CONCEPT OF THE COMMUNITY

A community is a group of people who:

1. Have common interests or characteristics

2. Interact with one another
3. Have a sense of unity or belonging
4. Function collectively within a defined social structure to address common concerns.

Principles of Community Health Nursing

1. Focus on the community as the unit of care.

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

Conditions in the Community Affecting Health

1. People
2. Location
3. Social System

Characteristics of a Healthy Community

1. A shared sense of being a community based on history and values

2. A general feeling of empowerment and control over matters that affect the community as a
whole
3. Existing structures that allow subgroups to participate in decision-marking in community
matters
4. The ability to cope with change, solve problems, and manage conflicts within acceptable
means
5. Open channels of communication and cooperation among the members of the community
6. Equitable and efficient use of community resources, with the view towards sustaining
natural resources.
 School of Nursing
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NCM 113 - COMMUNITY HEALTH NURSING 2

WEEK 1

THE COMMUNITY HEALTH NURSE

ROLES OF THE COMMUNITY HEALTH NURSE

1. CASE MANAGER
Assisting clients to make decisions about appropriate health care services and
to achieve service delivery integration and coordination which are among the
important roles of the community health nurse.
2. ADVOCATE
Clients in the community health nursing setting frequently are unable to
negotiate for change in the health care system. The nurse seeks to promote an
understanding of health problems, lobby for beneficial public policy and
stimulate supportive community action for health
3. TEACHER
Application of teaching – learning principles to facilitate behavioral
changes among clients is a basic intervention strategy in community
health.
4. PARTNER & COLLABORATOR
The aim of partnership and collaboration is to get people to work
together in order to address problems or concerns that affect them.
The community health nurse establishes and maintains valuable
working relationships with people such as people’s organization, health
organizations, educational institutions, socio-civic organization,
sectoral groups and the like.

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 Through health education, communities and health professional bodies
can become geared up to demand for change and begin to effect the
transformation in public policy that will address social and
environmental inequalities and therefore improve health.
5. HEALTH PLANNER/PROGRAMMER
• Identifies needs, priorities and problems of individuals, families and
communities
• Formulates nursing component of health plans. In doctor less area, she is
responsible for the formulation of the municipal health plan
• Interprets and implements the nursing plan, program policies, memoranda
and circulars for the concerned staff/personnel
• Provides technical assistance to rural health midwives in health matters.

6. MANAGER/SUPERVISOR
• Formulates individual, family, and aggregates centered care plan
• Interprets and implements program policies, memoranda and circulars
• Organizes work force, resources, equipments and supplies and delivery of
health care at local levels.
• Provides technical and administrative support to Rural Health Midwife
(RHM). Conducts regular supervisory visits and meetings to different
RHMs and give feedback on accomplishments/performances
7. COMMUNITY ORGANIZER
• Responsible for motivating and enhancing community participation in
terms of planning, organizing, implementing, and evaluating health
programs/services
• Initiates and participates in community development activities.
8. HEALTH EDUCATOR/TRAINER
• Identifies and interprets training needs of RHMs, Barangay Health
Workers/Volunteers (BHW/BHV) and Hilots
• Formulates appropriate training program designs
• Provides and arranges training and learning experiences of nursing and
midwife affiliates
• Conducts trainings for health personnel
• Acts as resource speaker on health and health related services as the
need arises
• Participates in the development and distribution of Information
Education and Communication (IEC) materials

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 9. CASE FINDER
• Because of the nurse proximity to families and aggregates in the
community, case finding has been a strategic role for many years.
• Example: at risk children are identified and followed periodically as
they developed
10. EPIDEMIOLOGIST
• The nurse uses the epidemiological method to study disease and health
among population groups and to deal with community-wide health
problems.
• Collecting data on health problem and care is an important
epidemiological role. Reasons why people do and do not use health
care are important elements in planning health services.
11. RECORDER/REPORTER/STATISTICIAN
• Prepares and submit required records and reports
• Review, validates, consolidates, analyzes, and interprets all records and
reports
• Maintains adequate, accurate and complete recording and reporting
12. COMMUNITY LEADER
The CHN, being a leader, a role model and respected in the community
is in a better position to empower others.
Empowerment is giving your influence to others for purpose of
personal and organization growth.

MAJOR FUNCTIONS & ACTIVITIES OF THE COMMUNITY HEALTH NURSE

I. ADMINISTRATION & MANAGEMENT

A. Planning & Programming

• Participate in the formulation of the city health plan. Develop the
nursing service component of the plan.
- Collect , process and analyze data needed for planning.
- Make data projection.
- Identify nursing needs, problems and requirement.
- Establish priorities.
• Formulate program for implementing nursing plan.
- Set time frame for activities.

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 - Modify plans based on need and requirements for nursing
inputs.
- Discuss nursing programs with community leaders organized
groups and health related agencies.
B. Oversee the Nursing Inputs into the different programs
• Determine needs of nursing personnel for training/development or for
administrative support.
• Interpret needs of nursing personnel for administrative support.
C. Monitoring
• Monitor status of implementation of nursing inputs.
- Provide feedback to community and health related groups/agencies of
nursing inputs in programs.
- Provide feedback in the implementation of results of studies research
in nursing services.
- Redirect nursing programs as required.
• Maintain/Review records and reports on nursing services.
- Process reports.
- Verify data if required.
- Identify strengths and weaknesses in the delivery of health services.
- Submit reports on nursing services periodically.
D. Evaluation
• Assess periodically strategies and activities as to their effectiveness and
appropriates.
-Utilize monitoring tools in collecting data at specified periods.
- Make recommendations.
• Assess extent objectives of nursing inputs are attained.
-Review objectives in relation to outputs of nursing component.
- Study strategies/alternative chosen for implementation in relation
to objectives.
- Make recommendations.
- Discuss finding and recommendations.

E. Coordination
• Identify groups in the community through which nursing
programs/services can be implemented.

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 - Utilize various methods in identifying groups/health related
agencies which provide community services.
-Establish and maintain updated directory.
• Coordinate nursing inputs with other health programs elements.
-Identify the inter-relationship of nursing inputs with the inputs of
other health discipline and related agencies.
-Define working relationship that could promote coordination.
-Promote effective working relationship of groups and within the
group.
-Monitor group activities.
• Identify groups in the community through which nursing
programs/services can be implemented.
- Utilize various methods in identifying groups/health related
agencies which provide community services.
-Establish and maintain updated directory.
F. Resources
1. Staff
• Review needs/requirements for staff to implement nursing component
in the health programs.
-Determine the job requirements of the programs for nursing inputs.
- Review present staffing pattern and capabilities.
- Study other resources which can be utilized to extend existing staff.
-Interpret and discuss needs.
• Plan for adequate implementation of nursing inputs in terms of existing
staff.
-Look at quality/quantity of expected outputs from nursing.
- Plan for the effective utilization of nursing manpower.
2. Physical Facilities
• Determine programs needs for physical facilities to implement the
nursing components.
- Look at details required of present facilities and geographic location
which influence effective delivery of nursing inputs.
- Assess needs for new physical facilities modifying of present facilities.
- Discuss with physical charge and make recommendations.
• Interpret needs for essential working and sanitation facilities for nursing
personnel.
-Determine minimum requirements for delivery of safe nursing services.

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 - Make recommendations.
-Discuss with physician in charge and community leaders.
G. Logistics
• Determine needs and requirements of programs for logistics supports of
instruments for delivery of nursing services.
- Look at quantity and quality of supplies, materials, equipments and
instruments for delivery in charge.
- Identify anticipated requirements.
- Discuss with physician in charge.
• Implement the accepted system, for maintenance and replenishments
of stock levels in health centers.
- Utilize the logistic system.
• Assess and monitor states of supplies/equipment.
- Check monthly reports on logistics of health center.
- Verify information by comparing report with management.
- Discuss findings with staff, physician in charge.

II. TECHNICAL
A. Patient/Family Health
• Determine nursing needs/requirements.
-Perform physical examination and home selected laboratory
procedures.
- Relate findings with community and home environment.
- Assess family health needs in relation to patient health needs.
- Interpret findings to patient/family.
• Provide/arrange for nursing services.
-Plan care.
- Identify objectives to patient/family.
- Set priorities.
- Assess effectiveness of nursing care.
- Teach or guide patient/family in health promotion, disease or
accident prevention and rehabilitation.
- Refer cases needing further care to the head of the health
department or to other health facility.
- Follow-up of priority cases.
B. Disaster Emergency

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 • Plan with staff the nursing inputs for disaster/emergency situation.
- Identify needs and requirement for nursing services.
- Determine man power needs and logistics supports for delivery of
nursing inputs.
- Contribute to the plan by identifying nursing inputs.
• Identify nursing inputs of community/health-related agencies
organization.
- Participate in the planning of nursing inputs
- Assure the coordination of nursing inputs with other agencies.
• Participate in implementing plan.
- Assist in the implementation of the plan.
- Monitor implementation of nursing inputs in the plan.
C. Epidemiology
• Maintain surveillance of occurrence of symptoms of notifiable disease.
- Study utilization of medicines and relate to health problems.
- Identify age groups/areas affected.
- Conduct investigation to define problems.
- Reports findings to physician.
- reports notifiable disease.
• Participate in conducting epidermiological invetigation.
- Assist in processing data.
D. Environmental Sanitation
• Relate aspects of environmental situation of the family/community to the
planned nursing inputs of health programs.
- Include environmental element of the community in supervisory visits.
• Coordinate the nursing inputs with environmental santitation activities.
- Plan the education contribution of nursing to coincide with programs
environmental sanitation activities.
- Refer problems identified to sanitarian.

III. SUPPORTIVE

A. Community organization
• Participate in informing community about services and community
inputs in health care.

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 - Determine what community can contribute.
- Explain the contribution and needs for nursing.
- encourage group/community participation.
• Organize groups to assist and support the implemetation of nursing
programs.
- Establish communication lines with groups among groups.
- Plan with groups’ specific contribution, the time froms and resources
needs.
- Identify outputs.
- Monitor/Coordinate group activities.
B. Health education
• Assure that health education intagrated in all nursing inputs gear on
health education to health problems of family/community obtain
appropriates information materials.
C. Staff Development and Training of Manpower
• Relate findings of supervisory visits to training requirement .
- Identify competencies headed by nursing personnel in implementing
new programs.
- Interpret the needs.
• Plan for ways of meetings, training development needs of nursing
personnel.
- Relate needs to type of training/development program needs utilize
varied methods in developing capabilities of staff.
- Recommend for special training of staff.
• Conduct/participate in training development program.
- Conduct orientation and on the job training.
- Assist personnels in re-entry and utilizing knoledge/skills gained in the
work situation.
- share new techniques with nursing staff.
D. Research Development
• Identify areas in health and/or nursing services needing
investigation and research.
- Review the monitored information of nursing services.
- Select areas whom research is feasible and would have an impact
in the delivery of nursing services.
- Participate in the selction of the reasearch areas in which nursing a
component.

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 • Participate in the implementation of studies/research.
- Look at planned activities to fit in the research activities.
- Oversee/monitor nursing inputs in the research activities.
• Participate in the documentation of the findings and in the
designation and utilization of such to concerned groups.
- Oversee the processing of data.

REFERENCES

1. COMMUNITY HEALTH NURSING: An Approach to Families and Population

Group -Erlinda David, Maria Jesusa Lourdes Rodolfo, Virginia Serraon-
Claudio, Adela Jamorabo-Ruiz

2. NURSING CARE OF THE COMMUNITY: A comprehensive text on community

and public health nursing in the Philippines – Zenaida U. Famorca, Mary A.
Nies, Melanie Mcewen

"

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 School of Nursing

NCM 113 – COMMUNITY HEALTH NURSING 2

COMMUNITY DIAGNOSIS
• the process of determining the health status of the community and the factors
responsible for it.
• aims to obtain general information about the community’s profile to determine the
community’s strength and weaknesses. It is in knowing its profile, that the community
can resolve its health problems and needs.

According to Freeman & Heinrich (1981), community health diagnosis is based on three
interdependent, interacting and constantly changing conditions:

1. The health status of the community, including the population’s level of vulnerability
• An estimate of the health status relates the characteristics of two factors, namely: the
people and the environment. This is consistent with the epidemiologic approach that
Finnegan & Ervin (1989) described as a model for community assessment in which
measurable variables to describe the person, place and time support the presence of an
actual or potential community health problem.

2. Community health capability or the ability of the community to deal with its health
problems
• The community’s capacity to promote or sustain health depends on the extent of its
economic, institutional and human resources. The mere presence or availability of such
resources does not necessarily guarantee people’s health. People need to make out how
these resources can be optimally used their advantage.

3. Community action potential, or the patterns in which the community is likely to work on
its problems.
• Communities take different courses of action to address their health needs and problems.
Each develops its own approach to mobilize community participation for health. The nurse
assesses the community for its attributes that determine the pattern of health action.
Freeman & Heinrich (1981) describe the following important aspects of community health
action:

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 a. Value people give to health over their other needs in life that provide the forward
motion for health action – is the health problem perceived to be important to the
people? Is it perceived to need immediate attention? Are there other concerns in the
community that take priority?
b. Community’s relationship with the political system and government institutions that
support health actions – How responsive is the government to the health needs and
problems of the community? To what extent does the political system or government
institutions allow for people’s organizations’ participation in decision-making about
planning and implementation of health actions?
c. Habits that the community has developed for dealing with common problems – is
there genuine partnership among all stakeholders to push the agenda of promoting
and sustaining health in the community? What are the different approaches or.
Strategies that they have developed and implemented?

TYPES OF COMMUNITY DIAGNOSIS

1. COMPREHENSIVE COMMUNITY DIAGNOSIS

• Aims to obtain a general information about the community.

2. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS

• Type of assessment that responds to a particular need.
• For example, a nurse is confronted with health and medical problems resulting
from mine tailings being disposed into the river systems by a mining company.

Since a community diagnosis investigates the community-meaning, the people

and its environment the nurse proceeds with the identification of the population
who were affected by the hazards posed by mine tailings. Then she goes on to
characterize the environmental factors along with the other elements which are
relevant to the specific problem being investigated.

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS

A. DEMOGRAPHIC VARIABLES
1. Total Population and geographical distribution including urban-rural index and
population density
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth rate, crude death rate and life
expectancy at birth
4. Patterns of migration
5. Population projections
6. Household size

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 • The above parameters are of importance to the CHN because these
describes the population being served, suggest their health risk and
needs, growth or decline, who are those potential to increase exposure to
communicable diseases and affects resources needed.

• It is also important to know whether there are population groups that

need special attention such as indigenous people, internal refugees and
other socially dislocated groups as a result of disasters, calamities and
development programs.

B. SOCIO-ECONOMIC AND CULTURAL VARIABLES

1. SOCIAL INDICATORS
a. Educational level which may be indicative of poverty and may reflect on health
perception and utilization pattern of the community (includes schools, types of
education, literacy rates, day care centers)
b. Housing conditions which may suggest health hazards (congestion, fire, exposure
to elements)
c. Social Classes or groupings

THERE ARE NO LIMITS AS TO THE LIST OF SOCIO ECONOMIC AND CULTURAL

FACTORS THAT MAY DIRECTLY OR INDIRECTLY AFFECT THE HEALTH STATUS OF THE
COMMUNITY. HOWEVER THE NURSE SHOULD CONSIDER THE FOLLOWING AS
ESSENTIAL INFORMATION:

2. ECONOMIC INDICATORS
a. Poverty level income
b. Unemployment and underemployment rates
c. Proportion of salaried and wage earners to total economically active population
d. Types of industry present in the community
e. Occupation common in the community.
f. Communication network (whether formal or informal channels) necessary for
disseminating health information or facilitating referral of clients to the health care
system
g. Transportation system including road networks necessary for accessibility of the
people to health care delivery system

C. ENVIRONMENTAL INDICATORS
A. Physical/geographical/topographical characteristics of the community
• Land areas that contribute to vector problems

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 • Terrain characteristics that contribute to accidents or pose as geohazard zones
• Land usage in industry
• Climate/season
B. Water supply
• % population with access to safe, adequate water supply
• Source of water supply
C. Waste disposal
• % population served by daily garbage collection system
• % population with safe excreta disposal system
• Types of waste disposal and garbage disposal system
D. Air, water and land pollution
• Industries within the community having health hazards associated with it
• Air and water pollution index
E. Cultural Factors
a. Variables that may break up the people into groups within the community such
as:
• Ethnicity
• Social class
• Language
• Religion
• Race
• Political orientation
b. Cultural beliefs and practices that affect health
c. Concepts about health and illness

D. HEALTH & ILLNESS PATTERNS

1. Leading causes of mortality
2. Leading causes of morbidity
3. Leading causes of infant mortality
4. Leading causes of maternal mortality
5. Leading causes of hospital admission

E. HEALTH RESOURCES
1. Manpower resources
a. Categories of health manpower available
b. Geographical distribution of health manpower
c. Manpower-population ration
d. Distribution of health manpower according to type of organization
(government, non-government, health units, private)
e. Quality of health manpower
f. Existing manpower development/policies
2. Material resources
a. Health budget and expenditures

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 b. Sources of health funding
c. Categories of health institutions available in the community
d. Hospital bed-population ration
e. Categories of health services available

F. POLITICAL/LEADERSHIP PATTERN
1. Power structures in the community (formal or informal)
2. Attitudes of the people toward authority
3. Conditions/events/issues that cause social conflict/upheavals or that lead to
social bonding or unification
4. Practices/approaches that are effective in settling issues and concerns within the
community.

The political and leadership pattern is a vital element in achieving the goal of high
level wellness among the people. It reflects the action potential of the state and
its people to address the health needs and problems of the community. It also
mirrors the sensitivity of the government to the people’s struggle for better lives.
In assessing the community, the nurse escribes the following:

• At the end of the assessment phase, the Community Health Nurse should have
a list of priority health and nursing problem.
• After which, the nurse now formulates a community diagnosis.

COMMUNTIY DIAGNOSIS: THE PROCESS

The process of community diagnosis consists of collecting, organizing, synthesizing,
analyzing and interpreting health data.
This process reflects the community health nurse competencies essential for
assessment and analysis in public health.

The initial tasks done by the nurse prior to community diagnosis includes:
1. Prepare materials and tools needed for interview (e.g. survey forms, household list, local
calendar, clip board and ballpen)
2. Organize the community diagnosis team (e.g. activities and function) and
3. Inform the community

STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

1. DETERMINING THE OBJECTIVES

• This is the precise statement of the community’s problem.

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 • The nurse decides on the depth and scope of the data he needs to gather.
• Based and most important is to achieve his goal on health promotion and disease
prevention. The nurse gathers data on the geographic, economic, political, social,
cultural and behavioral conditions important to disease control and wellness
promotion.

2. DEFINING THE STUDY POPULATION

• Based on the objectives of the community assessment, the nurse identifies the
population group to be included in the study.
• It may include the entire population or focused on a specific population (e.g. infant and
young children or elderly population

3. DETERMINING THE DATA TO BE COLLECTED

• Establishing guidelines on what needs to be assessed help the nurse organize the data
collection process and to identify factors that influence a community’s state of
wellness.
• Basically, the objective set in first step, will guide the nurse in identifying the specific
data to be collected and the sources of these data.

4. COLLECTING THE DATA

• A systematic approach to data collection is needed in order to obtain a comprehensive
profile of community’s level of functioning or competence.

Methods to collect data

a. Records review
b. Surveys and observations
c. Interviews
d. Participant observation

Windshield survey – a common method of community assessment , simply

the OCULAR SURVEY.

5. DEVELOPING THE INSTRUMENTS

• Instruments or tools facilitates the nurse’s data-gathering activities. The following are
the most common instruments that the nurse use in her data collection:
a. Survey questionnaire
b. Interview guide
c. Observation checklist

6. ACTUAL DATA GATHERING

• The process of obtaining existing, readily available data.
• It usually describes the demographic characteristics such as age, gender, socio-
economic status.

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 • It includes vital statistics, such as selected morbidity and mortality rate.
• Prior to data gathering, the nurse meet the individuals who will be involved in the data
collation to familiarize them on the instruments to be used.
• During the actual data gathering, the nurse supervises and monitors the data collectors
by checking the filled up instruments in terms od completeness, accuracy and reliability
of the information collected.

7. DATA COLLATION
• The first step of the processing of data.
• The data from the questionnaire are organized and the number of times each answer is
given is counted.
• There are two types of data that may be generated:
1. Numerical data (can be counted)
2. Descriptive data ( can be described)

• After data collection, the nurse is now ready to put together all the information.

8. DATA PRESENTATION
• Results of the community diagnosis may be presented to members of the community or
to the key leaders.
• Descriptive data is merely presented in narrative reports (e.g. geographic data, beliefs
regarding illness/death)
• Numerical data are presented in table or graphs, showing key information, showing
comparisons including patterns and trends.
• Your findings when presented shall be simple and easy to understand.

EXAMPLE OF DATA PRESENTATION

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9. DATA ANALYSIS
• Critical reflection and data analysis in community diagnosis aims to establish trends
and patterns in terms of health needs and problems of the community.
• The nurse identifies the origins and effects of the problem, the points at which
intervention might occur, and the parties that have an interest in the problem and
its solution

10. IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS

Community health nursing problems are categorized as:
1. Health status problems – they maybe described in terms of increased or
decreased morbidity, mortality, fertility or reduced capability for wellness
2. Health resources problems – they may be described in terms of lack of or
absence of manpower, money, materials or institutions necessary to solve health
problems
3. Health related problems – they may be described in terms of existence of social,
economic, environmental and political factors that aggravate the illness-inducing
situations in the community.

11. PRIORITY SETTING

• After the problems have been identified, the next task for the nurse and the
community is to prioritize which health problems can be attended to
considering the resources available at the moment.

In priority setting the nurse makes use of the following criteria:

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 a. Nature of the condition/problem presented – the problems are classified by the nurse as
health status, health resources or health related problems;
b. Magnitude of the problem – this refers to the severity of the problem which can be
measured in terms of the proportion of the population affected by the problem;
c. Modifiability of the problem – this refers to the probability of reducing, controlling or
eradicating the problems;
d. Preventive potential – this refers to the probability of controlling or reducing the effects
posed by the problem;
e. Social concern – this refers to the perception of the population or the community as they
are affected by the problem and their readiness to act on the problem

• Each problem will be scored according to each criterion and divided by the
highest possible score multiplied by the weight.
• Then the final score for each criterion will be added to give the total score for
the problem.
• The problem with the highest total score is given high priority by the nurse.

REFERENCES:

1. COMMUNITY HEALTH NURSING: An Approach to Families and Population

Group -Erlinda David, Maria Jesusa Lourdes Rodolfo, Virginia Serraon-
Claudio, Adela Jamorabo-Ruiz
2. NURSING PRACTICE IN THE COMMUNITY: fifth edition, Araceli S. Maglaya

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PROF. LENIE R. AGPALASIN

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