CHN 1 lecture

Public Health Nursing

MARISSA S. FERNANDEZ, RN,MAN

 Overview:
 What is a community?
 = 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
 What is health?
 - Health-illness continuum
 - High-level wellness
 - Agent-host-environment
 - Health belief
 - Evolutionary-based
 - Health promotion
 - WHO definition
 What is community health?  
 = part of paramedical and medical intervention/ approach which is concerned on
the health of the whole population
 aims:
 1. health promotion
 2. disease prevention
 3. management of factors affecting health
 What is nursing?
 - assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness

 Public Health Nursing: the term used before for Community Health Nursing
 According to Dr. C.E. Winslow, Public Health is a science & art of 3 P’s :
 1. Prevention of Disease
 2. Prolonging life
 3. Promotion of health and efficiency through organized community effort
 What is Community Health Nursing?  
 “The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the
promotion of health, prevention of disease and disability and rehabilitation.”
 COMMUNITY HEALTH NURSING (CHN):
 = a specialized field of nursing practice
 = a science of Public Health combined with Public Health Nursing Skills and
Social Assistance with the goal of raising the level of health of the citizenry, to
raise optimum level of functioning of the citizenry (Characteristic of CHN).
 BASIC PRINCIPLES OF CHN:
 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.

 ROLES OF THE PUBLIC HEALTH NURSE:

 1. Clinician, who is a health care provider, taking care of the sick people at home
or in the RHU
 2. Health Educator, who aims towards health promotion and illness prevention
through dissemination of correct information; educating people
 3. Facilitator, who establishes multi-sectoral linkages by referral system
 4. Supervisor, who monitors and supervises the performance of midwives
 TARGET POPULATION (IFC) ARE:
 1. I ndividual
 2. F amily
 3. C ommunity

 3 Elements considered in CHN:

 1.# Science of Public Health (core foundation in CHN),
 2.# Public Health Nursing Skills
 3.# Social Assistance Functions
 OBJECTIVES OF PUBLIC HEALTH: (CODES )
 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 )

 1. I nformation: to share ideas to keep population group knowledgeable and aware
 2. E ducation: change within the individual
 3 Key Elements of Education:
 - K nowledge
 - A ttitude
 - S kills
 3. C ommunication: interaction involving 2 or more persons or agencies
 3 Elements of Communication:
 1. Message
 2. Sender
 3. Receiver
 PUBLIC HEALTH WORKERS (PHW) PHW’s: are members of the health team who
are professionals namely:
 1. Medical Officer (MO)-Physician
 2. Public Health Nurse (PHN)-Registered Nurse
 3. Rural Health Midwife (RHM)-Registered Midwife-
 4. Dentist
 5. Nutritionist
 6. Medical Technologist
 7. Pharmacist
 8. Rural Sanitary Inspector (RSI)-must be a sanitary engineer
 Health care delivery System:
 Philippine Department of Health:
 5 MAJOR FUNCTIONS:
 1. Ensure equal access to basic health services
 2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
 3. Ensure a minimum level of implementation nationwide of services regarded as
public health goods
 4. Plan and establish arrangements for the public health systems to achieve
economies of scale
 5. Maintain a medium of regulations and standards to protect consumers and guide
providers
 BASIC HEALTH SERVICES UNDER OPHS OF DOH:
 E ducation regarding Health
 L ocal Endemic Diseases
 E xpanded Program on Immunization
 M aternal & Child Health Services
 E ssential drugs and Herbal plants
 N utritional Health Services (PD 491): Creation of Nutrition Council of the
Phils.
 T reatment of Communicable & Non communicable Diseases S anitation of the
environment (PD 856): Sanitary Code of the Philippines
 D ental Health Promotion
 A ccess to and use of hospitals as Centers of Wellness
 M ental Health Promotion
 VISION:
 BY 2030 (DREAM OF DOH)
 = A Global Leader for attaining better health outcomes,
 = Competitive and responsive health care systems, and
 = Equitable health financing

 MISSION:
 To guarantee EQUITABLE, SUSTAINABLE and QUALITY health for all
Filipinos, especially the poor and to lead the quest for excellence in health.
 Principles to attain the vision of DOH
 1. Equity: equal health services for all-no discrimination
 2. Quality: DOH is after the quality of service not the quantity Philosophy of
DOH: “Quality is above quantity”
 3. Accessibility: DOH utilize strategies for delivery of health services

 HEALTH CARE DELIVERY SYSTEM:

 “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.”
 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:
 RHO (National Health Agency)
 - existing national agencies like PGH or
 - specialized agencies like Heart Center for Asia, NKI
 MHO & PHO (Municipal/Provincial Health Office)
 BHS & RHU (Barangay Health Station/Rural Health Unit)
 3 LEVELS OF HEALTH CARE
 1. Primary-prevention of illness or promotion of health
 2. Secondary-curative
 3. Tertiary-rehabilitative

 Referral System in Levels of the Health Care:

 " Barangay Health Station (BHS) is under the management of Rural Health Midwife
(RHM)
 " Rural Health Unit (RHU) is under the management or supervision of PHN
 " Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the
implementation of the policies and activities of RHU, directly under the supervision of
MHO (who acts as administrator)

 REFERRAL SYSTEM: BHS→ RHU→ MHO→ PHO→ RHO→ National

Agencies→ Specialized Agencies
According to Increasing Complexity of the Services
According to the Type of Service
Provided

Type Services Type Example

Primary Health Promotion, Health Promotion and Information Dissemination
Preventive Care, illness Prevention
Continuing Care for
common health
problems, attention to
psychological and
social care, referrals
Secondary Surgery, Medical
services by Specialists Diagnosis and Treatment Screening
Tertiary Advanced, specialized,
diagnostic, therapeutic Rehabilitation PT/OT
& rehabilitative care
 LEVELS OF PREVENTION
PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Illness Prevention of Complications Prevention of Disability, etc.
Prevention thru Early Dx and Tx

Provided at – - When hospitalization is deemed - When highly-specialized medical

- Health care/RHU necessary and referral is made to care is necessary
- Brgy. Health Stations emergency (now district), - Referrals are made to hospitals
- Main Health Center provincial or regional or private and medical center such as PGH,
- Community Hospital and hospitals PHC, POC, National Center for
Health Center Mental Health, and other gov’t
- Private and Semi-private private hospitals at the municipal
agencies level
 CHARACTERISTICS OF PHC
 1. Acceptable 4. Accessible
 2. Affordable 5. Available
 3. Sustainable 6. Attainable


 UTILIZES APPROPRIATE TECHNOLOGIES USED BY PHC: (ACCEFS)

 A ffordable, accessible, acceptable, available
 C ost wise=economical in nature
 C omplex procedures which provide a simple outcome
 E ffective
 F easibility of use=possibility of use at all times
 S cope of technology is safe & secure
 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

 4 CONTRIBUTIONS OF PHC TO DOH & ECONOMY:

 1. Training of Health Workers
 2. Creation of Botika sa Baryo & Botika sa Health Center
 3. Herbal Plants
 4. Oresol
 A. TRAINING OF HEALTH WORKERS
 3 Levels of Training:
 1. Grassroot/Village
 = Includes Barangay Health Volunteers (BHV) and Barangay Health Workers
(BHW)
 =Non professionals, didn’t undergo formal training, receive no salary but are
given incentive in the form of honorarium from the local government since 1993
 2. Intermediate - these are professionals including the 8 members of the PHWs
 3. First Line Personnel - the specialist
 B. 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)
 Co-Trimoxazole:
 = it’s a combination of 2 generics of drugs which is antibacterial
 - Trimethoprim(TMP) - Has a bacteriostatic action that stops/inhibits
multiplication of bacteria !For GUT, GIT & URTI (TMP combined with SMX)
 - Sulfamethoxazole (SMX) - Has bactericidal action that kills bacteria !For
GUT, GIT, URTI & Skin Infections
 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
 TB DRUGS: Rifampicin (RIF) Isoniazid (INH) Pyrazinamide (PZA)
 Paracetamol Has an analgesic & anti-pyretic effect
 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
 Oresol: a management for diarrhea to prevent dehydration under the Control of Diarrheal
Diseases (CDD) Program
 Nifedipine: !An anti-hypertensive drug !According to DOH, 16% of population belonging
to 25 years old & above in the community are hypertensive
 C. 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
 C. 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
 POLICIES TO ABIDE:
 - Know indications
 - Know parts of plants with therapeutic value: roots, fruits, leaves
 - Know official procedure/preparation
 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
 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 Bicarbonate/NaHCO3 2.5 grams Buffer content of solution Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle contractility especially
the heart & GIT

 PREPARATION OF PROPER HOMEMADE ORESOL

 A volume or one liter homemade oresol Smaller volume or a glass homemade oresol

Water 1000 ml. or 1 liter 250 ml

Sugar 8 teaspoon 2 teaspoon
Salt 1 teaspoon ! teaspoon or a pinch of salt=10-12 granules of rock
salt: iodized salt=tips of thumb & index finger are
penetrated with salt