CHN CHAPTER 3 Flashcards
Public Health Nurse uses various tools and procedures
nursing process/ ADPIE
Standards of Public Health Nursing in the Philippines developed by?
National League of Philippine Government Nurses in 2005
Management function
When organizes “Nursing Services” of the local health agency
P-O-S-D-C
when nurses organizes “Nursing Services” she embodiMANAGEMENT FUNCTION
Responsible for the delivery of the package of
services provided by the program to the target clientele.
program manager
Reports on program accomplishments
Documentation of management skills
Supervisor of the midwives and other
auxiliary health workers in the catchment area.
Public Health Nurse
Has developed a Supervisory package
complete with supervisory checklists for various programs and proved to be useful to supervisors.
THE SENTRONG SIGLA PROGRAM
PHN AS SUPERVISOR
-supervisor of midwives and other auxiliary health workers in the catchment area.
- she formulates a supervisory plan
-conducts supervisory
visits to implement the plan
-uses supervisory checklist
Nursing care function
Nursing care plan/ ADPIE
Nursing care function
-Nursing Process/ ADPIE
-Home visit
-Referral of patient to appropriate level of care
-This function of the PHN bring activities or group of activities systematically into
proper relation or harmony with each other.
- establishes linkages and collaborative relationship
Collaborating and coordinating function
uses her skills in advocacy for the creation of supportive environment
through policies and reengineering of the physical environment for healthier
actions.
-provides client with information that allows them to make healthier choices and practices.
health promotion and education function
Nurses recognize cues from client that indicate need to learn. and when nurse respond to that cue they are___.
TEACHING
-to mobilize communities for health
actions.
-calls for the active participation of the community.
Health Promotion
-is a means of mobilizing people to solve their own problems
-people learn that their problems
have social causes and fighting back is a more reasonable, dignified approach
than passive acceptance and personal alienation.
community organizing,
-Initiates formulation of staff development and training programs for midwives and auxiliary workers.
-Conducts them in collaboration with other resource person
-does evaluation of training outcomes
Training function
-is a research activity of the nurses.
-It is a continuous
collection and analysis of data of cases and deaths.
Disease surveillance
-to measure the magnitude of the problem
-to measure
the effect of the control program.
Purpose of disease surveillance
-Acts as the nurse in charge in the same health center
- She supervises, guides, coordinates and evaluates
the work of her nurses.
PHN III
-Frontline health worker and prime mover for all health programs and activities
-first contact of the patient in the health center
-screen, record, assist , gives treatment, health educate,home visit or follow-up cases of patient
-she has to submit and prepare weekly, monthly, quarterly, or annually reports.
PHN II
-Supervising public health nurse
-assigned in health center with lying-in clinic and takes charge of unit, assuming bigger responsibility than the rest.
-supervises and coordinates work of nurses, midwives and other H.P.
-She attends meetings, conferences or seminars for her own career growth and for the improvement of health services.
NURSE V
-Manages and oversees the performance of a group of nurses assigned in number of health centers in district or area.
-Performs consultation and objective assessment and evaluation
-She consolidates I evaluates and analyzes the necessary weekly, monthly,
quarterly and annual reports.
-studies and evaluates the performance ratings of nurses
- She conducts program orientation to pre-service
and in-service nurse trainees and students.
-She likewise acts as a nursing
consultant on technical matters.
Nurse program supervisor or Nurse VI
-community health nursing process,
-nursing procedures during
clinic and home visits,
-community organizing, health promotion and educatioh,
surveillance, records and reports.
COMPETENCIES SKILLS AND KNOWLEDGE
-is central to all nursing actions- it is the very essence of nursing, applicable in any setting, in
any frame of reference, and within any philosophy
-systematic, scientific, dynamic, on-going interpersonal
process
Nursing process
Collection of Data
Assessment
Various methods to collect datas:
-Community surveys: Interview
-Observation of health related behaviors:
-Review of statistics, epidemiological & relevant studies.
-Health records: lab and physical examinations.
Categories of Health Problems
-Health deficits
-health threats
-foreseeable crisis or stress points
conditions that promote disease or injury and prevent people from realizing their health potential.
Ex. inadequate immunization
Health threats
A gap between actual and achievable health status.
Health Deficit
stressful occurrences such as death or illness of family member
Stress point/ Foreseeable crisis
Health problem that can be alleviated with medical or social technology
Health Need
a situation in which there is demonstrated health need combined with actual or potential resources to apply remedial measures and commitment to act on part of the provider or client
Health problem
are prioritized in order of urgency
to determine those that need the earliest action or attention such as those that
actually threaten the health of the client (individual, family or community).
- They are legal records to protect the agency and the health care
providers or the client himself/herself.
-They also provide data for research and
education.
Plans of care
declaration of purpose or intent that gives essential direction to action.
goal
This provides
data which is needed to plan the client’s care and ensure its continuity: serves
as an important communication tool for various team members: furnishes written
evidence of the quality of care that the clients received and their response to
it
Documentation
three classic frameworks or Evaluation of Care
-Structural elements
-Process elements
-Outcome elements
Program Based Cases
e.g., IMCI
Manage by the nurse
Non-program based cases
Refer to the physician
Emergency Cases
Provide first-aid treatment and refer when necessary to next level of care
The patient visit to avail services offered by facility:
-For consultation on matters that ailed them physically.
-Pre-natal/ Post-partum care
-Well baby check up
-Immunization
-free medication under DOTS
CLINIC VISIT
Standard procedures performed during clinic visits:
REGISTRATION/ADMISSION
1.Greet the client upon entry and establish rapport.
2. Prepare the family record of new patients or retrieve records of old clients.
3. Elicit and record the client’s chief complaint and clinical history.
4. Perform physical examination on the client and record it accordingly.
Standard procedures performed during clinic visits:
WAITING TIME
- Give priority numbers to ,clients.
- Implement the “first-come,first serve”
policy except for emergency/urgent ‘cases.
Standard procedures performed during clinic visits:
TRIAGING
A. Manage program-based cases
B.Refer all non-program based cases to physician
C.Provide first-aid treatment to emergency cases and refer when necessary to the next level of care.
Standard procedures performed during clinic visits:
Clinical Evaluation
1 . Validate clinical history and physical examination
2. The nurse arrives at an evidence-based diagnosis and provides rational
treatment based on DOH programs.
a. identify the patient’s problem
b. formulate/write the nursing
diagnosis and validate
c. give/perform the nursing
intervention
d. evaluate the intervention if it has
enabled the patient to achieve the
desired outcome
3. Inform the client on the nature of the illness, the appropriate treatment and
prevention and control measures.
Standard procedures performed during clinic visits:
Laboratory and other diagnostic examinations
- Identify a designated referral laboratory when needed.
Standard procedures performed during clinic visits:
Referral System
- Refer pt if he needs further management following the two way referral system
BHS to RHU; RHU to RHU; RHU to HOSPITAL - Accompany the patient when an emergency referral is needed.
Standard procedures performed during clinic visits:
Prescription/Dispensing
Give proper instructions on drug intake
Standard procedures performed during clinic visits:
health education
- Conduct one-on-one counseling with the patient.
- Reinforce health education and counseling messages
- Give appointments for the next visit.
Standard procedures performed during clinic visits:
I. Registration/admission
II. Waiting time
III.Triaging
IV.Clinical evaluation
V.Laboratory and other diagnostic examinations
VI. Referral System
VII. Prescription/Dispensing
VIII. Health education
BP Taking
Preparatory phase:
-make sure client is relaxed and has rested for at least 5 minutes
-should not have smoked or ingested caffeine within 30 minutes before BP taking
Applying the BP cuff and stetoschope
-Apply cuff at upper arm 2-3 cm above bracial artery
-apply cuff snugly with no creases
-keep arm level with heart by placing on table or chair arm or supporting it. if client in recumbent position, rest arm at his/her side.
-palpate brachial pulse correctly just below or slightly medial to antecubital area.
Obtaining the BP readying by auscultation:
-stethoscope head over brachial pulse
-use Bell (or diaphragm for obese) of stethoscope
-inflate the cuff rapidly by pumping the build until reaches 30mmhg above palpated SBP.
-Deflate cuff slowly at rate of 2-3 mmhg/beat
-listen to pulse sound/korotkoff sounds
(first clear tapping sound (korotkoff phase I : Systolic BP)
(Softening/Muffling sounds or Disappearance of sound (Korotkoff sound V: Diastolic BP)
Recording BP and other guidelines:
For every first visit
-take the mean of 2 readings, obtained at least 2 minutes apart, consider this as client’s blood pressure.
-if first 2 readings differ by 5 mmhg or more. obtain a 3rd reading and include this in the average. if first visit repeat in the other arm. subsequently, BP READINGS SHOULD BE PERFORMED ON THE ARM WITH HIGHER BP.
-document phase I,IV, V following format (Systolic/ muffling/disappearance)
-inform client of result and stay for a while to answer questions/concerns.
a 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.
Home visit
Purpose of home visit
-To give care to the sick, post-partum mother and her newborn. to teach responsible family member to give subsequent care.
-to assess living condition of the patient and his family and their health practices to provide appropriate health teaching.
-To give health teaching about prevention & control of diseases
-To establish close relationship between health agencies and public for promotion of health.
-to make use of inter-referral system and promote the utilization of community services.
**Principles of home visit
**assemble the records of patient and list of names to be visited. study the case and have written nursing plan.
-Home visit must have a purpose or objective
-Make use of all available information about pt and his family through family records.
-Give priority to essential needs of individual and family.
-delivery of care should involve the individual and family.
-Plan should be flexible
Guidelines to consider regarding the frequency of home visits:
**no definite rule to be followed on the frequency of home visit.
may vary according to the need of patient or family for nursing care
-Physical, psychological, and educational needs of individual and family.
-acceptance of family for services to be rendered. interest and willingness to cooperate.
-the policy of specific agency and emphasis given towards their health programs.
-health agencies and number of health personnel involved in care of specific family.
-careful evaluation of past services given to family and how the family avail of nursing services.
-ability of patient and his family to recognize their own needs, knowledge of available resources and their ability to make use of resources for the benefit.
steps in conducting home visits
- Greet the patient and introduce yourself
- State the purpose of the visit
- Observe the patient and determine the health needs
- Put the bag in a convenient place then proceed to perform the bag technique
- Perform the nursing care needed and give health teachings
- Record all important data, observation and care rendered
- Make appointment for a return visit.
a tool by which nurse will enable her to perform nursing procedure with ease and deftness.
-save time and effort
-with end view of rendering effective nursing care to clients.
Bag technique
Essential and indispensible equipment of public health nurse. contains basic medication and articles.
Public health bag
Principles of bag technique
-minimize, if not prevent the spread of any infection
-saves time and effort in performance of nursing procedures
-show the effectiveness of total care given to an individual or family
-the bag technique can be performed in variety of ways depending on agency’s policy, home situation, or as long as principles of avoiding transfer of infection is observed.
Contents of the public health bag
Paper lining
Extra paper for making waste bag
Plastic/linen lining
Apron
Hand towel
Soap in a soap dish
Thermometers (oral and rectal)
2 pairs of sCissors ( surgical and bandage )
2 pairs of forceps (curved and straight )
Disposable syringes with needles (g. 23 & 25)
Hypodermic needles g. 19,22,23,25
Sterile dressing
Cotton balls ( dry and with alcohol )
Cord clamp
Micropore plaster
Tape measure
1 pair of sterile gloves
Baby’s scale
Alcohol lamp
2 test tubes
Test tube holders
Solutions of
Betadine
Zephiran solution
Spirit of ammonia
Acetic acid
70% alcohol
Hydrogen peroxide
Ophthalmic ointment
Benedict’s solution
*Sphygmomanometer and stethoscope are carried separately.
what are the equippment being carried separately in PHN bag?
Sphygmomanometer and stethoscope
Important points to consider In the use of the bag
- The bag should contain all the necessary articles, supplies and equipments that will be used to answer emergency needs.
- The bag and its contents should be cleaned very often, the supplies replaced,
and ready for use anytime . - The bag and its contents should be well protected from contact with any article
in the patient’s home. Consider the bag and its contents clean and sterile,
while articles that belong to the patients as dirty and contaminated. - The arrangement of the contents of the bag should be the one most convenient to the user, to facilitate efficiency and avoid confusion.
Steps In Performing the Bag Technique Actions
1) -PUT THE BAG
Upon arrival at the patient’s home, place the bag on the table lined with a clean paper. The clean side must be out and the folded part, touching the table.
RATIONALE: To protect the bag from getting contaminated
2) -H20 (WATER)
Ask for a basin of water or a glass of drinking water if tap water is not available.
RATIONALE: To be used for handwashing
3) -TOWEL/ TSABON
Open the bag and take out the towel and soap.
RATIONALE:To prepare for handwashing
4) -WASH
Wash hands using soap and water. wipe to dry.
RATIONALE: To prevent infection from the care provider to the client
5) -APRON
Take out the apron from the bag and put it on with the right side out
RATIONALE: To protect the nurse’s uniform
6) -GET ALL
Put out all the necessary articles needed for the specific care
RATIONALE: To have them readily accessible
7) -CLOSE IT
Close the bag and put it in one corner of the working area.
RATIONALE: To prevent contamination
8) -NURSING CARE RN
Proceed in performing the necessary nursing care and treatment
RATIONALE:To give comfort and security and hasten recovery
9) -LINISIN KO
After giving the treatment, clean all things that were used and perform handwashing.
RATIONALE: To protect the caregiver and prevent infection
10) -BALIK SA BAG
Open the bag and return all things that were used in their proper places after cleaning them.
11) - REMOVE APRON
Remove apron, folding it away from the person, the soiled side in and the clean side out. Place it in the bag
12) -TAPOS NA!
Fold the lining, place it inside the bag and Close the bag.
13) -DOCUMENTATION
Take the record and have a talk with the Mother. Write down all the necessary data that were gathered, observations, nursing care and treatment rendered. Give instructions for care of patients in the absence of the nurse.
RATIONALE: For reference in the next visit
14) -NEXT APPOINTMENT
Make appointment for the next visit (either home or clinic) taking note of the date and time)
RATIONALE: For follow-up care
Giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can
maintain himself/herself, or die peacefully in dignity
NURSING CARE IN THE HOME
Principles in Nursing Care
- Nurisng care Utilize medical plan of care and treatment
- Nursing care utilizes skills that would give maximum comfort & security to the individual.
- Nursing care at home as teaching opportunity to patient or to responsible member of the family.
- Nursing care Should recognize dangers in the patient’s over-prolonged acceptance of support & comfort.
- Nursing care is a good opportunity for detecting abnormal s/sx, observing pt attitude towards care given, and progress by patient.
Isolation Technique in the Home
-All articles used by the patient should not be mixed with the articles used by
the rest of the members of the household.
- Frequent washing and airing of beddings and other articles and disinfection of
room are imperative. Abundant use of soap, water, sunlight and some chemical disinfectants is necessary.
-The one caring for the sick member should be provided with a protected gown
that should be used only within the room of the sick.
- All discharges from the nose and throat of a communicable disease
patient, should be discarded.
-Articles soiled with discharges should first be boiled in water 30 minutes before
laundering. Those could be burned, should be burned.
process of change, building the capability of people for future community
action.
“empowerment”
(relationships, structure and resources)
social organizations
(knowledge, beliefs and attitudes)
Ideology
Five stages of Organizing: A Community Health Promotion Model
Stage 1: Community Analysis/ Community diagnosis/ community needs assessment/ health education planning/ mapping
“The process of assessing and defining needs, opportunities and resources
involved in initiating community health action program (Haglund).”
Community Analysis/ Community diagnosis/ community needs assessment/ health education planning/ mapping
Community analysis has 5 components:
-Demographic, social & economic profile of the community derived from secondary data.
-health risk profile (social, behavioral, and environmental risks).
Behavioral: Dietary habit & lifestyle
concern (drugs, alcohol, tobacco)
Social: Unemployment, low education,
isolation
-Health/wellness outcomes profile (morbidity/ mortality data)
-Survey of current health promotion programs
-Studies conducted in certain target groups.
Steps in community analysis
a) Define the Community: determine geographical boundaries of target community
b) Collect data
c) Assess community capacity: “driving forces”
d) Assess community barriers
e) Assess readiness for change.
f) Synthesis data and set priorities.
Stage 2: Design and Initiation
a) Establish a core planning group and select a local Organizer. 5-8 members.
b) Choose an organizational structure.
-Leadership board or council: existing local leaders working for common cause
-Coalition: linking organization to work on community issues
- “Lead” or official agency: single agency takes primary lead of liaison for health promotion.
-Grass-roots: informal structures like neighborhood residents.
-Citizen panels: group of citizen (5-10) to form partnership with government agency.
-Networks and consortia: network develop because of certain concerns.
c) Identify, select and recruit organizational members.
d) Define the organization mission and goals.
e) Clarify roles and responsibilities of people involved in the organization.
f) Provide training and recognition.
Stage 3: Implementation
Implementation put design plans into action.
a) Generate broad citizen participation
b) Develop a sequential work plan.
c) Use comprehensive, integrated strategies.
d) Integrate community values into the programs, materials and messages.
Stage 4: Program Maintenance - Consolidation
To maintain and consolidate gains of the program, the following are essential:
a) Integrate intervention activities into community networks.
b) Establish a positive organizational culture.
c) Establish an ongoing recruitment plan.
d) disseminate results
Stage 5: Dissemination - Reassessment
formative evaluation is done for timely modification of strategies & activities.
a) Update the community analysis.
b) Assess effectiveness of interventions/programs.
c) Chart future directories and modifications.
d) Summarize and disseminate results.
Five stages of Organizing: A Community Health Promotion Model
Stage 1: Community Analysis
Stage 2: Design and Initiation
Stage 3: Implementation
Stage 4: Program Maintenance - Consolidation
Stage 5: Dissemination - Reassessment
composite expression of the social and cultural circumstances that
condition and constrain behavior.
lifestyle
According to him, “health is promoted by providing
a decent standard of living, good labor conditions, education, physical culture,
means of rest and recreation”
Henry E. 1945
First person to use term “health promotion”.
“the process of enabling
people to increase control over and to improve their health.”
Ottawa charter: Health Promotion
prerequisite for Health
-Peace,
-Shelter,
-Education,
-Food,
-Income,
-A stable eco-system,
-Sustainable resources,
-Social justice and,
-Equity.
In order to operationalize the concept of health promotion the Charter
recommended the following action areas:
- Build Healthy Public Policy
- Create Supportive Environments
- Strengthen Community Action
- Develop Personal Skills
- Reorient Health Services
The WHO cites the following principles of health promotion:
- Health promotion involves the population as a whole.
- Health promotion is directed towards action on the determinants or cause
health. - Health promotion combines diverse, but complementary methods or approaches.
- Health promotion aims particularly at effective and concrete public participation.
- Health promotion is primarily a societal and political venture and not a medical service.
“mediating
strategy between people and their environments, synthesizing personal choice
and social responsibility in health.”
“Health Promotion” defined by WHO
“any combination of learning experience
designed to facilitate voluntary adoptions of behaviors conducive to health.”
Health Education : Green 1980
the process of assisting individuals, acting
separately or collectively, to make informed decisions about matters affecting the
personal health and that of others.”
“Health Education” by The National Task Force on the Preparation and Practice of Health Educators
(1983)
The Scope of Health Education
-covers the continuum of the levels of
prevention
Health education takes place in various setting
-Formal or informal/Incidental
*Health centers, Hospital, Health
Organization
-Schools
-Communities
-Worksites e.g., industries, offices, food establishment etc.
-The study of occurences and distribution of diseases
-Distribution and determinants of health states or events in specified
population
-the application of this study to the control of health problems
EPIDEMIOLOGY
Two main areas of investigation of epidemiology:
1st area: The distribution of health status in terms of age, gender, race, geography, time
2nd area: explanations of the patterns of disease distribution in terms of causal factors.
the backbone of the prevention of the disease
Epidemiology
Uses of Epidemiology:
-study the history of health population, rise and fall of diseases.
-diagnose the health of community
-study the work of health services with view of improving them.
-estimate the risk of diseases etc. and chances of avoiding them
-identify syndromes by describing the distribution and association of phenomena in population.
-complete the clinical picture of chronic disease and describe their natural history.
-search for causes of death and disease. defined by their composition, inheritance, experience, behavior, and environment
***THE EPIDEMIOLOGIC TRIANGLE
HOST
ENVIRONMENT
AGENT
- A change in any of the
component will alter an existing equilibrium to increase or decrease the frequency
of the disease.
is any organism that harbors and provides nourishment
for another organism.
Host
intrinsic property of microorganism to survive and multiply in the
environment to produce disease.
Agent
the infectious agent or its
toxic component that is transmitted from the source of infection to the susceptible
body
causative agent
the sum
total of all external condition and influences that affects the development of an organism which can be biological, social and physical.
-It affects both agents and the host
Environment
Three component of the environment:.
-Physical environment: inanimate; geophysical condition of climate
-Biological environment: makes up living things; plants & animal life
-Socio-economic environment: economic development
Agents of disease
A. Nutritive elements
excess: cholesterol
deficiencies : vitamins, proteins
B. Chemical agents
poisons: carbon monoxide, drugs
allergens: ragweeds, poison ivy
C. Physical agents
heat, light, ionizing radiation
D. Infectious Agents
Metazoa: Hookworm,
Schistosomiasis
Protozoa: Amoeba, Mlaria
Bacteria: Rheumatic fever, Typhoid,
Lobar Pneumonia
Fungi: Histoplasmosis, Athlete’s foot
Rickettsia: Spotted fever, Rocky
Mountain
Virusis: Measles, mumps, chicken pox,
polio, rabies
Host Factors (Intrinsic Factors)
Influences exposure, susceptibility, or response to agents:
A. Genetic: Sickle cell disease
B. Age
C. Sex
D. Ethnic group
E. Physiologic :Fatigue, pregnancy,
puberty, stress
F. Immunologic experience: Hypersensitivity
Passive: Maternal antibodies,
gammaglobulin
Active: Prior Infection, Immunization
G. Inter-current or pre-existing disease
H. Human Behavior: Hygiene, food
handling
Environmental factors (Extrinsic Factors)
Influences existence of the agent,
exposure, or susceptibility to agent
A. Physical environment: Geology, Climate
B. Biologic Environment
Human Population: Density
Flora: source of food, vertebrates &
arthropod as source of agent
C. Socio-economic environment
Occupation: exposure to chemicals
Urbanization: Urban crowding, Tension
& pressures
Disruption: Wars, Disasters
These variables are studied since they determine the
individuals and populations at greatest risks of acquiring particular disease, and
knowledge of these associations may have predictive value.
epidemiology variables
-Time; Person; Place
Refers to both periods during which cases were exposed to the source of infection, and The period which illness occurred.
Time
reported number of cases of a
disease exceed the expected, or usual number for that period.
Epidemic period
refers to the characteristics of the individual who were exposed and who
contacted the infection or the disease in question.
can be described by:
-inherent/ acquired characteristics (sex, age, race)
-activities: (work, play religion, custom)
-circumstances: social, economic, environmental condition
Person
features, factor or conditions which existed in or described the
environment in which the disease occurred.
Place
described
in terms of street, address, city, municipality, province, region or country.
Geographic area
-intermittent occurrence of a few isolated and unrelated cases in a given locality.
-Cases are few and scattered
-Occur on and off
-Intermittently through a period of time
-e.g., Rabies
Sporadic
-Continuous occurence
-usual number of cases in a given locality
-always occurring in the locality and the level of occurrence is more or less
constant through a period of time.
-Maybe low or high
-it is in a way already identifiable with the locality itself
-e.g., Schistosomiasis (leyte & samar)
Filariasis (Sorsogon)
Tuberculosis
Endemic
-unusually large number of cases in a relatively short period of time.
- disproportionate relationship between the number of cases and the period of occurrence.
-the more acute in disproportion the more urgent and serious the problem.
-number of cases is much more than the usual number of cases in that locality.
Epidemic
-occurrence of epidemic of the same disease in several countries.
-occurence from an international perspective
pandemic
Outline of Plan for Epidemiological Investigation
- Establish fact of presence of epidemic
-Verify of diagnosis
-Reporting
-unusual prevalence of disease - Establish time and space relationship of the disease
- Relations to characteristic of the group of community
- Correlation of all data obtained
responsible for providing timely and
accurate information on diseases in the locality.
epidemiologic
information service
Epidemiologic information service and among its responsibilities includes:
a. Surveillance of infectious diseases with outbreak potential
b. Assisting local government units in the investigation of outbreak and their
control
c. Developing information package on public health
d. Providing technical assistance related to epidemiology
an on-going systematic collection, analysis, interpretation and dissemination of health data.
Public health surveillance
considered information loops or cycles involving health care providers, public health agencies and the public.
Surveillance system
continuous collection and analysis of data of cases and death.
Surveillance
The objectives of surveillance are:
- To measure the MAGNITUDE of the problem.
- To measure the EFFECT of the control program.
-a hospital based information
system that monitors the occurrence of infectious diseases with outbreak
potential.
-It also serves as a supplemental information system of the Department
of Health.
The National Epidemic Sentinel Surveillance System (NESSS)
Objectives of NESSS
- 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.
The NESSS 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 :
1) Cholera
2) Hepatitis A
3) Hepatitis B
4) Malaria
5) Typhoid Fever
C-HA-HB-M-T
Clinically Diagnosed:
Not mentioned in Laboratory and under surveillance system
Under Surveillance System:
1. Acute flaccid paralysis
2. Measles
3. Maternal and neonatal tetanus
4. Paralytic shellfish poisoning
5. Fireworks and related injury
6. HIV /AIDS
A-M-M-P-F-H
Importance of Outbreak investigation:
- Control and prevention measure
- Severity and risk to others
- Research opportunities
- Public, political or legal concerns
- Program consideration
- Training
Sources of Outbreak investigation:
- Surveillance data
- Medical Practitioner
- Affected persons I group
- Concerned citizen
- Media
Steps in Outbreak Investigation:
Step 1 -Prepare for field work
Step 2 -Establish the existence of an outbreak
Step 3 -Verify Diagnosis
Step 4 -Define and Identify cases
Step 5 -Perform descriptive epidemiology
Step 6 -Developing Hypotheses
Step 7 -Evaluate hypotheses
Step 8 -Refine hypotheses and execute additional studies
Step 9 -Implement control and prevention measures
Step 10 - Communicate findings
Step 11 - Follow-up Recommendations
an aggregation of cases in a given area over a particular period
without regards to whether the number of cases is more than the expected
Cluster
Function of the Epidemiology Nurse:
a) Implement public health surveillance
b) Monitor local health personnel conducting disease surveillance
c) Conduct and or assist other health personnel in outbreak investigation
d) Assist in the conduct of rapid surveys and surveillance during disasters
e) Assist in the conduct of surveys, program evaluations, and other epidemiologic studies
f) Assist in the conduct of training course in epidemiology
g) Assist the epidemiologist in preparing the annual report and financial plan
h) Responsible for inventory and maintenance of epidemiology and surveillance
unit (ESU) equipment
Specific role during Epidemiological Investigations:
- Maintains surveillance of the occurrence of notifiable disease.
- Coordinates with other members of the health team
- Participates in case findings and collection of laboratory specimens.
- Isolates cases of communicable disease.
- Renders nursing care, teaches and supervises giving of care.
- Performs and teach household members method, concurrent and terminal
disinfection. - Gives health teachings to prevent further spreads of disease
- Follow up cases and contacts.
- Organizes, coordinates and conducts community health education campaign I
meetings. - Refers cases when necessary.
- Coordinates with other concerned community agencies.
- Accomplishes and keeps records and reports and submits to proper office I
agency.
-Systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths.
Vital statistics
Refers to a systematic approach of obtaining, organizing and analyzing
numerical facts so that conclusion may be drawn.
Statistics
It indicates the state of health
of a community and the success or failure of health work.
Statistics of disease (morbidity) and death (mortality)
Statistic on population and the characteristics such as age and sex, distribution are obtained from?
NSO (National Statistic Office)
Births and Deaths are registered in t?
Office of Local Civil Registrar of Municipality or City
In cities, births and deaths are registered at?
City Health Department
Use of Vital Statistics:
- Indices (index) 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 for Vital Statistics:
- Population census
- Registration of Vital data
- Health Survey
- Studies and researches
The relationship between a vital event and those persons exposed
to the occurrence of said event, within given area and specified unit of time.
Rate
describe the relationship between two (2) numerical quantities of events without taking particular considerations to the
time or place.
Ratio
referred to the total living population.
Crude or General Rates
specific population class or group
Specific Rate
a measure of one characteristic of the natural growth or
increase of a population.
Crude Birth Rate
- a measure of one mortality from all causes which may result
in a decrease of population
Crude Death Rate
-measures the risk of dying during the 1st year of life.
-a good index of the general health condition of a community.
Infant Mortality Rate
-measures the risk of dying from causes related to pregnancy, childbirth and puerperium.
-It is an index of the obstetrical care
needed and received by women in a community.
Maternal Mortality Rate
measures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion, irrespective of duration of pregnancy.
Fetal Death Rate
measures the risk of dying the 1st month of life
Neonatal Death Rate
describes more accurately the risk of exposure of certain
classes or groups to particular diseases.
Specific Death Rate
measures the frequency of occurrence of the phenomenon during a given period of time
Incidence Rate -
measures the proportion of the population which exhibits a
particular disease at a particular time.
Prevalence Rate
shows the numerical relationship
between deaths from all causes (or group of causes), age (or group of age) etc.,
and the total no. of deaths from all causes in all ages taken together
Proportionate Mortality (Death Ratios)
index of a killing power of a disease and is influenced by
incomplete reporting and poor morbidity data.
Case Fatality Ratio
The following are most commonly used graphs in presenting Data:
-Line or Curved Graphs
-Bar Graphs
-Area Diagram (Pie Chart)
shows peaks, valleys and seasonal trends. Also used
to show the trends of birth and death rates over a
period of time;
Line/curved graphs
shows the relative importance of parts to the whole.
Area diagram/ Pie chart
each bar represents or expresses a quantity in terms of rates
or percentages of a particular observation like causes of illness
and deaths.
Bar Graphs
Functions Of Nurses:
- 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 (FHSIS)
- To provide summary of data on health services delivery and selected program
accomplished - To provide data with data from other sources, 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 studies - To ensure that the data reported are useful and accurate and are
disseminated in a timely - To minimize the recording and reporting burden at the service delivery level in
order to allow more time for patient care and promotive activities.
Components of FHSIS
- Family Treatment Record
- Target Client List
- Reporting Forms
- Output Reports
The fundamental building block or foundation of the Field Health Service
Information System is the?
Treatment Record
form or pieces of paper upon which the presenting symptoms or complaints of the patient on consultation and the diagnosis (if available), treatment and date of treatment is recorded.
Treatment Record
the second “building block” of the FHSIS
Target/Client Lists
Target/Client Lists purposes:
1 . To plan and carry out patient care and service delivery.
2. To facilitate the monitoring and supervision for services.
3. To report services delivered.
4. To provide a clinic-level data base which can be accessed for further studies.
Notification of Death Form
e1
Maternal Death Report
e2
Perinatal Death Report
e3
Report of Notifiable Diseases
M1; weekly
All information
related to the clienUpatients history, complaint, diagnosis, services and/or
treatment is contained in three documents or records:
(1) the individual treatment
record.
(2) The TargeUCiient List (TCL)
(3) the tally sheeUreport forms
-The lowest level of reporting unit
-it is expected to report health services provided to its defined catchment area
Barangay Health Station (BHS),
BHS can be considered a reporting unit if the following conditions are satisfied:
- It renders/delivers health services to a defined catchment area which may be
composed of one or more barangay
*A midwife render regular services to the area. - Health services may be provided for any physical structure designated for the
purposes i.e. a BHS building, a barangay hall or a place of residence. - The catchment area served is not a service area of any RHU.
*It should not include satellite BHS which are visited by the midwife but part of
the catchment of the Mmother BHS”.
The next level of reporting unit is the?
it is expected to report health services provided to the RHU
or MHC catchment area which is usually the Poblacion and nearby barangays.
Rural Health Unit (RHU) or Main Health
Center (MHC)
the following are considered reporting units and are expected
to submit FHSIS reports in cases where public health related services are
provided:
BHS/BHC
RHU/MHC
PH/CHO
RH
