COMMUNITY HEALTH NURSING
know certain concepts:
Public Health Nursing practice has been influenced by
the changing global and local health trends these
brought PHN into new frontiers & have positioned
nurses to emerge as leaders in health promotion and
advocacy validated by WHO report acknowledging the
significant contribution of the nursing workforce to the
achievement of health outcomes, particularly
MILLENIUM DEVELOPMENT GOALS
GLOBAL & COUNTRY HEALTH IMPERATIVES
Changes exerting pressures on the Public Health
Systems:
1. Shift in demographic & epidemiological trends
in disease
2. New technologies for health care,
communication & information
3. Existing & emerging environmental hazards
associated with globalization
4. Health Reforms
United Nations General Assembly adopted a common
vision of poverty reduction and sustainable
development in September 2000 exemplified by the
Millennium Development Goals (MDG) based
on:freedom,equality,solidarity,tolerance,health respect
for nature and shared responsibility
8 Millennium Development Goals are as follows:
1. Eradicate extreme poverty & hunger
2. Achieve universal primary education
3. Promote gender equality& empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria & other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
• Health is essential to the achievement of this
goal
• Participation of all members in the society both
developing and developed countries is required
• Achievement of these goals by 2015 is now the
priority
• Country initiatives to implement a more cost-
effective health care services
• The Health Sector Reform Agenda (HSRA)
implemented through FOURmula ONE &
operationalized in the National Objectives for
Health 2005 to 2010-spells out the program
imperatives of the health sector in line with MDG &
Medium-Term Dev’t Plan of the country
Evolution of Public Health Nursing in the Phil.
• To have a better understanding we need to
HEALTH-(WHO) as a “ state of complete
physical,mental,and social well being, not merely the
absence of disease or infirmity.”
Determinants of Health as listed by WHO:
1.Income and social status
2.Education-low education are link to poor health
3.Physical Environment-safe water supply & clean air
4.Employment & working conditions
5.Social support network-greater family support better
6.Culture-customs & traditions
7.Genetics-inheritance
8.Personal behavior & coping skills-healthy lifestyle
9.Health Services-access & use
10. Gender-suffering from diff. diseases
• Public Health Nursing (Winslow)-”science and
art of preventing disease, prolonging life,
promoting health and efficiency through
organized community effort for the sanitation
of the environment, control of communicable
disease, the education of individuals in personal
hygiene, the organization of medical and
nursing services for the early diagnosis and
preventive treatment of disease & the
development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these
benefits as to enable every citizen to realize his
birthright of health and longevity.”
• WHO—”the art of applying science in the
context of politics so as to reduce inequalities in
health while ensuring the best health for the
greatest number.”
GAYLORD - is an organized community program
designed to prolong life , because it is the duty of
the Department of Health to prevent unnecessary
illness.
Hanlon - Public health is dedicated to the highest
level of physical, mental & social well-being &
longevity consistent with available knowledge and
resources at a given time and place. It holds this
goal as its contribution to the most effective total
development and life of the individual and his
society.
JACOBSON - a learned practice discipline with the
ultimate goal of contributing as individuals & in
collaboration with others, to the promotion of the
client’s optimum level of functioning through teaching
& delivery of care.
WHO - Special field of nursing that combines the skills
of nursing, public health & some phases of social
assistance & functions as part of the total public health
program for the promotion of health, the improvement Employment
of the conditions in the social & physical environment,
Education
rehabilitation of illness and disability.
Housing
RUTH FREEMAN
Public health is a core element of governments’
• Special field of nursing that combines skills in
attempts to improve & promote the health & welfare of
Public Health Nursing & some phases of social
their citizens.
assistance to further community health.
It further presented the core business of Public Health
• Is a service rendered by a professional nurse
as:
with the community, groups, families and
individuals at home, in health centers, in clinics, 1. Disease control
in school, in places of work for the promotion of
health, prevention of illness, care of the sick at 2. Injury prevention
home & rehabilitation 3. Health protection
ECO-SYSTEMS INFLUENCES ON OPTIMUM LEVEL OF 4. Healthy public policy including environmental
FUNCTIONING (OLOF) hazards in workplace,housing,food,water,etc.
POLITICAL 5.Promotion of health and equitable health gain
Safety PHILOSOPHY
Oppression CHN-based on worth & dignity of man

People Empowerment CONCEPTS

BEHAVIOR 1.The primary focus of CHN practice is on health

promotion
Culture
2.CHN practice is extended to benefit not only the
Mores individual but the whole family and community
Ethnic Customs 3.CHNurses are generalists in terms of their practice
HEREDITY 4.Contact with client & family may continue over a long
period of time includes all ages & types of health care
Generic Endowment
5.The nature of CHN practice requires that current
- Defects
knowledge derived from biological & social sciences,
-Strengths ecology, clinical nursing & community organizing be
utilized
-Risks
6.The dynamic process of assessing, planning,
Familial ,Ethnic
intervening,
Racial
provide periodic measurements of progress ,
HEALTH CARE evaluation & a continuum of the cycle until the
termination of nursing problem.
DEL. SYSTEM
PRINCIPLES
Promotive
1.CHN is based on the recognized needs of
Preventive communities, families. groups & individuals.
Curative 2.The CHNurse must understand fully the objectives &
Rehabilitative policies of the agency she represents.

ENVIRONMENT 3.In CHNsg the family is the unit of service.

Air, Food 4.CHN must be available to all regardless of race, creed

& socio-economic status.
Water Waste
5.Health teaching is a primary responsibility of the
Urban/Rural CHNurse.
Noise 6.CHNurse works as a member of the health team.
Radiation 7.There must be provision for periodic evaluation in
Pollution CHN services.

SOCIO 8.Opportunities for continuing staff education programs

for nurses must be provided by the CHN agency.
ECONOMIC
 The CHN Nurse also has a responsibility for his/her
own professional growth.
9. The CHN Nurse makes use of available community
health resources.
10.The CHN Nurse utilizes the already existing active
organized groups in the community.
11.There must be provision for educative supervision in
CHN.
12.There should be accurate recording & reporting in
CHN.
• Apply nursing process in meeting the health and
nursing needs of the community and
• Mobilize resources in the community;
• With leadership potential;
• Resourcefulness and creativity;
Honesty and integrity and, Active membership to
professional nursing organizations.
The PHN performs functions and activities in accordance
INTERDISCIPLINARY AND INTERSECTORAL
with the dominant values of PHN, within the
COLLABORATION
profession’s ethico-legal framework and in accordance
with the needs of the client and available resources for
health care.
The FUNCTIONS & ACTIVITES OF a PHN are :
management training, supervision, provision of nursing
care, health promotion and education and coordination
are consistent with the Nursing Law (RA 9173) and
program policies formulated by DOH and LGU
The PHN considers the needs of her/his clients and their
available resources for health and health care.
The PHN, in coordination with the faculty of colleges of
nursing, participates in teaching, guidance and
supervision of students in nursing and midwifery for
their related learning experiences (RLE) in the
community setting.
The PHN participates in the conduct of research and
utilizes research findings in his/her nursing practice.
SUPERVISION
• The PHN supervises midwives within her
catchments area in accordance with the
agency’s policies
• The PHN formulates a supervisory plan.
• Identifies the factors that affect the midwives
performance and job satisfaction; and
their need for supervision;
• Defines standards of performance & goals for
health services for each supervisee’s
catchments area/s;
• Sets achievable performance targets in
consultation with his/her supervisees;
• Prioritizes problems and concerns using
adequately defined criteria;
• Formulates objectives and strategies to meet
the midwives’ need for supervision;
• Determines standards and criteria for
evaluating supervisory visits.
• conducts supervisory visits
• Determines each supervisee’s specific needs for
supervision and development;
• Evaluates the effects of training and other staff
development programs/activities;
• Initiates and participates in developing policies
and guidelines that promote good
performance in nursing and midwifery services.
• Formulates policies and guidelines for nursing
services and,
advocates for the approval/passage of
facilitative/supportive mechanisms of improving
performance conditions.
• The PHN establishes linkages and collaborative
relationships with other health professionals,
GOs, NGO and POS to address the
community’s health problems.
• Identifies opportunities for establishing linkages
with different stakeholders in health
maintaining communication
• Uses knowledge on the community to link with
or refer to appropriate community
resources
• Attends multidisciplinary and multisectoral
activities
• Identifies strategies to strengthen referral
system.
•  Collaborates with health care providers,
professionals, community representatives in
ADPIE programs for community health
NURSING PROCESS
• Establishes a working relationship to help
ensure good quality data and to enhance
partnership in addressing identified
health needs and problems.
• Establishes rapport with the client
• Collects data that are appropriate and accurate
from individual, family and community
Uses different data collection methods and sources
such as surveys, qualitative interviews,
observation and review of records and reports.
• Ensures community participation in data
gathering
Records data collected in appropriate forms and
files them in a manner that facilitates retrieval.
 • The PHN recognizes the broad impact of certain
factors on the client’s health and nursing
problems
• The PHN analyzes data collected to determine
diagnosis
• Examines and interrelates data on the clients –
individual, family and community;
• Identifies actual and potential problems of the
client;
• Validates interpretation with the client
concerned
• Determines the possible causes of the identified
nursing and health problems and the factors
that could facilitate or hinder their resolution.
• The PHN formulates a nursing/community
diagnoses.
• Collaborates with clients and assists them in
taking responsibility for maintaining, restoring
their health by increasing their knowledge, and
control .
• Helps clients make informed choices about
health issues and interventions
• Maximizes the ability of their clients to take
responsibility for, and manage their health
according to their resources and personal
skills.
• Supports the client in developing skills for self-
advocacy.
• Assists clients in identifying their strengths and
available resources to address, their
needs;
• Uses empowering strategies such as visioning
and facilitation
• Applies epidemiological strategies such as
screening, surveillance, vaccination CD
response and outbreak management and
education.
• The PHN evaluates the responses of her/his
clients to interventions in order to revise
data base, diagnoses and plan, and to
formulate recommendations.
• Analyzes the results of evaluation with the
client;
• Uses reflective practice as an evaluation
strategy;
• Uses the results of evaluation to revise the data
base,diagnoses and plan; and,
• Uses the results of evaluation to make
recommendations to decision
makers/policymakers.
HEALTH PROMOTION & HEALTH EDUCATION
• The PHN recognizes the role of healthy lifestyle
in the prevention of a number of health
problems & integrates healthy lifestyle in
health programs.
• The PHN plans, conducts, and evaluates health
promotion and health education activities
properly.
• The PHN demonstrates knowledge and skills on:
(a) how to advocate for healthy public
policy, (b) creating supportive
environments, (c) strengthening community
action, and (d) developing client’s
personal skills. He/
• The PHN actively works to build capacity for
health promotion among the midwives,
volunteer health workers and community
partners.
DEMONSTRATING PROFESSIONAL RESPONSIBILITY
AND ACCOUNTABILITY
The PHN recognizes that her/his personal attitudes,
beliefs, assumptions, feelings and, values about
health have potential effects on his/her professional
actions and interventions.
The PHN accepts accountability for her/his actions
and engages in nursing practice that is ethical, safe,
acceptable and evidence-based. He/She
The PHN protects her/his professional autonomy,
assumes responsibility for professional
development and contribute to the professional
development of others.
The PHN institutes changes/improvements in
service delivery and management of health facility
to improve client’s access and use of public health
nursing services. He/She
The PHN maintains links and collaboration with
other professional nurses and nursing groups to
strengthen his/her nursing practice.
The PHN Maintains links and collaboration with the
government agencies and non-government
organizations (including political, community and
religious groups).
The PHN conducts and/or facilitates in various
training activities for public health nurses,
midwives, barangay health workers, nursing aide
and volunteers.
Community Health Nursing Process
• Is the central to all nursing actions-it is the very
essence of nursing, applicable in any setting, in
any frame of reference, and within any
philosophy
• Is a systematic,scientific,dynamic,on-going
• Interpersonal process in which the nurses &
the clients are viewed as a system w/ each
affecting the other & both being affected by the
factors w/n the behavior
 • process of DM results in the optimal health care
for the clients to whom the nurse applies the
process
Components of Nursing Process
• Assessment: Initiate contact, Demonstrate a
caring attitude, mutual trust & confidence,
Collect Data from all sources, ID health
problems, assess coping capability,analyze data
• Planning : prioritize needs, establish goals
based on the needs & capabilities of staff,
construct action plan & operational plan,
develop evaluation parameters, revise plan as
needed
• Implementation of planned Care: putting plan
into action, coordinate services, utilize
resources, delegate ,supervise, monitor, HE,
training, document responses to action
• Evaluation of Care: Performance Appraisal, ID
needed alterations, revise plans as necessary
Sequence of Activities In Family Nursing Practice
• Establish a working relationship
• Conduct Initial Assessment
• Categorizes health problems
• Determine the nature & extent of the family’s
performance of the health tasks.
• Det. priorities among list of health problems
• Ranks health problems according to priorities
• Decide on what to tackle
• Make FNCP
• Implement the Plan
• Evaluate, re-define nursing problems &
reformulate objectives according to evaluation.
Family Health Task & Responsibilities
• Recognizing interruptions of health
development ( Ability to recognize presence of
health problems)
• Making decisions about taking appropriate
health action.
• Providing nursing care to the sick, disabled & or
dependent members of the family.
• Maintaining a home environment conducive to
health maintenance & personal development.
• Maintaining a reciprocal relationship with the
community & its health institution.
Family- the basic unit of the community. All members of
the family are empowered to maintain their health
status. They must be free from disease or infirmity with
no disabilities.
Family Health Office: is tasked to operationalize health
programs geared towards the health of the family.
It concerned with the health of the mother & the
unborn, the newborn, infant, child,the adolescent &
youth the adult men & women & older persons
Family Health: Specifically it aims to:
1.Improve the survival & well being of mothers & the
unborn
2.Reduce morbidity & mortality rates for children 0-9
years
3.Reduce mortality from preventable causes among
adolescents & young people
4.Reduce morbidity & mortality among Filipino adults &
improve their quality of life
5.Reduce morbidity & mortality of older persons &
improve their quality of life
STRATEGIC THRUST 2005-2010
1.Launch & implement the Basic Emergency Obstetric
Care or BEMOC strategy in coordination with the DOH
• BEMOC strategy entails the establishment of
facilities that provide emergency obstetric care
for every 125,000 pop. & which are located
strategically
• It calls for planning for childbirth & upgrading of
technical capabilities of local health providers
2. Improve the quality of prenatal & postnatal care
• Pregnant women should have at least 4
prenatal visits
• Postpartum care should extend to more women
after childbirth, miscarriage & after unsafe
abortion
3.Reduce women’s exposure to health risks through
responsible parenthood & health care packages
4.LGUs,NGOs & other stakeholders must advocate for
health through resource generation& allocation for
health services.
Essential Health Service Packages Available in the
Health Care Facilities (every woman has to receive
before & after pregnancy & or delivery of a baby.
1. Antenatal Registration
2. Tetanus Toxoid Immunization
3. Micronutrient Supplementation
4. Treatment of Diseases & other Conditions
5. Clean & Safe Delivery
Standard Prenatal Visits that a woman has to receive
during pregnancy
1st visit - As early as possible before 4 mos. Or during 1 st
trimester
2nd visit - During the second trimester
3rd visit - During the third trimester
Every 2 weeks - After 8th mo. until delivery
Clean and Safe Delivery
1.Do a quick check upon admission for ER signs (vaginal
bleeding, severe abdominal pain, convulsion,
unconscious , difficulty in breathing, fever, severe
vomiting, severe headache, very ill
2.Make her comfortable
3.Assess the woman in Labor( LMP,# of pregnancies,
start
Of labor pains, age/height, danger signs of pregnancy
4.Determine the stage of Labor
5.Decide if the woman can safely deliver
6.Give supportive care throughout labor
7.Monitor & manage labor
8.Monitor closely within1 hour after delivery
9.Continue care after 1 hour PP. watch closely for 2 hrs.
10Educate & counsel on FP & provide methods available
11.Teach on birth registration, BF, NB screening 48hrs-
2wks after birth, schedule when to return for
consultation PP visits
Recommended Schedule of Post Partum Care Visits:
First visit - First week post-partum Preferably 3-5 days
Second Visit - Six weeks Post-Partum
Family Planning Program
Goal: Provide universal access to family planning
information & services wherever & whenever these are
needed
Aims to: reduce infant deaths ,neonatal deaths, under-
five deaths ,maternal deaths
Objectives: Address the need to help couples achieve
their desired family size
Ensure that quality FP services are available in DOH
retained hospitals LGU managed health facilities , NGO,
private sector
The Child Health Programs (Newborn , Infant and
Children )
• Vulnerable age group for common childhood
diseases
• Goal: Reduce morbidity & mortality rates for
children 0-9 years.
• Programs available in all Health Facilities:
1.Infant & Young Child Feeding
2.Newborn Screening
3.Expanded Program on Immunization
4.Management of Childhood Illness
5.Micronutrient Supplementation
6.Dental Health
7.Early Child Development
8.Child Health Injuries
Strategic Thrusts for 2005-2010
• Develop local capability to deliver the health
package for children
• Implement programs & projects that favor
disadvantaged population
• Apply Reaching Every Barangay (REB)
strategy for immunization
• Intensify HE at the ground level
• Enhance Med, Nursing & MW education w/
cost-effective life saving strategies (IMCI)
• Pursue the implementation of Laws & policies
(Early Childhood Dev’t Act 2000,NB Act of
2004,EO 286 Bright Child Program, EO 51 Milk
Code, Rooming-In & Breastfeeding Act)
Infant and Young Child Feeding
• Global Strategy for IYCF was jointly issued WHO
and UNICEF in 2002
• Strategy calls for the promotion of breastmilk as
the ideal food for the healthy growth &
development of infant
• & exclusive BF for the first 6 months of life for
optimal growth
• Goal: Reduce Child Mortality by 2/3 by 2015
• Objective: To improve the health & nutritional
status of infant & young children
Expanded Program On Immunization
• With the commitment of our country to
Universal Child Immunization Goal acceleration
of EPI coverage had began in 1986
• Hepatitis B immunization has been integrated in
1992 among 0-1 y.o. but 40% of the eligible
targets were prioritized.
• Western Regional Goal : Eliminate HB before
2012
• Fully immunized Child is a child who has
received 1 dose of BCG,3 doses of DPT, OPV,
Hepatitis B and 1 dose of AMV before his first
birthday
General Principles in Vaccinating Children
• It is safe & immunologically effective to
administer ALL EPI vaccines on the same day at
different sites of the body
• AMV is given as soon as the child is 9 months
old regardless of whether other vaccines will be
given on that day
• The vaccination schedule should not be
restarted from the beginning even if the interval
between doses exceeded the recommended
interval
 • Moderate fever, malnutrition, mild respiratory
infection, cough diarrhea & vomiting are not
contraindication to immunization, unless the
child is so sick that he needs to be hospitalized
• When Handling, transporting and storing
vaccines special care must be given to provide
quality potent vaccines among the targets
• “First Expiry and First Out” FEFO vaccine is
practiced to assure that all vaccines are utilized
before expiry date
• Temperature Monitoring of Vaccines is done in
all levels of Health Facilities to monitor vaccine
temperature
• Done twice a day early morning & afternoon
before going Home
• Temperature is plotted every day in a
temperature Monitoring Chart to Monitor to
monitor break in the cold chain
Integrated Management of Childhood Illness
• Has been established as an approach to
strengthen the provision of comprehensive &
essential health packages to the children
• Methods Utilized in managing childhood Illness:
Assess the patient, Classify the disease, Treat
the patient, Counsel the Patient
• Color Coded System has been Utilized:
• Green - Mild – Home Care
• Yellow – Moderate – Manage at the RHU
• Pink - Severe - Urgent Referral in Hospital
Nutrition Program
Goal: Improve the quality of life of Filipinos through
better nutrition, improved health and increased
productivity
Programs and Projects:
1.Micronutirent Supplementation
2.Food Fortification
3.Essential MCH Services Package
4.Nutrition Information
5.Home school & community production
6.Food Assistance
7.Livelihood Assistance
Nursing Procedures
Clinic Visit
the patient visit the Health Center/clinic to avail of the
services offered by the facility primarily for consultation
on matters that aid them physically Services offered:
Pre-natal and post partum care
Well baby check-up, immunizations,free medecines –
DOTS & HE etc.
Standard Procedures Performed During Clinic Visits
• Pre-Consultation conference is conducted prior
to admission
1.Registration/Admission-GEPEP(Greet,Establish
Rapport, Prepare family record, Elicit & record
complaint, PE
2.Waiting Time-first come first served according to
priority numbers
3.Triaging- Managed program-based cases (IMCI)
Refer all non-program based cases to physician
Provide first-aid treatment to emergency cases & refer
when necessary
4.Clinical Evaluation
a. validates clinical history and PE
b. arrives at evidenced-based diagnosis &
provides rational treatment based on DOH
program: ID patients problem formulate
nursing diagnosis, perform nursing
intervention, evaluate
c. Inform client on the nature of illness,
treatment prevention & control
5.Laboratory & other Diagnostic Examinations
6.Referral System-using two-way referral system
7.Prescription/dispensing-give proper instructions
8.Health Education-counseling, appointment for next
visit
HOME VISIT
• Is a family-nurse contact which allows the
health worker to assess the home & family
situations in order to provide the necessary
nursing care & health related activities
• Important to have a Plan of Visit-to meet the
needs of the client and to achieve the best
results of the desired outcome.
PURPOSE
1. Give nursing care to the sick, post partum& her NB.
2. Assess the living condition of the patient & his family
3. Give HE on prevention & control
4. Establish close relationship between agencies &
public
5. Make use of the inter-referral system to promote the
utilization of community services.
Principles in preparing for HV (assemble records, lists
of patients to be visited have NCP)
• HV should have a purpose or objective
• Planning for HV should make use of all available
information about the patient & his family
through family records
 • In panning, priority should be given to the
essential needs of the individual and his family
• Planning & delivery of care should involve the
individual and family
• Planning should be flexible
Guidelines to Consider on the Frequency of Home Visit
No definite rule but may vary according to the need of
patient and family
1.The physical & psychological needs and educational
needs of individual and family
2.The acceptance of the family for the services to be
rendered
3.Policy of the agency & program emphasis
4.Other health agencies & no. of health personnel
involved in the care
5.Careful evaluation of past services given to the family
6.Ability of the family to recognize their own needs,
knowledge of resources and their utilization
Steps in the Conduct of Home Visit
1.Greet and introduce yourself
2.State the purpose of the visit
3.Observe and determine the patient health needs
4.Put the bag in a convenient place & proceed to
perform Bag Technique
5.Perform the nursing care needed ,HE
6.Record all important data, observation & care
rendered
7.Make appointment for return visit
Bag Technique
• Is a tool by which the nurse, during her HV will
enable her to perform a nursing procedure with
ease & deftness, to save time & effort w/ the
end view of rendering effective nursing care to
clients
Principles of Bag Technique
1. It minimizes if not prevent the spread of
infection
2. It saves time and effort
3. Should show effectiveness
4. Can be performed in a variety of ways
Public Health Bag
• Is an essential & indispensable
equipment of a PHN which she has to
carry along during her HV
Important Considerations in the Use of the Bag
1. Bag should contain all the necessary articles, supplies
2. Contents should be cleaned often, supplies replaced
3. Contents should be well protected from contact with
any articles in the patient’s home
4. Arrangement of the contents should be the one
most convenient to the user.
Community Organizing
• Empowerment or building the capability of
people for future community action.
• Key ELEMENTS of the Community w/c maybe
reactivated to bring social & behavioral change
1.Organization (relationships, structure & resources)
2.Ideology (knowledge, beliefs & attitudes)
3.Change Agents
Five Stages of Organizing A Community Health
Promotion Mod
1.Community Analysis-assessing & defining needs,
opportunities & resources involved
2.Design & Initiation (formation of Organization)
3.Implementation
4.Program Maintenance – Consolidation (strengthening)
5.Dissemination-Reassessment
Public Health Nursing in Schools
• The primary role of the school nurse is to
support student learning & ensure that
educational potential is not hampered or unmet
health needs.
• Assist the pupils in acquiring health knowledge
in developing attitudes & practices conducive to
healthful living
• Based on the philosophy that the academic
performances of the pupils & the instructional
outcomes are also determined by the quality of
health of the school population & the
community where they come from.
Objectives of School Nursing: To promote & maintain
the health of the school populace by proving
comprehensive& quality nursing care.
Duties & Responsibilities of the School Nurse:
1.Health advocacy
2.Health & nutrition assessment including vision &
hearing
3.Supervision of the health & safety of the school plant
4.Treatment of common ailments & attending to
emergency cases
5.Referrals and follow-up of the pupils & personnel
6.Home visit
7.Community outreach
8.Recording & reporting of accomplishments
9.Monitoring & evaluation of programs & projects
Non-Communicable Diseases
Integrated Community Based Non-Communicable
Diseases Prevention & Control Program
• Aim at preventing the four major
Non-CD/chronic/lifestyle related diseases ,
cardiovascular diseases , cancers , COPD , DM
• Through promotion of healthy lifestyle
Healthy Lifestyle is defined as a way of life that
promotes & protects health and well-being.
Includes practices that promote health as:
• Healthy diet & nutrition
• Regular & adequate physical activity & leisure
• Avoidance of substances that can be abused-
tobacco, alcohol, addicting substances,
• adequate stress mgt. relaxation
• Safe sex and immunization
Goal: Reduce the toll of morbidity, disability and
premature deaths due to chronic, non-communicable
lifestyle related disease
Objectives:
1.Analyze the social & economic, political & behavioral
determinants of NCD
2.Reduce exposure of individuals & pop. to major
determinants of NCD
3.Strengthen health care for people with NCD through
health sector reforms & cost-effective interventions.
To achieve the goal the following approaches should
characterize the program:
1.Comprehensive Approach Focused on Primary
Prevention
• prevention of risk factors primordial
prevention,removal of risk factors)
2.Community-based Approach
• involves people participation,recognizes people
as the center of any health & dev’t effort
3. Integrated Approach
Role of Public Health Nurse in Non-Communicable
1.Health Advocate -help people towards optimal
degree of independence in DM & asserting the right to
safer & better community
2.Health Educator -inform, motivate & guide the
people into action.
3.Health Care Provider- emphasizing on health
promotion & prevention
4.Community Organizer- community health
development and people empowerment
5.Health Trainer- provide technical assistance
6.Researcher- community assessment, epidemiological
studies & intervention studies
Promoting Stress Management
1.Spirituality-(Mediation,effectivce way of relaxation)
2.Self-Awareness-increases sensitivity to inner self
3.Scheduling: Time Management( managing one’s self
to optimize time available to achieve gratifying results
4.Siesta-it relaxes the mind and body
5.Stretching-relaxes stress muscle & induces sleep
6.Sensation Techniques- massage
7.Sports-
8.Socials – dancing
9.Sounds & Songs- music provides a medium of for
thoughts & emotion expression
10.Speak to Me -talking to someone
11.Stress Debriefing-assist crisis worker deal positively
with emotional impact
12.Smile- people who smile are healthy people
COMMUNITY - Group or collection of locality-based
individual, interacting in social units and sharing
common interests, characteristics, values and/or goals
ALLENDER Sense of unity & belongingness.
LUNDY AND JANES Exhibits a commitment with one
another.
CLARK Functions collectively within a defined social
structure to address common concerns
SHUSTER & GOEPPINGER Locality-based entity, which
reflects society's institution, informal groups, and
aggregates
GEOPOLITICAL COMMUNITY -Territorial communities
governed by man-made boundaries (laws). - e.g.
barangays, municipalities, cities, provinces, regions,
continents.
FUNCTIONAL COMMUNITY -- More abstract set-up:
group of people of share the same culture, perspective,
religion, history, interest or goals
HEALTH - a state of complete physical, mental and
social well-being and not merely the absence of disease
and infirmity.
MURRAY -A state of well-being wherein an individual is
able to purposeful, adaptive responses and processes--
Physically, mentally, emotionally, spiritually and socially.
PENDER - Competent self-care, satisfying relationship
with others and goal-directed behavior.
OTHER PRINCIPLES
Optimum Level of Functioning
Health-illness continuum
High-level wellness
Agent-host-environment
Health belief Evolutionary-based
Health promotion citizen to realize his birth right of health and
longevity
MODERN CONCEPT OF HEALTH - It refers to the
optimum level of functioning of an individual, family & PUBLIC HEALTH NURSING
community. -Jacobson
-a specialized field of nursing that focuses on the health
HEALTH-ILLNESS CONTINUUM needs of communities and their practice applied to
promoting and protecting the health of the population.
The Illness-Wellness Continuum proposes that
individuals can move farther to the right, towards Public Health Core:
greater health and wellbeing, passing through the
1. Disease Control
stages of awareness, education, and growth. Worsening
2. Injury Prevention
states of health are reflected by signs, symptoms and
3. Health Protection
disability.
4. public policy including those in relation to
DETERMINANTS OF HEALTH existing hazards
5. Promotion of health and equitable health gain.
Income & Social Status
ROLES OF PUBLIC HEALTH NURSE
Education
Clinician, who is a health care provider, taking care of
Physical Environment
the sick people at home or in the RHU
Employment & working conditions
Health Educator, who aims towards health promotion
Social support networks and illness prevention through dissemination of correct
information, educating people
Culture Genetics
Facilitator, who establishes multi-sectoral linkages by
Personal behavior & coping skills referral system
Health Services Supervisor, who monitors and supervises the
Gender performance of midwives

COMMUNITY HEALTH Leader, Change Agent/Catalyst

Part of paramedical and medical Advocator, who act on behalf of the client
interventions/approach which is concerned on the Researcher
health of the whole population
3 IMPORTANT ELEMENTS OF CHN
-Service rendered by a professional nurse with
communities, groups, families, individuals at home, in 1. Population-Based/Focused Providing care
health centers, clinics, in schools, in places of work for based on the greater need of a 0
promotion of health, prevention of illness, care of the population/community.
sick at home and rehabilitation. 2. It has 3 Level of Clientele Individual, Family,
Community
The utilization of the nursing process in the different 3. Identifies Public Health Interventions
levels of clientele-individuals, families, population
groups and communities, concerned with the Public Health Interventions
promotion of health, prevention of disease and
1. Disease Surveillance & Case Finding To measure
disability and rehabilitation.” ( Maglaya, et al)
the magnitude of the problem
-Encompasses subspecialties: Public Health Nursing, 2. Outreach: Population Assessment
School Nursing, Occupational Health Nursing and other 3. Screening
areas like home care, & independent nursing practice 4. Referral and Follow-up
5. Case Management
PUBLIC HEALTH 6. Delegated Functions
science and art of preventing disease, prolonging life, 7. Health Teaching/Education
promoting health and efficiency through organized 8. Counselling
community effort for: 9. Consultations
10. Collaboration/Coordination
1. The sanitation of the environment 11. Networking/Coalition Building
2. The control of communicable infections 12. Community Organizing
3. The education of the individual in personal 13. Advocacy
hygiene 14. Social Marketing
4. The organization of medical and nursing 15. Policy development & Enforcement
services for the early diagnosis and preventive
treatment of disease BASIC PRINCIPLES OF CHN
5. The development of a social machinery to 1.COMMUNITY AS THE CLIENT
ensure everyone a standard of living, adequate
for maintenance of health to enable every The community is the patient in CHN, the family is the
unit of care and there are four levels of clientele:
individual, family, population group (those who share
common characteristics, developmental stages and
common exposure to health problems – e.g. children,
elderly), and the community.
2. ACTIVE PARTICIPATION
In CHN, the client is considered as an ACTIVE partner
NOT PASSIVE recipient of care
3. ADAPTIVE
CHN practice is affected by developments in health
technology, in particular, changes in society, in general
4. NETWORKING
The goal of CHN is achieved through multi-sectoral
efforts
5. BROAD SYSTEM CHN
is a part of health care system and the larger human
services system.
FAMILY
 Basic unit of the society.
• a group of persons united by the ties of marriage,
blood, or adoption, constituting a single household and
interacting with each other in their respective social
positions, usually those of spouses, parents, children,
and siblings.
• Performs two major functions: REPRODUCTION &
SOCIALIZATION
TYPES OF FAMILY
• Nuclear family: Traditional type
• Extended family: grandparents, married offspring,
and grandchildren
• Joint family: composed of sets of siblings, theirs
spouses, and their dependent children
• Blended family: Divorced or widowed parents who
have children marry
• Family by Choice: newly recognized type of family
NURSING ASSESSMENT PROCESS
FIRST LEVEL OF ASSESSMENT: Process of determining
the existing or potential health condition or problems of
the family.
(1) Wellness state
(2) Health threats
(3) Health deficit
(4) Stress points/foreseable crisis
SECOND LEVEL OF ASSESSMENT: Nature or type of
nursing problems that the family encountered. Factors
related in maintaining wellness, environment &
personal development
• Family’s realities
• Perceptions/assumption
STEPS IN FAMILY NURSING ASSESSMENT
1. Family structure, characteristics and dynamics
2. Socio-economic and Cultural characteristics
3. Home & Environment
4. Health Status of each member
5. Values and practices on health
promotion/maintenance & disease prevention
DATA GATHERING: FAMILY NURSING ASSESSMENT
1. Data Collection
1. Source of Data: Primary | Secondary
2. Data Validation
3. Data Analysis/Interpretation
4. Family Nursing Diagnosis
These are assessment, diagnosis, planning,
implementation, and evaluation.
1.Assessment. Assessment is the first step and involves
critical thinking skills and data collection; subjective and
objective. ...
2.Diagnosis
3.Planning
4.Implementation
5.Evaluation
DATA GATHERING METHODS
1. Observation: Communication and interaction
patterns, role perceptions, current home &
environment conditions
2. Physical Examination: Inspection, Auscultation,
Percussion & Palpation
3. Interview: Family health history
4. Records Review: Gathers data using existing patient
health records
5. Laboratory/Diagnostics Tests
DATA ANALYSIS
NURSING DIAGNOSIS: FAMILY NURSING PROBLEM
(1) Statement of unhealthful response
(2) Statement of factors which retains the undesirable
response and preventing the desired change.
Note: The more specific the problem, the more useful is
the nursing diagnosis
e.g. Inability to utilize community resources for health
care due to lack of adequate family resources,
specifically…
a. financial resources
b. manpower resources
c. time
NURSING CARE PLAN
-a systematic blueprint that the nurse designed to
minimize or eliminate the identified health and family
nursing problems.
- Action oriented
- Systematic approach
- Risk-based (foreseeable)
- Goal: Deliver the most appropriate care to the client
by eliminating barriers to the family development.
PRIORITIZING HEALTH PROBLEMS
Four Criteria for Determining Priorities:
1. Nature of the condition or problem
presented
2. Modifiability of the condition
3. Preventive potential
4. Salience: Family perception to
urgency/seriousness of condition.
Non-communicable diseases, also known as chronic
diseases or lifestyle related diseases includes:
cardiovascular diseases (heart disease/stroke) cancer,
diabetes mellitus and chronic respiratory diseases
including injuries and mental health disorders which are
collectively responsible for almost 70% of all mortalities
worldwide and 68% in the Philippines. The term NCDs
refers to a group of conditions that are not mainly
caused by an acute infection, result in long-term health
consequences and often create a need for long-term
treatment and care. Many NCDs can be prevented by
reducing common risk factors such as tobacco use,
harmful alcohol use, physical inactivity and eating
unhealthy diet. But with the globalization, unbalance
life & work and poor access to healthy foods, makes it
so difficult for people to maintain healthy choices. The
rapid rise in the prevalence of these diseases represents
one of the major health challenges to global
development in coming century.
After studying this module, you should be able to:
1. Define basic concepts and terminologies in family
health.
2. Be familiar with various DOH-related programs or
packaged that caters specific group in the community.
3. Be familiar with the roles of community health nurses
in the implementation of various DOH-related programs
to reduce mortality and morbidity in the community.
Underlying Concepts The NCD program aimed in
preventing non-communicable diseases: cardiovascular
diseases, cancers, chronic pulmonary diseases and
diabetes mellitus including injuries (e.g. road traffic
injuries), mental health condition/disorders, blindness,
renal diseases and program for persons with disabilities
and special needs.
Related policies and laws
1. AO No. 2011-0003 or The National policy on
Strengthening the Prevention and Control of Chronic
Lifestyle Related Non-Communicable Diseases
2. AO No. 2012-0029 or The Implementing Guidelines
on the Institutionalization of Philippine Package of
Essential NCD Interventions (PhilPEN) on the Integrated
Management of Hypertension and Diabetes for Primary
Health Care Facilities
3. AO No. 2013 – 0005 or The National Policy on the
Unified Registry Systems of the Department of Health
(Chronic Non-Communicable Diseases, Injury Related
Cases, Persons with Disabilities, and Violence Against
Women and Children Registry Systems)
4. AO 2015-0052: “National Policy on Palliative &
Hospice Care in the Philippines
5. AO 2016-0001: “Revised Policy on Cancer Prevention
and Control Program 6. AO 2016 – 0014 - Implementing
Guidelines on the Organization of Health Clubs for
Patients with Hypertension and Diabetes in Health
Facilities
Philippine Investment in Preventing and Controlling
NCDs
• NCDs account for 68% of all deaths in the Philippines,
and the probability of dying between the ages of 30 and
70 years from one of the four main NCDs is 29% in the
Philippines.
• The economic cost of NCDs to the Philippine economy
is PHP 756.5 billion per year, which is equivalent to 4.8%
of the country’s annual gross domestic product.
• NCDs in the Philippines are causing a surge in health-
care costs and social care and welfare support needs
and are contributing to reduced productivity.
1. Establishing program direction and infrastructure: A
good data gathering on existing risk factors and
prevalence of NCD will help diagnose a community and
the basis for program objective setting and activity
implementation. This will also facilitate rational funding
and resourcing. Establishing a team to manage the
program is a must.
2. Changing environments. Establishing partnership and
intersectoral coordinating mechanism in order to
develop policies and programs that ensure health and
environment are not compromised by economic
progress.
3. Changing lifestyle. Public awareness and advocacy
dissemination can reach to all members of the
community through all means/platform available. At the
community level, we can utilize barangay assembly,
mother/father classes, IEC posting to public places like
sari-sari stores, plaza or market places.
4. Reorienting health services. Reorienting focus of
health service delivery from cure to health promotion or
wellness.
Role of Public Health Nurse in NCD Prevention &
Control:
1. Health advocate:
a. Promoting active community participation.
b. Facilitates people towards optimal degree of
independence in decisionmaking and asserting their
right to a safer and better community.
2. Health Educator
a. Facilitates change in behavior-seeking condition.
b. Health education focuses on establishing or inducing
changes in personal and group attitudes and behavior
that promote healthier living conditions.
3. Health care provider
a. Provision of care directed towards risk factor
reduction
4. Community Organizer
a. Community health development and community
empowerment.
5. Health Trainer
a. Provides technical assistance; teaching and
supervision on clinical management on non-
communicable diseases and other community-based
services.
6. Researcher
a. Improves quality of care and promotes innovations.
b. Prevents implementing irrelevant interventions.
The Community health bag is designed to carry
equipment and material needed during a visit to the
home, school or factory. Equipment and material are
needed to make tests and to demonstrate patient care
such as eye irrigation, application of
ointments ,medications. (TNAI) It contains basic
medications and articles which are necessary for giving
care.
The overall objective of using community health bag in a
systematic method is “to be able to carry out nursing
procedures in the family with improvised equipments
articles available at home, maintaining scientific and
nursing principles which can also be practiced by the
family in her absence”.
PURPOSE:
• To prevent spread of infection from one patient
to another and from one place to another by
keeping bag and its contents as clean as
possible.
• To demonstrate the principles of cleanliness to
patients and family members by using the bag
in orderly way.
• To carry out selected procedure,
demonstrations, teaching and follow up
services for patients and family members
PRINCIPLES:
• 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.
• Bag technique should not overshadow concern for the
patient rather should show the effectiveness of total
care given to an individual or family.
INDICATIONS:
The public health bag is used by public health nurse to-
• Provide antenatal, intranatal and postnatal care to
mother and child.
• Perform certain diagnostic procedures such as Hb
testing, urine testing for early detection of high-risk
cases and provide timely treatment.
CONTD....
• Demonstarte certain Procedures to family members
or community such as preparing oral dehydration
solution (ORS),baby bath,application of benzyl benzoate
in cases of scabies.
• Provide emergency and first aid services (+) in case of
accidents and minor ailments.
• Provide and demonstrate care in case of
communicable diseases such as chickenpox.
• Provide follow up services in chronic illness such as
diabetes,paraplegia or amputation.
• Access the need of individual and families and give
health education in care of malnutrition,environmental
hazards,home accidents and immunization etc
Internal compartment: These are used for keeping
solutions and medicines for internal and external use,
simple instruments for dressing, articles for certain
procedures such as temperature taking, urine testing,
antenatal examination and few additional things for
health teaching
Procedure: -
 Select area of work.
 Spread newspaper
 Remove hand washing material
 Wash hands
 Remove the apron from the bag and put it on.
 Remove needed equipment’s.
 Close the bag.
 After procedure, wash hands under tap water.
 Use cotton swab moistened with spirit and wipe
outside of used bottles
 Wait for 5 minutes.
 Return articles to the bag.
 Fold used newspaper with used side inside, and
return to outside pocket.
 Close the bag.
 Write a report of what was observed, what was
done, instructions given.
Evaluation and Documentation
• Record all relevant findings about the client and
members of the family.

• Take note of environmental factors which affect the

clients/family health.

• Include quality of nurse-patient relationship.

• Assess effectiveness of nursing care provided.

Care of the bag In order to keep the bag ready for use
at any time, observe some of the following instructions.

 Clean the bag daily,protect from excessive heat

or rain to reserve it in a good condition.

• Replace the drugs,dressing and linen daily in the

bag.

• Empty all the contents,wash the bag with soap

and water once in a week or more frequently
depending on how much it has been used and dry it
the sun.

• Wash the non-expendable articles such as

instruments,linen and utensils with soap and water
and boil them.

• Repalce cotton or plastic bags containing swabs

and dressing with sterile one.

• Check gloves,catheters,thermometer and glass

articles,replace if spoilt or broken.

• Repack the bag in an orderly way;keep articles in

their usual places to make them easily traceble.

Nurse’s responsibility:

- The bag should contain all necessary articles,

supplies and equipment.
- The bag and its contents should be cleaned.
- The bag and its contents should be well
protected.
- Hand washing should be done frequently.
- The bag should be cleaned thoroughly before
reusing.
- Record the procedure after performing.