Community LE 5

• Death rate


  Number of deaths/1,000 midyear population in a given year
• Cause-specific Death Rate


  Deaths per 100,000 because most causes of death, rates of occurrence are low
• Fetal death ratio


  Fetal deaths/1,000 live births
• Fetal death rate


  Fetal deaths/1,000 births (births plus fetal deaths)
• Neonatal mortality rate


  Neonatal deaths per 1,000 live births
• Perinatal mortality rate


  Number of deaths of fetuses weighing at least 500 g (or when birth is unavailable, after 22 completed weeks of gestation or with a crown-heel length of 25 cm or more) and early neonatal deaths per 1,000 total births
• Proportion of dying from specific cause

  Deaths from a specific cause can be expressed as percentage of all deaths
• Infant mortality rate


  Number of deaths of infants under age 1 per 1,000 live births in a given year
• Maternal mortality ratio


  Number of women who die as a result of complication from pregnancy or childbearing in a given year per 100,000 live births in that year
• Home Visit


  A (professional) family-nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities

  
• Purpose of Home Visit

  • Make use of the inter-referral system and to promote the utilization of community services
  • Assess the living condition of the patient and his family and their health practices in order to provide the appropriate health teaching
  • Give health teachings regarding the prevention and control of diseases
  • Give care to the sick, to a postpartum mother and her newborn with the view teach a responsible family member to give the subsequent care
  • Establish close relationship between the health agencies and the public for the promotion of health
• Principles of Home Visit


  • Consider and give priority to the essential needs if the individual and his family
  • Use of all available information about the patient and his family through family records
  • must have a Purpose or objective
  • Involve the individual and family
  • Should be Flexible
• Guidelines for Home Visit


  • NEEDS - physical needs psychological needs and educational needs of the individual and family
  • ACCEPTANCE - acceptance of the family for the services to be rendered, their interest and the willingness to cooperate
  • POLICY - policy of a specific agency and the emphasis given towards their health programs
  • ACCOUNT - account other health agencies and the number of health personnel already involved in the care of a specific family
  • EVALUATION - Careful evaluation of past services given to the family and how the family avails of the nursing services
  • ABILITY - ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits
• Bag Technique


  a tool by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort with the end view of rendering effective nursing care to clients
• Principles of Bag Technique


  • Performing the bag technique will minimize, if not, prevent the spread of any infection
  • It saves time and effort in the performance of nursing procedures
  • The bag technique can be performed in a variety of ways depending on the agency's policy, the home situation, or as long as principles of avoiding transfer of infection is always observed
• Points to consider for Bag Technique

  • The bag should contain all the necessary articles, supplies and equipment that will be used to answer the emergency needs
  • The bag and its contents should be cleaned very often, the supplies replaced and ready for use anytime
  • The bag and its contents should be well protected from contact with any article in the patient's home
  • Consider the bag and its contents clean and sterile, while articles that belong to the patients as dirty and contaminated
  • The arrangement of the contents of the bag should be the one most convenient to the user, to facilitate efficiency and avoid confusion
• Family Health Teaching Plan for Home Visit

  • Health problem - Identified health condition that was presented during home visit
  • Goal of care - SMART
  • Nursing intervention - Independent nursing action mainly will focus on how to answer the health problem through health teachings and actions that are appropriate and evidence-based
  • Resources - Materials needed in conducting health teachings during home visit
  • Expected outcome - Assumption after providing health teaching
• Environmental Health


  Refers to all physical, chemical, and biological factors external to a person, and all related behavior, but excluding those natural environments that cannot be reasonably modified
• "As a fundamental component of a comprehensive public health system, environmental health works to advance policies and programs to reduce chemical and other environmental exposures in air, water, soil, and food to protect residents and provide communities with healthier environments"
• Areas of Environmental Health


  • Built environment
  • Work-related exposure
  • Outdoor air quality
  • Healthy home
  • Water quality
  • Food safety
  • Waste management
• Environmental Health Problems


  • Built environment: Drunk driving
  • Secondhand smoke
  • Noise exposure
  • Urban crowding
  • Technological hazards

  Work-related exposure: Asbestos exposure

  • Agricultural accidents
  • Excessive exposure to x-rays

  Outdoor air quality: Gaseous pollutants

  • Greenhouse effect
  • Destruction of the ozone layer
  • Aerial spraying of herbicides and pesticides
  • Acid rain
  • Nuclear facility emissions

  Healthy home: Homelessness

  • Rodent and insect infestation
  • Presence of lead-based paint
  • Sick building syndrome
  • Unsafe neighborhoods
  • Radon gas seepage in homes and schools

  Water quality: Contamination of drinking supply by human waste

  • Oil spills in the world's waterways
  • Pesticide or herbicide infiltration of groundwater
  • Aquifer contamination by industrial pollutants
  • Heavy metal poisoning of fish

  Food safety: Malnutrition

  • Bacterial food poisoning
  • Food adulteration
  • Disruption of food chains by ecosystem destruction
  • Carcinogenic chemical food additives

  Waste management: Use of nonbiodegradable plastics

  • Poorly designed solid waste dumps
  • Inadequate sewage systems
  • Transport and storage of hazardous waste
  • Illegal industrial dumping
  • Radioactive hazardous wastes
• Conceptual Model of How Built Environment Affects Health

  • The Built Environment (Underlying Context): Land use patterns
  • Transportation networks
  • Infrastructure systems
  • Public facilities
  • Buildings

  Mediating Factors (Exposure Media): Environmental toxins

  • Local climate
  • Noise level
  • Crime level
  • Disasters and accidents
  • Access to services

  Downstream Pathways (Human Response): Behavioral (physical activity, diet behavior, smoking, drinking, taking drugs)

  • Psychological (satisfaction, depression, distress, social cohesion)
  • Physiological (infection, immune, system activation, hormonal response)

  Health Status (Outcome Indicators): Individual level (BMI, perceived health status, well-being)

  • Population level (cause-specific mortality rates, morbidity rates)
• Major Air Pollutants


  • Ozone
  • Carbon Monoxide
  • Nitrogen Dioxides
  • Sulfur Dioxide
  • Particulate Matter
  • Lead
• Environmental Sanitation


  • Promotion of hygiene
  • Prevention of disease and other consequences of ill-health relating to environmental factors
• In PH: Presidential Decree 856 s. 1975 remains key legal document regulating all areas cited above
• Major Laws Regulating Sanitation in PH


  • Presidential Decree 856 - Sanitation Code of PH
  • Presidential Decree 825 - Anti-Littering Law
  • Republic Act 9003 - Solid Waste Management Act
  • Republic Act 8749 - Clean Air Act
  • Republic Act 9275 - Clean Water Act
  • Republic Act 9512 - National Environmental Awareness and Education Act
  • E.O 26 - Nationwide Smoking Ban
  • Republic Act 10611 - Food Safety Act
  • Republic Act 11311 - Provision of Clean Toilets in Public Transportation Terminals
• Prohibitions of the Code of Sanitation on Water Safety

  • Washing and bathing within a radius of 25 m from any well or other source of drinking water
  • Construction of artesians, deep or shallow well within 25 m from any source of pollution including septic tanks and sewer systems
  • Drilling a well within 50 m distance from cemetery
  • Construction of dwellings within the catchment area of protected spring water source
• Levels of Water Supply in PH

  • Level I (Point Source): Protected well or developed spring with an outlet but without distribution system

  Level II (Communal Faucet or Stand post): Water supply facility composed of source, reservoir, piped distribution network with adequate treatment facility and communal faucets

  Level III (Waterworks/ Water Districts): With source, reservoir, piped distribution network with adequate treatment facility and household taps
• Rules on Food Safety (Sanitation Code of PH)


  • Food establishment must have sanitary permit from city that has jurisdiction
  • No person shall be employed in food establishment without health certificate properly issued by city or municipal health officer
  • No person shall be allowed to work on food handling while afflicted with communicable disease like boils, infected wounds, respiratory infections, diarrhea, GI upset
  • After proper washing, utensils are subjected to one of bactericidal treatments: Immersion for at least half a minute in clean hot water 77C
  • Immersion for at least 1 min in lukewarm water containing 55-100 ppm of chlorine solution
  • Exposure to steam for at least 15 mins to 77C or 5 mins to 200C
• Prohibited Acts on Solid Waste Management Act of PH

  • Open burning of solid waste
  • Open dumping
  • Burying in flood-prone areas
  • Squatting in landfills
  • Operation of landfills on any aquifer, groundwater reservoir or watershed
  • Construction of establishment within 200 meters from a dump/landfill
• Color Coding for Healthcare Waste

  • Black or colorless: Nonhazardous and nonbiodegradeable waste
  • Green: Nonhazardous biodegredeable wastes
  • Yellow with biohazard symbol: Pathological or anatomical waste
  • Yellow with black band: Pharmaceutical, cytotoxic, chemical wastes labeled separately
  • Yellow bag that can be autoclaved: Infectious
  • Orange with radioactive symbol: Radioactive
• Guidelines for Safe Sanitation Systems (Toilets)

  • Toilet design, construction, management and use should ensure users are safely separated from excreta
  • Toilet slab and pan or pedestal should be constructed using durable material easily cleaned
  • Toilet superstructure needs to prevent rainwater, storm water, animals, and insects from entering
  • Provide safety and privacy with lockable doors for shared or public toilets
  • Include provision of culturally and context-appropriate facilities for anal cleansing, handwashing, menstrual hygiene
  • Well-maintained and regularly cleaned
• Herbal medicine plants approved by DOH

  • Lagundi (Vitex negundo)
  • Yerba (hierba) buena (mentha cordifelia)
  • Sambong (blumea balsamifera)
  • Tsaang gubat (carmona retusa)
  • Niyug-niyogan (quisqualis indica L.)
  • Bayabas (Psidium guajava L.)
  • Akapulko (cassia alata L.)
  • Ulasimang bato (peperonica pellucida)
  • Bawang (allium sativum)
  • Ampalaya (mamordica charantia)
• Lagundi


  Uses & Preparation: Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15 minutes)

  Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in water to produce a glass, three times a day)

  Skin diseases (dermatitis, scabies, ulcer, eczema) - Wash & clean the skin/wound with the decoction

  Headache – Crush leaves may be applied on the forehead

  Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area
• Yerba Buena


  Uses & Preparation: Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15 minutes. Divide decoction into 2 parts, drink one part every 3 hours.

  Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap. Massage sap on painful parts with eucalyptus

  Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)

  Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle solution

  Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity

  Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion.

  Nausea & Fainting – Crush leaves and apply at nostrils of patients

  Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a paste, rub on affected area

  Pruritus – Boil plant alone or with eucalyptus in water. Use decoction
• Clinic Visit


  1. Registration/Admission

  2. Waiting time

  3. Triaging

  4. Clinical Evaluation
• Home Visit


  Professional face to face contact made by a nurse with the patient or the family to provide necessary health care activities and to further attain the objective of the agency
• Purposes of Home Visit

  • Protection against diseases
  • Providing essential treatment
  • Providing comfort and relief from pain to the patient
  • Giving a support and empathy to the patient and his family
  • Using domestic equipment for the nursing
  • Providing health education
  • Giving as much respect as possible to the faiths and beliefs of the family during the procedure
• Principles of Home Visit

  • Home visits should be planned with purpose
  • The purpose of home visits should be clear and must meet the needs of the patients
  • Home visits should be regular and flexible
  • Home visit should be educative
  • Home visits should give excellent opportunities for nurses to demonstrate hygienic principles
  • Home visit should be convenient, acceptable and educative to pts
  • The nurse should make an attempt to include each family member while using nursing process
  • The nurse and the family must develop a positive interpersonal relationship in their work to achieve the goal
  • The nurse must respect the patient's rights
  • Home visits should be recorded in the diary and family folder
• Factors affecting Frequency of Home Visit


  • Acceptance of the family
  • Ability to recognize own needs
  • Physical, psychological and educational needs
  • Other health agencies and health personnel involved
  • Policy of a given health agency
  • Evaluation of past services given to a family