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