COMMUNITY HEALTH NURSING

1. COMMUNITY HEALTH NURSING

2. LEVELS OF HEALTH CARE SERVICES

3. Nat'l & Regional Health services Medical centers Teaching & Training Hospitals Tertiary Level Facilities Secondary Level Faciities Provincial / City Health Services & Hopitals Emergency & District Hospitals Primary Level Facilities Rural Health Units Community Hospitals & Health Centers Private practitioners, Puericulture Centers Barangay Health Stations Pyramidal Health Structure

4. THE PUBLIC HEALTH NURSE

5. Qualifications and Functions • Must be professionally qualified and licensed to practice in the arena of public health nursing • Consistent with the nursing law

6. Management function • Inherent in the practice of PHN • Performs Program Manager • Organizes the nursing service of the local health agency • Supervisory function • Supervisor of the midwives and other health workers

7. Nursing care function • Inherent function of the nurse • Based on the science of art and caring • Caring for all levels of clientele toward health promotion and disease prevention • Collaborating and coordinating function • Care coordinators for communities and their members • Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

8. Health promotion and education function • Activities goes beyond health teachings and health information campaigns • Training function • Initiates the formulation of staff development and training programs for midwives and other auxiliary workers

9. Research function • Participates in the conduct of research and utilizes research findings in her practice • Disease surveillance • Measure the magnitude of the problem • Measure the effect of the control program

10. NURSING PROCEDURES

11. Clinic visit • Patient visits the health center • Most common is BP measurement • Home visit • Family-nurse contact • The PHN visits the patient • Bag technique • Tool by which the nurse during her visit will enable her to perform a nursing procedure with ease and deftness, save time and effort • Most important principle • Minimize if not prevent the spread of any infection • Important points to consider in the use of the bag • Contain all necessary articles • Cleaned very often • Well protected • Arrangement-most convenient

12. PUBLIC HEALTH PROGRAMS

13. PUBLIC HEALTH PROGRAMS • Sets of interventions put together to operationalize policies and standards directed towards the prevention of certain public health problems • FAMILY HEALTH • NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL • COMMUNICABLE DISEASE PREVENTION AND CONTROL • ENVIRONMENTAL HEALTH AND SANITATION • OTHER PRIORITY HEALTH PROGRAMS • SentrongSigla • Herbal Medicine • Health Emergency Preparedness and Response Program • National Voluntary Blood Services Program • BotikangBarangay

14. FAMILY HEALTH Basic unit of the community Concerned with the health of the mother, unborn, newborn, infant, child, adolescent and youth, adult men and women and older persons

15. FAMILY HEALTH • Maternal Health Program • Family Planning Program • Child Health Programs • EPI • Management of Childhood Illnesses • Nutrition Program • Oral Health Program • Adolescent Health Program • Adult Men, Women • Older Person • Philippine Reproductive Health

16. FAMILY HEALTH….. • Aims to: • Improve the survival, health and well being of mothers and the unborn • Pre-pregnancy • Prenatal • Natal • Postnatal stages • Reduce morbidity and mortality rates: • Children 0-9 years old • Among Filipino adults and older persons and improve quality life • Mortality from preventable causes among adolescents and young people

17. 1. MATERNAL HEALTH PROGRAM Tasked to reduce MMR by three quarters by 2015 to achieve MDG a. Antenatal Registration b. Tetanus Toxoid Immunization c. Micronutrient Supplementation d. Treatment of Diseases e. Clean and Safe Delivery

18. Micronutrient supplementation

19. Recommended Schedule for Post Partum Care Visits

20. 2. FAMILY PLANNING PROGRAM • Annual Population Growth • 2.36% • Population expected to double in 29 years • Total fertility rate • 3.5 children/woman • 3 to 4 million getting pregnant/year • 85% expected to progress full term • National Demographic and Health Survey (2003) • 44% women got pregnant with 1st child ages 20-24 • 6.1% Ages 15-19 • 35-39 – highest percentage of using contraceptives • 15-19 – lowest percentage

21. Married women • 48.8% - use any form of contraceptive method • 33.4% - modern method • 15.5% - traditional method • 51.1% - do not use any form of contraceptive method

22. Family Planning Methods • Female sterilization • Cutting or blocking two fallopian tubes (BTL) • Male sterilization • Vas deferens is tied and cut or blocked through a small opening on the scrotal skin (Vasectomy) • Effective 3 months after the procedure • Pill • Hormones – estrogen and progesterone • Taken daily PO • Male condom • Thin sheath of latex • Dual protection from STIs including HIV

23. Injectables • Synthetic hormone – progestin which suppresses ovulation, thickens cervical mucus • LAM • Postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women • Effective only for a maximum of 6 months postpartum • Mucus/Billings/Ovulation • Abstaining from SI during fertile days • Can not be used by woman with unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult

24. BBT • Identifying the fertile and infertile period by daily taking and recording rise in BT during and after ovulation • Temp is taken 3 hours of undisturbed rest (usually morning) • Sympto-thermal method • Combination of BBT and Billing/Mucus method • Two day method • Simple fertility awareness based method • Cervical secretions as an indicator of fertility • Checking the presence of secretions daily • Standard days method • Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to avoid pregnancy

25. Misconception about Family Planning Methods • Some family planning methods causes abortion • Abortion is termination of pregnancy; family planning prevents pregnancy • Using contraceptives will render the couples sterile • Only vasectomy and BTL considered permanent methods and chosen by the couples who have completed desired family size • Using contraceptive methods will result to loss of sexual desire • Contraceptives free the couple from unwanted pregnancies, this enhances couple’s sexual relationship

26. Strategy calls for the: • Promotion of breastmilk as the ideal food for the healthy growth and development of infants • Exclusive breastfeeding for the first 6 months of life • Overall objective: • Improve the survival of infants and young children by improving their nutritional status, G & D through optimal feeding

27. 4. EXPANDED PROGRAM IMMUNIZATION • Plz follow sri lankan one…

28. General principles which apply in vaccinating children • Safe and immunologically effective to administer all EPI vaccine on the same day at different sites of the body • Measles vaccine should be given as soon as the child is 9 months old • 9 months – 85% protection • 1 year above – 95% protection • Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or years • Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized

29. Absolute contraindications to immunizations are: • DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose • Vaccines containing the whole pertussis component should not be given to children with an evolving neurological disease • Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation • Safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response

30. Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels • No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT • Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluents supplied with them • Repeat BCG vaccination if the child does not develop a scar after the 1st injection • Use one syringe one needle per child during vaccination

31. 6. Nutrition Program • Common nutritional deficiencies • Vitamin A • Iron • iodine

32. Nutrition Programs and Projects • Micronutrient Supplementation • “Araw ng Sangkap Pinoy” (Garantisadong Pambata) • Twice a year distribution of Vit. A capsule to children 6 – 71 mos • Food Fortification Program (RA 8976) • Addition of essential nutrients to a widely consumed food product • Mandatory fortification of staples namely; • Flour with Iron and Vitamin A • Cooking oil and refined sugar with Vitamin A • Voluntary fortification of processed foods through “sangkap pinoy seal”

33. Nutrition Programs and Projects… • Essential Maternal and Child Health Service Package • Breast feeding • Complementary feeding • Micronutrient Supplementation • Nutrition information, communication and education • Home, School and Community Food Production • Food Assistance • Livelihood Assistance

34. Nutritional guidelines for micronutrient supplementation Universal Supplementation of Vitamin A

35. Supplementation for pregnant and post partum women

36. 6. Oral Health Program • Classifications of oral intervention • PREVENTIVE • Oral examination • Oral hygiene • Pit and fissure sealant • Flouride utilization program • CURATIVE • Permanent filling • Gum treatment • Atraumatic restorative treatment • Temporary filling • Extraction • Drainage of localized oral abscess • PROMOTIVE SERVICES • Health education

37. REPRODUCTIVE HEALTH • A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes.

38. CONCEPTS • A married couple has the capability to reproduce/procreate. • RH is the exercise of reproductive right with responsibility (e.q. it is the freedom to when and how to do so) • Includes sexual health for the purpose of enhancement of life and personal relations (sexual health means protection from STD, from harmful reproductive practices and violence, control and freedom over sexual relations. • Means safe pregnancy and delivery. The right of access to appropriate health information and services to enable woman to go through pregnancy and childbirth safely. • Includes protection from unwanted pregnancy by having access to safe and acceptable methods of family planning of their choice. • Includes protection from harmful reproductive practices and violence. • Assures access to information on sexuality to achieve sexual enjoyment.

39. VISION • Reproductive health practice as a way of life for every man and woman throughout life.

40. GOALS • To achieve healthy sexual development and maturation • Achieve their reproductive intention • Avoid illness/diseases, injuries, disabilities related to sexuality and reproduction • Receive appropriate counseling and care of RH problems • Every pregnancy should be intended • Every birth should be healthy • Every sex act should be free of coercion and infection • Achieve a desired family size

41. STRATEGIES • Increase and improve the use of more effective or modern contraceptive methods. Increase the type of methods’ offered available in the program • Provision of care; treatment and rehabilitation for RH, if possible in all facilities (clinic & hospital) • RH care provision should be focused on adolescent, men and unmarried and other displaced people with RH problems. • Strengthen outreach activities and the referral system • Prevent specific RH problems through information dissemination and counseling of clients with RH problems.

42. TEN ELEMENTS OF RH • Maternal and Child Health Nutrition • Family planning • Prevention and Management of Abortion Complications • Prevention and Treatment of RTI including STDs, HIV and AIDS • Education and Counseling on Sexuality and Sexual Health • Breast and Reproductive Tract Cancers and other Gynecological conditions • Men’s Reproductive Health • Adolescent Reproductive Health • Violence against Women (VAW) • Prevention and Treatment of Infertility and Sexual Disorder

43. Factors/Determinants of Reproductive Health • Socio-economic conditions • Poverty • Nutrition • Living condition • Family environment • Family surroundings influence the family’s knowledge, attitudes and practices (KAP) • Many still adhere to superstitious beliefs in terms of health practices among the elders and tend to pass it on to the next generation. • Decision of other members may prevail even against the will of the concerned individual.

44. Status of women • Destined to bear and raise children • Reducing their mobility and access to education, employment and other activities related to personal development. • Number and short spacing of pregnancies can contribute to health or mental/physical burden or deterioration. • Women should be given equal right in; • Education • Making decision • to have or not to have children for their health and well-being • Health protection • Right to be free from torture and ill treatment • Right to participate in the political arena. • Social and Gender Issues

45. Biological, Cultural and Psycho-Social Factors • Biological • Refers to the individual (knowledge of his her reproductive organ and its functions) • Culture • Country’s norms, practices of RH. • Care provider need to know the cultural values and orientation of their clients.