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

NURSING PRACTICE IN THE COMMU !NITY Fifth Edition ARACELIS. MAGLAYA Editor

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

Philippin e Copyright© 2009, 2004, 2003, 2002, 2000,. 1997 by ARGONAUTA CORPORATION Marikir1a City and ARACELIS. MAGLAYA ROSALINDA G. CRUZ-EARNSHAW MA. BRIDGETTE T. LAO-NARIO MA. CORAZON S. MAGLAYA LUZ BARBARA L. PAMBID-DONES LUCILA B. RABUCO WINIFREDA 0. UBAS-DE LEON ALL RIGHTS RESERVED A written permission of the editol" and publisher must be secured if any part of th. is book is reproduce d by any means and in any Crom whatsoever. Every au U1eatic copy of this book bears a serial number and the signature of the editor or any one of the contributors. ISBN 978-971 91924-4-2 6733 Published and exclusively distributed by: Argonauta Corporation No. 1 Maki ling Street Marikina Village. Nangka Marikina Cjty Tel. No. 941-61-60

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

-CONTRIBUTORS Araceli S. Maglaya, RN, Ph D Professor Centeaniill Pmressorial Chair Colle. ge of Nursing lfoivc1-sity of the Philippines M,mila Rosalinda G. Cruz-Earnshaw, RN, MN, MPA Nurse Ed11cator Ecurnenica J Christian College Tnrlm: City Former Faculty College of Nursing University of the Philippines Maniln Former Consult,mt Phi Jippine J)epartment of llcalth-Local Government Assistance an<l Monitoring Service and Essentia l National Heaith Resectrch Luz Barbara L. Pambid-Dones, RN, MPH Associate Professor College of Nursing University of the Philippines Manila Ma. Corazon S. Maglaya, MD Medical Consultant Smjth Bell Group of Companies Resource Person "Doctors-On-Line" Program, DZAS Ma. Bridgette T. Lao-Nario, RN, MA Fac11lly Azusa Pacific School of Nursing Second Caceers in Nursing Pr O?,l'WTI Azusa, California, USA Telemetry Nurse Definitive Observat ion Unit Whittier 1-lospita l Medico] Center Azusa, Californ ia, USA Winifreda 0. Ubas-de Leon, BSMT, MPH Professor (Retired) Department of Porasito logy College of Public Health University of the Philippines, Manila Lucila B. Rabuco, MSc Public Health (Nutrition), PHO Professor Centenninl Professorilll Chair Department of N11trition College of Public Health University of the Philippines Manjla

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

PREFACE The fifth edition of lhe book Nursing Practice in Lhe Commun ity focuses on theory-based practice methodologies using the competenc.-y-based framework. Theories which describe, explain and predict behavior of clients (particu](lrl y families, groups and the community) pro~ide background framework s to guide readers on the bases for the selection of content and critical thinking directions by phase of the nursing process. Within these purpose s and background of the book, the cdito1· and contributing authors hope to enhance the teaching-learning empowering compelencics of practitioners, teachers and students based on the uniqueness of every client and the health-healing situation in every nurse-client relationship. Precision a Dd cohel'cnce in concept elaboration and illustration hopefu Jly achieve clarity iu b,-eaking <lown complex processes to describe the application of the 11u1·sing process by type of dieat. Particularly fo. r clinical instructors and students challenged enough to pursue the breadth and depth of community health nun;:e practice, the Lheory-based melhodologie s presented in this book provide teaching-learning alternatives to prevent the likelihood of using ''ready-made·~ nursing care plans and client records to comply with course requirements. The book begins with a presentation of community health nursing (CI-f N) as contel\. i: and practice using a four-client perspective: the individua J, family, population group and community. \'Vithin the backdrop of social, political, cu Jtural and economic determinan L-; of health and il1ness, the chapter discusses the health care delivery system, the nalional health situation and the componen ts, prncesses and ethicolegal aspects of community health nursing practice. As a CHN praclice option in ma. ny countries, community-based case management is discussed towards the end of the chapter. Chapter 2 presents theory-based methods and tools on assessment in family health nursing practice. The,!\ssessment Data Base and The Typology of Nursing Problems in Family Nursing Practice are updated using precise concepts related with major family theories: The Systems Model, Interactiona l and Development Models and The Structural Functional Framework. Genograms, ecomap and family-life chronology are discussed as additional assessment tools with speci,fic guides on construction and interpretation contained in Appendices B1 to 83. Chapter 3 focuses on concepts, steps and intervention options in developing the family nursing care plan. A sample evaluation plan illustrates bow to specify eva Juation criteria/indicators, standards and types of methods and tools. Chapter 4 covers concepts, methods and tools related with the implementation and evaluation phases in family nursing practice. Two types of evaluation a1·e discussed: formative and surnmative evaluation. Each type is presented to address specific components of family h. ealtb nursing care based on evaluation criteria/indicators and standards. Challenges and directions include supervision of a case load of priority families by geographical assignment or catchment area and t11e case management approach in working with priority families. Chapter 5 focuses on the nursing perspecti ve of the partnersh. ip approach and the participatory action methodology explicitly illustrating the "Look-Think-Act" cyclical process using empirical data on the empowering experienc es of fam. ilies in a village in Abra Province. Tnterdisciplinazy teamwork and interagency collaboration are enhanced through competencies on partnership with diverse groups forming cross functiona l teams.

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

Chapter 6 presents the concepts and methods of the workb'TOupapproach in developing community competence. Chapter 7 describes the processes, methods and tools for assessing community health needs by type of community diagnosis. Application of demography, vital statistics and epidemiology as public health tools are illustrated by major concept or tool. Chapter 8 discusses the,ipproach es and steps im·olved in planning community health nursing programs and services. Community competence and community strengtb or empowerment as change outcomes are iltustr::ited as ex,1mples of evaluation measun::s to pursue using tl1e participatory-approach. Chapter 9 presents the nu. rsi. ng interventions for community heallh at1d developme nt. Within the perspectives of primary health care, henlfh promolio11 and community competence. community health development ;;trntegies include community organizing towards commtlllity participation in hi:;:il Lh. cafrncity-building through competency­ based trnining, partnership ant. ! collab1n,1Lion, a<lvocacy and supervis ion. Caseload managemen t is described as a process and ;m approach to systemati CTtlly address the health needs and problems of a number of dients under specific health prngrams or services. Chapter IO presents assessment and management protocols for safe motherhood and well-baby care. Chapter n describes nurse-managed maternal care in the communi ty. Based on standards of prenatal care, home delivery and postpartum care, application o( the nursing process in a nurse-managed care is presented. Chapter 12 describes independent nu. rsing prnctice using specific strategies, examples and experiences such as conducting developmental screerung for preschoolers and maintaining a health promotion clinic to iiddress client concerns like nutrition, comfort, mobility and sleep pattern. The components of nursing consultation together wi. th otl1er topics such as charging nursing professional fee, marketing services of the nursing clinic and establishing linkages and a referral system are discussed. Chapter 13 focuses on enhancing competencies on nutrition for wellness, presenting the functions and foo<l sources of macrnnutrients (carbohydrates, proteins and fats) and mit:ronutrients (vitaminsaud mi. nerals). Methods and tools to assess nutritional status . (e. g. dietary and anthropometric methods, biophysical tests and clinical examination) are also described in the chapter. Competencies on nutrition and wellness enhance the nurse's confidence to assume an independent role or wnrk in co11nbor-ation,,ith the health team in addressing malnutrition as a health problem and risk factor oflifestyle diseases in many communities in the Philippines and in many parts of the world. Chapter 14 focuses on concepts, strategies and interventions to address malnutrition in early cbildhood based on common causes of undernutrition among Filipino children. Chapter 15 describes the life cycle and measures for prevention and control of parasites as causative agents of selected communicable diseases such as malaria, filariasis, schistosomiasis and intestina l parasitis m. Chapter 16 describes assessment and management protocols to address selected common lifeslyle-i:elated health concerns and ptoblems of adult clients.

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

1 Chapter 17 presents the c~mcepls and _princ:i!,l es of nursing mauagernent. public health system. Eth1colcgal cons1dera l1ons are discussed. m the local Finallv chapter 18 discusses community-based participatory re co11in;L:11it Y health nursing practice. The nature, process and oseta,rch to en J,auce ·11 t d · · · I d u conies of ~ empowerment are 1 11stn e usmg emp1rica ata based . ·.-amilv multidisciplirwry research on malaria preventio n nnd control iin 13 t1urty-month.. d t f ·u f nvo V}J1CF s·· . ' I a Province. families as comtnullll)' re~ en ·s o a VI age o Daoglas ]VJ u. n icipality Ab·.. 0 1 x~-nine The fifth edition is a product of fivi: years of exploring options based ti practitioners, clinical instructor:,;, senior focu Jty and students O 1 on ecclback from and facilit,1te critical thinking and analysis in commuriit y healntl,ow_ t_o encouroge. l.. d tl ·1,. J. 1 nu. 1s1nn I,. Theoret1ca p«:rspech~·es pr OVl. e le 1ases,or t 1e application of the 11.. 0 ,rnct1ce. by tn>c of cl,cot using pract1cc-hnsed methodologi. es. Each cl · ~ 1 smg process. r . l" · I · rnpte1 pro · d opportunity,or pnict1ooners. c 1111ca 111st1·uctors and student s l "1 cs an practice perspective from the vuntage point of participaton ° see th c nursing en J11mcing client's empowering potential. _r approach towards The book is dedicated to all families and nurses who are sources· of ho. strength to enhance healing and ;1ttain wellness. pe, v.-,sdom and Araceli S. Maglaya . Tagaytay Cil)' . July J6, 2009

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

TABLE OF CONTENTS CHAPTER 1 Community Health Nursing: Context and Practice Rosalinda G. Cruz-Earnshaw Community Health Nursing 16 Framework for Community Health Nursing 11 Clients of Commun ity Health Nurses 17 Individual 17 Family 18 Population group 18 Community 18 Health 19 Factors affecting health J9 Health Care Delivery System 22 Public health 22 The Philippines health care delivery system Departmen t of Health 23 MIiiennium Developmen t Goals (MDGs) 24 23 Medium-Term Philippine Development Plan (MTPDP) Health Sector Reform Agenda (HSRA) 24 FOURmula ONE for Health (Fl) 24 National Objectives for Heal th (NOH) 25 Devolution of health services 25 The National Health Situation 26 Demographic profile 26 Health profile. 27 Primary Health Care and Health Promotion 30 Primary health care so Health promotion 32 Nursing Practice in the Commun ity 33 Critical thinking in community health nursing 34 Nursing process 34 !' Program planning, implementation and evaluatio n 38 Health education 38 Management and supervision 38 Research and evidence-based nursing practice 38 Community Health Nursing in the Philippines 39 Public health nursing 40 Occupational health nursing 42 School nursing 42 Community-Based Case Management 43 Ethlcolegal Aspects of Commun ity Health Nursing u 24 19 ________,,,,,,,,,,,,,,-,

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

CHAPTER 2 Assessment in Family Health Nursing Practice A mceli S. Maglaya Family Perspective In Community Health Nursing Practice Family Nursing Practice: Theoretical Perspectives 51 Nursin B Assessrne~t: Operational Framework 511 Steps in Family Nursing Assessment ss Data Collection SJ Types of Data in Family Nursing As. sessment S7 Data-gathering Methods and Tools 57 Data Analysis 62 Nursing Diagnoses: Family Nursing Problems 63 The Typology of Nursing Problems in Family Health Care Conclusion 72 CHAPTER 3 Developing the Family Nursing Care Plan Araceli S. Maglaya The Family Nursing Care Plan 76 Steps in Developing a Family Nurstng Care Plan Prioritizing Health Conditions and Problems 77 Factors Affecting Priority-Setting 79 Scoring 81 50 64 76 Formulation of Goals and Objectives of Care a1 Developing the Intervention Pl;:1n 83 Analyze Realities and Possibilities based on Family's Lived Experience of Meaning and Concerns 84 Focus on Interventions to Help the Family Perform the Health Tasks as Catalyze Behavior Change Through Motivation and Support 90 Criteria for Selecting the Type of Nurse-Fami ly Contact 9l Developing the Evaluation Plan 92 Documentation 92 CHAPTER4 50 76 Implementation and Evaluation in Family Nursing Practice 97 Araceli S. Maglaya Expert Carin B: Methods and Possibilitie s 97 Competency-Based Teaching 98 Learning is an Intellectua l and Emotiona l Process 99 Learning is facllltated when experiences have meaning to the learner 101 Learning is an Individual Matter: Ensure Mastery of Competenc ies for Sustained Actions 102 Maximizing Caring Possibilities l. 03 Expertise through Reflective Practice 105 The Evaluation Phase 1D7 Challenges and Directions 101 d

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

CHAPTERS The Partnership Approa ch and the Participator y Action Methodo logy: The Nursing Perspective 110 A1·aceli S. Maglaya Human Care and Nursing Practice 1. 10 Options ror Change 111 Participatory Action and Empowering Experiences of Families in Danglas, Abra 114 Enhancing Interdisciplinary and lnteragency Collaboration Ll5 The Essential Ingredients of Partnership !l G Belief In Egalitarian Rel;:itionship 116 Open-mindedness UG Respect. ;111d Trusl 117 Commitment to Enhance e<1ch other's Capabilities for Partnership !H Capabili ties Necessary for Partnership us Skills Necessary to Function as an Integrated Unit l J 8 Summary 1211 CHAPTER 6 oeveloplng Community Compete nce through the Work Group Approach Araceli S. Maglaya 130 Introduction 130 Communit y Competence 131 The Work Group Model as Strategic Approach to Community Competence 131 The Staees of Group Development 132 The Stage of Orientation 132 The Stage of Conf'lict 133 The Stage of Cohesiveness 134 The Work Group Stage 134 The Termination Stage 135 The Various Stages at Work 135 Interventions to Facilit. :ite Group Growth 135 Provide the Necessary Orientation, Structure and Direction 136 Process, Negotiate and Resolve Conflicts to Member's Satisfaction 138 Be Awar,e of the Effects of Own Behavior on the Group: Use the Self for Group Growth J45 Act as the Group's Completer/Re~ource Person 147 Derive Opportunities to Apply Learning on Another Situation 1. 47 Work Group: Hub of Communi ty Organization, Competence and Empowerment 1,11 CHAPTER 7 Assessing Community Health Needs Luz Barba1'a P. Dones Introduction 1so The Community Diagnosis 150 Ecologic Approach to Community Diagnosis 151 Types of Community Diagnosis is2 Comprehensive Communi ty Diagnosis 152 Problem-Oriented Community Diagnos is '15S Commun ity Diagnosis : The Process 155 150

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

d tins community Diagnosis iss Steps in con uc, Determining the Objectives 157 Defining 1he Study Population 157 Determining the Data to be Collected 158 Collecting the Data 158 Developing the Instrument 161 Actuill Data Gathering 16B Data collation 169 Data Presentation 171 Data Analysis 174 Identifying lhe Community Health !Nursing Problems Priority-s etting 17s II f Public Health Tools in Commun ity Health Nursing App canon o Demography 179 Sources of oemograph ·lc Data 179 Population Size 1so Population Composition Population Distribution Vital Statistics 1s4 181 183 Epidemiology 186 The Multiple Causation Theory 186 Natural History of Disease 188 Levels of Prevention of Health Problems 188 Concept of Causality and Associatio n 191 The Epidemiolo gical Approac h 192 Descriptive Epidemiology 192 Analytica l Epidemio logy 197 lnterventional or Experimental Epidemiology 198 Evaluation Epidemiology 19s Conclusion 199 CHAPTER 8 174 179 Planning for Community Health Nursing Programs and Services Luz. iklrbara P. Dones Introduction 202 What Is Planning? 202 Approaches to Planning Health Programs 203 Participatory Planning for Community Health 203 Planning for Health Promotion 204 The Planning Cycle 206 Situationa l Analysis 206 Goal and Objective Setting 212 Strategy and Activity-Setting 213 Oeveloplng an Evaluation Plan 214 Conclusion 220 202 JI

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

CHAPTER 9 Nursing Interventions for Community Health and Development 223 L11z /Jorhnra P. Dones Introduction 223 Community Competence as Outcome or Community Health Nursing Interventions 223 Community Health Development Strategies 225 Health Promotion 226 Community Or,iani2ing towards Community P. >rticlpotion in Health 229 Capacity-Build ing through Competency-based Training 233 Partnership and Collaboration 236 Advocacy 237 Supervision 238 Making a Supervisory Pl,m 239 Methods and Tools for Supervision 240 Conducting a Supervisory Visit 20 Case Study Illustrating the Appl lea ti on of the Steps in Supervisory Planning 241 C;,seload Management 241 Conclusion 243 CHAPTER 10 Logic Trees for Safe Motherhood and Well-Baby Care Ma. Corazon S.. Maglaya and Araceli,Vfagla11a Introduction 247 The Use of Logic Trees 247 Assessment Protocol for lnltlal Pre-natal Check-up 248 Logic Tree Flowchart No. 28 :iso Management Protocol for Initial Pre-natal Check-up 251 Assessment Protocol for Follow-up Pre-natal Check-up 255 Logic Tree Flowchart No. 29 257 Management Protocol for Follow-up Pre-natal Check-up 258 Assessment Protocol for Home Delivery 260 Logic Tree Flowchart No. 30 261 Management Protocol for Home Delivery 262 Assessm ent Protocol for Care of the Newborn Immediately after Birth 267 Logic Tree Flowchart No. 31 269 Management Protocol for Care of the Newborn Immediately after Birth 270 Assessment Protocol for Postpartum Check-up 273 Logic Tree Flowchart No. 32 274 Management Protocol for Postpartum Check-up. 275 Assessment Protocol for Well Baby Check-up 280 Logic Tree Flowchart No. 33-A 2a1 Management Protocol for Well Baby Check-up 282 247 Assessmen t Protocol for Well Baby Check-up, Patient is more than one month old 284 Logic Tree Flowchart No. 33-B 285 Management Protocol for Well Baby Check-up, Patient is more than one month old 286

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

1 CHAPTER 11 Nurse-Managed Maternal Care in the Communit y i'1aria Brigelle T. La. o-Nctrio · Introduction 288 Role of Materna l Care 289 Standard s of Prenatal Care 290 Components of Pregnancy C. ire 291 Antenatal Regi·stration 293 Tetanus Toxoid Immunization 293 Macronutrient and Micronutrient Supplemen tation 294 Micronu trient Supplementation: Iron Supplem entation 294 Vitamin A Supplementation 295 Treatment of Diseases and Other Conditions 296 Early Detection and Management of Complications of Pregnancy Family Planning Counseling 2!l7 STD/HIV/AIDS Prevention and Management 297 Standards in Home Delivery 297 Standar ds in Postpartum Visit 300 The Nursing Process in a Nurse-Managed Care 302 Nursing Assessme nt and Diagnoses 30. 2 Determining Outcome s of Care 303 Choosing Nursing Interventions 30. a Home Visit as an Intervention 304 288 296 CHAPTERl Z 3W Dem_onstrating Independ ent Nursing Practice ll-1a. Brigei-te T. Lao-Na1·io Experiences in Setting up Independent Nursing Practice 311 Metro Manila Developmental Screening for Preschoolers 311 Providing Consulting Services 3!3 The Health Promotion Nursing CJinic 316 Commonly Used Nursing Diagnoses 318 Establishing the Outcome s of Care 320 The Nursing Consultation and its Componen ts 320 Charging Clients a Nursing Professiona l Fee 322 Marketing the Services of the Nursing Clinic 323 Establishing Linkages and a Referral System 323 CHAPTER 13 Enhancin g Competencies on Nutrition for Wellness Lucila 13. Rabuco Introduction 326 Nutrition 326 Food 327 Nutrients 327 Macronu trients 327 Mfcronutrients 32() Assessme nt of Nulritional Status 333 Indirect methods 334

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

Direct methods 337 Common Nutritional Problems of Public HC!illth Importance! 340 Protein-Energy Malnutrition (P. E. M. ) 340 Iron Deficiency Anem,a 341 Vit;im,n A 0eflclency Disorders 3a2 Iodine Deficiency Disorders 343 Overweight anrt obesity 344 Summary 344 CHAPTER 14 Appropri ate Technology for the Prevention and Control of Malnutrition in Early Childhood 346 Arac;e/i S. Mt1glaya Nutritional Status of Filipino Children: Con~equences and lrnplicalions 346 Causes or Malnu Lrition Rela Led to Feeding Pr;:icticcs 347 Non-breast-feeding or Early Weaning 347 Absence or or Inadequate Complementary Feedinr, during Extended Periods of Breastfeeding or Dependence on Artificial Feeding 348 Lack of or Inadequate Skill in Managing Dl3rrhea at Home 348 Intervent ions Using Appropr iate Technology 348 Family Competency-Buildlne on Nutritional Status of Children and Options to Enhance Proper Nutrition 348 Regular Complementary Feeding Using Protein Powders 349 Increase Knowledge on the Daily Recommended Energy and Nutrient Intakes (RENI) for Infants and Toddlers 351 Appropriate Home Management of Dinrrhea 352 Summary 354 CHAPTER 15 Parasitology in Nursing Practice Wi11{freda 0. Ubas-de Leon Introduction 356 Tne Parasites 356 Directly-Transmitted Parasite 357 Enterobius (Oxyuris) vermicularls 357 Soll-Transmitted Parasites 358 Ascaris lumbricoides 3S8 Trichurls trichlura 362 Hookworms 362 Food Transmitted Parasites 369 Taenia solium and Taenia saginata 369 Paragonimus westermani 370 Capillaria i:;hllippinensis 371 Heterophyid Flukes 37] Water-borne Protozoa 372 Entamoeba histolytica 372 Giardla lamblia 373 Oyptosporidium hominis 37"' Cyclospora tayiltensis 377 356

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

Blastocysts hominis 377 Veclor-Borne Parasites 378 Plasmodia 378 Babesia spp 37'9 Wuchereria bancrofti and Brugia malayi 380 Schistosoma japonicu m 384 Conclusio n 385 CHAPTER 16 Logic Tree for Common Adult Health Problem s Ma, Corazon S. Maglaya and Araceli Maglaya Introductio n 38"8 The Logic Trees 388 Assessment Protocol for Problem on Cough, Colds or Difficulty of Breathing not Associated with Fever 389 Logic Tree Flowchar t No. 7 391 Management Protocol for Problem on Cough, Colds or Difficulty of Breathing not Associated with Fever ·392 Assessment Protocol for Problem on Skin Lesions 394 Logic Tree Flowchart No. 9 395 Management Protocol for Problem on Skin Lesions Assessment Protocol for Problem on Body Weakness Logic Tree Flowchart No. 10 aoo 396 399 Management Protocol for for Problem on Body Weakness 401 Assessment Protornl for Problem on Abdomina l Pain, Epigastrlc 403 Logic Tree Flowchart No. 11 404 Management Protocol for for Problem on Abdominal Pain, Epigastric 405 Assessment Protocol for Problem on Insomnia 407 Logic Tree Flowchart No. 16 408 Management Protocol for Problem Insomnia d09 Assessment Protocol for Problem on Dizziness 412 Logic Tree Flowchart No. 24 413 Management Protocol for Problem Dizziness 414 CHAPTER 17 Nurs· ng Management in the Local Public Health System . Rosalinda G. Cruz-Earnshaw Introduction 419 Management Functions 419 Management in Public Health 421 The Loe. al Public Health Organization. 421 Th Context of the Local Public Health Organii:atio n ·421 e PHN as a Manager and Superviso r 421 Planning 421 Organizing 423. Staffing 425 Leading (directing) 425 Et))· Controlling 426 'COlegal Considerations d2. 9 388 419

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

CHAPTER 18 Enhancing Practice through Community-Based Participatory Research 432 Araceli S. Maglaya Introduction "32 Community-Based Participatory Research 432 Enhancing Empowering Potential : The Human Response Perspective 433 Facilitating Behavior Chanse thru Motivation-Sup port Interventions 435 Empowerment: Nature, Process and Outcomes 436 Health in the Ha11ds of the People 438 Behavior Change Over Time 438 Community Leaders Update the Researcher at the University 43'. I Community-Based Research: Insights for Enhancing Nursing Practice 439 APPENDICES Al Community Health Nursing Practice Model 445 A2 Laws that Impact on People's Health and CHN 446 A. 3 Health Programs of the DOH 448 B Family Assessment Tools aqg Bl Constructing and Interpreting a Genogram aq9 B2 Constructing the Family Ecomap 45S B3 Constructing the Family-Life Chronology 456 Cl Charting Nursing Care, Progress Notes and Client Responses/Outcomes 4S7 C2 Family Service Progress Record 458 C3 Instructions on the Use of the Family Service and Progress Record 461 D Selecting a Fruit Exercise 467 E Empowerment for Health Promotion/ Lifestyle Change 472 F Recommen ded Energy and Nutrient Intakes Per Day For Selected Population Groups 473 G Trends in Cdmmunity Health and Community Health Nurslng Practice 474

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

-Chapter 1 COMMUNITY HEALTH NURSING: CONTEXT AND PRACTICE Rosalinda G. Cruz-Earnshaw Commuui l')' healtl1 1mrsing (CHN) is one of tl1e two majo1· fields of nursing in tl1e Philippines; Lbe other is hospital 1rnrsing. Some people use the terms commu nity hcaltli nursing aml public health nursing intercha ngeably. However. the former is broadi::r th:m Lhe latter; it inc:ludes public hea]th nursing, occupational health nursing and sd1uul uursing. COMMUNITY HEALTH NURSING Clark defines community health nursing tis a "synthesis of nursing knowledge and practice and the science and practi c. :e of public health, implemented via a systemalic use of the nursing process am) ol. hm· p1·ocess,es lo promote health aml prevent illness in populatinn groups~ (;mo8:5). The other processes isiduui. : management, supervision, rescan:h. advocacy and polilic. 11 action. Annex Al. pn?sents a model of communit y beallh nursing practice \>vhich illustrates the relationsh ip betv. reeo nursing l)ractice as sc. ic. ncc and art, core community J1ealtb fm,ctions and essential communil y hea. 1tl1 services. The follm\ing st,itements characterize CHN: (1) Promotion of health and prevention of dise;. 1sc are the goals of professional praclice: (2) Community health nursing practice is comprehensive, general. continual anti not episodic;; (3) There are different levels of clienlcle--individ1wls. families and popufation groups and the practitioner 1·eco~nb:es Lhc primacy of the population as a whole; (4) The nurse and the client have gre. iter control in making dccisio11s related to health care and they collaborate as equals; (5) The nurse recognizes the impact of different factors on health and has a gn:ater awaren. e..<;s of bis/her clients' lives and situations (Clark. 2008: 10-13). CHN is t·he tot11lity nf its philosophy and beliefs, principles, processes and standards. As one of the subsystems, it influences and is influenced by the health care. delivery system. CHN is practiced within a specific econornk, political, socio-cultura l and erwironmc ntal conlext. The roles and functions of CHNs directly contribute to the health of their clients. ·n1e essence of nursing is the same even if practiced in different settings. Nursing is defined as the science and 11rt of caring. N11rsing as an art is reflected in the nurses' interactions and comm11nica\ion \-. ;th clients thatnre geared Inwards tl1e improvement not j11st of their health hut ;1lso their ability l<> deal with the determinant s and consequences o{ their health problems. According to Parse, the responsibil ity of nursing to society is to guide individaals and 16

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

families "in choosing possibilities in changing tl1c health process which is accomp lished by intersubjective participation "'ith people" (George, 2002:439 ). The art of nursing is demonstrated by nlll'ses who c,m maintain the delicate balance between c. loi. ng things for their clients and doing things with them, thus co-cre;iting a better or more me. 111ingful reality. The prnctice of community health nursing, therefore, entails active interaclion and partnership between the nurse. ind the client. Sud, parlne,-:. hip recognizes the autonomy of both parties and the potential of e;ich one in unrid1ing their relationship. Nursing is also a scie11ce, which means that community health nurses should use practice-based and evidence-based methods and tools. 'I11ey :. ilso need to engage in generating evidence to support their practice throu Rh research. Quantilative research is needed lo descrihe or quantify vari<1blcs of inter·est lo comm uni Ly health nurses or to eval 11 ate I he cff eel iveness of e:dsting; pr-icli. ces, proccd u res or intc rveu Lions. Qua Ii tut ive research can be done to understand specific human response phenomena such as client-partners' livetl experiences on poverty,1nd adaptation. The roles of CHNs are grouped by Clark (:2008; 14-22) into clie11t-01·ie11ted roles (caregiver, educator, counselor, refern1l i·esource, role model and case manager); deliverv-m·ien led Mies (coordinatm·, collaborator and li,\ison); and, pvp11/a1ion­ oriented roles (case finder, leader, change agent, community mobilizer. coc1lition builder, policy advocate, social marketer and researcher). ln rcccnl years, lhe case manager role in tbc community setting is gaining importance as an innovative strategy to provide high quality care in a· financially restricted environment. As lhe case management concepts of client independence. control, advocacy and coordination ctre already reflected in current nursing models and philosophies, nurses are considered the most appropriate professionals to fill the role of cnsc managers(Kno Umueller, 1989; Bergen, 1992). As a CHN practice optiott in many countries, commun ity-based case managem ent is discussed at length towards the end of this chapter. FRAMEWORK FOR COMMUNITY HEALTH NURSING The practice of nursing, particularly in CI-IN differs from one geographic area (country or region) to another. It is influenced by a number of factors primarily the scope of practice as "defined by the nursing Jaw, policies and standards of the Department of Health and organizations where CHNs WO("k and the health needs and problems of the people. The macro framework for CHN practice has four components: (1) the health care delivery system, with its CHN subsystem; (2) the clients (individual, family, popu Jation group and com Jnuuity); (3) health which is the goal of the health care deliveiy system (HCDS); and, (4) the economic, sociocultural, political and environmenta l factors that affect the 1-JCDS, tl1e practice of community healtl, nursing and the people's health. These constitute the conte. xt of commu. njty health nursing practice in tbe Philippines This chapter elaborates on the different components of the framework. CLIENTS OF COMMUNITY HEALTH NURSES There a. re different levels of clientele in community health nursing-the individual, family, population group and community, with the latter os the primary client. Individual

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

The CHN deals with individunls-sick or well--on a daily ba. sis. Since the health problems of indh;duals are intertwined with those of the ol11cr members of the family and coma11mity, Lhey are also considere d as an "entry point'' in working \vith lhe. se clients. Family From a systems perspective. n family is detined as a collection of people who are inte!!,nilcd, i11t1r:wti11g and intt. !nlependent (Thmt, 1997:126).,Just like other systems, the parts (family mcmher. s) interact with e. 1ch other and the action of one affects t J1c other members. The family has a boundary which. means thatotherp eoplecon recognize its m P. mbers and those who arc not. In fact a person may be identified primarily ns a member of a particular family. 18 There have heen many cl1a11ges in the social coote11. 1: of the Fi Jipino family and these may have modified how it performs its healtb tasks and its capacity to re1nain as the prim,u-y source of support to its members. Population group A population sroup is a group of people who share common characteristics, developmental stage or comm. on e. :-::posure to particular environ m. ental factors, ru1d consequcnlly common health p1·oblems, issues and concerns. Allender and Spradley (2001) identifie tl population "ag,;re~ates" withdeue lopmentalneeds (such us: maternal, prenatal arn J newborn populations; infant, toddler and preschoo l populations; school­ aged and adolescents: adulls and working populations; and, older adult populations) and t J1ose that are tu/nerable (rura J clients, the poor, migrant workers, minority popu Jotions experiencing health tl. isparilies, Lhose w'itl1 mental health issues, those living with a. ddiction. tho!>e in correctional facilities and those in long-term care settings). Population groups a. re lbe usual targets or beneficiaries of social services and benllh progrnms. Community A community is a group of people sharing common geographic boundar ies and/or commo n values and interests ";thin aspe-cificsocia lsystem. This social syst CJTI includes hea Jt J1 system, family system, economic system, educational system, religious system, welfare l>")'Stem, political system, recrealional system, legal system and commu nkation system (Allender and Sprad Jey. p. 360), Behringer and Richards describ e a community as ""·el. >s of people shaped by relationships, interdependence, mutual interests and patterns of interaction (Leonard, 2000:93). Although all communitie s :ire the same (according to the general systems theory), each one is unique because it functions \,itbin a specific sociocu J tura J, politica l, economic and en\'ironmental conle. '<l. They also vary in terms of commu nity dynrunics--cilizeu participation. power and decision malting structures anc. l commun ity collaboration effons (Allender and Spradley, 362-~164). A community is regarded as an organisnl \\ilh its o,vn stages of develop ment and it matures through rime. Development Lo; faciljtated by some catalysts from within and outsidr the community. Anderson and Mc Farlane (Anderso n, 2000:157) developed the commun ity-as-client -

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

model which later: on was rcnamccl w cornmunity-ns-part ner model. The two elements of the model urc: foc:11s on 11lc comrnuni1y ns partner anti the,: use of the nursing process. At the coreofthc asscssmcncwhcc l ;irelhcpcoplcof1h ecomm11nity-their demographi cs, values, llclids und history. The: people ;tr'(;affcctcd hy, and also influence eight subsy:;tcm:;; ur the cn1111111111ily-physkal environme nt. cducntinn, snfcty and trnnspo,·tntinn, politics and government, health and social services, communication, economics and recreation. HEALTH Heallh is a hnsi1: l111m,1n right. On the 6'1' Global Conference rm I lealth Promotion in 200. 5 the Unilcll Nations affirmed its recognition tluit the enjoyment of the highest st:mdard ()f hcu 1th is <ln C of the fundamental rights of every hmnan being (The 13angkok Charter for Health Promotion, 2005). Health which is viewed as a continuum, is considered as the goal of public health in gcnernl,,rnd community health nursing, in particular. It is an important prerequisite {u11d conseq1. 1enr1!) of development. By promotin-g health and preventing disease, CBNs, therefore, contrib11te to the country's economic and social development. There a. re a number of delinitions hjghlightiap; the different dimensions of health and basicnlly focusing on the individual. These should guide nurses in identifying areas for assessmenl and interventi ons. The most frequently cited is that of the WHO: "Healtl1 is a state of completepl1ysic:a l, mental and social well-being and not merely the absence of disease or infirmity " (v VHO, 199. 5). Dubn (1959, in Pender, 1987:21), Oil the other band, emphasized high-level wel JJless which be defined as: "an integrated metl1od of functioni. ng which is oriented toward ma'Cimizing the potential which the individual is capable. It requiresthat the individual maintain a co11tinuum of balance and purposeful direction witl1in the environment where he is functionu1g'". Rene Dubas in his book JVlan Adapting (1965) defined health as "a quality of life, involving social, emotional, mental, spiritual and biological fitness on Lhe part of the irtdividunl, which results from adaptations to the 1mvi ro. nment (Butler, 2001:2). Florence Nightingale looked into health and illness in relation to the environment ­ ventila Lion, noise, ligbt, cleanliness, diet and restful bed. She prescribed ways to improve hen 1th by manipul ating the environment. Dorothea Orem, on Lhe other hand, defined hea Jth as a "state charncte rized by soundness and wholeness of human structures and bodily and mental fonctions ~(1985 in Pender, 23). Factors affecting health There is a strong link between a society's health and its economk developm ent, which i. n turn is determined by its social and political structu·res and processes. The link between inequaliti es in income and wealth and inequalities in health is"vell-established (Wilkinson, 1996 in Naidoo and Wi Us, 2000:12 ). Culture and environment which impact on people's health are also affected by the country's politics and economy. The different' international conference. son health pr()motion identified thedeterminants of, or prerequisites for health such as peace, food and shelter, clean water, education, adequate economic resources, a stable ecosystem, sustiunabl e resources, social justice and equity and access to basic httman rights. In her keynote address during the 5<b 19

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

20 international Conference on Health Promot ion in 2000, t·he UN Secretary General pointed out that "many o. f the major detenninnnt·s of hetter health lie ot1tside Lhe health s ·stem. K. nowledp,c made available · to people. Clr~an envin)nmcnts. Access to bask ser·vices. Fair societies. Fulllllcd ·1,um;in rights. Gond government. £nnbling people to make decisions relevnnt to thci1· lives, and t<> net on I hem" (Pro. ceedings of the 5th Jnterm. tlional Conference on Health Promotion, 2000). In 2005, the Hangknk Charter for Health J>rnmotion identified "critical factors" that now influence henlth 1111d these ::ire: increasing ineqt Lalilies within,rnd between countries, new pntterns of consumption and communicati on, commercialization, global environmental thnnge nnd urbanization. The other faclors lhat influence health idenlifh,,<l bv the Charter arc rnpid nnd often,,tlverse social, econon1ic,111d demographic changes lh~t affect t]Je worldng conclitio us. learning envirnnmenls, family patterns, and the ct1lture andsoci Hl fal;ric of communities. · Poverty and health Povertv is an inclic:1tion of the continuing sodal injustice and foilw·e of a country's develop,;;ent efforts. It is a multidim ensional 1. :011stnicl Llmt goes beyond income measurements. The United Nntions(UN) Human Development Index (HDI) summarizes a composite index of life e.-..--pectaacy,.,clull lilerac~, rate, combined primary, seeon<lm,> a. nd tertiary gross enrollment. rnt. io and gross domestic product (GDP), among olhers (MTPDP 2004-2010). The Philippines is the 90'" among the 177 countries ranked by the United ~ations Development Progrnm in terms ofht1man developruenl (Philippine Star, 2/28/08). The po\'crl. y incidence in the country was estimated at 3496 in 2000, up from 33% in 1997 (MTPDP 2004-2010). More than half of the total i11come flows to the richest 20% of the population (MTPDP 1993-1998). Accordi1 1g to the Social Weather Station (SWS), almost 16 of every 100 survey respondents claimed to have experienced involuntary hunger because they bad nothing to eat in early 2008 (Mangahas, 2008). The pour have poor health hecause they do not have the rcsou1·ccs to afford the bnsic requisites of health; they are not covered by health insurance; and they do not have the capacity to effectively transnct or negotiate,vit11 the health cam system which seems to be mo1·e res1)ortsive to the needs of those witb the necessirny financial resource s. Poverty, however, is a not a complete explmintion for poor health. The poor are not a homogeneous group. Marti and Henry point out that poverty is the only characteri stic that the poor share for their cultural orientatio ns, values, beliefs, practices and need'< vary greally (199t: 523). Culture and health Cul111re is, broadly spe;iking, a wayoflife; it is the tota Uty of who we are as a people. 1l is stable, which means that it endures over time and is passed on from one generation to t J1e Jlext. As such, it is obviously ru. 1 impo1-tm1t innuence on people·s health. Culture includes many things such as beliefs, values and customs 01· practices-how we socialize or internet with others, how we relax and spend our free time, the food tliat we eat or dn not eat. how we p·reparl! our food, how we treat,md r. 1re few pregnant women, how we deliver babies and take care of newborns, how we cope with our problems, l1ow and when we seek help, among many others. Culture has positive effects on health. An example is the value t11at we Filipinos place on close family ties and social relationships. Families, relatives and friends are a m;-ijor source of financial, emotional, instl'Ufllental,mcl social support, espccia Uy during crisis

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

situations. The.-;c relationships conlribulc to our s,!nse of emotional well-being and mental hcnllh. Some people hnvc beliefs ;1rnl prndiccs thnt adversely nffcc L henllh. 11 is, howev~r, difficul L to b. ;ol;11e Lhc cffcc. :ts of <'11 I Lure because nf the com:LI rrcnt in rluences of poverty and i V,nor:111(:u. and the in,1clcquncic;; oft he hc,1ilh care delivery system. Environment and health The envirunrnenl plays. t direct in/lucm:c on the health of people. I'or example, it provides breeding sites for im:ccl vccto rs of tlii;cases like malaria, dcn~uc und filariasis, which are,;till major he;1lth problem:<: in some p,trls of thl! country. An unsanitary environ 111~,11L i:,; al:-o a major fac. :tor i 11 lh. e causution of diarrheal <liscase. c; such us chnlcru and typhuid fl. 'vcr. ll is lite brcctling ground of animals and insects that harbor and tmm:mil microor g;111i~rns. l'vl,1l. 1ria, dengue ;inti filari,tsis ctre still m,ijor problems in many part. s of the co1111tr_v. Jn the environment could he found toxic substances such as lead, mercury, asbestos, pesticides. lobaccu,solvent. ". ind PC13s. These could adversely affecthuman ·reproduction, the br..iin,111cl i111m1:ne <;ystcm i111d C<. Jul<l cause c;111ct'r (Necdle111;m and Landrigan, i994). Tohac. :c-n partit:ularly is a major thre. i~ lo health because it co11l<1i11s over 4000 chemicals (in. cludin~ hydrogen cyanide. sulfur dioxide. carbon monoxide, ammonia, fornrnldch~·dc, nrsenie. bcnzc-nc, chromium, lead, nitrosamines. benz:opyr ene, nicotine, cndmit UTl,md c;1rbon monoxides) many of wl1ich are irrilanls. carcinogens and mutagens. 1oxins rmcl substances I. hat increase blood pressure, promote h1mors, affect the heart and brain, dam<1ge the hmgs and cc1use kidney and reproductive malfuncti ons (f,'rarnework Conventio n on Tohnc;co Con trc)l Alli,mce, Philippines). The increase of carbon dioxide, m<,!lhnne and nitrous oxide (mnong other gases) in the eartl1's atmosphere has depleted the !">7. (me layer. The deterioration of the ecosystem has been implicnled in the rapid increase of cancer cases and other health problems throughout the world. Specifically, there is n rise in cancer-causing ultraviolet radiation, surface ail-temper::iture and carbon dioxide. The denudntion of our forests lrns c Hrectly and indirectly resulted in many healtb problems. Rivers have dried up or are extreme ly polluted, thus depriving many people of their m::ijor source of djetnry protein. The International Physicians for the Prevention of Nuclear War estimates that millions of cancer cases will result from the nuclear testing conducted in the past. The WHO also estirn. ates about 20,000 deaths a year in the world dnc to pesticide poisoning alone (Philipp ine Breast Cancer Ne. twork, 1997). The so-called El Ni1io and La Ni,ia phenomena whicl1 have been caused by in~ults to the environment have caused thousands of deaths due to disasters (Nash, 1998). The state of the world's environmen1 is tl1e direct t·esult of the interaction of a number of factors such as Ludustrializ. ation, government policies, poverty ancl an uncaring attitude towaxds th. e environment. Politics and health Policies reflect the priorities of government and the,·alue system of policy makers. The health budget is the most concrete expressio n of t J1e go\'ernment's political,. vill. Many Fili)'linos do not hnve full access to basic health goods and services because of the sevcrclv limited health cnrc financing. In 1999, the amount spent for health was only 3-'-1% ·of the gross national product, lower than Vl HO-recommended 5%. This 21

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

22 tnrnslates to the fact lhnl c1lrnost half of health expendjturcs is out-of-pocket; jn olher words, lhe "financial burden on individual families is heavy, leaving access to care highly inequitab le" (NSCB, 2002). The severely lim. ited heullh budget is,ilso the biggest hind. ranee to the fu!J implementatio n of we Jl-n1eaning policies such as national heallh insurance. · There n. re a number of lnws that impacl on people's beallh directly (such as the salt iodization law and food fortificalion law) and indirect ly sucb as Lhoi,;e Ulat affect their purchasing power (mi11 imum wage, e. 'f()ctllded value-added lax, encccgy law, etc. ), family aod social rchitionships (e. g., laws protecting women and children). environment, and access Lo education and employment opportu njties. There are also laws that affect the delivery of health services--tbe Loca J Goven1ment Code, National Healtl1 Insurance Act and the professional practice acts of U1e differe. nt professions (mtrsing, mich,~fcry and medkine). HEALTH CARE DELIVERY SYSTEM A health care delivery system is the totality of usocietal services and actj vities designed to protector restore the health ofindividu::i]s, families, groups and com. 1ntm it:ies (Bant,1, 1986 in Cookfair. 1996:66). II includes both govenw1eul and non-gover nment hea 11-h facilities Q1ospitals, clinics, diagnostic. : centers, health centers), programs, services and activities (preventive, promotive, curative alld rehabilitative). Preventiv e health care is a major concern of the government-owned health centers wbj Je curative c;ire is pro"idccl by hospitals, both government and private. · The health care delivery system is affected by po Jicies sucl, as RA 9439 and RA 9502 (refer to Annex A2 for a listing of laws that impact on people' healtl1 and the health care delivery system) Public health Public health is generally regarded as a responsibility of government. One of the most guoted definitions of public health is that of Winslow (1920): '. 'Public health is the science and art of prev~nting disease, prolonging life, and promoti ng hew. th and efficiency through organized community effort; for the sanitati. on of the environment ; the con1rol of communicab le infections; the education of the individu al in persona J hygiene; the organization of medical and nursing services for Lbe early di. ignos is and preventive treatmentofdi. ~ea se; and, the de Yelopment of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so OL·ganizing these benefits as to enable every citizen to realize his birthright of health and longevity" (Hanlon and Pickett, 1979:4). Today public health could be defined in terms of its three c Qce functions : assessment, policy development and assurance. Assessme11t is the regular collection and analysis of healtl1 d,1ta. These data are used for program plannin~ and policy developruent. Policy deuelopmenl involves advocacy and politfoal action to develop policies in various levels of decision making. Assurance is makingsurethathea lth serv;ces are effective, available and accessible to the people (Iostitl Lte of Medicine, 1988 in Clark, 2008:87-88). Related to the core functions of public health there are ten essentia l hea Jth services (ASTON in Lundy and Janes: 2001: 875) which are: (1) monitoring l1ealtb status to identify community health problems; (2) cliagnosing and i. twcstigaii ng healt11 pi·oblems and hazards in lhe community ; (3) informfog, educating and empo=ering people

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

about health iss\lcs; (4) mobi Ji;,:ing communily partnership s to identify and solve bea. lth prohlems; (5) developing pnlirir. '> :md r,lans tlwl support imlividual, family and community efforts: (6) enforcing laws ~111c. l regulations that protect health and e11surc s;ifety; (7) linking people to needed person.,11,eallb services,11rcl ensuring the provision nfhealth care tlrnt is ot. hen,;se 1111arnilablc; (8) c11suri1111, competent public health and personal health care workforc e; (9} C\'alualing cffccti"cm~ss. accessibility am. I quality of personal nnd population-based health sen:iccs;,and, ( w) rcst,;arcliing for new insights aml mnovative solutions Lo health problems. Public health nurses shoulc. l participal e in these cssenti,1I henllh services. The Philippine health care delivery system This section prescnls some of l. l Je major componen ts of the Philippine bcalth care delivery system tl1. it constitute l. 11e con Lex L of communi Ly health nursing-the Department of Health, l\lillcnnium Developmen L Goals. Medium-Term Philippi ne Development Plan, Health Set:tor Reform ;\genda. FOURmula One for Hca ltl1, National Objectives for Health and local health care system (dc\'olution of health services). Departme nt of Health The DOH leads tn efforts to improve tbc ·h L:ulth of Filipinos, in ponnership,\ith other government agencies, the p1;vate sector, NGOs and communiti es. \IVith the exception of a few governme nt agencies (such as the University of Lhe Philippines on<l Armed Forces of the Philippines) and,1ffluent cittcs (E;uch as Manila. Makoti and Quezon City) operating their own health facilities, the DOIi remains to be the national government's biggest health (particulal'ly curative) care provider. The DOH used to have control and supervision over all barangay health stations, rural health units and hundreds of hospitals throughout the country (special and specialty hospitals, medical centers. and regional, provincial. district und municipal hospitals). Today, only the regional hospitals, medical centers, special and spcc. inlty hospitals and a few re-nntiona. l ized provincial hospitals are directly under it. The DOH exercises rcgu latory powers over health facilities and products. lt takes the lead in the formulat io. n of policies and standards related to health facilities, health produ1>ts and health human resources. It provides LGUs the neces;;ary support in managing their local health system. It also implements a number of hel'lllh programs (Refer to Annex A3 for a listing of DOH health programs). The DOH has undergone transformation to be more responsive to its post-devolution function s. One of the major changes at the Central Office is the creation of the Bureau of Local Health Development, which is concerned with locnl health systems development, health care financing programs, quality improvemen t programs, inter-sectorn. 1 (public­ private) coordination and local projects. The direction being pursued by the OOH 1s guided by the Mlllen~ium Development Goals, Medh Jm-Te rm Phllippin·e Developme-nt Plan, Health Sector Reform Agenda, FOURmu la One and National Objectives for Health, 23

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

I 24 Millennium Development Goals (MDGs) The ~ncem to improve people·s health is universal because there is a strong corre. lat1on between health and development. Poor health is n consequence and cause of poveny and underdeve lopment. Poverty also breeds despair and turmoil. To address these problems, the United Nations spearhe aded the formulation of t J,e l\ll DGs,~ith the corresponding targe Ls. These goals are: (1) eradicate extreme poverty and hunger: (2} achieve universal primary educ-'ltion; (3) promote gender equality and empower women; (4) reduce chil<l mortality; (5) improve m;iternal healrh; (6) combat Hl V /AJ DS, malaria and ot J1er diseases; (7) ensure envfronmcnta J sustainability; and, (8) develop a global partnership for development. Medium-Term Philippine Development Pion (MTPDP) Chapter 12 of the MPdium-Terai Philippine Development Plan 2004-2010 spells out the priority strategies to meet the basic needs of the poor_ The following health priorities were identified: (1) reduc. 1:ion of the cost of medicines; (2) expansio n of health insurance partic. :ularl_v for indigents through premium subsidy; (3). strengthening national and local health systems through the implementation of the Health Sector Reform...\genda: (4) improq;ment ofhealt J1 care management system; Cs) improvement ofhea Jtb and productivity through Rand D; and, (6) establishment of drugtreatrn ent and rehahilltation centers and the expansio n of existing ones. Specifically for public health. the plan provides for tbe strengthening of health promotion a Jld disease prevention and control programs: (1) achieve and maintain fufl, fmmunized d1ild,en cm·erage to 95%: (2) achieve and mairttain sputum positive TB~= dmec. 1cion rate of,0% and cure rate of 8. 5%; (3) widen the choice and reach of family planning ser,;ces and increase the prevalence rctte of men and women/couples practicing responsible parenthood using either modern, natural or artificial methods to 60¾ by 2010; (4) contai:n HIV/.. \. 1D5 prevalence to 1% or less for groups at high risk for Hf\. infection: (. :;J reduce malaria morbidity rate by 50% from 48 cases per 10-0. 000 populatirm in 2002 to 24 cases per 100,000 population by the year 2010; (6) jmplernent micmnutrient fortifieation of foods; and, (7) heighte n advocacy for the pr CJ'. ision o; adolescen t health services including sexualit y educatio n and counseling. Health Sector Reform Agenda (HSRA) Tov:ards the end of the twentieth cenb J ry, the DOH has come up with the HSRA 1999-2004 that included the fo!Jo,..ing refonns: (1) pr O\ide fiscal autonom y to government hospitals: (2) secure funding for priority puh Hc health programs; (3) promote the d E"\·elopmem of local health systems and ensure its effective performance; (4) strengthen thie capacities of health ri::gulatory agencies; and (. 5) expand the coverage of the ~ationp;J Health Insurance Program. FOURmula ONE for Health (F1) The FOL. Rmula OXE ·.,·hich is the implementation framewo rk of the HSRA, has three goals: O':'Uer health outcomes, more responsive health systems and equitable health care financing. The elements of the strategy are: hea Jtb financing, health regulation, health sen ice deli Yery and good governance. Accord. in" to the Secretan of Hca Jth F1 is th<: guiding philosophy and strategic approach of the DOH (Foreword: NOH 2005:8).

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

... National Objectives for Health (NOH) The :-J(JH :2005-2r J1<J is an importa. nt tlocument that re-Jkc..1:S the i\IUG'i. MTPDP, HSRt,,ind Fi. It includes a stalcmc:nt of vision, mission, principles. )?. oa Js and objectives, ke\· iuc. i-. larg. :ts. inc. lic:. itrirs and slntlcgics l J hring the health sector tn its desir<:d ou. tc:om. :. '> (http://www. do h. gov. ph/noh). Till' t:i~irm oft he STOl i is"hcalth for all Fili 11i110s-,md the mission is toensureacct:. ssibility nnu qvalitv of health care to impro,·e the quality of lifo of all Filipinos. e.,-. pecially the por,r. Tlw hasir. : pr111cip/es arl!: ( 1) fostering a i,trong and healthy naf ion: (:l) enh;im:ing 1..he perfommm:e nf the health scc:lnr; (i) ensuring univcn,:il ac:cess tr J quality esscnti,tl health care; anti. (,i J impmvin~ rnac:ro-econornic: anti sncial comlitio 11s fr Jr heucr healtli g. si11s. Th!! g<1ol~. ire: (1) better hc;1lth uult. :1Jrnes: (2) more n:spvn~ivc lil·alth ~\·stem:,1tl, (;. i) mr,rc L-quitahlc health t,1rc financing. Th,· medium-l <:n11 t J/. Jjectiul!s a·rc tfl: (1) ""'cure i11cr EOa,-,ed. bct1era11d ~uswi11cc J in,·estmcnu, in 111:,Jllh: (~J assure Lhe qu,ilit-y and,iffordahililv 1;f bf'allh goods and services: (:3) improve the accessibility and nv:-iil;ihility of hasi<: and es.,ential bcallh c. tre for all; (3) Improve health syst1::ms pcrfonnance at the m1tiom1I and local levels. Devolution of health services One of the most significant laws that radic. 1lly d1a. nged the landsc. ipc of health care delivery in t. he country is RA 7160 or more commonly known as the Local Go,·emmenl 0:>de. The Code aims to: transform local government units into self­ reliant communilies and active partners in the attainment of national gorus th. rough a more re. sponsi,·t: and accountable lo Cc!I governmen t structure instituted through a system of dct:e11Lr..Jjza Ljon. Throughout the country, there are about 79 pro\inces,113 cities, 1,496 munici-pa lities. and 41, 943 harangays. (http://www. do h,gou. ph/kp/ statistics /no_cities_prou). In 1993. health sen ices were de\'oked or transferred from the Department of Health to the local go.-crnmenl uniu,--all pn,,incial. district nnd municipal ho"!)itals to the provincial gm·emments and the rural health unirs (Rl:!Us) and barangay health stalions (BHSs) lo the municipal governments. In 1999 there were 2,381 RH Us and 11. 39:{ BHSs (Baut. ista et al., 2002:t9). Each province, city and municipality has a Local He. ilth Roard (LE-1B). This body is a gootl \'enue for making the local health system more respons1\·e to the needs of the people. Tt is mandated to propose annual budgetary allocations for the operation and maintenance of health facilities and services "ithin the municipa Jjt y, city or province. At the prmincial le\·el. it is composed of the: governor (chair), pro,incial health officer (Yice chair), chairman of the Committe e Oil Health of the Sanggunfang Panlala"igan, DOH representative and NGO representati\'e. At the city und rnunjc;ipal level, the LHB is composed of the follo\\ing: mayor (chair), municipal health ofncer (vice chair). chair of the Committee on Health of the Sangguniang Bayan. DO A representative an<l NGO representati\ ·e. Al the municipal le\·el, many public bealth nurses hnve been appointed as DOH representati\'es. This means that they ha\·e been retained br the DOH. Many of them. howe\'er. perform dual functions-those of a public. health nurse und those of a DOH representative. l'\[any of the local go\'ernruent units-cannot afford-to hire a 25

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

16 ~ pl,1t\·111tnt. 1 lw 1>()1 I h,,s. lhl'n. fort. nlli,wtd 1h1:-"<'I-up H;..., for111 of suppnrt lo low-111uu11\· 111\1111\ 1p·1h11.--.. Tl11-. h,ft w tlw ll0,11lcr. <f11p 111 lw. illh,-:11v frn111 th.. n11t1un:rl i;<wer11mt·n1 In 1h, 1. CUs h. l', 1,-. 11l1,-. l ln h"1h 1h,· 1111111"·,·mcnl a11tl tlthri,,ralio11 of lwalrh rrn·r delinrv. Some L (:\ ·-. h. iq 1h, p,,htic. tl ",II,111cl linnn,·i. 11 1·. 1p:ibili t~· 10 s11pp,wt 1lwir own llc:;1111 cnrc ~,-. t,111 whik utlwr-do mt. ~,n11, U:tts ~"'" th,·1r 1'1 l~s :--c: 1;;,;:rlanc. ·:-in n,·cordancc "llh R. \ 01-i "l111, m,.-. 1,In not. ll ha~ 1'«-"<'ll,~t. rhli-. tn-d lh. 1l,tn LGt;·s financial c-ap:rhilitv. a d~·nnmit: nntl n·sporn,ive poht1t,1l lc~11..l.-r--lti p,111d t·ommuni1vc111p,,wlr111e m arc tlw important i11grcuioul:-ofan , fft·cth,. loc-~11 h,·. tlth-.,-i-tl'm ,\lmc«t two d,-. nd,~. ifkr th, tl,,·oluticm orlw. ilth sc·n-i<-cs. tht. 'rc h: n need to look into it" 1111p,lt'I 1111 i"'"I'"-', 1a,. 11th 11,... ubo import. int to know how Pl INs pcrfon11cd their Joh<:. ho,,· till'~ µ,·n. ·,i, t! 1hei r mft.., and h1Jw l hey,;cw their profe... sion;tl <lcvclnpmcnt i11 n dt"n"'°d,.,. :l-up. THE NATIONAL HEALTH SITUAT ION Thl n. 11mnal lre. allh s-ituru,nn gin~~ us. in idc. i or the health ~ih1alion in Lhc c-nmm1111111e:-\\here nur-. e<: \\Ork. Hec. 1usc of lhl' different to11Jltions prcvnilin,:: in thl'.,,. r ·nmumti,-.. their he. 11th pu·turc c.-. :pcclt. 'dly v;1ri1s. For example, i,;oitc-r i"' highly pn-,·,lt 111 in th,· \Jo,ntam Pm'1nl·e "hilc sc-histo!'ominsis is cmfomic in Lt. '~1<'. The loc;. J hc;,ith-. 1111 1111111. tlwr. :-1orc. needs tn hc> co;tablished for each prvviuce. city. :inn munic1p~lit: The "''"1 !-ectiun ~h cs a,;i:neral dcmogr. iphic-:ind h P:tlth profile of Filipinos. Il must be T'f'£~ni1ed.. h O\\t, er. ll1al t. hc, 1?,:!ional differrncc. co in many import;rnt socioeconomic nrd ph} 11:;1I fact,J~ Jre t:r. m~lald to difference:-in the rcgion:il hc;1lth picll. Jre. Demographic profile Th, Phihppin1. ~ r. inhxl 12" in the world in tcnns oflolal popul;ition which was 88. 6 m1lh11n,n,\IIJ:ll<;t inri-<llltp. 1 Wll"U-,C<!ll. '5 11. 'i,qr Jl,',J'II) 'J11i-. is projrc-t Nl to iocn:r1s~· f() 91, RM(. "i<111 in..;r110 (:-S. iri,,naf Ohjrc-ti H. "" for //caltl1. :. !OO!;. :. ! 1). Ac-r-nrtli11g lo t!J<: Prcsitlcnl i11 lrrr 1'1illt of ;,;,,1,. 111 \dclrc'-" in. July :. mo8, the c H111tr_v·s ;innu;d ror1tla1i,rn gn,wrh n,t,:,, :>,,4'\,. dr,"n (rnm the 2. :i6"°, in th<: 1990s (111c l'hilippine Star, 8/:3/08). Jn :u,rq. 1lw a,,rn~ life PYptc-tnnc-y :it hinh h"n" 72. 8 ycnrs for femnlcs ant. l 67. 5 years fo1 111,tlc--.--up from th, ;,~er. 1.,:1,,f '11. 6 ~Nr< for both-. ci. cs in 1()80. The c:ounlrv's pupul.,111Jn i~ "'",.,uu;:, "th-11 u·,1r<. :i, rh,· mt·cli:in ;,g,. The dc-p1ndc11 c:y rali<; is 6t. J \<liu h 111,;i11, lhat r,;i \011111-\ d,·1wmlt11r,-(c,-14 yc:;ir<:,,Id) 1111d Ii,1ld dt:p Pndcnts (ti_<; \t·ir,. 11l<. J :m<l. 11,oq J :,r, J,<111;: upp<>rl<-d IH wo pt·opl<",1~cd 15-<,,i. ·11,i,·1y-seven p<>r-c-, 111 fr"",) uf tlw loltal po11ul. nir,n art· in the 0-14 :1~:<' group whit<: ::i. 8'... '6 arc in lhc 1,_:; and ubm·t ;i~, ~mup c:--o H. 20051. J. n 21 i<,o. I hl re we: re n hiut 2.-;5 1)(oµk for eve,-y ~1u:irc kil011H't L' r ofr'h i Ii r,pi nc t Cr Titory. .. l\h-tn, Manila hm, IJw hq;hc.-. 1 p11pula1inn tlc-n,ily. 111c. J C. 1\1{ ha<, the lowc!'lt (NOH, ::'[)(l~J 1iw f>')f)lll,,wm in tht! urhan :irca, i-. incrrn,-in~ very rnp1dly. From lh<' :;7% o( the ltl!al P,pufatfon rn 1984 (UNICEF, 198f>J the fi~l1rr incrc11-. cd to 48'. I(, in :too,1 (NOi i 2005) -

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

Health profile One of Lhe issues roised about hcaltb statistics in the country is Lheir :-iccuracy, completeness anti rclii;hility. Diffcrcm sou recs sometimes quote diffe Tent figurr-o;. ·n. c intention of including some statistics in 1his charter is to give a general pict11re of the epidemiologit:i:11 pau ems and I r·ends in the hea J1 h of Filipinos. Births and deaths '111c cn1dc birth rate (Cilfl) in 2cmn was 23. 1 per l O00 population while ll1c~ crude death i:nte (CDR) w. is 4. 8 per 1000 population. 13,iscd on these figures, the rntc of nnturnl increase in the country's populalion for 1hc same year was 18. 3 (23. 1 mi_nus 4. 8) for C\Cry 1000 population (NOH, 2005). Despite ll1e decline in the fertility of women, the Lota] fc. rtillty rate (TFR) in the Philippinrs remains high (3. 1 births per woman in 2004. according to lbc AOB) comp;ired tt> the neighboring Southeast Asian countries. Rural women have more children 1han urban women. Uneducated women also have m Qre children thaa t Jwsc who arc with cvllege education. Those in the 25-29 age group have tlle highest fertility rate (NOH :tr;o5). Belwccn 1998 and 2003, the infant mortality rate (IMR) wa.,; 29/rnoo Jive births, which it-,vithin the \-\'J-f O global gual for JMR of less llrnn 50/101Jo live births. This figure w<:nl down to :t6/ woo live births in 2004. The child mort. :ilit:y rate (CMR) hch-:een 1998 and 2003 was 12/1000 live bi J·ths (NOH 2005). The matem;i_l mortality r;:ite (MM R. J was 2/1000 Live births (ADB. 2006). Tbere are more deaths among males than females. ·n1is e~-plains Lhc "feminization~ of old age. causes of morbidity and mortality The following are tbc leading causes of mortality among Filipinos: (J) heart disease; (2) vascular syiacm clis:ease; (3) malignant neoplasms; (4) accidents (5) pneumon ia; (6) TB. all iorms: (7) ill·clefined :ind unknqwn cause of mnrta Ji L-y:(8) chr<Jnic respiratory disease; (9) diahcles rnellit11s; antl, (1n) certain conditions originating in the perinat:. tl period (Philippine Hc:allh Statistics 2004). Mo,;t of these discai. ;es are highly preventable. Dci;pilc the improvements ln the field of public health, many of the common causes of morbidity can be prevented easily by improving environmental sanitatio n and personal hyp,iem: aml 1hruup,h health education. In 2004, the leading c11usc. <; of morbidity were: (1) m:utc lower respiratory tract infection (RTI) and pneumon ia; (:!) bronchitis and hrum:liiulilis; (:!) a Cllle watery diarrhea; (4) influenza: (5) hypertensio n; (6) TB rc,.,-,ir111ory; (7) chick1mpox; (8) diseasei; of the heart: (9) malaria: and. (l O) dengue fcvr-r (PMS 2004). Infants and children ·11,c leading causes ofrofant mortality in 2004 were: ( 1) bacterial sepsis of newborn: (2) respiratory distress of ne,,,bom; (3) pueumouia ; (4) disorders related ro short ge..<;t;1tinn ;ind lnw hirth weight 111)! cb;ewhere classified; (s) congenita l pneumonias; (6) conienital malfonn;ilion of the heurt; [7) neonatal aspiration syndrome; (8) 01her cong('ni1nl nu,lform;Hion ; (9) intraulc. :rine liyµox. ia and birth asphyxia; (io) diarrhea and gastroenteritis of presumed infectious origin (Pl IS 2004). 11al r1ut Til. ion is,·err cum mon amcmgchilclren, particularly protein-energy malnutrition. J 112001, 31% children under 5yc;ir<; old were u,iderwejght (ADB, ~ooo) The Philippines h:is nne of the. : high<e'>l blindness rates in the \:oriel. ll is estimaled that 17 children become permanently blind everyd:1y,1nd lack of Vitamin,\ i~ thi? primary cat L--e of 27

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

tlwir lilandn. _., (1'011. 1)<1<1), lndi,w dlic·i,111-y whklt r(s11ILs In 11wn1:tl and j~rowth r<t:11tln11on,., Clllllll1Cll1 Ill r,111. II... 1.,.,,. 11,·car,.. old and :. 1h CJV(!, and i11 pn·gn1111l Utttl lac·t:1t111i-: rnntlwr,. (N,,tlon. 11 Nutri Lion <:crnnl'i l, t</<Jt JJ. An, n,c,~i"t,,riou.-. lwnllh n111nrn,unong t 1..-. vo1111~~. aecordin R l n I he Vv I II) is I lie I act 1h:1t :111110,;t I in <'\'l't)' :~ l'ilipitw nd1,1t-»1·,11lo. : 11g1-<l 1:1 tu LS ~=1110k1· l'ii. ;11relles (f'nn·:tll;i, :ioo7) Maternal mortality l\htll'r11:1I nwn. 11i1, i< 11 m:n11r iuclic. 1lor nf a \\u11w11·,-h,·:ilth s1n111s. II i,, <li!lir11:d hy tlw \,'IHI 11'-th< t!1·t1tlt n J ti 11t1rr11111 ultill' J>r<'!J"""',,,. withi11,'/:! days of l<"r111i T1ut in11 of 111rqm11wr1 rrr,,,,,,·r11·t 11( t/11',Jur 11tw11 unti,1,,. ~it(' vj rl H: 1n·1·y11,11/C'!f. fi-tn11 <lll!J c't11rs, n·lut, ti ro. ur cwµrt1l'<If11l ''!I tlw 11r,,y11t111n, or its 111cu,c19,111,·11/. 1>111 /l(lt. frr,111 CJrrirfrnt"I nr in.-idrnta/ cu,,,,~. Tiw rnatlr11af mortality nilc in 2000,w,. o. : 2/ 1 noo I ivc hirt 11_, (/II rn. 21106 ). 'I11c lt-adin~ rmt'-''' nf nl'l!t'n1af mortali t} in :t. 004 w(re: (1) nr 111,r r·omplicntiom:,·clntetl l<l prc~urmr~ t)('('umn~ 111 the ro UT'-l' vflal Hir., lt·livcry.,nd p111>rprrium: (:. !) hypr·rt1n Ai r,n C'>rn1lit-,11in;: f'"''~r1.,n,"··,·hildh1rth ;111d pue. rpcrium; (;3) poslpnr111m hcmnrrh;i J. tt: (4) prt>~nanr) "''" :,h.,n1,·; 01111.,,ml. '; and. (~) hemorrfw)';c in curl~· prcitnancy (. :!00-1 Phihprini ll,. 1lth ~tal1-Lic. ). Matem;il mortality ~hould fl<,·i<n~rd within the greater contcx1 of womcn'i; health. Anal~,,~ 11!' ""m·n·~ ponr he:ihh ;in<l malt:n1~,J 111ort:ility should c1111si<ler the '"'t'rafl ,,odnl. r,1lt 11ml. J)n,I 1'<-·1111,11nk f. '11Vir1111 men l. The woman who <lies frnnl prc~11;1 ncy· relull'ti,·. :111,,·<,. rn<>r,. J,l«b 111,,., pi>Ur, "ith lo"' rd L1c111io11;if status. :r 1111rf1ipara, :wrl ;111111w '. ;!11rt tik, J\,h,· 1·ome" frmn :on area wh,rr· I ht· n111enalal !>cn·it. ·c" ciro in:ic-,, <tlilc· irnn,p1n (;,·ilit1<<. ar P poor; supplyt Jfblood for lr~rnsftr,_i,,n j., inadeq1ralc; ,.,t.."ll dn,;;,.,uppli,..; and L~~11ipm<>n l. ire not 11\';iilribfc; and adcqualcly skflled help in labor and d P)f\1·r:, 1 nt>l n Yallabl:. Elderly Prub. 1bh 1h,· mu-:1 commr,n lv doc-umen 1ed prt>blcms of nlclcr p-eoplc nr<· !hose wlat,r J 1,, · t hr,r h,:dt h. ;,i:cr,rdi~g IO th" !)() 11. I he d<lcrly suffer fr<Jm I he Mdv11 bl!: burd,n· nf ci;;<'n r:m:,·,,nd communir:1b fc· dist':l'..,;s. 'Inc· f<"ading ~11,-. cs of murl,iuity among,,Id,, f Y'tlfll· ;,r, infl11(!!17~l. rnrunwn i:, and TIJ. '/'Jw lr·:iclirlg ('. :. l\JS(!t,,,r 111,11-iality are c~1r,Jj,,-,-,..,ntl;,r d1va~,.... pnr-11rno11i;1, m:1fi~n. in 1 nenpl:,<. ms, Tll, COl'I >, di:1bc:rc. c; mel!Jtu-;, J!llt. !Tfllnt.-. 1,n. :if u It,..,., nc rid Pnl.., ~,n<l inj11ri1:,,, n,·phrit is, 11cph rolic i. yn<l ronic and n"phm,1s,u,,J vptiu:mia ( PHS 20<,c J in :s'Oli :. mo5). TI1,; prc,. iltm,,,fn11lnli,Jnal ciihr'i n1·ydisor<lcrs nmm1g older people is hii;. h: nncniia, 45'""; rh1«m1nr d11u·u n,·. 1:;',, :incl nhf Jll;nin. 12%. Thtn· :He more r,lclcr won1cn (16",',J th:rn old. ·r n Rn /11',J "hn ~,rr 11nrl1·rwr·ipit (N;11i,,n:J I lle;1Jtlt 01,jecti,·cs, 1. 44). According M th Food. ind-Su1n111,n R,,, ar·h ln«titute (2001:21} LJ,~· prcvale11cc uf chmnic,..nt·rzy dcftcit-n e> 1:< h1~h.-r in f<·m Alr, tlwn in mllfc-,;, ;,nd the :-. cvcri ty i ncn. msl!S uith a~e · fo 1995 thl·n· wcr,· 345 ooo.,,,0,,11· cit11tn<: (9. 2%) with sonw lvp( nf (lio;;1hility. Low v1,1on........ th· rnu-1 ·11mrnon l"'-)X't u,11~ arn<mi. :,-fdc-rl. 1,~r,m,·n (,1,, 1 'J/, :,o. ; comp::ircd lo 3',,......,. ; nmofl_i: d J..rf~ m,·n). Thc <,th,:r tvp,·, 11( di,;1hil1ty tli,,t olrl,·r p,·t)pk suffer from 1,"cn,leal T16s (partial and total), poor lwanng, hlin<lnc,s (par1ial and tuta J) nnd pa~ll i,,i!> (?-:so, :,_(,c11 ).

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

Lifestyle-related diseases The p;ittc,rns of morbidity and r YHH1ality lt~1V<s changr,d si Y,ni/ic:mtly. While infectious di,-,r;:1<;e,; r:11111i11 tu hr· tlw main t:iusr<; rif rn1,rbi<li1y, c-ardiov~ 1<;1·11l11r (!j,_,,:,~1·s. di:,betes mcllitu. s, c:,nc,J', 1111d chr,,n,c rc:sp,r:,torydisrc;;sc. s, the 'if>·C1. JIJ·d i1fc~tylc disca. scs. have become I he l1·:,cli11~ c;,11s<:s,,f d,;;,th,.. WI I() r,-..t11nal$ th Ht ho%,,r ;,JI dc:,th~ are tlue lo c:hrnni,· dis P:t S1,-., Eii~lity pcn;cnt (f$11%) o( L11csc· r,ecur in 11,w-;i11d rnit. ldl<:-incrime countri,~s lilw the l'hilippines (WI IIJ,. <rto. 5). By 21,2n, it i,-. t·~rirw,rc:d th:it 7~% >ftotal dc::tths will ht: 111trih11t1d tn the rnajr,r nnn-r-,,mmuni C'. ahlf di. <;r. :1s1<; (Wnrlrl I Jc;,lth /\sscmhly, 2004). l'coplc·s Ii festylc (rart iculnrly their unlicalt11y diet, sedenta ry work and Incl< of exercise) ha. o; hc~cn identified Ir, he: the rnojor rc11S()J1 why they dfo from the diseases which used to be associntc<l with c Jcvclopcd cnunlrics. Cnrdiov,)scul;,r disensc~ C<Jmprisc 25% of the lolol dcitlhs. Nine 17ilipinos die of cnrdi{lv:isc11l:,r dii,a,:1~a: every hour·. Di;ihclcs mcllitus, "·hich is rr~ardcd as "the biggest hc;. 11111 catasll'ophc th1c world has ever seen.. (C.,slillo. 200:3) is found in 4 out of 1-00 Filipinos. N,;t surprisi11~ly, nwre diabetics :ire found in ud,an areas (6. 8%) than in rural arc. il> (2. 5%) (FNJU). Ca nccr is I he most dreaded,,r 1111 disc. ises bec,111se of its very high case fa tali I:) r. ile and the lori,: suffering LJ1at patic11Ls expcr·icnce. The leading canc<. :r sitei; amonv; males arc: lung. liver. c:nlnn/rect11m. prostate, leukemia, stomach, nasoph. irynx. non-Hot. lgkin's lyrnrhnma, nrnl 1·nv11r :ind l:1rynx. 1\mnn~ fomalt'. :S, these arc: breast, cervb., colon/ r C'ct11m. luni;, ovary. thymitl. leukcmi H, Jiqr, ntems and,;tr,mnch. I Philippine Cancer Society. 2008). In ;iddition to lifestyle, a major factor in the 011i. ~a1ion of malignnnt nec,plasms is the drastic change in thr:, physic;nl envir1111meot nnd greater expr Jsure of people l O cl,cmicals (such as polychlorinatcd birhcnyls c>r r CBs), rndia1ion nnd other carcinogen ic s11bst<111ccs (Cone,:wus; Needleman and Landrigan. 1994). Infectious and commu nicable diseases t\lthuugh the m11nhcr of dc;iths £mm infectious dise. ases hns decre;1sed, many of these ar C'-;;Lill majnr puhlic health problems in the country Cholera and typhoid fe,·er is still a commrm m·r111-r Pn1p in m;my part<; nf tht. :: cow,Lry. Tit" number of panuylic shl'. llli~h pni:;cmini (more oommonly known ;is rnd Lide) continul!S to incrcas~ b~cause of 1hc rlcgrnclntion of the country's bodies of waler. In th,: pasl fc-w ycari,;, there were infcctinw; diseases lhal have emerged such as the :-;cnry severe acute respiratory syndrome (SARS). SA RS has highlighted the f;ict that the trn11smissio11 ofinfcctiou!' di!'eases is fn. cilit,1ted hy the increasing rhysical mobility of people and ease in u·. iveling frnm one country to unother. There is a steady increase. Llrougli relatively slow. in the number of HIV.. \b seropositive C!;l Ses in the count,·y-2,454 c.,ses rrom. January t982 to February 20. 06. HN/Af DS is no longer just associated with hmnose,,uality. Al >tml one-th, rd of the cases were O FWs (seafor·crs, dorneslic helpers. entertainers and heallh workers). About three-quarters (74'. )(,) were males. The mode of lraos,nission is prim;1rily (9:~%) throu~h sexual int ercoursc ( DO 1-1.. 2006). The inct·<asc in olhl:r sc-. ually tnmsmit1cd dis(ases (STDs) :;uch a,; :,-yphilis and gonorrhea is due tn u11 lrn mpcretl pro:-tituli<rn in many areas of the country. Prostitution hus nlways been identified as o,onsequcnce of poverty. STDs (and 1. hc nc"ly emerging disca;;c. :s) furthcr hurdcn the health care system which at the mome. ni coul<I nm cope adequately with the leading cnuse. s of morbidity aod mortality. 29

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

Tuberculosis which was the number one cause of mortality about so years ago continue lo be n major killer of Filipi_nos. TB pi-cvulence in 2003 wus 458 per 100,000 · population (ADB, 2006) and this problem is made wori:;e by the resistant sl Tains of the TB microorgani sms. Unfortunate ly, TH wm J1ot significantly decline over the next 1. wo decades (ADB, 2004). Leprosy, too, is still a public health concern in some parts of the country. Schistosomiasis continues to affect hundred s of l:'laranga ys in 24 endemic provinces. Rabies incidence in the Philippines is one of the highest in tl,e world. It is estimated thul about 12% of the population arc chronic carriers of hepatitis B (DOH). The significance of tbis figure lies on th~ very close association between hepatitis B and hepatic carcinoma. Tluee fatal and debilitating diseascs-ma Jn1ia, filarinsis and dengue fever are hrougl1t about by the vector mosquito. IVJalaria. is endcm. ic in most provinces in the country. Filariasis, on the other hand, is endemk in the Bicol Region and some provinces in Rcgiun 10 and Aluvl M. In the past few years, there has been a significant increase_in the incidence of dengue fever (DOH). Mental illness Mental illness is the third most common form of disability, after visual and hearing impafrments, according to a disability survey by the National Stat is. tics Office in ::woo. Almost 2 deaths (t. 8) per 100. 000 poputat ion resulted from suicide and self-inf)jcted injudes. Jn anntber survey in 2004, 0. 7% of the households included have a family member with mental disability. The incidence of mealal illness is repurter. lly bjghest among older age groups. Othc1· vuloerable groups are drug users and those who could not cope with strc.-sses of daily living (NOH 200s). PRIMARY HEALTH CARE AND HEALTH PROMOTION TJ1c practice of commun ity health nursing is guided by the philosophy, goals,md strategies of primary heallb care and health prmnotion. In their search for more effective st:rategies am. l interventio ns, commu nity health nurses should also learn from the lessons o( Alma-Ata and the different,charters of health promo Lion. A major Jesson from ;ill of them is that meaningful improvements in the socioeconomic determina nts of health a re required to have sigoifica. i. 1t nmproven1en ts in people's health. Pr;mary health care In 1978, reprp_,;eatativesfrom 134 countries who attended the International Conference on Primary Healt J1 Care in AJrna-Ata, USSR signed the Declaratio n on Primary Healtl1 Cn1·e (Pl r C) because they believed that lhe global health situation was unjust. Thet·e was a wide gap in the health of underdeveloped and developed countries and even withi. n countries. Communit,, health nurses subscribe to Lhe beliefs articulated in the Declaration, specifical l):: (1) The promotion and protection oft he health of the people is essential to susta. ined economic and social rlevelopment and contributes to a better quality of life and to world reace; (2) The people have t'hc right and dnty to pnrticipnte individually and colle(;t;vely in the planning and implementation of tbeir hca Jtb care; (3) PHC is premised on tl Je spirit of social ju!-licc; and, (4) PHC is an integral part of the country's health system and of the overall social and economic development of ·the community ((WHO/UN[CEF t978:2-4). 30

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

PHC wns viewed as the approach that could improve the health situation throughout the world. It was defined 11s "essential health cnrc based cm practical. scientifically sound nnd socially acceptable methods and Lechnolo1,,')' made universnlly accessible to individuals and families in Llui! community thrrmgh their full participation and al II cost that the community c;in afford lo maintai11 :1t every stage of their development in the spirit of self reliance and self determination" (\-\THO/UNICEF p. 16). The essential clements of PIIC include: cducntion about pre\'ailing health problems, including methods of prevention and control; promotion of adequate food supply and proper nutrition; immuniz.-1tio11 againsl the major infectious disenscs; provision of safe w11ler and basic saniwtion; maternal and child hc111lh care, including family planning; prevention and control of loc11lly endemic diseases; appropriate treatmen t of common diseases and injuries; and, provision of essential drugs. Although these . were identified decmles. igo, Lhesc are slill reflective oft he needs of most people in the world, particularly in developing countries. Realizing that health and illness are multi-causal and could be addressed only by an integrnted effort, the CHN works with other health workers and those from other government agencies and non-government org:mizations (NGOs). Mullisectoral linkage ensures that the different facets of health problems are addressed. (These concepts 11re elaborated in other chaplt:rs of this hook. ) Appropriate technology is used in addressing people's problems for many reasons. Herbal medicines and acupressu. re which have been proven to be effective,-have the advantage of safety, acceptability and affordability. Three decades after the International Conference on Primary Health Care, access to basic health services has not significantly improved for certain segments of the country's population. Vlhy? The nnswer lies on the political commitment to primary health ·care which "implies more than formal support from the government and community leaders.... For developing cou ntrics in particular, it implies the transfer of a greater share of health resources to the under-served majority of the population. At the same time, there is a need to increase the national health budget until the total population has access to essential health care... '' (WHO/UNJCEF 1978, in Werner and Sanders, p. 18). In addition, many people (health workers and communities) have not fully understood the essence of community participation and have not developed the necessary competencies to participate more effectively. Nurses should do their share in making basic health services available and accessible through advocacy and proper management of health programs and services. Community participation should he ensured in all the phases of the nursing process and other community he. 11th nursing processes. Nurses must be competent on the use ofparlicipntory npproach to engage clients/communi ty portncrs to look, think and act in order to address illness realities and barriers to quality health care, hy enhancing the competence of client-partners to unclcrsland, anal~01. e nnd carry out options to address hopelessness, apathy and helplessness, they can sustnin their motivat_ion to change the current reality in order to out health and health care in their hands (i\lnglaya, 2008). The participatory approach is descdbed in Chapter 5 antl pursued,,;t11 specific examples in Chapter 18 as participatory action research on family empowerment for malaria preventi_on and control inn baranga)' in Abra Province. 31

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

32 Health promotion Almost ten years after the Declaration of Primary Heah11 Care was sil!,ned, the Ottawa Charter of I-leallh Promotion came out of the First lnternationa J Conference <JII He::dth Promntion in November J986. The Charter defines health promotion as ~Lht. : pr()(;c:-:s of enabling people to increase conl Tol over, and to improve. their health". l t identified live priority action areas: builtli11g healthy public policy, crcu ting :rnppoi-L ive environments, su·eng Lhening community action. develop ing personal skills and rcoriei Jling health services 111c Second Iuternntionril Conference on Health Promotion that was hclr1 in Adelaide, south Australia in 1988 focused on healthy public policy. I-'our priority nrew-; wc:rc identified: supporting the lwallh of women, improving food security, safc. :l. v nncl nutrition, reduci11g tobat:co and alcohol use and creating suppo1·tive environments for health. 'fhe Third Jnternational Conference on Health Promot ion tl H1t w·. is helcl in Suntls,·all, Sweden centered on sustainable development and equity in creatinli\ supporti ve euviro. nmc. nrs for health. The. Jakarta Declarnlion on Leading Health Promotion in Lo lhe 21"' Ceutury whjcl, is t J,e output of the Fourth International Confere nce Oil Health Prr Jm11Li ou held in 1997 identified five priorities for action: promoti ng social responsibility for health, i11<. :re. 1::;i11g community capacity and empowe ring tbe individual, expanding anti cnn"olidating partnerships for health, increasing _investments for health developmen t a11d securing an infrastmcturc for health promot10n. The Fifth Global Conference on Health Promotion (2000) examined theconl1·ibu Lions maclehy h Mlth promotion in improving the health and quality of life of people living in difficult circumstances. It called for the strengthening of the science anc. l ar L of health prulllotion and strengthening politica J skills and actions for health promotion. Recognizing the changed glol~al context for health promotion, the Bangkok Chai·ter of Health Promotion io 11 Globalized 1-Vorld which was adopted during Lhe 6'11 Global Conference on Health f>romotton in 2005 focuses on the nee<l Lo adclress Lhe determinants of health in a globali7. ed world through health promolio n. Com;eqoent ly, it exp. inds the definition of health promotion to include the determinants of health: Health promotion is the procc-;s of enuhling people to increase control over their health and its determinants. This is done by strengthening individual skills and capabilities and the capacity of gr◊ups to change the social and economic conditions that affect J1ealth (Tang, Beaglehole and O'Byrne, 2005:884). 'J11e Charter recognjzesthatorganizedand empoweredconi nnmities nre higl1 ly effective in detem1ining their own health, and are making go"ernmenti; c'lnd the priv;. 1te sector accountable for the health consequenc es of t11eir policies and practice. <;. About U1irty years after Ll,e Alma-Ala Declaration and twenty-two years after the Ot-tawa Charter. there arc many questions that still need to be asked. 1s there enough political will to inslitule meaningful and lasting structura l changes tl,at de> not only aim to improve J1ea. Jth b11t to effectively address the socioeconomic and othe1· determinants of liea Jtb·? Are the communities compct. cnt, confident and committed enough to actively participate in matters that affect them? And the questions to be answered by community health nurses are: Do nurses engaged in practice do so Jn acc. ordance

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

v,ri. th the beliefs of primary health care,md hen Ith promotion·! /\re they committed Lo help cataly-. ;r,c change in their c1111111111 11itic~? :\re they willing to share power with the community :md trcot them as pa1'lncri; ;md not just as recipients of health services? Are they willing Lo learn ho\\' to \\'ork,,ilh thr~ c:nrnm11nily as partners? CHNs should take affirmative actions to h... tp comrnunitic:s a1tain 1 he: gm1l nf PHC and ]1ea]th prnmotion-imr>r ovcd henllh n nd quality of life. NURSING PRACTICE IN THE COMMUNITY Nursing practice in the c<>mnrnnit y cnt;1ils the utili~atirm of a number of processes to respo11d to the hcnlth 1u:cc. ls ancl problt. :111s of clients, m;111agc henlth progn1111s nnd resources, nnd infltwnc:e clccisions tlrnl :ill'ccl l he delivery ofhc:illh and nun:in~ servic. :c. :s. And to he cffcc:livc. c:n1111111111ity health nurses should ;rnhsc. :ribc to LIH! pri1wiplcs of equity, participation, and involvement oflhcir dicnts in 111aki11)!, dm:bions 11ho111 hc:1lth care. As Leon. ird pointed 11111, ltt:nlth L':1111101 he improved just hy mere provision of health services. Nur S<;:s and dic11ts shrn dcl he p;irt 11crs in working fo1· the ac:hicn,m,m t of the latter's health go,1ls (2000:95). Clwptcr 5 cl:1horntcs on the p:irtncrship appro. ich and the par Licipatory,1ctio11 methodology from a nursini;; perspcctiv c. Table 1. 1 presents lhc different processes that arc important i11 conlrihuting 10 the attainment of the go;ils of co111mu11 ity lwallh. There arc lhn. :e major targets or foci of nursing aclions or pmccsscs-clicnts. hen Ith cnrc unit uncl political lc,11. len,/dcc: isio11 makers. The processcscngugcd in by CHNs inc:lude: nursin)!, process: program planning, implementation and evaluation: henlth educ:111 ion: 111:111age111cnt and i-uper\'ision; quality assurance; research; nnd, advor. acy c1nd poliliail :iclion. Lc;ic. lcrsh ip cuts across these processes. F. ocus J. tanzet-Processes · , Gllents _ Nurs Jng process,, '. Program planning, fmplementatlon, monitoring and. :, evaluation,,. Health edu·catlon ~' '. -. lijealtn'. care unit (health Management-and super:vlslo n 1, center) Quality assur:ance Nursfng. researi. h:/, health systems research --.---I ~d Y0Cl!CV and politic a I action Political leaders/ decision-makers ' -. Table l,. 1 Processes In commun ity health nursing A common element in all of these processes is critical t11inking because there are no hard and fast rules to use with diffcirent clients and siluations. Even so-called standards could not capture all the 1x,ssible situations or circumsta nces in lhe field or workplace. 33

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

Critical thinking in community health nursing Because of thecomplcxil)1 of problems, issues and concerns t J1attheyface in their day­ to-day professional practic11, nurses need to thinlk criticallv. l>andman and Bandman (1995:7) defined critical thinking as the ''rntional e:rnmi;ation of idens, inferences, assumplions, principles, argume_nts, conclusions, issues, statements, beliefs and actions". l11is means that mirses should not accept as true o. r correct somell1 iug simply because others say so or continue to do certain things because these l1ave been done by their seniors. Critical thinking in nursing means U1at nurses sh. ould: (1) use the processes of critical iliinking in all of daily lh>ing; (2) discriminate among the uses and miimses of lant~uage in nursing; l3) identify and formulate nursing problems; (4) analyze mea L1ings of terms in" relation lo their indkation. their cause or purpose, and their significance; (5) analy1. e arguments and issues into premises and conclusions; (6) examine nursing assumptions; (7) report data and dues accurately; (8) make and check inferences hascd on data, making sure that the inferences arc, al least. plausil>le; (9) fornmla le imd clnrify beliefs; ( w) verify, corroborate, and justify claims. beliufs, couclusions, decisions and actions; (u) give relevant reasons for beliefs and conclusions; (12) formufal e an<l clarify \'aluejudgments; (13) seek reasons, cdtcria, 1111d p,rinciples that effectively justify value judgments: and, (14) evahmte U1e soundness of conclusions. Nursing process Nursing process is the main framework or guide in nursing practice ru1cl the means by which nurses work with clicnt-partn. ers to enhance wellness or address the healtb needs and problems of lhcir clients. Jl is a logical and systematic way of processing information gathered from diff'erent sources and translating intentions into meaningful actions or interventions. There are five phases: asse. ~sment, diagnosis, planning of outcomes and interventions, implementation and evaluation, The nurse starts with the establishment of a working relationship. '111c nursing process by type of client-parlner is well illustrated in specific chapters in the book. 34 Establishing a working relationship The relationship between CHNs nnd their clients lasts for months or years; it does not end after tbe resolution of a health problem of the client. Particufarly in mral communities, PHNsare either personally related to their clients or the latter are friends or acquaintances. Establishing a working relationship based on respect, tn1st, shared goals and cla'rity of expectations results in positive outcomes such as good qua Uty of collected data, partnership iu addressing identified l1ealth needs and problems, and satisfaction of the nurse am! the client in wu. rking loge LI rer. Assessment Assessment is the process of collecting, organizing and analyzing data/information about the clicnl. The CHN should collect nor just quantitati ve but also qualitative data. Qualitative data gi\'e a more in-depth underst:tn<ling not just of the clients' health and nursing problems but their lived experience. Qualitative data represent the clients' perspective while tl1e quantitative data are collected from the nurse's poin l of view.

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

Table. 1. 2 presents the basic data/information that need lo be collected by type of c Hen t-parh1er. Ln a:ssessing populatio n groups, other data shollld be added, parlicul. u:ly ou lbeir context. For exainple, assessment of workers sbou Jd also foc1,1s on f:ictors snch as nature of their work, imrnediotc physical and social environ ment, exposure lo occupational health ha7. ards and hcnlt J1 resources. Assessment lndlvldual Famlly Community Health Status Family structure, l:)emographic, c;ultural and Knowledge, attitudes charac:ter,stlcs. ind soc:loeconomlc: variables and practices (KAP) dynal7'ias Snvironmlc'rrtal factors Adaptation Propess Socioeconomic and cu,ltural 1-1<. >alth nnd lllh CS!\ patterns Pattern characterlst1cs Commun1ty resources Lifestyle Environmental fac~ors Community competence Help-seeking behavior He;:ilth stc1tus of each Examples: l J till:z:ation of health n1ember Parrticlpal ion services Values and practices on Mechlnery for health promotion/ focllltatlng Interaction mafntenanc.. and disease and dec;islo,,-maklng prcv-enbon Articulateness Compelenctes on famlly Conflict management he,3lth care Reasons for the failure of p>ast health programs. Table 1. 2 Assessme nt data for lndlvlduals, famllles and communities Diagnosis Diagnosis is the identification of the client's welness stl'ltus or needs and problems based on an analysis of the data/infonnu tion gat11ered. A CHN formulates a nursing diagnosis. Nursing diagnosis was defined in the 121" North American Nursing Diagnosis Association (NANDA) Conference in 1996 as "a clinical judgment about individual, family or commun ity responses to actual or potential healtl1 pi:oblerns/life process es" There were 165 NANDA nursing <liagnoses in 2003-2004 (Daniels, 2005:221. ; 1513-1514). NANDA·s focus, however has been at the indi,vidual ralhe,-than co1nmunrty level of diagnosis. Refer to the Typology of Nm·sing Problems in Fa1nily Nursing Practice (Chapter 2) and the three categories of community health nursing p1·oblems­ health status problems, health l'esources problems and health-related problems, jn Chapter 7. Planning of outcomes and interventions Planning is a logical step-by-step process in designing a plan of action to accomplish specifo. : goals and objectives (Allender and Spradley, 378). Desfred outcomes could be in terms of a person's health, knowledge, attitudes and practice s, and ability to cope,-vith problems. (Refer to Chapter 3 for developing family nursing care plan and Chapter 8 for planning for community heal th nu rsiug programs and services. ) Objectives of care which reflect the desired outcomes, should be specific, measurable, attainab le, realistic and bave specific time frame (SMART). The presence of SMART 35

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

objectives,,;\l dcfinild~· facilitnt,, cvuhmtiou. Nursing intervention!'-should: (1) lw appropi-i, 1Lc and responsive lo Ille c·omliti1m o,­ l)l'Ohlcms of tlw clic111 :111tl sl H1uld co111 i-il.,utc LO th(: a1rnin11wn1 of Llw oli_il'~·I h~:s: (2) he c,·idence-hased and nflccti"<' ~1fnun,rn~ standards:(:,) he c. :ullurall_v ~:cnsi1ivc and ,\pprnpriatt' It> thcdic111·~ personal l'irc11m:;tancc~: and, (,1) e11ha11<:C' llw c·npabilit~·and cmpowcrin R pol1nli:il nt" clients. Some of the mo. ~I common nursing actions or interventions inn commu. 11 ily selling :1n: provision of n11n;i11g care, counseling, U<!alth eduv:i I ion. capacity-bu ildi n J!., L'oordi naling and making r~frrrnls. If the focu:, is ;i co1umu11ity or population g,·oup. :-:ystcm:1 Lie in ttrven I it'll usu;1 ll_, takes the form of a prnjcct or program. Com111u nil_y hcallh programs invol"e Lhc diffenm t levels of pre\'enlion-primary. sccu11Llnry and tertiary (l'cfcr to Chapter 7). ln the Jighl of lhl' nnrsing proftssion·s efforts to sta11dan lizc 1hc lan)!. uugt· th. lt n11rse:-. use, then;> arc olht>r 1ax0110mks i11 udclition to the NANDA--N11r:-<ing lnlc1-vt'11Lio11s Chi:;si1kntion and ~ursi11g Oulcomcs Classification (Da11i L'ls. 354-5). Cl l Ns shcn1lcl b1 familial' with lhes-e taxonomies and use their ni;. cncy·s reeomrnendcd t:lassificat ion. Implementation In tlw nur,;ing process. the impl<!'nientation phase con::;ists of doing or ca1-.-)·i11g n111 the intl'. 1'\-Clllic>ni-: sµecifi. ed in tlw <'an plan in p H1·trwr,-;hip with c·li0nl-p,Jrlm:n--Hllll/or other rncmb~rs of Lite team. 11 im·oh·e~,~nhnnrini,: c-li<--nt-pnrt 1wrs· :thilil_\' Lo 1111lcu:;h thei. r empowering put1:ntial for \\'c!ll nes,;. prevention. 111;111a1;,111C'nt ol' con ln.,I o 1· J <·al I h problems. It. ioc. :lu JI)~ the use ur pnrt icipolory action 111ethndnlogy le> 111:L,i111izc L'lie111-pa,1ncrs· cxperit:nces 011 ll\c ~1ook-think-;ict·· iren11ixe <'-'1)Crientin. J knrni11g cycle. Clifnl·partner competence is ;1ch ie\'ed I h rough. idcquatc opportuniti es for f)nn_:I ic( sessions rui<l feedbae. k.. Evaluation Evnluntion µhase of the nursing process is u planned. nngoi11g. r11rpnseful activity in 1,hjch Lhe nurse anti the client-purtner dctcnn inc I ha client's prc,µ,rcss I,;ward ac Mevemenl 11I goals And outcomes. ll als(l involves e. xumining the olher sl\:!ps of the nursin,\ process. As. '~lfaro-Le Fe\TC (:'. !002: J91) ic:uc. :dnct Jy e..xplt1irn,, evalu,tlin. ~ nursing care includes analyzing nursing inputs ;inti client-partner n~alities in c.,;1cli step oft. be nursi Dg prnress (r-ig. 1. 1). Ev. 1lnalion is an important nspect or Lhe nursing process L,. _. causc cnncl11sinns drnwn from tllc evalu:ition det(o!. rmine wlwt her I lie 1111rsing illterventions shrndd be lermi111. 1Lt:d. c::011ti1111ed or changed/ modific~I. Ev,dua1irn1 is continuous. Evalualinn done wbilc or immediately after implc111c11tiug a n11rsi11g inlervent fon em1bles the nurse and client-parlncr lo m:ike on-Lhe-spvl muuili. :;,t iuns in an intervention {J{n:;. ier ;md others, 2004: ;i 18). ·11,e focus of 1:val11::ition in the care of individuals are: quality of life, fl. 1nctiomd,;!al us, patient satisfaction. cumplinnce measu,·es, and im pacl ol' c:duca Liomd iu I crv Gn tiorn; (Alfaro-Lc Fcvrc, :wo6:234). Tlwsu rtre the brc J. i<l arnas con H1ined in Lhe nb_iecli\'c!' ol nursing cnre. ln family health nursing, the nurse uelen11ines the exlenl lu wbicl, the family eould perform its health tasks lo 11wi11Lain wellness or to addn,ss speeific he~dt h threats. health de J-icits, ronesel!ahle c-risi,;: / stress-points. In evaluatingprov. nuns. Lheevahwlor look<. into the inputs, processes a 11d/01· oul con H;~. Inputs are the importan t resources the progr;im cannot do without (e. ~.. Iron anu Vita1T1i11 A for. i nutrition progrnm :cind vaccines ror ;in immuni zaliu JJ p,-ogram). 36

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

l'rn,,,,.-<. <C':< 11rc imporl:1111· activitk-s of the f>l'OAT":-tm. Thf oult T>mes of a prn?,ram are rn11p11l:<. cffel'IS :rncl imp:11·1. n1111wts ;1r, tlw sp,<"ilk prc><h1.-~s nr s<·1-vkcs whit'h ;Jn nf'ti\'ily is cxpc·elcd to prmh1c-c !'rnm ils i11p111s to adlit!\'C its ob Jcclivcs. /;'[(cc/fl arc the l'l~Ulls of lhe 111'!-' of prn. i L'l'I Olltplll S. ITIIJ)(IC:( is lhc OIIIClllll C of pro~um effects and is :111 <Jsprcssion ur broader. lo1w,-ra11ge pro!-!,r:1m ohjcc1 ivcs. EVALUATION l\sse,srnqnt Diagnosis Planning lmr,lementotlon J. Deler111111e 1. 0eterm1ne 1. Determine 1. Analyze how whether there if p~oblem/s, rf th E' the plan was ,1re changes in requiring i ntcrllentions,mplamented. he;ifth status. nursing care are approprl. ite 2. Dt!termine arc resolved,. ind adequate v Jh<1t fact ors 2. Make sure that Improved or tq <1chleve :ire retared with esses:sn1ent data con tr. oiled. client the success In ,.,re acr. urate and outcomes lmplementtng the cumplete. 2. Con~ider ' if plan. there ere new 2. Speclfy problems. the client's 3, Specify what status base·d fai:tors cmated on expected problems or outcomes of barriers to care. ciire. Fig 1. 1 Application of Evaluation by Phase of the Nursing Process Documentation [L i,; nut enough to :issess, <fo1gnose, plan. implement and evaluute. CHNs should document all the things that they <lid and the corresponding outcomes. Their dnct1me a1,1tion should indudc the following: client assessment and health needs/ probh·ms idcnliued, intervention~ c::inied oul, client response to interventions, outc:-u1t H. s of i11ll'n·culions on<l ruture plan of care (Clark. 1999:209). ln the he;1ILh 1. :enle. rs, it is also important for the PHNs to document what they do, whet her clis. ·111-t;cntcred, pro. g1·am-rebted or unit-centered. They should document their inn,w:ttinns, tbc Lr pmticipntion in multidisciplinary endeavors nnd their efforts in shaping policies or influencing policy mnkcrs. Of llt1;: djfferent responsibilities of the CI-IN, documentation is considered by many as lhe least pri Mity; ii is an ndclitional '·burden". However. no matter how it is \iewed by prat:Lilioncrs, cinr11menlai-io11 is still an impnrtnn1 cnrnponenl of the nursing process. It sen'!'-" a 1111mbe1· of rnnctions, among which are: ( t) it scr Yes ni:; a ··proof· of the t. hin king and 1!1wisinn-1m1k ing that n1irse. s do; (2) it co11lrl protect the n11rs P frnm n law,;uit (it is gentrally believed thal what is not written was not done); (3) it ){i\"l!S decision makers an idea of tlw wurl,;lo,1<l of I1L11·ses; nnd. (4) it provides information 1h,. 11 could be used in n:s~arch. inti q11. :ility a,;sur,111c;e acti,,ities and for lrai. Jti. i1~ purposes. 37

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

' 38 Program planning, implementation and evaluation To nddress Lhe needs and problems of the community 01· specific population groups, Cl-r Ns, 1011,ether,,ith other hc,dth worker. :; participate in tl,t:: planning, implementation, monitoring and c>,·alualion of he;1lth prpgrnms. (l'rogram planning implemenlalion and evnluation. ire cfo;cusscd in t:bapte:irs 8 nnd 9) Health education Heallb cducntion isoneoftl1cst T,1lcgiesofhealtb promotion nnrl a major function and intervention of a Cl J N. Gnat. :n and Kreuter defi nc health education as "any combinati on oflcarning experience1S J-,signecl to focil'itnte voluntary actions conducive to healtb that people can take on tlll'ir '"ni inclivicluall_,. or collectively, as citi;,. cns looking after their own henlth or as dt,cis,on maker:s looking after the he:,lth of others and the co JJ1mon good of the co1mm1nit< l1991, in ~'lec1dc. 1997:156). The gonls of heullh educ.,liun include: (1) c. lienr p. ortidpati1111 in henlt. b decision 111:iking; (2) increasc,,J potenti:il to comply with ho. 11th rec:ommcnclations; (3) de\'elopme11t of self c. JT(;? skills; (4) improved clie J1I and family coping: (5) increased pnrticip,Hion in continuing care for specific conditions; and. (6) adoption of healthier lifestyles (JCAHO in Cl,1rk, 2008:263). Management and supervision CHNs i11 different levels perform diffei:-ent management and supervisory functions. A general dd-inition and description of management functions may be the same but the scope. ind le\'el or acthilics done may be different for ench level of n,an,igement. Quality assurance in community health nursing Toe pro,·ision of qmtliry c..ueis a profossio11:1J re. sponsihilil)'· It is not enough Lo ensure the de. li"el')· of ba~ic health services and implementation of public health programs. CH?\s. rogc-tbcr witlt olhcr health workers should ensure the quality in healt J1 (and nursing) care.,\!lender and Spradley, (2001) identified five reasons for doi1. 1~ quali L)' measurement and improvement io community he~llh nursing: (1) professional sclf­ regt Jlntioa of clinical competence; (2) certific;ition and accreditation; (:3) legislation and regulation: (4) reimbursement; and, (5) C:C)nsumer demands. For a more detailed discussion ofmam1gem ent in public heal ti 1, refer lo Cht1pler 17. Research and evidence-based nursing practice To improve the quality r,f nursing servic.-. es in the commu nity, there is a need l'o ado pl evidencc-hased practice. Evidence-based practice is t J1c ''conscientious inlcgral·ion of be.,;;t re. ~e:icch e,;dence with clinical expertise and p:Jlicnt v. :dues aml needs for the delivery of quality, co,;1-effr:c. :li\'<: h1:ol1h ~re" (Sackelt und As1;1>c. :iates. 2000 in Burns and Grove. :zc,07=500). E,,den<·e-ba. scd rwr. 'ling, therefore, is" t Jn: procesi. by which nur. :es mn J:e clinkal dcci,;innq using lhe be. ~t av;iil:thl c research evidence, their· clinic. al e>. 1>ertise and patient preferences (University of Minnesota. in Simpson, 2004: 10). There i,; a nef. 'd. therefore. for Cl INs to engage or pnrti6p:1te in research. To be able to int~grate t J,c best resc:1rch evid.,nce into practic1·, they should have working knowledge on research concepts and processes and skills to be a hie to critique publis11 ecl rcscnrch reports. CHNs also <. 'Onduct research with the community to generate knowledge th;1I U1e latter can use 10 iniluence policy and decision makers. They can serve as resource·persons in

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

the community's rcsc. 1rch activities. Research in communit y health serves a number of purposes, among whid1 ore: (1) improve our understanding of elicnts and their specific contexts; (2) provide data needed frn· prugrnn 1 and policy development and cvnl LL. atfon; (31 supprn-t advoeacy and lobbying for speeilk pc. llicies; (4) improve the delivery of l1ealth service. s and implementation of existing progr:uns; (5) improve cos·t-effectiveness of program s; and, (6) project a good image of nurses. Advocacy and politica l action Advocac y is an ethic;il and professiona J responsibility. The American Nurses Association (2007, i. n Clark, 2008:6) defines advocacy as.. the act of pleading or argu. ing in favor of a cause, idc:-1. or policy 011 someone e'lse's behalf, with a focus on developing the community, system, individual, or family's capacity to ple;;id their own c;rnse or act on their own behalf'. Policy advoc:ac..-y is a very important modality for influencin g the l,eallh of people (Williams, 1991:619). Community hca Jth nurses arc in a very strategic position to speak on issues that directly and indirectly impact on the health of tho community. But in doing :advocacy, they uphol<l a c Jien L"s nutonomy, which means that they reserve for their clients the right Lo make thei. r· c,wn c. lcc:i. sions. They just Lr;rnslate am] ::u-ticulute tlie problems, aspirntions. he,alth and illness cxpcdcnces, the perspectives and positions of their clients, particular ly those who are vulnerab le, to health planners and policy makers, until such time that the clients can do these for LJ1emselves. Nol too long ago, the preval1ent view among nurses is that politics is outside the concern of nurses and it is "unetl1ical'0 lo engage in political actions. Politics, then, was associated with '·activists" wlio were viewed negatively by 1nany nurses. Today nurses getting involved witl, politics are uol frowned upon anymore. Being politic HI means spealdng up and rneeti. og,v;th politicians. Nurses should a Jways be adcquutcly prcpared-witl1 accnrate ancl up-to-date data/infor mati(ln, researches and sound 1. 1ss11111ptions and reasoning; better if they have well-written and engaging position papers. Political nclion requires a good working knowledge on the workings of tbe political system and the dynamics of policy-maki ng both at the local and national levels. COMMUNITY HEALTH NURSING IN THE PHILIPPINES Musi of the c C)mmun ity hea Jtb nurses in the Philippines work in hea Jth centers as . public healt J1 nurses, industries/companies as occupational health nurses (company nurses) and school nurses. Few of them work with non-government organizations (NGOs). The roles and functions of nurses are defined by the nursing law (RA 9173) and standards that are developed by professional associations such as the Philippine Nurses Association (PNA), Occupational Mealth Nurses Association of the Philippines (OHNAP) an<l the National League of Philippin e Government Nurses (NLPGN) and agenc. ies such as tbe Departm ent of Education (Dep E<l). 39

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

II I I l I 40 Public health nursing PHN5, togetl1cr witl1 the other members of 1 he healtl1 te. 1111, arc the implementers of the luc:11 ~ovcrnmcnt units' mandate in pn1nmting and proter. :ting the health of their <·011slit111m1s. They parlicipnl C' in the planning, i111plement;llion, monitorin g aml cn1lu:1li11n or tht LOU'~ 111:tllh progrnms. They HC1' n;; proi;. rnm 1·<wrdinr. itors of hcaltl, progra1m,sud1 ~s EPI, TB C:1nllrol Pl'Ogn1n1. Lcprns,-Cmitrnl progrnm, etc. Thev also deliver nursing services 10 indivithials in the health ccntcri. ;, :,;chnol5 and home~, incluclini; he. illh t:dut:11ion. The fum·lions "'. 1~1,tc~ivilics of PHNs contained in the resource manual Trc1i1d11g C11ul'sc on S1111eru1s1011Jor Lhe Public lfrullh Nt1l'se (l 99,i) are listed on the foll01\ing page,;. PH~ FUNCTIONS AND ACTIVl TIES Monagemerit 1. Plans ~nd organizes the Jl. l. lr&lng. senllc;e of the health UFllt. 1. 1 tdemil!es problems ralatell to clients, re:;ourcei;, program Implementation and. service delivery. 1. 2 Prepates the nursing servtce plan. 2. Participate s. in the preparation of the munlclpal he,alth plan. 3. Participares In the l111p/ementation of the municipal health plara., 4. Implements the nursing service plan.,.,, : 4. l COordlnates with the different health units and related a-ge'ncles ~nd facilities. 4,2Delegatesthe task to the mldwive,, ff,nece55_ary.,. \',.,. s. Monitors and eval11ates tile lmplep,e Dta~o J1,o. f th~' J'lursing·se~vlce plan. 6. Initiates chal)ges for the Improvement\ o~ services. ' 7. Manages-th e RHU In the a. bsjnce of tile rut'al health physician (R\-IP).,., rralnfr1g · · ·· Participates in meeting. the train Ins needs of midwives, stuoent ¢Hllate;,; and ot. her " t Talnees. ·, l. Ptioriti;es Ifie identified needs of rural he. 11th mld Wlves (RHMs J that can b. e ad dres "".,.... In., ·, Sed r M" ~ '. 2. Or1111nlzes ii 5tilff develcpmen Jprogram for ~HMs. l Condu$a staff education program 0< GOA¢hln B sei:,,on. 4. Evaloates effects of tral11"11 on wort perfarmance, Supervision. ' ' ' '· ' I Supervises the l!HMs: l. form1111tes uuper\liso r¥ plan. 1. 1 ldentift§ f Ktor~affetlln,. tf!e ~J~oand-,Jol). satf~adtlon ot;the mldwlw!s :l J'' 1. 2 Identifies the needs.-of. tlle ~~fa;. :liu~lon In mlatlo~ to: congruence betweefi~ ~a~)~~J1~ n1;1I t'oa Js, work situation, 1 motivatio1' JDD,al~~-a tlo1'1,. knp. wledge, skllls ahd;'. atti;u... andperforma11Genr.,1t~i~. _:?. "'~·. i. ~,,. '. "es; l,31dentfffespto,j~ l Alijeotilie,gb 5tlpe1Vfslon. 1. 5 Determines 1ndl'cat " ervlsorv Visits. '.

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

--2. Implements the supervisory plan 2. 1 Conducts supervisory v1,;it. 2. 2 Reviews objective~. target< and norms with midwives. 2. 3 M(i)r:ivates the midwlv Ps l O Improve performance. Gives recognrhon for good r,c:rlormancc: ar1c J, Provides the midwives opportunities to reollze the. Ir own potcnrtal. 2. 4 Provides technical ~upervlslon to midwives. Ensures that techniques and procedures are done according to standurd5, targets aro monito red, and care Is prov,de. d and recol'dect Guides the mldw1,,cs in the formuk1tion of baranga y health,pl. :i ns; Reviews bar. inr. u1v health plans +ormul. ;1ted; Monitors the 1mpieme1~tatlon of 1:1,e bar;ingay health plan; Identifies gaps, neec Js ;Jntl problems in tl1e lmplementatior, of lhe baraqgay health p~an; and, Guides the midwives In insttt L1tirtg needed corrective n,easures. 2. s Performs adm1nis tralion and lc. idersh Jr,,1c:twities. Pr ovlde~ adm1nis lratwc support: lnterpr-ets pol1cies, guidehne,s. mcmofrlnda and other administrative issuances; assesses ·supply ot st'oc:k levels; fac1lllates acquisition of logistic requirements; and, P;llocat. ei; and distrlb1. 1tc s suppllcs. 2,6 Performs activlt'ies related ro pel"Sonner management. !nltiatesand part;dpale sln activltfes to promote perso'nal a11d profe&Siona growt'h Caif midwive:. ; Evaluates the perl:orman. ce of midwives; ensures adhere nce to Civil Servlc Rules arad Regulatjpns and RA 6713; Initiates an·d reco'mmends personnel actf0ns such as promotion s, transfers, recommendat10n s,for awa·rds, al'ld other recognition; and, Reviews and lnjtlals·dallytime records (DTRs) and midwives' reports. 3: rvi. onltors~nd evalua!es midwives' performanc e 1n the implementation of public health programs. 3. 1 Prepares and utilizes appropriate rnonit. orlr(g and evaluation tools. 3. 2·Conduct s regular superwlsory vislt:s., 3. 3 Provides feedback to the. R HP and midwives. 3. 4 IJtjlizes results of. monltor thg and evaluation Lo strengthen supervision. . 3. 5 oo·eum!?nts findings during monitoring. and ev;ituation. 4. Maintains records and reports. 4,1 Reviews cllnlc records and reports. 4.. 2 Valldat!es-the completeness and accuracy of recl)orts. 4. 3 ove Fsees proper and systematic fillna of records :and reports. Prov,fsion of ijealth and nursing care Provides health a. nd nursing ~are to ind Tvldua1s, families and communities. 1. Identifies health needs an(! problems of indlvlduals~ fam Hle$" and communltr'es. 2. Formulates Individua l, family-and community nurslng/heal th care pls. tn, 3. Coordinates with rnd JVJdual groups and agencies for resource assistance In imp[ementing the health car'"e plan. 4. lm Pclement:s health care plans. for lndlvldua1 s, families and the community. 5. Evaluates nursing Interventions and ethe. r-components of care provided to individuals, families and the communitv. 41

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

I I ftf, ed UJmton-, ad:lvlt Jes. th edt. tc. ldc:ln Btdvitles on the capablllties of client~. PSJ orpn(zatfor,s. other agencies and communttfes 8"1. Wati. ble within ~nd outside the community and which can e fn:IR~rnentatron of lnd Mdual, farn;ty and community health to other he;1lth personnel, health faclllty or govemment agency. ~~. JXJH. Trafnlng Course on Superv;slon for the Public Health N11r~e ~roe Manual. 1994 Occupational health nursing Occupation11] he,1ltl1 nursing is ''aimed at assisting workers in all occupations to cope with actual and potential sl1·csses in relation to their work and work environment. It is primarily geared at helping workers attain and maintain optimum level of physical and psychological functioning " (PNA-ANSAP, 1982). Book IV of the Labor Code contains provisions on health, safety and welfare benefits for employees. Section 4(b, c, and d) of Rule 1. states that if a company has more than so workers. the services of a full-time nurse should be provided. A comp. any nurse wbo is a registered nurse, should preferably l1ave training in occupational nursing conducted by the DOH, University of·ttie Philippines Manila College of Pub Uc Health, or any organization accredited by the former. The major considen1tions tn occupationa l health nursing practice are laws (such as PD 856-Sanitation Cone of the Philippin es), policies and standards (e. g., Department of Labor and Employment, Department of Health, Social Security System, Philippine Health insurance Corp. oration and Employees Compensation Commission) and professional standards such as those developed by the OHNAP and the PNA. The standa. rd job description or statement of the duties and responsibilities of occupationa l nurses has been formulated by the OH NAP. The duties and responsibilities are grouped into four headings--curative/pal1iative, preventive, educative and adm Lnistrative functions. The mnjor areas of concern of occupatio nal health nurses include: emergency and palliative care, fomj]y planning, counseling, immunizatio n, environmental sanitation, wod, safety, disaster prevention and con-LJ·ol, orientation of new employees, and dissemination of bealtb information/ health education. In small compani es, physicians are either totally absent or are just working part-time. Because of this, nurses are,Llso in charge of a number of administrative functions (OHNAP 2002). School nursing-School nursing aims to promote the health of school personnel and pupil/students. It aims to prevent health-problems tbal could hinder students' learning and performance 42

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

of their developmental task;;. l lt11llh. in this partleulnr instance. is considered ns an important resource in cduration. The major con;;itlcratiom: in sdwol nursi11 practice i11clude l:,ws such as the Child and )'outh Wdfan Co<1e ( l'D tw:,) and Letter of tm<I n1t·tinn 7(JI [rlcrlnrin,. : the School Health Proram th, priority pro)!. 1'11111 ol° the nnlionnl i;ow·rnntt. mt); policies and standards,,f the lkpa11 n1cnt,,f Ed11c:1 I ion ;u1J the t Hl I I. and. sl:lncb rds nf the 11 ursing profes. '<ion. And probably nmn· import. int i ntlu,·nc,·s an· I It,;-scwio N·onn111 it: rca. lit ies in thesc:honll'. home. '-, co11111111nitir;:. nnd l,w,11 gm·Lrnmrnt units (1. <'ills). Jusl like workt·rs i. n their workpln,:cs. :<chool ehildren who nn: in school ;ire 1,;c111·r. illy well. For this reason. ll Hlst of the :1et i,ities of sdu,ol 1111rs1·s arc fnc11stcl 1111 hculth advocacy. health promotion. di,,,asc 1')rc,·1n1i,1n and ('arl_,, d,t.."<'Linn 11( di,;<!r,s,·. More specifically. mirst,-; p,·rform: r 1) hl·:ilth and 11111ritio11 :1,. :s1·ssmc11t. s<.-rct11i111;, :111d l'. :lse­ fin<lin,;: (:!) ln. 'al111l!l1t pf l'llllllll VII ail llll'llt S and :II l<'l Hlini: to l. 'llll'l"). :("llt'. )' C';1St,'1,: C:-1) counseling and he,1lth L'dl K':llion: (. 1) 1111r::;ini,: proccdurc:;;: (5) supen'isi(>n ufthc health and safety o( the,;chonl: and (6) reforr,1ls nnd foll,iw-up,: of pupils and personnel. On top of these. the nurse rna11agc:-< lhl! sc. :hool clinic, nmnitnr:-: ;111(1 evaluates hcallh progr:,ms and projccls, For 11 detailed prc. entation of the nctivitics vf schvul 11111"ses. rcfur lo Ch. ipter 4 of the NLPGN 's book l'ul>licllealll1 Nursing in the Philimii11es (:2007). <;OMMUNITY-BASED CASE MANAGEMENT W'hile there is no clear agreement :thnul thr dcfi11itin11 nnd romponcnl aclivilies of case numascm,mt, it. <. Ust. ! i:-: bused nu the ussumption that people with eomplcx he,ilth problems need :1ssi:;tnnce in usin1-: the hl!althc. 1ri-s,slcm dfr,·tivrly (Rheaume and others,. 1994). Casemanagcmcut isnhou td10iceandc111powermcn1 for people. To achieve these, case managers nc J. ?<l to be accessible and act ns people',; advoc:itc (Thornicroft, 1991). Bergen (1992) divides 1-ive tlisti1u:1 phases of ca$c finding. assei-smcnt and need/ problem identification, desi )!. n and implementation of ca1·c pac. ka1-:cs, monitoring or reassessment, which lead to the last ph. asi: of case doslu-c or repetition of the cycle. The responsibilities of the case manaer, are, therefore, to assess,,uonitvr. nrnluallr plan and nctivate intesventicm::; and coorclinnt P. hc:1lthcare services to the indivi<luali z. ed needs of patients and tl1cir families (L::thridgc and Lamb, 1989: Gibson an J others, 1994). To achieve this, Meisler and M idycttc (1994) specify live roles of n nurse case manager: manager. clinician, consultant, educator and resca. reher. A manager's role involves financial accountabil ity in terms of evaluatin g and monitoring costs and resources. As a clinician, the nurse case manager develops and manages plan of care for a specific patient trpe or population thrnu)!. h cnordinating with hoi.-pital staff for the discharge. plan and the rest of the team for th1:e hornc-base<l <:are. As consultnnt, the case m1111ager collol)oratcs with the multi-disciplinary le. am, sen. :cs,1:; a patient liaison, offers clinical support nn<l expertise, coordinate.., consnltatfons and encour:iges ptltient and family pnr Licipation. The cducntor's rnlc inclmlcs explainin g the use of a patient's care plm,, involvin g tbe entire team in the total i:wocc,ss of c,q1·c and updating the team of practice cb. angcs. As a researcher, Lhe cusc ma11np. cr rontinuousl y monitors and evaluates outcomes and costs. Case management aims to acl1ieve quality and access wh. i1c nutna)!. ing cost in a seamless healtl1 care system. It is a systernatit 11rocess llrnl hopes to achieve cost effective, high quality, comprehensive health service. " for clients across a continuum of care. 43.. _ .. Sl;<:tmo;u wilii Cam St;arn11::1

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

5· 6. 7. /\_n<lersnn. r-;. T. (201,o J. "A mndcl to idc practice:-in ET A. nclcriaon and. I Mc F:1rlnnc (Eds) C:rnnrrwnily us l'c1rtner. :i-· c<l. Philadelphia: l. ipr,incott. Arroyo, G. M. (:mo8). "Stale of the Nation J\tldres.-;~, The Philippine Slur. 8/o:',/o R. Asian Ocvcloprncnl Br,nk (2004) lfra/1l1 Sector. Our Frcimc,uork Policies and Stmtc gics. Aian Development Hank Ecrmomicsand Research l)cpartmenl. l Ju5ic Stoti. li,:s 2ou6. /Jeuclo,-,mg. Wcm /Jcr Countries. [ay 2vo6. ·,\ 5tidc in human development"', wloria L Philippine Star. 2/28/08. 8. 9· Har1dn1nn, E. L.. &: Bam. l111an, B. (1995). Cr·iticul 111inking in,Vl/rsing. 2 ed. Norwilk. Connecticut: Appleton and L;inge. g,111,. knk Charter for He:1lth Prommion in a Clobali1. ed \. \. Qrld. Si-..1:h Global Jo. "' Conference on Health Pmmolion. Bangkok. Thailanc. L Augus1 22. 2005. 11. g,,utista. V. l\., Legaspi, P. E.. Santi. ago, F..V.. &. Juan. L.. J. (2002). National and f.,r,,al Covcr11mc:111 Roll!S in Public Heu/ch Under Devolution. Quezon City: University of the Philippines Press. 1Jc:111ehnmp. T. L., & \,\'alte rs, L. (Eds. ). (1994). Contemporary /ssue1; in Uioe tltics. Bdmont. Californi:i: 'Wadsworth Puhlishing Company. lj-Bergen. A. (1992). Case management in community care: concep L,;. practic and implication for nursin-Jo111·nal of 11dua11ced N11r::. ing t7. 11n6-1113. 14 Burns. 1'.. & Grove. S. K. (2007). Understanding. V11rsing Resrnrch. n11ilding "" F:tid111ec-Bc1:<<·d f'rr1ttitr'.. Sl. l..oui1,, l'\list:ouri· Elsc,;cr. 15. llullcr.. l. T. (2oni)-Princip/r,s of fleolth Educatirm and /-feal/'1 Prc,11111ti1111. :l'" ed. Helmnnl, CA: W;1clsworth/1homsnn Leaming. t6. Cnstilln. R. t2<>03). The biggest health catast Tophe the world has ever seen. J1/1ilippilf(: f)aily Inquirer. August 30. 17. Clark, l..f. (21108). Community 1-feczlth Nursing. Adv1Jcacy Jo,-Pupulatior1 J-lculth. 5"' ed. Upper Saddle River. New. Jersey; Pearson Education, Inc.. 18. Clark, r-1..r. (1999). Commtmity Health Nursing. 3J ed. Stamford. Co11nccticut: Appleton and Lange. 19. Cone, r, 1. (2005). Silent s,ww. Tire Slow Poisoning of the Arctic. New York: Grove Prcs. :. !O. Cookfoir.. f. l VI. (1996). Nursing C<lre in the Comm. 1111ity. 2 ed. SL Louis: Mosby. :. !l. Dnnicls. R. (2005). N11rsin9 Fuindamentu L,;. Curing and Clinical Decision Mnki11g. Singapore: Thomson/Ddmnr Learning. I -·, s Sl;<:tmo;u wilii Cam St;arn11::1

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

l'raclices.,Journal of. 4. duanced Nursing. 27, 9;33-939. 40. Leonard, B. (2000). QCommunily ernpowerm enl am. I he. aling". In E. T. Anderson and J. Mc Farlane. Community as a Partner. 3"' ed. Philadelphia: Lippincott. 41. Lundy. K. S., &J,tnes. S. (2001). Community J-leallf, Nursing: Caring for tlie Public's Heolt'1. Sudburgh, Massachusetts : Jones ;;ind Uarllcll Publisher~. 42. Mang. ahas, M. MUpdate on Poverty anti Hunger". Philippin e Daily Inq11irer. 5/17/08. 43. Maglaya, A. S. (2008). Delil Jrwing Quofity Service, Servicing Comm Lmiti es: N111·ses Leading Primar·y Health Care. Philippine Jom·nnl of Nursing 78 (2),10-13. 44. Martin, M. E., & H1:mry, M. (1991. ). ''Cultuml rekltivily'' in 13. W. Sprndlcy (Ed. ) Reoclings in Com111w1ity I-lcallh N111·si11g. 411' eel. Pl1iladelphia: J. B. Lippincoll Company. 45. Meade, C. (1997). QCommunit y health eauc;;ition". In J. M. Swanson a. nd M. A.. Nies (e·ds) Community Health Nursing. J'hil. 1delphia: W. B. Saunders Compan y. 46. Meisler, N., & Midyette, P. (1994). CNS to case manager: broadening the scope. Nursing Management:, 2. 5(11), 44-46. 47. Naicloo, J.. & Wills, J. {2000). Heafrh Promotion. 2"'1 ed. London: 13:iilliere Tindall/Royal College of Nursing. 48. Nash, M. (1998). Fire and rain. Time. April 20. 49. National Economic. Developme nt Autbority. J\fedium 7'e1·m Development Plan 1993-1998. 50. National Economic Developm ent Auth ority. Medium-T erm Dcueloprnent Plan 2004-2010 51. National League of Philippine Government Nurses. (2007) "Standard s of Public Health Nursing in the Philippin es'', In Public Health Nursing in the Philippin es. Manila: NLPGN. 52. National Nutrition Council. (1994) Philippine Plan qf Actionfor Nutrition: 1993-. 1998. Makati: National Nutrition Council. 53. Nationa l St. itistical Coordination Board. http://\V\vw. nscb. gov. ph/ fact. sheet/ pdfo1/fsi_o8. asp. May 9, 2002. 54, Needleman, H. L., & Landrigan, P. J. (1994). Raising Children Toxic Pree. New York: Avon Books. 55. Occupationa l Health Nurses Association oftbe Philippines. (2002) Reference Manual. Post-Graduate Co111'sc in Occupational Health and 47

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

(l Cl \r. i r'-"· r T I. ?tl<ll'~ 'm,1-·l 1111:11[. t,, rr,u ti ,-tn FT \nch. rsott :111d. r 'r,Frl··. q:,1~, C. ·~·1tl'"t1,1, r. ·-r11o·,· t 't·I l'l11i,11ltlph1. 1· Lippim·ou. \rr""· 1 :. ~! 1. 2,,.-,'l. l ;-;t,1 ',,f th '-111 n \<l lr·-.,-Tfw /'hi/1J'I'"'" Srur. ~ 'l-,~ \L'" 1·-nl,,pr,i. ·nc f11nl. I'"" al({, 1i1l1 :,. ·r,ir-P·,,· f n11:rr11·,_,,. ~-r,,Uci,·. < 1-:,,. I' ·,r. \<1,'l1 ("I "\dpnl'' l11 II 11k r' "" tllll.,. 11111 R,. :1. 11 d1 . [''t"r ;r·n,"nt. t;,1;1.,,,itt::tu-.. ~Pf,,~ / J,·t··l,,,.,,,a \ft"f'l,)f'I' l ·,,r,,rtrrs:, \{. 1,y ,:ft,C \f, (\;1ttdm 1. n. F 1. & H onilm. 111. fl I 11Jl,I I 'ri'rn1I f/1111A. 11r1111 \"rr:"<//HJ...:. "' r1I. Nnr",1111-. l"nnnc,·th'III: \ppl.,11111. 111. l I 1111tr 10 B. ini. :J..,,k1"h,111rrt,,rll,,1l1h l'rp111nlr111111r,1 l,l,h. ol1,d\\'11ld S"th\:l11lul Confonm·,· nu Ht,d1h rrc,mor1<m ll,1n,:kul.. rl1 111,111,I \11,:11,1,. · :Pn,, ~nuli<t,1.,·_,\. l. 1g. 1-. p1. r F. Sm,11,1,:0. l· \'.,,... 1t1111. I. I 1. :11.-:.-l :Vr1t!f1111/ 11. arrcl f. 1x·<1l r;,'l'l'rnm,111 f?t>I,·-: 111 f'id,/w I r,,11/1/r ( ·11c/,.,. I >no>/11t11111. 1)111·1, 111 l'it',: Linivl'r,;i Ly nt the l'h1l1pp1111s ['11. ;. Dc:1uchamp, T. I~. &. \V,dt,·~. l.. (f,:cl,. ) ( t N I l. <"crrr,·nr1-,wt. 11·11 Js-:u,~ irr I :J. Rirnthir:. <. Helrno111, ('al,for111,,: \\',1d-. w111 I h 1'11hl1,(1111r l ·11111p,m J 1:3. Dergcn. A. ( 1992). Cai:c· mana~em, ·n: an r-1 t11111u11111,. c. 1r,· n ll RL'pt:-, pr. rct 1,:,·-. nnd i111plic:11ion fnr n11r.-:in~.,lr>11n1,il "' \ri1rr1w1·,I s,11-,,111,1 1-. 1,uo-1113. 14. Bum!;, N.. & Cron. ~. K. (:iocr). 1 ·rrli·rst1w,l111t1 '\'11r,,im1 lfrst"t1r('l1. r;11/l<fi119 a11 Hr1irlc·1wr-fi(l:;1d l'l'lll'tic·,·. SI I. mu,. \l,,,onn 1·'. l,,·, u·r 15. Bu Llt::r.. 1. T. (2Ct CH). l'ri,wif)f,, P/ ll,rilrlr h/111·t Hi1u1 nm/ ffn1lth Prvmnrio,1. :1"',d_ lklm1m1. t. \: \\·.,i1,\,11r1h Tlw111-:on l. 1. tml11~. 16. Castillo, R. {2003). Tlw hl AA"l 111',dth c. n,,.,tmplw lht:: world ha-. ever !. ecn. Philippine Ouilv ln(luir C'f". Aul(u,t :1n. L7. Clark. :\!..I. (2008). Cu111rnu11 1t11 lfcci/1/i. Vrirsitr~,.. \tlt·ocuc: 11Jor l'npuicttion Hcalrh. S'' ed. Uppt!r Saddle Rh·er, NL'",k N y· 1..,ar;,)n l-:<luc. 111on, J nc. 18. Clark. :1-l..l. ( 1999). Commu11i1µ 1/,alrfr,'\·ursinv. 3 ' t:<l. Slnmfurd, Conne,:lklll: Appleton and l. ·tn~W-19. Cone, :\I. (2005). Sill'nt Snow. 771,.. S/vu: P<>i. ~u11i11!J O.,(t J11u\ntic:. Ni;;" Yc,rk: Grove Pre$S. 20. Cookfair,. J. M. ( L996). Vursiny Cc~rr! in zit. : Community. :. i... i ed. SL Louis: Mosby. 21. Daniels. R. (2005). Nursing F11ind C111h:nrals. Car-i11y cmd Clinical l)€'cis-ion Making. Singnporc: Thomson/Ddmar Leaming. 45

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

t 44 ETHICOLEGAL ASPECTS OF COMMUNITY HEALTH NU. RSING T_he practice of community he. nlth nursi_ng is guided by a number of legal nnd ctl1ical pnnc1ples t Jia L center on the welfare ofc Uents and p,-olection of their rjghts. CHNs arc in a po,-ition lo innuence oll,ers to respect ::ind prolecl these rights. Nursing practice is legal if lhe practilioncr works w:ithin the bounds of law: it is ethical if the nurse upholds ethic. :,! principles such as autonomy, bene(icence/nonmaleficem. :e, juslicc, fidelity and veracity. Nurses should at all times.-e:spect their clien~· rigl1ts such as the riglll LU be infonncd about their condition and trenlment or any health intervention tlrnt needs to be done. The,· are entitled to accurate and adcqnate information so that the\' could make an info. rmcd dcc. ision. Cli1mts' refosa J (e. g., 1,pecific FP me U1ods) should not affect their access to o Uler lle:tlth s.-,-vices. Clients han~ the rigbt to safe ;ind quality care and nurses can ensure this only if they are competent. CH~s. therefore. b;ive a 1·esponsibility to update themselves on the la·test developments in health core and in com mu oily health nursing, They should read ne"· books, professional journals, manuals ond other related material s; and, attend seminars and confereuces that could enrich t J1ei1· profes!;lional prc1ctice. They should be updated on tbe latest Prnfessional Regulation Commission (PRC) guidelines on continuing professional education (GP E). Clients s J10uld be treated respectfully at all times. Their right to privacy, particularly during meclical or nursing procedlu-es should be respected. Their health records are tre. 1ted confidentially. rn prioritizing healt11 senrices and activities, health workers in genera] should be guided by l'hr principle "the gre. ftest good for tl1e greatest number''. Another principle that guides the pro,·ision of health services, particularly in governme. nt-owned health faci Jit Y is distributive justice. In a ·micro· setting. this could mean "fair. equitable and app1·opriatc distribution" (Beauchamp and Walters, p. 26) of services and resources such a,-medicines and medical supplies. J'rimaril)· because resou. rces are limited. PHNs should be guided by the equily rule. that is, (assuming that the need is the same) the scarce resources shcrnlcl he given to t JJe one who is in greater need. "Need" is dictated not only by one's health conditio n but also by his inability to pay. CHNs c. lo not only deliver needed health services, they also humanize the health care delivery system as well. REFERENCES 1. Adelaide Recommendations on Healthy Public Policy. Second luternational Conference on Heallb Pl'omotion. Adeluide, Soutb Australia. April 5-9, 1988. 2. Alfarn-1,ef-'cvre, R. (2006). Applying Nursing Process. A 'Tool. for Critical T11inking. 6'" ed. Phi Jadelphia: Lippincott Williams and Wilkins. 3, AJfaru-Le Fe11·e, R. (2002). Applying Niirsing Process. Promoting Collaborative Car P.. s'" ed. Philadelphin: Lippinc ott Williams and Wilkins. 4, Allender, J. A. & Spradley, B. \1V. (2001). Com11runity Health Nur·sing. s'" ed. Philadelphia: Uppincott.

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

Anderson, E. T. (:woo). "A model to guide prnclire.. in ET Anderson ond J 5· :i,,rc Farlane (Eds) Community as Pc,,. tner. 3"1 ed. Philadelph ia: Lippincott. Arroyo, G. i\11. (2008). "State of the Nation Address". The Philippine Sta,.. 6. 8/03/08. 7. Asian Development R,rnk (200,1) Health Sedor. Our Fn111iew ork Policies aud Stn1legies. Asi:111 Developm~nt Bank Economics and Research Department. Basic Statistfrs 2006. Dcwclopin9 Membe1· Coww·ies. May :2006. ''A slide in human development'·, editorial. Philippine Star. 2/28/08. 8. 9_ Banchunn, E. L., & B<1ndman. B. (1995). Crirical Thinkin{J i11 Nia-si11g. 2n J eel. Norwalk, Connecticut: Appleton and Lange. Bungkok Charter for Heallli Pi-omoti on in a Glnhalizcd World. Si:,.-th Glob. 11 10, conference on Healtb Promotio n. Bangkok, Thailand. August 22, 2005. B,t Ufr;ta, V. A. Legaspi. P. E.. Santiago, E. V., &,Juan, L. J. (2002). National 1. 1-UTld Local Gouemme111 /~oles in Public. Health Untler Devolution. Quezon City: University of U1e Philippin es Press. 12 Beaucha mp, T. L.. & Walters, L. (Eds. ). (1994). Co11temporary Jss11es in Bioethics. Belmont, California: V. Ja<lsworth Puhlishi11~ Company. 13. Bergen, A. (1992). Case management in cotrununity can!: concepts, praclices and jmpli Cl'ition for nursing.,Jo11:·nal of Adva11ced Nursillg 17, uu6-n 13. 14. Buras, N.. & Grove, S. K. (2007). Understanding Nursing Research. Building a11 Euidcnce-Based Practice. St. Louis, Missow·i: Elsevier. 15. Butler,. J. T. (2001). Pl'inci]>les o_(. f-leallh Ed11cutiun and Health Pmmotiorr. 3"1 ed. Belmont, CA: Wndsworth/Thomsun Leal'lling. 16. Cas Li Jlo, R. (2003). Tlie biggest health catastrophe the world has ever seen. Philippine Daily lllq1d1·er. August 30. 17. Clark, M.. J. (2008). Community Health Nursing. Aduocacyfor Population Health. 5th ed. Upper Saddle River, Ne-1v,Jersey: Pearson Education, Inc. 18. Clark, M. r. (1999). Community Hec,lth Nursing. 3rd ed. Stamford, Connecticut: Appleton and Lange. 19. Cone, M. (2005). Silent Snow. The Slow Poisoning of the /l1·ctic. New York: Grove Press. 20. Cool-.-fair,. J. M. (1996). Nur·sing Ca,-e in the Cornm1mity. 2'"1 ed. St. Louis: Mosby. 21. Daniels, R. (2005). Nursing F11inddme11to ls. Caring amf Clinical r>,1d,,;in11 Making. Singapore: ·n1omson/Delmm· Learning. 45

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

46 22. Dc:part:ment of Health (1999) National Objectives for IIe C-1lth. Philippines 1999-2004. 23. Department or Health (2005) National Objectives for Heallll. Philippines 2005-2010. 24. Departm ent of Health (1994) Training Course on Supervisionfo 1· the Public Health Nurse. Resource /vlanual. Manila: DOH. 25. Department of Health. HIV and AIDS Registry. February 2006. 26. Ethridge, P., & Lamb, G. S. (1989). Profession al n. ursing case management improves quality, ncces. c: and cost. Nursing Managem ent 20(3)1 30-35. 27. FNRI. Nutritional Guideline. sf or. the Prevention of Hea1·t Diseases and Diabetes Mellitu. s. n. d. 28. FNRJ. Nutritional Guidelines for· the Prevention of J-Jear L Diseases and Diabetes Mellitus. n. d. 29. Framework Convention on Tobacco Control AJ!iance, Philippin es (FCAP). Be smart, Don't start! Pamphlet. (nd) 30. George,,J. B. (2002). Nursing Theories. 51h ed. Upper Saddle llivcr, New ,Jersey: Prentice Hall. 31. Gibson, S. J., Martin, S. M., Johnson, M. B., Blue, R., & Miller DS (1994) CNS­ directed case management. Jow·nal of Nu,. sing Administration 24(6), 45-51. 32. Hanlon, J., & Pickett G (1979). Public Health-Administration and Practice. t" ed. St. Louis: The C. V. Mosby Co. 33. Health Promotion: Building the Equity Gap. The Fifth Global Conference on Health Promotion. Mexico City, !Yiexico. June 5-9, 2000. :34, Hunt, R. (1997). "Family involvement ". In Hunt, R., & Zurek, E. L. Introduction to Community Eased Nursing. Ph Hadelph ia: Lippincott Raven Publisl1ers. 35. Jakarta Dec1aration on Leading Healtll Promotion into the 21" Century. Fourth International Conference on Healt11 Promotion. Jakarta, Indonesia. Juyly 21-25, 1997. 36. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of Nursing: Concepts, Pmcess and Practice. New,Jersey: Upper Saddle River. 37. Knollmueller, R. (1989). Case management: what's in a name?. Nursing Management, 20(10) 38-42. 38. Labor Code of the Philippines and Its Implementing Rules and Regulations. 2007-2008 edition. Compiled, ec Uted and published by V. B. Faz. 39. Lee, D. T., & others. (1998). Cose ma. nagement: a review of defirutions and

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Practices. Journal of Advanced Nursing, 27, 933-939. 40. Leonard, f. l. (2000). ~c. ommu nity empowerment and healing~. In E. T. Anderson and,J. Mc Farlane. Commtmih J as a Partner. 3"1 ed. Philadelphia: Lippincott. 41. Lundy, KS., & Janes, S. (2001). Community Health Nursing: Caring. for the Public's Health. Sudburgh, Massachusetts: Jones and Bartlett Publishers. 42. Mangabas. r-1. UUpdate on Poverty :ind Hunger". Philippine Daily Inquirer. 5/17/08. 43. Maglaya, A. S. (2008). Deliver·ing QLLality Sen,icc, Se,·uicing Communities: Nurses Leading J>rimaiy Health Care. Philippjne Journal of Nursing 78 (2),10-13. 44. Martin, !\'I. E., & Henry. M. (1991). "Cultural relntivity.. in B. v V. Spr,idley (Ed. ) Readings i11 Commwtity Health N11rsi11g. 4th ed. Philadelphia:,l. B. Lippincott Company. 45. Meade, C. (-1997). "Community l1eallb education n. In J. M. Swanson and M. A. Nies (eds) Community Health Nursing. Philadelphia: W. B. Saunders Company. 46. Meisler, N., & Midyette, P. (1994). CNS to case manager: broadening the scope. Nursing Management, 25(11), 44-46. 47. Naidoo, J., & v Vills, J. (2000). Health Promoti o11. 2nd ed. London: Bailliere Tfodall/Royal College of Nursing. 48. Nash, M. (1998). Fire and rain. Time. April 20. 49. National Economic Development Authority. Medium Tenn Deue/opmcnt Plott 1993-1998. 50. National Economic Development Autho. rily. 1W-edium-Term Deuelopment Pla. n 2004-2010 51. National League of Philippine Government Nurses. (2007) ~standards of Public Health Nursing in the Philippines'". Jn Public Health Nursing in tile Philippines. Manila: NLPGN. 52. National Nutrition Council. (1994) Philippine Pion ~f Actionfor Nutrition: 1993-1998.. Makati: National Nutrition Council. 53. National Statistical Coordinntia n Board. http://ww-. v. nscb. gov. ph/ factsheet/ pdfo1/fsi_o8. asp. May 9, 2002. 54. Needleman, H. L., & Landrigan. P. J. (1994). Raising Children Toxi. c Free. New York: Avon Books. 55. Occupational Health Nurses Association of the Philippines. (2002) Reference Manua. l. Post-Graduate Caur·se in Occupation. al Hea/t T, and 47

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48 Sqfcr-y f'o,· Nurses. 56. Ottawa Chat·ter for Health Promotio n. First Internationa l Conference on Health Promotion. November 21., 1986. 57. ]>ende1·. N. (1987). Flea/th Promotion in Nursing. Practice. Secoud edition. Norw~Llk, Connecticut Appleton nnd Lange. ' 58. Philippine 13reast Cancer Net:wo,k Information Desk. Maiden issue. October, 1997. 59. Philippine Cam..-er Society ··\,\7orld Cancer Day" (advertisement) The Pl1ilippine Stea·. 2/4/08. 60. Philippine Nurses Associati on and Associat ion of Nursi11g Service Admini strators of Lbe Pbilip_piaes. (1982). SL:rnclanls of Occupal ional Health Nursing. Vol. II, Part 2. Manila. 61 Porcallo. D. ·1 out of 3 Pi. 110,r teens smoke cigarettes-V\'l-10". The Philippine Star. 12/23/07. 62. Primary Health Care. Report of llht! Interna Lional Conferenc e on Primary health Care. A. Jma-1\ta. USSR. September 6-12. 1978. Joi J1tly Sponsored by the world Health Organizatio n and the United Nations Children's Fund. 63. RA 7160-Local Government Code of 1991. 64. Rheaume, A., Fri. sch, S., Smith, A., & Kennedy, C. (1994). Case manage 1nent and nursing practice. Journal of 1Vursing Administration, 24(3), 30-36. 6S-Simpson, R. L. (2004). Evidence-b-a s_ed nursing offers certainty in the uncertai J J world of healthcare. Nurs1. 119 Munagemenl, October. Pp 10 and J 2. 66. Sundsvall Statement on Supportive Environments for Heallh. 111ird International Conference on Healt J1 Promotion. Sundsvall, Sweden. j_991. 67. Swanson, J. M., & Nies, M. A. (1997). Community Health Nursing. Promoting che Heulth of Aggregates. 2"'' ed. Philadelphia : W. B. Saunders Company. 68. Tang, K. C., Beag Jehore, R., & O' Byrne, D. (2005). Policy and partnerships for health promotion-addr E:ssing II. he c Jetermimmts of health. Editodal. J311/le1in of tllf: World flea/th Orgar1iza1i o11. 8~ (12), p. 884. r,9, ·n H, Ottaw;,, Chc1rter0f 11,~alth Promotion. First ln Lernationa J Conference on lic;,llh Prr. >molion. Ottaw;1, Onr-ario, Canoc Ja. November 17-21, 1986. 70. ·n10rnicrr,ft, G. (i991J. The conc(;pl of case mam,g-cmcnt for Jong term mental illnc,ss. lnternuti onol f<euiew r,,f l'syd,iolry, 3, 125-1:52. 71. Unitc:d. '-'ationi.. ( 1948). '/1,e Universal Dcrlaru. l ion of 11-umcm Rights. New Yr1rk: Authur. 72. Werm:r, n., & S:muc:r<,, D. (1997). 71ie Politi cs of/-leo(th Car<: and Child

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Survival. Palo Alto, Californ. ia: Health Rights. 73. Wilkinson, J. M. (2001). Nu,. sing Process and Critical T!ti1tki11g. 3"1 ed. Upper Saddle River, New Jerse-y: Prentice Hall. 74-Williams, C. (199 l). "Making things happen: commun ity health nursing and the policy arena", in B. v V. Sprodlcy (Ed. ) Readings in Commun ity F-iea/tl, Nursing. 41" ed. Philadelphia: JB Lippincott Company. 75. World Mealth J\. ssembly. Resolution of the ¼'orld Health Assembly. 57th WHA. May 22, 2004. 76. World Health Organization (20 05) Pn:!ventiag Chronic Diseases. A Vital Investment. Geneva: WHO. 77. World Health Organization. (1996) The World Health Rep. 9. n. Geneva: WHO. 78. World Health Organization. (1995) New Hori7. ons in Health. Manila: World Health Organizatio n Regional Office for the Western Pacific. 79. World Health Organizatio n/United Nations Child J·en lund (:1. 978) Pr-imary Health Care. Report of tl1e Intentationa l Conference 011 Primary Health Care. Alma-Ata, USSR. 6-12 September 1978. 49

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

50 CHAPTER 2: ASSESSMENT IN FAMILY HEALTH NURSING PRACTICE Araceli S. Nlaglay a FAMILY PERSPECTIVE IN COMMUNITY HEALTH NURSING PRACTICE Communi ty health nurse>s io 111::iny purls of the world lwve been using the fo1Tiily persps. >etivp 111 a<ldrl'!'. " individual clients· he;ilth nccdt. or prvblcms and enhance family functjoning for grriwth and dc,·clo1m1e11t. coping-with illness or los;.. m1Jbi 1 i7. ing r~"VUn. 'e$ :ind mainrnin ing an en,;ronmcnt that support wellr1e,:s and health. Even in the western,,·nrld. lik, the USA. whtre managed care s~·stcm is l Jic: stn. 1ct,. ire for patient cnrt' d,lin--ry (such a. bcallh rrrninlt:mmce organi7. ations and i11dcpe11 dcnt prnctjce a.-osociations ) renewc,d focus on the family is emerging ::ts institution-b:ised health =re js sl1-,'llj Jjcant ly decre;:i. si ng and home care is r"1pidly gro";ng. ·111ere an sc-..:?ral reasons for focusin~ on the family in community health nursing prat-ti. ". <. '. ba,-c,d,rn it" characteristic as an npen :md developing system of interacr-ing pen:on:ihties. with a i,,,n1cture and process en:1dcd i11 rcla1it1nsh ips ;imnng inclividtwl mt·mber-;. regul:lte<l b\' re!i,:mrce-; and stressors, and cxic;ting \,;thin tlw larger oonrnntnity (1'1aurer ;. i;,d !'imith 2005, p. 275). The family prr-ven L-;. 11,enerate.,;, LOlc11-atc:< and corn'rt. <s h<'alth pn>hlt:c11s umong i Ls membe rs (Fn:em:. 111 and Heinrich 1981, p. 81'1). It is a pow"rful influence on values. beliefs and practices on hc;ilth llnc1 illnes:-. For txample. based on studie.., on diabcte!i (C:1mphell 1987), pw11 <liab. :tic contt·,,I ~ a_,.,~·. iatt:tl wi Ll1 chronic fan;ilv contlil'l :mcl poor org~ini;,,atiull. but the studie~ dj:s-a Rr~'t" a.,, t<J wliet J11:r tlt~c families h:. ive low l)r high cohe:-ion. Ouhamel (198-:-) t;>x.,mined fr1mih· interactio n,md livpcrtern~ion and generated :1 significant hyp<1thcsi~ that hypcrtc. nshc 11alicnl S Sllflpt:ess anger and hostility. ·n,c s11pprc'ssion of th~e foelinp, l~d. s to unrc. snlve:c. l 1110:rital cnnfllct:, thal rccipr,,cally reinfu1-c-<' I he suppre;;.-:ion of iin~cr anc. l ho<:tilitv. Ikea use the fnmilyoper;1 Les as a system. dysfum:tion in;, mt;>ml>er na,w lw,elat<·d tc, disturhn nct. : in thf. ' \,·holl' f:. 1111ily, Family i11fon11;1 tion and part. ner<. hip ~ffe tt M·<l in trat·king d11w11 the occurrence and incidence of discnses, criri,:;ll in pn. :,\. '11ting thc,;prcad afc,m1 11111nic.,blc:,:w,e. <: (J\l:1111·er& Smith. p. 274). ·n1e family is a critic,--u rc Foun·c in maintaining health and delivery ofl11. :altl1 care because il is tlw loc11s,,f dcci. sion-11rnking 11n use of mnnpow(r n nd etonornic i-11pport, e. <:pedally during ill11c.,,_~ or crisis. The familv c;111 b,: the n-ic,st,·ffr-c-live ;,nd c,fflt:ic:nt link with the cnlin· L·o111mu11ily if orga11i1. ed a,. :'1i1Jn a. 11d p;,rtnc. :rship,11·r,,,, he· rs1:ihlishc·d lo create ancl ::. u.... 1. ai11 :m cnvironment t I,;, I promote l1c:d thy Ii fc.,tylc ur ca rly. ::i~c Ii nd i ng, prompt and ;1pprupriat!' t reatmcnt nf di!<em:C'c S. Chapter 18 dtsc-rihcs a t hi11y-111u11th l!Xpcrienee with familir:s in,J n1ral,illage in 0,111glns 1\.-1 u11ic-ipnli1y. Abra Province. where fr1 milies cn..--alt'd mccl1anism. s for malaria prevention and cont T'Cil usin~ 1hc part. icipat. ory action methodology.

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

Family hc;1llh nun;ing r,erspcclive includes two vit1ws: the family as unit of care and t J1c fo111ily ns context or selling of individual client care. This chapter and the next two clrnr,tcrs will c()ver cnnct:pts thal elucitla Lc on family hcallh nursing rnictice focusing on the family (ll> a functioning unit and clicnl-parlner. These concepts arc also applicahlc tc J individual dicnt care) within tltc family us context or set Ling. FAMILY NURSING PRACTICE: THEORETICAL PERSPECTIVES Family 111. n-singpn,cti<. :cemplwsizcs the need to understand lhc behaviorofthe. family as a dyna111ic. functirrnini:; unit which affects its capability to help itself and maintain sysleni integ,·ity, 01· its rc;,dincs:. to wurl< with Llw 11u1"'!<e in cu Lam:ing wcl. lness or ::icldressin~ prohle1ns 011 health and illue~. Tlworctic. il framewc J rks prvvidc directions hy which the n11rse c;111 org;,nize observations. focus inquiries, design tbe arp Hcation of the nursing process in r:. unj]y nursing practice :rnd communicate ren. lities :-111d outcomes of care (Mele. is 1985). The Family Systems Theory views rhc family ns :1 living snci11l sy/;ICm v..ithin a conlcxl in whith 111nlliplc envirnnmcnlril ad inns or fudor:<; m:cur over lhe life r. ourse. It is cnmpo. ~f'CI of in1crrcla1 !. !cl 11nrl in tcrcl epcndcnt ind ividu.-i ls who are org. inized into a single 11ni1 so a'< In attain i<pecific family functions or ;;o:ils. \Vi thin the family system, lhe family mrmh!'rs interact as a f11nctir:mal whole. '171c hch. wiors of difforcnt members are complcmcnl;iry or recirrocal, involvin~ give,tnd t,1ke. ;iction or reaction. The interrelationships in a fn1nily sys-le. mare intricately tied loge I her such that a chang;e in any vnc pm·t inevitably 1·c,;l1lts in clwnµ. cs in tht: entire i;yslem. The interrelatedness of curnpuncnls i11 the farnily s_q;te111 !;LYE'S rise Lu new qualities and chnractcristics thal nrc" function of tha L i11terrcl:1tcd11ess (Friedrnnn 1992. p. 118). The family as n system has houndaries or filtering mcchnnisms (i. e. norms, values. nt-1 ii ucles an<l rules) which re~ul:ite the amount and flow of,11ncrg_v. inf()rmation, resfl11rccs aad slimuli to and from the cxtc·rnal Cll\'ironmcnt. nr herwern fomih· 111Pmbers as suhs Ystems with separate boumlnric:< aficding each other anc11hc familr :system a, a,vh~lc (Clcmen­ Stone & others 200~. p. 181). In 1,c-allhy fomil~· runc-tinnin~. inputs (i. e. cner)c\y, stimuli, rc. sn11rcl!. '> anti infnrmalinn that tht fnmily system retei,·t:s and proces!'. es) are screened so that the rmuily takes in what is nc<'dcd frnm the environment and assimilates or modilics ii ln pronwte its ow11 s11..-. ;val and growth (Friedman 199:!, p. u9). The family ;is:, sy~lem h;1~ lhe pr0pensity 111 evolve. and grow so Lhat as growth takes pince. the system becomes mo1·e complex. articula IP :111d dif;criminate (11 Ii nuchcn 1974 ). Trn11sadicmal µruccsses uri11ten11:tic111s arnong fomily members. whc, nccur,y position/s or roh:/s. promote ori J1hibi L fnmily ru,wtioni1111, t Clemen-Stone & otlwrs 2002. p. 178). The lntcractionnl Approach or Syn1bolic lntcractimrnl Framework,,iews the family as 11 11 nily of i11L. :r;-1cti11g persnrn1H I ics \\'huse arliom; are h;iscd nn meanings they derive from inlcrnclinn~ 1111d la ken in an ever chanµ. ing proct'sit of new interactions. new interprclalio11s. and ne,,· mea11iugs:. Symbolic: com mu 111\:<1Lion 1-1volvi ng from the self. inc1 Lhc c1n-iro11mcnl helps intli,;t111als inle1-pret and select the environment to whic. :11 they n:spqnd. Tltis frnmework i Jentili L·s huw relationsltips with others affect an individual's functioning. The 1 ntcr;1ct;onal Approach emphasizes the antecedents and consequences of such prncesscs. is communication, dc,·i:;ion-mnking and problem i;olving: tnnllii:1 m11nagcnwnljn~$Ol11tic1n: re. 1i:tinns Ln «tress; and <Jlher family sil. u:ition, influen<·C!rl h~, l:1mily int·erac1ioni, and inle. rilclive processt:s (Aldous 1978; Hill and I l,u1sen 1960). To understand the family"s beh,wior ancl n::alit-ie:;, the nurse musl ;;co the cxp1,!ri,111ce from the family's point of view, slriviug for shared meanings through consensus. incl feedback The Devc. lopmcntal A1>proac. h views familydevelopmcn t throughout its gene. ration. a 1 life cycle, higblii;hting critic:1\ periods of family growth and development across the life 51

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

('Oun--. :-(Hill & 11~11$('\\ l Oh O: D\\v'!'lll & ?-lilkr 108;-). It he-Ip;: prt't:lict whnt,1 ~iv..-n fnmih· is <''-l'ericndn!! nl nn:,, pnrlic-ular lime. \\. hilt' tlwn' :u~. sodn-,c-onomk. cultural m1d cthni,· vnri:iti(,n:< in tlw family lif,, c~·,·ll'. th,, 1kvl'h1pm, 'nl n I appn1:1d1 can gu id..-an:1 l~·. si~ c,f a~;:c,;. :,nwn t,bu r,·lal,-<1,,,t 11. 1111 ici1,:1 t,'<l p,'rincl:: nf tt nu. sun I d,111 :1 nd. s on t hl' f:1111 ih· in l C\'111:' or rl'Sl)\l!Y,'$ l11' :1<lju1-t 11w11t :l S tlw f:1111 ily ~''''" t !in 11,~h,i11,·m OI in11:1I )'rtl<'L':-S of t1-..1nsiti,111 an,i drnn~c in tlw family :<t:1111,-n·qulr..'d to pr11n,·d i11 tfl,, l1 r,, c~·..i,, ( ( ·11'm(n­ Stonc & nthen, ::!Ot1:. !. p. 1-0). 1\1 illu;:tr:lle. i11 th, lif,·,·y,·k !'lag,·,,r 1:-unili,.., with young chilclr~n, the k,~ p1;n,·ipl~ of e111t11ional pn,-,~,__. _ oftm. nsiti,,11 is,H'l'<'!Hi11g n,·"· 11w111lwrs intt> th,: family s~-:,tc111 as thc C\mpll' :1d,im-1s to make spac;. for t. :hild(ren) :mdj.. inin~ in childbearing. financinl :111..l hou,-cho ld tasks (Carter nnd 11 lc Goldrick 1988. p. 15). Structural per-:-pcclh'l' specifi~ family ch:irncte.-i::tics such ns member role. ~. family fon11s le. p.. uudt':tr. sinile parent. hle11dtrd, e,1cnded). powe1· stn1ctnrc>s (C. f!.. matriard1al. pat1;:1reh:1I). cnn1111nnicatiu11 processes :1nd valtw l<YSWtns \\'hid, pro,;d(' order lo fam. ily interaction:--and intcrth:]ll'th. 1\'nl rebtinnshipi: :111d ;..crve lo 111·f;ani1. e performance of roles :111. d functions ( Frieclm:m 19<. :>8). Using l he. · St ruchtral­ Vunctionul pcrspcc;ti Yc. Frii:-dm:rn (1998) ;:ppt:ifi<'. s four struclurnl tlimcnsion:--: role stn K·ture. value system,..-omnntnic-:iti0n prm:es!'c:-. and power st TUcture. She identifies five funcliu1rnl an:as: affect;ve funcrion. socialization and family pbccmen t function, reproducth·e functio n, ct. :ont1mic fu. nctit)n :i. nd bcnllb cnr<' ninction. Uenllam (2003) gencr:it·cd more precise concepts and,·:1riabl~·s on I he sl rnc-rnrnl,111<l functional framework through her professiu11al nul'sing prnd ice and rese:\rch findings from three qualit:lli"" studies about family ht>allh,111wn~Appn lachi:m ramilies i 11 two southeastern Ohio counties. !ihedevcloped the F:1n1il_v HLall11 l\'lodd. 1slrnmewnrk 1·odescribc. e. \7)lain a. ad predict health outcomes and me:ins Lo circturn,erlbe the boundaries of household production of h<!. nhh. defined as the dynamic process th. rough which hou:scholds cuml,ioe thei. r (internal) knowledge. n"sources. and bch:n·ioral norms and patterns,,;th avajl;,ble (external) lcchnolog. ics. services. information. 111d skills to re;. ;tore. maintain. and promote the health of their members (Berman. Kcnd:ill and Dh:ittaclrnryyn 1994. p. 2). According to Denham. seven functional pn. Jcesses (p. 125) are used by fomilies to incorporate informa tion, rnlues and beliefs ioto beha,;or, activities :rnd ro11t;nes relevant to famil~· health. They involve ways family members interact 1·0 po-rcntiatc, negate, tl1reaten. mediate nnd enhance individual and family health. Denham spec. in cs these fonetional processes ns: (1) carcgiving; (2) cathexis (emotional bond between indhidual s :ind fumily): (:3) celebration (tangible forms of. shared mennings); (4) change (dyn:imic nonlinear process implying. iltering or mocli{S;ng the form, direction :. ind outcome thru alternativ CJs): (5) commu nication (pdmary ways to socivlize children about health bc Uefs, values, attitudes aud behaviors and use infornrntion. knowledge and actions opplicnule to health): (6) connectedness (ways the family as a s~·stem are linked together): (7) coordination (coopernlive sharing of re;::ourccs, skills,,1bilities, and information within the family and with the larger contextual environme nt to optim. ize individual's health potentials, potentiat e the household production of health and adticve family goa. ls). The family healtl, model specifics family routines as basic structure which pruvic. le 01·c. ler to famil~ member's lives and serve ro organize health vvitliin the houseltoltl where individuals assume interdependent 1·el<1tionships. roles, functions and purposes. Den ham's family routines (p. 184) iuclud. e: (l),;elf-care routines {patterned heha~;o rs. related to usunl uct:i,ities of d:. t. il_v Ji,,ing experienced across the life course. sucl1 as dietary, hygiene, sleep-rest, ph~",;ic.-1I activity and exercise. gender and sexuality); (2) safety and prevention (pertain to health protection, clisease prevention, avoidance and participation in high-risk behavior and efforts to prevent unintended injury :icross the life course, such as iuununization slalus, abuse aud violence. smoking. alcohol and substru1ce abuse); (3) mental health behaviors (ways by :''~ich individua ls and families attend to self-efficacy, cope ";th daily strnsses and ind1V1duate, such. as self-esteem, personal integrity, work and play, sb:ess levels); (4) 52

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

i;,111ih-,·,1r, {d. 1ily,h·ti, 11i,s. l1.,ditin11,1I l,\'lrnv i<n. 11111 spc,·i. d,·,l,·hratin11,; that ~in· 111,. 111m >=, In d. uly Ii f,·,uul pr,n,,k. sh.,r,d,'nim m,111. 11l,:1s11rc nm I lmpp1 Ill"'<" form nit iplt llh"lnl.,. ·r-.. '-lh. "'h.,, t c'l. 1 \'Ht it Hl !h"I hit it,,, :,c. H ilttl,. \. ··l,·hr11 I inn~. I r:u '1 l i,111,.,pi ri t tt:t 1 Ht H. I n. ·h J;:!. i1'll... pr. h·tit·,·~): l.-;) 111t1t~'. ",·an· I h;1,-.. h.,,,·hi,·h t111r11h,r..:. 111ak· d,L·i~i,111~ rll:1tt'd ttl la·nlth 1. ·. 111 nt't'd,. du,n,,· "htn. "·lll I"... :uut how lo..__.,,k :,;upp,,nh· fu~.,hh ~ervit·'--:,;-: .,n,I d,1trmi1w """ to rt"'l'<nd Ill 111<·,l..-111 dire,·11\',·~ 1111<! hc.,ltlt 1111nr111:11iu11): lh) nhnt h1. r, ·., r1. ~i, in,:. t 'H\,·~ t...,,, h h"lt fo 111 i1'· tth1ulhr-. :h'1.,~ i 11 hr:wt h,, ·ar·~~i ~·\,~ 1u·rn~~ th,· li Ji,·, 111,,. :i, I h,1,n,·1. dir,·.-1111,1 n·11 and nil<l,·::-,·1111,-11h11,, I h,,t11 h, 1'1:11,·d i, kul:;. p. 1rt1np:ll,· 111 lw. 1lth. rncl il1111,-,,·. 1r,· 11,,d~. i11cl ~11ppor1 111,111h,·r~ 111dh1du:i l l'f>llli1w pat1,'rtt-.,. ~u--·h ~\... pn\, 1..:;itln,q 1. ;,n d11ri11). : ilhuss. ~,q,pc,rt,, · 011nil1r1 \11... ·tinn, nntl nw111lw1 1111,·::-,ind n. sp1111, ihili1it,-l. \., t,:,,i,·,:1n11·111n s. ll,1111:11111'/o. l'l,1111, lh,11 l,1111ily rrn11in. ::<,in h. 11'11ual l. 1mih p:i11<r11,,,n l1Lnl1h anti h1:il1h,·. 1n "h1d1 pnn HI, l"r llw furnih nn l1f"'tu.. ·il1lll,,ay t,, nr). !:Uiill' int1. 'l'a~tl\ t· prt>L'l'~~es to c..·acr. · uut f;11uih· (unction~. ,\n :1daj'l,Hirn1,,ftlw Family lh·nlth T:i. <:I,,: Pc1·:,:pc-c. :tin· (i11i1i:1llrn1111·qlut11!71. :d br Fn,;(·111au 111d 11,·111dl·h 1q~l. pp.,,. 1 11f") ha!--IWl'll utili1Pd :t, lpc..~rntiu11 :,l lr;11nt·"·,,rk in Jtun1h· ht. "alth o,n·.-. it,~ pt. u:til"t ( B. ult,11 :111d ~t;,gbvn 10-H. ;\ldnlav;1 J(),l-...1,u1. 1} a~ 11 pn:dse mcthndnl,, i,;_, 111 inlq;ral<' 111,·,1ppli1·:1li«11,,I 1h,n1·,·t11·. d l'''''"l'<'·liq, wliil'11 Ct..111\-pr~,· parlk1d:iil),)1th,,-. c-nt11·:1I 1n1l' 111i l. 1111il_, P"'rfnnnann· nt fur H·linn, lo ;1IL1in. s11sl ain. m:11111:i III n nd rq:. :1111 1 nd" ah,.,I :tlld l. 11111 II' h,,ii I II. Tl11s,,p.-,·a I 11111. il I r:1 m,'w<>rk i~ bn;;..:d l'lll tltc prin,iplt thnl 111 ttl'rl\·r c,, 1u-lu.. ·, e \\. 't..11111. ~"' :tt1u. 11g fn111ih tnetulur:-4 :ind rerhwe 11r 1li111i11:11, f:i111ily lll'11hh prohhm,-, lh,· f:11111h.,,. "f1111('li Pni11~ 111\il p,,-f,. nus the follt,wini:, h,·11l1h ta:<k~: (1) r1·,·ni. :11i~L' th,· prt'S<'IH'<' nf II w.-llne,;,.-. s1:11l' <r h,·allh cn11oi1io11 or p,·nblem: ('..!) mala· cl,,,.,..,.,,,,.. 11h11111 tnl:i111: 11ppr,>pl'ia 1, h,·. d1h 111·1wn lo mnin1ai11 wellm~~ ::: or 111:111:ig, tlw IH:11111 prflhl.-111: en pr,wid,· 11ursi11,. : t',1r,· 111 th,· :<i<·k. disnbkcl, d,11t'1Hl..-111 or at-risk 111,111lwrs: (. J) m:,inlain ;1 l\nnn· t·1wi1·n11111vn1 n111,h11·1"l' 10 he:1 IL h 111ai11 Lc11:11H't' and p,. "rsnn:d d,ydc,p111c111: :·111d l :;) 111 iii:~,· t· 1111 n11111 i ty r,;,;1>111·<:cs fur hc:dlh,:,re. Tl,is openllirnmi fr:11t1L'\\'ork was 11;:\'d in tlw,arlr pm-t,,r 1<1-ns m: basis li. 11· i:i,emmlling. c;,lq\11ri1. i11). \. md f111111izi11g :\ Ty11ulogy of N11r:-i11i; l'rohh.-1us ia Fantily Hculth N11t·si11J,1 Practice (T:ihll. ' ::. :. :. :), Tht· first lilld-te,:t. _-cl t1·polo KV was published in 1978 hy lfoilw1 nnd 1\la). \l11ya. Through the y Purs thr typolo~v lws been npclaled. specifica lly in 1994. 1997. :2ou:1 aml '. !Oll<J. This. :hnpt. :r pres,·nt!:-the typology,is p:11·1 nf the discussion on fnrmulnting lhc nursing diagno. s. is in family nursing praclice. In conclusion. the Systems Ft·amcwork. the lntcractional and Dcn-,Jopn,entr LI Approaches,. incl tbe Structural-Functional n~odcl nre c. x:imptc..~ nf major theoretica. 1 perspective;; which dcscrihc. expl:ti11 and prcdk:l family bcha1·iur critical to undcrsl:rnding the family as a functioning 11ni1 and 11-;., dienl pnrtncr. l'nrlicularly in assessment, theni·etical pcr-aptctiv,~ provide a svstcmntk gultil' for the 1111,se to identif:-,· what ;isscssmcnt dau. in· 1WC'dec:I and how to g. :nerale,,;un nut, or,:;anizc and annlyz. e large amount of <lisparnti' data ahn111 the family (Fi-icd111. 1n 1<)')'. !, p. ;;9). The unique l1ehrivinr of the fomily as a funt. ·tioning unil l'Xplains the rcalitie,; :111d d.,i:1ree of npenne~ to change as client nnd p:wtner of' the nur,;e in family nur,;in,L\ practice. Thenrctic,11 frnmcworks whkh C'(plni11 and predict this uniq11< bcli. 1\-iu,-uf Lhc L'. unily provide directions on how the nurse o. ::m,,·ork ";111 tlle family (as fu1H:lio11in,L\ 1111it :111d client-pnrtner) by enhancing ils system effr-ctivcncss in,:u;;tainini:: n::>'ourcc/c11cq,,'Y availability and 11sc fo1·,,ystem chan~c-,ind f. icilitalini-. boundary dlidcnc::y in :1l10\\;nr, acces;; to external support or u_se of infnrm:llic)n In pn. 1111olc w,:lln.-,;,a,,ml1:1ncc growth and development. create an e1wiro1tment for a healthy lifest:-le. or man;i~e hcnllh or related problems. Respect for family 1·,tlucs and re;-1di11es,a lu umlcr:staml and mai, i,ni7. c use of fomily rull:!s. norms. and family ntliludcs (as \:U1t1po11cn1s ur fa111ily boundarie;: aud filtering mechanisms) arc essci1Lial in creating dficicnl, semi-permeable family system boundaries through a workin~ rel"tionship based on trust and guided by clear 53

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

and muttrnlly c. stablishcd g,()n\. s and expectations. Within an ntmo::-phere of respect, trust and belief in nn E. '~alitnrinn robtionship to enhance the fomily"s empowering potential, the famil~·-nur.-e partnen-:hip c:. 111 maximiu e.,1lericntial learning processes such as creating option:::. decon1--'truclinr-mindset,; llr curn:nt 1,·orkh·iews by anal~-✓. ing meani. u~s to gain new insigh~. and/nr rc,1rdt:'1i11g p:H!Prns and n,lat;onships in original w;,,ys that result in fresh rn..-nnin~s, expando:>d,,·11\"S of thinking. :. 111d differ. :!nt,·alues to di,;l·o,·er nt''' inte1-pretalions (tnd e,q~lanntiom: for "·hnl,,·as pre,;n11sl~-thought of as fixed :md absoluh· l Dtnham :. !t10:~ pp. 1~. 2;6 :md 280). Chnpters :~ and-1 focus 011 how to facilitate these proct:'sscs or crtali11g. d,-,·on:<tmr-tinf.. and reconstructing e.,-perienc.-. s. meauiugs. difforcnt valul"s arnl expa11<led w-ays of thinking to help Lhc fami. ly systematically handle the chall<!nges of going Lluough beh;nior change. NURSING ASSESSMENT: OPEIRATIONAL FRAMEWORK Nursing assessment is t. he fir. ;l major phnse of the nursing. process. In family he;,ilth nursing pmctie:e. Lhis imol Yes a set of actions by \\'hich the nur. se deten11ines U,e,;;talus of the farnil\" as n client. its ability to maint"in itself m; a sy~lem and funcnon_ing-tlll_it, and its abili~· to maintain well JJess. pre\·ent. control or resoln: p1·oblems in c>1·der to achieve heal1J1 ~md well-being among its m~111ben;. Datu about Lile present cow. litio11 or st-Jtus of t J,e family nre i;ath-ered and anal~-. :c J lmsecl 011 how frunily dynamic s. realities. possibilitie:-.,,,d,·11lnernbilities generate the antecede nts or factors associated \\i Lh health nnd illness e:,,perienre5. Utilizing Lhcoreticnl models to understand the char. icteris tics and beha,ior of the family as a functioning unit and cli. ent. the operational miruewo rk for assessme nt. ;:is described in this chapter. focltse. s on_ types of a~e..--sment dnta tu ge-nerate. method and tools to collect these data, and finally, application of the Family Health Tasks Perspective in determini ng family health nursing problems associated ";ti, speci Jk health conditions or problems. Nursing a!'Sessment includes data collection. data analysis or interpretation and problem definition or nursing diagnosis. Nursing diagnos. is i:-the end result of two maior c-.-pes of nursing assc.-<smcot in fatnily nursing practice baserl on the framework us~d in. this book. These are: (1) fir,:t-level assessment : (2) second-level assessment. First-le\'e J assessment is a proct;"SS whereby d:ita ::ihout the current health stntus of inch,..;dua l members. the family ns a ~-$tem and its environment are compared ;1gai11st norms or standards of persooa l. socfr1l aud em;i:ou,nental health and inlen\ctions/ interpersnnnl relationships,,ithin the family system. As end result of data analysis during the first-Ie,·el nssessment. specific health conditions or problems are identified and categorized as: (1) wellness srate/s; (:c1) health threats; (3) health deficits; and (4) stress points or foreseeab le crisis sit11ations (see T;ihle 2. 2). Second-level assessment, on the othel' hand, specifies the nursing problem s that the family encounters in performing the health tasks with respect to a given health condition or problem, and the cam,es, barriers or etiology or the family's in;ibility to perform the health task. These two le\'els of assessment specify a hierarchy of two sets of <la ta and their nnalyses. They reflect depth of data gathering and analysis on what health conditions or problems e. >. ist (first-levd assessment ), and why each health condition or problem related v,rith maintaining health or wellness e:-. ists. The latter is stated as explanation about the family's problem related lo maintainiug health/wellness, managing henlth problems/ illness experience, or pro\7iding a home environment conducive to health maintenance and personal development (second-level assessmen t).

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

STEPS IN FAMILY NURSING ASSESSMENT There are three major slcps in nursing n~cssmcnl ns applied to family nursing prnctice: darn collcc Lion; data analysi:;; ;;ind formulntion of diagnm;is. Figure 2. 1 illustrntrs these,;teps. Data collection for fir. ;t-kvcl fl&;cssmcnl invoh·cs gathcrin~ of fi\'C types of tl;ila which generates ll1e categoric ;, of health conditicms or problems of the family. TI1csc dnta include: I. Family slrudurc. clrnractcrislic;,; :111d d~,,amic. '. s: 2. Sociu-1..'<'<)1HJ111 k and l'tl lturnl chnrndcristics: 3. Home and c11vin111111c11t; 4. Health stntus uf ~·ad1 member; and 5. Vnlucs ;rnd practkl'S on health promo Lion/maintcnancc and disease prevention. Second-level nssessm Pnt dnt. i include those thnt sp1:cify or dc.-. cribc t111 f11mily's realities, perceptions about :md :1llitudes related lo Lill' assumption or pcrformnncc of family he-al th t. :1sks on eac]1 health condition or prnblcm identified during the first-level assessmel\ t. Dala analysis in,·nl,-cs sc,·eral sub-steps: ( 1) Snrlin~ 11f data fur broad calc):\Ol'ic..-. such as those related with thl' health st. ltus or pr;1rtii. :1s of f;11nily llll'llllwr,-: or dat:1 about home and environment:(:. !) Clusicrin~ ofrdnt(d cues 10 dck·rmirll: rd:r lions hips hct ween :1ntl among uala: (3) Distin!!,1. 1ishi11g relevant fro111 irrch-vn11l llal:1 to dt'ddc whal inform. it inn is pcrtincnl to un<lerstnm ling lhl' :-it11atio11 at hand bmsccl on spcci~ic rnlq~orics or dimensions; (4) lcknlif~·ing patterns :s11d1 as physiologic function. dcvc-lopmcntnl, nutritional/clietarv. coping/:iclaptatinn or 1·nn11111111il';1tio11 nr i11t. 1ractirn1 patterns nnd lifestyle; (5) Rcfating family data to relevant clinical/n·s,·:11Th findin~s and comparing patlerns with m1m1s or :;tanclnrds nf hcrtlth (c. J:(. nulritio1111l intake. i111111uni;,:Hion status, growth :ind devck,pmcnt. J1ocial nnc. l economic prntludi\'it~ ·. environmenta l health requisites) family functioning anrl assumption nf hen 1th tasks; (6) lnterpr. :ting results based on how fomilv characteristic. ;<, \','\lucs. attitudes. perceptions, lifo:;tylc, communication, interaction. decision m. iking. or role/task pe1·for111ance are as:soci:iled w;tlt specific beal U1 conditicins or problems identified: and l7l l\u1kinp, inferen~es or dr:'lwing conclusio ns ab1)Ul lhe n::asum, for tltc existence uf lhe heal U, condition or problem and risk factor/s relate<l lo non-maintenance of wellness state/s which can be attributed to non-per-t'ormancc of family heallh tasks. The last step in family ntrrsing assessment i11volvcs 111. ikini; a <liagnosi:.. This includes two types: (1) definition of wellness state/ poteutiul or heal Lh condition or µrob le ms as an end product of first-level assessment:. md ( 2) ddin it. ion vf family nursing problems as an end result of sccond-]c\'el nssessm cn L The family nursing vroblom is stated as an inability to perform a specific health task and the reasons (eliolo~v) why the family cannot perform such task. 55

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

56 Recognize Need to Use Data bas C'd on Evidence Ensure Ac~unuy arid Re-llab Hlry or Data Check for Inconsistencies Complete Missing Information Use COfflpl"N1e.. h1t-11fit-. ic1N~i PROBLEMS AND FAMILY NURSIN G DIAGNOSES -IOel-Dllbl of..,.,....,,.... Mollie; Fi~r-t~vrl A. sseum~n t: Define the Hel>lth Condition_s/Problem. s (aittgorlzed.,_., w@llness states, health dcffelts, health threats, foreseeable crises os stress points) . 5e. cond-level As:Sessrnent: Deline the Family Nur$in11 Problems/Dia gnoses (Table 2,2J ~ Statements of: Famlly's Inability to Perform Health Tasks on each Heahh Condition/ Problem specifying the. Bttie. u to Performance or Reasons ror Non pttformeni:e of Family Health Tasks quacv of

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

DATA COLLECTION The nurse is concerne d nbout two imporlanl things to ensure effective :ind efficient data collection in family nursing prnctice. Fu-stly, she has to identify the types or kinds of data needed. Secondly. she needs to specify the methods of data-gathering and Lhe necessar y tools to collect such data. Types of Data in Family Nursing Assessment What data are needed to arrive al a measure of the (amily"sability loacbievc heal Lhund well-being among. its members, while itmau1lains itself as a system and as. i fonctioning unit? Based on theoretical frameworks which describe family charactei-isl;c. s, explain and predict family beha\':ior. two t)1)es of dat. i are needed at two le\le)s of assessmen l in family nursing practice. As shown on Table 2. 1 (. "'-ssessment D,tla Base) the following constitute the first type of dat. i taken during the fin;t-level assessme nt: -1. Fa mi Jy slrnct u re, chara t. : lt H"isti Q; a ml tlyn. a m ics-iii cl udefamil y co I uposi t ion and demographic dala, type of family form aocl structure, decision-making patterns, interpersonal relatio111ships, interactional patterns/interpei:sonal relationship:; (sucl1 as presence of dyadic and triadic boundaries which llave the potential to alter members· diverging health beliefs, knowledge and beh:tvior) and communication patterns or processes affecting family relatedness (e. g. expression of fee. ling5 or emotions particu-1;:irly related ,,:ith addressing converging nnd diverging motivations or perceptions, such as tluring conflict) cons(stc ncy and congrnem:c bet". veen intended and received messages; and, explicitness of message for approprintcncss, effectivity and efficiency of the communication process related with role perfonn ance, indivi<lual members' health and family system integrity. 2. Socio-economic and cultural characteristics-include occupation, place of work, and income of each working member ; educational attainment of eacb family member; ethnic background and religious affiliatio n; family traditions, events or practices affecting members ' health or family functioni ng; significant others and the rnlc(s) they pluy in the family's life; and the relalionship of the family to the larger community. 3. Home. and environment-include information on housing and s Stnitation facilities; kind of neighborhood and availability of social, l1ealth, cor:nmunicati on and transportation facilities in the community. 4-Health status of each member-includes current and past significant bealth conditio n/s or illness/es; beliefs anc. l practices condudvc to health and illness; nutritiona l and develop mental status; physical assessment fine. lings And significant result,; of laboratory/diagnostic tests/screen ing procedures. 5-Values anc J practices on he:a JU1 promotion/mai ntenance and disease prevention-include use of promotive-preventive senrices as evidea_ced by immunizalion status of at-risk members and use of other heallhy life. style related services; adequacy of rest/sleep, exercise, relaxation acthities, stress managemen t or other healthy lifestyle pn11;tices; opportunities which enhance feelings of self-worth. self-efficacy and connec1edness to self, others and a higher powe:r; essence of meaningfulness. 57

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

I 58 A tool for gathering this assessme nt diltu base CADB) is presented in Table 2-. 1. Through lhis ADB, the nurse can identifyex:istiug and potentiahvellncss statc/s, health threat.,,,. bcrilth defidts and s. t.-css poinls/foreseeable crises in a given f,i111ily. Each family has it.-. ; own,.,·uy of behaving l'c1wn rds or resp()ncling to sih1. itions j n the face of these problems. The other l:\1Je of clnta rnken during the second-level assessment reflects the exte. ut to which the famil)· can perform the health tasks on each health condition or problem identified. These dat:1 inclt1de: 1. The family"s perception of U1c condition or problem; 2. Decisions mride and approprial·eness: if none, rensons, and 3. Actions taken ;ind rt",;ults: if none, reasons; and 4. Effects of decisions and actious on other family members. Data-gathering Methods and Tools Therearcsen'!ral methods of dat;1-g,1thcri11~ Llrnt Lhe nurseca11 selet·l from, depending on nvailahilil Y of rcso11n·es such ;1s matcri. :il, manpower, time and facilities. 'l1-1e critical point fn the choic<. > is concern for :1ccur:1cy. validity. reli:1bility. and acleriuru:y of ;i;;sc!<smt·n I J:1w. Poor qua I ity/i1tm T11r. 1le and i, 1adeq uatc dala t·a 11 lead to i,1acc11 rah:ly defined hc:1lth ;1111. J 1111r. ;ing prohlcms which, in tu. rn, lead to poorly designed fnmily ou. 1"'$ing c11re plan. To ensun" quality a&<es~,nenl data, a combino1tion of methods and sout·ce. s can provide cross-cl1ecks nnd cfata validation. To illnsh-ate. a comoination orinterview, observation. oculars11rn'. '"· direcl e;,.-;1mination (ph_vsical assessment). use oflaboratory or di. ignostic lc. ~ts and nicnr J re\-i L'W can bc utili:r. t. ·u i..., ~entr·atc lir,;t-le,·d nssess~nent dr-itn using the toul. :\ssessn1c nt Dat:1 Hust. for Fau1ily Nursi J1g. Pnict-. icc (Table 2. 1). The foll<lwiug :ll'C brief dcs LTiplious ot co1111111m melhod. s of,gathering d. ita about a family. its lt,·ulth status and. state off111wtioning: 1. Obscrvt Hion. This method of data collection is done through the use of the. St'IISOI')" cap. 1citks-sigh1_ hcnring. smcl J and touch. 'fhrnugh direct ob. sen-;ition. tlw 1111rsc ~athcn, i11for111:1tio11 about the fomily"s state of being :ind hdrnvioral rcsponsl'-"-The li. u11 ily"s lwnll h st:it11s can he inferred frc1111 1 lw i<i J:;ns :, nd. symptoms or p1·oblen1 a r·tns re fleer ed in t J1c following: ii, t;on11111111intl io11. i11l~raction pa11·cn1s and intc1-pe1-sonnl rdationshirs cxpc~t1:d. used ;ind tolerated by family members; h. l~ol1 p,·n·cptions/tn:sk nssumplions by each member·, including del"ision-ru:,kin. g p. itt,c-Jus: 11ncl c. Conditions in the honlt' and environment. Dntll g11. thcrcd through this method h:n·e the :1dva11tage of being subjected t·o vnlicl:ition nnd reli11bility testing hy other observers. . 2. Physicn J Exnminution. Signitica111 data about Lhe health status of i11divid11nl f;nnily 111e111h1~r. 'i c·. 111 he ohtainccl I lirough direct examina tion. This i,-d111w 1hr1)11gh inspccli1)n, palpation. percussion, m1scultntio11, mtas11rc111c111 rif,<p,. d(ir uvdy pm·t:. ; and n:vicwing the hvdy systems. His ('SS1111 iul fort lw 11111·s1 to l1nv1 I '1C' skill in performing physical assc~sment/ i1))Jlf'11i:<al in,,rcll,· lo help llw fo111ily hu nwarc off he hc:tltb s1. itus of its 1111ml Kr:.. Dula gcncrntcd fr11111 ph~sic:11I 11sscss11w111 form n s111>s1. 1ntive p,11"1 oflirst-lc,·cl :iss,ssmt'nl which may indic:;ilc presence o(heall h deficits (illrwss slates). The ll:chniqnes employed Juri11g the physical examination process are discussed extensively hy l3kkley (2007) and Ilnrlrnusk:t s,

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

Stoltcnberp;-,\llen. Baum;urn, and D:irling-f'ishcr (2002). 3. Jnterdew. Another major method of tlala-gathcrini,: is the interview. Ont.-! type of interview is comp le lin~ a health history for e. tch family member. The health hi Rtory dctt~rmine.-. current ill',1lth status lin:::ed on :-;ignilicant p;1st hc,1lth history t C,l?, dc"clnpnwnlol,H"CLHt1plishmr11ts. knnwn illnesses, allcrgks. restorati\'{c' trc,1lmcnl, r Psidenl'l: in endemic :1rcas for certain disc;. 1:,,p. s or c'~l"'""n. s In 1-·01111111111k:1hh· rlisenscs): family hislory (e. g. genetic hii,lory in relation lu health :md illness) and s,xial history, such . 1s intraf)<!rsnnal and intcq)ersun;il fadon, :iffcctin JJ. the family member· s social adjnslmcnt or vulner,1bility In stres:,;. mu cri!,is (Clemen-Slone anu <1thcn; l99l, p. :;?71). A second type of interview is c. :olleclin~ tlaltl by personally asking significnnt fnmilr 111crnh L·1·:a 111· rdnti\'CS quc:ations rq::arding he.-i!Lh, famil~· lifc c:qwric111·cs 1111d home L'11vini111111. !ut lo ~,·n Prnll' data 011 what wellness cnndilin11/s and lwallh prnhl,·ms,·xisl in lh,· fomily (Fit"!<l­ lcvr. l,\s. ~P. ~sm,·111. $L'· Tr1hl,· 2_!. !) :ind I lw l'nn-cspomlin;: f:unilr m11 sing problems for. :a..:h hl'allh,·m1Jitin11 nr pr0hlo. :rn (Scenncl-lc, ·cl As:;\. 'ssmc 11t. Table 2. 2). "nsuriu~ 1:nntid, 11tialily anti rnspe L"l for lhe family\; ri~ht lo self-clctcrmination arc key pri11ciplcs It> considur during all phases of the nnrsing prm:e:;s. The uun;c can also collect infurm:ition rrn111 cnllr. agur. s who work "ilh the family llt'<·Ordin. ; to their pnrticular scrvic·c spcci;1ltics as well os school pcri;onncl, employers, significant olhc1·s anti communi ty worker~ who can giw reliable and rr>lcv,rnt inforn1alion on lht. > famil~s lire. 111d experiences. Pn1cluct·ivil'y of lhu inlcniow process d(1pcnds upon the use of effective communicalio11 l Lchniquc:-tu l. 'licil the needed rc. <;ponsc s-. One major prol>lcm t'lll'l HLILLL'rcd by prutt ii ion er,: in gal htring dnl a (,. specially for the sccond-1,:,·el a~,-. cs:-;rncnt) is how In dctvrmi11t' whcr P the dienl is i11 terms of perception of the health tnndi Lion nr prnhll'n1 and the p:illerns ofrnping utiliz1'fl Ill rc.-;uln or 11ddrr. :. ~ it. There i~ a lcnclr1wy :111H,11J1. community health 1111rsc·s to r P:ulily ~in. ! out ad1·icc. hi. :allh lcac·hings or s,>lutions once they ha\'C itlenlified Lh<' h<alt h t·onditir111s t1r pr11blc111s. Thlrc are,·rlj· few instance$ when they ddcrminc first the dic11l0s pcrcrption of the hciilth condition or problem. tllll rciim1rccs in clct11ing with it he. fore they take at. :Livn or do nursing inlcr-·cntions. lntet·vicw ques6ons and communic;ition techniques must be guided by theorelkal perspectives in family heallh earl". Rlspecl, trust and cot11iclenliolity are crilkal v,ilues to 111ai11t,1i11 when t:onclu<"t ing the interview. Confidence on Lhc m:e of t:l\mmnnicnlion techniques c. :an come after bcini; familiar with nnd being L't. m1pete11t 011 the t L<;C of types of q11c. c;tio11s tli:H aim to e-..plrwc, validillt., t:larifr. offer fc(db:1ck, encourage vcrbaliwtions of lhouv. hts 1111d fceli11f;S, and offer m:e<led support or rcass11 rnncc. Second-level nsscs. smcnt cm1 be adeqnatc J~, done for each wcllnr. _<t<; stntc, health threat, health deficit or cri~is situntion by going through the followill H sl CJJS with family nicmbt. :rs who may need lo help each other validate interview data un rcaliti«::. ~ or experience.-; regarding performance 59

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

60 of the family lw11lth tasks: n. Determine 1r I he fomiil~· reco~nize. '< the existence of the conclilion or problem. Jf the fa 111j]y does not recognize the presence of the condition or prublcrn. explore lht: nmsuns why. Snmplc intervi1" qucsliuns: 1. \'\rhul cioe. :-Lht. ' fomil~ think ahonl the sill111tio11 /condilion of... ? (,\no ang palngay /lingin ninyo sn knlngaya n o kondi!-;,'Ull ng.... ·n u. \\'hat do you ·think is the reason why he/she appears (e. g. tliin. lethargic)? Or. wh,\· do you Ll1ink I. Je/she is hchaving thii-\\:ff.. ? (.-\J1<1 s:1 p::il:. ii,:a~· niuyo :mg d:. ihil;111 kung bnkit siya nagknka~unyan?) iii. \\'llnt do you think is happening to your... ? (Ano !'-a pnlngny ninyo :ind nangyay11ri sn inyong... ?) i\'. \\"hy do YOU think he/she is... ? (Ano s:i p:ilagay/tingin niayo :rng dnhilnn niya.. ?) b. If the family recognizes the presence of U1e condition or problem. determine if so111elhing has i. ltc!ell tlvnc lo mai11lt1in tl1c wd!J1e,;s "l:lte or rl'SOl\'e llll' problem. If Llw family has 11ol ck,m. ·.. 111)1. hini-t :1bout it. dl'it?rminc u1c reasuns why. U the fn mily h;is ur>I\\! sornct J1ins. ttbout the prnblcm ur condition. dcu. n11ine if the solution is cffectin~. Sample inten-iew questinns: 1. \\11at has been done to imprm·e the condition or sit 11ation·1 (Am J na :mg ll,lgawn pnra mngbago ang kalagayan... o mapai1;i an<l p:1kiramuam... ?) ii. \lih:it is the family',; pl:111 rcg:11·ding this? (An0 ani4 bin:th:-11:ik ng pamily:i Lu11gkvl c. lito?) iii. \Vl,at irnproyements in Liu: c. :untli Lion of... han: 1,een oh,srr-·cd? (,\nong mi-:,1 paj!bahago a11g inyong n:ipansin s:1 kalagaya n n i ?) iv. Whot df J ~,Ju think the fomih-should do :abc,111... '? (J\no sa palaga; 11in~·o ang d:1r,t1t gawin ng p:imily:1 lunglwl S:. t '. ?) c. Determine: if the f::1milycnc·ou ntcn;o Lherproblcms in im plcnacnting the intcr-·cntions for tlw \,·cll111~1,s stalu/ill Jlcmliaf. lacal Lb llffc:it. hc11llh deficit or c-ri<;i,;. \\'hat. arc these problems '! Snmrl, lnkr-·it·\. ' tp H·--t il)n. 'I: i. Vl'hnt,,,re the rrohlcms nr harr-i,,. rs,ncnuntcrc J in... '? (.-\1111-nnr, ;10~ 111yonp, naging probfo:nia sa pngp:ip:atupad n~ mga-;olu-.._\·on-;;,.. ':',,,. /\r111-:i no :1 ng mga m1ging . o;ag:tb<ll 1) hal:-1kid nang myong p. i11rl\V,J :1111;... ?) ii.,vh:H do,·011 think :. ire tli~· r Ta-;0 11s wlw there is m> irnprnvr:m;,H in the r-onditi11n of... '? · (,\1111-mw s. t pnl:11;:,~· 11inyn :,11;:. dnhibn fcung hakit w:il:a11g paglwbagu Clll J!. kalag Jv:111 111 '?) iii. V,'h) d1tl n Ju.-. tup tloanr; wlint you 11_..,c-(i to c. ln regarding. . ? (Haldi ninyo iti11ii:;il CJ hindi ipin:1p. p,1t1Jlny ang llali 11inyong gin:iwn,a.... a... ?) i\'. \\'hy ditl yc,u 1101 C◄Jr1linu<. : doin,:;, wli,1t we lta\'l! lli~CLISSCd reganling.. ? (Bak. it hindi nin)<> ipin,,gpntuloynnd ating

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

pu1a,;-usap,m Lungkol sa... ?) v. How did you do il? (Papaono ninyo ginaw. J i10?) Or how nftcn did you do it? (Gaano ninyo kadalas ginnwu itor) cl. Determine hnw the other family members arc behaving towards each other or how tbcy arc affected by the heolth condition or prohlem. Sam pl€' in I cr"iew questions: L. How are I. he other members affected by... ? (Ano ang naginµ epckto ng... sa ib,mg miyembro ng pamilra?) ii. How an, Lue: c>lher members reacti. ng to... ? (Ano and rcaksron ng ilnu1g miyembro ng pami. lya sa... ?) 4 Record Rc,·iew. The nmse may galher information through reviewing cxisling rccordi;,111cl. rcpo11s pertinent lo tbc c. :Hent. Thes<. ! include the i11<livid1. 1tal di11ic;,il n. :c:onls of the family members. lalmn. 1Lory and diag110:;Lic report~, i 111mu uizaliun records. reports aboul the home and cn,ironment;il c<>nditions. or similar s Ol Lrccs. 5. I. ahoratory /Diagnostic Tests. Anolher me Lhoc. l of data collection is Lhrnu~1 pe1-for111ing lnboratu,1,-tests. diagnostic procedure s, or other tests or integrity nod f1Loclious carried oul by Lhe nu. rsc herself and/or o Lhcr heallh workers. The Assessment Dnla Base (AD B) is supported and complemented by nthcr fn m ily ,1sscssmenl I nnls tn r-li1·i1 gcncn11 ionnl inf<Jrmal ion,il Jout farn ily structure nod processes (Acnngr:1111). f. ient;il d;iia ahont family relations-hip with tlll' ex1<'nrnl cnvironmen 1 nnd ils resources (c,·om Ap). a11<1 i111crnetive processes and fomil:, n~lntinnship problc,ms/ dif!ic-111 i-ks,1 ml strengths (fomily-Jifc elm mnlogy). Gcno,;rams j'. !,l"Hphic. nlly display infornrntion abo111 fomil_v members and their rtil:1tio11ship,; on·r,11 lc~1~1 thrcr gl'n!'ratinns. The Fan'lily Systems Theory of i\lurr;1~ 11mwn (19713) is 11scd as the conceptual framework for constrm:l. ing mid :111:1lyzin,:; i-;cuo~rnrn p. 11tcrns (i. c slructurnl, rcl;1tional an<l f1. 111ctional lnformalion :1ho11l :1 (:1111ily),·t!'\\'l'd hnriu nlallv :1cross 1h11 family conlc~:t and verti1;;,1lly througb i;c11cr:1tions. The hr<,adlh of th,~ current f;imily nmlexl captures the eonneelt!<l 11ess of 11uckm· :,nd cxlcndcd fomily 111c111bcrs w, well as e-i~uilicanl n\111-f;i111lly mtrnlicn; who h;.-·c· c.,,cr li,·ccl with or pl:1yed a major rulc in the family's life, ind11ding fomi Jy . sl rcnglhs :md \'ldncrahilil ies in,·elation li J Lhe ovcrnll Sil uation. Depcndi n A on the level ol as~css111c11 t cn111peli..:ntic:s o J' th. :: nurs-,, no<lul i UJd critical events in the Camily's hi. ~lory art· assr,;scd "ithi11 and Lhrougl1 life t·y. :11,; transitions, plac. :ing present issues in the c:n11lext ul I he familv',; evolutionary pallcrns. Current behavior or prnblcm/s or family me1nbers c::iu be ain,lyzcd from nrnltiplc perspecti ves. Data about the index pc,-,;on (IP). I he µer,;un with Lhe problem or symptom. can he,iew1~d in tlw c:onrex-1 or vadous subsystems (sui:11 as sihlini-:s. complcmcnlnry and symrnelricnl, rec:1procnl rcl:11 io11ship. s) or in rcl:Hion to Lile hrnndcr sut. :i11-c11lturn 1 context (e. g. the c:0111 munity and s<1l'i;1I i11sli1t1Lions}. Family mr111bers nre i111ervicwcd ;1ho111 1·hc p1·escnt silu Htion in rclu1i,111 lo the I hemes. mylhs. rule,; and emotionally chargeti issue;; of _prevfous gcncralio11s,. s11,:;~t~sli11i~ possible· 1·nr111cctions hclwt'C' l1 family events. Patterns of pn\'io11s illm:. s. s and carli1:r. shifl. s in fo111ily rclnt. innsh i J. )s lirou1;hl about through changes in fo mil~· st ructurc antl othcr c:ril1cal life clrnni;,l's can easily be noted 011 th<:: gcnogram, provi,lin~. i rid1 !:'Ourco: of inforrn:1lion about whal lead. s to change i J1 a pa Tticular fa mil. )" (Mc<. ;old rick mul G1::r);o11 1985, pp. ~-3). 61

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

62 An ecomap visunlly diagr:,ms the family's interactions or relationships with Lhe exten1111 environment and its resourc·cs. llsum111. :irize:c;o11 one page I he family strengths, con Diets and stresses in relation Lo its interactions witl1 ind. ivic. Jnal:; and agencies outside the family s_vstcm. As one of Lht:· forcrunncn< Lo use Llw ect)map, Harl1mu1 (1978) used the tool to l?. X:tminc boundary maintenaru:e nspet'. ls of fr1mily functioning. The ccomap dramatically il111slra1es the amount of<:?. nergy used by a f:1111ily lo rn;iintain its systelll, as v Jell as the presence or absence of situationa l supports nncl other family resources. ]t helps i<lcnlif-y how family energies ar-e being usec J nnd when relationships with the external environment-1re positively or negativel y in Oucndn)?, family funclioning. To ill\lstrate, if u family's tlovv of energy ns depicted on lht: ecomaµ 1·ellecls only an outward directional process(-...--), r-hc family may have difficulty p1·oviding a nurturing environm ent fo1· family members nnd nchieve ils gonls (Clemen-Slo ne nnd others 2002 p. 194-195). The ccomap is p;irricuh1 J"ly useful when the family is involved with several community systems or when the family perceives a lack of support from significa nt others. Family-life chronology helps cap:llre ~amily in L-eract iv_e pro~esses that J1ave_ evol~ed (Satir l967). Ltcun help tl1t' fanuly~<le~lify the ~trc~gths m fo,mly member re~atior~sh_1ps over time and the need Lo a-llc. r farmly f11nct10mng to reduce stress. By 1denttfymg latjonsllit difficult ic:s witl,in the family, the 1111rse can focllitate the development of re<.,. b Ii _, d'. effective family proct!sses by enc~ur~'. g'. ng mem ers to m" w11ys to 1scuss and ad<lress their difference:; io support of 111cliv1dual and family wellness (Clemen-Stone and others 2002 pp. 195-196). Appendic es B1 lo 83 describe how the genogram, ecomap and fanrily-life chronology are constmcted. DATA ANALYSIS Utilizing t J,e data gcner;1led from the tool on AS$essment D_;ita Base in Family Nursing Practice (See Table 2. 1), the nurse goes through data analysis. She sorts out and classifies or jlroups data by type 01· nature (e. ~. wbich are wellness states, threats, deficits, c,r stress points/foreseeable cr-iscs). Sbe rclntes them with e. ach other and determines patterns or reoccurring r-hcmcs among the data. She then compares these data,,nd the pottcrns or recurring themes with norms or standards. The standards or norm~ utilized in determining t J1e status o-f the family as a client or patienl can be classified into t J1ree lypes: 1. Normal healt J1 of indrvidual members; 2. Home and em;ronmental conditions conducive to health development, and; 3. Family characteristics, dynamics or level of functioning conducive to family growth aod development. Tbe first type-norrmil health of members-involves the physica l, social and emoti()lrn l well-beii,i:; of each fomily member. Home 11n<l environme ntal conditions include both the physical as well as the psychological and soc-io-cultun,1 milieu. Such n milieu considers the type and quality uf housing, aucquacy of Jiving space, adequacy of sanitation fnrilitics and rcso1u-ces lmtl1 in tlte home ;incl the community, the kind of neighborhood, psychological or socio-cultun~I norms. values, expecl;it ions or modes of lifo which enh:rnc(' health rlevclopnll'nt and prevent or cont·rol risk factors and hazards. TI1e thin. ! type-family rharactcdstic.,; or functioning-constitutes the client's ability as a system m maintain its boundary integrity and achieve its purposes through a dynamic interchange among its member s while responding to the externa l multi-

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

environments along a lime continuum. Charnctc ristic. « of hca1H1y family fiinctioniog are described as flexible role patterns, responsiveness to needs of individual members, dyo111nic problem-snlvint, mechanisms, ability tr, acc:c. pt help, npen rommunication patterns, cxpcric11ccoflrust and respe:ct in" w. irm :111d caring atmosphere a J1d capacity lo maintain and crcalc constructive relal;onships with the broader neighborhood and community (Clemen-Slone and others 199l, pp. :. t69-270). In order to achieve wellness among its members ;ind reduce or eliminate health problems, the st1111dord or norm of the family as 11 func Lioning unit involves the ability to perform the following health tasks: 1. Recognize the presence or a wellness state or health condition or problem; :?.. Mukc decision:=; about t11king apprnprfate health actinn to maintain wellness or manage the health prnblem; 3. Provide nursing c,11-e to lhc sick, disnbled, dependent or al-risk members; 4. Maintain a home envirnnmcnt conducive to health maintenance and personal <lcvclopmcnt; and, 5. Utilize communit y resources for health Cbtre. After relating family data to relevant cli·nical or research findings and comparison of pntterns with norms or standards, Assessment data, as categorized or reorganized, are interpreted and inferences are drawn. The end result of this analysis duri_ng the first-level assessme nt is a conclusion or a statement of a health condition or problem, classified as a wellness potential, health threat. health dcfic. it or stress point/foreseeable crisis. This definitio n constitutes any of the follov,ing: i. Transition state from a speciiic level of wellness to a l1igher level; 2. Medical or nursing diagnosis indicating cun:cnt health status of each family member; 3. Condition of home and environment conducive ·,o disease/illness or accidents ; nnd, 4. Man1ration/dcveloprnen tnl o. r situational crisis situation. The second-level of analysis ends with a definition of family nt'lrsing problems. To dctinc family nursing problems, eoch wellness state or l1e,1lth condition or problem must be nnaly,;ed in terms of how the famjly handles it. The process of data gathering for this :malyi;is has been described earlier (sec lnterview, Data-gathering Methods and Tools). The patterns and implications of these data reect expbmations and inferences about l11e family as a fltnct-ion_ing unit u1 tenns of its problems related to performance of family health tasks. The causes of or the reasons for tl1e existence of the condition or health condition or problem reflect barriers to the family's capabili ties to promote and maintain health among its members as it maintain s family system integrity. Figure 2. 1 sw11m. irizes the critical thinking process during tbe assessment phase in family health nur. sing practice. NURSING DIAGNOSES: FAMILY NURSING PROBLEMS 171e end result of t J,e second-l. cvel assessment is fl set of family mirsing problems for each health condition or problem. A wellness comlilion is a nursing judgment related with Lhe clienl's capability for wellness. A l1ea1th condition or problem is a situation which interferes witn tbe promotion and/or maintenance of health and recovery from illness or injury. A 6'3

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

64 ~,ellness state or hc~l~1 co~dition/problem becomes a family nursing problem when it 1s stated_ as the fam1ly ~ fmlure to perform adequate ly specific health tasks to enhance o: sustu~n _the we_llness s~::ite or m~ma11,e thc-h~alth problem. This is called u,e nursing d1agnos1s 111 family nursing practice. specifically defined a$ a di11ical judgment,1bout the family's response to actual or potential health problems or life processes (1'onh American Nursing Diagnosis Associat ion [NANDA] 200-1). One of the major barriers to the effective oper. 1tiona] i7,. ation ;ind application of the nursin~ process in family health c. ire is the absence of a classification syslt!m fur nursing problems that reflect the fami J.,· !,"latu:-and cap~bilitic-. s as a functioning unit. To fncilitate the process of defining family nursin}\ prnbleni!>. a rla,;. sifie M inn. ~ys1rm of family nursing problems was developed and field tcl-'tcu in 197R. TI1is tnol. call Fci A Tvpolog y of Nursing Problems in Family Nursing Practice (;. ee Tnhle 2. :-!). has b;cn used by nursing :<tudcnts. community health nurse pra<. :titioncrs and c<lucators. Thi-ough the year. ; redsions lu:l\·e been tk111e to ensure ;ill-inclusiv eness and m11h1al e. xclusivene.,s of the list. Jn 2003, pre. <;ence of wellness condition has been added in the first-level assessment pa1-t of the typology. THE TYPOLOGY OF NURSING PROBLEMS IN FAMILY HEALTH CARE The orgam:r Jng framework of the typc1logy is bnsed on the fomily health tasks (Frttmt1n t1nd l-lcinlich 198i, pp. 94-95). The rationnle for adopting these health tasks as 11,e frnmcwnrk <>f the typology is U1e fact that in con1111u11ir-y health nursing practice. the nun;e deal!. < mostly with problems within tbe domain of Jnmwn hch,l\ior or human response to !Icalth and illn<?SS. It is nol v1:ffy oft1;:n that 1l1e cpmmunity health nurse dcnls wilh Ila; physi<'nl, p,~yc·hologic. 11 nr c;linical condition of the patient requirin,:; he·r sustained di reel scn·kes such 1l!< n11r:-ing t:nre during IJ1c.,cute phase of an i. l. lncss in U1e bospi1:. 1I scttiug. :vruch ot the nurse·s efforts are directed at effecting chang. :-in the behavior of clients to adtie,,e optimum health. 111e conununity hea Jt J1 nu:rsc "·arks with and through the family to improve its capability lo achieve healtl111nd wellness among its meml Jers. TI1e typoloro·contains si;,;; main categoric:~ of problem,:: in family nursing care (see Table 2. 2). The Jirst cate~OT)' refers to the presence of wellness states, health threats, health deficits and foreseeable c,;sis situ:11ions or stress points. The result of the analysis of daw taken during the firsl-level a. s. sessme nt (utilizing t J1e tool Assessment Data Base for Family Nursing ) is reflected as statement of the he,~lth condition or problem. a,,·ellness state. health threal, liealt·h deficit or foreseeab le crisis/stress point.. After idenrif-vin~ these bc:1lth condition s or problems. the nurse tletermines the fornily·s ;ibility to perfom, the five hen Ith 1;1sks on each one. The remaining five main catc-gorics of prol Jlcms contain slatemeats of the family's inability to perform the health t;isk. s. The results of the unalysis of Jata takeu during IJ1e second-Jevel assessment arc reflected as statements of the family nursing problems. There are five main types. namely; J. Inability to recognize t J1e presence of the condition/prob lem due to... 2. Jnnhility to make decisions with respect to ta. king appropriate health action due to... 3. Jnubility to provide nursing care to the sick, disabled, dependent or at-risk member of 1he family due tv... 4. Ioobility to provide a home environment wl1ich is conducive to healtb maintenance and personal development due to... 5. Failure to uli Jize community resources for health care due to...

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

-The c:ategnriz. ·1tim1 llf pn,blcm!-in th,· t~~iln!'0· r11n'<1 it111 L'5 "L',·rrul ln·l'I" :11:ctrdin~ to the dt')!. rec nf $!Ctwrnli{) "r :sp~-ci1ic·1t,·.,\fipr c:1d1 main l':llc'i,!c>r\",,i fan11l~· n11r-1nt problem. ;;e~--cnil mnn spt'c·ift,· pr,1hl.-m--·,tr,· i, kn11 ri,·d ro'lkc I 111i;,·n11 r ril 1111, 11~ prnhl,111,; to or e~1'1:tna1ions f11r 1lw,,,,,-1,n,·, nf tlw 111nm pn,hl,·111 n,i-. i-. p. tr:ill,·1t111 h,·,:, ncq1ts of imm Pdi:ll C \'. 111~·. int,:rnwd1. 1t,· l :111,.,.,lllt I ult lt11. tt1 l"JU..,· "lw11 crl, Ill,r, 1111: th\ au!-e(~J of morbidity "r m11r1ah1-:,. "r :<-!rn1d111 ~1r. u,,i. 1...,n,11'-. 11111,,l'I 11f,, 11111-. i11~ di:,,~111>::is (:'>lundingt'r :md. J:1urc,n t',l--:;. pp. n<,-<. !-). \,·,·nnlin" 1,, 1lw latt,·r.., n11r-111~: diai;nosis com,ists of rwo pani::: I. ·n,~ :<lnlt'mcnt oi tlw llttlwalthflll n.,sp~lt1Sl': :incl. 2. ·n,t" '\latrm,·nt of t:io. :1nrs which-Ill' 1n;1inlninin" tin· 11111h-~lr.,hk respnn-<l' :rn<l pn,entin,z the do. :'iil'\?d d1. 111~v The more specilic th C' pmbl C'm d,1i11iti1>n (wlnl'h olqw11. I-.,,11 tltl' clrprh. md hrc,1dtli of the n:<St. !..''-:m1 e11tl. th~ mnn 11.-:tf11I 1:-the 1111r..,111;;. !1.,i-;111,-. 1, 111 d,·1,rm111rn1; nursin: intervention. Th,·i-cfor, ~.,t:-rn,m,,1s lhn,,,,r f11t11· 1<·,·.-t-.,,1,,,,,1,J1,111 d,·lir1111,111,·,11, I,~· st:itcd. Tn illuslr:il,. in., f. L111il) "llh H pr,11. 11.,j 1'11t1,11t,,i,11 I'.,t lhc,am,· ti1tu tht· hrcadwinnl!r of the f:trnih·,111d whn is 11111 r,·,·,·i,·i11~,111y car,· su,wr. ·i-;a,n. llw 1111.-..101; problem mar be,:;l,11. :<l n,. : (Gencrn l) lnahilir~ lo utilirt, 111111111111it,· n·,-nurc,·:-: f,,r lw. tlth c·:,rc du~'''. ' in 11l:·1u;,i-, l;1111ih r,,-0111·,·,,,., "P<'<'ih~·. illy. (Spedfic) 11. 1·1mm("1:il n·Mur,·,-. h. rno n I'<'",·r rci<1111 nc,;; C. ti1n~ With the Lnclusinn 01 wellness stnre!: '" r11rt of th,· tir,;1 I,, I I f-1.... '-t tts..,~~...,n,t..·nt. l ic an11 y nursing problems spcc,ficalh-rclntccl,,111, s11s1·1'111·,,1,.,,,,. Jt,1t, 1 1 tt h r ·1 ~ "'l:. ~ss"., '-'$. "'' 1111 t c i1n11 v system 1s :iddcd 1 n the updntc<l typolo~,·. · TABLE 2. 1 ASSESSMENT DATA BASE IN FAMILY NUR'il NG PRACTICE A. Famlly Structure, Characteri:. ti<:~ and Oyn1lmi P/"' 1 b I b h ' ~ "' ""on..~ Patt rn' 1. Mem ers aft e hou,ohold. b1tthd. lt~ !>el! c v 1. ' and relationship to the head ol th4: fa~ily · 1 ' li!IUS. po~t·on n the f. lm,ly 2. Socioder T1ogr. rphic da..-, of f'Tl". !mbers no: curr 'l. h · I · '"1 i IIVlnl' 1n tht I ous. ehold but wit maior roe 1n rcsourct e~nrr. 1o~n-'I'd us, 3. Type of famll1 structur,. and Form-e II ma, 1 e)(tendecl or blended r arrh..,I or p:itr1Mcha1, nuct";:,r, 4. 5. Dominant family members in tcnv of d~c ,-1s1on rn lei ( of health care) and care tend,ng " n~ <'<. ptcl;ill,· on matt, r< Family dy11am1cs. c;ommunication p. ittern/s Interpersonal relationship~ (r 8 dyad,; intcr. ict1on. :it Pr. o. :~.,~s. :ind,c ilnu lrt. ld1c t innate or great potenti. il to mediate or potentt. : 1" er;,cnon,-J wh,ch pos~csr. illness. growth, developm ent. an·' th~ f 1, ate factor·, rellv;int to h,.,..lth,., ~ am, '/ s. ab1I t h anticipated and unexpected event,_ 1 V to dndl · confl,ct, ch. inse, Developed and published by Siil Vllc,on G. Ballon-Reye~. (see Bailon SG and Maglaya AS: Fam,ty Hrolth Nurs/n _ ~~d Araceh S. Maglaya, 1978 Brain. c:hlld Manager s and Consultants. 1990): revlew:d &. ~ Pro,:..:sj,. Pnnt1n1~ 4, Manila. ii Od 2009 by A. S. Maglaya. l JPdilt<?d n 1991. 1997, 2003 65

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

e. c. 0 66 s~io-economic and Cuttural Characteristics 1 lncomc a1,d E,c~nses a. occupation. place or work and incorne or each working member b. Adequacy to meet basic ncccssitfcs (food, clothh,g, shelter) c. Who mal<e~ decision~ ;,boul money ;ind how 1t Is spent Educatiotii!I analnment ol each mcmt,er Ethnc: background and religious o1fflliation family Traditions. event~ or practices affec;ting members' he. a Ith or family 4. s. 6. rvnction,ng s,gnifiunt Other$-role(sl they play in family's life Relationship of the family to larger community-Nature and extent of particip. itton of th famiiy in comm~in lty activities t{orne and Environment 1. 2 3. 4. Hcusing a. /ldt!quacy of living s~ace LI. Sleepn!! arra1. !;Ernent c. Pre!enc,; of brceamg or resting sites of vectors or diseases (e. g. rnosoulcoes. roaches, mes, rodents, etc. ) d. Pte~ence of ac Ctccnt and fire hazards Food storafie-and cool,ing racillties W. Jter ~upply-~our<;e, ownership. potability Toilet !ac,lol y-t,·pe. ownersh, p, sanitary condition Garbase/ref,Jse dispo,al-type, sanitary condition Drainage sv~lem-type, san1ta,ry rondltion Kind of ne1ghoochood, e. g. congested, slum, etc. sooal and health facilities avallable commun icacion and transport anon facilities available Health Statt. J$ of each Famfly Member 1. Med,cal and nursing h,story indicating current or past slsnificanl Hlnesses or beliefs and pracoces conducive to health and illness 2. NLttr>t1cnal a H<:s~ment {specially for vulnerable or at-risk members) a. /. nthropornetrlc data· Measures of nutri Honal status of children-weight, he1~t m111-upper arm circumference: Risk assessment measures for Obe~1ty body ma~s index (81-. 111: wel5ht in legs. div,decf by height ,n /T\Ftersl ), wa1~r circumference (\,VC; greater than 90 crn. in men and oreater th;;" 80 cm 1n women ). waist hip ratio (WHR = waist ci1<. 1.,n1forence 1n cm d1v1ded by hip circumference in cm Central Obesity: Wf1R Pquar !I) or gre111er than 1. 0 cm. in men and 0. 85 in women). b, D'eta1y n,sro,y specify,ng qual,ry and quantity of food/nutrient intake per day c.. Eating/fc~'1,ng hal:>its/pr;icnce\ 3. Developmt'r. tal dv,ei. sm.. nt of infants, toddler~. and preschoolers-e. 9., Metro Mantia 0e,,elcpmemal Screening it"St (MMDSn. · Risk fano, as:essrnent ind t. 1nng p1'esenc. c of major and contributing modift. Jl::le risk factors tor specific l,f~sty Je diseases-e. g. hypertension, phy~ic. tl,n. act1v1ly, se-de11tary Jrfestyte, ci;garette/toba~c. o smoking. elcvaled blood lipids/cho!o1. erot, obesil-y, dtabe~es mellirus, Inadequate Hber rnt. :ike, Streu, a!cohol dr1n1'. ir-,a and ~Mer subst... mce ~buw

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

5. Physical assessment Indicating presence of illnes5 r. tate/s (diagno:.-~ or undiagnosed by medical prat:tltioners) 6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings E. Values, Habits, Practites on Health Promotion, Maintenance and Disease Prevention Examples Include: 1. Immunization status of family members 2. Healthy lifestyle practfcl!s. Specfry. 3. Adequacy of: a. rest and sleep b. exercise/activities c. use or protective measures-e. a. adequate footwear ln parasite-infested areas; use of bednets and protective clothing,n malaria and filariasii. endemic areas d. relaxation and other stress management activities e. oportunltles which enhance feelings or self worth, self efficacy and sense of connectedness lo self, others and a higher power, essence of meaningfulness. 4_ use of promotfve-prellentive health services (such as maternal and chlild heal,h supervision) and use of hc. ilthy life style-related services source: compendium of Phlllppine Medicine. Guidelines for a Healthy and Safe Weight flemen1 Program, PASOO Recommendation, 3rd Ed. (2000). Mana TABLE z. z A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST-LEVEL ASSESSMEIIIT I. sence of wellness Conditio n-stated as Potential or Readiness-a dlnical or ::r,dng judgment about a client in transltien from a specific level of we!lne~~ or c;apabilll Y to a higher level (NANDA, 2001). Wellness potential is a nursi AA d ment on wellness state or condition based on chent'. s performanc e, current ju m Bpetencles or clinical data but ~ l!/'Xplfcit expression of client d Psire.. Rea. diness GO t.. j d f enhanced wellness sr. i e 1s a nursing u gment on wellness state or condition or. d Ofl client's current competencies or performance clinical data and e,cpliclt b UC ' An Jon of desire to achieve a higher level of state or function in a specillc. ;irea expr......, on health promotion and maintenance. E~arnples of these are the following · Potential for Enhanced capability. for: A. l. Healthy Ufestyle-e. g. nutnfion/ diet, exercise/activity 2. Health Malntenance/H ealth Management 3. Parenting 4 Breastfeeding I f di s. Spiriti. ral Well-be ng-1process o a dent's developing/ unfolding of mynerv 1 through harmonious nterconr,ecte ness that comes from Inner strength sacred source/God (NANDA 2001) 6. Others, specify:---·-------67 ~

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

68 B. Readiness for Enhanced Capability for: 1. Healthy Lifestyle 2. Health Maintenance/H ealth Management 3. Parenting 4. Breastfeeding 5. Spiritual Well-being 6. Others, specify: _____ _ II. Presence of Health Threats-conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. Examples of these are the following : A. Presence of risk factors of specific diseases (e. g. lifestyle diseases, metabolic syndrome) B. Threat of cross infection from a communicable disease case c. Family size beyond what family resources can adequately provide o. Accident/ fire hazards. Example: 1. broken stairs 2. pointed/sharp objects, poisons, and medicines improperly kept 3. fire hazards 4. fall hazards s. others (specify): E. Faulty/unhealthful nutritional/eating habits or feeding techniques or practices-spec if y: 1. inadequate food Intake both In quality and quantity 2. excessive intake of certain nutrients 3. faulty eating habits 4. ineffective breastfeeding s. faulty feeding techniques F, Stress-provoking factors-specify: 1. strained marital relationship 2. strained parent-sibling relationsh ip 3. interpersonal conflicts between family members 4. care-giving burden G. Poor home/environmenta l condlition/sanitation-specify: 1. inadequate living. space 2. lack of food storage facilities 3. polluted water supply 4. presence of breeding or resting sites of vectors of diseases (e. g. mosquitoes, mes, roaches, rodents, etc. ) 5. imprope r garbage/refuse disposal 6. unsanitary waste disposal 7. Improper drainage, system 8. poor fighting and ventilation 9, noise pollution 10. air pollution d

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

H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices-specify: 1. alcohol drinking 2. cigarette/tobacco smoking 3. walking barefooted or inad1::qual e footwear 4, eating raw meal or fish 5. poor personal hygiene 6. self-medication/substance abuse 7. sexual promiscu ity 8. engaging in dangerous sportts 9. inadequate rest or sleep 10. lack of/inadequate exercise/physical activity 11. lack of/inadequate relaxation activities 12. non-use of self-protection measures (e. g. non-use of bednets in malaria and filariasis cndemfc oreas) J. Inherent personal characteristics-e. g. poor impulse control K. Health history which may participate/induce the occurrence of a health deficit, e. g. history of difficult labor L Inapprop riate rol. e assumption-e. g. child assuming mother's role, father not assuming his role M. Lack of immunization/inadequate immunization status specially of children N. Family disunity-e. g. 1. self-oriented behavior of member(s) 2. unresolved conflicts of member(s) 3. Intolerab le disagreement 0. Others, specify: _________ _ Ill. Presence of Health Deficits-Instances of failure In health maintenance. Examples include: A. Illness states, regardless of whether it is diagnosed or undiagnose d l;>y medical practitione r B. Failure to thrive/develop according to normal rate C. Disability-whether congenital or arising from illness; transient/ temporary (e. g. aphasia or temporary par. ilysis after a CVA) or permanent {e. g. leg amputation secondar y to di. ibetes, blindness from measles, lameness from polio) IV. Presence of Stress Points/Fo reseeable Crisis Situations-anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources; transitions (Le. passage from one life phase, condition or status to another, causing a forced or cha. sen change that results in the need to construct a new reality). Examples of these include: A. Marriage B. Pregnancy, labor, puerperl um C. Parenthood D. Additiona l member-e. g. newborn, lodger E.. Abortion 69

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

70 f!. Entrance at school G. Adolescence H. Divorce or separation I. Menopause . I. Chronic Illness K. Loss of Job L. Hospitalization of a family member M. Death of a membe-r N. Resettlement In a new community 0. Illegitimacy P. Others, specify __________ _ SECOND-LEVEL ASSESSMENT I. Inability to recognize the presence of the condition or problem due to1 A, Lack of or inadequate knowledge e. Denial about rts existence or severity as a ri!Sult of fear of conseque nces of diagnosis of problem, specifically: 1. soda I-stigma. loss of respect of peer/slgnfffcant others 2.. economic/cost lmpllcat1ons 3. physical consequences 4. emotlonel/psycho1ogicai Issues/concerns c. Attltude/philosopby In fife which hinders recognltion/a eceptance of a problem o. Others, specify __________ _ 11. Inability to make declsrons with respect to taklngcapproprlate health action due to: A. Failure to comprehend the nature/magnf-tude of the problem/condition s. Low salience of the-problem/condition c. Feeling of eonfusion, he1pfessness and/or resignation brought about by perctvved m. ignitude/severlty of the situation or problem, i. e., failure to break down problems into manageab le units of attack o. Lack of/Inadequate knowledge/Insight as to alternative courses of a1::tion open to them E. Inability to decfde which action to take from among a list of alternatives F. Conflicting opinions among family members/signlfk. int others regarding action to-take G Lack of/Inadequate knowledge of commun ity resources for care H. Fear of consequences of action, speciftcally: 1. soda! consequences 2. ec;anomic consequences 3. phys. leaf consequences 4. emotional/psychological consequences I. Negati\l. e. ittitude towards the health condition or pr-oblem-By negative attitude ls meant one that interferes with rational decision making J. Inaccessibility of appropriate resources for care, speciffcally: 1. physical Inaccessibility 2. cost constraints or econom ic/financial lnaccessibllity K. Lack of tru$t/confidence In the hea Uh personnel/agency l. Mrsconceptlons or erroneous Information about proposed course(s J of action M. Oth. ers,·specify _________ _

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

111. lnablllty to provide adequate nursing care to the sick: disabled, dependent or vulnerable/at-risk member of the family due to: A. Lack of/Inadequate knowledge about the disease/heal th condition (nature, severity, complications, prognosis and management) ; B. Lack of/Inadequate knowledge about child development and care c. Lack. of/inadequate know. ledge of the nature and extent of nursing care needed o. Lack of the necessa~y fac Tlities, equipment and supplies for care E. Lack of or Inadequate knowledge and skill in carryihg out the necessary intenientions/treatment/procedure/care (e. g., complex therapeutic regimen or healthy lifestyle program} F. Inadequate family resources for care, specifically: 1. absence of responsible member 2. financial constraints 3. limitatiohs/lack of physical resources-e. g., Isolation room G. Significant person's unexpressed feelings (e. g., hostiffty/anger, guilt, fear/ anxiety, despair, rejection) which affect his/her capacity to provide care. H. Philosophy ln life which negates/hinder caring for the slck, dlsabled, dependen~ vuln. erable/at-rlsk member · 1. Member's preoccupation with own concerns/interests J. Prolonged disease or disability progression which exhausts supportive capacity off'. tmily members K. Alte Fed role performance specify: 1. role denial or ambivalence 2. role strain 3. role dissatisfaction 4. role aonflfct 5. role confuston 6. role overload L. Others, specify _________ _ IV. Inability to pl'ovide a home environment conducive to health maintenance and personal development due to: A. Inadequate family resoqrces, sp. edf!cqlly: 1. financial constraints/llmlted financial resources 2. limited physical resources-e. g. lack of space to construct facfllt Y B. Failure to see benefits (specifically long-term ones) of investment in home environment improvement. C. Lack of/inadequate knowledge of importance of hyg. iene and sanitation 0. Lack of/Inadequate knowledge of,preventive measures E. Lack of skill in carrying out measures to improve home environment F. Ineffective communlcatio,n patterns within the family G. Lack of supportive r J?lationshlp among family members H. Negative attitude/ph ilosophy In life which Is not conducive to health maintenance and personal development 11

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

72 1. Lack of/inadequate competencies. in relating to each other for mutual growth and maturation (e. g. reduced ability to meet the physical and psychological needs of other members as a result of family's preoccupation with current problem or condition) J. Others, specify ____ _ v. Failure to utllhte community resources for health care due to: A. Lack of/Inadequate knowledge of ~ommur,lty resources for health care B. Failure to perceive the benefits of health care/servh;es c. Lack of trust/confidence In the agency/personnel o. Previous unpleasant experience with health worker E. Fear of consequences of action (preventive, diagnostic, therapeutic rehabllftatjvel, speclffcally: 1 physlcal/psychologlcal consequences 2. financial consequences 3. social consequences-e. g., loss of esteem of peer/significant others F. unavailability of required care/service G. inaccessibility of required care/service due to: 1. cost constraints 2. physical Inaccessibility, I. e. focatlon of facillry ~-Lack of or Inadequate family resouirces, specifically : 1. manpower resources-e. g., baby sitter 2. financial resources-e. g., cost of medicine presorlbed I. feeling of allenatlon to/lack of support from the community, e. g., stigma due to mental illness, AIDS, etc. J. Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care K. Others, specify ________ _ Developed and pubtrshed by Salvacion G. Bailon-Reyes and Araceli S. Maglaya in 1978 (see Bailon SG and Maglaya AS: Family Health Nursing-The Process, Printing 4. Manila. Braincillld Managers and Consultants, 1990); reviewed and updated in :1994, 1997, 2003 and 2009 by A. S. Maglaya. CONCLUSIO N: Guided by four major theoretical 1nodels presented earlier in this chapter, family nursing assessment is a deliberate and systematic process of gathering and analyzing data to identify and continuously validate J1ealth and nursing prohlems of families. TI1e operational framewo rk for family nursing assessmen t described in this chapte. r guides lbc nurse on how to understand and work with the family as a system and client as it goes through growth, development, health and il Jness experiences among its members. By going through the process of data collection and analysis, the nurse learns that families as clients have varied views of life, that they bold different nspirati. ons and that they respond to sjtuations or problems in unique ways. Family nursing assessment is an opportunity for learning about the families ' ways of knowing. The process challenges the nurse to evaluate her assumptions and premise s in order

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

Lo arrive al valic J conclusions. Accuracy in family n11rsini;,1i:sc. ~!m1cn L is :ichicvcd ns the nurse gets a~ close to the fomily's li,·ctl c. xpcricncc as n f11n,·1innin~ 1mi11111d c:lien1, using the participatory appronch. Thr\lu~h p;,r1nership. lilt· 1111r. <· and lhc family can enhance each other's cap;ihility lo look at and a11:ily;:c 1hc family sit11;1tinn or reality toge U1er in order to explore and pl;m for Ute m0-<. t cffer. ::Livc,,,fficient ~tnd sustainable options fnr action. REFERENCES 1. Alfaro-Le Fcnc. R. (1999). Crit icul Thi11ki11y in N,,,-si11g. Philadelphia: W. 13. Saunders Company, 2. Alfa ro-Le Fcvre. R. (:. !00:. 1). Applyi11y Nur:;ing l'ror:css: Pnm1ut ir1g Cull Clbor·atiuc Care. (5th e<l. ). Philaclelphiu, 1st: Lippi11coll, Willi:. 111,s am] Wilkins. 3. Aldow;, J. (1978). F11mily carec,·s: clcuclopn1c11icil chwige in. fa111ilias. New York: Wiley. 4. Bailon, S. G. and Maglaya A. S. (1990). Fumily Health N11rsi11y-Tlre P,-occss. Manila: Brainchild Managers :rnc..l Cnnsult:inl~. 5. Bailon, S. G. and Maglaya A. S. (1977). Tools and Guidelines for Nursing Care at the Family Level, P11rl 1: A Typology of Nursing Prciblems in Fnmily Kursing Pracrice. The Anphi Pn11er. ~, 1:1 (1). 13-~1. 6. Barkauskas, V. H., Sloltcnbcr J!,-Allc11, C., Baumann. t..C.. ct al. (::!002). Health and physical. issessment. (3rd ed. ). SU. 011is: Moshy. 7. Barka11sk11s, V. J-1., Stoltenberg-Allen, C.. Baumann, L. C., et. a 1. (1994). Hea'lth and physical assessme nt. St. Louis: Mosby. 8. Bates, 13. (1995). A Guide lo Physical Examination. Philadelphia: J. B. Lippincott. 9-Bickley, L. S. (2007}. Bate':; guide lo physical e.,·umi11al ion rind history taking. Philadelpl1i a, P. A: Lippincott \. Villiams and Wilkins. 10. Bowen, M. (1978). Family t/Je,-apy in clinical practice. New York: Jason Aronson. 11. Carter, B. and Mc Goldrick~ M. (Eds. ). (19RA). Tile chcmgi11g_/vm ily life cycle: aframewo,·kfor·family therapy. (2nd ed. ). p. 15. New York: Gardner Press. 12. Chick, N. and Meleis, A. I. (1986). Transitions: }1 nurs. ing concern. In P. L. Cleinn (Ed. ), Nursing Research Methodology: Issues and lmplementa-tion (pp. 237-257). Maryland: Aspt:u, Ro1:kville. 13. Clemen-Stone, S., Eigsti, G. O., Mcguire, S. L. (1991). Comprehensive Family and Communitl J Health Nursing. (3rd ed. ). St. Louis; Mosby Year Book Inc. 73

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

74 l4 15· 16. 17 19. 21. 25. 27. Clemen-Stone, S., Mc Gu. ire, S. and Eigsti, D. G. (2002). Con1preflensive Conmwnity Health Nursing: Family, Aggregate and Commtmity Practice. St. Louis: Mosby. Den ham, S. (2003). Family. Health: A Framewor·kfor Nursi'ng. Pbi Jadelprua: F. A. Davis Publishers. Duvall, E. M. (197J). Family Deuelopment. Philadelphia: J. B. Lippincott company. Duvall, E. M. and Miller, B. C. (1985). Marriage and Family Deuelopment. (6th ed. ). New York: Harper and Row Freeman, R. 13. and Heinrich, J. (1981). Community Health Nursing Practice. (2nd ed. ), Philadelphia: W. B. Saunder s Company Friedmru1. M. M. (1998). Family 111. a-sing: theory and practice. Norwalk. Conn: Appleton and Lange. Friedman, M. M. (1992). Family nursing: theory a11d practice. Norwalk, Conn: i\. ppleton and Lange. Hill R. and Hansen, D. A. (1960). The identification of conceptual framewo 1·ks u Lilized in family study. Marriage Family Living, 22, pp. 299-311. . Hollnsteiner, 1\1. R. (1975). The Filipino Family Confronts the Modern World. In M. R. Hollnstein er and others (Ed. ), Society, Culture, and the Filipino (pp. 214-226). 9uezon City: Atene_o de Manila University. Maglaya, A. S. (2004). Nursing Practice in the Commtinity. (4th ed. ). Marikina City: Argonauta Corporation. Mauren, F. A. and Smith, C. :M. (2005). Commu i1ity public health nursing practice: Health for. families and populations. (3rd ed. ). St. Louis: Elsevier Saunders. Meleis, A. I. (1985). Tlzeorehcal Nursing. Philadelphia: J. B. Lipp~cott Company. . Minuchen, S. (1974). Families andfamily therapy. Cambridge, M. A: Harvard University Press. Mc Goldrick, M. and Gerson, R. (1985). Genograms in Family Assessment. New York: W. VV. Norton and Company. 28. Mendez, P. P. and Landa Jocaoo, F. (1974). The Filipino family in Its Rural and Urban Orientation: Tlvo Case Studies in C~ilture and Education. Manila: Cenlro Escolar University Research and Developn1e11t Center. 29. Mundinger, M. O. and,Jauron, G. O. (1975). Developi ng a Nursing Diagnosis. Nursing Outlook, 23 (2), 96-97. 30. North American Nursing Diagnosis Association. (2ooi). · Philadelphia: NANDA.

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

31. Sntir, V. (1967). Conjoint family therapy: a guide to tf,eory and tcd111iq11e. Palo Alto, California: Science and Behavior Books. 32. Selder, F. (1989). Life Transition Theory: Lhe resolution of uncertainl y. Nursing and Health Care, 10 (8), 437-457. 33. Turner, M. N. (1974). Nursing Process: An Operalional f'ran1ework for Nursing Practice. ln. I. E. Hall and D. R. Weaver (Eds. ), Nursiny of Families in Crisis (pp. 10-32). Philndelphir1:,J. B. Lippinco LL 34. Wilkinson, J. (1996). Nursing process: A critical t/1i11ki11g app,·oach. (2nd ed. ). Menlo Park, Cn: Addison-Wes ley. 75

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76 CHAPTER 3: DEVELOPING THE FAMILY NURSING CARE PLAN Araceli S. l\faglaya THE FAMILY NURSING CARE PLAN Fom111l:11'ion ofthf' n1trsin~(';l~ plan is the nex-t step in the appli~tion of the nursing pnx:c~-: aflc>r. 1,<;t>,,mc:nt. "'ht:n lhl' f. imi Jy uursin~ problems of each health condit-ion or h<!. illh pn1bli!'m h;i, ~ l;-c,en,-.,x-cilic<l. 11u fomil) nurairu: l"31"C' pl. in i,-. a hlt11. 'prin l oi lhc nu rsin~ cure dc. <:ignctl lo ~stcmnticnlly en. biln("e tlw f;1mily'. ;,·. ~p. 1hilit)· t11 m;1it11:1in wcllncs. " nnd or m:an:ig~ hc;1l1h prohlcms throu J;h e,plinth lnrrnnl. 11.-. ;l ;:,,. 1)-< :ind <h. 11. l·11n,s ol r-nn· :ind uclihcrnlely chn,;cn :;ct of int,·n ~nlhn-. n.,oun·.,. _. 1n J ~·,. 1 lual H~n l'rito. :rfa. >=t,,nd. 1 rd. ~. 1nethod /s ;1 nd tools. As a ~Tit!fn _cu HI,. the r,unil:, 11un,. in~ ~·. 1n: plan is ntiwlarl~· updntetl for 111ouifkutio11s or chan,:c<: h,'-l..-1 on familv n-... :r><>n,-,.,,-. rcnliti~. ::. hclrn,·io1·al prc>cessc..« ancl 011tco111c·. s of c..-ire. Thc-n. · IJ~. ;,,,t>r:il n':L!-'11L' for 11laru1in!' nun. ini. : ~trt.-'. lt i:-;_1 1>')'l-tt.-"1nutic way l<l guide tl>c nu~ on hu,~ 10 cnha1wt tht family's cnp:thility (or health ::ind health c11rc n. sourcc ,:. t n· r. 1t un. di<> ;1110n., id n ti Ii 7. at ir111 Io rt,. hi,..,.,-. rwl'i fie d,,.,i n·d 1111t,.,11111.... 11f priori I i1cd he:ilth ('1'>11<lit1 11n, prnhltm,. Pl. in11111~ t"11harn,,. _ th,· nur,... ·,. fnr<'-<1)?. hl fnr tr. 1111work :ind t'l>ordin,:inn r,l. _. f'IC""' tu n_. :11rc :idc4u. «·, and e,m1111uil) of. ~ire. Sp,cili1-. :1lly 111 wnt', n 1,rrn. th, nur-in;r c:irc plan r>nm1nte s s~»ttm:itl,· n,m111111dn11io11 ;1111<>ng tho--,,n, "" r<l an th,,wahh. :,1n t ff,,n. min1mi1in~ ~-l P",md c Juplicnt i,m of ~rvk,·s in S-c?tiut;. :, ~,h H tht-rt. ' t, 1 (r-L.,~U nt t11rn,,,. L--rr Jf,1n((t\rh ·h~n ~1·v,~n1I hf... i1lth v,tork C'"r <. <trc providms:, an 11, th,. __ un· (.,m ii~ Thi, i-; p,t rt in r b rly t r1Jt: in vill:-. '1,C<-,,r :1 rt.-:1-. IL"N. I as tkl. 1 rrn, t1 ·um-<lit"" tnr tr. 1ini11~ in,..,,mn111nit) lwalth \\ork. Steps ;n Developing a Family Nursing Care Pion TI·e 1:"::,-<-,m,,n1 Jlh,1<' o( th< nur..ing pnx:c1-.., i. :t..·nl·ratl''> 1h,· 1,,-a Jth 1. 'Hlldition,. and ('Orr, "]')'tn<hn., l :ml: nur-1n1., prnblrm..,,,·hich h.. r,,mt· th,· 1,;. i:-es (ur thl· dc,.-lopme11t offll' nur-,11~ r 11, 1 L n ll,-~.-l1p1ny. a fornrh r-;,r, pbn invnh-cs rn:iny,t,·J"'· C1·n1rnlly the pl. 111,,m,,,,.,,, th f11l!..,-i11~ (, J Pri,riti.,,-. 1 h. rlth,-unditi,111 /.-. or problem,;; (:. !) Go;i f-., :,p J ol Jl,·11,,.... 11{ nu r 111~ r. 1n·; (3) r nt,·n·1n l i1Jn pl;i n; :md. {4) Evah1;1 t ion pltt n. Th,. '\. tn,1 a,,1, f" 111 d,·" 1, pin~ th f.,m,h nu r-,nr, r:irc-pl:1n cnrrt·,pn nd..,;1 ht ltc :1hovc ,'<.,rn J""' n,·nt-. l-1;:un· ~ 1.. 11,;,,-,,.,; ~·h, rn:nre pn·,nta11,,n of 1hc nursin~ rnrc pl. inning I"'""·,..., It,111'1:,,11h" h-1,,I h,.,lrh t-c,1. dt1ion, or pn,hlt·m-. prioriti;,1-tl a<T1>rd i11g tn I l\. r, 111.. t. · '" !,;, p,,.,, :111\"< r><I 1111,11.,nd ·di,·rw,· Th,· p1inri1l;,1·d lt,·ahh Ct ndrt,,,, 1 pr, ! ' 1.,,! tlior, <irr~· f>''ndrns: larn1h nur.-111~ prrihl,·1n_-. he('Ct1IIL' th, !~'<-h ( Ill II I..., p "'"' h I' 11 1, n1111wttf JII of s. :ul 11111J <>l,jl·l tiq-. or 11ur,i11~ c-:ir. T1,,,..,,. j, 111,!,,t t 11\t ~-p,-cl!) t~w, >. JH·rt,-..1 h,·.,lth/dinrc. il nutt:nml·,, fomily r,.,....,...,r"" U"'-'-f..,. L. n, T,,rt. · n1pt: l<""-J!4) ou:t:on. t.-.,,.

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

The next step is selection of appropriate nursing intcrycntfon s. It focuses on nlternativcs a11cl decision on appropriate i ntcrvcnlil Hl measures ln1scd on the specific ohjcctives formulated. The intcrvcntiuns specify the nursing actic,ns 1,, help the family eliminate the b~1rriers Lu the perform:incc nf hen Ith 1asks or the underlying cause/s of non-performan ce of experted heallh I11sks. ·n1cse inlcl"\·l:lltions im:lude fomily fornsed alternntivcs or slratc~ics to help mcn,ht·rs rccr,gnize/dct. ccl herillh prnhlcms or opportunities to enhance wcllnc. ~s ~t:,tc or conditir:,n, mnnitor, eliminate, ronlrol ;ind manage hen Ith problems nr su:st:iin wcllnc. ~:, condition/,;, The method of nurse-family contact nnd the resources needed rirc :,pecilicd i1. 1 this,tcp to ensure that necessary prcp:. iratiou is don(; lo ;ichievc the,,hjectives of care in llw moi,t. efficient w,ty. 11)e last step is the devclopmr. :nt of the cv;dll.,tior L plan. IL specific~ the criteri:. i/outwml'. s and evaluation sland. ir<ls. is e;:plicit mc;;i,;urcs tha1 determine achievement of formulated objectives based on a required or dcsirecl level of perfonnan<:c or accepted change in he:1lth co11ditinn <Jr family reality. ·I11is close relation. ship between the evaluation plan and Jhe form11IAted goals and objectives e. ~pl Dins the broken liae between the two boxes in Figure 3. 1. Prforitizing Health Conditions and Problems Based 011 !ltnndnrds of community health nursing practice, the 111Jrse handles a caseluac. 1 r,f clients in a specific municipality or cluster of villa~es. Given a caseload of families, thr nnr<;t> m:,y realize th:,t cvcn fo1· just one family, a number of health condition!': and f. im. ily nursing problem s ~an nol he addressed all :it 1hc same time wil'hin n specific pt. :rir,u. Consic. lcring the situation. she can rank the idenrified health condilion !>/flrohlcm. <: into prioritie!>, Bailon nnd ;\'1aglayn (1990) clc,;sed a tc,ol called Scale for R:inking I fcnllh Cnndirion~ and Problems Accc,rding to Priorities (See Table 3. J), Thi:< 1001 aims 1,, rncililnte clecision-makin g in determinin~ which particular health ctmdilions and their cnrrespondin. l( family nursing problems can b E: addressed by the 1nmw with Lhe f:unil., a,; clic11t-p,irtner al appropriate point. ~ in time. There are f O\Jr criteria for determining priorities among health cc>nditfoa/s or problems. These include: 1. Nature of the conclition or problem presented-categori zed into wellness sl:llc/potcntinl, health threal, heulth deficit and foreseeable crisis; :?. t'louifinbilil:'Of the rondition e1rprobkrn-refers to the probnbililyof success in enhancing the wellness stat. :, impro,;ng lhe condition. minimizing. allevi:lting or totally craui..:aliug the problem through intervention: 3. Prt'vcntivc Pownli Cll-refers to the nnlureand magnitude of future problems thn1 rnn hr minimized or totally prevented if iol. irvention is done on the couc Hti<m nr prohlem under consideration; 4, Salient·,·· refer:s to the famity·s perception and evaluation of the condition or problem in lcrms of seriousness and urgency of attention needed or family rcaclillliss. The cxpcricn,;e<l nurse prnctitioner c;rn tlctermine priorities among hea 1th conditions or prnblcm s utilbr. i11g her jutlsnll'11t uu all these. four criteria without necessarily going thru11,-:h Lhc process of scllrini. 111l' nrithmetir coruputations utilized in the ~cnlc can. howe,·cr, ~11idc the slmll'nts or new practitioners who still need to gain the sklll i11 <. h:l'itli11g whklt foct11rs have mor..: weight over others. The <'nmpnrations help :,-ystcrnafru: priority :-cllinll, hy determinin g_ a specific score for each problem on the list. The nurst. > considt:r:. several factors in order to be objective in lhe decision-making process when selling prinri Lie~. 77

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

78 Prloritite the Health Conditions and Problems based on: Nature of Condition or Problem Modif1ablll t y Preventive Potenti;ll Salience Define Goals and Ob)ectfves of Care Formulate · Expected Outcomes: Cond,rions which sustain wellness ~tate Conditions to be observed to show problem Is prevented, controlled, re:. olved or eliminated. a ent response/s Spec,'lc, Ml'asurable Oent-centered Statements/ Competenc,es Develop the Evaluatio n Plan Specify: Criteria, Standards, Outcomes Based on Objective~ of Care Methods/Tools Develop the Intervention Plan Decide on: Measures to help family eliminate: ba rrlers to perform;,nce of health tasks underlying cause/s of non-performance or health UHk S Family-centered altern,mves to recognize/ detect, monitor, control or manage health condition or problems Determine Methods of Nurse­ Family Contact Spec Jfy Resources Needed

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

Factors Affecting Priority-Setting Consiucri11g Liu. : first critcrim1-nature of the condition or rrnblc:m prcscnwd-the biggest weight i!i i. :ivcn tn wellness st~1tc ur polcnti:il b(:t:i11se of the prnmium on client's cffort!l or c Jc,;irc lo sustain/rnaint:iin hii. ;h lc,v1JI wellness. The sa1m: wci1{hl is assigned ton lu. :alth deficit IJccaust of ii. <: sense of clinical urgc11cy which rn::iy rt:quire immeuiulc intcrvc111in11. Forcsc1:;1hlc; c·risis is given the least wcigbt because cullure­ Jinkcd vi1riahles/ f:1ct. ors usually provide our families with,ideq11nlc supr,orl Lo cope with c. levclopmcntal or sil. 11alio11,1l crisis. The 1111r!le considers fhc nvailability of the following factc Jrs in determining the modifiability of a ltcnlth condition or problem: 1. Current knowledge, technology and interventions to enhance the wellness state or mnnngc the problem :2. Resources of the family-physical, financial and manpower 3. Resource~ or Lhe nurse-knowledge, skills and time 4. Resources of the community-facilities nnd community organi:r. ation or s11ppor1 TQ decide on an appropriate score for the preventive potential of a health condition or problem, the following factors arc considered: 1. Gr. ivi Ly or s E--vcrity of the problem-refers 10 the prog. rcss or tl1c disease/ problem indicating extent of,damage on the patient/famil y; olso indic;1tes prognosis, reversibility or modifiability of the problem. fngencral, the more severe or adv. incctl the problem is, the lower is the preventive potcnlial of tl1e problem. 2. Duralion of tl1e problem-refers to the length of time the problem has been existing. Generally speaking, duration of the problem has a direct relntionship to gravity; the nature of the problem is a variable tbat may, however, alter U1is relationship. Because of this relationship to gravity or the problem, duration has also a direct relationshtp to preventive potential. 3. Current Management-refers to the presence and appropriateness of intervention measu Tcs instit11ted to enhance the wellness state or remedy the problem. The institution of appropriate intervention increases the condition's preventive paten. ti. ti. 4. Exposure of any vulnerable or high-risk g Toup-increases the preventivepotenlial of :i condition or problem. 79

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

,---~-----=--=-::N~K:1:N:G~H=E~A=l~T:H~C~O~NDITIONS ANO PROBLEMS TABLE ~-1 SC. ALE RA ACCORDING TO PRIORITIES I 1. Criteria Nature of the conc!Jt:,on or problf!m presenrea Scale"': wellness state health deficit health threat forseeable crisis Weight 1 3 3 2 1 2_ Modiftobi/lty of the condition or problem 2 ·scale 0: easily modifiable partially modifiable not rnodlfi'able 3. Preventive potential Scale,,.,. : high 4. Sa/fence moderate low Scale : a condition or problem, needing immediate attention Scoring: a condition or problem not needing immediate attention not perceived as a problem or condition needing ehange 2 1 0 1 3 2 1 1 2 1 0 1) Decide on a sc::ore for each of the criteria. 2) Divide the SC"ore by the hlgtiest p. ossible score and multiply by the weight: (Score/ Highest Score) x Weight 3) Sum up the seores for all the criteria. The highest score is 5, equivalentt0 the total weight. Developed by Si1lvac1on G, Ballo111. a nd Aracelis. Maglaya, For details, see article: "Tools and Guidelines for Nursing at the Family Level".-rne Anphi Papers, 2. 2(1):13,1977. Updated by A. S. Maglaya in 2003 ~ Figures (0,1,2,3) for the weights and scale values are arbitrary, dictated more by convenience ln computation. I . roent Effective health management/health maintenance pattern and desire for or engage or in healthy lifestyle activities increase the prevent iv~ potential of a wellness state condition. 80

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

To determine the score for salience, the nurse evaluates the fanuly's perception of the condition or problem. As a general rule the family's concerns. fell needs :md/or readiness increase the score on salience. Scoring After thl:! score for each criterion has been decided on, the number is divhlcd hy the highest possible score in the scale. The quotient is multiplied by the weighl indicated for the criterion being considered. Then the sum of the scores for all the criteri. i is taken. The highest score is five (s), equivalent of the total weight. The nun,;e considers as priority those conditions and prnblems with tota J scores nearer fi\·~ (5). Thu~. t J,c higher the score of a given cond. ition or problem the more likely ii is tnkcn a~ n pdority. With the available scores, the mrrse then rru,ks health conditions r Lnc. l problems accordingly. Formulation of Goals and Objectives of Care A goal is a broad desired outcome toward which behavior is directed. An example of statement of goal in family health nursing practice is: After nurslnn lnte Tventlon the famllywlll be able to take care of the disabled Ghlld c,empetently A cardinal principle in goal setting states that goals must be set jointly with the family. This ensures the family"s commitment to their Tealization. ]3;"1sic to the establishmen t of mutually accept. ible goals is the family"s recognition and acceptan ce of existing lwallh needs and problems. The nurse must ascertain t J1e family's knowledge and acccptnnce of the problem as well as the desire lo take actions to resolve them. This is done during the assessment phase. Barriers to joint goal settfog between the nurse and the family include the following: 1. Failure on the part of the family to perceive the ex. istence of the problem. In many instances the problem is seen only hy the nurse while the fomily is perfectly satis Aed with the existing situation. An examp)I;! of this is the threat posed by intproper waste disposal. Many families especially in the rural areas, have no sanitary toilet facilities. But to i:;ome fo mil ies this is ao problem at all since there is the wide open field, the bush or Llw river which can serve t J1e same purpose. 2. The family may realize the existence of a health condition or problem but is too busy al the moment with other concerns and preoccupations. For example, a mother may perceive the need for immunization for the children but her household chores take precedence over other concerns. 3. Sometimes the family perceives the existence of a problem but does not see it ns serious enough to warrant attention. Tbe common cold is a condition that is all too often taken for granted. The same is tn1e with intestinal parasitis m which is commonly regarded as a normal condition in childhood. 4. The family may perceive the presence of the problem and the need to 81

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

82 lake action. lt mny, however, refuse lo face aad do something about the situntion. Freeman (1957, pp. 126--128) offers the followin g reasons for this kind of behavior. a. foear of conscquence(s) of Laki. ng action-For example, diagnosis of a disease condition may mean expense or social stigma for the family. b. Respect for tradition/cultural beliefs, v. ilues-In Philippine culture, elders piny a part in decision m. iking. Behavior which al'e not sanctionc<l hy the old fo. lks in the family arc not likely lo be adopted. A couple, for instnnce, muy uot ncecpt the gonl oflimiting family size to just three children iftl1cirparenls do not npprove of contraceptive pmcticc. c. Pnilurc to perceive the benefits of action proposed-This could be a function of a client's p1·evions expedence with health workers and their services. Going lo a health cente1·, for example, is un advice frequc11tly given by nu Tses. When this doe:; nol yield beneficial results from the point of view of the family, it will be ignored the next time it is offered. cl. Failure to relate tbc proposed action to the family's goals-Famj Jies differ in their prioritiz ing of goals. Econmnic and social goals generally occupy a higher position than health goals in fanlilies' rnnking of their concerns and preoccupations. W1~en proposed actions tu improve health are not related Lo frunily's goals (e. g. economic stability), they arc not likely to be accepted. 5. A big b:irrier to collaborative goal setting between the nurse and the family is failure to develop a working relationship. Nothing will be accomp lished, as a m::ittcr of fact, in a nurse',s work with families unless the family sees the nurse as someone who is genuinely concerned with its welfare. The elements of mutual respect, trust and confidence a1·e crucial to the success of U1e nurse-family partners hip towards better ]1ealth. Goals set by the nurse and the family should be realistic or attainable. They should be set at reasonable levels. Too high goals and their eon sequent frulure frustrate bo U1 the family and the nurse. ' A clear definition of rhe problem situation and an accurate assessment of available resources facilill. lte the set1ing ofrealistic goals. Both of these are functions of the depth and breath of the assessment process. Goals, like objectives, are best stated in terms of client outcomes, whether at the individual, family 01· community levels. Objectives, in contrast to goals, refer to more specific statements of the desired results or outcomes of care. They specify the criteria by which the degree of effectiveness of care is to be measured. Goals tell where the family is going; objectives are the milestones to reach the destination. · Objectives stated as outcomes of care in fam. :ily health nursing practice specify physical, psychosocial states or family behavior (or competencies). Examples are given below: 1. After nursing intervention, the malnourishe d preschool members of the family w:ill increase their wejghts by at least one pound per month. 2. After nursing intervention, the family will be'able to:

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

a. Feed Lhc rncntolly rct. nrdcd child according to prescribed quantity and quality of food. b. Teach the nfontally rctan Jecl chili] simple skills related to the activities of daily living. c. Apply measures taught lo prevent infedion in the mentally retarded member. '11ie 111ore specific the ohjective1,, the easier is the evaluation of their attainment. specifica lly staled objectives define the criteria for evaluation. Objectives vary nccording lo Lhc lime spnn required for t J1cir realization. Short­ term or immedi. itc ohjcclivc.-;,1re formulated for problem situation s which require immedintc nll'cntion, and results cnn he observed in a rnlntivt:ly short period of time. They arc,wcomplishcd with few 1111rsc-family contacts,rnd with the use of relatively less resources. l. 011~-lcrm or ultimate ohjec Lives, on th<. ! other hantl, require several nurse-family c-11cc>1111t,ers and an invest men L of more resources. ·111c n:iture of outcomes sought require time Lo demonstrate. Suc. :h is the: natun~ of behavior change which is often the object of 11ursi11g intl;!rvcntion. Mctl. ium-tcrm or inte1-medi ate objectives are those which are not immediutely achieved and are re. quired lo attain the loog-tenn ones. As wilh goals, objectives should be realislk and attainable considering the resources of the nurse, the family. iml the commun ity. 1 n. i<lcliti<Jn, they should be measurab le. Speciiic statement s of objectives foci! itate the evaluation of their attainme nt. Objectives and evaluation are directly related. Wl1en objectives are stated in terms of observable fact nnd/or behavior, the criteria for evaluation become inherent and evident. ,axample: Nursing goal The family will manage malaria as a disease and threat In an endemic area. Short-term/Immed iate objecttve-The sick member/s wlll take the drugs accurately as to dose, frequency, duration and drus combination. All members will use self-protection measures at night tilt early morning when bltfng time of the mosquito vector is expected. Medium-term/Intermediate ob Jectt-ve-All members will have regular medical check-up-and laboratory confirmation (i. e., blood smear) to monitor presence of malar Ta . Long-term objective-All members will carry out mosquito vector control measures. DEVELOPING THE INTERVENTION PLAN The next step in developing the family nursing care plan is formulating the intervention plan. This involves selection of appropr iate nursing interventions based on the formulated goals and objectives. In selecting the nursing interventions, the nurse decides on appropriote nursing actions among a set of alternative s, specifying the most effective or efficient method of nurse-family contact and the resources needed. Some examples of methods of nurse-family contact include the home visit, clinic conference, visit in the work place, sc;l]ool visit, telephone can, group approach (like health classes), 83

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

1 and use of the moil (e. g. letter /s, electronic mail). The resources which include n1alerial (e. g., supplies, equipment, teaching aids/kits. visual lr\aterials, handouts, charts, etc. ) or bunwn (e. g.. other health te::im members. de"elopment workers, community leaders) must be !. pecificcl in the plan to ensure thnt ncccssucy preparation, coordination and collaboration are done before the implement. ttion phase to maximize efficiency. The following general directions for nursing interventions can guide selection of appropriate nu. rsing inte. r,entiom;: 1. 2. 3. 4.. '\. nalyze \,;th tbe Family the Current Situation and Determine Choices and Possibi. Hties basecl on a Lived Experience of Meanjngs and Conce1·ns. Develop/Enhance Family'i; Competenc ies as Thinker, Doer and Feeler Focus on Interventions to Help Perform the Health Tasks Catal~-1,e Beha"ior Change through Motivation and Support. Analyze Realities and Possibilities based on Family's Lived Experience of Meaning and Concerns Family life and aursing p_ractic _e are bo~ phen?mei:iolo~ical unified realities of riencing the self interacting \\'1th others m specrfic s1tuabons that are affected bv expe.. d-. d--meanings. concerns. emot1_0J1S. past experie J1~es _an anti~tpa~e fnture (Benner and Wrubel 19s9). Theappro~r1nteness ?fthe nursm~ mterveotton 1~, therefore, dependent 00 the Jived meaning OI t. he experiences of fan1. 1ly members vv,th each other and with ~i-;e nurse, gi\·en the current _situation _and_ possibilities in hea)th and illness realities. Because family health nursl. tlg practice 1s a phenomeuolog1cal a-. _-perience for the fan,ih" and the nurse. the family becomes an active participant in the application of the n~rsing process. The family aud the nurse are participants in an active, mutual, dynamic interchange of realiti~s, conc:~rns _and resources_. Both n~ed to _analyze and understand the current health/illness situation as the family expenences 1l. To ensure appropriateness of oursi!1g inter,ention, tbe nurse nee~s to. expl<;>re with the fa_mily the p0ssibilities and choices presented by the current situation given the mearungs, con;ems, socia J relations, and resources. Through the participatory approach the nurse can select experiential learning strategies to help the family understand its behavior in terrns of dynamics, realities, vulnerabilities and po. ;;sibilities. Through the ULook-TI1 ink-Acl~ cycli C<ll process, the family can be encouraged to analy7. e antecedents or factors contributi ng to or producing specific health problems. Based on the analysis, the nurse can cata Jy,:e learning processes such that tl1e family caa learn to deconstrucl m. indsets or current beliefs and be guided on how to re-order patterns and relationships for fresh insights and workable options to modify and im pro,·e family dynamics aod realities. Develop/Enhance Cognition, Volition and Emotion To determine the appropriateness of nursing interventio n, the nurse is given a choice of possibflitics that helps her and the family gain a clearer understanding of the self as a thinker, a doer and a feeler. The choice contributes to a process of self-under standing of the family as a system and of each individual member (Allanach 1.-988, pp. 78-79).

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

Nursin1; interventions tluit cnhnncc,w ma. ximi:,,c the competencies c,f the fnmily as thinker include mnking inform;-i Lion/data or knnwlt'dp,c· rl'mlily nv. i ilnuk· 1111d m·ccssiblc for ease nf and <'onfidcn..-c 111 t111dt'rst,111d111i n1rrcnt s1rur1tio11-. 1n health and illness. Oecisio11-mak mg 011 approrri:it e :H·t i1111-, t" t. ti-a :1 rt'. I I k C'wisl·. 1 ·nit. 111e·,1 I. I lt\'l' loping :ind maximizing th<' skills :111(1 cnmmu11k,11iu11 <'>n1petc11d,·, of thr 1':im1l~ as tlncr c11hancc confidence in carry111~ nut thl' 1\l'ed1<l i111cr.,111i1111..: tn lnitiatv.,nd s11-:1;1i11 1'111111gc for health promoti,111 ~md 111oi11t11u1m·<·. nnd acn,rnte di,L':i,-,·/pn>l,lc111 nrnni1J!1·1111 ·nt. As feeler. the family need~ l di. !, dop tr,-tr~t11llhcn its., rr..,,-1 "''-' 1·<>111 pd1·1wie'-i II onli!I' l<J appropriatel y acknn\\'lcdgc aml undcr:,tand c111uli11m, gcrwrall·d b~ family lifr nr henlth ;ind illness situations (e. ~.. fe,1r, nn),(cr, an:dcty. jc:1lrm J<y. guilt). By doing so $l1Ch emotions r:m he lrnnsrornwd into growth-promoting C'hohr t-, nnd actions. \'i11cn the family renli:,es that acknowll:tl J?,iniz fcdin)!..-: a11d all<n,;n~ lhcm lo guide understanding of lhc situation and tht J sci f. l lw cxpcricm. :c <. :. 111 al lain llw greatest freedom in moving into new pt1ssihili1ie:<. Bcnnl'r nml Wruhel (1989) succi111·1ly expl::;a. :. ;ir:. :. 1:... :----------------------------------.._ By acknowl~dgin~ thl! J1. v~II ng in It o<. 1. om;,1111I 111c11,""W,,1 our f,., !mg!. v,f. ! crn gain the skill lo rehe. :tr~r :ind return to po 1111, f~clrn" ~\I' h, ~ 10v. pr d. c;om!ort,1nd contentment... Sy remembering. ind rf! ll P"",,1:111 pc, 11111c t,elins, on r1 w oc CJJs,or\$, we are sometim Ps ""~bled to ch~n&e our co t ·xt Qi',;hr..t1m,t;,,n,,, to on~s th t fc~tc, those Feelings, see new poss1t:tilities for,tion 11th um:h. w ·cd cu cum t mce~. or-.,mply experience pleasure and see thln&s 11. i ro. _l r li"l11 ih,s pn~H\'e. 1b11ttv m'-1 pr<,,,cit n respite and offer perspecbve d 1r1ri11 a mn of n1; t,,, It,; l1n: ~u<:11 ii lu 1r or an,Je~y. Thls respite may be what one 112cd5, 10 fo,c nd und t!. tancl tl:n ourre of the ncg;nive feelln. gs (pp, 170-1711. Focus on Interventions to Help the Family Perform the Health Tasks The nurse needs to focus her choice of ialcrvcntion. s on helping the family minimize or eliminate the possible reasons for or t:auscs of Lhc family's inability to do the health tasks: 1. Help the Family Recognize U1e Prohlem. Examples of nursing interventions to enhance the fomily'i. ability tc, rccugniz. c its health needs and problt:ms i,u. :lutl!:!: (a) inc:rc. 1. sing I he fnmily's knowledge on the nature, magnitude and c. 1us P of the prnhlem ; (h) helping the family see the implications nf the :-in. 1iition, or the et Jn. sequcncel, of the condition; (c) relatin;,; hc..lth need:. to the !/,\Jali-: of the fa mil~ (both health ;111cl non­ health relatcu :;ual<;); (ti) cncouragin)!, posilh·e or,,·hole. some emotional attitude toward the prohlcm by affirmin)'!, the family's c-~1pabilities/ qualities/resources and providing information on a,·ailable options. 2. Guide the Family on Ho·w to Decide on Appropri ate Health Actions to Take. Tbii;: can he done through: {a) illcalifyi11g ur cxpl()ring with the family Lhe courses of action,1\'ailable a11d Lhc r~ources needed for each; (b) discussing the cc H1sc4u1mces of each course of nction nvaifoblc; and, (c) analy-1. ing with the fomil_\' the 1:011;,cq 11cmccs nf innction. '3-Develop the Fami. ly's Abi Jjty and Comm ib'nenl to Provide Nursing Care to its Men1bers. The nurse can increase the family's confidence in providing nursing care to its sick, disabled nnd dependent 8. 5

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

4-86 member llu·oul!,h demonstration and practic. e St!ssions on procedures, treatments or techniques ut-ifo:ing readily available, low-cost materials and equipment and other 1·esources. Contracting is creative interventjon that can maximize opportunities to develop the ability and commitmen t of the family to provide nursing care to its members by focusing on assisting the member::-to act effective ly on their own behalf (Clemen-Stone and others 2002, p. 281). It is an intervention whereby the nurs C' l;reutes n situaliou in onler Lhut the client learns to achieve a specific health-related behavior thro11gh a sequentially arranged e. xp Hcit steps and c. :om. lilio11s or element s jointly identified by both parties. This intervention uses reinforceme nt contracts on a variety ofhfilllth-related hehavior requiring complex behavioral changes such as adherence to diet, medicati on and othe1· treatment regimens to mnintain desirable laboratory values. lose weight, and control blood pressur. e (Steckel 1980, p. 1597). Such complex bchnviora l changes n::quire the perform ance of e/1.--plicil steps (intermediate behavior s) and encl, step reqwre. s reinforcement if the terminal new behavior is to be learned and maintained. Contracting provides a systematic method of increasing desirable client beha,;or through the u:,,:e nf the principle of positive reinforcement. Using-this 1>rinciple the nui:se and the client mul:l. 1ally agree on favorable reinforcing experiences or consequences as 1·ewards when the client performs the desired behavior. In order to mnke this intervention effec:Live, the nec:essai:-y elements of the desired beha,;or must he made explicit and must be,Hitten in the form of a. n agreement. To make t JJe behavior consciously reinforced it mm,"t be observable a11d mt:asurab le. The contract specifies the terminal, intermed iate hehaviors and the reinforcers as rewards for the client in return foi: performing the behaviors. The client and the nurse jointly identify the terminal beha\ior and ll1e cumponent intermedia te behaviors. Steckel used contr. 1cting a::; interventi on in her researchei; on patienr adherence to health care prescriptions. She recomme nds that the contract be written, dated, signed by a JI parties concerned and a copy is given to each one. Furthermore, she specifies in her contract Lhe method for monitoring the behavior Utr Qugh recording. See Box 3. 1 for a sample family-nurse contract. Enha. nce the Capability of the Family to Provide a Home Environment Conducive to Health Mainten ance and Personal Development. l11e family can be taught specific competencies to ensure such a horne environme nt through environment al modificu tion, manipulation or manngcmcnt In minimize or clim. inate health threats or risks or Lu insta JI facilities for nursing care. The family c·an learn LO constn1c1 or mod if,,-needed facilities in the home such as a commode for a disabled or agc<l ~ember who car, not use the family·s toilet because of distance. Em iron mem~I c·ond it ions con<l uc. :ive to hrecd i ng and b abitation of vectors of disease.,:; (such as mosquitoes} can, likewise, be improved by the family if it has the necc.-=;snry competenc ies to cnrry out vector control measurt>s. For example. the nurse can teach !. 7:>ecific techniques or procedures like clearing Slrf'ilm h::inks of overhanging veget. ution and debris l. O expose them to sunlight and speed up water How to eliminate breeding sites of Anophe les flavirostris, the primary mosquito vector uf Malaria. Another example is U1e need to change water in flower vases..

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

5-.... at least every two days or not to allow water to remain stagnant. in artificial containers (like old tires or discarded cans) in order lo eliminate breeding places of Aer Jes egypti, mosquito vector of Dengue and Dengue Hemo1·rhagic Fever. To minimize or eliminate psycho-socia l threats or risks in the home environment, the nurse can work closely with the family to improve its commun ication patterns, role assumptions, relationships and interaction patterns. Facilitate the Family's Capabilit y to Utilize Co1n1nunlly Resources for Health Care. Another major intervention involves maximum use of available resources through coordination, collaborntion and team work provided by an effective referral syslem. Ea:,--y access to available health and socio-economic resources starts with maintain ing an updated file that lists such resources, their addresses or telephone numbers and specific services offered. A sample format of the file or index of community resources is shown below: Name of Agency Officil cand l\'pe of Client Requirements/ and Person to E-mail Address/ and Specific Procedures for Contact Telephone S-ervices/ Referr;il Number Schedule A two-way referral system can facilitate mobilization of resources for families. The nurse or the agency establishing such a system can have previous arrangem ents or agreements on the referral procedures and services with the agencies or resour. ces involved. A sample two-way referral form is shown in Figure 3. 2, The nurse of the referring agency accomp]jshes the first half of the form providing the necessacy information or case summary and specif);ng the reasons for referral or the services requested. She can let the family bring the form to the agency where referral is made. She can advice the fam1ly that after the necessary consultation is done v,ith the agency where referral is made, the family can bring back the second half of the form with information on services none, finclings and recommendat ions. Other alternatives are possible, such as a messengerial service that brings the fonns from one agency to the other. The nurse can also do the necessary communication \~ith ll1e personnel of the agency where referral is made for follow-up and coordination. An effective two-way referral. zystem ern;ures monitoring of the case, problem or situation, follow-up ofreq uired interventions, case or services and evaluation of the clients· status or family's problem/si. tuation. 87

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

88 (letterhead of Referrlng Agency specifying Name, Address and Telephone Number) Name of Agency to Which Referral is Made:-_· ________ _____ _ Address : ______________ Date:-Name of Patient/Famlly Head:-------------·--------Age: __ _ Sex: ____ Civll Status: ___ Occupation: ________ _____ _ Address : ___ _ Case Summary : Reason for,teferfal/Servlces Requested : Signature of Referring Personnel and Designation . " Name of Referring Age11cy:_--'--"---Addre. ss: _______--,-~-------------Date: ________ _ Name of Patient/Family-Head:_::::. ;.--". :..;. ;~:!. :-----,-----Age: ___ sex:. _...--------,,-$Af Ylces Oonm/Flodfr,s. $/Reoom m~end~ons: · '" ' ' I ,., ·signatur~ and Des Jgnallon (fit!e back-page Jor lnstrl)G#,t>nj) Fie-3,2. Sampla Two-Wa~ Refwi Form

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

(back page) Two-Way Referral Form Objective : Set-up a r'eferral system that facilitates ~ccess to services and information by client/ family and agencies. Instructions: 1. The personnel of the referring agency (e. g. barangay station; R. H. U. ) fills up the first half of the form providing pertinent data as indicated (i. e. case summary and reason for referral or services requested. 2. The client/family brings the referral form to the agency where referral Is made to avall of the services needed. 3. The personnel ofthe agency to which referrallsmadefills up the second half of the form, specifying the services renderetf/findfngs and recommendations, and sends back the form to the referring agency thmugh the cllent/family. 4. The client/family brings back to the referring agency (e. g., barangay station; R,. H. U. ) the duly accomplished second half of the form for decision, action or Information. The form Is flied with the client's record. 89

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

Catalyze Behavior Change Through Motivation and Support. To bring about self-directed cbange, people must learn to learn from their experiences. According to Ch. in and Benner (1976, p. 3. 7), frequently people have learned to defend against the potential lessons of experience when these threaten existing equilibria, whether iu the person or in the social system. I11 order to help people lower their defenses and allow themselves to experience the needed change, it is necessary to have a learning emrironrnent that nurtures the change. The change agent can help the client pul to maximum use valid knowl. edge through concern for: (1) human needs or the "use-val ue~ of a given piece of knowledge; (2) security, trust, self-esteem, self-identity, group esteem and group identity; (3) accurate and appropriate preparatio n and transmissiuo of messages. To cat Rly. tc the change process, support is needed so that an otbenvise insecure, threatened or anxious client who is facetl with the stresses of an unfamiliar reality can e.,1>erience stability or feel some sense of self-trust or confidence to sustain actions and complete the behavior change. lo family health nursing practice, the family as a system needs to achieve optimum reality-orientation in its adaptation to changing internal and el\. 1:ernal environment. This is done by developin g and institutiona lizing its own problem-solving structures and processes t J1rough performance of the family health tasks. To catalyze the beh:wior ci1ange towards problem-solving competencies, a theory of family healtb nursing intervention was developed by Maglaya (1988). Motivation and support are components of this intervention. Motivation as conceptualized in the intervention theory is :rny ei,:perience or infomiation that leads the family to desire and agree to undergo the behavior change or proposed measure and take the initial action to bring about the change (p. t8). Support as an intervention is any experience or information that maintains, restores orenbances tbe capabilities or resources of the family to sustain these actions and l'Omplete the change process. The intervention leads the family to feel "secured~ or "in control of the situation ~ in the face of uncertain ties, stresses, blocks or ba. rriers to the solu lion of the heallh condition or problem or threats to self-esteem and affection or danger to life (p. 19). To il Justrate, a young mother with a severely malnourished nine-month old baby suffering from dia1·rhea can be so overwhe lmed with her child's condition that she rejects any advice to do oral reliydration and continue feeding the child. Experience taught the mother that such actions lead to vomiting and more frequent bouts of diarrhea. Through m~tivation and support, the nurse c:m help the young motlier understand the cyclical relationship of diarrhea and malnulrition and the causes of diarrhea when giving oral feeding. She can develop the mother's competencies to administer oral rehydration slowly through the cup, spoon or dropper. She Clln demonstrate to the rnot J1er how to prepare and give easily digested rice gruel mixed wi Lh protein concentrates. made from powdered beans, sun-dried or toasted-dry small. fish or shrimps (see Chapter 14). During the initial ex-periences of the mother in carrying out such measures to manage diarrl1ea, the nurse's physical and psychological availability or accessibi Jjfy are sources of support especially during experiences of fear, doubt and hc Jplcssncss. When the nurse can not be physically presen L, the young motlier can be made to feel that the nurse's help is readily available through the clinic visit, telephone or written note. · ln an evidence-bas ed inten1ention research on family empowerment for malaria prevention and control in a rural barangay (village) in Abra Province, motivation­ support intervention consisted of four major components (Maglaya el al, 1999). The first component included visioning or goal-setting activities which helped families clarifr or spec. :ifr the reasons for the needed behavior change. The second component consfared of plannlng sessions which focus. ed on developing family competencies to specify the objectives and strategies to achieve expected goals (i. e., what can be done 90,

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

to achieve the specific behavior changes and how t11ese can be carried out). The third component consisting of implementation or practice sessions centered on providing the families guided experiences or opportuniti es to carry out or practice the competencies/ skills lean1ed. The last component focused on evaluatio-n activities which developed the faro. Hies' capabilitie s to specify "What happencdr, "What were missing?" and, "'What to do ne"'t?" Research findings showed that these four components of ilie motivation-support intervention significantly improved the fam}lies' competencies on early casefinding, prom pl/appropriate treatment, use of self-protection measures and environm ental manipulation to eliminate the breeding and resting sites of the mosquito-vector of malaria. Fleury's model of wellness motivation was adapted using the motivation-support intervention. Families were guided thru the behavior change process: from constructing the intention to initiate/sus tain the change to translating the intention into actions, and lastly to integrate the actions/change into exjsting lifestyle. Appendix E specifies the nursing interventions to facilitate the families' movement through each stage. Chapter 18 describes in detail the family empowerment process and outcomes based on an intervention research on malatia cont Tol done in Danglas, Abra Pi:ovince from 1997 to 1999. Criteria for Selecting the Type of Nurse-Family Contact Effectivity, efficiency, and appropriateness are major criteria for selecting the type of family-nurse contact. While the home visit is expensive in terms of time, effort, and logistics for the nurse, il is an effective and appropriate type of family-nurse contact if the objectives and outcomes of care require accurate appraisal of family relationships, home and environment, and family competencies (i. e. ilie best opportunity to obse. rve actual care given by family member s). The clinic or office conference is less expensive for the nurse and provides the opportuuity to use equipment that cannot be taken to the home. In some cases, the other team members in the clinic may be consulted or called upon to provide additional service. The clinic or office conference also emphasizes to the family the importance of empowerment and asswning responsibility for self-help. The telephone conference may be effective, efncient and appropriate if the objectives and outcome s of care require immediate access to data, given problems on distance or travel time. Sttch data include monitoring of health status or progress during the acute phase of an illness state, change i. n schedule of visitor family decision, and updates on outcomes or response s to care or treatment. The written communication is another less ti. me-consuming option for the nurse in instances when there are many priority families needing follow-up on top of problems of distance and travel time. If the family is motivated and independent enough such that the nurse can use the advantage of placing responsibility for action on the family, sending a letter, note (as reminder, follow-up on medica. tion/treatment or update on progress or referral) and learning materials are appropriate, effective and efficient options. A school visit or conference provides an opportunity to work with the family and school authorities on how to determine the degree of vulnerability of and work out interventions to help children and adolescents on specific health risks, hawr<ls or adjustment problems. An industrial plant or job site visit is done when the nurse and the family need to make an accurate assessment of health risks or hazards, and work with employer or supervisor on what can be done to improve on provisions for health and safety of workers. 91 l

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92 DEVELOPING THE EVALUATION PLAN The evaluation plan specines how the nurse will determine changes in health status, condition or situation and achievement of the outcomes of care specifjed in the objectives of the family nursing care plan. The plan includes evalua. tion criteria/ indicators, standards, methods and tools/evaluation data sources. As the nurses systematic guide to facilitate improvement in client's health status, home and environment condition or situation, behavior or role/task performance, the evaluation plan specifies the criteria as objective, measurable and Oexible indicators to determi ne achievement of expected perlonnance, behavior, circumstances or clirucal status (ICN 1989). An evaluation ~tandard refers to t11e desired or acceptable condition, clinical status or level of performance correspond. ing to an evaluation criterion or indicator against which actual condition, clinical status or performance is compared. The evaluation plan also includes evaluation methods and tools and/or evaluation data sources. Examples of evaluation methods include direct observation, interview, oral or written tests, record revie\,v, health/physical examination (e. g. _vi~a J signs and anthropometric measurement-taking, IPIPA, etc. ), Note that these are s1m1lar methods used during the assessment phase. It_must be re~embered that because the cyclical nature of the nursing process, e~aluation ushers m the assessm~n t phase at the next level of app Hcalion of the nursm~ proc_ess. ~valuation tools mclude performance evaluation checklist, ratmg scale, inte IV1ew guide, food recall form, food frequency and food record form as examples. Instruments such as weighing scale, thermometer, blood pressure apparatus, tape measure and glucometer are e..xamples of evaluation tools too. Evaluation data sources are records and reports which document the data results generated from specific methods and tools to determine achievement of expected outcomes based on the goals/ob jectives specified in the family health nursing care plan. See Table 3. 2 for a sample evaluation plan · DOCUMENTATION The family care plan isa written guide of the nurse and family to ensure a systematic approach to planned behavior change. Appendices C2 and C3 include The Family Service and Progress Record (FSPR) and the instructions on the Use of the Family Service and Progress Record. Together with Appendix C1 (Charting Nursing Care, Progress Notes and Client Responses/Out comes), these tools are examples of how to set up a record keeping system which proyjdes direction for planning, implen1entation and evaluation of client care. Accurate record keeping is an important responsibility of the community health nurse. It provides evidence for professional accountability and quality care.

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

i t g_ S°· &> ij, ~ " ~ 1. 0..., I. OUTCOMES Goal: Improve the nutri-tional status-of the two-year old family. member Objectives1 The family will be able to: 1. Provide adequate care to the two-year old member. . TABLE 3. 2 SAMPI. E EVALUATIO N PLAN EVALUATION CRITERIA/I NOICATORS EVALUATION STANDARDS Method Weight (as nutrltfonal status crlte-Increase or at least 1. Weight Monitor-rlon) kilogram In six weeks. Ing Performance Criteria/Indic ators: La identify inadequacies Jn specific Correct identification of Dietary history nutrl E!fll S generated from the inadequacies in intake of taking baseline dietary intake of th@ sperrlfic macronutrients, child. vitamins and mlnerals critical to growth, bone-development and strong immune system. Lb. Prepare meals based on Mcurate application of Record Review cycle menu plan Dally Nutrition Guide Pyramid for Filipino children 1-6 years. EVAWATION Tool/Data Source weighing scale, Early Chilonood Care and Development Card for 0-6 years food recall form or food frequency I record I ' ! menu plan l I ; l -j ___...

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

i t g_ S°· &> ij, ~ " ~ f \ TABLE 3. 2 SAMPLE EVALUATION PLAN (Continued) :~. ·,. ~;·i J6ia Mis <-~:_;_:. i... _~ IYAWA1IDII MWAl10II f. '1': ·'>-'·,,-· _,.,...,.._JIIIN..... n... a .,--'.... '.... f1'MIDANII Method,....., __ _ · ' miparau1>n QT o6iei ·-···n penormance i=v111uamn meats aulded by prtnclples such as nutrient preservation, Increased variety and appea Ung to taste. 1. c. Feed the child based on Child's dally food Recor,d Review estfmated food record aareed upon quality and Intake based on Observation performance e,,a\uatlon checklist quantity of food. recommended energy and Interview and nutrient Intake for age group 1. d. Carry out strategles/ Appropriate and Interview and performance evaluation checklist measures to address child's effective measures Observation eating Idiosyncrasies and based on child's age problems and nature/magn ftude of eating/feeding PJ'Clblems 2. Utilize community 2. a. Bring the child to the health Clinic follow-up at Record Review Early Childhood Care and resources for care center/clinic for regular least once during the Development Card for 0-6 years old early childhood growth month 1 monitoring and care. ,

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

p 1. 3. 4. 5. 6. 7-8. 9· ll-14· 15· REFERENCES Alfaro-Le Fevre, R. (1999). Critical Thinking in Nw·sing. Philadelphia: W. B. Saunders Company. Allanach, E. J. (1988). Perceived supportive behaviors and nursing occupational stress: An evolution of consciousness. Advances in N11rsing Science (1), 73-81. Bailon, S. G. and Maglaya. A. S. (1990). Family Health Nursing-71,e Process. Manila: Brainchild Managers and Consultant<,;. Benner, P. and Wrubel, J. (1989). 71te Primacy of Caring: Str-e. ~s and Coping in J-le_alth and Illness. Menlo Park, Ca: Addison-Wesley. Chin, R. and Benner, K. (1976). General Strategies for Effecting Change in Human Systems. In WG Bennis and others (Eds. ). The Planning of Change (p. 37). New Yock: Holt, Rinehart and Winston. Clemen-Stone, S., Mc Guire, S. L. and Eigsti, D. G. (2002). Comprehensive Communitt J Health Nw·sing: Family. Aggregate and Community Practice. St. Louis: Mosby. Denham, S. (2003). Fwnily Health: A Framework for Nursing. Philadelphia: P. A. Davis Publishers. Fleury, J. (1991). Empoweri ng Potential: A Theory of Wellness Motivation. Nursing Research, 40 (5), 2:86-291 Freeman, R. B. (1957). Public Health Nursing Practice. Philadelphia: W. B. Saunders. Little, E. and Carneva li, D. L. (1969). Nursing Care Pla,ming. Philadelphia: J. B. Lippincott. Logan. B. B. and Dawkins, C. E. (1986). Family-Centered Nursing in the Community. Menlo Park, Ca: Addison-Wesley. Maglaya, A. S. (2008)-Deliverin g Quality Sen,ice Serving Commun ities: Nurses leading Primary Health Care. Philippine Journal of Nursi11g, Vol. 78 (2), 10-13., :Maglaya, A. S. (2004). Nursing Practice m the Community. (4tl1 ed. ). :Marikina City: Argo. nauta Corporation. Maglaya, A. S. and others. (1999). A family health empowerment and intervention model towards prevention and control of malaria in the Philippines: The local government unit/nn-al health llnit perspective. Manila: DOH-ENHR. Maglaya, A. S. (19~8). Behavioral Catalysis: A Theory of Nursing Intervention i. n Family Hea Jth Care. The Anphi Papers, 23 (2), 14-20. 95

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