NURSING PRACTICE IN THE COMMUNITY Pifth EditionPhilippine Copyright © 2009, 2004, 2003, 2002, 2000, 1997 by ARGONAUTA CORPORATION Marikina City and ARACELI S. MAGLAYA ROSALINDA G. CRUZ-EARNSHAW MA. BRIDGETTE T. LAO-NARIO MA. CORAZON S. MAGLAYA LUZ BARBARA L. PAMBID-DONES LUCILA B. RABUCO WINIFREDA O. UBAS-DE LEON ALL RIGHTS RESERVED A written permission of the editor and publisher must be secured if any part of this book is reproduced by any means and in any from whatsoever. Every authentic copy of this book bears a serial number and the signature of the editor or any one of the contributors. (Ars, ) Published and exclusively distributed by: ISBN 978-971- 91924-4-2 Argonauta Corporation No. 1 Makiling Street Marikina Village, Nangka Marikina City Tel. No. 91-61-60 Scanned with CamScannerCONTRIBUTORS Araceli S. Maglaya, RN, PhD Professor Centennial Professorial Chair College of Nursing University of the Philippines Manil Rosalinda G. Cruz-Earnshaw, RN, MIN, MPA Nurse Educator cumenical Christian College rarlac City, Former Faculty College of Nursing i of the Philippines Former Consultant Philippine Department of Health-Local Government Assistance and Monitoring Service and Essential National Health Research Luz Barbara L. Pambid-Dones, RN, MPH College of Nursing University of the Philippines Manila Ma. Corazon S. Maglaya, MD ‘Medical Consultant Smith Bell Group of Companies Resource Person “Doctors-On-Line” Program, DZAS Ma. Bridgette T. Lao-Nario, RN, MA Faculty Ai Pacific School of Nursing Second Careers in Nursing Program Aisa, California, USA ‘Telemetry Nurse Definitive Observation Unit Whittier Hospital Medical Center Azusa, California, USA Winifreda O. Ubas-de Leon, BSMT, MPH Professor (Revired) Department of Parasitology College of Publie Health University of the Philippines, Manila Lucila B. Rabuco, MSc Public Health (Nutrition), PHD Professor Centennial Professorial Chair Department of Nutrition College of Public Health University of the Philippines Manila Scanned with CamScannerPREFACE tion of the book Nursing Practice in the Community focuses ‘on theory-based practice methodologies using the competency-based framework. Theories whieh describe, explain and predict behavior of cliente (particularly families, groups and the community) provide backgrourid frameworks to guide readers on the bases for the selection of content and critieal thinking directions by phase of the nursing process. Within these purposes and background of the book, the cditor and contributing authors hope to enhance the teaching-learning empowering competencies of practitioners, teachers and students based on the uniqueness of every client and the health-bealing situation in every nurse-client relationship. Precision and coherence in concept elaboration and illustration hopefully achieve clarity in breaking down complex processes to describe the application of the nursing process by type of client, Particularly for clinical instructors and students challenged enough to pursue the breadth and depth of community health nurse practice, the Leory-based methodelogi presented in this book provide teaching-learning alternatives to prevent the likelihood of using “ready-made” nursing caré plans and client records to comply with course requirernents. ‘The fifth e ‘The book begins with a presentation of community health nursing (CHN) as context and practice using a four-client perspective: the individual, family, population group and community. Within the backdrop of social, political, cultural and economic determinantsofhealth and illness, the chapter discusses the health care delivery system, the national health situation and the components, processes and cthicolegal aspects of community health nursing practice. As a CHN practice option in many 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 Assessment 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, Interactional and Development Models and The Structural Functional Framework. Genograms, ecomap and family-life chronology are discussed as additional assessment tools with specific guides on construction and interpretation contained in Appendices B1 to B3. Chapter focuses on concepts, steps and intervention options in developing the family nursing care plan. A sample evaluation plan illustrates how to specify evaluation riteria/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 are discussed: formative and summative evaluation. Each type is presented to address specific components of family health 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 the case management approach in working with priority familics. Chapter 5 focuses on the nursing perspective of the partnership approach and the participatory action methodology explicitly illustrating the “Look-Think-Act” cyclical process using empirical data on the empowering experiences of families in a village in Abra Provines. Interdisciplinary teamwork and interagency collaboration are enhanced through competencies on partnership with diverse groups forming cross functional teams. Scanned with CamScannerChapter 6 presents the conceptsand methods of the work group approach 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 sta nd epidemiology as public health tools are illustrated by major concept or tool Chapter 8 discusses the approaches and steps involved in planning community health nursing programs and services. Community competence and community strength or empowerment as change outcomes are illustrated as examples of evaluation measures to pursue using the participatory approach. Chapter 9 presents the nursing interventions for community health and development. Within the perspectives of primary health care, health promotion and community competence, community health development sirategies include community organizing towards community participation in health, capacity-building through competency- based training, partnership and collaboration, advocacy and supervision. Caseload management is described as a process and an approach to systematically address the hgalth needs and problems of a number of clients under specific health programs or services, Chapter 10 presents assessment and management protocols for safe motherhoed and well-baby care. Chapter 11 describes nurse-managed maternal care in the community. Based on standards of prenatal care, home delivery and postpartum care, application of the nursing process in a nurse-managed care is presented Chapter 12 describes independent nursing practice using specific strategies, examples and experiences such as conducting developmental screening for preschoolers and maintaining a health promotion clinic to address client concerns like nutrition, comfort, mobility and sleep pattern. The components of nursing consultation together with other topies 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 food sources of macronutrients (carbohydrates, proteins and fats) and micronutrients (vitamins and minerals). Methods and tools to assess nutritional status (eg. dietary and anthropometric methods, biophysical tests and clinical examination) are also described in tie chapter. Competencies on nutrition and wellness enhance the nurse’s confidence to assume an independent role or work in collaboration with the health team in addressing malnutrition as a health problem and risk factor of lifestyle 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 childhood based on common causes of undernutrition among Filipino children. Chapter 15 daseribes the life cycle and measures for prevention and control of parasites as causative agents of selected communicable diseases such as malaria, filariasis, schistosomiasis and intestinal parasitism. Chapter 16 describes assessment and management protocols to address selected common lifestyle-related health concerns and problems of adult clients. Scanned with CamScannerats the concepts and prineiples of nursing mana i i anagement ats the picolegal considerations are discussed. wement in the local Chapter 17 pres public health sys jecusses communit based participatory research t The nature, y atch to e : éy niue, process and. ouleomen or eee Ith wufyatrated using empirical data based in a Ss of family 1g research on malaria prevention Gnd GOnCol dnvotinn een 1 nity residents ofa village of Danglas Municipality, olving sixty-nine = » Abra Province, _ e. Finally, Chapter 38 di n vaith nursing preetice. community i empowerment multidiseiplina families as com “the fifth edition isa product of five years of exploring options based The Hffoners, clinical instructors, senior faculty San gudeoes Ge how eee rom ara ttnitate erikical thinking and analysis in community: featiliomee tn ee ang retical perepeetives provide the bases for thé ‘application of tha Sanne ee Theoreica! Tm using practice-based methodotogles. | Each {he nursing process opportunity for practitioners: ‘clinical instructors and students hapter provides an practice perspective from the vanrige point of participatory fo see the nursing race ing client's emspowsering potential. Y approach towards she book is dedicated to all families and nurses who are soure strength to enhance healing and attain wellness. turces of hope, wisdom and Araceli S. Maglaya Tagaytay City Scanned with CamScannerTABLE OF CONTENTS CHAPTER1 Community Health Nursing: Context and Practice Rosalinda G. Cruz-Earnshaw Community Health Nursing 16 Framework for Community Health Nursing 17 Clients of Community Health Nurses 27 © Individual 17 + Family is = Population group 18 Community 16 Health 19 * Factorsaffecting health 19 Health Care Delivery System 22 © Publichealth 22 Department of Health 23 Millennium Development Goals (MDGs) Health Sector Reform Agenda (HSRA) 24 FOURMula ONE for Health (F1) 24 National Objectives for Health (NOH) 25 Devolution of health services 25 ‘The National Health Situation 26 ‘Demographic profile 26 * Health profile 27 Primary Health Care and Health Promotion 39 © Primary health care 20 * Health promotion 22 Nursing Practice in the Community 33 © Nursing process 3 © Health education’ 32 * Management ang supervision 38 © Reseerch and evidence-based nursing practice Community Health Nursing in the Philippines 29 © Public health nursing 40 © Occupational health nurs: © School nursing 42 Community-Based Case Management 43 Ethicolegal Aspects of Community Health Nursing 42 The Philippines health care delivery system 2 a“ 2 Medium-term Philippine Development Plan (MTPDP) 24 Critical thinking in community health nursing 34 Program planning, implementation and evaluation 38 Scanned with CamScanner asCHAPTER 2 50 Assessment in Family Health Nursing Practice Araceli S. Maglaya Family Perspective in Community Health Nursing Practice 50 Family Nursing Practice: Theoretical Perspectives si Nursing Assessment: Operational Framework 54 Stops in Family Nursing Assessment 55 Data Collection $7 * Types of Data in Family Nursing Assessment 57 * Data-gathering Methods and Tools 57 Data Analysis 62 . Nursing Diagnoses: Family Nursing Problems 63 The Typology of Nursing Problems in Family Health Care 6a Conclusion 72 CHAPTER 3. 76 Developing the Family Nursing Care Plan Araceli 8. Maglaya The Farnily Nursing Care Plan 76 + Steys in Developing o Family Nursing Care Plan 75 + Prioritizing Health Conditions and Problems 77 + Factors Affecting Priority-Setting 79 * Scoring at * Formulation of Goals and Objectives of Care a1 Developing the Intervention Plan a3 © Analyze Realities and Possibilities based on Family's Lived Experience of Meaning and Concerns 6 + Focus on interventions to Help the Family Perform the Health Tasks 85 + Catalyze Behavior Change Through Motivation and Support 99 * Criteria for Selecting the Type of Nurse-Family Cantact m1 Developing the Evaluation Plan 92 Documentation 62 CHAPTER 4 Implementation and Evaluation in Family Nursing Practice ~ 7 Araceli 8. Maglaye Expert Caring: Methods and Possibilities 97 Competency-Based Teaching 98 + Leaming is an Intellectual and Emotional Process 99 + Learning is facilitated when experiences have meaning to the learner 101 + Learning is an individual Matter: Ensure Mastery of Competencies for Sustained Actions 102 Maximizing Caring Possibilities 203 Expertise through Reflective Practice 105 The Evaluation Phase 137 Challenges and Directions 107 Scanned with CamScannerCHAPTERS The Partnership Approach and the Participatory Action Methodology: The Nursing Perspective 110 Araceli S. Maglaya Human Care and Nursing Practice 120 Options for Change 111 Particigatory Action and Empowering Experiences of Families in Dangias, Abra 114 Enhancing Interdisciplinary and Interagency Cellaboration 113 The Essential Ingrediants of Partnership 116 * Belief in Egalitarian Relationship 116 * Open-mindedness 116 * Respect and Trust 17 + Commitment to Enhance each ather’s Capabilities for Partnership 117 Capabilities Necessary for Partnership 11s * Skills Necessary to Function as an Integrated Unit 118 Summary 17% CHAPTER 6 Developing Community Competence through the Work Group Approach 130 Araceli S. Maglaya Introduction 130 Community Competence 131 ‘The Work Group Model as Strategic Anproach to Community Competence 231 The Stages oF Group Development 137 + “The Stage of Orientation 132 The Stage of Conflict 133 The Stage of Cohesiveness 134 ‘The Work Group Stage 134 ‘The Termination Stage 135, + The Verious Stazes at Work 135 Interventions te Facilitate Group Growth 135, + Provide the Necessary Orientation, Structure and Direction 136 * Process, Negotiate and Resolve Conflicts to Member's Satisfaction 138 © Be Aware of the Effects of Own Behavior on the Group: Use the Self for Group Growth * Actas the Group's Completer/Resource Person 167 + Derive Oppartunities to Apply Learning on Another Situation 147 Work Group: Hub of Community Organization, Competence and Empowerment 47 CHAPTER 7 Assessing Community Health Needs 150 Luz Barbara P. Denes Introduction 150 The Community Diagnosis 250 + Ecologic Approach to Community Diagnosis 151 * Types of Community Diagnosis 152 + Comprehensive Community Diagnosis 152 + Problem-Oriented Community Diagnosis 155 Community Diegnosis: The Process 155 Scanned with CamScannerConducting Community Diagnosis 156 Steps 8 Cormining the Objectives 157 Defining the Study Population | 157 c petermining the Datato be Collected 158 = collecting the Data 358 t Seveloping the Instrument 161 © actual Data Gathering 368 = Data Collation 169 © Data Presentation 171 © pata analysis 174 y Peeatying the Community Health Nursing Problems 374 + Priority-setting 17 Application of Public Health Tools in Community Health Nursing 173 Demography 178 i = Sources of Demographic Data * Population Size 180 + Population Composition 182 + Population Distribution 183 Vital Statistics 184 Epidemiology 186 + The Multiple Causation Theory © Notural History of Disease 183 Levels of Prevention of Health Problems 188 Concept of Causality and Association 191 7 The Epidemiological Approach 392 Descriptive Epidemiology 392 Analytical Epidemiology 197 Interventional or Experimental Epidemiology 198 jeriology 198 286 = Evaluation & Conclusion 123, CHAPTER & Planning for Community Health Nursing Programs and Si Luz Barbara P. Dones Tt a aaa eet Introduction 202 ‘Whats Planning? 202 Approaches to Planning Health Programs 203 2) Participatory Flanning for Community Health 203 Planning for Health Promotion 204 The Planning Cycle 208, Situational Analysis 208, 5 Gos! and Objective sewing 212 Strategy and Activity-Setting 223 + Develaping an Evalun Conclusion 220 on Plan 21¢ Scanned with CamScannerCHAPTER 9 Nursing Interventions for Community Health and Development 223 Jar: Barbara P. Danes Introduction 223 Community Competence as Outcome of Community Health Nursing Interventions 223 Community Health Development Strategies 225 Health Promotion 226 Community Organizing towards Community Participation in Health 229 Capacity-Building through Competency-based Training 233 Partnership and Collaboration 236 Advocacy 237 Supervision 238 * Making ¢ Supervisory Plan 239 * Methods and Tools for Supervision 240 + Conducting a Supervisory Visit 200 * Case Study Illustrating the Application of the Steps in Supervisory Planning 242 Caseload Management 241 Conclusion 2a3 CHAPTER 10 Logic Trees for Safe Motherhood and Well-Baby Care 247 Ma. Corazon S. Maglaya and Araceli Maglaya Introduction 207 The Use of Logic Trees 247 Assessment Protoco! for Initial Pre-natal Check-up 248 Logic Tree Flowchart No. 28 250 Management Protocol for Initial Pre-natal Check-up 25 Assessment Protoco for Follow-up Pre-natal Chack-up 25s Logie Tree Flowchart No. 29257 Management Protocal for Follow-up Pre-natal Check-up 252 Assessment Protocol for Home Delivery 260 Logic Trae Flowchart No. 30 261, Management Protocol for Home Delivery 262 Assessment Protocol for Care of the Newborn Immediately after Birth 267 Logic Tree Flowchart No. 31 269 Management Protoco! 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 Protoco) for Well Baby Checkup 260, Logic Tree Flowchart No. 33-A 26: Management Protocol for Well Baby Cheek-up 282 Assessment Protoco) tor Well Baby Checx-up, Patient is more than one month old 284 Logic Tree Flowchart No. 33-2 285 Management Protocol for Well Baby Check-up, Patient is more than one month old 286 Scanned with CamScannerCHAPTER 11 Nurse-Managed Maternal Care in the Community Maria Brigette T. Lao-Nario Introduction 258 Role of Maternal Care 289 Standards of Prenatai Care 290 Components of Pregnancy Care 292 * Antenats! Registration 293 Tetanus Toxoid Immunization 293 ‘+ Micronutrient Supplementatior + Vitamin A Supplementation 235 + Treatment of Diseases and Other Conditions 296 + Early Detection and Management of Complications ‘+ Family Planning Counseling 297 + STD/HIV/AIDS Prevention and Management 297 Standards in Home Delivery 297 Standards in Postpartum Visit 300 The Nursing Process in a Nurse-Managed Care 302 Nursing Assessment and Diagnoses 302 Determining Qutcomes of Care 203 Choosing Nursing Interventions sve Home Visit as an Intervention 304 CHAPTER 12 Demonstrating Independent Nursing Practice Ma. Brigette T. Lao-Nario Experiences in Setting up Independent Nursing Practice Metso Manila Develapmental Screening for Preschoolers Providing Consulting Services 213 The Health Promotion Nursing Clinic 216 Commonly Used Nursing Diagnoses 318 Establishing the Outcomes of Care 320 ‘The Nursing Consultation and its Components 320, Charging Clients @ Nursing Professional Fee 322 Marketing the Services of the Nursing Clinic 223 Establishing Linkages and a Referral System 323 CHAPTER 13 Enhancing Competencies on Nutrition for Wellness Lucila B. Rabuco Imreduction 326 Nutrition 326 Food 327 Nutrients 327 ° Macronutrients 227 + Micronutrients 229 Assessment of Nutritional status 333, * indirect methods 234 Macronutrient and Micronutrient Supplementation 208 ron Supplementation 254 of Pregnancy 296 aur ant Scanned with CamScanner 288 310 326© Direct methods 337 Common Nutritiona’ Problems of Public Health Importance 340 + Protein-Eneray Malnutrition (P.EM.) 240 Won Deficiency Anemia 341 Vitamin A Deficiency Disorders 342 lodine Deficiency Disorders 343 Overweight and obesity 344 Summary 344 CHAPTER 14 Appropriate Technology for the Prevention and Control of Malnutrition in Early Childhood 346 Araceli S. Maglaya Nutritional Status of Filipino Children: Consequences and Implications 346 Causes of Malnutrition Related tu Feeding Practices 347 + Non-breast-feeding or Farly Weaning 34 + Absence of or inadequate Complementary Feeding during Extended Periods of Breastfeeding or Dependence on Artificial Feeding 34% > Lack of or Inadequate Skill in Managing Diarrhea at Home a8 Interventions Using Appropriate Technology 3s + Family Competency-Bullding 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 Eneray and Nutrient Intakes (RENID for Infants and Toddlers 361 ‘+ Appropriate Home Management of Diarrhea 352 Summary 354 CHAPTER 15 Parasitology in Nursing Practice 356 Winifreda O. Ubas-de Leon Introduction 355 The Parasites 355 Directly-Transmitted Parasite 357 + Enterobius (Oxyuris) vermicularis 357 Soil-Transmitted Parasites 358 © Ascaris lumoricoides se © Trichuristrichlura sez © Hockworms 262 Food Transmitted Parasites 369 © Tacnia solium and Taenia saginata 369 © Paragonimus westermani 370 © Capillaria chilippinensis 371 © Heterophyid Flukes 371 Water-borne Protozoa 272 * Entamoeba histolytica 372 © Giardialambiis 273 © Cryptosporidium hominis 373 * Cyclospora cayatensis 377 Scanned with CamScanner© Blastocysts hominis 377 Vector-Borne Parasites 378 + Plesmodia 378 * Babesia spp 279 ‘+ Wuchereria bancrofti and Brugia malayl 380 Schistosoma japonicum 28a Conclusion 388, CHAPTER 16 Logic Tree for Common Adult Health Problems 388 ‘Ma. Corazon S. Magiaya and Araceli Maglaya Introduction a8 The LogicTiees a8 ‘Assessment Protocol for Problem on Cough, Colds or Difficulty of Breathing not Associated with Fover 389 Logic Tree Flowchart No. 7 392 Management Protocol for Problem on Cough, Colds or Difficulty of Breathing not Associated with Fever 392 Assessment Protocol for Problem on Skin Lesions 334 Logic Tree Flowchart No.9 395 Management Pratocal far Problem on Skin Lesions 398 Assessment Protocol far Prablem on Body Weakness 399 Logic Tree Flawehart No. 10 «00 Management Protocol for for Problem on Body Weekness 201 Ascessmant Protocol for Problem on Abéominal Pain, Epigastric 403 Logic tree Flowchart No. 11404 Management Protocol for for Problem on Abdominal Pain, Epigastric sos Assessment Protocol for Problem on Insomnia 407 Logie Tree Flowchart No.16 408 Management Protocol for Problem Insomnia 403 Assessment Protocol for Problem on Dizziness 412 Logic Tree Flowchart No. 24 413 Management Protocol for Problem Dizziness axa CHAPTER 17 “rsing Management in the Local Public Health System Rosalinda G. Cruz-Earnshaw ‘as Introcuction ais Management Functions «a9 fanagement in Public Health 421 The Local Public Health Organization 421 Context of the Lecal Public Health Organization 421 asa Manager and Supervisor 722 The pany * Planning 421 S Organizing 223 * stating as Leading (directing) 2s ean etling se ‘2l Considerations 429 Scanned with CamScannerCHAPTER 18 Enhancing Practice through Community-Based Participatory Research 432 ‘Araceli S. Maglaya Introduction 332 Community-Based Participatory Research 422 Enhancing Empowering Potential: The Human Response Perspective 433 Facilitating @ehavior Change thru Motivation-Support Interventions 435 Empowerment: Nature, Process and Qutcomes 436 Health in the Hands of the People 438 Behavior Change Over Time aax Community Leaders Update the Researcher at the University «39 Community-Based Research: Insights for Enhancing Nursing Practice a36 APPENDICES Al Community Health Nursing Practice Model as 2 Laws that Impact on People’s Health and CHN ane Aa Health Programs of the DOH sau B Family Assessment Tools sag 81 Constructing and interpreting a Genogram 49 82 Constructng the Family Ecomap 455 B3 Constructing the Family-Life Chronology 456 C1 Charting Nursing Care, Progress Notes and Client Responses/Outcomes C2 Family Service Progress Record 458 C3__ Instructions on the Use of the Family Service and Progress Record 361 D Selectinga Fruit Exercise 467 E Empowerment for Health Promotion/ Lifestyle Change 472 487 F Recommended Energy and Nutrient Intakes Per Day For Selected Population Groups 473 G Trends in Community Health and Community Health Nursing Practice 474 Scanned with CamScannerChapter 1 COMMUNITY HEALTH NURSING: CONTEXT AND PRACTICE Rosalinda G. Cruz-Earnshaw Community health nursing (CHN) i in the Philippines; th Some people use the terms community health nursing wid public health nursing interchangeably. However, the former is broader than the killer; it includes public health nursing geccupational health nursing GES COMMUNITY HEALTH NURSING Clark defines community health nursing as a and active and the science and practice of public health, implemented via ind other processes to promote health and prevent illness in ion groups” (2008:5). The other processes include management, supervision, rescarch, advocaey and political action. Annex At presents a model of community health nursing practice which illustrates the relationship between nursing practice as seience and art, core community health functions and essential community health services. ‘The following statements characterize CHN: (2)-Promotion of health and:prevention of disease are the goals of professional practice; (2) Community health nursing practice s and not episodic; (3) There are ditferentlevelsof (gentéle-- individuals, families and population groups and the practitioner recognizes: the primacy of the population as a whole; (4) Theamrsesandstheselient-havexgceater ‘controlin making decisions related to health care and they-collaborate-as-equals; )Thenurse recognizes. the impact of different factors on health and-hasageeater

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