Community Health Nursing

2/11/2021
COMMUNITY HEALTH NURSING

Community health nursing (CHN), also called public health nursing or community nursing,
combines primary healthcare and nursing practice in a community setting.
Community health (CH) Nurses provide health services, preventive care, intervention and health
education to communities’ populations
Community Health Nurse
- Unlike a nurse who works with patients one-on-one in other clinical settings, community health
nurses focus on communities.
» CH nurses can have various roles in a community setting such as:
 Health education.
 Community advocacy.
 Ensuring a safe and healthy environment.
 Abuse and neglect prevention.
 Policy reform.
 Community development.
What they do depends on the communities they serve; lower income, school, and culturally
diverse communities all have different needs.
GLOBAL, NATIONAL and LOCAL HEALTH SITUATION

- The country Is facing a health crisis at present due to COVID19 pandemic. Where large
number of the population is affected.
The Philippines has presently recorded new increased cases and a daily additional COVID-19
cases still reported.
- The Department of Health and the Local Government Units are working together to find ways
of controlling the spread of the disease.
- With their Joint efforts national and local health facilities are Involved in the management of
cases. There is a problem in the scarcity of health workers (Doctors, Nurses, Medical
Technologists).
- Several private hospitals across Metro Manila earlier said beds allocated for COVID-19 cases
had reached full capacity following the easing of quarantine restrictions in a bid to revive the
economy.
- According to the DOH the current population of the country is estimated about 109,653 229
where the Philippines ranked 13th in the highest population rate.
- The Philippine population is considered young and for global population increase is 1.05 % per
year
According to the DOH top leading causes of MORBIDITY in the Philippines includes all forms
respiratory diseases, hypertension, kidney and urinary tract problems, all forms of diarrheal
diseases, and diabetes mellitus.
- For MORTALITY, it includes cardiovascular diseases, pneumonias, malignant
neoplasms/cancers, all forms of tuberculosis, accidents, COPD and allied conditions, diabetes
mellitus, nephritis/nephritic syndrome and other diseases of respiratory system.
- Morbidity -refers to the cases of illness in a given population in a specified period of time.
- Mortality -refers to the cases of deaths in a given population in a specified period of time
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HEALTH AND LONGEVITY AS BIRTHRIGHTS
- HEALTH IS A BASIC HUMAN RIGHT FOR EVERY FILIPINO.
LONGEVITY- average lifespan
- The lifespan increases among Filipinos according to the DOH and varies per year.
- There is an increase every year which is closely related to the different DOH health programs
- Life expectancy in the country in 2010-2015 was 68.6 years.
- Life expectancy at birth male/female in 2016-66)73
The life expectancy for Philippines in 2017 was 70.87 years. The life expectancy for Philippines
in 2018 was 71.03 years, a 0.23% increase from2017
The life expectancy for Philippines in 2019 was 71.16 years a 0.18% increase from 2018.
DEFINITION AND FOCUS

COMMUNITY
It is a group of people with common characteristics or interests living together within a territory
or geographical boundary
It is a place where people under usual conditions are found
It is derived from a latin word "comunicas" which means a group of people.
3 Elements of a community
1. Geographical Entity
2. Social Entity
3. Psycho-cultural Entity
Two specific types of a community

• Urban area " can refer to towns, cities, and suburbs. An urban area includes the city itself, as
well as the surrounding areas.
• Rural areas are the opposite of urban areas. Rural areas have low population density and large
amounts of undeveloped land (Barios),
HEALTH
- According to WHO Health is defined as a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.
- The state of being free from illness or injury.
- The enjoyment of the highest attainable standard of health is one of the fundamental rights of
every human being without distinction of race, religion, political belief economic or social
condition.

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- The health of all peoples is fundamental to the attainment of peace and security and is
dependent on the fullest co-operation of individuals and States
- The achievement of any state in the promotion and protection of health is of value to all.
COMMUNITY HEALTH
- Community health refers to the health status of the members of the community, to the problems
affecting their health and to the totality of the health care provided for the community.
- Community health is a branch of public health which focuses on people and their role as
determinants of their own and other people's health
AIMS of CHN
 To promote health and efficiency.
 To prevent and control of diseases and disabilities.
 To prolong life through need-based health care.
The basic strategies for health promotion were prioritized as:
- Advocate: Health is a resource for social and developmental means, thus the dimensions that
affect these factors must be changed to encourage health.
- Enable: Health equity must be reached where individuals must become empowered to control
the determinants that affect their health, such that they are able to reach the highest attainable
quality of life.
- Mediation: Health promotion cannot be achieved by the health sector alone, rather its success
will depend on the collaboration of all sectors of government (social, economic, etc.) as well as
independent organizations (media industry, etc.).
Definition of COMMUNITY HEALTH NURSING
- It is a synthesis of nursing and public health practice applied to promoting and preserving the
health of the people.
- According to Maglaya, CHN is 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.
- The goal of CHN as stated by Nisce is to raise the level of citizenry by helping communities
and families to cope with the discontinuities in and threats to health in such a way as to
maximize their potential for high-level wellness.
- The definition of CHN by the WHO Committee on expert in nursing is a special field of
nursing that combines the skills of nursing, public health and some phases of social assistance
and functions as part of the total public health program for the promotion of health, the
improvement of the conditions in the social and physical environment, rehabilitation of illness
and disability
- From Jacobson point of view CHN is learned practice discipline with the ultimate goal of
contributing as individuals and in collaboration with others to the promotion of the client's
optimum level of functioning thru' teaching and delivery of care (Jacobson)
- DR. Ruth B. Freeman: A service rendered by a professional nurse IFCs, population groups in
health centers, clinics, schools, workplace for the promotion of health prevention of illness, care
of the Public Health
Mission of CHN
- Health Promotion
- Health Protection
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- Health Balance
- Disease prevention
- Social Justice
PHILOSOPHY OF CHN
- According to Dr. M. Shetland the philosophy of CHN is based on the worth and dignity on the
worth and dignity of man.
- 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.
- CHN practice is affected by developments in health technology, in particular changes in
society, in general
- The goal CHN is achieved through multi-sectoral efforts - CHN is a part of health care system
and the larger human services system.
OBJECTIVES OF PUBLIC HEALTH

C.O.D.E.S
Control of Communicable Diseases
Organization of Medical and Nursing Services
Development of Social Machineries
Education of IFC on personal Hygiene. Health Education is the essential task of every health
worker
Sanitation of the environment
3 ELEMENTS IN HEALTH EDUCATION

1.Information: to share ideas to keep population group knowledgeable and aware
2. Education: change within the individual
3.Communication: interaction involving 2 or more persons or agencies
ROLES OF THE PUBLIC HEALTH NURSE

Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
Health Educator - who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
Facilitator - who establishes multi-sectoral linkages by referral system
Supervisor - who monitors and supervises the performance of midwives
Health Advocate - who speaks on behalf of the client
Collaborator - who working with other health team member
- In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions
or is not available, the Public Health Nurse will take charge of the MHO's responsibilities.
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Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Regulations of
RA 9173 (Philippine Nursing Act of 2002) includes:
- Supervision and care of women during pregnancy, labor and puerperium
- Performance of internal examination and delivery of babies
- Suturing lacerations in the absence of a physician
- Provision of first aid measures and emergency care
- Recommending herbal and symptomatic medicines
Responsibilities of CHN
- Be a part in developing an overall health plan, its implementation and evaluation for
communities
- Provide quality nursing services to the three levels of clientele
- Maintain coordination/linkages with other health team members, NGO/government agencies in
the Provision of public health services
-Conduct researches relevant to CHN services to improve provision of health care
- Provide opportunities for professional growth and continuing education for staff development
Responsibilities of a CH Nurse
In the care of the families:
- Provision of primary health care services
- Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
- Community organizing mobilization, community development and people empowerment
- Case finding and epidemiological investigation
- Program planning, implementation and evaluation
- Influencing executive and legislative individuals or bodies concerning health and development
Community = is a group of people sharing common geographic boundaries and/or common

values and interests.
Characteristics of Community:
1. It is defined by its geographic boundaries within certain identifiable characteristics.
2. It is made up of institutions organized into a social system with the institutions and
organizations linked in a complex network having a formal and informal power structure and a
communication system
3. A common or shared interest that binds the members together exists
4. It has an area with fluid boundaries within which a problem can be identified and solved
5. it has a population aggregate concept
Health = (WHO) is a state of complete physical and social wellbeing, not merely an absence of
disease or infirmity.

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Determinants of health:
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support networks
6. Culture
7. Genetics
8. Personal behavior and coping skin
9. Health services
10 Gender
Right to, and responsibility for health
Health is a basic human right.
The Universal Declaration of Human Rights Article 25; Section 1
- States that "Everyone has the right to a standard of living adequate for the health and well-
being of himself and of his family, including food, clothing, housing and medical care and
necessary social services, and the right to security in the event of unemployment, sickness,
disability widowhood, old age or other lack of livelihood in circumstances beyond his control
According to American Nurses Association (ANA)
Community health nursing practice promotes and preserves the health populations by integrating
the skills and knowledge relevant to both nursing and public health. The practice is
comprehensive and general and is not limited to a particular age, diagnostic group, or episodic
care.
CLIENTELE OF THE CHN

- Individual
- Family
Basis in identifying family nursing problems:
a. recognizing interruptions of health development
b. seeking health care
c. managing health and non-health crises
d. providing nursing care to the sick, disabled and dependent member of the family
e. maintaining a home environment conducive to good health and personal development
f. maintaining a reciprocal relationship with the community and health situations
Population group - is a group of people who share common characteristics, developmental stage
or common exposure to particular environmental factors and consequently common health
problems:
e.g., children, men, women, farmers, factory workers, commercial workers, prisoners, military
men, and elderly

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Children are the first to suffer from socioeconomic difficulties and political upheavals in a
country
CHARACTERISTICS OF A HEALTHY COMMUNITY

- Awareness that we are community
- Conservation of natural resources
- Recognition of, and respect for, the existence of subgroups
- Participation of subgroups in community affairs
- Preparation to meet crises
- Ability to problem solve
- Communication trough open channels
- Resources available to all
- Setting of disputes through legitimate mechanisms
- Participation by citizens in decision making Wellness of a high degree among its
members
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QUALIFICATIONS OF A CHN
. Bachelor of Science in Nursing
Registered Nurse
Master's Degree in Nursing or
Public Health with at least 5 years experiences as Public Health Nurse
CONCEPT OF HEALTH PROMOTION

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 (standing in community),
and economic systems. (OTTAWA CHARTER)
Health Promotion Action Means:
BUILDING HEALTHY PUBLIC POLICY
• Health promotion policy combines diverse but complementary approaches including
legislation, fiscal measures, taxation and organizational change.
• It is a coordinated action that leads to health, income and social policies that foster greater
equity. Joint action contributes to ensuring safer and healthier goods and services, healthier
public services, and cleaner, more enjoyable environments.
• Health promotion policy requires the identification of obstacles. The aim must be to make the
healthier choice the easier choice for policy makers as well.
CREATING SUPPORTIVE ENVIRONMENTS
• The links between people and their environment constitutes the basis for a socio-ecological
approach to health.
• The overall guiding principle for the world, nations, regions and communities alike, is the need
to encourage reciprocal maintenance - to take care of each other, our communities and our
natural environment.
• The conservation of natural resources throughout the world should be emphasized as a global
responsibility.
• The protection of the natural and built environments and the conservation of natural resources
must be addressed in any health promotion strategy.

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STRENGTHENING COMMUNITY ACTIONS
• Health promotion works through concrete and effective community action in setting priorities,
making decisions, planning strategies and implementing them to achieve better health. At the
heart of this process is the empowerment of communities.
• This requires full and continuous access to information, learning opportunities for health, as
well as funding support.
DEVELOPING PERSONAL SKILLS
• Health promotion supports personal and social development through providing information,
education for health, and enhancing life skills.
• It increases the options available to people to exercise more control over their own health and
over their environments, and to make choices conducive to health.
• 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. Action is required
through educational, professional, commercial and voluntary bodies, and within the institutions
themselves.
REORIENTING HEALTH SERVICES

• The responsibility for health promotion in health services is shared among individuals,
community groups, health professionals, health service institutions and governments.
• The role of the health sector must move increasingly in a health promotion direction, beyond its
responsibility for providing clinical and curative services.
• Reorienting health services also requires stronger attention to health research as well as changes
in professional education and training. This must lead to a change of attitude and organization of
health services which refocuses on the total needs of the individual as a whole person.
MOVING INTO THE FUTURE
• Health is created and lived by people within the settings of their everyday life; where they
learn, work, play and love. Health is created by caring for oneself and others, by being able to
take decisions and have control over one's life circumstances, and by ensuring that the society
one lives in creates conditions that allow the attainment of health by all its members.
Caring, holism and ecology are essential issues in developing strategies for health promotion.
Those involved should take as a guiding principle that, in each phase of planning,
implementation and evaluation of health promotion activities, women and men should become
equal partners
THEORIES/MODELS OF HEALTH PROMOTION DIFFERENCE OF THEORY AND

MODEL
NURSING THEORETICAL WORKS
A. Nursing Philosophies
1. Nightingales environmental theory
2. Watson’s theory of human caring
3. Benner Benner’s stages of nursing expertise Nursing Philosophies
4. Eriksson’s caritative Caring theory

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B. Nursing Conceptual Model
1. Roger's Science of Unitary Human being
2.Orem's self care deficit model
3.Kings General System Framework Nursing conceptual model
4. Neumans System Model
5. Roy's Adaptation Model
6. Johnson's Behavioral System Model
C. Nursing Theories
1. Peplau's Theory of Interpersonal Relationship
2. Orlando's Theory of Deliberate Nursing process
3. Travelbee's Human to human relationship
4. Hall's CORE, CARE, CURE
5. Abdellah's 21 Nursing problem
6. Henderson's Need theory
7. Pender's Health prmotion model
8. Leininger Theory of Culture Care Diversity
9. Newmans theory of Health as Expanding Consciousness
10. Parse's Theory of Human Becoming
11. Watson's Theory of Human Caring
12. Orlando's Nursing Process
13. Locsin's Technological Competency as Caring
LOCAL THEORIES AND MODELS OF NURSING INTERVENTION (PHILIPPINE

SETTING)
Locsin's Technological Nursing as Caring Model Agravante's CASAGRA Tranformative
Leadership model
Divinagracias COMPOSURE Model Kuan's retirement and Role Discontinuity Model
Abaquin's Prepare Me Holistic Nursing intervention
Laurentes Theory of Nursing Practice career
Synchronicity in human space-Time A theory of Nursing Engagement in Global Community
THEORIES RELEVANT IN NURSING PRACTICE

- Maslow's Human Needs theory
- Sullivan;s Transactional Analysis
- Von Bertallanfy's General System theory a lewin's Change theory
- Erikson's Psychosocial Development "Kohlberg's Moral Development
THEORY:

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• An integrated set of propositions that serve as an explanation for a phenomenon.
• A systematic arrangement of fundamental principles that provide a basis for explaining certain
happening of life.
MODEL:
• A subclass of theory. It provides for investigating and or addressing a phenomenon.
• Does not attempt to explain the processes underlying learning, but only to represent them
• Provides the vehicle for applying the theories
BANDURA'S Social cognitive theory provides a framework for human behavior. The theory
identifies human behavior as an interaction of personal factors, behavior, and the environment
(Bandura 1977; Bandura 1986).
• Social cognitive theory is helpful for understanding and predicting both individual and group
behavior and identifying methods in which behavior can be modified or changed.
Social Cognitive Theory: B represents behavior, P represents personal factors in the form of
cognitive, affective, and biological events, and E represents the external environment.
• In the model, the interaction between the person and behavior involves the influences of a
person's thoughts and actions.
• The interaction between the person and the environment involves human beliefs and cognitive
competencies that are developed and modified by social influences and structures within the
environment.
The third interaction, between the environment and behavior, involves a person's behavior
determining the aspects of their environment and in turn their behavior is modified by that
environment.
GREEN: HEALTH PROMOTION/EDUCATION
• "Health promotion" can be defined as "any combination of educational and environmental
supports for actions and conditions of living conducive to health" (Green and Kreuter, 1999).
• Health education aims at learning experiences and voluntary actions people take, individually
or collectively, for their own health, the health of others, or the common good of the community.
• Health education as "any combination of learning experiences designed to facilitate voluntary
actions conducive to health" (Green and Kreuter, 1999) emphasizes the importance of multiple
determinants of behavior.
• The task for health promotion, beyond health education, is how to make more healthful choices
easier choices.
• Health education provides the consciousness-raising, concern-arousing, and action-stimulating
impetus for the public involvement and commitment to social reform essential to its success in a
democracy.
The most appropriate "center of gravity" for health promotion is the community.
• A "community" may be a town or county in sparsely populated areas; or it may be a
neighborhood, worksite, or school in more populous metropolitan areas.
It can also apply to groups of people not. sharing a specific geographic association, but sharing
social, cultural, political, or economic interests that link them together.
COMMUNITY ORGANIZING TOWARDS COMMUNITY PARTICIPATION IN
HEALTH
Community health promotion requires the participation of local leadership and social networks to
facilitate the transmission and uptake of interventions for the overall population.
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EPIDEMIOLOGY
it is the study of occurrences and distribution of diseases as well as distribution and determinants
of health states or events in specified population, and the application of this study to the control
of health problems.
USES OF EPIDEMIOLOGY
According to Morris, epidemiology is used to:
1. Study the history of the health population and the rise and fall of diseases and changes in their
character.
2. Diagnose the health of the community and the condition of people to measure the distribution
and dimension of Illness in terms of incidence, prevalence, disability and mortality, to set health
problems in perspective and to define their relative importance and to identify groups needing
special attention.
3. Study the work of health services with a view of improving them. Operational research shows
how community expectations can result In the actual provisions of service.
4. Estimate the risk of disease, accident, defects and the chances of avoiding them.
5. Complete the clinical picture of chronic disease and describe their natural history.
6. Identify syndromes by describing the distribution and association of clinical phenomena in the
population.
7. Search for causes of health and disease by comparing the experience of groups that are clearly
defined by their composition, inheritance, experience, behavior and environments.
THE EPIDEMIOLOGIC TRIANGLE

HOST - Is any organism that harbors and provides nourishment for another organism.
- Are related to lower resistance as a result of exposure to the elements during floods or disasters.
AGENT - The intrinsic property of microorganism to survive and multiply in the environment to
produce disease. - The result of the introduction of new disease agents into the population.
ENVIRONMENT – The sum total of all external condition and influences that affects the
development of an organism which can be biological, social, and physical. The environment
affects both the agents and host.
- Changes in the physical environment; temperature, humidity, rainfall may directly or indirectly
influence equilibrium of agent and host
The Epidemiologic Triangle consists of three component – the host, environment and agent. The
model implies that each must be analyzed and understood for comprehensions and prediction of
patterns of a disease. A change in any of the component will alter an existing equilibrium to
increase or decrease the frequency of the disease.
THREE COMPONENTS OF THE ENVIRONMENT

1. PHYSICAL ENVIRONMENT – is composed of the inanimate surroundings such as the
geophysical conditions of the climate.
2. BIOLOGICAL ENVIRONMENT - makes up the living things around us such as plants and
animal life.
3. SOCIO-ECONOMIC ENVIRONMENT- may be in the form of level of economic
development of the community, presence of social disruptions and the like.

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DISEASE DISTRIBUTION
The method and technique of epidemiology are desired to detect the cause of a disease in relation
to the characteristic of the person who has it or to a factor present in his environment. These
variables are studied since they determine the individuals and populations at greatest risks of
acquiring particular disease, and knowledge of these associations may have predictive value
Time- refers to the period during which the cases of the disease being studied were exposed to
the source of infection and the period during which the illness occurred. This analysis of cases by
time enables the formulation of hypotheses concerning time and source of infection, mode of
transmission, and causative agent.
Epidemic period: a period during which the reported number of cases of a disease exceed the
expected, or usual number for that period.
Year: For many diseases the incidence (Frequency of occurrence) is not uniform during each of
12 consecutive months. Instead, the frequency is greater in one season than any of the others.
This seasonal variation is associated with variations in the risk of exposure of susceptible to the
source of infection.
Period of Consecutive years: recording the reported cases of a disease over a period of years-by
weeks, months or year of occurrence - useful in predicting the probable future incidence of the
disease and in planning appropriate prevention and control programs.
PATTERNS OF OCCURRENCE AND DISTRIBUTION

1. SPORADIC OCCURRENCE
It is the intermittent occurrence of a few isolated and unrelated cases in a given locality.
The cases are few and scattered, so that there is no apparent relationship between them and they
occur on and off, intermittently, through a period of time.
2. ENDEMIC OCCURRENCE
It is the continuous occurrence throughout a period of time, of the usual number of cases in a
given locality.
The disease is therefore always occurring in the locality and the level of occurrence is more or
less constant throughout a period of time.
3. EPIDEMIC OCCURRENCE
It is of unusually large number of cases in a relatively short period of time.
There is a disproportionate relationship between the number of cases and the period of
occurrence, the more acute is the disproportion, the more urgent and serious of the problem.
4. PANDEMIC
It is the simultaneous occurrence of epidemic of the same disease in several countries. It is
another occurrence from an international perspective.
(baka kasali sa exam bukas)

Factors affecting health of the community
Social exclusion
People can feel socially excluded for a number of different reasons. Factors may include poverty,
old age, mental ill-health or a physical or learning disability. This exclusion can have an effect

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on their health and ability to fulfil their full potential. We’re working hard to tackle social
exclusion and help make health fairer for everyone.
Housing
Poor quality housing can have a huge impact on health. It can make existing health conditions
worse, cause injuries and prevent people from reaching their full potential.
Education
Helping young people achieve their potential from an early age, including getting qualifications
plays a vital role in making sure they are healthy in later life.
Employment
Employment plays a big role in health as it provides financial stability, promotes independence
and is known to protect against physical and mental health problems. We’re working to provide
people with as much support to get into work as possible. We’re also working with local
employers to help them improve the health and wellbeing of employees as part of our new
Healthy Workplaces scheme.
Planning
Good local planning can actively support the health of individuals and the communities in which
they live, work and play. Read more about active design at Sport England.
Transport
In a largely rural community like Derbyshire, transport plays an important role in helping people
get to school, work and leisure facilities, as well as health services. While most people have
access to a car, some people don't and therefore public transport plays an important role in
connecting people.
Health impact assessments (HIA)
To look at the impacts that wider determinants have on health, we carry out health impact
assessments on a range of different topics. HIA consider any proposed changes in the local area
that may impact on people’s health and wellbeing. This could cover anything from a new council
policy about transport to a proposed housing development in your local area. The HIA looks at
the potential consequences for health and wellbeing that the changes may have.
Recommendations are then made on how to enhance the positive consequences and reduce the
negatives.
Characteristics of population
Population density is a measure of the total number of individuals in a given space at a given
time. Because populations are dynamic, indices of measurements taken at different times are
useful in comparing population density at different intervals.
The fecundity or birth rate of a population can be expressed as the theoretical maximum number
of offspring produced in a population. This also is known as a crude birth rate. Fecundity is also
expressed in terms of realized or ecological fecundity, which is the actual number of offspring
produced in a population under actual environmental conditions and ecological constraints.
Mortality or death rate is a measure of the number of individual deaths in a population over a
given period of time.
The population has the following characteristics:
1. Population Size and Density:
Total size is generally expressed as the number of individuals in a population.

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Population density is defined as the numbers of individuals per unit area or per unit volume of
environment. Larger organisms as trees may be expressed as 100 trees per hectare, whereas
smaller ones like phytoplanktons (as algae) as 1 million cells per cubic metre of water.
In terms of weight it may be 50 kilograms of fish per hectare of water surface. Density may be
numerical density (number of individuals per unit area or volume) when the size of individuals in
the population is relatively uniform, as mammals, birds or insects or biomass density (biomass
per unit area or volume) when the size of individuals is variable such as trees.
Since, the patterns of dispersion of organisms in nature are different population density is also
differentiated into crude density and ecological density.
a. Crude density:
It is the density (number or biomass) per unit total space.
b. Ecological density or specific or economic density:
It is the density (number or biomass) per unit of habitat space i.e., available area or volume that
can actually be colonized by the population.
This distinction becomes important due to the fact that organisms in nature grow generally
clumped into groups and rarely as uniformly distributed. For example, in plant species like
Cassia tora, Oplismemis burmanni, etc, individuals are found more crowded in shady patches
and few in other parts of some area. Thus, density calculated in total area (shady as well as
exposed) would be crude density, whereas the density value for only shady area (where the
plants actually grow) would be ecological density.
2. Population dispersion or spatial distribution:

Dispersion is the spatial pattern of individuals in a population relative to one another. In nature,
due to various biotic interactions and influence of abiotic factors, the following three basic
population distributions can be observed:
(a) Regular dispersion:
Here the individuals are more or less spaced at equal distance from one another. This is rare in
nature but in common is cropland. Animals with territorial behaviour tend towards this
dispersion.
(b) Random dispersion:
Here the position of one individual is unrelated to the positions of its neighbours. This is also
relatively rare in nature.
(c) Clumped dispersion:
Most populations exhibit this dispersion to some extent, with individuals aggregated into patches
interspersed with no or few individuals. Such aggregations may result from social aggregations,
such as family groups or may be due to certain patches of the environment being more
favourable for the population concerned.
3. Age structure:
In most types of populations, individuals are of different age. The proportion of individuals in
each age group is called age structure of that population. The ratio of the various age groups in a
population determines the current reproductive status of the population, thus anticipating its
future. From an ecological view point there are three major ecological ages in any population.
These are, pre-reproductive, reproductive and post reproductive. The relative duration of these
age groups in proportion to the life span varies greatly with different organisms.

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Age pyramid:
The model representing geometrically the proportions of different age groups in the population
of any organism is called age pyramid. According to Bodenheimer (1938), there are following
three basic types of age pyramids.
(a) A pyramids with a broad base (or triangular structure):

It indicates a high percentage of young individuals. In rapidly growing young populations birth
rate is high and population growth may be exponential as in yeasty house fly, Paramecium, etc.
Under such conditions, each successive generation will be more numerous than the preceding
one, and thus a pyramid with a broad base would result (Fig. A).
(b) Bell-Shaped Polygon:
It indicates a stationary population having an equal number of young and middle aged
individuals. As the growth rate becomes slow and stable, i.e., the pre-
reproductive and reproductive age groups become more or less equal in size, post-reproductive
group remaining as the smallest (Fig. B).
(c) An urn-shaped structure:
It indicates a low percentage of young individuals and shows a declining population. Such an un-
shaped figure is obtained when the birth rate is drastically reduced the pre-reproductive group
dwindles in proportion to the other two age groups of the population. (Fig. C).
4. Natality (birth rate):

Population increase because of natality. It is simply a broader term covering the production of
new individuals by birth, hatching, by fission, etc. The natality rate may be expressed as the
number of organisms born per female per unit time. In human population, the natality rate is
equivalent to the birth-rate. There are distinguished two types of natality.
(a) Maximum natality:
Also called as absolute or potential or physiological natality, it is the theoretical maximum
production of new individuals under ideal conditions which means that there are no ecological
limiting factors and that reproduction is limited only by physiological factors. It is a constant for
a given population. This is also called fecundity rate.
(b) Ecological natality:
Also called realized natality or simply natality, it is the population increase under an actual,
existing specific condition. Thus, it takes into account all possible existing environmental
conditions. This is also designated as fertility rate.
Natality is expressed as
∆Nn/∆ t = Absolute Natality rate (B)
∆Nn/N ∆ t = Specific natality rate (b) (i.e., natality rate per unit of population).
Where:
N = initial number of organisms.
n = new individuals in the population.
t = time
Further, the rate at which females produce offsprings is determined by the following three
population characteristics:

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(a) Clutch size or the number of young produced on each occasion.
(b) The time between one reproductive event and the next and
(c) The age of first reproduction.

Thus, natality usually increase with the period of maturity and then falls again as the organism
gets older.
5. Mortality (death rate):

Mortality means the rate of death of individuals in the population. Like natality, mortality may
be of following types:
(a) Minimum mortality:
Also called specific or potential mortality, it represents the theoretical minimum loss under ideal
or non-limiting conditions. It is a constant for a population.
(b) Ecological or realized mortality:
It is the actual loss of individuals under a given environmental condition. Ecological mortality is
not constant for a population and varies with population and environmental conditions, such as
predation, disease and other ecological hazards.
Vital index and survivorship curves:
A birth-death ratio (100 x births/deaths) is called vital index. For a population, the surviving
individuals are more significant for a population than the dead ones. The survival rates are
generally expressed by survivorship curves.
Biotic Potential:
Each population has the inherent power to grow. When the environment is unlimited, the specific
growth rate (i.e., the population growth rate per individual) becomes constant and maximum for
the existing conditions. The value of the growth rate under these favourable conditions is
maximal, is characteristics of a particular population age structure, and is a single index of the
inherent power of a population to grow.
It may be designated by the symbol r which is the exponent in the differential equation for
population growth in an unlimited environment under specific physical conditions. The index r is
actually the difference between the instantaneous specific natality rate and the instantaneous
specific death rate and may thus be expressed
r=b–d
The Overall population growth rate under unlimited environmental conditions (r) depends on the
age composition and the specific growth rates due to reproduction of component age groups.
Thus, there may be several values of r for a species depending upon population structure. When a
stationary and stable age distribution exists, the specific growth rate is called the intrinsic rate of
natural increase or r max. The maximum value of r is often called by the less specific but widely
used expression biotic potential or reproductive potential.
Chapman (1928) coined the term biotic potential to designate maximum reproductive power. He
defined it as “the inherent property of an organism to reproduce to survive, i.e., to increase in
numbers. It is a sort of algebraic sum of the number of young produced at each reproduction, the
number of reproductions in a given period of time, the sex ratio and their general ability to
survive under given physical conditions.” Thus, with the term of biotic potential, one is able to
put together natality, mortality and age distribution.

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But under natural conditions, this is a rare phenomenon, since environmental conditions do not
permit unlimited growth of any population. It size is kept under natural check.
Species differ widely in the number of young produced each year, in the average age to which
they live and in their average rate of mortality. When sufficient facts about a species are known,
a life table that tabulates the vital statistics of mortality and life expectancy for each group in the
population may be formulated.
In each table there are columns for age of individuals; numbers surviving to each age; the
number is dying in each age group; the proportion dying from the previous age category; fertility
rate; and the number of young born by each age group. The information obtained from these
figures provides the net reproductive rate of the population i.e., offspring left by each individual.
Social system within the community

Community as a social system mean that members of the same community are functionally
related with each other. This means they have their own role to play and they love doing their
work. All the part are linked with each other and they make an integrated whole. Community as
a system has three sub-system.
 Economic subsystem.
 Political Subsystem.
 Social subsystem.
Economic Subsystem.
For knowing well about the economic sub-system of a community, we will have to study its
main occupation, the wages, the mode of payment the assets, expenditure pattern etc. What
proportion of the income is spent on food, housing, clothing, education, health, etc. Same can be
done with urban community. The answer to these questions will help us to understand the
economic sub-system of the village.
The primary occupation of an Indian villager will be cultivation or labor work. A small section
will be managing their own land by employing laborers, while the majority will be working on
other’s land as laborers.
Land ownership particularly that of irrigated land, is concentrated only in the hands of a small
section of the population. Different regions will have different systems, but generally speaking,
laborers will be paid on a weekly basis. In many of the villages, old occupations, like that of
washer-men, goldsmith, iron-smith have been finished.
Political Subsystem.
Political word here signifies the concept of power. Although power is a mental notion and it is
real which is used for some sections of the society. For understanding the power structure
following questions have to be answered their answers will give us an idea about the power
structure of the community.
Who has the power in the community? The easiest technique of identification of powerful people
is by identifying the leaders of the community. Leaders denote those individuals who are
occupying some formal positions in local organizations: religious, political, economic or social.
It is difficult to recognize informal leaders because they exercise power without occupying any
positions.
Simplest way to identify them is by asking a number of people in the community who are helpful
and influential. The names suggested by a number of people can be considered as the informal
leaders of the community.

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What are the bases of power? Leadership has some foundations and they refer to a number of
factors like money, house, land, etc., caste membership, education, information, contacts and
networking, family prestige, memberships in important political parties, and business
establishment. A permutation of these influences helps the members.
How is power utilized? Next question arises is how the power is utilized by the leaders?
Supremacy can never be a status quo organization. It always strengthens in different forms and
ways. Political power strengthens economic power of the leaders which therefore, reinforces
political power. A politically acknowledged person will always try to strengthen his economic
base while economically powerful person will strengthen his position by developing strong
political contacts.
Official controllers of the community will be worked out by the Sarpanch and other elected
members of Gram Panchayat. Political parties, education, information, caste, etc. usually form
the bases of power. This power is used to get a family member or member of one’s group to run
Government aided schools and hostels.
Social Sub-System.
Everything covering non-economic and non-political are covered in this heading. The social
structure referring marriage, family, caste system, religious beliefs, values, etc. are some of the
aspects to be studied.
Census includes the total process of collecting, compiling, analyzing, evaluating, publishing and
disseminating statistical data regarding the population and housing and their geographical
location. Population characteristics include demographic, social and economic data and are
provided as of a particular date (reference period).
Census Methods:
Population censuses typically use one of two approaches:
De facto – meaning enumeration of individuals as of where they are found in the census,
regardless of where they normally reside.
De jure - meaning enumeration of individuals as of where they usually reside, regardless of
where they are on census day.
REVIEWER IN COMMUNITY HEALTH NURSING
DEFINITION, CONCEPT AND PRINCIPLES

Health – The World Health Organization defines health as a “state of complete physical, mental,
and social well-being, not merely the absence of disease or infirmity”. The modern concept of
health refers to optimum levels of individuals, families, and communities.
- ECO-SYSTEM INFLUENCES ON OPTIMUM LEVEL OF FUNCTIONING
(OLOF)
(Modified from Blum 1974:3) and further modified by the Community Health Nursing
Committee
✓ Political
- Safety, Oppression, People, Empowerment
✓ Behavioral

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- Culture, Habits, Mores, Ethnic Customs
✓ Hereditary
- Generic Endowment (Defects, Strengths, Risks, Ethnic, Racial)
✓ Health Care Delivery System
- Promotive, Preventive, Curative, Rehabilitative
✓ Environmental Influences
- Air, Food, Water waste, Noise, Radiation, Pollution
✓ Socio-economic Influence
- Employment, Education, Housing
Public Health – Dr. C.E. Winslow defines Public Health Nursing as the “science and art of
preventing disease, prolonging life, promoting health and efficiency through organized
community effort for the sanitation of the environment, control of communicable diseases, the
education of individuals in personal hygiene, the organization of medical and nursing services
for the early diagnosis and preventive treatment of diseases, and the development of the social
machinery to insure everyone a standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen his birthright of health and longevity”. TIP:
Just remember those bolded and underlined words, guys. 😊
Community Health Nursing (CHN) – Jacobson states that community health nursing is a learned
practice discipline with the ultimate goal of contributing, as individuals and in collaboration with
others.
- Dr. Ruth B. Freeman (1970) defines community health nursing as a service rendered by a
professional nurse with the communities, groups, families, and individuals at home, in health
centers, in clinics, in school, in places of work for the promotion of health, prevention of illness,
care of the sick at home and rehabilitation.
- The term “community health nursing” is composed of three major concepts:
1. Community > client
2. Health > goal
3. Nursing > the means
Philosophy – According to Margaret Shetland, CHN is based on the worth and dignity of man.
Goal -The ultimate goal of community health services is to raise the level of health of the
citizenry.
Principles of Community Health:
1. In CHN, the family is the unit of service.
2. Community Health Nursing must be available to all regardless of race, creed and socio-
economic status.
3. Health teaching is a primary responsibility of the community health nurse.
4. The goal of CHN is achieved through multi-sectoral efforts.
5. CHN is a part of health care system and the larger human services system Levels of
Clientele:
1. Individual – these are the people who consult at barangay health center to receive health
services such as pre-natal supervision, well-child follows up and morbidity services.

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2. Family – it is considered as a very important social institution that performs two major
functions – reproduction and socialization.
3. Population group – a group of people who share common characteristics, developmental
stage or common health problems. e.g. Children, Men, Women, Farmers, Elderly, etc.
3. Community – a group of people who share common geographic boundaries and/or common
values and interests.
Characteristics of a Healthy Community (Hunt and Zurek, 1997:12)
1. Awareness that “we are community”;
2. Conservation of Natural Resources;
3. Recognition of, respect for, the existence of subgroups;
4. Participation of subgroups in community affairs;
5. Preparation to meet crises;
6. Ability to problem-solve;
7. Communication through open channels;
8. Resources available to all;
9. Setting of disputes through legitimate mechanisms;
10. Participation by citizens in decision-making; and 11. Wellness of a high-degree among its
membranes.
NURSING PROCESS IN THE COMMUNITY

- The Nursing process in the Community plays a systematic, scientific, dynamic, and on-
going interpersonal process in which the nurse and the client are viewed as a system with each
affecting the other and both being affected by the factors within the behavior.
• ASSESSMENT – In this stage, it involves the collecting of relevant data on the health status of
the family, groups and community: demographic data, vital health statistics, community
dynamics, sociocultural, religious and occupational background, family dynamics, home and
environment, and patterns of coping.
➢ Typology of Nursing Problems
- Health Deficit – gap between actual and achievable status. Examples include: o Illness
states
o Failure to thrive/develop according to normal rate o Disability (e.g. malnutrition, blindness
from measles, leg amputation secondary to paralysis after a CVA)
- Health Threats – conditions that promote disease or injury o Presence of risk factors
(unhealthy diet, smoking, alcohol) o Cross infection from a communicable disease case o Family
size beyond what family resources can provide - Foreseeable Crisis – includes
stressful/anticipated occurrences on the individual or family. Examples include: o Marriage o
Abortion o Loss of Job
o Death of a family member
o Pregnancy
o Hospitalization of a family member
- Presence of Wellness Condition – stated as potential or readiness wherein client is in
transition from a specific level of wellness or capability to a higher level.

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• PLANNING – The next step after assessment is the formulation of nursing care plan.
➢ Family Nursing Care Plan – is defined as the blueprint of the care that the nurse aims to
minimize or eliminate health problems.
➢ Prioritizing Health Problems – Bailon and Maglaya (1990) devised a tool called Scale for
Ranking Health Conditions and Problems According to Priorities. This tool is used to objectivize
priority setting. o Nature of the Problem
o Modifiability of the condition or problem
o Preventive Potential o Salience
• IMPLEMENTATION – involves selection of various nursing interventions in which the
nurse has been determined by goals/objectives which have been previously set.
• EVALUATION – a judgement of the effectiveness of nursing care to meet client goals.
There are three frameworks from which nursing care is delivered:
➢ Structural Elements which include of physical settings, instrumentalities and conditions
through which a nursing care is given such as philosophy, objectives, buildings and financial
resources.
➢ Process Elements include of the nursing process itself such as taking the family health
data, performing physical examination, making a nursing diagnoses, determining of nursing
goals, writing a nursing care plan and determining the effectiveness of care.
➢ Outcome elements – changes in the client’s health status that result from the nursing
interventions rendered.
• DOCUMENTATION – this function importantly in community health nursing in
providing data which is
needed to plan for the client’s care and ensure its continuity.
HOME VISIT
- A home visit is a professional face to face contact made by a nurse to the patient in the
community to render health care activities and further attain an objective of the agency.
• Principles of Home Visit
➢ It should have a purpose or objective
➢ It should be flexible and practical

➢ Planning of care should include the individual and his/her family.
• Phases of Home Visit
1. Preparatory Phase – reviewing data/records before doing the home visit. Notify the
family of your intention to do the home visit. Introduce yourself and explain the purpose.
2. Home Visit Phase – actual visit to the patients. Assessment, Planning, Intervention and
providing health teaching should be conducted in this phase.
3. Post-Visit Phase – Documentation is done in this phase. Plan for your next visit with the
family. Referral to health workers must be done if warranted by the situation.
BAG TECHNIQUE
- A tool using a public health bag which is used by the nurse during a home visit. It
allows the nurse to perform
nursing procedures with ease and deftness.

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PUBLIC HEALTH BAG
- An equipment of a public health nurse which he/she uses during home visit. It contains
necessary articles, supplies and equipment needed for nursing care.
• Rationale – To render effective nursing care to the members of the family during home
visit.
• Principles
➢ The use of the bag technique aims to minimize if not totally prevent the spread of
infection from individuals to families, and to the community.
➢ Bag technique saves time and effort on the part of the nurse in performing nursing
procedures.
➢ Bag technique can be performed in variety of ways as long as the principle of avoiding
transfer of infection is carried out.
• Contents of the Bag
➢ Paper lining
➢ Extra paper for making bag for waste materials (paper bag) ➢ Plastic/linen lining
➢ Apron
➢ Hand towel in plastic bag

➢ Soap in soap dish
➢ Thermometers is case (one for oral & one for rectal)

➢ 2 pairs of scissors (1 surgical & 1 bandage)
➢ 2 pairs of forceps (1 curved & 1 straight)

➢ Syringes (5cc & 2cc)
➢ Hypodermic needles (19, 22, 23, 25)

➢ Sterile dressings
➢ Sterile cord tie

➢ Adhesive Plaster
➢ Alcohol lamp
➢ Tape measure
➢ Baby’s scale
➢ 1 pair of rubber gloves
➢ 2 test tubes
➢ Test tube holder
➢ Solutions
▪ Povidone Iodine
▪ 70% alcohol
▪ Zephiran Solution

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▪ Hydrogen Peroxide
▪ Spirit of Ammonia
▪ Acetic Acid
▪ Benedict’s Solution
NOTE: The stethoscope and sphygmomanometer should be carried separately.
HEALTH CARE DELIVERY SYSTEM IN THE PHILIPPINES

- It is a large, complex, multi-level and multi-disciplinary system that includes the totality
of all policies, facilities, equipment, products, human resources and services which address the
health needs, problems and concerns of the people.
Department of Health (DOH) – the highest governing agency for health.
➢ Vision: Leader, staunch advocate and model in promoting health for all in the Philippines
➢ Mission: Guarantee equitable, sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.
Levels of Health Care Services
➢ Primary: Barangay Health Stations, Rural Health Unit, Community Hospitals and Health
Centers, Private Practitioners/Puericulture Center
➢ Secondary: Emergency/District Hospitals, Provincial/City Health Services,
Provincial/City Hospitals
➢ Tertiary: Regional Health Services, Regional Medical Centers and Training Hospitals,
National Health Services, Medical Centers, Teaching and Training Hospitals.
Republic Act # 7160 – Local Government Code
- All structures, personnel and budgetary allocations from the provincial health level down
to the barangays were devolved to the Local Government units to deliver health care services to
the people.
PRIMARY HEALTH CARE (PHC)
- The World Health Organization (WHO) defined PHC as an essential health care made
universally accessible to individuals and families in the community by means of acceptable to
them through their full participation and at a cost that the community and country can afford at
every stage of development.
Conceptual Framework
o Goal: Health for all Filipinos and Health in the Hands of the People by the year 2020
o Mission: To strengthen the health care system by increasing opportunities and supporting
conditions wherein people will manage their own health care.
Legal Basis: Letter of Instruction 949 was signed on October 19, 1979 by then President
Ferdinand E. Marcos – one year after the First International Conference on Primary Health Care
was held in Alma Ata, USSR on September 612, 1978, sponsored by the World Health
Organization and UNICEF.
Elements/Components
➢ Environmental Sanitation
➢ Control of Communicable Diseases

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➢ Immunization
➢ Health Education
➢ Maternal and Child Health and Family and Planning

➢ Adequate Food and Proper Nutrition
➢ Provision of Medical Care and Emergency Treatment

➢ Treatment of Locally Endemic Diseases
➢ Provision of Essential Drugs

Pillars in Primary Health Care
➢ Active Community Participation
➢ Intra and Inter-sectoral Linkages

➢ Use of Appropriate Technology ➢ Support Mechanism made available
HERBAL MEDICINES
- The Department of Health approved the use of the following herbal plants.
- Republic Act # 8423 - Traditional and Alternative Medicine Act (TAMA) of 1997.
➢ Lagundi o Vitex negundo
o Uses: Asthma, Cough and Fever, Dysentery, Skin diseases, Headache, Rheumatism,
Sprain, Contusions, Insect bites, Aromatic bath for sick patients.
➢ Yerba (Hierba) Buena o Mentha cordifelia
o Uses: Pain such as Headache, Stomachache, Rheumatism, Arthritis, and Cough & cold,
Swollen gums, Toothache, Menstrual and gas pain, Nausea and Fainting, Insect bites,
Pruritis.
➢ Sambong
o Blumea balsamifera o Uses: Anti-edema, Diuretic, Anti-urolithiasis.
➢ Tsaang Gubat o Carmona retusa
o Uses: Diarrhea, Stomachache,
➢ Niyug-Niyogan o Quisqualis indica L. o Uses: Anti-helmintic
➢ Bayabas/Guavas o Psidium guajava L.

o Uses: For washing wounds, diarrhea, as gargle to relieve toothache
➢ Alkapulko o Cassia, alata L
o Uses: For Anti-fungal: Tinea Flava, Ringworm, Athlete’s foot, Scabies
➢ Ulasimang Bato o Peperonia pellucida
o Uses: Lowers uric acid
➢ Bawang
o Uses: Lowers cholesterol level in blood; for hypertension & toothache

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➢ Ampalaya o Mamordica charantia
o Uses: Diabetes Mellitus (Mild Non-insulin dependent) o
ASSESSING COMMUNITY HEALTH NEEDS
• Community Organizing Participatory Action Research (COPAR)
- According to Untalan (2005), it is a middle ground where the healthcare worker and the people
need to attain community organization. Also, it is a liberal freedom of the community where the
people are allowed to participate in the overall health care status of their community.
❖ Types of Community Diagnosis
✓ Comprehensive Community Diagnosis – aims to obtain a general information about the

community. The following are the elements of a comprehensive community diagnosis:
o Demographic Variables – includes the size, composition, and geographical distribution of
the population.
o Socio-Economic and Cultural Variables
▪ Social Indicators - include communication network, transportation system, educational
level, & housing conditions.
▪ Economic Indicators – include poverty level income, unemployment and
underemployment rates, types of industries in the community, & the common occupations.
▪ Environmental Indicators – include the physical, geographical/topographical
characteristics of the community, water supply, water disnposal, air, water and land pollution.
▪ Cultural Factors – variables that break up the people into groups such as: ethnicity, social
class, language, religion, race and political orientation.
o Health and Illness Patterns
▪ Mortality
▪ Morbidity
▪ Infant Mortality
▪ Maternal Mortality
▪ Hospital Admission o Health Resources
▪ Manpower Resources
▪ Material Resources o Political/Leadership Patterns ✓ Problem-Oriented Community
Diagnosis – Spradley (1990) describes the problem-oriented community diagnosis as the type of
assessment that responds to a particular need.
❖ Steps in Conducting Community Diagnosis
1. Determining the Objectives
2. Defining the Study Population
3. Determining the Data to be Gathered
4. Collecting the Data
5. Developing the Instrument
6. Actual Data Gathering
7. Data Collection

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8. Data Preparation
9. Data Analysis
10. Problem identification
a. Health Status Problems –increase or decreased morbidity, mortality, fertility or reduced
capability for wellness.
b. Health Resources Problems – are assets, means, strengths, and skills that contribute to the
promotion of health and well-being that exist within the community.
c. Health-related Problems – social, economic, environmental and political factors that
aggravate the illness situations in the community.
11. Priority Setting
a. Nature of the condition/Problem Presented
b. Magnitude of the Problem
c. Modifiability of the Problem
d. Preventive Potential
e. Social Concern
❖ Phases of COPAR Process
1. Pre-entry Phase
2. Entry Phase (Immersion Phase)
3. Formation Phase
4. Organization-Building Phase
5. Sustenance and Strengthening Phase
6. Phase out
• Vital Statistics – a tool used in estimating the extent or magnitude of health needs and
problems in the community
❖ Common Vital Statistical Indicators
a. Fertility Rates
1. Crude Birth Rate = _____number of live births___ x 1000
midyear population
2. General Fertility Rate = _____number of live births___ x 1000
midyear population of women, 15-44 years of age
b. Mortality Rates
1. Crude Death Rate = _____number of deaths______ x 1000
midyear population
2. Specific Mortality Rate = number of deaths in a specified group x1000
midyear population of the same
specified group
3. Cause-Of-Death Rate = number of deaths from a specified cause x1000
midyear Population

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4. Infant Mortality Rate = deaths under one year of age x 1000
number of live births
5. Maternal Mortality Rate = # of deaths due to pregnancy, delivery & puerperium x1000
number of live
births
6. Proportionate Mortality Rate= # of deaths from a particular cause x 100
Total deaths
7. Swaroop’s Index = # of deaths among those 50 years & over x 100
Total deaths
8. Case Fertility Rate = # of deaths from a specified cause x 100

# of cases of the same disease
c. Morbidity Rates
1. Incidence Rate = # of new cases of disease developing from a period of time x F
population at risk of developing the disease
2. Prevalence Rate = # of all and new cases of a disease x F
population examined
Note: *Mid-Year Population – July 1
• Epidemiology – study of occurrence and distribution of health conditions such as disease,
death, deformities or disabilities on human population. It rests on two important concepts:
a. Multiple Causation Theory – Disease can develop from multitude of factors and does not rest
on a single cause.
- The three models associated to this theory are the wheel, the web, and the
ecologic triad. The Ecologic triad is the most helpful because it considers the role of the
environment in disease causation. This triad is shown below:
1. Agent – any element, substance, or force that may serve as stimulus to initiate or
perpetuate a disease process. This may include biological, chemical, physical, mechanical and
nutritive.
2. Host – any living species (human or other animals) capable of being infected or affected.
3. Environment – everything external to a specific agent and host. This may be physical
environment, biological environment or socio-economic environment.
b. Levels of Prevention
1. Primary Prevention – prevention of emergence of risk factors (primordial prevention) and
removal of the risk factors or reduction of their levels (specific protection).

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2. Secondary Prevention – early detection and prompt treatment of existing health problems.
This may include screening, case finding, disease surveillance.
3. Tertiary Prevention – This limits disability progression. It restores client’s optimum level
of functioning.
c. Pattern of Disease Occurrence

1. Epidemic – A widespread of a disease that affect many persons at the same time. It
spreads from person to person in a locality where the disease is not permanently prevalent
2. Endemic – Constant long-term presence of a disease in a certain area.
e.g. Malaria cases in a mountainous region.
3. Sporadic – Refers to a disease that occurs infrequently and irregularly.
4. Pandemic – Epidemic that has spread over several countries or
continents, usually affecting a large number of people/global outbreak. e.g. COVID19
HEALTH LAWS (PHILIPPINES)
REPUBLIC ACTS
1. Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial
or agricultural establishment to furnish free emergency, medical and dental assistance to his
employees and laborers.
2. Republic Act 1082 – Rural Health Unit Act
3. Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
4. Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid January
31 of each year
5. Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
6. Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in
the Philippines
7. Republic Act 2644 – Philippine Midwifery Act
8. Republic Act 3573 – Law on reporting of Communicable Diseases
9. Republic Act 4073 – Liberalized treatment of Leprosy
10. Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it
can operative
11. Republic Act 5181 – Act prescribing permanent residence and reciprocity as
qualifications for any examination or registration for the practice of any profession in the
Philippines
12. Republic Act 5821 – The Pharmacy Act
13. Republic Act 5901 – 40 hours work for hospital workers
14. Republic Act 6111 – Medicare Act
15. Republic Act 6365 – Established a National Policy on Population and created the
Commission on population
16. Republic Act 6425 – Dangerous Drug Act of 1992

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17. Republic Act 6675 – Generics Act of 1988
18. Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
19. Republic Act 6725 – Act strengthening the prohibition on discrimination against women
with respect to terms and condition of employment
20. Republic Act 6972 – Day care center in every Barangay
21. Republic Act 7160 – Local Government Code
22. Republic Act 7164 – Philippine Nursing Act of 1991
23. Republic Act 7170 – Law that govern organ donation
24. Republic Act 7875 – National Health Insurance Act of 1995
25. Republic Act 7876 – Senior Citizen Center of every Barangay
26. Republic Act 7877 – Anti-sexual harassment Act of 1995
27. Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
28. Republic Act 8172 – Asin Law
29. Republic Act 8203 – Special Law on Counterfeit Drugs
30. Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
31. Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment
32. Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
33. Republic Act 8749 – The Philippine Clean Air Act of 1999
34. Republic Act 8981 – PRC Modernization Act of 2000
35. Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
36. Republic Act 9173 – Philippine Nursing Act of 2002
37. Republic Act 9288 – Newborn Screening Act
38. Republic Act No. 11223 – Universal Health Care Act
39. Republic Act 349 – Legalizes the use of human organs for surgical, medical and
scientific purposes.
PRESIDENTIAL DECREE - An order of the President. This power of the President which
allows him/her to act as legislators was exercised during the Martial Law period.
1. Presidential Decree 147 – Declares April and May as National Immunization Day
2. Presidential Decree 148 – Regulation on Woman and Child Labor Law
3. Presidential Decree 166 – Strengthened Family Planning program by promoting
participation of private sector in the formulation and implementation of program planning
policies.
4. Presidential Decree 223 – Professional Regulation Commission
5. Presidential Decree 491 – Nutrition Program
6. Presidential Decree 539 – Declaring last week of October every as Nurse’s Week ---
October 17, 1958
7. Presidential Decree 541 – Allowing former Filipino professionals to practice their
respective professions in the Philippines so they can provide the latent and expertise urgently
needed by the homeland
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8. Presidential Decree 568 – Role of Public Health midwives has been expanded after the
implementation of the Restructuring Health Care Delivery System (RHCDS)
9. Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide benefits
to person covered by SSS and GSIS for immediate injury, illness and disability.
10. Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
11. Presidential Decree 825 – Providing penalty for improper disposal garbage and other
forms of uncleanliness and for other purposes.
12. Presidential Decree 856 – Code of Sanitation
13. Presidential Decree 965 – Requiring applicants for Marriage License to receive
instruction on family planning and responsible parenthood.
14. Presidential Decree 996 – Provides for compulsory basic immunization for children and
infants below 8 years of age.
PROCLAMATION - an official declaration by the Chief Executive / Office of the President of
the Philippines on certain programs / projects / situation.
1. Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the
immunization program
2. Proclamation No. 499 – National AIDS Awareness Day
3. Proclamation No. 539 – Nurse’s Week – Every third week of October
4. Proclamation No. 1275 – Declaring the third week of October every year as “Midwifery
Week”
EXECUTIVE ORDER - an order issued by the executive branch of the government in order to
implement a constructional mandate or a statutory provision.
1. Executive Order 51 – The Milk Code Executive Order 174 – National Drug Policy on
Availability, Affordability, Safe, Effective and Good Quality drugs to all
2. Executive Order 209 – The Family Code (amended by RA 6809)
3. Executive Order 226 – Command responsibility
4. Executive Order 503 – Provides for the rules and regulations implementing the transfer of
personnel, assets, liabilities and records of national agencies whose functions are to be devoted to
the local government units.
SENTRONG SIGLA MOVEMENT (SSM)

- was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed
of 4 Pillars:
1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate

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CREATION OF “BOTIKA SA BARYO & BOTIKA SA HEALTH CENTER”
RA 6675: Generics Act of 1988: Implementing
“Oplan Walang Reseta Program”-solution to the absence of a medical officer who prescribed the
medicines so PHN are given the responsibility to prescribe generic medicines and “Walong
Wastong Gamot Program”- available generics in “Botika sa Baryo” & Health Center
***Father of Generics Act: Dr. Alfredo Bengzon
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

1. Co-Trimoxazole:
- it’s a combination of 2 generics of drugs which is antibacterial
2. Trimethoprim(TMP)
- Has a bacteriostatic action that stops/inhibits multiplication of bacteria
- For GUT, GIT & URTI (TMP combined with SMX)
3. Sulfamethoxazole (SMX)
- Has bactericidal action that kills bacteria
- For GUT, GIT, URTI & Skin Infections
4. Amoxicillin/Ampicillin
- An antibacterial drug that comes from the Penicillin family
- Effect is generally bacteriostatic (when source of infection is bacterial)
- These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect
of other antibiotics is anaphylactic shock
5. TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Paracetamol

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6. Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the “Botika” because of its effects:
- Anticoagulant-highly dangerous to Dengue patients that’s why it’s not available in
“Botika” & Health Center
7. Oresol
- a management for diarrhea to prevent dehydration under the Control of Diarrheal
Diseases (CDD) Program
8. Nifedipine:
- An anti-hypertensive drug
- According to DOH, 16% of population belonging to 25 years old & above in the
community are hypertensive
10 ADVOCATED HERBAL PLANTS BY DOH
HERBAL PLANTS
RA 8423: Alternative Traditional Medicine Law a program where patient may opt to use herbal
plants especially for drugs that are not available in dosage form or patients has no financial
means to buy the drug.
Traditional Medicine: Use of herbal plants
Part/s to Method/s of
Herbal Plant Scientific Name Indications
Use Preparation
Lagundi Lagundi Vitex Asthma, Leaves Decoction
Negundo cough, colds & Poultice
fever (ASCOF)
Pain and
inflammation
Ulasimang Peperonia Gout Leaves Decoction
Bato Pellucida Arthritis Poultice
Rheumatism
Bayabas Psidium Diarrhea Leaves Decoction
Quajava Toothache
Mouth and
wound
wash
Bawang Allium HPN Clove/Bulb Poultice
Sativum Toothache
Yerba Mentha Same as Lagundi Leaves Decoction
Buena Cordifelia Except asthma Poultice
Sambong Blumea Edema Leaves Decoction
balsanifera Diuretic
Akapulko Cassia All forms Leaves Decoction
Alata of skin Poultice
diseases Cream
Niyog Quisqualis Intestinal Seeds Decoction
Niyogan Indica Parasitism Poultice
(Nematodes) Juice
Tsaang Carmona Diarrhea Leaves Decoction
Gubat Resuta Infantile Poultice
colic
(Kabag)
Dental
caries
Ampalaya Mamordica Type II Diabetes Leaves Decoction
charantia (NIDDM)
Policies to Abide:
1. Know indications
2. Know parts of plants with therapeutic value: roots, fruits, leaves
3. Know official procedure/preparation

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Procedures/Preparations:
1. Decoction
- Gather leaves & wash thoroughly, place in a container the washed leaves & add water
- Let it boil without cover to vaporize/steam to release toxic substance & undesirable taste
- Use extracts for washing
2. Poultice
- Done by pounding or chewing leaves used by herbolaryo
- Example: Akapulko leaves-when pounded, it releases extracts coming out from the leaves
contains enzyme (serves as anti-inflammatory) then apply on affected skin or spewed it
over skin
- For treatment of skin diseases
3. Infusion
- To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water
where a brown solution is collected, pectin which serves as an adsorbent and astringent
4. Juice/Syrup
- To prepare a papaya juice, use ripe papaya & mechanically mashed then put inside a
blender & add water
- To produce it into a syrup, add sugar then heat to dissolve sugar & mix it
5. Cream/Ointment
- Start with poultice (pound leaves) to turn it semi-solid
- Add flour to keep preparation pasty & make it adhere to skin lesions
- To make it into an ointment: add oil (mineral, baby or any oil serves as moisturizer) to
the prepared cream to keep it lubricated while being massage on the affected area
D. ORESOL
Glucose 20 grams 1° Significance:
For re-absorption of Na
Facilitates assimilation of Na
2° Significance:
Provides heat & energy
Sodium Chloride/NaCl 3.5 grams For retention of water/fluid
Sodium 2.5 grams Buffer content of solution
Bicarbonate/NaHCO3 Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle
contractility especially the
heart & GIT
Homemade preparation of Oresol
1 pinch of salt and 1tsp of sugar to 1 glass of water(boiled)(240 ml.)
1 tsp of salt and 8 tsp of sugar to 1L of boiled water
EXPANDED PROGRAM ON IMMUNIZATION
THE FOUR MAJOR STRATEGIES OF EPI
1. Sustaining high routine FIC (fully immunized child) coverage of at least 90% in all
provinces and cities;
2. Sustaining the polio free country for global certification;
3. Eliminating measles by 2008 (for updating);
4. Eliminating neonatal tetanus by 2008 (for updating)
ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS
Minimum Minimum
Number
Vaccine Age at 1st Interval Reason
of Doses
Dose Between Doses
BCG (Bacillus Birth or 1 BCG is given at earliest
Calmette– anytime possible age protects the
Guérin) after birth possibility of TB meningitis &
Hep B (Hepatitis other TB infectious in which

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B) infants are prone. An early start
of Hep B reduces the chance of
being infected and becoming a
carrier. Prevents liver cirrhosis.
Pentavax An early start reduces the
chance of severe
6 weeks 3 4 weeks
pertusis.diptheria,tetanus,
influenza and heap B
OPV (Oral Polio The extent of protection against
Vaccine) 6 weeks 3 4 weeks polio is increased the earlier the
OPV is given
Measles 85% of measles can be
9 months prevented by immunization at
this stage.
ADMINISTRATION OF VACCINE
Vaccine Dose Route of Administration Site of Administration
BCG Infants: 0.05 ml Intradermal Right deltoid region of arm
Upper outer portion of
Pentavax 0.5 ml Intramuscular
thigh; middle third
2 drops; or
depending on
OPV Oral Mouth
manufacturer’s
instruction
Measles 0.5 ml Subcutaneous Outer part of the upper arm
Upper outer portion of
Hep B 0.5 ml Intramuscular
thigh; middle third
Tetanus Deltoid region of the upper
0.5 ml Intramuscular
Toxoid arm
TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN
Minimum Age / Percent
Vaccine Duration of Protection
Interval Protected
As early as possible
TT1 anytime during
pregnancy
Infants born to the mother will be
protected from neonatal tetanus;
TT2 At least 4 weeks later 80%
gives 3 years protection for the
mother.
At least 6 months protected from neonatal tetanus;
TT3 95%
later gives 5 years protection for the
mother.
protected from neonatal tetanus;
TT4 At least one year later 99%
gives 10 years protection for the
mother.
DOH P DOH Programs in Philippines ROGRAMS
Adolescent and Youth Health Program (AYHP)
Botika Ng Barangay (BnB)
Breastfeeding TSEK
Blood Donation Program
Belly Gud for Health

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Child Health and Development Strategic Plan Year 2001-2004
CHD Scorecard
Committee of Examiners for Undertakers and Embalmers
Committee of Examiners for Massage Therapy (CEMT)
Climate Change
Cardiovascular Disease
Chronic Obstructive Pulmonary Disease
Dental Health Program
Diabetes Prevention and Control Program
Emerging and Re-emerging Infectious Disease Program
Environmental Health
Expanded Program on Immunization
Essential Newborn Care
Family Planning Program
Food and Waterborne Diseases Prevention and Control Program
Food Fortification Program
Filariasis Control Program
Garantisadong Pambata
Human Resource for Health Network
Health Development Program for Older Persons - (Bureau or Office:
National Center for Disease Prevention and Control )
Health Development Program for Older Persons - R.A. 7876 (Senior Citizens
Center Act of the Philippines)
Health Development Program for Older Persons (Global Movement for
Active Ageing (Global Embrace 1999))
Health Development Program for Older Persons - R.A. 7432 (An Act to
Maximize the Contribution of Senior Citizens to Nation Building, Grant
Benefits and Special Privileges)
Health and Well-being of Older Persons
Infant and Young Child Feeding (IYCF)
Iligtas sa Tigdas ang Pinas
Inter Local Health Zone
Integrated Management of Childhood Illness (IMCI)
Knock Out Tigdas 2007
Leprosy Control Program
LGU Scorecard
Licensure Examinations for Paraprofessionals Undertaken by the
Department of Health
Malaria Control Program

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Measles Elimination Campaign (Ligtas Tigdas)
Micronutrient Program
National Tuberculosis Control Program
Natural Family Planning
National Filariasis Elimination Program
National Rabies Prevention and Control Program
Newborn Screening
National HIV/STI Prevention Program
National Mental Health Program
National Dengue Prevention and Control Program
National Prevention of Blindness Program
National Mental Health Program
National Safe Motherhood Program
Occupational Health Program
Oral Health Program
Persons with Disabilities
Province-wide Investment Plan for Health (PIPH)
Philippine Medical Tourism Program
Provision of Potable Water Program (SALINTUBIG Program - Sagana at
Ligtas na Tubig Para sa Lahat)
Philippine Cancer Control Program
Rural Health Midwives Placement Program (RHMPP) / Midwifery
Scholarship Program of the Philippines (MSPP)
Schistosomiasis Control Program
Soil Transmitted Helminthiasis Control Program
Smoking Cessation Program
Urban Health System Development (UHSD) Program
Unang Yakap (Essential Newborn Care: Protocol for New Life)
Violence and Injury Prevention Program
Women's Health and Safe Motherhood Project
Women and Children Protection Program
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STRATEGIES/PROGRAMS TO PROMOTE HEALTH TO VULNERABLE SECTORS
OF THE POPULATION
DOH ENDEMIC DISEASE CONTROL PROGRAMS
1. SCHISTOSOMIASIS CONTROL PROGRAM
POLICIES FOR SCHISTOSOMIASIS CONTROL
PROGRAM (SCP): CHES
1. C ase Finding
2. H ealth Education
3. E nvironmental Sanitation

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4. S nail Eradication
CASE FINDING:
6 Aspects or Thing to Know
1. Disease: Schistosomiasis
2. Other name: Bilhariazis or Snail Fever
3. Causative agent: Schistosoma-a blood fluke (parasite)
3 Types of Species:
a. Schistosoma japonicum-endemic in the Philippines & affecting Indonesia,
China, Japan, Korea Vector: Oncomelania quadrasi
b. Schistosoma mansoni
c. Schistosoma haematobium
4. Laboratory Procedures to rule out Schistosomiasis: Blood Examination: ↑ eosinophil
level indicates parasitism
Fecalysis: Kato Katz (plain stool exam that uses a special apparatus resembling a feeding
bottle sterilizer)
Procedure:
a. Collect specimen
b. Have the test tube undergo centrifugation for 20 minutes
c. Get specimen from precipitate & swab it on glass slide
d. Observe it on microscope
5. Signs & Symptoms
a. CNS: High grade fever→ cerebral convulsion
b. GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery (prolonged diarrhea of more
than 2 weeks & consistency is mucoid & bloody (with streaks of blood)
c. Liver: Presence of infection manifested by jaundice & hepatomegaly
d. Spleen: Infection of spleen→ inflammation→ enlargement of organ
(Splenomegaly)→ abdominal distension→ abdominal pain on the right upper
quadrant
e. Blood: Anemia & weakness
6. Treatment: Drug of Choice-Praziquantel (Biltricide) 60 mg/KBW/day
- Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000 mg/day
- Initial treatment: 1st 2 weeks=3000 mg/day, then do stool exam after 2 weeks→ if still
(+), extend treatment for another 2 weeks. Repeat stool exam, if still (+) after the
extended week, continue treatment for 2 weeks again. No adverse effect or over dosage
even if extended for a year.
- Length of Treatment: takes months to a year
Health Education:
1. It affects mostly farmers so educate them to wear rubber boots
2. Environmental Sanitation: Snail is the 1st concern
3. Water where snail thrives is the 2nd concern
4. Toilet=3rd concern
5. Food
6. Garbage
Snail Eradication: Use molluscicides treat the entire suspected soil with chemical solution that
kills snails
2. MALARIA CONTROL PROGRAM
CASE FINDING:
- Disease: Malaria
- Other name: Ague
- Causative Agent: Plasmodium-a protozoa
- 4 Types of Species:
a. Plasmodium falciparum-more fatal that affects the Philippine Vector: Female
Anopheles Mosquito (FAM)
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malariae

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- Laboratory Procedure: Malarial smear-extract blood at the height of fever because
plasmodium is very active & ruptures at this period.
- Signs & Symptoms of Malaria:
1. 1st Stage=Cold: Chilling sensation for 1-2 hours
2. 2nd Stage=Hot: High grade fever lasting for 3-4 hours
3. 3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration
- Treatment: Drug of Choice-Quinine
2 Forms:
a) Chloroquine (Aralen)
b) Primaquine
If Quinine is not available, may use Sulfadoxime-an antibacterial drug paired with pyrinthamine
PERSONAL PROTECTION:
1. Sleep under a mosquito net
2. Sleep in a screened room
3. Sleep with long sleeve attire
4. Use repellents that contains DET (diethyl toluamide or toluene which has a pungent odor
that drives away mosquitoes & an irritant to mucous membrane of respiratory tract when
inhaled
5. Plant a Neem Tree using the leaves
CLEAN:
- Chemical Method=insecticide spraying at night
- Larvae eating fish=Tilapia
- Environmental Sanitation & Health
- Education=insect, water, trash
- Anti-mosquito soap=basil citronella
- Neem tree=banana, banaba, gabi, eucalyptus provide repellent effect
3. MATERNAL and Child CARE PROGRAM
STRATEGIES:
A. Provision of Regular and Quality Maternal Care Services
1. Regular and quality pre-natal care
- hx-taking, utilization of HBMR (Home-Based Mother’s Record) as a guide in the identification
of risk factors
- PE: weight, height, BP-taking
- Perform head-to-toe assessment, abdominal exam
- Tetanus Toxoid Immunization
- Fe supplementation: given from 5th mo. of pregnancy to two months postpartum (100-120 mg
orally/day for 210 days)
- Laboratory exam: Heat-acetic acid test. Benedict’s test
- Oral/Dental exam
2.Pre-natal counseling
3. Provision of safe, delivery care
- all birth attendants shall ensure clean and safe deliveries at the faciltiies (RHUs/hospitals)
- at-risk pregnancies and mothers must be immediately referred to the nearest institution
4. Provision of quality postpartum care
5. Proper schedule of follow-up must be followed:
- 1st postpartum visit for home deliveries must be done within 24 hours after delivery
- 2nd, done at least 1 week after delivery
- 3rd, done 2-4 weeks thereafter
B. Attendants must be aware of the early signs, symptoms and complications. They should
follow the 3 CLEANS:
1. CLEAN Hands

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2. CLEAN Surface
3. CLEAN Cord
C. Improvement of the health personnel’s capabilities on newborn care,
midwifery thru trainings.
Note: All deliveries should be done in health care facilities ONLY
D. Improvement on the quality of care at the First Referral Level
- Orientation, training should be done on the use of proper filling-up of HBMR card
- Proper referrals/endorsements must be done for future If-ups
E. Prevention of unwanted pregnancies through family planning services
F. Prevention and management of STDs
G. Promotion of Appropriate health practices
H. Upgrade reporting services
I. Mobilize political commitment and community involvement to provide support to basic health
care delivery
4. FAMILY PLANNING PROGRAM
GOALS:
A. Safe Pregnancy
- Right age to be pregnant=20-35 years old, not less than 20 & not more than 35
- Right interval of pregnancy=once in 2 or 3 years
- Home Base Mother’s Record (HBMR): the record used for care of mothers in CHN
POLICIES:
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all Curricular Program:
- LOI 47 DECS states that Family Planning is to be integrated in all school curricular programs,
either baccalaureates or non-baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other agencies which can either be:
- Intrasectoral
- Intersectoral-Local or International (WHO, Unicef, USAID, Japhiego)
5. NUTRITION HEALTH SERVICES POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
A. Anthropometric Measurement: study of measurements of human dimensions
1. Age for Weight-if weight is not appropriate with the age:
- Stunting: growth retardation
- Wasting: connotes malnutrition
2. Age for Height-if height is not appropriate with the age:
- Stunting
- Weight for Height
Rule Male Female
1. Every height of 5ft. 110 lbs. 105 lbs.
2. Every increment of an inch above 5 ft. ADD + 6 + 5
3. Every decrement of an inch below 5 ft. SUBTRACT - 6 – 5
- Skin Folds Test-pinch the external oblique muscle (“bilbil”) with your palm
Normal: 1 inch
Overweight: > 1 inch
- Middle Upper Arm Circumference (MUAC)-used in children below 5 years old by
measuring the middle upper arm with a tape measure
Normal: 13 cms. & above

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Malnutrition: <13 cms
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
- Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u.
Pre-schoolers (12-83 months) : 200,000 i.u.
Post partum : 200,000 i.u.
***Never give Vitamin A to infants less than 6 months & pregnant women because it is
toxic
Anemia: Iron Deficiency Anemia
Target age group: 0-59 months (less than 5 years)
Give 3-6 mg/kbw/day
Always give the maximum
Example: Child weighs 8 kg
8 x 6=48 mg/day for the 1st 3 months then monitor
If still anemic, continue giving but compute again 6 mg/kbw
Goiter: Iodine Deficiency Disease (endemic in uphill)
Target age group: 0-59 months
Give 1 capsule (200 mg) of potassium iodate in oil once a year
For a child < 5 years old, empty contents of capsule in a cup with warm water because
he can’t tolerate it
Adverse Effect of Iodine Deficiency Disease that must be avoided:
Mental retardation-intelligence quotient: idiot, moron & imbecile
Growth retardation- cretinism (pedia) & dwarfism (adult
Macronutrient Malnutrition - available in large amount in the body (Protein Energy
Malnutrition or PEM)
Kwashiorkor-protein deficiency
Marasmus-carbohydrate deficiency (energy giving food)
Kwashiorkor Marasmus
Etiology Disease experienced by an elder child upon the birth of a new
baby
Muscle wasting
Deficiency CHON CHO
Age Toddlers (1-3 years old) All ages
Major Signs & Symptoms
Facial edema, moon facie Muscle wasting, old man’s facie
Hair Changes (+) color changes from black to brown or from
brown to golden yellow
(+) sparse “flag sign”
(-) hair changes
Skin Dermatosis: dryness, peeling off of the skin, desquamation
(-) Behavior Irritable Apathetic
Management High CHON diet High CHO diet

Hospital Setting Total Parenteral Nutrition (TPN)
Hyperalimentation process
IV infusion with CHON, CHO regulated by a Machine
POLICIES:
Food Production
- Fortification-products without any nutrient are added with nutrients
- RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)
=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003 where DOH
workers go to market to check if salt sold contains iodine by placing few drops of
reagent:
If salt color turns to blue violet→ fortified with iodine

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If salt color show no change→ not fortified with iodine
- RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier under
FVR, Erap Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA

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6. ENVIRONMENTAL SANITATION
- refers to all factors available in the environment affecting the health of the individual or
population
- regulated by PD 856: Comprehensive Sanitation Code of the Philippines
ENVIRONMENTAL HEALTH SERVICE (EHS) OF DOH IS RESPONSIBLE FOR
1. Promotion of healthy environmental conditions & prevention of environmental related
diseases through appropriate sanitation strategies
2. Promotion & implementation of sanitation programs through the Department of Health
Field Health Units
3. Conceptualization of new programs/projects to contend with emerging environmentally
related health problems
COMPONENTS:
1. Water Supply Sanitation Program
2. Proper Excreta and Sewage Disposal Program
3. Insect and Rodent Control
4. Food and Sanitation Program
5. Hospital Waste Management Program
1. WATER SUPPLY SANITATION PROGRAM
- Potable
- Free from any particles that might cause illness to an individual
Ways to make Water Potable:
1. Boiling: minimum of 3 minutes to maximum of 10 minutes for drinking
2. Sterilization: 30 minutes after the water starts to boil
3. Filtration: makes use of filter paper or cotton cloth to separate solid particle from liquid
if water comes from river
4. Coagulation/Flocculation: uses aluminum crystal (tawas) that collects or absorbs
particles from liquid part & becomes slimy

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- In 1 gallon of water, drop tawas (the size of magic cubes) & allow to stand for 6-8 hours
- Initially, water appears to be cloudy then after 6-8 hours of standing, the water becomes
clear
5. Chlorination: uses 100% pure concentrated chlorine bought from botika or given free by
health centers
- To prepare stock solution (SS): in 1 liter drinking water, add 1 tablespoon of concentrated
chlorine which is potent for 3-4 months
- To prepare the chlorinated water: in 2 ½ gallons of drinking water (10,000 ml=10 liters),
add 1 tablespoon from the prepared stock solution & let it stand for 30 minutes to react
with water
6. Fluoridation: adding fluoride to prevent dental caries (primary significance) & whitens
enamel of teeth ( 2nd significance)
7. Aeration: exposing drinking water in air to strengthen taste within 24 hours which is
usually used in uphill areas where there’s less or no pollution
3 Types of Approved Water Supply and Facilities
a. Level I
- Point Source
- A protected well or a developed spring with an outlet but without a distribution system
for rural areas where houses are thinly scattered.
a. Level II
- Communal faucet system or stand posts
- A system composed of a source, a reservoir, a piped distribution network and communal
faucets, located at not more than 25 meters from the farthest house in rural areas where
houses are clustered densely.
b. Level III
- Waterworks system or individual house connections
- A system with a source, a reservoir, a piped distributor network and household taps that
is suited for densely populated urban areas.
2. PROPER EXCRETA AND SEWAGE DISPOSAL SYSTEM
3 Types of Approved Toilet Facilities
a. Level 1
- Non-water carriage toilet facility:
1. Pit latrines
2. Reed Odorless Earth Closet
3. Bored-hole
4. Compost
- Toilets requiring small amount of water to wash waste into receiving space
1. Pour flush
2. Aqua privies
- Pit latrines
a. most commonly observed in rural area
b. has three components: the pit, a squatting plate and the super-structure
c. types of pit include
c.1. “Antipolo type”, a pit type of toilet provided with concrete floor and an elevated
seat with a cover
c.2. Ventilated Improved Pit or VIP, pit with a vent pipe
c.3. Reed Odourless Earth Closet or ROEC, a pit completely displaced from the
superstructure and connected to the squatting plate by a curved chute.
- Bored Hole Latrine
a. consists of relatively deep holes bored into the earth by mechanical or manual earth-
boring equipment
b. holes are about 10-18 inches in diameter and usually 15-35 feet deep. The hole is
provided to facilitate squatting.
c. Two types of bored-hole latrines are:
c.1. Wet Type - when the hole penetrates ground water table or other strata.

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c.2. Dry Type - when he hole does not reach ground water table; fills up at a faster rate
then than the wet type.
b. Level 2
- On site toilet facilities of the water carriage type with water sealed and flushed type with
septic vault/tank disposal facilities.
c. Level 3
- Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system
to treatment plant.
Things to Consider in Constructing a Toilet Facility:
1. At least 25 meters away from water sources at a lower elevation
2. It should be within your financial capability
3. It should be approved by the local health authorities
Care and Maintenance of Toilet Facility:
1. Water must be provided at all times.
2. Use toilet paper
3. Use lysol once a month for odor removal
4. Clean the bowl by muriatic acid to remove the stains.
5. Avoid depositing solid objects on the bowl to prevent clogging
6. Always check your toilet if it’s clean
7. Use plunger when clogging occurs. Don’t use sticks or rods to avoid the breakage of the
trap or the bowl.
3. PROPER SOLID WASTE MANAGEMENT
- refers to satisfactory methods of storage, collection and final disposal of solid wastes
Sources of Solid Waste:
1. Household Waste - these are wastes generated in or discharged from household including
shops but excluding commercial activities
2. Commercial Waste - restaurants, stationery shops, grocery shops or any commercial
activity are the main sources of commercial waste.
3. Market Waste - only refers to waste generated in or discharged from markets both for
whole sale and retailing
4. Institutional Waste - these are wastes generated in government, state enterprise and
private firm office.
5. Street Sweeping Waste - these are wastes generated by the street sweeping cleansing
service.
6. River Waste - includes all the wastes generated by the river and creek cleansing
7. Medical Waste - these are wastes generated in hospitals.
Components of Solid Waste
1. Garbage refers to left over vegetable, animal and fish material from kitchen and food
establishments. These materials have the tendency to decay giving off foul odors and
sometimes serve as food for flies and rats.
2. Rubbish refers to waste materials such as bottles, broken glass, tin can, waste papers,
discarded textile materials, porcelain wares, pieces of metal and other wrapping
materials.
3. Ashes are left over from burning of wood and coal. Ashes may become a nuisance
because of the dust associated with them.
4. Stable manure is animal manure collected from stables.
5. Dead animals like dead dogs, cats, rats, pigs, and chickens that are killed by cars and
trucks on streets and public highways. They include small and large animals that died
from disease.
6. Street sweeping includes dust, manure, leaves, cigarette butts, waste papers and other
materials that are swept from streets.
7. Night soil is human waste normally wrapped and thrown into sidewalks and streets. This
also includes human waste from pail system of toilets.
8. Yard cuttings includes leaves, branches, grass and other
Sanitary Ways of Treating Garbage:
1. Segregation-separating biodegradable from non biodegradable

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2. Collection-adherence to the proper collection time
Ways of Disposal
1. Household
○ Burial
► Deposited in 1m x 1m deep pits covered with
soil, located 25 m. away from water supply
○ Open burning
o Animal feeding
o Composting
o Grinding and disposal sewer
2. Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet
○ Incineration
Ecological Solid Waste Management: RA 9003- the use of incinerator approved in 2000
but was implemented in 2003 because of lack of funding to purchase
Hospital Waste Management
RA 4226-Hospital Licensure Act monitors the hospital license & proper management of
wastes as well as renewal of license to operate.
GOAL:
To prevent the risk of contraction contracting nosocomial infection from type disposal of
infectious, pathological and other wastes from hospital
COLOR CODING OF BIN TO KEEP WASTE:
Green : wet waste
Black : dry waste
Yellow: infectious/pathological waste like blood, sputum, urine, feces & gauze
Orange: toxic/hazardous waste
FOOD SANITATION PROGRAM POLICIES:

1. Food establishment are subject to inspection (approved of all food sources containers and
transport vehicles)
2. Comply with sanitary permit requirement
3. Comply with updated health certificates for food handlers, helpers, cooks
4. All ambulant vendors must submit a health certificate to determine present of intestinal
parasite and bacterial infection
3 POINTS OF CONTAMINATION
1. Place of production processing and source of supply
2. Transportation and storage
3. Retail and distribution points
FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS)
- It is a network of information
- It is intended to address the short term needs of DOH and LGU staff with managerial or
supervisory functions in facilities and program areas.
- It monitors health service delivery nationwide.
OBJECTIVES OF FHSIS
1. To provide summary data on health service delivery and selected program
accomplishment indicators at the barangay, municipality/ city, and district, provincial,
regional and national levels.
2. To provide data which when combined with data from other sources, can be used for
program monitoring and evaluation purposes.
3. To provide a standardized, facility-level data base that can be accessed for more in-depth
studies.
4. To minimize the recording and reporting burden at the service delivery level in order to
allow more time for patient care and promote activities.
IMPORTANCE OF FHSIS
1. Helps local government determine public health priorities.

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2. Basis for monitoring and evaluating health program implementation.
3. Basis for planning, budgeting, logistics and decision making at all levels.
4. Source of data to detect unusual occurrence of a disease.
5. Needed to monitor health status of the community.
6. Helps midwives in following up clients.
7. Documentation of RHM/PHN day to day activities.
COMPONENTS OF FHSIS
1. Individual Treatment Record (ITR)
2. Target Client List (TCL)
3. Summary Table
4. The Monthly Consolidation Table (MCT)
INDIVIDUAL TREATMENT RECORD (ITR)
- The fundamental building block or foundation of the Field Health Service Information
System is the INDIVIDUAL TREATMENT RECORD.
- This is a document, form or piece of paper upon which is recorded the date, name,
address of patient, presenting symptoms or complaint of the patient on consultation and
the diagnosis (if available), treatment and date of treatment.
TARGET CLIENT LIST (TCL)
- The Target Client Lists constitute the second “building block” of the FHSIS and are
intended to serve several purposes
1. First is to plan and carry out patient care and service delivery. Such lists will be of
considerable value to midwives/nurses in monitoring service delivery to clients in
general and in particular to groups of patients identified as “targets” or “eligibles” for
one or another program of the Department
2. The second purpose of Target Client Lists is to facilitate the monitoring and
supervision of service delivery activities.
3. The third purpose is to report services delivered.
4. The fourth purpose of the Target Client Lists is to provide a clinic-level data base
which can be accessed for further studies
TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS
1. Target Client List for Prenatal Care
2. Target Client List for Post-Partum Care
3. Target Client List of Under 1 Year Old Children
4. Target Client List for Family Planning
5. Target Client List for Sick Children
6. NTP TB Register
7. National Leprosy Control Program Form 2-Central Registration
Form
SUMMARY TABLE
- The Summary Tables is a form with 12-month columns retained at the facility (BHS)
where the midwife records monthly all relevant data. The Summary Table is composed
of:
1. Health Program Accomplishment this can serve as proof of accomplishments to show
LGU officials whenever they visit the facility.
2. Morbidity Diseases the source of ten leading causes of morbidity for the
municipality/city. This summary table will help the nurse and MHO to get the monthly
trend of diseases
THE MONTHLY CONSOLIDATION TABLE (MCT)
- The Consolidation Table is an essential form in the FHSIS where the nurse at the RHU
records the reported data per indicator by each BHS or midwife.
- This is the source document of the nurse for the Quarterly Form.
- The Consolidation Table shall serve as the Output Table of the RHU as it already
contains listing of BHS per indicator.
FHSIS REPORTING

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- These are summary data that are transmitted or submitted on a monthly, quarterly and on
annual basis to higher level. The source of data for this component is dependent on the
records.
THE MONTHLY FORM
1. Program Report (M1)
- The Monthly Form contains selected indicators categorized as maternal care, child care,
family planning and disease control.
2. Morbidity Report (M2)
- The Monthly Morbidity Disease Report contains a list of all diseases by age and sex. The
Midwife uses the form for the monthly consolidation report of Morbidity Diseases and is
submitted to the PHN for quarterly consolidation.
THE QUARTERLY FORM
1. Program Report (Q1)
- The Quarterly Form is the municipality/city health report and contains the three-month
total of indicators categorized as maternal care, family planning, child care, dental health
and disease control
2. Morbidity Report (Q2)
- The PHN uses the form for the Quarterly Consolidation Report of Morbidity Diseases to
consolidate the Monthly Morbidity Diseases taken from the Summary Table.
THE ANNUAL FORMS (A-BHS, A1, A2 & A3)
- ABHS Form is the report of midwife which contains data on demographic, environmental
and natality.
- The report of nurse at the RHU/MHC are the Annual Form 1 which is the report on vital
statistics: demographic, environmental, natality and mortality.
- Annual Form 2 is the report that lists all diseases and their occurrence in the
municipality/city. The report is broken down by age and sex.
- Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is
also broken down by age and sex.
FLOW OF REPORTSON RECORDING
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE
TOOLS OF
SUBMISION
BHS Midwife - ITR Monthly Monthly Every 2nd
- TCL Form week of the
- ST (M1 & M2) succeeding
month
A-BHS Annually Every 2nd

Form week of
January
RHU PHN - ST Quarterly Quarterly Every 3rd
- MCT Form week of the
(Q1 & Q2) 1st
month of
succeeding
quarter
Annual Every 3rd
Forms week of
- A1 January
- A2
- A3

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LEARNING MODULE I
I. LEARNING TITLE
WEEK 1
UNIT I Overview of Community Health Nursing/Public Health Nursing in the
Philippines
INTRODUCTION
This topic introduces the students the concept of Community health Nursing, Public
Health, its meaning, principles, roles and responsibilities of a community health nurse in the
community. The knowledge gained will guide the students the scope of CHN in the delivery of
health services and health programs within the community.
II. LEARNING OUTCOMES
At the end of two weeks, the student will be expected to:

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1. Know the current health situation and health issues of the country.
2. Define comprehensive meaning of health, community and nursing.
3. Differentiate Community Health Nursing and Public Health Nursing.
4. Explain the standards of community health nursing practice in the Philippines
5. Discuss the evolution of CHN in the Philippines
6. Identify the different roles and responsibilities of a community health nurse.
III. LEARNING OUTLINE
A. Global and National Health Situation

B. Definition and Focus
1. Community
2. Health
3. Community health
4. Public Health
5. Community Health
6. Public Health Nursing
7. Community Health Nursing (CHN)
8. Evolution of Public Health Nursing in the Philippines
9. Standards of Public Health Nursing in the Philippines
10. Roles and Responsibilities of a Community Health Nurse
11. Nursing Core Values as a Community Health Nurse.
IV. LEARNING CONTENT
A. Global and National Health Situation

https://doh.gov.ph
http://apps.who.int>bitstream
HEALTH AND LONGEVITY AS BIRTHRIGHTS
LONGEVITY-average lifespan
Life expectancy in the country in 2010-2015 was 68.6 years, which was lower than the
world average by 2.2 years. Filipino females (72.06 years) tend to outlive their male
counterparts by 6.75 years. In 1990-1995, life expectancy was at 65.7 years and higher than the
world average by 1.1 years.(philjournalsci.dost.gov.ph)
Life expectancy at birth m/f (years, 2016), 66/73. Probability of dying under five ( per 1
000 live births, 2018), 28. Probability of dying between 15 and 60 years m/f
The life expectancy for Philippines in 2017 was 70.87 years, a 0.23% increase from
2016. Download Historical Data Save as Image.
In 2018 the life expectancy in Philippines increased to 71.1 years. That year, the life
expectancy for women was 75.39 years and for men 67.12 years.
The life expectancy for Philippines in 2019 was 71.16 years, a 0.18% increase from 2018.
(www.macrotrends.net › countries › PHL › life-expectan)
B. Definition and Focus

Community

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 a group of people with common characteristics or interests living together within a
territory or geographical boundary
 place where people under usual conditions are found
 Derived from a latin word “comunicas” which means a group of people.
3 Elements of a community
1. Geographical Entity
2. Social Entity
3. Psychocultural Entity
Health
 OLOF (Optimum Level of Functioning)

 Health-illness continuum
 High-level wellness
 Agent-host-environment
 Health belief
 Evolutionary-based
 Health promotion
 WHO definition Recognized
Community Health
Part of paramedical and medical intervention/approach which is concerned on the health
of the whole population
Community health refers to the health status of the members of the community, to the
problems affecting their health and to the totality of the health care provided for the
community.
AIMS of CHN
1. To promote health and efficiency.
2. To prevent and control of diseases and disabilities.
3. To prolong life through need based health care.
OTTAWA CHARTER FOR HEALTH PROMOTION
The Ottawa Charter for Health Promotion is the name of an international agreement

signed at the First International Conference on Health Promotion, organized by the World Health
Organization (WHO) and held in Ottawa, Canada, in November 1986.[1] It launched a series of
actions among international organizations, national governments and local communities to
achieve the goal of "Health For All" by the year 2000 and beyond through better health
promotion.
The thirtieth WHO World Health Assembly, held in 1977, had highlighted the
importance of promoting health so that all the international citizens had an "economically
productive" level of health by the year 2000. Further, a localised European taskforce developed a
strategy for health promotion in the WHO European Region.
Five action areas for health promotion were identified in the charter:
1. Building healthy public policy

2. Creating supportive environments
3. Strengthening community action
4. Developing personal skills
5. Re-orienting health care services toward prevention of illness and promotion of health
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The basic strategies for health promotion were prioritized as:
 Advocate: Health is a resource for social and developmental means, thus the dimensions that
affect these factors must be changed to encourage health.
 Enable: Health equity must be reached where individuals must become empowered to
control the determinants that affect their health, such that they are able to reach the highest
attainable quality of life.
 Mediation: Health promotion cannot be achieved by the health sector alone; rather its
success will depend on the collaboration of all sectors of government (social, economic, etc.)
as well as independent organizations (media, industry, etc.). (en.wikepedia.org)
JAKARTA DECLARATION ON LEADING HEALTH PROMOTION INTO THE 21ST

CENTURY
The Fourth International Conference on Health Promotion: New Players for a New Era -
Leading Health Promotion into the 21st Century, Jakarta, Indonesia, 21-25 July ,1997.
PRIORITIES FOR HEALTH PROMOTION IN THE 21ST CENTURY

1. Promote social responsibility for health
Decision-makers must be firmly committed to social responsibility. Both
the public and private sectors should promote health by pursuing policies and
practices that: • avoid harming the health of individuals • protect the environment
and ensure sustainable use of resources • restrict production of and trade in
inherently harmful goods and substances such as tobacco and armaments, as well
as discourage unhealthy marketing practices • safeguard both the citizen in the
marketplace and the individual in the workplace • include equity-focused health
impact assessments as an integral part of policy development.
2. Increase investments for health development
In many countries, current investment in health is inadequate and often
ineffective. Increasing investment for health development requires a truly
multisectoral approach including, for example, additional resources for education
and housing as well as for the health sector. Greater investment for health and
reorientation of existing investments, both within and among countries, has the
potential to achieve significant advances in human development, health and
quality of life. 20 Jakarta Declaration on Leading Health Promotion into the 21st
Century Investments for health should reflect the needs of particular groups such
as women, children, older people, and indigenous, poor and marginalized
populations.
3. Consolidate and expand partnerships for health
Health promotion requires partnerships for health and social development
between the different sectors at all levels of governance and society. Existing
partnerships need to be strengthened and the potential for new partnerships must
be explored. Partnerships offer mutual benefit for health through the sharing of
expertise, skills and resources. Each partnership must be transparent and
accountable and be based on agreed ethical principles, mutual understanding and
respect. WHO guidelines should be adhered to.
4. Increase community capacity and empower the individual
Health promotion is carried out by and with people, not on or to people. It
improves both the ability of individuals to take action, and the capacity of groups,
organizations or communities to influence the determinants of health. Improving
the capacity of communities for health promotion requires practical education,
leadership training, and access to resources. Empowering individuals demands
more consistent, reliable access to the decision-making process and the skills and
knowledge essential to effect change. Both traditional communication and the
new information media support this process. Social, cultural and spiritual
resources need to be harnessed in innovative ways
5. Secure an infrastructure for health promotion

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To secure an infrastructure for health promotion, new mechanisms for
funding it locally, nationally and globally must be found. Incentives should be
developed to influence the actions of governments, nongovernmental
organizations, educational institutions and the private sector to make sure that
resource mobilization for health promotion is maximized. “Settings for health”
represent the organizational base of the infrastructure required for health
promotion.
New health challenges mean that new and diverse networks need to be
created to achieve intersectoral collaboration. Such networks should provide
mutual assistance within and among countries and facilitate exchange of
information on which strategies have proved effective and in which settings.
Training in and practice of local leadership skills should be encouraged in order to
support health promotion activities. Documentation of experiences in health
promotion through research and project reporting should be enhanced to improve
planning, implementation and evaluation. All countries should develop the
appropriate political, legal, educational, social and economic environments
required to support health promotion.(www.who.int)
NURSING
 Both profession & a vocation. Assisting sick individuals to become healthy and healthy
individuals achieve optimum wellness
 Definition of Nursing by Dorothea Orem,Virginia Henderson and other Nursing
Theorists
Community Health Nursing
It is a synthesis of nursing and public health practice applied to promoting and preserving
the health of the people.
 “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.” ( Maglaya, et al)
 Goal: “To raise the level of citizenry by helping communities and families to cope with
the discontinuities in and threats to health in such a way as to maximize their potential for
high-level wellness” ( Nisce, et al)
 Special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health program for the
promotion of health, the improvement of the conditions in the social and physical
environment, rehabilitation of illness and disability ( WHO Expert Committee of
Nursing)
 A learned practice discipline with the ultimate goal of contributing as individuals and in
collaboration with others to the promotion of the client’s optimum level of functioning
thru’ teaching and delivery of care (Jacobson)
A service rendered by a professional nurse to IFCs, population groups in health centers,
clinics, schools , workplace for the promotion of health, prevention of illness, care of the Public
Health
Public health is the art and science of preventing illness, prolonging life and promoting
through organized efforts of the society.
Public Health is directed towards assisting every citizen to realize his birth rights and
longevity.”“The science and art of preventing disease, prolonging life and efficiency through
organized community effort for:
1. The sanitation of the environment

2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease

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The development of a social machinery to ensure every one a standard of living, adequate
for maintenance of health to enable every citizen to realize his birth right of health and longevity
(Dr. C.E Winslow)
OBJECTIVES OF PUBLIC HEALTH

C ontrol of Communicable Diseases
O rganization of Medical and Nursing Services
D evelopment of Social Machineries
E ducation of IFC on personal Hygiene→ Health Education is the essential task of every health
worker
S anitation of the environment
3 ELEMENTS IN HEALTH EDUCATION: IEC
I nformation: to share ideas to keep population group knowledgeable and aware
E ducation: change within the individual
C ommunication: interaction involving 2 or more persons or agencies
3 Key Elements of Education:

K nowledge
A ttitude
S kills
3 Elements of Communication:
Message
Sender
Receiver
Mission of CHN
Health Promotion
Health Protection
Health Balance
Disease prevention
Social Justice
Philosophy of CHN
“The philosophy of CHN is based on the worth and dignity on the worth and dignity of
man.”(Dr. M. Shetland)
1. 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.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of
care,
3. CHN practice is affected by developments in health technology, in particular, changes in
society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Basic Principles of CHN
Community Health Nursing (CHN) is a vital part of Public Health and there are 12
principles the govern CHN.
1. The recognized need of individuals, families and communities provides the basis for CHN
practice. Its primary purpose is to further apply public health measures within the framework
of the total CHN effort.
2. Knowledge and understanding of the objectives and policies of the agency facilities goal
achievement. The mission statement commits Community Health Nurses to positively actualize
their service to this end.
3. CHN considers the family as the unit of service. Its level of functioning is influenced by the
degree to which it can deal with its own problems. Therefore the family is an effective and
available channel for the most of the CHN efforts.

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4. Respect for the values, customs and beliefs of the clients contribute to the effectiveness of
care to the client. CHN services must be available sustainable and affordable to all regardless of
race, creed, color or socio-economic status.
5. CHN integrated health education and counseling as vital parts of functions. These
encourage and support community efforts in the discussion of issues to improve the people’s
health.
6. Collaborative work relationships with the co-workers and members of the health team
facilities accomplishments of goals. Each member is helped to see how his/her work benefits
the whole enterprise.
7. Periodic and continuing evaluation provides the means for assessing the degree to which
CHN goals and objectives are being attained. Clients are involved in the appraisal of their
health program through consultations, observations and accurate recording.
8. Continuing staff education program quality services to client and are essential to
upgrade and maintain sound nursing practices in their setting. Professional interest and
needs of Community Health Nurses are considered in planning staff development programs of
the agency.
9. Utilization of indigenous and existing community resources maximizing the success of
the efforts of the Community Health Nurses. The use of local available ailments. Linkages
with existing community resources, both public and private, increase the awareness of what care
they need what are entitled.
10. Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the CHN
programs. Organized community groups are encouraged to participate in the activities that will
meet community needs and interests.
11. Supervision of nursing services by qualified by CHN personnel provides guidance and
direction to the work to be done. Potentials of employees for effective and efficient work are
developed.
12. Accurate recording and reporting serve as the basis for evaluation of the progress of
planned programs and activities and as a guide for the future actions. Maintenance of
accurate records is a vital responsibility of community as these are utilized in studies and
researches and as legal documents.
Roles of the PUBLIC HEALTH NURSE

 Clinician, who is a health care provider, taking care of the sick people at home or in the
RHU
 Health Educator, who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
 Facilitator, who establishes multi-sectoral linkages by referral system
 Supervisor, who monitors and supervises the performance of midwives
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 Collaborator, who working with other health team member
 sick at home and rehabilitation (DR. Ruth B. Freeman)
In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the MHO’s
responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and

Regulations of RA 9173 (Philippine Nursing Act of 2002) includes:
 Supervision and care of women during pregnancy, labor and puerperium

 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic medicines
In the care of the families:

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 Provision of primary health care services
 Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
 Community organizing mobilization, community development and people empowerment

 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and
development
Responsibilities of CHN
 be a part in developing an overall health plan, its implementation and evaluation for
communities
 provide quality nursing services to the three levels of clientele
 maintain coordination/linkages with other health team members, NGO/government
agencies in the provision of public health services
 conduct researches relevant to CHN services to improve provision of health care
 provide opportunities for professional growth and continuing education for staff
development
EVOLUTION OF CHN WORLDWIDE AND IN THE PHILIPPINES

A. INFLUENCES OF ANCIENT CULTURES ON PUBLIC HEALTH
EGYPTIAN CIVILIZATION (ca 3000 BC)
Built irrigation canal and granaries for storage of food
Practice of prophylaxis by the medicine man and high priest
Emphasis on personal hygiene, cleanliness within & outside the body
Sanitation measures ( removal of refuse and crude fumigation in times of epidemics)
HEBREWS (C.A. 1400 BC)
Founders of public hygiene
Moses “father of Sanitation”
Mosaic Health Code pertained to every aspect of individual, family & community hygiene,
included:
a. Principles of personal hygiene (rest, sleep, hours of work, cleanliness)
b. Environmental sanitation
1. Inspection of food
2. Methods of disposal of excreta
3. Detecting and reporting diseases
4. Practice of isolation, quarantine, fumigation and disinfection
5. Detailed instructions on the correct way of hand washing
GREEKS (CA. 600 BC)

Hippocrates – “Father of Medicine”
> exponent of the science of preventive medicine
> introduced the philosophy of the interrelationship between physical and mental health ( “A
healthy mind dwells in a healthy body”)
ROMANS (CA. 50 BC) *
Contributed to the field of sanitation (building of Aqueducts, purification of water supply) *
Appointing of public health medical officers *
Establishment of hospitals which emphasized both preventive and curative aspects of care
B. DEVELOPMENT OF PUBLIC HEALTH NURSING AS A WORLD MOVEMENT
EARLY CHRISTIAN PERIOD (1 ST CENTURY)

Order of Deaconesses- organized visiting of the sick
- called visiting nurses
- forerunner of CHN
- endeavored to practice the corporal works of mercy (feeding the hungry, caring for the sick,
burying the dead) Phoebe a friend of St Paul and the first Deaconess and visiting nurse.
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MIDDLE AGES (500-1500)
Beguines of Flanders- worked as nursing sister in the hospital, but also gave care to the sick in
their homes, staying with the dying and consoling the families of the bereaved.
RENAISSANCE (1500-1700)
St Vincent De Paul- introduced modern principles of visiting nurse and social services
* taught that indiscriminate giving was harmful
* emphasized the concept of helping people help themselves
* organized the daughters of charity primarily for the care of the sick at home
* maintained the family is the unit of the service
* recognized the importance of supervision of those who render service to the sick
EARLY 19 TH CENTURY
Pastor Theodor Fliedner- German Lutheran pastor, went tour to raise funds when the main
industry of his community failed, came back with money and ideas for a program social work.
Fredericka Munster Fliedner- a wife pastor organized women society for visiting nursing the sick
poor in their homes Couple recognized the need for preparing the training those who care for the
sick, organized a hospital school of nursing in Germany ( Kaiserswerth Institute for the training
of Deaconesses)
Development of Modern PHN
Characterized by:
1. Clean-up measures in the control of communicable disease
2. Removal of refuse Clean-up campaign of prison and asylums Improvement of
working conditions of women and children
William Rathbone’s father of modern district nursing with the encouragement of Florence
Nightingale, organized a training school for nurses in the Liverpool Royal Infirmary which
provided training for hospital nurses, private duty nurses and district nurse.
PERIOD OF SCIENTIFIC CONTROL OF COMMUNICABLE DISEASES(1890-1910)

-Application of bacteriology and immunology
Period of health education (1910-present)
- Characterized by education for prevention of diseases with active cooperation of the individual
in the health action
PHN in USA
Lillian Wald
Conceived the idea of establishing a neighborhood nursing service for the sick poor in the
lower east side of New York
To her “the home visit should be like that of really interested friend, rather than that of an
impersonal paid visitors Teacher College of University of Columbia (1912)
-offered the first course of study of PHN
National Organization PHN organized in 1912 to upgrade the practice of PHN through
standardization of policies regarding the function and qualification of PHN.
PHN in The Philippines

PHN in THE Philippines Pre- Spanish Era- no records Spanish Regime (1591-1898)
Bro. Juan Climente (1577) – Started Public Health Services though a dispensary in Intramuros
Started water sanitation
Introduced small pox vaccine
Creation of position of district, provincial, national health officers
American Regime (1898- 1942)
1898 creation of board of the Health for Physician
1899 appointment of the first commissioner of health
1906 abolition of the board of health, creation of bureau of health
1912 PHN started in Cebu w/ 4 graduate nurses who dealt primarily in MCH services
1915 PHN began in Manila with 2 nurses who offered follow-up care of OB patients and
environmental sanitation services
Japanese Regime (1942-1945)
PHN services were interrupted

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Era of the Republic of the Philippines (1946 to present)
1947 DOH was divided into 3 bureaus
A Hospital
B Quarantine
C Health
May 18, 1954 – RA 1082 (RHU Act) was passed, implemented in July of the same year,
provided for the employment of health personnel, including nurses, who would man the RHUs
and help raise the health conditions of the rural population.
June 1957
RA 1891 (An Act Strengthening Health and Dental Services in the Rural Areas and Providing
Funds Thereof) was approved; created eight(8) categories of RHUs corresponding to 8
population groups to be served.
1975 – Formulation of the National Health Plan and the restructured Health Care Delivery
System.
1992- RA 7160 Devolution transferred authority to LGU by virtue of the Local Government
Code.
Appointments of RHU/City Health Department personnel (including nursing personnel) have to
be approved by the mayor.
Material supplies of health center have to be provided by the LGUs.
Date Event in the History of CHN in the Philippines

1901
 Act # 157 (Board of Health of the Philippines); Act # 309 (Provincial and Municipal Boards
of Health) were created.
1905
 Board of Health was abolished; functions were transferred to the Bureau of Health.
1912
 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs;
male nurses perform the functions of doctors
1919
 Act # 2808 (Nurses Law was created) – Carmen del Rosario, 1st Filipino Nurse supervisor
under Bureau of Health
Oct. 22, 1922
 Filipino Nurses Organization (Philippine Nurses’ Organization) was organized.
1923
 Zamboanga General Hospital School of Nursing & Baguio General Hospital were
established; other government schools of nursing were organized several years after.
1928
 1st Nursing convention was held
1940
 Manila Health Department was created.
1941
 Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created
through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistant chief nurse)
Dec. 8, 1941
 Victims of World War II were treated by the nurses of Manila.
July 1942
 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses
in Bilibid Prison as prisoners of war by the Japanese.
Feb. 1946
 Number of nurses decreased from 556 – 308.
1948
 First training center of the Bureau of Health was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin, Constancia Tuazon, Ms. Bugarin, Ms.
Ramos, and Zenaida Nisce composed the training staff.
1950
 Rural Health Demonstration and Training Center was created.

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1953
 The first 81 rural health units were organized.
1957
 RA 1891 amended some sections of RA 1082 and created the eight categories of rural health
unit causing an increase in the demand for the community health personnel.
1958-1965
 Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288)
1961
 Annie Sand organized the National League of Nurses of DOH.
1967
 Zenaida Nisce became the nursing program supervisor and consultant on the six special
diseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness).
1975
 Scope of responsibility of nurses and midwives became wider due to restructuring of the
health care delivery system.
1976-1986
 The need for Rural Health Practice Program was implemented.
1990- 1992
 Local Government Code of 1991 (RA 7160)
1993-1998
 Office of Nursing did not materialize in spite of persistent recommendation of the officers,
board members, and advisers of the National League of Nurses Inc.
Jan. 1999
 Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services
through Department Order # 29.
May 24, 1999
 EO # 102, which redirects the functions and operations of DOH, was signed by former
President Joseph Estrada.
Standards in CHN
1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
 At each level of prevention, develops plans that specify nursing actions unique to
needs of clients
5. Intervention
 Guided by the plan, intervenes to promote, maintain or restore health, prevent
illness and institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
 Participates in peer review and other means of evaluation to assure quality of
nursing practice
 Assumes professional development
 Contributes to development of others
8. Interdisciplinary Collaboration
 Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and evaluating
programs for community health
9. Research

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 Indulges in research to contribute to theory and practice in community health
nursing
www.rnpedia.com
Legal basis of CHN Practice

 Code of Ethics for Nurses
 R.A. # 9173
 Competency Standards of Nursing Practice in the Philippines
(https://www.prc.gov.ph.doc)
COMMUNITY HEALTH NURSE ROLES and FUNCTIONS
Qualifications
1. Bachelor of Science in Nursing
2. Registered Nurse of the Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems of individuals, families, and communities
2. Formulates municipal health plan in the absence of a medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and circular for
the concerned staff personnel
4. Provides technical assistance to rural health midwives in health matters
Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace
2. Develops the family’s capability to take care of the sick, disabled, or dependent member
Community Organizer
1. Motivates and enhances community participation in terms of planning, organizing,
implementing, and evaluating health services
2. Initiates and participates in community development activities
Coordinator of Services
1. Coordinates with individuals, families, and groups for health related services provided by
various members of the health team
2. Coordinates nursing program with other health programs like environmental sanitation,
health education, dental health, and mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the RHMs and Barangay Health Workers
(BHW).
2. Conducts training for RHMs and BHW on promotion and disease prevention
3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource
speaker on health and health related services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education
purposes
5. Conducts pre-marital counseling
Health Monitor
Detects deviation from health of individuals, families, groups, and communities through
contacts/visits with them
Role Model
HAHAHAHA
Provides good example of healthful living to the members of the community
Change Agent
Motivates changes in health behavior in individuals, families, groups, and communities
that also include lifestyle in order to promote and maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation
Researcher
1. Participates in the conduct of survey studies and researches on nursing and health-related
subjects
2. Coordinates with government and non-government organization in the implementation of
studies/research
NURSING CORE VALUES AS A COMMUNITY HEALTH NURSE

Mission
The National League for Nursing promotes excellence in nursing education to build a strong and
diverse nursing workforce to advance the health of our nation and the global community.
CORE VALUES
1. CARING: promoting health, healing, and hope in response to the human condition
2. INTEGRITY: respecting the dignity and moral wholeness of every person without
conditions or limitation;
3. DIVERSITY: affirming the uniqueness of and differences among persons, ideas, values,
and ethnicities.
4. EXCELLENCE: co-creating and implementing transformative strategies with daring
ingenuity.
CARING
A culture of caring, as a fundamental part of the nursing profession, characterizes our concern
and consideration for the whole person, our commitment to the common good, and our outreach
to those who are vulnerable. All organizational activities are managed in a participative and
person-centered way, demonstrating an ability to understand the needs of others and a
commitment to act always in the best interests of all stakeholders. Caring is best demonstrated by
a nurse's ability to embody the five core values of professional nursing. Core nursing values
essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and
social justice. The caring professional nurse integrates these values in clinical practice.
INTEGRITY
A culture of integrity is evident when organizational principles of open communication, ethical
decision-making, and humility are encouraged, expected, and demonstrated consistently. Not
only is doing the right thing simply how we do business, but our actions reveal our commitment
to truth telling and to how we always see ourselves from the perspective of others in a larger
community.
DIVERSITY
A culture of inclusive excellence encompasses many identities, influenced by the intersections of
race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities,
religious and political beliefs, or other ideologies. It also addresses behaviors across academic
and health enterprises. Differences affect innovation so we must work to understand both
ourselves and one another. And by acknowledging the legitimacy of us all, we move beyond
tolerance to celebrating the richness that differences bring forth.
EXCELLENCE
A culture of excellence reflects a commitment to continuous growth, improvement, and
understanding. It is a culture where transformation is embraced, and the status quo and
mediocrity are not tolerated.
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Community Health Nurses face daily challenges not experienced in a hospital setting, and
experience more autonomy than hospitalbased nurses. Nursing ethics and professional core
values play a substantial role in the decision-making process outside of the hospital setting.
(www.nln.org)
LEARNING MODULE II
WORLD HEALTH ORGANIZATION

The World Health Organization is a specialized agency of the United Nations responsible
for international public health. The WHO Constitution, which establishes the agency's governing
structure and principles, states its main objective as "the attainment by all peoples of the highest
possible level of health.
The WHO was established by constitution on 7 April 1948,[3] which is commemorated
as World Health Day.
The WHO's broad mandate includes advocating for universal healthcare, monitoring
public health risks, coordinating responses to health emergencies, and promoting human health
and well being. It provides technical assistance to countries, sets international health standards
and guidelines, and collects data on global health issues through the World Health Survey. Its
flagship publication, the World Health Report, provides expert assessments of global health
topics and health statistics on all nations.[8] The WHO also serves as a forum for summits and
discussions on health issues.(en.wikepedia.com)
The Eight Millennium Development Goals are:
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.
The MDGs are inter-dependent; all the MDG influence health, and health influences all the
MDGs. For example, better health enables children to learn and adults to earn. Gender
equality is essential to the achievement of better health. Reducing poverty, hunger and
environmental degradation positively influences, but also depends on, better health.
The SDGs also explicitly include disability and persons with disabilities 11 times.
Disability is referenced in multiple parts of the SDGs, specifically in the parts related to
education, growth and employment, inequality, accessibility of human settlements, as well as
data collection and the monitoring of the SDGs.
20
Although, the word “disability” is not cited directly in all goals, the goals are indeed
relevant to ensure the inclusion and development of persons with disabilities.
The newly implemented 2030 Agenda for Sustainable Development holds a deep promise
for persons with disabilities everywhere.

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The year 2016 marks the first year of the implementation of the SDGs. At this critical
point, Envision2030 will work to promote the mainstreaming of disability and
the implementation of the SDGs throughout its 15-year lifespan with objectives to:
 Raise awareness of the 2030 Agenda and the achievement of the SDGs for persons with
disabilities;
 Promote an active dialogue among stakeholders on the SDGs with a view to create a
better world for persons with disabilities; and
 Establish an ongoing live web resource on each SDG and disability.
The 17 sustainable development goals (SDGs) to transform our world:
GOAL 1: No Poverty
GOAL 2: Zero Hunger
GOAL 3: Good Health and Well-being
GOAL 4: Quality Education
GOAL 5: Gender Equality
GOAL 6: Clean Water and Sanitation
GOAL 7: Affordable and Clean Energy
GOAL 8: Decent Work and Economic Growth
GOAL 9: Industry, Innovation and Infrastructure
GOAL 10: Reduced Inequality
GOAL 11: Sustainable Cities and Communities
GOAL 12: Responsible Consumption and Production
GOAL 13: Climate Action
GOAL 14: Life Below Water
GOAL 15: Life on Land
GOAL 16: Peace and Justice Strong Institutions
GOAL 17: Partnerships to achieve the Goal
HEALTH CARE DELIVERY SYSTEM(HCDS)
It is the totality of all policies, facilities, equipment, products, human resources and
services which address the health needs, problems and concerns of the people. It is large,
complex, multi-level and multi-disciplinary. HCDS is often used to describe the way in which
health care is provided to the people.
HEALTH CARE SYSTEM

 is a complex set of organizations interacting to provide an array of health services
(Dizon, 1977).
 an organized plan of health services (Miller-Keane, 1987)
HEALTH CARE DELIVERY

 rendering health care services to the people (Williams-Tungpalan, 1981).
HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981)
 the network of health facilities and personnel which carries out the task of rendering
health care to the people.
The Philippine Health Care Delivery System

It is a complex set of organization between the public and the private sector to provide
health services.
PUBLIC SECTOR PRIVATE SECTOR
Government Funded from Taxes Voluntary Funded/Foundations/Privately Owned/

Corporation
DOH (National) LGU (Local) NGO (Non Profit Private Corporation

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(Profit
Specialty Tertiary Provincial Hospitals Civic groups/Organizations Private clinics

Hospitals
Regional Hospital District and Religious Private Hospitals

Emergency Hospitals Groups/Organizations
Medical Centers Medicare and Foundations Private Practitioners

Community Hospital
DOH RHU/MHO/CHO/BHS Other social voluntary Private Laboratories

representatives groups
The primary objectives of any health delivery system are:

1. to enable all citizens to receive health care services whenever needed
2. to deliver health services that are cost-effective and meet pre-established
standards of quality.
The goal of any health care delivery system should be to foster
optimal health outcomes by providing cost-effective, patient-centered, quality care with a
service emphasis. Health care delivery systems should be designed to motivate patients
and health care providers to make decisions consistent with this goal.
In HCDS there are three levels of health care & health care facility namely:
1. Primary Level of care -Primary Level of Health care Facility
2. Secondary Level of care -Secondary Level of Health care Facility
3. Te4rtiary Level of care -Tertiary Level of Health care facility
Primary Level of care

This includes prevention of illness or promotion of health.
It is the initial entry point for clients of the health care delivery system which is directed
towards the promotion and maintenance of health, the prevention of disease, the management of
common specific illnesses and usually ambulatory or outpatient settings. Services are offered by
the Primary level of Health Care Facility.
3. RHU/MHO
4. Private Clinics
5. Birthing/Lying in Centers
Secondary Level of care

It centers on early diagnosis and treatment of diseases.
This includes provision of specialized medical services by physician or a hospital on a
referral by the primary care provider. Services are offered by Secondary Level of Health Care
facility.
1. Community hospitals
2. District and emergency hospitals
Tertiary Level of care

Rehabilitation is:restoring health iand aimed at lessening the pain and discomfort of
illness and helping clients live with disease and disability. It also includes care of chronic ailment
that requires long term care and prevention of complications. Services are offered by Tertiary
Level of Health Care facility.
1. Specialized hospitals
Three Levels of Health worker
1. First level health worker – RHM(Rural Health Midwife)

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2. Second level of health worker– PHN & RSI(Public Healh Nurse, Rural Sanitary
Inspector)
3. Third Level health worker – MHO/RHP(Municipal Health Officer/Rural Health
Physician)
FACTORS AFFECTING THE DELIVERY OF HEALTH CARE SERVICES
1. Socio-economic factor
2. Technological advancement
3. Access to health care facility
4. High cost of hospitalization
5. Health consumers
6. Unequal distribution of health services and health personnel
7. Demographic changes
HEALTH CARE SYSTEM MODELS
1. Health Insurance Model - either provided by the State or voluntary
2. Social Security System Model- socisl security program contributed by the
individual, employee or from the government.
3. Government Funded Health Care Model
THREE STRATEGIES IN DELIVERING HEALTH SERVICES (ELEMENTS)
1. Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568
(1976)
2. Management Information Systems regulated by R.A. 3753: Vital Health Statistics Law
3. Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of
Implementation of PHC in the Philippines
CREATION OF RHCDS
1. RHO & National (Regional & National Health Offices) or existing national agencies like
PGH or specialized agencies like Heart Center for Asia, NKI
2. MHO & PHO (Municipal/Provincial Health Office)
3. BHS & RHU (Barangay Health Station/Rural Health Unit)
In the old organizational chart for every 5,000 population a BHS is built as satellite cent ger of
the RHU.
Referral System in Levels of the Health Care:
- Barangay Health Station (BHS) is under the management of Rural Health Midwife
(RHM), 1:500 catchment population
- Rural Health Unit (RHU) is under the management or supervision of PHN
- Public Health Nurse (PHN) caters to 1:10,000 catchment population, acts as managers in
the implementation of the policies and activities of RHU, directly under the supervision
of MHO (who acts as administrator),1:20,000catchment population
REFERRAL SYSTEM
It is the proper channeling and removing the barrier to further the management of health
problems of the client to the next level of health care and an intervention to direct client to another
healthcare facility to continue his/her treatment
BHS→ RHU→ MHO→ PHO→RHO→ National Agencies→Specialized Agencies

Two-way referral system
1.BHW, Midwife
2.PHN, Rural Sanitary inspector
3.Physician
PHILIPPINE HEALTH CARE DELIVERY SYSTEM
http://docshare01.docshare.tips/files/22355/223553382.pdf
Health is basic human right for all Filipinos.
Features of DOH reorganization

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1958- RA 1082-1stRural Health Act which increases the number in the employment of more
physicians, dentists, nurses, midwives and sanitary inspectors assigned to RHU’s and 1st 81 rural health units
were defined.
1972- RA 5435- defined authorities of regional directors for more meaningful decentralization and 13 regional
health offices were created.
•1974
IBRD- RHCDS implemented RHM were sent to BHS to man BHS and Midwives were trained and roles
expanded
•1982- EO 851 - integrated public health and hospital systems with emphasis on importance of putting together
promotive, preventive, curative and rehabilitative components of health care and utilization of BHW,
implementation of DOH impact programs, Role of Society in RHCDS and participation in information
drive of HCDS
COMPONENTS OF THE HEALTH DELIVERY SYSTEM
 The Department of Health Mandate:
The Department of Health shall be responsible for the following: formulation and
development of national health policies, guidelines, standards and manual of operations for
health services and programs; issuance of rules and regulations, licenses and accreditations;
promulgation of national health standards, goals, priorities and indicators; development of
special health programs and projects and advocacy for legislation on health policies and
programs. The primary function of the Department of Health is the promotion, protection,
preservation or restoration of the health of the people through the provision and delivery of
health services and through the regulation and encouragement of providers of health goods and
services (E.O. No. 119, Sec. 3).
The DOH is a policy and regulatory body for health and provides direction in the
implementation of the different health programs through:
4. Promotion of health
5. Prevention and control of diseases
6. Protection of the lrvels of clientele(Individual, Family & Community)
7. Management, Treatment, rehabilitation and restoration of health
VISION by 2030
A global leader for attaining better health outcomes, competitive and responsive health
care systemand equyitable health financing.
Mission
To guarantee equitable, sustainable and quality healtrh for every Filipinos leading to the
quest for excellence in health amongf the Filipino people.
Health as a right. Health for All Filipinos
The mission of the DOH, in partnership with the people to ensure equity, quality and
access to health care:
 by making services available
 by arousing community awareness
 by mobilizing resources
 by promoting the means to better health
CORE VALUES of the DOH
Integrity
This is upholding truth and pursuing honesty, accountability and consistency un
performing its functions.
Excellence
This is fostering innovation, effectiveness and efficiency, pro-action, dynamism and
openness to change
Compassion and Respect for Human Dignity
This is upholding the quality of life, respect for human dignity is encouraged by working
with sympathy and benevolence for the people in need.
Commitment
This is achieving its vision for the health and development of future generations.
Professionalism

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This is performing its functions in accordance with the highest ethical standards,
principles of accountability, and full responsibility.
Teamwork
Working together with a result-oriented mindset.
Stewardship of the Health of the People
Pursuing sustainable development and care for the environment since it impinges on the
health of the Filipinos.
Roles and Functions (EO 102)
1. Leadership in Health
2. Enable and Capacity Builder
3. Administrator of Specific Services
The DOH is composed of:
17 central offices
16 Centers Health Development
70 hospital
4 attached agencies
Center of Health Development/DOH Regional Office
 Responsible for field operationsin its administrative region and for providing catchment
area with efficient and effective medical services
 Tasked to implement laws, regulations, policies, and program.
 Tasked to coordinate with regional offices and agencies as well as with the local
governments.
 Acts as organizer and provide technical support and advocacy for the development of
local health management systems and their integrations in the contexts of the ILHS.
25
 Review and approve ILHS proposal for funding and integrate local health plans to
regional plans.
 Undertake monitoring of the development and implementation of ILHS.
DOH Hospitals
Provides hospital-based care; specialized or general services, some conduct research on clinical
priorities and training hospitals for medical specializations.
Attached Agencies
1. The Philippine Health Insurance Corporation is implementing the national health
insurance law, administers the medical program for both public and private
sectors.
2. The Dangerous Drug Board on the other hand, coordinates and manages the
dangerous drugs control program.
3. Philippine Institute of Traditional and Alternative Health Care(RA # 8423)
4. Philippine National AIDS Councils
Republic Act 8504
Philippine AIDS Prevention and Control Act of 1998 AN ACT
PROMULGATING POLICIES AND PRESCRIBING MEASURES FOR THE
PREVENTION AND CONTROL OF HIV/AIDS IN THE PHILIPPINES,
INSTITUTING A NATIONWIDE HIV/AIDS PROGRAM, ESTABLISHING A
COMPREHENSIVE HIV/AIDS MONITORING SYSTEM, STRENGTHENING
THE PHILIPPINE NATIONAL AIDS COUNCIL
REPUBLIC ACT No. 11166

An Act Strengthening the Philippine Comprehensive Policy on Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)
Prevention, Treatment, Care, and Support, and, Reconstituting the Philippine National
Aids Council (PNAC), Repealing for the Purpose Republic Act No. 8504, Otherwise

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Known as The "Philippine Aids Prevention and Control Act of 1998", and Appropriating
Funds
LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH SERVICES

In 1991, the Philippines Government devolved the management and delivery of health
services from the National Department of Health to locally elected provincial, city and
municipal governments. The granting of more powers, authority, responsibilities. and resources
by the national government to local. government units in order to be self-reliant and active
partners through Decentralization
Devolved Functions by Level of Government
LGU Devolved Health Services Reference
Barangay Maintenance of barangay health center Section 17.b.1.ii.
Municipalit Implementation of programs and projects on. Section 17.b.2.iii

y primary health care, maternal and child care, and
communicable and non-communicable disease
control services; Access to secondary and tertiary
health services Purchase of medicines, medical
supplies, and equipment needed to carry out the
said services
Province Hospitals and other tertiary health services Section 17.b.3.iv
City All the services and facilities of the municipality Section 17.b.4.
and province
Source: Local Government Code of 1991

CLASSIFICATION OF HEALTH FACILITIES (DOH AO No. 2012-0012a)

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Hospital Services Level 1 Level 3 Level3
Clinical service for Consulting All of level 1 plus the All of level 1 and level 2
In-patience specialist in, but following: plus the following:
not be limited to: Teaching, Training at
Medicine least any two (2)
Pediatrics accredited residency
Ob-Gyne Departmentalized Clinical training program for
Surgery Services physicians in any
medical/surgical
specialty and/or
subspecialty
Emergency and Respiratory Unit Physical Medical and
Out-patient Rehabilitation Unit
Service
Isolation facilities General ICU
Surgical High Risk Pregnancy Unit Ambulatory Surgical
Maternity Unit
Facilities
Dental Clinic NICU
Dental Clinic
Ancillary Service Secondary Tertiary Clinical Laboratory Tertiary Clinical Lab
Clinical Histopathology
Laboratory Unit
Blood Station Blood Station Blood Bank
1st Level X-ray 2 Level X-ray with Mobile 3rd Level X-ray
nd
Unit
Pharmacy
27
THE NATIONAL HEALTH
PLANhttps://www.doh.gov.ph/sites/default/files/publications/NOH-2017-2022-030619-1.pdf
It6 is a long-term directional plan for health; the blueprint defining the country’s health –
PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS
Goal
 to enable the Filipino population to achieve a level of health which will allow Filipino to
lead a socially and economically-productive life, with longer life expectancy, low infant
mortality, low maternal mortality and less disability through measures that will guarantee
access of everyone to essential health care
Objectives
 promote equity in health status among all segments of society
 address specific health problems of the population
 upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient,
and effective one in the provision of solutions to changing the health needs of the population
 promote active and sustained people’s participation in health care
POLICY THRUSTS AND STRATEGIES

There are policy thrusts and strategies which are commonly important. These are:
1. Information, education, and communication programs will be implemented to raise the
awareness of the public, including policy makers, program planners and decision makers;
2. An update of the legislative agenda for health, nutrition and family planning (HNFP), and
stronger advocacy for pending HNFP ±related legislations will be pursued;

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3. Integration of efforts in the health, nutrition and family planning sector to maximize resources
in the delivery of services through the establishment of coordinative mechanisms at both the
national and local levels;
4. Partnership between the public and the private sectors will be strengthen and institutionalized
to effectively utilize and monitor private resources for the sector;
5. Enhancement of the status and role of women as program beneficiaries and program
implementers will be pursued to enable them to substantially participate in the development
process.
THE HEALTH SEC TOR REFORM AGENDA(HSRA)
http://docshare01.docshare.tips/files/22355/223553382.pdf
PHILIPPINE HEALTH AGENDA 2016 - 2022.
With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system

with the values of Equity, Quality, Efficiency, Transparency, Accountability, Sustainability,
Resilience towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”.
https://www.doh.gov.ph/sites/default/files/basic-page/Philippine%20Health
%20Agenda_Dec1_1.pdf
PRIMARY HEALTH CARE
Definition by the World Health Organization (WHO)
Primary Health Care (PHC) is an essential health care made universally acceptable to
individuals and families in the community by means acceptable to them through their full
participation and at a cost that the community and country and can afford at every stage of
development.
Concept:
Primary Health Care (PHC) characterized by partnership and empowerment of people shall permeate as core
strategy in effective provision of essential health services.
Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by then Pres. Ferdinand E. Marcos pr5ovides Legal basis
in the official adoption of PHC in the Philippines.
Alma Ata Declaration

The Declaration of Alma-Ata was adopted at the International Conference on Primary
Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist
Republic), 6-12 September 1978
Eight essential elements based on the Alma Ata on PHC: An essential health care based on
practical, scientifically sound and socially acceptable methods and technology made universally,
accessible to individuals and families in the community by means of acceptable to them, through
their full participation and at a cost that community and country can afford to maintain at every
stage of their development in the spirit of self-reliance and self-determination.
1. Health Education
2. Treatment of Locally Endemic Diseases
3. Expanded Program on Immunization
4. Maternal and Child Health
5. Provision of Essential Drugs
6. Nutrition
7. Treatment of communicable and non-communicable diseases
8. Safe water and good waste disposal
Goal: Health for all Filipinos and Health in the hands of the people by the year 2020

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The ultimate goal of primary health care is better health for all. WHO has identified five key
elements to achieving that goal:
 Reducing exclusion and social disparities in health (universal coverage reforms);
 Organizing health services around people’s needs and expectations (service delivery
reforms);
 Integrating health into all sectors (public policy reforms);
 Pursuing collaborative models of policy dialogue (leadership reforms); and
 Increasing stakeholder participation
Mission
To strengthen the health care system by increasing opportunities and supporting conditions wherein
people will manage their own health care.
History
1974- WHO and UNICEF conducted a joint study
1975- World Health Assembly passed a resolution giving priority to the development of PHC
1977- World Health Assembly decided that main target of government and WHO is the attainment of the level of
health that would allow or permit them to lead a socially and economically productive life by year 2000
 May 1977. The 30th World Health Assembly adopted resolution which decided that the
main social target of governments and of WHO should be the attainment by all the people
of the world by the year 2000 a level of health that will permit them to lead a socially and
economically productive life.
 September 6-12, 1978. International Conference in PHC was held in this year at Alma
Ata, USSR (Russia)
 October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued Letter of
Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an
approach towards design, development, and implementation of programs which focus
health development at the community level.
 1979- WHA launched global strategy to attain health for all
 1980- PHC endorsed for implementation by respective regional community
Rationale
Adopting primary health care has the following rationales:
 Magnitude of Health Problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities
Objectives
1. Improvement in the level of health care of the community
2. Favorable population growth structure
3. Reduction in the prevalence of preventable, communicable and other disease.
4. Reduction in morbidity and mortality rates especially among infants and children.
5. Extension of essential health services with priority given to the underserved sectors.
6. Improvement in basic sanitation
7. Development of the capability of the community aimed at self- reliance.
8. Maximizing the contribution of the other sectors for the social and economic
development of the community.
Types of PHC workers
There are two types of primary health care workers in the Philippines:
1. Barangay Health Worker or Village Health Worker
2. Intermediate level Primary Health Worker
Four Pillars
1. Active Community Participation
2. Intra and Inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available
Strategies of PHC

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1)reorientation and reorganization by local government code of 1991 or RA 7160
2)effective preparation and enabling process for health action at all levels
3)mobilization of people to know their communities and identify basic health needs
4)development of utilization of technology
5)organization of communities arising from needs
6)increase opportunities
Essential Components of Primary Health Care
1)Multi-Sectoral Approach
a.Intrasectoral linkages
b.Intersectoral linkages
2)Community participation
a.Identify problem
b.Identify solution
c.Mobilizing resources
d . B a r r i e r s
1. Lack of motivation
2. Indifference on part of community people/Attitude
3. Resistant to change
4. Bureaucracy of government
5. Lack of managerial skills
6. Dependence on part of community people
3)Appropriate Technology
6 criteria:
1. effectiveness and safety
2. less complex
3. less costly
4. broader scope of technology
5. acceptability to local culture
6. feasibility
4)Community involvement
a.Involvement level:
1. Individual
2. Family-monitor growth and development of child and able to address
to problems in government
3.Community- organizations formed to promote health development
Major Strategies
1. Elevating health to a comprehensive and sustained national effort
Attaining health for all Filipinos will require expanding participation in health and health-
related programs whether as service provider or beneficiary. Empowerment to parents, families
and communities to make decisions of their health is the desired outcome.
Advocacy must be directed to national and local policy making to elicit support and
commitment to major health concerns through legislations, budgetary and logistical
considerations.
3. Promoting and supporting community managed health care
The health in the hands of the people brings the government closest to the people. It
necessitates a process of capacity building of communities and organization to plan, implement
and evaluate health programs at their levels.
3. Increasing efficiency in health sector
Using appropriate technology will make services and resources required for their
delivery, effective, affordable, accessible and culturally acceptable.
The development of human resources must correspond to the actual needs of the nation
and the policies it upholds such as PHC.

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The Department of Health (DOH) continue to support and assist both public and private
institutions particularly in faculty development, enhancement of relevant curricula and
development of standard teaching materials.
4. Advancing essential national health research
Essential National Health Research (ENHR) is an integrated strategy for organizing
and managing research using intersectoral, multi-disciplinary and scientific approach to
health programming and delivery.
Elements
The following are the eight (8) essential elements of primary health care:
1. Education for Health
This is one of the potent methodologies for information dissemination. It promotes the
partnership of both the family members and health workers in the promotion of health as well as
prevention of illness.
2. Locally Endemic Disease Control( PD # 3573)
The control of endemic disease focuses on the prevention of its occurrence to reduce
morbidity rate. Example Malaria control and Schistosomiasis control
3. Expanded Program on Immunization( PD # 996)
This program exists to control the occurrence of preventable illnesses especially of
children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and
other preventable disease are given for free by the government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning –(PD # 965)
The mother and child are the most delicate members of the community. So the protection
of the mother and child to illness and other risks would ensure good health for the community.
The goal of Family Planning includes spacing of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply( PD # 856)
Environmental Sanitation is defined as the study of all factors in the man’s environment,
which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic
need for life and one factor in man’s environment. Water is necessary for the maintenance of
healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
One basic need of the family is food. And if food is properly prepared then one may be
assured healthy family. There are many food resources found in the communities but because of
faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of
the problems that we have in the country.
7. Treatment of Communicable Diseases and Common Illness( PD # 3573)
The diseases spread through direct contact pose a great risk to those who can be infected.
Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of
death. Most communicable diseases are also preventable. The Government focuses on the
prevention, control and treatment of these illnesses
8. Supply of Essential Drugs
This focuses on the information campaign on the utilization and acquisition of drugs. In
response to this campaign, the GENERIC ACT ( RA # 6675)of the Philippines is enacted. It
includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine
Principles of PHC
1)Accessibility, acceptability, availability, and affordability of health services
The health services should be present where the supposed recipients are. They should
make use of the available resources within the community, wherein the focus would be more on
health promotion and prevention of illness through:
a.Health services are delivered where people live and work
b.Development of indigenous or resident volunteer health workers to provide healthcare
with an ideal ration of 1:10-20 households
c.Use of low cost, appropriate technology sustainable by community
d.Combined utilization of traditional medicines and essential drugs

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2)Partnership between community and health agencies in provision of quality, basic and
essential health services.Partnership between the community and the health agencies in the
provision of quality of life.
a.Community needs and priorities are basic for planning health services and activities
b.Training curriculum of community health workers I based on community health
problems and task analysis of community health workers
c.Regular supervision and periodic evaluation of community health
workers’performance by health staff to community
d.Development of promotive, preventive, curative and rehabilitative care
e.Recognition of role and traditional healers in delivery of health services
3)Community Participation
Community participation is the heart and soul of primary health care.
a.Awareness building and consciousness raising on health and developmental issues
b.Community building and organizing
c.Planning, implementation, monitoring and evaluation done by community
d.Community discussions done through small group discussions
e.Selection of community health workers by community
f.Foundation of health committees
g.Establishment of community health organizations
h.Mass health campaigns and community mobilization
4)Self-reliance
Through community participation and cohesiveness of people’s organization they can
generate support for health care through social mobilization, networking and mobilization of
local resources. Leadership and management skills should be develop among these people.
Existence of sustained health care facilities managed by the people is some of the major
indicators that the community is leading to self reliance.
a.Community generates support for health care
b.Mobilization of health resources
c.Training of community leaders on leadership and managerial skills
d.Income-generating projects
5)Recognition of interrelation of health and development. People are the center,

object and subject of development.
 Thus, the success of any undertaking that aims at serving the people is dependent on
people’s participation at all levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be based on the people’s needs
and problems (PCF, 1990)
 Part of the people’s participation is the partnership between the community and the
agencies found in the community; social mobilization and decentralization.
Recognition of interrelationship between the health and development
 Health is defined as not merely the absence of disease. Neither is it only a state of
physical and mental well-being. Health being a social phenomenon recognizes the
interplay of political, socio-cultural and economic factors as its determinant. Good Health
therefore, is manifested by the progressive improvements in the living conditions and
quality of life enjoyed by the community residents
 Development is the quest for an improved quality of life for all. Development is
multidimensional. It has political, social, cultural, institutional and environmental
dimensions (Gonzales 1994). Therefore, it is measured by the ability of people to satisfy
their basic needs.
Example: Scheduling of Barangay Health Workers in the health center
6)Social Mobilization
It enhances people’s participation or governance, support system provided by the government,
networking and developing secondary leaders.
Providing linkages between the government and the non-government organization and people’s
organization.

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a.Establishment of effective health referral system
b.Multi-sectoral and inter-disciplinary linkages
c.Integration, Education, Communication (IEC) support using multimedia channels
d.Collaboration among government agencies, non-government organizations and community
groups
7)Decentralization
a.Reallocation of budgetary resources
b.Advocacy for political will and support
c.Re-orientation of health profession
This ensures empowerment and that empowerment can only be facilitated if the administrative
structure provides local level political structures with more substantive responsibilities for
development initiators. This also facilities proper allocation of budgetary resources.
Concepts of Primary Health Care

1)PHC represents supplementary health system
2)Equip community with capability to solve its own problems by conducting trainings
3)Come into being only when community recognizes and accepts problems
4)Government officials don’t work in place of community and vice versa
5)Community involvement is the heart and soul of PHC
6)Good health is related to living conditions and lifestyle
7)Provide opportunity to underprivileged majority to develop to an acceptable level
LEVELS OF PREVENTION
1. Primary Prevention- Health Promotion Practices and Specific Protection from specific
Illnesses
2. Secondary Prevention-Practices on Early Diagnosis and Treatment of Diseases
3. Tertiary Prevention- Rehabilitation, Restoration and Maintenance of health and prevention
of complications and disability limitation
UNIVERSAL HEALTH CARE (UHC) LAW
In the 17th Congress,House Bill No. 5784 has been approved as UNIVERSAL HEALTH
COVERAGE ACT last September 7, 2017.
https://newsinfo.inquirer.net/928416/philippine-news-updates
Senate Bill No. 1896,-UNIVERSAL HEALTH CARE ACT, AN ACT INSTITUTING
UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, PRESCRIBING REFORMS IN THE
HEALTH CARE SYSTEM, APPROPRIATING FUNDS THEREFOR, AND FOR OTHER
PURPOSES
filed on July 30, 2018.
https://senate.gov.ph/lis/bill_res.aspx?congress=17&q=SBN-1896
And on February 20,2020, President Rodrigo R. Duterte of the Philippines officially
signed the Universal Health Care (UHC) Act into law, which guarantees equitable access to
quality and affordable healthcare services for all Filipinos. It will also automatically enroll
Filipino citizens into the National Health Insurance Program and expand PhilHealth coverage to
include free medical consultations and laboratory tests.
https://www.healthcareitnews.com/news/universal-healthcare-act-philippines
RA # 11223 - It is an act instituting universal health care for all Filipinos prescribing
reforms in the health care system and appropriating funds therefor.
Universal Health Care (UHC) law automatically enrolls all Filipino citizens in the
National Health Insurance Program and prescribes complementary reforms in
the health system which guarantees equitable access to quality and
affordable healthcare services for all Filipinos.
https://www.officialgazette.gov.ph/downloads/2019/02feb/20190220-RA-11223-
RRD.pdf
Universal Health Care is an approach that seeks to improve, streamline, and scale up the
reform strategies in HSRA and Fl in order to address inequities in health outcomes by ensuring
that all Filipinos, especially those belonging to the lowest two income quintiles, have equitable
access to quality health care.

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LEARNING MODULE III
I. LEARNING TITLE
WEEK 5,6
Unit 3. The Family & Filipino Cultures Values, and Practices in relation to Health Care of
Individual
and Family
INTRODUCTION
This topic will give the student knowledge about a family, how does it function, as a
client ,as a system and its tasks. This concept deals with the characteristic of a healthy family and
the different Filipino cultures values, and practices in relation to health care of individual and
family. It will provide the students better way of dealing and understanding with the family prior
to their CHN practice exposure
II. LEARNING OUTCOMES
At the end of two weeks, the student will be able to:

8. Describe a family.
9. Distinguish the different types of a family.
10. Determine how the family functions as a client and as a system.
11. Discuss the various family health task.
12. Explain how cultures, values, and practices affect he4alth care of a family.
13. Relate the characteristics of a healthy family
III LEARNING OUTLIN
A. The Family
A. Family as Basic Unit of the Society
B. Type
1. Family as a Client
2. Family as a System
C. Functions Developmental Stages
D. Family Health Task
E. Characteristics of a Health Family
B.Filipino Cultures Values, and Practices in relation to Health Care of Individual and
Family
A. Family Solidarity
B. Filipino Family Values
1. Communication
2. Helping Others and Gratitude
3. Respect
4. Independence
5. Service
6. Trust
IV. LEARNING CONTENT
WEEK 7,8,9

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Unit 3 Family Health Nursing
Family
 Basic unit in society, and is shaped by all forces surround it.
Values, beliefs, and customs of society influence the role and function of the family (invades
every aspect of the life of the family)
 It is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective familial roles and
create and maintain a common culture.
 An open and developing system of interacting personalities with structure and process
enacted in relationships among the individual members regulated by resources and
stressors and existing within the larger community (Smith & Maurer, 1995)
 Two or more people who live in the same household (usually), share a common
emotional bond, and perform certain interrelated social tasks (Spradly & Allender, 1996)
 An organization or social institution with continuity (past, present, and future). In which
there are certain behaviors in common that affect each other.
The Filipino Family
 Based on the Philippine Constitution, Family Code with focus on religious, legal, and
cultural aspects of the definition of family.
 The state recognizes the Filipino family as the foundation of the nation. Accordingly, it
shall strengthen its solidarity and actively promote its total development
 Marriage, as an inviolable social institution, is the foundation of family and shall be
protected by the state.
The state shall defend:
1. the right of spouses to found a family in accordance with their religious convictions and
the demands of responsible parenthood
2. the right of children to assistance including proper care and nutrition, and special
protection from all forms of neglect, abuse, cruelty, exploitation and other conditions
prejudicial to their development.
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and
implementation of policies and programs of that affect them
5. The family has the duty to care for its elderly members but the state may also do so
through just programs of social security
The Filipino Family and its Characteristics

The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship is felt in all
segments of social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often includes the third
cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial ties. Filipino marriage is
not an individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also have to learn to
repress their repressive tendencies
9. The older siblings have something of authority of their parents.
Types of Family
There are many types of family. They change overtime as a consequence of BIRTH,
DEATH, MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS
A. Structure
 NUCLEAR- a father, a mother with child/children living together but apart from
both sets of parents and other relatives.

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
EXTENDED- composed of two or more nuclear families economically and
socially related to each other. Multigenerational, including married brothers and
sisters, and the families.
 SINGLE PARENT-divorced or separated, unmarried or widowed male or female
with at least one child.
 BLENDED/RECONSTITUTED-a combination of two families with children
from both families and sometimes children of the newly married couple. It is also
a remarriage with children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing
resourcesCOHABITING/LIVE-IN-unmarried couple living together
 DYAD—husband and wife or other couple living alone without children
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and exchange
support who have no legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care for them
FUNCTIONAL TYPE:
 FAMILY OF PROCREATION- refers to the family you yourself created.
 FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority) PATRIARCHAL – full authority on the father or

any male member of the family e.g. eldest son, grandfather
 MATRIARCHAL – full authority of the mother or any female member of the
family, e.g. eldest sister, grandmother
 EGALITARIAN- husband and wife exercise a more or less amount of authority,
father and mother decides
 DEMOCRATIC – everybody is involve in decision making
 AUTHOCRATIC-
 LAISSEZ-FAIRE- “full autonomy”
 MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is
working overseas)
 PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group of kinsman
for certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are related to him
though his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
D. Residence
 PATRILOCAL – family resides / stays with / near domicile of the parents of the
husband
 MATRILOCAL – live near the domicile of the parents of the wife
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man’s humanness
o Physical functions of the family are met through parents providing food, clothing
and shelter, protection against danger provision for bodily repairs after fatigue or
illness, and through reproduction
o Affectional function – the family is the primary unit in which he child test his
emotional reactions
o Social functions – include providing social togetherness, fostering self esteem and
a personal identity tied to family identity, providing opportunity for observing and
learning social and sexual roles, accepting responsibility for behavior and
supporting individual creativity and initiative.

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Univesal Function of the Family by Doode
 REPRODUCTION – for replacement of members of society: to perpetuate the human
species
 STATUS PLACEMENT of individual in society
 BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
 Socialization and care of the children;
 Social control
The Family as a Unit of Care
Rationale for Considering the Family as a Unit of Care:
 The family is considered the natural and fundamental unit of society
 The family as a group generates, prevents, tolerates and corrects health problems within
its membership
 The health problems of the family members are interlocking
 The family is the most frequent focus of health decisions and action in personal care
 The family is an effective and available channel for much of the effort of the health
worker
The Family as the Client

Characteristics of a Family as a Client
 The family is a product of time and place-
o A family is different from other family who lives in another location in many
ways.
o A family who lived in the past is different from another family who lives at
present in many ways.
 The family develops its own lifestyle
o Develop its own patterns of behavior and its own style in life.
o Develops their own power system which either be:
 Balance-the parents and children have their own areas of decisions and
control.
 Strongly Bias-one member gains dominance over the others.
 The family operate as a group
o A family is a unit in which the action of any member may set of a whole series of
reaction within a group, and entity whose inner strength may be its greatest single
supportive factor when one of its members is stricken with illness or death.
 The family accommodates the needs of the individual members.
o An individual is unique human being who needs to assert his or herself in a way
that allows him to grow and develop.
o Sometimes, individual needs and group needs seem to find a natural balance;
1. The need for self-expression does not over shadow consideration for
others.
2. Power is equitably distributed.
3. Independence is permitted to flourish
 The family relates to the community
Family develops a stance with respect to the community:
1.The relationship between the families is wholesome and reciprocal; the family
utilizes the community resources and in turn, contributes to the improvement of the
community.
2. There are families who feel a sense of isolation from the community.
Families who maintain proud, “We keep to ourselves” attitude.
``` Families who are entirely passive taking the benefits from the community without either
contributing to it or demanding changes to it.
 The family has a growth cycle and passes developmental stages.
According to MAGLAYA there are 7 developmental stages of a family
STAGES OF A FAMILY
STAGES TASKS

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1. Beginning Establishing a mutually satisfying marriage
Family/Marriage Planning to have or not to have children
& Family Period of adjustment like routines in sleeping, eating, chores, sexual and
economic aspects
2. Child-bearing Having and adjusting the infant
family Supporting the needs of all three members
Renegotiating martial relationships
3. Family with a Adjusting to cost a family life
pre-school Adapting to the needs of pre-school children
Children Coping with parental loss of energy and privacy
Busy family children at this stage demand a great deal of time related to
growth and development needs and safety considerations.
4. Family with Adjusting to the activity of the growing children
school age Promoting joint decisions between children and parents
Children Important responsibility of preparing their children to be able to function in a
complex world while at the same
time maintaining their own satisfying marriage relationship.
Encouraging and supporting children’s educational achievements
5. Family with Maintaining open communication among members
teenagers and Supporting ethical and moral values within the family
young adult Balancing freedom with responsibility of teenagers
Releasing young adults with appropriate rituals and assistance
Family allows the adolescents more freedom and prepare them for their own
life as technology advances-gap between generations increase
6. Post-parental Strengthening martial relationships
family Maintaining supportive home base
Preparing for retirement
Children leave to set their own household-appears to represent the breaking of
the family
Family returns to two partners nuclear unit
Period from empty nest to retirement
7. Aging Family Maintaining ties with younger and older generations
Adjusting for retirement
Adjusting to loss of spouse and closing family house
Behaviors Indicating a Well Family
1. Able to provide for physical emotional and spiritual needs of family members
2. Able to be sensitive to the needs of the family members
3. Able to communicate thought and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing relationship
6. Maintain and create constructive and responsible community relationships
7. Able to grow with and through children
8. Ability to perform family roles flexibly
9. Able to help oneself and to accept help when appropriate
10. Demonstrate mutual respect for the individuality of family members
11. Ability to use a crisis experience as a means of growth
12. Demonstrate concern of family unity, loyalty and interfamily cooperation
Family Health Task
Health task differ in degrees from family to family
TASK- is a function, but with work or labor overtures assigned or demanded of the person
According to Maglaya there are 5 Family Health Tasks
1. Recognizing interruptions of health development
2. Making decisions about seeking health care/ to take action

3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health maintenance
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Eight Family Functions.
1. Physical maintenance- provision of basic needs of the family like food, shelter, clothing,
and health care to its members being certain that a family has ample resources to provide
2. Socialization of Family– preparation of children to live in the community and interact
with people outside the family.
3. Allocation of Resources- determines which family needs will be met and their order of
priority.
4. Maintenance of Order–opening an effective means of communication between family
members, integrating family values and enforcing common regulations for all family
members.
5. Division of Labor – who will fulfill certain roles e.g., family provider, home manager,
children’s caregiver
6. Reproduction/Procreation, Recruitment, and Release of family member
7. Placement of members into larger society –consists of selecting community activities
such as church, school, politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale– created when members serve as support people
to each other
Family Roles
Nurturing figure– primary caregiver to children or any dependent member.
Provider – provides the family’s basic needs.
Decision maker– makes decisions particularly in areas such as finance, resolution, of conflicts,
use of leisure time etc.
Problem-solver– resolves family problems to maintain unity and solidarity.
Health manager– monitors the health and ensures that members return to health appointments.
Gate keeper-determines what information will be released from the family or what new
information can be introduced.
Week 6
B. Filipino Cultures Values, and Practices in relation to Health Care of Individual and Family
Filipino families greatly influence patients' decisions about health care. Patients subjugate
personal needs and tend to go along with the demands of a more authoritative family figure
in order to maintain group harmony.
Filipino older adults tend to cope with illness with the help of family and friends, and
by faith in God. Complete cure or even the slightest improvement in a malady or illness is
viewed as a miracle. Filipino families greatly influence patients' decisions about health care.
Filipino values are, for the most part, centered at maintaining social harmony, motivated
primarily by the desire to be accepted within a group. The main sanction against diverging
from these values are the concepts of "Hiya", roughly translated as 'a sense of shame', and
"Amor propio" or 'self-esteem'.
The Filipino value system or Filipino values refers to the set of values that a majority of
the Filipino have historically held important in their lives. This Philippine values system
includes their own unique assemblage of consistent ideologies, moral codes, ethical
practices, etiquette and cultural and personal values that are promoted by their society.
As with any society though, the values that an individual holds sacred can differ on the
basis of religion, upbringing and other factors.
As a general description, the distinct value system of Filipinos is rooted primarily in
personal alliance systems, especially those based in kinship, obligation, friendship, religion
(particularly Christianity) and commercial relationships
We can enhance Filipino family solidarity by bringing up the old traditions like
eating family dinners all together without using gadgets, joining different leisure activities
with your family, attending family seminars or recollections, spending more time to one
another by going to the parks or other landmarks all.
Complete cure or even the slightest improvement in a malady or illness is viewed as a
miracle. Filipino families greatly influence patients' decisions about health care. Patients
subjugate personal needs and tend to go along with the demands of a more
authoritative family figure in order to maintain group harmony.
8 Classic Filipino Traits and Characteristics
Hospitality. This is one of the most popular qualities of Filipinos. ...

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Respect. This is often observed not just by younger people but also by people of all ages.
Strong Family Ties and Religions
Generosity
Helpfulness
Strong Work Ethic
Love
Caring
10 commendable traits and characteristics of a Filipino
1. Honest 6. Cheerful
2. Respectful 7. Active
3. Calm and Collected 8. Passionate
4. Resourceful 9. Jack of all Trades
5. Hard-working 10. Focused
FAMILY HEALTH NURSING PROCESS

Review of the Nursing Process
NURSING PROCESS
It is a scientific and systematized approach to health to care for individuals, families and
communities.
It is the means by which nurses address the health needs and problems of their clients and
illness prevention
It is a systematic, client-centered method or structuring the delivery of nursing care
Nursing process is a systematic, rational method of planning and providing individualized
nursing
care.
The purpose of nursing process
1. To identify client’s health status, actual or potential healthcare problems or need.
2. To establish plans to meet the identified needs and to deliver specific interventions to
meet those needs.
3. It provides a framework in which to practice nursing.
Characteristics of a nursing process:
1. Dynamic and cyclic
2. Patient centered
3. Goal directed
4. Open and Flexible
5. Problem Oriented
6. Planned
7. Universally accepted
8. Interpersonal and collaborative
9. Holistic
10. Systematic
Benefits of Nursing Process
1. Improves the quality of care that the client receives
2. Ensures a high level of client participation together with continuous evaluation designed
to meet the client’s unique needs
3. Enables nurses to use time and resources efficiently to both their own and their client’s
benefit
The steps of the Nursing Process
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Implementation
5. Evaluation

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Nursing Assessment
The process of collecting, validating and recording data about a client’s health status.
It identifies patient’s strengths and limitations and is done continuously throughout the
nursing process.
Nursing Diagnosis
In this phase the nurse sort, clusters and analyzes data.
These questions could serve as guidelines:
What are the actual and potential health problems for which the client needs nursing
assistance?
What factors contributed to this problem?
Nursing diagnoses are identified through actual and potential health problems or
responses to life
processes.
Types of nursing diagnosis:
It can be ACTUAL, POTENTIAL or WELLNESS DIAGNOSIS :
ACTUAL – identifies an occurring health problem
POTENTIAL – identifies a high risk health problem
WELLNESS‐ focused on promoting or enhancing a patient’s level of wellness.
Planning
Planning expected outcomes to resolve or minimize the identified problems of the client.
In collaboration with the client, the nurse develops specific nursing intervention for each
nursing diagnosis.
Its components are the following:
1. formulation of objectives
2. Setting Priorities
3. Formulating nursing care pianWriting nursing order
Implementation
These are actions taken to improve or help a situation”. It is considered a strategy or
planned action to accomplish the desired outcome or goal of a specific situation.
Intervention s “any treatment based upon clinical judgment and knowledge that a nurse
performs to enhance patient/client outcomes” (Moorhead, Johnson, Maas, & Swanson,
2018). In the nursing profession, the word intervention refers to planned activities carried
out by a nurse to ensure that a patient complains is addressed and are in place in order to
manage the care of the patient.
Also called intervention; putting the nursing care plan into action to achieve goals and
outcomes
As you implement your plan, you continue to assess your patient’s responses and modify
plan as needed.
The doing phase of the nursing process.
Care done should always be documented.
There are 3 identified nursing functions
1.Independent nursing function- based on the sound judgement of the nurse
2.Dependent nursing function- doctor’s orders are followed
3.Collaborative or interdependent nursing function- coordination with other members of
the health care team
Evaluation
Assessing the client’s response to nursing interventions and then comparing the response
to the goals or outcome criteria written in the planning phase
FAMILY HEALTH
- The continuing ability to meet defined functions in interaction with other social, political,
economic and health system.
- Possessing the abilities and resources to accomplish family developmental tasks.
FAMILY HEALTH NURSING PROCESS
Family nursing process is the same, whether the focus is the famiily as patient or as environment.
The goal is to help the family reach and maintain its maximum health in a given situation.

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PRINCIPLES OF FAMILY HEALTH CARE
1. Establishing good professional relationship with the family
2. Proper education and guidance should be provided
3. Gather all relevant information about family to identify problem and set priorities
4. Provide need-based support and services to the family to improve their health status
5. Health care services should be provided to the family irrespective of their age, sex, income,
religion, etc.
6. Duplication of health services should be avoided
7. Proper health message to be communicated to family in every contact
STEPS OF FAMILY HEALTH NURSING PROCES

1. ASSESSMENT
2. FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS
3. PLANNING
4. IMPLEMENTATION
5. EVALUATION PHASE
I. ASSESSMENT
Family Health Nursing Assessment
- This involves a set of actions by which the nurse measures the status of the family as a
client, its ability to maintain itself as a system and functioning unit, and its ability to
maintain wellness, prevent control and resolve problems in order to achieve health and
well-being among its members.
Data Collection Data Analysis Diagnosis
DATA COLLECTION
Two important things to ensure Effective and Efficient Data Collection in Family Nursing
Practice:
Identify the types of kinds of data needed
Specify the methods of data gathering and necessary tools for gathering data
DATA ANALYSIS - sorting out and classifying or grouping data by type of nature.
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS

1. Criteria for analysis
2. Process for analysis
sorting of data
clustering of related cues
distinguishing relevant from irrelevant cues
identifying patterns
comparing patterns
interpreting results of comparison
making inferences and drawing conclusions
NURSING DIAGNOSIS
The end result of the secondary level assessment and a set of family nursing problems for
each health condition or problem
First major phase of nursing process in family health nursing
It Involves a set of action by which the nurse measures the status of the family as a client.
Its ability to maintain wellness, prevent, control or resolve problems in order to achieve health
and wellness among its members
Data about present condition or status of the family are compared against the norms and
standards of personal, social, and environmental health, system integrity and ability to resolve
social problems.
The norms and standards are derived from values, beliefs, principles, rules or expectation.
TWO MAJOR TYPES

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1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions
or problems of the family are determined (WS, HT, HD, SP or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that
family encounters in performing health task with respect to given health condition or
problem and etiology or barriers to the family’s assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD

1. OBSERVATION
It is done through use of sensory capacities
The nurse gathers information about the family’s state of being and behavioral responses.
The family’s health status can be inferred from the signs /symptoms of problem areas within
the following areas:
a. communication and interaction patterns expected, used, and tolerated by family
members
b. role perception / task assumption by each member including decision making
patterns
c. conditions in the home and environment
Data gathered though this method have the advantage of being subjected to validation and
reliability testing by other observers.
2. PHYSICAL EXAMINATION
Health assessment of every member of the family, significant data about the health status of
individual members can be obtained through direct examination through IPPA, measurement of
specific body parts and reviewing the body systems.
Data gathered form substantive part of first level assessment which may indicate presence of
health deficits (illness state)
3. INTERVIEW
Productivity of interview process depends upon the use effective communication techniques
to elicit needed response.
Problems encountered during interview:
a. How to ascertain where the client is in terms of perception of health condition or problems
and the patterns of coping utilized to resolve them
b. Tendency of community health worker to readily give out advice, health teachings or
solutions
once they have identified the health condition or problems.
c. Provisions of models for phrasing interview questions utilization of deliberately chosen
communication
techniques for an adequate nursing assessment.
d. Confidence in the use of communication skills
e. Being familiar with and being competent in the use of type of question that aim to explore,
validate,
clarify, offer feedback, encourage verbalization of thought and feelings.
What to collect during interview?

1. completing health history of each family member
Health history determines current health status based on significant:
a. PAST HEALTH HISTOI\RY e.g. developmental accomplishment, known illnesses,
allergies, restorative treatment, residence in endemic areas for certain diseases or sources
of communicable diseases.
b. FAMILY HISTORY e.g. genetic history in relation to health and illness.
c. SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family
member social adjustment or vulnerability to stress and crisis
2. Collecting data by personally asking significant family members or relatives questions
regarding health, family life experiences and home environment to generate data on what
wellness condition and health problem exist in the family (first level assessment) and the
corresponding nursing problems for each health condition or problem (2nd level
assessment)
4. RECORDS REVIEW

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Gather information through reviewing existing records and reports pertinent to the
client
Individual clinical records of the family members, laboratory and diagnostic reports,
immunization records reports about home and environmental conditions
5. LABORATORY/ DIAGNOSTIC TEST
Tools Used in Family Assessment
Genogram
Ecomap
Initial Data Base
Family Assessment Guide
Genogram
Graphic representation of a family tree that displays detailed data on relationships
among individuals
Goes beyond a traditional family tree by allowing the user to analyze hereditary
patterns and psychological factors that punctuate relationships
Information on disorders running in the family such as alcoholism, depression,
diseases, alliances, and living situations
Four Rules to build a Genogram:
1. The male parent is always at the left of the family and the female parent is always at
the right of the family.
2. In the case of ambiguity, assume a male-female or female-female relationship.
3. Spouse must always be closer to his/her first partner, then the second partner (if any),
third partner, and so on . . .
4. The oldest child is always at the left his family, the youngest child is always at the
right his
family
FAMILY ASSESSMENT
INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
I. Family Structure, characteristics and dynamics
II. Socio-economic and cultural characteristics
III. Home and environment
IV. Health status of each member
V. Values and practices on health promotion/maintenance and disease prevention»
FAMILY STRUCTURE CHARACTERISTICS AND DYNAMIC
This includes the following:
a. composition and demographic data of the members of the family/household
b. their relationship to the head and place of residence
c. the type of family
d. family interaction/communication
e. Decision making patterns and dynamics
SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
This includes the following:
a. Income and Expenses
b. Occupation, place of work, and income of each working member
c. Adequacy to meet basic necessities
d. Who makes decisions about money and how it is spent
e. Educational attainment of each family member
f. Ethnic background and religious affiliations
g. Significant others-roles they play in the family’s life
h. Relationship of the family to the larger community (membership in organizations)
HOME AND ENVIRONMENT
a. Housing:
Adequacy of living space
Sleeping arrangement
Food storage and cooking facilities
Water supply, toilet facilities

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Presence of accident hazards
Garbage disposal
b. Kind of neighborhood
c. Social and Health Facilities
d. Communication and transportation facilities available
HEALTH STATUS OF EACH MEMBER
a. Medical and nursing history indicating current and past significant illness or beliefs and
practices conductive to health and illness
b. Nutritional and developmental status
c. Developmental assessment of infants, toddlers and preschoolers
d. Risk factor assessment
e. Physical assessment findings
f. Significant results of laboratory/diagnostic tests/screening procedures
g. Decision making on which or whom to seek advice regarding health
VALUES AND PRACTICE ON HEALTH PROMOTION/MAINTENANCE AND
DISEASE PREVENTION
a. Immunization status of the family members
b. Healthy lifestyle practices
c. Adequate of: rest/sleep, exercise/activities, use of protective measures, relaxation and stress
management
d. Utilization of health care facilities
FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS

Family profile and diagnosis
Family profile implies brief description of family structure and characteristics, family life
cycle and culture, socio economic conditions environmental factors health and medical history
etc. Family health diagnosis is the written statement of family health problems which are
assessed from analysis of data collected.
FIRST LEVEL ASSESSMENT
Name or Categories of Health Problems
1. Presence of Wellness Condition
Stated as Potential or Readiness
A clinical or nursing judgment about a client transition form a specific level of wellness
or capability to a higher level (NANDA, 2001)
Wellness Potential
It is a nursing judgement on wellness state or performance current competencies
expression of client’s desire
E.g. Potential for Enhanced Capability for parenting
2. Presence of Health Threats
Readiness for Enhanced Wellness State
It is a nursing judgement on wellness state or condition based on client’s current
competencies or performance, clinical data and explicit expression of desire to achieve higher
level or function in a specific area on health promotion and maintenance.
e.g Readiness for Enhanced Capability for Healthy Lifestyle
2. Presence of Health Threats
These are conditions that are conducive to disease and accident, or may result to failure to
maintain
wellness or realize health potential.
E.g. Presence of Risk Factors of specific disease, accident hazards, poor home/
environmental conditions, family history of hereditary disease, threat of cross infection,
faulty eating habits, poor environmental sanitation, unhealthy lifestyle/personal habits
3. Presence of Health Deficits
These are instances of failure in health maintenance
e.g. Illness states, diagnosed or undiagnosed by medical practitioner, disability, transient
(aphasia or temporary paralysis after a CVA), permanent (leg amputation secondary to
diabetes, lameness from polio)
4. Presence of Stress Points/Foreseeable Crisis

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Anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources.
e.g. marriage, pregnancy, parenthood, divorce, separation, loss of job, menopause death
SECOND LEVEL ASSESSMENT
Determining family’s ability to perform the Family Health Tasks on each health threat, health
deficit, foreseeable crisis on wellness potential.
Family Health Condition - a statement of family’s capabilities to maintain health and prevent
illness
Ability to recognize signs of health and development
Ability to manage health and non-health crisis
Ability to provide health care to its members
Ability to provide home environment conducive to good health and personal
development
Ability to utilize community resources for health care
FAMILY NURSING PROBLEM
Five Main Types:
Inability to recognize the presence on the condition/problem due to…
Inability to make decisions with respect to taking appropriate health action due to…
Inability to provide nursing care to the sick, disabled, or dependent member of the family
due to…
Inability to provides a home environment which is conducive to health maintenance and
personal
development due to…
Failure to utilize community resources for health due to…
TYPOLOGY OF PROBLEMS IN FAMILY HEALTH (SECOND LEVEL)

1. Inability to recognize the presence on the condition/problem due to:
1. Lack of inadequate knowledge
2. Denial about its existence or severity as result of fear of consequences of diagnosis of
problem
3. Attitude/philosophy in life which hinders recognition/acceptance of a problem
2. Inability to make decisions with respect to taking appropriate health action due
to:
1. Failure to comprehend the nature/magnitude of the problem/condition
2. Low salience of the problem
3. Feeling of confusion, helpnesness, and/or resignation brought about by perceived
magnitude/severity of the situation or problem
4. Lack of knowledge as the alternative courses of action open to them
5. Inability to decide which action to take from among a list of altenatives
6. Conflicting opinions among family members
7. Lack of knowledge of community resources for care.
8. Fear of consequences action
9. Negative attitude towards the health condition or problems
10. Inaccessibility of appropriate resources of care
11. Lack of trust /confidence in the health personnel/agency
12. Misconceptions or erroneousinformation about proposed course of action
3. Inability to provide adequate care to the sick,disabled,dependentor vulnerable/at
riskmember of the family due to:
1. Lack of knowledge about the disease/health condition
2. Lack of knowledge about child development and care
3. Lack of knowledge of the nature and extent of care needed
4. Lack of the necessary facilities, equipments and supplies of care
5. Lack of inadequate knowledge and skillin carrying out the necessary interventions
6. Inadequate family resources for care
7. Significant person’s unexpressed feelings
8. Philosophy in life which negates or hinders caring for the sick, disabled, dependent and at risk
member

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9. Member’s pr eoccupation with own concerns or interests
10. Prolonged disease or disability progression which exhaust supportive capacity of family
members
11. Altered role performance
4. Inability to provides a home environment which is conducive to health
maintenance and personal development due to:
1. Inadequate family resources
2. Failure to see benefits of investment in home and environment improvement
3. Lack of knowledge of preventive measures
4. Lack of skill in carrying out measures to improve home environment
5. Ineffective communication patterns with the family
6. Lack of supportive relationship among family members
7. Negative attitude in life which is not conducive to health maintenance and personal
development
8. Lack of competencies in relating to each other for mutual growth and maturation
5. Failure to utilize community resources for health due to:
1. Lack of knowledge of community resources for health
2. Failure to perceive the benefits health services
3. Lack of trust or confidence in the agency personnel
4. Previous unpleasant experience with health worker
5. Fear of consequences in action
6. Unavailability of required care
7. Inaccessibility of required care
8. Inadequate family resources
9. Feeling of alienation to the community.
10. Negative attitude in life which hinders effective utilization of community resources for health
care.
III. PLANNING PHASE (FAMILY HEALTH AND NURSING CARE PLAN
FORMULATION)
It is based on the analysis of diagnosed health problems and assessment of family’s
ability to resolve problems, establish priorities, setting goals and objectives, formulating family
health nursing care plan.
1. Analysis of diagnosed health problems and assessment of family’s ability to resolve
problems Family’s ability to resolve health problems can be assessed on the basis of:
a. ability to recognize the presence of health problems
b. ability to make decisions for taking appropriate health action
c. ability to provide desired care to the sick disabled
d. ability to maintain environment conducive to health promotion maintenance and
personnel
development
e. ability to utilize community for health care
2. Establish priorities -means rank ordering of the health problems.
Four Criteria for Determining Priorities:
1. Nature of the condition or problem
These are categorized into wellness state/potential, health threat, health deficit or
foreseeable crisis.
The biggest weight is given to the wellness state or potential because of the premium on
client’s effort or
desire to sustain/maintain high level of wellness. The same weight is given to health deficit
because of its
sense of clinical urgency, which may require immediate intervention. Foreseeable crisis is
given the least
weight because culture linked variables/factors usually provide our families with adequate
support to cope
with developmental or situational crisis.
2. Modifiability of the condition or problem

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This refers to the probability of success in enhancing the wellness state improving the
condition minimizing, alleviating or totally eradicating the problem through intervention.
This is possibility of resolving the problem through nursing intervention which includes:
a. Current knowledge, technology and interventions to enhance the wellness state or manage
the
problem.
b. Resources of the family
c. Resources of the nurse
d. Resources of the community
3. Preventive potential
This refers to the nature and magnitude of future problem that can be minimized or
totally prevented if interventions are done on the condition or problem under
consideration.It refers to the severity of the consequence of the problem and nature and
magnitude of the problem, interventions within available resources whether the problem can
be prevented, eradicated or controlled. These are:
1. Gravity or severity of the problem
It refers to the progress of the disease/problem indicating extent of damage on the
patient/family; also indicates prognosis, reversibility or modifiability of the problem. In general,
the more severe the problem is, the lower is the preventive potential of the problem.
2. Duration of the problem
This refers to the length of time the problem has existed. Generally speaking, duration of
the problem has a direct relationship to gravity; the nature of the problem is variable that may,
however, alter this
relationship. Because of this relationship to gravity of the problem, duration has also a direct
relationship to preventive potential.
3. Current management-refers to the presence and appropriateness of intervention
measures instituted to enhance the wellness state or remedy the problem. The institution of
appropriate intervention increases condition’s preventive potential.
4. Exposure of any vulnerable or high-risk group-increases the preventive potential of
condition or
problem
4. Salience
This refers to the family’s perception and evaluation of the condition or problem in terms
of seriousness and urgency of attention needed or family readiness.
It refers to the family’s perception about the seriousness of the problem
Prioritizing Health Problems

Criteria Weight
Nature or conditions of the problem 1
Scale: wellness state (3)
health deficit (3)
health threat (2)
foreseeable crisis (1)
Modifiability of the problem 2
Scale: easily modifiable (2)
partially modifiable (1)
not modifiable (1) 1
Preventive potential
Scale: high (3)
moderate (2)
low (1) 1
Salience
Scale: needs immediate attention (2)
Does not need immediate attention
(1)
Not perceived as a problem or
condition

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needing change (0)
SCORING :
1. Divide the score for each of the criteria
2. Divide the score by the highest possible score and multiply by the weight
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight
3. Setting goals and objectives
Formulation of Goals and Objectives
F0rmulating Goals and Objective for Health Promotion and Maintenance
Goal is a general statement of the condition or the state to be brought about by specific
course of action
Parts of a Nursing Objective
1. Time frame and condition
2. Terminal behavior or expected outcome
3. Criteria of acceptable performance
Example: After 2-3 months of rendering appropriate nursing actions,the family will be able to
maintain ability to recognize signs of health and development effectively.
Objective refers to more specific statements of the desired results or outcomes of care
Example: At the end of 2-3 months of rendering appropriate nursing actions - Time frame and
condition
the family will be able to maintain ability to recognize signs of health and
development- Terminal behavior or expected outcome effectively.
- Criteria of acceptable performance

They specify the criteria by which the degree of effectiveness of care is to be measured.
A cardinal principle in goal setting states that goal must be set jointly with the family. This
ensures family commitment to realization.
Basic to the establishment of mutually acceptable goals is the family’s recognition and
acceptance of existing health needs and problems.
Barriers to Joint Goal Setting Between the Nurse and the Family:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too busy at
the moment.
3. Sometimes the family perceives the existence of the problem but does not see it as serious
enough to warrant attention.
4. The family may perceive the presence of the problem and the need to take action. It may
however refuse to face and do something about the situation.
Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals.
5. A big barrier to collaborative goal setting between the nurse and the family is the working
relationship.
Client focused goal- e.g. provide need based care to malnourished children
Nurse focused goal- e.g. after the nursing intervention the mother will be able to
provide need based care to malnourished children.
Factors influence the goal formulation
1.interpersonal relationship
2.families perception of the problem
3.families felt need
4.families perception about seriousness of the problem
5.families ability to face the reality
4. Family health nursing care plan
Prior to making of the FNCP, you need to review the following:
1. data analyzed
2. health problem prioritized

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3. goals and objectives established
4. nursing interventions decided
All of these components put together for the schematic representation of the care plan
It should be realistic, consistent with the goals, agreeable to the family, need active
involvement of the family members, review of plan and mobilization of resources.
FAMILY NURSING CARE PLAN

It is the blue print of the care that the nurse designs to systematically minimize or eliminate
the identified health and nursing problem through explicitly formulated outcomes of care
(goals and objectives) and deliberately chosen set of interventions, resources and evaluation
criteria, standards, methods and tools.
Characteristics, which are Based on the Concept of Planning as a Process:

1. The nursing care plan focuses on actions which are designed to solve or minimize existing
problem. The plan is a blueprint for action. The cores of the plan are the approaches,
strategies, activities, methods and materials which the nurse hopes will improve the problem
situation.
2. 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.
3. 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.
4. 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.
5. 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.
6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the
evaluation of the plan’s effectiveness trigger another cycle of the planning process until the
health and nursing problems are eliminated.
Steps in Making Family Nursing Care Plan
Formulating a family care plan involves the following steps:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. The plan of interventions
4. The plan of evaluating care
Desirable Qualities of a Nursing Care Plan
1. It should be based on clear, explicit definition of the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family.
4. The nursing care plan is most useful in written form.
Importance of Planning Care
1. They individualize care to clients.
2. The nursing care plan helps in setting priorities by providing information about the client as
well as the nature of his problem.
3. The nursing care plan promotes systematic communication among those involve in the
health care effort.
4. Continuity of care is facilitated through the use of nursing care plans.Gaps and duplications
in the services provided are minimized, if not totally eliminated.
5. Nursing care plans facilitate the coordination of care by making known to other members of
the health team what the nurse is doing.
Steps in Developing Care Plan

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The assessment phase of the nursing process generates the health and nursing problems
which become the bases for the development of nursing care plan. The planning phase takes off
from there.
1. The prioritized conditions of the problem
2. Goals and objectives of the nursing care
3. The plan of interventions
4. The plan for evaluating care
This is a schematic presentation of the nursing care plan process. It starts with a list of
health condition or problems prioritized according to the nature, modifiability, preventive
potential and salience.
The prioritized health condition or problems and their corresponding nursing problems become
the basis for the next step which is the formulation of goals and objectives of nursing care. The
goals and objectives specify the expected health/clinical outcomes, family response/s, behavior
of competency outcomes.
Parts of a FNCP
1. Assessment
2.Family Nursing Diagnosis
3.Planning
4. Interventions
5. Rationale
6.Evaluation

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Sample of a FNCP
IV. IMPLEMENTATION (ACTION PHASE/FAMILY HEALTH AND NURSING CARE

PLAN IMPLEMENTATION)
This is the doing phase of the nursing process that is putting into action planned care to be
rendered to solve the problem.
STEPS
1. review of plan and mobilization of resources
2. implementation
3. documentation
During the implementation phase the following should be considered:
a. help family to understand the situation
b. relate families exiting socio economic condition to health problem
c. motivate family to implement actions
d. utilize the equipment and supplies
e. help family to utilize the community resources
In selecting appropriate nursing intervention, there are Three types:
1. Supplemental -direct nursing care services by the CHN to the sick
2. Developmental -CHN prepares some family members to give similar care in her absence.
3. Facilitative -CHN improves family’s physical facilities either by modifying the existing
facilities or by developing new facilities or removing the barrier.
CHN has to consider the available resource while planning intervention.
CHN has to consider the available resource while planning intervention. They are:
1. Family resources -physical intellectual capabilities, physical facilities, finance etc.

2. Community resources -health programs, community organization etc.
3. Nurse resources -her competency, time, support etc.
For the nurse to undertake implementation there are three types of nursing function namely:
1. Independent nursing function
2. Dependent Nursing function
3. Collaborative or interdependent nursing function
Types of Nursing Interventions

HAHAHAHA
There are three types of nursing interventions: Dependent, Independent, and Collaborative.
Dependent nursing interventions. Also called as physician-initiated interventions, these are
activities that require doctor’s orders or directions from other health care professionals. The
interventions performed by the nurse are part of the treatment process or medical management of
the patient’s medical diagnosis. An example of this is the administration of medications or
changing of dressings. directed toward treating or managing a medical diagnosis. A nurse who
solely decides and performs interventions under this category is liable to legal implications.
Independent nursing interventions. Nurses, as health care professionals, do not completely
rely on the medical management in order to provide care to their patients. Overtime, the notion
that nurses are doctor’s handmaidens, have drastically changed and empowered nurses to be
independent in their own terms. This is where the nurse-initiated interventions come in. Nurses
can perform caring interventions without a doctor’s prescription. The acceptable nursing actions
have foundations in medical and nursing literature and supported through evidence-based
practice research.
Focus on Interventions- to help the family performs Health Tasks:
1. Help the family recognize the problem
Increasing the family’s knowledge on the nature, magnitude and cause of the problem.
Helping the family see the implications of the situation or the consequences of the
condition.
Relating the health needs to the goals of the family.
Encouraging positive or wholesome emotional attitude toward the problem by
affirming the family’s capabilities/qualities/resources and providing
information on available actions.
2. Guide the family on how to decide on appropriate health actions to take.
Identifying or exploring with the family courses of action available and the resources
needed for each.
Discussing the consequences of action available.
Analyzing with the family of the consequences of inaction.
3. Develop the family’s ability and commitment to provide nursing care to each member.
Contracting-is a creative intervention that can maximize the opportunities to develop
the ability and commitment of the family to provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to health
maintenance and personal development.
The family can be taught specific competencies to ensure such home environment
through environmental manipulation or management to minimize or eliminate health
threats or risks or to install facilities of nursing care.
5. Facilitate the family’s capability to utilize community resources for health care.
Involves maximum use of available resources through the coordination, collaboration
and teamwork provided by effective referral system.
Implementing the Nursing Care Plan
During this phase, the nurse encounters the realities in family nursing practice that motivates
her to try out creative innovations or overwhelm her to frustration or inaction. A dynamic
attitude on personal and professional development is, therefore, necessary if she has to face
up challenges of nursing practice.
Implementation is a phenomenological experience. Actual situations and problems are
identified as the basis of implementation.
Meeting the challenges of this phase is the essence of family nursing practice. During this
phase, the nurse experiences with the family a lived meaningful world of mutual, dynamic
interchange of meanings, concerns, perceptions, biases, emotions and skills.
Just as the self aims to achieve body-mind integration to achieve wholeness in the
experience of “being” and “becoming” in expert caring. Unless there is such a dynamic and
active involvement between the nurse and the family in understanding and making choices
in this meaningful world of coping, aspirations, emotions and skills the nurse can’t hope to
achieve expert caring.
Expert Caring: Methods and Possibilities

HAHAHAHA
Expert caring in the implementation phase is demonstrated when the nurse carries out
interventions based on the family’s understanding of the lived experience of coping and
being in the world.
Expert caring is developing the capability of the family for “engage care” through the
nurses skilled practice, the family learns to choose and carry out the best possibilities of
caring given the meanings, concerns, emotions and resources (skills & equipment) as
experienced in the situation.
By being experts in caring, nurses must takeover and transform the notions of expertise.
Expert caring has nothing to do with possessing privileged information that increases one’s
control and domination of another. Rather, expert caring unleashes the possibilities inherent
in the self and the situation. Expert caring liberates and facilitates in such a way that the one
caring is enriched in the process.
Reasons that may bring about inappropriate choices of nursing intervention:
1. The tendency of the nurse to use “patterned” or “canned” approaches in working with
families
2. Inadequate appreciation of social or cultural factors or realties
3. Inadequate or limited repertoire of intervention techniques and skills in the face of
complicated behavioral problems in family life.
Factors/conditions that may bring non-compliance or non-acceptance of the family to take
actions on its each health problems:
1. The family’s information may be inadequate or inaccurate
2. The family has the necessary information but fails to relate them to the problem condition
3. The family is not willing to face the reality of the situation
4. The members may not be willing to oppose family, peer or social pressure
5. There may be adherence to patterned behavior
6. There is failure to relate the needed actions to family goals
7. The lack of confidence in the action proposed
IV. EVALUATION PHASE (FAMILY HEALTH AND NURSING CARE EVALUATION)
Evaluation - specifies how the health care provider will determine the achievement of the
outcome of the
desire
Evaluation – reflection off objectives
Standards - desired achievable level of performance against which actual practice is compared,
it serves as a guide in the formulation of objective
It is the assessment the client’s response to nursing interventions and then comparing that
response to predetermined standards or outcome criteria.
Evaluation is defined as the judgment of the effectiveness of nursing care to meet client
goals; in this phase nurse compare the client behavioral responses with predetermined client
goals and outcome criteria. –
Evaluation, the final step of the nursing process, is crucial to determine whether, after
application of the nursing process, the client’s condition or well-being improves. The nurse
applies all that is known about a client and the client’s condition, as well as experience with
previous clients, to evaluate whether nursing care was effective. The nurse conducts evaluation
measures to determine if expected outcomes are met, not the nursing interventions.
The expected outcomes are the standards against which the nurse judges if goals have been
met and thus if care is successful. Providing health care in a timely, competent, and cost-
effective manner is complex and challenging. The evaluation process will determine the
effectiveness of care, make necessary modifications, and to continuously ensure favorable client
outcomes.
It determines the extent of services rendered to the family .It accounts the number of visits ,
clinic visits, no. of immunization completed, reduction in mortality and morbidity.
Activities in Evaluation Phase
1. Identifying criteria and standards
Nurses evaluate the nursing care by knowing what to look for. A client’s goal and
expected outcome give the objective criteria needed in a client’s response to care.
2. Collecting evaluative data

HAHAHAHA
Evaluating client’s response to nursing care requires the use of evaluative measures. (e.g.
Skills and Techniques- like doing Physical Assessment, observation of the client’s performance,
discussions of the client’s feelings etc.)and decision about the client’s status and progress.
3. Interpreting and summarizing findings
Using evidence, the nurse makes judgement about the client’s condition. To develop
clinical judgement, match the result of evaluative measures with expected outcomes to determine
if the client’s status is improving or not.
Examine the goal attainment to determine the exact client behavior or response.
Assess the client for the presence of that behavior or response.
Compare the established outcome criteria with the behavior or response.
Judge the degree of agreement between outcome criteria and the behavior or response.
If there is no agreement between outcome criteria and response or behavior, identify the
barriers.
4. Documenting findings
Documentation and reporting are important parts of evaluation like written nursing
process notes, assessment flow sheets and endorsement among nurses regarding the client’s
progress towards meeting expected outcome.
5. Care Plans Revision
Evaluate expected outcomes and determine the goals of care have been met.
Then decide the need to adjust to the plan of care. If goal met successfully discontinue
that portion of care plan.
Components of Evaluation
1. Collecting the data related to the desired outcomes
2. Comparing the data with outcomes
3. Relating nursing activities to outcomes
4. Drawing conclusion about problem status
5. Continuing, modifying, or terminating the nursing care plan
Collecting the data
The nurse collects the data so that conclusion can be drawn about whether goals have been
met. It is usually necessary to collect both subjective & objective data. Data must be
recorded concisely and accurately to facilitate the next part of the evaluating process.
Comparing the data with outcomes
If the first part of the evaluation process has been carried out effectively , it is relatively
simple to determine whether a desired outcome has been met. Both the nurse and client play
an active role in comparing the client’s actual responses with the desired outcomes.
Relating nursing activities to outcomes
The third aspect of the evaluating process is determined whether the nursing activities had
any relation to the outcome.
Drawing conclusion about problem status
The nurse uses the judgement about goal achievement to determine whether the care plan
was effective in resolving, reducing or preventing client problems.
When goals have been met the nurse can draw one the following conclusions about the
status of the client’s problem.
The actual problem stated in the nursing diagnosis has been resolved, or the potential
problem is being prevented and the risk factors no longer exist. In these instances, the
nurse documents that the goals have been met and discontinues the care for the
problem.
The potential problem is being prevented, but the risk factors still present. In this case,
the nurse keeps the problem on the care plan.
The actual problem still exists even though some goals are being met. In this case the
nursing interventions must be continued.
Continuing, modifying, or terminating the nursing care plan
After drawing conclusion about the status of the client’s problems, the nurse modifies the
care plan as indicated. Whether or not goals were met, a number of decisions need to be
made about continuing, modifying or terminating nursing care for each problem.
Before making individual modification, the nurse must first determine why the plan as a
whole was not completely effective. This require a review of the entire plan.

HAHAHAHA
Factors Affecting Goal Attainment
1. Family Members
2. Health Team Members
3. Nurse
Evaluation Skill Required for Nurses
1. Nurse must know the hospital policies, procedure and protocols of interventions and
recording.
2. Nurse must have up to date knowledge and information of many subject.
3. Nurse must have intellectual and technical skill to monitor the effectiveness of nursing
interventions.
4. Nurse must have knowledge and skill of collecting subjective data and objective data.
Purposes of evaluation
1. Determine client’s behavioral response to nursing interventions.
2. Compare the client’s response with predetermined outcome criteria.
3. Appraise the extent to which client’s goals were attained.
4. Assess the collaboration of client and health care team members.
5. Identify the errors in the plan of care.
6. Monitor the quality of nursing care.

HAHAHAHA

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2/11/2021

COMMUNITY HEALTH NURSING

GLOBAL, NATIONAL and LOCAL HEALTH SITUATION

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DEFINITION AND FOCUS

Two specific types of a community

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OBJECTIVES OF PUBLIC HEALTH

3 ELEMENTS IN HEALTH EDUCATION

ROLES OF THE PUBLIC HEALTH NURSE

Community = is a group of people sharing common geographic boundaries and/or common

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CLIENTELE OF THE CHN

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CHARACTERISTICS OF A HEALTHY COMMUNITY

CONCEPT OF HEALTH PROMOTION

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REORIENTING HEALTH SERVICES

THEORIES/MODELS OF HEALTH PROMOTION DIFFERENCE OF THEORY AND

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LOCAL THEORIES AND MODELS OF NURSING INTERVENTION (PHILIPPINE

THEORIES RELEVANT IN NURSING PRACTICE

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THE EPIDEMIOLOGIC TRIANGLE

THREE COMPONENTS OF THE ENVIRONMENT

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PATTERNS OF OCCURRENCE AND DISTRIBUTION

(baka kasali sa exam bukas)

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2. Population dispersion or spatial distribution:

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(a) A pyramids with a broad base (or triangular structure):

4. Natality (birth rate):

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(c) The age of first reproduction.

5. Mortality (death rate):

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Social system within the community

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REVIEWER IN COMMUNITY HEALTH NURSING

DEFINITION, CONCEPT AND PRINCIPLES

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NURSING PROCESS IN THE COMMUNITY

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➢ It should be flexible and practical

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➢ Hand towel in plastic bag

➢ Thermometers is case (one for oral & one for rectal)

➢ 2 pairs of forceps (1 curved & 1 straight)

➢ Hypodermic needles (19, 22, 23, 25)

➢ Sterile cord tie

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HEALTH CARE DELIVERY SYSTEM IN THE PHILIPPINES

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➢ Maternal and Child Health and Family and Planning

➢ Provision of Medical Care and Emergency Treatment

➢ Provision of Essential Drugs