UNIT I. OVERVIEW OF THE PUBLIC HEALTH NURSING IN THE PHILIPPINES Flashcards
is one of the major fields of nursing in the Philippines; the
other is hospital nursing. We generally use the terms community health nursing and public
health nursing, and community health nurse and public health nurse interchangeably.
Community Health Nursing
Those
who work in rural health units (RHUs) or health centers are community health nurses and
are officially called_____. Occupational health nurses (company
nurses) and school health nurses are classified as .
public health nurses (PHNs) ; community health nurses
Public health systems are operating within a context of ongoing changes, which
exert several pressures on the public health system.
These changes include
- Shifts in demographic and epidemiological trends in diseases, including the
emergence and re-emergence of new diseases and the prevalence of risk and
protective factors - New technologies for health care, communication, and information
- Existing and emerging environmental hazards some associated with
globalization - Health reforms
gives us an idea of the health situation in the
communities where nurses work. Because of the different conditions prevailing in these
communities, their health picture expectedly varies. The local health situation, therefore,
needs to be established for each province, city, and municipality.
national health situation
implemented through FOURmula ONE and operationalized in the national objectives for health 2005 to 2010 spell out the program imperatives of the health sector. All of these are in line with the millennium development goal and the medium-term development plan of the country
health sector reform agenda (HSRA)
State of complete physical, mental, and social wellbeing, and not merely the absence
of disease or infirmity.
Health
relating to living together in organized groups or similar close
aggregates
Social
connotes community vitality and is a result of positive interaction
among groups within the community with an emphasis on health promotion and illness
prevention
Social health
’ refers to a positive rather than neutral state, framing health as a positive
aspiration
‘Wellbeing
Factors affecting health
- Income and social status
- Education
- Physical environment
- Employment and working conditions
- Social support networks
- Culture
- Genetics
- Personal behavior and coping skills
- Health services
- Gender
Indicators of health and illness
- Mortality and morbidity data
- Life expectancy
- Infant mortality
- Maternal mortality
- Age-adjusted death rates
- Disease incidence rates
(C.E. Winslow) is the science and art of (1) preventing disease, (2)
prolonging life, and (3) promoting health and efficiency through organized community
effort for;
1. Sanitation of the environment
2. Control of communicable infections
3. Education of the individual in personal hygiene
4. Organization of medical and nursing services for the early diagnosis and preventive
treatment of disease and
5. Development of the social machinery
Public health
The purpose of public health
is to improve the health of the public by promoting
healthy lifestyles, preventing disease and injury, and protecting the health of
communities.
Core public health functions
a. Assessment
b. Policy development
c. Assurance
is dedicated to the common attainment of the highest level of physical
mental and social well-being and longevity (Hanlon).
Public health
defined Community Health Nursing
as “the synthesis of nursing practice and public health practice applied to promoting and
preserving the health of populations”. This viewpoint noted that a community health nurse
directs care to individuals, families, or groups; this care, in turn, contributes to the health of
the total population.
American Nurses Association (ANA)
is considered to be a broader and more
general specialty area that encompasses subspecialties that include public health nursing,
school nursing, occupational health nursing, and other developing fields of practice such as
home health and independent nurse practice
Community health nursing
The philosophy of community health nursing is based on
the Worth and Dignity
of Man (Shetland
Field of Community Health Nursing in the Philippines
a. School Nursing
b. Occupational Health Nursing
Type of Public Health Nursing that focuses on the promotion of health and wellness
of the pupil/students, teaching and non-teaching personnel of the school.
School Nursing
The duties and
responsibilities of the school Nurse include the following:
- Health Advocacy
- Health and nutrition assessment –vision and hearing
- Supervision of the health and safety of the school plant
- Treatment of common ailments
- Referral and follow-up of pupils and personnel
- Home visits
- Community outreach like community assembly
- Recording and reporting of accomplishments
- Monitoring and evaluation of programs and projects
Functions of School Nurse
- School Health and Nutrition Survey
- Putting up a Functional School Clinic
- Health Assessment
- Standard Vision testing for School Children
- Ear examination
- Height and Weight Measurement and Nutritional status Determination
- Medical referrals
- Attendance to emergency cases
- Student Health Counseling
- Home Visitation
In the Philippines, the health of the people in the workplace is another important focus
for community health nursing practice, it is in the work setting that many individuals spend a
quarter to almost a third of their working lives each working person faces certain conditions
and develop certain patterns on the job that affect their health.
Occupational Health Nursing
has frequently been described as the synthesis of public health
nursing practice
Public Health Nursing
as a field of professional practice in nursing
and in public health in which technical nursing, interpersonal, analytical, and
organizational skills are applied to problems of health as they affect the community.
These skills are applied in concert with those of other persons engaged in
health care, through comprehensive nursing care for families and other groups
and through measures for evaluation or control of threats to health, for health
education of the public, and for mobilization of the public for health action
Public health nursing
Standards of Public Health Nursing Practice
Standard 1. Assessment Collects comprehensive data
Standard 2. Population diagnosis and
priorities
Analyzes assessment data
Standard 3. Outcomes Identification Identifies expected outcomes
Standard 4. Planning Develops a plan that reflects best practices
Standard 5. Implementation Implements identified plan
a. Coordination
b. Health education and
health promotion
c. Consultation
d. Regulatory activities
Standard 6. Evaluation Evaluates the health status of the
population
Standards of Professional Performance
Standard 7. Quality of practice Systematically enhances quality and
effectiveness
Standard 8. Education Attains knowledge and competency
Standard 9. Professional practice
evaluation
Evaluates own nursing practice
Standard 10. Collegiality and professional
relationships
Establishes collegial partnerships
Standard 11. Collaboration Collaborates with representatives of the
population
Standard 12. Ethics Integrates ethical provision
Standard 13 Research Integrates research findings
Standard 14. Resource utilization
population
Considers factors related to safety,
effectiveness, cost, and impact
Standard 15. Leadership
- Must be professionally qualified and licensed to practice in the area of public health
nursing. - Must possess personal qualities and “people skills” that would allow her practice to
make a difference in the lives of these people - Functions following the dominant values of public health nurses, within the ethicolegal framework of the nursing profession, and under the needs of the clients and
available resources for health care
Public health nurse
Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies and they are related to:
- Management function
- Supervisory function
- Nursing care function
- Collaborating and coordinating function
- Health promotion and education function
- Training and research
Francisca Friar Juan Clemente opened a medical dispensary in Intramuros
(the old walled city of Manila) for the indigent.
1577
Dominican Father Juan de Pergero worked toward installing a water system
in San Juan del Monte (now San Juan City, Metro Manila).
1690
Smallpox vaccination was introduced by Dr. Franciso de Balmis, the personal
physician of King Charles IV of Spain
1805
The first medicos titulares were appointed by the Spanish government;
medicos titulares worked as provincial health officers
1876
A 2-year course consisting of fundamental medical and dental subjects was
first offered atthe University of Santo Tomas; graduates of this course known
as cirujanos ministrantes served as male nurses and sanitation inspectors
1888
The United States Philippine Commission, through Act 157, created the board
of health of the Philippine Island with a commissioner of Public Health as its
chief executive officer.
The board of health eventually evolved into what is now the Department of
Health, subsequently provincial and municipal boards of health were formed.
1901
Act #2156 or the Fajardo act created a sanitary division made up of one to
four municipalities; each sanitary division has a president who had to be a
physician, sometimes a nurse
1912
The Philippine general hospital began to extend public health nursing service
in the home of patients by organizing a unit called social and home care
service, with two nurses as staff.
Puericulture Centers were organized by women’s clubs and other
community organizations which provided maternity and infant care. It is
staffed by a nurse or midwife, assisted by a part-time physician.
La Gota de Leche founded by Asociacion Feminista Filipina in 1905 was the
first center dedicated to the service of mothers and babies.
1915
The department of health was reorganized into bureaus.
1. Quarantine Hospitals took charge of the municipal and charity clinic
and health with sanitary divisions under it
2. The reorganization also placed the administration of city health
departments at the bureau level.
1947
Congress passed RA 1082 or the rural health act that provided for the
creation of a rural health unit in every municipality. RA 1082 provided for the employment of Physicians as municipal health
officers, public health nurses, midwives, and sanitation inspectors in the
rural health units.
1954
For more equitable distribution of health personnel, RA 1891, enacted in
1957, amended certain provisions in the Rural Health Act. This law created
eight categories of rural health units corresponding to the population size of
the municipalities.
1957
The Philippine healthcare delivery system was restructured, paving the way
for the healthcare system that exists to this day where health services are
classified in primary, secondary, and tertiary levels.
1970
RA 7160 or the Local Government Code was enacted; the law mandated the
devolution of basic services, including health services, to local government
units and the establishment of a local health board in every province and city
or municipality
1991
The Philippines is a signatory to the United Nations Millennium Declaration
adopted during the World Summit.
The member nations committed themselves to the attainment of the 8
Millennium Development Goals (MDGs). On its part, the DOH has committed
to the attainment of the health MDGs to reduce child mortality, improve
maternal health, and combat HIV/AIDS, malaria, and other diseases.
2000
has directed efforts toward comprehensive reforms
in health care with the health sector reform agenda launched in 1999 and its
implementation
1. Framework FOURmula One for health
2. Universal health care in 2010
e Department of Health
- aims to achieve the health system goals of better health
outcomes, sustained health financing, and a responsive health system that will provide
equitable access to health care. I
Universal health care
It is an approach to health reform implementation
deliberately focused on economically disadvantaged Filipinos to ensure that they are
given risk protection through enrollment in PHILHEALTH (Philippine health insurance
Corporation) and that they can access affordable and quality health services
Universal health care
Roles and functions of the community health nurse (CHN)
- Clinician-
- Advocate
- Collaborator
- Consultant
- Counselor
- Educator
- Researcher
- Case Manager
Focus on the health of the population
Clinician
speaks or acts for those who cannot speak
Advocate
work with people in the community
Collaborator-
catalyst to bring change, helping people understand process and action
Consultant
listens and provides feedback and information
Counselor
– provides SKA needed by the community member
Educator –
coordinates care in the system that is made up of many different
programs which have different policies
. Case Manager
is a tool used by the nurse during
home and community visits to able to provide care safely and efficiently
nursing bag, frequently called the PHN bag
a reminder of the need for hand hygiene, and other measures to
prevent the spread of infection. It also supports the idea that the nurse must be prepared for
a variety of situations while in the field.
bag service
Articles for infection control:
Soap in a covered soap dish and linen or disposable
paper towels for handwashing, apron, battles of antiseptics, and hand sanitizer.
Articles for assessment of family members:
Body thermometers, measuring tape,
newborn weighing scale, portable diagnostic aids such as a glucometer, or items for
benedict’s test (Benedict’s solution, medicine dropper, test-tube, test-tube holder,
alcohol lamp.) Note that the stethoscope and sphygmomanometer and carried
separately.
Sterile items:
Dressing, cotton balls, cotton tip applicators, size 2 and 5 ml with
needles, surgical gloves and cord clamp, one pair of surgical scissors and sterile pack
with kidney basin, two pairs of forceps straight and curved.
Clean articles:
Adhesive tape, bandage scissors.
Pieces of paper:
For lining the soap dish if the home sink is used for lining the bag a
washable rubber protector may also be used for this purpose, and folded paper to be
used as a waste receptacle if needed
The following are the general principles in the use of the nursing bag or (bag
technique):
- The bag technique helps the nurse with infection control.
- The bag technique allows the nurse to give care efficiently.
- The bag technique should not take away the nurse’s focus on the patient and the
family. - The bag technique may be performed in different ways. For infection control, the
following activities should be practiced during home visits and as part of the bag
technique:
a. Remember to proceed from “clean” to “contaminated”.
b. The bag and its content should be well protected from contact with an article in
the patient’s home.
c. Line the table and flat surface with paper and a washable protector on which the
bag and all of the articles to be used are placed.
d. Wash your hands before and after the physical assessment and physical care of
each family member.
e. Bring out only the articles needed for the care of the family.
f. Do not put any of the family’s articles on your paper lining or washable protector.
g. Whenever possible and as necessary, washer articles before putting them back
into the bag. If this is not possible, wrap them properly to prevent contaminating
the bag and its contents.
h. After using an article such as an apron or washable protector, find the
contaminated surface by holding the contaminated side inward.
i. Wash the inner cloth lining of the bag as necessary
is developed through family nurse contacts, which may
take the form of a clinic visit, group conference, telephone contact, written communication,
or hope to visit. The nurse uses the type of family nurse contact that is most suitable for the
purpose or situation at hand.
family nurse relationship
takes place in a private clinic, health center, barangay health station,
or in an albularyo clinic during a community outreach activity
clinic visit
y. The major advantage of a clinic
visit
y. The major advantage of a clinic
visit is the fact that the family member takes the initiative of visiting a professional health
worker, usually indicating the family’s readiness to participate in the health care process. It
also allows the nurse to maximize resources (other healthcare providers to whom the client
can be referred as needed, and what riyals resources, such as supplies and equipment). Also,
because the nurse has greater control over the environment, destruction, or lessened.
such as a conference of mothers in the neighborhood, provides
an opportunity for initial contact between the nurse and target families and the community.
It may take place at a health facility or in the community.
group conference
This type of family nurse contact is
appropriate for developing cooperation, leadership, self-reliance, and or community
awareness among group members.
group conference
The opportunity to share experiences and practical
solutions to common health concerns is a strength of this type of family nurse contact.
However, attendance in a group conference usually requires motivation and the availability
of target family members. The nurse, therefore, may not be able to reach the families in
greatest need of health through a group conference.
group conference
provides easy
access between the nurse and health worker and the family
telephone landline or mobile or cell
is used to give specific information to families, such as
instructions given to parents through school children. Although there is a potential for
reaching many families, being a one-way method, and requiring literacy and interest, the
nurse cannot be certain that the information will reach the intended recipient.
Written communication
is a professional, purposeful interaction that takes place in the family
residence aimed at promoting, maintaining, or restoring the health of the family are its
members.
home visit
makes up on the family requests, as a result of case findings, in
response to a referral, or to follow up clients who have to utilize services of a health facility
such as a health center, lying-in clinic, or hospital.
nurse
A home visit has the following advantages:
- It allows first-hand assessment of the home situation: family dynamics,
environmental factors affecting health, and resources within the home. - The nurse can seek out previously unidentified needs.
- It allows the nurse to adapt interventions according to family resources.
- It promotes family participation and focuses on the family as a unit.
- Teaching family members in the home is made easier by the familiar environment
and the recognition of the need to learn as they are faced with the actual home
situation. - The personalized nature of a home business gives to family a sense of confidence
in themselves and the agency
if possible, the nurse contacts the family determines the
family’s willingness for a home visit, and sets an appointment with them. A plan for the home
visit is formulated during this phase.
Previsit phase
For purposes of clarity, the following are specific principles in planning
for a home visit:
- Being a professional contact with the family, the home visit should have a purpose
- Use information about the family collected from all possible sources.
- The home visit plan focuses on identifying family needs, particularly needs to be
recognized by the family as requiring urgent attention. - Continuing care for a client who needs it will be provided by the client and or responsible
family members. - It is seldom that nurse has up-to-date, accurate, and all necessary information about the
client and the family. The plan should be practical and adaptable.
” is suggested for nursing students and
personal new to the service.
buddy system
may be another study, health professional, or a
member of the community such as a barangay health worker. The nurse should inform the
family to be visited of these practices, if possible before the visit.
buddy
the nurse must make a ___ of the house for
visiting and identify with other members of the health team of the time that one is expected
to be back at the health care facility. This will assist the colleagues in determining the
whereabouts of the nurse in case she is not back as indicated.
spot map
This phase begins as the nurse seeks permission to enter and lasts until he or she
leaves the family home. The in-home phase consists of initiation, implementation, and
termination.
In-home phase
t is customary to knock or ring the doorbell and, at the same time, in a
reasonably loud but non-threatening voice say, “Tao po, Si Jenny po ito, nurse sa health
center, “ Or a similar greeting in the vernacular or some other language common to the nurse
and the family.
Initiation:
involves the application of the nursing process
assessment, provision of direct nursing care as needed, and evaluation.
Implementation:
This consists of summarizing with the family the events during the
home visit and setting as a subsequent home visit or another form of family nurse contact
such as a clinic visit. If necessary, the nurse may also use this time to record findings, such as
vital signs of family members and body weight.
Terminations:
takes place when the nurse has returned to the health facility.
This involves documentation of to visit during which the nurse records events that transpired
during the visit, including personal observations and feelings of the nurse about the visit. This
will help the other members of the health team to understand the family, providing for more
effective intervention. If appropriate, a referral may be made if a subsequent visit has been
set, and planning for the next visit is done at this time.
Post-visit phase
Defined as a State of complete physical, mental, and social wellbeing, and not merely the
absence of disease or infirmity
. Health
C.E Winslow defined it as the science and art of preventing disease, prolonging life, and
promoting health and efficiency through organized community effort;
Public health
Public health is dedicated to the common attainment of the highest level of physical
mental and social well-being and longevity
Hanlon
Community Health Nursing is a learned practice discipline.
Jacobson
One of the qualifications and functions of a Public Health Nurse, as stated in the
standards of Public Health Nursing in the Philippines
a. Must be professionally qualified and licensed to practice in the area of public
health nursing
b. Must possess personal qualities and “people skills” that would allow her practice
to make a difference in the lives of these people
c. Functions following the dominant values of public health nurses, within the
ethico-legal framework of the nursing profession, and following the needs of the
clients and available resources for health care
d. All of the above
d. All of the above
The Philippine healthcare delivery system was restructured, paving the way for the
healthcare system that exists to this day where health services are classified in primary,
secondary, and tertiary levels
1970
Roles and functions of community health nurse I which the primary focus is the health
of the population
Clinician
Type of Public Health Nursing that focuses on the promotion of health and wellness of
the pupil/students, teaching and non-teaching personnel of the school
School Nursing
Working with people in the community is one of the important functions and roles of a
nurse in the community
Collaborator
Providing skills, Knowledge, and attitude needed by the Community member, is the role
of the community health nurse in the community
Researcher
- The PHN bag is an important tool in providing nursing care during a home visit. The most
important principle in bag technique states that it;
a. Should save time and effort
b. Should minimize if not prevent the spread of infection
c. Should not overshadow concern for the patient and his family
d. May be done in a variety of ways depending on the home situation, etc.
Give the rationale of your answer:
b. Should minimize if not prevent the spread of infection
To maintain the cleanliness of the bag and its contents, which of the following must the
nurse do?
a. Wash his/her hands before and after providing nursing care to the family members
b. In the care of family members, as much as possible, use only articles taken from the
bag
c. Put on an apron to protect her uniform and fold it with the right side out before
putting it back into the bag.
d. At the end of the visit, fold the lining on which the bag was placed, ensuring that the
contaminated side is on the outside.
a. Wash his/her hands before and after providing nursing care to the family members
Choice B goes against the idea of utilizing the family’s resources, which is encouraged in CHN. Choices C and D goes against the principle of asepsis of confining the contaminated surface of objects..
Which type of family-nurse contact will provide you with the best opportunity to observe
family dynamics?
a. Clinic consultation
b. Group conference
c. Home visit
d. Written communication
Give the rationale of your answer:
c. Home visit
Which of the following is an advantage of a home visit?
a. It allows the nurse to provide nursing care to a greater number of people.
b. It provides an opportunity to do a first-hand appraisal of the home situation.
c. It allows sharing of experiences among people with similar health problems.
d. It develops the family’s initiative in providing for the health needs of its members.
Give the rationale of your answer:
b. It provides an opportunity to do a first-hand appraisal of the home situation.
Which is contrary to the principles in planning a home visit?
a. A home visit should have a purpose or objective.
b. The plan should revolve around family health needs.
c. A home visit should be conducted in the manner prescribed by the RHU.
d. Planning of continuing care should involve a responsible family member.
c. A home visit should be conducted in the manner prescribed by the RHU.
The home visit plan should be flexible and practical, depending on factors, such as the family’s needs and the resources available to the nurse and the family.
