Sunteți pe pagina 1din 11

Definitions of COPAR A social development approach that aims to transform the apathetic, individualistic and voiceless poor into

into dynamic, participatory and politically responsive community. A collective, participatory, transformative, liberative , sustained and systematic process of building peoples organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference) A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967) A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD)

Importance of COPAR 1. COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. 2. COPAR prepares people/clients to eventually take over the management of a development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services. Principles of COPAR 1. 2. 3. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. COPAR should be based on the interest of the poorest sectors of society COPAR should lead to a self-reliant community and society.

COPAR Process A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity. COPAR Phases of Process 1. Pre-entry Phase Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it

Activities include:
o o o

Designing a plan for community development including all its activities and strategies for care development. Designing criteria for the selection of site Actually selecting the site for community care

2. Entry Phase Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collective action on these. This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following guidelines however. o o o Recognizes the role of local authorities by paying them visits to inform them of their presence and activities. The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role models. Avoid raising the consciousness of the community residents; adopt a low-key profile.

3. Organization Building Phase Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings (formal, informal, OJT) to develop their skills and in managing their own concerns/programs. 4. Sustenance and Strengthening Phase Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different communities setup in the organization building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance from the community-wide organization.

Strategies used may include:

o o o o o Bag Technique Definition

Education and training Networking and linkaging Conduct of mobilization on health and development concerns Implementing of livelihood projects Developing secondary leaders

Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care. Public health bag - is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care. Rationale To render effective nursing care to clients and /or members of the family during home visit. Principles 1. 2. 3. 4. The use of the bag technique should minimize if not totally prevent the spread of infection from individuals to families, hence, to the community. Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures. Bag technique should not overshadow concern for the patient rather should show the effectiveness of total care given to an individual or family. Bag technique can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding transfer of infection is carried out.

Special Considerations in the Use of the Bag 1. 2. 3. 4. 5. 6. The bag should contain all necessary articles, supplies and equipment which may be used to answer emergency needs. The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use at any time. The bag and its contents should be well protected from contact with any article in the home of the patients. Consider the bag and its contents clean and /or sterile while any article belonging to the patient as dirty and contaminated. The arrangement of the contents of the bag should be the one most convenient to the user to facilitate the efficiency and avoid confusion. Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the bag and its contents. The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using.

Contents of the Bag Paper lining Extra paper for making bag for waste materials (paper bag) Plastic linen/lining Apron Hand towel in plastic bag Soap in soap dish Thermometers in case [one oral and rectal] 2 pairs of scissors [1 surgical and 1 bandage] 2 pairs of forceps [ curved and straight] Syringes [5 ml and 2 ml] Hypodermic needles g. 19, 22, 23, 25 Sterile dressings [OS, C.B] Sterile Cord Tie Adhesive Plaster Dressing [OS, cotton ball] Alcohol lamp Tape Measure Babys scale 1 pair of rubber gloves 2 test tubes Test tube holder Medicines o betadine o 70% alcohol o ophthalmic ointment (antibiotic)

o o o o o

zephiran solution hydrogen peroxide spirit of ammonia acetic acid benedicts solution

Note: Blood Pressure Apparatus and Stethoscope are carried separately.


Steps/Procedures Actions 1. Upon arriving at the clients home, place the bag on the table or any flat surface lined with paper lining, clean side out (folded part touching the table). Put the bags handles or strap beneath the bag. 2. Ask for a basin of water and a glass of water if faucet is not available. Place these outside the work area. 3. Open the bag, take the linen/plastic lining and spread over work field or area. The paper lining, clean side out (folded part out). 4. Take out hand towel, soap dish and apron and the place them at one corner of the work area (within the confines of the linen/plastic lining). 5. Do handwashing. Wipe, dry with towel. Leave the plastic wrappers of the towel in a soap dish in the bag. 6. Put on apron right side out and wrong side with crease touching the body, sliding the head into the neck strap. Neatly tie the straps at the back. 7. Put out things most needed for the specific case (e.g.) thermometer, kidney basin, cotton ball, waste paper bag) and place at one corner of the work area. 8. Place waste paper bag outside of work area. 9. Close the bag. 10. Proceed to the specific nursing care or treatment. 11. After completing nursing care or treatment, clean and alcoholize the things used. 12. Do handwashing again. 13. Open the bag and put back all articles in their proper places. 14. Remove apron folding away from the body, with soiled sidefolded inwards, and the clean side out. Place it in the bag. 15. Fold the linen/plastic lining, clean; place it in the bag and close the bag. 16. Make post-visit conference on matters relevant to health care, taking anecdotal notes preparatory to final reporting. 17. Make appointment for the next visit (either home or clinic), taking note of the date, time and purpose.

Rationale To protect the bag from contamination.

To be used for handwashing. To protect the work field from being wet. To make a non-contaminated work field or area. To prepare for handwashing.

Handwashing prevents possible infection from one care provider to the client. To protect the nurses uniform. Keeping the crease creates aesthetic appearance. To make them readily accessible.

To prevent contamination of clean area. To give comfort and security, maintain personal hygiene and hasten recovery. To prevent contamination of bag and contents. To protect caregiver and prevent spread of infection to others.

To be used as reference for future visit. For follow-up care.

After Care 1. 2. Before keeping all articles in the bag, clean and alcoholize them. Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps and cover the bag.

Evaluation and Documentation 1. 2. 3. 4. Record all relevant findings about the client and members of the family. Take note of environmental factors which affect the clients/family health. Include quality of nurse-patient relationship. Assess effectiveness of nursing care provided.

Reference: Community Health Nursing Services in the Philippines, DOH Introduction Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program: Executive Order 51 Republic Act 7600 The Rooming-In and Breastfeeding Act of 1992

Program Objectives and Goals Protection and promotion of breastfeeding and lactation management education training

Activities and Strategies 1. Full Implementation of Laws Supporting the Program a. EO 51 THE MILK CODE protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) b. RA 7600 THE ROOMING IN and BREASTFEEDING ACT of 1992 An act providing incentives to government and private health institutions promoting and practicing rooming-in and breast-feeding. Provision for human milk bank. Information, education and re-education drive Sanction and Regulation

2. Conduct Orientation/Advocacy Meetings to Hospital/ Community

Advantages of Breastfeeding: Mother


Oxytocin help the uterus contracts Uterine involution Reduce incidence of Breast Cancer Promote Maternal-Infant Bonding Form of Family planning Method (Lactational Amenorrhea)

Baby
Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli

Positions in Breastfeeding of the baby:


1. 2. 3. Cradle Hold = head and neck are supported Football Hold Side Lying Position

BEST FOR BABIES REDUCE INCIDENCE OF ALLERGENS ECONOMICAL ANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) TEMPERATURE ALWAYS IDEAL FRESH MILK NEVER GOES OFF EMOTIONALLY BONDING EASY ONCE ESTABLISHED

DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED

A Typology of Nursing Problems in Family Nursing Practice

First Level Assessment I. Presence of Wellness Condition-stated as potential or Readiness-a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on clients performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples of this are the following A. Potential for Enhanced Capability for: 1. 2. 3. 4. 5. 6. Healthy lifestyle-e.g. nutrition/diet, exercise/activity Healthy maintenance/health management Parenting Breastfeeding Spiritual well-being-process of clients developing/unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/God (NANDA 2001) Others. Specify.

B. Readiness for Enhanced Capability for: 1. 2. 3. 4. 5. 6. Healthy lifestyle Health maintenance/health management Parenting Breastfeeding Spiritual well-being 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 this are the following: A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome) B. Threat of cross infection from communicable disease case C. Family size beyond what family resources can adequately provide D. Accident hazards specify. 1. 2. 3. 4. 5. Broken chairs Pointed /sharp objects, poisons and medicines improperly kept Fire hazards Fall hazards Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify. 1. 2. 3. 4. 5. Inadequate food intake both in quality and quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding techniques

F. Stress Provoking Factors. Specify. 1. 2. 3. 4. Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify. 1. 2. Inadequate living space Lack of food storage facilities

3. 4. 5. 6. 7. 8. 9. 10.

Polluted water supply Presence of breeding or resting sights of vectors of diseases Improper garbage/refuse disposal Unsanitary waste disposal Improper drainage system Poor lightning and ventilation Noise pollution Air pollution

H. Unsanitary Food Handling and Preparation I. Unhealthy Lifestyle and Personal Habits/Practices. Specify. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Alcohol drinking Cigarette/tobacco smoking Walking barefooted or inadequate footwear Eating raw meat or fish Poor personal hygiene Self medication/substance abuse Sexual promiscuity Engaging in dangerous sports Inadequate rest or sleep Lack of /inadequate exercise/physical activity Lack of/relaxation activities Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas).

J. Inherent Personal Characteristics-e.g. poor impulse control K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history of difficult labor. L. Inappropriate Role Assumption- e.g. child assuming mothers role, father not assuming his role. M. Lack of Immunization/Inadequate Immunization Status Specially of Children N. Family Disunity-e.g. 1. 2. 3. Self-oriented behavior of member(s) Unresolved conflicts of member(s) Intolerable disagreement

O. Others. Specify._________ III. Presence of health deficits-instances of failure in health maintenance. Examples include: A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner. B. Failure to thrive/develop according to normal rate C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles, lameness from polio) IV. Presence of stress points/foreseeable crisis situations-anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. Examples of this include: A. Marriage B. Pregnancy, labor, puerperium C. Parenthood D. Additional member-e.g. newborn, lodger E. Abortion F. Entrance at school G. Adolescence H. Divorce or separation I. Menopause J. Loss of job

K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy O. Others, specify.___________ Second-Level Assessment I. Inability to recognize the presence of the condition or problem due to: A. Lack of or inadequate knowledge B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: 1. 2. 3. 4. Social-stigma, loss of respect of peer/significant others Economic/cost implications Physical consequences Emotional/psychological issues/concerns

C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem D. Others. Specify _________ II. Inability to make decisions with respect to taking appropriate health action due to: A. Failure to comprehend the nature/magnitude of the problem/condition B. Low salience of the problem/condition C. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack. D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them E. Inability to decide which action to take from among a list of alternatives F. Conflicting opinions among family members/significant others regarding action to take. G. Lack of/inadequate knowledge of community resources for care H. Fear of consequences of action, specifically: 1. 2. 3. 4. Social consequences Economic consequences Physical consequences Emotional/psychological consequences

I. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational decision-making. J. In accessibility of appropriate resources for care, specifically: 1. 2. Physical Inaccessibility Costs constraints or economic/financial inaccessibility

K. Lack of trust/confidence in the health personnel/agency L. Misconceptions or erroneous information about proposed course(s) of action M. Others specify._________ III. Inability 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/health condition (nature, severity, complications, prognosis and management) B. Lack of/inadequate knowledge about child development and care C. Lack of/inadequate knowledge of the nature or extent of nursing care needed

D. Lack of the necessary facilities, equipment and supplies of care E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program). F. Inadequate family resources of care specifically: 1. 2. 3. Absence of responsible member Financial constraints Limitation of luck/lack of physical resources

G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to provide care. H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member I. Members preoccupation with on concerns/interests J. Prolonged disease or disabilities, which exhaust supportive capacity of family members. K. Altered role performance, specify. 1. 2. 3. 4. 5. 6. Role denials or ambivalence Role strain Role dissatisfaction Role conflict Role confusion Role overload

L. Others. Specify._________ IV. Inability to provide a home environment conducive to health maintenance and personal development due to: A. Inadequate family resources specifically: 1. 2. Financial constraints/limited financial resources Limited physical resources-e.i. lack of space to construct facility

B. Failure to see benefits (specifically long term ones) of investments in home environment improvement C. Lack of/inadequate knowledge of importance of hygiene and sanitation D. Lack of/inadequate knowledge of preventive measures E. Lack of skill in carrying out measures to improve home environment F. Ineffective communication pattern within the family G. Lack of supportive relationship among family members H. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal development I. 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 familys preoccupation with current problem or condition. J. Others specify._________ V. Failure to utilize community resources for health care due to: A. Lack of/inadequate knowledge of community resources for health care B. Failure to perceive the benefits of health care/services C. Lack of trust/confidence in the agency/personnel D. Previous unpleasant experience with health worker E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically : 1. 2. 3. Physical/psychological consequences Financial consequences Social consequences

F. Unavailability of required care/services

G. Inaccessibility of required services due to: 1. 2. Cost constrains Physical inaccessibility

H. Lack of or inadequate family resources, specifically 1. 2. Manpower resources, e.g. baby sitter Financial resources, cost of medicines prescribe

I. Feeling of alienation 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 __________ Communicable Diseases (Chronic)

Chronic 1. Tuberculosis TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent: Mycobacterium Tuberculosis Sign/Symptoms: cough afternoon fever weight loss night sweat blood stain sputum

Prevalence/Incidence: ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines Sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management Ventilation systems Ultraviolet lighting Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine drug therapy

Preventing Tuberculosis BCG vaccination Adequate rest Balanced diet Fresh air Adequate exercise Good personal Hygiene

National Tuberculosis Control Program key policies Case finding direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams Treatment shall be given free and on an ambulatory basis, except those with acute complications and emergencies Direct Observed Treatment Short Course comprehensive strategy to detect and cure TB patients.

DOTS (Direct Observed Treatment Short Course) Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)

If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month. o Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin daily Category 2-previously-treated patients with relapses or failures. o Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months. o Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+ ethambutol Category 3 new TB patients whose sputum is smear negative for 3 times and chest x-ray result of PTB minimal o Intensive Phase (daily for 2 months) Isioniazid + rifampicin + pyrazinamide o Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

o o

Intensive Phase (given daily for the first 2 months) - Rifampicin + Isioniazid + pyrazinamide + ethambutol.

2. Leprosy Sometimes known as Hansen's disease is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium Gerhard Armauer Hansen Historically, leprosy was an incurable and disfiguring disease Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms Early stage (CLUMP) Change in skin color Loss in sensation Ulcers that do not heal Muscle weakness Painful nerves Prevalence Rate Metro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population. Late Stage (GMISC) Gynocomastia Madarosis(loss of eyebrows) Inability to close eyelids (Lagopthalmos) Sinking nosebridge Clawing/contractures of fingers & nose

Management: Dapsone, Lamprene clofazimine and rifampin Multi-Drug-Therapy (MDT) six month course of tablets for the milder form of leprosy and two years for the more severe form

Leprosy Control Program WHO Classification basis of multi-drug therapy o Paucibacillary/PB non-infectious types. 6-9 months of treatment. o Multibacillary/MB infectious types. 24-30 months of treatment. Multi-drug therapy use of 2 or more drugs renders patients non-infectious a week after starting treatment o Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen o For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos. All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Responsibilities of the nurse: o Prevention health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene; o Casefinding o Management and treatment prevention of secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional support o Rehabilitation-makes patients capable, active and self-respecting member of society.

Reference: Ms Ma. Adelaida Morong, Far Eastern University- Institute of Nursing In-House Nursing Review

S-ar putea să vă placă și