HEALTH WHO state of complete physical, mental, and social well being, not merely the absence of a disease or infirmity PUBLIC HEALTH DR. C.E. Winslow It is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for a.sanitation of the environment b.control of communicable infections c.education of the individual in personal hygiene. d.organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and e.development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health. So organizing these benefits as to enable every citizen to realize his birthright of health and longevity”” (Hanlon, 1960. P.23) PUBLIC HEALTH NURSING WHO Expert Committee of Nursing a special field of nursing that combines the skills of nursing, public health and some phases of social assistance COMMUNITY HEALTH NURSING The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations (American Nurses Association, 1980, p. 2) It is considered to be a broader and more general specialty area that encompasses sub specialties that include public health nursing, school nursing, occupational health nursing, and other developing fields of practice such as home health, hospice care, and independent nurse practice. COMMUNITY HEALTH NURSING Ruth B. Freeman service rendered by a professional nurse with communities, families and individuals in all places Maglaya, et al “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” COMMUNITY HEALTH NURSING Jacobson Community Health Nursing is certainly not confined to public health nursing agencies a specialized field of nursing practice a science of Public Health combined with Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry (Characteristic of CHN) COMMUNITY HEALTH NURSING Margaret Sheltland man is of worth and dignity Philosophy of CHN What is community health? part of paramedical and medical intervention/ approach which is concerned on the health of the whole population aims: 1. health promotion 2. disease prevention 3. management of factors affecting health PUBLIC HEALTH NURSES Nurses in local / national health departments or public schools whether their official position title is Public Health Nurse or Nurse or School Nurse CLIENTS OF THE COMMUNITY HEALTH NURSE INDIVIDUAL FAMILY Basic Unit GROUP / AGGREGATE Entry point Common characteristics COMMUNITY Whole clientele BASIC PRINCIPLES OF CHN The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population & group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care BASIC PRINCIPLES OF CHN CHN practice is affected by developments in health technology, in particular, changes in society, in general The goal of CHN is achieved through multi-sectoral efforts CHN is a part of health care system and the larger human services system. ROLES AND RESPONSIBILITIES OF A COMMUNITY HEALTH NURSE Roles of Community Health Nurse The roles of the community health nurses are varied and dynamic. It is influenced by the nature of health needs of the population, specific goals of the health care system and attitudes and practices of the nurse in providing care. 1. Case Manager Assisting clients to make decisions about appropriate health care services and to achieve service delivery integration and coordination. 2. Advocate Clients in the community health nursing setting frequently are unable to negotiate for change in the health care system. The nurse seeks to promote an understanding of health problems, lobby for public policy and stimulate supportive community action for health. 3. Teacher Application of teaching- learning principles to facilitate behavioral changes among clients is a basic intervention strategy in community health. 4. Partner and Collaborator The aim of partnership and collaboration is to get people to work together in order to address problems or concerns that affect them. 5. Health Planner/Programmer Identifies needs, priorities and problems of individuals, families and communities Formulates nursing component of health plans Interprets and implements the nursing plan, program policies, memoranda and circulars for the concerned staff/personnel Provides technical assistance to rural health midwives in health matters 6. Manager/Supervisor Formulates individual, family and aggregates centered care plan Interprets and implements program policies Organizes work force, resources, equipments and supplies and delivery of health care at local levels Provides technical and administrative support to Rural Health Midwife (RHM). Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments/performances. 7.Community Organizer • Responsible for motivating and enhancing community participation in terms of planning, organizing, implementing and evaluating of health programs/services • Initiates and participates in community development activities 8.Health Educator/Trainer • Identifies and interprets training needs of RHMs, Barangay Health Workers/Volunteers (BHW/BHV) and Hilots • Formulates appropriate training program designs • Provides and arranges training and learning experiences of nursing and midwife affiliates • Conducts trainings for health personnel • Acts as resource speaker on health and health related services as the need arises • Participates in the development and distribution of Information Education and Communication (IEC)materials 9.Case-finder • Because of the proximity to families and aggregates in the community, case finding has been a strategic role for many years 10.Epidemiologist • The nurse uses the epidemiological method to study disease and health among population groups and to deal with community-wide health problems 11.Recorder/Reporter/Statistician • Prepares and summits required records and reports Review, validates, consolidates, analyzes, and interprets all records and reports • Maintains adequate, accurate and complete recording and reporting 12.Community Leader • The CHN, being a leader, a role model and respected in the community is in a better position to empower others Department of Health Vision FILIPINOS ARE AMONG THE HEALTHIEST PEOPLE IN SOUTHEAST ASIA BY 2022, AND ASIA by 2040 Mission TO LEAD THE COUNTRY IN THE DEVELOPMENT OF A PRODUCTIVE, RESILIENT, EQUITABLE AND PEOPLE CENTERED HEALTH SYSTEM FOR UNIVERSAL HEALTH CARE Department of Health The DOH holds the over all technical authority on health as it is a national health policy – maker and regulatory institution. THREE MAJOR ROLES IN THE HEALTH SECTOR : 1. Leadership in health 2. Enabler and capacity builder 3. Administrator of specific services ITS MANDATE IS TO DEVELOP A. NATIONAL PLANS B. TECHNICAL STANDARDS and C. GUIDELINES ON HEALTH Aside from being the regulator of all health services and products, the DOH is the provider of special tertiary health care services and technical assistance to health providers and stakeholders. Department of Health While pursuing its vision, the DOH adheres to the highest values of work, which are: INTEGRITY- believes in upholding truth and pursuing honesty, accountability and consistency in performing its functions. EXCELLENCE- continuously strive for the best by fostering innovation, effectiveness and efficiency, proaction,dynamism, and opennessto change COMPASSION AND RESPECT FOR HUMAN DIGNITY- upholds the quality of life, respect for human dignity is encouraged by working with sympathy and benevolence for the people in need. continuation COMMITMENT- commits to achieve its vision for the health and development of future generations. PROFESSIONALISM- performs its functions in accordance with the highest ethical standards and principles of accountability, and full responsibility . TEAMWORK- work together with a result –oriented mindset. STEWARDSHIP OF THE HEALTH OF THE PEOPLE- being stewards of health for the people, the department shall pursue sustainable development and care for the environment since it impinges on the health of the filipinos STANDARDS OF COMMUNITY HEALTH NURSING IN THE PHILIPPINES The professional nurse, including the community health nurse, must demonstrate comp areas of responsibility as determined by the Committee on Core Competency Standards Developm Nursing of the Philippines and the Commission on Higher Education Technical Committee on Nurs The Nursing Core Competency Standards were revised in 2012, building on the same set of key ar Together with a brief description and an example of each, the 11 key areas of responsibility are th 1. Safe & Quality Nursing Care a. Knowledge of health/illness status of the client b. Sound decision making c. Safety, comfort, and privacy of the client d. Priority setting based on client’s needs patients e. Administration of medications and health therapeutics f. Use of the nursing process 2. Management of Resources, Environment, & Equipment 3. Health Education 4. Legal Responsibility 5. Ethico-Moral Responsibility a. Organization of workload b. Use of financial resources for client care c. Mechanism to ensure proper functioning of equipment. d. Maintenance of a safe environment a. Assessment of client’s learning needs b. Development of a health education plan and learning materials c. Implementation and evaluation of the health education plan. a. Adherence to the nursing law and other relevant laws as well as to national, local and organizational policies including documentation of care given to clients a. Respect the rights of the client b. Responsibility and accountability for own decisions and actions c. Adherence to the international and national codes of ethics for nurses 6. Personal and Professional Development a. Identification of own learning needs. b. Pursuit of continuing education c. Projection of a professional image d. Positive attitude toward change and criticism e. Adherence to professional standards 7. Quality Improvement a. Data gathering for quality improvement. b. Participation in nursing audits and rounds c. Identification and reporting of variances in client care d. Recommendation of solutions to identified problems related to client care 8. Research a. Research-based formulation of solutions to problems in client care and dissemination and application of research findings 9. Records management a. Accurate and updated documentation of client care while observing legal imperatives in record keeping 10. Communication 11. Collaboration and Teamwork a. Uses therapeutic communication techniques during interactions with clients and coworkers for establishment of rapport, identifies verbal and nonverbal cues, and responds to client’s needs, while using formal and informal channels of communication and appropriate information technology. a. Establishment of collaborative relationship with colleagues and other members of the health team. b. Collaborative planning with other members of the health team. EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES Records of public health services in the Philippines date back to the Spanish regime. 1577 Juan Clemente, a Franciscan Friar opened a medical dispensary in Intramuros for the indigent. 1690 Dominican Father Ivan de Pergero worked toward installing a water system in San Juan del Monte and Manila. 1805 Smallpox vaccination was introduced by Dr. Francisco de Balmis, the personal physician of King Charles IV of Spain. 1876 First medicos titulareswere appointed by the Spanish government. They worked as provincial health officers. 1888 A 2- year course consisting of fundamental medical and dental subjects was first offered in the University of Santo Tomas. Graduates of this course known as cirujanos ministrantsserved as male nurses and sanitation inspectors. 1901 The United States Philippine Commission, through Act 157, created the board of Health of the Philippine Islands, with the Commissioner of Public Health as its chief executive officer. 1912 The Fajardo Act of 1912 created sanitary divisions made up of one to four municipalities. Each sanitary division had a “president”, who had to be a physician. 1915 Philippine General Hospital began to extend public health nursing services in the homes of patient by organizing a unit called Social and Home Care Service, with two staff nurses. La Gota de Leche (Founded in 1905 by the Association Feminista Filipina) was the first center dedicated to the service of mothers and babies 1947 The Department of Health was reorganized into bureaus: quarantine, hospitals that took charge of the municipal and charity clinics and health with the sanitary divisions under it. The reorganization also placed the administration of city health departments at the bureau level. 1954 Republic Act 1082 or the Rural Health Act that provided for the creation of a rural health unit in every municipality and employment of physicians to serve as municipal health officers, public health nurses, midwives, and sanitation inspectors in the rural health unit. 1957 Republic Act 1891 was enacted and amended certain provisions in the Rural Health Act. This law created 8 categories of rural health units corresponding to the population size of the municipalities. Regional Health offices were created as a result of decentralization efforts in 1958. 1970 Philippine health care delivery system was reconstructed, paving the way for the helath care system that exist to this day where health services are classified into primary, secondary and tertiarylevels. 1991 Republic Act 7160 or the Local Government Code was enacted. The law mandated devolution of basic services, including health services, to local government units and the establishment of a local head board in every province and city or municipality. 1999 The Health Sector Reform Agenda of the Philippines was launched, its implementation framework FOURmula One (F1) for Health in 2005, and Universal Health Care in 2010.Universal Health Care aims to achieve the health system goals of better health outcomes, sustained health financing and responsive health system that will provide equitable access to health care. Economically disadvantaged Filipinos are given risk protection through enrollment in PhilHealth (Philippine Health insurance Corporation) and that they are able to access affordable and quality health workers. 2000 The Philippines is a signatory to the United Nations Millennium Declaration adopted during the World Summit in September. The Department of Health has committed to the attainment of the health MDGs (Millennial Development Goals) to reduce child mortality, to improve maternal health, and to combat HIV/AIDS, malaria and other diseases. LEVELS OF PREVENTION LEARNING OBJECTIVES: 1. Integrate the three levels of prevention 2. Review the Universal health care law to the present health situation in the Philippines 3. Differentiating the 8 things the citizen to expect for the health care 4. Relate the strategic thrusts of Universal Health Care to the current health situation and the goal and objectives of Universal Health Care -Medical Care focuses on disease management -Cure public health efforts focus on health promotion and disease prevention 3 levels of prevention 1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention PRIMARY PREVENTION Relates to activities directed to preventing a problem before it occurs for susceptible individuals. 2 Elements 1. General health promotion 2. Specific protection Example: Promotion of good nutrition, provision of adequate shelter and encouraging regular exercise Specific protection efforts -Reduce or eliminate risk factors and include such measures as immunization, and water purification Primary level disease Prevention -directed towards individuals who are at Risk of developing a disease or those who are in the pre_x0002_pathogenic stage; deals with the removal of risk factors of specific protection of individuals against these risk factors Example; immunization, food supplementation, and malaria chemoprophylaxis. SECONDARY PREVENTION -Refers to early detection and prompt intervention during the period of early disease pathogenesis. -It was implemented after a problem has just begun but before signs and symptoms appear and target those populations who have risk factors Example: Mammography, Blood pressure screening, newborn screening and mass sputum examination for pulmonary tuberculosis Secondary prevention is also directed toward prompt intervention to prevent worsening conditions of the affected population. -This includes measures during the early stage of disease to prevent complications. -Teaching how to Oresol to her child suffering from diarrhea to prevent dehydration and administering vitamin A capsules to children with measles are examples. TERTIARY PREVENTION -Targets population that have experienced disease or injury and focuses on limitation of disability and rehabilitation. -Aims of tertiary prevention are to reduce the effects of disease and injury and to restore individuals to their optimal level of functioning. Examples: Teaching how to perform insulin injection techniques and disease management to a patient with diabetes, referring a patient with spinal injury for occupational and physical therapy and leading a support group for cancer patients who have undergone cancer treatment such as surgery, chemotherapy and radiation therapy. -The concept of prevention and population focused care figure prominently in a conceptual orientation to nursing practice referred to as “THINKING UPSTREAM”
