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Community Health Nursing

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Community Health Nursing

Community Health NursingCommunityA group if species who reside in a designated geographic are and who share common interests and bonds. A group of persons united by some common feature or shared interest. HealthA state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. Public HealthThe art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number. Community Health part of paramedical or medical intervention/ approach which is concerned on the health of the whole or population

Aims: health promotion disease preventionmanagement of factors affecting health 4Public Health NursingA special field of nursing that combines the skills of nursing, public health and some phases of social assistance for the promotion o health, the improvement of conditions in the social and physical environment, rehabilitation, prevention of illness and disability. PHN and CHN have been interchangeably by authors.

According to the National League of Philippine Government Nurses (NLPGN), PHN refers to the practice of nursing in national and and local govt health depts and public schools.5Community Health NursingThe utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. PHN and CHN have been interchangeably by authors.

According to the National League of Philippine Government Nurses (NLPGN), PHN refers to the practice of nursing in national and and local govt health depts and public schools.6Community Health NursingGoal: To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness. Four types of clientele:Individual Family unit of care, the foundation of our nation according to the 1987 constitution, social group characterized by common residence, economic cooperation, and reproduction (Murdock, 1965)/shared history and shared future (Betty Carter and Monica McGoldrick, 1999)Population Group children, elderlyCommunity - patient7The Philippine Healthcare Delivery SystemDepartment Of HealthMandated as the lead agency in health at the national level Local Government UnitsRuns the local health systemProvincial and district hospitalsRHUs and BHSs9Department Of HealthR.A. 7160 (1991) Local Government CodeDecentralizationLGU (implementation)DOH (governance)

E.O. 102 (1999)The Department of Health is the national authority on health, providing technical and other resource assistance to local government units, peoples organization, and other members of the civic society in effectively implementing programs, projects, and services that will:

10(a) Promote the health and well-being of every Filipino. (b) Prevent and control diseases among population at risks. (c) Protect individuals, families, and communities exposed. to hazards and risks that could affect their health, and (d)Treat, manage, and rehabilitate individuals affected by diseases and disability.

Roles and Functions: DOH EO 1021. Leadership in Health-national policy and regulatory institution where LGUs and NGOs will base their direction for health

112.Enabler and Capacity Builder-innovates new strategies in health to improve effectiveness of health programs- ensures highest achievable standards of quality health care3. Administrator of Specific Services-manage selected national health facilities that shall serve as national referral centers-administers health emergency response services

12Department Of HealthVision by 2030: A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable health financing.Mission: To guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health.

13Department Of HealthGoal: Health Sector Reform Agenda (HSRA)Overriding goal of the DOHConceptualized because although there has been a significant improvement in the health status of Filipinos for the fast 50 years some the following conditions were still seen in the population: slowing down in the reduction of Infant Mortality Rare (IMR) persistence of large variations in health status across population groupshigh burden from infectious diseasesrising burden from chronic and degenerative diseasesunattended emerging health risksburden of disease heaviest among the poor

14Support mechanisms of HSRA:Sound organizational developmentStrong Policies, Systems, and proceduresCapable Human ResourcesAdequate Financial Resources

Framework for Implementation: FOURmula One for HealthGoals Better health outcomesMore responsive health systemsEquitable health care financing

15The Four Elements:

Health financing investmentHealth regulationensure quality and affordability of health goodsHealth Service Delivery improve and ensure the accessibility and availability of basic and essential careGood governance enhance health system performance at national and local levels

16Primary Health CareEssential Health made universally accessible to individuals and families in the community by means acceptable to them thru their full participation and at cost that the community and country can afford at every stage of development.Mission: To strengthen the health care system by increase opportunities and supporting the conditions wherein people will manage their own health.

17Primary Health CareWas declared during the First conference on Primary Health Care was held in Alma Ata, USSR on Sept. 6-12, 1978 by the WHO as a strategy for community health.Goal: Health for All by the year 2000Letter of Instruction 949 signed on October 19, 1979 by Pres. Marcos with a theme: Health in the Hands of the People by 2020

18Primary Health CareIt is a strategy aimed to provide essential health care that is (concept): (CAPAS)Community-basedAccessiblePart and parcel of the total socio-economic development effort of the nationAcceptableSustainable at an affordable cost

19Primary Health CareElements of Primary Health CareEducation of prevailing Health ProblemsLocally-endemic Disease Prevention and Control Expanded Program of ImmunizationMaternal and Child Health and Family Planning Environmental Sanitation and Safe Water Supply Nutrition and Food Supply Treatment of Communicable & Non-communicable Diseases/ ConditionsSupply and Proper use of Essential Drugs and Herbal Medicine Dental Health Promotion Access to and use of hospitals as Centers of WellnessMental Health Promotion

20Primary Health CareThe Four Cornerstones/Pillars of Primary Health Care

Active Community ParticipationIntra and Inter-sectoral LinkagesUse of Appropriate TechnologySupport Mechanism Made Available

21Primary Health Care8 Millennium Development GoalsEradicate extreme hunger and povertyAchieve universal primary educationPromote gender equality and empower womenReduce child mortalityImprove maternal healthCombat HIV/AIDS, malaria and other diseasesEnsure environmental sustainabilityDevelop a global partnership for development Will be replaced by Sustainable Development Goals in September 2015 United Nations Development Programme 22Vital StatisticsThe systematic study of vital events such as births, deaths, illness, marriages and divorce.SOURCES OF DATA:Population Census once every 10 yearsRegistration of vital data birth, death, divorceIndividual Health records and family recordsWeekly Reports from Field health PersonnelCategories of Data according to Sources:Primary data- those obtained first hand by the investigator for the purpose of the studySecondary data- those which are existing and obtained by other people for purposes not necessarily those of the investigator

23Vital StatisticsMethods of data Collection:Documented SourcesOcular InspectionParticipant ObservationInterviewGroup InterviewSample SurveyFocus Group Discussion

24Vital StatisticsCrude Birth RateThe measure of one characteristic of the natural growth or increase of a population. Number of live births during a given yearx 1000 population estimated at mid year

General Fertility RateNumber of live births during a given year x 1000 female pop (15-44 y.o.) population estimated at mid-year for females age 15-44 during the same year

25Vital StatisticsCrude Death RateThe measure of one mortality from all causes which may result in a decrease of population.number of deaths from all causes during a given year x 1000 population estimated at mid year

Specific Death rateDescribes the risk of certain classes or groups to particular disease.Cause specificNumber of deaths from a specific condition during a given year population estimated at mid year x 100,000

Age SpecificNumber of deaths for a specified age group during a given year x 1000 population estimated at mid year for the specific age group

26Vital StatisticsInfant Mortality RateMeasures the risk of dying during the first year of life. It is a good index of the general health condition of the community. Number of deaths under 1 year of age during the given year x 1000 LBs Number of live births during the same yearMaternal Mortality RateMeasures the risk of dying from causes related to pregnancy, childbirth and puerperium.

Number of deaths from the puerperal complications during a given year number of live births during the same year x 100,000

Puerperium - the period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition27Vital StatisticsFetal Death RateMeasures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion, irrespective of duration of pregnancy.

Number of fetal deaths at 20 weeks of gestation (or more) during a given year x 1000 number of live births and fetal deaths during the same yearNeonatal Death RateMeasures the risk of dying the 1st month of life.serves as an index of the effects of prenatal care and obstetrical management of the newborn.

Number of deaths under 28 days of age during a given year x 1000 Number of live births during the same year

28Vital StatisticsBirth Death Ratio Number of live births in a specified population x 1000 Number of deaths in the same populationCase Fatality RatioNumber of deaths from a specified disease or condition Number of reported cases of the specified disease or conditionx 100,000

29Vital StatisticsGeneral Morbidity Rate

Total number of sick persons x 1000 population estimated at mid year

Prevalence Rate-measures the proportion of the population which exhibits a particular disease at a particular time; deals with NEW and OLD CASES

Number of old and new cases of a specific disease or conditionexisting at a point in time x 100,000total population at the same point in time

30Vital StatisticsIncidence RateMeasures the frequency of occurrence of the phenomenon; deals with NEW CASES.number of new cases of a specific disease or condition occurring during a given period of timepopulation at risk during the same time period x 100,000

31Vital StatisticsAttack rateAccurate measure of the risk of exposure.

Number of new cases of a disease in a time periodx 100 population at risk during that time

RateThe relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specified time.RatioDescribes the relationship between 2 numerical quantities or measures of events without taking particular considerations to the time or place.

32Expanded Program of ImmunizationGoal: morbidity and mortality reduction of immunizable diseases

33Expanded Program of Immunization

PD 996Compulsory Basic Immunization to all children before reaching 8 years oldStarted in 1976 by MOHTarget Population:A. Infants (0-12 months): BCG, DPT, OPV& Measles HBV (1996) B. School Entrants: MECS: Grade 1=7 years old DECS: Grade 1=6 yrs. old (1993) Booster of BCGRA 7846Compulsory HBV before 8 years old:1996PP 4Measles Elimination Program (September & October) 1994 1997 Ligtas Tigdas (6 months-8 years)

34Expanded Program of Immunization

PP 6Universal Mother & Child Immunization Law advocated by WHO from 1996 and onwards: 5 vaccines + Tetanus ToxoidStrengthens the EPI Program1. Pregnant mothers-Tetanus Toxoid2. Children: Infants-5 vaccines School entrants-BCG booster dose3. Before EPI total immunization-5 After EPI total immunization-6 (Tetanus toxoid was included)4. OPV was given to all children under 5 years old irregardless of the # of doses & the time OPV was givenPP 147Declaring the National Immunization Day Plus (NIDs Plus) initiated by former Sec. Flavier in 1993-1995Initially every 3rd Wednesday of January & February (1993-1995)1996 to present: Still being practiced but not every 3rd Wednesday of January & February2002: 2nd Tuesday of March & AprilAt present: depends on the Secretary

35Expanded Program of Immunization

PP 773Launched the Polio Elimination Program (PEP) 1995-2000: Zero Polio Philippines, 1. Knock Out Polio (KOP)2. Zero Polio Philippines (1996-2000)3. Patak Polio (< 5 years old)PP 1064AFP (Acute Flaccid Paralysis) Elimination Program-an adverse effect of PolioPP 1066Neonatal Tetanus EliminationMorbidityMortalityCold Dogs: 4 plastic containers filled with water which is placed in the freezer a day before immunization which is used as freezant to keep vaccine potent.

Tools provided by DOH: Vaccine Carrier which maybeBlack: use by staff of HC during epidemic & needs 5 cold dogsWhite: use by student affiliates & needs 4 cold dogs

36Expanded Program of Immunization

Vaccine (# of Doses)ScheduleSite and DoseBCG-1 doseAt BirthSchool Entrants (6 years old)

0.05ml ID (Deltoid)0.10ml ID (Deltoid)DPT-3 dosesHBV-3 doses

OPV-3 doses

1st 6 wks or 1 mos2nd 10 wks or 2 mos3rd 14 wks or 3 mos0.5ml IM (Upper Outer Thigh)

2 drops oral

MV-1 dose

9-12 months

0.05ml SC (Outer Part Upper Arm)Pentavaccine/Pentavalent vaccine DPT, HiB, and Hepa-B3 doses (6-10-14) 0.05ml IM

Rotavirus vaccine 2 doses (6-14wks and before 32wks or before 8mos) 1.5ml oral 37Expanded Program of ImmunizationTetanus Toxoid Immunization ScheduleRoute: 0.05ml IM (Deltoid) Primary DoseTT1Anytime during Pregnancy (5th-6th months)Primary DoseTT24 weeks after TT13 years immunity1st BoosterTT36 months after TT25 years immunity2nd BoosterTT41 year after TT310 years immunity3rd BoosterTT51 year after TT4Lifetime immunity38Expanded Program of ImmunizationSide EffectsBCG:Inflammation at the site (Kochs phenomenon) - warm compress Glandular enlargement, deep abscess, indolent ulceration - incision and drainage and powdered INH DPT: Inflammation at site: warm compressFever for a dayAbscess - incision and drainage and antiseptic (betadine)Measles: Fever 3-5 days within a week after injectionMild rashes 39Expanded Program of ImmunizationCOLD CHAIN LogisticsA system used to maintain the potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.Storage of vaccine should not exceed:-6 mos. @ the Regional Level -3 mos. @ the Provincial Level-1 mo. @ main Health Centers (with refrigerators)-not more than 5 days @ Health Centers (using transport boxes)Important points to remember:Arranging of stored vaccine according to:TypeExpiration dateDuration of StorageNumber of times they have been brought out to the fieldThe vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST should be distributed or used 1st

40Expanded Program of ImmunizationVaccines which are opened, though not consumed, should be discarded.Reasons: They cannot be used for future program because of vaccine half life (duration of potency).BCG and MV - 4 hours half lifeOther vaccine - 8 hours half life

Use Cold Dogs for transport.

Cold Dogs: 4 plastic containers filled with water which is placed in the freezer a day before immunization which is used as freezant to keep vaccine potent.

Tools provided by DOH: Vaccine Carrier which maybeBlack: use by staff of HC during epidemic & needs 5 cold dogsWhite: use by student affiliates & needs 4 cold dogs

41Expanded Program of Immunization

Storage TemperatureVaccineFormDose/ ContainerConditions when exposed to HEAT/ FREEZINGMost Sensitive to Heat

Least Sensitive to heat-25C to -15C FREEZERBODY OF THEREFRIGERATOR + 2C TO + 18C OPVLiquid20 dose/ special bottle or 25 dose/special bottleEasily damaged by heat: not destroyed by freezingMeaslesFreeze dried10 dose/vialEasily damaged by heat: not destroyed by freezingBCGFreeze dried20 dose/amp50 dose/ampDestroyed by heat, sunlight; not destroyed by freezingDPTLIQUID20 dose/vialDestroyed by freezingDamaged by heat and freezingHepa-BTetanus ToxiodLiqiud Liquid20 dose/vial Damaged by heat or freezing 42Expanded Program of ImmunizationFrequently Asked Questions (FAQs) Q: What if the child failed to return after the first dose of the vaccine (D.O.H.), can we still give it? A: YES. It is a MUST to complete the doses .

Q: Is it necessary to repeat the 1st dose? A: NO. just give the REMAINING doses not given.Remember the principle: Even if the interval exceeded that of the expected interval, continue to give the doses of the vaccine.

Q: What is the eligible age for giving immunization (up to what age can we give the immunization)? A: Before the child reaches 6 years old

Q: If there has been a reported epidemic of measles, is it okay to give measles vaccine at an earlier age? A: In case of measles epidemic, we can give MEASLES as early as 6 months of age .* A booster dose of BCG shall also be given to all school entrants both in private and public schools REGARDLESS of presence of BCG scar.

43Expanded Program of ImmunizationQ: What if the 2nd dose of Tetanus Toxoid was not given to the mother, when is the best time to give the dose? A: It has to be given after birth in order to protect the mother and the succeeding pregnancies.

Q: Is there any contraindication to giving DPT, OPV, Hepa-B? A: There is none, EXCEPT when the child had convulsions upon giving the 1st dose of DPT. Mothers must be warned that the incident of CONVULSION upon giving the 1st dose of DPT, MUST BE REPORTED. Q: What if the child has fever of