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 client’s 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. Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
(NANDA 2001)
6. Others. Specify.
B. Readiness for Enhanced Capability for:

1. Healthy lifestyle
2. Health maintenance/health 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
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. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
 5. Others specify.
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices.
Specify.

1. Inadequate food intake both in quality and quantity

2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.

1. Strained marital relationship

2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.

1. Inadequate living space

2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.

1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. 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 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. 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. Social-stigma, loss of respect of peer/significant others

2. Economic/cost implications
3. Physical consequences
4. 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. Social consequences
2. Economic consequences
3. Physical consequences
4. 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. Physical Inaccessibility
2. 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. Absence of responsible member

2. Financial constraints
3. 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. Member’s preoccupation with on concerns/interests

J. Prolonged disease or disabilities, which exhaust supportive capacity of family
members.

K. Altered role performance, specify.

1. Role denials or ambivalence

2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. 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. Financial constraints/limited financial resources

2. 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 family’s 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. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services

G. Inaccessibility of required services due to:

1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically

1. Manpower resources, e.g. baby sitter

2. 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 __________

Bag Technique
Definition
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. The use of the bag technique should minimize if not totally prevent the spread of
infection from individuals to families, hence, to the community.
2. Bag technique should save time and effort on the part of the nurse in the
performance of nursing procedures.
3. Bag technique should not overshadow concern for the patient rather should show
the effectiveness of total care given to an individual or family.
4. 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. The bag should contain all necessary articles, supplies and equipment which may
be used to answer emergency needs.
2. The bag and its contents should be cleaned as often as possible, supplies replaced
and ready for use at any time.
3. The bag and its contents should be well protected from contact with any article in
the home of the patients. Consider the bag and it’s contents clean and /or sterile
while any article belonging to the patient as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to
the user to facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for, helps in minimizing
or avoiding contamination of the bag and its contents.
6. 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
 Baby’s scale
 1 pair of rubber gloves
 2 test tubes
 Test tube holder
 Medicines
 betadine
 70% alcohol
 ophthalmic ointment (antibiotic)
  zephiran solution
 hydrogen peroxide
 spirit of ammonia
 acetic acid
 benedict’s solution
Note: Blood Pressure Apparatus and Stethoscope are carried separately.
Steps/Procedures
Actions Rationale

1. Upon arriving at the client’s 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 bag’s handles or
strap beneath the bag. To protect the bag from contamination.

2. Ask for a basin of water and a glass of water

if faucet is not available. Place these outside the To be used for handwashing.
work area. To protect the work field from being wet.

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). To make a non-contaminated work field or area.

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). To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel.

Leave the plastic wrappers of the towel in a Handwashing prevents possible infection from one care
soap dish in the bag. provider to the client.

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 To protect the nurses’ uniform. Keeping the crease create
back. aesthetic appearance.

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. To make them readily accessible.

8. Place waste paper bag outside of work area. To prevent contamination of clean area.

To give comfort and security, maintain personal hygiene

9. Close the bag. and hasten recovery.

10. Proceed to the specific nursing care or

treatment. To prevent contamination of bag and contents.

11. After completing nursing care or treatment, To protect caregiver and prevent spread of infection to
clean and alcoholize the things used. others.
 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. To be used as reference for future visit.

17. Make appointment for the next visit (either

home or clinic), taking note of the date, time
and purpose. For follow-up care.

After Care

1. Before keeping all articles in the bag, clean and alcoholize them.
2. 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. Record all relevant findings about the client and members of the family.
2. Take note of environmental factors which affect the clients/family health.
3. Include quality of nurse-patient relationship.
4. Assess effectiveness of nursing care provided.

Breastfeeding or Lactation Management Education

Training
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. Cradle Hold = head and neck are supported
2. Football Hold
3. 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

Community Health Nursing: An Overview

Community
 a group of people with common characteristics or interests living together within
a territory or geographical boundary
 place where people under usual conditions are found
 Derived from a latin word “comunicas” which means a group of people.
Health
 OLOF (Optimum Level of Functioning)
 Health-illness continuum
 High-level wellness
 Agent-host-environment
 Health belief
 Evolutionary-based
 Health promotion
 WHO definition
Community Health
 Part of paramedical and medical intervention/approach which is concerned on the
health of the whole population
Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
Nursing
 Both profession & a vocation. Assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness
Community Health Nursing
 “The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the
promotion of health, prevention of disease and disability and rehabilitation.”
( Maglaya, et al)
 Goal: “To raise the level of citizenry by helping communities and families to cope
with the discontinuities in and threats to health in such a way as to maximize their
potential for high-level wellness” ( Nisce, et al)
 Special field of nursing that combines the skills of nursing, public health and
some phases of social assistance and functions as part of the total public health
program for the promotion of health, the improvement of the conditions in the
social and physical environment, rehabilitation of illness and disability
( WHO Expert Committee of Nursing)
 A learned practice discipline with the ultimate goal of contributing as individuals
and in collaboration with others to the promotion of the client’s optimum level of
functioning thru’ teaching and delivery of care (Jacobson)
 A service rendered by a professional nurse to IFCs, population groups in health
centers, clinics, schools , workplace for the promotion of health, prevention of
illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)
Public Health
 “Public Health is directed towards assisting every citizen to realize his birth rights
and longevity.”“The science and art of preventing disease, prolonging life and
efficiency through organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and
preventive treatment of disease
5. The development of a social machinery to ensure every one a standard of living,
adequate for maintenance of health to enable every citizen to realize his birth right
of health and longevity (Dr. C.E Winslow)
Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice
Philosophy of CHN
 “The philosophy of CHN is based on the worth and dignity on the worth and
dignity of man.”(Dr. M. Shetland)
Basic Principles of CHN
1. The community is the patient in CHN, the family is the unit of care and there
are four levels of clientele: individual, family, population group (those who share
common characteristics, developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient
of care
3. CHN practice is affected by developments in health technology, in particular,
changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system

Roles of the PUBLIC HEALTH NURSE

 Clinician, who is a health care provider, taking care of the sick people at home or
in the RHU
 Health Educator, who aims towards health promotion and illness prevention
through dissemination of correct information; educating people
 Facilitator, who establishes multi-sectoral linkages by referral system
 Supervisor, who monitors and supervises the performance of midwives
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 Collaborator, who working with other health team member
*In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHO’s responsibilities.

Other Specific Responsibilities of a Nurse, spelled by the implementing rules

and Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
 Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.
In the care of the families:
 Provision of primary health care services
 Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
 Community organizing mobilization, community development and people
empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and
development
Responsibilities of CHN

 be a part in developing an overall health plan, its implementation and evaluation

for communities
 provide quality nursing services to the three levels of clientele
 maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health services
 conduct researches relevant to CHN services to improve provision of health care
 provide opportunities for professional growth and continuing education for staff
development
Standards in CHN

1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
 At each level of prevention, develops plans that specify nursing actions
unique to needs of clients
5. Intervention
  Guided by the plan, intervenes to promote, maintain or restore health, prevent
illness and institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
 Participates in peer review and other means of evaluation to assure quality of
nursing practice
 Assumes professional development
 Contributes to development of others
8. Interdisciplinary Collaboration
 Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and
evaluating programs for community health
9. Research
 Indulges in research to contribute to theory and practice in community health
nursing

Communicable Disease (Vector Borne)

Leptospirosis (Weil’s disease)

 An infectious disease that affects humans and animals, is considered the most
common zoonosis in the world
Causative Agent:
Leptospira interrogans

Sign/Symptoms:
 High fever
 Chills
 Vomiting
 Red eyes
 Diarrhea
 Severe headache
 muscle aches
 may include jaundice (yellow skin and eyes)
 abdominal pain
Treatment:
PET – > Penicillins, Erythromycin, Tetracycline
Malaria

 Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or
marsh fever) is an infectious disease that is widespread in many tropical and
subtropical regions.
Causative Agent:
Anopheles female mosquito

Signs & Symptoms:

 Chills to convulsion
 Hepatomegaly
 Anemia
 Sweats profusely
 Elevated temperature
Treatment:
 Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2
weeks before entering the endemic area.
 Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine
 Insecticide treatment of mosquito nets, house spraying, stream seeding and
clearing, sustainable preventive and vector control meas
Preventive Measures: (CLEAN)
 Chemically treated mosquito nets
 Larvae eating fish
 Environmental clean up
 Anti mosquito soap/lotion
 Neem trees/eucalyptus tree
Filariasis

 name for a group of tropical diseases caused by various thread-like parasitic

round worms (nematodes) and their larvae
 larvae transmit the disease to humans through a mosquito bite
 can progress to include gross enlargement of the limbs and genitalia in a condition
called elephantiasis
Sign/Symptoms:
Asymptomatic Stage
 Characterized by the presence of microfilariae in the peripheral blood
 No clinical signs and symptoms of the disease
 Some remain asymptomatic for years and in some instances for life
Acute Stage
 Lymphadenitis (inflammation of lymph nodes)
 Lymphangitis (inflammation of lymph vessels)
 In some cases the male genitalia is affected leading to orchitis (redness, painful
and tender scrotum)
Chronic Stage
 Hydrocoele (swelling of the scrotum)
 Lyphedema (temporary swelling of the upper and lower extremities
 Elephantiasis (enlargement and thickening of the skin of the lower and / or upper
extremities, scrotum, breast)
Management:
 Diethylcarbamazine citrate or Hetrazan
 Ivermectin,
 Albendazolethe
 No treatment can reverse elephantiasis
Schistosomiasis

 parasitic disease caused by a larvae

Causative Agent:
Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

 Bulging abdomen
 Abdominal pain
 Loose bowel movement
 Low grade fever
 Inflammation of liver & spleen
 Pallor
 Seizure
Preventive measures
 health education regarding mode of transmission and methods of protection;
proper disposal of feces and urine; improvement of irrigation and agriculture
practices
 Control of patient, contacts and the immediate environment
Treatment:
 Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)
Dengue

 DENGUE is a mosquito-borne infection which in recent years has become a

major international public health concern..
 It is found in tropical and sub-tropical regions around the world, predominantly in
urban and semi-urban areas.
Sign/Symptoms: (VLINOSPARD)
 Vomiting
 Low platelet
 Nausea
 Onset of fever
 Severe headache
 Pain of the muscle and joint
 Abdominal pain
 Rashes
 Diarrhea
Treatment:
 The mainstay of treatment is supportive therapy.
 Intravenous fluids
  A platelet transfusion
Community Organizing Participatory Action Research
(COPAR)
Definitions of COPAR
A social development approach that aims to transform the apathetic, individualistic
and voiceless poor into dynamic, participatory and politically responsive community.
 A collective, participatory, transformative, liberative,
sustained and systematic process of building people’s
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. 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.
2. COPAR should be based on the interest of the poorest sectors of society
3. 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:

 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.

 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:

 Education and training
 Networking and linkaging
 Conduct of mobilization on health and development concerns
 Implementing of livelihood projects
 Developing secondary leaders

Expanded Program for Immunization (EPI)

Principles of EPI
1. Epidemiological situation
2. Mass approach
3. Basic Health Service
The 7 immunizable diseases
1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B
Target Setting

 Infants 0-12 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old
Objectives of EPI

 To reduce morbidity and mortality rates among infants and children from six
childhood immunizable disease
Elements of EPI

 Target Setting
 Cold chain Logistic Management- Vaccine distribution through cold chain is
designed to ensure that the vaccines were maintained under proper environmental
condition until the time of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies
Administration of vaccines

#
of
Do
Vaccine Content Form & Dosage ses Route

Freeze dried
BCG (Bacillus Calmette Live attenuated Infant- 0.05mlPreschool-
Guerin) bacteria 0.1ml 1 ID

DT- weakened
toxin
DPT (Diphtheria P-killed bacteria
Pertussis Tetanus) liquid-0.5ml 3 IM

OPV (Oral Polio

Vaccine) weakened virus liquid-2drops 3 Oral

Hepatitis B Plasma derivative Liquid-0.5ml 3 IM

Measles Weakened virus Freeze dried- 0.5ml 1 Subcutaneous

Schedule of Vaccines

Age at 1st
Vaccine dose Interval between dose Protection

BCG is given at the earliest possible age protects

against the possibility of
BCG At birth TB infection from the other family members

An early start with DPT reduces

DPT 6 weeks 4 weeks the chance of severe pertussis

The extent of protection against

OPV 6weeks 4weeks polio is increased the earlier OPV is given.

An early start of Hepatitis B reduces

the chance of being infected and

@birth,6th week,14th becoming a carrier.

Hepa B @ birth week
 9m0s.- At least 85% of measles can be prevented by
Measles 11m0s. immunization at this age.
 6 months – earliest dose of measles given in case of outbreak
 9months-11months- regular schedule of measles vaccine
 15 months- latest dose of measles given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less than 12 months old child with complete
immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.
Tetanus Toxiod Immunization
Schedule for Women
Vaccine Minimum age interval % protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

TT4 1year later/during next pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

 There is no contraindication to immunization except when the child is
immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child
experienced convulsions after a DPT or measles vaccine, report such to the doctor
immediately.
 Malnutrition is not a contraindication for immunizing children rather; it is an
indication for immunization since common childhood diseases are often severe to
malnourished children.
Cold Chain under EPI

 Cold Chain is a system used to maintain potency of a vaccine from that of

manufacture to the time it is given to child or pregnant woman.
 The allowable timeframes for the storage of vaccines at different levels are:
 6months- Regional Level
 3months- Provincial Level/District Level
 1month-main health centers-with ref.
 Not more than 5days- Health centers using transport boxes.
 Most sensitive to heat: Freezer (-15 to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
 BCG
 DPT
 Hepa B
 TT
 Use those that will expire first, mark “X”/ exposure, 3rd- discard,
 Transport-use cold bags let it stand in room temperature for a while before storing
DPT.
 Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”) – vaccine is practiced to assure that all
vaccines are utilized before the expiry date. Proper arrangement of vaccines
and/or labeling of vaccines expiry date are done to identify those near to expire
vaccines