COMMUNITY HEALTH

NURSING

COMMUNITY

Social group determined with geographic

boundaries, common values and
interest.
-Its members known to interact each
others
its function with a particular social
structure exhibits, and create norms,
values and social
institution .

HEALTH

It is a state complete physical, mental, social

wellbeing not merely the absence of disease or
Infirmity. (WHO)
State of well being and using power the individual
possess to the fullest extent. (Nightingale)
An on going process- a way of life through which a
person develops and encourages every aspects
of the body, mind and feelings to interrelate
harmoniously as much as possible. (Kozier)
The modern concept of health refer to optimum
level of individual, families, and community.

Nursing

Is an art and science of holistic,

adaptive caring and helping profession
with focus centered to client concerned
with health promotion, health
maintenance and health restoration.

NURSING
(ADPCN) Nursing is a dynamic discipline. It is
an art & science of caring for individuals,
families groups & communities geared toward
promotion & restoration of health, prevention
of illness, alleviation of suffering & assisting
clients to face death w/ dignity and peace. It is
focused on assisting client as he or she
responds to health illness situations, utilizing
the nursing process & guided by ethico-legal
moral principles.
Art-gained frm experiences, practice
Science scientifically tested knowledge

COMMUNITY HEALTH NURSING

Field of nursing practice where services are carried out in

the community settings such as home, work place,
puericulture, clinic and the like.
Scope of services covered the whole range of health
promotive, preventive, curative & rehabilitative.
Special field of nursing that combines the (A) skills and
knowledge of nursing, (B) public health (C) some phases
of assistance and functions.
The nature of practice is comprehensive, general,
continual and not episodic.
It s practice directed to individuals, families, and groups,
the dominant responsibility is to the population as a
whole.

PUBLIC HEALTH

Art & science of preventing disease

prolonging life, promoting health, efficiency.
Services for early diagnosis & preventive
treatment of disease and the development
of social machinery to ensure everyone
standard of living adequate for
maintenance of health organizing of these
benefits as to able every citizen to realize
his birthright of health and longevity.

Health as Multi Factorial Phenomenon

A. Political
The political climate affects health. This involves ones leadership, how
he/she rules, manages and involves other people in decision making. If
our leaders today did not give emphasis on the health of citizens, there
would be government funding nor would there be any government led
programs for health. The following are subcomponents
1. Safety
Is the condition of being from harm, injury or loss (Webster)
If there were no laws to ensure protection from exploitative working
conditions, slavery could possibly exist and safety as a health need
wouldnot be a right. Government is also expanding access to social
security. Today, every Filipino has a right to obtain health benefits as a
result of his/her SSS membership

Political
2. Oppression
Oppression is unjust or cruel exercise of
authority or power. Before the advent of a
democratic way of government, people were
more prone to oppression. This does not mean
that oppression does not exist today it still
looms in our political environment. It ultimately
contributes to the poverty of citizen and in the
long run the health status of the people as
they are not able to purchase the necessary
drugs for their illness / condition.

Political
3. Political will
Political will is the determination to pursue
something which is in the interest of the
majority. This is a quality of a democratic
government. The people are allowed to
choose their representatives in congress
for enactment of laws and government.

Political
4. Empowerment
Empowerment is the ability of a person to
do something, creating the
circumstances where people can use their
faculties and abilities at the maximum
use level in the pursuit of common goals.
When one is empowered he or she feels
as though they are able to make
responsible choices and decide on future
steps based on their needs

Cultural
B. Cultural
Culture is the representation of nonphysical traits such as
values,beliefs, attitudes and customs shared by a group of people
and passed from one generation to the next (Potter, 1993), these
can be:
1. Practices In health care, these are customary actions usually
done to promote and maintain health like use of anting -anting or
lucky charms
2. Beliefs which is a state or habit of mind wherein a group of
people place a trust into something or a person (Webster) In health
care, beliefs motivate ones behavior to achieve health. Take for
example the belief that you
should not take baths on Fridays, although this not scientifically
proven, people by virtue of their culture will not take baths
because they believe that this could lead to sickness.

Heredity
Of course heredity also affects health
status of individuals.
Heredity is the genetic transmission of
traits from parents to offspring;
genetically determined (Miller-Keane,
1987) Certain diseases are found to be
genetically transmitted.

Environment
Environment as a factor in health is the sum
total of all theconditions and elements that
make up the surrounding and influence the
development of an individual. (Miller -Keane,
1987)
Florence Nightingale was a pioneer who truly
understood how the environment affected an
individuals health. When we discuss our
health situation you will discover that most
illness prevalent are truly preventable with
proper environmental sanitation and hygiene

Socio-economic
Refers to the production activities,
distribution and consumption of goods of
an individual. Without the proper means to
sustain a health lifestyle, this need
becomes neglected. It is difficult to
choose between medications that must be
bought today to address an illness and
food that must be bought in order to
survive another day.

Levels of Prevention
1.

2.

3.

Primary level health promotion

Secondary level Preventive, PA, early
detection & prompt treatment
Tertiary level - rehabilitation

HEALTH PROMOTION

"Health promotion is the process of enabling people

to increase control over, and to improve, their
health. To reach a state of complete physical,
mental, and social well-being, an individual or group
must be able to identify and to realize aspirations,
to satisfy needs, and to change or cope with the
environment. Health is, therefore, seen as a
resource for everyday life, not the objective of
living. Health is a positive concept emphasizing
social and personal resources, as well as physical
capacities. Therefore, health promotion is not just
the responsibility of the health sector, but goes
beyond healthy lifestyles to well-being.

OTTAWA CHARTER FOR HEALTH

PROMOTION

"The fundamental conditions and

resources for health are peace, shelter,
education, food, income, a stable
ecosystem, sustainable resources, social
justice, and equity. Improvement in
health requires a secure foundation in
these basic prerequisites.

Mediate

"The prerequisites and prospects for

health cannot be ensured by the health
sector alone. More importantly, health
promotion demands coordinated action
by all concerned: by governments, by
health and other social and economic
sectors, by nongovernmental and
voluntary organizations, by local
authorities, by industry, and by the
media.

People in all walks of life are involved as

individuals, families, and communities.
Professional and social groups and
health personnel have a major
responsibility to mediate between
differing interests in society for the
pursuit of health.
"Health promotion strategies and
programs should be adapted to the local
needs and possibilities of individual
countries and regions to take into
account differing social, cultural, and
economic systems.

Health Promotion Action Means

The Charter defines health promotion in
terms of the following activities: building
healthy public policy in the full range of
administrative and legislative action;
creating supportive environments via a
socio ecological approach to health;
strengthening community action and
democratic planning processes;
developing personal skills via education;
and reorienting health services toward
health promotion in addition to curative
services.

Moving into the Future

Citing caring, holism, and ecology as central

issues, the signatories to the Charter pledged
to promote health in various ways, including:
advocating a clear political commitment to
health and equity in all sectors;
counteracting trends and products that harm
health; reorienting health services toward
health promotion; recognizing health and its
maintenance as a major social investment.

Call for International

Action

The Charter concludes with a

statement calling on the
World Health Organization
and other international
bodies to advocate the
promotion of health.

ACTION AREAS OF OTTAWA

CHARTER FOR HEALTH
PROMOTION

Building healthy public

policy
Health promotion policy combines
diverse but complementary approaches,
including legislation, fiscal measures,
taxation and organisational change.
Health promotion policy requires the
identification of obstacles to the
adoption of healthy public policies in
non-health sectors and the development
of ways to remove them.

Creating supportive environments

The protection of the natural

and built environments and the
conservation of natural
resources must be addressed in
any health promotion strategy.
Work, leisure and living
environments should be a source
of health for people.

Strengthening community action

Community development draws on
existing human and material resources
to enhance self-help and social support,
and to develop flexible systems for
strengthening public participation in, and
direction of, health matters. This
requires full and continuous access to
information and learning opportunities
for health, as well as funding support

Developing personal skills

Through information and education
skills - enabling people to learn
(throughout life) to prepare
themselves for all of its stages and
to cope with chronic illness and
injuries is essential. This has to be
facilitated in school, home, work
and community settings.

Reorienting health services toward health

promotion

All health services of different

health agencies regardless of
their status of work should
promote Health.

Theories / Models of Health Promotion

Penders Theory
Individual
Characteristics
& Experiences
Prior
related
Behaviour
Personal
Factors;
Biological;
Psychologic
al sociocultural

Behaviour-specific
Cognitions & Affect
Perceived
benefit of
action
Perceived
barrier of
action
Perceived self
efficacy
Activity related
affect
Interpersonal
influences (family,
peers, providers)
norms, support
Situational
models
influences; options,

Behavioural
Outcome
Immediate
competing
demand
(low
control) &
preference
s
Commitme
nt to a
plan of
actionHealth
promotin
g
behavio
ur

Health Belief Model

Conceptual Model
Individual
Modifying
Likelihood of
Age, factors
sex, ethnicity,
Perception

personality, socioeconomics,
knowledge

Perceived
susceptibility/
seriousness of
disease

Perceived threat of
disease
Cues to action
Education
Symptoms
Media information

action

Perceived benefits
VS
Barrier to
behavioural

change
Likelihood of
behavioural
change

Bandura Self Efficacy

Self-efficacy is the belief in ones

capabilities to organize and execute the
courses of action required to manage
prospective situations.
Self-efficacy is a persons belief in his or
her ability to succeed in a particular
situation. Bandura described these
beliefs as determinants of how people
think, behave, and feel.

Role of Self Efficacy

The Role of Self-Efficacy
Virtually all people can identify goals they want to accomplish, things
they would like to change, and things they would like to achieve.
However, most people also realize that putting these plans into action
is not quite so simple. Bandura and others have found that an
individuals self-efficacy plays a major role in how goals, tasks, and
challenges are approached.
People with a strong sense of self-efficacy:
View challenging problems as tasks to be mastered.
Develop deeper interest in the activities in which they participate.
Form a stronger sense of commitment to their interests and activities.
Recover quickly from setbacks and disappointments.
People with a weak sense of self-efficacy:
Avoid challenging tasks.
Believe that difficult tasks and situations are beyond their capabilities.
Focus on personal failings and negative outcomes.
Quickly lose confidence in personal abilities (Bandura, 1994).

Sources of Self-Efficacy
1.

2.

3.

4.

Mastery Experiences
The most effective way of developing a strong sense of efficacy is through mastery experiences,"
Bandura explained (1994). Performing a task successfully strengthens our sense of self-efficacy.
However, failing to adequately deal with a task or challenge can undermine and weaken self-efficacy.
Social Modeling
Witnessing other people successfully completing a task is another important source of self-efficacy.
According to Bandura, Seeing people similar to oneself succeed by sustained effort raises observers'
beliefs that they too possess the capabilities master comparable activities to succeed (1994).
Social Persuasion
Bandura also asserted that people could be persuaded to belief that they have the skills and
capabilities to succeed. Consider a time when someone said something positive and encouraging that
helped you achieve a goal. Getting verbal encouragement from others helps people overcome selfdoubt and instead focus on giving their best effort to the task at hand.
Psychological Responses
Our own responses and emotional reactions to situations also play an important role in self-efficacy.
Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about
their personal abilities in a particular situation. A person who becomes extremely nervous before
speaking in public may develop a weak sense of self-efficacy in these situations. However, Bandura
also notes "it is not the sheer intensity of emotional and physical reactions that is important but rather
how they are perceived and interpreted" (1994). By learning how to minimize stress and elevate mood
when facing difficult or challenging tasks, people can improve their sense of self-efficacy.

Quiz

a.
b.
c.

What are the component of political factor in health? (1-4)

What is this health factors that determine the sum total of
all the condition& elements that makes up the
surroundings? (5)
It an art & science of preventing disease, prolonging life
and promoting health.(6)
Identify what level of preventions are the following
activities. (7-16)
Biopsy
d. scrotal exam
Diabetes awareness
e. tooth brushing drill
Application of braces for scoliosis

f. Immunization
g. Toilet construction
h. Proper Hand washing technique
i. Removal of tumor in abdomen
j. Physical therapy

Define Health.
Define nursing according
to ADPCN.
Define community.
Define community health
nursing.

DOH ROLES & FUNCTIONS

1. LEADERS IN HEALTH
2. ENABLE AND CAPACITY BUILDER
3. ADMINISTRATOR OF SPECIFIC
SERVICES

III Phil. Health Care Delivery System

DOH
MissionGuarantee equitable,
sustainable and quality health for
all Filipinos, especially the poor, and
to lead the quest for excellence in
health.
VISSION The Leader of Health
for All in the Philippines.

HSRA GOAL

SUPPORT MECHANISM WILL BE

THROUGH SOUND ORGANIZATIONAL
DEVELOPMENT, STRONG POLICIES
SYSTEM AND PROCEDURE CAPABLE
HUMAN RSOURCES AND ADEQUATE
FINANCIA RESOURCES

Fourmula one for Health

Better health outcome

More responsive health system
Equitable health care financing
ELEMENTS
Health financing
Health regulation
Health service delivery
Good governnce

Primary Health Care

Primary Health Care: as a philosophical approach to health

and health care

This approach is characterised by an holistic understanding

of health as wellbeing, rather than the absence of disease.
The presence of good health is dependent upon multiple
determinants; health services are important but so too are
housing, education, public works, industry, agriculture,
communication and other services. The health status of
communities is both a function of and a reflection of
development in those communities. The locus of control is
important in PHC; health services should reflect local needs
and involve communities and individuals at all levels of
planning and provision of services. Services and technology
should be affordable and acceptable to communities.
Through health promotion and preventive care, PHC aims
to eliminate causes of ill health. Equity is a crucial part of

PHC History

Alma Ata international conference on PHC in Sept.

12, 1978, the WHO and UNICEF proposed new
concept of PHC. This conference proved to be a
turning point in the history of health care policy.
Backed by the fundamental tenet that health is a
basic human right for which disparities or
inequalities should not allowed, it culminated with
a call for citizen led activities at the regional level
in public hygiene, health education, MCHC, FP.
Accepting that challenge, in 1981 the 34 th WHO
General conference drew up a set of global targets
aimed at improving health for all by the year 2000.

PHC Philosophy

holistic understanding of health

recognition of multiple determinants of
health
community control over health services
health promotion and disease prevention
equity in health care
research-based methods
accessible, acceptable, available,
affordable technology

PHC Strategies

needs-based planning
decentralised management
education
Inter-sectoral coordination and
cooperation
balance between health promotion,
prevention and treatment
multi-disciplinary health workers

PHC Services

locally based
affordable and accessible , available,
acceptable
well integrated
health care teams
health promotion
disease prevention
illness treatment
rehabilitation services

PHC Elements/ Components

E-Education for Health

L- Local Endemic Disease Control
E- Expanded Program on Immunization
M- Maternal & Child Care
E- Essential Drugs
N- Nutrition
T- Treatment of communicable diseases
S- Safe Water and Sanitation

Rationale for PHC

Many people die w/o seeing by the health care

provider.
Communicable disease are still dominant cause of
illness and death among all age group
Rapid population growth rate.
Poor environmental sanitation.
Lack of basic health knowledge
Thousands allied professionals were registered but
prefer to work in secondary or tertiary level
High cost of medical services now a days.
Budgetary allocation for health care institution are
not enough to sustain the health of the population

DOH PROGRAMS

MATERNAL AND CHILD HEALTH

Maternal care:
1. Ante- natal care registration, visits
2. tetanus toxoid immunization
3. micronutrient supplementation
4. tx of other diseases and conditions
5. clean and safe delivery- use of partograph
6. Post partum care
7. family planning program

CHILD CARE

Infant and child feeding

Newborn screening
EPI
Management of childhood illnesses
Micronutrient supplementation
Dental health
Early child development
Child health injuries

HEALTH SERVICES FOR NEWBORN, INFANT

AND CHILD

Newborn resuscitation
Newborn routine eye prophylaxis
Prevention & mgt of hypothermia of
newborn
Immediate & exclusive BF
Complimentary feeding at six mos.
Birth registration
Birth weight & monitoring
Full immunization

HEALTH SERVICES FOR NEWBORN, INFANT

AND CHILD

Micronutrient supplementation
Dental care
Developmental milestone screening
Advice on psychosocial stimulation
Growth monitoring and promotion
Nutritional screening
Disability detection
IMCI
First aid

REPRODUCTIVE HEALTH
ELEMENTS:

FP
MCH &Nutrition
Prevention & mgt of RTI, STI & HIV/AIDS
Prevention & mgt of abortion & its complication
Prevention & mgt of breast & repro CA other
gynecological conditions
Education & counselling on sexuality & sexual
health, mens reproductive health & involvement
Violence against women & children
Prevention & mgt of infertility & sexual dysfunction

Herbal Medicines

Akapulko (Cassia alata)a medicinal plant called "ringworm bush or schrub"

and "acapulco" in English, this Philippine herbal medicine is used to treat tinea
infections, insect bites, ringworms, eczema, scabies and itchiness.
Ampalaya (Momordica charantia)Common names include "bitter melon " or
"bitter gourd " in English. This Philippine herbal medicine has been found to be
effective in the treatment of diabetes (diabetes mellitus), hemofrhoids, coughs,
burns and scalds, and being studied for anti-cancer properties.
Bawang (Allium sativum)Common name in english is "Garlic". Bawang is a
used in Philippine herbal medicine to treat infection with antibacterial,
antiinflammatory, anti-cancer and anti-hypertensive properties. It is widely used
to reduce cholesterol level in blood.
Bayabas (Psidium guajava)- "Guava" in English. A Philippine herbal medicine
used as antiseptic, anti-inflammatory, anti-spasmodic, antioxidant
hepatoprotective, anti-allergy, antimicrobial, anti-plasmodial, anti-cough,
antidiabetic, and antigenotoxic in folkloric medicine.
Lagundi (Vitex negundo)- known as "5-leaved chaste tree" in english is used
in Philippine herbal medicine to treatcough, colds and fever. It is also used as
a relief for asthma & pharyngitis, rheumatism, dyspepsia, boils, and diarrhea.

Niyog-niyogan (Quisqualis indica L.)- is a vine known as "Chinese

honey suckle". This Philippine herbal medicine is used to eliminate
intestinal parasites.
Sambong (Blumea balsamifera)- English name: "Ngai camphor or
Blumea camphor" is a Philippine herbal medicine used to treatkidney
stones, wounds and cuts, rheumatism, anti-diarrhea, anti spasms, colds
and coughs and hypertension
Tsaang Gubat (Ehretia microphylla Lam.)- English :"Wild tea" is a
Philippine herbal medicine taken as tea to treat skin allergies including
eczema, scabies and itchiness wounds in child birth
Ulasimang Bato | Pansit-Pansitan(Peperomia pellucida) is a Phillipine
herbal medicine known for its effectivity in treating arthritis and gout.
Yerba Buena(Clinopodium douglasii)- commonly known as
Peppermint, is used in Philippine herbal medicine as analgesic to relive
body aches and pain due to rheumatism and gout. It is also used to treat
coughs, colds and insect bites

Health related laws in the

Phil.

RepublicAct 349Legalizes the use of

humanorgans for surgical, medical and
scientific purposes
RepublicAct 1080Civil Service
Eligibility
RepublicAct 1082Rural Health Unit
Act
Republic Act 1136 Act recognizing
the Divisionof Tuberculosis inthe DOH

RepublicAct 1891Act strengthening

Health and Dental services in the rural
areas.
Republic Act 2382 Philippine Medical
Act which regulates the practice
ofmedicines in the Philippines
RepublicAct 3573Law on reporting of
Communicable Diseases
RepublicAct 4073Liberalized treatment
of Leprosy
RepublicAct 6425Dangerous Drug Act
of 1992

RepublicAct 6675GenericsAct of1988

RepublicAct 7160Local Government
Code
RepublicAct 7170Law that govern organ
donation
RepublicAct 7277Magna Carta of
Disabled Persons
RepublicAct 7305The Magna Carta of
public Health Workers
RepublicAct 7432Senior Citizen Act

RepublicAct 7600Rooming In
andBreastfeedingAct of 1992
RepublicAct 7719National Blood
Service Act of 1994
RepublicAct 7883Barangay Health
workersBenefits and IncentivesAct
RepublicAct 8172Asin Law
RepublicAct 8423Philippine Institute
ofTraditional and Alternative Medicine

RepublicAct 8749The PhilippineClean

AirAct of1999
RepublicAct 9165Comprehensive
Dangerous Drugs Act 2002
RepublicAct 9173Philippine Nursing Act
of 2002
RepublicAct 9288Newborn Screening Act
Presidential Decree 147
DeclaresApril &May as National Immunization
Day

Presidential Decree 491 Nutrition Program

Presidential Decree 996 Provides for
compulsory basic immunization forchildren and
infants below 8 years of age
Presidential Decree 856 Code of Sanitation
Executive Order 51 The Milk Code
Administrative Order 114 Revised/updated
the roles and functions of theMunicipal Health
Officers, Public Health Nurses andRural Midwives

Community Organization

A process, mechanism or means of attaining

goal of community development
Deals with problem solving
Begins as a response to the need or
problems
Seek a social change
Bringing people together who have similar
needs or interest
In small task oriented-groups with certain
defined objectives and activities

co

In complex form, it requires bringing

together various sectors of the
population, relevant government and
non-government agencies and institution

Community Organizing

A continuous and sustained process of:

Guiding people to understand the

existing condition of their own
community

Organizing people to work collectively

and efficiently on their immediate and
long term problems

Community Organizing

Mobilizing people

Develop their capacity

Readiness to respond

Take action on their immediate and

l
longterm needs
COPAR- Community organizing
participatory action research
A social development approach that aims to
transform the apathetic, individualistic and
voiceless poor into dynamic participatory &
politically responsive community.

COPAR
A collective, participatory,
transformative, liberalative, sustained
and systematic process of building
peoples organization by mobilizing &
enhancing the capabilities & resources of
the people for the resolution of their
issues & concerns toward effective
change in their existing oppressive &
exploitative condition
(1994 National Rural CO Conference).

IMPORTANCE OF COPAR

Tool for the community development &

people empowerment as this helps the
community workers to generate community
participation in development activities.
Prepares people to eventually take over the
management of development program in
the future.
Maximizes community participation and
involvement: Community resources are
mobilized for health development services.

PRINCIPLES OF COPAR

People, especially the most oppressed,

exploited & deprive sectors are open to
change, have the capacity to change &
are able to bring about change.
COPAR, should based on the interest of
the poorest sectors of the society.
COPAR, should lead to self reliant
community and society.

METHOD USED IN COPAR

A progressive cycle action- reflection action, w/c

begin with small, local & concrete issues, identified
by the people & the evaluation and reflection of and
on the action taken by them.
Consciousness-raising, through experiential learning
is central to the COPAR process because it place
emphasis on learning that emerges from concrete
action & w/c encircle succeeding action.
COPAR is participatory and massed-based, because
it is primarily directed towards & based in favor of
the poor, the powerless & the oppressed.
COPAR is grouped centered & not leader certered.
Leaders are identified emerge & are tested through
action rather than appointed or selected external
force

Process/Phases of COPAR

Pre-entry phase conduct of preliminary social

analysis of the community is needed to be able to plan
the most effective way of entering the community
Preparation of staff
Do you like working for the people?
Do you believe on peoples capacity to change?
Do you believe that people have the potentials to
contribute to their own development?
Do you believe that people should be empowered to
make decision on matters affecting them?
Will you support peoples decision?
Are you committed to serving peoples interest?

Pre-entry

Site collection steps

Developing the criteria for site collection
Identifying potential municipality/
catchment area
Identifying potential barangay
Choosing the final project village/
barangay
Identification of the host family

Process/ Phases of COPAR

Entry phase- immersion phase

Community integration
Participating in community activities
Conversing with people in places where
they usually converge
Conducting house to house visit or social
calls
Social investigation
Collecting
Synthesizing
Collating
Analyzing data

Process / Phases of COPAR

Core group formation- the core group

will be a training ground for developing
leaders in:
Democratic & collective leadership
Planning & assuming task for formation
of a community wide organization
Handling & resolving group conflicts
Critical thinking & decision making
process

Task of core group

Integration with the core group members

Deeper social investigation

Training and education

Mobilizing the core group

Process / Phases of COPAR

Organization Building Phase it

signaled the start of the community
management of any development
program. The ultimate aim was to form a
structure or organization that would
coordinate & become responsible for
community wide health & development
activities

Organization-Building phase

Activities
pre-organization building activities
Listing of speakers, task of core group
Possible issues that may arise & how to respond
them
Organizing & setting the committee
Legal & technical recruitment
By laws, registration
Training & education of the organization
Income generating project.
Mobilization of the health organization

Process / Phases of COPAR

Consolidation & Expansion phase or

sustenance & Strengthening phase

it is a process molding the community

organization into cohesive unit &
strengthening the leadership group &
uniting the membership.

Consolidation & Expansion phase

Strategies :
education & training
Networking & linkaging
Conduct of mobilization of livelihood &
related development
Development of secondary leaders
Evaluation

Family
Basic unit of the society
Types :
Conjugal (nuclear) family
The term "nuclear family" is commonly used, to refer
to conjugal families. A "conjugal" family includes
only the husband, the wife, and unmarried children
who are not of age.Sociologists distinguish
between conjugal families (relatively independent
of the kindred of the parents and of other families
in general) and nuclear families (which maintain
relatively close ties with their kindred).

Matrifocal family (solo or single

parent)
A "matrifocal" family consists of a
motherand her children. Generally,
these children are her biological
offspring, although adoption of children
is a practice in nearly every society. This
kind of family is common where women
have the resources to rear their children
by themselves, or where men are more
mobile than women.

Extended family
The term "extended family. This term has two
distinct meanings. First, it serves as a synonym
of "consanguinal family" (consanguine means
"of the same blood"). Second, in societies
dominated by the conjugal family, it refers to "
kindred" who do not belong to the conjugal
family. These types refer to ideal or normative
structures found in particular societies. Any
society will exhibit some variation in the actual
composition and conception of families.

Blended family
Male same-sex couple with a child
The termblended familyorstepfamilydescribes
families with mixed parents: one or both parents
remarried, bringing children of the former family
into the new family.traditional familyrefers to "a
middleclass family with a bread-winning father
and a stay-at-home mother, married to each
other and raising their biological children,"
andnon traditionalto exceptions from this rule.

Principles of family nursing care plan

The nursing care plan focuses on actions which are

designed to solve or minimize existing problem. The plan is
a blueprint for action. The core of the plan are the
approaches, strategies, activities, methods and materials
which the nurse hopes will improve the problem situation.

The nursing care plan is a product of a deliberate

systematic process. the planning process is characterized
by logical analyses of data that are put together to arrive at
rational decisions. The interventions the nurse decides to
implement are chosen from among alternatives after
careful analysis and weighing of available options.

The nursing care plan, as with all plans, relates to the

future. It utilizes events in the past and what is happening
in the present to determine patterns. It also projects the
future scenario if the current situation is not corrected.

Principles of FNCP

The nursing care plan is based upon identified health

and nursing problems. The problems are the starting
points for the plan, and the foci of the objectives of care
and intervention measures.
The nursing care plan is a means to an end, not an end
in itself. The goal in planning is to deliver the most
appropriate care to the client by eliminating barriers to
family health development.
Nursing care planning is a continuous process, not a
one-shot-deal. The results of the evaluation of the
plans effectiveness trigger another cycle of the
planning process until the health and nursing problems
are eliminated.

FAMILY ASSESSMENT

A good family assessment requires astute observation

skills and the ability to be an active listener.
Assessment data can be obtained anytime health care
professionals interact with patients and families.
Gathering information about family structure, function,
and needs does not have to be restricted to structured
interviews. Anytime the family is present; you can
obtain more information about the family and their role
in the patients health care management. Informal
conversations with the patient and family while you
are passing medications, adjusting an intravenous
rate, or giving a tube feeding can yield data that will
help you complete the family picture.

Areas of Family Assessment

What is the family like?

Who is considered part of the family?
What is the patients position and role in the
family?
Who has most influence on the patient?
What are the ages and sex of the family members?
What are their occupations?
What is the health status of family members?
Are there physical limitations that would affect a
family members ability to help with care needs?

Areas of Family assessment

What resources are available to the family?

Can the family provide for the patients physical
needs?
What is the patients home like? Does it provide
sufficient safety and comfort features?
What is the patients ability to perform self-care?
What are the health insurance resources?
What neihgborhood or community resources are
available?
What connections does the family have with friends,
neighbors, church, community organizations?

Areas of Family Assessment

What are the familys educational background, lifestyle, and

beliefs?
What is the level of education of the family members and their
attitudes toward learning?
Do all family members have basic literacy skills?
Are there language barriers to verbal communication?
What is the familys lifestyle and cultural background?
Does the family have any folk medicine beliefs?
Are there potential conflicts between cultural beliefs and the
recommendations of health professionals?
What are the familys normal dietary patterns?
Does the family seem to be able to take in new information easily and
apply what was taught?
Does the family seem overwhelmed as a result of the need to learn
new skills?

Areas of Family Assessment

What is the familys understanding of the current

health care problem?
What do they think has caused the health care problem?
Why do they think the problem occurred now?
What do they think the illness does to the patient?
How severe do they believe the illness is?
What kind of treatment do they think the patient should
receive?
What are the most important results they think the patient
should obtain from the treatment?
What are the major problems the illness has caused for the
family?
What do they fear most about the situation?

Areas of Family Assessment

How does the family seem to function?

Do family members seem to be sensitive to the patient and to
each other?
Do family members appear to be able to communicate
effectively with each other?
Does the family indicate that they have the ability to accept help
from others when it is needed?
How open does the family seem to teaching?
Do key family members have the ability to make effective
decisions?
What experience does the family have in handling crisis
situations?
How did the family react to crises in the past and what resources
did they use to help them?

Areas of Family Assessment

What is the familys understanding of the current

health care problem?
What do they think has caused the health care problem?
Why do they think the problem occurred now?
What do they think the illness does to the patient?
How severe do they believe the illness is?
What kind of treatment do they think the patient should
receive?
What are the most important results they think the patient
should obtain from the treatment?
What are the major problems the illness has caused for the
family?
What do they fear most about the situation?

Areas of Family Assessment

What are the patient and familys teaching needs?

What do the patient and family think are the most
important things they need to know?
Do the patient and family know others with the same health
care problem?
Do the patient and family understand and agree with the
treatment plan?
Are there any physical or cognitive limitations that will be
barriers to learning?
Are the patient and family willing to negotiate goals with
the health care team?
Are the patients perceptions about what to do similar to
the familys point of view?

Assessment
Initial data base (IDB)
A.
B.
C.
D.

E.

Family structure
Socio-economic & cultural characteristic
Home & environment
Health status of family members of the
family
Values habit, practices on health
promotion, maintenance of disease
prevention

2. Data analysis

Sort data
Cluster/ group related data
Identify pattern (e.g. Function,
Behaviour, lifestyle)
Compare pattern w/ norm/ standard
Interpret result
Make inferences/ draw conclusion

3. Health conditions/problems and family

nursing diagnosis

1st level define health conditions/problems

A. wellness state
B. health deficit
C. health threats
D. foreseeable crisis
2nd level- define the family nursing problems
diagnosis as: familys inability to perform
health task on each health condition/problems
specifying the barrier to performance or reason
for non performance of family health task

Developing a Family Nursing Care Plan

Component:
1. Prioritization of conditions/ problems
knowledge , technology, &
intervention to enhance wellness
Resources of family, nurse community
2. Goals and objective of nursing care
3. Plan of intervention
4. Plan for evaluating care

Community Health Nursing

Process
Assessment of community health needs
Components: a. health status
b. health resources
c. health action potentials
Community diagnosis (community dx ppt)
Community Planning (principles)
Intervention- action, strategies, activities to
be done as solution to the problems identified
Evaluation

Elements of community planning process

Needs assessment: identifying the needs and assets of the community or

neighborhood and the particular health concerns and disparities,
Strategic planning: clarifying vision, goal, and directives, establishing
decision making processes and criteria, fostering sustainability, and
ensuring that resources are being appropriately used.
Building understanding about multiple determinants of health : raising
awareness about what contributes to good health and fostering buy-in
into a preventive approach to improving health and safety outcomes
Partnership and coalition building: determining and engaging the support
of key stakeholders and decision makers, including community
engagement
Prioritization: selecting the appropriate factors and combination of
factors
Comprehensive approaches: implementing multifaceted activities to
achieve desired outcomes
Evaluation: ongoing assessment and evaluation of community efforts

VITAL STATISTICS
Population natural increase:
Formula: Number of births Number of deaths
Rate of natural increase= CBR CDR
Absolute increase per year= Pt Po
t
Pt= population size at a later year
Po= population size at earlier time
t = number of years between time o and time t

Population Increase
Relative increase
= Pt_- Po_
Po
Population Composition:
Sex Ratio= Number of males X
Number of females
Fertility rates: CBR= number of live births X
1000
Midyear population

Vital Statistics
General fertility rates
= number of live births X 1000
Midyear population of women 15-44
yrs
CDR = Number of deaths X 1000
Midyear population
IMR=number of deaths < 1yr X1000
Number of live births

Epidemiology

The study of the distribution of diseases in populations and

of factors that influence the occurrence of disease.
Epidemiology examines epidemic (excess) and endemic
(always present) diseases; it is based on the observation
that most diseases do not occur randomly, but are related to
environmental and personal characteristics that vary by
place, time, and subgroup of the population. The
epidemiologist attempts to determine who is prone to a
particular disease; where risk of the disease is highest;
when the disease is most likely to occur and its trends over
time; what exposure its victims have in common; how much
the risk is increased through exposure; and how many cases
of the disease could be avoided by eliminating the exposure

n the course of history, the epidemiologic approach has helped to

explain the transmission of communicable diseases, such as cholera and
measles, by discovering what exposures or host factors were shared by
individuals who became sick. Modern epidemiologists have contributed
to an understanding of factors that influence the risk of chronic diseases,
particularly cardiovascular diseases and cancer, which account for most
deaths in developed countries today. Epidemiology has established the
causal association of cigarette smoking with heart disease; shown that
acquired immune deficiency syndrome (AIDS) is associated with certain
sexual practices; linked menopausal estrogen use to increased risk of
endometrial cancer but to decreased risk of osteoporosis; and
demonstrated the value of mammography in reducing breast cancer
mortality. By identifying personal characteristics and environmental
exposures that increase the risk of disease, epidemiologists provide
crucial input to risk assessments and contribute to the formulation of
public health policy.

Descriptive Epidemiology

Descriptive epidemiologic studies provide information about

the occurrence of disease in a population or its subgroups
and trends in the frequency of disease over time. Data
sources include death certificates, special disease registries,
surveys, and population censuses; the most common
measures of disease occurrence are (1) mortality (number of
deaths yearly per 1000 of population at risk); (2) incidence
(number of new cases yearly per 100,000 of population at
risk); and (3) prevalence (number of existing cases at a given
time per 100 of population at risk). Descriptive measures are
useful for identifying populations and subgroups at high and
low risk of disease and for monitoring time trends for specific
diseases. They provide the leads for analytic studies designed
to investigate factors responsible for such disease profiles.

Analytic Epidemiology

Analytic epidemiologic studies seek to identify specific

factors that increase or decrease the risk of disease
and to quantify the associated risk. In observational
studies, the researcher does not alter the behavior or
exposure of the study subjects, but observes them to
learn whether those exposed to different factors differ
in disease rates. Alternatively, the researcher
attempts to learn what factors distinguish people who
have developed a particular disease from those who
have not. In experimental studies, the investigator
alters the behavior, exposure, or treatment of people
to determine the impact of the intervention on the
disease. Usually two groups are studied, one that
experiences the intervention (the experimental group)
and one that does not (the control group). Outcome