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7. 2 Iftl1ere was improvement and no other sign or symptom developed, advice the patient to continue the above management for at least five more days. 7. 3 If there were no improvement, ask the patient if any new symptom had developed since the last visit; if any red symptom has developed, do the following :. 7. 3. 1 examine the patient for any red signs which could have developed since the patient's last visit. 7. 3. 2 proceed with either Plan B or Plan C depending on the presence or absence· of red signs or symptoms. 7. 4 If there were no. improvement and no new sign or symptom had developed since the last visit, proceed with Plan B. PLAN B: 1,0 Refer the patient to a doctor within 24-48 hours. 2,0 Advice the patient to do the following supportive management: 2. 1 stop smoking or avoid exposure to smoke; 2. 2 avoid crowded places; 2. 3 drink plenty of water and juic. e but not caffeine or cola-containing drinks; 2-4 have steam inhalation for 10-15 minutes as often as the patie. nt likes; there is no need to add anything to the v,1ater; 2. 5 drain mucus from the lungs by postural drainage following the procedure described section 3. 5 in Plan A; 2. 6 continue taking the antihypertensive medicine until patient is seen by the doctor; 2. 7 continue taking the medicine for ulcer until patient is seen by the doctor; 3. 0 Provide the doctor with the necessary clinical record or referral note containing the brief history of the disease, pertinent physical examination findings result of laboratory examination (if available) and initial management started at the referring level. (see Figure 3. 2 for a sample referral fom1) Plan C: 1. 0 Refer the patient immediately to a hospital, preferably the nearest one. 2. 0 Make the patient as comfortable as possible. 3. 0 If the patient coughed out large amount of blood, do the flowing: 3. 1 give tranexamic acid by mouth if patient is no longer vomiting or vitamin K preparation by parenteral route if available and patient is not in a position to take anything per orem; 3. 2 place ice on the patient's chest. 4. 0 Provide the doctor with the necessary clinical record or referral note containing the brief history of the disease, pertinent physical examination findings result of laboratory examination (if available) and initial management started at the referring level. (see Figure 3. 2 for a sample referral form) 393

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

394 ASSESSMENT PROTOCOL FOR PROBLEM ON SKIN LESIONS: ADULT PATIENT (Logic Tree No. 9) DIRECTION: Determine/identify which of the following symptoms/signs (S/S) or history dnta (Hx D) are present and follow the Howcharl for the appropriate plan of management. RED BLUE YELLOW GREEN S/S or Hx D S/S or HXO S/S or Hx D S/S or Hx D Reddish. swollen, P-atient had sexual Numbnes:-on the Patient ale or drank p,)inful pal th 1;:ontact two areas of th~ skin !. Omcthln J-1 or which srarted to five wc·e ~s lesion· got in contact on tt'ie f. icc and before the ~ore loss of ;,poetitc with !. omcthi11c rapidlv spread to appeared Markr. d wcieht loss sevcr·al minu1cs the oth~r parts Boil is "ripe.. or has Wound or sore has before the al the body. r LJpturcd been there tor le!. 1ons were Altered level of Ory scaly leslon. s $(~veral month~ noted c0Mclousnes1 involving large Lare~ sores or uleer. s Lesion~ are vetry flke confu~cd, area, ol the lesfon appear i H Itchy very Jl~cpy or body rings with small II chlness more unl'onsdous Pocket!. of pus pit in the middle !>evcrc in the- No1tr1fs !apret)d our noted on the Sores noted at the-evening w,th ei Jdl breath acne. f. 11mple or-cornt?r of the Other members of Skin behind the ln>ect bite mouth the family ai,o collar bont' and Non.. parnful toll'e on Swollen feet 1. 1ffccted between 1he ribs the genitalia Affected area could Body wcatme-)S sucli. cd tn when not feet anything Hi,tory of all~rgy to Inhaling when touched food. medicine, Patient fooh very gently with,05mctic, sick sharp pointed jewelry, rubber, 4 Fast but weak pul'. e objl!cts (?l C. Cool, rno,~t. pale History of asthm~ grey skin. Family has history Bllsleri of allergy or ln\/Olved the asthma whole body ar a . Small ~ore-s noted gr~. iter part of,t mainly betwee-n Grayi,h pr blackish the Hritcr!», foul S-mell,ng wrist, wah:t and/ ulcer or eenitals Mas1cs on 1he neck1 armpit. and/or e,oln (enlarged lymph-nodes) Crusting of the leslon . Ory scaly lesions Involving only sma Uarcas Wet,,. weeping skin lesions flat or raised pate. hes noted on the foce. skin folds, scalp, knees and/or elbow

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

at least one RED s/s or Hx D No at least one BLUE s/s or Hx D 1-~--1~0~ LOGICTREE fi,. QWq_f Aflf '-f O, I Yes Yes _,_ __ _, ______, Yes at least one YELLOW s/s or Hx D l No at least one GREEN s/s or Hx D No l Proceed with Plan 8 395

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

\ I \ \ ' I l.. I l l !. MANAGEMENT PROTOCOL FOR PROBLEM ON SKIN LESIONS: ADULT PATIENT (FLOW CHART NO. 9) PLAN A: 1. Determine knowledge of the patient or his companion on the management of the problem presented. 2. Based on 1. 0, do the fo Uowing if the skin lesion is a sore or ulcer especially if it is large. 5. 2. 1 Clean the sore with hydrogen pero:-. ide. povidone iodine, or plain soap and water then cover "ith a sterile gauze. Mild ~1a,·a decoction can also be used to clean the wound. 2. 2 Do not use any strong anti'septic solution like tinctures or alcohol. 2. 3 Ad,ise the patient to ba,·e the wound cleaned everyday or every other day. Based on 1. 0, advise the patient to do the following ifhe has acne or pimple. 3. 1 Wash the face at least twice a day with mild soap and water. 3. 2 Use astringent before going to bed or to use Perla soap (the white one) when washing the face at night. 3. 3 Do not scratch, touch or squeeze the pimple especially ifit is near the eyes or around the area of the nose or mouth. 34 Eat a balanced meal and avoid fatty or oily foods, or those rich in iodine. 3. 5 Drink plenty ofliquid like water or juice. 3. 6 Have enough sleep. 3. 7 Let the sunshine fall on the affected area. Based on 1. 0, do the foll O\\ing if the patient bas very itchy skin lesions and allergy, eczema or contact dermatitis js suspected. 4. 1 Give/prescribe over-the-counter antihistamine preparation specif)i. ng accuratelr the dose and frequency o( intake. 4. 2 Advise the patient not to operate any ma·chine, drive a '(ehicle or cross tl1e street alone while under treatment since tl1e medicines can make the patient very sleepy. 4. 3 Advise the patient or his companion to apply on the affected area any over-tl1e-counter lotion or cream or herbal medicine for itchiness. specifying accurately the method of preparation (specifically for herbal medicines) and the frequency of application. 4. 4 If the affected area is warm. advise the patient or his companio n to apply cotton or gauze soaked in cool salt solution for one hour three times a day. 4. 5 Advise the patient's companion to keep the patient's fingernai ls sl10rt or to put gloves/ mittens over the patient's hands to protect him from scratching himself. 4. 6 Advise the patient or his companion to avoid substances which could have caused the allergy, like chocolate, eggs, chicken, sea foods, cosmetics esp. perfumed ones. Based on 1. 0, advise the patient to do the following ifhe has a boil. 5. 1 Do not squee1. e or cul the boil i. fit is not yet "ripe". u,. ____ 3. 96-------------------------------

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

8. 9. 10. u. 5. 2 Apply wnrm compress over the boil and paint the surrounding area with tincture of iodine or povidone iodine solution 5. 3 Return to the clinic for follow-up if the boil is already uripe". Based on 1. 01 advise the patient or his companion to do the following ifhe bas patches or rings and fungal infection is suspected. 6. 1 Shave the head if sc. 1\p is affected. 6. 2 Apply calamine lotion if areil is reddislt. 6. 3 Apply antifungal ointment or gentian violet twice a day for at least three weeks. Based on 1. 0. advise the patient or his companion to do the following ifhe has small sores on the wrist, waist, genital area or between the fingers and is very itchy especially at night. The patient is most likely suffering from scabies. 7. l All household members (even il they have no complaint) must undergo the same treatmcnl. 7. 2 Bat J. 1e and scrub the whole b-ody especially the affected areas with sulfur soap and water. 7. 3 Apply bcuzyl benzoate, or any preparation for scabies, all over the body except for the face and leave it there for one whole day (24 hours) except rf househo ld member is a baby. 7-4 Bathe well the following day. 7. 5 Put on clean clothes and change the beddings. 7. 6 Was and boil contaminat ed clothes, towels and beddings. 7. 7 Repeat the procedur e twice at the most ifnecessaxy. 7. 8 Remind the patient and his companion the importance of personal cleanliness. Based on 1. 0, advise the patient or h. is companion to do the following if the skin lesion is dry, scaly and reddish. 8. 1 Take warm baths daily, gently rubbing the lesions with a soft brush. 8. 2 Apply calamine, starch solution or bland ointment containing 10% coal tar. 8. 3 Expose affected area to sunlight for 10-15 minutes everyday at around 10-11 am. Advise the patient to have a follow-up after five days. Do home visit if the patient fails. to return for a follow-up. Do the following during the follow-up. 11..1 Ask the patient or his companio n if the patient's condition ·has improved sin. ce the manageme nt was started. 11. 2 If there were some improvement, advise patient or his companion to continue the management until the signs and symptoms have disappeared completely. 11..;3 If there was no improvement, ask the patient or bis companion if any symptom developed since the last visit. 11-4 Examine the patient for any signs which could have developed since the last. visit. n. 5 Proceed. with Plan B, C or D depending on the signs and/or symptoms identified. 397

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

PLAN B: 1. 0 Refer the patient to a doctor within the week. 2. 0 If there are sores, advise the patient to clean it daily,vith any antiseptic solution like those containing povidone iodine, mild soap and water or mild guava decoction. 3. 0 Provide the doctor with appropriate clinical record or referral note containing a brief history, pertinent physical examination, laboratory result (if available) and management initiated at the referring level (see Figure 3. 2 for a sample referral form). PLAN C: 1. 0 Refer the patient to a doctor witl1in 24-48 hours. 2. 0 lf there are sores, advise the patient to clean it daily,vith any antiseptic solution like those containing povidonc iodine, mild soap and watex or mild guava decoction. 3. 0 Provide the doctor with appropriate clinical record or referral note containing a brief history, pertinent physical examination findings, laboratory results (if available) and management initiated at the referring level (see Figure 3. 2 for a sample referra J form). PLAN D: 1. 0 Refer tlle patient immediately to a hospital, preferabl y the nearest one, since tlle patient might be suffering from a severe allergic reaction, from Gas Gangrene or Erysipelas 2. 0 Make tlle patient as comfortable as possible. 3. 0 If there is fever, try to lower the patient's temperatu re by doing the following: 398 3. 1 Cover the patient lightly. 3. 2 Give the patient a quick sponge bath using tap water. 3. 3 Apply cold compress or ice cap over the patient's head. Provide the agency where the patient is being referred to with appropriate clinical record or referral note containing a hrief history, pertinent physical examination findings, laboratory results (if avar Jable) and management initiated at the referring level (see Figure 3. 2 for a sample referral form).

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

ASSESSMENT PROTOCOL FOR PROBLEM ON BODY WEAKNESS: ADULT PATIENT (Logic Tree No. 10) DIRECTION: Dc::termine/identify which of the following symptoms/signs (S/S) or bjstory data (Hx D) arc present and follow the flowchart for the appropriate plan of management. RED YELLOW GREEN 5/S or Hx D S/S or Hx O S/S or Hx D Weakness of only one Feels thirsty very often Generalized weakness or certain groups of Complains of frequent Patient has passed out muscles urination with worms recently Weakness precipitated normal or increased Patient has just by doing light work volume of urine recovered from an like sweeping the Feels hungry often illness floor or taking a bath Marked weight loss and Patient has some Difficulty of breathing the patient is not serious problem at even when at rest under any weight home, sc~ool or in Patient has a history of reduction program the office heart problem Frequent skin infection Masses (enlarged lymph Altered level of which tak. es time to nodes) along the consciousness like heal neck, armpit or groin patient is delirious, Family history Swollen face very sleepy or revealed 'that some Ory loo. se skin with unconscious relatives have or had sores In some areas Patient is severely diabetes Uneven discoloration malnourished Patient is malnourished of the hair, usually. (severe third degree} based on his weight streaks of yellowish- Nostrils spreading out Marked paleness of the brown hue with each breath lips, nail beds and/or Slight paleness of the Skin behind the inner aspect of the lips, nail beds and/or collarbone and eyelids inner a. spects of the between the ribs Pain when finger is eyelids sucked in when pressed gently over Sores at the corner of patient inhales the right upper the mouth Patient has slurred abdomen- Sunken eyes speech Abnorma l mass any Dilated and raised neck where In the body veins pulsating well above the collarbone with the patient in a reclining position Inequality In the strength of the left and right extremities Swelling of the 'feet or legs (both sides) 399

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

at least one RED s/s or Hx D No at least one YELLOW s/s or Hx D No at least one GREEN s/s or Hx D No Proceed with Pl,m A Yes No Improvement Proceed with Plan C Proceed with Plan B No at least one RED /s or Hx D since last visit in the patien·t's +,o--.,-t... i advice the patient condition Yes

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

MANAGEMENT PROTOCOL FOR PROBLEM ON BODY WEAKNESS: ADULT PATIENT (Logic Tree No. 10) PLAN A: J,0 2. 0 3. 0 Determine knowledge of the patient or his companion on the management of problems presented. Based on J. 0, do the following if patient is suspected to be suffering from parasitism. 2. 1 Give/prescribe over-the-counte r medicine or herbal medicine for parasitism specifying accurately the method of preparation {specific. a lly for herbal medicine), the dose and frequency of intake. 2. 2 Advise patient and/or his companion on how to prevent the recurrence of parasitism. 2. 3 Advise patient to have follow-up after one week Based on 1. u, do the fo Uowing if patient has pale lips, nail beds and/or inner aspect of eyelid and anemia is suspected. 3. 1 Give/prescribe over-the-counter medicine for anemia specifying accurately the method of preparatio n the dose and frequency of intake. Advise the patient to take the after eating. 3. 2 Advise him to cat iron-rich food like liver and bitter melon {ampalaya or amagroso) and green leafy vegetables. 3. 3 If anemia is due to par"°5itism, follow instructions above for suspected parasitism case.. 3. 4 Advise patient to have follow-up after one month or earlier if any yellow or red sign or symptom develops. 4. 0 Based on 1. 0, do the following if patient is slightly malnourished or patient just recovered from an illness: 4. 1. Give/presc ribe over-the-counter multivitamin preparations specifying accurately the dose and frequency of intake. 4. 2 Give the patient protein-rich foods like fish and beans. 4. 3 Serve the food in an appetizing manner 4-4 Give/prescribe rtiilk (non or low fat) unless patient cannot tolerate milk. In case patient has milk intolerance, give/prescn1>e soya milk. 4. 5 Advise patient to have follow-up after one month or earlier if any yellow or red sign/symptom develops. 5. 0 If there is no evidence of disease and patient seems to have some serious problem at home, at work or in school, tcy to help him solve the problem, referring to the appropriate person or agency if necessary. 6. o Do home visit if the patient fails to return for a follow-up. 7. 0 Do the following during the follow-up 7. 1 Ask iftl1~re was some improvement in the patient's condition since the last visit. 7. 2 If there were some improvement in the patient's condition, advise the patient or his companion to do the following: 7. 2. 1. Repeat treabnent for parasitism after six months if patient suffered from parasitism. 401

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

402 7. 2. 2 Continue multivitamins or iron preparation until the patient"s conditi1Jt1 has completely resolved. 7. 2. 3 Continue taking the milk and other protein-rich food. 7. 3 rf there was no improvement, ask the patient or his con1panion if new symptoms hnvc developed since the last visit. 7. 4 Examine the patient for any new signs which could have developed si nee the last visit. 7. 5 Proceed ";th Phrn B or C depending on the signs and/or symptoms identified. PLAN 8: 1. Refer the patient to a doctor within the week 2. If diabetes is suspected, advise patient to avoid sweets, soft drinks, instant powdered juices and processed/ca1med foods. Advice patient also to minimize use of sweeteners, nnd Hmit intake of carbohydrates and fatty foods. Diabetes Sll Spccted if nny of the following is present: 2. 1 Feeling thirsty very often (Polydypsia). 2. 2 Frequent urination \'lith normal or increased volume of urine (Polyuria) 2. 3 Feeling hungry often (Polyphagia). 2-4 Marked weight loss and U1e patient is not under any reducing program 2. 5 Frequent skin infection. 2. 6 \. \found sometimes takes longer time to heal. 2. 7 Family history revealed that some relatives have or had diabetes 3. Provide lhe doctor with appropriate clinical record or referral note containing a briefhist OI} ', pertinent physical examination findings, laboratory results (if available) and management initiated at the referring level (see Figure 3. 2 for a s. tm]Jle referral form). PLAN C: L Refer the patient immediate ly to a hospital (preferably the nearest one) since the patient might be suffering from stroke, heart failure, severe malnutrition or severe diabetes. 2. Make the patient as comfortable as possible. 3-Do not give t J1e patient any t Jt. ing by mouth unless the patient is fully conscious. 4-Provide tbe agency where the patient is being referred to with appropriate cl. inica J record or referral note containing a brief history, pertinent physical examination findings. laboratory results (if available) and management started al the referring level (see Figure 3. 2 for a sample referral form).

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

ASSESSMENT PROTOCOL FOR PROBLEM ON ABDOMINAL PAIN, EPIGASTRIC: ADULT PATIENT (Logic Tree No. 11) o JRECTION : Deten11ine/idcntify which of the following symptoms/signs (S/S) or history data (Hx D) are present and follow the flowchart for the appropriate plan of managemen t. RED YELLOW GREEN S/S or Hx D S/S or Hx D S/S or Hx D Severe pain, that is, it Pain moderate in Mild or tolerable pain is severe enough to intensity Pain described as interfere with sleep Recurrent or persistent burning or g. nawing or daily routine abdominal pain Pain is localized at the Sudden onset of pain Fatty food intolerance epigastric area Shortness of breath. or abdominal pain Pain occurred several Dizziness occurring about 2 hours after a meal or Vomiting of blood hours after a heavy in the middle of the Pain radiates to your or fatty (or oily) meal night chest, neck or Yellowish color otthe Pain relieved by food shoulder skin and/or eyes intake Blood in the stool or Temperature of 38. 60C Low grade fever stool Is black and above (temperature of Very tense or hard Pain when fingers 37. S0C to 38. S0C) abdominal wall are pressed gently Headache f>ati·ent Ii. es very quiet over the abdomen Loss of appetite to avoid making the especially over the Previous history of pain more severe epigastric area and eplgastric p. ain or Fast, shallow breathing right upper abdomen peptic ulcer disease and/or weak pulse Nausea and/or Patient took medicine that may be irregular vomiting for diabetes (like Cold clammy skin insulin, Diabenase and Euglucon) several hours before onset of condition. Body weakness Abdomen sounds. hollow when tapped . gently. 403

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

!I I I Yes N0. 11 Proceed with Plan C Proceed with Plan B No at least one RED s/s or Hx D since last visit Yes d

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

MANAGEMENT PROTOCOL FOR PROBLE M ON ABDOMINAL PAIN, EPIGASTI C: ADULT PATIENT (Flowchart No. 11) pl. AN A: 1. 2. 3. 4. 5. 6. 7. 8. Detennioe patient's knowledge on the management of problems presented. Based on 1. 0, give the patient sugared water or candy or sweetened juice if the epigastric pain occurred 4-5 hours after a meal or when the patient took medicine for diabetes before onset of the symptoms since the patient is more likely suffering from hypoglycemia or low blood sugar level. Based on 1. 0, do the foll O\";ng if hyperacidity, gastritis or ulcer is suspected: 3. 1 Give/prescribe over-the-counter antacid specifying accurately the dose and frequency of intake. 3. 2 Advise the patient to stop smoldilg, eating spicy or sour food, and drinking coffee, tea, cola drinks and/or alcoholic beverages. 3. 3 Ad,..;se patient to take small frequent meals (like taking small meals every hour). 3-4 Advise patient to avoid taking medicines which are irritating to the stomach like aspirin, erythromycin or medicines for arthritis. Based on 1. 0, do the following in case of gas pain: 4. 1 Advise patient to lie flat on his abdomen. 4. 2 Give/prescribe over-the-counter anti-flatulent preparation specifying accurately the dose and frequency. Based on 1. 0, manage the patient's fever if such sign and symptom is present. Advise patient to have follow-up after five days or earlier if any RED or YELLOW sign and/ or symptoms develop. Do home visit if the patient fails to come back for a follow-up. Do the following during the follow-up 8. 1 Ask the patient if there was some improvement in his condition. 8. 2 If there were some improvement, advise the patient to stop the medication when signs and ·symptoms disappear. 8. 3 If there was no improvement, ask the patientif new symptoms have developed since the last visit. 8. 4 Examine the patient and identify signs which developed since the last v;sit. 8. 5 Proceed with Plan B or C depending on the way new signs and symptoms identified. PLANB: 1. 0 Refer the patient to a doctor within 24 hours. 2. 0 Determine patient's knowledge on the management of problems presented 405

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

3. 0 Based on 2. 0, manage the patient'. s fever if such sign and syn1ptom is present. 4. 0 Based on 2. 0, advise the patient to avoid oily or fatty foods and alcoho Hc beverages. · 5. 0 Provide the doctor \vitb appcopriate clinical record or referral note containing a brief history, pertinent physical examination findings, laboratory results (if available) and management initiated at the referring level (see Figure 3. 2 for a sample referral form). PLANC: 1. 0 Refer the patient immediately to a hospital, preferably the nearest one, since the patient might be suffering from a heart attack or stone in the gall bladder \vith or without infection. 2. 0 Make the patient as comfortable as possible. 3. 0 Keep the patient as calm as possible. 4. 0 Do the following if there is a fever: 4. 1 Cover the patient lightly. 4. 2 Give the patient a quick sponge bath with water and alcohol or ice. 5. 0 Provide the agency /person where the patient is being referred to \.,,jtb appropriate clinical record or Tefe:rral note containing a brief history, pertinent physical examination findings, laboratory results (if available) and management initiated at the referring level (see Figure 3. 2 for a sample referral form). 406--

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

ASSESSMENT PROTOCOL FOR PROBLEM ON INSOMNIA: ADULT PATIENT (Logic Tree No. 16) DIRECTION: Determine/identify which of lhe following symptoms/sig_ns (S/S) or history data (Hx D) are present and follow t J1e flowchart for the appropnale plan of management. YELLOW S/S or Hx D Condition has been present for more than six months Insomnia is due to withdrawal from alcohol or drugs tor nervousness Patient is depressed, feels worthless, hopeless or guilty Patient felt some difficulty in thinking as manifested by either inability to concentrate or lack of decisiveness Loss of interest and pleasure in life with the patient withdrawing either partially or completely from work Patient is in an over enthusiastic mood getting involved in so many activities and feels little nee·d for sleep Patient has some hallucination or delusions Toothache Joint pain Tooth decay or gum swelling swelling and/or redness of a painful joint Patient looks untidy and unkept Patient is either elated or depressed Patent's emotiona l reaction is not appropriate for what he is saying or doing Patient's stream of talk is Incoherent He has sexual or religious preoccupation He is easily distracted from what he is doing or saying GREEN S/S or Hx D Itchiness of the anus at night Patient works very hard and he usually feels physically and/or mentally tired at the end of the day Sudi:len change in the daily routine like there is a newborn to be taken cared of or somebody in the family is sick There are some serious problems or pressure in school, office or at home Patient just suffered some adverse life situation like death of a loved one or loss of a job Faulty habits like taking after noon nap until late in the afternoon or going to bed hungry or immediate ly after a heavy meal or drinking coffee/tea after dinner or doing mental activity (like doing the assignment) after dinner Patient is alert and in touch with reality Redness or irritation of the anal area Patient looks tidy and clean · Patient's emotional reaction is appropriate for what he is saying or doing Patient's stream of talk is coherent Patient has no hallucination, delusion or_ Preoccupation A07

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

l \ ' \ \It ·.. ' ' t ' 408 Proceed with Plan B vement patient's ;.....-..1 . n No

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

MANAGEMENT PROTOCO L FOR PROBLEM ON INSOMN IJ. \: ADULT PATIENT (Logic Tree No. 16) p LAN A: 3· 6. Determine knowledge of lhe patient anc J/or his companion on the management oftlic problem presented. Based on J. o, advise lhc paticnt to do the following is caused by severe itchjness of the anal area al night (patient is most likely suffering from parasitism): 2. 1 Give/prescribe over-the-counter mc<licinc or herbal medicine 2. for parasilfam specifying accurately the method of preparation (specifically for herbal medicine), the dose,md frequency of intake. 2 Advise p. 1tient to observe cnvin. inmcnlal and 1>crsonal cleanlinesi; to avid r·ccurrencc <Jf purasitism. Based on 1. 0, advise patient to do the following if the insomnia is due to faulty habits (like laking a nap unli J late in t J1e afternoon, going to bed immediately i1f1. cr a heavy rnc,d, going to bed hungry, drinking tea or coffee after diner or indnlging in ment:11 activity after dinner). 3. 1 Change the faulty habit: 3. 1. 1 When te1king an afternoon nap, do not sleep until late in the · afternoon (beyond three o'clock in the afternoon) 3. 1. 2 Avoid drinking coffee, tea (except Chamomile tea or other non-caffe ine containing tea) or cola drinks late in the day cspccial. ly after runner. 3. 1. :1 Do the assignment or any mental activity early preferably before dinner. 3. 1-4 Try to relax both the mind and body after dinner. 3. 1. 5 Avoid watching stressful programs in the evening. 3. 2 Drink a glass of warm milk with or without honey or a glass of chocolate berore going to heel. 3. 3 Take a warm bath bcfoi:e going to bed. Based on 1. 0, if Ulc insomnia is due to some problem or pressure in school, in the office or at home, try to help the patient solve his problem. Refer him the proper authorities if possible. Based on 1. 0, do the following if the insomnia is due to sudden change in the patient's daily routine, like taking ca:re of a newborn, or if the patient just. suffered some adverse life situation, like death of a loved one or loss of a job. 5. 1 Advise patient to take some nap in the afternoon if possible. 5. 2 Give/prescribe over-the-counter multivitamins specifying accurately the <lose and frequency of intake. 5. 3 Give/prescribe medicine for allergy like one containing diphehydramii1-e for a few days. 5. 3. 1 Advice patient to take it after dinner. 5. 3. 2 Advice patient not to drive or operate a machine after intake of medicine. Advise patient to come back for follow-up if there is no improvement after one week or if any of the YELLOW signs and symptoms develop. 409

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

PLAN B: 1. 2. 4-5. 410 Refer the patient to a docto. r within the week. 1. 1 Refer him to a psychiatrist if any of the following are present: l. 2 1. 1. 1 Symptoms have been present for mort:! than six months. 1. 1. 2 Hallucin ations especially auditory one. 1. 1. 3 Delusions or false belief, especiall y one of grandeur (like l. l. 4 1. 1. 5 1. 1. 6 patient bdicves sbe is a queen, a prophet 01· a goddess) Patient has difficulty in thinking as obsetved in bfa. inability to concentrate or in his lack of decisiveness. Patient feds depressed, hopeless, worthless or guilty. He may also be so depressed that he loses interest in living and/or he has withdrawn from work and daily living, either completely or partially. Patient is in an ove,-enthusiastic mood, get involved in so many activities and feels little need for sleep. Patient looks untidy and unkept. Patient is out of touch with reality (he doesn't know who he is or says he is someone else or he says he is in son1e planet, etc. ) Patient has-Oat or inappropr iate emotional reaction to what he/she is saying or doing (like he say that his friend just died aml thill he is sad and yet he is smiling) · 1. 1. 10 Patient's talk is irrelevant nnd/or incoherent or he has sexual or religious preoccupnt-io n. 1. 1. 11 lie is easily clistracted. 1. 1. 12 The insomnia is associated with withdrawal from alcohol or medicine for nervousness like those containing diazepam or lorazepum Refer tbe patient to a general pnictilioner (like the Municipal Health Officer) if any of the following are present 1. 2. 1 Joint pain, 1. 2. 2 Swelling and/or redness of the painful joint 1. 2. 3 Item under 1. 1 are present and there is no psychiatrist available. Refer the patient to a dentist if the insomnia is due to toothache. Determine knowledg e of the pntient or that of his companion on the supportive management of problems presented llascd on 2..0, do the followin g if ll1cre is joint pain and/or swelling: 3. 1 Give/prescribe ovcr-the-couu ler medicine for pain or herbal medicine for arthritis. Srccifying accurately the met. hod of preparn tion (specifically for herbal medicine), the dose and frequency of intake. Tf an over-the-counter medicine for pain is be:i J1g given/prescribed, give/prescribe also an antacid to be taken wit]1 each does of the medicine for pain. H;ised on 2. 0, give/p1-escribe over-the-counter medicine for pain if there is a toothache. Specifyin g accurately the <lose and frequency '<'. >f inta J<c. Give/ prescribe also an antacid to he taken with each does of the medicine for pain. If the patient is very depressed, advise companion to take some precaution

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

6. 7·.,st suidde: agan Always hav1! someone stay with the patient. 5. 1 Keep ropes and_sharp}nstruments like knife, scissors, _ice pick, blade, 5·2 tc. away from the patient. ~eep sleeping pill~, inse L-ticides, kerosene and petroleum products s-3 away from the pahent. > 0 make sure that the patient doesn't get hold of any alcoholic D sed on-· ' · "ftl · · · a. 11edic:ine for nervousness 1 · 1e insomnia 1s caused by witl1dtawal d · nk O 1 1 · t · l I · II ri · 1 substances. Have someones ay wit 1 t 1c pahcnt a the time. frolll suc1, . 1 doctor with appropriate clinical record or referral note containing Pro':'id~ ~ ~c ry pertinent physical examination findings, laboratory results (if a bnef 115 ). 0 d ouu1. agcmcnt initiated at the referring level (sec Figure 3. 2 for-1ilablc an ' ' ave le referral form). asamp 411-=---

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

ASSESSMENT PROTOCOL FOR PROBLEM ON DIZZINESS: ADULT PATIENT (Logic Tree No. 24) D(RECI· 10N: Determine/identify which of the following symptoms/signs (S/S) history data (Hx D) are present and follow the flowchart for the appropriate plan~~ management. RED YELLOW GREEN S/S or Hx D S/S or Hx D S/S or Hx D Patient had head Injury Severe dizziness (patient had MIid earache-beforedlulnes. s started to stay In bed) Mild hearing loss Diulne_s~ is continuou s-and Marked weight loss Runny nose gradually becomes · worse Nausea and/or vomiting Nasal obstruction Projectile vomiting Seeing black or white spots Oiuiness occurred s-everal Blurring of vision Ear pain and/or discharge hours after eating or after A new, different or severe Mild hearing loss intake or tranquili:i:er or headache Ringing In the ear medicine ror diabetes Severe hearing loss Change In the patient's Dizziness occurrlng wh~ne-ver Very stiff neck behavior noted by family patient rides a vehicle Slurred speech or diffic-u1tv of and fri~nds (v3r, bus. etc. ) or a moving speaking Pati<ent Is we-a ring eyeglasses object Numbnes s or tlngllng (or used to wear one} Dizziness occurring when sensation Patient used lo have fainting there is sudden,hanges In Muscle weakness spells [epilepsy} position Wt!akrle. ss of leg muscles, Pati enl is a he41vy drinker One-sided hea. dache manifested as r-atling or Temperature of 390C and Attack Is preceded by an aura diffit. ult-y in w-ctlking above {seeing stars or flashes of Chest. pain P. Jtient has unsteady gait light, exces-siv. e yawnlng, Patient is confused (doesn't,or his re. et are far apan etc. } know his name, where when walkfng in an Patient is hyperventi lating as he i5 or what day it s> or attempt to maintain h1s a result· of anxiet Y patict\t is uncoscious balance Patient ts alert and calm a,o. od pressure either very Irregular pulse rate (one to six On ctnd off diuiness with high (above 100mm mis. sed beats per minute) the patient completely mercury diastolic} or very especially If patient has symptom free in t,etween low (ootv pal_patorv blood heart problem attacks pres1ure can be felt) lncoordination in the Pattent has not hc1d enough Hean rate is very fast or slow movementoftht'! ~Vl!S sleep for the pasr few "ery irregular(more than Patient squints when reading days sb mined be. at. s/minute) or took. Ing-at a picture or Temperature of 37. 5°C to puts readfng material far 38. 9°C from him or to near his Great difference between face, lying and sitting clla<tollc pressure Pale nan bells. lips and Inner c1. spect Of the eyelids -

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

dizziness r with at least one RED s/s or Hx D l No at least one YELLOW s/s or Hx D No at least one GREEN s/s or Hx D No Proceed with Plan A LOGIC TREE FLOW CHART No. 24 Yes Yes No Proceed with Plan C Proceed with Plan 8 No . at least one RED .-----~""""-111 1s/s or Hx D since last visit l Yes Improvem ent, ;..;.--:)lrlil":'l, I in the patient's · advice the patient . ' condition L--------Yes 413

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MANAG EMENT PROTOCOL FOR PROBLEM ON DIZZINESS: ADULT PATIENT (Logic Tree No. 24) PLAN A: 2. 3. 4. s. 6. 7. Determine knowledge of the patient and/or his companion on the management oft J1e problems presented. Based on 1. 0. do the following i( dizziness is accompani ed by mild hearing loss, runny nose and/or nasal obstruct ion: 2. 1 Gi"c/prescribc over-the-co unter medicine for colds specifying accurnle ly the dose and frequency of intake. 2..1. 1 Gi"e/pre. scribe a decongesta nt 2-. 1. 2 Ad,isc patient not lo drive or operate a machine while under medication since the medicine 1nay make him sleepy. B~ed on 1. 0, g-h-e the patient candy, sugared water or any s,veetened drink (aside from softdrin k) if the dizziness occurred several hours after a mea I or intake of medicine for diabetes (dizziness is most likely be due to low blood sugar). Based on 1. 0, gi\'e/prcscribe over-the-counter medicin e or herbal medicine fordininess if the :,-ymptom occnrs only when the patient rides a vehicle or uny mo~ing object. Specify accurately the method of preparation (specifically for herbal medicine), the dose ;ind frequency of intake. 4-1 Gi\'e/prescribe medicine for dizziness like those containing betahistine, mecli7. ine, dimcnhydrina te 4-2 Advise patient to take medicine 30 to 60 minutes before traveling 4-3 Inform patient that the medicine can make him sleepy so he must not drive a vehicle or operate a machin e while under medication. If_ dizziness is observed when pati. ent suddenly cba nges position, advise him to move or change position slowly, for example if he is lying down he should sit do\-,1 first before sttmding nnd avoid changing directly from lying l)OSilion to a standing p(,sition. ~ased on 1. 0. do the following if dininess is accompanied by one-sided eadachc "ith or "ill10ut an aura. 6·1 Ad\'isc the patient to rest in a dark room until the attack is over. 6·2 Give/prescribe over-the-counter medicine for headache, specifying ~ccurately the method ofp Teparatio n, the dose and frequency of intake. 6. 2. 1 Give/pr~cri he a paracetamol preporation. 6. 2. 2 Advise patient 10 take the medicine as soon as the aura is felt or seen if such is present. Do t11e follov,ing if there is a fever: 7·1 Gi"e/prlc'scrihe over-the-c ounter medic. inc or hcrbnl medicine for fever $1~ecifying at·c·urately the method of preparation (specifically for herhal medil'im. :). the dose and freqncncy of intake.. 7. L. J Giv<. '/prescribe a paracetamol preparntinn unless patient is alleqtic: to it. 7. 1. 2 If the patient is a. llergic to the above mentioned suhstance --

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

s. 9. 10. 11. 12. give/prescribe a pu!l"ely aspirin solution. 7. 1. 3 If aspi,·i n is to be given, give/prescribe an antacid wbkh is to he ta ken wilh ench dose of aspirin. 7. 2 Advise the patient or his companion to follow general instruction on the management of a patient with fever. Do the following i I Ute patient has pale lips, nail beds and/or inner aspect of the eyelid: 8. l Give/prescribe over-the-counter medicine for anemia specifying accurat ely the method of preparation, the dose and frequency of 8. 2 intake. 8. 1. 1 Give/prescribe iron preparation like one containing ferrous sulfate or ferrom; fumarate 8. 1. 2 Advise the patient to take the medicine after meals. 8. 1. 3 Advise tl1c pa Lient to iron preparation for at least one month. Advise the patient to eat iron-rich food like leafy vegetables, liver, kidney, lec1n meat, etc., If dizziness is mild and is not accompan ied by any other signs or symptoms or if the patient has not enough sleep for the past several days, give/prescribe over-thc-countet· multivjt. imins preparation, preferably one that contains some iron. Specify the method of preparation, the dose and tbe frequency of intake. Advise patient to come back for follow-up after one week or earlierif other symptoms develop. Do home visit if patient fails to come back for follow-up. Do the following during the follow-up vis. it: 12. 1 Ask if there was improvem ent in the patient's condition after the management has been started. 12. 2 If there were some improvement, advise the patient to stop the medication except if the patient is tak;ng iron preparation or multivitamins. 12. 3 lf there was no improvement, ask if any new symptom developed since the last visit. 12-4 Examine the patient for any new signs which could have developed since the last visit. PLAN 8: 1. Refer the patient to: 1. 1 An ophthalmologist within 24 to 48 hours if any of the following are present: 1. 1. 1 Double vision. 1. 1. 2 Patient sees black spots or white spots. 1. 1. 3 Incoordination of the eye movements. 1. 2 An ear specialist within 24-48 hours if anv of the following are present: · 1. 2. 1 Mild hearing loss 1. 2. 2 Ringing 01· buzzing in the ear 1..2. 3 Ear pain and/or discharge 1. 3 An optometrist within the week if the follovting signs and symptolll5 41. S

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

416 are present: 1. 3. 1 Blurring of vision 1. 3. 2 Patient is using a pair of eyegl. isses 01· uscc J to wear one 1. 3. 3 Patient !<((uints when reading or looking at n picture o. r places the rending material very close or vc1-y far from himself. 1. 4 A general prnct itioncr (the M HO, etc. ) wil hin 24 to 48 hours for all other patients,~;th yellow signs and/or !>-ymptoms or if a specialist is not. rva. ibble. 2. Do the following if there is a fever: 2. 1 Give/prescrih<-over-thc-cu11nlcr medicine or he,·bal m. cdicine for fever specif:dng accurately the method of preparation (specifically for herbal medicine). the dose :rnd frequency of intake. 2. 1. l Give/pre. scribe a paracetamol preparation unless the patient is 3llergic to it. 2. 1. 2 lf the patient is allergic to tl1e substance mentioned above, give/prescribe a purely aspirin preparation even if patient has hyper. :icidity or ulcer. · 2.-i. 3 lf :rn as-pirin preparation is being given, give/prescribe nlso au antacid that is to be tal,en,-vith each does of aspirin. 2. 2 Advise patient :rnd/or his companion to follow general instructions on the management of pa tiei1ts with fever. 3. Do the follo";ng if patient is a heavy drinker: 3. 1 Advise patient to stop drinking alcoholic drinks. 3. 2 Give/prescribe o Yer-the-counter multivitamins preparations specifying the dose and frequency of intake. 4-Give/prescribe over-the-counter medicine or herbal medicine for dizziness if dizziness is very severe. Specify accurately the method of preparation (specifically for herbal medicine), the close and frequency of intake. 4. 1 Advise the patient not to operate a machine or drive a vehicle while a. oder medic. :ition since the preparations can. cause drowsiness. 5. Do the following if I here is earache or discharge: 5. 1 Give/prescribe over-lhe-cow1te1· medicine for colds (decongestants), sp~ify accurately the dose and frequency of intake. 5. 2 Advise patient to clean ca. rs gently 2x a day. 5. 3 Give/prescribe over-the-counter medicine for pain specifying accurately the dose :ind frequency of intake. Advise patient to take the medicin e after meals. 6. Advise the patient to do the following if there blurring of vision: 6. 1 Rest the eyes. 6. :! Avoid readin_g if light is poor or while inside a moving vehicle 6. 3 Eat yellow fmits :rnd vegetables. 7. If the. re is incoordln:iti on in the movement of the eyes, cover the affected eye. 8. If the patient s..>e. '-black or white spots, advise him not to apply any medication on the eye until the doctor h:is seen him. 9. Provide the person to whom the patient is being referred to with appropriate clinical record or referral note containing a briefl1istory, pertinent physical

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

examinatio n findings. laboratory results (if available) and management initinted al the refening level (sec Figure 3. 2 for a sample referral form). PLAN C: 6. 0 l. 2. 3. 4. 5. 6. Refer the patient to a hospital immediately. Do the following while waiting for medical help or while on the way to the hospital if the bloo<l pressure is very low. 2. 1 Let the patient lie down \\'ith his head lower than his body. 2. 2 Cover the patient with a li,:;ht blanket if he feels cold. 2. 3 Lcl the patient sip some water if he is FULLY AWAKE. If patient's blood pressure is very high and he is a known hypertensive, make him drink his medicine for hyperte nsion. If the patient has fever, lmv. cr it down by foll O\\ing these steps: 4. 1 Cover the patient with a light blanket. 4. 2 Give the patient a quick sponge bath using tap water and alcohol or ice. 4. 3 Apply cold compres s, ice cap, fresh leaves ofkataka-taka or alagawor "saha ng saging" on the patient's forehead. Keep the patient calm and comfortable. Provide the,,g. ency /perso. n where the patient is being referred to with appropriat e clinical record or refc1·n11 note contai_ning a brief history, pertinent physical examination findings, laboratory results (if a\'ailable) and management initiated at the r-eferring level (see Figure 3. 2 for a sample referral form). REFERENCES Alfaro, R. (1990). Applying Nursing Diagnosis and Nursing Process: A Step­ by-Step G!lide (2nd eel. ). Philadelp hia: J. B. Lippincott Company. Bates, B. (1995). A Guide to Physical Examination. Philadelphia: J. B. Lippincott. Council on COPD and Pulmonary Rehabilitation Philippine College of Chest Physicians (2005). Clinical P,-acticc Guidelines in the Diagnosis and Managem ent of Ch,-011ic Obstructive Pulmonal"!) Disease (COPD) in the Philippines. Philippine College of Chest Physicians. 2005. Global Initiative for Asthma. (2008). Pocket Guide For Asthma Management and Pr·euentio11. Medical Communications Resources, Inc. 2008 Jan, N. (2007). Dizziness: Liglrtl1eaded11ess and Vertigq. http://W\IIW. we bmd. com/brain /tc/ dizziness-ligh tl1eadedness-and-vertigo. J<)inl Nationa l Committee on Prevention, Detection, Evaluation. and. Treatment of High Blood Pressure. (2003). The Seventh Report of the Jointf National Committee on Prevention, Detection Evaluation and Treatment 0 ' ' 417

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418 H. ,,. l. mm·nlt ', CM. nnd 01h,·1'!< (Eds. ). (~kph111\ll'I' llt-1:..!), lk.-i!liu11 'l'n·,·.-: ;,, 1Jw1<11t!J Si1"11r1w1: A l'n1i1c·t,,f tlw V. I'. Colln1· 11j'N111·.... i119 l-'lw11ltu. 1\1 nyt (. 'ti II Ir ::;1111 f. ( :. !(H)7}, ;\t,tlnmi,wl l'<1 i11. h I Ip:// www. 11111yrn:II II ll'..-·om/ hl'n h I 1/ t1hcloinh1111-pn I 11/ IX ;ooo I!\ M11yo t'llnk Stnff. (:. :00$).,\rrid,· 1m /)faz. infss. inhttp://www. 11111yocll, l'ill1l/hc~lll h/dln. lm:ss/ ns1111,1:J.,/ DSECrl ONS)'lll PIOlllt-l II( w. ~k'<'I' Di:->rders lkalth Cc11ll·1·. (:. :oo R). /11::1m1111i C1. h·11r://www.,, ch1t1d. sk-ll)(li:,c,rd,n;/1 nsoin II ill. ·' 11 111/ 11. l'hi\ippi11, Collc{l. c of Cln·st Phy:sk. inns. (:;?004). l'l1ilippi1w Co11s1·11si,s I', 011 1/11 /)i(l!/11vsis a111/ Mc-111t19c mn11t of /\stl111in. Philippim: Collt:141 of. Cl::. ~t·t Physicinn.--. ·

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Chapter 17 NURSING MANAGEMENT IN THE LOCAL PUBLIC HEAL TH SYSTEM Uosalincla C. Cr11:,,.-1.,·on1shaw INTRODUCTION Mana J-',clllc11t is the "'sci of intcrnclivc proccssl!S throu Ah which t-hc 11tili1. ation of rcso11rcc:-i l"l!Sll Its i II I ltc a(:c"m pl ishml!nl of c1rwmi1~1t ionnl ohjcctiv1:s" (Rakich, 1. ong~1 anrl 0°D1>11c,van. 1977;6). i\n·tmlin R to !{;1st nnd Rosenzweig, nrnni,gcmcnt is the primary force within an or R:1ni:i::1linn that coordinates the activities of the sul,systcms and relah:s them to it.,, 1;11viro11mc11l ( 1979:7). Mnna~c mc11t is ;. 111 imporla11l function in public health nursing. Public health nurses parlicipntc in the mana~emcnt or their hcallh centers and public health progrnms to improve people's accc.-;s to,,,ncl q11ality of, health services, that will hopefully lead to heller health outcomes for the comnnmity. There nrc three levels--top management, middle management and first level mnnn~emcnl or,mpcrv1s 1on. Top management is responsible for selling the orgnni;o. ation·s goals. objet:Livcs,md policies. Those in midclle management, on the ol her hand. develop the necessary departmental objectives and procedures to achieve ol'}Zanizational goals. St1peruisio,i (first level managem ent) is the-rirst level of 111nnai;cmcnt in the ()rgnni7~-ition nnd is concerned ";th cncouragin~ the members nf n work unit lo contribut e positively toward :iceomplishing lhc organization's goals and objcc:tivcs··. Supervisors manage those who produce an organization's goods ;111cl services (Rue and Byars, 1996:3-4) and are responsible for directing the work of suburdinatcs. In :,mull organizations such as local (municipal) public health organization, the distinction between lop management and middle managem ent, and between middle manage ment and supervisory level may be blurred. Ln fact, there may just be two levels: top and first level. The 'higher· management functions reside in the top local officials and the operational or day-to-d ay concerns are v. ;th the supervisors (such as public henlth nurses). MANAGEMENT FUNCTIONS The management functions are planning, organizing, staffing, leading or directing and controlling. Planning m cans forecasting, e. 5timating or projectin g what is most likely to occur in the future. In first level management, planning involves determining how to achieve the mandate orworkoftbe unit, which is the deliveryofhealthservicesand implementation 419--

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

nf hcuhh progra1rn;. J\hove lhc firsl level or munogcmcnt, planning includes defining 01w-1ni:r. nlir>n:il philosophy. in<l ohjcclivcs, establishing policies, standards :md prr J<:cdur·c!s; dc~velo1)inp, i:tn1Lci;ics, 1>rogrum. R and projects; and, rrep:,ring lh1~ h11dgct. Or11,1111!:1. i ng means dcsil!,ni ng the organization. ll (ml ails dist ril Ju ting and a rra ngi ng the worl< to unsure thal lhc unit f1111ctions smoothly. rt includes developing 1111 oq,\a11i:1. a I ion a I sl n1cl II re h;iscd 1m work 11clivi tic,; a nc. 1 func'l ions, and spcl Ii 111-; 011 I I he Ii 11cs of a11t hori ly II nd c11111m1mic. ition :rnwng Lhc ti i!Tcrnnl. units or sub-unit. s wil hi n the; orj. \1111i:r. atio11. /\11 org:mi:r. ation:il chart, shows the c. livisiou of work, chain nf c<>mm:md, type of work performed, grouping of wnrk segments and levels nf 111anagcme nt ( Do111~l:1ss, 1988 ::~6). s1arnn~ is concerned with getting and developing people for the jobs in the unit. IL inclutlcs sch:clion uf pc.-snnncl, sli1ff dcve. lopment, scheduling and 1,;ivin)!. ;1ssi11,n m l!. 11 ls. l. cadin A is directing lu Kl motivating people lo do their sha1·e in Lhe unit's woi·k. Lea<ling (or d irncl i ng) is the prnc. :css of 1. !nsuri ng Lhnl pcrsunncl dn whnl Lhey nre st1pposcd Io do to iu:cumplish tlic go;1ls of the organi:r. ation. Lt includes processes such as leadership, 11101 ivatlrm, delegation, co111111unication um! conflict management. In addition, top mana,;erncnt communicate s wit J1, nnd exerts influence to people outside thcfr or~m1 iirnl. ion. Controlling is determining lhe aclual performance compared with the desired output and Li1l<lng lhe necessary corrective ac Lion/s (Rue and l3yars, 1996: 6). Controlling which is l11c last step in the management process. involves the setting of standards, cnmpari11)!. actu;il pcrfor1111111cc wi L11 thcsc standards, reporting lheresul~ofa~sessmenl or,::valunl ion, aru J lakini; corrective nctions. I l ensures that the organization is on track as far as its vision, mission, goah;, ol~jectives, standards and targets are concerned. It is I he same rna11agemenl funclionsthat Lhe d. i:fferent levels of managers do--phlnning, org:rnizing, staffing; leading and controlling. However, they differ in the scope of tlieir f11nctio11s. Tup management, umlerstantlably performs functions and makes decisions thal h. :1vc )!,f Calcr impact on the organi:r. ntion. First level manageme nt is also important but the ccmscqucnccs of 1:11pcrvisors' action or inaction arc genera J]y less serious and could be remedied more e:1sily t J,:rn those of top management. To ht~ able lo perform lheir functions well, supervisors should possess four types of sldll:-;--tcchnical, human relations, administrative, and decision-making/problem­ solving. Tedwica/. skills refer to both knowledge aud skills related to the products and services of the unil--procei;scs, methods, n. od equipment or machine s, :. 1mong olhel's. In a se1vic:e cfolivory uni·t, a supervisor knows the job of his/he. r supervisees and can titke their place in emergency sit·tiations. Httmon l'C1otrons skills refer to a supervisor's abilily to understand ;111cl work with other people. In adtlitio H to his/her being able to work wilh individual employees, he/she should also be able Lo foster harmonious rcluliunship anwng her supervisee:;. Adminislrulive skills refer lo the supervisor's ability lo perform the planning, organizin g and controlling functions of first level nwnngcmcnt. Decision-muking/ pr·ohlem !wiving skills refer to his/her ability to critically :ma Jp. c information and problems aod make appropriate decisions. 420 Higher level ma JJagers, in addition to human relations skms, administrative skills, decision-mnkini:; und probli::m-:;o]ving skills, should have very good leadership and commun ication skil Js, and political savvy. Siace LGUs haye to compete for their share in the national pudget, their managers should be able to articulate their

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

concern s and i nnucnc. :c the executive branch of go11ern111c11t (Department of Budget and Management and the Ofllcc of the President). :ind Congres. '-(particularly the,·ery powerful Approprialions Co1111 nillcc or L11e !·louse of Representatives). Al the local level, RH U supervisors should be able to influence the mayor, Sanggunia n, budget officer and other personnel wbu prep. ire the municip al/city hudgct. Good ma nagcmcn l ''starts with a coorcli natc<l purposeful organization of people who, collectively on :1 runctionnl responsibility hnsis, :-ire responsible for: selling objectives, plannin g str:-1 tcg_r, sel:ti ng goals-short-term objectiv e, developing company philosophy, setting policies-I he pl. 111, planning the organization, prc,vi<ling personnel, establishing procedures, p1·oviding facilities, pr·1>vicling capit:-il, selling. pcrform~n ce stan<l;mts, initiati-ng management program s, develnpin)!, management informallon systems and :iclivaling people" (Meier, in Swansb11rg, 1993:19). These are responsib ilities of the different levels (Jf management. The aext section will focus on public heallh care organizations-the local hcal U1 departments and health centers. MANAGEMENT IN PUBLIC HEALTH Management processes arc the same evety\"'here but in public health, the context makes monagcment in public health in a way different. Management in public health, particular ly in the Philippine setting is a unique undertaking given Lhe different macro and micro contexts of lhe local public health organization--government. policies, programs of the nationa l governm ent, national and local health budgets, geography, political dynan,ics, and local culture. The local pub J;c health organization The health department is one of the departments or offices in the local governmen t unit. Its si7:e, which is reflected in the number of its human resources and budget, depends on a number of factors such as populat ion size, financial capability oflhe LGU and the local leaders' commitment to public health. Sometimes, a number of personnel are added for political consideration s, that is, fulfilling a promise made to political allies. And sometimes, casual employees have a short-term appointments becnuse there are just many people also waiting: for their turn to work. Big cities, particularly first class cities have bigger health department s, that is, more hca 1th personnel (not necessar ily more nurses) and health centers. Nursing is reflected as a distinct unit in the organizational structure. A nursing service has a chief nurse (Nul'Se V to VII), an assistant chief nurse, a number of superviso rs (some are assigned to different he;ilth progran1s such as materna J and child health) and PHNs and midwives who are assigned to the different health centers. These health centers :ire generally headed by physicians. In the other end of the continuum, there are poor or small municipalities that )lave only less than ten public health workers (including one or two nurses). There are also doctor-less municipalities and ·the R. HU may be headed by a public health nurse. The standard health services provided in health centers are immunization, prenatal, natal and postnatal care, consultations, laboratory and diagnostic examinations, emergency medical care, treatment of common illnesses and referral to hospital~. The scope and coverage of services are primarily determined by the availability of financial resources. 421

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Context of the local public health organization The capability of the public health system is influenced by dedsion. s made by the local chief executive and couna1, especially those oo budgetary allocation. How the: budget is <let. ermined and the degree of participation of the health center staff in the preparation of the hea Jth budget vary from one LGU to another. A number,,f management activities in the LGUs such as hiring of personnel and purchasing are centralized. The degree of pa. rticipat fon (and satisfac..-tion) of the health center staff vane$ from one organizatio n to another. In wme LG Us. non-gov ernment organizations (NGOs), people's orgaoii1. ations and even halikbayan s (returning Filipinos) are active in hea Jth an. d bea1th-relatecl endeavo rs. l,ocal Hcallh Boards, tov, are active in some LG Us but not 'in others. There arc oilier factors that affect the delivery of health services and implemenlalio n of public health program s. Since health centers are usually located in the town proper, the residents of far-flung barangays find it difficult to go to town for consultntion. Travel time is long and tr:insportation cost is high.. Although there arc baranga y health stations (IHl S), t. he needed medicines and supplies are not always available. To make thin~,; worse, thl!re is no efficient communication system that links t J1e main health centers to the BHSs and far-fiuog catchment areas. ·niese factors, in addilion to client-re lated factors pose as Lhreats or as chal Jenges to the public health system. THE PHN AS A MANAGER AND SUPERVISOR The following di..o;cussion of managem ent issues and concerns does not pertain to a specific public health organization. It is premised on the following realities and professional beliefs: {1) under a devolved sct-up, the major decision-makers in he,ilth nrc t J1c elected local officials whose term of office is three years (a mayor may be re­ elected twice);(:. <) m<Jst LG Us do not hnvc ndcquotc resources for health; (3) there are LGUs with outst:mdi ng performance in health despite their meager resources while there ::in' others 1h;11 p Prform poorly in he::ilth care delivery: (4) nursing has a unique contribution in pnhlic health: and. (5) the p'rimary responsibi Lity of nurses is the provi:,;km of nun. in)!, <;. ire aml hcallh services lo their clients--individuals, fnmilies, populntfon groups,Lnd communitie s. Planning Nurses porticiputc i. n planning for the whole local health organization. A component of lhc orj!. nniw1ion's plan is a nursing unit plan. 111ere are different types of plans that PHNs tire exposed to, nnd participate in--strategic plan, operational plan, program plnn,rncl nu~ing care plan. TI1is chapter is just concerned with the first two. A strategic phtn is o long-range plan which contains an organizational vision and mission, guidin11, principles, broad strategic objectives, and specific tactics, projects or activities for achieving the brond objectives (Goet~ch :rnd Davis, 2000:78) In strategic plrmning. l'HNs participate in reviewing the organiza tion·s !-trenglhs, weakness, opportuniti c,; and lhrc. il'> (SWOT); and in fo. rmulaling its beliefs, mission, vision nn. d goal. Altho\1gh strategic planning is a function and responsibility of all managers in ao organizatio n. the initiative usually comes from top managem ent. Nu. rscs particip Rte in strategic planning to articulate their aspirations and unique contribution to the 422

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organization. The nursing service/unit, s'hould also develop its <rim strale'~c plan. An operational plan, on the other hand, is a short-range plan that generally deals.... ;th the routine activities of tbe organization. In a health center. for exam rile. an operation,il plan addresses the requiremen t<; for delivering health services on a daily ba. ~is. It may include the train in?, of health center staff, incornt!generation, purchase ofinstrume-nts and equipment, introduct ion of a new system in queuing Qf clients, how l Q improve intra-office, intra-sectoral and intersectora l CQJlahoration, partic.-ipation in the training or affiliating nursing students, and a new system of recording, among others. A Nursing Service plan includes measures that address the specific needs and concerns of nurses. It focuses on those that impact on how nurses perform their job such as staff development, performance eva Juation, review of job descriptio n, mentoring and coaching, and performanc e standards, rewards system, etc. Plans should be realistic and should be acceptable to the decision-makers-th e local council (particularly the Health Committee) and the mayor.. The Local Health Board may also be of help in advocating for the nursing service plan. Preparation of budget Public health nurses play an important role in preparing a budget for the health department/health cen Lers. 'I11eykoowhow the health center operates and the demands for the health center's services. In preparin g a budget, PHNs should consider the cost­ effectiveness of their inte1ventions/activities. A11 year round, they should assess the cost-effectiveness of their activities or practices in the health center and constantl y explore on ways to improve their efficiency. Policies, standards and procedures Manuals of policies, standards and procedures are very important resources for health personne l. These serve as a guide for their actions and decisions. A manual of personnel policies, standards and procedures should contain all pertinent laws (such as a the Magna Carta of Public Health Workers and Code of Conduct and Ethical Standards) /policies emanating from national agencies such as the Civil Service Commiss ion and U1ose coming from the local governments). It should also contain professional standards prepa1·ed by the DOH, PRC, the PNA and tl1e NLPGN. The nurse supervisor should ensu1·e Lhat these important docume nts are availableto a11 PHNssothattheyare informed of their rights, duties and responsibilities as health workers and government employees. Organizing Prior to RA 7160 (Local Government Code), the organization al structure of be::ilth departments or units was standard. There was a nursing service in big health departments who was headed by a chief nurse (Nurse VIl or Nurse VI). Understandably, there have been and there will be structural changes in health departments and health centers because of cllanges in how decision makers view health care delivery. There is, of course, no one best way in structuring a public health organization, particularly a nursing service or unit. Most, if not al J pub Uc health orgaoization. s, have a wel1-defined organfaat:ional structure. Toe question, however, is whether the current structure is the best way by which the goals and objectives of the organization could be met. In asses. sing an existing organizational structure, nurses should be familiar with some of the principles of organization. 423

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Principles of organization Di Lisiori of work. Tbisis nlso called specialization ordepartmentation. Howv~i11 the work (11ealth sen;ces) be cli,ided? ls the cli,ision of work according to client groups (children, women, elderly). or pi-ugr,un (maternal aud child. commtrnicable diseases, non-communicable cliseases )? In big organizations, senices can be organized into clusters or teams. This means that a g Toup or team of sen ice providers (physician. nttrse, midwife and others) are assigned to a specific program, sen. ice or unit. HCl\,·ever. in small health centers. prob:. ibly the only di\ision of work that could be done is the one based on position (or profession). 'What are the duties and responsibilities of the physician. nurse and mid,dfe? Sometimes the d Lcrnnction of tllese pt·ofe. ssiooal responsibililies is not very clear all110ugh tile clifferent professional practice acts cottld sen'e us a guide. If there are no physicians. particularly in cases of emergency, nurses anu u1-idwives sometimes perform what are legally considered as medical function s. Coord-inatio11. Coordinati on is the "conscious activity of assembling and synchronizing differentiated work efforts so tl1at they function harmoniously in the attainm ent of orgnnization objecth·es~ (Rakich. Longest and o·oonovan. p. 143). Proper coordination results in harmonious relationship among the different groups within the organization. Man~· nurses are designated as coordinators of health programs like EPI, Naliona] TB Program. Healthy Lifestyle, Leprosy Control Program, Reproductive Health and Family Planning Program and n,,JCI; and other acthities such as medical missions, health campaigns, training programs, and information, education and communicatio n (TEC). Unfh J of command. This prindple means that an employee should be responsible to, and receive orders from, only one superior. lo some health organizations, this may not be easy to follow. For example, PHNs who ru·e assigned to health centers may be accountable to, and receh·e orders from two people-the chief nurse (who is usually in a different location) and the head of the health center. To prevent confusion and ill feelings among the staff, tl1e areas of concern and responsibilities of tl1e two beads should be adequately delineated and clarified. Allthority and 1·espo11sib ility.. Authorit y means a superior's right to command and exact obedience from his/her subordinates. If a PHN, for example, is given Tesponsibility as an EPT Coordinator she should also be grnoted corresponding authority to ensure that the program requirements are available and program activities are done by those assigned to do them. She, then will be accountable to her superior for the program's performance. Span of control. Span of control means "the number of subordinates reporting directly to a superior" (Rakich, Longest, and O'Donovan, p. 149). In the public llea Jth setting, the span of control for a J'HN who is the direct supervisor of midwives, is determined by a number of factors, such as: level of training or competence of the subordinates; degree of geograpl1ical dispersion or how far ·the subordinat es are from each other and how · accessible they are to the supervisor; and the level of difficulty or complexity of the supervisees' work. There are no fixe. d rules in determining t. he subordinate-s uperviso r ratio. What is important is tlia. t the span of control allows improved com. munication, efficiency and coordination (Douglass, D· 37).. Too many midwives reporting to a PHN can delay decision-making and responding the supervisees' problems, issues and concerns; too few, on the other hand is inefficient. If nurse supervisors nre adequate]y 424

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recording their supervisory activities, it may be easier to establish appropriate span of control in their respective areas. Nursing in the organizational structure Given the changing landscape of health care delh·ery. PHNs ha"e to confront these questions: how should nursing (and nurses) be reflected in the overnll organizational structure? Should there be a separate nursing service or unit in tlie local hea1th d. epartmen t? Are midwi-:es included in the nursing senice? How many levels of management should there be? W'hat roles and function s should be assign~cl to PHNs? There is no s. ingle answer to each of these questions. Nurses should actively participate in configuring their organizational structure. Staffing Staffing is a bigger problem in a hospital setting because there are three shifts to be covered by nurses. In community health, it is generally an 8 to 5 service. The concern in staffing is to have an adequate number of nurses, midwives and barangay health workers for the tot::il population. Thus, there should be a continge ncy plan in times of greater need such as disasters. A major problem of LGUs is inadequacy of health personnel which is mostly due to inadequate health budget. It is a challenge for nurses to be able to convince the local decision n1akers on the need for more nurses and midwives. It is a tough job for nurses given the fact that the Nursing Act of 2002 stipulates that the entry salary for nurses in govemrnent is SG 15. Nurses should properly and adequately document their activities so that their proposal for increased staffing will be considered seriously. Time and motion studies could be done,· with the assistance of, or in coordination with universities, professional organizations, colleges of nursing, and even NGOs and people's organizations. Leading (directing) To lead n1cans "to show, mark the way, guide the course" (J. 1arriner Tomey,p. 268). Leading is the management function that gets work done through others by giving direction, supervising, leading, motivating, delegating, communicating and managing conflict. The PHN leads the midwive s so that they could deliver health sel"',ices and meet the targets for their respective baramgays. Leadership Leadership is an important component of good management. rts essence is influencing others. In an organizationa l conte>. 4:, it is "making people want to do something" (Kron, in Rakich, Longest, and O'Donovan, p. 281). PHNs exert leadership in a number of ways: coaching, counseling, evaluating, delegating and rewarding (Frunzi and Savini 1997:174). The challenge for PHNs is how to influence their subordinates (and co-workers) to pursue the goals of the organization, specifically for them to: (1) behave respectfully towards their clients; (2) provide quality service; (3) meet program and/or service targets; (4) observe cost containment measures; and, (5) observe organizational ·values such as honesty, cooperation and punctuality. To be good leaders, nurses should possess technical competence, integrity, communicatio n skills ~d knowledge of group processes. 425

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Communication Communication is the most penrasive activity within an organization. The communication that is of great interest t-o nurse managers is one that moves people to action. TI1e flow of their communication is vertical (upward and downward) and horizontal. Nurse managers communicate to their subordinates about a. number of things: policies, standards, procedures and the work that need to be done; pertinent discussions and decisions made by the local chief executive and the local council; a11<l, feedback on important personnel issues and concerns. Integral to their comn1unication is conveyi. ng their concern for their subordinates' and clients' well:being. They also communicate upwards-to tbe head of the health departm ent/unit and to the local officials. They commun icate to inform, give feedback, and to innuence. Their communjcation to the LGU's decision makers should l;ie properly planned, particularly the message and medium. If the purpose is to influence, then, 1nanagers should have a good presentation--\. vritten and/or oral. In addition to these 'formal' app1·oaches, managers should also be able to communicate in a manner that is culturally apprnpriate and socially acceptable. Nurse managers also communicate with their peers from other offices (e. g. personne l, purchasing, supply, accounting, etc. ) to enlist their support or assistance. l:Ylaintaining an open communication line with heads of other offices/units can facilitate the flow of papers and goods for the health department/ office. More often than not communication with peers from other offices is informal. Delegation Delegation is entrustin g a task to another person who senres as one's representativ e. It is the process of transferring selected nursing tasks in a situation to an individual who is competent to perform. them. PHNs should delegate to save time, develop others for their future roles and responsibilities, motivate subordin ates and free themselves to manage. If a midwife can do a task very well, then the nurse should delegate. Controlling Controlling was defined by Fayol as "verifying whether everything occurs in conformity with the plan adopted, the instructions issued, and principles established. It has for its object to point out weaknesses and errors in order to rectify them and prevent recurrence" (Swansb urg, p. 367). There are four components of the control process: (1) plan, instructions, principles and standards; (2) obsenration, measurement and comparing "what fa" with "what should be~; (3) identification of weaknesses, problems, or errors; and, (4) correcting, rectifying or doing something about them.. Managers introduce controls within the organiwtion. Controls are important in improving service delivery beca11$e they serve as L·emiaders if there are deviations from targets and standards. There are a number of controls that could be introduced into the public health unit, some of which are: statistical reports, records (e. g., inventory for medicine s, FP supplies), audit, Gantt chart or schedule of activities. client feedback and incident reports. Evaluation of personnel In the Philippines, the evaluation of the performance of government employees is 426

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mandatory. Although there are many possible uses of perfnrm:mce evaluation, the most pron1inent are termination of 0000-performing assets", promotion of competent employees and giving of rewards (scholarships or salary increases). The performance appraisal of PHNs should focus on their duties and responsibilities (including additiona l assignments given to them). The rating given to them should be based on the extent to which they meet performance stanchu-ds. It is the responsibility of nurse n1anagers to define the standards of performa nce for the different nursing personnel. This sbou Jd be done in consultation,vith those cont:erned. In RHUs, PHNs evaluate the perforn1ance of midwives. Guide in conducting pe,:formance evaluation 1. Performance appraisal should be done jointly by the supervisor/rater and su pervisee/ ratee. 2. The. appraisal interview should be conducted in non-threa tening Wa)' at the office of the supervisor. The supervisor should ensure the confidentiality of what transpired during the interview. 3. The supervisor should use available records and reports to support bis/ her rating of the supervisee. 4. The result of the evaluation should be thoroughly discussed and the goals for the next evaluation period should be identified. 5. Both the rater and the ratee should sign the accomplished evaluation form.. 6. Ratees who do not agree ·with their supervisor's final rating should be informed of their right to appeal to a grievance committee within the LGU. Quality assurance Quality assurance ( QA) is animportantmanagement activity to honor the health facility's commitment to provide quality care to its clients. It is defined as a process that aims to guarantee quality or a level of excellence in client. care by comparing what is actually delivered to established standards. These standards are established by professional organizations, regulatory agencies (such as the DOH), accreditation bodies, and health organizatio ns (such as the WHO). Quality is present if clients receive care/service that is consistent,'lfith generally recognized contemporary standards. A standard is the desired level of performance against which actual practice is compared. It is "what should be" in terms of structure, process and outcome. Structure stando:,-ds define the rules under which service must be delivered. These cover the hea Jth care facility, human resources, equipment, supplies and manuals of policies. For example, RA 108:. 1 provides that a municipality with a population of 20,000-50,0 00, should have two PHNs while o·ne with a popufation greater than 50,000 should have four PHNs. The different public health programs have structure standards that a. i:-e critical to their success. For example, cold chain in EPI. essential drugs in MCH program and microscopes in the TB Control Program. 111e Standards of Public Health Nursing (NLPGN) define the qualifications of public health nurses. Process standards on the other hand, define bow nursing care is provided, ho,v services are to be carried out, and how programs are to be managed. Nursing standards are defined by the PNA and the NLPGN while the health program standards are contained in the DOH program manuals. 427

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Finally. outcome slcmdunls define both 11w de$ircd rc:-ult:-10 be. ichil. !vl!d aml the \mdesirablc ret OUIL. " lo be a,vidcd. Each health faci Hty/orgnnir. ::lliun should 11:wc-(and rcg\11:u·ly review) stnndnrds on healt. h care del. i\'ery. mouitl"r :ind ;,,,<1hmtc-its prncti<·l's nncl !'\!solve pr:ictice/hc;;ilth care delh-e-~· probl-c. ms. Sine~ m:iny of the struc-t11rl· st:mdurds,ire dependent on the :\\'nilability of financi:11 !"1>-!<0Urc-t?'s. hc-:ilth workl'n-sl1011ld,·11lisl the comm ii ment of the 1oca1 political leaders aud dcc L'-fon makcn; :mcl administratin: personnel. Se11trcmg Sigla Mot CTT1cn t M~· LGUs h,we stnrtt-d their quality us-o;urance proi;rams by respnndjng to the DOH's QA initiati,·e. the &ntr-o:ig Sigla. Tl" ~l·nt:·0119 Sig In !\lovemcnt c1ims lo make quality health,otf"'\-ic,·s t\\":lilabl4. ' and :1cee...--siblc to Filipinos. Its main compon ent is the certific. "lt ion,ind reco~nition ofht!:1l1h focilitics. ln Phase 1. the focus is RH Us am] health center. :. lne r~rnm'-' th~1t. 1r,· induc:fo-d :il"'t!: exp:m<led program on i11rn1uni7. at;on, disea. _~ sur Yeillanrc. contn,1 nf acme re. <. piratory infections. control nf cliarrhe;,il dl--eases. micronutrients-. uppleme nt;;ition/ nutrition. family planni 11p.. tt1bcrculosis control. sexual!:-tr. :insrnitt-ed di;. eases/ Al DS prc Ycntion,u1d control. cm;ronmcntal health arid snnita:tio n, canc-cr oontrol, p. i. nicula rly cef\-ic:ul cancer screening. {DOH) The standards are basically on structure or inputs for the deli,·cr) of the iden1ified sen. ;ces or progrnms. The a,-. sumption of the focus oo st TIJcturt> is that if all the aec. ts Slny infrastrucrure. equipmen t, pharmaceutic:. 1 ls. supplies and t. rai n ing programs or acti,.-ities are a,-:ulable, the likelihood of de U"erin~ "quality-sen·iccs is ~realer. The second pbe..-. e of &ntrong Sigla focu. s~ on proccs.-, stundard. s or the,vny he1c1lth workers deliver health sel"\;ccs, and outcome stnndards or the r~u. lt of the internction between ctn1cture and pn:>ees-<. st:ind:trdc.. The Sc:mtron!] Sigln h::i<: :i l)ualtry Stand. ards List.,,;th a !loo<! numberofstand:irds under four major hcadin~-facility and srs1cm. s. int~ted public bealtl1 fuocti-,ns. bao;ic cur. 11h·e !<(!n;ccs function, and n..ogulatory funct:ioru:. PHNs acth-ety participate in the Q1\ efforts of their local he. ii th departmcn L<;/ units by :idopting and im-plcm<'Tlting I. he program St.."-ndards. Nursing audtt :-. ~ng audi1 i,; part of the 11'--ernll qualtty a SS1Jrancc cffor L'i of an llii,Cll(..")'. It is n metl1od of t:"'-:1lu;;1 in~ the qu:oilit) of care g_ivcn 10 clients t J1roug. h the sys! cmut le rc,.-iew of cli E-nt ~l"d IPhanc-uf in C'l:men~Stnn,: rt al. 1991:852). It i<: a proccs~. not :m outcome~ aluation h j,., pr,,m1,..-d on the h(lid that ii thr· proc-c<, t)f dtli\'fring care/ sen,,~ ltr)i::,«th.,, "'it. h cctru<'lur PJ '",n :. c_conlanc" with r,;tahllshed stanc. J. :1rds, then t. hel"E' mu-..t be quality fnutmm<>J And. th::i nurcc1,c, documc:nt1:d in the dicnt's records t. heir a..s..,;,essment. inter>'e Titinn'-and e-,<1l1Latir,n 1>f c-an:. Por nursing. iudit purposes, it is assumed that what,.-a« not wriacn.....,a, nm done-. In commu nity he. 11th nursin~. Phan'!ufi< (1976) "<-"'en cnre c,tnndarcl..ci can bl! adopted or sli Jthtly modified as a fr. un--,,rl, fm nursinit audit O:. t;, coll<'ction instruments that \ooi U be t L"c:d to re,.,~ the ri'CO'ni'-retlt-ct th~· <;tand:ir<lc. : ( 1 J :\r,plic:i I ion ;1 nd execution of phv'!i1nan ~ I/Sl1. al ordt:r-. 12Joh-. t-r,a11<111 nf,\'mµtmn« and r,ac-tion. s: (3) :,upcrvisi6 n of th<.-pan,-. n1, (4)-. uf)Pl"'\·1-ion nf th,,.... p.,n1np,11n~ in ti..-car<': (~) reporting nnd n:-oording 16) apphc1st1on nf nu M-ini:, pn~-du rr<-,md,,~hniqut<;;,,r Hl, (7) prnmntiori of health b~ d. u,4"i. l,:,,n and t;-achin~ CChm Pn'-tonl ('t al.. p. 85'. L). u~in R I he-. e stand::ircl. s as. guide. data c-ntln:non instrum,-nl S <Jlould he-ahle l CJ provide-an'-wen: tn questions such as these: b(l",o,' d Jd tht-nurses <it the he;i Jlh cenh!r tnke c;,re of a baby who was

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

brought in for pneumonia (or diarrhea )? How was a diahetic pregnant woman cared for during the prerwtal check--up? Etc. A-l least once a month, a nursin~ audit can be conducted on randomly selected client records. This implies th:11 Lhcre has to be a good documentation of what nurses do to their clients. ETHICOLEGAL CONSIDERATIONS One of the majorc:. :hal lcnges in 11ursingma nagemen L is the pro,;sionofane nvironment that is cond11civ£' I 11 <I hic;1l ;1 nd lc:gal practice. 11. thical pnii:tice means providing quality cnre to clients rc:,~arcllcss of lheir social clas. ~ and hcliefs (political and religious), respecting tl1e rights of c:lii. :111s ;ind nrnintainini; confidentialit y 0f informati on. It also includes hchavinl!. in a m;inncr crmsisu. :nt "7th the values and norms of the community, professional cudc. o..;,,rel Ilk:-. (::,ud1 as the P::'. '-i A Code for Nurses). Legal practice means that nurses work in :in. :onlance with the Nursing I. aw and for those in government, lows such lhc Civil :-;c,,;ct: I ~,w (PD 807), Magna Carta Qf Public Health Workers (RA 7:305) anu Code r Jf Conduct and Elhical Standards for Government Officials and Employees (RA 6713). R,\ 6713 provides that.. public officials and employees shall at all times be accountable to Lhe people and shall disch. trge their duties with utmost responsibility. integrity, competence and loyalty. act c,·ith patriotism and justice, lead modest lives, and uphold public interest over pcr"om1l intercs C. PHNs should be guided by these values and principles at all times. Etl1ical nursini:t pr. icticc b a choice thal PHNs make every day. Thus, they should ask themselv es t. he folh,--;ni:; 4uestiont; (among others): Do I ~o to work on time? Do I go home on time or until all the clients were atti:nd. :d to? Do I make good useofmytimewhenlamat,.,,ork? Do 1 hnvc tl ~ood system that lessens the waiting time of clients? Do l attend to those who c. 1mc first or those whose problems need more urgent :iltcntion? Do I I real c Jients fairly and eq_ually regardless of the-ir social or personal circn mstanccs? Do I l rcat infon1ialion from clients confidentially? Do r n:spct. :l my clients' values and beliefs? Do 1-respecttheir decisions on molters related lo health care? Do 1 ndvoc:nt..: for policies that positively impact on people's health? Do 1 spe. 1k on their behalf ifl need to? Do 1 support them when theys:peakup for themselv~? Do I follow nursiog and progrnm standards in delh:eri:ng services to dients? Do I nse resources appropriat ely and efficiently? Am I fair in nllocating or distributing resources (medical supplies and medicines) to clients? Do I shuw respect in my dealings ";th other people? Do 1 lionor the promises and commitments that I make? Do I use my influence to benefit my unit and client:;? Am 1 good role model in health? Do I practice what I preach?. Am Ian asset to my profes. sion? Am r truthful and honest in my reports? TI1e PHN should be guided by the Civil Service Law which de. does the standards 429

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

6-7· s. 9· JO-Jl. 12. G Cl~ch J)I. and Davis SB (:!Ooo) Ouo/iry Mana o · · ·.. r, "cl. gement. 3.,1 d l River, New. Jc:rsc·y. c:arson,., ucat1on Company. e. lpper Saddle ::isl FE am. I Roscnzwci~~. JE (1979) Organb. ation and Ma ~~w York: Mc Graw-Hi I~ 8ook Comp,my. nagement. 3"' ed. Mnrrincr-Tomey A. (1996). Nursiny Munageml?n. l. and l-eadershi. sr. l.,ouis: Mosby. P-Csth ed. ). PO 807 _ The Civil Service Law Raid ch. J. s_., Longc_st B. B. a_n~ ~'Donovan T. R. (1977). Managing Health Care Qrganiu:1/1ons. Ph1l:ltlelph1a. W. B. Saundt!rs, Co. RA 6713-Code of Conduct and Ethical Sl,rndards for Public Officials and Employees Rue J ' I W 'lnd B},1rs L. L. C1996). Supervision (sth ed. ). Chicago: Jn-,;n, 1,ur" R. C. (1993). fntroductory Jvlanagem~t and uwdership 'or 3 Swnns," I 1· J' 1 · Clinical N1,rc;('. c;, Roi;ton:. Jone. c; and Bart ett Pub 1shers. 431

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

of working and monaging tn government service. It classifies the offenses that government employees commit as grave, less grave and light offenses and prescribes their corresponding penalty. Some of the: graue offenses are: dishonesty, gross neglect o( duty, grave misconduct, being notoriously undesirable, conviction of a crime, falsification of official documen ts, physical and mental incapacity or disability due to vicious habits, engaging directly and indirectly in partisnn political activities, contracting loans from persons with whom the office of the employee has business relations, disloyalty to the Republic and to the Filipino people, oppression, disgra. cefol :rnd immoral conduct, inefficiency and incc Jmpetence i. n the performance of official duties, frequent unauthoti. zed absences or tardiness, re!u:,a] to perform official duty and gross insubordinatio n. Some of the less graue offenses are: simp]e neglect of duty, simple misconduct, gi-oss discourte sy in 1he cour:se of official duties, insubordination, habitual drunkenness, nepotism. and unfair discrimination in rendering public service due to party affiliation or preference. · l,ight offenses include the follo,.,,;ng: neglect of duty; discourtesy in the course of offic;ia J duties; improper <Jr unauthorized solicilntion of contributions from su bordinatc cmployee. c;; violatfon 0freasom,hle office ru Jes and regulations; gambl. ing prohibit ed by law; refus;,J I() render overtime service; barro,ving money from subordinates; lending mrmcy at w,urious r:nes c,f interest; pursuit of private busine.,; s, vocation or profession withr Jut permis1,irm r·cquired by the Civil Service rules and regulations; and, promoti ng the sulc <Jf ticl«t L5 in hcha Jf of privat. c cntcrp. rises that are not intended for charitab le or public wc,I fare purpc,:;es. Ethical anti legal pn1ctic:1!S should be discussed during o. rient:ttion and training pmg,am s ;jnd emphas i:t-td during supervisory visits. It is very important that legal and ethical valur~,; and r>rim:iplcs serve as guide: in pcrfonnanc: e evaluation. [n other words, th CSf~ sh,,uld be inr. :<,rpr Jr;ll'cd into the pcrfr,rmllnce standards and criteria. Nurm, man&y. ;ern/1;upr~rvi <;,)rs sh'>uld f>c role models in public service. It is easier for th,,m 1,, r,nf,,r N: ft,,, rul,;. c; if they prac. 1ice wh:it th,;y expect their subordinat es to oln,crv,;. If rn;,m,;,.,,r., l!"xpcc:I <:thical and lt:~al practice from their staff, t J1ey should a J,,,, rmmaw, c:thir;;,lly :ind legally. REFERENCES J. Cl,,m1:11-Str:,n,, ~l. f!ig.,. ti DG, :,nd Mc Guire SL (1991) Comprelumsiue Family awl Com1111. mill) JJeolll, N11r:;ing. :~"' ed. St. Louis: Mo Hby Ue;Jr nook. z. f>1:partmc 111,,f llealtli. !·lrmlror10 Sfrcjl(J. A Guide for TU/Os and Health (:,111 lt!r::. n~d. ;{. J>·p:,rtm:nl,,( 11. :allh.. ':iant,·on/}. CJlg/o. Ovalily Standard,: I. L,;t fo,· lleofll, J/ru-U/li,,u. IJ. d. ,i. I U111Jy;1w,, J. M (,9,. HIJ '171c f@!l;tlm: N11rt1e IAWder Manage r. ~t. 1...ouii;: 'J11c <;. v. Mml,y <:,,r11p:suy. r;. 11,,,md 'i. I.. :. 11d Savini f J_g (1997). S1. 1perultifo11 (1th r!d. ). Upper S:idtlle IUvcr, IJ·w,J,,,i,,,y: J1··nff1:, I foll.

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

6-7· Goetsch DL and Davis SB (2000) Qiia/ity i\1ana River, New Jersey: Pearson Education Company~emen1. 3"'ed. Upper Saddle K st FE and Rosenzv,, eig JE (1. 979) Organization d N:w York: l\{c Graw-H il! Book Company. an Managern C111. 3n1 ed. s..,.,I' rriner-Tomey A (1996). Nursing Management and 1 d. in3 ·.. ·[osbv. ea crslnp. C51h ed) St. Louis. iv 9· PD 807 _ The Civil Service Law Rakich J. S., Long~t B. B. a_nd O'Donovan T. R. (19n). Managino Health ea t O-Organizations. Ph1ladelph1a:,<\I. B. Saundt:rs, Co. re RA 6713-Code of Conduct and Ethical Standards for Public Officials and 11. Employees L w and Byars L. L. (1996). Supe,,.,ision (5th ed. ). Chicago: Irwin 12. Rue · · "'ansburg R. C. (1993). Int Toduc tory Manag~men t and Leadership for 13. S.. / N'ttr S"" Boston:. Jones :ind 8artlett Publishe rs. clm1ca ·,,.,. 431----~

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Chapter 18 ENHANCING PRACTICE THROUGH COMMUNITY­ BASED PARTICIPATORY.. RESEARCH Araceli S. Maglaya INTRODUCTION Globally and locally, comnmn ity healtl1 nursing practice is faced with the ever increasing complexity of human behavior and human response related with cop int,. and adaptation, given the issues and challenges in addressing emerging and re-emerging diseases. Malaria, HIV/ AIDS and other major diseases are currently specified as United Nation Millennium Development priorities. Realities in nursing care and service support the need to generate new insights to address socio-behaviora l determinants tllat sustain disense prcvr1lencc, 11s a consequence of erratic therapy, passivity, apathy, hopelessness and hardiness of patients,111d thci1· families or inequities in health service access. These insights help nurses as catalysts of change to capture 'lived' e>..-peciences of client-partners as major stakeholders i. n the arena of family and communit y health development. The 'lived' experiences comprise the learning arena of both nurse­ practitioner-re searcher and community client-partner as co-researchers to understand how these experiences sustain disease preva1ence and determine, in pnrtne,· ship, what options can be explored to re-design adaptation realities for increased level of critical consciousne ss, level of control and choice over health, life and health c. Jre/ service decisions and actions. In the last two decades, nurse researcher s have explored the use of the participa tory approach (PA) and participatory action resenrch (PAR) or community-based participatory research (CBPR) in creating nev. r insights to communit-y health nursing practice for enhancing community empowerment potential while sustaining ethical principles, particularly relational ethics ( Austin and others, 2003) such as mutual respect, authentic engagement between nurse researcher and the community as co-researcher, acknowledgement of uncertain ly and possibility as inherent in human existence and attention to the environment ( to ensure respect for privacy). COMMUNITY-BASED PARTICIPATORY RESEARCH Community-based participatory research is a process iri which researchers and co1T1mnnity participants as co-researchers systematically work together in t.-ycles of 'look-think-act' to explore concerns, issues or problems that impact upon or dfarupt people's lives (Kock & Kralik, 2006, p. 27). Collaboratively, they reflect on ways to change situations or build capacity. TI1e cyclical nature of the participatory action research promotes reflection {reflection-in-action, reflection-on-action and reflection for action) and reconstruction of experiences and stories that enhance people's lives, at an individual /fam Hy level, community level, or both. 432-

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

participatory action research approac hes (Kock & Kralik, 2006, p. 25) can im·olvc 1be following: (1) Direct observation where the nurse-res eanhcr can immerse herself in t11e research site to unc. lerstand the context of the 'lived experiences ': (2) Seek out tbe stakeholders and involve their active pnrticipation to nmlcr:;tnnd their cxpcricnce5/ conte:-.-tua l knowledg e, issues and discover their accus and priorities; (3) Story telling through inter·de,,· techniques thnt encourage people t<. i sh:1rc their e~pl. 'riencc. <: in Lhc past, describing what "·orke<l or hasn't work am. l why"?: (4) Umlerstamling context through pn:scncc hy being with participan ts in the area where they hvc m order to have a feel for context, observing. listening, learning issnc.-;, !iccking iss11<!5, exploring solutions. opportunities, and mapping nnd/ or diagranuni11 g resources an<l fo1<lings; (s) Case stories shared hy :111 indi"i<lua J, a family or population aggregat e: (6) Group meetings with people sharing common fe;ulurcs. con..,erns or is..<:ucs whic. h pmvidc rich data generation and mo Liva tion for action: (7) Timelinl. '. ~,md chani;c an;ily~is invohing listing of major events and experiences with ;ipµroximatc dates, people's acco11nts of the past. of how customs. practices and things dose to them have d1:1ngc<l: (8) Shared pre::;eulalion:, and analysis. where local people :111d/ or outsiders. t!Specinllr at communit1· meetings use maps, models, di,1gr<1111s lo prc11e11t their finding:;; and, (9) Contrnst comparisons where one group is asked 10 anal)·r. c the rcspuascs from another group and vice versa, particularly useful in situ,1tions where gender awareness is import~u1t. CBPR can enhance commun ity nursing practice on at least two perspect ives. 111c nurse-catalyst-researcher aud the community participo nts as co-rc.,cm chers can generate data to understand the processes related to lived c~7)ericncc:: on hcaltl1, illness, inequity/access problems, concerns :md issuci; Lhat sustain status quo. Based on a clear un<lerslanding of these pn1t:esses, both can guide one unulhcr in unleashing the empower ing potent. in! to iinprove sense of control and choice tu move beyond status quo and use workable and effective options to create an environment supporti\'e of behavior chtmge and healthy lifestyle. Through the nurse's capability for. malnta. ining true presence {Parse, 1995, p. 82), t\11: person, family or com. munity participants are provided the moti\'ation and support to explore the depths of ideas, i. ssues, or events as they choose lo shed light on the linxl experiences that appear like apathy, passivity or hardiness to ·outsiden; looking in'_ 111e process of helping community participants describe. and dwc. 11 on lived e Kperienccs can be done through commu nication techniques like: "Tell us about your experience when you (or your family member) got sick of... ; Describe what was hardest for \'OU at that time; How was it like to you when that incident happened?; How did you feel when that happened?; What does it mean to you to... ?; Why do you think this wnv?" Lived experiences of families and commun. ily participants explicated as coping or ;daptnlion realities can be understood as lack of or inadequate sense of control or choice over problems or issues rather than apathy, passivity or indifference. Helping commun itv participan ts as co-researchers think about options to transcend tl1esituationand move on can be done through questions like: "What matters to vou now? Wl1at do \'OU think you can do? Describe what you would most like to change; How might you do things differently? ; \Vbat do you think would work?" ENHANCING EMPOWERING POTENTI AL: THE HUMAN RESPONSE PERSPECTIVE The com. munity health nurse (CHN) is continuously cha Jlenged by practice issues and gaps_ These are rooted in a multi-dime nsional and complex in1er. 1ction between epidemiologica l, socio-cultural, behavioral, political and economic factors affecting morbidi ty and mortality realities in the Philippines nnd many other countries. The 433 --

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

problem on prevention and control or malaria, for example, emanates from such factors 11s tl1e complexity of the multi-specie parasite, the multi-specie vector (Knell, 1990), the behavior of mnn a. s the intermediate host, the link between man-vector-parnsite, the occurrence or non-classical signs anti symptoms and resistance pnnerns, and, the im HJequacy of hasic health services for early case finding and prompt treatment. The socio-hch;n;nral aspects of client hehavior nnd the operational issues of health service implementation complicate the situation. Empirical dala on field-level m:magement of malaria derived from ex-periences in a village in Nueva Ecija showed that families have remained as spectators and passive recipients <luring malaria control progr11m imple111ent:1tion such as residual house sprnyillg, chemical t,·cntmcnt of hcd nets 11nd seeding of lnrvi\'orou$ fish in the st reams (Vcneradon, 1990). In,:mother study cond ut:tcd in four villnges in the Municipality of Quezon. Palaw:m Province, seventy-five percenl oft be responden ls thought thnt malaria is due ton combinalion of such f Ht·tors as changing climate, lurnger. over fatigue. the coming of full moon, <lirty surroundings, food nnd drinking water contnminah:d wilh mos4ujk, eggs (Ortegn and others, i997). Through the PHC !;trategy, com rn u njty health volunteers (Cl IVs) or barangay health workers (131-f Ws) were envisioned lo he the huh of community participation to increase accessibility of ba:--ic health services. However, Lhjs objective IH1S nol been truly attained. Acco Tcling lo Salazar and Santos ( 1988). lhis is <lue l'o the short:1p,e of ~m<l/ or frequent turnover ofthe;;;e he::1lth workers be~ansc or insufficient logistical support :ind po()rly sustained motivati onal support. Moremcr, t J1c Cli Vs became aide'5 in health care acting as local e:>. 'tensions of t J1c rural health personnel rather than communit y leaders oa health concerns (Venenicioa, 1990). In pursuing global and local partnerships for development to improve maternal and child health and combat major diseitses I ike-ma Jaria and HIV/ AIDS, nurse leaders and practitioners need to challenge old perspectives and paradigms i11 order to addi-ess t bese millennium development goals specified by the United Nations. New perspectives and fresh insights can be explored by the CHN through communit y­ b:isecl researches, which can shed light on t J1e psychosocial and behavior al dimensions related with enhancing empowering potential as alternative for communit y health development. Erthancing Lbe empowering pot·ential of client/community-partners can be pursued through the CHN';;; e:-rpertise in understaading human response as focal point in addressin~ health and illnc,ss experiences. issue. <:, g:-1ps and challenges. TI1e client/ comm11ni1y-partncr's human response is a dynamic "lived" experience on the realilyof "bei11g" and a m1tural movement tow;Jl'ds "becomin~" (Parse, 1995). Nurses are in the most appropriate and specific Lime and space for helping client-partners capture LJ1is unique and natural phenornenon through the participatory approach. Client-partners ar P lhe k Py s-t::ik Phold P. rs in understanding and knowing Lhe v.. ay, shedding light and uncoverin1,; 'wh::it,..,:,s, is and will be as it is t'Xperienced in the her P-,mrl-now. ' As partnen; (;apture explicitly the rf';ility and meaning of the human response, they gain fresh,·icw ahout t J1c situation and articulate possibi Hties fo. r moving beyond the status quo to create workable options f()r change. Utjlizing the human response perspective "ithin a community-ba sed research, directions for f=;ble and sustajn3ble alternatives for malaria prevention and control had been explored. In 1997 to 1999. a multidisciplinary communit y-based research was carried out with sixty nine (69) rural huu:. eholds in an agricultural villoge in Abra Prr";nce, where malaria is endemic (Maglaya and others, 1999). Through the participatory action methodology. rnoth·ation-support intervention processes were 434

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

utilized by the nursc-1·esea Tchcr-p:irtnc:r working with lhe 69 fomilics lo !?,Cneratc empirical data and unravel the depth of the issues, 14ars and fomily copin~ ~ml adaptation which sustninec J the diseasl! in the village for many ycnrs. The participatory approach,vas utilized lo explore with the local lc;,ders and the fomilics opportun ities to unleasl1 the empowering potcmi;1I of partners i11 ln:alth dc:vd(lpmcnt nl all len:ls: the national, regional, provincial, municipal and the villngc {ln,rnnga y) levels. The hub of the empowerm ent pcrspcdive is the work group composed of families in the village in parlncn ;hip witlt the local lc:n Ul!r S oncl the rural Jw;,lth unit tl'. tm. Thrqu~h motivation-support,ind expcricntfal lcan1ini. ; strategics, the rcsc11rch partni. :rs helped each other un(lerstand the process of l>eh~Jviur c. :lwnge from the rculity of status quo to human responses rel a led with 'moving beyond whal is" to where the family-community partners 'can be'. Fleury':,; stages of herilth behavior change dnsc:ribc human re.-;ponse on initiation.. me. I rnainlc11ance uf ru::w and positive henlth patterns (1991; 1995). Fleury·s theory w. is ad;,1 p1. cd in I he dc:sign, i rnplemcntation unc J cva luation of the fornily empowe rment experience s on malaria prcvenl irm ;ind c;ontrol in Jfarnngay Danglas, Danglas Munieipali L y, Abra Provincf! (Sec lllustr;:ition 18. 2). Using motivntion­ support interventions, the fornilics were gui Je<l thn;ugh the behavior change process from constructing the intention to initiate and sustain lhe change on lo translating the intention 10 action ancl, finally, integrating the action/s or change in Lo existing life style. FACILITATING BEHAVIOR CHANGE THRU MOTIVATION­ SUPPORT INTERVENTIONS Motivation-support interventions enhance, maintain or increase the client­ partners' c. lesfre lo initiule unc. l ::;ustain decisions and actions to complete the hehavior change process. The interventions include experiences that enhance client-partners· competence to understand the relatinnship of the purpose of the action t(, clients' goals, motives or ac;pirations ; ability to meet needs for self-esteem/sense of control competence/self-efficacy and autonomy or relatedness; skills to carry out the action or behavior that lead to efficient goal attainment; journey through the prncess of owning and affirmin g conunitment to sust. iin behavior change; and, desire to create a social network and lay supportive and outreach mechani sms and resources to facilitate availability and accessibi Jity of human can:! senrices (M,1glaya, 1988). ln order to create the intention to initiate and sustain the behavior change in stage 1, motjvation-support options are used to systematically work with families/clien t­ partners as they journey through their human response ex-periences to understand the meanjng or value of the behavior change needed and feel a sense of control to overcome/ manage barriers to change and assume o,vnership over the responsibility for the desired change. Using participatory approach, the nurse-catalyst and family/ community-partners can go through e>.."I)eriential learning processes wilh structured learning exercises as the· 'tribal story'. Client-partners share experiences on the realities of sense of aloneness, helplessness and self-pity in the face of inaccessibility and unavailability of health services or resources to cope v. ith endemic diseases amidst poverty and ignorance of options. Through the 'look and think· participatory approach, nurse and fam_ilies analyze specific pt'oblem/s in terms of nah1re. causes and consequences such as the epidemiology of malaria and the life cyde/bionomics of the mosquito-vector, in order to enhance a sense of control over the situation and ha\'e the ability to handle the disease. The 'action' phase covers additional skills development on / enhancement on early case finding, prompt and appropriate management and prevention and conlrol measures. Through stages 2 and 3. families/ communit y partners go through planning activities (to create tbe ·mind-set" that leads to efficient goal attainment), practice. feedback, and evaluation sessions oo c. ase detection, disease 435

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

prevention/ management and mosquito-vector control (to meet client-partners' needs for competence/ self-ef-ficacy, self-esteem/affirmation, sense of control and autonomy) done within the social context of the patients and families (to reinforce social support and network). Integration of behavior change into existing lifestyle (stage 3) is facilitated through e,'(J)eriential learning and practice-based options that ensure ease of implementation based on time and resources. To illustrate using empirical data on the community-bas ed research on family empowerme nt to¼-ards malaria prevention and control, stream cleaning/cleai-ing as mosquito-vector control strategy was simplified from the big group village-base d activity to household or small group/ neighborhood cluster approach to save on waiting time and address distance issue (Maglaya and other, 1999). The consensus of family work groups was to clean the part of the strean1 nearest to the house or yard of cacl1 family or neighborhood cluster. Stream management through thi. s option increased the frequency and 1·egularity of the implementation of the mosquito-vector control strategy. · EMPOWERMENT: NATURE, PROCESS AND OUTCOMES The research team's experiences working with the Abra-based l1eal thdecision-makers, rural health unit, local leaders and empowered families generated explicit insights and lessons on the what and bow of partnership options rooted on empowerm ent for transformational leadership and change. The experiences of both the local government unit (LGU) and the families showed parallel directi1;ms, patterns and cyclical processes of understanding the goals/ meaning/ purpose behind empowe rment and develop ing self/group efficacy for malnria prevention and control options achieved through planning, practice and reflection-feedback-eva luation e:\.-perien tial learning sessions. As end result of each set or combination of parallel and cyclical processes experienced by the LGU and the families, affirmati on of commitment to sustain the change is achieved. The complement-supplement nature of the LGU-family empowerment experiences deepens the effect of each set o( parallel and cyclical direction and pattern on resource access and exchange. See illustrations 18. 1 and 18. 2. The empowerment experiences of the families focus on thedevelopmentof thef91lowing competencies: 1. Recognize the existence of malaria as disease and health risk/threat 2. Decide to take prompt aad appropriate heal th action. What to do upon detection of cases with or witl1out laboi-atory tests or when life threatening signs and symptoms are encountered. 3. Provide adequate care to the sick, dependent, vulnerable or at-risk member (e. g., carry out measures for accuralte and complete treatment ; management of related health problems/compl ications; self-protection measures) 4. Provide a home environment conducive to health maintenance (i. e., carry out measures to reduce mosquito breeding and resting sites, and measures to, reduce man-mosciuito contact). 5. Maintain a mutual/reciprocal relationship with the community and its resources to increase access to health services, sustain activities on suxveillance, casefinding, follow-up, referral and environmen tal modification/ manipulation and other vector control measures. Each empowe rment journey is facilitated through a deepening of the family's insight 436

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

into its own vulnerabi lity to malaria and tbc feasibility of effective options it can take Through "action-observation-sharing-feedback-reflection" the fornilies understood their own ways of knowing about malariii prevention and control. The empowerment experien ces encour~gcd them to fin. d answers'totheirown questions: ~what happened?"· "What is missing?", "What's nell. 1:?r ' The 1ocal government unit health team together,¥ith other partner agencies provided the necessary support throughout the empowerment prncess,,-. rith concomitant changes in their o,vn competenci es and expnnsion of servi Cl. 'S. At the higher technical and administrative support levels, the empowerment experiences can focus on enhancing capabilitie s to perform critical rnles and responsibilities: 1. RHU Training, Supervision and. Mentori. ng on Family Empowerment Model as Health Education-Social Mobilization Strategy. Smveillance and Reporting Managem eu. t of referrals/morbidity cases from the barangay level Initial Microscopy Reading to Complement Effective Use of the DOH Algorithm on Management of Cases Resource A ccess/Mobil ilationfor Vector Control Activitiesin Coordination/ Partnership with Provincial-based support team/s. 2. LGU-PHO Program Support : Advocacy and Logistics (e. g., radio broadcast as IEC on Malaria Prevention and Control by Empowered Families). Training and Technical Supervision of the RHUs on Malaria Prevention and Control in partnership with the DOH Field Office Team Clinical Management Vector Control Microscopy Services (including quality control for initial reading done at ilie RHU). 3. DOH-Field Office Technical Support : Microscopy; Vector Control; Management of Severe/ Resistant Cases Technology Transfer Advocacy Through the Health Development Fund 4. Regional Office: Technology Transfer and Technical Support on Management of Logistics for: Blood Smear and Microscopy Insecticides 437 ------j

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Formulal-io n l,f lmplcmcnlinh Ciuiddin~: ;'llonilorin~. E,-.,ltmt1 on. f'i_Jd Research 5. N:::itionnl i Cl'ntr. il Ortir1: Poli~· Fon,111 l:ltinn h:i.."t.-d nn Fi el. ii Evalu:it-ion. St11dje!-/Rcport. c;: Direction. cc for :,\1111. iri:i C<>ntml PN~rnm Pl:mnin~ Throuish p.,rtner.-hip,111LI c,1u111crp,1r1i11~ qr:i1 1"i{"-thr e_xplicit outcomt>S of LGL'­ Family empnw<>mwn t 1:,pcric11c1:, 11wl11J\· 111rrt,1<. (. '{) i::i. !'l. '!-findin~ co Ycmec for prompt and. 1ccur:11, tn. Jllll('III a11d r,d111·ti11n uf mn.,tp111n Ian-;,) dcnc;itte~ thrnuf V] ~far ::Lream dt. ::111111}( and,11h,r,,n,;rn11111.. nt;,l 111anipul11tinn llll"<ISUrcs. Thruul!h th< family dw,ter network. the village ha,;; c..,tnhlbhed a monitorin,I! ~·stem for lwth di~tn::,· and 1110-. 41111t1 '-lll'l'1llani;1, "Cl"Vlll J! :t!' an ae11vation unit-for prompt deci. sion-111. 1kin~,111d appropri~1tc nclitm 111 tn-. ;ure malnria prc"·cntion and control. HEALTH IN THE HANDS OF THE PEOPLE f:imily t'mpowcm1cnt c·nh:111n :s i11trin:-ic-mol h~lion 10 sustain part1c1pation in mnlari:1 control :il'til·itic,; in tlw,·illag4:. l>tp. :ndt·nc<' on c:-. ·lt'nrnl source ofmoth·ation surh a-< rnonclary inrc11ti\'i!.. ; c:111 h,· rq,laec-<l hy i11c1·c:1si11f( mnnr~wer resource c-ap,1bilit. ' i<r v,,lunt. :er "'ork. I'm· t''(:1111pl,. h. '· hnvi11i,. n,nrc cmpo"·crc<l families moth,11,·d 1,, p:. trli,·ipnlv 111 1n,,~q 11it1i-,c·rt,,1· n1111 rol. 1cl i,·itie.-.. lrss tir1w is nc L·c. s:sar-· w do th,· n·quirct. l,1<·ti,·i1. '·· Thu:<. vol11111c,·1':$ 1w,·d uni\ n mn;,. ;mu m. of four hours~ ,,L'<!k to,iff..-r to 1lw c·nr111111. 111 it. ' t't1r,--i 1'1. ':lm 4;lc. 11·in,. : :111d,. ;, her n1:1l:1rin c:ontrol ncti,·itics. E,·en wit J1 111i11i111t1111,·olu11lt',r timl', tlw fon,ilic:: can cxre,;cnc:c more hc>rwfits from n. d1wing th, dsk of ). :t'ltini,: "irk fnm 111:11:-tri:1_ The H>rklu:,d burden to sust:·,in 111:1l:tri:i control nrtidlic,: ~ive11 lo curr,ntl~ · o,·cr-bunl,nc--..1 h:1n. u1i;ny health workers can be s-ha. n..... i by more people who nrc willin~ to put "l lc.. ihh in 1heir Hands.. fo1· a l\lnlarin ­ free con11nunity. BEHAVIOR CHANGE OVER TIME 438 3-20-2003 Dcar. \fo"am Maglaya. Kunmsta 1111 po ka!JO ciiym,? P11;:c11sy t1 na po kayo ku11g ngayon fang kami nc1kapa9$ula I st1 inyo. l\ami po. h11::y komi sr1 mga gmt Clin sa b11J..id pcro mas. ki 11a 1,apaa,w di,wmin 11nkah1limirto11 a11p pnglili11is sa wnig o stream gaya 119 pinagltir·aptm 11inyo11g iri1111r1> sn nmin. J..:anilarl po n<mg isang /-i119911 1w9luyo)I J'V kmni ng til<1pi(J 0Jin9,·rlings, Knsamo din po 11amin ang mgn t C1gn-J)OJf :;u J>U!llili11 i:; 119 uai!J· Soong lo:-t '11U11t/1 IIC1!J·111nss blood sun. ·cy po ka111i. nmg mgn 11ee111 n·e( oy µi11akiki12aba11ga11 po namin diro sa Dmig/(1. < at a. ko pa ang rriny J>innkamalclking lll'f'm tree. Sa akin po h11mihingi 0119 ifa11g taga-rito. Nag-mimiti11g,-;11 po kcmrinp 11190 empoweredfamilies. J\"a I1ag11.--upa11 10 1wmi11 JJi 8crlin (du ting /~II LI,w,·se) na hmg sana ay magrcw1ion ri11 po tayo. J..:umusta na fang po. :;a lahat diyan. Gumagafang at nagmamahal, Kapita11a Elena Bacoani

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

corvi MUNITY LEADERS UPDATE THE RESEARC HER AT THE UNIVERSITY , t..1~ ~-. 2Po..;:.. \ttrr 1,,... in~,\ 111alnn&1f Tt",· rt1n111n11Ht, fut,r,11u--1-''<1r.... n1c1lnri:1 ~ w-. ::. :. ~,\ in th,:,;11,1~, "ith \"11 p<1,111,,·,·. 1,,.._ 11!,·11t1lird '111nm:,1 11\,1"" hlo"d <11r,i. !y -~ Arni :;:0,,. 1 rn'. 111llt'l11 "·" 11\<11\llolr,,I 1,,...,.,1,,·,HVI ·.,·, i.. r,11J"1'ill,1111·r. t1,-c..;-r f. :,r......... ntl"\' n,e.. \:-!Un. ":.--,\nd,tr,". \tl\,.. 1,.. j,nn~. h :1\'1ti..-....-.,..,... ;u,.--,h·,,·cl h~ th,·,11,po\. "''"~ !,r··Ctt'S f<X:ll>'illl,: pr,.. \\'h,11 h;1 Pl'~'llt d ! \ \'h. 1t,. _ 1111-.-me;-' \\'ha: to. i.. n,,l'" Rrr·al r:. ~ i;i!, xi HHY'~ :i 1n,,111h nlt. r n,,,;11,'ll 11" P""it1,,· l'. l't'. _ :-tlys~~ of F. n,pqh~nn(nl F,p,__. ·ri,'t H. ·l'~.. \ j1H1rth'\ tr11111. 1,,·n,c nf lu1pr~l,... ~,11P"'-. lnd J. r,.,thy 1n 100(:> tn,,~n-..,;-nf p ""'r '",r h,,,111 h pr11hl,m-.. thr,,"~h tlo1 111n11m1n11-:, · a:fi-:n,a tinu (lf (. ")'\\. n l. ~Pt 1fidt. I\\. ·..:-. i 11<. i l"l'tl\ pr'l t"n,·t' l t 1 t ·11 ~ti' p I 11...:...,..... 'n, 1,,·,~tnr..;n rv,--1 U.-1 nc11. r. i>mpt. appn1pn. 1l t' trc. 1t111l'III and t,na.-it, 111 1·. 1rrn11~, 'Ill prt''<'t111,,· m'as11n·s fur efiecti,-. : n,anai;z.-m,,nt nf rt>~'n Hrp11)! dt"'·'"''· COMMUNI TY-BASED RESEARCH : INSIGHTS FOR ENHANCING NURSING PRACTICE E. 1npiric:ll dnla gcncrule<l thnu~h,-.,n,1111111 il\-h:ts<"d p:ir1idp,1t1>n rt"N':ird1 pnn-itle pn"Cision in undcr:-tand in~.,-p,·.-iti,· h,·lmn,1r:1I plt,11<\11w11:i 0. :11.-!1 ". 1111· pro,·,-:-iaes in,-olvcd in II n lea::h in~ l' 111 po"',·ri 11~ r >lt 1111. 1 I. 1111 I 11111,.,.,-1,.-11 I III t<·ra,·t",·,.,. p,·ri,· 11,:c" th111,-hcd light on the realities ofi-111,.,itl Ji,·11"1 k111"·mi:,. md v. 1htl. 1tt11 }: p,·n-,·pt1rn 1,-..11111I m,";ns. 011· inn repditi,·,·,:yd,· nf ·~111t11ri11i: :-pl'Cilk n1111p,1111·111:. 1>t h11m. 111 fl'"\1<111:-cs to dkctivdy iilcn ti fy l>pt inns l <' h,·11' fn, 11 i Ii,:-. /,·, 11111ll111 i1 ~· p. rt 111. r-< h:llldl,. ' !:" 1 hrnui,. h beha\'ior chan~c. I. i,·ed experi,11c,·:-,-h,,n·d 1", ""11111111it., di,,tt p:tr\11,·r--,·11h,,n1·,· th..: uur. ;c-,·a Lalyst-partne1·· s 111cnlal,111d pi-~dui-:-:<>l'i:il. 1pli1, to,;,,· l'np111;:,111d. 111:tpt. ttion re:ilitics and diffic111ties from th, l'li,·11t-part11,·rs· \h'l'Sl'<'l'liv,·, In,1 v:irin)!,,ml ~pportivc learning envi rnn 111,nl. the 11 u l'H' l'al,dy"I pa rtn L'r.-;111 hcl p 1. ·nmm11 11i1,. 1·1i L'nt partner. ; analy·✓-e the cxpcrit. :IH'I. ' as i I 11nfnlds "·it I, i 11 1 lw cirn1111:-:l:i 11,·cs,,·h irh tri~cl'\.-d or sustained the coping/ml. 1ptatin11 pn1hl111 1. U:-111;: ;iffc,·ti, 1·,rnd tt-d111irnl ::uppon iotcr..-entions, the 11\ll'SC c. ;111 help clil'nl-p:1rt1ll'r" g,nc.-rat,· msighls llt 11111hn;t:111d thl' e:-.-perienc e from the perspectivl of ·w1t;,1 happt. ·n,·d nncl "'lllll is happct1111g nc,w?' lo 'what the clicnt-p:lr1 ners \\"ish to happc11 or t,, htt·nm. :-·. :--ui<l;oinahilit~· of C1)111mu11itv­ based empowern1ent breakthroui;hs can be,1<:hic,·L·d with tlw rurnl h,·. 1lth u11it u,~u local leaders taking the lend in replicating; the c;1talyst role 10. supp011 dit-111s· journcv thru the behavior change process. Given the complt!.,dly llf the multi-spccit: parasite. the multi-specie vector and the link berwecn, man-,·cctor-par:1sitc. interd Li;ciplinary and interagency collaboration arc ctitical component$ of an cffccti,·c h. :alth can:/ sel'\;ce deli\'ery system. Community-based researches using the participatory approach provide tbe best opportu. nities to tmdcr,;tand the realities of h11nurn response of clicnt-partnen; und nurse cntalyst-pu rtner as both respond to health and health service problems in vt1rious ,,,1ys. The 'look-think-act' learn inf:, cyde pnr L1cipatory methodology dcwlopcu ns Lhe a~rse's conscious unconscious competence promotes menial agility. flexibility, opc-11-mmdedness, increased self-awareness, creativity, caring compete nce. efficacy and effidency in and passion for community health nursing practice. 439

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

440. ' Refec:tion ­ Feedback ­ Evaluation Visioning/ Goal Setting Finding Meaning/ Purpose In Empowerment Experience Provtoctal Baranpy. I Planning

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

r :!. g_ S" ! Ii, ~ '-' ~ ~ } :,. :.... Construct Intention to Initiate/Sustain Change e Enhance Perception of Need for Change Meaning/ Purpose of Change (Technical and Personal) Enhance Perc~ption of Control over Situation/ Problem and of Ability to Manage Possible Barriers to Change. Guide through the Process of Owning the Responsibility for Desired Change. Enhance Perception of Relationship of Change with Own Roles/Re. sponsibilities Help Relate Change with Responsibility and Sense of Efficacy,. to Actions towards Change Enhance Enacting Capabilities: Help Define Realistic Expectations and Prm<imal Goal­ Setting Ensure Specific Rules for Change as Guide on Performance Expected. Provide Discovery Learning Opportunities to Practice and Evaluate/ Monitor Own Goals/ Experiences/ Ca pabi I iti es Affirm Commitment to Change Feedback on Performance Enhance Perception of Meaning Behind Change into Existing life Patterns Enhance Client's Ability fo Facilitate Integration of Change into Daily or Regular Activities Enhance Workability of Change: Simplify, Customize to suit Family's Reality/Conditions. Enhance Sense of Efficacy in Handling Lapses and other Implementatio n Problems. Enhance Experience of Sense of Connectedness and Wholeness with C~nge Relate Meaning Behind Change with Own Goal/ Aspirations Affirm Sense of Responsibility and Efficacy to Achieve Mdlaria-Free Community : Perso11al and Group/ Community Commitment

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

f ~ ~ s: n lo ~ ~ " ~ r t... \ Construct Intention to Initiate/Sustain Change acifitate Enhance Perception of Need for Change! Meaning/ Purpose of Change (Te<:hnical and Personal) Enhance Perception of Control over Situation/ Problem and of Ability to Manage Possible Barriers to Change. · Guide through the Process of Owning the Responsiblllty for Desired Change. Enhance Perception or Relationship or Change with Own Roles/Responsibilities Help Relate Change with Responsibili ty and Sense of Efficacv.. to Actions towards Change Enhance Enacting Capabilities: Help Define Realistic Expectations and Proximal Goal­ Selting Ensure Specific Rules for Change as Guide on Performance Expected. Provide Discovery Learning Opportunities to Practice and Evaluate/ Monitor Own Goals/ Experiences/ Capabilities Affirm Commitment to Change Feedback on Performance Enhance Percepnon of Meaning Behind Change.. c. Integrate "ctions/Change into Existing Life Patterns Enhance Client's Ability to Facilitate Integration of Change into Daily or Regular Activities Enhance Workability of Change: Simplify, Customi1c to suit Family's Reality/Conditions. Enhance Sense of Efficacy in Handling lapses and other Implementation Problems. Enhance Experience of Sense of Connectedness and Wholeness with Change Relate Meaning Behind Change w,th Own Go. ii/ Asplratiom Affirm Sense of Responsibiliiy and Effic:icv to Achieve Mabria-Free Commun11y: Personal and Group/ Community Commitment

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

i t g_ S°· &> ij, ~ " ~ t I-' Enhance Perception of Need for Change/ Meaning/ Purpose of Change (Technical and Personal) Enhanc. e Perc~ption of Control over Situation/ Problem and of Ability to Manage Possible 'Barriers to Change. · Guide through the Process of Owning the Responsibilltv for Desired Change. Enhance. Perception of Relationship of Change with Own Roles/Responsibilities Help Relate Change with Responsibility and Sense of Efficacy,es/Processes (Adapted from f1e~ry;199ll B. Translate Intention to Actions towards Change Enha~ce Enacting Capabilities: Help Define Realistic Expectations and Proximal Goal­ Setting Ensure Specific Rules for Change as Guide on Performance Expected. Provide Discovery learning Opportunities to Practice and Evaluate/ Monitor Own Goals/ Experiences/ Capabilities Affirm Commitment to Change Feedback on Performance Enhance Perception of Meaning Behind Change ~ C. Integrate Aci\ons/Change into Existing life Patterns -' Enhance Client's Ability to Facilitate Integration of Change into Daily or Regular Activities Enhance Workabil;ty of Change: Simplify, Customize to suit Family's Reality/Conditions. Enhance Sense of Efficacy in Handling Lapses and other Implementation Problems. Enhance Experience of Sense or Connectedness and Wholeness with Change Relate Meaning Behind Change with Own Goal/ Aspirations Affirm Sense of Responsibility and Efficacy to Achieve Malaria-Free Community : Personal and Group/ Community Commitment

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

i t g_ S°· &> ij, ~ " ~ t,.. Enhance Perception of Need for Change, Meaning/ Purpose of Change (Technical and Personal) Enhance Perc~ption of Control over Situation/ Problem and of Abillty to Manage Possible Barriers to Chatge, · Gulde through the Process of Owning the Responsibil ity for Desired change. Enhance Perception of Relationship of Change with Own Roles/Responsibi lities Help Relate Change with Responsibility and Sense of Efficacy 1gl'f~ul"1lapted m>m f\eu('f, l. 991) ~ e. Translate Intention to /\ctions towards Change Enhance Enacting Capabilities: Help Deline Realistic Expectations and Proximal Goal-Setting Ensure Specific Rules for Change as Guide on Performa nee Expected. Provide Discovery Learniri B Opportunities to Practice and Evaluate/ Monitor Own Goals/ Experiences/ Capabilities Affirm Commitment to Change Feedback on Performance Enhance Perception of Meaning Behind Change ~ t. Integrate Actions7Change Into Existing Life Patterns I' Enhance Client's Ability to Facilitate Integration of Change into Daily or Regular Activities Enhance Workability of Change: Simplify, customize to suit Family's Reality/Conditions. Enhance Sense of Efficacy in Handling Lapses and other lmpfemematfon Problems. Enhance Experience of Sense of Connectedness and Wholeness with Change Relate Meaning Behind Change with Own Goal/ Aspirations Affirm Sense of Responsibility and Eflicacy to Achieve Mal. :iria-Free Community: Personal and Group/ Community Commitment

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442 REFERENCES 1. Austin W, Bergum V, & Dossetor. J. (2003). Relational ethics: an action ethic as afoundatio11fo1· health care. In \I. Tschudin (Ed). Approaches to Ethics. Toronto: Butterworth Heinemann. 2. Bustos MDG and others. (1999). State-of-the-Art: Malaria Research in the Philippines. Philippines : Philippine Council for Health Research and Development-Department of Science and Technology. 3. Fleury J. (1991). Empowen'ng Potential: A 11ieory of l Vellness Moriuacion. Nursing Research, 40 (5), 286-291 4. Fleury J. (1996). l-Vellness. Motivation Theory: An Exploration of Theoretical Relevance. Nursing Research, 45 (5), pp. 277-283. 5.. Knell N. (1990). l\'falaria: A publication of the tropical programme of the Wellcome 1)-ust. Oxford: iliford University Press. 6. Kock T and Kralik D. (2006). Participatory Action Research iri Health Care. Ox-ford: Black. ·well Publishing. 7. Laverack G and Wallerstein N. (2001). Measuring community empowerment: afresh look at organizational domains. Healtlt Promotion International, L6 (2), pp. 179-185. 8. Laverack G and Labonte R. (2000). A planning framewor·kfor commun ity empowerment goals within health promotion. Health Policy arid Planning, JS (3), pp. 255-262. 9. Maglaya AS, de las Llagas LA, Ancheta CA & Belizario VY. (1999). A family health empowerment interuenti on model 'towards prevention and control of malaria in the Philippin es: the local government unit/rural health unit perspective. Manila: Department of Health-Essential National Health Research. 10. Maglaya AS. (1988). Behauioral Catalysis: A Theory of Nursing Intervention in Family Health Care. The Anphi Papers, 23 (2), 14-20. u. Ortega L and Others. (1997). Fi:e. ld trial of selective and complete indoor spraying using bendiocarb (Ficam VC)for malaria control in the Philippines. Department of Health: Malaria Control Services. 12. Parse RR. (1995). Illuminations : The Human Becoming Theory in Practice and Research. New York: National League for Nursing Press. 13. Salazar N and Santos M. (1988). "Malaria: Research and operational issues. · Transactio n of the National Academy of Science and Technology, Republic of the Philippines, 12, pp. 437-463. 14. Veneration C. (1990). Field-level management of malaria and schistosomiasis: Experiences from n. vo Philippine Barangays. Quezon City: Institute of Philippine Culture, Ateneo de Manila University.

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

15· \\·or Jd Health ?rgani7:~tion (1996)~ \·ec_tor B_ionom~c:s in 7!1-r Epiclcminlogy d Coricrol o J. \lc1/ano Parr !fl: 1he 11 UO 5011cli-f-. 0;;1 t\1;10 Rcgio,1 ond rite ~ ;iescern Puc Uic Rcyiun. \ ·0111 me 11: l. c:11Jin9 Urcrol11rr-C<"rt rrc1/ Rcuiew J970-1994,

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

APPENDICES..

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

f i ~­s: 0 "' ~ ~ ~ ~, Assessment t \II ~ NURSING PRACTICE Art: Caring Towuds Human Becoming Sdence: Pr 1ctice-based Evidence Evidence-based Methods and Tools Assur;ince (Core Community Health Functions) oweri1111 Potential of People ibi!ltr for Hea:ih Promotion & , ~ and Mwgement Policy/ Program Developme nt/ AJJvoc-a<y/ lmplementalfon psto '

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APPENDIX A2 LAWS THAT IMPACT ON PEOPLE1S HEALTH AND CHN RA 1. 082 RA6365 RA6675 RA6713. RA 6758 RA7277 J{A. 7305 RA7432 RA7600 RA7610 RA7719 R. A7846 RA7875 RA7883 RA7885 RA s,72 RA 820::4 RA 8191 RA8344 446 RA8423 RA8504 RA8505 RA8749 RA8976 RA9003 RA 9173 RA9208 Rural Health Act (as amended by RA 1891) National Population Policy Generics Act of 1988 Code of Conduct and Ethical Standards for Public Officials and Employees Sala1y Standardiza tion Law Magna Carta for Disabled Persons Magna Carta for Public Health Workers Senior Citizens Act of1992 The Rooming-in and Breastfeeding Act Special Protection of Children Against Child Abuse, Exploitation and Discrimination Act (and amended by RA 9231) National Blood Services Act Compulsory Hepatitis B Immuni zation Act National Health Insurance Act llarangay Health Workers' Benefits and Incentives Act Corneal Transplunt ulion Act Salt lodization Act or ASl N Law Special Law on Counterfeit Drugs National Diabetes Act An Act Penalizing the Refusal of Hospitals and Medical Clinic.-; lo,\dministcr Appropriate Inltfal Medical Treatment and Support in ~mergem.-y Cases (amended Batas Pamhans..i llli;. 702) Traditional and Alternative Medicine Act of 1997 AJDS Prevention and Control Act Rape Victim A'isistance and Protection Act Clean Air Act of 1999 Food Fortification Law Ecological Solid Waste Managem ent Act Philippine Nursing Act of 2002. Anti-Trafficking in Persons Act of 2003

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RA9211 RA9255 RA92,57 RA9262 RA9288 RA9439 RA9482 RA9502 E051 PD603 PD807 PD825 PD856 PD996 LOI 949 An Act Regulating the Packaging, Use, Sale, Distribution and Advertisement of Tobacco Products An Act Allowing Illegitimate Children to Use the Surname of their Father Expanded Senior Citizens Act of 2003 Anti Violence Against Women and Children Act Newborn Screening Act Hospital Detention Law Anti-Rabies Act of 2007 Universally Accessible, Cheaper and Quality Medicines Act of2008 The National Code on the Marketing of Breastmilk Substi­ tutes, Breastm ilk Supplements and other Related Products (Milk Code) Child and Youth Welfare Code Civil Ser. ;ce Law Providing penalty for improper ga_rbage disposal Code on Sanitation Compulsory Immunization of all Children Below 8 Years of Age Against the Six Chi1dbood Immunizable Diseases Legal Basis of Primary Health Care 447

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APPENDIX A3 HEALTH PROGRAMS OF THE DOH 448 1. Adolescent and Youth Health and Development Program 2. Botika ng Barangay 3. Breastfeeding program/Mother and Baby Friendly Hospital Initiative 4-Blood Donation program 5. Cancer Control Program 6. Child Health 7. Diabetes Mellitus Prevention Program 8. Dengue Contr-ol Program 9. Dental Health Program 10. Doctors to the Barrios Program 11. Emerging Disease Control Program 12. Environmenta l Health 13. Expanded Program on Immunization 14. Family Planning 15. Food and v Vaterborne Diseases Prevention and Control Program 16. Food Fortification Program 17. F0UR. mula One 18. Garantisadong Pambata 19. GM. A 50/ Parallel Drug Importation 20. Healthy Lifestyle program 21. Health Sector Developmen t Program 22. Knock-out Tigdas 23. Leprosy Control Program 24. Malaria Control Program 25. Measles Elimination Campaign (ligtas Tigdas) 26. National Cardiovasc ular Disease Prevention and Control Prot,rram 27. National Filariasi s Elimination Program 28. National Mental Health Program 29. Natural Family Plaooi. ng 30. Nutrition 31. Occupational Health Program 32. Health Development Program for Older Persons 33-Pinoy MD 34. Persons with Disabilities Program 35. Pneumo11ia and Acute Respiratory Infections Program 36. Prevention of Blindness Program · 37. Rabies Control Program 38. Safe Motherh ood and Women's Health Program 39. Schistosomiasis Control Program 40. Smoking Cessation Program 4L. Soil Transmitted Helminthiasis 42. TB Control Program (Source: http://www. do h. gov. pti/prog rams. May 5, 2008)

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Appendix B _ FAMILY ASSESSMENT TOOLS APPENDIX 81 CONSTRUCTING ANO INTERPRETING A GENOGRAM PART 1. 1: GENOGRAM FORMAT* A. Symbols to describe basic family membership and str:ucture (include on genogram significa nt others who lived with or cared for family members-place them on U1e right side of the ~enogram with a notation about who they are. ) Male: D Index. Person (IP): Female: 0 Birth date-. SO. OS-Death date ~ [g]@ Marriage (give datel (Husband on left, wif-, on right): Y m. 70 Q Marital separation (give date): s. 83 < 7 Q IH. nh X living together n:ladonship or hat>On (give dat. r): 72 0 Divorce (g,se dat~): 0 d. 72 Q Cl\ltdren: list bv year of birth, beginning with oldest on left: Adopted or foue,r chlld rcn: Fratemel twins: Spontin eous ~bortion: fdendcal twins: ~ Induced abortion :. ~ Members of curl'en. tl P household (clrcle them): W~re c. hang:M ln custody have occ\Jrred. ple-il St: n. ote-: ~Rftence. Mc Goldrick. M. and Gerso,,, R. (1985). Genogrom In Femily. sssmorn. N-York: WW No'1on & Comc,eny, pp. 154-155 I I 0 I I Q D Prean~ncy:~ 6 mos. Stillbirth : ~ .... ______ _------... / ~ _,,' I ' ' I I I 449

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450 B. Family interaction patterns. The following symbols are optional. The c1inician may prefer to note them on a separate. sheet. They are among the least precise information on the genogram, but may be key indicators of relationship patterns the clinician want to remember. Conflictual relationsh ip: Very close reltionshlp: ~ l>istnt relationship:-=:J------0 Estnmgement or cut,off r7___J L _ _r-"\ (give dates if possible): L_J _. ' ~ Cut off 62-78 Fuoed and con Aictual : ~ C. Medical history. Since the genogram is meant to be an orienting map of the family, there is room to indicate only th~ most importan t factors. Thus, list only major or chronic illnesse$ and problems. Include dates in parentheses where feasible or applicable. Use DSM-IV categories or recognized abbreviations .,.,-here a..-ailable (e. g. cancer: CA; stro!ke: CVA). D. Other family information of special importance may also be noted on the genogram: 1. Ethnic background and migration d. lte 2.. Reli1ion or religious chai. nge 3. Eduation 4. Oc. wp. ai'tion or un~pfoyment 5. Retlrement 6. Trouble with law 7. i>hys. ical abuse or inces1 8. Obuitv 9. Alcohol or Oru1 abuse (symbol ; ~ Q) 10. Smoking 11. Oates wh.. n family members left home: LH '74. 12. Curr~nt l~tlon offamily members It is useful to have a space at the bottom of the genogram for notes on other key infor-matiom critical events, changes in the family structure since the genogram was made, patterns and other notations of major family issues or changes. These notations should always be dated, and should be kept to a minimum, since every extra piece of informati on on a gcnogram complicates it and therefore diminishes its readability.

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r-:!. g_ S" ! Ii, ~ '-' ~ f#IILYNAME_. ________ _ D111Aledln----------Fletllftlf I.. ;_,C, ftllly A!lln SS _-, PART 1. 2: GENOGRAM ___ FOR_M_:--......-------,-~--,;,---:,:----------Kev Issues, Patterns & Life Events Slgnlllant Other/s 11111 Genon, "-(19&5). G1n111f1ms In Famllw, Assessment. I ~..

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PART 1. 3: BRIEF GENOGRAM INTERVIEW GUIDE* Index Person, Children and Spouses Name? Date of Birth? Occupatio n? Are they married? Jf so, give name of spouses, and U1e 11ame and sex of c/rilclr-en with each spouse. Include all miscarriages, stillbirths, adopted andfoste.,· c11ildn!. 11. Include dates of man·iages, separations, divorces, birth aud deutli dales, cause of death, occupatio11. s, education of the above family members. Who lives iu the houseliold 11ow? Family of Origin ft,,fother's mime? Fatlter's name? They were which of how many children? Give name and sex of each sibling. Include all miscarriages, stillbirths, adopted and foster siblings. lnclude dates of the parents' marriages, separations, divorces, birth and de. crth dates, cause of death, occupations, education of the above family members. Who lived in the household when they were growing up? Mother's Family Identify the names of the mother's parents: The mother was which of how many children? Givenameandsexofeachofhersiblings. Includea llmiscarriages,stillbirths, adopted and foster siblings. Include dates of gra. ndparents' marriages, separations, divorces, birth and death dotes, cause of death, occupations and education of the above family members. Father's Family Identify the names oft hef at her's parents: The mother was_ which of how many children? Give name and sex of each of lier siblings. Include all miscarriages, stillbirths, adopted and foster siblings. Include dates of grandparents' marriages, separations, divorces, birth and death dates, cause of death, occupations and education of the above family members. Ethnicity Identify ethnic/religious background of family members and the languages/dialect s they spoke if not English/Fi lipino. Major Moves Specify major family moves and migratio. ns. Significant Others Add others who lived with or were important to the family. .. Reference: Mc Goldrick, M. and Gerson, R. (1985). Genograms in Family Assessment. New York :W. W. Norton &Company, pp. 157-158. 452

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All Those Listed, Indicate Any of the Following: for serious medical; behavioral, or emotional problems; job problems; drug or alcohol problems ; serious problems with the law. For All Those listed, Indicate Any Who Were: especially close; distant or conflictual; cut off from each other; overly dependent on each other. PART 1. 4: GENOGRAM INTERPRETIVE CATEGORIES* Category 1: Family Structure: Based on relational structure, family composition, sibling constellations and unusual family configurations, family themes, roles and relationships can be explored or validated. A. Household composition 1. Intact nuclear household 2. Single-parent household 3. Remarried family households 4. Tiu-ee-generational household 5. Household including non-nuclear family members B. Sibling constellation · 1. Birth order 2. Siblings' gender 3. Distance in age between siblings 4. Other factors influencing sibling constellation a. Timing of each child's birth in family's history b. Child's character istics c. Family's "program» for the child · d. Parental attitudes a T1d biases regarding sex differences e. · Child's sibling position in relation to that of parent C. Unusual family configurations Category 21 Life Cycle Fit: Ages and dates provide data on what life cycle transiti. ons the family is adapting to and whether life cycle events and ages occur within nonnative expectatio ns. Possible difficulties managing a specific phase of the life cycle can be explored. Category 3: Pattern Repetition Across Generations: Recognitio n of repetitive pa. tt. erns of functioning, relationship and family structure can suggest the possibility of patterns continuing into the present and into the future but which can be altered for family growth. A. Patterns of functioning B. Patterns of relationship C. Repeated structural patterns 453

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

4S4 Category 4: Life Events and Family Functioning: Tracking critical events and changes in fanilly functioning can be the bai;;es of making systematic connections between seeming coincidences, assess the impact of traumatic changes on family functioning and its vulnerabili ty to future stresses. A. Coincidences of life events B. The impact of life changes, transitions, and traumas C. Anniversary reactions D. Social, economic, and political events Category 5: Relational Pattern s and Triangles: Help determine intense relationships and based on the family's structure and positions in the life t.-ycle, dyadic and triangula r patterns that are rigid can be addressed, allowing members to function independently in each relationship and not automatically fall into a certain pattern of relating to one person because of the person's relationship with another person. A. Triangles B. Pa. rent-child triangles C. Common couple trim1gles D. Divorce and remarried fam. ily triangles E. Triangles in families with foster/adopt ed children F. Multigenerationa l triangles G. Relationsl1ip s outside the family Category 6: Family Balance and IInbalance: Patterns of contrast and balance provide data about how tl1e family is adapting to imbalances that may be stressing the system. A. Family structure B. Roles C. Level and style of functioning D. Resources

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APPENDIX 82 CONSTRUCTING THE FAMILY ECOMAP Work Mr. O: Cook Mr. O Oo Family or household Ana Pepe Figure B. 2 Ecomap. Fill in conn~ions where they exist. Indicate nature of connections with a descriptive word or by drawing different kinds of lines: for strong;-------for tenuous ; + l + for: stressful. Draw arrows( ➔➔➔ ) along lines to signify flow of energy, resources, and so on. Identify significant people and fill in empty circles as needed. (Adapted from Hartman, A: Diagrammatic assessment of family relationships, Social Casework 59:470, 1-978. ) 455

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456 APPENDIX 83 CONSTRUCTING THE FAMILY-LIFE CHRONOLOGY To mates Ast aboutllow they met, when they decfded to marry, etc. To Wife io Husband _..howshesawherparents,------Ask how he saw his parents, his her slb Jln1s, her family life siblings, his family life Bring chronology bac:k to when Bring chronology back to when she met her husband he met his wife Aslc about her~ns of marital life r I 'n>ma~ Ask about his expectation of marital life MIi abollt arty manled life; explore about the Influence of the past To mate4 as parents Ask about their expectations of parenting; explore about the influence of the past To c:hlfd. Ask about thechlfd'svlews of the parents, how he or she sees them having fun"' dlsa1reeln,1, etc. To famlly. as a whole.. Rl!assure fal. ritfv tfu,t It Is safe to comment; reinforce need for clear ~ujtl,Qtt~,lv'eclosure, pofntto next meeting, give hope based on stren;ths &i therr relationship over ti,rne. _... Figure B. 3 Main flow of fam,j Jy-life chronology. (Adapted from Satir, v: (1967). Conjoint family therapy: a guide to theory and tecftnique, Palo Alto, Calif: Science & Behavior Books, p. 135. )

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

APPENDIX Cl CHARTING NURSING CARE, PROGRESS NOTES AND CLIENT RESPONSES/ OUTCOMES* A. PURPOSES 1. Communicate care to other team members who need information on what the nurse has done and how the client is doing. 2. Help identify patterns of responses and changes in status. 3. Provide data for evaluation, research and improvement of quality of care. 4. Document data to supply validation for insurance or legal purposes. 8. TYPES OF CHARTING USING MNEMONICS 1. AIR-A (Assessment, Intervention, Response, Action). Chart the assessment data observed/gatliered, the interventions done, the client's response/s to the interventions and any action/s taken based on the response/s. 2. DAR (Data Action Response). Chart the data observed/gathered, the actions performed. and the response/s of the client. 3. DIE (Data, Intervention, Evaluatio n). Chart the data observed/ gathered, the interventions done and evaluation of the client's response/s. 4-Pi E (Problem, lnterventions, Evaluationj. Chart the status of the problem/s, the interventions performed and the evaluation of the client's response/s to the interventions. 5. SOAP, SOAPIE. Chart subjective data, objective data, analysis of assessment data to reflect nursing problem statement/s, intervention plan, ilnplei;nentation results and evaluation findings. 4 Adapted from Alfaro-Le Fevre, R. (2002). Applying Nursing Process: Promoting Collaoorative Care (s Edition). Fhiladelphia: Llppinoott Williams and Wilkens, pp. 149, 174 and 177. 451

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i t g_ S°· &> ij, ~ " ~ ~ APP£NDIXCl FAMUSBVICIANDPl OGRESSRKORD NEAD Of nt E FAMILY: FAMILY NUMIER: _______ _ I, I. Assesfflieat of the Fmlly, Ho~and Environmental Conditions: Al. Membffl of the Household FAMILY MEMIEII 1111,AT'ION Bllnt OATt MARITAl H1Gll£ST OCCUP~TION ilo. TO HEAD SEX STATUS l DUC. Typeof """' Month Year COMPL£Ti D Woni Platt -Al. Famllv Members not residing In the household but affect family re1ourc. e generation and use FAMl Y MEMBER Ra ATION ll RTMDATl MAIUT'-L H[GHEST OCCUPATION TO HEAD Stlt STATUS EDUC. typeof No. Name Month Year COMPll TEO Work Plate ~ A. Home and Environment Dat1! Assessect: ____ ~---1. Home a. Ownership: ( ) owned ( ) rented ( ) rent-free b. Construction. materials used: ( ) Light ( ) Mixed ( ) Strong c. Number of rooms used for sleeping: ______ _ d, Ugtlt1ng hitllltles: l 1 Eleetriti. ty ( ) Kerosene j ) Others: Specify e. General-sanitarycondillon: ________ __________ _ REMAJ. KS/ DAT£ ENTEREO REMARKS/ DATl ENl HE O

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

I 2. Drloklng Water Supply Source: ( ) private ( ) public Potability: _______ _ ____ _ Distance from house: Storage: ( ) none (direct from faucet or pipe) ( ) large covered container with faucet ( ) lar1e uncovered container without faucet ( ) others, specify _______ _ 3. Kitchen Cooking facility: ( ) electric stove ( ) gas stove ( ) firewood/ charcoal Sanitary condition: ________ _ Drainage facility: ( ) open drainage( ) l:!llnd drainage ( ) none 4, Waste Disposal a. Refuse and garbage Container: ( ) covered Method of dlspo,sal: ( l hog feeding ( l open dumping , ( ) burial In pit ( ) composting b. Toilet Type: ' ( ) open ( ) none ( ) open burning l I garbage collection ( ) others. specify: ___ _ 459

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

pp ENDIX C3 ~NSTRUCTIONS ON THE USE OF THE FAMILY SERVICE AND PROGRESS RECORD (FSPR)* I. OBJECTIV ES OF THE FSPR A. Facilitate the operationali?. ation of the concept of family-centered nursing care. B. Ensure a systematic approach illl the deliv!!ry of nursing services to families, spedfical \y the application of the nursing process. C. Serve as a tool in planning and evaluating care at the family level. D. Demonstrate and document the full range of services that nurses provide at the family level. II. DESCRIPTION OF THE FSPR The FSt>R consists of four parts, organized according to the steps in the nursing process. · a. Assessment of the family, home and environmental conditions b. Health Condition and Problem Sheet c. Nursing Care Plan. d. Service and Progress Reconl The FSPR is kept in the family folder /envelope together with the individual clinical records of family members. It is the exclusive responsibility of the community health nurse to keep it updated. Other members of the health team, however, may and should be encouraged to utilize the data contained in it. I. INSTRUCTIONS ON FILLING OUT THE FSPR: '. A. Identifying Information 1. Head of the Family-write the name of the recognized head of the household, family name first, followed by the first name. Example: Santos, Jose 2. Address-Write the full address, to include house number, street, municipality, district and/or city. 3. Family Number-This is obtained from the family registry and is usually written on the family folder/envelope. Bailon SQ,& Maglaya AS. (1990). Fam11y Health Nwsing-The~$. Metrv Martlla : Bn;ut1chi/d Manogersand Consultants; R~ in~ b11 A. S. Maglaya. 461

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D. Members of the Fumi Jy/Housc ·hold 1. Family member number-Eacl1 family number is assigned a number starting with I for the head, 2 for the spouse, and so on consecutively for the children and other members of the household. 2. Name-Write the names of all members of the househo]d (FSPR form, front page, Table Al) and the rest of the family not currently residing in the household but affect resource generation and use (FSPR form, front page, Table A. 2). \Vrite the surname first, then the given name. In the case of the wife, indicate her maiden name. In extended househo]ds, group members by family. If seyera J members with the same surname are listed. 3. 4. 5. 6. 7-8. Example: Santos, Jose head Maria Cruz wife Pedro son Anita daughter Relation to head-Indicate the relationship of members to the head of the household, e. g., \'\-Ue, son, daughter or mother. Sex-Enter M for male and F for female Birthdate-Enter the month aud year of birth Marital Status-Enter any one of the following statuses: a. Single (S)-a person who is not and has never been married b. Married (M)-a person living with another as a couple married by legal rite/ s. c. Common-law (CL)-a person living with another as a couple without the benefit of a legal marriage d. Widowed (W)-a person-whose spouse is dead and who has not remarried. e. Separated/Divorced (Sep. )-a person legally separated from his/ her spouse or who is living apart from bis/her spouse because of marital discord or si. m. i Jar reasons; a person whose bond of marriage has been dissolved and can therefore remarry. Highest education completed-This refers only to the highest level completed in th@ regular and formal system of education, i. e. elementary, high school and c.-o Uegiate education. Excluded are attendance in nursery and kindergarten schools a. ad in purely vocational courses such as dre. ~smaking or carpentry. a. Enter only the last level of education completed and not the one the person is in at the time of assessment. For the elementary lc-vel, write G-1 to C-6 (Grade 1-Grade VJ); for high school, HS--1 to HS-4, and for college education, C-1 to C-4 or C-5, as the case may be. For degree holders, write the degree, e. g., BSE or BSN. b. Write NONE if the person il!i over seven years old and has not gone to school. Leave the column blank for children below seven years old. Occupation 11 Ty Pe of work-indicate the nature of work the person is engaged in. Rx. ample: farming. b. Place-Specify the location of work: city, municipality, province or country (i( out1,i<le t J1e Philippines). Example: Makati c. Remarks-Write importartt events that happened to any member which may in any way alter the family's composition. e. g. births, de. 1th,<1, marriage s, an. cl migratio n. d. Date-Enter tlie date when entry on the MRemarlcs column" was ..--111111. = ===,,.-----------

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

written. c. The Hon'le and Environment 1. Home a. Ownership-check the appropria te box b. Constru ction materials is used-Check the appropriate box. Light-refers to such materials as bamboo, nipa, sawali, coconut leaves or cardboard 1-ti. xed-refers to ai combination of light materials, wood and/ or concrete Strong-refers to. a predominantly concrete house. c. Number of rooms used for sleeping-This refers to the number of rooms in the house, not necessarily private bedrooms that are used as sleeping areas. Write the number. d. Llghting facilities-Check the appropriate box. e. ~neral sanitary condition-Vvrite your impression of the general state of cleanliness of the house. Include objective data to support your impression. E. xample: House dirty and disorderly. Unwashed dirty clothes, pots and pans scattered in lone multi­ purpose room. 2. Water Supply a. Drinking Water Source-Check the appropriate box. Potability-Specify if safe for drinking purposes. Distance from h. ou~-Write the distance of the water source from the house in meters. lncludeifthereis a faucet connected to a public or private source inside the house Storage-Check the appropriate box. 3. Kitchen a. Cooking facility-Check the appropriate box b. Sanitary Condition.-Describe briefly the state of cleanliness of the kitchen area. Support your impression with objective data. Example: Generally clean. Pots and pans washed and kept in cupboards. No flies or <;QQqoacbes noted. c. Drainage facility-Check the appropriate box. None-When there is no drainage system. Waste water from kitchen nows directly to the ground, oftentimes forming a nearly permanent pool. Open drainage-Waste water flows through a system of pipes (could be improvised from bamboo) to an open pit or canal. Blind drainage-Waste water flows through a system of closed pipes t,o an underground pit or covered canal 4 Waste Disposal a. Refuse and garbage Container-Check the appropriate box Method of disposal-Check the appropriate box. If more than one method iis used, check the two most commonly utilized methods: Hog feeding-Garbage is used as bog feed Open dumping-Refuse and/or garbage piled in a dumping place (with or without pit) with no soil covering 463 I

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

5. 6. Toilet Open ~urning-Regularly piles refuse/garbage and later burned in the open air · Burial pit-Ref1USe/garbage is placed in a pit and covered when filled up. There is no intention to dig it up later for use as fertilizer. Compo sting-Involves buryi_ng Or stacking of alternating layers of organic-based refuse/ga rbage and. "treated soil" arranged so as to hasten rapid decay and decomposition into compost. This organic mixture can later be used as fertilizer Garbage Collection-Refuse/garbage collected by garbage truck or any type of garbage collection in the community. a. Type-Check appropriate box Pail syste. m-A pail or box is used to receive the excreta and disposed later when filled. This includes the "ballot" system wherein excreta is wrapped in a piece of paper or plastic and thrown later. Open pit privy-Consists of a pit covered by a platform with a hole. The hole is usually not covered. The platform may, in its simplest form, eonsists only of two pieces of wood or bamboo Closed pit privy-A pit privy in which the hole over the platform or toilet floor is provided with a cover. Bored-hole latrine-Consists of a deep (usually more than 10 feet) but relatively narrow (less than. two feet in diameter) hole made with a boring equipment. Overhung latrine-The toilet house is constructed over a body of water (stream, lake or river) into which excreta is allowed to foll freely. Antipolo type-The toilet house is elevated and the shallow pit is extended upwards to the platform (toilet floor) by means of a chute or pipe made of clay, metal, aluminum or board. Water-sealed latrine-An An1ipolo type of toilet, bored­ hole latrine or any pit privy wherein water-sealed toilet bowl is placed instead of the simple platform hole. Flush type-A toilet system where waste is disposed by flushing water through pipes (sewers) into a public sewerage system or jnto an individual disposal system like an inclividual septic tank. b. Distance from house-Write distance of toilet from the house in meters. If toilet is inside the house, write "inside the house". c. Sanitary condition-Describe briefly the state of cleanliness of the toilet. Substantiate impress ion wil. h objective data. Example: Very dirty, flies all over; stinks. Domesti c Animal a. J<ind-Write the kind of animal kept in the house. Example: Dog b. Number-Indicate the number of each kind of animal kept in the house.

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

c. Where kept-lndic. :itc where the domestic animal is kept. Example: Tied in hack·yanl. 7. The Community in General a General !':an itary condition-firiefly describe the state of sanitation of immediate vicinity \\l'hcre lrnuse is located. Mention specific data to substantiate ieneral in1pressio11. Ex. ample: street cluttered with litter. b. Housing congestion-Check appropriate ho)(. c. Presence of nreeding Site. <; of Vectors of Diseases-Check appropria. t c box. Specify the type of breeding site and vector/s of disease. Example: Slow (lowing mountain stream; Anopheles mosquitoes. d. Recreational facilities-Write recreationa l facilities available in the commun. ity e. Availability of health care facilities-Health facilities include government health centers and hospitals, private clinics and hospitals, private medical and dental practitioners, practicing nurses and midwives. f. Distance of house from the nearest health care facility-Indicate the approximate distance of the house from the nearest health care facility. D. Health Condition and Problem Sheet 1· Health Condition/s, \-Vellnes s State/s, Problems-These refer to wellness states, health deficits (diagnosed or not), health threats or foreseeable crises identified during the assessmen t process. Write only the conditions and p·roblcms which are adequately substantiated by cues gathered during the assessmen t process. Examples: threat of cross-infection from a communicable disease; malnutrition, pregnancy. 2. Nursing Problem s-Relate to tbe family's inabi Jity to assume one or-more health tasks witb respect to a particular health condition or problem. For each health condition or problem, write the nursing problems, specifyin g the major an<l contributory causes. Example: Health problem-malnutrition; Nursing problem-inability to recognize the presence of malnutrition in a pre-school member due to lack of knowledge about the health condition. 3-Support i. ng Data/Cue..,;;-These are the data gathered during the assessment process whkh pro,;dc evidence that the health and nursing problem.,; identified really exist. Write your entries brief)y and concisely in telegraphic form. Indude only data that prove the existence of the problems identified. 4. Date a. Identified-Write the ·complete data (day, month, ye. ar) when the health and nursing problems were identified b. Resolved-Write the complete date when the health and nursing problems were resolved. E. Nursing Care Plan 1. Health Conditions or Problems and Family Nursing Problems-This column is for health conditions/problems and family nu M. ing problems the nurse and the fam Hy decide Io tackle. 2. Objective/s of Nursing Care-For each health condition/ problem. 465

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

466 write the objectives of nursing car-e in terms of family outcomes. Example; 111e family will decide to have the primigravida member deliver in the bospita1. 3. Plan of Intervention-Write all the nurs. ing measures and activities designed to meet the objectives : Make entries brief and concise. 4. Evaluati on Plan-Specify:. a. Outcome Criteria or Indicators: Specify objective measun ~mentsof performance, behavior, circumstances or clinical status indicating progress to or achievement of client outcomes. b. Evaluation Standard. : Specify the desired or acceptable condition, clinical status or level of performance corresponding to each evaluation criterion or indicator against which actual condition, clinical status or perfom1ance will be compared. F. Service and Progress Notes 1. Date-For each nurse-family contact or service, '\vrite the complete date when entries were written about the health condition/pro blem. 2. Health condition/nursing problem-Refers to the health condition and nursing problem for which nursing interventi ons have been or are being done. 3. Nu. rsing Observations, Actions Taken, Respons es, and Evaluation of Progress/Outcomes-This is the column for the "nurses notes". Write briefly and concisely and! in telegraphic form. Specify the outcomes of each nun;e-family contact, e. g. reactions or cesponses to interventions, changes ia decisions or health status and problem areas identified. These data provide the bases for re-planning and/or termination of services. Select the appropriate type of charting using Mnemonics (See Appendix Ct). 4. Signature-Put your signature on top of your printed name for every en try on thjs "Service and Progress Notes".

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Appendix D SELECTING A FRUIT : "'..,/' EXERCISE* The objectives of this exercise-the selection of a fruit by a group-are to develop through role playing an understanding of leadership that is distributed and functional and to give you an opportunity to observe the task and maintenance functions in a decision-making group. Exercise material s include observation sheets for task and maintenance behavior and a la. rge envelope containing specific role-playing instructions for each group member. The exercise is developed for seven to ten participants, although more may be included. The coordinator should allow approximately thirty minutes conducting it, and proceeding as follows: 1. Explain the exercise, by stating objectives and discussing the following group functions. ·, Task functions-types of behaviol'S which are necessary to the group's fulfillment of its task. ' ' a. Starter: Initiates action within the group by proposing goals and tasks. b. Direction Giver: Suggests plans on how to proceed and focuses attention on the task to be done. c. I:aormation and Opinion Seeker: Asks for facts, information, opinions, tdeas and feelings from other group members to help group discussion. d.. Information and Opinion Giver: Provides facts, infonnation, ideas and relevant data to help group discussion.. · . e. ~aborator: Building on previous comment, giving examples, enlarging on lt. f. Energizer: Stimulates a higher quality of work from the group. g. Coordinator: Shows relationships among various ideas by pulling tbelll together and harmonues activities of various subgroups and member S· h. Consensus Taker: Checks the group to see if the members an: read Y to make decision or take some action.. i. Evaluator: Compares group decisions and accomplishments with gto UP standards and goals. j. Reality Tester: Examines the practicalitr, and workability of ideas. ~ alternatives, solutions, and applies them to real situations to see...,~ will work. Adapted from Johnson, D. W. and Johnson, F. P. {1975). Joining Together:~ Theory and Group Skills. F. n,glewood Cliffs., NJ. Prentice-Hall. Inc. 1975, PP. 31 · 1,fi1

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

k. Dio. gnoser: Arrnlyzes the sources of difficulties the group ha. <; in working effectively and the blocks to progress in accomplishing the group'11 goat... I. Summaril. er: Pulls toi. wthcr rclute<l idcws or suggestions, restates and summorfa cs major points dlscui;sc<l. Orou1> Building 1md Mulntcnancc Funct Jun~-types of behavior which contributes to build Jng rclnlionships, anti oohesivcness arnon)l: the members. a. I larmonizer and composer: Encourages members to analyze canst nic:t. ively their differences In opinions., searches for common clements in conflicts, and tries to reconcile disagreements. b. Communi cation Helper: Demons LTitt e.-, good communication skflts and makes sure that each group member understands what other members are saying. c. Encoumger of participation: Persuades everyone to participate, giving re CQb'Jlition for contributors, demonslr:iting acceptance and openness to ideas of others, is friendly and responsive to group members. d. Interpersonal Problem Solver: Encour:1ges open discussion of conflicts between group members in order to resolve conflicts and increase group togetherness. e. Trust Builder: Accepts and supports opennes s of other group members, reinforcing risk taking and encouraging individuality. f. Active Listener: Listens and serves as an interested audience for other members, is receptive to other's ideas, goes along with the group when not in disagreement. g. Process Observer: Expresses group standards and uses observations to help e. 'lamine group effectiven ess. h. Standard Setter: Expresses group standards and goals to make members aware of the direction of the work and the progress being made towards the goal and to get open acceptance to group norms and procedures. Select two observers, give them the task-maintenanc e observation sheets and tell them how to use them. Observers should be on the look out for: a. The functional behaviors present and absent in the group. b. How well participation is distributed in the group. c. What specific functiona l behaviors are being provided by· each group member. 3· Place the envelope containing the role-playing instruction envelopes in the center of the group with no further instructions orinfonnation. · 4 ~er the exercise is completed, conduct a generafdiscussion of the experience and include these questions: ·. a. What functional behavior was each member supposed to have role played,----------------

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

nnd how were these l:ar Tic J nut'! vi t fnnetionn\ lwhavior!-were-1ut-·i-1nt and ah<. ent in the 11,roup dcci. ttion-b. ~31:inv., :ind wh:it,H:n· lhc cun~,·qu,·nc·cs of Ilic hd1:iviors hclng present and nb,....ent? \'Jhat were the fcd\n~s of the part\c\1i::mts and thci r reaction~ to the CJCerclse c.. ~ and e)(pertencc. d. \c\ll,at conc\U$ions coul<l 1-K: <lrawn :'lhout lendcrship and group functioning from the c. xercise? 11te 1nstn1ction given ror use in the exercise nre as follow H: instructions ""'rillcn on the la~e envelope which contuins nil the other envelopes. Inside this envelope you will find three smal\er envelopes containin J,!; directions for the phas~ o{ this ~up ~t:ssion. You arc to open the first one (labeled Envelope I) at once. Later mstruction s wtll tel\ you when to open the second (Envelope ll) and the third (Envelope lll). Envelope l contains the followin g directions on a separate sheet: Directions for Envelope I: Time allowed: fifteen minutes Spe~ia\. ~structions: Ea~h ~ember is to take one of the enclosed envelopes and follow the mdi Vldual role-playmg mstructions contained in it. Task: The group is to select a fruit. DO NOT LET ANYO~ El. SE SEE YOUR INSTRUCI'l ONSt (After fifteen minutes go on to the ne. xt envelope) Envelope II contains tne following instructions on a separate sheet: Directions for Envelope Il: Time allowed: five minutes Task: You are to choose a group chairperson. (After five minutes go on to the next envelope) Envelope Ill contains the following instructions on a separate sheet: Directions for Envelope Ul: Time allowed: ten minutes Tas'k: You are to evaluate the. first phase of this group session. Special instrnctions for Phase rn. The newly sel~ed chairperson wil! l!ad a ~on on the roles and functions of group members 1~ the ~rocess of dec~making and their feelings and reactions to that process. The d1scuss1on should began with th,e report of the observers. 469

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

(After ten minutes, return the directions to th. ei. r respective envelopes and prepare for a general discussion of the exercise. ) lndividual instruction envelopes for Phase 1!: Each e. nvelope will have instrnctio ns for leadership function and position. Two of the instruction envelopes will also include special knowledge. The information will be given on a card in each envelope. The leadership functions. positions, and special information listed below will be assigned in the following order: a. Leadership function : Information and Opinion Giver Position: Support mango b. Leadership function: Encourager of participation Position: Introduce the idea of different fruit: banana c. Leadership function: Information and Opinion Seeker Position: Support chico d. Leadership function: Any Position: Any (Yoo ha"\e the special knowledge that the group is going to be asked to select a chairperson later in the exercise; you are to conduct yourself in such a manner that they will select you as chairperson) e. Leadership function: tension reliever ·position: Support orange f. Leadership function: Di. agnoser Position: Support orange g, 1-eadership function: Hannoniz. e:r and rompromiser Position: At a point in "'iiich there seems to be a clear polarity in the discussion, suggest a oompromise fruit sucll as pineapple or watermelon h. u:aduship functi1>n: Starter Position: Against mango i. Leadership function: Active listener Position. : Suppo~ mango ;. Leadership fu:nd:ion: Direction giver Pomioa. : Any U trwer than ten participate in the group, simply eliminate as many of the last three lo aw:le,..b. ::v flmction~ and positions as necessary. If more than ten participate, add more J, w:Le, ship functions and positions..

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

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Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

i t g_ S°· &> ij, ~ " ~,. ;:'j Construct Int Sustain Chan1 lnteren11ons le Enhr>< Perception of: Need for ch,1nee . M~n,ng/Purpo;e of Change Conlrol over sltuatlon/problrm -Ablllry 10 Manage Barrlen to Change Guldt through the Process of Owning the responslblllty for desired change Enhance Percepnon of relatlon1h1p of Change with own Roles/Ae1pon1lbllides Help Relate Change with Re1ponslblllty and Sense of Efficacy MPlm XI if FOIMIALflf wnoll/Uflfflll CKt MGr "9c111■Vidlplld~unt Tr~n~late lntenrion 10 Action~ towards Change [. nhanc E11act1nc wpabllltles fltfp O~hn.. ~eall:tfc bl)t"l!'JII< ifld ~kif I Ttrm Cio I: En~ur D s~-. cmc P. ult~ for Char&e n G~llie a, Performan ce E~p,ic~d Provide Dhwvery Learnlnc 0pportunfdu ll J Pracdte and Evaluat. t/Monitor O...-n Goah/ bperltn«s/ ~pabllltles Affirm Commitment to Chani~ Fetdlia,~ on Performance Enhance Pere-eptlon of /k;,nir. g l:thir,d Chanee lrnt'Uate Actbnt/Cmn~ lr,t-, E1hllr. & uft Pottie1m Et. har,u U'~~U,U c..... lf'. tecll J t ~,....,,11 Char l,U"I 1!<'-"f J I hn ol Oi:t, Jc:;(:;,,, E"'r:U'. 'l. If~(;,;;/' 1f ~ !). ;;~,;:-~--·· 7 "f; 0,:~hfl l-': tf. ~... 1 ;i" "/". ;~ // c,,,~-:........,.. ~... (t~,. _...-.,~~.. ~<l t. ~~(.. "". ;,-: '·i llt~Ji:..:t-'t! l~ :.,~r ~-e.--,, 'l~. !. r~ W!<Jr,(. e L7"VUiu M ~i s-,;,,,,t Qf W. Mct. MM-:1 u-~,r~,.,..,. _ <. Mh Q,;ar"t J f':~. r..~,11;::. r,~?. !'... ""e O. \?. '"'V. : ~-"'f,O,n G~;·l/J. :-;.. t:-:~-: 1-.. 'f-rr, ~r ~,. 1 t>-17/ :t:,-!;~ f l'" "! E::=r..s.-:--f :::, /.-t J ::,~ at'rat..,. 1 F1:'r. J/ I ev. rr~:..-. r­ ::,e......,..-~ ~I ~"'--C (;1r.,..,.-;/ (. orrt.,r-..,_ _.,_, C;. J,.. rr. r....,..~:~1. ~ s. _,.,, tu.,. Monlle ~ o/NIIISlnf, ms. J Adopted from ~J. (UIJJ. ~ Pottntlol: A V,. ory of Wtllntn Mot JWJti M. Nurslng Rtsnrd,, 4IJ ($), pp, 1. l~Z!/1.

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

' APf'£NOIX F RECOMMENOl!O ENIJRGY I\NO NUTrt1£11tr t NTAl<ES rc R DAY FOR SElll CTtl D POPULA'TION GROUPS -··---===-:::::::.-~sut C. ff. l> l01'U(Mfbtalm Ur5 __ ---=r;-,_:-:., (Nt RGV.... r ANf S, CHll Ollf N, VCl\f\~ Pill GN/1. NT WOMIN, WOMt N, ANO M ONHIS Tlll Mt Sll It MONTIIS NUf RIENf JNf Ad S-jl-~6-. C $-1 L:..)--" 6---l. :. !1_-:llt_2nll_Jrd _ _,lll t-1nd..L Wc,IQhl (~1:l,. I I l'I H tn1t1 !IV (J..c,,ll :;. ;,, no to/\! MIO l(. O0 3(10 300 SOCI,soo Pf Ol"ln (II) '. l I" 1t\ 311 IJ 611 6(, 66 81 1G Vl\11n,1n I\ J75. \00 400 10(1 ~00 1100 1100 800 !)00 900 h141 RCl VI\"''" C JO J\) 30 !30 ll S 80 80 80 105 100 (n,~) 11,11,mln 0. 7, OA o. s 0,6 0. 7 1,4 1. 4 1,4 1,& l. !> ' tmsl l\lb Ql1(\llln 03 0. 4 o,s O,G 0. 7 1,7 \,7 1,7 1. 7 1. 7 (mil,) Nl,icln (11,s l. S 4 ti 7 9 18 18 UI 17 ll NE) Fol3\C li S 80 160 200 300 600 600 600 500 500 lis Off. ) c~,~un\ 200 lmttl 400 !100 sso 700 1100 800 800 750 ?SO Iron (mgl 0. 38 10 8 9 11 2? J4 38 27 30 Iodine, \!Ill 90 90 90 90 no l00 200 200 200 200 Mogr,,:. $l?Jm 26 \fl'ISl S4 GS 76 100 20S 205 ws 250 2$0 Phosph ONS 90 27!1 460 500 · 500 '100 700 700 700 700 \mgl line (mg) 1,4 4. 2 4,5 s.,. 5. 4 5. 1 6,6 ' 9. 6 11. s 11,S Sel,enlum 6 10 22: lb 3S,s 15 40 40 (µgl f~11rlcle 0. 01 0. 5 0. 7 1. 0 1. 2 2,5 2. s 2. S 2. S 2. J lrnt!l 't..s Mnaanese 0. 003 0. 6 t,2 1,7 12. 0 2,0 2. 0 2. 6 2,1 \mal ~ Vitamin D s s s s s s I s s s (1,1&) Vlt■mll'I E 3 4 s· 6-7 n n l2 ll d \m&l V\tamln IC 6 9 n 11 :M S1 S1 S,l a SI (11&) 86. Vltal"ll'I 0. 1 o. s UI (n\l). ' \fltart\1n8 u O,i

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

APPENDIX G TRENDS IN COMMUNITY HEALTH AND COMMUNITY HEALTH NURSING PRACTICE Araceli S. Maglaya 1. HEALTH PROMOTION/HEALTHY LIFESTYLE DIRECTIONS & CHALLENGES A. RATIONALE/BASES: Rapid rise of non-rommunicab lediseases (cardio-vascular diseases, cancers, diabetes, kidney problems, and,chronic obstructive pulmonary diseases). 1997: 7 of 10 leading causes of death in the Philippines are lifestyle­ related: Diseases of the Heart ranked 6th as leading cause of illness. 1998: Noa-<::0mmunicable diseases contribute to almost 60% of deaths in the world and 43% of the global burden of disease. 2020: TI1ese diseases are expected to account for 73% of deaths in the world and 60% of the disease burden globally. Low and middle income countries suffer greatest impact. Rapid increase in these tliseases usually seen disproportionat ely in poor nnd disadvantaged populations. » These contribute to widening health gaps between and within countries. Exompfo: 1998: 0( the total num~r of deaths due to non-commun icable diseases, 77% occ-urred in developing c.-ountries and 85% of the disease bunlen wa. s borne by low and middle income countries. IJ. CHALLENGES Health Promotion Strntegies to brid~e inuquitnble differences in health stalus in popu. lations bt!twecn and within countries through: Focus on the Dctenninants of Hea. lth (Wt 10, Westen\ Pacific Region, 2003):

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

>). Healthy Environment Safe Physical environment; Supportive economic and social conditio. ns; Adequate supply of good food Restricted acces. s to tolbacco and alcohol. >> Effective Health Services Adequacy of preventive services Appropriatene ss of health services. Emphasis on importance of empowerment to promote and sustain healthy environment and healthy lifestyles: ,, Healthy Diet and Weight Control ,. Regular and Appropriate Physical Activity/Exercise » Stress Management » Control of Tobacco and Alcohol Use » Food Safety » Injury Prevention C. CREATIVE OPTIONS/l Nl TIA. TIVES requiring Multi-agency Partnerships, Advocacy, Health Public Policy and Organizational Practice, National and International Networking Interventions lo address challenges/issues on Poverty and Health » Health in the Hands of the People: Focus on "Being-In-Charge >> Participatory Approach to Developing Community Competence >> Interdisciplinary and lnteragency collaboration through Counter­ parting strategies. Development of Healthy Settings: Healthy Workplaces, Marketplaces, Villages. Cities/Municipalities, Health promoting Schools, Health promoting Hospitals and Healthy Islands Initiated in some western countries several years ago, the settings approach to health promotion was started in the Philippines in 1997 thru Administrative Order 341. » Principal Elements of a Healthy Cities Project (WHO 2000) Politicnl/local government commitment with a written policy statement Future vision/goal through consensus Jntersectoral committee/task fo~ with the d~ign3tion of coordinator nml programme to involve the community and other stakeholden, in planning and implementation. Development of a city henllh profile with health ~k factor., rclntlltl to i1hyslcnl tmd socinl en_vironments, idennfication of Jriority health problems through mtel'llecto~I ducus,don,, and 'r lnt·,0-r, of a loctll nction plan for resolving priority health ornn.. · tlrohl~ms. 475

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

476 The priority project activities are undertaken by multi-disciplinary terun. s that include substantial community participation, and usually not by a single government agency. lndicators and targets for the monitoring of progress of plan implementation with a mechanism for regulnr review and evaluation of plan implementation (e. g. annual progress review meeting) System of information services accessib le lo the general public and those interested. » Steps in the Development of Healtlly Cities (\VHO, 2000) Phase I Raising awareness of the Healthy Cities concept and approach Establishing anintenrectoral initial task force to oversee a Healthy Cities project Building support mechanisms Enhancing political \Vi U and gaining strong commitment of the local governme nt Phase 11 Appointing a steering committee Developin g a city bealth profi]e identifying health risk factors Developin g an action plan for the Healthy Cities project Integrating activities at elemental healthy settings to gain wider impacts (e. g.. schools. workplaces, marketplace. c;, hospitals) Raising awareness of tbe projed: Expanding capacity oftl1e project Phase Ill Implementing the planned activities Monitoring and evaluating the implement ation (focusing on :ma Jyzing what happened and what lessons were learned) Revising 1he action plan as required (identifying what will be done diffen:ntly) Developing sustainable mechanisms: Secure » 1'oli1ical commitment lntt-rsectora l collaboratio n » Community participation » r\wareness building Finance ,. Devt>-lopment of c-ompelencies "" Networking-national and international I

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

2. ACUTE CARE/ILLNESS CARE INCREASINGLY BEING DELIVERED IN THE HOME/COMMUNITY SETTINGS A. RATIONALE/BASES: Early Hospital Discharge due to: Lncreasing Costs of Hospital care/ Services ; Insurance Requirements etc. Increasing Burden of Chronic and Palliative Care By 2010 in the USA: 70% to 80% of illness care delivered in the home setting B. CHALLENGES/CR. EA TIVE OPTIONS Expertise/Comp etence on specific areas in Acute Care in the Home setting Case f>v{anagcment as nucleus of the of the continuum of care with the nurse case manager as orchestrator of services in precise and synchronous fashion thru the use of critical pathways, care maps and disease managemlnt protocols to identify key events that must occur to achieve outcomes and ensure patient progressio n through restoration/maintenance gnals. Nurse's roles vary from monitoring lo~g-tenn needs of enrollees of managed care to managing current episode of care (Lundy and James 2001: 144). Effective Use of the Two-Way Referral System Enhancing the Empowering Potential of Families on Acute/Ulness and Palliative Care to Prevent or Reduce Care Burden Enhancing Nursing Clie11ts' Healthy Tr:rnsitions to address sudden role chnn~es that result from moving from a wellness state to an acute i\\ness, from wellness to chronic illness or from chroniclty to a new wellness that encompasses the chronicity (Me\eis 2007: 471). 3. FOCUS ON CARE OF POPULATION AGGREGATES TO PROMOTE HEALTHY TRANSITIONS A. RATIONALE/DASE S: Population Shifts Increasing number of healtl1 care needs/problems of older popu Jation. ethnic and other mnrginnli1. ed groups Emphasis on chl\d and adolescent health. reproductive health/ women's het\llh Increasing scope, magnitude, 11nd impact of natuml and human-induced disasters around the world (ICN 2006). I

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

c11 I\ I,l. 'l{NOI~!-{ ANI> CUH/\'1'1 VE Ol'l'ION ~i 11-x11<irll Bu/Cl1111p1t P1u·n 11111h1111 1m of Epicl,,ull r,logll' Appmill'l1 lo c;111. 1 or l'op11l11tlu11 Clro11pll ' Work<iro11p Apprno rh to H11lin11rl: E111pow1 :l'l11. \ l'lc-nllnl of Pop1il11tl(l11 Cl'C)Up il V. JCJX,11L"I(/ Compc·kll<~ I on l)j,-;t L'll Lr l'n!Vt111ion, Mltlw11l1111, l'r<·p111l:d1w11ii 1111<I lfoli<f ltc NJion N" j11dudin1-t IHsk J\!l Sl'l'ISll WIII 1111d Mullidi Nc. i Jili,,. ' M II '',.,.,. 1,11y ftllngc11wn1 SI nc h·~lt H,,, Cll Slll'C Ile very O. ~ 1111. :livt'. Uc:,p.. lll S(]. ~ tu the Nhorl, rm... fiuni., 1. 11ul 10111-t-tcrrn hcnll h uccrls 1111t1 prolil(:nis <if clisns1cr-Nlrick1~11 po1111lutions. Promoting Equity of Acct:ss to needed l'lc:nllh und Social Services Specially of Women and Marginaliz ed Group,-, who a~c pnrticularly ill­ prepared un<l have <. Hfliculty surviving an<l rccovcrmi;; from disaster due to discrimination (ICN 2006). Use of"Human Becoming'" Approach to he. Ip clients hantllc polarilie · !r~nsition s a1;1d traj;ctories based on undcrst:mding t11e meaning ir Lived Experiences· : » The Silent Voice of Marginalized Groups " Older Clients: The Journey from tl1e Feeling of Uselessness to Enhancement of a Force of Character " Adolescence: The Trajectory from Childhood to Adulthood The Culturally Diverse Nursing Clients experienc. ing tran. sitions within such cultural phenomena as communication and. langua"'e affecting nurse-client interaction and ability to understand, express or respond to health and illness realities; effect of spatial behavior. use and control of interpersonal space; ethnic and kinship background affecting hea Jth beliefs, values and norms; and use of and response to time as pattern and orientation that relate to social processes, the conceptualization and ordering of social life (social time) and clock time directing regularity-in life (Clemen-Stone and others 2002: 259). · REFERENCES 1. Clemen-Stone, $., Mc Guire, S. L. and Eigsti, D. G. (2002). Comprehensive Community Health Nursfng: Family, Aggregate and Community Practice. St. Louis: Mosby. 2. International Council of Nurses (ICN). (2006). Position Statement on Nurses and Disaster Preparednes ·s. Geneva: ICN. 3 Kim, H. S. (2000). An Integrativ e Framework for Conceptualizing Clients: A p,-oposalfor a Nursing Perspectiue in the New Cen. tury. Nursing Science Quarterly, 13 (1. ), 37-44. -

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

I 8 (1'.-(l Ji) (:. ioc H ). L'<J1111111111i111 IJ,,,,I,1, N11,. ~l11rr C:arl,ir 7 'f/r ul,J11n1w, · "J' I'/ ~. K. ill 11 ",clllllry M11miacl11m1:ll1~:,J,111,:a :11111 H:,nl,:tt f'uhlic:,tlonis J,11111 ', /It'll I I,,::, ' ' ,1, / I' J'il/J//C fl 1 ' 1\. ::-1. (l'. <l). (:t00/4), N11r~l110 l'rw;tic,r in tlw Ct11111111111ftu. c4th ed. ). Mlllt,!:iyu,. A...,o,rn11t 11 Corporal 11111. fi· !khtil City.,.._. " r,,111r · 1 (:. ion7). 'J'/uiorc:lic(I/ N11r:ii11u: l~e1J<!IOpm,,11t r1r1d /'roaress. (/4th ed. ). c,. Mclclll, /\. ;,. 1 lppincoll Willl11111 :; and Wilk111x. J>hiladclph,,. 1. ~. R c,99a). '1'l11. : l/11111ur1 lkcor11i1iy Scliool uf 'J1'1011yht: I\ J>crspcctiue for 7. 1':ir11c, R. ·, o,t,cr Jlc C1lth l'rofcssimwls. 'l,1wusand Oaks, CA: Sage. N11r. ~cs ant Id llealth Organi:t. ation Western Pacific: Region. (2000). Health Settings: 8, Wor, al Guidelines for Deuelopit19 a lleal1/1y Cities Project. Documents Series J(cgion · · · no. 2 June 2000. 479

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

Book Cover Design and Layout Joi Marie Angelica M. lndlas I l ~ I ------------

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf

FRONT (l·R): Rosalinda G. Cruz-Earnsha w; Ma. Bridgette T. L3o SACK (l-R): Ar. tceli S. M~glaya; Ma. Coraton S. Mo not In plctur-c: Wlnirred;a: 0. Ub. as-de Leon ABOUT THE AUTHORS Rosalinda G. Cruz-Earnshaw, RN, M Academic Background: Public Program Administration and Nursiog Fom1C'r Faculty: De La School of Science,m lealth Luz Barbara L. Pambi Nurse Educ.. e( Liu.-ih Cfm*ulta Philippi l'hili1,pin~ D. H11rnuni1y (1980-1989). Uni.,,,..rsity lo elate) . i·r. ation, ealth and Selecled '. urs1ng ""·elopm<'nt ?ract·ltioner Ma. Corazon S. Maglaya, MD Governor, Central Tngalog, Philir,pine Medknl i-\s. ~nci:Jtic1n Volunlt..:t!r Phy~ici;tn, Community llascd R(habilitalion Program (Payatas, Que,;on City) a. nd Ouk-< Pal. id Social Action Center (Pasny Cityl Araceli S. Maglaya, RN, Ph D Resea. rth(r ~11,tl \<Vrittr Wlnlfred a 0. Ubas-de Leon, BSMT, MPH Co-rclilor,.,'ltl1 l'>r. \',·. lkl11~1r11,,Ir (~ot J1 ). Phi Hppill L" T,·,t 1,.,,,,J.. 11f ;\th lw.,I Paras. Jt,,1,.,)()1' (:,m J 1'ditir111). ::-. lanrl.,: ll'l'A<l F<trntt:r Con~ul L:1nt ;inf. I Rt~. 1rrhl'r. Ph ilippf n<: Dcpartn1< ·111 c,r I lc Jlth Lucila B. Rabuco, MSc Public Health, Ph D Prof<.-ss<Jr, College or Public I lealth. Unl,trsity of lhe Philippln..s ~'lanila ( 1981 to elate) Res<:arclwr and Mo<lu J., Writ-,r . Jmirnnl and Pc4'r Rrvirw(!'r : Philippin e Jourm1I on Nutrition and Philil"Pin e Journal or Science Ma. Bridgette T. lao-Nario, RN, MA Clinic,:, I F..,"f X'rt isc: M. o tcma I nnd Cb ild Nnn;ing-ancl t\fodie,11 Su~ical NUJ'Sing Fom1er ·F;1cult). C'olle~e n( Nur Sing.. University of the Philippines ~t..lnil. :t ( 1986-2004) eon... ~1111:ant nnd l..tet l U'<:r: Fnn,ily I lealtl, Nursing, ~1ent. al I lenlth Psychiatri C' Nursingt Couti>1tc·ncy-l·~~·d Curriculn. r Desiin. Prin1c:1ry.. l<-ahh Cnrc. Clinicnt Supervision, and Pcrf,)rn1;_111c" E,-.,l11ntio11 Community 11,:lith Nurso (1972-1976) Nllr<t" Prnetitioner ( 197!1-1983)

Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf