Escolar Documentos
Profissional Documentos
Cultura Documentos
Joy Colindres,RN,MAN
Overview of Community
Health Nursing
Application of
bacteriology
and
immunology
Period of Health Education (1910 to
present)
Emphasized on
education for
prevention of
diseases with
active cooperation
of individual in
health action
Public Health Nursing in the
Philippines
Pre-Spanish Era – no records
Spanish Regime (1591-1898)
Bro. Juan Clemente (1577) – started public
health services
Introduction of water sanitation
Introduction of small pox vaccine
Creation of position of district, provincial and
national health officers
American Regime (1898-1946)
1898 – creation of Board of Health for
physicians
1899 – appointment of the 1st
commissioner of health
1901 – Act No. 157 created Board of
Health for the City of Manila; Act No. 309
created Provincial and Municipal Boards of
Health
1905 – Act No. 1407 (reorganization act)
abolish Board of Health and was taken
over by the Bureau of Health under the
Department of Interior
1906 – creation of Bureau of Health
1912 – Fajardo Act (Act No. 2156) created
Sanitary Division. In the same year public
health nursing in the Philippines started.
1915 – Bureau of Health was renamed
Philippine Health Service; Reorganization Act
No. 2462 – created the office of General
Inspection, headed by nurse-physician Dr.
Rosario Pastor.
1916 to 1918 – Ms. Perlita Clark took charge of
the public health nursing
1917 – 4 nursing graduates from Manila were
employed to worked in the city school
1919
Public health nursing was inaugurated in Tondo,
Manila when visiting nurse Ms. Balbina Basa was
assigned to make a house to house visit, hold clinic
and dispensary work with special emphasis on
maternal and child care.
Philippine National Red Cross introduced the
operation of puericulture.
The program was later extended to the province
incorporation with Bureau of Public Welfare
Ms. Carmen del Rosario was appointed as
the first Filipino nurse under the Bureau of
Health
1923 – established 2 government schools
of nursing: Zamboanga General Hospital
School of Nursing and Baguio General
Hospital in Northern Luzon. In later year 4
more school were establish
1928 – Fist convention of nurses were
held
1933 – Reorganization Act No. 4007, the
Division of Maternal and Child Health of
the Public Welfare Commission was
transferred to the Bureau of Health
1940 – The Department of Health and
Welfare was created
Japanese Regime (1942-1945) – Public health
nursing were interrupted
1946 – after world war, the Bureau of Health
increased the number of public health nurse.
Mrs. Genara de Guzman, technical assistant in
nursing of the Ministry of Health and concurrent
president of Filipino Nurses Association
recommended the creation of a nursing office in
the Ministry of Health.
Era of Republic of the Philippines (1949 to
present)
1947 – Reorganization of government
offices under EO No. 94: Bureau of Public
Welfare to the office of the president and
renamed as Department of Health
1953 – the office of Health Education and
Personnel Training was created
May 18, 1954 – Republic Act 1082 was
passed creating Rural Health Units
June 1957 – Republic Act 1891 – an act
that strengthen health and dental services
in the rural health area
1975 – Formulation of National Health
Plan and the restructured Health Care
Delivery System
1982 – Executive Order No. 851, the health
education and manpower development service
was created, and Bureau of Food and Drug
1986 – The Ministry of Health became
Department of Health again
1991 – RA 7160 (Local Government Code).
Devolution – transfer of power from the national
to local government which aimed to built their
capabilities for self-government and developed a
self-reliant communities.
1993 to 1998 – National League of
Philippine Government Nurses was
organized
1996 – Primary Health Care as a
strategies to attain Health for all by the
year 2000
1999 – Creation of National Health
Planning Committee and Inter-Local
Health Zones through EO 205
May 24,1994 – EO 102 signed by Pres. Estrada,
redirecting the function and operations of the
DOH, nursing positions were devolved
1999 to 2004 – Health Sector Reform Agenda of
the Philippines was launched
2005 – Fourmula One for Health to ensure
speed, precision and effective coordination
towards improving the efficiency, effectiveness
and equity of health care delivery
Definitions and Focus: PHN/CHN
Both term are often interchange but
synonymous
PHN is a synthesis of public and
nursing practice. (Freeman)
PHN is a field of professional practice
in nursing and in public health in
which technical nursing,
interpersonal, analytical and
organizational skills are applied to
problems of health as they affect
community.
These skills are applied in concert with
those of other persons engaged in
health care, through comprehensive
nursing care of families and other
groups and through measures for
evaluation or control of threats to
health, for health education of the
public and for mobilization of the public
for health action.
Public Health
According to Dr. C.E. WINSLOW
PUBLIC HEALTH – is the science and art
of preventing disease, prolonging life,
promoting health and efficiency through
organized community effort for the
sanitations of the environment, control of
communicable diseases, education of
individuals in personal hygiene….
… the organization of medical and nursing
services for early diagnosis and preventive
treatment of disease, and the development
of the social machinery to ensure
everyone a standard of leaving adequate
for the maintenance of health, so
organizing these benefits as to enable
every citizen to realize his birthright of
health and longevity.
According to WHO
PUBLIC HEALTH – is the art of applying
science in the context of politics so as to
reduce inequalities in health while
ensuring the best health for the greater
number.
Therefore, the core element of
governments’ attempts to improve and
promote the health and welfare of their
citizens.
Core business of PUBLIC HEALTH
Disease control
Injury prevention
Health promotion
Healthy public policy, in relation to
environmental hazards
Promotion of health and equitable health gain
Essential Public Health Functions
Health situation monitoring and analysis
Epidemiological surveillance/disease
prevention and control
Development of policies and planning in
public health
Strategic management of health systems
and services for population health gain
Regulation and enforcement to protect
public health
Human resources development and
planning in public health
Health promotion, social participation and
empowerment
Ensuring the quality of personal and
population based health services
Research, development and
implementation of innovative public health
solutions
Public Health Nursing
Made great contributions to the
improvement of the health of the people
Leaders in providing quality health care
services to communities.
First level of health workers to be
knowledgeable about new public health
technologies and methodologies.
Usually the first to be trained to implement
new programs and apply new technology.
NURSING UNDER W.H.O
Demarcates the line of nursing action
To serve both well and ill in the community
Right to medical care and right to nursing care
are implied in the fundamental human rights
A changing trend in community care gave
birth to COMMUNITY HEALTH NURSING
Community Health Nursing
Maglaya, Jacobson, Freeman
Utilization of nursing process for clientele
Concerned with the promotion of health
(optimal level of functioning), prevention
disease and disability and rehabilitation
Achieved through teaching and delivery of
health care
GOAL: raise the level of health of the
citizenry
Philosophy (Dr. Margaret
Shetland)
Baseon the worth and dignity of
human
AGENT HOST
(microorganism or (living organism capable
chemical substance) of being infected by the agent)
Health- Illness Continuum
Health is a constantly changing state, with
high level wellness and death being on
opposite ends of a graduated scale, or
continuum.
High Level Wellness
High level wellness
refers to
functioning to one’s
maximum potential
while maintaining
balance of
purposeful
direction in the
environment(1977,
Rodale).
Needs Fulfillment Model
Health is a state in
which needs are
being sufficiently
met to allow an
individual to
function
successfully in life
with the ability to
achieve the highest
possible potential
Role Performance Model
Health is the ability
to perform all those
roles for which on
has been
socialized.
PRIMARY HEALTH
CARE
30 years ago, the Declaration of Alma-Ata
articulated primary health care as a set of
guiding values for health development, a
set of principles for the organization of
health services, and a range of
approaches for addressing priority health
needs and the fundamental determinants
of health.
The Declaration of Alma-Ata was
adopted at the International Conference
on Primary Health Care, Almaty (formerly
Alma-Ata), presently in Kazakhstan,
September 6-12, 1978.
It expressed the need for urgent action by
all governments, all health and
development workers, and the world
community to protect and promote the
health of all the people of the world.
It was the first international declaration
underlining the importance of primary
health care. The primary health care
approach has since then been accepted
by member countries of WHO as the key
to achieving the goal of "Health for All".
Primary health care, often
abbreviated as PHC, is
"essential health care based on practical,
scientifically sound and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation
and at a cost that the community and the
country can afford to maintain at every
stage of their development in the spirit of
self-determination"
In the Philippines, primary health care was
implemented under Letter Of Instruction
949 , which was signed by former
President Marcos on October 19, 1979.
MISSION
To strengthen the health care system by
increasing opportunities and supporting
the conditions wherein people will manage
their own health care
GOAL
Health for All
SELF-RELIANCE
ability to stand on their own self-sufficiency
In
accordance with the goal of the Department of
Health which is,
Framework
People’s empowerment and partnership is the
key strategy to achieve the goal “Health for all
Filipinos and Health in the hands of the
people by the year 2020”.
GENERAL PRINCIPLES AND
STRATEGIES
HEALTH AND DEVELOPMENT ARE
INTERRELATED
ESSENTIAL HEALTH SERVICES MUST
BE ACCESSIBLE, AVAILABLE,
ACCEPTABLE AND AFFORDABLE.
GENUINE PEOPLE’S PARTICIPATION
IS ESSENTIAL – Community
Participation
SELF-RELIANCE
SOCIAL MOBILIZATION
DECENTRALIZATION
PROVISION OF QUALITY, BASIC AND
ESSENTIAL HEALTH SERVICES
HEALTH AND DEVELOPMENT
ARE INTERRELATED
Convergence (meeting) of health, food,
nutrition, water, sanitation, and
population services.
Integration of PHC into national,
regional, provincial, municipal and
barangay development plans.
Coordination of activities with economic
planning, education, agriculture,
industry, housing, public works,
communication and social services.
Establishment of effective health referral
system
ESSENTIAL HEALTH SERVICES
MUST BE ACCESSIBLE, AVAILABLE
Health services delivered where the people
are
Use of indigenous volunteer health worker
as a health provider with a ratio of one
community health worker per 10-20
households
Use of traditional medicines with essential
drugs
GENUINE PEOPLE’S
PARTICIPATION IS ESSENTIAL
Awareness building and consciousness
rising on health- related issues.
Planning, implementations, monitoring and
evaluation done through small group
meeting (10-20 household cluster)
Selection of community health workers by the
community.
Formation of health committees.
Establishment of community health
organization at the parish or municipal level.
Mass health campaigns and mobilization to
combat health problems
SELF-RELIANCE
Use of local resources
Training of community in leadership
and management skills
Incorporation of income generating
projects, cooperatives and small scale
industries.
SOCIAL MOBILIZATION
Establishment of an effective health referral
system
Multi-sectoral and interdisciplinary linkage
Information, education, communication
support using multi-media
Collaboration between government and non-
government organizations
DECENTRALIZATION
Devolution (RA 7160)
Transfer of power from the national
government to local government unit
Reallocation of budgetary resources
Reorientation of health professionals on
Primary Health Care
Advocacy for political will and support from
the national leadership down to the
barangay level.
PROVISION OF QUALITY, BASIC
AND ESSENTIAL HEALTH SERVICES
Training design and curriculum based on
community needs and priorities
Attitude, knowledge and skills developed are
on promotive, preventive, curative and
rehabilitative health care
Regular monitoring and periodic evaluation
of community health worker performance by
the community and health staff.
MAJOR ELEMENTS
1. Use of Appropriate Technology
This emphasizes equity and justice, that
health is a basic right of every individual and
not just to those who can afford to pay their
own health care
Criteria in determining use of appropriate
technology
Effectiveness and safety
Complexity – simple and easy to apply
Cost
Scope of technology – effective, appropriate
Acceptability
Feasibility – compatible with the local setting
2. Multi-Sectoral Approach to Health
Environmental (social,
economic, physical conditions)
Intersectional Linkages
Primary Health Care forms an integral part
of the health system and the over all social
and economic development of the
community. As such, it is necessary to
unify health efforts within the health
organization it self and with other sectors
concerned. It implies the integration of
health plans with the plan for the total
community development.
Sectorsmost closely related to health
includes those concerned with:
Agricultural
Education
Public works
Local government
Social welfare
Population control
Private sectors
Intrasectoral Linkage
In the health sector, the acceptance or primary
health care necessitates the restructuring of the
health system to broaden health coverage and
make health service available to all. There is
now widely accepted pyramidal organization that
provides level of services starting with primary
health and progressing to specialty care.
Primary care is the hub of the health system.
National & Regional
Health Services, Medical
Centers, Teaching & Training
Hospitals
H H
E E
Barangay Health Public Health Nurse A A
Worker L L
TH T
F H
A F
C A
Barangay Health Rural Health Unit Physician I C
Stations Midwifes L I
I L
T I
I T
E I
S E
Barangay Health Sanitary Inspector S
Midwifes
PRIMARY HEALTH WORKER
Village/Grassroots
Train community health workers, health
auxiliary volunteers, TBA
1st contact of the community (initial link)
Work in liaison with local health service
worker
Provide elementary, curative preventive
health care measures
Intermediate level
General Medical Practitioners, PHN,
Midwifes
1st source of professional health care
Attend to health problems beyond the
competencies of the village workers
Provides support to the front line health
workers in term of supervision, training,
referral services and supplies through
linkages with other sectors
Health Personnel of first line hospitals
Physicians with specialty area, nurses and
dentists
Establish close contact with the village and
intermediate level health workers to promote
the continuity of care from hospital to
community to home.
Provide back-up health services for cases
requiring hospital or diagnostic facilities not
available in health care
3. Community participation
Defining their health and health related needs
and problems
Identifying realistic solution
Organizing community health action
Mobilizing local resources
Providing essential health services
Evaluating the results of health actions
ELEMENTS OF PRIMARY
HEALTH CARE
Self efficacy is
the ability or the
power to
produce an
effect/ change.
Psychologist Albert Bandura has defined
self-efficacy as one's belief in one's ability
to succeed in specific situations.
One's sense of self-efficacy can play a
major role in how one approaches goals,
tasks, and challenges.
According to Bandura's theory, people
with high self-efficacy:
are those who believe they can perform well
are more likely to view difficult tasks as
something to be mastered rather than
something to be avoided.
How self-efficacy affects human
function
Choices regarding behavior
People will be more inclined to take on a task
if they believe they can succeed. People
generally avoid tasks where their self-efficacy
is low, but will engage in tasks where their
self-efficacy is high.
Motivation
People with high self-efficacy in a task are
more likely to make more of an effort, and
persist longer, than those with low efficacy.
Thought patterns & responses
Low self-efficacy can lead people to believe
tasks are harder than they actually are.
People with high self-efficacy often take a
wider overview of a task in order to take the
best route of action.
People with high self-efficacy are shown to be
encouraged by obstacles to make a greater
effort.
Self-efficacy also affects how people respond
to failure.
A person with a high self-efficacy will attribute
the failure to external factors, where a person
with low self-efficacy will attribute failure to
low ability.
Health Behaviors
Health behaviors such as non-smoking,
physical exercise, dieting, condom use, dental
hygiene, seat belt use, or breast self-
examination are, among others, dependent on
one’s level of perceived self-efficacy (Conner
& Norman, 2005).
Self-efficacy beliefs are cognitions that
determine whether health behavior change
will be initiated, how much effort will be
expended, and how long it will be sustained in
the face of obstacles and failures.
Self-efficacy influences the effort one puts
forth to change risk behavior and the
persistence to continue striving despite
barriers and setbacks that may undermine
motivation.
Self-efficacy is directly related to health behavior, but
it also affects health behaviors indirectly through its
impact on goals.
Self-efficacy influences the challenges that people
take on as well as how high they set their goals (e.g.,
"I intend to reduce my smoking," or "I intend to quit
smoking altogether"). A number of studies on the
adoption of health practices have measured self-
efficacy to assess its potential influences in initiating
behavior change (Luszczynska, & Schwarzer, 2005).
TYPES OF HEALTH
PROMOTIONAL ACTIVITIES
HEALTH EDUCATION (information
dissemination)
Use of variety of media to offer information to
the public about the particular lifestyle choices
and personal behavior, the benefits of
changing that behavior and the improvement
of quality of life
FIVE PRIORITY ACTIONS AREA
Build healthy public policy;
Create supportive environments for health;
Strengthen community action for health;
Developed personal skills;
Re-orient health services
Jakarta Declaration on Leading
Health Promotion into the 21st
Century (1997)
Strategies and action areas are
relevant for all countries
Comprehensive approaches to health
development are most effective.
Setting for health offer practical
opportunities for the implementation of
comprehensive strategies.
Participation is essential to sustain efforts.
Health literacy fosters participations.
Five Priorities
Promote social responsibility for health;
Increase investments for health
development;
Expand partnerships for health
promotion;
Increase community capacity and
empower the individuals;
Secure an infrastructures for health
promotion
ACTIVITIES FOR HEALTH
PROMOTION
HEALTH APPRAISAL WELLNESS
ASSESSMENT PROGRAM
Appraise individuals of their risk factors that
are inherited in their lives/family in order to
motivate them to reduce specific risk and
develop positive health habits
Wellness assessment programs are focused
on more positive methods of enhancement
LIFE-STYLE AND BEHAVIOR CHANGE
PROGRAM
Basis for changing behavior
Geared towards enhancing the quality of life
and extending the life span
WORKSITE
WELLNESS
PROGRAM
Includes programs that
serve the needs of the
persons in their work
places
ENVIRONMENTAL
CONTROL
PROGRAM
Developed to address
the growing problem of
environment pollution
such as air, land,
water etc.
DISEASE PREVENTION
Disease prevention covers measures not
only to prevent the occurrence of
diseases, such as risk factor reduction, but
also to arrest it progress and reduce its
consequences once established. WHO
(1984)
Disease prevention is sometimes used as
a complementary term alongside health
promotion.
Although there is frequent overlap
between the content and strategies,
disease prevention is defined saparetly.
Disease prevention is considered to be
actions which usually emanates from
health sector, dealing with individuals and
populations identified as exhibiting
identifiable risk factors, often associated
with different risk behaviors.
LEVELS OF DISEASE
PREVENTION
PRIMARY LEVEL
Directed towards preventing the initial
occurrence of disease.
Decreases the risk or exposure of
individual and community to disease.
Example:
Health education about accident and poisoning
Health education about standards of nutrition and
growth and development, exercise requirements,
stress management, protection against
occupational hazard.
Immunization
Risk assessments for specific disease
Family planning services and family counseling
Environmental sanitation and provision of
adequate housing, recreation and work conditions
SECONDARY LEVEL
Focus on early identification of health
problem and prompt intervention to
alleviate health problems.
Includes prevention of complications and
disabilities.
Example
Screening surveys
Encouraging regular medical and dental
examination
Teaching self-examination for breast and testicular
cancer
Assessing growth and development of children
Maintaining skin integrity, turning, positioning,
exercising client, ensuring adequate rest and
sleep, food and fluid intake, elimination,
administering medical therapies such as
medications
TERTIARY LEVEL
Begins after illness, when defect or
disability is fixed or determined to be
irreversible
Focus to help rehabilitate individuals and
restore hem to an optimal level of
functioning within the constraints of the
disability
Example:
Referring client to a support group
Teaching diabetic client to prevent complications
Referring client to rehabilitation center
BAHAVIOR ASSOCIATED WITH
LEVELS OF PREVENTION
PRIMARY
Quit smoking and avoid alcohol intake
Regular exercise and eat well balance diet
Reduce fat and increase fiber intake
Take adequate fluid intake
Maintain ideal body weight
Complete immunization program
Avoid over exposure to sunlight and wear
protective gear at work place
SECONDARY
Have annual health examination
Regular pap’s test for women
Monthly BSE for women (20 and up)
Sputum examination for tuberculosis
Anal stool guaiac test and rectal examination
for client 50 y.o. and above
TERTIARY
Self monitoring of blood glucose among
diabetic client
Physical therapy after CVA
Participate in cardiac rehabilitation after MI
COMMUNITY ORGANIZING
TOWARDS COMMUNITY
PARTICIPATION IN HEALTH
COMMUNITY
Comunitas – latin word for group of
individuals
A community is a group of people sharing
common geographical boundaries and/or
common values and interest/ its functions
within a particular socio-cultural context.
(Maglaya, 2004)
A community is a collection of people who
interact with each other and whose
common interest or characteristics give
them a sense of unity and belonging.
(Spradley & Allender, 1996)
Dimensions of a Community
LOCATION
POPULATION
SOCIAL SYSTEM
LOCATION
1. boundary of the community
2. placement of health services
3. geographical features
4. climate
5. plants and animal (ecosystem)
6. human-made environment
POPULATION
1. size
2. density
3. composition\rate of growth and decline
4. cultural characteristics
5. social class
6. mobility
SOCIAL SYSTEM
health welfare
family political
economic recreational
education legal
region communication
Classifications of a community
URBAN
RURAL
SUB - URBAN
URBAN
city
high density area
socially heterogeneous population
complex structure
complex interpersonal social relations
non-agricultural occupation
RURAL
town - province
low density area
having simple life
close family ties
people usually spend time in farming and
fishing for foods
SUB - URBAN
suburbs
a combination of an urban and rural
community
thick population
heterogeneous with mixed family ties
Difference between Rural and
Urban Community
Criteria Rural Urban
2. Social relationship Strong and have close ties and interaction with Face to face contact but usually very casual
the community
4. Social structure No significant difference of wealth, more or There is very wide range of income
less there is even distribution of wealth distribution; few are rich and majority of the
people belong to a lower income
5. Social institution Not very specialized; less in membership; Highly specialized; wide scale institution;
small scale institution more membership
Population Size
Population Composition
Age distribution
Sex ratio
Population pyramid
Median age
Age dependency ratio
Other characteristics
Occupationalgroups, Economic group,
Educational attainment, Ethnic group
Population Distribution
Urban – Rural
Crowding Index – indicates the ease by
which a communicable disease can be
transmitted from one host to another
susceptible host
Population Density – determine the
congestion of the area/place
Vital statistics
The application of statistical
measurements to vital events such as
births, deaths and common illness that is
utilized to gauge the levels of health,
illness and health services of a
community.
Fertility rate
Crudebirth rate
General fertility rate
Mortality rates Morbidity rates
CDR Prevalence rate
Specific mortality rates Incidence rate
Infant mortality rate
Neonatal mortality rate
Post-neonatal rate
Maternal mortality rate
HEALTH INDICATORS.
A list of information determined the
health of a particular community
particularly the population.
TYPES OF HEALTH INDICATORS
CBR – Crude Birth Rate
CDR – Crude Death Rate
IMR – Infant Mortality/Morbidity Rate
MMR – Maternal Mortality/Morbidity Rate
NDR - Neonate Death Rate
IMPORTANCE/IMPLICATION OF
HEALTH STATISTICS
Itis a tool in planning, implementation
and evaluating health programs.
Serves as indexes of the health
condition obtaining in a community or
population group.
Provide variables due as to the nature
of health services or action needed.
Serves as basis for determining the
success or failure of such services or
actions.
Crude Birth Rate (CBR )
Refers to the number of live birth/1000
population (fertility rate).
= (250/550) x 1,000
= 454 / 1,000 population
= (15/250) x 1,000
= 0.06/ 1,000 population
= (7/250) x 1,000
= 0.028 / 1,000 population
Key Approach
PRIMARY HEALTH CARE
Levels of Health Care
Health Promotion Disease Prevention
Individual wellness Primary
Family wellness Secondary
Community wellness Tertiary
Environmental Focus on screening
wellness Case finding
Contact tracing
Social wellness
Multi-phasing screening
surveillance