2. APPRENTICE NURSING
*Extends from the founding of religious orders in the 6th century through the
crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established by
pastor Fliedner and his wife.
*Period of on the job training- desired of person to be trained
3. EDUCATED NURSING
*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas in London.
First program of formal education for nurses started.
4. CONTEMPORARY NURSING
*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes occurs.
INTUITIVE NURSING
*Cause of illness was believed to be the invasion of the victims body by an evil spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural power.
*Believed in medicine man (shaman or witch doctor) that had the power to heal by
using white magic.
They made use of hypnosis, charms, dances, incantations, purgatives, massage,fire,
water, herbs or other vegetations and even animals.
*Performing a trephine
Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
Goal of this therapy is to drive the evil spirit from the victims body.
*Nurses role was instinctive directive toward comforting, practicing midwifery and
being wet nurse to a child.
*Act performed without training and direction.
Babylonia
*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time
Egypt
*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of 250
recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged physicians was
Imhotep.
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses 5th book is a midwife and wet nurse.
Palestine
*The Hebrews book of genesis emphazised the teachings of Judaism regarding
hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-cleanliness
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.
China
*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of treating
wounds, infection and muscular afflictions.
*Chan Chun Ching Chinese Hippocrates.
*Emperor Shen Nung said to be the father of Chinese medicine and the inventor of
acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the sick will fall
to the female members of the household.
India
*First recorded reference to the nurses taking care of patients on the writings of
shushurutu.
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals throughout India
where nurses were employed.
Greece
*Made contribution in the area aesthetic arts and clinical medicine, but nursing was the
task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we associate the
Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine insisted that magic and philosophical theories
had no place in medicine.
*The work of women was restricted to the household. Where mistress of the mansion
gave nursing care to the sick slaves.
Rome
*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine First aid, field ambulance service and hospitals for
wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used in
medicine ever since.
APPRENTICE NURSING
*Religious orders of Christian Church played a major role in this kind of nursing.
Nursing Saints
* St. Hildegarde a Benedictine abbess in Germany, actually prescribed cures in her 2
books on medicine and natural history.
* St. Francis and Clara took vows of poverty, obedience, service and chastity and
took care of the sick and the afflicted; founders of the Franciscan Order and the Order
of the Poor Clares respectively.
* St. Elizabeth of Hungary the patroness of nurses; built a hospital for the sick and
the needy.
* St. Catherine of Siena the 1st lady with a lamp; became a tertiary of St.
Dominic and engaged in works of mercy among the sick and of the Church.
The Reformation
* St. Vincent de Paul set up the first program of social service in France and
organized the Community of the Sisters of Charity. His 1st superior and co-founder
was Louise de Gras (nee de Marillac).
England
* June 15, 1860 marked the day when 15 probationers entered St. Thomas Hospital
in London to establish the Nightingale system of Nursing, founded by Florence
Nightingale (May 12, 1820). Among the highlights in her life are the following:
- At age of 31, obtained parental consent to enter the Deaconess School at
Kaisserwerth.
- Had 3 months training at Kaisserwerth; later superintendent of the Establishment
for Gentlewomen During Illness (1853) during which time she initiated the policy of
admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women at Scutari
in the Crimea upon the request of Sir Sidney Herbert, Minister of War in England. At first
their work is not accepted because it consisted of cleaning the area, thus reducing the
infections, clothing for the men, writing letters to their families; their work served as
inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital in
London believed that schools should be self-supporting; that schools of nursing should
have decent living quarters for their student; that they should have paid nurse
instructors; that the school should correlate theory to practice and these students should
be taught the why not just how in nursing.
- 2 books written Note on Nursing and Notes on Hospital, contain many timely
portions applicable in the 1970s as they were in 1859.
United States
* At the time that Florence Nightingale was opening her school in London; the U.S was
on the brink of the civil war. However though the country was in a condition of chaos,
nursing had many supporters and the needs to train nurses were recognized.
- Linda Richards is the first graduate nurse in the U.S completed her training at the
New England Hospital for Women and Children in Boston, Massachusetts, patterned
after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan the
Bellevue Training School for Nurse in the New York City , the Connecticut training.
School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel Hampton
Robb as its 1st principal and the person most influential in directing the development of
nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization was
lad:
1. The Associated Alumnae, later known as the American Nurses Association was
begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses, later
known as the National League for Nursing Education, also began.
- During the Spanish American War (1898 1899) nurse were concerned with the
care of the wounded as well as care of those inflected with malaria and yellow fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in the
search for control yellow fever.
* 1913 1937
- a standard curriculum for schools of nursing was prepared by the National League
for Nursing Education.
- the practice of nursing was gradually infiltrated with educational objectives.
CONTEMPORARY NURSING
* Creation of United Nations in San Francisco California in 1945.
2 folds purpose are:
- International peace and international security with provisions for equal justice,
Machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic progress.
*Fray Juan Clemente was one of the 1st members of the Mission of the Order of St.
Francis in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he filled with
various medical remedies.
- Performed both the function of a physician and those of a nurse.
*Persons who really did nursing care of the sick were religious group (called
hospitallers) but they were assisted by Filipino attendants.
*In the early development of nursing, the work of the nurse and those of the physician
were not clearly defined.
* The Filipino Red Cross had its own constitution approved by the revolutionary
government. This was founded on February 17, 1899 with Dona Hilaria Aguinaldo as
president and Dona Sabina Herrera as secretary.
22. St. Rita Hospital and School of Midwifery (1956) and Nursing (1960)
1. Nursing Leaders
Florence Nightingale (1820-1910)
-recognized as nursings first scientist-theorist for her work, Notes on Nursing:
What It is, and What It is Not
-considered the founder of modern nursing.
-developed the Nightingale Training School of Nurses, which operated in 1860.
The scchool served as a model for other training schools. Its graduates traveled
to other countries to manage hospitals and institute nurse-training programs.
-Nightingales vision of nursing, which include public health and healt promotion
roles for nurses, was only partially addressed in the early days of nursing. The
focus tended to be on developing the profession within hospitals.
Clara Barton (1812-1921)
-organized the American Red Cross, which linked with the International Red
Cross when the U.S Congress ratified the Geneva Convention in 1882.
Lilian Wald (1867-1941)
-considered the founder of Public Health Nursing.
Lavinia L. Dock (1858-1956)
-active in the protest movement for womens right that resulted in the U.S
Constitution amendment in 1920, allowing women to vote.
Margaret Sanger (1879-1966)
-a nurse activist; considered the founder of planned Parenthood, was imprisoned
for opening the first birth control information clinic in Baltimore in 1916.
Lydia Hall
-developed the Care, Core, and Cure Theory
-Goal: To Care, and Cure Cores disease.
-Care for the patients BODY. Cure the DISEASE. Treat the PERSON ( or
patient) as the Core.
B. Nursing as a Profession
NURSING AS A PROFESSION
Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its memebers and make it possible to practice effectively.
Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well as a basic
liberal foundation.
2. A profession has a theoretical body of knowledge leaing to defined skills, abilities and
norms.
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profesion has a code of ethics for practice.
NURSING
- is a desciplined involved in the delivery of health care to the society.
- is a helping profession.
- is service-oriented to maintain health and well-being of people.
- is an art and science.
Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organism.
4. Nursing is committed to promoting individual, family, community, and national health
goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to color,
creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
Roles of a Professional
1. Caregiver/Care provider
- the traditional and most essential role.
- functions as nurturer, comforter, provider.
- mothering actions of the nurse.
- provides direct care and promotes comfort of client.
- activities involves knowledge and sensitivity to what matters and what is important to
clients.
- show concern for client welfare and acceptance of the client as a person.
2. Teacher
- provides information and helps the client to learn or acquire new knowledge and
technical skills.
- encourages compliance with prescribed therapy.
Promotes healthy lifestyle.
- interprets information to the client.
3. Counselor
- helps client to recognize and cope with stressful psychologic or social problems; to
develop an improve interpersonal relationships and to promote personal growth.
- Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.
4. Change agent
- initiate changes or assist clients to make modifications in themselves or in the system
of care.
5. Client advocate
- involves concern for and actions in behalf of the client to bring about a change.
- promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
- provides explanation in clients ;anguage and support clients decisions.
6. Manager
- makes decisions, coordinates activities of others, allocate resource evaluate care and
personnel.
- plans, give direction, develop staff, monitor operations, give the reward fairly and
represent both staff and administrations as needed.
7. Researcher
- participates in identifying significant researchable problems.
- participates in scientific investigation and must be a consumer of research findings.
-must be aware of the research process, language of research, a sensitive to issues
related to protecting the rights of human subjects.
1. Clinical Specialists
- is a nurse who has completed a masters degree in specialty and has considerable
clinical expertise in that specialty. She provides expert care to individuals, participates in
education health care professionals and ancillary, acts as a clinical consultant and
participates in research.
2. Nurse Practitioner
-is a nurse who has completed either as a certificate program or a masters degree in a
specialty and is also cerified by the appropriate specialty organization. She is skilled at
making nursing assessments, performing P.E., counselling, teaching and treating minor
and self-limiting illness.
3. Nurse-Midwife
- a nurse who has completed a program in midwifery; provides prenatal and postnatal
care and delivers babies to woman with uncomplicated pregnancies.
4. Nurse Anesthetist
- a nurse who completed the course of study in an anesthesia school and carries out
pre-operative status of clients.
5. Nurse Educator
- a nurse usually with advanced degree, who beaches in clinical or educational settings,
teaches theoretical knowledge, clinical skills and conduct research.
6. Nurse Entrepreneur -
- a nurse who has an advanced degree, and manages health-related business.
7. Nurse Administrator
- a nurse who functions at various levels of management in health settings; responsible
for the management and administration of resources and personnel involved in giving
patient care.
5. Nursing Education nurses working in school, review center and hospital as a C.I.
Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an amalgam of
activities
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying
III. Theories
*Group of related concepts that proposes actions that guide practice. May be broad but
limited only to particular aspects
Middle-range Theories
*The least abstract level because they include specific details in nursing practice like
population, condition and location.
C. HEALTH EDUCATION
1. Assess the learning needs of the patient and family.
2. Develops health education plan based on assessed and anticipated needs.
3. Develops learning materials for health education.
4. Implements the healtheducation plan.
5. Evaluates the outcome of health education.
D. LEGAL RESPONSIBILITY
1. Adheres to practice in accordance with the nursing law and other relevant legislation
including contracts, informed consent.
2. Adheres to organizational policies and procedures, local and national.
3. Documents care rendered to patients.
E. Ethico-Moral Responsibility
1. Respects the rights of individuals/groups.
2.Accepts responsibility and accountability for own decisions and actions.
3. Adheres to the national and international code pf ethics for nurses.
G. Quality Improvement
1. Utilizes data for quality improvement
2. Participtaes in nursing audits and rounds.
3. Identifies and reports variances.
4. Recommends solutions to identified causes of the problems.
5. Recommends improvement of systems and processes.
H. Reasearch
1. Utilizes varied methods of inquiry in solving problems.
2. Recommends actions for implementation.
3. Disseminates results of research findings.
4. Applies research findings in nursing practice.
I. Record Management
1. Maintains accurate and updated documentation of patient care.
2. Records outcome of patient care.
3. Observes legal imperatives in record keeping.
4. Maintains an effective recording and reporing system.
J. Communication
1. Utilizes effective communication in relating with clients, members with the team and
the public in general.
2. Utilizes effective communicationin therapeutic use of self to meet the needs of clients.
3. Utilizes formal and informal channels.
4. Responds to needs of individuals, families, groups and communities.
5. Uses appropriate information technology to facilitate communication.
2. Fields of Nursing
3. Roles and Functions
V. Legal Responsibility
A. Legal Aspects in the Practice of Nursing
B. The Philippine Nursing Law of 2002 (R.A 9173)
C. Related Laws Affecting the Practice of Nursing
IX. Research
A. Problem Identification
B. Ethics and Science of Research
C. The Scientific Approach
D. Research Process
E. Research Designs and Methodology
1. Qualitative
2. Quantitative
F. Utilization and Dissemination of Research Findings
X. Communication
A. Dynamics of Communication
B. Nurse-Client Relationship
C. Professional-Professional Relationship
D. Therapeutic Use of Self
E. Use of Information Technology
I. Safe and Quality Care, Health Education and Communication, Collaboration and
Team work
COMMUNITY HEALTH NURSING
HISTORY OF CHN
Date
1901 Act # 157 (Board of Health of the Philippines) ;
Act # 309 (Provincial and Municipal Boards of Health) were created.
1095 Board of Health was abolished; functions were transferred to the Bureau of
Health.
1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of
present MHOs; male nurses performs the functions of doctors.
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario, 1st Filipino Nurse supervisor under Bureau of Health.
October 22, 1922 Filipino Nurses Organization (Philippines Nurses Organization)
was organized.
1923 Zamboanga General Hospital School of Nursing and Baguio General Hospital
were established; other government schools of nursing were organized several years
after.
1928 1st Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the first ciy health officer; Office of Nursing was
created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz (assistant
chief nurse)
December 8, 1941 Victims of World War II were treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31
Filipino Nurses in Bilibid Prison as Prisoners of War by the Japanese.
February 1946 Number of Nurses decreased from 556 308.
1948 First training center of the Bureau of Health was organized by the Pasay City
Health Department. Trinidad Gomez, Marcela Gabatin, Constancia Tuazon, Ms.
Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff.
1950 Rural Health Demonstration and Training Center was created.
1953 The first 81 Rural Health Units were organized.
1957 RA 1891 Ammended some sections of RA 1082 and created the eight
categories of Rural Health Unit causing an increase in the demand for the community
health personnel.
1958 1965 Division of Nursing was abolished (RA 977) and Reorganization
Act (EO 288)
1961 Annie Sand organized the National Nurses of DOH.
1967 Zenaida Nisce became the nursing program supervisor and consultant on the
six special diseases (TB, Leprosy, V.D., Cancer, Filariasis, and Mental Health Illness).
1975 Scope of responsibility of nurses and midwives became wider due to
restructuring of the health care delivery system.
1976 1986 The need for Rural Health Practice Program was implemented.
1990 1992 Local Government Code of 1991 (RA 7160)
1993 1998 Office of Nursing did not materialize in spite of persistent
recommendation of the officers, board members, and advisers of the National League of
Nurses Inc.
January 1999 Nelia Hizon was positioned as the nursing adviser at the Office of
Public Health Services through Department Order # 29.
May 24, 1999 EO # 102, which redirects the functions and operations of DOH, was
signed by former President Joseph Estrada.
R.A 2382 Philippine Medical Act. This act defines the practice of medicine in the
country.
R.A 1082 Rural Health Act. It created the 1st 81 Rural Health Units.
- amended by R.A 1891; more physicians, dentists, nurses, midwives and
sanitary inspectors will live in the rural areas where they are assigned in order to raise
the health conditions of barrio people, hence help decrease the high incidence of
preventable diseases.
R.A 6425 Dangerous Drugs Act. It stipulates that the sale, administration, delivery,
distribution and transportation of prohibited drugs is punishable by law.
R.A 9165 The New Dangerous Draug Act of 2002.
P.D No. 651 requires that all Health Workers shall identify and encourage the
registration of all births within 30 days following delivery.
P.D No. 996 requires the compulsary immunization of all children below 8 years of
age against the 6 childhood immunizable diseases.
P.D No. 825 provides pernalty for improper disposal of garbage.
R.A 8749 Clean Air Act of 2000
P.D No. 856 Code of Sanitation. It provides for the control of all factors in mans
environment that affect health including the quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and recreation facilities, nilse, pollution and
control of nuisance.
R.A 6758 Standardizes the salary of government employees including the nursing
personnel.
R.A 6675 Generics Act of 1988 which promotes, requires and ensures the production
of an adequate supply, distribution, use and acceptance of drugs and medicines
identified by their generic name.
R.A 6713 Code of Conduct and Ethical Standards of Public Officials and Employees.
It is thepolicy of the state to promote high standards of ethics in public office. Public
officials and employeesshall at all times be accountable to the people and shall
discharges their duties with utmost responsibility, integrity, competence and loyalty, act
with patriotism and justice, lead modest lives uphold public interest over personal
interest.
R.A 7305 Magna Carta for Public Health Workers. This act aims: To promote and
improve the social and economic well-being of health workers, their living and working
conditions and terms of employment; to develop their skills and capabilities in order that
they will be more responsive and better equipped to deliver health projects and
programs; and to encouragethose with proper qualifications and excellent abilities to
join and remain in government service.
R.A 8423 Created the philippine Institute of Traditional and Alternative Health Care.
P.D No. 965 requires applicants for marriage license to receive instructions on family
planning and responsible parenthood.
P.D No. 79 defines, objectives, duties, and functions of POPCOM.
R.A 4073 advocates home treatment for lepsrosy.
Letter of Instruction No. 949 legal basis of PHC dated october 19, 1979.
-- promotes development of health programs on the
community level.
R.A 3573 requires reporing of all cases of communicable diseases and administration
of prophylaxis.
Misnistry Circular No. 2 of 1986 includes AIDS as notifiable disease.
R.A 7875 National Health Insurance Act
R.A 7432 Senior Citizens Act
R.A 7719 National Blood Services Act
R.A 8172 Salt Iodization Act ( ASIN LAW)
R.A 7277 Magna Carta for PWDS, provides their rehabilitation, self-development and
self-reliance and integration into the mainstream of society.
*A.O No. 2005 0014 National Policies on Infant and Young Child Feeding:
1. All newborns be breastfeed within 1 hour after birth.
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond.
I. Definition of Terms
Community derived from a latin word communicas which means a group of people.
- a group of people with common characteristics or interests living together within a
territory or geographical boundary.
- place where people under usual conditions are found.
COMPONENTS:
INDIVIDUAL PERCEPTIONS: Includes perceived susceptivility,seriousness and
threat.
MODIFYING FACTORS: Includes demographic variables, sociophysiologic
variables, structural variable, and cues to action.
LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the
perceived barriers.
4. EVOLUTIONARY BASED
PUBLIC HEALTH ( Dr. C.E. Winslow ) the science and art of preventing disease,
prolonging life, promoting health and efficiency through organized community effort for
the sanitation of the environment, control of communicable diseases, the education of
individuals in personal hygiene, the organization of medical and nursing services for the
early diagnosis and preventive treatment of diseases and the development of social
machinery to ensure everyone a standard of living adequate for the maintenance of
health, so organizing these benefits as to enable every citizen to realize his birthright of
birth and longevity.( Dr C.E Winslow ).
Aims:
1. health promotion
2. disease prvention
3. management of factors affecting health.
Concepts
1. The primary focus of community health nursing practice is on health promotion.
2. Community Health Nurses are generalist in terms of their practice through life but
the whole community.
3. Community Health Nurses are generalist in terms of their practice through life
continuity in its full range of health problems and needs.
4. The nature of CHN practice requires that current knowledge derived from the
biological, social science, ecology, clinical nursing and community health organizations
be utilized.
5. Contact with the client and or family may continue over a long period of time which
includes all ages and all types of health care.
6. The dynamic process of assessing, planning, implementing and intervening provide
measurements of progress, evaluation and a continuum of the cycle until the
termination of nursing is implicit in the practice of Community Health Nursing.
PHILOSOPHY OF CHN
*The philosophy of CHN is based on the worth and dignity of man.
-In the event that the Municipal Health Officer ( MHO ) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHOs responsibilites.
-Other Responsibilities of a Nurse, spelled by the implementing rules and regulations of
RA 7164 ( Philippine Nursing Act of 1991 ) includes:
*supervision and care of women during pregnancy, labor, and puerperium.
*Performance of Internal Examination and Delivery of Babies.
*Suturing lacerations in the absence of a Physicians.
*Provisions of First aid measures and Emergency Care.
*Recommending Herbal and Symptomatic Meds... Etc.
Concepts
1. Science and Art of Preventing diseases, prolonging life, promoting health and
efficiency through organized community effort for the:
a. sanitation of the environment.
b. control of communicable diseases.
c. the education of individuals in personal hygiene.
d. organization of medical and nursing services for early diagnosis and preventive
treatment of disease, and the development of social machinery to ensure everyone a
standard of living adequate for the maintenance of health, so organizing these benefits
as to enable every citizen to realize his birthright of health and longevity.
Determinants of Health
*Factors that can affect health
a. Income and social status - socioeconomic
b. Education - socioeconomic
c. Physical Environment - Environment
d. Employment and working conditions - socieconomic
e. Social support networks - socioeconomic
f. Culture, Customs and Traditions - Behavior
g. Genetics - Heredity
h. Personal Behavior and coping skills - Behavior
i. Health Services Health Care Delivery System
j. Gender Heredity
-ECOSYSTEM influence on OLOF ( Blum 1974 ).
In response to above trends, the global community, represented by the United Nations
General Assembly, decided to adopt a common vision of poberty reduction and
sustainable development in september 2000.
This vision is exemplified by the Millenium Development Goals (MDGs) which are
based on the fundamental values of:
FREEDOM
EQUALITY
SOLIDARITY
TOLERANCE
HEALTH HEALTH: MILLENIUM DEVELOPMENT GOALS
RESPECT FOR NATURE MDG 1: Eradicate extreme poverty and hunger
SHARED RESPONSIBILITY MDG 2: Achieve universal primary education
MDG 3: Promote gender equality and women
empowerment
MDG 4: Decreased child mortality
MDG 5: Increased maternal health
MDG 6: Combat HIV/AIDS, Malaria and other
diseases
MDG 7: Ensure environmental sustainability
MDG 8: Develop a global partnership for
development.
PRINCIPLES
1. The need of the community is the basis of community health nursing.
2. The community health nurse must understand fully the objectives and policies of the
agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of race, creed and socioeconomic status.
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation of community health nursing service.
7. Opportunities for continuing staff education programs for nurses must be provided by
the community health nurisng agency and the CHN as well.
8. The CHN makes use of available community health resources.
9. The CHN taps the already existing active organized groups in the community.
10. There must be provision for educative supervision in community health nuraing.
11.There should be accurate recording and reporting in community health nursing.
12. Health teaching is the primary responsibility of the community health nurse.
STANDARDS IN CHN
I. Theory
Applies theoretical concepts as basisfor decisions in practice.
II. Data Collection
Gathering comprehensive, accurate data systematically.
III. Diagnosis
Analyzes collected data to determine the needs / health problems of Individual,
Family, Community.
IV. Planning
At each level of prevention, develops plans that specify nursing actions unique to
needs of clients.
V. Intervention
Guided by the plan, intervenes to promote, maintain or restore health, prevent illness
and institute rehabilitation.
VI. Evaluation
Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnose and plan.
VII. Quality Assurance and Professional Development
Participates in peer review and other means of evaluation to assure quality of
nursing practice.
Assumes professional development.
Contributes to development of others.
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and community
representatives in assessing, planning, implementing and evaluating programs for
community health.
IX. Research
Indulges in research to contribute to theory and practice in community health
nursing.
B. Levels of Care
LEVELS OF CARE/PREVENTION
PRIMARY
- activites that prevent a problem before it occurs. Example: Immunization.
SECONDARY
- activities that provide early detection/diagnosis and treatment and Intervention.
Example: Breast self-examination, HIV screening, Operation timbang.
TERTIARY
- activities that correct a disease state and prevent it from further deteriorating.
Example: Teaching Insulin Administration in the home
C. Types of Clientele
TYPES OF CLIENTELE
INDIVIDUAL
- People who visits the health center.
- People who receives health services.
e.g., Prenatal Supervision
Well Child Follow ups.
Morbidity Service
Teaching Client on Insulin Administration
Basic approaches in looking at the individual:
1. atomistic
2. holistic
Perspective in understanding the individual:
1. BIOLOGICAL
a. unified whole
b. holon
c. diporphism
2. ANTHROPOLOGICAL
a. Essentialism
b. Social constructionism
c.Culture
3. PSYCHOLOGICAL
a. Psychosexual
b. Psychosocial
c. Behaviorism
d. Social learning
4. SOCIOLOGICAL
a. Family and kinship
b. Social groups
FAMILY
- Considered as the basic unit of care.
a. Nuclear
b. Extended with lolos and lalas, titios and titas
c. Cohabiting live-in, Not married but with kids.
d. Dyad married but without kids.
MODELS:
Stages of Family Development
STAGE 1 The Beginning Family ( newly wed couples ).
TASK: Compliance with the PD 965 and acceptance of the new member of the family.
STAGE 4 The Family with School Age Children ( 6 -12 years old).
TASK: Reinforce the concept of Responsible Parenthood.
STRUCTURAL FUNCTIONAL
Initial Data Base
Family Structure and Characteristics
Socio-economic and cultural Factors
Environmental Factors
Health Assessment of Each Member
Value Placed on Prevention of Disease
COMMUNITY Patient
- Defined by geographic boundaries with certain identifiable characteristics, with
common values and interests.
POPULATION GROUPS
-Aggregation of people who share common chaaracteristics, developmental stage or
common exposure to particular environmental factors thus resulting in common health
problems ( Clark, 1995: 5 ) e.g. children, elderly, women, workers, etc.
D. Health Care Delivery System
PHILIPPINE HEALTH CARE DELIVERY SYSTEM
1. PRIMARY LEVEL FACILITIES
2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES
Roles of DOH:
1. Leadership in Health
*Serve as the national policy and regulatory institution.
*Provide leadership in the formulation, monitoring and evaluation of the national health
policies, plans and programs.
*Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and Capacity builder
*Innovate new strategies in health.
*Exercise oversight functions and monitoring and evaluation of national health plans,
program and policies.
*Ensure the highest achievable standards of quality health care, promotion and
protection
3. Administrator of specific services
*Manage selected national health facilities and hospitals with modern and advanced
facilities.
*Administer direct services for emergent health concerns that require new complicated
technologies.
VISION:
(old)
- Health for all Filipinos
(new)
- The Leader of health for all in the Philippines
- The DOH is the leader, staunch advocate and model in promoting Health for all in the
Philippines.
(by 2030)
- A global leader for attaining better health outcomes, competetive and responsive
health care system, and equitable health financing.
MISSION:
- To guarantee equitable, sustainable and quality health for all Filipinos, especially the
poor, and to lead the quest for excellence in health.
Roadmap for All Stakeholders in Health: National Objectives for Health 2005 2010.
National Objective for Health: sets the target and the critical indicators, current
strategies based on field experience, and laying down new avenues for improved
interventions.
E. PHC as a Strategy
PHC as a Strategy
*October 19, 1979 Letter of Instruction ( LOI 949 ), the legal basis of PHC was
signed by President Ferdinand E. Marcos, which adopted PHC as an approacch toward
the design, development and implementation of programs focusing on health
development at community level.
LOI 949 signed by President Marcon with an underlying theme: Health in the hands
of the People by 2020.
An improved state of health and quality of life for all people attained through SELF-
RELIANCE.
Concept of PHC
KEY STRATEGY TO ACHIEVE THE GOAL:
- charactterized by partnership and empowerment of the people that shall permeate as
the core strategy in the effective provision of essential health service that are
community based, accessible, acceptable and sustainable at a cost, which the
community and the government can afford.
MISSION:
*To strengthen the health care system by increasing opportunities and supporting the
conditions wherein people will manage their own health care.
4. SELF RELIANCE
5. Partnership between the community and the health agencies in the provision of
quality of life = Providing linkages between the government and the non government
organization and peoples organization.
7. SOCIAL MOBILIZATION =
- It enhances people participation or governance, support system provided by the
Government, networking and developing secondary leaders.
8. DECENTRALIZATION
VII. Safe and Quality Care, Health Education, and Communication, Collaboration and
Teamwork
A. Principles and Theories of Growth and Development (Pediatric Nursing)
PRINCIPLES OF GROWTH AND DEVELOPMENT
PRINCIPLES EXAMPLES
Growth and development are continuous Although there are highs and lows in terms
processes from conception until death of the rate at which growth and
development proceed, a child grows new
cells and learns new skills at all times. An
example of how the rate of growth
changes is a comparison between that of
the first year and later in life. An infants
triples birthweights and increases height
by 50% during the first year of life. If this
tremendous growth rate were to continue,
the 5 ye-old child, when ready to begin
school, would weigh 1,600 Ib. And be 12
ft. 6 in. Tall.
Growth and development proceed in an Growth in height occurs in only one
orderly sequence. sequence from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they creep,
creep before they stand, stand before they
walk, and walk before they run. Some
children may skip a stage ( or pass
through it so quickly that the parents do
not observe the stage) or progress in a
different order, but most children follow a
predictable sequence of growth and
development.
Different children pass through the All stages of development have a range of
predictable stages at different rates. time rather than a certain point at which
they are usually accomplished. Two
children may pass through the motor
sequence at different rates. For example,
one child begins walking at 9 months while
another at 14 months. Both are developing
normally. They are both following the
predictable sequence; they are merely
developing at different rates.
All body systems do not develop at the Certain body tissues mature more rapidly
same rate. than others. For example, neurologic
tissue experiences its peak growth during
the first year of life, whereas genital
tissues grows little until puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning head;
Caudal means tail. Development
proceeds from head to tail. A newborn can
lift only his or her head off the bed when
he or she lies in a prone position. By age 2
months., the infant can lift his or her head
and chest off the bed; by 4 months., he or
she can lift his or her head, chest, and part
of the abdomen; by 5 months., the infant
has enough control to turn over ; by 9
months., he or she can control the legs
enough to crawl; and by 1 year., the child
can stand upright and perhaps walk. Motor
development has proceeded in a
cephalocaudal order from the head to
the lower extremities.
Development proceeds from proximal to This principle is closely related to
distal body part. cephalocaudal development. It can be
illustrated by tracing the progress of upper
extremity development. A newborn makes
;ittle use of the arms or hands. Any
movement, except to put a thumb in the
mouth, is a flailing motin. By age 3 or 4
months., the infant has enough arm control
to support the upper body weight on the
forearms, and the infant can coordinate
the hand to sccop up objects. By 10
months., the infant can coordinate the arm,
thumb, and index fingers, sufficiently well
to use a pincer-like grasp or be able to
pick up an object as fine as a piece of
breakfast cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding one.
refined skills. Because the child is able to control distal
body parts such as fingers, he or she is
able to perform fine motor skills ( a 3-year-
old colors best with a large crayon; a 12
yr-old can write with a fine pen).
There is an optimum time for initiation of A child cannot learn a task until his or her
experiences or learning. nervous system is mature enogh to allow
that particular learning. A child cannot
learn to sit, for example, no matter how
much thechilds parentshave him or her
practice, until the nervous system has
matured enough to allow back control. A
child who is not given the opportunity to
learn developmental tasks at the
appropriate or targert times for such
tasks may have ,ore difficulty than the
usual child learning the tasks later on. A
child who is confined to a body cast at 12
months., which is the time he or she would
normally learn to walk, may take a long
time to learn this skill once free of the cast
at, say, age 2 years old. The child has
passed the time of optimal learning fo that
particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until the
development can proceed. grasp reflex has faded nor stand steadily
until the walking reflex has faded.
Neonatal reflexes are replaced by
purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step over
learned by practice. and over before he or she accomplishes
this securely. If a child falls behind the
normal growth and development rate
because of illness, he or she is capable of
catch-up growth to bring him or her on
equal footing again with his or her age
group.
THEORIES OF DEVELOPMENT
1. Definition of Theories
Theory a systematic statement of principles that provides a framework for explaining
some phenomenon. Developmental theories provide road maps for explaining human
development.
Developmental Task a skill or a growth responsibility arising at a particular time in an
individuals life, the achievement of which will provide a foundation for the
accomplishment of future tasks. It is not so much chronological as the completion of
developmental tasks that defines whether a child has passed from one developmental
stage of childhood to another. For example, a child is not a toddler just because he or
she is 1 year plus 1 day old; he or she becomes a toddler when he or she has passed
through the development stage of infancy.
A. TEST III
1. Client in Pain
CLIENT IN PAIN
Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the skin
that respond to intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System
2. Peri-operative Care
3. Alterations in Human Functioning
a Disturbance in Oxygenation
b Disturbance in Metabolic and Endocrine Functioning
c Disturbance in Elimination
B. TEST IV
1. Alterations in Human Functioning
a. Disturbances in Fluids and Electrolytes
b. Inflammatory and Infectious Disturbances
c. Disturbances in Immunologic functioning
d. Disturbances in Cellular functioning
2. Client Biologic Crisis
3. Emergency and Disaster Nursing
C. TEST V
1. Disturbances in Perception and Coordination
a. Neurologic Disorders
b. Sensory Disorders
c. Musculo-skeletal Disorders
d. Degenerative Disorders
2. Maladaptive Patterns of Behavior
a. Anxiety Response and Anxiety Related Disorders
b. Psycho-physiologic Responses, Somatoform, and Sleep Disorders
c. Abuse and Violence
d. Emotional Responses and Mood Disorders
e. Schizophrenia and Other Psychotic and Mood Disorders
f. Social Responses and Personality Disorders
g. Substance related Disorders
h. Eating Disorders
i. Sexual Disorders
j. Emotional Disorders of Infants, Children and Adolescents.