OTHER AREAS OF community public health

nursing
A. SCHOOL NURSING- traditionally it is defined as :
1. School health services
2. School health education
3. A healthy school environment both physical and psychosocial aspects
v RA 124, 1947 (Philippines) an act to provide Medical Inspection of Children
Enrolled in Private schools, Colleges, universities
vThe law stated that, it is the duty of the school heads with a total of .>300
enrolment to provide for a part-or full time physician for the annual medical
examination ofpupils and students. – under the direct supervisionof DOH

• WHO ( 1950) Expert Committee on School Health Services recognized that:

“ effectively, children need good health.”
• Most common of low school enrolment :
• nutritional deficiencies
• Poor health in school-age children
1980s- ROLES AND RESPONSIBILITIES OF
SCHOOLS REDEFINED
• The evolving roles resulted to the expansion of components
to 8
4. health promotion of school personnel
5. School-community projects and outreach
6. Nutrition and food safety
7. Physical education and recreation
8. Mental health , counseling and social support
DepEd order no. 43 s.2011
• Directs the INTEGRATION OF SCHOOL HEALTH NURSING PROGRAM
(SHNP)
• School based services
1. Comprehensive School Health Education ( grade k-12)-addresses the
physical ,mental, emotional & social dimensions of health, the HEALTH
EDUCATION includes
ü Personal health, family health,consumer health, environmental health, sexuality
education, mental and emotional health, injury prevention and control of disease,
substance abuse and abuse.
2. Physical education and Activity- this is promoted through a variety of planned
physical activities
3. Nutrition services
4. School health services
5. School counseling, psychological and social services
NURSE’S ROLE IN THE SCHOOL SETTING
I. PRIMARY PREVENTION
üNutrition education
üImmunizations
üSafety
üHealth education
II. SECONDARY PREVENTION
üScreening
üCase finding
üHome visits
III. TERTIARY PREVENTION
üReferral of students for substance abuse or behavior problems
üPrevention of complications and adverse effects
üFaculty & staff monitoring
Source: Neis,M, & Mcewen, M., Community and Public Helath nursing 2nd edition, pp 45-50
2. OCCUPATIONAL HEALTH NURSING
• Art.23- United Nations Declaration of Human Rights states that:
“Everyone has the right to work, to free choice of employment, to
just and favorable conditions of work.”
The government-thru Occupational safety and health (OSH)- DOLE
-was given the rule-making and true enforcement powers to
implement the stipulations of the Phil Constitution and Phil Labor
Code thru its Occupational Safety and Health Center ( OSHC)
Aim: promotion and maintenance of the highest degree of
physical , mental and social well-being of workers in all occupations.
OCCUPATIONAL HEALTH NURSING derives its
theoretical, conceptual and factual framework
from a multidisciplinary base.
I. Nursing science – to provide the context of health care delivery and
recognize the needs of individual, family groups and populations with
the framework of prevention, health promotion and illness and injury
care management
II. Medical science- specific treatment and management of occupational
health illness and injury integrated with nursing health surveillance
activities
III. Occupational health science – including toxicology, to recognize route of
exposure, examine relationships between chemical exposure in the
workplace and acute and latent health effects such a burns, cancer, and
understand dose-response relationship
 Occupational health strategies :
Assessment & control of hazards in the workplace
• Health hazards- elements in the workplace that can cause work-
related disease
• How? – risk anticipation and assessment by creating a job-safety
analysis.
1. Administrative control
2. Engineering- adaptation of chemical, physical or technological
improvements
3. Material provision-PPEs to decrease exposure to hazards
4. Supplementation-lab works, health care

Source: Neis,M, & Mcewen, M., Community and Public Helath nursing 2nd edition, pp 45-50
 NCM 113
Community Health Nursing
(Population Groups and Community)

Health Statistics and

Epidemiology

GUILLERMO A. AMBID III, MPA, LPT, RN

Lecturer
Learning Objectives:
1. Assess the health status of the population groups and communities.
2. Prioritize community health nursing needs and concerns.
3. Develop community diagnosis
4. Formulate a community health care plan based from prioritized health needs.
5. Implement safe and quality interventions to address health needs, problems and issues.
6. Provide appropriate evidence-based community health interventions using a
participatory approach.
7. Monitor and evaluate outcomes of health projects, programs and services,
8. Document client’s responses/ nursing care services rendered and processes/outcomes
of the nurse- client working relationship.
Course content:
D. Implementing Community Health
A. Community Health Assessment
Interventions
Tools
1. Importance of Partnership and Collaboration
1. Collecting Primary Data
2. Activities Involved in Collaboration and Advocacy
2. Secondary Data Sources
3. Community Organizing and Social Mobilization
Methods of present 4. Core Principles in Community Organizing
Community Data 5. Goals of Community Organizing
6. Community Organizing Participator Research
B. Community Diagnosis
1. Types
2. Schemes in Stating Community
E. Monitoring and Evaluating Community Health
Diagnosis
Programs
1. Designing and Implementing Evaluation
C. Planning Community Health 2. Types of Evaluation
Interventions 3. Steps of Program Evaluation
1. Priority Setting
2. Formulating Goals and Objectives F. Documentation and Reporting
3. Deciding on Community 1. Family Health Records
Interventions/Action Plan 2. Community profile
A. Community Health Assessment Tools
• Three Important tools in identifying community’s health needs.
• Demography
• Vital Statistics and
• Epidemiology

 Population
To recognize the health  the physical and topographical characteristic
status of the community  Socio- economic and cultural factors
these elements are to be  health and basic social services and
considered:
 the power structure within the community
1. Collecting primary data
Primary data are directly obtained to answer the community diagnosis objectives

A. Observation –
•This method provides an opportunity to check the validity or truth of many verbal statements.
•It is an important and useful method of collecting data when informants are unable to directly
supply information.

B. Survey- Ocular survey or windshield survey walking or driving through community appreciating what
can be seen and perceived as the people go along with their daily lives.
C. Informant Interview- It involves asking and answering questions following a systematic procedure
aimed at yielding first-hand information from the subject of inquiry.
1. Face-to-face interview ,
2. Telephone interview , D. Community Forum
3. Individual interview ,
4. Group interview
5. Structured interview,
6. Unstructured interview
E. Focus Group Discussion-
It is very popular method appropriate in the community
 to elicit and explore opinions of people,

 determine their attitudes and practices regarding a limited set of concept

2. Secondary Data Sources

• Data that are obtained by other people which can be used to answer the community diagnosis objectives.
• Records are written information that are kept in folders.
• Data may be obtained by reviewing those that have been compiled by health or non-health agencies the
government or other sources

ü Registry of Vital Events

ü Health Records and Report
ü Disease Registries
ü Census Data
[Link] of present Community Data
1. Survey questionnaire
- Form one uses to document the data being collected
2. Focus group discussion guide
- Serves to facilitate the direction and flow of exchange of ideas on specific topics or
concepts among the participants
3. Key informant interview guide
- Helps give direction to the person doing the interview using a set of prepared
questions on a very specific subject.
4. Observational checklist
B. Community Diagnosis
1. Types of Community Diagnosis

 Comprehensive Community Diagnosis

 Problem-Oriented Community Diagnosis

v Comprehensive Community Diagnosis

•Aims to obtain general information about the community through

epidemiologic approach, socio-economic approach, and behavioral approach

v Problem-Oriented Community Diagnosis- Characterize the biophysical,

psychological, physical environmental, socio-cultural and behavioral as well as system
factors relevant to specific problem being investigated.
A. Demographic Variables
Shows the size, composition and geographical distribution of the population.

Total population and geographical distribution including urban-rural

index and population density
1. Age and sex composition
2. Household size
3. Selected vital indicators
4. Patterns of migration
5. Population projections
B. Socio-Economic and Cultural Variables
Socio-economic and cultural factors that directly or indirectly affect the health status of the community.

Data about leading causes of illness and deaths and their

1. Social indicators
respective rates of occurrence
2. Economic indicators
1. Leading causes of mortality
3. Environmental indicators
2. Leading causes of morbidity
4. Cultural factors
3. Leading causes of infant and child mortality
5. Health and Illness Patterns
4. Leading cause of maternal mortality
5. Leading cause of hospital admission
6. Leading cause of clinic consultation
7. Nutrition status
D. Health Resources
Resources that are available in the community that essential in the delivery of basic health services

1. Manpower resources – human resources in the health system. People who provide
health services. All personnel involved in planning, managing, and delivering health
care.

*Importance: without qualified health manpower, facilities and equipment alone

cannot meet community health needs.

2. Material resources – these are the physical and consumable items needed to support
health services. Facilities, equipment, and supplies used in the provision of health care.
Ex. Health Centers, hospital, clinics (buildings), Medical equipments, Medicines, IEC
Materials

*Importance: Even the most skilled health workers cannot function well without the
proper tools, facilities and supplies.
Steps in Conducting Community Diagnosis
1. Determining the objectives
2. Defining the study population
3. Determining the data to be collected
Schemes in Stating Community Diagnosis
Diagnosis
After analyzing the data, the next step is to make a definitive statement (diagnosis)
identifying what the problem is or the needs are. Nursing diagnoses for communities may
be formulated regarding the following issues:
• Inaccessible and unavailable services
• Mortality and morbidity rates
• Communicable disease rates
• Specific populations at risk for physical or emotional problems
• Health-promotion needs for specific populations
• Community dysfunction
• Environmental hazards (ANA, 1986)
 Note:
The format of the problem statement varies, depending on the
philosophy of the agency conducting the assessment.
• For example, problems or needs may be stated simply in epidemiological terms, such
as a high rate of adolescent pregnancies, whereas in other instances you may be asked
to state the problem or need as a nursing diagnostic statement.
North American Nursing Diagnosis Association (NANDA) classification system of nursing diagnoses
focused on the physical needs of individual clients but was not applicable to the family and community
situations faced by community health nurses.

1. NANDA classification system has expanded to include biological, psychological,

and social needs of individuals and families. Because of ongoing refinement, the
taxonomy of nursing diagnoses at present has 11 functional health patterns.
Tools have been developed to assess the community using the functional health pattern
typology (Gikow & Kucharski, 1987; Wright, 1985).
Newer NANDA diagnoses may also apply to communities; examples include the
diagnoses impaired home maintenance and impaired social interaction.
2. Omaha System, Omaha Visiting Nurse Association
- and has been used in home care, public health, and school health practice
settings, among others.
- Client problems/needs/concerns are organized into four domains:
- physiological,
- psychosocial,
- health-related behaviors, and
- environmental.
Each domain may involve actual or potential problems or opportunities for
health promotion.
•The system includes four categories of interventions: teaching, guidance, and
counseling; treatments and procedures; case management; and surveillance.
Although originally developed for application with individuals or families, users
are now applying the problem domains and interventions with communities
(Martin, 2005).
•The Omaha System includes more environmental and community factors than
are considered in the NANDA system.
OMAHA SYSTEM-
is a research-based, comprehensive practice and

documentation standardized taxonomy designed to describe

client care
i s a s t a n d a rd i ze d h e a l t h c a re t e r m i n o l o g y
consisting of an assessment component (Problem
Classification Scheme ), a care plan/services
c o m p o n e n t ( I n t e rve n t i o n S ch e m e ) , a n d a n
evaluation component (Problem Rating Scale for
Outcomes).
3. SHUSTER AND GOEPPINGER
• a locality-based entity, composed of systems of formal
organizations reflecting society's institutions, informal groups
and aggregates

Community diagnoses should include these four parts:

[Link] problem.
[Link] population or vulnerable group.
[Link] effects of the problem on the population/vulnerable
group.
[Link] indicators of the problem in this community.
Quick Comparison Table

Feature NANDA-I Omaha System Shuster & Goeppinger

Standardized nursing Documentation & Public health/community

Main Role
diagnoses outcome measurement nursing framework

Home health, community Public health & population

Setting Clinical & community
health health

Classifying problems + Health promotion &

Focus Naming problems
tracking outcomes prevention

Measures change in
Broad population health
Strength Specific, precise diagnoses knowledge, behavior,
application
status
 Categories of Community Health Nursing Problems
A. Health status problems

B. Health resources problems

C. Health-related problems

Planning Community Health Interventions

After the problems have been identified, the next task is to prioritize which health problems can be
attended to considering available resources, limitations and constraints

A. Nature of the condition/problem

1. Priority Setting
B. Magnitude of the problem
Criteria
C. Modifiability of the problem
D. Preventive potential
E. Social concern
2. Formulating Goals and Objectives
Goal and Objective Setting

Goals and objectives will serve as guide to the efforts of the nurse and the
people to address the health problem.

Goal is a desired end. It is directed towards solving the health status

problems that were identified in the community diagnosis. It states the
ultimate desire state.

Objectives are more precise. They are considered as planned end

point of all activities and are concerned with the resolution of the
health problem itself. They have to be stated in specific and measurable
terms. ( SMART)
Goals and Objectives will serve to address the health problems.

[Link] is the present health condition of the people in the community

B. Why are the people in the community in such condition?
[Link] are the roots of these problems
[Link] solution will address the problems?

The goal of a program is directed at addressing the health problem while the
objectives addressed the risk factors. The sub- objectives address the
contributing risk
Goal corresponds to Health Problem
Objective corresponds to Risk factors
Sub-objective corresponds to Contributing risk factors
3. Deciding on Community Interventions/Action Plan
In community health nursing involves the orderly process of assessing the
What is planning ?
health problems and needs of the community.

Approaches to planning health programs

Community-based approach which empowers the people to address their health needs and
problems
Integrated approach which considers various dimensions of health and development
Comprehensive approach which strikes at the root of the problem and address the social
determinants of health
 APPROACHES TO PLANNING HEALTH PROGRAMS
Participatory Planning for Community Health

•For community and health development programs and services to become relevant,
responsive and sustainable, planning should involves people’s participation.

•People’s participation enables the community to become an integral part of the

decision-making and action process ( WHO, 1995 ) and guarantees the integration of
their indigenous knowledge and serves as social preparation for the program plan’s
implementation (WHSMP-PC, 2003 ) the whole process of engaging the community in
planning the process starts by analyzing how the nurse looks at the people or the community
in the scheme of development work.

•Planning for sustainable community health development grounded on health

promotion and wellness can only be achieved when programs and projects utilize three
important approaches (Tuazon et al 2003)
1. Community-based approach which empowers the people to address their health needs and problems

2. Integrated approach which considers various dimensions of health and development such as
changing lifestyle, changing environment and reorienting health care systems

3. Comprehensive approach which strikes at the root of the problem and address the social
determinants of health

PRECEDE it corresponds to the assessment phase of the model involving

social, epidemiological, behavioral/environmental, educational/ecological
and administrative and policy assessments. Since the model examines the
different dimensions, it is guaranteed a more comprehensive perspective of
addressing a health problem.
PROCEED embodies the implementation and evaluation phase and stands
for policy, regulatory and organizational construct in educational and
environmental diagnosis.
Comparison Table

Feature Community-Based Integrated Comprehensive

Scope Local & specific Multiple linked services Broad, all-encompassing

Service efficiency &

Focus Local needs All determinants of health
coordination

Level Barangay / local Sectoral collaboration Provincial / national

Long-term systemic
Strength Relevance, ownership Resource efficiency
change

Limitation Limited scope Complex management High cost, slower results

Planning for Health Promotion
The Planning Cycle

 Situational Analysis gather health data, tabulate, analyze, and interpret data.
Identify health problems, set priority

 Goal and Objective Setting Define program goals and objectives, Assign
priorities among objectives

 Strategy/ Activity Setting Design intervention and programs and strategies,

Ascertain resources, Analyze constraints and limitations

 Evaluation Determine outcomes, Specify criteria and standards

Situational Analysis
•In this phase of planning cycle the nurse together with the community identify and provide explanation to the
problems

• Stages in Conducting Situational Analysis

•Phase 1 Social Diagnosis How the situation affects the quality of life of the population in its social term

•Phase 2 Epidemiological Diagnosis- Determine how the situation affects the health of the population in
epidemiological terms.

•Phase 3 Behavioral and Environmental Diagnosis- What aspects of the problem can be solved by people
adopting new behaviors or alternative lifestyle/ what aspects can be altered by changes in the environment

•Phase 4 Educational and Organizational Diagnosis- Which of the behaviors are due to predisposing factors/
which are due to enabling factors or reinforcing factors

•Phase 5 Administrative and Policy Diagnosis which of the factors can be modified through education or
through advocacy.
•Strategy and Activity Setting

•Defines the strategies and the activities that the nurse and the community set to
achieve in order to realize the goals and objectives. The nurse facilitates the
community define the strategy or approach in health program.

•The particular phase of planning cycle involves three activities

1. Designing the health programs or services

2. Budgeting involve specifying the requirements of each program in relation to

the necessary resources and considering constraints that may hamper
implementation of program and activities

3. Making a time plan or schedule helps the community organize the activities
in such a way that time, money and efforts are not wasted.
 D. Implementing Community Health Interventions
1. Importance of Partnership and Collaboration
Working together enables organizations to accomplish their goals much quicker because resources,
skills and views are pooled together.

•2. Activities Involved in Collaboration and Advocacy Activities Involved in Collaboration

 Networking
 coordination
 cooperation
 collaboration
 coalition or multi- sector collaboration
Activities involved in advocacy
1. Informing the people about the rightness of the cause.
2. Thoroughly discussing the people the nature of the alternatives.
3. Supporting people’s right to make choice and act on their choice.
4. Influencing public opinion.

3. Community Organizing and Social Mobilization

Community organizing is a process whereby the community
members develop the capability to assess their health needs and
problems, plan and implement actions to solve their problems,
put up and sustain organizational structures which will support
and monitor implementation of health initiatives by the people.
4. Core Principles in Community Organizing
•Democracy and social welfare;
• Community roots for community programs;
• Citizen understanding, support, and participation and professional
service;
• Co-operation;
• Social Welfare Programs;
•Adequacy, distribution, and organisation of social welfare services; and.
• Prevention.
 5. Goals of Community Organizing
•Community organizing is the process by which people come together to
identify common problems or goals, mobilize resources, and, in other
ways, develop and implement strategies for reaching the objectives they
want to accomplish. ...
•Gaining an understanding of the community.

6. Community Organizing Participatory Research

COPAR stands for Community Organizing Participatory Action Research
 A social development approach that aims to transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and politically responsive community.
 A process by which a community identifies its needs and objectives, develops confidence to take
action in respect to them and in doing so, extends and develops cooperative and collaborative
attitudes and practices in the community (Ross 1967).
• A continuous and sustained process of educating the people to understand
and develop their critical awareness of their existing condition, working with
the people collectively and efficiently on their immediate and long-term
problems, and mobilizing the people to develop their capability and readiness
to respond and take action on their immediate needs towards solving their
long-term problems (CO: A manual of experience, PCPD).
Process
The sequence of steps whereby members of a community come together to critically assess to evaluate
community conditions and work together to improve those conditions.
Structure
Refers to a particular group of community members that work together for a common health and health
related goals.
Emphasis
1. Community working to solve its own problem.
2. Direction is established internally and externally.
3. Development and implementation of a specific project less important than the development of the
capacity of the community to establish the project.
4. Consciousness raising involves perceiving health and medical care within the total structure of society.
 Importance
1. COPAR is an important tool for community development and people empowerment as this
helps the community workers to generate community participation in development activities.
2. COPAR prepares people/clients to eventually take over the management of a
[Link] in the future.
3. COPAR maximizes community participation and involvement; community resources are
mobilized for community services.

Principles
1. People especially the most oppressed, exploited and deprived sectors are
open to change, have the capacity to change and are able to bring about
change.
2. COPAR should be based on the interest of the poorest sector of the
community.
3. COPAR should lead to a self-reliant community and society.
 Phases of COPAR
1. Pre-Entry Phase
Is the initial phase of the organizing process where the community organizer looks for
communities to serve and help. Activities include:
A. Preparation of the Institution
 Train faculty and students in COPAR.
 Formulate plans for institutionalizing COPAR.
 Revise/enrich curriculum and immersion program.
 Coordinate participants of other departments.
B. Site Selection
 Initial networking with local government.
 Conduct preliminary special investigation.
 Make long/short list of potential communities.
 Do ocular survey of listed communities
C. Criteria for Initial Site Selection
 Must have a population of 100-200 families.
 Economically depressed. No strong resistance from the community.
 No serious peace and order problem.
 No similar group or organization holding the same program.

D. Identifying Potential Municipalities

Make long/short list of potential municipalities

E. Identifying Potential Community

 Do the same process as in selecting municipality.
 Consult key informants and residents.
 Coordinate with local government and NGOs for future activities.
F. Choosing Final Community
 Conduct informal interviews with community residents and key informants.
 Determine the need of the program in the community.
 Take note of political development.
 Develop community profiles for secondary data.
 Develop survey tools.
 Pay courtesy call to community leaders.
 Choose foster families based on guidelines
G. Identifying Host Family
 House is strategically located in the community.
 Should not belong to the rich segment.
 Respected by both formal and informal leaders.
 Neighbors are not hesitant to enter the house.
 No member of the host family should be moving out in the community.
2. Entry Phase
sometimes called the social preparation phase. Is crucial in
determining which strategies for organizing would suit the chosen
community. Success of the activities depend on how much the
community organizers has integrated with the community.

3. Organization-building Phase
Entails the formation of more formal structure and the inclusion of
more formal procedure of planning, implementing, and evaluating
community-wise activities. It is at this phase where the organized
leaders or groups are being given training (formal, informal, OJT)
to develop their style in managing their own concerns/programs.
•4. Sustenance and Strengthening Phase
•Occurs when the community organization has already been established and the
community members are already actively participating in community-wide
undertakings. At this point, the different committees setup in the organization-
building phase are already expected to be functioning by way of planning,
implementing and evaluating their own programs, with the overall guidance from
the community-wide organization.
5. Monitoring and Evaluating Community Health Programs
1. Designing and Implementing Evaluation
Phase of planning cycle that determines whether the program is relevant, effective,
efficient and adequate.
It concerned with finding out the specific input, process and output/outcome
indicators.
Involves two processes, observation and measurement. The nurse observes, then
compare the observed data with some criterion standard or indicators of good
performance.
 •[Link] on Evaluation Plan

 It is a process by which we judge the worth or value of something (Suchman,

1967)
 Evaluation involves two processes namely observation and measurement
 There are two approaches of evaluating a program

[Link] methods of evaluation determine the meaning and experience of

the program for the people involved and interpreted the effects that may
observed
B. Quantitative methods measure and score changes occurring as a result of the
program. Such measurements are systematically made using pre-selected
instruments to detect expected changes.
 •An evaluation may look into three aspects of program

1. Process evaluation measures the activities of the program ,

its quality and who it is reaching out.
2. Impact evaluation measures the immediate effects of the
program and determines whether the objectives of the program
were met.
3. Outcome evaluation measures the long-term effects of the
program and determines if it meets the goal of the program.
 MODULE 2 ACTIVITY
•INSTRUCTIONS:
•When planning for sustainable community development grounded on health promotion and
wellness.
•Explain how these can be achieved when programs and projects utilize three important
approaches (Tuazon et al 2003).
•Limit your answer to 10 sentences for each approach.
1. Community-based approach (which empowers the people to address their health needs and
problems)
2. Integrated approach (which considers various dimensions of health and development such
as changing lifestyle, environment and reorienting health care systems)
3. Comprehensive approach (which strikes at the root of the problem and addresses the social
determinants of health