Professional Documents
Culture Documents
CHN Lecture SY2015-2016 1 Semester
CHN Lecture SY2015-2016 1 Semester
SY2015-2016
st
1 Semester
Home Visit - a family-nurse contact which allows the health worker to assess the home&
family situations in order to provide necessary nursing care & health related activities. It is a
professional face to face contact made by the nurse to the client/ family to provide necessary
health care activities & to further attain an objective of the health agency.
1. Give nursing care to the sick, a postpartum mother & her newborn with the
view to teach a responsible family member
2. Assess the living condition of the patient & his family & their health practices
in order to provide health teachings
5. Establish close relationship between health agencies & public for promotion of
health
5. Evaluation of past services & how they made use of nursing services
6. Ability client/ family to recognize their needs, available resources & how they
utilize these resources
Principles in Planning for a Home Visit:
4. Plan for continuing care should involve individual & his family
1. The bag should contain all necessary articles, supplies & equipment which maybe
used to answer emergency needs
2. The bag & its contents should be cleaned as often, supplies replaced & ready for use
anytime
3. The bag & its contents should be protected from contact with any articles in the home
of patients. Consider the bag & its contents, clean & sterile while any article belonging
to patient as dirty & contaminated
6. The bag when used for communicable diseases should be cleansed/ disinfected before
keeping/ reusing
PROCEDURE IN BAG TECHNIQUE:
1. Upon arriving a client’s home, place the bag on table or any flat surface lined
with paper lining, clean side out [ folded part touching table],Put bag ‘s handles/
strap beneath the bag
2. Ask for a basin of water/ glass of water if faucet not available, place this outside
working area
3. Open the bag, take the linen/ plastic lining & spread over work field area. The
paper lining, clean side out.
4. Take out hand towel, soap in soap dish & apron & place them at one corner of
work area[ within the confines of linen/plastic lining]
6. Put on apron, right side out & wrong side with crease, touching the body, sliding
the head into the head strap. Neatly tie straps at the back
7. Put out things most needed when rendering nursing care [thermometer, kidney
basin, CB, waste paper bag [& place at one corner of work area.
8. Place paper receptacle outside work area
11. After completing nursing care / treatment, clean & alcoholize things used
13. Open bag & put back all articles in their proper places
14. Remove apron, folding away from body, with soiled side folded inwards, & the
clean side out. Place it in the bag
15. Clean & fold linen/ plastic lining, place it in the bag & close the bag
16. Get the bag, fold the paper lining & place in between the flaps & cover the bag
Definitions:
Health - a state of complete physical, mental and social well- being and not
merely the absence of disease or infirmity. [World Health Organization
1958]
Community - a collection of people who interact with one another & whose
common interests or characteristics form basis for a sense of unity or
belonging.
Public Health Nursing was coined by Lilian Wald when she was the
director of Henry Street Settlement in New York to denote a service
that was available to all people.
LEVELS of CLIENTELE:
1. INDIVIDUAL - as the client /patient. From the healthy/well to the dying- all age
group, from birth to senescence. Ex. The nurse may do prenatal check up on a
healthy young women, assess health status of infants coming to health center
during a well-baby clinic, follow up on medications /treatments of an elderly
newly discharged from hospital, assist a diabetic patient on meal planning, or
help a family care for terminal cancer patient.
A 40y.o.male may begin a program for walking 3 miles each day. If the
goal of his program were “to decrease the risk of cardiovascular
disease’ then the activity be considered DISEASE PREVENTION OR
HEALTH PROTECTION. By contrast, if the motivation for his walking
regimen were to “increase his overall health & feeling of well-being”
then the activity would be considered HEALTH PROMOTION behavior.
Health promotion & health protection as complementary process –
both affect quality of life.
CONCEPTS/PRINCIPLES IN CHN
1. Integrity
2. Excellence
3. Compassion & respect for human dignity
4. Commitment
5. Professionalism
6. Teamwork
7. Stewardship of health of people
LEVELS OF HEALTH CARE DELIVERY- DOH
1. Category A - Primary Care Facility- first contact health care facility, offers basic
services, emergency services/ provision for normal deliveries
a. without in-patient beds like health centers, out patient clinics, dental
clinics
b. with in patient beds- short stay,1 or 2 days, infirmaries, birthing[ lying – I ]
facilities
2. Category B - Custodial Care Facility- provide long term care, basic services like
food / shelter to patients with chronic conditions/ rehabilitation- custodial
psychiatric facilities, substance drug abuse treatment/ rehabilitation centers,
sanitaria/ leprosaria & nursing homes
3. Category C- Diagnostic / Therapeutic Facility- facility for examination of human body,
specimens from human body for diagnosis, treatment of disease, drinking water
analysis.
a. Laboratory facility-clinical laboratory, HIV testing lab, Blood service lab, drug testing
lab, newborn screening lab, laboratory for drinking water analysis
b. Radiologic facility providing services such as X- ray, CT scan, MRI, ultrasonography
c. Nuclear medicine facility- regulated by Phil. Nuclear Research Institute [PNRI]
utilizing application of radioactive materials in diagnosis, treatment or medical
research except the use of sealed radiation sources in radiotherapy as in internal
radiation therapy
Referral System - A client is first cared for by the family which may/ or may not
seek assistance of the barangay. From either of theses 2 entities, the case is
referred to BHS. Necessary referrals may then be made to the main health center or
private agencies within the poblacion. Further management maybe provided as the
case may warrant through system of referrals to district / provincial/ regional
hospitals & central referral system.
Population – Based Rural Health Manpower Needs – RURAL HEALTH UNIT
Health Sector Reform: Universal Health Care [UHC] – KALUSUGAN PANGKALAHATAN also
called AUINO HEALTH AGENDA –latest in series of continuing efforts of government to bring
health reforms. Built upon 2 previous platform reforms:
1. Quality assurance
2. Grants & technical assistance
3. Awards
4. Health promotion
• Guiding Principles for Sentrong Sigla :
1. Recognition for achieving good quality
2. Quality improvement is unending process
3. SS certification focus on core public health- child health,
maternal care, prevention of communicable diseases,
healthy lifestyle
4. Quality improvement is a partnership of stakeholders
5. Roles, responsibilities /contributions promote reciprocity
6. Even distribution of quality health services
7. SS shall involve partners – NGOs, GO, as advocates
HEALTH SECTOR REFORM AGENDA[ HSRA] 1999-2004 : health
reform areas:
1. Local health system development - networking of facilities
2. Hospital reforms - cost efficient hospitals
3. Public health program reforms - strengthen public health
delivery system
4. Health regulatory reforms - DOH ensure health products,
facilities, devices are safe, affordable
5. Social health insurance reforms - Phil Health Insurance
Corporation
FOURmula ONE FOR HEALTH [ 2005- 2020]
• Designed to implement health interventions as single package,
includes public / private, sectors, national agencies/LGUs, civil
society
Goals
1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing
FOURmula ONE Components:
1. Health financing - better, sustained investment in health. Phil
Health thru National Health Insurance Program & DOH
2. Health regulation - access to affordable products, devices,
services & facilities.
3. Health service delivery - accessible/available basic health care
for all
4. Good governance - improve health systems performance at
national/local levels
MAJOR PUBLIC HEALTH PROGRAMS:
On September 6-12 , 1978, health leaders form around 200 countries attended
International Conference for Primary Health Care held at Alma Ata USSR initiated by
WHO & United Nations Children’s Fund. The universal goal of PHC is HEALTH FOR
ALL by the year 2000.
Letter of Instruction 949 was signed on October 19, 1979 to formally launch PHC.
Key strategy to achieve the Goal: Partnership with and empowerment of the
People.
The Alma Ata Declaration listed 8 essential services:
R.A. 8423 Traditional & Alternative Medicine Act of 1997 - signed into law through Dr. Juan
Flavier – the then Sec. of Health. It created the Phil. Institute of Traditional & Alternative
Health Care [PITAHC], tasked to promote / advocate the use of traditional/ alternative health
care- herbal medicine, reflexology, chiropractics, nutritional therapy etc.
ENVIRONMENTAL HEALTH – definitions:
1. Solid waste
2. Water
3. Air
4. Toxic & hazardous waste
5. Occupational health
6. Food safety
7. Sanitation & climate change
8 Environmental Health Indicators that need to be monitored- DOH:
1. Households with access to improved or safe water
a. Level 1[ point source] – protected well [ shallow or deep] , improved dug well,
developed spring, or rainwater cistern with an outlet but without distribution
system: rural areas : served 15-25 households: point of consumption is at the
source itself, placing water reservoir at risk for contamination
b. Level 11[ communal point system or stand post] composed of a source , reservoir,
piped distribution network & a communal faucet located no more than 25 meters
from the farthest house, suitable for rural/ urban areas. Contamination from level
11 sources may take place during it transport / storage in households
TOXIC & HAZARDOUS WASTE CONTROL- The National Poison Management &
Control Center [NPMCC] PGH reported 1,286 poisoning cases, the top causes are:
2. Minimum sizes of rooms & heir least horizontal dimensions shall be as follows:
• Rooms for human habitations- 6.00m2 with at least horizontal dimension of
2.00m
• Kitchen- 3.00m2 with at least horizontal dimension of 1.50m
• Bath & toilets – 1.20m2 with at least horizontal dimension of 900mm
INFORMATION & COMMUNICATION TECHNOLOGY [ICT] & COMMUNITY HEALTH
eHealth – the use of ICT for health [WHO 2012 ]: a cost- effective way of using ICT
in health care services, health surveillance , health literature, health education &
research.
Considerations in eHealth:
1. Communicating with patient thru teleconference, electronic mail [ e-mail],
short message service [SMS]
2. Recording. Retrieving, & mining data in electronic medical record [EMR]
3. Providing patient teachings with the aid of radio, TV, computers, smartphones
& tablets
Benefits of well- managed patient information system:
1. Limited budget
2. Emergence of free/ open source software
3. Decentralized government
4. Target users are unfamiliar with technology
5. Surplus of “ digital native” registered nurse
A.O. No.2010- 0036 – Universal Health Care also known as
KALUSUGAN PANGKALAHATAN [KP] DOH. This health reform agenda
has 3 priority health directions
4 Elements of Telemedicine:
1. Provide clinical support
2. Overcome geographical barriers, connecting users who are not in
same physical location
3. Use of various types of ICT
4. Goal – to improve health outcomes
HEALTH PROMOTION, RISK REDUCTION & CAPACITY BUILDING STRATEGIES
HEALTH PROMOTION
• Any combination of health education & related organizational, economic &
environmental supports for behavior of individuals, groups, or communities
conducive to health.
• Behavior motivated by desire to increase well being & to reach health potential
Health Protection – behaviors one engages with intent to prevent disease, detect
disease in early stages or maximize health within the constraints of disease.
Examples- immunization, screening for cervical cancer
Risk - probability that a specific event will occur in a given time frame. Exposure
that is associated with a disease.
Risk reduction – proactive process, individuals participate in behaviors that enable
them to react to actual or potential threats to their health [Pender 1996].
Nutritional guidelines for Filipinos:
1. Eat variety of foods
2. Breastfeeding exclusively from birth- 6 months
3. Maintain children’s normal growth- proper diet
4. Consume fish, lean meat, poultry , dried beans
5. Eat foods cooked in edible oil
6. Consume milk, milk products & calcium – rich foods
7. Eat more vegetables/ fruits/ root crops
8. Use iodized salt, avoid salty foods
9. Eat clean / safe foods
10. Exercise regularly, avoid smoking & alcohol
OTTAWA CHARTER FOR HEALTH PROMOTION
Basic principles:
1. Message
2. Format
3. Environment
4. Experience
5. Participation
6. Evaluations
MATERNAL, NEWBORN AND CHILDHEALTH & NUTRITION
Leading Causes of maternal deaths [Philippines] 2006
1. Complications related to pregnancy occurring in the course of labor, delivery,&
puerperium
2. Hypertension complicating pregnancy, childbirth & puerperium
3. Postpartum hemorrhage
4. Pregnancy with abortive outcomes
Risk factors of maternal/neonatal death:
a. Having mistimed, unplanned, unwanted/unsupported pregnancy
b. Not securing adequate care during pregnancy
c. Delivering without skilled birth attendance[MD, nurse, midwives]/ no access to
emergency /neonatal care
d. Not having postpartum/postnatal care for mother /baby
Leading causes of infant mortality [Philippines] 2006
1. Bacterial sepsis of newborn
2. Respiratory distress
3. Pneumonia
4. Disorders related to short gestation/low birth weight
5. Congenital malformations of heart
6. Congenital pneumonia
7. Neonatal aspiration syndrome
8. Other congenital malformations
9. Intrauterine hypoxia/ birth asphyxia
10. Diarrhea/ gastroenteritis
MNCHN Maternal Newborn & Child Health & Nutrition strategy aims:
A. O. 50-A s 2001 – National Family Planning Policy, asserts that family planning as
health intervention shall be made available to all men & women of reproductive
age [15-44 years old]. FP prevents high – risks pregnancies brought about by the
following conditions:
1. Too young / too old- Less than 18 years old or over 34 years old
2. Having too many [ 4 or more] pregnancies
3. Having closely spaced [ too close] pregnancies [ less than 36 months]
4. Being too ill or unhealthy/ too sick or having an existing disease/ disorder – iron
deficiency anemia
4 Pillars [guiding principles] of PFPP
1. Responsible parenthood
2. Respect for life
3. Birth spacing
4. Informed choice
NEWBORN SCREENING
• RA 9288 Newborn Screening Act of 2004
Disorders --- Long term effects
1. Congenital hypothyroidism- severe mental retardation
2. Congenital hyperplasia - death
3. Galactosemia- death/ cataract
4. Phynylketonuria – severe mental retardation
5. G6PD- Glucose -6-phosphate dehydrogenase deficiency- severe anemia/ kernicterus
6. Maple syrup urine disease- death
• Newborn screening procedure - Specimen is obtained by heel prick. Few drops of blood
blotted on special absorbent filter card & sent to NSC [National Screening Center]. Blood
sample may be obtained by physician, nurse, medical technologist or trained midwife.
Available in hospitals, lying in clinics, RHUs, health centers, private clinics. If babies are
delivered at home, they are brought to nearest institution offering NBS.
• Normal [negative] result available by 7- 14 working days. Positive result relayed to parents
immediately, referred to specialist for confirmatory testing / further management
NEWBORN HEARING SCREENING
Types of disasters:
1. Natural hazard – physical force- typhoon, flood, landslide, earthquake &
volcanic activity
2. Biological hazard-s process/ phenomenon of organic origin or conveyed by
biological vectors, including exposure to pathogenic microorganisms, toxins, &
bioactive substances- disease outbreaks, red tide poisoning
3. Technological hazard- arises from technological/ industrial conditions,
accidents, dangerous procedures, infrastructure failures- stampede, armed
conflicts, terrorist activities, riots
Types of disasters, Philippines:
a. Natural Disasters: Communicable disease outbreaks, droughts,
earthquake, floods, heat waves, landslides, mudflow/ debris flow[
lahar], red tide phenomena, tsunamis, volcanic activities, weather
disturbance [ tornadoes, typhoon]
b. Man – made disasters- civil unrest, riots, explosions, bombings,
fires, mass transit accidents, mining accidents, pollution,
stampedes, structural failure[ bridges] , terrorist related events,
toxic/ hazardous spills, wars, open armed conflicts
• RA 10121 – Philippine Disaster Risk Reduction and Management
Act: developing & implementing[ NDRRMP] National Risk
Reduction and Management Plan : priority areas:
a. Disaster prevention/ mitigation by reducing vulnerabilities
b. Disaster preparedness
c. Disaster response
d. Rehabilitation / recovery
1. Health advocate
2. Health educator
3. Health care provider
4. Community organizer
5. Health trainer
6. Researchers
MENTAL HEALTH - a state of social well- being in which the individual
realizes his/ her own potential [self- image], can cope with normal
stresses of life [resiliency], can work productively / fruitfully
[productive/creative], & is able to make contribution to his/her
community [sense of purpose] – WHO 1999.
VISUAL IMPAIRMENT
• AO 179 s 2004-National Prevention of Blindness Program –
advocacy / health education on nature , risk factors extent of visual
impairment , complications, early diagnosis, treatment &
prevention of visual impairment.
COMMUNICABLE DISEASES
Top 10 causes of morbidity in the Philippines [2010]
1. Acute respiratory infection
2. Acute lower respiratory tract infection& pneumonia
3. Bronchitis
4. Hypertension
5. Acute watery diarrhea
6. Influenza
7. Urinary tract infection
8. Tuberculosis [TB] respiratory
9. Accidents
10. Injuries
• Communicable diseases- caused by infectious agents or its toxic
products, transmitted directly or indirectly to person, animal or
intermediary host or inanimate environment
• Communicable disease could either be contagious or infectious disease
• “Contagion“ derivative of “contact” is transmitted by direct physical
contact
• Infectious disease is transmitted indirectly thru contaminated food, body
fluids, objects, airborne inhalation or thru vector organisms that would
require a break or inoculation in skin or mucous membranes of
individuals
• Infectious diseases is sometimes called contagious, however other
infectious diseases are usually NOT regarded as contagious
EPIDEMIOLOGIC TRIANGLE MODEL- 3 components:
1. Agent - bacteria [ TB] , viruses [ influenza], rickettsia[ rocky mountain spotted fever
], fungi [ athlete’s foot] ,protozoa[ malaria ], helminths [ ascariasis] & arthropods [
scabies]
2. Host- any organism that harbors / provides nutrition for the agent- humans,
animals. The ability of host to fight the agent causing infection influenced by-age,
gender, socio economic status, ethnicity, nutrition & immune status, genetics,
hygiene, behavior
3. Environment – condition in which agent may exist, survive or originate comprising:
a. Physical –temperature, weather, soil, water, food sources
b. Biological- animals, insects, flora, other humans as reservoir or foster survival
of organisms
c. Socioeconomic- behavior, personality attitudes, cultural characteristics,
occupation, urbanization
CHAIN OF INFECTION - elements:
1. Causative agent- bacteria, viruses, rickettsia, fungi, protozoa, helminthes
2. Reservoir- environment / object in or on which organism survives &
multiplies- inanimate objects, humans, animals
3. Portal of exit- path by which an agent leaves its reservoir- respiratory,
genitourinary, skin, mucous membranes, gastrointestinal tract
4. Mode of transmission- means by which agent passes from the portal of
exit in reservoir to susceptible host. Transmitted thru contact, airborne,
droplet, vehicle, vector – borne
5. Portal of entry- path by which an agent invades susceptible host, same as
portal of exit.
6. Susceptible host- various factors of individual that present barriers to
invasion & multiplication of agents
Functions of Public Health Nurse in the Control of Communicable
Diseases:
1. Report immediately to Municipal Health Office any known
case of notifiable disease
2. Refer immediately to nearest hospital
3. Conduct health education toward prevention of outbreak
4. Assist in diagnosis of suspect based on signs/ symptoms
5. Conduct epidemiologic investigation as a means of
contacting families, case finding, individual / community
health education
END SLIDE