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CHN February 17, 2022

Community Health Nursing

WHO - combination of nursing skills, sociology, and public health
ANA - synthesis of nursing practice + public health practice applied to promoting and
preserving health of the population
Margaret Jacobson - achievement of OLOF by teaching and delivery of care

Level
Functioning
of
OLOF =
Optimum

Political

Socio-
Behavior -
Economic
Lifestyle
OLOF

Heredity
Environment

Health Care
Delivery System

1. Political
a. Safety
b. Oppression
c. People empowerment
2. Behavior
- lifestyle of the people
- ex. nutrition
3. Heredity
- genetic, part of DNA ; familial disease
- morbidity and mortality
4. Socio-Economic
a. Education
b. Employment - financial resources
c. Housing
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5. Environment
- infectious and communicable diseases
6. Health Care Delivery System
- services:
a. Promotive**
- health promotion (PRIMARY FOCUS) = by health education
- role: EDUCATOR ‼
- function: GENERALIST ‼
- specific functions: RTPCR MO NURSE
a. Role model
b. Trainer - trains the midwife, etc
c. Planner
d. Coordinator of services
e. Recording
f. Manager
g. Organizer
NURSE - care provider
b. Preventive*
- vaccination, immunization
c. Curative
d. Rehabilitative

‼ Primary Goal of CHN: SELF RELIANCE FOR ALL

‼ Ultimate Goal: RAISE THE LEVEL OF HEALTH OF THE ENTIRE CITIZENRY
‼ Philosophy: UPHOLD THE WORTH & THE DIGNITY OF MAN (Margaret Shetland)
‼ Devolution / Decentralization of HCDS: not self reliant, so they are able to establish a local
unit = RA 7160 - local government code ; LGU - Local Government Units
‼ LGU - focus of delivery of health care services

RA 7610 - Anti-Child Abuse Law

‼ John Joseph Hanlon - attainment of total development (highest level of physical, mental,
emotional health using the available resources)
- development of health in ALL ASPECT = HOLISTIC
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‼ Purdom - involves survival of human species, all phases of human development (from
womb to tomb)

Ruth Freeman - service rendered by the professional nurse to the 4 levels of clientele in
different health settings

Settings: ———-> Subspecialties:

a. Home Public Health Nursing - RA 7305
b. Clinic Magna Carta for Public Health Workers
c. School School Health Nursing - RA 124
d. Work Occupational Health Nursing - RA 1054
Salvacion Bailon-Reyes - one of the prominent community health nurse
- a nursing service provided outside a purely curative institution
(hospital)

Araceli Maglaya - one of the prominent community health nurse ; author of INITIAL
DATABASE ; family health nursing
- Mother of Family & Public Health Nursing in the PH
- utilization of the nursing process to benefit the individual, the family, and the
community

ADPIE is NOT USED. Only APIE because Diagnosis is part of Assessment

A - Assessment
P - Planning
I - Implementation
E - Evaluation

GENERAL SPECIFIC

Community Health Nursing Community Based Nursing

Primary Client Community Individuals & Family

Focus of Care Primary Level Secondary & Tertiary Level

- preservation and protection - acute and chronic patients
- promotion and prevention
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Services Direct Direct & Indirect

Nursing Process Applied in the community as a whole Setting is specific

- ex. Out-Patient Services (Operation
Tuli), medical missions

*Both are talking about “ COMMUNITY PRACTICE “

CLIENTS IN CHN
CHN - population focused practice ; entire population or specific population

Levels:
1. Individuals
- entry point ; ex. asking the head of the family before doing home visit
- approaches:
a. Atomistic - by parts
b. Holistic - as a whole (body, mind, soul)
2. Family
- unit of service and the focus of care
- main care giver in the primary level of care
- ALLEN: people together by birth, marriage, adoption, or choice
- JOHNSON: social unit interacting with a larger society
- FRIEDMAN: two or more persons joined together by bonds of sharing & emotional
closeness and who identify themselves as family
- Functions:
S - socialization
H - health care ; ex. IMCI
A - affection ; love & belongingness
R - reproduction
E - economic function
S - social class / status placement
- ‼ TYPES OF THE FAMILY:
a. Nuclear
- mother, father, child / children (natural or adopted)
b. Extended
- 3 generations involved ; grandparents, parents, children
c. Dyad
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- husband and wife ; no children

- usually newly married or empty nesters
d. Blended
- one or both spouses have child / children from previous marriage
e. Compound
- the male more than one spouse ; common in Muslim community
- PD 1083 - Code of Muslim Personal Laws
f. Cohabitating
- live in
- common law spouse
g. Single Parent
- death of spouse, separation, pregnancy outside of wedlock
h. Gay or Lesbian Family
- same sex cohabitating, may or may not have children
EO 209 - Family Code of the PH
- marriage is a permanent union between a man and a woman

- 8 STAGES OF FAMILY CYCLE (Evelyn Hall)

a. Beginning of Family
- married or committed without children ; dyad
b. Child bearing Family
- birth to 30 months old child
c. Family with preschooler
- 30 months to 6 years old child
d. Families with school-age
- oldest child is between 6-13 years old
e. Family with teenagers
- oldest child is between 13-20 years old
f. Family launching young adults
- first to last child leaves home
g. Middle aged family
- empty nesters to retirement of both spouses
h. Aging family
- retirement to death of both spouses

IMCI (video lecture on google classroom; WATCH IT!!)

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Green - Home ; nursing care always starts at home

Yellow - RHU
Pink - Hospital

3. Aggregate
- subgroups or population groups

*VULNERABLE GROUPS
- roles: “ PAP “
a. Promotion
b. Advocate
c. Partner - with HCT, LGU

- groups:
a. Infants / children
- leading cause of death: PNEUMONIA
- most causes in PH: CALABARZON (Region 4A) ; Cavite, Laguna, Batangas,
Rizal, Quezon
- leading problem in children: MALNUTRITION
> Vitamin A - night blindness, xereophthalmia (no tears = no lubrication
in the eyes)
> Iron - Iron deficiency anemia
> Iodine - Goiter, mental retardation
b. Pregnant Woman
- 1st trimester = organogenesis
- specifically 2nd month = vital organs are formed & developed
- causes of maternal mortality:
1. complications related to pregnancy, labor & delivery, postpartum
2. hypertension (if more specific is asked)
3. post partal hemorrhage - GLOBAL
- most seen in: CALABARZON
c. Adolescents
- stage of exploration
- role: COUNSELOR - they have many questions
- high risk for STIs (worldwide: gonorrhea, chlamydia, syphillis, HIV & AIDS),
violence, substance use ( only an addiction - physical dependence )
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- high risk for suicide ; due to coping mechanisms not fully developed
d. Elderly
- aging is a natural process
- 2 types of aging:
1. Chronological Age
- by the number
- older adult: 65 years old and above = (DOH, PSA): 4%
2. Functional Age
- depends on the performance of ADL
- ‼ basis of assessment (elderly) in the community = ADL
- leading cause of death for 65 years old & above (PSA):
1. Heart diseases
2. Cancer
3. Pneumonia
- RA 7432 = Senior Citizen Act ; 60 years old & above
- RA 9257 = Expanded Senior Citizens Act
- RA 9994 = Newest Senior Citizens Act
- RA 7876 = Senior Citizen Center for Every Barangay Act
- RA 7875 = PH Health Insurance Act ; PHILHEALTH launched
- RA 10606 = Amended Philhealth Law

Projected life expectancy in the PH (DOH, PSA)

2015 - 2020
Female = 74.34 years old
Male = 68.81 years old
‼ 2020 - 2025
Female = 75.54 years old
Male = 70.01 years old

‼ 9, 10, 11 + 3 digits - usually the most recent ; updated

4. Community
- entire client, primary client
- elements:
a. Social
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b. Geographical
c. Psychocultural
There are people living with each other in a certain area practicing culture
- types:
a. Urban
- cities
- 51.2 % of population
b. Rural
- province
- 48.8 & of population
c. Sub-urban
d. Rurban
- ruralized
e. Metropolitan
- center of trade & industry
- classification (Maurer & Smith):
a. Geopolitical
- traditional (natural or man made)
- ex. barangay, sitio, purok, cities, province or state, nation
b. Phenomenological
- relational based on culture, values, interest, and goals
- ex. LGBTQIA
- determinants of health and disease (WHO):
a. Socio & economic environment
- income, education, social status
b. Physical environment
- safe water, clean air, safe workplace, housing
c. Individual behavior
- cultural practices
d. Biology & genetics
- heredity, genes
e. Health services
- access & availability, programs, protocols

CONTEXT - continuous change

- needs of people are always changing
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UN - Sept. 6, 2000 (EVERY SEPTEMBER)

- Millennium Summit at UN Headquarters, NYC
- joined by 191 countries
- target: 2015

‼ 8 Millennium Development Goals:

“ PEG… C… MAME… G “
Poverty
Education
Gender equality

Child mortality

Maternal health
Aids, HIV, Malaria, and other diseases
Environmental sustainability

Global partnership

DOH - MDG 4&5

Sept. 25, 2015 - UN assembly with 193 countries at NYC

- target: 2030

2030 Development Agenda - “ Transforming Our World: the 2030 Agenda for Sustainable
Development ”

‼ Sustainable Development Goals (SDGs) or Global Goals

- 17 goals: “ PHHEG … CEDII … SuRe … CA … WaLa … Peace … Partnership “

Poverty
Hunger
Health and well being ‼ - boards: vaccination
Education ‼ - health promotion ; educators
Gender equality
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Clean water and sanitation ‼ - WHO: Global Wash (water, sanitation, hygiene) Program
clean Energy
Decent work and economic growth
Industry, innovation, and infrastructure
reduced Inequalities

Sustainable cities
Responsible consumption

Climate Action ‼ - pollution

life below Water ‼
life on Land (Life on) ‼
Peace
Partnership for Goals ‼ - Primary Health Care

standard nurse to patient ratio = 1:5

SETTINGS:
1. Occupational Health Nursing
- setting: work place
- goal: ensure SAFETY of the workers in the workplace
- attend to HAZARDS of the workplace:
a. Safety hazards
- involves unsafe conditions or acts that increase the risk of injury for
workers
b. Health hazards
- elements in the working environment that can cause work related
diseases to the workers
- specific hazards:
> Biological - microorganisms (bacteria, fungi, etc.)
> Chemical - toxic substances, gases
> Mechanical - machines
> Physical - environment (temperature, humidity, ventilation)
> Psychosocial - relationships, salary, contract, tenure
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- RA 1054
- 1 RN - ratio = 1:100
- 100 or more workers
- NO RN - a health care facility is 1 km away from the workplace
- less than 100 workers
- clients: well population
- competencies (according to AAOHN American Association of Occupational Health
Nurses)
a. Clinical and primary care
- Primary: CHN
- Clinical: CBN
b. Case management
c. Work place, work force, environmental health issues
d. Legal and ethical responsibilities
e. Management and administration
- nursing audit
f. Health promotion and disease preventions
g. Health and safety education
h Research
i. Professionalism
- OHNAP
= Occupational Health Nurses Association of the Philippines
= 1st president: Ms. Anita Santos
= August 19, 1964
- PD 442
= The Philippine Labor Code
a. Working periods and rest periods
*Article 83
- 8 hrs/day for 5 days/week = 40 hrs
- if there is a demand of work: 6 days/week = 48 hrs ; should be given
additional compensation of at least 30% on the 6th day

*Article 84
- short duration rest periods during working hours

*Article 85
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- regular meal periods of no less than 60 mins

b. Medical, dental, and occupational safety

*Article 156
- must have first aid medicines and equipments in the workplace

*Article 157
- employees
> 100 or more = 1 full time nurse, infirmary or clinic with 1 bed capacity
(1 bed : 100 workers)
> 200 - 300 = 1 full time nurse, part time MD & dentist (at least 2 hrs)
> 300 + = full time nurse, MD, dentist (at least 8 hrs/shift)

c. Compensation
*Article 86
- night shift differential ( 10pm to 6am ) = not less than 10% of regular
wage every hour of work
*Article 87
- overtime = at least 25% additional per hour after 8 hours of shift
*Article 91
- rest day = must not be less than 24 hours after 6 consecutive working
days
- employees = determine the rest days
- exception = religious grounds
*Article 93
- work on scheduled rest days or holidays = additional compensation of
at least 30% from regular wage
- holiday + rest day = work ; additional compensation of at least 50%

School Health Nursing

‼ “ ROGARS “
- RA 124
- Role:
a. Facilitator
b. Advocate
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- Once a year ; SY - twice (beg. & end of SY)

- Orient that only 5 students are allowed in the clinic ; pulling out from class for assessment
- One to one interaction during assessment
> male nurse - male child, female nurse - female child
= to prevent issues and accusations
= exceptions:
1. class advisor tags along
2. there is parent consent
- Gather information by interview
1. Class adviser - does it affect their class performance?
2. Guardian / care taker, giver
- Assessment ; most important
1. Nutritional status
a. Less than 10 (book) , less than 5 (WHO) - height & weight by age
b. More than 10 (book), more than 5 (WHO) - BMI (kg/m2)
- Not normal = Feeding Program (120 days consistently)
= aka. Breakfast Feeding Program
= prerequisite: DEWORMING - performed with consent

2. Visual Acuity
- Snellen’s chart
- Normal: 20/20
- If 20/40 or above = refer to the class adviser for observation if it affects the grade of
the student

3. Hearing Screening
- Ballpen Click Test
- 2-3 cm say from ears

4. IPPA
- Physical assessment
- School assessment form
- Pattern:
1. Arms
2. Eyes (V.A)
3. Nose
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4. Mouth (Dental)
5. Ears
6. Neck & chest
7. Hair
8. Lower extremities

- Record
- Rapid class inspection ; unannounced
- School health program focus (WHO)
1. School health services
2. School health education
3. Healthy school environment
4. Health promotion for school personnels
5. School to community projects = Outreach programs
6. Nutrition and food safety = in the cafeteria
7. P.E. & recreation
8. Mental health, counseling, provide social support to the students

Public Health Nursing

- the science and the art to Promote health, Prevent diseases, Prolong life (Charles Edward
Winslow)
- nursing service rendered to the public or the community (Margaret Shetland)

Public Health Intervention Wheel

- scope of public health nursing practice
- framework
- 1998: Linda Keller, Minnesotta DOH, USA

17 Public Health Interventions:

1. Surveillance
2. Disease & other health investigation
3. Outreach
4. Screening
5. Case finding
6. Referral & follow-up
7. Case management
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8. Delegated functions
9. Educator
10. Counseling
11. Consultation
12. Collaborating - minimum of 2
13. Coalation building
14. Community organizing
15. Advocacy
16. Social marketing
17. Policy development

PHN History in PH
- civilization introduced by the Spanish
- Spanish Era: provincial health officers - medicos titulares
- First course = UST 1888
= Fundamentals only - medical & dental
= Graduates were called: Circujanos ministrantes
> male nurses & sanitary inspectors
- 1901 = Board of Health of the Philippine Islands
= Act 157
= Commissioner - CEO
- 1939 = President Manuel L. Quezon : changed to Department of Health & Public Welfare
(1st name of DOH)
= 1st secretary - Dr. Jose Fabella
- 1947 = President Manuel Roxas : separated DOH from Public Welfare
= Under EO 94, signed Oct, 4, 1947
= Secretary - Dr. Antoni Villarama
- 1978 = President Marcos : changed to Ministry of Health
- 1986 = President C. Aquino : changed back to DOH
= EO 119

“Kagawaran ng Kalusugan” - Tagalog name of DOH

- 1905 = First Puericulture Center / Milk Station

> Was called La Gota de Leche “The drop of milk”
> spearheaded by nurses
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- 1915 = PGH (started 1910) started offering Public health nursing service
= PGH was run by American doctors
= 1st Filipino director : Dr. Vicente de Jesus (Jan. 1, 1919)

First Hospital in the PH - Hospital Real ; “The Royal Hospital”

- in Cebu, 1565
- for the royals

- 1577 = Hospital de los Indios Naturales ; “Hospital for the Poor”

= In Intramuros
= made out of nipas & bamboos - only 2 wards
= made by Fr. Clemente
= burned down in 1583
= Chinese (suffered from Leprosy) donated land & made into Hospital de San Lazaro
- 1954 = RA 1082 ; Rural Health Act
= President Magsaysay - clinic in every municipality
- 1958 = Regional Health Offices
- 1961 = D. Macapagal
= RA 3720 ; Food, Drug, Cosmetic Act
= Creation of FDA
- 1965 = Marcos - implemented Martial Law in Sept. 21, 1972
= 1974 - restructuring of health cared delivery systems
> levels of care : primary, secondary, tertiary
= 1979 - PHC ; first country to adopt public health care (Oct. 19)
- specialty medical institutions:
a. Philippine Heart Center - 1975
b. Philippine Children’s Medical Center - 1979
c. Lung Center of the Phils - 1981
d. National Kidney Institute - 1983
- 1986 to 1992 = C. Aquino
= EO 51 - Milk Code of the Philippines ; Oct. 1986
= RA 6675 - Generics Act ; affordable medicine
= RA 7160 - Local Government Code ; devolution - LGU ; 1991
= RA 7305 - Manga Carta for Public Health Workers - benefits for health care
workers ; 1992
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- 1992 to 1998 = Fidel V. Ramos

= Secretary of DOH: Dr. Juan Flavier
> “ Let’s DOH it ” ; premier years of DOH
> Doctor from rural community ; Barrio doctor
> Kontra Kolera
> Oplan Alis Disease
- introduced National Immunization Day ; Wednesday
- first immunization plan
- WHO & UNICEF
> ASAP
- Araw ng Sangkap Pinoy
- to attend to the problem of malnutrition
- gave Vit. A, Iron
> Kung Sila Mahal Nyo, Magplano
- Family Planning
> YOSI KADIRI
- Anti smoking campaign
> ASIN LAW
- RA 8172
- Iodine Deficiency Program
= RA 7170 - Organ Donation Act of 1991
= RA 7875 - PhilHealth
= 1996 - 1st ever female secretary of Health : Dr. Carmencita Reodica
> Early Childhood Development Program
* IMCI
* EPI - Extended Program on Immunization
* Supplemental Feeding Program for the Children of the PH
> Adolescent Health Care Program
> Women’s Health & Safe Motherhood
> Integrated Reproductive Health Program
> BnB -Botika ng Barangay
> TAMA - Traditional & Alternative Medicine Act
- RA 8423
- Herbal Medicine
- 1918 = Estrada
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Public Health:
1. Home Visits ‼
2. Clinic Visits ‼

CLINIC VISIT - BHS (RHU)

- phases:
1. Pre-consultation conference
- data = CHIEF COMPLAINT
2. Medical exam phase
- assessment ; physician phase
3. Nursing intervention phase
4. Post consultation conference
- most important activity: HEALTH TEACHING ‼
> main goal: promotion of health
> components:
Information
Communication
Education
> criteria for education:
Knowledge - biggest percentage
Skills
Attitude

* 5 ACTION AREAS OF HEALTH PROMOTION

- Ottawa Charter for Change (Canada ; Nov. 17-21, 1986) ; WHO

Develop personal skills

Reorient public health services
Building public health policy
Strengthening community action
Create supportive environments

* METHODS OF HEALTH TEACHING

1. One to One Teaching
2. FGD - Focus Group Discussion
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- ex. proper breast feeding to pregnant mothers

3. Mass Media Teaching
- ex. online class through zoom

* ACTIVITIES
1. Registration
2. Waiting time
3. Triaging ‼
a. Program based
- there is a protocol to be followed
- ex. a child has a fever, you give paracetamol
- 3rd PRIORITY
b. Non-program based
- need to refer ; referral
- ex. person got bit by a rabid dog, dog must be captured = referral
- 2nd PRIORITY
c. Emergency case based
- first aid
- 1st PRIORITY
4. Clinical evaluation
- physical assessment
5. Laboratory examination
- rapid tests, usually screening procedures
- for HIV: ELISA can be done bec rapid
6. Dispensing of drugs
- over the counter drugs
- prescribed drugs ; protocol / DOH program
- 8 common drugs:
Co-trimoxazole - antibiotic
Amoxicillin
Rifampicin / Rifampin - prescribed ; DOTS - anti TB drugs
Isoniazid - prescribed ; DOTS - anti TB drugs
Pyrazinamid - prescribed ; DOTS - anti TB drugs
Paracetamol
Oresol / Oral rehydrating solution
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Nifedipine - antihypertensive drugs

7. Referral system
- comprehensive 2 way referral system = used in the PH ‼
8. Health education
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CHN 2 February 22, 2022

‼ HOME VISIT
“P“
- Purpose
- Principles
- Phases
- Prequency

PURPOSE
“ PUSA = CAT “
- To provide nursing Care
- To Assess the living conditions of the family
- To provide health Teachings

PRINCIPLES
“ PM “
- Purpose and objectives
- Prioritization
- Plan of visit
= characteristics:
a. Practical
b. Plexible
c. include Pamily
- Make use of all available information from the client

PHASES
“ P.I.P “
*Initiation before pre-visit phase is starting to talk with the community
Pre-visit Phase
- must know your purpose
- must have a plan
In-home Phase
1. Initiation
a. knock
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b. non-threatening voice
c. greet
d. introduce
e. observe the environment
f. establish rapport
g. state the purpose
2. Implementation
- nursing process
a. assessment
b. nursing care
c. evaluate
3. Termination
- summarize with the family the activities done
- setting of the next visit or clinic visit
- record your findings
Post-visit Phase
- return to the health facility
- documentation of the visit done
- referral ; if required

‼ PACTORS APECTING THE PREQUENCY OF VISIT

“ PAPANO “

Policies of specific agency

Acceptance of the family - MOST IMPORTANT
Past services rendered
Ability of the family to recognize needs
Needs of the family - determinant of home visit
Other health services involved

‼ BAG TECHNIQUE
- tool that you use during home visit ; NOT the EQUIPMENT
- equipment: CHN / PHN / MCN / OB Bag
- Home visit: bag on LAP
- Bag technique: bag on CLEAN TABLE
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- don’t throw away the paper lining and other contents in the house of the family = throw it
away in the health center

PRINCIPLES
Minimize, if not prevent the spread of contamination - MOST IMPORTANT
Effectiveness of total care
Save time and effort
Avoid contaminations
Hand washing
- most effective way of infection control
- 4 to 5 mL ; 2 pumps of liquid soap
- running water
- most important principle: FRICTION

AREAS / CONTENTS OF THE BAG - clean and sterile

TOP
- things can be waved ; “ganunin “
a. paper lining
b. plastic lining
c. gloves
d. apron
FRONT
- T.T
a. thermometer
b. test tube
c. test tube holder
CENTER
- everything that’s not in the top, front, and rear
REAR
- chemical and solutions
a. alcohol
b. Benedict’s
c. acetic acid
d. ammonia
e. ophthalmic ointment
f. betadine
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EMERGING FIELDS OF CHN IN PH

1. Home Health Care

- providing nursing care to individuals and family in their own residence
- PDN
- examples:
a. chronically ill
b. convalescent (recovering)
c. elderly
d. disability that requires nursing care
e. high risk pregnancies

2. Hospice Home Care

- home care specifically rendered to terminally ill patients
- purpose: Provide comfort
Improve quality of life
Support the patient and the family
- type of care: PALLIATIVE CARE

3. Faith Community Nursing

- aka. Parish Nursing
- art and science of combining nursing with spiritual care
- focus: PROMOTION and HOLISTIC CARE

NURSING PROCESS
Community - APIE

ASSESSMENT
- “ DATA ”
1. Data Collection
2. Data Collation
3. Data Presentation
4. Data Analysis
5. Data Utilization
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DATA COLLECTION
Primary Data
- first hand
1. INTERVIEW ‼
- first hand, most reliable
- types:
a. Informant Interview
b. Key-person Interview
- Barangay captain, Parish priest

2. OBSERVATION
- types:
a. Participant Observation
b. Rapid Observation
- aka. Windshield observation
- used during ocular inspection
- used to take a look at the whole community

3. SURVEY / QUESTIONNAIRES
- where you get bulk of data ‼

4. COMMUNITY FORUM
- aka. Community Assembly
- “ pagpulong - pulong “ ; Famorca
- open meeting with the members of the community

5. FOCUS GROUP
- smaller group meeting ; 6-12 members only

Secondary Data
- reports, records, documents
- records REVIEW
1. CENSUS
- official enumeration of the total population
- 2 types:
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a. DE JURE
- point of origin
- “ taga asa ka? “
b. DE FACTO
- factual / actual location during the time of census
- “ asa ka karon? “

DEMOGRAPHY
- characteristics of the population
STATISTICS
- figures, percent, ratio, proportion
VITAL STATISTICS
- statistics about health
- health indicators:
a. Morbidity - confirmed diseases / cases
b. Mortality - deaths in relation to diseases

2. REGISTRATION ‼
- births and deaths
- PD 651 = registration of births & deaths
= report within 60 days
- PD 766 = amended law on registration of births & deaths
= Section 2 - Births
> Points to remember:
a. without fee
b. done within 30 days
c. registration of birth
d. done by:
hospital - attending physician
maternity clinic / lying in - nurse, midwife
outside the facility / home - parent or any member of
the family
e. done at local civil registrar / municipal health office / city health
office
f. location: where birth occurred
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= Section 5 - Death
> Points to remember:
a. without fee
b. done within 30 days
c. done by:
Health facility
- last attending physician
- doctor who pronounces the death ; will issue death certificate
- submitted to the Local Health Officer (doctors) within 48 hours
- absence of LHO - report to the mayor
- if both LHO & mayor are absent - report to municipal secretary
Outside the facility
- ex. home, road
- nearest relative = any person who has knowledge
- report to LHO within 48 hrs ; issuing person of death certificate
> location: where you were BORN
= report within 30 days

GOLDEN RULE - To where you are added, that is where you will be subtracted ; if dual -
both

- RA 3753
= Civil Registration Law
= creation of civil registry system ; NSO
- RA 10625
= PSA ; Philippines Statistics Authority
= Ninoy Aquino, 2013
= Philippine Statistical Act
- PD 856
= Sanitation Code of the PH
= requires death certificate before burial
- PD 825
= Garbage Disposal Law
= working from 8 to 5 - 825
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‼ FHSIS
- Field Health Service Information System
- reporting tool in the community
- EO 352 = official recording & reporting system of the DOH
- Record Keeping = BHS or RHU ; daily basis
- Reporting = BHS or RHU
= Provincial health office
= Regional health office
- Components ‼
1. Treatment Record*
- fundamental building block of FHSIS
> Individual
> Family

2. Target Client List* (TCL)

- secondary building block of FHSIS
- examples:
a. pregnant under pre-natal and pos-natal
b. children under 1 year
c. sick children (IMCI)
d. those availing family planning
e. communicable diseases (ex. TB)
> TB DOTS - Direct Observe Treatment Short course
- names are listed

3. Tally Reporting Form

- monthly report
a. Rx programs
b. Morbidity
- cases are listed

4. Summary Report
- 12 columns
- codes:
Events
 Page 9 of 24

* Births
* Deaths = E1
Monthly report
- prepared by the midwife = submitted to the nurse
* M1 - Program Report
* M2 - Morbidity Report
Quarterly report
- prepared by the nurse = submitted to the provincial health office
* Q1 - 3 mos Program Report
* Q2 - 3 mos Morbidity Report
Annual report
- prepared by the nurse
* A1 - demographic, births & deaths report / year
* A2 - morbidity report by age & sex
* A3 - deaths by age & sex

Office Person Frequency Schedule of

Submission

Barangay Health Station Midwife Monthly Every 2nd week of

(M1, M2) succeeding month

Annual Every 2nd week of

( A - barangay form ) January

Rural Health Unit Nurse Quarterly Every 3rd week of the

( Q1, Q2 ) 1st month every quarter
(Jan, April, June, Oct)

Annual Every 3rd week of

( A1, A2, A3 ) January

Provincial / City Health Provincial / City FHSIS Quarterly Every 4th week of the
Office Coordinator ( Q1, Q2) 1st month every quarter

Annual Every 4th week of

( A1, A2, A3 ) January
 Page 10 of 24

Regional Regional FHSIS Quarterly Every 2nd week of the

Coordinator ( Q1, Q2 ) 2nd month of every
quarter (Feb, May, Aug,
Nov)

Annual Every 2nd week of

( A1, A2, A3 ) March

NESSS
- National Epidemic Sentinel Surveillance System
- hospital based information of disease occurrences
- data will show:
Cases by geographic location
Demographic characteristics of the disease
Information
Estimates
Trends
- will also provide supplemental information to the DOH
- diseases under surveillance
Lab Diagnosed Diseases Clinic Diagnosed Disease

Malaria Everything not in Lab

Typhoid fever
Cholera, Covid-19
Hepatitis A & B, HIV

DATA COLLATION
- categorization

DATA PRESENTATION
- types:
1. Descriptive
- narration
2. Numerical
- figures, numbers, percentage, ratio
 Page 11 of 24

a. Line Graph
- trends (peaks & valleys) with a given period of time
b. Bar Graph
- showing comparisons of variables
c. Pie Chart
- percentage distribution or composition
- should not be more than 6 variables
d. Scatter Diagram
- correlation of 2 variables
e. Population Pyramid
- age and sex of the population
- aka. “Age-Sex Pyramid “
- types:
1. Expansive / Expanding ‼
- wider base ; narrow top
- younger population, ⬆ birth rate, ⬆ mortality, ⬆ fertility rate
- ⬇ life expectancy
- “ GROWING POPULATION "
2. Constrictive
- narrow base
- ⬇ percentage of younger population
- ⬇ birth rate (declining)
- ⬇ fertility rate
3. Stationary
- equal proportion of the population
- population is stable

DATA ANALYSIS
- standard

DATA UTILIZATION
- using of the data gathered
 Page 12 of 24

‼ FAMILY ASSESSMENT

First Level of Assessment

- Problems of the family
- tool used: IDB (made by Araceli Maglaya)
> aka. Family Health Assessment Form

1. Family Structure
a. Surname
b. Address / Contact information
c. Source of information - usually head of the family
d. Data gathered by
e. Household members - age, relationship to the head
> Tools:
*Genogram - outlines family structure by genealogy (min. 3 gen)
*Family Health Tree - family’s medical and health history based on genogram
*Ecomap - linkages to its supra systems

2. Socio-economic and Cultural

- dialect used
- source of income

3. Home Management
- usual dynamics in the home
- lifestyle

4. Health Assessment of the Family

- each member should be assessed

5. Resources of the Family

- who is working?
- where do they get their income?

RESULT (1st Level)

- typology of nursing problems ‼
 Page 13 of 24

1. Health Threat
- problems are external ; around self and affects health
2. Health Deficit
- problems are internal ; within self
3. Foreseeable Crisis
- problems in the future

Second Level of Assessment

- Performance of the family health task
- recognition of the problem = SALIENCE

RESULT (2nd level)

- “ INABILITY “

Family Nursing Diagnosis Tool = NANDA ; Family Level

Family Coping Index

COMMUNITY ASSESSMENT
- aka. Community Situational Analysis , Community Diagnosis
- 2 types:
1. Comprehensive Community Diagnosis
- GENERAL assessment
- data collection ➡ problem identification
2. Problem-Oriented Community Diagnosis
- SPECIFIC assessment
- problem ➡ data collection
- Assessment Tool:
OMAHA SYSTEM OF 2011
> domains and problems:
a. Environmental Domain
- sanitation, neighborhood, resident, income, workplace
b. Psychosocial Domain
- communication ; relationships, parenting style
c. Physiological Domain
- health function and processes
 Page 14 of 24

d. Health Related Behaviors Domain

- nutrition, sleep & rest, physical activity, hygiene, family planning

RESULT: Community Health Problems

1. Health related problems
2. Health status problems
3. Health resource problems

‼ In community practice, the END RESULT of ASSESSMENT is always PROBLEM

IDENTIFICATION ‼ (APIE)

Problems are always MULTIPLE - must solve each problem one by one ; prioritization

PLANNING

1. PRIORITIZATION ‼
- criteria:
FAMILY COMMUNITY

Nature of the Problem Nature of the Problem

Modifiability of the Problem* Modifiability of the Problem

Magnitude of the Problem*

Preventive Potential Preventive Potential

Salience Social Concern (like salience)

*Modifiability = has the most weight ; most important

*Magnitude of the Problem = unique criterion for community

FAMILY

CRITERIA SCORE WEIGHT

Nature of the Problem 1

Health Deficit 3
Health Threat 2
Foreseeable Crisis 1
 Page 15 of 24

Modifiability of the Problem 2

Easily 2
Intermediate 1
Not Modifiable 0

Preventive Potential 1
Highly 3
Moderate 2
Low 1

Salience 1
Needs urgent attention 2
Not urgent attention 1
Not a felt problem 0

COMMUNITY

CRITERIA SCORE WEIGHT

Nature of the Problem 1

Health Status Problem 3
Health Resource Problem 2
Health Related Problem 1

Modifiability of the Problem 4

Easily 3
Intermediate 2
Low 1
Not Modifiable 0

Magnitude 3
75-100% of population 4
50-74% of population 3
25-49% of population 2
<25% of population 1

Preventive Potential 1
Highly 3
Moderate 2
Low 1
 Page 16 of 24

Social Concern 1
Needs urgent attention 2
Not urgent attention 1
Not a felt problem 0

Points:
1. The score and the weight are fixed and constant.
2. The public health nurse decides the score as well as interprets.
3. The highest score in the family = 5.
4. The highest score in the community = 10.
5. Rule: The higher the score, the more priority it is.
6. Formula: ( Score / Highest Score ) x Weight

Example:
Problem A = 2.16 - #3
Problem B = 3.99 - #1 Priority
Problem C = 2.33 - #2

2. SETTING OF GOALS
a. Short
- specific ; addresses FACTORS affecting the main problem
- intervention measures are done
- ex. water, toilet, garbage
b. Long
- general ; directly addresses MAIN PROBLEMS
- ex. sanitation

Specific
Measurable
Attainable
Realistic
Time-bound

3. DEVELOP A PLAN
a. Family - FNCP ; family nursing care plan
b. Community - CHP ; community health plan
 Page 17 of 24

4. FORMULATION OF EVALUATION TOOLS

- short term goals will affect because that is where the interventions are

INTERVENTION
- aka. Implementation Phase
- professional stage in the nursing process = performing nursing procedures
> functions:
a. Dependent - more on hospital setting
b. Independent - CHN
c. Interdependent - CHN ; collaboration

EVALUATION
- 2 types:
1. Qualitative
2. Quantitative
- both qualitative and quantitative are important but more on QUALI
- components:
Evaluation Parameters

Structure Inputs and resources Adequacy, Appropriateness

Process Procedure performed Effectiveness, Efficiency

Outcome Result Goals

Met, Unmet, Partially Met

CHN HOSPITAL

Client - Family / Community Client - Patient / Individual

“Data” A Physical Assessment, Chief Complaints,

End result - problem identification Laboratory

D Problem Identification
Prioritization (activity)

Prioritization P Set goals

Set goals Care plan - NCP (patient focused)
Care plan - FNCP, CHP
 Page 18 of 24

Action I Action
- Independent & Interdependent - Dependent

Structure E Outcome based

Process
Outcome

‼ CO-PAR
= Community Organizing Participatory Action Research

PAR
- research in the community
- you are the one performing but more on helping
- basic research only

GOALS:
CO = Self reliance
PAR = Social transformation
COPAR = Community development

PRINCIPLES: “ PDC "

P - People centered
Participative
Process oriented - phases
Poorest sectors (oppressed, depressed, underserved sectors)
> DOH Criteria = GIDA - Geographically Isolated and in a Disadvantaged Area
D - Democratic ; listen to the people
Developmental
C - Change
S - Self reliance

COPAR TEAM:
1. Project director - overall head of the entire COPAR ; school president
2. Project manager - right hand of director ;dean of the college
3. Coordinator for Immersion - responsible for site selection & safety of the team ; community
coordinator
 Page 19 of 24

4. Health Service Coordinator - goes to the site with you and helps you ; CI
5. Community Organizers - implements the organizing activities ; students
6. Training Officer - trains and implements the training ; internal (yourself) or external (invite
speakers)
7. Financial Officer - like treasurer
8. Book Keeper - financial activities ; recording
9. Secretary - documentation

COPAR TRAININGS
1. SALT
- Self Awareness and Leadership Training
- concept of man
- HCDS
- PHC
- levels of care
- current Phil Health situation
- leadership styles
= “country“ and “self“

2. PAR and Management Training

- basic research
- different managerial skills
= “-ing” ; ex. budgeting, managing, controlling, planning, directing

3. Basic Health Skills Training

- hand washing technique
- isolation technique
- bag technique
- BP technique
- thermometer technique
- aseptic technique
= “ techniques “

4. Advance Health Skills Training

- first aid
- emergency care
 Page 20 of 24

- disaster management
- bandaging
- triaging
= “Emergency and Disaster”

5. Specialized Health Skills Training

- herbal medicine
- alternative health care practices
- family planning
= “Special Concepts”

‼ HERBAL MEDICINE
RA 8423 - TAMA ; Traditional Alternative Medicine Act

PREPARATIONS:
1. Decoction
- boil at least 20 minutes
2. Poultice
- direct application ; pounding and grinding
3. Infusion
- soaking in hot water ; 10 - 15 minutes
- like tea
4. Juice / Syrup
- juice is more concentrated ; pure
- syrup = honey + juice
5. Cream / Ointment
- cream = starch is added
- ointment = starch + oil is added

“ SANTA LUBBY “

SAMBONG Edema, Diuretic Leaves Decoction

AKAPULKO Anti-fungal Leaves Decoction, Poultice, Cream

NIYOG-NIYOGAN Intestinal Parasitism Seeds Decoction, Poultice, Juice

TSAANG GUBAT Diarrhea, Stomachache Leaves Decoction, Poultice

 Page 21 of 24

AMPALAYA Diabetes Leaves Decoction

LAGUNDI Asthma, Cough, Colds, Fever Leaves Decoction, Poultice

ULASIMANG BATO / Gout, Arthritis, Rheumatism Leaves Decoction, Poultice

PANSIT-PANSITAN

BAYABAS Wound care, Toothache Leaves Decoction

BAWANG Hypertension, Toothache Clove / Bulb Poultice

YERBA BUENA Cough, Colds, Fever, Leaves Decoction, Poultice

Dysmenorrhea

ALTERNATIVE HEALTH CARE PRACTICES

1. Massage
- pressure to any part of the body
2. Reflexology
- pressure only on the sole and palm
3. Acupressure
- pressure on the body meridians / acupoints
4. Acupuncture
- using fine thin needles
5. Aromatherapy
6. Chiropractic
- proper alignment of the spine and pelvis
7. Reiki
- palm on the head of the person and absorbing negative energy / transferring positive
energy
8. Pranic Healing
- Prana = aura
- healing of the aura of the person
9. Meditation
- peace and relaxation of the mind
10. Yoga
- peace and relaxation of the body and mind
11. Yin-Yang
 Page 22 of 24

- balance of 2 forces ; positive & negative, good & bad, feminine & masculine
‼ COPAR PROCESS
- Jimenez

PRE-ENTRY
1. Community Consultation / Community Assembly
2. Site Selection
3. Ocular Inspection
4. Preliminary social investigation
5. Networking with LGUs
6. Identify foster family
7. Develop survey tool
Preliminary - Secondary
Deepening - Primary

ENTRY
1. Arrival and Integration - “ RISER ”
Rapport
Imbibe with the life of the community
Share
Experiences
Respect the community
2. Information Dissemination
3. Identify potential leaders
- characteristics of leaders: TORPE
4. Core-group formation
5. Deepening social investigation
- getting first hand information from the community
6. SALT

COMMUNITY STUDY / DIAGNOSIS PHASE

1. Research Phase
- selection of the research team
2. Training on data collection and data validation
3. Planning and actual data gathering
 Page 23 of 24

4. Community Validation
5. Presentation of the community study / diagnosis and recommendations
6. Prioritization of Community needs and problems for action
*Validity of Cdx - 6 months

COMMUNITY ORGANIZING & CAPABILITY BUILDING PHASE

= building the community and organization
1. Election of Officers
2. Development of management system
3. Definition of roles and functions of officers and members
4. Team building / Action-Reflection-Action
5. Organization of working committees
6. Training of CHO / community leaders

COMMUNITY ACTION PHASE

1. Implementation and Mobilization
2. Project Implementation, monitoring and evaluation (PIME)
3. Selection and training of CHW
4. Setting up of linkages and referral systems

SUSTENANCE AND STRENGTHENING PHASE

= everything will sustain and strengthen
1. Setting up of financing scheme
2. Constitution and by-laws
3. Identification of Secondary Leaders
4. Continuing Education
5. Development of medium and long term goals

TERMINATION PHASE
1. Self-reliance
2. Transfer of responsibility to the community
 Page 24 of 24

Cdx

PE E Co Ca $

T
X RN Officers CHW
Time (has extra)
Oriented for change
Respected by the people
Poorest sector (member)
Effective communication skills
 Page 1 of 17

CHN - Continuation May 17, 2022

‼ LOCAL HEALTH SYSTEM

⌘ Inter local health system

- Applying the concept of district health system
- Focus of delivery of care in the community practice in the PH: LGU
☼ RA 7160 : Local Government Code of the PH
⌁ Local Government Code of the PH
⌁ Decentralization, devolution

⌘ LGU Health Score Card

- The assessment tool in order to know if the LGU is doing their job in terms of the
programs of the DOH
- Indicators:
☼ Health spending
⌁ budget allocated for the implementation of the health programs
☼ Governance for health
☼ Public health interventions
☼ Financial risk protection
- Composition:
☼ People - 150,000 to 500,000 of the population
☼ Boundaries
☼ Health workers - Health care team:
⌁ RN - Collaborative
⌁ MD - Leader
⌁ RM
⌁ San Eng
⌁ BHW - Barangay Health Workers
☼ Health facility
⌁ Primary - Primary Care
⌁ Central - Secondary and Tertiary Care
 Page 2 of 17

‼ LEVELS OF CARE

Promotion and Prevention

❗P •
Pre-patho , “ WELL ”

Diagnosis and Cure

S ⭕ Provincial hospital
Symptomatic , “ SICK ”

Rehabilitation
❗T ⃝ Regional hospital
Recovery , Terminal , Critical

Anything with health teaching for the well population = always PRIMARY
Any screening or diagnostic done = SECONDARY
Puericulture center is the same as lying-in centers
Vaccination is done even when someone is sick = can become an intervention
Immunization is done before someone gets sick = more GENERAL ; prevention
❗ FOCUS OF CHN = PRIMARY LEVEL OF CARE

⌘ REFERRAL SYSTEM
- Comprehensive 2-way referral system

LOCAL HEALTH SECTOR: Under DOH

Community
↕
BHS - should be in every barangay
(Barangay health center is under RHU)
↕
RHU - minimum 1
↕
Municipal / District Hospital
↕
Provincial Hospital
↕
Medical / Regional Centers

⌀ ALL can refer to a Private Hospital! (PRIVATE HEALTH SECTOR)

 Page 3 of 17

⌘ DOH
- Changed by the Marcos: Ministry of Health
- Vision by 2030: To be a global leader for attaining better health outcomes,
competitive & responsive health care system, and equitable health financing
- Mission: Guarantee equitable, sustainable, and quality health for all Filipinos
especially the poor, and to the quest for excellence in health
- Goals:
☼ 1999 - 2004: Erap
⌁ HSRA: Health Sector Reform Agenda
⌁ Dr. Romualdez : 1998 - 2001
⌁ Dr. Dayrit : 2001 - 2005
☼ 2005 - 2010: Gloria Macapagal Arroyo
⌁ Fourmula One for Health
⌁ Dr. Duque III : 2005 - 2010
⌁ Dr. Cabral : 2010
⌁ Goals: “BEM”
Better health outcomes
Equitable health care financing
More responsive health system
⌁ 4 Elements:
Health financing → investment
Health service delivery → acceptable & accessible
Health regulation → quality & affordability
Good governance
☼ 2011 - 2016: Aquino
⌁ Universal Health Care
⌁ AO #36
⌁ “Kalusugang Pangkalahatan”
⌁ Dr. Ona : 2010 - 2014
⌁ Dr. Garin : 2014 - 2016 ; issue - Dengvaxia
⌁ Goals: “ BRF ”
Better health outcomes
Responsive health system
 Page 4 of 17

Financial risk protection

⌁ Elements:
Health financing
Health service delivery
Health regulation
Good governance
Human resources for health
Health information

⌘ Deployment Programs:
⌀ NARS
- Under GMA
- Nurses Assigned in Rural Service Projects
- Just a training ; given a certificate
- Given a stipend of ₱ 8,000
- Contract: 6 months ; non renewable

⌀ RN HEALS
- Under PNoy
- Registered Nurses for Health Enhancement And Local Service projects
- Combination of training & employment
- Given a certificate of employment & certificate of training
- Salary: ₱ 8,000
- Contract: 12 months ; non renewable

⌀ NDP
- Under Duterte
- Nurse Deployment Program
- No longer a training program, but an employment opportunity for nurses
- Given a certificate of employment and certificate of completion → PHN II
- Contract: 6 months ; renewable
- Salary grade 15 - ₱ 30,531 ; 16 - ₱ 33,584
 Page 5 of 17

☼ 2016 - 2022: Duterte

⌁ Philippine Health Agenda - PHA
⌁ Vision: Filipinos are among the healthiest people in South East Asia by
2022 and in Asia by 2040
⌁ Mission: To lead the country in the development of a productive,
resilient, equitable, and people-centered health system
⌁ Dr. Ubial : July 2016 - Oct. 2017
• Goal: ALL for health towards health for ALL ; “Lahat para sa
kalusugan tungo sa kalusugan para sa lahat”
▴ Financial protection
▴ Better health outcomes
▴ Responsiveness
• 3 Guarantees:
▴ All life stages & triple burden of the disease
▴ Service delivery network
▴ Universal health insurance
⌁ Dr. Francisco Duque III : Nov. 6, 2017 - Present
• Goal: Fourmula One Plus for Health
• Focus: Accountability
• 5 Pillars:
▴ Health financing
▴ Health service delivery
▴ Health regulation
▴ Good governance
▴ Performance accountability

⌘ DOH EXECUTIVE COMMITTEE

☼ Secretary
- Only one: Duque III

☼ Undersecretary:
- 9 members:
 Page 6 of 17

- Vega, Cabotaje, Villaverde, Roger Tong-an, Vidal-Taino (CPA), Bayugo, Dumama,

David
- OIC: Vergeire

⌘ KEY FACTORS:
- National Health Insurance Program = PhilHealth
☼ RA 7875 - Launched on 1995
☼ RA 10606 - National Health Insurance Act of the Philippines of 2013
☼ Oct. 2019 - Circular Order #9 Series of 2019: PhilHealth contribution will
increase 3% by 2020 → increment of 0.5% every year → 5% by 2025
- Guidelines:
☼ Member = Self-earning, sponsor, indigent, retirees, abandoned children, OFW
⌁ RA 10022 = OFW Law ; Migrant Workers Act
⌁ RA 10801 = OWAA Act ; Overseas Welfare
☼ Updated contribution
☼ Senior Citizen = Lifetime membership
☼ PWD
⌁ RA 11228 = Mandatory PhilHealth coverage to all PWD
☼ Dependents
⌁ Parents = 60 years old and above, with permanent disability
⌁ Legitimate spouse
⌁ 21 years old and below - legitimate, illegitimate, foster child
RA 10165 = Foster Act of 2012
☼ Cancer patients
⌁ RA 11215 = National Integrated Cancer Control Act
⌁ Signed on Feb. 14, 2019
- Benefits:
☼ Inpatient coverage - subsidy:
⌁ Room
⌁ Drugs and medicines
⌁ Laboratories
⌁ OR
⌁ Professional fees for confinement of less than 24 hours
 Page 7 of 17

• Maximum per confinement = 45 days in total ; for member

• Another 45 days to all dependents (shared privilege)
☼ Outpatient benefits - only at accredited RHU & Clinics
- Not paid by PhilHealth:
☼ Gravida 5 onwards
☼ Drugs or devices that is not prescribed
☼ Treatment for alcohol abuse
☼ Cosmetic surgery
☼ Optometric services

⌘ ROLES & FUNCTIONS OF THE DOH

- Under EO 102 : Estrada on May 24, 1999
- “ LEA “
Leadership in health
Enabler and capacity builder
Administrator of health services
- DOH Facilities: Levels of care
- DOH Classification of Hospitals
☼ General Hospital
☼ Special Hospitals = provides services for a specific disease
⌁ RA 4226 = Hospital Licensure Act of the PH
☼ 2021 - DOH Hospital Profile
⌁ 66 Hospitals
Level 3 = 37
Level 2 = 7
Level 1 = 21
Psychiatric Care Facility = 1 only
➣ Mariveles Mental Wellness & Gen. Hospital
⌁ 4 Government Owned:
Lung Center
National Kidney Center
PCMC
PH Heart Center
 Page 8 of 17

Luzon = 38
Visayas = 12
Mindanao = 16

‼ LEVELS OF GENERAL HOSPITAL

• Consulting specialist
• Emergency & Outpatient
• Isolation facilities
LEVEL 1 • Surgical / Maternity facilities
• Dental clinic
• Laboratory
• Pharmacy

• Everything in Level 1
• Departmentalized clinical services - ex. Stroke unit
• Respiratory unit
LEVEL 2
• ICU
• NICU
• High risk pregnancy unit

• Everything in Level 1 and 2

• Residency Training
• Rehabilitation unit
LEVEL 3
• Ambulatory surgical unit
• Dialysis
• Blood bank

CATEGORIES TYPE OF FACILITY EXAMPLES

Primary Care Facility • Health Center

- First contact health facility • Outpatient Clinic
A
• Dental Clinic
• Lying-in

Custodial Care Facility • Psychiatric Facilities

B - Long term care including food & • Rehabs
shelter • Nursing Homes
 Page 9 of 17

Diagnostic & Therapeutic Facility • Lab Facilities

- Diagnosis and sometimes • Drug Testing Facilities
C
treatment • HIV Testing Facilities
• Blood Services Facilities

Specialized Outpatient Facility • Dialysis Centers

- Highly specialized procedures • Cancer Centers - radiation &
D
chemotherapy
• Ambulatory Surgical Facilities

‼ PRIMARY HEALTH CARE

- Under the Alma Ata Declaration: Sept. 6 - 12, 1978 @ Alma Ata, USSR
- First SE Asian country to adapt PHC: Philippines
⌁ Oct. 19, 1979 = LOI 949 by Ferdinand Marcos Sr.
⌁ Goal: Health in the hands of the people by the year 2020
- Astana Declaration
☼ New ; Occurred Oct. 25 - 26, 2018 @ Astana, Kazakhstan
☼ 40 years after Alma Ata Declaration
☼ Title: “From Alma Ata towards universal health coverage and the sustainable
developmental goals, reaffirming the 1978 goal”
☼ Goal: Health and well-being for ALL, leaving no one behind
- Universal Health Care Act of the PH
☼ RA 11223 ; Feb. 20, 2019
☼ Goal: Health for ALL, no Filipino must be left behind
☼ Players: DOH, WHO, UNICEF
- Principles:
☼ 4As
Accessibility
Availability
Affordability
Acceptability
☼ Community Participation
☼ People - center of development
☼ Self-Reliance
 Page 10 of 17

☼ Partnership
☼ Health and development
☼ Social mobilization
☼ Decentralization
- Sectors:
☼ Public
☼ Private
- Levels of workers:
☼ BHW / Village worker / Auxiliary worker
☼ Intermediate level health workers
⌁ Health Care Team
⌁ Those with degrees
- Pillars / Cornerstones of PHC
“ I ♡ USA “

Intra and Intersectional linkages

Use of appropriate technology
⌁ Ex. Halamang gamot / herbal meds
Support mechanisms made available
Active community participation
- Elements:
“ I SEE MALE HE COMM “
Immunization = EPI
⌁ PD 996 = 6 immunizable diseases
TB, Diphtheria, Pertussis, Tetanus, Polio, Measles
⌁ RA 10152 = 10 immunizable diseases:
PD 966 + Hep. B, Mumps, Rubella, HiB

Sanitation
⌁ PD 856 = Sanitation Code
⌁ PD 825 = Garbage Disposal
✾ WHO = Global WASH Program ( Water Sanitation Hygiene )

❋ Water Facilities:
 Page 11 of 17

Level I : Point Source

⌁ 250m, 15 - 25 households
⌁ 40 - 140 L/min
⌁ ex. Well
Level II : Communal Faucet
⌁ 25m, 4 - 6 households
⌁ 40 - 80 L/capita/day
⌁ ex. Stand-post (?)
Level III : Waterwork System, Piping System
⌁ Consumption per cubic centimeter (cc)
⌁ ex. Household taps

❋ Toilet Facilities:
Level I : Non water carriage toilet or Pour flush
⌁ ex. Pit-Latrines
Level II : Flush type with Septic tank
Level III : Flush type with Septic tank and with Treatment facility

❋ Food Sanitation:
Sanitary Permit - issued by MHO or sanitary engineer / inspector
Health Certificates - necessary for food handlers
Rights:
Right source
Right preparation
Right cooking
Right storage
Golden Rule: If in doubt - throw it out!

❋ Waste Management:
RA 9003 - Solid Waste Management
Health Care Waste / Biomedical Waste:
⌁ From the DOH manual on health care waste management
Black : General waste
 Page 12 of 17

Green : Non-hazardous biodegradable

Yellow with biohazard symbol : pathological & anatomical waste
Yellow with Black band : pharmaceutical, cytotoxic, chemical waste
Yellow bag : Autoclave, infectious waste
Orange : Radioactive waste

Essential Drugs
⌁ Botkia ng Baranggay - BNB
⌁ RA 6675 = Generics Act of the PH
= Low priced generic OTC & prescription drugs
⌁ EO 174 = National Drug Policy
⌁ RA 5821 = The Pharmacy Act

Emergency care

Maternal and child health

Adequate food and proper nutrition

⌁ PD 491 = The Nutrition Act of the PH
⌁ RA 11148 = Kalusugan at Nutrisyon ng Mag-Nanay Act of 2018
= Give good nutrition in the first 1,000 days of life
⌁ RA 8976 = Food Fortification Program
= Food with the Sangkap Pinoy Seal
= ex. Ketchup, hotdogs

Locally Endemic Diseases

Health Education

Communicable Diseases
⌁ RA 3573 = Law on Reporting of CDs ; OLD
⌁ RA 11332 = Mandatory Reporting of Notifiable Diseases of 2018
 Page 13 of 17

⌘ 4 Pillars of Safe Motherhood:

☼ Pre-Natal
☼ BEMONC - Basic Emergency Obstetrics and Neonatal Care
☼ Clean and Safe Delivery
☼ Post-Partal

⌀ PRE-NATAL
- Home Based Mother’s Record / HBMR
- Called Pink Card
VISITS CHECK-UP

1st Visit - 1st trimester 1st - 7th LM : Once a month / 4 weeks

2nd visit - 2nd trimester 8th - 9th LM : Twice a month / q 2 weeks

3rd visit - 3rd trimester 10th LM : q week

8 months onward - every 2 weeks Sex should be avoided 6 weeks before

EDD
At least 4 times in 1 pregnancy

- Supplements: ‼
☼ Vit. A = 4th month ; 10,000 IU 2x/week
Post-Partum ; 1 dose of 200,000 IU within 4weeks after delivery
☼ Iron & Folate = 2nd trimester ; given for 6 months
Iron: 60 mg/cap OD ; 180 tabs whole pregnancy
Folate: 0.4 mg
☼ Iodine = once 200 mg during entire pregnancy

⌀ BEMOC Facility
- RHU, BHS, Lying-in clinics, Birthing home, Stand-alone facility
- DOH: At least 1 RM or RN in the facility
Physician on call
- WHO: 1 BEMOC Facility in every 125,000 population
- DOH states that the provider (RN or RM) can do the following:
6 Functions
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☼ Parenteral administration of oxytocin on the 3rd stage of labor

☼ Parenteral administration of anticonvulsant
☼ Parenteral administration of initial antibiotics
☼ Performance of assisted deliveries
☼ Removal of retained products or conception
☼ Manual removal of retained placenta

Can provide emergency newborn interventions:

☼ Newborn resuscitation
☼ Treatment of neonatal sepsis / infection
☼ O2 support

⌀ CLEAN & SAFE DELIVERY

- Home delivery = NO
- Facility based delivery = YES

⌀ POST-PARTAL
- Visit:
☼ First: 1st week preferably 3-5 days after delivery
Famorca - within 72 hours
Hospital - within 24 hours
☼ Second: 6th week post delivery
- Supplement:
☼ Iron & Folate = 60 mg/0.4 mg OD for 3 months ; 90 tabs
☼ Vit. A = 200,000 IU within 4 weeks after delivery

⌘ CHILDREN:
Micronutrient Supplementation
- Target population: 6 months - 5 years old
- Garantisadong Pambata = (1st) April, (2nd) October
- Vit. A = < 1 y.o : 100,000 IU, 6 months and 11 months “ONCE”
> 1 y.o : 200,000 IU, every 6 months
- Iron = Syrup, 30 mg/5mL ; 1 tbsp OD for 3 months
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30mg once a week for 6 months

- Iodine = 1 cap/year, 200mg

BREASTFEEDING:
TSEK
- Tama, Skapat, Eksklusibo
- Guidelines:
☼ Exclusive BF for 6 months
☼ 6 months onward: complementary food
☼ Extend BF up to 2 years and beyond
- Benefits:
Bonding (Maternal & Infant) - abdomen after delivery
Resistance - antibodies ; IgA = GAtas! Passive Natural
Economic - readily available
Allergy free
Safe
Timely
Family planing
Easy to digest
Error free formula
Diarrhea prevention
Inexhaustible supply
No vitamins needed
Guaranteed
- Proper positioning and latchment
TOUCH OUTWARD OPEN / SPACE

Upper lip No No Yes

Lower lip Yes Yes No

Chin Yes ☓ ☓

☼ Football Hold
Non - dominant Hand = hold dominant arm
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Dominant Hand = hold head and neck of baby

Arm of dominant hand = supports body of the baby
Stimulate using rooting reflex ; use nipple

‼ NEWBORN SCREENING
- RA 9288
- Earliest: 24 hours ; Latest: 2 weeks
- Most accurate: 48 - 72 hours
- Heel prick method = side of the heel
☼ Blood sample placed on a filter paper / Guthrie Card
☼ Founder: Robert Guthrie
- Who can perform:
☼ MD
☼ RN
☼ Medtech
☼ Midwife
- Disorders checked: Metabolic, congenital disorders
☼ CH / Congenital Hypothyroidism
☼ CAH / Congenital Adrenal Hyperplasia
☼ GAL / Galactosemia
☼ PKU / Phenylketonuria
☼ G6PDd / Glucose-6-Phosphate Dehydrogenase Deficiency

‼ CHN ALERT TIPS

1. Community is the setting
☼ Pick the choice that is for community
2. Community nurse and not a hospital nurse
☼ Think like a community nurse!
☼ Primary care, first aid
3. Anything that has teaching and education is always the BEST answer
4. Transformation, change, social transformation/change → people / community
5. People or community (BIDA) = always the center of CHN
6. Use your COMMON SENSE - Wag tanga
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7. If All of the above, none of the above, any of the same of the mentioned = In CHN
ONLY, 80% that is the correct answer
8. CHN practice is always attending to the WELL population
9. Always remember the letter P: Promotion, Prevention, Participation, People,
Partnership
10. Approach is MULTI-SECTORAL and COLLABORATIVE
11. Primary goal of CHN: SELF-RELIANCE
12. Nursing care is not individualistic = groups, family, community ; Hospital is
individualistic
13. Prioritization can be done using the NURSING PROCESS - APIE
P - goal, objectives
I - action, resources, mobilization
E - outcome, parameters
14. If they have the same meaning, usually wrong ; if opposite, it could be one of them
15. CHN = General answer ; Hospital = Specific
16. Laws = recent law have 5 or more numbers ; starts with 10 or 11
17. Always remember you are taking the PHILIPPINE licensure exam ; people and PHN
are always partners
18. The most “Hampas Lupa” answer is the best
19. Community → groups → family
20. NINI