Community Health Nursing Notes Summary

Community Health Nursing: Definitions: 1)

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World World Healt Health h Org Organi anizat zatio ion: n: a. Special Special field field of nursing nursing that that combine combines s skills skills of nursing nursing public public health… health… b. Functio Function n as part part of tota totall public public healt health h program program for: i. Promoti Promotion on of health health ii. Improvement Improvement of condition condition iii.Rehabilitation of illness and disability Jacobsen a. Learned practice discipline with ultimate ultimate goal of contributing contributing as individuals individuals to promote client’s optimum level of functioning through teaching and delivery of care Dr. Dr. Rut Ruth h B. B. Fre Freem eman an a. CHN is is a unique unique blend blend of nursing and public public health health practice practice aimed at at developing developing and and enhancing health capabilities of people. It is involved in entire spectrum of health services for the community Tinkha Tinkham m and Voor Voorhie hies, s, 1972 1972 a. CHN is is a field field of nursing nursing in in which which family family and commu communiti nities es are pati patients ents b. Unique Unique blend blend of nursing nursing and public public healt health h practice practice woven woven into into human human service service c. “The hall hallmark mark of of CHN is that that it it is populat population ion or aggre aggregate gate-foc -focused used.” .”

Philosophy of CHN Dr. Margaret Shetland: “Philosophy is based on the worth and dignity of man.” Ultimate Goal “To raise level of health of the citizenry.” Objectives of CHN 1) 2) 3)

part partic iciipat pate… cond conduc uctt rese resear arch ches es… … coo coordina dinatte…

Concepts of CHN • •

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emphasis on importance of “greatest good for the greatest number” assessing health needs, planning, implementing and evaluating impact of health services on population group priority of health promotive and disease preventive strategies over curative interventions tools for measuring and analyzing community health problems application of principles of management and organization of the delivery of health services to the community

Basic Principles of Community Health Nursing •

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family is the unit of care, community is the patient and the four levels of clientele of CHN are: individual ○ ○ family group ○ ○ community goal of improving community health involves multidisciplinary effort CHN works not for individual patient, family, group or community. The latter are active partners, not passive-recipients of care Practice of CHN is affected by changes in society in general and by developments in health field in particular CHN is part of community health system, which in turn is part of the larger human services system

Barangay Health Centers 1 doctor, 1 nurse, midwives, 2 barangay health workers. 1 nurse= 5000 people

Wednesday: check-up and free immunizations

Roles and Functions • • •

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Planner: e.g. IMCI = Integrated management of childhood illnesses Provider of Nsg Services: direct nursing care of sick; provides patient continuity of care Manager/Supervisor: formulates individual, family, group and community centered care of  plan; organize work force Coordinator of Services: coordinates with individuals, family, group for health related services provided by GO’s and NGO’s  Trainer/health educator/counselor: identifies and interprets training needs of RHM’s, BHW’s and hilots; resource speaker; IEC materials Health Monitor: detects deviation from health of individual, family, group and community through contact visits with them; use of systematic and objective assessment Role model: provides good example/ model of healthful living to public Change agent: motivates changes in health behavior of individual, family, group and community including lifestyle to promote and maintain health. “most difficult role.” Recorder/reporter/statisticiain: prepares and submits records and reports Researcher: participates/assists in conduct of surveys

Community Health Nursing: History: •

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Early Christian era: virgins, noblewomen and plebeians took care of sick Phoebe: 1st visiting nurse Mr. William Rathbone: ○ Philanthropist who first thought of public health nursing ○ District nursing service in Liverpool in 1859 ○ More emphasis on midwifery Forerunner of public health nursing system ○ In the USA: ○ Public HN developed from visiting nursing service under missionary societies and visiting nursing associations ○

1877: women’s board of NY mission established 1 st visiting nurses

History of Public Health •

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Babylonians Understood need for hygiene ○ Developed medical skills ○ Egyptians ○ Developed variety of pharmaceutical preparations ○ Constructed earth privies and public drainage system Hebrew Mosaic Law ○ Maternal health, communicable disease control, protection of food, water, waste and sanitary disposal Greeks ○ Linked health to environment ○ Wealthy people value personal cleanliness, exercise, diet and sanitation Romans Viewed medicine from a community health and social medicine perspective ○ Emphasized regulation of medical practice ○ Provision of pure water ○ ○ Sewage systems, public food preparation ○ Women visited and cared for the sick Christianity Brought idea of personal responsibility ○ Started the care for the sick ○ Middle Ages Poor sanitary conditions ○ ○ Increase in communicable diseases (cholera, bubonic plague, smallpox) Religious convents and monasteries established hospitals ○ Started movement of health education and personal hygiene ○

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Renaissance Health practices were influenced by recognition of human dignity and worth ○ Elizabeth Poor Law: established 1601, guaranteed medical services to poor and lame ○ individuals Industrial Revolution Advances in transportation ○ ○ Religious women started to provide nursing care in institutions and homes

Milestones in history of public health • • • • • • • •

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1601- Elizabeth Poor Law 1617- Sisterhood of Dames de Charite organized by St. Vincent de Paul 1789- Baltimore Health Department 1798- Marine Hospital Service, nuns visited poor 1813- Ladies Benevolent Society of Charleston, South Carolina founded 1836- Lutheran deaconesses provided home visits in Germany 1851- Nightingale visited Kaiserwerth, 3 months of nursing training 1855- Quarantine Board, established in New Orleans; beginning of tuberculosis campaign in US 1859- district nursing established by William Rathbone 1860- Florence Nightingale Training School for Nurses established in St. Thomas Hospital in London 1864- Beginning of Red Cross

Community Health Nursing Historical Background in Philippines • • •

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1901- Act 157, est. Board of Health of Philippines 1905- Act 1407, est. Bureau of Health, under Department of Interior 1912- Fajardo Act (Act 2156) – Sanitary Division, forerunner of present Municipal Health Offices; President of Sanitary division took charge of 2 to 3 municipalities. Philippine General Hospital sent 4 nurses to Cebu 1914- School of Nursing rendered by Filipino Nurse employed by Bureau of Health in   Tacloban, Leyte 1915- Philippine Health Service; Reorganization Act 2462 created. Office of Inspector General and Office of District Nursing headed by Dr. Rosario Pastor, a nurse and physician 1915-1918- Ms. Perlita Clark took charge of Public Health Nursing Works 1919- 1st Filipino Nurse Supervisor was appointed, 84 PHN’s assigned in 5 health stations 1927- Office of District Nursing abolished and changed to Section of Public Health Nursing 1930- Section for Nursing 1941- Outbreak of war, PHN’s were assisted to take care of sick and wounded 1942- 31 nurses as POW’s at Bilibid Prison, released to Director of Bureau and Health, Dr. Eusebio Aguilar 1948- 1st training center of Bureau of Health organized in cooperation with Pasay City Health Department 1950- Rural Health Demonstration and Training Center by DOH 1958-1965- RA 977 abolished Division of Nursing ○ Annie Sand= nursing consultant, Office of Secretary of Health  Founded DOH National League of Nurses Inc. ○ RA 977created 8 regional offices in country increased to 11 then to 16

Primary Health Care (Basic Health Care) Definition 1)

Worl World dH Hea ealt lth h Org Organ aniz izat atio ion: n: “ess “essen enti tial al heal health th care care made made univ univer ersa sall lly y acc acces essi sibl ble e to to individuals and families by means acceptable to them, through full participation and at cost that the community and country can afford at every stage of development.”

Conceptual Framework  •

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Goal: Health for all Filipinos and Health in the hands of th epoeple by the year 2020 Mission: to strengthen the health care system by increasing opportunities and supporting conditions wherein people will manage their own health care.

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Concept: Primary Health Care (PHC) characterized by partnership and empowerment of  people shall permeate as core strategy in effective provision of essential health services

Legal Basis • •

Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by then Pres. Ferdinand E. Marcos Historical Background ○ 1974- WHO and UNICEF conducted a joint study ○ 1975- World Health Assembly passed a resolution giving priority to the development of PHC 1977- World Health Assembly decided that main target of government and WHO is ○ the attainment of the level of health that would allow or permit them to lead a socially and economically productive life by year 2000 ○

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September 6-12, 1978- 1st International Conference on Primary Health Care in Alma Ata, USSR 1979- WHA launched global strategy to attain health for all 1980- PHC endorsed for implementation by respective regional community

Why Philippines Adopted PHC 1) 2) 3) 4)

magni magnitud tude e of of heal health th proble problems ms inadequa inadequate te and unequ unequal al distri distributi bution on of healt health h resource resources s incre increase ased d cost cost of of medic medical al care care isolation isolation of health care activities activities from other developmental developmental activities activities

Principles of PHC 1)

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Accessibility, Accessibility, acceptabili acceptability, ty, availabilit availability, y, and affordability affordability of of health health services services a. Health Health servic services es are delivere delivered d where where people people live live and work work b. Development Development of indigenous indigenous or resident volunteer volunteer health health workers workers to provide health care with an ideal ration of 1:10-20 households c. Use of low low cost, cost, approp appropriat riate e technolo technology gy sustaina sustainable ble by commun community ity d. Combined Combined utili utilizati zation on of traditio traditional nal medicin medicines es and essentia essentiall drugs Partnership Partnership between between community community and health health agencies agencies in in provision provision of of quality, quality, basic and essential health services a. Community Community needs and prioritie priorities s are basic for for planning planning health health services services and and activities activities b. Training curriculum curriculum of community community health health workers workers I based based on on community community health problems and task analysis of community health workers c. Regular Regular supervi supervision sion and and periodic periodic evaluati evaluation on of communit community y health health workers’ workers’ performance by health staff to community d. Developm Development ent of promotiv promotive, e, preventive preventive,, curative curative and rehabili rehabilitat tative ive care e. Recogni Recognition tion of role role and traditio traditional nal healers healers in deliver delivery y of health service services s Commun Communit ity y Parti Partici cipat patio ion n a. Awareness building and consciousn consciousness ess raising raising on health health and development developmental al issues issues b. Commu Communit nity y buildi building ng and and orga organiz nizin ing g c. Plannin Planning, g, implement implementatio ation, n, monitorin monitoring g and evaluat evaluation ion done done by community community d. Communit Community y discussio discussions ns done done through through small small group group discus discussion sions s e. Selecti Selection on of communit community y health health work workers ers by by communi community ty f. Foun Founda dati tion on of of heal health th com commi mitt ttee ees s g. Establis Establishmen hmentt of commu community nity health health organ organizat izations ions h. Mass health health campai campaigns gns and and commun community ity mobiliza mobilization tion Sel Self-r f-reli eliance nce a. Communit Community y genera generates tes support support for health health care b. Mobil Mobiliza izati tion on of of healt health h resou resource rces s c. Trainin Training g of communi community ty leaders leaders on on leadersh leadership ip and manag manageria eriall skills skills d. Incom Income-g e-gene enerat rating ing proje project cts s Recognit Recognition ion of inter interrela relatio tion n of health health and devel developme opment nt a. Convergence Convergence of health, food, nutrition nutrition,, water, water, sanitation sanitation and population population services services b. Integration Integration of PHC into national, national, provincial, provincial, municipal and barangay barangay development development plan Soci Social al Mobi Mobili liza zati tion on a. Establis Establishmen hmentt of effec effective tive health health referr referral al system system b. Multi-se Multi-secto ctoral ral and inter-di inter-discip sciplina linary ry linka linkages ges c. Integration, Integration, Education, Education, Communica Communication tion (IEC) support using multimedia multimedia channels channels d. Collaboration Collaboration among government government agencies, non-government non-government organizations organizations and community groups Dece Decent ntra rali liza zati tion on a. Real Realloc locat ation ion of of budget budgetar ary y resourc resources es

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Advoc Advocacy acy for for poli politi tical cal wil willl and suppo support rt Re-or Re-orie ienta ntati tion on of hea healt lth h profes professio sion n

Strategies of PHC 1) 2) 3) 4) 5) 6)

reorientation reorientation and reorganizati reorganization on by local government government code of 1991 or RA 7160 effective preparation preparation and and enabling enabling process process for health action at all all levels levels mobilization mobilization of people to know know their their communities communities and identify identify basic basic health health needs needs developm development ent of util utilizat ization ion of techn technolo ology gy organiza organizatio tion n of commu communiti nities es arisin arising g from from needs needs incr increa ease se oppor opportu tuni niti ties es

Essential Components of Primary Health Care 1)

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Multi Multi-Se -Sect ctora orall Approa Approach ch a. Intr Intras asec ecto tora rall link linkag ages es b. Inte Inters rsec ecto tora rall link linkag ages es Commun Communit ity y part partici icipat patio ion n a. Iden Identi tify fy prob proble lem m b. Iden Identi tify fy solu soluti tion on c. Mobi Mobili lizi zing ng reso resour urce ces s d. Barriers i. Lack of moti motivat vation ion ii. Indifference Indifference on part of community community iii.Resistant to change iv.Bureaucracy of government v. Lack of managerial managerial skills skills vi.Dependence on part of community Appr Approp opri riat ate e Techn Technol olog ogy y a. 6 criteria: i. effectiv effectivenes eness s and safety safety ii. less complex complex iii.less costly iv.broader scope of technology v. acceptability acceptability to local culture culture vi.feasibility Comm Commun unit ity y invo involv lvem emen entt a. Invo Involv lvem emen entt leve level: l: i. Indiv Individu idual al ii. Family-monitor Family-monitor growth and development development of child and able to address to problems in government iii.Community- organizations formed to promote health development

Concepts of Primary Health Care 1) 2) 3) 4) 5) 6) 7)

PHC represen represents ts suppleme supplementar ntary y healt health h system system Equip community community with capability capability to solve solve its own problems problems by conducting conducting trainings trainings Come into into being being only only when communi community ty recogni recognizes zes and accept accepts s problems problems Governme Government nt official officials s don’t work work in place place of communi community ty and vice vice versa Communi Community ty involv involveme ement nt is the hear heartt and and soul soul of PHC PHC Good healt health h is related related to to living living condit conditions ions and and lifesty lifestyle le Provide opportunity opportunity to underprivileged underprivileged majority majority to develop develop to to an acceptable acceptable level level a. Basi Basic c mini minima mali list stic ic need needs: s: i. Food ii. Clothin Clothing g iii.Shelter and clean environment iv.Health v. Education Education and information information vi.Security of life vii.Means of livelihood 8) Communi Community ty must take take its role role and respon responsibi sibilit lity y to develop develop basic basic needs needs 9) PHC activi activitie ties s must be in in harmony harmony with with existin existing g institut institution ion 10) PHC activities activities must be flexible in its application application 11) Must be related to public public health services services and technical support support levels of public… Elements of Primary Health Care 1) 2)

Education Loca Locall lly y Ende Endemi mic c Dise Diseas ases es

a. Filariasis b. Schi Schist stos osom omia iasi sis s 3) Esse Essent ntia iall bas basic ic drug drugs s a. Cotrimo imoxazo xazolle b. Amoxicillin c. Rifampicin d. Isoniazid e. Ethambutol f. Paracetamol g. Pyra yrazina zinami mid de h. Oresol i. Nifedipine 4) Mate Materna rnall and and Chil Child d Heal Health th Car Care e 5) Expan Expanded ded pro progra gram m of immu immuniz nizat atio ion n a. BCGBCG- bac bacill illus us calme calmett tte e gue guerin rin b. OPVOPV- oral oral poli polio o vac vacci cine ne c. AMVAMV- ant antii-me meas asle les s vacc vaccin ine e d. DPTDPT- dypth dyptheri eria a pert pertuss ussis is tet tetanu anus s e. Anti-Hep B 6) Nutrition a. IDDIDD- iodi iodine ne def defici icienc ency y di disor sorde derr b. IDAIDA- iron iron defic deficien iency cy anemia anemia c. PEMPEM- prot protein ein energ energy y malnu malnutr trit itio ion n 7) Treat Treatmen mentt of of comm common on disea diseases ses 8) Safe Safe wate waterr suppl supply y and and sanit sanitat atio ion n 9) Preventi Prevention on and cont control rol of leadi leading ng communi communicabl cable e diseases diseases 10) Promoti Promotion on of dental dental health health 11) Elderly and and disabled’s disabled’s physical physical and mental mental health health The Philippine Healthcare Delivery System • • •

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Health Care System- organized plan of health services Health Care Delivery- rendering services to people Health Care Delivery System- network of health facilities and personnel which carries out task of rendering health care to people Philippine Health Care System- complex set of organizations interacting to provide an array of health services RA 7160 Local Gov’t Code of 1991 ○ Provides for decentralization ○ Places in local gov’ts to manage health care system ○

Levels of Health Care Facilities 1)

Pri Primar mary le level vel a. Composed Composed of baran barangay, gay, munici municipal pal and and medicare medicare health health facilit facilities ies

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1st contact emergency care c. rural health units, chest clinics, malaria eradication eradication units, units, schistosomi schistosomiasis asis control control units, puericulture units, private clinics, company clincis d. earl early y symp sympto toma mati tic c stag stage e Seco Second ndar ary y leve levell a. Consists of district district health health care care institutio institutions ns with capabilities capabilities and and facilities facilities for cases with hospitalization b. Smaller non-departmental non-departmentalized ized hospitals hospitals including emergency and regional hospitals hospitals Ter Tertiary le level vel a. Highly Highly techn technolog ological ical and sophisti sophisticat cated ed servic services es b. Specialized Specialized centers, centers, regional health care institutions institutions and and provincial provincial health care centers

Multi-Sectoral Approach to Health •

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Intersectoral Sectors most closely related to health ○ ○ Agriculture, education, public works, local governments, social welfare, population control, private sectors Intrasectoral

Restructured Healthcare Delivery System

Rationale • • •

healthcare system serves only small portion of rural population diseases do not require sohphistication some problems can be handled by other postiions besides MHO (Municipal Health Officer)

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3 levels of health care provided by RHU (rural health unit) staff, with referral and supervisory system support redefinition of roles and relationships among RHU staff  establishment of satellite health centers in selected barangays

Features of DOH reorganization •

1958- RA 1082 ○ ○

1st Rural Health Act employment of more physicians, dentists, nurses, midwives and sanitary inspectors assigned to RHU’s

1st 81 rural health units 1972- RA 5435 ○ defined authorities of regional directors for more meaningful decentralization ○ 13 regional health offices 1974 IBRD- RHCDS implemented RHM were sent to BHS to man BHS ○ Midwives were trained and roles expanded ○ 1982- EO 851 ○ integrated public health and hospital systems with emphasis on importance of  putting together promotive, preventive, curative and rehabilitative components of  health care utilization of BHW ○ implementation of DOH impact programs ○ ○

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Role of Society in RHCDS • • •

participation in information drive of HCDS identifying identifying problems identify sources

Local Health Board • • • •

propose annual budget identify problems identify what programs Chairman, vice-chairman, chairman of committee on health, DOH representative, NGO representative

Two-way referral system Referral- intervention to direct client to another healthcare facility to continue his/her treatment Population BHS Midwife Sanitary Inspectors PHN

BHS RHU Midwife

Physician Secondary Health Care Facility  Tertiary Health Care Facility

BHW

Types of Health Care Systems 1) 2)

Tradit ditional nal a. E.g. E.g. cli clien entt prov provid ider er NonNon-Tr Trad adit itio iona nall a. Holi Holist stic ic Hea Healt lth h Cent Center ers s i. Believes that time, time, space and encouragement encouragement can help people people find strength to deal with problems confronting them ii. Spiritual, Spiritual, physical and psychological psychological care iii.Acts: 1. Past Pastor oral al coun counse seli ling ng 2. Stre Stress ss redu reduct ctio ion n 3. Parenting 4. Diet Dietar ary y cond condit itio ioni ning ng b. Fai Faith Healin ling i. Believes that that disease is a state state of mind so one can can alter his state state of mind so he will be healed c. Chiropractic

i. System of manipulation treatment which teaches that all diseases are caused d. e. f. g.

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by impringement on spinal column and corrected by spinal adjustment ii. Daniel PalmerPalmer- founder founder Acupuncture i. Insertion Insertion of needles into into selected body parts parts to control control pain Acupressure i. Finger pressure pressure to control control pain pain in body parts parts Kinesiology i. Study of movement movement which applies applies principles principles of anatomy to movement movement Reflexology i. Systematic Systematic massage massage of soles of of feet ii. Applies same principles principles as applied in acupressure Massage i. Relieves tension, tension, enhances flexibility flexibility and creates creates coordination coordination between mind and body Homeopathy i. Use of variety of herbs, drugs drugs and chemicals that when used used in small quantities quantities can cure or prevent disease caused by same substance in larger doses

Health Promotion, Health Maintenance, and Disease Prevention Health Promotion •

Defintion WHO- “Health promotion includes encouraging healthy lifestyles, creating supportive environments for health, strengthening community action, reorienting health services to place primary focus on promoting health and preventing disease, and building healthy public policy.” ○ Pender, 1996- “Health promotion is a behavior motivated by the desire to increase well being and actualize human health potential.” Health promotion includes any activity that helps people to change or maintain lifestyles that support a state of optimal health or balance of physical, emotional, social, spiritual and intellectual health. Prominence of health promotion came about as a result of changing patterns of health and corresponding emphasis on “lifestyle” as a factor. PHE (Public Health Education) can only have impact on PH only if joined other sectors and brought multiples social forces to bear. Green- “Behavioral changes that health education is able to effect can only be maintained if  supportive environment were provided via: political, economic, social, biological and other sectors.” 1st use of term, health promotion- 1945, Henry E. Sigerist Defined 4 major tasks of medicine ○ Promotion of health   Prevention of illness Restoration of the sick   Rehabilitation ○

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Sigerist: “Health is promoted by providing a good labor condition, education, physical culture and means of rest and recreation.” Concepts used and found in Ottawa Charter for Health Promotion which  occurred 40 years later 1986, WHO, Health and Welfare Canada and Canadian Public Health Association organized an International Conference on Health Promotion later known as Ottawa Charter ○ ○ Guiding principle in health promotion efforts currently ○

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Ottawa Charter for Health Promotion • •

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“Process of enabling people to increase control over and to improve their health”  To reach a state of complete physical, mental and social well-being , an individual or group must be able to identify and to realized aspiration; to satisfy needs and to change and cope with environment Health promotion is not just a responsibility of the health sector, but goes beyond healthy lifestyles to well-being. Prerequesite for Health Peace ○ ○ Shelter Education ○ ○ Food ○ Income ○ A stable eco-system ○ Sustainable resources ○ Social Justice ○ Equity In order to operationalize the concept of Health Promotion, the Charter recommended the following areas. Build Health Public Policy ○ Coordinated action that leads to health, income and social policies that  foster greater equity Create Supportive Environment ○  Societies are complex and interrelated  Overall guiding principle is the need to encourage reciprocal maintenance to take care of each other, our communities and our natural environment  Conservation of natural resources throughout world should be emphasized as a global responsibility Changing patterns of life; work and leisure leave a significant impact on  health Systematic assessment of health impact of rapidly changing environment,  especially in areas of technology, works, energy production and urbanization ○ Strengthen Community Action  Setting priorities, making decisions, planning strategies and implementing Heart of this process is Empowerment of communities   Community development helps to enhance self-help and social support, to develop flexible system for strengthening public participation in and direction of health matters Develop Personal Skills ○   Through providing information, education for health and enhancing life skills  Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illnesses and injuries ○ Reorient Health Services  Health services are shared among individuals; community groups, health service institutions and government