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8/3/2019 Chn Presentation

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PHILIPPINE COMMUNITYHEALTH

c. Scope of Community HealthNursing

d. Concepts and Principles of CHN

By Pamela Jane M. Zamora, R.N .


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FRAMEWORK FOR CHN PRACTICE

INDIVIDUAL

Family

Population

Group

Community

HEALTH CAREDELIVERYSYSTEM

COMMUNITYHEALTHNURSINGPRACTICE

. Philosophy/beliefs

. PrinciplesPrimary Health CareEthicolegal aspects

. ProcessesCritical thinkingNursing ProcessProgram Planning,Implementation,

and Evaluation.Management andsupervision

ResearchQuality AssuranceAdvocacy andpolitical Action

. Roles and Function

ECONOMIC, SOCIOCULTURAL, POLITICALAND ENVIRONMENTAL FACTORS

HEALTH


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PRINCIPLES:

Primary Health Care

Ethicolegal aspects


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CONCEPT: PRIMARY HEALTH CARE

HISTORY OF PRIMARY HEALTH CARE

May 1977- The 30th World Health Assembly adopted resolution WHA30:43. This resolution decided that the main social target of governments andof WHO should be the attainment by all the people of the world by the year 2000 a level of health that will permit them to lead a socially andeconomically productive life.

September 12, 1978- International Conference on Primary HealthCare was held in this year at Alma Ata. USSRThe conference came up with what is known popularly as the Alma AtaDeclaration, which represents a global ideal, a new vision about how toachieve world health. The Declaration stated that primary health care is thekey to attaining the health-for-all goal.

1979- The World Health Assembly launched the Global Strategy for Health for all.

October 19, 1979- The President of the Philippines issued Letter of Instruction 949 which mandated the Ministry of Health to adopt PrimaryHealth Care as an approach towards design, development, andimplementation of programs, which focus health development at the


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DEFINITION OF PRIMARY HEALTH CARE

The Alma Ata Conference defines Primary HealthCare as essential health care based on practical,scientifically sound and socially acceptable methodsand technology made universally, accessible to

individuals and families in the community by means of acceptable to the, through their full participation and ata cost that community and country cam afford tomaintain at every stage of their development in the spiritof self-reliance and self-determination. It forms asintegral part of both the countrys health system, of which it is the central function and the main focus, andof the overall social and economic development of thecommunity.


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GLOBAL GOAL OF PRIMARY HEALTH CARE

The global goal as stated in the Alma AtaDeclaration is Health for All by the year 2000 throughself-reliance.

The Health for All goals does not meanhowever that nobody will be sick or disabledanymore. Nor does it mean that health care

professionals will provide care for everybody in thecountry or the world for all their existing ailments.What it means is that health begins at home, inschools and in the work place.


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PRIMARY HEALTH CARE PRINCIPLES AND STRATEGIES

1. Accessibility, Availability, Affordability and Acceptability of Health Services.

Strategies:a. Health services delivered where the people areb. Use of indigenous/resident volunteer health worker as a health care

provider with a ratio of one community health worker per 10-20

households.c. Use of traditional (herbal) medicine with essential drugs.

2. Provision of quality, basic and essential health services

Strategies:a. Training design and curriculum based on community needs and

prioritiesb. Attitudes, knowledge and skills developed are on promotive,

preventive, curative and rehabilitative health care.c. Regular monitoring and periodic evaluation of community health

worker performance by the community and health staff.


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3 . Community Participation

Strategies:a. Awareness-building and consciousness raising on health and

health- related issues.b. Planning, implementation, monitoring and evaluation done

through small group meetings (10-20 households cluster)c. Selection of community health workers by the community.d. Formation of health committees/

e. Establishment of a community health organization at the parishor municipal level.f. Mass health campaigns and mobilization to combat health

problems.

4. Self-Reliance

Strategies:Community generates support (cash, labor) for health programsa. Use of local resources (human, financial, material)b. Training of community in leadership and management skills.

c. Incorporation of income generating projects, cooperatives andsmall scale industries.


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5 . Recognition of the interrelationship of health and developmentStrategies:

a. Convergence of health, food, nutrition, water, sanitation and populationservices.b. Integration of PHC into national, regional, provincial, municipal and

barangay development plans.c. Coordination of activities with economic planning, education,

agriculture, industry, housing, public works, communication and socialservices.

d. Establishment of an effective health referral system.

6. Social MobilizationStrategies:

a. Establishment of an effective health referral systemb. Multi-sectoral and interdisciplinary linkagec. Information, education, communication support using multi media.d. Collaboration between government and non-governmental

organizations

7. DecentralizationStrategies:

a. Reallocation of budgetary resourcesb. Reorientation of health professionals on PHC

c. Advocacy for political will and support from the national leadershipdown to the barangay level.


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ESSENTIAL HEALTH SERVICES IN PRIMARY HEALTH CARE

The Alma Ata report on PHC outlined eight essential elements to be

emphasized in PHC. These shall comprise the initial and continuing care atthe point of entry into health system. The list of essential elements is amodification of the basic health services of earlier times. To facilitate easyrecall of these, the acronym ELEMENTS is used to present these.

1. Education for health

2. Locally Endemic Diseases ControlMalaria, Leprosy, Leptospirosis

3. Expanded Program of ImmunizationPoliomyelitis, measles, tetanus, diphtheria and other deadly but

preventable diseases.4. Maternal and Child Health including responsible parenthood

protection of mother and child against illness and other risks.5 . Essential drugsProper utilization and acquisition of drugsGeneric Act of the Philippines Campaign

6. Nutrition7. Treatment of Communicable and Non-Communicable Diseases.

8. Safe water and sanitation.


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ETHICOLEGAL ASPECTS OF NURSING PRACTICE IN THECOMMUNITY

Guided by a number of legal and ethical principles centered on thewelfare of clients and protection of their rights.

Professional practice is legal if the practitioner works in accordancewith the law.

Ethical practice is characterized by three major principle:Respect for Autonomy the ability to decide: adequate information,

intellectual competence; power to act ypon your decision,and respect for the individual autonomy of others.

- self determinationBeneficence acts of mercy and charity, to apply measures for the

benefit of the sick.

- maximize the good, minimize harmJustice fairness, equals must be treated equally and un-equals

must be treated unequally.- example: distributive justice, compensatory justice

- Bases for Clients rights and their rights have professionalresponsibility.


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Other Universal Ethical Principles are:

4.Veracity in association with truth,disclose factual informationso that patient can exercise personalautonomy

5 .Nonmaleficence not to inflict evil or harm, someway similar toBeneficence

6.Confidentiality privacy, important aspectof trust that patientsplace to health professionals

7. Role Fidelity practice as team


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Some Applications:

Right to be informed about condition and treatments,interventions to be done.

Right to accurate or adequate information to make aninformed decision.

Example: to decide or to refuse treatment.

Right to safe and quality care.Example: update client on latest development

of health care

Right to privacy

Do Not only deliver health services butHumanize the Health Care Delivery System.


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Other IMPORTANT CONCEPTS:

C H N is composed of three major concepts:

COMMUNITY (CLIENT)HEALTH (GOAL)NURSING (MEANS)

HEALTHPUBLIC HEALTHPRIMARY HEALTH CARERIGHT TO, AND RESPONSIBILITY FOR HEALTH


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RIGHT TO, AND RESPONSIBILITY FOR HEALTH

HEALTH is a basic human right(Universal Declaration of Human Rights Article 1,Philippine Constitution and By Laws; Article 13, section 11 The state shall adopt an integrated and comprehensiveapproach to health development which shall endeavor tomake essential goods, health and other social servicesavailable to all people at affordable cost.

WHO (199 5 ) Governments have a responsibility for thehealth of their people by providing adequate health and

social measures.Congressional Commission on Health (1993). Health

as a Fundamental Right, Health deserves to a top nationalpriority. The state, individuals, families and communitiesshare the responsibility for health and as responsibility of all sectors..


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PROCESSES IN C H N PRACTICE

1.Critical Thinking Rational examination of ideas, inferences, assumptions, principles,arguments, conclusions, issues,statements, beliefs and action.

Critical thinking in all of daily livingDiscriminate among the uses and misuses of

language in nursingIdentify and formulate nursing problemsAnalyze meaning of terms in relation to their

indication, cause or purpose.Analyze arguments, issues and conclusionsExamine nursing assumptionsReport data and clues accurately


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1.Critical Thinking

Make and check inferences based on data,make it sure plausible

Formulate and clarify beliefs

Verify, corroborate and justify claims, beliefs,conclusions, decisions and actionsGive relevant reasons for belief and

conclusions

Formulate and clarify value judgmentsSeek reasons, criteria and principles thateffectively justify value judgments and

Evaluate the soundness of conclusions


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2. Nursing Process the means by which nursesaddress the health needs and problems of their clients. It is a logical and systematicway of processing information gatheredfrom different sources and translatingintentions into meaningful actions or interventions.

FOUR PHASES: ASSESSMENT, PLANNING,IMPLEMENTATION AND EVALUATION


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3. Management and Supervision Managementactivities depend on the size and level of autonomy of health center

Example: Organizes nursing service,manages the RHUin the absence of the Physician.

:Supervises the Rural HealthMidwives.:many more.


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4. Research in Community Health

Purposes:1. improve our understanding of clients

and their specific context

2. provide date needed for program andpolicy development and evaluation

3. improve the delivery of health servicesand implementation

4. improve cost-effectiveness of programs

5 . project a good image of nurses


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5 . Quality Assurance

Characteristics:

appropriate health services are available and accessible

health care is effective, desired outcomes for the clients areobtained

health service is equitable; given to most needy

health interventions are safe and are based on professional andagency standards

good interpersonal relation, based on mutual respect

proper coordination among health workers and a working referralsystem

efficiency and economy in the provision of services.


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.Quality Assurance Process of ensuring that clientsreceive the agreed-upon level of care through settingup of standards, monitoring and evaluation practices.

Example: The Sentrong Sigla Movement or Centers for Vitality.

6.Standards - desired level of performance against actualpractice is compared. What should be ?

7. Advocacy and Political Action An act of pleading for or giving verbal support for a cause

- To speak up for the clients rights- Speaking up and meeting with politicians

and hand in our issues, our positions,demands and many.

- For policy making or legislations.


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Health : A state of complete physical, mental

and social well being and not merely the absenceof disease or infirmity (WHO, 1946/1948)

: emphasis not the prevailing physical andmental conditions of the people and the

community.: recognizes the multifaceted nature of health

and that health involves different dimensions, it

considers the political, economic andsocial/cultural dimensions that affect the living

conditions and quality of life


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2 Basic Components of a Concept of Health ( Kass)1. well workingness - identifies the physical

ability of components of the body to function.2 . wholeness simultaneous functioning of the

different components of the ability to self-heal.

Health : is the ability of the person to adapt to continuingphysical, social and personal change ( Dubos, Candus,Thrall)

Health : a state in which the organism is functioningeffectively, fulfilling needs, successfully responding to therequirement or demands of the environment, whetherexternal or internal, and pursuing its biological destiny,including growth and reproduction. ( Engel)


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D isease that which is malfunctioning or maladaptation of

biologic of biologic and psychophysiologic processes in theindividual- may occur at any biological level i.e. the cell, the

organ, system, and the body.- Incapacity to perform ones roles.

Illness the threat of incapacity of the person to fulfill personal expectations or perform social role or taskrefers more to the experiential/ behavioral level

nonphysical and nonphysiological incapacityas personal, interpersonal and cultural responses to diseaseor discomfort


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T hree Structural D omains of Health Care

1. Professional utilizes biomedicine and which is primarily interested in the recognition andtreatment of disease (curing) and generatingtechnological intervention.

2. Popular family and social networks

3. Folk non professional healers or the traditional

healing.

Both popular and folk or traditional healing are principally concerned with illness that is treating

the human experience of disease.


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Community Health Nursing


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Community Health Nursing-one of the two major fields of Nursing in thePhilippines- the other is Hospital Nursing

Definitions of CHNBy Ruth B. Freeman:

It refers to a a service rendered byprofessional nurse with communities, groups,families, individuals at home, in health centers, inclinics, in school, in places of work for the promotion

of health, prevention of illness, care of the sick athome and rehabilitation.


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By Jacobson

Is a learned practice discipline with ultimate goalof contributing, as individuals and in collaborationwith others, to the promotion of the clients optimumlevel of functioning through teaching and delivery of care.

By American Nurses Association

CHN practice promotes and preserves the healthof populations by integrating the skills and knowledgerelevant to both nursing and public health.


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COMMUNI TY HEAL T H NURSING- is broader than public health nursing because it

encompasses nursing practice in a wide variety of communityservices and consumer advocate areas, and in a variety of roles,at times including independent practice.

- is the synthesis of nursing practice and public health practice.

2 Major Fields of Nursing in the Philippines

1. Community Health Nursing-School health nursing

-Occupational health nursing

2. Hospital Nursing or Institutional Nursing


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PUBLIC HEALTH NURSING - (WHO) is a specialfield of nursing that combines skills in public healthnursing, public health, and some phases of social

assistance and function as part of the total publichealth program for the: promotion of health,improvement of condition in social and physicalenvironment, rehabilitation, prevention of illness and

disability.


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Public Health (By D r. C.E. Winslow)T he Science and Art of :

(1) preventing disease,(2) prolonging life, and(3) promoting health and efficiency though organized

community effort for

a. the sanitation of the environment, b. the control of communicable disease,c. the education of individuals in personal hygiene,d. the organization of medical and nursing services for the early

diagnosis preventive treatment of disease ande. the development of social machinery to insure a standard of living adequate for the maintenance of health, so organizingthere benefits as to enable every citizen to realize his birth rightof health and longevity.


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Key phrase: through community effort

Ex: Government efforts (legislation,support from taxes, etc.), private efforts orfunds, multidisciplinary public health efforts.

Mission of Public Health SOCIAL JUSTICE.which entitles all persons to basicnecessities: adequate income and health

protection, accepts collective burdens to makesuch possible.


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COMMUNITY HEALTH NURSING

- its basic knowledge and skills are anchored on NursingTheories and Concepts from the science of the publichealth such as:

1. Importance of the greatest good for the greater number

(ethics)

2. Assess health needs, plan, implement, and evaluatethe impact of health services on population or groups(nursing process)

3. Priority of health promotion and disease preventionstrategies over curative


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4. Tools for measuring and analyzing community health

problem(Biostatistics, Demography, Epidemiology)

5. Application of principle of management and organization

6. Its practice and enhanced by bodies of knowledge of other academic discipline (sociology, psychology,anthropology, economics, political science)

Philosophy of CHN : Worth and Dignity of Man (Person)By: Margaret Shetland.


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Highlight/ Concept of C H N

1. Goal of Professional Practice Promotion of health and Preservationof life

2. Nature of Practice Comprehensive, general, continual, not episodic3. Knowledge Base Nursing and Public Health4. Levels of Clientele individual, families, groups (aggregate),

community, sick or well in daily basis, health tasks, children,elderly, youth

5. Practitioner s recognition Primacy of population as a whole6. Greater control for both nurse and client in health care decision7. Collaboration between nurse and clients as equals8. Recognition of the impact of different factors of their client lives and

situationG oal of CHN To raise the level of health of the citizenry

to help the community and families to cope until discontinuitiesof health and threats; a way to maximize potential for high level wellnessand promote reciprocally supportive relationship between people and their

physical and social environment.


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PRINCIPLES OF CHN1.Based on recognized needs of communities, families, groups andindividual

2.Full understanding of objectives and policies of the agency

3 .Family is the unit of services

4.Available to all regardless of sex, status, political beliefs and others.

5.Health teaching a primary responsibility of community health nurse.

6.The nurse works as a member of the team

7.Periodic evaluation of Community Health Nursing Services

8.Opportunities continuing education and professional growth

9.Make use of available community health resources

10.Utilizes existing active organized groups


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11.Provide educative supervision

12.Accurate Recording and Reporting


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2.School Health Nursing

to promote health of school children and preventhealth problem that hinders learning andperformance of their developmental task.

Health on important requisite in education

determined by: age, developmental stage, healthproblems, genetic consideration; policies andstandards of DECS/DepEd, DOH, and the nursingprofessions; socio-economic realities in the schoolsand LGUs.


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Clients of the Community Health Nurse

1.Individual- sick or well- on a daily basis- who consult at the health center and receives services

a. prenatalb. well -baby follow upc. morbidityd. chronic illness: diabetes, hypertension

e. clients seen during home follow upf. school consultationg. workplace visit - conferenceh. other community based activities


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2. Family

Rationale: (Maglaya & Bailon)1.Natural and fundamental unit of society; importantsocial institution

2.Generates, prevents, tolerates and connecthealthy problems within its members

3 .Health problems of family members areinterlocking

4.The most frequent focus of health decisions andactions in personal care.

5.An effective and available channel for much of thecommunity nursing effort.

6.Service of the most solid support to its membersspecially the young, elderly and less-fortunate.


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Family Health Nursing

- A level of community nursing practices directed on the family as the unit of care, with the Health as the Goal and Nursing as the medium, Channel or

Provider of CareNurses Role and Functions: assist family cope effectively with health problemby increasing in capacity to perform with health task and to render familyindependent with continues guidance of the nurse till no longer needed.

Roles of the Nurse:1.Health Monitor

2.Provider of Care

3 .Coordinator of family service

4.Facilitator

5.Teacher

6.Counselor


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3. Population Group or Aggregate

- who share common characteristics, developmental stage, commonexposure to environmental factor which results to common health to to

to common health problems

a. children e. prisonersb. women f. farmersc. factory worker g. elderlyd. commercial sex workers


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Leading ailments of school children

a. dental carries g. otitis media

b. parasitism h. tinea flavac. colds i. PEMd. Pediculosis j. EOR & Blindnesse. URTI k. enlarged glandsf. CEDC- Children in Especially

Difficult CircumstancesEx: neglected, street children, impaired with disability,drug users, working children, cultural minorities & IPs

Elderly/Senior Citizen 4.5 million

a. influenza g. COPDb.T.B. h. ischemic heart diseasec. Bronchitis i. Respiratory Diseased. Pneumonia j. Asthmae. CVD k. Physical disabilitiesf. Senility


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4. Community

A group of people sharing a common geographic boundaries and/ or

common values and interest. It functions within a particular socioculturalcontext with varying physical environment, coping and behaving.(Maglaya 200 3 , Nsg. Practice in Community)

A social group of people interacting with each other, determined bygeographic boundaries, living together to attain certain and commongoals and sharing the same interests (Untalan 2005, COPAR)


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Refers to groups composed of individuals, families, organizations, or business that share a common language, common values, a commonhistory, or common purpose. ( Aleria Narda 200 3 , Community Health

and Wellness Needs Asst.)


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T hank you

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