EVALUATION OF HEALTH PROGRAMS AND NURSING

SERVICES RELATED TO THE CARE OF CHILDREN AT RISK

OR WITH PROBLEMS
OVERVIEW
“Child health is a state of physical, mental, intellectual,
social and emotional well-being and not merely the
absence of disease or infirmity”. › Children represent the
future, and ensuring their healthy growth and development
ought to be a prime concern of all societies. Newborns are
particularly vulnerable and children are vulnerable to
malnutrition and infectious diseases, many of which can
be effectively prevented or treated.
 CHILD HEALTH CARE
OBJECTIVES
1. Decreasing childhood death and infant
mortality rate.
2. Promote and protect health of child.
3. Nutritious diet to children.
4. Monitoring child growth and development
5. Toward health level of children 3
 CHILD HEALTH SERVICES
1. Newborn care
2. Breast feeding
3. Immunization
4. Growth and development monitoring
5. Personal hygiene
 NEWBORN CARE
The first week of the life in most
crucial period in infancy

Objectives:
a. Establish and maintenance of cardio respiratory function
b. Maintenance of body temperature.
c. Avoidance of infection.
d. Establishing of breast feeding
e. Early detection and treatment of any congenital and disorder.
IMMEDIATE CARE APGAR SCORE
Taken in 1 minute and again at 5 minutes
after birth.and disorder.
BREASTFEEDING IMMUNIZATION
 GROWTH AND DEVELOPMENT
MONITORING
Head and Chest circumference
Weight
Behavioral development
PERSONAL HYGIENE
QUALITY ASSURANCE IN THE DELIVERY OF CARE TO
CHILDREN AT RISK OR WITH PROBLEMS
 QUALITY ASSURANCE
Quality assurance (QA) plays a vital role in
ensuring that the care we provide is not
only effective but also safe, equitable, and
tailored to the needs of vulnerable children.

Children considered at risk may come from impoverished

backgrounds, have disabilities, or suffer abuse and neglect.
Others may be dealing with chronic illnesses or
developmental delays. These children require focused,
consistent, and coordinated care.
The delivery of care is primarily carried out
through Barangay Health Centers (BHCs),
public hospitals, and community-based
outreach.

Some of the services delivered include:

Immunization
Nutritional support like feeding programs and vitamin
supplementation
Growth and development monitoring
Developmental screenings for early identification of
delays
 INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS (IMCI) PROGRAM
The Department of Health (DOH) implements
the IMCI program, a comprehensive strategy
aimed at reducing mortality and morbidity
among children under five. This program
integrates preventive and curative
interventions to address common childhood
illnesses.
 CHALLENGES IN QUALITY ASSURANCE
FOR CHILD CARE

Resource Training Lack of

Limitations Deficiencies Supervision
 QUALITY ASSURANCE IN THE DELIVERY OF CARE TO
CHILDREN AT RISK OR WITH PROBLEMS

Ensuring quality in child healthcare delivery is a shared responsibility.

As future nurses, we must advocate for systems that promote safety,
equity, and child-centered care. With strengthened programs,
resources, and trained personnel, we can better protect and serve
children at risk or facing health problems.
APPROPRIATE DISCHARGE PLAN
INCLUDING HEALTH
EDUCATION
 DISCHARGE PLAN
Discharge from hospital can be a welcome
relief for the patient, but it can also be an
anxiety and fear. Adequate preparation must
be made to help transfer from a dependent
role to a more independent role.

During this transition, nurse can facilitate

the process by being aware of the
individual patient’s needs including
physical, emotional and psychological
needs of both patient and family.
 REASONS FOR DISCHARGING
Assist a patient to transfer positively from
a dependent to a more independent role.

To help relatives to provide an

environment that best meet the needs of
the patient .

Obtain relative and community support of

the client during convalescence at home.
 PROCEDURE FOR DISCHARGING A PATIENT FROM THE HOSPITAL
Assessment

What is the needed information about the physical, emotional and

psychological needs of a client?
What disabilities and limitations that will extend after discharge.
Are home plans well understood?
What areas must be involved in teaching the client?
How much is the family involved in continuing to support the
patient at home.
 PROCEDURE FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Preparation of the patient

Discuss information regarding admission to the

patient and relatives
 PROCEDURE FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Preparation of the equipment

Patient’s chart and discharge summary note

Admission and discharge register.
Daily returns form (census sheet) .
Medication for home use .
Educational pamphlets as required.
Specific equipment needed upon discharge e.g.
insulin syringe
 STEPS FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Start planning for discharge early while the patient is

still in hospital .

Verify discharge orders from patient’s doctor.

Collaborate with appropriate heath team members.

Order any equipment or supplies patient will need to

take home.
 STEPS FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Coordinate with patient and family regarding time and

day of discharge and mode of transportation.
Talk with patient about his future expectation regarding
his health.
Encourage patient to verbalize his concern and be alert
or nonverbal clues.
Discuss with family or significant others on how they can
help the patient to maximize potential.
 STEPS FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Teach on self-care at home where possible and supply

written instructions.
Evaluate patient’s understanding of teaching.
Assist patient to put together all his belongs and assist
him in packing.
Collect required medication for home use from
pharmacy. Repeat instructions for use to patient and
relatives.
 STEPS FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Give the discharge form to patient and make sure the

instructions regarding medication, diet, exercise and
date for follow up appointment are clear.
Collect patient’s valuables and countercheck with him to
make sure that everything is in order.
Assist client to dress his home clothes.
Instruct patient or relatives to settle the hospital bills.
 STEPS FOR DISCHARGING A PATIENT FROM THE HOSPITAL

Escort client to his transport and say ‘bye’.

Strip the bed and put linen into the laundry bag.
Clean the bed thoroughly using disinfectant and re make
it.
Empty the locker or bed side table and clean for the next
client
 KEY POINTS
The impression which is formed by the client during the
first contact will always last and may affect his attitude
towards care received.
Observe verbal and non verbal expressions indicating
pain, fear and anxiety.
Accurate and appropriate documentation is necessary
during the process of admission Involve the patient or
relatives as much as possible in the plan of patient’s
care.
 KEY POINTS
Plans for client’s discharge should start early, and be
incorporated in client’s total care. It should not be left
until the day of going home.
Collect patient’s valuables and countercheck with him to
make sure that everything is in order.
Assist to transfer the client on a wheel chair or stretcher
to the car in situations where the client is unable to walk.
 KEY POINTS
Encourage patient to verbalize his concern and be alert
or nonverbal clues.
Teach on self-care at home where possible and supply
written instructions and evaluate patient’s
understanding of teaching
ACCURATE RECORDING AND
DOCUMENTATION
 DOCUMENTATION
Defined as anything written or printed that is relied on as
record or proof for authorized persons

Effective documentation reflects the quality care and

provide evidence for healthcare members
accountability in giving care
 MEDICAL RECORD OR CHART
An account of the client’s health history, current health
status, treatment and progress

A highly confidential legal documents by which nurses,

physicians, and other team members communicate
about the client
 PURPOSES OF DOCUMENTATION
1. Communication
2. Planning patients care
3. Legal documents- the clients record is legal document
and is admissible to court.
- “ CARE NOT DOCUMENTED IS CARE NOT DONE”
- Common Problem in Documentation
a. Not charting the correct time when evens occurred
b. Failing to records verbal orders or failing to them signed
c. Charting actions in advance to save time
d. Documenting incorrect data
 PURPOSES OF DOCUMENTATION

4. Research
5. Education
6. Quality assurance monitoring/Auditing monitoring
7. Statistics
8. Reimbursement
9. Financial Billing
 TYPES OF RECORDS
1. Temporary records
- these are temporary records use to facilitate
communication to maintain information for easy
accessibility
- must be updated whenever there is a change in the
patient’s plan of care
ex. - vital signs list
- white board notation
- bedside turning records
- medication card
 TYPES OF RECORDS
2. Permanent records
it can be paper chart or a computerized record

a. paper chart- a permanent record of the client’s

healthcare
b. Computerized record- it allows to quickly enter specific
assessment data and information and retrieval of data
 SYSTEM OF ORGANIZING CONTENTS
1. Source-oriented Records (SOR)
- the client chart is organized so that each discipline has a
separate part in which to record the data
- components:
a. Admission sheet
b. Physician order sheet
c. Medical History
d. Nurses notes
e. Special records or reports
 SYSTEM OF ORGANIZING CONTENTS
2. Problem Oriented Clinical Records (POCR-POR)
- the data about the client is recorded and arranged according to
the problem the client has rather than according to the source of
informations
- Components:
1. database- contains all the available assessment information
pertaining to the client
- it is subjected for revision
2. Problem list- is a list of problem that is carefully compiled once
the database had been collected and analyzed
 SYSTEM OF ORGANIZING CONTENTS
- each problem is labelled and numbered so that it can be identified throughout
the records
- it can be active or inactive
- when several problems have common etiology 2 methods are being used:

a. Sub-listing- is a group of all manifestations of a major problem that requires

separate management
ex. I- Vehicular accident
IA- Self-care deficit
IB- Impaired mobility
IC- Total Incontinence
 SYSTEM OF ORGANIZING CONTENTS
b. Cross-referencing method- lists all problems separately using consecutive
number
- a “ Related to on the right”
ex.
Problem list Related to

CVA

2. Self-care deficit #1

3. Impaired Physical Mobility #1

c. Redefinition- is necessary to reflect a change in the client problem

 SYSTEM OF ORGANIZING CONTENTS
3. Initial list of orders or Nursing Care Plan
- is generated by the person who list the problem
- Medical Care plan
Nursing Care Plan

4. Progress Notes
- healthcare team monitor and record the progress of a client’s problem
- ways of writing progress notes:
a. SOAP/SAPIE/SOAPIER
b. PIE format
c. Focus Charting
d. Charting by Exceptions
 COMMON RECORD KEEPING FORMS
1. Nursing Health History
- it is completed during the admission of the client
- it provide baseline data that can be compared with changes
in the client condition

2. Nursing Kardex
- is a from or card that is kept in a potable “flip- over “ file or
notebook at the nurse station
- it as a tool for the change-of-shift report
 COMMON RECORD KEEPING FORMS
-data available in the Kardex
a. Personal data e. Daily nsg procedures
b. Basic needs f. Medication IV
c. allergies g. ttt
d. Dx test
3. Graphic sheets and flow sheets
- these are forms that allow nurses to assess the client and
document routine repetitive care quickly
- it includes: graphic sheets, I and O sheet, medication and
daily nursing care
 COMMON RECORD KEEPING FORMS
4. Nursing Care Plan
- 2 types:
a. Traditional care plan
b. Standardized care plan

5. Discharge and Summary Forms

- it contains information with emphasis on preparing the client
for efficient, timely discharge from a healthcare institution
- discharge summary includes:
a. Description of the client’s condition upon discharge
b. Current health medication
 COMMON RECORD KEEPING FORMS
c. treatment
d. diet
e. Activity level
f. Restrictions

6. Discharge Against Medical Advice/ HAMA or AMA

- these are use by the agency to those client who leave the
institution without the permission of the physician
 CHARACTERISTICS OF GOOD RECORDING
1. Timing
2. Confidentiality
3. Permanence
- all entries in the chart are made in dark colored ink so that
the record is permanent and changes can be identified
4. Signature
- each recording on the nursing notes is signed by the nurse
making it.
- include the NAME and the TITLE
- affix the signature and place at the end of the charting at the
right margin of the nurses notes
 CHARACTERISTICS OF GOOD RECORDING
5. Accuracy
- accurate notations consist of facts or exact observation
rather than opinions of an observation

-place client complaint in quotation

- ERROR in charting
- if BLANKS APPEARS IN NOTATION
 CHARACTERISTICS OF GOOD RECORDING
6. Sequence and Organizing
- document event in the order in which it occurs and notes
should appear in each succeeding line.
- avoid DOUBLE CHARTING
- avoid squeezing informations into a space in between7.
7. Appropriateness
- only information that pertains to the client health problem
and care is recorded
8. Completeness
- the information that is recorded needs to be complete and
helpful to the client and health care provider
 CHARACTERISTICS OF GOOD RECORDING
- the following informations should be charted:
a. Physicians visit
b. Times the patient leaves and return to the unit and mode of
transportation and destination
c. Medication should be charted immediately after given
d. Treatment should be charted immediately after given
9. Use of standard terminology
10. Brevity
- entries are concise
- start with capital and end with a period
11. Legal Awareness
- chart only what you have personally have done, observed, heard,
smelled and felt
12. Do not use the word “Pt” in the chart
PATIENT ANALYTICAL REPORT
(PAR)
 PATIENT ANALYTICAL REPORT

A Patient Analytical Report is a detailed and systematic summary of a

patient's clinical data, medical history, diagnosis, interventions, progress,
and outcomes. It is used by healthcare professionals to analyze the
patient’s condition, guide decision-making, evaluate the effectiveness of
care, and ensure continuity of treatment.
 PURPOSE

To evaluate the overall health status of a patient

To analyze clinical findings and outcomes
To support clinical decision-making
To facilitate communication among the healthcare team
To serve as a reference for case studies, research, or academic
presentations
 CONTENTS OF A PATIENT ANALYTICAL REPORT
1. Patient Demographics
Full Name
Age
Sex
Date of Birth
Address
Civil Status
Occupation
Religion (if relevant to care)
Date of Admission and Discharge
2. Chief Complaint
The main reason why the patient sought medical attention (e.g., “Shortness of
breath,” “High-grade fever,” “Loss of consciousness”).
3. History of Present Illness (HPI)
Chronological account of the current illness
Onset, duration, progression, associated signs and symptoms
Self-treatment or previous consultations
 CONTENTS OF A PATIENT ANALYTICAL REPORT
4. Past Medical History
Previous illnesses, hospitalizations, surgeries
Known chronic conditions (e.g., asthma, diabetes)
Medications and allergies
5. Family and Social History
Hereditary diseases
Lifestyle (e.g., smoking, alcohol use)
Family structure and support system
6. Physical Examination Findings
Vital signs (BP, HR, RR, Temp, SpO2)
General appearance
Systematic examination (head to toe)
7. Diagnostic Tests and Results
Laboratory results (CBC, urinalysis, etc.)
Imaging studies (X-ray, CT scan, MRI)
Other tests (ECG, ultrasound, culture tests)
 CONTENTS OF A PATIENT ANALYTICAL REPORT
8. Clinical Impression/Diagnosis
Final medical diagnosis made by the physician
Differential diagnoses (if any)
9. Therapeutic Management
Medications given (name, dose, route, frequency)
Surgical or non-surgical interventions
Therapies (IV therapy, oxygen support, physical therapy, etc.)
Diet and activity orders
10. Progress Notes and Evaluation
Day-to-day summary of patient’s response to treatment
Notable changes or complications
Multidisciplinary input (e.g., from doctors, nurses, therapists)
11. Nursing Care
Nursing assessments
Identified nursing problems or diagnoses
Interventions and patient responses
Health teachings provided
 CONTENTS OF A PATIENT ANALYTICAL REPORT
12. Prognosis
Expected clinical outcome
Whether the condition is improving, stable, or deteriorating
13. Discharge Summary or Outcome
Date and condition upon discharge
Medications on discharge
Home instructions, follow-up appointments
14. Analysis and Interpretation
Summary and clinical reasoning behind the diagnosis and treatment
Evaluation of the effectiveness of care
Recommendations for further management or referral
THANK YOU