COMMUNITY HEALTH MIDWIVES 2.

Midwives process
PROCESS 3. Planning
4. Implementation
Community health purposes and goals 5. Evaluation
are realized through the application of a
series of steps that lead to desired CHARACTERISTICS OF THE
results. The midwives process is central MIDWIVES PROCESS
to a midwives actions: it is very  The system is open and flexible
essence of midwives, applicable in any to meet the unique needs of the
setting, in any frame of reference, and family and community
within any philosophy. Its uniqueness  It is cyclic and dynamic
will depend on the best application of because all steps are interrelated;
midwife and public health skills to family there is no absolute beginning or
and community problems. end.
 It is client-centered; it
THE MIDWIVES PROCESS individualizes the approach to
- Is a systematic, scientific, end clients particular needs.
dynamic on going  It is goal-directed
interpersonal process in which  It permits creativity for the
the midwives and the clients are midwife and client in devising
viewed as a system with each ways to solve the stated health
affecting the other and both being problem.
affected by the factors within the  It emphasizes feedback which
behavior. The process is a series leads either to assessment of the
of actions that lead toward a problem or to revision of the care
particular result. This process of plan.
decision-making results in the  It is universally applicable to
optimal health care for the clients the midwives process as used as
to whom the midwives applies the framework for midwives care in
process all types of healthcare setting
with clients of all age group.
- Systematic rational method of
planning and providing
midwives care. Its goal is to
identify a clients health status,
actual of potential health problem,
to establish plans to meet the ASSESSMENT
identified needs and to deliver
specific midwives - Provides an estimate of the
interventions to address those degree to which a family
needs. group or community is
achieving the level of health
A system of planning the delivery of possible for them, identifies
midwives care, consisting of the specific deficiencies or
following steps: guidance needed and
estimates the possible
1. Assessment
 effects of the nursing - These data are collected
interventions. systematically and
- Effects of the midwives continuously, then are recorded
interventions unity is in appropriate forms and kept
achieving the level of health systematically so that retrieval of
possible for them, identifies information is facilitated.
specific deficiencies or Collected data are treated
guidance needed and confidentially.
estimates the possible.
- A group of people living in the
COLLECTION OF DATA same place or having a particular
Relevant data are collected on characteristics in common.
the health status of the family - Is described as a compilation of
groups and community; survey questions sent out to a
Demographic data, vital health filtered target audience to
statistics, community dynamic understand more about a
including power structure, studies particular community. It is an
of disease surveillance, economic, online survey software capability
cultural and environmental that enables sending a survey to
characteristics, utilization of a pre-selected enrolled audience.
health services by the population This ensures high data quality
and on individuals and families and high response rates because
health status, education. Socio- the community members have
cultural, religious and already shown intent to
occupational background, family participate in the research study.
dynamics environment and
patterns of coping. WHAT ARE COMMUNITY SURVEY
QUESTIONS?

VARIOUS METHODS ARE Community survey questions are

EMPLOYED TO COLLECT DATA: described as questions used to gain
community surveys (interview of insights from the members belonging
individuals, families, groups & to a community. They may be
significant others) qualitative survey questions or
quantitative survey questions,
COMMUNITY SURVEYS: interview of depending on the community manager's
individuals, family groups and significant research needs. Researchers pose
others questions to the community members to
monitor socioeconomic factors, health,
observation of health related behaviors wellbeing, employment, etc. And
of individuals, family groups and understand the needs of the community
environmental factors review of statistics. better.
Epidemiological and relevant studies:
individual and family health records: 1. ASSESSMENT
laboratory and screening test and - Used to establish a database
physical examinations of individuals. about the clients response to
health concerns or illness
 and the ability to manage OBSERVING - gathering data using the
health care needs. Involves five (5) senses; a conscious,
data collection, deliberate skill that is developed only
organization and validation. through effort and with on organized
- The assessment process approach.
involves the following steps
which are taken with the APPROACHES OF OBSERVATION
active participation of the  Noticing the stimuli
client/s especially in  Selecting, organizing, and
decisions made; interpreting data
 Sequence in observation
 Clinical signs of client distress
TYPES OF ASSESSMENT  Threats to the client's safety, real
or anticipated
A. INITIAL ASSESSMENT to establish  Presence and functioning of
a complete database for problem associated equipments
identification, reference, and future  Immediate environment, including
comparison I-R-F the people in it

B. FOCUS ASSESSMENT to determine INTERVIEWING - planned

the status of a specific problem communication or on conversation
identified in an earlier assessment, with a purpose, to give info, identify
identify new and overlooked problems. problem of mutual concern, evaluate
change, teach, provide counseling
C. EMERGENCY ASSESSMENT to and therapy.
identify life-threatening problems
APPROACHES IN INTERVIEWING
D. TIME-LAPSED ASSESSMENT to
compare the clients current status to 1. DIRECTIVE INTERVIEW tightly
baseline data previously obtained. structured and elicits specific
information, to gather
METHODS OF ASSESSMENT information in limited amount of
Methods will vary depending on the time.
learning outcome(s) to be measured.
 DIRECT METHODS are when 2. NONDIRECTIVE INTERVIEW
students demonstrate that they rapport building interview, the
have achieved a learning midwife allows the patient to
outcome or objective. control the purpose, subject
 INDIRECT METHODS are when matter, and pacing C-S-P
students (or others) report (problem solving, counseling and
perceptions of how well students performance appraisal.)
have achieved an objective or
outcome. EXAMINING - systematic data collection
that uses observational skills to detect
ASSESSMENT METHODS health problem
Head to toe assessment -  Relevant literature
CEPHALOCAUDAL
COLLECTION OF DATA
SCREENING EXAMINATION - brief - Relevant data are collected
review of essential functioning of various on the health status of the
parts or system family groups, and community
DATA COLLECTION
THE ASSESSMENT PROCESS C-O-V-
R - Is an important aspect at any
1. Collecting data type of research study.
2. Organizing data Inaccurate data collection can
3. Validating data impact the results of a study and
4. Recording data ultimately lead to invalid results.
- Methods for impact evaluation
1. COLLECTING DATA - process of vary along a continuum. At the
gathering information about the end of this continuum are
clients health status. quantitative methods and or other
end of the continuum are
DATABASE - all information about
qualitative methods for data
the client (history. Physical assessment,
results of laboratory and diagnostic tests) collection.
- Is define as the ongoing
TYPES OF DATA systematic collection, analysis
 SUBJECTIVE SYMPTOMS OR and interpretation of health data
COVERT DATA: are apparent necessary for designing,
only to the person affected and implementing, and evaluating
can be described or verified public health prevention
only by that person. programs.
 OBJECTIVE SIGNS OR OVERT - To develop effective prevention
DATA: are detectable by an strategies, countries need to
observer or can be tested improve their information.
against an accepted standard
METHODS OF DATA COLLECTION
SOURCES OF DATA
1. PRIMARY DATA – are those
PRIMARY: which are collecting for the first
 client time and are original in character.
2. SECONDARY DATA – are those
SECONDARY which have already been
 Family members collected by someone else and
 Other support person which have through some
 Other health professional statistical analysis.
 Records
 Reports
 Laboratories and
diagnostic analysis DEMOGRAPHIC DATA – vital health
statistics, community dynamic including
power structure, studies of dse Act of double checking or verifying data
surveillance, economic, cultural, to confirm that they are accurate and
environmental characteristics, utilization factual
of health services by the population and
on individuals and families: health status, Validation help the midwife to:
education, socio-cultural, religious and  Ensure that assessment
occupational background, family information is complete
dynamics, environment and patterns of  Obtain additional information that
coping may have been overlooked
 Differentiate between cues and
2. ORGANIZING DATA inferences
 Avoid jumping to conclusions and
Nursing conceptual models like Orem’s focusing in the wrong direction to
self-care model. Roy's adoption model, identify the problem.
functional health patterns
GUIDELINES IN VALIDATING DATA:
The use of models in midwives
provide midwife to focus on the role of Compare subjective and
midwives and its applications rather objective data to verify the clients
than medical practice. |n addition, it statement: with your observations.
helps patient care to be Systematic,
purposeful. Controlled and effective.  Clarity any vague statement
 Double check data that extremely
One of the commonly used abnormal
models in nursing is roy adaptation  Determine the presence of
model. According to roy adoptation factors that may interfere with
model. The aim of nursing is to increase accurate measurement.
compliance and life expectancy. Roy  Use references to explain
adaptation model evaluates the patient phenomena
in physiologic mode, self-concept mode.
Role function mode and
interdependence mode aiming to
provide holistic care. This article EPIDEMIOLOGY is the study of
describes the use of roy adoptation (scientific. Systematic. And data driven)
model in the care of a patient who has of the distribution (frequency. Pattern)
been diagnosed with breast cancer and and determinants (causes. Risk factors)
had breast-conserving surgery. Patient's of health-related states and events (not
data was evaluated in the four modes 0f just disease) in specified population
roy adaptation model [physiologic, self- (neighborhood. School, city. State,
concept, role function, and country. Global).
interdependence modes] and the
nursing process was applied. 4. RECORDING DATA

Accurate documentation is essential

3. VALIDATING DATA and should include all the data collected
about the client’s health status. Data is
recorded in a factual manner and not receive affordable and quality health
interpreted by a midwife. benefits. This involves providing
adequate resources health human
Family survey is designed to allow resources. Health facilities. And health
agencies to collect information about the financing.
families of enrolled children and analyze
the aggregated results throug charts UHC'S THREE THRUSTS
and graphs. Family surveys can be used
to collect information for any number of To attain UHC, three strategic
purposes, such as: family needs thrusts are 10 be pursued, namely:
assessment. 1) Financial risk protection
through expansion in
VISION enrollment and benefit
delivery of the notional
Filipinos are among the healthiest health insurance program
people in Southeast Asia by 2022, and (NHIP);
Asia by 2040 2) Improved access to quality
hospitals and health care
MISSION facilities; and
To lead the country in the 3) Attainment of health-
development of a productive, related millennium
resilient, equitable and people- development goals
centered health system. (MDGS).

UNIVERSAL HEALTH CARE 1. FINANCIAL RISK PROTECTION

UHC to address inequity in the Protection from the financial

health system impacts of health care is attained by
making any filipino eligible to enroll, to
UNIVERSAL HEALTH CARE AND ITS know their entitlements and
AIM responsibilities. To avail of health
Universal health care (uhc). Also services, and to be reimbursed by
referred to as kalusugan pangkalahatan Philhealth with regard to health care
(kp). Is the “provision to every Filipinos expenditures
of the highest possible quality of health
care that is accessible, efficient, Philhealth operations are to be
equitably distributed, adequately funded, redirected towards enhancing national
and fairly financed. And appropriately and regional health insurance system.
used by an informed and empowered The NHIP enrollment shall be rapidly
public. The Aquino administration puts it expanded to improve population
as the availability and accessibility of coverage. The availing of outpatient and
health services and necessities for all inpatient services shall be intensively
Filipinos. promoted. Moreover. The use of
information technology shall be
It is a government mandate maximized to speed up Philhealth
aiming to ensure that every Filipino shall claims processing.
 trends. As well as the prevention and
2. IMPROVED ACCESS TO QUALITY control of non- communicable diseases.
HOSPITALS AND HEALTH CARE
FACILITIES The organization of community
health teams (CHTs) in each priority
Improved access to quality population area is one way to achieve
hospitals and health facilities shall be health-related MDGS. CHTs are groups
achieved in a number of creative of volunteers, who will assist families
approaches. First, the quality of with their health needs. Provide health
government-owned and operated information. And facilitate
hospitals and health facilities is to be communication with other health
upgraded to accommodate larger providers. RNheals nurses will be
capacity. To attend to all types of trained to become trainers and
emergency. And to handle non- supervisors to coordinate with
communicable diseases. The health community level workers and chts by
faculty enhancement program (HFEP) the end of 2011, it is targeted that there
shall provide funds to improve facility will be 20 000 chts and 10.000 rnheals
preparedness for trauma and other
emergencies. The aim of HFEP was to Another effort will be the
upgrade 20% of DOH-retained hospital; provision of necessary services using
46% of provincial hospltals. 46% of the life cycle approach. These services
district hospitals and 51% of rural health include family planning. Ante-natal care,
units (RHUs) by end at 2011. delivery in health facilities, newborn care,
and the Garantisadong Pambata
Financial efforts shall be provided package.
to allow immediate rehabilitation and
construction of critical health facilities. In Better coordination among
addition to that, treatment packs for government agencies, such as DOH,
hypertension and diabetes shall be DEPED. DSWD, and DILG, would also
obtained and distributed to RHUs. be essential for the achievement of
these MDGS.
The DOH licensure and CATEGORIES OF HEALTH
Philhealth accreditation for hospitals and PROBLEMS
health facilities shall be streamlined and  Health deficits
unified.  Health threats
 Foreseeable crisis or
3. ATTAINMENT OF HEALTH- stress points
RELATED MDGS
The community health midwife
Further efforts and additional analyzes the data in accordance with
resources are to be applied on public the midwife conception of the source of
health programs to reduce maternal and the client’s problems and need that can
child mortality. Morbidity and mortality be met through midwife intervention.
from tuberculosis and malaria. And The midwife diagnosis are interpreted
incidence of hiv/aids. Localities shall be and validated with individuals. Member
prepared for the emerging disease of the community and family groups
concerned. Their capabilities and change which midwife intervention can
limitations to cope are identified. be expected to effect.

PLANNING MIDWIFE ACTIONS/ CARE

HEALTH DEFICIT The plan for midwife action or
Occurs when there is a gap care is based on the actual and potential
between actual and achievable health problems that were identified and
status. Exploration and evaluation of prioritize. Planning action include the
possible precursors of health deficits following steps;
such as history of repeated infections or
miscarriages are noted. No regular GOAL SETTING
health checkup is another example A goal is a declaration of purpose
or intent that gives essential direction to
HEALTH THREATS action. Specific objective of care are
Are conditions that promote made with the individual/family in terms
disease or injury and prevent people of activities of daily living and adaptive
from realizing their health potential. An functioning based on remaining
example of a health threat is when the capabilities resulting from this condition
population is inadequately immunized and capabilities to cope with stress
against preventable diseases. associated with his/her disease
condition or environment. This
FORESEEABLE objectives are stated in behavioral terms:
Crisis includes stressful specific, measurable, attainable, realistic
occurrences such as death or illness of and time-bounded. The midwife
a family member prioritize these objective.
A health need exist when there is a
health problem that can be alleviated S - Specific
with medical or social technology. M - Measurable
A - Attainable
A HEALTH PROBLEM is a situation in R - Realistic
which there is demonstrated health T - Time bounded
need combined with actual or potential
resources to apply remedial measures
and a commitment to act on the part of
the provider or the client 1. SET YOUR OBJECTIVE
• Before you begin writing
COMMUNITY HEALTH MIDWIFE questions for your survey, ask
PROCESS yourself and your team what
The process of assessment in your objective are.
community health midwife includes: • What do you want to learn?
intensive fact finding, the application of • How is this survey data going
professional judgment in estimating the to help us?
meaning and importance of these facts • What do our member want
to the family and the community, the from us?
availability of midwifes resources that • How do members feel about
can be provided, and the degree of the community? What do they
love and what do they change.
 • How can we provide a better survey, your goal is to
experience for the community? keep it as short as
• Make assumption about the possible for members. If
answer you expect to see. you’re asking questions
And write survey questions that is not relevant to the
that will either confirm or member, don’t ask it. You
reject your assumptions. For will waste your
the re-launch of participant’s time, and risk
smiley360.com we focus on not receiving any
what features our user spent responses at all.
the most and least time on.
What new features they
wanted us to introduce next
and how they felt about the Community health team.pdf
design and the layout, text
content ease of time use of
the website. LAWS AFFECTING PUBLIC HEALTH
• In your community, you might
run a survey to define or
redefine your community R.A 7160 (LOCAL GOVERNMENT
guidelines, validate an idea CODE) – the local government, the
you’ve thinking of launching, responsibility for the delivery of basic
or simply measure satisfaction services and facilities of the national
and utility of the community. government has been transferred to
the local government.

2. WRITE YOUR SURVEY R.A 1082 – the first Rural Health Act,
QUESTIONS called for the employment of more
• There are number of physicians, dentist, nurses, midwife and
things to keep in mind to sanitary inspector.
ensure that your survey is
easy for your members to P.D 651 – requires that all health
complete, and gives you workers shall identify and encourage the
the most useful results. registration of all births within 30
• Watch out for bias days following delivery.
• Unless you have a survey
professional at your P.D 996 – require the compulsory
disposal who knows what immunization of all children below 8
she’s doing, be extra years of age against the 6 childhood
careful when writing your communicable diseases.
questions so that survey
questions do not lead P.D 965 – requires applications for
members to answer in any marriage license to received
particular way. instruction on family planning and
• You might be tempted to responsible parenthood.
write: when writing a
R.A 7305 – known as magna carta or
public health workers. This act aims to
promote the social and economic well-
being of health workers.

Two Levels of Primary Health Care

Workers

1. Barangay Health Workers -

trained community health workers
or health auxiliary volunteers or
traditional birth attendants or
healers.
2. Intermediate level health
workers- include the Public
Health Nurse, Rural Sanitary
Inspector and midwives.
  These are the list of the ten (10) medicinal plants that the Philippine Department
of Health (DOH) through its "Traditional Health Program" has endorsed. All ten
(10) herbs have been thoroughly tested and have been clinically proven to have
medicinal value in the relief and treatment of various aliments:
Herbal Medicine Plants Approved by the DOH

Uses & Preparation:

Asthma, Cough & Fever - Decoction ( Boil raw fruits or
leaves in 2 glasses of water for 15 minutes)Dysentery,
Colds & Pain - Decoction ( Boil a handful of leaves &
flowers in water to produce a glass, three times a day)
Skin diseases (dermatitis, scabies, ulcer, eczema) -
Wash & clean the skin/wound with the decoction
Headache - Crush leaves may be applied on the
forehead
Plant Name: Rheumatism, sprain, contusions, insect bites -
Lagundi (Vitex Pound the leaves and apply on affected area
negundo)

Uses & Preparation:

Pain (headache, stomachache) - Boil chopped leaves in 2
glasses of water for 15 minutes. Divide decoction into 2
parts, drink one part every 3 hours.
Rheumatism, arthritis and headache - Crush the fresh
leaves and squeeze sap. Massage sap on painful parts with
eucalyptus
Cough & Cold - Soak 10 fresh leaves in a glass of hot
Plant Name: water, drink as tea. (expectorant)
Yerba (Hierba ) Swollen gums - Steep 6 g. of fresh plant in a glass of
Buena (Mentha boiling water for 30 minutes. Use as a gargle solution
cordifelia) Toothache - Cut fresh plant and squeeze sap. Soak a piece
of cotton in the sap and insert this in aching tooth cavity
Menstrual & gas pain - Soak a handful of leaves in a lass
of boiling water. Drink infusion.
Nausea & Fainting - Crush leaves and apply at nostrils of
patients
Insect bites - Crush leaves and apply juice on affected area
or pound leaves until like a paste, rub on affected area
Pruritis - Boil plant alone or with eucalyptus in water. Use
decoction as a wash on affected area.
 Uses & Preparation:
Anti-edema, diuretic, anti-urolithiasis -
Boil chopped leaves in a glass of
water for 15 minutes until one glassful
remains. Divide decoction into 3 parts, drink
one part 3 times a day.
Plant Name:
Diarrhea - Chopped leaves and boil in
Sambong (Blumea
a glass of water for 15 minutes. Drink one
balsamifera)
part every 3 hours.

Uses & Preparation:

Diarrhea - Boil chopped leaves into 2 glasses of water
for 15 minutes. Divide decoction into 4 parts. Drink 1 part
every 3 hours
Stomachache - Boil chopped leaves in 1 glass of
Plant Name: water for 15 minutes. Cool and strain.
Tsaang
Gubat (Carmona
retusa)

Uses & Preparation:

Anti-helmintic - The seeds are taken 2 hours after supper.
If no worms are expelled, the dose may be repeated after
one week. (Caution: Not to be given to children below 4
years old)

Plant Name:
Niyug-
niyogan (Quisqualis
indica L.)

Uses & Preparation:

For washing wounds - Maybe use twice a day
Diarrhea - May be taken 3-4 times a day
As gargle and for toothache - Warm decoction is used
for gargle. Freshly pounded leaves are used for
toothache. Boil chopped leaves for 15 minutes at low fire.
Plant Name: Do not cover and then let it cool and strain
Bayabas/Guava (Psidium
guajava L.)
 Uses & Preparation:
Anti-fungal (tinea flava, ringworm, athlete’s
foot and scabies) - Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2
times a day

Plant Name:
Akapulko (Cassia
alata L.)

Uses & Preparation:

Lowers uric acid (rheumatism and gout) - One a half cup
leaves are boiled in two glass of water over low fire. Do not
cover pot. Divide into 3 parts and drink one part 3 times a
day

Plant Name:
Ulasimang
Bato(Peperonica
pellucida)

Uses & Preparation:

Hypertension - Maybe fried, roasted, soaked in
vinegar for 30 minutes, or blanched in boiled water
for 15 minutes. Take 2 pieces 3 times a day after
meals.
Toothache - Pound a small piece and apply to
affected area
Plant Name:
Bawang (Allium
sativum)

Uses & Preparation:

Diabetes Mellitus (Mild non-insulin dependent) -
Chopped leaves then boil in a glass of water for 15
minutes. Do not cover. Cool and strain. Take 1/3 cup 3
times a day after meals

Plant Name
Ampalaya (Mamordica
Charantia)
Reminders on the Use of Herbal rendered services to this particular px or
Medicine family.
1. Avoid the use of insecticide as 3. Planning should revolve around the
these may leave poison on plants. essential needs of the individual and
2. In the preparation of herbal his/her family but priority should be
medicine, use a clay pot and given to those needs recognized by the
remove cover while boiling at low family itself.
heat. 4. Planning of a continuing care should
3. Use only part of the plant being involve the individual and his/her family.
advocated. 5. Planning should be flexible and
4. Follow accurate dose of practical.
suggested preparation.
5. Use only one kind of herbal plant FACTORS TO BE CONSIDERED IN
for each type of symptoms or DETERMINING THE FREQUENCY OF
sickness. HOME VISIT
6. Stop giving the herbal medication
in case untoward reaction such There is no definite rule as to frequency
as allergy occurs. of a home visit. Since the population in a
7. If signs and symptoms are not given community is much more than
relieved after 2 to 3 doses of what the midwife can handle,
herbal medication, consult a prioritization of needs for a home visit is
doctor. necessary.
The frequency of home visit should take
into consideration the following factors:
 The physical, physiological, and
HOME VISIT – a professional face to educational needs of the
face contact made by a midwife to the individual and family
patient or the family to provide  The acceptance of the family for
necessary health care activities and to the services offered, the
further attain an objective of the agency. willingness and interest to
It is made to the client or to a cooperate.
responsible member of the family.  Take into account other health
agencies and number of health
PRINCIPLES IN PREPARING FOR A personnel already involved in the
HOME VISIT care of a specific family.
 The policy of a given agency and
Planning for a home visit is an essential the emphasis placed on a given
tool in achieving best results. health program.
1. A home visit should have a purpose  A careful evaluation of past
or objective. services given to a family and
2. Planning for a home visit should how this family made use of such
make use of all available information nursing services
about the px and his/her family through  The ability of the px and his/her
family health records, knowledge of the family to recognize their own
health center personnel, including those needs, their knowledge of
from other agencies that may have available resources and their
 abilities to use these resources The public health bag is an essential
on their own accord. and indispensable equipment of a public
health nurse which she has to carry
STEPS IN HOME VISIT along during her home visits. It contains
1. Greet the client or household member basic medication and articles which are
and introduce yourself necessary for giving care.
2. Explain purpose of home visit.
3. Inquire about health and welfare of Principles
client/px and the other family members. Performing the bag technique will
Ask about any health and health-related minimize, if not, prevent the spread of
problems. any infection.
4. Place bag in a convenient place It saves time and effort in the
before doing bag technique. performance of nursing procedures.
5. Wash hands and wear apron and put The bag technique can be performed in
out needed articles and/or medicine, a variety of ways depending on the
dressings form bag. agency’s policy, the home situation, or
6. Perform physical assessment and as long as principles of avoiding transfer
midwifery care needed. If more than one of infection is always observed.
member of the family is for health
supervision and care, start with the well Contents
member to avoid transfer of infection. The following are the contents of a
7. Give the necessary health teaching Public Health Nurse bag:
and advice based on client’s px need  Paper lining
and condition. If px is weak or too  Extra paper for making bag
indisposed on a for waste materials (paper
8. Wash hands and close bag. bag)
9. Record findings and midwifery care  Plastic/linen lining
given.  Apron
10. Make appointment either for a clinic  Hand towel in plastic bag
or home visit.  Soap in a soap dish
11. On succeeding home visit and when  Thermometers in case (oral
midwife has gained the family’s trust and rectal)
and confidence, she/he may look into
 2 pairs of scissors (surgical
more detailed aspects of the household
and bandage)
and surroundings and other health
 2 pairs of forceps (curved and
problems/concerns.
straight)
 syringes (5ml and 2ml)
The bag technique is a tool by which  Hypodermic needles (g. 19,
the nurse, during her visit will enable her 22, 23, 25)
to perform a nursing procedure with  Sterile dressings (OS,C.B)
ease and deftness, to save time and  Sterile Cord Tie
effort with the end view of rendering  Adhesive plaster
effective nursing care to clients.
 Cotton balls
 Cord clamp
  Micropore plaster
 Tape measure
 1 pair of sterile gloves
 Baby’s scale
 Alcohol lamp
 2 test tubes
 Test tube holders
 Solutions of:
 Betadine
 70% alcohol
 Zephiran solution
 Hydrogen peroxide
 Spirit of ammnonia
 Ophthalmic ointment
 Acetic acid
 Benedict’s solution
 *BP apparatus and
stethoscope are carried
separately and are never
placed in the bag.

Points to consider
1. The bag should contain all the
necessary articles, supplies and
equipment that will be used to
answer the emergency needs
2. The bag and its contents should
be cleaned very often, the
supplies replaced and ready for
use anytime.
3. The bag and its contents should
be well protected from contact
with any article in the patient’s
home.
4. Consider the bag and its contents
clean and sterile, while articles
that belong to the patients as
dirty and contaminated.
5. The arrangement of the contents
of the bag should be the one
most convenient to the user, to Steps
facilitate efficiency and avoid The following are steps in performing
confusion. bag technique and rationale for each
action:
Action Rationale

Upon arrival at the patient’s home, place the bag on the table To protect the bag from getting
lined with a clean paper. The clean side must be out and the contaminated.
folder part, touching the table

Ask for a basin of water or a glass of drinking water if tap To be used for hand washing.
waster is not available.

Open the bag and take out the towel and soap. To prepare for hand washing.

Wash hands using soap and water, wipe to dry. To prevent infection from the care
provider to the client.

Take out the apron from the bag and put it on with the right To protect the nurse’s uniform.
side

Put out all the necessary articles needed for the specific care. To have them readily accessible

Close the bag and put it in one corner of the working area To prevent contamination

Proceed in performing the necessary nursing care treatment. To give comfort and security and
hasten recovery

After giving the treatment, clean all things that were used and To protect the caregiver and
perform hand washing. prevent infection

Open the bag and return all things that were used in their
proper places after cleaning them.

Remove apron, folding it away from the person, the soiled Remove apron, folding it away
side in and the clean side out. from the person, the soiled side in
and the clean side out. Place it in
the bag.

Fold the lining, place it inside the bag and close the bag

Take the record and have a talk with the mother. Write down
all the necessary data that were gathered, observations,
nursing care and treatment rendered. Give instructions for
care of patients in the absence of the nurse.

Make appointment for the next visit (either home or clinic) For follow-up care
taking note of the date and time.
Laws Affecting Public Health and
Practice of CHN  R.A. 2382 – Philippine Medical
Act.- This act defines the practice
of medicine in the country.
R.A. 7160 – or the Local Government  R.A. 1082 – Rural Health Act.- It
Code created the 1st 81 Rural Health
This involves the devolution of powers, Units. amended by RA 1891;
functions and responsibilities to the local more physicians, dentists, nurses,
government both rural & urban. The midwives and sanitary inspectors
Code aims to transform local will live in the rural areas where
government units into self-reliant they are assigned in order to
communities and active partners in the raise the health conditions of
attainment of national goals thru’ a more barrio people ,hence help
responsive and accountable local decrease the high incidence of
government structure instituted thru’ a preventable diseases
system of decentralization. Hence, each  R.A. 6425 – Dangerous Drugs
province, city and municipality has a Act- It stipulates that the sale,
LOCAL HEALTH BOARD (LHB) which administration, delivery,
is mandated to propose annual distribution and transportation of
budgetary allocations for the operation prohibited drugs is punishable by
and maintenance of their own health law.
facilities.  R.A. 9165 – the new Dangerous
Drug Act of 2002
Composition of LHB  P.D. No. 651- Requires that all
 Provincial Level health workers shall identify and
 Governor- chair encourage the registration of all
 Provincial Health Officer – vice births within 30 days following
chairman delivery.
 Chairman, Committee on Health  P.D. No. 996- Requires the
of Sangguniang Panlalawigan compulsory immunization of all
 DOH representative children below 8 yrs. of age
 NGO representative against the 6 childhood
 City and Municipal Level immunizable diseases.
 Mayor – chair  P.D. No. 825- Provides penalty
 MHO – vice chair for improper disposal of garbage.
 Chairman, Committee on Health  R.A. 8749 – Clean Air Act of
of Sangguniang Bayan 2000
 DOH representative  P.D. No. 856 – Code on
 NGO representative Sanitation. It provides for the
control of all factors in man’s
Effective Local Health System environment that affect health
Depends on: including the quality of water,
 The LGU’s financial capability food, milk, insects, animal
 A dynamic and responsive carriers, transmitters of disease,
political leadership sanitary and recreation facilities,
 Community empowerment
 noise, pollution and control of receive instructions on family
nuisance planning and responsible
 R.A 6758- Standardizes the parenthood.
salary of government employees  P.D. NO. 79- Defines, objectives,
including the nursing personnel. duties and functions of POPCOM
 R.A. 6675 – Generics Act of  RA 4073- advocates home
1988. Which promotes, requires treatment for leprosy
and ensures the production of an  Letter of Instruction No. 949 -
adequate supply, distribution, use legal basis of PHC dated OCT.
and acceptance of drugs and 19, 1979
medicines identified by their promotes development of health
generic name. programs on the community level
 R.A. 6713 – Code of Conduct  RA 3573- requires reporting of all
and Ethical Standards of cases of communicable diseases
Public Officials and Employees and administration of prophylaxis
It is the policy of the state to  Ministry Circular No. 2 of 1986-
promote high standards of ethics includes AIDS as notifiable
in public office. Public officials disease
and employees shall at all times  R.A. 7875 – National Health
be accountable to the people and Insurance Act
shall discharges their duties with  R.A. 7432 – Senior Citizens Act
utmost responsibility, integrity,  R. A. 7719 – National Blood
competence and loyalty, act with Services Act
patriotism and justice, lead  R.A. 8172 – Salt Iodization Act
modest lives uphold public (ASIN LAW)
interest over personal interest.  R.A. 7277- Magna Carta for
 R.A. 7305 – Magna Carta for PWD’s, provides their
Public Health Workers rehabilitation, self development
This act aims: to promote and and self-reliance and integration
improve the social and economic into the mainstream of society
well-being of health workers, their  O. No. 2005-0014- National
living and working conditions and Policies on Infant and Young
terms of employment; to develop Child Feeding:.All newborns be
their skills and capabilities in breastfeed within 1 hr after birth
order that they will be more Infants be exclusively
responsive and better equipped breastfeed for 6 months.
to deliver health projects and Infants be given timely,
programs; and to encourage adequate and safe
those with proper qualifications complementary foods
and excellent abilities to join and Breastfeeding be continued
remain in government service. up to 2 years and beyond
 R.A. 8423 -Created the Philippine  EO 51- Phil. Code of Marketing of
Institute of Traditional and Breast milk Substitutes
Alternative Health Care.
 R.A. – 7600 – Rooming In and
 P.D. No. 965- Requires Breastfeeding Act of 1992
applicants for marriage license to
 R.A. 8976- Food Fortification Law
  R.A. 8980 - promulgates a 1. Active community participation
comprehensive policy and a 2. Intra-intersectoral linkage
national system for ECCD 3. Use of appropriate technology
 A.O. No. 2006- 0015- defines the 4. Support mechanism
Implementing guidelines on
Hepatitis B Immunization for Level of healthcare services
Infants
 R.A. 7846 -mandates PHC delivery system
Compulsory Hepatitis B
Immunization among infants and Primary, secondary, tertiary
children less than 8 yrs old
 R.A. 2029- mandates Liver Two Levels of Primary Health Care
Cancer and Hepatitis B Workers
Awareness Month Act (February)
 A.O. No. 2006-0012 - specifies 3. Barangay Health Workers -
the Revised Implementing Rules trained community health workers
and Regulations of E.O. 51 or or health auxiliary volunteers or
Milk Code, Relevant International traditional birth attendants or
Agreements, Penalizing healers.
Violations thereof and for other 4. Intermediate level health
purposes. workers- include the Public
Health Nurse, Rural Sanitary
Inspector and midwives.
STRATEGIES OF Development PHC
Traditional and healthcare practice
- Reorganization - Herbal medicine
- Preparation in primary levels
- Mobilization of people to know Maternal and child health nursing
communities
- Teach self- reliance and - Mother and infant
determination - Ensure expectant mother
- Utilization of appropriate maintains good health
technology focusing on - Take care of child
indigenous resources - Normal delivery and healthy
- Arising from health needs children
- Increase opportunities in local - Care of pregnant, safe delivery,
level planning postnatal care, examination,
- Dev’t of intrasectoral linkages lactation
- Emphasizing partnership not just - Guidance of parents for infertility
provider and receiver - and family planning
cooperation - Every child must be given love
and security, healthy surrounding,
Framework of meeting – organizational proper nutrition, health
strategy supervision, born well, safe
delivery
4 cornerstone or pillars of PHC
 - Pregnancy, labor, and delivery, - Referral system
puerperium is a continuum of life
cycle. Nursing care during pregnancy
- Personal, cultural, religious, and - RHU, BHS have the masterlist of
attitudes are unique characteristic pregnant in catchment area
and attitude with unique - HBMR (home based mother
experiences record)
- MCHN is family centered - Detect risk factor and danger
(emphasizes importance of father) signs
- 2.3 M Filipino women get - TBA may provide prenatal visit
pregnant, 2 M birth/yr, 1993 using HBMR because they have
motherhood survey the authority and capacity
- NSMS perinatal mortality (27.1%)
per births 3 prenatal visits
- Maternal mortality (179.74%) per 1. During 1st trimester
1000 live births 2. 2nd trimester
- Maternal death due to 3. 3rd – 3 or more visits
hemorrhage, hypertensive
complication, sepsis Standard Physical Examination
- lack of accessibility to facility - weight, height, bp, eyes
- Infant and child mortality declined examination, palm of hands,
57 per 1000 births to 49 per 1000 abdominal exam, fundic height,
(1995) position, presentation, FHT, face,
- common problem infants: hands, lower extremities, breast,
diarrhea, acute respiratory neck
infection(infant) - History taking, Tt, iron, lab exam
- measles (risk for non- immunized) RH incompatibility management–
phototherapy
Maternal care – prenatal 5th months to 2 months postpartum –
- Objective: to reach all pregnant iron supplementation 100 to 200mg
women through sufficient care for daily 210 days (per orem)
healthy pregnancy and full term - For Goiter, 1 iodized oil capsule
baby - Malaria prophylaxis
- Special care for high risk mother chloroquine( 150 mg) 2 tabs per
(tagging record as HR meaning week
highly risk)with red ink
Preparation for delivery
Initial evaluation and screening are 1. 1st stage
classified: - medical handwashing (with soap
and water)
1. Normal patient – health - Prepare room and bed.
instruction, counseling, advise - Explain course of labor and
prenatal procedure.
2. Patient with serious or - Abdominal palpation
potential serious complication - Listen to FHT (normal FHT 120-
3. Patient with mild complication 160 bpm)
 - Take blood pressure, - Put baby to breast for sucking
temperature, pulse, exam for reflex
edema, vulva(bleeding or - Place baby in blanket to prevent
bulging), intensity and interval of hypothermia.
contractions - Check for trauma and
- Make sure to empty bladder. malformations.
- Place Kelly pad under buttocks, - Take and record weight
and give enema. (anthropometric measurements)
- Advise not to eat more (soft diet length from sole to head
during labor). - Head, chest, abdomen, weight,
- Waist to knee (if not able to take body temperature
bath) but advise the woman to - Rooming in, kangaroo mother
take a bath first. care
- Breastfeeding (tummy to tummy)
2. 2nd stage - Dress cord (75% rubbing alcohol
- Cleansing of vulva. in between cord and genitalia 2x
- Put mask and gown or apron, a day)
googles, rubber gloves - Vernix caseosa regulate
- Clean dressing towel. temperature.
- Advise woman in bearing down - Dress baby to keep warm.
slowly to avoid sudden expulsion - Don’t forget to record the time of
of head and have lacerations. delivery.
- Fundal pressure is discouraged. - Apgar scoring (heart rate,
- Support perineum by a cloth to respiratory effort, muscle tone,
prevent lacerations or tears. reflex, irritability and color) 0,1,2
- Clamp the cord. - For Hemorrhage, manual
- Wipe mouth, nose, and throat. compression left hand fundus to
- 30 mins massage abdomen. vagina to stop bleeding. Put ice
pack and massage fundus.
3. 3rd stage of labor - HR hospitalized (More than
- Place placenta in kidney basin gravida 4, PPH, medical illness,
against perineum hypertensive, cephalopelvic
disproportion, placenta previa,
Signs of placental separation: placenta abruptio, multifetal
- Lengthening of cord pregnancy, myomectomy
- Gushing of blood (hospital)
- Raising of fundus

After delivery: Nursing care after delivery

- Check for amount of blood loss, - Cut and clamp cord with umbilical
hemorrhage 1hr after. scissors.
- Clamp with 2 clamps, wait for - Uterus is contracted and hard.
cord pulsations to stop. - Check blood pressure and pulse.
- Wipe eyes with cloth. - Check Placenta if completed,
laceration along birth canal.
 - Check reflexes, congenital
defects, v/s of baby
- Birth certificate is signed.
- Growth monitoring chart
- Apply tetracycline ophthalmic
ointment by separating inner to
outer canthus.
- Physical examination in Immunization
abnormalities, 2.5 kg low birth
weight, premature EPI – Expanded program on
- Recording and reporting ITR, Immunization
TCL (Submitted to FHS central - Launched on July 1976 by DOH,
office) in cooperation with WHO ande
UNICEF

Risk factors in pregnancy Objective of EPI: to reduce morbidity

 Age under 18 or more 35 y/o and mortality among infants and
 Height less than 4 ft children from 6 childhood immunizable
 History of cesarean delivery, diseases
postpartum hemorrhage
 History of Tb, heart disease,
Principles of EPI
diabetes mellitus, goiter, abortion,
Epidemiological situation
stillbirth
Schedules based on occurrence
Basis of health service integrated to
health services
Breastfeeding – for 6 months
RHU distribution of immunization
Physical and psychological benefits
Private facilities
- Complete food for infant
- Strengthens immune system Elements of EPI
- Reduce exposure to infection
 Target setting
Benefits to Mother – reduce risk of
 Cold chain logistic management
blood loss after birth
 ICE (Information, education,
- Natural methods of delaying
communication )
pregnancy or family planning
 Assessment and evaluation of
- Reduce risk of cancer and
program’s overall performance
osteoporosis
 Surveillance studies and
Benefits to Household in Community research
– conserve funds
Legal basis on EPI

 PD 996 (September 16, 1976) –

provdiing for compulsory basic
 immunization for infants and
children below 8 yrs of age
 PP 6 (April 3, 1986) –
implementing UN goal on
Universal child immunization by
1990
 PP 46 (September 16, 1992) –
reaffirming the commitment of
Philippines to Universal child and
mother immunization goal of the
WH assembly
 PP 147 (March 3, 1993) –
declaring April 21 and May 19,
1993 in every third Wednesday of
January and February thereafter
for 2 yrs as National
immunization days
 RA 7846 (December 30, 1994) -
requiring compulsory
immunization against hepa b for
infants and children below 8 y/o
 PP 773 (March 28, 1996) –
declaring April 17 and March
15,1996 in every 3rd Wednesday
of April and May 1996 to 2000 as
“knock out polio days”
 PP 1066 (August 26, 1997)-
declaring a national neonatal
tetanus elimination campaign
starting 1997;
 PP 1064 (August 27, 1997)
enjoining all sectors of society to
participate in the acute flaccid
paralysis AFP surveillance
component of polio eradication
campaign of Philippines
 PP 4 (July 29,1998) declaring
period from September 16 –
October 14,1998 as the Ligtas
Tigdas month and launching
Philippine Measles elimination
campaign
Routine immunization schedule

Vaccine Minimum age Number of Minimum Reasons

at first dose doses interval
between
doses
BCG birth or any 1 dose given at the
time after birth earliest
possible age to
protect against
possibility of
infections form
other family
members
DPT 6 wks (1 ½ 3 doses 4 weeks reduce chance
mos) of severe
pertussis
OPV 6 wks 3 doses 4 weeks extend of
protection
against polio
Hepa B 6 wks 3 doses 4 weeks reduce chance
of being
infected in
becoming a
carrier
Measles 9 mos 1 dose 80 % can be
prevented

School Entrance

BCG – all school both public and private regardless presence of BCG scar

Tetanus toxoid immunization

Vaccine Minimum age Percent protected Duration of

interval protection
TT1 as early as possible 80%
during pregnancy
TT2 atleast 4 wks later 80%  protection
from
neonatal
tetanus
 gives 3 yr
protection
 from mother
TT3 6 mos. later 90%  3 yrs,
neonatal
tetanus
 gives 5 yrs
protection
TT4 at least 1 yr 99%  10 yrs
protection
TT5 atleast 1 yr later 99%  lifetime
protection for
the mother
 all infants are
protected

- Counseling
DPT – TT1, TT2 - Communicate hunger ( pass, put
Pregnancy - TT3, TT4, TT5 a finger in mouth, sucking
movement)
Growth and devt birth to 6 yrs - Do not give cow’s or goat’s milk,
Physical nad motor devt cereal or extra drinks (Not
2mos, 3 mos, enough vitamin a, allergies,
difficulty in digesting animal milk)
IMCI (Integrated Management of Child - Giving other reduces breastmilk
Illness) – how to treat the sick child and taken and produces
teach mother to continue treatment at
home, return for immediate care
- Assess child feeding, identify Advantage of breastfeeding –
feeding problems, assessing nutrients needed by infants, provide all
child care for development water an infant needs, protects against
infection
Increase fluids, when to return for follow Less likely to get diarrhea, pneumonia,
up visit, give relevant advise using diabetes, ear infection
communication skills, using mother card, Contents of breastmilk - Protein, facts,
feeding recommendation lactose (special milk sugar), vitamin A,
C iron (easily absorbed)
Feeding recommendation – Essential fatty acids – for growing
appropriate sick and healthy brain, eyes, blood vessels; is not
- Birth up to 6 mos of age – available in other milk
exclusive breastfeeding day and
night (8 times in 24 hrs), No Benefits to Mothers
water or other fluids - Helps to develop close loving
- Good nutrition – good health relationship
- Improve child growth - Look at baby’s face and gentle
- With exemption of medicines, massage
vitamins if needed - Protects mother’s health
 - Helps uterus return to previous  Animal foods to help become
size strong and lively.
- Prevents bleeding and anemia,  Peas, beans, nuts, dark green
ovarian cancer, breast cancer leaves and orange foods helps
- Additional health to build self healthy eyes and fewer infection
confidence  3 meals and snack and variety of
foods
 Encourage to drink and eat
Feeding Recommendation for 6-12 during illness to recover quickly.
mos
Feeding recommendation for 12 mos
- Breastfeeding as child wants to 2 yrs old
- Adequate lugaw, fish, chicken,
dilis, egg yolk, 3x/day, 5x/day if
not breastfeeding Breastfeeding longer
- Small chewable items to eat with Replace with oreasol, yogurt, semisolid
fingers foods
- After 6 mos. Can’t meet energy No condensed milk
needs, need complimentary Persistent diarrhea because of difficulty
foods which is source of energy, milk digestion
nutrient rich, and locally
affordable
- Cereals with milk, fruits, veg,
milk,eggs, fish (3x daily)
- Gently encouraging to eat with
adequate serving
- Smiling, offering extra bite, no to
threatening or forcing to eat

Good complimentary foods – energy

rich, nutrient rich, locally affordable
6 mos – 1 food at a time for 3 days
 Lugaw – boiled family rice ½
tablespoon boiling water
 Mashed vegetables – squash,
bulanglang, potato, munggo,
unseasoned mixed with lugaw
 Boiled flake fish – sinigang,
tinola, kusido
 Ripe fruits – banana mash, dilis
toasted pulverized, margarin

Key messages
 2yrs grow strong and healthy
 Starting other foods help grow
well