Discussed by: Prof.

Aida Garcia
Bachelor of Science in Nursing 2YA

CHNN211 LEC: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

- Philippine government
Coverage for Prelim:
- Under Philippine gov. they put up dep. Of health and called it
• Evolution PHN in the Phil
Department of Public Health and Welfare. - Pinagsama ang 2
• National/ Global Health Situation
dep. Na to dhil they become the case of mortality ung pag nag
• Community Health Nursing kasakit pwede mamatay at kumuha ng needs so lalo hihirap.
• Phil Health Care Delivery System - Modern times: department of health and DSWD - DSWD –
• Primary Health Care pinipili nila ung mga indigent, children. - Hindi pa ito na fully
• Rural Health Unit implement nood dahil mahitap ang ph kaya nung nag bago ang
• Family Health Nursing pres. nagpatupad ng↓
• Herbal Medicine • EO No. 317 (1941)
• Family nursing care plan - Full implementation of Commonwealth Act No. 430. •
Dr. Jose Fabella
EVOLUTION: PUBLIC HEALTH NURSING IN THE - 1st Department Secretary of Health and Public Welfare. •
PHILIPPINES 1947 – Post war
• 1577 - the Department of Health was reorganized into bureaus: - Bureau
- Franciscan Friar Juan Clemente (Priest) opened medical of Hospitals and a Bureau of Quarantine were created under
dispensary in Intramuros for the indigent. DOH.
- This medical dispensary is now san Lazaro hospital - - Took charge of municipal and charity clinics.
Dispensary – nag bibibgay ng libreng gamot - (DOH nagging 2 dept. kase lalong nag hirap ang ph after
• 1690 nung war at maraming infectious diseases)
- Dominican Father Juan de Pergero (Priest) worked toward - Creation of Nursing Service Division.
installing water system in San Juan del Monte and Manila. - They 1) Bureau of Health with the sanitary divisions under it. -
adopted the idea of john snow who find out that cholera Originally male nurses handle sanitation during Spain
contaminates water so they put up water station. • 1805 time
- Smallpox vaccination was introduced by Francisco de - Eventually nung nag karoon ng sanitary div. at
Balmis, a personal physician of King Charles IV of Spain. • 1876 doctor na ang boss nila.
- First medicos titulares (Certified doctor) were appointed by - After non ung sanitary division pinasok na nila yung
the Spanish government. trabaho under DOH
- Dumarami na ang sakit dito sa pilipinas kaya nag padala sila - DOH responsible na ngayon sa disease prevention
ng mga doctor pero maraming doc. ang ayaw pumunta dito. Kaya and health promotion
gumawa sila ng 2yrs course sa UST↓ • 1888 2) Bureau of public welfare (became the Social Welfare
- 2-year courses consisting of fundamental medical and dental Administration, katumbas ng DSWD)
subjects - First offered UST. 3) Bureau of hospitals – curative
- Graduates were “cirujanos ministrantes”. 4) Bureau of hospitals – preventive care services. •
- Serve as male nurses and sanitation inspectors. They are the 1951
one who are given the responsibility when it comes to - Sanitary district was converted into a Rural Health Unit. - 81
sanitation of the community. selected provinces (ginawa lang sa mga probinsyang Malaki
• 1901 ang problema).
- United States Philippine Commission - Vital statistics - bilang ng mga namatay, nag kasakit at
- Act 157, created Board of Health of Philippine Islands with gumaling. Ang binibilang lang ay ung mga sakit na
Commissioner of the Public Health (like duque), as chief mabilis kumalat.
executive officer (now DOH) - 7 Basic Health Services:
• Fajardo Act of 1912 1. Maternal and Child Health
- created Sanitary Divisions made up of one to four 2. Environmental Health
municipalities. 3. Communicable Disease Control
- Each sanitary division had a president who had to be 4. Vital Statistics
physician. 5. Medical Care
• 1915 6. Health Education
- Philippine General Hospital began to extend public health 7. Public Health Nursing
nursing services in homes by organizing unit called social • 1954 – R. A. 1082 or Rural Health Act
and home services. - Initially known as sanitary district/division.
• 1905 Asociacion Femenista Filipina - Creation of RHU in every municipality.
- La Gota de Leche was the first center dedicated to the service - Created post for Municipal Health Officer.
of mother and babies. - Originally 81 provinces have this now lahat na ay meron.
• Commonwealth Act No. 430

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 1995 created the Philippine Health Insurance Corporation
• 1957 – R. A. 1891 (PhilHealth) to provide health insurance coverage for all
- amend certain provisions in Rural Health Act. Filipinos.
- Created 8 categories of rural health units corresponding to the - Health governance and regulation – The enactment of LGC in
population size of the municipalities. 1991 led to dual governance in health, with the DOH
- Barangay Health Station – branch RHU; no dentist; main stay governing at the national level and the LGUs at the
midwife; barangay health worker. subnational level.
- Rural Sanitary Inspector – siya na nagiinspect ng sanitation. • 2010
• 1970 - Agenda launched in 1999 Health Service Delivery. Both the
- Classification of health services into: Primary, Secondary and national government and LGUs manage the delivery of
Tertiary Levels of Care. primitive, preventive, curative and rehabilitative health
- PHN population ratio is 1: 20,000. (1-nurse) services.
- Primary Level of Care – for health promotion and disease Universal Health Care
prevention. (Rural Health center formal na tawag sa health - Aims to achieve the health system goals of better health
center) outcomes, sustained health financing, responsive health system
- Secondary Level of Care – pag may sakit, moderate that will provide equitable access to health care.
specialized care. District hospital Universal Health Care Act Kalusugan Pangkalahatan
- Tertiary Level of Care – highly specialized care. • (Republic Act No. 11223)
RA 1891 - automatically enrolls all Filipino citizens in the National Health
- In 1957 amend certain provisions in rural health act - Created Insurance Program.
8 categories of rural health units corresponding to the - Provide all Filipinos with access to affordable, quality, and
population size of the municipalities comprehensive health services.
- Ung mga lugar na hindi naabot ng health center ay tinayuan
ng barangay health station- branch of rural health unit
- Barangay health station- no dental chair and no nurses and NATIONAL OR GLOBAL HEALTH SITUATION
doc available unlike in RHU. Population
- Rural sanitary inspector- inspects environment if it can cause - Demographic – yung bilang
sickness. - Population by gender = Male 50.5% and Female 49.5% -
• 1991 October, R. A. 7160 or Local Government Code - Population by age = age 5-14 – 21% and age 15-24 – 20% - Life
Decentralization of entire government – all structures, expectancy – mas tumatagal ang buhay ng mga kababaihan.
personnel, and budgetary allocations from the provincial health • M 68.8 & F 74.3 (2015-2020)
level down to the barangays were devolved to the local Annual Ave Pop Growth Rate (%)
government unit (LGU) to facilitate health service delivery.
- What happened in the health system in phil because of the 2010 – 2015 1.73%
local government code? – decentralized kase nag hati-hati
na sa work. 2015 – 2020 1.59 %
- Delivery health services – now the responsibility of the LGU
- DOH changes its role from one of implementation to one of 2020 - 2025 1.41 %
governance.
• 2000
- Millennium Development Goals
- adopted during world summit in September. Created 8
goals Projected Population / Total
- 1 – connected to poverty
- 4, 5, 6 – connected with health Yr. 2020 109,947,900

Yr. 2025 117,959,400

Yr. 2030 125,337.500

- Using the annual average population growth rate, you will

compute for projected population.
- Ave fertility in the Philippines = 3

• 2005 Natality
- FOURmula One (F1) for health and Universal Health Care in - Birth
2010 – agenda launched in 1999 - Live births by age of the mother
- Health Service Delivery - Both the national government and - Live births by sex and regions (NCR, CAR, REG 1…) - Live
LGUs manage the delivery of promotive, preventive, births by attendance (M.D, Public health nurse, Midwife,
curative and rehabilitative health services. Traditional birth attendant, others)
- Health Financing – The National Health Insurance Act of
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- NCR has many facilities

In 2013
- 531,280 registered deaths from all causes and all ages. -
Males: 304,516 (57%) Females: 226,764 (43%) - For
every 1,000 population - More than 5 people die.

Notifiable Diseases
- Dengue 361,000 confirmed cases. 1, 373 deaths. January 1 to
October 25 (2018 – 2019)
- Diphtheria 197 confirmed cases, 47 deaths.
• January 1 to October 5 (2018 – 2019)
• Measles 42, 400 confirmed cases, 560 deaths.
• January 1 to October 12 (2018 – 2019). Most affected 1 year
old.
• Polio 3 confirmed cases, 13 confirmed environmental
- Pinagbabawalan na yung pagpapaanak sa bahay. - Traditional
samples; 4.4 Million target immunization for children up
birth attendant – manghihilot
to 5 years old.
Morbidity or Mortality • October 2019 to January 2020
- Sickness and death
- Morbidity: ten leading causes (TB other forms, Dengue fever, TB
respiratory, Acute water diarrhea…)
- Mortality: all causes by age group
- Infectious – microorganism (morbidity)
- Lifestyle – naninigarilyo, pagiinom ng alak (mortality)

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• Income and social status – (ang poverty could result to
Global Health Situation infection and bad lifestyle)
• April 10, 2020 • Employment and working conditions – (mas mabigat ang
- Coronavirus Disease 2019 (COVID-19) is an infectious trabaho ng mga males kumpara sa females)
disease caused by a new coronavirus recently introduced • Education – (madalas mag kasakit ang mga less educated
to humans for the first time”. kase may sarili silang beliefs at kulang ang pinag aralan
- WHO called it a pandemic. nila)
- Virus spreads all over the world. • Physical environment – (kung madumi tataas ang infection)
- About 80% of COVID-19 (+) have mild symptoms. • • Health services – (walang resources)
September 2019 • Social support networks – (para masustain ang health)
- Synchronized polio vaccination campaigns Nov to Dec 2019
• Personal behavior and coping skills – (sa mga nag online
in targeted regions reached a total of 1,404,517 (exceeding
games dapat may social interaction pa din sila sa family
target) children below 5 years old in NCR and 2,937,327
nila or friends)
(95%) children in Mindanao.”
• Genetics
• January 30, 2020
• Gender
- Polio vaccination must intensify until last child is reached
• Culture
and fully protected.
Public health
• April 7, 2020
- In tgaalog pangkalusugang pang kalahatan
- Urgent Need for Investment in Nursing.
Winslow
- “In Philippines, shortfall of nurses at 249,843 by 2030.
- A science and Art of Prevents Disease, promote
Greater investment now to retain them in Philippine health
health/efficiency, Prolong life.
sector.”
- Organized community effort for:
COMMUNITY HEALTH NURSING • Sanitation environment
Community • Control communicable disease
- A group of people with common characteristics or interests • Education personal hygiene
living together within a territory or geographical boundary • Organization of medicine
place where people under usual conditions are found (mass • Nursing service.
approach). - (↑ kapag naman nagawa ito lahat ng tao mag kakaroon ng ↓) -
- Common illness ang tinatarget For early detection and prevent treatment of disease. -
Health Development of social machinery to ensure a standard of
- WHO: states of complete physical, mental and social – wellbeing. adequate living for maintenance of health.
Not merely an absence of disease or infirmity (This should be (Social machinery- para malaman kung anong part ng govt.
complete so kapag malabo ang mata mo you are not healthy ang tutulong)
dapat kase kumpleto) - Enable every citizen to realize birth right of health and
- Modern definition: OLOF or Optimum Level of Functioning - longevity. (kaya mula noon hanggang ngayon bawal ang
Generally, influences health 🡪 eco-system abortion bcs we have the right to live and live long)
• Political – safety, oppression, people, and empowerment. • - Nung ginawa niya ito maraming sakit at nakita niya na kapag
Behavior – culture, habits, ethnic customs. nag tulong-tulongan ang mga tao na co-conquer naman ito.
• Heredity – generic endowment (defect, strengths, risk). • WHO
Health care delivery system – promotive, preventive, - Art of applying science in the context of politics. (Madalas
curative, rehabilitative. kausap ang politics kaya meron politics sa meaning)
• Environment – air, food, water waste, urban or rural, noise, - Public health is a core element of government attempt to
pollution, radiation. improve citizens welfare (gov. dpat ang unang mangalaga sa
health ng kalahatan)
• Socio-economic – employment, education, housing -
Determinants of health – is affected by combination of many • Essential public health function. (ito dpat ang gawin ng
factors (using this malalaman mo kung ano ang tinatarget mo sa gov.)
isang community): • Development of policy in public health regulation to
• Environment and circumstances protect public human resources.
• Surveillance (mga sakit na binibilang)
 • Research, innovation solution. 4th year)
• (↑ kapag nagawa ito lahat ng govt. mag kakaroon ng) QUESTIONS:
Ensure quality health service health promotion. (at para 1. Trabaho ng government – WHO
ma bawasan ang hindi pag kakapantay pantay dahil 2. Kapag ginawa natin ito ay hahaba ang buhay natin –
lagging nag kakasakit nag mga mahihirap ↓) Winslow
• Reduce inequalities; ensure best health for the greatest 3. Dapat gumaw ng policy and rergulate ito – WHO 4.
number. Kayo-kayo mag linis ng katawan/kapaligiran ninyo – Winslow
- DOST – to research (tuberculosis, dpaat gawan ng research sa

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a) Same age group – bata at matanda
Public Health Nursing b) Same characteristics – mga buntis
Lillian Wald c) Exposed to same environmental factor – sisilipin
- Coined (made the word public health nursing) ang environment.
- (orphanage) Director: Henry St. Settlement in New York - (Considered as one population group kaya sila
Service that is available to all people or “public” 🡪 government naka bukod-bukod)
agency 🡪 care of poor people. o Community – group of person sharing the same culture
- Invented bag technique situated in same geographical location. Main patient and
- Since nurse in govt. she thought to take care of the public. main concern.
National League of Philippine Government Nurses - Practice of Jacobson
nursing in local or national government health department and - Broader than PHN.
public school. - Nursing practice in a wide variety of services and consumer
- Position, title, designation (civil service commission) - Public advocate areas, variety roles, including independent practice.
health nurse (nurse in local or national health department or - Not confined in PHN.
public school)
Concept of Community Health Nursing
- Difference of Public health nursing and community health
1. Focus of care – health promotion.
nursing is only one area or setting of work as dictated by
2. Duration of care – over a long period of time.
funding. (gov. sa tax kumukuha ng sahod; CHN mas
3. Coverage of care
malawak at lahat ng working sa community or hindi nag
• All ages
wowork sa hospital are working here like health center. PHN
• All types of health care
naman working in government hospitals)
- Another definition of public health na gumawa sa PH - • Care for all regardless of race
Samahan ng mga nurses na working in PH • Creed
- Working in public instituition either in public school, public • Nationality
local dep, public national dept. • Socio-economic
Community Health Nursing • Nationality
Dr. Ruth Freeman 4. Benefits – family and community.
- A service rendered by professional nurse with the individual, 5. Knowledge used – current, multi-disciplinary (biology, ecology,
family, group, and community at home, health clinic, clinics, social science).
schools, places of work for: • Generalist in terms of practice.
• The promotion of health (main emphasis, kapag ito ang • Applies nursing process in taking action.
lumabas sa borad exam) • Goal of CHN 🡪 raise level of health.
• Prevention of illness
Principle of Community Health Nursing
• Care of sick at home
• Must fully understand objectives and principles. (Orient ka muna
• Rehabilitation
sa vision and mission)
- Ex. In hospitals 1 bed per nurse kaya individual, at kapag nasa
• Primary Responsibility: health teaching.
community ang nurse aalagaan niya ang family, group, and
community. • Care is based on recognized needs of Individual, Family, and
- Patient – may sakit na Community.
- Client – walang sakit • Resources of community (GO & NGO) must be fully utilized. •
- 4 level of client: There should be Accurate Record & Reporting. (to know if nag
o Individual – unique, sick or well, the “entry point”. o de-decrease or nag i-increase.
Family – group of people bound by blood. Marriage and • Family (unit of service).
adoption, the “unit of service”. (Unit of service in • Knowledge used - No Knowledge will be obsolete Current,
community are buong pamilya. In hospitals u can say Updated.
“pwede po mag pa BP pero uunahin ko muna po ang mga • Evaluation: periodic.
patient ko balikan ko na lang po kayo” pero in community • Part of health team. (Rural health sanitary inspector na ang
“dpat each family have healthy status”) nangangalaga sa environment hindi na nurse)
o Group – population group or risk group. • Philosophy: worth and dignity of man (Dr. Margaret Shetland)
 policies of DOH (series of intervention ang ibig sabihin ng
The Public Health Nurses program)
- Professional qualifications: licensed
• Polices of local government health agency (Ex. Acc. To rule
- Personal qualifications:
bawal na mag paanak sa bahay)
• People skills - Competencies skill and knowledge:
• strength on physical, mental and emotional. 1) Nursing Process
• Tested in leadership, resourcefulness, creative, honesty, and 2) Nursing Procedure (vaccination, usually diagnosing
integrity. procedure and health education, home visit or clinic visit) 3)
• Difference in interest, willingness (capacity to work with Community Organizing (for third year students) 4) Health
people). Promotion and Education (first year subject) 5) Surveillance,
- Function consistent: records and reports
• Nursing law 2002 - Philippine nursing RA 9173 • Program

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- Identifies with supervisee issue or problem.
Functions of PHN - Breach of procedure or protocol 🡪 coaching stat 🡪 training
1. Nursing care function (needs further capacity enhancement).
- Based on Science and Art of caring 7. Management function
- Towards health promotion and disease prevention of - Organizes nursing service – implement nursing service plan
individual, family, and community. as part of the overall municipal health plan.
- Uses nursing process and recognized needs of the client. - - 5 management functions:
Home visits or referral (other health provider, environmental 1) Planning
health, social services) 2) Organizing
- Every Wednesday is bakuna day in Luzon, Visayas and 3) Staffing
mindanao 4) Directing
2. Collaborating and coordinating functions 5) Controlling (evaluation)
- Bring group of activity in harmony with each other. - Public Health Nursing
PHN care coordinator. PHN II
- Linkages with: - Frontline Health Worker.
• Government agencies - First Contact of patient (works in health center). -
• NGO Prime mover for all health programs and activities. -
• Health professionals Assist physician during consultation.
• Private sector. - Provides health education (pre or post clinic visit). -
3. Research function Reaches out in community.
- Activity – Disease Surveillance Continuous collection and - Organizes community assemblies for health promotion. -
analysis of data of cases and deaths. Performs Home Visits.
- Purpose of Disease Surveillance: measure magnitude of - Prepare, submit reports (W, M, Q, A).
problem and measure effect of program to improve PHN III
strategies. - Acts as nurse in charge.
- Data will be used to improve care. - Supervises, guides, coordinates work of nurse.
- CHN2- 10 family ang iinterviewhin = 120 people 4. - Interpret policies, participates in planning health program. -
Training function Toward managerial
- Initiate staff development and training program for midwives PHN V
and barangay health worker. - Supervising PHN.
- Training Needs Assessment (TNA). - Assigned in health center with lying-in. (paanakan) -
- Design, conducts training with resources person, and Takes charge of staff and unit.
evaluate training. - Participates in program planning. (madalas nasa munisipyo to
- Training of nursing and midwifery affiliates (RLE). - supervise nurse 2 )
Community organizing. - Attends, meeting, conference for improvement of health services.
5. Health promotion and education function - Aside form BSN kailangan nag masteral of science in nursing ka
- Health education tatanggalin na kase ung MAN
• Is part of our basic health service. - Candidate for managerial nurse ang nag masteral.
• Major components of health program that is done on PHN VI
daily basis. - Nurse program supervisor.
• Solid knowledge of principles of teaching or learning. - - Conducts Program Orientation.
As an educator that provides information (better choices) - Uses - Conducts pre-service and in-service orientation. -
skills in advocacy, influence for health promotion. 6. Supervisory Consolidate reports.
function - Study ratings of PHN performance.
- Supervisor of midwives and auxiliary health workers. - - Initiate meeting, conferences for joint planning. -
Formulate supervisory plan and conducts supervisory visit Nursing consultant on technical matters.
(supervisory checklist).
Laws Affecting PHN
 • RA 6758 – Standardized salaries of government employees - Primary level of health care
Nursing personnel. 1. Rural Health Unit (RHU)
• RA 7305 – Magna Carta of Public Health workers. - Improved 2. Barangay Health Station (BHS)
the social and economic well-being of health workers. 3. Puericulture Center
- Higher basic salary, hazard allowance, laundry allowance, 4. Clinics of large Industrial firms – employee
subsistence allowance 5. Private practitioners or private clinics and others •
• RA 6713 – Code of conduct and ethical standard for public - Basic level of health care.
Officials and employees. Utmost responsibilities, integrity, • Promotion of health, early diagnosis of disease or disability
competence, loyalty, lead modest lives and uphold public and prevention of disease.
interest over personal interest. • The FIRST CONTACT between community members and
other levels of health facility.
Levels of Care

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- Devolving primary and secondary health services
Secondary level of health care delivery Local government units (LGUs)
1. Emergency Hospital (pag aari ni mayor) RA 7160: Implementing Rules and Regulation (IRR) of the
2. District Hospital (pag aari ni mayor) local Government Code of 1991
3. Provincial Hospital (pag aari ni governor) - Devolution of hospital services.
4. City/ Municipal Hospital (pag aari ni governor) • Moderately - Decentralization of basic hospital services.
specialized equipment and laboratory facilities Capable of In public sector:
Minor surgeries Referral Center for PHC. - Managed, coordinated, and regulated by the DOH. o
• Kapag hindi kaya nito ipapadala sa ↓ DOH
Tertiary level of health care − Composed of Central Office (San Lazaro Manila)
1. Regional health service − 17 Regional Offices (ROs)
2. Regional medical services and training hospital − Retained hospitals
3. National health services DOH – Specialty Hospital
4. Medical centers • Lung Center of the Philippines
5. Teaching and training hospital • National Kidney and Transplant Institute
• Ultimate highly specialized health personnel • Philippine Children’s Medical Center
• Highly specialized technical level • Philippine Heart Center
• Specialized ICU DOH – Metro Manila Hospitals
• Advanced diagnostic services for: • Amang Rodriguez Memorial Medical Center
o Diagnosis • Dr. Jose Fabella Memorial Hospitals
o Treatment of disease and disability
• East Avenue Medical Center
QUESTIONS:
• Jose R. Reyes Memorial Medical Center
1. Emphasis of care – promotion
• National Center for Mental Health
2. Primary responsibilities if maayos pakiramdam – health
teaching • National Children’s Hospital
3. Four levels of client – I, F, G, C • E. Rodriguez, Quezon City
• Philippine Orthopedic Center
• Quirino Memorial Medical Center
PHILIPPINE HEALTH CARE DELIVERY SYSTEM • Research Institute for Tropical Medicine
The Philippines • Rizal Medical Center
- Paano yung sistema na pagbibigay serbisyo pagdating sa • San Lazaro Hospital
kalusugan sa mga Pilipino. • Tondo Medical Center
- Archipelago with 7,100 islands. - These hospitals are considered as covid referral hospitals
- Geographically, divided into 3 main islands: Luzon, Visayas and DOH – Regional Hospital
Mindanao. Regional Hospital in Cagayan Valley
- 17 regions, including the Autonomous Region of Muslim • Batanes General Hospital
Mindanao (ARMM). • Cagayan Valley Medical Center
- 82 provinces. • Southern Isabela General Hospital
- 135 cities.
• Region II Trauma and Medical Center
- 1,493 municipalities.
Regional Hospitals on NCR
- 2 Sectors:
• Dr. Jose N. Rodriguez Memorial Hospital – Tala, Caloocan City
• Private Sector
• Las Piñas General Hospital and Satellite Trauma Center •
- production and provision of health goods and services
San Lorenzo Ruiz General Hospital
(private clinics, hospitals and laboratories,
drugstores, and other facilities) • Valenzuela Medical Center
- Regional hospital – governor, mas Malaki ang sahod dahil galling
• Public Sector
sa DOH
- Decentralized health care system. Department of Health
- Health center – mayor
(DOH). Local government units (LGUs).
Levels of Health Care Delivery
 - Section 8 “Minimum Standards and Construction of a Hospital.” - Year 2015 bumagsak tayo sa no. 4, 5, 2 - So nag conduct ng
Republic Act No. 4226 (Hospital Licensure Law) categorized self-evaluation ang Pilipinas at nalaman ito:
based on “service capacities and compliance with standards for
manpower, equipment, construction and physical activities.
1) Primary prevention – maintenance
2) Secondary prevention – referral hospitals
3) Tertiary prevention – highly skilled and technology

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condition or in one type of patient.
Hospital classification scheme
General Hospital
- Services for all types of illness, injuries or deformities.
Level 1
• You must be able to deliver the care of the general public. •
Consult: medicine, pedia, OB-Gynecology, surgery • ER and
OPD
• Isolation Facility
• Surgical or Maternity facilities
• Dental clinic
- • A staff of qualified medical, allied medical and administrative
Maraming namatay sa region na ito pero marami naman palang personnel. (dapat may license)
hospital so they checked the hospital claiming that they are • Headed by a physician duly licensed by the Professional
hospital but below the standard of RA 4226. Regulation Commission (PRC)
Millennium Development Goals: Level 2
1) Eradicate extreme poverty and hunger. • Level 1 plus (lahat nasa lvl. 1 nandito)
2) Achieve universal primary education. • Departmentalized clinical services
3) Promote gender equality and empower women. • Respiratory unit (respiratory therapist works here) •
4) Reduce child mortality. General ICU – critical care sa matanda
5) Improve maternal health. • High Risk Pregnancy Unit
6) Combat HIV/ Aids, Malaria, and other disease. • NICU – critical care sa bata (Neonatal Intensive Care Unit) • An
7) Ensure environmental sustainability. organized staff of qualified and competent personnel with Chief
8) Global partnership for development. of Hospital or Medical Director and appropriate board-certified
- For sustainable development. Clinical Department Heads.
• Medical director – pinaka mataas
New Classification of Hospitals and Other Facilities
Level 3
According to Ownership
• Level 2 plus
- Government – created by law. May be under DOH, DND, DOJ,
LGU, SUCs, GOCC, and others. • Teaching or training with accredited residency training program
- Private – may be single proprietorship, partnership, corporation, in 4 clinical services. (intern doctor – like student nurses)
cooperative, foundation, religious, non government • Physical Medicine and rehabilitation unit.
organization, and others. • Ambulatory surgical clinic (can perform minor surgery) •
According to Scope of Services Dialysis clinic
- General Hospitals – provides medical and surgical care to the sick • Teaching and/or training hospital with accredited residency
and injured and maternity care and shall have as minimum, the training program for physicians in the four (4) major
following clinical services: medicine, pediatrics, obstetrics, specialties, namely:
and gynecology, surgery and anesthesia, emergency services, 1) Medicine
out-patient and ancillary services. 2) Pediatrics
- Specialty Hospitals – specializes in a particular disease or 3) Obstetrics and Gynecology
4) Surgery
 General Level 1 Level 2 Level 3 Surgical or High risk Ambulatory
maternity Pregnancy unit surgical clinic
Clinical Consulting Level 1 plus all: Level 2 plus all: facilities
services specialists
for in in: Department Teaching or Dental clinic NICU Dialysis clinic
patients Medicine aliz ed training with
Pediatrics clinical accredited
OB-GYNE services residency Ancillary Secondary Tertiary Tertiary lab
Surgery training services clinical clinical with
program in laboratory laboratory histopathology
the 4 major
clinical Blood station Blood station Blood bank
services
1st level x-ray 2nd level x-ray 3rd level x-ray
Emergency Respiratory unit Physical
and out medicine and Pharmacy
patients rehabilitation
services unit

Isolation General ICU Specialty Hospital

facilities − for specific disease, condition or type of patient, particular
disease, particular organ or groups of organs, particular group
such as children, women, elderly and others

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- For cancer diagnosis facility
Category D – Specialized Outpatient Facility
Examples of Specialty Hospitals - Dialysis clinic
- Ambulatory surgical
Particular Particular Organ(s) Particular - Cancer chemotherapeutic
Disease Group of - Center/ clinic
Patients - Radiation facility
- Physical medicine
National Lung Center Philippines
- Rehab center/clinic
Orthopedic Children’s
Hospital Medical Center

National Philippine Heart National

Center for Center Children’s
Mental Hospital
Health

San Lazaro National Kidney Dr. Jose Fabella

Hospital and Transplant Memorial Hospital
Institute

Health Facilities Classification

Category A – Primary Care Facility
- W/out in pt. Health charts, out pt. Clinic, dental clinics – first Classification of Hospitals
contact health facility According to Trauma Capability: Guidelines formulated by PCS
- W/ in-pt. – birthing (lying-in), infirmaries – first contact health a) Trauma – capable facility
facility - A DOH licensed hospital designated as a trauma center. -
Category B – Custodial Care Facility Open 24 /7
- Long term care w/ food & shelter to chronic condition needing - Tertiary hospital
ongoing health & nursing care due to impairment, reduce b) Trauma – receiving facility
independence in activities of daily living and rehabilitation. - A DOH licensed hospital w/ in the trauma service area which
- Ex. Custodial psychiatric facilities substance drug abuse therapy receives trauma pt. for transport to the point of care or a
and rehab center, nursing homes, leprosaria/sanitaria Category C – trauma center
Diagnostic / Therapeutic Facility - Open 24/7
- Lab facility Department of Health
- Radiologic facility - The Philippines’ Department of Health (DOH) (Filipino:
 Kagawaran ng Kalusugan) is the principal health agency in the - Ensure highest standard
ph. Administrator of specific services:
- It is the executive department of the Philippine Government - Manage selected national health facilities
responsible for ensuring access to basic public health services - Administer direct service for emergent concern -
to all Filipinos through the provision of quality health care and Administer health emergency response services
the regulation of providers of health goods and services Attached Agencies
- Main governing body - The DOH – constituted of various central bureaus and services in
- Guidance / technical assistance to LGU the Central Office, Centers for Health Development (CHD) in
- Center for Health Development every region, and DOH retained hospitals
Provincial Government - CHN - always updated kaya sa board exam dpt balikan ito
- Administration of provincial or district hospital Filipinos – Vision, Mission, Core Values, & Strategic Goals 1)
Municipal or City Government Vision
- In charge of PHC (RHU/Health Center) - Filipinos are among the healthies people in Sountheast Asia
- BHS by 2022, and Asia by 2040
- Plan, implementation basic health services (health services) 2) Mission
- To lead the country in the development of a Productive,
DOH Rules and Functions Resilient, Equitable and People-centered health system for
Leadership in health: Universal Health Care
- National Policy and regulatory institution 3) Core Values
- Leader in formulation, monitoring, and evaluation of national • Professionalism - DOH performs its functions in accordance
health policies with highest ethical standards, principles of accountability,
- Advocate adoption of health policies and full responsibility.
Enabler and capacity builder: • Responsiveness
- Taga turo • Integrity - The Department believes in upholding truth &
- Innovate new strategies in health pursuing honesty, accountability & consistency in
- Oversight function & monitoring, evaluation of national health performing its functions
plan

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• Compassion & Respect for Human Dignity - DOH upholds

quality of life, respect for human dignity is encouraged by
working w/ sympathy & benevolence for people in need.
• Excellence - DOH continuously strive for the best by
fostering innovation, effectiveness & efficiency, pro action
dynamism, and openness to change
• Commitment – With all our hearts & minds, the Dept.
commits to achieve its vision for health & development of
future generations
• Teamwork – DOH employees work together with a result
oriented mindset.
• Stewardship of the health of the people – Being stewards of
health for the people, the Dept shall pursue sustainable
development & care for environment since it impinges on
the health of Filipinos.
• Strategic Goals – Better Health Outcomes, More Responsive Frameworks of HSRA – 4mula One for Health Plus (F1 Plus)
Health System, More Equitable Healthcare Financing, 4 Pillars of F1 for Health
Financing, Service delivery, Regulation , Governance 1) Health financing – secures sustainable investment to improve
4) Goal health outcomes and ensure efficient and equitable use of
- Formula 1 for Health – Pres. Gloria Macapagal Arroyo - health resources
HSRA – health sector reform agenda 2) Health regulation – ensure high quality and affordable health
• Health financing produts, devices, facilities, and services. RA 11223 Pang
• Health regulation kalusugang pangkalhatan universal health care.
• Local health system 3) Health Service Delivery – ensure the accessibility of essential
• Public health programs quality health services at appropriate levels of care
• Hospital system 4) Good Governance – streghthen leadership and management
capacities, coordination and support mechanisms necessary to
ensure functional people-centered and participatory health
systems
5) Performance Accountability – use management systems to
drive better execution of policies and programs in the DOH
while ensuring responsibility to all stakeholders
 • Cross-cutting pillar of F1 Plus for Health
- which is on performance accountability, it introduces
evidence-based metrics in the health system to
objectively monitor and ensure its responsiveness to
addressing the healthcare needs of Filipinos.
- It supports the achievement of Ambisyon Natin 2040:
Matatag, Maginhawa at Panatag na Buhay

- Mas specific na ito kesa sa millenum developmental goal at ang

tawag na dito ngayon ay sustainable developmental goals.

Health targets of Sustainable Development Goals (SDG) 2030 -

Goal 3 “Good health & well-being” and other health-related targets
in:
• Goal 1 “No poverty”,
• Goal 2 “Zero hunger”
• Goal 6 “Clean water and sanitation”
• Goal 7 “Clean energy”
• Goal 11 “Sustainable cities and communities”
• Goal 13 “Climate action”
• Goal 16 “Peace, justice”

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WHO and UNICEF (United Nations Children’s Fund)
World Health Organization (WHO) - Concept: Health and development of workers for the
- A specialized agency of the United Nations (UN) provides global protection and promotion of health of all the people.
leadership on health matters (kapag healthy daw ang tao madedevelop ang country
- WHO constitution came into force on April 7, 1948. - katulad ngayong pandemic kapag maraming may sakit
1946 – natapos ang gera bumabagsak din ang ating ekonomiya)
- Alma Ata Declaration on Primary Health Care
5 Core Functions of WHO
- Health – fundamental right.
1) Provide leadership on matters critical to health & engage
- Global burden of health inequalities exists.
partnerships when joint action is needed
- Economic and Social development – basic importance for full
2) Shape research agenda. Stimulate generation, translation, &
attainment of health for all.
dissemination of valuable knowledge.
- Government has responsibility for health of people. -
3) Setting norms, standards. Promote & monitor implementation. 4) President at this time is Ferdinand Marcos
Articulating ethical and evidence-based policy options. 5) Provide
Letter Of Instruction (LOI) 949 of 1979
technical support, catalyze change & build sustainable institutional
- First Asian country. (na nagpatupad nito dahil kay Ferdinand
capacity.
Marcos)
- Health – is a product of Socio and Economic development. -
PRIMARY HEALTH CARE
What is the legal basis of primary health care – Letter of
- Essential health care.
instruction 949
- Practical, significantly sound, and socially acceptable methods
- Legal basis of primary health care
and technology.
- Hindi na dumaan s amga senado kundi nag bigay lang ng
- Universally accessible to individual and family in community. -
instruction si president marcos
Through full participation, At cost can afford to maintain; At every
- Hindi nahirapan yung presidente na ipublish yan sa pilipinas
stage of their development.
dahil bago pa mangyari yan, meron na tayong mga RHU
- In Spirit of self-reliance and self-determination.
na pinatayo in 81 provinces.
PHC History
Definition of Public Health Care
September 6 – 12, 1978
- Essential health care
- First international Conference for Primary Health Care. -
- practical, significantly sound & socially acceptable methods &
Happened at: At Alma Ata and USSR (Russia) - Organized by:
 technology
- Universally accessible to I & F in community (mga madaling
mapuntahan)
- Accessible – means w/in 30 min narating na ung health center at
w/in 1 hr naman kapag hospital
- Through full participation of family – active participation - At
cost can afford to maintain – hindi na ilalabas yung pera. - At
every stage of their development
- In Spirit of self-reliance & self-determination
Universal Goal
- Health for all by year 2000. (hindi na attain)
- Acceptable level of health for all in the world.
- Intersectoral
- Through Individual and Community self – reliance. -
linkages – w/in the health system (hospital) - Intersectoral
LOI theme: Health in the Hands of the people by 2020 -
linkages
Primary health care:
- Philippines has a challenge when it comes to location. -
1) Education for health. (using internet fb live) Geographically we are isolate w/ one another because we
2) Locally endemic disease treatment. (malaria etc)
are island.
3) EPI – NIP (National Immunization Program)
- It needs bridges and roads to reach other people. -
4) MCH with responsible parenthood (pagaalala sa buntis at bata at
DPWH ang dapat tumulong sa atin dito
pag bibigay contraceptives – maternal and child health) 5) Essential
- Personal hygiene reason kung bakit nagkaka infection
drugs (libreng gamut)
hanggang sa isinam a ito sa libro
6) Nutrition. (vitamins, iron na libre)
7. Community participation
7) Treatment of communicable disease and non-communicable
- Clients are not recipients of care but active partners. - Dito
disease.
tayo laging bumabagsak kay dapat tayong mag scaling or
8) Safe water and sanitation.
rating, wag mag lagay ng mataas na score kung alam namn
Key Principle of PHC hidni susunod ang community
1. Accessibility – within 30 mins narating 8. Equitable distribution of health resources
2. Affordability – wala silang gagastusin - (DTTB) Doctors to The Barrio Program – if you want to
3. Acceptability – within the culture. study medicine at have scholarship avail this but this have
4. Availability – available dapat resources natin return service. If you study on state and government
5. Support mechanism university hindi sila agad agad makakapag abroad.
6. Multi sectoral approach

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- Basic services at brgy level
- RN Heals – ang munisipyo ang mag papasweldo sa tauhan na - Satellite station of RHU
nasa loob. Nung maraming pinagaawa ang DOH na ang - Manned by volunteer BHW under the supervision of midwife -
magbabayad to pay and hire these nurses but ilalagay sa Branch ito ng health center
facility ni mayor. - Ang pagkakaiba dito sa main health center, ang BHS ay kulang
9. Appropriate technology ng health care workers.
- Health technology – tools, drugs, methods, procedures and - What facility of the government is considered as smallest? -
techniques. barangay health station.
- Criteria:
1) Safe Rural Health Unity – Personnel
2) Effective MHO / Municipal Health Officer
3) Affordable - Or Rural Health Physician
4) Simple - Head the health services
5) Acceptable - Roles/ functions: Administrator of RHU – plan & budget -
6) Feasible or reliable Community physician
7) Ecological effects - Mga mataas ang doctor dito sila ang tumatayong admin at
8) Potential to contribute to individual and community humahawak ng pondo at medico legal
development - Medico-legal officer of Municipality – pag mag dedemanda, may
- Lagundi and leopolds maneuver assessment from para ditto.
- Manager of health center: Nurses
RURAL HEALTH UNIT PHN / Public Health Nurse
- Main Health Centers - RHM - Supervises/guides
- Primary level health facility in municipality - Field Health Service Information System (FHSIS) – Prepares,
- Focus: preventive, promotive health services report – main responsible in recording report
- Supervision of BHS - Nursing Process – utilize when responding
- 1 : 20,000 • NCP – Nursing Care Process (one person)
Barangay Health Station • FNCP – Family Nursing Care Plan (family)
- 1st contact health care facility • CNCP – nursing process for whole community - GO, NGO,
private business, people – performing collaboration - Hospital one
nursing process will be used while in community three nursing Health Referral System
process will be used - Set of activities undertaken by health care provider in response to
PHM / Public Health Midwife its inability to provide necessary health intervention - 2-way
- Manages BHS, trains BHW barangay health worker - referral system:
Provides midwife services & program • If the one health facility cannot provide the health service, it
- Pt. assessment for referral will refer to the hospital. (hindi kakayanin ng health center
- Health information, education, & communication - ang confinement ni patient so irerefer siya sa hospital and
Organizes community vice versa)
- Facilitate brgy health planning • If the hospital cannot provide the health service, it will refer
- Mga ginagawa dito is related with reproductive health to the health facility.
RSI / Rural Sanitary Inspector
Interlocal Health Zone - ILHZ
- Ensures healthy environment Composition
- Through advocacy, monitoring, regulatory
- People – Ideal health district population size (100,000 & 500,000)
- Ex. Inspect water supply
for optimum efficiency, effectiveness (WHO, 1986). - Population
- Community sanitation ay sa nurses dati pero ngayon hindi na
Vary - depending on number of LGUs decide to cooperate &
BHW / Barangay Health Worker
cluster
- Interface between community & RHU
- Boundaries – Clear boundaries between Inter Local Health Zones
- Trainings: preventive health care. FP,
- determine accountability & respective health service
- MCH, Nut, San’tion, Rep’tive H.
providers.
- RA 7883 – Entitled to hazard & subsistence allowance
- Geographical locations & access to referral facilities such as
Local Health Board district hospitals are usual basis in forming the boundaries - Health
- Chairman – mayor / prov. Governor → municipal health officer, Facilities – A district or provincial hospital (referral hospital for
doctor → sanggunian → rep. from the people - Representative secondary level of health care), Rural Health Units (RHU),
from the people – example representative ng mga matatanda = Barangay health stations (BHS) & other health services deciding to
president of Senior Citizen; sa mga kabataan = SK Sangguniang work together as an integrated health system.
kabataan – usually this are the people who has a capacity to decide - Health Workers – Right mix of health providers needed to deliver
and they can help in planning. These are the people who have the comprehensive health services.
capacity to decide and be part of the planning. - Groups of health providers are:
- Function: • Department of Health
• Prepares budget • District hospital
• Advisory committee • Rural Health Unit
• Advisor
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• Basic Health Unit

• Private clinics
• Volunteer health workers
• Non-Government Organization
• Community-based organizations.
- They form LHZ team to plan joint strategies for district health
care.
- Hindi pwedeng mag pagamot sa health center kapag hindi siya
sakop ng boundary dahil:
- Sa reporting and recording
- Mauubos ang pondo natin
- Mauubusan ang gamit tapos ung kabila madami pang stock.
- Kapag lumagpas an sa 100, 000 kailangan ng isa pang health
center. Yun ang tinatawag na district 1, 2, 3
- Health facility, dpt ung district 1 kumpleto ang gamit may health
center, referral hospital at kumpletong health worker. Kung FAMILY HEALTH NURSING
anong meron sa isa ganun din dpt sa district 2. Bawal ang National Statistical Coordination Board
hiraman ng health worker dito. - Family - a group of people usually living together and composed
of the head by blood, marriage and legal adoption. (Community will
not develop kapag nag ka-kanya-kanya)
- Johnson – Social unit interacting with the larger society. - Allen –
Characterized by people together because of birth, marriage,
adoption, or choice. (he is foreigner and divorce in their country is
legal)
- Executive Order 209 Family Code – Marriage is special contract
of permanent union between man and woman. (President ang
 nag sabi nito, in our society we accept a male with a partner as
one family pero kapag legalities they are not accepted. Kaya
kapag namatay ang dalawang mag kasintahang parehas na
lalaki o babae pwedeng i-contest ng mga kamag anak ang mga
naiwang ari-arian)
- Friedman - two or more persons who are joined together by bonds
of sharing and emotional closeness and identify themselves as
part of family. (hindi kailangan kasal; like live in partners)
Family Assessment
- The family interview:
• Effective communication is essential in the 1st step to •
Components of Initial Data Base:
establish trusting relationship.
1) Family structure, characteristics and dynamics
• Same principles used in an effective interview with a client
2) Socio-economic and cultural characteristics (sahod, pinag
apply.
aralan, religion, saan sila nag mula)
• Family assessment tools are available.
3) Home and environment (malinis ba ung bahay, gawa ba
• Many agencies have a standard form.
saan)
• Tool: IDB or Initial Data Base 4) Health status of each member (sinong mga nag ka sakit,
- NCP: vital signs and cephalo caudal assessment commonly respiratory diseases, mag banggit ng top 10
diseases)
5) Values and practice on health promotion, maintenance and
disease prevention (hand washing, sleeping pattern,
vaccination history – mga batang 5 years old and below
lang ang tanungin)

Family forms or family structure

Based on Internal Organization and Membership or Components.
• Dyad
- Empty nester. (newlywed, or matgal ng kasal but do not have
a child)
• Cohabitating
- Live-in.

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- Pregnancy outside of wedlock, separation, death of spouse. -
- Common law spouses and children. (means live-in but this is usually sa babae napupunta ang anak
what we should use in our form) • Gay or Lesbian Family
- Not married legally but they are married in terms of the law - Cohabitating couple of same sex, not legal.
of masses or common table. - Acceptable as a family in society but not acceptable in the
- Medical professional should not use the word “live-in legality
verbally and by documenting
• Compound family Classification of family
- Man has more than 1 wife. Based on Authority
- Acceptable under Presidential Degree 1083. • Patriarchal
- This is not acceptable for woman. - Authority is vested on the oldest male in the family, often the
- Muslim relationship can do this father.
• Blended - kung sino ung nag de-decide siya dpt ang interviewhin •
- 1 or both spouses bring in child or children from previous Matriarchal
marriage in their new living arrangement. - Authority is vested in the mother or mother’s kin.
- parehas patay/hiwlay sa asawa at may anak at nag sama as
one family at nag ka sariling anak. Maraming challenge • Matricentric
dito - Prolonged absence of the father gives the mother a dominant
• Nuclear position in the family, although the father may also share
- Husband, wife, children, marriage, procreation. • with the mother in decision making.
Extended - kapag nasa abroad ung asawa at humingi ng decision making
- 3 generations. Married sibling and their family with sa kanya, kung sino ung nasa bahay siya pa din ang
grandparents. masusunod
• Single Parent • Patricentric
 - Prolonged absence of the mother gives the father a dominant - In this case, the husband has more than one wife at the same
position in the family, although the father may also share time. This type of family can be found mostly in Saudi
with the mother in decision making. Arabia.
- kabaliktaran nung matricentric • Polyandrous Family
Based on Pattern of Residence - This family consists of a wife with more than one husband.
- Newly wed need assistance kase maraming bata at matandang This can be found in the Todas of Southern India.
namamatay dito sa PH
- This would determine who are the supports person of the family Genogram
• Patrilocal - Known as McGoldrick–Gerson study, a Lapidus schematic or a
- When a married couple lives with or near the husband’s family diagram.
family. - A pictorial display of a person's family relationships and medical
• Matrilocal history.
- When a couple lives with or near the mother’s family.
MALE FEMALE
• Neo-Local
- When a married couple sets up a home separate from either
side of their families.
- Can stand on their own
Based on Pattern of Lineage
- Kayamanan ang pag uusapan dito, usually happens in Chinese
people - Straight line signifies good relationship to each other, broken
• Patrilineal Family lines broken family
- This type of family occurs when property and title
inheritance pass down through the father’s side.
• Matrilineal Family
- his is where the property and title inheritance pass through
the mother’s side.
Based on Amount of Mates
• Monogamous Family
- In this instance, a husband only has one wife. This is the
western idea of a typical marriage.
• Polygamous Family

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• Language spoken at home and in the community

• Health beliefs
• Crisis events (In PH umbilical cord are displayed in front
of the house)
• Holidays and special events
• Contact with cultural and religious institutions
• Values about education and work
• Values about family structure (power, hierarchy, rules,
subsystems, and boundaries)
 Developmental Assessment
- Duvall (1977) theory of development stages of family life
- Stages within the life cycle of every family; each stage
includes distinct family developmental tasks.
Marriage
- For a family to function as a unit they should ↓
- Formation of identity as a couple.
- Inclusion of spouse in realignment of relationship with
extended families. (kapag kinasal tapos nakitira sa pamilya)
- Parenthood decision making.
Family with Young Children
- Integration of children into family unit. (reason why in the us
Culturagram workaholic so ung responsibilidad sa anak hindi na
- Develop a better understanding of the sociocultural context of the nagagampanan)
family as well as identify appropriate interventions for the - Adjustment of tasks: Child rearing, financial and household. -
family. (Congress & Kung, 2005) Accommodation of new parenting and grand parenting role.
- Most important because this causes hindrance, hindi mo maayos (parehas dapat tutulong)
ang health niya if marami siyang pinaniniwalaan • Reasons for Family with Adolescent
relocation - Development of increasing autonomy for children. (children
• Legal status practice independence)
• Time in the community - Midlife re-exam of marital and career issues.
naghihiwaly madalas ang mag asawa ay dahil parehas
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grandchildren. (kung dati ung magulang lagi na susunod ngayon
- Initial shift towards concern for older generation. (alam na nilang may asawa na dpt din iconsider ung kabilang pamilya) - Dealing
tatanda na sila) with disabilities and older generation.
- Consider children as blacksheep of the family kase makulit na but - Ga-graduate na ang anak, mag kaka sariling pamilya, etc
we have to explain na dumadaan lang tlga sa ganon. - Anong Aging Family
problema ng pamilya na may adolescent na anak Family as - Maintaining as couple or individual while adapting to aging
Launching Centers process.
- Establishment for different identities for parents and children. - - Support role of middle generation.
Renegotiation of marital relationship. - Support and autonomy of older generation.
- Re-adjustment of relationship to include in-laws and
- Preparation for own death; deal with loss of spouse, sibling, peers. - Pinagkukuhanan ng mga kagamitan
- Highest stress is a death of a spouse tapos walang support ng • Welfare and protection
pamilya hihina katawan niya at mamatay na din siya. o Partners - companionship, affective, sex, socioeconomic. o
Children - Emotional gratification, psychological security,
Family according to Defrain and Montalvo motivation, morale.
Description of a healthy family working as a unit: Levels of Preventive Care
- Interact with one another. 1) Primary Prevention
- Can establish priorities.
• Health promotion
- Support, respect, and affirm one another.
• Specific promotion
- Members has flexible role.
• Genetic counseling
- Foster responsibility and value service to others. -
Have sense of play. • Environmental change
- Ability to cope with stress. • Hearing conservation
- Start of first interaction in the family. • Immunization
• Status placement • Prenatal care
- Family confers its social rank into the society. • Vocal hygiene
- Kung mahirap ang magulang un na rin ang classification ng • Prevention of secondary communication disorder 2)
mga bata Secondary Prevention
• Economic function • Early diagnosis and prompt treatment
o Rural family – unit of production. • Disability limitation
o Urban family – unit of consumption, enterprise. 3) Tertiary Prevention
• Physical maintenance • Restoration and rehabilitation
- Survival needs of dependents.

Characteristics of a Healthy Family

HERBAL MEDICINE
- Republic Act 8423, known as the Traditional and Alternative
Medicine Act (TAMA) of 1997 - traditional medicine program.
- Traditional and Alternative Medicine Act (TAMA) Authored
by Senator Juan Flavier and approved on December 1997.
(dati siyang secretary of DOH)
- This gave rise to the creation of Philippine Institute of
Traditional and Alternative Health Care (PITAHC).
- Tasked to promote and advocates use of traditional and
 Functions of Family - Family as a first teacher of societal rules.
• Procreation alternative health care modalities through scientific research
- Universal accepted institution for reproductive functioning or and product development.
child-rearing. - Philippine Department of Health (DOH) through its "Traditional
- Most Filipinos are catholic so we are mono type relationship Health Program" has endorsed 10 medicinal plants to be used
• Socialization of family members as herbal medicine in Philippines due to its health benefits.

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• Asthma, Cough and Fever – Decoction. Boil raw fruits or
Traditional Health Program leaves in 2 glasses of water for 15 minutes.
- 10 medicinal plants as herbal medicines in Philippines. - Attested • Dysentery, Colds and Pain – Decoction. Boil a handful of
by National Science and Development Board. - Sum total of leaves and flowers in water to produce a glass, three times
knowledge, skills and practice on health care, not a day.
necessary explicable in the context of modern, scientific • Skin diseases (dermatitis, scabies, ulcer, eczema) - Wash and
philosophical framework. clean the skin or wound with the decoction.
- Recognized by people to help maintain and improve their health • Headache – Crush leaves may be applied on the forehead.
towards the wholeness of their being, community and society (didik-dikin at ilalagay sa noon g patient na may bimpo)
and their interaction based on culture, history, heritage and
• Rheumatism, sprain, contusions, insect bites – Pound the
consciousness.
leaves and apply on affected area.
Medical Plants Preparation Yerba Buena
• Decoction - Mentha cordifelia – scientific name
- Boil recommended parts in water. - Analgesic to relive body aches and
- Boiling time: 20 minutes. pain due to rheumatism and gout. It is
- Kapag maligam-gam na hatiin into equal parts into 3. - also used to treat coughs, colds and
Inumin 3 times a day insect bites.
- Pinapakuluan ng walang takip with minimal water para mas - Uses and preparation:
concentrated • Swollen gums – Steep 6 g. of fresh plant in a glass of boiling
- Mas magandang gamitin ang palayok para mas makatasan water for 30 minutes. Use as a gargle solution. • Toothache –
ang dahon. Cut fresh plant and squeeze sap. Soak a piece
• Infusion of cotton in the sap and insert this in aching tooth cavity.
- Plant part soaked in hot water like tea. (this is only for a remedy)
- 10 – 15 minutes. • Menstrual and gas pain – Soak a handful of leaves in a class
• Poultice of boiling water. Drink infusion.
- Directly apply recommended part on affected area. - • Nausea and Fainting – Crush leaves and apply at nostrils of
For bruises, wounds, rashes. patients. (amoy nito ay pwede ibigay sa pt.)
- Di-dik-dikin at ung katas ay ipapahid sa affected part. • • Insect bites – Crush leaves and apply juice on affected area
Tincture or pound leaves until like a paste, rub on affected area.
- Mix plant part in alcohol. • Pruritis – Boil plant alone or with eucalyptus in water. Use
- May alcohol pang preserve at pang katas decoction as a wash on affected area. (sa pangagati
Halamang Gamot ipanghuhugas natin ito)
- Akapulko • Pain (headache, stomachache) – Boil chopped leaves in 2
- Ampalaya glasses of water for 15 minutes. Divide decoction into 2
- Bawang parts, drink one part every 3 hours.
- Bayabas • Rheumatism, arthritis and headache – Crush the fresh leaves
- Lagundi and squeeze sap. Massage sap on painful parts with
- Niyog-niyugan eucalyptus
- Sambong • Cough and Cold – Soak 10 fresh leaves in a glass of hot
- Tsaang gubat water, drink as tea (expectorant).
- Pansit-pansitan Sambong
- Yerba Buena - Blumea balsamifera – scientific name
Lagundi - Treat kidney stones, gout (rich in
- Vitex negundo – scientific name proteins).
- 5-leaved chaste tree – english name - Uses and preparation:
- used in Philippine herbal • Anti-edema, diuretic, anti
- Medicine to treat cough, colds and urolithiasis – Boil chopped leaves
fever. in a glass of water for 15 minutes until one glassful
- Relief for asthma and pharyngitis. remains. Urolithiasis is a stone in the kidney.
- Recommended for mild covid infection • Divide decoction into 3 parts, drink one part 3 times a day. •
- Uses and preparation: Diarrhea – Chopped leaves and boil in a glass of water for 15
 minutes. Drink one part every 3 hours. (mas maiksi interval - Uses and preparation:
kase ung m.o causing diarrhea mabilis mag multiply) • Diarrhea – Boil chopped leaves into 2 glasses of water for 15
Tsaang Gubat minutes. Divide decoction into 4 parts. Drink 1 part every
- Carmona retusa – scientific name 3 hours.
- Wild tea – english name • Stomachache – Boil chopped leaves in 1 glass of water for 15
- Taken as tea to treat diarrhea with minutes. Cool and strain.
abdominal pain.

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• Divide into 3 parts and drink one part 3 times a day.
Niyog-niyogan Bawang
- Quisqualis indica – scientific name - Allium sativum – scientific name
- Chinese honey suckles – english name - Garlic – English name
- To eliminate intestinal parasites. - Treat infection with antibacterial,
- Uses and preparation: anti-inflammatory, anti-cancer and
• Anti-helmintic – The seeds are taken antihypertensive properties.
2 hours after supper. - To reduce cholesterol level in blood.
• If no worms are expelled, the dose may be repeated after one - Uses and preparation:
week. • Hypertension – Maybe fried, roasted, soaked in vinegar for 30
• Caution: Not to be given to children below 4 years old. minutes, or blanched in boiled water for 15 minutes.
Bayabas Take 2 pieces 3 times a day after meals. (bawal kainin ng
- Psidium guajava – scientific name deretsyo dahil mainit ito at baka mag ka ulcer ang patient;
- Guava – english name dapat taken as maintenance para umepekto)
- As antiseptic, anti-inflammatory, • Toothache – Pound a small piece and apply to affected area.
antispasmodic, antioxidant Ampalaya
hepatoprotective, anti-allergy, - Momordica charantia – scientific name
antimicrobial, anti-plasmodial, anticough, antidiabetic, and - Bitter melon or bitter ground. – English
antigenotoxic in folkloric medicine. name
- Uses and preparation: - Treatment of diabetes (diabetes mellitus),
• For washing wounds – Maybe use twice a day. (pang langgas hemorrhoids, coughs, burns and scalds,
sa mga na circumcise) and being studied for anticancer
• Diarrhea – May be taken 3-4 times a day. properties.
• As gargle and for toothache – Warm decoction is used for - Muarng dahon or ung batang dahon ang gagamitin dito -
gargle. Freshly pounded leaves are used for toothache. Mild diabetes lang kaya lutasan
Boil chopped leaves for 15 minutes at low fire. Do not - Uses and preparation:
cover and then let it cool and strain. • Dependent – Chopped leaves then boil in a glass of water for
- Note: sa mga bagong panganak unang ligo ay dahon ng lagundi o 15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3
bayabas times a day after meals.
Akapulko
- Cassia alata – scientific name Reminders on the Use of Herbal Medicine
- Ringworm bush or schrub and Acapulco – 1. Avoid the use of insecticide as these may leave poison on plants.
English name 2. In the preparation of herbal medicine, use a clay pot and remove
- To treat tinea infections, insect bites, cover while boiling at low heat.
ringworms, eczema, scabies and itchiness. 3. Use only part of the plant being advocated.
- Not native plant in the PH, it is from the 4. Follow accurate dose of suggested preparation. 5. Use only one
spain. kind of herbal plant for each type of symptoms or sickness. (bawal
- To treat had-had, buni, alipunga. Takes several times to effect - inumin ng sabay-sabay ang ibat ibang dahon)
Uses and preparation: 6. Stop giving the herbal medication in case untoward reaction
• Anti-fungal (tinea flava, ringworm, athlete’s foot and such as allergy occurs.
scabies) – Fresh, matured leaves are pounded. 7. If signs and symptoms are not relieved after 2 to 3 doses of
herbal medication, consult a doctor.
• Apply soap to the affected area 1-2 times a day.
Ulasimang Bato or Pansit-Pansitan Alternative Health Care Modalities
- Peperonica pellucida – scientific name - As defined by law.
- Effective in treating arthritis and gout. - Other forms of non-allopathic, occasionally nonindigenous or
- Uses and preparation: imported healing methods.
• Lowers uric acid (rheumatism and - Includes: reflexology, acupressure, chiropactics, and nutritional
gout) therapy.
• One a half cup leaves is boiled in two glass of water over low Acupressure
fire. Do not cover pot. (kapag sobrang kulo na hinaan na) - Application of pressure on acupuncture points without puncturing
 the skin. Acupressure stimulates the body at certain meridians, - Application of therapeutic pressure on the body’s reflex points to
or pressure points. enhance body’s natural healing mechanisms and balance body
- Meron tayong meridian point at ang katapos-tapusan nun ay CNS. functions. Based on principle that internal glands and organs
From meridian point put pressure so that the body will have can be influenced by properly applying pressure to the
natural healing. corresponding reflex area on the body.
Reflexology

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Acupuncture - Acupuncture points are anatomically defined areas

on the skin relative to certain landmarks on body. Indicated that
there were holes in the skin through which qi energy could flow. -
Uses meridian point but doesn’t use pressure but rather punctured.
Massage
- Superficial soft parts of the body are rubbed, stroked, kneaded or
tapped for remedial, aesthetic, hygienic or limited therapeutic
purposes.
Chiropratic
- Concerned with pathogenesis, diagnosis, therapy and prophylaxis
of functional disturbances, patho-mechanical
states, pain syndromes and neurophysiological effects relieve
to static and dynamics of locomotors system, especially spine
and pelvis. Traditionally uses manipulation of the spine and
limbs.
- Ina-aligned ang mga buto
Herbal Medicine or Phytomedicine
- Finished, labeled, medicinal products that contain as active
ingredients, aerial or underground parts of the plant or other
materials or combination thereof, either in the crude state or as
plant preparations.

Nutritional Therapy
- Use of food as medicine and to improve health by enhancing the
nutritional value of food components that reduces risk of
disease. Synonymous with nutritional healing.
- Kapag nurse na inoorder ng doctor ang nutrition.
Pranic Healing
- Holistic approach of healing that follows the principle of
balancing energy.
- Ex. Hot and cold compress.
 health. It is adaptable to any practice setting or specialization
FAMILY NURSING PROCESS and the components may be used sequentially or concurrently.
− The blueprint of the care that the nurse designs to systematically Phase of nursing process
minimize or eliminate the identified health and family nursing 1. Assessment
problems through explicitly formulated outcomes of care and 2. Diagnosis
deliberately chosen set. 3. Planning
− We always start after we get the trust of the client with 4. Implementation
assessment and with our plan tsaka pa lang mag intervention − Not 5. Evaluation
all problems can be eliminated some will just be reduced or - Relating – rapie
minimize. - Since we are taking care of the family inu-una dito ung relating -
We also start with introducing our self during interview, discussing
− FNCP considers two level of assessment:
the procedure.
- Health problem – first level of assessment
- Family nursing problem – second level of assessment Assessment
1. Data collection
Nursing process
2. Data analysis
− A problem-solving approach that enables the nurse to provide
- “kamusta po kayo? Ilan po ang anak niyo?”
care in an organize and scientific manner. It is applicable to
individuals, families and community groups at any level of

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3. Physical examination
Data collection - Done through inspection, palpation, percussion,
Three sources of data auscultation measurement of specific body parts and
1. First source – health status of the family. reviewing the body systems.
2. Second source – family’s status as functioning unit. (undergo - They use their CHN Bag
some process and stages that is called developmental stage. As
4. Review of records
they grow they should accomplish. Each developmental stage
- Reviewing existing records and reports pertinent to the
they have to accomplish something. If they are dysfunctional
and do not know how to work with one another then mag kaka client.
gaps sa illnesses or health at hindi magiging successful ang 5. Laboratory or diagnostic test
isang pamilya) - Performing laboratory tests, diagnostic procedures or other
3. Third source - family's environment (because they can live to test of integrity and function carried out by the nurse
illnesses like infection) herself and /or health workers.
- Hospital nurse – collects data about past health - Mga buntis at may t bang karaniwang meron nito. 5
Methods of gathering data types of data use as initial data base for family nursing 1.
1. Direct observation Family structure and characteristics
- A method of data collection which is done through the use a. Members of the household; relationship to the head of the
of all sensory capacities. family.
- The nurse gathers information about the family’s state of b. Demographic data- age, sex, civil status, position in the
being and behavioral responses. family.
- Presence of s/s: c. Place of residence of each member - whether living with or
▪ Physical make up of each member. elsewhere.
▪ Communication or language patterns expected and d. Type of family structure-matriarchal, patriarchal, nuclear or
tolerated. extended.
▪ Role perception/task assumption by each member, e. Dominant family members in terms of decision making in
including decision-making patterns. matters of health care.
▪ Conditions in home and environment f. General family relationship - presence of obvious or ready
− We should use our sensory (kung nakikita mo na wag mo observable conflict between members; communication
ng tanungin) patterns among members.
2. Interviewing - This is the first data we ask.
- Productivity of interview process depends upon the use of - Place of residence, hindi naman need ilagay minsan dahil
effective communication techniques to elicit needed pare-parehas naman sila ng tirahan
responses. - Name, initial lang dapat ang ilagay
- Encourage verbalization of thought and feelings and offer - Address, wag ng masyadong kumpleto (st. brgy and city
needed support or reassurance. pwede na magamit)
- Use the initial data base for you to be guided on how to
interview.
 poverty line at kung tugma ba ung minimum wage na
Househo Age Sex Civil Position Place of
ld sinasabi sa PH.
status in the residence
member family b. Educational attainment of its members (kapag bata pa kinder
ganun, student)
RD 24 Male Live-in Father Living c. Ethnic background and religious affiliation
with d. Significant others - roles they play in the family
e. Relationship of family to community- what is the
JC 23 Female Live-in Mother Living participation of the family in community activities?
with
Hou Occup Pl Inc Educati So/
AL 3 Male Son Son Living
with seho ation a om onal roles
e
ld ce attainm in
OJ 2 Female Daughter Daughter Living
with mem of ent the
ber wo family
rk
2. Socio-economic and cultural factors
Rd Carpenter Qc P9000 High Provider
a. Income and expense
/mos. school
- Occupation, place of work, income of each working
grad
member
- Adequacy to meet basic necessities (food, clothing, Jc Housewife - - College grad House
shelter) keeper
- Who makes decision about money and how it is spent - We
ask kung saan sila nag tatrabaho, mag kano ang income for
one month, para malaman kung ang pamilya ay below the
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• The family lives in a small room
Al Children - - - Member • Inadequate living space
• They do not have beds and used to sleep in their floors, in
Oj Baby - - - Member a slanted position
• There is presence of breeding or resting sites of vectors of
disease as manifested by an open-canal found outside
their house.
3. Environmental factors • Presence of fire hazards due to the used of candle during
a. Housing night/sleep time
• Adequacy of living space. • Presence of fall hazards due to dark surroundings and un
• Sleeping arrangement. railed stairs
• Presence of insects and rodents. • They used to fetch water from the faucet of their neighbor
• Adequacy of the furniture. • Poor environmental sanitation due to poor drainage • Poor
• Food storage and cooking facilities. environmental condition due to dirty toilet bowl and
• Presence of accidents hazards. slippery toilet floor
• Water supply-source, ownership, portability. • Poor environmental condition as manifested by pile of
• Toilet facility-type, ownership, sanitary condition. • garbage found in their hallway
Garbage/refuse disposal – type, sanitary condition. • 4. Health assessment of each member
Drainage system – type and sanitary condition. a. Medical and nursing history indicating past significant
- Strong – pure cement illness, beliefs and practices conducive to illness.
- Light – pure wood • Anthropometric data- weight, height.
- Mixed – wood and cement • Dietary history indicating quality and quantity of food
b. Kind of neighborhood- congested, slum, etc. intake per day
c. Social and health facilities available • Eating/feeding habits and practices
d. Communication and transportation b. Nutritional assessment (specifically for vulnerable or at risk
- May alaga bang hayop or halaman members)
- May toilet ba at maayos na tubig c. Current health status indicating presence of illness states
- Example: housing (diagnosed/undiagnosed by medical practitioner)
 - Mahiyain ang pamilya kaya hindi sasabihin ang sakit. Kaya • Health problem:
dapat ikaw na ang mag sasabi banggitin mo ung top 10 - Is defined as situation or condition which interferes with the
diseases. promotion and/ or maintenance of health and recovery from
- Communicable at infectious diseases ang common 5. illness and injury.
Value placed on preventive disease - A health problem becomes a nursing problem when it can be
a. Immunization status of children modified through nursing interventions.
b. Use of other preventive services • Health need:
- We ask kung nag handwashing, napapaliguan ang mga bata, - Exist when there is a health problem that can be alleviated
at ngayong covid-19 maraming prevention na ginagawa. with medical or social technology.
Data analysis - Not all family have health need. Because one may know how
- Comparison of the gathered data to the standard or norms. - to solve or eliminate the problem but if they don’t lalabas ang
Norm – means normal and it is called standard health need pupunta pa sila sa health center. - Dapat natin silang
- Q: what are you going to do in data analysis? Data analysis is maturuan para hindi sila umasa sa atin.
comparison with the norm.
- Ex. Temperature Diagnosis
• Three types of standards or norms Typology/ types of nursing problem
a. Normal health of individual members. - The study or systematic classification of types. (we use first level
b. Home and environment conditions conducive to family of assessment if it is health deficit, threat and foreseeable crisis)
development. (normal na bahay means hindi nag dudulot ng - A tool or classification of family nursing problems that reflects
sakit ang bahay kaya it is conducive for the family the family status and capabilities as a functioning unit. (we use
development) second level of assessment which is family nursing problem) -
c. Family characteristics, dynamic and level of functioning ”kailan po kayo nangupahan dito?”
conducive to family development. (each developmental task First level
dapat nagagawa natin ang responsibilidad natin kase kung a. Health deficits
hidi natin nagagawa it can lead to illness) - Instances of failure in health maintenance and development.

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(madami ng anak hindi na ma provide ang needs)
- Occurs when there is a gap between actual and achievable • Accident hazards
health status. o Broken stairs
- Diagnosed/suspected illness states of family members. - o Pointed sharp objects, poison and medicine
Sudden or premature or untimely death illness or disability and improperly kept
failures to adapt reality of life emotional control and stability.
o Fire hazards
- Deviations in growth and development. o Fall hazards.
- Personality disorders.
• Inadequate food intake both in quantity and quality o
- Hindi na maintain ang kalusugan may sakit, disabled, hindi
Excessive intake of certain nutrients
lumalaki, at mental disorder
o Faulty eating habits
- Example:
• Stress provoking factors
• Illness regardless whether it is diagnosed.
o Strained marital relationship
• Failure to thrive or inability to develop according to o Strain parent-sibling relationship
normal rate. o Interpersonal conflicts between family members.
• Disability arising from illness, whether • Poor environmental sanitation
transient/temporary.
o Inadequate living space
− Temporary: aphasia or temporary paralysis after cva. − o Inadequate personal belongings/utensils
Permanent: leg amputation secondary to dm, blindness from o Lack of food storage facilities
measles, paralysis from polio. o Polluted water supply
b. Health threats o Presence of breeding places of insects and rodents
- Condition that are conducive to diseases, accidents or failure o Improper garbage/refuse disposal
to realize one’s health potential. o Unsanitary waste disposal
- Walang sakit, magkakaroon palang dahil siguro may ganito ng o Improper drainage system
sakit ang pamilya o Noise pollution
- Example: o Air pollution
• Health history of specific condition/disease • Unsanitary food handling and preparation
o Family history of dm • Personal habits/ practices
• Threat of gross infection of cd case o Frequent drinking of alcohol
• Family size beyond what resources can adequately provide o Excessive smoking
 o Walking barefooted • Marriage
o Eating raw meat/fish • Pregnancy, labor, puerperium
o Poor personal hygiene • Parenthood
o Self-medication • Additional member-newborn, lodger.
o Use of dangerous drugs or narcotics • Abortion
o Sexual promiscuity • Entrance at school
o Engaging in dangerous sports
• Adolescence
• Inherent personal characteristics- short temper
• Loss of job
• Health history which may precipitate the occurrence of
• Death of a spouse /member (pinaka mataas na stress
health deficit-previous history of difficult labor.
source kaya kapag hindi natin na suportahan ang tao
• Improper role assumption-child assuming mother’s role, hihina ang katawan niya at mamamatay na siya)
father not assuming his role.
• Resettlement in new community
• Lack of/ inadequate immunization status of children •
• Illegitimacy
Family disunity
Drill
o Self-oriented behaviour of members
• Wellness state – walang sakit o problema
o Unresolved conflicts among members
• Deficit – may sakit na
o Intolerable disagreements
• Threat – mag kaka sakit pa lang, posibleng mag ka sakit •
c. Stress points/ foreseeable crisis situation
Foreseeable crisis / stress point – stress ang buhay, maraming
- Anticipated periods of unusual demand on the individual or
adjustment
family in terms of adjustments/family resources.
Health Problem
- Kailangan maraming period of assessment and adjustment
i. First Level of Assessment – Presence of health deficit, health
dahil crucial period ito ng pamilya
threats, and foreseeable crisis/ stress points in the family.
- Example:

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• Subjective – from patients − Second level of assessment is considered as diagnosis

• Objective – from nurses Two parts:
• Maglaya framework – used table here in the Philippines 1. General
Second level of assessment - The statement of the unhealthful response
Family health task:
- Family health task
1. Inability to recognize presence of problem
- Nandito ung mga hindi niya nagawa or inabilities
2. Inability to make decisions with respect to taking appropriate
2. Specific
health action
- The statement of factors which are maintaining the
3. Inability to provide adequate nursing care to the sick, undesirable response and preventing the desired change -
disabled, dependent or vulnerable/at risk member of the
Due to or related to
family.
- Dahilan kung bakit hindi niya nagagawa
4. Inability to provide home conducive to health maintenance,
Example:
personal development
• General: inability to utilized the community resources for
5. Failure to utilize community resources for health care
health care due to
− Should use community health center
• Specific: lack of adequate family resources, specifically, o
− Kapag may hindi nagawa dito there is inability
 Financial 5. Nursing care is a means to an end, not an end in itself. (it is a
o Manpower continues process, isang fmily kase ito e maso-solve ung isa
o Time tapos meron na naman)
6. Nursing care plan is a continuous process not a one-shot
deal.
Desirable qualities a nursing care plan
Planning
1. Based on clear definition of the problems.
- “hmmm, priority natin ang malnutrition tapos sumunod
2. Good plan is realistic.
scabies…”
Family nursing care plan (fncp) 3. Should be consistent with goals &philosophy of the health
agency.
- “a family nursing care plan is the set of actions the nurse
decides to implement to be able to resolve identified family 4. Nursing care plan is drawn with the family. (dapat lahat ng
health and nursing problems.” sinabi mong plano gusto din nila)
Characteristics family nursing care plan 5. Nursing care plan is best kept in written form.
1. Nursing care plan focuses on actions which are designed to Importance of planning care
solve or minimize existing problem. (there are problems that 1. Individualized care to clients (iba iba ung plano kada
cannot be eliminated) pamilya)
2. Nursing care plan is a product of deliberate systematic 2. Nursing care plan helps in setting priorities by providing
process. (assessment to planning) information about client as well as nature if his problem. 3.
3. Nursing care plan, as with all other plans, relates to the Nursing care plan promotes systematic communication among
future. (based on their identified problem what should we those involve in health care effort.
do for their future) 4. Continuity of care is facilitated through use of nursing care 5.
4. Nursing care plan is based upon identified health & nursing Nursing care plans facilitate coordination of care by making
problems. known to other members of the health team what nurse is doing.

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Priorities
1. Nature of condition or problem
- Categorized into wellness state/ potential, health threat,
health deficit of foreseeable crisis.
2. Modifiability of the problem
- Refers to the probability of success in minimizing,
alleviation or totally eradicating the problem through
nursing intervention
3. Preventive potential
- Refers to the nature and magnitude of future problems
that can be minimized or totally prevented if intervention
is done on the problem under consideration.
4. Salience
- Refers to the family’s perception and evaluation of
the
problem in terms of seriousness an urgency
attention
needed.
Scoring
• Decide on a score for each of the criteria.
• Divide the score by the highest possible score and
multiply by
the weight.
 Score/highest score x weight
• Sum up the scores for all the criteria. The highest score is
equivalent to the total weight.
Scale for ranking family health problems according to
priorities
Summary:
− The list of health problems ranked according to priorities is
presented:
• Malnutrition 5
• Scabies 4
• Improper refuse disposal 3.67
Goals and objectives
- Goals of care – titingnan health problem
- Objective of care – titingnan ay family health nursing problem
Formulation of goals and objectives of nursing care
Example 1:
- At the end of nursing intervention, the family will be able to
start a piggery business.
Example 2:
- At the end of nursing intervention, the family will be able to
start litigation proceedings against landlord.
Goals
- A cardinal principle in goal setting states that goals must be
set mutually with the family.
- Basic to the establishment of mutually acceptable goals is
the family’s recognition and acceptance of existing health
needs and problems.
- Goals set by the nurse and the family should be realistic or
attainable.
- Goals are best stated in terms of client’s outcomes, whether
at the individual, family, or community levels.
Barriers to joint goal setting between nurse and family
1. Failure on part of family to perceive existence of the
problem.
2. Family may realize existence of health condition/problem
but is too busy at the moment.

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3. Sometimes, family perceives existence of problem but does Nurse-oriented Client-oriented

not see it as serious enough to warrant attention.
Nurse-oriented objectives Stating objectives in terms
4. Family may perceive presence of problem & need to take
will not tell if the nurse’s of client outcomes will
action. However refuse to face & do something about the
activities produced some indicate during the
situation.
beneficial evaluation phase whether
• Reasons to this kind of behaviour: the desired changes in the
results; they only indicate
- Fear of consequences of taking actions. what the nurse did and in problem situation resulted
- Respect for tradition. qualitative evaluation, how from the nurse’s action.
- Failure to perceive the benefits of action. well she
- Failure to relate the proposed action to the family’s performed them.
goals.
5. A big barrier to collaborative goal setting between nurse &
the family is the working relationship.

Objectives
- Refer to more specific statements of the desired results or
outcomes of care."
a) nurse-oriented based on activities of nurse or
b) client-oriented stated in terms of outcomes.
 Example: Example: mentally challenged child.
• During the home visit, the • After the nursing
nurse will discuss the intervention, the
importance of malnourished pre-school
immunization. member of the family Objective time
will increase their weights
• During the second nurse by at least one pound per Short-term Medium-term Long-term
family contact, the month. • After the nursing or immediate or intermediate or ultimate
nurse intervention, there will objectives objectives objectives
will show the different be improved
types of relationship Problem Are those which Require several
fertility-regulating among family members. situations are not nurse-family
methods. • After the nurse’s visit, the which require immediately encounters
family will bring the pre immediate attention achieved and are
school members to the required to attain
well baby clinic the the long term
following ones.
day.
Results can be The nature of
observed in a the outcomes
relatively short sought
period of time. requires time to
General objective Specific objective demonstrate
After the nursing After the nursing They are Investment of
intervention, the family intervention, the family accomplished more resources
will utilize will bring the with few
community resources for pregnant member to the nurse-family
health care. health center regularly for contacts and
check ups relatively less
After the nursing resources.
intervention, the family will The family will also consult
be able to take care of the the health center on every
mentally challenged child episode of illness among
competently. members. Example of nursing goal / objective
− The family will cope effectively with the threat of pulmonary
Define the criteria for
tuberculosis.
evaluation
• Short term -the infant and preschool members of the family
will be immunized with bcg.
• Medium term -all members of the family will have a complete
physical check-up to rule out pulmonary tuberculosis.
• recognize Example: • Long term -all members of the family will participate in the
• Decide • After the nursing care of the sick members and apply preventive measures
• Care intervention, the family against the spread of infection.
•H&e will be able to feed the
mentally challenged Implementation
• Comm resources
prescribed - “eto po ipapakita ko po sainyo paano niyo bubuhatin si indang.”
quantity and quality of food. Selecting appropriate nursing actions
• They will be able to teach - The choice of nursing intervention is highly dependent on two
the child simple skills major variables:
related to activities of 1. The nature of the problem
daily living and - Resolve around family’s assumption of the health tasks.
• The family will be able to 2. Resource available to solve the problem
apply measures taught - Aimed at minimizing or eliminating reasons for or causes
to of family’s inability to do these tasks.
prevent infection in the

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• S – specific
Goals and objectives • M – measurable
 • A – attainable usually indicating the family readiness to participate in the
• R – realistic health care process.
• T- time bound - Because the nurse has greater control over the environment,
Principles of nursing actions distractions are lessened and the family may feel less confident to
- Stimulate recognition & acceptance of health needs/problems - discuss family health concerns. • Group approach
Work on the family’s failure to decide on taking appropriate health - Appropriate for developing cooperation, leadership, self
actions reliance and or community awareness among group
- Increase family’s confidence in providing nursing care to its sick, members.
disabled and dependent member through demonstrations on - The opportunity to share experiences and practical solutions
nursing procedures utilizing supplies and equipment’s available to common health concerns is strength of this type of
in the home. family-nurse contact.
- Involve patient & family in order to motivate them to assume • Telephone conference
responsibility for their own care. • Written communication
- Explain and clarify doubts thus the role of the nurse shifts direct - Used to give specific information to families, such as
care giver to that of a teacher. (dapat may skills si nanay ituro instructions given to parents through school children. • School visit
aht nung skills na naituro sa atin tuwing lab) or conference
- Explore ways to minimize or prevent threats to the maintenance • Industrial or job site visit
of health & personal development among family members - Utilize
intervention measures involving environmental manipulations Implementation
through improvements on physical facilities in home either by The nursing bag
construction of needed ones or modifying existing ones. - Frequently called the phn bag is a tool used by the nurse
- Minimize or eliminate psychological threats in home during home or community visits to be able to provide care
environment. Nurse can work closely with family to improve its safely and efficiently.
communication patterns, role assumptions & relationships & - Serves as a reminder of the need for hand hygiene and other
interaction patterns. measures to prevent the spread of infection.
Types of resources - Nursing bag usually has the ff. Contents:
• Family resources • Articles for infection control
- Physical & psycho-social strengths &assets of individual • Articles for assessment of family members
members, financial capabilities, physical facilities & • Note that the stethoscope and sphygmomanometer are
support system provided by relatives and significant carried separately.
others. (wag pagastusin ang pamilya) • Articles for nursing care
• Nurse resources • Sterile items
- Knowledge about family health, her skills in helping family • Clean articles
manage them. These skills may range from simple nursing • Pieces of paper
procedure to complicated behavioral problems such as
- Bag technique helps the nurse in infection control. - Bag
marital disharmony. Availability of time &logistical
technique allows the nurse to give care efficiently. - It saves time
support are also part of resources of the nurse.
and effort by ensuring that the articles needed for nursing care
- (CHN Bag, IDB, Black Payong etc.) are available.
• Community resources - Bag technique should not take away the nurse’s focus on the
- Include existing agencies, programs or activities for health patient and the family.
and related needs/problems and community organization for - Bag technique may be performed in different ways, principles
health actions. (manpower ng health center etc.) Methods of of asepsis are of the essence and should be practiced at all
intervention times.
Family-nurse contact
• Home-visit Evaluation
- Home visit is a professional, purposeful interaction that takes - “nangyare ba ung dapat mangyare?
place in the family’s residence aimed at promoting, - “the determination of whether the objectives set were attained or
maintaining and restoring the health of the family or its to what degree they were attained.”
members. - “evaluation is always related to objectives.”
• Clinic- visit - “evaluation when address to the result or outcome of care answers
- Takes place in a private clinic health center, barangay health the question “did the intended results occur?”” - “there is always an
station. element of subjectivity in evaluation; the process involves value
- Major advantage is the fact that a family member takes the judgement which is subjective” - “evaluation also involves
initiative of visiting the professional health worker, decision-making”

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Dimensions of evaluation
• Effectiveness – focus is attainment of the objectives
• Efficiency – relates to cost whether in terms of money, time,
effort, or materials. (mas maiksi mo na solve ang problema mas
 efficient ka)
• Appropriateness- ability to solve or correct existing problem
situation, a question that involves professional judgement.
• Adequacy- pertains to its comprehensiveness whether all
necessary activities were performed in order to realize the
intended results. (lahat ba nagawa na natin?)
Criteria and standard
• Standard- once a value judgement is applied to a criterion; it
acquires the status of a standard.
• It refers to the desired level of performance corresponding with
a criterion against which actual performance is compared.
• It tells us what the acceptable level of performance or state of
affairs should be for us to say that the intervention was
successful.
• Criteria- refer to signs or indicators that tell us if the objective
has been achieved.
- They are names & description of variables that are relevant
indicators of having attained the objectives.
- They are free from any value judgement and are
independent to time frame.
Criteria and Standard
• Standard
- It refers to the desired level of performance corresponding
with a criterion against
• Criteria
- They are names & description of variables that are
relevant indicators of having attained the objectives.
Standard Criteria

Ex: infant nutrition With correct attachment

On demand in correct position
Breast feeding

Activities and Outcome

• Activities
- Are actions performed to accomplish an objective. They
are the things the nurse does in order to achieved a desired
result or outcome. Activities consume time and resources.
Examples are health teachings, demonstration and
referrals.
• Outcome
- Is the results produced by activities. Where activity is the
cause, outcome is the effect. They can also be immediate,
immediate or ultimate outcomes. Patient care outcomes
can be measured along three broad lines:
o Physical condition - decreased temperature or weight
and change in clinical manifestations
o Psychological or attitudinal status - decreased anxiety
and favourable attitude towards health care personnel.
o Knowledge on learning behavior - compliance of the
patient with instructions given by the nurse.

Mag Review maigiii!! Gooood luckkk ���� – Aki

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