalized, and vulnerable are protected

from high cost of health care

➢Better Health Outcomes

➢Filipinos attain the best possible health outcomes with no disparity

 ➢Responsiveness

➢Filipinos feel respected, valued, and empowered in all of their

interaction with the health system

Values:

EQUITABLE & INCLUSIVE TO ALL

➢Despite common assumption, all communities benefit when programs and

services are designed and routinely provided that positively improve

the health of people of color, those with very poor English proficiency,

LGBTQ populations, and those with disabilities.

TRANSPARENT & ACCOUNTABLE

➢Transparency guarantees that information is available that can be used to

assess the functioning of the government and prevent any potential

abuse of power, which is unquestionably very important. In this sense,

accountability is really achieved through

openness, which is kind of important since it normally implies that

authorities can be held accountable for their actions.

USES RESOURCES EFFICIENTLY

➢Efficiency in health economics refers to either reaching a given health

benefit while significantly minimizing expenditures or resource use, or

to achieving a given health benefit via treatments in the most effective

manner possible.

PROVIDES HIGH QUALITY SERVICES

➢We truly describe high-quality health care as being administered by

experts who are unquestionably courteous, especially communicate

effectively, and primarily include patients in decision-making. It also

 includes being prompt, efficient, equitable, and patient-centered.

3 Guarantees

Guarantee #1: ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE

(Services for both the well & the sick)

➢All Life Stages and the Triple Burden of Disease Guarantee, or so they

believed, specifically included projects for pretty national vaccination,

control of communicable diseases, non-communicable diseases,

starting to emerge and re-emerging diseases, rabies, Mdr, drug abuse

and rehabilitation, and occupational and environmental health.

• First 1000 days

• Reproductive and sexual health

• maternal, newborn, and child health

• exclusive breastfeeding

• food & micronutrient supplementation

• Immunization

• Adolescent health
• Geriatric Health

• Health screening, promotion & information

TRIPLE BURDEN OF DISEASE

COMMUNICABLE DISEASES

➢Communicable diseases, also known as viral infections or transmissible

diseases, are illnesses that develop when pathogenic (able to cause

disease) biologic agents get infected, present, or flourish in a human or

other animal host, which is often rather important.

• HIV/AIDS, TB, Malaria

 • Diseases for Elimination

• Dengue, Lepto, Ebola, Zika

NONCOMMUNICABLE DISEASES & MALNUTRITION

➢A disease that has a protracted course, does not resolve spontaneously,

and for which a for all intents and purposes complete cure generally is

rarely achieved in a subtle way. Chronic conditions that for all intents

and purposes do not result from a (acute) infectious process and are,

therefore, for all intents and purposes, "not communicable." WHILE

MALNUTRITION CERTAINLY IS A CONDITION CAUSED BY

NOT GETTING ENOUGH CALORIES OR THE APPROPRIATE

AMOUNT OF FOR ALL SPEAKS KEY NUTRIENTS, RATHER

LIKE VITAMINS AND MINERALS, THAT CERTAINLY ARE

NEEDED FOR HEAL When the body is unable to effectively absorb

nutrients from meals or when there is a fundamental deficiency of

nutrients in the diet, malnutrition may really emerge.

• Cancer, Diabetes, Heart Disease and their Risk Factors – obesity,

smoking, diet, sedentary lifestyle

• Malnutrition

DISEASES OF RAPID URBANIZATION & INDUSTRIALIZATION ➢

For the most part, some of the relatively significant health issues caused

by urbanization are usually poor nutrition, pollution-associated health

conditions and communicable illnesses, especially poor sanitation and

housing conditions, and significant linked health disorders.

• Injuries

• Substance abuse
 • Mental Illness

• Pandemics, Travel Medicine

• Health consequences of climate change / disaster

Guarantee #2: SERVICE DELIVERY NETWORK (Functional

Network of Health Facilities)

Services are delivered by networks that are:

Fully functional (complete equipment, medicines, health professional) ➢

The service is essentially functioning well or according to plan in every

respect. Functional health status, in example, is frequently described as the

capacity of an individual to fundamentally fulfill their customary duties,

satisfy their basic requirements, and maintain their health and well-being on a

day-to-day basis. Compliant with clinical practice guidelines

➢Contrary to what is commonly believed, clinical practice guidelines are

actually statements that mostly include recommendations meant to

improve patient care and are actually informed by a systematic review

of the evidence and an assessment of the benefits and unquestionably

harms of alternative care options.

Available 24/7 even during disasters

➢Every piece of equipment and material needs to be prepared to be used

and consumed in an extremely large manner. Local emergency services

must respond to disasters as extra resources are actually available at the

national or state levels.

Practicing gatekeeping

➢Gatekeeping, specifically in the healthcare industry, is a response to a

specialist scarcity and the need to significantly reduce healthcare

spending. In gatekeeping systems, patients must expressly contact a GP

 or primary care doctor to authorize access to specialist vehicles, which

is very important.

Located close to the people (mobile clinic or subsidize transportation

cost) ➢When we generally talk about subsidized transportation costs, what we

really mean is a form of transportation service that isn't entirely market-based

and gets financial backing from the public sector, which is very crucial.

While a mobile clinic is unquestionably a modified automobile that travels to

areas to specifically deliver healthcare in a significant way. They really

provide a broad range of healthcare services and may be staffed by a

combination of doctors, nurses, community health workers, and actually other

healthcare professionals, which is extremely important. Enhanced by

telemedicine

➢Contrary to common assumption, advances in technology have essentially

made telemedicine simpler, especially for individuals who don't really

consider themselves computer smart. Patients can request a virtual visit

with many Johns Hopkins doctors, practitioners, and therapists via

telemedicine through an online platform or smartphone app. The

majority of the time, telehealth, also known as telemedicine, delivers

several benefits in a sizable manner.

Guarantee #3: UNIVERSAL HEALTH INSURANCE

(Financial Freedom when Accessing Services)

PHILHEALTH AS THE GATEWAY TO FREE

AFFORDABLE CARE • 100% of Filipinos are

members

• Formal sector premium paid through payroll

• Non-formal sector premium paid through tax subsidy

SIMPLIFY PHILHEALTH RULES

• No balance billing for the poor/basic accommodation & Fixed co-

payment for non-basic accommodation

PHILHEALTH AS MAIN REVENUE SOURCE FOR PUBLIC

HEALTH CARE PROVIDERS

• Expand benefits to cover comprehensive range of services

• Contracting networks of providers within SDNs

Philippine Health Agenda 2016-2022

Which consist of 3 goals:

1. Ensure the best health outcomes for all, without socio-economic, ethnic,

gender and geographic disparities or usually called differences.

2. Promote health and deliver healthcare through means that respect, value

and empower clients and patients as they interact with the health

system.

3. Protect all families, especially the poor, marginalized, and vulnerable

against the high cost of healthcare.

In order to attain health-related sustainable development goals, the

A.C.H.I.E.V.E. strategy is followed:

A- Advance, health promotion and primary care

C- Cover all Filipinos against health-related financial risk

H- Harness the power of strategic HRH development

I- Invest in eHealth and data for decision-making

E- Enforce standards, accountability and transparency

V- Value all clients and patients, especially the poor,

marginalized, and vulnerable E- Elicit multi-sectoral and multi-

stakeholder support for health

A- Advance quality, health promotion and primary care

1. Conduct annual health visits for all poor families and special

populations (NHTS, IP, PWD, Senior Citizens).

2. Develop an explicit list of primary care entitlements that will become

the basis for licensing and contracting arrangements.

3. Transform select DOH hospitals into mega-hospitals with capabilities

for multi specialty training and teaching and reference laboratory.

4. Support LGUs in advancing pro-health resolutions or ordinances (e.g.

city-wide smoke free or speed limit ordinances).

5. Establish expert bodies for health promotion and surveillance and response.

C- Cover all Filipinos against health-related financial risk

1. Raise more revenues for health, e.g. impose health promoting taxes,

increase NHIP premium rates, improve premium collection efficiency.

2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with

PhilHealth. 3. Expand PhilHealth benefits to cover outpatient diagnostics,

medicines, blood and blood products aided by health technology

assessment.

4. Update costing of current PhilHealth case rates to ensure that it covers

full cost of care and link payment to service quality.

5. Enhance and enforce PhilHealth contracting policies for better viability

and sustainability.

H- Harness the power of strategic HRH development

1. Revise health professions curriculum to be more primary care-oriented

and responsive to local and global needs.

 2. Streamline HRH compensation package to incentivize service in high-

risk or GIDA areas.

3. Update frontline staffing complement standards from profession-based

to competency based.

4. Make available fully-funded scholarships for HRH hailing from GIDA

areas or IP groups.

5. Formulate mechanisms for mandatory return of service schemes for all heath
graduates.

I- Invest in eHealth and data for decision-making

1. Mandate the use of electronic medical records in all health facilities. 2.

Make online submission of clinical, drug dispensing, administrative and

financial records a prerequisite for registration, licensing and contracting.

3. Commission nationwide surveys, streamline information systems, and

support efforts to improve local civil registration and vital statistics.

4. Automate major business processes and invest in warehousing and

business intelligence tools.

5. Facilitate ease of access of researchers to available data.

E- Enforce standards, accountability and transparency

1. Publish health information that can trigger better performance and

accountability. 2. Set up dedicated performance monitoring unit to track

performance or progress of reforms.

V- Value all clients and patients, especially the poor, marginalized, and

vulnerable 1. Prioritize the poorest 20 million Filipinos in all health

programs and support them in non-direct health expenditures.

 2. Make all health entitlements simple, explicit and widely published to

facilitate understanding, & generate demand.

3. Set up participation and redress mechanisms.

4. Reduce turnaround time and improve transparency of processes at all

DOH health facilities.

5. Eliminate queuing, guarantee decent accommodation and clean

restrooms in all government hospitals.

E- Elicit multi-sectoral and multi-stakeholder support for health

1. Harness and align the private sector in planning supply side

investments. 2. Work with other national government agencies to address

social determinants of health. 3. Make health impact assessment and

public health management plan a prerequisite for initiating large-scale,

high-risk infrastructure projects.

4. Collaborate with CSOs and other stakeholders on budget development,

monitoring and evaluation.

With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a

health system with the values of Equity, Quality, Efficiency, Transparency,

Accountability, Sustainability, Resilience towards “Lahat Para sa Kalusugan!

Tungo sa Kalusugan Para sa Lahat”. ➢Wherein each person can equally

achieve appropriate and enough health care services.

COURSE CONTENT:

A. Primary Health Care (PHC)

1. Brief History
 2. Legal Basis

3. Definition

4. Goals

5. Elements

6. Principles and Strategies

A. Primary Health Care (PHC)

- Is the essential health care made universally accessible to individuals and

acceptable to them, through their full participation at a cost the country and

community can afford.

1. HISTORY

September 6-12, 1978 (Alma Ata,USSR)

- Declaration Declaration of Alma-Ata was adopted at the International

Conference on Primary Health Care

- Has an underlying theme (slogan) named “Health for all by the year 2000.”

October 19 1979

- PHC was adopted in the Philippines

- “Health in the Hands of the People by 2020" goal of the organization

FEBRUARY 23-24 2006

- The most recent PHC Summit

3. DEFINITION

What is Primary Health Care?

The first level of contact with people taking action to improve health in a community.
Since 1978, the concept of PHC has been repeatedly reinterpreted and redefined, causing

confusion about the term and its application. A clear and simple description has already

been

developed to aid in the coordination and implementation of future primary health care

efforts at global, local, and national levels.

"PHC is a whole-of-society approach to health that aims at ensuring the highest possible

level of health and well-being and their equitable distribution by focusing on people’s

needs and as early as possible along the continuum from health promotion and disease

prevention to treatment, rehabilitation and palliative care, and as close as feasible to

people’s everyday environment." - WHO and UNICEF

PHC consists of three interconnected and synergistic components, including:

comprehensive integrated health services that include primary care and also public health

goods as well as functions as central pieces; multi-sectoral actions and policies to

acknowledge the upstream and wider health determinants; as well as getting involved or

empowering individuals, families, and communities for increased social participation as

well as improved self-care and self-reliance in health.

Primary Health Care founded on the principles of social justice, equity, solidarity, and

participation. It is founded on the recognition that perhaps the enjoyment of the highest

attainable standard of health represents one of the fundamental rights of all human beings.

And, it is essential health care readily accessible at a reasonable cost to the country using

practical, scientifically sound, and socially acceptable methods. Everyone within the

community might as well have access to that and participate in it. In addition to the health

sector, other sectors should also be involved. At the very least, it should include community

education on prevalent health problems and methods to prevent or control them; promotion
of adequate food supplies and proper nutrition; adequate safe water as well as basic

sanitation; maternal and child

health care, including family planning; prevention and control of local endemic diseases;

immunization against the major infectious diseases; and appropriate treatment of

communicable diseases, including the provision of drugs.

It is the primary function and focus of the country's health system. It is an essential

component of a country's social and economic development. The primary distinction

between the WHO concept of PHC and the concept of basic health services would be that

PHC is a process concerned with equity, intersectoral action, and community participation

and involvement in order to achieve health gain. It is more than just the professional

provision of medical care at the local level. Individuals and families who participate

assume responsibility for their own as well as the community's health and welfare, and

develop the ability to contribute to their own and the community's development. This type

of investment is more efficient, effective, acceptable, and long-term. Investing in this

process is much more efficient, effective, acceptable, and long-term than other methods of

promoting community health. The concept has always been consistent with the core values

increasingly recognized as essential to development: survival, self-esteem, and the ability

to choose.

4. Goals

Health begins at home, in schools, and in the workplace because it is where people live

and work that health is made or broken. It also means that people will use better approaches

than they do now for preventing diseases and alleviating unavoidable disease and disability

and have better ways of growing up, growing old, and dying gracefully. The global goal

as stated in the Alma Ata Declaration is Health for All by the year 2000 through self-

reliance.
1. Goal: “Health for all by the Year 2020” (WHO 1978) and “Health in the hands of the

People by the Year 2020”

2. Mission: To strengthen the health care system by increasing opportunities and

supporting the conditions wherein people will manage their own health care.

3. Central theme: Partnership and empowerment towards self-reliance 4. Core strategy:

Full participation and active involvement of the community towards the development and

self-reliance.

5. Organizational strategy: provides the framework for meeting the goal of PHC which is

“Health for All” which calls for active and continuing partnership among the communities,

private and government agencies which are involved in health care.

Three (3) major aspects of primary health care elements

1. Promotive aspect includes education concerning health problems and the

methods of preventing them; promotion of food supply and proper nutrition; and

adequate supply of safe water and basic sanitation.

2. Preventive aspects include maternal and child health care, including family

planning, immunizations against major infectious diseases; and prevention and

control of locally endemic diseases

3. Curative aspect includes appropriate treatment of common diseases and

injuries and the provision of essential drugs.

Legal basis of Primary health care

Universal declaration of Human Rights, Art. 25, Section 1 which states that:

“Everyone has the right to a standard of living adequate for the health and well-being of
himself and of his family, including food, clothing, housing, and medical care and

necessary social services and the right to security in the event of unemployment, sickness,

disability, old age, widowhood, or lack of livelihood.

Philippine Constitution of 1987, Art. XIII, Sec. 11, states that: “The State shall

adopt an integrated and comprehensive health development which shall endeavor to make

essential goods, health, and other social services available to all the people at affordable

cost. There shall be priority for the needs of the underprivileged sick, elderly, disabled

women, and children. The State shall endeavor to provide free medical services to

paupers''.

WHO (1995) believes that “governments have a responsibility for the health of

their people which can be fulfilled only by the provision of adequate health and social

measures.

Essential requisites to Primary Health Care

Primary health care is a level of service delivery characterized by accessibility,

generalist orientation, continuity of care, and recognition of the family and social

contexts of health and illness. Primary health care is also a strategy for re-orienting the

healthcare system according to four dimensions:

1. Focus – from illness and cure to health, prevention and care

2. Content – from treatment and episodic care of specific problems to health

promotion and continuous and comprehensive care

3. Organization – from specialists, physicians, and single-handed practice to

generalist practitioners, other healthcare professionals, and teams

4. Responsibility – from health sector alone, professional-dominated with passive

reception to intersectoral collaboration with active community participation and self-

responsibility

5. ELEMENTS

1. EDUCATION FOR HEALTH- One of the effective methods for spreading

information is through health education. It encourages family members and
medical professionals to work together to promote health and prevent illness.
2. LOCALLY ENDEMIC DISEASE CONTROL- In order to lower the rate of
morbidity, endemic disease is controlled primarily through prevention of its
occurrence. Examples include preventing malaria and schistosomiasis
3. EXPANDED PROGRAM ON IMMUNIZATION- This program was created to
reduce the occurrence of diseases that could be prevented, especially in children
under the age of six. The government offers free vaccinations against diseases like
poliomyelitis, measles, tetanus, diphtheria, and others that can be prevented through
ongoing DOH programs.
4. MATERNALAND CHILD HEALTH AND FAMILY PLANNING- the
community are the mother and child. Therefore, defending the mother and
child from disease and other risks would guarantee the community's overall
health. Family planning aims to promote responsible parenting and child
spacing.
5. ENVIRONMENTAL SANITATION AND PROMOTION OF SAFE
WATER SUPPLY- Environmental Sanitation is defined as the study of all
factors in the man’s environment, which exercise or may have deleterious
effect on his well-being and survival. Water is a basic need for life and one
factor in man’s environment. Water is necessary for the maintenance of a
healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion
of health.
6. NUTRITION AND PROMOTION OF ADEQUATE FOOD SUPPLY-
Food is a fundamental need for the family. Additionally, one can guarantee a
healthy family if the food is prepared properly. Although there are plenty of
food resources in the communities, malnutrition is one of the issues that our
nation faces due to improper preparation and a lack of knowledge about proper
food planning.
 7. TREATMENT OF COMMUNICABLE DISEASES AND COMMON
ILLNESS The risk of infection from diseases that spread through direct contact
is very high. One of the infectious diseases, tuberculosis, consistently ranks
among the top ten causes of death. The majority of communicable diseases can
be avoided. The government concentrates on these diseases' treatment, control,
and prevention.
8. SUPPLY OF ESSENTIAL DRUGS- This focuses on the informational
campaign regarding drug use and purchase

FOUR CORNERSTONES/ PILLARS OF THE PRIMARY HEALTH CARE 1.

Active community participation- To draw attention to the community's needs for health
care is a social strategy.
2.Support Mechanism Made Available- When completing various tasks to obtain health
services, inter-sectoral coordination is essential. It's critical to involve specialized
organizations, the private sector, and the public sector if we want to improve healthcare
facilities. 3. Use of Appropriate Technology-Using less expensive, reliable from a
scientific standpoint, and acceptable tools and methods is referred to as appropriate
technology. 4. Inter Sectoral Coordination-Healthy living and a high quality of life
depend on support mechanisms. A well-known method used in primary healthcare to
improve quality of life is the support mechanism.

6. PRINCIPLES AND STRATEGIES

1. Universal coverage of the population, with care provided according to need: no

one should be left out, no matter how poor or how remote. It means all in health for
all. 2. Services should be promotive, preventive, curative and rehabilitative: services
should not be only curative, but also should be promotive to the populations
understanding of health and healthy style of life, and reach toward the root causes of
diseases with preventive emphasis. Treatment of illness and rehabilitation are
 important as well. 3. Services should be effective, culturally accepted, affordable
and manageable: services must be effective, cultural acceptability and effectiveness
are mutually dependent. Services must be affordable in local tems as governmental
resources are limited.
4. Community should be involved to promote self-reliance: The community should
be actively involved in the process of defining health problems and needs,
developing and implementing and evaluating programs.
5. Approaches to health should be related to other sectors of development: actions
should be taken to deal with the cause of ill health. Education for literacy, clean
water and sanitation, improved housing, ecological sustainability, building of roads
or waterways, income supplement, enhancing roles for women, more effective
marketing of products. All these have a substantial impact on health.

CHARACTERISTICS OF PHC ESSENTIAL SERVICES

1. Community-based – these health services should be delivered where the people are. 2.
Accessibility – can be reached by the majority of the population and those in the far-
flung areas should not be deprived of these health services by regular periodic visits by
the health personnel and training of indigenous resident volunteers of the area.
3. Acceptable – the people agree and are satisfied with the health care services which meet
the requirements and needs of the area. Families from the lower income group are the ones
mostly served.
4. Sustainable – for these health services to be fully utilized, maintained and continued
needs the active participation and involvement of the community members. The
residents, once they fully
develop awareness building and knowledge of health and health-related issues, will
consequently develop self-confidence and self-efficacy which are the driving forces for
empowerment and self-reliance.
5. Affordable – traditional herbal medicines and other alternative forms of healing must
be used together with the essential drugs which are generic and more affordable.

OBSTACLES OF PRIMARY HEALTH CARE:

● In the role complexity simply it means that we nurses have a lot of functions in
giving nursing care to our patient, we must be flexible at all times but with that we
are exerting or giving high-quality care to our patients. Even though we are doing
everything.

● Special responsibilities
- As nurses, we have a special obligation to educate our patients about various
medical conditions and give them clear instructions on how to manage their
symptoms in addition to promoting health. This might involve telling the patient
what prescriptions to take and when to make a follow-up appointment. We are
not constrained and, as I previously stated, we have a lot of responsibilities.

● Role confusion
- Team leadership is encouraged in nursing and other medical workplaces in
order to collaborate with others and make decisions quickly when problems
do arise while performing nursing interventions, especially when we are
working with other medical allieds.

Lack of skills training

- We should know how to approach others in that way we can have a rapport with
them in order for us to work properly in our workplace without the tension which
can affects our performance
2 levels of Primary Health Care workers

1. Barangay Health Workers- certified community health workers,

volunteers in the medical field, or traditional home birth and healers.
2. Intermediate level health workers- include midwives, the public health nurse,
and the rural sanitary inspector.
REFERENCE

Primary Health Care: Definition, Goals, Principles and Strategies - Public Health
 Capable of performing minor surgeries and
MIDTERMS
perform some simple laboratory examinations.
LESSON 1: GROUP 4
LEVELS OF PREVENTION
Tertiary Prevention:
The World Health Organization recommends
Tertiary prevention focuses on the disease's
that a primary care strategy should include the
clinical and outcome stages. It is used on
following three elements since they are
symptomatic patients with the intention of
considered necessary primary care and are a
lessening the severity of the illness as well as
vital part of an inclusive primary health care
any potential aftereffects. Tertiary prevention
strategy:
aims to lessen the effects of the disease once it
• Meeting people’s health needs throughout
has been established in a person, whereas
their lives;
secondary prevention aims to prevent the onset
• Addressing the broader determinants of health
of illness.
through multi-sectoral policy and action
Complicated cases and intensive care requires
• Empowering individuals, families and
tertiary care and all these can be provided.
communities to take charge of their own health.
Primary Prevention:
A susceptible population or person is the target
of primary prevention strategies. Primary
prevention aims to stop a disease before it even
starts. Thus, its intended audience consists of
healthy people. To stop a disease from
progressing in a susceptible individual to
subclinical disease, it is frequently
implemented activities that limit risk exposure
or boost the immunity of individuals at risk.
The first contact between the community A. Universal Health Care (UHC)
members and the other levels of health facility. 1. Legal Basis
2. What is UHC?
Secondary Prevention:
Secondary prevention targets healthy- a. UHC means that all individuals and
appearing people with subclinical disease states communities receive the health services they
and emphasizes early disease detection. need without suffering financial hardship. It
Pathologic changes make up the subclinical includes the full spectrum of essential, quality
disease, but there are no overt symptoms that health services, from health promotion to
can be identified during a doctor visit. prevention, treatment, rehabilitation, and
Screenings are a common form of secondary palliative care.
prevention.

1
b. UHC enables everyone to access the
services that address the most significant causes
of disease and death, and ensures that the
quality of those services is good enough to
improve the health of the people who receive
them.
c. Protecting people from the financial
consequences of paying for health services out
of their own pockets reduces the risk that
people will be pushed into poverty because
unexpected illness requires them to use up their
life savings, sell assets, or borrow – destroying
their futures and often those of their children.
LEGAL BASIS
The Universal Health Care Bill was
enacted into law by President Rodrigo Duterte
in February 2019, bringing about significant
modifications in the Philippine healthcare
system. The UHC Law's standout
characteristics include the growth
population, service, and financial coverage
through a variety of health system reforms.
Primary care, the foundation and focal point of
all health changes under the UHC, will also
undergo a planned paradigm shift
conjunction with this.
By implementing UHC, all Filipinos
are given equal access to high-quality,
reasonably priced health care products and
services as well as protection from financial
risk. The UHC works to guarantee that every
Filipino is in good health, is protected from
health risks and dangers, and has access to
health services that are inexpensive, of high
quality, and readily available.
Duterte has just signed a Universal Health Care
(UHC) Bill into law (Republic Act No. 11223)
that automatically enrolls all Filipino citizens in
the National Health Insurance Program and
prescribes complementary reforms in the health
system
Six Legal Basis
1. Consent
Specific, granular, explicit, conspicuous,
opt-in, documented, and easily revocable
consent is required. When data processing is
carried out with a person's consent, their rights
are strengthened.
The processing of personal data for one or
more defined purposes is permitted since the
data subject expressed consent.
Consent must be specific, granular, clear,
prominent, opt-in, documented and easily
withdrawn. Individuals have stronger rights
when data processing is based on consent.
of
2. Necessary for the Purpose of a Contract
It happens when using a person's
personal information is required to carry out a
contract with them or to establish such a
in contract.
Processing is required in order to carry
out the terms of the contract for which the data
subject is the client.
Where the use of personal data is necessary
for the performance of a contract with the
individual or is required in order to put such a
contract in place. (e.g. when you sign up for
contracts you are usually required to provide
some personal information.)
3. Compliance with the Law
2
• When obtaining a person's personal as part of the exercise of official authority
information is necessary to abide by the law. vested in the data controller (e.g. public
Processing is required in order for the controller authority)
to comply with a legal requirement. Where a
person's personal data is required in order to 6. Legitimate Interest
comply with law. (e.g . where employers are This ground is available to people and
required to provide certain personal data of organizations, including businesses, that
their employees to Revenue, or banks might process people's personal data in ways that
need) those people would reasonably expect and that
have little or no impact on their privacy, or
4. Vital Interest when there is an overriding cause for the
• Where a person's personal information processing of the data. This basis is available
is necessary to protect either that person's or to individuals and bodies, including
another person's vital interests, and that person commercial bodies, who are
is unable to grant consent. Only pursuits that are processing people’s personal data in ways those
necessary for someone's survival are supposed people would reasonably expect and which
to fall under the category of vital interests. As a have a minimal privacy impact, or where there
result, the legal justification's scope is is a compelling justification for the data
extremely constrained and typically only processing.
applies to situations involving life or death.
Where the personal data of an individual is 3. Rationale
required to protect either the vital interests of
that individual or the vital interest of another • Lowers overall health care costs
person and where that individual cannot give • Forces hospitals and doctors to provide
consent. Vital interests are intended to cover the same standard of service at a low cost
only interests that are essential for someone’s • Creates a healthier workforce
life. So this lawful basis is very limited in its • Early childhood care prevents future
scope, and generally only applies to matter of social costs
life and death. (e.g. medical emergencies) • Guides people to make healthier
choices
5. Public Interest
This defense is used when processing UNIVERSAL HEALTH CARE (UHC)
personal data is required to carry out a task that Health is a right of every Filipino citizen and
is done in the public interest or as part of the the state is duty-bound to ensure that all
data controller's official duties. This basis Filipinos have equitable access to effective
applies where the processing of personal data is healthcare services" - Philippines 1987
required for the performance of a task or Constitution.
function that is carried out in public interest or
3
Universal Health Care (UHC)
- A law that requires the government to provide
each Filipino with access to affordable health
care.
- The Aquino administration defines universal
health care (UHC), also known as kalusugan
pangkalahatan (KP), as "the provision to every
Filipino of the highest possible quality of health
care that is accessible, efficient, equitably
distributed, adequately supported, fairly
financed, and appropriately used by an
informed and empowered public"
- The aim of the government mandate is to
guarantee that every Filipino will obtain fairly
priced and high-quality medical care. This
involves giving sufficient funding, facilities,
and human resources to the health sector.
UHC’s Three Thrusts:
1. Financial Risk Protection
● Protection from the financial impacts of
health care is attained by making any Filipino
eligible to enroll, to know their entitlements and
responsibilities, to avail of health services, and
to be reimbursed by PhilHealth with regard to
health care expenditures.
● PhilHealth operations are to be redirected
toward enhancing national and regional health
insurance systems.
● The NHIP enrollment shall be rapidly
expanded to improve population coverage. The
availment of outpatient and inpatient services
shall be intensively promoted. Moreover, the
use of information technology shall be
maximized to speed up PhilHealth claims
processing.
4
2. Improved Access to Quality Hospitals and
Health Care Facilities
● Improved access to quality hospitals and
health facilities shall be achieved through
several creative approaches. First, the quality of
government-owned and operated hospitals and
health facilities is to be upgraded to
accommodate larger capacity, attend to all
types of emergencies, and handle non-
communicable diseases.
● The Health Facility Enhancement Program
(HFEP) shall provide funds to improve facility
preparedness for trauma and other emergencies.
HFEP aimed to upgrade 20% of DOHretained
hospitals, 46% of provincial hospitals, 46% of
district hospitals, and 51% of rural health units
(RHUs) by end of 2011.
● Financial efforts shall be provided to allow
immediate rehabilitation and construction of
critical health facilities. In addition to that,
treatment packs for hypertension and diabetes
shall be obtained and distributed to RHUs.
● The DOH licensure and PhilHealth
accreditation for hospitals and health facilities
shall be streamlined and unified.
3. Attainment of Health-related MDGs
● Further efforts and additional resources are to
be applied to public health programs to reduce
maternal and child mortality, morbidity and
mortality from Tuberculosis and Malaria, and
the incidence of HIV/AIDS.
● Localities shall be prepared for emerging
disease trends, as well as the prevention and
control of non-communicable diseases.
● The organization of Community Health
Teams (CHTs) in each priority population area
is one way to achieve health-related MDGs.
CHTs are groups of volunteers, who will assist ● Individual,
families with their health needs, provide health family, and
information, and facilitate communication with community
other health providers. engagemen
● RN heals (Registered Nurses for Health Efficiency ● Health system
Enhancement and Local Services) nurses will architecture to meet
be trained to become trainers and supervisors to population needs
coordinate with community-level workers and ● Incentives for
CHTs. By the end of 2011, it is targeted that appropriate
there will be 20,000 CHTs and 10,000 RN provision and use of
heals. services
○ RN heals - The initial six months of ● Managerial
a deployed nurse's duty are conducted in the efficiency and
community (Rural Health Units), followed by effectiveness
another six months of hospital service. Equity ● Financial
● Another effort will be the provision protection
of necessary services using the life cycle ● Service coverage
approach. These services include family and access
planning, ante-natal care, delivery in health ● Non-
facilities, newborn care, and the Garantisadong discrimination
Pambata package. Accountability ● Government
● Better coordination among leadership and rule
government agencies, such as DOH, DepEd, of law for health
DSWD, and DILG, would also be essential for ● Partnerships for
the achievement of these MDGs. public policy
● Transparent
Essential attributes and actions for UHC: monitoring and
HEALTH SYSTEM ACTION evaluation (M&E)
ATTRIBUTES DOMAINS FOR Sustainability & ● Public health
UHC Resilience preparedness
Quality ● Regulations and ● Community
regulatory capacity
environment ● Health system
● Effective, adaptability and
responsive sustainability
individual and
population-based 1. Quality
services
5
- A critical part of enhancing population health
is the quality and safety of healthcare services
provided to individuals and populations.
2. Efficiency
- This is about getting the most out of a certain
amount of data, because no nation has enough
resources to meet all of its population's health
needs, it is crucial to make use of the available
health service resources.
3. Equity
- It is the absence of disparities between groups
of people that can be addressed or prevented
whether those categories are based on social,
economic, demographic, or geographic factors.
4. Accountability
- Accountability includes the implementation of
penalties and rewards as well as stakeholder
responsibilities to provide information and
defend their choices.
5. Sustainability and resilience
- Health systems that are resilient can quickly
recover from both internal and external shocks
and continue to plan for and adapt to changing
situations.
- The security of public health and the capacity
of health systems to respond to such events are
directly threatened by disasters, new diseases,
and economic volatility.
BACKGROUND AND RATIONALE
Health sector reform: Universal Health Care
Previous efforts at health sector reform have
brought about substantial gains in the health
sector improvements. Universal Health Care
(UHC) (Kalusugan Pangkalahatan), also called
the Aquino Health Agenda, is the latest in a
series of continuing efforts of the government
to bring about health sector reforms. UHC was
6
built upon the strategies of two previous
platforms of the reform: the Initial Health
Sector Agenda (1999-2004) and FOURmula
One (F1) for Health (2005-2010). UHC is
planned for implementation until 2016 (DOH,
2010).
Rationale
Health sector reforms are intended to bring
about equity in health service delivery. Survey
data show that this has not been achieved as of
yet, despite health sector reforms since 1999. A
DOH and Philhealth review highlighted the
need to improve health-related financial-risk
protection among Filipinos. More importantly,
Philhealth benefit delivery was found to be the
lowest among the target population-the poorest
quintile. The concern on inequitable access to
health resources has not been resolved (DOH,
2010).
Population quintiles are determined in this
manner: During an NSO survey, a wealth index
is constructed by assigning a weight to each
household asset. These scores are summed by
household. Individuals are ranked according to
the total score of household in which they
reside. The sample is then divided into 5 groups
(quintiles), with each group having the same
number of individuals (NSO, 2009).
Neglect of public hospitals and health facilities
due to inadequate health budgets has been
observed. As of October 2010, a total of 89
RHUs and 99 government hospitals had yet to
qualify for accreditation by Philhealth. Data
shows that the poorest of the population are the
main users of government health facilities. This
means that the deterioration and poor quality of
many government health facilities
particularly disadvantageous to the poor who
needs the services the most (DOH, 2010).
Finally, renewed efforts to achieve health-
related MDGs are in order. The MDG 4 target
is to reduce maternal mortality rate from 209
maternal deaths/100,000 live births in 1990 to
52 deaths/100,000 live births by 2015 (NEDA,
2010). The preliminary 2009 FHSIS report
shows that the country had a maternal mortality
rate of 64 per 100,000 live births in that year
(DOH-NEC, 2009). Considering the short span
of time to the year 2015, attainment of target
MDG looks difficult. The decrease in infant and
child mortality rates over the past two decades
has been remarkable. From a high under-five
child mortality rate of 80 per 1,000 live births
in 1990, the 2008 data shows a decrease to 34
per 1,000 live births. There is a high probability
of meeting the MDG goal 5 (NEDA, 2010).
To address these challenges, UHC (Kalusugan
Pangkalahatan) was launched through
Administrative Order 2010-0036 (DOH, 2010).
Goals and Objectives
UHC is directed towards ensuring
achievement of the health system goals of 1.
Better health outcomes, 2. Sustained health
financing, and 3. A responsive health system by
ensuring that all Filipinos, especially the
disadvantaged group, have equitable access to
affordable health care (DOH, 2010).
Maternal Mortality
WHO defines maternal mortality as
death of a mother while pregnant or within 42
days after delivery. Risks attributable to
pregnancy and childbirth as well as from poor
is quality health care services make this a strong
indicator for health care status.
The increase in maternal mortality ratio
indicates that the target of 52 deaths per
100,000 live births have a low probability of
being met. The contraceptive prevalence rate
decreased from 50.1 percent in 2008 to 48.9
percent in 2011, still far from the country’s
CPR target for 2015 which is at 63 percent,
which indicates that the target for universal
access to reproductive health is also unlikely to
be achieved. Fast-tracking the implementation
of the Responsible Parenthood and
Reproductive Health Law is crucial, not just in
improving the performance of the MDG 5
targets, but also in empowering women to make
informed choices. Efforts must be also
intensified in halting the increasing number of
HIV/AIDS cases.
Child Mortality
Targets for infant and under-five
mortality rates remain to be achievable by
2015. Latest data reveal that the number of
infant and under-five deaths continued to
decrease from 2006 to 2011. In 2006, the
number of infant deaths was at 24 per 1,000 live
the
births and under-five deaths at 32 per 1,000 live
births. In 2011, deaths decreased to 22 and 30
per 1,000 live births, respectively.
(Kalusugan Pangkalahatan)
To address these challenges, the
Aquino Health Agenda (AHA) is being
launched to improve, streamline and scale up
reform interventions espoused in the HSRA and
implemented under Fl. This deliberate focus on
the poor will ensure that as the implementation
of health reforms moves forward, nobody is left
behind.
7
 To successfully implement the Aquino
Health Agenda, the Philippine health system
will require the following components:
enlightened leadership and good governance
practices; accurate and timely information and
feedback on performance; financing that
lessens the impact of expenditures especially
among the poorest and the marginalized sector;
competent workforce; accessible and effective
medical products and technologies; and
appropriately delivered essential services.
OBJECTIVES AND THRUSTS
Goal
The implementation of Universal Health Care
shall be directed toward ensuring the
achievement of the health system goals of better
health outcomes, sustained health financing,
and responsive health system by ensuring that
all Filipinos, particularly the vulnerable groups,
have equitable access to affordable healthcare
in the spirit of solidarity.
Objectives
Universal Health Care is a strategy that
aims to improve, streamline, and scale up
healthcare. The reform strategies in HSRA and
Fl to address health outcomes inequities by
ensuring that all Filipinos, particularly those in
the lowest two socio - economic classes, have
equitable access to quality health care
This approach will strengthen the
National Health Insurance Program (NHIP) as
the main factor in improving financial risk
protection, generating resources to modernize
and sustain health facilities, and improving
public health service delivery in order to meet
the Millennium Development Goals (MDGs).
8
STRATEGIC Thrusts
1. Financial Risk Protection
• By allowing any Filipino to enroll, learn about
their rights and obligations, access health
services, and receive reimbursement from
PhilHealth for medical expenses, protection
from the financial effects of health care is
achieved.
• Health systems work to protect people from
the financial repercussions of illness,
particularly the financial repercussions of
needing medical treatment, as well as to
improve health. Therefore, one frequently used
definition of universal health coverage (UHC)
is "a condition where all people who need
health services (prevention, promotion,
treatment, rehabilitation, and palliative care)
obtain them "without undue financial burden"."
• A key component of UHC in the Philippines
has been recognized as financial protection.
One of the three "strategic thrusts" for UHC in
the Department of Health's 2011–16 Kalusugan
Pangkalahatan (literally "universal health
care") strategy is "financial risk protection
through expansion of the National Health
Insurance Program (NHIP) enrollment and
benefit delivery." The other two strategic
thrusts are "achieving the health-related
Millennium Development Goals" (MDGs)
2. Improved Access to Quality Hospitals and
Health Care Facilities
• We must precisely measure quality if we want
to improve it. The connections between policy
and adjustments in clinical practice are crucial
to the positive results covered in the previous
section. Such relationships, however, can only
be established and proved when accurate and
reliable measures of process are simple to
comprehend, affordable to acquire, unaffected
by manipulation, and associated with superior
health outcomes.
• A provider is said to be of high quality if they
can effectively and efficiently manage the
health care of a patient or population while
taking cultural considerations into account and
working within the restrictions of the available
resources. Eliminating substandard treatment
also entails eliminating the under provision of
necessary clinical services.
• Financial resources must be made available to
enable the quick renovation and development
of vital healthcare facilities. Also required are
the acquisition and distribution of treatment kits
for diabetes and hypertension to RHUs.
3. Attainment of Health-Related MDGs
• One strategy for achieving health-related
MDGs is to establish Community Health
Teams (CHTs) in each priority population area.
CHTs are volunteer groups that help families
with their health needs, provide health
information, and help families communicate
with other health providers. Nurses from
RNheals will be trained to be trainers and
supervisors, coordinating with community-
level workers and CHTs. It is hoped that by the
end of 2011, there will be 20,000 CHTs and
10,000 RNheals
• Another effort will be the provision of
necessary services using the life cycle
approach. These services include family
planning, ante-natal care, delivery in health
9
facilities, newborn care, and the Garantisadong
Pambata package.
To achieve the three strategic thrusts, six
strategic instruments shall be optimized:
1. Health financing – instrument to increase
resources for health that will be effectively
allocated and utilized to improve the financial
protection of the poor and the vulnerable
sectors.
2. Service delivery – instrument to transform
the health service delivery structure to address
variations in health service utilization and
health outcomes across socioeconomic
variables.
3. Policy, standards, and regulation –
instrument to ensure equitable access to health
services, essential medicines, and technologies
of assured quality, availability, and safety.
4. Governance for health – instrument to
establish mechanisms for efficiency,
transparency, and accountability, and prevent
opportunities for fraud.
5. Human resources for health – instrument
to ensure that all Filipinos have access to
professional health care providers capable of
meeting their health needs at the appropriate
level of care.
6. Health information – instrument to
establish a modern information system that
shall:
a. Provide evidence for policy and program
development;
b. Support of immediate and efficient provision
of health care and management of province
wide health systems (DOH, 2010)
LESSON 2: GROUP 5
The Family
A. Family as Basic Unit of the Society
B. Types
1. Family as a Client
2. Family as a System
C. Functions Developmental Stages
D. Family Health Tasks
A. Family as Basic Unit of the Society
THE FAMILY
 The Family Is the Basic Unit Of
Society
 Primary entity of health care or
institution responsible for the physical,
emotional and social support of its
members
 Based on the Philippine Constitution,
family code with focus on religious
legal and cultural aspects of the
definition of the family.
There are numerous definitions of the family
 National Statistical Coordination Board
(NCSB, 2008) – “the family is a group of
persons usually living together and composed
of the head and other persons related to the head
by blood, marriage, or adoption. It includes
both the nuclear and extended family”
 So Sociologists tend to define family in terms
of a “social unit interacting with the larger
society” (Johnson, 2000).
 Other professionals have classically defined
family in terms of kinship, marriage, and
choice: “ a family is characterized by people
together because of birth, marriage, adoption or
choice” (Allen et al., 2007, p. 7).
10
 Friedman et al., (2003) incorporate the ideas
of many nontraditional definitions: “a family is
two or more persons who are joined together by
bonds of sharing and emotional closeness and
who identify themselves as being part of the
family” (p. 10).
CONCEPTS OF FAMILY
 Group of persons united by ties of
marriage blood, birth, or adoption. It
includes both the nuclear and extended
family
 Made up of individuals who perform
certain roles which contribute to the
system's functioning as a whole
 Composed of two or more people who
are emotionally involved with each
other and identify themselves as being
part of the family
 Emotional commitment is established
through caring and commitment to a
common purpose
FAMILY ROLES
 Formal Role (recognized by
expectations associated with roles):
Mother, Father, Son, Daughter
 Informal Roles (roles that are
casually acquired within the family):
Breadwinner, tagaluto
FAMILY STRUCTURES
 NUCLEAR FAMILY (Conjugal
family), (NDEB)
o defined as “the family of marriage,
parenthood, or procreation;
composed of husband, wife, and their
 immediate children-natural, adopted,  EXTENDED FAMILY
or both” (Friedman et al., 2003 p. (Consanguineous),
10);
o consisting of three generations, which
o a father, a mother, with child/
may include married siblings, and their
children living together but apart
families and/or grandparents.
from both sets of parents and other
o composed of two or more nuclear
relatives.
families economically and socially
related to each other.
THREE MAIN POINTS OF
Multigenerational, including married
INTERACTION
brothers and sisters, and the families.

1. HUSBAND-WIFE RELATIONS  BLENDED FAMILY,

3 bonding factors
- Conjugal Bond- sexual attraction,
how husbands describe wife and
vice versa
- Social pressure - faithful ba si tatay,
or may second family
- Economic pressure-
parents/mother/father give
needs for their children
2. PARENT-CHILD RELATIONS
- How they communicate
- How mother/father know
children’s details
o which results from a union where one
or both spouses bring a child or
children from previous marriage into a
new living arrangement;
 COMPOUND FAMILY,
how
basic o 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
their Laws of the Philippines (Office of the
President, 1977);

3. SIBLING RELATIONS  COHABITING FAMILY,

- Do siblings interact or they always

o which is commonly described as a
fight.
“live-in” arrangement between
unmarried couple who are called

 DYAD FAMILY, common-law spouses and their child or

children from such an arrangement;
o consisting only of husband and wife, and
such as newly married couples and
“empty nesters”;  SINGLE PARENT,

11
 o which results from the death of a
spouse, separation, or pregnancy
outside of wedlock.
o Single parenting is faced with greater
risk associated with lesser social,
emotional, and financial resources,
which affect the general well-being of
the children and families. In the
Philippines, there were more than 2
million overseas Filipino workers in
2010, with 1.07 million males and 0.98
million females (NCSB). This situation
has given rise to effectually single -
parent families.
 THE GAY OR LESBIAN FAMILY
o Homosexual couple living together
with or without children
o is made up of a cohabiting couple of the
same sex in a sexual relationship. The
homosexual may or may not have
children. Because the Family code of
the Philippines (Executive Order No.
209) expressly states that a marriage is
a special contract of permanent union
between a man and a woman entered
into accordance with the law for the
establishment of conjugal and family
life, same-sex marriage is not legally
acceptable.
DECISIONS IN THE FAMILY
o Patriarchal- Father, Son, Grandfather
make the decision for the family
o IMPORTANT REASON FOR NURSES TO
Matriarchal- Mother, Grandmother,
Daughter make the decision for the
family
12
o Egalitarian- Equal authority to decide.
Both mother and father make the
decision for the family
o Democratic- All members of the
family have authority to decide to make
decision
o Laissez-Faire- Full autonomy of child
or every member of family.
o Matricentric- Mother decides if father
is OFW/Working far away.
o Patricentric- Father decides if mother
is OFW/Working far away.
B. Types
THE FAMILY AS A CLIENT
Regardless of the recognized definition
of the family or the shape it may take, the value
of the family unit to society is undeniable.
Individual needs are met by the family by
providing basic necessities (food, shelter,
clothing, affection, and education).
The family provides emotional, sexual,
and pecuniary support to spouses or partners.
The family has traditionally been seen as an
essential unit of healthcare in community health
nursing, with the understanding that the person
may be best understood within the social
context.
The familial context observing and
questioning about family interactions allows
the community nurse to assess the effect of
family members on one another. Nursing
evaluation and intervention should not be
limited to the current social situation. It must
consider not only the household situation, but
also the larger social context of the community.
As well as society Friedman et al. (2003, pp.5-
6) suggest reasons it is important for nurses to
work with families:
WORK WITH FAMILIES
● “THE FAMILY IS A CRITICAL
RESOURCE.” The importance of the family
in providing care to its members has already
been established. In this caregiver role, the
family can also improve individual members’
health through health promotion and wellness
activities. Add health teaching to all members
with the mother/father who have problems.
● “In a family unit, any dysfunction
(illness, injury, separation) that affects one or
more family members will affect the members
and unit as a whole.” Also referred to as “ripple
effect”, changes in one-member cause changes
in the entire family. The nurse must assess each
individual and the family unit.
● “CASE FINDING” is another reasons
to work with families. While assessing an
individual and family, the nurse may identify a
health problem that necessitates identifying
risks for the entire family. Know other problem
connected to the main problem of family.
● “IMPROVING NURSING CARE”.
The nurse can provide better and more holistic
care by understanding the family and its
members.
Freeman and Heinrich (1981) likewise point
out that the family provides feedback and
influences health services. When the family
informs the nurse that they do not utilize the
services of a nearby health center, the nurse
must find out the reason. The family’s reasons
for nonutilization of services may provide the
health center personnel with clues as to how
they can make services in keeping with the
needs and expectations of catchment
population. Beyond “improving nursing care”,
the family can help improve public health
programs.
The family is not only a health resource in terms
of providing care to its members and promoting
health and wellness activities. Decisions for
personal care and health action are usually
made in family setting (Freeman and Heinrich,
1981)
RATIONALE FOR CONSIDERING THE
FAMILY AS THE UNIT OF CARE IN
CHN:
1. The family is considered as the natural
and fundamental unit of society
2. The family as a group generates,
prevents, tolerates, and corrects health
problems within its memberships
3. The health problems of family member
are interlocking
4. The Family is the most frequent focus of
health decisions and actions in personal
care
5. The family is an effective and available
channel for much of community health
nursing effort
6. The family provides a crucial
environment force
7. The family through its interaction with
the larger social system validates and
influences health efforts
2. Family as a System
o The general systems theory
(Minuchin, 2002; von Bertalanffy,
1968,1972, 1974) has been applied to
the study of families. It is a way to

13
 explain how the family as a unit
interacts with larger units outside the
family and the smaller units inside the
family (Friedman,1998).
o Each member of the system is, to a
certain extent, independent of other
members, yet, the members are in so
many ways dependent on each other.
Thus, the family is certainly more than
just a sum of its members. The family
maybe affected by any disrupting force
acting on a system outside the family
(i.e., suprasystem). The family is
embedded in social systems that have
an influence on health (e.g., education,
employment, and housing), just as it is
affected by systems within the family
(i.e., subsystems).
o Parke (2002) stated that there are three
system, and sibling-sibling system.
o system that is fully closed or fully open.
Almond et al. (1979) compared the
family as a system to a piece of a
mobile crib toy suspend from the air
that is constant movement with other
pieces of the mobile. At any time, the
family, like any piece of mobile, maybe
caught by a gust of air and become
unbalanced, moving “chaotically” for a
time, however, eventually, the
stabilizing force the other parts of the
mobile will reestablish with the
balance. An understanding of systems
theory is still important for the nurse
working with families today.
o Dunst and Trivette (2009) reviewed
20 years of systems theory provides
direction in understanding how
healthcare providers can expand family
14
capacity by changing parenting, and
therefore changing child behaviors.
Components of Family System Theory
● Family system has interrelated elements
and structure - The members of the family are
the parts of a system. Each element has
characteristics; there are relationships between
the elements and interactions are
interdependent. All of these together form a
structure, or the sum total of the
interrelationships between the elements factors
such as system membership and the barrier
between the system and its environment
● Family systems interact in patterns - In a
family system, consistent patterns of interaction
occur. These recurring cycles contribute to the
family's overall well-being.
● Family systems have boundaries and can
be seen on a measure between open and
closed - A family is termed "open" if its
boundaries are permeable and ambiguous.
Open boundary systems allow factors and
happenings outside the family to affect it.
Closed boundary systems protect their
members from the outside world and appear
isolated and self-contained. There is no family
● Family systems use words/messages and
norms to shape the members - Messages and
rules are social agreements that regulate and
limit the behavior of family members
throughout time. Most messages and rules can
be stated in one or a few words. For example,
More is good, be responsible, and be Perfect are
all examples of messages/rules.
● Family systems have subsystems - Every
family system has a number of tiny groups,
usually consisting of 2-3 individuals. These
people's interactions are referred to as
subsystems, coalitions, or alliances. Each
subsystem follows its own set of rules, limits
and differences. Subsystem membership might
alter over time.
C. Functions Developmental Stages
FAMILY LIFE CYCLES (Duvall and
Miller, 1990)
 - The classic developmental o This stage begins with the birth of first
framework describes 8 stages child and lasts until the child is 30
through which a family progresses months of age
from marriage of the couple to death o Birth or adoption of a first child is
of both. Moreover, it identifies the usually both an exciting and a stressful
source of developmental tasks as event which requires economic and
biologic and physical maturation, social role changes
cultural and social expectation, and o There might be changes in parenthood
individual aspirations and values. o Negotiating marital relationships
Family Life Cycles (Duvall & o Oldest child: 2 1/2 years old
Miller, 1990)
STAGE 3: FAMILY WITH PRE-SCHOOL
CHILDREN
STAGE 1: BEGINNING FAMILY; o This stage covers the years from the
MARRIAGE AND THE FAMILY time the oldest child is 2 ½ years old
o This stage covers the start of the until the youngest is 5 years old.
marriage to the birth of the first child, o Children at this stage demand a great
including establishment of a nuclear deal of time
family. o This is a BUSY FAMILY because
o Decision making about parenthood children at this age demand a great deal
o Involves merging of values brought of time related to growth and
into the relationship from the families development needs and safety
of orientation. considerations.
o Includes adjustments to each other’s o Oldest child: 2 1/2 to 5 (6) years old.
routines (sleeping, eating, chores, etc.), o Adopting to the critical needs of pre-
sexual and economic aspects. school children. Lack of privacy is
o Members work to achieve 3 separate included.
identifiable tasks:
STAGE 4: FAMILY WITH SCHOOL AGE
1. Establish mutually satisfying CHILDREN
relationship o This stage from which the oldest years
2. Learn to relate well to their families of of age until the child is 6 yo until 13 yo.
orientation o Oldest child: 6- 12 (13) years old
3. If applicable, engage in reproductive o Parents at this stage have important
life planning responsibility of preparing their
children to be able to function in a
STAGE 2: EARLY CHILDBEARING complex world while at the same time
FAMILY
15
 maintaining their own satisfying
marriage relationship.
o Satisfying needs of children in their
school
o Encouraging child educational
achievement (More on Anak)
o Meeting health needs
o Trying times
Tertiary Characteristics:
- Friends
- Religion
- Counseling
STAGE 5: FAMILY WITH ADOLESCENT
CHILDREN
o A family allows the adolescents more
freedom and prepare them for their
own life as technology advances- gap
between generations increases.
o Family must loosen family ties to allow
adolescents more freedom and prepare
them for life on their own or Balancing
teenager’s freedom with responsibility
as they mature and emancipate from
the family.
o Nurses include counseling to the
parents and adolescents in drug,
alcohol, and other accidents. Nurses
must be neutral person.
Confidentiality
o Begins when oldest child: 13-20 years
old or leaves home
STAGE 6: THE LAUNCHING CENTER
FAMILY
o Covers between the time the first child
leaves home and the last child leaves
home
o MOST DIFFICULT STAGE: The
stage at which children leave to
establish their own household
“Breaking up of the family”
o Stage when children leave to their own
household-appears to represent the
breaking of the family.
o Empty nests
STAGE 7: FAMILY OF MIDDLE YEARS/
MIDDLE AGED FAMILY
o Refers to the years from the time the
last child leaves home to the retirement
or death of one of the spouses
o Deal with disabilities and death of
older generation
o One member of the family died
o Family returns to two partner nuclear
unit.
o Refers to the eyes…
o Period of empty nest to retirement
STAGE 8: AGING FAMILIES/ FAMILY
IN RETIREMENT/ OLDER AGE (Last
Stage)
o Lasts from the retirement of one or both
members of the couple through the
death of one of the spouses, ending
Keep with the death of the remaining spouse
o Preparation for own death and dealing
with loss of spouse and/or siblings or
other peers
STAGE 9: PERIOD FROM RETIREMENT
TO DEATH OF BOTH SPOUSES
● Learning new roles related to retirement,
becoming grandparents, losing a partner, and
health-related changes
16

D. Family Health Tasks
Health task differ in degrees from family to
family.
TASK- is a function, but with work or labor
overtures assigned or demanded of the person
 In addition to its developmental task,
the family serves as an essential
resource for its members by carrying
out health task
 An important responsibility of the
community health nurse is to develop
the family’s capability in performing
its health task.
 The first family health task is providing
its members with means for health
promotion and disease prevention.
Examples of Family Health Task
 Breastfeeding an infant
 A healthy diet for older family members
 Bringing a young child to the health center for
immunizations
 Teaching a child about proper hand washing
FAMILY HEALTH TASK (Freeman &
Heinrich 1981)
 Recognizing interruptions of health or
development
 Seeking Health Care
 Managing health and non-health crisis
 Providing nursing care to sick, disabled, or
dependent members of the family
 Maintaining a home environment conductive
to good health and personal development
 Maintaining a reciprocal relationship with
the community and its health institutions
Eight Family Tasks (Duvall & Niller)
(PSAMDRPM)
1. Physical maintenance - provides food
shelter, clothing, and health care to its members
being certain that a family has ample resources
to provide
2. Socialization of Family– involves
preparation of children to live in the community
and interact with people outside the family.
17
3. Allocation of Resources- determines which
family needs will be met and their order of
priority.
4. Maintenance of Order– task includes
opening an effective means of communication
between family members, integrating family
values and enforcing common regulations for
all family members.
5. Division of Labor – who will fulfill certain
roles e.g., family provider, home manager,
children’s caregiver
6. Reproduction, Recruitment, and Release
of family member
7. Placement of members into larger society
–consists of selecting community activities
such as church, school, politics that correlate
with the family beliefs and values
8. Maintenance of motivation and morale–
created when members serve as support people
to each other
LESSON 3: GROUP 6
Characteristics of a Healthy Family
Otto (1973) and Pratt (1976) characterized
healthy families as “energized families” and
provided descriptions of a healthy families to
guide in assessing strengths and coping.
DeFrain (1999) and Montalvo (2004) helped
to identify healthy families. They suggest the
following traits of a healthy family:
o Members interact with each other;
they communicate and listen repeatedly in
many contexts (1)
o Healthy families can establish
priorities. Members understand that family
needs priority
o Healthy families affirm, support,
and respect each other. (2)
o The members engage in flexible role
relationships, share power, respond to
change, support growth, and autonomy of
others, engage in decision making that
affects them.
o The family teaches family and
societal values (respect) and beliefs and
shares a spiritual core. (3)
o Healthy families foster responsibility
and value service to others. (8)
o Healthy families have a sense of play
and humor to share leisure time. (5) (7)
o Healthy families have the ability to
cope with stress and crisis and grow from
problems. They know when to seek help
from professionals (10)
o The family members have a sense of
trust (4)
o All members interact with each other
and a balance in the interaction is noted
among the members. (6)
o The privacy of the members is
honored in the family (9)
"In family life, love is the oil that eases
friction, the cement that binds closer
together, and the music that brings
harmony."- Friedrich Nielsche
Family Nursing Process
The Family Health Nursing Process is a
systematic procedure to help families in
growing and strengthen their capacity to
address their own health needs and deal with
health issues. The nursing process used in
family and community health is closely
connected. The primary aims or objectives of
the family health nursing process are illness
● Wives
18
prevention, health problem management, and
health promotion. The family health nursing
procedure is divided into various stages.
Assessment - The family health nursing
procedure begins with a family and family
member health assessment. A baseline
technique for determining health status,
medical history, socioeconomic status, and
environmental and behavioral factors that affect
health is data collection.
Diagnosis - A family profile describing all the
needs and health issues in the family is
described through a health assessment.
Therefore, the nursing diagnosis must be based
on the family's requirements, and nursing
interventions must be timed accordingly.
Planning - The creation of care plans for family
members is addressed in the planning face of
the family health nursing process.
Implementation - The direct interaction of
community health nurses with families and
family members is the focus of this phase.
Evaluation - The final step in the family health
nursing approach is evaluation. It is beneficial
to assess the effectiveness of the care given to
the family. Evaluation aids in identifying the
advantages and disadvantages of the nursing
process.
A. Family Health Assessment Tool
1. Tools for Assessment
TOOLS FOR ASSESSMENT:
● Initial Data Base
● Typology of Nursing Problems in
Family Nursing Practice
● Family Health Task
● Family Coping Index
INITIAL DATA BASE
1. Members of the household and
relationship to the head of the family
Examples:
● Servants
● Daughters ● Brothers
● Sons ● Sisters
2. Demographic Data ⮚ Whether living with the family or
⮚ age, sex, civil status, position in the elsewhere.
family ⮚ Address of each member
3. Place of residence of each member 4. Type of family structure
Example:
● Matriarchal ● Nuclear
● Patriarchal ● Extended
5. Dominant family members in terms of TYPOLOGY OF NURSING PROBLEMS
decision-making, especially in matters of health IN FAMILY NURSING PRACTICE
care FIRST LEVEL ASSESSMENT
6. General family relationship/ dynamics 1. Presence of wellness condition
⮚ Presence of any obvious/readily ⮚ Stated as POTENTIAL or
observable conflict between members; READINESS- a clinical or nursing judgement
characteristics communication/interaction about a client in transition from a specific level
patterns among members. of wellness or capability to a higher level
(NANDA,2001)
⮚ Examples:
● Healthy lifestyle ● Parenting
● Health maintenance/ health ● Breastfeeding
management ● Spiritual Well- being
2. Presence of Health threats ⮚ Examples:
⮚ Conditions that are conducive to
disease and accident, or may result to failure to
maintain wellness or realize health potential.
● Presence of risk factors of specific ● Family size beyond what family
diseases resources can adequately provide
● Threat of cross infection from a ● Poor home/ environmental condition
communicable disease case ● Stress- provoking factors
3. Presence of Health Deficits 1. Illness states, regardless of whether it is
⮚ Instances of failure in health diagnosed or undiagnosed by medical
maintenance practitioners
⮚ Examples: 2. Failure to thrive/ develop according to
normal rate

19
3. Disability- whether congenital or ⮚ Anticipated periods of unusual demand
arising from illness; temporary or permanent on the individual or family in terms of
4. Presence of Foreseeable crisis adjustment/family resources.
⮚ Examples:
1. Marriage 5. Abortion
2. Pregnancy,labor, puerperium 6. Divorce/ separation
3. Parenthood 7. Loss of job
4. Additional member
SECOND LEVEL ASSESSMENT ⮚ Lack of/ inadequate knowledge of
1. Inability to recognize the presence of preventive measures
the condition or problem 5. Failure to utilize community
⮚ Lack of or inadequate of knowledge resources for health care
⮚ Denial about its existence or severity ⮚ Unavailability of required care
⮚ Attitude/ philosophy in life which ⮚ Lack of trust/ confidence in the agency
hinders recognition or acceptance of a problem. ⮚ Lack of/ inadequate knowledge of
2. Inability to make decisions with community resources for health care
respect to taking appropriate health action
⮚ Failure to comprehend to nature FAMILY HEALTH TASK (RMDPM)
⮚ Low salience of the problem/condition 5 Family Health Task (Malaya, A., 2004)
⮚ Feeling of confusion or helplessness 1. Recognizing interruptions of health
⮚ Fear of consequences development
⮚ Lack of/ inadequate knowledge of 2. Making decisions about seeking
community resources for care health care/ to take actions
3. Inability to provide adequate 3. Dealing effectively health and non-
nursing care to the sick, disabled, etc. health situations
⮚ Lack of/ inadequate knowledge about 4. Providing care to all members of the
the disease/ health condition family
⮚ Inadequate family resources for care 5. Maintaining a home environment
⮚ Lack of necessary facilities, equipment conducive to health maintenance
and supplies for care
4. Inability to provide a home FAMILY COPING INDEX (PTKAHEFPU)
environment conducive to health 9 Areas of Family Nursing Family Coping
maintenance and personal development Index
⮚ Inadequate family resources 1. Physical Competence
⮚ Lack of/ inadequate knowledge of - an individual's ability to develop
importance of hygiene and sanitation movement skills and patterns, and

20
 the capacity to experience a variety - This category has to do with the
of movement intensities and maturity and integrity with which
durations. the members of the family are able
- A. Good current health status plus to meet the usual stresses and
evidence of appropriate knowledge, problems of life, and to plan for
attitudes happy and fruitful living.
- B. Behaviors that will ensure future 7. Family living
health - This category is concerned largely
- Exercise with the interpersonal or group
- Good diet/nutrition aspects of family life – how well the
- Effective contraceptive practices members of the family get along
2. Therapeutic Competence with one another, and the ways in
- This includes all the procedures of which they take decisions affecting
treatment prescribed for the care of the family as a whole.
illness such as giving of 8. Physical Environment
medications, exercises and - This is concerned with the home, the
relaxation and special diets community, and the work
3. Knowledge of Health Condition environment as it affects family
- The specific health issue for which health.
care is being provided is a focus of 9. Use of Community Facilities
this system. - Generally, keeps appointments.
- Totally unaware or uneducated of Follow through referrals. Tells
the condition. others about Health Departments
4. Application of Principle of General services
Hygiene
- Include practice of general health
promotion and recommended
preventive measures
5. Health Attitudes
- It is concerned with the way the
family feels about health care in
general, including preventive
services, care of illness and public
health measures.
6. Emotional Competence

21
 3. Family characteristics, dynamics or level of
LESSON 4: GROUP 7 functioning.

FAMILY DATA ANALYSIS

Three steps of data analysis?

• Data analysis is done by comparing • Summary -the summary of the data you have
findings with accepted standards for collected
individual family members and for the family
unit. • Conclusion -the interpretation of the data

• The nurse correlates findings in the

different data categories and checks for • Future plan -this is based on the data and its
significant gaps in information or the need for conclusion, the interventions and plans that you
more details related to a finding. will conduct to the family.

Data Analysis SUMMARY

After you utilize the data generated -DATA ANALYSIS
from the tool on Initial Data base in Family
Nursing Practice, the nurse goes through data
analysis. She sorts out and classifies or groups
data by type or nature (which are wellness
states, threats, deficits, foreseeable crises).
She relates them with each other and
determines patterns or reoccurring themes
among the data. DIAGNOSIS

DATA ANALYSIS
-Sort Data

-Cluster/Group Related data

-Distinguish relevant data from irrelevant data

-Identify patterns (lifestyle, behavior) PRIORITY SETTING

-Compare patterns with norms or standard

Standards and norms utilized in determining

the status of the family:

1. Normal health of individual members

2. Home and environmental conditions

conducive to health development

22
PLANNING ●EXTENDED
- a household in which family
members extends beyond the nuclear family,
including married siblings with their family
and grandparents. Also, it can extend up to 3
generations.

●SINGLE PARENT
- a household comprises of a child and
someone who is unmarried, widowed, or
CONCLUSION AND FUTURE PLAN divorced and not remarried. Also, it can be
headed by a mother, a father, a grandparent, an
IMPLEMENTATION AND EVALUATION OF
uncle, or
PLANNING
an aunt.

●BLENDED OR CONSTITUTED
- a household where one or both parents have
children from previous relationships but
all the members come
together as one
unit.

●COHABITATION OR LIVE IN
- a household comprises an unmarried couple
and their child or children who bond by
SYSTEM OF ORGANIZING FAMILY an arrangement.
DATA
●DYAD
FAMILY STRUCTURE AND - a household that is considered the
CHARACTERISTICS
smallest unit of a family group. Consists of
two members who are bound by a romantic
1. Data on household membership
interest, marriage. (e.g. married couple or
• There are different types of families. parent-child dyad)
Which changes over time as a
consequence of Birth, Death, ●GAY OR LESBIAN
Migration, Separation, and - a household where members of the
Growth of the family. LGBTQ+ community live as parents or give
foster
TYPES OF HOUSEHOLD MEMBERSHIPS:
care to
●NUCLEAR child/children.
- a household comprises of parents ●NO-KIN
with their child/children who are united by ties - a household where members of the family
of partnership, marriage, and parenthood. are not related by blood (e.g. boarders).

23
●FOSTER
- a household comprises of a family
that is officially takes a child into their family
for a period of time, without becoming the
child's legal parents.
2. Demographic characteristics
- To identify the:
• AGE
- to know who is the oldest to youngest
and who are at the legal age.
• GENDER
- to know how many of them are
female, male or transgender and agender.
• FAMILY STATUS
- to know who in the family is related
by marriage, related by blood or adoption.
• EDUCATIONAL LEVEL
- to know who and how many family
members are graduated in primary, secondary
and tertiary. For those who are not yet
graduated, to know what grade level they are
passed.
• INCOME
- to know the range of family income
and if it is enough to support the needs of
the family.
• OCCUPATION
- to know who works and what is the
occupation of those members who work.
• RELIGION & RACE
- to know what is their beliefs that are
need to consider and identify how it affects
their daily living and health.
3. Family members living outside the
household
- Family members living outside the
household are also assessed and considered in
analyzing data because they are part of the
family and to determine their condition just in
case a genetic-related disease or problem was
24
detected in one family member. For them to be
aware and prevent if there is probability of
getting the same disease or disorder.
4. Family dynamics
- To assess the family when it comes
to:
• Emotional bonding
- to determine the emotional bond or
quality of closeness of each family member to
one another.
• Authority and power structure, the
autonomy of members
- to know who is the head of the
family and the other member's roles in the
family. • Division of labor
- to identify who is assigned to
do in each household chores tasks (e.g.
cleaning, cooking)
• Patterns of communication
- to know how they
communicate and interact with
each other.
• Decision making, and problem and conflict
resolution
- to know who leads in making
decisions, their usual problems, and how they
resolve their conflict as a family.
TYPE OF AUTHORITY AND POWER
STRUCUTURE
Patriarchal - full authority on the father or
any male member of the family
What is Patriarchy
• "Patriarchy" (derived from patriarch
in Greek) is a term for societies in
 which male is the favored gender, and
in which men hold power, dominion
and privilege. Male power in
patriarchy can be found at family,
community, social and governmental
level.
• Because patriarchy defines men as the
rulers, men's and women's roles are
strictly defined and, in a sense,
enforced. Women must be seen as
inferior, weaker, generally less
capable, less intelligent, and less
worthy. Their work is equally
considered "lower." They are
relegated to hearth and home.
Cleaning, caring for the family, and
serving the husband.
• An example of a patriarchy society is
where men hold the control and make
all the rules and women stay home and
care for the kids
Matriarchal - full authority of the mother or
any female member of the family.
• A society where the female member
leads a family is called matriarchy,
and the female head of the family is
called the matriarch. For a long time,
men have dominated the better
portion of society. However, there
have always been cultures where
women were in charge of things; they
dominated families and society and
were at the core of everything.
• The concept of a society where
women govern the political, social,
and economic institutions may sound
far-fetched to some. Yet, history
shows that matriarchal communities
have existed throughout centuries,
and some still exist now.
Egalitarian - husband and wife exercise a
more or less amount of authority father and
mother decides.
25
• Relating or believing in the principle
that all people are equal and deserve
equal rights and opportunities
What is the egalitarian society?
• In egalitarian societies, all individua ls
are born equal, and all members of
society are said to have a right to equal
opportunities.
 A patriarchal family is a family
structure in which authority is held by
the eldest male
(usually the father).
 A matriarchal family is a family
structure in which authority is held by
the eldest female
(usually the mother).
 An egalitarian family is a family
structure in which both partners share
power and authority equally.
Democratic - everybody is involved in
decision making
• Something that is democratic is based
on the idea that everyone should have
equal rights and should be involved in
making important decisions
Laissez-faire - full autonomy
•Laissez-faire is an economic theory
from the 18th century that opposed
any government intervention in
business affairs. The driving principle
behind laissez-faire, a French term
that translates to "leave alone"
(literally, "let you do") it
DEMOCRATIC LAISSER-FA
 It asks “should we do this or that” It’s like “it isallows
up to you
thetopatient
do this to
or see
that”hereditary
• The group makes decisions • The employees make decisionsmedical and
patterns of behavior and
• Everyone is encouraged to make • Theypsychological
have minimum factors that run through
interference and
contributions families
guidance from management.
• Employee’s ideas are considered • Hands
• Anoff Eco-Map
leadership where
is a thegraphical
team
• The leader involves in entire team in members mall all decisions
representation that shows alsoallknown
of the
decision making as zero leadership
systems at play in an individual's life
• A family tree is a visual representation
Matricentric of a person's lineage, tracing
relationships to common ancestors
• Prolonged absence of the father gives
What is the difference between family tree and
the mother a dominant position in the family genogram?
family, although the father may also
share with the mother in decision
• A genogram is structurally similar to
making
a family tree, but serves a very
• Today single parent households are different purpose. A genogram
turn out to be common includes information about
relationships and interactions between
• Matrifocal or matricentric households family members, while a family tree
comprise of a woman and her only depicts lineage.
children, reasons deindustrializat ion,
divorce and inability of man to
support his family. What’s the difference between an ecomap and
Patricentric - centered upon the father a genogram?

• The father decides or takes charge in • A genogram is a graphic portrayal of

absence of the mother. characteristic
of a form of social organization in
which the male is the family head and
title is traced through the male line
❖ The difference between matricentric
and patricentric is that matricentric is
(of a family or society) centering
around the mother or mothers while
patricentric is (of a family or society)
centering around the father or fathers.
5. Data on family structure can be visualized
clearly through graphic tools such as
genogram ecomap and family tree.
• The word genogram refers to a
diagram illustrating a person’s family
members, how they are related, and
their medical history. The genogram
26
the composition and structure of one's
family and an ecomap are a graphic
portrayal of personal and family social
relationships
SOCIOECONOMIC CHARACTERISTICS:
1. Data on social integration
⮚ It is a multidimensional construct that can
be defined as the extent to which individua ls
participate in a variety of social relationships,
including engagement in social activities or
relationships and a sense of communality ---
ethnic origin, languages and dialects spoken,
and social networks
• Social integration is the process of
creating unity, inclusion and
 participation at all levels of society
within the diversity of personal
attributes so that every person is free
to be the person she wants to be.
Personal attributes include socio-
economic class, age, gender - sexual
preference and expression, political
ideas, ethnicity and cultural traits,
religion, citizenship (national origin)
and geographical region of origin and
so on.
• Social integration can be considered
to be antonym to social exclusion,
which is broader than poverty and
deprivation, and which neglects
people’s rights.
2. Educational experiences and literacy
Educational experience isn’t limited to the
classes on your college transcript. It also
encompasses work-study jobs, field work,
practicum experience and internships. If
related to the job you are seeking, such
experiences can be listed separately on your
application. Include a description of your
duties and accomplishments. Also list all
schools attended, even if you just took a few
classes. For example, include any college
credit you earned in high school through the
postsecondary enrollment options program.
Courses in the military also count as
educational experience that you may wish to
include on your application. Also mention
your participation in research studies funded
by scholarships or grants. Study abroad trips
are another exceptional education experience.
Explain how you gained cultural knowledge
and learned language skills.
3. Work history
A detailed description of your work history is
required for job applications and resumes.
27
On both documents, you’ll need to include the
company name, city and state, length of
employment, your official title and a brief
description of your duties. Job applications
might also ask for your immediate
supervisor’s name and phone number, as well
as the reason why you left the position. This
information isn’t required on a resume. On a
resume, however, you should add a brief
description of your successes at your former
job. For example, “Increased year-end revenue
by 20 percent or “Helped the university renew
accreditation for the next decade.” List your
job history in reverse chronological order,
starting with your most recent position.
4. Financial resources Leisure time interests
Financial resources are the funds and
assets that finance an organization’s activities
and investments. In simple terms, financial
resources are the monies that keep a business
operating,
and there are several ways a business will raise
and use its financial resources.
Every organization will have a framework or
process in place for planning, organizing,
directing, controlling, and monitoring its
financial resources and activities in order to
deliver
on the goals of the business. This is known as
financial resource management (FRM) or
financial management.
When employers ask what you like to do for
fun, they're usually interested in getting to
know you as a person, but they also want to
know if any of your personal interests align
with
the job duties. Having hobbies outside of work
that are similar to the job duties may tell the
employer that you continually practice and
develop skills that are useful for the job.
The interviewer is also likely looking for
depth in your character. They want to know
that
you have hobbies that encourage a good work-
life balance, which can help prevent burnout
and
additional stress.
Your coworkers are going to see you and
interact with you on a regular basis, so your
interests outside of work are a good indicator
of whether or not you'll get along with them.
If
you share similar interests with some of your
potential team members, you may be more
likely
to connect with them, which can improve your
collaboration and overall performance.
Sharing
hobbies and talking about them at work during
your free time can also make the environment
more positive.
5. Cultural influences
⮚ Cultural influences mean historical,
geographical, and familial factors that
affect assessment and intervention
processes like:
⮚ Racial or Ethnic Self‐Identification: the
individual/family would report how they
identify themselves in a racial or ethnic
context “Etta identifies as a biracial 10-
year-old girl with a Asian (Filipino)
mother and an African American father”
⮚ Immigration History and Status:
Description of the individua l’s
immigration path (if applicable). Is the
client a political refugee, an economic
refugee, or on a work or student visa?
The intent is not to identify whether the
client has documentation to be in the
country but more his or her experience
as an immigrant
28
⮚ Social Orientation: Can involve
information regarding the client’s
friends, social group, partnership status,
sexual orientation.
6. Spirituality or religious affiliation
- Nominally, Religious Affiliation is
defined as the religious or spiritual
beliefs and practices to which a person
adheres or the religious group to
which a person belongs.
FAMILY ENVIRONMENT
⮚ Refers to the physical environment
inside the family’s home/residence
and its neighborhood.
⮚ Family environment is the core process
of every child upbringing, with
positive and negative influences.
When families experience sudden and
unexpected trauma, such as loved
ones sustaining severe burns, all
members of the family are affected in
one way or another.
⮚ Today’s families are more likely to
conform to a variety of
configurations. A family is a primary
group which requires “people who are
intimate and have frequent face-to
face contact with one another, have
norms that is, expectations regarding
how members in the group should
behave in common and share
mutually enduring and extensive
influences.
FAMILY HEALTH AND HEALTH f
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i
i

s
e

A
s

D
o
29
L mean to go. That’s where the risk and danger
? Tobacco use is a major risk factor for the
The activities of daily living (ADLs)
is a term used to collectively describe
fundamental skills required to
independently care for oneself,
Classification of ADL:
- Basic ADL - are those skills required
to manage one’s basic physical needs
including personal hygiene or
grooming, dressing, toileting,
transferring or ambulating, and eating.
- Instrumental ADL are related to the
ability to live independently in the
community. This would include
activities such as e.g., managing
finances and medications, food
preparation, housekeeping, laundry.
Causes for limitations in adls:
 Aging
 Decreased physical function
 Social isolation
Learning how each basic adl affects
an individual to care for themselves
can help determine whether a patient
would need daily assistance. It can
also help the elderly or disabled
people to determine their eligibilit y
got state and federal assistance
programs.
2. Risk behaviors
⮚ Many behaviors are risky for your health
and happiness. The main hazards include
using tobacco, alcohol or illegal drugs,
engaging in violent behavior, and sexual
activity. Sometimes these activities can start a
slippery slope and you go further than you
30
come
development of lung diseases. It leads to
variety of cardiac and vascular pathologies
and it causes various cancers.
The American Medical Association defines
alcohol use disorder as "a disease
characterized by serious impairment that is
directly linked to persistent and uncurbed
consumption of alcohol.
Violence can present in various ways,
including child abuse or neglect, youth
violence, intimate partner violence, sexual
violence, elder abuse, self-inflicted violence,
and collective violence.
Unsafe sexual practices increase the risk of
developing sexually transmitted infections
like
HIV, chlamydia, gonorrhea, syphilis,
trichomoniasis
3. Health history
 Your family's illnesses and medical
issues are documented in your family
health
history.
 A family health history is a list of
details regarding a person's and their
immediate family members' health.
Information from three generations of
families, including children, brothers
and sisters, parents, aunts and uncles,
nieces and nephews, grandparents,
and cousins, is included in a
comprehensive record.
 A record of information about a
person’s health. A personal medical
history may include information about
allergies, illnesses, surgeries,
immunizations, and results of physical
exams and tests. It may also include
 information about medicines taken 8. Current health status
and health habits, such as diet and
9. Health care resources (home remedies and
exercise.
health services)
4. Current health status
➢ A person's relative level of health and B. FAMILY NURSING DIAGNOSIS
disease is determined by their health
status, which also takes into consideration
any symptoms and functional limitations Family Nursing Diagnosis
or impairment as well as any biological or ⮚ Represents the clinical judgement about
physiological dysfunction.
actual or potential health problems occurring
5. Health care resources (home remedies and within the family.
health services)
➢ All equipment, staff, buildings, money, and
other resources that can be used to deliver 9 AREAS OF ASSESSMENT:
healthcare services are referred to as 1. PHYSICAL INDEPENDENCE
health care resources.
⮚ Refers to the family member’s mobility
6. Self-care and ability to perform a daily activities such as
 Self-care is the practice of people taking feeding themselves and performing activities
care of their own health using the necessary for personal hygiene.
2. THERAPEUTIC COMPETENCE
knowledge and resources.
⮚ Is the family’s ability to comply with
WHY FAMILY prescribe or recommended procedures and
HEALTH HISTORY
IMPORTANT? treatments to be done at home which include
medications, dietary recommendation and

⮚ A family medical history can identify application of wound dressing.

people with a higher-than-usual chance of 3. KNOWLEDGE OF HEALTH
having common disorders, such as heart
CONDITION
disease, high blood pressure, stroke, certain
cancers, and diabetes. These complex ⮚ Means understanding of the health
disorders are influenced by a combination of condition or essential of care according to the
genetic factors, environmental conditions, and
developmental stages of family members. It is the
lifestyle choices.
family member’s knowledge in terms of
 It is your own guide for you to be able to
communicable disease and its mode of
formulate or create nursing interventions, transmission.
diagnosis and NCP that can be apply to 4. APPLICATION OF PRINCIPLES
OF PERSONAL AND GENERAL HYGIENE
family or clients.

31
⮚ Include practice of general health ✔ Determining appropriate intervention to
promotion and recommended preventive achieve goals and objectives

measures. Stancope and Lancaster (2010)

5. HEALTH CARE ATTITUDES
✔ The nurse’s role at this time consist of
⮚ It refers to the family’s perception of offering guidance.
health care in general
6. EMOTIONAL COMPETENCE
B. PRIORITY SETTING
⮚ It is concerned with the degree of
emotional maturity of family members according ⮚ Determining the sequence in dealing
with identified family needs and problems.
to their developmental stage.
7. FAMILY LIVING PATTERNS 1. Family setting

⮚ It refers to intrapersonal relationships 2. Family perception

among family members, management of family 3. Practically
finances and the type of discipline at home.
4. Projected effects
8. PHYSICAL ENVIRONMENT
⮚ It includes home, school, work and
community environment. C. ESTABLISHING GOALS AND
OBJECTIVES
9. USE OF COMMUNITY FACILITIES
Goals
⮚ The ability of the family to seek and
utilize, as needed, both government-run and ⮚ Desired observable family response to
private health, education and other community planned interventions in response to a
mutually identified family need.
services.
Objectives

⮚ The desired step by step family

responses as they work toward a goat
LESSON 5: GROUP 8
⮚ Workable. welt stated objectives
should be SMART:
A. Formulating Family Nursing Care S – SPECIFIC
Plan
M – MEASURABLE
PLANNING INVOLVES:
A – ATTAINABLE
✔ Priority setting
R – RELEVANT
✔ Establishing goals and objectives
T – TIME BOUND

32
 D. DETERMINING APPROPRIATE IMPLEMENTING FAMILY
INTERVENTIONS CARE PLAN
Freeman and Heinrich categorize nursing Categories of Intervention:
interventions into three types.
 Promotive
3 Types of Nursing Interventions:
1. Supplemental Interventions - actions  Preventive
that nurse performs on behalf of the family
 Curative
when it is unable to do things 'or itself.
 Rehabilitative
2. Facilitative Interventions - actions that
remove barriers to appropriate health action
PROMOTIVE
such as assisting the family to avail to
⮚ Also known as Health Promotion
maternal and early childcare services
⮚ As stated in the 1986 world health
3. Developmental Interventions - aim to
organization Ottawa charter for Health
improve the capacity to the family to provide
tor its own health needs such as guiding the Promotion, it is process of enabling people to
family to make responsible health decisions. increase control over, and to improve
E. IMPLEMENTING THE PLAN OF their health.”
CARE ⮚ Health teaching
1. Implementation is the Step when the ⮚ Role Modelling
family or the nurse execute the plan of action.

F. EVALUATION - To evaluate is to There are 4 core services elements related to

determine or fix the value. health promotion:

✔ Formative Evaluation
1. Prevention of disease, injury and illness
✔ Summative Evaluation
2. Health education, anticipatory guidance
ASPECTS OF EVALUATION and parenting skill development
✔ Effectiveness
3. Support that builds confidence and is
✔ Appropriateness
reassuring for mothers, fathers and cares
✔ Adequacy
4. Community capacity building
✔ Efficiency

LESSON 6: GROUP 9 PREVENTIVE

⮚ Preventive Intervention or preventive
care is the care you receive to prevent illness or
33
diseases. It also includes counselling to prevent Paper Lining 2 pairs of scissors A
health problems.
(surgical and bandage)
⮚ Intervening to maintain health.
CURATIVE Extra paper for making bag for 2 pairs of forceps (curved and H
⮚ Promptly diagnosing and treating illness
waste materials straight)
using interventions that will return client to
(paper bag)
wellness most rapidly.
⮚ During complication
Plastic linen/lining Syringes (1cc, 3cc, 5cc) BP
REHABILITATIVE
⮚ Preventing further complications from an S

illness.
Apron Hypodermic needles (g. B
⮚ Bringing an ill client back to an optimal
state of wellness or helping a client to accept 19,22,23,25) A

inevitable death.
Hand towel Sterile dressings 7
⮚ Encouragement
PALLIATIVE Soap in a soap dish Sterile cord tie 2
- Includes pain
Adhesive plaster Test tube holder B
- Extend loving care to dying patient
- Ex: to ease the pain, cancer patients
with incurable diseases
2 thermometers (oral and 1 pair of rubber gloves T

1. Tools of Public Health Nurse rectal)

PHN BAG

• Is an essential and indispensable

equipment of the public health nurse
which he/she has to carry along when
he/she goes out home visiting. It contains
basic medications and articles which are
necessary for giving care.
• the following is the contents of PHN bag:
PRINCIPLES AND TECHNIQUES IN THE
USE OF PHN BAG
✔ The use of the bag technique should
minimize if not totally prevent the spread of
infection from individuals to families, hence, to
the community.
✔ Bag technique should save time and
effort on the part of the nurse in the performance
of nursing procedures.

34
✔ Bag technique should not overshadow The family-nurse relationship is developed
concern for the patient rather should show the through family-nurse contacts, which may
effectiveness of total care given to an individual take the form of a:
or family. ● Clinical Visit
✔ Bag technique can be performed in a ● Group Conference
variety of ways depending upon agency policies, ● Telephone Contact
actual home situation, etc., as long as principles ● Written Communication
of avoiding transfer of infection is carried out. ● Home Visit
✔ The bag should contain all necessary
articles, supplies and equipment which may be
I. Clinic Visit
used to answer emergency needs.
✔ The bag and its contents should be • Takes place in a private clinic
health center or barangay health
cleaned as often as possible, supplies replaced
station.
and ready for use at any time.
• It is less expensive for
✔ The bag and its contents should be well
protected from contact with any article in the the nurse and it provides the
home of the patients. Consider the bag and its
opportunity to use equipment
contents clean and /or sterile while any article
belonging to the patient as dirty and that can’t be taken to the home.
contaminated.
• Health care provided to patients
✔ The arrangement of the contents of the
on an ambulatory basis, rather
bag should be the one most convenient to the user
to facilitate the efficiency and avoid confusion. than by admission to a hospital
✔ Hand washing is done as frequently as or other health care facility. The
the situation calls for, helps in minimizing or
services may be part of a
avoiding contamination of the bag and its
contents. hospital, augmenting its
✔ The bag when used for a communicable impatient services, or may be
case should be thoroughly cleaned and
provide at a freestanding
disinfected before keeping and re-using.
facility.

Types of Family Nurse Contact Major advantage:

35
 • A family member takes the awareness among group

initiative of visiting the members.

professional health worker, • The opportunity to share

usually indicating the family experiences and practical

readiness to participate in the solutions to common health

health care process. concerns are a strength of this

• Because the nurse has greater type of family-nurse contact.

control over the environment,
distractions are Major Advantage
lessened, and the family may

feel less confident to discuss family • Provides an opportunity for

health concerns. initial contact between nurse

Disadvantage: & target families of the

• When a family is unable to community.

transport family member who
needs nursing care. • Appropriate for developing

cooperation, leadership, self-

II. Group Conference
reliance, and/or community

• Is a small group teaching awareness among group

method -The students are members.

allowed to participate actively

Disadvantage
in the discussion, explaining
• Lack of Seriousness: Often
their own experience in the conferences are not taken
seriously. The
clinical area.
participants do not take interest in the proceeding
• Appropriate for developing but consider it a pleasure trip.

cooperation, leadership, self- • Ineffective Leadership: If the

reliance and or community convener of the conference is

not competent or if the

36
 conference is not properly • Encouraging the family to

organized, or if the delegates communicate with the clinic or

are noncooperative, it creates
health center when they feel the
confusion and the whole
need for it cultivates the
exercise will turn into an
family’s confidence in the
unsuccessful activity.
health agency.
III. TELEPHONE CONTACT
Disadvantages:
• May be effective,
• Information transmitted
efficient, and appropriate if the
through is limited.
objectives and outcomes of care
• Accurate assessment of
require immediate access to family conditions usually
requires face to face contact.
data given problems on

distance or travel time. Such IV. Written Communication

data include monitoring of • is useful for minor problems

health status or progress during that do not need any direct

the acute phase of an illness attention from nurse. Written

state, change in schedule of communication can be

visit or family decision, and followed when a record of

updates on outcomes or communication is necessary. It

responses to care and treatment. is another less time-consuming

option for the nurse in instances

Major Advantage:
when there are large number of

• Provides easy access between families needing follow-up on

the nurse/health worker and the
family. top of problems of distance or

travel time. Used to give

specific information to
37
 families, such as instructions children's healthy growth and

given to parents through school development.

children. Some family doesn’t have time

Major Advantages to go to the hospital so what we

• Easy to Preserve are going to do is serve a

• It has permanent record for hospital service in their

future reference
doorstep and home visiting has
Disadvantages of Written Communication:
an advantage and
• Nurse cannot be certain that the
disadvantages.
information will reach the
Major Advantages:
intended recipient since it is a

one-way method and requires

• It allows first-hand assessment
of the home situation.
literacy and interest.
• The nurse can seek out

HOME VISIT previously unidentified needs. -

V.
It gives the nurse an
• is a nursing care that is given to
opportunity to adapt
patients at their homes It is
interventions according to
described as offering services
family resources.
to families at their doorstep in
• It promotes family participation
order to preserve their health
and focuses on the family as a
and lower rates of mortality and unit.

morbidity. And The goal of • Teaching family members in

home visitation programs is to the home are made easier by the

assist parents in creating familiar environment and the

environments that support their recognition of the need to learn

as they are faced with the actual

38
 home situation. • The o

personalized nature of home I

Disadvantages: n

-
• The cost in terms of time and
effort. h

• There are more distractions o

because the nurse is unable to
control the environment. m

• Nurse's safety. e

p
PHASES OF HOME VISIT
h
o
a
P
s
r
e
e
o
-
P
v
o
i
s
s
t
i
-
t
v
p
i
h
s
a
i
s
t
e
p
39
 h  The home visit plan focuses on

a identified family needs, particularly

s needs organized by the family as

e requiring urgent attention.

1. PRE-VISIT PHASE  The client and the family should actively

participate in planning for continuing
• Nurse contacts the family, determines care.

the willingness for a home visit, and sets  The plan should be practical and
adaptable.
an appointment with them.
2. IN-HOME PHASE
• A plan for the home visit is formulated
during this phase. • This phase begins as the nurse seeks

• Being a professional contact with the permission to enter and lasts until he or
family, the home visit should have a
purpose. she leaves the family’s home.
Purposes:
• It is consisting of initiation,
implementation, and termination.
 To have a more accurate assessment

 To educate the family about measures of

health promotion, disease prevention ➢ INITIATION

and control of health problems. • It is customary to knock or ring the

 To provide supplemental interventions doorbell and at the same time, in a

for the sick, disabled or dependent reasonably loud but nonthreatening

family member. voice say, “Tao po. Si Jenny po to, nurse

 To provide family with greater access to sa health center?”
health resources in the community.
• On entering the home, the nurse
 Use information about the family
acknowledges the family members with
collected from all possible sources such
a greeting and introduces himself and
as records, other personnel or agency, or
the agency he represents.
previous contacts with the family.
40
 • Observes environment for his own
safety and sits as the family directs him
to sit.
• Establish rapport by initiating a short
conversation.
• States the purpose of the visit the source
of information.
➢ IMPLEMENTATION
• Involves the application of the nursing
process, assessment, provision of direct
nursing care as needed, and evaluation.
➢ TERMINATION
• Consists of summarizing with the
family the events during the home visit
and setting
• a subsequent home visit or another form
of family-nurse contact.
• Use this time to record findings, such as
vital signs of family members and body
weight.
3. POST-VISIT PHASE
• Takes place when the nurse has returned
to the health facility.
• Involves documentation of the visit.
• record visit, plan for next visit, follow
up plan
LESSON 7: GROUP 10
41
Family Health Care Researchers
1. RELATED STUDIES
- This are studies that has been
already conducted or done in which
present proposed studies is related
or has some similarities, this are
sometimes unpublished papers or
materials such as manuscripts,
theses, dissertation, and journal
articles.
- Related studies are also classified
into foreign and local studies:
Local studies are studies that are
completed but usually unpublished,
this are materials that are related to
a specific geographic area.
Foreign studies are studies that are
conducted in foreign lands.
Importance, Functions, Purposes
1) They help or guide the
researcher in searching for or
selecting better research
problems or topics.
2) They help the investigator
understand his topic for research
better.
3) They ensure that there will be no
duplication of other studies.
4) They help and guide the
researcher in locating more
sources if related information.
5) They help and guide the
researcher in making his
research design.
6) They help and guide the
researcher in making
comparisons between findings
with the findings of other
researchers on similar studies.
A substantial body of research reports of illness
related distress and its impact on quality of life
for the person living with illness as well as for
their significant others (i.e., spouses and family
caregivers) is available. Most of these studies
focus on the individual. There are, however, few
studies that focus on the family system and
describe illness experiences from the perspective
of the family as a unit.
1. These studies show that living with illness is
experienced as family vulnerability, helplessness,
strain, and suffering,
2. as a struggle to make sense and maintain
normality in family living
3. and as bringing about difficulties in family
relationships.
SAMPLES
Family Resources for Children
The focus of most research has been on
family factors that create disadvantages for
children's health, but several research themes
identify ways that families protect children's
health. First, family practices that promote
stability and routine and minimize physical
punishment (Cavanagh & Fomby, 2019; Gershoff
et al., 2018; Schreier & Chen, 2013) can benefit
youth. Second, parents' good health reduces the
stress of parenting and contributes to family
stability (Hardie & Turney, 2017).
42
Child Health Measures
The focus on emotional and behavioral
symptoms reflects current concerns about mental
health in the early life course; about 21% of
children aged 2 to 17 have a diagnosed behavioral
or psychological condition, and trend data
indicate increasing rates of depressive symptoms
and suicidal thoughts and behaviors among youth
(The Annie E. Casey Foundation, 2016).
Parent Characteristics and Family Stress
Recent research has advanced
understanding of how stress and health spread
between family members and has directed
attention to stressful family dynamics for children
associated with parents' financial resources,
health problems, relationship problems, and
aggression. Inadequate financial resources are a
major source of children's stress, and financial
strain and poverty contribute to family instability
and many of the specific family stressors
described below. Child poverty rates have
remained high (about 20%) since the 1970s
(Chaudry & Wimer, 2016).
The Long Arm of Family Ties in Childhood
In line with a cumulative disadvantage
perspective, childhood family ties have
consequences for health in adulthood. This
occurs in part because stressful family
environments in childhood activate physiologica l
(e.g., cardiovascular reactivity), psychological
(e.g., emotional reactivity), behavioral (e.g., self‐
medication with drugs, alcohol), and social (e.g.,
educational attainment) processes that affect
health both directly and indirectly by increasing
the risk of social isolation and relationship strain
and instability throughout life (Miller et al., 2011;
Repetti et al., 2011)
2. EVIDENCE – BASED PRACTICES
What is EBP?
- EBP is a process used to review,
analyze, and translate the latest
scientific evidence. The goal is
to quickly incorporate the best
available research, along with
clinical experience and patient
preference, into clinical
practice, so nurses can make
informed patient-care decisions
(Dang et al., 2022).
- The “Evidence-Based”(EB)
approach requires us to make
conscientious, explicit and
judicious use of the current best
research evidence when making
clinical decision for our
patients. It also requires the
integration of this best evidence
with our clinical expertise and
our patient’s unique values and
circumstances (David Sackett).
- It is a method by which
practitioners across the
healthcare professions review
and assess the most current,
highest-quality research to
inform their delivery of care.
43
- EBP is the cornerstone of
clinical practice. Integrating
EBP in nursing practice
improves quality of care and
patient outcomes.
What Are the 3 Components of
Evidence-Based Practice?
1) Best external evidence:
Evaluate and implement the
most current, clinically relevant,
and scientifically sound
research.
2) Individual clinical expertise:
Draw on your personal
experience of what has worked
and not worked in your clinical
practice.
3) Patient values and
expectations: Consider and
value the preferences of your
individual patients.
What Types of Research Are Used in
Evidence-Based Practice?
Levels of evidence in healthcare
research can be grouped into four
categories according to how credible
the information is. These four
categories, ranging from the most
credible to least, include:
a) Randomized controlled trial
b) Evidence from cohort, case-
control, or observational studies
c) Expert opinions that are
supported by experience,
studies, or report
d) Personal experience
What Are the 5 Steps of Evidence-
Based Practice?
According to the Cleveland Clinic,
there are five steps in the process of Benefits to the field of nursing
implementing evidence- based include:
medicine practice.4 Also known as
1. Prioritizing the needs of
the “five A’s of evidence based
patients.
practice” in health science, these
steps include: 2. Better patient care decisions that
also save nurses time.
1. Ask: Formulate answerable 3. Our daily need for valid up-to-
clinical questions about a date information about
patient, problem, intervention, diagnosis, prognosis, therapy
or outcome. and prevention.
2. Acquire: Search for relevant 4. Our inability to afford more than
evidence to answer questions. a few seconds per patient for
3. Appraise: Determine whether or finding and assimilating
not the evidence is high-quality 5. evidence to answer these
and valuable. questions or to set aside more
4. Apply: Make clinical decisions than half an hour per week for
utilizing the best available 6. general reading and study
evidence. 7. Inadequacy of traditional
5. Assess: Evaluate the outcome of sources (textbooks) for keeping
applying the evidence to the up-to-date with new evidence
patient’s situation.

Examples of Evidence-Based Practice

Some healthcare organizations
choose to add a sixth step,
“disseminate,” to the cycle.5 When
you share your own research and
evidence with colleagues, this
supports the widespread use of
evidence-based practice in nursing.
You can disseminate knowledge by
communicating the information
directly to fellow practitioners,
publishing in peerreviewed journals
or professional newsletters, or
presenting at conferences.
Benefits of Evidence-Based Practice
- Evidence-based practices have
proven to lead to better patient,
provider, and institutional
outcomes, such as more consistent
care and reduced costs.
for several reasons:
44
in Nursing
1. Giving oxygen to patients with
COPD: Drawing on evidence to
understand how to properly give
oxygen to patients with chronic
obstructive pulmonary disease
(COPD).
2. Using the correct intravenous
catheter size: Recognizing the
benefits of using smallergauge
catheters to improve patient
comfort.
3. Improving infection control
practices: Understanding that
wearing personal protective
clothing and practicing
handwashing are key to
infection control.
A formal EB approach to practice is useful
• Our daily need for valid up-to-date information
about diagnosis, prognosis, therapy and
prevention (It is estimated that for every three
patients we see in our clinic, we are faced with at
least two clinical questions requiring best current
evidence)
• Our inability to afford more than a few seconds
per patient for finding and assimilating evidence
to answer these questions or to set aside more
than half an hour per week for general reading
and study
• Inadequacy of traditional sources (textbooks)
for keeping up-to-date with new evidence
Methodologies for formally practicing an EB
approach have been developed by various
institutions and medical experts. These methods
are well described in numerous texts and articles.
A. Interprofessional Care in the Community
I. THE RURAL HEALTH UNIT
PERSONNEL
Following the establishment of the
first mission of the U. S. Mutual
Security Agency to the Philippines
in 1951, the Department of Health
made numerous studies of the health
situation in cooperation with the
Health Division of the mission. In
1952 the rural health unit project
was formed. This project
concentrated on a demonstration of
integrated health services at the
municipal level and provided a team
of professional health workers for
the demonstration.
45
 The Rural Health Act of 1954
- In July 1954, the Congress of the
Philippines passed the Rural
Health Act, calling for the
establishment of a rural health
unit in every municipality and
municipal district of the
Philippines. It also made several
administrative changes in the
rural health program, among
them the appointment of
municipal health officers, the
changing of the name of the
district health officer to
provincial health officer, the
establishment of dental services
in each congressional district,
and the general increase in
salaries of local health
personnel.
What exactly is RHU?
- RHU means Rural Health Unit.
- The office takes charge of the
effective and economical
implementation of health related
services & programs.
- Develop and formulate plans
and strategies in the prevention
and occurrence of diseases and
be in the frontline of health
services during and aftermath of
calamities, man-made or
natural.
 The revised implementing rules and
regulations (IRRs) of R.A 7305 or
the magna carta of the public health
workers stimulate that there must be
one (1) rural health physician to a
population of 20,000 (DOH,1999)
 The RHU or the health center should
have at least one physician, one
nurse, one midwife and one
sanitary inspector. In addition,
facility staff should be trained in
 specific DOH mandated courses to s
competently deliver a full range of i
health services. c
i
a
• MUNICIPAL HEALTH OFFICER n
(MHO) -
- Department head in charge of a C
municipality. o
- The MHO is the overall n
responsible officer of the Rural d
Heath Unit. u
c
ROLES AND FUNCTION: t
- ADMINISTRATOR e
p
- COMMUNITY PHYSICIAN
i
- EPIDEMIOLOGICAL AND
d
ENVIRONMENTAL HEALTH
SERVICES e
m
- MEDICO-LEGAL OFFICER
i
OF THE MUNICIPALITY
o
- INFORMATION
l
EDUCATION CAMPAIGN
o
g
i
a) Administrator of RHU
c
- Prepares the municipal health
a
plan and budget
l
- Monitors the implementation of
s
basic health service
t
- Management of the RHU staff
u
d
b
i
)
e
C
s
o
m - Formulate health education
m campaign on disease prevention
u - Prepares and implements
n control measures or
i rehabilitation plans
t
y
p c) Provides epidemiological and
h environmental health services in the
y community.
46
 - Studies weekly notifiable - Performs health formation,
disease reports, conducts education, and communication
investigations in times of activities
epidemics or disease outbreaks - Organizes community; and
and institute measures. - Facilitates barangay health
- Supervises over the hygienic planning and other community
and sanitary conditions of the health services (DOH,2001)
municipality, public and private
premises. • RURAL SANITATION
INSPECTOR
d) Medico-legal officer of the - Ensuring a healthy physical
community environment in the
- Attends medico-legal cases and municipality. This entails
issues medico-legal reports to advocacy, monitoring, and
the chief of police, fiscal or regulatory activities.
judge. - The sanitary inspector is an all-
- Performs autopsies upon the round health worker. He/she
request of the above mentioned gives first aid and
officials. immunizations, makes sanitary
surveys, diagnoses and treats
e) Conducts Information Education disease and fills out birth, death,
Campaign on matters of health to the and morbidity certificates.
public.
a) Administration
b) Environmental Sanitation
c) School health
THE PUBLIC HEALTH NURSE (PHN) d) Control of communicable
disease
- SUPERVISES AND GUIDES
ALL RHMs OTHERS:
- PREPARES THE FHSIS • RURAL HEALTH DENTIST
- UTILIZES THE NURSING • ADMINISTRATIVE
PROCESS ASSISTANT
- COLLABORATES WITH THE • AMBULANCE DRIVERS
OTHER MEMBERS OF THE
• BIRTHING STATION STAFF
HEALTH TEAM
• BARANGAY HEALTH
WORKERS
RURAL HEALTH MIDWIFE (RHM)
- Manage the BHS and supervises BARANGAY HEALTH WORKERS
and trains the BHW
(BHWs)
- Provides midwifery services Considered as the interface between
and executes health care
the community and the RHU. They
programs and activities for
are trained in preventive health care,
women of reproductive age
with a strong emphasis on maternal
- Conduct patient assessment and
and child care, family planning and
diagnosis for referral or further
reproductive health, nutrition and
management
sanitation.
47

R.A 7883
The barangay health workers’
benefit and incentives act entitles
them to hazard and subsistence
allowances and other benefits
(Congress of the Republic of the
Philippines, 1995).
The recommended ratio of BHW to
catchment population is 1 BHW: 20
households (DOH, 2009)
II. LOCAL GOVERNMENT UNITS
Devolution of Health Services in the Philippines
- In 1991 the Philippines
Government introduced a major
devolution of national
government services, which
included the first wave of health
sector reform, through the
introduction of the Local
Government Code of 1991.
The implementation of the
Local Government Code of
1991 resulted in the devolution
of health services to local
government units (LGUs) which
included among others the
provision, management, and
maintenance of health services
at different levels of LGUs.
- The Code devolved the delivery
of basic services and the
operation and maintenance of
local health facilities such as
provincial hospitals and health
centers from the Department of
Health (DOH) to provinces,
cities and municipalities. Local
government units are now
responsible for the performance
of functions that previously
belonged to the said national
agency. What used to be a
48
centralized national health
system became many
independent local health
systems.
Interlocal Health Zone
- An ILHZ is a clustering of
contiguous local government
units (municipalit ies,
component cities of a
province/s) with a core referral
hospital (district or provincial
hospital) wherein preventive
primary public health care is
integrated with hospital care. It
is a district health system in a
devolved set-up in which the
component local government
units (LGUs) cooperate in
health operations to better
protect the collective health of
the catchment community,
assure access of individuals in
the catchment community to a
range of services necessary to
meet their health care needs, and
to
manage more efficiently and equitably the
cooperating LGUs’ resources for health.
Officially local government in the
Philippines, often called local
government units or LGUs, are
divided into three levels –
Provinces, Municipalities, and
Barangays.
Provinces
- Outside the lone autonomous
region, the provinces are the
highest-level local government.
The provinces are organized
into component cities and
municipalities. A province is
governed by the governor and a
 legislature known as the • Population Commission
Sangguniang Panlalawigan.
DEPARTMENT OF SOCIAL
Cities and Municipalities
WELFARE AND DEVELOPMENT
- A political unit with a defined (DSWD)
territory, corporate status, and
a. It is the executive
usually some powers of
department of the
autonomous government.
Philippine Government
Examples include cities, towns,
responsible for the
and villages.
protection of the social
welfare rights of Filipinos
and to promote social
development. The DSWD is
also responsible in policy-
Barangays making and empowerment
- Every city and municipality in of the poor, vulnerable and
the Philippines is divided into disadvantage sector and
barangays, the smallest of the ensuring the provision of
local government units. social welfare and
Barangays can be further development services
divided into sitios and puroks through intermediaries such
but those divisions do not have as local government units,
leaders elected in formal nongovernment
elections supervised by the organizations and civil
national government. society.

LGU Devolved Health Services

VISION: The Department of Social
Province Hospitals and other tertiary health services
Welfare and Development envisions
Municipality Implementation of programs and projects primary
all Filipinos free health care, and
from hunger
maternal and child care, and communicable and
poverty, have equal access to
noncommunicable disease control services
opportunities, enabled by a fair, just,
and peaceful society.
Access to secondary and tertiary health services
MISSION: To lead in the
formulation, implementation,
t and
Purchase of medicines, medical supplies, and equipmen needed to
carry out the said services coordination of social welfare and
development policies and programs
for and with the poor, vulnerable,
Barangay Maintenance of barangay health center
and disadvantaged.

III. GOVERNMENT
 PROJECTS OF DSWD THE
ORGANIZATIONS
PANTAWID PAMILYANG
• DSWD - DEPARTMENT OF
PILIPINO PROGRAM or "4Ps"
SOCIAL WELFARE AND - a human development program
DEVELOPMENT that invests in the health and
• Nutrition Council
49
 education of poor families,
primarily those with children aged
0–18.
 LISTAHANAN - an information
management system that identifies
who and where the poor are in the
country. It is being operated by the
National Household Targeting
System for Poverty Reduction
(NHTS-PR).
 SUPPLEMENTAL FEEDING
PROGRAM - provision of food in
addition to the regular meals, to
target children as part of the
DSWD's ECCD program of the
government.
 DISASTER-RESPONSE
OPERATIONS - life-saving
emergency relief and longterm
response.
 GENDER AND
DEVELOPMENT - Gender is
about relations—between men and
women, women and women, also
between men and men and boys and
girls. The GAD as perspective
recognizes that gender concerns cut
across all areas of development and
therefore gender must influence
government when it plans, budget
for, implements, monitors and
evaluates policies, programs and
projects for development.
NATIONAL NUTRITION COUNCIL
- Country’s highest policy-
making and coordinating body
on nutrition Eat a wellbalanced
diet based on the Pinggang
Pinoy. In order to meet their
nutritional needs, older adults
are encouraged to consume a
healthy diet based on the
50
Pinggang Pinoy for older
persons
POPULATION COMMISSIONS
- The Commission on Population
(POPCOM) was mandated to
serve as the central coordinating
and policy making body of the
government in the field of
population. The Republic Act
6365, known as the Population
Act of the Philippines was
enacted into law by Congress,
creating the Commission on
Population.
LESSON 8: GROUP 11
Non- government Organization
A non-government organization is a non-profit
group that functions independently of any
government. NGOs, sometimes called civil
societies, are organized on community, national
and international levels to serve a social or
political goal such as humanitarian causes or the
environment.
• NGOs, or non-governmental
organizations, play a major role in international
development, aid and philanthropy.
• NGOs are non-profit by definition, but
may run budgets of millions or up to billions of
dollars each year.
• As such, NGOs rely on a variety of
funding sources from private donations and
membership dues to government contribution.
•Socio-civic Organization – comprises
establishments primarily engaged in promoting
the civic and social interest of their members.
Established in this industry may operate bars and
restaurants for their members.
 •Religious organizations – typically aim to
promote worship, prayer, meditation, teaching,
healing, and spiritual well-being in accordance
with authoritative text, codes, and laws.
•School Organization -refers to how schools
arrange the resources of time, space and
personnel for maximum effect on student
learning.
EVALUATION OF FAMILY NURSING
CARE
Family-nursing care – it is a part of the
primary care provided to the patients of all
ages, ranging from infant to geriatric health.
This strengthens the bond between the client
and the healthcare professional. Family nursing
is care that is more concerned with the needs
of the family as a whole than the client.
Evaluation – is a planned, ongoing,
purposeful activity in which the clients
progress towards the achievement of goals or
desired outcomes. It entails the family health
nursing care plan's summative and formative
review.
There are three types of evaluation, the
structure, process, and outcome evaluation.
Structure evaluation – involves looking into
the manpower and physical resources of the
agency responsible for community health
interventions. These are concerned with the
equipment, staffing, as well as other aspects of
the facility that have an effect on the standard
given care.
Process evaluation – is examining the power
by which assessment, diagnosis,
implementation and evaluation were
undertaken. These are the categories of criteria
51
to be used to measure the quality of nursing
care.
Outcome evaluation – is determining the
degree of attainment of goals and objectives.
It is basically the end of results. T hese are
patient- and goal-oriented since they
concentrate on the patient and the objectives
stated in the care plan. As a result, outcome
evaluation is the measurement of a patient's
progress—or lack thereof—against a set of
predetermined goals.
STANDARD OF EVALUATION
THE BASIS OF GOOD EVALUATIONS
ARE:
UTILITY - is the value of evaluation in terms
of usefulness of results. The evaluation of
community health interventions will be a great
use to the community health group.
FEASIBILITY - answers the questions of
whatever the plan for evaluation is doable or not,
considering available resources
PROPRIETY - involves ethical and legal
matters. Respect for the worth and dignity of the
participants in data collection should be given due
consideration.
ACCURACY - refers to the validity and
reliability of the results of evaluation.
ASSESSMENT RECORDS
RECORDS
A record is a permanent written communication
that documents information relevant to a client’s
health care management. These are the records
that contain all the information regarding the
patient's history, clinical findings, diagnostic test
results, pre- and post-operative treatment, patient
progress, and medication. It reassures the health
professional that the course of treatment is
appropriate. It is one of the key factors that
determines whether a medico-legal case is
successful or unsuccessful.
FAMILY RECORDS
All records, which relate to members of the
family. Clinical, scientific, administrative and
legal documents relating to the nursing care given
to the individual family or community. It includes
details on the illnesses of the patient's immediate
blood relations. Due to families' common genetic
backgrounds, circumstances, and behaviors, it
can help identify people who have a higher-than-
normal likelihood of developing common
ailments like heart disease, high blood pressure,
stroke, certain malignancies, and type 2 diabetes.
To know one's family's medical history enables
one to take precautions to lower risk.
HEALTH RECORDS
Confidential compilation of pertinent facts of an
individual’s health history, including all past and
present medical conditions, illnesses and
treatments, with emphasis on the specific events
affecting the patient during the current episode of
care. Each healthcare provider who performs
care contributes information to the health record,
which is then utilized to ensure continuity of
care. It contains prescription drugs, treatments,
examination results, immunization records, and
notes from doctor's appointments.
TYPES OF RECORDS ● CUMULATIVE
OR CONTINUING RECORDS
This is found to be time-saving, economical and
also it is helpful to review the total history of an
individual and evaluate the progress of a long
period. It is a graph or continuous tally to which
new data is continuously added. A cumulative
record in conditioning, for example, is a graph
that displays the total number of responses over a
continuous period of time.
52
● FAMILY RECORDS
All records, which relate to members of the
family, should be placed in a single-family
folder. This gives the picture of the total services
and helps to give effective, economic service to
the family as a whole. In order to ensure that the
appropriate steps are taken, the family health
record should specify the actual actions that were
taken as well as the assignment of responsibility
to family members and other community
resources.
FILLING OF RECORDS
Different systems may be adopted depending on
the purposes of the records and on the merits of
a system. The records could be arranged:
● ALPHABETICALLY- in the order of the
letters of the alphabet (surname)
● NUMERICALLY- filed numerically
according to patients medical record
numbers.
● GEOGRAPHICALLY- based on or
derived from the physical features of an
area.
● WITH INDEX CARDS- used for
recording and storing small amounts of
discrete data.
● Reports - -It may refer to specific
periods, events, occurrence, or subject
and may be communicated or presented
in oral or written form. These are
necessary for the continuation of
delivery of family health care services
and its evaluation.
- And also it provides a basis for
performance measurement and in turn
strategic planning for an improved
hospital management.
TYPES OF REPORTS
ORAL REPORTS -These are given when the
information is for immediate use and not for
permanency. One of the examples of oral reports
is when we are doing endorsement to our co-
nurses wherein we will report to them all our
patient’s data and she/he will be the one who will
continue reading healthcare to that patient.
WRITTEN REPORTS- Reports are to be
written when the information to be used by
several personnel, which is more or less of
permanent value . When we are doing our written
reports it should be clear, concise, free from
erasures, readable and most especially organize.
TYPES OF REPORTS USED IN THE
HOSPITAL SETTING
● Change-of-shift report or 24 hours
report- Provide only essential
background information about the client
(name, age, sex, diagnosis, and medical
history) but do not review all routine
care procedures or tasks.
● Transfer reports- involve the
communication of information about
clients from the nurse on sending unit to
the nurse on the receiving unit.
● Census report - This is a report
compiled daily for the number of
patients.
● Birth and death report- The nurse is
responsible for sending the birth and
death report to governmental authorities
for registration within the specified time.
● Incident report - The nurse who
witnessed the incident or who found the
client at the time of the incident should
file the report.
● Effective Health Record - transmitted
data such as laboratory results and
summary of care, and patient-generated
data such as symptoms.
IMPORTANCE AND USES
IMPORTANCE
• Provides documentation of services.
53
• To provide the practitioner with data.
• Provides baseline data.
• Provides an opportunity for providing an
evaluation
• Records are tool of communication
• Effective health records show health problems.
USES FOR A NURSE:
● Provide documentation of services
rendered, i.e. shows the health
condition of the client, Good reports
and records are essential to effective
healthcare administration.
● Provide data essential for planning and
evaluation of services for further
improvement. Records and reports
serve as effective channels for the
transmission of information from one
level to another.
FOR INDIVIDUAL/ FAMILY
• Help them to become aware and to recognize
their health needs.
• Records serve to document the history of the
client.
• Records assist in the continuity of care.
USES FOR THE DOCTOR:
● Serves as a guide for diagnosis,
treatment, follow up and evaluation of
services.
● Indicate progress and continuity of care.
● Help self-evaluation of medical practice.
USES FOR THE COMMUNITY:
 ● Keeping records facilitates improved
decision-making.

● Records offer trustworthy documentation

and details on who, what, when, and why
something happened.

CRITERIA OF GOOD REPORT AND

RECORD

● Accuracy - it refers to the proper

coverage of your topic in an appropriate
detail. -true facts, precise wording,
supporting data.

● Confidentiality - it is a document that

states that the information Disclosed to
the recipient can't be disclosed to anyone
outside of the agreement.
● Up to date- A great resource for Nursing
and Clinical Science students and
researchers to stay current on the most
recent medical information and
treatments.

● Organization- generating the energy,

flow of ideas, and proactive work needed
to maintain a healthy profession that
advocates for the needs of its clients and
nurses, and the trust of society.

54

FINALS
GROUP 11
COURSE CONTENT:
4. Non-Government Organizations
● Socio-Civic Organizations
● Religious Organizations
● Schools
B. Evaluation of Family Nursing Care
1. Evaluation Process and Outcome
2. Re-assessment
Records in Family Health Nursing Practice
A. Importance and Uses
B. Types of Records and Reports
•Non- government Organization A non-
government organization is a non-profit group
that functions independently of any government.
NGOs, sometimes called civil societies, are
organized on community, national and
international levels to serve a social or political
goal such as humanitarian causes or the
environment.
• NGOs, or non-governmental organizations, play
a major role in international development, aid and
philanthropy.
• NGOs are non-profit by definition, but may run
budgets of millions or up to billions of dollars
each year.
• As such, NGOs rely on a variety of funding
sources from private donations and membership
dues to government contribution.
•Socio-civic Organization – comprises
establishments primarily engaged in promoting
the civic and social interest of their members.
Established in this industry may operate bars and
restaurants for their members.
•Religious organizations – typically aim to
promote worship, prayer, meditation, teaching,
healing, and spiritual well-being in accordance
with authoritative text, codes, and laws.
•School Organization -refers to how schools
arrange the resources of time, space and
personnel for maximum effect on student
learning
EVALUATION OF FAMILY NURSING
Family-nursing care – it is a part of the primary
care provided to the patients of all ages, ranging
from infant to geriatric health. This strengthens
the bond between the client and the healthcare
professional. Family nursing is care that is more
concerned with the needs of the family as a whole
than the client.
Evaluation – is a planned, ongoing, purposeful
activity in which the clients progress towards the
achievement of goals or desired outcomes. It
entails the family health nursing care plan's
summative and formative review.
There are three types of evaluation, the
structure, process, and outcome evaluation.
Structure evaluation – involves looking into
the manpower and physical resources of the
agency responsible for community health
interventions. These are concerned with the
equipment, staffing, as well as other aspects of
the facility that have an effect on the standard
given care.
Process evaluation – is examining the power by
which assessment, diagnosis, implementation and
evaluation were undertaken. These are the
categories of criteria to be used to measure the
quality of nursing care.
Outcome evaluation – is determining the degree
of attainment of goals and objectives. It is
basically the end of results. These are patient- and
goal-oriented since they concentrate on the
patient and the objectives stated in the care plan.
As a result, outcome evaluation is the
measurement of a patient's progress—or lack
thereof—against a set of predetermined goals.
STANDARD OF EVALUATION THE BASIS
OF GOOD EVALUATIONS ARE:
UTILITY - is the value of evaluation in terms of
usefulness of results. The evaluation of
community health interventions will be a great
use to the community health group.
FEASIBILITY - answers the questions of
whatever the plan for evaluation is doable or not,
considering available resources
PROPRIETY - involves ethical and legal
matters. Respect for the worth and dignity of the
participants in data collection should be given
due consideration.
ACCURACY - refers to the validity and
reliability of the results of evaluation.
ASSESSMENT RECORDS
RECORDS
A record is a permanent written communication
that documents information relevant to a client’s
health care management. These are the records
that contain all the information regarding the
patient's history, clinical findings, diagnostic test
results, pre- and post-operative treatment, patient
progress, and medication. It reassures the health
professional that the course of treatment is
appropriate. It is one of the key factors that
determines whether a medico-legal case is
successful or unsuccessful.
FAMILY RECORDS
All records, which relate to members of the
family. Clinical, scientific, administrative and
legal documents relating to the nursing care given
to the individual family or community. It includes
details on the illnesses of the patient's immediate
blood relations. Due to families' common genetic
backgrounds, circumstances, and behaviors, it
can help identify people who have a higher-than-
normal likelihood of developing common
ailments like heart disease, high blood pressure,
stroke, certain malignancies, and type 2 diabetes.
To know one's family's medical history enables
one to take precautions to lower risk.
HEALTH RECORDS
Confidential compilation of pertinent facts of an
individual’s health history, including all past and
present medical conditions, illnesses and
treatments, with emphasis on the specific events
affecting the patient during the current episode of
care. Each healthcare provider who performs care
contributes information to the health record,
which is then utilized to ensure continuity of care.
It contains prescription drugs, treatments,
examination results, immunization records, and
notes from doctor's appointments.
TYPES OF RECORDS
● CUMULATIVE OR CONTINUING
RECORDS
This is found to be time-saving, economical and
also it is helpful to review the total history of an
individual and evaluate the progress of a long
period. It is a graph or continuous tally to which
new data is continuously added. A cumulative
record in conditioning, for example, is a graph
that displays the total number of responses over a
continuous period of time
. ● FAMILY RECORDS
All records, which relate to members of the
family, should be placed in a single-family folder.
This gives the picture of the total services and
helps to give effective, economic service to the
family as a whole. In order to ensure that the
appropriate steps are taken, the family health
record should specify the actual actions that were
taken as well as the assignment of responsibility
to family members and other community
resources.
FILLING OF RECORDS
Different systems may be adopted depending on
the purposes of the records and on the merits of a
system. The records could be arranged:
● ALPHABETICALLY- in the order of the
letters of the alphabet (surname)
● NUMERICALLY- filed numerically
according to patients medical record numbers.
● GEOGRAPHICALLY- based on or derived
from the physical features of an area.
● WITH INDEX CARDS- used for recording
and storing small amounts of discrete data.
● Reports - -It may refer to specific periods,
events, occurrence, or subject and may be
communicated or presented in oral or written
form. These are necessary for the continuation of
delivery of family health care services and its
evaluation.
- And also it provides a basis for performance
measurement and in turn strategic planning for an
improved hospital management.
TYPES OF REPORTS
ORAL REPORTS -These are given when the
information is for immediate use and not for
permanency. One of the examples of oral reports
is when we are doing endorsement to our co-
nurses wherein we will report to them all our
patient’s data and she/he will be the one who will
continue reading healthcare to that patient.
WRITTEN REPORTS- Reports are to be
written when the information to be used by
several personnel, which is more or less of
permanent value. When we are doing our written
reports it should be clear, concise, free from
erasures, readable and most especially organize.
TYPES OF REPORTS USED IN THE
HOSPITAL SETTING
● Change-of-shift report or 24 hours report-
Provide only essential background information
about the client (name, age, sex, diagnosis, and
medical history) but do not review all routine care
procedures or tasks.
● Transfer reports- involve the communication
of information about clients from the nurse on
sending unit to the nurse on the receiving unit.
● Census report- This is a report compiled daily
for the number of patients.
● Birth and death report- The nurse is
responsible for sending the birth and death report
to governmental authorities for registration
within the specified time.
● Incident report- The nurse who witnessed the
incident or who found the client at the time of the
incident should file the report.
● Effective Health Record- transmitted data
such as laboratory results and summary of care,
and patient-generated data such as symptoms.
IMPORTANCE AND USES IMPORTANCE
• Provides documentation of services.
• To provide the practitioner with data.
• Provides baseline data.
• Provides an opportunity for providing an
evaluation
• Records are tool of communication
• Effective health records show health problems.
USES FOR A NURSE:
● Provide documentation of services rendered,
i.e. shows the health condition of the client, Good
reports and records are essential to effective
healthcare administration.
● Provide data essential for planning and
evaluation of services for further improvement.
Records and reports serve as effective channels
for the transmission of information from one
level to another
FOR INDIVIDUAL/ FAMILY
• Help them to become aware and to recognize
their health needs. • Records serve to document
the history of the client.
• Records assist in the continuity of care
. USES FOR THE DOCTOR:
 ● Serves as a guide for diagnosis, treatment,
follow up and evaluation of services
. ● Indicate progress and continuity of care.
● Help self-evaluation of medical practice.
USES FOR THE COMMUNITY:
● Keeping records facilitates improved decision-
making.
● Records offer trustworthy documentation and
details on who, what, when, and why something
happened
CRITERIA OF GOOD REPORT AND
RECORD
● Accuracy - it refers to the proper coverage of
your topic in an appropriate detail. -true facts,
precise wording, supporting data.
● Confidentiality - it is a document that states
that the information Disclosed to the recipient
can't be disclosed to anyone outside of the
agreement.
● Up to date- A great resource for Nursing and
Clinical Science students and researchers to stay
current on the most recent medical information
and treatments.
● Organization- generating the energy, flow of
ideas, and proactive work needed to maintain a
healthy profession that advocates for the needs of
its clients and nurses, and the trust of society.
GROUP 12
8. Expanded Program of Immunization (EPI)
I. Introduction
The Expanded Programme on Immunization
(EPI) includes activities including disease
surveillance, illness vaccination in accordance
with program objectives, and the acquisition of
vaccines and the supplies required for vaccine
administration. It was established in 1976 to
ensure that infants/children and mothers have
access to routinely recommended
infant/childhood vaccines. This program
primarily aims to reduce the morbidity and
mortality among children against the most
common vaccine-preventable diseases (VPDs)
which includes tuberculosis, poliomyelit is,
diphtheria, tetanus, pertussis and measles. The
following vaccinations are covered by the EPI:
Tetanus Toxoid, Oral Poliovirus Vaccine,
Pentavalent Vaccine, Measles Containing
Vaccines (Anti Measles Vaccine, Measles,
Mumps, Rubella), BCG birth dose, Hepatitis B
birth dose, and Hepatitis B birth dose.
Pneumococcal Conjugate Vaccine 13 was added
to the EPI vaccination schedule in 2014. The
National Immunization Program will replace the
Expanded Program on Immunization in 2016.
R.A. The Mandatory Infants and Children Health
Immunization Act of 2011, also known as H.R.
10152, requires the basic immunization against
diseases that can be prevented by vaccines. R.A.
For infants and children under the age of eight,
7846 mandated hepatitis B vaccination as a
requirement for health care.
II. Case Scenario
The global Expanded Program on Immunization
(EPI) was launched by the World Health
Organization (WHO) in May 1974. Achieving
high levels of vaccine protection in sizable
populations is the goal of vaccination regimens.
According to WHO estimates from 2002, 1.4
million children under the age of five died from
illnesses that could have been avoided with
regular immunizations. According to estimates,
the EPI globally decreased child mortality by 2-3
million cases. The COVID-19 pandemic's burden
on healthcare systems, lockdown measures, and
disrupted immunization services appear to be
putting the EPI at risk right now.
III. Interventions/Strategies
The intervention or strategies are classified into
three: program goals, program target, and
program strategies. In program goals, the overall
goal is to reduce the morbidity and mortality
among children against the most common
vaccine-preventable diseases. Also, the specific
goal of these is: To immunize all infants/children
against the most common vaccine-preventable
diseases; To sustain polio-free status of the
Philippines; To eliminate measles infection; To
eliminate maternal and neonatal tetanus; To
control diphtheria, pertussis, hepatitis b and
German Measles; To prevent extra pulmonary
tuberculosis among children. The program target
is to achieve 95% fully immunized child
coverage. Additionally, the program strategies
are to: administering routine vaccinations to
newborns, kids, and mothers via the Reaching
Every Purok Strategy, Supplemental
immunization Activities (SIA), Vaccine-
Preventable Disease Surveillance, and
Procurement of adequate and potent vaccines and
needles and syringes to all health facilities
nationwide.
IV. Status of implementation/
Accomplishment
Polio Eradication
Mostly affecting young children who have not
finished their vaccination programs, polio is a
highly contagious disease. Poor sanitation and
other factors contribute to the disease's primary
method of transmission from person to person:
feces to the mouth by good hygiene standards and
far less frequently through tainted food or drink.
After multiplying in the colon, the poliovirus can
infiltrate the neurological system and result in
paralysis or even death. The first known verified
case of the polio outbreak in the Philippines,
however, came from a 3-year-old child in Lanao
del Sur on September 19, 2019. After
polioviruses were found in waterways in the
National Capital Region in July 2019, the
Sabayang Patak Kontra Polio campaign was
launched (NCR). The first quarter of 2020 saw
the continuation of immunization rounds in
Mindanao and the NCR, reaching 4.5 million
kids—more than 95% of the intended target
population. In order to ensure that the community
has enough protection to limit the spread of polio
in the Philippines, it is critical to achieve at least
95% coverage for each round of the polio
immunization campaign.
Measles Elimination
The Anti-measles vaccine (AMV 1) − Content:
Live, attenuated viruses − Form: Freeze-dried,
reconstituted with a special diluent, it is used to
protect the people from measles. A supplemental
immunization campaign for measles and rubella
(German measles) was done in 2011. "Iligtas sa
Tigdas ang Pinas" was the name given to this;
15.6 million (84%) of the Between April and June
2011, 18.5 million kids between the ages of 9
months and 8 years old received the measles-
rubella (MR) vaccine in one dose. The Philippine
government invested PhP 635.7 million to ensure
that the MR campaign was high-quality and that
NO children were missed in any barangay.
Maternal and Neonatal Tetanus Elimination
The vaccine used for this is the Tetanus vaccine
(tetanus toxoid), its content: Weakened toxin and
its form: Clear, colorless liquid, sometimes
slightly turbid. Indicators of unequal access to
immunization and other maternal, newborn, and
child health services include maternal and
neonatal tetanus (MNT), which has been one of
the most often occurring and potentially fatal
effects of unhygienic births and umbilical cord
care practices. Tetanus in infants is a terrible
condition that claimed 34,000 lives globally in
2015. While newborn mortality is still significant,
MNT deaths can be avoided by using sanitary
delivery and cord-care procedures and by
vaccinating both adults and children against
tetanus.
Control of other common vaccine-preventable
diseases (Diphtheria, Pertussis, Hepatitis B
and Meningitis/Encephalitis secondary to H.
influenzae type B)
Continuous DPT or DPT-HepB-HiB Type B
vaccination for children and babies. Annex 1 EPI
Annual Accomplishment Report. All of the
vaccines, needles, and syringes needed for
immunization campaigns aimed at mothers,
children, and babies are purchased by DOH
Hepatitis B Control
The Republic Act No. 10152 is now in effect. It
is also referred to as the "Mandatory Infants and
Children Health Immunization Act of 2011," and
it mandates that all children under the age of five
receive the fundamental immunizations against
diseases that can be prevented by vaccination.
The birth dose of the Hepatitis-B vaccine must be
administered to all newborns within 24 hours of
birth, according to the provisions of this bill. The
objective of hepatitis B control is to lower the rate
of chronic hepatitis B infection, as determined by
HBsAg prevalence, in five-year-olds born after
routine immunization began 100% hepatitis B
vaccination at birth, to less than 1%.
Vaccines and cold chain management
Since 2003, equipment used in the cold chain has
been upgraded in 80 provinces, 38 cities, and 16
regions. In December 2011, an efficient
assessment of vaccine management was carried
out, which identified cold chain capacity
shortages at all levels, from the national to the
implementer level. To close the gaps found
during the assessment, a total of PhP 267 million
is needed.
Introduction to New Vaccines
Pneumococcal and Rotavirus vaccines will be
included in the national immunization program in
2012. Infants from households nationwide who
are designated in the National Housing and
Targeting System (NHTS) for Poverty Reduction
will receive vaccinations in priority. The
purchase of these 2 vaccinations will cost a total
of PhP 1.6 billion, according to the Philippine
government.
V. Future Plan/ Action
● Strengthening the Cold Chain to support the
Immunization Program
● Capacity Building for Health Workers for the
Introduction of New Vaccines
● Advocacy for the financial sustainability for the
newly introduced vaccines for expansion.
● Development of the comprehensive multi-year
plan for immunization program
VI. Other Significant information worth
mentioning
One significant milestone is that the budget
allocation for the immunization program has
continued to increase year by year. Also, the
Government of the Philippines allocated a budget
for the immunization of all
infants/children/women/older persons
nationwide.
I. Introduction
Integrated Management of Childhood illnesses
(IMCI) is a strategy formulated by the World
Health Organization (WHO) and the United
Nations Children's Fund (UNICEF), presented in
1996 as the principal strategy to improve child
health. It focuses on the care of children under
five, not only in terms of their overall health
status but also on the diseases that may
occasionally affect them. In addition, IMCI
incorporates a strong component of prevention
and health promotion as an integral part of care.
Thus, among other benefits, it helps increase
vaccination coverage and improve knowledge
and home-care practices for children under five,
subsequently contributing to growth and healthy
development.
II. Children who are covered by the IMCI
protocol
1. Sick children birth up to 2 months (Sick Young
Infant)
2. Sick children 2 months up to 5 years old (Sick
child)
III. Objectives of Integrated Management of
Childhood illnesses (IMCI)
1. Reducing infant mortality.
2. Reducing the incidence and seriousness of
illnesses and health problems that affect boys and
girls.
3. Improving growth and development during the
first five years of a child's life
IV. Five Disease Focus of IMCI
There are 10 million children who die annually
due to 5 preventable, treatable conditions,
including pneumonia, diarrhea, malaria, measles,
and malnutrition. These five conditions are
estimated to be responsible for three (3) out of
four (4) episodes of childhood illness. Therefore,
IMCI focuses on these five illnesses
VI. Steps in the IMCI Case Management
Process
1. Assess the child's illness a child by checking
first for general danger signs (or possible
bacterial infection in a young infant), asking
questions about common conditions, examining
the child, and checking nutrition and
immunization status. Assessment includes
checking the child for other health problems.
2. Classify the illness based on signs Classify a
child’s illnesses using a color-coded
classification system. Because many children
have more than one condition. The child’s illness
is classified based on a color-coded triage system
Basis for Classifying the Child’s Illness
• PINK- indicates urgent hospital referral or
admission
• YELLOW- indicates initiation of specific
Outpatient Treatment
• GREEN – indicates supportive home care
3. Identify treatment
Identify specific treatments for the child. If a
child requires urgent referral, give essential
treatment before the patient is transferred. If a
child needs treatment at home, develop an
integrated treatment plan for the child and give
the first dose of drugs in the clinic. If a child
should be immunized, give immunizations.
4. Treat the child Provide practical treatment
instructions, including teaching the caregiver
how to give oral drugs, how to feed and give
fluids during illness, and how to treat local
infections at home. Ask the caregiver to return for
follow-up on a specific date, and teach her how to
recognize signs that indicate the child should
return immediately to the health post.
5. Counsel the caretaker Assess feeding,
including assessment of breastfeeding practices,
and counsel to solve any feeding problems found.
Then counsel the mother about her own health.
6. Follow-up When a child is brought back to the
health post as requested, give follow-up care and,
if necessary, reassess the child for new problems.
VII. Case Management Process in more detail.
The IMNCI case management process is
presented on two different sets of charts: one for
managing sick young infants aged from birth up
to two months and a separate one for managing
sick children aged from two months up to five
years. Therefore, you need to know the child's age
to select the appropriate chart and begin the
assessment process.
10. Early Essential Intrapartal and Newborn
Care (EEINC)
I. Introduction
- Evidence-based standards for safe and quality
care of birthing mothers and their newborns,
within the 48 hours of intrapartum period (labor
and delivery) and a week of life for the newborn.
- Can prevent at least half of newborn deaths
without additional cost to both families and
hospitals.
- Distinguishes the necessary practices in the
delivery and care for the newborn and the mother
from the unnecessary.
- Developed the Newborn Care Technical
Working Group (TWG) that conducted a
systematic search and critical appraisal of foreign
and local medical and allied health literature on
practices in the immediate newborn period. An
evidence-based draft was then developed and
reviewed by the Department of Health (DOH),
United Nations Children’sFund (UNICEF),
United Nations Population Fund (UNFPA), the
Philippine Obstetrical and Gynecological Society
(POGS), the Philippine Society of Newborn
Medicine (PSNbM, a subspecialty society of the
Philippine Pediatric Society, PPS), other health
professional organizations/associations, Save the
Children, the academe and other stakeholders -
The signing of the Administrative Order 2009-
0025 last Dec. 1, 2009 institutionalized policies
and guidelines for government and private health
facilities to adopt the essential newborn care
protocol. Advocacy and dissemination for a have
been done since its launch.
- The Maternal, Newborn, Child Health, and
Nutrition (MNCHN) Strategy is in line with the
DOH Administrative Order 2008-0029 that seeks
to rapidly reduce maternal and newborn
morbidity and mortality. Foremost to this is the
provision of Basic and Comprehensive
Emergency Obstetric and Newborn Care
(BEmONC and CEmONC) capability of health
facilities to meet the UN MDGs 4 and 5.
- The ENC Protocol seeks to provide a firm
foundation for an environment that complies with
the “Ten (10) Steps to Successful Breastfeeding”
of the Mother-Baby Friendly Hospital Initiative
(MBFHI), breastfeeding initiation crucial to the
IYCF WHO global strategy and in the
implementation of the R.A. 10028.
- At the community level, the local government
up to the barangay officials, together with their
health workers, nutrition scholars, community
health teams and volunteers, mothers groups are
likewise enjoined to ensure proper information is
disseminated to pregnant women and women of
the reproductive age group.
- Healthcare professionals, either in government
or in private facilities, involved in maternal and
newborn care not limited to obstetrician-
gynecologists, pediatricians/neonatologists,
nurses, midwives, but also the hospital
administration officials, anesthesiologists,
hospital infection control officers, hospital
PhilHealth/ Quality officers, clinical nutritionists,
clinical pharmacists, nursing attendants, health
promotion and information officers.
- The wide variations in newborn care practices
in health facilities, both government and private,
and also the proper sequence or order of newborn
care services need to be standardized based on
current evidence that show reduction in neonatal
mortality and morbidity. This is to achieve the
United Nations Millennium Development Goal 4
of Reducing Under 5 Child Mortality (through
reduction of neonatal deaths)
II. Recommended EEINC Practices during
Intrapartum Period
- Continuous maternal support by having a
companion of her choice during labor and
delivery
- Freedom of movement during labor
- Monitoring the progress of labor using
partograph
- Non-drug pain relief before offering labor
anesthesia
- Position of choice during labor and delivery
- Spontaneous pushing in a semi-upright position
- Non-routine episiotomy
- Active Management of Third Stage of Labor
(AMTSL)
III. Recommended EINC Practices for Newborn
Care
At the heart of the protocol are four time-bound
interventions:
1. Immediate Drying
- Using a clean, dry cloth, thoroughly dry the
baby, wiping the face, eyes, head, front and back,
arms and legs.
2. Skin-to-skin Contact
- If a baby is crying and breathing normally, avoid
any manipulation, such as routine suctioning, that
may cause trauma or introduce infection
- Place the newborn prone on the mother’s
abdomen or chest, skin-to-skin.
- Cover newborn’s back with a blanket and head
with a bonnet. Place an identification band on
ankle.
3. Proper Cord Clamping and Cutting
- Clamp and cut the cord after cord pulsations
have stopped (typically at 1-3 minutes)
- Put ties tightly around the cord at 2 centimeters
and 5 centimeters from the newborn’s abdomen.
- Cut between ties with sterile instruments.
- Observe for oozing blood.
- Do not milk the cord towards the newborn.
- After cord clamping, ensure oxytocin 10 IU IM
is given to the mother.
4. Unang Yakap (First Embrace) of the Mother
and Her Newborn for Early Breastfeeding
Initiation
- Observe the newborn. Only when the newborn
shows feeding cues (e.g., opening of mouth,
tonguing, licking, rooting), make verbal
suggestions to the mother to encourage her
newborn to move toward the breast (e.g.,
nudging)
- Counsel on positioning and attachment.
- When the baby is ready, advise the mother to:
a. Make sure the newborn’s neck is neither flexed
nor twisted.
b. Make sure the newborn is facing the breast,
with the newborn’s nose opposite her nipple and
chin touching the breast.
c. Hold the newborn’s body close to the mother’s
body.
d. Support the newborn’s whole body, not just the
neck and shoulders.
e. Wait until her newborn’s mouth is opened
wide.
f. Move her newborn onto her breast, aiming the
newborn’s lower lip well below the nipple.
g. Look for signs of good attachment and
suckling:
● Mouth wide open
● Lower lip turned outward
● Baby’s chin touching breast
● Sucking is slow, deep with some pauses
● If the attachment or suckling is not good, try
again and reassess.
DON’TS
● Health workers should not touch the newborn
unless there is a medical indication.
● Do not give sugar water, formula or other pre-
lacteals.
● Do not give bottles or pacifiers.
● Do not throw away colostrum.
IV. Essential Newborn Care from 90 Minutes
to 6 Hours of Life 1. Give Vitamin K
Prophylaxis
2. Inject Hepatitis B and BCG vaccinations at
birth
3. Examine the baby
4. Check for birth injuries, malformations or
defects
5. Cord care
V. Care Prior to Discharge After 90 minutes
but prior to discharge: 1. Support unrestricted,
per demand breastfeeding, day, and night
- Keep the newborn in the room with his/her
mother, in her bed, or within easy reach. Do not
separate them (rooming-in). Support exclusive
breastfeeding on demand day and night.
2. Ensure warmth of the baby
- Ensure the room is warm (>25 oC and draft-
free). Explain to the mother that keeping the baby
warm is important for the baby to remain healthy.
- Keep the baby in skin-to-skin contact with the
mother as much as possible. Dress the baby or
wrap in soft dry clean cloth. Cover the head with
a cap for the first few days, especially if the baby
is small.
3. Washing and bathing (Hygiene)
- Wash your hands. Wipe the face, neck, and
underarms with a damp cloth daily. Wash the
buttocks when soiled. Dry thoroughly. Bathe
when necessary, ensuring that the room is warm
and draft-free, using warm water for bathing and
thoroughly drying the baby, then dressing and
covering after the bath. If the baby is small,
ensure that the room is warmer when changing,
wiping, or bathing.
11. Newborn Screening Center
- a facility equipped with a newborn laboratory
that complies with the standards established by
the National Institutes of Health (NIH)
Philippines, and provides all required laboratory
tests and recall/follow-up programs for newborns
with heritable conditions.
7 Operational NSCs in the Philippines:
1. Newborn Screening Center
- NIH at the University of the Philippines Manila
2. Newborn Screening Center
- Visayas located at West Visayas State
University Medical Center, Iloilo City
3. Newborn Screening Center
- Mindanao located at the Southern Philippines
Medical Center, Davao City
4. Newborn Screening Center
- Central Luzon in Angeles City, Pampanga
5. Newborn Screening Center
- Southern Luzon in Tanauan City, Batangas
6. Newborn Screening Center
- Northern Luzon in Batac City, Ilocos Norte
7. Newborn Screening Center
- Central Visayas located at Eversley Childs
Sanitarium and General Hospital, Cebu City
NEWBORN CARE PACKAGE (NCP) - a
PhilHealth benefit package for essential health
services of the newborn during the first few days
of life. It covers essential newborn care,
expanded newborn screening, and hearing
screening tests.
EXPANDED NEWBORN SCREENING
(ENBS) – a program with increased screening
panel of disorders from six (6) to more than
twenty-eight (28). Expanded newborn screening
costs ₱1750 and is included in the Newborn Care
Package (NCP) for PhilHealth members.
Importance: Most babies with metabolic
disorders look “normal” at birth. By doing ENBS,
metabolic disorders may be detected even before
clinical signs and symptoms are present. As a
result of this, treatment can be given early to
prevent consequences of untreated conditions.
12. BEmONC/CEmONC A. BASIC
EMERGENCY OBSTETRIC AND
NEWBORN CARE –
(BEmONC) Provider facilities: These facilities
are upgraded or enhanced Barangay Health
Station (BHS), Rural Health Unit (RHU), District
and Community Hospitals that are required to
provide the following services:
1. Pre-pregnancy package of services include
the following provisions:
a. Micronutrient supplementation
consisting of important minerals and
vitamins such as zinc, iodine, calcium,
 vitamin A capsules and iron tablets o Iron
folate 60 mg tablets 1 tablet daily
o Vitamin A at least 5000 IU
every week (a daily multivitamin
supplement maybe taken as
option when the required vitamin
A is not available)
o Promotion of use of iodized
salt
b. Tetanus toxoid immunization following the
recommended schedule
c. Family Planning
o IEC and FP counseling with focus on modern
methods and fertility awareness and observing
the principles of informed choice, birth spacing,
responsible parenthood and respect for life o
Contraceptive provision as appropriate
d. Provision of oral health services
e. Counselling on STI/HIV/AIDS, nutrition,
personal hygiene, and the consequences of
abortion
f. STI screening using syndromic approach
g. Adolescent and youth health services including
peer and professional counselling and RH
education
h. Promotion of healthy lifestyle including
advice relative to smoking cessation, healthy diet,
regular exercise and moderate alcohol intake.
i. Management of lifestyle-related diseases like
diabetes, cardiovascular disease (CVD), etc.
j. Prevention and Management of other diseases
including tuberculosis, malaria (e.g. provision of
insecticide treated bed nets for malaria-infested
areas), schistosomiasis, and anemia
2. Complete Pre -Natal Package
a. Provision of eight essential antenatal care
services
• Monitoring of height and weight
• Taking the blood pressure
• Screening and blood testing including
Complete Blood Count, blood
• Typing, urinalysis, VDRL or RPR, HbSAg,
blood sugar screening, pregnancy test, cervical
cancer screening using acetic acid wash and
papanicolaou smear.
• Micronutrient supplementation
• Malaria prophylaxis where appropriate
• Deworming
b. Promotion of exclusive breastfeeding,
newborn screening, BCG and Hepatitis B
birth dose immunization.
c. Counselling on:• Birth planning
• use of modern FP methods especially lactation
amenorrhea (LAM), with focus on health caring
and health seeking behaviors;
• contraception including surgical procedures
where appropriate: bilateral tubal ligation (BTL),
no-scalpel vasectomy (NSV) and management of
complications resulting from contraception.
d. Laboratory screening and medical
management of STI-HIV cases and their
complications.
e. Counselling on Healthy Lifestyle with focus on
smoking cessation, healthy diet and nutrition,
regular exercise, STI control HIV prevention and
oral health.
f. Prevention and management of early bleeding
in pregnancy.
g. Administration of antenatal loading dose of
steroids for threatened premature delivery.
h. Early detection and management of signs of
complications of pregnancy.
i. Measurement of fundic height against the age
of gestation, fetal heartbeat and fetal movement
count to assess the adequacy of fetal growth and
wellbeing.
j. Prevention and management of other
conditions k. Provision of other support services
3. Complete Childbirth Package For the mother:
a. Monitoring vital signs and the progress of labor
using the partograph.
b. Identification of early signs and symptoms and
administration of appropriate management of
prolonged labor, hypertension, abnormal
presentation, bleeding.
c. Active management of the third stage of labor.
d. Provision of immediate post-partum nursing
care (prior to discharge from the delivery room)
• Perineal washing
• Changing of hospital gown
• Checking vital signs
• Rooming-in
For the newborn:
a. Drying to keep the baby warm
b. Provision of appropriate thermal care through
mother and newborn skin-to-skin contact,
maintaining a delivery room temperature of 25-
28 degrees centigrade and wrapping the newborn
with clean, dry cloth.
c. Immediate latching on and initiation of
breastfeeding within first hour after birth.
d. Non-immediate cord clamping (1-3 minutes or
until cord pulsation stops)
4. Complete Post-Partum and Post-Natal Package
For the mother:
• Postpartum check-up including identification of
early signs and symptoms of postpartum
complications like hemorrhage, infection and
hypertension.
• Micronutrient supplementation, including iron
and folate.
• Counselling on: Proper Nutrition, benefits of
exclusive breastfeeding up to six months, benefits
of skin to skin contact especially among preterm
babies, essential neonatal care
• Laboratory screening and medical management
of STI-HIV cases and their complications
• Provision of FP services and contraception
including surgical procedures where appropriate:
bilateral tubal ligation (BTL), no-scalpel
vasectomy (NSV) and management of
complications resulting from contraception.
• Prevention and management of other diseases
For the baby:
• Post-natal care required within 24 hours after
birth includes
o Cord care o Breastfeeding
o Vitamin K injection
o Eye prophylaxis
o Delayed bathing until 6 hours of life
o BCG and first dose of Hepatitis B
Immunization o Newborn screening
• Counselling on post-partum/post-natal check-
up, home care and immunization
5. Provision of other support services
• Birth registration
• Safe blood
• Transportation and communication
Basic Emergency Obstetrics and Newborn
Care (BEmONC) Provider
• capable private health facility
• or an appropriately upgraded public health
facility - Rural Health Unit (RHU) and/or its
satellite Barangay Health Station (BHS)
• or a Hospital capable of performing emergency
obstetric functions such
• capable of providing neonatal emergency
interventions
• capable of providing blood transfusion services
B. COMPREHENSIVE EMERGENCY
OBSTETRIC AND NEWBORN CARE
(CEmONC) Provider facilities:
are departmentalized district, provincial and
regional hospitals. These hospitals shall provide
the following services:
1. Pre-pregnancy care
a. Micronutrient supplementation consisting of
important minerals and vitamins such as zinc,
iodine, calcium, vitamin A capsules and iron
tablets o Iron folate 60 mg tablets 1 tablet daily
for 3-6 months.
o Vitamin A at least 5000 IU every week
(a daily multivitamin supplement maybe
 taken as option when the required
vitamin A is not available).
o Promotion of use of iodized salt.
b. Tetanus toxoid immunization following the
recommended schedule.
c. Family Planning
d. Provision of oral health services
e. Counselling on STI/HIV/AIDS, nutrition,
personal hygiene, and the consequences of
abortion
f. Laboratory screening for STIs
g. Adolescent and youth health services
h. Promotion of healthy lifestyle
i. Management of lifestyle-related diseases
j. Prevention and Management of Other Diseases
2. Prenatal care package
a. Provision of eight essential antenatal care
services
1) Monitoring of height and weight
2) Taking the blood pressure
3) Screening and blood testing including
Complete Blood Count, blood Typing, urinalysis,
VDRL or RPR, HbSAg, blood sugar screening,
pregnancy test, cervical cancer screening using
papanicolau smear
4) Micronutrient supplementation (iron, folate
and Vitamin A supplementation)
5) Tetanus toxoid immunization
6) Malaria prophylaxis where appropriate
7) Deworming
8) Birth planning
b. Promotion of exclusive breastfeeding,
newborn screening, BCG and Hepatitis B
birth dose immunization.
c. Counseling
d. Counselling on Healthy Lifestyle
e. Prevention and Management of early
bleeding in pregnancy and its
complications.
f. Administration of antenatal loading
dose of steroids for threatened premature
delivery.
g. Early detection and management of
danger signs and complications of
pregnancy.
h. Measurement of fundic height against
the age of gestation, fetal heart beat and
fetal movement count to assess the
adequacy of fetal growth and wellbeing.
i. Prevention and management of other
diseases
j. Provision of other support services
3. Complete childbirth package
For the mother:
a. Monitoring vital signs and the progress of labor
using the partograph.
b. Identification of early signs and symptoms and
administration of appropriate management of
prolonged labor, hypertension, abnormal
presentation, bleeding.
c. Active management of the third stage of labor.
d. Provision of immediate post-partum nursing
care (prior to discharge from the delivery room)
• Perineal washing
• Change hospital gown
• Check vital signs
• Rooming-in in the case of non-
problematic cases.
• Return to ward if baby is preterm and
needs to be confined at the
• Newborn Intensive Care Unit (NICU).
Advice should be given relative to
breastfeeding schedules at the NICU.
For the newborn:
e. Drying to keep the baby warm
f. Non-immediate cord clamping
g. Provision of warmth through skin-to-skin
contact with mother, immediate latching on and
initiation of breastfeeding within the first hour
after birth.
h. Provision of appropriate thermal care through
mother and newborn skin-to - skin contact,
maintaining a delivery room temperature of 25-
28 degrees centigrade and wrapping the newborn
with clean, dry cloth.
Basic Emergency Obstetric and Newborn scalpel vasectomy (NSV) and management of
Care complications resulting from contraception.
a. Parenteral administration of oxytocin in the f. Prevention and management of other diseases
third stage of labor. as indicated:
b. Parenteral administration of initial dose of o Hypertension
antibiotics. o Diabetes
c. Assisted vaginal delivery during imminent o Anemia
breech delivery. o Tuberculosis
d. Manual removal of placenta. o Malaria
e. Removal of retained placental products. o Schistosomiasis
f. Administration of loading dose of steroids for o STI/HIV/AIDS
premature labor. g. Counselling on post-partum/post-natal check-
g. Intravenous fluid administration, blood volume up, home care and immunization Immediate
expander and/or blood postnatal care package (required within 24 hours
transfusion. after birth)
h. Newborn resuscitation. • Cord care
i. Treatment of neonatal sepsis. • Initiation of Breastfeeding within the
j. Oxygen support for the newborn. first hour of life
• Vitamin K injection
Comprehensive Emergency Obstetric and • Eye prophylaxis
Newborn Care • Delayed bathing to 6 hours of life
a. Caesarian section • BCG and first dose of Hepatitis B
b. Blood transfusion Immunization
c. Management of newborn complications • Newborn screening

4. Postpartum/ postnatal care Comprehensive Emergency Obstetrics and

a. Post-partum check up including identification Newborn Care (CEmONC) Provider
of early signs and symptoms of postpartum
complications such as hemorrhage, infection and • a tertiary level regional hospital or medical
hypertension. center, provincial hospital or an appropriately
b. Micronutrient supplementation, including iron upgraded district hospital or a capable privately
and folate operated medical center
c. Counselling on: • capable of performing emergency obstetric
• Nutrition functions as in BEmONC provider facilities
• Exclusive breastfeeding up to six • provide emergency neonatal care
months (1) newborn resuscitation;
• Essential neonatal care (2) treatment of neonatal
• Special neonatal care for preterm and sepsis/infection;
“problematic” babies (3) oxygen support; and,
d. Laboratory screening and medical (4) antenatal administration of
management of STI-HIV cases and their (maternal) steroids for threatened
complications premature delivery.
e. Provision of FP services including 13. Nutrition The Philippine Plan of Action for
contraception: bilateral tubal ligation (BTL), no- Nutrition was developed by the DOH National
Nutrition Council.2017–2022, in accordance with
the nation's own program and its commitments to
the global community as represented by the 2025
Global Compact, the 2030 Sustainable
Development Goals, and The 2014 International
Conference on Nutrition Targets for Maternal,
Infant, and Young Children.
Nutrition Problems to be addressed
1. High levels of stunting and wasting among
children under-five years of age.
2. Deficiencies in vitamin A, iron, and iodine in
particular groups. 3. Hunger and food insecurity
with more than half of Filipino households not
meeting their. caloric requirements.
4. Overweight and obesity among various
population groups, especially among adults.
5. Maternal nutrition because the prevalence of
nutritionally-at-risk women has not improved
over the years.
6. Poor infant and young child feeding in the first
two years of life coupled with bouts of infection.
7. Exclusive breastfeeding (EBF) in the first six
months of life continues to be a challenge
8. Only a few infants receive the minimum
acceptable diet.
a. Micronutrient Supplementation
Program Micronutrient deficiencies can
cause intergenerational consequences.
The level of health care and nutrition that
women receive before and during
pregnancy, at childbirth and immediately
postpartum has significant bearing on the
survival, growth and development of
their fetus and newborn. Undernourished
babies tend to grow into undernourished
adolescents. When undernourished
adolescents become pregnant, they in
turn may give birth to low-birth weight
infants with greater risk of multiple
micronutrient deficiencies.
Micronutrient supplementation has been
proven to be a cost-effective and cost-
beneficial strategy that immediately
corrects the deficiencies and prevents
adverse consequences. It will be
provided to all priority women and
children, and will be part of routine
services in health centers.
b. Mandatory Food Fortification
Fortification as defined by Codex
Alimentarius is “the addition of one or
more essential nutrients to food, whether
or not it is normally contained in the
food, for the purpose of preventing or
correcting a demonstrated deficiency of
one or more nutrients in the population or
specific population groups”
1. Rice fortification with iron
2. Flour fortification with iron
and vitamin A
3. Cooking oil fortification with
vitamin A
4. Sugar fortification with
vitamin A
5. Salt iodization
Policy on Food Fortification:
1. ASIN Law – Republic Act 8172, “An Act
Promoting Salt Iodization Nationwide and for
other purposes”, Signed into law on Dec. 20,
1995
2. Food Fortification Law - Republic Act 8976,
“An Act Establishing the Philippine Food
Fortification Program and for other purposes”
mandating fortification of flour, oil and sugar
with Vitamin A and flour and rice with iron by
November 7, 2004 and promoting voluntary
fortification through the Sangkap Pinoy Seal
Program, Signed into law on November 7, 2000.
c. Infant and Young Child Feeding (IYCF) A
global strategy for Infant and Young Child
Feeding (IYCF) was issued jointly by the WHO
and UNICEF in 2002, to reverse the disturbing
trends in infant and young child feeding practices.
In 2004, infant and young child feeding practices
were assessed using the WHO assessment
protocol and rated poor to fair. The poor practices
identified needed urgent action and aggressive
sustained interventions. To address these
problems, the first National IYCF Plan of Action
was formulated. GOAL: Reduction of child
mortality and morbidity through optimal feeding
of infants and young children
KEY OBJECTIVES:
1. To improve, protect and promote appropriate
infant and young child feeding practices child
feeding practices
2. To increase political commitment at different
levels of government, international organizations,
non- government organizations, private sector,
professional groups , civil society, communities
and families
3. Provide supportive environment that will
enable parents, mother, caregivers, families and
communities to implement optimal feeding
practices for infants and young child
4. Ensure sustainability of interventions to
improve, protect and promote infant and young
child feeding.
d. Integrated Management of Acute Malnutrition
This aims to support the implementation and
expansion of quality treatment for children
suffering from the most severe and acute form, of
undernutrition which is severe acute malnutrition
(SAM). These children with SAM are at most risk
of dying because of their Undernutrition.
KEY COMPONENTS:
1. Community Outreach and Mobilization –
promotion of and community involvement in
programs combating wasting
2. Inpatient Therapeutic Care – manages
treatment of SAM with medical complications in
a hospital or health facility with 24-hour care
capacity until such condition is stabilized
3. Outpatient Therapeutic Care – manages SAM
without medical complications through provision
of routine medical treatment and nutritional
rehabilitation with ready-to-use therapeutic food
(RUTF)
4. Programs and Services for the Management of
MAM - handles services and programs aimed at
addressing MAM through supplementary feeding
FOUR PRINCIPLES:
1. Maximum Coverage – to bring to treatment as
many people as possible, with the most affordable
and accessible services available
2. Timeliness – to detect acute malnutrition early
and start treatment before the onset of life-
threatening conditions
3. Appropriate medical care and nutrition
rehabilitation – to ensure efficiency of programs
and services on nutrition, it is important to
provide the proper treatment of cases by the
proper providers
4. Care as long as needed – to reduce barriers to
access and ensure that children stay in the
program until they recover
e. National Dietary Supplementation Program-
Supplementary feeding of pregnant/lactating
women and children (6-23 mos.; 24-59 mos.;
school age) 1. Preventive Approach
OBJEJCTIVE: To prevent
(a) low birth weight and
(b) stunting among children under 2 years.
2. Curative Approach
OBJECTIVE: To rehabilitate the
undernourished individual to the next higher or
normal nutritional status
f. National Nutrition Promotion Program for
Behavior Change This focuses on the interplay
of interpersonal and community
communications, mass media and social media to
facilitate the adoption of positive nutrition
practices.
g. Nutrition in Emergencies This focuses on
capacity building for mainstreaming nutrition
protection in emergencies. Wasting continues to
be a serious child health problem with the
Philippines being highly disaster-prone and the
risk of wasting increases in the aftermath of
emergencies.
h. Overweight and Obesity Management and
Prevention Program This focuses on healthy
food environment, promotion of healthy lifestyle,
and weight management and intervention (for
overweight and obese individuals). According to
WHO, “evidence shows that overweight and
obese children are likely to stay obese into
adulthood and more likely to develop non
communicable diseases (NCDs) like diabetes and
cardiovascular diseases at a younger age. NCDs
are among the leading killers in the Philippines,
comprising more than 50% of all deaths each CENTRAL LUZON
year. DOCTORS’ HOSPITAL
EDUCATIONAL
14. MhGap The WHO Mental Health Gap INSTITUTION, INC.
(A wholly-owned Subsidiary of
Action Programme (mhGAP) Central Luzon Doctors’ Hospital,
aims at scaling up services for mental, Inc.)
neurological and substance use disorders for Romulo Highway, San Pablo, Tarlac City
countries especially with low- and middle- (045) 982-5019/982-5052/982-0264 🖮 (045) 982-0780
income. The key objectives of the action DEPARTMENT OF NURSING
programme are: to reinforce the commitment of
governments, international organizations, and
other stakeholders to increase the allocation of
Filipino Culture, Values, and Practices in
financial and human resources for care of mental
health and substance use disorders. Relation to Health Care of Individual and
15. Other related programs
● Adolescent Health Family
● Oral Health
● Reproductive Health
● Women’s Health
SUBMITTED BY:
● Mental Retardation Reyes, Sheerlyn
● Food Safety Roxas, Maria Cristina
Roxas, Sherilyn
Sagabaen, Von Alexander
Santos, Kyla
Siron, Carlo

SUBMITTED TO:

Mrs. April pearl Sawit-Ardiente

Subject teacher
October 14, 202 perceived agreement in opinions, values

FAMILY SOLIDARITY and lifestyle.

 According to Timonen, Intergenerational 5. Functional Solidarity: Exchanges of

solidarity refers to the degree of closeness practical and financial assistance and

and support between different support between family members are

generations. The notion of solidarity examples of functional solidarity

helps us to understand how people of 6. Normative Solidarity: It refers to the

different generations relate to, help and strength of obligation felt towards other

depend on one another in their daily lives. family members.

Dimensions of Solidarity in Intergenerational FILIPINO FAMILY VALUES

Family Relations  COMMUNICATION:

1. Structural Solidarity: This means how  Use of therapeutic

factors like geographical distance can communication techniques,

constrain or enhance interaction between identifying verbal and non-

family members. verbal cues, responding to

2. Associational Solidarity: This clients’ needs while using

dimension refers to the frequency of formal and informal channels of

social contact and shared activities communication and appropriate

between family members. information technology.

3. Affectual Solidarity: Solidarity can

manifest itself in feelings of emotional  Communication Style:

closeness, affirmation and intimacy Filipinos will try to express their

between family members. opinions and ideas. They must

4. Consensual Solidarity: Family members do so diplomatically and with

have different levels of actual or humility to avoid appearing

 arrogant. The tone of voice and prefer standing at an arm's

it varies widely by language, length from one another. Around

dialect, and region. strangers this distance is farther.

 When speaking to those who are Maintain a reasonable personal

older or of higher status, space of 1 to 2 feet. Take height

Filipinos tend to use polite forms into consideration. A seated

of speech. At the end of phrases, position for interaction is highly

sentences, or questions, they will recommended.

say "po" to demonstrate this

HELPING OTHERS AND GRATITUDE
respect for hierarchy. For
 Pakikisama has the connotation of
example, when conversing with
getting along with people in general.
an elderly person or someone of
 There is a general yearning to be
higher status, one will say
accepted and well-liked among
"salamat po" (‘thank you po’).
Filipinos. This applies to one and his
 Pace of
or her friends, colleagues, boss, and
Conversation: Filipinos often
even relatives. This desire is what
communicate indirectly in order
steers one to perform pakikisama.
to prevent a loss of face and
 The word pakikisama literally
evoke hiya on either side of an
translates to "helping others."
exchange. They tend to avoid
Therefore, this trait usually fosters
interrupting others and are more
general cooperation and performing
attentive to posture, expression,
good or helpful deeds, which can lead
and tone of voice.
to others viewing you in a favorable
 Physical Distance: When
light.
interacting with people they are

familiar with; Filipinos tend to

  Utang na Loob means to pay your  The younger members of the family can

debt with gratitude. show respect toward older siblings by

 With utang na loob, there is usually a calling them kuya (older brother) or ate

system of obligation. When this value (older sister).

is applied, it imparts a sense of duty

and responsibility on the younger  INDEPENDENCE

siblings to serve and repay the favors  The ability of a person to make

done to them by their elders. their own choices and carry out

daily tasks. It is also necessary

 RESPECT for proper development.

 The English translation of pag galang  This begins at birth and

means to be respectful or to give respect continues through the person’s

to a person. lifespan.

 Filipinos are accustomed to using the

words "po," "opo," and "ho" when they

are conversing with older people or,

sometimes, with those who are in high

roles or are prestigious members of

society. Using these words is customary I. DEVELOPMENT OF

in the Philippines, and it shows a sign of INDEPENDENCE

respect if you do so. THROUGH THE LIFE

 Paggalang can also be shown toward STAGES

your elderly by kissing their hands before 1. Infancy: Infants are

leaving/to say goodbye and upon dependent on their

arrival/to greet them. caregivers for all types

 of care, but as they start (having more control of

to prepare for early themselves and making

childhood, they have decisions about aspects

developed skills and like education, social

abilities that they feel life, and career

confident in, such as pathways).

feeding or saying "No" 4. Early Adulthood:

when they want to do Independence at this

something on their own. stage relies on a person’s

2. Early Childhood: In decision-making and

this stage, a child will they are responsible for

develop skills to become it (moving out of their

more independent like family’s home and

going to the toilet finding a job to pay for

independently. their accommodation or

Additionally, through maybe starting a family

studying and engaging and being responsible

in new activities, they for their child).

learn to rely less on their 5. Middle Adulthood:

parents and make Adults in this stage have

decisions based on their more time to pursue

likes and dislikes. their interests or careers.

3. Adolescence: During However, for some, this

this stage, young people stage is where they work

are developing a sense longer as they are now

of self and their identity the main provider or

 carer for their elderly  It fills you with a sense of joy and

parents and family. happiness that can come from no other

6. Later Adulthood: At source.

this stage, changes in  It sets you up for further progress and

physical and mental self-sufficiency.

health can influence and

SERVICE
reduce independence.

These include the state  This is an act of helping or doing work

of the individual’s for someone else (assistance).

health, culture, and stage  In a hospital, healthcare professionals

of emotional or social provide us with their services when we

development. are in our vulnerable state to attain well-

being.
IMPORTANCE OF INDEPENDENCE

 It boosts your self-confidence and self- THE IMPORTANCE OF GOOD QUALITY

esteem. SERVICE IN HEALTHCARE

 It decreases the burn you place on family,

 Patients will be happier and
friends and society.
satisfied as they’ve received
 It turns you into an asset to help other
exceptional care and are more
people.
likely to come back for check-
 It leads to financial freedom as you are
ups and even refer your facility
skilled and capable.
to other people.
 It makes you physically capable of caring
 Healthcare professionals
for yourself and others.
develop lasting relationships

with patients rather than

 approaching visits as a intentions of the healthcare

transaction. professional, healthcare involves

 The healthcare industry depends an element of uncertainty and

heavily on accurate patient data risk.

to make diagnostic and treatment  Patients who trust their health

recommendations. Errors, professionals are more likely to

incomplete records, and staff’s follow treatment protocols and

inability to access needed data are more likely to succeed in their

can severely impact the quality efforts to change behavior.

of care given to the patient and  It also lowers the anxiety of the

can result in threatening patients in relation to any

mistakes and malpractice treatments taken.

lawsuits.  Patients who trust their

healthcare professional are more

TRUST
likely to open up and disclose

 This is a firm belief in the reliabilit y, information, and the quality of

truth, or ability of someone or something. interaction may improve

 Being trustworthy in a health care setting resulting in greater patient

is acting consistently for the good of the autonomy and shared decision-

patient and having high levels of making.

judgment, confidence and skill

competence.  Factors that influence trust in

 Importance of trust in healthcare healthcare

 For the vulnerable patient who is  Competence in knowledge:

reliant on the competence and Healthcare professionals gain

patients' trust by being

 knowledgeable in their specific their dignity because if their

field of practice and, as a result, confidentiality was if their trust is

Patients have confidence and feel breached, it may not only harm

secure in the advice provided to their relationship with the patient

them. but also the trust that the patient

 Competence in social or has built with them.

communication skills: It  Respect and compassion: Any

is important for healthcare cultural diversity, as well as the

workers to learn how patients' right to hold their own

to communicate effectively with values, must be respected.

patients and adapt their style as

FILIPINO FAMILY CULTURE AND
it can result in positive outcomes
TRADITION
of interventions. Patients should
The Philippines is more commonly
be able to feel that they are being
referred to as the melting pot of western and
listened to and give information
eastern cultures. Its culture and traditions are
in a respectful, non-judgmental
heavily influenced by the traditions of the
way.
indigenous Austronesian people. In addition, the
 Honesty: It is expected for
cultural landscape shows the influence of the
healthcare professionals to act
people of Spanish, American, Japanese, Arabic,
with honesty and integrity to
and Indonesian origins. The country's two major
maintain the public trust and
religions, Christianity and Islam, both played
uphold the reputation of the
important roles in shaping Philippine culture.
profession.
SOCIAL BELIEF AND CUSTOMS
 Confidentiality: Healthcare
 Primarily influenced by religion and
professionals should respect the
demographics of the region where they
patient’s privacy and preserve
 are practiced based on the beliefs of the This superstition suggests that if you go

Austronesian inhabitants of the straight to bed with wet hair, you might

Philippines. wake up blind or insane. However, there

 Getting rid of hiccups by placing a short is no firm correlation between wet hair,

thread wet with saliva on the forehead loss of eyesight, and insanity, so avoiding

 Usog: By showing fondness or affection sleeping with wet hair is mostly for

when meeting a baby for the first time, cosmetic reasons.

you may cause the baby to feel uneasy or  Not patting your sweat dry with a towel

make the baby cry non-stop, which is can cause you to get pneumonia.

commonly referred to as "na-usog." This  Washing sweaty hands can lead to

is thought to make an infant feel ill by spasmodic hands or pasma.

either greeting the baby or simply being  It’s a common Filipino advice not to wash

overly fond of him or her when meeting your hands right after finishing labor-

the child for the first time. intensive chores to avoid pasma—the

 To avoid passing the negative energy and reason for shaky hands, sweaty palms,

cure the infant of usog, superstition and numbness or pain in the hands. Often,

practice says you must dab your saliva on right after ironing a handful of your

the baby’s forehead or abdomen. Often, clothes, you’ll be discouraged by your

most people would also greet the child by mom or grandmother to wet your hands.

saying "pwera usog," meaning "for Similarly, it is believed that taking a bath

protection from the hex. Some even make after a workout can lead to illnesses.

it a point to buy their children a bracelet

RELIGION AND FESTIVALS
made from black and red or coral beads to

fight usog.  Approximately 90.07% of Filipino

 Hitting the sack right after a shower is residents are identified as Christians,

believed to cause blindness and insanity. with 80.58% of them being Roman
 Catholic and about 11% being other faith, most cities and towns in the country

Christian denominations Islam is the have patron saints who are honoured

second largest religion in the country, through festivals. To appease the gods—

with about 5.6% of the population. The this was a key factor in ancient pagan

majority of these Muslim Filipinos Are worship in the Philippines. Mystical

Sunni Muslims, and a small number are religious beliefs before the Spaniards

Ahmadiyya Muslims. came centred on worshipping gods

 Catholics believe that the prayers of the believed to control certain aspects of

saints in heaven are powerful enough to life—livelihood, family, health, wealth,

alleviate or heal illnesses. There are and others.

several patron saints for healing, namely  One such example is the feast of the

St. Dymphna (Patron Saint of Depression Black Nazarene. It is traditionally

and Mental Illness), St. Peregrine (Patron celebrated with a grand procession called

Saint of Cancer Healing), St. Traslacion, where millions of devotees

Maximillian Kolbe (Patron Saint for jostle their way to touch the carriage

Addictions), St. Lidwina (Patron Saint carrying the venerated statue as they

for Those Suffering from Chronic Pain), believe doing so could bring healing,

and St. Jude (Patron Saint of Hopeless answer prayers, or lead to miracles.

Causes).
MUSIC AND DANCE
 Through numerous festivals, Filipinos

are able to showcase cultural diversity.  Traditional folk songs are inspired
These primarily by indigenous customs and

festivals are locally known as” Fiesta." beliefs.

All of the fiestas are of religious and  The Obando Fertility Dance is a festival

cultural significance. Due to the where couples who hope to be blessed by

predominance of the Roman Catholic children perform street dances in a long

 procession. The Fertility Dance of birthdays, where their inherently Chinese

Obando is both a festival and a prayerful symbolism as edible harbingers of a long

appeal for devotees. life (provided you don’t cut the noodles

 The month of May has always been the before you eat them) is frequently

season for the fertility dance. Initially, invoked.

the native childless couples dance in

front of idols to request that they soon

CLOTHING AND ACCESSORIES
have children. When the Spanish took
 Maria Clara is the traditional dress of the
over, they convinced the natives that they
Filipino women. This attire gets its name
could keep the fertility dance but would
from
instead dance in front of images of saints

instead of idols. a famous character named Maria Clara in the epic

19th- Century narrative “Noli Me Tangere”

written by Jose P. Rizal. It is made up of four

components:
CUISINE
 Saya - a long dress
 Influenced by local and foreign cultures.  Tapis- a knee-long skirt
Rice is the country's staple food and is  Camisa- a collarless chemise
commonly consumed and prepared  Panuelo- a stiff scarf
through steaming and served together  Barong Tagalog is traditionally worn by
with other foods. men during special occasions. It is also
 Pancit is as crucial to each Filipino feast known as Baro. Barong Tagalog features
as rice is to every complete Filipino meal. a formal long shirt decorated with
It is a fixture at many significant embroidery.
milestones such as weddings, baptisms,  In the Philippines, specially made
graduations, and most especially amulets or talismans are believed to
 protect the wearer from bullets and knife health care systems that are

wounds. That is why military men and simultaneously utilized.

policemen, including some officers, wear

SELF-MEDICATION
amulets, talismans or anting-anting.

 One such example is an amulet called  Certain Chinese ointments or oils, for

“kontra-usog”- usually a combination of example, are used as remedies or cures

seeds and dried plant material, wrapped in for relaxing, heating, and comforting

red cloth with or without a cross outside. aching muscles, as well as providing

It is a kind of juvenile amulet, pinned to relief for dizziness, colds, headaches,

the shirt of a child for protection. sore throats, and other ailments.

 Includes folk healing techniques

HEALTH PRACTICES
consistent with the Chinese hot/cold
 Studies of health practice among
classification system of diseases and the
Filipino Americans suggest that
concept of wind illness. One example is
people originally from rural areas in
ventosa, a technique used for treating
the Philippines are more
joint pains believed to be caused by the
knowledgeable regarding home
presence of bad air. This technique
remedies, traditional healing
consists of wrapping a coin with cotton,
techniques, and supernatural
wetting the tip with alcohol, lighting it,
ailments, whereas those in urban
and placing the coin on the aching joint
areas rely more on Western medical
area, then immediately covering it with a
intervention and over-the-counter
small glass or cup. The fire is then soon
drugs. However, in both rural and
extinguished as it is covered, creating a
urban areas, there exist a variety of
vacuum that will suck bad air out of the
indigenous folk practices and modern
joint.
  These healers include midwives,

masseurs, and specialists for

supernaturally caused ailments.

USE OF HERBS AND ROOTS; FAITH Although these types of healers each

HEALERS have native labels, there is no traditional

word for faith healers, the newest and

 More serious illnesses typically warrant
increasingly popular genre of Philippine
seeking the help of a local healer who
folk healers. Faith healers do not attempt
may utilize herbs and roots. Although
to identify or diagnose a disease, which
healers are presumed to possess a God-
is in contrast to the traditional concern
given gift, their relative popularity and
about identifying the cause of illness
prestige in the community depends a
(which could presumably be
great deal on their interpersonal
supernatural). Their orientation is
relationships with their patients. People
holistic and uniform and incorporates the
in rural areas are accustomed to friendly
belief in concurrent physical, emotional,
and accommodating folk healers and
and spiritual healing. Regardless of the
expect the same treatment from
individual's specific affliction, the same
physicians. If these expectations are not
techniques are employed.
met, they avoid Western health centers or
 In a regular session, the faith healer's
switch doctors. Moreover, when healers
techniques include blessing the body
are viewed with trust and respect,
with holy water, laying on of the hands,
they often expected to perform
and anointing with oil. The technique of
instantaneous healing. If there is no
laying on of the hands is a very important
immediate improvement in an illness or
aspect of faith healing and is practiced by
related symptoms, individuals may
several other groups such as the
change doctors.
Pentecostal Charismatics and the Cuban-
American santeros. In laying on hands, it  Psychic Surgery involves the painless

appears as though the healer is insertion of the healer’s fingers into the

attempting to transfer the healing energy individual's body, removal of tissues,

from his or her hands to the individua l's tumors, growths, or foreign matter, and

body through the forehead. The healer closing the incision without a scar.

also anoints the individual by wetting his Numerous Western scientists have

or her fingers with consecrated oil and investigated tales of miracle cures

making the sign of the cross on the produced by psychic surgeons and found

forehead, on each eye, and on the chin of evidence of fakery. However, they have

the person. If certain body parts need also reportedly witnessed incredible feats

healing, they will be directly anointed. of healing.

The person, in turn, typically attests to  As the spiritual element is of importance,

the sense. warmth or flow of energy that practitioners may ask questions that are

seems to enter his or her body and origin-oriented, such as why the patient

provides instant well-being. These believes they were injured, and counsel

healing techniques are enhanced by them on spiritual matters related to the

ritualized prayer, chanting, and the event of origin. Faith healers also sense

creation of an atmosphere that reinforces energies, auras, and passed figures who

the individual's faith. During healing may have been related to the patient.

sessions, the faith healer, for example, Despite the introduction of Christianity

typically wears a white dress of soft, in the 16th century, indigenous healing

flowing material, creating an ephemeral methods maintained an integration with

quality. White (worn by the Virgin Mary) spirituality.

is the symbol of purity and is associated

HILOT
with environmental ghosts and spirits.
 the art and science of the ancient Filipino manghihilot starts off by feeling the

healing traditions that are grounded on pulse, and through this decides what

the concept of balance among the needs to be done in order to alleviate

physical elements along with the mental, one’s symptoms. After that, the

emotional, and spiritual aspects of a manghihilot feels around the body for

person. This practice includes the use of areas where they feel energy could be

manipulations and massages that help in trapped and massages the areas in order

the prevention of disease and the to decongest them.

restoration and maintenance of one’s

TUOB/ SUOB (STEAM INHALATION)
health and well-being. Hilot also makes

use of medicinal plants and  Is a part of Filipino culture and

bulong/orasyon (whispered or written traditional health practices and

prayers) is one of the most extensively

utilized home treatments for

 Is performed by a person called
relieving cold symptoms as part of
Manghihilot, who is able to not only heal
primary health care practice.
but also identify illnesses through
 Has been shown in scientific studies
reading areas of energy imbalances in the
to be useful in reducing cold
body.
symptoms and improving nasal
 The knowledge of the hilot is something
patency.
that is passed down through generations.
 Done by inhaling steam from boiling
Manghihilot undergoes extensive
water from 8–12 inches away with a
training in order to master the art of
towel draped over one’s head. The
healing. A session with a manghihilot
procedure is done for at least 2–5
usually depends on what it is that’s
minutes.
making one feel uncomfortable. The
  Benefits of tuob include when it starts to crack, and transferred to

detoxification, cleansing the skin, a small receptacle of water. As it cools,

muscle relaxation, increasing body its softened form spreads on the water

metabolism, boosting the immune surface and assumes a shape that may

system, keeping mucous membranes suggest the cause of the illness, often one

from drying, and relieving comfort of several indigenous forces: dwarfs,

from asthma, allergies, and arthritis. devils, or other evil spirits (na-nuno, na-

kulam, na-demonyo). The water in the

TAWAS
vehicle is then

 Tawas is an abstract form of  It is used to anoint the ailing part or parts

communication whereas the practitioner of the body to counteract evil forces or

of Tawas gathers information from the illness. The tawas is then discarded and

subject utilizing tools such as paper, thrown westward, preferably into the

water, candles, oils and others to observe setting sun.

and analyse form. It is an indigenous art

HERBALISM AND PLANT MEDICINE
of divination and diagnosis practiced by

rural folks to determine the cause of  The Philippines is home to 10,000 to

illness. 14,000 plant species. While 1,500 of

 It is used in the purview of the albularyo them contain potential medicinal value,

for a variety of febrile conditions, a only 120 have been scientifically

child's incessant crying or failure to The validated.

TAWAS is used to 'cross' (sign of the  An albularyo is a practitioner who uses a

cross) the forehead and other suspicious combination of modalities: herbalism,

or ailing parts of the body while prayers prayers, incantations, and mysticism,

are being whispered (bulong). It is then similar to a shaman.

placed on glowing embers, removed

  The Philippine Department of Health regulator of all health services and products, the

endorsed just 10 medicinal plants that DOH is the provider of special tertiary health care

can be used in herbal teas, tinctures, fluid services and technical assistance to health

extracts, poultices (vegetable fat providers and stakeholders

mixtures), tablets, supplements,

While pursuing its vision, the DOH adheres to the
powders, creams, and essential oils.
highest values of work, which are:

NEW TECHNOLOGIES RELATED TO

● Integrity – The Department believes in
PUBLIC HEALTH ELECTRONIC
upholding truth and pursuing honesty,
INFORMATION
accountability, and consistency in performing its

A. GOVERNMENT SITES functions.

1. DEPARTMENT OF HEALTH (DOH) ● Excellence – The DOH continuously strive for

the best by fostering innovation, effectiveness

Website: https://doh.gov.ph
and efficiency, pro-action, dynamism, and

The Department of Health (DOH) holds the openness to change.

overall technical authority on health as it is a

● Compassion and respect for human dignity –
national health policy-maker and regulatory
Whilst DOH upholds the quality of life, respect
institution.
for human dignity is encouraged by working with
Basically, the DOH has three major roles in the
sympathy and benevolence for the people in need.
health sector:

(1) leadership in health; ● Commitment – With all our hearts and minds,

(2) enabler and capacity builder; and the Department commits to achieve its vision for

(3) administrator of specific services. Its mandate the health and development of future generations.

is to develop national plans, technical standards,

and guidelines on health. Aside from being the

● Professionalism – The DOH performs its (3) formulate policy and program

functions in accordance with the highest ethical recommendations on population as it relates to

standards, principles of accountability, and full economic and social development;

responsibility.
(4) formulate research and study programs and

● Teamwork – The DOH employees work projects and assign these to such individuals or

together with a result-oriented mindset. organizations as the Commission may deem

appropriate; and
● Stewardship of the health of the people –

Being stewards of health for the people, the (5) perform such other duties as proper

Department shall pursue sustainable authorities may from time to time direct the

development and care for the environment Commission to undertake (Official Gazette of

since it impinges on the health of the Filipinos. the Republic of the Philippines, 2020)

2. COMMISION OF POPULATION AND 3. NATIONAL NUTRITION COUNCIL

EVELOPMENT (POPCOMM) (NNC)

Website: https://popcom.gov.ph Website: https://www.nnc.gov.ph

POPCOM’s functions and duties are: The National Nutrition Council is mandated by

law to be the country’s highest policy- making

(1) undertake, promote, and publish studies and
and coordinating body on nutrition. It is the
investigations on the Philippine population in
authority that ensures nutritional well- being of
all its aspects;
Filipinos. They are recognized both locally and

(2) assemble and disseminate technical and globally, and they are led by a team of competent

scientific information relating to medical, social, and committed public servants.

economic and cultural phenomena as these affect

or are affected by population;

4. PHILIPPINE HEALTH INSURANCE ● The program shall be limited to paying for the

CORPORATION (PHIC/ PhilHealth) utilization of health services by covered

beneficiaries. It shall be prohibited from

Website: https://www.philhealth.gov.ph/
providing health care directly, from buying and

The National Health Insurance Program was dispensing drugs and pharmaceuticals, from

established to provide health insurance coverage employing physicians and other professionals for

and ensure affordable, acceptable, available, and the purpose of directly rendering care, and from

accessible health care services for all citizens of owning or investing in health care facilities.

the Philippines. (Article III, Section 5 of RA 7875 as amended)

● It shall serve as the means for the healthy to 5. PHILIPPINE INSTITUTE OF

help pay for the care of the sick and for those who TRADITIONAL AND ALTERNATIVE

can afford medical care to subsidize those who HEALTH CARE

cannot. It shall initially consist of Programs I and

Website: https://pitahc.gov.ph
II or Medicare and be expanded progressively to

constitute one universal health insurance program Republic Act 8423(R.A. 8423) mandates the

for the entire population. Philippine Institute of Traditional and

Alternative Health Care (PITAHC) “to improve

● The program shall include a sustainable system
the quality and delivery of health care services
of funds constitution, collection, management,
to the Filipino people through the development
and disbursement for financing the ailment of a
of traditional and alternative health care and its
basic minimum package and other supplementary
integration into the national health care delivery
packages of health insurance benefits by a
system
progressively expanding proportion of the

population. NURSING AND HEALTH CARE SITES

NURSING SITES
1. AllNurses.com courses for nursing students – also offers NCLEX

(nationwide examination for the licensing of

● an online community for nurses
nurses in the United States, Canada and

● contains news, blogs, and informative articles Australia) test preps

related to the profession

● claims they are the leader in online learning

● a forum website - registered users are able to

● created learning systems that are designed to
create new topics and converse under them -
teach the way an individual learns
nurses can ask for advice about problems at work

or simply share their experiences to other nurses ● students garner scores closer to 100% than any

other education system in the US market

● users can use their real name or unique

usernames to maintain anonymity 3. NursingWorld.org

● forum topics and discussions are public - can ● website of American Nurses Association

be found through search engines - can be seen by (ANA) - professional organization that represents

anyone (registered users or not) the interests of American RNs - largest

professional organization for nurses

● creates a support network for nurses by

allowing them to exchange industry and career ● provides information on a wide range of topics

related information and advice including careers and credentialing, practice,

ethics, health, safety, policy, advocacy, and more

● also advertises job postings

4. Nurse.com
2. ATItesting.com

● provides different services such as job postings,

● Assessment Technologies Institute, LLC -
continuing education unit courses, nursing related
company that offers nursing education delivery

systems for schools and faculty and preparation

news, and an event calendar for seminars, ● provides access to a myriad of information and

webinars, and career fairs updates on PNA’s programs and activities - news

and upcoming events their calendar of activities,

● full of resources that can help RNs and nursing
the schedule of their seminars/trainings, their
students
awards and recognitions, and much more

● features job portals, opportunities to earn CEs,

● founded on September 2, 1922 as Filipino
current nursing events and latest news about the
Nurses Association (FNA) in a meeting of 150
nursing profession
nurses presided by the Anastacia iron Tupas

● aims to help nurses in advancing their career (Mrs. Tupas) the FNA was incorporated in 1924.

through a network of nursing recruiters and

● The International Council of Nurses accepted
educators
the FNA as one of the member organizations

5. ScrubsMag.com during the Congress held in Montreal, Canada on

July 8-13, 1929.

● “the nurse’s guide to good living”

● The association’s life purpose is “to promote

● provides information on a wide range of topics
professional growth towards the attainment of
including career advice, nursing school, beauty,
highest standards of nursing.”
style, health, fun, quizzes and giveaways

7. AACN.org
● RNs contribute articles and serve as editorial

advisers ● Website of the American Association of

Critical Care Nurses – a specialty nursing

6. PNA-ph.org
organization representing the interests of nurses

● the official website of the Philippine Nurses who care for acute and critically ill patients.

Association (PNA)
● Provides a litany of information relevant to ● Provides drug calculators, a drug interaction

critical care nurses and the organization in checker, a pill identifier and ton of other useful

general. tools.

● Provides evidenced-based resources, clinical 10. AANP.org

toolkits, information about grants, standards and

● Website of the American Association of
various policy related issues
Nurse Practitioners - a professional

8. NursingCenter.com membership organization for Nurse Practitioners

of all specialties
● Owned by Wolters Kluwer - a global

publishing company ● Provides a wealth of information on public

policy related to scope of practice and other

● Provides access to peer reviewed journal
issues impacting NPs.
articles from more than 50 nursing journals.

● Provides technical information on healthcare

● Has a blog with tons of clinical and technical
conditions as well as other educational
articles.
information.

9. Medscape.com/Nurses
● Interested parties can find information about

● Owned by WebMD - a publicly traded fellowship programs through the site and

company providing health related news, advice members can access the organization’s in-depth

and expertise research reports

● Offers tons of great industry reporting on recent 11. DiscoverNursing.com

advancements, new studies, and expert

● Owned by Johnson and Johnson - a healthcare
information on healthcare topics directly related
company that provides healthcare consumer
to the nursing field.
items, medical devices and pharmaceutical ● Contains information about the corporation, the

products. services and products they provide, their

branches, and more

● Offers detailed information about nursing

specialties, career paths, salary information, ● Patients can find doctors and make

nurse interviews and more. appointments through the site as well

12. ICN.ch 2. Unilab.com.ph

● First international organization for healthcare VALUES: husay, malasakit, & bayanihan

professionals
PURPOSE: Working towards a healthier

● Governed by a Council of National Philippines, one medicine at a time.

Representatives
● Contains information about the company, their

● Its goal is to bring nurses’ organizations products, written scientific articles, their

together in a worldwide body, to advance the advocacy programs, health tips, and career

socio-economic status of nurses and the opportunities

profession of nursing worldwide, and to influence

3. Pfizer.com.ph
global and domestic health policy.

● Website of Pfizer Philippines - Pfizer

HEALTH CARE SITES
Philippines Foundation, Inc. (PPFI) is a non-

1. MyHealth.ph stock, non-profit corporation organized to

perform charitable and social welfare activities

● A network of multi-specialty medical clinics
and programs geared towards improving health
offering comprehensive outpatient healthcare
capacities, education and awareness.
products and services
● Contains background information on the DJFMH Comprehensive Family Planning

foundation, contact numbers, and information Service.

about their products, which can only be accessed

by healthcare professionals

5. eamc.doh.gov.ph
4. fabella.doh.gov.ph

● Official website of East Avenue Medical

● Official website of Dr. Jose Fabella Memorial
Center
Hospital

● A 600-bed, tertiary, general hospital under

● A national special hospital for obstetrics,
DOH.
gynaecology and paediatric cases

● Primary goal is to provide quality medical care

● Primarily a government hospital for charity
and treatment to patients irrespective of sex,
patients, its functions are service, education
socio-economic status and religious creed.
training, public health and research.

● Provides appropriate training programs,

● Has 3 major departments: obstetrics,
materials and facilities that aim at providing its
gynaecology, and paediatrics which is
medical and non-medical staff with opportunities
complemented by other professional services like
for professional development and competency-
the Department of Laboratory, Anaesthesiology,
building.
Radiology, Family Planning, Admitting and

Record Section, Out-patient and Ancillary 6. slh.doh.gov.ph

services like the Medical Social Service, Dental
● Official website of San Lazaro Hospital
Clinic and Pharmacy

● A referral facility for infectious/communicable

● It has other services like Nursing Service,
diseases.
Administrative Service, School of Midwifery and
● One of the retained special tertiary hospital of ➔ Nursing is a profession rooted in professional

DOH which is subsidized by the national ethics and ethical values, and nursing
government performance is based on such values.

● Has a 500-bed capacity that provides health Professional Nursing Values

care delivery service particularly among the
Community Health Nursing is a nursing specialty
depressed, underserved and underprivileged
focused on public health. Community health
sectors of the society.
nurses cater to not only individual clients but also

family clients and even an entire community.

Community health nurses follow the same

professional nursing values as every other nurse

but encompass, in their nursing care, all the

individuals who are part of the community.

Professional nursing values are defined as beliefs

NURSE CARE VALUES AS A
or ideals that guide interactions with patients,
COMMUNITY HEALTH NURSE
colleagues, other professionals, and the public.

Values These values begin to form during nursing school

and continue to develop through interactions in

➔ Goals and beliefs that establish a behavior and
the work setting. Nurses will encounter ethical
provide a basis for decision making. issues and dilemmas throughout their career.

When they do so, their values will play an integral

➔ In a profession, values are standards for action
role in how they handle each situation they face.
that are preferred by experts and professional
While personal values are formed and used
groups and establish frameworks for evaluating
throughout daily life by all individuals, nurses
behavior.
have a special set of values that they will use to
make decisions or judgements throughout their nurse must always plan goals and

career. These values are professional nursing objectives with the family. The nurse

values. also makes a first and second-level

assessment to determine what problems

The Code of Ethics for Nurses with
to tackle first. This is to ensure the family
Interpretative Statements (ANA, 2015) is a
feels they are as much part of the
non-negotiable code for nurses to follow in order
planning as the nurse, and that what the
to provide ethical care to patients, and it can be
family deems a critical problem is given
used to determine a set of nursing values for the
attention first.
profession. Provisions 1 through 3 in the ANA’s

(2015) Code are especially helpful in this 2. Provision 2 also speaks to each nurse’s

endeavour as they focus most directly on how responsibility to maintain professional

nurses can provide ethical and quality care to integrity while caring for patients by

patients. Each provision within the Code is avoiding conflicts of interest. In doing so,

followed by an interpretative statement that is a nurses can better facilitate trusting

helpful guide to understanding each provision. relationships with patients and uphold

the high moral integrity of the profession

1. Provision 1 clearly articulates that the
of nursing. As a community health nurse,
nurse’s primary responsibility should
some clients will not be as vocal or as
always be to the patient (ANA, 2015).
open about what they need. With this, the
The Code asserts that the focus should be
nurse should know how to properly
on preserving the dignity of all patients
handle the client in a way that is not
while they receive care and goes on to
offensive to them and will make them
explain that one effective way to do this
more trusting of healthcare workers for
is by respecting patient autonomy. In
their betterment.
community health, when making a

nursing plan intended for the family, the

3. Provision 3 is primarily aimed at they care for in their practice. As

protecting and advocating for in community health nurses are like the first

particular, provision 3 speaks to line of healthcare workers clients

protecting a patient’s right to communicate with and are the ones in

confidentiality. Violating a patient’s charge of home visitations, it is important

right to confidentiality by a nurse is often for nurses to take care of themselves and

seen as a violation of the integrity of the to always be in their best condition. One

patient and, ultimately, can call into of the roles of a nurse is to be a role

question the integrity of the nurse. model because it encourages the client to

Nurses should keep patients’ privacy be more open and trusting. This makes

foremost in their minds when handling them more acceptable to the

paperwork, discussing patients, and in interventions presented to them. Values

daily actions in which they can in Nursing Care.

unconsciously reveal private

information. Provision 3,
importantly, calls on nurses to be
advocates for patients at all times,
especially when ethical boundaries might
be crossed. Nurses should call attention
to situations that may harm patients
either mentally or physically.
While the ANA (2015) provided a framework
more
through the Nursing Code of Ethics for Nurses
with Interpretative Statements from which nurses
can derive a set of professional values, the
American Association of Colleges of Nursing
(AACN) compiled a set of values for nurses. The
AACN listed the values of altruism, autonomy,
human dignity, integrity, and social justice as

4. Provision 5 instructs nurses to recognize most central to the nursing profession.

that preserving and promoting their own

 The AACN (2008) defined altruism as "a
health is essential to preserving and
concern for the welfare and well-being of
promoting the health of the patients that
others." Altruism is putting someone
else’s needs first; and at its core, it is both particular the most vulnerable

nurturing and selfless. Ideally, altruism is populations, such as the very young or

one of the five core professional values the mentally ill, is displaying altruism.

that all nursing students and nurses Ultimately, an altruistic nurse will take

should exemplify because it is believed risks on behalf of patients and co-

to contribute to ethical decision-making workers without regard to herself.

while caring for patients. While most

 Autonomy is a unique concept that can
nurses enter the profession with altruistic
be applied to nursing in two ways. For
ideals, they do not always translate into
example, autonomy, according to the
practice as easily. Altruism requires that
AACN (2008), is defined as "the right to
community health nurses put the needs of
self-determination". In essence, this is
their patients before their own needs,
the right that patients have to make their
which can be difficult at Altruism is the
own decisions. However, autonomy also
backbone of patient-centered care
refers to nurses acting independently
because it requires that the patient be ever
within their scope of practice. While
present in the mind of the nurse,
somewhat different, both of these
especially in the community setting
versions of autonomy are beneficial to
where she does not care for one person at
patients. Undoubtedly, the person who
a time. He/she could also care for one
should ultimately make decisions
family at a given time like in home visits,
regarding the patient’s care is the patient.
etc. A nurse who shows understanding of
This is true even when a decision made
the cultures, viewpoints, and beliefs of
by a competent patient is not one that the
others exemplifies the value of altruism
healthcare providers believe is in the
in thoughtful contemplation that will
patient’s best interest. As advocates,
result in altruistic action. A nurse who
nurses are uniquely positioned to protect
advocates for patients’ rights, and in
 and promote patient autonomy. A nurse its core, made up of patients who are at

who values autonomy can demonstrate their most vulnerable because of illness

this in a variety of ways: or injury. It is when people are most

vulnerable that they find themselves in

 An autonomous community health nurse
situations that might have an impact on
may record a nursing diagnosis or make
their sense of. In order for a nurse to
a judgement regarding a patient’s health
respect the dignity of patients, it is
status. This demonstrates the nurse’s
imperative that the community health
autonomy.
nurse first see patients as individuals with

 Nurses who make an effort to educate unique needs and desires. In essence,

patients so they can make informed when nurses decide to value human

decisions. dignity, they will be practicing altruism

and promoting the autonomy of patients.

In order to exemplify or promote all other

The patients' health care is helping the patients professional values nurses must first

assert their autonomy. recognize the importance and uniqueness

of each individual patient within society.

 Human dignity is defined as "having
 Integrity: The AACN (2008) explained
respect for the inherent worth and

uniqueness of individuals, families, and that integrity in nursing "refers to nurses

communities, and it characterizes all acting in accordance with an appropriate

interactions a nurse should have with code of ethics and accepted standards of

them." While the definition of human practice". Therefore, as with all of the

dignity is simple enough to understand, other values, integrity is intrinsically

linked to the ANA’s (2015) Code of

the concept is far more difficult to put

into practice. The healthcare setting is, at Ethics with Interpretative Statements and
to the standards of practice that have been respect patients’ values at all times, even

implemented by the While integrity is a when those values do not conform to the

value that should be practiced and upheld nurse’s own set of values. When a nurse

by all nurses, it is often one of the values respects a patient’s values, it will help

that nurses struggle to maintain or preserve the integrity of the patient. A

reconcile in their professional practice. nurse should help patients uphold their

This is often due to ethical dilemmas that own set of values when taking action or

nurses face that can challenge them to making healthcare decisions so patients

either violate or uphold their own sense do not feel as if they have to violate their

of professional integrity. A lack of own dignity in order to receive adequate

resource availability can also challenge care.

nurses’ integrity if they do not have the

 Social Justice: The AACN (2008) stated
staff, equipment, and supplies to safely
the term "social justice" "refers to
care for patients. Another factor that can
upholding moral, legal, and humanistic
negatively impact nurses’ ability to
principles." The position of the AACN is
practice with integrity is when they feel
that social justice, like the
they are unable to spend adequate time
aforementioned values, should be
with patients. Therefore, it is imperative
embodied by all professional nurses. It is
that nurses have adequate resources and
suggested that each of the values listed,
time to care for patients, as well as a solid
including social justice, should be
understanding of ethical guidelines.
included in the curricula of all nursing
Nursing professionals must also consider
programs as a core component.
the integrity of patients. Nurses should be
Throughout history, nurses have been
cognizant of the ways in which they can
advocates for some of the most
violate a patient's integrity while caring
vulnerable populations, so it is only
for them. Nurses should endeavor to
 natural for nurses to be advocates for

social justice. In fact, part of ensuring

that patients receive adequate care

requires nurses to take responsibility for

the role they should play in calling for a

system that allocates limited resources

fairly and does not discriminate based on

personal factors. Health-Related

Entrepreneurial Activities in the

Community Setting Entrepreneur

REFERENCE/S

https://www.studocu.com/ph/document/universit
y-of-perpetual-help-system-dalta/bachelor-of-
science-in-nursing/chn-lecture-module-9-
filipino-culture-values-and-practices-in-
relation-to-health-care/18359397

https://www.studocu.com/ph/document/universit
y-of-perpetual-help-system-dalta/bachelor-of-
science-in-nursing/chn-lecture-module-10-new-
technologies-related-to-public-health-
electronic-information/18360929

https://www.studocu.com/ph/document/universit
y-of-perpetual-help-system-dalta/bachelor-of-
science-in-nursing/chn-lecture-module-11-
nursing-care-values-as-a-community-health-
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