Community Health Nursing lec from sir LINAO

8/8/2019 Community Health Nursing lec from sir LINAO

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HISTORY OF CHN

1901 - Act # 157 ( Board of Health of thePhilippines) ; Act # 309 ( Provincial andMunicipal Boards of Health) were created.

1905 - Board of Health was abolished; functions were transferred to the Bureau of Health.

1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners ofpresent MHOs; male nurses performs the functions of doctors

1919 Act # 2808 (Nurses Law was created)- Carmen del Rosario , 1st Fil. Nurse

supervisor under Bureau of Health Oct. 22, 1922 Filipino Nurses Organization (Philippine Nurses Organization) was

organized.

1923 Zamboanga General Hospital School of Nursing & Baguio General Hospital wereestablished; other government schools of nursing were organized several years after.

1928- 1st Nursing convention was held

1940 Manila Health Department was created.

1941 Dr. Mariano Icasiano became the first city health officer; Office of Nursing wascreated through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistantchief nurse)

Dec. 8, 1941 Victims of World War II were treated by the nurses of Manila.

July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31Filipino nurses in Bilibid Prison as prisoners of war by the Japanese.

Feb. 1946 Number of nurses decreased from 556 308.

1948 First training center of the Bureau of Health was organized by the Pasay CityHealth Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Ms. Bugarin, Ms.Ramos, and Zenaida Nisce composed the training staff.

1950 Rural Health Demonstration and Training Center was created.

1953 The first 81 rural health units were organized.

1957 RA 1891 amended some sections of RA 1082 and created the eight categories ofrural health unit causing an increase in the demand for the community health personnel.

1958-1965 Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288)

1961 Annie Sand organized the National League of Nurses of DOH.

1967 Zenaida Nisce became the nursing program supervisor and consultant on the sixspecial diseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness).

1975 Scope of responsibility of nurses and midwives became wider due to restructuringof the health care delivery system.

1976-1986 The need for Rural Health Practice Program was implemented.

1990- 1992- Local Government Code of 1991 (RA 7160)

1993-1998 Office of Nursing did not materialize in spite of persistent recommendationof the officers, board members, and advisers of the National League of NursesInc.

Jan. 1999 Nelia Hizon was positioned as the nursing adviser at the Office of Public HealthServices through Department Order # 29.

May 24, 1999 EO # 102, which redirects the functions and operations of DOH, wassigned by former President Joseph Estrada.

LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSINGR.A. 7160 - or the Local Government Code. This involves the devolution of powers, functions andresponsibilities to the local government both rural & urban.The Code aims to transform localgovernment units into self-reliant communities and active partners in the attainment of nationalgoals thru a more responsive and accountable local government structure instituted thru asystem of decentralization. Hence, each province, city and municipality has a LOCAL HEALTHBOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation andmaintenance of their own health facilities.

Composition of LHBProvincial Level1.Governor- chair2. Provincial Health Officer vice chair3. Chair , Committee on Health of SangguniangPanlalawigan4. DOH rep.5. NGO rep.

City and Municipal Level1. Mayor chair 4. DOH Representative


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2. MHO vice chair 5. NGO Representative3. Chair, Committee on Health of Sangguniang Bayan

R.A. 2382 Philippine Medical Act. This act defines the practice of medicine in the country.

R.A. 1082 Rural Health Act. It created the 1st 81 Rural Health Units; amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary inspectors will live in the ruralareas where they are assigned in order to raise the health conditions of barrio people,hence help decrease the high incidence of preventable diseases

R.A. 6425 Dangerous Drugs Act. It stipulates that the sale, administration, delivery,

distribution and transportation of prohibited drugs is punishable by law. R.A. 9165 the new Dangerous Drug Act of 2002

P.D. No. 651 requires that all health workers shall identify and encourage the registrationof all births within 30 days following delivery.

P.D. No. 996 requires the compulsory immunization of all children below 8 yrs. of ageagainst the 6 childhood immunizable diseases.

P.D. No. 825 provides penalty for improper disposal of garbage.

R.A. 8749 Clean Air Act of 2000

P.D. No. 856 Code on Sanitation. It provides for the control of all factors in mansenvironment that affect health including the quality of water, food, milk, insects, animalcarriers, transmitters of disease, sanitary and recreation facilities, noise, pollution andcontrol of nuisance.

R.A. 6758 standardizes the salary of government employees including the nursingpersonnel.

R.A. 6675 Generics Act of 1988 which promotes, requires and ensures the production ofan adequate supply, distribution, use and acceptance of drugs and medicines identified bytheir generic name.

R.A. 6713 Code of Conduct and Ethical Standards of Public Officials and Employees. It isthe policy of the state to promote high standards of ethics in public office. Public officialsand employees shall at all times be accountable to the people and shall discharges theirduties with utmost responsibility, integrity, competence and loyalty, act with patriotismand justice, lead modest lives uphold public interest over personal interest.

R.A. 7305 Magna Carta for Public Health Workers. This act aims: to promote and improve

the social and economic well-being of health workers, their living and working conditionsand terms of employment; to develop their skills and capabilities in order that they will bemore responsive and better equipped to deliver health projects and programs; and toencourage those with proper qualifications and excellent abilities to join and remain ingovernment service.

R.A. 8423 created the Philippine Institute of Traditional and Alternative Health Care.

P.D. No. 965 requires applicants for marriage license to receive instructions on familyplanning and responsible parenthood.

P.D. NO. 79 defines , objectives, duties and functions of POPCOM

RA 4073 advocates home treatment for leprosy

Letter of Instruction No. 949 legal basis of PHC dated OCT. 19, 1979; promotesdevelopment of health programs on the community level

RA 3573 requires reporting of all cases of communicable diseases and administration ofprophylaxis

Ministry Circular No. 2 of 1986 includes AIDS as notifiable disease

R.A. 7875 National Health Insurance Act

R.A. 7432 Senior Citizens Act

R. A. 7719 - National Blood Services Act

R.A. 8172 Salt Iodization Act ( ASIN LAW)

R.A. 7277- Magna Carta for PWDs, provides their rehabilitation, self-development andself-reliance and integration into the mainstream of society

A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding:1.All newborns be breastfeed within 1 hr after birth

2. Infants be exclusively breastfeed for 6 mos.3. Infants be given timely, adequate and safe complementary foods4. Breastfeeding be continued up to 2 years and beyond

EO 51- Phil. Code of Marketing of Breastmilk Substitutes

R.A.- 7600 Rooming In and Breastfeeding Act of 1992

R.A. 8976- Food Fortification Law

A..O. No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunizationfor Infants

R.A. 7846- mandates Compulsory Hepatitis B Immunization among infants and childrenless than 8 yrs old


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R.A. 2029- madates Liver Cancer and Hepatitis B Awareness Month Act ( February)

Concepts:

The primary focus of community health nursing is health promotion.

Community health nurses provide care necessary to meet the requirements of anindividual all throughout the life cycle.

Knowledge on different fields (biological and social sciences, clinical nursing, andcommunity health organizations) is used.

Nursing process in community health nursing changes based on the needs of thecommunity.

Goal:

To elevate the level health of the multitude.Philosophy

Worth and dignity of man.Principles

1. The need of the community is the basis of community health nursing.2. The community health nurse must understand fully the objectives and policies of the

agency she represents.3. The family is the unit of service.4. CHN must be available to all regardless of race,creed and socioeconomic status

5. The CHN works as a member of the health team6. There must be provision for periodic evaluation of community health nursing services7. Opportunities for continuing staff education programs for nurses must be provided by the

community health nursing agency and the CHN as well8. The CHN makes use of available community health resources9. The CHN taps the already existing active organized groups in the community10. There must be provision for educative supervision in community health nursing11. There should be accurate recording and reporting in community health nursing12.Health teaching is the primary responsibility of the community health nurse

ROLES AND FUNCTION OF THE PHNThe PHN has various roles spelled out in the law and the standards prescribed by the DOH and

different nursing associations.The PHN can only perform his/her functions effectively if she/he:

a. has the necessary knowledge, skills, and attitudes in dealing with the health needs andproblems of his/her clients;

b. is familiar with the structure and dynamics of the health care system and its broadersocio-cultural, economic, and political context;

c. is knowledgeable of laws and policies affecting the health care system in general andnursing practice in particular and of nursing and program standards.

NURSING LAWSection 28 of RA 9173 (Philippine Nursing Act of 2002)Scope of nursing:

A person shall be deemed to be practicing nursing when he/she singly or in collaboration withanother, initiates and performs nursing services to individuals, families andcommunities in any health care setting.

LEVELS OF CARE/ PREVENTION1. PRIMARY LEVEL

Health services offered at this level are to individuals in fair health and to patientswith diseases in the early symptomatic stage.

2. SECONDARY LEVELServices offered to patients with symptomatic stages of disease which require

moderately specialized knowledge and technical resources for adequate treatment.3. TERTIARY LEVEL

Services rendered at this level are for clients afflicted with diseases which seriouslythreaten their health and which require highly technical and specialized knowledge,facilities, and personnel to treat effectively.

Types of Clientele1. INDIVIDUALS2. FAMILIES3. COMMUNITIES4. POPULATION GROUPS


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- Aggregate of people who share common characteristics, developmental stage orcommon exposure to particular environmental factors thus resulting in common healthproblems ( Clark, 1995:5) e.g. children . elderly, women, workers etc.

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

THE DEPARTMENT OF HEALTHVISION: Health for all FilipinosMISSION: Ensure accessibility & quality of health care to improve the quality of life ofall Filipinos, especially the poor.

NATIONAL OBJECTIVES

1. Improve the general health status of the population (reduce infant mortality rate, reducechild morality rate, reduce maternal mortality rate, reduce total fertility rate, increase lifeexpectancy & the quality of life years).

2. Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B,Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases,Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & ChronicKidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia &Obesity.

3. Eliminate the ff. diseases as public health problems:


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Schistosomiasis

Malaria

Filariasis

Leprosy

Rabies

Measles

Tetanus

Diphtheria & Pertussis

Vitamin A Deficiency & Iodine Deficiency Disorders4. Eradicate Poliomyelitis5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness,

personal hygiene, mental health & less stressful life & prevent violent & risk-takingbehaviors.

6. Promote the health & nutrition of families & special populations through child, adolescent& youth, adult health, womens health, health of older persons, health of indigenouspeople, health of migrant workers and health of different disabled persons and of the rural& urban poor.

7. Promote environmental health and sustainable development through the promotion andmaintenance of healthy homes, schools, workplaces, establishments and communitiestowns and cities.

Basic Principles to Achieve Improvement in Health1. Universal access to basic health services must be ensured.2. The health and nutrition of vulnerable groups must be prioritized.3. The epidemiological shift from infection to degenerative diseases must be managed.4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals1. Increasing investment for Primary Health Care.2. Development of national standards and objectives for health.3. Assurance of health care.4. Support to the local system development.

5. Support for frontline health workers.

COMMUNITY HEALTH NURSING- is a unique blend ofnursingand publichealth practice woven into a human service that

properly developed and applied, has a tremendous impact on human well-being.- is a service rendered by a professional nurse with the community, groups, families, and

individuals at home, in health centers, in clinics, in schools and in places of work for thepromotion of health.

PUBLIC HEALTH the science and art ofpreventing disease,prolonging life,promoting healthand efficiency through organized communityeffortfor the sanitation of the environment, controlof communicable dses, the education of individuals in personal hygiene, the organization ofmedical and nursing services for the early diagnosis andpreventive treatmentof disease, andthe development of the social machinery to ensure a standard of living adequate for themaintenance of health, so organizing these benefits as to enable every citizen to realize hisbirthright of health and longevity. (Dr. C.E. Winslow)

PRIMARY HEALTH CARE (PHC)

May 1977 -30th World Health Assembly decided that the main health target of thegovernment and WHO is the attainment of a level of health that would permit them to leada socially and economically productive life by the year 2000.

September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR)The Alma Ata Declaration stated that PHC was the key to attain the health for all goal

October 19, 1979 - Letter of Instruction (LOI) 949), the legal basis of PHC was signed by

Pres. Ferdinand E. Marcos,

which adopted PHC as an approach towards the design, development and implementation of

programs focusing on health development at community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

Magnitude of Health Problems

Inadequate and unequal distribution of health resources

Increasing cost of medical care


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Isolation of health care activities from other development activities

DEFINITION OF PRIMARY HEALTH CARE

essential health care made universally accessible to individuals and families in thecommunity by means acceptable to them, through their full participation and at cost thatthe community can afford at every stage of development.

a practical approach to making health benefits within the reach of all people.

an approach to health development, which is carried out through a set of activities and

whose ultimate aim is the continuous improvement and maintenance of health status ofthe community.

GOAL OF PRIMARY HEALTH CARE:HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE

by the year 2020.An improved state of health and quality of life for all people attained through SELF-RELIANCE.

B KEY STRATEGY TO ACHIEVE THE GOAL:Partnership with and Empowerment of the people - permeate as the core strategy in

the effective provision of essential health services that are community based, accessible,acceptable, and sustainable, at a cost, which the community and the government can afford.

OBJECTIVES OF PRIMARY HEALTH CARE

Improvement in the level of health care of the community

Favorable population growth structure

Reduction in the prevalence of preventable, communicable and other disease.

Reduction in morbidity and mortality rates especially among infants and children.

Extension of essential health services with priority given to the underserved sectors.

Improvement in Basic Sanitation

Development of the capability of the community aimed at self-reliance.

Maximizing the contribution of the other sectors for the social and economicdevelopment of the community.

MISSION:To strengthen the health care system by increasing opportunities and supporting theconditions wherein people will manage their own health care.

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS1. Barangay Health Workers - trained community health workers or health auxiliary

volunteers or traditional birth attendants or healers.2. Intermediate level health workers include the Public Health Nurse, Rural Sanitary Inspector

and midwives.

PRINCIPLES OF PRIMARY HEALTH CARE1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of

health services.The health services should be present where the supposed recipients are. They shouldmake use of the available resources within the community, wherein the focus would bemore on health promotion and prevention of illness.

2. COMMUNITY PARTICIPATION =heart and soul of PHC3. People are the center, object and subjectof development.

Thus, the success of any undertaking that aims at serving the people is dependent onpeoples participation at all levels of decision-making; planning, implementing, monitoringand evaluating. Any undertaking must also be based on the peoples needs and problems

(PCF, 1990) Part of the peoples participation is the partnership between the community and the

agencies found in the community; social mobilization and decentralization.

In general, health work should start from where the people are and building on what theyhave. Example: Scheduling of Barangay Health Workers in the health centerBARRIERS OF COMMUNITY INVOLVEMENT

Lack of motivation

Attitude

Resistance to change

Dependence on the part of community people


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Lack of managerial skills4. SELF-RELIANCE5. Partnership between the community and the health agencies in the provision of

quality of life.Providing linkages between the government and the non-government organization and

peoples organization.6. Recognition of interrelationship between the health and development

HEALTH

is not merely the absence of disease. Neither it is only a state of physical and mentalwell-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore, is manifested bythe progressive improvements in the living conditions and quality of life enjoyed by thecommunity residents (PCF, DEVELOPMENT is the quest for an improved quality of life forall. Development is multi-dimensional. It has a political, social, cultural, institutional andenvironmental dimensions(Gonzales 1994). Therefore, it is measured by the ability ofpeople to satisfy their basic needs.

7. SOCIAL MOBILIZATIONIt enhances people participation or governance, support system provided by the

Government, networking and developing secondary leaders.

8. DECENTRALIZATION

ELEMENTS/COMPONENTS of PHC

- Education for Health- Locally Endemic Disease Control- Expanded Program on Immunization- Maternal and Child Health- Essential Drugs and Elderly Care

-Nutrition

- Treatment of CD and Non-CD- Sanitation: Water and Environment

MAJOR STRATEGIES OF PRIMARY HEALTH CAREA. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS.

Attaining Health for all Filipino will require expanding participation in health and

health related programs whether as service provider or beneficiary. Empowerment to

parents, families and communities to make decisions of their health is really the desired

outcome.

Advocacy must be directed to National and Local policy making to elicit support

and commitment to major health concerns through legislations, budgetary and logistical

considerations.

B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CAREThe health in the hands of the people brings the government closest to the people.

It necessitates a process of capacity building of communities and organization to plan,implement and evaluate health programs at their levels.

C. INCREASING EFFICIENCIES IN THE HEALTH SECTORUsing appropriate technology will make services and resources required for their

delivery, effective, affordable, accessible and culturally acceptable. The development of

human resources must correspond to the actual needs of the nation and the policies it

upholds such as PHC. The DOH will continue to support and assist both public and private

institutions particularly in faculty development, enhancement of relevant curricula and

development of standard teaching materials.

D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCHEssential National Health Research (ENHR) is an integrated strategy for organizing

and managing research using intersectoral, multi-disciplinary and scientific approach tohealth programming and delivery.

FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE1. Active Community Participation


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Areas to Be Assessed

1. Physical independence: This category is concerned with the ability to move about to get out of bed, to take careof daily grooming, walking and other things which involves the daily activities.

2. Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill,such as giving medication, dressings, exercise and relaxation, special diets.

3. Knowledge of Health Condition: This system is concerned with the particular health condition that is theoccasion of care

4. Application of the Principles of General Hygiene: This is concerned with the family action in relation tomaintaining family nutrition, securing adequate rest and relaxation for family members, carrying out acceptedpreventive measures, such as immunization.

5. Health Attitudes: This category is concerned with the way the family feels about health care in general, includingpreventive services, care of illness and public health measures.

6. Emotional Competence: This category has to do with the maturity and integrity with which the members of thefamily are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living.

7. Family Living: This category is concerned largely with the interpersonal with the interpersonal or group aspectsof family life how well the members of the family get along with one another, the ways in which they takedecisions affecting the family as a whole.

8. Physical Environment: This is concerned with the home, the community and the work environment as it affectsfamily health.

9. Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells others aboutHealth Departments services

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Community Health Nursing lec from sir LINAO