Phases of the COPAR Process

I. Pre-entry Phase

A. Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help.

B. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it.

Activities include:

1. Designing a plan for community development including all its activities and strategies for care development.

2. Designing criteria for the selection of site

3. Actually selecting the site for community care

II. Entry Phase

A. Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical
events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them
to take collective action on these.

B. This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following
guidelines however.

1. Recognizes the role of local authorities by paying them visits to inform them of their presence and activities.

2. The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of
their being role models.

3. Avoid raising the consciousness of the community residents; adopt a low-key profile.

III. Organization Building Phase

A. Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and
evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings (formal,
informal, OJT) to develop their skills and in managing their own concerns/programs.

IV. Sustenance and Strengthening Phase

A. Occurs when the community organization has already been established and the community members are already actively
participating in community-wide undertakings. At this point, the different communities setup in the organization building phase are
already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance
from the community-wide organization.

1. Strategies used may include:

a. Education and training

b. Networking and linkaging

c. Conduct of mobilization on health and development concerns

d. Implementing of livelihood projects

e. Developing secondary leaders

Community Organizing Participatory Research (COPAR)

[1]
Definitions of COPAR:

· A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and
politically responsive community.

· A collective, participatory, transformative, liberative, sustained and systematic process of building people’s organizations by
mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting
change in their existing oppressive and exploitative conditions (1994 National Rural Conference)

· A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in
doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967)

· A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing
condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to
develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems
(CO: A manual of experience, PCPD)

Importance of COPAR:

1. COPAR is an important tool for community development and people empowerment as this helps the community workers to
generate community participation in development activities.

2. COPAR prepares people/clients to eventually take over the management of a development programs in the future.

3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.
Principles of COPAR:

1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are
able to bring about change.

2. COPAR should be based on the interest of the poorest sectors of society

3. COPAR should lead to a self-reliant community and society.

COPAR Process:

· A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the
evaluation and the reflection of and on the action taken by them.

· Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges
from concrete action and which enriches succeeding action.

· COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and
oppressed.

· COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than
appointed or selected by some external force or entity.

Expended Program for Immunization (EPI)

Principles of EPI include:

1. Epidemiological situation

2. Mass approach

3. Basic Health Service

The 7 immunizable diseases are:

1. Tuberculosis

2. Diptheria

3. Pertussis

4. Measles

5. Poliomyelitis

6. Tetanus

7. Hepatitis B

Administration of vaccines:

Vaccine Content Form & Dosage # of Doses Route

BCG Live attenuated Freeze dried infant- 1 ID

bacteria 0.05ml

Preschool-0.1ml

DPT DT- weakened toxin liquid-0.5ml 3 IM

P-killed bacteria

OPV weakened virus liquid-2drops 3 Oral

Hepa B Plasma derivative Liquid-0.5ml 3 IM

Measles Weakened virus Freeze dried- 0.5ml 1 Subcutaneous

Schedule of Vaccines:

Vaccine Age at 1st dose Interval between dose Protection

BCG At birth

DPT 6 weeks 4 weeks DPT

OPV 6weeks 4weeks Poliomyelitis

Hepa B @ birth @birth,6th week,14th HepaB

week

Measles 9m0s.-11m0s. measles

6 months – earliest dose of measles given in case of outbreak

9months-11months- regular schedule of measles vaccine

15 months- latest dose of measles given

4-5 years old- catch up dose

Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti
measles.

Vaccine Minimum age interval % protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

TT4 1year later/during next 99% 10 years

pregnany

TT5 1 year later/third 99% Lifetime

pregnancy

There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or
cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately.

Malnutrition is not a contraindication for immunizing children rather, it is an indication for immunization since common childhood
diseases are often severe to malnourished children.

Cold Chain under EPI:

Ø Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant
woman.

Ø The allowable timeframes for the storage of vaccines at different levels are:

o 6months- Regional Level

o 3months- Provincial Level/District Level

o 1month-main health centers-with ref.

o Not more than 5days- Health centers using transport boxes.

Ø Most sensitive to heat: Freezer (-15 to -25 degrees C)

o OPV

o Measles

Ø Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celcius)

o BCG

o DPT

o Hepa B

o TT

Ø Use those that will expire first, mark “X”/ exposure, 3rd- discard,

Ø Transport-use cold bags, let it stand in room temperature for a while before storing DPT.

Ø Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.

FEFO (“first expiry and first out”) - vaccine is practiced to assure that all vaccines are utilized before the expiry date.

Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.

Herbal Medicines/Plants Approved by the DOH

Plant Name: Lagundi ( Vitex negundo)

 Uses & Preparation:
Asthma, Cough & Fever - Decoction ( Boil raw fruits or leaves
in 2 glasses of water for 15 minutes)Dysentery, Colds & Pain -
Decoction ( Boil a handful of leaves & flowers in water to
produce a glass, three times a day)

Skin diseases (dermatitis, scabies, ulcer, eczema) - Wash &

clean the skin/wound with the decoction
[1]
Headache - Crush leaves may be applied on the forehead

Rheumatism, sprain, contusions, insect bites - Pound the

leaves and apply on affected area

Plant Name: Yerba (Hierba) Buena ( Mentha cordifelia)

Uses & Preparation:

Pain (headache, stomachache) - Boil chopped leaves in 2
glasses of water for 15 minutes. Divide decoction into 2 parts,
drink one part every 3 hours.
Rheumatism, arthritis and headache - Crush the fresh leaves
and squeeze sap. Massage sap on painful parts with
eucalyptus
Cough & Cold - Soak 10 fresh leaves in a glass of hot water,
[2] drink as tea. (expectorant)
Swollen gums - Steep 6 g. of fresh plant in a glass of boiling
water for 30 minutes. Use as a gargle solution
Toothache - Cut fresh plant and squeeze sap. Soak a piece of
cotton in the sap and insert this in aching tooth cavity
Menstrual & gas pain - Soak a handful of leaves in a lass of
boiling water. Drink infusion.
Nausea & Fainting - Crush leaves and apply at nostrils of
patients
Insect bites - Crush leaves and apply juice on affected area or
pound leaves until like a paste, rub on affected area
Pruritis - Boil plant alone or with eucalyptus in water. Use
decoction as a wash on affected area.

Plant Name: Sambong ( Blumea balsamifera)

Uses & Preparation:

Anti-edema, diuretic, anti-urolithiasis - Boil chopped leaves in a
glass of water for 15 minutes until one glassful remains. Divide
decoction into 3 parts, drink one part 3 times a day.
Diarrhea - Chopped leaves and boil in a glass of water for 15
minutes. Drink one part every 3 hours.
[3]

Plant Name: Tsaang Gubat ( Carmona retusa)

Uses & Preparation:

Diarrhea - Boil chopped leaves into 2 glasses of water for 15
minutes. Divide decoction into 4 parts. Drink 1 part every 3
hours
Stomachache - Boil chopped leaves in 1 glass of water for 15
[4] minutes. Cool and strain.

Plant Name: Niyug-Niyogan ( Quisqualis indica L.)

Uses & Preparation:

Anti-helmintic - The seeds are taken 2 hours after supper. If no
worms are expelled, the dose may be repeated after one
week. (Caution: Not to be given to children below 4 years old)

[5]

Plant Name: Bayabas/Guava( Psidium guajava L.)

 Uses & Preparation:
For washing wounds - Maybe use twice a day
Diarrhea - May be taken 3-4 times a day
As gargle and for toothache - Warm decoction is used for
gargle. Freshly pounded leaves are used for toothache. Boil
chopped leaves for 15 minutes at low fire. Do not cover and
[6] then let it cool and strain

Plant Name: Akapulko( Cassia, alata L.)

Uses & Preparation:

Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) -
Fresh, matured leaves are pounded. Apply soap to the affected
area 1-2 times a day

[7]

Plant Name: Ulasimang Bato( Peperonica pellucida

Uses & Preparation:

Lowers uric acid (rheumatism and gout) - One a half cup
leaves are boiled in two glass of water over low fire. Do not
cover pot. Divide into 3 parts and drink one part 3 times a day

[8]

Plant Name: Bawang/Garlic

Uses & Preparation:

Hypertension - Maybe fried, roasted, soaked in vinegar for 30
minutes, or blanched in boiled water for 15 minutes. Take 2
pieces 3 times a day after meals.
Toothache - Pound a small piece and apply to affected area

[9]

Plant Name: Ampalaya

Uses & Preparation:

Diabetes Mellitus (Mild non-insulin dependent) - Chopped
leaves then boil in a glass of water for 15 minutes. Do not
cover. Cool and strain. Take 1/3 cup 3 times a day after meals

[10]

Steps in Making a Family Nursing Care Plan (FNCP)

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.

Formulating a family care plan [1] involves the following steps:

The prioritized condition/s or problems

The goals and objectives of nursing care

the plan of interventions

The plan of evaluating care

 [2]

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.

Facts about Breastfeeding

Why is breast-feeding important?

Breast milk is the healthiest food for babies and offers the most complete nutrition, such as antibodies to help
fight illness. With the exception of a daily vitamin D supplement, breast milk is the only source of nutrition
needed during the first 6 months of life. After 6 months, iron-fortified foods are gradually introduced as you
continue to breast-feed. All major professional medical organizations that focus on children, such as the
American Academy of Pediatrics (AAP), recommend breast-feeding for at least the first year of a baby’s life or
longer if desired. Your baby receives more health benefits the longer you breast-feed. Also, your breast milk
changes to meet your baby’s nutritional needs as he or she grows.

Breast-feeding helps your body recover from the stresses of pregnancy, labor, and delivery. It also lowers your risk for developing
breast cancer. The longer you breast-feed, the more this risk is reduced.

The first few weeks of breast-feeding typically are the most difficult. You are recovering from childbirth, adjusting to hormonal changes,
and operating with little sleep. Many women are also mentally and emotionally exhausted. Minor problems, such as sore or cracked
nipples, may seem overwhelming. However, most breast-feeding problems are easily prevented or solved. Overcoming these
challenges during these first few weeks boosts your confidence, which makes you more likely to continue breast-feeding for a full year.
Most women who persevere with breast-feeding have a great sense of accomplishment and recognize the importance of providing
their child with the best possible nutrition.

What are the benefits of breastfeeding?

Breastfeeding offers many benefits to the baby:

• Breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler.
• Breastfed infants, and those who are fed expressed breast milk, have fewer deaths during the first year and experience fewer
illnesses than babies fed formula.
• Some of the nutrients in breast milk also help protect an infant against some common childhood illnesses and infections, such as
diarrhea, middle ear infections, and certain lung infections.
• Some recent NICHD-supported research also suggests that breast milk contains important fatty acids (building blocks) that help an
infant’s brain develop. Two specific fatty acids, known as DHA and AA, may help increase infants’ cognitive skills. Many types of infant
formulas available in the United States are fortified with DHA and AA, and all formula available for preterm infants is fortified with these
fatty acids.

Breastfeeding also benefits the mother:

• In response to the baby’s sucking, the mother’s body releases a hormone that makes her uterus contract and get smaller.
• Many mothers also get emotional benefits from breastfeeding because of the closeness of this interaction with the baby and from
the satisfaction of helping to nourish their babies.
• Some research suggest that mothers who breastfeed their babies have fewer episodes of post-delivery depression.
• There is evolving evidence to indicate that certain types of cancer (such as breast, uterus, and ovarian cancer) occur less often in
mothers who have breastfed their babies.
• Many societies and cultures also encourage mothers to breastfeed, which can offer support to a new mother.

Breast milk

The exact properties of breast milk are not entirely understood, but the nutrient content of mature milk is relatively stable. Its
ingredients come from the mother’s food supply and the nutrients in her bloodstream at the time of feeding. If that is not enough,
nutrients come from the mother’s bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses
500–600 more calories a day just producing milk for her offspring. The exact composition of breast milk varies from day to day, and
even hour to hour, depending on both the manner in which the baby nurses and the mother’s food consumption and environment, so
the ratio of water to fat fluctuates.

Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates; hind milk, which is increasingly
released as the feed progresses, is creamier. There is no sharp distinction between foremilk and hind milk, the change is very gradual.
Research from Peter Hartmann’s group tells us that fat content of the milk is primarily determined by the emptiness of the breast—the
less milk in the breast, the higher the fat content. The breast can never be truly "emptied" since milk production is continuous.

Bonding

The hormones released during breastfeeding strengthen the mother’s nurturing feelings towards the child. Strengthening the maternal
bond is very important as up to 80% of mothers suffer from some form of postnatal depression, though most cases are very mild. The
woman’s partner and other caregivers can support her in a variety of ways and this support is an important factor in successful
breastfeeding. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.

Breastfeeding can have an impact on the personal relationship between a mother’s partner and the child. While some partners may
feel left out when the mother is feeding the baby, others see it as an opportunity for strengthening family bonds. Looking after a new
baby and breastfeeding takes time. This can add pressure to the partner and the family, because the partner has to care for the
mother as well as performing tasks she would otherwise do. However, as partners are often very willing to give this support, this
pressure can help to strengthen family bonds.

If the mother is away, an alternative caregiver may be able to use expressed breast milk (EBM) to feed the baby. The various breast
pumps available for sale and rent make it possible for working mothers to breastfeed their babies for as long as they want. However,
the mother must produce and store enough milk to feed the child for the time she is away and this may not always be practical. Also,
the other caregiver must be comfortable in handling breast milk. These two factors may prompt the mother - perhaps against her
wishes - to switch to artificial feeding, either temporarily or permanently.

Time and place for breastfeeding

Breastfeeding at least once every two to three hours helps to keep up the milk production. For most women, a target of eight
breastfeeding or pumping sessions every 24 hours keeps their milk production high It is common for newborn babies to feed more
often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day. Feeding a baby
on demand (sometimes referred to as "on cue"), which may mean breastfeeding many times more than the recommended minimum,
feeding when the baby shows early signs of hunger, is the best way to maintain milk production and ensure the baby’s needs for milk
and comfort are being satisfied. However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too
frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hind milk, potentially creating
problems.

Babies usually show they are hungry by waking up (newborns), mouthing their fists, moaning or fussing. Crying is a late indicator of
hunger. When babies’ cheeks are stroked, the rooting instinct makes them move their face towards the stroking and open their mouth.

Breastfeeding can make mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions
can last for up to an hour or more (there is no time limit for breastfeeding). Having water readily available helps mothers maintain
proper hydration.

Human Milk for Human Infants

The primary benefit of breast milk is nutritional. Human milk contains just the right amount of fatty acids, lactose, water, and amino
acids for human digestion, brain development, and growth.

Cow’s milk contains a different type of protein than breast milk. This is good for calves, but human infants can have difficulty digesting
it. Bottle-fed infants tend to be fatter than breast-fed infants, but not necessarily healthier.

Breast-fed babies have fewer illnesses because human milk transfers to the infant a mother’s antibodies to disease. About 80 percent
of the cells in breast milk are macrophages, cells that kill bacteria, fungi and viruses. Breast-fed babies are protected, in varying
degrees, from a number of illnesses, including pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections,
and German measles. Furthermore, mothers produce antibodies to whatever disease is present in their environment, making their milk
custom-designed to fight the diseases their babies are exposed to as well.

A breast-fed baby’s digestive tract contains large amounts of Lactobacillus bifidus, beneficial bacteria that prevent the growth of
harmful organisms. Human milk straight from the breast is always sterile, never contaminated by polluted water or dirty bottles, which
can also lead to diarrhea in the infant.
Human milk contains at least 100 ingredients not found in formula. No babies are allergic to their mother’s milk, although they may
have a reaction to something the mother eats. If she eliminates it from her diet, the problem resolves itself.

Sucking at the breast promotes good jaw development as well. Its harder work to get milk out of a breast than a bottle, and the
exercise strengthens the jaws and encourages the growth of straight, healthy teeth. The baby at the breast also can control the flow of
milk by sucking and stopping. With a bottle, the baby must constantly suck or react to the pressure of the nipple placed in the mouth.

Nursing may have psychological benefits for the infant as well, creating an early attachment between mother and child. At birth, infants
see only 12 to 15 inches, the distance between a nursing baby and its mother’s face. Studies have found that infants as young as 1
week prefer the smell of their own mother’s milk. When nursing pads soaked with breast milk are placed in their cribs, they turn their
faces toward the one that smells familiar.

Many psychologists believe the nursing baby enjoys a sense of security from the warmth and presence of the mother, especially when
there’s skin-to-skin contact during feeding. Parents of bottle-fed babies may be tempted to prop bottles in the baby’s mouth, with no
human contact during feeding. But a nursing mother must cuddle her infant closely many times during the day. Nursing becomes more
than a way to feed a baby; it’s a source of warmth and comfort.