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. Exposure to a Risk Factor Recent meat Ingestion No recent meat lmrestfon Total Health Status With Enteritis Without Enteritb necrotlcan1 necrotlcans 50 16 11 41 61 57 Usihg the formula for the odds ratio: OR=ad/bc = so (41)/16 (11) = 11,6 Total 66 S2 118 The OR inclicates that the people who were diagnosed to have Enteritis necroticans were u. 6 times more likely to have ingested meat compared to those who were not diagnosed to have the disease. Attributable Risk provides information about absolute effect of the e;,,. l)osure or the e. xcess risk of the di$ease to a causal agent. It gives a better idea tban the RRR of the impact of successfi_1J preventiv e or public hea]th program might have in reducing the problem. It is computed by taking the difference in the incidence rates of disease between e;,,. 'J)osed and non-exposed population. Attributable Risk= Incidence Rate among e11posed-Incidence Rate amon1 the non exposed The concept of attributable risk can be shown by looking into lbe relationship of mothers' atlendnnc e to reg1. 1h1r pre-natal clinic visits to maternal complications. The incidence rate of maternal complications among those who regularly attend pre-natal clinic was 53/10,000 live hirtbs compared to those who do not attend pre-natal clinic at 798/10. 000 live births. The AR was computed at 745 which means that 745 excess cases of maternal complications can be attributed lo non-attendance of pregnant women to regular pre-natal clinics. . Analytic Study Designs: Cohort and Case-Contro l Analytic studies employ cohort and case-control study designs to systematically detem1ine whether or not the risk of disease is different for individual s e. xposed or not exposed to a factor of inleres L Cohort studies arc also called follow-up or incidence studies stru·t with the determination of the suspected exposure factor among the study population and ascertaining their disease status later in the study. Coho. rt can be prospective or retrospecti ve. If the prospective eohort will be employed, the measure of clisease frequency lo be used will be the incidence rate. 111e retrospective cohort uses the prevalence rate as measure of disease frequency. The relative risk, odds ratio and attributab le risk are used to measure st Tength of association between disease and suspected factor. The figure 7. 3 (Beagleho le, et al, 1993) shows how the cohort study design is carried out: 197 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
198 In case-control study design (Fig. 7. 4), the study populatio n's disease status will be ascertained first. Those with the disease are considered as coses and those who do not have the disease are considered in the control group. The p1·esence of the suspected el\. l)Osurc factor for both groups will then be determined. The incidence or prevalence rate can not be computed in case-control study design; hence, the odds ratio will be the measure of disease association. lnterventional or Experimental Epidemiology Ioterventiona l Epidemiology aims to test effectiveness or ""reasonableness" of intervention programs designed to prevent and control diseases utilizing randomjzed controlled or clinical trials, field or community trials. Evaluation Epidemiology Evaluation Epidemiology attempts to measure the effectiveness of different health services and intervention programs. The app Jication of epiclemio ]ogical methods in evaluating programs to control and prevent epidemics of communicable diseases led to global efforts in eradicating cliseases like polio or thwart transmission of diseases to pandemic proportion. (Beagle hole et al, 1993) | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
CONCLUSION The nurse uses Community Diagnosis as a tool in the assessment of the community's health status. A,; a p Tofile, it describes the different factors that relate to existing health and illness patterns of the community and its people. These factors include Lhe demographic variables, socio-economic and cultural factors, environmental factors, health resources, political and leadership patterns found in the community. As a pro\;ess, community diagnosis involves the co]lcctio_n, collation, synthesis, analysis and interpretation of health data in order to define the diffe. rent community health nursing problems. Figure 4 illustrates this process. It is carried out with the active participation of community members with the specific purpose of bringing about change i11 order to improve the quality of life of the people. The three clisciplines of public health-demogrnpl1y, vital statistics and epidemio logy _ are utilized by the nurse in analyzing the factors that bring about ill health in the community. Demography helps the nurse understand the characteristics of the population in terms of its size, composition and distribution in space. It also makes it easy for her to define the focus of ca rein tcnns o(specific population groups. Vital statistics are indices of the health and illness status of the community. They serve as bases for planning, implemen ting, monitoring and evaluating community healtl1 nursing programs and services. The epidemiological approach is used by the nurse to explain probable ca uses ofhea Ith conditions as they occur in the comm unity. It consists of four phases descriptive, analytical, intervention 1md evaluation epidemiology. Descriptive epidemiology aims to descrioe the occurrence of health conditions in the community in terms of the atnibutes of the people (genetic make-up, demographi c characteristics and lifestyles), the pattern of time Lhe disease emerges and the characteristic of the place where the disease appeared. 11te nurse will then fommlate a hypothesis regarding the relationsl1ip hetween the exposure factors and the health or disease conditions under study. To prove the association between a suspected factor and disease, the hypothesis will undergo a systematic process of testing to prove that the risk of disc;. 1se is different for individuals whu are exposed or not exposed lo a factor. This is the second phase of the epidemiological approach ca Ued analytical epidemio logy where the nurse establishes a causal association between a dis~e and suspected risk factors present in the community. Analytic studies that are commonly used a. re cohort and c:ise-control sllldy designs. To test the strength of this association, risk estimates arc computed. The health problems and the factors that con LTibute d to these problems can now be presented using the PRECEDE-PROCEED Model that will be discussed in the ne)((: chapter. J. REFERENCES Anderson, ET and Mc Farlane, J. (2004). Community as Partner: Theory and Practice in Nursing. Lippincott Williams and Wilkins. Philadelphia 2, ·neaglchole R, Bo11ita Rand Kjellstrorn T. (l993j Basic Epidemiology. World Health Organization. 3. Bennett FJ (Ed. ). (1979). Community Diagnosis and Health Actio11. A Manual for 1}opical and Rural Areas. London and Basingstoke: The Macmillan Press Ltd. 199 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
200. 1 C' ""~l.,I(' ( 1003l Crnnmu nil-y l"li:ii-:. nt>'-i!". 1 n,\ R Omrttn ( Ed). Co1H1111111 it JI Modrl~ m t>rt-. ·i<pho n,ur:tric-. o: I. Pl':\ l S-~t{-. 2l. N.. w York: Springer. !-Cl4rk.,1. 1. \100::).,·un-111!} i,i chr C1mmrmi r. 11. Norwnlk. Co11m:clicut: J\pplctc,n und I..anp b. C'Jnr"k. ;-. 1. 1 l. :Pt,3l. c... w,·11111iry hr-uitlr 1111n;in9: curing. fc)I' pop11lat ions. 4'" eel l"(-ar-so;:; Cduc;,ll(> ·i. lnc. l'ppcr ~addk R. h·l·r. N. 1 074~8. -; l'\c:',"'C'" er.. {1o~l'' l",,,. n. ru, :tlt_v fl N::lth,\nnlµsls:.. A Holistic A. pproac'1. o. G rant.,wn. "la. pl. ::1ud:. \s~'<·n Systems. rmnrµn. 1 Jrn. l l::,...._"ln. ~ lt OSo). \. n Epidemiologic.,l Approad1 to Community A~ <c-. cnt rt.-i..t.,· Ht'tl. !~h S11rsing 0(3): 147-151. Septembcr 1989. Copyright 10"4 Bu,d,"-11,· ec"'. 11i& Publkations. Flon-ndo. PF t!'t al ~::coo$) Communitv IJiagno!'i!' of Zone 3. Barangay Sro. 1-., ~ J.. a~ Jurc. r.. Fi; a-;vs.-10 l·::-bl,;hed Co-..r::urut) Di. i. lroosi"' CP Manila College of Nursing. ·-F~;,c RB ar-d l:i('"'..a.--ich. J (1981). Community Health,Yursi11g Practice (2"" «-i M:,~d~..,i~ v. ·e: u..ode. s. l~ F~~=. ''T 1c S-6l P'a Hm T5. in evaluation: et:aluating dc L·clapmcnt and o.......-wrr{¥,:J '!:, cv. r-. c. s 1. dth partiapan ts. :. ta. cm. ilia a Publi. shen-Lld. L<lndon . c;c. Ba..'<i::. ;:. r..;o e. l' H. wdoc:C"Tl Sa:!k O, Prio-i-iy &tting Of Community Hcalili ~Vun:ing Probfr:=. ,. _;. So t JP Cna7-e$:!e (X~ursin1;. CHX Specialty Group. 1. 5 iidv-. r. C. O. {. 1-c-<:<c) 'Vivar. coo practice numng in the communi ty. Thou. c;. ;md ~CA:"-i= t!i. Hunt. R 1~51 for. r'Xluction to oommtrni ty-bo. scd numng. 3"' cd Lfppinco 11 ·...-. aa~ t. v.-,. n~< :-. Kuss,~ f'ruol. ir-Gir. a. d. L.. L,:r. in.. S.. ~17.. C., and Kennpll y, P. (1997). J-\ public l:irahh cur-. ir;;; rnod,cj. PJJbu:; Health Suning, 14, 81-91.. 1. 8. Lil~' 1 D. LJ II!""' Id.-\ af'd ~1oftl"'}-, P. 11994) Fnurula1 ions of Erndcmiology, :~ "Ja-<.. o~. r ~ I ·.._,,,,<"T"",t)" P-r.,..~ Jc;. Ln:xf) <. i,. !a~ S (Ed'<} (2091) Community Jlealth Nursing: Caring for the Pur. x's Hrai:'1.. ;. :..,...-bu SIi!~:,<.. ~ and Ba rt J!.-tt Publi Ciltions. 20 ;. ac. 1A~~ D and P~. TT f1,r,-~J. Epidrmwlogy: Principles and Mcrlux L... Bo-'on. MA.. J....-<le, Rn,wn _. nd C-0. 21. M. a. :e:saci. P!>-. '2f. l Ol1, PTcrarir-2; ~ for the future. In P. S. Mallc:-on (F.,d. ). v--r. mun-·y-1,cso:J rr. u:rrrz~ rdurat0ri <pp. 1-7} :,_,_ York: Springc-r. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
22. Mcrcndo It. (199a). Readings in Uealth System. ~ Manauement. UP Manila: Collcy,c of l'uhlic Health. 23. Mendmr. 1-1 OM 11nd r11hers. (1997). Fmmdatirms of Statistical Analysis for the Jlealth Sr. fences (Volume 1). UI' M:inil:i: College of Puhlic Health. 24. Moral R, el al. (2007). Community Diagnosis of Masagana. Brgy. Sta. Ana, Pateros, Met1·0 Manila. Unpublished Community Diagnosis, University of the Philippines, Manila. 25. Muecke. M. (1989). Community Hca Ith Diagnosis in Nursfng. Public Health Nursing 1(1): 23-25, March 1984 Keprinted hy Blackwc U Scientific Publicatfons Inc. 26. Payne, AMM (L965) The environment in human e. cology: General considerations. In Pan-Amer ican Health Organization: Environmental Determinanrs of Community Well-Being. Washington, D. C. 1965 p. 3. 27. Sanders. IT (l958). Theories of community development, Rural Sociology. 23, 1-. 12. 28. Spradley BW. (t990). Community Health Nursing: Concepts and Practices. Glenview. Illinois: Scott, Foresman and Co. 29. Stnnhopc M and Lancaster J. (Eds. ) (t996). Communi ty Health Nursing: Promoting Health of Aggrega tes, Familfrs, and Tndividuals (4th Edition). St. Louis: Mosby Yea T Book. 30. Tan. ML :md Dalisay. GY Manual on Operations Ri:search. Health Action Information Network. Que?. on City. 31. 1\iazoo. JA., Dones. LBJ>. and Bonito. SR(2003). A Training ;i,Janualfor Health \Yorkers,m Promoting HM/thy Lifestyle..~ l JP :Manila College of Nursing Department of He:ilth-World Health Organi7. ation. 32. \'nl:rnis 13. (1992). Epidemiology in Nur·sing and Health Care. Norwalk. Conncc L;cul: Appleton and Lange. 33. Women's Health and Safe Motherhooa Project-Partnerships Component (2003). "'/11e P. R. A.-A Participatory Planning Process". Department of Health and E. uropenn Commission in the Philippines. 201 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Ch ptcr 8 1PLANNING FOR COMMUNITY HEALTH NURSING1 PROGRAMS AND SERVICES ru JNTROO-""CTIO ",.... ""'~--. r~ ~-i r,,~,r.,~mc'-p'l'T. l T"i< r-'l'P 1l~1,,;;. -L ..,.,..-~-:: ;"-~~ uc:"'l,,.., t-<t?..-,,,;-,.-: n "'I", '1;,,, ~ r. : 4h(' r-1.-:,-:-r. "1 r-:'1\,. ·!l-. r1 nr~.. J ,...-c.-c. 7"'"-. 4:r:-"';,d "-=': ..,..., er r-~ :. ~""' 1. r j,-n-n,-_-,-i..-r 1,. _ ,,, ~-. ' .._. ',r. ;,, r·\;io,. _.. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
202 Chapter 8 PLANNING FOR COMMUNITY HEALTH NURSING PROGRAMS · AND SERVICES Luz Barbara P. Dones INTRODUCTION Planniogandimplementationofhea]t. hse1vicesandprogramsforgroups,populations and communities involve the application of the nursing process based on participatory community de,·elopment model. Since a lot of factors in the external environment need to be considered by the nurse, planning for nursing programs and services generally becomes more complex. Factors that may affect the planning process include existing health policies and legislation, level of technology in the area, econom ic resources and presence of programs and institutions tlrnt are supportive. or that may conf1ict with proposed programs. la addition, the nurse,vill find herself,vorking with other members of the health team or,,ith other sectors that may have different orientati on or strate. gies in terms of,ie"ing solutions to co JUJJ1unity J3ealth problems. The most important challenge to the nurse however, remains that of generating and sustaining the community's sense of ownership and commitment to health programs and services that address their needs and problem s. WHAT IS PLANNING? Planning has been defined in many ways by maoy authors. What is common about these definitions is that planning is a process, normally, future steps to be undertaken in order to achieve a desired end. This implies that the planner assesses the nature and ex1:eot of the problems as well as constraints and limitations t J3at may affect planning decisi on. s. In general, pl anni ng. i s done in our desire to source out and allocate resoa rces to improve the present state of affairs. Mercado (1993) summarizes the concepts of planning as follows: 1. Planning is futuristic. 2. Planning is change-oriented. 3. Plannin g is a continuous and dynamic process. 4. Planning is flexible. 5. Plann. ing is a systematic process. In community health nursing, ilie nurse pursues the objective of enhancing wellness and improving the health status and quality of life of the people. She does this by applying the nursing process in providing solutions to identified cornn1lmity health problems and needs. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
rlaoning in community health nursing involves the orderly process of assessing 1. he health problems and needs of the community. Commun ily health problems are conditions or situations that intervene with the communit)'S capability lo achieve wellness. They are generally categorized as health status problems, healt J1 resources and healtl1-related problems. Priority goals are set accorcling to which (lroblems or needs are being addressed in relation to the availability of resources. Interventiqns arc carefully thought of consideri ng constraints or limitations as tl1ey may hamper the reali. rnlion of set goals. In order to keep the community healthy, the muse develops "itb the commun ity health programs a11d Sel""\ices as well as organizational structure and resources to maintain tliem. APPROACHES TO PLANNING HEALTH PROGRAMS Participatory Planning for Community Health For community and health development programs and. scr,ices lo become rele\·anl, responsive and sustainable, planning should involve people"s parlici-pation. People's participation enables the community to become an integral pirrtof1hc dedsio11-making and action process (\VHO 1995) a. nd guarantees the integration of their indigenous knowledge and serves as social prepara Lio n for the program plan·s implemcnli'ttion (WHSMP-PC 2003). The whole process of engaging the community in the planninl? process starts by analyzing how tbe nurse looks at the people or the community in the scheme of development work. The Primary Health Care /\pproach (WHO, 1978) emphasizes the need to work with people as equal partners towards the goals of incrcasecl individual and commun ity control, political efficacy, improved quality of community life and social justice. (Wallerstein 1992) Planning for a sustainab le community health development grounded on heal U1 promotion and wellness can 011ly be achieved when programs and projects utilize three important approaches: (Tuazon eta! 2003) Communi ty-b Med approach which empowers the people to address their health needs and problems Integrated approach which considers various dimensions of health and developm ent such as changing lifestyle, changing environment and reorienting healtl1 care systems Compreh ensive approach which strikes at the root of the problem and addresses the social determinants of health PRECEDE-PROCEED Model in Community Health Planning The PRECEDE-PROC EED Model (Green and Kreuter 1999) is one of the extensively used models to guide nursing practice in health promotion planning, implementation and evaluation. There are two phases of the model. PRECEOE stands for pr C>disposing, reinforcing, and enabling constructs in educational/ecologica l diagnosis and evalualfon. lt corresponds to the assessment phase of the model itwoh;ng social, epidemio logical, behavioral/ environmental, educational/e cological a11d administrative and policy assessments. Since the model examines the different dimensions, it guarantees a more comprehensive perspective of acldrcssi11g u he.. 1\th problem. The PROCEED embodies the implementation and evaluation phases and stands for policy, regulatory and organizational<--onstructs in educational and environmental diagnosis. 203 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
204 For the nurse and the communily, using the l'RECEDE-PROCEED Model clarifies the possible roles of the stakehol. ders as wel U as the strategies/appr oaches in addressi ng the health problems. Ph Ml!S Administrative and Polley Assessmf!fl1: Edu J;atfona Ecoloa1c. i, ( ) r HEALTH Predisposing PROMOTION factors Health Reinforcing education factors Enabling Policy factors regulation organization hppl9mentation Planning for Health Promotion Phase2 Phase 1 Epldemlolag Jcal, Social Msassmeni Assessment . ' Health PNase9 Outcome Evaluation Quality of life ') In Green's original PRECEDE Model (1980), the framework analyzes the social concerns, the health problems and the behavioral and non-behavioral factors that contribu te to the health problems. Unhealthy behaviors are further evaluated by looking into contributing factors identified as predisposing, enabling and reinforcing factors. These contributing factors become the focus of a health education intervention aimed at voluntary adoption of healthy behaviors _ lfthe adoption of a healthy behavior entails organi7..atiomtl, environmenta l, logislati-ve or economic change, then the change | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
process needs more than just heallh education. W11en factors other than behaviors are adcfressed, the process becomes one of heal U1 promotion. Hawe, Degeling and Hall (1990) employed the PRECEDE framework in needs assessment but expanded it to assess not only the health education needs but also the be,,lth promotfon needs of a community. Thus, risk factors do not onlv look at behaviors. Social, organizationa l economic, legislative,md environmentat' factors (non-behavioral factors) are als~ considered as 1isk factors. Risk factors are analyzed for their predisposing, enabling a. nd reinforcing factors. The original PRECEDE model, thus, was extended lo encompass. the,~ider environmental, policy and organi. zational foctors that Green and Kreuter had found important in launching national programs of community health promotion. The goals of the model are lo explain healtl1-re Jated behadors and environments, and tu design and evaluate the interventions needed to influence holh Lhe behaviors and the living conditions that in:f:luence them and their con~cque L1ces. (Green and Kreuter 1999) As you c. an see, the issues raised by Hawe, Degeling and Hall were addressed in ilie PRECEDE-PROCEF. O Framework. This model has been npplictl, tested, studied, extended, and verified in over 960 published studies nnd thousands of unpublished projects in community, school, clinical, und workplace settings over the last decade. (http://www. Igreen. net/precede. htm) 111e figure below shows the relationship of health education and lieal U1 promotion: \., Enviro. ri. mel)(al Policy HEAL TH PROMOTION egulato Environ--mental--Socia Environ-mentat·-HEAL TH PROMOTION. nviron mei:)tal tno Env(ron rriental Relationship of Health Education and Health Promotion Source: Green LWand Kreuter MW (1991) 205 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
-· 206 'i Ht: PLANNING CYCLE \\,'"' \':t11 tlw nur,;<' 11111k1 the 1>lanning process simple an<l uncomplicntcd so people :\\"<' nbk h 1',u-lkip11tl· in it? Often, people Jose interest in planning because of the t\,·hni,·:1l la11g11:11. ~l-:111ll pr11cc,;s that nurses and olbcr p1·orc:ssio11:1ls use. This need not "-' th,, <":1,;,: 1wopll' 1,110w helter about their community; they,il::;c> ;;ire :wticulale about 1h,i1· m·,·d,-:111d lhl·ir pn1hl L·ms. Whal the nun;e or olhe1· health professionals nc:etl to \\,, is t., t:wilital, p,oph to express 1. hc:msc:lvc:s. A common 1cehniq11c for pl;111ning Lo lw p:11·1i,·ip:11ory is In ask k:ncl qu1:stions for people lo tliscuss about. The n111·sc and tlw l'lll1lt111111ity can go about lhe planning cycle guided by the followin~ questions (Mtn:11clo 199:{): Situationa l Analysis Gather health data Tabulate, analyze and interpret data Evaluation Determi ne outcomes Specify criteria and standard Strategy/Activity Setting Design Intervention programs and srrategie s Ascertain resources Analyze constraints and limitations How do we get there? Situational Analysis Identify health problems Set priorities Goal and Objective Setting Define program goals and objectives Assign priorities among objectives . Auswering Lhc question "\-Vhere are we now?" involves the process of collecting, synthesi7. ing, nnolyzi ng and i ntcrpreting in formotion inn munner l'hnt provides a clear pict11rn of the health stlll"us of the community. It brings out the health problems of tl1e communit y. In this phase of the planning cycle, the nurse, togctherwit J1 the community idcn1ify Hnd provide explanation 10 the problems. After the nurse :ind the people have g:itliercd data abont the: he Hlth status of lhe communit y, they identify and proceed | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
to explain the problems leading them to project what situatfon needs to be changed, developed or maintained. The common belier among hea Ith professionals is thut situational an;ilysis is usually driven by a need to immedintc Jy ad(li-ess an aclm1l or ;i polenlial health problem or condition. Therefore, lhe goal nf 1111y hcallh intervention is mninl. y lo mitigate the effects of the heallh problem or health risks. ln this ccmtcxl, p(!(iplc lend to develop ;1 <:risis-oricnl1'!fi behavior, responding only lo situutions if lhcy pen:civc the health thrcnts. The health i-;ituation is considered solved if it nu lunger poses ri lhrc:H lo the population. The I lc;illh Promotion perspective goes hcyc>nd merely providing health services. The O1t;1wa Charter on Mcallh Promotion ( 1986) highli~hts the need to address the fundamental conditions and resources for health c11re-pe11ce, shelter, education, food, i11co111<;, a st11hlc eco-systern, sustain:ihlr: resources, social justice nntl equity. Following the PRECEDE framework, the. ~itualional analysis involn-s "consciously determining social, physic. ii, cultural and political f. 1ctors that affect behaviors" (WHO 2003). Enguging tl11. : people lo analyze human behavior. is a product of complex factors will. enable them lo he more pro-active in modifying behaviors and creating environments to prevent health prnbll)ms and protect them from hcallh risks. Stages in Conducting Situational Analysis Using the PRECEDE-PROCEED Model (Green and Kreuter J999; WHO 2003), t J1e situ:itional analysis \,~11 proceed as follows: se ~ SOtlal Diagnosis ~rmlne how tl:ie sit Uatibn affects the qua llty of 11fe of the population In Its socral s. Does the sltuatlori result in the breakdown otfemi!Y relationships? Ool!S it ea~ to economic catastrophe? Does lt,lead to shorter life spansi' Does It lead to ·v1otence and conflict? iehase 2Epldemlological Diagnosis · ~t,rmlne how-the situatfon. iffects1he health of the population In Ttlemtologloal,terms., 00@$ ~~ §ltuatfon leads to high rates of mortality and i,rbldltyi'-l!>oes 1he situation cau&e S diseases to 5pread it undesirable ar:id con Jrolled rates/ han a Bef,tavloral and Environmental Diagnosis. ~ aspepts of the pmb1-m can be solved by ~e. adopt ing ne,w behaviors or ler'natfve lifest Vles? What11$pkts can tie altered by changes In the environment eluding new pcllldes, pra1ra. ms and more responsive health c,re ~ms? 207 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
208 Phase 4 Educational and Organlutlonal Diagnosis Which of the behaviors are due to predispos ing factors (beliefs, attitudes and knowledge) ? · Which are due to enab1Jn1 factors (influences of the Immediate environment, accessibility to reso\Jrces and services) ? Which are due to reinforclngfacttrrs {social pressures, media messages, religious and lnstltutlonal dogmas)? Phase 5 Administrative and Pa Ucy Olapos ls Which of the fact. ors can be modified throush education? Which can be modified through advocacy? Which can be modified throush social moblll,atfon? Fig. L2 Steps In Analyzing the SJtuation (Social Mobilization for Healtfl Promotion, World Health Organlultlon, 2003). Soclal Diagnosis Tdentifyin g the priority problem requires stating the specific population affected by the problem, its magnitude or the extent that it affects the quality of life of the said population. This comprises the fu:st phase of the situational analysis-the social diagnosis. Social diagnosi s conveys the impact of the health problem in terms of the overall quality of life of the people in the community. Green and Kreuter (1980), look at quality 9flife as a subjectively defined problem of individual s or communities. The following are examples of indicators of extent of social problems present in a community or a population group: Illegitimacy Population W-elfal'e Absentee rsm Drscrlmln~on Unemployment Hostlllty VC!>te S crowding Alienation esr,nies Riots e sodal dlasn MJ s. must M described in terms of the. following: » M~gnltudeofthe problem-ls the pioblem widely e,cperlenced · by the pe(!ple?.. Populatio n· ~ffected by the problem-rs the problem conffn. ed to a speclflc population group? Does It lnv:olva a p_articular vulnerable or risk sroup?' » Severity or gravity oftlu! prablem-ls ~a debilitating problem? 1$ It causing premature "llilths In tire popuiatjon? · » What are Its lmpflca Uons to potentfal years of life lost, quality oii llfe, econcmlc ar,d h~lth Cilte c;osts? ..... | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Epidemiological Diagnosis Epidemiological diagnosis eiq>resses the beallh problems in tcm1s of "ital heahh indicators of mortality, morbidity, fertility, disability or deformity. The extent of these problems is described in relation to: >> Distribution of the condition in terms of person, place nnd » time char. icteristics }> Intensity of the condition in terms of incidence and pre\lalence ; and » Doraliou of the condition Behaviora l and Environment al Diagnosis Tbe third stage of the silualional analysis involves exnminalion of the health problem by providing additional data about the factors thnl are contributing to the health problem. It is concerned wilh detem1ining the behaviurnl and environmental factors that account for the health problems. Explain why the problem is occurring and being maintained. This is done by looking for risk mm·kcrs. Risk markers point or :snggcst where the problem · might be occurring. For example. if the probh. !111 it-intestinnl parasitism among young children, the risk markers wotdd inclmle children, aged 2 to 7 years, low socio-economic status nml belonging to urban and rural poor origins. Although risk markers are associated with occurrence of problem, they are not necessarily contributing to it. Idenlify the risk factors that directly account for the problem. Risk factor refers to any attribute, characteristic or exposure of an individual which increases the likelihood of developing a disease or illness condition (WHO 2001). rusk factors can either be behavioral or environmental. Behavioral indicators cited by Green and Kreuter (1980) can be expressed in terms of the following: ,. Utilization of a specific service » Carrying out of a particular action ,. Consumption of certain commodity, product » Compliance to a prescribed regimen ,. Ability to perform self-care An example of a risk factor for intestinal parasitism among young children is increased hand-soil contact brought about by play activities witl1 and on the soil. Other than behavior and lifestyle, the environment of the population can also ex'Plain the problem. Environme nt does not only refer to the physical environment. U also encompasses policy, social, cnltural, economic and physical factors present in the communit y that determine behavior. Enviromnent,11 risk factors for the problem of intestinal parasitism among young children include unsanitary excreta disposal system, lack of water sllpply necessary for hygienic practices and use of freslt hwnan feces for fertilizer in vegetable gardens and 1ice fields. Ed4cationa l and Organizationa l Diagnosis · Educational and organizational diagnosis looks into the contributing factors of a problem that rn. ay become the focus of subsequent intervention. Contributing risk factors (Green et al 1986) are those U1at contribute to or account for the risk factor. These a re sot1:ed into: ,. Pl'edisposing-any characteristic of the client that motivates behavior related to health; they can be described in terms of the client's lu1owledge, attitudes, 209 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
values and perception s » Enabling-any characte ristic of the environment that facilital'es health behavio,., and any skill or resource required to attain the belwvio1· ,, Reinforcing-rewardorpu11ishme11t followingorantici patedasa consequence of a health behavior The factors are s011ed out into logical order that will help tease out the causal pathways leading to the problem. The following framework wil J help the nurse and the people assess factors associated with or contribut ing to the health problem under investigation. Administrative and Policy Diagnosis me Examples lues, beliefs, self-es J;eem, health locus port, soc:fal deslrablllty, cultural norms onutron, h~stng, 'transport routes, tlty, sensttlvlty ·or acceptability to·target ventlve care, fl~anclal-lncentfves for ortunttles for participation in on health and equity nmental pr,otectio n laws,. SJ. Ire to hazardous materials, school .. d With· o'r Contributing to the · 1ellna,. r~ Hall, 1990)., The administrative and policy diagnosis de6nesthepossib le points of action where the health problem can be addressed. Tn a way, the last phase suggests the activities that will lead to the resolution of the health problem. Adminisb·ative and policy diagnosis is not lilnited to assessing health education needs oftbe population group or community. It must also highlight issues necessary to create a suppor. tive environment to enable individuals to adopt and maintain healthy lifestyles such as need for healthy pub Hc policies, community action, more responsive health care system and healthy physical environment. Problem identification and explanatio n are facilitated with tbe use ofa.. tool" known as "problem tree. " The "problem tree" visually maps out the probable causes of the health status problem. An example is given on the ne. xt page. 210 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Poor Qu 1 a ty of llf Years old in 8 e of children 2-12 arangay Sta. Cruz High incidence a intestinal. nd Prevalence of Paras1tis m among children aged 2-12 Years F:---r==~~~---:'f-r _-:----__-l_--.----_:~. :1;y-poor personal t,abits Lo W level of education unsanitary waste disposal system ["'-" __ _,, ___ lack of basic health facilities government neglect poor child care P reoccupation with economic activities poor utili healths of rtit'-'de negative a viders health pro . factio1'1 job dlssat15 health 1s least t priority in terms of ~-----1--------_;. _...., budget l One notices that the rools of the health status problem (high incidence and prevalence of parasitism) are related to health resources and liealtb-celated problems like educational status, grinding poverty, government neglect and quality of health care providers. By explaining and analy. iing the problems using a problem tree, the people will recognize what situation needs to be changed or what can be done in order to effect a desired change. 211 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2U Goal and Objective Setting "V{here do we want to go?~ refers to the process of for11111lal'in g the goals and objectives of the hc,1lth pro J. >;rnm and nursit1g services in order to change the status quo. Goals nncl objectiws will serve ns ~uide lo the efforts of the nurse and the people to ntldr C'. ss the health problems. A goal i J:; a desired end. The desired end may be a total change, improvement or maintenance of it :-ii uation. II is directed towards solving the hen I Lb status problem s that were identified in lhc community diagnosis. It is gcncr. illy broad and not constrained by time or rcsnnrces. It s1:1tcs the ultimate desired state. Objectives ;ire more precise. TI1ey· are com;idered as pl::inned end point of all. ictivitics. Objectives are concerned with U1e resolution of the he. :iltb problcrn itself. They have to be stated in specific and measurab lt: tcm1s.,. ~.,, Goal what you ultlmohtly want to achieve by running the program; ducrlbes tht! chnge In the hl!Olth probl~m or condition that ' motivated you to design an Intervention ' Objeecive describes what changes Vou want to bring about in the target group In terms of their behallfoe; describes what the program achieves~ has to . be stated $pedfically . sub-obfectfve change In afactorwhfch Is a prerequ Tslte for the change in behavior The example below shows the relationship of Goal, Objective and Sub-objective to analysis ofhe. 'llth problem: ti ld,Pnlblem .,.,... _ a·· c.......... Excessive l!Xp GSUre Goal of school chffdntn to ultravtolet li8ht Nor enou,I\ shade In Objecdve Khuol~nds ,.,..,ts and teachers Sub-not sufflden1fy Obf■ctlu awar. oftbltof sunnposute (p~ lnsuffldentfonds tobwlld....,....., Oep(d. _no~ on pt utliidfolt ·rtsttel ewposmw10w...-(l..,'9r~-Reduce exposure to of school chlldrento ultraviolet light Increase the amount of shade In school playgrounds Increase the teachers ' and parents' knowledge of risk of exposure to UV exposure Acquire Php 60,000 for shade/shelters Have UV exposure protection 1'1l Cl H'p Oia Ct:d Into Dep Ed polk;y | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
The goal of a program is directed at addressing: the health problem while the ohjectives address U1e risk factors. The sub-objectives address the contrihuli11g risks. Goal corr~spo nds to Health problem Objectiv e corresponds to Sub-objective corresponds to Risk factor Conrrlbutlng risk r actor Strategy and Activity Setting "How do we get there?· defines the strategies and the activities that the nurse and the community set to achieve in order to realize the goals and objectives. It implies the identification of resources-manpower, money, materials, technology, time and institutions-needed to implement a prognun. The nurse facilitates the commun ity define the. strategy or ap11ronch in a hc11lth program. A program is defined as a timed series of activities to be carried out in order to correct the 11ealth problem. Resources needed for the implemcn tution of the activities are estimated. Constrain ts or limitation s that affect planning decisions are alsc> assessed. This particular phase of the planning cycle involve..c; three activities: Designing lhe health programs o,. seruices involves defining the strategy objectives and the strategy activities. Strate1,,y olljectivcs describe what you. O..Q in the program. They state what your program is going to provide and deliver. They bring about the achievement of multiple objectives or sub objectives.--------~----------------------Example of multiple sub-objectives rinked to a single strategy ob~c. tive (Hawe, Doge/Ing and Holl 1990) improve teen-age rs' self-esteem Improve and practice skills on how tousay no" In difficult sit. uations Strategy Objective: Conduct assertiveness training workshops for teen-agers Increase peer support among teen-agers Strategy activitie s are what you actual1y do to meet your strategy objective. They make up the component parts of the strategy objective. They are categorized as service, developmental and support activities. Ser.-ice acth;ties provide direct health care services to the population such as immunizations, family planning services, 213 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
nutrition supplemen tation and the like. Developmental activities are directed towa J·ds transferring knowledge and skills to specific group of people like Lhc community volunteer health workers or mothers. Suppo1·t activities ~encrntc rnntcrial, technical nnd manpower resources lo SU$tain the service and devclopm cnla J nclivilics. Ace:twll Df scr. tqy ob Judl M and activities In., _. l'CIIN promotion pro1ram Strc11egy Objective: Run a 3-week local media campaign regarding exerc:ise facilities and activities In Brgy Sta Ana Strategy Activities: Coordinate with local paper to have special feature on exercise and health in the community Run ads and news releases In local paper listing available exercise facilities in the community., ~ Strategy Objective : Involve local commun ity est. iblishments in Brgy Sta Ana in lobbying for additional exercise facilities forthe community Strategy Activities : Hold a press conference with expert in cardiovascular disease and exercise, local officla Is, prominent personalities and people with CVD in the community Organize an open day at the gym to try out facilities and raise funds; give talks on benefits of exercise Bud. geting invokes specifying Lhe requireme nts of each program in relation to the necessary resources and considering constraints that may luimper impleme I1tation of programs and acthities. l\fal..ing a time plan or schedule helps the community organize t J,e activities i11 such a v. :ay that time, money :rnd effons are not wasted. Since the progrnms are constrained b,· time. the nurse sees to it that what is intended lo be <lone a1·e carried out ac~ording to the specification of a plan but allowing for flexibility Developing an Evaluation Plan In orderto find out iftheprogram. s and services achieved lhe purpose for which they were fon:nulated. the nurse. ind the community pose the question ~uow do we know ,,·e are therer. Thls is the pha. 5e o( the planning cycle that detennin es whether the program is rele,·ant. effecti Ye. effici,mt and adequate. r1 is concerned,vit. h finding out tbe specific in_put, process and output/outcome indicator s of the pro. gram stating the criteria and standards of each. This c.-..ercise is ca Jled CWJJuation. Evaluation is the process by-which we judge the worth or va Jue of something (Suchma. n 214 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1967). Evaluation involves two processes, nan1ely, observation and me;:isurement The nurse observes, lhen compares the ohserved data with some criterion slamfard or indicators of good performance. There are two approaches of evaluating a program. Qualitative methods of evaluation determine the meaning and experience of the program for the people involved; and interprets the effects that may be obs1:rved. Quanlilalivc methods measure and 'score' changes occurring as a result of the program. Such measurements are systematica lly made using pm-selec ted inslrurneots to detect cxpecti;:d changes. An evaluation may look into three <spects of a program, namely: its processes, impact and outcomes. Process evaluation measnres tl1e acrivitias of rhe program, its quality and who it is reaching out. Impact evaluation measures the immediate effect's of lhe program and determines wht:)U1er the objectives oflhe program were met Outcome evnluution measures the lorrg-term effects of lhe program and determines if it meets lhe goal of the program How program components relate to evaluatfon (Hawe,. Dageling and Hali, 1990) Goal is measured In Objective and sub-objectiv e is measured In Strategy objective is measured in Outcome Evaluation Impact Evaluation Process-Evaluatio n Andersoi1 and Mc Furlan e (2004) use a three-p,rrt model for program evaluation that they have adapted from Green and Lewis (1986): PROCESS EVALUATION IMPACTWALU~ON OUTCOME EVALUATION Information to Pro,:ram imprementallon lm'IJledlir~ affecu of lnclden~ anti colled inctudlng: prou. mon · prl'Voll E-ncr. of rid:: LJ Siu:, response ICno Wledge flleton, morbidity and Ll Recipient response ' Altitudes mortality ' r: Pra«tdoner repoose Percepao11$ 0 Competencies of r 51tlils-per:sonne. l (: Bellef5" '"'. Ac. UH lo resourus-Soma!..,..,,,,,, When to apply lnltlal Implementation of n l'o determine If faqon Ta me~~lfvltal program or when changes are that affect health and health lndlcatof S I made, In a delrelopctl program (behavior nd Ufestyle $ucl, n tncidcnc,e and and l!fl Vlronme nt) have IIN!llllle!IQ! ~s "-chllnpd been alterttl 1.-~ ~-... · Ta meaoure if people's 1-= quality-of life has :,:, lmpro,,ed to. How do nun;e and the nrnrnnmity know that the program has achieved what it has set to do? This is the purpose of using indicators. Indicators are considered as "markers". ·n,ey show progr,~s1: :ind help to mensure change. Indicators consi. <;t of measurements and are often expressed in numbers such as percentages, rates and ratios. 215 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Indicators m:iy be c:itegori7. ed :1s to availability, relevance, accessibility, utilizatio n, coverage, quality. effort. efficiency, and impact (J,euerslei n 1986). Indicator Purpose Example Availab Ulty Show whether something Whether there is one available exists and if it Is avallab le. trained local health w0rk,er for every. " '--· ·---Relevance Sl'low how relevant or Whethe r the newly acquired approprlat~ something Is. program vehicle can access hilly project srtes than the old one. Accessibility Oeterrnlne whether what Whethe r a health center may be out exists is actually Within reach of reach by the people because of of those who need them. mountains, flooded rivers, lack of transport or people's poverty Utilrzation Show to what extent Number of non-literate who are something that has been attending llteraay classes regularly made available is actually being used for that purpose. Coverage Show what proportion of Number of people estimated or those who need something known to have tuberculosis that are ar~ actually receiving It actually receiving reglllartreatment, ___ N'1"P-nn-r<: Quality Show the Q. uality or standard Water quality Is free-from harmful, of somethi ng disease-causing substance s or-----:... _.. Effort Show how much. and what How long It takes how many number is being Invested In order to of health w·orkers to construct what __...,_.. _........... ~..--L..-. r-~..-:1.......... ;~ :a--· Efficiency Show whether resourc~ and Number, frequency and quality of actfvltles are being. put to use supervisory visits a~er attending a to achieve the objectives. training program on supervision Impact Show If what you are doing Is Reduction In the lncloence. really making any difference of measles after a 6-month immunization campaig n Using the d~1t:1 and information gencrnted frnm the above indicators offers the nurse, community and Lhe people provic. liog the funds to make recommendations on the future and directions of the health programs being evaluated. Evaluating Communit y Competence Utilizing the Participatory Approach Conventionally, the way lo evaluate the outcomes of health and developmen t intervention program s is to look at the changes tlrnt occur in the population, the health care system within Lhe community 1. 1r the community environment it·self. The ultimate measure of effectivenessofintervcntion programs and services is the health status of the popula1inr1. IL can be described in terms of epidemiologic studies. Bnt whfle mortality and morhiciiry cl:. 1La are ohjcc Li\'C measures, lhc nurse is nlso conc-. crncd ii, measuring change;; in people's knowledge. bchavior. skills and attitudes and their emotional ,vell-being. The PRECEDE-PROCEED Model clearly demonstrates this framework. There are several paradigms in ev. iluation (Anderson and Mc Farlane 2004), however, 216 c1 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
participatory evaluation hcst describes the framework that pursue capacity-builcling in an empowering appro,1ch. (Minkler 1. 997; Kellogg Foundntion 1998 in Anderson and Mc Farlane 2004) Bartle (2000) emphasized that Lht: task of cv;1l11ating the community 's strength or competenc e is nut the researcher's sole responsibility. It i. s as much as the community's responsibility lo ev. iluatc its m,11 strength within its own cultural and contexl. But how do we operationalize the participatory approach iu evaluating the level of community competence? There are two important issues a nurse ls faced with in planning evaluation_ of commu. nity competence_ What arc the outcomes to look for in measuring community changes and community competence? What are t Jie methods and tools to employ to maximize participation of the commu11ity in evaluating community changes and competence? Measuring Change Outcome s The ultimate goal of community l1ealth nursing interventions is community competence. \l'lhile achievement of program goals, objectives 11ml strategics can easily be quantified, measuring commun ity strengtl1 or competence is still an unfamiliar ground for the m1rsc. The concept of commu1Jity competence is firmly Jjnked lo empowerm ent where people achieve a consensus on their health needs and problems, possible solutions and unified actions to address these needs and problems. (Cottrell 1976; Minkler 1991: Wass 2000). Cottrell (1976) nnd Eng and Parker (1994) tlefine comrnunit-y competence iu te1111s uf eight di111ensiu11s. 111ese dimensions are used to qualitntivcly describe the extent the commun ity has ac;hieved competence. In the succeeding chapter, the eight dimensions are described exhaustively in the context of communit y health an<l development intervenlioni;. Similarly, Bartle (2007) in his model of community empowerment includes the sixteen clements tbat define community strength. Cottrcll's eight dimensions and Bartie's sixteen clements provide inclicators thul will help the people themselves un<lcrstau<l their status as u community and their capacity for self-reliance in terms of managing their own health problems. Furthermor e, using tl. lcse indicators,vill enahle the nurse to measure the response of the commun. ity to the programs t)1at are being implemented in lhe community as well as the efncieney of various sectors of the community to achieve a common goal. Cottreu-s Dimensions of Community Bartie's Elements to Measure Commu. i lty Competence (1976) Strength or Empowerment (2007) seir-otner awareness and clarltlf of Altruism situational definition Common values articulateness Communal services commitment Communications machinery forfacilltating participant. lnteraotion and decision-making Confidence Context Information 217 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
218 gement of r-elatlons w Ttll wlder ·ty Stren,th or Empowerment {2007) lnterven n Leadership Networking, Organization Pollttcal power Skills Trust Unlty Wealth. Bartle (::woo) admits that t·hese elements can not e. asily be measured using a checklist to quantify community strength. Wass (2000) agrees that there are limitations to quantitative approacl1es a Jooe hence, evaluating any activity needs to be built around methods appropriate to the program and where the participation of the people can b. e maximized. Qualitative methods sucl1 as conununity observations, interviews i1nd discussions with the people can generate an abundance of data and information necessary to measure community change. These methods have been discussed in the previous chapter. If the nurse expects the community members to take part in the evaluation, tools to measure change ioitiat;ve outcomes must be uscr. :friendly, easy to admini. ster, and written in a language that is clear or compre hensible. Aside from ensuring reliability and validity of tools or instruments, the nurse should also make certaia that community members assigned to partake in the evaluation are well-trained in the use of the tools. · Participatory Evaluation : The Nagcarlan-UP Manila College of Nursing Experience Tcrmlnadon Phas~ Ma11111n1t wlln __ ~--'I wlll9rsoc!«J COMMUNITY Moblllz,e | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
On the seventh year of Nagcar lan-UP Manila Co1lege of Nursing partnership, students assigned in Nagcarlan, Laguna decided to conduct a study to determine the level of community competence of selected barangay s. The faculty and students developed a framework for evaluating community compelence built on Cottrell's eight dimensions using participalory approach. The framework reflected the different dimensions in the contex-t of the comnnmity organfain g process. This was discussed in a meeting with t J1e baranga y officials. [twas emphasized that unlike in past program evaluations, the fo1thcoming activity will seek the involvement of the people in measuring the extent of community competence related to specific programs that were implemented in the barangay. The people themselves were interested to know if there were concrete evidences of cbange as a result of the programs. Fo,· the community volunteer health workers, their concern isto develop a tool or a report form thattl1eyca n use to regularly monitor change outcome s in the community. Having realiz:ed that, t J1e community 's involvemen t in the evaluation of community competence began. The first stage was to develop evaluation tools that the community members, the community leaders or barangay offkia Js, and the health workers of tbe community can use to evaluate community compete nce on specific programs. Although there were existing tools or instruments that can be adapted based on studies and researches done in other countries, the students realized tl1at the indicators for each of the community competence dimensions do nol capture the community's own realities and experiences. 111Us, it was necessary to generate defmitions or indicators from the people's conte:1. 1:. In order to operationalize this, the students together,-. rith the selected barangay o(1icials; community volunteer health workers and com. munity represen tatives (they were composed mostly of the students' foster parents) did the following: 1. Operationalize the definition of each dimension of community competence in terms of knowledge, attitude and skills indicators; 2. Construct an evaluation tool that quantifies community responses to indicators of community competence; and 3. Detennine the validity and reliability of the evaluation tool as it measures the dimensions of community compet~mce. While the students did a literature search on the community compete nce indicators, a series of focus group discussio ns were conducted in the community to identify process indicators in each cotnmunity competence dimension i. n relation to the diffe1·ent community programs that were implemented. These programs include waste management, nutrition, healthy lifestyle, hypertension and livelihood projects. The process indicators were then translated into questionnaire s and observation checklists. Knowledge and attitude domains will be evaluated with a questionnaire atthehousehold level. Thus, communi ty members are the intended responde nts. The skill compone nt will be measured with an observation checklist and utilized al the ~purok" level. This is so because the program implementation was at the purok level. Evaluation using the observation checklist will be done by the community volunteer health workers and the barangay officials. The instruments were pre-teste d in a paral Jel community. Vague, unclear and ambiguous statements in the instruments were restated and/or modified. All the instruments on the five l1ealth and health-related programs were sent to content specialists (the Munic"ipal Health Officer, a public health nurse, facu. lty from College of Nursing and faculty from Cone. ge of Public Health) for content validation. Content validjty indices were calculated while interrater reliability was tested for observation checklists. The program evaluation tools were rated valid in terms of content. Using the 219 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
SPSS (Statistical Package for Social Sciences), the phi correlation coefficient (<I>) was determined to establish the degree of inter. Tater agreement. Jf there is high interrater agreement, the instrument is said to be reliable (Abaca et al 2006). After the instrument s were proven to have very good and acceptable content validity and reliability, the instrumen ts were employed for the actual evaluation of community competence on varied programs. The process of developing the eva Juation tools for other health progrruns was replicated in other barangays. ln one barangay where community competence in addi:essing the problems on waste management, diabetes mellitus, hypertension, parasitism and unhea Jthy lifestyle was evaluated, the community and tbe students agret:d on the following findings: (Abad et, al, 2007) 1. Community members possess the knowledge and attitudes to deal '1-\'ltb tl1e problems but there is a gi-eat need to develop the skills because of the inadequate compete nce in the psychomotor domain. This is consistent with the iindings in the dimension of self-other awareness and clarity of situation 2. Conflict containment is an asset of the community because of the presence ofleaderswho act as mediators. People remain tohavepeaceful relationship despite differences in ideas and opinjons about the problems. 3. The articulateness dimension needs improvemen t to enable them to communicate with authoritative bodies and other community mem,bers to address the problems. 4. People have to work on their commitment and participation in order to sustain the programs. 5. There is much to improve in relation to creating mechanisms for facilitating participant interaction and decision-making and allo~" people to identify cour. ses of action, put up organizational structures and formulate a plan of implementation for identified areas of action to address problems. 6. Socia] support and management with,-vider society must be strengthened to promote unity in solving health problems and to establish outside linkages. The people realized that it was not enough having the nursing students drift in and out of the community to implement programs. More than anything else, they have the respons ibility to sustain these programs. They also recognized which dimensions of community competence they have to work on. An in1portant realization is the fact that the people consider their communjty leaders or bnrangay officials as solely responsib le to address community health problems. The evaluation results highlighted the important areas for competency-b u Hding towards commun ity development. CONCLUSION The planning stage of the community health nursing process begins with the identification and analysis of problems. Once the health problems are defined, the nurse together with the community identifies what conditions they. want the commnnity to achieve. This will bring her to the next phase of setting the goal and objective s of the plan. Strategies and activities are developed specifying the needed resources 220 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
and mechanisms in order to reach the desired end. Finally, the nurse identifies what parameters to use in measuring whether tl1c goals and objectives were attained. REFERENCES 1. Abaca, MJM et al. (2006) Developing Measures of Community Competence in Barangay Talangan, Nagca,·/an, Laguna. UP Manila College of Nursing (unpublished). 2. Abad, YKG et al. (2007). Evaluating Community Competence of Barcmgay Balinacon, Nagcai·lan, Laguna. UP Manila Cllege of Nursing (unpublished). 3. Anderson, ET and Mc Farlane, J. (2004). Community as Partner: Theory and Practice in Nursing. Lippincott 'Williams and Wilkins. Philadelphia 4. Bartle, P. (1967, 19871 2007, :wo9). Participatory Methods of Measuring Empowerment. Retrieved July 9, 2009. bttp://ww1,v. scn. o rg/comp. modu1es/ mea-parl1tml 5. Clark, M,J. (1992). Nursing in the Communitt J. Norwalk, Connecticut: Appleton and Lange. 6. Feuerste in, MT. (1986).. Port:11e1-s in Evaluation: Eva. luating Development and Community Programmes with Participants. Macmillan Publishers Ltd. London and Basingstoke 7. Green, LW and Kreuter, MW. (1999). Healtlt Promotion Planning: An Educational Ecological App1'oach. 3rd edition. Mountain View, California: Mayfield Publishing Company. 8. Green, LW and Lewis, FM. (1986). 1'\,feasurement and Evaluation in Health Promotion and Health Education. Pruo Alto, California: Mayfield Publishing Company. · 9, Green, LW, Kreuter, MW, Deeds, SG and Partridge KB. (1980}. Health Education Pla11ning: A Diagnostic Approach. Palo Alto: Mayfield Publishing. 10. Hawe, P., Dageling, D., and Hall, J.. (1990). Evaluating Health Promotion: A Health Workers Guide. Mac Leman and Petty Py Limited, Sydney. 11. Mercado R. (1993). Readings in Health St Jstems-Managemen t. UP Manila: College of Public Health. 12. Spradley BW. {1990). Community Health Nursing: Concepts and Practices. Glenview, Illinois: Scott, Foresman and Co. 13. Stanhope M and Lancaster J. {2002). Foundations of Communih J Health Nursing; Communih J-Oriented Practice. St. Louis: Mosby. 14. Suchman E. (1967). Evaluative Research. Principles and Practice in Public Seruice and Social Action Programs. New York: Russell Sage Foundation. 15. Tuazon, JA., Dones, LBP. and Bonito, SR. (2003). A Training Manual for Health Workers on. Promoting· Healthy Lifestyles U. P Manila College of 221-- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
222 16. Nursing-D epartment of Health-World Hcnlth Organiz ation. Women's Health and Safe Motherhood Project-Purlnerships Comp (2003). 0Tlie P. R. A.-A Participaton J Planning Process... Departtn oneru. Health and Tiuropc:m Commission in the Philippines. ent of 17. World Health Orgunizatioo. (August-September 1978). The Declorati Alma /\ta. World Ifeal1h Organizat ion. on of 18. World Health Organiza tion. (1995). District-Health Systems: Glob 1 Regional Re1Jictu Based on Experiences in Various Cou. nh·ies. Geneva ~ 011d Health Organi7,ation World Health Organization (2003). Social l\1ob;i· 0_i-lct for Health Prornotion. Regional Office for the Western Pacific. Manila. V. Oho11 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Chapter 9 NURSING INTERVENTIONS FOR COMMUNITY HEALTH AND DEVELOPMENT Luz Barbara P. Dones INTRODUCTION The World Health Ocganization's (1978) definition of health emphasizes not only the prevailing pl1ysical and mental conditions of the people and the community. It also considers the political, economic, social anrl cu Jtucal dimensions that affect their living conditions and quality of life. In Lhis context, the interventions of the nurse cannot be limited to actions geared towards the reduction of mortality and morbidity. Community health nursing interventions necessarily ca JI for improvements in the standards of living and quality of life of the people and Lhe community. The WHO definition of health, therefore, clearly makes a stand on the link between health and developmen t. It implies that a healthy population is a moving force for economic growth of the community. Consequently, marked improvement in the economic conditions of the people will enable them to enjoy a sustained level of health and wellness. In the health development process, the Alm. a Ata Declaration (1978) stresses two important concerns in addressing he. al th issues in the community. The fast concern is the 11eedfo1· un integmced approach in solving health problems. Communily health needs and problems are not solved by simply inducing changes in personal and group attitudes and behavior. lf one e Kpects lasting and sustainable solution, reforms have to be canied oul wi U1in U1e health care delivery system and the larger socio-economic and political system. The second important concern is the need for enhanced capabi/ityfor greater parlicipalfor1 cmd inuolucmcnt of the people in hca/rh efforts includi11g policy making and influencing decisions. Often, U1e people most affected by the problem feel helpless simply because tl1ey do not believe they have the power to change their situation. In other words, community health nursing interventions must focus on providing health-rela ted interventions to improve the health status of the population and enhancin g the capability of the communi ty to manage its own health. COMMUNITY COMPETENCE AS OUTCOME OF COMMUNITY HEALTH NURSING INTERVENTIONS Community competence is defined as tl1e ability of tbe communi1y to (a) collaborate effectively in identifying its problems a_nd needs; (b) achieve a working consensus on goals and priorities; (3) agree on ways and means to implement the agreed. upon goals; and (4) collaborate effectively in the required actions to achieve goals and priorities. (Cotb·ell, 1976; Hawe, Degeling and Harl, 1990; Wass, 2000) It is very much linked to the concept of community empowerment (Minkler, 1991; Wass 2. 000) where 223 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
tht· cummunity is nblc lo rccogni7. C. solve: ond carry out actions to address its ov. rn problem s. AL"COrding to Cotlre-11 ( l976). \he! communit y con be described as having increased oornpdence by e.,amininf! the ch<1ngcs in tl1c commu nity itself, its networks. its slnlcturcs. the way in whicb pt-oplc perc-civc the community, o,.,-nership of issues, and perceived nc: well as acl'Unl ;empowerment in he11lth n. nd social issues". Cornmllnity competl"nce was conccptunlizcd by Cottrell :-ind various studies identified its dirnen<:inns, hm_. c,·cr. only a few s. Lmlic. " looked into the entirety of its eight dim~nsions On<" of lhc,;tudic:-was cnndurtcd h_v Eng. 1ncl Parker in 1994. They evalunt L"Ci !l he;ilth promotion pro~r. im in ~lis$is;;ippi Delt,1 ;ind described the concept of community tn1pow,n11enl 11<sing the folllo";ng dimensions: J. ~·lf-otlir:r au0'1rcnrs. " am/ darity <!f c1 situatinnal definition, defined ns how well ca..:h parlor the community perceives its identity and position on issues r!!lnted lc, ntlwr part S nf I he community. ·111e community members arc seen to perceive the problem. accept its existence and attempt to articulate this with neighbors or ton small pnrt of the community. 2. Articulatc11es.-:. defined as Lhe ability to articulate involvement in the collective ,;cws. ::illitud. :s. needs. nnd intentions of Lhe community; Lhe process or e. xcbaa,zing inform::ition; :i11d how well t J1c comn1unity derives a common rnc-aning from th<. other parts of the community. TI,e community is seen wilh a 1':TTlll(1 nfindi,;dual, who share the prohlem and nrticula1e 1his with other meml><·rs of the community cspecia Jly to the authorities. 3. Cnmmitmem. defined :is a relationship worthy of enhancing and m:iintaining. 'I11is definition i-; basically vngue but the guide questions identified by r;ng and Pnrker su~e. st identification of individua l roles and the commun ity·s contin11ot L<; acth·c pnnidpnlion in effort. s l<> solve the problem. The community is,-C>en ns group ofindi,;dual,. "'ho arc faced with a problem. h. ive talked aboul l11e problem and hnve identified wh:Jt onc·s roles :ire in solving the problem. Commitment is co1tsidcrcd the nr>cfal paint for shifting into the ne~:t phase of organi7Jng. havi11g identified individual!; who wou Jd be part of tlit! core group, orgnni7,ational stn,H. :turc, ::ind po~<;;n JJe implementers of program plans. 4. J\1uc-liin C!r!J fnr fa C"ilita1in. 9 participan t interaction and decisitm making, which refers to the Ability of the community lo establish fonnal mechanisms for-n. prnsent:Hh. e input into decision-maldni:r.. The prognu11 plnn is seen as the 1a11~ib J,, ou Lpul uf thi,-dimr Jm,ion Jerivcd Crom problem nnd role iclcn Lif-ic Ht ion and cummunity-wid. : disc:ui. sions on the problem. It presents I he co,,rsc-" of :ict. ion. .,;. Ccm{lirt eontninm C!nl curd accomrnodat ion, which relates to ll1e establishments of prt)(·d11n-s to :ic:<:t,mmodate open conflict and continued interaction lwtwt>..,11 d,ff,..n.,rlt part:< of tho comm1111i1y. This dim('n:-ion is token as pnrt of the machint·ry, os in 1. vc-ry organi7...-ition. there should be a unit responsible for m1u1agi 11g c,inflic H. o. Parririparion. de. fined a. s the procc.-ss of committi11~ to the communil)' and c,ont. ribu tin~ w se1,in1?. goals 1rnd planning Interventions. ln this rcscnrch stu<ly. Lhi..; dimension is identified as the ac, of attending and contributing to the acu,;ti~s se1 by the program plans. Crantinit thnt 1he problems arc felt nl!'Cd--of Ull' c. ""Omn1unity: p:irt:ic:ipatio n is ex-pected Lo be hjgh. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1 7. 8. Sociaf :mppar·t. which involves knmvingnnd caring for others in a neighborhood and the \'l>'illingncss nf people to assist hy providing support. It i. q further defined as the set of behaviors indic;1tive of the acceptance of the community on the provisions of the progrnm plans and contributing resources, political, financial and olher forms of support that promote pro6'Tam efficiency. M·anagemen t of,·elalions with wider society, which involves using resources and support offered by lh1: larger society and reducing the threats of larger social pressure on community life. In this dimension, the community is seen to be c.,1pable of establishing exlerna. J linkages and its members assuming Hdvocacy roles in efforts to solve t Jie problem orto further develop the existing programs. community competence is a product of an iterative process of mentoring the people in a partnership context. Competency-building does not merely consist of giving information a. nd leaching skills which the nurse expects the people to demonstrate if and,vhcn she asks them to. Competcn. C),·-building is all about achieving change in person. ti and group attitudes and behavior and deciding to adopt and sustain healthy practices and lifestyles that eventua lly improve the people"s quality of life. COMMUNITY HEALTH DEVELOPMENT STRATEGIES The framework of community hen. Ith developmen t is best captured in the training package develor>ed by the Women"s Health and Safe Motherhood Project (2003). It huilds on the concepts of Primary Health Care. mai. nstreaming gender in health, strengt. l1 cning partnership building and the use of community organizing and development approaches. The CHD framework evolved from tbe long years of government and non-government organiwtinns· collaborative experiences in attempting to create a more responsive and relevant health care system in t. l1e local and global spheres. Primary Health Care Approa ch Philosophy f. Structure Services Gender ;and Health Promotio n + Strengthene d Partnerslhip Building and Commun ity Organizing Strateeies Community Health Development Integrated Comprehen sive Sustainable To address 1'11c two important concerns i. n addressing the health issues of the people. namely 1) need for ;111 integrated approach in solving htalth problems, and 2) need for enhanced cnpabilil'y for itrcatcr participation nnd involvemenl of the people in health efforts including policy mak;ng and influ1:ncing dt!cisions. this chapter high Jjghts the difforc111 approaches and stn1tegies that the nurse can employ to help tl1e people and the community to bring out Lhcir potential and achieve the highest level of health. Primary Health Care and the concept and elements of participatory approoch have 225 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1~1..·n di<:('US!tc-d in previ!"u. « ch:iptcr-s. Con:i:equcnl ly. i U11sl rntion t~f a pp lien tion nr I hc. !lc :<Lrnl1..~it--s 1111d :i. ~~pm:ichf. '" fn,111 project-based nm] t"e-"t'nn. :h-bu:<c. :d cxpc:ricncc",,r ~\ld('n\s. l Od mu·H· pnic-tiliunt'rs \,ill tw c-it C(l. 216 HEALTH PROMOTION R>llowini:, th<-He:11Lh fc-r,\ti proj. 1. rnm. th,, \\'orld I lcalth Orµ11niwlion clircctccl its df<>rt,; 1\)\\-;u-tl:, dcnlopini th<. · l'On<'t'J'l of lwulth pn,molion 1tsinr. lhc Primary l·lcnllh Care,\ppr Nl<'h. ·11ir Ol'taw. 1 Char U. 'T for MNtlth Promoli(>n wm,; the result of the Fir:I lntt>malnna l C:t1nt0t"\:ncc-cn I h-:11111 l'n,1111,tion nnd wn:< built on the values of the Dr.-lnr. 11ion,,f. \. lmn.-\In II :-tnk:< th. 11 he:1lth pn,motion m11s1 occur on five fronts namely: ( 1 o~o) Ruildini; hc;1lthy puhlk p"l,lky Cr<!nlhl!? cnvimnmcnt$ ""hid, support healthy living $tn?n)!tli.-nini c,,mmunity nction Help-in~ pt'<r'k develop their skills R<'On,·nlm~ hc·. ilth ~-;:tcm C'('Qrdinis tn \\710 C 1986). IV ensure cffc-cth·cncss of these five areas. health workers mu"l 1-. e eff<'(:'tin in crdt·o-eoc:t J and media tion in order 10 enable people to 1,sain ("(>ll!TT>I o,. :r their lh·c;; Ton,!;-. Tilford and Robinson (1990) agree t11111 the Ottawa Cha. nn,. _" ·nt'" puhlit'. h<'-11th appm:1d 1 in h<:':ihh promotion" and tha1 it differs frum u-adi11nnal puhh..-health. ipprr\;lcb 111 thn.-e imporrnut wnys: Jt re<. "<..>:;Jllh.... the bro-ad nature vf health promotion and the need to wurl-.,,,th,,tber q_-ctor:: Jr in!'litution:-whose works impact on lw. 1hh IL n..~",:m1e-the,-;i]ue of p:irtner. ;hip,,;11i rommunitic..; cnahlinp, th. cm to i;ain c<\ntrol o,·cr i~"ue..; affecting therr health 11 ['Pt"t:,,:1111.._,... 1h. : primacy of peoplc·s c11,-ironrncn1 (hath l)hy:;ica J and :-QCJ'l-f-'¢ln<,mic) in de1em1ining healtl1 and the need to work for ch:uur"' 111 th,J en,ironmen L rather than focusing solely at the level of irnh,idual beh~,;or change As 1n the ~lar. 11ion of Alm. a AL1. the Ottm.. a Charter for Health Prcnnm ion ackno,,·1,--d,:< "' 1h,· n L"n-<"il}' for politic. 11 action :rnd allo"-in~ health prohlcrm, to be deal!,,,tit 1\1 th,:,1r root <',.,use__ Th!' S<-<'Ond lott. rnnti onal Conference of He:1J1h Promc,tion in Adcluidc {19Ff-l J m..,de d1ar 1hc 1mport. nnce ">f h!!-"lhhy public polky urnin J; ind1rntriall7. c<l coontrie--tt J dc H·l)l) 1'>Qlk1e<: 1h;it 1....,v,n,he J;. "ll) flf rich and pu1Jr countric:,,-. l'rlorhy areas for ;. rlion ""rr 1dn11fied ac. fqllo,,-,: Suppc,n f,,r,-·nm~n·., h Nthh E. ltn11n1111,,n ()fhun11;,·r :,nd malmllrition R<.-<lucti<m oiwh:1e("(, wn,,-inn. :ind alcohol p-roduciion CN3l HHl of-. upprlrtl\ ·,. Pm:irrmm<'n:-. 10 rrnmotin1t hc;ilth Th<" TI1ird Jnternationn J C<Jnfere. nce on HC?nlth Promot ion in Sunds"all, S'4e<fen (1~1) madt n"<",mmf'ndn u<m for ac11nn 10 C"'r C'I\IC.-li UJ)f)Ortiv · cnvironrnenl'~. Tiw ~,mm,·nd..,11,m'-,n, hid--<l· ~trt'lll!thc n1n1t,uln><". ac,, 1tlrm1~1 communltr nction E. r..1ltl1 11;. : c,mmun 11',int. I indwi,lual. ; to u1lcc control overt heir hct1lth o. 1nd,..,,_,,.,r,n,,,m throu~h v.-Ju,.,-:,11,m and cmpowcrmcnl ~tt, n S(th,nm~ c-M,p-ra11m tl1r,,u1,!), allian,·c building; ond l-. ncurin~-qu1u,hlt·. 11·,.-... 11>,, ur>r>orthc-t>nvirunment 1hrouglt m Ki1. o11on of ronlhctin J!. 111t.-r!. !. ~rn amr,ntr, members of !!OCicty | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Fiu:1lly, in 1997. tlu-. Jak:. 1r-ta Declaration on Leading Hc:1lth Promotion into lltc 21' Ccnlury was. i tui-nin/. \ point as it w;:1s the first he. :ilth promotio n conference held in a develop in). \ <:'>11ntry nnd actively participated in hy the private sector in developing hcnllh promnl ion slralc Kic s. It identified the importance or health promotion as an investrm;nt ::ind reiterated the need to address social determinants or health, which arc: (1997) Pc. ice. sheller. education Suc:ial security, social relations, empowerment of women Fnod, im:omc A :;table ecosystem, sustainable resource use !:incialju..,1. ice, respect for human rights and equity Poverty which is the greatest threat to health What were Lhe lessons learned from the international conferences on health from 1986 to 1997? ·. 111.,t health and health p romolion will never be the sole responsibility of the lit. !alth prr Jfessionnls and the health professio n a Jone; Health programs should address the social c. let:e. nnfoants to health in order to be effective and su!>"tainable; and Commitment to health is a commitment to social justice, equity, community participatio n and sustainable de,·e Jopmen L The Philippine c. xperience in advancing health promotjoo programs were initially tied up with control aml pre,·ention of non-communicable dis-eases(~CD J like hypertensio n, cancer. dinhetes mellitus. asthma and chronic obstructive pulmonary disease (COPDJ. The Filipinos. kno"·n to he more crisis-oriented than health conscious. vould usually need to have-"Cri,,u_. _ l1e11lt h reasons for instituting,m<l maintai ning healthy lifestyle. The fran~·work fnr a11 i11tegrn1t. ;J comllluni L~·-based NCD pn:,·ention and control program in the· <:nuntry t T11:izon el al, 2003) took off from the \NHO's general frame--·ork on intc,:?. r:11l-d NC:!) r1r,q11Lio11 ;,ml r. :ontrul in the \vestem Pacific Region (Wl!O-'..VPRO, 1998). \\"ltil..-1111t. ·gr. 1t cd NCO pre\'cntion reco!{ni7. ei; the import;im;e of institutions and com1111111itr i 11 t,~·altlt promotio n, delivery ;1nd mriintenancc. much of the interventions shcrnl J put pnr1in1br rrnpha;; is 111 imlivich1nl control tluou?,b chan~in?, behavior and lifo,-. t}'ks. I low,v~-r. <,:011:;;i~krabl1. : prnl!,ro::-s in ?i CD pre'-'e Qlion and control cnn be nchicvcd by cn:ati11~ ti health protective c1wiro11me t through healthy public policies 11,a: well as hcalllt-"Cctor l·cfon11s and cost-cffectfre interventions. 227 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
"lb' fr. un;,,wc1rk l'ho~,,1 nho,-c w;1i, u1ill1c-Ll in dc,·dopinµ n trninini; ·111111111111 for he-, 1 workt>f'l' 1,n pn. "n <. >I ini:, lw:ill hv ti fc,$1~·h:,.. The 11111 nicipnlity of P:1 lt·r?l' n nd l he f Jrovj~ 1 h lf G11im:1rno: "'Crt· lh L· pi\N ll TC'lll' for tlw 1rnini11g pr OF. r11111 whi(·h rocuscu "" ti~~ following key inlcrvcnt i,,11,1 r:11,,,:. ic-:<: (Tlll17t'l1,·t nl. :..:oo~i) c 228 1. Din. '<:tion tlnd 111fr:1:sln1l'111r~ l::nh,111<-ini. ; ancl :::tr,11Alhl·ni11. 1; lo<'nl govc~n. mcn1 11nil (l. GU) c;:ip:,hility to dtv,lop :ind i1npll'rne11t pohc1cx and pro~nirn :1imc·d nt NCll pn·,·,ntit>n. 111,I c·ontrol. Str<'n'1-"lh,·nin~ rcs(. 'nr<" h t·:1p:ibility. 11tili7J1lio11 :ind infominlion c..;ch:in1s, on NCD in o~dcr to incren:c:c cfficic. ncy and dfo,:t h"t'nt'R' of he all h care deliver:-,· to control t he..<:e dise:1. scs.. :. t. Changing. cn,irunmenls.. E..c:tahl L,. hin~ partner. ::h1p:-; and 111ler~e~lora l coordina Lin g cn~h:111i. :<ms in nrdcr t_o develop pohc1cs and pro~rarns lhat en. $ure h,:allh anti cn,,ronm cnt are not compro1n1 sed by =oomic pm,:. n:.-:..-.. l'olkie!:' tn\JSl he developed to Pro,;d,· he. 1lthy choic~ of food. reduce produc Lin11 of :inim:il fats and encourage production "nu con:o:umplioo of vegetables and frui L"-as well ai consumptjon of moderate amounts of unsatur ated fats ■ Encourage food industry to develop. produce and market he:;ilthy foods p:irticularly !'hose ";t11 10\v sat11nilt>d f:1t :rnd salt conten1 l..e,cii-lat,~ for proper food labeling Adopt and support anti-smoking Jegisl;1tion t,, pr<Jtecm nrm. smokers· righl lo dean air: crcat~ mecha11i-..111:. !<l discoura ge tobac. co use and 1,. ;:1rl\· smr. iking initiation · Enrour. ige rhrsi<-~,111cth;ty and exerci Af! by nwkini;: facilitie. " av::iilablc. accessible and attrncl i,·< 10 p,-<>ple Support iniliativcs of priw1tc sector and non~m,emmen tal nrgnni7. :H inns '" develop community he. ~llh-.,r. ·icc. 'i and intc;,ratc NCI> pn'ler Hi'>n ;incl control mc:,~urc,5 into thc. :-. c 1,cr. ·iec.... -. Rrimhur-;e hf':c'tlth promr,tive prncticc-; lien Ith co,L~ for rro-,,-ntion and control of nuncom1nurak:1i,h. : di<,c. "~ En-. urin~ f1tll 1,immuni1y pnrtic-ipation in the implrm,·nu11,,n 11( XCTJ pn:v'tntion and control Jnteg. ratmz hc,,lth, l1f,:,. t,·lcs and bch;:i,·iors into other health promr,t1n~ ;n1trnt1~'"",uch ao; f-Jca J1hy Cities, Healthy School" and H,·-,lth~ Wr,rk,;it~ 3. Chan,:!,in,; lif~rvle ~ising public-a"'·:irencs. "' I~· µroduc. in~ ;u,d dis!:cmi na Lin~ ~nrmation th:rnu Jth m;,~o; m'<iio. h,. nhh c:1mpnign. s. public 1nfnnn:u10n ~-,,. 1, m.,-ind <. (·h1>ol i'<. 111CI1tion At the L'<lmmunit~ "-"'el, mt Jtb,-'"' d;. 1.,....,_, h::imn~oy a. '-!. C'mbl 1es. p,o«;t:ing in <'Ommunitv hullc-tin ho:1rd <= or in places '"'here m. oc-1 pt.,. oopl<> frequc;,r or conve1"1;C such as sari- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
si,ri lllorcs or marketplaces are example:; of activities that can be c,1sily carried out 4. Rcur·icnlinl!, health services Reorienting focus nf health delivery from cure to health promotion or wellness. ·n1is can be achieved by enhancing the skills of hcalt h wnrkers in " scrc:ening, c:isc finding as well as prevention and managem ent of NCO ,. prevention of risk factors that contribute to devel(Jpment of major NCO Develop ing skill5 of hea Jth workers for prevention and control of NCO in the aieas of » Epidemio logy » prcvcn lion strategies and intervention practices » health promot1on » program management and evaluation " community organi1jng and mobilization COMMUNITY ORGANIZING TOWARDS COMMUNITY PARTICIPATION IN HEALTH Commun ity participation recognizes people as Lhe center of any developme nt effort. Jt is a process by which members of Lhe community: Develop the capability to assume greater responsibility for assessing their health needs. :md problems; Plan and act to implement their solutions; Create and maintain orgnniz. ation in support of these efforts; and Evaluate the effects and bring about necessary adjustments in goa Js ,ind collective action. ·n,c \Vl!O ( 1995) further nffirrns that ~,community partic. ipation is a fundamen tal rcq11iremc nl to nc. hieve health und sustainable development... eaahling citizenship lo h<'c-omc nn intci. :rnl p,1r1 of the dccision-m,iking and action process... and reflects the cwc J fur development of more ncthc communilics in their rights-. To achieve thii;, Comn1u. nity Or~nnizing (CO). n socinl dcvelopmenr methodology is utilized lo fncilit:all: the process of forming nnd sustnining self-reliant and self-determinin g com 1111111 it h.-s. Effcctin). I ch:111~c through (·ommunity p. :irticipatin n means changing the condition s \\;thin lhe con1mu11ity and ultimately, people·s beha";ors. This means introducing or ins1i1111i11g n Lw pro). lrams and policies that ";II positively impact on their health. The luv,,I,if communily·s pa1·Licipalio11 re Uects I. he lt:!vel of power a community orisani:1. :. 1tioll h:'ls am! their capability lo lap resources in order to respond to their net,tls. Participation in h<. !allh,·:m ran!?,e dramati cally from passive involvement in pre lleh'rmincd aclivitius 10 full conlrol or health organizations and healt J1-relatcd affairs. lncn:as,d parti,;ipulion addresses the issue of sustainability of health. Wny is there a n L-ctl lo s11st:1i11 health prn~T:11rn;'? The answer is: simply. because we need to sustain hc:1lth or I. he pcopll'.,\ sus1ain ahlc community health developmerlt grounded on hc,ilth 1ir·<rnwlio11 and w<'ilrwss can only be achieved when program s and projects Ulili:r. c three impon:1111 :. tpproache.-<: Cnrnmunit ·y-ha. sed approach which empowers the people to addre. ss thc:>ir health needs and problems Loteg-ratc<I approach which considers various dimensions ofhea Jth and development such as changing Lifestyle, changing, environment 229 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
230 nud reorienting hen Ith c.-1r1a: syslems Comprchcnsivl' RJlpro Ac h which strike)' 11t the root of the problem nnd addresses the sociu I dctcnninan ts r,f health C<'rnn1ui1ily or)!nnizin~ work is c.,rric J out by the nur Sl' with the ~oat of motivating, , J,:,min):\ 11nd srckini widl·· 1·om1111111ity p<1rti<·ipalicm in ucc:ision-making i,, aclivilic R ~;nt hnn' 1hc_11;>:"ntiul to impact posi~ively 0~1 com1111111ity health. Unli~c in t_,callh cducalinn ;Kt,,,tu·:< whl'rl..' th~ nur~,. nm::: to 111f111c11~·c. drnngc. ind ~1vcl1fy n1t1tudcs J t,chiwior of p,npll· as 111d1v1Cl11nlt:. the nur.,;c s efforts nrc dll"cc. :Lcd towords :Hl I ·1 ·. I I... ·'. 1 01117;11)'. and mn '1 111r1~ t H' pcop c to 111111;:itc nnu sustnm c rnngcs ns ;_1 group or ns n[1?:o"''ani7. ~1tir-n. Tlw p L'oplc. 1rt 1101 :L~ individ11nl:s h11l n:; member s of thc,w groups or -'11.,_ · I I.. I. t1 rg;iniznlions. !11 nmm11t11ty,)r~n111z111g.. t H. ' cmp 1:1s1s 1s more on stren~t 1cn1ng 1c 0 ember,-· capahili!:)· in prohll:'m-sold n~ and decision-making skills nece..c;s:, ry for scl r-111.... rdi:rnl de,-dop1rnmt 1111Untl\"l'l', Conununit y 011!. llli Ting i, a pn)ce~ whereby the community mcmhers de,·clop the abilit,· to ns~cs. s 1h.. 1r health tl L'etls a. nd problems. pl. 1n. ind implement net-ions to ~i--e tb~ prnblem,;. pul ~p ~md su;;tain_ o~an_izational structur e..-. which,,ii! !<upport and monitor implementation of health lll Jbati~·es by the people. 1n orgoni7. ing lhe c:ortimunit:-·. the nurse $toes through the fo Uo,-,og phases (Andamo, J986; Manalili, 1985): A. Prepanito~· Pl~ase. T!1e acth. iti~ in the prep~atory _phase i~1clm J~ area selection. commurut y pro-filing. entry in the com111urut y and mteg,-at,on with the p('OPle. 1. A roa sclec:n'ort To ~uide rhe nurse in choosini:1. a. nd prioriti7. ing areas for community hc,1lt h development. the follo"ing quest. iun. s must be answered: L,; rhe comm uni~ in n,ei:<l ofassistam. :e? Do the r::urnmuni~-rno.,111110.,n. fol. '! the need to work logclhcr to overcome o.,pccific hc:alth pnc Jl,lcm? Art> there cvnccrned groups and 1Jrganiz;1tions that the nurse c. 111 pos~ihly h'nrk "ith? \-\'hat,,;II be the counterpar1 of the community in terms of c'1mmunity-;-upport, commil'ment ;md hum. in resources':' 2. Community pr-ofili119 Once th, a,,.,. h:i$ been scl<:cte. <l. ;t Cl)mmunily member who ii-known r111<l ;icc('Jltl'cl b, tl1t' r><·npl,~ ";II h<: chosen to acl ns the contact person. TIie c11ntac-t per-. nn r:111 id,·ntify otlwr pcr. ;;nns who C. "1. 11 b1· depended 11pon to in11101t.-,wt" 111,--. in the r-nmnrnnity. ·111,·s< people will com rose the c«irc ~rnufl "h<1" ill. ~,-.,~t the· nur<:1. : 111 dning n <:t>n11nunity profile. A <:<J1111111111ity prnhlc pr11,1dt,-:tn n,crv1e-,,· r)f dern<\,:rnphir· chnr:1t ·1crislic,-. co111111u11il)' and 1i~11lth-rdat l'd,-..-r. ·in.-,;; and fac-dit,c,. II will,-cr"c a. s,111 initi,d d11tahasc o( the ron1r111111it:,. :,nd pnn·id<· the basi,-for pla11ni11K ;ind pro~r;,mmi nµ of Orj1. :Jl117. llli?, :l<'ll\llll"'-. It c.,n nl'--'J help d L'termin(· llw :ippr·opriall· 11ppnmc. il and me-thn<l ol or)?. ani7Jn)?.,;p,. :cific to the popula1ion group or sct:lor. s thnt ,-. ;11 he-or:i:,ani Ted. 3. Rnrry in thf' <'ommu11iry and imc:gration u-itl1 the people. l:iefon· :'H'tu,J cn1. ry into I ht" com mu 11ity. ha. sic inform,r tion about the II rca in nfatinn tll tla· (·uhural practice:. and lif Mtyle of the p<'oplc· m11~t lw kno"'11. F. ~ahh,hrns,: r.. r,,xirt,md i111. c. i:,rntin,I! '"1th Lhcm will hr much c-11sic-r if one Is at-)1.-I{, unde~-iand. accept or imbibe their l. 'Ommunit y life. Lh·ing with | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
the people, undergoing their hardships nnd problems and sharing their hopes and,1spirations help build rn11t11al trnst and cooperation. Herc arc some g11irlclincs in cnnducting integration work: Rccogn i?. c: the role and position of lncal authorities. Adapt a lifestyle in keeping wi Lh that of the community. Choose a modest dwelling which the people, especially the economi cally <. lisadvantaged v. ill not hesitate to eater. Avoid raising expectations of the people. Be clear with your objectives and limitations. Partidpat e diree1ly in production p Tocess. Make house cal. ls and seek out people where they usually gather. Participate in some social activities. B o...,. anizalional Phase. The organi:;,. ational phase consists of activities leading..., to the formation of a people's organization. i. Sociul preparatio n The integration work paves the way for the nurse to be introduced into the community and signals the beginning of the social preparation phase. While continuously learning more about the conditions of the commu JJ. ity, the nurse deepe,ns and strengthens her ties with the people. 2. Spotting and deueloping potential leaders As a result of living and IJeing with t J,e people, the nurse comes to know who,i m0ng them have deep concem and imderstancli. ng of the conditions of the community. Howeve r, it is necessary that they should also be able to g;:iin the tnist and respect of the community members. Pro"iding opportunities that will demonstrate their potentia J as leaders can test their commitment to the community"s well-being. The nurse must conscious ly pro,·ide learning experiences that will prepare them as future leaders of the community. ll is not necess. iry that the r>otential leader is highly educated or one !,donging to nffluent family in the commun ity. What is more importan t is fo,· that person lo be able to identify,vith, understand and articulate effedively the problems that beset the community. lt is to his advantage if he hm; a relatively wide influence not only among the poor but also among the elite. Perhaps, one important consideration in selecting potential leaders will be their wi Uingness to work for the desired change. 3. Co,·e g,-oupfo,mati on The core group consists of the identified potential leaders who,,. ;11 be tasked with laying down the fo1111cfation of a strong people's organization. Ideally, the c-orc gro11p represents the different sectors of the commun ity-women, yo11th. fnrmers m· workers-depending on the type of Lhe community. The nurse :1ssists the sectoral representatives in formilil!, core groups in their respective sectors. She also facilit<1tcs in skills development of core group members 1·el;ited In lh1: tasks they ""ill assume in the organization. See Ch<1pters 14 and 15 for specific interventions to develop partnershi p competencies and workiroup task and maintenance functions. The core group serves as training g Tound for developing the potential leaders in: democratic and collective leadership planning and assuruing tasks for the formation of a community-wide organization 231 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
c. 232-1- hnndlin$', nnd rc:solvin A group c<. mflic:-ts criticnl lhinkin~ nnd tlccisio11-11inki11ii proce!cls Sctti11q 1111 the con11111111itu c J1'(1C111i7ntio11 When all 1-,ctural orw11~i✓11Li<Jn:-huvc lll'L'II put up, the people. trc rcndy to f11n11 a cu1111111111ity-wid L· t>r)). :111i,. :itk111. This uq. ;nni:r. ation will f:H. :ilit:tll. ! wid1r partidp:~ti,111 ;u1tl C'lllhttivc action 011 c-0111111u11ity pruhl,111 s. \\'h,·11 tht·11r1tnni ;;1li!>11 is rornwd. th L n11rs~· n1nkcs sure Llrnl tlu. :n' is 111. a:--inn11n p;1rti.-ip:11io11 111' 11ml control 1,y the rne111hc1·s i11 nll its nt·th;tit", Thl' or~a11i,. i1t1u1111l 1<tn1t·tt1rc 111usl b L' simple to facilitate cons11l1n1io11 nml d,L'i,:itm-11,11ki11g a11rn11g it:-; 111t·111ln:rs. l'ar·t uf the orµ. :111i1. l H101111l :::tnll'I urt· will hl' working co111111ittccs specific. illy crcntcd to 10<:>I.. into th,· tl,ff L·n:nt n>n<··rns of thv 1J1·g:111izatio11 and con1munity. One,-11ch,·,1111111it1, ~ i~ tlw h L·:ilth n,mrnitl L'C:. The nurse,,ssists in l. iying out pl1111, of tl1. :: ln:allh l"m1miltt'C' thnl initially includes idcntificntion of i>ro,,p,·. :tiw 1:on111n111it~ · h,·nllh w11rk<·r s (CHWs). The committee mny d,>c1dc to in,ol\·. :: th. ::m in the nc"t phnse. Education l. l. Jld Tr:,inin~ Ph:isc. TI1c purpose of the ed11c:1tion nnd trnining ph:1..<:c i~ to strengthen the o~ani7. ation :rnd develop its capabili ty to attend to the cornn1111ii1 y·,-h.,,-j,· h,alt h-1. ·:i r,· rwtd-<. "l11is c:in be ncl1icvccl hy cnnd11ct i ng the rornm1tn1t~· Lh:i~nn,i~. t Taining of r,11111111. mity health workers. 11ndert Rldng health ,:cn-iet::. " :iml rn11bili,Jt1on nnd leadership skills training. 1. Cuml11cri11f1 c,)m1111111ify diny11osis The cnmmu111tvt. litt~110,:1,-t>' <. lc111c lo come up with a pn,lilc ofloc.-11 hc. 1llh "iltl:ttinn th:11 ";11,cn-c as h~1si--; of hcalth fll'OAnim~ ant. I service:-, to be cldi Hn. '<. 1 tu the,-. 1111m1mity. The nurse a!>si~s the. : people in dcvcl Dping 11 plan :ind in the,1c. :t-u:il ccm<lucl of community diagnosis. She also helps t1,. :: community tu identify. ant1l)~. 1. e u. 11<..I understand the implic:..1l ions of th<! dat:1 that they ha,·<: cullectcd. 2. Traimng nf rmnmuni Jy hcolrh worker s Afl,:r the rt'<. ults of the community diagnosis ha. 5 been prcscmtcd. the c(7111111unity d,-ritlcs on t J11. ! r~)lcs the community h C'lllh workers arc cx J>t. '(;ted to pcrfom, and the comr>ctcncics and pcrsonnl qnnlit i~ they should pos,e. ss. Ba!<ed on an 1114recd upon c. rih:ria, Lhc pe<. 1r,l1. : "ill dtcidc ,,·ho will be trained a,; community hcallh worker :-bnscd on the expected roles of tlw Cl-!Ws. After the community health workers hnvc hccn named, tlic 11ur:-ic facilitate..,; the C'(lntluct of n r raining needs assc.,;o;mc11I (TNA) w dctcrm inc t11~ level uf health,kill, and kno,...-lcdgc the trriincc. c; possess. The rcsul L-. of thi"' a...... c_-. i:ment ";11 s. cn·c ~,... the bnsis for the health skills training currin1lum which "'ill focus on the rcquirc·d cornpc. :tcm. :. ies. 3. Health scruice. s 011d mohili,. <1/ ion TI1c organi. r)trion take-. the le:id in 11ndenak. in14 net ivi I ics that will solve lhe prublc:m,-Lht c:,1mmunitv,,,-,,nfr()llf r·d with. l:'. nl!,a J. ti n)t them in c·o Ucctive work j!h,.,., tlw P'-'',pl,,ppon uni ti,--. tn 1,,1 and "'t rt· n J:I hvn cnl'Jccti\'C spirit and. ii 1h~·,-. ~1111. : t111w. build an J c11h,111n.-their 1;c,11lidt. :11n;. Oftentim es. JW<>pl, nre very,n1. wr t" Jl'l \,,1 hou1 con-:1JLrn t inn I" rc:,.,,u recs nccclcd to c;i~ ottl th, f!L'tion. It \,-ill dn well for 1lw 1111r,-. e tn t1·r1d1 the people how tn fll1Llnll7!'-th,· pr11bl,·111.-. 1h01 n€'t. d 1n be. idclr P<;<-ed ot a ~ivcn time. This will pr...-vent fru:-tral i1m on th,: pan of the p("<lµlc when they do not seem to achic-v, their goah right,j W. «y. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
D. 4. Leade1·s hip-rorrnation activities The process of dcw:l,,pingcommunilylenders is n con ti nur)lls:ind sustainc<. l proccsi:;. Lc,Jdcrs learn a lot hy r,ng11ging in actuol ori;anb:ation al activities :=:11ch ns conduct of nw,·tings, :,51,,!~c;mcnt, plannin~. implcmcnh1Lion, moniloring and cv,iluation,,f ;1ctivitics. They can ut ili:,,c t hcscopportunities in mastcrill)!,<Jrg;,nizini;. ~kills, human n. :1;,t ionsdevcloprncnt or ~upervisory skins. How1jver, they an not enough. Their expr. :rienccs can very well serve as bases for theory l1;arning when they undergo fonnal le,1dership skills Lraining which can inc. Jud(: skills in financi;il anc J prr,jcct/prngram mnnngcrncnt. l\. s the nurse works with the nrganiu,rion and the community, she will be ahlc lei nsscs~ the specific tr:iining and other prnctical needs of the leaden; :ind plan for a conlrnuing educatio n pmgr. :im for them. See Chapters 14 nnd If> for inh:rventions on leadership formation. Jntersectoral Collahor;,il'ion Phase£ As the organi7. ation grows, its needs will :ilfio grow. ·r111. : need for resource. <;-matcrial. human, financial-will have to be sourced externally. Assistance and support in any form can he funneled into the organi;,. ;iri,111 through c-nl111bnrn1 inn with other nrgani7. a tirms and communitie. 5. The nur:-c is in lhc he. st position tn focilitalc and coordinate with institutions, ugcncics and other key pcnplc to ;irticnlate the community's need for support and assistance. E. Phase-Out. ~\s the organization and the community assume grea1er responsibility in m. rnagin?, Lheir hcallh-c. irc needs, the nurse gradually prepares for turn-over of work and develops a plan fc;,r monitoring and subseque nt follow-up of tbe organization's. activities until the community is rcatly for fu JJ disengagement and phase-out. CAPACIT Y-BUILDING THROUGH COMPETENCY-BASED TRAINING l11e efficiency and effectiveness of the health care system to address the health concenli-of the community depends on the level of compete nce of the people who are expected t. o deliver the services and m;mngc the available resource. ". In a setting where the nurse c:rn only rely on volunteer workc·rs wilh little or no formal trnining on hea Jth services pro,·isinn. she needs to equip these workers with knowledge and skills as basic health service provider s. health tenchers and community he~lth leaders to the rest of tl. 1c populntion in the community. · The competency-based framework involves the mastery of a cluster of related knowledge, skills. and nttituclc. s critical to performance of one's role or responsibilities mcm;urcd agninst well-accepted standards. (Sullivan, 1995) ll is n systematic approach to developing and enhancin'1, the competence of an individual being trained to perform a certain role in a practice setting. Usin~ a compete ncy-based framework (Ma~layn, 2006) in trninin/'. \ of community volunteer health workers makes certain that the necessary compete11cics ;ire ac4uircd anu performancc of U1e roles and responsibi lities can be cerl ificd 11<)t only as competent but proficient. The following describes I he process or co111petency-ba,-;cc. l trainin !!, from the experience s ur UP Manila Collq:;e of Nursing students' application of competency-based framework in training of communit y volunteer health workers a. nd partners in Nagcarlan, Laguna and San ,Tuan, [btangas. (Abad et,11, 2007; King et al, 2008; Mascarenas, et al,2008) 1. Analysis of work serting. The initial phase in developin g a competency based training program for conununity volunteer health workers is to 233 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. S. l'Olt..,idc-r th E' present health issues :ind t-onccxns Clf t J1e communit y nnd its pop,1\ati<'n. An nw;,i,·~n,. s,. <; of I lw h,callh silm1lion provide~ direct-ion to the rolel'. T'\'!<J'l11:-:ibilitk s nnd task;, that the henlth workers will be prnparcd and train~l for. The folln";ni:. !\C-th-itic..-. will help lhc nurse comprn J1end the hcnlth ronditinns 111 tlw work s L'tt-i~: revie"· of thl' Ct. '>111111unit)· din_1-;11osis rcpor1 inten;t''' l>f \..,:,y l'l. 111inm11i ty lc(1<kn-pnrticnlarly the local chief e. xe<:utini nnd tlw t'l>11ndlor for health inteniew of the municip~B hcnlt J1 officer 01· staff of. t J1e Rural Hea]t}1 Unit ocular sun"€y of the community random int..-n;l!w of residents in the comn. m1l. ity SJX"C[f. uin9 the-roll'$ of th£? community Lolu11teer health workers. The nurse aoaly«~" tltlc' critknl roles that the health workers will need to car~· out to addl"CS$ UH. ' heallh i~-u.-.. aod concerns of the community. ln addition, the munkipa Jlty may ha,·"' special hea Jtl1 programs being implemented in which C. 1.."'fc'. t11e roles and ~p<>n,;ibili ti. :-s may have to be redefined. Gcncrnlly, the roles of LUI! health workers include health care pro,;dcr, health educator/ tcach. :r nnd rommuni~· h<c'altb leader. ln some of the barangnys in Na~carlan. La. pm. ;.. I :\ood ct al. 200-) the..--c three roles especially the last two were deemed cruc1al in Ute m1. plemeo lat Joo of a health~· lifestyle pro~ram that is working on pl'C!'-ention ;i. ad control of major risk factors to noncommunicab le diseases smokin~. akohul drin. ki. n~. unhealthy diet and ::-edentary lifestyle. ln San J1um. 8,11. ang:as (King et al. 2008) "-here the nursing students implemented a comix>t-e nc.-:,-t". Lx 'CI training. Ute role of health care p ro,;der was g. ive. n focus in the hi:ht ;h.-. : the barang:iy health workers are actively in,·olved in tbc implernent. :tiion of 1he Integrated :>-tanagement of Childhood ll Jnc. '-1' (TMC]). lo othe:r baranirny,; of San,Juan. Batangru;. (:,Olascarcn as. 2008) l11c mothers '-"t're the recipients of a training program on home management of 11,,-ICI relalfil conrutians. ln this training program, the mother's role as health care p~,der for her cb. J1d v.-as also the focus. Specifying the responsibilin·es or rasks related to tf,e rol. e. \\fhen describing ui~ ~nsihilities znd U1. Sl:s. take into account v.-hal the Pc:partm 1;n1 of Heallh only ex-pect. s the h~tu,,-:orkers ro perform in their respec·l. ivc communities. Tite :,lunicipal Health Office as well as the local government unit will he hrdd account;;ble for "-hate,. ·er ill coru. equc ncc t J1e health worker':, nction rnay brinit. no not erp,. !ct the health worker to perfonn Lasks which nrc d<·:1rly l11e mid..,i(e·s rc:5'ponsibil ity. Another consideration,,..,;IJ be 1J1c level of cduc..,tion of the hea Jth worken;. One can no L expect the hea I th workers tn function with lhe same competence and proficienc:-· as professio nal hcal(h workers. S~fyfng the skills, lmmvledge and altitudes needed to perform the tasks. Each "pecinc task will be anal}7..ed in tcnn_s of the following: Skill-what !<;/are the ~ha,ior/s nc.-ed<--<l to perform the task Knov. led~e-"'· hi\t is/an? the content needed to be oblc to perform the,.,kil,J Anirud!!-what are the feelings, beliefs, approach or values towards others, one self or one's work which facilitate the execution of a '>lo1] or a pa. rticolar task 0'nducti n Q rhc rraining needs ~ <>nl (TNA). ·n1e TNA is cruci:1I as ii lnve$the nu. r-s. e who is de,..eloping the training program an cs Lirn. 1te of the entry | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
competency of the participant-; to the training progrnm. This is done by giving them n pre-test to cvnhrntc thci. r level of knowledge and attitude nnd readiness in term~; of the new material that they will go through in the training. Skills test can ;ilso be done lo evaluate performance hnsecl on standards. In the TNA cond11cled by the nursing students, thev were able to detecl wrong information about vit.,d si). \ns Laki11g from the pre-t~st. Errors were observed in vital signs taking <. luring Lhc skills lest. These observations were used as bases to make sure thnt the misinformation arc corrected and the errors avoided. The TNA results can actually help in developing the instructional design or the lesson plan for the training and in providing details in the SKA analysis of each task. 6. Developing the instructional design. After the TNA. the nurse is now ready to develop the instructional design. The instructional design is similar to the lesson plan. lt specifics the content. the instructiona l activities or the teacbing leitming methods,me. I how the competencies are going to be evaluated. The SKA analysis,..;I] be the basis for making the instructi,mal plan. All behaviors listed under SKJLLS are the competencies that should be boned in actual clinical setting with actual patients. All items or content Listed under KNOWLEDGE will have to be learned during didactics or in a classroom setting or practice sessions. All items under ATITru DE should be taught both in classroo m and practice sessions and actual clinical setting- All items listed under skills, knowledg. e and attitudes are the COM PETENCl ES that the bealth workers need to learn_ When planning for tl1e instructional activities, be guided by the following principles: Leaming activities must be purposeful, planned and organized. They should engage the learners to listen and interact with one another. make observations. think or analyze critically, perform skills or demonstrate behaviors that approximate the expected or intended training outcomes (Bil Jings 1. 958). Lea min~ activities sbou. ld be designed in such a way that they pro~res. siv<;?ly contribute lo the achievement of competencies of a training course while preparing the learners for ·more complicated cognitive, psychomoto r and cognitive competencies. Kemp (1971) states that content should he meaningfully a J1d systematical ly or~anizcd in a way that there is a graduated sequencing of content from simple to complex starting \,ith fact learning, moving on to concept formation. principles and then to higher intellectual levels of problem soh,ing. prediction and inference_ Consider principles of learning in meeting learners ' needs and abilities. The teacher must recognize lhe many variables in a given situation that can affect indjvidual's desire to learn and ability to master the needed skills (Schweer l976). " Recognize the student as on Individual; respect individual student's worth and dignity regardless of teacher's expectations and goals » Motiv:oition patterns are highly individua lized. Students tend to be highly motivate d when they can see a direct relationship between the learning activity and their learning needs. 235 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
236 Provide flelcibility in selecting available resources for clinical/ practical experienc. e assignments _ (Schweer, 1976) There must he freedom to select clinical /practicnl experience from a wide w,riety of settings within the total community to increase opportunities for providing all learner!. with desired experiences at the time needed. Maintain an. environment of acceptnnce by personnel in the RHU. 7. Develop ing the evaluation p(an. The final phase of developin g a competency based training program is designing. the evaluatio n tools to detem1ine achievement of lea. ming outcomes. The follo·wing are guidelines in developing an evaluation plan (Maglaya 2006). Specifythelearningoutcomcs/ competc nciesand the testing condition under which the learners are to be evaluated Detem1ine the performance standards and specific criteria/in. dicators to measure the achievement of the standards Identify evaluation methods appropriate to the learning outcomes. Specify the so LJices of evaluation data. Use appropriat e evaluation tools to measure achievemen t of the learning outcomes PARTNERSHIP AND COLLABORA TION Health and hea Jth-related problems i. n the community are varied. Most often the problems are complicated and too many for the nurse and the people or tliei; organization to band. le. They cannot solve the problems alone. They must work with otber people or groups to increase the probability of accomplish ing the goals tl1at they have set. A,; tbe saying goes, there is strength in numbers. The nurse must plan to establish and maintain valuable working relationships with people such as peoples' organizations, health organizations, edu<:ational institutions, the local government units, financial institutions, religious groups, socio-civic organizations, sectoral groups and the Like. The aim of partnership and collaboration is to get _people to work together in order to address problems or concerns that affect them. It gives people tlrn opportunity to learn skills in group relationship, interpersonal relations, critical analysis and most important of all, decision-making process in the context of de. mocratic leadership. Working toget J1er enables organi:1..ations to accompli sh their goa1s much quicker because resources, skills and views are poo,Jed together. Organization s can com. mit and work together in different ways (ICHSP 2000). 1. Networking is a relationship among organizations that consists of exchanging information about each other's goals and objectives, services or facilities. Th. is results in the organizations' becoming aware of each other's worth and capabilitie s and how e. ach can contribute to the accomplis hment of the network's goals a. ad objectives. Net... vorking requires small amount of time, yet it has great potential in terms of joint actions. 2. Coordinatiorz is a relationship where organizations mocjjfy their activities in order to provide better service to the target beneficiary. To a certoin e>..--tent, this level of organizationa l relationship becomes tirne-conswning as it requires more involvement and trust on the part of the committed | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. 4. 5. organization. Modification of activities that are more responsive to community's needs may significantly improve people's lives. Cooperation is a relationship where organizations share information and resou.-ces and make adjustments in one's own agenda to accommodate the other organization's agenda. In this type of. relationship, organizations share ownership of the success, rewards as well as p. roblems and hassles that go with working together. Collaboration is the level of organizationa l relationship where organizations help each other enhance their capacities in performing their tasks as well as in the provision of services. At this point, people become partners rather than competitors. Collaboration entails a lot of-work but the potential for change can be great. Coalition or Multi-sector Collaboration is the level of relationship where organizations and citizens form a partners hip. All parties give priority to the good of the community. It requires great investment in terms of effort, time, trust and the will to make a change. The following are general ideas for the mrrs e on how to get started in partnersh ip and collaboration work: 1. It is imperative for the nurse to involve all the stakeholders in the process of forging partnership and collaboration with the community. 2. In working together, the nurse and the community face risks together. It is important therefore, that they need to know and trust eacb other. 3. Determine how each organizat ion views the problem, how it proposes to solve the problem and how it perceives an organizational relationship can help solve the problem _ 4. Organizations should agree on the kind or level of relationshi p that will help best accomplish the group goals considering needs and available resources_ 5. When organizations have agreed on the type of organizational relationship, formulate grnund rules that will become tl:te bases for decision-making. The following are the most importan t points: ADVOCACY Listen to what each has to say. Points of agreeme nt can only be reached if there is an excl1ange of information. Take time to listen to people who voice different opinions or concerns. Keep an open mind. Try to identify points of unity from diverse opinions. Don't force organizations to give up their iden. tities. Remember, organizations work together for a common good. They do· not work together just so they can outdo each other. Advocacy work is one way the nurse can promote active community participation. The nurse helps the people attain optimal degree of independence in decision-making in asserting their rights to a safe and better community. Advocacy work in nursing has gone a long way from one who just acts on be]1alf or intercedes for the client to one who assists parties to understand eacb other so that agreement is reached (Stanhope and Lancaster, 1992). Today, tl1e nurse as an advocate places the client's rights as priority. She is responsible for providing mechani sms for people to participate in activities 237 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
tbot aim to improve the conditions of the commun ity. The nurse os an ndvocatc helps empower the people to mnke decisions and carry out actions that bave the potential lo better their lives. Advocacy work involves (Kohnke,. 1982): 1. In. formi ng the people about the rightness o. f clie cause. The nu1·se conveys the problem to the people, shows how it affects them and describes what possible net. ions they can take. 2. Tl101·ou9'1ly discussing with tlae people t'lw nalure of the alt'er11atiues, tlicir co11l'e111 arid possible consequences. While discussing the alternatives, the community's needs and problems are amplified and eventually become the basis for decision-making,. It is through this process that the nu1\5e and the people come to agree on the relevance and appropria teness of the actions to be taken to solve the problem. 3. Suppo,·ting peop Je'. s riglrt to make a clroiceand to act on thei1·choice. The nurse puts emphnsis on the people's right to decide on actions that they think should benefit the community. It is also the nurse's responsibi lity to facilitate the process of weighing the benefits and losses of the alternatives. 1N11ateve. r the outcome of the decisio11-making process, Lhe nurse assures the people that they do not have to change thei1· decisions because of others· objections or pressure. 4. I11jlue11ci11g public opinfon. The nurse affirms the decision made by the people by getting powerfu l indjviduals and groups to listen, support and make substantial changes to solve the problem. SUPERVISION Supervision is a developmental and enabling process whereby the nw-se supervisor ensures tlrnl work is done effectively and efficiently by the person (Morriss ey, 1970) being supervised and at the same time, keeps the person satisfied and motivated with his work. Supe,vis ion is also seen as a focilitating process that consists of inspecting and evaluating the work of another in order to remedy rather than punish poor perform:rnce (Gillias 1989). If the goal of community health nursing is community health and commm1 ity developmen t. it is necessary for the nurse to invest in training members of the community organization not only in Ll1e provision ofaclual health services but also i. n mnnngemcnl functions. In community-managed health programs, it is the intention t Jrnt the nurse will eventually hand over the management of the heallh program to the people and the organizatio n. \-Vhat are the objectives of supervision? Supervis ion is done in order to: identify t J1c superviso1y needs of the worker determine ways of meeting the needs of the worker develop the capability of the worker to solve own problems and meet own needs by providing continuing personal guidance and professional development evaluate t·heperformanceof the worker as it becomes the basis for providing help or guidance In communit y health nursing, supervision is seen more as a coaching (Gillies 1989) function ratherthan a function of control. This isso because tl1e intensity of supervision 238- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
can not be likened to institutions where the environm ent can be readily controlled and where the supervisor can expect a cert'ain a level of competence from the workers }laving more or less passed certain qualifying criteria for the positions. Tbis is quite different in the community where the workers have varying levels of cognitiv e and psycl1omotor capabilities not to mention their attitudes towards health work. In t J1e community, most of the supervisory functions of the nurse are dfrected towards lower Jevel health workers, thus, they will requfre closer supervi&ion than do professional health workers. In addition, supervision ·is not based on set ru]es or formula but 011 each supervisory situation. The nurse as a coach to health workers uses persuasion, exhortation and judicious mixture of reward and punishm ent to motivate the players toward hlgher levels of performance. She emphasizes group goals rather than fulfilling the needs an. d desires of individual group members. . A nursing supervisory plaa is a written document on how to organize and systematize supervisory activities. It includes objectives, strategies, resources and timetable of activities to meet the identified needs of the person being supervised. Generally, supervisory needs arise from: inadequat e skills, knowledge and attitude conflict between organizational and individual goals work and personal situation Jack of motivation Making a Supervisory Pion The following are tbe steps in making a supervisory plan (Public Health Nurse · Manual on Supervision, DOH): 1. The nurse conducts a situational analysis focusing on supervisory needs assessment. lnformaliou regarding supervisory needs of the workers can be taken from the following; Review of records and reports Observation of the person at work Interview of the wo-rker Interview of co-workers and clients of the worker in the community 2. Supervisory needs and problems may be prioriti;,:ed based on the following criteria: Degree of importance or urgency of the problem/need Activities/strategies needed to meet identified needs Availability of resources needed to meet identified need Magnitude and e:-. 'tent of the problem/need Time frame to carry out actions 3. Set objectives. 4. Select activities, strategies and resources needed to meet identified objectives. 5. Identify indicators for evaluation. Met the needs Perfo1·mance increased Improved quality of service 239 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Methods and Tools for Supervision 240. ·...... t11bd1 TOC111-1 ~ of r KOrds and reports ~dfomal s-nonal data sheet of the wo.-ker.. c Gent records performance evak Atton,. daily time record 1epo, ts 5t,jbm1tted,. ~hshment reports,. ... t Mget cilent list Actual observatl oi, of worker's Observation 1ulde in the form of: perlormance in V1trio\. ts situations: quemon nalre dinic checklist home visit.. conduct of lndlvldual or group das~ nursins conferenc e orgamzation/lmplementation of communltv projects and activities tndivldua Vsroup conferences and Anecdotal report m Ntinp Cfltfcal Incident report Performance evaluatfon form, Minute$ of meetings Manuals/handbooks Modules/ca$e studies Nursing audit Supenilsory logbook Conducting a Supervisory Visit 1. All super:isory,·isits must be pla. nned. The nurse reviews the outcomes and recommendatio ns of the previous visit and hosed on these; formulnt e u work pla. ti for the,;sit. If necessary, discuss the work plan with. other team members fol" collaboration. Determine \\!hat materials a I"e needed fol" the conduct of the supervisory visit. 2. The actual conduct of the visit is divided into three parts: a. Opening-The nurse creates a wann, open and friendly atmosphere. Discuss the objectives of the viisit, ell.-pected outcomes, the process and the time frame. b. Body-The nurse discusses the following points with the wo I"ker: Results and recommendations of the last visit. Actions token by the worker and the outcome of these actions New areas of concern of the health worker Actions to address concerns Review objectives and exlebt to which they were attained c. Closure-The nurse expresses appreciation and support extended during the visit. Togetl1er v..ith the worker, she plans for the subsequent visit. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
case Study Illustrating the Application of the Steps ;n Supervisory p/onn;ng Unda. a Public Hea Jlh Z--:ursc of Municipali ty o( Son. Ju:m. has fhe midwi. ve. < under her sopen-ision. They are :S:ona. '. \lildred. Letty. Celia.-. nd. Jane. \\'hile Linda was doing her annual e,:ahmlioo nf mi Jwhe-:. '<he fnund oul lhat their targets,...-ere not being met. She conducted ~uper,.,..,_ory visit~ to a II midh-ivc;; and found the fo Uo,~;ng : Sometimes. logii:tics and supplies come 1:He and in;id CQu ale: reqtii~tion not submitted on lime Target client lists. tall J i:h~ts/n. :portin J< fonn-. ;ind I nnlmrnt n-cord. " weru nol propedy filled up an J updo le<l. Reasons i,ti,-. ;n by the live midw1vcs nre the follo,dng: ",,Tong compurntion of 1ar,tct": don·, know updalc<l )!11ldeline-in target-set1. ing » inadequ ate reporting and n:cnrdin~ fonns 1) con fusion in lhe use of FH IS form » t. lifficult terrain affect Lhe perform:mn· of l"dia :ntll !Sonn » inadc..'Qutltc lv\S of Jnnc who ii-new in 1hc :,;l'n·in· Based on the above situation. l. indn makei-n plnn. Folln";ni lhc slrp~ in plannini. sht! identified the priority problem that is poor recnrdini: an J n·por1i11 g whii-11 is cnmmon to the five mid"ives under her supervi,-;ion. Poor ncordini: and n·1"1rtin~ an. · dt1L' to: \~Tong computa tion of t;irgets: they do n~,t h:w,· tlw u1xlak(l r. uidclincs in target-setting confusion in the new Fl:11S form inade. quate recording and reportin~ forms l\ sample supervisory plan is shown on Table 9. 1. ·n,c supcn·i~ory.-;trn tei;tics/ncth;ties are directed at achieving the identified learning objectives and the cvnluntion indicotors as learning outcome s in supervision. CASELOAD MANAGEMENT An important function of Lhe nurse in community selling is tu providl. ' health care services for groups of individuals with similar hcnlth prnhh. :ms ur comlitions. A caseload refers to the number of clients being served in a :::pcdtic pro~ram or sen'ice. Caseload manag ement differs from case mnnagcmcnl hccnusc it fuc LL-. cs on the common problems of aggregates or groups. Case mnnai:;emcnt is dircctl)d to the individual client. It takes into account lhe client":< characteristics and specific responses to its health condition from which the nur'<c huild-s her nursinµ. cnrc plan for. Caseload manageme nt however, is consistent with the epidcmiolo~ ic apprv:Jch bcc. 'luse olht::r than personal variables, it considers envirvrunental variable.., as important influences in the aggregate's vulnerability to certain disease conditions. The nurse therefore highlights in her plan of care variou. s intervention slrategics that will diminish lbe population group's vulnerabilities and in1prove t J1cir competencies in health care management. Caseload can be identified from the different health scn;ce registries of the henlth center. In the Ph Hippines, the Department of Hen Ith put emphns L, on several programs that need to be given attention to. Examples of these proi;rams that the nurse ca. n obtain a case load from are the National Tuberculosis l'rogram-Dire<:t Observed Treatment Short Course (NTP-DOTS), lategratcd Management of Childhood lllaess 241 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
242 I. I, (!MCI) and Matcrnnl and Child Health Programs. TD casc_s are in~portant focu of case load management as well as pregnant and nmlno~r1sl. 1ed children. Clien/ ,,;t11 cardiov;iscular di. seuses. dinbctcs or cancer nre becoming important case I s of the nurse because of the high mortality it brings in the comm11~ities. More::ds the disnbilitfos resulting from these conditions put II toll on the social and econor:: consequen<.-es in the r,opulntion. 1c 111e nurse us a casclood manager assesses the henllh status of _Lhe indiv:idua J cli :tnd determines their risk factors and variables-~:it lead to their vulnerability to e;;:s disease conditions. Aside from health risks ar1s111g ~rom personal or demogra 1 _c charocteristics, vulnerability issues among population groups consist of ha P_ lie limited control, powerlessness, disenfranchisement or alienation, victimization VIng o disadvantag<.-d status. More ofte I1, the risks that vulnerable populations run _and are genl. !rnlly 11ot voluntary or under their control. (Stru1hope and Lanca:;ter 1 into Anderson and Mc Farlanc. :woo) Peoplc-ore made to feel and believe that there'c 992; no hope for Lbem and as such. le. irn to just accept Lheir condition and depend on ~n ~e out from other people. rn this kind of situntion. the nurse must facilitate the P O e of having people to tn1st themselves and gain confidence in their ability to tranr~cess thcir present slate through community part:nerships. (Freire, 1997) 5 0nn r.,,u le S of _..... bl Nty Cone. pt Examples 1'2altfl r'illlcs Certain as~ of Special population sroups physiology, environme nt,. _ (lncludfng personal as age groups, indigenous people or low-income L habits, social anc:t physical. environment) make It more sroups llkely to CMVelop particular Infants, young children /:: health problems adolescents, elderly, '.. the_ homeless, medically Indigent, ethnic groups Umleed control Based on the health-. fteld Infants whose health status concept that describes depend on their mothers the lndlvfduals as sharing health management and c:ontn:>I and responsll,ility health seeking behavio rs; for their health status but people who can not access lfffll!ly affected by soc:fety, specific health services bfolotw, environment and because of poor financial health care system status ~, Umlted flnancl. al resources Poorly educated, low-puts Individuals to Income people dependent,-OS,ttonsand r,., l'llducas their ability to h, millce dlolces about their 02 l. lfranc:hrsement health FNllna of Hparatf C#I from Streetchlldren ; run-away mainstream society anslna from lade of social support· adolescents !4 may IMt. consecauence of ~ deviance diaplavec, by these people ;w,_■ty to fulfill IIQfpltlled aodaf rofes | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Vlctlmlz'atton Blaming the victim for are. 1s Impoverished people outside lndf Vldual control leading to limited access to services Disadvanta ged status Being 11'1 the rnlnorlt'( Hn,lts Indigenous groups; women the partrcipatlon of this people in health planning Source: Sta11hopt! and l!ancastu, 1992 The nurse develops and implements the plan of care in the conte. x-t of the above causes or sources of vulnerabil ities of her caseloaa. In addressing the specific need for health care treatment, the nurse focuses on care coordinat ion with other members of the health team depending on the actual or potential health and medical problem s of the caseload. [f several members of the health team will be involved, care coordination calls for a mechani sm for systematic follow-up or monitoring of the progress of c Uents under the caseload. Referral an<l follow-up to va1;ous community resources will be an integral part of cure coordination and allow the clients to access health services. In this regard, the nurse will be responsible for identifying resources that are available for the clients. Collaboration with other sectors or disciplin es in ca. re provision addresses the issues of vulnerability. As health advocates, nurses are ex-peeled to advance the interest of her clients for better health conditions by lobbying for healthy policies and delivery of quality health service. Although much· of the work to be done by the nurse as n caseload manager involves tl1e external environmen t, it is equally important to put emphasis on developing the competency of the clients in self-care and to facilitate behavior change. This can be carried out as group intervention wbe:re clients under the nurses caseload come together to learn specific skills related to their health care. The nurse can take this opportun ity for clients to cultivate and foster a supportive system among them. CONCLUSION Working with aggregates of people for sustaine d participation in health development work requires empowerment processes and competencies. The nursing interventions described in this chapter are a. imed at developi ng these competenc ies....,,;th the communit-y. The Primary Health Care Approach serves as the context of these interventions while community competence is seen as the ultimate goal of all these interventions. Health promotion as an approach is important mainly because it encompass es health education. Health education mainly focuses on individual behavior al change but health promotion believes that behavioral changes can be speeded \tp with environmental changei;; and reorientation of health care system. Jndividual behavioral changes coupled ·w:ith community organizing and mobilization facilitates Ll1c empowerment process. Bul nurses need lo ensure that the initial efforts will be sustainable. Sustainab ility is guaranteed through capability-buildi ng activities and proper supervisio n of l1calth workers who are ex7Jecte<l to monitor the different health activities in the com. munjty. From time to time, the commu1tity \vill need to lobby for support from other people in their effort to address their health concerns. Issues of vulnerabi lity limit certain groups of people to access health services. For this reason, the nurse must teach them how the process of advocacy, partnership and collaborat ion work to improve their health status. 243 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
i t g_ S°· &> ij, ~ " ~ "' t I.,,_,.,.,.,u, Poo, rtpartlng/reco1dl~g dutto· L wrona aimpum!on of llflel,: don't h~ an updo!td CUiatllllt for ia,aeuetvnc b, confusion In the use of ne,, FHISf Of'l!'I c. ln Jdequ,te logistics/11Jp plie,..--TABLE 9. ~ SAMPLE SUPf RVISORY-Pl AN. "'......,....... ~ 3,.,.,,...,f E$]Ac: "'"'-TA1111" TIM£ fl!AMl INOICATUll3 ~ rr,ldwl<le J will I,,, able t CI. a. compute tatl'ls evercne on compur~ilon of lllrccts b. i"d on $Rur1I 3 hou1s dutti,a Mldwl'tf S compute targets COrtec(IV based OIi upaotcd gufdi!llnt5 tlt. alth Saturd. ly correctly le>r dlf~nt Pf01'3ffl$ updated auldtllnfl Ml~lvi'l mte. ting ~ on 1111dated gvld~ln M follow up during supc,vlsory Ylslt b. we-lid l\ll,up the 011t111slon on the purpme~; objectives of the S ~ur. 11 Health 3 hours Mldwl'les l(tompllsh f HIS forms FHIS torm pn,perly IIIIW FHIS form Midwives during SGI\Uday a Ct11rite!r mtetlng Eitercisn on the procedurelor fil\in R up FHIS form Follow-up durlng 1upervlsory visit c. r@q Utst loglstlcs/ supplle$ Olstl/S. SIQn on the lrnportante of wbmit1ing S Rttral Health 3 hours during Midwlve5 deroo11Stfite proper on time 11!Q. Ulsltlon ol l01isflts/ ~uppll~ifn lime Midwives satunlay filllng-up of rtqulsltlon fortn S meeting berciseson howto fll\-up requ1$1tlon forn\5 Fa Dow LIP during supervlsof'/ Visit . Demonstratlon and exercises Qnhow Ii> S Rural Health 3 hours during Midwives submit requisition or d. keep inventory of sel ui,,an· updated monitoring system for Midwives Saturday logistics andsupplles on ttmc. stotks up 10 <late inventorv of stotks meeting Mldwlves show updated . follow-up during wpervisoryvisil inventorv of stocks. ~Adapted from the Department of Health. (199. 4). Resource Manual for the Public Health If urse on Supervision. ' | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1. 2. 3. REFERENCES Abad, Y. et al (2007). Community Diagnosis and Program Plan of Barangay Balinacon, Nagcal"lan, Laguna. (Unpublished Community Diagnosis. ) University of the Philippines College of Nursing Andamo, GP. (March, 1986). Community Organizing in Health. Paper presented in ACHAN Conference on Social Mobilization. Billings, D (1998) Teaching in Nursing: A Guide for Faculi:IJ, Philadelphia. Saunders 4. Departme nt of Health. (1994). Resource Manual for the Public Health Nu,-se on Supervision. Manila, Philippines: DOH. 5. Gale. a, G. (2001). Integrated NCD Preuentio11 and Control:D emonstration P,·ojects. World Health Organization-Western Pacific Regional Ofnce. Manila. Philippines 6. Gillies, DA. (1989). Nursing Management: A Systenw Approach. 2nd edition. Pltiladelphia: W. B. Saunders Co. Harcourt Brace Jovanovich, Inc. 7. Integrated Commu nity Health Services Project-Aus Aid Assisted (ICHSP-AA) (2000). Community Health Development: A Resource Handbook. 4h Floor Philippi ne Tuberculosis Society Bldg., Tayuman cor. Rizal Avenue, Sta. Cruz, Manila. · 8. Kemp,. TE (1971) lnslructional Design: A Planfor Unit and Cour·se Development, Fearon Publishers, California. · 9. IGng, H. et al (2008) Competency-based Vital Signs, Height and Weight Tnki11g. (Unpublished research). University of the Philippines Manila. 10. Kolmke MF. (1982). Advocacy Risk a!ld Realii'y. St. Louis: The CV Mosby Co. 11. Maglaya,A., et. al (Eds). (2006). Competency-Based BSNCurriculum. Manila: University of the Philippines Manila College of Nursing 12. Manalili, AG. (1985). Community Organizing: Towards People's Developme nt. Training and Enhancement Program Reader for Land Bank of the Philippines. 13. Morrissey, G. (. 1970). Management by Objectives and Results. Reading, Massachusetts: Addison-Wesley, p. 105. 14. Schweer, J and Gebbie, K. (1976) Creative Teaching in Clinical Nursing. The CV Mosby Company. St Louis. 15. Stanhope, M and Lancaster, J. (1992). Community Health Nttrsirig: Process and Practice Jo,-Promoting Health. 3nl edition. St. Louis: Mosby Year Book. 16. Sullivan, R. (1995). The Competency-Based Approach to Training. USA: U. S. Agency for International Development. 245 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
246 17. T11a Y. on, J., Dones, LRP., Bonito, SR. (2003) A Tl'ai11ing Ma!1ualfor He Wor-kers on Promoting Healthy Lifestyles. UP Co Jlcgo of Nursmg-Dep nrtmalth of HC31th-Wor1d Health Organization ent 18. World Hcnlth Organization. (August-September 1978). The Declaration Almo Ala. World Health. of J 9. World He:ilth Organization (1998). Regional Pla11for Integrated f',·eue. and Cardiouascular Diseases and Diabetes for tire \1\/estem Pacific R 11 ti_0 n 1998-2003. \"1orld Health Organi7. ation. Regional Office for lhe w egion Pacific Manila, Philippines estern | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
chapter 10 ·LOGIC TREES FOR SAFE MOTHERHOOD AND WELL-BABY CARE Ma. Corazon S. Maglay a and Araceli S. Maglaya INTRODUCTION Maternal and pediatric population groups comprise sixty percent (60%) or more of the total population of most communities. With emphasis on safe moth. erhood and well-child care, the rural health nurse or the nurse practitioner can be guided in handling mothers and babies as population groups using logic trees OD prenatal supervis ion, home delivery, postpartum care and well-baby care. The use of assessm ·ent and management protocols on safe motherhood and well baby supervision are critical options for improving access to quality health service and nursing care specially on enhancing wellness and improving competencies for handling population aggregates. THE USE OF LOGIC TREES Assessment and management protocols for safe motherhood and well-baby care have been developed by the authors based OD a long experience in general medical and episodic nu1·sing practice in the community. Each protocol focuses on a specific complaint, history or physical assessment data or a set of signs and symptoms. The assessment protocol specifies the appropriate history, physical examinatio n findings and other pertinen t data. These hea Jth assessment data are classified under red, yellow or green categories. The management protocol indicates el\-p]ic. it interventions to handle the case or situation, classified as Plan A, Plan B, Plan C or Plan D depending upon specific combination/s of red, yellow, or green health assessment data. The pi:otocol includes branching logic so that the assessmen t data obtained from a given patient or case and the appropriate management are "individualized" according to the patient's signs, symptoms or experiences. This chapter includes Logic Tree protocols on pregnancy, home delivery, postpartum, newborn and well-baby care. 247 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1 248 ASSESSMENT PROTOCOL FOR INITIAL PRE-NATAL CHECK-UP (Logic Tree No. 28) DIRECTION : Determine/identify whlch of the fol1owing symptoms/signs (S/S) or history data O-Lx D) are present and follow the Oowchart for the appropriate plan of management. RED YELLOW GREEN S/S or Hx D 5/S or Hx D S/S or Hx D Vaginal bleeding (even Continuous pregnancy LMP or quickening is if minimal only) (I. e., patient did known especially if there not have any Slight nausea and/or Is no associated menstruation from vomiting abdominal pain the time of the last Frequent but non- Abdominal pain, delivery until onset painful urination especially If In the of this pregnancy) durins the first few lower part of the LMP or quickening is weeks of pregnancy abdomen not known or during the later Sudden release of fluid Patient has been part of it from the vagina pregnant for at Difficulty of breathing Blurring of vision least five times or is during the last three Persistent and/or severe pregnant for the first months of pregnancy headache time Leg cram P,s during the Difficulty of breathing Complications during later months of I during the first six the previous pregnancy months of pregnancy pregnancy (like Increase in non-foul or If it occurs in hypertension, smelling mucoid patient with heart bleeding, excessive· vaginal discharge problem vomiting, etc. ). : Fetal movement still Blood pressure higher Persistent and/or present (may even be than the pre-excessive nausea increasing in number pregnant BP and/or vomiting and quality) in a Nostrils spreading out Chills pregnancy with AOG with each breath Cough and/or colds of at least 20 weeks Patient in pain Diarrhea or Patient's blood pressure Swelling of the hands constipation within normal limits Swelling of the face Painful urination based on her BP especially around the Itchiness of the vaginal before she became eyes area pregnant Marked swelling of the Foul smefling vaginal Patient is not in pain legs and feet specially discharg e Weight within normal du ring the first six Patient has heart range based on her months of pregnancy problem li'ke weight before she Fetal heart rate less than rheumatic fever 120 beats per minute Patient has other or more than 160 medical problems. beats per minute (like diabetes. hypertension, tuberculosis, | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
RED YELLOW GREEN ~ s/S or Hx D S/S or Hx D S/S or Hx D i..-----:: regoancv with AOG of goiter. etc. ). becam., pregnant and her.. it'I a :i least 16 weeks. Fetal movement has stopped AOG f tal heart beat or has decreased In Fundlc h"lght within the NO e d I number and/or in quality expected limit based on-3ppreclate n " noncv with AOG of at Weight is more than what the AOG preg ls expected based on Head of the fetus Is occupying least 16 weeks her weight before she the lower portion of the became pr.,enant and womb while the buttocks AOG occupy the upper portion Temper. iture of 37. S c and in a pregnancy with AOG above of at l~ast 20 weeks. Pale lips, nail beds and/ Only one fct DI heartbeat Is or inner aspect of the appreciat ed in a pregn:,ncy eyelids with AOG ol at least 16. Ear discharge weeks Runny nos~ Slight swellins of the feet BP higher than her u,uat during the few weeks of BP before,he become pregnancy pregnant o·r BP ol 140/90 Whistling or noisy sound when the patient breathes Another ilbdominal mass aside from the g. rowing womb Fundlc height lllgher than what Is expected based on AOG. Head is occupyln Q the upper portion of the womb white the bu·ttocks occupies the lower port1on (breech or "suhi") or head Is occupying either the left or right side (baby is in lhe transverse position} In a ~regnan,v with AOG of at leart 24 weeks More than one fetal.. heartbear·can be henrd In a pregnacv wilh AOG of. at least 16 weeks: . . ... . L 249- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2:50 at least one RED s/s or Hx D at least one YELLOW s/s or Hx D at least one GREEN s/s or Hx D Proceed with Plan C Proceed with Plan B Proceed with Plan A | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
PLANA: MANAGEMENT PROTOCOL FOR INITIAL PRE-NATAL CHECK-UP (Flowchart No. 28) 1. o Dcternune patient's knowledge on bow to take care of herself during pregnancy. 2. 0 Based on 1. 0, teach the patient about proper nutrition. 2. 1-Importan ce of well-balanced, good and nutritious meals (e. g., food sources of iron and p.-otein for hemoglobin production). 2. 2 Stress the inclusion of proper nutrition in pregnam.-y (e. g., inci:eased intake of food sources of minerals like calcium for fetal bone developm ent; avoid high intake of sugar and salt). 3. 0 Based on 1. 0, advise tl,e patient to have enough rest and s1eep and to perform prenatal exercises to prevent or n1inimize discomforts like low back pain and to learn the proper breathing and "bearing down" techniques (start at last trimester for "bearing dowu" exer~-:ises). 4. 0 Advise the patient to take a bath daily and to have daily bowel movement. 5. 0 Advise her to stop smol<lng, drinking alcoholic beverage, and not to take just any over-the-counter me<licine or herbal medicine unless prescribed by the doctor. 6. o Advise the patient to use proper clothing: 6. 1 Use comfortab le, loose titting clothes. 6. 2 Avoid usin?;tig ht brassieres, garter belts or "bigkis". 6. 3 Use low-hee1e d comfortab le shoes. 7. 0 Advise the patient to do the following to relieve minor discomforts in pregnancy. 7. 1 Por nausen nnd vomiting (morning sickness): 7. 1. 1. 1 fave a light bre;,kfast (crackers, unbuttered toasted bread, etc. ) 7. _1. 2. Eat sm:ill frequent meals (around five to six times a day) instead of three full meals, if tl1e symptom occurs later in the day. 7. 1. 3. Avoid fatty or oily foods. 7. 2 For ''he:u·thum.. : 7. 2. 1. Hove small frequent mca1s. 7. 2. 2-. no not lie do"''" immedia tely after eating. 7. 3 For co11stipatio11: 7. 3. 1 Increase fluid intake preferably in the form of milk, soup or juice. 7. :;. 2 Eat plenty ofvcgetables and raw fruits especially ripe p:apaya. 7-4 For varicosit;i es and hemorrhoids: 7. 4.-1. Raise or elevate the legs at least twice a day. 7. 4. 2. When lying down. lie sideways (either left or right side) with the top leg forw;u·d thus placi_ng the weight of the baby on the bed. 7. 4. 3. Do leg raising exercises. 7. 4-4. Do not stny in one position for a long time. 7. 4. 5. Use support or eh1s Hc stocking5, if necessary, for varicose veins. 7-4. 6. Do knee-chest position if there are hemorrhoids. 7. 5 For incre<1sed non-fo U-1 smelling mucoid vaginal discharge: 7. 5. 1. Take a bath daily. 7. 5. 2. Wash genital area frequently using mild soap and water or with 251 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
252 one tablespoon Del ~Jonte vinegar mixed with 1/2 "tabo'' lukewarm water. 7. 6 For shortness of breath dw-ing the last three months of pregnancy (patient lrns no history or heart problem): 7. 6. 1. Advise patient to asswne a semi-sitting position with tbe back we. l J supported by pino·ws instead of lying flat. 7. 6. 2. Discourage patient from using "bigkis". 7. 7 For crnmps: 7. 7. 1. Rub or gently miissage the affected part. 7. 7. ::!.. Elevatc the feet often. 7. 7. 3. Keep the extremitjes warm. 7. 7. 4. Tnkc milk. 7. S For swelling of the lower extremities: 7. 8. 1. Rest frequently witl1 the legs elevated. lf an activity can he done while sitting down. :,it down "md don·t do it while standing 01· squatting. 7. S. 2.,"'11eoever possible, elevate the legs. 8. o If the patient asks about sexual intercottrse, ·inform her that it is pern1issible but it is advi:,;ed to avoid such an activity daring the last two months of pregnancy lo reduce the chances of premature delivery. 9. 0 Give/prescribe over-the-counter multivitamin and iron preparation especially if lhe AOG is 1uore than 12 weeks. 9. i Give/prescribe iron preparation, specifying accurately the dose and frequency of the intake. 9. 1. 1. Advise lhe patient to take the medicine after meals. 9. 1. 2. Givc nn iron preparation that has Folic Acid especially during the first three months of pregnancy. 9. 2 Give/prescribe multivitamin preparation aside from the iron preparatio n. Specify uc:c:urately the dose and frequency of intake. 10. 0 Advise the patient to have a re. gu]arpre-natal check-up using the following PLAN B: schedule : o lo 28 weeks : once a month 29 to 35 weeks : once every two weeks 36 to 40 weeks : once a week The patient can have a more frequent check-up if there are problems. 1. 0 Refor the patient to a doctor within 24 to 48 hours. 2. 0 Determine patient's knowledge on supportive management of the problems presented. 3. 0 Based on 2. 0, do the following supportive managem ent: 3. 1. If there is fever: 3. 1. 1. Give/prescribe over-the-counter medicine for fever, preferably a purely paracetamol preparation, specifying accw·ately the dose and frequency of the intake. a. lfthe pa. tient is allergic to the substance mentioned above, give/ presc1ibe a purely aspirin preparation. b. Advise the patient to take the medicine on a full stomach. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. 3. 3. 4. 3. 5. 3. 9. 3. 1. 2. Advice patient to take a quick bath using lukewarm water. If there is cough, colds, and/or runny nose, advise lhe patient to: 3. 2. 1. lncrease fluid intake (at least eight glasses a day) in lhe form of juice, soup. milk, etc. 3. 2. 2. Have steam inh,1lation fo1· 15 minutes t,vo to three timr_<; a cl.,y. 3. 2. 3. Gargle warm salt solution if she has a sore throat. Tf there is excessive vomitinp. n ud/nr nausea: 3. 3. 1. Give/prescribe over-the-counter medicin e for nausea or vomiting. or herh:11 medicine for dizziness. specifying nccnrntcly the method of prcparntio n (specifa:ully fo1· herbal medicine), tlw dose nnd frequency of intake. Advise patient that the medicine could nrnke her sleepy. 3. 3. 2. Ad,'ise the patient to do the following: a. Eat 11 light breakfast only. b. Tnke small frequent meals instead of tlcree f-t,11 onc. c;. c. Avoid fatty or oily foods. 1f there is diarrhea : 3. 4. 1. Advise p:1tientto drink ornl rehydration solution. 3. 4. 2. Give/prescribe herbnl medicine for dinn·hea. specifying accta·alcly the method of prepara. tion. the dose and frequency of intake. 3-4. 3. Advise the patient to avoid fatty foods. 3-4. 4. Advise pati1. ml to eat b-anana (latundan), apple or star apple. If there is corn,tipation. advise to: 3. 5. 1. Drink plenty of fluids. 3. 5. 2. Eat plenty oflenfyvegetobles,e. g., kangkong/sayo tc tops, maluni:;g: 1y 3. 5. 3. 3. 5-4. and alugbati. Eat fresh fru. it like dpe papaya. Avoid eating banana (especially the latundan variety), apple or star apple. If there is itchines s of the vaginal area and/or foul-smelling vaginal discharge, advise the patient to take a batll daily and to wa~h her genital area frequently, using one tablespoon Del Monte vinegar mixed "'ith 1/2 "tabo~ lukewann ·water. If there is painful urination, advise patient to drink plenty of fluids (at least eight glasses) especinlly buko juice. If there is ear discharg"l, adv:ise patient to cleru1 her ears with hydrogen peroxide daily and to dry it well aften-vards. Advise the patient to see the doctor as soon as possible and not to wait until the following day if there are other medical problems (like diabetes, goi. tcr, hypertension, heart prohlem ), surgi. c:il problem (like another nbdominal mass other tlrnn the gro.,;ng womb) or obsteb;cal problem (like the b<1by has stopped moving or fundic height is higher than e.-xpected or weight is greater than expected). 4. 0 Based on 2. 0, teach/advise the patient on the proper pre-natal care (see sections 2. 0 to 6. o of PLAN A of this Logic Tree): 4. 1. Proper nutrition · 4. 2. Proper clothing and personal cleanliness and bowel habits. 4. 3. Stop smoking and drinking alcoholic drinks. 4. 4. Consult a doctor before taking any medicine. 5. 0 Based on 2. 0, give/prescr ibe over-the-countecmu ltivitamins and iron preparation for pregnant women, specifying accurately the dose and frequency of intake. 253 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
6. o Pro'-;de the doctor to whom the pa~e~t is be!ng referred to :-vith appropna. clinical record or referral note crmtammg a bnef history, physical examin. tc tinclings laboralorv results (if available) and managcm. ent started at the re~eut~on · · ',, rr11 level (See Figure 3 of Chapter 3 for a sample referral form). 1 g PLAN C: 1. 0 2. 0 5. 0 254 Refer the patient immediately to a hospita l (preferabl y the nearest one). Keep the patient calm. Make the patient lie do,,.,"Il quietly. If the patient has djfficulty of breathing, place ber in a semi-sitting position. her back well supported by pillows. 'v1 th P~o~de the hospital where the pati. ~~t is being r~ferred to with appro ri. chmcal record or refenal note contaming a bnef history, physical e.-... :am J ti ate findings, laboratory res U-lts (if available) and management started at the refe~ 00 level (See Figure 3. 2 of Chapter 3 for a sample referral fonn)..., tlg | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT !PROTOCOL FOR FOLLOW-UP PRE-NATAL CHECK UP (Logic Tree No. 29) DIRECTION: Determine/identify whlch of the following symptom s/signs (S/S) or history data (Hx D) are present and follow the flowchart for the appropriate plan of management. RED S/S or Hx D Vaginal bleeding even if spotting only specially if there is no associated abdominal pain Abdomin al pain especially if severe and/or in the lower part of the abdomen Sudden release of fluid from the vagina Blurring of vision Perststent and/or severe headache Difficulty of breathing during the first six months of pregnancy or it occurs in a patient with a known heart problem Swelling of the face especially upon waking up Swelling of the hands Systolic Pressure of 160 mm mercury and above or Diastolic Pressure of 100 mm mercury and above No fetal heart rate in a pregnancy with AOG of at least 16 weeks Fetal heart rate less than 120 beats per minute or more than 160 beats per minute YELLOW S/S or HXO Persistent and/or excessive nausea and/or vomiting Chills Ear discharge Cough and/or colds Diarrhea or constipation Painful urination Itchiness of the vaginal area Foul smelling vaginal discharge Fetal movement has stopped or has decreased In number and/or In quality Fetal movement has not been felt and the AOG is at least 20 weeks Weight gain of 5 lbs. (or 2. 25 kilos) per week or higher or less than one pound (400 grams) a week in pregnan cy with more than 12 weeks AOG Fundlc height higher or lower than what Is expected based on AOG Head, back or arms occupying the top or upper part of the fundus GREEN S/S or Hx D Slfght. nausea and/or vomiting Frequent but non-painful urination during the first few weeks of pregnancy or during the last few weeks of the pregnancy Difficulty of breathing during the last three months of pregnancy Leg cramps during the later months of pregnancy Increased non-foul smelling mucoid vaginal discharge Regular fetal movements if AOG is at least 20 weeks Weight gain of 75 grams (0. 1 lbs. ) per week during the first three months and 400 grams (1 lb. ) per week during the remaining months Patient's blood pressure within normal llmlts based on her previous blood pressure readings Fundic height within the expected llmlt based on AOG Head is occupying the 255 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
RED YELLOW GREEN S/S or Hx D S/5 or Hx D S/S or Hxo-- Marked swclllnc of the More than one fetal lower portion of th;--legs and feel during heart beat is noted womb whil. :e the the first six months in pregnancy with buttocks occupy the of the preg11ancy more than 20 weeks upper portion Nostrils spread out with AOG Only one fetal heart each breath Another abdominal beat appreciated mass ;:islde from the Fetal heart rate of growing womb is felt 120-140 beats per Pale lips. nailbeds and/ minute or inner nspect of Slight swelling of the the eyelids feet during the last Runny nose three months of Whistling or noisy pregnancy sound when t·he patient breathes Temperature of 37. 5 c and above lncrenslng trend in the BP reading based on previou s visits -. . 256 .., | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
-Pregnancy at least one RED s/s or Hx D !"" at least one YEI. I. OW s/s or Hx D No at least one GREEN LOGIC TREE FLOW CHART NO. 29 I Yes ~ Yes s/sor Hx O J -· ~ Proceed with Plan C Proceed with Plan 13 Proceed with Plan A 257 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2S8 PLANA: MANAGEMENT PROTOCOL FOR FOLLOW-UP PRE-NATAL CHECK-UP (Flowchart No. 29) 1. 0 Advise the patient to continue her multivitamins and iron supplements. 2. 0 Remind the patient about the importan ce of proper nutrition, persona l hygiene, taking enough rest, using the right kind of clothing and the importan ce of exercise. Advise the patient to do the following to relieve the minor discomforts of pregnancy: 3. 1. For nausea and/or vomiting ("morning sickness"): 3. 1. 1. Have a light breakfast. 3. 1. 2. Eat small frequent meals instead of three full meals, if the nausea/ vomiting occurs later in ithe day. 3. 1. 3. Avoid fatty foods. 3. 2. FOi:· "heartburn": 3. 2. 1. Have small frequent meals. 3. 2. 2. Do not lie down immediately after eating. 3,3. For constipation: 3. 3. 1. Drink plenly offlujds. 3. 3. 2. Eat plenty of leafy vegetab les and raw fruits especially ripe papaya. 3. 3. 3. Avoid eating banana (especially the latundan variety), apple or sta T apple. 3-4-For varicosities and hemorrhoids: 3. 4. 1. Do not stand or stay in one position for a 1011g time. 3. 4. 2. Whenever possible, sit down and elevat~ the legs for at least five 3. 4. 3. 3. 4. 4. 3-4-S-minutes. Do leg raising exercises. Use support or elastic stockings, if necessary. When lying down, lie sideways (either left or right side) with the top leg forward thereby placing the baby's weight on the bed. 3. 4. 6. Do knee-chest position if there are hemorrhoids. 3. 5. For increased non-foul smelling mucoid vaginal discharge: 3. 5. 1. Take a balh dailv. 3. 5. 2. Wash tl1e genitltl area frequently,,.,ith soap and water or with one tablespoon Del Monte vinegar mixed with 1/2 utabo" lukewarm water. 3. 6. For shortness of breathing during the last tlnee months of pregnancy: 3. 6. 1. Assume a semi-sitt ing position with the back well supported by pillows. 3,6. 2. Discourage the patie. nl from wearing "biglds~. 3-7-For leg cramps: 3. 7. 1. Rub or massage the affecte_d area gently. 3. 7. 2. Elevate the feel often. 3-7-3, Keep the leg ·warm. 3·8· For swelli11g of the legs: 3. 8. 1. Rest frnquently. 3. 8. 2. If an activity can be done while sitting down, sil down. md don't do ,...._ _____________ _ = | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. 8. 3. it whil~ standing or squatting, Whenever possible, elevate the legs. 4. 0 Advise patient to prepare the haby"s things as soon as possible. 5. 0 Encourage the patient tq have regular pre-natal check-up. 6. o Do home visit if patient fails to return for follow-up. PLAN B: 1. 0 Refer the patient to a doctor within 24 to 48 hou_rs. 2. 0 Advise patient to continue taking multivitamins and iron supplement. 3. 0 Encourage the patient to follow the advice given during the :fitst visit, especial1y those pertaining to personal cleanliness, proper nutrition and exercises. 4. 0 For the supportive ma. n. agement of the problems presented, follow the instruction given in Plan B of the Managemen t Protocol for Initial Pre-natal check-up (Logic Tree Flowchart #28). 5. 0 Pi:ovide the doctor to whom the patient is being referred to with the appropriate record or referral note containing tl1e briefhistory, physical examination findings, laboratory results (if available) and management started at the referring level. PLAN C: 1. 0 Refer the patient iinmediately to a hospital (preferab ly the nearest one). 2. 0 Keep the patient and her companion calm. 3. 0 Make the patient lie down quietly. 4. 0 If she has difficulty breathing, place the patient in a semi-sitting position with her back well supported. 5. 0 Provide the hospital where the patient is being referred to with the appropriate clinical record or referral note containing a brief history, physical examination findings, laboratory results (if available) and management started at the referring level. 259 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR HOME DELIVERY (Logic Tree No. 30)· DIRECTION: Determine/identify which of the following symptoms/s igns (S/S) or history data CHx D) are present and fo11ow the flowcb. art for the app·ropriate plan of managemenl. RED YELLOW GREEN S/S or Hx D S/S or Hx D S/S or Hx D Severe and persistent AOG Is less tham 38 weeks or AOG is 38 to 42 weeks head:>che, dizziness. more than ti2 weeks.. course of pregnancy has been .. 81LJrtinc: of vision.. Suspicion of mulliple uneventfu l (I. e., there has swelling of the face and pregnanc:y been no problem) finger~ or convul-s1on History of' previious. Previous precnancjcs were at any time durina the complicc1 ·ted delivery uncomplicated course of the pregnancy Hist·ory of al least one. Patient is 1n good health Vaginal bleeding, <peclally c;,c. sarlan section. Physlcal e><amln. ition finding lf painless, a1 any point Patient is givine bir-th for the within normal limits during the course or first time No ramily history of multiple pn~gnitncv eoby Is in a breed, posilion pregnancies Rupture of b~S or water. Fetal hean beat less than Baby In cephalic position before labor pains 120/min or more than. Fetal heart beat t20 160/mln started 160/min No problem during the first Either sys. tollc or diastolic. Patient's gene rel c:ondition. staee of h1hor blood pres<Ur G Is higher Is poor No core coll than pre-pregnant state Baby cded spontarieously or 1-r this not known, BP of. Placenta came out within 15 more than 140/90 rninute. s. Baby In a horl2on1al position. No l3cerat1on ob~erved Patient has heart problem Placen~ is complete Cord came out fir~t Womb ls well contracted Labor more t h. sn 24 houn Very minima l bleeding after without anvorogras s. the third st:igc of iabor Plac. enta not delivere d within 15 minutes. after birth of. the baby. Exccs!ii,. ;,c bleeding. :ifter birth of the baby. Laceration s·ecn on lnspec. tfon or the-perinea I nrea , Parts or the placenta still In the womb as suggested by profuse bleeding a her delivery of thee pt. acenta Of by incumplete plnccnla on ln~pectfon Sl,gn~ and s-vmpto,n s of shock Uler\JS doc~n·t 5-l JY c-ontr. ac. ted 260 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I . LOGIC TREE FLOW CHART NO. 30 Labor Pains at least one RED s/s or Hx D at least one YELLOW s/s or Hxo l o ot least one GREEN s/s or Hx D Yes Yes : 1. Give the mother son1ti,,ourlsh. I No mant then tct her slcco; 2. Attend to the baby; 3. Givo after core instructions. 4. Register the baby's birth or instruct the famlly 10 do it. Proceed with Plan 8 Yes there is still time to bring patient to the hospital Proceed with Plan A Yes 1. At lease one RED s/s or HD has developed durinr. tht-de Uvt!'ry or inirncdiately after 2, More thon one baby Wi)$ born (twins. lrlpleu. &tc) 3. Baby IS premature (AOG less than 36 week) 261 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
262 MANAG EMENT PROTOCOL FOR HOME DELIVERY (Flowchart No. 30) PLAN A: l. O Do the following during the first stage of labor (from onset of true labor pain. until the cervix is ful Jy open): s J. J. Advise Lhe pat. il:!1ll not to bear down during this stage. 1. 2. Do not give the patient a heavy mea J. 1. 2. 1. If possible, do not give the patient anyt)1ing by mouth until after the delivery. 1. 2. 2. If she is hungry, a glass of milk and/or some cookies could be given. 1. 3. Keep the patient calm. 1-4. Prepare the work are:1. 1. 4. 1. Choose an area in the home which would provide enough privacy und comfort for hoth the patient and health personne l. a. If a room is not available, an area can be sealed off by draping a dean bed sheet or blanket over a chair thus tlie blanket acts as a curtain. J. 4. 2. Wash yom: hands with soap and water and dry them using the clean hand towel in the delivery kit. 1. 43. Place the following things for the baby in one part of the working area: a. clean clr Hh to dry the baby b. baby's bhmket and bonnet c. pack of cotton bulls d. 70% alcohol e. bowl of warm watc,· f. one cord dressing pack g. abdomin al binders h. diaper i. large safety pins j. sando or camisa Place the following things for the mother: 1-4. 4. a. Put at the bead part of the patient a change of clothing Oike a housccfress). b. Place the following at U1e foot of the patient (if plastic lining is available, spread it out and place these things on it): a pair of sharp scissors or blade soaked in 70% alcohol. O bowl with warm previously boiled water bowl for the placenta ("inunan") D one pack of umbilical ties O one pack of cotton balls O paper waste basket 0 diaper c. Improvise a pad: wrap any of the fol]owing in a clean cloth: old newspapers, clean rags and/or old clothes. d. If another plastic linfog is available, place the improvised pad on top of it. e. Place the pad (with or without the plastic lining) under the patient's buttocks. With a brosh, scrub your bands with soap and rinse with warm previously boiled water using the pouring method (that is, ask someone to pour wate~ | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2. 0 J. 6. 1. 7. over yom· haods). If available, use an apron. If true labor pains have just started, adv. ise the patient to urinate since a full bladder may delay progress of labor. lf sterile gloves are available, do an internal exam and determine how wide the opening of the cervix is. Do the following during the second stage oflabor (from complete opening of the cervb, up to the birth of the baby): 2. 1. lfyou arrive during tl1is stage, do the following: 2. 1. 1. Wash hanlls willi soap and warm, previously boiled water. using the pouring method for rinsing. 2. 1. 2. Spread on the working area at least the following thiogs or ask somebody to spread tbem out while you assist in the delive. ry of the baby: a. dean cloth tu dry the baby, blanket and bonnet h. :. i pai 1· of scissors or a blade soaked in 70% alcolwl c. :. howl or bnsin with warm previously boil<. :<l water d. basin for the placenta c. lwo sterile 11mbilical clamps 01· cord tics f. pack of cotton balls )!.. p:qwr waste bnskct h dc:,n rl1JI h 1r, s11pport Lhe perineum ., d1nt1i:?,c of clo1·hing for I he mother 2. 2. Clean the perinea] area of the palient using cot1:on balls and warm water every time fecal material comes out when the patient bears down. 2. 3. Wear a pair of sterile gloves. Make sure to change the· gloves if it gets in contact with any fecal material. 2-4. Instruct the patient to bear down properly. 2. 6. 2. 4. 1.. Mouth must be closed and the force directed to the perinea) 2. 4. 2. 2. 4. 3. 2-4. 4. area. Bearing down must be done only while the womb is contracting. Patient must rest between contractions. Patient must continuously bear down during the whole time the uterus is contracting. Watch for ruphue of the bag of water and wait for the crowning of the baby's bead. Support the area just below the opening of the birtl1 canal with the palm of the hand (either left or right) using a piece of clean cloth or diaper as lining. Deliver the baby's head: 2. 7. 1. Extend the baby's head up gently to prevent it from getting io contact with the anus. 2. 7. 2. As soon as the baby"s head comes out, pass the fingers of one hand to the baby's neck to check if there is one or more coils of the umbilical cord, support the baby's l,ead with the other hand. 2..7. 3. If there i. s a cord coiled around the neck, do the following: a. If the coil is loose, slip it over the bead. b. If the coil is tight or not loose enough to slip over the head, quickly tie the co;rd twice (the ties should be around one inch apart), then cut the cord bel:\'lleen the two ties; deliver the baby promptly. 2. 7. 4. Instruct the patient to stop bearing down and breathe thrn the mouth after the baby's head bas been delivered. 263 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
264 3 2. 8. 2. 10. 2. U 2. 12 2. 13 3. 3. 3. 4. 3. 5. ::?. 7. 5. \\;ipe tl1e baby's face with a dry piece of cloth (or with your hands) to remove I. be l,lood :1nd/or mucus which might be covering the baby's face. Deliver the baby's shoulder : 2. 8. 1. Gr,1sp the head with both bands. 2. 8. 2. Apply a gentle downwa rd pull until one shoulder is delivered. 2. 8. 3. Apply a gentle upward pull to deliver the other shoulder. \Vith the left haod (or right band if you are left banded) support the l,aby's body as it goes out. With the other hand. grasp the baby's legs as soon as they come out. Place the middle finger between the ankles to prevent the baby from fa Uing. Dry th: skin oftb: newborn ";·tl1in 30 seconds of birth. Stimulate the baby to cry 1f he doesn t do so spontaneously. \Vithin the 1irst 60 seconds, pl. ice Lbe baby in a prone position on the mother·s chest. Co\'er his bac. k with a clean dry blanket and his head with a clean dry bonnet. · V\lil h in 3 111 i uu l{'S, after the un1bilical pulsation has stopped, clamp tbe cord: cm from the base ifit has not yel been cul yel. Place another clamp S cm trom the base and cut the con. I between the two clamps. Do not milk tlw cord. Do not pull the cord unless there are signs of placental separation. If there are signs of placental se_paration, deliver it _completely. 3. 2. 1. Pull the cord slowly and gently until t11e placenta spontaneo usly comes 3. 2. 2. 3. 2. 3. out. Rotate the placenta. Place the placenta in a basin or bowl and inspect it as well as its membranes untler a good Ught. Feel if the womb is hard a. nd well contracted or soft and relaxed. If it is soft, massage it gently to make it contract. If ice is available, ice pack can be applied over lhe area belo-.,· the mother's umbilicus. Inspect lhe perineum for any lacerntions (tears). If there are no lacerations, clean the pedn_eum wit J1 cotton and warm water. 3. 6. Remove the pad and the plastic lining under tl1e patient's buttocks and change Mer clothes. Do not apply "bigkis~. 3. 7. Give her nom-ishme. at like soup, milk, tea, etc. 3. 8. AJlow the mother to sleep. 4. 0 Stay with the patient for two bours after the de Hvery of the placenta. Do the following during this period: 4. 1. Oh1:erv<" the pntient for any untowar d signs and symptoms (like bleeding, dizzi11ess, cold,mc J clammy perspiration, etc. ) 4. 2. Attend lo ll1e newborn. 4. 3. Take down data needed for the birth certificates (]ike the mother's age, her maiden name, lter obstetrical history, etc. ) 4. 4. Give cifter care i11s1. ruclio11s like the diet for bol:h U1e motl1er a. nd child, cord care, etc. 5. 0 lf the baby is in breech position ("suhi") and there is no time to bring the patient to a doctor or hospitnl, do the following: 5. 1. Do tl1c :;amc prepnrutio ns dur. ing t J1e 6rst stage of labor. 5. 2. Perform the follm,;ng mnneuvers during the second stage oflabor: 5. 2. 1. Delwer the baby up to the shoulde r. a. Urasp both feet of the baby. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
b. App~y a downward pull steadily but gently, holding higher portions as they come out (like the calves the thighs then the hips).. ' ' 5. 2. 2. Deliver the shoulder using either of these two methods: a. While maintaining the gentle do"'1Tlward pull, slowly tum U1e body such that one shoulder and arm appear at the opening of the birth canal and can tlms be released and delivered first; then turn the baby again so that the other shoulder and acm could be delivered. b. While still maintaining the gentle outward pull, grasp both. feet again in one hand tben gently draw the baby upwards; with the other hand, free the shoulder and am1, then gently pull the baby downward and deliver the other arm and shoulder. 5. 2. 3. Deliver the head. a. After delivering both shoulder, support the hahy's body with one hand. \\Tith the fingers of the other hand, check the neck for cord coil. ff there is cord coil, see if it is loose enough to pass over the ·baby's h~ad as it is delivered. If not. tie the cord twice, with the tics around an incb apart, then cut between the ties. b. lntroduce the left inde. x finger (or that of the right if you are left handed) into the mouili of the baby. c. Hook inde. x and mid die fingers of the other hand over the baby's neck and grasp ilie shoulders. d. While still maintaini ng the pull, elevate tbe baby's body until head is completely delivered. 5. 2. 4. Grasp the baby's feet and hold the baby securely while ensuring drainage of secretions. Stimulate ilie baby if it doesn't cry _5. POntaneou sly. 5. 2. 5 Dry the baby's skin, place him on his mother's chest and cut the cord as expfained in section 2. 11 to 2. l3 of this plan. 5 :J Manage the t J1ircl stage of bboor and th;, t"·o hours immedi,1tely after birth as in Cephalic present:rtion (head first) as explained in items 3. 1 to 4-4 of this plan 6. o Befo1·e leaving the patient, be sure that: 6. 1. The womb is bard and contracted and remains so. 6. 2. There is no excessive bleeding. 6. 3. The placenta is complete. 6. 4. The baby and mother are both in good condition and without any untoward signs and symptoms. PLAN B: 1. 0 Refer the patient immediately to a hospital ( preferably the nearest one). 2..0 Accompa ny 'the patient to the referred level. 3. 0 If the patient hasn't delivered yet, be prepared in case the patient gives birth on the way to the hospital. . 4. 0 Keep her calm. 5. 0 [f tbet"e is shock, do the following: 265 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
6. o 266 5. 1. Make her lie down \\ith the head lower than the body. 5. 2. Cover the patient lightly. \-voile patient is in transit or waiting for the services of the higher level fac T where patient is being referred to and there is massive bleeding after the thlity stage of lr1bor. uo th!' folio,,; ng: rd 6. 1. Apply cold compress or ice car below the patient's umbilicus. 6. 2. lft J,e bleeding docsn·t slop. press the above menlioned area. 6. 3. If there is still some bleeding, grasp the womb in both hands and slo 1. wy press,t. Endorse the patient at the referred le,·e L See Figure 3. 2 for a sample refi form. erral 7. 1, Gi,·e the brief history including the obstetrical history if possible. 7. 2. Gi"e the physical e. xamination findings as well as the management st at the referring level. arted --....:;,-1 Sc..:~rn tic J wiln C1m1Soam1t:i I I I I | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR CARE OF THE NEWBORN IMMEDIATELY AFTER BIRTH {Logic Tree No. 31) DIRECTI ON: Determine/identify which of the following symptoms/signs (S/S) or history data (Hx D) are present and follow the flowchart for the appropriate plan of management. RED S/S or Hx D , Baby is with pink body and blue e><tremities or is blue all over. Baby Ja;1, to cry after $:·t Jmulation or g. ives a very weak cry Heart beat. ls less than :too be~ts. per minute O:i. by h:is very weak cry or has no r~sponse when stimulated 510. n (H irregular breathing Extremities are flaccid Flat abdomen or ha~ an opening with or without exposed internal organ~ very matked concave breast bone Saby·:s head either ver·y small or very big with or without ten~e fontanelle Baby's head Is too sm. >11 or too big Baby's weight very low Baby hll difficulty of breathinr, Temper. H u re is low (below 36°C) INITIAL EXAMINATION YELLOW S/S or Hx D Club feet Extra finger/toe Nondevelopment of one part of the extremity DETAILED EXAMINATION One of the testes hasn't desc. e. nded vet Opening ofth~ urethra ob·served lo be at the underside of the penis GREEN S/S or Hx D Baby is pink all over Sp. onrnneous crying or b;,~y cried ef L~r slight stfmulaoon Heart beat is 100 beats per mi nule or more Baby gives a good sustained and vig010u~ cry when stimulated Extr-emil:i~s have active motion Abdomen Is. globular No obvious conge-nital defett. (cleft lip, etc. J Baby weighs about6 lbs (around 3 kilos) Temperatur e at leas1 36 ~c No. bru Js:es or. rushes on the skin F. qual exrrnnsion of the chest Both testes have desce-nded Opening of the urethra noted to be at the tip of the penis Female infant has both vaginal and urethral openings V/ith 3nnl opening Extremities with equal lengt. h and strength Fecdmgf. are well tolerated Vigorous suck Jng 267 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
RED YELLOW GREEN S/S or Hxo ~ S/S or Hx D S/S or H><D Baby weighs about 6 lbs ~ Baby's head is too small (around 3 kilos) or too big Temperature at least Baby's weight very low 36°c Baby has difficulty of No bruises or rashes on breathing the skin Temperatu re is low Equal expansion of the (below 360C) chest Cleft palate, Both testes have specially if the descended whole palate is Opening of the Involved Rashes or bruises urethra noted to on the skin be at the tip of the penis Inequality in the F,emale infant has movement of the chest both vaginal and Defect in the urethral openings breast bone With anal opening causing difficulty in Extremities with equal length and breathing strength Mass or lump along. the midline of the Feedings are well back tolerated Either vaginal or Vigorous sucking urethral opening Is absent Abdomen is flat or with an opening No anal opening Inequality in the length or strength of the extremities Vomiting specially during feedings Failure to suck or poor suck Bleeding from any source specially the cord . . 268 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
LOGIC TREE f LOW CHART NO. 31 at least one RED s/s or Hx D noted on r----------. initial examination Proceed with Plan C ___ I"----,0 at least one Yes YELLOW !-------------!JI. ~ s/s or Hx D noted on l'roceed with Plan B initial examination No at least one GREEN s/s or Hx D noted on Initial examination Proceed with Plan A No at least one RED s/s or i--~ Hx D noted on detallcdi--,~ examination Proceed with Plan C Yes at least one YELLOW s/~ or H,c O noted on detalled e,camination Give aftercare instructions to the family 269 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
MANAGEMENT PROTOCOL FOR CARE OF THE NEWBORN IMMEDIATELY AFTER BIRTH (Flowchart No. 31) PLAN A: 1. 0 Within the iirst 30 seconds, while waiting for the placenta to be expelled, dry the baby, cleal· l1is air . ray and stimulate h1m to cry if he does not do so spontaneously. 1. 1 Gently wipe th~ baby's face, neck and hody but do not wipe off veroix. 1. 2 Do not suction unless the baby·s mouth aud/or nose is blocked with secretio ns or other materials. 2. 0 Do a quick physical examination and observe the following: 2. 1 His color : blue all over, completely pink or blue extremities with pink body. 2. 2 Heart or pulse rate : absent, below 100 beats per minute or 1. 00 beats and ahove. 2. 3 His grimace or response to an irritation (like the suction bulb being placed in his nose) : no response, gives a grimace or gives a good, vigorous and sustained cry. 2. 4 His activity or muscle tone: flaccid/soft, some bendingofth. e extremities or has active motion. 2. 5 His respiration: absent, slow/frregula{" or he is crying vigorously. 2. 6 His physical,ippeara nce: any obvious congenital defect, like abse:ace of an extremity, concave breast hone or flat abdomen. 3. 0 Within the first 60 seconds: 4. 0 5. 0 270 3. 1 If the newborn is hreatbing or crying and Lhei:e are no abnorm : abdomen or chest, place him in a prone position on the mother's cbr head turned to either breast. Ensure that there is skin-to-skin conta, the mother and the ne,vbom '-' in his ·. vith his hetween 3. 2 Covei: his back with a clean dry blanket and his bead with a clean dry bonnet. Within 90 minutes of life, initiate breastfeeding. 4. 1 Make sure that the newborn is properly position, and 1us whole hody well supported 4. 2 Observe for feeding cues such as tonguing, licking or rooting. 4. 3 Encourage the mother to nudge the newborn towards her breast. 4. 4 Do not give sugared water, formula, milk or any prelactea ls. 4. 5 Do not throw away the colostrums. After the first full breastfeed is completed, separate the newborn from his mother, do the following: 5. 1 Administer eye care and give immunization (BCG and Hepatitis 8) if available. 5. 2 Postpone giving the baby a bath till at least six hours after birth. 5. 2. 1 Clean yo\Jr hands with soap, water and alcohol. 5. 2. 2 Wet some sterile cotton balls with warm water and use them to clean the baby's eyes. Start from the corner of the eye near the nose bridge and then move gent Jy towards the outer corner of the eye. 5. 2. 3 Clean the baby's skin with the wet cotton balls. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
5. 2-4 Start by cleaning the face, the scalp then co ti special attention to the skin folds. n nue downwards. Pay 5. 2. 5 Wrap the baby in a clean blanket. 5_3 Dress tl1e cord after the giving the baby a bath. 5. 3. 1 Clean the hands thor?ughly with alcohol again. 5. 3. 2 W~t the cotton balls m the cord dressing pack with alcohol 5. 3. 3 gs~ng fl:e ~et cotto 1n balls, clean the area around the umbilicus 5. 3. 4 smg c1rcu ar stro ces, start cleaning the center mov· tw d Do this several times. mg ou ar s. 5. 3. 5 Throw away the cotton ball after each circular stroke. 5. 3. 6 Clean ~e cord with t~e alcohol-wet cotton balls starting from the base gomg up. Do this several times, discarding the used cotton ball each time. 5. 3. 7 flace a piece of sterile gauze that has been cut halfway thru the middle at the base of the cord bringing the cut edges around the cord. 5. 3. 8 If the cord stump. is long, clump or tightly tie the cord around one inch from the base. Trim the cord aroqnd an inch from the clump or tie using a sharp sterile blade or a pair of sterile scissors, 5. 3. 9 "\Vith a piece of sterile gaure, express out the blood from the stump and clean the top of the stump with alcohol-wet cotton ball~.. 5. 3. 10 Put another sterile gauze around the stump and wet 11 with alcohol. 5. 3. 11 Put the top dressing and tie the abdominal binder. 6. o Do a more complete physical examination after the cord dressing. 6. 1 Take the baby's weiight if possible. 6. 2 Take bis temperature by rectum... d b e if any of the 6. 3 Examine the baby's skin under a good light ap. 0 serv following are pre~ent:_ · 6. 3. 1 Birth mark. tbe bead for obvious defect 6. 3. 2 Any rashes or bruises 6-4 E~mreabn ormality in the eyes, nose, like very small or ~ery dlar/ ge le~p,alate, and absence of skull. mouth ears, cleft lip an or c. '-· 'f there 1s: 6. 5 Examine the chest and observe 1 t fthe chest. 6. 5. 1 Inequality in the movemen : breast bone) which could cause 6. 5. 2 Any defect Oike a concav. difficulty in breathing. fl t or if the abdominal wall is open 6. 6 Observe if the abdomen is globular~~ a.. with or without exposed internal org ass ~pecially along the m1dlme. 6. 7 Examine the back for any lump or 01 · 6. 8 Examine the genital area. 6. 8. 1 ln a male infant: tes have descended... at the tip or at its a Feel if both tes. of the pems,s. ·f tl e opemng al b. Check 1 1. 1 ening and a urethr d ·ae ' vag U1a op un ersi · ck "ftbere J. S a · f nt che 1 ) · t th 6. 8. 2 In a·female JO a '. cornes out . articular attenaon o e opening (where urine rt. remities paying p 6. 9 Examine the upper and lower ex fi gers non-development or · "1:ra n, following: t Jike club feet, e. m·ty defec f e. xtre1 · 'ties 6. 9. 1 Any ob V1ous lopmcnt o nn,.., of the extrenu. improper deve gt11 or leni,~1 · the stren 1t 6. 9. 2 Inequality in ning is preser. 271 6-10 &-..amine if the anal ope I j | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
272 7. 0 JI there is an abnonnality observed during the examination refer the patient to the hospital. See Figure 3. 2 of Cbapter 3 for a sample referral fonn. 8. o If the baby·s temperature is below 36 °C, do the follo"ting: 8. L Wrap him in a blanket. 8. 2. Place the baby under a lighted bulb or Uuorescent Jamp. Ifthe latter js used, the bab~ ·s l. ~-e::. should be covered since the light of the fluorescent lamp can cause clamaie lo the baby's eyes. 8. 3 Create an impro;-ised incubator especially if the baby has to be brought to a hospital. PLAN 8: 8. 3. 1 Put warm water inside bottles,...,jth tight covers. 8. 3. 2 Place the bottles insid~ the bo J, large enoug J1 to contain the baby and the bottles. Place the bottle along a1J the sides of the box. 8. 3. 3 Cover the bonom of the box v,;th a warm hlanke L 8. 3-4 Cover the bottles and blanket with another blanket or with a towel. 8. 3. 5 Place the baby inside the impro,ised incubator. LO Refer the patient to a doctor within 24 to 48 hours. 2. 0 Manage the baby as in Plan A.. 3. 0 Pro,. ide the doctor with appropriate clinical material or referral note containi ng a brief history, physical examination findings, and management given at the referring level. See Figure ~1. 2 of Chapter 3 for a sample referra J form. PLAN C: 1. 0 Refer the baby immediately to a hospi. tal (preferably the nearest one). 2. 0 If the baby doe. sn't breathe wilhin one minute after birtl1, do mouth to moutb resuscitation at once. Make sure there is no mucus in the baby's nose or mouth. 3. 0 lflhere is clif:ficu Jty of breathing, dean the nose and mouth. 4. 0 If there is no heart beat., do cardiac massage AT ONCE using the index and middle fingers of one hand. 5. 0 Ifthereisa. n openi. ngal the abdominal wall, aodsomeio ternal organs are exposed, cover it with a clean cloth that was soaked in warm boiled water. 6. o If there is bleeding. try to stop it by applying direct pressure. If the,bleeding is coming from I. he cord, put another tie and make sure it is tight enough. 7. 0 lftherc is a mass along the baby's back place hioi face down (nakada pa) with his head turne<l to one side. 8. o Accnmrany the baby ro the hnspilal or if this is not possible, provide the hospital \,ith a referral note containing a brief history, physical examination findings, and any mnnagcml'nt given. SP. e Figure 3. 2 for a sumplc referral form. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR POSTPARTUM CHECKUP (Logic Tree No. 32) o IRECTION : Determine/identify which of the following symptoms/ signs (S/S) or history data (Hx D) are present and follow the flowchart for the appropriate: plan of management. RED YELLOW GREEN S/5 or Hx D S/S or Hx D S/S or Hx D Profuse vaginal Foul-smelling vagina Vaginal discharge change bleeding discharse from bloody durine Abdominal pain Vaginal discharge the first few days and Altered level of continues to be gradually becoming consciousnes!. bloody even after whitish but non-foul- Patient in pain the third day smelting Pulse is weak and fast Tempera ture of 37. sc Breast engorged and and above heavy but not painful Blood pressure Blood pressure slightly and swollen either very high high (systolic of 140 Patient Is alert (systolic above to 160 mm mercury Pulse is strong and l60 mm mercury) and/or diastolic regular or very low (only of90-100 mm Blood pressure within palpatorvl mercury) norm. I limits cold, clammy skin Pale lips, nallbeds or Temperature is below Womb is soft and not inner aspect of the 37 ·c contracted eyelids Womb hard and well Abdomin al wall cracked or bleeding contracted (gradually very rigid nipples becomes smaller) Breast is painful, swollen and red wound at the genital area, especially if infet1ed . 273 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
at least one RED s/s or H>'O hil S developed since Iii)! v,sll er to Logic Numbers 7 and 15 at lea!. t one YELLOW s/s or Hx O has developed since la!. t visit ~lp:irlum ~cvcnth ticnt has | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
MANAGEMENT PROTOCO L FOR POST-PARTUM CHECK-UP AND CARE OF THE NEWBORN (Flowchart No. 32} PLAN A: 1. 0 2. 0 3. 0 Visit the p:il'icnt :ind her newborn baby at le11st once a day unti J the seventh day and as often as necessary afterwards depending on their needs. Dete1m·ine knowledge of the patient on post-partum care and of the newborn. Based on 2. 0, advise the patient on the followin g aspects during the first visit: 3. 1. Nutritio n-3. 1. 1. Liquid diel (milk, soup, elc. ) or soft diet ()ugaw, oabnea J, etc. ) 3. 1. 2. :-3. 1. 3. should he given on the fir. ;t day. Start full or rr. g11lar diet on the second day after delivery. Slr C. 'i/'\ the importance of eating the right ldnd and the right amount of food especially if the mother is breastfeeding the newborn. 3. 2. Person:il cleanliness-3. 2. 1. Advise p:llicnt to take sponge bath daily du. ring the first two days after delivery b11t n quick full bath can be started as early as the third day if she is strong enough. 3. 2. 2. Breast and nipples should he cleaned with soap and water before and after ench breastfeeding session. 3. 2. 3. Perineum (puerta) should be properly washed with soap and warm wnter every time she urinates. Do not apply alcohol on the area. 3. 3. F. arly ambulntjon-3. 3. 1. On the first day, patient must stay in bed but should move freely in it. She c:rn sit down aud dangle her legs at the side of the bed, she can go to the batl,room or toilet if she is assisted. 3. 3. 2. On the second c. fay she should start walking around even if it is still painful to do sci. 3. 3. 3. Discourage the patient from staying in bed for long time unless there is profuse vaginal blced1ng. 3. 4. Bowel habits-pnticnt should have daily bowel movement. 3. 5. Abdominal mnssage-patient should not have her abdomen 111as.-. ~1ged. 3. 6. Clothing-;3. 6. 1. Patient should wear dean, loose, comfortab le clothes. 3. 6. 2. Discourage the patient from wearing a ~bigkis". 4. 0 Based on 2. 0, advise patient on how to give milk feed properly. 4. 1. Breastfeeding should not be done if any of the followin g are present: 4. 1. 1. On the part of the patient: a. u ntrc:l'ted tubercu Jos'is b. any serious illness c. swellinp,. intl11mm11tion or open wound in the chest. 4. 1. 2. On the p;tr1 of the baby: a.,my defect in the mouth, like cleft lip and/or cleft palate. b. baby is too weak to suck (e. g., baby is premature or small for his 3A'C). 4. 2. I low lo breastfeed the baby: 4. 2. 1. Both breasts should be washed before and after feewng then dried with a clean towel. 275 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
276 4-2. 2. Give the baby both breasts evecy feeding tin1e to prevent nipple from gro,,ing sore. During the first days, feeding time should be limited to five minutes. This then is slowly increased up to 15-20 minutes per feecling. 4. 2. 3. TI1e milk feedings can be given every three to four hours or it can be given per demand. · 4. 2. 4. Both the baby and the mother should assume a comfortable position. a. If feeding is done ·. vith the mother is lying dov. 'Il, she should be on her side with her bead supported by her arm; the baby is placed on his side facing his mother and supported by a pillow. b. If U1efeeding is done whilethe motherissitting up, a comfortable chair must be used: if possible, her feet should be placed on a stool; 10 make both mother and baby more comfortable, a pillow may be used to support the arm carrying the baby or it may be placed under him. c. Make sw·e that the breasts doesn't press on the baby's nose. 4. 3. How to bottle-feed the baby: 4. 3. 1. Keep all supplies clean and sterilized. a. With a bottle brush. scrub the bottles, artificial nipples and caps with soapy water; squeeze some water through the holes in the nipples; rinse well. b. Place bottles ( upside down), utensils, nipples and caps in a large saucepan with enough water to cover the things being boiled; allow water to boil. c. Remove artificial nipples and caps (with a lndle or a pair of tongs) after the water has boiled for around three minutes; keep sterilized artificial nipples and caps in a clean covered container. d. Allow the other articles to boil for two minutes then remove; keep in clean covered container together with the caps and rubber nipples. 4. 3. 2. Observe clennlines s when preparing the milk formula. a. Wash hands before mokjng the milk formula. b. Whe·n using canned milk, wash the top part vnth soap and water before opening; wash also the can opener. 4. 3. 3. Use tl1e right proportion of milk to water. a. Powdere d milk-depends on the brand being used; most i_nfant formulas produced by Mead Johnson (like Alacta) and by Wyeth (like Ronna, S-26 and SMA) need one scoop of powdered milk for every tvvo ounces ofhoiled wot er while Nestle products Oike Lactogen, Nestogen. Nan and Pe Jargon) need one scoop of milk for every one ounce of boiled water. b. Evaporated or reconstituted milk-depends on the brand being used, but usually one ounce of milk is needed for every ounce of hoiled water. To make sure, c Jiec:k the direction given in each can. 4. 3. 4. Always use boiled water. 4. 3. 5. DO NOT USE CONDENSED MILK. 4. 4. Advise patient to burp tlie baby after each feeding. 5. 0 Based on 2. 0, instruct the patient on how to bathe the newborn during the first visit: | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Sponge bath-5. 1. 1. Undress the baby and wrap the baby in a forge towel or blanket. With a piece of cotton, clean the h Aby's cars and nose gen Uy. Using a piece of clean soft wash cloth dipped in clean warm water, wash the baby's face gently. 5. 1. 4. While supporting the baby's bead and back with one hand, soap his head with the other hand. Us. e circular motion going from front to back. 5. 1. 5. 5. 1. 6. 5. 1. 7. 5. 1. 8. 5. 1. 9. R:inse well and pat dry. Soap the rest of the baby's body and ri. nse well. If the baby is a girl, clean her genitals "-ith a piece of cotton soaked in clean warm water usi11g a downward stroke. Pat dry. Do not apply powder. If the cord hasn't fallen off yet, change tlie dressing using sterile gauze prnvided by heal th worker. a. make sure the gauze placed around tl1e cord is wet with a Jcobol. b. cover with dry gauze and apply a binder. 5. 1. 10 If the cord has fallen off, the umbilicus should be cleaned gently with alcohol and a piece of clean cloth. 5. 1. u Dress him in clean and comfortabl e clothes. Tub bath-given as soon as the cord falls off an<l the'umbilicus is dry. 5. 2. 1. Fill a big basin (big enough to accommodate the baby) with about Urree inches of w. irm waler. With the elbow, check the temperature of the water to make sure it is wann enough. 5. 2. 2. Clean. the baby·s nose, ears, face an<l hail' following the same procednre as in $ponge bath. Use shampoo (mild) for the hair. 5. 2. 3, Soap your hands and quickly soap the baby's body paying particular attention to skin folds. 5. 2. 4. Lower the baby into the basin with water. Be snre to support the head and tbe back oftbe baby. 5. 2. 5. Rinse with washcloth. Rinse also the genital area especially if the baby is a girl 5:2. 6. Lift the baby and place him on a towel. 5. 2. 7. Pat dry, malting sure the areas between the skin folds are also dried. 5. 2. 8. Dress him i. n clean comfortable clothes. Do not apply powder. 6. o During the subsequent home visits, do the followin g: 6. 1. Ask the patient tf any of the YELLOW or RED ·symptoms developed since the last visit. 6. 2. Examine the patient for any signs which could have developed since the last visit. 6. 3. If new signs or symptoms have developed, proceed with either Pia. a A, Plan B or Plan C as indicated. 6. <1. If there are only green signs and symptoms, tell the patient to: 6. 4. 1. Follow advise given during the first visit. 6. 4. 2. Continue taking iron preparation given during the pre-natal period. 6. <1. 3. Do the following if the breasts become engorged. a. Support the breasts with a well-iitting brassiere. b. Pump the breast (with the use of a breast pump) or manually express out the milk; if there is a refrigerator, the milk can be 277 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
placed in a clean feeding bottle and stored in tbe refrigerator; this can then be given to the baby during the feeding time. Warm the milk before giving to the baby. c. Apply cold compres s, ice cap or "i,aha ng saging" over the engorged breast. 7. o Advise the patient to visit the health center six to ejght weeks after the delivery so the doctor can give her a final check-up. PLAN 8: 1. 0 Refer the patient to a doctor within 24 to 48 hours. 2. 0 Determine knowledge of the patient or that of her companion on tl1e supportive management of the. problems presented. 3. 0 Based on 2. 0, do the follovving if there is a fever: 278 3. 1. Give/prescribe over-the-counter med. kine or herba1 medicine for fever, specifying accurately the dose, frequency of intake and the method of preparation (specifically for herbal m. edicine). 3. 1. 1. Give/prescrib e a paracetamol prepru·ation wtless the patient is allergic to sucl1 substances. 3. 1. 2. If the patient is allergic to the above mentioned substances, give/ prescribe a purely aspirin preparation. 3. 1. 3. Advise patient to take the medicine after meals. 3. 2. Advise the patient to follow instructions on general management of patients ,Yith fever. 4. 0 Based on 2. 0, do ~e following if the breasts are swo1len, painful bard, and accompanied by a crack in the nipple: 4. 1. Give/prescri be over-the-counter medicine or herba J medicine for pain, specifying accurate ly the dose, method of-preparation (specific ally for he. rbal medicine ) the dose and frequency. 4. 1. 1. Give/prescribe paracetamol preparatio n unless the patient is allergic to such substances. 4. 1. 2. If the patient is allergic to the above-mentioned substances, give/ prescribe a glafenin e preparatio n. 4. 1. 3. Advise the patient to take the medicine only if the pain is severe. 4. 1. 4. Advise patient to take the medicine after meals. 4. 2. Advise the patient to do the following: 4. 2. 1. Stop breastf eedj ng. 4. 2. 2. St1pport t}1e breast with brassiere. 4. 2. 3. Apply cold compress, ice cap or "saha ng saging'' over the breast. 5. 0 Based on 2. 0, do the follmving if the nipple(s) is (are) cracked and/or bleeding: 5. 1. Do not allow the baby to nurse on the affected side. 5. 2. Pump out or manually express out the milk from the affected side. Do not give the milk to the baby. 5. 3. Wash the nipple with mildsoapand warm water before and after pumping or expressing out the milk. Apply breast milk around the nipples as lubricant. 5. 4. Use a nipple shield if possible. 6. o Based on 2. 0, do the following if there is a foul-smelling vaginal discharge and/or | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
s. o· infected wound in the genital area. 6. 1. A,dvise patient to wash the perinea! area with soap and water more often. Do not use a Jcol10l. 6. 2. Advise patient lo observer personal clean Uness. Based on 2. 0, do the following if the patient is pale: 7. 1. Give/prescribe over-the-counter medicine for anemia (iron preparations) specifying accurately tl1e dose and frequency of intake. Advise her to drink the medicine after meals. 7. 2. Advise patient to eat iron-rich food such as melunggay, ampalaya, liver, etc. Based on 2:0, do the following if the patient has slightly high blood pressure: 8. 1. If patient is a known hypertensive and she is taking something for it, advise her to take it. 8. 2. If the patient is nol taking anything foi-l1er hyperten sion, give herbal medicine that will increase hei-urine output, 8. 3. Keep the patient calm. · 9. o If the patient's blood pressure is low, let her have more rest and ask another member of the family to take care of the newborn especially at night. 10. o If the patient. is depressed, try to determine the cause of her depression and help her through the ei. 'Perience using appropriate nursing interventions (e. g., support: informational, technical, emotional/ affective, interpe1·sonal). Refei-to a psychiatrist if necessary. u. o Provide the doctor to whom the patient is being referred to with appropriate clinical materia J or referral note contain. log a brief history, physical examinat ion findings, and management initiated at tile refen·ing level. PLAN C: 1. 0 Refer the patient immed. iate ly to a hospital (preferably the nearest one) with the duly accomplished referral form. 2. 0 Do the following if there is profuse vaginal bleed. log and tile womb is soft \Vh. ile waiting for medical llelp: 2. 1. Apply an ice bag over the womb_ 2. 2. If there is stil J bleeding, press oo the area of the. womb. 2. 3. lf there is still profuse bleeding, grasp tile wound in both hands and gently squee;,;e it. 3. 0 Do the following if the patient is. in shock (fast and weak pulse, very low blood pressure and cold, clammy skin). 3. 1. Let the patient lie down with the head lower tllan tile body. 3. 2. Cover the patient J-igbtlyshe feels cold. 3. 3. Give her some wai:m water to sip if she is fully'conscious. 4. 0 If there is abdominal pain, DO NOT GIVE. ANYTHING FOR THE PAIN. 5. 0 Try to keep the patient calm especially if her blood pressure is high or she is in pain 279 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR WELL BABY CHECK-UP, NEONATAL PERIOD (Logic Tree No. 33-A) DIREcn ON: Determine/identify which of tl1e following symptoms/ signs (S/S) or history dal'a (Hx D) m-e present and follow the flowchart for tht: approp i-iate plan of mannge. ment. RED GREEN S/S or H)(Q 5/S or Hx D Patient has not had first bowel Patient had first bowel movement movement or urine within 72 hours within 72 hours from birth then from birth followed by greenish soft stools Weak. unsustalned cry Patient has urinated within the first 72 Poor suck (patient could hardly hours of life finish one ounce of milk formula) Strong, sustained cry Weak or unequal movement of the Good suck extremities Patient cries and shows increased Convulsion or twitching activity when he is hungry or Patient is lethargic uncomfort able (wet, etc. ) but Marked increase in head circumfe rence becomes quiet and relaxed after he (more than 1/2 im:h in one month) is fed or made comfort able Yellowish color of the skin or eyes, Patient is active with generalized especially If noted Immediately activity when awake after birth or if observed to be Slight yellowish color of the skin noted intensifying instead of \ubsiding, on the second day of life but begins starting the fifth day of life or it to subside starting the fifth day and persists beyond two weeks of life completely disappear after two Bluish or whitish color of the skin, lips weeks and inner aspect of the eyelids Pinkish color of the skin Full or tense fontanelle or sunken Fontanelle Oat and soft fontanelle Vigorious crying when stimulat ed Weak. unsustained cry when started or Patient shows violent startle response when stimulated when loud noise is made Foul-smelllng umbilical cord No startle response to loud noise Inequality in the movement of the e Ktremlties 280 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
LOGIC TREE FLOW CHART NO . 33. A Yes fever, cough, colds, diarrhea or other f problems Refer to appropriate Logic Tree-! N~o Yes Patienl is more than;-------------_. one month !,~ refer to Logic Tree 1133-B at least one RED s/s or Hx O 7 Yes ------------.,)1.-i Proceed with , Plan B ! No ~-at least one GREEN s/s or Hx D Yes l-Proceed with Plan A at least one RED s/s or----------,-,)1,7 Hx D developed since r j last visit advice companion to bring back the baby after one month 28'1 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
MANAGEMENT PROTOCOL FOR WELL-BABY CHECK-UP, NEONATAL PERIOD (Flowchart No. 33-A) PLAN A: 1. 0 Determin P knowledge of the motlier or the patient's compnn1on on tl1e proper care of the newborn. 2. 0 Based on 1. 0, advise mother or companion to give the patient a tub bath daily (even on Tuesday and Fridays). Give the same instructions enumerated in section 5. 0 of Management Protocol for Flowcl,nrt No. 32. 3. 0 Based on 1. 0, show Lhl! patient's companion how to cl~an tl1e umbilicus with . ilcohol and cotton buus during the first visit. 3. 1,vhen the cord hasn't dried up yet, make sure that the sterile gauze placed around the con J (not the lop dressing) is soaked with alcohol. 3. 2 After the cord has fallen off. the navel should be gently cleansed using cotton buds and alcohol. 4. 0 Based on 1. 0. advise companion on infant feeding during tbe first visit. Give the same ad,-ise st. i. ted in section 4. 0 of Manngemen t Protocol for Flowchart No. 32. 282 5. 0 Based on 1. 0, advise companion to e::... l)ose the patient to early n'lorning for ten minutes e,·erydny if slight yellowish skin color appear starting on the third day. 6. o Ba. sed on 1. 0. give/prescribe over-the-co unter multi-vita mins if Lhe bnhy is at least one week old. 6. 1 On t J1c fir. st day the medicine is to be given, give the patient only one drop. lncre.-. se the amount by one drop per day up to the tenth clay. So on the second d;,iy two drops '";II be given then on the t J1ird day tbree drops and so 011 until on the tenth day the baby is given ten drops or 0. 3 cc. From the elen:nlh day on,,·ards. give 0. 3 cc. 6. 2 Give t J1e medicine oncl:l per daiy only. 6. 3 Stop the medicin e if the patient develops any rashes or signs of allergy or dfarrhe:i. 7. 0 Based on t. O, advise the companion to bring the patient either a privnte pediatrician or the Health Center for BCG vaccination and 1st dose of Hepatitis B. vaccine 8. o Advise companio n to bring patient back afler one month. PLAN 8: 1. 0 Refer the patient immediately to a hospital (preferably tl,c nearest one). 2. 0 Do the following if there is bk. '<.--di:n. g from lhc c.-ord while waiting for medical help. 2. 1 Remo\'o:t Lhe cord dressing 2. 2 \'\Tith a clean piece of cloth or ~auzc, r,ress the cord between the l. humb and index finger. 2. :l If thert is still bleedjn,i_, place another tic. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Jf there i~ _yellowish c~lor of the skin, place ll1c baby under a fluorescent lamp 3. o while wail. Ing for medical help. Cover his eyes with a clean piece of cloth. Jf tbe patient h?sn_'t had bowel_ movement nor passed out flotus within 72 hours 4. 0 after birth, don t gwe any laxative. provide the hospital where the patient is being referred to with the appr?Pri:3te rnical record or referral note containing a brief history, physical exanunatio n ~~dings and management started at the referring level. (See Figure 3. 2 for a sample referral form) 283 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR. WELL BABY CHECK-UP, PATIENT IS MORE THAN ONE MONTH OLD (Logic Tree No. 33-B) DIRECTIO N: Detennine/iden tify which of the following symptom s/signs (S/S) or history data (Hx D) are present and follow the flowchart for the appropriate plan of management. 284 RED S/S or Hx D Showed delay in different developm ental milestones Poor suck or appetite Patient doesn't seems to gain weight Patient is lethargic Marked increase In head circumference (more than l/2 inch per month up to the 4th month; more than 1/4 inch per month up to the 12th month; more than one inch during the entire second year and more than 1/2 inch per year from the third to the fifth year) Patient is severely malnourished or overnourished Unequal movement of the extremities No startle response when there is a loud noise GREEN S/S or Hx D Patient is able to do the different developmenta l milestones on the expected period Patient is apparent ly healthy Patient has good suck or appetite Patient is at least two months old and has not had any vaccination or incomplete dose was given like only one was given instead of two) Patient is active and alert Head circumference increase is within normal limits Patient's weight is within normal limits or he is either mild or moderately Patient's weight is within normal limits or he is either first or second degree malnourished Patient shows violent startle response when there is a loud noise malnourished Patient shows violent startle response when there is a loud noise | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
fever, cough, colds, diarrhea or other problems i Ne Patient is more than LOGIC TREE FLOW CHART NO, 33-B Yes Refer to appropriate Logic Tree one month---------=--:1~ refer to Logic (-Tree #33-A ! Ve, at least one RED s/s or H)(D at least one GREEN s/s or Hx D ! Proceed with Plan A ,. Yes Proceed with Plan 8 Yes at least one RED s/s or H><D developed since last visit L..-..--.-..---_j advice companion to bring back the baby after one month 285 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
MANAGEMENT PROTOCOL FOR WELL-BABY CHECK-UP, PATIENT IS MORE THAN ONE MONTH OLD (Flowchart No. 33-B) PLAN A: 1. 0 Determine the knowledge of the companion on the care of the child. 2. 0 Based on 1. 0, advise the companion to stnrt giving solid food at· the age of four months. 3. 0 4-0 s. o 2..1 Ad,-ise companion on bow to prepare delicious, nutritious but economical supplementary feeding. Refer to Chapter 14 for preparation of protein powders.. 2. 2 lntrodoce one kind of food at a time and observe if the patient is allergic to any of the food introduced. 2. 3 Observe cleanliness when prepari ng the food. Based on 1. 0, give/prescribe o,·er-the-counter multi-vitamin preparations, specif)in g accurately the dose and frequency of intake. Ba....<:ed on L. O. advi...-=:e the companion to have the patient immunized using the following scbedu. le: 4. 1 If the family cou Jd afford to buy ·the vaccine 4. 1. 1. 2 months old : firs-t dose of DPT and OPV 4,. 1. 2. 4 months old : second dose of DPT, OPV and Hepatiti s B 4.. 1. 3. 6 months old: third dose of DPT and OPV 4. 1. 4. 12 mont~ old: Ml\,f R 4. 1. 5. a1 lea. "1 6 months from 3rd dose of DPT: fourth dose of DPT 4. 1. 6. 14 months old: third dose of Hepatitis B 4-2 If the family could not afford to buy the vaccine, advise the companion to have the baby iinmun. i7..ed during the scheduled dates sel by the health center (~ledicine is supplied by the Department of He. c-ilth). 4. 3 If the schedule given in 4. 1 could not be followed for some reasoo (like the patient was sick at the time), the fol Jo,...,j. ng schedule should be followed: 4. 3. 1 DPT-a. Fir.-t d=e given at the earliest possible pe. riod. b. Second dose given ·within si>C months aft-er the first dose. c. Tiiird dose given within s L" months (or at least within one year) af1cr the second dose. d. Booster do<:e given one y<mr after t J1e third dose. 4. 3. 2 OPV-4--3-3 4. 3-4 a. First do:;e given together.,... ;th first dose of DPT or al Lhe earliest possihlc period. h. &-crmd do<c to be given within six to eight mo11t J1s after the firs1 dose. c. TI1ird dose to be given within six lo twelve months after the second dose. BCG-anv-rime be{',,'een the doses o-f OPV Measles :_ anytime after t. he 9th month of age Advise compa. nioo 10 bring patient for well baby check-up 11s. ing the following schedule: S. t Up to one p,ar old: monthly (m..inlmum of eight visits the whole year). | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
.... I 6. 0 5. 2 5. 3 5-4 One to ·n:vo years : four tim~ the whole year or every tliree month,;. Two to sax years old : three time..,; a year. The patient can have check-up more often thaa the above schedule if he has some hea Ith prohlems Clike heart djseasc, etc. ) During the follow-up vjsits, determine if any of the yel Jow signs or. symptoms have developed. 6_1 rf at least o_ne ~1~s developed, patient should be referred to a doctor, ceferably a petl1atnc1an (Plan B). ~-2 If none has developed, advi. se companion to bring the patient back ' for follow-up. Follow the schedule given in section 5. 0. p LAN 8: J. 0 2. 0 Refer the patient to a doctor within 24 to 48 hours. Provide the doctor to whom the patient is being referred to 'With the a~pro~riate linical record or referral note containfog a brief history (including f~dang h~tory fr there is malnutrition or poor weight gain) and physical examination :findtngs. See Figure 3. 2 for a sample referral form. 287 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
288 Chapter 11 NURSE-MANAGED MATERNAL CARE IN THE COMMUNITY Maria Brigette T. Lao-Nario INTRODUCTION The role of nurses and mid,.,,;ves is twofold-to help create positive situations and opportunities for women exp<?riencing pregnancy, birtlting and the postnatal period. The other role is lo pro,ridc care based on available evidence that becomes the basis for clinical judgment and interventions. Republic Act No. 9173, an act provi<'lin g fa,; a more responsive nursing profession, states thatthe practice of ursi J1g includes but not limited to unursi11g care dudng conception, labor, deliuery, infoncy... As independent nurse pr-actitioner·s, nurses are primarily responsible for the promotion of health, prevention of illness". (1) This law sets the basis for nursing practice on materna l care. The government bas set goals for the he. ilth sector which are intended to help attain better health outcomes, a more responsive health system and a more equitable health financing. The goals pertainjng to mothers and the newborn are listed below together with b:iseline indicators from the 2003 National Health Demograph ic Survey (2,3): 1. Maternal mortality is reduced from 172/100,00 LB to 90/100,ooo LB 2. Perinatal mortality is i:educed from 2-4 perinatal deatbs/1.,ooo LB to 18 perinat11l dcaths/1,ooo LB 3. Low birth weigh I infants are ceduced from 12~ to 10% 4. Risk factors assm:i Mcd with maternal morbidity and mortalit y are reduced through accomplishing the fol lo1,11ing: 4. 1 the prevalence rate of iron deficiency anemia among the pregnant is reduced from 43. 9% to :J8% 4. 2 Total contraceptive prevalence is inct·eased from 48. 9% to 80% 4. 3 Modem natural and artilficial prevalence is increased from 33. 4% to 60% 4. 4 Percentage or deliveries assisted by skilled birth attendants in a health care facility is increased from 53. 9% to 70% 4. 5 Percentage or postpartum visit within the 1st week of delivery is increased from 51% to 80% 5. Neonatnl mortality is reduced to 10 deaths/1,ooo LB fron1 t7 deatl1s /1,ooo Lll 6. Neonatal tetanus is reduced to less than one case/ 1,000 LB from 0. 07/1,000 LB Special attention is net!Cled oo the nutritional state of women. The woman 's state of nutrition before and during pregnancy is vital for a good pregnancy outcome. For example, maternal undernutrition is common in some parts of Asia whei:e more | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
than 10% of women 15 years-49 years are shorter than 1,15 cm. :ind h,we body mass index of< 18. 5 kg/m". Short stature is a risk factor for cesarean delivery while low maternal body mass index is associate d with intrauter ine growth restriction While maternal undcrnutrition has little effect on the volume or compr,sition of breast mi. lk unless malnutrition is severe, the concentration of some micronutrients (vitamin A, iodine, thiamin, riboflavin, pyridoxine, and cobalamin) in breast milk is dependent on maternal status and intake, so the risk of infant depletion is increased hy matern. il deficiency(29) current results on the nutritional state of Filipino pregnant and lactating mothers are as follows: (:30) Percentage classification of pregnant women hy weight-for-height classification : Philippines, 1998, 2003, 2005 year Total sun1ects Nutrmonslly at Kl5k 1998 2880 30. 7 2003 594 26. 6 :.,u OS 360 28. 4-Percentage distributio n oflactating mothers by nutritional status: Philippines, 1998, 2003. 2005 Year This chapter is intended to help the nurse deliver her ca. re based on standard and to be a partner in creating positive, enriching and meaningful experiences in pregnancy and birthing for the woman and the unborn child. The objectives are as fo11ows: 1. describe the standards of prenatal, delivery and postpartum care 2. illustrate the use of the nursing process in implementing a nurse-inanaged maternal child care 3. discuss home visit as an intervention ROLE OF MATERNAL CARE Maternal care is an important service that helps protect the mother, fetus and newborn. By screening a predominan tly healthy populati on, risk factors are detected and options for treatment are taken. Ideally, risk assessment is done n. ot on Jy for each pregnant patient but also for someone planning a pregnancy. There is a shift in emphasis from the ''risk approach·· that identifies high-risk pregnancies during the prenatal period tu an approac h Lhat prept1res all pregnant women for t. he risk of complications at childbirth. This shift is reflected in the thrust oft J1e Women's health and Safe Motherhood Project 2 for 2006-2012 It also includes improved quality of Family Planning (FP) counseling and expanded s1::rvicc avoilability, as well as organization of more itinerant teams providing permanent met hods and IUD insertion on outreach basis and Integration of Sexually Transmitted Infections (STI) services into maternal care and family planning protocols, wherever appropriate (4) The detection a. nd management of preg. nancy-related problems is directly related-to reducing the causes of maternal mortality and morbidity. \Vhen. conditions that make 289 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
de Uvery risky are seen in a pr. egnancy visit, the woman is referred to a su. itable facility or health p. rofessionals who are skilled in managin g her needs. The visit, then, becomes an indirect way of reducing maternal complic ations. Continuity of care is an important element in p1·ovision of services. Nurses are an important link in ensuring that current and subsequent pregnancy visits are done in a manner that conform to standard. Nurses are highly skilled in making c Hnical judgment s that form as a basis for pl:rnnin!;!, and interventions. They can help the woman make a commitment to a good pregnancy outcome. Hodnett (2000) performed a meta-analysis of two studies involving 1815 women. Cn the studies, the women were cared for by (nurse) mi<lwives who performed continui ty of care and anoll1er set by a combination of physicians and (nurse) michvives. Women who had continuity of care from a team of (nur. se)midwives were less Ukely to have prenatal hospital admission, and more likely Lo participate in preuatal e<luca Lloo programs. They wet'e. Liso less likely to have drugs for pain relief during labour und their newbo1·ns were less likely to requfre resuscitation. No differences were detected in Apgar scores, low birthweigbt and stillbirths or neonatal deaths. They were mo1:e likely to be pleased with their antenatal, intrapartum and postnatal care (5). The results of this study highligh t and beneficial effects of continuity of ca1·e which ls in part is dependent on the health care provider. STANDARDS OF PRENATAL CARE Prenatal care is the monitoring and management of the patienl dudng pregnancy to prevent complications of pregnancy and promote a healthy outcome for both mother and infant ( (Bulecheck et al 2008, p. 580) (6) In the NHDS of 2003, 9 out of 10 mothers received can? from nurses and 01-idwives (50%) and physicians (38%) and traditional birth attendants (7%) while 6% did not receive any prenata l care. A woman without pregnancy complications need.,:; to have one prenatal visit every 4 weeks up to the 28 weeks, and every 2 weeks from 37-36 weeks and every week thereon until birth. (Murray & Mac Kinney, 2006; Lowdermilk & Perry, 2004) (6,7) The frequency is increased in the 3"1 trimester because of the possibility of complications thntmay arise. This warrants more frequent monitoring. The more risks a pregnant woman has, the more visits are needed. Information from the 2003 NHDS show that one (1) out of ten (;10) had the 1"' prenatal check up at 6-7 months of pregnancy. Three out of ten had their prenatal check up on the 4th to 5th month. There is a segment of Filipino wom,en who are at the highest health risk during pregnancy (2): (1) preg;nant women less thau 18 years old, (2) women who received only up to elementary education; (3) women in 20% of the poorest households; (4) women in areas of armed conflict; (5) women victims of domestic violence; and (6) pregnant women with concurrent chronic illness (iron deficiency anemia, tuberculosis, cardiovascu lar diseases, diabetes mellitus, etc) The goal of the governmen t is for a U pregnant women to have at least four (4) antenatal visits in a pregnancy. The 2007 WHO standard recommends at least 4 prenatal visits. This is largely based on a study done by Villar et al (2001) who reviewed ten trials involving ove1· 60,000 women. Seven trials evaluated the number of antenatal clinic visits, and tliree trials evaluated the type of care provider. A reduction in the number of antenatal visits was nol associ:1ted with an increase in any of the negative maternal and perinatal outcomes reviewed. However, trials from develope d countries suggest that women can be less satisfied with the reduced number of visits and feel that their e:icpectations with care,ire not fulfilled. Antenatal care provided by a midwife/general 290 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
titioner was associated with improved perception of care by women. Clinical ~c tive"l1ess of 1nidwife/genera] practitioner managed ca. re was :similar to that of ec trician/g_vna ecologist led slmred care. The authors concluded that a reducrion ?b~e nuinber of antenata l care visits with or without ~111 increased e1nphasis on the 111 ttent of the visits could be implemented wit J1out any increase in adverse biological con e ·. 1 ( ) t rual and pennat. a outcomes. 8 (11:J e Below is a comparisou or p1·enatal visits from the DOH (9) and the ICSl (1. 0): SCHEDULE OF VISIT Age of ~station (AOG) In weeks DOH Sentrong Slgla ICS1 1 4-16 f, 8 2 17-28 1. 9-12_ 3 29-36 16-18. 4 31-40-22 5 ' 28 6. 32 7· 36 8-11. 38-41 COMPONENTS OF PREGNANCY CARE Health services are in place in our health care delivery system for mothers and their unborn child The essential health care package include: 1. antenatal registration 2. tetanus toxoid immunization ;3. macro11utrient and micronutriuen l supplemen tation 4. treatment of diseases and other condition s 5. early detection. and management of comp1ications of pregnanc y 6. clean and safe delivery 7. support to breastfeeding 8. family planning counseling 9. STD/HIV/ AIDS prevention and management 10. Oral care These are all integrated in acti. vities done by nurses, midwives and doctors during pregnancy visits. A list of what can be expe<:ted in each visit are included in the package of health services (9): First trimester 4-l. 6Weeks . Compute AOG & EDC; prepares Home Based Maternal Record (HB~~), Phy. sl!!:al examination & vit,al signs second ttlmesier Physlcal examination, fundlc height, qulckeninl & vital signs & confirm EOC; update HBMR Physical omlnation, ~Ital signs, fundlc lieight. fetal heart ione EDC; update HBMR Physlcal examination, vital signs, fund~ he 291 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
292 !icreenlng for medlaal problems and danger signs (initiate first ald measures as needed & refer to physician) Provide routine pre8JJBn CV care: -tror, supplement -Low dose Vlt A -Tetanus toxold Immunization -Malarta prophylaxis for endemtc;:,mys -CBC~ Urinalysis 5f. :rean for d~nger signs: -l)allor -bleeding -abdominal pain sc~nfor; -pre-eclampsla {20th week) -~Uonal diabetes (24th week) Urinalv. sts and rand Qm blood sup,;. If available ~avlde 1st ard ' measures, as needed & refer to phv Slctan Pr:ovlda routine pregnanc;v care: -lr. 011. suppfement -Low &is. ; Vitamin A supplement -Tetanus toscold Immunization Sc:l'een for danger signs -Pallor -bleeding , abdominal pain Screen for. : -painless vaginal bleeding -preterm labor headache -puffiness edema Provide routine pregnancy. caret ~ Iron supplement-Low dose Vltamtn A supplement -Tetanus to><(?ld Immunization, · lfineeded. -Repeat, h. emoslob in, protein In urine and ra. nclom bfood sug~lj If available 37-40 weeks Screen for danger signs -Pallor -bleeding .-abdominal pain Screen for: -painless vaginal bleedlng -preterm tabor headache -puffines s edpema ' I Proyide routine pregi:ic1nc;;y care: I -Iron supple merit -Low 9,os. e Vlcamln A supplement ~ Tetanus toxold, immuniz ation, If ne,eded. -J\e'peat CBC/Hgb, "blood.. typing, If available | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
First semester 4-16 weeks provide counseling messages and infdalize birth plan: ~. r,Ji. Jtrlt1Of1 & hygiene olscomforts in pregnancy oo's and don't's 1n pregnancy Warning signs In pregnancy Fertility awarene s-s apd FP Breastfeeding, Child care and family health g Delivery and emergency preparation s schedule'2nd p~enatal visit1~ update 'HBMR / Second semester 17-2Bweeks Provide counsellilg messages and review birth p_lan: -Nutrition & hygiene Dlscomrorts in pregnancy 1 ' D01s and don't's in pregnancy U Warning signs In pregnancy l. Fertility awareness and FP 1 Breastfeeding, Child core and family health l, Delivery and emergency preparal'ions Schedule 2nd prenatal visit & update HBMR If this Is the 1st visit, ensure that 1st trimester activities have been done ANTENATAL REGISTRATION Third Semester Z9-36weeks Provide counsel ing messages and validate birth plan: 17 Nutrition & hygiene 0 Nutrition & hygiene n Do'sahd don't's In pregnancy I, Warning signs In pregnancy [l Fertility awareness and FP. D Breastfeedfng, Child care and family health 0 Delivery and emergency pfeparations D Personal hygiene after delivery Schedule 4th prenatal visit preferab ly 1-2 weeks before dellvery 37-40weeks Provide lnforma-tjon and validate birth plan: [] Do's and don't's 0 [. I 0 l J in pregnancy Warning signs in pregnancy Fertility awareness and FP Breastfeedi ng, Child care and family health Delivery and emergency preparations n Personal hygiene after delivery When a woman comes in for"the first prenatal visit, whicl1 the government ai D1S on the 4th to. 16 weeks of pregnancy, the healtb care provider computes the age of gestation ond the expected date of delivery. 'The home based maternal record (HBMR) is also prepared. (. u) The HBMR is nc!taiaed by the woman anti serves as her "passport" to appropriate healtll care. It is a simple card designed to facilitate the easy recording and interpretution of compre l1ensive information on the health status of a woman before her firi>-t pregnnn<. :y, during ll1e current pregnancy, delivery, postpartum and neonatal periods, and during l,vo subsequent pregnancies. The cards can also be used to record inform. at ion duriug tl1e periods between pregnancies and on the woman's breast-feeding, family planning, and tetanus toxoid immunization status. . TETANUS TOXOID IMMUNIZATION Tetanus is caused by an anaerobic spore forming bacteria called clostridium tetani that enters the body of the newborn through unsterilc techniques in cutting and dressing the umbilical cord. Wh~eit is found in the environment, t11e organism can only survive 293 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
..-First semester Second Semester Third Semester--4-16 weeks 17-28wee ks 29-36weeks 37-4,0 weeks-provide counseling Provlde counseling ' Provide lnforma-tion Provide counsel-messages and messag-cs and Ing messages and validate birth lnltfalite birth plah: review birth plan: and valrdate plan: r J Nutrition & U Nutrition & birth plan: l J Del's and don't's hygiene,, hyglt:me ~ 1 Nutrition & in pregnancy ' ! Discomforts In ' I Discomforts in hygiene 0 Warning signs In-pregnancy pregnancy !. J Nutrition & pregnancy oo's and don't's f Do's and don't's In hygiene i J Fertility I ' in pregnancy preenancy C, Do's and awareness and 1J warning signs 1n l J Warning signs In don't's in FP pregnancy pregnancy pregnancy C Breastfeeding, ' Ferttllty I Fertility 0 Warning signs Child care and awi. lreness and FP awareness ahd FP in pregnancy family health r. ; Breastfe eding, l Breastfeed ing, 0 Fertility U Delivery and Child care. and Child care and awareness and emergency famrly health family health FP, preparations J Oellverv and L Delivery and I] Breastfeeding, 0 Personal hygiene emergency emergency Chtld care and after delivery preparalion!. prepara Hons family health [J Delivery and Schedule 2nd Schedule 2nd emergency I prenatal visit & l prenatal visit & preparations update HBMR update HBMR r, Personal hygiene after H this is the 1st delive(y visit, ensure that 1st trimester acti Vlties Schedule 4th have been done prenatal visit preferably 1-2 weeks before delivery ANTENATAL REGISTRATION When,t woman comes in for the firstprenntnl visit, which the governmen t aims on Lhe 4h L<> 16 w11cks or pnign~mcy. the health care provider computes the age of gestation :incl ll1l' cxpl'ctccl date of delivery. The home based maternal record (HBMR) is also prc:pn 1·c·ll. ( u) Tlw ll BM R is retained by Lhe woman and serves as her "passport" to . tpprnpl'ial c ltl. )alth care. lt b a sirnple card designed to facilitate the easy recording and intcq)l'etation of comprehensi Ye informi\lion 011 the health status of a woman before her lirst pregnancy. during the current pregnancy, delivery, postpartum and nconal. al period:-; antl during t,w, subsequent pregnanc ies. The cards can also be used tn record i11form:1tio11 thu;ng the periods hetween p1·egnancies and on the woman's brcnst-fecding, family plnnning, and tetanus toxoid immunization status. TETANUS TOXOID IMMUNIZAT ION Telanm; is caused by an anaerobic spore forming bacteria called clostrid:ium tetani that enters the body of the newborn through unsterile techniques in cutting and dressing the umbilical cord. While it is found in the environment, the organism can only survive 293 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
in human tis"Ue. <-so environmental eradic.,tio n is not an option. Stanfield et al (1973) report hat 2 d,;,ses of tetanus can protect tbe person for J.-3 years. (1. 2) This protection is most beneficial if tbe last dose of the to:. :oid is given at least 2 weeks before delivery (\\'HO. 2007. p2) Toe international goal is for all women giving birth and all the ~-.-born to be protected from tetanus. (13) The 2003 ~abonal Dem'>graphic Health Survey reports that ·women who received 2 d O$e5 of TT c. le<.-r~ fr<Jm 38% to 37%. Davao Region has the highest cov<::rage at 49. 1% a. id Caga:,-an \'alley at 47. 9%. ARfu'\I as,~;th the 1. 998 NDHS is still the lowest at 23-4"".. followed by CAR at 28. 7% The u. mberofdeaths from tetanus has decreased through the years. [a the 2007. there were 12. i reported cases of neonata l tetanus. In the country sur,eillan ce report of the \VHO. According tu DOH Adrninistrati,·e Order no. 1~ 1995, IT shall be given to women on their 5'" to 6"' month of pregnancy. (14) The list includes the estimated period of protection for the woman when immu. oized (\c VRO 2002, p. 130) (14) 294 cv (ltprd1es s of Period of Protection None 3 vear. s 5 years 10 years All child-beari ng ears The guideline suggests that no woman should be given more than 5 TT doses in her lifetime. \\'ben the woman is inunune to tetanus, she also conveys five (5) months irnmu11ity to the infant. This protects the newborn from neonata l tetanus. MACRONURIENT AND MICRONUTRIENT SUPPLEMENTATION lntel"\·entions fro maternal health include supplementation for folic acid, iron, \'itamin,. \. and balanced energy and protein intake to improve maternal and fetal outcomes. Tht-important years for intervention related to nutrition are frmn pregnancy to two ve..irs of a~I!. Inability to make the essential interventions availabl e causes inm:er.,ible damages and increases the r~sk of girls becoming malnourished mothers, ,,·ho tben ha Yc a low-birth-weight babies (31) MICRONUTRIENT SUPPLEMENTATION : IRON SUPPLEM ENTATION lro11 dcficicncv,1nemia is the most common micronutrient deficiency. It affects the nc,,·hom and infant in ways ranging from low birthwei~ht t:o cognitive problems. Pr1:11,1rnnt women at or 1war :-ea level are ~ah,g(1rized as having anemia if the hemoglobin (HI). ) i,; l<:-,-s thn11 11,:\/dl or hl"rnatocri1 (I let) l~s than 33%. At higher altitudes, people h,w<: hi~her H!i, an<l I-Jct lc\'cls (Fishb Ht Ch and Punning, 21Jo9) (15) Pag:m:. i and Pa~aoa (:mo:i) report that at 51000 fco::t above sea level, a Hg level of less than 14g/dl is indicative of an<. 'n1ia. Thjs information is importl:lnt especially for prrtients living in hi$:h altitude nrcm, (. 10) | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |