COMMUNITY HEALTH NURSING What is a community ? - a group of people with common characteristics or interests living together within a territory or geographical boundary - place where people under usual conditions are found What is community health ? - part of paramedical and medical intervention/approach which is concerned on the health of the whole population - aims: 1. health promotion 2. disease prevention 3. management of factors affecting health What is nursing ? nursing ? - assisting sick individuals to become healthy and healthy individuals achieve optimum wellness. What is Community Health Nursing ? Nursing ? “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” - Maglaya, Maglaya, et al BASIC PRINCIPLES OF CHN • • • • •
COMMUNITY is COMMUNITY is the patient in CHN. FAMILY is FAMILY is the unit of care. The The cli clien entt is is con consi side dere red d as as an an ACTIVE partner NOT partner NOT PASSIVE recipient of care. The goal of goal of CHN is achieved through MULTI-SECTORAL EFFORTS. CHN is a part of health health care system system and and the the larger larger human human services services system. system.
HEALTH TEACHING is a primary responsibility of a CHN nurse • CHN must be availa available ble to to all all regardle regardless ss of race, race, creed creed and and socioe socioecono conomic mic status. • The CHN CHN Nurse Nurse make makes s use of of availa available ble comm communi unity ty healt health h resour resource ces. s. • There There must must be provis provision ion for period periodic ic eval evaluat uation ion of CHN CHN serv service ices. s. Roles of the PUBLIC HEALTH NURSE • • • •
CLINICIAN, who is a health care provider, taking care of the sick people at home or in the RHU HEALTH EDUCATOR, who aims towards health promotion and illness prevention through dissemination of correct information; educating people FACILITATOR, who establishes multi-sectoral linkages by referral system SUPERVISOR, who monitors and supervises the performance of midwives
FIVE FOLD MISSION OF CHN 1. 2. 3. 4. 5.
Heal Health th pro promo moti tion on Heal Health th prot protec ectio tion n Heal Health th bala balanc nce e Dise Diseas ase e prev preven enti tion on Soci Social al just justic ice e
COMMUNITY HEALTH NURSING PROCESS A. Asse Assess ssme ment nt 1. Init Initia iate te con conta tact ct 2. Demons Demonstra trate te caring caring attitu attitude de 3. Mutual Mutual trust trust and and confid confidenc ence e 4. Collec Collectt data data from all all possib possible le sourc sources es 5. Identi Identify fy health health proble problems ms Categories: Health deficit- occurs deficit- occurs when there is a gap between actual and achievable health status. Health threats- conditions threats- conditions that promote disease or injury and prevent people from realizing their health potential. Foreseeable crisis- includes crisis- includes stressful occurrences such as death or illnesses of a family member. Health need- exists need- exists when there is a health problem that can be alleviated with medical or social technology. Health problem- is problem- is a situation in which there is a demonstrated health need. 6. Assess coping ability. 7. Analyze and interpret data. B. Planning 1. Prio Priori riti tize ze need needs. s. 2. Establish Establish goals goals based based on needs needs and and capabiliti capabilities es . 3. Construct Construct action action and and operationa operationall plan. plan. 4. Develo Develop p evalua evaluatio tion n parame parameter ters. s. C. Implementation of Planned Care 1. Put Put pla plan n int into o act actio ion n 2. Coordin Coordinate ate care/ care/ servic services es 3. Utiliz Utilize e comm communi unity ty resour resources ces 4. Delegate, Delegate, superv supervise ise and and monitor monitor service services s provided provided 5. Document Document response responses s to to nursin nursing g action actions s D. Evaluation of care and services rendered 1. Moni Monito torr outc outcom omes es 2. Perf Perfor orma manc nce e appra apprais isal al 3. Estima Estimate te cost cost bene benefit fit ratio ratio 4. Asse Assess ssme ment nt pro probl blem ems s 5. Identi Identify fy neede needed d alte alterat ration ions s 6. Revi Revise se plan plan as need needed ed
MODERN CONCEPT OF HEALTH - Refers to the optimum level of individuals, families and communities FACTORS AFFECTING OLOF: BHHEPS • Behavioral • Heredity • Heal Health th Care Care deli delive very ry syst system em • Environment • Political • Socio-economic
TEN DETERMINANTS OF HEALTH 1. Gender 2. Genetics 3. Education 4. Emplo mploym yme ent 5. Culture 6. Heal Health th serv servic ices es 7. Income 8. Pers Person onal al beha behavi vior or 9. Phys Physic ical al envi enviro ronm nmen entt 10.Social support network COMMUNITY HEALTH NURSING GOAL: To raise the health of the citizenry. Main activity: Health teaching (health promotion) PHILOSOPHY: Worth and dignity of man. DEPARTMENT OF HEALTH VISION: The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines. MISSION: NEW- guarantee equitability, sustainability and quality of life for all Filipinos especially for the poor and shall lead the quest for excellence in heath OLD: ensure accessibility and quality of life, for all Filipinos especially the poor GOAL: Health Sector Reform Agenda (HSRA) Framework for implementation of HSRA: FOURmula ONE for Health (BEM ) GOALS of FOURmula ONE for Health: (BEM 1. Bett Better er heal health th outc outcom omes es 2. Equita Equitable ble hea health lth care care financ financing ing 3. More More respo responsi nsive ve heal health th syst systems ems FOUR elements of the strategy: • Hea Health lth Care are Fina inancin ncing g • Health lth regulation • Hea Health lth ser serv vice ice de delive livery ry • Good ood he health alth gove overna rnance nce ROLES OF DOH (LEA (LEA)) 1. Lead Leader ersh ship ip in in Hea Healt lth h 2. Enable Enablerr and and Capac Capacity ity Buil Builder der 3. Admini Administr strato atorr of specif specific ic servi services ces
PRIMARY HEALTH CARE GOAL: Health for all Filipinos in the year 2000 and in the hands of the people in the year 2020 MISSION: Strengthen health care delivery system 5 STAKEHOLDERS OF HEALTH 1. 2. 3. 4. 5.
LGU DOH Philhe Philhealt alth h Insuran Insurance ce Corpor Corporati ation on Comm Commun unit itie ies s NGO’s
NURSING ROADMAP Originated 2007 - Transf Transform ormati ation on Progra Program m of Nursin Nursing g Profes Professio sion n - adopted adopted from Public Public governanc governance e system system (PGS), (PGS), as instituted instituted by Institu Institute te for for Solidarity in Asia (ISA)
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June 5, 2008 - signing of the nursing roadmap by the COORDINATING BODY FOR GOOD GOVERNANCE OF THE NURSING PROFESSION (CBGGNP) and PHILIPPINE NURSNG ORGANIZATION (PNA) Association of Deans of Philippine College of Nursing ADPCN ( ADPCN ))- minor player for nursing roadmap. VISION: By 2030, the Philippines shall be the lead in promoting professional nursing in the Asia Pacific Region. MISSION: We, the Filipino nurses are committed to provide society with professional nursing service through innovations in education and training, research and management that will improve the well-being and quality of life BALANCED SCOREBOARD
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implementation of nursing roadmap Developed by OHNAP for executing the Nursing Roadmap
4 BROAD PERSPECTIVES: 1. Lear Learni ning ng and and Gro Growt wth h 2. Inte Intern rnal al proc proces esse ses s 3. Cust Custom omer er pers perspe pect ctiv ives es 4. Fina Financ ncia iall pers perspe pect ctiv ives es STRATEGIC OBJECTIVES DSL GG 1. 2. 3. 4. 5.
Dyna Dynami mic c lead leader ers s Standards rds Good Good gov gover erna nanc nce e Linkages Grow Growth th and and Produ Product ctiv ivity ity
NATIONAL HEALTH PLAN
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The blueprint defining the the country’s: PPST PROBLEMS, PROBLEMS, POLICY THRUSTS, THRUSTS, STRATEGIES and THRUSTS Caters from 1995-2020 A long long term term dir direc ectio tiona nall plan plan for for hea health lth..
GOAL: To enable the Filipino to achieve a level of health that is accessible. OBJECTIVE: Equity- Achieve “ Health for all by year 2020” PRIMARY HEALTH CARE- strategy of NHP MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” • refers to the the 23 programs, programs, projects, projects, activities activities of the the DOH DOH for the year 1993, 1993, which marks the beginning of its journey towards DOH vision “Health for more in ‘94” • activities activities in 1994 1994 focused focused on on Cancer Cancer preventio prevention, n, Reprod Reproductiv uctive e health health,, • Mental Mental health health and mainte maintenan nance ce of of a safe safe environ environmen mentt “Health Focus in 1995”… “Think Health, Health Link” In lieu of “Five of “Five in ‘95”, DOH characterized what a… Healthy __________________ should be: BARRIO► Residents actively participate in attaining good health; they are • PART ARTNER NERS in in hea healt lth h car care e • Highlight Pr Project: BOTIKA SA PASO CAMPAIGN Goal : to maintain herbal plants in pots for family use CITY ► The physical environment in the workplace, streets, and public places promotes health, safety, order, and cleanliness through structural manpower support • Health-rel Health-related ated Strategies: Strategies: Construct Construction ion of well-mainta well-maintained, ined, income-ge income-generat nerating ing public toilets; designation of a “Pook-Sakayan, “Pook-Sakayan, Pook-Babaan” MARKET ► adequate water supply ► proper drainage ► well-maintained toilet facilities ► proper garbage and waste disposal is observed by vendors ► cleanliness maintained ► affordable quality foods ► has a well-organized and honest market system HOSPITAL ► A “CENTER OF WELLNESS” ► Promotes preventive care ► provides clean and adequate resources, affordable and accessible services ► Patient-centered ► Governed by competent health team members and personnel
SCHOOL ► Health instructions provided through classroom/extra-curricular activities ► Maintains adequate, basic health services to both pupils, teachers, and other personnel Sample School Initiative : Little Doctor Program - outstanding students are chosen yearly on the bases of their healthy conditions and lifestyles STREET ► Well-maintained roads and public waiting areas ► Well-marked traffic signs and pedestrian crossing lane and visible street names ► Clean and obstruction-free sidewalks ► With minimal traffic problems ► With adequate strict law enforcement Project: Pook-Tawiran (Kapag ikaw ay nahuli, walang sisihan) Goal : To promote and reorient people especially erring pedestrians on the use of pedestrian crossings. PRISON ► Physical Environment: clean, safe detention place with adequate facilities ► Psychosocial Environment: services address the mental, spiritual, physical, social and economic needs of inmates; has an atmosphere that actively promotes JUSTICE, PEACE, REHABILITATION and a HEALTHY LIFESTYLE
PRIMARY HEALTH CARE • PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health development. It is a strategy aimed to provide essential health care that is: • Community-based • Accessible • Part and parcel of the total socio-economic development effort of the nation • Acceptable • Sustainable at an affordable cost. Framework People’s Empowerment and Partnership is the Key Strategy to achieve the goal, “Health For all Filipinos by the t he year 2000 And Health in the Hands of the People by the year 2020”
4 PILLARS OF PHC: (MAPS) (MAPS) 1. MultiMulti-sec sector toral al approa approach ch 2. Appr Approp opri riat ate e tech techno nolo logy gy 3. Part Partic icip ipat atio ion n activ active e 4. Suppo Support rt system system availa available ble
3 LEVELS OF PREVENTION PRIMARY LEVEL Health Promotion and Illness Prevention
SECONDARY LEVEL TERTIARY LEVEL Prevention Prevention of Disability,etc ofComplications thru EarlyDx and Tx
Provided at – ► Health care/RHU ► Brgy. Health Stations ►Main Health Center ►Community Hospital and Health Center ►Private and Semiprivate agencies
When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals
When highlyspecialized medical care is necessary ► referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level hospitals
TYPES OF PRIMARY HEALTH WORKERS Village/Grassroots He Health Wo Workers
EXAMPLE
CHARACTERISTICS
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Trained Community Health worker; • health Au Auxiliary volunteer; • Traditional Bir Birth Attendant • •
•
Initial link, 1st contact of the Community Work in in liaison w/ w/ th the local health service workers Provide el elementary curative preventive health care measures
Intermediate Le Level Health Pe Personnel of First-Line Hospitals •
• • •
General Medical Practitioners Public He Health Nurses Midwives
1st source of professional health care • Attend to health problems beyond the competence of village health Workers • Provide support to the frontline health workers in terms of supervision, supervision, training, referral services and supplies thru linkages with other sectors
• • •
•
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Physicians with specialty area Nurses Dentists
Establish close contact with the village and intermediate level health workers to promote the continuity of acre from hospital to community to home Provide back-up health services for cases requiring hospital or diagnostic facilities not available in health care.
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS? Acronym: ELEMENTS + DAM • Educ Educat atio ion n of pre preva vaili iling ng Hea Healt lth h Prob Proble lems ms • Locall Locally-e y-ende ndemic mic Diseas Disease e Prev Preven entio tion n and and Contro Controll • Expa Expand nded ed Prog Progra ram m of Immu Immuni niza zati tion on • Matern Maternal al and Child Child Health Health and Family Family Planni Planning ng • Enviro Environme nmenta ntall Sanit Sanitati ation on and Safe Safe Wate Waterr Supp Supply ly • Nutr Nutrit itio ion n and and Food Food Supply pply • Treatment Treatment of Communicab Communicable le & Non-commun Non-communicabl icable e Diseas Diseases/ es/ Condition Conditions s • Supply Supply and and Prop Proper er use use of Essen Essentia tiall Drugs Drugs and and Herbal Herbal Medi Medicin cine e • Dent Denta al Hea Healt lth h Pro Prom motio otion n • Access Access to and and use use of of hospi hospital tals s as Center Centers s of Wellne Wellness ss • Ment Mental al Healt ealth h Pro Promo moti tion on MILLENIUM DEVELOPMENTAL GOALS -Formulated in the year 2000 by the UN general assembly. PEGCMMEG • Pove Povert rty y erad eradic icat atio ion( n(20 2015 15)) • Education • Gender equality • Chil Child d mort mortal alit ity y to to dec decre reas ase e • Mala Malari ria/ a/AI AID DS to to com combat • Maternal health • Envi Enviro ronm nmen entt sus susta tain inab abil ilit ity y • Glob lobal pa partnersh rship Expanded Program on Immunization Goal: morbidity and mortality reduction of immunizable diseases • LEGAL BASIS- PD 996-Compulsary, Basic Immunization for children 8 years old and below (0-8 y/o), thus covers 2 age groups - infants WEDNESDAY- designated as IMMUNIZATION DAY ELEMENTS OF EPI: • Target setting • Info Inform rmat atio ion, n, educ educat atio ion n and com commu muni nica cati tion on • Cold Cold cha chain in log logis isti tic c mana manage geme ment nt • Surv Survei eill llan ance ce and and ev evalua aluati tion on PRINCIPLES IN VACCINATING CHILDREN • •
•
•
•
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It is safe and immunologi immunologically cally effective effective to adminis administer ter all all EPI EPI vaccines vaccines on the the same day at different sites of the body. The vaccinati vaccination on schedule schedule should should not be restarted restarted from he beginnin beginning g even even if the interval between doss exceeded the recommended intervals by months or years. Giving Giving doses doses of of a vaccine vaccine at less less than the recommend recommended ed 4 weeks interval interval may lessen the antibody response. Lengthening the interval between doses of vaccine leads to higher antibody levels. No extra extra dose doses s must must be given given to to childr children/ en/mot mother her who who miss missed ed a dose dose of of DPT/HB/OPV/TT. The vaccination must be continued as if no ti me had elapsed between doses. It is safe and effect effective ive with with mild mild side side effects effects after vaccinati vaccination. on. Local Local reacti reaction, on, fever and systemic symptoms can result as part of the normal immune response. Use one syring syringe e one one needl needle e per per child child duri during ng vacc vaccina inatio tion. n.
Schedule: • • • •
At birth: BCG 1 ½ mon month ths: s: Fir First st dos doses es of DPT DPT,, Hep Hep B, OPV OPV 2 ½ mon month ths: s: Sec Secon ond d dos doses es of DPT DPT,, Hep Hep B, OPV OPV 3 ½ mon month ths: s: Thi Third rd dos doses es of DPT DPT,, Hep Hep B, OPV OPV
Tetanus Toxoid: • First Pregnancy Pregnancy:: TT1TT1- 5th 5th to 6th mo of of pregnan pregnancy, cy, after 4 weeks weeks TT2 TT2 (3 (3 years years immunity) • Second Second Pregna Pregnancy: ncy: TT3 (1st booster booster dose) dose) – 5th 5th to 6th (5 (5 years years immunity) immunity) • Third Pregnancy: Pregnancy: TT4 (2nd booster booster dose) dose) – 5th 5th to 6th (10 years years immunity) immunity) • Fourth Fourth Pregn Pregnanc ancy: y: TT5 TT5 (3rd boos booster ter dose) dose) – 5th 5th to 6th (life (life-lo -long ng long long immunity) Administration: • • • • • • •
BCG: (infants) 0.05 ml intradermal (school entrants) 0.10 ml intradermal DPT: 0.5 ml intramuscular Hepa B: 0.5 ml intramuscular OPV: 2 drops per orem Measles: 0.5 ml subcutaneous subcutaneous Tetanus toxoid: 0.5 ml intramuscular
TARGET-SETTING •
involv involves es the the calc calcula ulatio tion n of the eligib eligible le popu populat lation ion.. “Eligible population consists of any group of people targeted for specific immunizations due to their susceptibility to one or several of the EPI diseases.”
VACCINE COMPUTATION: I. Compute for the eligible population= Total population x : Infant/school age= 0.03 Pregnant woman= 0.035 Polio outbreak= 11.5 Measles outbreak= 14.5 II. Determine Annual Dose-doses required in a year for complete coverage AD = EP x BCG- 1 OPV-3 HB-3 MEASLES-1 TT-5 III. Determine Wastage Allowance Wastage Dose = Annual Dose x % wastage allowance AD X BCG e, DPT/TT,OPV} 1.67 HB- 1.2 M-2 BCG I- 2.5
IV. COMPUTED ALLOWANCE= Wastage allowance # of recipients All vaccines are 20 except BCG E, MEASLES= 10 OPV=25 V. OVERALL TOTAL= CA X 1.25 After rounding off, always add add 1 COLD CHAIN A system used to maintain the potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. Principles: I. Storage Storage of vaccine should not exceed: • - 6 mos. @ the Regional Level • - 3 mos. @ the Provincial Level/District Level • - 1 mo. @ Main Health Centers (with refrigerators) • - not more than 5 days @ Health Centers (using transport boxes) Important points to remember: Arranging of stored vaccine vaccine according to : • Type • Expiration date • Duration ion of Storage • # of of times times they they have have been been brou brought ght out to the field field EPIDEMIOLOGY - Backbone in the prevention of the disease. - the study of occurrence and distribution of a disease as well as the distribution and determinants of health states or events in i n a specified population
The EPIDEMIOLOGIC TRIANGLE: Agent - the intrinsic property of microorganisms to survive and multiply in the environment to produce disease Host- ( intrinsic intrinsic factors)factors)- influences exposure, susceptibility or response to agents Environment- ( extrinsic extrinsic factors)- influences the existence of the agent, exposure, or susceptibility to agent.
OUTLINE PLAN FOR EPIDEMIOLOGICAL INVESTIGATION 1. Establish Establish fact of the the presen presence ce of of epidemi epidemic c • Verify diagnosis diagnosis-- do clinical clinical and laboratory laboratory studies studies t confirm confirm the data 2. Establish Establish time time and space space relations relationship hip of the the disease disease • Are the cases cases limited limited to or conce concentrate ntrated d in any particular particular geographi geographical cal subdivision of the affected community? • Relation Relation of of cases cases by days days of onset onset to to onset onset of of the first known known casescases- maybe maybe done by days, week or months. 3. Relations to characteristic of the t he group of community • Relation Relation of of cases cases to age, age, group, group, sex, color, color, occupa occupation, tion, school school attend attendance ance,, past immunization • Rela Relati tion on to milk milk and and foo food d sup suppl ply y • Rela Relati tion on of of case cases s and and know known n carr carrie iers rs ifif any any
4. Correlation of all data obtained • Summarize Summarize the data clearly clearly with with the the aid of such such tables and charts charts which which are are necessary to give a clear picture of the situation • Build up the the case case for the the final final conclus conclusion ion carefully carefully utilizing utilizing all all the the evidenc evidence e available. STAGES OF A DISEASE: BACKBONE TO CONTROL A DISEASE • • • •
Incubation period- exposure to an infection to the appearance of the first symptom Prodromal periodperiod- from the appearance of the first symptom to the appearance of a pathognomonic sign Stage of illnessillness- a stage where the patient manifest most of the signs and symptoms ConvalescenceConvalescence- stage of recovery, r ecovery, and a gradual decrease of symptoms manifested
Patterns of Disease Occurrence • • • •
Epidemic-high Epidemic-high incidence of new cases of a specific disease in excess of the expected. EndemicEndemic- habitual presence of a disease. Sporadic- disease occurs every now and then. PandemicPandemic- global occurrence of a disease
National Epidemic Sentinel System (NESS) - hospital-based information system that monitors the occurrence of infectious diseases with outbreak potential. Why is there a need to investigate an outbreak? 1. Contro Controll and preven prevention tion measur measure e 2. Severi Severity ty and and risks risks to othe others rs 3. Rese Resear arch ch oppor opportu tuni niti ties es 4. Public Public,, politic political al and and legal legal conce concerns rns 5. Prog Progra ram m consi conside dera ratio tion n 6. training VITAL STATISTICS Refers to the systematic study of vita events events such as births, illnesses, illnesses, marriages, divorce, separation and deaths. RATE- the relationship between a vital event and those persons exposed to the occurrence of the said event RATIO- the relationship between two numerical quantities or measures of events without taking particular consideration to the time or place. USE OF VITAL STATTISTICS: 1. Indices Indices of the the health health and and illness illness status status of of the commun community ity 2. Serves Serves as the bases for for planning, planning, implementin implementing, g, monitoring monitoring and evaluat evaluating ing community health nursing programs and services SOURCES OF DATA: 1. Popu Popula lati tion on cens census us 2. Regist Registrat ration ion of vital vital data data 3. Heal Health th surv survey ey 4. Stud Studie ies s and and resea researc rche hes s
CRUDE OR GENERAL RATES- refers to the total living population SPECIFIC RATE- the relationship for a specific population class or group CRUDE BIRTH RATERATE- natural growth growth or increase of a population CBR- Total # of live births in a given calendar year Estimated population as July 1 of same year x 1,000 CRUDE DEATH RATE CDR- Total # of deaths in a given calendar year Estimated population as July 1 of same year
x 1,000
INFANT MORTALITY RATE- a good index of the general health condition of of a community. IMR- Total # of death under 1 year year of age registered in a given year Total # of live births of the same calendar year x 1,000 MATERNAL MORTALITY RATE- an index of the obstetrical care needed and received by women in a community MMR- Total # of deaths from maternal causes registered in a given year Total # of live births of the same calendar year x 1,000 FETAL DEATH RATE- measures pregnancy wastage FDR- Total # of FETAL deaths registered in a given year Total # of live births of the same calendar year x 1,000 NEONATAL DEATH RATE- an index of the effects of prenatal care and obstetrical management of the newborn NDR- Total # of deaths under 28 days days of age registered in a given year Total # of live births of the same calendar year x 1,000 SPECIFIC DEATH RATE SDR- Deaths in specific class or group registered in a given calendar year x 100,000 Estimated population as July 1 of same specified class or group of the sad year EXAMPLES: CSDR, ASDR, SSDR CSDR- # of deaths from a specific cause registered in a given calendar year Estimated population as July 1 of same year x 100,000 ASDR- # of deaths in particular age age group registered registered in a given calendar year year Estimated population as July 1 of same year x 100,000 SSDR- # of deaths in certain sex registered in a given calendar year Estimated population as July 1 of same year x 100,000 ATTACK RATE- a more accurate measure measure of the risk of exposure exposure AR- # of persons acquiring a disease # of exposed to same disease in same year x 100 INCIDENCE RATE- measures the frequency frequency of occurrence occurrence of the phenomenon phenomenon during a given period of time IR- # of new cases of particular disease during a specified period of time Estimated population as of July 1 of the same year x 100,000
PREVALENCE RATE PR- # of new and old cases of a certain disease disease during a specified period period of time Total # of persons examined at same given time x 100 CASE FATALITY RATIO- index of a killing power of a disease CFR- # of registered deaths from a specific disease for a given year # of registered cases from same specific disease in same year
x 100
FIELD HEALTH SERVICE INFORMATION SYSYTEM (FHSIS) A recording system that may give a picture about the accomplished accomplished indicators at the brgy. Community, district, provincial, regional and national levels. COMPONENTS: 1. Family Family Treatment Treatment recordrecord- the funda fundamenta mentall building building block block - the form or piece of paper upon which recorded the presenting symptoms or complaints of the patient 2. Target client list - to plan and carry out patient care and service delivery - to report services delivered 2. Tally/ Tally/ Reporting Reporting formsforms- only mechan mechanism ism through through which which date are routine routinely ly transmitted from one facility to another. Reports are submitted directly to the PROVINCIAL HEALTH OFFICE. TALLY/REPORTING FORMS FHIS/ E- deaths E-1- notification of death form E-2- Maternal death form E-3- Perinatal Death form FHSIS/M- monthly M-1- Monthly Field Health service Activity report M-2- Monthly natality report M-3- Monthly Mortality report M-4- Monthly laboratory report M-5- Monthly Dental report M-6- Family Planning Subsidized Surgical Procedure Report M-7- Monthly Social Hygiene Clinic Activity Report FHSIS/Q- Quarterly Q-1- Quarterly Field Health Service Activity Report Q-2- Quarterly Dental Facility Inspection Report Q3- Quarterly Environmental Health Activities Activities Q-4- Quarterly Reports of Malaria Control Activities Q-5- Drugs And Supplies Quarterly Status Report Q-6- Laboratory Supplies Quarterly Status Report DISEASES UNDER SURVELLANCE (NESS): Laboratory diagnosed: 1. Cholera 2. Hep Hepatit atitis is A 3. Hep Hepatit atitis is B 4. Malaria 5. Typh Typhoi oid d feve fever r
Clinically diagnosed: 1. DHF 2. Diph Diphth ther eria ia 3. Measles 4. Meni Mening ngoc ococ occa call dise diseas ase e 5. Neon Neonat atal al teta tetanu nus s 6. Non Non neo neona nata tall teta tetanu nus s 7. Pertussis 8. Rabies 9. Lept Leptos ospi piro rosi sis s 10.Poliomyelitis Under Surveillance system: 1. Poli Poliom omye yeli liti tis s 2. Measles 3. Matern Maternal al and and neon neonata atall tetan tetanus us 4. Paraly Paralytic tic shel shellfis lfish h poiso poisonin ning g 5. Firewo Fireworks rks and relate related d injury injury 6. HIV/AIDS
COMMUNITY ORGANIZING
COMMUNITY DIAGNOSIS -A process in which the PHN and the community are identifying community problems that will serve as basis in formulating community programs -It is derived and will be the bases for developing and implementing CHN intervention and strategies.
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COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
To bring about social - A PROCESS of enhancing community participation and and behavioral development to prepare people to changes, social organizations, ideology become the manager of their own and change agents are community in the future. needed. Often termed as EMPOWERMENT of building the capability of people for future community action.
COPAR Pre entry phase: Selection of Site 1. Unde Unders rser erve ved d comm commun unit ity y 2. Lack of health health services services in the the commun community ity 3. Poor Poor heal health th stat status us 4. Rela Relati tive ve pea peace ce and and ord order er 5. Accept Acceptab able le by by the the comm communi unity ty 6. No health health related organiz organization ations/pro s/programs grams conduc conducted ted in the place to prevent prevent duplication and competition Entry phase 1. Organi Organize ze core core grou group p criter criteria ia 2. Educ Educat ate e the the peop people le 3. Coll Collec ectt the the data data 4. Involve Involve the people people in the prioriti prioritizatio zation n of identified identified needs needs and proble problems ms Organization and Building phase 1. Comm Commun unit ity y orga organi niza zatio tion n 2. Elec Electi tion on of offi office cers rs Sustenance and strengthening phase Phase out
COMMUNITY ORGANIZING PARTICIPATORY PARTICIPATORY ACTION COMMUNITY ORGANIZING RESEARCH I. Pre- entry Community Analysis/ Diagnosis/ Mapping
II. Entry phase
Design and Initiation
ACTIVITIES 1. 2. 3. 4. 5. 6.
Area Area sele select ctio ion n Cont Contac actt per perso sons ns Cour Courte tesy sy call calls s Intr Introd oduc ucti tion on of self self Leade aders mee meet Agen Agenda da sett settin ing g
1. Family hosting 2. Core Core grou group p for forma mati tion on
III. Organization and Building Implementation phase IV. Sustenance and strengthening phase
Program maintenancemaintenanceConsolidation
Commitment Organization
V. Phase out
Dissemination/ Reassessment
How can I leave the people ? When to leave the people?
WHEN? • Change in attitude • Objectives meet • Resources maximized HOW? • Pull out intervention • Institutionalization • Consultancy services 10 MEDICINAL PLANTS: LUBBY SANTA Lagundi Sambong Ulasimang-Bato Ampalaya Bawang Niyog-niyogan Bayabas Tsaang gubat Yerba-buena Akapulko RA 8423: utilization of medicinal plants as alternative for high cost medications. Policies: 1. The indications/uses of plants 2. The part of the plant to be used 3. Preparation of a. Decoction e. oils b. Poultice f. ointment c. Infusion g. tincture d. Syrup h. Elixir
HERBAL MEDICINES COMMON NAME
SCIENTIFIC NAME
INDICATIONS
Lagundi
Vitex negundo
S- skin diseases A-aromatic bath R- rheumatism A- asthma, body aches aches H- headache, cough
Ulasimang bato
Peperonia pellucida
Gouty arthritis
Bawang
Allium sativum
Hypertension, toothache
Bayabas
Psidium guava
Mouthwash, wound wash, diarrhea
Yerba Buena
Mentha cordifolia
SARAH + menstrual pains, insect bites, headaches, body pans
Lagundi
Vitex negundo
S- skin diseases A-aromatic bath R- rheumatism A- asthma, body aches aches H- headache, cough
Ulasimang bato
Peperonia pellucida
Gouty arthritis
Bawang
Allium sativum
Hypertension, toothache
Bayabas
Psidium guava
Mouthwash, wound wash, diarrhea
Yerba Buena
Mentha cordifolia
SARAH + menstrual pains, insect bites, headaches, body pans
CHN PROCEDURES CLINIC VISIT I. Admission/Registration II. Waiting ti time III. Triaging a. IMCI b. Contro Controll of diar diarrhe rheal al dise disease ases s IV. Clinical evaluation a. Eval Evalua uate te the the c/c c/c,h ,hx, x, P.E P.E b. Eviden Evidenced ced based based practic practice/m e/medi edicin cine e c. Illness Illness,, treatm treatment ent and and prev prevent ention ion V. Laboratory test and other DX examinations a. Bene Benedi dict ct´s ´s tes testt b. Heat Heat and and acet acetic ic acid acid test test VI. Referral-2-way referral system VII. Prescription and Dispensing VIII. Health education
HEAT AND ACETIC ACID TEST
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Place 3-5 m of urine + 6-8 drops of heat + acetic acid solution then pre heat in bunsen burner Observe for precipitation or cloudiness Cloudy- + for protein (PIH)
BENEDICT’S TEST – determination of glucose content - Pour 3-5 ml of benedict’s solution + 6-8 drops of urine - Heat for 3 minutes in i n a bunsen burner RESULT: Blue- negative Green- trace (+1)-normal for pregnant woman Yellow- +2 Orange- +3 Red-+4 HOME VISIT- a nurse –family contact which allows the health worker to asssess the home and family situations in order to provide the necessary nursing care and health related activities PUROSES OF A HOME VISIT: 1. Give nursing nursing care care to the the sick, sick, postpartum postpartum mother mother and and her newborn newborn 2. Assess Assess the living living condition condition of the the patient patient and his family family and the health health practices 3. Give health health teachin teaching g regarding regarding the prevent prevention ion and control control of disease disease 4. Establish Establish close close relations relationship hip between between agencies agencies and and the public public for the promotion of health 5. Make use use of the inter-r inter-referra eferrall system system and to promot promote e the utilizati utilization on of community services PRINCIPLES OF A HOME VISIT • • • • •
Must Must have have a pur purpo pose se or obje object ctiv ive. e. Must Must use all all availa available ble info informa rmatio tion n about about the the patien patientt and his his famil family y Must Must give give prio priority rity to the the esse essenti ntial al nee needs ds of of the the famil family y The planning planning and delivery delivery must involve involve the individua individuall and and his his family family.. Must be flexible
IMPORTANT POINTS TO REMEMBER: 4 C’s + H 1. Contains Contains all the necess necessary ary articles, articles, supplies supplies and and equipment equipment to answer answer emergency needs 2. Cleaned Cleaned very often, often, supplies supplies replace replaced d and ready ready for use anytime. anytime. 3. Consider Consider the bag bag and its contents contents clean clean and sterile sterile,, while articles articles belongi belonging ng to the patient as dirty and contaminated. 4. Collection Collection of article article should should be conven convenient ient to the user, user, to facilitate facilitate efficien efficiency cy and avoid confusion, proper arrangement must be maintained. 5. Handwash Handwashing ing is done done as frequently frequently as as situation situation for, helps helps minimizin minimizing g and avoiding contamination of the bag and its contents.
STEPS IN CONDUCTING HOME VISIT I. II. III. IV. V. VI. VII. VIII.
Greet Purpose Health inquiry Bag placement Physical exa examination Health teaching Record Appointment
BAG TECHNIQUE PHN BAG- essential and indispensable equipment of a PHN PRINCIPLES OF BAG TECHNIQUE: 1. Minimize, Minimize, if not not prevent prevent the the spread spread of any any infectio infections. ns. 2. Saves Saves time and and effort in the performan performance ce of nursing nursing proce procedure. dure. 3. Show the the effectiven effectiveness ess of total total care of the individ individual ual and the family. family. 4. Variety Variety of ways should should be perform performed ed depending depending on on the agency’s agency’s policy. policy. PROCEDURE 1. Bag placement- L arm flexed @ 45°; not too close; close; not too far R arm- long, non folding black umbrella 2. Ask for basin of H2O or glass of water 3. Open/ secure towel/ get soap 4. Handwashing 5. Apron in- right side out 6. Articles out 7. Close CHN bag 8. Physical examination 9. Hand washing and clean articles 10. Articles in 11. Apron out- clean side out 12. Close CHN bag 13. RECORD 14. Setting up next schedule THERMOMETER TECHNIQUE Procedure: 1 cotton ball- dry 3 cotton ball- soap-soaked 3 cotton ball- water- soaked 1 cotton ball- alcohol- final disinfection 1 cotton ball- dry Oral- 2-3 min Rectal- 1 min Axilla- 5-8 min
ISOLATION TECHNIQUE IN THE HOME CONSIDERATIONS: 1. Articles Articles used used by the patient patient should should not be mixed mixed with with the articles articles used by by other family members. 2. Frequent Frequent hand hand washing washing and airing airing of beddings beddings and and other other articles articles and disinfection of the room are imperative. Abundant use of soap, water, sunlight and some chemical disinfectants is necessary. 3. The one one caring caring for the sick sick should should be provid provided ed with a gown gown that that should should be used only within the room. 4. Al discharge discharges s from the nose nose and throat throat of a communica communicable ble disease disease pt should should be carefully discarded. 5. Articles Articles soiled soiled with dischar discharges ges should should be boiled boiled for 30 minutes minutes before before washing. MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAMS Water Supply Sanitation Program 3 Types of Approved Water Supply and Facilities: • Level II-Point So Source • Level Level II-Com II-Commun munal al faucet faucet system system or stand stand posts posts • Level Level III-Wa III-Water terwor works ks syste system m or indivi individua duall house house conne connecti ctions ons Proper Excreta and Sewage Disposal System 3 Types of Approved Toilet Facilities: Level 1 Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies
Level 2 On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities
Level 3 Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system to treatment plant.
FOOD SANITATION PROGRAM 4 RIGHTS IN FOOD SAFETY: 1. Right Source • Always Always buy fresh fresh meat, meat, fish fish,, fruit fruits s and and vege vegetab tables les.. • Alwa Always ys look look at the the exp expir iry y dat date. e. • Use Use wate waterr only only fro from m clea clean n and and safe safe sou sourc rces es 2. Right Preparation • Avoid Avoid cont contact act betwee between n raw raw food foods s and and cook cooked ed foo foods. ds. • Always Always buy pasteu pasteuriz rized ed milk and fruit fruit juices juices.. • Wash vegetables vegetables well if to be eaten eaten raw such such as lettuc lettuce, e, cucumb cucumber, er, tomatoe tomatoes s and carrots. 3. Right Cooking • Cook food thorough thoroughly ly and and ensure ensure that the temperatur temperature e on on all parts of the food should reach 70 degrees centigrade • Eat Eat coo cooke ked d foo food d imm immed edia iate tely ly.. 4. Right Storage • All cooke cooked d foods foods shoul should d be left left at room room tempera temperatur ture e for NOT NOT more more then then TWO HOURS to prevent multiplication of bacteria. • Store cooked cooked foods foods carefully. carefully. Be sure sure to to use use tightly tightly sealed sealed contain containers ers for storing food. RULE IN FOOD SAFETY: When in doubt, throw it out! HOSPITAL WASTE MANAGEMENT PROGRAM • •
A Hospit Hospital al Waste Waste manageme management nt progra program m shall shall be prepared prepared and implemente implemented d as a requirement for renewal /registration /r egistration of licenses by hospitals. Training Training of all all hospital hospital personne personnell involve involved d in waste waste managem management ent shall shall be an an essential part of hospital training program.
OTHER PRIORITY HEALTH PROGRAMS SENTRONG SIGLA MOVEMENT -Quality assurance program GOAL: To make DOH and LGU active partners in providing quality health services. Key strategies: 1. Certif Certifica icate te Recogn Recognitio ition n Program Program= = CRP 2. Contin Continuou uous s Quality Quality Improve Improvemen ment=C t=CQI QI SENTRONG SIGLA MOVEMENT: Goal: Better quality of life, quality health Objective: Better and more effective collaboration between DOH and LGUs DOH: Provider of technical and financial assistance packages for health care including regulation LGU: Prime developers of heath systems and direst implementers of health programs PILLARS OF SSM: QATH • Quality ity assurance • Award • Tech Techni nica call and and gran grants ts assi assist stan ance ce • Health pr promotion What are the agencies that can apply for SSM? This program is intended for RHU’s and Health Centers and not the hospitals.
PU B LIC HEALTH PROGRAMS • Maternal Care Program • Strategies: A. Provision of Regular and Quality Quality Maternal Care Services regular and quality pre-natal care • hx-taking, utilization of HBMR (Home-Based Mother’s Record) • as a guid guide e in in the the identi identific ficati ation on of risk risk fact factors ors • PE: PE: wei weigh ght, t, hei heigh ght, t, BP-t BP-tak akin ing g • Perfor Perform m head head-to -to-to -toe e ass assess essmen ment, t, abdo abdomin minal al exam exam • Teta Tetanu nus s Tox Toxoi oid d Imm Immun uniz izat atio ion n • Fe supp supplem lement entati ation on:: given given from from 5th 5th mo. of of pregna pregnancy ncy to to two mont months hs postpartum (100-120 mg orally/day for 210 days) • Laboratory ex exam: 1. Heat Heat-ac -acet etic ic aci acid d test test.. 2. Bene Benedi dict ct’s ’s tes testt • Oral/Dental ex exam ► ►
Pre-natal counseling Provision of safe, delivery care • all birth birth attend attendants ants shall ensure ensure clean clean and safe deliveries deliveries at home home or at the the faciltiies (RHUs/hospitals) • at-risk at-risk pregna pregnancies ncies and mothers mothers must must be immediately immediately referred referred to to the the nearest nearest institution • untrai untrained ned TBA’ TBA’s s who activ actively ely pract practice ice must must be identi identifie fied, d, traine trained d and supervised by a personnel of the nearest BHS/RHU trained on maternal care. ► Provision of quality postpartum care • Proper Proper schedu schedule le of follow follow-up -up must must be be foll followe owed: d: • 1st post postpar partum tum visit visit for home home deli deliver veries ies must must be done done within within 2 4 hours after delivery • - 2nd, 2nd, done at least 1 week after delivery • - 3rd, 3rd, done 2- 4 weeks thereafter • Attend Attendant ants s must must be be aware aware of of the early early signs signs,, sympto symptoms ms and and complications. They should follow the 3 CLEANS: CLEAN HAND S CLEAN Surface CLEAN Cor d 3 FACTORS CONTRIBUTING TO PREGNANCY RELATED ILLNESS AND DEATH AMONG MOTHERS AND INFANTS 1. too early pregnancy 2. pregnancy before age 20 or after age 35 3. pregnancy after the 4th baby NUTRITION PROGRAM Goal: The improvement of the nutritional status and quality of life of the population through the adoption of desirable dietary practices and healthy lifestyle. • Villav Villaviej ieja a et. al. al. Rice Rice is the the main main sourc source e of prote protein in among among Fili Filipin pinos os • WATER- most essential of all nutrients FILIPINO PYRAMID Fats= 1 serving (eat sparingly) Proteins= 2-4 servings (need some ) Fruits= 2-3 servings Vegetables =3-5 servings
Carbohydrates=6-11 servings (eat more) Fluid= 8-12 servings (drink a lot) Programs and projects: •
Micr Micron onut utri rien entt Supp Supple leme ment ntat atio ion n - To address the health and nutritional needs of infants and children and improve their growth and survival. • Food Fortifi ification ion -Voluntary fortification of processed foods through the “Sangkap Pinoy seal.”
FAMILY PLANNING PROGRAM Methods of Family Planning: I. Spacing A. Hormonal • Oral ral Con Contraceptives • Injectables • Inplants B. Barrier • IUD • Condom • Diap Diaph hrag ragm, Cerv Cervic ical al cap cap C. Biologic Biologic - Lactation-Amenorrhea Method D. Natural Natural - Basal Body Temperature (BBT) • Sympto-thermal • Cervical Mucus ORAL CONTRACEPTIVES • • • • • • • •
first 21 pills pills have have a combina combination tion of synthet synthetic ic estroge estrogen n and and proges progesterone terone hormones last 7 pills pills of a 28-day 28-day pack have no hormon hormones es and and are are called called spacer spacer pills pills Pill Pill stops stops ovula ovulatio tion, n, preven preventin ting g the ovari ovaries es from from releasi releasing ng eggs eggs thickens thickens cervical cervical mucus, mucus, makin making g it harder harder for for sperm sperm to enter enter the uterus uterus first 21 pills pills have have a combina combination tion of synthet synthetic ic estroge estrogen n and and proges progesterone terone hormones last 7 pills pills of a 28-day 28-day pack have no hormon hormones es and and are are called called spacer spacer pills pills Pill Pill stops stops ovula ovulatio tion, n, preven preventin ting g the ovari ovaries es from from releasi releasing ng eggs eggs thickens thickens cervical cervical mucus, mucus, makin making g it harder harder for for sperm sperm to enter enter the uterus uterus
Missed Pills: Late Start 1 day late starting the next package: Take 2 pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks. 2 days late starting the next package: Take 2 pills per day for 2 days, then continue as usual. Use a backup form of birth control for two weeks. 3 or more days late starting the next package: Call the clinic for instructions.
CONTRACEPTIVE INPLANTS • • • •
soft capsules, capsules, about about 1½ inch long, long, under under the the skin skin in a woman’s woman’s upper, upper, inner inner arm prevents prevents pregna pregnancy ncy by thicke thickening ning the cervical cervical mucus mucus so that sperm can’t can’t get into the uterus and by stopping ovulation Effe Effect ctiv ive e cont contra race cept ptio ion n for for thre three e year years. s. doesn doesn't 't inte interfe rfere re with with fertili fertility ty once once it's remove removed d
DEPO-PROVERA: AN INJECTABLE CONTRACEPTIVE • • • • •
drug drug very simi similar lar to prog progest estero erone, ne, a hormo hormone ne norma normally lly prod produc uced ed by the the ovaries every month as part of the menstrual cycle preven prevents ts pregn pregnanc ancy y for up to 3 mont months hs with with each each injec injectio tion n ("shot" ("shot"). ). give given n as 1 sho shott in the the butt buttoc ock k or uppe upperr arm arm first first shot shot should should be be given given withi within n 5 days days after after the the beginn beginning ing of of a normal normal menstrual period, and shots should be repeated every 3 months. good good for 2 year years s unles unless s no othe otherr form form of birth birth cont control rol is righ rightt for you. you.
INTRAUTERINE DEVICE (IUD) • • • •
a small small object object that is inserte inserted d through through the cervix cervix and placed placed in the uterus uterus to prevent pregnancy can last 1-10 years usually usually inserte inserted d during during a menstr menstrual ual period period when the cervix cervix is slightly slightly open and pregnancy is least likely recomm recommen ended ded that that women women check check thei theirr IUD after after each each period period
CERVICAL CAP (FEMCAP) • •
A silico silicone ne cup cup insert inserted ed into into the the vagina vagina to to preven preventt pregna pregnancy ncy It is recommend recommended ed that that spermic spermicide ide be be added added to increa increase se the the effecti effectivene veness ss of of this method. • Last Lasts s for for up up to to two two yea years • acts by blocki blocking ng the the entranc entrance e to the uterus uterus;; spermic spermicide ide acts acts by by killing killing and immobilizing the sperm, preventing it from fertilizing the egg. II. Permanent (surgical/irreversible) A. Tubal Ligation - done in women; a 15 min. surgical procedure in which the fallopian tubes are tied and cut to prevent passage of sperms B. Vasectomy Vasectomy - done in men, was deferens is tied and cut to block passage of sperm MENTAL HEALTH PROGRAMS 4 FACETS OF MENTAL HEALTH: DEFINED BURDENBURDEN- burden currently affecting persons persons with mental mental disorders UNDEFINED BURDENBURDEN- burden relating to the impact of mental health problems to persons other than the individual directly affected. HIDDEN BURDENBURDEN- the stigma and violations of human rights. FUTURE BURDENBURDEN- burden in the future resulting from the aging of the population.
