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- 1. 1.CD control program 1.CD control program Communicable diseases Communicable diseases National Tuberculosis Control National Tuberculosis Control Program – key policies Program – key policies Case finding – direct Sputum Case finding – direct Sputum Microscopy and X-ray Microscopy and X-ray examination of examination of TB TB symptomatics symptomatics who are negative after 2 who are negative after 2 or more or more sputum exams sputum exams Treatment – shall be given free Treatment – shall be given free and on and on an ambula an ambulatory tory basis, basis, except those with acute except those with acute complications and emergencies complications and emergencies Direct Observed Treatment Short Direct Observed Treatment Short Course – comprehensive strategy Course – comprehensive strategy to detect and cure TB to detect and cure TB patients. patients. Category and Treatment Regimen Category and Treatment Regimen Category 1- new TB patients whose sputum is Category 1- new TB patients whose sputum is positive; seriously ill patients with positive; seriously ill patients with severe forms severe forms of smear-negative PTB with extensive of smear-negative PTB with extensive parenchymal involvement (moderately- or far- parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.) pleurisy, etc.) Category 2-previously-treated patients with Category 2-previously-treated patients with relapses or failures. relapses or failures. Category 3 – new TB patients whose sputum is Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x smear-negative for 3 times and chest x-ray -ray result of PTB minimal result of PTB minimal Category 1- Category 1- new TB patients whose sputum is new TB patients whose sputum is positive; positive; seriously ill patients with severe forms of smear- seriously ill patients with severe forms of smear- negative PTB with extensive parenchymal negative PTB with extensive parenchymal involvement (moderately- or far- advanced) and involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.) extra-pulmonary TB (meningitis, pleurisy, etc.) Intensive Phase (given daily for the first 2 months)- Intensive Phase (given daily for the first 2 months)- Rifampicin + Isioniazid + Rifampicin + Isioniazid + pyrazinamide + ethambutol. pyrazinamide + ethambutol. If sputum result becomes negative after 2 If sputum result becomes negative after 2 months, months, maintenance phase starts. But if sputum is still positive maintenance phase starts. But if sputum is still positive in 2 months, all in 2 months, all drugs are discontinued from 2-3 days drugs are discontinued from 2-3 days and a sputum specimen is examined for and a sputum specimen is examined for culture and drug culture and drug sensitivity. The patient resumes taking the 4 drugs for sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at another month and then another smear exam is done at the end of the 3 the end of the 3rd rd month. month. Maintenance Phase (after 3 Maintenance Phase (after 3rd rd month, regardless of the month, regardless of the result of the s result of the sputum exam)-INH + rifampicin daily putum exam)-INH + rifampicin daily Category 2-previously-treated patients with relapses or Category 2-previously-treated patients with relapses or failures. failures. Intensive Phase (daily for 3 months, Intensive Phase (daily for 3 months, month 1,2 & 3)- month 1,2 & 3)- Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 streptomycin for the first 2 months Streptomycin+ months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3 rifampicin pyrazinamide+ ethambutol on the 3rd rd month. month. If sputum is still positive after 3 months, the intensive If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months. intensive phase is continued for the next 5 months. Maintenance Phase (daily for 5 months, month Maintenance Phase (daily for 5 months, month 4,5,6,7,& 4,5,6,7,& 8)-Isionazid+ rifampicin+ ethambutol 8)-Isionazid+ rifampicin+ ethambutol Category 3 – new TB patients whose Category 3 – new TB patients whose sputum is smear- sputum is smear- negative for 3 times and chest x-ray result of PTB negative for 3 times and chest x-ray result of PTB minimal minimal Intensive Phase (daily for 2 months) Intensive Phase (daily for 2 months) – Isioniazid – Isioniazid + rifampicin + pyrazinamide + rifampicin + pyrazinamide Maintenance Phase (daily for the next 2 months) Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin - Isioniazid + rifampicin Stop TB ; Do it with Stop TB ; Do it with DOTS DOTS Advocacy is a Advocacy is a planned and continuo planned and continuous effort to us effort to inform people about issue and instigate change. inform people about issue and instigate change. Advocacy usually takes place over an extended Advocacy usually takes place over an extended period of time and includes a variety period of time and includes a variety of of strategies to communicate a specific message. strategies to communicate a specific message. TB is the number one infectious killer in the TB is the number one infectious killer in the world. world. One TB suspect can infect another 10 healthy One TB suspect can infect another 10 healthy persons persons Leprosy Control Program Leprosy Control Program WHO Classification – basis of multi-drug therapy WHO Classification – basis of multi-drug therapy ▪ ▪ Paucibacillary/PB – non- Paucibacillary/PB – non- infectious types. 6-9 months of infectious types. 6-9 months of treatment. treatment. ▪ ▪ Multibacillary/MB – infectious Multibacillary/MB – infectious types. 24-30 months of types. 24-30 months of treatment. treatment. Multi-drug therapy – use of 2 or Multi-drug therapy – use of 2 or more drugs more drugs renders patients non-infectious a week after renders patients non-infectious a week after starting treatment starting treatment ▪ ▪ Patients w/ single skin lesion and Patients w/ single skin lesion and a negative slit skin smear are a negative slit skin smear are treated w/ a single dose of ROM treated w/ a single dose of ROM regimen regimen ▪ ▪ For PB leprosy cases- For PB leprosy cases- Rifampicin+Dapsone on Day 1 Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 then Dapsone from Day 2-28. 6 blister packs taken monthly blister packs taken monthly within a max. period of 9 mos. within a max. period of 9 mos. All patients who have complied w/ MDT are All patients who have complied w/ MDT are considered cured and no longer regarded as a considered cured and no longer regarded as a case of leprosy, even if some sequelae case of leprosy, even if some sequelae of leprosy of leprosy remain. remain. Responsibilities of the nurse Responsibilities of the nurse ▪ ▪ Prevention – health education, Prevention – health education, healthful living through proper healthful living through proper nutrition, adequate rest, sleep nutrition, adequate rest, sleep and good personal hygiene; and good personal hygiene; ▪ ▪ Casefinding Casefinding ▪ ▪ Management and treatment – Management and treatment – prevention of secondary injuries, prevention of secondary injuries, handling of utensils; special handling of utensils; special shoes w/ padded soles; shoes w/ padded soles; importance of sustained therapy, importance of sustained therapy, correct dosage, effects of drugs correct dosage, effects of drugs and the need for medical check- and the need for medical check- up from time to time; mental & up from time to time; mental & emotional support emotional support ▪ ▪ Rehabilitation-makes patients Rehabilitation-makes patients capable, active and self- capable, active and self- respecting member of society. respecting member of society. Control of Schistosomiasis – a tropical disease caused Control of Schistosomiasis – a tropical disease caused by by a blood fluke, Schistosoma a blood fluke, Schistosoma Japonicum Japonicum ; transmitted by a ; transmitted by a tiny snail tiny snail Oncomelania quadrasi Oncomelania quadrasi Preventive measures – health education Preventive measures – health education regarding mode of transmission and methods of regarding mode of transmission and methods of protection; proper disposal of feces and urine; protection; proper disposal of feces and urine; improvement of irrigation and agriculture improvement of irrigation and agriculture practices practices Control of patient, contacts and the immediate Control of patient, contacts and the immediate environment environment Specific treatment- Praziquantel – drug of choice Specific treatment- Praziquantel – drug of choice Programs on Filariasis, Malaria and Dengue Hemorrhagic Programs on Filariasis, Malaria and Dengue Hemorrhagic Fever Fever Filariasis- a chronic prasitic infection caused by Filariasis- a chronic prasitic infection caused by a nematode, Wuchereria a nematode, Wuchereria bancrofti. bancrofti. Young and Young and adult worms adult worms live in the lymphatic vessels and live in the lymphatic vessels and nodes, while the micro filariae nodes, while the micro filariae are in the blood; are in the blood; transmitted transmitted through bites through bites from an from an infected infected female mosquito, Aedes female mosquito, Aedes poecilius, poecilius, that bites at that bites at night. night. ▪ ▪ Treatment: Diethylcarbamazine Treatment: Diethylcarbamazine citrate or Hetrazan citrate or Hetrazan ▪ ▪ Elephantiasis and Hydrocoele Elephantiasis and Hydrocoele are handled through surgery, are handled through surgery, prevention and supportive care prevention and supportive care Malaria – infection caused by the Malaria – infection caused by the bite of the female bite of the female Anopheles Anopheles mosquito mosquito, , Chemoprophylaxis – Chloroquine taken Chemoprophylaxis – Chloroquine taken at weekly intervals, starting from 1-2 at weekly intervals, starting from 1-2 weeks before entering the endemic area. weeks before entering the endemic area. Anti-malarial drugs – sulfadoxine, Anti-malarial drugs – sulfadoxine, quiinine sulfate, tetracycline, quinidine quiinine sulfate, tetracycline, quinidine Insecticide treatment of mosquito nets, Insecticide treatment of mosquito nets, house spraying, stream seeding and house spraying, stream seeding and clearing, sustainable preventive and clearing, sustainable preventive and vector control meas vector control meas Dengue H-fever Dengue H-fever
- 2. 4 4 o’clock o’clock habit habit Programs on Measles. Chickenpox, Programs on Measles. Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus – Mumps, Diphtheria, Pertusis, Tetanus – focused on health information focused on health information campaigns and intensive immunization campaigns and intensive immunization of children in barangays. of children in barangays. Prevention and Control Program on Parasitic Prevention and Control Program on Parasitic Infestations Infestations ( ( STH STH e.g. e.g. Ascaris, Ascaris, Trichuris, Trichuris, Hookworm) Hookworm) and and Paragonimiasis in communities where eating of fresh or Paragonimiasis in communities where eating of fresh or inadequately cooked crab is a practice inadequately cooked crab is a practice Management: Management: 1. Deworming 1. Deworming 2. Health Education re: 2. Health Education re: ▪ ▪ Good personal hygiene Good personal hygiene ▪ ▪ Use of footwear Use of footwear ▪ ▪ Washing fruits and Washing fruits and vegetables vegetables well well ▪ ▪ Use of sanitary toilets Use of sanitary toilets ▪ ▪ Sanitary disposal of garbage Sanitary disposal of garbage ▪ ▪ Boiling drinking water at least 2- Boiling drinking water at least 2- 3 3 min. min. from from boiling boiling point point or or chlorination chlorination Prevention and Control on Leptospirosis Prevention and Control on Leptospirosis/ Weil’s Disease/ / Weil’s Disease/ Mud Mud fever/Flood fever/ fever/Flood fever/ Spirochetal Jaundice Spirochetal Jaundice thru thru contact contact with with the skin/ open wound the skin/ open wound with water or with water or moist moist soil contaminated soil contaminated with urine of infected rat with urine of infected rat And Rabies And Rabies Mgt. of Rabies Mgt. of Rabies Wash wound with soap and water, betadine or Wash wound with soap and water, betadine or alcohol may be applied alcohol may be applied If dog If dog is healthy observe is healthy observe for 14 day for 14 days. If nothing s. If nothing happens- no need for ttt.If it dies happens- no need for ttt.If it dies or shows or shows rabies, kill then bring head for lab. Exam & rabies, kill then bring head for lab. Exam & consult doctor. consult doctor. Active immunization – body develops Ab Active immunization – body develops Ab against against rabies up rabies up to 3 to 3 yrs. yrs. Passive Passive I I – – giving giving Ab Ab to to persons persons with with head head and and neck bites, multiple single deep bites, neck bites, multiple single deep bites, contamination of mucous membranes or thin contamination of mucous membranes or thin covering of the eyes, lips or mouth covering of the eyes, lips or mouth to provide to provide immediate protection immediate protection RPO – immunization of pets at 3 mos. of RPO – immunization of pets at 3 mos. of age and age and yearly thereafter yearly thereafter Prevention and Control on STIs Prevention and Control on STIs - - Gonorrhea, Syphilis, HIV/AIDS, Gonorrhea, Syphilis, HIV/AIDS, Trichomoniasis,Chlamyd Trichomoniasis,Chlamydia, ia, Hep B Hep B ( the mo ( the most st serious type ‘cause of severe cx. Eg. Massive serious type ‘cause of severe cx. Eg. Massive liver damage and hepatocarcinoma liver damage and hepatocarcinoma - - 4 C’s 4 C’s in the Sy in the Syndromic Mgt ndromic Mgt - - 1. Compliance 1. Compliance - - 2. Counseling/ Education 2. Counseling/ Education - - 3. Contact tracing to treat partner 3. Contact tracing to treat partner - - 4. Condom use 4. Condom use - - Hep B vaccination Hep B vaccination - - Universal precautions Universal precautions - - Safe sex Safe sex 2. Community Needs Assessment/ 2. Community Needs Assessment/ Community Diagnosis Community Diagnosis Community Diagnosis Community Diagnosis A process by which the nurse A process by which the nurse collects data about collects data about the community in order to identify factors the community in order to identify factors which which may influence the deaths and illnesses of the may influence the deaths and illnesses of the population population to formulate a community health nursing to formulate a community health nursing diagnosis and develop and implement community diagnosis and develop and implement community health nursing interventions and strategies health nursing interventions and strategies Done to come up with a Done to come up with a profile of local health profile of local health situation situation Will serve as a basis Will serve as a basis of health programs and of health programs and services to be delivered to the services to be delivered to the community community Starts with determining the health status of the Starts with determining the health status of the community community 2 Types of Community Diagnosis 2 Types of Community Diagnosis 1. 1. Com Compre prehen hensiv sive Com e Commun munity D ity Diag iagnos nosis is aims to obtain general information about aims to obtain general information about the community the community 2. 2. Pro Proble blem-O m-Orie riente nted Comm d Communi unity Dia ty Diagno gnosis sis type of assessment responds to a type of assessment responds to a particular need particular need ELEMENTS OF ELEMENTS OF COMPREHEN COMPREHENSIVE SIVE COMMUNITY DIAGNOSIS COMMUNITY DIAGNOSIS 1. 1. DE DEMO MOGR GRAP APHI HIC VA C VARI RIAB ABLE LES S i. i. To Tota tal l po popu pula lati tion on & & Ge Geog ogra raph phic ical al distribution including Urban-Rural index distribution including Urban-Rural index & Population Density & Population Density i ii i. . A Ag ge e & & S Se ex x c co om mp po os si iti tio on n ii iii. i. Se Sele lect cted v ed vit ital i al ind ndic icat ator ors e. s e.q. G q. Gro rowt wth h rate, CBR, CDR & Life expectancy rate rate, CBR, CDR & Life expectancy rate i iv v. . P Pa at tt te er rn ns s o of f m mi ig gr ra ati tio on n v v. . P Po op pu ul la at ti io on n p pr ro oj je ec cti tio on n Note: Note: Population groups that need special Population groups that need special attentions: attentions: ▪ ▪ Indigenous people Indigenous people ▪ ▪ Socially dislocated groups as a Socially dislocated groups as a result of disasters, calamities & result of disasters, calamities & development programs development programs 2. 2. Soc Socio- io-eco econom nomic & Cu ic & Cultu ltural v ral vari ariabl ables es i i. . S So oc ci ia al i l in nd di ic ca at to or rs s Communication network Communication network Transportation system Transportation system Educational level Educational level Housing conditions Housing conditions i ii i. . E Ec co on no om mi ic c i in nd di ic ca at to or rs s Poverty level income Poverty level income Employment rate Employment rate Types of industry present in the Types of industry present in the community community Occupation common in the community Occupation common in the community ii iii. i. En Env vir iro onm nme ent ntal al in ind dic icat ato ors rs Physical/geographical/topographical Physical/geographical/topographical characteristics characteristics Water supply Water supply Waste disposal Waste disposal Air, Water and Land pollution Air, Water and Land pollution i iv v. . C Cu ul lt tu ur ra al f l fa ac ct to or rs s Variables that may break up people into Variables that may break up people into groups within the community e.q. groups within the community e.q. ▪ ▪ Ethnicity Ethnicity ▪ ▪ Social class Social class ▪ ▪ Language Language ▪ ▪ Religion Religion ▪ ▪ Race Race ▪ ▪ Political orientation Political orientation Cultural beliefs and practices that affect Cultural beliefs and practices that affect health health Concepts about Health and Illness Concepts about Health and Illness 3. 3. He Heal alth & th & il illn lnes ess pa s patt tter erns ns Leading cause of mortality Leading cause of mortality Leading cause of morbidity Leading cause of morbidity Leading cause of infant mortality Leading cause of infant mortality Leading cause of maternal mortality Leading cause of maternal mortality Leading cause of hospital admission Leading cause of hospital admission 4. 4. He Heal alth th re reso sour urce ces s Manpower resources Manpower resources Material resources Material resources 5. 5. Pol Politi itical cal/Le /Leade adershi rship p pa patte tterns rns Reflects the action potential of the state Reflects the action potential of the state and its people to address the and its people to address the health health needs and problems of the community needs and problems of the community Mirrors the sensitivity of the Mirrors the sensitivity of the government to the people’s struggle for government to the people’s struggle for better lives better lives PROCESS OF COMMUNITY DIAGNOSIS PROCESS OF COMMUNITY DIAGNOSIS Consists of; Consists of; 1. 1. Col Collec lectin ting, org g, organi anizin zing & synth g & synthesi esizin zing dat g data a In order to identify the In order to identify the different factors different factors that may directly or indirectly influence that may directly or indirectly influence the health of the the health of the population population 2. 2. Ana Analyz lyzing ing & in & inter terpre preting ting hea health d lth data ata Seek explanations for the occurrence of Seek explanations for the occurrence of health needs and problems of the health needs and problems of the community community
- 3. 3. 3. For Formul mulati ation of C on of Comm ommuni unity He ty Healt alth Nur h Nursing sing Diagnoses Diagnoses Will become the bases for developing Will become the bases for developing and implementing community health and implementing community health nursing interventions and strategies nursing interventions and strategies STEPS IN CONDUCTING COMMUNITY STEPS IN CONDUCTING COMMUNITY DIAGNOSIS DIAGNOSIS 1. 1. DETERMINING THE OBJECTIVES – the DETERMINING THE OBJECTIVES – the nurse nurse decides on the depth and scope of decides on the depth and scope of the data she the data she needs to gather. needs to gather. 2. 2. DEFINING THE STUDY POPULATION – DEFINING THE STUDY POPULATION – the nurse the nurse identifies the population group identifies the population group to be included in to be included in the study. the study. 3. 3. DETERMINING THE DATA TO BE DETERMINING THE DATA TO BE COLLECTED – the COLLECTED – the objectives will guide objectives will guide the nurse in identifying the the nurse in identifying the specific data specific data she will collect, and will she will collect, and will also decide also decide on on the sources of these data. the sources of these data. 4. 4. COLLECTIN COLLECTING THE DATA – G THE DATA – the nurse the nurse decides on decides on the specific methods the specific methods depending on the type of depending on the type of data to be data to be generated. generated. Ocular survey Ocular survey, interview, , interview, and rec and records ords review, review, 5. 5. DEVELOPING THE INSTRUMENT instruments/tools DEVELOPING THE INSTRUMENT instruments/tools facilitate the nurse’s facilitate the nurse’s data-gathering activities. data-gathering activities. Most Most common in common instrume struments nts: : survey questionnaire survey questionnaire interview guide interview guide observation checklist observation checklist 6. 6. ACTUAL DATA GATHERING – the nurse ACTUAL DATA GATHERING – the nurse supervises supervises the data collectors by the data collectors by checking the filled-up checking the filled-up instruments in instruments in terms of completeness, accuracy terms of completeness, accuracy and and reliability of the information collected. reliability of the information collected. 7. 7. DATA COLLATION – the nurse is now DATA COLLATION – the nurse is now ready to put ready to put together all the information. together all the information. Numerical data Numerical data Descriptive data Descriptive data 8. 8. DATA PRESENTATION – will depend DATA PRESENTATION – will depend largely on largely on the type of data obtained. the type of data obtained. Descriptive- narrative reports Descriptive- narrative reports numerical data- table or graphs numerical data- table or graphs 9. 9. DATA ANALYSIS – aims to establish DATA ANALYSIS – aims to establish trends and trends and patterns in terms of health patterns in terms of health needs and problems needs and problems of the community. of the community. 10. 10. Identifying Identifying Community Community Health Nursing Health Nursing Problems Problems a. a. He Heal alth th St Stat atus us Pr Prob oble lems ms Increased/decreased morbidity, Increased/decreased morbidity, mortality fertility or reduced capability mortality fertility or reduced capability for wellness for wellness b. b. He Heal alth Re th Reso sour urce ces Pro s Probl blem ems s Lack of or absence of manpower, money, Lack of or absence of manpower, money, materials or institutions necessary to materials or institutions necessary to solve health problems solve health problems c. c. He Heal alth th Re Rela late ted P d Pro robl blem ems s Existence of social, economic, Existence of social, economic, environmental and political factors that environmental and political factors that aggravate the illness-inducing situations aggravate the illness-inducing situations in the community in the community 11. 11. Prio Priority-se rity-setting tting a. a. Nat Nature of th ure of the cond e conditi ition/ on/pro proble blem pre m present sented ed Classified as health status, health Classified as health status, health resources or health related problems resources or health related problems b. b. Ma Magn gnit itud ude of e of th the p e pro robl blem em Severity of the problem which can be Severity of the problem which can be measured in terms of the measured in terms of the proportion of proportion of the population affected by the problem the population affected by the problem c. c. Mo Modi difi fiab abil ilit ity of th y of the pr e prob oble lem m Probability of reducing, controlling or Probability of reducing, controlling or eradicating the problem eradicating the problem d. d. Pr Prev even enti tive ve po pote tent ntia ial l Probability of controlling or reducing the Probability of controlling or reducing the effects posed by the problem effects posed by the problem e. e. So Soci cia al c l con once cern rn Perception of the population or the Perception of the population or the community as they are affected by the community as they are affected by the problem and their readiness to act problem and their readiness to act on on the problem the problem PLANNING PLANNING WHAT IS PLANNING? WHAT IS PLANNING? is a process that entails is a process that entails formulation of formulation of steps to be undertaken in the steps to be undertaken in the future in future in order to achieve a desired end. order to achieve a desired end. Concepts of Planning: Concepts of Planning: Planning is futuristic. Planning is futuristic. Planning is change-oriented. Planning is change-oriented. Planning is a continuous and dynamic Planning is a continuous and dynamic process. process. Planning is flexible. Planning is flexible. Planning is a systematic process. Planning is a systematic process. THE PLANNING CYCLE: THE PLANNING CYCLE: 1. 1. Situational Analysis Situational Analysis gather health data gather health data tabulate, analyze and interpret data tabulate, analyze and interpret data identify health problems identify health problems set priority set priority 2. 2. Goal and Objective Setting Goal and Objective Setting define program goals and objectives define program goals and objectives assign priorities among objectives assign priorities among objectives 3. 3. St Stra rate tegy gy/A /Act ctiv ivit ity y Se Sett ttin ing g Design CHN Program Design CHN Program Ascertain resources Ascertain resources Analyze constraints and limitations Analyze constraints and limitations 4 4. . E Ev va al lu ua at ti io on n determines outcomes determines outcomes specify criteria and standards specify criteria and standards Application of Public Health Tools ( Application of Public Health Tools (discuss in separate discuss in separate slide) slide) Three important tools Three important tools The health disciplines of The health disciplines of 1. 1. Demography Demography 2. 2. Vital statistics Vital statistics 3. 3. Epidemiology Epidemiology 3. COMMUNITY ORGANIZING 3. COMMUNITY ORGANIZING A process whereby the community members A process whereby the community members develop the capability to assess their develop the capability to assess their health health needs and problems, plan and implement actions needs and problems, plan and implement actions to solve these problems, put up sustain to solve these problems, put up sustain organizational structures which will support and organizational structures which will support and monitor implementation of health initiatives by monitor implementation of health initiatives by the people the people maglaya maglaya COMMUNITY ORGANIZING COMMUNITY ORGANIZING Purpose: Purpose: Empowerment or building the Empowerment or building the capability capability of people for future community action of people for future community action Approaches to community Approaches to community development development a a. . So Soci cial al ch chan ang ge es s Building up social organizations Building up social organizations (relationships, structure and resources) (relationships, structure and resources) b. b. Ch Chan ange ge in i in ide deol olog ogy y Knowledge, beliefs and attitude Knowledge, beliefs and attitude c c. . Ch Chan ang ge e ag agen ents ts Capacity to influence others by setting a Capacity to influence others by setting a good example. good example. Principles of CO: Principles of CO: 1. 1. We Welf lfar are a e app ppro roac ach h People esp. the oppressed, exploited and People esp. the oppressed, exploited and deprived sectors are most open to change, have deprived sectors are most open to change, have the capacity to change and are the capacity to change and are able to bring able to bring about change. Hence , CO is based on the about change. Hence , CO is based on the ff: ff: a. a. Pow Power er mus must r t resi eside de in t in the p he peop eople le
- 4. b. b. Dev Develo elopm pment. ent. is fr is from t om the pe he peopl ople to th e to the e people people c. c. Pe Peop ople pa le part rtic icip ipat atio ion n 2. 2. Te Tech chno nolo logi gica cal ap l appr proa oach ch must be based on the poorest sectors must be based on the poorest sectors of society. of society. The solutions of problems commonly shared by The solutions of problems commonly shared by these sectors must be focused on these sectors must be focused on collective collective organizations, planning and action organizations, planning and action 3. 3. Tr Tran ansf sfor orma mato tory a ry app ppro roah ah should lead to self-reliant communities should lead to self-reliant communities Five stages Five stages 1. 1. Community analysis Community analysis 2. 2. Design and initiation Design and initiation 3. 3. Implementation Implementation 4. 4. Program maintenance – consolidation Program maintenance – consolidation 5. 5. Dissemination – reassessment Dissemination – reassessment 1.Community analysis 1.Community analysis The process of assessing and defining needs, The process of assessing and defining needs, opportunities and resources involved in opportunities and resources involved in initiating community health action . initiating community health action . Maybe referred to as community diagnosis, Maybe referred to as community diagnosis, community needs assessment, health education community needs assessment, health education planning and mapping planning and mapping 5 components of community analysis 5 components of community analysis 1. 1. Demo Demograp graphic, hic, social social and and econo economic mic prof profile of ile of the the community derived from secondary data. community derived from secondary data. 2. 2. Hea Health ri lth risk pr sk profi ofile (so le (socia cial, be l, behav haviou ioural an ral and d environmental risks) environmental risks) Behavioural- dietary habits and other life Behavioural- dietary habits and other life style concerns like alcohol, tobacco and style concerns like alcohol, tobacco and drugs drugs Social indicators- exposure to long term Social indicators- exposure to long term unemployment, low education and unemployment, low education and isolation. isolation. 3. 3. Hea Health lth/we /wellne llness o ss out c ut come omes pr s profi ofile le (morbidity/mortality data) (morbidity/mortality data) 4. 4. Sur Survey of cu vey of curre rrent heal nt health pro th promot motion pr ion progr ograms ams. . 5. 5. Stu Studie dies cond s conduct ucted in ce ed in certa rtain tar in targe get gro t groups ups Steps in community analysis Steps in community analysis Steps in community analysis Steps in community analysis i i. . D De ef fi in ni in ng g t th he e c co om mm mu un ni it ty y 1. 1. De Dete term rmin inin ing th g the ge e geog ogra raph phic b ic bou ound ndar arie ies s of the target community of the target community i ii i. . C Co ol ll le ec ct ti in ng g d da at ta a ii iii. i. As Asse sess ssin ing g co comm mmun unit ity y ca capa paci city ty 1. 1. En Enta tail ils a s an e n eva valu luat atio ion o n of t f the he dr driv ivin ing g forces which may facilitate or forces which may facilitate or impede impede the advocated change the advocated change iv iv. . A Ass sses essi sing c ng com omm mun unit ity ba y bar rri rier ers s v v. . A Ass sses essi sing ng r rea ead din ines ess t s to c o cha hang nge e 1 1. . C Co om mm mu un ni it ty y i in nt te er re es st t 2. 2. Pe Perc rcep epti tion on on on th the i e imp mpor orta tanc nce o e of t f the he problem problem vi vi. . Sy Synt nthe hesi sis d s dat ata a a and nd se set p t pri rior orit itie ies s 1. 1. Pr Prov ovid ide a c e a com ommu muni nity p ty pro rofi file o le of t f the n he nee eeds ds and resources and will become the and resources and will become the Basis Basis for designing prospective community for designing prospective community interventions for health promotion interventions for health promotion 2.Design and initiation 2.Design and initiation STEPS: STEPS: 1. 1. Establish a core Establish a core planning planning group and group and select a select a local organizer. local organizer. Requirements: Requirements: Select 5-8 member in charge for Select 5-8 member in charge for core core planning and management of the planning and management of the program program With management skills, good listener With management skills, good listener and conflict resolution skills. and conflict resolution skills. 2. 2. Cho Choose ose an o an org rgani anizat zation ional st al struc ructur ture. e. This activate the community This activate the community participation. participation. Types: Types: a. a. Leadersh Leadership board ip board council council- existing local - existing local leaders working for a common cause leaders working for a common cause b. b. Coaliti Coalition- linking on- linking organiza organizations and tions and groups to work on community issues. groups to work on community issues. c. c. “lead” or official agency- a single agency “lead” or official agency- a single agency takes the primary responsibility of a takes the primary responsibility of a liaison for health promotion activities in liaison for health promotion activities in the community. the community. d. d. Grass-roots- informal structures in the Grass-roots- informal structures in the community like the neighbourhood community like the neighbourhood residents. residents. e. e. Citizens panels- a group of citizens (5- Citizens panels- a group of citizens (5- 10) emerge to form a partnership with 10) emerge to form a partnership with the government agency. the government agency. f. f. Networks and consortia- network Networks and consortia- network develop because of a certain concerns develop because of a certain concerns 3. 3. Ide Identi ntify, se fy, selec lect and rec t and recruit or ruit orga ganiz nizati ationa onal l members. members. As much as possible different groups, As much as possible different groups, organizations sectors should be organizations sectors should be represented. represented. Chosen representative have power for Chosen representative have power for the group they represents the group they represents 4. 4. Def Define ine the the org organi anizat zation ion mis missio sion a n and nd go goals als. . This will specify the This will specify the what, who, where, what, who, where, when and extent of the when and extent of the organizational organizational objectives. objectives. 5. 5. Cla Clarif rify role y roles and res s and respo ponsib nsibili ilitie ties of peo s of people ple involved in the organization. involved in the organization. This is done to establish a smooth This is done to establish a smooth working relationship and avoid working relationship and avoid overlapping of responsibilities. overlapping of responsibilities. 6. 6. Pro Provid vide tr e train aining ing and and rec recog ogniti nition. on. Active involvement in planning and Active involvement in planning and management of programs may require management of programs may require skills development training. skills development training. Recognition of the programs Recognition of the programs accomplishment and individuals accomplishment and individuals contribution to the success of the contribution to the success of the program and boost morale of the program and boost morale of the members. members. 3.Implementation 3.Implementation -put the design plan into action. -put the design plan into action. a. a. Gen Genera erate br te broad c oad citi itizen p zen part artici icipat pation ion How? How? ▪ ▪ Organizing task force, who, with Organizing task force, who, with appropriate guidance can appropriate guidance can provide the necessary support. provide the necessary support. b. b. Dev Develo elop a p a seq sequen uentia tial w l work ork pla plan n Activities should be planned Activities should be planned sequentially. Often, times has to be sequentially. Often, times has to be modified as events modified as events unfold. Community unfold. Community members may have to constantly members may have to constantly monitor implementation steps. monitor implementation steps. c. c. Use Use com compre prehen hensiv sive, e, int integr egrate ated d stra strateg tegies ies Generally the program utilize more than Generally the program utilize more than one strategies that must one strategies that must complement complement each other. each other. d. d. Integ Integrate rate comm community unity value values in s into t to the he prog programs, rams, materials and messages. materials and messages. The community language, values and The community language, values and norms have to be incorporated into the norms have to be incorporated into the program. program. 4.Program maintenance – consolidation 4.Program maintenance – consolidation The program a this point has experienced s The program a this point has experienced some ome degree of success and has weathered through degree of success and has weathered through implementation problems, the organization and implementation problems, the organization and program is gaining acceptance in the program is gaining acceptance in the community. community. Maintenance: Maintenance: a. a. Int Integr egrate inte ate interve rventi ntion activ on activiti ities into com es into commun munity ity networks networks This can be affected through This can be affected through implementation problems. implementation problems. The organization and program is gaining The organization and program is gaining acceptance in the community. acceptance in the community. b. b. Estab Establish lish a a posit positive ive orga organizat nizational ional cultu culture. re.
- 5. A positive environment is a critical A positive environment is a critical element in maintaining cooperation and element in maintaining cooperation and preventing fast turnover of members. preventing fast turnover of members. This is a result This is a result of good group process of good group process based on trust, respect, and openness. based on trust, respect, and openness. c. c. Est Establ ablish a ish an on n ongoi going r ng recr ecruit uitmen ment pl t plan. an. It should be expected that volunteers It should be expected that volunteers may leave the organization. may leave the organization. This requires a built in mechanisms for This requires a built in mechanisms for continuous recruitment and training of continuous recruitment and training of new members. new members. d. d. Di Disse ssemi mina nate te re resul sults ts. . Continuous feedback to the community Continuous feedback to the community on results of activities enhances on results of activities enhances visibility and acceptance of the visibility and acceptance of the organization. organization. Dissemination of information is vital to Dissemination of information is vital to gain and maintain community support. gain and maintain community support. 5. 5.Dissemination-Reassessment Dissemination-Reassessment Continuous assessment is part of the Continuous assessment is part of the monitoring monitoring aspect in the management of the aspect in the management of the program program a. a. Upd Update ate the the com commun munity ity ana analys lysis. is. Is there a change in leadership, Is there a change in leadership, resources and participation? resources and participation? This may necessitate reorganization and This may necessitate reorganization and new collaboration with other new collaboration with other organizations. organizations. b. b. Assess Assess effec effectiven tiveness ess of of inter interventio ventions/pr ns/program ograms. s. Quantitative and qualitative methods of Quantitative and qualitative methods of evaluation can be used to determine evaluation can be used to determine participation, support and behavior participation, support and behavior change level of decision making and change level of decision making and other factors deemed important to the other factors deemed important to the program. program. c. c. Cha Chart fu rt futur ture dir e direct ectori ories and m es and mod odific ificati ations ons. . This may mean revision of goals and This may mean revision of goals and objectives and development of new objectives and development of new strategies. strategies. Revitalization of collaboration and Revitalization of collaboration and networking may be vital in support of networking may be vital in support of new ventures. new ventures. d. d. Sum Summar marize a ize and d nd diss issemi eminat nate res e result ults. s. Some organization die because of the Some organization die because of the lack of visibility. lack of visibility. Thus, a Thus, a dissemination dissemination plan may plan may be be helpful in diffusion of information to helpful in diffusion of information to further boost support to the further boost support to the organization’s endeavour. organization’s endeavour. The Health Resource Development The Health Resource Development Program Program Community Health Organizing Utilizing COPAR Community Health Organizing Utilizing COPAR HRDP HRDP Was developed and sponsored by the Was developed and sponsored by the Philippine Philippine Center for Population and Center for Population and Development (PCPD) Development (PCPD) To make health services available and accessible To make health services available and accessible to depressed and underserved communities in to depressed and underserved communities in the Philippines the Philippines PCPD is a non-stock, non-profit institution, which PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions serves as a resource center assisting institutions and agencies through programs and and agencies through programs and projects projects geared toward the social human development of geared toward the social human development of rural and urban communities rural and urban communities Formerly known as The Population Center Formerly known as The Population Center Foundation Foundation HISTORY OF HRDP HISTORY OF HRDP HRDP I HRDP I Trained the faculty, medical/nursing Trained the faculty, medical/nursing students to provide health care services students to provide health care services to the far flung barrios to the far flung barrios because of lack because of lack of man power for health services at the of man power for health services at the same time that similar activities fulfilled same time that similar activities fulfilled the curricular requirements of the the curricular requirements of the students for public health students for public health The PCPD The PCPD provides seed m provides seed money for oney for the the income generating projects income generating projects The CO uses his/her own strategy or The CO uses his/her own strategy or method in developing the community method in developing the community Short-term service Short-term service HISTORY OF HRDP HISTORY OF HRDP HRDP II HRDP II The 2 The 2nd nd cycle uses the same strategy but cycle uses the same strategy but the program could not be sustained by the program could not be sustained by the schools or hospitals and the income- the schools or hospitals and the income- generating projects eventually become generating projects eventually become the hindrance to the goal of achieving the hindrance to the goal of achieving the health program because the people the health program because the people tend to be more interested in the income tend to be more interested in the income generated by the projects generated by the projects Both HRDP I and HRDP II have brought Both HRDP I and HRDP II have brought about some changes in the community about some changes in the community life of the people life of the people Established basic health infrastructure; Established basic health infrastructure; basic health services were increased; basic health services were increased; there were trained workers and there were trained workers and organized health groups to take care of organized health groups to take care of the needs of the the needs of the community community HISTORY OF HRDP HISTORY OF HRDP HRDP III HRDP III PCPD refined the program and resulted PCPD refined the program and resulted to what is now called to what is now called HRDP III, which has HRDP III, which has these unique features: these unique features: ▪ ▪ Comprehensive training of the Comprehensive training of the staff and faculty of the staff and faculty of the participating agency in which the participating agency in which the community work was initiated community work was initiated ▪ ▪ Periodic training program and Periodic training program and regular assistance to the regular assistance to the participating agency were participating agency were provided to strengthen the provided to strengthen the health outreach program to health outreach program to become community oriented become community oriented ▪ ▪ PHC as the approach with which PHC as the approach with which all nursing/medical students, all nursing/medical students, their CI’s and indigenous health their CI’s and indigenous health workers are trained for workers are trained for community health work and community health work and around which all other project around which all other project inputs will revolve inputs will revolve HISTORY OF HRDP HISTORY OF HRDP Community organizing as the main Community organizing as the main strategy to be employed in preparing the strategy to be employed in preparing the communities to develop their community communities to develop their community health care systems and the health care systems and the establishment of community health establishment of community health organization to manage the community organization to manage the community health programs health programs Organizing work in the communities Organizing work in the communities were done in 3 phases were done in 3 phases PAR as fascinating strategy for PAR as fascinating strategy for maximum community involvement maximum community involvement through collective identification and through collective identification and analysis of community health problems analysis of community health problems and collective health action and collective health action Available funds to finance community Available funds to finance community initiated projects initiated projects COPAR? COPAR? Since Management Leadership and Since Management Leadership and Jurisprudence are courses taught in the Jurisprudence are courses taught in the classroom members of this group of students classroom members of this group of students were trained to manage and acts as were trained to manage and acts as leaders of leaders of the different levels of the students who were the different levels of the students who were involved in COPAR involved in COPAR Principles of management were applied in Principles of management were applied in carrying out primary health care carrying out primary health care The community m The community members, CHW’ embers, CHW’s s and leaders and leaders were empowered to manage their own health were empowered to manage their own health projects projects Conducted seminars and trainings as well as Conducted seminars and trainings as well as health education and services needed by health education and services needed by community(exposure and immersion 6-8 weeks) community(exposure and immersion 6-8 weeks) THE HRDP-COPAR PROCESS THE HRDP-COPAR PROCESS 1. 1. PR PRE- E-EN ENT TRY RY PH PHAS ASE E 2 2. . E EN NT TR RY P Y PH HA AS SE E
- 6. 3. 3. CO COMMU MMUNI NITY TY STU STUDY/ DY/DIA DIAGNO GNOSIS SIS PHASE/RESEARCH PHASE PHASE/RESEARCH PHASE 4. 4. COMM COMMUNIT UNITY Y ORGA ORGANIZAT NIZATION ION AND AND CAPA CAPABILIT BILITY- Y- BUILDING PHASE BUILDING PHASE 5. 5. CO COMM MMUN UNIT ITY AC Y ACTI TION P ON PHA HASE SE 6. 6. SUS SUSTEN TENAN ANCE AND S CE AND STRE TRENG NGTHE THENIN NING PHA G PHASE SE 1. Pre-Entry Phase 1. Pre-Entry Phase Preparation of the Institution Preparation of the Institution Train faculty and students in COPAR. Train faculty and students in COPAR. Formulate plans for institutionalizing COPAR. Formulate plans for institutionalizing COPAR. Revise/enrich curriculum and immersion Revise/enrich curriculum and immersion program. program. Coordinate participants of other departments. Coordinate participants of other departments. Site Selection Site Selection Initial networking with local government. Initial networking with local government. Conduct preliminary special investigation. Conduct preliminary special investigation. Make long/short list of potential communities. Make long/short list of potential communities. Do ocular survey of listed communities. Do ocular survey of listed communities. Criteria for Initial Site Selection Criteria for Initial Site Selection o Must have a population of 100-200 o Must have a population of 100-200 families. families. o Economically depressed. o Economically depressed. o No strong resistance from the o No strong resistance from the community. community. o No serious peace and order problem. o No serious peace and order problem. o No similar group or organization holding the o No similar group or organization holding the same program. same program. Identifying Potential Barangay Identifying Potential Barangay o Do the same process as in selecting o Do the same process as in selecting municipality. municipality. o Consult key informants and residents. o Consult key informants and residents. o Coordinate with local government and NGOs o Coordinate with local government and NGOs for future activities. for future activities. Choosing Final Barangay Choosing Final Barangay o Conduct informal interviews with community o Conduct informal interviews with community residents and key informants. residents and key informants. o Determine the need of the program in the o Determine the need of the program in the community. community. o Take note of political development. o Take note of political development. o Develop community profiles for secondary o Develop community profiles for secondary data. data. o Develop survey tools. o Develop survey tools. o Pay courtesy call to community leaders. o Pay courtesy call to community leaders. o Choose foster families based on guidelines. o Choose foster families based on guidelines. Identifying Host Family Identifying Host Family o House is strategically located in the o House is strategically located in the community. community. o Should not belong to the rich o Should not belong to the rich segment. segment. o Respected by both formal and informal o Respected by both formal and informal leaders. leaders. o Neighbours are not hesitant to enter the o Neighbours are not hesitant to enter the house. house. o No member of the host family s o No member of the host family should be hould be moving out in the community. moving out in the community. 2. Entry Phase 2. Entry Phase Guidelines for Entry Guidelines for Entry o Recognize the role of local o Recognize the role of local authorities by authorities by paying them visits to inform their paying them visits to inform their presence and presence and activities. activities. o Her appearance, speech, behavior and lifestyle o Her appearance, speech, behavior and lifestyle should be in keeping with those of should be in keeping with those of the the community residents without disregard of their community residents without disregard of their being role model. being role model. o Avoid raising the consciousness of the o Avoid raising the consciousness of the community residents; adopt a low-key profile. community residents; adopt a low-key profile. Activities in the Entry Phase Activities in the Entry Phase Integration - establishing rapport with the Integration - establishing rapport with the people in continuing effort to imbibe community people in continuing effort to imbibe community life. life. § living with the community § living with the community § seek out to converse with § seek out to converse with people people where they usually congregate where they usually congregate § lend a hand in § lend a hand in household chores household chores § avoid gambling and drinking § avoid gambling and drinking Deepening social investigation/community study Deepening social investigation/community study verification and enrichment of data collected verification and enrichment of data collected from initial survey from initial survey conduct baseline survey by students, conduct baseline survey by students, results relayed through community results relayed through community assembly assembly Leader Spotting Through Leader Spotting Through Sociogram. Sociogram. Key persons - approached by Key persons - approached by most people most people Opinion leader - approach by key persons Opinion leader - approach by key persons Isolates - never or hardly consulted Isolates - never or hardly consulted 4.NCD prevention and control program 4.NCD prevention and control program 1. 1. Pre Preven ventio tion and Co n and Contr ntrol of Ca ol of Cardi rdiova ovascul scular ar Diseases Diseases 2. 2. Can Cancer P cer Prev revent ention a ion and E nd Earl arly De y Detec tectio tion n 3. 3. Nat’ Nat’l Di l Diabete abetes Pr s Prevent evention ion and and Contr Control P ol Progra rogram m 4. 4. Pre Preven ventio tion and C n and Cont ontrol o rol of Kid f Kidney D ney Dise isease ase 5. 5. Pro Progra gram on Men m on Mental He tal Healt alth and Men h and Mental Di tal Disor sorder ders s 6. 6. Pr Prog ogra ram on Dr m on Drug De ug Depe pend nden ence/ ce/ Substance Abuse Substance Abuse 7. 7. Com Commun munity ity-Ba -Based Reh sed Rehabi abilit litati ation Prog on Program ram 8. 8. Pro Progra gram on the El m on the Elder derly/ ly/Ger Geriat iatric Nu ric Nursi rsing ng Services Services 9. 9. Pro Progra grams o ms on Bli n Blindn ndness ess, De , Deafn afness a ess and nd Osteoporosis Osteoporosis 1. 1. Prevention Prevention and and Control Control of of Cardiovascular Cardiovascular Diseases Diseases heart – 1 heart – 1st st leading leading cause cause of of death death blood blood vessels vessels - - 2 2nd nd Types: Types: 1. 1. Co Cong ngen enit ital H al Hea eart D rt Dis isea ease ( se (CH CHD) D): : 2. 2. Rh Rheu eumat matic F ic Fev ever or R er or Rhe heuma umatic tic Hea Heart D rt Dise ise as ase e 3. 3. Hy Hyp per erte tens nsio ion n 4. 4. pr prim imar ary or es y or esse sent ntia ial l 5. 5. Isc Ischem hemic Hea ic Heart Dis rt Diseas ease/ Ath e/ Athero eroscl sclero erosis sis 1.Congenital Heart Disease (CHD): Result of the 1.Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in pulmonary stenosis, and cyanosis; most prevalent in children children Causes: environmental factors, maternal diseases or Causes: environmental factors, maternal diseases or genetic aberrations genetic aberrations 2. 2. Rhe Rheuma umatic Fe tic Fever or R ver or Rheu heumat matic Hea ic Heart Dis rt Diseas ease: e: Systematic inflammatory disease that may Systematic inflammatory disease that may develop as a delayed reaction to repeated and develop as a delayed reaction to repeated and an inadequately treated infection of the an inadequately treated infection of the upper upper respiratory tract by group A beta-hemolytic respiratory tract by group A beta-hemolytic streptococci. streptococci. 3. 3. Hyp Hypert ertens ension ion: Pers : Persist istent el ent eleva evatio tion of the n of the arterial blood pressure. arterial blood pressure. 4. 4. prim primary ary or or essent essential) ial) ;freq ;frequent uent amon among fe g females males but severe,malignant form is more common but severe,malignant form is more common among males among males 5. 5. Isc Ischem hemic Hea ic Heart Dis rt Diseas ease/ Ath e/ Athero eroscl sclero erosis: sis: Condition usually caused by the occlusion of Condition usually caused by the occlusion of the the coronary arteries by thrombus or clot formation. coronary arteries by thrombus or clot formation. higher among males than females for the higher among males than females for the latter latter are are protected protected by by estrogen estrogen before before menopause menopause PF: HPN, DM, Smoking PF: HPN, DM, Smoking Minor Minor RF: RF: stress, stress, strong strong family family history, history, obesity obesity CVD CVD CVD CVD Primary Prevention: CVD Primary Prevention: CVD Primary Prevention thru health education is the Primary Prevention thru health education is the main focus of the program: main focus of the program: 1. 1. mai mainte ntenan nance ce of of ide ideal b al body ody wt. wt. 2 2. . d di ie et t - - l lo ow w f fa at t 3. 3. alc alcoho ohol/s l/smok moking ing avo avoida idance nce 4 4. . E Ex xe er rc ci is se e 5. 5. re regu gula lar B r BP c P che heck ck up up 2. 2. Can Cancer P cer Prev revent ention a ion and Ea nd Early rly Det Detect ection ion Any malignant tumor arising from the abnormal Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the and uncontrolled division of cells causing the destruction in the surrounding tissues. destruction in the surrounding tissues.
- 7. Common Cancer: Lung cancer, cervical cancer, Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer. cancer, skin cancer, prostate cancer. 3 3rd rd leading cause of illness and leading cause of illness and death ( Phil.) death ( Phil.) Incidence can Incidence can only be only be reduced thru reduced thru prevention prevention and early detection and early detection NINE WARNING SIGNS OF CANCER: NINE WARNING SIGNS OF CANCER: Change in blood bowel or bladder habits Change in blood bowel or bladder habits A sore that does not heal A sore that does not heal Unusual bleeding or discharge Unusual bleeding or discharge Thickening or lump in breast or elsewhere Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Indigestion or difficulty in swallowing Obvious change in wart or mole Obvious change in wart or mole Nagging cough or hoarseness Nagging cough or hoarseness Unexplained anemia Unexplained anemia Sudden unexplained weight loss Sudden unexplained weight loss Prevention & Early Detection Prevention & Early Detection PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES One third of all cancers are curable if One third of all cancers are curable if detected early and treated properly. detected early and treated properly. Three major forms of treatment of Three major forms of treatment of cancer: cancer: Surgery Surgery Radiation Therapy Radiation Therapy Chemotherapy Chemotherapy 3.Nat’l Diabetes Prevention and Control Program 3.Nat’l Diabetes Prevention and Control Program Aim: Aim: Controlling and assimilating healthy lifestyle in Controlling and assimilating healthy lifestyle in the the Filipino Filipino culture culture ( ( 2005-2010) 2005-2010) thru thru IEC IEC Main Concern: modifiable risk factors( diet, body Main Concern: modifiable risk factors( diet, body wt., smoking, alcohol, stress, sedentary living, wt., smoking, alcohol, stress, sedentary living, birth wt. ,migration birth wt. ,migration 4.Prevention and Control of Kidney Disease 4.Prevention and Control of Kidney Disease Acute or Rapidly Progressive Renal Failure : Acute or Rapidly Progressive Renal Failure : A A sudden decline in renal function resulting from the sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or failure of the renal circulation or by glomerular or tubular damage causing the accumulation of tubular damage causing the accumulation of substances that is normally eliminated in the urine in substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions. endocrine, and metabolic functions. Acute Nephritis: Acute Nephritis: A severe inflammation of the kidney A severe inflammation of the kidney caused by infection, degenerative disease, or disease caused by infection, degenerative disease, or disease of the blood vessels. of the blood vessels. Chronic Renal Failure: Chronic Renal Failure: A progressive deterioration of A progressive deterioration of renal function that ends as uremia and its renal function that ends as uremia and its complications unless dialysis or kidney transplant is complications unless dialysis or kidney transplant is performed. performed. Neprolithiasis: A disorder characterized by the Neprolithiasis: A disorder characterized by the presence of calculi in the presence of calculi in the kidney. kidney. Nephrotic Syndrome: A clinical disorder of Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the excessive leakage of plasma proteins into the urine because of increased permeability of the urine because of increased permeability of the glomerular capillary membrane glomerular capillary membrane Urinary Tract Infection: A disease caused by the Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the presence of pathogenic microorganisms in the urinary tract with or without signs and urinary tract with or without signs and symptoms. symptoms. Renal Tubular Defects: An abnormal condition in Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into the reabsorption of selected materials back into the blood and secretion, collection, and the blood and secretion, collection, and conduction of urine. conduction of urine. Urinary Tract Obstruction: A condition wherein Urinary Tract Obstruction: A condition wherein the urine flow is the urine flow is blocked or clogged. blocked or clogged. 5. Program on Mental Health and Mental 5. Program on Mental Health and Mental Disorders Disorders 6. Program on Drug Dependence/ 6. Program on Drug Dependence/ Substance Abuse Substance Abuse 7.Community-Based Rehabilitation Program 7.Community-Based Rehabilitation Program A creative application of the primary health A creative application of the primary health care care approach in rehabilitation services, which approach in rehabilitation services, which involves measures taken at the community level involves measures taken at the community level to use and build on the resources of the to use and build on the resources of the community with the community people, community with the community people, including impaired, disabled and handicapped including impaired, disabled and handicapped persons as well. persons as well. Goal: To improve the quality of life and increase Goal: To improve the quality of life and increase productivity of disabled, handicapped persons. productivity of disabled, handicapped persons. Aim: To reduce the prevalence of disability Aim: To reduce the prevalence of disability through prevention, early detection and through prevention, early detection and provision of rehabilitation services at the provision of rehabilitation services at the community level. community level. 8. 8. Pro Progra gram on the El m on the Elder derly/ ly/Ger Geriat iatric Nu ric Nursi rsing ng Services Services 7 7 humanitarian humanitarian issues: issues: family, family, health, health, income, income, security, employ security, employment and lab ment and labor, or, social welfare, social welfare, education, recreation, culltural activities and education, recreation, culltural activities and housing housing Leading causes of illness:elderly Leading causes of illness:elderly Influenza, HPN, diarrhea, Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, bronchitis, TB, diseases. of the heart, pneumonia, malaria, pneumonia, malaria, malignant malignant neoplasm, neoplasm, chickenpox chickenpox Leading causes of death:elderly Leading causes of death:elderly Diseases of Diseases of heart and heart and vascular system vascular system Pneumonia, TB, CCOPD Pneumonia, TB, CCOPD Malignant neoplasms Malignant neoplasms Diabetes Diabetes Nephritis Nephritis Accidents Accidents 9.Programs on Blindness, Deafness and 9.Programs on Blindness, Deafness and Osteoporosis Osteoporosis Cataract- main causes of blindness Cataract- main causes of blindness VAD- main cause of childhood blindness; most VAD- main cause of childhood blindness; most serious eye problem of Fil. children below 6 serious eye problem of Fil. children below 6 yrs. yrs. old old Osteoporosis special problem in Osteoporosis special problem in women, women, highest bet. 50—79 highest bet. 50—79 yrs. old, MENOPAUSE- main yrs. old, MENOPAUSE- main cause cause Prevention of NCD/Role of Nursing in Health Promotion Prevention of NCD/Role of Nursing in Health Promotion And Advocacy And Advocacy Yosi Kadiri- anti smoking Yosi Kadiri- anti smoking Edi Exercise/Hataw-regular physical activity Edi Exercise/Hataw-regular physical activity Tiya Kulit/ Iwas Sakit Diet-low salt, low Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high fat, high fiber diet fiber diet Mag HL – exercise, no smoking, avoidance of Mag HL – exercise, no smoking, avoidance of alcohol, healthy diet, iwas stress, watch alcohol, healthy diet, iwas stress, watch wt. wt. Sentrong Sigla Movement ( SSM) Sentrong Sigla Movement ( SSM) -a certification recognition program which develops and -a certification recognition program which develops and promotes standards for health facilities promotes standards for health facilities - - Joint effort bet.: Joint effort bet.: 1.DOH – provides technical and financial assistance 1.DOH – provides technical and financial assistance packages for health care packages for health care 2. LGUs – 2. LGUs – direct implementers of direct implementers of health programs health programs & & prime develop prime developers of health centers and ers of health centers and hospitals hospitals making services accessible to every Filipino making services accessible to every Filipino Pillars of SSM Pillars of SSM 1. 1. Qu Qual alit ity A y Ass ssur uran ance ce 2. 2. Gra Grant nt and and Tec Techni hnical cal Ass Assist istanc ance e 3. 3. He Heal alth th Pr Prom omot otio ion n 4 4. . A Aw wa ar rd ds s Expected Outcome: SSM Expected Outcome: SSM Empowered Empowered individuals individuals adopting adopting healthy healthy lifestyle, imp lifestyle, improved roved health-seeking health-seeking behavior and behavior and well-being & increased demand for quality well-being & increased demand for quality health services health services Institutions will develop policies, provide quality Institutions will develop policies, provide quality services , services , institute institute system for system for surveillance/ surveillance/ merits and advocate for laws merits and advocate for laws Programs: SSM Programs: SSM EPI EPI Disease Surveillance Disease Surveillance CARI CARI CDD CDD Nutrition/ Micronutrient Supplementation- Nutrition/ Micronutrient Supplementation- *Food Fortification : *Food Fortification : Rice –iron; Oil and sugar – Vit. Rice –iron; Oil and sugar – Vit. A; A; Flour-Vit. A Flour-Vit. A & & iron; Salt- iron; Salt- iodine iodine Integrated Management of Childhood Illness Integrated Management of Childhood Illness ( IMCI) ( IMCI)
- 8. Integrates management of most Integrates management of most common common childhood pr childhood problems ( oblems ( diarrhea, diarrhea, pneumonia, pneumonia, measles, malnutrition, DHF, malaria) measles, malnutrition, DHF, malaria) Involves family Involves family members and members and community in the community in the health care process for physical growth and health care process for physical growth and mental development & disease prevention mental development & disease prevention IV. The Public Health Nurse IV. The Public Health Nurse Definition and terms: Definition and terms: Public Health Nursing Public Health Nursing refers to the practice of refers to the practice of nursing in local/national nursing in local/national health departments (which includes health health departments (which includes health centers and rural health units) and schools. centers and rural health units) and schools. It is a community health nursing practice in the It is a community health nursing practice in the public sector public sector Public Health Nurses Public Health Nurses Refers to the nurses in the local/national health Refers to the nurses in the local/national health departments or public schools whether their departments or public schools whether their official position title is public health nurse or official position title is public health nurse or nurse or school nurse nurse or school nurse Leaders in providing quality health services to Leaders in providing quality health services to the the communities communities First level of health workers to be First level of health workers to be knowledgeable about new public health knowledgeable about new public health technologies and methodologies technologies and methodologies Usually the first ones to be trained to implement Usually the first ones to be trained to implement new programs and apply new new programs and apply new technologies technologies Qualifications Qualifications Must be professionally qualified and licensed to Must be professionally qualified and licensed to practice in the arena of public health nursing practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA Consistent with the nursing law of 2002 (RA 9173) 9173) 7 Roles and Functions 7 Roles and Functions 1. 1. Ma Mana nage geme ment nt fu func ncti tion on Inherent in the practice of PHN Inherent in the practice of PHN Organizes the nursing service of the Organizes the nursing service of the local health agency local health agency Applications of 5 management Functions Applications of 5 management Functions “POSDC” in organizing the nursing “POSDC” in organizing the nursing service and the local health agency. service and the local health agency. 2. 2. Su Supe perv rviso isory ry fu func ncti tion on Supervisor of the midwives and other Supervisor of the midwives and other health workers health workers 3. 3. Nu Nurs rsin ing c g car are e fu func ncti tion on Inherent function of the nurse Inherent function of the nurse Based on the science of art and caring Based on the science of art and caring Caring for all levels of clientele toward Caring for all levels of clientele toward health promotion and disease prevention health promotion and disease prevention 4. 4. Col Collab labora oratin ting and coo g and coordi rdinat nating fun ing functi ction on Care coordinators for communities and Care coordinators for communities and their members their members Establishes linkages and collaborative Establishes linkages and collaborative relationships with other health relationships with other health professionals, government agencies, professionals, government agencies, private sectors, NGO’s people’s private sectors, NGO’s people’s organizations to address health organizations to address health problems problems 5. 5. Hea Health p lth prom romoti otion and e on and educ ducati ation fun on functi ction on Activities goes beyond health teachings Activities goes beyond health teachings and health information campaigns and health information campaigns 6. 6. Tr Trai aini ning ng fu func ncti tion on Initiates the formulation of staff Initiates the formulation of staff development and training programs for development and training programs for midwives and other auxiliary workers midwives and other auxiliary workers 7. 7. Re Rese sear arch ch fu func ncti tion on Participates in the conduct of research Participates in the conduct of research and utilizes research findings in her and utilizes research findings in her practice practice Disease surveillance Disease surveillance ▪ ▪ Measure the magnitude of the Measure the magnitude of the problem problem ▪ ▪ Measure the effect of the control Measure the effect of the control program program Competencies and skills Competencies and skills 1. 1. Com Commun munity ity hea health lth nur nursin sing p g proc rocess ess 2. 2. Nursi Nursing p ng proced rocedures ures durin during cl g clinic inic and and home home visits visits 3. 3. Co Comm mmun unit ity y or orga gani nizi zing ng 4. 4. Hea Health lth pro promot motion ion and and ed educa ucatio tion n 5. 5. Su Surv rvei eill lla anc nce e 6. 6. Re Reco cord rdin ing an g and r d rep epor orti ting ng 7. 7. ep epid idem emio iolo log gy y IV. SPECIAL FIELDS IN IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING COMMUNITY HEALTH NURSING School nursing School nursing and and occupational health nursing occupational health nursing School nursing School nursing A type of public health nursing A type of public health nursing that focuses on that focuses on the promotion of health and wellness of the the promotion of health and wellness of the pupils/students, teaching and non teaching pupils/students, teaching and non teaching personnel of the schools. personnel of the schools. The primary role is to support the The primary role is to support the student student learning and ensure that educational potential is learning and ensure that educational potential is not hampered by unmet health needs not hampered by unmet health needs Assist the students in making choices for a Assist the students in making choices for a healthy life style, reduce risk healthy life style, reduce risk taking behaviour taking behaviour and focus on issues such and focus on issues such as prevention of drug as prevention of drug and substance abuse, teenage and substance abuse, teenage pregnancy, pregnancy, STD,Malnutrition, CD and NCD STD,Malnutrition, CD and NCD founded by: Lillian Wald (1902) founded by: Lillian Wald (1902) a member of the professional educational a member of the professional educational employed to aid students in developing their full employed to aid students in developing their full health potential in health health potential in health and education and education HNC (health and Nutrition Center) of the HNC (health and Nutrition Center) of the DepEd DepEd Mandated to safeguard the health and Mandated to safeguard the health and nutritional well-being of the total school nutritional well-being of the total school population. population. 2 division 2 division 1 1. . h he ea al lt th h 4 sections 4 sections Medical Medical Dental Dental Nursing Nursing Health education Health education 2. 2. nu nutr trit itio ion di n divi visi sion on Objectives of School Nursing Objectives of School Nursing General General: To pr : To promote and ma omote and maintain the health intain the health of of the school populace by the school populace by proving comprehensive proving comprehensive and quality nursing care. and quality nursing care. 6 Spe 6 Specif cific ic: : 1. 1. Pro Provid vide qual e quality nu ity nursi rsing ser ng servic vice to the sch e to the school ool population population 2. 2. Cre Create awa ate awaren reness am ess among ch ong child ildren ren, pers , personn onnel el and administrators on the importance of the and administrators on the importance of the promotive and preventive aspects of health promotive and preventive aspects of health through health education. through health education. 3. 3. Enc Encour ourage th age the prov e provisi ision of stan on of standar dard func d functio tional nal facilities facilities 4. 4. Prov Providing iding nursin nursing g perso personnel nnel with with oppo opportuniti rtunities es for continuing education and training. for continuing education and training. 5. 5. Con Conduc duct and par t and partic ticipa ipate in rese te in researc arches re hes relate lated to d to nursing care. nursing care. 6. 6. Estab Establish/ lish/ streng strengthen then linka linkages ges with with gove governmen rnment t and non-government organization/agencies and non-government organization/agencies ▪ ▪ for school community health for school community health work. work. 9 Duties and responsibilities of the school nurses 9 Duties and responsibilities of the school nurses 1. 1. He Heal alth th ad advo voca cacy cy 2. 2. Hea Health and nu lth and nutri tritio tion asses n assessme sment inc nt includ luding ot ing other her screening procedures such as vision and screening procedures such as vision and hearing. hearing. 3. 3. Sup Superv ervisi ision of t on of the he he healt alth and s h and safe afety of ty of the the school plant. school plant. 4. 4. Tre Treatm atment of co ent of comm mmon ail on ailmen ments and at ts and atten tendin ding to g to emergency cases. emergency cases. 5. 5. Refer Referrals rals and and follo follow-up w-up of of pupi pupils and ls and perso personnel nnel 6 6. . H Ho om me v e vi is si it ts s 7. 7. Co Comm mmun unit ity out y outre reac ach h E.g.,: E.g.,: ▪ ▪ attending community assemblies attending community assemblies ▪ ▪ and organizing school and organizing school community health councils. community health councils. 8. 8. Rec Record ording and re ing and repo porti rting of acco ng of accompl mplish ishmen ments ts
- 9. 9. 9. Mon Monito itorin ring and e g and eval valuat uation of p ion of prog rogram rams and s and projects. projects. Skills and competencies Skills and competencies 1. 1. Ass Assessm essment ent and and scr screen eening ing ski skills lls 2. 2. He Heal alth c th cou ounse nsell llin ing sk g skil ills ls 3. 3. So Soci cial mo al mobi bili liza zati tion sk on skil ills ls 4. 4. Goo Good ora d oral and wr l and writt itten com en commun munica icatio tion skil n skills ls 5. 5. Ba Basi sic m c man anag agem emen ent sk t skil ills ls 6 6. . L Li if fe e s sk ki il ll ls s 16 function of the school nurse 16 function of the school nurse 1. 1. School health and nutritional survey (from 1 School health and nutritional survey (from 1st st visit and Qyr)- for data and planning purposes visit and Qyr)- for data and planning purposes Survey of the ff: Survey of the ff: current health situation current health situation and nutritional status and nutritional status Facilities Facilities Health education activities Health education activities 2. 2. Put Puttin ting up g up a sch a school ool cli clinic ( nic (R.A R.A. 12 . 124) 4) 3. 3. Hea Health a lth asses ssessme sment (e nt (ever very ye y year o ar or wi r with th epidemics) epidemics) Purpose: Purpose: detect the signs of illness and physical detect the signs of illness and physical defects for early correction. defects for early correction. Health habits Health habits 4. 4. Sta Standa ndard vis rd vision te ion testi sting for sc ng for schoo hool chil l childre dren n (20/20) (20/20) a a Purpose: Purpose: Screen students with poor visual acuity Screen students with poor visual acuity and indentify other ocular problems and indentify other ocular problems Refer students with eye disease and Refer students with eye disease and errors of refraction for further errors of refraction for further examination and management. examination and management. 5. 5. Ea Ear r ex exam amin inat atio ion n Methods: Methods: Observation Observation Examination by using penlight or Examination by using penlight or otoscope otoscope Screening Screening test test (whisper (whisper test, test, conversation voice test, ball pen click.) conversation voice test, ball pen click.) 6. 6. Hei Height an ght and weig d weight mea ht measure suremen ment and nutr t and nutriti itiona onal l status determination status determination Height and weight measurement Height and weight measurement is a procedure is a procedure for evaluating the tallness or the shortness and for evaluating the tallness or the shortness and the heaviness of a pupil. the heaviness of a pupil. DepEd DepEd <10 years old=weight for age and height <10 years old=weight for age and height for age for age >10 years old= BMI >10 years old= BMI Appropriate school feeding programs with rice, Appropriate school feeding programs with rice, milk or fortified noodles are given to children milk or fortified noodles are given to children with below normal nutritional status for 120 with below normal nutritional status for 120 feeding days feeding days Deworming is a pre requite prior to Deworming is a pre requite prior to feeding feeding Consent from parent is pre requisite Consent from parent is pre requisite prior to de- prior to de- worming worming 7. 7. Me Medi dica cal r l ref efer erra rals ls 8. 8. Att Attend endanc ance t e to o eme emerge rgency ncy cas cases es 9. 9. Student health counselling( Student health counselling( for student who for student who manifest the physical and emotional symptoms manifest the physical and emotional symptoms) ) (parents, teacher, and student) (parents, teacher, and student) 10. 10. Healt Health and nutritio h and nutrition educati n education activiti on activities es Training programs, Training programs, conferences/workshops for teachers, conferences/workshops for teachers, pupils and parents pupils and parents 11. 11. Organization Organization of scho of school-Community ol-Community Health and Health and Nutrition Councils Nutrition Councils Membership shall come from both school Membership shall come from both school and community and community This attend to the health related This attend to the health related problems and concerns problems and concerns 12. 12. Comm Communicab unicable disease co le disease control ntrol In participation of both the teachers, In participation of both the teachers, parents and students parents and students Encourage the importance of Encourage the importance of immunization for prevention immunization for prevention 13. 13. Estab Establishm lishment of Data Bank on School Hea ent of Data Bank on School Health lth and Nutrition Activities and Nutrition Activities Treatment in the school clinic Treatment in the school clinic Record of the school visit Record of the school visit Health assessment report of the school Health assessment report of the school health personnel health personnel Health and nutritional status of Health and nutritional status of pupils/students pupils/students Form 86 of teaching and non teaching Form 86 of teaching and non teaching personnel personnel Teachers health profile Teachers health profile Records of attended emergency case Records of attended emergency case Inventory of clinic and equipment Inventory of clinic and equipment supplies supplies Health and nutrition activities in school Health and nutrition activities in school Record of accomplishment of school Record of accomplishment of school health services health services Records of officers/ officials of the Records of officers/ officials of the School-Community Health Council and School-Community Health Council and their accomplishment their accomplishment Action plan Action plan 14. 14. Schoo School plant inspect l plant inspection for healthy envir ion for healthy environment onment Others concerns: school site, area, Others concerns: school site, area, location, space and sanitation, location, space and sanitation, classroom and others rooms, school classroom and others rooms, school clinics, water supplies, sanitation, school clinics, water supplies, sanitation, school canteen. canteen. Inspect for the size, lighting, ventilation, Inspect for the size, lighting, ventilation, arrangement of seats. arrangement of seats. 15. 15. Rapid Cl Rapid Classroom Inspe assroom Inspection( after ction( after holidays and holidays and epidemics but not to exceed more than epidemics but not to exceed more than a month a month except for cases of epidemics) except for cases of epidemics) Procedure same as HA Procedure same as HA Purpose: Purpose: Detect cases of CD Detect cases of CD Note the correction that have Note the correction that have been made been made Note if the eyeglasses are correctly adjusted Note if the eyeglasses are correctly adjusted Note the general cleanliness of the students Note the general cleanliness of the students Note new ailments. Note new ailments. 16. Home visitation 16. Home visitation Indication: Indication: Pupils whose parents are afraid of some Pupils whose parents are afraid of some medical procedures medical procedures Pupils who get re-infected because of Pupils who get re-infected because of home conditions home conditions Pupils suffering from CD Pupils suffering from CD Pupils who are absent frequently Pupils who are absent frequently because of sickness because of sickness Pupils who are malnourished. Pupils who are malnourished. •Occupational health nursing •Occupational health nursing By American Association of Occupational Health By American Association of Occupational Health • • The special practice that provides for and The special practice that provides for and delivers health care services to workers and delivers health care services to workers and worker populations. worker populations. The practice focuses on promotion, protection, The practice focuses on promotion, protection, and restoration of workers’ health within the and restoration of workers’ health within the context of a safe and context of a safe and health work environment. health work environment. Occupational health nursing is autonomous, and Occupational health nursing is autonomous, and occupational health nurses make independent occupational health nurses make independent nursing judgments in nursing judgments in providing occupational providing occupational health services. health services. The foundation of The foundation of occupati occupational health nursing onal health nursing practice is research-based with an emphasis on practice is research-based with an emphasis on optimizing health, preventing illness and injury, optimizing health, preventing illness and injury, and reducing health hazards. and reducing health hazards. By PNA – ANSAP, 1982 By PNA – ANSAP, 1982 • •Is aimed at assisting workers in Is aimed at assisting workers in all occupations all occupations to cope with actual and potential stresses in to cope with actual and potential stresses in relation to their work and work relation to their work and work environment. environment. It is primarily geared at helping workers attain It is primarily geared at helping workers attain and maintain optimum level of physical and and maintain optimum level of physical and psychological functioning. psychological functioning.