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COMMUNITY HEALTH NURSING

Prof. Michael Bryann Sta.Maria-Flores BSN, RN, RM, MAN(c)

Roles of the DOH:


1. Leadership in health
Serve as the national policy and regulatory institution
Provide leadership in the formulation, monitoring and evaluation of the national health policies, plans and programs
Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and capacity builder
Innovate new strategies in health
Exercise oversight functions and monitoring and evaluation of national health plans, program and policies
Ensure the highest achievable standards of quality health care, promotion and protection
3. Administrator of specific services
Manage selected national health facilities and hospitals with modern and advanced facilities
Administer direct services for emergent health concerns that require new complicated technologies

Vision: The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines
Mission: Guarantee equitable, sustainable quality health for all Filipinos, especially the poor and shall lead the quest for excellence in Health.
Goal: Health Sector reform Agenda (HSRA)

Rationale for HSRA:


Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates
Persistence of large variations in health status across population groups and geographic areas
High burden from infectious diseases
Rising burden from chronic and degenerative diseases
Unattended emerging health risks from environmental and work related factors
Burden of disease is heaviest on the poor
Framework for the Implementation of HSRA: FOURmula One for Health
Goals of FOURmula ONE for Health:
1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing

Elements of the Strategy:


1. Health financing to foster greater, better and sustained investments in health
2. Health regulation to ensure quality and affordability of health goods and services
3. Health service delivery to improve and ensure the accessibility and availability of basic and essential health care in both public and
private facilities and services
4. Good governance to enhance health system performance at the national and local levels
Roadmap for All Stakeholders in Health: National Objectives for Health 2005 2010
National Objective for Health: sets the target and the critical indicators, current strategies based on field experience, and laying down new avenues
for improved interventions.
Objectives of the Health Sector:
Improve general health status of the population
Reduce morbidity and mortality from certain diseases
Eliminate certain diseases as public health problems
Promote healthy lifestyle and environmental health
Protect vulnerable groups with special health and nutrition needs
Strengthen national and local health systems to ensure better health service delivery
Pursue public health and hospital reforms
Reduce the cost and sure the quality of essential drugs
Institute health regulatory reforms
Strengthen health governance and management support systems
Institute safety nets for the vulnerable and marginalized groups
Expand the coverage of social health insurance
Mobilize more resources for health
Improve efficiency in the allocation, production and utilization of resources for health
PRIMARY HEALTH CARE
LOI 949 signed by President Marcos with an underlying theme: Health in the Hands of the People by 2020

Concept of PHC - characterized by partnership and empowerment of the people that shall permeate as the core strategy in the effective provision
of essential health service that are community based, accessible, acceptable and sustainable at a cost which the community and the government
can afford

Elements/Components of Primary Health Care:


Education for Health
Locally Endemic and Communicable Disease Control and Treatment
Expanded Program on Immunization
Maternal and Child Health and Family Planning

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Essential drugs
Nutrition
Treatment (Medical care and Emergency treatment)
Sanitation of the Environment

Strategies of Primary Health Care


1. Reorientation and reorganization of the national health care system
2. Effective preparation and enabling process for health action at all levels
3. Mobilization of the people to know their communities and identifying their basic health needs
4. Development and utilization of appropriate technology
5. Organization of communities
6. Increase opportunities for community participation
7. Development of intra-sectoral linkages
8. Emphasizing partnership

Four Cornerstones/Pillars in Primary Health Care


1. Active community participation
2. Intra-intersectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

Types of Primary Health Care workers depend upon:


Available health manpower resources
Local health needs and problems
Political and financial feasibility

Two levels of primary health care workers:


1. Village or Barangay Health workers
2. Intermediate level health workers

Levels of Health Care and Referral System


1. Primary level of Care health care provided by center physicians, PHN, Rural Health Midwives, barangay health workers and others at the
barangay health station and rural health units
2. Secondary level of care given by physicians with basic health training; given in health facilities which are privately owned or government
operated such as infirmaries, municipal and district hospitals and OPD of provincial hospitals; serves as the referral center for primary
health facilities
3. Tertiary level of care care rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals
and specialized hospitals

Functions of the PHN:


1. Management function
2. Training Function
3. Supervisory function
4. Health care provider/ Nursing care function
5. Health promotion and education function
6. Collaborating and coordinating function
7. research function

COMMUNITY HEALTH NURSING PROCESS


Assessment
Initiate contact
Demonstrate caring attitudes
Mutual trust and confidence
Collect data from all possible sources
Identify health problems
Assess coping ability
Analyze and interpret data

Planning Nursing Action


Prioritize needs
Establish goals based on needs
Construct action and operation plan
Develop evaluation parameters
Revise plan as needed
Implementation of planned care
Put nursing care plan to action
Coordinate care/ services
Utilize community resources
Delegate
Supervise/monitor health services provided
Provide health education and training
Document responses

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Evaluation of Care and Services Rendered
Nursing audit
Care outcomes
Performance appraisal
Estimate cost benefit ratio
Re-assessment of problems
Identify needed alterations
Revise plans as necessary

NURSING PROCEDURES

Clinic visit patient visits the Health center to avail of the services thereto offered by the facility primarily for consultation on matters that ailed them
physically

Standard procedures performed during clinic visits:


I. Registration/ Admission
1. Greet client and establish rapport
2. Prepare the family record or retrieve records of old clients
3. Elicit and record the clients chief complaint and clinical history
4. Perform physical examination on the client and record it accordingly

II. Waiting time


1. Give priority numbers to clients
2. Implement the first come, first served policy except for emergency cases

III. Triaging
1. Manage program-based cases (like the IMCI)
2. Refer all non-program based cases to the physician
3. Provide first aid treatment to emergency cases and refer to the next level when necessary

IV. Clinical evaluation


1. Validate clinical history and physical exam
2. Nurse arrives at evidence-based diagnosis and provides rational treatment based on DOH programs
3. Inform the client on the nature of the illness, appropriate treatment and prevention and control measures

V. Laboratory and other diagnostic examinations


1. Identify a designated referral laboratory when needed

VI. Referral system


1. Refer patient if he needs further management following the 2-way referral system
2. Accompany the patient when an emergency referral is needed

VII. Prescription/dispensing
1. Give proper instructions on drug intake

VIII. Health education


1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit

Blood pressure measurement


Procedure:
1. Preparatory phase
Introduce self to client
Make sure client is relaxed and has rested for at least 5 minutes
Explain the procedure
Assist to a seated or supine position

2. Applying the BP cuff and stethoscope


Bare clients arm
Apply cuff around upper arm 2-3 cm above brachial artery
Keep manometer at eye level
Keep arm level with his heart by placing it on a table or a chair arm or by supporting it
Palpate brachial pulse correctly just below or slightly medial to the antecubital area
3. Obtaining the BP reading by using palpatory method
While palpating the brachial or radial pulse, close valve or pressure bulb and inflate cuff until pulse disappears
Note point at which pulse disappeared palpated systolic BP
Deflate cuff fully
Wait 1-2 minutes before inflating cuff again

Obtaining the BP reading by auscultation


Place earpieces of stethoscope in ears and stethoscope head over the brachial pulse
Use the bell of the stethoscope to auscultate pulse

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Watching the manometer, inflate the cuff rapidly by pumping the bulb until the column reaches 30 mmHg above the palpatd SBP
Deflate the cuff slowly at a rate of 2-3 mmHg per beat
While the cuff is deflating, listen for pulse sounds (Korotkoff sounds) (1st clear tapping sound Systolic BP and disappearance of sound
Diastolic BP
4. Recording BP and other guidelines
For every visit, take the mean of 2 reading, obtained at least 2 minutes apart
If first visit, repeat procedure with other arm. Subsequent BP readings should be performed on the arm, with a higher BP reading

Home visit family nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing
care and health related activities

Purpose of Home Visit:


1. To give nursing care to the clients
2. To assess living conditions of the patient and his family and their health practices
3. To give health teachings regarding prevention and control of diseases
4. To establish close relationships between the health agencies and the public
5. To make use of the inter-referral system and to promote the utilization of community services

Principles involve in Preparing for a Home visit:


1. Must have a purpose or objective
2. Should make use of all available information about a patient
3. Should consider and give priority to needs of clients
4. Should involve the clients
5. Should be flexible

Guidelines to consider regarding the Frequency of Home Visits


1. Needs of the client
2. Acceptance of the family
3. Policy of a specific agency
4. Other health agencies and personnel involved in care of family
5. Past services given to families
6. Ability of clients to recognize own needs

Steps in conducting home visits


1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine the health needs
4. Put the bag in a convenient place then proceed to perform the bag technique
5. Perform nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make an appointment for a return visit

Bag Technique: too by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and
effort

Public Health Bag: an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits

Principles of Bag Technique:


1. Minimize, if not prevent the spread of infection
2. Saves time and effort of the nurse
3. Should show effectiveness of total care given to an individual or family
4. Can be performed in a variety of ways

Important points to consider in the use of the bag technique:


1. The bag should contain all necessary articles, supplies and equipments that will be used
2. The bag and its contents should be cleaned very often, supplies replaced and ready for use anytime
3. The bag and its contents should be well-protected from contact with any article in the paitents home.
4. The arrangement of the contents of the bag should be the one most convenient for the user, to facilitate efficiency and avoid confusion

Nursing care in the Home

Principles in Nursing Care:


1. Nursing care utilizes a medical plan of care and treatment
2. Performance of nursing care utilizes skills that would give maximum comfort and security to the individual
3. Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family
4. Performance of nursing care should recognize dangers in the patients over-prolonged acceptance of support and comfort
5. Nursing care is a good opportunity for detecting abnormal signs and symptoms, observing patients attitude towards care given and the
progress of the patient

COMMUNITY ORGANIZING
Maglaya DOH
1. Preparatory Phase Community Analysis
2. Organizational Phase Design and Initiation

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3. Education and training Implementation
4. Collaboration Phase Program Maintenance-
Consolidation
5. Phase Out Dissemination
Reassessment

1. Community analysis
5 components
Demographic, social and economic profile of the community derived from secondary data
Health risk profile
Health/wellness outcome profile
Survey of current health promotion programs
Studies conducted in certain target groups
Steps in community analysis
Define the community
Collect data
Assess community capacity
Assess community barriers
Assess readiness for change
Synthesis of data and set priorities

2. Design and initiation


Establish a core planning group and select a local organizer
Choose an organizational structure
Identify, select and recruit organizational members
Define the organization mission and goals
Clarify roles and responsibilities of people involved in the organization
Provide trainings and recognition

3. Implementation
Generate broad citizen participation
Develop a sequential work plan
Use comprehensive integrated strategies
Integrate community values

4. Program maintenance consolidation


Integrate intervention activities into community networks
Establish a positive organizational structure
Establish an ongoing recruitment plan
Disseminate results

5. Dissemination reassessment
Update the community analysis
Assess effectiveness of interventions/programs
Chart future directories and modifications
Summarize and disseminate results

GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS

Community Diagnosis: an in-depth process of finding out the profiles, health status of the community and the factors affecting the present status

Contents:
1. Introduction
1.1 Rationale accurate, valid, timely and relevant information on the community profile and health problems are essential so that
resources can be maximized
1.2 Purpose to analyze the data in order to develop responsive intervention strategies that address the root cause of the problem
1.3 Statement of Objective what are to be accomplished to attain the study
1.4 Methodology and tool used a description of the adoption, construction and administration of instruments
1.5 Limitation of the study state any limitations that exist in the reference or given population or area of assignment

2. Target Community Profile


2.1 Geographical Identifiers historical background, location, boundaries, population, physical features, climate, spot map
2.2 Population Profile Total estimated population of Barangay, Population Density,
2.3 Socio-demographic Profile total population of families surveyed, number of households, age and sex distribution, sex ratio,
dependency ratio, civil status, types of families, religious distribution, place of origin, length of residency
2.4 Socio-economic indicators educational attainment, literacy rate, occupation, income, housing, ventilation
2.5 Environmental indicators Water supply, excreta disposal, garbage disposal, pet ownership, domestic animals
2.6 Health profile food storage, infant feeding practices, immunization, community facilities, health seeking behaviors, communication
resource and family planning
2.7 Morbidity and mortality data leading cause of morbidity, mortality, infant mortality and maternal mortality

3. Analysis of Data
3.1 Identification of health problems

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3.2 Prioritized problems identified

4. Action plan based from prioritized problem identified


4.1 Intervention strategies

5. Conclusion

6. Recommendation

Community Diagnosis
1. Preparation of Community Diagnosis
a. Identify barangay to survey or required by the health center
b. Ocular survey
c. Community assembly
2. Conduct of survey proper using the format/survey form
a. Random sampling or saturation
b. Guidelines in filling survey form
c. Data collection techniques
3. Make graph or chart of each data gathered
4. Data analysis and interpretation
5. Preparation of action plan /project plan
HEALTH PROMOTION AND EDUCATION

Ottawa charter for Health Promotion

Health promotion process of enabling people to increase control over and to improve their health

Prerequisite for Health:


Peace
Shelter
Education
Food
Income
A stable eco-system
Sustainable resources
Social justice
Equity

To Operationalize concept of health promotion, the Charter recommended the following action ares:
Build Health Public policy
Create supportive environment
Strengthen community action
Develop personal skills
Reorient health services

WHO Principles of Health Promotion:


1. Involves the population as whole in the context of their everyday life
2. It is directed towards actions on the determinants or causes of health
3. It combines diverse, but complementary methods or approaches
4. It aims particularly at effective and concrete public participation
5. It is primarily a societal and political venture and not a medical service

Health Education any combination of learning experience designed to facilitate voluntary adoptions of behaviors conducive to health

EPIDEMIOLOGY
Epidemiology: study of occurrences and distribution of diseases as well as the distribution and determinants of health state or events in a
specified population, and the application of this study to the control of health problems

Uses of Epidemiology:
1. Study the history of the health population and the rise and fall of diseases and changes in their character
2. Diagnose the health of the community
3. Study the work of health services with a view of improving them
4. Estimate the risk of disease, accident, defects and the chances of avoiding them
5. Identify syndromes by describing the distribution and association of clinical phenomena in the population
6. Complete the clinical picture of chronic disease and describe their natural history
7. Search for causes of health and disease by comparing the experience of groups

Epidemiologic triangle: Agent, Host and Environment


Agents of disease:
Nutritive elements in excess or in deficiencies
Chemical agents

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Physical agents
Infectious agents
Host Factors (intrinsic factors) influence exposure, susceptibility or response to agents
Genetics
Age
Sex
Ethnic group
Physiologic functioning
Immunologic experience
Inter-current or pre-existing disease
Human behavior
Environmental factors (extrinsic factors) - influence existence of the agent, exposure or susceptibility to agents
Physical environment
Biologic environment
Socio-economic environment
Preventive strategies :
1. Change the peoples behavior to manipulate the environment and reduce their exposure to biological and non-biological disease agents
2. manipulate the environment and prevent production or presence of disease agents
3. Increase mans resistance or immunity to disease agents
Patterns of Occurrence and Distribution of Disease:
1. Sporadic occurrence intermittent occurrence of a few isolated and unrelated cases in a given locality
2. Endemic occurrence continuous occurrence throughout a period of time
3. Epidemic occurrence unusually large number of cases in a relatively short period of time
4. Pandemic simultaneous occurrence of epidemic of the same disease in several countries
Outline of Plan for Epidemiological Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relations to characteristic of the group of community
4. Correlation of all data obtained
Steps in Outbreak Investigation:
1. Prepare for field work
2. Establish existence of an outbreak
3. Verify diagnosis
4. Define and Identify cases
5. Perform descriptive epidemiology
6. Developing hypotheses
7. Evaluate hypotheses
8. Refine hypotheses and execute additional studies
9. implement control and prevention measures
10. Communicate findings
11. Follow-up Recommendations
National Epidemic Sentinel Surveillance System (NESSS)
Hospital based information system that monitors the occurrence of infectious diseases with outbreak potential
Serves as a supplemental information system of the Dept of Health
Objectives:
To provide early warning on occurrence of outbreaks
To provide program managers, policy makers, and public administrators, rapid, accurate and timely information so that inventive and
control measures can be instituted
NESS DATA shows:
Trends of cases across time
Demographic characteristics of cases
Estimates of case fatality ratio
Clustering of cases in a geographical area
Information to formulate hypotheses for disease causation
Diseases under surveillance (NESSS)
Laboratory diagnosed
Cholera
Hepatitis A
Hepatitis B
Malaria
Typhoid fever
Clinically diagnosed
Dengue Hemorrhagic fever
Diphtheria
Measles
Meningococcal disease
Neonatal tetanus
Non-neonatal tetanus
Pertussis
Rabies
Leptospirosis
Poliomyelitis
Under surveillance system:

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1. Acute flaccid paralysis
2. Measles
3. Maternal and neonatal tetanus
4. Paralytic shellfish poisoning
5. Fireworks and related injury
6. HIV/AIDS
Importance of outbreak investigation:
Control and prevention measure
Severity and risk to others
Research oppurtunities
Public, political or legal concerns
Program consideration
Training
Sources:
Surveillance data
Medical practitioner
Affected persons/ groups
Concerned citizens
Media
Functions of the Epidemiology Nurse:
1. Implement public health surveillance
2. Monitor local health personnel conducting disease surveillance
3. Conduct and/ or assist other health personnel in outbreak investigation
4. Assist in the conduct of rapid surveys and surveillance during disasters
5. Assist in the conduct of surveys, program evaluations and other epidemiologic studies
6. Assist in the conduct of training course in epidemiology
7. Assist the epidemiologist in preparing the annual report and financial plan
8. Responsible for inventory and maintenance of epidemiology and surveillance unit equipment

VITAL STATISTICS
Systematic study of vital events such as births, illnesses, marriages, divorces, separation and deaths
Use of Vital Statistics:
Indices of the health and illness status of a community
Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services
Sources of Data:
Population census
Registration of vital data
Health survey
Studies and research
Rate shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during
a specified unit of time
Ratio used to describe the relationship between 2 numerical quantities or measures of events without taking particular considerations to the
time of place
Crude or general rates referred to the total living population
Specific rate the relationship is for a specific population class or group
Presentation of Data:
Line or curved graphs shows peaks, valleys and seasonal trends
Bar graphs for comparison of data
Area diagram or pie charts shows relative importance of parts to the whole
Functions of the Nurse:
Collects data
Tabulates data
Analyzes and interprets data
Evaluates data
Recommends redirection and or strengthening of specific areas of health programs as needed
FIELD HEALTH SERVICES AND INFORMATION SYSTEM
Objectives:
To provide summary of data on health service delivery and selected programs
To provide data which can be used for program monitoring and evaluation purposes
To provide a standardized, facility level data base which can be accessed for a more in-depth study
To ensure that the data reported are useful and accurate
To minimize recording and reporting burden at the service delivery level
Components:
1. Family treatment record fundamental building block or foundation of the FHSIS
2. Target client list second building block
3. Reporting forms
4. Output reports
Reporting Units:
Barangay Health Stations/ Barangay Health Centers
Rural Health Units or Main Health Center
Provincial hospital or City Health Office
Regional Hospital
SCHOOL NURSING

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Objectives: To promote and maintain the health of the school populace by providing comprehensive and quality nursing care
Functions:
1. School Health and Nutrition Survey
2. Putting up a functional School Clinic
3. Health assessment
4. Standard vision testing for school children
5. Ear examination
6. Ht and wt measurement and nutritional status determination
7. Medical referrals
8. Attendance to emergency cases
9. Student health counseling
10. Health and nutrition education activities
11. Organization of School-Community Health and Nutrition Councils
12. Communicable disease control
13. Establishment of Data bank on school health and nutrition activities
14. School plant inspection
15. Rapid classroom inspection
16. Home visitation
OCCUPATIONAL HEALTH NURSING
Primary focus: Mission of occupational health and safety is to assure every working man and woman in the country is safe and in healthful working
conditions
Essential Components:
1. Health promotion and prevention
2. Worker and workplace health hazard assessment and surveillance
3. Injury and illness investigation
4. Primary care
5. Case management
6. counseling
7. Management administration
8. Legal/ethical monitoring
9. Research
10. Community orientation
Issues in Occupational Health Nursing
A. Categories of Workplace Hazards
Physical hazards
Chemical hazards
Biologic hazards
Mechanical hazards
Psychosocial hazards
B. Work-related Injuries and Illnesses
C. Workers compensation
PUBLIC HEALTH PROGRAMS
FAMILY HEALTH
Aims to:
1. Improve the survival, health and well-being of mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal and
postnatal packages.
2. Reduce morbidity and mortality rates for children 0-9 years.
3. Reduce mortality from preventable causes among adolescents and young people.
4. Reduce mortality and morbidity among Filipino adults and improve their quality of life.
5. Reduce morbidity and mortality of older persons and improve their quality of life
Maternal Health Program
Strategic thrusts for 2005-2010
Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH.
Improve the quality of prenatal and postnatal care
Reduce womens exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health
care package to all women of reproductive age
LGUs, NGOs and other stakeholders must advocate for heatlh through resource generation and allocation for health services to be
provided for the mother and the unborn
A. Antenatal Registration
Prenatal Visits Period of Pregnancy
1st visit As early as possible before 4 months
or during the 1st trimester
2 visit
nd During the 2nd trimester
3 visit
rd During the 3rd trimester
Every 2 weeks After 8th month until delivery
B. Tetanus Toxoid Immunization
A series of 2 doses of TT vaccination must be received by a woman one month before delivery to protect the baby from neonatal tetanus
3 booster dose shots are needed to complete the five doses following the recommended schedule to provide full protection for both mother
and child
mother is then called as a fully immunized mother
C. Micronutrient supplementation:
Vit A: 10,000 IU 2x a week starting on 4th month of pregnancy
Iron: 600mg/400ug tablet daily
D. Treatment of Diseases and other conditions

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E. Clean and Safe Delivery
1. Do a quick check upon admission for emergency signs.
2. Make the woman comfortable/
3. Assess the woman in labor.
4. Determine the stage of labor.
5. Decide if the woman can safely deliver.
6. Give supportive care throughout labor.
7. Monitor and manage labor.
8. Monitor closely within one hour after delivery and give supportive care.
9. Continue care after one hour postpartum.
10. Educate and counsel on Family Planning and provide Family Planning Method if available and decisions made by the woman.
11. Inform, teach and counsel the woman on important MCH messages:
birth registration
importance of breastfeeding
Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth
Schedule when to return for consultation for post partum visits
1st visit 1st week post partum preferably 3-5 days
2nd visit 6 weeks post partum

FAMILY PLANNING
Goal: Provide universal access to family planning information and services wherever and whenever these re needed
Vaccin Minim # of Minimu Route, Storag Type/ form
FP Aims to contribute to:
e um Dos m Dosage, e temp of vaccine
Reduced infant deaths age at es interval Site
Neonatal deaths 1st betwee
Under-five deaths dose n doses
Maternal deaths BCG Birth 1 ID 2-8 C Freeze
Objectives: or 0.05 ml in dried, live
Addresses the need to help couples and individuals achieve anyti Right body attenuated
their desired family size within the context of responsible me arm of ref bacteria
parenthood and improve their reproductive health to attain after
sustainable development birth
Ensure that quality FP services are available in DOH retained DPT 6 3 4 weeks IM 2-8 C D
hospitals, LGU managed health facilities, NGOs and private weeks 0.5 ml in weakened
sector Thigh body toxin
Strategies: (vastus of ref P killed
Focus service delivery to urban and rural poor lateralis) bacteria
Reestablish the FP outreach program T toxin
Strengthen FP provision in regions with high unmet needs OPV 6 3 4 weeks Oral -15 to Live
Promote frontline participation of hospitals weeks 2 drops -25C attenuated
Mainstream modern natural family planning Mouth (freez virus
Promote and implement CSR strategy er)
Different Family Planning Methods: Hepa At 3 6 wks IM 2-8 C RNA
1. Female sterilization B birth interval 0.5 ml in recombinan
2. Male sterilization from 1st Thigh body t
3. Pills dose to (vastus of ref
4. Male condom 2nd lateralis)
5. Injectibles dose, 8
6. Lactational amenorrhea method (LAM) wks
7. Mucus/ Billings Method interval
8. Basal Body temperature from 2nd
9. Two-day method to 3rd
10. Symptothermal method dose
11. Standard days method Measl 9 1 SQ -15 to Freeze
Misconceptions about Family Planning Methods: es month 0.5 ml -25C dried, live
Some family planning methods cause abortion s Outer (freez attenuated
Using contraceptives will render couples sterile part of er) virus
Using contraceptive methods will results to loss of upper
sexual desire arm
CHILD HEALTH PROGRAMS
Infant and young child feeding
Newborn screening
Expanded program on immunization
Management of childhood illnesses
Micronutrient supplementation
Dental health
Early child development
Child health injuries
National Plan iof Action for 2005-2010 for Infant and Young Child Feeding

Goal: Reduce child mortality rate by 2/3 by 2015

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Objective: To improve health and nutrition status of infants and young children
Outcome: To improve exclusive and extended breastfeeding and complementary feeding
Key messages on infant and young child feeding
Initiate breastfeeding within 1 hour after birth
Exclusive for the first 6 months of life
Complemented at 6 months with appropriate foods, excluding milk supplements
Extend breastfeeding up to 2 years and beyond.
Breastfeeding benefits
To Infants:
Provides a nutritional complete food for the young infant
Strengthens infants immune system
Safely rehydrates and provides essential nutrients
Reduces infants exposure to infection
Increase IQ points

To Mother:
Reduces womans risk of excessive blood loss after birth
Provides natural methods of delaying pregnancies
Reduces the risk of ovarian and breast cancers and osteoporosis

To Household and the Community:


Conserve funds that would be spent on breastmilk substitute
Saves medical cost to families

EPI

Principles in Vaccinating Children:


It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body.
Measles vaccine should be given as soon as the child is 9m/o.
Vaccination schedule should not be restarted from beginning even if interval exceeds recommended interval.
Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination.
Absolute contraindications: DPT 2 or DPT3 to a child who had convulsions or shock within 3 days after DPT administration; BCG to
immunosuppressed clients
Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen antibody response
False contraindications: malnutrition, low-grade fever, mild respiratory infections, and other minor illnesses and diarrhea
Management of CHILDHOOD ILLNESSES
Methods:
Assess the patient
Classify the disease
Treat the patient
Counsel the patient

Color Presentation Classification of Disease Level of Management


Green Mild Home Care
Yellow Moderate Managed at the RHU
Pink Severe Urgent Referral in Hospital
NUTRITION PROGRAM
Goal: Improve the quality of life of Filipinos through better nutrition, improved health and increased productivity
Strategies:
1. Food based interventions for sustained improvements in nutritional status
2. Life-cycle approach with strategic attention to 0-3 year old children, adolescent females and pregnant/lactating women
3. Geographical focus to needier areas
Programs and projects:
1. Micronutrient Supplementation Araw ng Sangkap Pinoy
2. Food Fortification
3. Essential maternal and child health service package
4. Nutrition information, communication and education
5. Home, school and community food production
6. Food assistance includes center based complementary feeding for wasted/stunted children and pregnant women
7. Livelihood assistance

ORAL HEALTH PROGRAM


Goal: Reduce the prevalence rate of dental caries and periodontal diseases by the end of 2010 among general population
Objectives:
Increase proportion of Orally Fit Children under 6 y/o to 80% by 2010
Control oral health risks among the young people
Improve the oral health conditions of pregnant women by 20% and older persons by 10% every year until 2010

Classification of Oral Interventions:


Preventive services
Curative/treatment services

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Promotive services

ADOLESCENT HEALTH PROGRAM

Essential health care package for the Adolescent and Youth:


1. Management of illness
2. Counseling on substance abuse, sexuality and Reproductive tract infections
3. Nutrition and diet counseling
4. Mental health
5. Family planning and responsible sexual behavior
6. Dental care

ADULT MEN AND WOMEN

Essential health care package for the Adult Male and Female:
1. Management of illness
2. Counseling on substance abuse, sexuality and Reproductive tract infections
3. Nutrition and diet counseling
4. Mental health
5. Family planning and responsible sexual behavior
6. Dental care
7. Screening and management of lifestyle related and other degenerative diseases

PHILIPPINE REPRODUCTIVE HEALTH

Main objectives:
Reducing maternal mortality rate
Reducing child mortality rate
Halting and reversing spread of HIV/AIDS
Increasing access to reproductive health information and services

10 Element of RH:
1. Family planning
2. Maternal and Child Health and Nutrition
3. Prevention and Management of Reproductive Tract Infections
4. Adolescent Reproductive Health
5. Prevention and Management of Abortion and its complications
6. Prevention and Management of Breast and Reproductive Tract Cancers and other gynecologic principles
7. Education and counseling on Sexuality and Sexual Health
8. Violence against Women and Children
9. Prevention and management of Infertility and Sexual Dysfunction
10. Mens Reproductive Health

FAMILY NURSING ASSESSMENT:


Steps:
1. Data Collection
2. Data Analysis
3. Family Nursing Diagnoses
Criteria for Prioritization of Family health problems:
1. Nature of the problem
2. Modifiability of the problem
3. Preventive potential
4. Salience

Family Nursing Care Plan: Blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family
nursing problems
Features:
1. Focuses on actions to solve or minimize existing problems
2. Product of a deliberate systematic process
3. Relates to the future
4. Based upon health and nursing problems
5. Means to an end
6. Continuous proess

Qualities:
1. Based on a problem
2. Realistic
3. Prepared jointly with the family
4. In written form
Steps in Developing FNCP
1. Prioritize the Health Conditions and Problems
2. Define Goals and Objectives of Care
3. Select Appropriate Nursing Interventions
4. Develop Evaluation Plan

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NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL
Goal: Reduce the toll of morbidity, disability and premature deaths due to chronic, non-communicable lifestyle related disease
Key intervention Strategies:
1. Establishing program direction and infrastructure
2. Changing environments
3. Changing lifestyle
4. Reorienting health services
4 Major non-communicable diseases:
Cardiovascular diseases
Cancer
Chronic obstructive pulmonary disease
Diabetes mellitus
Role of the PHN in NCD prevention and control:
Health advocate PHN promotes active community participation in NCD prevention and control; helps people towards optimal degree of
independence in decision making and in asserting their right to a safer and better community
Health educator concerned with promoting health as well as reducing behavior-induced disease, focuses on establishing or inducing
changes in personal and group attitudes and behavior that promote healthier living
Health care provider
Community organizer community health development and empowerment of the people by raising their levels of awareness regarding non
communicable diseases
Health trainer provides technical assistance in the assessment of the skills of auxiliary health workers in NCD prevention and control
Researcher provides valuable information for prevention and control
Risk factor Cardio- Diabetes Cancer Respiratory
vascular conditions
dse
Smoking
Diet
Physical
inactivity
Obesity
Alcohol
Increased
BP
Bld glucose
Bld lipids

Risk Factor Key area for Prevention


Elevated blood Promote proper nutrition:
lipid limit intake of fatty, salty and
High intake of preserved foods
fatty foods increase intake of vegetables and
Inadequate intake fruits
of dietary fiber avoid high calorie low nutrient value
food
start developing healthy habits in
children
Overweight and Encourage more physical activity and exercise:
obesity Moderate physical activity of at least
Sedentary 39 minutes for most days
lifestyle Integrate physical inactivity and
exercise into regular activities
Encourage walking as exercise
Smoking Promote smoke-free environment:
Smoking cessation for active smokers
Prohibit smoking inside living areas
Avoid smoke-filled places
Advocate for implementation of
policies and Clean Air Act
Support Policies that limit access of
youth to cigarettes
Excessive use of Discourage excessive drinking of alcoholic
alcohol beverages
Hyperlipidemia, Early diagnosis and prompt treatment
HPN, DM

NATIONAL PREVENTION OF BLINDNESS PROGRAM


VISION 2020: Right to Sight is global initiative to eliminate avoidable blindness by year 2020
Vision: All Fililpinos enjoy the right to sight by year 2020
Mission: The DOH, Local Health Units, partners and stakeholders commit to:
1. Strengthen partnership among and with stakeholders to eliminate avoidable blindness in the Philippines
2. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness
3. Provide access to quality eye care services for all

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4. Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos
Goal: Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care
5 preventable/treatable conditions causing blindness:
Cataract
Refractive errors and low vision
Trachoma
Onchocerciasis
Childhood blindness
MENTAL HEALTH AND MENTAL DISORDERS
Four Facets as public health burden:
Defined burden burden currently affecting persons with mental disorders and is measured in terms of prevalence and other indicators
such as quality of life
Undefined burden portion of the burden relating to the impact of mental health problems to persons other than the individual directly
affected
Hidden burden refers to the stigma and violations of human rights
Future burden refers to the burden in the future relating from the aging of the population, increasing social problems and unrest inherited
from the existing burden
Pointers for Having Mental Health:
Maintain good physical health
Undergo annual medical exam
Develop and maintain a wholesome lifestyle
Avoid smoking, substance abuse and excessive alcohol
Have a realistic goal in life
Have a friend whom you can confide and ventilate your problems
Dont live in the past and avoid worrying about the future
Live one-day at a time
Avoid excessive stress
Develop and sustain solid spiritual values
COMMUNITY DIAGNOSIS
Types:
1. Comprehensive Community diagnosis
2. Problem Oriented Community diagnosis
Steps:
1. Determining Objectives
2. Defining Study Population
3. Determining Data to be Collected
4. Data Collecting Methods
5. Developing the Instrument
6. Actual Data Gathering
7. Data Collation
8. Data Presentation
9. Data Analysis
10. Identifying Community Health Nursing Problems
11. Priority-Setting
Criteria for prioritization of COMMUNITY Problems:
1. Nature of the problem
2. Magnitude of the Problem
3. Modifiability of the Problem
4. Preventive Potential
5. Social concern
Environmental Sanitation: study of all factors in mans physical environment, which may exercise a deleterious effect on his health, well-being
and survival
Approved types of water facilities:
Level I Point source
Level II Communal faucet system or stand-posts
Level III Waterworks System or Individual House connections
Approved types of Toilet facilities:
Level I non-water carriages (pit latrines, reed odorless earth closet) and with water (pour flush toilets and aqua privies)
Level II on site toilet facilities water sealed and flush type with septic vault/tank disposal facilities
Level III toilet facilities connected to septic tanks and/or to sewerage system to treatment plant
FOOD SANITATION PROGRAM
Four rights in Food Safety:
Right source
Right preparation
Right cooking
Right storage
HOSPITAL WASTE MANAGEMENT PROGRAM
Policies:
All newly constructed/authorized and existing government and private hospitals shall prepare and implement a Hospital Waste
Management (HWM) program as a requirement for registration/renewal of licenses
Use of appropriate technology and indigenous materials for HWM system shall be adopted
Training of all hospital personnel involved in waste management shall be part of hospital training program

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Public information campaign on health and environmental hazards arising from mismanagement of hospital shall be the responsibility
of hospital administration
DOH HWM guidelines/policies shall be guided by existing legislative health and environmental protection laws policies on waste
management
Local ordinances regarding the collection and disposal techniques shall be institutionalized
SENTRONG SIGLA
Joint effort of the DOH and LGU
Aims to promote availability of quality health services in health centers and hospitals and to make these services accessible to every
Filipino
Main component is the certification recognition program that develops and promotes standards for health facilities
Guiding Principles
Recognition for achieving good quality shall be the main incentive in SS certification
Quality improvement is an unending process
Focus shall be on core public health programs that are most beneficial to the people
Quality improvement is a partnership that empowers all stakeholders
DOH shall give purposive technical assistance to targeted health facilities
Assessment for certification shall involve other stakeholders in order to provide objectivity and varying perspective into the process
GOALS:
Long-term: Institutionalize within the health sector the leadership, processes, knowledge, attitudes and skills and organizations to generate
continuous quality improvement in health care
Intermediate: To improve quality of health care in outpatient health facilities, hospitals and public health services in communities
Specific goal: To improve the quality of out-patient health care and of public health services in communities
Level and Scope of Certification:
1. Basic SS certification minimum input, process and output standards
2. Specialty awards second level quality standards
3. Award for Excellence highest level quality standards
4 Pillars of SSM
1. Quality Assurance Pillar
2. Grants and Technical Assistance Pillar
3. Health Promotion Pillar
4. Award Pillar
HERBAL MEDICINE
Herbal plant Uses
Sambong Anti-edema, diuretic, anti-urolithiasis
Akapulko Anti-fungal, Ringworm, athletes foot, scabies,
Tinea Flava
Niyug-niyogan Anti-helminthic
Tsaang Gubat For Diarrhea and Stomachache
Ampalaya Lower blood sugar levels
Lagundi For cough, fever, asthma, dysentery, colds
and pain, skin diseases, headache,
rheumatism, sprain, insect bites, aromatic
bath for sick patients
Ulasimang bato Lowers uric acid
Bayabas Washing wounds, diarrhea, toothache
bawang For hypertension and toothache
Yerba buena For pain, rheumatism, arthritis, cough and
cold, swollen gums, toothache, menstrual and
gas pain, nausea and fainting, insect bites and
pruritus

Reminders on the Use of Herbal Medicine:


1. Avoid the use of insecticides
2. Use a clay pot and remove cover while boiling at low heat.
3. Use only the part being advocated
4. follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptom or sickness.
6. Stop giving the herbal medication in cases of untoward reactions.
7. If signs and symptoms are not relieved after 2-3 doses, consult a doctor.

HEALTH EMERGENCY PREPAREDNESS AND RESPONSE PROGRAM

Legal mandate: Presidential Decree no. 1566. Strengthening the Philippine Disaster Control Capability and Establishing the National Program on
Community Disaster Preparedness

Disaster serious disruption of the functioning of a society, causing wide spread human, material or environmental losses which exceed the ability
of the affected society to cope
Emergency as any occurrence, which requires an immediate response
Hazards any phenomenon, which has the potential to cause disruption or damage to humans and their environment
Risk the level of loss or damage that can be predicted from a particular hazard affecting a particular place at a particular time from the point of
view of the community

Classifications of disaster according to its cause:

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1. Natural disaster force of nature
2. Human generated/manmade disaster

Classification of disasters according to onset:


1. Acute or sudden impact events
2. Slow or chronic genesis

Contributing Factors to disaster occurrence and severity:


1. Human vulnerability resulting from poverty and social inequality
2. environmental degradation resulting from poor land use
3. Rapid population growth especially among the poor

General Principles of Disaster Management


1. The first priority protection of people who are at risk
2. Second priority protection of critical resources and systems on which communities depend
3. Disaster management must be an integral function of national development plans and objectives
4. Disaster management relies upon an understanding of hazard risks
5. Capabilities must be developed prior to impact of a hazard.
6. Disaster management must be based upon interdisciplinary collaboration
7. Disaster management will only be as effective as the extent to which commitment, knowledge and capabilities can be applied.

Principles of Emergency Preparedness:


1. It is the responsibility of all
2. Should be woven into the community and administrative levels of both government and non-government organizations
3. Emergency preparedness is an important aspect of emergency management
4. Emergency preparedness is connected to other aspects of emergency management
5. Should concentrate on process and people rather than documentation
6. Emergency preparedness should not be done in isolation
7. Emergency preparedness should not concentrate only on disasters but integrate prevention and response strategies for any scale of
emergency
8. Hospitals play a very vital role in the management of emergencies
9. Main objective is to decrease mortality, morbidity and to prevent disability
10. Every hospital should have a regularly updated disaster plan

Purpose of the Disaster Plan:


1. To Provide policy for effective response to both internal and external disaster situations
2. Identify hospital capability to handle mass casualty
3. Identify responsibilities of individuals and departments in the event of a disaster situation
4. Identify standard operating guidelines for emergency activities and responses

NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM

RA 7719 Blood Services Act of 1994

Objectives:
To promote and encourage voluntary blood donation by the citizenry
To provide adequate, safe, affordable and equitable distribution of supply of blood and blood products
To mobilize all sectors of the community to participate in mechanisms for voluntary and non-profit collection of blood

Vision: Envision network of modernized national and regional blood centers operating on a fully, voluntary, non-remunerated blood donation
system

Mission: Ensure adequate, safe and accessible blood supply by:


a. promoting voluntary blood donation as a way of life
b. establishing new blood service facilities and upgrading existing ones
c. organizing association of blood donors and training medical practitioners on national blood use

Eligible Blood Donors must:


Weigh more than 45 kg for 250ml of donated blood; 50 kg for 450ml of donated blood
Be in good health
Be aged 16-5 yrs of age
Have BP in safe range 90-160 mmHg systolic and 60-100 mmHg diastolic
Have HGB at least 12.5g/dL

BOTIKA NG BARANGAY
Goal: To promote equity in health by ensuring the availability and accessibility of affordable, safe and effective quality essential drugs to all, with
priority for marginalized, underserved, critical and hard to reach areas.
Objectives:
To Rationalize the distribution of common drugs and medicines among intended beneficiaries
To serve as mechanism for the DOH to establish partnership with LGU and Community Organizations
Optimize involvement of the Barangay Health workers addressing the Health needs of the community

STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES 2006

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Public health nursing practice of nursing in local/national health departments; community health nursing practiced in the public sector
Community health nursing broader than public health nursing because it encompasses nursing practice in a wide variety of community services
and consumer advocate areas and in a variety of roles
Public health nurses refers to nurses in the local health departments whether their official position is Public Health Nurse or Nurse or School
Nurse
Nursing service separate and distinct unit of the local health agency which is composed of nurses, midwives and auxiliaries such as barangay
health workers, nursing aides and volunteers
Standard desired and achievable level of performance against which actual practice is compared
Criterion objective, measurable, relevant and flexible indicator related to performance, behavior, circumstances or clinical status

I. Organization and Management


A. A nursing service is organized in a local health agency to ensure the effective delivery of nursing services and nursing component of public health
programs
B. The nursing service is headed by a qualified chief nurse (RA 9173)
C. The nursing service has a written vision, mission, philosophy, goals and objectives.
D. The nursing service formulates/reviews and implements the nursing service plan, manual of policies and nursing standards.
E. The nursing service participates in planning for the health agencys physical facilities, equipment and supplies and in monitoring their use.
F. The nursing service participates in the official recruitment, selection, promotion and discharge process at all levels involving nursing personnel and
in making decisions involving nurses and midwives and nursing practice.
G. The Nursing service initiates/ strengthens mechanisms within the agency that enhance nursing and midwifery contribution to the overall
community health goals.

II. Qualifications and Functions of the PHN


A. The PHN has the professional, personal and other qualifications that are appropriate to his job responsibilities ( a graduate of BSN and a
registered Nurse,RN)
B. The PHN performs functions and activities in accordance with the dominant values of Public health nurses, within the professions ethicolegal
framework and in accordance with the needs of the client and available resources for health care.
C. The PHN, in coordination with the faculty of colleges of nursing, participates in teaching, guidance and supervision of students in nursing and
midwifery for their related learning experiences (RLE) in the community setting.
D. The PHN participates in the conduct or research and utilizes research findings in his/her nursing practice

III. Supervision
A. The PHN supervises midwives within her catchment area in accordance with the agencys policies and in a manner that improves performance
and promotes job satisfaction
1. The PHN formulates a supervisory plan.
2. The PHN conducts supervisory visits to implement the supervisory plan
3. The PHN regularly monitors and evaluates midwives and nursing auxiliaries performance in the implementation of public health
programs.
4. The PHN initiates and participates in activities to promote his/her supervisees personal and professional growth.
5. The PHN initiates and participates in developing policies and guidelines that promote good performance in nursing and midwifery
services.

IV. Interdisciplinary and Intersectoral Collaboration


A. The PHN establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector
(businesses) non-government organizations and peoples organizations to address the communitys health problems
B. The PHN collaborates with other health care providers, professionals and community representatives in assessing, planning, implementing and
evaluating programs for community health.

V. Nursing Process
A. The PHN establishes a working relationship to help ensure good quality data and to facilitate on enhance partnership in addressing identified
health needs and problems.
B. The PHN systematically collects data that are appropriate and accurate.
C. The PHN recognizes the broad impact of certain factors on the clients health and nursing problems and their readiness or willingness to do
something about their problems.
D. The PHN analyzes data collected about the community, family and individual to determine the diagnoses.
E. the PHN formulates a nursing/ community diagnosis/
F. The PHN develops jointly with the client a nursing care plan or program plan for the priority nursing problems.
G. The PHN implements the nursing care plan/program plan to promote, maintain or restore health, to prevent illness, to effect rehabilitation and to
improve the capability of clients.
H. The PHN evaluates the responses of his clients to interventions in order to revise data base, diagnose and plan and to formulate
recommendations.

VI. Health promotion and Health education


A. The PHN recognizes the role of a healthy lifestyle in the different health programs.
B. The PHN plans, conducts and evaluates health promotion and health education activities properly.
C. The PHN demonstrates knowledge and skills on how to advocate for healthy public policy, creating supportive environment, strengthening
community action and developing clients personal skills
D. The PHN actively works to build capacity for health promotion among the midwives, volunteer health workers and community partners.

VII. Demonstrating Professional Responsibility and Accountability


A. The PHN recognizes that her/his personal attitudes, beliefs, assumptions, feelings and values about health have potential effects on his
professional actions and interventions.
B. The PHN accepts accountability for his actions and engages in nursing practice that is ethical, safe, acceptable and evidence-based.

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C. The PHN protects his professional autonomy, assumes responsibility for professional development and contribute to the professional
development of thers.
D. The PHN institutes changes/ improvements in service delivery and management of health facility to improve clients access and use of public
health nursing services.
E. The PHN maintains links and collaboration with other professional nurses and nursing groups to strengthen his/her nursing practice
F. The PHN maintains links and collaboration with government agencies and non-government organizations.
G. The PHN conducts and/or facilitates in various training activities for public health nurses, midwives, barangay health workers, nursing aide and
volunteers.

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