Community Health Nursing- Lecture Notes

Prepared by: Mr. Lincoln T. Sumaylo

COMMUNITY
Community- a group of people w/ common characteristics or interest living together w/n
a territory or geographical boundary.
-place where people are found.
Community as the client/patient in CHN ( client- well; patient- sick)
Health- a state of complete physical, mental, & social well-being and not merely
the absence of a disease, illness or infirmity- WHO
Nursing- Florence Nightingale- placing an individual in an env’t. that will promote
optimum capacity for self-reparative process
- an art and science of rendering care to individual, families and
community.
- assisting an individual, sick or well, in the performance of those activities
contributing to health or its recovery in such a way as to help gain
independence. (OLOF)

COMMUNITY HEALTH NURSING

1. Maglaya
- The utilization of the nsg. process in the diff levels of clientele- indiv, families, pop
grps, and comm. concerned with
a. promotion of health
b. prevention of diseases
c. disability & rehab
2. Jacobson
- CHN is learned practice discipline with the ultimate goal of contributing, as individual &
in collaboration with others, to the promotion of the client’s optimum level of functioning
through teaching & delivery of care.
Nursing Function:
a. Independent
b. Collaborative or Interdisciplinary---Health Team Approach
3. Freeman
-Unique blend of nursing & public health practice aimed at developing & enhancing
health capabilities of the people, service rendered by a professional nurse with the
comm., groups, families, and individual at home, in H centers, in clinics, in school, in
places of work for the ff:
1. Promotion of health
2. Prevention of illness
3. Care of the sick at home and rehab
- self-reliance

BASIC CONCEPTS OF CHN

1. The Primary focus of CHN is Health Promotion & Disease Prevention
Primary goal - self reliance in health or enhanced capabilities
Ultimate goal - raise level of # of citizenry
Philosophy of CHN- Worth and dignity of man
2. CHN practices -to benefit the individual, family, special groups & community
3. CHN are generalists in terms of practice thru out life’s continuum—its full range of
health problems & needs
4. Nature of CHN practice requires knowledge on biological, social sciences
5. Implicit in CHN is the Nursing Process (ADPIE)—an independent nursing function
Nursing Function:
1. Independent- without supervision of MD
2. Collaborative- in collaboration with other H team ( interdisciplinary, intrasectoral)

ROLES OF THE NURSE IN COMMUNITY HEALTH NURSING

Clinician – focus on the health of the individuals on the larger context of the community
Advocate – promote self-care and self-determination
Collaborator – brings together strengths and weaknesses of people involved toward a
common goal
Researcher – utilizes data to predict future phenomenon and modify interventions
Counselor – key tasks include listening and providing feedback and information
Case Manager – oversees all aspects of care to facilitate delivery of cost-efficient care;
to individualize and coordinate care
Educator – provide knowledge, skills and attitudes that people need to make
appropriate
choices or decision
Hospice Care – providing care skills in a home and other settings and balancing client’s
needs

CATEGORIES OF HEALTH PROBLEMS

HEALTH DEFICIT
■ A gap between actual and achievable health status
■ Instances of failure in health maintenance
■ Possible precursors of health deficit:
Examples:
■ ILLNESS states, diagnosed or undiagnosed
■ Failure to thrive/develop
■ Disability
■Transient (aphasia or temporary paralysis after a CVA)
■Permanent (leg amputation secondary to diabetes, blindness from measles, lameness
from polio)

HEALTH THREAT - conditions that are conducive to disease, accident or failure to

realize
one’s potential
Examples:
■ Family history of hereditary disease
■ Threat of cross infection
■ Accident hazards
■ Faulty eating habits
■ Poor environmental sanitation
■ Unhealthy lifestyle/personal habits

FORESEEABLE CRISIS - anticipated periods of unusual demand on the individual or

family in terms of adjustment/family resources
Examples:
■ Marriage
■ Pregnancy
■ Parenthood
■ Divorce or separation
■ Loss of job
■ Menopause
■ Death

PRIORITIZING HEALTH PROBLEMS

NATURE OF THE PROBLEM – categorized into health deficit, health threat and
foreseeable crisis
 Health deficit 3
 Health threat 2
 Foreseeable crisis 1
MODIFIABILITY OF THE PROBLEM – refers to the probability of success in
minimizing, alleviating or totally eradicating the problem through intervention
 Easily modifiable 2
 Partially modifiable 1
 Not modifiable 0
PREVENTIVE POTENTIAL –refers to the nature and magnitude of future problems that
can be
minimized or totally prevented if intervention is done on the problem under
consideration
 High 3
 Moderate 2
 Low 1
SALIENCE – refers to the family’s perception and evaluation of the problem in terms of
seriousness and urgency of attention needed
 A serious problem, immediate attention needed 2
 A problem, but not needing immediate attention 1
 Not a felt need / problem 0

KEY POINTS IN VACCINE ADMINISTRATION

• BCG -lay the syringe and needle almost flat along the child’s arm
- if the vaccine is injected correctly into the skin, a flat wheal with
the surface pitted like an orange peer will appear at the injection
site
• OPV -if necessary open the child’s mouth by squeezing the cheeks
gently between your fingers to make lips point upwards
- put drops of vaccine straight from the dropper onto the child’s
tongue but do not let the dropper touch the child’s tongue
- if the child spit out the vaccine, give another dose
• HEPA and DPT -the best injection site is the outer part of the child’s midthigh
- ask the mother of the child to hold the child’s legs
• MEASLES the best injection site is on the outer side of the upper arm
• TETANUS TOXOID- the best injection site for a woman is the outer side of the left
upper arm of the mother

PRINCIPLES OF VACCINATION
1. No BCG to a child born positive with HIV or AIDS
2. DPT is not given to a child who has recurrent convulsions or active neurologic
disease
3. DPT2 or DPT3 is not given to a child who has had convulsions or shock w/in 3 days
4. Don’t immunize children before referral
5. Moderate fever, malnutrition, mild resp. infection, cough, diarrhea & mild vomiting
aren’t contraindication to vaccination.
6. Safe to administer all EPI vaccines on the same day at different sites of the body.
7. No food 30 minutes after giving OPV.
8. Assess the child for allergy to egg before giving measles vaccine.
9. Measles vaccine should be given as soon as the child is 9 months old regardless of
whether other vaccines will be given on that day.
10. Vaccination schedule should not be restarted from the beginning even if the interval
between doses
exceeded.
11. It is safe and effective with mild side effects after vaccination.
12. Do not repeat BCG vaccination if the child does not develop a scar after the first
injection.
13. Strictly follow the principle of never, ever reconstitute the freeze dried vaccines to
any diluents.
14. Use one syringe, one needle per child during vaccination.
15. During vaccination, clean the skin with cotton ball, moistened with water only (boiled
H20)

MEDICINAL PLANT- SANTA LUBBY

S- Sambong Anti-edema
Diuretic
Anti-urolithiasis
A- Ampalaya Diabetes Mellitus
N- Niyug-niyogan Anti-helminthic
T- Tsaang Gubat Remember: STD
Stomachache
Tsaang gubat
Diarrhea
A- Akapulko Anti-fungal
L- lagundi S-kin diseases
 H-eadache
A-sthma, cough and fever
R-heumatism, sprain, insect bites
E-czema
Dysentery
U-Ulasimang bato Uric acid excretion
(pansit pansitan) Remember:
Ulasimang bato, uric acid
B- Bawang Hypertension (to lower cholesterol levels in the blood)
Toothache
Remember:
BawHaT (Bawang for Hypertension, toothache)
B- Bayabas/ Guavas Diarrhea
Washing of wounds
Gargle to relieve toothache
Y- Yerba Buena S-wollen gums
P-ain
I-nsect bites
T-oothache
M-enstrual and gas pain
A-rthritis
N-ausea and fainting
D-iarrhea

Reminders on the Use of Herbal Medicine

1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
7. If signs and symptoms are not relieved after 2 or 3 doses, consult a doctor

BAG TECHNIQUE
- a tool making use of a public health bag and which the public health nurse can perform
procedures during home visits.
Rationale: - Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.
Special Consideration:
B - bag and its contents must be free from any contamination.
A- always perform handwashing.
G- gather necessary equipments to render effective
nursing care.

Steps in Performing the Bag Technique Actions:

1. Upon arrival, place the bag on the table lined with a clean paper. (The clean side
must be out and folded part, touching the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used and perform handwashing.
10. Open the bag and return all things that were used in their proper place
11. Remove apron, folding it away fro the person, the soiled side in and the clean side
out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.

WATER SUPPLY SANITATION PROGRAM

Approved type of water supply facilities:
LEVEL I (Point Source)
- a protected well or a developed spring with an outlet but
without a distribution system.
- serves 15 to 25 households
- outreach must not be more than 250 meters from the
farthest user
LEVEL II (Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped
distribution network and communal faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest
house
LEVEL III (Waterworks System or Individual House Connections)
- a system with a source, a reservoir, a piped distributor
network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection

PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM

Approved types of toilet facilities:
LEVEL I Non-water carriage toilet facility – no water is necessary to wash the waste
into the receiving space.
Ex. Pit latrines, Reed odorless earth closet Toilet facility requiring small amount of water
to wash the waste into the receiving space.
Ex. Pour flush toilet, Aqua privies

LEVEL II- on site toilet facilities of the carriage type with water-sealed and flushed type
with septic tank/vault disposal facilities
LEVEL III - water carriage types of toilet facilities connected to septic and/or to
sewerage system to treatment plant

FOOD SANITATION PROGRAM

FOUR RIGHTS IN FOOD SAFETY:
1. Right source
- always buy fresh meat, fish, fruits and vegetables
- check for expiry dates of processed foods
- avoid buying canned foods with dents, bulges, deformation, broken seals and
improper seams
- use clean and safe water
- if doubt of water source – boil water for at least 2 minutes
2. Right preparation
- avoid contact between raw and cooked foods
- always buy pasteurized milk and fruit juices
- wash vegetables well if eaten raw
- wash hands and kitchen utensils before and after preparing food
- sweep kitchen floors to remove food droppings
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts of the food should reach
70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT more than 2 hours
- store foods carefully: 4 -5 hours hot conditions: at least or above 60 degrees
centigrade cold conditions: below or equal to 10 degrees centigrade
- do not overburden the refrigerator
- reheat stored food before eating
-at least 70 degrees centigrade

Rule in Food Safety:

“WHEN IN DOUBT, THROW IT OUT”

DEPARTMENT OF HEALTH
VISION:
The DOH is the leader, staunch advocate and model in promoting Health for All in
the Philippines.

MISSION:
NEW- guarantee equitability, sustainability and quality of life for all Filipinos
especially for the poor and shall lead the quest for excellence in heath
OLD: ensure accessibility and quality of life, for all Filipinos especially the poor

GOAL: Health Sector Reform Agenda (HSRA)

Framework for implementation of HSRA: FOURmula ONE for Health
GOALS of FOURmula ONE for Health: (BEM)
1. Better health outcomes
2. Equitable health care financing
3. More responsive health systems

FOUR elements of the strategy:

• Health Care Financing
• Health regulation
• Health service delivery
• Good health governance
ROLES OF DOH (LEA)
1. Leadership in Health
2. Enabler and Capacity Builder
3. Administrator of specific services

PRIMARY HEALTH CARE (PHC)

according to the World Health organization is an essential health care made universally
accessible 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 can afford at
every stage of development

• The goal of PHC is health for all Filipinos and Health in the hands of the people by the
year 2020
• Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of PHC
• The first international conference on primary health care was held in Alma, Ata, USSR
on September 6-12, 1978 sponsored by the WHO and UNICEF
• The framework for meeting the goal of primary health care is organizational strategy,
it calls for among communities, private and government agencies with the end view of
health development

The four cornerstone/pillars in primary health care includes:

1. active community participation
2. intra and inter sectoral linkages
3. use of appropriate technology
4. support mechanism made available

EPIDEMIOLOGY
• Systematic and scientific study of the distribution patterns and determinants of health,
disease and condition for the purpose of promoting wellness and preventing disease
conditions
• Basic concepts that guide epidemiological study include: biostatistics, aggregate at
risk, the natural life history of a disease, levels of prevention, host-agent-environment
relationships, multiple causation, person-place-time-relationships
• When monitoring incidence of infectious disease, the term used to distinguish relative
frequency in time and space include the following:

Sporadic – presence of occasional cases of the disease

Endemic – constant long-term presence of the disease
Epidemic – presence of the disease at a much higher frequency over a short
period of time
Pandemic – presence of a disease in many countries in a relatively short
period of time