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Premium member Presentation Transcript COMMUNITY HEALTH NURSING: COMMUNITY HEALTH NURSING Leilani España-Capili, RN, MAN LecturerDefinition of CHN: Definition of CHN Is a service rendered by professional nurse with the Community, Groups, Families, and Individuals at home, in health centers, clinics, schools, place of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation.Slide 3: Philosophy: Worth and dignity of man, Concepts: Primary focus is on health promotion. Practice is extended not only to individual but the whole family & community. C.H.Nurse is a generalist in terms of practiceSlide 4: Goal: To raise the level of health of the citizenry. Objectives: To participate in the development of an over all health plan for the community. To provide quality nursing services to individuals, families & communities.Slide 5: To coordinate nursing services with various members of health team. To participate in and/or conduct researches relevant to community health and community health nursing services and disseminate their results for improvement of health.Principles:: Principles: Is based on recognized needs of communities, families, groups and individuals. The Family is the unit of service. Must be available to all regardless of race, creed, and status. Health Teaching is a primary responsibility of C.H. NurseSlide 7: CHN works as a member of the health team and make uses of the available community health resources. There should be accurate recording and reporting.Slide 8: The hallmark of community health nursing is that it is population- or aggregate-focusedSlide 9: CHN is a synthesis of nursing and public health practice 1. emphasis on the importance of the “greatest good for the greatest number” 2. assessing health needs planning, implementing and evaluating the impact of health services on population groupsSlide 10: 3. priority of health-promotive and diseasepreventive strategies over curative interventions 4. tools for measuring and analyzing community health problems; and 5. application of principles of management and organization in the delivery of health services to the communitySlide 11: Basic Concepts and Principles of Community Health Nursing 1. The family is the unit of care; the community is the patient and there are four levels of clientele in community health nursing. 2. The goal of improving community health is realized through multidisciplinary effort.Slide 12: 3. The community health nurse works with and not for the individual patient, family, group or community. The latter are active partners, not passive recipients of care. 4. The practice of community health nursing is affected by changes in society in general and by developments in the health field in particular.Slide 13: 5. Community health nursing is part of the community health system, which in turn is part of the larger human services systemMISSIONS OF C.H.N: MISSIONS OF C.H.N Health Promotion – actions related to lifestyles and choices that maintains / enhances a population’s health. Health Protection – includes activities designed to detect or prevent illness or alter disease processes.Slide 15: Health Balance – state of well being that results from a healthy interaction between a person’s body, mind, spirit and environment. Disease Prevention – activities designed to protect people from disease and its consequence.Slide 16: Social Justice – all people have a right to certain “basics” of life and health protection.C. H.N ROLES OF THE NURSE : C. H.N ROLES OF THE NURSE Clinician – focus on the health of individuals in the larger context of the community. Advocate – advocates self care, people’s ability to be active participant in their own health, and self determination, the right to make their own decision.Slide 18: Collaborator – brings together strengths and resources of people involved toward a common goal. Educator – provide s-k-a that the people need to make appropriate choices or decision. Hospice care – providing care skills in a home or other setting.CLIENTS OF THE C.H. NURSE: CLIENTS OF THE C.H. NURSE INDIVIDUAL (sick or well) Can be considered as entry point in working with the whole family. FAMILY Health task: 1. Recognizing interruptions of health or developmentClients…: Clients… 2. Seeking health care 3. Managing health & non health crises 4. Providing care to the sick, disabled & dependent member of the family 5. Maintaining a home environment conducive to good health & development 6. Maintaining good relationship with community & health institution.POPULATION GROUP: POPULATION GROUP A group of people who share common characteristics, developmental stage or common exposure to particular environmental factors & consequently common health problems:(Children, Elderly) COMMUNITY Group of people sharing common geographic boundaries, values & interests.Brief History of CHN / PHN: Brief History of CHN / PHN SPANISH REGIME Bro. Juan Clemente started health services through a dispensary in Intramuros Start of water sanitation Introduction of small pox vaccineBrief History of CHN / PHN: Brief History of CHN / PHN AMERICAN REGIME 1898 - Creation of the Board of Health for Physicians 1901 - Creation of Board of Health for City of Manila, Provincial and Municipal Boards of Health 1905 – abolished Board of Health, activities were taken over by the bureau of health under Department of Interior.Brief History of CHN / PHN: Brief History of CHN / PHN 1906 – abolition of Board of Health; creation of Bureau of Health 1912 – Creation of Sanitary Divisions 1915 – BOH was renamed Philippine Health Service with Director of Health as head. 1928 – First convention of Nurses was heldBrief History of CHN / PHN: Brief History of CHN / PHN 1930 – Section of PHN was converted to Section of Nursing 1933 – Reorganization act 4007 – Division of Mat. & Child Health of the office of Public welfare commission was transferred to Bureau Of HealthBrief History of CHN / PHN: Brief History of CHN / PHN ERA OF THE REP. OF THE PHILS. (1946 to present) 1947 – Bureau of Public welfare was renamed DOH June 1957 – Rep Act 1891 (An act Strengthening Health and dental Services in the Rural AreasBrief History of CHN / PHN: Brief History of CHN / PHN 1975 – Formulation of the National Health Plan and the restructured Health Care delivery system 1982 – E.O 851 Health Educ. And Manpower Dev. Service was created and Bureau of Food and Drugs assumed the functions of the Food and Drug Admin.Brief History of CHN / PHN: Brief History of CHN / PHN 1986 – Min. of Health became DOH again 1987 – reorganization E.O – 119. Secretary Of Health covered 5 offices: Chief of Staff Public Health Services Hospital & Facilities Services Standard & regulations Management ServiceBrief History of CHN / PHN: Brief History of CHN / PHN 1991 – Rep. Act 7160 Local Government Code passed & implemented 1992 – Full implementation of rep. Act No. 7160 DOH Changed role from one of implementation to one of governanceBrief History of CHN / PHN: Brief History of CHN / PHN Significant Changed: branching out of the office of Public health services to form the office of special concern. Nat. Immunization Day Nat. Micronutrient Campaign (Araw ng Sangkap Pinoy) Disaster Magt. Urban Health and Nutrition projectBrief History of CHN / PHN: Brief History of CHN / PHN Traditional Medicine Doctors to the Barrios Program Let’s DOH it became a national battle cry. 1996 – Primary Health Care as strategy to attain Health for All by the year 2000Brief History of CHN / PHN: Brief History of CHN / PHN 1999 – Creation of the National Health Planning Committee (NHPC) And establishment of Inter-Local Health Zone 1999 – 2004 = Health Sector Reform Agenda of the Phils. Was launched 2005 – DOH launched Fourmula One for Health to ensure speed, precision andBrief History of CHN / PHN: Brief History of CHN / PHN 2005 – DOH launched Fourmula One for Health to ensure speed, precision and effective coordination towards improving the efficiency, effectiveness and equity of Health Care delivery.DOH Plans, Programs & Projects: DOH Plans, Programs & Projects VISION: Health for all Filipinos and Health in the hands of people by 2020. MISSION: Ensure accessibility and quality of health care to improve the quality of life of all Filipinos, especially the poor.ROLE OF DOH: ROLE OF DOH Ensuring equal access to basic health services. Ensuring the formulation of national policies for proper division of labor and proper coordination of operations among government agency jurisdictionsSlide 36: Ensuring a minimum level of implementation of nationwide services regarded as public health goods. Planning & establishing arrangements for the public health system to achieve economics of scale. Maintaining a medium of regulations and standards to protect consumers and guide providers.Basic Principles to achieve Improvement in Health: Basic Principles to achieve Improvement in Health Universal access to basic health services must be ensured. The health and nutrition of vulnerable groups must be prioritized. Performance of the health sector must be enhanced.Strategies to achieve health goals: Strategies to achieve health goals Increasing investment for PHC Dev. National standards and objective. for health. Assurance of the health care. Support to local health system development. Support for frontline health workers.D.O.H PROGRAMS: D.O.H PROGRAMS 1. DENTAL HEALTH PROGRAM Vision : A lifetime of oral health and no tooth decay for the next generation . Objective: to prevent and control of dental diseases & conditions. Strategy : Sang Milyong Sepilyo for social mobilization.dental: dental Important task of the CHN Solicit new toothbrushes from concerned citizens.Doh prog..: Doh prog.. 2. OSTEOPOROSIS PREVENTION A disease that weakens the bones, making it more fragile and likely to break. Usually asymptomatic until after a fracture occurs. Factors : Female, menopause, fx hx, smoking, alcohol, thin & small built. Diagnosis : Measurement of bone denssty by DEXA (Dual Energy Xray Absorptionmetry machine) Prevention : Exercise, Regular intake of calcium, & check upDoh prog..: Doh prog.. 3. HEALTH EDUCATION & COMMUNITY ORGANIZATION4. PRIMARY HEALTH CARE: 4. PRIMARY HEALTH CARE Definition: is essential health care made universally accessible to individuals and families in the community by means accessible to them. Goal: Health for all Filipinos and health in the hands of the people by the year 2020.PHC cont.: PHC cont. Mission: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. Concept: Partnership and empowerment of the people towards the development of Self -Reliance.Phc cont.: Phc cont . Legal Basis: Letter of Instruction (LOI) 949 , adopted from the First International Conference on PHC held in Alma Ata, USSR on September 6 – 12, 1978. ELEMENTS: Education for Health Locally endemic diseases controlElements..: Elements.. 3. EPI 4. Maternal & Child Health & Family Planning. 5. Essential Drugs 6. Nutrition 7. Treatment of CD & Non CD 8. Safe water SanitationPHC Principles & Strategies: PHC Principles & Strategies Accessibility, Availability, Affordability , Acceptability of Health Services. Provision of quality, basic and essential health services. (regular monitoring & evaluation of health workers performance) Community Participation (formation of health committees)PHC principle…: PHC principle… 4. Self Reliance (use of human, material & financial resources) 5. Recognition of the interrelationship of health & development (collaboration & referral system) 6. Social Mobilization 7. Decentralization (Reallocation of budget resources, reorientation of health workers)4 CORNERSTONES/ PILLARS IN PHC: 4 CORNERSTONES/ PILLARS IN PHC Active community participation Intra and inter-sectoral linkages Use of appropriate technology Support mechanism made availableLEVELS OF HEALTH CARE SERVICES: LEVELS OF HEALTH CARE SERVICES Primary Level Facilities Health services offered to individuals with fair health & to clients with diseases in early symptomatic stages. Include RHU, Community Hospitals, Health Centers, Private Practitioners, Puericulture Center, Brgy. Health Stations.Secondary Level Facilities: Secondary Level Facilities Offer services to clients with symptomatic stages of disease which require moderately specialized knowledge & technical resources for adequate treatment. Include emergency/ district hospitals, Provincial/ City Health services & facilitiesTertiary Level Facilities: Tertiary Level Facilities Include highly technological and sophisticated services offered by medical centers and large hospital. These are specialized hospitals/ institution. National & regional Health Services, Medical Centers, Teaching & Training Hospitals.A Pyramidal Health Structure: A Pyramidal Health Structure Levels of Facilities National & Regional Health Services TERTIARY LEVEL Medical Centers, Teaching & training Hospitals Provincial. City Health SECONDARY LEVEL Services & Hospitals Emergency & District Hospitals Rural Health Units, Community Hospitals TERTIARY Health Centers, Private Practitioners LEVEL Puericulture Centers, Bgry. Health Stations5. Reproductive Health Framework (DOH Administrative Order No. 43 series of 2000): 5. Reproductive Health Framework (DOH Administrative Order No. 43 series of 2000) Reproductive Health “ state of complete physical, mental and social well being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes” (ICPD, 1994). Reproductive Health Care “constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving RH problems” (ICPD, 1994).REPRODUCTIVE HEALTH POLICY: REPRODUCTIVE HEALTH POLICY VISION RH as a way of life for every woman and man. MISSION Undertake reforms to develop national self-sufficiency in achieving the goals; Create an environment for health providers to achieve the national goals and objectives; Mobilize resources and expertise to build capacity as well as to monitor and evaluate the progress of Reproductive Health. GOAL Universal access to quality reproductive health care.ELEMENTS of RH Services (DOH Administrative Order No. 43 series of 2000): ELEMENTS of RH Services (DOH Administrative Order No. 43 series of 2000) Maternal - Child Health and Nutrition Family Planning Prevention and Treatment of Reproductive Tract Infections, including HIV/AIDS Breast and Reproductive Tract Cancers and other Gynecological Conditions Prevention and Management of Abortion and its ComplicationsELEMENTS…: ELEMENTS… Male Involvement in Reproductive Health Adolescent and Youth Health Violence Against Women and Children Prevention and Treatment of Infertility and Sexual Dysfunction Education and Counseling on Sexuality and Sexual healthIntegrated Reproductive Health Framework: Integrated Reproductive Health Framework Individuals, Families and Communities Public & Private Better Quality Life Access to RH Services & Information MMR IMR HIV & AIDS Gender-Culture-Rights-Based ApproachSlide 59: Purple Reproductive cancer Violence Against Women & Children Infertility Sexuality PMAC (Prevention, Mgt. Of Abortion) Mens Repro. HealthPitch: Pitch Maternal & Child Health Nutrition FP STD/HIV & AIDS Prevention ARH (Adolescent reproductive Health) Integrated Service DeliveryGreen: Green Integrated Service delivery Financing Good Governance RegulatoryGuiding Principles: Guiding Principles Family-Centered Gender Sensitive Life Course Approach Partnership and Networking Evidence-BasedREPRODUCTIVE HEALTH POLICY: REPRODUCTIVE HEALTH POLICY GENERAL OBJECTIVE By the year 2015, relevant RH services are available in all DOH-retained hospitals and LGU health facilities SPECIFIC OBJECTIVES Create awareness and demand for RH services;Slide 64: Provide an integrated quality RH package at all retained hospitals and LGU health facilities through capacity-building as well as through improved performance in standards and regulations; Strengthen partnerships in the provision of RH care services; Integration of RH in the academic curriculum for medical and other allied health professions; Develop an integrated system of reporting and recording; Integrate RH services in health financing and social insuranceADOLESCENT REPRODUCTIVE HEALTH: ADOLESCENT REPRODUCTIVE HEALTH Adolescent and Youth Health Program (DOH Administrative Order # 34-A, series 2000) Goal: Promotion of healthy development - healthy lifestyle - promote (+) values & caring relationship - lifeskills approach - create a safe & supportive environment Prevention/management of health risks STI-HIV/AIDS - Abortion - Mental Health PMS - VAWC - Substance use/abuse Teen Pregnancy - Malnutrition - Injuries/disabilitiesSlide 66: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Develop models for adolescent-friendly health services/environment; Comprehensive health care package; Capability-building of young people to promote healthy lifestyles, including sound RH practices, injury prevention; Advocate fertility awareness & human sexuality among HS teachers/students, which help promote responsible sexuality.MATERNAL - CHILD HEALTH & NUTRITION: MATERNAL - CHILD HEALTH & NUTRITION Safe Motherhood Policy (DOH Administrative Order # 79, series 2000) Three (3) Delay Delay in deciding to seek medical care Delay in reaching appropriate care Delay in receiving care at health facilities Goal: To improve the survival, health and well-being of mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal and postnatal stages.Slide 68: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Launch & implement the Basic Emergency Obstetric Care (BEMOC) Strategy; Improve the quality of pre/postnatal care; Reduce women’s exposure to health risks; Partnership/networking for resource generation & allocation of health services.Slide 69: Home Based Mother’s Record (HBMR) Is a tool used when rendering prenatal care that serve as guide to identify risks factors. Iron Supplementation is given to pregnant mothers at 5 th months up to 2 months post natal (210 days) at 100 – 200mg. / day.FAMILY PLANNING: FAMILY PLANNING National Family Planning Policy (DOH Administrative Order # 79, s. 2000) Four (4) Pillars: - Responsible parenthood - Birth spacing - Respect for life - Informed choice Goal: To provide universal access to FP information and services, whenever and wherever these are needed. Strategic Thrusts (National Objectives for Health, 2005 – 2010) : Strategic Thrusts (National Objectives for Health, 2005 – 2010) Intensify the promotion of Natural Family Planning (AO # 132, s. 2004); Billings Ovulation Method - Basal Body Temperature - Sympto-thermal Method Lactational Amenorrhea - Standard Days Method Advocacy and orientation on Fertility Awareness; Advocacy on Contraceptive Self-Reliance Strategy (AO # 156, s. 2004); Poor-users, priority access to free/subsidized contraceptives Non-poor users, access to FP commodities through out-of-pocket purchase, or subsidized provisions by ‘better-off’ LGUs Public- Private collaboration.STI-HIV/AIDS: STI-HIV/AIDS Policy Guidelines for the Prevention & Management of STI-HIV/AIDS (Administrative Order # 2, series 1997; Administrative Order # 7-C, series 1995) Goal: Contain the transmission of HIV/AIDS and other reproductive tract infections, and mitigate their impact.Slide 73: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Extend disease surveillance & diagnostic facilities to more sites; Prevent and control mother-to-child transmission, and among workers dealing with human body/parts, tissues & fluids, through education and capability-building; Promote safe sex and other (+) behaviors; Address the stigma & discrimination; Strengthen collaboration with partner agencies to reach out to the ‘hidden’ vulnerable and marginalized groups; Improve the central management of the multi-sector STI-HIV/AIDS Program through regular review of roles & responsibilities, and by establishing a comprehensive monitoring and evaluation system.PREVENTION and MANAGEMENT of ABORTION and its COMPLICATIONS: PREVENTION and MANAGEMENT of ABORTION and its COMPLICATIONS DOH Administrative Order # 45-B, series 2000 Three (3) Key Elements Prevention and treatment Counseling Linkage with other RH services Goal: To improve the accessibility of quality post-abortion care services to all WRA..Slide 75: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Expand capability-building of frontline health workers; Upgrade level 1 and level 2 health facilities; Strengthen advocacy, reduction of unwanted/unplanned pregnancy; Partnership/networking for resource generation & allocation of health services.VIOLENCE AGAINST WOMEN and CHILDREN: VIOLENCE AGAINST WOMEN and CHILDREN Establishment of Women & Children Protection Units (WCPU) in all DOH-retained Hospitals (DOH Administrative Order # 1-B, series 1997) Goal: To provide a holistic, gender-sensitive health care to women and children who are victims of violence.Slide 77: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Expand/upgrade WCPU in DOH-retained hospitals; Intensify the enforcement of laws and policies (Anti-Rape Law, Anti-Sexual Harassment Law, VAWC Act, GAD budget, etc..); Promote information, education and advocacy campaigns; Strengthen male involvement in VAWC; Partnership/networking for resource generation & allocation of health services.BREAST and REPRODUCTIVE TRACT CANCERS and other gynecologic conditions: BREAST and REPRODUCTIVE TRACT CANCERS and other gynecologic conditions Philippine Cancer Control Program (Administrative Order # 89-A, s. 1990) Goal: Reduction of morbidity and mortality from cancer and improvement in the QOL. Objectives: [To increase early detection and screening] Self-breast examination (monthly); Clinical breast examination (every 1-3 years) Pap smear/visual acetic acid screening (every 3 years) Digital rectal examination (every 3 years)Slide 79: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Healthy Lifestyle Promotion Programs using community-based approaches; Information, education & advocacy campaigns in the reduction of risk factors, early detection and management, and improvement in the QOL; Training of clinicians and other frontline health workers in health promotion, screening, early diagnosis, treatment, rehabilitation and palliative care; Strengthen networking and collaboration; Financial risk protection measures, by lowering the cost of essential drugs and provision of better social health insurance-benefit package.MALE INVOLVEMENT in REPRODUCTIVE HEALTH: MALE INVOLVEMENT in REPRODUCTIVE HEALTH Policy & Strategic Framework in MIRH (AO # 2006-0035, series 2006) Goal: Enhance active involvement of the Filipino male in RH contributing to the achievement of the NOH and gender equality. Objective: To establish and/or strengthen structures, mechanisms and systems for active MIRH.Slide 81: Strategic Thrusts (National Objectives for Health, 2005 – 2010) Male involvement in: MCHN - ARH - FP PMAC - STI-HIV/AIDS - VAWC Male RH services: FP counseling and methods provision (condoms, NSV); STI-HIV/AIDS screening & treatment, including counseling; Screening, counseling and treatment for andropause, infertility, sexual dysfunction; Screening & treatment for testicular and prostate-related diseases, including CA; Promotion of Healthy Lifestyle.Slide 82: AS A STUDENT NURSE ASSIGNED IN CALOOCAN HEALTH CENTER, HOW CAN YOU HELP THE TEAM IN THE PROMOTION OF THE GOAL & OBJs. OF DOH.Slide 83: 2. HEALTH EDUCATION IS AN IMPORTANT TASK OF A NURSE IN THE COMMUNITY, WHAT STRATEGIES/ METHODS WILL YOU USE TO MAKE YOUR HEALTH TEACHING EFFECTIVE.Slide 84: 1 – 3 Principles of CHN 4 – 8 missions of CHN 9 – 13 – roles of the nurse in the community You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.