CHN 2 ILG Complete

MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca, Cagayan
INSTRUCTIONAL
LEARNING GUIDE
Community Health Nursing II

FIRST SEMESTER, F.Y. 2020-2021
PREPARED BY
KAREN MAE S. ALCANTARA, RN, MSN
Review Coordinator / Level IV Coordinator
Clinical Instructor
Email Add: [email protected]
[email protected]
College of Nursing
Medical College of Northern Philippines
REVIEWER
REYNALDO M. ADDUCUL, RN, RM, MSN, JD
Dean, College of Nursing
Executive Assistant to the President
Medical College of Northern Philippines
PREFACE
This course covers the concepts and principles in the provision of basic care in terms of health
promotion, health maintenance and disease prevention at community level - recognized as the
basic unit of the larger community. It includes the study of the Philippine Health Care Delivery
System, Community Organizing Participatory Action Research and global context of public
health.
How to Use this Learning Guide:
This shall serve as the students’ guide to complete the course within the specified time frame.
Each chapter contains Intended Learning Outcomes which are expected to be met at the end of
the semester.
A comprehensive lecture notes from credible resources are given along with self-assessment
and critical thinking exercises to gauge the students’ understanding of the topics presented.
Moreover, recorded videos, visual presentations and forum discussions are also provided for
supplemental information. Specific instructions and requirements are given in each chapter.
For the Individual Learning Portfolio:

✓ Detachable answer sheets are provided at the end of each chapter.
✓ Students must duly accomplish all self-assessment exercises and evaluation
✓ Outputs must be compiled in a short, yellow clear book with proper tabs and labels
✓ Outputs can either be encoded or hand written. For encoded outputs, use short
bond paper, Tahoma 11 with standard margins
✓ The Individual Learning Portfolio shall be submitted manually or thru LMS
(online/digital)
Features of the Instructional Learning Guide:

• Chapter Outcomes
• Key Terms
• Lecture Content
• Discussion / Teacher’s Insights
• Relate to Practice (Application)
• Self-assessment exercises (to be included in Portfolio Assessments)
• Appendices
• Summary of References
TABLE OF CONTENTS
PRELIMINARY PERIOD
I. Health Community
a. Definition of community, characteristics and classification
b. Components of a community
c. Concepts of a healthy community
d. Elements of a healthy community
e. Factors that affect community health
f. Effects of a healthy community
II. Health Statistics and Epidemiology

a. Health Statistics
b. Health indicators and implications
c. Epidemiology
d. Natural History of Disease
e. Outbreak Investigation
MIDTERM PERIOD
III. Community Health Care Development Process

a. Approaches to community development
b. Community Organizing
c. Principles of Community Organizing
d. Phases of Community Organizing
b. HRDP-COPAR Model as a strategy for community development
c. Phases of COPAR
d. Critical Activities
e. Roles and activities in community health care development
SEMI-FINAL PERIOD
IV. Care Enhancement Qualities of health workers in community setting

a. The community health worker
b. Qualities of a health worker
c. Functions of a health worker
d. The community health worker as a health educator
e. Conflict Management
VII. Disaster Management

a. Types of Disasters
b. Characteristics of Disasters
c. Disaster Management
d. National Disaster Risk Reduction
e. Disaster Responses
FINAL PERIOD
V. Application of Nursing Process in the Care of the Community

a. The community health care process
b. Community Assessment
c. Community Diagnosis
d. Planning and Priority-setting
e. Implementing the Community Health Interventions
f. Evaluation of Community Health Interventions
APPENDICES
• Rubrics
• List of additional references
• Acknowledgement and Disclaimer
COURSE DETAILS
Subject: Community Health Nursing II Units: 3 No. Of Class Hrs: 3 hrs / week
Section: ________ Year Level: II Course: BSN
Subject Teacher: _______________________ Contact Number: _________
Consultation Time: __________________
Schedule:
Course Description:
Course Audit - MCN covers concepts in of high-risk pregnancy, labor and delivery, its causes
and management, care of infants and children including integrated management of childhood
diseases, and basic family planning. that will provide students with a broad overview of
obstetrics-related issues. It is intended to equip nursing students with the necessary knowledge
that is expected of a professional nurse. It contains topics that will greatly help the students to
deal and manage various health concerns and situations in the clinical and community settings.
Course Outcomes:
To develop knowledge, Skills, and Attitude in identifying patients with complications of
pregnancy, labor and delivery, care of growing infants, implementation of IMCI program, and
family planning counseling specifically:
1. To recognize deviations from normal.
2. To identify cases of bleeding during the various stages of pregnancy
3. To define characteristics of abnormal labor.
4. To develop skills in assessing patients with danger signs.
5. To conduct timely referral for specialized medical assistance as necessary.
6. To recognize family planning concepts and methods and acquire the skills to
counsel/motivate family planning clients
7. To identify the different theories and stages of growth and development and its
characteristics
8. To identify the needs during the different stages of growth and development
9. To identify the health problems of a sick young child.
Methodology of Implementation:
This is a distance learning strategy where students and teachers are physically at a distance
with each other while the teaching and learning process is going on. The teacher shall meet
students thru different modes of communication (social network, online class, text messaging,
email, messenger etc.) to provide an orientation of the program for the students to follow
throughout the duration of the course.
Guidelines are prepared by the teachers based on institutional policies to ensure that students
will be able to follow through the different activities designed specifically for the course. There
is no face to face activity, which means students are not required to report to school to attend
classes, rather, they shall interact with their teachers in different technology-based
communication strategies.
Topics shall be assigned according to the syllabus of the subject. Activities are given at pre-
determined time to be completed by the students. At the completion of each topic, students are
required to take the evaluation examinations which shall be given by the teachers which
determine applicability of the lessons learned.
During the duration of the course, students can consult their teachers from time to time to
address their difficulties or challenges they may encounter along the way.
The subjects are structured in sequential order. Course materials and references shall be
provided by the teachers in advance to facilitate teaching and learning process.
Delivery Mode:
1. Printed Text Materials or saved in flash drives
2. Audio / video materials
3. Web links
PRELIMINARY PERIOD
CHAPTER 1
This chapter adds information about community health and vital statistics.
Duration: 12 hours
MAJOR TOPIC/S SUBTOPIC/S

I. Health Community a. Definition of community, characteristics
and classification
b. Components of a community
c. Concepts of a healthy community
d. Elements of a healthy community
e. Factors that affect community health
f. Effects of a healthy community
II. Health Statistics and Epidemiology a. Health Statistics

b. Health indicators and implications
c. Epidemiology
d. Natural History of Disease
e. Outbreak Investigation
Specific Activities:
1. Critical Thinking Exercises
Before you proceed…
✓ Set your learning goals. At the end of this chapter, you are expected to attain the following
Intended Learning Outcomes:
1. Define community and health
2. List the characteristics of a community
3. Compare the different types of community
4. Discuss the factors that affect community health
5. Define epidemiology
6. Explain the applications of epidemiology
7. Calculate measures/indicators used in assessing community health
8. Enumerate steps in conducting outbreak investigation
✓ Prepare your books and notebooks. Highlight concepts that need to be reinforced. Jot down
supplemental information as needed.
✓ Be sure to read the entire lecture notes. DO NOT SKIP. An electronic copy of this chapter is
also provided along with other resources to facilitate better understanding of the topics.
Let’s Begin!
KEY TERMS
⚫ Community
⚫ Epidemiology
⚫ Vital Statistics
⚫ Sporadic
⚫ Epidemic
⚫ Endemic
⚫ Pandemic
⚫ Mortality
⚫ Mobidity
⚫ Cases/Prevalence
I. HEALTH COMMUNITY
Terminologies:
⚫ Community
- A social group determined by geographic boundaries and/or common values
and interests. It functions within a particular social structure and exhibits and
create norms, values and social institutions
- a collection of people who interact with one another ad whose common

interests or characteristics form the basis for a sense of unity or belonging
(Allender et. Al)
- a group of people who share something in common and interact with one
another, who exhibit a commitment with another ad may share a geographic
boundary (Lundy and Janes)
⚫ Population
- used to denote a group of people having common personal or
environmental characteristics. Refers to the people in the community
⚫ Aggregates
- subgroups or sub-populations that have some common characteristics or
concerns
- Example: group of elderly women; group of people undergoing treatment
for Diabetes
Attributes of Community:
A. People
B. Place
C. Interaction
D. Common characteristics, interests or goals
Components:
⚫ Environment – physical, social-cultured, educational and employment milieu
⚫ Population behavior and lifestyle – self-responsibility, self-care competency
⚫ Human biology – genetic characteristics of a community/population
⚫ Systems of health care – prevention, promotion, cure and rehabilitation
Two main types of communities:

1. Geopolitical communities - formed by both natural and man-made boundaries (barangays,
municipalities, cities, provinces, regions, nations). This is also called as “territorial communities”
Classifications:
✓ Rural – usually small and occupation of the people is usually farming, fishing
and food-gathering. It consists of simple folk characterized by primary group
relation, well-knit and having a high degree of group feeling. People assume
agric
✓ Urban – high density, a social heterogeneous population and a complex

structure, non-agricultural occupations, something different from an area
characterized by complex interpersonal social relations. People assume
industrial-type of works
2. Phenomenological communities - refers to relational or interactive groups; setting is more

abstract and people share a common perspective, identity, culture etc. (schools, churches). This
is also called “functional communities”
Five Functions of a Community

1. Production, distribution, and consumption of goods and services
- These are the means by which the community provides for the economic needs of
its members.
2. Socialization
- processes and ways on how the residents interact with the members of the
community
3. Social control
- The way in which order is maintained in a community. Laws are enforced by the
police, public health regulations are implemented to protect people from certain
diseases
4. Social inter-participation
- Refers to community activities that are designed to meet people’s needs for
companionship.
5. Mutual support
- Refers to its ability to provide resources at a time of illness or disaster
Characteristics of a Healthy Community
Healthy communities or at least the idea and principles of living in a healthy community is a
trend whose popularity has been steadily increasing.
Factors that foster optimum level of community functioning:
1. Access to quality education

⚫ Education and health go hand in hand. Those who pursue a higher level of
education have longer lifespans and often experience a higher quality of life than
their peers. Having a school that reinforces health education is a powerful tool for a
parent to have when they are trying to raise their children to be mindful of their
food choices and activity levels.
2. The community naturally blends into its environment

⚫ It’s also very important for a healthy community to be part of its natural
environment. Being part of the natural surroundings also offers benefits of a less
concrete nature, by allowing residents a chance to feel closer to nature.
3. Health care and preventive health services

⚫ It should be taken as a given that healthy communities have access to quality
health care facilities.
4. Access to healthy food

⚫ Access to healthy food is also very important for any health-conscious community.
It allows residents to make dietary choices thus making them healthier.
5. Fitness and wellness opportunities

⚫ Fitness and wellness opportunities are often foundational amenities for a health
minded community. It’s important that residents not need to venture far to get
daily exercise. Wellness doesn’t just mean exercise, though – it also means access
to like-minded individuals who will provide support and even motivation.
Elements of Community:
1. Promotion of healthful living:
a. Individual level:
✓ Smoking cessation
✓ Reduction of alcohol
✓ Drug abuse
✓ Exercise and fitness
✓ Stress management
b. Family level:
✓ Family planning
✓ Pregnancy and infant care
✓ Immunizations
✓ Information about STD
c. Group level
✓ Occupational safety and health
✓ Accidental injury may be considered
d. Community level:
✓ Toxic agent control
✓ Flouridation of water
✓ Infectious agent control
2. Prevention of Health Problems:
⚫ Health protection activities are highly varied. They may include the prevention of
nutritional deficiencies, accidents at work and at home, communicable diseases,
CVDs, cancers, pollution, etc.
3. Remedial Care for Health Problems:

⚫ Community health nurses provide direct and indirect services to individuals with
chronic health problems.
⚫ A variety of health care services provide direct services, such as home visits for
assessment and monitoring of health problems, dietary planning, administration of
injections, personal care, home-making services, and information about equipment
resources (bath seats, wheel chairs, canes, walkers, syringes, etc.)
➢ Indirect services
- Focus on assisting people with health problems to obtain
treatment.
- Example: a community health nurse may assist a person to get
a physician’s appointment after eliciting data about an elevated BP, a
persistent cough or vaginal bleeding
➢ In other instances, the nurse may refer an individual or family to
other agencies that provide information and/or therapy such as:
1. A family therapy and counseling program
2. A self-help group or association
3. A chemical dependency counseling and treatment center
4. Rehabilitation
⚫ Services that focus on reducing disability and/or restoring function are provided at
the individual, family and community level.
⚫ At the individual level, a community health nurse in conjunction with other allied
health workers may assist disabled people regain some degree of lost function, prevent
further disability, and develop new skills that enable them to assume an appropriate
vocation or degree of independence.
5. Evaluation:
⚫ Essential component of community health practices
⚫ Aims: Determine effectiveness of current activities
Determine needs
Develop improved services.
6. Research
⚫ Provide the means to identify problems and examine improved methods of
providing health services
Investigates:
◆ Patterns of illness and health
◆ Possible causes and means of preventing specific problems
◆ Deficiencies in services
◆ Effectiveness of treatment programs such as weight reduction, stress
management, substance abuse programs
◆ The effect of societal and environmental changes on existing services
◆ Utilization of existing health services
FACTORS THAT AFFECT COMMUNITY HEALTH
1. Income and Social Status - Higher income and social status are linked to better health
2. Education - Low education levels are linked with poor health, more stress and lower self-
confidence
3. Physical Environment - Safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health
4. Employment and working conditions - People in employment are healthier, particularly those
who have more control over their working conditions
5. Social support networks - greater support from families, friends and communities is linked to
better health
6. Culture - Customs and traditions, and the beliefs of the family and community all affect
health
7. Genetics - Inheritance plays a part in determining lifespan, healthiness and the likelihood of
developing certain illnesses
8. Personal Behavior and coping skills - Balanced eating, keeping active, smoking, drinking and
how we deal with life’s stresses and challenges all affect health.
9. Health services - Access and use of service that prevent and treat disease influence health
10. Gender - Men and women suffer from different types of diseases at different ages.
II. HEALTH STATISTICS AND EPIDEMIOLOGY
Terminologies:
⚫ Statistics
- refers to a systematic approach of obtaining, organizing and analyzing
numerical facts so that conclusion may be drawn from them
⚫ Vital Statistics
- refers to the systematic study of vital events such as births, illnesses, marriages,
divorce, separation and deaths
⚫ Epidemiology
- study of occurences and distribution of diseases as well as the distribution and
determinants of health states or events in specified population, and the
application of this study to the control of health problems
A. Vital Statistics
Statistics on disease and death indicate the health status of the community and the success or
failure of the health activities and programs that were implemented.
Table 1. Recording of Statistics

National Statistics Office Local Civil Registry
Population and Characteristics Births and Death statistics
⚫ Age
⚫ Sex
⚫ Distribution
Use of Vital Statistics

⚫ indices of the health and illness status of a community
⚫ Serves as bases for planning, implementing, monitoring and evaluating community health
nursing programs and services
Sources of data
⚫ Population census
⚫ Registration of vital data
⚫ Health surveys
⚫ Studies and researches
Rate
Definition: Shows the relationship between a vital event and those persons exposed to the
occurrence of said event, within a given area and during a specified unit of time. It is evident
that the persons experiencing the event must come from the total population exposed to the
risk of the same event
Ratio
Definition: Used to describe the relationship between 2 numerical quantities or measures of

events without taking particular considerations to the time or place. These quantities need not
necessarily represent the same entities, although the unit of measure must be the same for
both numerator and denominator of the ratio
Crude or General rates
Definition: Refers to total living population. It must be presumed that the total population was
exposed to the risk of occurrence of the event
Specific rate
Definition:The relationship is for a specific population class or group. It limits the occurrence of
the event to the portion of the population definitely exposed to it
Midyear population
Definition: Refers to the estimated population as of July 1 of a specified year
Crude birth rate

- a measure of one characteristic of the natural growth or increase in population
total no. of live births registered in a given year

CBR = ---------------------------------------------------------------- x 1000
Estimated population as of July 1 o the same year
Crude death rate

- a measure of one mortality from all causes which may result in a decrease of population
total no. of deaths registered in a given calendar year

CDR = --------------------------------------------------------------------- x 1000
Estimated population as of July 1 o the same year
Infant Mortality rate

- measures the risk of dying during the first year of life. It is a good index of the general health
condition of a community since it reflects the changes in the environment and medical condition
of a community.
total no. of deaths under 1 year of age registered in a given year

IMR = ----------------------------------------------------------------------------------- x 1000
total no. of live births registered of the same year
General fertility rate

- measure of one characteristic of natural growth compared to the fertility age group
total no. of live births registered in a given year

GFR = ------------------------------------------------------------------ x 1000
total population of fertility age group
Specific Death rate

- Describes more accurately the risk of exposure of certain classes or groups to particular
diseases.
Deaths in a specific class or group registered in a year

SDR = -------------------------------------------------------------------------- x 100,000
estimated population as of July 1 in same specified
class / group of said year
Age specific death rate
No. Of death in a particular age group registered in a given calendar year

ASDR = ----------------------------------------------------------------------------------------- x 100,000
Estimated population as of July 1 in same age group of the same year
Sex specific death rate
No.of deaths of a certain sex in a given year

SSDR = -------------------------------------------------------------------------------- x 100,000
estimated population as of July 1 (same sex for the same year)
Cause Specific Death rate
No. of deaths from a specific cause in a given year

CSDR = ------------------------------------------------------ x 100,000
estimated population as of July 1 of the same year
Fetal death rate

- Measures pregnancy wastage. Death of the product of conception occurs prior to its complete
expulsion, irrespective of duration of pregnancy
Total no of fetal deaths in a given year

FDR = ----------------------------------------------------- x 1000
total no. of live births in the same year
Neonatal death rate

Measures the risk of dying the 1st month of life. May serves as an index of the effects of
prenatal care and obstetrical management on the newborn
No. of Deaths under 28 days of age in a given yr.

NDR = --------------------------------------------------------------------x 1000
total no. of live births in the same year
Maternal Mortality Rate

Measures the risk of dying from causes related to pregnancy, childbirth and puerperium. An
index of the obstetrical care needed and received by the women in a community
No. of deaths from maternal causes registered for a given year

MMR = ----------------------------------------------------------------------------------- x 1000
Total no. of live births registered of the same year
Swaroops Index
Measures the risk of dying for 50 years old and above
No. of Deaths of 50 yrs. Old and above

SI = ----------------------------------------------------------------- x 100
estimated population as of July 1 of the same year
Proportionate Mortality Rate

- Shows the numerical relationship between deaths from a cause, age etc.
No. of registered deaths from a specific cause

PMR = ------------------------------------------------------------------ x 100
no. of registered deaths from all causes
Case Fatality Ratio

- Index of a killing power of the disease. It is influenced by incomplete reporting and poor
morbidity data
No. of registered deaths from a specific disease for a given year

CFR = ---------------------------------------------------------------------------------- x 100
No. of registered cases from specific disease
Incidence Rate
- Measures the frequency of occurrence of the phenomenon during a given period of time.
Deals only with new cases
No. of new cases of a particular disease in a specified time

IDR = ---------------------------------------------------------------------------- X 100,000
Sum of person - time at risk
Attack Rate
- A more accurate measure of the risk of exposure. Useful in epidemiological investigation
No. of persons acquiring the disease in a given year

AR = -------------------------------------------------------------------------- X 100
No. of exposed to same disease in same year
Prevalence Rate
- Measures the proportion of the population which exhibits a particular diseases at a particular
time. This can only be determined following a survey of the population concerned, deals with
total (new and old) number of cases
No. of new and old cases of a certain disease at a given time

PR = ------------------------------------------------------------------------------- x 100
Total no. of persons examined at the same given time
Factors affecting Prevalence

Increased by Decreased by
Longer duration of the disease Shorter duration of the disease
Prolongation of life of patients without cure High case-fatality rate from disease
Increase in new cases (increase in incidence) Decrease in new cases
In-migration of cases In-migration of healthy people
Out-migration of healthy people Out-migration of cases
In-migration of susceptible people Improved cure rates of cases
Improved diagnostics facilities (better
reporting)
Proportionate Mortality (Death Ratios)

- shows the numerical relationship between deaths from all causes (or group of causes), age
(or group of age) and the total number of deaths from all causes in all ages taken together
No. of registered deaths from specific cause or age for a given calendar year
PM = ------------------------------------------------------------------------------------------------- x 100
Number of registered deaths from all causes, all ages in same year
Presentation of Data
✓ Line or curved graphs - shows peaks, valleys and seasonal trends. Also used to show the
trends of birth and death rates over a period of time
✓ Bar graphs - each bar represents or expresses a quantity in terms of rates or percentages
of a particular observation like causes of illness and deaths
✓ Area Diagram (Pie Charts) - shows the relative importance of parts to the whole
Functions of the Nurse:

✓ Collects data
✓ Tabulates data
✓ Analyzes and interprets data
✓ Evaluates data
✓ Recommends redirection and/or strengthening specific areas of heath programs as needed
Epidemiology
-backbone of the prevention of diseases
2 Main Areas of Investigation

1. Definition, study of distribution of disease
- describes the distribution of health status in terms of age, gender, race,
geography and time
2. Search for the determinants (causes) of the disease and its observed distributions
- involves explanations of the patterns of disease distribution in terms of casual
factors.
Uses of Epidemiology
⚫ To study the history of the health populations and the rise and fall of disease and changes
in their character
⚫ To diagnose the health of the community and the community and the condition of people;
to measure the distribution and dimension of illness in terms of incidence, prevalence,
disability and mortality
⚫ To study the working of health services with a view of improving them
⚫ To estimate the risks of disease, accident, defect and the chances of avoiding them
⚫ Uses of Epidemiology
⚫ To identify syndromes by describing the distribution and association of clinical phenomena
in the population
⚫ To complete the clinical picture of chronic disease and describe their natural history
⚫ To search for causes of health and disease by comparing the experience of groups that are
clearly defined by their composition, inheritance, experience, behavior and environments
Epidemiologic Triangle
HOST
ENVIRON
AGENT
MENT
HOST
⚫ Host - any organism that harbors and provides nourishment for another organism
⚫ Agent - intrinsic property of microorganisms to survive and multiply in the environment
⚫ Environment - sum total of all external condition and influences that affects the
development of an organism which can be biological, social and
3 Components of the Environment:
1. Physical environment: consists of the inanimate surroundings such as the
geophysical conditions of the climate
2. Biological environment: makes up the living things around us
3. Socio-economic: level of economic development of the community; presence of
social disruptions
Disease Distribution
Variables: TIME, PERSON and PLACE
⚫ Time: refers both to the period during which the cases of the disease being studied
were exposed to the source of infection and the period during which the illness
occurred.
Ex: Epidemic period, Year, Period of Consecutive years
⚫ Persons: refers to the characteristics of the individual who were exposed and who
contacted the infection or the disease in question
Ex: Age, Sex and Occupation
⚫Place: refers to the features, factor or conditions which existed in or described the
environment in which the disease occurred.
Patterns of Occurrence and Distribution
⚫ Sporadic: intermittent occurrence of a few isolated and unrelated cases in a given locality;
“on and off”, “seasonal”
Example: Rabies
⚫ Endemic: continuous occurrence throughout a period of time, of the usual number of cases
in a given locality.
Example: schistosomiasis is endemic in Leyte and Samar
⚫ Epidemic: occurrence is of unusually large number of cases in a relatively short period of
time. There is a disproportionate relationship between the number of cases and the period
of occurrence; “outbreak”
Example: Dengue outbreak during rainy season; Measles outbreak
⚫ Pandemic: simultaneous occurrence of epidemic of the same disease in several countries;
“International Perspective”
Example: HIV/AIDS; Covid-19
Outline of Plan for Epidemiological Investigation

1. Establish fact of presence of epidemic
◼ Verify diagnosis: do clinical and laboratory studies to confirm the data
◼ Reporting
◼ Is there an unusual prevalence of the disease
2. Establish time and space relationship of the disease

◼ Are the cases limited to or concentrated in any particular geographical subdivision of
the affected community
◼ Relation of cases by days of onset of the first known cases
3. Relations to characteristic of the group of community

◼ Relation of cases to age groups, sex, color, occupation, school, attendance, past
immunization etc.
◼ Relation of sanitary facilities, especially water supply, sewerage disposal, general
sanitation of homes, and relation to animal or insects vector
◼ Relation to milk and food supply
◼ Relation of cases to other cases and known carriers if any
4. Correlation of all data obtained

◼ Summarize data clearly with the aid of such tables and charts are necessary to give a
clear picture of the situation
◼ Build up the case for the final conclusion carefully utilizing all the evidence available
◼ Establish the source of the epidemic and the manner of the spread, if possible
◼ Make suggestions as to the control, if disease is still present in community and as to
prevention of future outbreaks
Outline on the Operational Procedure during a Disease Outbreak

1.Organization of Team
⚫ Coordination of personnel
⚫ Orientation/ demonstration on the methodology to be employed
⚫ Checklist on the team’s paraphernalia
⚫ Pooling of data and resource-record keeping
2. Epidemiological Investigation
⚫ Active case finding
⚫ Carriers and contact control
⚫ Surveillance
3. Collection of laboratory specimens
⚫ Rectal swabbing
⚫ Food sampling
⚫ Other that are relevant to disease
4. Treatment of Patients and contacts
⚫ Analgesics and antipyretics
⚫ Antibiotics
⚫ Parenteral fluids
⚫ Supportive drugs
⚫ Emergency drugs
⚫ Isolation of patients- “cordon sanitaire”
⚫ Boiling and disenfection of fomites
⚫ Conduction of patient to hospitals
5. Immunization campaign
⚫ Type of vaccine
⚫ Dosage, schedule, technique
⚫ Areas to be covered
⚫ Target population
⚫ Consolidation and evaluation of data
6. Environmental Sanitation (during the survey)
⚫ Water
⚫ Toilets and surroundings
⚫ Garbage disposal
⚫ Insect and vermin control
⚫ Food sanitation
7. Health education
⚫ Individual approach
⚫ Community approach and meetings
⚫ Schools PTA, church and other congregations
8. Involvement of other agencies
9. Reporting
⚫ Telegraphic report
⚫ written
Functions of the Epidemiology Nurse

⚫ Implement public health surveillance
⚫ Monitor local health personnel conducting disease surveillance
⚫ Conduct and/or assist other health personnel in outbreak investigation
⚫ Assist in the conduct of rapid surveys and surveillance during disasters
⚫ Assist in the conduct of surveys, program evaluations and other epidemiologic studies
⚫ Assist in the conduct of training course in epidemiology
⚫ Assist the epidemiologist in preparing the annual report and financial plan
⚫ Responsible for inventory and maintenance of epidemiology and surveillance unit (ESU)
equipment
Specific Roles of Nurses during Epidemiological Investigations:
⚫ Maintains surveillance of the occurrence of notifiable diseases

⚫ Coordinates with other members of the health team during a disease outbreak
⚫ Participates in case finding and collection of laboratory specimens
⚫ Isolates cases of CD
⚫ Functions of the Nurse in Epidemiology
⚫ Renders nursing care teaches and supervises giving of care
⚫ Performs and teach household members methods concurrent and terminal disinfection
⚫ Give health teaching to prevent further spread of disease to individuals and families
⚫ Follow-up cases and contacts
⚫ Organize, coordinate and conduct community health education campaign/ meetings
⚫ Refer cases when necessary
⚫ Coordinates with other concerned community agencies
⚫ Accomplishes and keep records and reports and submits to proper office/ agency
Pertinent Laws
RA 3753 – Civil Registry Law
RA 3573 – Law on Reporting of Notifiable Disease
PD 651 - Requiring the Registration of Births and Deaths in the Philippines which occurred from
January 1, 1974 and thereafter
Teacher’s Insights:
In this chapter, you have been informed of the components and characteristics of a
community. You have learned also the different factors that play a vital role in the overall
health status of the community. It is therefore imperative for public health nurses to be
aware of how these factors affect and interact with one another.
In addition, epidemiology and vital statistics provided insights and opened doors to certain
health programs with the purpose of improving the health status of the entire community.
Good job! You have reached the end of Chapter 1!

Proceed to the next page and answer the self-assessment exercise.
PRELIMINARY PERIOD
CHAPTER I
SELF-ASSESSMENT EXERCISE
1. Post a photo of your community and describe it briefly (5 points)
2. List down 5 examples of diseases in your community based on their classifications
PANDEMIC EPIDEMIC ENDEMIC SPORADIC
Concept on Vital Statistics

Situation:
As of July 1, 2020, statistics showed that the total population in Barangay Alimannao, increased
from 15,452 to 16,564. There were several deaths recorded and cases of endemic and
emerging diseases have risen significantly. Refer to the data below:
Total Number of Live births: 567
Deaths of infants: 11
Maternal Deaths due to post-partum haemorrhage: 20
Total number of abortion/miscarriage: 5
Total number of Covid cases: 25
Dengue cases as of August 15, 2020: 65
Estimated population at risk for Dengue: 10,045
Identify the following data:

1. Crude Birth Rate
2. Fetal Death Rate
3. Maternal Death Rate
4. Infant Mortality Rate
5. Incidence Rate of Dengue
6. Incidence Rate of Covid
MIDTERM PERIOD
CHAPTER 1
This chapter adds information about community health and vital statistics.
Duration: 12 hours

Community Health Care Development a. Approaches to community development
Process b. Community Organizing
c. Principles of Community Organizing
d. Phases of Community Organizing
b. HRDP-COPAR Model as a strategy for
community development
c. Phases of COPAR
d. Critical Activities
1. Critical Thinking Exercise and Short Essays
1. Identify approaches in community development
2. Describe community organizing
3. Differentiate the phases of community organizing
4. Discuss and relate significance of HRDP-COPAR in the community
5. Differentiate the phases of COPAR
6. Identify significant strategies under each phase
Let’s Begin!
KEY TERMS
⚫ Community Organizing
⚫ HRDP-COPAR
⚫ Community Development
⚫ People Empowerment
COMMUNITY HEALTH CARE DEVELOPMENT
• Approaches to development:
1. Welfare Approach
- assumes that poverty is God-given and that poverty is destined.
- believes that poverty is caused by bad luck
2. Modernization Approach
- when the community began to accept and utilize technology and industrialization
- assumes that development can be attained by abandoning the traditional
methods/practices and adopt the technology of industrial countries
- poverty is due to lack of education, resources and technology
3. Transformatory/Participatory Approach
- focused on empowering the poor and oppressed sectors of society so that they can pursue
a just and human society
- poverty is not God-given: rather it is rooted in the historical past and is maintained by the
oppressive structures in the society.
THE HEALTH RESOURCES DEVELOPMENT PROGRAM (HRDP) & COMMUNITY

ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) MODEL
HRDP
Definition:
- a model for establishing & implementing effective, sustainable & participatory PHC programs
in DDU communities
- it entails development & mobilization of students & faculty of paramedical institutions, &
enrichment of health oriented curriculum & reorienting the health education of future health
workers to be more responsive & relevant to the current community health needs
➢ Program initiated by the Population center Foundation as its contribution to the

development of alternative health care system in the Philippines.
➢ Based on a belief that potential health manpower exists in the form of students, faculty,
and hospital/clinic staff who can be mobilized to work with people to act on their own
health problem.
➢ A model for PHC
Community Organizing
➢ A promising tool for achieving the PHC goals of self-reliance and self-determination
➢ A continuous and sustained process of educating the people to understand and develop
their critical awareness of their existing conditions, working with people collectively and
efficiently on their immediate and long term problems, and mobilizing the people to
develop the capability and readiness to respond and take action on their immediate
needs toward solving their long-term problems
Objectives:
1. To make people aware of the social realities toward the development of local initiative and
strengthening people's capabilities
2. To form structures that upholds the people’s basic interests
3. To initiate responsible actions to address the community health and social problems
Participatory Action Research (PAR)

➢ An investigation of the problems and issues concerning the life and environment of the
underprivileged in society by way of a research collaboration with the underprivileged,
whose representatives participate in the actual research process as equal partners in
studying their own problem
➢ Conceived as an innovation over the traditional research approach. Unlike PR.

traditional research considers people as objects of research rather than active
collaborators of change and development. Whereas, the traditional research caters only
to the interest of the academes and development agencies, veers away from
dependence of the outside researchers.
Central Element:
✓ Participation – is an active process whereby the expected beneficiaries of the research
are the main actors in the research process
STRATEGIES
1. Strengthening the integration of PHC, COPAR, Adult teaching learning concepts,
strategies & methodologies in the health science curricula.
2. Systematization of the student’s exposure program.
3. Development of CHO which can sustain health development program.
4. Community-capability building through leadership & health skills trainings.
5. Provision of health services by the faculty, students & the trained BHW
• COPAR – a social development approach that aims to transform the apathetic,

individualistic, voiceless poor into dynamic, participatory & politically responsive
community.
➢ A collective, participatory, transformative, liberative, sustained & systematic process of

building people’s organizations by mobilizing & enhancing the capabilities & resources of
the people for the resolution of their issues & concerns towards affecting change to their
existing oppressive & exploitative conditions
Objectives: (Self-reliance & People Empowerment)
1. To make people aware of social realities toward the development of local initiative,
optimal use of human, technical & material resources & strengthening of people’s
capabilities.
2. To form structures that uphold the people’s basic interest as oppressed, deprived
sections of the community, & as a people bound by the interest to serve the people.
3. To initiate responsible actions intended to address holistically the various community
health & social problems.
IMPORTANCE
1. Help community workers to generate community participation in development
activities.
2. Prepares people to eventually take over the management of a development program
in the future.
3. Maximizes community participation & involvement & community resources are
mobilized for community services.
PRINCIPLES
1. People, especially the most oppressed, exploited & deprived sectors are open to change,
have the capacity to change & are able to bring about change.
Power must reside in the people:
- Development is from people to people.
- People’s participation should always be present.
2. COPAR should be based on the interests of the poorest sectors of society.
3. COPAR should lead to a self-reliant community & society.
PROCESSES/METHODS USED IN COPAR
1. Progressive Cycle of Action-Reflection-Action Session (ARAS)

- begins with small, local, concrete issues identified by the people & the evaluation &
reflection of the action taken by them
2. Consciousness-raising through experiential learning

- is central to the COPAR process because it places emphasis on learning that emerges
from concrete action that enriches succeeding actions
3. Participatory & mass-based

- primarily directed toward the mobilization of the poor, the powerless & oppressed sector of
the community
4. Group-centered & not leader oriented

- leaders are identified, emerge & tested through action rather than appointed or
selected by some external force.
CRITICAL STEPS/ACTIVITIES IN COPAR
1) INTEGRATION – health workers become one with the people in order to:
➢ Immerse himself in the poor community
➢ Understand deeply the culture, economy, leaders, history, rhythms & lifestyle in the
community.
METHODS OF INTEGRATION
1. Participation in direct production activities of the people.
2. Conduct house-to-house visits.
3. Participation in social activities like birthday, fiesta, wakes, weddings, seasonal rituals,
benefit dances, etc.
4. Conversing with people where they usually gather such as in stores, water wells,
washing streams or in church yards.
5. Helping out in household chores
2) SOCIAL INVESTIGATION – Community study
- a systematic process of collecting, collating, analyzing data to draw a clear picture of

the community.
Pointers in conducting Social Investigation:
➢ Use of survey questionnaire is discouraged.
➢ Community leaders can be trained to initially assist the community workers/CO in doing
SI.
> Data can be more effectively & efficiently collected through informal methods (house-
to-house visit, participating in conversation)
> Secondary data should be thoroughly examined because much of the information
might already be available.
➢ SI is facilitated if the CO is properly integrated & has acquired the trust of the people.
➢ Confirmation & validation of community data should be done regularly
3) TENTATIVE PROGRAM PLANNING

- CO to choose one issue to work on in order to begin organizing the people
4) GROUNDWORK
- Going around & motivating the people on a one-on-one basis to do something on the
issue that has been chosen
5) THE MEETING
- People collectively ratify what they have already decided individually.
- it gives people the collective power & confidence
- problems & issues are discussed
7. ROLE PLAY
- To act out the meeting that will take place between the leaders of the people & the
government representative
- a way of training the people to participate what will happen & prepare themselves for
such eventually
8. MOBILIZATION/ACTION
- actual experience of people
- carrying out the plans & activities
8. EVALUATION
- People review step 1-7 to determine whether they were successful or not in their
objectives
9. REFLECTION
- dealing with deeper ongoing concern to look at the positive side
- CO is trying to build an organization
- it gives people time to reflect on the reality of life compared to the ideal
10. ORGANIZATION
- the people’s organization is the result of many successive & similar actions of the people
- a final organizational structure is set-up with elected officers & supporting members.
PHASES OF COPAR
1. PRE-ENTRY PHASE
- initial, simplest phase of the organizing process in terms of actual outputs, activities &
strategies.
- CO looks for communities to serve or to help
- takes 1-2 months to complete
2 main activities:
➢ Selection of Project Site
➢ Identification of Host Family/Staff House
Other activities:
• Train faculty and students in COPAR
• Formulate plan for institutionalizing COPAR
• Revise/enrich curriculum and immersion program
• Coordinate participants of other departments
• Formulate criteria and guidelines for site selection
• Do initial networking with local government
• Conduct preliminary social investigation
• Make long list/short list of potential communities
• Do ocular survey of short-listed communities
• Interview barangay officials, leaders, and key informants
• Choose sites/community for the immersion programs
• Coordinate with local government/NGOs for assistance
• Develop community profiles for secondary data
• Develop survey tools
• Pay courtesy call to community leaders
• Choose foster families based on guidelines
CRITERIA FOR SITE SELECTION:
✓ It must have a population of 100-200 families.
✓ The area is relatively socio-economically depressed
✓ It must have a relative concentration of poor people.
✓ There is no strong resistance from the community.
✓ There must be no serious peace and order problem.
✓ There must be no similar group or organization holding the same program
2. THE ENTRY PHASE

➢ Most crucial phase
➢ Also called Social Preparation phase for it allows the community to be actively involved
in the entire implementation of the program.
➢ Success will depend on:
1. how much the project implementors have integrated with the community people.
2. their understanding of the place & events
3. their willingness & readiness to commit oneself towards the program.
ACTIVITIES:
1) Integrate with community residents
- Integration is the process of establishing rapport with the people in a continuing
effort to imbibe the community life by living with them & undergoing the same
experience, sharing their hopes, aspirations & hardships towards building mutual trust &
cooperation
2) Conduct deepening Social Investigation
• Social Investigation – is the systematic process of collecting, collating & analyzing

data to draw a clear picture of the community
- an investigation was already made at the beginning phase of organizing but an in-
depth investigation is needed to better view how the community & its people
perform in general
3. Dissemination information/sensitize community residents on the program & PHC.

- information campaign can be done in small group discussions, house-to-house visit,
in informal social gatherings.
- side by side with the organization campaign is the delivery of basic health services,
done simultaneously
4. Formulate criteria for selection of Core Group Member

- people themselves will formulate criteria
- core group members are selected by the community residents during the assembly.
- Sample of criteria:
a. they must be respected members of the community.
- credible & loved by the community
b. they must belong to the poor sector in the community.
c. they must be responsible, committed individuals, willing to work for social change &
transformation.
- willing to serve for others without waiting for anything in return.
d. they must be willing to learn.
e. they must possess a good communication skills & able to express himself to others
in a group
5. Define roles & function of the core group members

Roles & Functions:
a. Social preparation of the community for health & development work.
b. Organizing a community research team for the conduct of community assessment
diagnosis.
c. Setting up the CHO & facilitate the identification of potential CHW.
d. Scrutinizing & mobilizing the community to act on their own & participate in the
delivery of essential health services.
Note: 1. Core group is not a permanent group.
2. Number of members has no limit as long as the member is willing to fulfill the
function.
3. Some can be elected to become CHWs.
4. Selection of members should be well represented from all sectors
6. Deliver essential basic health services

- a good opportunity to build rapport to the community
7. Continue Social Investigation

- SI is a continuous process
8. Conduct team building activities/sensitization/informal education among CGM
9. Presentation of baseline survey results to community

- so that people will be able to understand the general scenario of their community.
- present creatively
10. Conduct Self-awareness Leadership Training (SALT) among the CGM/potential leaders
- for the growth & development of the community
- conduct training during the most convenient time of the people
11. Consult community to organize CHO

CHO – is charged with the management of relevant & appropriate health programs
- ensure the collective participation in decision-making, planning, implementation &
evaluation of community project
- establish a network of linkages/network for mobilizing external support

- generate resources for maintaining & sustaining health programs or activities
- raising the community’s consciousness in health & other broader issues
- mobilizing the people to act on their health problems & issues affecting them.
- they are being elected
3. COMMUNITY STUDY/DIAGNOSIS PHASE
- research phase
ACTIVITIES:
a. Selection of research team
b. Train community research team
Community Research Team – is a small adhoc body composed of residents
selected by the community to look into the causes of problems; train on data
collection methods & techniques, development of data collection tools & training
on capability-building
c. Planning for the actual gathering of data
d. Data gathering
e. Training on data validation
-includes data tabulation & preliminary analysis of data
f. Community validation
g. Presentation of the study & recommendation
4. COMMUNITY ORGANIZATION & CAPABILITY BUILDING PHASE/ORGANIZATION

BUILDING PHASE
- signals the start of community self-management because it entails the formation of
more formal structures & the inclusion of more formal procedures of planning,
implementing, & evaluating community-wide activities.
ACTIVITIES:
a. Community meetings to draw up guidelines for the organization of the CHO.
b. Election of CHO officers
c. Development of management systems & procedures
d. Team building
e. Working out legal requirements for the establishments of CHO.
f. Organization of working committees/task group
g. Training of CHO officers & community leaders
5. COMMUNITY ACTION PHASE

ACTIVITIES:
a. Organization & training of CHWs.
b. Setting-up of linkages/network referral system
c. Initial identification & implementation of resource mobilization schemes.
6. SUSTENANCE & STRENGTHENING PHASE

- the community can already stand on its own.
- people can sustain the program even without the help of project implementors.
- trained leaders & workers take the over-all management of the program.
ACTIVITIES:
a. Formulation & ratification of constitution & by-laws
b. Identification & development of secondary leaders.
c. Setting-up & institutionalization of financing scheme
d. Assess/re-plan community health programs.
e. Formalizing & institutionalization of linkages, networks & referral system
f. Development & implementation of viable management systems & procedures,
committees, continuing education, training of leaders, CHWs & community residents.
HRDP-COPAR STAFF
1. Project Director – School Head
2. Project Manager – Dean
3. Community Organizer
4. Coordinator of Student Community Immersion
5. Health Services Coordinator
6. Training Coordinator
7. Financial Officer
8. Bookkeeper
9. Secretary
Phases of the HRDP-COPAR process (4 phases)

I. Pre-entry Phase
II. Entry Phase
III. Organization-Building and Capability
Building Phase
IV. Sustenance and Strengthening Phase
I. PRE-ENTRY PHASE
- the preparatory phase of the HRDP-COPAR process
- simplest phase in terms of actual outputs and strategies
- it takes only 1 to 2 months to complete
- done usually at the institutional level
- students participation is minimal
Site Selection
- entails the sequential implementation of sub-activities to ensure that the project sites
will be responsive to whatever health and development interventions initiated
- important in determining the working relationship as well as the need for the project
Criteria in Site Selection

1. Depressed, poor community
2. Inaccessibility or inadequacy of health services
3. Poor health status of the community
4. With no serious peace and order problem
5. No strong resistance from the community regarding the model utilized
6. No similar agencies or programs currently in the community
Preliminary Social Investigation

- initial gathering of data about potential sites, focusing on the data necessary to
determine the site that best conforms with the criteria set
Social Investigation- a systematic and scientific process of collecting, collating,
synthesizing and analyzing data to draw a clear picture of the community
Guidelines for Choosing the Final barangay

1. Conduct of ocular survey
2. Conduct of informal interviews with key persons and informants
3. Assess whether our services are in fact needed in the area
4. Validate the secondary collected
* It is essential to inform concerned authorities so that project endorsement and
support to the program can be secured
Identification of Host Family

- community work becomes more effective if we live in the area
- Ensures round-the-clock integration and experiencing the community
Criteria in Choosing Host Family

1. Should be strategically located in the barangay
2. Should belong to the majority of the group in the community (poor sector)
3. Should be respected by both the formal and informal leaders
4. Should have a house where neighbors, especially the poor are welcome
5. No member of the host family will be displaced
II. ENTRY PHASE

- sometimes called the social preparation phase
- crucial in determining which strategies for organizing would suit best the community
- lays the foundation of the organizing work as well as determines the relationship of
the people to the organizers
Guidelines for Entry in the Community

1. Recognize the role of the authorities
2. Appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents
3. Avoid passing expectations off the community residents
* There are five interrelated and simultaneous activities that can be carried out in the
entry phase
Integration with the Community

Integration – the process of establishing rapport with the people in a continuing effort
to imbibe community life by living with them and undergoing the same experience,
sharing their hopes, aspirations and hardships towards building mutual trust and
cooperation (Ferrer, 1982).
➢ The success of activities in the latter parts of the organizing process greatly depend on
how much the community organizer has integrated with the community.
Methods of Integration
a. Participation in direct production activities
b. Participation in social activities
c. Conversing with people where they usually gather
d. Doing household chores
Identification of Potential Leaders or Core Group Formation

- a process of selecting and training the core group which is considered critical in
community organizing
Potential leaders – considered the future CO’s and possible partners in the management
and in the delivery of basic health services
Core Group – group of individuals who possess leadership potentials to be formed/

organized into a cohesive working group
III. ORGANIZATION-BUILDING PHASE

- begins when the community starts to study their own problems
- usually starts with the formation of research team
- phase where the community leaders develop their full potential as leaders of the
community
- characterized by the formation of working groups and the capability building activities
provided by the team.
Research Team Formation
- the team who are charged with the conduct of Participatory Action Research
- the first working group that is formed in the formal organization that is being formed in
the community
- initiated by the Core Group and when the community people starts verbalizing about
the need to look deeper into the problems of the community
IV. SUSTENANCE AND STRENGTHENING PHASE

❖ Consolation and expansion
❖ Networking and establishing
❖ Implementation of livelihood projects
❖ Developing secondary leaders
COPAR is a vital part of public health nursing. It aims to transform the apathetic,
individualistic and voiceless poor into dynamic, participatory and politically responsive
community. Our role as nurses is very crucial in helping these communities to become self-
reliant. Careful selection of potential leaders and needs assessment are key factors towards
the achievement of this goal. Hence, public health nurses must be equipped with sufficient
knowledge on how they could help build an empowered community.
Good job! You have reached the end of Chapter 1!

Proceed to the next page and answer the self-assessment exercises
MIDTERM PERIOD
CHAPTER 2
Direction: Provide a brief answer for each question.
1) How does Participatory Action Research differ from Basic Research?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2) In identifying potential leaders in the community, what characteristics should we take

into consideration?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3. Describe a “self-reliant” and “empowered” community
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
SEMI-FINAL PERIOD
CHAPTER 3
This chapter adds information about the care enhancement qualities of health workers and
concepts in disaster risk reduction and management.
Duration: 12 hours

Care Enhancement Qualities of health a. The community health worker
workers in community setting b. Qualities of a health worker
c. Functions of a health worker
d. The community health worker as a health
educator
e. Conflict Management
Disaster Management a. Types of Disasters

b. Characteristics of Disasters
c. Disaster Management
d. National Disaster Risk Reduction
e. Disaster Responses
1. Define care enhancement qualities
2. Cite the care enhancement qualities of a nurse
3. Explain roles and functions of health workers
4. Define conflict management
5. Discuss the different conflict management styles
6. Define disaster and disaster management
7. Discuss impact of disaster in a community
8. Describe the roles and functions/responsibilities of a nurse during disaster
Let’s Begin!
KEY TERMS
⚫ Conflict management
⚫ Disaster
⚫ Disaster management
Let’s begin!
CARE ENHANCEMENT QUALITIES OF HEALTH WORKERS IN COMMUNITY

SETTING
A.DESCRIPTION OF A COMMUNITY HEALTH WORKER

A community health worker is one who provides basic community health care services for
promotion of health, prevention of illness, simple treatment and rehabilitation. The services
utilize the philosophy, content, method and skills of public health care.
B. QUALITIES OF A HEALTH WORKER
* Open – accept need for joint planning and decision relative to health care in a particular
situation not resistant to change
* Tactful – one who presides over an assembly, meeting or discussion in a subtle manner, does
not embarrass but gives constructive criticisms.
* Coordinator – brings into consonance or harmony the community’s health care activity.
* Objective – unbiased and fair in decision-making
* Good listener – always available for the participant to voice out their sentiments and needs.
* Efficient – knowledgeable about everything relevant to his practice; has the necessary skills
expected of him.
* Flexible – able to cope with different situations
* Critical thinker – desides on what has been analyzed.
C. FUNCTIONS OF A HEALTH WORKER

1. Community health service provider
-Carries out health services contributing to the promotion of health, prevention of
illness, early treatment of illness and rehabilitation.
- Appraises health needs and hazards (existing or potential).
2. Facilitator
- Helps plan a comprehensive health program with the people
- Continuing guidance and supervisory assistance
3. Health counselor
- Giving appropriate advice and broadening the client’s insight about a problem so that
appropriate decisions are made which can lead to positive resolution of the problem.
- Provides health counseling including emotional support to individuals, family, group
and community.
4. Co-Researcher
-Provides the community with stimulation necessary for a wider or more complex study
of problems.
- Enforce community to do prompt and intelligent reporting of epidemiologic
investigation of diseases.
- Suggest areas that need research ( by creating dissatisfaction)
- Participate in planning for the study and in formulating procedures
- Assist in the collection of data.
- Help interpret findings collectively.
- Act on the result of the research
- Plan and conduct of nursing and related studies that contribute to the improvement of
nursing and
health services, either alone or independently, or in collaboration of other members of
the health
and intersect oral teams.
5. Member of a team
- In operating within the team, one must be willing to listen as well as to contribute, to
teach as well
as to learn, to lead as well as to follow, to share authority as well as to work under it.
- Helps make multiple services which the family receives in the course of health care,
coorfinated and
comprehensive as possible.
- Consults with and refers to appropriate personnel for any other community services.
6. Health Educator
- Health education is an accepted activity at all levels of public work. A health educator
is the one who improves the health of the people by employing various methods or
scientific procedures to stimulate, arouse and guide people to healthful ways of living.
She takes into consideration these aspects of health education.
a. Information- provision of knowledge
b. Education- change in knowledge, attitude and skills
c. Communication- exchange of information
D. TRAITS AND QUALITIES OF A HEALTH EDUCATOR
1. Efficient- plans with the people, organizes, conducts, directs health education activities
according
to the needs of the community.
2. Good communicator- provides participants with clear and relevant information
3. Good listener- hears what’s being said and what’s behind the words
4. Keen observer- keeps eye on the proceedings, processes and participants behavior.
5. Systematic- knows how to put in sequence or logical order the parts of the session
6. Creative/Resourceful- uses available resources, involves participants
7. Analytical- critical thinker
8. Tactful- brings about issues in smooth, subtle manner
9. Knowledgeable- able to impart relevant, updated and sufficient input
10. Open- invites ideas, suggestions, criticisms; involves people in decision making
11. With sense of humor- knows how to place a touch of humor to keep audience alive
12. Change agent- involves participants actively in assuming the responsibility for his own
learning
GUIDELINES ON HOW TO BECOME AN EFFECTIVE HEALTH EDUCATOR IN TERMS OF:
A)Teaching methodologies/strategies ( selection and use)

- In making decisions about methodologies, the health educator has to choose specific
methods that will bring about the desired output. The methods should also correspond
to the
objectives. A technique/ method should:
1. Generate active participation of the learner
2. Provide quick feedback
3. Facilitate transfer of learning to on-the-job situation
4. Develop desirable behavior pattern
5. Motivate participants to improve their level of performance in class and on the job
6. Allow opportunity to learn at individual and group leaders.
Categories of Training Methods Related to Learning Categories
OBJECTIVES LEARNING CATEGORY TRAINING METHODS

To facilitate the trainee’s Knowledge Lecture
learning Panel discussion
Symposium
Conference
Field trip
Project methods
Film
Coaching
On-the-job-training
Programmed instruction
Tutorial
Brainstorming
Seminar
Attitude Roleplay
Case Study
Group Discussion
Simulation
Management games
Skills Demonstrations
Apprenticeship
Exercise
Roleplay
Project Method
B. Preparations of Materials
- Are the training aids available?( black board, chalk, pad papers, pentel pens, kraft
paper,masking tape)
- Are the hand-outs well package?
C. Uses of A Teaching Plan
- A teaching plan is a list of steps and activities and equipment needed in health
education sessions. A lesson should be planned by having an outline of what is to be
taught and the methods to be used. Time allocation for the various activities should also
be included.
BASIC COMPETENCIES
1. Knowledge 2. Skills 3.Attitude
A. Knowledge- the health worker must have adequate, accurate and up-to-date information
on and understanding of the following:
1. The community under her care- its characteristics, resources, social and professional
organizations, intersectoral agencies and man power concerned with health care and
community development, prevailing health hazards, disease and related problems.
2. Prevailing attitudes, values, cultural practices and beliefs which are relevant to health in the
community.
3. The structure, objectives, functions, service programs and standard operating proceduresof
her employing health agency.
4. The health team: composition, roles and functions of each member
5. Existing referral system and facilities in the community, when and how to refer.
CONFLICT MANAGEMENT
DEFINITION OF CONFLICT
◼ An active effort by individual or group for its own preferred interest at the cost of
others.
◼ It is a process in which effort is purposely made by “A” to offset the effort of “B” by
some form of blocking that will result in frustrating “B” in attaining his / her goal.
◼ Conflict tends to obstruct cooperative action, create suspicion and distrust and decrease
productivity.
LEVELS OF CONFLICT
◼ INTRA PERSONAL CONFLICT
◼ INTER PERSONAL CONFLICT
◼ INTER GROUP CONFLICT
◼ INTER GROUP CONFLICT
VIEWS ON CONFLICT
◼ TRADITIONAL VIEW- Conflict is harmful & need to be suppressed and avoided.
◼ MODERN VIEW- It is a natural occurrence. Conflict should be encouraged, It is
necessary for harmonious, peaceful, cooperative atmosphere leading to TEAM WORK
◼ FUNCTIONAL CONFLICT – Conflict that supports the goals of the group and improve the
performance are functional or Constructive form of conflict. It is creatively managed that
shakes people out of their mental ruts and give them new points of view.
◼ DYSFUNCTIONAL CONFLICT - It is a conflict that hinders group performance due to
poor communication, lack of openness & trust between people, failure to be responsive
to the needs & aspirations of the others.
INTRA PERSONAL CONFLICT

◼ FRUSTRATION
◼ GOAL CONFLICT
◼ ROLE CONFLICT
◼ FRUSTRATION
- The obstacle that hinders a person in attaining a goal is a source of a frustration.
- It is caused by –
✓ Environmental Factors
✓ Personal inadequacies
✓ Conflict frustration
◼ GOAL CONFLICT
- Conflict related to GOALS
◼ ROLE CONFLICT
- SOURCES OF ROLE CONFLICT
✓ Competitive Environment
✓ Differential Reward system
✓ Scarce Resource
✓ Role Ambiguity
✓ Cultural Differences
◼ INTER- PERSONAL CONFLICT

CONFLICT RESOLUTION PROCESS - BASIC ASSUMPTIONS
✓ Every individual is unique
✓ Every individuals has the inborn potentiality to resolve conflict.
✓ An Attitude of patience must be maintained
✓ Difference of opinions are healthy & beneficial
✓ Certain amount of confidentiality must be maintained
✓ Anger & Conflict must be accepted.
◼ WIN-WIN Approach must be adopted
CONFLICT- RESOLUTION MECHANISM

✓ Define the Problem
✓ Collects facts & Opinions
✓ Consider all solutions proposed
✓ Define the expected result
✓ Select the solution
✓ Implement the solution.
STRATEGIES
◼ COMPETITION
• When quick decision is vital
• On important issues where unpopular actions need implementations
• On issues vital to the organization’s welfare & when you know you are right.
• Against people who take advantage of non- cooperative behaviour.
◼ COLLABORATION
• When your objective is to learn
• Find an integrative solution when both sets of concerns are too important to be
compromised.
◼ AVOIDANCE
• When a issue is trivial
• To let people cool down and regain perspective.
• When others can resolve the conflict more effectively
◼ ACCOMODATION
• When issues are more important to others than yourself to satisfy others.
• To minimize loss when you are outmatched.
• When harmony & stability are especially important
◼ COMPROMISE
• To achieve TEMPORARY settlements to complex issues.
• When opponents with equal power are committed to mutually exclusive goals
• To arrive at expedient solutions under time pressure.
•
◼ DECISION MAKING
TYPES OF DECISION MAKERS

◼ CONVINCERS
- They are the persuader- promoters types. They tend to act on their emotions, deciding
quickly on whatever feels good
◼ CARERS
They decide on the basis of their feelings but are concerned with others. Since they
don’t want to hurt or disturb others, they take long time to take decision
◼ CALCULATORS
They are perfectionists. They want all the information before making decision.
MAKING OBJECTIVITY IN DM
✓ Realize that you may be experiencing stress
✓ Beware of heavy emotional leaning
✓ Are you motivated by a hidden agenda ?
✓ Self-deception of wishful thinking can cause erroneous judgments.
✓ Don’t make decisions based on assumptions about what “everybody knows”.
✓ Don’t lose sight of the big picture
✓ Seek as much good, objective advice as you can.
GROUP DECISION
✓ Define the issue.
✓ Gather the alternatives.
✓ Assign advocacy subgroups.
✓ Challenge and criticize.
✓ Reverse perspectives.
✓ Reach a consensus
DISASTER MANAGEMENT
Emergency – any event endangering the life or health of a significant number of people and
demanding immediate action.
- May result from a natural, man-made, technological, or societal hazard (DOH,2012).
- The agency, community family, or individual can manage using his/her own resources.
Disaster – any event that causes a level of destruction, death, or injury that affects the
abilities of the community to respond to the incident using available resources.
- Depending on the characteristics of the disaster, may be beyond the ability of the
community to respond and recover from the incident using their own resources
• Mass Casualty – 100 or more individuals are involved

• Multiple Casualty – more than 2 but fewer than 100 individuals are involved
• Casualties can be classified as direct/ indirect victim, displaced person, or a refugee.
• Direct Victim – individual who is immediately affected by the event
• Indirect Victim – family member or friend of the victim or a first responder
• Displaced Persons – those who have to evacuate their home, school, or business as a result
of a disaster
• Refugees – group of people who have fled their home or even their country as a result of
famine, drought, natural disaster, war, or civil unrest.
Types of Disasters:
1. Natural Hazard – physical force, such as typhoon, flood, landslide, earthquake, and
volcanic activity
2. Biological Hazard – process or phenomenon of organic origin or conveyed by biological
vectors, including exposure to pathogenic microorganisms, toxins, and bioactive substances
(ex: disease outbreaks, red tide poisoning)
3. Technological Hazard – arises from technological or industrial conditions, including
accidents, dangerous procedures, and infrastructure failures.
4. Societal Hazard – results from the interaction of varying political, social, or economic
factors, which may have a negative impact on the community (ex: stampedes, armed conflicts,
terrorist activity, riots)
5. NA-TECH (natural-technological disaster) – natural disaster that creates or results in a
widespread technological problem (ex: earthquake that causes structural collapse of roadways
or bridges that, in turn, brought down electrical wires and caused subsequent fires; chemical
spill resulting from a flood)
Terrorism – “criminal acts, including against civilians, committed with the intent to cause
death or serious bodily injury, or taking of hostages, with the purpose to provoke a state of
terror in the general public or in a group of persons or particular persons, intimidate a
population or compel a govt. or an international org. to do or to abstain from doing any act”
(UN Security Council, 2004).
Weapons of mass destruction – any weapon that’s designed or intended to cause death or
serious bodily injury through the release, dissemination, or impact of toxic or poisonous
chemicals, or its precursors.
Characteristics of Disasters:
• Frequency – how often a disaster occurs
• Predictability – the ability to tell when and if a disaster event will occur
• Preventability – a characteristic indicating that actions can be taken to avoid a disaster
• Imminence – speed of onset of an impending disaster
• Scope and number of casualties – the range of its effect
• Intensity – describes the level of destruction and devastation
Disaster Management Stages:

1. Preventions Stage – occurs before a disaster is imminent and is known as the “non-
disaster stage.”
2. Preparedness and Planning Stage – includes training in first aid, assembling a disaster
emergency kit, establishing a predetermined meeting place away from home, and
making a family communication plan
3. Response Stage – begins immediately after the disaster incident occurs
• Includes evacuation, search and rescue, and staging area (the on-site
incident command station), and triage area.
• Disaster Triage – focus is to do as little as possible, for the greatest
number, in the shortest period of time (START triage/ simple triage and
rapid treatment)
4. Recovery Stage – begins when the danger from the disaster has passed and concerned
local and national agencies are present in the area to help victims rebuild their lives and
the community
First Responders – responsible for incident management at the local level (ex: police,
fire, public health, public works, and medical emergency services)
Public Health System – broad term used to describe all of the governmental and
nongovernmental organizations and agencies that contribute to the improvement of the health
of populations.
The Philippine Red Cross

• Officially founded in 1947. PRC carried out 2 main functions: blood provision and
disaster-related services.
• Present-day, offers 6 major services:
1. National Blood Services
2. Safety Services – training in first aid, basic life support, water safety, accident
prevention
3. Social Services – guidance and counseling, psychological support, tracing service,
referral service, early livelihood recovery program, hot meals
4. Volunteer Services
5. Community health and nursing services – Basic Health Education Program, Primary
Health Care
6. Disaster Management Services – relief operations, deployment of disaster response
teams, organization of brgy. disaster action team, preposition of relief supplies
R.A. 10121 – Philippine Disaster Risk Reduction and Management Act; specified the policy
of developing and implementing a National Disaster Risk Reduction and Management Plan
(NDRRMP)
• NDRRMP has 4 priority areas:
1. Disaster prevention and mitigation by reducing vulnerabilities and exposure and
enhancing capabilities of communities
2. Disaster preparedness
3. Disaster response
4. Rehabilitation and recovery
Incident Command System (ICS) – standardized, on-scene, all-hazard incident

management concept
• The Command Staff, composed of people who report directly to the Incident
Commander, usually includes:
1. Public Information Officer – provides the public, media, and/or other agencies with
required information related to the incident
2. Safety Officer – monitors operations related to the incident and advises the Incident
Command on matters of operational safety, including the health and safety of
responding personnel; has the authority to stop any unsafe act.
3. Liaison Officer – takes charge of coordinating with representatives from cooperating and
assisting agencies or organizations.
4. General Staff – responsible for the functional aspects of the incident command structure
Community Responses to a Disaster:

1. Heroic Phase – nearly everyone feels the need to rush to help people survive
a. Medical personnel may work hours without sleep, under dangerous and life-
threatening conditions; may help out in areas in which they’re not familiar and
have no experience
2. Honeymoon Phase – survivors gather together and begin to tell their stories and review
over and over again what has occurred
a. Bonds are formed among victims and health care workers
b. Gratitude is expressed for being alive
3. Disillusionment Phase – feelings of despair arise
a. Medical personnel may begin to experience depression due to exhaustion
b. People realize the way things were before is not the way things are now and
may never be the same again
4. Reconstruction Phase – some sense of normalcy in returning
a. Restored some of the buildings, business, homes and services
b. Counseling support for victims
c. People begin to look to the future
Common Individual Reactions to a Disaster
• Emotional, cognitive, physical, and interpersonal reactions to a disaster usually resolve in
1-3 months after the disaster
• Posttraumatic Stress Disorder (PTSD) – can occur following an individual’s experiencing or
witnessing a life-threatening event; often relive the experience through nightmares and
flashbacks
In this chapter, you have been informed of the care enhancement qualities of nurses
assigned in the community. In this way, we will be able to elicit participation among the
members of the community which is a vital component in developing a better, resilient and
more responsible health care system.
Disasters and emergencies have been increasing all over the world. Todays, with
technological advancement, acquiring knowledge and its application in the realm of action is
regarded as the only effective way for prevent disasters or reducing its effects. It is important
for vulnerable people to learn about disasters. There are different methods to educate
vulnerable people, but no method is better than others. Trained people can better protect
themselves and others. In this regard, planning and designing comprehensive educational
programs are necessary for people to face disasters.
• Good job! You have reached the end of Chapter 3!

• Proceed to the next page and answer the self-assessment exercise.
SEMI-FINAL PERIOD
CHAPTER 3
Activity 1
GIVE IT SOME THOUGHT!

Take some time to think about the questions below. Make your answers brief but concise.
1. What are the main hazards that your community or society is exposed to?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. What disasters have your community or society had to cope with?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. What were the social, economic and political effects of those disasters?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
ƒ
4. What are your community/society’s main vulnerabilities? ƒ
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5. Which groups and persons might be particularly vulnerable? What are they vulnerable to and what
are the sources of their vulnerability?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
6. What capacities, expertise and resources do you have to help minimize disaster risk?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
7. What capacities, expertise and resources can you find in your community/society that can help
minimize disaster risk? ƒ
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
8. How can you use those capacities, expertise and resources for teaching disaster management?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
ACTIVITY 2. Conflict Management

Accomplish the following tasks:
Have you ever experienced being involved in a conflict? Elaborate

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
What conflict-resolution strategy did you apply?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
FINAL PERIOD
CHAPTER 4
This chapter adds information about the community health process, its steps and proper
implementation.
Duration: 12 hours

Application of Nursing Process in the a. The community health care process
Care of the Community b. Community Assessment
c. Community Diagnosis
d. Planning and Priority-setting
e. Implementing the Community Health
Interventions
f. Evaluation of Community Health
Interventions
1. Utilize the nursing process in the management of community health
2. Identify factors that contribute to proper assessment and diagnosis of community’s
needs
3. Plan, organize and implement interventions to improve community health
Let’s Begin!
KEY TERMS
⚫ Community assessment
⚫ Community diagnosis
Let’s begin!
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 governments
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. Target client list
- TCL for prenatal care
- TCL for postpartum care
- TCL of under 1-year-old children
- TCL for family planning
- TCL for sick children
a. National tuberculosis program
b. National leprosy control program central registration form
3. summary table (accomplished by midwife)
4. monthly consolidation table(MTC)
REPORTING FORMS (FHSIS)

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 judgment about the community’s
health status, resources and health action potential.
Factors:
• 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.
• Active participation of the people
• To foster participation, the community should have genuine
representation in the planning group.
• 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.
Criteria 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.
3. Ability to reduce risk

- is related to the availability of expertise among the health team and the
community itself.
- Involves the 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.
Teacher’s Insight:
The effectiveness of community health nursing practice depends on how well the nursing process is
used as a tool to enhance aggregate or population health. It involves appropriate application of a
systematic series of actions with the goal of helping clients achieve their optimum level of health. The
components of the nursing process are assessment, diagnosis, planning, implementation and
evaluation. The concept of community as client refers to a group or population as their focus of
nursing service. The community’s health is reflected in its status, structure, and processes. The nurse
and residents must first establish a relationship of reciprocal influence and exchange before any
change can take place. Interaction could be considered as an essential step in the process.
• Good job! You have reached the end of Chapter 4!

• Proceed to the next page and answer the self-assessment exercise.
FINAL PERIOD
CHAPTER 4
SELF-ASSESSMENT EXERCISES
Activities
1. Make a Needs Assessment Tool based on the profile of your own community
2. Among the identified “needs” in your community, prepare a plan of program to address
the concern. List down all possible interventions and how are you going to evaluate the
program.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Share your experience during your exposure in the community.

Highlight the application of nursing process.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
REFERENCES:
Bailon-Reyes, S. Community Health Nursing: The Basics of Practice, National Bookstore,

2006
Community/ Public Health Nursing Practice: Health for Families (IE), Gail, 2014
David, E. et al., Community Health Nursing: An Approach to Families and Population

Groups. Manila: Merriam and Webster, 2007
DOH-Department of Health National Health Plan
Nursing Care of the Community: A Comprehensive Text on Community and Public

Health (Philippines, 1st ed, Famorca, 2013)
Maglaya, A. Nursing Practice in the Community, 4 th ed, Marikina City:Argonauta

Corporation. 2005
Pender, N.,et al. Health Promotion in Nursing Practice, Singapore: Pearson Educational
Incorporated, 2006
Resource Marterial. Resource Units in NCM 100-105 with Clinical Focus. (2004). Manila,
Philippines,. ADPCN.

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

Community Health Nursing II

For the Individual Learning Portfolio:

Features of the Instructional Learning Guide:

II. Health Statistics and Epidemiology

III. Community Health Care Development Process

IV. Care Enhancement Qualities of health workers in community setting

VII. Disaster Management

V. Application of Nursing Process in the Care of the Community

MAJOR TOPIC/S SUBTOPIC/S

II. Health Statistics and Epidemiology a. Health Statistics

Before you proceed…

- a collection of people who interact with one another ad whose common

Two main types of communities:

✓ Urban – high density, a social heterogeneous population and a complex

2. Phenomenological communities - refers to relational or interactive groups; setting is more

Five Functions of a Community

Characteristics of a Healthy Community

Factors that foster optimum level of community functioning:

1. Access to quality education

2. The community naturally blends into its environment

3. Health care and preventive health services

4. Access to healthy food

5. Fitness and wellness opportunities

3. Remedial Care for Health Problems:

FACTORS THAT AFFECT COMMUNITY HEALTH

II. HEALTH STATISTICS AND EPIDEMIOLOGY

Table 1. Recording of Statistics

Use of Vital Statistics

Definition: Used to describe the relationship between 2 numerical quantities or measures of

Crude or General rates

Definition: Refers to the estimated population as of July 1 of a specified year

Crude birth rate

total no. of live births registered in a given year

Crude death rate

total no. of deaths registered in a given calendar year

Infant Mortality rate

total no. of deaths under 1 year of age registered in a given year

General fertility rate

total no. of live births registered in a given year

Specific Death rate

Deaths in a specific class or group registered in a year

Age specific death rate

No. Of death in a particular age group registered in a given calendar year

Sex specific death rate

No.of deaths of a certain sex in a given year

Cause Specific Death rate

No. of deaths from a specific cause in a given year

Fetal death rate

Total no of fetal deaths in a given year

Neonatal death rate

No. of Deaths under 28 days of age in a given yr.

Maternal Mortality Rate

No. of deaths from maternal causes registered for a given year

No. of Deaths of 50 yrs. Old and above

Proportionate Mortality Rate

No. of registered deaths from a specific cause

Case Fatality Ratio