A. Community health nursing (CHN)  in the Phil.

, the nuclear family is referred to as the “mag-

 The utilization of the nursing process in the different levels Anak”, the primary unit and building block in the Fil
of clientele – individuals, families, populations, groups, and Christian family structure.
communities, concerned with the promotion of health,  For Fil-Muslims and other non-Christian groups, when
prevention of disease, and disability and rehabilitation. nuclear families are united through the extension of the H-
W bond as a result of plural marriages, this is referred to
B. 2 MAJOR FIELDS OF NURSING as a polygamous family.
 CHN is one of the 2 major fields of nursing in Phil; the other
is hospital nursing. 2. Extended or consanguineous family
 The terms PHN and CHN are used interchangeably. Those  a form of combining nuclear families into larger units
who work in RHUs are officially called Public Health through the parent-child relationships.
Nurses.  it is composed of 2 or more residential units of 3 or more
generations affiliated through the extension of the parent-
C. PHILOSOPHY OF CHN: child relationship, that is, grandparents, parents, and
 The philosophy of CHN is based on the worth and grandchildren.
dignity of men. This philosophy of care is based on the  It has a controlled social relationship that the children learn
belief that care directed to the individual, the family, to adjust to persons of varying age levels.
and the group contributes to the healthcare of the
population as a whole 3. Single-Parent Family
 has only one parent, mother or father. Are formed in
D. GOAL OF CHN: numerous ways from the loss of a spouse by death,
 To assist the individual, family, and community in divorce, separation, or desertion, from the out-of-wedlock
attaining their highest level of holistic health which is birth of a child (unwed woman), or from the adoption of a
attained through multidisciplinary effort, and to child.
promote reciprocally supportive relationships between  single-parents are responsible for the economic, physical,
people and their physical and social environment. spiritual, and emotional care of the family.
 Have to set priorities as they balance work and family
E. MISSION OF CHN
responsibilities with well-established support from family
 health promotion
members and support groups.
 health protection
 health balance
 disease prevention H. The Filipino having close family ties, in the internal
 social justice structure, has 3 main points of interaction:

F. CLASSIFICATION OF COMMUNITIES 1. Husband-Wife Relations- there are 3 bonding factors

 Rural community – also known as open lands, often involved:
agricultural in nature which is more spacious and less a. Conjugal bond- the internal sense of obligation and
densely populated. (Ex. Sto. Tomas, La Union) privilege, respect, affection, or sexual attraction
existing in the mind and heart of each spouse.
 Urban communities- often known as cities or cities which
b. Social pressure, the couple is expected to be loving
are non-agricultural by nature, are densely populated, and
marked by industrial products and technology. (ex. Central and faithful to each other all throughout of marriage
Business Districts – (Makati City) c. Economic cooperation, which links the couple
together as they support their family’s basic needs.
 Suburban – usually the administrative capital of a province
characterized by a unique mix of agriculture and industry 2. Parent-Child Relations-
(ex. San Fernando City, La Union)  a strong bond exists between parents and children.
 Filipino parents are loving, caring, and protective.
G. Family Structure They train and discipline their children with the hopes
 Refers to the characteristics and demographics (age, of a better future for them. They provide for their
sex, number) of individual members who make up needs, and they believe that the best inheritance they
family units. Traditionally, the family as a structure may can leave their children is for them to finish their
be classified as either: college education. In return, the children love, respect,
and obey their parents.
1. Nuclear or conjugal family
 Consists of a husband, a wife, and their children (natural or 3. Sibling Relations
adopted) who live in a common household.  Fil parents train and discipline their children on mutual
 this is the reproductive unit in which marital tie is a chief love, protection, and respect. Other brothers and
building force that motivates the H&W to work out a sisters have the responsibility to take care of younger
harmonious relationship based on an amiability of siblings especially when parents are away. Brothers
interests, mutual understanding, and sympathy. look after their sisters to protect them from harm. The
 younger children love, obey, and respect their kuya and • Reinvest in couple identity with concurrent
ate. development of independent interest
• Relating harmoniously to kin
• Releasing young adults into lives of their own with
I. DEVELOPMENTAL STAGES OF FAMILY
appropriate rituals and assistance.
 Renegotiating marital relationship
1. Beginning Family. This stage covers the start of the • Shift from work role to leisure and semi-retirement or
marriage to the birth of the first child, including the full retirement
establishment of a new household and the beginning of a
nuclear family. 8. Aging Family. This stage lasts from the retirement of
• Building a new life together as a couple one or both members of the couple through the death of
one of the spouses, ending with the death of the
2. Childbearing Family. This stage begins with the birth of remaining spouse.
the first child and lasts until the child is 30 months of age. • Assisting with aging or ill parents.
• Constructively fitting into the community of families • Balancing teenager’s freedom with responsibility as
with school-aged children. they mature and emancipate from the family
 Coping with parental energy depletion and lack of
privacy. J. SUSTAINABLE DEVELOPMENT GOALS
• Deal with disabilities and the death of the older
generation. 1. No poverty
• Encouraging the child’s educational achievement. 2. Zero hunger
• establishing a mutually satisfying marriage 3. Good health and well-being
4. Quality Education
3. Family with Preschool children. This stage covers the 5. Gender equality
years from the time the oldest child is 2 ½ years old until 6. Clean water and sanitation
the youngest child is 5 years old. 7. Affordable and clean energy
8. Decent work and economic growth
4. Family with School-age children. The stage from which 9. Industry, innovation, and infrastructure
the oldest child is 6 years of age until the child turns 13 10. Reduced inequalities
years of age. 11. Sustainable cities and communities
12. Responsible consumption and production
5. Family with Teenagers. This stage begins when the 13. Climate action
oldest child is 13 years of age and ends when the youngest 14. Life below water
child is 20 years of age or leaves home. 15. Life on land
 Integrate infants into the family unit 16. Peace, justice, and strong institutions
17. Partnerships for the goals.
6. Launching Center Family. This stage covers between the
time the first child leaves home and the last child leaves K. UNDERLYING CAUSES OF MATERNAL DEATHS
home. 1. Delays in seeking care, making referrals, and providing
• Maintaining a satisfying marital relationship appropriate medical management or treatment
• Maintaining a supportive home base. 2. Closely spaced birth
• Maintaining couple and individual functioning while 3. Frequent pregnancies
adapting to the aging process 4. Poor detection and management of high risks
• Maintaining ties with older and younger generations pregnancies
• Make decisions regarding parenthood 5. Poor access to health facilities due to geographic
 Meeting the needs of additional children while distance and transportation cost
continuing to meet those of the firstborn. 6. Lack of competence in managing obstetrical emergencies
• Meeting the physical health needs of all family by some members of the healthcare team
members.
L. BEMOC STRATEGY/ POSTPARTUM VISITS
7. Middle-Aged Family. This stage refers to the years from
the time the last child leaves home to the retirement or
Basic Emergency Obstetric Care (BEMOC strategy)
death of one of the spouses.
 facilities established to provide emergency obstetric care
• Parents begin a shift toward concern for the older
for every 125,000 population, in coordination with DOH,
generation.
and which are strategically located.
• Parents refocus on midlife marital and career issues
 The BEMOC strategy calls for families and communities to
• Prepare for your own death and deal with the loss of a
plan for childbirth and upgrade the technical capabilities of
spouse, and/or siblings, and other peers.
local health providers.
• Realign relationships to include in-laws and
Recommended Schedule of Postpartum Visits:
grandchildren
1st after 24 hours
 2nd 1 week after
3rd 2 weeks after
 Ligtas Buntis Campaign-a strategy to increase the
visibility of FP as an essential public health service.
 It aims to improve the access of men, women, and
couples to family planning and safe motherhood
services.
 Reduce women’s exposure to health risks by
institutionalizing responsible parenthood and providing
appropriate health care packages for:
Women of reproductive age (especially those who are
less than 18 and over 35 years old)
Women with low educational attainment and financial
resources
Women with unmanaged chronic illness
Women who had just given birth in the last 18 months

M. SCHEDULE OF TETANUS TOXOID IMMUNIZATION

TT1  As early as possible or anytime

during pregnancy
 80% protection
TT2  4 weeks after TT1
 80% protection
 3 years period of protection
TT3  6 months after TT2 EXPANDED PROGRAM ON IMMUNIZATION
 90% protection
 The EPI was launched in July 1976 by the DOH in
 5 years period of protection
cooperation with WHO and UNICEF.
TT4  1 year after TT3
 99% protection
 10 years period of protection  The original objective was to reduce the morbidity and
TT5  1 year after TT4 mortality among infants and children caused by the
 99% protection seven childhood diseases.
 Lifetime protection

 A fully immunized child: receives one dose of BCG and

DPT as a child is categorized as TT1 TT2. Begins with TT3 Hepa B at birth, 3 doses of OPV, 3 doses of PENTA,
A series of 2 doses of Tetanus Toxoid vaccination must be and 1 dose meales vaccine before the child’s 1st
received by a woman one month before delivery to protect birthday.
the baby from neonatal tetanus.
FIM (Fully immunized mother) – a mother who has Republic Act No. 10152
received the 5 doses of TT
“Mandatory Infants and Children Health Immunization
Act” of 2011 signed by President Aquino III in July 26,
2010. The mandatory includes basic immunization for
N. NATIONAL IMMUNIZATION PROGRAM OF THE children under 5 including other types of diseases
DOH determined by the DOH.

 TETANUS TOXOID IMMUNIZATION IMMUNIZATION

Neonatal Tetanus is one of the public health concerns that • The process by which vaccines are introduced
we need to address among newborns. To protect them from into the body. VACCINES are administered to
deadly disease, tetanus toxoid immunization is important induce immunity thereby causing the recipient’s
from pregnant women and child-bearing age women. immune system to react to the vaccines that
produce antibodies to fight the diseases.
Both mother and child are protected against tetanus and
neonatal tetanus. A series of 2 doses of Tetanus Toxoid
Vaccination must be received by a woman one month
before delivery to protect baby from neonatal tetanus.
And the 3 booster dose shots to complete the 5 doses
following the recommended schedule provides full
protection for both mother and child. The mother is then
called as a “Fully Immunized Mother” (FIM).
 O. IMCI/ STEPS IN THE CASE MANAGEMENT
PROCESS

• Integrated Management of Childhood Illness

• A strategy for reducing mortality and morbidity associated
with major causes of childhood illnesses of children under
five years old.
• Was initiated jointly in 1992 by DOH (Department of
Health), WHO (World Health Organization), and UNICEF
(United Nations Children’s Fund).
• The pilot implementation of the program was conducted in
Sarangani and Zamboanga del Norte province

STEPS IN THE CASE MANAGEMENT PROCESS

1. Assess the patient - means of taking a history and doing
a physical examination.
2. Classify the illness – a thorough assessment supported
by laboratory results is necessary for classification and
confirmation of the disease.
3. Classification of the disease: 1. Mild, 2. Moderate, 3.
Severe
4. Treat the child – this means giving treatment in the health
center, prescribing drugs or other treatments to be given at
home, and teaching the mother how to carry out the
treatments.
5. Counsel the mother – assessing how the child is fed and
telling her about the foods and fluids to give the child and
when to bring back the child to the health center.

P. COLOR CODING IN IMCI

Color Classification of Level of

presentation diseases management
Green Mild Home care
Yellow Moderate Management at
the RHU
Pink severe Urgent referral
to hospital

Q. CONTENTS OF THE OB BAG

1. Front of Bag, Left to Right

 Thermometer in case
 Tape measure
 Adhesive plaster
 Cotton Applicator
2. On the Right Rear of the Bag
 Test tubes and holder
 Medicine Dropper
 Alcohol Lamp
C. On Left Rear of Bag
 Medicine Glass
 Baby Scale
 Bandage scissors
 Rubber suction
D. Back of Bag, Left to Right
 70% Alcohol
 Betadine solution
  Hydrogen Peroxide 6. Put the on apron the right side out and the wrong side with a
 Ophthalmic Ointment crease touching the body, sliding the head into the neck strap.
 Zephiran Solution Neatly tie the straps at the back.
 Spirit of Ammonia Rat.: To protect the nurse’s uniform. Keeping the
 Acetic Acid crease creates an aesthetic appearance.
 8 Benedict’s Solution 7. Put out things most needed for specific cases (thermometer,
 Liquid Soap kidney basin, cb, waste paper bag) and place at one corner of
 Cotton in Sterile Water the work area.
E. In the Center of the Bag Rat.: To make them readily accessible
 Pairs of forceps (curved and straight) 8. Place the waste paper bag outside of work area.
 1 surgical scissors Rat.: To prevent contamination of bag and contents
 Sterile Dressing (OS & cotton balls) 9. Close the bag.
 Roller Bandage Rat.: To give comfort and security, maintain personal
 Syringe (5 ml, 2 ml) hygiene and hasten recovery
 Hypodermic needle (g 19,22,23,25)
 Sterile cord clamp Perform nursing care needed and give health teachings.
 Kidney basin 10. Proceed to the specific nursing care or treatment
F. On the Top pile, Center of Bag Rat.: To prevent contamination of clean area
 Hand towel in plastic bag 12. After completing nursing care or treatment, clean and
 Soap in soap dish alcoholize the things used.
 Apron Rat.: To protect caregiver and prevent spread of infection
 Plastic/ linen lining to others.
G. Pocket of Bag 13. Do handwashing again.
 Surgical Gloves
 Waste Paper Receptacle
S. ACTIVITIES INHERENT IN COMMUNITY
Note: Folded paper lining inserted between the flaps and cover
ORGANIZING
of the bag.
1. Guiding people to understand the existing condition of
*** BP apparatus and stethoscope are carried separately.
their community
2. Organizing people to work collectively and efficiently
R. STEPS IN CONDUCTING HOME VISITS on their immediate and long-term problems
 Greet the patient and introduce yourself. 3. Mobilizing the people to develop their capability and
 State the purpose of the visit. readiness to respond and take action on their
 Observe the patient and determine the health needs immediate needs to solve their long-term problems.
 Put the bag in a convenient place and then proceed to
perform the bag technique: T. Approaches to Community Organizing:

Steps: 1. Issue-based Approach- revolves around

1. Upon arriving at the client’s home, place the bag on the table certain community issues and problems and
or any flat surface lined with paper lining and clean the side out mobilizes people to negotiate from a position
(folded part touching the table). Put the bag’s handles or strap of strength in number.
beneath the bag.
Rationale: To protect the bag from contamination. Issue - a problem of public concern on which
2. Ask for a basin of water and a glass of water if a faucet is not people are willing to act on to initiate change.
available. Place these outside the work area. * A vision or a goal guides the community or
Rat.: To be used for handwashing organization in changing problematic conditions. It
3. Open the bag, take the linen/plastic lining and spread over holds the group together until the goal is attained.
work field or area. The paper lining, clean side out (folded part
out) 2. Micro-Project Approach – also known as
Rat.: To protect the work field from being wet. To make a socio-economic approach that focuses on
non-contaminated work field or area. social or economic issues which can be
4. Take out a hand towel, soap dish, and apron and place them resolved through the introduction of projects.
at one corner of the work area (within the confines of the
linen/plastic lining) 3. Faith- Based Approach - an organizing
Rat.: To prepare for handwashing. approach based on religious affiliation.
5. Do handwashing. Wipe, dry with a towel. Leave the plastic
wrappers of the towel and the soap dish in the bag. U. PHASES OF COPAR
Rat.: Handwashing prevents possible infection from the A. Pre-entry phase - also known as project site selection. It
care provider to the client. involves the conduct of preliminary social
 analysis/investigation of the community to be able to plan The EPI Program’s purpose is to immunize children from
the most effective way of entering the community. the infectious diseases of tuberculosis, poliomyelitis,
B. Entry Phase – also known as social preparation of the diphtheria, pertussis, tetanus, Hepa B, and measles; and
community. It is considered crucial because the success to immunize pregnant mothers in order to prevent tetanus
of later activities depends largely on the community neonatorum in their newly born infants. In addition, the
organizer’s (CO) extent of integration with the people, his Nutrition Program’s goal is to provide proper nutrition to
understanding of the events in the community, and how he children and mothers and help them become resistant to
is identified by the people. diseases.
C. Helping Phase – also known as community involvement.
This cover gathering data and encouraging people to
identify and analyze their needs and problems
D. Phase out - This phase could mean that a program is X. CASES THAT NEED HOME VISITATION
already community-managed. Facilitators (or outsiders)
withdraw from self-reliant groups who will now continue to The following are some cases needing home visitation:
implement the cycle of direction setting, organizing,
1. Pupils whose parents are afraid of some
planning, implementation, and review for the benefit of the
community members. medical procedures
2. Pupils who get re-infected because of home
conditions
V. WHEN TO PHASE OUT
1. When the objectives have been attained 3. Pupils suffering from communicable diseases
2. When the impact of the project has become visible or 4. Pupils who are absent frequently because of
change has been made sickness
3. When the members of the community can take over the
planning, implementation, monitoring, and evaluation of 5. Pupils who are malnourished
the project
4. When the community resources can already be Y. EPIDEMIOLOGICAL TRIANGLE
maximized by the people. *A change in any of the components will alter an existing
5. When a viable community-based organization has been equilibrium to increase or decrease the frequency of the
established disease. (a model of how infectious disease is spread)

W. MAN-DISEASE AGENT-ENVIRONMENT TRIAD/ 1. HOST – any organism that harbors and provides nourishment
PREVENTIVE STRATEGIES for another organism. (or to a parasite that depends on it for its
HOW THE TRIAD WORKS: survival)
Man, by manipulating his environment, is able to prevent 2. AGENT:
contracting disease by blocking disease agents from  the intrinsic property of microorganisms to survive and
entering his body; thus, the disease agents are unable to multiply in the environment to produce disease
attack his body.  Causative agent is the infectious agent or its toxic
component that is transmitted from the source of
infection to the susceptible body.
THREE PREVENTIVE STRATEGIES IN THE MAN-DISEASE-  It is the organism that does the infecting such as a virus
ENVIRONMENT TRIAD: or a parasite
 1st strategy is exemplified by the people’s use of food  the cause, source, or vehicle by which infectious
safety practices such as the use of safe water for drinking organisms are transmitted.
and cooking; handwashing before cooking and eating; 3.. ENVIRONMENT:
washing vegetables properly during preparation and  the sum total of all external conditions and influences
storing cooked food at the right temperature. These food that affect the development of an organism which can
safety practices will prevent people from contracting be biological, social, and physical.
infectious diseases through ingesting contaminated food  the environment affects both the agent and the host. It
and water. is the place and correct conditions for the agent to come
 The 2nd strategy for preventing the production of together with the host and infect it.
disease agents is shown by the treatment of wastewater
coming from domestic and industrial sources prior to Z. NATIONAL EPIDEMIC SENTINEL SURVEILLANCE
release in the environment, particularly in the rivers. This SYSTEM
strategy is specified in RA 9275 “Clean Water Act of 2004” The National Epidemic Sentinel Surveillance System (NESSS)
which took effect on May 6, 2004, and it aimed to abate and its Role
and control water pollution from land-based sources. hospital-based information system that monitors the
 The 3rd strategy for increasing a person’s resistance to occurrence of infectious diseases with outbreak potential.
infectious diseases is clearly demonstrated in the various
maternal and child health programs of EPI and Nutrition.
 It also serves as a supplemental information system of the
DOH.
Objectives:
1. to provide early warning on the occurrence of
outbreaks
2. To provide program managers, policymakers, and
public administrators, with rapid, accurate, and timely
information so that inventive and control measures can
be instituted.
The NESSS Data shows:
Trends of cases across time
Demographic characteristics of cases
Estimates of case fatality ratio
Clustering of cases in a geographical area
Information to formulate a hypothesis for disease causation
Diseases Under Surveillance (NESSS)
 Laboratory Diagnosed:
Cholera
Hepatitis A
Hepatitis B
Malaria
Typhoid Fever
 Clinically Diagnosed
Dengue Hemorrhagic Fever
Diphtheria
Measles
Meningococcal Disease
Neonatal Tetanus
Non-Neonatal Tetanus
Pertussis
Rabies
Leptospirosis
Acute Flaccid Paralysis (Poliomyelitis)
 Under Surveillance System:
Acute flaccid paralysis
Measles
Maternal and neonatal status
paralytic shellfish poisoning
Fireworks related injury
IV/AIDS
 Scope for Level 2 Revalida in CHN

A. Community Health Nursing and the different

clienteles.
B. 2 major fields of Nursing
C. Philosophy of CHN
D. Goal of CHN
E. Mission of CHN
F. Classification of communities
G. Family structures
H. Points of interaction in the internal structure
I. Developmental Stages of the Family
J. Sustainable Development goals
K. Underlying causes of Maternal deaths
L. BEMOC Strategy/ Postpartum Visits
M. Schedule of Tetanus Toxoid Immunization
N. National Immunization Program of the DOH
O. IMCI/ Steps in Case Management Process
P. Color Coding in IMCI
Q. Contents of the OB Bag
R. Steps in Conducting Home Visits
S. Activities inherent in Community Organizing
T. Approaches to Community Organizing
U. Phases of COPAR
V. When to Phase-out
W. Man-Disease Agent-Environment Triad/
Preventive Strategies
X. Cases that needs Home Visitation
Y. Epidemiologic Triangle
Z. National Epidemic Sentinel Surveillance
System