NCM 113

COMMUNITY HEALTH NURSING II

JOSEPHINE B. TULABING, MAN RN

 MIDTERM TOPICS:
NURSING PROCESS IN THE CARE OF POPULATION GROUPS AND
COMMUNITY

• Community Health Assessment Tools

• Community Diagnosis
• Planning Community Health Interventions
• Implementing Community Health Interventions
• Proper Excreta Disposal / Food Safety/ Sanitation / Vermin and Vector
Control/ Built Environment
• Monitoring and Evaluation of Community Health Programs Implemented
• Documentation and Reporting
NURSING PROCESS IN THE
CARE OF POPULATION
GROUPS AND COMMUNITY
 Learning Outcomes:
At the end of this term, the students will be able to:

 Assess the health needs of various population groups in the community.

 Create comprehensive care plans that target the specific health challenges and priorities of
different population segments, with a focus on promoting fairness and inclusiveness.

 Apply evidence-based strategies to prevent and address prevalent health issues among
specific population groups.

 Collaborate with community stakeholders and organizations to enhance health promotion

efforts and ensure that resources are available to meet the needs of the population.

 Evaluate the impact of nursing interventions on improving the health outcomes of population
groups.
PROPER EXCRETA AND
SEWAGE DISPOSAL
• It is significant to note that there has been an increase
in the proportion of households having sanitary toilet
facilities both in the urban and rural areas but there is
also an increase in the absolute number of persons,
which do not have access to sanitary toilet facilities.
• Health surveys reveal that there is underutilization of
sanitary toilet facilities in the sense that the mothers still
allow their children to move their bowels elsewhere
despite the presence of toilets in their own homes.
Approved Types of Toilet Facilities
LEVEL I
• Non-water carriage toilet facility- no water is
necessary to wash the waste into the receiving
space.
• Examples are pit latrines, reed odorless earth
closet
• Toilet facilities require a small amount of water to
wash the waste into the receiving space.
• Examples are pour toilet and aqua privies.
Approved Types of Toilet Facilities
LEVEL II
• On-site toilet facilities of the water carriage type
with water sealed and flush type with a septic vault/
tank disposal facilities.
Approved Types of Toilet Facilities
LEVEL III
• water carriage types of toilet facilities connected
to septic tanks and/or to sewerage system to
treatment plant.
Approved Types of Toilet Facilities
LEVEL III
• In rural areas, the “blind drainage” type of wastewater
collection and disposal facility shall continue to be the
emphasis until such time that sewer facilities and off-site
treatment facilities are made available to clustered houses in
rural areas.
Approved Types of Toilet Facilities
LEVEL III
• Conventional sewerage facilities are to be
promoted for construction in “Poblacion” and cities
in the country as development objectives to attain
control and prevention of fecal-water-borne
diseases.
• Other policies embodied in the Sanitation Code of
the Philippines shall be pursued and enforced by
the local government units.
FOOD SAFETY
FOOD SAFETY
• defined as the assurance that food will not cause
any harm to the consumer when it is prepared and
eaten according to its intended use.
FOOD SAFETY
• To gear toward food safety, the DOH for an inter-
agency committee that is led by the Food and Drug
Administration (FDA).
• In 2009, Republic Act 9711 was enacted and it is
now known as the Food and Drug Administration
Act, which strengthened the FDA in safeguarding
the safety and quality of processed foods, drugs,
diagnostic reagents, medical devices, cosmetic and
household substances.
FOOD SAFETY
• The food preparation and storage rooms should
never be used or be directly connected to a
sleeping apartment or toilet.
• No animals can be kept in the food area.
• The display of any live animal in the food area is
strictly prohibited.
• Floors, walls, and ceilings must be made of
materials that can be cleaned.
FOOD SAFETY
• Utensils must be scrapped from all food particles
and be washed in warm water (49°C) with soap.
• If running water is not available, the wash water
shall be changed frequently.
FOOD SAFETY
• The utensils are then subjected to one of the
following bactericidal treatments:
1. Immersion for at least 30 seconds in clean hot
water (77°C).
2. Immersion for at least 1 minute in lukewarm water
containing 55-100 ppm of chlorine solution.
3. Exposure to steam for at least 15 minutes to 77°C,
or 5 minutes to at least 200°C.
FOOD SAFETY
• It shall be the duty of the Sanitation Inspector of
the city, municipality, or province to perform an
inspection and evaluation of the compliance of food
establishments to the set standards at a frequency
specified by the implementing rules and regulations.
FOOD SAFETY
• Ambulant food vendors shall sell only bottled
drinks and prepacked food.
• They are prohibited from selling food that requires
the use of utensils.
• As monitored by the FHSIS, all food handlers must
maintain an updated health certificate.
• The public health nurses are in an advantageous
position to participate in the monitoring and
implementation of the ordinance on food handlers
as they are given the task to collate and report data
FOOD SAFETY
• The public health nurses are in an advantageous
position to participate in the monitoring and
implementation of the ordinance on food handlers
as they are given the task of collating and reporting
data in the FHSIS system.
SANITATION
SANITATION
• The Philippines Sanitation sourcebook and
Decision Aid developed DENR, the DOH and the
Local Water Utilities Administration (LWUA) in 2005
limited the definition of sanitation to “hygienic and
proper management, collection, disposal or reuse
of human excreta (feces or urine) and community
liquid wastes to safeguard the health of individuals
and communities”.
SANITATION
• This is proof of the development of the arts
and sciences involved in the various fields of
sanitation, that is, a singular code on
sanitation such as the Presidential Decree
856: the Code on Sanitation of the
Philippines of 1976 may need to be revisited
and updated to provide a more
comprehensive coverage of this growing
discipline.
 SANITATION FACILITIES
Box-and-can privy (or bucket latrine)
• Fecal matter is collected in a can or bucket,
which is periodically removed for emptying
and cleaning.
 SANITATION FACILITIES
Pit latrine ( or pit privy)
• Fecal matter is eliminated into a hole in the
ground that leads to a dug pit.
• Generally, a latrine refers to toilet facilities without
a bowl.
• It can be equipped with either a squatting plate
or a riser with a seat. The pit reduces the volume of
its content as the liquid infiltrates the surrounding
soil.
 SANITATION FACILITIES
Antipolo toilet
• It is made up of an elevated pit privy that
has a covered latrine.
• The elevation ensures that the bottom of
the pit is at least 1.5 meters above the water
table.
 SANITATION FACILITIES
Septic privy
• Fecal matter is collected in a built septic
tank that is collected to a sewerage system.
• The septic tank contains water but there
is no drop pipe from the latrine that is
dipped into the water.
 SANITATION FACILITIES
Aqua privy
• Fecal matter is eliminated into a water-sealed drop
pipe that leads from the latrine to a small water-filled
septic tank located directly below the squatting plate.
The drop pipe extends below the septic tank water
level to form a simple water seal.
• An effluent pipe is installed in the septic tank to
prevent overflow of water through the squatting plate.
Water loss is then replaced by adding water with each
toilet use. A ventilation pipe with a fly screen on top is
part of the design of the housing of this facility.
 SANITATION FACILITIES
Overhung latrine
• Fecal material is directly eliminated into a body of water such
as a flowing river that is underneath the facility.
• Public health organizations such as the WHO recognize the
acceptability of the use of such in disaster situations like heavy
flooding when the body of water is deemed polluted.
• The chosen body of water should be large and freely flowing.
• The public health nurse should coordinate with downstream
communities on releasing advisories that the body of water is
polluted.
 SANITATION FACILITIES
Ventilated-improved pit (VIP) latrine
• It is a pit latrine with a screened air vent installed
directly over the pit.
• The ambient air that enters the pit hole pushes the
foul air onto the air vent.
• The screen on top of the vent prevents entry of
insects attracted by the smell.
• F il l e d p its a re th e n cove re d w ith so il fo r
composting, and the facility is directed or relocated
to another pit.
 SANITATION FACILITIES
Concrete vault privy
• Fecal matter is collected in a pit privy lined with
concrete in such a manner as to make it watertight.
Chemical privy
• Fecal matter is collected into the tank that
contains a caustic chemical solution, which in turn
controls and facilitates the waste decomposition.
 SANITATION FACILITIES
Compost privy
• Fecal matter is collected into a pit with urine
and anal cleansing materials with the addition
of organic garbage such as leaves and grass
to allow biological decomposition and
production of agricultural or fishpond
compost (or night soil).
 SANITATION FACILITIES
Pour-flush latrine
• It has a bowl with a water-seal trap similar
to the conventional tank-flush toilet except
that it requires only a small volume of water
for flushing.
• Feces at the water-sealed trap are washed
off by small quantities of water hand-
poured from a container.
 SANITATION FACILITIES
Tank-flush toilet
• Feces are excreted into a bowl with a water
-sealed trap. The water tank that receives a
limited amount of water empties into the bowl
for flushing of fecal materials through the
water-sealed trap and into the sewerage
system.
• The trap retains an amount of the flush to
mountain the water seal.
 SANITATION FACILITIES
Urine diversion dehydration toilet (UDDT)
• It is a waterless toilet system that allows the
separate collection and on-site storage or treatment
of urine and feces.
• The site could be made up of a urine separation
toilet with the urine side leading to a collecting
container for agricultural use and the fecal side
leading to a ventilated vault.
• The fecal vault is kept “dry” and the feces are left
to dehydrate for agricultural use.
 SANITATION FACILITIES
In 2010, the DOH published the Philippine Sustainable
Sanitation Roadmap and defined the three sanitation
facilities that are considered sanitary under the DOH
and the National Statistics Office (NSO) definitions:
• Water-sealed toilet connected to a sewer or septic
tank, used exclusively by the household.
• Water-sealed toilet connected to another depository
type, used exclusively by the household.
• Closed pit used exclusively by the household
 SANITATION FACILITIES
The same considers the following as unsanitary facilities:
• Water-sealed toilet connected to a sewer or septic tank,
shared with other households.
• Water-sealed toilet connected to another depository type,
shared with another household.
• Closed pit, shared with another household.
• Open pit.
• Hanging toilet.
• Other unsanitary types of practice.
• Open defecation
VERMIN AND VECTOR
CONTROL
The DOH has also prepared the Implementing Rules and
Regulations of Chapter XIV Vermin Control of the Code of
Sanitation of the Philippines (PD 856). This document
defined the following terms:
Vermin. A group of insects or small animals such as flies,
mosquitoes, cockroaches, fleas, lice, bedbugs, mice, and
rats which are vectors of the disease.
Insects. Flies, mosquitoes, cockroaches, bedbugs, fleas,
lice, ticks, ants and other arthropods.
Pest. Any destructive or unwanted insect or other small
animals (rats, mice, etc.) that cause annoyance, discomfort,
nuisance, or transmission of disease to humans and damage
to structures.
Rodent. Small mammals such as rats and mice, are
characterized by constantly growing incisor teeth used for
gnawing or nibbling.
Vector. Any organism that transmits infection by inoculation
into the skin, food, or other objects; or by biological
reproduction within the organism.
The DOH identified the strategies of a vermin abatement
program, namely
• It must be community-wide and community-participated.
• It must be technically coordinated.
• It must be continuing.
• It must be basically a partnership between the private and
government sectors.
• It should preferably utilize indigenous technology and
resources to attain self-reliance.
The DOH outlined the various vermin control and disinfection
methods, which include:
• Environmental sanitation control: The maintenance of
cleanliness of the immediate premises and proper building
construction and maintenance so as to prevent access of
pests into human dwellings. Clean-up drives are aimed at
altering or eliminating the breeding sites of the vectors.
• Naturalistic control: A pest control method that utilizes
nature and nature’s systems without disturbing the balance
of nature.
Biological and genetic control: A method that utilizes living
predators, parasites, and other natural enemies of the pest
species to reduce or eliminate the pest populations. It is
aimed at killing the larvae without polluting the environment.
Mechanical and physical control: A method that utilizes
rodenticides, insecticides, larvicides, and pesticides.
Integrated control: A method that controls pests through the
use of different methods and procedures that are used to
complement each other. These procedures may include the
use of pesticides, environmental sanitation measures, and
natural, as well as mechanical and biological control methods
BUILT ENVIRONMENTS
• The built environment refers to the manmade
structures that provide a setting for human activities.
• In the Philippines, Presidential Decree Number
1096 (P.D. 1096) also known as the National Building
Code of the Philippines, governs the design of built
environments.
• In 2004, the Department of Public Works and
Highways developed the Revised Implementing
Rules and Regulations of the National Building Code
of the Philippines.
Some of the provisions enacted to protect public
health are as follows.
• Minimum air space shall provided as follows
•School rooms- 3.00 m³ with 1.00 m2 of floor
area per person
•Workshops, factories, and offices- 12.00 m³ of air
space per person
•Habitable rooms- 14.00 m³ of air space per
person
Minimum sizes of rooms and their least horizontal
dimensions shall be as follows:
• Rooms for human habitations- 6.00m² with at least
a horizontal dimension of 2.00m
• Kitchen- 3.00m² with at least a horizontal
dimension of 1.50m
• Bath and toilet – 1.20m² with a least horizontal
dimension of 900mm
Ceiling height of habitable rooms:
• Rooms provided with artificial ventilation shall have
ceiling heights not less than 2.40m (8ft.) measured
from the floor to the ceiling.
• Rooms with natural ventilation shall have ceiling
heights of not less than 2.70m (9ft.)
• Mezzanine floors shall have a clear ceiling height
not less than 1.80m above and below it
Minimum window sizes:
• Rooms intended for any use, not provided with an
artificial ventilation system, shall be provided with a
window or windows with a total free area of
openings equal to at least 10% of the floor area of
the room, provided that such opening shall be not
less than 1.00 m².
• Toilet and bathrooms, laundry rooms, and similar
rooms shall be provided with windows with an area
not less than 1/20 of the floor area such opening
shall not be less than 240mm².
• Such window or windows shall open directly to a
cour t, ya rd , p ub l ic stre e t or a l l e y, or op e n
watercourse.
References:
• Nies M.A., McEwen M., & Sumile E.F. (2020).
Community and Public Health Nursing (2nd
Philippine ed). Elsevier Inc.
• Famorca, Z. U., Nies, M. A., & McEwen, M. (2013).
Nursing Care of the Community: A Comprehensive
Text on Community and Public Health Nursing in the
Philippines. Elsevier Inc.
THANK YOU