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Specialized Fields of Community Health Nursing

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jaymie ann rose camacho

on 27 September 2013

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Transcript of Specialized Fields of Community Health Nursing

School Health Nursing
-School Health Nursing is the application of nursing theories and principles in the care of the school population.
Aims of the program
1. School Services-Maintain school clinic,screening all
2. Health instruction- as health educator/counselor.
3. Health monitoring-
a. Mental Health-substance abuse,sexual health.
b.environmental health- food sanitation, water supply, safe environment, safe toilet.
c. School community linkage-as community organizer.
DepEd Health and Nutrition Center
The Health and Nutrition Center(HNC)
under the department of Education has responsibility to safeguard the health and nutritional well-being of the total school population. it has two divisions: the nutrition division and the health division which has four sections namely: Medical,Dental,Nursing and Health Education.

Determinants of School Health Nursing
* Characteristics of the clientele
* Policies of the Department of Education
* Program of the Department of Health
* Standard of the Nursing Profession

Objectives of School Health
School Health Nursing aims to promote and
maintain the health of the school populace by providing comprehensive and quality nursing care.
Specially, it aims to achieve the following objectives:

Duties and Responsibilities of School Nurses

1. Health advocacy and health education;
2 .Health and nutrition assessment including screening procedures like vision and hearing;
3. Supervision of the health and safety of the school plant;
4. Treatment of common ailments and attending to emergency cases;
5. Referrals and follow-up pupils and personnel;
6. Home visits
7. Community outreach like organizing school community health councils;
8. Recording and reporting of accomplishments;
9. Monitoring and evaluating of programs and projects;

Functions of the School Nurse
1. School health and nutrition program oncludes current health and nutritional status of school children, status of health facilities, and actual status of health education activities being undertaken by the teachers and health personnel;
2. Putting up a functional school clinic for the treatment of minor ailments and attendance to emergency cases as mandated by R.A 124;
3. Health assessment involves
a. Interviewing for data-gathering
b. Through physical examination - percussion, palpation, auscultation and percussion;
c. Taking of vital signs
d. Vision acuity test/ hearing test

e. Appraisal of general physical and mental condition.
F. Recording of findings
4. The nurse looks signs of illness, physical defects and bad health habits. The corresponding health teachings or advice must be given.
5. Standard vision testing for school children and referring child with 20/40 visual acuity or poorer to an eye specialist. Parents should be informed ASAP.
6. Ear examination - the primary concern of the nurse is to detect hearing difficulties or disorders as early as possible through.
a. Observation.
b. Using penlight or otoscope for visual inspection.
c. Conducting screening test like whisper test, conversation voice test, ballpen click test and the tuning fork test.
7. Height and weight measurement and nutritional status determination - to determine the nutritional status children, the DepEd uses weight-for-age and height-for-age indicators for children below 10 years old while the BMI (body mass index) is used for children 10 years old and above which is done at beginning and end of the school year.
a. School feeding programs with rice, milk or fortified noodles - are given to children with below nutritional status for 120 days.
b. DE-worming is done prior to be feeding program and must be accompanied by parents' consent

8. Medical referrals- a student with an existing medical illness or condition may be reffed for further assessment or intervention by the appropriate professional or agency. the parents must return the referral slip duly signed by the medical resource or physician.
9. Attendance to emergency cases - administers appropriate first aid measures and refers immediately to the appropriate medical facility.
10. Student health counseling- especially on matters of emotional and physical problems. Parents and guardians should also be involved in these activities.
11. Health and nutrition education activities- the nurse can do this in both formal and informal settings by:
a. planning and conducting training progams, seminars and workshops on health-related topics involving the students,parents,clinic teachers and other members of the faculty.
b. Acting as a resource person on health-related activities;
c. disseminating relevant finding on health promotion and malunggay and saluyot which are now considered as "miracle or wonder" plants.
12. Organization of school and community health and nutrition councils- where the school and members of the community are its members. The set of officers are encouraged to sponsor or conduct motivated to take active participation in the solution of school community health problems.
13. Communicable disease prevention and control- this is a joint responsibility of the school,parents,students and DepEd. if a student manifest signs of contagious or infectious disease, he/she should be immediately referred and sent home upon notification of the parent or guardian and shall not be permitted until school authorities are fully satisfied that the child is well.

a. Checks the immunization status of the child and encourages compliance to immunization requirements;
b. Aids in early detection;
c. Helps to provide parental notification and information;
d. Makes the necessary medical referrals.
14. Establishment of data bank on school health and nutrition activities
-accurate and updated school health records should contain the following:
a Treatments in the school clinic
b. Records of school visits(RHU and school health personnel)
c. Health Assessment Report of the School Health Personnel

d. Health and Nutritional Status of the students/pupils
e. Form 86 of teaching and non-teaching personnel
f. Teachers' Health profile
g. Records of emergency cases attended to
h. Records of referrals made
i. Inventory of clinic equipment and supplies
j. Health and nutrition activities in school
k. Records of accomplishments of school health services
l. Records of officers/officials of the School-community Health Council and their accomplishments
m. Action plan
n. Performance contract

15. School plant inspection for healthy environment-in addition to the minimun standards for schools, particular attention is given to provision and hygienic maintenance of toilets, school clinics, water supplies,sanitation of school canteen and safety and nutritional values of foods being served.
16. Rapid classroom inspection- is done as routine procedure and may be made immediately after holidays and between health assessments but should not be more than once a month except in cases of epidemics.
a. Detect cases of communicable diseases.
b. Note the corrections that have been made
c. Note if eyeglasses used by the students are correctly adjusted
d. Note the general cleanliness of the pupils
e. Note new ailments

Conducting the Classroom Inspection
1. Choose a well-lighted place like the entrance to a room or corridor and stand with your back towards the light;
2. Instruct the children to line up showing their hands,arms,hair,nose throat,ears,neck,chest,feet and legs and carefully observe for any signs of abnormality,defect or unhygienic practices.
3. Compare present with past findings.
4. If rapid classroom inspection is done in relation to an epidemic carefully observe for signs and symptoms of the disease in question.
5. Record the findings in the school health examination card.
6. Follow-up:
a. Discuss the findings with the classroom teacher and the parents ASAP.
b. Any case found which requires closer and more careful examination should be seen at the clinic and be given intervention or be referred promptly.
* Executive Order No, 14, s.1946 - creation of the Medical and Dental Services granting authority for the voluntary contribution of 50 centavos per pupil for the maintenance of the service.
* RA No, 951 s.1947 - Medical inspection of school children enrolled in private schools, colleges and universities in the Philippines.
* RA No. 847 s.1953 - Return of the Medical and Dental Services from the Department of Health to the Department of Education.
* R.A No. 2620 s.1961 - Nationalization of the Medical and Dental services of the Bureau of Public Schools, Department of Education.
* PD 491 s.1974 - Nutrition Act of Philippines - creation of National Nutrition Council with DECS as a member; designation of July as Nutrition Month.
*LOI No. 764 s.1978 - declaring the School Health Program as priority program of the national government with the aim of educating teachers and school children in the use of medicinal plants as simple remedies for common ailments.
* E.O. No. 234 s.1987- reorganizing the National Nutrition Council - the revised functions of member agencies like DECS have been affected.
Some legal bases of the School Health Program

* PD 603 Child and youth welfare code:
- Art I - general principles- the child is the most important asset of a nation. Every effort should be enacted to promote his welfare and enhance his opportunities for useful, happy life"
- Art II - Promotion of Health - "it should be the responsibility of the health, welfare and education entities to assist the parents in looking after the health of the child"
- Art III - The rights of the Child- "Every child has the right to a balanced diet, adequate clothing, sufficient shelter, proper medical attention and the basis physical requirements of a healthy and vigorous life".
Occupational Health Nursing is the
application of Nursing principles and procedures in conserving the health of workers in all occupations. It aims to assist the workers in all occupations to cope with actual and potential stresses in relation to their work environment. The focus of occupational health nursing is on the promotion, protection,and restoration of worker's health within the context of a safe and healthy work environment.
Determinants of Occupational Health Nursing Practice
1. Government policies and standards.
a. Department of Labor and employment
b. Department of Health
c. Social Security System
d. Philippine Health Insurance Corporation
e. Employees Compensation Commission
2. Professional Standards
a. Occupational Health Nurses Association
b. Philippine Nurses Association

Nursing in the Workplace
1. Focuses on promotion, protection, and restoration of worker's health within the context of a safe and healthy work environment.
2. Aimed at optimizing health, preventing illness and injury, and deducing health hazards.
RA 1054 Occupational Health Act

RA 1054 stipulates the healthcare requirements for occupations. these are as follows:
1. For businesses with <30 employess - OHN services are provided by the PHN
2. For businesses with 30-100 employees and located within 1 km- OHN services are provided by the PHN

3. For businesses with 30-100 employees but are located beyond 1km - an OHN is needed, together with supplies and equipments
4. For businesses with 201-300 employees - OHN, supplies, and equipment are needed
5. For businesses with 201-300 employees - OHN, supplies, equipment, resident physician, and dentist are needed
6. For businesses with >301 employees - OHN, supplies,equipment,physician,dentist,permanent clinic(1:100) or accessible hospital within 2 km are required.

Key Elements of Occupational Health Programs
1. Health Protection- is composed of health risk management at work(health hazard identification, health risk assessment and its control measures, health surveillance, information, instruction and training and monitoring and record-keeping
2. Health Promotion - assessment of health risk associated with workplace, living environment and lifestyle, and employee information and assistance program.
Functions of Responsibilities of the Occupational Health Nurse
PD 856, Chapter VII of the Industrial Hygiene of the sanitaion Code of the Philippines stipulates the following functions and responsibilities of occupational health nurses:

1. Works with Occupational Health Team to lend the sanitary industrial hygiene of all industrial establishments like hospitals to find out their compliance with the sanitation code and its implementing rules and regulations.
2. Recommends to the local Health Authority the issuance of license/business permits.
3. Coordinates with other government agencies relative to the implementation of the implementing rules and regulations.
4. Attends to complaints of all the business establishments in the area of assignment related to industrial hygiene and recommends appropriate measures for immediate compliance.
5. Participate to provide, install and maintain in good condition all control facilities and protective barriers for potential and actual hazards.
6. Informs all affected workers regarding the nature of hazards and the reasons for the control measures and protective equipment
7. Makes a periodic testing for physical examination of the workers and other health examination related to workers' exposure to potential or actual hazards in the workplace.
8. Provides control measures to reduce noise,dust,health and other hazards.
9. Ensures strict compliance on the regular use and proper maintenance of Personal Protective Equipment ( PPE).
10. Provides employees/workers occupational health services/facilities.
11. Refers or elevates to higher authority all unresolved issues in relation to occupational and environmental health problems.
12. Prepares and submits yearly reports to the local and National Government.

Miss magdalena Valenzuela of the Department of Health founded the Industrial Nursing Unit(INU) of the Philippine Nurses' Association in Novemver 11,1950 which is an organization of nurses working as company nurses. The INU was later changed to Occupational Health Nurses' Association of the Philippines,Inc.(OHNAP) on Sept 10,1960. On Sept. 25,1979, its constitutuion and by-laws created a Specialty Board that granted its first Certified Occupational Health Nurse title to its first graduate.

DOH Occupational Health Programs
By virtue of the Sanitation Code of the Philippines, Chapter VII- industrial Hygiene(PD 856), the department of Health is further tasked with the administration and enforcement of sanitary requirements, environmental measures, provision of personal protective equipment and health ervices applicable to all workplace.
The organization of DOH in 2000 left the occupational health program to the national center for disease prevention and control (NCDPC) an environmental and occupational health office (EOHO)
Objective of the Occupational Health program
1. improve the health status of the workers.
2. provide maximum access to the occupational services.
3.develop the skills and aptitude of health personnel on thw anticipation, recognition, evaluation, and control of health hazards and other health and occupational concern
4.reduce morbidity and mortality rates among workers in the workplace.
5.reduce disanility incidence due to work relatev illnesses, diseases and poisonings.
6.establish a monitoring/ reporting system for occupational diseases.
Program strategies/ key result areas

1. establish/ intitutionalize regional occupational toxicology(wherein Mercury Surveillance is
incorporated) and Poison Control Center.
2. Intergration of Occupational Health Services ( OHS) as part of the primary Health Aprroach.
3. Upgrade manpowert capabalitiy of health personnel and existing facilities.
4. Preventive and promotive occupational health strategies.
5. Toxicovigilance activities.
6. Advocacy campaign through the "Healthty Workplace" initiative.
7. Research.
8/ Multi-agency linkages
Community Mental Health Nursing
Mental Health

Mental health is defined as a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively. The emotional adjustment thath a person can involvee the promotion of a healthy state of mind among the whole population through:
* Developing positive outlook
* Strengtheing coping mechanisms
Stresses in the environment of chidlren such as times of disasters and natural calamities, disistegrationn of the values, structure functions of the family and urbanization, migration,drugs, and physical and sexual abuse and poverty have direct effects on physical and mental health
Trend in Mental Health
The modern trend in the care of the mentallly ill is usually home care management. Acute cases are refered to and treater at the National Center for Mental Health (NCMH) or hospitals with facilities for psychiatric care/management where they are later discharged or confined suoervusuib ir care is needed.

The aim of school health nursing is to promote the health of school children and prevent health problems that would hinder the learning process and performance of their developmental task. health is considered an important requisite for education.
Occupational Health Nursing
Specialized Field Community Health Nursing
Community Mental Health Nursing

Community Mental Health Nursing is a unique process which an intergration of concepts fromm nursing, mental health, social psychology,psychology,community networks and the basis sciences.
Vulnerable Groups
Vulnerable groups to the development of mental illness include women,street childre,victimes of torture or violence,internal refugees,victims of armed conflicts, and victims of natural man-made disasters.
With the shift to community mental health care, the nurse should use to bio-psycho-social perpective when working, in partnership with the patient, his family and the community in order to understand their needs and conduct health promotion activities on a holistic basis.
The focus of community mental health nursing is on mental health promotion. There is no need to indentify the disease as it aims to increase mental wellness of people. This is different from psychiatric Nursing where it is focused on mental illnes prevention which aims to identify psychiatric conditions and shorten the disease process.

Components of the Mental Health Program
* Stress Management
* Drugs and Alcohol abuse Rehabilitation
* Treatment and Rehabilitation of Mentally-ill Patients
* Special project for vulnerable Groups
Mental Health in the Philippines
The first known organized care for the mentally ill was established in the last 19th century at the hospicio de San Jose, for sailors of the Spanish naval fleet. The Americans, in the 1900s, gradually transformed the treatment of mental illness from the use of traditional indigenous medicines to a more scientific approach. Two Americal phsyicians opened a clinic for mentals disorders, using somatic treatments, such as fever therapy, insulin schock therapy, lock's solution, barbiturates and electro-convulsive treatment.
* 1904- the first 'insane Department' was opened in a goverment hospital
* 1918 - the City sanitarium was built
* 1928 - the mentally ill were tranferred to National Psychopatic Hospital in mandaluyong where it is now called as the National Center for Mental Health
For almost five decades, the mental health program has largely been centered on the treatment of those with mental disorders in a mental hospital setting. There are now efforts to establish psychiatric wards in university and private hospitals but these small units are unable to respond to theneeds of the growing number of patients with mental disorders.
* 1950- the Philipine Mental Health Association was organized which is an non-goverment civic association.
*1986- the newly appointed Secretary of Health created a project team for mental health composed primarily faculty members from university psychiatric departments who worked closely with the staff of the national mental hospital.
*988-1990 - a multi-sectoral consultation led to the organization of the National Program for Mental Health (NPMH) at the department of Health.
Mental illness in the Philippines
In 1993-1994, a population survey for mental disorders was conducted by the University of Philippines Psychiatrists Foundation Inc, in collaboration with the Regional Helath Office. The study areas covered both urban and rural settings in three provinces (region VI).
The prevelence of mental disorders was 35%. The three most frequent diagnoses among the adults were:

1. Psychosis(4.3%)
2. Anxiety(14.3%)
3. Panic (5.6%)

For children and adolescents, the top five most prevalent psychiatric conditions were:
1. Enuresis(9,3%)
2. Speech and language disorders(3.9%)
3. Menta sub-normality (3.7%)
4. Adaption reaction (2.4%)
5. Neurotic disorder (1.1%)
1988 National Program for Mental Health
The NPMH, in recognition of the prevailing conditions and their mental health implications, identified five priority areas of concern.
1. Patients with mental disorders
2. Victims of disasters and violence
3. Street children and victims of child abuse
4. Substance abusers
5. Overseas workers
The department of Health organized a Task Force on Mental Health to imokement the National Program for Mental Health which organized mental health coordinators in all regions of the country. These are psychiatrists and other mental health professionals who implemented the programs for the identified mental health priority ares in collaboration with the regional and provincial health authorities.
The initial multi-sectorial consultation facilitated the presentation by the Task Firce if its mental health priority areas of concern to the agencies in the goverment and other sectors of society together with the following agencies:
1. DOLE concerning programs for overseas workers;
2. DSWD in relation to their programs for family, women and child welfare and protection;
3. National Defence Department regarding disaster management through its National Disaster Coordinating Council;
4. Local goverment departments in implementing their own programs as well as in initiating community mental health programs, especially the intergration of mental health care in primary health care;and
5. Presidential Drug Enforcement Agency (PDEA) collaborates with the NPMH regarding the country's substance abuse programs.

The Department of Health (through the NPMH) supervises and monitors the drug treatment and rehabilitation facilities as well as the laboratoties where drug testing takes place. In addition, the NPMH, in collaboration with the University of the Philippines Psychiatrists foundation Inc(UPPFI), a non-govermental organization, composed of the facult Psychiatry frim the University of the Philippines, organized a Mental Health Task Force in Disaster, which conceptualized implements the psychosocial intervention program for victims of the series of disasters that have affected the country since 1990.
Mental Health Legislation and Policy
There is no mental health law in the Philippines. The laws that govern the provision of mental health services are contained in various parts of the Administrative and Penal Code promulgated in 1917.
The prevention, treatment and rehabilitation from substance abuse are covered in the Dangerous Drugs Act(which was revised in 2001). A Dangerous drugs Board is responsible for the policy; a Presidential Drug Enforcement Agency implements the policy and the Department of Health supervises and monitors the laboratories where drug testing, treatment and rehabilitation take place.
In April 2001, the Secretary of Health signed the National Mental Health Policy, which is now known as Administrative Order No.5, series of 2001. The document contains generic goals and strategies for the Mental Health Program. Although signed in April 2001, the policy has still to be presented and implemented by the various stakeholders in mental health.
2002 National Mental Health Program
The current National Mental Health Program (NMHP) reactivated in 2002 has been placed under the administrative authority of the undersecretary of Health for Operations.

Study data regarding the prevalence of mental illness in the Philippines in the Lubao study (1970s) revealed that 10.8%-17.2% of adults and 18.6%-29% of children consulting a health center were found to have psychiatric problems. Seventy-five percent(75%_ of mental illnesses presenting at health centers were not recognized by the health workers in the sapang palay study.
Resultss showed a prevalence of mental illness in 12 per 1000 people (the internationally recognized rate is 1/1000). If the above data were extrapolated (taking into account that the Philippines has a population of over 80 million), then the figures of mentally ill pople accrdinng to the lubao data would exceed 2,4600,000 and 720,000 according to the sapang palay data. The differences between these two rates is that the lubao study included mild cases of mental illness whereas the sapang palay study restricted its data to those with moderate to severe mental illness.
The above data only pertains to those who are identified as having a psychiatric illness and not those who may have psychosocial or minor psychiatric problems (conde,2004).
The NMHP has identified six areas of concern in which it need to give priority,namely:
1. Mental disorders;
2. Subtance abuse;
3. Disaster and crisis management;
4. Women, children and other vulnerable groups;
5. Epilepsy;
6. Overseas Filipino workers
With the exception of epilepsy, the other five areas of priority were already provided for in the previous National Mental Health Program. In the treatment of mental disorders,the NMHP has articulated its support for the policy shift from mental hospital-based psychiatric treatment
Community-based mental mental health care. This integration of mental health care in general health services proposes, as a first step, the opening up of acute psychiatric units and outpatient clinics in 72 government hospitals and the provision of psychiatric drugs. So far, primarily because of budgetary constraints, only 10 hospitals have opened and outpatient clinic. For those hospitals that have opened clinics, the NMHP has provided guidelines and recommendations as to the standars of psychiatric care.
Lusog-Isip program
The NMHP has sustained its Lusog Isip (Mental Health Program and considers this its flahship program because the Department of Health has integrated it into some of its programs, especially its Healthy Lifestyle Theme.

Lusog Isip is an annual advocacy and mental health promotion program directed and mental health concerns other than mental disorders.
A 'life course' approach has been adopted and its yearly promotions have ranged from mental health in children and adolescents to stress in the workplace. Stress management programs for health workes and goverment employees have been positively recienved and have given NMHP futher credit.
Nursing Responsibilities and Functions
1. In mental Health Promotion
a. Health education/teachings focusing on the promotion of meantal health among families and the community.
b. Organize parents' classes where developmental stages and pereios of crises in the child's development are taken up with the parents using interctive approaches like discussion, role-playing, film-showing,sociodrama, or talk show format.

c. Discuss the roles of parents in the care and emotional support of their children and their active participation during critical perios like onset of menarche or milestones in their lives like first day in school, and graduation, among other.
2. In prevention and Control
a. Conduct case-finding activities especially among members of families with history of mental illnesses in your community.
b. Be aware if the signs and symptoms of developing mental illness and do early referral so that diagnosis and treatment can be done at an early stage.
c. Encourage verbalization of the client's fears and anxieties by providing d listening ear and carirng behavior.
3. In Rehabilitation
a. Encourage the patietn' participation in occupational activities that are suited to his/her interests, capabilities expirience and training.
B. Advise the family on the importance of regular clinic isits by the patient and make regular home visits for observation of patient and follow up of medications.
4. In Research and Epidemiology - Participate actively in epidemiological survey to be aware of the size and extent of mental health problems of the community and organize a program for better preventive, curative and rehabilitative measures.
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