Community Health Nursing

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s the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools.

Features FNCP: 1. The nursing care plan focuses on actions which are designed to solve or minimize existing

problem. The plan is a blueprint for action. The core of the plan are the approaches, strategies, activities, methods and materials which the nurse hopes will improve the problem situation. 2. The

nursing care plan is a product of a deliberate systematic process. the planning process is characterized by logical analyses of data that are put together to arrive at rational decisions. The interventions the nurse decides to implement are chosen from among alternatives after careful analysis and weighing of available options.

3. The

nursing care plan, as with all plans, relates to the future. It utilizes events in the past and what is happening in the present to determine patterns. It also projects the future scenario if the current situation is not corrected.

4. The

nursing care plan is based upon identified

health and

nursing problems. The problems are the starting points for the plan, and the foci of the objectives of care and intervention measures. 5. The

nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to family

health development.

6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the

evaluation of the plan’s effectiveness trigger another cycle of the planning process until the

health and

nursing problems are eliminated.

The assessment phase of the nursing process generates the health and nursing problems which become the bases for the development of nursing care plan. The planning phase takes off from there. Formulating a family care plan involves the following steps: 1. The prioritized condition/s or problems 2. The goals and objectives of nursing care

3. the plan of interventions 4. The plan of evaluating care

1. Efficient ○

plans with the people, organizes, conducts, directs health education activities according to the needs of the community

○ knowledgeable about everything relevant to his practice; has the necessary skills expected of him 2. Good listener

○ hears what’s being said and what’s behind the words ○ always available for the participant to voice out their sentiments and needs

3. Keen observer

○ keep an eye on the proceedings, process and participants’ behavior 4. Systematic

○ knows how to put in sequence or logical order the parts of the session 5. Creative/Resourceful

○ uses available resources 6. Analytical/Critical thinker

○ decides on what has been analyzed 7. Tactful

○ brings about issues in smooth subtle manner ○ does not embarrass but gives constructive criticisms 8. Knowledgeable ○ able to impart relevant, updated and sufficient input 9. Open

○ invites ideas, suggestions, criticisms ○

involves people in decision making

○ accepts need for joint planning and decision relative to health care in a particular situation; not resistant to change 10. Sense of humor

○ knows how to place a touch of humor to keep audience alive 11. Change agent

○ involves participants actively in assuming the responsibility for his own learning 12. Coordinator ○ brings into consonance of harmony the community’s health care activities 13. Objective ○

unbiased and fair in

decision making

14. Flexible

○ able to cope with different situations Community Health Service provider

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carries out health services contributing to the promotion of health, prevention of illness, early treatment of illness and rehabilitation.

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appraises health needs and hazards (existing or potential)

Facilitator •

helps plan a comprehensive health program with the people

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continuing guidance and supervisory assistance

Health Counselor •

provides health counseling including emotional support to individuals, family, group and community

Co-researcher •

provides the community with stimulation necessary for a wider or more complex study or problems.

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enforce community to do prompt and intelligent reporting of epidemiologic investigation of disease.

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suggest areas hat need research (by creating dissatisfaction)

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participate in planning for the study in formulating procedures

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assist in the collection of data

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helps interpret findings collectively

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act on the result of the research

Member of a Team •

in operating within the team, one must be willing to listen as well as to contribute, to teach as well as to learn, to lead as well as to follow, to share as well as to work under it

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helps make multiple services which the family receives in the course of health care, coordinated, continuous and comprehensive as possible

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consults with and refers to appropriate personnel for any other community services

Health Educator •

health education is an accepted activity at all levels of public works. A health educator is the one who improves the health of the people by employing various methods of scientific procedures to stimulate, arouse and guide people to healthful ways of living. She takes into consideration these aspects of health education: ○ information – provision of knowledge ○ education – change in knowledge, attitude and skills ○ communication – exchange of information

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

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

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Activities include:

activities

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1. Designing a plan for community development including all its activities and strategies for care development. 2. Designing criteria for the selection of site 3. Actually selecting the site for community care II. Entry Phase A. Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collective action on these. B. This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following guidelines however. 1. Recognizes the role of local authorities by paying them visits to inform them of their presence and activities. 2. The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role models. 3. Avoid raising the consciousness of the community residents; adopt a low-key profile. III. Organization Building Phase A. Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings (formal, informal, OJT) to develop their skills and in managing their own concerns/programs. IV. Sustenance and Strengthening Phase A. Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different communities setup in the organization building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance from the community-wide organization. 1. Strategies used may include: a. Education and training b. Networking and linkaging c. Conduct of mobilization on health and development concerns d. Implementing of livelihood projects e. Developing secondary leaders Definitions of COPAR: • A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

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

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

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• A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the

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people to develop their capability and

readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD) Importance of COPAR: 1. COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. 2. COPAR prepares people/clients to eventually take over the management of a development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services. Principles of COPAR:

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1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. 2. COPAR should be based on the interest of the poorest sectors of society 3. COPAR should lead to a self-reliant community and society.

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

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• Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. • COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. • COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.

Expended program for Immunization (EPI) •

Principles of EPI include: 1. Epidemiological situation 2. Mass approach 3. Basic Health Service

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The 7 immunizable diseases are: 1.

Tuberculosis

2. Diptheria 3. Pertussis 4.

Measles

5. Poliomyelitis 6. Tetanus 7.

Hepatitis B

Administration of

vaccines:

Vaccine

Content

Form & Dosage

BCG

Live attenuated bacteria

Freeze dried

# of Doses

Route

1

ID

liquid-0.5ml

3

IM

infant- 0.05ml Preschool-0.1ml

DPT

DT- weakened toxin P-killed bacteria

OPV

weakened virus

liquid-2drops

3

Oral

Hepa B

Plasma derivative

Liquid-0.5ml

3

IM

Weakened virus

Freeze dried0.5ml

1

Measles

Subcutaneous

Schedule of

Vaccines:

Vaccine

Age at 1st dose

BCG

At birth

DPT

Interval between dose

Protection

6 weeks

4 weeks

DPT

OPV

6weeks

4weeks

Poliomyelitis

Hepa B

@ birth

@birth,6th week,14th week

HepaB

Measles

9m0s.-11m0s. measles

6 months – earliest dose of

measles given in case of outbreak

9months-11months- regular schedule of 15 months- latest dose of

measles vaccine measles given

4-5 years old- catch up dose Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti

measles.

Vaccine

Minimum age interval

% protected

Duration of Protection

TT1

As early as possible

0%

0

TT2

4 weeks later

80%

3 years

TT3

6 months later

95%

5 years

TT4

1year later/during next pregnany

99%

10 years

TT5

1 year later/third pregnancy

99%

Lifetime

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

•

measles vaccine, report such to

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

Cold Chain under EPI:  Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.  The allowable timeframes for the storage of vaccines at different levels are: o

6months- Regional Level

o

3months- Provincial Level/District Level

o

1month-main health centers-with ref.

o

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

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

OPV Measles

o

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

BCG

o

DPT

o

Hepa B

o

TT

 Use those that will expire first, mark “X”/ exposure, 3rd- discard,  Transport-use cold bags, let it stand in room temperature for a while before storing DPT.  Half life packs: 4hours-BCG, DPT, Polio, 8 hours-

measles, TT, Hepa B.

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

vaccines and/or labeling of

expiry date are done to identify those near to expire

vaccines vaccines.

Expended program for Immunization (EPI) •

Principles of EPI include: 1. Epidemiological situation 2. Mass approach 3. Basic Health Service

•

The 7 immunizable diseases are: 1.

Tuberculosis

2. Diptheria 3. Pertussis 4.

Measles

5. Poliomyelitis 6. Tetanus 7.

Hepatitis B

Administration of

vaccines:

Vaccine

Content

Form & Dosage

BCG

Live attenuated bacteria

Freeze dried

# of Doses

Route

1

ID

liquid-0.5ml

3

IM

infant- 0.05ml Preschool-0.1ml

DPT

DT- weakened toxin P-killed bacteria

OPV

weakened virus

liquid-2drops

3

Oral

Hepa B

Plasma derivative

Liquid-0.5ml

3

IM

Weakened virus

Freeze dried0.5ml

1

Subcutaneous

Measles

Schedule of

Vaccines:

Vaccine

Age at 1st dose

BCG

At birth

DPT

6 weeks

Interval between dose

Protection

4 weeks

DPT

OPV

6weeks

4weeks

Poliomyelitis

Hepa B

@ birth

@birth,6th week,14th week

HepaB

Measles

9m0s.-11m0s. measles

6 months – earliest dose of

measles given in case of outbreak

9months-11months- regular schedule of 15 months- latest dose of

measles vaccine measles given

4-5 years old- catch up dose Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti

•

Vaccine

Minimum age interval

% protected

Duration of Protection

TT1

As early as possible

0%

0

TT2

4 weeks later

80%

3 years

TT3

6 months later

95%

5 years

TT4

1year later/during next pregnany

99%

10 years

TT5

1 year later/third pregnancy

99%

Lifetime

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

•

measles.

measles vaccine, report such to

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

Cold Chain under EPI:

 Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.  The allowable timeframes for the storage of vaccines at different levels are: o

6months- Regional Level

o

3months- Provincial Level/District Level

o

1month-main health centers-with ref.

o

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

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

OPV Measles

o

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

BCG

o

DPT

o

Hepa B

o

TT

 Use those that will expire first, mark “X”/ exposure, 3rd- discard,  Transport-use cold bags, let it stand in room temperature for a while before storing DPT.  Half life packs: 4hours-BCG, DPT, Polio, 8 hours-

measles, TT, Hepa B.

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

vaccines and/or labeling of

expiry date are done to identify those near to expire

vaccines vaccines.