CHN LEC TERM 2 EXAM

DAY 9 : PRIMARY HEALTH CARE (PHC)

May 1977 - 30th World Health Assembly decided that the main health target of the government and
WHO is the attainment of a level of health that would permit the m to lead a socially and economically
productive life by the year 2000

September 6-12, 1978 - 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

October 19, 1979 - Letter of Instruction (LOI) 949, the legal basis of PH was signed by Pres. Ferdinand E.
Marcos, which adopted PH as an approach towards the design, development and implementation of
programs focusing on health development at community level.

Rationale for Adopting Primary Health Care

-Magnitude of Health Problems
-Inadequate and unequal distribution of health resources
-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
acceptable to them, through their full participation and at cost that the community can afford at every
stage of development.
-A practical approach to making health benefits within the reach of all people.
-An approach to health development, which is carried out through a set of activities and whose ultimate
aim is the continuous improvement and maintenance of health status.

Goal of Primary Health Care

-HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year
2020.
- An improved state of health and quality of life for all people attained through SELF RELIANCE

Key Strategy to Achieve the Goal:

-Partnership with and Empowerment of the People - permeate as the core strategy in the effective
provision of essential health services that are community based, accessible, acceptable, and sustainable,
at a cost, which the community and the government can afford.

Objectives of Primary Health Care

-Improvement in the level of health care of the community
-Favorable population growth structure
-Reduction in the prevalence of preventable, communicable and other disease.
-Reduction in morbidity and mortality rates especially among infants and children.
-Extension of essential health services with priority given to the underserved sectors
 -Improvement in Basic Sanitation
-Development of the capability of the community aimed at self- reliance
-Maximizing the contribution of the other sectors for the social and economic development of the
community.

Mission
To strengthen the health care system by increasing opportunities and supporting the conditions wherein
people will manage their own health care.

Two Levels of Primary Health Care Workers

1. Barangay Health Workers - trained community health workers or health auxiliary volunteers or
traditional birth attendants or healers.
2. Intermediate Level Health Workers- include the Public Health Nurse, Rural Sanitary Inspector and
midwives.

Principles of Primary Health Care

1. 4 A's (Accessibility, Availability, Affordability & Acceptability, Appropriateness of Health Services.)
-The health services should be present where the supposed recipients are. They should make use of the
available resources within the community, wherein the focus would be more on health promotion and
prevention of illness
2. Community Participation
-heart and soul of PHC
[Link] are the center, object and subject of development.
-Thus the success of any undertaking that aims at serving the people is dependent on people's
participation at all levels of decision-making; planning, implementing, monitoring and evaluating. Any
undertaking must also De based on the people's needs and problems (PCF,1990)
-Part of the people's participation is the partnership between the community and the agencies found in
the community; social mobilization and decentralization.
-In general, health work should start from where the people are and building on what they have.
Example Scheduling of Barangay Health Workers in the health center

Barriers of Community Involvement

-Lack of motivation
-Attitude
-Resistance to change
-Dependence on the part of community people
-Lack of managerial skills

4. Self-reliance
-Through community participation and cohesiveness of people's organization they can generate support
for health care through social mobilization, networking and mobilization of local resources. Leadership
and management skills should be developed among these people. Existence of sustained health care
facilities managed by the people is some of the major indicators that the community is leading to self-
reliance
5. Partnership between the community and the health agencies in the provision of quality of life. -
Providing linkages between the government and the nongovernment organization and people's
organization
6. Recognition of interrelationship between the health and development
-Health- Is not merely the absence of disease. Neither is it only a state of physical and mental well-being.
Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic
factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the
living conditions and quality of life enjoyed by the community residents (PCF,
-Development- is the quest for an improved quality of life for all. Development is multidimensional. It
has political, social, cultural, institutional and environmental dimensions (Gonzales 1994). Therefore, it is
measured by ability of people to satisfy their basic needs.
7. Social Mobilization
-It enhances people participation or governance, support system provided by the Government,
networking and developing secondary leaders
8. Decentralization
-This ensures empowerment and that empowerment can only be facilitated if the administrative
structure provides local level political structures with more substantive responsibilities for development
initiators. This also facilities proper allocation of budgetary resources.

8 Elements of Primary Health Care (ELEMENTS)

1. Education for Health
-Is one of the potent methodologies for information dissemination. It promotes the partnership of both
the family members and health workers in the promotion of health as well as prevention of illness
2. Locally Endemic Disease Control
-The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate.
Example Malaria Control and Schistosomiasis Control
3. Expanded Program on Immunization
-This program exists to control the occurrence of preventable illnesses especially of children below 6
years old. Immunizations on poliomyelitis, measles tetanus diphtheria and other preventable disease are
given for free by the government and ongoing program of the DOH
[Link] and Child Health and Family Planning
-The mother and child are the most delicate members of the community So the protection of the
mother and child to illness and other risks would ensure good health for the community. The goal of
Family Planning includes spacing of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
-Environmental Sanitation is defined as the study of all factors in the man's environment, which exercise
or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one
factor in man's environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water
and Sanitation is necessary for basic promotion of health
6. Nutrition and Promotion of Adequate Food Supply
-One basic need of the family is food. And if food is properly prepared then one may be assured healthy
family. There are many food resources found in the communities but because of faulty preparation and
lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in
the country
[Link] of Communicable Diseases and Common Illness
-The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis
is one of the communicable diseases continuously occupies the top ten causes of death. Most
communicable diseases are also preventable. The Government foçuses on the prevention, control and
treatment of these illnesses.
8. Supply of Essential Drugs
-This focuses on the information campaign on the utilization and acquisition of drugs. In response to
this campaign, the GENERIC ACT of the Philippines is enacted. It includes the following drugs
Cotrimoxazole Paracetamol' Amoxycillin, Oresol, Nifedipine: Rifampicin, INH (isoniazid) and
Pyrazinamide, Ethambutol, Streptomycin, Albendazole,Quinine

Major Strategies of Primary Health Care

1. Elevating Health to a Comprehensive and Sustained National 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 resources required for their delivery, effective,
affordable accessible and culturally acceptable. The development of human resources must correspond
to the actual needs of the nation and the policies it upholds such as PHC. The DOH will continue to
support and assist both public and private institutions particularly in faculty development, enhancement
of relevant curricula and development of standard teaching materials

Advancing Essential National Health Research

-Essential National Health Research (ENHR) is an integrated strategy for organizing and managing
research using intersectoral, multidisciplinary and scientific approach to health programming and
delivery.

Four Cornerstones/Pillars in Primary Health Care

[Link] Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

RA 8423 or the Traditional and Alternative Medicine Act of 1997

(10 Medicinal Plants / Herbal Medicine)

-Decoction is boiling the part of material in water; 20 minutes is the recommended boiling time
-Infusion is soaking plant material in water much like making a tea 10-15 minutes is the recommended
soaking period
-Poultice is applying plant material directly on the affected part

Medicinal Plants ( LUBBY Uses/ Indications Preparation

SANTA)
Lagundi ( Vitex Negundo) Asthma, cough and colds, fever. Decoction /wash affected site
dysentery, pain, Skin diseases. with decoction
(scabies, ulcer, eczema),
wounds
UlasimangBato / Pansit- Lowers blood uric acid Decoction / eaten raw
pansitan ( Peperonica Pellucida) (rheumatism and gout)
Bawang ( Allium Sativum) Hypertension, lowers blood Eaten raw/ fried applied on
cholesterol, toothache parts

Bayabas (Psidium guajava L.) Washing wound, diarrhea, Decoction

gargle toothache
Yerba Buena ( Mentha Cordifeli) Headache, stomach ache, cough Massage sap ,Infusion,
and colds, rheumatism, arthriti Decoction
Sambong (Blumea Balsamifera) Anti-edema/Anti-urolithiasis Decoction
Akapulko (Cassia Alata L.) Anti-fungal Poultice
Niyog-niyogan (Quisqualis Anti-helminthic // worm Seeds are used
Indica L.)
Tsaang Gubat ( Carmona Diarrhea, stomach ache Decoction
Retusa)
Ampalaya ( Mamordica iabetes Mellitus (Mild Non- Decoction, Steam
Charantia) Insulin- Dependent)

Sentrong Sigla Movement

Certification Program: SS Seal (main Component)
Objectives: better and more effective collaboration between DOH and LGU
DOH: as a provider of technical and financial assistance packages of health care
LGU: as a prime developer of health system and direct implementers of health programs
4 Pillars: - Health promotion
-Award
-Quality Assurance
-Grants and Technical Assistance

Principles and Strategies of Primary Health Care ([Link].I.S)

-Provision of quality and essentials health services
-RA 7160: Decentralization
-- political will advocacy
 -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
-Mobilization: social
- Increase Community Participation
-- Consciousness-raising on health concerns
Self-reliance
-- Use of cooperatives and community business

ALTERNATIVE HEALTH CARE MODALITIES

TERM DEFINITION
ACUPRESSURE A method of healing and health promotion that
uses the application of pressure on acupuncture
points without puncturing the skin.
ACUPUNCTURE A method of healing using special needles to
puncture and stimulate specific anatomical
points on the body.
AROMATHERAPY The art and science of the sense of smell
whereby essential aromatic oils are combined
and then applied to the body in some form of
treatment.
CHIROPRACTIC A discipline of the healing arts concerned with
the pathogenesis, diagnosis, therapy, and
prophylaxis of functional disturbances,
pathomechanical states, pain syndromes, and
neurophysiological effects related to the static
and dynamics of the locomotor system,
especially of the spine and pelvis.
MASSAGE A method wherein the superficial soft parts of
the body are rubbed, stroked, kneaded, or
tapped for remedial, aesthetic, hygienic, or
limited therapeutic purposes.
PRANIC HEALING A holistic approach of healing that follows the
principle of balancing energy.

DAY 10 : THE FAMILY

Family
-Basic unit in society, and is shaped by all forces surround it
--Values, beliefs, and customs of society influence the role and function of the family (invades every
aspect of the life of the family)
-Is a unit of interacting persons bound by ties of blood, marriage or adoption
--Constitute a single household, interacts with each other in their respective familial roles and create
and maintain a common culture.
-An open and developing system of interacting personalities with structure and process enacted in
relationships among the individual members regulated by resources and stressors and existing within
the larger community (Smith & Maurer, 1995)
-Two or more people who live in the same household (usually), share a common emotional bond, and
perform certain interrelated social tasks (Spradly & Allender, 1996)
-An organization or social institution with continuity (past, present, and future). In which there are
certain behaviors in common that affect each other.

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
1. 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 cruelty exploitation/and other conditions prejudicial to their development
3. the right of the family to a family living wage income
[Link] right of families or family associations to participate in the planning and implementation of policies
and programs of that affect them
Section 4
The family has the duty to care for its elderly members but the state may also do so through just
programs of social security

The Filipino Family and its Characteristics

The basic social units of Philippine society are the nuclear family:
1. Although the basic unit is the nuclear family, the influence of kinship is felt in all segments of social
organizations
[Link] of relationships and descent patterns are bilateral
[Link] circles is considerably greater because effective range often includes the third cousin
[Link] group is further enlarged by a finial, spiritual or ceremonial ties. Filipino marriage is not an
individual but a family affair
[Link] goes with this kingship system
[Link] family has a profound effect on daily decisions
[Link] is a great degree of equality between husband and wife
[Link] not only have to respect their parents and obey them, but also have to learn to repress their
repressive tendencies
[Link] older siblings have something of authority of their parents

Types of Family
- There are many types of family. They change overtime as a consequence of BIRTH, DEATH, MIGRATION
SEPARATION and GROWTH OF FAMILY MEMBERS

A. Structure
-NUCLEAR- a father, a mother with child/children living together but apart from both sets of parents and
other relatives.
-EXTENDED- composed of two or more nuclear families economically and socially related to each other
Multigenerational, including married brothers and sisters, and the families
-SINGLE PARENT-divorced or separated, unmarried or widowed male or female with at least one child
-BLENDED/RECONSTITUTED-a combination of two families with children from both families and
sometimes children of the newly married couple. It is also a remarriage with children from previous
marriage
-COMPOUND-one man/woman with several spouses
-COMMUNAL-more than one monogamous couple sharing resources
-COHABITING/LIVE-IN-unmarried couple living together
-DYAD- husband and wife or other couple living alone without children
-GAY/LESBIAN-homosexual couple living together with or without children
-NO-KIN- a group of at least two people sharing a relationship and exchange support who have no legal
or blood tie to each other
-FOSTER- substitute family for children whose parents are unable to care for them

FUNCTIONAL TYPE:
-FAMILY OF PROCREATION- refers to the family you yourself created.
-FAMILY OF ORIENTATION-refers to the family where you came from.

B. Decisions in the family (Authority)

-PATRIARCHAL - full authority on the father or any male member of the family e.g., eldest son,
grandfather
-MATRIARCHAL - full authority of the mother or any female member of the family, e.g., eldest sister,
grandmother
-EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother
decides
-DEMOCRATIC - everybody is involved in decision making
-AUTHOCRATIC- LAISSEZ-FAIRE- "full autonomy"
-MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g., father is working
overseas)
-PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group of kinsmen for
certain social purposes)
PATRILINEAL - Affiliates a person with a group of relatives who are related to him though his father
BILATERAL- both parents
MATRILINEAL - related through mother

D. Residence
-PATRILOCAL - family resides / stays with / near domicile of the parents of the husband
-MATRILOCAL - live near the domicile of the parents of the wife

Ackerman States that the Function of Family are:

1. Insuring the physical survival of the species
[Link] the culture, thereby insuring the man’s humanness
--Physical functions of the family are met through parents providing food, clothing and shelter,
protection against danger provision for bodily repairs after fatigue or illness, and through reproduction.
--Affectional function. - the family is the primary unit in which the child test his emotional reaction
--Social functions - include providing social togetherness, fostering self-esteem and a personal identily
tied to family identity. providing opportunity for observing and learning social and sexual roles,
accepting, responsibility. for behavior and supporting individual creativity and initiative

Universal Function of the Family by Doode

-REPRODUCTION - for replacement of members of society: to perpetuate the human species
-STATUS PLACEMENT of individual in society
-BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
-Socialization and care of the children;
-Social control

The Family as a Unit of Care

Rationale for Considering the Family as a Unit of Care:
-The family is considered the natural and fundamental unit of society
-The family as a group generates, prevents, tolerates and corrects health problems within its
membership
-The health problems of the family members are interlocking
-The family is the most frequent focus of health decisions and action in personal care
-The family is an effective and available channel for much of the effort of the health worker
The Family as the client
Characteristics of a Family as a Client
-The family is a product of time and place-
-- A family is different from other family who lives in another location in many ways.
--A family who lived in the past is different from another family who lives at present in many ways.
-The family develops its own lifestyle
--Develop its own patterns of behavior and its own style in life
--Develops their own power system which either be:
 Balance-the parents and children have their own areas of decisions and control
Strongly Bias-one member gains dominance over the others.
-The family operates as a group
--A family is a unit in which the action of any member may set of a whole series of reaction within a
group, and entity whose inner strength may be its greatest single supportive factor when one of its
members is stricken with illness or death.
-The family accommodates the needs of the individual members.
--An individual is unique human being who needs to assert his or herself in a way that allows him to
grow and develop.
--Sometimes, individual needs and group needs seem to find a natural balance;
The need for self-expression does not over shadow consideration for others
Power is equitably distributed.
Independence is permitted to flourish
-The family relates to the community
--Family develops a stance with respect to the community:
The relationship between the families is wholesome and reciprocal; the family utilizes the community
resources and in turn, contributes to the improvement of the community.
There are families who feel a sense of isolation from the community.
-- Families who maintain proud, "We keep to ourselves" attitude
--Families who are entirely passive taking the benefits from the community without either contributing
to it or demanding changes to it.
-The family has a growth cycle
-- Families pass through predictable development stages (Duvall & Miller, 1990)

STAGES:
Stage 1: MARRIAGE & THE FAMILY
- Involves merging of values brought into the relationship from the families of orientation.
- Includes adjustments to each other's routines (sleeping, eating, chores, etc.), sexual and economic
aspects.
-Members work to achieve 3 separate identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
STAGE 2: EARLY CHILDBEARING FAMILY
-Birth or adoption of a first child which requires economic and social role changes
Oldest child: 2-1/2 years
Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN
-This is a busy family because children at this stage demand a great deal of time related to growth and
development needs and safety considerations.
-Oldest child: 2-1/2 to 6 years old
Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
- -Parents at this stage have important responsibility of preparing their children to be able to function in
a complex world while at the same time maintaining their own satisfying marriage relationship.
-Oldest child: 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
- A family allows the adolescents more freedom and prepare them for their own life as technology
advances-gap between generations increases
-Oldest child: 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
-Stage when children leave to set their own household-appears to represent the breaking of the family
---Empty nests
Stage 7: FAMILY OF MIDDLE YEARS
-Family returns to two partners nuclear unit
- Period from empty nest to retirement
Stage 8: FAMILY IN RETIREMENT/OLDER AGE
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES
12 Behaviors Indicating a Well Family
-Able to provide for physical emotional and spiritual 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
-Able to initiate and maintain growth producing relationship
- Maintain and create constructive and responsible community relationships
-Able to grow with and through children
-Ability to perform family roles flexibly
-Able to help oneself and to accept help when appropriate
-Demonstrate mutual respect for the individuality of family members
-Ability to use a crisis experience as a means of growth
-Demonstrate concern of family unity, loyalty and interfamily cooperation

Family Health Task

-Health task differ in degrees from family to family
-TASK- is a function, but with work or labor overtures assigned or demanded of the person
- Duvall & Niller identified 8 tasks essential for a family to function as a unit:

Eight Family Tasks (Duvall & Niller)

1. Physical maintenance- provides food shelter, clothing, and health care to its members being certain
that a family has ample resources to provide
[Link] of Family- involves preparation of children to live in the community and interact with
people outside the family.
[Link] of Resources- determines which family needs will be met and their order of priority.
[Link] of Order- task includes opening an effective means of communication between family
members integrating family values and enforcing common regulations for all family members.
[Link] of Labor - who will fulfill certain roles e g. family provider, home manager, children's caregiver
[Link], Recruitment, and Release of family member
[Link] of members into larger society -consists of selecting community activities such as church,
school, politics that correlate with the family beliefs and values
[Link] of motivation and morale- created when members serve as support people to each
other

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

[Link] interruptions of health development
2. Making decisions about seeking health care/ to take action
3. Dealing effectively health and non-health situations
[Link] care to all members of the family
[Link] a home environment conducive to health maintenance
Family Roles
-Nurturing figure- primary caregiver to children or any dependent member.
-Provider - provides the family's basic needs.
-Decision maker- makes decisions particularly in areas such as finance, resolution, of conflicts, use of
leisure time etc.
- Problem-solver- resolves family problems to maintain unity and solidarity.
-Health manager- monitors the health and ensures that members return to health appointments
-Gate keeper-Determines what information will be released from the family or what new information
can be introduced.

Theoretical Approaches to Family Health Care (Family Apgar)

Family Models
- the use of family model provides a perspective of focus for understanding the family
-have categorized according to their basic focus as developmental, interactional structural-functional,
and systems model

Developmental Models
Duvall's and Stevenson' Family Development Model
-Evelyn Duvall' (1977) family developmental framework provides guide to examine and analyze the basic
changes and developmental tasks common to most families during their life cycle. Although each family
has unique characteristics normative patterns of sequential development are common to all families -
These stages and developmental tasks illustrate common family behaviors that may be expected at
specific times in the family life cycle. The stages are marked by the age of the oldest child however some
overlapping occurs in families with several children

STAGES OF DEVELOPMENT BASIC FAMILY TASK

Beginning Families / Early Childbearing Physical Maintenance

Families with preschoolers Allocation of resources

Families with school children Division of Labor

Families with teen-agers Socialization of members

 Launching center families Reproduction, recruitment and release of
Members
Middle-aged families Placement of members in larger community
Maintenance of motivation and morale
Aging families

-Duvall's developmental model is an excellent guide for assessing, analyzing and planning around basic
family tasks developmental stage, however, this model does not include the family structure or
physiological aspects. which should be considered for a comprehensive view of the family. This model is
applicable for nuclear families with growing children and families who are experiencing health-related
problems

Stevenson' Family Developmental Model

- Joanne Stevenson (1977) describes the basic tasks and responsibilities of families in four stages.
STAGES HEALTH TASKS
Emerging family (from marriage for 7 to 10 years) Couple strives for independence from their
parents and to develop a sense of responsibility
for family life.
Crystallizing family (with teenage children) To assume responsibility for growth and
development of individual members and outside
organizations.
Interacting family (children grown and small Assumption of responsibility for “continued
grandchildren) survival and enhancement of the nation.”
Actualizing family (aging couple alone again) Assume the responsibility for sharing the wisdom
of age, reviewing life and putting affairs in order.

-She views family tasks as maintaining a common household rearing children and finding satisfying work
and leisure 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 structure, nor it addresses health promotion and
health-related concerns that the family may face.

Structural- Functional Model

Friedman' Structural- Functional Family Model

-Was developed from sociological frameworks and systems theory by Marilyn Friedman (1986)
-The family is the focus of this model as it interacts with supra-systems in the community and with
individual family members in the subsystem.

Friedman’s Family Model Components

STRUCTURAL COMPONENTS FUNCTIONAL COMPONENTS
Family composition Affective
Value Systems Physical necessities and care
 Communication Patterns Economic
Role Structure Reproductive
Power Structure Socialization and social placement
Family coping

-Structural component examines the family unit, how it is organized and how members relate to one
another in terms of values, communication network, role system and power while functional
components refers to the interaction outcomes resulting from family organizational structure.
-The structural-functional components and parts all intimately interrelate and interact, the others affect
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 parts that interacts with others and changes the whole family configuration.
- This model is comprehensive and incorporates three major areas, 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
Family Apgar Questionnaire (SMILKESTEIN, 1978)

Total Score:
7-10 = suggests a highly functional family
4-6 = moderately dysfunctional family
0-3 = severely dysfunctional family
Health as a Goal of Family Health Care
-HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in the family
-HEALTH THREAT- these are the conditions that make it more likely for 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- this refers to states of wellness and the likelihood for health maintenance or
improvement to occur depending on the desire of the family
Roles of Health Care Provider in Family Health Care
-HEALTH MONITOR
-PROVIDER OF CARE COORDINATOR
-FACILITATOR
-TEACHER
-COUNSELOR

DAY 11: FAMILY HEALTH ASSESSMENT

Family Health Assessment

In the family health nursing, this involves a set of actions by which the nurse measures the status of the
family as a client, its ability to maintain itself as a system and functioning unit, and its ability to maintain
wellness, prevent, control and resolve problems in order to achieve health and well-being among its
members.

Data about the present condition or status of the family are compared against norms or standards of
personal, social and environmental health, system integrity and ability to resolve system problems.

These norms or standards are arrived from values, beliefs, principles, rules or expectation.

Nursing Assessment includes data collection, data analysis or interpretation and problem definition
or nursing diagnosis.
These are:
1. First level assessment is a process whereby existing and potential health conditions or problems are
categized as
a. Wellness state
b Health threats
C. Health deficit
D. Stress points or foreseeable crisis situation
2. Second level assessment defines the nature or type of nursing problems that the family encounters
in performing the health tasks with respect to a given health condition or problems and etiology or
barriers to the family's assumption of these task.
Steps in family Nursing Assessment
There are three major steps in nursing assessment as applied to family nursing practice.
Data collection for first level assessment involves gathering of five types of data which will generate the
categories of health conditions or problems of the family. These data include :
[Link] structure, characteristics and dynamic-include the composition, demographic data of the
members of the family/household, their relationship to the head and place of residence, the type of,
and family interaction /communication and decision-making patterns and dynamics
2. Socio-economic and cultural characteristic-include occupation, place of work and income of each
working member; educational attainment of each family member; ethnic background and religious
affiliation; significant others and the role they play in the family's life; the relationship of the family to
the larger community

3. Home environment included information on housing and sanitation facilities; kind of neighborhood
and availability of social, health; communication and transportation facilities in the community
4. Health status of each member includes current and past significant illness; beliefs and practices
conducive to health and illness; nutritional and development status, physical assessment findings and
significant results of laboratory/diagnostics/screening procedures
[Link] and practices on health promotion/maintenance and disease prevention include use of
preventive services adequacy of rest/sleep, exercise. Relaxation activities, stress management of other
healthy lifestyle activities, and immunization status of at-risk family members.

Second-level assessment data include:

[Link] or describe the family's realities
2. Perceptions about and attitudes
3. Performance of health task on each health condition or problem identified during the first level
assessment

Data Gathering Methods and Tools

-There are several methods of data gathering that the nurse can select from depending on the
availability of resources such as materials, manpower, time and facilities.
-The critical point in the choice is concern for validity, reliability and adequacy of assessment data.
-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.

The following are brief description of common methods of gathering data about a family, its status and
state of functioning;
1. Observation- this method of data collection is done through the use of the sensory capacities- sight,
hearing, smell and touch. Through direct observation the nurse gathers information about family's state
of being and behavioral responses. The family's health status can be inferred from the signs and
symptoms of the problem areas reflected in the followings:
a. Communication and interactions pattern expected, used and tolerated by family members
b. Role perceptions/task assumptions by each member, including decision-making patterns
c. Conditions in the home and environment
2. Physical Examination- significant data about health status of individual family members can be
obtained through direct examination. This is done through inspection, palpation, percussion,
auscultation, measurement of specific body parts and reviewing the body system. It is essential for the
nurse to have the skills in performing physical assessment / appraisal in order to help the family be
aware of the health status of its member.
3. Interview - another major method of data gathering is the interview.
a. One type of interview is completing a health history for each family member.
b. Second type interview is collecting data by personally asking significant family members or relatives
questions regarding health, family life experiences and home environment to generate data on what
wellness condition and health problems exist in the family (first level and second level of assessment)
Notes:
- Productivity of the interview process depends upon the use of effective communication techniques to
elicit the needed responses.
-One major problem encountered by practitioners in gathering data (especially for the second level
assessment) is how to ascertain where the client is in terms of perception of health condition or
problems and the patterns of coping utilized to resolve them.
-Second level of assessment can be adequately done for each wellness state, health threats, health
deficit or crisis situation by going through the following procedures:

4. Record Review- the nurse may gather information through reviewing existing records and reports
pertinent to the client. These include the individual clinical records of the family members, laboratory
and diagnostic reports, immunization records, report about home and environmental conditions or
similar sources.
[Link] /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
- Distinguishing relevant from irrelevant data to decide what information is pertinent to understanding
the situation at hand and what information is immaterial.
- Identifying patterns such as physiologic function, developmental, nutritional /dietary,
coping/adaptation or communication pattern and lifestyle
- Comparing patterns with norms or standards of health, family functioning and assumption of health
task
-Interpreting results of comparisons to determine signs, symptoms or cues of specific wellness state,
health deficit, health threats or foreseeable crisis/s/stress point/ and their underlying causes or
associated factors
-Making inferences or drawing conclusions about the reasons for the existence of the health condition
or problems or risks for non-maintenance of wellness state which can be attributed to non-performance
of family health tasks.

DAY 12: FAMILY DATA ANALYSIS AND FAMILY NURSING DIAGNOSIS

After collecting data, these are analyzed, sorted out and grouped. The synthesized information will be
compared to the norm to determine the nature and sources of the data gathered.

From the inference made conclusions are formed. Hence, diagnoses are formulated and priorities set for
planning and implementation

Health problems are categorized according to factors affecting priority status.

Nature:
1. Health Threat - condition
2. Health Deficit- may lead to illness
3. Foreseeable crisis
Greater weight is assigned to health deficit over health threats because the former usually demands
more immediate intervention than the latter. On the other hand, foreseeable crisis is given the least
attention because culture-linked factors usually provide adequate support to cope with
developmental/situational crises

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

Salience
To determine the salience score, evaluate the family s perception ad evaluation of the problem in terms
of seriousness and urgency of attention needed. The family's concern and felt needs require priority
attention.

Listing and Categorizing Health Problems

The highest score is 5 equivalents to the total weight. The nurse considers as priority those conditions
and problems with total scores nearer five (5), Thus the higher score of the given problem the more
likely it is taken as a priority. With this score the nurse then ranks health conditions and problems
accordingly.
The Prioritized Health Problems
The list of health condition or problems ranked according to priorities is presented
1. Cough and fever 4.66
2. Scabies 4.5
3. Malnutrition 4.0

The end result of the second-level assessment is a set of family nursing problems for each health
conditions. A wellness condition is a nursing judgement related with the client's capability for wellness.
A health condition or problem is a situation which interferes with the promotion and or maintenance of
health and recovery from illness or injury. A wellness state or health condition/problem becomes a
nursing problem when it stated as the family's failure to perform adequately specific health task to
enhance the wellness state or manage the health problem. This is called NURSING DIAGNOSIS in family
nursing practice.

One of the major barriers to the effective operationalization and application of the nursing process in
the family health care is the absence of the classification system for nursing problems that reflect the
family status and capabilities as a functioning unit. To facilitate the process of defining family nursing
problems, a classification system of family nursing problems was developed and filed-tested in 1978.

The Typology of Nursing Problems in Family Health Care

The organizing principle of the typology is Freeman's Family Health Tasks. The rationale for adopting
these task as the framework of the typology is the fact that in community health nursing practice one
deals mostly with problems within the domain the human behavior or human response to health and
illness.

The result of the analysis of data taken during the first-level assessment is reflected as statement of
health condition or problems, either wellness states, health threats, health deficit and foreseeable crisis
situations or stress points. The results of the analysis of data taken during the second-level assessment
are reflected as statement of the family nursing problems.
HEALTH PROBLEMS FAMILY NURSING PROBLEMS

FIRST LEVEL OF ASSESSMENT SSECOND LEVEL ASSESSMENT

A. Potential for enhanced 1. Presence of wellness 1. Inability to recognize the
capability: Condition- stated as potential or presence of condition or
- Healthy lifestyle readiness- a clinical or nursing problem due to:
-Healthy maintenance /health judgement about the client in a. Lack of/inadequate
management transition from specific level of knowledge
- Parenting wellness or capability to a b. Denial about its existence or
-Breastfeeding higher level. severity as a result of fear of
-Spiritual well-bein consequences of diagnosis of
problems specially:
B. Readiness for enhanced 1. Social stigma, loss of respect
capability for: of peers/significant others
2. Economic/cost implication
-Healthy lifestyle 3. Physical consequences
- Healthy maintenance /health 4. Emotional/psychological
management issues/concerns
- Parenting 5. Attitude/philosophy in life
- Breastfeeding
- Spiritual well-being [Link] to make decisions
with respect to taking
A. Presence of risk factors of 2. Presence of health deficits- appropriate health actions due
specific diseases (lifestyle instances of failure in health to:
diseases, metabolic syndrome) maintenance. a. Failure to comprehend the
nature/magnitude of the
B. Threats of cross infection problem
from communicable diseases b. Low salience of the problem
c. Feeling of confusion,
C. Family size beyond what helplessness/or resignation
family resources can adequately brought about perceived
provide magnitude, severity of the
problem
D. Accident hazard d. Lack/inadequate
- Broken chair knowledge/insight as to
- Pointed sharps objects, alternative courses of action
poisons and medicines open to them
improperly kept e. Inability to decide which
- Fire hazards actions to take from among a
-Fall hazards list of alternatives
f. Lack /inadequate knowledge
E. Faulty /unhealthy of community health resources
nutrition/eating habit or for care
feeding g. Fear of consequences of
- Inadequate food intake both actions:
quality and quantity 1. Social consequences
-Excessive intake of certain 2 Economic consequences
nutrients 3. Physical consequences
-Faulty eating habits 4. Emotional /psychological
-Ineffective breast feeding - consequences
Faulty feeding techniques h. Negative attitude towards
health condition
F. Stress-provoking Factors i. Inaccessibility of appropriate
-Strained marital relationship resources of care
-Strained parent-sibling 1. Physical accessibility
relationship 2. Cost constraints or
-Interpersonal conflicts economic/financial agency Lack
between family members of confidence /trust in the
-Caregiving burden health personnel/agency
k. Misconception or erroneous
G. Poor home/ environmental information about proposed
condition/sanitation, course of action
-Inadequate living space
- Lack of food storage facilities 3. Inability to provide adequate
-Polluted water supply nursing care to the sick,
-Presence of breeding or resting disabled, dependent or
sights of vectors of diseases vulnerable/at risk member of
-Improper garbage /refuse the family due to:
disposal a. Lack of /inadequate
-Insanitary waste disposal knowledge about
-Improper drainage system disease/health conditions
-Poor lighting and ventilation b. Lack of /inadequate
-Noise pollution knowledge about child
-Air pollution development and care
c. Lack of /inadequate
H. Unsanitary food handling and knowledge of the nature or
preparation extent of nursing care needed.
d. Lack of necessary care
I. Unhealthy lifestyle and facilities, equipment and
personal habits/practices supplies
-Alcohol drinking e. Lack of/inadequate
-Cigarette/tobacco smoking knowledge or skills in carryout
-Walking barefoot or the necessary intervention or
inadequate footwear treatment or procedures
-Eating raw meat or fish f. Inadequate family resources
-Poor personal hygiene of care specifically
-Self-medication/substance 1. Absence of responsible
abuse member
-Sexual promiscuity 2. Financial constraint
-Engaging in dangerous sports 3. Limitation of luck/lack of
-Inadequate rest/sleep Lack of/ physical resources
inadequate exercise/physical g. Significant person's
activity unexpressed feelings h.
-Lack of relaxation activities Philosophy in life that
-Non-use of self-protection negates /hinders caring for the
measures sick, disabled, dependent,
vulnerable i. Members
J. Inherent personal preoccupation with concerns
characteristic (poor impulse /interest
control) j. Prolonged disease or
disabilities, which exhaust
K. Health history, which may supportive capacity of family
induce the occurrence of health members
deficit k. Altered role performance:
1. Role denial
L. Inappropriate role 2. Role strain
assumption (child assuming 3. Role dissatisfaction
mother's role, father not 4. Role conflict
assuming his role 5. Role confusion
6. Role overload
M. Lack of
immunization/inadequate 4. Inability to provide home a
immunization status home environment conducive
to health maintenance and
N. Family disunity personal development due to:
a. Inadequate family resources
1. Financial constraint/limited
A. Illness state, regardless resources
whether it is diagnosed or 3. Presence of Health Threats- 2. Limited physical resources
undiagnosed by medical condition that are conducive to b. Failure to see benefits of
practitioner diseases and accident. or may investment in home
B. Failure to thrive/develop result to failure to maintain environment improvement
according to normal rate wellness or realize health c. Lack/in adequate knowledge
C. Disability-whether congenital potentials of the importance of hygiene
or arising from illness and sanitation
d. Lack of/ inadequate
 A. Marriage 4. Presence of stress points/ knowledge on preventive
B. Pregnancy, labor, puerperium foreseeable crisis situations- measures
C. Parenthood anticipated periods of unusual e. Lack of skills in carryout
D. Additional member demand on the individual or measures to improve home
E. Abortion family in terms of environment
F. Entrance at school adjustment/family resources f. Ineffective communication
G. Adolescence pattern within the family
H. Divorce or separation g. Lack of supportive
I. Menopause relationships among family
J. Loss of job members
K. Hospitalization of a family h. Negative
member attitudes/philosophy in life
L. Resettlement in a new i. Lack of/ inadequate
community competences in relating to each
M. Illegitimacy other for mutual growth and
maturation

5. Failure to utilize community

resources for health care due
to:
a. Lack/inadequate knowledge
of community resources for
health
b. Failure to perceive the
benefits for health care services
c. Lack of trust/confidence in
the agency /personnel
d. Previous unpleasant
experience with health worker
e. Fear of consequences of
actions
f. Unavailability of required
services due to cost restraints
or physical inaccessibility
g. Lack of or inadequate family
resources
h. Feeling of alienation to /lack
of support from the community
i. Negative attitudes/philosophy
in life

DAY 13: FORMULATING AND IMPLEMENTING THE PLAN OF CARE

A plan of intervention is designed upon completion of the assessment and the analysis and health
diagnosis of the family.
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

Choice of family health care intervention should focus on what help lessen or eliminate possible reasons
for family's inability to do the tasks. Health education and training, or simply health teaching, enhances
the family abilities to recognize health problems, decide on appropriate health actions to take and
develop the ability to provide care for its members. The maximum use of available resources through
coordination and collaboration via an effective referral and conduction system is one of important tool
for intervention. Also included as intervention tools are the bag, thermometer, and isolation techniques
and dispensing home health care.

To guide the nurse in priority setting, the following factors need to be considered:
- Family safety - a life threatening situation is given top priority (Maurer and Smith,2009)
-Family perception - next to life threatening emergencies, priority is given to the need that the family
recognizes as most urgent and/or important (Maurer and Smith, 2009)
-Practicality - together with the family, the nurse looks into existing resources and constraints
-Projected effects - the immediate resolution of a family concern gives the family a sense of
accomplishment and confidence in themselves and the nurse.

Establishing Goals and Objectives

-Specific - the objective clearly articulates who is expected to do what, i.e., the family or a target family
member will manifest a particular behavior.
-Measurable - observable, measurable and whenever possible, quantifiable indications of the family's
achievement as a result of their efforts toward a goal provide a concrete basis for monitoring and
evaluation.
-Attainable - The objective has to be realistic and in conformity with available resources, existing
constraints, and family traits, such as style and functioning.
-Time bound - Having a specified target time or date helps the family and the nurse in focusing their
attention and efforts toward the attainment of the objective (Doran 1981)

Determining appropriate Intervention

Nursing Intervention categorize into three types (Freeman and Heinrich (1981)
-Supplemental interventions = are actions that the nurse performs on behalf of the family when it is
unable to do things for itself, such as providing direct nursing care to a sick or disabled family member.
-Facilitative interventions = refer to actions that remove barriers to appropriate health action, such as
assisting the family to avail of maternal and early child care services.
-Developmental interventions= aim to improve the capacity of the family to provide for its own health
needs, such as guiding the family to make responsible health decisions. this type of intervention is
directed toward family empowerment.

Plan of Evaluating Care

Evaluation is determining the value of nursing care that has been given to a family. The product of the
step is used for further decision making: to terminate, continue, or modify the interventions.

Aspects of evaluation that are useful in family health care:

- Effectiveness is determination of whether goals and objectives were attained
-Appropriateness refers to the suitability of the goals/objectives and interventions to the identified
family health needs
-Adequacy means the degree of sufficiency of goals/objectives and interventions in attaining the desired
change in the family
-Efficiency is the relationship of the resources use to attain the desired outcomes

Example: Name of Family______________

HEALTH PROBLEMS FAMILY NURSING GOALS OBJECTIVES

PROBLEMS
Cough and fever 1. Inability to recognize After nursing After nursing
the existence of the intervention, the intervention, the
problem due to following are expected following should be
ignorance of facts. to take place: achieved:
[Link] to make 1. The chances of [Link] family should
decisions with respect spreading acquire adequate
to taking appropriate communicable diseases information about the
health action due to to the other member disease, including signs
a. Failure to of the family and symptoms of the
comprehend the 2. The reoccurrence of disease, immediate
nature, magnitude or coughs and colds health care assistance
scope of the problem among family members and preventive
b. Lack of knowledge as will be prevented or measures.
to alternative courses minimized 2. Discuss with the
of actions open to family the
them consequences of failing
to take appropriate
health actions at the
earliest possible time.

INTERVENTION METHODS OF NURSING RESOURCES REQUIRED EVALUATION

METHODS
FAMILY CONTACT
1. Discuss with the Home Visit 1. Visual Aid Criteria:
family members the 2. Time and efforts of Cured Cough
 importance of knowing Clinic Visit both nurse and the Standard
the necessary family In 3-4 visits, cough will
information about the 3. Monetary allowance be cured through
disease to prevent for nurse 5 family care
spreading them. transportation
expenses.
These include the
following:
a. covering the mouth
when sneezing or
coughing
b. properly disposing of
oral and nasal
discharges
c. eating a well-
balanced diet
composed of
economical but
nutritious foods
d. maintaining proper
personal
environmental hygiene

2. Provide adequate
knowledge on the
various ways on
maintaining cleanliness
of their surroundings.
3. Explain the
importance of proper
food preparation,
exercise and rest in
strengthening one's
resistance against
illness.
4. Provide information
on health centers in
the vicinity for
immediate health care
assistance.
Implementation is putting the family health care plan into action. The implementation phase is should
be flexible. As family and the community Nurse work together, new information is used to adapt and
change the plan as necessary. Family health interventions are geared towards assisting the family in
carrying out functions that members cannot perform on their own. In Health promotion and disease
prevention, the nurse assists the family in improving their chances of becoming independent.

Families take risks every time they smoke, drink and engage in a stressful lifestyle. As the nurse explains
the reason behind the proposed changes, the family may choose to deny that it is jeopardizing
member's present and future health and may simply continue with risk-taking behaviors. Such a
situation will require the CHN ingenuity. The family's resistance to the proposed changes may be caused
by factors that are not yet considered, such as pressing basic needs that may include food, clothing, and
housing. Promoting health and preventing diseases may not be part of the family's life experience; if this
is the case, the health workers must first educate them before any positive behavioral change may be
observed.

According to Malaya (2003), there are four types of intervention for health promotion and disease
prevention.
These are:
1. Increasing knowledge and skills,
2. Increasing family strengths
3. Decreasing exposure to risk factors
4.. Decreasing susceptibility.

Increasing Knowledges and skills includes assisting families to make informal choices about helpful
lifestyle and behavior that will lessen or totally eliminate harmful environmental influences that
adversely affect their health
-The first involves creating awareness that is achieved by working together with the CHN to uncover
actual or potential problems.
-The second step is to learn to recognize families at risk.
-The third step offers families at risk the benefits of knowing how to motivate and support behavioral
changes.

Increasing Family Strength refers to the factors or forces that contribute to family unity and solidarity;
and that foster the development of inherent family potentials. These factors include the following:
1. Physical, emotional and spiritual factors
2. Healthy child-rearing practices and discipline
3. Meaningful and clear communication
[Link] security and encouragement
5. Growth-inducing relationships and experiences
6. Responsible community relationships
7. Growth with/and through children
8. Self-help and acceptance of help
9. Flexibility to family functions and roles
10. Mutual respect for individuality
11. Crisis as a measure for growth
12. Family unity and loyalty and intra-family cooperation
13. Adaptability of family strength

Decreasing exposure to risk factors includes making parental behavior complement the child's
behavior. In homes where parents are uninformed, the parent responds differently to the child's
attempt to communicate; the same is true with regard to their general behavior towards the child. This
may lead to a significant difference later in the child intellectual ability. For the most part, the child well-
being is influenced by the presence or absence of physical hazards in /her surroundings. Physical hazards
present in the home should be removed or replaced for the child's benefits. Raising healthy-well-
rounded children requires plenty of patience and vigilance.

DECREASING SUSCEPTIBILITY means educating the family on the principles of prevention and disease
control. It is fact that personal hygiene and cleanliness are primary factors in disease control and
prevention. It is expected that the family knows which signs and symptoms need medical attention and
how to take care of minor illnesses. Family perception of health risks and their susceptibility will
determine how they change their behavior. If the overweight family believes obesity to be a threat to
their health and the CHN works with them to change their eating habits to reduce and maintain and
ideal weight, the family is likely to react positively to change. Health workers who introduce threat as a
motivator to action are morally obligated to reduce the threat through meaningful and purposeful
intervention.

Methods of Teaching Knowledge

1. Teach only the facts that the client needs to know
2. Carefully plan activities for the client where they can apply what they have just learned. Do not limit
yourself to lectures; giving materials, pamphlets; invite resources.
3. Encourage them to learn more from their own experiences, books, role models and from other family
members.
4. Use visual aids, handouts, audiovisuals, tapes

Methods of Teaching Skills

1. Describing a skills or tasks analysis
2. Demonstrating a skill
3. Practicing or return demonstration of the family member of the skill

Methods of Teaching Attitude

1. Attitude, emotions and values is the tendency to behave in a certain way, either positively or
negatively,
2. These are not easily developed. Health education must not only remind the client to be thorough, but
he or she mus also demonstrate it.
3. Attitudes are shaped by:
a. Providing relevant background information
b. Providing models or examples
c. Providing experience
d. Encouraging discussion/feedback
e. Role playing or practice activities

Preparing a Health Education

To be an effective educator, one must start with a teaching plan so as to have a very clean ide of the
topic to be discussed and the activities to be demonstrated.
Example:

Teaching Objectives Attracting Client Activities Evaluation

Interest
After the session, the [Link] pictures of [Link] picture of [Link] and answer
client will be able to: malnourished children each child with about pictures exhibit
1. Examine a child for [Link] example of malnutrition; Discuss. [Link] taking return
signs and symptoms of weight list of children [Link] why they think demonstration
malnutrition and interpret with malnourishment
2. Demonstrate how client develops in children
to weigh and interpret [Link] ways to
weight prevent and treat
3. Discuss types of malnourishment.
malnutrition and
causes
[Link] how to
protect them.

Interpretation of the Teaching Plan

Encourage the client /family member to share their ideas first and their views about the topic. Provide
feedback to inform client whether their opinions and ideas are accurate or not. Be diplomatic or tactful
when correcting /pointing out inaccurate opinions or ideas.

Evaluation of health teaching activity and effectiveness of the health educator

An effective health educator:

1 was clearly heard and understood in what she /he taught
2 Used simple language
3 Used visual aid
4. summarized the main points.

DAY 14: HOME HEALTH CARE AND HEALTH EDUCATION

A. Home Health Care and People centered Care aim to develop and nurtured.

Informed and Empowerment Individuals and Families through the following:

1. Equitable access to health system, effective treatments and psychosocial support
2. Access to clear, concise and intelligible health information and education that increases health literacy
and allows for informed decision-making
3. Personal skills which allow control over health and engagement with health care system-
communication, mutual collaboration and respect, goal-setting, decision-making, problem solving and
self-care
4. Supported involvement in health care decision-making, including health policy, programs
development resource allocation, and health financing

People Centered Health Care

What can be done?
-Create supportive environments aimed at respecting protecting and fulfilling the right to safe and
quality health care
-Advocate health policies that ensure effective, holistic and people centered health and nursing care.

Primary Health Care

-Key to attaining acceptable level of health for the population
-Surest route to appropriate, accessible, affordable care
-Best gatekeeper for the referral system
-Optimizes the power of prevention and health 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
-Families
-Special groups
-Communities

Core Health Professional Competencies Needed

-A Patient-centered focus- addressing social, emotional as well as physical health
-Partnership; interdisciplinary teamwork
-Investments in information/ communication technology
-Shared learning accountability
-Health economics, financing

Core Health Professional Competencies

-Epidemiology, health determinants, public health
-Communication, collaboration, team-building
-Health Promotion; risk reduction
-Academic- service partnerships
-Accountability, organizational effectiveness
- Quality improvement
B. DISPENSING HOME HEALTH CARE
The Bag Technique
1. To enhance the capacity of the PHN and home health care givers to promote the values and
principles of family- centered care, including access, safety, affordability and satisfaction, the use of
the bag technique should be strictly undertaken. As a role model, the PHN and Home Health Care giver
should reinforce a culture of caring. communicating and healing in the context pf psychological, cultural
and social determinants of health
2. Use of the PHN bag, or any receptacle for health care paraphernalia brought by the health care
personnel to the patient's home should be governed by the principle that anything that are outside the
bag is considered contaminated, and therefore, should not touch what are inside the bag.
3. To protect the inside contents of the bag, barrier materials (paper or cloth) should first be placed
under the bag before it is placed down inside the client's home. The health worker must therefore, wash
his/her hands before opening and getting out the bag contents for use in nursing procedures
4. Once the needed bag contents are taken outside the bag (also placed on top of the barrier materials),
the bag is closed until after the procedure for nursing care is accomplished
5. After any equipment used is cleaned, waste materials disposed of and the hands of the health worker
washed, the bag is reopened for returning the used equipment and then closed. The barrier materials
may be disposed of or folded "inside out" or its contaminated side in and placed on the top of the closed
bag for disposal later.

The Thermometer Technique

1. Digital thermometer that features large displays are easier to read, which may be more convenient.
These thermometers also tend to give result quicker than standards thermometer. Always check for the
low batteries so accuracy can be assured.
2. Aseptic technique must be constantly in the health worker's mind while dispensing care from the
client and from the home to home. A dispenser of cotton or tissue papers to be moistened with
disinfectant should be kept handy to prevent transfer of infections via the thermometer. The principles
of "clean to dirty" and "proper waste disposal should be the rule to follow.

Wound Care
1. Any wound should be considered ineffective and all materials and equipment used for wound care at
home should be properly disinfected before leaving the client's home
2. The principles of "Clean to Dirty' should be the rule in the cleaning the wound of the client. Clean
gloves can be used for large infected wounds, while sterile gloves and forceps should be used for
surgical wound care. Equipment used can be sterilized chemically or by boiling for 15 minutes after
cleaning with soap and water. These should be done before replacing the used equipment into the
health worker bag.

Home Isolation Techniques

1. Isolation technique isolates or separates the offending microorganisms but must not necessanly
isolate the client.
2. The health worker must know the nature of the client's disease and how this may be transferred
from person to person.
3 After this, the family should be informed on steps to take to prevent transmission from one family
member to another or to visitors/neighbor
4. Families with member who are sick with diseases transferred via the respiratory tract should be
taught the respiratory precaution techniques.
-Avoid droplet infection
- Droplets are dispersed by coughing, sneezing or talking
-Microorganism can remain suspended in the air and are dispersed by air current,
- Disinfections of eating and drinking utensils of the sick member
5. Those with diseases transmitted via the gastrointestinal tract should be taught enteric pre cautions
- Proper handwashing techniques and use of gloves to dispose of fecal materials and things that came in
contact with the client's vomitus and feces
6. Those diseases form organisms transferred through the skin or bloody fluids should practice contact
precautions. There are also organisms which inhabits inanimate hosts or vectors before transfer to other
people.
These include:
- Denque fever
-Malaria
-Leptospirosis
-These are special precautionary measures such as mosquito net use, insect repellants, detour from risky
wooded area, floods and crowds
7. Strict isolation or combined precaution is required for diseases which can be transferred through
multiple body orifices or have multiple routes of transmission. Family members who are either elderly or
are very young have lower immune resistance and thus need most precaution isolation measures
applied, and should therefore into consideration

Common Problems that Affect the Quality of Care

Health worker skills:

1. Incomplete examinations and counseling

2. Poor communications between health workers and parents
3. Irrational use of drugs

Health System Issues:

1. Location of health services and responsibility
2. Availability of appropriate drugs and vaccines
3. supervision/decision of labor/ organization of work

Community and Family Practices

1. Delayed care seeking
2. Poor knowledge of when to return to a health facility
3. Seeking assistance from unqualified providers
4. Poor adherence to health worker advice and treatment

Health Education Principles

- It considers the health status of the people, which is determined by the economic and social
conscience of the country.
- It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly
for the improvement of health conditions of the family, community, and nation.
-It involves motivation, experience, and change in conduct and thinking, while stimulating active
interest. It develops and provides experience for change in people's attitudes, customs, and habits in
relation to health and everyday living.
- It should be recognized as the basic function of all health workers
- It takes place in the home, in the school, and in the community.
- It is a cooperative effort requiring all categories of health personnel to work together in close
teamwork with fames, groups, and the community.
- It meets the needs, interests, and problems of the people affected.
-It finds means and ways of carrying out plans by encouraging individual and community participation.
- It is a slow, continuous process that involves constant changes and revisions until objectives are
achieved
--Makes use of supplementary aids and devices to help with the verbal instructions.
-It utilizes community resources by careful evaluation of the different services and resources found in
the community
-It is a creative process requiring methods and techniques with various characteristics, not following a
rigid and flexible pattern
- It aims to help people make use of their own efforts and education to improve their conditions of living
-It makes careful evaluation of the planning, organization, and implementation of all health education
programs and activities.

DAY 15: FAMILY HEALTH CARE EVALUATION AND RECORDS IN THE FAMILY
HEALTH NURSING

Definition and Concepts

-Evaluation is interwoven in every nursing activity and every step of the health nurse. Concerned with
the determination of whether the objectives set were attained or to what degree they were attained.
-Evaluation is always related to objectives.
-Evaluation when address to the result or outcome of care answers the question "did the intended
results occur?"
-There is always an element of subjectivity in evaluation; the process involves value judgement which is
subjective
-Evaluation also involves decision-making. "did nursing make a difference?" or "what results came out of
the nursing activity?" decisions have to be made on whether the objectives have to be formulated,
approaches and strategies modified, resources increased and the like.
- If evaluation shows that the objectives was not achieved, the nurse has to find out the reason why; the
objectives may be unrealistic, nursing actions may be inappropriate or uncontrollable environment
factors may be operative in this situation.
Dimensions of Evaluation

-EFFECTIVENESS focus is attainment of the objectives.

-EFFICIENCY relates to cost whether in terms of money, time, effort, or materials
-APPROPRIATENESS is the 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.

Criteria and Standard

-CRITERIA refer to the signs or indicators that tell us if the objective has been achieved. They are names
and 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.
-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.

Activity and Outcomes

-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.
1. PHYSICAL CONDITION - decreased temperature or weight and change in clinical manifestations
2. PSYCHOLOGICAL OR ATTITUDINAL STATUS - decreased anxiety and favorable attitude towards health
care personnel
3. KNOWLEDGE ON LEARNING BEHAVIOR - compliance of the patient with instructions given by the
nurse

Importance of Evaluation
-Evaluation, whether of single activity or an entire program, is an expensive and time-consuming
process. The temptation to forego it in favor of more activities is therefore understandably appealing
-There are foremost reasons why nurses should evaluate their activities and/or intervention:
--To eliminate or stop the continued performance of useless activities and interventions:
-- To increase the efficiency of nursing interventions
--To provide documentations of the results of nursing efforts and justification of the cost of nursing
services.
--To promote growth of the profession and refinement of nursing practice

Records in Family Health Nursing Practice

Records are necessary for the continuation of delivery of family health care services and its evaluation
while evaluation of family health services is necessary to identify the new and continuing family health
needs.

Family records include information based on factual events, observation results or measurements taken
such as height, weight, body circumference or laboratory examinations carried out like hemoglobin,
urine test, stool test and sputum examination depending upon the problem of the family. These also
includes records of immunization, nutritional status, medical prescription and curative procedures
carried out. Demographic data and individual personal history are also included in the family folder.

Health records refer to forms on which information about an individual and family is noted. Information
varies from socio- economic, psychological, environmental factors etc. Records are a practical and
indispensable aid to the doctor, nurse and other health care workers in giving best service to individual,
family or community. Recorded facts have value and scientific accuracy and are guidelines for better
administration of family health services. Contributions of health team members are reflected in case
records. Records are also a means of communication between a health worker and the families.

A. Importance and Uses

-Provides documentation of services that have been rendered and supply data that are essential for
program planning.
-To provide the practitioner with data required for application of professional services for improvement
of family's health
-Records are tools of communication.
-Effective health record shows health problem in the family and other factors that affect health-
standardized sheet/form.
-Records indicate a plan for future.
-Provides baseline data to estimate long-term changes related to services
-Provides opportunity for providing evaluation of the situation.

Purpose of documenting Family Health History which is an important

component of family health records are the following:
-Provides facts that are necessary for evaluating health situation of the family; it should also describe
the nature and impact on health threat. It should describe the health condition and interacting forces
within the family in their daily living
-To provide an opportunity for mutual exploration of the health situation by the nurse and by the family
so that they can explain to each other their concern, expectations and probable actions
-To provide baseline and periodic data from which to estimate the long-term changes, services provided
and response of the family to these changes and services

Family health records should represent a comprehensive, systematically organized data and information
that are essential for nursing care decisions. The community health nurse must ensure adequacy of
support records for her action. Though each agency has its own system of recording, the community
health nurse can find her own ways of adapting family history and progress record to her own practice,
style and informational needs. Her records may be a valuable resource when agency records are being
revised or the system is being reorganized. The community health nurse may need to build into the
records, methods for incorporating information necessary for case planning and assessing health service
utilization.

Criteria for Recording in Family Health Records

The criteria should reflect both the purpose and process of community health nursing practice.
-Records should concentrate on the family and community focus of care. It should reflect not only the
health of the members of the family but also the ways in which the functioning of the family as a unit
has an impact on the health of family as a whole. It should also specify the ways in which family
functions within its physical and social environment
-Family health records should serve as guides for comprehensive care. These should include health
threats and health behaviors that have significance for family health. For example, an adequately
immunized family may have a health threat from emotionally immature and impulsive parents
-An apparently healthy family may have poor nutritional habits and poor housekeeping practice inviting
accidents. It is important that records show the problem as it develops so that the change can be
identified.
- The record should indicate the expected outcomes and also the degree to which outcomes are
achieved .This means that the goals of care to a family are also defined in the records.
-The family health record should have specified actions planned for the family actions actually taken and
distribution of responsibility to family and other community resources so that necessary activities are
carried out. Action taken should be recorded in such a way that it can be easily located and future
planning can be done
-The family record should indicate family response to nursing action.
-Since initial planning and implementation can redefine a problem the record must show revision in the
status of the problem so that further planning can be done accordingly.
-Record system should possess sufficient uniformity to make recording, tabulation and collection easy
and to permit inter-unit-in-service comparisons and easy reference.
-Maintenance of records should require a minimal amount of time. Unimportant and irrelevant data
reading may also require more time and lengthy records may result in errors.
- Family records should be quickly available to the user. Accessibility is not always easy to achieve.
Compiled individual and family records can be made available at a central location for easy reference
only for professional use.
-Family records require reasonable storage space. As the number of individuals are increased, the
records also increase and require more storage space and facilities.
-Depending upon the number of years, records should be retained, according to agency policies and
storage space will be required
-Family record system should provide confidentiality of record content. For example, sometimes a
mother in the family may not like information about family planning methods she has adopted to be
shared with other members of the family or her neighborhood women. There should be provision for
such confidential information and sometimes official records in the agency do not have provisions for
such recording. The community health nurse must find her own ways to I incorporate such
summarization into her recording so that priority needs can be attended to first.
Use of Records
1. For a Nurse
-Provides basic facts for services. Shows health condition as it is and as accepted by individual/family
-Provides a basis for analyzing needs, short and long-term planning
-Prevents duplication of services and helps follow up effectively
-Helps the nurse to evaluate care and teaching
-Helps to organize her work in an orderly way and to make effective use of time
- Serves as a guide to professional growth
- Enables the nurse to judge the quality and quantity of work done

2. For Individual/Family
-Help them to become aware and to recognize their health needs
-Can be used as a teaching tool too

3. For the Doctor

-Serves as a guide for diagnosis, treatment and evaluation of services
-Indicates progress
-May be used in research

4. For the Organization and Community

-Helps to assess the health assets and needs of the community
-Helps in making studies for research, legislative action and planning budget
- is legal evidence of the services rendered by each worker
-Provides a justification for expenditure of funds

B. Types of Records and Reports

1. Cumulative or Continuing Records
-This is found to be time saving, economical and also it is helpful to review the total history of an
individual and evaluate the progress of a long period. (e.g.) child's record should provide space for
newborn, infant and preschool data.
-The system of using one record for home and clinic services in which home visits are recorded in blue
and clinic visit in red ink helps coordinate the services and saves the time.

2. Family records
-The basic unit of service is the family. All records, which relate to members of family, should be placed
in a single- family folder. This gives the picture of the total services and helps to give effective, economic
service to the family as a whole
-Separate record forms may be needed for different types of service such as TB, maternity etc. all such
individual records which relate to members of one family should be placed in a single-family folder.

The records may be grouped according to:

1. Age of the family member for whom records are used
-a New boll1 care
-Road to health card -e
-Toddler card e
-Old age or elderly card e
-Mother-child link card

2. Health care requirement cards as per health conditions and morbidity status
-Pregnant women or antenatal card
- Person with illnesses (e.g., Tuberculosis record, Diabetes record, Hypertension case card)
-Drug addicts or alcoholics' record
-Any chronic care records
-Immunization record

Usually for family health service a family folder including different cards is maintained. This includes
socio-demographic information, children's health status (including height, Weight, immunization and
feeding habits etc.) ,maternal records. morbidity records and observations of general health status of
family and the environment of the family.

These records have individual formats and styles of recording which is prescribed for each agency. The
method of recording is usually a standard one and general Nursing instructions are provided.

FILLING OF RECORDS
- Different systems may be adopted depending on the purposes of the records and on the merits of a
system. Records could be arranged in the following ways:
--Alphabetically
--Numerically
--Geographically and
--With index cards

REGISTERS
-It provides indication of the total volume of service and type of cases seen. Clerical assistance may be
needed for this. Registers can be of varied types such as immunization register, clinic attendance
register, family planning register, birth register and death register.

REPORTS
-Reports can be compiled daily, weekly, monthly, quarterly and annually.
-Report summarizes the services of the nurse and/or the agency and may be in the form of an analysis of
some aspect of a service. These are based on records and registers and so it is relevant for the nurses to
maintain the records regarding their daily case load, service load and activities. Thus, the data can be
obtained continuously and for a long period.

PURPOSES OF WRITING REPORTS

-To show the kind and quantity of service rendered over to a specific period
-To show the progress in reaching goals
-As an aid in studying health conditions
-As an aid in planning.
-To interpret the services to the public and to other interested agencies.

In addition to the statistical reports, the nurse should write a narrative report every month which
provides as opportunity to present problems for administrative considerations. Maintaining records is
time consuming, but they are of definite importance today in the community health practice in solving
its health problems.

DAY 16: MATERNAL, NEWBORN AND CHILD HEALTH AND NUTRITION

Nutrition may be defined as the science of food and its relationship to health and concerned primarily
with the part played by nutrients in body growth, development and maintenance

Nutritional status is the current body status, of a person or a population group, related to their state of
nourishment (the consumption and utilization of nutrients)

> FOLIC ACID

- If you’re planning to become pregnant, you need 800 micrograms of folic acid a day – which you can
find in up to six cups of fortified cereal, or three cups of boiled spinach. You should continue to consume
this amount of folic acid during your entire pregnancy.

> CALCIUM
-You need 3000 milligrams of calcium a day – or a little more than three cups of milk. If your developing
baby is lactating the calcium it needs it may take it from your bones.

> IRON
- In your second trimester, your blood volume increases by 50 percent, so you need 27 milligrams of iron
daily—equivalent to almost seven cups of kidney beans.

> VITAMIN D
- You need 800 IU of vitamin D every day—same amount youll 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.

Concerns for Maternal Nutrition and Weight Do Not End at Delivery

- Nutrition after delivery
-- If breastfeeding, still consume additional calories (500 kcal/day)
-- Vitamin supplements if deficiencies noted
-Weight after delivery
-- Up to 75% of women weigh more than their pre-pregnancy weight at one year postpartum
--Postpartum weight retention
= Increases the risk for adverse outcomes in future pregnancies
= Influences a woman's long-term health by increasing risk for developing other conditions such as
hypertension and diabetes.

B. Newborn Nutritional Requirement

Schedules of Newborn Feeding:
A. First feeding.
-May be breastfed immediately following delivery (colostrum is not irritating if aspirated and is absorbed
by the respiratory system)
-Feed in the first hour of life
-Latest to start feeding is 2-3 hours (when normal low blood sugar occurs).
- First feeding--many facilities give sterile water, a few swallows to half ounce to evaluate feeding
capability. (Glucose water no longer recommended for first feeding due to danger of aspiration
pneumonia.)
-Give full-strength formula or breast milk as soon as newborn shows an interest.
B. Subsequent feeding
-Routine schedule: 2- to 4-hour feedings.
-Self-demand: Baby is fed according to needs, when hungry, usually every 3-4 hours. (Breastfeeding may
be 1½- 3 hours.)
-Calories and Fluid Needs

A. Fluid:
140-160 mL/kg of body weight in 24 hours.
-Fluid needs are high because the newborn is unable to concentrate urine
-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
-Recommended allowance: 15-20% of daily calories
D. Fat
-Recommended daily intake:
= 30-40% for term
- Fat intake of 9 kcal/g triglycerides
= Infancy: 30-50% of total kcal
E. Carbohydrates
-Carbohydrate constitutes 40-50% of total daily calories
-Almost all the CHO in the human milk and infant formula is lactose
F. Minerals
-Accretion of Ca, Phosphorus, Mg and iron is maximal at the third trimester of pregnancy.
G. Supplements
1 Vitamin K: All infants receive at birth
2. Vitamin D: Breastfed infants or infants who take <500 ml/day of vit. D fortified formula
3. Iron: Breastfed infants
-Fe absorption is good from human milk, but concentration is low.
4. Fluoride: May be dependent on water supply .

C. Child Nutritional Requirement. Nutritional status of children during the critical period is of
paramount importance for later physical, mental & social development.

Outcomes of inadequate diet.

= Poor muscle development
=Reduced work capacity
=Poor social development
=High rates of illness
=Difficulty in school

NUTRIENT 0-6 MONTH 7-12 MONTH 1-5 YEARS

K-Calorie 120 100 1000-1500
Protein 2.3-1.8 gm/kg 1.8-1.5 gm/kg 17-22 gm
Calcium (Ca) 0.5-0-6 mg 0.5- 0.6 mg 0.4- 0.5 mg
Iron (Fe) 6mg 10 mg 15-20 mg
Vit A 400 mg 300 mg 250-300 mg
Thiamine (B1) 0.3 mg 0.3 mg 0.6-0.8 mg
Riboflavin (b2) 0.4 mg 0.4 mg 0.7 – 0.8 mg
Vit C 30 mg 30 mg 30-40 mg
Folic Acid 35 mg 25 mg 50-100 mg

Complementary Feeding
-Means complementing solid/semi-solid food with breast milk after child attains age of six months
--It should be timely, }
--Adequate, safe
--Should be prepared with locally available food

Purpose:
-After the age of 6 months, child is ready to start eating semi-solid food
-Breast milk alone is no longer enough for the baby's nutritional needs}
-Breastfeeding must continue along with complementary feeding

What Type of Food Should be Given?

-7. > 4 food groups
- Grains, roots and tubers
- Legumes and nuts
-Dairy products (milk, yogurt, cheese)
- Flesh foods (meat, fish, poultry and liver/organ meats)
-Eggs
-Vitamin- rich fruits and vegetables
-other fruits and vegetables