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Definition and Focus of Community Health Nursing • Maintain coordination/linkages with other health team
members, NGO/government agencies in the provision of public
PUBLIC HEALTH health services.
“science and art of preventing disease prolonging life and • Initiates and conducts researches relevant to CHN services to
promoting health and efficiency through organized community improve provision of health care.
effort for the sanitation to ensure living adequate for the • Initiates and provides opportunities for professional growth and
maintenance of health” - Dr. C.E. Winslow continuing education for staff development.

PUBLIC HEALTH NURSING PUBLIC HEALTH NURSING IN THE PHILIPPINES

“Special field of nursing that combines the skills of nursing, public
health, and some phases of social assistance and functions as part Global and National Health Situations
of the total public health program.”
World Health Organization (WHO) defined health as a state of
COMMUNITY HEALTH NURSING complete physical, mental and social well-being and not merely
“Service rendered by a professional nurse to communities, groups, the absence of disease or infirmity. The health of all peoples is
families, and individuals at home, in health centers, in clinics, in fundamental to the attainment of peace and security and is
schools, and in places of work for the promotion of health, dependent on the fullest cooperation of individuals and States.
prevention of illness, care of the sick at home, and rehabilitation. “ Governments have a responsibility for the health of their people
-Ruth B. Freeman which can be fulfilled only by the provision of adequate health and
social measures.
“Nursing practice in a wide variety of community services and
consumer advocate areas, and in a variety of roles, at times GLOBAL HEALTH
including independent practice… Community nursing is certainly Global health is viewed in different ways, as the Institute of
not confined to public health nursing agencies.” – Jacobson, 1975 Medicine- USA (1997) defined it as health problems, issues and
concerns that transcends national boundaries, which may be
“The utilization of the nursing process in the different levels of influenced by circumstances or experiences in other countries,
clientele– individuals, population groups and communities, and which are best addressed by cooperative actions and
concerned with the promotion of health, prevention of disease solutions.
and disability and rehabilitation.” -Maglaya, et al GOAL!!
Current definition of global health by Koplan et al. stated it as an
“Raise the level of the citizenry by helping communities and area for study, research and practice that places a priority on
families to cope with the discontinuities in and threats to health in improving health and achieving health equity for all people
such a way as to maximize their potential for high-level wellness” worldwide. Moreover, Kickbush define global health as, “those
-Nisce, et al health issues that transcend national boundaries and
governments and call for actions on the global forces that
STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES determine the health of people.
• The standards differentiated public health nursing from
community health nursing only in one area: setting of work as Global health focus on people across the whole plane rather than
dictated by funding. concerns of nation. Global health initiatives consider both medical
• The government is the employer of Public Health Nurses both at and non-medical disciplines, such as epidemiology, sociology,
the national and local health agencies. Principles of CHN economic disparities, public policy, environmental factors, cultural
• The community is the patient in CHN, the family is the unit of studies, etc.
care and there are four levels of clientele: individual, family,
population group(those who share common characteristics, 10 threats to global health (World Health Organization, 2019)
developmental stages and common exposure to health problems 1. Air pollution and climate change
– e.g. children, elderly), and the community. 2. Non-communicable diseases
• In CHN, the client is considered as an ACTIVE partner NOT a 3. Global influenza pandemic
passive recipient of care. • CHN practice is affected by 4. Fragile and vulnerable settings
developments in health technology, in particular, changes in 5. Antimicrobial resistance
society, in general 6. Ebola and other high threat pathogens
• The goal of CHN is achieved through multi-sectoral efforts. 7. Weak primary health care
• CHN is a part of health care system and the larger human 8. Vaccine hesitancy
services system. Responsibilities of the Community Health Nurse 9. Dengue
• Participates in developing an overall health plan, its 10. HIV
implementation and evaluation for communities.
• Provide quality nursing services to the four levels of clientele.

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Health Status Statistics – PHILIPPINES

Field Health Service Information System (FHSIS 2018) Crude WHO works with agencies, foundations, government,
Death Rate – indicates the number of deaths occurring during the non-governmental organizations, and private sector groups to
year, per 1,000 population estimated at midyear. address the world’s health needs. Its’ headquarters is in Geneva,
Switzerland and it has 193members. It is governed through
Under Five Mortality Rate (UFMR) representatives within its World Health Assembly. A
The probability of a child born in a specific year or period dying thirty-four-member Executive Board, elected by the World
before reaching the age of five, expressed per 1,000 live births. HealthAssembly,supports the WHO. In addition, six regional
committees focus on health concerns within Southeast Asia, the
Infant Mortality Rate (IMR) Eastern Mediterranean, the Americas, Africa, the Western Pacific,
Number of deaths per 1,000 live births under one year of age. and Europe.

Perinatal Deaths MILLENIUM DEVELOPMENT GOALS

Refers to the number of stillbirths and deaths in the first week of In September 2000, leaders of 189 countries gathered at the
life (early neonatal mortality). united nations headquarters and signed the historic Millennium
Declaration, in which they committed to achieving a set of eight
Neonatal Deaths (NT Deaths) measurable goals that range from halving extreme poverty and
Deaths among live births during the first 28 completed days of life. hunger to promoting gender equality and reducing child mortality,
by the target date of 2015.
Maternal Mortality Rate
Death of a woman while pregnant or within 42 days of Sustainable Development Goals
termination of pregnancy, irrespective of the duration and site of The Sustainable Development Goals build on the millennium
the pregnancy, from any cause related to aggravated by the development Goals (MDGs), eight anti-poverty targets that the
pregnancy or its management but not from accidental or world committed to achieving by 2015. Enormous progress has
incidental cause. been madeontheMDGs, showing the value of a unifying agenda
underpinned by goals and targets. Formed from The 2030 Agenda
Crude Birth Rate for Sustainable Development, adopted by all United Nations
Is the number of live births occurring among the population of a Member States in 2015. The UN recognize that ending poverty
given geographical area during a given year, per 1,000 mid-year and other deprivations must go hand-in-hand with strategies that
total population of the given geographical area during the same improve health and education, reduce inequality, and spur
year economic growth – all while tackling climate change and working
to preserve our oceans and forest.
Morbidity -
It is the state of being symptomatic or unhealthy for a disease or DEPARTMENT OF HEALTH – PHILIPPINES
condition.
The Department of Health (DOH) is the country’s principal health
Morbidity Rate - agency. It is responsiblefor ensuring access to basic public health
The proportion of patients with a disease during a given year per services through the provision of quality healthcareandthe
population. regulation of providers of health goods and services.

Mortality Rate The primary function of the Department is the promotion,

Is related to the number of deaths caused by the health event protection, preservation or restoration of the health of the people
under investigation in defined population during a specified throughtheprovision and delivery of health services and through
interval. the regulationandencouragement of providers of health goods
and services.
WORLD HEALTH ORGANIZATION
Better health for everyone, everywhere VISION
The DOH is the leader, staunch advocate and model in promoting
World Health Organization(WHO) is the directing and healthforall in the Philippines.
coordinating authority on international health within the united
nations system. Its mission “is the attainment by all peoples of the MISSION
highest possible level of health” Thus, it is widely known in many Guarantee, equitable, sustainable, and quality health for all
activities, such as medical research, immunization campaigns Filipinos, especially the poor and shall lead the quest for
against fatal disease, improves housing, nutrition, sanitation, and excellence in health.
working conditions in developing countries. Moreover, italso
performs charting statistical health trends and issues warnings
about possible health problems.

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Local Health System and Devolution of Health Services

Secondary and NICU Tertiary lab
• Devolution made local government executives responsible
clinical laboratory withhistopatholog
tooperatelocal health care services. y
• RA 7160 Local Government Code aims to transformlocal
government units into selfreliant communities Blood station Tertiary clinical Blood bank
• 1993 health services were devolved or transferred laboratory
fromDepartmentof Health to the local government units.
1 st Level X-ray Blood station 3 rd level X-ray
Objectives for Local Health Systems
1. Establish local health system for effective and efficient delivery Pharmacy 2 nd level X-ray Specialty hospitals
with mobile unit
of healthcare services.
2. Upgrade the health care management and service capabilities
Trauma
of local health care facilities.
capabilityhospitals
3. Promote inter-LGU linkages
4. Foster participation of the private sector, NGOs and Trauma-capableFa
communities inlocal health system development. cilityTrauma
5. Ensure the quality of health service delivery at the local level. -receivingfacility

CLASSIFICATION OF HOSPITALS
CLASSIFICATION OF OTHER HEALTH FACILITIES

• According to ownership
A. Primary Care Facility- first contact care facility that offers
✓ Government- created by law
basicservices including emergency service and provision for
✓ Private- owned and operated with funds throughdonation,
normal deliveries
principal investment or other means by any individual,
1. With in-patient beds- Infirmary, birthing home
corporation or organization.
2. Without beds- medical out-patient clinic, OFWclinic, dental
clinic
• According to scope of services
✓ General- services for all kinds of illnesses, diseases, injuries or
B. Custodial care facility-provides long term care to patients with
deformities
chronic/mental illness, in need of rehabilitation or requiring
✓ Specialty- specializes in particular condition or disease
ongoing health and nursing care
1. Custodial psychiatric care facility
• According to functional capacity
2. Substance abuse treatment and rehabilitation center
✓ General
3. Sanitarium/leprosarium
4. Nursing home

LEVEl 1 LEVEL 2 LEVEL 3 C. Diagnostic/ Therapeutic Care Facility- examines

humanbodyorspecimens from the human body for diagnosis or
Consulting Level 1 plus: Level 2 plus: treatment ofdiseases
specialists in 1.Laboratory facility- clinical lab, HIV testing center,
medicine, Bloodservicefacility, drug testing lab, Newborn screening lab
Pediatrics,
2.Radiologic facility
OB-Gyne, Surgery
3.Nuclear medicine facility
Emergency and Departmentalized Teaching/training
Out- patient clinical services withaccredited D. Specialized Out-Patient Facility- with highly competent
services residencytraining andtrainedstaff that performs highly specialized procedures on
programinthe4maj anout-patientbasis
or clinical services 1. Dialysis clinic
2. Ambulatory surgical clinic
Isolation facilities Respiratory Unit Physical 3. In-vitro fertilization center
medicineandrehab
4. Stem cell facility
ilitation unit
5. Oncology chemotherapeutic center
Surgical/Maternity General ICU Ambulatory 6. Radiation oncology facility
facilities surgical clinic 7. Physical medicine and rehabilitation center

Dental clinic High risk Dialysis clinic

pregnancy unit

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PRIMARY HEALTH CARE LEVELS OF HEALTH CARE REFERRAL SYSTEM

WHO defines PHC as an essential health care made 1. Primary Level of Care
universallyaccessible to individuals and families in the community • The first contact between the community members
bymeansacceptable to them to their full participation and at the andtheotherlevels of health facility
cost that thecommunity and country can afford at every stage of
development 2. Secondary Level of Care.
• Given in health facilities either privately owned or
Historical Background governmentoperated.
PHC was declared during the First International Conference
onPrimaryHealth Care held in Alma Ata, USSR on September 6-12, 3. Tertiary Level of Care
1978 by WHO. The goal was “Health for All by the year 2000” this • Tertiary care is rendered by specialist in health facilities.
was adoptedinthePhilippines through Letter of Instruction 949 Complicatedcases and intensive care
signed by President MarcosonOctober 19,1979 and has an
underlying theme of “Health in theHandsofthe People by 2020
LEVELS OF PREVENTION
Elements/Components of Primary Health Care
1. Environmental sanitation • Primary prevention- aims to prevent disease or injury beforeit
2. Control of Communicable Diseases everoccurs.
3. Immunization ✓ Health education about healthy and safe measures ✓
4. Health Education Immunization
5. Maternal and Child Health and Family Planning ✓ Laws to mandate and enforce healthy and safe practices
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency Treatment • Secondary prevention- aims to reduce the impact of a
8. Treatment of Locally Endemic Diseases diseaseorinjury that has already occurred.
9. Provision of Essential Drugs ✓ Regular exams and screening tests
✓ Diet and exercise to prevent further attacks
STRATEGIES
1. Reorientation and reorganization of the national • Tertiary prevention- aims to soften the impact of an
healthcaresystems with the establishment of functional support ongoingillnessor injury that has lasting effects.
mechanism. ✓ Cardiac or stroke rehabilitation programs
2. Effective preparation and enabling process for health in all ✓ Vocational rehabilitation programs
levels. ✓ Support groups that allow members to share strategiesforliving
3. Mobilization of the people to know their well
communitiesandidentifying their basic health needs with the end
inviewofproviding appropriate solutions. 4. Develop and utilization UNIVERSAL HEALTH CARE
of appropriate technology focusingonlocal indigenous resources (UHC), also referred to as Kalusugan Pangkalahatan (KP),
available in and acceptable in the community. isthe“provision to every Filipino of the highest possible quality of
5. Organization of communities arising from their expressedneeds healthcarethat is accessible, efficient, equitably distributed,
6. Increase opportunities for community participation inlocal level adequatelyfunded, fairly financed, and appropriately used by an
planning, management, monitoring and evaluation informed and empoweredpublic.
7. Development of intra-sectoral linkages with other government
andprivate agencies FAMILY
8. Emphasizing partnership so that the health workers
andthecommunity leaders/members view each other as partners FAMILY AS BASIC UNIT OF SOCIETY
✓ Genetic transmission unit
PHC TEAM ✓ Matrix of personality of development and the most intimate
• Physician emotional unit of society
•Nurse auxiliaries ✓ Enduring social form in which a person is incorporated
• Nurse ✓ Lifelong involvement
•Locally trained community health workers ✓ Shared attributes
• Midwives ✓ Genetics – physical and psychological
✓ Developmental – shared home, lifestyle, social activities
✓ Sense of belonging
✓ Security/defense against a potentially hostile environment
✓ Companionship
✓ Societal expectations

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✓ Sense of responsibility towards members & others ✓ Basis of

affection/care Classification According to Function
✓ Built-in problems • Family of Procreation- refers to the family you yourself created.
✓ Generation gap • Family of Orientation-refers to the family where you came
✓ Dependence of members
✓ Emotional attachment/involvement Family as a Unit of Care
✓ The family endures despite problems • The family is considered the natural and fundamental unit of
✓ Resource utilization society.
✓ Authority • The family as a group generates, prevents, tolerates and corrects
✓ Individual sense of responsibility health problems within its membership.
• The health problems of the family members are interlocking.
Classification according to structure • The family is the most frequent focus of health decisions and
actioninpersonal care.
Nuclear family • The family is an effective and available channel for much of the
• A father and mother with/without children living together but effort of the health worker.
apart from both sets of parents and relatives
• Separate dwelling not shared with members of the family of TYPES OF FAMILY Family as a Client
origin/orientation of either spouse • The family is the foreground and individuals are in the
• Economically independent background
• The focus is concentrated on each and every individual as they
Extended family affect the whole family
• Two or more nuclear families economically and socially • The focus is concentrated on how the family as a whole is
relatedtoeachother reactingtoan event when a family member experiences a health
• Unilaterally/ bilaterally extended issue
• Includes 3 generations
• Lives together as a group Characteristics of Family as a Client
1. The family is a product of time and place
Single Parent Family ▪ A family is different from other family who lives in another
• Children < 17 years of age, living in a family unit with a single locationinmany ways.
parent, another relative or non-relative ▪ A family who lived in the past is different from another family
• May result from: • wholivesat present in many ways.
Loss of spouse by death, divorce, separation
• Out of wedlock birth of a child • From adoption 2. The family develops its own lifestyle
• Migration (OFWs) Blended/ Reconstituted family ▪ Develop its own patterns of behavior and its own style in life.
• Includes step-parents and step-children ▪ Develops their own power system which either be:
• Caused by divorce, annulment with remarriage and ▪ Balance-the parents and children have their own areas of
separationCompound family decisions andcontrol.
• One woman/ man with several spouses ▪ Strongly Bias-one member gains dominance over the others.

Communal family 3. The family operates as a group

• Grouping of individuals which are formed for specific ideological ▪ A family is a unit in which the action of any member may set of a
or societal purposes wholeseries of reaction within a group, and entity whose inner
• Considered as an alternative lifestyle for people who feel strengthmaybe its greatest single supportive factor when one of
alienatedfrom the economically privileged society • Vary within its members is stricken with illness or death.
social context
4. The family accommodates the needs of the individual members.
Cohabitation/ Live-in ▪ An individual is unique human being who needs to assert his or
• Unmarried couple living together herself in a way that allows him to grow and develop.
No-kin ▪ Sometimes, individual needs and group needs seemto find a
• A group of at least two people sharing a relationship and natural balance;
exchangesupport who have no legal or blood tie to each other 1. The need for self-expression does not overshadow
Foster considerationfor others.
• Substitute family for children whose parents are unable to care 2. Power is equitably distributed.
for them 3. Independence is permitted to flourish

Gay/ lesbian Family as a System

• Homosexual couple living together with/without children • The focus is on the family as a client

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• Viewed as an international system in which the whole is greater 2. Childbearing Family

thanthe sum of its parts From the birth of the first child until that child is 2 1/2 years old.
• Focuses on the individual and family members become the Developmental Tasks:
target for nursing interventions • Adjusting to increased family size
• Caring for an infant
FUNCTIONS & DEVELOPMENTAL STAGES • Providing a positive developmental environment

Functions of a Family 3. Family with Preschoolers

When the oldest child is between the ages of 2 1/2 and 6.
Biologic Reproduction
Developmental Tasks:
Child-rearing/Caring Nutrition
▪ Satisfying the needs and interests of preschool children
Health maintenance
▪ Coping with demands on energy and attention with less privacy
Recreation
at home.
• Economic
4. Family with School Age Children
Provision of adequate financial resources
When the oldest child is between the ages of 6 and 13.
Resource allocation
Developmental Tasks:
Ensure financial security
▪ Promoting educational achievement
▪ Fitting in with the community of families with school-age
• Educational
children.
Teach skills, attitudes and skills relating to other functions

5. Family with Teenagers

• Psychological/ Affection
When the oldest child is between the ages of 13 and 20.
Promotes the natural development of personalities Offer
Developmental Tasks:
optimum psychological protection
▪ Allowing and helping children to become more independent
Promotes ability to form relationships with people within the
▪ Coping with their independence
familycircle
▪ Developing new interests beyond child care.
• Socio-cultural
6. Launching
Socialization of children
From the time the oldest child leaves the family for independent
Promotion of status and legitimacy
adult life till the time the last child leaves. Developmental Tasks:
▪ Releasing young adults and accepting new ways of relating to
Developmental Stages/ Family Life Cycle
them
Assess a patient and family developmental concerns Identifies
▪ Maintaining a supportive home base
stages of family development that reflect the biological functions
▪ Adapting to new living circumstances.
of raising children
As the family system moves together through time, the individual
7. Empty nest
life cycles
From the time the children are gone till the marital couple retires
Intertwines with the life cycles of other family members
from employment.
Families go through different stages for which specific
Developmental Tasks
developmental tasks must be accomplished
▪ Renewing and redefining the marriage relationship
Families who are not able to accomplish these tasks may
▪ Maintaining ties with children and their families
developdifficulties with subsequent family development.
▪ Preparing for retirement years.
1. Beginning Family
8. Aging family
Beginning Family: The couple establishes their home but do not
From retirement till the death of the surviving marriage partner.
yet have children.
Developmental Tasks:
Involves merging of values brought into the relationship
▪ Adjusting to retirement
fromthefamilies of orientation.
▪ Coping with the death of the marriage partner and life alone
Includes adjustments to each other’s routines (sleeping, eating,
chores, etc.), sexual and economic aspects.
FAMILY HEALTH TASK
❖ Members work to achieve 3 separate identifiable tasks:
• Health task differ in degrees from family to family
1. Establish a mutually satisfying relationship
• TASK- is a function, but with work or labor overtures assigned or
2. Learn to relate well to their families of orientation
demanded of the person
3. If applicable, engage in reproductive life planning

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Family Health Tasks (Duvall & Niller) A community health nurse works with and through the family to
1. Physical maintenance- provides food, shelter, clothing, and improveitsbehavior related to health. ASSESSMENT AND
healthcare to its members being certain that a family has ample DIAGNOSES IN FAMILY NURSING PRACTICE
resources toprovide There are two major types in dealing with the assessment of the
2. Socialization of Family- involves preparation of children to live familyaccording to nursing practice:
inthecommunity and interact with people outside the family.
3. Allocation of Resources- determines which family needs will 1. FIRST LEVEL ASSESSMENT - the process of determining existing
bemet and their order of priority. and potential health conditions or problems of the family. These
4. Maintenance of Order- task includes opening an effective health conditions are categorized as:
means of communication between family members, integrating
family values andenforcing common regulations for all family A. WELLNESS CONDITION - stated as Potential or Readiness - A
members. clinical or nursing judgment about a client in transition froma
5. Division of Labor – who will fulfill certain roles e.g., family specificlevel of wellness or capability to a higher level.
provider, home manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family member
A. Potential or Capability for: B. Readiness for Enhanced
7. Placement of members into larger society –consists of selecting
Capabilityfor:
community activities such as church, school, politics that
correlatewiththe family beliefs and values • Healthy Lifestyle – e.g. • Healthy Lifestyle
8. Maintenance of motivation and morale- created when nutrition, diet, exercise, • Health Maintenance/
members serveas support people to each other activity HealthManagement
• Health Maintenance/ • Parenting
Family Health Tasks (Maglaya) Health Management • Breastfeeding
• Parenting • Spiritual Well-being Others
• Breastfeeding
1. Recognizing interruptions of health development
• Spiritual Well-being Others
2. Making decisions about seeking health care/ to take action
3. Dealing effectively health and non-health situations 4. Providing
care to all members of the family B. HEALTH THREATS - Conditions that are conducive to disease
5. Maintaining a home environment conducive to health and accident, or may result tofailureto maintain wellness or realize
maintenance health potential

CHARACTERISTICS OF HEALTHY FAMILY A. Presence of risk factors of specific diseases

o Able to provide for physical, emotional and spiritual needs of B. Threat of cross infection from a communicable disease case
familymembers C. Family size beyond what family resources can adequately
o Able to be sensitive to the needs of the family members provide
o Able to communicate thoughts and feelings effectively D. Accident/ fire hazards
o Able to provide support, security and encouragement E. Faulty/ unhealthful nutritional/ eating habits or feeding
o Able to initiate and maintain growth producing relationship techniques or practices
o Maintain and create constructive and responsible community F. Stress provoking factors
relationships G. Poor home environmental condition/ sanitation
o Able to grow with and through children H. Unsanitary food handling and preparation
o Ability to perform family roles flexibly I. Unhealthful lifestyle and personal habits/practices
o Able to help oneself and to accept help when appropriate J. Inherent personal characteristics
o Demonstrate mutual respect for the individuality of family K. Health history which may participate/ induce the occurrence of
members a healthdeficit
o Ability to use a crisis experience as a means of growth L. Inappropriate role assumption
o Demonstrate concern of family unity, loyalty and inter family M. Lack of immunization/ inadequate immunization status
cooperation specially of children
N. Family disunity
FAMILY NURSING PROCESS: O. Others
Includes data collection, data analysis or interpretation and
problemdefinitionor nursing diagnosis C. HEALTH DEFICITS - Instances of failure in health maintenance
The rationale for adopting this health tasks as the framework of (disease - regardless of whetheritis diagnosed or undiagnosed by
the typologyisthe fact that in community health nursing practice, medical practitioner, disability, developmental lag)
one deals mostly withproblems within the domain of human
behavior or human response tohealthand illness. D. STRESS POINTS / FORESEABLE CRISIS - Anticipated periods of
unusual demand on the individual or family
intermsofadjustment/family resources. - Examples of this include:
A. Marriage

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B. Pregnancy, labor, puerperium

conducive tohealthandillness;
C. Parenthood
nutritional and
D. Additional member-e.g. newborn, lodger developmental status;
E. Abortion physical assessment findings
F. Entrance at school and significant results of
G. Adolescence laboratory/ diagnostic tests/
H. Divorce or separation screening procedures
I. Menopause
Value placed on health Include use of promotive -
J. Loss of job
promotions, health preventive services as
K. Hospitalization of a family member
maintenance and prevention evidenced by immunization
L. Death of a member of disease status and use of
M. Resettlement in a new community otherhealthy lifestyle related
N. Illegitimacy services; adequacy of
O. Others, specify.__________ rest/sleep

Statement of the Problem: Data gathering methods includes:

P = Problem, E = Etiology (Cause), S = Signs/Symptoms Observation, physical examination, interview, review of records
andlaboratoryand diagnostic procedures.
Example: Diarrhea (undiagnosed) as health deficit related to
eating of contaminated&unclean food as evidenced by: 2. SECOND LEVEL ASSESSMENT - identifies the nature or type of
• Loose watery stool nursing problems the family experiences intheperformance of
• 4X bowel movement/day their health tasks with respect to a certain health
• Poor skin turgor body weakness,and as conditionorhealth problem.
verbalized,”symptomkahaponpa sang aga ako naga lupot”. “kag
nagakutoy akon tiyan”. FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS
I. Inability to recognize the presence of the condition or
Data collection for first level assessment includes gathering the problemdueto:
fivetypesofdata, namely: a. Lack of or inadequate knowledge
b. Denial about its existence or severity as a result of fear of
consequencesof diagnosis of problem, specifically:
Family structure and Include family composition i. Social-stigma, loss of respect of peer/significant others
characteristics and demographic data, ii. Economic/cost implications
typeof family form and iii. Physical consequences
structure, iv. Emotional/psychological issues/concerns
decision-makingpatternsand c. Attitude/ Philosophy in life, which hinders recognition /
communication patterns
acceptanceof aproblem
affecting family relatedness
d. Others. Specify _________
Socio-economic and cultural Include occupation, place of
factors work, and incomeof II. Inability to make decisions with respect to taking appropriate
eachworking member, healthactiondue to:
educational attainment, a. Failure to comprehend the nature/magnitude of the
ethnicbackground, religious problem/condition
affiliation, family b. Low salience of the problem/condition
traditionsandthe relationship
c. Feeling of confusion, helplessness and/or resignation brought
of the family to a larger
community about byperceive magnitude/severity of the situation or problem,
i.e. failure to breakdownproblems into manageable units of attack.
Home and Environmental Include information on d. Lack of/inadequate knowledge/insight as to alternative courses
factors housing and of actionopen to them
sanitationfacilities;kind of e. Inability to decide which action to take from among a list of
neighborhood and availability alternatives
of social, health, f. Conflicting opinions among family members/significant others
communication, and
regardingaction to take.
transportation facilities
inthecommunity. g. Lack of/inadequate knowledge of community resources for care
h. Fear of consequences of action, specifically:
Health assessment of each Includes current and past i. Social consequences
member significant healthconditionsor ii. Economic consequences
illness; beliefs and practices iii. Physical consequences

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iv. Emotional/psychological consequences e. Lack of skill in carrying out measures to improve home
i. Negative attitude towards the health condition or problem-by environment
negativeattitude is meant one that interferes with rational f. Ineffective communication pattern within the family g. Lack of
decision-making. supportive relationship among family members
j. In accessibility of appropriate resources for care, specifically: h. Negative attitudes/philosophy in life which is not conducive to
i. Physical Inaccessibility healthmaintenance and personal development
ii. Costs constraints or economic/financial inaccessibility i. Lack of/inadequate competencies in relating to each other for
k. Lack of trust/confidence in the health personnel/agency mutual growthand maturation (e.g. reduced ability to meet the
l. Misconceptions or erroneous information about proposed physical and psychological needs of other members as a result of
course(s) of actionm. family’s preoccupation with current problem or condition.
Others specify._________ j. Others specify._________

III. Inability to provide adequate nursing care to the sick, V. Failure to utilize community resources for health care due to:
disabled, dependentorvulnerable/at risk member of the family a. Lack of/inadequate knowledge of community resources for
due to: healthcare
a. Lack of/inadequate knowledge about the disease/health b. Failure to perceive the benefits of health care/services
condition(nature, severity, complications, prognosis and c. Lack of trust/confidence in the agency/personnel
management) d. Previous unpleasant experience with health worker e. Fear of
b. Lack of/inadequate knowledge about child development and consequences of action (preventive, diagnostic, therapeutic,
care rehabilitative) specifically :
c. Lack of/inadequate knowledge of the nature or extent of i. Physical/psychological consequences
nursing careneeded ii. Financial consequences
d. Lack of the necessary facilities, equipment and supplies of care iii. Social consequences
e. Lack of/inadequate knowledge or skill in carrying out the f. Unavailability of required care/services
necessary intervention or treatment/procedure of care (i.e. g. Inaccessibility of required services due to:
complex therapeutic regimenor healthy lifestyle program). i. Cost constrains
f. Inadequate family resources of care specifically: ii. Physical inaccessibility
i. Absence of responsible member h. Lack of or inadequate family resources, specifically i. Manpower
ii. Financial constraints resources, e.g. baby sitter
iii. Limitation of luck/lack of physical resources ii. Financial resources, cost of medicines prescribe
g. Significant persons unexpressed feelings (e.g. hostility/anger, i. Feeling of alienation to/lack of support from the community,
guilt, fear/anxiety, despair, rejection) which his/her capacities to e.g. stigmadueto mental illness, AIDS, etc.
provide care. j. Negative attitude/ philosophy in life which hinders
h. Philosophy in life which negates/hinder caring for the sick, effective/maximumutilization of community resources for health
disabled, dependent, vulnerable/at risk member care
i. Member’s preoccupation with on concerns/interests j. k. Others, specify __________
Prolonged disease or disabilities, which exhaust supportive
capacity of familymembers. Second Level of Assessment:
k. Altered role performance, specify. Example:
i. Role denials or ambivalence
ii. Role strain Inability to provide adequate nursing care due to:
iii. Role dissatisfaction a. Lack of knowledge and skill in treatment of diarrhea as
iv. Role conflict verbalizedby the mother: “Wala ko kabalo kon paano bulngon ang
v. Role confusion lupot”.
vi. Role overload
vii. Others. Specify._________ Family health task

IV. Inability to provide a home environment conducive to health In order to achieve wellness among its members and reduce or
maintenanceand personal development due to: eliminatehealth problems, the standard or norm of the family as a
a. Inadequate family resources specifically: functioning unit involves the ability to perform the following
i. Financial constraints/limited financial resources health tasks:
ii. Limited physical resources-e.i. lack of space to construct facility A. Recognize the presence of a wellness state or health condition
b. Failure to see benefits (specifically long term ones) of or problem
investments inhomeenvironment improvement B. Make decisions about taking appropriate health action to
c. Lack of/inadequate knowledge of importance of hygiene and maintainwellnessor manage the health problem
sanitation C. Provide nursing care to the sick, disabled, dependent or at-risk
d. Lack of/inadequate knowledge of preventive measures members

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D. Maintain a home environment conducive to health FOUR CRITERIA IN PRIORITIZNG HEALTH CONDITIONS (Maglaya
maintenance andpersonal development et. al., 2017)
E. Utilize community resources for health care
1. NATURE OF THE PROBLEM - Is the problem a: a. Wellness
Note: condition b. Health deficit c. Health threat d. Foreseeable crisis
• Utilizing the data gathered from the Initial Data Base (IDB), the
nursegoesthough the data analysis. The end-result of the analysis 2. MODIFIABILITY OF THE CONDITION - Probability of success in
during the first-level assessment is a conclusion or a statement of enhancing wellness state, improving the condition, minimizing,
a health condition or problem, classified as a wellness potential, alleviating or totally eradicating the problemthrough intervention.
health threat and health deficit or stress point/ foreseeable crisis. - Factors to consider in determining modifiability of the problem:
• The second - level of assessment ends with a definition of family o Current knowledge, technology and interventions to enhance
nursingproblems, in terms of how the family handles it. wellness stateor manage the problem o Resources of the
family-physical, financial and manpower o Resources of the
PLANNING, IMPLEMENTING AND EVALUATING IN FAMILY nurse-knowledge, skill and time o Resources of the
NURSINGPRACTICE community-facilities and community organizationor support

FAMILY NURSING CARE PLAN 3. PREVENTIVE POTENTIAL - Nature and magnitude of future
Is a blueprint of nursing care designed to systematically enhance problems that can be minimized or totallyprevented if
the family’scapability to maintain wellness, manage health interventions are done on the problem. - Factors to consider in
problems through explicitlyformulated goals and objectives of determining preventive potential: o Gravity or severity of the
care and deliberately chosen set of interventions, resources, & problem – refers to the progress of diseaseindicating extent of
evaluation criteria, standards, methods/tools. damage on the client. The more severe of advancedtheproblem,
the lower is the preventive potential. o Duration of the problem –
STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN refers to the length of time the problemhas beenexisting. Has a
1. Prioritize Health Conditions or Problems direct relationship to gravity & preventive potential. O Current
2. Goal and Objectives of Nursing Care Management – refers to the presence and appropriateness of
3. Intervention Plan intervention measures instituted to enhance the wellness state or
4. Evaluation Plan remedythe problem. The institution of appropriate intervention
increase thepreventive potential. o Exposure of any vulnerable or
HEALTH PROBLEM high-risk group – Increases the preventivepotential in determining
Process whereby existing and potential health conditions or the score for salience. The family’s concerns, felt needs, or
problemof thefamilies are determined. They reflect depth of data readiness increases the salience.
gathering and analysisonwhat health conditions or problems
exists. This is derived from the First Level Assessment of the 4. SALIENCE - Family’s perception & evaluation of the problem in
Typology of NursingProblems. terms of seriousness &urgency of attention needed or family
readiness
Which categorizes the presence of:
Wellness state Scale for Ranking Health and Conditions and Problems According
Health deficits toPriorities
Health threats
Foreseeable crisis or stress points
CRITERIA SCORE WEIGHT

FAMILY NURSING DIAGNOSIS

Nature of the Condition
Defines the nature or type of nursing problems that the family
encountersinperforming the health tasks with respect to a given Wellness State 3 1
health conditionor problem,and the etiology or barriers to the Health Deficit 3
family’s assumption of these tasks. Health Threat Foreseeable 2
This is derived from the Second Level Assessment of the Typology Crisis 1
of NursingProblems.
This include those that specify or describe the family’s realities, Modifiability of the Condition
perceptionsabout and attitudes related to the assumption or
Easily modifiable Partially 2 2
performance of familyhealthtasks on each health condition or
modifiable Not modifiable 1
problem identified during the first-level assessment.
0
The nurse should learn to prioritize the numerous family nursing
problemconsidering the available resources of the nurse, the Preventive Potential
family and the community.
High 3 1

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Components of an objective (ABCD):

Moderate 2
1. Actor / Subject – client, any part of the client or some
Low 1
attributes of theclient
Salience .2. Behavior / Verb – action of the client to perform.
3. Conditions / Modifiers - explain the circumstances under which
A condition needing 2 1 thebehavioris to be performed, (what, where, when, how)
immediate attention 4. Determinant / Criterion of Desired Performance - Level at
A condition needing 1 whichtheclientwill perform the specified behavior.
immediate attention
Not perceived as a condition 0
Example: Diarrhea (undiagnosed) as health deficit related to
needing change
eating of contaminated&unclean food.

SCORING AND PRIORITIZING Goal

1. Decide on a score for each of the criteria. After 1 day of effective health care strategies, Rosario’s diarrhea
2. Divide the score by the highest possible score and multiply by will belessened from 4x bowel movement to twice/day.
the weight
Score Objective
------------------------ X Weight Within 2 hours of health education and nursing care, the family
Highest Score will: a. Provide adequate nursing care

3. Sum up the scores for all the criteria. The highest score is 5, HEALTH CARE STRATEGIES
equivalent to the total weight. This involves selection of appropriate nursing interventions/
4. Rank the overall score of each nursing problem. health carestrategies based on the formulated goal and objective.
5. The nursing problem with the highest score will be the priority
whiletheproblem with the lowest score will be the least priority. Focus on Interventions to Help the Family Performs Health Tasks
Example Diarrhea (undiagnosed) as health deficit related to eating - Help the family recognize the problem
of contaminated&unclean food. - Guide the family on how to decide on appropriate health actions
totake.
GOAL OF CARE - Develop the family’s ability and commitment to provide nursing
• a broad desired outcome toward which behavior is directed. caretoeachmember.
• The Cardinal Principle: - Enhance the capability of the family to provide home
Goals must be jointly set with the family. environment conduciveto health maintenance and personal
This ensures the family commitment to their realization. development.
• Goals set by the nurse & family should be realistic or attainable. - Facilitate the family’s capability to utilize community resources
• Too high goals & their consequent failure frustrate both the for healthcare.Guidelines for Implementing Nursing Activities
family &thenurse. - Nursing actions should be based on scientific knowledge, nursing
researchandprofessional standards of care.
OBJECTIVES OF CARE - Nurse should understand clearly the orders to be implemented
• This refers to a more specific / more precise statements of the andquestionany that are not understood. - Nursing actions should
desiredresultsor outcome of care. be adapted to the individual client.
• The more specific the objective, the easier is the evaluation of - Nursing actions should always be safe.
their attainment - Nursing actions often require teaching, support and comfort.
- Nursing actions should be holistic.
Types of objective: - Nursing actions should respect the dignity of the client and
1. Short term/ Immediate objective enhancetheclient’s self esteem
• Formulated for problem which require immediate attention and - Clients should be encouraged to participate actively in
results observed is short time period with few nurse family implementing thenursing actions.
contacts, use of less resources.
Implementation requires the following skills from the nurse:
2. Long term/ Ultimate objective - Cognitive Skills
• Require several nurse-family encounters & investment of more – problem solving, decision making, critical thinking andcreative
resources. Outcomes sought require time to demonstrate. thinking.
- Interpersonal or communication skills
3. Medium term/ Intermediate objective - Technical skills – hands on skills such as manipulating equipment,
• Those which are not immediately achieved. givingmedications and others.

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Example: Diarrhea (undiagnosed) as health deficit related to Rehabilitative

eating of contaminated&unclean food. ▪ Emphasizes the importance of assisting clients to function
adequately in the physical, mental, social, economic and
vocational areas of their lives
Health Care Strategies:
▪ Assist to return to former function
a. Teach and demonstrate to the mother how to mix and give ORS ▪ Assist clients in adjusting how to perform activities in order to
as follows: 1 L of clean & potable water mix with 8 level tsps. achieve maximum abilities
Sugar and 1 level tsp. salt
a. Give frequent small sips of ORS over 4hr period. Tools of Public Health Nursing
b. Give extra fluid, food-based fluids such as soup, rice water or
bukojuice The PHN Bag
c. Continue breast feeding frequently and longer at each feeding. Bag technique
Tool by which the nurse, during her
visit, will enable her
EVALUATION to perform nursing procedure with
Specifies how the nurse will determine changes in health status, ease and deftness, to
conditionandachievement of outcomes of care specified in the save time and effort, with the end
objectives of family nursingcare plan. view of rendering effective nursing care to clients.
Public health bag
Ongoing Evaluation – done while or immediately after
❖ Is an essential and indispensable equipment of the public
implementing anorder; enables nurse to make on-the-spot
health nurse which he/she has to carry along when he/she goes
modifications in an intervention. out home visiting. It contains basic
medications and articles which are necessary for giving care
Intermittent Evaluation- performed at specific time intervals to
showtheextent of progress towards the goal and enables nurse to ❖ Rationale- to render effective nursing care to
correct any deficiencies and modifycareplan; also called PROCESS clients and /or members of the family during home visit
Evaluation.
Principles

Terminal Evaluation – indicates client’s condition at the time of 1. The use of the bag technique should minimize if not totally
discharge; includes status of goal achievement and an evaluation prevent the spread of infection from individuals to families, hence,
of the client’s self-care abilities withregardtofollow-up care to the community.
2. Bag technique should save time and effort on the part of the
Example: Diarrhea (undiagnosed) as health deficit related to nurse in the performance of nursing procedures.
3. Bag technique should not overshadow concern for the patient
eating of contaminated&unclean food.
rather should show
the effectiveness of total care given to an individual or family.
Evaluation: After 1 day of Health teaching and Nursing Care, the 4. Bag technique can be performed in a variety of ways depending
goal is partially met asevidenced by soft formed stool 2x per day upon agency policies, actual home situation, etc., as long as
and the parents nowprovides proper care to Rosario. principles of avoiding transfer of infection is carried out

IMPLEMENTING FAMILY CARE PLAN Special Considerations

1. The bag should contain all necessary articles, supplies and
equipment which may be used
Promotion of health
to answer emergency needs.
▪ Behavior motivated by the desire to increase well-being and
2. The bag and its contents should be cleaned as often as possible,
actualize human health potential
supplies replaced
▪ Not disease oriented
and ready for use at any time.
▪ Motivated by personal “approach” to wellness
3. The bag and its contents should be well protected from contact
▪ Seeks to expand positive potential for health
with any article in the home of the patients. Consider the bag and
its contents clean and /or sterile while any article belonging to the
Prevention of disease/injury
patient as dirty and contaminated.
▪ Also known as health protection
4. The arrangement of the contents of the bag should be the one
▪ Behavior motivated by a desire to actively avoid illness, detect it
most convenient to the user to facilitate the efficiency and avoid
early or maintain
confusion.
functioning within the constraints of illness
5. Hand washing is done as frequently as the situation calls for,
▪ Illness/injury specific
helps in minimizing
▪ Motivated by avoidance of illness
or avoiding contamination of the bag and its contents.
▪ Seeks to thwart the occurrence of insults to health and
6. The bag when used for a communicable case should be
well-being
thoroughly cleaned and
disinfected before keeping and reusing
Curative
▪ To provide treatment
Contents of the bag
▪ Basic first aid and initial treatment in the community
• Paper lining

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• Extra paper for making waste bag

• Plastic/linen lining
• Apron
• Hand towel Group conference
• Soap in a soap dish
• Thermometers (oral and rectal) ▪ Certain group of targets are gathered
• 2 pairs of scissors (surgical and bandage) together in one common place for
• 2 pairs of forceps (curved and straight) discussions and health service provision
• Disposable syringes with needles (g. 23 & ▪ Less effort and time needed for the
25) nurse than conducting house visits
• Hypodermic needles (g. 19, 22, 23, 25) ▪ Usually used for advocacies and health
• Sterile dressing education sessions
• Cotton balls
• Cord clamp
• Micropore plaster
• Tape measure
• 1 pair of sterile gloves
• Baby’s scale Telephone conference
• Alcohol lamp
• 2 test tubes ▪ May be effective, efficient and appropriate if the objectives
• Test tube holders require immediate access to
• Solutions of: data, given problems on distance or travel time
Betadine ▪ Data includes monitoring health status during acute phase of
70% alcohol illness, change in schedule
Zephiran solution of visit or family decision, and updates on outcomes or responses
Hydrogen peroxide to care or treatment
Spirit of ammonia
Ophthalmic ointment Written communication
Acetic acid
Benedict’s solution ▪ Less time-consuming option for the nurse in instances when
there are many families
Types of Family-Nurse Contact needing follow-up on top problems of distance and travel time
▪ Effective if the family is independent and motivated enough
✓ Clinical visit
✓ Home visit Interprofessional Care in the Community
✓ Group conference
✓ Telephone calls 1. Rural Health Unit Personnel
✓ Written communications • The health care services of the municipality are generally
provided by the
municipality’s Rural Health Unit with its municipal health center
Clinical visit and Barangay
Health Stations (BHS).
▪ When the client goes to the • The BHS is the initial unit, which dispenses basic health care, i.e.
Barangay Health Station or Rural maternal and
Health Unit childcare, immunizations, treatment of simple medical conditions,
▪ Less expensive for the nurse nutrition,
▪ Provides opportunity for the use of family planning, sanitary health care, emergency treatment and
equipment that cannot be taken to health education.
the home 2. Local Government Units
▪ Other team members in the clinic • are institutional units whose fiscal, legislative and executive
may be consulted or called in to provide additional service authority extending
▪ Emphasizes the importance of empowerment and assuming over the smallest geographical areas distinguished for
responsibility for self-help administrative and political
purposes.

• It is responsible for delivering a broad range of services in

Home visit relation to roads;
▪ Expensive in terms of time, effort traffic; planning; housing; economic and community development;
and logistics for the nurse environment,
▪ Effective and appropriate type of recreation and amenity services; fire services and maintaining the
family-nurse register of
contact if the objectives and electors.
outcomes of care 3. Government Organizations
require accurate appraisal of family • It is the primary government agency mandated to develop,
relationships, home and environment and family competencies implement, and

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coordinate social protection and poverty-reduction solutions for (Blau and Scott, 1970)"
and with the
poor, vulnerable, and disadvantaged.

National Nutrition Council (NNC)

IMPORTANCE AND USES OF RECORDS IN FAMILY HEALTH
• It is an agency of the Philippine government under the NURSING PRACTICE
Department of Health ✔ All professional persons need to be accountable for the
(DOH) responsible for creating a conducive policy environment for performance of their duties tothe public.
national and ✔ Since nursing has been considered as profession, nurses need
local nutrition planning, implementation, monitoring and to record their work oncompletion.
evaluation, and ✔ Records are a practical and indispensable aid to the doctor,
surveillance using state-of the art technology and approaches.
nurse and paramedical personnel in giving the best possible
Commission on Population (POPCOM) service to the clients.
✔ Report summarizes the services of the person or personnel and
• It is a government agency mandated as the over-all coordinating, of the agency
monitoring and
policy making body of the population program. It is the lead Record
agency promoting • A permanent written communication that documents
population activities.
information relevant to a client’s health care management.
Non-Government Organizations • A record is a clinical, scientific, administrative and legal
document relating to the nursingcare given to the individual family
•It is a non-profit, citizen-based group that functions or community. Purpose of
independently of government.
•NGOs, sometimes called civil societies, are organized on Records
community, national and
• Supply data that are essential for programme planning and
international levels to serve specific social or political purposes,
and are cooperative, evaluation.
rather than commercial, in nature. • Provide the practitioner with data required for the application of
professional services forthe improvement of family's health.
Civic Organization • Tools of communication between health workers, the family &
other development personnel
• It means any local service club, veterans' post, fraternal society
or association,
PRINCIPLES in Record Writing
volunteer fire or rescue groups, or local civic league or association
of 10 or more • Written clearly, appropriately and adequately.
persons not proprietary but operated exclusively for educational • Contain facts based on observation, conversation and action.
and charitable • Select relevant facts and the recording should be neat,
purposes, including the promotion of community welfare, and the complete and uniform
net earnings are • It should be handled carefully and accounted for.
devoted exclusively to charitable, educational, recreational or • Records should be written immediately after an interview.
social welfare purposes.
• Records are confidential documents.
Religious Organization • Accurately dated, timed and signed
• Not include abbreviations, jargon, meaningless phrases
● It is defined by federal and state laws, which vary by state.
● For example, one state defines a religious organization for Report
health insurance purposes • Are oral or written exchanges of information shared between
as is defined as an entity that is set up exclusively for religious
caregivers or workers inanumber of ways.
purposes and has
obtained nonprofit tax status. • A report is the summary of the services of person or personnel
and of the agency.
School
Field Health Service Information System (FHSIS)
• The language of education contributes heavily to the • Is a major component of the network information sources
self-identification of individuals. developed by the Department of Health (DOH) to enable it to
• NGOs, can be defined as "formal organizations, and as such, they
better manage its nationwide health service delivery activities.
emerge when a
group of people organizes themselves into a social unit “that was • This has been designed to provide the basic service data needed
established with the to monitor activities ineach programs Importance of FHSIS
explicit objective of achieving certain ends and formulating rules • Helps local government determine public health priorities.
to govern the • Basis for monitoring and evaluating health program
relations among the members of the organization and the duties implementation.
of each member”

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• Basis for planning, budgeting, logistics and decision making at all • M1- Program Report. It contains selected indicators categorized
levels. as maternal care, childcare, family planning and disease control,
• Source of data to detect unusual occurrence of a disease. the same indicators found in the TCL and Summary Tables.

TYPES OF RECORDS AND REPORTS • M2- Monthly Morbidity Disease Report contains a list of all
Field Health Service Information System (FHSIS) diseases by age and sex
• Records- are facility based documents. Data are more detailed
and contains day todayactivities of the health workers. The source b. Quarterly Forms (Q1, Q2)
of data for this component is the services delivered to • Q1- municipality/city health report and contains the three
patients/clients month total of indicators categorized as maternal care, family
• Reports-summary data that are transmitted or submitted on a planning, child care, dental health and disease control.
monthly, quarterly andonannual basis to higher level. The source • Q2- Quarterly Consolidation Report of Morbidity Diseases to
of data for this component is dependent ontherecords consolidate the MonthlyMorbidity Diseases taken from the
Summary Table. It is submitted every third week of the first month
Components of FHSIS (Recording) of the succeeding quarter
1. ITR- Individual Treatment Record
• Fundamental building block/ foundation of FHSIS c. Annual Forms (A1, A2, A3, A-BRGY) • A1- consists of data and
• A document, form or piece of paper upon which is recorded the indicators needed only on a yearly basis
date, name, address of patient, presenting symptoms or complaint • A2- report that lists all diseases and their occurrence in the
of the patient on consultation and the diagnosis (if available), municipality/city. The report is disaggregated by age and sex
treatment and date of treatment. • A3- report of all deaths occurred in the municipality/city
• This record will be maintained as part of the system of records at disaggregated by age andsex
each health facility on all patients seen • A-BRGY- report which contains data on demographic,
environmental, natality andmortality
2. Target Client List (TCL)
⮚ constitute the second “building block” of the FHSIS and are EXPANDED PROGRAM ON IMMUNIZATION
intended to serve several purposes: • Objective: reduce morbidity and mortality among infants and
a. to plan and carry out patient care and service delivery children
b. to facilitate the monitoring and supervision of service delivery • PD 996 – compulsory Immunization of children less than 8 years
activities old
c. to report services delivered d. to provide a clinic-level data base • RA 10152 – mandatory infants and children up to 5 years old
which can be accessed for further studies immunization act of 2011 Hep B vaccine – 1 st vaccine to be given
7 + 2 vaccines Cold Chain Management
TCLs to be maintained (v2012): • Used to maintain potency of the vaccine
• Target Client List for Prenatal Care
• Target Client List for Post-Partum Care General Policies on Cold Chain
• Target Client List for Nutrition and Expanded Program for 1. Stock vaccine neatly on the shelves not on the door 2. Keep
Immunization diluent in lower shelves or in the door
• Target Client List for Family Planning 3. Clearly separate different types of vaccine
• Target Client List for Sick Children 4. FEFO – first to expire, first to open 5. Store measles and OPV
with frozen ice pack in the transport boxes
3. Summary Table 6. Discard BCG vaccines after 4 hours of reconstitution
• Is a form with 12-month columns retained at the facility (BHS) 7. Discard DPT, Polio, Measles, and TT after 8 hours of
where the midwife/nurserecords all monthly data reconstitutio
• A summary of all the data from TCL or registries
• Morbidity Diseases – the nurse accomplishes this table on a Time frame for Storage of Vaccine
monthly basis. This summarytable can also be the source of ten 1. 6 months at the regional level
leading causes of morbidity and reportable diseasefor the 2. 3 months at the provincial level/ district level
municipality/ city 3. 1 month at the main health centers (with refrigerators)
4. Not more than 5 days at health center/ BHU
4. Monthly Consolidation Table (MCT)
• The Public Health Nurse (PHN) records data from all barangays. Tetanus Toxoid Immunization Schedule for Women
This is the source document of the nurse for the Quarterly Form. • When given to women of childbearing age, vaccines that
• The MCT shall serve as the output table of the RHU as it already contain tetanustoxoid (TT) not only protect women against
contains listing of indicators by barangay a. Monthly Forms (M1, tetanus, but also prevent neonatal tetanus in n their newborn
M2) infants

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS ▪ During the 1st seconds:

An approach established to strengthen the provision of ▪ Do not ventilate unless the baby is floppy/limp and not breathing
comprehensive andessential health package to the children. ▪ Do not suction unless the mouth/ nose are blocked with
The strategy was developed by the: secretions or other material
- World Health Organization (WHO) and United Nations Children’s • Within 0 – 3 minutes
Fund(UNICEF)
- In the Philippines, IMCI was started on a pilot basis in 1996 Notes:
- Aims to reduce childhood mortality and improve the quality of o Do not wipe off vernix
carefor major childhood illness, especially at first level health o Do not bathe the newborn
facilities. o Do not do foot printing
o No slapping
IMCI Process o No hanging upsidedown
1. Assess- ask, look, listen, and feel for; o No squeezing of chest
a. Signs and symptoms
b. Main symptoms and common health issues 2. Early skin to skin contact
2. Classify & identify treatment - severity of calassification; a. Skin to skin contact between mother and newborn
RED- severe, urgent referral required b. Delayed washing for at least 6 hours prevent hypotermia,
YELLOW- treat in clinic infection, andhypoglycemia
GREEN- home treatment • After 30 seconds drying
3. Treat o If newborn is breathing or crying:
4. Counsel o Position the newborn prone on the mother’s abdomen or chest
5. Follow Up o Cover the newborn’s back with a dry blanket
o Cover the newborn’s head with a bonnet
ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
• Aims to increase the quality of care around the time of birth and Notes:
duringthefirst few weeks of life to eliminate preventable causes of o Avoid manipulation (suctioning) that may cause trauma or
newborn death. infection
o Place identification band on the ankle (not wrist)
EINC practices during the intrapartum period o Skin to skin contact is doable even for CS newborns
• continuous maternal support by having a companion of choice
during labor and delivery 3. Properly timed cored clumping and cutting
• freedom of movement during labor a. Prevents anemia, protects against death due to hemorrhage in
• monitoring progress of labor using the partograph prematurenewborn
• non-drug pain relief before offering labor anesthesia • position b. Properly timed cord clumping and cutting means waiting for the
of choice during labor and delivery cord pulsation to stop (1-3 minutes)
• spontaneous pushing in a semi-upright position • 1 – 3 minutes
• non-routine episiotomy o Remove the first set of gloves
• and active management of the third stage of labor (AMTSL) o After the umbilical pulsations have stopped, clamp the cord
using a sterileplastic clamp or tie at 2 cm from the umbilical base
Early Essential Newborn Care o Clamp again at 5 cm from the base
• Emphasize are sequence of 4 actions that are performed step by o Cut the cord close to the plastic clamp
step
• is organized so that essential time bound interventions are not Notes:
interrupted; and ▪ Do not milk the cord towards the baby
• fills a gap for a package of bundled interventions in a guideline ▪ Cut the cord close to the plastic clamp so that there is no need
format for a 2nd “trim”
▪ Do not apply any substance onto the cord
1. Immediate and thorough drying
a. For 30 sec to 1 min 4. Non-separation of the mother and newborn for early initiation
b. Warms the newborn and stimulate breathing of breastfeeding
• Within 1st 30 secs • Provides colostrum – a substance equivalent to the babies first
o Call out the time of birth immunizationfor its protective properties
o Dry the newborn thoroughly for at least 30 seconds o Remove • Within 90 minutes
wet cloth o Leave the newborn in skin to skin contact
o Do a quick check of breathing while drying o Observe for feeding cues, including tonguing, licking, rooting
o Point these out to the mother and encourage her to nudge the
Notes: newborntowards the breast

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• Counsel on positioning Where is it available?

o Newborn’s neck is not flexed nor twisted All practicing health institutions:
o Newborn is facing the breast Hospitals
o Newborn’s body is close to mother’s body Lying-in
o Newborn’s whole body is supported Clinics
• Counsel on attachment and sucking Health Centers
o Mouth wide open Rural Health Units
o Lower lip turned outwards
o Baby’s chin touching the breast Expanded newborn package from 6 – 28 , expanded is 28
o Sucking is slow, deep with some pauses disorders whichinclude: hemoglobinopathies and additional
metabolic disorders. Cost 1500 or 1800
Notes:
o Minimize handling by health workers When are the results available?
o Do not give sugar water, formula or other - Within 3 weeks after the laboratory receives and tests the
o Do not give bottles or pacifiers samples.
o Do not throw away colostrum A negative screen means… - The results are normal and the baby
• Weighing, bathing, eye care, examinations, injections (hepatitis is not suffering from any of the disorders being screened. In case
B, VitaminK) should be done after the first full breastfeed is of a positive screen…
completed - The Newborn Screening Nurse Coordinator will immediately
• Postpone washing until at least 6 hours informthecoordinator of the institution. The parents are recalled
for confirmatory testing

NEWBORN SCREENING BASIC EMERGENCY OBSTETRICS AND NEWBORN CARE

ANDCOMPREHENSIVE EMERGENCY OBSTETRICS AND NEWBORN
Republic Act No. 9288 or the Newborn Screening Act of 2004 CARE
- To reduce preventable deaths of all Filipino newborns due to
more common and rare congenital disorders through timely BEmONC
screening and proper management Basic Emergency Obstetrics and Newborn Care
- Introduce in 1996 adopted in 2004 by the DOH Oxytocic drugs IV / IM
- A simple procedure to find out if a baby has a congenital Antibiotics IV / IM
metabolic disorder. Anticonvulsants IV / IM
Manual removal of placenta
Why is it important? Manual vacuum aspiration of retained products of conception
- Because most babies with metabolic disorders look normal at Vacuum extraction
birth. One may only know it once signs and symptoms are already Newborn resuscitation
severe and irreversible. These disorders may lead to mental Treatment of neonatal sepsis / infection
retardation and even death, if untreated. Oxygen support

When is it done?
- It is ideally done on the 48th hour or at least 24 hours after birth. CEmONC
Becausesome disorders are not detected if the test is done earlier Comprehensive Emergency Obstetrics and Newborn Care
than 24 hours. And the baby must be screened again after 2 weeks Oxytocic drugs IV / IM
to obtain more accurateresults. Antibiotics IV / IM
Anticonvulsants IV / IM
How is it done Manual removal of placenta
-A few drops of blood are taken from the baby's heel, blotted on a Manual vacuum aspiration of retained products of conception
special absorbent filter card and then sent to Newborn Screening Vacuum extraction
Center (NSC). Surgery (cesarean section)
–paying for an amount, 500 – 600 pesos. Blood transfusion
Newborn resuscitation
Who will collect the sample? Treatment of neonatal sepsis / infection
Physician Oxygen support
Nurse Management of low birth weight or preterm newborn Other
Midwife specialized newborn services
Medical Technologist

NCM 104 REVIEWER MIDTERM LEVEL 2 reresma@usa.edu.ph

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NUTRITION PROGRAM Thiswhich involves periodic collection of data and analysis and
dissemination of analyzed information.
Objectives
To decrease the morbidity and mortality rates secondary to LEGAL MILESTONES:
Avitaminoses andother nutritional deficiencies among the A. PD 491 – Nutrition Act of the Philippines
population mostly composed of infants and children. ● declares nutrition as a priority of the government
● creates the National Nutrition Council
Goal ● designated July as the Nutrition Month
The improvement of nutritional status, productivity and quality of
life of thepopulation through the adoption of desirable dietary B. RA 832- rice Enrichment Law
practices and healthy lifestyle Philippine Food and Nutrition ● All milled rice will have to be enriched with pre-mixed Rice
Programs- directed towards the provision of nutrition services to
the DOH’s identified priority vulnerable groups: infants, C. RA 8172- FIXED Salt
preschoolers, schoolers, women of child bearing age (also
included are the pregnant and lactating mothers) and theelderly D. Policy on Vitamin A Supplementation Program

Coverage
● Protein-energy malnutrition (PEM)
● Vitamin A Deficiency (VAD)
● Iron Deficiency Anemia (IDA)
● Iodine Deficiency Disorders ( IDD)

1. MALNUTRITION REHABILITATION PROGRAM

2. MICRONUTRIENT SUPPLEMENTATION PROGRAM

- Interventions to address the health and nutritional needs of
infants andchildren
- Garantisadong Pambata
1. Vitamin A Supplementation twice a year
2. Araw ng SangkapPinoy

Target Preparation Dose/Duration Infant

100,000 IU 1 dose only Children 200,000 IU 1 cap
every 6 months Pregnant Women 10,000 IU 1 cap/tab twice a
week start at 4months until delivery
Post-partum Women 200,000 IU 1 cap/ 1 dose within 4 weeks
after delivery

3. FOOD FORTIFICATION PROGRAM

o FORTIFICATION is the addition of a micronutrient deficient in
the diet toacommonly and widely consumed food or seasoning.
o Food fortification or enrichment is the process of adding
micronutrients (essential trace elements and vitamins) to food.

RA 8976 – Food Fortification Law

1. Rice – iron
2. Flour – iron and Vit. A
3. Cooking oil – Vit. A
4. Sugar – Vit. A

4. NUTRITION SURVEILLANCE SYSTEM

The Nutrition Surveillance system involves keeping a close
watchonthestate of nutrition and the causes of malnutrition
within a locality.

NCM 104 REVIEWER MIDTERM LEVEL 2 reresma@usa.edu.ph