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SESSION 9  HEALTH FOR ALL FILIPINOS by the year 2000 AND

HEALTH IN THE HANDS OF THE PEOPLE by the
Primary Health Care (PHC) year 2020.
 An improved state of health and quality of life for all
Overview people attained through SELF RELIANCE.

May 1977 Key Strategy to Achieve the Goal:

 30th World Health Assembly decided that the Mission Partnership with and Empowerment of the People
  To strengthen the health care system by increasing  permeate as the core strategy in the effective provision of
opportunities and supporting the conditions wherein essential health services that are community based,
people will accessible, acceptable, and sustainable, at a cost, which
 manage their own health care. the community and the government can afford.
 Two Levels of Primary Health Care Workers
 1. Barangay Health Workers – trained community MISSION
health workers or health auxiliary volunteers or  To strengthen the health care system by increasing
traditional birth opportunities and supporting the conditions wherein
 attendants or healers. people will manage their own health care.
 2. Intermediate Level Health Workers- include the
Public Health Nurse, Rural Sanitary Inspector and Two Levels of Primary Health Care Workers
midwives. main health target of the government and 1. Barangay Health Workers
WHO is the attainment of a level of health that would  trained community health workers or health auxiliary
permit them to lead a socially and economically volunteers or traditional birth attendants or healers.
productive life by the year 2000. 2. Intermediate Level Health Workers
 include the Public Health Nurse, Rural Sanitary
September 6-12, 1978 Inspector and midwives.
 First International Conference on PHC in Alma Ata,
Russia (USSR) The Alma Ata Declaration stated that
PHC was the key to attain the “health for all” goal Principles of Primary Health Care
1. 4 A’s
October 19, 1979  Accessibility
 Letter of Instruction (LOI) 949, the legal basis of PHC  Availability
was signed by Pres. Ferdinand E. Marcos, which  Affordability
adopted PHC as an approach towards the design,  Acceptability
development and implementation of programs focusing  Appropriateness of Health Services.
on health development at community level.  The health services should be present where the
supposed recipients are. They should make use of the
Rationale for Adopting Primary Health Care available resources within the community, wherein the
 Magnitude of Health Problems focus would be more on health promotion and
 Inadequate and unequal distribution of health resources prevention of illness.
 Increasing cost of medical care
 Isolation of health care activities from other
development activities

Definition of Primary Health Care

 Essential health care made universally accessible to
individuals and families in the community by means 2. Community Participation
acceptable to them, through their full participation and at  heart and soul of PHC
cost that the community can afford at every stage of
development. 3. People are the center, object and subject of development.
 A practical approach to making health benefits within  Thus, the success of any undertaking that aims at
the reach of all people. serving the people is dependent on people’s
 An approach to health development, which is carried out participation at all levels of decision-making; planning,
through a set of activities and whose ultimate aim is the implementing, monitoring and evaluating. Any
continuous improvement and maintenance of health undertaking must also be based on the people’s needs and
status problems (PCF, 1990)

Goal of Primary Health Care

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 Part of the people’s participation is the partnership This also facilities proper allocation of budgetary
between the community and the agencies found in the resources.
community; social mobilization and decentralization.
 In general, health work should start from where the 8 Elements of Primary Health Care (ELEMENTS) 1.
people are and building on what they have. Example: 1.Education for Health
Scheduling of Barangay Health Workers in the health  Is one of the potent methodologies for information
center dissemination. It promotes the partnership of both the
family members and health workers in the promotion of
Barriers of Community Involvement health as well as prevention of illness.
 Lack of motivation
 Attitude 2. Locally Endemic Disease Control
 Resistance to change  The control of endemic disease focuses on the prevention
 Dependence on the part of community people of its occurrence to reduce morbidity rate. Example
 Lack of managerial skills Malaria Control and Schistosomiasis Control

4. Self-reliance 3. Expanded Program on Immunization

 Through community participation and cohesiveness of  This program exists to control the occurrence of
people’s organization they can generate support for preventable illnesses especially of children below 6 years
health care through social mobilization, networking and old. Immunizations on poliomyelitis, measles, tetanus,
mobilization of local resources. Leadership and diphtheria and other preventable disease are given for
management skills should be developed among these free by the government and ongoing program of the
people. Existence of sustained health care facilities DOH
managed by the people is some of the major indicators
that the community is leading to self-reliance 4. Maternal and Child Health and Family Planning
5. Partnership between the community and the health agencies in  The mother and child are the most delicate members of
the provision of quality of life. the community. So the protection of the mother and child
 Providing linkages between the government and the to illness and other risks would ensure good health for the
nongovernment organization and people’s organization. community. The goal of Family Planning includes
spacing of children and responsible parenthood.
6. Recognition of interrelationship between the health and
development 5. Environmental Sanitation and Promotion of Safe Water Supply
Health
 Is not merely the absence of disease. Neither is it only a Environmental Sanitation
state of physical and mental well-being. Health being a  is defined as the study of all factors in the man’s
social phenomenon recognizes the interplay of political, environment, which exercise or may exercise deleterious
socio-cultural and economic factors as its determinant. effect on his well-being and survival. Water is a basic
Good Health therefore, is manifested by the progressive need for life and one factor in man’s environment. Water is
improvements in the living conditions and quality of life necessary for the maintenance of healthy lifestyle. Safe
enjoyed by the community residents (PCF) Water and Sanitation is necessary for basic promotion of
health.
Development
 is the quest for an improved quality of life for all. 6. Nutrition and Promotion of Adequate Food Supply
Development is multidimensional. It has political, social,  One basic need of the family is food. And if food is
cultural, institutional and environmental dimensions properly prepared then one may be assured healthy
(Gonzales 1994). Therefore, it is measured by the ability family. There are many food resources found in the
of people to satisfy their basic needs. communities but because of faulty preparation and lack
of knowledge regarding proper food planning,
7. Social Mobilization Malnutrition is one of the problems that we have in the
 It enhances people participation or governance, support country.
system provided by the Government, networking and
developing secondary leaders 7. Treatment of Communicable Diseases and Common Illness
 The diseases spread through direct contact pose a great
8. Decentralization risk to those who can be infected.
 This ensures empowerment and that empowerment can
only be facilitated if the administrative structure Tuberculosis is one of the communicable diseases continuously
provides local level political structures with more occupies the top ten causes of death. Most communicable diseases
substantive responsibilities for development initiators. are also preventable. The Government focuses on the prevention,
control and treatment of these illnesses.

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RA 8423 or the Traditional and Alternative Medicine Act of 1997

8. Supply of Essential Drugs  (10 Medicinal Plants / Herbal Medicine)
 This focuses on the information campaign on the
utilization and acquisition of drugs. Decoction is
 In response to this campaign, the GENERIC ACT of the  boiling the part of material in water; 20 minutes is the
Philippines is enacted. It includes the following drugs: recommended boiling time
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and Infusion
Pyrazinamide, Ethambutol, Streptomycin, Albendazole,  is soaking plant material in water much like making a
Quinine tea; 10-15 minutes is the recommended soaking period

Major Strategies of Primary Health Care Poultice

1. Elevating Health to a Comprehensive and Sustained National  is applying plant material directly on the affected part
Effort.
 Attaining Health for all Filipino will require expanding
participation in health and health related programs
whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is really the desired outcome.
 Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
considerations.

2. Promoting and Supporting Community Managed Health Care

 The health in the hands of the people brings the
government closest to the people. It necessitates a
process of capacity building of communities and
organization to plan, implement and evaluate health
programs at their levels.

3. Increasing Efficiencies in the Health Sector

 Using appropriate technology will make services and Sentrong Sigla Movement
resources required for their delivery, effective, Certification Program: SS Seal (main Component)
affordable, accessible and culturally acceptable. The Objectives:
development of human resources must correspond to the  better and more effective collaboration between DOH
actual needs of the nation and the policies it upholds such as and LGU
PHC. The DOH will continue to support and assist both DOH:
public and private institutions particularly in faculty  as a provider of technical and financial assistance
development, enhancement of relevant curricula and packages of health care
development of standard teaching materials. LGU:
 as a prime developer of health system and direct
implementers of health programs
4. Advancing Essential National Health Research 4 Pillars:
 Essential National Health Research (ENHR) is an  Health promotion
integrated strategy for organizing and managing  Award
research using intersectoral, multi-disciplinary and  Quality Assurance
scientific approach to health programming and delivery.  Grants and Technical Assistanc

Four Cornerstones/Pillars in Primary Health Care Principles and Strategies of Primary Health Care (P.R.A.M.I.S)
1. Active Community Participation
2. Intra and Inter-sectoral Linkages Provision
3. Use of Appropriate Technology  of quality and essentials health services
4. Support mechanism made available R.A 7160: Decentralization
 political will advocacy

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A’s of Health Services (Acceptable, Affordable, Available)

 Delivery of health care services to where people are
 Use of indigenous volunteer workers as health care provider
 Use of traditional Medication
SESSION 10
Mobilization: social
The Family
Increase Community Participation
 Consciousness-raising on health concerns
Family
Self-reliance
 Basic unit in society, and is shaped by all forces
 Use of cooperatives and community business
surround it.
Alternative Health Care Modalities  Values, beliefs, and customs of society influence the role
Acupressure and function of the family (invades every aspect of the
life of the family)
 A method of healing and health promotion that uses the
application of pressure on acupuncture points without
Is a unit of interacting persons bound by ties of blood, marriage
puncturing the skin.
or adoption.
Acupuncture  Constitute a single household, interacts with each other in
their respective familial roles and create and maintain a
 A method of healing using special needles to puncture
common culture.
and stimulate specific anatomical points on the body.
An open and developing system of interacting personalities with
Aromatherapy
structure and process enacted in relationships among the
 The art and science of the sense of smell whereby
individual members regulated by resources and stressors and
essential aromatic oils are combined and then applied to
existing within the larger community (Smith & Maurer, 1995)
the body in some form of treatment.
Two or more people who live in the same household (usually),
Chiropractic
share a common emotional bond, and perform certain
 A discipline of the healing arts concerned with the
interrelated social tasks (Spradly & Allender, 1996)
pathogenesis, diagnosis, therapy, and prophylaxis of
functional disturbances, pathomechanical states, pain
An organization or social institution with continuity (past,
syndromes, and neurophysiological effects related to the
present, and future). In which there are certain behaviors in
static and dynamics of the locomotor system, especially of
common that affect each other.
the spine and pelvis.
The Filipino Family
 Based on the Philippine Constitution, Family Code with
focus on religious, legal, and cultural aspects of the
definition of family.

Section 1
 The state recognizes the Filipino family as the
foundation of the nation. Accordingly, it shall
strengthen its solidarity and actively promote its total
development

Section 2
 Marriage, as an inviolable social institution, is the
foundation of family and shall be protected by the state.

Section 3
The state shall defend –
 the right of spouses to found a family in accordance with
their religious convictions and the demands of responsible
parenthood
2. the right of children to assistance including proper care and
nutrition, and special protection from all forms of neglect, abuse,

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cruelty, exploitation and other conditions prejudicial to their NO-KIN

development  a group of at least two people sharing a relationship and
3. the right of the family to a family living wage income 4. the exchange support who have no legal or blood tie to each
right of families or family associations to participate in the other
planning and implementation of policies and programs of that
affect them FOSTER
 substitute family for children whose parents are unable
Section 4 to care for them
 The family has the duty to care for its elderly members
but the state may also do so through just programs of FUNCTIONAL TYPE:
social security FAMILY OF PROCREATION
 refers to the family you yourself created.
Types of Family
 There are many types of family. They change overtime FAMILY OF ORIENTATION
as a consequence of BIRTH, DEATH, MIGRATION,  refers to the family where you came from.
SEPARATION and GROWTH OF FAMILY
MEMBERS B. Decisions in the family (Authority)
PATRIARCHAL
A. Structure  full authority on the father or any male member of the
NUCLEAR family e.g., eldest son, grandfather 
 a father, a mother with child/children living together
but apart from both sets of parents and other relatives. MATRIARCHAL
 full authority of the mother or any female member of
EXTENDED the family, e.g., eldest sister, grandmother
 composed of two or more nuclear families economically
and socially related to each other. Multigenerational, EGALITARIAN
including married brothers and sisters, and the families.  husband and wife exercise a more or less amount of
authority, father and mother decides
SINGLE PARENT
 divorced or separated, unmarried or widowed male or DEMOCRATIC
female with at least one child.  everybody is involved in decision making

BLENDED/RECONSTITUTED AUTHOCRATIC-
 a combination of two families with children from both
families and sometimes children of the newly married LAISSEZ-FAIRE
couple. It is also a remarriage with children from previous  “full autonomy”
marriage.
MATRICENTRIC
COMPOUND  the mother decides/takes charge in absence of the father
 one man/woman with several spouses (e.g., father is working overseas)

COMMUNAL PATRICENTIC
 more than one monogamous couple sharing resources  the father decides/ takes charge in absence of the mother

COHABITING/LIVE-IN
unmarried couple living together
C. Decent (cultural norms, which affiliate a person with a
particular group of kinsmen for certain social purposes)

PATRILINEAL
DYAD  Affiliates a person with a group of relatives who are
 husband and wife or other couple living alone without related to him though his father
children
BILATERAL
GAY/LESBIAN  both parents
 homosexual couple living together with or without
children MATRILINEAL

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 related through mother Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN

 This is a busy family because children at this stage
Ackerman States that the Function of Family are: demand a great deal of time related to growth and
1. Insuring the physical survival of the species development needs and safety considerations.
2. Transmitting the culture, thereby insuring man’s humanness  Oldest child: 2-1/2 to 6 years old
Physical functions of the family
 are met through parents providing food, clothing and Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
shelter, protection against danger provision for bodily  Parents at this stage have important responsibility of
repairs after fatigue or illness, and through reproduction preparing their children to be able to function in a
complex world while at the same time maintaining their
Affectional function own satisfying marriage relationship.
 the family is the primary unit in which he child test his  Oldest child: 6-12 years old
emotional reactions
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
Social functions  A family allows the adolescents more freedom and
 include providing social togetherness, fostering self- prepare them for their own life as technology advances-
esteem and a personal identity tied to family identity, gap between generations increases
providing opportunity for observing and learning social  Oldest child: 12-20 years old
and sexual roles, accepting responsibility for behavior and
supporting individual creativity and initiative. Stage 6: THE LAUNCHING CENTER FAMILY
 Stage when children leave to set their own household-
Universal Function of the Family by Doode appears to represent the breaking of the family
1. REPRODUCTION  Empty nests
 for replacement of members of society: to perpetuate the
human species Stage 7: FAMILY OF MIDDLE YEARS
 Family returns to two partners nuclear unit
2. STATUS PLACEMENT  Period from empty nest to retirement
 of individual in society
3. BIOLOGICAL and MAINTENANCE OF THE YOUNG and Stage 8: FAMILY IN RETIREMENT/OLDER AGE
dependent members
4. Socialization and care of the children Stage 9: PERIOD FROM RETIREMENT TO DEATH OF
5. Social control BOTH SPOUSES

Balance
 the parents and children have their own areas of
decisions and control. 12 Behaviors Indicating a Well Family
Strongly Bias  Able to provide for physical emotional and spiritual
 one member gains dominance over the others. needs of family members
 Able to be sensitive to the needs of the family members
 Able to communicate thought and feelings effectively
 Able to provide support, security and encouragement
STAGES:
 Able to initiate and maintain growth producing
Stage 1: MARRIAGE & THE FAMILY
relationship
 Involves merging of values brought into the relationship
 Maintain and create constructive and responsible
from the families of orientation.
community relationships
 Includes adjustments to each other’s routines (sleeping,
 Able to grow with and through children
eating, chores, etc.), sexual and economic aspects.
 Ability to perform family roles flexibly
 Members work to achieve 3 separate identifiable tasks:
 Able to help oneself and to accept help when appropriate
1. Establish a mutually satisfying relationship
 Demonstrate mutual respect for the individuality of
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning family members
 Ability to use a crisis experience as a means of growth
Stage 2: EARLY CHILDBEARING FAMILY  Demonstrate concern of family unity, loyalty and
 Birth or adoption of a first child which requires interfamily cooperation
economic and social role changes
 Oldest child: 2-1/2 years Family Health Task
Health task differ in degrees from family to family
TASK

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 is a function, but with work or labor overtures assigned  makes decisions particularly in areas such as finance,
or demanded of the person resolution, of conflicts, use of leisure time etc.

Problem-solver
Duvall & Niller identified 8 tasks essential for a family to function  resolves family problems to maintain unity and
as a unit: solidarity.

Eight Family Tasks (Duvall & Niller) Health manager

1. Physical maintenance  monitors the health and ensures that members return to
 provides food shelter, clothing, and health care to its health appointments.
members being certain that a family has ample
resources to provide Gate keeper
 Determines what information will be released from the
2. Socialization of Family family or what new information can be introduced.
 involves preparation of children to live in the
community and interact with people outside the family.

3. Allocation of Resources
 determines which family needs will be met and their Theoretical Approaches to Family Health Care (Family Apgar)
order of priority. Family Models
 the use of family model provides a perspective of focus
4. Maintenance of Order for understanding the family
 task includes opening an effective means of  have categorized according to their basic focus as
communication between family members, integrating developmental, interactional structural-functional, and
family values and enforcing common regulations for all systems model
family members.
5. Division of Labor Developmental Models
 who will fulfill certain roles e.g., family provider, home Duvall’s and Stevenson’s Family Development Model
manager, children’s caregiver
Evelyn Duvall’ (1977) family developmental framework
6. Reproduction, Recruitment, and Release of family member  provides guide to examine and analyze the basic changes
and developmental tasks common to most families
7. Placement of members into larger society during their life cycle. Although each family has unique
 consists of selecting community activities such as characteristics normative patterns of sequential
church, school, politics that correlate with the family development are common to all families
beliefs and values These stages and developmental tasks illustrate common family
behaviors that may be expected at specific times in
8. Maintenance of motivation and morale the family life cycle. The stages are marked by the age of the
 created when members serve as support people to each oldest child however some overlapping occurs in
other families with several children.

5 Family Health Tasks (Maglaya, A., 2004)

1. Recognizing interruptions of health development
2. Making decisions about seeking health care/ to take action
3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health
maintenance

Family Roles
Nurturing figure Duvall’s developmental model
 primary caregiver to children or any dependent  is an excellent guide for assessing, analyzing and
member. planning around basic family tasks developmental stage,
however, this model does not include the family
Provider structure or physiological aspects, which should be
 provides the family’s basic needs. considered for a comprehensive view of the family.

Decision maker

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 This model is applicable for nuclear families with The structural-functional components and parts
growing children and families who are experiencing  all intimately interrelate and interact; the others affect
health-related problems. each component and part.
This model provides a broad framework for examining the
interactions among family and within the community.
This incorporates physical, psychosocial and cultural aspects of the
family along with interacting relationships.
This model is very applicable to any type of family and their
health-related problems
Systems Model
Calgary’s Family Model (System’s Model)
Is an integrated conceptual framework of several theorists.
Model is based on three major categories: family structure,
function and development. Each is further subdivided into
Stevenson’s Family Developmental Model parts that interacts with others and changes the whole family
Joanne Stevenson (1977) configuration.
 describes the basic tasks and responsibilities of families This model is comprehensive and incorporates three major areas,
in four stages. namely, the structure, function and development of
the family.
 It is complex, with too many sub concepts for the health worker
to explore and focus.
 It can be applied to any type of family with any health-related
problems.

 She views family tasks as maintaining a common

household rearing children and finding satisfying work
and leisure. It also includes sustaining appropriate health
patterns and providing mutual support and acculturation of
family members.
 This model is useful for nuclear families because it
examines psychosocial patterns to specific stage of
development, however, it also does not include family Total Score:
structure, nor it addresses health promotion and health- 7-10 = suggests a highly functional family
related concerns that the family may face. 4-6 = moderately dysfunctional family
0-3 = severely dysfunctional family
Structural- Functional Model
Friedman’s Structural- Functional Family Model Health as a Goal of Family Health Care
 Was developed from sociological frameworks and HEALTH DEFICIT
systems theory by Marilyn Friedman (1986)  this refers to conditions of health breakdowns or advent
 The family is the focus of this model as it interacts with of illness in the family
supra-systems in the community and with individual
family members in the subsystem HEALTH THREAT
 these are the conditions that make it more likely for
Friedman’s Family Model Components accidents, disease or failure to thrive or develop to
occur.

FORESEEABLE CRISIS
 these are anticipated periods of unusual demand on the
family in terms of time or resources

WELLNESS POTENTIAL
Structural component examines the family unit, how it is  this refers to states of wellness and the likelihood for
organized and how members relate to one another in terms of health maintenance or improvementto occur depending
values, communication network, role system and power while on the desire of the family
functional components refers to the interaction outcomes
resulting from family organizational structure Roles of Health Care Provider in Family Health Care

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 HEALTH MONITOR findings and significant results of laboratory/diagnostics/screening

 PROVIDER OF CARE procedures
 COORDINATOR 5. Values and practices on health promotion/maintenance and
 FACILITATOR disease prevention include use of preventive services; adequacy of
 TEACHER rest/sleep, exercise. Relaxation activities, stress management of other
 COUNSELOR healthy lifestyle activities, and immunization status of at-risk family
members
SESSION 11
Family Health Assessment Second-level assessment data include:
1. Specify or describe the family’s realities
Nursing Assessment 2. Perceptions about and attitudes
 includes data collection, data analysis or interpretation and 3. Performance of health task on each health condition or
problem definition or nursing diagnosis. These are: 1. problem identified during the first level assessment

First level assessment Data Gathering Methods and Tools

 is a process whereby existing and potential health There are several methods of data gathering that the nurse can select
conditions or problems are categorized as: from depending on the availability of resources
a. Wellness state such as materials, manpower, time and facilities.
b. Health threats The critical point in the choice is concern for validity, reliability
c. Health deficit and adequacy of assessment data.
d. Stress points or foreseeable crisis situation Poor quality /inaccurate and inadequate data can lead to
inaccurately defined health and nursing problems which,
in turn, lead to a poorly designed family nursing care plan
2. Second level assessment
The following are brief description of common methods of
 defines the nature or type of nursing problems that the
gathering data about a family, its status and state of functioning;
family encounters in performing the health tasks with
respect to a given health condition or problems and
1. Observation
etiology or barriers to the family ’s assumption of these
This method of data collection is done through the use of the
task.
sensory capacities- sight, hearing, smell
and touch. Through direct observation the nurse gathers information
Steps in family Nursing Assessment
about family’s state of being and behavioral
There are three major steps in nursing assessment as applied to
responses. The family’s health status can be inferred from the signs
family nursing practice.
and symptoms of the problem areas reflected in
the followings:
Data collection for first level assessment
a. Communication and interactions pattern expected, used and
 involves gathering of five types of data which will
tolerated by family members
generate the categories of health conditions or problems
b. Role perceptions/task assumptions by each member, including
of the family. These data include:
decision-making patterns
1. Family structure, characteristics and dynamic-include the
c. Conditions in the home and environment
composition, demographic data of the members of the
family/household, their relationship to the head and place of
2. Physical Examination
residence, the type of, and family interaction /communication and
 significant data about health status of individual family
decision-making patterns and dynamics
members can be obtained through direct examination.
This is done through inspection, palpation, percussion,
2. Socio-economic and cultural characteristic-include occupation,
auscultation, measurement of specific body parts and
place of work and income of each working member; educational
reviewing the body system. It is essential for the nurse to
attainment of each family member; ethnic background and religious
have the skills in performing physical assessment /
affiliation; significant others and the role they play in the family’s
appraisal in order to help the family be aware of the health
life; the relationship of the family to the larger community
status of its member.
3. Home environment included information on housing and
sanitation facilities; kind of neighborhood and availability of
3. Interview
social, health; communication and transportation facilities in the
community  another major method of data gathering is the
interview.
4. Health status of each member includes current and past
significant illness; beliefs and practices conducive to health and a. One type of interview is completing a health history for each
illness; nutritional and development status; physical assessment family member.

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Interpreting results
b. Second type interview is collecting data by personally asking  of comparisons to determine signs, symptoms or cues of
significant family members or relatives questions specific wellness state, health deficit, health threats or
regarding health, family life experiences and home environment foreseeable crisis/s/stress point/ and their underlying
to generate data on what wellness condition and health problems causes or associated factors
exist in the family (first level and second level of assessment)
Making inferences or drawing conclusions
4. Record Review  about the reasons for the existence of the health
 the nurse may gather information through reviewing condition or problems or risks for non-maintenance of
existing records and reports pertinent to the client. wellness state which can be attributed to non-
These include the individual clinical records of the performance of family health tasks.
family members, laboratory and diagnostic reports,
immunization records, report about home and
environmental conditions or similar sources.

5. Laboratory /Diagnostic Test

 another method of data collection is through performing
laboratory tests, diagnostic procedures or other tests of
integrity and function carried out by the nurse herself
and /or other health workers.

Data Analysis
 Utilizing the data generated from the tool on initial base
in family nursing practice, the nurse goes through data
analysis. She sorts out and classify or group data by type
or nature (e.g., which are wellness states, threats, deficits or
stress points/foreseeable crisis. She relates them with each
other and determines patterns or reoccurring themes among
data. She then compares these data and the patterns or
reoccurring themes with norms or standards.

Data Analysis involves several sub-steps:

Sorting of data
 for broad categories such as those related with health
status or practices of family members or data about
home and environment

Clustering
 of related cues to determine relationships between and
among data SESSION 12
Family Data Analysis and Family Nursing
Diagnosis
Distinguishing relevant from irrelevant data
 to decide what information is pertinent to Health problems are categorized according to factors affecting
understanding the situation at hand and what priority status.
information is immaterial. Nature:
1. Health Threat - condition
Identifying patterns 2. Health Deficit- may lead to illness
3. Foreseeable crisis
 such as physiologic function, developmental, nutritional
/dietary, coping/adaptation or communication pattern
Greater weight is assigned to health deficit over health threats
and lifestyle
because the former usually demands more immediate
intervention than the latter. On the other hand, foreseeable crisis is
Comparing patterns
given the least attention because culture-linked factors usually
 with norms or standards of health, family functioning
provide adequate support to cope with developmental/situational
and assumption of health task
crises.

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Modifiability
 The community health manager must consider some
important factors in defining modifiability of the health
problems- or probability of success in minimizing,
alleviating or totally eradicating the problem through
health intervention.
1. Current knowledge, technology and intervention to manage the
problem
2. Resources of the family (Physical, financial, manpower)
3. Resources of the community (facilities and community
organizations)
4. Resources of the community health manager knowledge skill
and time)

Preventive Potentials
 To decide on the appropriate score for the preventive
potential of the health problem- or the nature and
magnitude of future problems that can be minimized or
preventive if intervention is done, the following factors
are considered:

1. Severity of the problem

 the more severe or advanced the problem, the lower the
preventive potential

2. Duration of the problem

 the longer the problem has existed, the lower the
preventive potential.

3. Current management
 application of appropriate intervention increases the
problem’s preventive potentials

SESSION 13
Formulating and Implementing the Plan
Salience of Care
 To determine the salience score, evaluate the family’s
perception ad evaluation of the problem in terms of
A plan of intervention is designed upon completion of the
seriousness and urgency of attention needed. The
assessment and the analysis and health diagnosis of the family.
family’s concern and felt needs require priority
attention.
The purpose of the plan is
to elicit behavioral change in the family that will promote health/
or prevent dysfunction. The family is expected to be an active
participant in the planning process. The success of the planned
behavioral changes depends largely on the degree of responsibility
that the family concerned is willing to assure.

The planning process involves the following steps:

1. Determining the order of priority of existing or potential
problems
2. Identifying problems that can be handled by the community
health nurse and the family, and those that maybe referred to
others for assistance.
3. Setting goals and objectives to resolve the problems
4. Predicting actions and expected outcomes

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To guide the nurse in priority setting, the following factors need  aim to improve the capacity of the family to provide for
to be considered: its own health needs, such as guiding the family to make
Family safety responsible health decisions. this type of intervention is
 a life threatening situation is given top priority (Maurer directed toward family empowerment.
and Smith,2009)

Family perception Plan of Evaluating Care

 next to life threatening emergencies, priority is given to Evaluation is determining the value of nursing care that has been
the need that the family recognizes as most urgent given to a family. The product of the step is used for
and/or important (Maurer and Smith, 2009) further decision making: to terminate, continue, or modify the
interventions.
Practicality Aspects of evaluation that are useful in family health care:
 together with the family, the nurse looks into existing Effectiveness
resources and constraints.  is determination of whether goals and objectives were
attained.
Projected effects
 the immediate resolution of a family concern gives the Appropriateness
family a sense of accomplishment and confidence in  refers to the suitability of the goals/objectives and
themselves and the nurse interventions to the identified family health needs

Establishing Goals and Objectives Adequacy

Specific  means the degree of sufficiency of goals/objectives and
 the objective clearly articulates who is expected to do interventions in attaining the desired change in the
what, i.e., the family or a target family member will family
manifest a particular behavior
Efficiency
Measurable  is the relationship of the resources use to attain the
 observable, measurable and whenever possible, desired outcomes
quantifiable indications of the family’s achievement as a
result of their efforts toward a goal provide a concrete Implementation
basis for monitoring and evaluation.  is putting the family health care plan into action. The
implementation phase is should be flexible.
Attainable
 The objective has to be realistic and in conformity with According to Maglaya (2003), there are four types of intervention
available resources, existing constraints, and family for health promotion and disease prevention. These are:
traits, such as style and functioning. 1. Increasing knowledge and skills,
2. Increasing family strengths
Time bound 3. Decreasing exposure to risk factors
 Having a specified target time or date helps the family 4. Decreasing susceptibility.
and the nurse in focusing their attention and efforts
toward the attainment of the objective (Doran,1981)
Increasing Knowledges and skills
Determining appropriate Intervention  includes assisting families to make informal choice s
Nursing Intervention categorize into three types (Freeman and about helpful lifestyle and behavior that will lessen or
Heinrich (1981) totally eliminate harmful environmental influences that
Supplemental interventions adversely affect their health.
 are actions that the nurse performs on behalf of the  The first involves creating awareness that is achieved by
family when it is unable to do things for itself, such as working together with the CHN to uncover actual or
providing direct nursing care to a sick or disabled potential problems.
family member.  The second step is to learn to recognize families at risk.
 The third step offers families at risk the benefits of
Facilitative interventions knowing how to motivate and support behavioral changes.
 refer to actions that remove barriers to appropriate
health action, such as assisting the family to avail of Increasing Family Strength
maternal and early child care services.  refers to the factors or forces that contribute to family
unity and solidarity; and that foster the development of
Developmental interventions inherent family potentials. These factors include the
following:

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1. Physical, emotional and spiritual factors

2. Healthy child-rearing practices and discipline
3. Meaningful and clear communication
4. Support security and encouragement
5. Growth-inducing relationships and experiences
6. Responsible community relationships SESSION 14
7. Growth with/and through children
8. Self-help and acceptance of help Home Health Care and Health Education
9. Flexibility to family functions and roles
10. Mutual respect for individuality A. Home Health Care and People centered Care aim to develop
11. Crisis as a measure for growth and nurtured.
12. Family unity and loyalty and intra-family cooperation
13. Adaptability of family strength Informed and Empowerment Individuals and Families through
Decreasing exposure to risk factors the following:
 includes making parental behavior complement the
child’s behavior. In homes where parents are 1. Equitable access to health system, effective treatments and
uninformed, the parent responds differently to the psychosocial support
child’s attempt to communicate; the same is true with 2. Access to clear, concise and intelligible health information and
regard to their general behavior towards the child. This education that increases health literacy and allows for informed
may lead to a significant difference later in the chil’d decision-making
intellectual ability. For the most part, the child well-being 3. Personal skills which allow control over health and engagement
is influenced by the presence or absence of physical with health care system- communication, mutual collaboration and
hazards in /her surroundings. Physical hazards present in respect, goal-setting, decision-making, problem solving and self-care
the home should be removed or replaced for the child’s 4. Supported involvement in health care decision-making,
benefits. Raising healthy-well-rounded children requires including health policy, programs development .resource
plenty of patience and vigilance. allocation, and health financing.

Decreasing susceptibility People Centered Health Care

 means educating the family on the principles of What can be done?
prevention and disease control. It is fact that personal  Create supportive environments aimed at respecting
hygiene and cleanliness are primary factors in disease protecting and fulfilling the right to safe and quality
control and prevention. It is expected that the family health care.
knows which signs and symptoms need medical attention  Advocate health policies that ensure effective, holistic
and how to take cae of minor illnesses. Family perception and people centered health and nursing care.
of health risks and their susceptibility will determine how
they change their behavior. If the overweight family Primary Health Care
believes obesity to be a threat to their health and the CHN  Key to attaining acceptable level of health for the
works with them to change their eating habits to reduce and population
maintain and ideal weight, the family is likely to react  Surest route to appropriate, accessible, affordable care
positively to change. Health workers who introduce threat  Best gatekeeper for the referral system
as a motivator to action are morally obligated to reduce the  Optimizes the power of prevention and health
threat through meaningful and purposeful intervention. promotion
 Strengthens health system (structure and organization
of health services)
 Support multi-sectoral engagement and use of
interdisciplinary teams

Primary Health Care Nurse

 Health promotion
 Prevention of illness
 Treatment
 Rehabilitation

Clients:
 Individuals

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 Families  that features large displays are easier to read, which

 Special groups may be more convenient. These thermometers also tend to
 Communities give result quicker than standards thermometer. Always
check for the low batteries so accuracy can be assured.
Core Health Professional Competencies Needed
 A Patient-centered focus- addressing social, emotional 2. Aseptic technique
as well as physical health  must be constantly in the health worker’s mind while
 Partnership; interdisciplinary teamwork dispensing care from the client and from the home to
 Investments in information/ communication technology home. A dispenser of cotton or tissue papers to be
 Shared learning accountability moistened with disinfectant should be kept handy to
 Health economics, financing prevent transfer of infections via the thermometer. The
principles of “clean to dirty” and “proper waste disposal
should be the rule to follow.
Core Health Professional Competencies
 Epidemiology, health determinants, public health
Wound Care
 Communication, collaboration, team-building
1. Any wound should be considered ineffective and all materials
 Health Promotion; risk reduction and equipment used for wound care at home should be properly
 Academic- service partnerships disinfected before leaving the client’s home
 Accountability, organizational effectiveness
 Quality improvement 2. The principles of “Clean to Dirty” should be the rule in the
cleaning the wound of the client.
B. DISPENSING HOME HEALTH CARE
The Bag Technique Clean gloves
1. To enhance the capacity of the PHN and home health care  can be used for large infected wounds,
givers to promote the values and principles of family-centered
care, including access, safety, affordability and satisfaction, the sterile gloves and forceps
use of the bag technique should be strictly undertaken. As a role  should be used for surgical wound care.
model, the PHN and Home Health Care giver should reinforce a
culture of caring, communicating and healing in the context pf Equipment used can be sterilized chemically or by boiling for 15
psychological, cultural and social determinants of health minutes after cleaning with soap and water. These should be done
before replacing the used equipment into the health worker’ bag.
2. Use of the PHN bag, or any receptacle for health care
paraphernalia brought by the health care personnel to the Home Isolation Techniques
patient’s home should be governed by the principle that anything 1. Isolation technique
that are outside the bag is considered contaminated, and  isolates or separates the offending microorganisms but
therefore, should not touch what are inside the bag. must not necessarily isolate the client.

3. To protect the inside contents of the bag, barrier materials 2. The health worker
(paper or cloth) should first be placed under the bag before it is
 must know the nature of the client’s disease and how
placed down inside the client’s home. The health worker must
this may be transferred from person to person.
therefore, wash his/her hands before opening and getting out the bag
3. After this, the family should be informed on steps to take to
contents for use in nursing procedures.
prevent transmission from one family member to another or to
visitors/neighbor.
4. Once the needed bag contents are taken outside the bag (also
placed on top of the barrier materials), the bag is closed until
4. Families with member who are sick with diseases transferred
after the procedure for nursing care is accomplished
via the respiratory tract should be taught the respiratory
precaution techniques:
 Avoid droplet infection
5. After any equipment used is cleaned, waste materials disposed
 Droplets are dispersed by coughing, sneezing or talking
of and the hands of the health worker washed, the bag is
reopened for returning the used equipment and then closed. The  Microorganism can remain suspended in the air and are
barrier materials may be disposed of or folded “inside out” or its dispersed by air current,
contaminated side in and placed on the top of the closed bag for  Disinfections of eating and drinking utensils of the sick
disposal later. member

The Thermometer Technique 5. Those with diseases transmitted via the gastrointestinal tract
1. Digital thermometer should be taught enteric precautions

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 Proper handwashing techniques and use of gloves to  also involves decision-making. “did nursing make a
dispose of fecal materials and things that came in difference?” or “what results came out of the nursing
contact with the client’s vomitus and feces activity?” decisions have to be made on whether the
FOMITES – DOON NA TUMITIRA ANG ORGANISM objectives have to be formulated, approaches and
strategies modified, resources increased and the like.
6. Those diseases form organisms transferred through the skin or  If evaluation shows that the objectives was not achieved,
bldy fluids should practice contact precautions. There are also the nurse has to find out the reason why; the objectives
organisms which inhabits inanimate hosts or vectors before may be unrealistic, nursing actions may be
transfer to other people. These include: inappropriate or uncontrollable environment factors
 Dengue fever may be operative in this situation.
 Malaria
 Leptospirosis Dimensions of Evaluation
 These are special precautionary measures such as mosquito EFFECTIVENESS
net use, insect repellants, detour from risky wooded areas,  focus is attainment of the objectives
floods and crowds
EFFICIENCY
7. Strict isolation or combined precaution  relates to cost whether in terms of money, time, effort,
 is required for diseases which can be transferred or materials
through multiple body orifices or have multiple routes
of transmission. Family members who are either elderly APPROPRIATENESS
or are very young have lower immune resistance and  is the ability to solve or correct existing problem
thus need most precaution isolation measures applied, situation, a question that involves professional
and should therefore into consideration judgement.

Common Problems that Affect the Quality of Care ADEQUACY

Health worker skills:  pertains to its comprehensiveness whether all necessary
1. Incomplete examinations and counseling activities were performed in order to realize the
2. Poor communications between health workers and parents intended results.
3. Irrational use of drugs Criteria and Standard
CRITERIA
Health System Issues:  refer to the signs or indicators that tell us if the objective
1. Location of health services and responsibility has been achieved. They are names and description of
2. Availability of appropriate drugs and vaccines variables that are relevant indicators of having attained
3. supervision/decision of labor/ organization of work the objectives. They are free from any value judgement
and are independent to time frame.

Community and Family Practices STANDARD

1. Delayed care seeking  once a value judgement is applied to a criterion; it
2. Poor knowledge of when to return to a health facility acquires the status of a standard. It refers to the desired
3. Seeking assistance from unqualified providers level of performance corresponding with a criterion
4. Poor adherence to health worker advice and treatment 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
SESSION 15
Activity and Outcomes
Family Health Care Evaluation and
ACTIVITIES
Records in the Family Health Nursing
 are actions performed to accomplish an objective. They
are the things the nurse does in order to achieved a
Evaluation desired result or outcome. Activities consume time and
 is interwoven in every nursing activity and every step of resources. Examples are health teachings, demonstration
the health nurse. Concerned with the determination of and referrals.
whether the objectives set were attained or to what degree
they were attained. OUTCOME
 is always related to objectives.  is the results produced by activities. Where activity is the
 when address to the result or outcome of care answers the cause, outcome is the effect. They can also be immediate,
question “did the intended results occur?” immediate or ultimate outcomes.
 There is always an element of subjectivity in evaluation;
the process involves value judgement which is subjective Patient care outcomes can be measured along three broad lines:

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1. PHYSICAL CONDITION 2. Family records

 decreased temperature or weight and change in clinical  The basic unit of service is the family. All records, which
manifestations relate to members of family, should be placed in a
single-family folder. This gives the picture of the total
2. PSYCHOLOGICAL OR ATTITUDINAL STATUS services and helps to give effective, economic service to
 decreased anxiety and favorable attitude towards health the family as a whole.
care personnel.  Separate record forms may be needed for different types
of service such as TB, maternity etc. all such individual
3. KNOWLEDGE ON LEARNING BEHAVIOR records which relate to members of one family should be
 compliance of the patient with instructions given by the placed in a single-family folder.
nurse.

The records may be grouped according to:

Records in Family Health Nursing Practice 1. Age of the family member for whom records are used
1. Records  a New boll1 care
 are necessary for the continuation of delivery of family  Road to health card -e
health care services and its evaluation while evaluation of  Toddler card e
family health services is necessary to identify the new and  Old age or elderly card e
continuing family health needs.  Mother-child link card

2. Health care requirement cards as per health conditions and

2. Family records morbidity status
 include information based on factual events, observation  Pregnant women or antenatal card
results or measurements taken such as height, weight,  Intra natal card or labor record
body circumference or laboratory examinations carried  Person with illnesses (e.g., Tuberculosis record, Diabetes
out like hemoglobin, urine test, stool test and sputum record, Hypertension case card)
examination depending upon the problem of the family.  Drug addicts or alcoholics’ record
These also includes records of immunization, nutritional
 Any chronic care records
status, medical prescription and curative procedures carried
 Immunization record
out. Demographic data and individual personal history are
also included in the family folders.
FILLING OF RECORDS
3. Health records  Different systems may be adopted depending on the
purposes of the records and on the merits of a system.
 refer to forms on which information about an individual
Records could be arranged in the following ways:
and family is noted. Information varies from socio-
1. Alphabetically
economic, psychological, environmental factors etc.
2. Numerically
Records are a practical and indispensable aid to the doctor,
3. Geographically
nurse and other health care workers in giving best service to
4. With index cards
individual, family or community. Recorded facts have value
and scientific accuracy and are guidelines for better
REGISTERS
administration of family health services. Contributions of
health team members are reflected in case records. Records  It provides indication of the total volume of service and
are also a means of communication between a health type of cases seen. Clerical assistance may be needed for
worker and the families. this. Registers can be of varied types such as
immunization register, clinic attendance register, family
planning register, birth register and death register.
Types of Records and Reports
1. Cumulative or Continuing Records REPORTS
 This is found to be time saving, economical and also it is  Reports can be compiled daily, weekly, monthly,
helpful to review the total history of an individual and quarterly and annually.
evaluate the progress of a long period. (e.g.) child’s  Report summarizes the services of the nurse and/or the
record should provide space for newborn, infant and agency and may be in the form of an analysis of some
preschool data. aspect of a service. These are based on records and
 The system of using one record for home and clinic registers and so it is relevant for the nurses to maintain the
services in which home visits are recorded in blue and records regarding their daily case load, service load and
clinic visit in red ink helps coordinate the services and activities. Thus, the data can be obtained continuously and
saves the time. for a long period.
PURPOSES OF WRITING REPORTS

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 To show the kind and quantity of service rendered over Concerns for Maternal Nutrition and Weight Do Not End at
to a specific period. Delivery
 To show the progress in reaching goals. Nutrition after delivery
 As an aid in studying health conditions.  If breastfeeding, still consume additional calories (500
 As an aid in planning. kcal/day)
 To interpret the services to the public and to other  Vitamin supplements if deficiencies noted
interested agencies
Weight after delivery
SESSION 16
 Up to 75% of women weigh more than their pre-
Maternal, Newborn and Child Health and pregnancy weight at one year postpartum
Nutrition  Postpartum weight retention
Nutrition  Increases the risk for adverse outcomes in future
 may be defined as the science of food and its relationship pregnancies
to health and concerned primarily with the part played  Influences a woman’s long-term health by increasing
by nutrients in body growth, development and risk for developing other conditions such as
maintenance hypertension and diabetes.

Nutritional status B. Newborn Nutritional Requirement

 is the current body status, of a person or a population Schedules of Newborn Feeding:
group, related to their state of nourishment (the A. First feeding.
consumption and utilization of nutrients).  May be breastfed immediately following delivery
(colostrum – ANTIBODIES) is not irritating if
A. Nutritional Requirement During Pregnancy aspirated and is absorbed by the respiratory system).
 Feed in the first hour of life.
1. FOLIC ACID  Latest to start feeding is 2–3 hours (when normal low
 If you’re planning to become pregnant you need 800 blood sugar occurs).
MICROGRAMS OF FOLIC ACID A DAY – which you
can find in up to six cups of fortified, cereal or three First feeding
cups of boiled spinach. You should continue to consume  many facilities give sterile water, a few swallows to half
this amount of folic acid during your entire pregnancy. ounce to evaluate feeding capability.
(Glucose water no longer recommended for first feeding due to
2. CALCIUM danger of aspiration pneumonia.)
 You need 1,000 MILLIGRAM OF CALCIUM
EVERYDAY – or a little more than 3 cups of milk. If Give full-strength formula or breast milk as soon as newborn
your developing baby is lacking the calcium it needs, it shows an interest.
may take it from your bones. B. Subsequent feeding.
 Routine schedule: 2- to 4-hour feedings.
3. IRON Self-demand:
 In your second trimester, your blood volume increases by  Baby is fed according to needs, when hungry, usually
50 percent, so you need 27 MILLIGRAMS OF IRON every 3–4 hours. (Breastfeeding may be 1½–
DAILY- equivalent to almost seven cups of kidney beans  3 hours.)
Calories and Fluid Needs
4. VITAMIN D
 You need 600 IU OF VITAMIN D EVERYDAY – the
same amount you’ll find in 13 hard boiled eggs. Vitamin
D is important during your entire pregnancy but if
you’re avoiding the sun it becomes even more crucial,

A. Fluid: 140–160 mL/kg of body weight in 24 hours.

 Fluid needs are high because the newborn is unable to
concentrate urine.

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 More fluids should be given in hot weather or when the

baby has an elevated temperature.

B. Energy
 Healthy term babies grow well with intake of 90-120
kcal/kg/D 125 - 140 kcal/kg/D

C. Protein Complementary Feeding

 Recommended allowance:15-20 % of daily calories Means complementing solid/semi-solid food with breast milk after
child attains age of six months.
D. Fat  It should be timely,
 Recommended daily intake: 30-40% for term  Adequate, safe
 Fat intake of 9 kcal/g triglycerides  Should be prepared with locally available food
 Infancy: 30-50% of total kcal
Purpose:
E. Carbohydrates  After the age of 6 months, child is ready to start eating
 Carbohydrate constitutes 40-50% of total daily calories semi-solid food
 Almost all the CHO in the human milk and infant  Breast milk alone is no longer enough for the baby’s
formula is lactose nutritional needs
 Breastfeeding must continue along with complementary
F. Minerals feeding
 Accretion of Ca, Phosphorus, Mg and iron is maximal at
the third trimester of pregnancy. What Type of Food Should be Given?
 7. ≥ 4 food groups
G. Supplements  Grains, roots and tubers
1. Vitamin K:  Legumes and nuts
 All infants receive at birth  Dairy products (milk, yogurt, cheese)
2. Vitamin D:  Flesh foods (meat, fish, poultry and liver/organ meats)
 Breastfed infants or infants who take <500 ml/day of vit.  Eggs
D fortified formula  Vitamin-A rich fruits and vegetables
3. Iron:  other fruits and vegetables
 Breastfed infants
NTD – NEUTRAL TUBE DEFECTS
Fe absorption 1. MENINGOCELA
 is good from human milk, but concentration is low. 2. MENINGOMYELOCELE

4. Fluoride: LAM- LACTATIONAL AMENORRHEA METHOD

 May be dependent on water supply  Family planning method during lactation

C. Child Nutritional Requirement. Postpartum – after pregnancy

Nutritional status of children during the critical period is of
paramount importance for later physical, mental & social VITAMIN K INJECT : VASTUS LATERALIS
development.
COMPLEMENTARY FEEDING AFTER 6 MONTHS = BF +
Outcomes of inadequate diet: SEMI SOLIDS FOODS
➢ Poor muscle development
➢ Reduced work capacity
➢ Poor social development
➢ High rates of illness
➢ Difficulty in school

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