PROFESSIONAL ADJUSTMENT

Definition of terms:

Adjustment - an educational process referring to changes in behavior towards better

life, better relationships and better contribution to society.

           -   Adaptation to a particular condition, position, or purpose.

Profession - a calling by which members profess to have acquired special knowledge by
training, by experience or both so that they may guide or advice or serve others in that
field.

-       A vocation requiring knowledge of some department of learning or science.

Professional Adjustment - the growth of the whole individual and development of all
his/her capacities: physical, mental, social and spiritual towards efficient and effective
performance of his/her profession.

Ethics - A system of moral principles.

Moral - of pertaining to or concerned with the principles on rules of right conduct or
the distinction between right and        wrong; ethical.

Judgment - an act on instance of judging.

Norm - a standard, model or pattern.

Standard - something considered by authority or by general consent as a basis

comparison; an approved model.

Right - in accordance with what is good, proper or just:

a.    in conformity with fact, reason, truth or some standard or principle; correct.

b.    correct in judgment; opinion or action.

Wrong - not in accordance in what is morally right or good.

            - deviating from truth or fact; erroneous, nit correct in action, judgment,  
opinion, method.

Incompetence - lack of ability.

Malpractice - failure of the professional person, as a physician or lawyers, to render    

proper services through reprehensible ignorance or negligence or through criminal
intent.

-       any improper, negligent practice, misconduct or misuse.

Negligence- the quality, fact, or result of being negligent; neglect

an instance of being negligence; negligence in discharging once responsibilities.

Prudent - wise or judicious in practical affairs; sagacious; or circumspect; sober.

                 careful in providing for the future.

Value - relative worth, merit, or      importance

             monetary or material worth, as in commerce or trade.

Association - an organization or people with a common purpose and having a

formal       structure.

Different Fields of  Nursing:

1.    Hospital or Institutional Nursing

2.    Public Health Nursing or Community Health Nursing

3.    Private Duty or Special Duty Nursing

4.    Industrial or Occupational Health Nursing

5.    Nursing Education

6.    Military Nursing

7.    School Nursing

8.    Clinic Nursing

9.    Independent Nursing Practice

INSTITUTIONAL NURSING

-       Nursing in hospitals and related facilities such as extended care facilities, nursing
homes, and neighborhood clinics, comprises all of the basic components of
comprehensive patient care and family health. The educational qualification for
beginning practitioners is a Bachelor of Science in Nursing degree.

Advantages of Staff Nursing in Hospitals:

  1.     There is always a supervisor whom one can Consult if problems exist.

  2.     Nurses are updated with new trends in medicine and in the nursing care of  
patients.

  3.     They undergo rotation to different units and have a chance to determine their
special area of choice before they are assigned permanently        in One area such as
Medicine, Pediatrics, Surgery, ICU-CCU,   Obstetrics, Operating Room, Delivery Room,
etc.

  4.    They have an eight-hour day and a forty-hour week duty which provides for two
days of rest way form duty. They have provisions for sick leaves, holidays, and vacations
with pay according to personnel policies of the institution.

  5.    They have the chance to get promoted to higher positions if they are qualified.

  6.     Salary increases are given     periodically according to merit system thereby
increasing their initiative and best efforts.
  7.     They are considered an important member of the health team in providing care to
the patients.

  8.     More staff development programs are available in hospitals.

Disadvantages of Staff Nursing in Hospitals:

          The disadvantages usually do not out weight the advantages.

  1.     There is great possibility of understanding which may require sacrifice some of
their plans. Nurses to put in overtime work and this is especially true in hospitals where
budget for personnel is limited.

  2.     Because of the bulk of work, some staff       nurses do not find time to improve
their skills through continuing education programs. Or, if the hospitals are far-flung, no
continuing education programs are provided.

  3.     Administrative problems and overwork may tend to dissatisfy the staff nurse.

PUBLIC HEALTH NURSING OR COMMUNITY HEALTH NURSING

-       Public health nursing is also called community nursing. The National Health
Program of the Philippines gives as much emphasis on the promotion of health and
prevention of diseases rather than care of the sick.

Advantages of Public Health Nursing:

1.    The focus of nursing care is only family and community health         rather than on
an individual basis. Here, the nurse will be able to see the total picture of family and
community health.

2.    It gives the nurse a better perspective of the health conditions of the community
and the health programs conceived and implemented by the government, and to
appreciate the nurses’ role in nation building.
3.    It maximizes efforts to improvise where there are no sufficient facilities, supplies,
and equipment.

4.    It enables the nurse to utilize various community resources and maximize
coordination with other members of the health team.

5.    Focus of care is more on educational and preventive aspects. Thus, nurses have the
privilege of contributing to the program for healthy citizenry especially among the rural
poor.

6.    Individuals, families and communities are motivated to assume responsibility for

their own health care.

Disadvantages of Public Health Nursing:

1.    Cases found in public health     nursing are limited mostly to chronic and/or
communicable diseases.

2.    There are more hazards in public health than in hospital nursing, such as exposure
to elements (inclement weather, heat of sun,    rain), dog or snake bites, accidents.

3.    There are no fixed hours of work. The nurse may be called upon any time of the day
or night.

4.     Some claim that public health nursing is not as exciting nor as glamorous as
hospital work.

5.     Facilities for care of the sick are limited so that practice or skills may also be limited.

6.    The public health nurse may not be immediately aware of changes or trends in the
fields of medicine or nursing.

7.    Public health nursing is not a place for introverts. A nurse has to be outgoing to
meet people.

8.    There is no immediate supervisor to consult in case of emergency.

NURSE IN IN-SERVICE EDUCATION PROGRAMS

-       In-service education programs have been in existence for many years both in
hospitals and public health agencies. This is one way of improving service in these
agencies.

-       Many tertiary hospitals and public health agencies have nursing staff in charge of
staff development training and research.

PRIVATE DUTY NURSING

-       Nurses in private practice are expected to be expert clinicians as well as expert

generalists in nursing. They use the title Private Duty Nurse, Private Nurse Practitioner,
Special Duty Nurse or Private Duty Nurse Specialist.

-       A private duty nurse is a registered nurse who undertakes to give comprehensive
nursing care to a client on a one-to-one ratio. She/he is an independent contractor. The
patient may be provided care in the hospital or in the home.

Qualifications of a Private Nurse Practitioner:

A private nurse practitioner must:

1. Be a registered nurse in the Philippines;

2. Have the following documents for the current year;

a. Professional Tax Receipt (PTR)

b. Professional Regulation Commissions Card (PRC)

c. Residence Certificate

3. Have at least two (2) years of      bedside nursing experience as a professional
nurse      in a general hospital immediately prior to application;

4. Be applicable to the Director of Nursing Service as suitable for orientation to do  

private duty nursing;

5. Be a full time private duty nurse;

6. Preferably have undergone a Critical Care Nursing Course

7. Be a certified I.V. Nurse therapy by the ANSAP (Association of Nursing Science  

Administration of the Philippines).

Policies and guidelines for nurses accompanying patients out of the country:

Passport and other travel papers. All expenses for fees and processing of visa and travel
papers are paid for by the patient or his/her representative.

a.    Passport, paid round trip ticket, and other papers are paid for by the patient or
his/her possession of the private duty nurse at all times.

b.    A travel and accidental    insurance in all the amount of P50,000.00 shall be
provided for the private duty nurse and paid for by the patient or his representative
effective 72 hours before departure and throughout the period of stay abroad while in
the employment of the patient.

c.     The corresponding amount of     salary computed at eight (8) hours multiplied by   
two (2) shifts and the number of days the patient plans to be out of the country shall be
left in the Philippines for ready withdrawal by the private duty nurse’s authorized
representative on designated dates per      agreement of parties concerned.

d.    A daily travel allowance in addition to the Private Duty Nurse’s regular salary while
out        of the country is negotiable with the employer.

e.    The female private duty nurse who is caring for a male patient must be provided a
separate room for rest periods.

f.     All hotel, lodging and food expenses while out of town or out of the country shall
be paid for      by the employer.

Advantages of Private Duty Practice:

Private duty practices gives the following advantages:

1. The chance to see life as it really is, to study human nature and to know at close range
interesting people of different nationalities, cultures, religion, and status;
2. The opportunity to make real friends through close association with the patient and
his family;

3. The chance to travel and see the world;

4. The ability to own time, adjust     work and private life satisfactorily, and direct off-
duty  time into enjoyable leisure;

5. The chance to keep abreast with new knowledge and procedures which provide an
exciting, stimulating experience, with infinite variety of problems to       solve and
personal satisfaction to be gleaned; and

6. The challenge of giving his/her best in providing care and        having the satisfaction
of seeing its results.

Disadvantages of Private Duty Practice

1. Some private duty nurses create a situation in which the patients become totally
dependent on them.

2. Many private duty nurses graduated so long       ago and have not upgraded their
knowledge and skills.

3. There are not enough nurses for evening and night shifts, for holiday, week-ends and
vacation           periods.

4. Being a lone practitioner minimizes opportunity for developing good relationships

with other hospital personnel.

5. Some private duty nurses resent supervision by hospital staff.

6. Little assistance is given by the Head Nurse when the patient is critically ill and the
private duty       nurse needs help in giving   treatment or in changing the position of
the patient. The   private duty nurse sometimes goes without meals because the Head
Nurse    does not arrange for relief when the patient cannot be left alone.

7. Private duty nurses have very little or no participation in professional activities. If they
ever do, they do so on their own time and expense.
8. Nurses who are very experienced and well-qualified receive the same fees as the new
graduates.

Definition of terms:

Adjustment - an educational process referring to changes in behavior towards better

life, better relationships and better contribution to society.

           -   Adaptation to a particular condition, position, or purpose.

Profession - a calling by which members profess to have acquired special knowledge by
training, by experience or both so that they may guide or advice or serve others in that
field.

-       A vocation requiring knowledge of some department of learning or science.

Professional Adjustment - the growth of the whole individual and development of all
his/her capacities: physical, mental, social and spiritual towards efficient and effective
performance of his/her profession.

Ethics - A system of moral principles.

Moral - of pertaining to or concerned with the principles on rules of right conduct or
the distinction between right and        wrong; ethical.

Judgment - an act on instance of judging.

Norm - a standard, model or pattern.

Standard - something considered by authority or by general consent as a basis

comparison; an approved model.

Right - in accordance with what is good, proper or just:

a.    in conformity with fact, reason, truth or some standard or principle; correct.

b.    correct in judgment; opinion or action.

Wrong - not in accordance in what is morally right or good.

            - deviating from truth or fact; erroneous, nit correct in action, judgment,  
opinion, method.

Incompetence - lack of ability.

Malpractice - failure of the professional person, as a physician or lawyers, to render    

proper services through reprehensible ignorance or negligence or through criminal
intent.

-       any improper, negligent practice, misconduct or misuse.

Negligence- the quality, fact, or result of being negligent; neglect

an instance of being negligence; negligence in discharging once responsibilities.

Prudent - wise or judicious in practical affairs; sagacious; or circumspect; sober.

                 careful in providing for the future.

Value - relative worth, merit, or      importance

             monetary or material worth, as in commerce or trade.

Association - an organization or people with a common purpose and having a

formal       structure.

Different Fields of  Nursing:

1.    Hospital or Institutional Nursing

2.    Public Health Nursing or Community Health Nursing

3.    Private Duty or Special Duty Nursing

4.    Industrial or Occupational Health Nursing

5.    Nursing Education

6.    Military Nursing

7.    School Nursing

8.    Clinic Nursing

9.    Independent Nursing Practice

INSTITUTIONAL NURSING

-       Nursing in hospitals and related facilities such as extended care facilities, nursing
homes, and neighborhood clinics, comprises all of the basic components of
comprehensive patient care and family health. The educational qualification for
beginning practitioners is a Bachelor of Science in Nursing degree.

Advantages of Staff Nursing in Hospitals:

  1.     There is always a supervisor whom one can Consult if problems exist.

  2.     Nurses are updated with new trends in medicine and in the nursing care of  
patients.

  3.     They undergo rotation to different units and have a chance to determine their
special area of choice before they are assigned permanently        in One area such as
Medicine, Pediatrics, Surgery, ICU-CCU,   Obstetrics, Operating Room, Delivery Room,
etc.

  4.    They have an eight-hour day and a forty-hour week duty which provides for two
days of rest way form duty. They have provisions for sick leaves, holidays, and vacations
with pay according to personnel policies of the institution.

  5.    They have the chance to get promoted to higher positions if they are qualified.

  6.     Salary increases are given     periodically according to merit system thereby
increasing their initiative and best efforts.
  7.     They are considered an important member of the health team in providing care to
the patients.

  8.     More staff development programs are available in hospitals.

Disadvantages of Staff Nursing in Hospitals:

          The disadvantages usually do not out weight the advantages.

  1.     There is great possibility of understanding which may require sacrifice some of
their plans. Nurses to put in overtime work and this is especially true in hospitals where
budget for personnel is limited.

  2.     Because of the bulk of work, some staff       nurses do not find time to improve
their skills through continuing education programs. Or, if the hospitals are far-flung, no
continuing education programs are provided.

  3.     Administrative problems and overwork may tend to dissatisfy the staff nurse.

PUBLIC HEALTH NURSING OR COMMUNITY HEALTH NURSING

-       Public health nursing is also called community nursing. The National Health
Program of the Philippines gives as much emphasis on the promotion of health and
prevention of diseases rather than care of the sick.

Advantages of Public Health Nursing:

1.    The focus of nursing care is only family and community health         rather than on
an individual basis. Here, the nurse will be able to see the total picture of family and
community health.

2.    It gives the nurse a better perspective of the health conditions of the community
and the health programs conceived and implemented by the government, and to
appreciate the nurses’ role in nation building.
3.    It maximizes efforts to improvise where there are no sufficient facilities, supplies,
and equipment.

4.    It enables the nurse to utilize various community resources and maximize
coordination with other members of the health team.

5.    Focus of care is more on educational and preventive aspects. Thus, nurses have the
privilege of contributing to the program for healthy citizenry especially among the rural
poor.

6.    Individuals, families and communities are motivated to assume responsibility for

their own health care.

Disadvantages of Public Health Nursing:

1.    Cases found in public health     nursing are limited mostly to chronic and/or
communicable diseases.

2.    There are more hazards in public health than in hospital nursing, such as exposure
to elements (inclement weather, heat of sun,    rain), dog or snake bites, accidents.

3.    There are no fixed hours of work. The nurse may be called upon any time of the day
or night.

4.     Some claim that public health nursing is not as exciting nor as glamorous as
hospital work.

5.     Facilities for care of the sick are limited so that practice or skills may also be limited.

6.    The public health nurse may not be immediately aware of changes or trends in the
fields of medicine or nursing.

7.    Public health nursing is not a place for introverts. A nurse has to be outgoing to
meet people.

8.    There is no immediate supervisor to consult in case of emergency.

NURSE IN IN-SERVICE EDUCATION PROGRAMS

-       In-service education programs have been in existence for many years both in
hospitals and public health agencies. This is one way of improving service in these
agencies.

-       Many tertiary hospitals and public health agencies have nursing staff in charge of
staff development training and research.

PRIVATE DUTY NURSING

-       Nurses in private practice are expected to be expert clinicians as well as expert

generalists in nursing. They use the title Private Duty Nurse, Private Nurse Practitioner,
Special Duty Nurse or Private Duty Nurse Specialist.

-       A private duty nurse is a registered nurse who undertakes to give comprehensive
nursing care to a client on a one-to-one ratio. She/he is an independent contractor. The
patient may be provided care in the hospital or in the home.

Qualifications of a Private Nurse Practitioner:

A private nurse practitioner must:

1. Be a registered nurse in the Philippines;

2. Have the following documents for the current year;

a. Professional Tax Receipt (PTR)

b. Professional Regulation Commissions Card (PRC)

c. Residence Certificate

3. Have at least two (2) years of      bedside nursing experience as a professional
nurse      in a general hospital immediately prior to application;

4. Be applicable to the Director of Nursing Service as suitable for orientation to do  

private duty nursing;

5. Be a full time private duty nurse;

6. Preferably have undergone a Critical Care Nursing Course

7. Be a certified I.V. Nurse therapy by the ANSAP (Association of Nursing Science  

Administration of the Philippines).

Policies and guidelines for nurses accompanying patients out of the country:

Passport and other travel papers. All expenses for fees and processing of visa and travel
papers are paid for by the patient or his/her representative.

a.    Passport, paid round trip ticket, and other papers are paid for by the patient or
his/her possession of the private duty nurse at all times.

b.    A travel and accidental    insurance in all the amount of P50,000.00 shall be
provided for the private duty nurse and paid for by the patient or his representative
effective 72 hours before departure and throughout the period of stay abroad while in
the employment of the patient.

c.     The corresponding amount of     salary computed at eight (8) hours multiplied by   
two (2) shifts and the number of days the patient plans to be out of the country shall be
left in the Philippines for ready withdrawal by the private duty nurse’s authorized
representative on designated dates per      agreement of parties concerned.

d.    A daily travel allowance in addition to the Private Duty Nurse’s regular salary while
out        of the country is negotiable with the employer.

e.    The female private duty nurse who is caring for a male patient must be provided a
separate room for rest periods.

f.     All hotel, lodging and food expenses while out of town or out of the country shall
be paid for      by the employer.

Advantages of Private Duty Practice:

Private duty practices gives the following advantages:

1. The chance to see life as it really is, to study human nature and to know at close range
interesting people of different nationalities, cultures, religion, and status;
2. The opportunity to make real friends through close association with the patient and
his family;

3. The chance to travel and see the world;

4. The ability to own time, adjust     work and private life satisfactorily, and direct off-
duty  time into enjoyable leisure;

5. The chance to keep abreast with new knowledge and procedures which provide an
exciting, stimulating experience, with infinite variety of problems to       solve and
personal satisfaction to be gleaned; and

6. The challenge of giving his/her best in providing care and        having the satisfaction
of seeing its results.

Disadvantages of Private Duty Practice

1. Some private duty nurses create a situation in which the patients become totally
dependent on them.

2. Many private duty nurses graduated so long       ago and have not upgraded their
knowledge and skills.

3. There are not enough nurses for evening and night shifts, for holiday, week-ends and
vacation           periods.

4. Being a lone practitioner minimizes opportunity for developing good relationships

with other hospital personnel.

5. Some private duty nurses resent supervision by hospital staff.

6. Little assistance is given by the Head Nurse when the patient is critically ill and the
private duty       nurse needs help in giving   treatment or in changing the position of
the patient. The   private duty nurse sometimes goes without meals because the Head
Nurse    does not arrange for relief when the patient cannot be left alone.

7. Private duty nurses have very little or no participation in professional activities. If they
ever do, they do so on their own time and expense.
8. Nurses who are very experienced and well-qualified receive the same fees as the new
graduates.

EPIDEMIOLOGY AND VITAL STATISTICS:

-       Concerned with the study of factors that influence the occurrence and distribution
of diseases, defects, disability or death which occur in groups or aggregation of
individuals

-       It is the study of the spread of disease in a group of individuals

-       It is the study of  the spread of disease in a group or individuals as in public health

-       The backbone of prevention of disease

Uses of Epidemiology:

-       To study the history of the health populations and the rise and fall of disease and
changes in their character

-       To diagnose the health of the community and the community and the condition of
people; to measure the distribution and dimension of illness in terms of incidence,
prevalence, disability and mortality

-       To study the working of health services with a view of improving them

-       To estimate the risks of disease, accident, defect and the chances of avoiding them

Outline of Plan for Epidemiological Investigation:

1.    Establish fact of presence of epidemic

-       Verify diagnosis

-       Reporting

-       Is there an unusual prevalence of the disease

2.    Establish time and space relationship of the disease

-       Are the cases limited to or concentrated in any particular geographical subdivision

of the affected community

-       Relation of cases by days of onset of the first known cases

3. Relations to characteristic of the group of community

-       Relation of cases to age groups, sex, color, occupation, school, attendance, past  

immunization etc.

-       Relation of sanitary facilities, especially water supply, sewerage disposal, general

sanitation of homes, and relation to animal or insects vector

-       Relation to milk and food supply

-       Relation of cases to other cases and known carriers if any

3.    Correlation of all data obtained

-       Summarize data clearly with the aid of such tables and charts are necessary to give
a clear picture of the situation

-       Build up the case for the final conclusion carefully utilizing all the evidence
available

-       Establish the source of the epidemic and the manner of the spread, if possible

-       Make suggestions as to the control, if disease is still present in community and as

to prevention of future outbreaks

Outline on the Operational Procedure during a Disease Outbreak

1.    Organization of Team

-       Coordination of personnel

-       Orientation/ demonstration on the methodology to be employed

-       Checklist on the team’s paraphernalia

     -    Pooling of data and resource-record keeping

     2. Epidemiological Investigation

     -   Active case finding

     -   Carriers and contact control

     -   Surveillance

     3. Collection of laboratory specimens

     -    Rectal swabbing

     -    Food sampling

     -    Others that are relevant to disease

     4. Treatment of Patients and contacts

     -    Analgesics and antipyretics

     -    Antibiotics

     -    Parenteral fluids

     -    Supportive drugs

     -    Emergency drugs

     -    Isolation of patients- “cordon sanitaire”

     -    Boiling and disinfection of fomites

     -    Conduction of patient to hospitals

     5. Immunization campaign

     -   Type of vaccine

     -   Dosage, schedule, technique

     -   Areas to be covered

     -   Target population

     -   Consolidation and evaluation of data

    6. Environmental Sanitation (during the survey)

     -   Water

     -   Toilets and surroundings

     -   Garbage disposal

     -   Insect and vermin control

     -   Food sanitation

     7. Health education

     -   Individual approach

     -   Community approach and meetings

     -   Schools PTA, church and other congregations

     8. Involvement of other agencies

     9. Reporting

     -   Telegraphic report written

Functions of the Nurse in Epidemiology:

1.    Maintains surveillance of the occurrence of notifiable diseases

     2. Coordinates with other members of the health team during a disease outbreak

     3. Participates in case finding and collection of laboratory specimens

     4. Isolates cases of CD

     5. Renders nursing care teaches and supervises giving of care

     6. Performs and teach household members methods concurrent and terminal     
disinfection

     7. Give health teaching to prevent further spread of disease to individuals and
families

     8. Follow-up cases and contacts

     9. Organize, coordinate and conduct community health education campaign/

meetings

     10. Refer cases when necessary

     11. Coordinates with other concerned community agencies

     12. Accomplishes and keeps records and reports and submits to proper office/
agency.

Vital Statistics

-       Refers to the systematic study of vital events such as births, illnesses, marriages,
divorces and the separation and deaths

-       Statistics of disease and death indicate the state of health of community and the
success or failure of health work

-       Statistics on population and the characteristics such as age and sex distribution are
obtained from the NSO

-       Births and deaths are registered in the office of the Local Civil registrar of the
municipality

Sources of Data:

-       Population census
-       Registration of vital data

-       Health surveys

-       Studies and researches

Specific rate

-       The relationship is for a specific population class or group. It limits the occurrence
of the event to the portion of the population definitely exposed to it.

Fertility rates

Crude birth rate - a measure of one characteristic of the natural growth or increase in
population

   

                 total no. of live births registered in a given year

CBR   =      total no. of live births registered of same year          x 1000

General fertility rate

-       measure of one characteristic of natural growth compared to the  fertility age    

group

   

                      total no. of live births registered in a given year

    GFR    =     total population of fertility age                              x1000

Mortality rates
 

        Crude death rate - a measure of one mortality from all causes which may result in a
decrease in the population

                     Total no. of deaths registered in a given year

    CDR    =     estimated population of the same year                  x 1000

Specific Death Rate

-       Describes more accurately the risk of exposure of certain classes or groups to

particular diseases.

                     

 Deaths in a specific class or group registered in a year

    SDR    =     estimated population of the same year                             x  100,000

Age Specific Death Rate

No. of deaths in a specific age group in a given year

    ASDR   =        estimated population of that same age group               x 100,000

Sex Specific Death Rate

      No.of deaths of a certain sex in a given year

   SSDR    =        estimated population of that same sex for a yr.         x 100,000

 
Cause Specific Death Rate

                         No. of deaths in a specific cause in a given year

   CSDR     =       estimated population of the same year                      x 100,000

Infant Mortality Rate

-       Measures the risk of dying during the 1  year of life. A good index of the general
st

health condition of a community since it reflects the changes in the environmental and
medical condition of the community

    Total no. of deaths under 1 yr. of age in a given year

   IMR      =       total no. of live births I n the same year                         x 1000

Maternal Mortality Rate

-       Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium. An index of the obstetrical care needed and received by the women in a
community

                            No. of deaths from maternal causes

    MMR     =        Total no. of live births                                  x 1000

Fetal Death Rate

-       Measures pregnancy wastage. Death of the product of conception occurs prior to

its complete expulsion, irrespective of duration of pregnancy

  

                            Total no of fetal deaths in a given year

    FDR      =        total no. of live births in the same year       x 1000

Neonatal Death Rate

-       Measures the risk of dying the 1  month of life. May serves as an index of the
st

effects of prenatal care and obstetrical management on the newborn

                          No. of Deaths under 28 days of age in a given yr.

   NDR      =        total no. of live births in the same year                       x 1000

Swaroops Index

-       Measures the risk of dying for 50 yrs. Old and above

                           No. of Deaths of 50 yrs. Old and above

   SI         =        estimated population of the same year         x 100

Proportionate Mortality Rate

-       Shows the numerical relationship between deaths from a cause, age etc.

                       

      No. of registered deaths from a specific cause

  PMR       =        no. of registered deaths from all causes               x 100

 
Case Fatality Ratio

-       Index of a killing power of the disease. It is influence by incomplete reporting and

poor morbidity data

                         No. of registered deaths from a specific disease

  CFR        =       No. of registered cases from specific disease          x 100

Incidence Rate

-       Measures the frequency of occurrence of the phenomenon during  a given period

of time. Deals only with new cases

                    No. of cases of a particular disease in a specified time

   IR     =     estimated population of the same yr.                               X100,000

Prevalence Rate

-       Measures the proportion of the population which exhibits a particular diseases at a

particular time

                   No. of new and old cases of a certain disease

   PR    =      Total no. of persons examined                            x 100

Attack Rate
-       A more accurate measure of the risk of exposure. Useful in epidemiological
investigation

                      No. of persons acquiring the disease in a given yr.

     AR     =      No. of exposed to same disease in same yr.                 X 100

10 Leading Causes of Morbidity as 2019

1.    AURI

2.    HPN

3.    Acute lower respiratory tract infection and pneumonia

4.    UTI

5.    Bronchitis

6.    Influenza

7.    Acute watery diarrhea

8.    Asthma

9.    TB

10.   Acute febrile illness

10 Leading Causes of Mortality as 2020

1.    Heart disease

2.    Cancer

3.    Accidents
4.    Chronic lower respiratory diseases

5.    Stroke

6.    Alzheimer’s disease

7.    Diabetes

8.    Influenza and pneumonia

9.    Nephritis

10.  Intentional self harm or suicide

Main Causes of Maternal Mortality

1.    Complications related to pregnancy occuring  in the course of labor, delivery and

puerperium

2.    HPN complicating pregnancy, childbirth and puerperium

3.    Postpartum hemorrhage

4.    Pregnancy with abortive outcome

5.    Hemorrhages related to pregnancy

Presentation of Data

-       Line graphs - shows peaks, valleys and seasonal trends, it is used to show trends of
births and death rates over a period of time

-       Bar graphs - each bar represents or expresses a quantity in terms of rates or

percentages of a particular observation like causes of illness and deaths

-       Area diagrams - pie charts-shows the relative importance of parts of the whole

 
Functions of the Nurse:

-       Collects data

-       Tabulates data

-       Analyses and interprets data

-       Evaluates data

-       Recommends redirection and or strengthening of specific areas of health program

as needed

What is HEALTH and NURSING PROBLEMS?

Nursing problems - are conditions experienced by the patient or the patient's family
for which the nurse may provide professional service.

-       The nurse makes a nursing diagnosis that identifies the impaired state and
determines the care needed to augment the patient's ability to perform self-care.

-       The requirements for care are classified in four levels: care given to sustain life is
sustenal care; care given to assist the patient in self-care is remedial care; care that helps
the patient develop new skills and goals in self-care is restorative care; and care given to
guide the patient to a level of self-help beyond the normal level is preventive care.

Health - is the level of functional and (or) metabolic efficiency of a living being.
In humans, it is the general condition of a person in mind, body and spirit, usually
meaning to being free from illness, injury or pain (as in “good health” or “healthy”).

-       The World Health Organization (WHO) defined health in its broader sense in

1946 as "a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity."

-       Although this definition has been subject to controversy, in particular as having a

lack of operational value and the problem created by use of the word "complete", it
remains the most enduring.

 
PROGRAMS FOR BASIC HEALTH SERVICES

Environmental Sanitation - the study of all factors in man’s physical environment,

which may exercise a deleterious effect on his health well –being and survival

Factors:

-       Water sanitation

-       Food sanitation

-       Refuse and garbage disposal

-       Excreta disposal

-       Insect vector and rodent control

-       Housing

-       Air pollution

-       Noise

-       Radiological protection

-       Institutional sanitation

-       Stream pollution

Sanitation Strategies:

-       Water quality surveillance

-       Evaluation of food establishments

-       Proper solid and liquid waste management

-       Sanitation of public places

-       Sanitation management of disaster areas

-       Impact assessment of environmentally critical projects

-       Enforcement of sanitation laws, rules, regulations and standards

Major Environmental Sanitation Programs:

-       Health and sanitation

-       Water supply Sanitation Program

-       Proper Excreta and sewage disposal program

-       Food sanitation program

-       Hospital Waste management program

Health and Sanitation:

Diseases related to Sanitation:

-       Diarrhea

-       Tuberculosis

-       Intestinal parasitism

-       Schistosomiasis

-       Malaria

-       Infectious hepatitis

-       Filariasis

-       Dhf

 
PD 856

-       Comprehensive Sanitation Code of the Philippines 1978

-       DOH and EHS has the authority to act on this Implementation

Water supply Sanitation Program:

Policies:

-       Approved types of water facilities

-       Unapproved type of water facility

-       Access to safe and potable drinking water

-       Water quality and monitoring surveillance

-       Waterworks/ water system and well construction

Approved Types of Water Supply Facilities:

-       Level I (Point source) - A protected well or a developed spring with an outlet but
without a distribution system, generally adaptable for rural areas where the house are
thinly scattered. Serves 15 to 25 households and its outreach must be not more than
250 meters.

-       Level II (Communal Faucet system or Stand- posts) - a system composed of a

source reservoir, a piped distribution network and communal faucets, located at not
more than 25 meters from the farthest house. Serves 100 households with 1 faucet per
4- 6 households.

-       Level III- (Waterworks system or individual House connections - A system with

source, a reservoir a pipe distributor network and household taps. Used for populated
urban areas. Requires minimum treatment disinfection

 
Unapproved Type of Water Facility:

-       Water coming from doubtful sources such as open dug wells, unimproved springs,
wells that needs priming and the like

Access to Safe and Potable Drinking Water:

-       All households shall be provided with safe and adequate water supply

Water Quality and Monitoring Surveillance:

-       Every municipality through its RHUs must formulate an operational plan for quality
and monitoring surveillance every year

-       Require quality standards that meet the provisions of the National Standards for
Drinking water set by the DOH

-       The examination of drinking water shall be performed only in private or

government laboratories duly accredited by DOH

-       Certification of potability of an existing water source or this is issued by the

Secretary of Health or his duly authorized representative

Disinfection of water supply sources are required on the following

       1. Newly constructed water supply facilities

       2. Water supply facility that has been repaired / improved

       3. Water sources found to be positive bacteriologically by laboratory analysis

       4. Container disinfection of drinking water collected from a water facility that is
subject to recontamination

 
Waterworks/water system and well construction

       1. Well sites shall require the prior approval of the Secretary of Health

       2. Well construction shall comply to sanitary requirements of the DOH

       3. Water supply system shall supply safe and potable water in adequate quantity

       4. Water shall be made readily available to consumers/ users preferably to water
piped direct to homes

       5. Adequate pressure and volume shall be provided in the water system distribution
line

Proper Excreta and Sewage Disposal Program

Policies:

Approved Type of Toilet Facilities:

1.    Level I

a.    Non-water carriage toilet facility- no water is necessary to wash the waste in the
receiving space. e.g. pit latrines, reed odorless earth closet

b.    Toilet facilities requiring small amount of water to wash the waste into the 
receiving space e.g. Pour flash toilet and aqua privies

2.    Level II- on site  toilet facilities of the water carriage type with water- sealed and
flush type with septic vault/ tank disposal facilities

3.    Level III- water carriage types of toilet facilities connected to septic tanks and/or to
sewerage system to treatment plant

 
-       In rural areas the “blind drainage” type of wastewater collection and disposal
facility shall continue to be the emphasis until such time that sewer facilities and off-site
treatment facilities shall be made available to clustered houses in rural areas

-       Conventional sewerage facilities are to be promoted for construction in

“Poblacions” and cities in the country

Food Sanitation Program

Policies:

Food establishments shall be appraised as to the following sanitary conditions:

      1. Inspection/ approval of all food sources, containers, transport vehicles

      2. Compliance to Sanitary permit requirements for all establishments

      3. Provision of updated health certificate for food handlers, cooks and cook helpers
which include monitoring as to presence of intestinal parasites  and bacterial infection

      4. Destruction of banning of food unfit for human consumption

      5. Training of food handlers and operators on food sanitation

      6. Food establishments shall be rated and classified as follows:

             Class A- Excellent

             Class B- Very Satisfactory

             Class C- Satisfactory

      7. Ambulant food vendors shall comply with the requirements as to the issuance of
health certificate which also include monitoring the presence of intestinal parasite and
bacterial infection

      8. Household food sanitation are to be promoted and monitored and food hygiene
education to be intensified through HE and provision of IEC material
 

Hospital Waste Management Program:

Policies:

1.    All newly constructed/ authorized and existing government and private hospitals
shall prepare and implement a Hospital waste management Program as a requirement
for registration/ renewal of licenses

2.    The use of appropriate technology and indigenous materials for HWM system shall
be adopted

3.    Training of all hospital personnel involved in waste management shall be an

essential part of hospital training program

4.    Public Information campaign on health and environmental hazard arising from

mismanagement of hospital shall be the responsibility of hospital administration

5.    DOH Hospital Waste management guidelines/policies shall be guided by existing

legislative health and environmental protection laws/ policies on waste management

6.    Local ordinances regarding the collection and disposal techniques, especially

incinerators, shall be institutionalized

Nursing Responsibilities and Activities:

1.    Health Education

2.    Actively participate in the training component of the service like in Food handlers
class and attend training/ workshops related to environmental sanitation

3.    Assist in deworming activities for the school children and targeted groups

4.    Effectively and efficiently coordinate programs/projects/activities with other

government and NGOs
5.    Acts as an advocate or facilitator to families, the community in matters of program/
projects/activities on environmental health in coordination with others members of
RHU, especially the RSI

6.    Actively participate in environmental sanitation campaigns and projects in the

community

7.    Be a role model for others in the community to emulate in terms of cleanliness in
the home and surrounding  

8.    Participate in the research studies to be conducted in their respective area

of assignment

9.    Help in the interpretation and implementation of PD 856 commonly known as

Sanitation Code of the Philippines

10.  Assist in the Disaster Management, which will be implemented at all levels

Reproductive Health

-       A state of complete physical, mental and social well being and not merely the
absence of disease or infirmity in all matters relating to the reproductive system  and its
functions and process.

Concepts:

-       A married couple has the capability to reproduce/ procreate

-       Reproductive health is the exercise of reproductive right with responsibility

-       RH includes sexual health for the purpose of enhancement of life and personal
relations

-       RH means safe pregnancy and delivery

 
Vision:

-       Reproductive health practice as a way of life for every man and woman throughout
life.

Goals:

-       To achieve healthy sexual development and maturation

-       To achieve their reproductive intention

-       To avoid illness diseases, injuries disabilities related to sexuality and reproduction

-       To receive appropriate counselling and care of RH problems

Strategies:

-       Increase in improve the use of more effective or modern contraceptive methods

-       Provision of care, treatment and rehabilitation for

-       RH, if possible in all facilities

-       RH care provision should be focused on adolescent, men and unmarried and other
displaced people with RH problems

-       Strengthen outreach activities and the referral system

-       Prevent specific RH problems

Ten Elements of RH

1.    Maternal and Child Health and Nutrition

2.    Family Planning

3.    Prevention and Management of abortion complications

4.    Prevention and treatment of Reproductive Tract Infections including STDs, HIV and
AIDS

5.    Education and counselling on sexuality and sexual health

6.    Breast and Reproductive Tract Cancers and other Gynecological conditions

7.    Men’s reproductive Health

8.    Adolescent Reproductive Health

9.    Violence against Women (VAW)

10.  Prevention and Treatment of infertility and sexual disorder

Philosophy:

-       Pregnancy, labor and and delivery and the puerperium are part of the continuum
of the  total life cycle.

-       Personal, cultural and religious attitudes and beliefs  influence the meaning of
pregnancy for individuals and make each experience unique

-       Maternal- child nursing is family centered

Standard Prenatal Visit:

-       The standard prenatal visit should include the following:

-       Weight, height and BP taking

-       Examination of the eyes and palm of the hands for pallor

-       Abdominal examination-include fundic height, fetal position, presentation and fetal

heart ton

-       Face, hands and extremities for edema

-       Examination of the breast

-       Examination of the neck for thyroid gland enlargement (goiter)

Basic Prenatal Service:

-       History taking

-       PE

-       Treatment of disease

-       Tetanus Toxoid immunization

-       Iron supplementation

-       Health education

-       Laboratory examination

-       Oral dental examination

-       All pregnant women shall be given Tetanus Toxoid immunization

-       Iron supplementation should be given from the 5  month of pregnancy up to 2

th

months postpartum ( 100-200 mg orally per daily per orem for 210 days)

-       In goiter endemic areas, all pregnant women shall be given one  iodized oil
capsule every year

-       In malaria infested areas, all pregnant women shall be given prophylaxis in the
form of Chlorquine ( 150 mg. Base/ tablet) 2 tablets per week for the whole duration of
pregnancy

Nursing Care during Childbirth

-       All Birth attendants shall ensure clean and safe deliveries at the facilities.
 

Family Planning:

Natural Method:

1.    Cervical mucus method-cervical mucus

2.    Basal body temperature-increase in body temperature during ovulation

3.    Sympto-thermal-symptoms associated with ovulation e.g. breast tenderness,

spotting, frequency of urination

Benefits:

a.    Serves as a mutual understanding for the couple

b.    It helps women to understand their menstrual cycle

c.     No side- effects

4.    LAM-Lactational Amenorrhea Method (LAM)

Indications:

a.    The mother has not resume her menstrual cycle

b.    The mother is breastfeeding 24 hrs a day

c.     The child is less than 6 months

Advantages:

a.    It gives all the sufficient nutrients to the baby

b.    The breastmilk protects the baby from diseases like diarrhea and other
communicable diseases

c.     It is cost-effective and not needing medical supervision

d.    It helps in uterine involution

e.    Cancer is prevented

f.     Promotes Maternal and child bonding

g.    It gives the couple ample time to decide for proper family planning method

Important considerations in the use of LAM:

- The mother must use other method of FP if she is:

     1. Start menstruating

     2. The baby is starting to eat fruits, vegetables and fish

     3. The mother is breastfeeding less than 24 hours a day

     4. Ideal pattern of breastfeeding is at least 8-10 times a day

Artificial Method:

1.    Pills

-       Pills are taken on the 1  day or within 5 days of menstruation

st

-       Pills are taken on the same hour everyday either day time or at night

-       There are 28 tablets in 1 packet - 21 are called active pills and 7 are without
hormones

Advantages:

a.    It is effective if it is taken on time

b.    It does not interfere with sexual intercourse

c.    Can help in the regulation of the women`s menstrual cycle

-       The pill works in several ways to prevent pregnancy. The pill suppresses ovulation
so that an egg is not released from the ovaries, and changes the cervical mucus, causing
it to become thicker and making it more difficult for sperm to swim into the womb. The
pill also does not allow the lining of the womb to develop enough to receive and
nurture a fertilized egg. This method of birth control offers no protection against
sexually-transmitted diseases.

1.    Condom

Advantages:

a.    It does not require medical supervision and has no side-effects

b.    Practical

c.     Can be used in the prevention of STD,HIVs and AIDS

d.    Interrupts sex, reduces sensation

e.    Comes in different sizes, shapes, color and textures

f.     The only contraindication: Latex allergy (severe redness, swelling, itching)

-       The male condom is a barrier contraceptive made of latex or polyurethane. The condom
must be fitted over the erect penis. The condom is sold over-the-counter and when used
properly is an inexpensive, effective barrier to pregnancy and sexually-transmitted disease.

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Nursing Leadership and Management

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  MCNP

  College of Nursing

  BSN First Semester 2021-2022

  BSN LEVEL 4 SUBJECTS

  BSN4-A

  Nursing Leadership and Management

  FINALS

  Community Organization

Community Organization
What is an Organization?

•       an orderly arrangement of group effort to provide unity of action in the pursuit of
a common purpose (Miclat)

1991 Local Government Code : Republic Act 7160                     

•        Devolution is the turnover of responsibility to the local government units in the

delivery of basic services that were earlier the responsibilities of the national
government.
•       These basic services include health, hospital services, social welfare services,
community forestry projects, agricultural extension and onsite research, locally funded
public works, school building facilities, promotion and development of local tourism,
telecommunication services and other investment support programs.

What is Community Organization?

      As a problem-solving methodology, it mobilizes people to act and solve their

issues and problems

      As an educational approach, it equips people with necessary knowledge, skills,

and appropriate values or attitude to manage their own development

      As an organizing process, it catalyzes the evolution of alternative structures that

are instruments of the people to assert, protect and fight for their interests.

      Develop capabilities to assess their health needs and problems, plan and
implement actions to solve their problems, put up and sustain organizational structures
who will support and monitor implementation of health initiatives by the
people (Maglaya etal. 2002)

      Finding solutions to societal problems by redistributing resources, functions and

decision-making power (Perlman and Gurin)

      Aimed to enable people to shape their own destiny in a continuous and sustained
manner whereby willingness of the people or people’s participation and empowerment
is important

Components of CO:

      Educating/ awareness building:

                 -  people will be helped to understand their own situation

                 -  people will develop critical consciousness of their existing

                    conditions
       Organizing/ Centralized democratic approach:

                 -  people will be trained to develop their capacity to decide for

                    themselves through participative approach

                 -  people will work collectively and efficiently on their immediate and

                    long term problems

      Mobilization:

                 - people test their strength though collective efforts in sectoral and

                   multi-sectoral struggles

                 - develop capability and readiness to respond to take action in their

                   immediate and long-term problems

Principles of CO:

      Planning group needs to represent all people concerned and discussion must
include people with technical knowledge of health problem

      Technique of asking questions often important in developing community

organization and group discussion

      Major decision must be made by the entire group

      Local factors and available personnel should be asked in determining what type of
organization is desirable and practicable

      Functions of an agency and members must be defined

      A good organizational plan can succeed only when the people who operate it will
see with its values which are compatible personally and not antagonistic professionally

Therefore …

      Basic trust in people

       CO should lead to community development

      CO should be based on the interest of the most exploited and oppressed sectors
and classes of society (Class-based organizing)

      CO emerges as a result of the dissatisfaction with an existing order where a social
imbalance occurs

      People are central to all development

      CO is committed to the democratic process and goals

      Community people have the capacity to change

      CO upholds the belief on the innate dignity and worth of community people

Philosophy of community organizing:

“Acceptance of the right of the community to decide what it wants rather than having
the organizer’s views imposed on it, belief on the capacity of the people to find richer
and more satisfying ways of living if they are helped to use the resources within
themselves and their environment which are and could be made available to them ”

Purposes of CO:

Community organization aims to empower people towards self-managed, self-

directed, self- determining, self reliant communities.

•       To solve certain problems and meet needs

•       To achieve selected social goals

•       To strengthen the people’s capacity in dealing with the problems, needs and
aspirations

 
Goals of CO:

      To motivate, enhance and seek wider community participation in decision-making

with positive impact to people’s health

      To empower people towards self-managed, self-directed, self-determining, self-

reliant communities

Types of Goals:

      Task Goals: concrete tasks to be undertaken to meet specific needs and people’s

aspirations or to solve particular problem

      Process Goals: process of helping people in the community, strengthen quality of

participation, prepare them for their specific roles in community-building and
development

      Relationship goals: focused on changing certain types of relationships ad decision-

making process in community diffusing power to a wider base. CO believes in
participative leadership since people’s participation develops enlightened citizenry

Objectives of CO:

      To remove blocks to growth

-          Ignorance

-          Negative values/patterns/attitudes

-          Regionalism/ Fractionalism

-          Oppressive power structures that take advantage of the poor and the weak

      To release potentialities and bring about people’s empowerment

      To develop capacity of indigenous leaders to manage community life and be self
reliant formal and informal leaders
       To develop the ability to function as an integrated unit

      To encourage the full use of inner or indigenous resources for community
development before tapping outside resources

      To change/modify existing policies/programs that are oppressive and irrelevant

and to propose needed ones

Roles of a Community Organizer:

      Enabler

      Helper

      Guide

      Initiator

      Broker

      Advocate

      Consultant

      Intervenor

      Planner

      Researcher

PHASES OF COMMUNITY ORGANIZING:

I.            Assessment / Preparatory Phase

          1. Site Selection

   Guide questions in choosing and prioritizing areas for community development :

1.    Is the community in need of assistance?

2.    Do the community members feel the need to work 

     together to overcome a specific health problem?

3.    Are there concerned groups and organizations that

     the health care worker can possibly work with?

4.    What will be the counterpart of the community in terms of community support,

commitment and human resources?

Criteria for site selection:

        a. relatively economically depressed

        b. population of 100-200 families (varies with the resources and

                manpower available)

        c. relative concentration of poor people

        d. no strong resistance from the community

        e. relatively free of similar agencies and programs

        f. with significant health or health-related community problems

        g. other considerations are language, distance, transportation and communication  

facilities

             2. Community Profiling

                 - provides an overview of the demographic characteristics, community and

health related services and facilities which will serve as the initial database of the
community 
 

Objectives of the community profile:

-       provide the basis for planning and programming of organizing activities

-       determine the correct approach and method of organizing

-       gather data about the community in order to identify and understand problems
and issues

-       identify classes and sectors to determine interests towards problems and issues

** A contact person must first be chosen to aid the health professional in coming up

with a community profile.

Characteristics of the contact person :

           a.   known and accepted by the people

           b.   well respected; service oriented

           c.   representative of the poor majority

           d.   recognizes need for change

           3. Entry / Integration

               -  establishing rapport with the people in a continuing effort to imbibe the
community by living with them and undergoing the same experiences, sharing their
hopes and aspirations and hardships towards building mutual trust and cooperation

Guidelines in conducting integration:

 
·         Recognize the role and position of local authorities

·         Adapt a lifestyle in keeping with that of the community

·         Choose a modest dwelling which the people, especially the economically

disadvantaged will not hesitate to enter

·         Avoid raising expectations of the people. Be clear with your objectives and
limitations

·         Participate directly in production process

·         Make house calls and seek out people where they usually gather

·         Participate in some social activities

          4. Community Health Diagnosis

               - a tool in determining health status

              - a systematic approach/ study of the health condition of a community, 

involving the collection, analysis and interpretation of data including statistical data

Community Health Diagnosis

      The health status of the community is the product of the various interacting
elements such as population, the physical and topographical characteristics, socio-
economic and cultural factors, health and basic social services and power structure
within the community. The interrelationship of these elements will explain the health
and illness pattern of the community (Maglaya etal. 2002)

n  Focus: Both a Profile and a Process

Profile: it is a description of a community’s state of health as determined by its physical,
economic, political and social factors

Process:

 1. It is a continuous learning experience for the community organizers and the
community as well.

2. It allows the community to:

             - gradually become aware of its situation            

             - understand at its own pace the potential advantages of change  which
eventually lead to changes in attitude, values and behavior 

3. It is an organized attempt in involving the people in solving

                    problems that concern them most

Types of Community Diagnosis:

According to degree of detail or depth:

1. Comprehensive – obtains general info about the community

2. Problem oriented – obtains information about a specific need/problem

Community Participation:

-       Awareness building and consciousness raising on health and health related issues

-       Planning, implementation, monitoring and evaluation done through small group

meetings (10-12 households)

-       Selection of CHW by the community

-       Community building and organizing

 

Self-Reliance:

-       Community generates support for the health program

-       Use of local resources

-       Training of community in leadership and management skills

-       Incorporation of income generating projects, cooperatives and business

Recognition of interrelationship between health and government:

-       Convergence of health, food, nutrition, water, sanitation, and population services

-       Integration of PHC into national, regional, provincial, municipal, Barangay

development plans

Social Mobilization:

-       Establishment of an active health referral

-       Multisectoral and interdisciplinary linkages

-       Information, Education, Communication support using multimedia

-       Collaboration between government and non- government organization

Decentralization:

-       Reallocation of budgetary resources

-       Re-orientation of Health professionals on Primary Health Care

-       Advocacy for political will and support from national leadership down to the
barangay level
 

I.            Organizational Phase

-          Social Preparation

-          Spotting of potential leaders

-          Core Group Formation

-          Setting up the community organization

II.          Education and Training Phase

-          Conducting Community Diagnosis

                   Determining the objectives

                                    Defining the study population

                                    Determining the data to be collected

                                    Collecting the data

                                    Developing the Instrument

                                    Actual Data Gathering

                                    Data Collation

                                    Data Presentation

                                    Data Analysis

                                    Identifying Community Health Problems

                                    Priority-setting

-       Training of community health workers

-       Health services and mobilization

-       Leadership formation activities

III.        Intersectoral Collaboration Phase

IV.         Phase-out

TWO LEVELS OF PRIMARY HEALTH WORKER:

1.    Village or  Barangay Health Workers

2.    Intermediate Level Health workers

LEVELS OF HEALTH CARE DELIVERY SYSTEM:

1.    Primary - health services offered at this level are to individuals in fair health and to
patients with diseases in the early symptomatic stages. (Barangay Health Station, Rural
Health Units, Community Hospitals, Health Center, Puericulture Centers)

2.    Secondary - offer services to clients with symptomatic stages of the disease which
require moderately specialized knowledge and technical resources for adequate
treatment. (Emergency/District Hospital, Provincial/City Hospitals, Provincial/City Health
Service)

3.    Tertiary - services offered at this level are for clients afflicted with diseases which
seriously threaten their health and which require highly technical and specialized
knowledge, facilities and personnel to treat effectively. (National and regional health
services, medical centers, teaching and training hospitals)

×This lesson is not ready to be taken.

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