Competency

Appraisal 1

Kristal Liza C. Besario, RN,

MAN
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Objectives:
At the end of the discussion, the students will
be able to:
1. Discuss the importance of the Nursing
Core Competency in the Nursing
Profession
2. Understand & appreciate the relevance of
having the core competencies
3. Demonstrate awareness on how to apply
the core competencies in the current
status of nursing in the Philippines
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11 Key Areas
National
of
Responsibility Nursing Core
Competency
(2009)
Standards
(2012)
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11 Key Areas of
Responsibility
1. Safe & Quality Nursing Practice
2. Management of Resources & Environment
3. Health Education
4. Legal Responsibility
5. Ethico-Moral Responsibility
6. Personal & Professional Development
7. Quality Improvement
8. Research
9. Record Management
10.Communication
11.Collaboration & Teamwork
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Conceptual Framework of the NNCCS

(2012)

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Beginning Nurses Role on Client

Care
1. Practices in accordance with Legal
Principles and the Code of Ethics in
making personal and professional
judgment
2. Utilizes the nursing process in the
interdisciplinary care of clients that
empowers the client & promotes safe
quality care
3. Maintains complete, accurate and up-todate recording &reporting system
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Client Care
4. Establishes collaborative
relationship with colleagues and
other members of the team to
enhance nursing and other health
care services
5. Promotes professional and personal
growth and development

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Beginning Nurses Role on

Management & Leadership
1. Demonstrate management &
leadership skills to provide safe and
quality care
2. Demonstrate accountability for safe
nursing practice
3. Demonstrates management &
leadership skills to deliver health
programs & services effectively to
specific client groups in the
community setting
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Management & Leadership

4. Manages a community/village based
health facility/component of a health
program or a nursing service
5. Demonstrate ability to lead and
supervise nursing support staff
6. Utilizes appropriate mechanisms for
networking, linkages building and
referrals
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Beginning Nurses Role on Research

1. Engages in nursing or health related
research with or under the supervision of
an experienced researcher
2. Evaluate research study/report utilizing
guidelines in the conduct of a written
research critique
3. Applies the research process in improving
patient care in partnership with a quality
improvement/quality assurance/nursing
audit team
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Community Health
Nursing
Kristal Liza C. Besario,RN,MAN

KLCBesario

Health Promotion
First International Conference on
Health Promotion, Ottawa, 21
November 1986
The aim of the conference was to
continue to identify action to achieve
the objectives of the World Health
Org Health for all by the year 2000
(launched 1981)
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Health Promotion
Health Promotion is the process of
enabling people to increase control
over & improve their health.
Health is seen as a resource of
everyday life, not the objective of
living.
Health Promotion is not the
responsibility of the health sector,
but goes beyond healthy lifestyle to
wellbeing.
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Fundamental condition & resources

needed for Good Health

Peace
Shelter
Education
Food
Income
A stable ecosystem
Sustainable resources
Social justice and equity.
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3 Strategies for Health

Promotion
1. Advocate
2. Enable
3. Mediate

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Local Needs & Possibilities

People from all walks of life are
involved
Health promotion strategies and
programs should be adapted to the
local needs and possibilities of
individual countries and regions to
take into account differing social,
cultural and economic systems.
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Priority Action Areas

Build healthy public policy
Health promotion policy requires the
identification of obstacles to the adoption
of healthy public policies in non-health
sectors and the development of ways to
remove them.
Create supportive environments
the protection of the natural and built
environments, and the conservation of
natural resources
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Priority Action Areas

Strengthen community action
this requires full and continuous access
to information and learning opportunities
for health, as well as funding support.
Develop personal skills
enabling people to learn (throughout
life) to prepare themselves for all of its
stages and to cope with chronic illness
and injuries is essential.
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Priority Action Areas

Reorient health services
Reorienting health services also requires
stronger attention to health research, as well
as changes in professional education and
training.
Moving into the future
A guiding principle should be that women
and men should become equal partners in
each phase of planning, implementation and
evaluation of health promotion activities.
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Health Promotion
VISION BY 2030
A global leader for attaining better
health outcomes, competitive and
responsive health care system, and
equitable health financing.
MISSION
To guarantee equitable, sustainable
and quality health for all Filipinos,
especially the poor, and to lead the
quest for excellence in health.
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Health Promotion, Health Protection

& Illness Prevention
PREVENTION avoiding the
development of disease in the future
and consist of all intervention to limit
progression of a disease (Edelman &
Mandle 2002)

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LEVELS OF PREVENTION
1. Primary Prevention focuses on
health promotion & protection
against specific health problems
PURPOSE: to decrease the risk of
exposure of the individual or the
community to the disease

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LEVELS OF PREVENTION
2. Secondary Prevention - focuses
on early identification of health
problems & Prompt intervention to
alleviate health problems.
Its goal is to identify individuals in an
early stage of a disease process & to
limit future disability

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LEVELS OF PREVENTION
3. Tertiary Prevention focuses on
restoration & rehabilitation with the
goal of returning the individual to an
optimal level of functioning.

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Health Promotion, Health Protection

& Illness Prevention
PROMOTION behavior motivated by
the desire to increase well-being and
actualize human health potential
(Pender, Murdaugh & Parsons)

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Health Promotion, Health Protection

& Illness Prevention
HEALTH PROTECTION/ILLNESS
PREVENTION behavior motivated
by a desire to actively avoid illness,
detect it early, or maintain
functioning within the constraints of
illness.

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Sites for Health-Promotion Activities

The type of program depends on the
current concerns & the expertise of
the sponsoring department or group.

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Health Promotion Model

Individual Characteristics &
Experiences
The importance of an individuals
unique personal factors or
characteristics & experiences will
depend on the target behavior for
health promotion.
Nursing intervention usually focus on
factors that can be modified and
however to also focus to factors that
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Health Promotion Model

Behavior-Specific Cognitions &
Affect
This set of variables is considered to
be of major motivational significance
for acquiring & maintaining healthpromoting behavior.
a) Perceived benefits of Action
anticipated benefits or outcomes
affect the persons plan to
participate in health-promoting
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Health Promotion Model

b.) Perceived barriers to action A persons
perceptions about available time,
inconvenience, expense and difficulty
performing the ability may act as
barriers (imaginary/real)
c.) Perceived self-efficacy refers to the
conviction that a person can
successfully carry out the behavior
necessary to achieve a desired outcome.
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Health Promotion Model

d.) Activity-related affect subjective
feelings that occur before, during and
following an activity can influence
whether a person will repeat the
behavior again or maintain the
behavior.
e.) Interpersonal influences persons
perceptions concerning the behaviors,
beliefs, or attitudes of others.
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Health Promotion Model

f.) Situational influences are direct
and indirect influences on health
promotion behaviors and include
perceptions of available options,
demand characteristics, and the
aesthetic features of the
environment.

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Commitment to a Plan of
Action
This involves 2 processes
1. Commitment
2. Strategies

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Immediate Competing Demands &

Preferences
Competing demands are those
behaviors over which an individual
has a low level of control.
Competing preferences are
behaviors over which an individual
has a high level of control, however,
this control depends on the
individuals ability to self-regulating
to not give in.
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Behavioral Outcomes
Health-promoting behavior, the
outcome of the Health Promotion
Model, is directed toward attaining
positive health outcomes for the
client.

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Stages of Health Behavior

Change
1. Precontemplational Stage the person
typically denies having a problem, views
others as having a problem, and, therefore,
wants others to change their behavior.
2. Contemplation Stage the person
acknowledges having a problem, seriously
considers changing a specific behavior,
actively gathers information, and
verbalizes plans to change the behavior in
the near future.
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Stages of Health Behavior

Change
3. Preparation Stage the person
undertakes cognitive & behavioral
activities that prepare the person for
change.
The person makes the final specific
plans to accomplish the changes.
4. Maintenance Stage the person
integrates newly adopted behavior
patterns into his or her lifestyle
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Stages of Health Behavior

Change
4. Maintenance Stage the person
integrates newly adopted behavior
patterns into his or her lifestyle.
This stage lasts until the person no longer
experiences temptation to return to
previous unhealthy behaviors.
5. Termination Stage the ultimate goal
where the individual has complete
confidence that the problem is no longer a
temptation or threat.
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The NURSES Role in Health

Promotion
Programs used for health promotion
includes:
1. Information Dissemination
2. Health Risk Appraisal
3. Lifestyle & Behavior Change
4. Environmental Control

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COPAR

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Community Organizing Participatory

Action Research
COPAR is a social development approach
that aims to transform the apathetic, poor
into dynamic, participatory and politically
responsive community.
A process by which a community identifies
its needs and objectives, develops
confidence to take action in respect to them
and in doing so, extends and develops
cooperative and collaborative attitudes and
practices in the community (Rose 1967).
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Community Organizing Participatory

Action Research
A continuous and sustained process
of educating the people to
understand and develop their critical
awareness of their existing
conditions, working with the people
collectively and efficiently on their
immediate needs toward solving
their long-term problems.
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Importance of COPAR
COPAR is an important tool for community
development and people empowerment as this
helps the community workers to generate
community participation in development
activities.
COPAR prepares people to eventually take over
the management of a development program in
the future.
COPAR maximizes community participation and
involvement; community resources are
mobilized for health development services.
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Principles of COPAR
People, especially the oppressed,
exploited and deprived sectors are open
to change, have the capacity to change
and are able to bring about change.
COPAR should be based on the interests
of the poorest sectors of the society.
COPAR should lead to a self-reliant
community and society.

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Process/Methods used in
COPAR
A PROGRESSIVE CYCLE OF ACTION-REFLECTION-ACTION
Which begins in small, local and concrete issues identified by the people and
the evaluation and reflection of and on the action taken by them.
CONSCIOUSNESS-RAISING
Through experiential learning is central to the COPAR process because it places
emphasis on learning that emerges from concrete action and which encircles
succeeding action.
COPAR IS PARTICIPATORY & MASS-BASED
Because it is primarily directed towards and biased in favor of the poor, the
powerless and the oppressed.
COPAR IS GROUP-CENTERED
And not leader centered. Leaders are identified, emerge and are tested through
action rather than appointed or selected by some external force or entity.

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Phases of COPAR

PRE-ENTRY
ENTRY
ORGANIZING
SUSTENANCE AND
STRENGTHENING
PHASE-OUT
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PRE ENTRY PHASE

The initial phase of the organizing
process where the community
organizer looks for communities to
serve or help.
It is the most complex phase in terms
of actual outputs, activities, and
strategies and time spent for it.
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Recommended Activities
Statement of objectives, and realization
of copar guidelines.
Laying out the site criteria.
Site selection.
Meeting and courtesy call to the local
government unit of the selected site.
Courtesy call to the barangay level.
Meeting w/ the will be foster parents
of the health care students.
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Criteria for Site Selection

Is the community in need of assistance?
Do the community members feel need to
work together to overcome a specific health
problem?
Are there concerned groups and
organizations that the nurse can possibly
work with?
What will be the counterpart of the
community in terms of community support,
commitment and human resources?
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ENTRY IN THE COMMUNITY AND INTEGRATION

WITH THE PEOPLE

Before actual entry into the community, basic

information about the area in relation to the
cultural practices and lifestyles of the people
must be known.
Establishing rapport and integrating with them
will be much easier if one is able to understand,
accept or imbibe their community life.
Living with the people, undergoing their
hardships and problems and sharing their
hopes and aspirations help build mutual trust
and cooperation.
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Some Guidelines in Conducting

Integration Work
Recognize the role and position of local authorities.
Adapt a lifestyle in keeping w/ that of the community.
Choose a modest dwelling which the people,
especially the economically disadvantaged will not
hesitate to enter.
Avoid raising expectations of the people. Be clear w/
your objectives and limitations.
Participate directly in production process.
Make house calls and seek out people where they
usually gather.
Participate in some social activities.
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ENTRY PHASE
Sometimes called the immersion
phase as it the activities done here
includes the sentization of the people
on the critical events in their life,
motivating them to share their
dreams and ideas on how to manage
their concerns and eventually
mobilizing them to make collective
action on THESE.
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Recommended Activities
Courtesy call to mayor, or the local government
leader of the selected site.
Courtesy call to the barangay level.
Meeting with the foster parents.
Appreciating the environment.
Meeting with community officials and residents.
General assembly.
Preparation of survey forms.
Actual survey.
Analysis of the data gathered
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ORGANIZATIONAL-BUILDING
PHASE
The formation of more formal
structures and the inclusion of more
formal procedures of planning,
implementing and evaluating
community-wide activities. It is at
this phase where the organized
leaders or groups are being given
trainings to develop their ask
(attitude, knowledge and skills) in
managing their own
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Recommended Activities
Meeting with the officials.
Identifying problems.
Spreading awareness and soliciting solution or
suggestion.
Analysis of the presented solution.
Planning of the activities.
Organizing the people to build their own
organization.
Registration of the organization.
Implementing of the said activities.
Evaluation.
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SUSTENANCE &
STRENGTHENING PHASE
Occur when the community
organization has already been
established and the community-wide
undertakings. At this point, the
different committees set-up in the
organization-building phase are
already expected to be functioning
by way of planning, implementing
and evaluating their own programs,
w/ the overall guidance from the
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Recommended Activities
Meeting with the organizational leaders.
Evaluation of the programs.
Re-implementing of the programs.
(for unmet goals)
Education and training.
Networking and linking.
Implementation of livelihood projects.
Developing secondary leaders.
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PHASE OUT
The phase when the health care
workers leave the community to
stand-alone. This phase should be
stated during the entry phase so that
the people will be ready to for this
phase. The organizations built should
be ready to sustain the test of the
community itself because the real
evaluation will be done by the
residents of the community itself.
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Recommended Activities
Leaving the immersion site.
Documentation.

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The Community Health Worker as a

Documenter / Reporter
The community health worker keeps a written account of
services rendered, observations, condition, needs, problems
and attitude of the client in community activities,
accomplishments made and, etc.

Community workers takes responsibility to disseminate
pertinent information to appropriate authorities, agencies,
and most especially to the client. At the same time, the
community worker develops the peoples capabilities to
keep/maintain their recording and reporting system.

RECORDS refer to forms on which information pertaining
the client is noted.
REPORTS - refers to periodic summaries of the
services/activities of an organization/unit or the analysis of
certain phases of its work. KLCBesario

PURPOSE OF RECORDS
AND REPORTS

Measure service/program directed to

the clients.
Provide basis for future planning.
Interpret the work to the public and
other agencies, community.
Aid in studying the conditions of the
community.
Contributes to client care.
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Community Health Needs

Definition on Terminologies/Categories of
Health Problems
1. Health Threat Conditions that are
conducive to diseases, accidents or
failure to identify ones potential.
Ex. Family History, Threat of cross
contamination, Accident Hazards, Faulty
eating habits, Poor environmental
sanitation, Unhealthy lifestyle
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Community Health Needs

2. Foreseeable Crisis anticipated
periods of unusual demand on the
individual or family in terms of
judgment/family resources
Ex. Marriage, Pregnancy, Parenthood,
Divorce/Separation, Loss of job,
Menopause, Death

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Community Health Needs

3. Health Deficits a gap between
health actual and achievable health
status, instances of failure in health
maintenance
Ex. Illness state
(diagnosed/undiagnosed)
Failure to thrive/develop
Disability
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Community Health Needs

Community is seen as the primary
client of the nurses for 2 reasons:
1. Community has a direct influence on
the health of the individual, families
and sub-populations
2. It is at this level that most health
service provision occurs

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Community Health Needs

The community nurse will deal with the
community characteristics in
planning & developing specific
programs & in ensuring the delivery
of effective health services.

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Community Diagnosis
Client starts with determining its health
status.
The nurse collects data about the
community in order to identify the
different factors (direct/indirect) that may
influence the health of the population.
Then, proceeds to analyze & seek
explanations for the occurrence of health
needs & problems of the community
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Community Diagnosis
The community health nursing
diagnoses are then derived & will
become the bases for developing &
implementing community
diagnosis/community
assessment/situational analysis.
The health status of the community is
a product of the various interacting
elements
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Types of Community
Diagnosis
1. Comprehensive Community
Diagnosis aims to obtain a general
information about the community
A. Demographic Variables show the
size, composition & geographical
distribution of the population
B. Socio-Economic & Cultural Variables
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Types of Community
Diagnosis
A. Demographic Variables show the
size, composition & geographical
distribution of the population
B. Socio-Economic & Cultural Variables
C. Health & Illness Patterns
D. Health Resources
E. Political/Leadership Patterns

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Types of Community
Diagnosis
2. Problem-Oriented Community
Diagnosis
- Type of assessment that responds to
a particular need

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Community Diagnosis: The

Process
Consist of : Collecting, Organizing,
Synthesizing, Analyzing and
Interpreting health data.

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Steps in Conducting a Community

Diagnosis
1.
2.
3.
4.
5.
6.
7.
8.

Determining the Objectives

Defining the Study Population
Determining the Data to be Collected
Collecting the Data
Developing the Instrument
Actual Data Gathering
Data Collation
Data Presentation
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Steps in Conducting a Community

Diagnosis
9. Data Analysis
10. Identifying the Community Health
Nursing Problems
11. Priority-setting

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Application of Public Health Tools in

Community Health Nursing
Tools in measuring & analyzing
community health problems were
borrowed to form part of our
assessment tools in the diagnosis of
community health problems.

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1. DEMOGRAPHY
Is the science which deals with the
study of the Human Populations size,
composition and distribution in
space.
Helps the nurse find reasons or
rationale why or how a particular
population or group is influenced by
a variety of factors resulting in
vulnerability to disease.
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Sources of Demographic
Data
Census as an official & periodic
enumeration of population
De jure/De Facto
Sample surveys
Registration system

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A. Population Size
This will allow the nurse to make
comparison about population
changes over time.
It will also help the nurse to
rationalize the types of health
programs/interventions which are
going to be provided for the
community
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How to get Population Size

1. Determining the increase in the
population resulting from excess of
births compared to death
2. Determine the increase in the population
using data obtained during two census
periods this implies that the increase
in the size of the population is not
merely attributed to excess in births but
also the effect of migration
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B. Population Composition
The nurse utilizes data on Age & Sex
composition to decide who among
the population groups merits
attention in terms of health services
& programs

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Computation on
Population Composition
1. Sex Composition
2. Age Composition
3. Age & Sex Composition

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C. Population Distribution
This will help the nurse decide hoe meager
resources can be justifiability allocated based
on concentration of population in a certain place
1. Urban-rural distribution proportion of people
living in urban compared to rural areas
2. Crowding Index describe by dividing the
number of persons in a household with he
number of rooms used by the family for
sleeping
3. Population Density computed by dividing the
number of people living in a given land area
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2. VITAL STATISTIC
This will able the nurse to describe
the health status of the people which
serve as the basis for developing,
implementing and evaluating
programs & intervention strategies

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3. EPIDIMIOLOGY
The study of the occurrence &
distribution of health conditions on
Human Populations.
It is also concerned with the study of
probable factors that influences the
development of these health
condition

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Important Concepts on
Epidemiology
1. The Multiple Causation Theory
Disease development does not rest
on a single cause. Health conditions
result from a multitude of factors.
- The Ecologic Triad Model highlights
the hosts, environments & agents
roles in disease development

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Agent
Is any element, substance or force,
either animate or inanimate, the
presence or absence of which may
serve as stimulus to initiate or
perpetuate a disease process.
This happens only when the agent
comes in contact with a susceptible
host & under proper environmental
conditions
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Host
Is any organism that harbors &
provides nourishment for another
organism.
The resistance of the host may be
specific or non-specific.
HERD IMMUNITY is the probability
of a group or community developing
an epidemic upon introduction if an
infectious agent
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Environment
1. Physical Environment
2. Biological Environment
3. Socio-economic Environment

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The Epidemiological
Approach
The phases of epidemiological approach:
1. Descriptive Epidemiology disease
distribution & frequency
2. Analytical Epidemiology analyze the
cause/ determinants of disease through
hypothesis testing
3. Intervention/Experimental Epidemiology
answers questions about the effectiveness
of new methods for controlling disease or
for improving underlying conditions
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The Epidemiological
Approach
The phases of epidemiological
approach:
4. Evaluation Epidemiology attempts
to measure the effectiveness of
different health services and
programmes

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Revised Child Immunization

2014
BIRTH
Only BCG immunization at Birth
ROUTE & DOSE, EFFECT,
CONTRAINDICATIONS, NSG
MANAGEMENT
BCG is usually combined with
Hepatitis B at birth

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Revised Child Immunization

2014
6th WEEK
Pentavalent Vaccine is Given (Penta 1)
there may be delays so allowance is given
2 months is given with 4 months interval
per vaccine dose may still be sync with
the EPI Schedule
Oral Polio Vaccine
ROUTE & DOSE, EFFECT,
CONTRAINDICATIONS, NSG MANAGEMENT
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Revised Child Immunization

2014
9th WEEK
Only Measles Vaccine is given
ROUTE & DOSE, EFFECT,
CONTRAINDICATIONS, NSG
MANAGEMENT

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Revised Child Immunization

2014
10th WEEK
Penta 2
OPV 2
ROUTE & DOSE, EFFECT,
CONTRAINDICATIONS, NSG MANAGEMENT

Vaccines are given 4 weeks apart

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Revised Child Immunization

2014
14th WEEK
Penta 3
OPV 3
12th 15th WEEK
MMR Vaccine is given
ROUTE & DOSE, EFFECT,
CONTRAINDICATIONS, NSG MANAGEMENT
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The Philippine
Health Care Delivery System
Health System is an interrelated system
in which a country organizes available
resources for the maintenance and
improvement of the health of its citizens
and communities
A health system comprises all
organizations, institutions and resources
devoted to producing actions whose
primary intent is to improve health
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Definition of Terms
HEALTH CARE SYSTEM an organized
plan of health services
HEALTH CARE DELIVERY rendering
health care services to the people
HEALTH CARE DELIVERY SYSTEM
the network of health facilities &
personnel which carries out the task
of rendering health care to the
people.
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Vision
The DOH is the leader, staunch
advocate & model in promoting
Health for All in the Philippines.

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Mission
Guarantee equitable, sustainable &
quality health for all Filipinos,
especially the poor & shall lead to
quest for excellence in health.

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Goal
Health Sector Reform Agenda - is
the overriding goal of the DOH.
Support mechanisms will be through
sound organizational development,
strong policies, systems and
procedures, capable human
resources & adequate financial
resources.
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Rationale for Health Sector

Reform
1. Slowing in the reduction in the Infant
Mortality Rate & the Maternal Mortality Rate
2. Persistence of large variations in health
status across population groups &
geographic areas.
3. High burden from chronic & degenerative
diseases
4. Unattended emerging health risks from
environmental & work related factors
5. Burden of disease is heaviest on the poor
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Framework for implementation of

HSRA: FOURmula ONE for Health
It intends to interpret critical
interventions as a single package
backed by effective management
infrastructure & financing
arrangements following a sectorwide
approach.

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Goals for F1 for Health

Better health outcomes
More responsive health systems
Equitable health care financing

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Specific Objectives to attain F1 plan

F1 Component 1: HEALTH FINANCING
Mobilizing resources from extra budgetary
sources
Coordinating local and national health
spending
Focusing direct subsidies to priority programs
Adopting a performance based financing
system
Expanding the national health insurance
program
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Specific Objectives to attain F1 plan

F1 Component 1: HEALTH FINANCING
The objective of financing reforms
under FOURmula ONEfor Health is to
secure more, better and sustained
investments in health to provide
equity and improve health outcomes,
especially for the poor.

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Specific Objectives to attain F1 plan

F1 Component 2: HEALTH REGULATION
Harmonizing licensing, accreditation
and certification
Issuance of quality seals
Assuring the availability of low-priced
quality essential medicines
commonly used by the poor

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Specific Objectives to attain F1 plan

F1 Component 2: HEALTH REGULATION
The main objective of health
regulation under FOURmula ONEfor
Health is assuring access to quality
and affordable health products,
devices, facilities and services,
especially those commonly used by
the poor.
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Specific Objectives to attain F1 plan

F1 Component 3: HEALTH SERVICE
DELIVERY
Ensuring the availability of providers of
basic and essential health services in
localities
designating providers of specific and
specialized services in localities
intensifying public health programs in
targeted localities
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Specific Objectives to attain F1 plan

F1 Component 3: HEALTH SERVICE
DELIVERY
Objective: FOURmula ONEfor Health
interventions in service delivery are
aimed at improving the accessibility
and availability of basic and essential
health care for all,particularly the
poor. This shall cover all public and
private facilities and services
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Specific Objectives to attain F1 plan

F1 Component 4: GOOD GOVERNANCE
IN HEALTH
establishing FOUR-IN-ONE advanced
implementation sites
developing on LGU FOURmula ONE for
Health Scorecard
institutionalizing a FOURmula ONE for
Health Expanded Professional
CareerTrack
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Specific Objectives to attain F1 plan

F1 Component 4: GOOD GOVERNANCE IN
HEALTH
The objective of good governance in health is
to improve health systemsperformance at the
national and local levels. FOURmula ONEfor
Health will introduce interventions to improve
governance in local health systems, improve
coordination across local health systems,
enhance effective private-public partnership,
and improve national capacities to manage
the health sector
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PHC as an approach to Delivery of

Health Care Services
PHC was declared during the First
International Conference on Primary
Health Care held in Alma Ata, USSR
on Sept 6-12, 1978 by WHO.
It is a strategy, which focuses
responsibility for health on the
individual, his family and the
community.
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Elements/Components of
Primary Health Care
1.
2.
3.
4.
5.

Environmental Sanitation
Control of Communicable Diseases
Immunization
Health Education
Maternal & Child Health & Family
Planning
6. Adequate Food & Proper Nutrition
7. Treatment of Locally Endemic Diseases
8. Provision of Essential Drugs
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 The framework for meeting the goal

of primary health care is
organizational strategy, which calls
for active & continuing partnership
among the communities, private &
government agencies in health
development

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4 cornerstones/pillars in
PHC

Active community participation

Intra & inter-sectoral linkages
Use of appropriate technology
Support mechanism made available

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Types of Primary Health Care

Workers
Various categories of health workers
make up the primary health care
team. The types vary in different
communities depending upon:
Available health manpower resources
Local health needs & problem
Political & financial feasibility

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 In general, the PHC team may consist

of physicians, nurses, midwives,
nurse auxiliaries, locally trained
community health workers,
traditional birth attendants &
healers.
2 levels of primary health care
workers
1. Village or barangay Health Workers
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Levels of Health Care &

Referral System
Primary Level of Care is devolved to the
cities & the municipalities. It is health care
provided by center physicians, public
health nurses, rural health midwives,
barangay health workers, traditional
healers & others at the barangay health
stations & rural health units.
Usually the first contact between the
community members & the other levels of
health facility.
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Levels of Health Care &

Referral System
Secondary Level of Care is given by physicians
with basic health training. This is usually given in
health facilities either privately owned or
government operated such as infirmaries,
municipal & district hospital and out-patient
departments of provincial hospitals.
Serves as referral center for the primary health
facilities.
Capable of performing minor surgeries &
perform some simple laboratory examinations.

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Levels of Health Care &

Referral System
Tertiary Level of Care rendered by
specialist in health facilities including
medical centers as well as regional &
provincial hospitals, & specialized hospitals
such as the Philippine Heart Center.
Is the referral center for secondary care
facilities.
Complicated cases & intensive care
requires tertiary care & all these can be
provided by the tertiary care facility.
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Levels of Health Care

Services
The higher the level, the more
qualified the health personnel & the
more sophisticated the health
equipment.

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Care of Pregnant Woman

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Objectives:
At the end of the lesson, the students
will be able to:
1. Identify the goals & philosophy of
maternal & child nursing
2. Use critical thinking in assessing &
implementing care to pregnant
women
3. Apply appropriate care to real
patients with the use of NCP
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MENSTRUATION
A menstruation cycle is a episodic
uterine bleeding in response to cyclic
hormonal changes
Its purpose is to bring an ovum to
maturity & renew a uterine tissue bed
that will be responsible for the ovas
growth should it be fertilized
A process that allows for conception
& implantation of a new life.
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MENSTRUATION
The length of menstrual cycle differs from
woman to woman, but the average is 28 days.
Menarche 9-17 years old
Interval 28 days, 23-35 days not unsual
Duration 2-7 days, 1-9 days not abnormal
Amount 30-80ml, saturating pad/tampon in
less than an hour is heavy bleeding
Color dark red, combination of blood, mucus
& endometrial tissue
Odor Similar to that of Marigolds
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Physiology of Menstruation
Body structures that are involved in
the Physiology of the menstrual cycle
1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus

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Physiology of Menstruation

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PHASES OF MENSTRUAL
CYCLE
Proliferative immediately after a
menstrual flow (during the first 4-5 days)
& the lining of the uterus is very thin
Secretory after ovulation, the formation
of progesterone in the corpus luteum
causes the glands of the uterine
endometrium to become twisted in
appearance & dilated with quantities of
glycogen & mucin.
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PHASES OF MENSTRUAL
CYCLE
Ischemic if (-) fertilization, the
corpus luteum in the ovary geins to
regress after 8-10 days. The
production of progesterone &
estrogen decrease and the
endometrium of the uterus begins to
degenerate. The capillaries rupture,
with minute hemmorhages, & the
endometrium sloughs off
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PHASES OF MENSTRUAL
CYCLE
Menses menstrual flow is composed
of:
1. Blood from the ruptured capillaries
2. Mucin from the gland
3. Fragments of endrometrial tissues
4. The microscopic, atrophied, &
unfertilized ovem
- The first day of menstrual flow
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