IMCI

CHAPTER I
THE PROBLEM
INTRODUCTION
For any Filipino family, especially among the poor, an illness striking any of its members
is viewed as a catastrophe. Like any other third-world country, the Philippines have been
struggling in some health issues. Diseases are easily transmitted due to the proximity of the
people to environmental hazards with houses being built close to each other, near the polluted
creeks or under the bridges where every day they encounter the smoke emitted from the car
exhaust systems. This proved to be harmful, especially to children who have yet to develop their
immune systems.
With poverty as one of the major problems, most people unable to acquire quality care
that they desperately need. Most settle for albularyos or herbal medicines that can either worsen
the condition or alleviate the symptoms but only by a tad bit.
Every year more than eleven million children in developing countries die before they
reach their fifth birthday, many during the first year of life. Seven in ten of these deaths are due
to Acute Respiratory Infection (ARI) mostly pneumonia; diarrhea, measles, malaria or
malnutrition- and often to a combinations of these conditions.
Experience and evidence show that improvements in child health are not necessarily
dependent on the use of sophisticated and expensive technologies but rather on effective
strategies that are based on a holistic approach, are available to the majority of those in need,
and which take into account the capacity and structure of health systems as well as traditions and
beliefs in the community.
To address five leading causes of childhood deaths in the world: pneumonia, diarrhea,
measles, malaria and malnutrition, the Integrated Management of Childhood Illness (IMCI) was
launched in 1995 by World Health Organization (WHO) and United Nations Childrens Fund
(UNICEF). IMCI has three main components: improvements in case-management skills of health
staff; improvements in the health systems; and improvements of family and community
practices.
With the Commission on Higher Education (CHED) Memorandum Order No. 5 Series
2008 under Article III, Section IV empowering the implementation of DOH programs, IMCI
being one of which, in the nursing curriculum, the researchers would like to know the lived
experiences of both faculty and students, not only how it affected their delivery of nursing care to
the pediatric clients in the community settings but also its contribution in their growth as a health
care practitioner.
BACKGROUND OF THE STUDY
Cavinti is situated at the eastern part of the Laguna province. The northern political
boundary is the municipality of Lumban, Kalayaan and Paete; the southern political boundary is
the municipality of Luisiana. The eastern political boundary is the municipality of Sampaloc and
Mauban in Quezon province; the western political boundary is the municipality of Pagsanjan.
Cavinti, Laguna is approximately 122 kilometers from Manila.
Cavinti, the third largest community in Laguna (next to Calamba and Paete, respectively),
has a land area of 25, 770 hectares. Overall, Cavinti is classified as a fourth class municipality. It
is composed of 19 barangays (6 urban and 13 rural).
From the totality of its land area, the forested area is 10,470.06 hectares; the agricultural
area is 10,705.45 hectares; and the build-up area (residential, commercial, industrial,
institutional, parks and open space) is 4,595.19 hectares.
The said area experiences a fair weather for most days of the year. Occasional rain
showers are also evident. In terms of communication, the facilities include one telephone
company, one telegraph, one post office and six communication towers (three Globe towers,
two Smart towers and one Sun Cellular tower).The modes of transportation include jeepneys
and tricycles. They also engaged in walking and in the use of farm animals like carabaos and
horses to reach their destinations.
In terms of economy, agriculture, and banking and lending is involved. The common type
of livelihood in the area is agricultural in nature. People greatly rely on farming to survive. Their
major crops typically include the following: coconut, rice, vegetables, root crops, santol,
lanzones, banana, citrus and rambutan. They produce rice products like kalamay and sinukmani.
The people also engage in pandan weaving to create hats, bags, envelopes, and other pandanbased products. The community has rivers, fish ponds and piggeries. As for banking and lending,
the community has one rural bank and a lending firm.
Tourist spots in the area include four falls, two lakes, two caves and one garden. One of
the tourist spots was named after the municipalitys patron saint for 403 years, El Salvador del
Mundo (Jesus). There are six major resorts in the area.
Specific areas to which the student nurses are assigned are Barangay Udia, Barangay
Bukal and Barangay Layug which is the adopted community of the college of nursing.
In the quest of describing and promoting understanding of human experiences and how
these experiences are involved in utilizing the Integrated Management of Childhood Illness, this
study utilized a qualitative research that will examine their life experiences in an effort to
generate, understand and give them meaning. This study utilized phenomenologic approach, one
of the many types of qualitative research that examines the lived experiences of humans.
Phenomenological researchers hope to gain an understanding of the essential truths of the lived
experiences. (Burns and Grove, 2005)
With the Commission on Higher Education (CHED) Memorandum Order No. 5 Series 2008
under Article III, Section IV empowering the implementation of DOH programs, IMCI being one
of which, in the nursing curriculum, the researchers would like to know the lived experiences of
both faculty and students, not only how it affected their delivery of nursing care to the pediatric
clients in the community settings but also its contribution in their growth as a health care
practitioner.
STATEMENT OF THE PROBLEM
Major Problems
This study will describe the lived experience of faculty and nursing students on
Integrated Management of Childhood Illness (IMCI) strategy in a selected community in Cavinti,
Laguna
SIGNIFICANCE OF THE STUDY

This study will be beneficial to a number of people specifically the ff:
Clinical Instructors. The result of the study will give them a basis on giving a more
comprehensive lectures and further implementation of the strategy in all community duties.
Nursing Students. The result of study will guide them on implementation of Integrated
Management of Childhood Illness during their community exposure. At the same time it will
help them in utilizing the Integrated Management of Childhood Illness strategy.
The administration. The result of the study will provide insight on extent of utilization of IMCI
by the faculty and students in the community setting. Thus, this will give them ideas and
strategies on how to modify their approach on further empowering and implementing the IMCI
by the clinical instructors and students.
Association of Dean of the Philippines Colleges of Nursing (ADPCN). The result of the study
will provide an insight on how the Integrated Management of Childhood Illness is being
implemented in a selected college of nursing.
Department of Health (DOH). The result of the study will serve as an evaluation tool on how
the Integrated Management of Childhood Illness is being utilized in the community. The
researchers also request to cover more diseases like scabies and dengue and provide more
assessment, classification, treatment and counselling of those certain diseases. As well as to
dispose of old copies of IMCI charts and produce more copies of the new version to avoid
confusion and to have school to school campaign regarding the utilization of IMCI strategy.
Future researchers. The result of the study regarding the lived experiences of faculty and
nursing students utilizing the IMCI strategy in a selected community in Cavinti, Laguna will
serve as a reference guide and a basis for future researches on other aspect of IMCI.
SCOPE AND LIMITATION
This study is a qualitative descriptive phenomenological type of research regarding the

lived experience of selected faculty and nursing students on Integrated Management of
Childhood Illness. IMCI is a strategy fostering holistic approach to child health and development
is built upon successful experiences gained from effective child health interventions.
This was conducted in a selected community in Cavinti, Laguna. This study was
conducted during the first semester of academic year 2010-2011. The participants were selected
faculty members and nursing students who were exposed in the mentioned community and had
experienced utilizing the IMCI strategy in their community duties.
The involvement of the participants would depend upon their accessibility and
willingness to be a part of the research. Data gathering was done through individual interviews
that guided by a set of semi- structured questions. The questions asked were based on the flow of
the conversation between the researchers and the respondents. The researchers utilized a nonprobability, purposive sampling wherein the participants were picked based on the criteria given
by the researchers.
The study focused on analyzing and interpreting the subjective and objective data
gathered from the respondents. This study was intended to focus on how various individuals
express their experiences and insights. The participants in this study also had different
backgrounds as to places of assignment, activities and extent of knowledge imparted to them by

their respective mentors.
The study was limited to the area of the participants experiences, insights and opinions
which was discussed during the interview.
DEFINITION OF TERMS
Lived Experiences refers to the initial reaction of the faculty and students and their experiences
and insights upon utilizing the IMCI strategy
IMCI strategy refers on the usage of Integrated Management of Childhood Illness (IMCI)
strategy in assessing clients, classifying their illnesses according to the signs and symptoms and
treating them according to their classification by the selected faculty and nursing students of a
selected college of nursing
Faculty refers to currently employed clinical instructors who has training and has experience in
utilizing IMCI in the teaching learning situations in the RLE.
Nursing Students refers to those who are currently enrolled on the first semester of the
academic year 2010-2011 and had experienced using the IMCI strategy in their community
duties
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CHAPTER II
REVIEW OF RELATED LITERATURE
This chapter shows relevant information that explain the concepts used in this study.
The following literatures came from the significant references such as books, journals and
reliable websites.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

S. Gove et al (1997). Integrated management of childhood illness by outpatient health
workers: technical basis. WHO bulletin OMS. Vol 75. Suppl 1.
Infant and young child mortality remains unacceptably high in developing countries, with
about twelve million deaths occurring annually in under- five year old children; seven in every
ten of these deaths are due to diarrhea, pneumonia, measles, malaria, malnutrition and often to a
combinations of these conditions.
Updated WHO guidelines presented in the training course

The IMCI guidelines incorporate current World Health Organization (WHO) case
management guidelines for pneumonia and ear infection, diarrhea with dehydration, dysentery
and persistent diarrhea and malaria. Significant simplifications have been made in the
classification of nutritional status, classifying severe malnutrition based only on clinically
apparent severe wasting and signs of kwashiorkor was the approach used earlier in the ARI
training materials and is supported by a study carried out in Kenya.
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Implementation of IMCI in different countries.

Using a set of interventions for the integrated treatment and prevention of major
childhood illnesses, the IMCI strategy aims to reduce death and the frequency and severity of
illness and disability, and to contribute to improved growth and development. This set of
intervention aims to improve practices both in health facilities and in the home.
The core IMCI strategies, and the first intervention to be made available to countries, is a
set of guidelines for integrated case management of the 5 most important causes of childhood
death- ARI, diarrhea, measles, malaria and malnutrition- and common associated conditions.
In other countries the combinations of individual guidelines that constitute IMCI may be
modified to include other important conditions for which effective treatment and preventive
practices have been identified. The main interventions of the global IMCI strategy will evolve as
experience is gained in implementation as new findings from health research.
Newton et. al, Hypothetical performance of syndrome-based management of acute

paediatric admissions of children aged more than 60 days in a Kenyan district hospital.
(2003)
Over the last ten years, considerable effort has been put into developing the integrated
management of childhood illness initiative, a generic, but adaptable, approach to the assessment
and management of sick children when they present to first level health facilities in resource
poor countries. Under the IMCI initiative, algorithms define illness severity and make
recommendations about treatment and hospital referral. Target facilities often run by community
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nurses or medical assistants. To complement the referral strategy, a manual addresses inpatient
management was produced recently. A number of studies have examined the assessment and
referral components of IMCI, but the possible impact on inpatient management has not been
addressed. Syndromic management according to IMCI therefore may become the de facto
approach to initial medical management for inpatients. In essence, much clinical medicine is
syndrome based. Characteristic combination of symptoms, signs, and investigations often define
a disease state.
The emphasis in medical training and texts is still to use clinical skills to maximize the
sensitivity and specificity of diagnosis within the paradigm of treating the single most probable
cause of illness. However, this reductionist approach may be costly (in terms of mortality and
morbidity) in situations in which the precision of classification is limited by the availability and
quality of symptoms, signs, and results of investigations (lowering sensitivity, specificity, or
both), in which illnesses are particularly severe (high case fatality), and in which true mixed
pathology is more frequent. The latter two conditions apply in many resource-poor countries,
notably areas where malaria is endemic. Tacit acknowledgement of this situation means that
many health workers treat children for more than one possible disease a feature also implicit
in a syndromic approach to management.
Bryce, EdD et. al, The multi- country evaluation of the integrated management of
childhood illness strategy: Lessons for the evaluation of public health interventions.
American Journal of Public Health (2004)
Integrated management of childhood illness is a strategy for improving child health and
development. The IMCI strategy was developed in a stepwise fashion. It began with the set of
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case management guidelines for sick children seen in first level health facilities. Over time, the
strategy expanded to include a range of guidelines and interventions addressing child health
needs at household, community, referral levels. The detailed review of the development and
evaluation of the case management guidelines is available elsewhere. IMCI has 3 components,
each of which is adapted in countries on the basis of local epidemiology, health system
characteristics and culture. One component focuses on improving the skills of health workers
through training and reinforcement of correct performance. Training is based on a set of adapted
algorithms that guide the health worker through a process of assessing signs and symptoms,
classifying the illness on the basis of treatment needs, and providing appropriate treatment and
education of childs care giver. The IMCI guidelines include identifying malnutrition and
anemia, checking vaccination status, providing nutritional counseling effectively with the
mothers. A second component of IMCI aims to improve health system supports for child health
service delivery, including the availability of drugs, effective supervision, and the use of
monitoring and health information system data. The third component focuses on a set of family
practices that are important for child health and development and implementation of community
and household based interventions to increase the proportions of children exposed to these
practices.
IMCI is a complex strategy, incorporating numerous interventions that affect child health
through a variety of pathways. Designing the evaluation required the development of a model
that defined how the introduction of IMCI was expected to lead to changes in child mortality,
health and nutrition. These changes are referred to as the impact within the MCE.
Evaluations of large scale interventions may involve different degrees of control by the
research team. Evaluation of program efficacy is conducted when interventions are delivered
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through health services in relatively restricted areas, under close supervision. They answer the
question of whether given ideal circumstances the intervention has an effect. On the other hand,
evaluation of program effectiveness assess whether the interventions have an effect under the
real life circumstances faced by health services. Few public health programs are
implementation in ways that can support evaluations that are either entirely efficacy or entirely
Effectiveness. This dimension of program evaluation should therefore be considered as a
continuum.
The Multi Country Evaluation (MCE) emphasized the assessment of IMCI impact.
Nonetheless, the WHO and the advisers agreed from the start that the evaluation should also
assess provision, utilization and population coverage indicators. If an impact was demonstrated,
this approach would document the underlying steps that led to success and contribute to the
adoption and successful implementation of IMCI in other settings. If no impact was documented,
the stepwise approach would reveal where and why IMCI failed and identify problems that
needed to be addressed. The stepwise approach was also cost-effective. Complex and costly
impact evaluations were carried out within an MCE site only if simpler evaluations of the
preceding steps showed that IMCI implementation was progressing well was associated with the
expected intermediate outcomes. Provision or utilization was assessed by using routine
information systems or by surveying health facilities. However, population coverage and impact
usually required field data collection with important cost implications. The step wise approach
resulted in substantial savings because relatively simple evaluations showed that more time was
needed to expand the provision of IMCI interventions before more costly population coverage or
impact studies were conducted.
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Implementation of evaluation which is guided by the design decisions described above,

the MCE consisted of a series of independent studies with compatible designs, each tailored to
the stage and characteristics of IMCI. Implementation in the participating country with the set of
site specific studies included those with prospective, retrospective, and mixed designs. They
reflected a continuum from efficacy to effectiveness, with variable degree s of influence from the
evaluation team on program implementation. Each study included a plausibility type evaluation.
Regardless whether a probability design was also present, with all studies measured in an
identical set of indicators also added a limited number of site-specific to respond to local
characteristics and questions. Assessment of costs to providers and clients were included as an
essential aspect of the evaluation. In this section is the description on how the MCE was
implemented.
World Health Organization and UNICEF. Model Chapter for textbooks: Integrated
Management of Childhood Illnesses, 1997. Department of Child and Adolescent Health and
Development (CAH).
Treatment of Cough and Difficult of Breathing (Probable Pneumonia)
Based on a combination of the above clinical signs, children presenting with cough or
difficult breathing can be classified into three categories: those who require referral for possible
Severe pneumonia or any danger signs or chest indrawing or stridor in calm child, those who
require antibiotics as outpatients because they are highly likely to have bacterial Pneumonia and
those who simply have cough and colds and dont need antibiotics.
Those who require referral for possible Severe pneumonia most likely will have invasive
bacterial organisms and diseases that may be life-threatening. This warrants the use of injectable
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antibiotics. Those who require antibiotics as outpatients because they are highly likely to have
bacterial Pneumonia as defined by World Health Organization (WHO), detects about 80 percent
of children with pneumonia who need antibiotic treatment. Treatment based on this classification
has been shown to reduce mortality. Those who simply have cough and colds and dont need
antibiotics may require a safe remedy to a relieve cough. A child with cough and cold normally
improves in one or two weeks. However, a child with chronic cough (more than 30 days) needs
to be further assessed (and, if needed, referred) to exclude tuberculosis, asthma, whooping cough
or another problem.
Treatment of persistent diarrhea

The guidelines emphasize the nutritional therapy of persistent diarrhea, stressing the
importance of both adequate feeding and use of micronutrient supplementation. The majority of
children with persistent diarrhea can be treated on an ambulatory basis with food available in the
home; however, some require specialized care in the hospital. In the IMCI guidelines mothers are
advised to replace animal milk with increased breastfeeding or fermented products such as
yogurt, or to replace half of the milk with nutrient- rich semisolid complimentary food.
Following these guidelines temporarily reduces the amount of animal milk lactose in the diet:
provides a sufficient intake of energy, protein, vitamins, and minerals to facilitate the repair
process in the damaged gut mucosa and improve nutritional status; avoids giving foods or drinks
that may aggravate the diarrhea; and ensures that the childs food intake during convalescence is
adequate to correct any undernutrition and prevent its recurrence. If diarrhea does not respond to
five days of nutritional therapy at home, the child is referred to hospital.
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Micronutrient deficiencies are common in children with malnutrition. All children with
persistent diarrhea should receive daily supplements of multivitamins and minerals for two
weeks. These should provide as broad range of vitamins and minerals as possible.
The integrate guidelines ensure that every child with persistent diarrhea is also examined
for important non- intestinal infections, such as pneumonia and otitis media. Persistent diarrhea
in such children will not improve until these infections have been diagnosed and treated
correctly. Young infants under two months of age or any sick child with persistent diarrhea plus
evidence of dehydration should be rehydrated. (Unless the child is malnourished) and referred to
hospital for further management. These children may require special efforts to maintain
hydration and replacement of animal milk with lactose-free milk formula.
Treatment of Malaria
All children with fever and any general danger sign or stiff neck are classified as having
very severe febrile disease and should be urgently referred to a hospital after pre-referral
treatment with antibiotics (the same choice as for severe pneumonia or very severe disease).
In areas where malaria Plasmodium falciparum is present, such children should also
receive a pre-referral dose of an anti-malarial (intramuscular quinine).
In a high malaria risk area or season, children with fever and no general danger sign or
stiff neck should be classified as having malaria. Presumptive treatment for malaria should be
given to all children who present with fever in the clinic, or who have a history of fever during
this illness. Although a substantial number of children will be treated for malaria when in fact
they have another febrile illness, presumptive treatment for malaria is justified in this category
given the high rate of malaria risk and the possibility that another illness might cause the malaria
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infection to progress. This recommendation is intended to maximze sensitivity, ensuring that as

many true cases as possible receive proper anti-malarial treatment.
In a low malarial risk area or season, children with fever (or history of fever) and no
general danger sign or stiff neck are classified as having malaria and given an anti-malarial only
if they have no runny nose (a sign of ARI), no measles, and no other obvious cause of fever
(pneumonia, sore throat, etc.).
Evidence of another infection lowers the probability that the child's illness is due to
malaria. Therefore, children in a low malaria risk area or season, who have evidence of another
infection, should not be given an anti-malarial.
In a low malaria risk area or season, children with runny nose, measles or clinical signs of
other possible infection are classified as having Fever Malaria Unlikely. These children need
follow-up. If their fever lasts more than five days, they should be referred for further assessment
to determine causes of prolonged pyrexia. If possible, in low malaria risk settings, a simple
malaria laboratory test is highly advisable.
In a no malaria risk area or season an attempt should be made to distinguish cases of possible
bacterial infection, which require antibiotic treatment, from cases of non-complicated viral
infection. Presence of a runny nose in such situations has no or very little diagnostic value.
When there are obvious causes of fever present such as pneumonia, ear infection, or
sore throat children could be classified as having possible bacterial infection and treated
accordingly.
In a no malaria risk area or season, if no clinical signs of obvious infection are found, the
working classification becomes uncomplicated fever.
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Such children should be followed up in two days and assessed further. As in other
situations, all children with fever lasting more than five days should be referred for further
assessment.
Children with high fever, defined as an axillary temperature greater than 39.5C or a
rectal greater than 39C, should be given a single dose of paracetamol to combat hyperthermia.
Treatment of Measles
All children with fever should be checked for signs of current or recent measles (within
the last three months) and measles complications.
Severe complicated measles is present when a child with measles displays any general
danger sign, or has severe stomatitis with deep and extensive mouth ulcers or severe eye
complications, such as clouding of the cornea. These children should be urgently referred to a
hospital.
Children with less severe measles complications, such as pus draining from the eye (a
sign of conjunctivitis) or non-deep and non-extensive mouth ulcers, are classified as measles
with eye or mouth complications. These children can be safely treated at the outpatient facility.
This treatment includes oral vitamin A, tetracycline ointment for children with pus draining from
the eye, and gentian violet for children with mouth ulcers.
Children classified with pneumonia, diarrhoea or ear infection and measles with eye or
mouth complications should be treated for the other classification(s) and given a vitamin A
treatment regimen. Because measles depresses the immune system, these children may be also
referred to hospital for treatment.
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If no signs of measles complications have been found after a complete examination, a

child is classified as having measles. These children can be effectively and safely managed at
home with vitamin A treatment.
Treatment for Malnutrition or Anemia

Children with severe malnutrition or severe anaemia (exhibiting visible severe wasting,
or severe palmar pallor or oedema of both feet) are at high risk of death from various severe
diseases and need urgent referral to a hospital where their treatment (special feeding, antibiotics
or blood transfusions, etc.) can be carefully monitored.
Children with anaemia or low (or very low) weight for age also have a higher risk of
severe disease and should be assessed for feeding problems. This assessment should identify
common, important problems with feeding that feasibly can be corrected if the caretaker is
provided effective counselling and acceptable feeding recommendations based on the childs age.
When children are classified as having anaemia they should be treated with oral iron.
During treatment, the child should be seen every two weeks (follow-up), at which time an
additional 14 days of iron treatment is given. If there is no response in pallor after two months,
the child should be referred to the hospital for further assessment. Iron is not given to children
with severe malnutrition who will be referred. In areas where there is evidence that hookworm,
whipworm, and ascaris are the main causes and contributors to anaemia and malnutrition,
regular deworming with mebendazole every four to six months is recommended. Mebendazole is
inexpensive and safe in young children.
Children who are not low (or very low) weight for age and who show no other signs of
malnutrition are classified as having no anaemia and not very low weight. Because children less
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than 2 years old have a higher risk of feeding problems and malnutrition than older children do,
their feeding should be assessed. If problems are identified, the mother needs to be counselled
about feeding her child according to the recommended national IMCI clinical guidelines.
Impact of IMCI interventions

The IMCI approach incorporated several child health interventions. For some of these
interventions there is substantial evidence of potential mortality reduction. Extensive clinical
experiences and several analyses of national diarrheal mortality rates have also suggested an
impact oral rehydration therapy on diarrheal mortality related to dehydration. For other
interventions, clinical experience but only limited published data indicate a relationship to
mortality reduction. Mortality reduction can be expected if nutrition counseling to promote
breastfeeding and energy and nutrient rich complementary foods is successful in improving
infant and child feeding and growth. Demonstrating improved growth as a result of the adapted
and focused IMCI nutrition counseling is the currently the subject of research studies sponsored
by World Health Organization (WHO) / CHD.
P.Randall et. al, Potential Implications of the integrated management of childhood illness
(IMCI) for hospital referral and pharmaceutical usage in western Uganda, Tropical
Medicine and International health.(1998)
The integrated management of childhood illness approach is currently being implemented
by a number of countries worldwide. In developing countries diarrhea, pneumonia, measles,
malaria, and malnutrition account for both 70% of visits to health facilities and deaths of children
under five. The World Health Organization (WHO), United Nations Childrens Fund (UNICEF)
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and others have developed the integrated management of childhood illness approach, which
combines case management algorithms and preventive measures to target major cause s of death
(WHO 1995). The IMCI algorithm starts with assess and classify section where the health
worker enquires about danger signs which would require immediate hospital referral: lethargy or
unconsciousness, recent convulsions, inability to drink or vomiting everything. This is followed
by questions about their history of present illness. If the caregiver indicates one of these is
present, additional questions are to be asked and an examination has to be conducted before
continuing with the sequence. The child is then assessed for anemia and malnutrition and his and
her immunization status is checked. Findings are then classified and treat the child section
indicates appropriate clinical management. In the counseling of the mother further information
will be gathered in the cause of illness, caring of the child at home, and other enquiry that may
contribute to the condition of the child.
In a prospective study previously reported, assess and classify component of IMCI was
used by medical assistants in an outpatient department in Kabarole district hospital in western
Uganda. The intent of this study was not to validate the IMCI classifications against the experts
in pediatric assessment but to compare the IMCI classifications of medical assistants with
prevailing standard of care provided by general medical officers in a typical Uganda district
hospital. Upon discussion adopting the IMCI approach to treatment of childhood illness involves
a major change in the health worker approach to sick children. Although IMCI validation studies
are now being reported, these have not focused on the potential impact of IMCI on health
services. They have found out that they could achieve substantial saving in drug costs, reduce
hospital referrals and potentially the use of hospital inpatient resources. And the conclusion of
this study is that it indicates that use of IMCI guidelines would substantially reduce number of
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children referred to the hospital from an outpatient facility. In comparison with other studies, the
reduction in referrals would be of a similar order regardless of whether the referral practices of
the specialist pediatricians or general medical officers were used as a comparison. The tendency
to underestimate the severity of the illness and the need for hospitalization was particularly
alarming. This would suggest that the need for making algorithms more user friendly.
S.H. Factor et. al, Diagnosis and management of febrile children using the WHO/UNICEF
guidelines for IMCI in Dhaka, Bangladesh. WHO, (2001)
Case management approaches for the diagnosis and treatment of childhood illness in
developing countries often use a limited set of signs and symptoms and standardized measures
for disease classification and treatment. The children with acute respiratory infection and
diarrheal disease such as approaches have been documented to reduce both cause-specific and
overall childhood mortality. The success of these disease specific approaches led WHO and
UNICEF to incorporate them into a set of guidelines for the integrated management of childhood
illness (IMCI), which includes modules or subsets of guidelines for the recognition and
management of children with acute respiratory infections, diarrhea, measles, malaria and other
febrile illness, and malnutrition conditions responsible for over 70% of childhood deaths in
developing countries Because children may present to a health care facility with more than one
disease and different disease entities may be manifested by the same array of common
symptoms, the IMCI scheme allows for the simultaneous diagnosis of more than one disease and
ensures that each will receive treatment, if indicated. The IMCI guidelines contain a module for
the evaluation of febrile children that focuses on the diagnosis and treatment of malaria. In areas
where malaria is highly prevalent, the high predictive value of fever for malaria makes this focus
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appropriate. The performance of the IMCI fever module in identifying children with bacterial
infection in an area of low malaria prevalence has never been evaluated. The objectives of this
study were to determine how well the IMCI guidelines perform in identifying children with
bacterial infections in need of antibiotics in an area of low malaria prevalence and how much the
existing IMCI fever module, which identifies children as having very severe febrile disease in
a non-malaria area that contributes to the overall IMCI performance, and to evaluate alternative
fever modules for inclusion in the integrated guidelines.
Improved case management by integration of disease- specific guidelines

Beyond the expected impact from each of the disease interventions included within IMCI
are additional benefits which can be expected by dealing adequately with the overlap in clinical
presentation and treatment of several important diseases, and by facilitating the treatment of
children who present with multiple clinical problems. Guidelines and training materials focused
on one disease result in under treatment of other conditions. Both pneumonia and malaria can
present with fever, cough and fast breathing or, when severe, with fever and chest wall in
drawing. Depressed consciousness can be due to diarrhea with severe dehydration, meningitis,
severe malaria, severe hypoxia, hypoglycemia, or other conditions. Measles can be complicated
by pneumonia, diarrhea, laryngotracheitis, or otitis media and most deaths result from the first
three conditions. Asking health workers to integrate disease specific guidelines from several
programmes when managing a sick child can result an inadequate care.
P. R. Kolstad, et al. The integrated management of childhood illness in western Uganda,

2008
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In developing countries, five diseases (pneumonia, diarrhea, mlaria, measles and

malnutrition) cause the majority of deaths in under 5-year-old children.
The IMCI approach begins with the health worker inquiring about the presence of danger
signs: lethargy or coma, convulsions, inability to drink, or persistent vomiting. The presence of a
danger sign indicates urgent need for referral to hospital. Next, the health worker assesses and
classifies the childs illness, selects appropriate treatment, and provides advice to the childs
carer.
Clinical assessments were carried out by two medical assistants and four general medical
officers. The medical assistants were secondary school graduates with three years of medical
assistant training and eighteen to thirty six months of clinical experience. Immediately prior to
commencement of the study, an intensive five-day training to assess and classify component of
the algorithm was conducted. Continuous supervision was provided to monitor the work of the
two medical assistants and resolve any difficulties.
Reference standards were based on the medical officers assessment, standardized history
and physical examination procedures, and common diagnostic criteria as follows: Severe
pneumonia: medical officers diagnosis of severe pneumonia; or diagnosis of pneumonia, plus
grunting respiration at rest and lower chest wall indrawing (chest indrawing). Pneumonia:
medical officers diagnosis of pneumonia, or WHO radiographic findings of pneumonia, and not
severe pneumonia. Non-pneumonia respiratory disease: medical officers diagnosis of upper
respiratory tract infection, common cold, pharyngitis, laryngitis, bronchiolitis, tonsillitis or
coryza, with no radiographic evidence of pneumonia (if chest film was obtained). Diarrhea:
carers report of diarrhea with three or more stools per day lasting less than fourteen days.
Dehydration: medical officers diagnosis by assessment of skin turgor. Persistent diarrhea:
26
carers report of diarrhea with a duration of fourteen days or longer. Dysentery: diarrhea with
blood in the stool reported to the medical officer. Malaria, definition A: fever within the previous
twenty-four hours reported to the medical officer and a blood film with one or more malaria
parasites. Malaria, definition B: fever within the previous twenty-four hours reported to the
medical officer and five thousand or more malaria parasites per l of blood. Measles: medical
officers diagnosis of measles. Otitis media: medical officers diagnosis of acute or chronic otitis
media. Mastoiditis: medical officers diagnosis of mastoiditis. Meningitis: medical officers
diagnosis of meningitis. Severe malnutrition: weight-for-age Z-score (WAZ) of negative three or
worse, or medical officers diagnosis of kwashiorkor. Malnutrition: WAZ between negative two
and negative three, and not severe malnutrition. Anaemia: haematocrit between fifthteen percent
and thirty-five percent. Severe Anaemia: haematocrit less than fifthteen percent.
Performance of health workers after training in integrated management of childhood

illness.
This is an article that describes the first test of the draft training materials for integrated
management of childhood illness (IMCI) by first level primary health workers. The primary
objective of the study was to determine how well the health workers could assess, classify and
treat ill children (aged 2-59 months) and counsel their mothers after receiving training using the
draft version of the WHO/UNICEF course on IMCI. Our observations included assessing
whether the mother was adequately taught to deliver key treatments and whether advice was
effectively given. The IMCI course was designed to teach integrated management of sick infants
and young children to first level health workers in primary care settings that have no laboratory
support and only a limited number of essential drugs. This process involves assessment of signs
27
and symptoms of illness and the nutritional and immunization status of the children. The illness
or illnesses are classified and appropriate treatments are identified for each classification. The
course emphasizes making appropriate, timely decisions for referral of the seriously ill child to
hospital and giving important pre-referral treatment for example giving the first dose of
antibiotic or quinine, prior to referral.
Eleanor Gouws et. al, Improving antimicrobial use among health workers in first level
facilities: results from the Multi-Country Evaluation of the Integrated Management of
Childhood Illness strategy. (2004)
Despite advances over the past few decades made in reducing child mortality, more than
10 million children die each year before they reach the age of five, at least 6 in 10 of these deaths
could be prevented if existing affordable interventions were available to all children who need
them. Antimicrobial drugs are the one of the most powerful and important interventions available
to reduce child mortality. Antibiotics are proven treatment for pneumonia, bacterial infections in
neonates, the premature rupture of membranes, and for some cases of diarrhea, including
cholera, shigella dysentery, giardiasis and amoebiasis, anti-malarial drug are needed to treat
malaria in children. The increasing rate of biological resistance to antimicrobials has bccn
recognized as a public health emergency. Studies have documented high levels of antibiotic
misuse among health-care workers, such as using antibiotics to treat viral diseases or using
incorrect dosages. Thus one important strategy for slowing the development of resistance is to
reduce the unnecessary use of these drugs. Efforts to reduce the prevalence of antimicrobial
resistance in low income and middle income countries have increasingly focused on the
promising approach of providing appropriate education for health. Training health workers in
28
IMCI case management has been conducted in more than 100 developing countries in both in
service and pre-service contexts. The training is based on a set of case management guidelines
that is adapted in each country prior to use. The training guides the health worker through the
process of assessing signs and symptoms, classifying the illness based on treatment needs and
providing appropriate treatment and education of childs caregiver. The IMCI guidelines include
information on identifying malnutrition and anemia. Checking vaccination status, providing
nutritional counseling and communicating effectively with care givers. The training emphasizes
supervised clinical practices and in some settings health workers are visited in their facilities
shortly after training to reinforce their new IMCI skills. The multi-country evaluation of IMCI
effectiveness, cost and impact is a global program designed to evaluate the impact of IMCI on
child health and its cost-effectiveness.
Asian Development Bank (ADB), Early Childhood Development. WHO publications

(2007).
IMCI in the Philippines
According to the Early Childhood Development Organization (EDC Org.), children from
poor Filipino families were three times more likely to die before the age of 5 than children from
well-off families. The relatively poor progress in child development in the country was due
largely to the economic stagnation and underinvestment in social welfare programs in the past.
Not enough was done to establish adequate national child health services, or to implement
intensive programs that could compensate for limited incomes through health monitoring,
education and well-designed and targeted supplementation.
29
A comprehensive and integrated package of cost-effective early childhood interventions

and services was implemented addressing the needs of poor children from prenatal care to birth
to enrollment in the first grade. The service packages included integrated management of
childhood illnesses (IMCI), an expanded immunization program, supplemental feeding,
micronutrient supplementation, and deworming. These are known to be effective measures in
ensuring child survival.
Utilizing the IMCI strategy by health care workers in managing childhood illnesses in
managing childhood illness ensures that high-risk children are given adequate and effective care.
It encourages family members their child caring behavior. The IMCI health trained health
workers should be monitored and supervised regularly to see to it that they use knowledge,
attitude and skill they acquired during the training. Records review should also be done during
the monitoring. Counseling and care givers classes should be conducted to help family members
improve their child-caring behavior.
NURSING STUDENTS
Dr. Sinda, Dr. Yap, Dr. Abaquin, Dean Palomares, Dr. Palad, Ms. Cuevas, Dr. De Vera
POLICIES AND STANDARDS FOR BACHELOR OF SCIENCE IN NURSING (BSN)
PROGRAM CHED MEMORANDUM ORDER (CMO), No. 5, Series of 2008
In accordance with pertinent provisions of Republic Act No. 7722, otherwise known as
the Higher Education Act of 1994 and pursuant to Commission en Banc Resolution No. 93-2008
dated March 10, 2008 and for the purpose of rationalizing Nursing Education in the country in
order to provide relevant and quality health services locally and internationally, the following
30
policies and standards for Bachelor of Science in Nursing (BSN) program are hereby adopted
and promulgated by the Commission.
In the article I, section 1 of Policies and standards for Bachelor of Science in nursing
program by the commission on higher education, a person is a unique bio-psycho-socio-cultural
and spiritual being, always in constant interaction with the environment. These interactions affect
individuals, families, population groups and societal health status. The nurse assumes the caring
role in the promotion of health, prevention of diseases, restoration of health, alleviation of
suffering and, when recovery is not possible, in assisting patients towards peaceful death.
The nurse collaborates with other members of the health team and other sectors to
achieve quality healthcare. Moreover, the nurse works with the individuals, families, population
groups, community and society in ensuring active participation in the delivery of holistic
healthcare.
Within the context of the Philippine society, nursing education with caring as its
foundation, subscribes to the following core values which are vital components in the
development of a professional nurse and are emphasized in the BSN program.
These core values are the following: Love of God, love of People, love of Country; under
caring as the core of nursing, professional nurses should manifest compassion, competence,
confidence, conscience, commitment (commitment to a culture of excellence, discipline,
integrity and professionalism). Under the love of people, a professional nurse should manifest
respect for the dignity of each person regarded of creed, color, gender and political affiliation.
And for love of country, it includes showing patriotism. (civic duty, social responsibility and
good governance)
31
A strong liberal arts and sciences education with a transdisciplinary approach, enhances
this belief. The BSN program therefore, aims to prepare a nurse who, upon completion of the
program, demonstrates beginning professional competencies and shall continue to assume
responsibility for professional development and utilizes research findings in the practice of the
profession. The following are the Key Areas of Responsibility for which the nurse should
demonstrate competence.
The core competencies includes safe and quality nursing care, management of resources
and environment, health education, legal responsibility, ethico-moral responsibility, personal and
professional development, quality improvement, research, record management, communication,
collaboration and teamwork that a professional nurse must have.
According to Dr Sinda and other members: Article V Section 6 Higher Education
Institutions offering the Bachelor of Science in nursing program must conform to the standard
curriculum embodied in this Commission on higher education Memorandum Order (CMO)
provided that program innovations shall be subject to prior review by the Commission.
According to Article V Section 7 which is the Level Objectives which states that the
student shall be given opportunities to be exposed to the various levels of health care (health
promotion, disease prevention, risk reduction, curative and restoration of health) with various
client groups (individual, family, population groups and community). These opportunities shall
be given in graduated experiences to ensure that the competencies per course, per level and for
the whole program are developed. Before graduation, the student shall approximate the
competencies of a professional nurse as they assume the various roles and responsibilities. For
the level IV, the following objectives should be achieved:
32
Level IV
At the end of the 4th year, given actual clients/situation the student shall be able to
demonstrate competencies in all the key areas of responsibility. Specifically, the student shall:
utilize the nursing care process in the care of clients across the lifespan with problems in
inflammatory and immunologic reactions, cellular aberrations and acute biologic crisis, in
disaster/emergency situations; apply a nursing theory in the management of care of a client for
case study; and, observe the core values cherished by the nursing profession (love of God,
caring, love of country and of people) and the bioethical principles in the care of clients; and,
demonstrate leadership and management skills in the care of a group of clients in the community
and hospital setting utilizing research findings;
Maria Stanhope, Jeanette Lancaster, Barriers to Specializing in Public Health Nursing

community and public health nursing, Mosby Inc 2004
One of the most serious barriers to the development of specialist in public health nursing
is the mindset of many nurses that the only role for the nurse is at the bedside or at the clients
side, and indeed the heart of nursing is the direct care provided in personal contacts with client.
On the other hand, two things should be clear. First, whether a nurse is able to provide direct care
services to a particular client depends on decisions made by individuals within and outside of the
care system. Second, nurses need to be involved in those fundamental decisions. Perhaps the
one-one focus of nursing and the historical expectations of the proper role of women have
influenced nurses to view less positively other ways of contributing, such as administration,
consultation, and research.
33
However, two things have changed. First, in all fields, within and outside of nursing
women have taken on every role imaginable. Second, the number of male nurses is steadily
growing- nursing is no longer just a female population. These two changes have opened doors to
new roles that may not have been considered appropriate for nurses in the past.
A second barrier to population- focused public health nursing practice consists of the
structures within which nurses work and the process of role socialization within these structures.
For example, the absence of a particular role in a nursing unit may suggest that the role is
undesirable or inaccessible to nurses.
A third barrier is that few nurses receive graduate level preparation in the concepts and
strategies of the disciplines basic to public health. As mentioned previously, masters level
program for public health nursing do not give the in-depth attention to population assessment and
management skills that the other parts of the curriculum, particularly the direct care aspects,
receive.
Billings, Diane M. And Halstead, Judith A. teaching in nursing: a Guide for faculty.
Pennsylvania: W.B.Saunders Company. 1998
According to Billings and Halstead, curriculum is defined as formal and informal
content and process by which learners gain knowledge and understanding, develop skills and
alter attitudes, appreciations and values under the auspices of the school
Curriculum in Nursing has also been viewed from a number of perspectives. For
Heidgerken, curriculum entailed all planned and day to day learning experiences of the students
and faculty, including both organized instruction and clinical experiences. For Taba, all curricula
are composed of certain elements. Usually it contains statement of aims and specific objectives.
34
It must indicate some selection and organization content. It either implies or manifest certain
patterns of teaching or learning, whether because the objectives demands them or because the
content organization requires them. Finally, it includes a program of evaluation of the outcome.
Nelms defined curriculum in a more personal meaning. He states that curriculum is the
educational journey, in an educational environment in which the biography of the person
(student) interacts with the history of the culture of nursing through the biography of another
person(faculty) to create meaning and release potential in the lives of all participants.
PHENOMENOLOGICAL STUDY
Niewswiadomy, R.M. (2008). Phenomenological Studies. Foundations of Nursing Research
Fifth Edition, 172-173.
Phenomenological studies examine human experiences through the descriptions provided
by the people involved. These experiences are called lived experiences. The goal of
phenomenological studies is to describe the meaning that experiences hold for each subject. This
type of research is used to study areas in which there is little knowledge.
In phenomenological research, respondents are asked to describe their experience as they
perceived them. They may write about their experiences, but information is generally obtained
through interviews.
To understand the lived experience from the vantage point of the subject, the researcher
must take into account her or his own beliefs and feelings. The researcher must first identify
what she or he expects to discover and then deliberately put aside these ideas; this process is
called bracketing. Only when the researcher put aside her or his own ideas about the
35
phenomenon is it possible to see the experience from the eyes of the person who has lived the
experience.
Parse, Coyne, and Smith (1985) wrote that the analysis of data from these types of studies
requires that the researcher dwell with the subjects descriptions in quiet contemplation. The
researcher then tries to uncover the meaning of the lived experience for each subject. Themes
and patterns are sought in the data. Data collection and data analysis occur simultaneously.
Phenomenological research methods are very different from the methods used in
quantitative research. Mariano (1990) asserted that phenomenology could be difficult to
understand, particularly if a person has had a limited background in philosophy. Although,
phenomenological research has sometimes been viewed as so-called soft science, Streubert and
Carpenter (2002) contended that this research method is rigorous, critical and systematic. They
called for the beginning research to seek a mentor who has experience in phenomenological
research.
Donalek (2004) wrote that conducting qualitative research is a challenging, exciting, and
at times, exhaustive process. However, she asserted that the final research product might be
very satisfying for the researcher.
BRACKETING
T. Groenewald (2004). A phenomenological research design illustrated. International
journal of qualitative methods 3(1)
Bracketing and Phenomenological Reduction
The term reduction , coined by Husserl, though will do nothing with the reductionist
natural science methodology, it will do great justice to human phenomena through over-analysis.
36
There will be the removal from the lived contexts of the phenomena and worse possibly reducing
phenomena to cause and effect.
Phenomenologic reduction instead refers to the deliberate and purposeful opening by the
researcher to the phenomenon in its own right with its own meaning. It further points out to a
suspension or bracketing out, in a sense that in its regard no position is taken either for or
against, the researchers own presupposition and not allowing the researchers meanings and
interpretations or theoretical concepts to enter the unique world of the informant/participant.
World Health Organization (2005). Handbook, Integrated Management of Childhood

Illness,
According to the World Health Organization, (2009), the primary reason for developing
interventions to imimprove the community medicines management for childhood illnewss is to
ensure that correct treatment is available and that families are able to seek, obtain, and
appropriately use medicines for common childhood illnesses such as malaria, pneumonia, coughs
and colds, or diarrhea. In many countries, as recommended by the WHO, these common child
health problems are addressed using an approach known as Integrated Management of Childhood
Illness (IMCI). In addition to comprehensive IMCI training programs, many other public and
private health programs have developed interventions intended to improve access to pediatric
medicines by caregivers or prescribing and dispensing of these medicines by health providers
IMCI provides a model for comprehensive implementation of proven public health
interventions. An evaluation carried out in 5 countries. Showed improvements in health worker
performance following IMCI training. Children seen by IMCI trained health workers were
significantly more likely to receive correct treatments, and IMCI trained health workers
37
communicated better with carers. Although IMCI consultations take longer, IMCI was shown to
be efficient and cost less than routine care in some settings. Despite these improvements,
absolute levels of health worker performance were often poor. In Uganda, less than half of
children received correct treatment, and in Peru this was as low as 10%. Even in the most
successful implementation sites there was considerable room for improvement. (Horwood et al.
2009)
World Health Organization (2005). Handbook, Integrated Management of Childhood
Illness,
According to the World Health Organization, (2009), integrated case management relies
on case detection using simple clinical signs and empirical treatment. As few clinical signs as
possible are used. The signs are based on expert clinical opinion and research results, and strike a
balance between sensitivity and specificity. The treatments are developed according to actionoriented classifications rather than exact diagnosis. They cover the most likely diseases
represented by each classification.
The IMCI process can be used by doctors, nurses, and other health professionals who see
sick infants and children aged from 1 week up to five years. It is a case management process for
a first-level facility such as a clinic, a health centre or an outpatient department of a hospital.
The IMCI guidelines describe how to care for a child who is brought to a clinic with an
illness, or for a scheduled follow-up visit to check the childs progress. The guidelines give
instructions for how to routinely assess a child for general danger signs, common illnesses,
malnutrition and anaemia, and to look for other problems. In addition to treatment, the guidelines
incorporate basic activities for illness prevention.
38
In assessment, first check for danger signs and possible bacterial infections, we should
also ask for questions about common conditions, examine the child, and check nutrition and
immunization status. Assessment includes checking the child for other health problems.
In classifying illnesses, a colour-coded triage system is used. Because many children
have more than one condition, each illness is classified according to the management required
such as an urgent condition which requires pre-referral treatment which is indicated by a red
colour. Specific medical treatment is signified by a yellow colour, and simple advice on home
management is indicated by a colour green.
After classifying all conditions, identify specific treatments for the child. If a child
requires urgent referral, give essential treatment before the patient is transferred. If a child needs
treatment at home, develop an integrated treatment plan for the child and give the first dose of
drugs in the clinic. If a child should be immunized, give immunization.
Provide practical treatment instructions, including teaching the caretaker how to give oral
drugs, how to feed and give fluids during illness, and how to treat local infections at home. Ask
the caretaker to return for follow-up on a specific date, and teach her how to recognized signs
that indicate the child should return immediately to the health facility.
Assess feeding, including assessment of breastfeeding practices, and counsel to solve any
feeding problems found. Then counsel the mother about her own health. When a child is brought
back to the clinic as requested, give follow up care and, if necessary, reassess the child for new
problem
39
United Nations Foundations, (2002), Report on Community IMCI PlanningMeeting

In 2002, Community IMCI was being implemented in 26 out of the 111 districts of Madagascar.
This covers 636 sites with a population of 252,8000 inhabitants. Of the sites, 161 (25%) are
already autonomous and are able to continue implementation using their own resources. The
criteria of autonomy are based on: existence of a volunteer, presence of surveillance and growth
monitoring activities, regular IEC activities, AAA done periodically, existence of a community
financing system, regular supply of agricultural inputs, supervision of Agricultural staff, presence
of a co-ordination committee. (According to United Nations Foundations, 2002)
Cesar G. Victora, Taghreed Adam, Jennifer Bryce, and David B. Evans, Integrated
Management of the Sick Child (2006)
SAFE AND QUALITY NURSING CARE
The first component of IMCI includes health worker training and the reinforcement of
correct performance. Training is based on a set of adapted algorithms (Gove 1997) that guide
health workers through a process of assessing signs and symptoms, classifying the illness
according to treatment needs, and providing appropriate treatment and education to the child's
caregiver.
Sick children attending a first-level health facility are initially checked for danger signs
and for the main symptoms of the key IMCI diseases: diarrhea, malaria, pneumonia, measles,
and other severe infections. Next, all children are assessed for malnutrition and anemia, and
vaccination status is verified. Children under two years of age, as well as older children
presenting low weight for age, receive nutrition counseling. Other health problems related by
caretakers are then assessed, and children are classified according to a color code: pink
40
(immediate referral), yellow (management in the outpatient facility), or green (home

management). Separate case-management algorithms are available for children under two
months of age. IMCI health worker training emphasizes the integration of curative care with
preventive measures, including nutrition and vaccinations. A special training module addresses
how to communicate effectively with mothers. The training course was originally designed to
last 11 days, including a large amount of hands-on experience.
Newton et. al, Hypothetical performance of syndrome-based management of acute

paediatric admissions of children aged more than 60 days in a Kenyan district hospital.
(2003)
PROMOTES ACCURACY IN ASSESSMENT

41
a disease state.
P. R. Kolstad, et al. The integrated management of childhood illness in western Uganda,

2008
ALLOWS MASTERY AND EXPERTISE OR CLINICAL JUDGMENT

42
World Health Organization and UNICEF. Model Chapter for textbooks: Integrated
Management of Childhood Illnesses, 1997. Department of Child and Adolescent Health and
Development (CAH).
ALLOWS THE NURSE TO PRACTICE INDEPENDENT FUNCTIONS

43
NOT BEING FULLY UTILIZED
The overall health status of Filipinos has improved in the past several
decades. Infant
mortality rate, maternal mortality ratio, life expectancy at birth and other
vital indicators
of health have shown improving trends. However, improvements in health
have not been
at par with expectations as compared with neighboring Southeast Asian
countries.
SYNTHESIS
Gove (1997) and Bryce (2004) discussed the guidelines for integrated management of
childhood illness are based on both expert clinical opinion and research results. The IMCI
guidelines incorporate current WHO case management guidelines for pneumonia and ear
infection, diarrhea with dehydration, dysentery and persistent diarrhea and malaria.
Newton (2003), P.Randall (1998), S.H. Factor (2001), P. R. Kolstad (2008), Eleanor
Gouws (2004) tackled on the training health care workers on the utilization of IMCI. Using a set
of interventions for the integrated treatment and prevention of major childhood illnesses, the
IMCI strategy aims to reduce death and the frequency and severity of illness and disability, and
44
to contribute to improved growth and development. However, the challenge now is to apply the
lessons from these programs to strategies that promote coordination and, where appropriate,
greater integration of activities in order to improve the prevention and management of childhood
illnesses which will be used on evaluating the target population on their implementation. The
IMCI has 3 components, One component focuses on improving the skills of health workers
through training and reinforcement of correct performance. The second component of IMCI aims
to improve health system supports for child health service delivery, including the availability of
drugs, effective supervision, and the use of monitoring and health information system data. The
third component focuses on a set of family practices that are important for child health and
development and encourages the development and encourages the development and
implementation of community and household based interventions to increase the proportions of
children exposed to these practices.
Asian Development Bank (ADB) (2007) talked about the IMCI being implemented here
in the Philippines and how it helped on treating common childhood illnesses.
Dr. Sinda, Dr. Yap, Dr. Abaquin, Dean Palomares, Dr. Palad, Ms. Cuevas, Dr. De
Vera(2008) this article discusses the policies and standards of bachelor of science in nursing
stated in the CHED Memorandum Order. The objectives of the curriculum and the course of
level IV is also discussed in this article.
Maria Stanhope and Jeanette Lancaster (2004) discuss the barriers to the development of
specialists in public health nursing. Nowadays, gender is no longer an obstacle in nursing.
Before, only women indulge themselves into nursing. Today, mens population in the nursing
profession is almost equal to that of women. Second barrier mentioned is the presence of a role
45
in a nursing structure in public health nursing. Another is the difference between the graduate
level preparation compared to that of the masters level program.
Billings, Diane M. And Halstead, Judith A.(1998) defines the meaning of curriculum.
Nursing curriculum is also considered in this article as well as the different denotations from
different individuals.
CONCEPTUAL FRAMEWORK
This conceptual paradigm aims to describe the lived experiences of faculty and students
on Integrated Management of Childhood Illness in a Selected Community in Cavinti, Laguna.
The center of the paradigm is the lived experience of the faculty and students on
Integrated Management of Childhood Illness in Cavinti, Laguna since their experiences were the
basis in the formulation of the following themes which is placed around the center circle. The
first themes which is Integrated Management of Childhood Illness allows mastery and expertise
or clinical judgment because the student and faculty expressed that there clinical performance
has improved upon using Integrated Management of Childhood Illness. The second theme,
Integrated Management of Childhood Illness provides accuracy in assessment because the
student and faculty discussed in the interview that their assessment skills have been enhanced.
Another theme is that Integrated Management of Childhood Illness allows the nurse to practice
independent functions because the faculty and students state that upon the usage of Integrated
Management of Childhood Illness in their clinical duty, they were able to apply it individually.
Another theme is that IMCI promotes safe and quality nursing care, according to the faculty and
students when they are practicing IMCI they belive that all the interventions that they provide are
safe and at the same time effective. And the last theme which is Integrated Management of
Childhood Illness is not fully implemented because based on the experiences of the faculty and
46
student in their duty, Integrated Management of Childhood Illness is lacking integration and its
utilizations is limited to those who have knowledge about it.
CONCEPTUAL PARADIGM
47
Figure 1. Lived Experience of Faculty and Students on IMCI on Selected Community in Cavinti,
Laguna
CHAPTER III
METHODOLOGY
This chapter presented and described how the study was done, the instrument utilized and
the method used in gathering and analyzing the data.
RESEARCH DESIGN
This study, Lived Experience of Faculty and Nursing Students in Utilizing the Integrated
Management of Childhood Illness (IMCI) Strategy in a Selected Community in Cavinti, Laguna
is a qualitative, descriptive and phenomenological type of study.
Qualitative research is a systematic, subjective approached used to describe and promote
understanding to life experiences that will give meaning to them. In addition, qualitative research
focuses on discovery and understanding of the whole, an approach that is consistent with the
holistic philosophy of nursing.
Qualitative research will use semi-structured questions in conducting interviews to gather
data. The data included the interpretations of the subjects with no attempts to control the
interaction. Qualitative data takes the form of works and will be analyzed in terms of individual
48
responses or descriptive summaries or both. The findings will be unique to that study, and it is
not the intent of the researcher to generalize the feelings to a larger population. However,
understanding the meaning of a phenomenon in a particular situation is useful for understating
the similar phenomena in similar situations. (Burns, 2005)
Phenomenology is not just a study dealing with certain phenomena, but it is about
thinking deeper and understanding the experience of the said phenomena. Many suggested to
approach this type of study such as immersion, coming to the phenomenological aim of the
inquiry, existential inquiry expressions and processing phenomenological contextual processing,
analysis of interpretative interaction, writing phenomenological narrative and writing a narrative
on the meaning of the study. (Munhall, 2007)
Bracketing refers to the process of identifying and holding in abeyance preconceived
beliefs and opinions about the phenomenon under the study. Through this, the researchers must
become unknowing wherein the researchers will voice out their beliefs preconceptions,
assumptions and what they expect from the study through a group self awareness counseling.
After doing so, the researchers will proceed to the process of intuiting wherein they remain open
to the meaning attributed to the phenomenon by those who have experienced it. With this, the
researchers will have a common understanding about the phenomenon under the study. Then
analysis and interpretation will follow. The researchers will concentrate within the data gathered
and common themes will arise from it.
SAMPLING DESIGN
The researchers utilized a non-probability, purposive sampling wherein the participants
were picked based on the criteria given by the researchers. Participant for this study were fourth
49
year nursing students currently enrolled in the first semester of the academic year 2010 2011
who had finished their clinical rotation in Cavinti, Laguna and had applied the IMCI strategy
during their community duty. As for the faculty, they were current clinical instructor who followup students in Cavinti, Laguna.
MATERIALS/EQUIPMENTS USED IN THE STUDY
The researchers utilized semi-structured one-on-one interview to gather data which were
used to describe the lived experience of faculty and nursing student utilizing the IMCI strategy.
Two (2) of the researchers facilitated the interview in which one was the encoder of the data
including the non-verbal cues that were exhibited by the respondents. Follow up questions would
be asked to allow the participant to elucidate and substantiate their answers.
The material that the researcher used was a semi-structured interview specifically pointing
open ended questions to the participant that served as a rough guide to the researchers while
conducting the study.
Semi-structured interviews were conducted with an open framework which allows attentive,
two-way communication. The questions were spontaneously thrown over the course of the
interview, usually out of the sentence given by the respondent. The preceding questions were
generated during the interview, which allowed both parties the flexibility to dig deeper into the
details.
Other tools necessary during the actual data collection, taking into consideration that this
study required an in-depth interview, a video camera was used depending on the willingness of
the interviewees. Moreover, this device helped the researchers in providing back-ups whenever
occurrence of unavoidable circumstance that might happen.
50
DATA GATHERING PROCEDURE

Prior to the data gathering, the researcher underwent becoming phenomenological
process wherein the researcher conceptualized the different concepts, opinions and experiences
of the utilization of IMCI strategy in a selected community. These were carried out until the
researchers had a full understanding of the said phenomenon. Then the researchers went into the
process of unknowing. Becoming unknowing means that an individual must clear his/her
own insight from assumptions and belief system. To get this point, the researchers underwent
bracketing where personal knowledge, experience and biases regarding utilizing the IMCI
strategy. In order to do this, the researchers underwent a journal bracketing about their own
experiences in utilizing the IMCI strategy. After the researchers had shared their own experiences
and insights regarding the said phenomenon, the researchers immersed themselves once more in
the phenomenon and again utilized the IMCI strategy in a given time frame. Again, the
researchers met for a journal bracketing where they expressed their thoughts, insights,
experiences, preconceptions, beliefs, what they expected from the study and other things that
might affect their acceptance and understanding others experiences to generate themes from the
researchers journal bracketing done. By bracketing, the researchers formulated a series of openended questions that served as a guide, though these questions would not be a limiting factor
upon the actual interview. These questions were formulated in a way that the researchers were
able to collect the data needed from the participants regarding their thoughts, insights and
experiences in the utilization of the IMCI strategy. A series of follow-up questions were based on
the responses elicited from the respondents.
51
After undergoing the said bracketing, the researchers would be the unknowing on the
phenomenon and unbiased when conducting the actual interviews with the chosen faculty and
students of the selected college of nursing.
The study started after the submission of the letter of approval to the Dean asking
permission to conduct the said research. After acquisition of approval, the researchers
commenced the study.
The next step would be the selection of participants. The respondents were selected
through non-probability, purposive sampling based on the criteria set by the researchers.
Before carrying out the actual interview of the chosen participants, the researchers
presented a letter of consent to the participants. This letter of consent included the scope of the
interview, use of a digital camera for video recording, transcription of the participants answers, a
proof of cooperation of the participant to the study and that the interview conducted were kept
with utmost confidentiality and that the respondents identity were kept anonymous.
The interview involved two researchers. One was responsible for asking the questions
and the other for recording the entire interview, including the body language that might be
elicited from the questioning. The interview commenced after the participant was oriented about
the details of the study. Moreover, the respondent was assured of their identitys anonymity and
all answers were dealt with confidentiality as stated in the consent letter. Before the interview,
the respondents stated that there would be no right or wrong answers and they could take as
much time as they would require answering the questions given to them. The researchers started
the interview proper by asking an open-ended question regarding their experience during their
community duty in Cavinti, Laguna and the utilization of the IMCI strategy.
52
After the interview, the researchers chose another participant from the same college of
nursing who utilized the IMCI strategy. After the conduction of the interview and recording of
the information needed, the data were analyzed and interpreted and themes were formulated.
Analysis was supported by the related literatures collected.
Data collection continued until the researchers had reached saturation in which no
new themes or essence emerged from the participants and the data gathered were already
repetitive. (Speziale, 2003)
DATA ANALYSIS PLAN
Since this was qualitative type of study no Statistical Treatment used. Only statements
from the participants were taken and analyzed.
In analyzing the data, the transcription of all the interviews gathered was done. After, the
researchers read the entire disclosure of the transcribed interviews straight through to obtain a
sense of the whole. Then the researchers reread the transcribed interviews of each participant and
selected specific phrases which the researches interpreted as the essence of each interview. For
each phrase that was selected meaning units were formulated. Then the researchers have
reflected on the meaning units and extrapolate the essence for each participant. After, the
researchers have related the meaning units to each other and clustered the ones that have the
same thought. Then the themes were formulated. Then the researchers have examined the
meaning units and themes for redundancies, clarification or elaboration.
53
CHAPTER IV
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
This chapter presents the analysis and interpretation of the raw and refined data derived
from the transcriptions of the interview with the participants. This chapter also presents the data
collected by the researchers and its analysis with corresponding interpretation, supported by
different related literature with the help of researchers verbalization
The data gathered were put in a tabular form comprising of the participants description,
its meaning units and the interpretation based on the study. The major themes were the
following: IMCI promotes safe and quality nursing care, IMCI promotes accuracy in assessment,
IMCI allows mastery and expertise or clinical judgment, IMCI allows the nurse to practice
independent functions, and IMCI is not fully utilized.
54
Table 1. IMCI promotes safe and quality nursing care

Raw data
Meaning units
Participant 1: So the thing Allows the nurse to be careful
Theme
IMCI promotes
with IMCI is that at the end of
quality nursing care
every
checklist
safe
and
may
recommendation and plan of

action compared sa PE and
Nursing Health history na pure
assessment lang.
Participant 1:
mas detailed
siya
Participant 2: Tapos. for us

nurses
na
nagpaparactice,
hindi ako masisisi sa mga

55
gamot
na
nandoon
kasi
dispensing lang naman ng

drugs doon,
kahit walang
prescription. So kahit nurse ka

tapos nagbigay ka ng gamot,
meron
kang
panlaban.
Mapapakita mo na meron
nakalagay sa IMCI. So pwede
ka
magbigay
ng
actual
treatment without the doctors

orders
Participant
parang
ano
3:
Okay
specific
Actually
siya
kasi
yung
mga
gagawin mo mga sasabihin

mo. Pero parang ano Yung
ibang parts Parang alam mo
rin naman kahit walang ano
kahit hindi IMCI chart ang
gamit.
Participant 3: Depende sa cues
56
na
makikita
mo
parang
kinacategorize
siya
Categorize as in yung kung

may
Pneumonia
ganun
ba
Mga
yung
severe,
moderate and mild Base

kasi sa cues na pinepresent,
may equivalent na category.
Ayun nga Example pag may
diarrhea Kung may danger
signs, severe na agad yun
Tapos pag nacategorize na
yung
illness,
may
interventions na dun. Na para

sa category na.
Participant
4:
Strengths,
maganda siya in a way na in

just one sitting marami ka
magagawa
Marami
ka
sa
client
magagawa
mo.
na
interventions kasi integrated

nga siya eh hindi ba, treating a
57
lot of symptoms already in

just one sitting at the same
time
yung
structured
algorithm
niya
mababa
ang
chances nang error niya.
Participant 5: Pero nung nakita

ko yung chart naisip ko parang
mas maganda siya kasi mas
specific. Andoon na din yung
interventions. Kasi kunwari
mataas
yung
temperature
bigyan mo ng ganito, tapos

kung may cough bigyan mo
nito. Ayun. Kasi diba kapag
were dealing with pediatric
patients masyadong maselan
kasi fragile yung body nila at
madaling makakuha ng sakit
ang mga bata so ayun
Participant 1: Easier in a way Allows the nurse to give better

na nandyan na yung levels eh, interventions
58
kung
yung
symptoms
na
present ganito ika-categorize

mo na lang, pero yun nga, like
what I have said yung sa
pagdadiagnose at sa treatment
what if hindi pala yun ang
sakit niya according to IMCI
(hand gestures moving away
the
body)
what
if
my
underlying ano pa disease pa.
participant 2: sa IMCI naman

lahat yung makikita. Yung
nagtatae po ba, gaano kataas
yung temperature ng bata,
tapos observe niyo po, tapos
bigyan ng paracetamol kada
apat na oras, tapos pag hindi
bumaba, balik po kayo ulit
dito. Pag pangatlong araw na.
Kasi three days naman yun.
Participant
3:
Sa
IMCI
59
mismo Medyo konti pa kasi

alam ko tapos once ko lang
ever
nagamit
yun
pero
Narealize ko Sa IMCI
Ano siya Hindi nga ba sabi
nila Pwede ka magbigay ng
teaching tsaka interventions
kahit walang doctor basta
sundin
nakalagay
mo
lang
doon
yung
Nothing
more, nothing less Ayun

And may guide din kasi alam
mo kung ano yung Hindi ka
basta basta nagaassess Alam
mo yung kung ano iaassess
mo kasi nakalagay na doon.
Participant 3: Yung sa time

kasi na ginamit ko yun Wala
naman ano Kasi yun nga,
nagcocomplain about cough
and colds, ganyan Tapos
wala naman danger signs yung
60
patient
noon
Tapos
Parang yung labas noon, ano

lang Talagang cough and
colds
lang
Walang
pneumonia or anything, so
Parang yung interventions
Na yung health teaching na
interventions Kasi diba sa
community
madalas
na
interventions health teaching

talaga Ayun, yung tinuro ko
noon Sabi ko huwag siyang
magtatake ng cough meds
without
prescription.
Mag
kalamansi juice tsaka tinuruan

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant
4:
Strengths,

magagawa
sa
client
mo.
61
Marami
ka
magagawa
na

time
yung
structured
algorithm
niya
mababa
ang
chances nang error niya.
Participant 5: Mas naging,

kumbaga mas naging sigurado
ako sa mga interventions kasi
by the book siya.
Participant 5: Mas magiging

maganda
yung
resulta
nursing
interventions
ng
na
ginawa ko kasi sa IMCI meron

pa yang mga treatment
Participant 5: yung pagiging

detailed niya in terms of the
interventions niya at specific
62
siya dun sa lahat
Participant 1: Easier in a way

na nandyan na yung levels eh,
kung
yung
symptoms
na Prevents Error

the
body)
what
if
my
Participant
2:
Strengths
Maganda kasi siya User

friendly kasi madali naman
siyang maindihan Tapos. for
us nurses na nagpaparactice,
gamot
na
nandoon
kasi
63
drugs doon,
kahit walang

meron
kang
panlaban.
ka
magbigay
ng
actual

orders.
Participant
3:
Sa
IMCI

ever
nagamit
yun
pero
sundin
nakalagay
mo
lang
doon
yung
Nothing

64

Participant 3 : Yung sa time
patient
noon
Tapos

colds
lang
Walang
community
madalas
na

65
without
prescription.
Mag

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant
4:
Marami
ka
magagawa na interventions
kasi integrated nga siya eh
hindi ba, treating a lot of
symptoms already in just one
sitting at the same time yung
algorithm
niya
structured
mababa ang chances nang

error niya.
(makes
zigzag
gesture of hand) Susundan mo

nalang, kasi step by step na
ito, ewan ko nalang kung
magkamali ka pa sa pagsunod
ng step 1 step 2 step 3, 4. 5.
Participant 5: sa IMCI meron

pa
yang
mga
treatment
66
halimbawa sa cough bigyan

mo siya ng ganitong gamot.
And then after noon kailangan
after 7 days kailangan ng
check up para malaman kung
naging tama yung ginawa mo
or naging appropriate yung
gamot na naibigay mo.
Participant 1: Kasi what I have

said, sa community kailangan
mabilis ka diba and then IMCI
is much easier to do kaysa
thorough physical assessment
Promotes confidence
Participant 2: So kahit nurse

ka tapos nagbigay ka ng
gamot, meron kang panlaban.
ka
magbigay
ng
actual

orders.
67
Participant
parang
ano
3:
Okay
specific
Actually
siya
kasi
yung
mga

gamit.
Participant 5: kasi by the book

siya. Di ba kapag by the book,
mas
confident
tayo
sa
interventions at mas safe yun

sa patient na ginagawan natin
ng
intervention.
So
yun
feeling ko, confident ako at

mas
secure
na
eto
yung
tamang interventions for that

patient.
68
All of the participant said that IMCI allows tha nurse to be careful and therefore IMCI promotes
safe and quality nursing care So the thing with IMCI is that at the end of every checklist may
recommendation and plan of action compared sa PE and Nursing Health history na pure
assessment lang. , mas detailed siya (P1). Tapos. for us nurses na nagpaparactice, hindi
ako masisisi sa mga gamot na nandoon kasi dispensing lang naman ng drugs doon, kahit
walang prescription. So kahit nurse ka tapos nagbigay ka ng gamot, meron kang panlaban.
Mapapakita mo na meron nakalagay sa IMCI. So pwede ka magbigay ng actual treatment
without the doctors orders (P2). Actually parang Okay siya kasi ano specific yung mga
gagawin mo mga sasabihin mo. Pero parang ano Yung ibang parts Parang alam mo rin
naman kahit walang ano kahit hindi IMCI chart ang gamit. . Depende sa cues na makikita
mo parang kinacategorize siya Categorize as in yung kung may Pneumonia ba yung ganun
Mga severe, moderate and mild Base kasi sa cues na pinepresent, may equivalent na category.
Ayun nga Example pag may diarrhea Kung may danger signs, severe na agad yun
Tapos pag nacategorize na yung illness, may interventions na dun. Na para sa category na.
(P3). Strengths, maganda siya in a way na in just one sitting marami ka magagawa sa client
mo. Marami ka magagawa na interventions kasi integrated nga siya eh hindi ba, treating a lot of
symptoms already in just one sitting at the same time yung algorithm niya structured mababa ang
chances nang error niya. (P4) . Pero nung nakita ko yung chart naisip ko parang mas
maganda siya kasi mas specific. Andoon na din yung interventions. Kasi kunwari mataas yung
temperature bigyan mo ng ganito, tapos kung may cough bigyan mo nito. Ayun. Kasi diba kapag
69
were dealing with pediatric patients masyadong maselan kasi fragile yung body nila at
madaling makakuha ng sakit ang mga bata so ayun (P5)
Then another participant verbalized that IMCI allows to give better interventions Easier in a
way na nandyan na yung levels eh, kung yung symptoms na present ganito ika-categorize mo na
lang, pero yun nga, like what I have said yung sa pagdadiagnose at sa treatment what if hindi
pala yun ang sakit niya according to IMCI (hand gestures moving away the body) what if my
underlying ano pa disease pa. (P1). sa IMCI naman lahat yung makikita. Yung nagtatae po
ba, gaano kataas yung temperature ng bata, tapos observe niyo po, tapos bigyan ng paracetamol
kada apat na oras, tapos pag hindi bumaba, balik po kayo ulit dito. Pag pangatlong araw na.
Kasi three days naman yun. (P2). Sa IMCI mismo Medyo konti pa kasi alam ko tapos once
ko lang ever nagamit yun pero Narealize ko Sa IMCI Ano siya Hindi nga ba sabi nila
Pwede ka magbigay ng teaching tsaka interventions kahit walang doctor basta sundin mo lang
yung nakalagay doon Nothing more, nothing less Ayun And may guide din kasi alam mo
kung ano yung Hindi ka basta basta nagaassess Alam mo yung kung ano iaassess mo kasi
nakalagay na doon., Yung sa time kasi na ginamit ko yun Wala naman ano Kasi yun nga,
nagcocomplain about cough and colds, ganyan Tapos wala naman danger signs yung patient
noon Tapos Parang yung labas noon, ano lang Talagang cough and colds lang Walang
pneumonia or anything, so Parang yung interventions Na yung health teaching na
interventions Kasi diba sa community madalas na interventions health teaching talaga
Ayun, yung tinuro ko noon Sabi ko huwag siyang magtatake ng cough meds without
prescription. Mag kalamansi juice tsaka tinuruan ko rin mag chest physiotherapy and increase
water intake din. (P3). Strengths, maganda siya in a way na in just one sitting marami ka
70
magagawa sa client mo. Marami ka magagawa na interventions kasi integrated nga siya eh
hindi ba, treating a lot of symptoms already in just one sitting at the same time yung algorithm
niya structured mababa ang chances nang error niya. (P4)
Then another verbalized that it prevents error Mas naging, kumbaga mas naging sigurado ako
sa mga interventions kasi by the book siya. , Mas magiging maganda yung resulta ng nursing
interventions na ginawa ko kasi sa IMCI meron pa yang mga treatment. yung pagiging
detailed niya in terms of the interventions niya at specific siya dun sa lahat (P5). Easier in a
way na nandyan na yung levels eh, kung yung symptoms na present ganito ika-categorize mo na
lang, pero yun nga, like what I have said yung sa pagdadiagnose at sa treatment what if hindi
pala yun ang sakit niya according to IMCI (hand gestures moving away the body) what if my
underlying ano pa disease pa. (P1). Strengths Maganda kasi siya User friendly kasi
madali naman siyang maindihan Tapos. for us nurses na nagpaparactice, hindi ako masisisi
sa mga gamot na nandoon kasi dispensing lang naman ng drugs doon,
kahit walang
prescription. So kahit nurse ka tapos nagbigay ka ng gamot, meron kang panlaban. Mapapakita
mo na meron nakalagay sa IMCI. So pwede ka magbigay ng actual treatment without the
doctors orders. (P2). Sa IMCI mismo Medyo konti pa kasi alam ko tapos once ko lang ever
nagamit yun pero Narealize ko Sa IMCI Ano siya Hindi nga ba sabi nila Pwede ka
magbigay ng teaching tsaka interventions kahit walang doctor basta sundin mo lang yung
nakalagay doon Nothing more, nothing less Ayun And may guide din kasi alam mo kung
ano yung Hindi ka basta basta nagaassess Alam mo yung kung ano iaassess mo kasi
nakalagay na doon., Yung sa time kasi na ginamit ko yun Wala naman ano Kasi yun nga,
71

water intake din. (P3)
Then lastly another participant verbalized that it promotes confidence Marami ka magagawa na
interventions kasi integrated nga siya eh hindi ba, treating a lot of symptoms already in just one
sitting at the same time yung algorithm niya structured mababa ang chances nang error niya.
(makes zigzag gesture of hand) Susundan mo nalang, kasi step by step na ito, ewan ko nalang
kung magkamali ka pa sa pagsunod ng step 1 step 2 step 3, 4. 5. (P4). sa IMCI meron pa yang
mga treatment halimbawa sa cough bigyan mo siya ng ganitong gamot. And then after noon
kailangan after 7 days kailangan ng check up para malaman kung naging tama yung ginawa mo
or naging appropriate yung gamot na naibigay mo. (P5). Kasi what I have said, sa community
kailangan mabilis ka diba and then IMCI is much easier to do kaysa thorough physical
assessment (P1). So kahit nurse ka tapos nagbigay ka ng gamot, meron kang panlaban.
Mapapakita mo na meron nakalagay sa IMCI. So pwede ka magbigay ng actual treatment
without the doctors orders. (P2). Actually parang Okay siya kasi ano specific yung mga
gagawin mo mga sasabihin mo. Pero parang ano Yung ibang parts Parang alam mo rin
naman kahit walang ano kahit hindi IMCI chart ang gamit. (P3). kasi by the book siya. Di
ba kapag by the book, mas confident tayo sa interventions at mas safe yun sa patient na
ginagawan natin ng intervention. So yun feeling ko, confident ako at mas secure na eto yung
tamang interventions for that patient. (P5)
72
The first component of IMCI includes health worker training and the reinforcement of
correct performance. Training is based on a set of adapted algorithms (Gove 1997) that guide
health workers through a process of assessing signs and symptoms, classifying the illness
according to treatment needs, and providing appropriate treatment and education to the child's
caregiver.
Sick children attending a first-level health facility are initially checked for danger signs
and for the main symptoms of the key IMCI diseases: diarrhea, malaria, pneumonia, measles,
and other severe infections. Next, all children are assessed for malnutrition and anemia, and
vaccination status is verified. Children under two years of age, as well as older children
presenting low weight for age, receive nutrition counseling. Other health problems related by
caretakers are then assessed, and children are classified according to a color code: pink
(immediate referral), yellow (management in the outpatient facility), or green (home
management). Separate case-management algorithms are available for children under two
months of age. IMCI health worker training emphasizes the integration of curative care with
preventive measures, including nutrition and vaccinations. A special training module addresses
how to communicate effectively with mothers. The training course was originally designed to
last 11 days, including a large amount of hands-on experience.
Table 2. IMCI promotes accuracy in assessment

Raw data
Meaning units
Theme
Participant 1: Nandyan na Provides precise assessment
IMCI promotes accuracy in
yung levels eh, kung yung
assessment
symptoms na present ganito

73
ika-categorize mo na lang.
Participant 1: IMCI kasi yung

sa IMCI allotted lang siya sa
Malaria, Dengue ganito so
parang kung nakikita mo ung
symptoms under that( making
hand gestures) at hindi siya
specific
na
kunwari
kung
symptoms lang yun parang

ano (thinking) ndi talaga sya
nakacategorize.
So
paano
kung iba ung sakit pero same

symptoms
nagfafall
na
sa
din
Malaria
siya
and
Dengue
Participant 2: Assessment. So
ilang araw na yung lagnat,
nagtae po ba.
So sa IMCI
naman lahat yung makikita.

Yung nagtatae po ba, gaano
kataas yung temperature ng
74
bata, tapos observe niyo po,

tapos bigyan ng paracetamol
kada apat na oras, tapos pag
hindi bumaba, balik po kayo
ulit dito. Pag pangatlong araw
na.
Participant
parang
ano
3:
Okay
specific
Actually
siya
kasi
yung
mga

gamit.
Participant 3: Kasi pag ano

Depende sa cues na makikita
mo
parang
kinacategorize
siya Categorize as in yung

kung may Pneumonia ba yung
ganun
Mga
severe,
75

yung
illness,
may

sa category na yun.
Participant 3: And may guide \

din kasi alam mo kung ano
yung Hindi ka basta basta
nagaassess Alam mo yung
kung ano iaassess mo kasi
nakalagay na doon.
Participant 3: Sa IMCI kasi

Nag
aano
siya
Parang
inaalam niya yung past at

present and specific siya kung
ano sakit nung patient.
76
Participant 5: nakita ko yung

chart naisip ko parang mas
maganda
siya
kasi
mas
specific.
Participant 1: Easier in a way Easily categorized

kung
yung
symptoms
na

mo na lang,
Participant 1: IMCI allotted

lang siya sa Malaria, Dengue
ganito so parang kung nakikita
mo
ung
symptoms
under
that( making hand gestures) at

hindi siya specific na kunwari
kung
symptoms
lang
yun
parang ano (thinking) ndi

talaga sya nakacategorize. So
paano kung iba ung sakit pero
same symptoms na din siya
77
nagfafall
sa
Malaria
and
Dengue ( zipping her jacket up

and down while grinning).
Participant
2:
Yung
sa
community, for example, may

mga nagkakalagnat tapos sabi
nagtatae, siyempre I-aassess
din kung may dengue nga ba,
tapos yung sa RR ng baby for
pneumonia.
Tapos,yun
din
ilang araw na, tapos yung mga

co-management tulad ng diet.
Participant 3: Sort off. Kasi

yung complaints nung patient
na pinaggamitan ko nun is
fever
lang
so
hindi
siya
macacategorize as Dengue or
Malaria
kasi
no
other
symptoms expressed. So the

thing with IMCI is that at the
end of every checklist may
78

assessment lang.Bookmark
Participant 3: Kasi yun nga,

patient
noon
Tapos

colds
lang
Walang

mo
parang
kinacategorize

ganun
Mga
severe,
79

yung
illness,
may

sa category na yun.
Participant 4: Yung patient

kasi may history of dengue
tapos they have this weight na
4 years old yung bata tapos 12
kilos
lang
ata.
In
that
nadiscuss ko yung sa IMCI.

Like ano ba nakasabi dun.
Whats the standard weight for
this age in months na bata?
Tapos nung sinabi ko sa kanila
icheck yung sa IMCI yung sa
graph sa likod Yun, doon
yung discussion namin. Kasi
80
nandoon yun kung saan yung

normal weight tapos kung
nasaan yung weight nung bata.
Kaya
naformulate
problem
na
yung
malnutrition.
Tapos pagka mga discussion,

siyempre kailangan ko din ng
reference. Like kapag may
mga sakit nga tapos pag
tinatanong ko sila about nung
interventions.
Like
for
example fever management,

management
which
Is
commonly na hindi kasi na

ano naneneglect kasi yung
fever and home management
ng diseases.
Participant 5: Yung mga fever

naka categorize siya, kumbaga
classified siya as dengue or
malaria
81
Participant 1: Sort off. Kasi Organize and systematic

yung complaints nung patient
fever
lang
so
hindi
siya
Malaria
kasi
no
other

assessment lang.
Participant
2:
Yung
sa
community, for example, may

mga nagkakalagnat tapos sabi
nagtatae, siyempre I-aassess
din kung may dengue nga ba,
tapos yung sa RR ng baby for
pneumonia.
Tapos,yun
din
ilang araw na, tapos yung mga

co-management tulad ng diet.
82

mo
parang
kinacategorize

ganun
Mga
severe,

yung
illness,
may

sa category na yun.

83

patient
noon
Tapos

colds
lang
Walang
community
madalas
na

without
prescription.
Mag

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant 4: maganda siya

kasi yun nga nakakapag assess
ng client na mas mabuti and at
84
the same time structured yung

sinusundan mo so there is no
way for you to get lost in the
process at the same time
kapag
matagal
ka
na
gumagamit ng IMCI ano rin

siya efficient
Participant 5: yung pagiging

detailed niya in terms of the
interventions niya at specific
siya dun sa lahat
All of the participant verbalized that it provides precise assessment thus IMCI promotes accuracy
in assessment Nandyan na yung levels eh, kung yung symptoms na present ganito ikacategorize mo na lang.. IMCI kasi yung sa IMCI allotted lang siya sa Malaria, Dengue ganito
so parang kung nakikita mo ung symptoms under that( making hand gestures) at hindi siya
specific na kunwari kung symptoms lang yun parang ano (thinking) ndi talaga sya
nakacategorize. So paano kung iba ung sakit pero same symptoms na din siya nagfafall sa
Malaria and Dengue (P1). Assessment. So ilang araw na yung lagnat, nagtae po ba. So sa
IMCI naman lahat yung makikita. Yung nagtatae po ba, gaano kataas yung temperature ng bata,
tapos observe niyo po, tapos bigyan ng paracetamol kada apat na oras, tapos pag hindi bumaba,
balik po kayo ulit dito. Pag pangatlong araw na. (P2). Actually parang Okay siya kasi
85
ano specific yung mga gagawin mo mga sasabihin mo. Pero parang ano Yung ibang
parts Parang alam mo rin naman kahit walang ano kahit hindi IMCI chart ang gamit. ,
Kasi pag ano Depende sa cues na makikita mo parang kinacategorize siya Categorize as
in yung kung may Pneumonia ba yung ganun Mga severe, moderate and mild Base kasi sa
cues na pinepresent, may equivalent na category. Ayun nga Example pag may diarrhea
Kung may danger signs, severe na agad yun Tapos pag nacategorize na yung illness, may
interventions na dun. Na para sa category na yun. , And may guide din kasi alam mo kung
nakalagay na doon., Sa IMCI kasi Nag aano siya Parang inaalam niya yung past at
present and specific siya kung ano sakit nung patient. (P3). nakita ko yung chart naisip ko
parang mas maganda siya kasi mas specific. (P5). Easier in a way na nandyan na yung levels
eh, kung yung symptoms na present ganito ika-categorize mo na lang, , IMCI allotted lang
siya sa Malaria, Dengue ganito so parang kung nakikita mo ung symptoms under that( making
hand gestures) at hindi siya specific na kunwari kung symptoms lang yun parang ano (thinking)
ndi talaga sya nakacategorize. So paano kung iba ung sakit pero same symptoms na din siya
nagfafall sa Malaria and Dengue ( zipping her jacket up and down while grinning). (P1).
Yung sa community, for example, may mga nagkakalagnat tapos sabi nagtatae, siyempre Iaassess din kung may dengue nga ba, tapos yung sa RR ng baby for pneumonia. Tapos,yun din
ilang araw na, tapos yung mga co-management tulad ng diet. (P2). Sort off. Kasi yung
complaints nung patient na pinaggamitan ko nun is fever lang so hindi siya macacategorize as
Dengue or Malaria kasi no other symptoms expressed. So the thing with IMCI is that at the end
of every checklist may recommendation and plan of action compared sa PE and Nursing Health
history na pure assessment lang.Bookmark, Kasi yun nga, nagcocomplain about cough and
86
colds, ganyan Tapos wala naman danger signs yung patient noon Tapos Parang yung
labas noon, ano lang Talagang cough and colds lang Kasi pag ano Depende sa cues na
makikita mo parang kinacategorize siya Categorize as in yung kung may Pneumonia ba yung
ganun Mga severe, moderate and mild Base kasi sa cues na pinepresent, may equivalent na
category. Ayun nga Example pag may diarrhea Kung may danger signs, severe na agad
yun Tapos pag nacategorize na yung illness, may interventions na dun. Na para sa category
na yun.( P3). Yung patient kasi may history of dengue tapos they have this weight na 4 years
old yung bata tapos 12 kilos lang ata. In that nadiscuss ko yung sa IMCI. Like ano ba nakasabi
dun. Whats the standard weight for this age in months na bata? Tapos nung sinabi ko sa kanila
icheck yung sa IMCI yung sa graph sa likod Yun, doon yung discussion namin. Kasi nandoon
yun kung saan yung normal weight tapos kung nasaan yung weight nung bata. Kaya
naformulate yung problem na malnutrition. Tapos pagka mga discussion, siyempre kailangan ko
din ng reference. Like kapag may mga sakit nga tapos pag tinatanong ko sila about nung
interventions. Like for example fever management, management which Is commonly na hindi
kasi na ano naneneglect kasi yung fever and home management ng diseases. (P4). Yung
mga fever naka categorize siya, kumbaga classified siya as dengue or malaria (P5)
Another partcipants verbalized that IMCI is easily categorized, organized and systematic Sa
IMCI kasi Nag aano siya Parang inaalam niya yung past at present and specific siya kung
ano sakit nung patient. (P3), nakita ko yung chart naisip ko parang mas maganda siya kasi
mas specific. (P5). Easier in a way na nandyan na yung levels eh, kung yung symptoms na
present ganito ika-categorize mo na lang, , IMCI allotted lang siya sa Malaria, Dengue
ganito so parang kung nakikita mo ung symptoms under that( making hand gestures) at hindi
siya specific na kunwari kung symptoms lang yun parang ano (thinking) ndi talaga sya
87
nakacategorize. So paano kung iba ung sakit pero same symptoms na din siya nagfafall sa
Malaria and Dengue ( zipping her jacket up and down while grinning). (P1) Yung sa
community, for example, may mga nagkakalagnat tapos sabi nagtatae, siyempre I-aassess din
kung may dengue nga ba, tapos yung sa RR ng baby for pneumonia. Tapos,yun din ilang araw
na, tapos yung mga co-management tulad ng diet. (P2).
Sort off. Kasi yung complaints nung patient na pinaggamitan ko nun is fever lang so hindi siya
macacategorize as Dengue or Malaria kasi no other symptoms expressed. So the thing with
IMCI is that at the end of every checklist may recommendation and plan of action compared sa
PE and Nursing Health history na pure assessment lang.Bookmark, Kasi yun nga,
noon Tapos Parang yung labas noon, ano lang Talagang cough and colds lang Kasi pag
ano Depende sa cues na makikita mo parang kinacategorize siya Categorize as in yung
kung may Pneumonia ba yung ganun Mga severe, moderate and mild Base kasi sa cues na
pinepresent, may equivalent na category. Ayun nga Example pag may diarrhea Kung may
danger signs, severe na agad yun Tapos pag nacategorize na yung illness, may interventions
na dun. Na para sa category na yun.( P3).
Yung patient kasi may history of dengue tapos they have this weight na 4 years old yung bata
tapos 12 kilos lang ata. In that nadiscuss ko yung sa IMCI. Like ano ba nakasabi dun. Whats the
standard weight for this age in months na bata? Tapos nung sinabi ko sa kanila icheck yung sa
IMCI yung sa graph sa likod Yun, doon yung discussion namin. Kasi nandoon yun kung saan
yung normal weight tapos kung nasaan yung weight nung bata. Kaya naformulate yung problem
na malnutrition. Tapos pagka mga discussion, siyempre kailangan ko din ng reference. Like
kapag may mga sakit nga tapos pag tinatanong ko sila about nung interventions. Like for
88
example fever management, management which Is commonly na hindi kasi na ano

naneneglect kasi yung fever and home management ng diseases. (P4). Yung sa time kasi na
ginamit ko yun Wala naman ano Kasi yun nga, nagcocomplain about cough and colds,
ganyan Tapos wala naman danger signs yung patient noon Tapos Parang yung labas
noon, ano lang Talagang cough and colds lang Walang pneumonia or anything, so
Parang yung interventions Na yung health teaching na interventions Kasi diba sa
community madalas na interventions health teaching talaga Ayun, yung tinuro ko noon Sabi
ko huwag siyang magtatake ng cough meds without prescription. Mag kalamansi juice tsaka
tinuruan ko rin mag chest physiotherapy and increase water intake din. (P3). maganda siya
kasi yun nga nakakapag assess ng client na mas mabuti and at the same time structured yung
sinusundan mo so there is no way for you to get lost in the process at the same time kapag
matagal ka na gumagamit ng IMCI ano rin siya efficient (P4), yung pagiging detailed niya
in terms of the interventions niya at specific siya dun sa lahat (P5)
89
a disease state.
Table 3. IMCI allows mastery and expertise or clinical judgment

Raw data
Participant 1: nandyan
Meaning units
na Properly guided
yung levels eh, kung yung
Theme
IMCI allows
mastery
and
expertise or clinical judgment
symptoms na present ganito

ika-categorize mo na lang
Participant 2: So, ganun siya.

Kahit wala nang chart, pero
90
pag alam mo na yung structure

niya, yung assessment. Kasi
assessment naman yun eh,
tapos
nandoon
yung
mga
management naman. pag Alam

mo na yun, madali na siya
maaply.

mo
parang
kinacategorize

ganun
Mga
severe,

yung
illness,
may
91
sa category na yun.
Participant
3:
Pwede
ka
magbigay ng teaching tsaka

interventions
kahit
walang
doctor basta sundin mo lang

yung
nakalagay
doon
Nothing more, nothing less

Ayun And may guide din
kasi
alam
mo
kung
ano

nakalagay na doon.
Participant 3: Kasi yun nga,

patient
noon
Tapos

colds
lang
Walang
92
community
madalas
na

without
prescription.
Mag

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant
4:
Strengths,

magagawa
Marami
ka
sa
client
magagawa
mo.
na

93

time
yung
structured
algorithm
niya
mababa
ang
chances
nang
(makes
zigzag
error
niya.
gesture
of
hand) Susundan mo nalang,

kasi step by step na ito, ewan
ko nalang kung magkamali ka
pa sa pagsunod ng step 1 step
2 step 3, 4. 5.
Participant
5:
Noong
una
naisip ko ang toxic naman,

may pa-chart chart pa. Pero
nung nakita ko yung chart
naisip ko parang mas maganda
siya kasi mas specific.
Participant 5: Mas madami

kasi
laman
yung
PE
na
ginagamit for Pediatric sa

IMCI at mas specific siya. Pati
yung mga jargons, yung mga
94
terms mas madali compared sa

PE natin. Kasi kahit na may
medical terms sa IMCI chart
mas madali parang intindihin
yun. At may kasama na siyang
interventions
kaya
mas
madali. Kaya for me IMCI

yung mas magandang gamitin
for pediatric clients.
Participant 1: Its much easier User friendly and easy to

to use, however hindi lahat ng, understand
parang hindi lahat cover niya
(using hand gestures with an
open palm) ng sickness.

kung
yung
symptoms
na

95

the
body)
what
if
my
Participant 1: Kailangan may

background ka, kahit yung
lecture lang kung paano mo
ika-categorize kasi kung wala,
parang mangangapa ka talaga
kung hindi mo alam gagawin.
Pero IMCI diba may check list
na xa na nagtatanong na lang
yes or no. Wala lang.
Participant 1: IMCI is much

easier to do kaysa thorough
physical assessment
Participant 2: Maganda kasi

siya
madali
User
friendly
naman
kasi
siyang
96
maindihan

mo
parang
kinacategorize

ganun
Mga
severe,

yung
illness,
may

sa category na yun.

97

patient
noon
Tapos

colds
lang
Walang
community
madalas
na
interventions health
Participant
4:
Marami
ka
magagawa na interventions
kasi integrated nga siya eh
hindi ba, treating a lot of
symptoms already in just one
sitting at the same time yung
algorithm niya structured
Participant 5: Sa akin okay

lang. Noong una naisip ko ang
98
toxic naman, may pa-chart

chart pa. Pero nung nakita ko
yung chart naisip ko parang
mas maganda siya kasi mas
specific. Andoon na din yung
interventions.
Participant 1: Its much easier

to use, however hindi lahat ng, Accessible or easy to use
parang hindi lahat cover niya
(using hand gestures with an
open palm) ng sickness.

kung
yung
symptoms
na

99
the
body)
what
if
my
Participant 1: Kailangn may

background ka, kahit yung
lecture lang kung paano mo
ika-categorize kasi kung wala,
parang mangangapa ka talaga
kung hindi mo alam gagawin.
Participant 1: IMCI is much

easier to do kaysa thorough
physical assessment
Participant 2: So, ganun siya.

Kahit wala nang chart, pero
pag alam mo na yung structure
niya, yung assessment. Kasi
assessment naman yun eh,
tapos
nandoon
yung
mga
management naman. pag Alam

mo na yun, madali na siya
maaply.
100
Participant
3:
Sa
IMCI

ever
nagamit
yun
pero
sundin
nakalagay
mo
lang
doon
yung
Nothing

Participant 4: Maganda siya in

a way na in just one sitting
marami ka magagawa sa client
mo. Marami ka magagawa na
101

time
Participant 5: Mas madami

kasi
laman
yung
PE
na
ginagamit for Pediatric sa

IMCI at mas specific siya. Pati
yung mga jargons, yung mga
terms mas madali compared sa
PE natin. Kasi kahit na may
medical terms sa IMCI chart
mas madali parang intindihin
yun. At may kasama na siyang
interventions
kaya
mas
madali.
The participants verbalized that IMCI is properly Guided therefore IMCI allows mastery and
expertise or clinical judgment. nandyan na yung levels eh, kung yung symptoms na present
ganito ika-categorize mo na lang (P1). ganun siya. Kahit wala nang chart, pero pag alam mo
102
na yung structure niya, yung assessment. Kasi assessment naman yun eh, tapos nandoon yung
mga management naman. pag Alam mo na yun, madali na siya maaply.(P2) Kasi pag ano
Depende sa cues na makikita mo parang kinacategorize siya Categorize as in yung kung may
Pneumonia ba yung ganun Mga severe, moderate and mild Base kasi sa cues na
pinepresent, may equivalent na category. Ayun nga Example pag may diarrhea Kung may
danger signs, severe na agad yun Tapos pag nacategorize na yung illness, may interventions
na dun. Na para sa category na yun., Pwede ka magbigay ng teaching tsaka interventions
kahit walang doctor basta sundin mo lang yung nakalagay doon Nothing more, nothing less
Ayun And may guide din kasi alam mo kung ano yung Hindi ka basta basta nagaassess
Alam mo yung kung ano iaassess mo kasi nakalagay na doon., Kasi yun nga, nagcocomplain
about cough and colds, ganyan Tapos wala naman danger signs yung patient noon Tapos
Parang yung labas noon, ano lang Talagang cough and colds lang Walang pneumonia or
anything, so Parang yung interventions Na yung health teaching na interventions Kasi
diba sa community madalas na interventions health teaching talaga Ayun, yung tinuro ko
noon Sabi ko huwag siyang magtatake ng cough meds without prescription. Mag kalamansi
juice tsaka tinuruan ko rin mag chest physiotherapy and increase water intake din. (P3).
maganda siya in a way na in just one sitting marami ka magagawa sa client mo. Marami ka
magagawa na interventions kasi integrated nga siya eh hindi ba, treating a lot of symptoms
already in just one sitting at the same time yung algorithm niya structured mababa ang chances
nang error niya. (makes zigzag gesture of hand) Susundan mo nalang, kasi step by step na ito,
ewan ko nalang kung magkamali ka pa sa pagsunod ng step 1 step 2 step 3, 4. 5. (P4). Noong
una naisip ko ang toxic naman, may pa-chart chart pa. Pero nung nakita ko yung chart naisip ko
parang mas maganda siya kasi mas specific., Mas madami kasi laman yung PE na ginagamit
103
for Pediatric sa IMCI at mas specific siya. Pati yung mga jargons, yung mga terms mas madali
compared sa PE natin. Kasi kahit na may medical terms sa IMCI chart mas madali parang
intindihin yun. At may kasama na siyang interventions kaya mas madali. Kaya for me IMCI yung
mas magandang gamitin for pediatric clients. (P5)
Another is it is User friendly and easy to understand and accessible to use Its much easier to
use, however hindi lahat ng, parang hindi lahat cover niya (using hand gestures with an open
palm) ng sickness. , Easier in a way na nandyan na yung levels eh, kung yung symptoms na
present ganito ika-categorize mo na lang, pero yun nga, like what I have said yung sa
pagdadiagnose at sa treatment what if hindi pala yun ang sakit niya according to IMCI (hand
gestures moving away the body) what if my underlying ano pa disease pa. , Kailangan may
background ka, kahit yung lecture lang kung paano mo ika-categorize kasi kung wala, parang
mangangapa ka talaga kung hindi mo alam gagawin. Pero IMCI diba may check list na xa na
nagtatanong na lang yes or no. Wala lang., IMCI is much easier to do kaysa thorough
physical assessment (P1). Maganda kasi siya User friendly kasi madali naman siyang
maindihan (P2). Kasi pag ano Depende sa cues na makikita mo parang kinacategorize
siya Categorize as in yung kung may Pneumonia ba yung ganun Mga severe, moderate and
mild Base kasi sa cues na pinepresent, may equivalent na category. Ayun nga Example pag
may diarrhea Kung may danger signs, severe na agad yun Tapos pag nacategorize na
yung illness, may interventions na dun. Na para sa category na yun., Yung sa time kasi na
ginamit ko yun Wala naman ano Kasi yun nga, nagcocomplain about cough and colds,
ganyan Tapos wala naman danger signs yung patient noon Tapos Parang yung labas
noon, ano lang Talagang cough and colds lang Walang pneumonia or anything, so
Parang yung interventions Na yung health teaching na interventions Kasi diba sa
104
community madalas na interventions health (P3). Marami ka magagawa na interventions kasi

integrated nga siya eh hindi ba, treating a lot of symptoms already in just one sitting at the same
time yung algorithm niya structured (P4). Sa akin okay lang. Noong una naisip ko ang toxic
naman, may pa-chart chart pa. Pero nung nakita ko yung chart naisip ko parang mas maganda
siya kasi mas specific. Andoon na din yung interventions. (P5) Sa IMCI mismo Medyo konti
pa kasi alam ko tapos once ko lang ever nagamit yun pero Narealize ko Sa IMCI Ano
siya Hindi nga ba sabi nila Pwede ka magbigay ng teaching tsaka interventions kahit
walang doctor basta sundin mo lang yung nakalagay doon Nothing more, nothing less
Alam mo yung kung ano iaassess mo kasi nakalagay na doon. (P3). Maganda siya in a way na
in just one sitting marami ka magagawa sa client mo. Marami ka magagawa na interventions
kasi integrated nga siya eh hindi ba, treating a lot of symptoms already in just one sitting at the
same time (P4). Mas madami kasi laman yung PE na ginagamit for Pediatric sa IMCI at mas
specific siya. Pati yung mga jargons, yung mga terms mas madali compared sa PE natin. Kasi
kahit na may medical terms sa IMCI chart mas madali parang intindihin yun. At may kasama na
siyang interventions kaya mas madali. (P5)
105
Table 4. IMCI allows the nurse to practice independent functions

Raw data
Meaning units
Theme
Participant 1: Sort off. Kasi Formulation of independent IMCI allows the nurse to
yung complaints nung patient nursing care
practice independent functions
fever
lang
so
hindi
siya
Malaria
kasi
no
other

106
assessment lang.
Participant 2: madali naman

siyang maindihan Tapos. for
us nurses na nagpaparactice,
gamot
na
nandoon
kasi

drugs doon,
kahit walang

meron
kang
panlaban.
ka
magbigay
ng
actual

orders.
Participant
3:
Sa
IMCI

ever
nagamit
yun
pero
107

sundin
nakalagay
mo
lang
doon
yung
Nothing


patient
noon
Tapos

colds
lang
Walang
108
community
madalas
na

without
prescription.
Mag

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant 4: Susundan mo
Participant 5: Andoon na din

yung
interventions.
Kasi
109
kunwari
mataas
yung
temperature bigyan mo ng
ganito, tapos kung may cough
bigyan mo nito.
Participant 5: she complained

na may lagnat siya na 39
degrees, for three days tapos
yun meron ding ubo at sipon.
Yung
sa
intermittent,
kanya
parang
pabalik-balik,
ayun pinassess sa amin ng

clinical instructor kung ano
yung mga other symptoms. So
ayun. Sa intervention nakaindicate na bigyan siya ng
drugs for fever, increase fluid,
ayun management for fever
yung mga cold compress para
di ma-shock about sa fever.
Participant 2: Kahit wala nang

chart, pero pag alam mo na
110
yung structure niya, yung Promotes self reliance

assessment. Kasi assessment
naman yun eh, tapos nandoon
yung
mga
management
naman. pag Alam mo na yun,

madali na siya maaply. So
siguro yung mga nurses doon.
Wala man sila nung booklet,
pero since I believe they have
undergone training, enough
training para maaply yung
IMCI, kahit wala man sila
nung
booklet,
they
are
applying that in the rural

health unit.
Participant 2: For us nurses na

nagpaparactice,
hindi
ako
masisisi sa mga gamot na

nandoon kasi dispensing lang
naman ng drugs doon, kahit
walang prescription. So kahit
nurse ka tapos nagbigay ka ng
111
gamot, meron kang panlaban.

nakalagay sa IMCI.

patient
noon
Tapos

colds
lang
Walang
community
madalas
na

112
without
prescription.
Mag

ko
rin
physiotherapy
mag
chest
and
increase
water intake din.
Participant
3:
Pwede
ka
magbigay ng teaching tsaka

interventions
kahit
walang
doctor basta sundin mo lang

yung
nakalagay
doon
Nothing more, nothing less

Ayun And may guide din
kasi
alam
mo
kung
ano

nakalagay na doon.
Particpant 4: Kapag ginagamit

na yung IMCI, kasi kung if
you know it by heart tingin mo
palang sa client mo alam mo
113
na,
isang
assessment
mo
palang alam mo na kung

anong treatment, alam mo na
kung anung interventions ang
sasabihn mo sa client mo.

by the book siya. Di ba kapag
by the book, mas confident
tayo sa interventions at mas
safe
yun
sa
ginagawan
patient
natin
na
ng
intervention. So yun feeling

ko, confident ako at mas
secure na eto yung tamang
interventions for that patient.
Participant
5:
Noong
una
naisip ko ang toxic naman,

may pa-chart chart pa. Pero
nung nakita ko yung chart
114
naisip ko parang mas maganda

siya kasi mas specific. Andoon
na din yung interventions.
Participant 2: So ilang araw na

yung lagnat, nagtae po ba. So
sa IMCI naman lahat yung
makikita. Yung nagtatae po ba,
gaano
kataas
yung Promotes sureness of action
temperature ng bata, tapos

observe niyo po, tapos bigyan
ng paracetamol kada apat na
oras, tapos pag hindi bumaba,
balik po kayo ulit dito. Pag
pangatlong araw na.
Participant
3:
Sa
IMCI

ever
nagamit
yun
pero
115

sundin
mo
nakalagay
lang
doon
yung
Nothing

Participant
parang
ano
3:
Okay
specific
Actually
siya
kasi
yung
mga

gamit.
Participant 4: Susundan mo
116

Hindi ba tuloy tuloy naman
siya so yung chances ng error
nang practitioner mababa,

by the book siya. Di ba kapag
by the book, mas confident
tayo sa interventions at mas
safe
yun
ginagawan
sa
patient
natin
na
ng
intervention. So yun feeling

ko, confident ako at mas
secure na eto yung tamang
interventions for that patient.
The participant verbalized that IMCI
allows formulation of independent
nursing action
therefore IMCI allows the nurse to practice independent functions. Sort off. Kasi yung
117
complaints nung patient na pinaggamitan ko nun is fever lang so hindi siya macacategorize as
Dengue or Malaria kasi no other symptoms expressed. So the thing with IMCI is that at the end
of every checklist may recommendation and plan of action compared sa PE and Nursing Health
history na pure assessment lang. (P1). madali naman siyang maindihan Tapos. for us
nurses na nagpaparactice, hindi ako masisisi sa mga gamot na nandoon kasi dispensing lang
naman ng drugs doon, kahit walang prescription. So kahit nurse ka tapos nagbigay ka ng
gamot, meron kang panlaban. Mapapakita mo na meron nakalagay sa IMCI. So pwede ka
magbigay ng actual treatment without the doctors orders. (P2). Sa IMCI mismo Medyo
konti pa kasi alam ko tapos once ko lang ever nagamit yun pero Narealize ko Sa IMCI
Ano siya Hindi nga ba sabi nila Pwede ka magbigay ng teaching tsaka interventions kahit
walang doctor basta sundin mo lang yung nakalagay doon Nothing more, nothing less
Alam mo yung kung ano iaassess mo kasi nakalagay na doon., Yung sa time kasi na ginamit
ko yun Wala naman ano Kasi yun nga, nagcocomplain about cough and colds, ganyan
Tapos wala naman danger signs yung patient noon Tapos Parang yung labas noon, ano
lang Talagang cough and colds lang Walang pneumonia or anything, so Parang yung
interventions Na yung health teaching na interventions Kasi diba sa community madalas na
interventions health teaching talaga Ayun, yung tinuro ko noon Sabi ko huwag siyang
magtatake ng cough meds without prescription. Mag kalamansi juice tsaka tinuruan ko rin mag
chest physiotherapy and increase water intake din. (P3). Susundan mo nalang, kasi step by
step na ito, ewan ko nalang kung magkamali ka pa sa pagsunod ng step 1 step 2 step 3, 4. 5.
(P4). Andoon na din yung interventions. Kasi kunwari mataas yung temperature bigyan mo ng
ganito, tapos kung may cough bigyan mo nito. , she complained na may lagnat siya na 39
118
degrees, for three days tapos yun meron ding ubo at sipon. Yung sa kanya parang intermittent,
pabalik-balik, ayun pinassess sa amin ng clinical instructor kung ano yung mga other symptoms.
So ayun. Sa intervention naka-indicate na bigyan siya ng drugs for fever, increase fluid, ayun
management for fever yung mga cold compress para di ma-shock about sa fever. (P5)
Another verbalized that promotes self reliance Kahit wala nang chart, pero pag alam mo na
yung structure niya, yung assessment. Kasi assessment naman yun eh, tapos nandoon yung mga
management naman. pag Alam mo na yun, madali na siya maaply. So siguro yung mga nurses
doon. Wala man sila nung booklet, pero since I believe they have undergone training, enough
training para maaply yung IMCI, kahit wala man sila nung booklet, they are applying that in the
rural health unit., For us nurses na nagpaparactice, hindi ako masisisi sa mga gamot na
nandoon kasi dispensing lang naman ng drugs doon, kahit walang prescription. So kahit nurse
ka tapos nagbigay ka ng gamot, meron kang panlaban. Mapapakita mo na meron nakalagay sa
IMCI. (P2). Yung sa time kasi na ginamit ko yun Wala naman ano Kasi yun nga,
water intake din., Pwede ka magbigay ng teaching tsaka interventions kahit walang doctor
basta sundin mo lang yung nakalagay doon Nothing more, nothing less Ayun And may
guide din kasi alam mo kung ano yung Hindi ka basta basta nagaassess Alam mo yung kung
ano iaassess mo kasi nakalagay na doon. (P3). Kapag ginagamit na yung IMCI, kasi kung if
119
you know it by heart tingin mo palang sa client mo alam mo na, isang assessment mo palang
alam mo na kung anong treatment, alam mo na kung anung interventions ang sasabihn mo sa
client mo. (P4)
Then another verbalized promotes sureness of action Mas naging, kumbaga mas naging
sigurado ako sa mga interventions kasi by the book siya. Di ba kapag by the book, mas confident
tayo sa interventions at mas safe yun sa patient na ginagawan natin ng intervention. So yun
feeling ko, confident ako at mas secure na eto yung tamang interventions for that patient.,
Noong una naisip ko ang toxic naman, may pa-chart chart pa. Pero nung nakita ko yung chart
naisip ko parang mas maganda siya kasi mas specific. Andoon na din yung interventions. (P5),
So ilang araw na yung lagnat, nagtae po ba. So sa IMCI naman lahat yung makikita. Yung
nagtatae po ba, gaano kataas yung temperature ng bata, tapos observe niyo po, tapos bigyan ng
paracetamol kada apat na oras, tapos pag hindi bumaba, balik po kayo ulit dito. Pag
pangatlong araw na.(P2), Sa IMCI mismo Medyo konti pa kasi alam ko tapos once ko lang
ever nagamit yun pero Narealize ko Sa IMCI Ano siya Hindi nga ba sabi nila Pwede
ka magbigay ng teaching tsaka interventions kahit walang doctor basta sundin mo lang yung
nakalagay doon Nothing more, nothing less Ayun And may guide din kasi alam mo kung
nakalagay na doon. , Actually parang Okay siya kasi ano specific yung mga gagawin
mo mga sasabihin mo. Pero parang ano Yung ibang parts Parang alam mo rin naman
kahit walang ano kahit hindi IMCI chart ang gamit. (P3). Susundan mo nalang, kasi step
by step na ito, ewan ko nalang kung magkamali ka pa sa pagsunod ng step 1 step 2 step 3, 4. 5.
Hindi ba tuloy tuloy naman siya so yung chances ng error nang practitioner mababa, (P4),
Mas naging, kumbaga mas naging sigurado ako sa mga interventions kasi by the book siya. Di
120
ba kapag by the book, mas confident tayo sa interventions at mas safe yun sa patient na
ginagawan natin ng intervention. So yun feeling ko, confident ako at mas secure na eto yung
tamang interventions for that patient. (P5)
Table 5. IMCI is not fully utilized

Raw data
Meaning units
Particpant 1: Yung first
IMCI
discussion ng IMCI is way
discussed
is
not
Theme
thoroughly IMCI is not fully utilized
back two years ago, so medyo

basic lang siya then yung
checklist and kung paano
121
gagamitin iyon were not

thouroughly discussed.
Participant 1: Inexplain siya

na parang yung level ganito
lang(making hand gestures
upward little by little) pero
yung how to do it and how to
apply the chart sa actual duty
ndi siya masyadong na
elaborate.
Participant 1: First of all, its
not properly taught sa students
parang how to integrate it sa
duty, second, pag nasa duty ka
na, hindi mo din siya
mapapractice dahil sa sobrang
daming patients and since
hindi nga siya nature, parang
hindi ka din thoroughly
magaguide ng C.I. pag
nandoon ka na.
Participant 2: Ano. Sa mga
122
bata. Yung IMCI kasi hindi

naman gaano nagagamit dun
sa health center kasi may
standard procedure siya.
Kumbaga, kahit yung mga
nurses dun. Kasi, sa rural
health unit, dalawang nurses
lang ata nandoon, tapos the
rest midwives. So ang sa
IMCI, wala akong nakikita
gumagamit noon.
Participant 2: Hindi, kasi I

assumed na nacover na yung
IMCI sa inyo before as a
lecture. Pero nagdicuss naman
ako nung mga tidbits lang.
Hindi yung actual discussion.
Participant 2: Yung din yung
balak ko gawin for this
rotation, eh. Two rotations na
ang dumaan, hindi siya
naemphasize ang IMCI. Kasi
meron na ginagamit nila sa
123
pag assess yung PE niyo na

forms, tapos yung CST,
Family Database. So iyon lang
yung nauutilize. So plano ko
maglaan ng IMCI day na lahat
may booklet. Kasi, few lang
rin yung may dala ng booklet.
Parang in a group siguro, one.
Ayon. So during the first
week, review lahat ng
concepts. Kasi lito lito din
yung mga nangyayari sa mga
estudyante. Yung conpets
parang lumilipad na tipong
iniisip ilog, iniisip happy
happy.
Participant 3: Actually, first

time kong gamit ng totoo yung
IMCI noon. Kasi dati, pag
ano
parang binabasa lang
naming siya. Pati dati pag duty

kami sa ibang hospital and
124
health center parang ginamit

lang siya pag take ng cues
pero hindi naming ginamit as
in from the start ng pagaassess
ng patient hanggang sa pag
health
teaching
and
intervention sa kanya. So first

time ko gamitin yun sa Cavinti
sa health center dun.
Participant 3: Sa IMCI
mismo Hmmm. Medyo
konti pa kasi alam ko tapos
once ko lang ever nagamit yun
pero Narealize ko Sa
IMCI Ano siya
Participant 4: Pero in reality
hindi
siya
masyado
naeemphasize kasi ang focus

nga namin is different. Ang
focus kasi nila when they
conduct home visit is to
identify the problems of the
125
family, so yung IMCI bale

parang ano nalang siya side,
parang its a part of the whole
picture, pero at the same time
hindi nga formal pero naapply
naman dun.
Participant 4: In passing
discussion lang ng IMCI
kapag when the question arise,
yun doon na nadidiscuss.
Participant 5:
All of the participant experiences that IMCI is not thoroughly discussed and therefore IMCI is
not fully utilized
The participant verbalized Yung first discussion ng IMCI is way back two years ago, so medyo
basic lang siya then yung checklist and kung paano gagamitin iyon were not thouroughly
discussed., Inexplain siya na parang yung level ganito lang(making hand gestures upward
little by little) pero yung how to do it and how to apply the chart sa actual duty ndi siya
masyadong na elaborate. , First of all, its not properly taught sa students parang how to
integrate it sa duty, second, pag nasa duty ka na, hindi mo din siya mapapractice dahil sa
sobrang daming patients and since hindi nga siya nature, parang hindi ka din thoroughly
magaguide ng C.I. pag nandoon ka na.,(P1). Ano. Sa mga bata. Yung IMCI kasi hindi naman
126
gaano nagagamit dun sa health center kasi may standard procedure siya. Kumbaga, kahit yung
mga nurses dun. Kasi, sa rural health unit, dalawang nurses lang ata nandoon, tapos the rest
midwives. So ang sa IMCI, wala akong nakikita gumagamit noon.
Hindi, kasi I assumed na nacover na yung IMCI sa inyo before as a lecture. Pero nagdicuss
naman ako nung mga tidbits lang. Hindi yung actual discussion., , Yung din yung balak ko
gawin for this rotation, eh. Two rotations na ang dumaan, hindi siya naemphasize ang IMCI.
Kasi meron na ginagamit nila sa pag assess yung PE niyo na forms, tapos yung CST, Family
Database. So iyon lang yung nauutilize. So plano ko maglaan ng IMCI day na lahat may
booklet. Kasi, few lang rin yung may dala ng booklet. Parang in a group siguro, one. Ayon. So
during the first week, review lahat ng concepts. Kasi lito lito din yung mga nangyayari sa mga
estudyante. Yung conpets parang lumilipad na tipong iniisip ilog, iniisip happy happy. ( P2).
Actually, first time kong gamit ng totoo yung IMCI noon. Kasi dati, pag ano parang
binabasa lang naming siya. Pati dati pag duty kami sa ibang hospital and health center parang
ginamit lang siya pag take ng cues pero hindi naming ginamit as in from the start ng pagaassess
ng patient hanggang sa pag health teaching and intervention sa kanya. So first time ko gamitin
yun sa Cavinti sa health center dun. , Sa IMCI mismo Hmmm. Medyo konti pa kasi alam
ko tapos once ko lang ever nagamit yun pero Narealize ko Sa IMCI Ano siya ( P3).
Pero in reality hindi siya masyado naeemphasize kasi ang focus nga namin is different. Ang
focus kasi nila when they conduct home visit is to identify the problems of the family, so yung
IMCI bale parang ano nalang siya side, parang its a part of the whole picture, pero at the same
time hindi nga formal pero naapply naman dun. , In passing discussion lang ng IMCI kapag
when the question arise, yun doon na nadidiscuss.(P4).
127
The overall health status of Filipinos has improved in the past several
decades. Infant mortality rate, maternal mortality ratio, life expectancy at
birth and other vital indicators of health have shown improving trends.
However, improvements in health have not been at par with expectations as
compared with neighboring Southeast Asian countries.
CHAPTER V
SUMMARY OF FINDINGS CONCLUSION AND RECOMMENDATION
This chapter contains the summary of the findings obtained from the gathered data. This
chapter also includes the conclusion which explains the phenomenon being studied and the
recommendation suggested by the researchers
Summary of findings
According to the analysis and interpretation of data gathered the experience of utilizing
integrated management of childhood illness:
1. Promotes safe and quality nursing care
128
a. Because it allows the nurse to be careful

b. Because it allows the nurse to give better interventions
c. Because it prevents Error
2. Promotes accuracy in assessment
a. Because it promotes accurate assessment
b. Because it is easily categorized
c. Because it is organize and systematic
3. Allows mastery and expertise or clinical judgment
a. Because it properly guide the nurse in providing interventions
b. Because it is user friendly and easy to understand
c. Because of its accessible and easy to use
4. Allows the nurse to practice independent functions
a. Because there is formulation of independent nursing care
b. Because it promotes self reliance
c. Because it promotes of sureness of action
Conclusion
Based on the lived experience of both faculty and nursing students on Integrated
Management of Childhood Illness in a selected community in Cavinti, Laguna better
implementation of IMCI allows enhancement of Knowledge, Skills and Attitudes thus contribute
in the health of the family, community and the country.
Recommendations
Based on the conclusion of the study, the researchers recommend the following:
129
Clinical Instructors. To utilize the study in developing the knowledge, skills and attitude of the
nursing students during their community exposure.
Nursing Students. To reflect on their own experiences which could be the same with the
described experiences of the participants in this study.
The administration. To provide nursing students, adequate knowledge about the Integrated
Management of Childhood Illness. To emphasize the importance of the utilization of the
Integrated Management of Childhood Illness in the community exposure.
Department of Health (DOH). to cover more diseases like scabies and dengue and provide
more assessment, classification, treatment and counselling of those certain diseases. As well as to
dispose of old copies of IMCI charts and produce more copies of the new version to avoid
confusion and to have school to school campaign regarding the utilization of IMCI strategy.
Future researchers. To conduct studies that will further explore on the experiences of faculty
members and nursing students on utilizing the Integrated Management of Childhood Illness
during their community exposure.
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CHAPTER I

BACKGROUND OF THE STUDY

STATEMENT OF THE PROBLEM

SIGNIFICANCE OF THE STUDY

SCOPE AND LIMITATION

This study is a qualitative descriptive phenomenological type of research regarding the

backgrounds as to places of assignment, activities and extent of knowledge imparted to them by

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

Updated WHO guidelines presented in the training course

Implementation of IMCI in different countries.

Newton et. al, Hypothetical performance of syndrome-based management of acute

Implementation of evaluation which is guided by the design decisions described above,

Treatment of persistent diarrhea

infection to progress. This recommendation is intended to maximze sensitivity, ensuring that as

If no signs of measles complications have been found after a complete examination, a

Treatment for Malnutrition or Anemia

Impact of IMCI interventions

Improved case management by integration of disease- specific guidelines

P. R. Kolstad, et al. The integrated management of childhood illness in western Uganda,

In developing countries, five diseases (pneumonia, diarrhea, mlaria, measles and

Performance of health workers after training in integrated management of childhood

Asian Development Bank (ADB), Early Childhood Development. WHO publications

A comprehensive and integrated package of cost-effective early childhood interventions

Maria Stanhope, Jeanette Lancaster, Barriers to Specializing in Public Health Nursing

World Health Organization (2005). Handbook, Integrated Management of Childhood

United Nations Foundations, (2002), Report on Community IMCI PlanningMeeting

(immediate referral), yellow (management in the outpatient facility), or green (home

Newton et. al, Hypothetical performance of syndrome-based management of acute

PROMOTES ACCURACY IN ASSESSMENT

P. R. Kolstad, et al. The integrated management of childhood illness in western Uganda,

ALLOWS MASTERY AND EXPERTISE OR CLINICAL JUDGMENT

ALLOWS THE NURSE TO PRACTICE INDEPENDENT FUNCTIONS

DATA GATHERING PROCEDURE

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Table 1. IMCI promotes safe and quality nursing care

with IMCI is that at the end of

quality nursing care

recommendation and plan of

Participant 2: Tapos. for us

hindi ako masisisi sa mga

dispensing lang naman ng

prescription. So kahit nurse ka

treatment without the doctors

gagawin mo mga sasabihin

Participant 3: Depende sa cues

Categorize as in yung kung

moderate and mild Base

interventions na dun. Na para

maganda siya in a way na in

interventions kasi integrated

lot of symptoms already in

chances nang error niya.

Participant 5: Pero nung nakita

bigyan mo ng ganito, tapos

Participant 1: Easier in a way Allows the nurse to give better

present ganito ika-categorize

underlying ano pa disease pa.

participant 2: sa IMCI naman

mismo Medyo konti pa kasi

more, nothing less Ayun

Participant 3: Yung sa time

Parang yung labas noon, ano

interventions health teaching

kalamansi juice tsaka tinuruan