POINTS IN COMMUNITY HEALTH NURSING

Definitions of CHN by:

WHO – Combination of Nursing Skills, Sociology and Public Health
Freeman – a service rendered by a professional nurse with communities, groups,
families, individuals at home,
in health centers, in clinics, in schools, in places of work for promotion of health,
prevention of illness, care of the sick at home and rehabilitation.
Jacobson – Achievement of Optimum level of functioning through
teaching and delivery of care
Bailon-Reyes – It is a field of nursing practice where services are delivered
outside of purely curative institution, but
In community settings such as home, the school, place of work health centers and
clinics.
Maglaya – Utilization of nursing process to benefit the Individual, Family and
Community
Hanlon – attainment of highest level of physical, mental, and social
well-being and longevity consistent with
available Knowledge and resources at a given place and time.

Philosophy – Based on worth and dignity of man (Shetland)

Goal – Raise the level of citizenry (Nisce)

PUBLIC HEALTH
Winslow – Science and art of preventing disease, prolonging life, promoting health
and efficiency. Knowing your birthrights, health and longevity
Purdom – Survival of Human Species
Hanlon – most effective total development of life of individual and society

DEPARTMENT OF HEALTH – PHILIPPINES

Vision – The DOH is the leader, staunch advocate and model in promoting Health
for All in the Philippines.
Mission – guarantee equitable, sustainable and quality health for all Filipinos,
especially the poor and shall lead the quest for excellence in
health.
Goal – Health Sector Reform Agenda (HSRA)
<span> </span>
<span> </span>
PRIMARY HEALTH CARE
~ It is essential health care made universally accessible to individuals and families
in the community by means acceptable to them, through their full participation and
at a cost that the community and country can afford at every stage of development.
~1st International Conference was on <span>September 6 to 12, 1978</span> at
<span>Alma Ata, USSR</span> sponsored by WHO
~ Adopted in the Philippines on <span>October 19, 1979</span> through
<span>Letter of Instruction 949</span> singed by Pres. Marcos

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

Elements/components of PHC
1. Environmental Sanitation 6. Adequate
Food and Proper nutrition
2. Control of Communicable Diseases 7. Provision of
Medical Care and Emergency Treatment
3. Immunization 8. Treatment of locally
Endemic Disease
4. Health Education 9. Provision
of Essential Drugs
5. Maternal and Child and Family Planning

Four Cornerstones/ Pillars of PHC

1. Active Community Participation 3. Use of Appropriate
Technology
2. Intra and Inter-sectoral Linkages 4. Support mechanism
made available

HOME VISIT
~ It is nurse-family contact which allows health worker to assess the home and
family situations in order to provide the necessary nursing care and health related
activities.

PURPOSES OF HOME VISIT

1. To <span>give nursing care</span> to sick, post partum mother and her
newborn.
2. To <span>assess the living condition</span> of the patient and his family and
their health practices.
3. To <span>give Health teaching</span> regarding the prevention and control of
diseases.
4. To <span>establish close relationship</span> between the agencies and the
public for the promotion of health.
5. To <span>make use of the inter-referral system</span> and to promote the
utilization of community services

PRINCIPLES OF HOME VISIT

1. Home Visit must have a <span>Purpose or Objective</span>
2. Home Visit must <span>use all available information</span> about the patient
and his family
3. Home Visits’ planning must<span> give priority to the essential needs
</span>of the family
4. Home Visits’ planning and delivery must <span>involve the individual and
family</span>
5. Home Visit must be <span>flexible </span>

7 STEPS IN CONDUCTING HOME VISIT

1. <span>Greet</span> the Patient and Introduce elf
2. <span>State the purpose</span> of the visit
3. <span>Observe</span> the patient and determine the health needs
4. <span>Put the bag in a convenient place</span> and proceed to perform the bag
technique
5. <span>Perform the nursing care</span> needed and give health teachings
6. <span>Record </span>all important, observation and care rendered
7. <span>Make appointment</span> for a return visit
BAG TECHNIQUE
~ It is a <span>TOOL</span> making use of a public health bag through which the
nurse, during his/her home visit, can perform nursing procedure with <span>ease
and deftness, saving time and effort</span> with the end in view of rendering
effective nursing care.

PHN Bag – essential and indispensable equipment of a PHN

Principles of Bag Technique
µ Minimize, if not prevent spread of any infection
µ Saves time and effort in the performance of nursing procedure
µ Show the effectiveness of total care to the individual and family
µ Variety of way should be performed depending on the agency’s policy
Important points in Bag Technique
The Bag should be:
¶ Contain all the necessary article, supplies and equipments
¶ Cleaned very often, supplies replaced and ready for use anytime
¶ Consider the bag and its contents clean and sterile
¶ Collection of article should Convenient to the user, to facilitate efficiency and
avoid confusion

COMMUNITY DIAGNOSIS
Ü A process in which the PHN and the community are identifying community
problems that will serve as basis in formulating community program
Ü It is derived and will become the bases for developing and implementing
Community Health Nursing intervention and strategies.

Steps in Conducting Community Diagnosis

1. 1. Determining Objectives
2. Defining the study population
3. Determining the data to be collected
 4. Collecting Data
5. Developing the instruments
6. Actual Data gathering
7. Data Collation
8. Data Presentation
9. Data Analysis
10.Identifying CHN problems
11.Priority Setting

Two types of Community Diagnosis

1. Comprehensive – Obtaining general information about community
Elements:

- Demographic Variables
- Socio-economic and Cultural Variables
- Health and Illness Patterns
- Health Resources
- Political Leadership Patterns

2. Problem-oriented or Specific – Obtaining particular information about

the community

3 Types of Team in Community Health Nursing

<span>1. Nursing Team –</span><span> </span>Part of health team and is
responsible for planning and implementation of nursing services
to individual, families, groups and community as a whole. It is a single disciplinary
team whose leaders is a nurse with the highest educational attainment or work
experience.
<span>2. Health Team –</span> Composed of people from various disciplines in
health filed that work together- Typical Rural
Health Team.
<span>3. Intersectoral –</span> Consist of professional workers from various
disciplines outside of health field but whose work
have relevance to the impact on continuity of care.
~Elements-
£ An attitude of mutual trust, confidence and respect
£ Commonly agreed and understood goal and plan of action
£ Effective leadership
£ A clear division of labor and appropriate allocation of responsibilities among
members
£ Supportive, Collaborative and Cooperative relationship among the members of
the team
£ Open and Honest Communication
£ Recognition of Responsibility of each professional group
£ Appropriate use of available resources so as to achieve the goals of the team
£ Provision for periodic evaluation of teams functioning
£ Continuous education for the members of the group

Commonly Used Records and Reports in Community Health Nursing Practice

þ Individual Clinical Records – these are health records of clients/ patients who
were served by the health agency. They include a child Health record
includingImmunization Card, for infants and children, a Prenatal Record for
pregnant women.
þ Family Folder – it is large envelope whose face sheets contain information
about family. It also contains clinical records of members who have utilized the
health agency’s services.
þ Administrative Records – These comprise records which are being maintained
for administrative purposes, such as planning the health agency’s budget,
requisitioning equipment, drugs and other supplies, evaluating programs and staff
performance. (Example: Record of daily clinic attendance, outreach services,
registers)
þ Periodic reports on health status of the community, activities and services
delivered by the health agency.

REPRODUCTIVE HEALTH

Prenatal Visits
1st Visit - As early in pregnancy as possible before four months or during the 1st
trimester
2nd Visit - During the 2nd trimester
3rd Visit - During the 3rd trimester
Every 2 weeks - After 8th moth of pregnancy

Recommended Schedule of Post Partum Care Visits:

1st Visit - 1st week post partum preferably 3 to 5 days

2nd Visit - 6 weeks post partum

Tetanus Toxoid Immunization Schedule for Women

(Given intramuscularly at the Deltoid region of the upper arm)

TT1
As early as possible during pregnancy

TT2
At least 4 weeks later
80%
~Infants born to the mother will be protected from neonatal tetanus
~ Gives 3 years protection for the mother

TT3
At least 6 months later
95%
~Infant born to mother will be protected from neonatal tetanus
~ Gives 5 years protection for the mother
TT4
At least one year
99%
~Infants born to the mother will be protected from neonatal tetanus
~ Gives 10 years protection for the mother

TT5
At least one year later
99%
~ gives life time protection for the mother
~ All infants born to that mother will be protected

The strategic thrust for 2005-2010 includes:

~ Launch and implement the Basic Emergency Obstetric Care or
BEMOC strategy in coordination with the DOH, The BEMOC strategy in
coordination with the DOH. The BEMOC strategy entails the establishment of
facilities that provide emergency obstetric care for every 125,000 population and
which are located strategically. The strategy calls for families and communities to
plan for childbirth and the upgrading of technical capabilities of local health
providers.
~ Improve the quality of prenatal and postnatal care. Pregnant women
should have at least four prenatal visits with time for adequate evaluation and
management of disease and conditions that may but put the pregnancy at risk. Post-
partum care should extend to more women after childbirth, after a miscarriage or
after an unsafe abortion.
~ Reduce women’s exposure to health risks through the institutionalism
of responsible parenthood and provision of appropriate health care package to all
women of reproductive age, women with low educational and financial resources,
women with unmanaged chronic illness and women who had just given birth in the
last 18 months.
~ LGUs, NGOs and other stakeholders must advocate for health through
resource generation and allocation for health services to be provided for the mother
and the unborn.

Home Deliveries Need to Remember!

  Clean Hands
 Clean Surface
 Clean Cord

Expanded Program on Immunization

Children need not die young if they receive complete and timely immunization.
Children who are not fully immunized are more susceptible to common childhood
diseases. The Expanded Program on Immunization is one of the DOH Programs
that has already been institutionalized and adopted by all LGUs in the region. Its
objective is to reduce infant mortality and morbidity through decreasing the
prevalence of six (6) immunizable diseases (TB, diphtheria, pertussis, tetanus,
polio and measles)
Special campaigns have been undertaken to improve further program
implementation, notably the National Immunization Days
(NID), <span><span>Knock Out Polio
(KOP)</span></span> and <span><span>Garantisadong Pambata
(GP)</span></span> since 1993 to 2000. This is being supported by
increasing/sustaining the routine immunization and improved surveillance system.
Cold Chain
~ It is scheme used to preserve the potency of a vaccine. An appropriate
storage of vaccine from the time it was manufactured till the time it has to be given
to the child or the mother.
~ Vaccines’ lifespan is determined by where it is stored or kept

 6 months – Regional Hospital

 3 months – Provincial Hospital
 1 month – Main Health Centers
 5 days – RHU and BHS

~ In transporting, use cold dogs