Health Care Delivery

FOCUS KNOWLEDGE BASE

Promotion and Preservation from nursing and public health

of the health of populations

NATURE OF PRACTICE LEVELS OF CLIENTELE:

comprehensive, general, individuals, family, population
continual and not episodic groups and community as a whole

COMMUNITY HEALTH
A group of people sharing common state of complete physical, mental
geographic boundaries and and social well-being, not merely the
common values and interests. absence of disease or infirmity

WORLD HEALTH MODERN CONCEPT OF

ORGANIZATION HEALTH
- Optimum level of individuals, This factor pertains to the power and
families and communites authority to regulate the environment
 FACTORS AFFECTING
LEVEL OF FUNCTIONING
HEALTH CARE
POLITICAL DELIVERY SYSTEM

This factor pertains to the power One component of this factor is the
and authority to regulate the primary health care which is a
environment Examples:  partnership approach
Goal: Effective provision of health
Safety
services that are community-based
 Oppression
and accessible
 People empowermen
Components:
 Promotive
 Preventive
BEHAVIORAL  Curative
 Rehabilitative

Components
 Culture
 Habits
 Ethnic customs
Examples ENVIRONMENT
HEREDITY
Smoking AL INFLUENCES
 Intake of alcoholic drinks 
Substance abuse  Components 
Air  Components
Lack of exercise
Food   Genetic endowment
Water waste   Defects
Urban/rural noise   Strengths
Radiation   Risks:
SOCIOECONOMIC
Pollution  Familial
INFLUENCES
 Ethnic
 Racial
Components 
Employment 
Education
Housing
PUBLIC HEALTH NURSING
Public health as the science and art of preventing disease, prolonging life and
efficiency to enable every citizen to realize his birthright of health and
longevity ( Winslow)
Public health is dedicated to the common attainment of the highest level of
physical, mental and social well-being and longevity
GOAL: contribute to the most effective total development and life of the individual
and his society. (Hanlon)
Community health nursing is a learned practice discipline
Ultimate Goal : contribute to the promotion of client’s optimum level of
functioning
Through teaching and delivery of care. (Jacobson)
Community health nursing is a service rendered by a professional nurse
with the community, groups, families and individuals
GOAL: promotion of health, prevention of illness, care of the sick at home and
rehabilitation (Freeman)
Philosophy of community health nursing is based on the worth and dignity of
man. (Shetland)

CONCEPTS OF COMMUNITY HEALTH NURSING

 HEALTH PROMOTION – primary focus of community health nursing practice
 Practice is extended to benefit not only the individual but the whole family
and community
 Community health nurses are GENERALISTS
PRINCIPLES OF COMMUNITY HEALTH NURSING
 Community health nursing is based on recognized needs of communities,
families, groups and individuals
 The community health nurse must understand fully the objectives and
policies of the agency she represents
 FAMILY – unit of service
 Community health nursing must be available to all
 HEALTH TEACHING – primary responsibility of the community health nurse
 The community health nurse works as a member of the health team
 There must be periodic evaluation
 Opportunities for continuing staff education program must be provided
 PRINCIPLES OF COMMUNITY HEALTH NURSING
 Make use of available community health resources
 Utilize existing active groups in the community
 Educative supervision
 Accurate recording and reporting
ULTIMATE GOAL: Raise the level of health of the citizenry

ROLES OF THE NURSE IN

COMMUNITY HEALTH NURSING
Clinician – focus on the health of the individuals on the larger context of the
community
Advocate – promote self-care and self-determination
Collaborator – brings together strengths and weaknesses of people involved
toward a common goal
Researcher – utilizes data to predict future phenomenon and modify interventions
Counselor – key tasks include listening and providing feedback and information
Case Manager – oversees all aspects of care to facilitate delivery of cost-efficient
care; to individualize and coordinate care
Educator – provide knowledge, skills and attitudes that people need to make
appropriate choices or decision
Hospice Care – providing care skills in a home and other settings and balancing
client’s needs
 THE NURSING PROCESS
WORLD HEALTH ORGANIZATION IMPLEMENTATION
translation of care plan into
ASSESSMENT - Process of collecting action
and processing data/information about STEPS:
the client
Initiate contact
STEPS: Demonstrate caring attitudes
Collect data from all Develop mutual trust
possible sources Put nursing plan to action
Identify problems Coordinate care / services
Analyze and interpret data Utilize community resources
Delegate and supervise
Monitor health services provided
Provide health educatin
Document responses to nursing
PL PLANNING action
formulation of steps to be
undertaken to achieve desired end
STEPS:
EVALUATION
Prioritize needs
Establish goals based on process of making
needs and capabilities judgments as to the extent the
Construct action and objectives are met
operation plan
STEPS:
Devise evaluation
 Care outcomes
parameters
Revise plan as neede  Performance appraisal
 Estimate cost benefit ratio
 Assessment problems
 Identify needed alterations
 Revise plans as necessary
 CATEGORIES OF HEALTH PROBLEMS

HEALTH DEFICIT HEALTH THREAT

A gap between actual and achievable conditions that are conducive to disease,
health status accident or failure to
 Instances of failure in health realize one’s potential
maintenance Examples:
 Possible precursors of health deficit: Family history of hereditary disease
 History of repeated infections or Threat of cross infection
miscarriages Accident hazards
 No regular health check-up Faulty eating habits
Examples: Poor environmental sanitation
 ILLNESS states, diagnosed or Unhealthy lifestyle/personal habits
undiagnosed
 Failure to thrive/develop
 Disability
 Transient (aphasia or temporary
paralysis after a CVA) PRIORITIZING HEALTH PROBLEMS
Permanent (leg amputation secondary to NATURE OF THE PROBLEM
diabetes, blindness
from measles, lameness from polio) categorized into health deficit, health threat
and
foreseeable crisis
Health deficit 3
FORESEEABLE CRISIS Health threat 2
Foreseeable crisis 1
Anticipated periods of unusual demand on the
individual
or family in terms of adjustment/family
resources

Examples:
MODIFIABILITY OF THE PROBLEM
Marriage
Pregnancy
Parenthood
Divorce or separation refers to the probability of success in
Loss of job minimizing, alleviating or totally
Menopause eradicating the problem through
Death intervention
Easily modifiable 2
Partially modifiable 1
Not modifiable 0
 PREVENTIVE POTENTIAL SALIENCE
refers to the nature and magnitude of refers to the family’s perception and
future problems evaluation of the problem in
that can be minimized or totally prevented terms of seriousness and urgency of
if intervention is done on the problem attention needed
under consideration A serious problem, immediate attention
High 3 needed 2
Moderate 2 A problem, but not needing immediate
Low 1 attention 1
Not a felt need / problem 0

EVALUATION OF CARE AND SERVICES PROVIDED

STRUCTURAL ELEMENTS PROCESS ELEMENTS
include the physical settings, steps of the nursing process ( assessment,
instrumentalities and planning,
conditions through which nursing care is implementing and evaluating)
given Components:
Components: Taking the family health database
Philosophy Performing physical examination
Objectives Making a nursing diagnosis
Building Determining nursing goals
Organizational structure Writing a nursing care plan
Financial resources (budget, equipment, Performing nursing interventions
staff) Coordination of services
Measuring success of nursing actions

OUTCOME ELEMENT
changes in the client’s health status that
result from
nursing interventions
COMPONENTS
 modification of signs and symptoms
 Knowledge
 Attitude
 Satisfaction
 Skill level of client
 Compliance with treatment regimen
 staff)

NURSING PROCEDURES

PRE-CONSULTATION CONFERENCE MEDICAL EXAMINATION

1. Greet and make client at ease 1. Assist client before, during and after
2. Take clinical history examination by physician
3. Take temperature, blood pressure, 2. Inform physician of relevant findings
height and weight gathered in pre-conference
4. Perform physical assessment 3. Work with the physician during the
5. Do laboratory examinations examination
6. Write findings on client records 4. Ensure privacy, safety and comfort of
patient throughout procedure
5. Observe confidentiality of examination
results
PRE-CONSULTATION CONFERENCE Nursing Intervention:
1. Carry out physician’s orders as giving
1. Explain findings and needed care or
medication or injection
intervention
2. Explain and reinforce physician’s
2. Refer patient to other health
orders and advises
worker/agency
3. Teach patient measures to promote
3. Make appointment for next
and maintain health as proper
clinic/home visit
diet, exercise and
Personal hygiene.
4. Seek information regarding health
status of other family members
5. Counseling
 DEPARTMENT OF HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility of health care to improve the quality of life of the
Filipinos especially the poor

NATIONAL HEALTH OBJECTIVES

 Improve the general health status of the population
 Reduce morbidity, mortality, disability and complications
 Eliminate the following diseases as public health problems (schistosomiasis,
malaria, filariasis, leprosy, rabies, measles, tetanus, diphtheria, pertussis,
vitamin A and iodine deficiency)
 Eradicate poliomyelitis
 Promote healthy lifestyle
 Promote health and nutrition of families and special populations
 Promote environmental health and sustainable development

BASIC PRINCIPLES TO ACHIEVE

IMPROVEMENT IN HEALTH
 Ensure universal access to basic health services
 Epidemiological shift from infectious to degenerative disease must be managed
 Enhance the performance of the health sector
 Ensure the prioritization of the health and nutrition of vulnerable
groups
PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS
 Support for frontline health workers and local system development
 Assurance of health care
 Increasing investment for primary health care
 Development of national standards and objectives for health

- Dental health program

- Osteoporosis prevention
- Health education and community organizing
- Primary health care
- Reproductive health
- Older persons health service
- Guidelines for good nutrition
- Respiratory Infection Control
- Alternative health care
- Maternal and child care
- Sentrong Sigla Movement
 PRIMARY HEALTH CARE
 Essential health care made universally acceptable to individuals and
families in the community
 By means acceptable to them and through their full participation
 At a cost that the community and country can afford at every stage
of development

ESSENTIAL HEALTH CARE

SERVICES
GOAL : Health for all Filipinos and Health in the Hands of the People by the year
2020
MISSION : To strengthen the health care system wherein people will manage their
own health care
CONCEPT : partnership and empowerment of the people
LEGAL BASIS:
 Letter of Instruction 949
 President Ferdinand Marcos
 October 19, 1979
 First International Conference on Primary Health care
 Alma Ata, USSR
 September 6-12, 1978
 Sponsored by the World Health Organization and UNICEF

ELEMENTS/COMPONENTS of PHC

- Education for Health

- Locally Endemic Disease Control
- Expanded Program on Immunization
- Maternal and Child Health
- Essential Drugs and Elderly Care
- Nutrition
- Treatment of CD and Non-CD
- Sanitation: Water and Environment
ORGANIZATIONAL STRATEGY
Framework for meeting the goal of primary health care
Calls for active and continuing partnership among the communities,
private and government agencies in health development

LEVELS OF HEALTH CARE SERVICES

PRIMARY
 Barangay Health Station
 Rural Health Unit
SECONDARY
 Emergency/District
Hospitals
 Provincial/City Hospitals
TERTIARY
 Private Practitioners
 Community Hospitals
 Regional Medical Centers
and Training Hospitals
 National Medical Centers
 Teaching and Training
Hospital

TWO LEVELS OF PHC WORKER

 VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs)

- Trained community health workers
- Health auxiliary volunteer
- Traditional birth attendant or healer

 INTERMEDIATE LEVEL HEALTH WORKERS

- General medical practitioner
- Public health nurse
- Rural sanitary inspector
- Midwives