KEY POINTS IN COMMUNITY HEALTH NURSING

Some test taking techniques:

A-ssimilate essential principles in the care of patients in the
community
These principles may include:
1. have a purpose or objective when conducting home visit
2. plan ahead
3. priority should be given to the recognized needs of the family
4. there is no definite rule as to the frequency of a home visit
5. frequency of home visit should take into account, the physical,
psychological and educational needs of the individual and family
6. the initial step in conducting a home visit is to GREET the client and
introduce yourself
7. soiled articles with discharge should be boiled in water 30 minutes before
laundering
B- ag Technique
- steps which are carried out by the nurse to facilitate the
performance of nursing procedures with ease and deafness
Remember the:
Bag and its contents must be protected from any possible contamination
Always wash your hands to prevent the spread of infection
Gather all necessary articles and supplies to answer emergency needs
Note: blood pressure apparatus and stethoscope are carried
separately
Consider the following principles:
1. prevention of contamination
Note: place waste paper bag outside the work areas
2. protection of the caregiver
Note: clean and alcoholize all articles after use
3. make articles readily accessible
Note: place the articles in one corner of the work area
4. make follow-up care
Note: set the date and time for the next visit
C- ommunity Based Rehabilitation Program
the goal of this program is the improvement of quality of life and
productivity of disabled persons
R.A 7277, Magna Carta for Disabled Persons, serves as the legal basis of
the program
The components of the program include: social preparations, services
preparation, training, information, education and communication and
monitoring, supervision and evaluation

 The VISION of the Department of Health is: health for all Filipinos
The MISSION of the Department of Health is: Ensure accessibility of
health care to improve the quality of life of all Filipinos especially the
poor
The basic principles to achieve improvement in health include:
E nsure universal access to basic health services
E pidemiological shift from infectious to degenerative disease must
be managed
E nhance the performance of health sector
E nsure the priotization of health and nutrition of vulnerable groups
The primary strategies to achieve health goals include:
S upport for frontline health workers and to local system
development
A ssurance of health care
I ncreasing investment for primary health care
D evelopment of national standard and objectives for health
Primary health Care (PHC), according to the World Health organization
is an essential health care made universally accessible to individuals and
families in the community by means acceptable to them through their full
participation and at a cost that the community and country can afford at
every stage of development
The goal of PHC is health for all Filipinos and Health in the hands of
the people by the year 2020
Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of
PHC
The first international conference on primary health care was held in
Alma, Ata, USSR on September 6-12, 1978 sponsored by the WHO and
UNICEF
The framework for meeting the goal of primary health care is
organizational strategy, it calls for among communities, private and
government agencies with the end view of health development
The four cornerstone/pillars in primary health care includes:
1. active community participation
2. intra and inter sectoral linkages
3. use of appropriate technology
4. support mechanism made available
The expanded program on immunization aims to reduce the morbidity
and mortality among infants and children caused by the six childhood
immunizable diseases. It was launched in July 1976.
P.D. 996 (September 16, 1976) provides for compulsory basic
immunization for infants and children below 8 years of age. The EPI
program is based on epidemiological situations.
Presidential proclamation no. 147 (March 3, 1993) declares April 21
and May 19, 1993 and every third Wednesday of January and February
thereafter for two years as National Immunization Days.
R.A. 7846 (December 30, 1994) requires compulsory immunization
against hepatitis B for infants and children below 8 years old

 the ultimate goal of promotion of reproductive health is QUALITY OF

LIFE. The focus of the Philippine framework of the program is
Reproductive Health status in terms of, its elements. The ten elements
of Reproductive Health includes:
1. maternal and child health and nutrition
2. family planning
3. prevention and management of abortion complications
4. prevention and treatment of reproductive tract infection (RTIs)
including STDs, HIV and AIDS
5. education and counseling on sexuality and sexual health
6. breast and reproductive tract cancers and other gynecological
conditions
7. mens reproductive health
8. violence against women
9. prevention and treatment of infertility and sexual disorders
10. adolescent reproductive
the goal of the 2000 Nutritional Guidance for Filipinos is the
improvement of nutritional status, productivity and quality of life of the
population through adoption of desirable dietary practices and healthy
lifestyle. An example is the exclusive breastfeeding of infants from
birth to 4-6 months and the use of iodized salt.
The use of fluoride in the prevention of tooth decay is carried out by
making four application of fluoride about a week apart among children
who are aged 3, 7, 10 and 13 because at these ages new teeth have
erupted
The goal for health care and services for older persons is to provide a
longer disability-free life. This is carried out through a holistic care
approach
To reduce the blindness prevalence rate in the Philippines, the prevention
of blindness program was conceived. It is subdivided into four programs
namely, cataract program, primary eye care, vitamin A deficiency program
and other eye care program
The goals of the mental health program include: promotion of mental
health, decreased health-related effects of stressful lifestyle and
reduction of prevalence of mental ill health and disorders in the
Philippines
The Sentrong sigla movement aims to promote availability of quality
health services in health centers and hospitals and to make these
services accessible to every Filipino
Sang Milyong Sepilyo is a strategy for social mobilization of Dental
health program. It aims to emphasize the importance of oral health in
relation to total body health to increase public awareness on the
prevention of common dental diseases

D- OH PROGRAMS
D OH-

ental health Program

steoporosis prevention
ealth education and Community Organization

PROGRAMS-

rimary Health Care

eproductive health
lder Persons health Services
uidelines for Good Nutrition
espiratory Infection control
ccupressures
aternal and Child care
entrong Sigla Movement

E- pidemiology
Systematic and scientific study of the distribution patterns and
determinants of health, disease and condition for the purpose of
promoting wellness and preventing disease conditions
Basic concepts that guide epidemiological study include: biostatistics,
aggregate at risk, the natural life history of a disease, levels of
prevention, host-agent-environment relationships, multiple causation,
person-place-time-relationships
When monitoring incidence of infectious disease, the term used to
distinguish relative frequency in time and space include the following:
Sporadic presence of occasional cases of the disease
Endemic constant long-term presence of the disease
Epidemic presence of the disease at a much higher frequency over a short
period of time
Pandemic presence of a disease in many countries in a relatively short
period of time
Effective implementation of the epidemiological process requires a
multi disciplinary approach
A community health nurse must apply the principles of epidemiology in
order to provide preventive services to the community
Community health nurses participate in may epidemiological activities
like: case finding, health teaching, counseling and follow up essential
to the prevention of diseases and other conditions

F- ormulas for Mortality and Morbidity Statistics

CRUDE BIRTH RATE (CBR) a measure of one characteristics of the
natural growth or increase of a population
CBR= total number of live births registered in a given calendar year x 1000
Estimated population as July 1 of same year
CRUDE DEATH RATE (CDR) a measure of one mortality from all causes
which may result in a decrease of population
CDR= total number of deaths registered in a given calendar year x 1000
Estimated population as of July 1 of same year
INFANT MORTALITY RATE (IMR) measure the risk of dying during the
1st year if life
IMR= total number of deaths under 1 year of age registered
in a given calendar year
x 1000
total number of registered live births of same calendar year

MATERNAL MORTALITY RATE (MMR) it measures the risk of dying

from causes related to pregnancy, childbirth and puerperum
MMR= total number of deaths from maternal causes registered
For a given year
x 1000
total number of live births registered of same year
INCIDENCE RATE (IR) measures the frequency of occurrence of the
phenomenon during a given period of time. Deals only with new cases
IR= no of new cases of a particular disease registered
During a specified period of time
Estimated population as of July of same year

x 100, 000

PREVALENCE RATE (PR) measures the proportion of the population which

exhibits a particular disease at a particular time. Deals with total (old and
new) number cases
PR= no of new and old cases of a certain disease registered
At a given time
x 100
Total no of persons examined at same year given time

K- ey Points to EPI

A fully immunized child should have received one (1) dose of BCG,
three (3) doses of DPT, three (3) doses of OP, three (3) doses of
hepatitis B and one (1) dose of measles, before the childs birthday
Moderate fever, malnutrition, mild respiratory infection, cough,
diarrhea and vomiting are not contraindications to vaccination
DPT2 or DPT3 is not given to a child who has had convulsion or shock
within 3 days of the pervious dose
BCG vaccine is not given to a child with clinical AIDS
Measles and polio vaccines are most sensitive to heat

Vaccine

ADMNISTRATION OF VACCINES
Dose
Route
of Site
of
Administration
administration

BCG

Infant-

DPT,
HEPATITIS B
POLIO

MEASLES
TETANUS
TOXOID

School
entrance0.5 ML

Intradermal

Right
deltoid
region of the arm

age Intradermal

Left
deltoid
region of the arm
Upper,
outer
portion of the
thigh
Mouth

Intramuscular

2
drops,
or Oral
depending
on
manufacturers
instructions
0.5 ml
Subcutaneous
0.5 ml

Deep
Intramuscular

Outer Part of the

Upper arm
Deltoid region of
the upper arm

K- ey Points in Vaccine Administration

BCG- lay the syringe and needle almost flat along the childs arm
- if the vaccine is injected correctly into the skin, a flat wheal
with the surface pitted like an orange peer will appear at the injection
site

OPV if necessary open the childs mouth by squeezing the cheeks

gently between your fingers to make lips point upwards
- put drops of vaccine straight from the dropper onto the childs
tongue but do not let the dropper touch the childs tongue
- if the child spit out the vaccine, give another dose

HEPA and DPT the best injection site is the outer part of the
childs midthigh
- ask the mother of the child to hold the childs legs

MEASLES the best injection site is on the outer side of the upper
arm

TETANUS TOXOID the best injection site for a woman is the outer
side of the left upper arm

Vaccine Dose
TT1
TT2
TT3
TT4
TT5

Timing of Vaccination
5-6 months of pregnancy
1 month/ 4 weeks after TT1
at least 6 months later
at least 1 year later
at least 1 year later

Note: TT1 gives initial protection, TT2 provides 3 years protection for
the mother, TT3 provides 5 years protection, TT4 provides 10 years
protection and TT5 provides lifetime protection of the mother

Bag Technique
- a tool making use of the public health bag through which the nurse
during the visit can perform nursing procedures with ease and deftness,
saving time and effort at the end in view of rendering effective nursing
care
- PUBLIC HEALTH BAG essential and indispensable equipment of the
public health nurse
- principles: should minimize if not totally prevent the spread of
infection: should save time and effort
- special consideration: hand washing
- content of the bag: Bp apparatus and stethoscope are carried
separately; medicines also include betadine, 70% alcohol, benedicts
solution
- place waste paper bag outside of work area to prevent contamination of
clean area

CARE OF THE OLDER PERSON

- first cause of morbidity among the 50+ years old: influenza
- top cause of mortality among the 60+ years old: Diseases of the heart
- common health problems: difficulty in walking, difficulty in chewing,
impaired vision in at least one eye, hearing problem
- goal: A longer disability free life
- Resolution 46: the UN principle for older persons to add life to years
that have been added to life

COMMUNITY HEALTH NURSING:

- Goal: promotion of the clients optimum level of functioning through
teaching and delivery of care
- Philosophy: based on the worth and dignity of man
- the primary focus of CHN practice is HEALTH PROMOTION
- community health nurse are generalists in terms of their practice
- family is the unit of service
- HEALTH TEACHING is the primary responsibility of the community
health nurse

CHN ROLES OF THE NURSE:

- Clinician: focus on the health of individuals in the larger context of the
community
- Advocate: advocates self-care, peoples ability to be active participants
in their own health, and self-determination, the right to make their own
decisions
- Collaborator: brings together strengths and resources of people
involved toward a common goal
- Counselor; key tasks include listening and providing feedback and
information
- Educator: provides skills, knowledge and attitudes that the people need
to make appropriate choices or decisions
_ Hospice care: providing care skills in a home or other setting and
balancing the clients needs

COMMUNITY ASSESSMENT:
- process of examining the community in collaboration with the community
members to develop strategies that improve health and quality of life for
the community
- community competence refers to the communitys ability to identify
needs, achieve working consequence and agree and work together to meet
goals
- three dimensions include: status, structure and process
- status- information about morbidity and mortality, life expectancy,
crime rates and education
- structure socioeconomic, age, gender, resources
- process how the community operates and functions as a whole

CHN CLINIC VISIT:

- PRE-CONSUATION VISIT: clinical history taking, vital sings, physical
assessments, laboratory exams and documentation
- MEDICAL EXAMINATION: ensure privacy, safety and comfort of the
patient throughout procedure

- POST-CONSULATION: explain findings and needed care, refer as

needed, make appointment for nest clinic/ home visit

COMMUNITY ORGANIZING:
- a continuous of awareness building, organizing and mobilizing community
members towards community development
- phases of activities:
PRE-ENTRY- preparation of the staff
- site selection
ENTRY PHASE integration with the community
- courtesy calls, information campaigns, identification
of potential leaders
CORE-GROUP FORMATION AND MOBILIZING
- integration with the core group
ORGANIZATIO- BUILDING
- organizing barrio health committee, setting up the community
organization
CONSOLIDATION AND EXPANSION PHASE
- networking and establishing linkages, implementation of
livelihood-projects and developing secondary leaders

DENTAL HEALTH PROGRAM:

- vision: a lifetime oral health and no tooth decay for the nest
generations
-objective: to prevent and control dental diseases and conditions
- Sang milyong Sepilyo- project for social mobilization of dental health
program
DEPARTMENT OF HEALTH:
- Vision: health for all filipinos
- mission: enhance accessibility and quality of health care to improve the
quality of life of all Filipinos, especially the poor
- basic principles to achieve improvement of health
1. ensured universal access to basic health services
2. health and nutrition of vulnerable groups must be prioritized
3. epidemiological shift from infection to degenerative diseases must
be managed
4. performance of the health sector must be enhanced
- primary strategies:
1. assurance of health care
2. increased investment for primary health care
3. development of national standards and objectives for health
4. support to local health system development and frontline health
workers