SCOPE OF NURSING LICENSURE EXAMINATION (NLE)

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing

Practice I)
NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE I
TEST DESCRIPTION: Theories, concepts, principles and processes basic to
the practice of nursing with emphasis on health promotion and health
maintenance. It includes basic nursing skills in the care of clients across age
groups in any setting.
Moreover, it encompasses the varied roles, functions and responsibilities of
the professional nurse in varied health care settings.
TEST SCOPE:
I. Personal and Professional Growth and Development

A. Historical Perspective in Nursing

HISTORICAL FOUNDATION OF NURSING

The Four Great Periods of Nursing

1. INTUITIVE NURSING
*This untaught nursing was instinctive.
*Dated from pre-historic times.
*Practice among primitive tribes and lasted through Christian era.
*Performed out of feeling of compassion to others.
*Out of wish to do good- HELPING

2. APPRENTICE NURSING
*Extends from the founding of religious orders in the 6th century through
the crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established
by pastor Fliedner and his wife.
*Period of on the job training- desired of person to be trained

3. EDUCATED NURSING
*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas in
London.
First program of formal education for nurses started.

4. CONTEMPORARY NURSING
*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes
occurs.
INTUITIVE NURSING
*Cause of illness was believed to be the invasion of the victims body by an evil
spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural
power.
*Believed in medicine man (shaman or witch doctor) that had the power to
heal by using white magic.
They made use of hypnosis, charms, dances, incantations, purgatives,
massage,fire, water, herbs or other vegetations and even animals.
*Performing a trephine
Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
Goal of this therapy is to drive the evil spirit from the victims body.
*Nurses role was instinctive directive toward comforting, practicing midwifery
and being wet nurse to a child.
*Act performed without training and direction.

Babylonia
*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time

Egypt
*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of
250 recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged
physicians was Imhotep.
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses 5th book is a midwife and wet nurse.

Palestine
*The Hebrews book of genesis emphazised the teachings of Judaism
regarding hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-cleanliness
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.
China
*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of
treating wounds, infection and muscular afflictions.
*Chan Chun Ching Chinese Hippocrates.
*Emperor Shen Nung said to be the father of Chinese medicine and the
inventor of acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the
sick will fall to the female members of the household.

India
*First recorded reference to the nurses taking care of patients on the writings
of shushurutu.
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals
throughout India where nurses were employed.

Greece
*Made contribution in the area aesthetic arts and clinical medicine, but nursing
was the task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we
associate the Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine insisted that magic and philosophical
theories had no place in medicine.
*The work of women was restricted to the household. Where mistress of the
mansion gave nursing care to the sick slaves.

Rome
*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine First aid, field ambulance service and hospitals
for wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used
in medicine ever since.

APPRENTICE NURSING
*Religious orders of Christian Church played a major role in this kind of
nursing.

The Crusades (11th Century)

*Series of holy wars were conducted by Christian in an attempt to recapture
the Holy land from the Turks.
*Military religious orders founded during the crusades established hospitals
and staffed them with men who served as nurses. Among these were:
- The knights of St. John of Jerusalem served both as warriors in battle
and nurses in the hospital and was called Knights Hospitallers.
- The Teutonic Knights built hospitals cared for sick and denfended the
faith.
- The Knights of St. Lazarus established primarily for the nursing of
lepers, forerunners of our now known communicable diseases hospital (also
called lazarettos).

The Rise of Religious Nursing Orders

* The Regular Orders established monasteries to house travelers, paupers
and patient under one roof. Later as society became better organized
hospitals tended to become separate institutions apart from monsteries.
*The Secular Orders developed for the primary purpose of nursing; were
similar to the regular orders by their temporary vows, uniformity in dress and
religious observation.
*The Nursing Orders definitely organized. The sisters advanced the stage
of probationer to wearing the white robe to receiving the hood; They were all
under the superintendent of nurses or director of nursing; later adopted a
uniform dress that eventually became entirely standardized.

Nursing Saints
* St. Hildegarde a Benedictine abbess in Germany, actually prescribed
cures in her 2 books on medicine and natural history.
* St. Francis and Clara took vows of poverty, obedience, service and
chastity and took care of the sick and the afflicted; founders of the Franciscan
Order and the Order of the Poor Clares respectively.
* St. Elizabeth of Hungary the patroness of nurses; built a hospital for the
sick and the needy.
* St. Catherine of Siena the 1st lady with a lamp; became a tertiary of
St. Dominic and engaged in works of mercy among the sick and of the Church.

The Reformation
* St. Vincent de Paul set up the first program of social service in France and
organized the Community of the Sisters of Charity. His 1st superior and
co-founder was Louise de Gras (nee de Marillac).

The Intellectual Revolution (17th Century)

 Characterized by the development of natural science, medicine, arts and as
well as interest in human beings and their welfare. Among the leaders for
reform were:
* St. John of God founder of the Brother Hospitallers and declared the
patron of all hospitals and sick folk by Pope Leo XIII in 1930.
* George Fox founder of the sect known as the Soicety of Friends (Quakers)
who advocated equality of men and women, thus making it easier for women
to become active in Nursing.
* John Howard introduced prison reforms (fresh air and plenty of water).
* Philippe Pinel introduced his modern open-door treatment of the mentally
ill.
* Elizabeth Fry greatly improved prison conditions by developing work fo the
prisoners and the segregations of sexes, later established the Insitute of
Nursing sisters, the first organization of women to be trained as private duty
nurse.
* Mother Mary Catherine MccAuley founder of the Order of the Sisters of
Mercy, 2nd largest of the Roman Catholic Orders.
* Theodor Fliedner and his wife Friederike Mumster established the Institute
of Kaisserwerth on the Rhine for the practical training of Deaconesses (1836),
which is considered as the 1st Organized training school for nurses. It was
here where Florence Nightingale received some of her training and the
inspiration for the establishment of her school of nursing. Some of its features
includes:
1. A rotating 3 year experience in cooking and housekeeping, laundry and
linen and nursing care in the womens and mens wards; and
2. A preliminary and probationary 3 months period of trial and error for both
school and student.

The Dark Period of Nursing (17th 19th Century)

* Many hospitals were closed; the wealth took care of their sick at home; the
indigent sick were taken care of by uneducated, illiterate women who had no
background for nursing.
* Charles Dickens in his book entitled Martin Chuzzleswit published the selfish
and cruel conduct of 2 private duty nurses namely Sairey Gamp and Betsy
Prig.

THE PERIOD OF EDUCATED NURSING

England
* June 15, 1860 marked the day when 15 probationers entered St. Thomas
Hospital in London to establish the Nightingale system of Nursing,
founded by Florence Nightingale (May 12, 1820). Among the highlights in
her life are the following:
 - At age of 31, obtained parental consent to enter the Deaconess School
at Kaisserwerth.
- Had 3 months training at Kaisserwerth; later superintendent of the
Establishment for Gentlewomen During Illness (1853) during which time she
initiated the policy of admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women
at Scutari in the Crimea upon the request of Sir Sidney Herbert, Minister of
War in England. At first their work is not accepted because it consisted of
cleaning the area, thus reducing the infections, clothing for the men, writing
letters to their families; their work served as inspiration for the Red Cross later
on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas
Hospital in London believed that schools should be self-supporting; that
schools of nursing should have decent living quarters for their student; that
they should have paid nurse instructors; that the school should correlate theory
to practice and these students should be taught the why not just how in
nursing.
- 2 books written Note on Nursing and Notes on Hospital, contain many
timely portions applicable in the 1970s as they were in 1859.

United States
* At the time that Florence Nightingale was opening her school in London; the
U.S was on the brink of the civil war. However though the country was in a
condition of chaos, nursing had many supporters and the needs to train nurses
were recognized.
- Linda Richards is the first graduate nurse in the U.S completed her
training at the New England Hospital for Women and Children in Boston,
Massachusetts, patterned after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan
the Bellevue Training School for Nurse in the New York City , the
Connecticut training. School in New Haven and the Massachusetts General
Hospital in Boston.
- In 1881 founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel
Hampton Robb as its 1st principal and the person most influential in directing
the development of nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing
organization was lad:
1. The Associated Alumnae, later known as the American Nurses
Association was begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses,
later known as the National League for Nursing Education, also began.
 - During the Spanish American War (1898 1899) nurse were concerned
with the care of the wounded as well as care of those inflected with malaria
and yellow fever.
Nurse Clara Louise Maas gave her life for the advancement of medical
science in the search for control yellow fever.

The 20th Century

*In 1900 1912
- advancement in hospital nursing, private duty nursing, public health
nursing, school nursing, government service and pre-maternal nursing;
- there was a growing awareness for the preventive measures that could
be uses to maintaing the heath of the nation;
- There was beginning specialization in medicine.

* 1913 1937
- a standard curriculum for schools of nursing was prepared by the
National League for Nursing Education.
- the practice of nursing was gradually infiltrated with educational
objectives.

* Worl War I (1917 1918)

- Private duty nurses were now nursing in the hospitals rather than in
homes.
- Opening of more nursing schools as a result of the construction of more
hospitals.
- Increase demand for public health nurse for preventice aspects of care.
- Awareness of the need for military ranking among nurses for which a bill
was later introduced and passed.
Julia Stimson was the first woman to hold rank of major.

* World War II (1942 1945)

- the start of Aero-medical nursing (flight nursing)
- Creation of the U.S Cadet Nurses Corps with Mrs. Lucille Ptery Leone as
director and later the 1st woman to serve as assistant surgeon of the U.S
public Health Service.
- granting of permanent commissioned rank for both army and navy
nurses.
- the concept of family centered care as methods to help patient help
themselves.
- concept of psychosomatic medicine and early ambulation.
- consept of creative nursing, which has necessitated the need for
laundering definitive studies of all aspects of nursing thus helping to raise the
standards to a professional level.
CONTEMPORARY NURSING
* Creation of United Nations in San Francisco California in 1945.
2 folds purpose are:
- International peace and international security with provisions for equal
justice,
Machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic
progress.

World Health Organization (WHO)

- Special agency of U.N, established in Geneva, Switzerland in 1948
- providing health information in fighting diseases and improving the
nutrition, living standards and environmental conditions of all people.
- Scientific and Technical Research used in disease prevention and health
care.
- Social Force affecting Nursing Legislation, prepared health care,
technology efficiency and nursing involvement with minority groups.

NURSING IN THE PHILIPPINES

Early Care of the Sick

* Early life of Filipinos had been more or less mixed with superstitious belief.
- believed in the powers of witch.
- belief in the powers of herbolarios (albularyo)
* Hospitals existed as early as 15th Century, which were established by the
religious and also by Spanish administration.
* Franciscan Order is more than any other religious group. Among their early
hospitals are:

The Earliest Hospitals Established were the following:

HOSPITAL REAL de MANILA (1577) established primarily for kings
soldiers and Spanish civilians. Founded by Gov. Francisco de Sande.
SAN LAZARO HOSPITAL (1578) exclusively for the service of leprous
patients. Named after San Lazaro, patron saint of lepers. Founded by
Brother Juan Clemente.
HOSPITAL de INDIOS (1586) established by the Franciscan Order: offered
general services, supported purely by alms and contributions from charitable
persons.
HOSPITAL de AGUAS SANTAS (1590) convalescent hospital in Pansol,
Laguna; this was near medicinal spring, which cured several patients.
Founded by Brother J. Bautista of the Franciscan Order.
SAN JUAN de DIOS HOSPITAL (1596) founded by brotherhood of
misericordia; administered by the hospitallers of San Juan de Dios.
HOSPITAL de DULAC (1602 1603) located in Paco and existed only for 1
year.
HOSPITAL de NUEVA CACERES (1655) general hospital located in Bicol.
HOSPITAL de CONVALENSCECIA (1656) estimated by the Brotherhood of
San Juan de Dios on the little island on the Pasig River, where the Hospicio de
San Jose now stands; patients of San Juan de Dios Hospital who were in the
convalescent stage were sent there for their complete recovery.
HOSPITAL de ZAMBOANGA (1842) this is a governement military hospital
run and finance by Spanish governement.
HOSPITAL de CAVITE (1842) a general hospital estimated and managed
by Brotherhood of San Juan de Dios.
HOSPITAL de SAN GABRIEL (1866) exclusively for Chinese patients .

*Fray Juan Clemente was one of the 1st members of the Mission of the
Order of St. Francis in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he
filled with various medical remedies.
- Performed both the function of a physician and those of a nurse.
*Persons who really did nursing care of the sick were religious group (called
hospitallers) but they were assisted by Filipino attendants.
*In the early development of nursing, the work of the nurse and those of the
physician were not clearly defined.

Nursing Service during the Philippine Revolution

* The women during the Philippine revolutions took active part in nursing the
wounded soldier. They dress wounds, alleviate pains, prepared food and gave
comfort even without previous trainings.
* These were the prominent women who volunteered and gave nursing
service.
Josephine Bracken wife of Jose Rizal Installed a field hospital in an estate
house in tejeros, Provided nursing care to the wounded night and day.
Mrs. Rosa Sevilla de Alvaro volunteered her service for the wounded
soldier at age of 18; he work hand in hand with Dona Hilaria de Aguinaldo and
they led other Filipino women to form the Filipino Red Cross in 1899.
converted their house into quarters for the Filipino soldier, during the Philippine
American war that broke out in 1899.
Dona Hilaria de Aguinaldo wife of Emilio Aguinaldo; Organized the Filipino
Red Cross under the inspiration of Apolinario Mabini.
Dona Maria de Aguinaldo second wife of Emilio Aguinaldo. Provided
nursing care for the Filipino soldier during the revolution. President of the
Filipino Red Cross branch in Batangas.
Melchora Aquino (Tandang Sora) Nurse the wounded Filipino soldiers and
gave them shelter and food.
Captain Salome A revolutionary leader in Nueva Ecija; provided nursing
care to the wounded when not in combat.
Agueda Kahabagan Revolutionary leader in Laguna, also provided
nursing services to her troop.
Trinidad Tecson Ina ng Biac na Bato, stayed in the hospital at Biac na
Bato to care for the wounded soldier.

* The Filipino Red Cross had its own constitution approved by the
revolutionary government. This was founded on February 17, 1899 with
Dona Hilaria Aguinaldo as president and Dona Sabina Herrera as secretary.

The Rise of Hospital and Nursing Schools

*The need for hospitals, dispensaries and laboratories led to the
establishement of the Board of Health in July 1901;
*A small dispensary in Manila opened for civil officers and employees, called
Civil Hospital.
*The need for doctors and nurses to help eradicate the epidemics of cholera
and smallpox led to the employment of U.S physicians and graduate nurses.
*In 1906 the idea of training Filipino girls to become nurses intiated the growth
of nursing schools.
1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
- It was ran by the Baptist Foreign Mission Society of America.
- Miss Rose Nicolet, a graduate of New England Hospital for woman
and children in Boston, Massachusetts, was the first superintendent.
- Miss Flora Ernst, an American nurse, took charge of the school in
1942.

2. St. Pauls Hospital School of Nursing (Manila, 1907)

- The hospital was established by the Archbishop of Manila, The Most
Reverend Jeremiah Harty, under the supervision of the Sisters of St.
Paul de Chartres.
- It was located in Intramuros and it provided general hospital services.
-First trained nursing student graduated after 3 years.
-No standard requirements for admission except willingness to work.

3. Philippine General Hospital School of Nursing (1907)

- In 1907, with the support of the Governor General Forbes and the
Director of Health and among others, she opened classes in nursing
under the auspices of the Bureau of Education.
- Anastacia Giron-Tupas, was the first Filipino to occupy the position of
chief nurse and superintendent in the Philippines, succeeded her.
4. St. Lukes Hospital School of Nursing (Quezon City, 1907)
- The Hospital is an Episcopalian Institution. It began as a small
dispensary in 1903. In 1907, the school opened with three Filipino girls
admitted.
- Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses.

5. Mary Johnston Hospital and School of Nursing (Manila, 1907)

- It started as a small dispensary on Calle Cervantes (now Avenida)
- It was called Bethany Dispensary and was founded by the Methodist
Mission.
- Miss Librada Javelera was the first Filipino director of the school.

6. Philippine Christian Mission Institute School of Nursing.

- The United Christian Missionary of Indianapolis, operated Three
schools of Nursing:
1. Sallie Long Read Memorial Hospital School of Nursing (Laoag,
Ilocos Norte,1903)
2. Mary Chiles Hospital School of Nursing (Manila, 1911)
3. Frank Dunn Memorial Hospital

7. San Juan de Dios Hospital School of Nursing (Intramuros, Manila,

1913)
- Was destroyed during the war with a new hospital built along Dewey
Boulevard.

8. Emmanuel Hospital School of Nursing (Capiz, 1913)

9. Southern Island Hospital School of Nursing (Cebu, 1918)

- The hospital was established under the Bureau of Health with
Anastacia Giron-Tupas as the organizer.

10. Zamboanga general Hospital School of Nursing (1921)

11. Chinese General Hospital School of Nursing (1921)

12. Baguio General Hospital School of Nursing (1923)

13. Manila Sanitarium and Hospital School of Nursing (1930)

14. Quezon Memorial Hospital School of Nursing (1957)

15. North General Hospital School of Nursing (1946)

16. Siliman University School of Nursing (Dumaguete, 1947)

17. Occidental Negros Provincial Hospital School of Nursing (1946)

18. Cebu (Velez) General Hospital School of Nursing (1951)

19. Brokenshire School of Nursing (Nueva Ecija, 1960)

20. De Ocampo Memorial School of Nursing (1954)

21. Marian School of Nursing (1960)

22. St. Rita Hospital and School of Midwifery (1956) and Nursing (1960)

Advantages of University Hospitals over Hospital Schools of Nursing:

1. students are treated as students and not as employees.
2. adequate financial support.
3. The head of the school is responsible only for the education of students
in nursing and;
4. The environment for the university school of nursing school education.

The First Colleges of Nursing in the Philippines

a. University of Santo Tomas .College of Nursing (1946)
- The first basic collegiate school for Nursing in the Philippines.
b. Manila Central University College of Nursing (1948)
c. University of the Philippines College of Nursing (1948). Ms.Julita
Sotejo was its first Dean
d. Southwestern College College School of Nursing (Cebu, 1947)
e. Philippine Union College of Nursing (1947)
f. Central Philippine College of Nursing (1947)
g. Siliman University College of Nursing (1947)
h. Philippine Womens University College of Nursing (1951)
i. FEU Institute of Nursing (1955)
j. UE College of Nursing (1958)
k. Saint Paul College of Nursing (Manila, 1958)

Nursing Leaders in the Philippines

*Anastacia Giron-Tupaz First Filipino nurse to hold the position of Chief
Nurse Superintendent; Founder of PNA (Philippine Nurses Association)
*Cesaria Tan First Filipino to receive a masters degree abroad.
*Socorro Sirilan Pioneered in Hospital Social Service in San Lazaro
Hospital where she was the Chief Nurse.
*Rosa Militar Pioneered in School Health Education.
*Sor Ricarda Mendoza Pioneer in Nursing Education.
*Socorro Diaz First Editor of the PNA magazine called The Message
*Conchita Ruiz First full-time editor of the PNA magazine called The
Filipino Nurse.
*Loreta Tupaz Dean of the Philippine Nursing, regarded as the Florence
Nightingale of Iloilo.
Some Highlights in the History of Nursing in the Philippines
*1906 at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo
City, 4 women started training in nursing; 3 female graduated in 1909 as
Qualified Surgical and Medical Nurses.
*1907 19 students admitted to a preliminary course in nursing as the
Philippine Normal College.
*1909 A nursing school was established under the Bureau of Education by
Authority of Act No. 1931.
*1910 Act No. 1975 recognized the school under the Bureau of Health. The
school continued as one of the activities of the newly opened Philippine
General Hospital and became known as the Philippine General Hospital
School of Nursing.
*1915 Act No. 2468 authorized the granting of the titles of graduate in
nursing and graduate in midwifery to nursing midwifery students of the
PGHSN.
- Public Health Nursing in the Bureau of Health began in accordance with
Act No. 2468.
*1919 Act No. 2808 (Nurses Law) was passed, enacted regulating the
practice of the nursing profession in the Philippines Islands.It also provided the
holding of exam for the practice of nursing on the 2nd Monday of June and
December of each year. This act was later amended in 1922, 1933 and 1950.
*1920 1st Board Examination for Nurse was conducted by the Board of
Examiners, 93 candidates took the exam, 68 passed with the highest rating of
93.5% - Anna Dahlgren.
- theoretical exam was held at the UP Amphitheater of the College of
Medicine and Surgery. Practical Exam at the PGH Library.
*1922 Filipino Nurses Association was established (now PNA) as the
National Organization of Filipino Nurses.
First President Rosario Delgado
Founder Anastacia Giron-Tupas
*1924 A standard curriculum for school of Nursing was published by the
PNA.
*1948 UP College of Nursing was established.
- First attempt to offer a 4 year basic nursing course leading to a B.S
Nursing Degree
- The 1st attempt to elevate nursing as profession by enriching and
broadening the preparation of nurses and by educating them in a University
Setting.
- The idea was conceived by Julita V. Sotejo, a Nurse and Lawyer, who
later became the 1st Dean of the School.
- A program was opened for graduate of the 3 year hospital nursing
course to obtain a B.S Nursing Degree at the U.P College of Nursing. This
program ended in 1975.
*1951 Republic Act 649 provided for the standardization of nurses salaries
both in institution and in public health.
*1953 Republic Act No. 877 (Nursing Practice Law) was approved. Minor
revisions were incorporated in 1957, 1966 1970 and 1972.
*1955 The UPCN offered a Master of Arts in (Nursing) Degree program to
prepare BSN holders of demonstrated competence and scholarship for senior
positions in nursing and to encourage nursing research.
- A one-year course leading to a certificate of Public Health Nursing was
opened at the UPCN. This program ended in 1969.
*1965 The Academy of Nursing of the Philippines (ANPHI) approved its
constitution.
- Among its objectives are initiate, promote, sponsor, encourage, and/or
conduct nursing studies and research, and to serve as a medium of exchange
through conference, seminar, institute and workshops.
*1966 R.A 4704, amending R.A 877 was approved.
*1968 A movement toward accreditation of Nursing Schools in the
Philippines was started.
*1970 WHO started an ongoing project in nursing education on family
planning to prepare faculty members to introduce family planning in basic
nursing curricula.
- R.A 6136 amending R.A 877 and 4704 was approved.
*1972 A national seminar on Public Health Nursing Education was held with
WHO technical assistance.
*1975 A national seminar on Public Health Nursing Education was held with
WHO technical assistance.
*1975 A National Health Plan was formulated.
- It redefined the functions and responsibilities of nurses and other health
workers with implication for Nursing Education and Community Health Nursing.
- The Psychiatric-Nursing Specialists, Inc. (PNSI), the 1st independent
Nurse Practitioners groups, was established.
*1976 A National Workshop on the Proposed Nurse-Midwife Curriculum of
Schools of Nursing in the Ministry of Health was sponsored by the Ministry.
The Workshop drafted an experimental 4-year Nurse-Midwifery curriculum.
*1977 ILO convention 149 and recommendations 157, concerning the
employment of Nursing Personnel and the conditions of their life and work,
were adopted in Geneva.
*1978 The Declaration of the Economic and School Welfare of Filipino
Nurses was passed by the PNA.
*1979 The 1st National Nurse Congress was held, its theme Nursing Issues
in the 80s.
- The 1st National Tripartite Conference on employment and conditions
of life and work of Nursing and other Health Personnel was held.
- Labor, management and government were involved.
*2002 Philippine Nursing Act of 2002 (R.A 9173)
1. Nursing Leaders
Florence Nightingale (1820-1910)
-recognized as nursings first scientist-theorist for her work, Notes on
Nursing: What It is, and What It is Not
-considered the founder of modern nursing.
-developed the Nightingale Training School of Nurses, which operated
in 1860. The scchool served as a model for other training schools. Its
graduates traveled to other countries to manage hospitals and institute
nurse-training programs.
-Nightingales vision of nursing, which include public health and healt
promotion roles for nurses, was only partially addressed in the early
days of nursing. The focus tended to be on developing the profession
within hospitals.
Clara Barton (1812-1921)
-organized the American Red Cross, which linked with the
International Red Cross when the U.S Congress ratified the Geneva
Convention in 1882.
Lilian Wald (1867-1941)
-considered the founder of Public Health Nursing.
Lavinia L. Dock (1858-1956)
-active in the protest movement for womens right that resulted in the
U.S Constitution amendment in 1920, allowing women to vote.
Margaret Sanger (1879-1966)
-a nurse activist; considered the founder of planned Parenthood, was
imprisoned for opening the first birth control information clinic in
Baltimore in 1916.
Lydia Hall
-developed the Care, Core, and Cure Theory
-Goal: To Care, and Cure Cores disease.
-Care for the patients BODY. Cure the DISEASE. Treat the PERSON (
or patient) as the Core.

B. Nursing as a Profession
NURSING AS A PROFESSION

Profession is a calling that requires special knowledge, skill and

preparation.
An occupation that requires advanced knowledge and skills and that it grows
out societys needs for special services.

Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its memebers and make it possible to practice effectively.
Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well
as a basic liberal foundation.
2. A profession has a theoretical body of knowledge leaing to defined skills,
abilities and norms.
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profesion has a code of ethics for practice.

NURSING
- is a desciplined involved in the delivery of health care to the society.
- is a helping profession.
- is service-oriented to maintain health and well-being of people.
- is an art and science.

NURSE originated from a Latin word NUTRIX, to nourish.

Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as
physiological, psychological, and sociological organism.
4. Nursing is committed to promoting individual, family, community, and
national health goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard
to color, creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in
the delivery of health care.

Personal Qualities of a Nurse:

1. Must have a Bachelor of Science degree in Nursing.
2. Must be physically and mentally fit.
3. Must have a license to prac tice nursing in the country.

- A professional nurse therefore, is a person who has completed a basic

nursing education program and is licensed in his country to practice
professional nursing.

Roles of a Professional

1. Caregiver/Care provider
- the traditional and most essential role.
- functions as nurturer, comforter, provider.
- mothering actions of the nurse.
- provides direct care and promotes comfort of client.
- activities involves knowledge and sensitivity to what matters and what is
important to clients.
- show concern for client welfare and acceptance of the client as a person.

2. Teacher
- provides information and helps the client to learn or acquire new knowledge
and technical skills.
- encourages compliance with prescribed therapy.
Promotes healthy lifestyle.
- interprets information to the client.

3. Counselor
- helps client to recognize and cope with stressful psychologic or social
problems; to develop an improve interpersonal relationships and to promote
personal growth.
- Encourages the client to look at alternative behaviors recognize the choices
and develop a sense of control.

4. Change agent
- initiate changes or assist clients to make modifications in themselves or in the
system of care.

5. Client advocate
- involves concern for and actions in behalf of the client to bring about a
change.
- promotes what is best for the client, ensuring that the clients needs are met
and protecting the clients right.
- provides explanation in clients ;anguage and support clients decisions.

6. Manager
- makes decisions, coordinates activities of others, allocate resource evaluate
care and personnel.
- plans, give direction, develop staff, monitor operations, give the reward fairly
and represent both staff and administrations as needed.

7. Researcher
- participates in identifying significant researchable problems.
- participates in scientific investigation and must be a consumer of research
findings.
-must be aware of the research process, language of research, a sensitive to
issues related to protecting the rights of human subjects.
Expanded role as of the Nurse

1. Clinical Specialists
- is a nurse who has completed a masters degree in specialty and has
considerable clinical expertise in that specialty. She provides expert care to
individuals, participates in education health care professionals and ancillary,
acts as a clinical consultant and participates in research.

2. Nurse Practitioner
-is a nurse who has completed either as a certificate program or a masters
degree in a specialty and is also cerified by the appropriate specialty
organization. She is skilled at making nursing assessments, performing P.E.,
counselling, teaching and treating minor and self-limiting illness.

3. Nurse-Midwife
- a nurse who has completed a program in midwifery; provides prenatal and
postnatal care and delivers babies to woman with uncomplicated pregnancies.

4. Nurse Anesthetist
- a nurse who completed the course of study in an anesthesia school and
carries out pre-operative status of clients.

5. Nurse Educator
- a nurse usually with advanced degree, who beaches in clinical or educational
settings, teaches theoretical knowledge, clinical skills and conduct research.

6. Nurse Entrepreneur -
- a nurse who has an advanced degree, and manages health-related business.

7. Nurse Administrator
- a nurse who functions at various levels of management in health settings;
responsible for the management and administration of resources and
personnel involved in giving patient care.

Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing a nurse working in an institution with

patients.
Example: rehabilitation, lying-in, etc.

2. Public Health Nursing/Community Health Nursing usually deals with

families and communities. ( no confinement, OPD only ).
Example: brgy, Health Center.
3. Private Duty/Special Duty Nurse privatey hired.

4. Industrial/Occupational Nursing a nurse working in factories, office,

companies.

5. Nursing Education nurses working in school, review center and hospital

as a C.I.

6. Military Nurse nurses working in a military base.

7. Clinic Nurse nurses working in a private and public clinic.

8. Independent Nursing Practice private practice, BP monitoring, home

service.
- Independent Nurse Practtioner.

Nursing Theory and Theorists

4 Essential concepts common among nursing theories:

- Individual
- Health
- Environment
- Nursing

FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY

- Defined Nursing: The act of utilizing the environment of the patient to
assist him in his recovery.
- Focuses on changing and manipulating the environment in order to put the
patient in the best possible conditions for nature to act.
- Identified 5 environmental factors: fresh air, pure water, efficient drainage,
cleanliness/sanitation and light/direct sunlight.
- Considered a clean, well-ventilated, quiet environment essential for recovery.
- Deficiencies in these 5 factors produce illness or luch of health but with a
nurturing environment, the body could repair itself.

DOROTHEA OREMS SELF-CARE THEORY

- Defined Nursing: The act of assisting others in the provision and
management of self-care to maintain/improve human functioning at home
level of effectiveness.
- Focuses on activities that adult individuals perform on their own behalf to
maintain life, health and well-being.
-Has a strong health promotion and maintainance focus.
C. Theoretical Foundation of Nursing Applied in Health Care Situations
THEORETICAL FOUNDATION OF NURSING
I. Philosophy
Specifies the definition of the metaparadigm concepts (person, environment,
health, and nursing) in each of
the conceptual models of nursing.
Sets forth meaning through analysis, reasoning, and logical argument. It
provides a broad understanding and
direction.

Florence Nightingale - Modern Nursing; Environmental Theory

*Disease is a reparative process, and that the manipulation of the environment
- ventilation, warmth, light, diet, cleanliness, and noise - would contribute to the
process and health of the patient.
*Did not agree with the germ theory of disease although she accepted the ill
effects of contamination from organic materials from the patients and the
environment hence found sanitation as important.
*Also renowned for pioneering statistical analysis of healthcare.

Ernestine Wiedenbach - Helping Art of Clinical Nursing

* nursing is nurturing or caring for someone in a motherly fashion.
*Proposed that nurses identify patients need-for-help by:
o Observing behaviors regarding comfort.
o Exploring meanings of the behavior.
o Knowing the cause of discomfort.
o Knowing if they can solve on their own or need help.

Virginia Henderson - Definition of Nursing; 14 Basic Needs

*The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or to recovery (or to a
peaceful death) that he would perform unaided if he had the necessary
strength, will, or knowledge and to do this in such a way as to help him gain
independence as rapidly as possible
*14 Basic Needs:
1. Breathe 8. Clean body and intact integument
2. Eat and drink 9. Safe environment
3. Eliminate 10. Communicate
4. Motion and position 11. Worship
5. Rest and sleep 12.Work
6. Clothing 13.Play
7. Temperature 14.Learn
Faye Glenn Abdellah - 21 Nursing Problems
*Problem solving was seen as the way of presenting nursing(patient) problems
as the patient moved towards health.
*Contributed to nursing theory development through the systematic analysis of
research reports to formulate the 21 nursing problems that served as an early
guide for comprehensive nursing care.

Lydia Hall - Care, Core, and Cure

*The theory consists of 3 major tenets:
o The nurse functions differently in the 3 interlocking aspects of the patient:
-Cure (Disease) shared with doctors
-Core (Person) addressed by therapeutic use of self; shared with
psychiatry/psychology, religious ministry, etc.
-Care (Body) exclusive to nurses; involves intimate bodily care like feeding,
bathing and toileting
o As the patient needs less medical care, he needs more professional nursing
care
o Wholly professional nursing care will hasten recovery

Jean Watson - Philosophy and Science of Caring; Carative Factors

*Caring is a universal social phenomenon that is only effective when practiced
interpersonally. Nurses should be sensitized to humanistic aspects of caring
*10 Carative Factors
1. Form humanistic-altruistic values 6. Scientific problem-solving method for
decisions
2. Instill faith-hope 7. Promote interpersonal teaching-
learning
3. Cultivate sensitivity 8. Provide supportive, protective, or
corrective
environemnt
4. Develop helping-trust relationship 9. Assist gratifying human needs
5. Promote and accept expression
of positive and negative 10. Allowance for existential-
phenomeno-
logical forces

Patricia Benner - Novice to Expert

*Validated the Dreyfus Model of Skill Acquisition in nursing practice with the
systematic description of the 5 stages (Novice, Advanced beginner,
Competent, Proficient, and Expert).
BENNERS STAGES OF NURSING EXPERTISE
STAGE I, Novice
*Has no experience (e.g., Nursing Student)
*Performance is limited inflexible, and governed by context-free rules and
regulations rather than experience.
*Novices have no life experience in the application of rules.
*Just tell me what I need to do and I do it.
STAGE II, Advanced Beginner
*Demonstrate marginally acceptable performance.
* Recognizes the meaningful aspect of a real situation.
*Has experienced enough real situations to make judgement about them.
*Principles to guide actions begin to be formulated and are focused on
experience.
STAGE III, Competent
*Has 2 to 3 years of experience.
*Demonstrates organizational and planning abilities.
*Differentiates important factors from less inportant aspects of care.
*Coordinates multiple complex care demands.
*Develops when the nurse begins to see his or her actions in terms of long-
range goals or plans which he or she is consciously aware of.
STAGE IV, Proficient
*Has 3 to 5 years of experience.
*Perceives situations as a whole rather than in terms of parts as in Stage II.
*Uses maxims as guides for what to consider in a situation.
*Has holistic understanding of the client, which improves decision making.
*Focuses on long-terms goals.
STAGE V, Expert
*Performance is fluid, flexible, and highly proficient; no longer requires rules
guidelines, or maxims to connect an understanding of the situation to
appropriate action.
*Demonstrates highly-skilled intuitive and analytical ability in new situations.
*Is inclined to take a certain action because it felt right.

II. Conceptual Models

*Frameworks or paradigms that give a broad frame of reference for systematic
approaches to the concerned phenomena.
*Concepts that specify their interrelationship to form an organized perspective
for viewing the phenomena
Grand Theories
*Derived from models but as theories, they propose testable truths or
outcomes based on use of the model in Practice.

Dorothea Orem - Self- Care Deficit Theory

*Composed of 3 Theories:
o Theory of Self Care
o Theory of Self-Care Deficit
o Theory of Nursing Systems - 3 Types:
 Wholly Compensatory - do for the patient.
Partly Compensatory - help the patient do for himself.
Supportive Educative - help the patient learn to do for himself; nurse has
important
role in designing nursing care.

Myra Estrin Levine - Conservation Model

*Major Concepts:
o Wholism (Holism)
o Adaptation - process whereby patients retain integrity; establish body
economy to safeguard stability:
Environment
Organismic Response - (1)Fight or flight, (2)inflammatory response,
(3)response to stress, (4)perceptual awareness
Trophicogenesis - alternative to nursing diagnosis
o Conservation - 4 principles of conservation - Nursing intervention is based
on the conservation of the patients:
Energy
Structural Integrity
Personal Integrity
Social Integrity
*Composed of 3 Theories- (1) conservation (2) redundancy (3) therapeutic
intention.

Martha Rogers - Unitary Human Beings

*Principles of Homeodynamics
Helicy - spiral development in continuous, non-repeating, and innovative
patterning.
Resonancy - patterning changes with development from lower to higher
frequency(intensity).
Integrality - continuous mutual process of person and environment.
*Theoretical Assertions
Energy - Man as a whole is more than the sum of his parts.
Openness - Man and environment continuously exchange matter and
energy.
Helicy - Life evolves irreversibly and unidirectionally along space and time.
Pattern and organization identify man and reflect his innovative wholeness.
Sentient, thinking being - man has capacity for abstraction and imagery,
language and thought, sensation and emotion.

Dorothy Johnson - Behavioral Systems Model

*Considered attachment or affiliative subsystem as cornerstone of social
organizations
*Nursing problems arise because there are disturbances in the structure or
function of the subsystems:
Dependency
Achievement
Aggressive
Ingestive
Eliminative
Sexual

Sister Callista Roy - Adaptation Model

*Proposed that humans are biophychosocial beings who exist within an
environment
*Environment and self provides 3 types of stimuli: (1) focal (2) residual (3)
contextual
*Human stimuli create needs in adaptation modes, such as physiological self-
concept, role function, and interdependence
*Through adaptive mechanisms, regulator and cognator, a person shows
adaptive or ineffective response that need nursing intervention.

Imogene King - Interacting Systems Framework; Goal Attainment Theory

*Nursing is a process of human interaction between nurses and patients who
communicate to set goals, explore means of attaining goals, and agree on
what means to use
*Perceptions, judgement and actions of nurse and patient lead to reaction,
interaction and transaction
*Interacting systems:
Personal System - perception, self, body image, growth and development
Interpersonal System - role, interaction, communication, transaction, and
stress
Social System - organization, power-authority status, decision making.

Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an
amalgam of activities
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying

Life span - concept of continuous change from birth to death

Dependence-independence continuum
 5 factors influencing AL: Biological, Psychological, Socio-cultural,
Environmental,
Politicoeconomic.
*The individuality of living is the way in which the individual attends to ALs in
regard to place on life span and dependence-independence continuum and as
influenced by the 5 factors.

III. Theories
*Group of related concepts that proposes actions that guide practice. May be
broad but limited only to particular aspects
Middle-range Theories
*The least abstract level because they include specific details in nursing
practice like population, condition and location.

Hildegard Peplau - Psychodynamic Nursing; Mother of Psychiatric Nursing

*Stressed the importance of the nurses ability to understand ones own
behavior to help others identify felt difficulties.
*4 Phases of Nurse-Patient Relationship
Orientation
Identification
Exploitation
Resolution
*6 Nursing Roles
1. Stranger 4. Leader
2.Resource Person 5. Surrogate
3. Teacher 6. Counselor
*4 Psychobiological Experiences that compel destructive or constructive
responses
Needs
Frustrations
Conflicts
Anxieties

Ida Jean Orlando - Nursing Process; Dynamic Nurse-Patient Relationship

*Focused on patients verbal and nonverbal expressions of need and the
nurses reactions to the behavior
*3 Elements of a Nursing Situation
Patient behaviors
Nurse reactions
Nurse actions
*Used the nursing process to meet patients needs through deliberate action;
advanced nursing beyond automatic response to disciplined and professional
response.
Joyce Travelbee - Human-to-Human Relationship Model
*Nursing was accomplished through human-to-human relationship:
1. Original encounter
2. Emerging identities
3. Developing empathy
4. Developing sympathy
5. Rapport

Katherine Kolcaba - Theory of Comfort

*Defined healthcare needs as those needs for comfort including physical,
psycho-spiritual, social, andenvironmental needs
*Intervening factors influence clients perception of comfort: age, attitude,
emotional support, experience, finance, prognosis
*Types of comfort:
1. Relief when specific need is fulfilled
2. Sense of ease, calm, and contentment
3. Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain - Modeling and Role-Modeling

*Synthesis of multiple theories related to basic needs, developmental tasks,
object attachment, and adaptive coping potential
*Views nursing as self-care based on the persons perception of the world and
adaptation to stressors
*Promotes growth and development while recognizing individual differences
according to worldview and inherent endowment.

Ramona Mercer - Maternal Role Attainment

*Focused on parenting and maternal role attainment in diverse populations.
*Developed a complex theory to explain the factors impacting the maternal role
over time.

Kathryn Barnard - Parent-Child Interaction; Child Health Assessment

Interaction Theory
*Individual characteristics of each member influence the parent-infant system
and that adaptive behavior modifies those characteristics to meet the
needs of the system
*The theory is based on scales developed to measure feeding, teaching, and
environment.

Madeleine Leininger - Transcultural Care Theory; Ethnonursing

*Some of the major concepts are care, caring, culture, cultural values, and
cultural variations
*Caring is seen as the central theme in nursing care, knowledge and practice.
*Caring includes assistive, supportive, facilitative acts towards people with
actual or anticipated needs
*3 types of Nursing Actions
Cultural Care Preservation or Maintenance - retention of relevant care
values unique to culture
Cultural Care Accommodation or Negotiation - adapting culture with
professional care providers
Cultural Care Repatterning or Restructuring - changing life-ways while still
respecting culture for a healthier outcome.

Rosemarie Rizzo Parse - Human Becoming

*A unique, humanistic approach instead of a physiological basis for nursing
*Nursing is a human science that is not dependent on medicine or any
discipline for its practice
*Major concepts include:
Imaging Connecting-separating
Valuing Powering
Languaging Originating
Revealing-concealing Transforming
Enabling-limiting

Merle Mishel - Uncertainty in Illness

*Researched into experiences with uncertainty as it relates to chronic and life-
threatening illness.
*Later reconceptualized to accommodate the responses to uncertainty over
time in people with chronic conditions who may not resolve the
uncertainty.

Margaret Newman - Model of Health

*Major concepts are movement, time, space and consciousness. Movement is
a reflection of consciousness.
Time is a function of movement. Time is a measure of consciousness.
*The goal of nursing is not to promote wellness or to prevent illness, but to
help people use the power within them as they evolve toward a higher
level of consciousness.

Evelyn Adam - Conceptual Model for Nursing

*Used a model from Dorothy Johnson and definition of nursing from Virginia
Henderson
*Identified assumptions, beliefs, and values, and major units
*Included goal of the profession, beneficiary of the professional service, role of
the professional, source of the beneficiarys difficulty, the intervention of the
professional, and the consequence.

Nola Pender - Health Promotion Model

*The goal of nursing care is the optimal health of the individual
*Developed the idea that promoting optimal health supersedes disease
prevention
*Identifies cognitive-perceptual factors of a person, like importance of health-
promotion behavior and its perceived barriers, and these factors are modified
by demographics, biology, interpersonal influences, and situational and
behavioral factors.

D. Continuing Professional Education

E. Professional Organizations in Nursing

F. The Nurse in Health Care

1. Eleven Key Areas of Responsibility

ELEVEN KEY AREAS OF RESPONSIBILITY

A. SAFE AND QUALITY NURSING CARE

1. Demonstrate knowledge based on the health/Illness status of indiidual
groups.
2. Provides sound decision making in the care of individuals/groups.
3. Promote wholeness and well-being including safety and comfort of patients.
4. Sets priorities in nursing care based on patients need.
5. Ensures continuity of care..
6. Administersmedications and other health therapeutics.
7. Utilizes the nursing process as framework for nursing.
8. Formulates a plan of care in collaboration with patients and other members
of the health team.
9. Implements planned nursing care to achieve identified outcomes.
10. Evaluates progress toward expected outcomes.
11. Responds to the urgency of the patients condition.

B. MANAGEMENT OF RESOURCES AND ENVIRONMENT

1. Organizes work load to facilitate patient care.
2. Utilizes resources to support Patient care.
3. Ensures availability of human resorces.
4. Checks proper functioning of equipment/facilities.
5. Maintains a safe and therapeutic environment.
6. Practices stewardship in the management of resources.

C. HEALTH EDUCATION
1. Assess the learning needs of the patient and family.
2. Develops health education plan based on assessed and anticipated needs.
3. Develops learning materials for health education.
4. Implements the healtheducation plan.
5. Evaluates the outcome of health education.

D. LEGAL RESPONSIBILITY
1. Adheres to practice in accordance with the nursing law and other relevant
legislation including contracts, informed consent.
2. Adheres to organizational policies and procedures, local and national.
3. Documents care rendered to patients.

E. Ethico-Moral Responsibility
1. Respects the rights of individuals/groups.
2.Accepts responsibility and accountability for own decisions and actions.
3. Adheres to the national and international code pf ethics for nurses.

F. Personal and Professional Development

1. Identifies own learning needs.
2. Pursues continuing education.
3. Gets involved in professional organizations and civic activities.
4. Projects a professional image of the nurse.
5. Possesses positive attitude towards change and criticism.
6. Performs function according to professional standards.

G. Quality Improvement
1. Utilizes data for quality improvement
2. Participtaes in nursing audits and rounds.
3. Identifies and reports variances.
4. Recommends solutions to identified causes of the problems.
5. Recommends improvement of systems and processes.

H. Reasearch
1. Utilizes varied methods of inquiry in solving problems.
2. Recommends actions for implementation.
3. Disseminates results of research findings.
4. Applies research findings in nursing practice.

I. Record Management
1. Maintains accurate and updated documentation of patient care.
2. Records outcome of patient care.
3. Observes legal imperatives in record keeping.
4. Maintains an effective recording and reporing system.
J. Communication
1. Utilizes effective communication in relating with clients, members with the
team and the public in general.
2. Utilizes effective communicationin therapeutic use of self to meet the needs
of clients.
3. Utilizes formal and informal channels.
4. Responds to needs of individuals, families, groups and communities.
5. Uses appropriate information technology to facilitate communication.

K. Collaboration and Teamwork

1. Establishes collaborative relationship with colleagues and other members of
the health team for the health plan.
2. Functions effectively as a team player.

2. Fields of Nursing
3. Roles and Functions

II. Safe and Quality Care

A. The Nursing Process
NURSING PROCESS
Definition
- It is a systematic, client-centered method for structuring the delivery of
nursing care.

B. Basic Nursing Skills

1. Vital Signs
2. Physical Examination and Health Assessment
3. Administration of Medications
4. Asepsis and Infection Control
5. First Aid Measures
6. Wound Care
7. Perioperative Care
8. Post-operative Care
9. Post-mortem Care
C. Measures to meet physiological needs
1. Oxygenation
2. Nutrition
3. Activity, Rest and Sleep
4. Fluid and Electrolyte Balance
5. Urinary Elimination
6. Bowel Elimination
7. Safety, Comfort and Hygiene
8. Mobility and Immobility

III. Health Education

A. Teaching and Learning Principles in the Care of Client
B. Health Education in All Levels of Care
C. Discharge Planning

IV. Ethico-Moral Responsibility

A. Bioethical Principles
1. Beneficence
2. Non-maleficence
3. Justice
4. Autonomy
5. Stewardship
6. Truth Telling
7. Confidentiality
8. Privacy
9. Informed Consent
B. Patients Bill of Rights
C. Code of Ethics in Nursing

V. Legal Responsibility
A. Legal Aspects in the Practice of Nursing
B. The Philippine Nursing Law of 2002 (R.A 9173)
C. Related Laws Affecting the Practice of Nursing

VI. Management of Environment and Resources

A. Theories and Principles of Management
B. Nursing Administration and Management
C. Theories, Principles and Styles of Leadership
D. Concepts and Principles of Organization
E. Patient Care Classification
F. Nursing Care Systems
G. Delegation and Accountability

VII. Records Management

A. Anecdotal Report
B. Incident Report
C. Memorandum
D. Hospital Manual
E. Documentation
F. Endorsement and End of Shift Report
G. Referral

VIII. Quality Improvement

A. Standards of Nursing Practice
B. Nursing Audit
C. Accreditation/Certification in Nursing Practice
D. Quality Assurance

IX. Research
A. Problem Identification
B. Ethics and Science of Research
C. The Scientific Approach
D. Research Process
E. Research Designs and Methodology
1. Qualitative
2. Quantitative
F. Utilization and Dissemination of Research Findings

X. Communication
A. Dynamics of Communication
B. Nurse-Client Relationship
C. Professional-Professional Relationship
D. Therapeutic Use of Self
E. Use of Information Technology

XI. Collaboration and Teamwork

A. Networking
B. Inter-agency Partnership
C. Teamwork Strategies
D. Nursing and Partnership with Other Profession and Agencies

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing

Practice II)
NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE II
TEST DESCRIPTION: Theories, concepts, principle and processes in the care
of individuals, families, groups and communities to promote health and prevent
illness, and alleviate pain and discomfort, utilizing the nursing process as
framework. This includes care of high risk and at-risk mothers, children and
families during the various stages of life cycle.
TEST SCOPE:
Part I: CHN

I. Safe and Quality Care, Health Education and Communication, Collaboration

and Team work
COMMUNITY HEALTH NURSING
HISTORY OF CHN
Date
1901 Act # 157 (Board of Health of the Philippines) ;
Act # 309 (Provincial and Municipal Boards of Health) were created.
1095 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 performs the functions of doctors.
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario, 1st Filipino Nurse supervisor under Bureau of
Health.
October 22, 1922 Filipino Nurses Organization (Philippines Nurses
Organization) was organized.
1923 Zamboanga General Hospital School of Nursing and 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 ciy health officer; Office of
Nursing was created through the effort of Vicenta Ponce (Chief Nurse) and
Rosario Ordiz (assistant chief nurse)
December 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.
February 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.
1953 The first 81 Rural Health Units were organized.
1957 RA 1891 Ammended 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 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.
January 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.

Laws Affecting Public Health andPractice of Community Health Nursing

R.A 7160 or the Local Government Code. This involves the devolution of
powers, functions and responsibilities to the local government both rural and
urban. The Code aims to transform local government unit into self-reliant
communities and active partners in the attainment of national goals thru a
more responsive and accountable local government structure instituted thru a
system of decentralization. Hence, each province, city and municipality has a
LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual
budgetary allocations for the operation and maintenance of their own health
facilities.

Composition of Local Health Board ( LHB )

Provincial Level
1. Governor Chair
2. Provincial Health Officer vice chair
3. Chair, Committee on Health of Sangguniang Panlalawigan.
4. DOH Representative.
5. NGO Respresentative.
City and Municipal Level
1. Mayor Chair
2. MHO vise chair
3. Chair, Committee on Health of Sangguniang Bayan.
4. DOH Representative
5. NGO Representative
Effective LHS Depends on:
1. The LGUs financial capability.
2. A dynamic and responsive political leadership
3. Community Empowerment

R.A 2382 Philippine Medical Act. This act defines the practice of medicine in
the country.
R.A 1082 Rural Health Act. It created the 1st 81 Rural Health Units.
- amended by R.A 1891; more physicians, dentists, nurses,
midwives and sanitary inspectors will live in the rural areas where they are
assigned in order to raise the health conditions of barrio people, hence help
decrease the high incidence of preventable diseases.
R.A 6425 Dangerous Drugs Act. It stipulates that the sale, administration,
delivery, distribution and transportation of prohibited drugs is punishable by
law.
R.A 9165 The New Dangerous Draug Act of 2002.
P.D No. 651 requires that all Health Workers shall identify and encourage
the registration of all births within 30 days following delivery.
P.D No. 996 requires the compulsary immunization of all children below 8
years of age against the 6 childhood immunizable diseases.
P.D No. 825 provides pernalty for improper disposal of garbage.
R.A 8749 Clean Air Act of 2000
P.D No. 856 Code of Sanitation. It provides for the control of all factors in
mans environment that affect health including the quality of water, food, milk,
insects, animal carriers, transmitters of disease, sanitary and recreation
facilities, nilse, pollution and control of nuisance.
R.A 6758 Standardizes the salary of government employees including the
nursing personnel.
R.A 6675 Generics Act of 1988 which promotes, requires and ensures the
production of an adequate supply, distribution, use and acceptance of drugs
and medicines identified by their generic name.
R.A 6713 Code of Conduct and Ethical Standards of Public Officials and
Employees. It is thepolicy of the state to promote high standards of ethics in
public office. Public officials and employeesshall at all times be accountable to
the people and shall discharges their duties with utmost responsibility,
integrity, competence and loyalty, act with patriotism and justice, lead modest
lives uphold public interest over personal interest.
R.A 7305 Magna Carta for Public Health Workers. This act aims: To promote
and improve the social and economic well-being of health workers, their living
and working conditions and terms of employment; to develop their skills and
capabilities in order that they will be more responsive and better equipped to
deliver health projects and programs; and to encouragethose with proper
qualifications and excellent abilities to join and remain in government service.
R.A 8423 Created the philippine Institute of Traditional and Alternative
Health Care.
P.D No. 965 requires applicants for marriage license to receive instructions
on family planning and responsible parenthood.
P.D No. 79 defines, objectives, duties, and functions of POPCOM.
R.A 4073 advocates home treatment for lepsrosy.
Letter of Instruction No. 949 legal basis of PHC dated october 19, 1979.
-- promotes development of health programs on the
community level.
R.A 3573 requires reporing of all cases of communicable diseases and
administration of prophylaxis.
Misnistry Circular No. 2 of 1986 includes AIDS as notifiable disease.
R.A 7875 National Health Insurance Act
R.A 7432 Senior Citizens Act
R.A 7719 National Blood Services Act
R.A 8172 Salt Iodization Act ( ASIN LAW)
R.A 7277 Magna Carta for PWDS, provides their rehabilitation, self-
development and self-reliance and integration into the mainstream of society.

*A.O No. 2005 0014 National Policies on Infant and Young Child Feeding:
1. All newborns be breastfeed within 1 hour after birth.
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond.

E.O 51 Philippine Code of Marketing of Breastmilk Substitutes.

R.A 7600 Rooming In and Breastfeeding Act of 1992.
R.A 8976 Food Fortification Law
R.A 8980 Promulgates a comprehensive policy and a national system for
ECCD.

A.O. No. 2006 0015 Defines the Implementing guidelines on Hepatitis B

Immunization for infants.
R.A 7846 Mandates Compulsary Hepatitis B Immunization among infants
and children less than 8 years old.
R.A 2029 Mandates Liver Cancer and Hepatitis B Awareness Month Act (
February ).
A.O No. 2006 0012 Specifies the Revised Implementing Rules and
Regulations of E.O 51 or Milk Code, Relevant International Agreements,
Penalizing Violations thereof and for other purposes.

I. Definition of Terms
Community derived from a latin word communicas which means a group
of people.
- 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.

HEALTH is the OLOF (Optimum level of Functioning).

(WHO)- state of complete physical, mental and social well being, not merely
the absence of disease or infirmity.
-It primarily affects the physical well-being of people in a society.
-Health is a fundamental human right.
-A personal and social responsibility.
-A multifactorial approach.

1. HEALTH ILLNESS CONTINUUM

- A predictive grid that displays the Likelihood of a person to participate
in preventive health care.
- A Degree of client wellness ranging from optimum wellness to death.
- Dynamic state, matters as a person adopts to change in internal and a
holistic well being.

HIGH-LEVEL GOOD NORMAL ILLNESS DEATH

WELLNES HEALTH HEALTH

HEALTH ILLNESS CONTINUUM, as shown here, represents the

process of achieving HIGH LEVEL OF WELLNESS or the
consequences of unhealthy lifestyle. In this figure, there are three
parameters on how to achieve high level of wellness.
These are: (A) Awareness, (E) Education, and (G) Growth.
Otherwise, an individual who continuously live an unhealthy lifestyle, will
be on the other side of the grid, and would develop the following: (S)
Signs and Symptoms (S) Syndrome, and (D) Disorder or disability
which may lead disease or premature death.

2. AGENT HOST ENVIRONMENT MODEL

- Primarily used to predict an illness
AGENT Any environmental factor or stressor, chemical,
mechanical, physical, psychosocial, that by its presence or absence
can lead to illness or disease.
- Causative etiologic factor
HOST Persons who may or may not be at risk of acquiring the
disease.
- with intrinsic factor
ENVIRONMENT All factors external to the host that may or may
not predispose the person to the development of the disease.

-Requires the individual to maintain a continuum of balance and

purposeful direction with environment.
Ex: Etiologic factor of Dengue? --- Virus
AGENT HOST

A. Etiologic Factors: B. Intrinsic Factors &

1. Biological infections----virus, Environmental Factors
bacteria 1. Age
- fungi, protozoa, 2. Sex (m or f)
helminthes, ectoparasites F - Weak emotional;
2. Chemical- carcinogens, morbidity: common diseases
poisons, allergens M - Mortality ( killer
Ex. GMOs carcinogen diseases)
MSG- poison 3. Behavior
3. Mechanical- car accidents, etc 4. Educational attainment-
4. Environmental/physical- occupation
heatstroke 5. Prior immunologic- response
5. Nutritive- excess or deficiency
6. Psychological C. Extrinsic Factors
1. Natural boundaries- physical,
geography
2. Biological environment
3. Socioeconomic envt.-
political boundary

3. HEALTH BELIEF MODEL

- Helps determine whether an individual is likely to participate in disease
prevention and promotion activities.
- Usefool tools in developing programs for helping people change to
healthier lifestyles and develop a more positive attitudetoward
preventivehealthier measures.

COMPONENTS:
INDIVIDUAL PERCEPTIONS: Includes perceived
susceptivility,seriousness and threat. Seriousness of an illness.
MODIFYING FACTORS: Includes demographic variables,
sociophysiologic variables, structural variable, and cues to action.
Susceptibility to an illness.
LIKELIHOOD TO ACTION: Depends on the perceived benefit versus
the perceived barriers. Benefits of taking actions.

Ex. Male infected w/ STD & female non-infectious----- Increase

susceptibility of transmission
HIV infection (commercial sex farers, sea workers, medical team
 Susceptibility, possible MOT--- unprotected sex- occupational hazard

Prevention: Safer Sex Practices

Abstinence
Be faithful
Correct, consistent, continuous use of condom
Do not penetrate (SOP)

HIV infected age groups

Males age 40-49 seafarers ratio: 1: 5 anal sex- wont get pregnant, common in rural

Vaginal: 1: 1000

Females 20-29 Anal: 1: 200-----highest risk

Oral lowest risk

4. EVOLUTIONARY BASED MODEL

illness & death serve an evolutionary function- based on Darwins
Survival of the fittest theory
Elements:
a. Life events developmental variables & those associated with
changes
b. Lifestyle determinants personal & learned adaptive strategies a
person uses to make lifestyle changes
c. Evolutionary viability within the social context extent to which a
person fx to promote survival
d. Control perceptions
e. Viability emotions affective reactions developed from life events
f. Health determinants

5. HEALTH PROMOTION MODEL

* Directed at increasing clients well being.
* All efforts increasing well being ( no threat ) ex. Sex education
Combating any possible disease ( no existing disease )

Illness Highly subjective feeling of being sick or ill.

PUBLIC HEALTH ( Dr. C.E. Winslow ) 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 social machinery to
ensure everyone a standard of living adequate for the maintenance of health,
so organizing these benefits as to enable every citizen to realize his birthright
of birth and longevity.( Dr C.E Winslow ).

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.

INDIVIDUAL CLIENT: APPLIED STUDY: COMMUNITY AS CLIENT:

Anatomy Structure Demographic study of population
Physic Function Sociology
Pathos Malfunction Epidemiology study of disease

NURSING both profession and a vocation. Assisting sick individuals to

become healthy and healthy individuals achieve optimum wellness.

1. Virginia Henderson
- Assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness

2. Dorothea Orem
- Providing assistance to clients to achieve self-care towards optimum
wellness.
Early years- fetus- 12 years/ younger adults- 12-24 years
Orem- self care, autonomy----independent patient

3. Florence Nightingale
- Placing an individual in an environment. that will promote optimum capacity
for self-reparative process
- individual capable of self-repair and there is something to repair in an
individual.
COMMUNITY HEALTH NURSING
-Synthesis of public and nursing practice.

(WHO Expert Committee of Nursing)

- 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.

- a specialized field of nursing practice.

1. Utilitarianism: greatest good for the greatest number.
2. Nursing Process.
3. Priority of health-promotive and disease-preventive startegies over curative
interventions.
4. Tools for measuring and analyzing Community Health problems.
5. Application of principles of management and organization in the delivery of
health services to the community.

(Maglaya) 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.

(Jacobson) is a learned practice disciplined with the ultimate goal of

contributing as individual and incollaboration with others, to the promotion of
clients optimum level of functioning through teaching and delivery of care.

(Dr. Ruth B. Freeman)

- 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 sick at home and rehabilitation.
- Technical nursing, interpersonal, analytical and organizational skills are
applied to problems of health as they affect the community.
-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., grps, families, and indiv 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
Factors affecting Optimum Level of Functioning (OLOF)
1. Political
2. Behavioral
3. Hereditary
4. Health Care Delivery System
5. Environmental Influences
6. Socio economic Influences

Concepts
1. The primary focus of community health nursing practice is on health
promotion and disease prevention.
Primary goal self reliance in health or enhanced capabilities.
Ultimate goal raise level of number of citizenry.
Philosophy of CHN Worth and dignity of man.
2. CHN practices to benefit the individual, family, special groups, and
community
*CHN is integrated and comprehensive
3. Community Health Nurses are generalist in terms of their practice through
life but the whole community its full range of health problems and needs.
4. Community Health Nurses are generalist in terms of their practice through
life continuity in its full range of health problems and needs.
5. The nature of CHN practice requires that current knowledge derived from
the biological, social science, ecology, clinical nursing and community health
organizations be utilized.
6. Contact with the client and or family may continue over a long period of time
which includes all ages and all types of health care.
Levels of Health Care:
Primary Health Care: Management at the level of community
Secondary Health Care: Regional, District, Municipal, and Local Hospital
Tertiary Health Care: Sophisticated Medical Center Heart Center, KI
7. The dynamic process of assessing, planning, implementing and intervening
provide measurements of progress, evaluation and a continuum of the cycle
until the termination of nursing is implicit in the practice of Community Health
Nursing.
Nursing Function:
Independent without supervision of MD
Collaborative in collaboration with other Health team
( interdisciplinary, intrasectoral )

II. 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.
Goal: To raise the level of citizenry by helping 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
To elevate the level health of the multitude.

MISSION OF CHN ( FIVE FOLD MISSION )

*Health Promotion activities related to enhancement of health.
*Health Protection activities designed to protect the people.
*Health Balance activities designed to maintain well being.
*Disease Prevention activities relate to avoid complication = primary,
secondary, tertiary.
*Social Justice activities related to practice practice equity among clients.

PHILOSOPHY OF CHN
*The philosophy of CHN is based on the worth and dignity of man.

Roles of COMMUNITY HEALTH NURSE / PUBLIC HEALTH NURSE

CLINICIANS - who is a health care providers, taking care of the sick people at
home or in the RHU.
HEALTHEDUCATOR who aims towards health promotion and Illness
prevention through dissemination of correctr information; educating people.
ADVOCATOR acts on behalf of the client.
FACILITATOR who establishes multi sectoral linkages by referral system.
SUPERVISOR who monitors and supervises the performance of midwives.
COLLABORATOR 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 MHOs responsibilites.
-Other Responsibilities of a Nurse, spelled by the implementing rules and
regulations of RA 7164 ( Philippine Nursing Act of 1991 ) 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 Physicians.
*Provisions of First aid measures and Emergency Care.
*Recommending Herbal and Symptomatic Meds... Etc.

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.
-Program planning, Implementation, and Evaluation.
-Influencing executive and legislative individuals or bodies concerning health
and develoment.

ROLES OF THE COMMUNITY HEALTH NURSE

1. Planner/ Programmer- identifies needs, priorities & problems if individual,

family, & comm.
- Formulates nursing component of H plans
In doctorless areas, she is responsible for the formulation of the
municipal health plan
Provides technical assistance to rural health midwives in health
matters like target setting.
2. Provider of Nursing care- provides direct nsg care to the sick, disabled in the
homes, clinics, schools,
or places of work
provide continuity of patient care
3. Manager/ Supervisor- formulates care plan for the:
4 Clientele:
a. Requisitions, allocates, distributes materials (meds & medical
supplies & records & reports equips
b. Interprets and implements programs, policies, memoranda, &
circulars
c. Conducts regular supervisory visits & meetings to diff RHMs & gives
feedbacks on accomplishments
4. Community Organizer- motivates & enhance community participation in
terms of planning, org, implementing
and evaluating Health programs/ services.
5. Coordinator of Health Services- coordination with other health team &
other govt org (GOs & NGOs) to other
health programs as envt. sanitation health education, dental health &
mental health.
6. Trainer/ Health educator/ counselor- conducts training for RHMs, BHWs,
hilots who aim towards H promo & illness prevention through dissemination of
correct info;
educating people
7. Researcher- coordinates with govt. & NGOs in the implementation of
studies/ researches
participates in the conduct of surveys studies & researches on Nsg
and H related subjs.
8. Health Monitor----evaluating what deviates from normal
9. Manager ---under the nurse---midwives
10. Change Agent
11. Client Advocate

Responsibilities of COMMUNITY HEALTH NURSE

-Be a part in developing an overall health plan, it is 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 opprotunities for professional growth and continuing education for
staff development..

PUBLIC HEALTH

1. WINSLOW
- The science & art of preventing disease, prolonging life, promoting
health & efficiency through
organized community effort
To enable each citizen to realize his birth right of health & longevity.
Major concepts:
1. Health promotion
2. Peoples participation towards self-reliance
2. HANLON
- Most effective goal towards total development and life of the individual
& his society

3. PURDOM
- Applies holism in early years of life, young, adults, mid year & later
- Prioritizes the survival of human being

PUBLIC HEALTH NURSING

(Cuevas, 2007)
-In the light of the changing national and global helath situation and the
acknowledgement that nursing is a significant contributor to health, the public
health nurse is strategically positioned to make a difference in the health
outcomes of individuals, families, and communities cared for.

Concepts
1. Science and Art of Preventing diseases, prolonging life, promoting health
and efficiency through organized community effort for the:
a. sanitation of the environment.
b. control of communicable diseases.
c. the education of individuals in personal hygiene.
d. organization of medical and nursing services for early diagnosis and
preventive treatment of disease, and the development of social machinery to
ensure everyone a standard of living adequate for the maintenance of health,
so organizing these benefits as to enable every citizen to realize his birthright
of health and longevity.

Determinants of Health
*Factors that can affect health
a. Income and social status - socioeconomic
b. Education - socioeconomic
c. Physical Environment - Environment
d. Employment and working conditions - socieconomic
e. Social support networks - socioeconomic
f. Culture, Customs and Traditions - Behavior
g. Genetics - Heredity
h. Personal Behavior and coping skills - Behavior
i. Health Services Health Care Delivery System
j. Gender Heredity
-ECOSYSTEM influence on OLOF ( Blum 1974 ).

CORE Busyness of Public Health:

1. Disease control
2. Injury Prevention
3. Health Protection
4. Health public policy including those in relation to environmental hazards
such as in the work place, housing, food, water, etc.,
5. Promotion of health and equitable health gain.

In response to above trends, the global community, represented by the United

Nations General Assembly, decided to adopt a common vision of poberty
reduction and sustainable development in september 2000.
This vision is exemplified by the Millenium Development Goals (MDGs)
which are based on the fundamental values of:
FREEDOM
EQUALITY
SOLIDARITY
TOLERANCE
HEALTH HEALTH: MILLENIUM DEVELOPMENT
GOALS
RESPECT FOR NATURE MDG 1: Eradicate extreme poverty and
hunger
Target: Halve, between 1990 and 2015, the
porportion of people whose
 income is less than one dollar a
day.
Target: Halve, between 1990 and 2015,
the proportion of people who suffer
from hunger.

SHARED RESPONSIBILITY MDG 2: Achieve universal primary

education
Target: Ensure that, by 2015, children
everywhere, boys and girls alike,
will be able to complete a full
course of primary schooling.

MDG 3: Promote gender equality and

women empowerment
Target: Eliminate gender disparity in
primary and secondary education
preferably by 2005 and to all levels
of education no later than 2015.

MDG 4: Decreased child mortality

Target: Reduce by 2/3, between 1990 and
2015, the under five mortality
rate.

MDG 5: Increased maternal health

Target: Reduce by three quarters,
between 1990 and 2015, the
maternal mortality ratio.

MDG 6: Combat HIV/AIDS, Malaria and

other diseases
Target: Have halted by 2015 and begun to
reverse the spread of HIV / AIDS
Target: Have halted by 2015 and begun to
reverse the incidence of malaria
and other major diseases.

MDG 7: Ensure environmental

sustainability
Target : Integrate the principles of
sustainable development into
country policies and programmes
 and reverse the loss of
environmental resources.
Target : Halve, by 2015, the proportion of
people without sustainable access
to safe drinking water
Target: By 2020, to have achieved a
significant improvement in the
lives of at least 100 million slum
dwellers.

MDG 8: Develop a global partnership for

development.
Target : Develop further an open, rule-
based, predictable, non-
discriminatory trading and financial
system.
Target: Address the special needs of the
least developed countries.
Target: Address the special needs of
landlocked countries and small
island developing States.
Target: Deal comprehensively with the
debt problems of developing
countries through national and
international measures in order to
make debt sustainable in the long
term.

COMMUNITY HEALTH NURSING PUBLIC HEALTH NURSING

( ART ) and Science ( SCIENCE ) and Art
*Synthesis of nursing practice and *Synthesis of public health and
public health practice applied to nursing practice.
promoting and preserving the *Specific/subspecialty nursing
health of the populations. practice.
*Directs care to individuals, *Defined as the practice of
families, or groups; this care, in turn promoting and protecting health of
contributes to the health of the total populations using knowledge from
population. nursing social and public health
*knowldge = nursing and PHN sciences.
*More General Specialty area that *CORE FUNCTIONS:
encompasses subspecialties that a. Assessment
include Public Health Nursing and b. Policy development
other developing fields of practice c. Assurance
such as home health, hospice care, *Essential Functions:
 and independent nursing practice. -Heart monitoring and analysis.
-Epidemiological
surveillance/disease prevention
and control and all.

A. Principles and Standards of CHN

PRINCIPLES AND STANDARD OF CHN

PRINCIPLES
1. The need of the community is the basis of community health nursing.
2. The community health nurse must understand fully the objectives and
policies of the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of race, creed and socioeconomic
status.
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation of community health nursing
service.
7. Opportunities for continuing staff education programs for nurses must be
provided by the community health nurisng agency and the CHN as well.
8. The CHN makes use of available community health resources.
9. The CHN taps the already existing active organized groups in the
community.
10. There must be provision for educative supervision in community health
nuraing.
11.There should be accurate recording and reporting in community health
nursing.
12. Health teaching is the primary responsibility of the community health nurse.

STANDARDS IN CHN
I. Theory
Applies theoretical concepts as basisfor decisions in practice.
II. Data Collection
Gathering comprehensive, accurate data systematically.
III. Diagnosis
Analyzes collected data to determine the needs / health problems of
Individual, Family, Community.
IV. Planning
At each level of prevention, develops plans that specify nursing actions
unique to needs of clients.
V. Intervention
Guided by the plan, intervenes to promote, maintain or restore health,
prevent illness and institute rehabilitation.
VI. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnose and plan.
VII. 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.
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and
evaluating programs for community health.
IX. Research
Indulges in research to contribute to theory and practice in community
health nursing.

B. Levels of Care
LEVELS OF CARE/PREVENTION

PRIMARY
-Is devolved to the cities and the municipalities. It is health care provided by
center physicians, public health nurses, rural health midwives, barangay health
workers, traditional healers and others at the barangay health stations and
rural health units. The primary health facility is usually the first contact
between the community members and the other levels of health facility.
- activites that prevent a problem before it occurs. Example: Immunization.
SECONDARY
-Secondary care is given by physicians with basic health training. This is
usually given in health facilities and district hospitals and out-patient
departments of provincial hospitals. This serves as a referral center for the
primary health facilities. Secondary facilities are capable of performing minor
surgeris and perform some simple laboratory examinations.
- activities that provide early detection/diagnosis and treatment and
Intervention. Example: Breast self-examination, HIV screening, Operation
timbang.
TERTIARY
-Is rendered by specialists in health facilities including medical centers as well
as regional and provincial hospitals, and specialized hospitals such as the
Philippine Heart Center. The tertiary health facility is the referral center for the
secondary care facilities. Complicated cases and intensive care requires
tertiary care and all these can be provided by the tertiary care facility.
- activities that correct a disease state and prevent it from further deteriorating.
Example: Teaching Insulin Administration in the home
C. Types of Clientele
TYPES OF CLIENTELE

INDIVIDUAL
- People who visits the health center.
- People who receives health services.
e.g., Prenatal Supervision
Well Child Follow ups.
Morbidity Service
Teaching Client on Insulin Administration
Basic approaches in looking at the individual:
1. atomistic the basic constituents of an individual, use concepts of biology
which in turn refers to essentialism --- behavior --- psychological --- human
behavior is dictated by experience.
2. holistic suprasystems sociological in nature social constructionism
nurture behavior
SEX --- a biological concept (male / female)
--- a sociological concept --- gender --- musculinity or femininity --- based
on culture.
--- on sexual orientation: attracted to Opposite sex heterosexual
Same sex homosexual
Both bisexual

Perspective in understanding the individual:

1. BIOLOGICAL
a. unified whole
b. holon
c. diporphism
2. ANTHROPOLOGICAL
a. Essentialism
b. Social constructionism
c.Culture
3. PSYCHOLOGICAL
a. Psychosexual
b. Psychosocial
c. Behaviorism
d. Social learning
4. SOCIOLOGICAL
a. Family and kinship
b. Social groups

FAMILY
- 2 or more individuals who commit to live together for an extended period of
time not necessarily with marital affinity or blood relations.
- Considered as the basic unit of care.
a. Nuclear
b. Extended with lolos and lalas, titios and titas
c. Cohabiting live-in, Not married but with kids.
d. Dyad married but without kids.

MODELS:
Stages of Family Development by Evelyn Duvall
STAGE 1 The Beginning Family ( newly wed couples ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
family.

STAGE 2 The Early Child Bearing Family ( 0 30 months ).

TASK: Emphasize the importance of pregnancy and immunization and learn
the concept of parenting

STAGE 3 The Family with Preschool Children ( 3 6 years old ).

TASK: Learn the concept of Responsible Parenthood.

STAGE 4 The Family with School Age Children ( 6 -12 years old).
TASK: Reinforce the concept of Responsible Parenthood.

STAGE 5 The Family with Teenagers (13 25 years old ).

TASK: Parents to learn the concept of let go system and understand the
generation gap.

STAGE 6 Launching Center ( 1st Child will get married upto the last child ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
Family.

STAGE 7 Family with Middle Adult Parents ( 36 60 years old ).

TASK: Provide a Healthy Environment, adjust with a new lifestyle and adjust
with the financial aspect.

STAGE 8 The Aging Family ( 61 years old upto death ).

TASK: Learn the concept of Death Positively.

8 Family Tasks or Basic Tasks of Developmental Model:

Physical maintenance
Allocation of resources- income given to wife
Division of labor joint parenting
Socialization of family members
Reproduction, recruitment & release
*Maintenance of order- high crime rate
 Placement of members in larger society- Indication familys
success
Maintenance of motivation & morale
Criticisms: very limited & cannot apply to all situation

STRUCTURAL FUNCTIONAL
Initial Data Base
a. Family Structure and Characteristics
Nuclear basic family
Extended in-law relations, or grandparents relations
*members of household in relation to head
*demographic data ( sex male or female, age, civil status )
Live in = married/ common law WIFE
Male Patriarchal Female Matriarchal
*types and structure of family
*dominant members in health
*general family relationship

Assessment: Family
-Initial data base
-1st level assessment
-2nd level assessment

b. Socio-economic and cultural Factors

*resources and expenses
*educational attainment
*ethnic background
*religious affiliation
*SO ( do not live with the family but influences decision )
*Influences to larger communities

c. Environmental Factors
*housing- number of rooms for sleeping
*kind of neighborhood
*social health facilities available
*comm. And transportatx facilities

d. Health Assessment of Each Member PE

e. Value Placed on Prevention of Disease

*Immunization
*Compliance behavior
First Level Assessment
*Health Threats:
-Conditions that are conducive to disease, accident or failure to realize ones
health potential
-Example:
Family history of illness hereditary like DM, HPN
Nutritional problem eating salty foods
Personal behavior smoking, self medication, sexual practices, drugs,
excessive drinking
Inherent personality characteristics short temperedness, short attention
span
Short cross infection
Poor home environment
Lack / Inadequate immunization
Hazards fire, falls, or accidents-
Family size beyond what resources can provide -

*Health Deficits:
-Instances of failure in health maintenance ( disease, disability, developmental
lag )
3 TYPES:
a. Disease / Illness URTI, marasmus, scabies, edema
b. Disabilities blindness, polio, colorblindness, deafness
c. Developmental Problem like mental retardation, gigantism, hormonal,
dwarfism

*Stree points / Forseeable Crisis Situation:

-Anticipated periods of unusual demand on the individual or family in terms of
adjustment or family resources ( nature situations )
-Example:
Entrance in school
Adolescents (circumcision, menarche, puberty)
Courtship (falling inlove, breaking up)
Marriage, pregnancy, abortion, puerperium
Death, unemployment, transfer or relocation, graduation, board exam

Second Level Assessment (Family tasks involved)

Family tasks that cant be performed

*Recognition of the problem
*Decision on appropriate health action
*Care to affected family member
*Provision of health home environment
*Utilization of community resources for health care
Problem Prioritization:
*Natur eof the Problem
Health Deficit
Health Threat
Forseeable Crisis
*Preventive Potential
High
Moderate
Low
*Modifiability
Easily modifiable
Partially modifiable
Not modifiable
*Salience
High
Moderate
Low
Family Service and Progress Record

Family Coping Index

Physical Independence ability of the family to move in and out of bed and
performed activities of daily living.
Therapeutic Independence abilty of the family to comply with the therapeutic
regimen ( diet, medication and usage of appliances ).
Knowledge of Health Condition wisdom of the family to understand the
disease process.
Application of General and Personal Hygiene ability of the family to perform
hygiene and maintain environment conducive for living.
Emotional Competence ability of the family to make decision maturely and
appropriately ( facing the reality of life ).
Family Living Pattern the relationship of the family towards each other with
love, respect and trust.
Utilization of Community Resources ability of the family to know the function
and existence of resources within the vicinity.
Health Care Attitude relationship of the family with the health care provider.
Physical Environment ability of the family to maintain environment conducive
for living.

COMMUNITY Patient
- Defined by geographic boundaries with certain identifiable characteristics,
with common values and interests.
POPULATION GROUPS-
-Aggregation of people who share common chaaracteristics, developmental
stage or common exposure to particular environmental factors thus resulting in
common health problems ( Clark, 1995: 5 ) e.g. children, elderly, women,
workers, etc.

- Vulnerable Groups: or High Risk Groups ( before )

*Infants and Young Children dependent to caretakers
*School age most negected
*Adolescents identify crisis, HIV
*Mother 1/3 of population health problem ( pregnancy, delivery,
puerperium )
*Males too macho to consult
*Old People degenerative disease

- Specialized Fields:
*COMMUNITY MENTAL HEALTH NURSING a unique process which
includes an integration of concepts from nursing, mental health, social
psychology, psychology, community networks, and the basic sciences.
Focus: Mental Health Promotion no need to identify disease, increase mental
wellness of people.
Nursing: Strengthening the support mechanism
Psychiatric Nursing-Focus: Mental Disease Prevention
Focus: Mental Disease Prevention identify disease and shorten disease
process

*OCCUPATIONAL HEALTH NURSING the application of nursing principles

and procedures in conserving the health of workers in all occupations.
Aims: Health promotion and prvention of disease and injuries, risk
minimization, ensuring safe work place from industrial to service

*SCHOOL AND HEALTH NURSING the application of nursing theories and

principles in the care of the school population.
Components:
School Health Services- maintain school clinic, screening all children-
visual, hearing, scoliosis

Health Instruction- health education/ counselor direct & undirect

Healthful School Living- health monitor

Mental health- substance abuse, sexual H

 Environmental health- food sanitation, water supply, safe environment,
safe toilet

School community- linkage- comm. Organizer

D. Health Care Delivery System

PHILIPPINE HEALTH CARE DELIVERY SYSTEM

The Philippine health care delivery system is composed of two sectors: (1)
the public sector, which largely financed through a tax-based budgeting
system at both national and local levels and where health care is generally
given free at the point of service and (2) the private sector (for profit and
non-profit providers) which is largely market-oriented and where health care
is paid through user fees at the point of service.

The public sector consists of the national and local government agencies
providing health services. At the national level, the Department of Health
(DOH) is mandated as the lead agency in health. It has a regional field office in
every region and maintains specialty hospitals, regional hospitals and medical
centers. It also maintains provincial health teams made up of DOH
representatives to the local health boards and personnel involved in
communicable disease control, specifically for malaria and schistosomiasis.
Other national government agencies providing health care services such as
the Philippine General Hospital are also part of this sector.
With the devolution of health services, the local health system is now run by
Local Government Units (LGUs). The provincial and district hospitals are under
the provincial government while the city/municipal government manages the
health centers/rural health units (RHUs) and barangay health stations (BHSs).
In every province, city or municipality, there is a local health board chaired by
the local chief executive. Its function is mainly to serve as advisory body to the
local executive and the sanggunian or local legislative council on health-
related matters.

The private sector includes for-profit and non-profit health providers. Their
involvement in maintaining the peoples health is enormous. This includes
providing health services in clinics and hospitals, health insurance,
manufacture of medicines, vaccines, medical supplies, equipment, and other
health and nutrition products, research and development, human resource
development and other health-related services.

1. PRIMARY LEVEL FACILITIES

2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES
Classify as to what level the following belong
1. Teaching and Training Hospitals _______________
2. City Health Services _______________
3. Emergency and District Hospitals _______________
4. Private Practitioners _______________
5. Heart Institutes _______________
6. Puericulture Centers _______________
7. RHU Primary Level Facilities

Primary RHU, Brgy health centers

Secondary District Hospitals
Tertiary Provincial Hospitals, City Hospitals

THE DEPARTMENT OF HEALTH

DEPARTMENT OF HEALTH
-Lead agency in the Health Sector
-Sets the goals for the nations health status
-Establishes PARTNERSHIP

DOH MANDATE
1. Formulation
2. Support
3. Issuance
4. Promulgation
5. Development

Roles of DOH:
1. Leadership in Health
*Serve as the national policy and regulatory institution.
*Provide leadership in the formulation, monitoring and evaluation of the
national health policies, plans and programs.
*Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and Capacity builder
*Innovate new strategies in health.
*Exercise oversight functions and monitoring and evaluation of national health
plans, program and policies.
*Ensure the highest achievable standards of quality health care, promotion and
protection
3. Administrator of specific services
*Manage selected national health facilities and hospitals with modern and
advanced facilities.
*Administer direct services for emergent health concerns that require new
complicated technologies.

Primary Function of of DOH

-Promotion
-Protection
-Preservation
-Restoration

VISION:
Old: Health for all Filipinos
New: The Leader of health for all in the Philippines
New: The DOH is the leader, staunch advocate and model in promoting Health
for all in the Philippines.

New: A global leader for attaining better health outcomes, competetive and
responsive health care system, and equitable health financing by 2030.

MISSION:
-Old: Ensure accessability and quality of health care services to improve the
quality of life of all Filipinos, especially the poor.
-New:To guarantee equitable, sustainable and quality health for all Filipinos,
especially the poor, and to lead the quest for excellence in health.

PHILOSOPHY OF DOH:
-Quality is above Quantity!
PRINCIPLES OF DOH
P Performance of health sector must be enhanced.
U Universal Access to basic health services.
S Shifting from infectious to degenerative diseases must be managed.
H Health, and nutrition of vulnerable group must be prioritized.

STRATEGIES OF DOH
SAID!!!
S support the local health system and front line workers.
A assurance of health care for all.
I increase investment of PHC.
D development of national standards.
GOAL: Heal Sector Reform Agenda ( HSRA ).

Rationale for HSRA:

*Slowing down in the reduction of Infant Mortality and Maternal Mortality
Rates.
*Persistence of large variations in health status across population groups and
geographic areas.
*High burden from infectious diseases.
*Rising burden from chronic and degenerative diseases.
*Unattended emerging health risks from environmenmental and work related
factors.
*Burden of disease is heaviest on the poor.

Framework for the Implementation of HSRA: FOURmula One for Health

Goals of FOURmula ONE for Health:

1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing

Elements of the Strategy:

1. Health financing to foster greater, better and sustained investments in
health.
2. Health regulation to ensure quality and affordability of health goods and
services.
3. Health service delivery to improve and ensure the accessibility and
availability of basic and essential health care in both public and private
facilities and services.
4. Good governance to enhance health system performance at the national
and local levels.

Roadmap for All Stakeholders in Health: National Objectives for Health

2005 2010.

National Objective for Health: sets the target and the critical indicators,
current strategies based on field experience, and laying down new avenues for
improved interventions.

Goals and Objectives of the Health Sector:

*Improve general health status of the population.
 ( reduce the infant mortality rate, reduce child mortality rate, reduce maternal
mortality rate, reduce total fertility rate, increase life expectancy and the quality
of life years ).
*Reduce morbidity and mortality from certain diseases.
*Eliminate certain diseases as public health problems.
- Schistosomiasis
- Malaria
- Filariasis
- Leprosy
- Rabies
- Measles
- Tetanus
- Diphtheria and Pertussis
- Vitamin A Deficiency and Iodine deficiency disorders.
*Eradicate Poliomyelitis
*Promote healthy lifestyle and environmental health.
*Protect vulnerable groups with special health and nutrition needs.
*Strenthen national and local health systems to ensure better health service
delivery.
*Pursue public health and hospital reforms.
*Reduce the cost and sure the quality of essential drugs.
*Institute health regulatory reforms.
*Strengthen health governance and management support systems.
*Institute safety nets for the vulnerable and margenalized groups.
*Expand the coverage of social health insurance.
*Mobilize more resources for health
*Improve efficiency in the allocation, production and utilization of resources for
health.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health servicesmust be ensured.
2. The health and nutrrition of vulnerable groups must be prioritized
3. The epidemiological shift from infection to degenerative diseases must be
managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals

1. Increasing investment for primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

E. PHC as a Strategy
PHC as a Strategy

PRIMARY HEALTH CARE (PHC)

*May 1977 30th World Health Assembly decided that the main health target
of the government and WHO is the attainment of a level of health that would
permit them to lead a socially and economically productive life by the year
2000.

*September 6 12, 1978 First InternationalConference on PHC in Alma Ata,

Russia ( USSR ) the Alma Ata Declaration stated that PHC was the key to
attain the health for all goal.

*October 19, 1979 Letter of Instruction ( LOI 949 ), the legal basis of PHC
was signed by President Ferdinand E. Marcos, which adopted PHC as an
approacch toward the design, development and implementation of programs
focusing on health development at community level.
LOI 949 signed by President Marcon with an underlying theme: Health in
the hands of the People by 2020.

Rationale for Adopting PRIMARY HEALTH CARE:

*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.

DEFINITION OF PRIMARY HEALTH CARE

*Essential health care made universally accessible to individuals and families
in the community by means acceptable to them, through their full participation
and at cost that the community can afford at every stage of development.
*A practice approach to making health benefits within the reach of all people.
*An approach to health development, which is carried out through a set of
activities and whose ultimate aim is the continuous improvement and
maintenance of health status of the community.

Goal of PRIMARY HEALTH CARE:

*Health for all Filipinos by the year 2000 and health in the Hands of the people
by the year 2020.

An improved state of health and quality of life for all people attained through
SELF-RELIANCE.
Concept of PHC
KEY STRATEGY TO ACHIEVE THE GOAL:
- charactterized by partnership and empowerment of the people that shall
permeate as the core strategy in the effective provision of essential health
service that are community based, accessible, acceptable and sustainable at a
cost, which the community and the government can afford.

OBJECTIVES OF PRIMARY HEALTH CARE

*Improvement in the level of health care of the community.
*Favorable population growth structure.
*Reduction in the prevalence of preventable, communicable and other disease.
*Reductionin morbidity and mortality rates especially among infants and
children.
*Extension of essential health services with priority given to the underserved
sectors.
*Improvement in Basic Sanitation.
*Development of the capability of the community aimed at self reliance.
*Maximizing the contribution of the other sectors for the social and economic
development of the community.

MISSION:
*To strengthen the health care system by increasing opportunities and
supporting the conditions wherein people will manage their own health care.

Two levels of PRIMARY HEALTH CARE WORKERS

1. Barangay Health Workers trained community health workers or health
auxiliary volunteers or traditional birth attendants or healers.
2. Intermediate Level Health Workers include the Public Health Nurse, Rural
Sanitary Inspector and Midwives.

Levels of Health Care and Referral System

1. Primary Level of Care Health care provided by center physicians, PHN,
Rural Health Midwives,Barangay Health Workers and other at the Baragay
Heath Station and Rural Health Units.
2. Secondary Level of Care Given by physicians with Basic Health Training;
given in Health Facilities which are privately owned or government operated
such as infirmaries, municipal and district hospitals and OPD of Provincial
Hospitals; serves as the Referral Center for Primary Health Facilities.
3. Tertiary Level of Care Care rendered by Specialists in Health Facilitis
including Medical Centers as well as Regional and Provincial Hospitals and
specialized Hospitals.

PRINCIPLES OF PRIMARY HEALTH CARE

 1. 4 As = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of Health Services. The Health Services should ebe
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.
2. Community Participation = Heart and Soul of Primary Health Care.
3. People are the center, object and subject of development =
- Thus, the success of any undertaking that aims at serving the people
is dependent on peoples participation at all levels of decision - making;
planning, implementing, monitoring and evaluating. Any undertaking
must also be based on the peoples needs and problems ( PCF, 1990 ).
- Part of the peoples participation is the partnership between the
community and the agencies found in the community; social
mobilization and decentralization.
- In general, health work should start from where the people are and
building on what they have. Example: Scheduling of Barangay Health
Workers in the Health Centers.

Barriers of COMMUNITY INVOLVEMENT

- Lack of motivation
- Attitude
- Resistance to change
- Dependence on the part of community people
- Lack of managerial skills

4. SELF RELIANCE

5. Partnership between the community and the health agencies in the

provision of quality of life = Providing linkages between the government and
the non government organization and peoples organization.

6. Recognition of interrelationship between the health and development =

HEALTH
- is not merely the absence of disease. Neither it is only a state of physical and
mental well being.
- Health being a soical 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 (PCF,
DEVELOPMENT is the quest for an improved quality of life for all.
-Development is mulit dimentional. It has a political, social, cultural,
institutional and environmental dimensions ( Gonzales 1994 ). Therefore, it is
measured by the ability of people to satisfy their basic needs.
7. SOCIAL MOBILIZATION =
- It enhances people participation or governance, support system provided by
the Government, networking and developing secondary leaders.

8. DECENTRALIZATION

Strategies of PRIMARY HEALTH CARE

1. Reorientation ond reorganization of the national health care system.
2. Effective preparation and enabling process for health action at all levels.
3. Mobilization of the people to know their communities and identifying their
basic health needs.
4. Development and utilization of appropriate technology.
5. Organization of communities.
6. Increase opportunities for community participation.
7. Development of intra intersectoral linkages.
8. Emphasizing partnership.

MAJOR STRATEGIES OF PRIMARY HEALTH CARE

A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED
NATIONAL EFFORT
- Attaining Health for aal Filipino will require expanding participation in health
and health related programs whether as service provider oe beneficiary.
Empowerment to parents, families and communities to make decisions of their
health is really 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.
B. 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 builiding of communities and
organization to plan, implement and ealuate health prgrams at their levels.
C. INCREASING EFFICIENCIES IN THE 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. The DOH will continue to
support and assist both public and private institutions particularly in faculty
development, enhancementof relevant curricula and development of standard
teaching materials.
D. 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.

FOUR CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE

1. Active community participation
2. Intra Intersectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH

NAME INDICATIONS DOSAGE
1. Five leaf Chaste tree 1. Asthma *Divide the decoction
LAGUNDI (Vitex 2. Cough into 3 parts:
negundo) 3. Body Pain -For asthma and cough,
4. Fever drink 1 part 3 times a
day.
-For fever and body
pains,drink 1 part every
4 hours.
2. Marsh Mint; 1. Body aches and *Divide decoction into 2
Peppermint YERBA pain, parts and drink 1 part
BUENA (Clinopodium e.g., rheumatism, every 3 hours.
douglasii) headache, swollen
gums,toothache,
menstrual and gas pain.
3. Blumea camphora 1. Swelling *Divide decoction into 3
SAMBONG (Blumea 2. Inducing diuresis ( parts and drink 1 parts 3
balsamifera) anti urolithiasis ) times a day.
4. TSAANG GUBAT 1. Effective in treating *Drink the warm
(Ehretia microphylla intestinal motility and decoction. If it persists,
Lam). also used as a mouth or if there is no
wash since the leaves improvement an hour
of this shrub has high after drinking the
flouride content. decoction, consult a
doctor.
5. ULASIMANG BATO 1. Effective in fighting *The leaves can be
(Peperomia pellucida). arthritis and gout. eaten fresh (about a
-also known as PANSIT- cupful) as a salad or
PANSITAN. decocted and drunk as
tea. For the Decoction,
boil a cup of clean
chopped leaves in 2
cups of water. Boil for 15
to 20 minutes. Strain, let
cool and drink a cup
after meals (3 time a
day).
6. Garlic 1. Reduces cholesterol *Eat 6 cloves of garlic
BAWANG (Allium in the blood and hence, together with meals.
sativum) helps control blood
pressure.
(Hypertension,
Hyperlipidemia)
7. Chinese honeysuckle 1. Elimination of *Chew and swallow only
NIYOG NIYOGAN Intestinal worms, dried seeds 2 hours
(Quisqualis Indica L.) particularly the ascaris after dinner according to
and trichina. the following:
ADULTS = 8 -10 seeds
9 12 years old = 6 7
seeds
6 8 years old = 5 6
seeds
4 5 years old = 4 5
seeds
8. Guava 1. ANTISEPTIC (to *For wound cleaning,
BAYABAS (Psidium clean/disinfect wounds) use decoction for
Guajava) 2. Mouth wash washing the wound 2
infection, sore gums times a day.
and tooth decay. *For tooth decay and
swelling of gums, gargle
with warm decoction 3
times a day.
9. Ringworm bush Treatment of ringworms *Apply the juice on the
AKAPULKO also known and skin fungal affected area 1 to 2
as bayabas infections. times a day.
bayabasan (Cassia 1. Ring worm *If the person develops
alata) 2. Athletes foot an allergy while using
3. Scabies the above preparation,
prepare the following:
= Put 1 cup of chopped
 fresh leaves in an
earthen jar. Pour in 2
glasses of water and
cover it.
= Boil the mixture until
the 2 glasses of water
originally poured have
been reduced to 1 glass
of water.
= Strain the mixture.
Use it while it is warm.
= Apply the warm
decoctionon the affected
area 1 to 2 times a day.
10. Bitter gourd or Bitter 1. Mild Non Insulin *Drink cup of cold or
melon Dependent Diabetes warm decoction 3 times
AMPALAYA (Momordica Meelitus a day after meals.
Charantia) = Lowers Blood Sugar
Levels.

11. Ginger (Zingiber 1. Motion Sickness, *An abortifacient if taken

officinale) sore throat, nausea and in large amounts; should
vomiting, migraine not be used by persons
headaches, arthritis. with cholelithiasis unless
directed by the
physician; may increase
the risk of bleeding
when used concurrently
with anticoagulants and
antiplatelets.
*Chop and Mash a piece
of ginger root, and mix in
a glass of water.
*Boil the mixture.
*Drink the cold or warm
decoction as needed.

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 being advocated
4. follow accurate dose of suggested preparation.
 5. Use only one kind of herbal plant for each type of symptom or sickness.
6. Stop giving the herbal medication in cases of untoward reactions.
7. If signs and symptoms are not relieved after 2-3 doses, consult a
doctor.

Elements/Components of Primary Health Care: E L E M E N T S D A M

*Education For Health
-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.
*Locally Endemic Disease Prevention and Control
-The control of endemic disease focuses on the prevention of its occurrence to
reduce morbidity rate. Example Malaria Control and Schistosomiasis Control.
*Expanded Program of Immunization
-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.
*Maternal and Child Health and Family Planning
-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.
*Environmental Sanitation and Promotion of Safe Water Supply
-Environmental Sanitation is defined as the study of all factors in the mans
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 mans environment. Water is
necessary for the maintenance of healthy lifestyle.
-Safe Water and Sanitation is necessary for basic promotion of health.
*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 knowledge regarding proper food planning,
Malnutrition is one of the problems that we have in the country.
*Treatment of Communicable Diseases and Common Illness
-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 illness.
*Supply and Proper Use of Essential Drugs and Herbal Medicine
-This focuses on the information campaign on the utilization and acquisition of
drugs.
-In response to this campaign, the GENERIC ACT of the Phiippines is
enacted. It includes the following drugs: Cotrimoxazole, Paracetamol,
Amoxycilli, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,
Ethambutol, Streptomycin, Albendazole,Quinine.
*Dental Health Promotion
*Acces to and Use of Hospitals as Centers of Wellness
*Mental Health Promotion

Functions of the PRIMARY HEALTH NURSING:

1. Management Function
2.Training Function
3.Supervisory Function
4.Health Care Provider Nursing Care Function
5. Health Promotion and Education Function
6. Collaborating and Coordinating Function
7.Research Function

F. Family-based Nursing Services (Family Health Nursing Process)

FAMILY BASED NURSING SERVICES (FAMILY HEALTH NURING
PROCESS)
FAMILY HEALTH NURSING

FAMILY HEALTH NURSING

*Is a special field in nursing in which the family is the unit of care, health as its
goal and nursing as its medium or channel of care.

FAMILY NURSING PROCESS

*It is a means by which the health care provider addresses the health needs
and problems of the client.
*It is a logocal and systematic, way of processing information gathered from
different source and translating into meaningful actions or interventions.

Concept of Family as a Basic Unit of Society

*The Universal Declaration of Human Rights in Article 16 states that the family
is the natural and fundamental unit of society and is entitled to protection both
by society and the State.

STEPS:
1. RELATING
- Establishing a working relationship. Results in positive outcomes such as
good quality of data, partnership in addressing identified health need and
problems, and satisfaction of the nurse and the client.
2. ASSESSMENT
- Data Collection, Data Analysis and Data Interpretation and Problem definition
or Nursing Diagnosis.
TWO TYPES OF ASSESSMENT
a. First Level Assessment Data on status / conditions of family
household members.
b. Second Level Assessment Data on family assumption of health tasks
on each problem identified in the First Level Assessment.
3. PLANNING
- Determination of how to assist client in resolving concerns related to
restoration. Maintenance or promotion of health.
- Establishment of priorities, set goals / objectives, selects strategies, describe
rationale.
4. IMPLEMENTATION
- The carring out of plan of care by client and nurse, make ongoing
assessment, update / revise plan, document responses.
5. EVALUATION
- A systematic, continuous process of comparing the clients response with
written goal and objective.
-Determines progress and evaluate the implemented intervention as to:
1. Effectiveness
2. Efficiency
3. Adequacy
4. Acceptability
5. Appropriateness

I. NURSING ASSESSMENT
-Involves a set of actions by which the nurse measures the status of the family
as a client, their ability to maintain wellness, prevent and control or resolve
problems in order to achieve health and well being among its members.

Steps in Nursing Assessment

1. Data Collection
- The process of identifying the types or kinds of data needed.
- Specify the methods necessary to collect such data.

Methods of Data Collection

a. Observation is use of all sensory capacities. The familys status can
be inferred from the manifestations of problem areas reflected in the
following:
1. Communication and interaction pattern expected, used and tolerated
by family members.
2. Role perceptions / tasks assumptions by each member including
decision making patterns.
3. Conditions in the home and environment
 b. Physical Examination is done through inspection, palpation,
percussion, and auscultation.
c. Interview by completing health history for each member. Health
history determines current health status.
d. Record Review is the review existing records and reports pertinent to
the client / family such as diagnostic reports and immunization records.
e. Laboratory / Diagnostic Tests

5 Types of Date in Family Nursing Assessment (Initial Data Base)

A. Family Structure, Characteristics and Dynamics
1. Members of the household and relationship to the head of the family
2. Demographic data - age, sex, civil status, position in the family
3. Place of residence of each member - whether living with the family or
elsewhere.
4. Type of family structure - e.g. matriarchal or patriarchal, nuclear or
extended
5. Dominant family members in terms of decision-making, especially in
matters of health care.
6. General family relationship / dynamics - presence of any obvious /
readily observable conflict between members; characteristic,
communication / interaction pattern among members.

B. Socio-economic and Cultural Characteristics

1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others - role(s) they play in family's life
5. Relationship of the family to larger community - Nature and extent of
participation of the family in community activities.

C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of disease (e.g.
mosquitoes, roaches, flies, rodents, etc)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply - source, ownership, sanitary condition
 g. Garbage/ refuse disposal - type, sanitary condition
h. Drainage system - type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum
3. Social and health facilities available
4. Communication and transportation facilities available

D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant
illnesses or beliefs and practices conducive to health and illness.
2. Nutritional assessment ( specially for vulnerable or risk at-risk
members)
a. Anthropometric data: Measures of nutritional status of children-
weight, height, mid-upper arm circumference.
b. Dietary history specifying quality and quantity of food/ nutrient intake
per day
c. Eating/feeding habits /practices
3. Developmental assessment of infants, toddlers, and preschoolers -
e.g., Metro Manila Developmental Screening Test (MMDST)
4. Risk factor assessment indicating presence of major and
contributing modifiable risk factors for - e.g. hypertension physical
inactivity, sedentary lifestyle, cigarette/ tobacco smoking, elevated blood
lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking and other substance abuse.
5. Physical assessment indicating presence of illness state/s
(diagnosed or undiagnosed by medical practitioners.

6. Results of laboratory / diagnostic and other screening procedures

supportive of assessment findings.

E. Values, Habits, Practices on Health Promotion, Maintenance and

Disease Prevention Such as:
1. Immunization status of family members.
2. Healthy lifestyle practices.
3. Adequacy of :
a. rest and sleep
b. exercise / activities
c. Use of protective measures - e.g. adequate footwear in parasite-
infested areas; use of bednets and protective clothing in malaria
and filariasis endemic areas.
d. Use of relaxation and other stress management activities
4. Use of promotive-preventive health services.

2. Data Analysis
Steps:
1. Sorting of data for broad categories (such as those related with health
status or practices about home and environment).
2. Clustering of related cues to determine relationship among data.
3. Distinguishing relevant from irrelevant data. This will help in deciding
what information is pertinent to the situation at hand and what
information is immaterial.
4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication patterns.
5. Compare patterns with norms or standards of health, family functioning
and assumption of health tasks.
6. Interpreting results of comparisons to determine signs and symptoms
or cues of specific wellness state/s, health deficit/s, health threat/s,
foreseeable crises/stress point/s and their underlying causes or
associated factors.
7. Making conclusions about the reasons for the existence of the health
condition or problem, or risk for non-maintenance of wellness state/s
which can be attributed to non-performance of family tasks.

3. Problem Definition/Nursing Diagnosis

End result of 2 major types of assessment.

Family Nursing Problem - Stated as an inability to perform specific health

task and the reasons / etiology) why the family cannot perform such task.

Consists of 2 parts: main category of problem (coming from unattained

health task) and specific problems (statement of factors contributory for
the existence of the main problem.
Example: (general): Inability to utilize resources for health care due to
lack of adequate family resources, specifically: (specific)
a. financial resources
b. manpower resources
c. time
The more specific the problem definition, the more
useful is the nursing diagnosis in determining the
nursing intervention. Therefore, as many as three or
four levels of problem definition can be stated.

Typology of Nursing Problems in Family Nursing Practice

1. First Level of Assessment process whereby existing potential

health conditions/problems of the family are determined.
 a. Presence of Wellness Condition states as potential or
readiness a clinical or nursing judgement about a client in
transition from a specific level of wellness or capability to a higher
level.

b. Presence of Health Deficits - Instances of failure in health

maintenance.
A. Illness States, regardless of whether it is diagnosed or undiagnosed
by medical practitioner
B. Failure to thrive/ develop according to normal rate
C. Disability - whether (1) congenital or (2) arising from illness.

c. Presence of Health Threats - Conditions that are conducive to

disease, accident or failure to realize one's health potential.
A. Family history of hereditary condition / disease
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards .
1. broken stairs
2. pointed /sharp objects, poisons, & medicines improperly kept
3. fire hazards
4. fall hazards
5. others (specify):________
E. Faulty / unhealthy nutritional / eating habits or feeding techniques /
practices.
1. inadequate food intake both in quality and quantity
2. excessive intake of certain nutrients
3. faulty eating habits
4. ineffective breastfeeding
5. faulty feeding techniques
F. Stress-provoking factors
1. strained marital relationship
2. strained parent-sibling relationship
3. interpersonal conflicts between family members
4. care-giving burden
G. Poor home / environmental condition/ sanitation
1. inadequate living space
2. lack of food storage facilities
3. polluted water supply
4. presence of breeding or resting sites of vectors of diseases
5. improper garbage / refuse disposal
6. unsanitary waste disposal
7. poor lightning and ventilation
8. noise pollution
 9. air pollution
H. Unsanitary food handling and preparation
I. Unhealthy lifestyle and personal habits /practices
1. alcohol drinking
2. cigarette / tobacco smoking
3. walking barefooted or inadequate footwear
4. eating raw meat or fish
5. poor personal hygiene
6. self-medication/ substance abuse
7. sexual promiscuity
8. engaging in dangerous sports
9. inadequate rest or sleep
10. lack of / inadequate exercise / physical activity
11. lack of / inadequate activities
12. non-use of self-protection measures (e.g. non-use of bednets in
Malaria and Filariasis endemic areas)
J. inherent personal characteristics - such as poor impulses control
K. Health history which may precipitate / induce the occurrence of a
health deficit, e.g. previous history of difficult labor.
L. Inappropriate role assumption - e.g. child assuming mother's role,
father not assuming his role
M. Lack of immunization / inadequate immunization status specially of
children
N. Family disunity - e.g. self-oriented behavior of members (s),
unresolved conflicts of members(s), intolerable disagreement
O. Others, specify : _____________

d. Presence of Stress Points / Foreseeable Crisis - Anticipated

periods of unusual demand on the individual or family in terms of
adjustment / family resources.
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member - e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of Job
K. Hospitalization of a family member
L. Death of a Member
M. Resettlement in a new community
N. Illegitimacy
 O. Other, Specify ______________

2. Second Level of Assessment defines the nature or type of nursing

problems that the family encounters in performing health.

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem, specifically :
1. social-stigma, loss of respect of peers / significant others
2. economic / cost implications
3. physical consequences
4. emotional / psychological issues / concerns
C. Attitude / philosophy in life which hinders recognition / acceptance of
a problem.
D. Others, specify __________

II. Inability to make decisions with respect to taking appropriate health

action due to:
A. Failure to comprehend the nature/ magnitude of the problem /
condition
B. Low salience of the problem / condition
C. Feeling of confusion, helplessness and / or resignation brought by
perceived magnitudes / severity of the situation or problem, i.e.,
failure to break down problems into manageable units of attacks
D. Lack of / or inadequate knowledge / insight as to alternative courses
of action to take
E. Inability to decide which action to take among the list of alternatives
F. Conflicting opinions among family members / significant others
regarding action to take
G. Lack of / or inadequate knowledge of community resources for care
H. Fear of consequence of action, specially:
social consequences
economic consequences
physical / psychological consequences
I. Negative attitude towards the health problem By negative attitude
is meant one that interferes with rational decision making
J. Inaccessibility of appropriate resources for care, specifically:
1. physical inaccessibility
2. cost constraints or economic / financial inaccessibility
K. Lack of trust / confidence in the health personnel / agency
L. Others, specify______________
III. Inability to provide adequate nursing care to sick, disabled, dependent
or vulnerable / at-risk member of the family due to:
A. Lack of / inadequate knowledge about the disease / health condition
(nature, severity, complications, prognosis and management );
B. Lack of / inadequate knowledge about the child development and
care;
Lack of / inadequate knowledge of the nature and extent of nursing
care needed;
C. Lack of the necessary facilities, equipment and supplies for care;
D. Lack of or inadequate knowledge and skill in carrying out the
necessary interventions / treatment / procedure / care (e.g., complex
therapeutic regimen or healthy lifestyle program);
E. Inadequate family resources for care, specifically:
Absence of responsible member
Financial constraints
Limitations / lack of physical resources e.g. isolation room
F. Significant persons unexpressed feelings (e.g. hostility / anger, guilt,
fear / anxiety, despair, rejection) which disable his / her capacities to
provide care.
G. Philosophy in life which negates / hinder caring the sick, disabled,
dependent, vulnerable / At risk member
H. Members preoccupation with own concerns / interests
I. Prolonged disease or disability progression which exhausts
supportive capacity of family members
J. Altered role performance specify :
a. role denial or ambivalence
b. role strain
c. role dissatisfaction
d. role conflict
e. role confusion
f. role overload
K. Others, specify _________________

IV. Inability to provide a home environment conducive to health

maintenance and personal development due to :
A. Inadequate family resources, specifically:
a. financial constraints / limited financial resources
b. limited physical resources e.g. lack of space to construct facility
B. Failure to see benefits (specifically long-term ones) of investment in
home environment improvement
C. Lack of / inadequate knowledge of importance of hygiene and
sanitation
D. Lack of / inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
 F. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude / philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of / inadequate competencies in relating to each other for
mutual growth and maturation (e.g. reduced ability to meet the
physical and psychological needs of other members as a result of
J. familys preoccupation with current problem or condition)
K. Others, specify --------------------------

V. Failure to utilize community resources for health care due to :

A. Lack of / inadequate knowledge of community resources for health
care
B. Failure to perceive the benefits of health care / services
C. Lack of trust / confidence in the agency / personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic.
Rehabilitative ), specifically :
a. physical / psychological consequences
b. financial consequences
c. social consequences e.g. , loss of esteem of peer / significant
others
F. Unavailability of required care / service
G. Inaccessibility of required care / service due to:
a. cost constraints
b. physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically ;
a. manpower resources e.g. baby sitter
b. financial resources e.g., cost of medicine prescribed
I. Feeling of alienation to / lack of support from the community, e.g.,
stigma due to mental illness, AIDS, etc.
J. Negative attitude / philosophy in life which hinders effective /
maximum utilization of community resources for health care
K. Others, specify----------------

II. PLANNING
- The step in the process which answers the following questions:
*What is to be done?
*How is to be done?
*When it is to be done?
-It is actually the phase wherein the health care provider formulates a care
plan.

Steps in developing a Family Nursing Care Plan

 1. Prioritized problems
2. Goals and Objectives of the Nursing Care
3. Plan of Intervention
4. Plan for Evaluating Care.

Prioritizing Health Problems

1. Nature of the Problem Presented - Categorized into wellness state,
health threat, health deficit and foreseeable crisis.

2. Modifiability of the Problem/Condition - Refers to the probability of

success in enhancing, improving, minimizing, alleviating or totally
eradicating the problem through intervention.

3. Preventive Potentials - 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.

4. Salience - Refers to the family's perception and evaluation of the

problem in terms of seriousness and urgency of attention needed or
family readiness.

Scoring
1. Decide a score for each of the criteria
2. divide the score by the highest possible & multiply by the weight
Score x weight
Highest score
3. Sum up the score of all criteria. The highest score is 5 equivalent to the
total weight.

CRITERIA Weight
1. Nature of the problems Presented 1
Scale:
-Health deficit / Wellness 3
-Health threat 2
-Foreseeable crisis 1
2. Modifiability of the problem 2
Scale:
-Easily modifiable 2
-Partially modifiable 1
-Not modifiable 0
3. Preventive potential 1
Scale:
-High 3
-Moderate 2
-Low 1
4. Salience 1
Salience:
-A condition / problem needing Immediate 2
attention
*A condition / problem not needing 1
Immediate attention
*Not perceived as a problem or condition 0
needing change.

Factors affecting priority setting:

The nurse considers the availability of the following in determining the
modifiability of a health condition or problem.
1. Current Knowledge, Technology and Interventions
2. Resources of the family Physical, Financial and Manpower
3. Resources of the nurse Knowledge, Skills and Time
4. Resources of the Community Facilities and Community organization or
support.

Factors in Deciding Appropriate Score for Preventive Potential

1. Gravity or severity of the problem - Refers to the progress of the disease/
problem indicating extent of damage on the patient / family. Also indicates
the prognosis, reversibility of the problem
2. Duration of the problem - refers to the length of time the problem has
been existing
3. Current Management - refers to the presence and appropriateness of
intervention
4. Exposure of any high risk group

Family Nursing Care Plan

* It is the blueprint of care that the nurse designs to systematically minimize
or eliminate the identified family health problem through explicitly formulated
outcomes of care (goal and objectives) and deliberately chosen set of
interventions/resources and evaluation criteria, standards, methods and tools.

Characteristics of Family Nursing Care Plan

1. It focuses on actions which are designed to solve or alleviate & existing
problem.
2. It is a product of deliberate systematic process.
3. The FNCP as with other plans relates to the future.
4. It revolves around identified health problems.
5. It is a mean to an end and not a end to itself.
6. It is a continuous process, not one shot deal.

Desirable Qualities of Family Nursing Care Plan

1. It should be based on a clear definition of the problem.
2. A good plan is realistic, meaning it can be implemented with reasonable
chance of success
3. It should be consistent with the goals and philosophy of the health agency.
4. Its drawn with the family.
5. Its best kept in written form.

Setting/ Formulating Goals & Objectives

This will set direction of the plan.
This should be stated in terms of client outcomes whether at the
individual, family or community level.
The mutual setting of goals which is the cornerstone of effective planning
consists of:
1. Identifying possible resources.
2. Delineating alternative approaches to meet goals.
3. Selecting specific interventions.
4. Operationalizing the plan - setting of priorities.

Goal
* It is a general statement of the condition or state to be brought about
by specific courses of action.

Cardinal Principle in Goal setting

* It must be set jointly with the family. This ensures family commitment
to their realization.
* Basic to the establishment of mutually acceptable goal in the familys
recognition and acceptance of existing health needs and problems.

Barriers to Joint Goal Setting

1. Failure in the part of the family to perceive the existence of the problem.
2. Sometimes the family perceives the existence of the problem but does
not see it as serious enough to warrant attention.

Characteristics of Goals/ Objectives

1. Specific
2. Measurable
3. Attainable
4. Realistic
5. Time bound
Objective
Refers to a more specific statement of desired outcome of care.
They specify the criteria by which the degree of effectiveness of care is
to be measured.

Types of Objective
1. Short term or Immediate Objective
Formulated for problem situation which require immediate attention &
results can be observed in a relatively short period of time.
They are accomplished with few HCP-family contacts & relatively less
resources.
2. Medium or Intermediate objective
Objectives which is not immediately achieved & is required to attain
the long ones.
3. Long Term or Ultimate Objective
This requires several HCP-family contacts & an investment of more
resources.

Plan of Actions/ Interventions

Its aim is to minimize all the possible reasons for causes of the
familys inability to do certain tasks.

It is highly dependent on 2 Major Variables:

1. nature of the problem
2. the resources available to solve the problem

Typology of Interventions
1. Supplemental - the HCP is the direct provider of care.
2. Facilitative - HCP removes barriers to needed services.
3. Developmental - improves clients capacity.

III. Implementation
Actual doing of interventions to solve health problems.

IV. Evaluation
Determination whether goals / objectives are met.
Determination whether nursing care rendered to the family are
effective.
Determines the resolution of the problem or the need to reassess,
and re-plan and re-implement nursing interventions.

According to Alfaro-LeFevre:

Evaluation is being applied through the steps of the nursing process:

 Assessment changes in health status.
Diagnosis if identified family nursing problems were resolved,
improved or controlled.
Planning are the interventions appropriate & adequate enough to
resolve identified problems.
Implementation determine how the plan was implemented, what
factors aid in the success and determine barriers to the care.

Types of Evaluation:
On-going Evaluation analysis during the implementation of the
activity, its relevance, efficiency and effectiveness.

Terminal Evaluation undertaken 6-12 months after the care was

completed.

Ex-post Evaluation undertaken years after the care was provided

Steps in Evaluation:
1. Decide what to Evaluate.
Determine relevance, progress, effectiveness, impact and
efficiency
2. Design the Evaluation Plan
Quantitative a quantifiable means of evaluation which can be
done through numerical counting of the evaluation source.
Qualitative descriptive transcription of the outcome conducted
through interview to acquire an in-depth understanding of the
outcome.
3. Collect Relevant Data that will support the outcome
4. Analyze Data - What does the data mean?
5. Make Decisions
If interventions are effective, interventions done can be applied
to other client / group with the similar circumstances
If ineffective, give recommendations
6. Report / Give Feedbacks

Dimensions of Evaluation
1. Effectiveness focused on the attainment of the objectives.
2. Efficiency related to cost whether in terms on money, effort or
materials.
 3. Appropriateness refer its ability to solve or correct the existing
problem, a question which involves professional judgment.
4. Adequacy pertains to its comprehensiveness.

Tools Being used during Evaluation

Instruments are tools are being used to evaluate the outcome of the
nursing interventions:

Thermometer
Tape measure
Ruler
BP apparatus
Weighing scale
Checklist
Key Guide Questionnaires
Return Demonstrations

Methods of Evaluation
1. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises
1.1 Family Based Nursing Services (Family Health Nursing Process)
Nursing Assessment of Family:
First Level Assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance
and disease prevention
Second Level Assessment data include those that specify or describe the
familys realities, perceptions about and attitudes related to the assumption or
performance of family health tasks on each health condition or problem
identified during the first level assessment.
Developing the Nursing Care Plan
Steps in developing a family care plan:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. The plan of interventions
4. The plan for evaluating care
Implementing the Nursing Care Plan
During this phase the nurse encounters the realities in family nursing practice
which can motivate her to try out creative innovations or overwhelm her to
frustration or inaction. As the nurse practitioner works with clients she
experiences varying degrees of demands on her resources. A dynamic attitude
on personal and professional development is, therefore, necessary if she has
to face up to challenges of nursing practice.
Evaluation of Family Health Services.

G. Population Group-based Nursing Services

H. Community-based Nursing Services/ Community Health Nursing Process

COMMUNITY HEALTH NURSING PROCESS
1. Assessment/Diagnosis
a. Collection of data ( subjective: expressed by client or SO; objective:
measurable- interview & observations,senses, intrn)
b. Categories of health problems
2. Planning
3. Implementation
4. Evaluation- 3 elements : structural , process & measurable outcome or
objective

4 Tools/ Instruments for Data Collection:

1. Nursing history subj
2. PE- Obj
3. Lab- Obj
4. Process recording- obj (analyzed by RN)
CHN NOTES:
1. Primary Goal in CHN Self-reliance in health
2. Ultimate Goal in CHN Raise the level of health of the citizenry
3. Unit of care - Family
4. Levels of Clientele Individual, Family, Special Population &
Community
5. Primary Focus Health Promotion & Disease Prevention
6. Philosophy Of CHN Uphold the worth & dignity of man
7. Theoretical Bases of CHN Practice Theories & Principles of Nursing &
Public Health
8. CHN as : People-oriented, comprehensive & integrated,
focus on health

I. Community Organizing
COMMUNITY ORGANIZING
Maglaya DOH
Preparatory Phase Community Analysis
Organizational Phase Design and Initiation
Education and training Implementation
Collaboration Phase Program Maintenance Consolidation
Phase Out Dissemination Reassessment

COMMUNITY ORGANIZING a continuous and sustained (i.e. never-ending)

process of awareness-raising, organizing, and mobilizing. Awareness primary
motivation to action
Basic Concepts and Principles
Based on concrete analysis of actual situation
Basic trust on the people
By, for, with, and among the people
Anyone is capable of change
Self-willed changes have more meaning than imposed ones

Context of Community Organizing (CO): Current situation

towards the poor, deprived, oppressed (i.e. not all) but
struggling segments of the society

Goal of Community Organizing (CO): Community Development the

creation of a society that provides equal access to all benefits and
opportunities the society can offer to the people

Application of CO in Health: PRIMARY HEALTH CARE

PRIMARY HEALTH CARE

- Essential care (i.e. not alternative)
- Based on scientifically sound and socially acceptable methods and technology
- Made universally available to individuals, families, and communities
- At a cost they can afford at any given stage of their development
- Through their full participation
- Towards self- reliance and self-determination

Major Pillars of Primary Health Care

a. Multi-sectoral approach (inter- and intra-sectoral linkages)
b. Peoples participation
Partnership or shared leadership; minimum level of peoples participation
c. Appropriate technology underwent experimentation and with high empirical basis;
e.g. herbal medicine and accupressure
d. Support mechanism made available

COMMUNITY ORGANIZING IN HEALTH

Two types of community:

a. Organized community with peoples organization
b. Virgin community without peoples organization
Phases of CO:
1. SOCIAL INVESTIGATION
Preliminary Investigation
- done before entry to community
- secondary data sources are utilized
- baseline information from secondary data sources (e.g.
Records Review)
Deepening Social Investigation
- continuous appraisal of community situation through primary
data sources
2. ENTRY low-key or low-profile approach
Upon entry, start the following:
a. Deepening Social Investigation
b. Social Preparation
c. Community Integration
3. SOCIAL PREPARATION tampering the grounds for setting up health
programs

Target: community leaders

- Establish rapport, develop trust, clarify intentions and
expectations
- Starts upon entry, ends with launching
Methods: courtesy call and attendance to meetings
4. COMMUNITY INTEGRATION imbibing the community way of life
Target: community
- Deepen rapport, develop mutual trust, draw objectives
Methods: house-to-house, going to places where people are, direct
participation in the production process (best method)
5. SMALL GROUP FORMATION
- cluster of 8-15 households
- manageable units
- data processing of community diagnosis is being done
6. ELECTION OF CHWs
7. LAUNCHING social preparation ends
8. COMMUNITY DIAGNOSIS
Outcome: Problems and needs of the people
9. TRAINING AND SERVICES
Advanced community health workers have the leadership traits
10. CORE GROUP FORMATION
- Group of advanced CHWs
11. PHASE OUT so that people can practice self-reliance
- Provide opportunity for the health workers to stand on their
own
 Indicator of Phase-out: Advanced CHWs are able to assume staff level
functions

COMMUNITY ORGANIZING PROCESS (COPAR)

PRE-ENTRY
1. Site selection
2. Preliminary Social Investigation
ENTRY
1. Social preparation
2. Community integration
3. Deepening social investigation
ORGANIZATION FORMATION PHASE
1. Small group formation
2. Election of CHW (women; middle-aged; married)
3. Organizational meetings - to clarify matters
TRAINING PHASE
1. Training needs assessment COMMUNITY DIAGNOSIS
2. Curriculum development based on problems identified
3. Actual training
4. Training evaluation
SERVICES PHASE
1. Community clinics
2. Other services
LEADERSHIP FORMATION PHASE
1. Core group formation
2. Advanced training
CONSOLIDATION PHASE
1. Evaluation session
2. Staff development
SUSTENANCE AND MAINTENANCE PHASE
1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies

1. Community analysisThe process of assessing and defining needs,

opportunities and resources involved in initiating community health action
program. This process may be referred to as community diagnosis, community
needs assessment, health education planning, and mapping.

5 components
Demographic, social and economic profile of the community
derived from secondary data
Health risk profile
 Health/wellness outcome profile
Survey of current health promotion programs
Studies conducted in certain target groups
Steps in community analysis
Define the community - Determine the geographic boundaries of the
target community. This is usually done in consultation with representatives of
the various sectors.
Collect data As earlier mentioned, several types of data have to
be collected and analyzed.
Assess community capacity This entails and evaluation of the
driving forces which may facilitate or impede the advocated
change. Current programs have to be assessed including the
potential of the various types of leaders/influential, organization
and programs.
Assess community barriers Are there features of the new
program which run counter to existing customs and traditions? Is
the community resilient to change?
Assess readiness for change _ Data gathered will help in the
assessment of community interest, their perception on the
importance of the problem.
Synthesis of data and set priorities This will provide a
community profile of the needs and resources, and will become
the basis for designing prospective community interventions for
health promotion.

2. Design and initiation

In designing and initiating interventions the following should be done:
Establish a core planning group and select a local organizer -
Five to eight committed members of the community may be
selected to do the planning and management of the program.
Choose an organizational structure - There are several
organization structures which can be utilized to activate
community participation. These include the following:
Leadership board or council existing local leaders working for
a common cause
Coalition linking organizations and groups to work on
community issues.
Lead or official agency a single agency takes the primary
responsibility of a liaison for health promotion activities in the
community.
Grass-roots informal structures in the community like the
neighborhood residents.
Citizen panels a group of citizens (5-10) emerge to form a
partnership with a government agency
 Networks and consortia Network develop because of certain
concerns.
Identify, select and recruit organizational members - As much as
possible, different groups, organizations sectors should be
represented. Chosen representative have power for the groups
they represent.
Define the organization mission and goals - This will specify the
what, who, where, when and extent of the organizational
objectives.
Clarify roles and responsibilities of people involved in the
organization - This is done to establish a smooth working
relationship and avoid overlapping of responsibilities.
Provide trainings and recognition - Active involvement in planning
and management of programs may require skills development
training. Recognition of the programs accomplishment and
individuals contribution to the success of the program and boost
morale of the members.

3. Implementation
Implementation put design phase into action. To do so, the following
must be done:
Generate broad citizen participation - There are several ways to
generate citizen participation. One of them is organizing task
force, who, with appropriate guidance can provide the necessary
support.
Develop a sequential work plan - Activities should be planned
sequentially. Oftentimes, plan has to be modified as events
unfold. Community members may have to constantly monitor
implementation steps.
Use comprehensive integrated strategies - . Generally the
program utilize more than one strategies that must complement
each other.
Integrate community values into the programs, materials and
messages. The community language, values and norms have to
be incorporated into the program.

4. Program maintenance consolidation

The program at this point has experienced some degree of success and
has weathered through implementation problems. The organization and
program is gaining acceptance in the community.
Integrate intervention activities into community networks - This
can be affected through implementation problems. The
organization and program is gaining acceptance in the
 community.
Establish a positive organizational structure - A positive
environment is a critical element in maintaining cooperation and
preventing fast turnover of members. This is the result of good
group based on trust, respect, and openness.
Establish an ongoing recruitment plan- It should be expected that
volunteers may leave the organization. This requires a built in
mechanism for continuous recruitment and training of new
members.
Disseminate results - Continuous feedback to the community on
results of activities enhances visibility and acceptance of the
organization. Dissemination of information is vital to gain and
maintain community support.

5. Dissemination reassessment
Continuous assessment is part of the monitoring aspect in the
management of the program. Formative evaluation is done to provide
timely modification of strategies and activities. However, before any
programs reach its final step, evaluation is done for future direction.
Update the community analysis - Is there a change in leadership,
resources and participation? This may necessitate reorganization
and new collaboration with other organizations.
Assess effectiveness of interventions/programs - Quantitative
and qualitative methods of evaluation can be used to determine
participation, support and behavior change level of decision-
making and other factors deemed important to the program
Chart future directories and modifications - This may mean
revision of goals and objectives and development of new
strategies. Revitalization of collaboration and networking may be
vital in support of new ventures.
Summarize and disseminate results - . Some organizations die
because of the lack of visibility. Thus, a dissemination plan
maybe helpful in diffusion of information to further boost support
to the organizations endeavor.

GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS

Community Diagnosis: an in-depth process of finding out the profiles, health

status of the community and the factors affecting the present status

Contents:
1. Introduction
1.1 Rationale accurate, valid, timely and relevant information on the
community profile and health problems are essential so that resources can be
maximized
1.2 Purpose to analyze the data in order to develop responsive
intervention strategies that address the root cause of the problem
1.3 Statement of Objective what are to be accomplished to attain the
study
1.4 Methodology and tool used a description of the adoption,
construction and administration of instruments
1.5 Limitation of the study state any limitations that exist in the
reference or given population or area of assignment

2. Target Community Profile

2.1 Geographical Identifiers historical background, location,
boundaries, population, physical features, climate, spot map
2.2 Population Profile Total estimated population of Barangay,
Population Density,
2.3 Socio-demographic Profile total population of families surveyed,
number of households, age and sex distribution, sex ratio, dependency ratio,
civil status, types of families, religious distribution, place of origin, length of
residency
2.4 Socio-economic indicators educational attainment, literacy rate,
occupation, income, housing, ventilation
2.5 Environmental indicators Water supply, excreta disposal, garbage
disposal, pet ownership, domestic animals
2.6 Health profile food storage, infant feeding practices, immunization,
community facilities, health seeking behaviors, communication resource and
family planning
2.7 Morbidity and mortality data leading cause of morbidity, mortality,
infant mortality and maternal mortality

3. Analysis of Data
3.1 Identification of health problems
3.2 Prioritized problems identified

4. Action plan based from prioritized problem identified

4.1 Intervention strategies

5. Conclusion

6. Recommendation

Community Diagnosis
1. Preparation of Community Diagnosis
a. Identify barangay to survey or required by the health center
b. Ocular survey
 c. Community assembly
2. Conduct of survey proper using the format/survey form
a. Random sampling or saturation
b. Guidelines in filling survey form
c. Data collection techniques
3. Make graph or chart of each data gathered
4. Data analysis and interpretation
5. Preparation of action plan /project plan

J. Public Health Programs

PUBLIC HEALTH PROGRAMS

Comprehensive Maternal and Child Health Program

*EPI ( EXPANDED PROGRAM ON IMMUNIZATION )
*CDD ( CONTROL OF DIARRHEAL DISEASES )
*CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS )
*UFC (UNDER FIVE CLINICS )
*MC ( MATERNAL CARE )
*BF ( BREAST FEEDING )
*MRP ( MALNUTRITION REHABILITATION PROGRAM )
*VAD (VITAMIN A DEFICIENCY )
*IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY
ANEMIA )
*FP ( FAMILY PLANNING )

*EPI (EXPANDED PROGRAM ON IMMUNIZATION )

PD 996 Compulsory Basic Immunization to all
children before reaching 8 years old
Started in 1976 by MOH
Target Population:
A. Infants (0-12 months):
BCG, DPT, OPV& Measles
HBV (1996)
B. School Entrants:
MECS: Grade 1=7 years old
DECS: Grade 1=6 yrs. old (1993)
Booster of BCG

RA 7846 Compulsory HBV before 8 years

old:1996
PP 4 Measles Elimination Program
 (September & October) 1994-1997-
Ligtas Tigdas (6 months-8 years)

PP 6 Universal Mother & Child Immunization

Law advocated by WHO from 1996
and onwards: 5 vaccines + Tetanus
Toxoid
Strengthens the EPI Program
1. Pregnant mothers-Tetanus Toxoid
2. Children:
Infants-5 vaccines
School entrants-BCG booster dose
3. Before EPI total immunization-5
After EPI total immunization-6
(Tetanus
toxoid was included)
4. OPV was given to all children under
5 years old irregardless of the # of
doses & the time OPV was given

PP 147 Declaring the National Immunization

Day Plus (NIDs Plus) initiated by
former Sec. Flavier in 1993-95
Initially every 3rd Wednesday of
January & February (1993-1995)
1996 to present: Still being practiced
but not every 3rd Wednesday of
January & February
2002: 2nd Tuesday of March & April
At present: depends on the Secretary
PP 773 Launched the Polio Elimination
Program (PEP) 1995-2000: Zero Polio
Philippines, 1. Knock Out Polio (KOP)
2. Zero Polio Philippines (1996-2000)
3. Patak Polio (< 5 years old)
PP 1064 AFP (Acute Flaccid Paralysis)
Elimination Program-an adverse effect
of Polio
PP 1066 Neonatal Tetanus Elimination
Morbidity
Mortality
*RSI locates a venue for immunization called Patak Center and composed of
1 organizer, 1 runner, 1 vaccinator, 1 recorder and 1 health educator catering
to a population of 1,000
Policies of EPI:
I. Coverage--------------------------------------
A. Target Setting
B. FIC ( Full Immunized Child )
C. Wastage Allowance
OBJECTIVES OF EPI: To reduce morbidity and mortality rates among infants
and children from 6 or 7 immunizable disease
II. Cold Chain
III. Immunization Technical Responsibilities of PHN
IV. Surveillance--------------------------------
Planning, Supervision, and Training---
Mobilization, Monitoring and Health Education Administrative and
Supportive Role of PHN
Referral, Research and Evaluation ---

I. Coverage
A. Target Setting:
1. Target Population is the population group meant to be benefited by the EPI
Programs where DOH is responsible.
a. Infants ( 0 12 ) get the 3% of population
b. School Entrants get the 3% of population ( dictum of DOH ) = 6 years
c. Pregnant Women get the 3.5 % of population ( MWKA ) = 15 49 years
2. Eligible Population ( EP ) rae those qualified to receive specific
immunizations where PHW is responsible PHN, RHM, MO
*3 Population Groups to benefit
a. Infants (I) BCG, DPT, OPV, HBV, MV
b. School Entrants (S.E) Booster of BCG
c. Pregnant Women (PW) Tetanus Toxoid
*To determine Eligible Population:
EP = Population of the Community x 0.03 (Infants and School Entrants) or
X 0.035 (Pregnant Women)
*Example: Lanting Community with a population of 7000
a.) DPT = for infants
EP = 7000 X 0.03 = 210 to receive DPT
b.) Tetanus Toxiod = for pregnant women
EP = 7000 X .035 = 245 to receive TT
c.) Booster BCG = for school entrants
EP = 7000 X 0.03 = 210 to receive booster BCG

B. Fully Immunized Child ( FIC ) is a child who receives the 5 sets of

vaccines (BCG, DPT, OPV, Hepa B and Measles and who receives 11
doses of vaccines.

Vaccine (# of Doses) Infants (0-12 months) School Entrants

 Right age to receive the
vaccine
BCG-1 dose 0 age (at birth)-12 1 booster dose (6 years
months old)
DPT-3 doses 1st Dose-6 wks./1
OPV-3 doses mos.
HBV-3 doses 2nd Dose-10 wks./2
mos.
3rd Dose-14 wks./3
mos.
MV-1 dose 9-12 months

*MV may be given 6 months if there is an epidemic.

c. Wastage Allowance
- DOH doesnt ptoduce vaccines biologically and therefore dependent on
suppliers abroad: Germany and Switzerland to economize:
1. Be aware of the availability of vaccines:
Example: BCG
CHN: vial Private Practice: ampule
Frozen powder with a diluent
( 1 ml per content )

2. How many receipients = ?????

-Follow DOH Dictum: On the day of immunization, if 50% and above of

computed recipents arrive in the health center, open a vial but if less than
50%, dont open.
Example: In 20 recipients, 10 arrive = open a vial
-Half life of Vaccines is the duration of potency:
a. Vaccine with 4 hours half life: BCG, MV ( need to mix )
*If open at 8:00 am, its good till 12:00 noon
At 12:30 pm, dont give anymore because its not potent anymore.
b. Vaccine with 8 hours half life: DPT, OPV, HBV, TT (already in solution /
liquid form ready to administer)
Table of Reference for Requesting Vaccines from DOH
Vaccine Availability Dosage # of Doses to Wastage Number of
complete Allowance Recipients per
immunization Multiplier Vaccines
Factor (MF)
BCG Vial:
1. I Frozen .05 ml 1 dose 60% 2.5 20
2. SE Powder .1 ml 1 dose 40% 1.67 10
with
1ml diluent
DPT Vial: 10 ml .5 ml 3 doses 40% 1.67 20
liquid
OPV Plastic 2-3 gtts 3 doses 40% 1.67 25(1ml=15gtts)
(Sabin) bottle: 5 ml
slightly
pink
Liquid
HBV Vial: .5, 1, <10 y/o: .5 3 doses 10% 1.2 .5 ml=1
10 ml >10 y/o: 1 .5 ml
MV Vial: .5 ml 1 dose 50% 2 10
Frozen
Powder
with
Diluent
Soln=5ml
per content
TT Vial: 10 ml .5 ml 5 doses 40% 1.67 20
liquid
*Parenteral = Salk vaccine ( sinasaksak ) has 5 ml per content
*Oral Polio Vaccine (OPV) = Sabin (sa bibig)
For OPV: 5 ml (availability) 1 ml = 15 gtts 1 ml = 15 gtts = 5 recipients
3 gtts (dosage) 2 ml = 30 gtts = 10 recipients
3 ml = 45 gtts = 15 recipients
4 ml = 60 gtts = 20 recipients
5 ml = 75 gtts = 25 recipients

Right Time for Pregnant Women to receive Tetanus Toxoid

Primary Dose TT1 Anytime during ? Immunity
th
Pregnancy (5 -6 th

months)
Primary Dose TT2 4 weeks after TT1 3 years immunity
1st Booster TT3 6 months after 5 years immunity
TT2
2nd Booster TT4 1 year after TT3 10 years
immunity
3rd Booster TT5 1 year after TT4 Lifetime immunity

Examples:
1. Mrs Dela Cruz received the 1st booster dose (TT3) on November 20, 2004.
When is the 2nd booster? November 20, 2005
2. As a child, you have 3 doses of DPT. Now you become pregnant. What you
need to receive are the 3 booster doses only-TT3, TT4 & TT5 respectively.
3. If as a child, only 1 dose of DPT was given, is there a definite immunity?
Theres no definite # of years of immunity. If until 3 years she failed to
receive vaccine, she got to start with the 1st dose.

Wastage Allowances of DOH Multiplier Factors

BCG (I) 60% 2.5
MV 50% 2.0
BCG (SE) 40% 1.67
DPT
OPV
TT
HBV 10% 1.2

Steps to Compute the Number of Vaccine to be Requested from DOH

1. Determine the Eligible Population (EP)
EP=Population of the Community x 0.03 (I & SE) or 0.035 (PW)
2. Determine the Annual Dose (AD)
AD=EP x # of doses of the vaccine
3. Determine the Wastage Allowance (WA)
WA=computed AD x MF of the vaccine
4. Determine the Complete Coverage (CC)
CC=WA # of recipients per vaccine
5. Determine the Overall Total in Allowance (OT)
OT=CC x 1.25 (constant), DOH usually grants an allowance of 25% of the
CC

Example: Determine the # of vaccines to be requested from DOH of DPT for

Lanting Community with a population of 4000
1. EP=4000 x 0.03=120
2. AD=120 x 3 doses=360
3. WA=360 x 1.67=601
4. CC=601 20=30
5. 30 x 1.25=37.5 or 38 vials to be given by DOH (or 8 vials allowance)

II. Cold Chain

-Tools or Procedures to follow to keep vaccine potent ( expected desired
effect ).
Policies:
1. Proper Storage: store vaccines in refrigerators
 RHO 3 Given 6 months to store vaccines

MHO PHO 2 Given 3 months to store vaccines

BHS RHU 1 Given 1 month to store vaccines

RHCDS

- Freezer OPV: most sensitive to heat

-15 C to -20 C MV

Body of Refrigerator BCG

2 C to 8 C DPT
HBV
TT: least sensitive to heat
OPV & MV: highly sensitive to heat
OPV, MV & BCG: Not damage by freezing
DPT, HBV & TT: Damaged by freezing so not placed in the freezer

2. Proper Transport
- Vaccines are to be transported from the health center to the area of
immunization (community: focused, based & oriented)
- Tools provided by DOH: Vaccine Carrier which maybe
a. Black: use by staff of HC during epidemic & needs 5 cold dogs
b. White: use by student affiliates & needs 4 cold dogs
- Cold Dogs: 4 plastic containers filled with water which is placed in
the freezer a day before immunization which is used as freezant to
keep vaccine potent

3. Proper Handling of Vaccine (After Care of Vaccine): Dictum of DOH

a. Vaccines which are opened, though not consumed, should be
discarded
Reasons: cant be used for future program because vaccines have
half - life (duration of potency of vaccine)
BCG -4 hours half life
MV
Other vaccines -8 hours half life

BCG, OPV & MV are composed of live attenuated bacteria & virus
so before discarding them, disinfect 1st with 1% Hcl or any
disinfectant like zonrox, chlorox or dumex
BCG (Bacilli Calmette-Guerin Vaccine): live attenuated bacteria
OPV & Measles Vaccine: live attenuated virus

DPT, HBV & TT can be readily discarded if not consumed

 DPT:
Diphtheria-weakened toxoid treated with chemical solution to
weaken microorganism
Pertussis-killed bacteria
Tetanus-weakened toxoid
HBV: plasma derived, identified to be RNA & DNA recombinant from
blood
TT: weakened toxoid
b. Vaccines which are taken out from Health Center for 3x or more are
considered overly exposed & not potent anymore therefore it should
be discarded
Put notation (state the date) on the unopened vaccine as to when it
was taken out from health center May 19, 2006
Jun. 19, 2006
Jul. 19, 2006-cant be used anymore after this

I. Immunization
Guiding Principles for HW in Administering Vaccines & Screening of
Children for Immunizations:
1. No BCG for a child born clinically positive to AIDS because they have a
damage immune system & introducing bacteria will further aggravate
their condition
2. There are no contraindications such as slight fever, LBM, cough & colds
and malnutrition, in giving the immunization unless upon assessment of
the practitioner that the child has serious medical problems that
warrants hospitalization
3. In giving immunization with multiple doses such as DPT, OPV & HBV,
continue counting in giving the doses. Never count back even though
the interval exceeds weeks, months or years. As long as the child is on
the eligible age
Example: DPT, OPV & HBV
1st dose: At 6 weeks (1 months), the child was given vaccination
2nd dose: The mother brought back the child when he was 8 months old
instead at 10 weeks (2 months). PHN should still give the 2 nd dose
3rd dose: The mother brought back the child at 2 years old. PHN should
still give the vaccine because child is still at the eligible age (0-59
months or 4 years & 11 months or 5 years old) to receive vaccine

4. DPT: it is a normal reaction for a child to develop high grade fever

because of the pertussis component (killed bacteria)
SOP Management:
Paracetamol q 4 hours RTC for the 1st 2 days (or 3, 4 days if still febrile)
If after 1st dose of DPT, the child develops high grade fever with
convulsion, DPT 2 & 3 are not given anymore because convulsion
affects the brain cells resulting to brain damage
DPT vaccine is only for prophylactic/ preventive use
 5. Things to consider in administering vaccines:
a. Vaccine
b. Dosage
c. SOA (Site of Administration)
d. ROA (Route of Administration)
e. Side Effect: patterns of reaction that is considered normal

Vaccines Dosage SOA ROA Conferred

Immunity
BCG I=.05 ml I=R deltoid Intradermal Artificial
SE=.1 ml SE=L deltoid (needle is Active
parallel to
site=10-15
angle
Side Effects: Wheal=10 mm that disappears after 30 minutes
1st week : develops soreness and inflammation
nd th
2 -11 week : develops abscess and ulceration
12th week (3 months): heals and develops permanent scar

Age of Consultation BCG Site of Injection

Right Age (0-12 months) Right Deltoid
Wrong Age but still eligible Left Deltoid
Example: 4 years old
Booster Dose at Age 6 Left Deltoid
*If after BCG, there is no soreness & inflammation, no abscess & ulceration
and no scar developed, there is wrong preparation of site where PHW used
alcohol that kills the microorganism contained in the BCG vaccine. Thus,
repeat the dose on same site but a little lower.
*Site preparation: Use clean cotton ball & wet with sterile water only
*For non-healing abscess & ulceration:
BCG was wrongly administered by IM or SQ by PHW so incision &
drainage should be done by MD only and INH tablet, an anti-bacterial,
pounded, pulverized & applied on the site. Then repeat the dose again but
not on the same site.

Vaccine Dosage SOA ROA Conferred

Immunity
DPT .5 ml Thigh (vastus Intramuscular Artificial
lateralis) (Z tract) Active
where muscle
is grasped
and squeezed
Side Effects:
1. High grade fever due to Pertussis Component which contains killed bacteria
2. Soreness and inflammation
SOP Management:
Paracetamol (anti-pyretic & analgesic) q 4 hours RTC for 1st 3 days or till with
fever
Nursing Care: 1st Day=apply cold compress on site
2nd , 3rd & 4th Day=apply alternating cold & warm compress
Adverse Effect: If convulsion occurs on 1st dose, discontinue DPT 2 & DPT 3
because of the sensitivity to DPT Component but private MD gives DT which is
not available in DOH

Vaccine Dosage SOA ROA Conferred

Immunity
OPV 2-3 gtts Mouth Oral: Artificial
Sabin by Dr. Active
Albert Sabin
Salk
(parenteral
polio vaccine)
by Dr. Jones
Salk
Side Effect: None
Nursing Care:
1. NPO for 1st 20-30 minutes after receiving vaccine to prevent nausea &
vomiting
2. In case the child vomits after vaccination, repeat giving the vaccine because
it requires 30 minutes to absorb the OPV
HBV .5 ml Thigh (vastus Intramuscular Artificial
lateralis) Active
Side Effects: Soreness and inflammation on site
SOP Management: Paracetamol q 4 hours RTC for 1st 2 days or till with fever
HBV & DPT are given together but never administer these 2 vaccines in one
site:
DPT HBV
1st Dose Right Left
nd
2 Dose Left Right
3rd Dose Right Left
MV .5 ml Posterior Subcutaneous Artificial
aspect of (45 angle) Active
Deltoid
Side Effect: High grade fever
SOP Management: Paracetamol q 4 hours RTC for 1st 2 days
MV given on same site with BCG but MV is given at 9 months while BCG at
birth
In case, rashes develop after vaccination which makes the child irritable due to
itchiness,
give anti-histamines: Diphenydramine (Benadryl) syrup or
Apply Caladryl or Calamine Lotion which has anti-
histamine and cooling effect to relieve itchiness
TT .5 ml Deltoid or Intramuscular Artificial
Gluteal Active
muscle
Side Effect: Soreness and inflammation on the site which is tolerable by
pregnant woman so no need to take medicines. Just apply cold compress on
site to relieve discomfort

2 Forms of Immunization Conferring Immunity:

1. Natural
a. Active
b. Passive
2. Artificial

IMMUNITY
Natural Artificial
Provided by nature Accepts vaccine
No vaccine was given
Duration is longer/even for a lifetime Duration is shorter period
Example:
BCG-vaccine for protection from TB
gives 7-10 years immunity so booster
is needed
HBV-after 3 doses booster is needed
after 1 year
Active=person himself is involved in Active=person himself has no
the production of antibodies participation and done by another
1. Carrier (person harbors the disease person
but asymptomatic) of the disease Upon receiving vaccine (antigen) for
2. Constant exposure to disease immunizable diseases such as BCG,
3. Acquired or experienced the DPT, OPV, MV and HBV
disease
Passive Passive
1. Breastfeeding IgA (present in 1. Serum (Blood):
colostrums) HBV
2. Perinatal immunity is acquired ATS (Anti-Tetanus Serum)
during the term of pregnancy ADS (Anti-Diptheria Serum)
 2. Antitoxin: poison or causes
infection
TAT (Tetanus Antitoxin)
DAT (Diptheria Antitoxin)
3. Immunoglobulins: IgA, IgD, IgE,
IgG & IgM where IgG is most
predominant

IV. Surveillance--------------- To be discussed unde r Communicable Diseases.

Planning, Supervision and Training
Mobilization, Monitoring, and Health Education
Referral, Research and Evaluation

*CDD ( CONTROL OF DIARRHEAL DISEASES )

Policies to implement CDD:
1. Health Education on Personal Hygiene
- washing of hands before eating and after use of toilet
2. Breastfeeding ( BF )
- Two ( 2 ) Beneficiaries of BF Program:
a. Mother regulated by R.A. 7600: Breastfeeding and Rooming In Act.
*Beastfeeding is an effective contraceptive method because it stimulates
the anterior pituitary gland to produce prolactin hormone putting the female
in an anovulatory stage theres amenorrhea for 6 months form the time she
gave birth.
*Rooming in ( RI ) is putting together of mother and the newborn and it
stimulates the posterior pituitary gland to release oxytocin hormone
stimulates the uterine muscle contraction that inhibits the implantation of
fertilized zygote in the endometrium no pregnancy occurs.
b. Children regulated by EO 51: Milk Code of the Philippines
Dictum of Milk Code: Never commercialized a brand name of milk.
- 3 Principles to make breastfeeding effective: 3 Es
a. Early: start Breastfeeding as early as possible
Normal Spontaneous Delivery (NSD): after 30 minutes
CS: after 3 4 hours
b. Exclusive: for the 1st six months; never alternate Breastfeeding with any
supplementary feeding.
c. Extensive: Breastfeeding can be extended to 2 years.
- Advantages of Breastfeeding:
Breast milk: EO 51 best for babies
Reduced allergy
Easily established
Always available
Safe making stool soft
 Temperature: right teemperature 24C body reference if to be frozen,
preservation is minimum of 3 months and maximum of 6
months

Fresh always
Emotional bonding
Economical
Digestible: contains lactalbumin, a protein substance
Immunity: colostrum contains Ig A that protects baby for the 1st 3 months
Nutritious ( optional )
GIT diseases such as diarrhea is minimize / lessen because its sterile
3. Measles: immunization preventive and prophylactic
4. Oresol: a management for diarrhea to prevent dehydration
2 Concepts of Diarrhea:
a. Frequency of passing out stool = 3x/day
b. Consistency of the stool = watery
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM
1. Two problems in CDD
1. High child mortality due to
diarrhea
2. High diarrhea incidence among under fives
2. Highest incidence in age 6 23 months
3. Highest mortality in the first 2 years of
life
4. Main causes of death in diarrhea :
DEHYDRATION
MALNUTRITION
5. To prevent dehydration, give home fluids
am as soon as diarrhea starts and if
dehydration is present, rehydrate early,
correctly and effectively by giving ORS
6. For undernutrition, continue feeding
during diarrhea especially breastfeeding.
7. Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
 8. Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed
infants.
9. Advantages of breastfeeding in relation
to CDD
1.Breast milk is sterile
2.Presence of antibodies protection against
diarrhea
3.Intestinal Flora in BF infants prevents growth
of diarrhea causing bacteria.
10. Breastfeeding decreases incidence
rate by 8-20% and mortality by 24-27% in
infants under 6 months of age.
11. When to wean?
4-6 months soft mashed foods 2x a day
6 months variety of
foods 4x a day
12. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest
source
- protecting water from contamination at the
source and in the home
3.Good personal and domestic hygiene
- handwashing
- use of latrines
- proper disposal of stools of young children
4.Measles immunization.

Contents of One Pack Oresol Dissolved in One Liter drinking Water

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
Bicarbonate/NaHCO3 solution
Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth
muscle contractility
especially the heart &
GIT
*Never advice mother to buy brandnames like pedialyte or gatorade

Preparation of Proper Homemade Oresol

A volume or one liter homemade Smaller volume or a glass homemade
oresol 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
*For making solutions = use 250 ml of water
*For drinking medicines = a glass is 240 ml of water.

3 Categories of Dehydration:
a. No dehydration-uses oresol
b. Some dehydration-uses oresol
c. Severe dehydration-uses IVF
Objectives/Plan/Policies of the Use of the following Program:
a. Plan A: for prevention of dehydration
b. Plan B: for treatment of dehydration-mild & moderate
c. Plan C: for treatment of dehydration-severe

CDD MANAGEMENT CHART

Assessment Category Treatment

1. Condition No dehydration Plan A-prevention of

a. Normal DHN
b. Well
c. Alert 3 Principles/3 Fs:
2. Fontanel-normal 1. Increase fluid: Tea-
3. Eyeballs-normal lipton tea bag left
Tears-present standing in a cup of
4. Mouth, Tongue & water for 15 minutes &
Lips: moist or wet there is brownish
Thirst: drinks normally discoloration
5. Skin Turgor-returns =pectin, a diuretic & has
back quickly which is an absorbent effect
done at forearm Fruit Juices-not from
highly fibrous fruits like
pineapple, mango,
guyabano.

Oresol-am or buko
where 3 electrolytes are
present: Na, K & Ca
which are lost in
diarrhea

Oresol is given/LBM or
every time stool is
passed out:
< 2 years old: 50-100ml.
always give the
maximum amount
2-10 years old: 100-200
ml.
10 years old & above: as
much as tolerated &
desired

2. Increase feeding:
3. Fast referral
1. Condition Some dehydration Plan B-Treatment of
a. Restless mild & Moderate DHN
b. Irritable using oresol
2. Sunken fontanel
3. Sunken eyeballs & If less than 2 years old:
absent tears use age in months
4. Dry mouth, tongue & If < 4 months: 200-400
lips ml.
Eagerness to drink 5-11 months: 400-600
5. Skin returns back ml.
slowly 12-23 months: 600-800
ml.
2-4 y/o: 800-1200 ml.
5-14 y/o: 1200-2200 ml.
 15 & above: 2200-4000
ml.

Treatment Plan: 1st 4

hours always give the
maximum
1. Condition Severe dehydration Plan C-treatment of
a. Unconsciousness severe DHN using IVF
b. Lethargic Priority-choice of IVF:
c. Floppy-apathetic or 1. D5LRS-best or 1st
passive choice if available for
2. Very sunken fontanel severe DHN since
3. Very sunken eyeballs dextrose gives
& absent tears additional source of
4. Very dry mouth, energy & improves
tongue & lips appetite D5-is glucose
Refuses to drink orally LRS-has 3 chlorides
5. Skin returns back 2. LRS-Lactate Ringers
very, very slowly best or Hartman solution is
done at the abdomen the most appropriate
choice if no D5LRS
3. Plain NSS or 0.9 NaCl
4. D5W
5. D10W

2 Victims of Severe Dehydration:

a. Child: give 100 mg/kg body weight in the 1st 4 hours
Example: 8 kg=800 ml. IVF to be infused on the 1st 4 hours for patient with
severe dehydration (8 am-12 noon)
b. Adult: give 3-4 liters of IVF in 1st 4 hours
Example: 9am-1pm=4 liters=1 liter/hour
If still severe dehydration, 2-6pm=infuse 4 liters IVF
Fruits for Diarrhea:
Apple: has pectin & tarum which has an absorbent property, eat the skin
Banana: has K+
Caimito: eat the flesh in cases of constipation but in diarrheal cases, eat the
extracts, milky substances (dagta) found on the inside of the skin
Duhat: wash first the fruit then sprinkle with rock salt & shake, notice extracts
to come out of the fruit, eat both skin & flesh
Fruits to avoid during diarrhea: Papaya flesh, pineapple flesh, mango,
guyabano & kaimito flesh
BRAT Diet: Banana, Rice, Apple, Tea, toasted bread or toasted rice beads
which has activated charcoal that acts as absorbent
Direction: In a cup of warm water, add 1 tablespoon of toasted rice or bread &
allow to stand for 20-30 minutes produces a blackish discoloration which is
pectin

TYPES OF DIARRHEA
o ACUTE : < 14DAYS
o PERSISTENT: 14 DAYS or more
o DYSENTERY: Blood in the stool; with or without mucus

CLASSIFY DEHYDRATION

SEVERE DEHYDRATION
Two of the following:
Abnormally sleepy
Sunken eyes
Drinks poorly
Skin pinch goes very slowly
Treat PLAN C: Referral to hospital for IVF!!!

SOME DEHYDRATION
Two of the following:
Restless, irritable
Sunken eyes
THIRSTY: drinks eagerly
Skin pinch goes back
Treat PLAN B
O.R.S: first 4hours after assessment
200-400ml 0-4mos
400-700ml 4-12mos
700-900ml 1-2 yrs
900ml-1L 2-5yrs

NO DEHYDRATION
Not enough signs to classify some or severe
Treat PLAN A
Give extra fluids
50-100ml after each watery stool (0-2y/o)
100-200ml (2 y/o & above)
as tolerated (10y/o & above)
Continue feeding
Return if with danger sign/s.
*CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS )
Goal: Morality and Morbidity reduction of Pnuemonia.
Target groups: very young: <2 months
Older child: 2 months 5 years old
Child with cough and colds
Program:
1. Assessment:
History: Subjective
Age
Cough and Duration
Able to Drink or stop feeding
Fever ---- duration
Convulsion

Physical Examination: Objective

Weight, Height
Respiratory Rate one whole minute
Fast Breathing
*Less than 2 months 60/min or >
*2 months 1 year 50/min or >
*1- 5 years old 40/min or >
Observe for :
- Chest in drawing
- Stridor during inhalation
- LOC
- Wheeze during exhalation
- Fever
- Malnutrition
- Level of Consciousness

2. STANDARD CLASSIFICATION OF ILLNESS:

I. Infants 2 months to 5 years old

1. VERY SEVERE DISEASE:
If any 3 of the 5 Danger signs are present
Signs and Symptoms:
a. Not able to drink
b. Convulsion
c. Sleepy
d. Stridor
e. Severe Malnutrition

Treatment:
1. Refer urgently to hospital
 2. 1st dose of antibiotics
3. Treatment of Fever ( TSB ) * Wheeze (NEBULIZE)
4. Antimalarial

2. PNEUMONIA:
Signs and Symptoms:
a. Chest in drawing
b. Nasal flaring
c. Grunting
d. Cyanosis

2 Types:
a. Severe Pneumonia
Symptoms: Chest indrawing, cyanosis, nasal flaring, grunting.
Treatment: Same with very severe but anti malarial is not given.

b. Not Severe Pneumonia

Symptoms: No chest in drawing and fast breathing.
Treatment: 1. Home care TSB, Nutrition, Steam inhalation
2. Antibiotics for 2 days and follow up after 2 days.
a. If it improves, consume all meds finish the course
of the treatment.
b. If worse, refer.

3. NO PNEUMONIA
Assess for other problems and provide home care.
No Chest indrawing, No fever
If with sore throat in children: Mild, warm tea with syrup.
If chronic, refer.

II. Infants lessthan 2 months

1. VERY SEVERE DISEASE
Symptoms: Stopped feeding well
Convulsions
Abnormally sleepy
Stridor
Wheeze
Severe malnutrition and Fever of 38C or Hypothermia
(<35.5C)
Treatment: Refer urgently to hospital
Keep warm
Give first doses of antibiotic
2. PNEUMONIA
Symptoms: Severe Chest indrawing and Fast Breathing
Treatment: Same as severe.

*UFC (UNDER FIVE CLINICS )

The first five years of life form the foundations of the childs physical and
mental growth and development. Studies have shown the mortality and
morbidity are high among this age group. The Department of Health
established the Under Five Clinic Program to address this problem.

Program Objectives and Goals:

*Monitor growth and development of the chiild until 5 years of age.
*Identify factors that may hinder the growth and development of the child.

Activities and Strategies:

1. Regular height and weight determination / monitoring until 5 years old.
0 1 year old = monthly
1 year old and above = quarterly
2. Recording of immunization, vitamins, supplementation, deworming and
feeding.
3. Provision of IEC materials ( ex. Posters, charts, toys ) that promote and
enhance childs proper growth and development.
4. Provision of a sagfe and learning oriented environment for the child.
5. Monitoring and Evaluation.

**BREASTFEEDING / LACTATION MANAGEMENT EDUCATION

TRAINING**
-Breastfeeding practices has been proven to be very beneficial to both mother
and baby thus the creation of the following laws support the full implementation
of this program.
Executive Order 51
Republic Act 7600
The Rooming in and Breastfeeding Act of 1992.

*MC ( MATERNAL CARE )

*BF ( BREAST FEEDING )
*MRP ( MALNUTRITION REHABILITATION PROGRAM )
*VAD (VITAMIN A DEFICIENCY )
*IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY
ANEMIA )
*FP ( FAMILY PLANNING )

II. Research and Quality Improvement

A. Research in the Community
B. National Health Situation
C. Vital Statistics
D. Epidemiology
E. Demography

III. Management of Resources and Environment and Records Management

A. Field Health Services and Information System

B. Target-setting
C. Environmental Sanitation

IV. Ethico-Moral-Legal Responsibility

A. Socio-cultural Values, Beliefs and Practices of Individuals, Families, Groups
and Communities
B. Code of Ethics for Government Workers
C. WHO, DOH, LGU Policies on Health
D. Local Government Code
E. Issues

V. Personal and Professional Development

A. Self-assessment of CHN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones Self, Enhancing Competence in
Community Health Nursing and Related Areas.
VI. Part II: MCN

VII. Safe and Quality Care, Health Education, and Communication,

Collaboration and Teamwork
A. Principles and Theories of Growth and Development (Pediatric Nursing)
PRINCIPLES OF GROWTH AND DEVELOPMENT
PRINCIPLES EXAMPLES
Growth and development are Although there are highs and lows in
continuous processes from terms of the rate at which growth and
conception until death development proceed, a child grows
new cells and learns new skills at all
times. An example of how the rate of
growth changes is a comparison
between that of the first year and later
in life. An infants triples birthweights
and increases height by 50% during
the first year of life. If this tremendous
growth rate were to continue, the 5
ye-old child, when ready to begin
school, would weigh 1,600 Ib. And be
12 ft. 6 in. Tall.
Growth and development proceed in Growth in height occurs in only one
an orderly sequence. sequence from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they
creep, creep before they stand, stand
before they walk, and walk before
they run. Some children may skip a
stage ( or pass through it so quickly
that the parents do not observe the
stage) or progress in a different order,
but most children follow a predictable
sequence of growth and development.
Different children pass through the All stages of development have a
predictable stages at different rates. range of time rather than a certain
point at which they are usually
accomplished. Two children may pass
through the motor sequence at
different rates. For example, one child
begins walking at 9 months while
another at 14 months. Both are
developing normally. They are both
 following the predictable sequence;
they are merely developing at different
rates.
All body systems do not develop at Certain body tissues mature more
the same rate. rapidly than others. For example,
neurologic tissue experiences its peak
growth during the first year of life,
whereas genital tissues grows little
until puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning
head; Caudal means tail.
Development proceeds from head to
tail. A newborn can lift only his or her
head off the bed when he or she lies
in a prone position. By age 2 months.,
the infant can lift his or her head and
chest off the bed; by 4 months., he or
she can lift his or her head, chest, and
part of the abdomen; by 5 months.,
the infant has enough control to turn
over ; by 9 months., he or she can
control the legs enough to crawl; and
by 1 year., the child can stand upright
and perhaps walk. Motor development
has proceeded in a cephalocaudal
order from the head to the lower
extremities.
Development proceeds from proximal This principle is closely related to
to distal body part. cephalocaudal development. It can be
illustrated by tracing the progress of
upper extremity development. A
newborn makes ;ittle use of the arms
or hands. Any movement, except to
put a thumb in the mouth, is a flailing
motin. By age 3 or 4 months., the
infant has enough arm control to
support the upper body weight on the
forearms, and the infant can
coordinate the hand to sccop up
objects. By 10 months., the infant can
coordinate the arm, thumb, and index
fingers, sufficiently well to use a
pincer-like grasp or be able to pick up
 an object as fine as a piece of
breakfast cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding
refined skills. one. Because the child is able to
control distal body parts such as
fingers, he or she is able to perform
fine motor skills ( a 3-year- old colors
best with a large crayon; a 12 yr-old
can write with a fine pen).
There is an optimum time for initiation A child cannot learn a task until his or
of experiences or learning. her nervous system is mature enogh
to allow that particular learning. A
child cannot learn to sit, for example,
no matter how much thechilds
parentshave him or her practice, until
the nervous system has matured
enough to allow back control. A child
who is not given the opportunity to
learn developmental tasks at the
appropriate or targert times for such
tasks may have ,ore difficulty than the
usual child learning the tasks later on.
A child who is confined to a body cast
at 12 months., which is the time he or
she would normally learn to walk, may
take a long time to learn this skill once
free of the cast at, say, age 2 years
old. The child has passed the time of
optimal learning fo that particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until
development can proceed. the grasp reflex has faded nor stand
steadily until the walking reflex has
faded. Neonatal reflexes are replaced
by purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step
learned by practice. over and over before he or she
accomplishes this securely. If a child
falls behind the normal growth and
development rate because of illness,
he or she is capable of catch-up
growth to bring him or her on equal
footing again with his or her age
group.
THEORIES OF DEVELOPMENT

1. Definition of Theories
Theory a systematic statement of principles that provides a framework for
explaining some phenomenon. Developmental theories provide road maps for
explaining human development.
Developmental Task a skill or a growth responsibility arising at a particular
time in an individuals life, the achievement of which will provide a foundation
for the accomplishment of future tasks. It is not so much chronological as the
completion of developmental tasks that defines whether a child has passed
from one developmental stage of childhood to another. For example, a child is
not a toddler just because he or she is 1 year plus 1 day old; he or she
becomes a toddler when he or she has passed through the development stage
of infancy.

2. Basic Division of Childhood

Stage Age Period
Neonate From 28 days of life
Infant 1 month 1 year
Toddler 1 3 years
Preschooler 3 5 year
School-age child 6 12 years
Adolescent 13 20 years

3. Freuds Stages of Childhood (Psychosexual Development)

Stage Psychosexual Stage Nursing Implications
Infant ORAL STAGE: Child explores Provide oral stimulation
the world by using his or her by giving pacifiers; do
mouth, especially the tongue. not discourage thumb
sucking. Breastfeeding
may provide more
stimulation than formula
feeding because it
requires the infant to
expend more energy.
Toddler ANAL STAGE: Child learns to Help children achieve
control urination and defecation. bowel and bladder
 control without undue
emphasis on its
importance. If at all
possible, continue bowel
and bladder training
while child is
hospitalized.
Preschooler PHALLIC STAGE: Child learns Accept childs sexual
sexual identity through interest,such as fonding
awareness of genital area. his or her own genitals,
as a normal area of
exploration. Helps
parents answer the
childs questions about
birth or sexual
differences.
School-age LATENT STAGE: Childs Help the child have
child personality development appears positive experiences as
to be non-active or dormant. his or her self-esteem
continues to grow and
as he or she prepares
for the conflicts of
adolescence.
Adolescent GENITAL STAGE: Adolescent Provide appropriate
develops sexual maturity and opportunities for the
learns to establish satisfactory child to relate with
relationships with the opposite opposite sex; allow the
sex. child to verbalize
feelings about new
relationships.

Eriksons Stages of Childhood (Psychosocial Development)

Stage Developmental Task Nursing Implications
Infant Developmental task is to Provide a primary
form a sense of trust caregiver.Provide
versus mistrust. Child experiences that add to
learns to love and be security such as soft
loved. sounds and touch.
Provide visual stimulation
for active child
involvement.
Toddler Developmental task is to Provide opportunities for
form a sense of decision makingsuch as
 autonomy versus offering choicesof clothes
shame. Child learns to to wear or toys to play
be independent and with. Praise ability to
make decisions for make decisions rather
himself or herself. than judge or correct the
childs decision.
Preschooler Developmental task is to Provide opportunities for
form a sense of initiative exploring new places or
versus guilt. Child learns activities. Allow play to
how to do things (basic include activities
problem solving) and involving water, clay (for
that doing things is modeling), or finger
desirable. paints.
School-age child Developmental task is to Provide opportunities
form a sense of industry such as allowing child to
versus inferiority. Child assemble and complete
learns how to do things a short project so that the
well. child feels rewarded for
the accomplishement.
Adolescent Developmental task is to Provide opportunites for
form a sense of identity the adolescent to discuss
versus role confusion. feelings about events
Adolescent learns who important to him or her.
he or she is and what Offer support and praise
kind of person he or she for decision making.
will be by adjusting to a
new body image,
seeking emancipation
from parents, choosing a
vocation, and
determining a value
system.

Piagets Stages of Cognitive Development

Stage of Development Age Span Nursing Implication

Sensorimotor neonatal 1 month Stimuli are assimilated
reflexes into beginning mental
images.Behavior is
entirely reflexive.
Primary circular reaction 1 4 months Hand mouth and ear
eye coordination develop.
Infant spends much time
 looking at objects and
separating self from
them. Beginning intention
of behavior is present (
the infant brings thumb to
mouth for a purpose: to
suck it ). An enjoyable
activity for the period: a
rattle or a tape of parents
voice.
Secondary circular 4 8 months Infant learns to initiate,
reaction recognize, and
repeatpleasurable
experiences from
environment. Memory
traces are present;
infants anticipates
familiar events ( a
parent coming near him
will pick him up ). Good
toy for this period: mirror;
good game: peek a
boo.
Coordination of 8 12 months Infant can plan activities
secondary reaction to attain specific goals;
can perceive that others
can cause activity and
that activities of own body
are separate from activity
of objects; can search for
and retrieve toy that
disappears from view;
and can recognize
shapes and sizes of
familiar objects. Because
of increased sense of
separateness, infant
experiences separation
anxiety when primary
caregiver leaves. Good
toy for this period: nesting
toys ( e.g., colored boxes
).
Tertiary circular reaction 12 18 months Child is able to
experiment
Invention of new means 18 24 months
through mental
combination
Pre operational 2 7 years
thought
Concrete operational 7 12 years
thought
Formal operational 12 years
thought

B. Nursing Care in the Different stages of Growth and Development including

1. Nutrition
2. Safety
3. Language Development
4. Discipline
5. Play
6. Immunization
7. Anticipatory guidance
8. Values formation
C. Human Sexuality and Reproduction including Family Planning
D. Nursing Care of Women during Normal Labor, Delivery and Postpartum
E. Nursing Care of the Newborn
1. APGAR Scoring
2. Newborn Scoring
3. Maintenance of Body Processes (oxygenation, temperature)
F. Nursing Care of Women with Complications of Pregnancy, Labor, Delivery
and Postpartum Period (High-risk conditions)
G. Nursing Care of High-risk Newborn
1. Prematurity
2. Congenital defects
3. Infections
H. Nursing Care of Women with Disturbances in Reproduction and
Gynecology

VIII. Research and Quality Improvement

A. Fertility Statistics
B. Infant Morbidity and Mortality
C. Maternal Mortality
D. Standards of Maternal and Child Nursing Practice
IX. Ethico-Moral-Legal Responsibility
A. Socio-Cultural Values, Belief, and Practices of Individuals, Families related
to MCN.
B. WHO, DOH, LGU Policies on Health of Women and Children
C. Family Code
D. Child and Youth Welfare Code
E. Issues related to MCN

X. Personal and Professional Development

A. Self-assessment of MCN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones self, Enhancing Competence in
MCN and Related Areas.

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing

Practice III, IV and V)
NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE III, IV, V
TEST DESCRIPTION: Theories, concepts, principles and processes in the
care of clients with altred health patterns, utilizing the nursing process and
integrating the key areas of nursing competencies.
TEST SCOPE:
I. Safe & Quality Care, Health Education, Management of Environment &
Resources, and Quality Improvement.

A. TEST III
1. Client in Pain
CLIENT IN PAIN

Pain- the fifth vital sign

- an unpleasant sensory and emotional experience associated with actual

or potential

Basic Categories of Pain:

 1. Acute Pain- sudden pain which is usually relieved in seconds or
after a few weeks.
2. Chronic Pain (Non-Malignant)- constant, intermittent pain which
usually persists even after healing of the injured tissue
3. Cancer-Related Pain- May be acute or chronic; may or may not
be relieved by medications.

Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in
the skin that respond to intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System

2. Peri-operative Care
3. Alterations in Human Functioning
a Disturbance in Oxygenation
b Disturbance in Metabolic and Endocrine Functioning
c Disturbance in Elimination

B. TEST IV
1. Alterations in Human Functioning
a. Disturbances in Fluids and Electrolytes
b. Inflammatory and Infectious Disturbances
c. Disturbances in Immunologic functioning
d. Disturbances in Cellular functioning
2. Client Biologic Crisis
3. Emergency and Disaster Nursing

C. TEST V
1. Disturbances in Perception and Coordination
a. Neurologic Disorders
b. Sensory Disorders
c. Musculo-skeletal Disorders
d. Degenerative Disorders
2. Maladaptive Patterns of Behavior
a. Anxiety Response and Anxiety Related Disorders
b. Psycho-physiologic Responses, Somatoform, and Sleep Disorders
c. Abuse and Violence
d. Emotional Responses and Mood Disorders
e. Schizophrenia and Other Psychotic and Mood Disorders
f. Social Responses and Personality Disorders
g. Substance related Disorders
h. Eating Disorders
i. Sexual Disorders
j. Emotional Disorders of Infants, Children and Adolescents.

II. Personal and Professional Development

A. Nurse-Client Relationship
B. Continuing Education

III. Communication, Collaboration and Teamwork

A. Team approach
B. Referral
C. Network/linkage
D. Therapeutic communication

IV. Ethico-Moral-Legal Responsibility

A. confidentiality
B. Clients Rights
1. Informed Consent
2. Refusal to take medications, Treatment and Admission Procedures
C. Nursing Accountability
D. Documentation/charting
E. Culture Sensitivity