University of San

Agustin
COLLEGE OF NURSING, NUTRITION AND DIETETICS
General Luna St., 5000, Iloilo City Philippines
[Link]

NCM 113:
COMMUNITY HEALTH
NURSING 2
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
 RA 124, 1947 (Philippines) an act to provide Medical Inspection of Children Enrolled in Private
schools, Colleges, universities
The 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
 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
Nutrition education
Immunizations
Safety
Health education
II. SECONDARY PREVENTION
Screening
Case finding
Home visits
III. TERTIARY PREVENTION
Referral of students for substance abuse or behavior problems
Prevention of complications and adverse effects
Faculty
Source: Neis,M, & staff
& Mcewen, monitoring
M., Community and Public Helath nursing 2 edition, pp 45-50
nd
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 2 nd edition, pp 45-50
Module 2

Health
Statistics and
Epidemiology
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
Interventions
Assessment Tools
1. Importance of Partnership and Collaboration
1. Collecting Primary Data
2. Activities Involved in Collaboration and
2. Secondary Data Sources
Advocacy
Methods of present 3. Community Organizing and Social Mobilization
Community Data 4. Core Principles in Community Organizing
5. Goals of Community Organizing
B. Community Diagnosis
6. Community Organizing Participator Research
1. Types
2. Schemes in Stating Community
E. Monitoring and Evaluating Community
Diagnosis
Health 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  the physical and topographical characteristic
health status of  Socio- economic and cultural factors
the community  health and basic social services and
these elements are  the power structure within the community
to be considered:
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
 Registry of Vital Events
 Health Records and Report
 Disease Registries
 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

 Comprehensive Community Diagnosis

•Aims to obtain general information about the community through

epidemiologic approach, socio-economic approach, and behavioral
approach

Problem-Oriented Community Diagnosis-

Characterize the biophysical, psychological, physical environmental, socio-
cultural and behavioral as well as system factors relevant to specific
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

1. Social indicators
deaths and their respective rates of
2. Economic indicators occurrence
1. Leading causes of mortality
3. Environmental indicators
2. Leading causes of morbidity
4. Cultural factors
3. Leading causes of infant and child
5. Health and Illness Patterns
mortality
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

[Link] resources

[Link] resources
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
 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
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
is a standardized health care terminology
consisting of an assessment component
(Problem Classification Scheme), a care
plan/services component (Intervention Scheme),
and an 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.
 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
[Link] 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
What is
assessing the health problems and needs of the community.
planning ?
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.
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
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
• 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
 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.
[Link] should be based on the interest of the poorest sector
of the community.
[Link] 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.
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
•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
[Link] 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

[Link] evaluation measures the activities of

the program , its quality and who it is reaching out.
[Link] evaluation measures the immediate
effects of the program and determines whether the
objectives of the program were met.
[Link] 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