Nursing Process in

the Care of
Population Groups
and Community

CHN2 team 2021

Community Health Assessment Tool
A. Primary Data Collection- the community is the
primary source of data. Primary data are data
that have not been gathered before and are
collected by the nurse through observation,
survey, informant interview, community forum,
and focus group discussion.
 Primary data collection:
● Observation- rapid observation of a community may
be done through an ocular survey, either by riding a
vehicle or walking.

● Survey- made up of a series of questions for

systematic collection of information from a sample
of individual or families
● Informant interview- purposeful talks with either
key informants or ordinary members of the
community.
1. Structured interview- the nurse directs the talk based
on an interview guide.
2. Unstructured interview- the informant guides the talk
● Community forum- an open meeting of the
members of the community (ex. Pulong pulong sa
barangay)
- Besides data gathering, the community forum may
also be used as a venue for informing the people
about secondary data, for data validation, and for
getting feedback from the people themselves about
previously gathered data.
● Focus group
A focus group differs from a community forum in the
sense that the focus group is made up of a much
smaller group , usually 6- 12 members only(Maurer
and Smith, 2009). Example: first- time pregnant
woman
B. Secondary Data Collection- taken from
existing data sources. Going over secondary
data first gives the nurse a picture of what is
already known about the population under
study, which may facilitate collection of
primary data.
SECONDARY DATA SOURCES
1. Registry of vital events-Act 3753(Civil Registration
Law, Philippine Legislature), enacted in 1930,
established the civil registry system in the Philippines
and requires the registration of vital events such as
births, marriages and deaths.
- R.A 7160(Local Government Code) assigned the
function of civil registration to local governments and
mandated the appointment of local (City/municipal)
Civil Registrars.
- The PSA serves as the central repository of civil
registries and the Civil Registrar General of the
philippines.
SECONDARY DATA SOURCES

2. Health Records and Reports

As specified by Executive Order No. 352(Office of the

President, Republic of the Philippines, 1996), the Field Health
Service Information System (FHSIS) is the official recording
and reporting system of the Department of Health and is used
by the NSCB to generate health statistics
The FHIS MAnual of operations lists and describes the following recording
tools:

1. The individual Treatment Record (ITR) is the building block of the FHIS. it contains
the date, name, address of patient, presenting symptoms or complaint of the patient
on consultation, and the diagnosis, treatment, and date of treatment.
2. Target Client Lists (TCLs) are the second building block of the FHSIS. It is used to
plan and carry out patient care, to facilitate monitoring and supervision of service
delivery activities, and to report services delivered.
3. Summary table is accomplished by the midwife. It is a 12-column table in which
columns correspond to the 12 months of the year. This record is kept at the BHS and
has 2 components: Health Program Accomplishment and Morbidity/ Diseases.
4. The monthly Consolidation table(MCT) is accomplished by the nurse based on the
summary table.it serves as the source document for the quarterly form and the output
table of the RHU or health center.
 The reporting forms, as enumerated in the FHSIS
manual of Operations are the following:
1. Monthly forms are regularly prepared by the midwife and submitted to the nurse,
who then uses the data to prepare the Quarterly forms.
a. Program report (M1)- contains indicators categorized as maternal care, child care,
family planning, and disease control.
b. Morbidity report (M2)- contains a list of all cases of disease by age and sex.
2. Quarterly forms are usually prepared by the nurse. There should only be one
quarterly form for the municipality/ city.
c. Program report(Q1)- contains the three month total of indicators categorized as
maternal care, family planning, child care, dental health, and disease control.
d. Morbidity report(Q2)- is a 3- month consolidation of morbidity report(M2)
3. Annual forms:
a. A- BHS is a report by the midwife that contains
demographic, environmental, and natality data.
b. Annual form 1 (A-1) is 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 form 3 (A-3) also prepared by the nurse, is the yearly
report of all deaths (mortality) by age and sex.
SECONDARY DATA SOURCES

3. Disease Registries- A listing of persons

diagnosed with a specific type of disease in the
defined population. Data collected through disease
registries serve as basis for monitoring, decision-
making,and program management.
SECONDARY DATA SOURCES

4. Census data- a census is a periodic governmental

enumeration of the population. During a census,
people may be assigned to a locality by de jure or
de facto method. De jure assignment is based on the
legally established place of residence of people,
whereas de facto is according to the actual physical
location of the people(NSCB, 2012).
METHODS TO PRESENT
COMMUNITY DATA
1. Bar Graph- to compare values across different
categories of data.
2. Line graph- to have a visual image of trends in data
over time and age.
3. Pie Chart- to show percentage distribution or composition of a
variable, such as population or households.
4. Scatter plot or diagram- to show correlation between two variables.
The values of both variables in subjects are plotted in a graph with an x-
axis and a y- axis.
Community
Diagnosis
Community Diagnosis
-The process of determining the health status of the community
and the factors responsible for it. The term is applied both to the
process of determination and to its findings(WHO, 2004)
- It is a quantitative and qualitative description of the health of
citizens and the factors that influence their health. Community
diagnosis allows identification of problems and areas of
improvement, thereby stimulating action(WHO, 1994)
TYPES OF
COMMUNITY
DIAGNOSIS
1. Traditional research approach
2. Participatory action research
(PAR)
Points of comparison Traditional research approach COPAR

Decision Making Top- down Bottom- up

emphasis expert/ nurse- driven process community - driven process
Much premium is placed on the data Premium is placed on the
and output process

Roles Nurse as researcher: the community Community members as

member are subjects/ objects of the researchers: the nurse is a
research instrument facilitator and recorder
Data analysis is done by the nurse and Data analysis is done collectively
then presented to the community. by the community.

Methodology Research tools and methodologies are Research tools and

predetermined/ prepackaged by the methodologies are made by the
nurse organizer. community.

Output Upon completion, the study is packaged, Conclusions and

submitted to the agency, and published. recommendations are made by
Recommendations are made by the the community.
researcher based on the findings of the
study.
Schemes in Stating
Community
Diagnoses
● SHUSTER AND GOEPPINGER
Shuster and Goppinger (2004)proposed a practical adaptation of a
format of nursing diagnoses for population groups previously
presented by Green and Slade (2001) The three- part statement
consist of:

1. The health risk or specified problem to which the community is

exposed.
2. The specific aggregate or community with whom the nurse will
be working to deal with the risk or problem.
3. Related factors that influence how the community will respond
to the health risk or problem.
● OHAMA SYSTEM
- The Ohama System has been used as a framework
for the care of individuals, families, and
communities by nurses, nursing educators,
physicians, and other health care providers.
- It is a comprehensive and research- based
classification system for client problems that exists
in the public domain, meaning, it is not held under
copyright.
The Ohama classification system has three
components that are to be used together:
1. A problem classification scheme(client assessment)- serves as a guide in collecting ,
classifying, analyzing, documenting , and communicating health and health- related
needs and strengths.
2. Intervention Scheme (care plans and services)- The Intervention Scheme is
designed to describe and communicate multidisciplinary practice, practice
that is intended to prevent illness, improve or restore health, decrease
deterioration, and/or provide comfort before death.
3. Problem Rating Scale for Outcomes (client change/evaluation)- The Problem
Rating Scale for Outcomes is a method to evaluate client progress
throughout the period of service. It consists of three five-point, Likert-type
scales to measure the entire range of severity for the concepts of
Knowledge, Behavior, and Status.
 Domains and Problems of the Problem Classification
Scheme

1. Environmental Domain: Material resources and physical

surroundings both inside and outside the living area, neighborhood,
and broader community.
● Income
● Sanitation
● Residence
● Neighborhood/workplace safety
2. Psychosocial Domain: Patterns of behavior, emotion,
communication, relationships, and development.

● Communication with community resources

● Social contact
● Role change
● Interpersonal relationship
● Spirituality
● Grief
● Mental health
● Sexuality
● Caretaking/parenting
● Neglect
● Abuse
● Growth and development
3. Physiological Domain: Functions and processes that
maintain life

Hearing ,Respiration
Circulation, Neuro-musculo-skeletal function,
Vision
Digestion,hydration, Consciousness ,
Bowel function, Skin,
Urinary function, Pain,
Reproductive function, Oral health,
Pregnancy, Cognition,
Postpartum, Speech and language,
Communicable/infectious condition
4. Health-related Behaviors Domain: Patterns of activity that
maintain or promote wellness, promote recovery, and decrease the
risk of disease.

● Nutrition
● Sleep and rest patterns
● Physical activity
● Personal care
● Substance use
● Family planning
● Health care supervision
● Medication regimen
PLANNING COMMUNITY HEALTH
INTERVENTIONS
1. PRIORITY SETTING
THIS STEP PROVIDES THE NURSE AND THE HEALTH TEAM WITH A
LOGICAL MEANS OF ESTABLISHING PRIORITY AMONG THE
IDENTIFIED HEALTH CONCERNS.

WHO has suggested the following criteria to decide on a community health

concern for intervention:

1. Significance of the problem- based on the number of people in the

community affected by the problem or condition.
2. Community awareness- when people are aware of the risk arising from
a condition pervasive in the community, they are likely to have the
motivation to deal with the condition and give it a priority.
3. Ability to reduce risk- it is related to the availability of
expertise(Shuster and Goeppinger, 2004) among the health team and the
community itself.

4. In determining cost of reducing risk, the nurse has to consider

economic, social, and ethical equisites and consequences of planned
action.

5. Ability to identify the target population for the intervention is the

matter of availability of data sources such as FHSIS, census, survey
reports, and/ or case- finding or screening tools.

6. Availability of resources to intervene in the reduction of risk entails

technological, financial, and other material resources of the community,
the nurse, and the health agency.
 2. 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. Defines the desired step- by-
step family responses as they work toward a goal.
 Specific, measurable, attainable, relevant, and time- bound (SMART)
objectives provide a solid basis for monitoring and evaluation.

SPECIFIC- the objective clearly articulates who is expected to do what

MEASURABLE- observable, measurable, and whenever possible, quantifiable
indications of the family’s achievement as a result of their efforts toward a goal provide
a complete basis for monitoring and evaluation.
ATTAINABLE- the objective has to be realistic and in conformity with available
resources, existing constraints, and family traits, such as style and functioning.
RELEVANT- the objective is appropriate for family need or problem that is intended to
be minimized , alleviated or resolved.
TIME-BOUND- having a specified target time or date helps the family and the nurse in
focusing their attention and efforts toward the attainment of the objective(Doran, 1981)
3. Deciding on community interventions
Because of their inherent differences, what may work for one
community may not be effective in another .
The group analyzes the reasons for people’s health behavior and
direct strategies to respond to the underlying causes.
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
 IMPLEMENTING THE COMMUNITY
HEALTH INTERVENTIONS
It is often referred to as the action phase, implementation is the most exciting
phase for most health workers.

The entire process is intended to enhance the community’s capability in dealing

with common health conditions/ problems.

The nurse’s role therefore is to facilitate the process rather than directly
implement the planned interventions.

Collaboration with other sectors such as the local government and other
agencies may also be necessary.
EVALUATION OF COMMUNITY HEALTH
INTERVENTIONS
 EVALUATION OF COMMUNITY HEALTH
INTERVENTIONS
Evaluation approaches maybe directed towards structure, process, and/ or
outcome.
● STRUCTURE EVALUATION- involves looking into the manpower and
physical resources of the agency responsible for community health
interventions.
● PROCESS EVALUATION- is examining the manpower by which
assessment, diagnosis, planning, implementation, and evaluation were
undertaken.
● OUTCOME EVALUATION- is determining the degree of attainment of
goals and objectives.
 Standards of evaluation
The bases of good evaluation are:

1. Utility- is the value of the evaluation in terms of results. This will provide the
basis for utilizing the community health process in dealing with other community
concerns in the future.
2. Feasibility- answers the question of whether the plan for evaluation is doable or
not, considering available resources(time, facilities, and expertise).
3. Propriety- involves ethical and legal matters. Respect for the worth and dignity of
the participants in the data collection should be given due consideration.
4. Accuracy- refers to the validity and reliability of teh results of evaluation.
Accurate evaluation begins with accurate documentation while the community
health process is ongoing.
Types of evaluation:

Formative evaluations are used primarily to provide

information for initiative improvement by examining the
delivery of the initiative, its implementation, procedures,
personnel, etc.

Summative evaluations, in contrast, examine the initiative's

outcomes and are used to provide information that will assist
in making decisions regarding the initiative's adoption,
continuation or expansion and can assist in judgments of the
initiative's overall merit based on certain criteria.

Comprehensive evaluations combine both process and

outcome questions.
Steps of program evaluation:
1. Planning
The relevant questions during evaluation planning and implementation involve
determining the feasibility of the evaluation, identifying stakeholders, and
specifying short- and long-term goals.

2. Implementation — Formative and Process Evaluation

Evaluation during a program’s implementation may examine whether the
program is successfully recruiting and retaining its intended participants,
using training materials that meet standards for accuracy and clarity,
maintaining its projected timelines, coordinating efficiently with other
ongoing programs and activities, and meeting applicable legal standards
3. Completion — Summative, Outcome, and Impact Evaluation
Following completion of the program, evaluation may examine its immediate
outcomes or long-term impact or summarize its overall performance,
including, for example, its efficiency and sustainability. A program’s outcome
can be defined as “the state of the target population or the social conditions
that a program is expected to have changed,” (Rossi et al., 2004, p. 204).

4. Dissemination and Reporting

To ensure that the dissemination and reporting of results to all appropriate
audiences is accomplished in a comprehensive and systematic manner,
one needs to develop a dissemination plan during the planning stage of the
evaluation. This plan should include guidelines on who will present results,
which audiences will receive the results, and who will be included as a
coauthor on manuscripts and presentations.
COMMUNITY
ORGANIZING
 COMMUNITY ORGANIZING
Community organizing as a process consists of steps or activities that instill
and reinforce the people’s self- confidence on their own collective strengths
and capabilities(Manalili, 1990)

Community organizing is the process of educating and mobilizing members

of the community to enable them to resolve community problems.
The emphases of community organizing in
primary health care are:
1. People from the community working together to solve their own
problems
2. Internal organizational consolidations a prerequisite to external
expansion
3. Social movement first before technical change
4. Health reforms occurring within the context of broader social
transformation
Community development is the end goal of of
community organizing and all other efforts towards
uplifting the status of the poor and marginalized.
Community development will have to be defined and
visualized by the community members and their
participation is crucial in the attainment of this vision.
Core principles in Community Organizing

1. CO is people- centered: the basic premise of any community organizing

endeavor is that the people are the means and ends of development, and
community empowerment is the process and the outcome.(Felix, 1998)
2. CO is participative: the participation of the community in the entire process-
assessment, planning, implementation and evaluation- should be ensured.
3. CO is democratic: it is a process that allows the majority of people to
recognize and critically analyze their difficulties and articulate their
aspirations.
4. CO is developmental: CO should be directed towards
changing current undesirable conditions.

5. CO is process- oriented: The CO goals of

empowerment and development are achieved through a
process of change.
 Goals of community organizing
1. People’s empowerment- through the process of CO, people learn to
overcome their powerlessness and develop their capacity to maximize their
control over the situation and start to place the future in their own hands.
2. Building relatively permanent structures and people’s organizations- CO
aims to establish and sustain relatively permanent organizational structures
that best serve the needs and aspirations of the people.
3. Improve quality of life- CO also seeks to secure short- and long- term
improvements in the quality of life of the people.