Chn211 Transes - Prelims

CHN211: COMMUNITY HEALTH NURSING TRANSES FOR PRELIMS
● La Gota de Leche - 1st center dedicated to

the service of mo. & babies
TOPICS:
1. Overview of CHN / PHN Fajardo Act of 1912
a. Evolution: Public Health Nursing ● created Sanitary Divisions made up of 1 to 4
in the Philippines municipalities
b. Concept & Principles of ● each sanitary division had a president who
CHN/PHN had to be physician
c. National / Global Health Situation
1915
d. National Health Situation (2023
Update) ● Philippine General Hospital (PGH) began to
2. Health Care Delivery System extend public health nursing services in
3. Primary Health Care homes by organizing unit called Social &
a. Primary Health Care: Background Home Care Services
(History, Definition, Elements, Commonwealth Act No. 430
etc.) ● created Department of Public Health and
b. Rural Health Unit (RHU)
c. Herbal Medicine Welfare
4. Family Health Nursing EO No. 317 (1941)
5. Family Nursing & Nursing Process ● full implementation of Commonwealth Act
No. 430
Dr. Jose Fabella
WEEK 1
Evolution: PHN in the Philippines ● 1st Department Secretary of Health and
Public Welfare
1577
1947
● Franciscan Friar, Juan Clemente, opened
● post war
medical dispensary in Intramuros for the
● the DOH was recognized into bureaus:
indigent
1690 Bureau of Hospitals and a Bureau of
Quarantine
● Dominican Father, Juan de Pergero, worked
toward installing water system in San juan ● took charge of municipal &
del Monte & Manila charity clinics
1805 Bureau of Health with the sanitary
● smallpox vaccination by Francisco de divisions under it
Balmis, a personal physician of King charles Bureau of Public Welfare (became
IV of Spain the Social Welfare Administration)
1876 Curative (Bureau of Hospitals)
● first medicos titulares were appointed by preventive care services (Bureau of
the Spanish government. Health)
1888 Creation of Nursing Service Division
● 2-year courses consisting of fundamental 1951
medical & dental subjects - 1st offered by ● Sanitary District was converted into a Rural
UST. Health Unit
● Graduates were cirujanos ministrantes ● w/ 7 Basic Health Services: maternal &
○ serve as male nurses & sanitation Child Health, Environmental Health,
inspectors Communicable Disease Control, Vital
1901 Statistics, Medical Care, Health Education &
● United States Philippines Commission Public Health Nursing
● Act 157, created Board of Health of ● 81 selected provinces
Philippine Islands with Commissioner of RA 1082 or Rural Health Act (1954)
the Public Health, as chief executive officer ● creation of RHU in every municipality
(now DOH) ● created post for Municipal Health Officer
Asociacion Feminista Filipina (1905) 1970
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● Restructured Health Care Delivery ➔ aims to achieve the health system
● classification of health services into: goals of better health outcomes,
○ Primary level sustained health financing,
○ Secondary level responsive health system that will
○ Tertiary level provide equitable access to health
● PHN population ratio is 1 : 20,000 care
RA 1891 RA No. 11223
● In 1957 amend certain provisions in Rural ● Universal Health Care Act / Kalusugan
Health Act Pangkalahatan
● created 8 categories of rural health units ● automatically enrolls all Filipino citizens in
corresponding to the population size of the the National Health Insurance Program
municipalities. ● provide all filipinos with access to
RA 7160 affordable, quality, and comprehensive
● Local Government Code health services
● October 1991
● decentralization of entire government
● all structures, personnel, & budgetary CONCEPT & PRINCIPLES OF CHN/PHN
allocations from the provincial health level What is COMMUNITY?
down to the barangays were devolved to the ● a group of people with common
LGU to facilitate health service delivery characteristics or interests living together
● Delivery of health service within a territory or geographical boundary
○ now the responsibility of the LGU place where people under usual conditions
● DOH changed its role from one of are found
implementation to one of governance
Millenium Development Goals Definition of HEALTH
● WHO: State of complete Physical, Mental &
Social well-being, not merely an absence of
disease or infirmity
● Modern Definition: OLOF (Optimum Level
of Functioning
ECO-SYSTEM
● adopted during world summit in September
2000 ● Generally influences health
FOURmula 1 (F1) for health, 2005 &
Universal Care in 2010 POLITICAL
● agenda launched in 1999 Health Service ● Safety, Oppression, People Empowerment
Delivery - Both the national government BEHAVIOR
and LGUs manage the delivery of ● Culture, Habits, Ethnic Customs
promotive, preventive, curative, HEREDITY
rehabilitative health services ● Generic Endowment (Defect, Strengths,
Risk)
FOURmula One (F1), 2005 HEALTH CARE DELIVERY SYSTEM
➔ Health governance and regulation ● Promotive, Preventive, Curative,
➔ The enactment of LGC in 1991 led to Rehabilitative
dual governance in health, with the ENVIRONMENT
DOH governing at the national level ● Air, Food, Water Waste, Urban/Rural,
and the LGUs at the subnational Noise, Pollution, Radiation
level SOCIO-ECONOMIC
Universal Health Care ● Employment, Education, Housing
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↓ ↓
Determinants of Health Reduce
Health is affected by many factors - Environment Enable EVERY INEQUALITIES
and circumstances CITIZEN to realize Ensure BEST HEALTH
BIRTHRIGHT of for the GREATEST
● Income & Social Status
health & longevity number
● Employment & working conditions
● Education
● Physical Environment Public Health Nursing
● Health Services (Definition by Lillian Ward)
● Social Support Networks Director: Henry St. Settlement in New York
● Personal Behavior & Coping Skills ● Service is AVAILABLE to ALL people
● Genetics ● PUBLIC GOVERNMENT AGENCY care of
● Gender poor people
● Culture National League of Philippine Government
Nurses (NLPGN)
Public Health ● Practice of nursing in local/national
government health department & public
WINSLOW WHO school
● Position/Title/Designation
A science & art of Art of applying science ○ Civil Service Commission
Prevents Dse, Promote in the context of ○ Public Health Nurse
health/efficiency, politics ○ Nurses in local/national health
Prolong life
department or public school
Organized Public Health is a ● Different PHN & CHN is only ONE AREA →
COMMUNITY CORE Element of setting of work as dictated by FUNDING
EFFORT for: GOVERNMENT
- Sanitation attempt to improve Community Health Nursing
environment citizens welfare (Definition by Dr. Ruth Freeman)
- Control CD - Essential PH
- Educational Fxns ● A service rendered by professional nurse
personal ● With the I, F, G & C
hygiene ● At HOME, HC, CLINICS, SCHOOLS,
- Organization of PLACES OF WORK
Medicine & ● For the Promotion of Health, Prevention of
Nursing
Illness, Care of Sick at home &
Services
Rehabilitation
For early dx. & Essential public health
previous tx. of dse. FXNS. Four Level of Clientele
Development of social Development policy in 1. Individual
machinery to ensure a public health - Unique
standard of Regulation to protect - Sick or Well
adequate living for public - “Entry Point”
maintenance of Human Resource 2. Family
health Development - Group of person bound by
Surveillance
blood/marriage/adoption
Research, innovative
solution - “Unit of Service”
Ensure quality health 3. Community
service - Group of persons sharing same
Health promotion culture situated in same
geographical location
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- Main Patient ● Unit of Service: FAMILY
- Main Concern ● Knowledge Used
4. Group/Population Group/Risk Group ○ No knowledge will be obsolete
- Same age group ○ Current, Updated
- Same characteristic ● Evaluation
- Exposed to same environmental ○ Periodic
factor ● Part of health team
Community Health Nursing Philosophy

(Definition by Jacobson) (According to Dr. Margaret Shetland)
● Broader than PHN ● Worth & Dignity of man
● Nursing Practice in wide variety of services
& consumer advocate areas, variety roles, The Public Health Nurse
including independent practice
● Professional Qualifications: Licensed
● Not confined in Public Health Nursing
● Personal Qualifications:
○ “People Skills”
Concept of Community Health Nursing ○ Strength - physical, mental, &
● FOCUS OF CARE emotional
○ Health promotion ○ Tested - leadership,
● DURATION OF CARE resourcefulness, creative, honesty, &
○ Over a long period of time integrity
● COVERAGE OF CARE ○ Difference - interest, willingness
○ All ages (capacity to work with people)
○ All types of health care
○ Care is for all (regardless of race, Functions Consistent with:
creed, nationality, & socio-economic, 1. Nursing Law 2002
nationality) 2. Program Policies of DOH
● WHO BENEFITS? a. Garantisadong Pambata: Essential
○ Family, Community Child Survival Package
● KNOWLEDGE USED? b. Breastfeeding: Nature’s Health Plan
○ Current, Multi-disciplinary: 3. Policies of Local Government Health
(Biology, Ecology, Social Science) Agency
● Generalist in terms of practice
● Applies nursing process in taking action Competencies Skill & Knowledge
1. Nursing Process
Goal of Community Health Nursing
2. Nursing Procedure (Home Visit/Clinic
● Raise Level of Health Visit)
3. Community Organizing
Principles of CHN 4. Health Promotion & Education
● Must fully understand objectives & 5. Surveillance, records & reports
principles
● Primary Responsibility: HEALTH Functions of PHN
TEACHING NURSING CARE FXN
● Care is based on Recognized Needs of I, F, & ● Based on Science & Art of caring
C ● Towards health PROMOTION & Dse.
● Resources of community (GO & NGO) must Previous: I, F, & C
be fully utilized ● Uses Nursing Process: Recognized NEEDS
● There should be accurate Record of of clients
Reporting ● Home visits
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● Referral ○ Solid knowledge of principles of
○ Other health provider teaching/learning
○ Environmental health ● As an educator - Provide information →
○ Social services better choices
COLLABORATING & COORDINATING FXN ● Uses skills in ADVOCACY, influence for
● Bring group of activity in harmony with health promotion
each other
● PHN Care Coordinator SUPERVISORY FUNCTION
● Linkages with: ● PHN - Supervisor of midwives & auxiliary
○ Government agencies health workers
○ NGO ● Formulate supervisory plan & conducts
○ Health professionals supervisory visit (supervisory checklist)
○ Private sector ● Identifies with supervisee issue / problem -
RESEARCH FXN breach of procedure/protocol → coaching
● Activity - Disease Surveillance STAT → Training (needs further capacity
○ Continuous collection & analysis of enhancement)
data of cases & deaths
● Purpose of Disease Surveillance MANAGEMENT FUNCTION
1. Measure Magnitude of problem ● 5 Management Fxns to attain objective
2. Measure effect of program - To 1. Planning
improve strategies 2. Organizing
● “DATA WILL BE USED TO IMPROVED 3. Staffing
CARE” 4. Directing &
5. Controlling (Evaluation)
● Organizes nursing service - implement
nursing service plan as part of the overall
municipal health plan
The Public Health Nurse

● PHN II
○ Frontline Health Worker. First
Contact of pt. (Works in health
center)
○ Prime mover for all health programs
& activities
TRAINING FXN ○ Assist physician during consultation
● Initiate Staff Development & Training ○ Provides health education (pre/post
program for Midvibes & BHW clinic visit)
● Training Needs Assessment (TNA) ○ Reaches out in community
● Design, conducts training with resource ○ Organizes community assemblies for
person, Evaluate training health promotion
● Training of Nursing & Midwifery Affiliates ○ Performs home visits
(RLE) ○ Prepare, submit reports (W, M, Q,
● Community - “Community Organizing” A)
HEALTH PROMOTION & EDUCATION FXN ● PHN III
● Health Education ○ Acts as Nurse-in-Charge
○ Basic Health Service ○ Supervises, guides, coordinates work
○ Major Component of health of nurse
program. Done on daily basis. ○ Interpret policies, participates in
planning health program
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● NURSE V ● Promotion of health, early diagnosis of dse
○ “Supervising PHN” or disability & prevention of dse.
○ Assigned in health center with ● The first contact between community
lying-in members & other levels of health facility
○ Takes charge of staff & unit Secondary Level of Health Care
○ Participates in program planning ● Emergency Hospital
○ Attends, meeting, conference for ● District Hospital
improvement of health services ● Provincial Hospital
○ Evaluate performance of staff ● City Hospital
● NURSE VI ● Moderately specialized equipment &
○ “Nurse Program Supervisor” laboratory facilities Capable of Minor
○ Conducts pre-service & in-service surgeries Referral Center for PHC
orientation Tertiary Health Care
○ Consolidate reports ● Regional Health Services
○ Study ratings of PHN performance ● Regional Medical Services & Training
○ Initiate meeting, conferences for Hospital
joint planning ● National Health Services
○ Nursing consultant on technical ● Medical Centers
matters ● Teaching & Training Hospital
● Ultimate highly specialized health
Laws Affecting PHN personnel
RA 6758 ● Highly specialized technical level
● Standardized Salaries of government ● Specialized ICU advanced diagnostic
employees (Nursing Personnel) services for DX, TX of DSE & Disability
RA 7305
● Magna Carta of Public Health National / Global Health Situation
Workers POPULATION (gender, age group, life expectancy,
● Improved the social & economic well-being growth rate, projected population)
of health workers GENDER
● (Higher basic salary, hazard allowance,
laundry allowance, subsistence allowance)
RA 6713
● Code of Conduct & Ethical Standards for
Public Officials & Employees
● Utmost responsibility, integrity,
competence, loyalty, lead modest lives &
uphold public interest over personal
interest
AGE GROUP
Levels of Care
Primary Level of Health Care
1. Rural Health Unit (RHU)
2. Barangay Health Station (BHS)
3. Puericulture Center
4. Clinics of large industrial firms - employee
5. Private practitioners/private clinics and
others
● Basic level of health care
LIFE EXPECTANCY
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ANNUAL AVERAGE POPULATION GROWTH

RATE %
PROJECTED POPULATION
MORBIDITY (sickness) / MORTALITY (death)
NATALITY (birth)
● In 2013
○ 531,280 registered deaths from all
causes and all ages
○ Males: 304, 516 (57%)
Females: 226, 764 (43%)
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○ For every 1,000 population = more
than 5 people die
NOTIFIABLE DISEASES
1. Dengue
2. Diphtheria
3. Measles
● most affected by age group of
measles deaths (median: 1 y/o)
● 41% less than 9 mos.
● 40% 1-4 y/o
4. Polio
Today’s Health Situation - NATIONAL

● COVID-19 is an infectious disease by a new ● 1999 - Average Life Expectancy at
coronavirus recently introduced to humans Birth was 68.6 years
for the first time ○ 67.1 years in 2000-2005
● WHO called it pandemic ○ 71.6 years in 2015-2020
● Virus spreads all over the world ■ 71.28 for females
● About 80% of COVID-19 (+) have mild ■ 66.03 for males
symptoms ○ 249 people for every square
● January 30, 2020 kilometer of Philippine territory
○ According to WHO, polio ● Metro Manila has the highest Population
vaccination must intensify until last Density = 16,051
child is reached & fully protected ○ CAR has the lowest = 75 (National
● DOH September 2019: synchronized polio Health Objectives)
vaccination campaigns ○ From 37% of the Total
● November to December 2019 in targeted Population in 1984 (UNICEF,
regions reached a total of 1,404,517 1986) the figure increased to 44%
(exceeding target) children below 5 y/o in Ten Years later.
NCR and 2,937,327 (95%) children in ● Annual Population Rate
Mindanao ○ Average pop growth rate (PGR)
● April 7, 2020 of 1.7% ANNUALLY for the period
○ According to WHO, urgent need for ○ Global trend PGR DECLINED
investment in Nursing from 2000-2010 level of 1.9%
● In the Philippines, the shortfall of nurses
will be 249,843 by 2030. Greater
THE NATIONAL HEALTH SITUATION
investment now to retain them in the
Philippine health sector. ● High Population Density = Transmission of
infectious and communicable diseases
● Greater need for social services such as:
National Health Situation (2023 Update)
○ Decent housing
DEMOGRAPHIC PROFILE ○ Transportation
● The Philippines is one of the populous ○ Communication
countries in the world in 2000. ○ Education
● Projected to increase to 82,636,689 in ○ Health Services
2004 (National Health Objectives, 1999) ● High levels of stress in congested areas
● 2015 Philippines Population = 101 Million leads to:
● Predicted Phil. Population of 103,242,900 ○ Disintegration of moral values &
(2016/PSA) social institutions
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○ Incidence of a number of health 2. Hypertension complicating
problems, including mental health pregnancy, childbirth and
problems puerperium
3. Postpartum hemorrhage
HEALTH PROFILE 4. Pregnancy with abortive outcome
5. Hemorrhages related to pregnancy
Birth and Deaths ● Analysis of women’s poor health and
● Crude Birth Rate (CBR) in 1997 was maternal mortality should consider the
28.4 per 1000 population overall social, cultural, and economic
● Crude Death Rate (CDR) = 6.1 per environment. (Poor, low educational status,
1000 population multipara, anemic)
● The rate of natural increase in the country’s
population for the same year was 22.3
Infant Mortality
(28.4 minus 6.1) for every 1000
population ● Infant mortality rate decreased from 34 per
● Rural women have more children than 1000 live births to 23 per 1,000 live births
urban women. ● Under-five mortality rate or deaths of
● Uneducated women also have more children below 5 years old.
children than those who are with college ○ Down from 54 per 1,000 live births
education. to 31 per 1,000 live births in the
● Those in the 25-29 age group have the same year was 67/1000 live births.
highest fertility rate (National Demographic ● Infant mortality rate is one of the most
and Health Survey, 1999) sensitive indicators of health status of a
country or community. Results from:
1. Poor maternal conditions
Maternal Mortality 2. Unhealthy environment
● Maternal Mortality Rate (MMR) was 3. Inadequate health care delivery
1.8/1000 live births (DOH) 1995 or 18 system
maternal deaths for every 10,000 live ● Leading causes of infant mortality in
births. (Source: Maglaya) 1997 were:
○ From 126 per 100,000 live 1. Respiratory conditions of the fetus
births in 2012 to 114 per and newborn
100,000 live births in 2015. 2. Pneumonias
(Source: NOH) 3. Congenital anomalies
● Maternal Mortality - Major Indicator of a 4. Birth injury and difficult labor
Woman’s Health Status 5. Diarrheal diseases
○ Defined by WHO as the Death of a 6. Septicemia
Woman while Pregnant or within 42 7. Measles
Days of Termination of Pregnancy 8. Meningitis
from any cause related to, or 9. Other diseases of the respiratory
aggravated by the pregnancy or its system
management, but not from 10. Aminovitaminosis and other
accidental or incidental causes. nutritional deficiency. (1997
● Leading Causes of Maternal Mortality Philippine Health Statistics)
in 1997
1. Normal delivery and other
Nutrition (National Nutrition Survey)
complications related to pregnancy
occuring in the course of labor, ● Stunting remained unchanged
delivery and puerperium ○ 33.1% in 2005
○ 33.4% in 2015
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● Stunting is high among residing in rural ● Major public health problem (Urban Areas)
areas (38.1%) ● Increase in STD’s (Syphilis & Gonorrhea
● High among those belonging to the poorest due to Unhampered Prostitution in the
quintiles (49.7) country)
● Prostitution has always been identified as a
consequence of poverty.
Death Rate
● Death rate among males is higher than
females - referred as the FEMINIZATION Tuberculosis
of old age ● Number one cause of mortality about 50
years ago continue to be a major killer of
filipinos.
● TB case detection rate and treatment
success rate both exceeded the national
targets of 93.6 and 90 percent, respectively
(DOH 2016 report)
● Philippines remained one of the 30 high TB
burden countries in the world: Incidence of
554 per 100,000 population in 2016 (WHO,
2017)
Leprosy
● MDT (Multi-drug Therapy) 1.7/10,000
**Mortality - Infectious in Lifestyle** (1995)
Schistosomiasis
● Affect hundred of barangays in 24 endemic
provinces.
Rabies
● Incidence in the philippines is one of the
highest in the world
Hepatitis B
● 12% of the Population are chronic carriers
**Morbidity - Infectious in Nature** (Hepatitis B and Hepatic Sarcoma)
SARS Mosquito
● “Scary” Severe Acute Respiratory Syndrome ● Malaria
● Transmission of infectious diseases is ● Filariasis
facilitated by the increasing mobility of ● Dengue Fever
people and ease in traveling from one
country to another.
POVERTY AND HEALTH
Factors:
AIDS ● Illiteracy
● Acquired immunodeficiency syndrome ● Unfounded health benefits
(AIDS) ● Harmful practices
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● Inadequate Nutrition ● Implemented via systematic use of the
● Poor environmental sanitation nursing process and other processes to
● Inadequate source of potable water supply promote health and prevent illness in POP.
● Congested housing unit
● Limited access to basic health services
● Inability to make decisions on matters
which are important to health
WEEK 2
Philippines Health Care Delivery System
CULTURAL INFLUENCES ON HEALTH
● The Philippines archipelago with 7,100
Defined as islands geographically, divided into 3 main
● Is a way of life islands: Luzon, Visayas, Mindanao;
● Passed in from one generation to the next ● There are 17 regions including Autonomous
● Includes beliefs, values and customs or Region of Muslim Mindanao (ARMM;
practices ● 82 provinces
● Traditional ● 135 cities
● 1,493 municipalities
ENVIRONMENTAL INFLUENCES ON
HEALTH 2 Sectors
● Unsanitary Environment (Major factor) Private Sector
● Breeding ground of animals and insects that ● production and provision of health goods
harbor and transmit microorganisms. and services (private clinics, hospitals &
● Deterioration of the ecosystem laboratories, drugstores, & other facilities)
● Exposure to chemicals and other air
pollutants (Cancer & Respiratory diseases) Public Sector
● Decentralized health care system
OTHER INFLUENCES ON HEALTH ● Department of Health (DOH)
● Industrialization ● Local Government Units (LGUs)
● Government policies ● Devolving primary and secondary health
● Poverty and an uncaring attitude towards services delivery LGUs
the environment ● RA 7160
○ Implementing Rules and Regulation
POLTICAL INFLUENCES ON HEALTH (IRR) of the Local Government Code
● Health policies emanate from congress, the of 1991
executive department (DOH) ○ devolution of health services
● Policies that affect health = health care ○ decentralization of basic health
delivery system and the practice of nursing services
in the Philippines ● Managed, coordinated, regulated by the
● Health budget is the most concrete DOH
expression of the government’s political ● DOH
will. ○ composed of central Office
● Health spending has always been ○ 17 Regional Offices (ROs)
inadequate. ○ retained hospitals
● DOH Specialty Hospital
CONCEPT OF CHN ○ Lung Center of the PH
CHN (Clark) ○ National Kidney and Transplant
● Synthesis of nursing knowledge and Institute
practice ○ PH Children’s Medical Center
● Science and practice of public health ○ PH Heart Center
● DOH Metro Manila Hospitals
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○ Amang Rodriguez Memorial Medical ● Sec. 8 “Minimum STandards and
Center Construction of a Hospital” RA No. 4226
○ Dr. Jose Fabella Memorial Hospital (Hospital Licensure Law)
○ East Avenue Medical Center ● categorized based on service capacities and
○ Jose R. Reyes Memorial medical compliance with standards for manpower,
Center equipment, construction, and physical
○ National Center for Mental Health activities
○ National Children’s Hospital
○ E. Rodriguez, Quezon City
○ Philippine Orthopedic Center
○ QuiriNO Memorial Medical Center
○ Research Institute for Tropical
Medicine
○ Rizal Medical Center
○ San Lazaro Hospital
○ Tondo Medical Center
● DOH Regional Hospitals
○ Regional Hospitals in Cagayan
Valley
Batanes General Hospital
Cagayan Valley Medical
Center
Southern Isabela General
hospital
Region II Trauma and
Medical Center New Classifications of Hospitals & Other
Facilities
○ Regional Hospitals in NCR
Dr. Jose N. Rodriguez According to OWNERSHIP
Memorial Hospital - Tala, A. Government
Cal. City ● created by law. May be under DOH,
Las Pinas General Hospital & DND, DOJ, PNP, LGU, SUCs, GOCC
Satellite Trauma Center and others
San Lazaro Ruiz General B. Private
Hospital ● may be a single proprietorship,
partnership, corporation,
Valenzuela Medical Center
cooperative, foundation, religious,
non-government organization and
Levels of Health Care Delivery
others.
According to SCOPE OF SERVICE

A. General Hospital
● provides medical and surgical care
to the sick and injured and
maternity care and shall have as
minimum, the following clinical
services: medicine, pediatrics,
obstetrics and gynecology, surgery
and anesthesia, emergency services,
out-patient, and ancillary services
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B. Specialty Hospital
● specializes in a particular disease or
condition or in one type of patient.
Hospital Classification Scheme

General Hospital
● services for all types of illness, injuries or
deformities
○ General: level 1, 2, 3 (teaching /
training)
○ Specialty
According to Functional Capacity

A. LEVEL 1
● A staff of qualified medical, allied Specialty Hospital
medical and administrative
● For specific dse, condition or type of patient
personnel
○ Particular disease
● headed by a physician duly licensed
○ Particular organ or groups of organs
by the Professional Regulation
Commission (PRC) ○ Particular group such as children,
B. LEVEL 2 women, elderly and others
● Level 1 plus
● Departmentalized clinical services
● Respiratory unit
● General ICU
● High Risk Pregnancy Unit
● NICU
● An organized staff of qualified and
competent personnel with Chief of
Hospital/Medical Director and
appropriate board-certified Clinical
Department Heads
C. LEVEL 3
● Level 2 plus Hospital Facilities Classification
● Teaching/training with accredited Category A / Primary Care Facility
residency training program in 4 ● First contact health facility
clinical service ○ Without in-pt. hospital centers,
● Physical Medicine & rehabilitation out-pt, dental clinics
unit ○ With in-pt., birthing (lying-in),
● Ambulatory surgical clinic infirmaries
● Dialysis clinic
● Teaching and/or training hospital Category B / Custodial Care Facility
with accredited reisdency training
● Long-term care with food and shelter to
program for physicians in the four
chronic conditions needing ongoing health
(4) major specialities, namely:
& nursing care due to impairment, reduce
○ Medicine
independence in activities of daily living &
○ Pediatrics
rehab.
○ Obstetrics and Gynecology
● Example:
○ Surgery
○ Custodial psychiatric facilities
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○ substance drug abuse tx & rehab
center
○ nursing homes
○ leprosaria/ sanitaria
Category C / Diagnostic / Therapeutic

Facility
● Example:
○ Lab facility
○ Radiologic facility
○ For cancer dx-facility
I. DOH
Category D / Special Outpatient Facility ● Main governing Body
● Example: ● Guidance/technical assistance to LGU
○ Dialysis clinic ● Center for Health Development
○ Ambulatory surgical
○ Cancer chemotherapeutic II. Provincial Government
center/clinic, radiation facility, ● Administration of provincial or district
physical medicine & rehab hospital
center/clinic
III. Municipal or City
● In-charge of PHC (RHU/Health Center)
(BHS)
● Plan, implement basic health services
(hospital service)
Department of Health
● The Philippines’ Department of Health
(DOH) (Filipino: Kagawaran ng
Kalusugan) is the principal health agency in
the Philippines. It is the executive
department of the Philippine Government
responsible for ensuring access to basic
public health services to all Filipinos
Classification of Hospitals through the provision of quality health care
According to Trauma Capability: and the regulation of providers of health
Guidelines formulated by PCS goods and services.
A. Trauma-Capable Facility
● A DOH license designated as a DOH Roles and Functions
trauma center. 1. Leadership in health
B. Trauma-Receiving Facility ● National policy & regulatory
● A DOH licensed hospital within the institution
trauma service area which receives ● Leader in formulation, monitoring &
trauma patients for transport to the evaluation of national health policies
point of care or a trauma center. ● Advocate adoption of health policies
2. Enabler and capacity builder
● Innovate new strategies in health
ROSI & CAMS | 14

●Oversight function & monitoring, accountability & consistency in performing
evaluation of national health plan its functions
● Ensure highest standard ● Excellence – DOH continuously strives for
3. Administrator of specific services the best by fostering innovation,
● Manage selected national health effectiveness & efficiency, pro-action,
facilities dynamism, and openness to change.
● Administer direct service for ● Compassion & respect for human
emergent concern dignity – DOH upholds quality of life,
● Administer health emergency respect for human dignity is encouraged by
response services working w/ sympathy & benevolence for
people in need.
Attached Agencies ● Commitment – With all our hearts &
● the DOH – constituted of various central minds, the Dept. commits to achieve its
bureaus and services in the Central Office, vision for health & development of future
Centers for Health Development (CHD) in generations.
every region, and DOH-retained hospitals. ● Teamwork – DOH employees work
together with a result- oriented mindset.
● Stewardship of the health of the
people – Being stewards of health for the
people, the Department shall pursue
sustainable development & care for the
environment since it impinges on the health
of Filipinos.
Goal
● HSRA
● Health Sector Reform Agenda: Health
financing, health regulation, local health
system, public health programs & hospital
system
Vision
● Filipinos are among the healthiest people
in Southeast Asia by 2022, and Asia by
2040
Mission
● To lead the country in the development of a
Productive, Resilient, Equitable, and
People-centered health system for
Universal Health Care
Core Values
● Professionalism – DOH performs its
functions in accordance with highest ethical
standards, principles of accountability, and
full responsibility.
● Integrity – The Department believes in
upholding truth & pursuing honesty,
ROSI & CAMS | 15

○ Goal 11 “Sustainable cities and
communities”
○ Goal 13 “Climate action”
○ Goal 16 “Peace, justice”
World Health Organization

● A specialized agency of the United Nations
(UN) provides global leadership on health
matters
● WHO constitution came into force on April
7, 1948.
5 Core Functions of DOH

1. Provide leadership on matters critical to
health & engage partnerships when joint
action is needed
2. Shape research agenda. Stimulate
generation, translation, & dissemination of
valuable knowledge.
3. 3. Setting norms, standards. Promote &
Persintent Inequities in Health Outcomes monitor implementation.
● Every year, around 2000 mothers die due to 4. Articulating ethical and evidence-based
pregnancy-related complications. policy options.
● A Filipino child born to the poorest family is 5. Provide technical support, catalyze change
3 times more likely to not reach his 5th & build sustainable institutional capacity.
birthday, compared to one born to the
richest family.
● 3 out of 10 children are stunted.
WEEK 3
Primary Health Care
Sustainable Development Goals (SDG)
Brief History
● Health targets of Sustainable Development
Sept 6-12, 1978
Goals (SDG) 2030, particularly: Goal 3
● International Conference for Primary
“Good health & well-being”
Health Care
● And other health-related targets in:
● At Alma Ata, USSR (where the conference
○ Goal 1 “No poverty”
was held)
○ Goal 2 “Zero hunger”
○ The International Conference on
○ Goal 6 “Clean water and sanitation”
Primary Health Care calls for urgent
○ Goal 7 “Clean energy”
action by all governments, all health
ROSI & CAMS | 16
and development workers, and the ● Safe water & sanitation
world community to protect and
promote the health of all the people Universal Goal
of the world by the year 2000 Health for all by year 2000
● WHO & UNICEF (United Nations ● Acceptable level of health for all in the
Children’s Fund world
● Health development of workers for the ● Through I & C self-reliance
protection & promotion of health of all the
people Letter of Instruction Theme
● Health in the hands of the people by 2020
Alma Ata Declaration on Primary Health
Care
● Health - basic fundamental right Key Principles of Primary Health Care
● Global burden of health inequalities exist (4As)
● Economic & Social Development - basic ● Accessibility
impotence for full attainment of health for ○ Accessible
all ○ Consider the time travel
● Government has resp for health of people ○ Within 30 minutes
● Availability
Letter of Instruction (LOI) 949 of 1979 ○ Services are regularly available
● First Asian country ○ Organized given affordability
● Health is a product of Socio & Economic ● Affordability
development ○ affordable
○ It considers the out-of-the pocket
Definition expenses
● Essential health care ○ It is with the bracket of philhealth
● Practical, significantly sound & socially ● Acceptability
acceptable methods & technology
● Universally accessible to I & F in Support Mechanism
community
● Through full participation - active
involvement
● At cost can afford to maintain
● At every stage of their development
● In spirit of self-reliance & determination
Elements
● Education for health
○ give awareness
● Locally endemic disease treatment
● Expanded Programme on Immunization
● Maternal and Child Health with responsible
parenthood
● Essential drugs
○ libreng gamot
● Nutrition
○ vitamin A and other multivitamins Multisectoral Approach
● Treatment for Com Disease &
● Intrasectoral linkages
Noncommunicable Disease
ROSI & CAMS | 17

○ Communication, collaboration,
cooperation within health sector
● Intersectoral linkages
○ other agencies or department (eg
deped basta lahat ng sector of
government
Community Participation
● Clients are not recipients of care but
ACTIVE partners
● full participation 2 Levels of PHC Workers
1. Village or Barangay Health Worker
Equitable Distribution of Health ○ Auxiliary health workers, trained
Resources health workers
● DDTB (doctors to the barrio program) ○ BHW
○ Fifth-sixth class municipalities for 2 2. Intermediate Level Health Workers
years ○ Gen Med practitioners, PHN, PHM,
● RN Heals Dentist, RSI
○ Registered nurse health
enhancement and local services for 1 Varies depending on:
year 1. Availability of health manpower
2. Local health needs and problems
3. Political and financial feasibility
3 Levels of Prevention
Primary Prevention
● An intervention that prevents the disease
process from ever beginning
● immunization, health teaching. Wala pang
sakit
● Ex.: Diabetes
○ Adopt a healthy diet
Appropriate Technology ○ Exercise or other plans to prevent
● Health technology diabetes onset in the future
○ Tools, drugs, methods, procedures &
techniques Secondary Prevention
● Criteria ● An intervention that identifies and stops a
○ Safe, effective, affordable, simple, disease early on in the disease process
acceptable, feasible/reliable, before the patient even realizes anything is
ecological effects, potential to wrong (before any clinical signs arise)
contribute to I & C development. ● pt is symptomatic so need mag lab test
● prevent lumala sakit and makahawa
● Ex.: Diabetes
○ Doing blood glucose screening of
asymptomatic patients
Tertiary Prevention
ROSI & CAMS | 18

● An intervention that is used for those who Medico-legal officer of
○
already have clinical signs of disease. These municipality
interventions attempt to cure pt, decrease 2. PHN/Public Health Nurse
morbidity, decrease mortality or increase ● Supervises/guides - Rural Health
functionality midwife
● chronic illnesses ● Prepares, report - FHSIS (Field
● Ex. Diabetes Health Service & Information
○ Use medications to treat previously System)
diagnosed diabetics in hopes of ● Nursing Process - utilize when
decreasing the onset and/or severity responding
of symptoms ● GO, NGO, private business, people
● FHSIS
RURAL HEALTH UNIT (RHU)
Urban Health Unit
● Health Centers
● Primary level healthcare facility in
municipality/city
● Focus: preventive, promotive health
services
● Supervision of Barangay Health Station
● 1 : 20,000
Barangay Health Station (BHS)

● Satellite station of RHU
● 1st contact health care facility
3. PHM/Public Health Midwife
● Basic services at brgy. Level ● Manages Barangay Health Station
● Manned by volunteer BHW under the trains Barangay Health Workers
supervision of midwife ● Provides midwife services &
program
● Pt assessment for referral
● Health info, education and
communication
● Organizes community
● Facilitate brgy. Health planning
4. RSI/Rural Sanitary Inspector
● Ensures healthy environment
● Through advocacy, monitoring,
regulatory
● Ex. Inspect water supply
RHU Personnel 5. BHW/Brgy. Health Worker
1. MHO/Municipal Health Officer ● Interface between community &
RHU
● Or Rural Health Physician
● Trainings: preventive health care FP,
● Head the health services
MCH, Nutrition, San’tion, Rep’tive
● Roles/functions
H.
○ Administer of RHU - plan &
● RA 7883… Entitled to hazard &
budget
subsistence allowance
○ Community physician
ROSI & CAMS | 19

Local Health Board
City Health Board/

Provincial Health Board
Inter Local Health Zones of Negros

Occidental
Inter Local Health Zone (ILHZ)

Composition:
Health Referral System ● People
○ Ideal health district population size
● Set of activities undertaken by health care
(100,000 & 500,000) - for optimum
provider in response to its inability to
efficiency, effectives (WHO, 1986)
provider in response to its inability to
○ Population vary - depending on
provide necessary health intervention
number of LGUs decide to cooperate
& cluster
● Boundaries
○ Clear boundaries between Inter
Local Health Zones - determine
accountability & resp. health service
providers.
○ Geographical locations & access to
referral facilities such as district
hospitals are the usual basis in
Two-Way Referral System forming the boundaries.
● Health Facilities
ROSI & CAMS | 20

○ A district or provincial hospital ● Recognized by people to help maintain &
(referral hospital for secondary level improve their health towards the wholeness
of health care), Rural Health Units of their being, community & society & their
(RHU), Barangay health stations interaction based on culture, history,
(BHS) & other health services heritage & consciousness
deciding to work together as an
integrated health system. Medicinal Plants Preparation
● Health Workers
1. Decoction
○ Right mix of health providers
● boil recommended parts in water
needed to deliver comprehensive
● boiling time: 20 minutes
health services.
2. Infusion
○ Groups of health providers are:
● plant part soaked in hot water like
DOH, district hospital, RHU, BHS,
tea
private clinics, volunteer health
● 10 - 15 minutes
workers, NGO & community-based
3. Poultice
organization.
● directly apply recommended part on
○ They form a LHZ team to plan joint
affected area
strategies for district health care.
● for bruises, wounds, rashes
4. Tincture
HERBAL MEDICINE ● mix plant part in alcohol
Republic Act 8423, known as

Halamang Gamot (approved by DOH)
the Traditional and Alternative
Medicine Act (TAMA) of 1997 LAGUNDI
● Traditional medicine program ● Vetix negundo
● Authored by Senator Juan Flavier and ● "5-leaved chaste tree“
approved on December 1997 ● used in Philippine herbal medicine to treat
● This gave rise to the creation of Philippine cough, colds and fever.
Institute of Traditional and ● relief for asthma & pharyngitis
Alternative Health Care (PITAHC)
● tasked to promote and advocates use of USES & PREPARATIONS:
traditional & alternative health care 1. Asthma, Cough & Fever – Decoction (
modalities through scientific research & Boil raw fruits or leaves in 2 glasses of water
product development for 15 minutes)
● The Philippine Department of Health 2. Dysentery, Colds & Pain – Decoction (
(DOH) through its "Traditional Health Boil a handful of leaves & flowers in water
Program" has endorsed 10 medicinal to produce a glass, three times a day)
plants to be used as herbal medicine in the 3. Skin diseases (dermatitis, scabies,
Philippines due to its health benefits. ulcer, eczema) - Wash & clean the
skin/wound with the decoction
Traditional Health Program 4. Headache – Crush leaves may be applied
● 10 medicinal plants as herbal medicines in on the forehead
Philippines attested by National Science & 5. Rheumatism, sprain, contusions,
Development Board insect bites – Pound the leaves and apply
on affected area
Traditional Medicine
YERBA BUENA
● Sum total of knowledge, skills & practice on
health care, not necessary explicable in the ● (Mentha cordifelia)
context of modern, scientific philosophical
framework
ROSI & CAMS | 21
● analgesic to relive body aches and pain due TSAANG GUBAT
to rheumatism and gout. It is also used to
● (Carmona retusa)
treat coughs, colds and insect bites
● "Wild tea" (gubat = wild animals)
● taken as tea to treat diarrhea with
USES & PREPARATIONS:
abdominal pain
1. Swollen gums – Steep 6 g. of fresh plant
in a glass of boiling water for 30 minutes.
USES & PREPARATIONS:
Use as a gargle solution
1. Diarrhea – Boil chopped leaves into 2
2. Toothache – Cut fresh plant and squeeze
glasses of water for 15 minutes. Divide
sap. Soak a piece of cotton in the sap and
decoction into 4 parts. Drink 1 part every 3
insert this in aching tooth cavity
hours
3. Menstrual & gas pain – Soak a handful
2. Stomach Ache – Boil chopped leaves in 1
of leaves in a glass of boiling water. Drink
glass of water for 15 minutes. Cool and
infusion.
strain
4. Nausea & Fainting – Crush leaves &
apply at nostrils of patients
NIYOG-NIYOGAN
5. Insect bites – Crush leaves and apply juice
on affected area or pound leaves until like a ● Quisqualis indica
paste, rub on affected area ● "Chinese honeysuckle"
6. Pruritus – Boil plant alone or with ● to eliminate intestinal parasites.
eucalyptus in water. Use decoction as a
wash on affected area. USES & PREPARATIONS:
7. Pain (headache, stomachache) – Boil 1. Anthelmintic – The seeds are taken 2
chopped leaves in 2 glasses of water for 15 hours after supper.
minutes. Divide decoction into 2 parts, 2. If no worms are expelled, the dose may be
drink one part every 3 hours. repeated after one week.
8. Rheumatism, arthritis and headache (Caution: Not to be given to children below 4 years
– Crush the fresh leaves and squeeze sap. old)
Massage sap on painful parts with
eucalyptus BAYABAS
9. Cough & Cold – Soak 10 fresh leaves in a ● Psidium Guajava (guava = bayabas)
glass of hot water, drink as tea. ● as antiseptic, anti-inflammatory,
(expectorant) anti-spasmodic, antioxidant
hepatoprotective, anti-allergy,
SAMBONG antimicrobial, anti-plasmodial, anti-cough,
● Blumea Balsafimera antidiabetic, and antigenotoxic in folkloric
● treat kidney stones, gout medicine
USES & PREPARATIONS: USES & PREPARATIONS:

1. Anti-edema, diuretic, anti-urolithiasis 1. For washing wounds – Maybe use twice
a. Boil chopped leaves in a glass of a day
water for 15 minutes until one 2. Diarrhea – May be taken 3-4 times a day
glassful remains. 3. As gargle and for toothache – Warm
b. Divide decoction into 3 parts, decoction is used for gargle. Freshly
drink one part 3 times a day. pounded leaves are used for toothache. Boil
2. Diarrhea – Chopped leaves and boil in a chopped leaves for 15 minutes at low fire.
glass of water for 15 minutes. Drink one part Do not cover and then let it cool and strain
every 3 hours.
AKAPULKO
● Cassia alata
ROSI & CAMS | 22
● "ringworm bush or schrub" and "acapulco"
● to treat tinea infections, insect bites, USES & PREPARATIONS:
ringworms, eczema, scabies and itchiness 1. Diabetes Mellitus (Mild non-insulin
dependent
USES & PREPARATIONS: a. Chopped leaves then boil in a glass
1. Anti-fungal (tinea flava, ringworm, of water for 15 minutes. Do not
athlete’s foot and scabies) cover.
a. Fresh, matured leaves are pounded. b. Cool and strain.
b. Apply soap to the affected area 1-2 c. Take 1/3 cup 3 times a day after
times a day meals
ULASIMANG BATO | PANSIT-PANSITAN Reminders on the Use of Herbal Medicine

● Peperonica Pellucida 1. Avoid the use of insecticide as these may
● effective in treating arthritis and gout. leave poison on plants.
2. In the preparation of herbal medicine, use a
USES & PREPARATIONS: clay pot and remove cover while boiling at
1. Lowers uric acid (rheumatism and low heat.
gout): 3. Use only part of the plant being advocated.
a. One and a half cup leaves are boiled 4. Follow accurate dose of suggested
in two glasses of water over low fire. preparation.
Do not cover the pot. 5. Use only one kind of herbal plant for each
b. Divide into 3 parts and drink one type of symptoms or sickness.
part 3 times a day 6. Stop giving the herbal medication in case
untoward reaction such as allergy occurs.
BAWANG 7. If signs and symptoms are not relieved after
2 to 3 doses of herbal medication, consult a
● Allium Sativum
doctor.
● Garlic
● treat infection with antibacterial, anti
Alternative Health Care Modalities
inflammatory, anti-cancer and
anti-hypertensive properties. ● Other forms of nonallopathic, occasionally
● to reduce cholesterol level in blood. non indigenous or imported healing
methods.
USES & PREPARATIONS: ● includes: reflexology, acupressure,
1. Hypertension chiropractics, nutritional therapy
a. Maybe fried, roasted, soaked in
vinegar for 30 minutes, or blanched ACUPRESSURE
in boiled water for 15 minutes. ● Application of pressure on acupuncture
b. Take 2 pieces 3 times a day after points w/o puncturing the skin
meals. ● acupressure stimulates the body at certain
2. Toothache meridians, or pressure points
a. Pound a small piece and apply to
affected area
AMPALAYA
● Momordica Charantia
● bitter melon / bitter gourd
● treatment of diabetes (diabetes mellitus),
hemorrhoids, coughs, burns and scalds, and
being studied for anti-cancer properties.
ROSI & CAMS | 23

● Acupuncture points are anatomically
defined areas on the skin relative to certain
landmarks on the body. Indicated that there
were holes in the skin through which qi
energy could flow.
MASSAGE
● Superficial soft parts of the body are
rubbed, stroked, kneaded or tapped for
remedial, aesthetic, hygenicor limited
therapeutic purposes
CHIROPRACTIC
● Concerned w/ pathogenesis, diagnosis,
REFLEXOLOGY therapy & prophylaxis of functional
disturbances, pathomechanical states, pain
● Application of therapeutic pressure on the
syndromes & neurophysiological effects
body’s reflex points to enhance body’s
relate to static & dynamics of locomotor
natural healing mechanisms & balance body
system, esp. spine & pelvis
functions. Based on principle that internal
● traditionally uses manipulation of the spine
glands & organs can be influenced by
and limbs
properly applying pressure to the
corresponding reflex area on the body.
HERBAL MEDICINE / PHYTOMEDICINE
● Finished, labeled, medicinal products that
contain as active ingredients, aerial or
underground parts of the plant or other
materials or combination thereof, either in
the crude state or as plant preparations.
NUTRITIONAL THERAPY
● Use of food as medicine & to improve health
by enhancing the nutritional value of food
components that reduces risk of disease.
Synonymous w/ nutritional healing
PRANIC HEALING
● Holistic approach of healing that follows the
principle of balancing energy.
WEEK 4
Family Health Nursing
FAMILY
ACUPUNCTURE ● National Statistical Coordination
● Using needles to puncture & stimulate Board:
specific anatomical points of body
ROSI & CAMS | 24

○ A group of person usually living
together and composed of the head
by blood, marriage and adoption
● Johnson:
○ Social unit interacting with the
larger society
● Allen:
○ Characterized by people together
because of birth, marriage,
adoption, or choice
● EO 209 Family Code:
○ marriage is a special contract of
permanent union between man &
woman 5 Components of IDB
○ that’s why divorce + same sex ● Family structure, characteristics and
marriage are not allowed dynamics
● Friedman: ● Socio-economic and cultural characteristics
○ 2 or more persons who are joined ● Home and environment
by bonds of sharing & emotional ● Health status of each member
closeness & identify themselves as ● Values and practice on health promotion,
part of FAMILY maintenance and disease prevention
○ no marriage involved
○ live-in is considered as a family
Family Forms / Structures
(based on internal organization and membership /
Family Assessment components)
Interview 1. Dyad
● Effective communication is essential in the ● Empty nester
1st step to establish a trusting relationship. 2. Cohabiting
● the same principles used in an effective ● Live-in
interview with a client applies. ● Common law spouses & children
● Family assessment tools are available 3. Compound family
● Many agencies have a standard form ● Man has more that 1 wife
○ Initial Data Base (IDB) ● PD 1083
○ Family service and progress record 4. Blended
● 1 or both spouses bring in
child/children from previous
marriage in their new living
arrangement.
5. Nuclear
● Husband,wife, children
● Marriage
● procreation
6. Extended
● 3 generations
● Married sibling & their F w/
grandparents
7. Single parent
● Pregnancy outside of wedlock
● Separation
ROSI & CAMS | 25

● Death of spouse ○ Husband has more than one wife at
8. Gay / Lesbian family the same time. This type of family
● Cohabitating couple of same sex can be found mostly in Saudi Arabia.
● Not legal ● Polyandrous Family
○ consists of a wife with more than
Classification of Family one husband. Can be found in Todas
based on authority of Southern India.
● Patriarchal
Genogram
○ authority is vested on the oldest
male in the family, often the father. ● known as McGoldrick–Gerson study, a
● Matriarchal Lapidus schematic or a family diagram
○ authority is vested in the mother or pictorial display of person's family
mother’s kin. relationships & medical history
● Matricentric
○ prolonged absence of father gives
mother a dominant position in the
family, although father may also
share with mother in decision
making.
● Patricentric
based on pattern of residence

● Patrilocal
○ When a married couple lives with or
near the husband's family.
● Matrilocal
○ When a couple lives with or near
their mother's family.
● Neo-Local
○ When a married couple sets up
home separate from either side of
their families.
based on pattern of lineage

● Patrilineal Family
○ Occurs when property & title
inheritance passes down through
father’s side.
● Matrilineal Family
○ Property & title inheritance passes
through mother’s side
based on amount of mates

● Monogamous Family
○ Husband only has one wife; western
idea of typical marriage.
● Polygamous Family
ROSI & CAMS | 26

Developmental Assessment
● Duvall (1977) theory of development stages
of family life
● stages within the life cycle of every family;
each stage includes distinct family
Culturagram
developmental tasks
● (Congress & Kung, 2005)
● develop a better understanding of the Developmental Stages of the Family
sociocultural context of the family as well as
MARRIAGE
identify appropriate interventions for the
family. ● Formation of identity as a couple
** Areas (Congress & Kung, 2005) ** ● Inclusion of spouse in realignment of
● Reasons for relocation relationship with extended families
● Legal status ● Parenthood decision making
● Time in the community ● Scope of the Stage: Married couple Couple
● Language spoken at home and in the makes commitment to one another
community ● Family Developmental Tasks
● Health beliefs ○ Establishing mutually satisfying
● Crisis events marriage
● Holidays and special events ● Family Developmental Tasks
● Contact with cultural and religious ○ Fit into the kin network
institutions
● Values about education and work W/ YOUNG CHILDREN
● Values about family structure (power, ● Scope of the Stage - Oldest child is infant
hierarchy, rules, subsystems, and through 12 y.o
boundaries) ● Family Developmental Tasks Adjusting to
infants & encouraging their development
ROSI & CAMS | 27

● Establish satisfying family life for child & ○ Interact w/ one another
parent ○ Can establish priorities
● Integration of children into F. unit ○ Support, respect, affirm one another
● Adjustment of tasks: Child rearing, financial ○ Members have flexible role
& household ○ Foster responsibility & value service
● Accommodation of new parenting & to others
grandparenting role ○ Have sense of play
○ Ability to cope w/ stress
W/ ADOLESCENTS
● Scope of the Stage - with 13y/o to 20 y/o Functions of Family
children ● Procreation
● Family Developmental Tasks = Balancing ○ Universal accepted institution for
freedom with responsibility as teens, reproductive fxning / child-rearing
mature and emancipate ● Socialization of family members
● Family Developmental Tasks = Establishing ○ F. First teacher of societal rules
outside interests & career ● Status placement
● Devp. Of increasing autonomy for children ○ F. Confers its social rank into the
● Midlife reexam. Of marital & career issues society.
● Initial shift towards concern for older ● Economic fxn
generation ○ RURAL FAMILY - UNIT OF
PRODUCTION
AS LAUNCHING CENTERS ○ URBAN FAMILY - UNIT OF
● Scope of the Stage = First child leaves home CONSUMPTION, ENTERPRISE
to last child leaving home ● Physical maintenance
● Family Developmental Tasks = Assisting ○ Survival needs of dependents
young adults to work, attend school, ● Welfare and protection
military or marriage ○ PARTNERS
● Est. for diff identities for parents & children ■ companionship,affective,sex,
● Renegotiation of marital relationship socioeconomic
● Readjustment of relationship to include ○ CHILDREN
in-laws & grandchildren ■ Emotional gratification,
● Dealing w/ disabilities & older generation psychological security,
motivation, morale
AGING FAMILY
● Scope of the Stage - Retirement to moving Family as Client
out of Family home ● Family as Important Unit of Health Care
● Family Developmental Tasks = Coping with ○ indv. can be best understood w/in
loss and living alone the social context of the family.
● Family Developmental Tasks = Adapting to ● Reasons it is important for the nurses to
retirement and aging work with families:
● Maintaining as couple/indv.. while adapting 1. Family is a critical resource. The
to aging process importance of family is giving care
● Support role of middle generation to its members.
● Support & autonomy of older generation 2. In the family unit, & dysfunctions
● Prep. For own death, deal w/ loss of spouse, (like illness, injury, separation) -
sibling, peers affects 1 or more family members
…affects the unit as a whole.. .
Characteristics of a Healthy Family known as “ripple effect”
● Defrain & Montalvo
ROSI & CAMS | 28
3. “Case finding” - N. identifies health
Traditional Health Care Practices in the
prob that necessitates identifying Philippines
risks for entire family.
Hilot
4. Improving nursing care. - N. can
provide better & more holistic care ● one of the practices of Filipino traditional
by understanding family & its medicine, thought of as ‘healing’. Hilot or
members. massage makes use of the most popular and
useful herbs: tanglad, lagundi, sambong and
Family as a System more native plants that have healing and
therapeutic properties on.
● General System Theory
● different types of manghihilot:
○ Explains how the family as a unit
1. Comadrona
interacts w/ larger units outside the
family & with smaller units inside expert in post-natal massage.
the family. 2. Acupressurist
● 3 Subsystem of the Family (Parke 2002) aligns nerves and balances
○ Parent-Child Subsystem electrical energy.
○ Marital Subsystem 3. Reflexologist
○ Sibling-sibling Subsystem drains excess energy.
4. Herbalist
Family Health Tasks uses herbal in healing.
1st task
Cupping Therapy
● providing members means for health
promotion & disease prevention. ● a form of alternative medication that uses
● Ex. Breastfeeding an infant, a healthy diet “cups” on the skin to create suction. This
for older family members, bringing a young suction is trusted to help in mobilizing
child to the health center for blood flow and promote the healing of a
immunizations, and teaching a child about broad range of medical ailments. Cupping is
proper handwashing are a few examples of used in treating various diseases/
family health conditions such as acne and facial paralysis,
however, cupping can cause mild side
effects, such as mild discomfort, burns,
Health Tasks according to Freeman and bruises, and skin infection.
Heinrich (1981)
● Recognize interruptions of health or Levels of Preventive Care
development.
● Primary prevention
● Seeking health care.
○ health promotion
● Manage health & nonhealthy crises. The
○ specific protection
family’s ability to cope with crisis and
○ actions taken BEFORE the onset of a
develop from its experience is an indicator
specific disease
of a healthy family.
○ E.g.
● Provide nursing care to sick, disabled or
■ Bed nets
dependent family members of family
■ Vaccines
● Maintain a home environment conducive to
● Secondary prevention
good health & personal development.
○ early diagnosis and prompt
● Home should have an atmosphere of
treatment
security & comfort for psychosocial
○ disability limitations
development.
● Tertiary prevention
● Maintain reciprocal relationship with
○ restoration and rehabilitation
community & health institutions.
ROSI & CAMS | 29

Primary Prevention practice setting or specialization and the
● Health education components may be used sequentially or
● Genetic counseling concurrently.”
● Environmental change
● Hearing conservation Phases of Nursing Process
● Immunization 1. Assessment
● Prenatal care 2. Diagnosis
● Vocal hygiene 3. Planning
● Prevention of secondary Communication 4. Implementation
Disorders 5. Evaluation
(RELATING - RAPIE)
Nursing Assessment Phase

I. DATA COLLECTION
THREE SOURCES OF DATA
1. First source - Health status of the family
2. Second Source - Family’s status as a
functioning unit
3. Third Source - Family's
METHODS OF GATHERING DATA

1. Direct Observation
● A method of data collection which is
Primary Level of Prevention done through the
● Actions taken before the onset of a specific ● The nurse gathers information about
disease the family’s state of being and
● Examples: behavioral responses.
○ Bed nets ● Presence of S/S
○ Vaccines ○ Physical make up of each
member
○ Communication or language
patterns expected and
WEEK 5
Family Nursing & Nursing Process tolerated.
○ Role perception/task
NURSING PROCESS assumption by each member,
Family Nursing Process including decision-making
● “the blueprint of the care that the nurse patterns.
designs to systematically minimize or ○ Conditions in home and
eliminate the identified health and family environment
nursing problems through explicitly
formulated outcomes of care and 2. Interviewing
deliberately chosen set” ● Productivity of the interview process
depends upon the use of effective
Nursing Process communication techniques to elicit
● “a problem-solving approach that enables needed responses.
the nurse to provide care in an organize and ● Encourage verbalization of thought
scientific manner. It is applicable to and feelings and offer needed
individuals, families and community groups support or reassurance.
at any level of health. It is adaptable to any
ROSI & CAMS | 30

3. Physical Examination i. Occupation, place of work,
● Done through inspection, palpation, income of each working
percussion, auscultation member
measurement of specific body parts ii. Adequacy to meet basic
and reviewing the body systems necessities
(food,clothing,shelter)
4. Review of Records iii. Who makes decision about
● Reviewing existing records and money and how it is spent
reports pertinent to the client b. Educational attainment of its
members
5. Laboratory/Diagnostic Tests c. Ethnic background and religious
● Performing laboratory tests, affiliation
diagnostic procedures or other test d. Significant others - roles they play in
of integrity and function carried out the family
by the nurse herself and /or health e. Relationship of family to community
workers - what is the participation of the
family in community activities
FIVE TYPES OF DATA USE AS INITIAL EXAMPLE:
DATA BASE FOR FAMILY NURSING
PRACTICE
1. Family Structure and Characteristics
a. Members of the household -
relationship to the head of the
family.
b. Demographic data - age, sex, 3. Environmental Factors
civil status, position in the family a. Housing
c. Place of residence of each i. Adequacy of living space
member - whether living w/ or ii. Sleeping arrangement.
elsewhere. iii. Presence of insects and
d. Type of family structure - rodents.
matriarchal, patriarchal, nuclear / iv. Adequacy of the furniture
extended. v. Food storage and cooking
e. Dominant family members in facilities
terms of decision making in matters vi. Presence of accidents
of health care. hazards
f. General family relationship - vii. Water supply - source,
presence of obvious/ready ownership, potability
observable conflict between viii. Toilet facility - type,
members; communication patterns ownership, sanitary
among members condition
EXAMPLE: ix. Garbage/refuse disposal -
type, sanitary condition
x. Drainage system - type and
sanitary condition
b. Kind of neighborhood - congested,
slum, etc.
c. Social and health facilities available
d. Communication and Transportation
2. Socio-economic and Cultural Factors
a. Income and expense
ROSI & CAMS | 31

EXAMPLE:
Nursing Diagnosis Phase
TYPOLOGY OF NURSING PROBLEM
● “the study or systematic classification of
types.”
● “A tool or classification of a family nursing
problems that reflects the family status and
capabilities as a functioning unit.”
4. Health Assessment of Each Member
a. Medical and Nursing History
indicating past significant illness, First Level of Assessment
beliefs and practices conducive to Presence of health deficit, health threats,
illness. and foreseeable crisis / stress points in the
i. Anthropometric data - family.
weight, height
ii. Dietary history indicating A. Health Deficits
quality and quantity of food ● Instances of failure in health maintenance
intake per day and development
b. Nutritional assessment (specifically ● Occurs when there is a gap between actual
for vulnerable or at risk members) and achievable health status.
c. Current health status indicating ● Diagnosed/suspected illness states of family
presence of illness states members
(diagnosed/undiagnosed by ● Sudden or premature or untimely death
5. Value Placed on Preventive Disease illness or disability and failures to adapt
a. Immunization status of children reality of life emotional control and stability
b. Use of other preventive service ● Deviations in growth and development
● Personality disorders
II. DATA ANALYSIS Example:
● “Comparison of the gathered DATA to the ● Illness regardless whether it is diagnosed
STANDARDS OR NORMS” ● Failure to thrive or inability to develop
according to normal rate.
THREE TYPES OF STANDARDS OR NORMS ● Disability arising from illness, whether
1. Normal health of individual members transient/temporary
2. Home and environment conditions TEMPORARY
conducive to family development ● Aphasia or temporary paralysis after
3. Family characteristics, dynamic and CVA
level of functioning conducive to PERMANENT
● Leg amputation secondary to DM,
HEALTH PROBLEM blindness from measles, paralysis
● “Is defined as a situation or condition which from polio.
interferes with the promotion and/ or
maintenance of health and recovery from B. Stress Points/ Foreseeable Crisis
illness and injury.” Situation
● “A health problem becomes a nursing ● Anticipated periods of unusual demand on
problem when it can be modified through the individual or family in terms of
nursing interventions.” adjustments/family resources
HEALTH NEED ● Example:
● “Exists when there is a health problem that ○ Marriage
can be alleviated with medical or social ○ Pregnancy, labor, puerperium
technology. ” ○ Parenthood
ROSI & CAMS | 32

○ Additional member-newborn, lodger ○ Unsanitary Food Handling and
○ Abortion Preparation
○ Entrance at school ○ Personal Habits/ Practice
○ Adolescence o Loss of job o Death of ■ Frequent drinking of alcohol
a spouse /member ■ Excessive smoking
○ Resettlement in new community ■ Walking barefooted
○ Illegitimacy ■ Eating raw meat/fish
C . Health Threats ■ Poor personal hygiene
● Conditions that are conducive to diseases, ■ Self- medication
accidents or failure to realize one’s health ■ Use of dangerous drugs or
potential. narcotics
● Example: ■ Sexual promiscuity
○ Health history of specific ■ Engaging in dangerous
condition/disease. family history of sports
DM ○ Inherent personal characteristics-
○ Threat of gross infection of CD case short temper
○ Family size beyond what resources ○ Health history which may
can adequately provide precipitate the occurrence of health
○ Accident Hazard deficit- previous history of difficult
■ Broken stairs labor.
■ Pointed sharp objects, poison ○ Improper role assumption-child
and medicine improperly assuming mother’s role, father not
kept assuming his role.
■ Fire hazards ○ Lack of/ inadequate immunization
■ Fall hazards status of children
○ Inadequate food intake both in ○ Family disunity
quantity and quality ■ Self-oriented behavior of
■ Excessive intake of certain members
nutrients ■ Unresolved conflicts among
■ Faulty eating habit member
○ Stress Provoking Factor ■ Intolerable disagreements
■ Strained marital relationship DRILL
■ Strain parent-sibling ● Deficit
relationship ● Threat
■ Interpersonal conflicts ● Foreseeable Crisis / Stress Point
between family members ○ Dengue
○ Poor Environmental Sanitation ○ TB
■ Inadequate living space ○ Seperated
■ Inadequate personal ○ Teenage Pregnancy
belongings/utensils
■ Lack of food storage facilities
■ Polluted water supply
■ Presence of breeding places
of insects and rodents
■ Improper garbage / refuse
disposal
■ Unsanitary waste disposal
■ Improper drainage system
■ Noise pollution
■ Air pollution
ROSI & CAMS | 33
Second Level of Assessment I. Negative attitude towards the health
FAMILY HEALTH TASK condition or problem-by negative
I. Inability to recognize presence of attitude is meant one that interferes
problem with rational decision-making.
A. . Lack of or inadequate knowledge J. In accessibility of appropriate
B. Denial about its existence or severity resources for care, specifically:
as a result of fear of consequences of ■ Physical Inaccessibility
diagnosis of problem, specifically: ■ Costs constraints or
■ Social-stigma, loss of respect economic/financial
of peer/significant others inaccessibility
■ Economic/cost implications K. Lack of trust/confidence in the
■ Physical consequences health personnel/agency
■ Emotional/psychological L. Misconceptions or erroneous
issues/concerns information about proposed
C. Attitude/Philosophy in life, which course(s) of action
hinders recognition/acceptance of M. Others specify.________
D. Others. Specify____ III. Inability to provide adequate nursing
II. Inability to make decisions with care to the sick, disabled, dependent
respect to taking appropriate health or vulnerable/at risk member of the
action family.
A. Failure to comprehend the A. Lack of/inadequate knowledge
nature/magnitude of the about the disease/health condition
problem/condition (nature, severity, complications,
B. Low salience of the prognosis and management)
problem/condition B. Lack of/inadequate knowledge
C. Feeling of confusion, helplessness about child development and care
and/or resignation brought about by C. Lack of/inadequate knowledge of
perceive magnitude/severity of the the nature or extent of nursing care
situation or problem, i.e. failure to needed
breakdown problems into D. Lack of the necessary facilities,
manageable units of attack. equipment and supplies of care
D. Lack of/inadequate E. Lack of/inadequate knowledge or
knowledge/insight as to alternative skill in carrying out the necessary
courses of action open to them intervention or treatment/procedure
E. Inability to decide which action to of care (i.e. complex therapeutic
take from among a list of regimen or healthy lifestyle
alternatives program).
F. Conflicting opinions among family F. Inadequate family resources of care
members/significant others specifically:
regarding action to take. ■ Absence of responsible
G. Lack of/inadequate knowledge of member
community resources for care ■ Financial constraints
H. Fear of consequences of action, ■ Limitation of luck/lack of
specifically: physical resource
■ Social consequences G. Significant persons unexpressed
■ Economic consequences feelings (e.g. hostility/anger, guilt,
■ Physical consequences fear/anxiety, despair, rejection)
■ Emotional/psychological which his/her capacities to provide
consequences care.
ROSI & CAMS | 34

H. Philosophy in life which psychological needs of other
negates/hinder caring for the sick, members as a result of family’s
disabled, dependent, vulnerable/at preoccupation with current problem
risk member or condition.
I. Member’s preoccupation with on J. Others
concerns/interests V. Failure to utilize community
J. Prolonged disease or disabilities, resources for health care
which exhaust supportive capacity of A. Lack of/inadequate knowledge of
family members. community resources for health care
K. Altered role performance. Specify: B. Failure to perceive the benefits of
■ Role denials or ambivalence health care/services
■ Role strain C. Lack of trust/confidence in the
■ Role dissatisfaction agency/personnel
■ Role conflict D. Previous unpleasant experience with
■ Role confusion health worker
■ Role overload E. Fear of consequences of action
L. Others. Specify_______ (preventive, diagnostic, therapeutic,
IV. Inability to provide home conducive rehabilitative) specifically:
to health maintenance, personal ■ Physical/psychological
development consequences
A. Inadequate family resources ■ Financial consequences
specifically: ■ Social consequences
■ Financial constraints/limited F. Unavailability of required
financial resources care/services
■ Limited physical G. Inaccessibility of required services
resources-e.i. lack of space to due to:
construct facility ■ Cost constrains
B. Failure to see benefits (specifically ■ Physical inaccessibility
long term ones) of investments in H. . Lack of or inadequate family
home envt improvement resources, specifically:
C. Lack of/inadequate knowledge of ■ Manpower resources, e.g.
importance of hygiene and baby sitter
sanitation ■ Financial resources, cost of
D. Lack of/inadequate knowledge of medicines prescribe
preventive measures I. Feeling of alienation to/lack of
E. Lack of skill in carrying out support from community, e.g.stigma
measures to improve home d/t to mental prob,AIDS, etc.
environment J. Negative attitude/ philosophy in life
F. Ineffective communication pattern which hinders effective/maximum
within the family utilization of community resources
G. Lack of supportive relationship for health care
among family members K. Others: ___________specify
H. Negative attitudes/philosophy in life
which is not conducive to health
maintenance and personal
development
I. Lack of/inadequate competencies in
relating to each other for mutual
growth and maturation (e.g. reduced
ability to meet the physical and
ROSI & CAMS | 35

2. Nursing care plan is a product of deliberate
Nursing Diagnosis: Two Parts systematic process.
Family Health Task: 3. Nursing care plan, as with all other plans,
1. General relates to the future.
● the statement of the unhealthful 4. Nursing care plan is based upon identified
response health & nursing problems.
Due to or related to: 5. Nursing care is a means to an end, not an
2. Specific end in itself.
● the statement of factors which are 6. Nursing care plan is a continuous process
maintaining the undesirable not a one-shot deal.
response and preventing the desired
change Desirable Qualities of a Nursing Care Plan
1. Based on clear definition of the problems.
EXAMPLE 2. Good plan is realistic.
Family Health Task: 3. Should be consistent with goals &
1. General philosophy of the health agency.
● Inability to utilized the community 4. Nursing care plan is drawn with the family.
resources for health care due to 5. Nursing care plan is best kept in written
Due to or related to: form.
2. Specific
● Lack of adequate family resources, Importance of PLanning Care
specifically: 1. .Individualized care to clients
○ Financial 2. Nursing care plan helps in setting priorities
○ Manpower by providing information about client as
well as nature if his problem.
○ Time
3. Nursing care plan promotes systematic
communication among those involve in
health care effort.
4. Continuity of care is facilitated through use
of nursing care.
5. Nursing care plans facilitate coordination of
care by making known to other members of
the health team what nurse is doing.
Nursing Planning Phase: PRIORITIES

FOUR CRITERIA FOR DETERMINING
PRIORITIES
1. Nature of condition or problem
● Categorized into wellness state/
Nursing Planning Phase potential, health threat, health
FAMILY NURSING CARE PLAN (FNCP) deficit of foreseeable crisis.
● “A Family Nursing Care Plan is the set of 2. Modifiability of the Problem
actions the nurse decides to implement to ● Refers to the probability of success
be able to resolve identified family health in minimizing, alleviation or totally
and nursing problems.” eradicating the problem through
nursing intervention.
Characteristics Family Nursing Care Plan 3. Preventive Potential
1. Nursing care plan focuses on actions which ● Refers to the nature and magnitude
are designed to solve or minimize existing of future problems that can be
problem. minimized or totally prevented if
ROSI & CAMS | 36

intervention is done on the problem
under consideration.
4. Salience
● Refers to the family’s perception and
evaluation of the problem in terms
of seriousness an urgency attention
needed.
SCORING
a. Decide on a score for each of the criteria. Malnutrition
b. Divide the score by the highest possible
score and multiply by the weight
= SCORE / HIGHEST SCORE x WEIGHT
c. Sum up the scores for all the criteria. The
highest score is 5, is equivalent to the total
weight
Scale for Ranking Family Health Problems

according to Priorities
Example Summary
The list of health problems ranked according to
priorities is presented:
● Malnutrition = 5
● Scabies = 4
● Improper Refuse Disposal = 3.67
Nursing Planning Phase: GOALS AND

OBJECTIVES
FORMULATION OF GOALS AND
OBJECTIVES OF NURSING CARE
Establishment of Goals:
GOALS
● Is a general statement of condition or state
to be brought about by specific courses of
EXAMPLE CASE:
action.
Scabies
● It is the end towards which all efforts are
directed
Example:
➢ After nursing intervention, the
family will be able to take care of the
premature infant competently.
● Goals relate to health mater
○ specifically the alleviation of disease
conditions.
○ And health problems that
Improper Refuse Disposal intertwined with other problems like
socio-economic ones
Example 1:
ROSI & CAMS | 37

➢ At the end of nursing intervention, ● refer to more specific statements of the
the family will be able to start a desired results or outcomes of care.
piggery business. ● Either:
Example 2: ○ nurse-oriented based on activities of
➢ At the end of nursing intervention, nurse or;
the family will be able to start ○ client-oriented stated in terms of
litigation proceedings against outcomes.
landlord.
● A cardinal principle in goal setting states
that goals must be set mutually with the
family.
● Basic to the establishment of mutually
acceptable goals is the family’s recognition
and acceptance of existing health needs and
problems.
● Goals set by the nurse and the family should
be realistic or attainable.
● Goals are best stated in terms of client’s
NURSE ORIENTED VS CLIENT ORIENTED
outcomes, whether at the individual, family,
or community levels. Nurse-Oriented Client-Oriented
Barriers to Joint Goal Setting Between Nurse-oriented Stating objectives in

objectives will not tell terms of client
Nurse and Family
if the nurse’s activities outcomes will indicate
1. Failure on part of the family to perceive the produced some during the evaluation
existence of the problem. beneficial results; they phase whether the
2. Family may realize the existence of a health only indicate what the desired changes in the
condition/problem but is too busy at the nurse did and in problem situation
moment. qualitative evaluation, resulted from the
how well she nurse’s action.
3. Sometimes, the family perceives the
performed them.
existence of a problem but does not see it as Example:
serious enough to warrant attention. Example: ● after the
4. A family may perceive the presence of a ● during the nursing
problem & need to take action. However, home visit, the intervention,
they refuse to face & do something about nurse will the
the situation. discuss the malnourished
importance of pre-school
a. Reasons to this kind of behavior:
immunization. member of the
● Fear of consequences of ● during the family will
taking actions. second increase their
● Respect for tradition. nurse-family weights by at
● Failure to perceive the contact, the least one pound
benefits of action. nurse will show per month.
the different ● after the
● Failure to relate the
types of nursing
proposed action to the fertility-regulati intervention,
family’s goals ng m there will be
5. A big barrier to collaborative goal setting improved
between nurse & the family is the working relationship
relationship. among family
members.
● after the nurse’s
OBJECTIVES
visit, the family
ROSI & CAMS | 38

will bring the

pre-school
members to the
well-baby clinic
the follow
GENERAL VS SPECIFIC OBJECTIVE

General Objective Specific Objective
Example of Nursing Goal / Objective:
After the nursing After the nursing
intervention, the family intervention, the family ● The family will cope effectively with the
will utilize community will bring the pregnant threat of pulmonary tuberculosis.
resources for health member to the health ● Short Term - The infant and preschool
care. center regularly for members of the family will be immunized
check ups. with BCG
After the nursing ● Medium Term - All members of the
intervention, the family The family will also
family will have a complete physical
will be able to take care consult the health
of the mentally center on every episode check-up to rule out pulmonary tuberculosis
challenged child of illness among ● Long Term - All members of the family
competently. members. will participate in the care of the sick
members and apply preventive measures
● Recognize Define the criteria for against the spread of infection
● Decide evaluation
● Care
● H&E Example:
● Comm ● After the Nursing Implementation Phase
Resources nursing Selecting Appropriate Nursing Actions
intervention,
the family will The choice of nursing intervention is highly
be able to feed dependent on two major variables:
the mentally 1. The nature of the problem
challenged ● Resource available to solve the prob
prescribed 2. Resource available to solve the
quantity and
problem
quality of food.
● They will be ● Aimed at minimizing or eliminating
able to teach reasons for or causes of family’s
the child simple inability to do these tasks.
skills related to
activities of
daily living and
● The family will
be able to apply
measures
taught to
prevent
infection in the
mentally
challenged
child. Principles of Nursing Actions
● stimulate recognition & acceptance of
OBJECTIVE TIME FRAME health needs/problems
● work on the family’s failure to decide on
taking appropriate health actions
ROSI & CAMS | 39
● increase family’s confidence in providing Family-Nurse Contact
nursing care to its sick, disabled and ● Home-Visit
dependent members through ○ Home visit is a professional,
demonstrations on nursing procedures purposeful interaction that takes
utilizing supplies and equipment available place in the family’s residence aimed
in the home. at promoting, maintaining and
● involve patients & family in order to restoring the health of the family or
motivate them to assume responsibility for its members.
their own care. ● Clinic-Visit
● Explain and clarify doubts thus the role of ○ takes place in a private clinic health
the nurse shifts direct care giver to that of a center, barangay health station.
teacher. ○ Major advantage is the fact that a
● Explore ways to minimize or prevent threats family member takes the initiative of
to the maintenance of health & personal visiting the professional health
development among family members worker, usually indicating the family
● Utilize intervention measures involving readiness to participate in the health
environmental manipulations through care process.
improvements on physical facilities in home ○ Because the nurse has greater
either by construction of needed ones or control over the environment,
modifying existing ones distractions are lessened and the
● Minimize or eliminate psychological threats family may feel less confident to
in the home environment. Nurses can work discuss family health concerns.
closely with family to improve its ● Group Approach
communication patterns, role assumptions ○ appropriate for developing
& relationships & interaction patterns. cooperation, leadership,
self-reliance and or community
Types of Resources awareness among group members.
1. Family Resources ○ The opportunity to share
● physical & psycho-social strengths & experiences and practical solutions
assets of individual members, to common health concerns is a
financial capabilities, physical strength of this type of family-nurse
facilities & support system provided contact.
by relatives and significant others. ● Telephone Conference
2. Nurse Resources ● Written Communication
● knowledge about family health, her ○ used to give specific information to
skills in helping family manage families, such as instructions given
them. These skills may range from to parents through school children.
simple nursing procedures to ● School Visit or Conference
complicated behavioral problems ● Industrial or Job Site Visit
such as marital disharmony.
Availability of time & logistical
support are also part of resources of
the nurse.
3. Community Resources
● include existing agencies, programs
or activities for health and related
needs/problems and community
organization for health actions.
Methods of Intervention
ROSI & CAMS | 40
The Nursing Bag ● EFFICIENCY - relates to cost whether in
● Frequently called the PHN bag is a tool used terms of money, time, effort, or materials
by the nurse during home or community ● APPROPRIATENESS - ability to solve or
visits to be able to provide care safely and correct existing problem situations, a
efficiently. question that involves professional
● Serves as a reminder of the need for hand judgment.
hygiene and other measures to prevent the ● ADEQUACY - pertains to its
spread of infection. comprehensiveness whether all necessary
● Nursing bag usually has the ff. contents: activities were performed in order to realize
○ Articles for infection control the intended results.
○ Articles for assessment of family
members Criteria and Standard
○ Note that the stethoscope and ● STANDARD
sphygmomanometer are carried ○ Once a value judgment is applied to
separately. a criterion; it acquires the status of a
○ Articles for nursing care standard.
○ Sterile items ○ It refers to the desired level of
○ Clean articles performance corresponding with a
○ Pieces of paper criterion against which actual
● Bag technique helps the nurse in infection performance is compared.
control. ○ It tells us what the acceptable level
● Bag technique allows the nurse to give care of performance or state of affairs
efficiently. should be for us to say that the
● It saves time and effort by ensuring that the intervention was successful.
articles needed for nursing care are ○ It refers to the desired level of
available. performance corresponding with a
● Bag technique should not take away the criterion against
nurse’s focus on the patient and the family.
● Bag technique may be performed in ● CRITERIA
different ways, principles of asepsis are of ○ refer to signs or indicators that tell
the essence and should be practiced at all us if the objective has been achieved.
times. ○ They are names & descriptions of
variables that are relevant indicators
Nursing Evaluation Phase of having attained the objectives.
● “The determination of whether the ○ They are free from any value
objectives set were obtained or to what judgment and are independent to
degree they were attained.” time frame
● “Evaluation is always related to objectives.” ○ They are names & description of
variables that are relevant indicators
● “Evaluation when addressed to the result or
of having attained the objectives
outcome of care answers the question ‘did
the intended results occur?’”
● “There is always an element of subjectivity
in evaluation; the process involves value
judgment which is subjective”
● “Evaluation also involves decision-making
Activity and Outcome
Dimensions of Evaluation
● ACTIVITIES
● EFFECTIVENESS - focus is attainment of ○ are actions performed to accomplish
the objectives an objective. They are the things the
ROSI & CAMS | 41
nurse does in order to achieve a
desired result or outcome. Activities
consume time and resources.
Examples are health teachings,
demonstration and referrals.
● OUTCOME
○ is the results produced by activities.
Where activity is the cause, outcome
is the effect. They can also be
immediate, immediate or ultimate
outcomes. Patient care outcomes can
be measured along three broad
lines:
■ PHYSICAL CONDITION -
decreased temperature or
weight and change in clinical
manifestations
■ PSYCHOLOGICAL OR
ATTITUDINAL STATUS -
decreased anxiety and
favorable attitude towards
health care personnel.
■ KNOWLEDGE ON
LEARNING BEHAVIOR -
compliance of the patient
with instructions given by
the nurse
ROSI & CAMS | 42

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CHN211: COMMUNITY HEALTH NURSING TRANSES FOR PRELIMS

● La Gota de Leche - 1st center dedicated to

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Community Health Nursing Philosophy

The Public Health Nurse

ANNUAL AVERAGE POPULATION GROWTH

MORBIDITY (sickness) / MORTALITY (death)

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Today’s Health Situation - NATIONAL

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According to SCOPE OF SERVICE

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Hospital Classification Scheme

According to Functional Capacity

Category C / Diagnostic / Therapeutic

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World Health Organization

5 Core Functions of DOH

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Barangay Health Station (BHS)

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Local Health Board

City Health Board/

Inter Local Health Zones of Negros

Inter Local Health Zone (ILHZ)

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Republic Act 8423, known as

USES & PREPARATIONS: USES & PREPARATIONS:

ULASIMANG BATO | PANSIT-PANSITAN Reminders on the Use of Herbal Medicine

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based on pattern of residence

based on pattern of lineage

based on amount of mates

ROSI & CAMS | 26

ROSI & CAMS | 27

ROSI & CAMS | 29

Nursing Assessment Phase

METHODS OF GATHERING DATA

ROSI & CAMS | 30

ROSI & CAMS | 31

ROSI & CAMS | 32

ROSI & CAMS | 34

ROSI & CAMS | 35

Nursing Planning Phase: PRIORITIES

ROSI & CAMS | 36

Scale for Ranking Family Health Problems

Nursing Planning Phase: GOALS AND

ROSI & CAMS | 37

Barriers to Joint Goal Setting Between Nurse-oriented Stating objectives in

ROSI & CAMS | 38

will bring the