UNIVERSITY OF SOUTHERN PHILIPPINES FOUNDATION

College of Health Sciences- Department of Nursing

NGCM 113 COMMUNITY HEALTH NURSING 2

Population Groups and the Community as Clients

The Nursing Process in the care of the community

The nursing process in the care of the community A community is

a group of people who:

  Have a common interest or characteristics

  Interact with one another
  Have sense of unity or belonging
  Function collectively within a defined social structure to address common

concerns
A community may be phenomenological (functional) or geopolitical (territorial)

Principals of community health nursing

1. Community is the focus of care, nurse responsibility is to the community as a whole

2. Give priority to community needs
3. Work with the community as an equal partner of the health team
4. Focus on primary prevention for appropriate activities
5. Promote a healthful physical and psychosocial environment
6. Reach out to all who may benefit from a specific service
7. Promote optimum use of resources
8. Collaborate with others working in the community health

Conditions in the community affecting health

  People
  Location
  Social system

Characteristics of a healthy community

  a shared sense of being a community based on history and values

  general feeling of empowerment
  existing structures that allow subgroups within the community to participate in decision

making

  the ability to cope with change, solve problems, and manage conflicts within the

community through acceptable means

  open channels of communication

 equitable and efficient use of community resources Aims

1. achieve a good quality life

2. create a health supportive environment
3. provide basic sanitation
4. supply access to health care

Community Assessment

the data needed to be collected depend on the objectives of community assessment. In general, the nurse
needs to collect data on the nurse needs to collect data on three categories of community health.
Determinants: people, place and social system.
DATA COLLECTED FOR THE HEALTH P.A.T.C.H(planed approach to community health) PROCESS FOR HEALTH
PLANING

1. community profile: demographic educational and economic data

2. morbidity and mortality data, including unique health events(e.g., completion of barangay health station, a
typhoon that caused flooding of residential areas)
3. behavioral data focusing on behavioral risk factors, such as smoking, drinking and leading a sedentary life
style, and prevailing good health practices in the community, such as breast feeding and getting regular
exercise
4. opinion data from community leaders, such as what they think about the main health problems of the
community their causes, measures that may alleviate or correct them

*problem oriented assessment is focused on a particular aspect of health: focusing on what’s problem the
community have in mind

TOOLS IN COMMUNITY ASSESSMENT Collecting primary data

Observation

 ocular survey/ windshield survey Survey

Informant interview

  talks to the community people

  key informants: consist of formal and informal community leaders or persons of position

and influence Community forum

 pulong – pulong sa barangay focus group

Secondary data source

 health records and reports

field health service information (FHSIS) recording and reporting tools FHSIS is as basis for

1.priority setting by local goverments

2. planning and decision making at different levels(barangay, municipality, district, provincial, and national)
3. monitoring and evaluating health program implementation

The FHSIS manual of operations

1.individual treatment record(ITR)(building block of FHSIS)

-health workers are advised not to rely on client-maintained

2.targent client list

a.tcl for prenatal care

b. tcl for postpartum care

c. tcl of under 1-year-old children
d. tcl for family planning
e. tcl for sick children
f. national tuberculosis program regiser.
g. national leprosy control program central registration form

3. summary table (accomplished by midwife) 4. monthly consolidation table(MTC)

The reporting forms, as enumerated in the FHSIS manual of operations

1. monthly forms( regularly prepared by the midwife and summited to the nurse)

a.program report(m1)
contains indicators categorized as maternal care, child care, family planning

b. morbidity report(m2)
contains list of all cases of disease by age and sex.
2.quarterly forms(prepared by the nurse) a.program report(q1)

3-month total indicators categorized as maternal care, family planning child care, dental health and disease
control
b.morbidity

3. annual forms a. A-BHS

demographic, environmental, and natality data b. annual form 1 (a-1)

prepared by the nurse and is the report of the RHU or health center . it contains demographic and
environmental data and data on natality and mortality for the entire year

c. annual form 2 (a-2)

prepared by the nurse, is the yearly morbidity report by age and sex d. annual for 3( a-3)
prepared by the nurse, yearly report of all mortality by age and sex disease registry census data

COMMUNITY DIAGNOSIS

Community diagnosis is the process of determining the health status of the community and the factors
responsible for it.

In this phase the, the health workers makes a judgement about the community’s health satus, resources and
health action potential or likely hood that the community will act to meet health needs to resolve health
problems. And this consist of:

  the health risk or specific problem to which the community is exposed.

  The specific aggregate or community with whom the nurse will be working to deal with

the risk or problem.

  Related factors that influence how the community will respond to the health risk or

problem application of this nursing diagnosis

Planning Community Health Interventions

As in other fields of nursing practice, planning for community health interventions is based on findings
during assessment and formulated nursing diagnosis.

PLANNING phase – involves priority setting, formulating goals and objectives, and deciding on
community interventions.

o  Active participation of the people

o  To foster participation, the community should have genuine representation in the

planning group.

o  Deciding on community representatives will be facilitated if the community has been

organized earlier.

Priority Setting

- Provides the nurse and the health team with a logical means of establishing priority

among the identified health concerns.

Criterias to decide on a community health concern for intervention according to The World Health
Organization (WHO):

1. Significance of the problem

- is based on the number of people in the community affected by the problem or condition.
If the concerns are:
DISEASE CONDITION – this may be estimated in terms of its prevalence rate.

POTENTIAL PROBLEM – its significance is determined by estimating the number of people at risk of developing
the condition.

2. The level of community awareness and the priority its members give to the health concern is a
MAJOR consideration. Related to the priority that the community gives to the health concern,
Shuster and Goeppinger (2004) also mention community motivation to deal with the condition.
3. Ability to reduce risk

 - is related to the availability of expertise among the health team and the community itself.
 - Involves the health team’s level of influence in decision making related to actions in resolving the
community health concern.

4. Cost of reducing risk

- The nurse has to consider economic, social, and ethical requisites and consequences of planned actions.

5. Ability to identify the target population

- For the intervention is a matter of availability of data sources, such as FHSIS, census, survey reports, and
case-finding or screening tools.

6. Availability of resources

- to intervene the reduction of risk entails technological, financial, and other material resources of the
community, the nurse, and the health agency.

For a realistic and useful outcome, the priority-setting process requires the joint effort of the community, the
nurse, and other stakeholders, such as the other members of the health team.

 - The group defines guidelines for discussion, particularly on the manner of reconciling differences of
opinion.
 - Shuster and Goeppinger (2004) suggested a flexible process using the nominal group technique
wherein each group member has an equal voice in decision making, thereby avoiding control of the
process by the more dominant members of the group.
 - This technique is appropriate for brainstorming and ranking ideas, when consensus- building is
desired over making a choice based on the opinion of the majority.
 - The group makes a list of the identified community health problems or conditions. Each of the
identified problems is treated separately according to a set of criteria agreed upon by the group such
as those suggested by the WHO.

As suggested by Shuster and Goeppinger (2004), the following steps are carried out:

1. From a scale of 1 to 10, being the lowest, the members give each criterion a weight based on their
perception of a weight based on their perception of its degree of importance in solving the problem.
2. From a scale of 1 to 10, being the lowest, each member rates the criteria in terms of the likelihood of
the group being able to influence or change the situation.
3. Collate the weights (from step 1) and ratings (from step 2) made by the members of the group.
4. Compute the total priority score of the problem by multiplying collated weight and rating of each
criterion.
5. The priority score of the problem is calculated by adding the products obtained in step 4

After repeating the process on all identified health problems, compare the total priority scores of the
problems. The problem with the highest total priority score is assigned top priority, the next highest is
assigned to second, and so on.

FORMULATING GOALS AND OBJECTIVES

Goals are the desired outcomes at the end of interventions, whereas objectives are the short- term changes in
the community that are observed as the health team and the community work towards the attainment of
goals.
Objectives serve as instructions, defining what should be detected in the community as interventions are
being implemented.
Specific, measurable, attainable, relevant, and time-bound (SMART) objectives provide a solid basis for
monitoring and evaluation.

Deciding on community interventions

The group analyzed the reasons for the people’s health behavior and directs strategies to respond to the
underlying causes. For example, reasons for preference of home delivery over facility-based delivery should be
identified. If the majority of the women would choose to have a home delivery because of cost or lack of
access of birthing facilities, strategies should then be focused on improving facility-based services. But if the
primary reason is sociocultural, the planning team may opt to concentrate on providing opportunities for skills
development of traditional birth attendants and/or exerting effort to gain the trust and confidence of the
women and their families.

In the process of developing the plan, the group takes into consideration the demographic, psychological,
social, cultural, and economic characteristics of the target population on one hand and the available health
resources on the other hand.

Implementing the community health interventions

- Often referred to as the action phase, implementation is the most exciting phase for most health workers.
Aside from being able to deal with the recognized priority health

concern, the entire process is intended to enhance the community’s capability in dealing with common health
conditions/problems.

 - The nurses role therefore may be to facilitate the process rather than directly implement the process
rather than directly implement the planned interventions.
 - Implementation also entails coordination of the plan with the community and the other members of
the health team. This requires a common understanding of the goals, objectives and planned
interventions among the members of the implementing group.
 - Collaboration with the other sectors such as the local government and other agencies may also be
necessary.

Evaluation of community health interventions

Evaluation approaches may be directed structure, process, and outcome.

Structure evaluation involves looking into the manpower and physical resources of the agency
responsible for community health interventions.
Process evaluation is examining the manner by which assessment, diagnosis, planning,
implementation, and evaluation were undertaken.

Outcome evaluation is determining the degree of attainment of goals and objectives.

Ongoing evaluation or monitoring is done during implementation to provide feedback on compliance

to the plan as well as on need for changes in the plan to improve the process and outcomes of
interventions.

STANDARD OF EVALUATION

The bases for a good evaluation are its utility, feasibility, propriety, and accuracy. (CDC, 2011)

Utility is the value of the evaluation in terms of usefulness of results. The evaluation of community
health interventions will be great use to the community health group, as it helps the group gain insight
into strengths and weaknesses of the plan and the manner of its implementation.

Feasibility answers the question of whether the plan for evaluation is doable or not, considering
available resources. Resources include facilities, time, and expertise for conducting the evaluation.

Propriety involves ethical and legal matters. Respect for the worth and dignity of the participants in
data collection should be given due consideration. The results of evaluation should be truthfully
reported to give credit where it is due and to show the strengths and weaknesses of the community:
strengths to encourage further growth and weaknesses for remedial action, if possible.
Accuracy refers to the validity and reliability of the results of evaluation. Accurate evaluation begins with
accurate documentation while the community health process is ongoing.