33314130 Operational Definition Final Feu

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FAR EASTERN UNIVERSITYAssociate in Health Science EducationPHC II - Related Learning Experience

OPERATIONAL DEFINITION OF TERMS: Data to be collected during Community Diagnosis

Family - a group of persons usually living together and composed of the head and other persons related to the head byblood, marriage or adoption. It includes both the nuclear and extended family. Moreover, they are sharing same resources

(such as food, utilities, money and alike), social responsibilities and privileges. Two families sharing one household but 1decision maker considered as 1 family, if both have a decision-maker they are considered as 2 familiesHousehold - a social unit consisting of a person living alone or a group of persons who sleep in the same house. Ahousehold may consist of several families

A. Demographic data

Age – age as of last birthday

Sex - male or female

Civil status- enter any of the following:

a. Single (S) - person is not and has never been married.

b. Married (M) – person living with another person bound by legal ritesc. Common Law (CL) – person living with another person without the benefit of a lega

marriage; a couple living together for five years or more without a marriage license but is solemnized isconsidered to be married.

d. Widowed (W) – person whose spouse has died, and has not remarried. Widow forfemale; widower for male

e. Separated / Divorce – person legally separatd from his/her spouse or who is living apart

from his/her spouse because of marital discord or similar reasons; a person whose bond of marriagehas been dissolved and can therefore remarry

4. Religion – indicate religion for each family member. Note: in case of children (0-14), they assume the

mother’s religion as articulated in the Family Code of the Philippines. Indicate religious sect.

5. Head of the Family – the primary decision-maker in the family; or he/she could be the recognized head

by the family

6. Educational status – (7 and above) indicate status for each member of the family. Indicate whetherhe/she is:

Degree holder / college graduate

presently studying and highest completed level: Pido Dido CS- grade 5

had stopped studying and highest completed level: : Pedro Penduko Had Stopped- 2nd year high school

No formal education – has never had any formal education (elementary, high school, college)

For collation purposes, further break it down into:

Degree holders/ college graduate - also include graduates of vocational coursesCurrently studying- elementary, high school and college levelHad stopped studying - Elementary graduate/undergraduate;

High School graduate/undergraduateCollege/Vocational courses undergraduate

7. Type of family – indicate structure as to nuclear or extended type. In terms of decision-making, we use

matriarchal or patriarchal types.

8. Literacy Rate – in the Philippines, persons aged 15 years old and above who are unable to read AND

write are considered illiterates.Literacy rate = # ppl 15 y.o. and above who can read AND write x 100

# ppl aged 15 and above



9. Ethnic background – refers to selected cultural and sometimes physical characteristics used to classify

people into groups or categories considered to be significantly different from others. mangyan, t’boletc. These people may be considered as indigents or having special needs

10. Race - is a biological subspecies, or variety of a species, consisting of a more or less distinc

population with anatomical traits that distinguish it clearly from other races.

11. Regional origin – could be Luzon, Visayas, Mindanao, or per region if you want to be

specific12.Primary Dialect Spoken – primary dialect used by the family

13. Patterns of Migration – determine whether there is a large number of in-migration or out-migrationin the community as well as the reasons behind the trends. Determine if transient or permanentTransient: below 6 months; Permanent: 6 months above

14. Disadvantaged People – these are people or groups of people who have special needs in terms o

basic health needs and services, and not necessarily financial in nature (ostracized groups likerefugees, tribes, OSY etc.)- individuals or group of individuals who are considered economically, physically and socially

disadvantaged. These include needy family heads and other needy adults, indigent children, out-of

school youths, physically and mentally disabled persons, distressed individuals and families, and

disadvantaged children.

Population Density – will determine how congested a place is and has implications in terms of the adequacyof basic health services present in the community. It can be computed by dividing the number of people livingin a given land area. Total land area, area per purok

Population density: land area (sq. km)___ x 100Total population

Compute population density per purok if barangay has puroks.

15. Population Projection – important in establishing what services and health programs to implemen

and strengthen. For example, in the event that current trends in birth and death rates would lead toa dramatic increase in the population, the community can strengthen their program on maternal andchild care, and immunization programs to cater to the young population, at the same time launchingprograms on family planning to control the growth of population.

16. Urban-Rural Index (if applicable) – determine as to what percent of the community can be

considered urban or ruralUrban Barangay :

definition includes the criteria on the economic and social functions of barrios,poblaciones, and central districts as follows:

1. In their entirely, all municipal jurisdictions which, whether designated as chartered cities,

provincial, capital or not, have a population density of at least 1,000 persons per square

kilometer.

2. Poblaciones or central districts of municipalities and cities which have a population density of at

least 500 persons per square kilometer.

3. Poblaciones or central districts (not included in nos. 1 and 2) regardless of population sizewhich have the following:

a. Street pattern, i.e., network of street in either at parallel or right angle orientation;

b. At least six establishments (commercial, manufacturing, recreational and/or personaservice); and

c. At least three of the following:

i) a town hall, church or chapel with religious services at least once a month;ii) a public plaza, park or cemetery;

iii) a market place or building where trading activities are carried on at least once a

week; and



iv) a public building like school, hospital, puericulture and health center or library.

4. Barrios/barangays having at least 1,000 inhabitants which met the conditions

setforth in no. 3 above, and in which the occupation of the inhabitants is

predominantly non-farming/fishing.

(1) If a barangay has a population size of 5,000 or more, then a barangay is considered urban, or (2) If a barangay has at least one establishment with a minimum of 100 employees(3) If a barangay has 5 or more establishments with a minimum of 10 employees, and 5 or more facilities

within the 2 km radiusfrom the brgy hall

Rural Barangay – an area outside any area classified as urban

17. Under-employment – underemployment is preset if one of the following is present:If there is under

utilization of skills

18. Dependency ratio - the ratio of the economically dependent part of the population to the productive part

The economically dependent part is recognized to be children who are too young to work, and individuals

that are too old, that is, generally, individuals under the age of 15 and over the age of 65. The productive par

makes up the gap in between (ages 15 - 64).

II.COMMUNITY AS A PLACEEnvironment1. Spot map

should be oriented to the Northhouseholds (should be numbered accdg to control number in the survey tool for easy reference, case

finding, contact tracing)

Determine total number of households

Households:

Family:geographical boundariesroads, bridges, arcs (if present)significant landmarksinstitutional facilities (health center, brgy hall, church, hospitals, market, talipapa, recreational facilities

water district, municipal hall,schools, etc)topography (mountains, bodies of water, etc)

• Provide legends for easy reference. Legends should be simple and easy to recognize.

• Important landmarks/facilities should be labeled with their actual names, not just as “school”or “street”, for example)

• Distances among households, facilities, roads, etc should be realistic and proportioned toestablish areas of congestion or proximity)

3. Areas that contribute to vector problems4. Terrain characteristics that poses hazards5. History of the barangay6. Climate (year-round) and occurrence of sickness and illness7. Presence of air and water pollution

Communication System – use for health information dissemination (formal and informal modes of communication)Transportation System – transportation system and road networks use to access health facilities

III. COMMUNITY AS A SOCIAL SYSTEM

A. Perception of present problems in the community - The community people’s perception on common/ presen

problems either health related or in general such as peace and order, waste disposal, substance abuse etcThese are the problems that the people are concerned and are willing to act on.

B. Ways of resolving perceived community problems - Methods utilized by the community people - if any- to

solve the problems perceived to be their major concern.

C. Economic Aspects



1. Occupation / Livelihood / Other sources of Income - The types and place of occupations of the

members of the family are to be identified. The data to be gathered is exhaustive (meaning therecan be a variety of answers and not just limited to 3 to 5 as what is common in other items), thusthe students must learn how to categorize data upon reaching data organization/collation. Thisdata will also determine the proportion of salary/wage-earners to the economically activepopulation, and other means of earning a living, if not working.

i. Occupation - with employer

a. Employed (regular and contractual)

b. Unemployedc. Underemployed (as defined above)

ii. Livelihood – example are sari-sari store, hog raising etc

2. House and Land Ownership - This will reveal whether the family owns/rents or leases the house

in which they live.

3. Family monthly income and expenditure - Income of all earners in the family should be known

to get the families’ monthly income. Variables should be mutually exclusive. Also identify family’smonthly expenditure.

4. Prioritization of expenditures - The family’s monthly expenditures should be ranked according to

their budget allocation. It will reflect how much the family is willing to spend on health care.

5. Resources allotted to healthcare - Resources allotted to health care, such as savings and health

insurance, give an idea on how the family values their health. It shows how prepared they are tomeet basic health care needs, especially during emergencies.

D. Health Aspect1. Environmental

a. Housing:a.1 construction materials:

light – bamboo, nipa, coconut leaves, sawali, etcstrong – predominantly concretemixed – combination of light materials, wood or concrete

a.2 adequacy of living space:Adequacy of living space = 1 individual : 6 square metersTo measure the degree of inadequacy of space

a.3 ventilation: means of providing currents of fresh air (for purifying, curing, refreshing) and expelling

stagnant or foul air Ask for family’s perception of air circulation inside the house, provided that the CO worker adequatelyexplains what ventilationis 1. well- ventilated or 2. poorly ventilated

** Ventilation is not essentially dependent on the number or size of windows in relation to total flooarea, but of the adequacy of circulation of fresh air. Windows may always be shut, or there may be nowindows present at all. There may be other openings in the room/house as means for fresh air toenter such as the doors, the spaces in between bamboo slats (as flooring/ walls), spaces between theroofing and the walls, etc.** This is a subjective data. As much as possible we would like the students to interview the familiesinsi de the house to validate their responses. However, we are also guided by one of the mainprinciples of CO - that we have BASIC TRUST IN THE COMMUNITY PEOPLE. In cases when the

family says it is well-ventilated and the CO worker thinks otherwise, it may be an indication of thewrong perception of the family regarding ventilation or the probable unawareness as to theimportance of having adequate ventilation, etc. which in turn may indirectly affect their health.

a.4 lighting facilities: artificial means of providing light / illumination. Facilities used already reflecadequacy and safety for the family. Ex. Electricity, kerosene, candles, none

b. Source and storage of water

b.1 sources (raw water point source)



Surface water – derived from streams, brooks, rivers; subjects to seasonal availability and aresubjects to contamination if untreated

- usual water source of public water supplies. Public water supplies have the surfacewater treated to meet

acceptable standards.Ground water – wells and springs

Wells – either dug, driven, bored or drilled for the purpose of obtaining water dependingupon the construction and depth of water to be reached. Method of construction dependson the geological formation through which the well is to pass.

Dug and driven – soft ground/ sand and gravel, for wells with depth of less than100 feet

Bored and drilled – hard rocky grounds, with depths of more than 100 ftDeep wells or artesian wells – depth of more than 100 feet

Springs – groundwater seepages which are created when the level of underground watercomes in contact with the surface. Contamination occurs at the point of seepage.Rainwater – basically free from impurities. However contamination may occur at thecollection and storage points, and by air pollution (ex. Acid rain)

For data collation:Approved types of water supply facilities: (DOH book p315)

Level I ( point source) - a protected well or a developed spring with an outlet but without a

distribution system, generally adaptable for rural areas where the houses are thinlyscattered. A Level I facility normally serves an average of 15 households. Farthesthousehold not more 25O meters

Level II (communal faucet system or standposts) - a system composed of a source, a

reservoir, a piped distribution network, and communal faucets. Usually, one faucet serves 4to 6 households. Generally suitable for rural and urban fringe areas where houses are

clustered densely to justify a simple piped system. Should not be located more than 25

meters from the farthest house

Level III (waterworks system or individual house connections) - a system with a

source, a reservoir, a piped distribution network and household taps. It is generally suited

for densely populated urban areas. Ex Nawasa, Maynilad

b.2. storage: covered, uncovered container

b.3 household ways to maintain sanitation of drinking water Boiling – safest and surest way

- should be boiled for at least 2 minutes more after reaching boiling point of 100 degreecelsius to kill all vegetative bacteria, viruses, fungi

- at least 2 minutes as minimum suitable time of boiling water for low level locations andan additional 1 minute per 1000

meters additional elevation. (water boils at higher temp at high altitude)Filtration – done before boiling or disinfecting

- common household filters used in the Phils : sand filters, cloth filters, intermittent waterfilter Sedimentation – impurities in water are allowed to settle at the bottom of the container for 30

minutes - 1 hr and pouringthe top part in a new clean container without creating turbulence

Flocculation and sedimentation – use of aluminum sulfate ( tawas) to form precipitates of theimpurities found in the turbid water and allowing them to settle at the bottom of the container

Aeration – transferring water from one container to another or by stirring water to createturbulence which in most cases, remove objectionable attributes

Chemical disinfection:Chlorination – normal dose= 1.5 mg / L



Disinfection – use of tincture of iodine – 2 drops / LBuying commercially prepared water

c. Toilet facility (type, ownership, distance form water source)

Terms:Septic tank – a sealed settling chamber receiving all sewage and sullage from a dwellingSullage - domestic waste water not containing excreta (ex. laundry water/bathwater); also called graywater

** sewage is different from sewerageSewage – human excreta diluted by water, often contains domestic wastewater Sewerage system – provides necessary facilities for the collection of wastewater within the household,institution or commercial establishments into a treatment plant for final disposal making sure that thereceiving water is not polluted

- advantage: excellent health benefits and convenience- disadvantage: requires large amounts of water and very high construction and

maintenance cost

c.1 ownership : private, shared, public

c.2 types:Pail system – a pail or box is used to receive the excreta and disposed later when filled (includes

‘ballot system’ wherein excreta is wrapped in a piece of paper/plastic and thrown later Open pit privy – consists of a pit covered by a platform with a hole. The hole is usually not

covered. The platform may, in its simplest form, consist only of 2 pieces of wood or bambooClosed pit privy – a pit privy in which the hole over the platform or toilet floor is provided with a

cover Bored-hole latrine – consists of a deep (usually more than 10 feet) but relatively narrow (less

than 2 meters in diameter) hole made with a boring equipmentOverhung latrine – toilet house is constructed over a body of water (stream, lake, river) into

which excreta is allowed to fall freelyAntipolo type – toilet house is elevated and the shallow pit is extended upwards to the platform

(toilet floor) by means of a chute or pipe made of metal, clay, aluminum or boardWater sealed latrine – an antipolo type of toilet, bored hole latrine or any pit privy wherein water

sealed toilet bowl is placed instead of the simple platform hole; (+) septic tank

Flush type – a toilet system where waste is disposed by flushing water through pipes (sewers)into a public sewerage system or into an individual disposal system like an individual septictank

Unsanitary methods of excreta disposal:Overhung latrine – contaminates bodies of water Bored hole latrine – attracts flies and other insectsOpen pit privy – emits bad odor Open field/ beaches/ under trees – attracts insects and rats and contaminates water source

c.3. Distance from water source: Toilet facility should at least be 25 meters away from water sourceand at a lower elevation

d. Drainage system

d.1. TypesOpen drainage – wastewater flows through a system of pipes to an open pit or canalBlind drainage – wastewater flows through a system of closed pipes to an underground pit or

covered canalNone – no drainage system. Wastewater flows directly to the ground, oftentimes forming a nearly

permanent pool

d.2. Condition : is wastewater stagnant / free flowing?

e.Refuse disposal and managementTerms:



Refuse – a general term applied to solid / semisolid waste materials other than human excretaGarbage – left over vegetables, animal and fish material from kitchen / food establishments. Thesehave the tendency to decay and give off foul odors and sometimes serve as food for flies, rats, etc

e.1 Types:Hog feeding - garbage is used as hog feed (and also to chicken and other livestock)Open dumping – refuse and/or garbage piled in a dumping place (with or without pit) with no soi

coveringOpen burning - regularly piles refuse / garbage and later burned in open air. This is uncontrolled

burning which is usually done for yard and street sweeping. It may be allowed in rural areaswhere it will not worsen already existing air pollution.

Burial pit – refuse / garbage placed in a pit and covered when filled up. There is no intention todig it up later for use as fertilizer This should be located 25 meters away from any well usedfore water supply.

Composting – involves buying or stacking of alternating layers of organic based refuse/garbageand ‘treated soil’ arranged as to hasten rapid decay and decomposition into compost. Thisorganic mixture can later be used as fertilizer

Garbage collection

e.2 Management : (community-based)Resource recovery – sorting /collection /marketing of recyclable materials by organized

individuals (eco aides) for domestic/commercial establishments

Biogas production – production of methane thru bacterial decomposition of organic mattervegetation, animal manure in a biogas digester (target beneficiaries: families with backyardpiggeries/ poultry-raising projects)

Recycling – reproduction of waste to new materials and products* The choices are not limited to the refuse disposal and management stated above

f. Food preparation – refers to usual method of preparation of food (fried, steamed, grilled, etc)

g. Food sanitation – before cooking, during, and after cooking

h. Domestic animals (dogs and cats only) upkeep/ vaccine : where kept, date of las

vaccination

i. Breeding sites and control of vectors:

h.1. Vector type: ex. mosquitoes, flies, cockroaches, rodentsh.2 Control measures: insecticides, 4 o’clock habit, fumigation, stream clearing, stream seeding

mechanical means (flytraps, sticky tapes, screening, flooding of extensive breeding grounds)good sanitation (use of water sealed latrine, covered garbage containers, etc)Stream clearing – aimed at exposing the vector mosquito to sunlight to inhibit breeding and to

increase stream velocity to flush out immature stage of mosquito dev’t in the stream banksStream seeding - seeding of at least one stream in each barangay and construction of at leas

one propagation pond per municipalityInformation dissemination / education/ communication campaigns

h.3. Presence of breeding sites

2. Health managementa. Authority consulted during illness – Authority - those who had formal or informal training regarding

health and health management, and that are recognized by the people (i.e. doctors,albularyo, hilotetc) This is to establish if the disease or illness had been properly diagnosed. Before assessing thisask first about the illness or disease suffered by the family for the last year up to present and if the

family have/had done anything about.b. Medication taken during illness – during the course of illness (for the past year), if the family has

taken any medication (self-prescription, prescribed by md, herbal medicine)c. Perception on what is a healthy person – self –explanatory. If they think a child that is malusog

walang sakit, mataba, masigla is considered healthy. Somewhat affects the concept of healthpromotion and disease prevention within the community

d. Perception on what causes illness – yields their knowledge, perception or any misconception aboutwhat causes disease or illness ( maligno, duwende, engkanto etc)

e. Community health programs and servicese.1 Presence, Awareness and utilization of community health programs – Description o

existing health and health related programs that the community has or are implementing



Awareness and utilization of community people regarding these programs (assess using CST)FGD should be done to inquire why they are not availing certain programs or following certainpolicies even if they are aware of it.

e.2 Method of family planning used – Natural or Artificial (read on types of natural and artificial FPmethods). Before asking this, inquire first if they are utilizing FP methods since this question doesnot necessarily apply to all.

e.3 Nutritional status of target age group (0-6 years old) – weigh children from 0-6 years old andidentify presence of malnutrition with their respective categories. (Refer to DOH book; table foassessing malnutrition in children will be handed out)

e.4 Immunization status of target age group of “0-12 months” and “1 year to 8 years old”. Pleasespecify the vaccine and the number of doses (if applicable)

0 -12 months – ideal age or schedule to complete the immunization (DOH - EPI)

Name

Age BCG DPT OPV Hepa B Measles

Remarks

Complete?Incomplete?FullyImmunized?

Note: “Fully immunized” vaccination status is only applicable for children at least 9

months old.“Complete” - when the child has completed required vaccinations scheduled in the

EPI(applicable only for children 9 mos and below)

“Incomplete” – when the child has not yet received all required vaccinations asscheduled in the EPI

>1 year – 8 years old ( since BCG can be administered to a child until he reaches 8 y/oDOH allows a child to be fully immunizes until age 8)

Name Age BCG DPT OPV Hepa B Measles

Remarks

Complete?Incomplete

?Fullyimmunized?

Note: DOH requires all children to have complete immunization by 8 years of age.This is because some children fail to follow the suggested schedule due to some reason

i.e. sickness,unavailability, etc

f. Maternal care – For women who are 1) presently pregnant and 2) 6 weeks post partum.

Pre-natal Check ups (Refer to the Maglaya)

-28 weeks / 1st

trimester

29-35 weeks / 2nd

trimester

36-40 weeks/3rd

trimester Once a month Every 2 weeks Once a week

Ante-partum- labor attendant present (doctor, nurse, hilot, albularyo etc)location of delivery (home, hospital etc)infant mortality (for the past year only)

Immunization status – please read book regarding the number and the time of tetanus toxoidimmunization mothers should

have. Refer to table below for suggested format.

Tetanus toxoid (Refer to DOH book p.112-113)

1st pregnancy 2nd pregnancy 3rd pregnancy 4th pregnancy



Complete?Incomplete?




*Take note that the DPT vaccine given to the mother during infancy may be considered asTT1 and TT2

Post-partum check-up for home deliveries: (refer to DOH book p. 104)1st visit : within 24 hrs post delivery2nd visit : at least one week after delivery3rd visit : 2-4 weeks after the 2nd visit

8. Manpower resourcesa. Categories of health manpower available – health manpower refers to number of nurses, doctors

midwives, dentist, medical technicians, BNS (Barangay Nutrition Scholar), BHWs and trained hilots(mga nagpapaanak) who are serving the community and their corresponding time of availability

b. Geographical distribution of health manpower – how health manpower is distributed within thecommunity

c. Manpower-population ratio – nurse-population ratio, doctor-population ratio (Refer to DOH book fotheir recommendations)

Rural Health Physician = 1:20,000 Public Health Nurse = 1:20,000 Rural Health Midwife = 1:5,000

Rural Health Inspector = 1:20,000 Rural Health Dentist = 1:50,000

d. Distribution of health manpower according to health facilities – how health manpower is distributed

to various community health facilities (brgy health center, hospital, Rural Health Units etc.)e. Distribution of health manpower according to type of organizations (government, non-government, health units

private)

f. Quality of health manpower – description or background information (training, seminars attended

extent of experience etc.) of all available health manpower the community has.

g. Existing manpower development/ policies – Trainings, seminars that are conducted for manpowe

development. Manpower related policies implemented in the community (tasks, rules and regulationsetc.)

9. Material resources of the community

a. health budget and expenditures ( % allotted, budgeting)

b. sources of health funding (Government, NGOs, private agencies)

c. categories of health institutions (Health centers, RHU, hospital, daycare center, clinics, lying-in)

d. categories of health services available (health programs)

e. Hospital bed-population ratio

10. Vital indicators: Crude birth rate (could be extracted from demographic data, records review) and Crudedeath rate

(Refer to Maglaya for the formulas for vital statistics)

11.Infant feeding (0 to 2 years old)Breastfed – if from 0 to 6 months, child was on pure breast milk

BottlefedMIxed

E. Political/Leadership Patterns1. Power structures (formal and informal)

formal- with officially delegated and/or elected leaders

informal- leaders considered out of legal mechanism2. Attitudes of people towards authority 3. Conditions/events/issues that cause social conflict/ upheavals or that lead to social bonding or unification – Ex. ethnicity, social class, language, religion, race, and political orientation4. Perceived problems of community people and brgy officials (per purok



5. Practices approaches which are effective in setting issues and concerns within the community this includes

perceived solution/s for the problems (Per purok))

RISK FACTOR ASSESSMENT- HEIGHT, WEIGHT, FOOD INTAKE, BMI, BP, HISTORY OF DISEASES, SMOKING, ALCOHOL DRINKING,

SEDENTARY LIFESTYLE, DIAGNOSED AND IF WITH MEDICATIONS

NOTE: CHOICES FOR THE ITEMS/ DATA TO BE GATHERED ARE NOT LIMITED TO THOSE INDICATED HERE. DOCOMPREHENSIVE RESEARCH AND MAKE SURE CHOICES ARE LIMNITED OR APPLICABLE ONLY TO THE

COMMUNITY.

PLEASE BE REMINDED THAT TIME DURATION FOR THE DATA TO BE GATHERED SHOIULD BE CONSTANT (FOR THE PAST YEAR )!!

PLEASE ALSO BE REMINDED THAT A COMMUNITY SURVEY TOOL AND THE QUESTIONS INCLUDED IN IT MAYVARY FROM ONE COMMUNITY TO ANOTHER!!!!!

THIS ENCOMPASSES THE FIVE DATA GATHERING TOOLS AND METHODS: CST, KII, FGD, OCULAR SURVEY,AND RECORDS REVIEW

Reference materials:Nursing Practice in the Community. 4th ed., Maglaya. AS. etal., Nangka, Marikina City. Argonauta Corp.

Community Health Nursing Service in the Philippines (DOH), Reyala, JP etal. National League of Government Nurses.2000.Community Nursing in Developing Countries. Byrne, M. Great Britain. Oxford University Press, 1986.Human Ecology and Public Health. Kilbourne, E. Toronto, Canada. Macmillan Company, 1993.Module on Proper Excreta Disposal. NTTC Learning Resource Unit.The Nurses’ Role In Safeguarding the Human Environment. International Council of Nurses. Geneva, Switzerland, 1986.Various official websites of the following : DOH, DOLE, NSOPersonal communication with Ms. Maglaya

33314130 Operational Definition Final Feu

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