The multiple causation of disease refers to the complex interplay of various factors that contribute to disease occurrence. Some key points: - Leading causes of morbidity and mortality differ and are influenced by factors like environment, lifestyle, access to care, socioeconomics - Infectious diseases remain major causes of death globally but non-communicable diseases are increasing in developing countries - For infants, conditions present at birth and during the neonatal period account for many deaths along with infections like pneumonia - Maternal deaths are often due to complications of pregnancy, delivery and postpartum period that are preventable with adequate care - Notifiable infectious diseases continue to pose public health challenges and require surveillance, prevention and control efforts.

1. PUBLIC
HEALTH
NURSE

2. Roles and Functions
Roles Functions
-Identifies priorities and problems of
individuals, families and community.
-formulates nursing component of
health plans. In doctorless area, she/he
is responsible for the formulation of the
municipal health plan.
1. Planner/ Programmer -interprets and implements the nursing
plan, program policies, memoranda
and circulars for the concerned staff/
personnel.
-provides technical assistance to rural
health midwives in health matters like
target setting, etc.

3. Roles and Functions
Roles Functions
-provides direct nursing care to the
sick, disabled in the home, clinic,
school or place of work.
-Develops the family’s capability to take
2. Provider of Nursing Care care of the sick, disabled or dependent
member.
-provides continuity of patient care.

4. Roles Functions
-formulates individual, family, group and
community centered care plan.
-interprets and implements program
policies, memoranda and circulars.
-organizes work force, resources,
equipments and supplies and delivery of
health care at local levels.
-requisitions, allocates, distributes materials
3. Manager/Supervisor (medicine and medical supplies, records
and reports equipment.)
-provides technical and administrative
support to Rural Health Midwife (RHM)
-Conducts regular supervisory visits and
meetings to different RHMs and gives
feedback on
accomplishments/performances.

5. Roles and Functions
Roles Functions
-responsible for motivating and
enhancing community participation in
terms of planning, organizing and
implementing and evaluating health
programs/services.
4. Community Organizer
-initiates and participates in community
development activities.

6. Roles and Functions
Roles Functions
-coordinates with individuals, families,
and groups for health and related
health services provided by various
members of health team and other
Government Organizations (Gos) and
Non-Government Organizations
(NGOs).
5. Coordinator of Services
-Coordinates nursing program with
other health programs as
environmental sanitation, health
education, dental health and mental
health

7. Roles Functions
-facilitates training for BHWs
-organizes orientation/training of
concernes groups including non-
government organizations
-acts as a resource speaker/person on
health and health related services
6. Trainer/Health Educator/Counselor -participates in the development and
distribution of Information Education
and Communication (IEC) materials
-initiates the use of tri-media: radio/TV
and cinema plugs, print ads, and other
indigenous resources for health
education purposes.
-conducts pre-marital counseling

8. Roles and Functions
Roles Functions
-detects deviation from health of
individuals, families, groups of the
community through contact/visits with
them.
-uses symptomatic and objective
7. Health Monitor
observation and other forms of data
gathering like morbidity, registry,
questionnaire, checklist, and anecdo-
report/record to monitor growth ad
development and health status of
individuals, families and communities.

9. Roles and Functions
Roles Functions
-provides good example/model of
8. Role model
healthful living to the public/community.
-motivates changes in health behavior
of individuals, families, group and
9. Change Agent
community including lifestyle in order to
promote and maintain health.
-prepares and submits required reports
and records
-Maintains adequate, accurate and
10. Recorder/Reporter/Statistician complete recording and reporting.
-reviews, validates, consolidates,
analyzes and interprets all records and
reports.

10. Roles and Functions
Roles Functions
-prepares statistical data/charts and
other data presentations for display
and for presentation in staff meetings
conferences and seminars/workshops.
-partipates/assists in the conduct of
surveys studies and researches on
nursing and health related subjects
11. Researcher
-coordinates with government and non-
government organization in the
implementation of studies/research.

11. Competencies/Skills
COMMUNITY HEALTH NURSING PROCESS
EPIDEMIOLOGY
HEALTH PROMOTION
HOME CARE

12. COMMUNITY HEALTH
NURSING PROCESS
• the nursing process is a systematic, scientific,
dynamic, on-going iterpersonal process in which the
nurses and the clients are viewed as a system with
each affecting the other and both being affected by
the factors within the beahivior.

13. • It includes:
ASSESSMENT
-provides an estimate of the degree to which a family,
group or community is achieving the level of health
possible for them, identifies specific deficiencies or
guidance needed and estimates the possible effects
of the nursing interventions

14. -the process of assessment includes: intensive fact
finding, the application of ping the professional
judgement in estimating the meaning and
importance of these facts to the family and the
comunity, the availability of nursing resources that
can be provided, and the degree of change which
nursing intervention can be expected to effect.

15. PLANNING NURSING ACTIONS/CARE
-the plan for nursing action or care is bassed on the
actual and potential problems that were identified
and prioritized. Planning nursing actions include the
following steps:

16. a. Goal setting- a goal is a declaration of purpose or
intent that gives essential direction to action.
Specific objectives of care made with the
individual/family in terms of activities of daily living,
and adaptive functioning based on remaining
capabilities resulting from this condition and
capability to cope with stress associated with
his/her disease condition or environment.

17. b. Contructing a Plan of Action-the planning phase of
community health nursing process is concerned with
choosing from among the possible courses of action,
selecting the appropriate types of nursing intervention,
identifying appropriate and available resources for care and
developing an operational plan.
c. Developing an Operational Plan- to develop an
operational paln, the community heal;th nurse must
establish priorities, phase and coordinate activities.

18. IMPLEMENTATION OF PLANNED CARE
-in community health nursing, implementation involves
various nursing interventions which have been
determined by the goals/objectives which have
been previously set.
-the community health nurses monitor the health
services provided, make proper referrals as
necessary and supervise midwives and BHWs.
-documentation is an important function
of the community health nurses.

19. EVALUATION OF CARE AND SERVICES
PROVIDED
-evaluation is interwoven in every nursing activity and
evry step of the community health nurse. There are
3 classic frameworks from which nursing care is
delivered.

20. a. Structural elements-include the physical settings,
instrumentalities and conditions through which
nursing care is given such as philosphy, objectives,
building, organixational structure, financial
resources such as budget, equipment and staff.

21. b. Process elements-include the steps of the nursing
process itself assessing, palnning, implementing
and evaluating: such as taking the family health
data base; performing physical examination;
making a nursing diagnosis; determining nursing
goals; writing a nursing care plan; performing the
necessary nursing interventions and coordination of
services and measuring success of nursing actions.

22. c. Outcome elements-are changes in the client’s
health status that result from nursing intervention.
These changes include modification of symptom,
signs, knowledge, attitudes, satisfaction, skill level
and compliance with treatment regimen.
BACK

23. EPIDEMIOLOGY
-is the study of the distribution and determinants of
health-related states or events (including disease),
and the application of this study to the control of
diseases and other health problems.
-

24. Uses of Epidemiology
According to Morris, uses of epidemiology include the ff:
• to diagnose the health of the community and the condition of
people; to measure the distribution and dimension of illness in
terms of incidence, prevalence, disability and mortality; to set
health problems in perspective and to define their relative
importance; and to identify groups needing special attention.
-
New methods of monitoring must be constantly sought.
• to study the history of the health populations and the rise and
fall of disease and changes in their character.

25. Uses of Epidemiology
• to study the working of health services with a view of
improving them.
• to estimate the risks of diseases, accident, defect and the
chances of avoiding them.
• to complete the clinical picture of chronic disease and
-
describe their natural history
• to identify syndromes by describing the distribution and
association of clinical phenomena in the population

26. Uses of Epidemiology
• to search for causes of health and disease by comparing the
experience of groups that are clearly defined by their
composition, inheritance, experience, behavior and
environments.
-

27. EPIDEMIOLOGICAL TRIAD
The best known,
but most dated
model of
communicable
- disease is the
Epidemiologic
Triad

28. -
This model comprises a
susceptible host (the person at risk for the
disease), a disease agent (the proximate
cause), and an environmental context for the
interaction between host and agent.

29. Outline of Plan for Epidemiological
Investigation
1. Establish fact of presence of Epidemic
• Verify diagnosis
• Reporting
• Is there an unusual prevalence of the disease
-
2. Establish time and space relationship of the disease
• Are the cases limited to or concetrated in any
particular geographical subdivision of the affected
community?

30. Outline of Plan for Epidemiological
Investigation
• Relation of cases by days of onset to onset of the
first known cases-may be done by days, weeks or
months (in general, by weeks gives best overall
picture).
-
3. Relations to characteristic of the group of
community:
• Relation of cases to age groups, sex, color,
occupation, school attendance, past immunization,
etc.

31. Outline of Plan for Epidemiological
Investigation
• Relation of sanitary facilities, especially water
supply, sewerage disposal, general sanitation of
homes, and relation to animal or insect vectors.
• Relation to milk and food supply.
• - cases and known
Relation of cases to other
carriers if any.

32. Outline of Plan for Epidemiological
Investigation
4. Correlation of all data obtained
• Summarize data clearly with the aid of such tables and
charts are necessary to give a clear picture of the
situation.
• Build up the case for the finalconclusion carefully utilizing
all the evidence available.
-
• Establish the source of the epidemic and the manner of
the spread, if possible.
• Make suggestions as to the control, if disease is still
present in community and as to prevent of future
outbreaks.

33. Outline on the Operational Procedure During
a Disease Outbreak
1. Organization of Team
• Coordination of personnel
• Orientation/demonstration on the methodology to
be emplyed
-
• Area Assignment of Teams
• Check-list on the team’s paraphernalia
• Pooling of data and resource-record keeping

34. Outline on the Operational Procedure During
a Disease Outbreak
2. Epidemiologic al Investigation
• Active case finding
• Carriers and contact control
• Surveillance
3. Collection of Laboratory Specimens
-
• Rectal swabbing
• Food Sampling
• Other that are relevant to the disease

35. Outline on the Operational Procedure During
a Disease Outbreak
4. Treatment of Patients and Contacts
• Analgesics/antipyretics
• Antibiotics
• Parenteral fluids
• Supportive drugs
-
• Emergency drugs
• Isolation of patient “cordon sanitaire”
• Boiling and disinfection of fomites
• Conduction of patient to hospital

36. Outline on the Operational Procedure During
a Disease Outbreak
5. Immunization
• Type of vaccine
• Dosage, schedule, technique
• Areas to be covered
-
• Target population
• Consolidation and evaluation of data

37. Outline on the Operational Procedure During
a Disease Outbreak
6. Environmental Sanitation (During the survey)
• Water
• Toilets and surroundings
• Garbage disposal
-
• Insect and Vermin control
• Food sanitation

38. Outline on the Operational Procedure During
a Disease Outbreak
7. Health Education
• Individual approach
• Community approach and meetings
• Schools P.T.A. , church and other congragations
8. Involvement of other Agencies
-
9. Reporting
• Telegraphic report
• Written

39. Functions of the Nurse in Epidemiology
• Maintains surveillance of the occurrence of
notifiable disease.
• Coordinates with other members of the health
team during a disease outbreak.
• Participates in casefinding and collection of
laboratory specimens. -
• Isolates cases of communicable diseases.
• Renders nursing care teaches and supervises
giving care.

40. Functions of the Nurse in Epidemiology
• Performs and teach
housefold members
methods concurrent
and terminal
disinfection.
• Give health teaching
-
to prevent further
spread of disease to
individuals and
families.
• Follow up cases and

41. MULTIPLE CAUSATION OF DISEASE
MORBIDITY: 10 LEADING CAUSES
Rate/100,000 Population
PHILIPPINES, 1998
1. Diarrheas 6. TB Respiratory
2. Pneumonias 7. Malaria
3. Bronchitis -
8. Diseases of the heart
4. Influenza 9. Dengue fever
5. Hypertension 10.Chickenpox

42. MULTIPLE CAUSATION OF DISEASE
MORTALITY: 10 LEADING CAUSES
Number and Rate/100,000 Population
PHILIPPINES, 1995
1. Diseases of the Heart
2. Diseases of the Vascular System
3. Pneumonias -
4. Malignant Neoplasms
5. Tuberculosis. All forms

43. MULTIPLE CAUSATION OF DISEASE
MORTALITY: 10 LEADING CAUSES
Number and Rate/100,000 Population
PHILIPPINES, 1995
6. Accidents
7. Chronic Obstructive Pulmonary Disease & Allied
Conditions -
8. Other diseases of the Respiratory System
9. Diabetes Mellitus
10. Nephritis, Nephrotic Syndrome and Nephrosis

44. MULTIPLE CAUSATION OF DISEASE
INFANT MORTALITY: 10 LEADING CAUSES
PHILIPPINES, 1995
1. Pneumonias
2. Respiratory Condition of Fetus and Newborn
3. Congenital Anomalies -
4. Birth Injury & Difficult Labor
5. Diarrheal Diseases

45. MULTIPLE CAUSATION OF DISEASE
INFANT MORTALITY: 10 LEADING CAUSES
PHILIPPINES, 1995
6. Septicemia
7. Meningitis
-
8. Avitaminoses & Other Nutritional Deficiency
9. Other Diseases of the Respiratory System
10. Measles

46. MULTIPLE CAUSATION OF DISEASE
MATERNAL MORTALITY: BY MAIN CAUSE
PHILIPPINES, 1995
1. Complications related to pregnancy occurring in
the course of labour, delivery & puerperium
2. Hypertension complicating pregnancy, childbirth
and puerperium -
3. Postpartum hemorrhage
4. Pregnancy with abortive outcome
5. Hemorrhages related to pregnancy

47. MULTIPLE CAUSATION OF DISEASE
NOTIFIABLE DISEASES • Diseases of the Heart
• Diarrheas • Malignant Neoplasms
• Pneumonias • Chickenpox
• Bronchitis/Bronchiolitis • Dengue Fever
• Influenza • Malaria
• Measles - • Cholera
• TB respiratory • Typhoid &
• TB meningitis Paratyphoid fever
• TB other forms • Viral hepatitis

48. MULTIPLE CAUSATION OF DISEASE
NOTIFIABLE DISEASES • AIDS/ HIV Infection
• Rabies • Leprosy
• Diphtheria • Schistosomiasis
• Tetanus Neonatrum • Filiriasis
• Tetanus • Meningitis/
• Poliomyelitis - Encephalitis
• Whooping cough • Leptospirosis
• Gonorrhea • Poisoning
• Syphilis • Hypertension

49. IMMUNITY HERD
-describes a form of immunity that occurs when the vaccination
of a significant portion of a population (or herd) provides a
measure of protection for individuals who have not
developed immunity.
-proposes that, in contagious diseases that are transmitted
from individual to individual, chains of infection are likely to
be disrupted when large-numbers of a population are
immune or less susceptible to the disease.
-The greater the proportion of individuals who are resistant, the
smaller the probability that a susceptible individual will
come into contact with an infectious individual.

50. IMMUNITY HERD

51. IMMUNITY HERD
Estimated Herd Immunity thresholds for vaccine preventable diseases
Herd immunity
Disease Transmission R0
threshold
Diphtheria Saliva 6–7 85%
Measles Airborne 12–18 83–94%
Mumps Airborne droplet 4–7 75–86%
Pertussis Airborne droplet 12–17 92–94%
Polio Fecal-oral route 5–7 80–86%
Rubella Airborne droplet 5–7 80–85%
Smallpox Social contact 6–7 83–85%

52. BACK

53. HEALTH EDUCATION
- is a process whereby knowledge, attitude and
practice of people are changed to improve
individual, family and community health.
- Is a means of improving the health of the people by
employing various methods of scientific
procedures to show the most healthful ways of
living.

54. Principles of Health Education
1. Health education considers the health status of the
people.
2. Health Education is learning.
3. Health education involves motivation, experience
and change in conduct and thinking.
4. Health education should be recognized as a basic
function of all health workers.
5. Health education takes place in the home, in the
school and the community.

55. Principles of Health Education
6. Health education is a cooperative effort.
7. Health education meets needs, interests and
problems of the people affected.
8. Health education is achieved by doing.
9. Health education is a slow continuous process.
10. Health education makes use of supplementary aids
and devices.

56. Principles of Health Education
11. Health education utilizes resources.
12. Health education is a creative process.
13. Health education helps people attain health
through their own efforts.
14. Health education makes careful evaluation of the
planning.

57. Health Education Teaching Methods and
Strategies
• Interviewing • Group work-buzz
• Counseling sessions
• Lecture-discussion • Use of Publication
• Open forum • Nominal Group
• Technique
Workshop
• Laboratory Training
• Case Study
• Use of IEC
• Role play
(information, education
• Symposium and communication)

58. Qualities of a Good Health Educator
• Knowledgeable/mastery • Patience
of the subject matter • Creative and
• Credible immovative
• Good Listener • Effective motivator
• Can emphasize with • Ability to rephrase
other • Encourages group
• Posses teaching skills participation
• Flexible • Good sense of
humor

59. BACK

60. HOME CARE
- giving to the individual patient the nursing care
required by his/her specific illness or trauma to
help him/her reach a level of functioning at which
he/she can maintain himself/herself, or die
peacefully in dignity.

61. Principles in Nursing Care
1. Nursing care utilizes a medical plan of care and
treatment.
2. The performance of nursing care utilizes skills that
would give maximum comfort and security to the
individual.
3. Nursing care given at home should be used as a
teaching opportunity to the patient or to any
responsible member of the family.

62. Principles in Nursing Care
4. The performance of nursing care should recognize
dangers in the patient’s over-prolonged
acceptance and comfort.
5. Nursing care is a good opportunity for detecting
abnormal signs and symptoms, observing patient’s
attitude towards care given and the progress
exhibited by the patient.

63. Isolation Technique in the Home
Generally, strict isolation technique is difficult to carry
out in the homes where houses are small
and occupy a large number of people.
1. All articles used by the patient should not
be mixed with the articles used by the
rest of the members of the household.
2. Frequent washing and airing od beddings
and other articles and disinfection of room
are imperative. Abundant use of soap,
water, sunlight and some chemical
disinfectants is necessary.

64. Isolation Technique in the Home
3. The one caring for the sick member should be
provided with a protected gown that should be used
only within the room of the sick.
4. All discharges, especially from the nose and throat
of a communicable disease patient, should be
carefully discarded.
5. Articles soiled with dischages should first be boiled
in water 30 minutes before laundering. Those could
be burned, should be burned.

65. Prepared by:
Group 3
“J-roy and the Piklets”