Community

▪ a group of people with common characteristics or interests living together within a

territory or geographical boundary
▪ place where people under usual conditions are found
▪ Derived from a latin word “comunicas” which means a group of people.
Health
▪ OLOF (Optimum Level of Functioning)
▪ Health-illness continuum
▪ High-level wellness
▪ Agent-host-environment
▪ Health belief
▪ Evolutionary-based
▪ Health promotion
▪ WHO definition
Community Health
▪ Part of paramedical and medical intervention/approach which is concerned on the
health of the whole population
Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
Nursing
▪ Both profession & a vocation. Assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness
Community Health Nursing
▪ “The utilization of the nursing process in the different levels of clientele-individuals,
families, population groups and communities, concerned with the promotion of
health, prevention of disease and disability and rehabilitation.” ( Maglaya, et al)
▪ Goal: “To raise the level of citizenry by helping communities and families to cope
with the discontinuities in and threats to health in such a way as to maximize their
potential for high-level wellness” ( Nisce, et al)
▪ Special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health program
for the promotion of health, the improvement of the conditions in the social and
physical environment, rehabilitation of illness and disability ( WHO Expert
Committee of Nursing)
▪ A learned practice discipline with the ultimate goal of contributing as individuals
and in collaboration with others to the promotion of the client’s optimum level of
functioning thru’ teaching and delivery of care (Jacobson)
▪ A service rendered by a professional nurse to IFCs, population groups in health
centers, clinics, schools , workplace for the promotion of health, prevention of
illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)
Public Health
▪ “Public Health is directed towards assisting every citizen to realize his birth rights
and longevity.”“The science and art of preventing disease, prolonging life and
efficiency through organized community effort for:
 1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and
preventive treatment of disease
5. The development of a social machinery to ensure every one a standard of living,
adequate for maintenance of health to enable every citizen to realize his birth right of
health and longevity (Dr. C.E Winslow)
Mission of CHN
▪ Health Promotion
▪ Health Protection
▪ Health Balance
▪ Disease prevention
▪ Social Justice
Philosophy of CHN
▪ “The philosophy of CHN is based on the worth and dignity on the worth and dignity
of man.”(Dr. M. Shetland)
Basic Principles of CHN
1. The community is the patient in CHN, the family is the unit of care and there
are four levels of clientele: individual, family, population group (those who share
common characteristics, developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of
care
3. CHN practice is affected by developments in health technology, in particular,
changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Roles of the PUBLIC HEALTH NURSE

▪ Clinician, who is a health care provider, taking care of the sick people at home or in
the RHU
▪ Health Educator, who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
▪ Facilitator, who establishes multi-sectoral linkages by referral system
▪ Supervisor, who monitors and supervises the performance of midwives
▪ Health Advocator, who speaks on behalf of the client
▪ Advocator, who act on behalf of the client
▪ Collaborator, who working with other health team member
*In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions
or is not available, the Public Health Nurse will take charge of the MHO’s responsibilities.

Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Regulations of
RA 7164 (Philippine Nursing Act of 1991) includes:
 ▪ Supervision and care of women during pregnancy, labor and puerperium
▪ Performance of internal examination and delivery of babies
▪ Suturing lacerations in the absence of a physician
▪ Provision of first aid measures and emergency care
▪ Recommending herbal and symptomatic meds…etc.
In the care of the families:
▪ Provision of primary health care services
▪ Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
▪ Community organizing mobilization, community development and people
empowerment
▪ Case finding and epidemiological investigation
▪ Program planning, implementation and evaluation
▪ Influencing executive and legislative individuals or bodies concerning health and
development
Responsibilities of CHN

▪ be a part in developing an overall health plan, its implementation and evaluation for
communities
▪ provide quality nursing services to the three levels of clientele
▪ maintain coordination/linkages with other health team members, NGO/government
agencies in the provision of public health services
▪ conduct researches relevant to CHN services to improve provision of health care
▪ provide opportunities for professional growth and continuing education for staff
development
Standards in CHN

1. Theory
▪ Applies theoretical concepts as basis for decisions in practice
2. Data Collection
▪ Gathers comprehensive, accurate data systematically
3. Diagnosis
▪ Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
▪ At each level of prevention, develops plans that specify nursing actions
unique to needs of clients
5. Intervention
▪ Guided by the plan, intervenes to promote, maintain or restore health,
prevent illness and institute rehabilitation
6. Evaluation
▪ Evaluates responses of clients to interventions to note progress toward
goal achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
▪ Participates in peer review and other means of evaluation to assure
quality of nursing practice
▪ Assumes professional development
 ▪ Contributes to development of others
8. Interdisciplinary Collaboration
▪ Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and
evaluating programs for community health
9. Research
▪ Indulges in research to contribute to theory and practice in community
health nursing
Reference:
Community Health Nursing
Ms. Adel Morong R.N., M.S.N.

Definitions of COPAR

▪ A social development approach that aims to transform the apathetic, individualistic

and voiceless poor into dynamic, participatory and politically responsive

community.
▪ A collective, participatory, transformative, liberative, sustained and systematic
process of building people’s organizations by mobilizing and enhancing the
capabilities and resources of the people for the resolution of their issues and
concerns towards effecting change in their existing oppressive and exploitative
conditions (1994 National Rural Conference)
▪ A process by which a community identifies its needs and objectives, develops
confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community (Ross 1967)
▪ A continuous and sustained process of educating the people to understand and
develop their critical awareness of their existing condition, working with the people
collectively and efficiently on their immediate and long-term problems, and
 mobilizing the people to develop their capability and readiness to respond and take
action on their immediate needs towards solving their long-term problems (CO: A
manual of experience, PCPD)
Importance of COPAR

1. COPAR is an important tool for community development and people empowerment

as this helps the community workers to generate community participation in
development activities.
2. COPAR prepares people/clients to eventually take over the management of a
development programs in the future.
3. COPAR maximizes community participation and involvement; community resources
are mobilized for community services.
Principles of COPAR

1. People, especially the most oppressed, exploited and deprived sectors are open to
change, have the capacity to change and are able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of society
3. COPAR should lead to a self-reliant community and society.
COPAR Process
▪A progressive cycle of action-reflection action which begins with small, local and
concrete issues identified by the people and the evaluation and the reflection of and
on the action taken by them.
▪ Consciousness through experimental learning central to the COPAR process because
it places emphasis on learning that emerges from concrete action and which enriches
succeeding action.
▪ COPAR is participatory and mass-based because it is primarily directed towards and
biased in favor of the poor, the powerless and oppressed.
▪ COPAR is group-centered and not leader-oriented. Leaders are identified, emerge
and are tested through action rather than appointed or selected by some external
force or entity.
COPAR Phases of Process
1. Pre-entry Phase
▪ Is the initial phase of the organizing process where the community/organizer looks
for communities to serve/help.
▪ It is considered the simplest phase in terms of actual outputs, activities and strategies
and time spent for it
Activities include:
▪
▪ Designing a plan for community development including all its activities
and strategies for care development.
▪ Designing criteria for the selection of site
▪ Actually selecting the site for community care
2. Entry Phase
▪ Sometimes called the social preparation phase as to the activities done here includes
the sensitization of the people on the critical events in their life, innovating them to
 share their dreams and ideas on how to manage their concerns and eventually
mobilizing them to take collective action on these.
▪ This phase signals the actual entry of the community worker/organizer into the
community. She must be guided by the following guidelines however.
▪
▪ Recognizes the role of local authorities by paying them visits to inform
them of their presence and activities.
▪ The appearance, speech, behavior and lifestyle should be in keeping
with those of the community residents without disregard of their being
role models.
▪ Avoid raising the consciousness of the community residents; adopt a
low-key profile.
3. Organization Building Phase
▪ Entails the formation of more formal structures and the inclusion of more formal
procedures of planning, implementation, and evaluating community-wide activities.
It is at this phase where the organized leaders or groups are being given trainings
(formal, informal, OJT) to develop their skills and in managing their own
concerns/programs.
4. Sustenance and Strengthening Phase
▪ Occurs when the community organization has already been established and the
community members are already actively participating in community-wide
undertakings. At this point, the different communities setup in the organization
building phase are already expected to be functioning by way of planning,
implementing and evaluating their own programs with the overall guidance from the
community-wide organization.
Strategies used may include:
▪
▪ Education and training
▪ Networking and linkaging
▪ Conduct of mobilization on health and development concerns
▪ Implementing of livelihood projects
▪ Developing secondary leaders
Vision
▪ Health for all Filipinos
Mission
▪Ensure accessibility & quality of health care to improve the quality of life of all
Filipinos, especially the poor.
National Objectives
1. Improve the general health status of the population (reduce infant mortality rate,
reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate,
increase life expectancy & the quality of life years).
2. Reduce morbidity, mortality, disability & complications from Diarrheas,
Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted
Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive
 Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders,
Protein Energy Malnutrition, and Iron Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
1. Schistosomiasis
2. Malaria
3. Filariasis
4. Leprosy
5. Rabies
6. Measles
7. Tetanus
8. Diphtheria & Pertussis
9. Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical activity &
fitness, personal hygiene, mental health & less stressful life & prevent violent &
risk-taking behaviors.
6. Promote the health & nutrition of families & special populations through child,
adolescent & youth, adult health, women’s health, health of older persons, health of
indigenous people, health of migrant workers and health of different disabled
persons and of the rural & urban poor.
7. Promote environmental health and sustainable development through the promotion
and maintenance of healthy homes, schools, workplaces, establishments and
communities’ towns and cities.
Basic Principles to Achieve Improvement in Health
1. Universal access to basic health services must be ensured.
2. The health and nutrition of vulnerable groups must be prioritized.
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.
Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
rinciples of EPI
 1. Epidemiological situation
2. Mass approach
3. Basic Health Service
The 7 immunizable diseases
1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B
Target Setting

▪ Infants 0-12 months

▪ Pregnant and Post Partum Women
▪ School Entrants/ Grade 1 / 7 years old
Objectives of EPI

▪ To reduce morbidity and mortality rates among infants and children from six
childhood immunizable disease
Elements of EPI

▪ Target Setting
▪ Cold chain Logistic Management- Vaccine distribution through cold chain is
designed to ensure that the vaccines were maintained under proper environmental
condition until the time of administration.
▪ Information, Education and Communication (IEC)
▪ Assessment and evaluation of Over-all performance of the program
▪ Surveillance and research studies
Administration of vaccines

# of
Vaccine Content Form & Dosage Doses Route
 Freeze dried
BCG (Bacillus Calmette Live attenuated Infant- 0.05mlPreschool-
Guerin) bacteria 0.1ml 1 ID

DT- weakened
toxin
DPT (Diphtheria P-killed bacteria
Pertussis Tetanus) liquid-0.5ml 3 IM

OPV (Oral Polio

Vaccine) weakened virus liquid-2drops 3 Oral

Hepatitis B Plasma derivative Liquid-0.5ml 3 IM

Measles Weakened virus Freeze dried- 0.5ml 1 Subcutaneo

Schedule of Vaccines

Age at 1st Interval between

Vaccine dose dose Protection

BCG is given at the earliest possible age protects against

the possibility of TB infection from the other family
BCG At birth members

An early start with DPT reduces the chance of severe

DPT 6 weeks 4 weeks pertussis

The extent of protection against polio is increased the

OPV 6weeks 4weeks earlier OPV is given.

An early start of Hepatitis B reduces

@birth,6th the chance of being infected and becoming a carrier.
Hepa B @ birth week,14th week

9m0s.- At least 85% of measles can be prevented by

Measles 11m0s. immunization at this age.
▪ 6 months – earliest dose of measles given in case of outbreak
▪ 9months-11months- regular schedule of measles vaccine
▪ 15 months- latest dose of measles given
▪ 4-5 years old- catch up dose
▪ Fully Immunized Child (FIC)– less than 12 months old child with complete
immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.
Tetanus Toxiod Immunization
Schedule for Women
Vaccine Minimum age interval % protected Duration of Protection
 TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

TT4 1year later/during next pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

▪ There is no contraindication to immunization except when the child is
immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child
experienced convulsions after a DPT or measles vaccine, report such to the doctor
immediately.
▪ Malnutrition is not a contraindication for immunizing children rather; it is an
indication for immunization since common childhood diseases are often severe to
malnourished children.
Cold Chain under EPI

▪
Cold Chain is a system used to maintain potency of a vaccine from that of
manufacture to the time it is given to child or pregnant woman.
▪ The allowable timeframes for the storage of vaccines at different levels are:
▪ 6months- Regional Level
▪ 3months- Provincial Level/District Level
▪ 1month-main health centers-with ref.
▪ Not more than 5days- Health centers using transport boxes.
▪ Most sensitive to heat: Freezer (-15 to -25 degrees C)
▪ OPV
▪ Measles
▪ Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
▪ BCG
▪ DPT
▪ Hepa B
▪ TT
▪ Use those that will expire first, mark “X”/ exposure, 3rd- discard,
▪ Transport-use cold bags let it stand in room temperature for a while before storing
DPT.
▪ Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
▪ FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines
are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of
vaccines expiry date are done to identify those near to expire vaccines.
Community Assessment
▪ Status
▪ Structure
▪ Process
Types of Community Assessment
Community Diagnosis
▪ A process by which the nurse collects data about the community in order to identify
factors which may influence the deaths and illnesses of the population, to formulate
a community health nursing diagnosis and develop and implement community health
nursing interventions and strategies.
2 Types:
Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis

▪ aims to obtain general information about the ▪ type of assessment responds to a

community particular need
Steps:
Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Implementation Phase
1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback
Evaluation Phase
Biostatistics
▪ DEMOGRAPHY – study of population size, composition and spatial distribution as
affected by births, deaths and migration.
▪ Sources: Census – complete enumeration of the population
2 Ways of Assigning People
1. De Jure – People were assigned to the place where assigned to the place they usually
live regardless of where they are at the time of census.
2. De Facto – People were assigned to the place where they are physically present at
are at the time of census regardless, of their usual place of residence.
Components
1. Population size
2. Population composition
▪ Age Distribution
▪ Sex Ratio
▪ Population Pyramid
 ▪ Median age – age below which 50% of the population falls and above
which 50% of the population falls. The lower the median age, the
younger the population (high fertility, high death rates).
▪ Age – Dependency Ratio – used as an index of age-induced economic
drain on human resources
▪ Other characteristics:
7.
▪ occupational groups
▪ economic groups
▪ educational attainment
▪ ethnic group
3. Population Distribution
▪ Urban-Rural – shows the proportion of people living in urban compared
to the rural areas
▪ Crowding Index – indicates the ease by which a communicable disease
can be transmitted from 1 host to another susceptible host.
▪ Population Density – determines congestion of the place
Vital Statistics
▪ The application of statistical measures to vital events (births, deaths and common
illnesses) that is utilized to gauge the levels of health, illness and health services of a
community.
Types of Vital Statistics

Fertility Rate
1. Crude Birth Rate
Total # of livebirths in a given calendar year X 1000
Estimated population as of July 1 of the same given year
2. General Fertility Rate
Total # of livebirths in a given calendar year X 1000
Total number of reproductive age
Mortality Rate

1. Crude Death Rate

_Total # of death in a given calendar year_ X 1000
Estimated population as of July 1 of the same calendar year
2. Infant Mortality Rate
Total # of death below 1 yr in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year
3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year
Morbidity Rate
1. Prevalence Rate
Total # of new & old cases in a given calendar year X 100
Estimated population as of July 1 of the same calendar year
2. Incidence Rate
Total # of new cases in a given calendar year_ X 100
Estimated population as of July 1 of the same calendar year
3. Attack Rate
Total # of person who are exposed to the disease X 100
Estimated population as of July 1 of the same calendar year
Epidemiology

▪ the study of distribution of disease or physiologic condition among human

population s and the factors affecting such distribution
▪ the study of the occurrence and distribution of health conditions such as disease,
death, deformities or disabilities on human populations
1. Patterns of disease occurrence
Epidemic
▪ A situation when there is a high incidence of new cases of a specific disease in
excess of the expected.
▪ when the proportion of the susceptible are high compared to the proportion of the
immunes
Epidemic potential
▪ an area becomes vulnerable to a disease upsurge due to causal factors such as
climatic changes, ecologic changes, or socio-economic changes
Endemic
▪ habitual presence of a disease in a given geographic location accounting for the low
number of both immunes and susceptibles.E.g. Malaria is a disease endemic at
Palawan.
▪ The causative factor of the disease is constantly available or present to the area.
Sporadic
▪ disease occurs every now and then affecting only a small number of people relative
to the total population
▪ intermittent
Pandemic
▪ global occurrence of a disease
Steps in Epidemiological Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
2. Role of the Nurse
▪ Case Finding
▪ Health Teaching
▪ Counseling
▪ Follow up visit
Community Health Nurse Roles and Functions
Qualifications

1. Bachelor of Science in Nursing

2. Registered Nurse of the Philippines
Planner/Programmer

1. Identifies needs, priorities, and problems of individuals, families, and communities

2. Formulates municipal health plan in the absence of a medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and circular
for the concerned staff personnel
4. Provides technical assistance to rural health midwives in health matters
Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or
workplace
2. Develops the family’s capability to take care of the sick, disabled, or dependent
member
Community Organizer

1. Motivates and enhances community participation in terms of planning, organizing,

implementing, and evaluating health services
2. Initiates and participates in community development activities
Coordinator of Services

1. Coordinates with individuals, families, and groups for health related services
provided by various members of the health team
2. Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health
Trainer/Health Educator

1. Identifies and interprets training needs of the RHMs, Barangay Health Workers
(BHW), and hilots
2. Conducts training for RHMs and hilots on promotion and disease prevention
3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource
speaker on health and health related services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health
education purposes
5. Conducts pre-marital counseling
Health Monitor

▪ Detects deviation from health of individuals, families, groups, and communities

through contacts/visits with them
Role Model

▪ Provides good example of healthful living to the members of the community

Change Agent

▪ Motivates changes in health behavior in individuals, families, groups, and

communities that also include lifestyle in order to promote and maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation
Researcher

1. Participates in the conduct of survey studies and researches on nursing and health-
related subjects
2. Coordinates with government and non-government organization in the
implementation of studies/research

Family Care Plan

Definition

▪ It is the blue print of the care that the nurse designs to systematically minimize or
eliminate the identified health and nursing problem through explicitly formulated
outcomes of care (goals and objectives) and deliberately chosen set of interventions,
resources and evaluation criteria, standards, methods and tools.
Characteristics, which are Based on the Concept of Planning as a Process:
1. The nursing care plan focuses on actions, which are designed to solve or minimize
existing problem.
▪ The cores of the plan are the approaches, strategies, activities, methods
and materials, which the nurse hopes, will improve the problem.
2. The nursing care plan is a product of the liberate systematic process.
3. The nursing care plan as with all other plans relate to the future.
▪ It utilizes events in the past and what is happening in the present to
determine patterns. It also projects the future scenario if the situation is
not corrected.
4. The nursing care plan is based upon identified health and nursing problems.
5. The nursing care plan is a means to an end, not an end in itself.
▪ The goal in planning is to deliver the most appropriate care to the client
by eliminating barriers to the family health development.
6. The nursing care plan is a continuous process not a one shot deal.
▪ The results of evaluation of the plan’s effectiveness trigger another cycle
of the planning process until the health and nursing problems are
eliminated.
Desirable Qualities of a Nursing Care Plan
1. It should be based on clear, explicit definition of the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family.
4. The nursing care plan is most useful in written form.
Importance of Planning Care
1. They individualize care to clients.
2. The nursing care plan helps in setting priorities by providing information about the
client as well as the nature of his problem.
3. The nursing care plan promotes systematic communication among those involve in
the health care effort.
4. Continuity of care is facilitated through the use of nursing care plans.
▪ Gaps and duplications in the services provided are minimized, if not
totally eliminated.
5. Nursing care plans facilitate the coordination of care by making known to other
members of the health team what the nurse is doing.
Steps in Developing Care Plan
1. The prioritized conditions of the problem
2. Goals and objectives of the nursing care
3. The plan of interventions
4. The plan for evaluating care
Prioritizing Health Problems
Four Criteria for Determining Priorities:
1. Nature of the condition or problem – categorized into wellness state/potential, health
threat, health deficit of foreseeable crisis.
2. Modifiability of the condition or problem-refers to the probability of success in
enhancing the wellness state improving the condition minimizing, alleviating or
totally eradicating the problem through intervention.
3. Preventive potential-refers to the nature and magnitude of future problem that can be
minimized or totally prevented if interventions are done on the condition or problem
under consideration.
4. Salience-refers to the family’s perception and evaluation of the condition or problem
in terms of seriousness and urgency of attention needed or family readiness.
Factors Affecting Priority Setting
Nature of the problem
▪ The biggest weight is given to the wellness state or potential because of the premium
on client’s effort or desire to sustain/maintain high level of wellness.
▪ The same weight is given to health deficit because of its sense of clinical urgency,
which may require immediate intervention.
▪ Foreseeable crisis is given the least weight because culture linked variables/factors
usually provide our families with adequate support to cope with developmental or
situational crisis.
Modifiability if the problem
 ▪ Current knowledge, technology and interventions to enhance the wellness state or
manage the problem.
▪ Resources of the family
▪ Resources of the nurse
▪ Resources of the community
Preventive potential
▪ Gravity or severity of the problem-refers to the progress of the disease/problem
indicating extent of damage on the patient/family; also indicates prognosis,
reversibility or modifiability of the problem. In general, the more severe the problem
is, the lower is the preventive potential of the problem.
▪ Duration of the problem-refers to the length of time the problem has existed.
Generally speaking, duration of the problem has a direct relationship to gravity; the
nature of the problem is variable that may, however, alter this relationship. Because
of this relationship to gravity of the problem, duration has also a direct relationship
to preventive potential.
▪ Current management-refers to the presence and appropriateness of intervention
measures instituted to enhance the wellness state or remedy the problem. The
institution of appropriate intervention increases condition’s preventive potential.
▪ Exposure of any vulnerable or high risk group-increases the preventive potential of
condition or problem
Formulation of Goals and Objectives
▪ GOAL-is a general statement of condition or state to be brought about by specific
courses of action.
▪ OBJECTIVE-refers to a more specific statement of the desired results or outcomes
of care. They specify the criteria by which the degree of effectiveness of care is to be
measured.
*A cardinal principle in goal setting states that goal must be set jointly with the family. This
ensures family commitment to realization.

* Basic to the establishment of mutually acceptable goals is the family’s recognition and
acceptance of existing health needs and problems.

Barriers to Joint Goal Setting Between the Nurse and the Family:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too
busy at the moment.
3. Sometimes the family perceives the existence of the problem but does not see it as
serious enough to warrant attention.
4. The family may perceive the presence of the problem and the need to take action. It
may however refuse to face and do something about the situation.
▪ Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals.
 5. A big barrier to collaborative goal setting between the nurse and the family is the
working relationship.
Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
▪ Increasing the family’s knowledge on the nature, magnitude and cause
of the problem.
▪ Helping the family see the implications of the situation or the
consequences of the condition.
▪ Relating the health needs to the goals of the family.
▪ Encouraging positive or wholesome emotional attitude toward the
problem by affirming the
family’s capabilities/qualities/resources and providing
information on available actions.
2. Guide the family on how to decide on appropriate health actions to take.
▪ Identifying or exploring with the family courses of action available and
the resources needed for each.
▪ Discussing the consequences of action available.
▪ Analyzing with the family of the consequences of inaction.
3. Develop the family’s ability and commitment to provide nursing care to each
member.
▪ Contracting-is a creative intervention that can maximize the
opportunities to develop the ability and commitment of the family to
provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to
health maintenance and personal development.
▪ The family can be taught specific competencies to ensure such home
environment through environmental manipulation or management to
minimize or eliminate health threats or risks or to install facilities of
nursing care.
5. Facilitate the family’s capability to utilize community resources for health care.
▪ Involves maximum use of available resources through the coordination,
collaboration and teamwork provided by effective referral system.
Criteria for Selecting the Type of Nurse Family Contact
1. Effectivity
2. Efficiency
3. Appropriateness
Types of Nurse Family Contact
Home Visit
▪ While it is expensive in terms of time, effort and logistics for the nurse, it is an
effective and appropriate type of family nurse contact if the objectives and outcomes
of care require accurate appraisal of family relationship, home and environment and
family competencies. i.e. The best opportunity to serve the actual care given by
family members.
Clinic or Office Conference
 ▪ It is less expensive for the nurse and provides the opportunity to use equipment that
can’t be taken to the home. In some cases, the other team members in the clinic may
be consulted or called in to provide additional service.
Telephone Conference
▪ May be effective, efficient, and appropriate if the objectives and outcomes of care
require immediate access to data given problems on distance or travel time. Such
data include monitoring of health status or progress during the acute phase of an
illness state, change in schedule of visit or family decision, and updates on outcomes
or responses to care and treatment.
Written Communication
▪ It is another less time consuming option for the nurse in instances when there are
large number of families needing follow-up on top of problems of distance or travel
time.
School Visit or Conference
▪ It is done to work with family and school authorities on how to appraise the degree
of vulnerability of and worked out interventions to help children and adolescence on
specific health risks, hazards or adjustment problems.
Industrial or Job Site Visit
▪ It is done when the nurse and family need to make an accurate assessment of health
risks or hazards and work with employer or supervisor on what can be done to
improve on provisions for health and safety of workers.
Implementing the Nursing Care Plan
▪ During this phase, the nurse encounters the realities in family nursing practice that
motivates her to try out creative innovations or overwhelm her to frustration or
inaction. A dynamic attitude on personal and professional development is, therefore,
necessary if she has to face up challenges of nursing practice.
Implementation Phase: A Phenomenological Experience
▪ Meeting the challenges of this phase is the essence of family nursing practice.
During this phase, the nurse experiences with the family a lived meaningful world of
mutual, dynamic interchange of meanings, concerns, perceptions, biases, emotions
and skills. Just as the self aims to achieve body-mind integration to achieve
wholeness in the experience of “being” and “becoming” in expert caring. Unless
there is such a dynamic and active involvement between the nurse and the family in
understanding and making choices in this meaningful world of coping, aspirations,
emotions and skills the nurse can’t hope to achieve expert caring.
Expert Caring: Methods and Possibilities
▪ Expert caring in the implementation phase is demonstrated phase is demonstrated
when the nurse carries out interventions based on the family’s understanding of the
lived experience of coping and being in the world. Expert caring is developing the
capability of the family for “engage care” through the nurses skilled practice, the
family learns to choose and carry out the best possibilities of caring given the
meanings, concerns, emotions and resources(skills & equipments) as experienced in
the situation. While the challenge for expert caring is a reality, the nurse is enriched
as a result of such an experience (Benner & Wrubel 1989).
 ▪ …By being experts in caring, nurses must takeover and transform the notions of
expertise. Expert caring has nothing to do with possessing privileged information
that increases one’s control and domination of another. Rather, expert caring
unleashes the possibilities inherent in the self and the situation. Expert caring
liberates and facilitates in such a way that the one caring is enriched in the process.
▪ While expert caring does not happen overnight to the novice nurse, there are
methods and possibilities that can enhance learning towards expert caring. Such
methods and possibilities need to be carried out and experienced in real contexts and
real relationships to achieve skillfully comportment and excellence in the current
situation.
Two such major methods and possibilities:
1. Performance-focus learning through competency-based teaching
2. Maximizing caring possibilities for personal and professional development
Competency-Based Teaching
▪ A substantive part of the implementation phase is directed towards developing the
family’s competencies to perform the health tasks. Competencies include the
cognitive (knowledge), psychomotor (skills) and attitudinal or affective(emotions,
feelings, values). The following are examples of these family health competencies
using the corresponding health task in our case illustration:
▪ Health Task: The family recognizes the possibility of cross-infection of scabies to
other family members.
Cognitive Competency:
1. The family explains the cause of scabies
2. The family enumerates ways by which cross-infection of scabies can occur among
the family members.
3. Health Task: The family provides a home environment conducive to health
maintenance and personal development of its members.
Psychomotor Competency:
▪ The family carries out the agreed-upon measures to improve home sanitation and
personal hygiene of family members.
▪ Health Task: The family decides to take appropriate health action.
Attitudinal or Affective Competencies:
1. Family members express feelings or emotions that act as barriers to decision-making
2. Family members acknowledge the existence of these feelings or emotions.
▪ In order to systematically work towards development of the family’s
competencies, such competencies need to be explicitly defined.
Cognitive and psychomotor competencies are reflected explicitly as
objectives in the family nursing care plan. The attitudinal or affective
competencies may also be translated into objective of care as feelings,
emotions or philosophy in life that enhance the family’s desire or
commitment to behavior change and sustain the needed action.
Learning Principles and Teaching- Learning Methods and Techniques that the Nurse Can Use in
Competency-Based Teaching:
1. Learning is both intellectual and emotional process.
2. Learning is facilitated when experience has meaning.
 3. Learning is individual matter.
Learning is Both Intellectual and Emotional Process
Six General Methods and Techniques:
1. Provide information to shape attitude
2. Provide experiential learning activities to shape attitudes
3. Provide examples or models to shape attitudes
4. Providing opportunities for small group discussion
5. Role playing exercises
6. Explore the benefits of power of silence
Learning is Facilitated When Experience Has Meaning
1. Analyze and process family members all teaching-learning based on their grasp on
the live experience of the situation in terms of the meaning for the self.
2. Involve the family actively in determining areas for teaching-learning based on the
health tasks that members made to perform.
3. Used examples or illustrations that the family is familiar with.
Learning is Individual Matter: Ensure Mastery of Competencies for Sustained Actions:
Some Techniques to Develop Mastery:
1. Make the learning active by providing opportunities for the family to do specific
activities, answer questions or apply learning in solving problems.
2. Ensure clarity. Use words, examples, visual materials and handouts that the family
can understand.
3. Ensure adequate evaluation, feedback, monitoring and support for sustained action
by:
▪ Explaining well how the family is doing
▪ Giving the necessary affirmations or reassurances
▪ Explaining how the skill can be improved
▪ Exploring with the family how modifications can be carried out to
maximize situated possibilities or best options.

REPUBLIC ACT – an act passed by the Congress of the Philippines, while the form of
government is Republican government.
▪ Republic Act 349 – Legalizes the use of human organs for surgical, medical and
scientific purposes.
▪ Republic Act 1054 – Requires the owner, lessee or operator of any commercial,
industrial or agricultural establishment to furnish free emergency, medical and dental
assistance to his employees and laborers.
▪ Republic Act 1080 – Civil Service Eligibility
▪ Republic Act 1082 – Rural Health Unit Act
▪ Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
▪ Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid
January 31 of each year
▪ Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
▪ Republic Act 2382 – Philippine Medical Act which regulates the practice of
medicines in the Philippines
▪ Republic Act 2644 – Philippine Midwifery Act
▪ Republic Act 3573 – Law on reporting of Communicable Diseases
▪ Republic Act 4073 – Liberalized treatment of Leprosy
▪ Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed
before it can operative
▪ Republic Act 5181 – Act prescribing permanent residence and reciprocity as
qualifications for any examination or registration for the practice of any profession
in the Philippines
▪ Republic Act 5821 – The Pharmacy Act
▪ Republic Act 5901 – 40 hours work for hospital workers
▪ Republic Act 6111 – Medicare Act
▪ Republic Act 6365 – Established a National Policy on Population and created the
Commission on population
▪ Republic Act 6425 – Dangerous Drug Act of 1992
▪ Republic Act 6511 – Act to standardize the examination and registration fees
charged by the National Boards, and for other purposes.
▪ Republic Act 6675 – Generics Act of 1988
▪ Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
▪ Republic Act 6725 – Act strengthening the prohibition on discrimination against
women with respect to terms and condition of employment
▪ Republic Act 6727 – Wage Rationalization Act
▪ Republic Act 6758 – Standardized the salaries
▪ Republic Act 6809 – Majority age is 18 years old
▪ Republic Act 6972 – Day care center in every Barangay
▪ Republic Act 7160 – Local Government Code
▪ Republic Act 7164 – Philippine Nursing Act of 1991
▪ Republic Act 7170 – Law that govern organ donation
▪ Republic Act 7192 – Women in development nation building
▪ Republic Act 7277 – Magna Carta of Disabled Persons
▪ Republic Act 7305 – The Magna Carta of public Health Workers
▪ Republic Act 7392 – Philippine Midwifery Act of 1992
▪ Republic Act 7432 – Senior Citizen Act
▪ Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
▪ Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
▪ Republic Act 7624 – Drug Education Law
▪ Republic Act 7641 – New Retirement Law
▪ Republic Act 7658 – An act prohibiting the employment of children below 15 years
of age
▪ Republic Act 7719 – National Blood Service Act of 1994
▪ Republic Act 7875 – National Health Insurance Act of 1995
▪ Republic Act 7876 – Senior Citizen Center of every Barangay
▪ Republic Act 7877 – Anti-sexual harassment Act of 1995
▪ Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
▪ Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
▪ Republic Act 8172 – Asin Law
 ▪ Republic Act 8187 – Paternity Leave Act of 1995
▪ Republic Act 8203 – Special Law on Counterfeit Drugs
▪ Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
▪ Republic Act 8291 – Government Service Insurance System Act of 1997 (amended
PD 1146)
▪ Republic Act 8344 – Hospital Doctors to treat emergency cases referred for
treatment
▪ Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
▪ Republic Act 8424 – Personal tax Exemption
▪ Republic Act 8749 – The Philippine Clean Air Act of 1999
▪ Republic Act 8981 – PRC Modernization Act of 2000
▪ Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
▪ Republic Act 9173 – Philippine Nursing Act of 2002
▪ Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This power of the President which
allows him/her to act as legislators was exercised during the Marshall Law period.
▪ Presidential Decree 46 – An act making it punishable for any public officials or
employee, whether of the national or local government, to receive directly or
indirectly any gifts or valuable things
▪ Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four
children
▪ Presidential Decree 69 – Limits the number of children to four (4) tax exemption
purposes
▪ Presidential Decree 79 – Population Commission
▪ Presidential Decree 147 – Declares April and May as National Immunization Day
▪ Presidential Decree 148 – Regulation on Woman and Child Labor Law
▪ Presidential Decree 166 – Strengthened Family Planning program by promoting
participation of private sector in the formulation and implementation of program
planning policies.
▪ Presidential Decree 169 – Requiring Attending Physician and/or persons treating
injuries resulting from any form of violence.
▪ Presidential Decree 223 – Professional Regulation Commission
▪ Presidential Decree 442 – Labor Code Promotes and protects employees self-
organization and collective bargaining rights. Provision for a 10% right differential
pay for hospital workers.
▪ Presidential Decree 491 – Nutrition Program
▪ Presidential Decree 539 – Declaring last week of October every as Nurse’s Week.
October 17, 1958
▪ Presidential Decree 541 – Allowing former Filipino professionals to practice their
respective professions in the Philippines so they can provide the latent and expertise
urgently needed by the homeland
▪ Presidential Decree 568 – Role of Public Health midwives has been expanded after
the implementation of the Restructed Health Care Delivery System (RHCDS)
▪ Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child
Adoption
 ▪ Presidential Decree 626 – Employee Compensation and State Insurance Fund.
Provide benefits to person covered by SSS and GSIS for immediate injury, illness
and disability.
▪ Presidential Decree 651 – All births and deaths must be registered 30 days after
delivery.
▪ Presidential Decree 825 – Providing penalty for improper disposal garbage and other
forms of uncleanliness and for other purposes.
▪ Presidential Decree 851 – 13th Month pay
▪ Presidential Decree 856 – Code of Sanitation
▪ Presidential Decree 965 – Requiring applicants for Marriage License to receive
instruction on family planning and responsible parenthood.
▪ Presidential Decree 996 – Provides for compulsory basic immunization for children
and infants below 8 years of age.
▪ Presidential Decree 1083 – Muslim Holidays
▪ Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to
take Board Examination pending their naturalization.
▪ Presidential Decree 1519 – Gives medicare benefits to all government employees
regardless of status of appointment.
▪ Presidential Decree 1636 – requires compulsory membership in the SSS and self-
employed
▪ Presidential Decree 4226 – Hospital Licensure Act
PROCLAMATION – an official declaration by the Chief Executive / Office of the President of
the Philippines on certain programs / projects / situation
▪ Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s
in the immunization program
▪ Proclamation No. 118 – Professional regulation Week is June 16 to 22
▪ Proclamation No. 499 – National AIDS Awareness Day
▪ Proclamation No. 539 – Nurse’s Week – Every third week of October
▪ Proclamation No. 1275 – Declaring the third week of October every year as
“Midwifery Week”
LETTER OF INSTRUCTION – An order issued by the President to serve as a guide to his/her
previous decree or order.
▪ LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical
professions and social work to prepare, plan and implement integration of family
planning in their curriculum to require their graduate to take the licensing
examination.
▪ LOI 949 – Act on health and health related activities must be integrated with other
activities of the overall national development program. Primary Health Care (10-19-
79)
▪ LOI 1000 – Government agencies should be given preference to members of the
accredited professional organization when hiring
EXECUTIVE ORDER – an order issued by the executive branch of the government in order to
implement a constructional mandate or a statutory provision.
▪ Executive Order 51 – The Milk Code
▪ Executive Order 174 – National Drug Policy on Availability, Affordability, Safe,
Effective and Good Quality drugs to all
 ▪ Executive Order 180 – Government Workers Collective Bargaining Rights
Guidelines on the right to Organize of government employee.
▪ Executive Order 203 – List of regular holidays and special holidays
▪ Executive Order 209 – The Family Code (amended by RA 6809)
▪ Executive Order 226 – Command responsibility
▪ Executive Order 503 – Provides for the rules and regulations implementing the
transfer of personnel, assets, liabilities and records of national agencies whose
functions are to be devoted to the local government units.
▪ Executive Order 857 – Compulsory Dollar Remittance Law
Other Important Information
▪ Administrative Order 114 – Revised/updated the roles and functions of the
Municipal Health Officers, Public Health Nurses and Rural Midwives
▪ ILO Convention 149 – Provides the improvement of life and work conditions of
nursing personnel.