Community Health Nursing

PRIMARY HEALTH CARE

WELLNESSILLNESSMODELS OF HEALTH Clinical Model

Adaptive Model

Role Performance Model

Eudemonistic Model

Clinical Model

A model of health, wellness, and illness that narrowly defines health as the absence of disease.

Adaptive Model

A model of health, wellness, and illness that views health as adaptation to the physical and social world in which a person lives and disease as maladaptation to this world.

Role Performance Model

A model of health, wellness, and illness that views health in functional terms; here, if a person can function, he or she is healthy.

Eudemonistic Model

A model of health, wellness, and illness that focuses on health as well-being, self-fulfillment, and self-actualization.

DIMENSIONS OF HEALTH

FACTORS AFFECTING HEALTH

POLITICS

BEHAVIOR

HEALTH CARE DELIVERY SYSTEMS

HEREDITARY

ENVIRONMENT

SOCIO-ECONOMIC

16OPTIMUM LEVEL OF FUNCTIONING

LEVELS OF PREVENTION

PRIMARY - prevention or delay of the actual occurrence of illness or disease.

SECONDARY - early detection and treatment of the disease

TERTIARY - prevention of complications of a disease and rehabilitation of the individual.

PHILIPPINE HEALTH CARE DELIVERY SYSTEMNATIONAL HEALTH SITUATIONPopulation : as of 2010 is 94 Million

Growing at an annual rate of 1.75%-2.32%

65% of the population will be living in urban areas by 2020

LIFE EXPECTANCY Males: 66.9 years

Females: 72.2 yearsLEADING CAUSES OF MORBIDITY Diarrheal DiseasesAcute bronchitisPneumoniasInfluenzaChickenpoxHypertensionDengue Fever

TyphoidParatyphoid FeverTuberculosisMalariaAccidentsMalignant NeoplasmDiseases of the heartLEADING CAUSES OF MORTALITYDiseases of the HeartDiseases of the Vascular SystemPneumoniasDiseases of Respiratory SystemChronic Obstructive Pulmonary Disease (COPD)TuberculosisAccidents and diarrheal diseasesDiabetes MellitusMalignant Neoplasm (cancer)Nephritis, Nephritic syndrome, and nephrosisCOMPONENTSDepartment of Health Mandate:

Shall be responsible for the formulation and development of national health policies, guidelines, standards manual of operations for health services and programsissuance of rules and regulations, licenses and accreditationspromulgation of national health standards, goals , priorities and indicatorsdevelopment of special health programs and projects advocacy for legislation on health policies and programs

PRIMARY FUNCTION OF DOHis the promotion , protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services

(E.O. No. 119, Sec. 3).

VISIONMISSION GOAL31

framework for implementation of HSRA

Rationale: Reduction of IMR and MMR MILLENIUM DEVELOPMENT GOALS 1- 2-3-4-5-6- 7-8-Goals of FOURmula OneBetter health outcomes

More responsive health systems

Equitable health care financing FOUR ELEMENTS 35HEALTH FINANCING Secure more, better and sustained investments in healthHEALTH REGULATION quality and affordable health products, devices, facilities and services, HEALTH SERVICE DELIVERY

accessibility and availability of basic and essential health care for allGOOD GOVERNANCE To improve health systems performance at the national and local levelsPRINCIPLESUniversal accessibility.

Vulnerable groups such as women, children, and elders are the emphasis of health care services.

Emphasis on the promotion of healthy lifestyle due to increase of lifestyle diseases.OBJECTIVESImprove general health statusReduce morbidity, mortality, disabilityEliminate public health problemsPromote healthy lifestyleProtect vulnerable groups

LOCAL HEALTH SYSTEM Local Government Code

PeopleBoundariesHeath Facilities Health WorkersCOMMUNITY HEALTH NURSING GOALPromotion of OLOF thru teaching and delivery of carePHILOSOPHYBased on the WORTH & DIGNITY of manPRIMARY FOCUS: Health Promotion

UNIT OF SERVICE: Family

PRIMARY RESPONSIBILITY: Health Teaching

CORE OF PHN - Disease control

- Injury prevention

- Health protection

- Healthy public policy

- Promotion of health and equitable health gain ESSENTIAL FUNCTIONSHealth situation and monitoring analysis Epidemiological surveillanceDevelopment of public health policies Health systems and services managementRegulation and enforcement to protect public health Human resources development and planning in public health Health promotion, social participation and empowerment Quality personal and population health services Research of public health solutions PUBLIC HEALTH NURSE FUNCTIONSManagerSupervisor Care ProviderCollaborator CoordinatorHealth Educator Trainer Researcher CHN PROCESS ASSESSMENT

PLANNING

IMPLEMENTATION

EVALUATION ASSESSMENTInitiate Contact Demonstrate caring attitudes Mutual trust & confidence Collect data from all possible sources Identify health problems Assess coping ability Analyze and interpret dataFIRST LEVEL OF ASSESSMENT ASSESSMENTINITIAL DATA BASE Family structure, characteristics and dynamicsSocio-economic and cultural characteristicsHome and EnvironmentHealth Status of each memberValues and Practices on Health Promotion and Maintenance

54Approved type of water facilities

Level 1 (Point Source)

a protected well or a developed spring with an outlet but without a distribution systemindicated for rural areasserves 15-25 households; its outreach is not more than 250 m from the farthest useryields 40-140 L/ min

Level II (Communal Faucet or Stand Posts)

With a source, reservoir, piped distribution network and communal faucetsLocated at not more than 25 m from the farthest houseDelivers 40-80 L of water per capital per day to an average of 100 householdsFit for rural areas where houses are densely clustered

Level III (Individual House Connections or Waterworks System)

With a source, reservoir, piped distributor network and household tapsFit for densely populated urban communitiesRequires minimum treatment or disinfectionProper Excreta and Sewage Disposal Program

Level I

Non-water carriage toilet facility no water necessary to wash the waste into receiving space e.g. pit latrines, reed odorless earth closet.Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g. pour flush toilet & aqua privies

Level II

On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.

Level III

Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant.

Nature of the ProblemWellness Statethis refers to states of wellness and the likelihood for health maintenance or improvement to occur depending on the desire of the family

Health Threatsthese are the conditions that make it more likely for accidents, disease or failure to thrive or develop to occur. Health Deficit- this refers to conditions of health breakdowns or advent of illness in the family

Stress Points or Foreseeable Crisisthese are anticipated periods of unusual demand on the family in terms of time or resources

Most important in prioritizing family health problem:Modifiability of the Problem Preventive PotentialSaliency of the ProblemPLANNINGPrioritize needs Establish goal based on needs & capabilities of staff Construct action and Operation plan Develop evaluation parameters Revise plan as needed

IMPLEMENTATION Nursing plan to action Coordinate care/services Utilize community resources Delegate Supervise/Monitor health service provided Provide health education and training Document responses to Nursing action EVALUATION Nursing Audit Care Outcomes Performance Appraisal Estimate cost benefit ratioAssessment of problems Identify needed alterationsRevise plans as necessary NURSING PROCEDURESCLINIC VISITBLOOD PRESSURE MEASUREMENT HOME VISIT HOME VISITPRINCIPLES

Based on needs of the familyHave purpose or objective- directionalMake use of available information- case follow-upPractical and flexible Should involve the family membersNo definite rule for frequency

PHASES Preparatory Phase

Actual Home-visit

Post-Visit FACTORS INFLUENCING FREQUENCY Physical, Psychological, Educational NeedsAbility of the Family to recognize needsPolicy of a given agency Interest, willingness, acceptance of the family Evaluation of the past services renderedNumber of personnel involved Familys knowledge and ability to use their own resources BAG TECHNIQUE tool for ease and deftness to save and effort Rationale : Principle: Most important in the use of the bag:

PHN Bag equipment

- contains basic medications and articles

Paper Lining Extra paper for waste bagApronHand towel Soap in a soap dish Thermometer(rectal & oral)2 pairs of scissors (surgical and bandage)2 pairs of forceps (curved and straight)Disposable syringes with needles (g. 23 & 25) Hypodermic needles g. 19,22,23,25Sterile dressingCotton balls Cord clampMicropore plasterTape measure 1 pair of sterile gloves Babys scale Alcohol lamp 2 test tubes Test tube holders Solutions: BetadineZephiran Solution Spirit of amonia Acetic acid 70% alcohol Hydrogen peroxide Opthalmic oinmentBenedicts solution

81NURSING CARE IN THE HOME Principles: Utilizes a medical plan of care and treatmentGive maximum comfort and securityHealth EducationRecognize dangersDetect abnormal signs and symptoms Observe progress of the patient ISOLATION TECHNIQUE Should not be mixed Frequent washing and airing Protective gown for caregiver All discharges should be carefully discarded If soiled with discharges, boil in water for 30 minutes before laundering CLINIC VISITPhases:

Pre-consultation Medical Examination Nursing InterventionPost-consultation TRIAGE Program-Based Care

Non-Program-Based Care

Emergency Cases

PRIMARY HEALTH CAREGOALHealth in the hands of people by 2020.

MISSIONIncreasing opportunities where people can manage their own health care.

THEMEPartnership and Empowerment towards self-reliance

STRATEGYFull participation and active involvement of the community towards the development of self-reliance.

3 MAJOR ASPECTS OF PHCPromotiveHealth educationPreventiveMaternal and Child CareImmunizationCurativeTreatment of common diseasesEssential DrugsFOUR PILLARS OF PHCActive Community ParitcipationIntra and inter-sectoral linkages Use of appropriate technology Support mechanism made availableESSENTIAL SERVICES OF PHCAdequate and safe supply water and basic sanitationControl of communicable diseasesImmunizationEducation on prevailing health problems and prevention of illnessMaternal and Child health and Family Planning Care Adequate food and proper nutritionProvision of medical care and emergency treatmentTreatment of locally endemic diseaseProvision of essential drugs and herbal medicines

QUALITIES OF HEALTH CARE PROVIDERSOpen

Tactful

Coordinator

Objective

Good listener

Efficient

Flexible

Critical thinker

HEALTH CARE WORKERS AT THE PRIMARY LEVELGRASSROOTS HEALTHCARE WORKERSor Village Health Workers

PROVIDES SIMPLE CURTIVE PREVENTIVE HEALTHCARE MEASURES

PARTICIPATE ON ACTIVITIES THAT ARE AIMED TO IMPROVE SOCIO-ECONOMIC STATUS OF THE COMMUNITY

BHW, VOLUNTEERS, TRADITIONAL BIRTH ATTENDANTS or HILOTSINTERMDIATE-LEVEL HEALTH WORKERSFirst source of professional healthcare

ATTEND TO HEALTH PROBLEMS THAT ARE BEYOND KNOWLEDGE OF VILLAGE/GRASSROOTS

SUPPORTS FRONT-LINE HEALTH WORKERS IN TERMS OF SUPERVISION, TRAINING, SUPPLIES

DOCTORS, NURSES, MIDWIVES LEVELS OF HEALTH CARE FACILITIESPRIMARY LEVEL Rural Health Units

Sub-centers

Community Hospitals

Health CentersSECONDARY LEVELProvincial Hospitals

Regional HospitalsTERTIARY LEVELNational Hospitals

Medical CentersTWO-WAY REFERRAL SYSTEMPOPULATIONBarangay Health StationsRural Health Station MidwifeBHW

RHU MidwifePublic Health NurseSanitary InspectorPhysician2nd Level Healthcare Facility3rd Level Healthcare FacilityMULTISECTORAL APPROACH TO HEALTHOther health-related systems(Government/Private)Community HealthEnvironment(Social , economic , physical , etc.) Ways of the People(Cultural)Health Care SystemHEALTH CARE PROCESS APPLIED TO THE FAMILY FAMILY

PLACE AND RESIDENCEPatrilocalMatrilocalBilocalNeolocalAvunculocalDESCENTPatrilinealMatrilinealBilateralAUTHORITYPatriarchalMatriarchalEgalitarianMatricentric

SECOND LEVEL OF ASSESSMENTFAMILY HEALTH TASKS

Recognizing interruptions of health development

Making decisions about seeking health care/ to take action

Dealing effectively health and non-health situations

Providing care to all members of the family

Maintaining a home environment conducive to health maintenance FAMILY HEALTH CONDITIONFamilys capabilities to maintain health and prevent illnessFAMILY HEALTH CARE PLAN

Formulating afamily care planinvolves the following steps:

1. The prioritized condition/s or problems2. The goals and objectives of nursing care3. The plan of interventions4. The plan of evaluating care

FAMILY HEALTH CARE STRATEGIESPRE-NATAL CAREHistorySigns and Symptoms of PregnancyCheck-ups during pregnancyImmunizationNutritionPersonal HabitsOthers

CARE OF THE NEWBORNBreastfeedingSupplementary feedingCord careBathing Immunization (EPI)

PARENTINGResponsibilitiesENVIRONMENTAL CARE AND SANITATIONCleanliness in the homeBackyard Sanitation HEALTH EDUCATION EVALUATIONEvaluation PlanStandardsCriteria