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CHAPTER IV. NURSING PROCESS IN THE CARE OF POPULATION GROUPS AND

COMMUNITY
LESSON TITLE
Definition of Terms, Community Health Assessment Tools, Community Diagnosis,
Planning Community Health Interventions, Implementing Community Health Interventions,
Monitoring and Evaluating Community Health Programs Implemented, Millennium
Development Goals-Oriented-Community Based Learning Experience Sustainability Program,
Documenting and Reporting .

INTRODUCTION
With your intention as a nurse to advance the health status of the community people,
it is imperative that you must utilize the nursing process in the care of the community.
Likewise, you must recognize that the community is not just the setting or the context for
providing community health nursing. It is the focus of nursing care (Nies and McEwen, 2011).

LEARNING OUTCOMES:
Upon completion of this lesson, you should have:
1. explicated the different assessment tools used in community assessment;
2. described the conditions affecting the health of a given community; and
3. utilized nursing process in managing community health concerns.

WARM-UP ACTIVITY

Based on your prior knowledge on the application of nursing process. Think of word/s
or statement/s that describe/s on how nursing process is implemented in the community
using the letters of the word PROCESS as indicated below. Once done, take a photo your
answer and post it on the discussion forum created by your respective instructor.

P=
R=
O=
C=
E=
S=
S=

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CENTRAL ACTIVITIES

Learning Input 1 – Definition of Terms, Community Diagnosis

A. Definition of Terms

Community Assessment. This refers to the collection of data in the community which serve
as a guide in determining the actual and potential health problems.

Community Diagnosis. It is a quantitative and qualitative description of the health of citizens

and the factors which influence their health. It identifies problems, proposes areas for
improvement and stimulates action.

Census. This is an official count or survey of a population, typically recording various details
of individuals.

Focus Group. It is a small group, usually 6-12 members only.

Key Informants. These are the formal and informal community leaders or persons of position
and influence, such as leaders in local government schools and businesses.

COMMUNITY ASSESSMENT
Community Assessment refers to a process by which community members gain an
understanding of the health, concerns, and health care systems of the community by
identifying, collecting, analyzing, disseminating information on community assets, strengths,
resources, and needs ([Link]
Primarily, it involves the collection of data which is mainly dependent on the objectives
of the assessment. In general, the community health nurse desires to collect data on the three
categories of the community health determinants such as people, place and social system.

A. Community Health Assessment Tools

Generally, sources of data are grouped into primary and secondary data. In fact,
in the community health practice the community itself is the primary source of data.
Primary data are those have not been gathered before and collected by the nurse through
observation, survey and the like. On the other hand, secondary data are primarily taken
from the existing data sources. The following are the tools that are commonly used for
the conduct of community assessment.

1. Collecting Primary Data

a. Observation
This may be done through an ocular or windshield survey, either by driving
or riding a vehicle or walking through it. This gives the community health nurse

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the opportunity to observe the people as well as to take note of the

environmental conditions and existing facilities.

b. Survey
This may be necessary when there is no available when there is no available
information about the community or specific population group to be studied.
According to Mauret & Smith (2009), survey is made up of a series of
questions for systematic collection of information from a sample of individuals
or families in a community which may be written or oral. In addition, a survey
is also appropriate for determining attitudes, knowledge, behaviors and
perception of health and health services. Likewise, it is also used by the nurse
in identifying patterns of utilization of health services (Mauret & Smith, 2009).

c. Informant Review
This denotes to a purposeful talks with either key informants or ordinary
members of the community. According to Lundy & Jane (2009), informant
review provides the nurse valuable information on community perceptions
about the health and health care.
The interview may be structured where the nurse will direct the talk based
on an interview guide, or it may be unstructured where the informant guides
the talk.

d. Community Forum
This refers to an open meeting of members of the community (Lundy &
Janes, 2009). Community forum does not only give the nurse information on
community perceptions on needs, health and health care, but it also an
effective tool in providing the people with medium for expressing their views
and developing their capacity to influence decision makers.
Likewise, community forum may also be used as a venue for informing
people about secondary data, for data validation and for getting feedback from
the community people themselves about the gathered data previously.

e. Focus Group
This method is effective in the assessment of health needs of a specific
groups in the community (Lundy & Janes, 2009. A good example is a focus
group of teenage mothers.

2. Secondary Data Sources

a. Registry of Vital Events
Unfailing civil registration and vital statistics provide a realistic basis for
program planning and implementation. The birth and death registries are of
the particular importance to the community health nurse, since they are
sources of fertility and mortality data.
The R. A. 3753 otherwise known as the Civil Registration Law was enacted
in 1930, established the civil registry in the Philippines that requires the

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registration of vital events like births, marriages and deaths. Correspondingly,

the R.A. 7160 known as the Local Government assigned the function of civil
registration to local governments and mandated the appointment of Local
(municipal/city) Civil Registrars.

b. Health Records and Reports

The Executive Order No. 352 (Office of the President, Republic of the
Philippines specifies that the Field Health Service Information System (FHSIS)
as the official recording and reporting system of the Department of Health and
used by the NSCB to generate health statistics.
Essentially, the FHSIS is a tool in monitoring health status of the population
at the different levels. Thus, it serves as basis for priority setting by local
governments, planning and decision making at barangay, municipality, district,
provincial as well as national levels. Moreover, FHSIS is used for monitoring and
evaluating health program implementation. Detection of unusual occurrence
of diseases is being facilitated. And it also provides a standardized, facility-level
database for more in-depth studies (DOH-LMS, 2011).

c. Disease Registries
Disease registry refers a listing of persons with specific type of disease in a
defined population. The data or information that are collected through disease
registries serve as basis for monitoring, decision making and management of
program (DOH,2011). In fact, the DOH has developed and maintained registries
for HIV/AIDS and chronic noncommunicable diseases, specifically cancer,
diabetes, chronic obstructive pulmonary disease and stroke.

d. Census Data
A census refers to the periodic governmental enumeration of the
population.
The Batas Pambansa Blg. 72 provides for a national census of the
population and other related data in the Philippines for every 10 years. The
Philippine Statistical System (PSS) provides statistical information and services
to the public. The NSCB is the policy-making and coordination body of the PSS,
where the NSO now the PSA (Philippine Statistics Authority) is the PSS arm that
generates general purpose statistics such as population, employment, prices,
and family income/expenditures (Astrologo, 2011).

B. Community Diagnosis
According to World Health Organization (2004), community diagnosis is 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.
Moreover, it is the 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.

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1. Methods to Present Community Data

Community data are presented to the health team and the members of the
community for the following purposes:
a. To inform the health team and members of the community of existing health
and health-related conditions in the community in an easily understandable
manner.
b. To make members of the community appreciate the significance and relevance
of health information to their lives.
c. To solicit broader support and participation in the community health process.
d. To validate findings.
e. To allow for a wider perspective in the analysis of data.
f. To provide a basis for decision making.

Depending on the context and the purpose of the presentation, community

data may be presented as text, in tables, or in pictorial for (maps and graphs). Maps
can be used to show differences or similarities across geographic areas (United
Nations Economic Commission, 2009a). Like for example, barangays may be color
coded in a municipality map to show immunization rates of infants. In divergence,
numeric data are usually more clearly presented through tables and graphs or
charts. Graphs for presenting community data and their uses are the following:

a. Bar Graph. This is use to compare values across different categories of data.
For example, a population pyramid is made up to two horizontal bar graphs
representing the age structure of the male and female population.

b. Line Graph. This is utilize to have a visual image of trends in data over time
or age. For example, the trend of the total fertility rate or average number
of children per woman in the Philippines from 2000-2020.

c. Pie Chart. This is commonly use in showing percentage distribution or

composition of a variable, such as population or households. A pie chart is
an effective tool in highlighting the value of a group in relation to the whole
population. However, it can only illustrate only a small number of
categories, usually not more than six. For example, a pie chart may be used
to visually present the percentage distribution of households based on
environmental variables, such as water source method of refuse, and
excreta disposal.

d. Scatter plot or diagram. This is make to show the correlation between two
variables. The values of both variables in subjects are plotted in a graph
with an x-axis and a y-axis. For example, a diagram may be done to show a
positive correlation between body mass index and waist circumference
among women aged 20 years and above.

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2. Types of Community Diagnosis

a. Traditional Research.
A method of research that follows a systematic or scientific procedure in
which a question is asked and a hypothesis is proposed in which it is either
proved or disproved. This is related to the investigation or experimentation
aimed at the discovery and interpretation of facts or revision of accepted
theories or laws in the light of new facts.

b. Participatory Action Research (PAR)

An approach to research that aims at promoting change among the
participants. Members of the group being studied participate as partners in all
phases of the research, including design, data collection, analysis and
dissemination.

This table below shows the difference of Traditional Research Approach and COPAR as
to decision making emphasis, roles, methodology and output.
Points of Traditional Research COPAR
comparison Approach
Decision making Top-down Bottom-up
Emphasis Expert/Nurse-driven process Community-driven process
Much premium is placed on Premium is placed on the process
the data and output
Roles Nurse as researcher: the Community members as
community members are researchers: the nurse is a facilitator
subjects or objects of and recorder.
research, usually
respondents of the research
instrument. Data analysis is done collectively by
the community.
Data analysis is done by the
nurse, and then presented
to the community.
Methodology Research tools and Research tools and methodologies
methodologies are are identified and developed by the
predetermined/prepackaged community.
by the nurse-organizer.
Output Upon completion, the study Conclusions and recommendations
is packaged, submitted to are made by the community. These
the agency, and published. will lead to agreed community
Recommendations are made actions/projects. The whole
by the researcher based on research cycle continues until it
findings of the study. becomes part of community life,
leading towards community
development. Community members
formulate the recommendations.

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3. Schemes in Stating Community Diagnosis

The community health nurse may choose from the different schemes in
stating community diagnosis as follows:

a. NANDA.
This focused more on individual but in the recent versions, it has included
diagnoses in the community level.

b. Shuster and Goeppinger

It proposed a practical adaptation of a format of nursing diagnoses for
population groups.
Three-part statement of community diagnosis:
• 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.
For example, Risk of maternal complications leading to maternal mortality
among women in (community-related to cost and inaccessibility of skilled birth
attendance and the community members’ perception that skilled birth
attendance and facility-based delivery are not necessary during childbirth.

c. The Omaha System = a comprehensive and research-based classification

system for client problems that exists in the public domain.
#Components of the classification system:
• Problem classification scheme (client assessment)
• Intervention scheme
• Problem rating scale for outcomes

Omaha System Overview

The Omaha System consists of three components that offer a relational, reliable, and
valid structure and set of terms that can link clinical data to demographic, financial,
administrative, and staffing data.

Components Terms Purpose

• 4 domains
Problem Classification Organize assessment
Scheme • 42 problems (needs and strengths) for
• 2 sets of modifiers individuals, families,
and communities

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• Clusters of problem specific

signs/symptoms
• 4 categories
Intervention Scheme Organize multidisciplinary
• 75 targets and 1 other practitioners’ care plans
• Client-specific information and the services they
deliver

• 3 concepts
Problem Rating Scale for Evaluate individual, family,
Outcomes • 5-point Likert-type scale or community change over
time

c. 1. Problem Classification Scheme. This serves as a guide in collecting, classifying,

analyzing, documenting and communicating health-related needs and strengths.

Levels of problems or areas of concern:

1. First and most general level of classification is composed of 4 domains:
➢ Environmental
➢ Psychosocial
➢ Physiological
➢ Health-related behaviors
2. Second level consists of problems or areas of concern under the 4
domains:
➢ Environmental domain (material resources and physical surroundings
both inside and outside the living area, neighborhood, and broader
community)
= Income = residence
= sanitation = neighborhood/workplace safety
➢ Psychosocial domain (patterns of behavior, emotion, communication,
relationships, and development)
= communication w/ = mental health
= community resources = sexuality
= social contact = caretaking/parenting
= role change = neglect
= interpersonal relationship = abuse
= spirituality = growth and development
= grief
➢ Physiological domain (functions and processes that maintain life)
= hearing = respiration
= vision = circulation
= speech and language = digestion/hydration
= oral health = bowel function
= cognition = urinary function

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= pain = reproductive function

= consciousness = pregnancy
= skin = postpartum
= neuromuscular function = communicable/infectious
Condition
➢ Health-related behaviors domain (patterns of activity that maintain or
promote wellness, promote recovery, and decrease the risk of disease)
= nutrition = substance use
= sleep and rest patterns = family planning
= physical activity = health care supervision
= personal care = medication regimen
3. Third level presents the problem or area of concern classified according to
2 sets of qualifiers
➢ Area of concern is categorized into health promotion, potential
problem
➢ Level of clientele (individual, family or community)
4. The fourth and most specific level is made up of clusters of signs and
symptoms that describe the actual problems

d. 2. 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.

Categories:

Teaching, Guidance, and Counseling: Activities designed to provide information and

materials, encourage action and responsibility for self-care and coping, and assist the
individual/family/community to make decisions and solve problems.

Treatments and Procedures: Technical activities such as wound care, specimen

collection, resistive exercises, and medication prescriptions that are designed to
prevent, decrease, or alleviate signs and symptoms of the
individual/family/community.

Case Management: Activities such as coordination, advocacy, and referral that

facilitate service delivery, improve communication among health and human service
providers, promote assertiveness, and guide the individual/family/community
toward use of appropriate resources.

Surveillance: Activities such as detection, measurement, critical analysis, and

monitoring intended to identify the individual/family/community's status in relation
to a given condition or phenomenon.

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c. 3. Problem Rating Scale for Outcomes. This 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. Knowledge is defined as what the client knows, Behavior as what the client
does, and Status as the number and severity of the client’s signs and symptoms or
predicament. Each of the subscales is a continuum providing an evaluation framework
for examining problem-specific client ratings at regular or predictable times.
Suggested times include admission, specific interim points, and dismissal.

Concepts and Ratings of the Problem Rating Scale for Outcomes:

Concepts 1 2 3 4 5
Knowledge: No Minimal Basic Adequate Superior
Ability of the client to knowledge knowledge knowledge knowledge knowledge
remember and
interpret information
Behavior: Not Rarely Inconsistently Usually Consistently
Observable appropriate appropriate appropriate appropriate appropriate
responses, actions, behavior behavior behavior behavior behavior
or activities of the
client fitting the
occasion or purpose
Status: Extreme Severe signs/ Moderate Minimal No signs/
Condition of the signs/ symptoms signs/ signs/ symptoms
client in relation to symptoms symptoms symptoms
objective and
subjective defining
characteristics

SAMPLE APPLICATION OF THE OMAHA SYSTEM

Influenza Outbreak: Reduce Disease Transmission in a Community

Information Obtained during a Project/Incident:

Bloom County, population 120,000, is a metropolitan county in Minnesota. The

residents became the client of this case study when they experienced the first confirmed
influenza case during the winter holiday season. Unfortunately, the person was employed as
a clerk at a store located in a large regional shopping mall, continued to work while feeling ill
during the busy holiday season, and exposed many people. The clerk died five days after
becoming ill.

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Residents began to panic. Although the health department quickly exhausted their
supply of vaccine, the U.S. Centers for Disease Control and Prevention sent enough doses for
all county residents the following week. The Bloom County Health Department then offered
24-hour/day immunization clinics. Many of the clinics were inundated with worried residents
and security became a concern. In addition, there were numerous people including friends,
family members, and co-workers of confirmed cases who experienced mild symptoms of fever
and cough. It was not possible to know if they were experiencing the early stages of influenza
and needed to be quarantined to protect others, or a milder illness.

The health department's health educators, public health nurses, and other staff
conducted an aggressive media campaign with the help of the state health department and
local pharmacists, physicians, health care facilities, stores, churches, and other community
groups. In addition to providing information about disease prevention and treatment and how
to obtain vaccine, the campaign included warnings about the limitations of the vaccine and
the need to reduce contact with others. Many residents were unwilling to follow a voluntary
quarantine especially because it was the holiday season; few events were cancelled or
postponed and event attendance decreased minimally. Despite a public plea to schedule
appointments with health care providers for specific symptoms, many residents continued to
visit local emergency departments.

Health department staff conducted contact investigations for documented influenza

cases and attempted to quarantine exposed family members. Staff members worked with the
state health department to disseminate accurate and timely public information and quell the
rising panic of the public. By the time the influenza outbreak ended, the county experienced
more than 200 cases and 31 deaths.

Application of the Omaha System:

DOMAIN: PHYSIOLOGICAL
Problem: Communicable/infectious condition (high priority)
I. Problem Classification Scheme
Modifiers: Community and Actual

SIGNS/SYMPTOMS OF ACTUAL:

• infection
• fever
• positive screening/culture/laboratory results
• inadequate supplies/equipment/policies to prevent transmission
• does not follow infection control regimen
• inadequate immunity

II. Intervention Scheme

Category: Teaching, Guidance, and Counseling
TARGETS AND CLIENT-SPECIFIC INFORMATION:

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• anatomy/physiology (transmission)
• communication (distributed information about the disease, how to obtain anti-
viral medication/its limitations; attempted to reduce public panic)
• education (sessions about reducing risk of transmission)
• infection precautions (effective preventive measures and actions including
voluntary quarantine and visits to usual health care providers)
• medical/dental care (appropriate/adequate use-medical home versus
emergency room)

Category: Treatments and Procedures

TARGETS AND CLIENT-SPECIFIC INFORMATION:

• Medication administration (anti-viral medication for those who were ill)

Category: Case Management

TARGETS AND CLIENT-SPECIFIC INFORMATION:

• Communication (health department organized media campaign supported by

many individuals and groups)
• Infection precautions (enforced quarantine for exposed residents)

Category: Surveillance
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• Infection precautions (conducted contact investigation, monitored

adherence, tracked reports of cases and deaths)

III. Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (most residents were aware of outbreak, those
who were ill knew they needed to receive the anti-viral medication-not aware of
other precautions; some were overly concerned)
Behavior: 3-inconsistently appropriate behavior (most residents who were ill
received anti-viral medication; many would not restrict their activities/follow
voluntary quarantine)
Status: 2-severe signs/symptoms (extensive influenza infection with many cases and
deaths, monitored statistics)

Activity 1 (Lecture): A short quiz will be uploaded in the mVLE.

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Learning Input 2: Planning and Implementing Community Health Interventions, Monitoring

and Evaluating Community Health Programs

C. 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
diagnoses.
Planning is a logical process of decision making to determine which of the
identified health concerns requires more immediate consideration (priority setting)
and what actions may be undertaken to achieve goals and objectives.

1. Priority Setting
This step provides the nurse and the health team with a logical means of
establishing priority among the identified health concerns. The WHO has suggested
the following criteria to decide on a community health concern for intervention:

• Significance of the problem is based on the number of people in the

community affected by the problem or condition.
• The level of the community awareness and the priority its members
give to the health concern is a major consideration.
• Ability to reduce risk is related to the availability of expertise (Shuster
and Goeppinger, 2004) among the health team and the community
itself.
• In determining cost of reducing risk, the nurse has to consider
economic, social, and ethical requisites and consequences of planned
action/s.
• Ability to identify the target population for the intervention is a matter
of availability of data sources, such as FHSIS, census, survey reports,
and/or case-finding or screening tools.
• 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.

STEPS IN PRIORITY SETTING:

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.
1. From a scale of 1 to 10, 1 being the lowest, the members give each
criterion a weight based on their perception of its degree of
importance in solving the problem.

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2. From a scale of 1 to 10, 1 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 the
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 problem. The problem with the highest
total priority score is assigned top priority, the next highest is assigned
second priority, and so on.

IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS

a. Health Status Problems. This is described in terms of increased or decreased
morbidity, mortality, fertility or reduced capability for wellness

b. Health Resources Problems. This is described in terms of lack or absence of

manpower, money, materials or institutions necessary to solve health problems

c. Health-Related Problems. This is described in terms of existence of social, economic,

environmental and political factors that aggravate the illness-inducing situations in the
community

PRIORITY SETTING
a. Nature of the condition/problem presented – problems are classified as health
status, health resources or health-related problems
b. Magnitude of the problem – 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 – refers to the probability of controlling or reducing the
effects posed by the problem
d. Social concern – 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
PRIORITIZING HEALTH CONDITIONS/PROBLEMS: SCORING SYSTEM
CRITERIA SCORE WEIGHT
Nature of the Problem
a. Health Status 3
b. Health Resource 2 1
c. Health-related 1
Magnitude of the Problem
a. Affects 75 – 100% of the population 4
b. Affects 50 – 74% of the population 3 3
c. Affects 25 – 49% of the population 2
d. Affects less than 25% of the population 1

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Preventive Potential
a. High 3
b. Moderate 2 4
c. Low 1
d. Not modifiable 0
Preventive Potential
a. High 3
b. Moderate 2 1
c. Low 1
Social Concern
a. Urgent community concern; expressed readiness for 2
action 1 1
b. Recognized as a problem but not needing immediate 0
action
c. Not a community concern

a. 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.
SMART (specific, measurable, attainable, realistic, time-bound)

b. Deciding on Community Development Interventions/Action Plan

The group analyzes the reasons for people’s health behavior and directs
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 resources on the other
hand.

D. Implementing Community Health Interventions or Action Phase

The entire process is intended to enhance the community’s capability in dealing
with common health conditions/problems. The nurse’s role is to facilitate 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 other sectors such as the local government and other
agencies may also be necessary.

1. Importance of Partnership and Collaboration

A community partnership is a collaborative relationship between willing
entities formed to address shared objectives. Effective partnerships leverage the
strengths of each partner and apply it strategically to the issue at hand. It might
take more work, and it might take longer, but strong partnerships build the

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relationships, shared understanding, and collective focus to make lasting progress

on issues related to community and economic development.

Collaboration is a process of participation through which people, groups,

and organizations work together to achieve desired results. Collaborations
accomplish shared vision, achieve positive outcomes for the audiences they serve,
and build an interdependent system to address issues and opportunities.
Health and health-related problems in the community are varied, most
often they are complicated and too many that the nurse and the people or
organizations could not handle. Therefore, they need to work with other people
or groups to increase the probability of accomplishing the goals that they have
set. The nurse must plan to establish and maintain valuable working relationships
with people such as people’s organizations, health organizations, educational
institutions, the local government units, financial institutions, religious groups,
socio-civic organizations, sectoral groups and the like.
The aim of partnership and collaboration is to get people to work together
in order to address problems or concerns that affect them. It gives people the
opportunity to learn skills in group relationship, interpersonal relations, critical
analysis and most important of all, decision-making process in the context of
democratic leadership.

Importance:
a. greater efficiency and less duplicated effort.
b. access to additional resources or lower costs through sharing
c. improved service coordination across agencies, with better pathways or
referral systems for service users
d. a holistic approach to meeting client needs, with better and more efficient
access to the range of services required, improved quality and consistency
of service and greater responsiveness to needs
e. organizational knowledge and improved service system capability
f. greater innovation and flexibility to respond to changing, emerging or more
complex client needs and changing operations and operational
environments
g. access to up-to-date information, new ideas and strategic thinking
h. improved capacity to demonstrate best practice
i. political and lobbying strength
j. increased capacity to successfully submit tenders or expressions of interest
and to deliver projects, and
k. additional expertise, support or legal protection for small, new, or struggling
organizations.

2. Activities Involved in Collaboration and Advocacy

Advocacy work is one way the nurse can promote active community
participation. The nurse helps the people attain optimal degree of independence
in decision-making in asserting their rights to a safe and better community.

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Advocacy work involves:

a. Informing the people about the rightness of the cause. The nurse conveys the
problem to the people, shows how it affects them and describes what possible
actions they can take.
b. Thoroughly discussing with the people the nature of the alternatives, their
content and possible consequences. While discussing the alternatives, the
community’s needs and problems are amplified and eventually become the
basis for decision-making.
c. Supporting people’s right to make a choice and to act on their choice. The
nurse puts emphasis on the people’s right to decide on actions that they think
should benefit the community.
d. Influencing public opinion. The nurse affirms the decision made by the people
by getting powerful individuals and groups to listen, support and make
substantial changes to solve the problem.

3. Community Organizing and Social Mobilization (taken in COPAR Concept)

4. Programs
a. Proper excreta disposal
b. Food Safety Sanitation
c. Vermin and Vector Control
d. Built Environment

E. Monitoring and Evaluating Community Health Programs Implemented

1. Designing and Implementing Evaluation Plan
In order to find out if the programs and services achieved the purpose for
which they were formulated, the nurse and the community pose the question
“How do we know we are there?”
This is the phase of the planning cycle that determines whether the
program is relevant, effective, efficient and adequate. It is concerned with finding
out the specific input, process and output/outcome indicators of the program
stating the criteria and standards of each. This exercise is called evaluation.

a. Monitoring = refers to an organized process of overseeing and checking the

activities undertaken in a project, to ascertain whether it is capable of
achieving the planned results or not.

b. Evaluation = the process by which we judge the worth or value of something.

This is a scientific process that gauges the success of the project or program in
meeting the objectives

Evaluation involves two processes: observation and measurement. The

nurse observes, then compares the observed data with some criterion standard
or indicators of good performance.

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Two approaches of evaluating a program:

• Qualitative methods of evaluation = determine the meaning and
experience of the program for the people involved; and interprets the
effects that may be observed.
• Quantitative methods = measure and score changes occurring as a
result of the program.

Aspects of a program to be evaluated:

• Process evaluation = measures the activities of the program, its
quality and who is reaching out
• Impact evaluation = measures the immediate effects of the
program and determines whether the objectives of the program
were met
• Outcome evaluation = measures the long-term effects of the
program and determines if it meets the goal of the program

2. Types of Evaluation
a. Formative
o Definition
▪ Evaluates a program during development in order to make early
improvements
▪ Helps to refine or improve a program
o Uses
▪ When starting a new program
▪ To assist in the early phases of program development
o Examples
▪ How well is the program being delivered?
▪ What strategies can we use to improve this program?
b. Summative
o Definition
▪ Provides information on program effectiveness
▪ Is conducted after the completion of the program design
o Uses
▪ To help decide whether to continue, end, or expand a program
o Examples
▪ Should funding continue for this program?
▪ Should service expand to other after-school programs in the
community?
c. Process
o Definition
▪ Focuses on program implementation
▪ Determines whether specific program strategies were implemented as
planned
o Uses
▪ To determine why an established program has changed over time

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▪ To address inefficiencies in program delivery

▪ To accurately portray program operations to outside parties (e.g., for
replication elsewhere)
o Examples
▪ Did your program meet its goals for participant recruitment?
▪ Did participants receive the specified number of service hours?
d. Outcomes
o Definition
▪ Focuses on the changes in comprehension, attitudes, behaviors, and
practices that result from program activities
▪ Can include both short- and long-term results
o Uses
▪ To decide whether an activity affected participants’ outcomes
▪ To establish and measure clear benefits of the program
o Examples
▪ Did your participants report the expected changes after completing a
program cycle?
▪ What are the short- or long-term results observed among (or reported
by) participants?
e. Impact
o Definition
▪ Focuses on long-term, sustained changes as a result of program
activities, both positive and negative and intended and unintended
o Uses
▪ To influence policy
▪ To see impact in longitudinal studies with comparison groups
o Examples
▪ What changes in your program participants’ behaviors are attributable
to your program?
▪ What effects would program participants miss out on without this
program?

3. Steps of Program Evaluation

a. Establish stakeholders
b. Describe the program
c. Select evaluation design
d. Collect data
e. Generate conclusions
f. State findings and provide recommendations

Activity 2 (Lecture) – Short Quiz

A short quiz will be uploaded in the mVLE.

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Wrap-up Activity
Answer each of the questions briefly but concise in not more than 2 sentences:

1. What was the most important thing you learned in Chapter 2?

2. What question still remains in your mind?

Assessment
Answer the post-evaluation (long) examination posted in the mVLE.

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