What is Healthy Community? A social group determined by geographic boundaries and/or common values and interest. Its members know and interact with each other. It functions within a particular social structure and exhibit and creates norms, values and social institution. What are the Characteristics? 1. Prompts its members to have a high degree of awareness that we are community. 2. Uses its natural resources while taking steps to conserve them for future generations. 3. Openly recognizes the existence of subgroups and welcomes their participation in community affairs. 4. Prepared to meet crisis. 5. Has open channels communication that allows information to flow among all subgroups of its citizens and in all direction. 6. Seeks to make each of its systems resources available to all members of the community. 7. Has legitimate and effective ways to settle disputes and meet needs that arises within the community. 8. Encourage maximum citizen participation in decision making. 9. Promotes a high level wellness among its members. 10.Is a problem solving community, it identifies, analyzes and organize to meet its own needs. Classification of Community a. URBAN – High – density, a socially homogenous population and a complex structure, non – agricultural occupations; something different from an area characterized by complex interpersonal social relation an urban community. One in which a number of people are not engaged in the collection or production of food. b. RURAL – usually small and the occupation of the people are usually farming, fishing, and food gathering. It is by simple folks characterized by primary group relation well – knit and having a high degree of group feeling. c. RUBAN – a combination or a rural and urban community. Components of a Community a. PEOPLE – the core that makes up the community included is a study of a demographic characteristic of the population as well as the values, beliefs and history of the people. b. SUBSYSTEM OF COMMUNITY o Housing - included the types and characteristics of housing facilities, presence of housing laws / regulations governing the people. o Education – includes laws, regulation, RAT 10 of educators to learners, distribution of education facilities, presence of informal education facilities and activities existing in the community. o Fire and Safety - availability and accessibility of fire protection and safety services and facilities. o Politics and Government – existing political structure, decision – making process or pattern leadership styles observed, etc. o Health – Health Facilities/ Services/ Activities and its availability and accessibility, ratio of provider/ clients served; priorities in programs. o Communication – systems, types or forms of communication existing how it influences community health. o Economics – occupation, types of economics activities engaged by people.


o Recreation – recreational activities/ facilities including types of
consumers, appropriateness of recreational activities and consumers. Factors Affecting Community Health o o o o o o Political Socio – cultural Economics Environment Health Care Delivery Heredity

Elements of a Healthy Community a. b. c. d. e. f. People are partners in health care. People work together to attain goals. Physical environment promotes health, safety, order and cleanliness. Safe water and nutritious foods. Families provide members with basic needs. Available, affordable health care.


Vital Statistics  The application of statistical method and techniques to the study of the vital facts such as these concerning births, deaths and illnesses.  Statistical data which relate to the total numbers of various kinds of biologic or vital events (like births, illnesses, marriages, divorces/ separations, illnesses and deaths) to the size and characteristics of the affected population. Statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success or failure of health work. Statistics on population and the characteristics such as age and sex distribution are obtained from the National Statistics Office (NSO), the office charged with registering vital facts in the country. Birth and deaths are registered in the Office of the Local Civil Registrar of the municipality or city. The Local Civil Registrar of municipality is usually the Municipal Treasurer or the Municipal Health Officer. In cities, births and deaths are registered at the City Health Department. Health Indicators  A list of information which would determine the health of a particular community like population, crude birth rate, crude death rate, infant and maternal death rates and to tuberculosis death rate. a. BIRTH – the act or process of being born.

Rates – a relation indicating the number of times a certain event occurs when a certain number of exposures to the risks of occurrence in present in a given period of time. Crude Birth Rates – is only a rough measure of fertility in a population since it makes us of mid – year population (which includes the number of men and women incapable of child – bearing) as its denominator. - Live births per 1000 population. b. DEATH – the cessation of all physical and chemical processes that invariably occurs in all living things. Crude Death Rates – is only a rough measure of the force of mortality or the probability of dying in a population because death rates are largely influenced by age and sex composition of the population. c. MARRIAGES – the institution whereby men and women are joined in a special kind of social and legal dependence for the purpose of founding and maintaining a family. d. MIGRATION – the transfer of the individual from one locality to another.

Rates and Ratios
Rates – In the Vital Statistics, a rate shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given a area and during a specified unit of time. It is evident that the persons experiencing the events (the numerator) must come from the total population exposed to the risk of same event (the denominator). Ratio – it is used to describe the relationship between two numerical quantities or measures of events without taking particular considerations to the time or place.


These quantities need not necessarily represent the same entities, although the unit of measure must be the same for both numerator and denominator of the ratio. Crude or General Rates – These rates are referred to the total living population. It must be presumed that the total population was exposed to the risk of the occurrence of the event. Specific Rates – The relationship is for a specific population class or group. It limits the occurrence of the event to the portion of the population definitely exposed to it. Crude Birth Rate – A measure of one characteristic of the natural growth or increase of a population. CBR = Total No. of live births registered in a given calendar year Estimated population as July 1 of same year Crude Death Rate – A measure of one mortality from all causes which may result in a decrease of population. Total No. of live deaths registered in a given calendar year Estimated population as July 1 of same year Infant Mortality Rate – Measures the risk of dying during the 1st year of life. It is a good index of the general health condition of a community since it reflects the changes in the environmental and medical conditions of a community. Total No. of deaths under 1 year of age registered in a given calendar year IMR = Total No. of registered live births of same calendar year Maternal Mortality Rate – It measures the risk of dying from causes related to pregnancy, childbirth, and puerperium. It is an index of the obstetrical care needed and received by the women in a community. Total No. of deaths maternal causes registered in a given year MMR = . x 1000 . x 1000 x 1000


x 1000

Total No. of live births registered of same year

Foetal Death Rate – Measures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion, irrespective of duration of pregnancy. Total No. of Foetal deaths registered in a given calendar year . FDR= Total No. of live births registered of same year Neonatal Death Rate – Measures the risk of dying the 1st month of life. May serve as index of the effects of prenatal care and obstetrical management on the newborn. No. of deaths under 28 days of age registered in a given calendar year . NDR= Total No. of live births registered of same year x 1000 x 1000

Specific Death Rate – Describes more accurately the risk of exposure of certain classes or groups to particular diseases. To understand the forces of mortality, the rates should be made specific provided the data are available for both the


population and the event in their specifications. Specific rates render more comparable and thus, reveal the problems of public health. Deaths in specific class or group registered in a given calendar year . Specific D.R. = Estimated population as July 1 in same specified class or group of said year Examples: No. of deaths from a specific cause registered in a given calendar year . Cause specific Death Rate = Estimated population as July 1 in same specified class or group of said year No. of deaths in a particular age group registered in a given calendar year . Age specific Death Rate = Estimated population as July 1 in same specified class or group of said year No. of deaths of a certain sex registered in a given calendar year . Sex specific Death Rate = Estimated population as July 1 in same specified class or group of said year





Incidence Rate – Measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases. No. of new cases of a particular disease registered during a specified period of time IR = Estimated population as July 1 in same year


Prevalence Rate – Measures the proportion of the population which exhibits a particular disease at a particular time. This can only be determined following a survey of the population concerned. Deals with total (old and new) number cases. No. new and old cases of a certain disease registered at a given time . Total no. of person examined at same given time Attack Rate – A more accurate measure of the risk of exposure. Useful in epidemiological investigations. No. of persons acquiring a disease registered in a given year No. exposed to same disease in same year Proportionate Mortality (Death Ratios) – Shows the numerical relationship between deaths from a cause (a groups of causes), age (or groups of age), etc. and the total no. of deaths from all causes in all ages taken together. Not a measure of risk of dying. No. of registered deaths from a specific cause or age for a given calendar year . PM = x 100 No. of registered deaths from all causes, all ages in same year Adjusted or Standardized Rates – To render the rates of 2 communities comparable, adjustment for the difference in age, sex, race and any other factors which influence vital events to be made. .

PR =


AR =



Two methods: a. By applying observed specific rates to some standard population. b. By applying specific rates of standard population to corresponding classes or groups of the local population. Case Fatality Ratio – Index of the killing power of a disease. It is influenced by incomplete reporting and poor morbidity data. No. of registered deaths from a specific disease for given calendar year No. of registered cases from same specific disease in same year .


x 100

Implications of Health Statistics to Individual, Family and Community
1. Vital Statistics is indispensable tool in planning, implementation and evaluation of any health programs. 2. They serve as index of the health conditions obtaining in a community or population group. 3. Provide valuable clues as to the nature of health services or actions needed. 4. Serve as bases for determining the success or failure of health services or action. 5. Health personnel share with the community they serve the responsibility of planning and taking the necessary actions to solve the latter’s health problems. 6. Health personnel are expected to be able to maintain accurate and updated statistical records and reports.


1. Welfare Approach  The immediate and or spontaneous response to ameliorate the manifestation of poverty, especially on the personal level.  Assumes that poverty is God – given, destined. Hence the poor should accept their condition since they will receive their just reward in.  Believes that bad luck, natural disasters and certain circumstances that are beyond the control of people cause poverty.

2. Modernization Approach
     Also referred to as the project development approach. Introduces whatever resources that are lacking in a given community. Focuses as technological approach. Also consider a national strategy which adopts the western mode of technological development. Assumes that development consists of abandoning the traditional methods of doing things and must adopt the technology of industrial countries. Believes that poverty is due to lack of education, lack of resources such as capital and technology.

COPAR (Community Organizing Participatory Action Research)

3. Transformatory or Participatory Approach  The process of empowering or transforming the poor and the oppressed sectors of society so that they can pursue a more just and humane society.  Assumes that poverty is not God – given rather it is rooted in the historical past and is maintained by the oppressive structures in society.  Believes that poverty is caused by prevalence of exploitation, expression, domination and other unjust structures.  Transform the community from oppressed to dynamics one.  People are the one to solve their problems while the facilitator (nurse) is only to motivate them.  Money is not involved in this approach but the things that surround them.

The Philippine Center for Population and Development in its effort to support the Department of Health in the implementation of Primary Health Care (PHC) designed the Health Resource Development Program (HRDP) to enable the health training institutions e.g. schools of medicine, nursing and midwifery to effectively implement their community – based health programs. HRDP sees Community Organizing (CO) as a tool for people’s empowerment to health. It is used to generate community participation and involvement in health activities and to prepare communities to set up their own health programs. DEFINITION OF COPAR  A social development approach that aims to transform the Apathetic, Individual, Voiceless poor into dynamic, participatory and politically responsive community.  This is also a collective, participatory, transformative and systematic process of building people organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change their existing oppressive and exploitative conditions. (1994 National Rural CO Conference)


 

A process by which a community identifies its needs and subjective, 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. (ROSE 1967) A continuous and sustained process of educating with people to understand and develop their critical awareness of their existing conditions 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, but not making them as subjects of research but rather participants or co – researchers. (CO: A Manual of Experiencing PCPD) Transformation of force, that enables the individuals, families, communities to be responsible for their own health. A phenomenon of interest goals and objectives at the health care worker and the people in their way to health citizenry.

IMPORTANCE OF COPAR 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 / client eventually take over the management of a development program in the future. 3. COPAR maximizes community participation and involvement. 4. COPAR mobilized community resources for community services. PRINCIPLES OF COPAR 1. People, especially the oppressed and exploited sectors are most open to change and are able to bring about change. Along this line, community organizations should be based on the following: a. Power must reside in the people – participation indicate power to cooperate in order to have a good result. b. Development is from the people to the people – progress is in the hands of the people. c. People’s participation should always be present – participation is essential elements in COPAR. 2. COPAR should be for the interest of the poorest sectors of the society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and actions. 3. COPAR should lead to self – reliant community and society. PROCESS/METHODS USED IN COPAR

1. Progressive Cycle of Action – Reflection – Action
 Which begins with small, local and concrete issues identified by the people and the evaluation and reflection of and on the action taken by them.

2. Consciousness – Raising
 Through experimental learning is central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action.

3. Participatory and Mass - Based
 Because it is primarily directed towards and biased in favor of the poor, the participatory the powerless and the oppressed.

4. Group – Centered and Not Leader - Oriented
 Leaders are identified emerged and are listed thru action rather than appointed or selected by some external force or entity.

POINTERS IN BUILDING PEOPLE’S ORGANIZATION 1. Integration  A Community Organizer becoming one with the people in order to:


a. immerse himself in the poor community. b. understanding deeply the culture, economy, leaders, history and lifestyle in the community. METHODS OF INTEGRATION a. Participation in direct production activities of the people like planting, harvesting, fishing, and broom making. b. Conduct of house to house visits. c. Participation in social activities such as birthday parties, weddings, fiestas, wakes, seasonal rituals and others. Community workers nowhere should refrain from drinking. While drinking is an effective strategies in integrating with male residents, excessive drinking has a negative effect on the community worker’s reputation. d. Conversing with the people where they usually gather such as stores, water walls, washing streams and in churchyard. e. Helping out in household chores like cooking, dishwashing, cleaning the house etc. 2. Social Investigation  A systematic process of collecting, collating and analyzing data to draw a clear picture of the community.  Also known as Community Study. POINTERS FOR THE CONDUCT OF SOCIAL INVESTIGATION a. Use of survey questionnaire is discouraged. b. Community leaders can be trained to initially assist the community worker/organizer in doing social investigation. c. Data can be more effectively and efficiently collected through informal methods (house to house visits, participating in conversing in jeepneys and others) d. Secondary data should be thoroughly examined because much of the information might be available. e. Social Investigation is facilitated is the Community Organizer is properly integrated and has acquired the trust of the people. f. Confirmation and validation of community data should be alone. 3. Tentative Program Planning  Community Organizer to choose one issue to work on in order to begin organizing the people. 4. Ground working  Going ground and motivating the people on a one on one basis to do something on the issue that has been chosen. 5. Group Meeting  People collectively ratifying what they have already decided individually.  The meeting gives the people the collective power and confidence.  Problems and issues are discussed. 6. Rehearsal / Dry run (Role Play)  Means the act out the meeting that will take place between the leaders of the people and the government representative.  It is a way of training the people to participate what will happen and prepare themselves for such eventually. 7. Mobilization or Action  Actual experience of the people in confronting the powerful and the actual exercise of people power. 8. Evaluation  The people reviewing the steps 1-7 so as to determine whether they were successful or not in their objectives. 9. Reflection


 Dealing with deeper on going concerns to look at the positive values
 Community Organizer is trying to build in the organization. It gives the people time to reflect on the stock reality of life compared to the ideal.

10. Organization  The People’s Organization is the result of many successive and similar actions of the people.  The final organizational structure is set – up with elected officers and supporting members.  The steps in building organizations are done in all or any of the phase of the COPAR process.  Their application and the specific strategies and purpose may vary slightly depending on the phase of the process it is applied. PHASES OF COPAR 1. Pre – entry Phase  Is the initial phase of the organizing process where the community organizer looks for communities to serve or help.  Is it considered as the simplest phase in terms of actual outputs, activities and strategies and time spent for it. ACTIVITIES: 1. Designing a plan for community development including all its activities and strategies for care or development. 2. Designing criteria for the selection of site. 3. Actually selecting the site for community care. METHODS OF PRELIMINARY SOCIAL INVESTIGATION a. Use of secondary data from various government officers, particularly the Provincial Health and/or the Rural Health Unit and other community organization. b. Use of secondary data from other community based health program. c. Coordination with extension workers from both government and non – government agencies. d. Conduct of ocular observations, noting the accessibility, geography, terrain, settlement patterns and available physical resources. CRITERIA: a. Depressed Rural Community. (Consider number of population) b. Health Services. (Check BHS, Health Personnel, Adequate Facilities, Distance of secondary Hospital (30 min.) c. Health Condition. (Assess the malnutrition, Infant Mortality Rate, Maternal Mortality Rate) d. No similar or free of similar agencies. e. Peace and order situation. (main concern for the safety of Health Personnel) f. No strong resistance from the people. (there is no rejection within the community) 2. Entry Phase  Sometimes called the Social Preparation Phase as it is the activities done. This phase includes the sensitization of the people on the critical events in their life, motivating their to share their dreams and ideas on how to manage their concern and eventually mobilizing them to collective actions on those concerns this signals the entry of the community organizing.  This phase signals the actual entry of the community worker / organizer into the community. ACTIVITIES: 1. The sensitization of the people on the critical events in their life. 2. Motivating them to share their dreams and ideas on how to manage their concerns. 3. And eventually mobilizing them to take collective action on these. GUIDELINES FOR ENTRY INTO THE COMMUNITY


a. Recognize the role of the local authorities by paying, them visits to
inform them of your presence and to orient them on the project objectives. b. One’s appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of there being role models. c. Avoid raising the expectations/consciousness of the community residents by adopting a low key profile and approach. (Not to higher the levels of expectations.) METHODS OF ENTRY PHASE a. House to house visits. b. Participation in social activities. c. Converse people in their usual gatherings. d. Participate in livelihood activities. e. Participate in household chores. 3. Organization Building Phase  Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementing, evaluating community - wide activities.  It is the phase where the organized leaders or groups are being given trainings (Formal or Informal, OJT) in order for them to manage their concerns or programs.  Purpose: to develop their knowledge, skills, and attitudes to organize and managing their own problems and programs. 4. Sustenance and Strengthening Phase  Occurs when the community organization has already been established and the community members already actively participating in community wide undertaking.  At this point, the different committees set – up 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. STRATEGIES: 1. Education and training. 2. Networking and linkaging. 3. Conduct of mobilization on health and development concerns. 4. Implementation of livelihood projects. 5. Developing secondary leaders in the community. CRITICAL ACTIVITIES IN COPAR PROCESS 1. Selection of research committee. 2. Training on how to gather data. 3. Plan for the actual data gathering. 4. Analyze those information gathered. 5. Assembly. (talk able their concern of the people in community) 6. Prioritization of needs. (assigned to the committees)

Community Based People Organization
Participatory Research The task of identifying what the problem are Involves the community group experiencing the problem Immediate problem situation.

Participatory Research V.S Tradition Research Tradition Research Done by the professional or outside researcher.

The choice of the problem is based on the

What the outside researcher expects, the community should be.


Problem Identification is jointly undertaken by the people who are actors in the situation and by the researcher who is initiating the research process. The Community Assisted by a researcher. Dominated by trained outside researcher. Make up of quantitative method.

Method of data gathering

Does not adhere to any standard design.

1. RECODER / DOCUMENTATION Responsibilities: a. Keeps a written account of services rendered observations of the conditions of the client, the needs and problem the attitude of the client with the community. b. Records our development changes – accomplishments of the health care providers and the client accomplishments. 2. REPORTER Responsibilities: a. Disseminate any information which are necessary for the client in the community. b. Disseminate any information to the appropriate authority or any agencies.   We must develop the people capabilities to keep their own recording and reporting. FORM WHICH: a. Records  Refers to written documents. b. Reports  Refers to periodic summarizes of the services and activities rendered to the community. PURPOSES OF RECORDING AND REPORTING

a. Provide basis for future planning.
b. c. d. e. To contribute to client’s care. Measure the services or programs rendered or directed to the client. Aids or part in the studying the conditions of the community. To interpret the work to the public and other agencies.

ACTIVITIES RELATED TO THE ROLE AS RECORDED AND REPORTER a. Record daily activities. b. Record keeping and filling. c. Disseminate reports.


 Schedule of Health Center.  Schedule for laboratory. d. Train people in making reports.  Encourage with people to report in the Health Center. e. Assist people in research and community development activity.

“Report should be concise and condensed.”
EFFECTIVE AND USEFUL REPORTS DEPENDENCE UPON CERTAIN BASIC PRINCIPLES SUCH AS: a. All items should be carefully selected in order to give significant information. b. Reports are of the most interest value when they are arranged to that comparison may be made between successive periods of time. c. Reports of value only when the items included carry a common meaning to all who make all of them. d. Reports are more readily received when presented in an interesting manner.


COMMUNITY HEALTH WORKER  Is one who provides basic community health care services for promotion of health, prevention of illness, simple treatment and rehabilitation, the services rendered utilize the a goal or objectives, content, method and skills used in Primary Health Care and has a qualities of a good Health Worker.

QUALITIES OF A HEALTH WORKER a. OPEN  Accepts needs of joint planning and decisions relative to health care in particular situation not resistant to changes; open to suggestions and criticism. b. TACTFUL  One who presides over an assembly meeting or discussion in a subtle manner; does not embarrass but gives constructive criticisms; has good diction, proper choice of words. c. OBJECTIVE  Gives fair judgment, no biases.  Unbiased and fair in decision making; no favoritism. d. GOOD LISTENER  Attentive always available for the participant to voice out their sentiments and needs, listening is the key to good assessment; open to ideas; has empathy. e. EFFICIENT  Knowledgeable about everything relevant to his/her practice; has the necessary skills expected from him/her. f. FLEXIBLE  Able to cope with different situation.

g. CRITICAL THINKER / ANALYTICAL  Decides on the basis of what has been analyzed.  Always a presence of mind. FUNCTION OF A HEALTH WORKER 1. COMMUNITY HEALTH SERVICE PROVIDER


 

Carries out health services contributing to the promotion of health, prevention of illness, early treatment of illnesses and rehabilitation. Appraises health needs and hazards.


 Emphasis on the active role of the client in all aspect of care include client in
all aspects of care. 3. COORDINATOR  Brings into consonance or harmony the community’s health care activity; one goal / common goal.

4. FACILITATOR   Helps plans a comprehensive health program with the people. Provide continuing guidance and supervisory.

5. HEALTH COUNSELOR  Provides health counseling including emotional support to individuals, family, groups, and community.

6. CO – RESEARCHER       Provides health with stimulation necessary for a wider or ore complex study or problem. Enforces community to do prompt and intelligent reporting of epidemiologic investigation of diseases. Suggest areas that need research. Participates in planning for the study and in formulation procedures. Assist in the collection of data. Helps interpret findings. Acts on the result of the research / study.

7. MEMBERS OF A TEAM  In operating within the team, one must be willing to listen as well as to contribute to teach as well as to learn, lead as well as to follow to share authority as well as to work under.  Helps make multiple services which the family receives in the course of health care. Coordinated, continuous and comprehensive as possible.  Consults with and refers to appropriate personnel for any other community services. 8. ADVOCATOR  Representative of the client.  Act as referral agent and assist client in obtaining the care deserve in the patient. 9. HEALTH EDUCATOR  Primary responsibility of Community Health Nurse.  Is one who improves the health of the people by employing various methods or scientific procedures to stimulate arouse and guide people to healthful ways of living.

 Health Education is accepted to all levels of public work.

1. Information – provision of knowledge. 2. Education – change in knowledge, attitude and skills.


3. Communication – exchange of information.
TRAITS AND QUALITIES OF A HEALTH EDUCATOR 1. Efficient  Plans with a people according to the needs of the client or community.  Knowledgeable about everything relevant to his practice; has the necessary skills expected of him. 2. Good Communicator and always validate information  Provide the participants with clear and relevant information. 3. Good listener  Hears what’s being said and what’s behind the words.  Always available for the participant to voice out their sentiments and needs. 4. Keen observer  Maintain eye to eye contact.  Keep an eye on the proceedings, process and participants’ behavior. 5. Systematic  Put into sequence, how to arranged the activity.  Knows how to put in sequence or logical order the parts of the session. 6. Creative and Resourceful  Use any available resources and evolve participants in the discussion. 7. Tactful  Brings about issues in smooth subtle manner.  Does not embarrass but gives constructive criticisms. 8. Good Sense of Humor  Knows how to place a touch of humor to keep audience alive. 9. Knowledgeable  Have to knowledge relevant. 10. Open  Inviting the client to give their reaction, and share, ideas and criticism.  Involves people in decision making.  Accepts need for joint planning and decision relative to health care in a particular situation; not resistant to change. 11. Good Critical Thinker / Analytical  Decides on what has been analyzed.  Involves participants actively in assuming the responsibility for his own learning. 12. Change Agent  Let the client participate in the activities.  Involves participants actively in assuming the responsibility for his own learning. In making decisions about methodologies, the health educator has to choose specific methods that will bring about the desired output and the technique should: 1. 2. 3. 4. 5. Generate active participation of the learner. Provide quick feedback. Facilitate, transfer of learning. Develop desirable behavior pattern positive change. Motivate participants to improve their level of performance like return demonstrations of learners. 6. Allow opportunity to learn at individual and group levels.


BASIC SKILLS IN FACILITATING 1. Have a complete understanding of the subject matter. 2. Know your reach and limitations. 3. Be open and flexible. 4. Know how to salute, recognize and acknowledge your client. 5. Learn how to count. 6. Know your left and right. 7. Watch your time. GUIDELINES TO BE EFFECTIVE HEALTH EDUCATOR IN TERMS OF A. Teaching and Methodologies / Strategies (Selection and Uses) – appropriate for the participants.  Health Education has to choose specific materials that will bring about the desired output. a. b. c. d. It should be generate active participation. It should provide quick feedback. Develop desirable behavior patterns positive attitude. Methodologies and strategies must motivate the participants to improve their level of performance. e. It should allow opportunity to learn at individual and group levels. f. It should facilitate transfer of learning to on the job site. METHODS SHOWED a. Generate active participation of the learner. b. Provide guide feedback. c. Facilitate transfer of learning to on – the – job situation. B. Preparation of IEC materials  Blackboard, chalk, pad paper, hand – outs. C. Uses of a Teaching Plan  List of steps and activities and equipments needed in health education session.  A lesson should be planned by having an outline of what is to be taught and the methods to be used.  Time allocation for various activities should also be included. SESSION DESIGN  Document which contains the rationale, objectives, subject matter / topic, methodology and resources to be used during the health teaching. CHARACTERISTICS OF HEALTH TEACHING PLAN a. May emphasize a phase of phase of behavior change process that is related to the client’s health need and problems. b. Should be also follow the sequence of that process from pre – training to be continued. c. Performance of a behavior that helps resolves a health need or problem. d. Represents a package of education services provided to the participants consumers or even to the students it should be based on participants’ viewpoint. e. Helps the health educator recognize and use methods of learning that involves the clients’ active participation. f. Should also include a list of specific actions or abilities that the client may perform at intervals during the education session or at the end of the session. Example: Topic: _____________________________ Goal: _______________________________________________________________________________ Venue: _____________________________________________________________________________ Participants: _______________________________________________________________________ Learning Objectives Content Methodology Time Frame Resources Person Responsible Evaluation


After hrs. lecture

__ of
Manpower, Internet, Books,

discussion the will able to: 1.) 2.)

client be Lecture Discussion / Role Play/ ___ min.

Parameters of Question and Answer Mr. _______ / Ms. ________ / Open Forum

Magazine, Tapes / film showing, Multi media, Money, Facilities.

Conflict Management Skills of a Health Worker
Conflict  To come into opposition neither weapons as in battle physically as in children’s round and tumble or verbally as quarrel between two persons. Ii is due to different ideas, viewpoint and opinion. Conflict Management  Employing various strategies appropriate for the situation in order to solve with conflict. a. Know clear definition of your responsibilities. b. Know the different needs of the individual.




Mo ve Awa y

Move Against

Move Toward
Open confrontation Communication Sort out ideas, feelings Brainstorming 4d sol’n Resolution of conflict Through resolution through growth Increase options.

Surrender Distract Suppressing Differences Denial Sickness Fragmentation

Fighting Back Escalation of feelings of anger Distortion of perception


 Total suppression of differences will lead to physical and psychological

 If conflict is handled properly this could be a source of couth.  If conflict is not handled properly this could be a source of psychological
decline / decay. SOURCES AND CAUSES OF CONFLICT 1. 2. 3. 4. 5. 6. Competition Rivalry Communication Barriers Cultural differences Different values and need Lack of respect


1. Isolation (ignored)
2. No feedback recognition 3. Negative feedback (criticism) 4. Favoritism 5. Mix messages 6. Lecturing or talking by 7. Unrealistic dead limit / giving irrational order 8. passive aggression (pretending) 9. Personal put down (harsh negative criticism) 10. Breaking Promises 11.Threatening 12.Attacking TYPES OF CONFLICT 1. Intrasender  Originates in the sender who gives conflicting instructions. 2. Intersender  Arises when an individual receives conflicting message from two or more sources. 3. Interrole  Occurs when an individual belongs to ore than one group simultaneously, have multiple role within the some organization. 4. Person role  The result of disparity between internal and external role.  May occur when one’s values, needs or capabilities were incompatible with the role requirement. 5. Interperson  Common among people whose positions require interaction with other person who has various roles in the same organization or other organizations.


6. Intragroup conflict
 Occurs when the group faces a new problem. 7. Intergroup  Common where two groups have different goals and can achieve their goals only at the others expensive. 8. Role Ambiguity  Condition in which individual don’t know what is expected of them. Reason: a. Inadequate job description. b. Incomplete explanation of assigned tasks. c. Rapid technological change. STRATEGIES IN CONFLICT MANAGEMENT 1. Avoiding  A strategies that allows conflicting parties to calm down.  Can be used when issue is not critical.  Also appropriate when the other party is more powerful the issue is important.  When one has no chance of meeting the goods or the cost of dealing with the conflict is higher than the benefit of the resolution.  Also appropriate when one wishes to reduce tension and gain composure.  Create a lose –lose situation thru unassertive and uncooperative means. 2. Accommodating or Cooperating  Cooperative but unassertive.  Creates a win – lose situation.  Self – sacrificing - one neglects one’s own needs to meet the goals of the other party.  Appropriate if the opponent is right more powerful, the issue is more important to someone else. 3. Competing  Power oriented mode that is assertive but cooperative.  Appropriate when the person is very knowledgeable about.  Opposite of Accommodating = one is aggressive and pursue ones. 4. Comprising  Moderates both assertiveness and cooperation.  Result to lose – lose situation. 5. Collaborating  Assertive and cooperation.  It contributes to effective problem solving.  Requires mutual respect open and honest communication and should decision making process.  Problem are identified, alternatives explored ramification considered until difficulties are resolved.  Most effective method in dealing conflict.  Resolution, creates a win – win situation. Because there is an honest and open communication APPROACHES TO CONFLICT RESOLUTION 1. Win – Lose Situation  Method includes the use of position, power, mental and physical power, failure to respond, majority rule. 2. Lose – Lose Situation


Since the anger and resentment of the loser does not disappear but simply goes underground to emerge later as “Backlash”

3. Win – Win Situation  Focus on goals.  Emphasizes consensus and integrative approaches to decision making.  Collaborating  Common goals identified, conflict if openly surface and honestly faced, can improved both planning and implementation.  More alternatives are likely to emerge.

CHAPTER 6 HEALTH CARE PROCESS Application COPAR in Community Health Process
STEPS: 1. COMMUNITY ASSESSMENT  Getting to know the community client This includes:

a. Decide what data are to be gathered.  What data need to be researched yet? What are already available? Which of these are fully, reflective of actual reality? Which are needed to be confirmed, validated, or investigated further?



o Demographic Data – information about the population: Size,
Structure / Composition, Distribution, Density.

o Socio – economic Data – Occupation, Income Levels of Families,
Land Ownership, Production Quality.

o Political – Leadership Structure and Style, Decision – Making Process
/ Pattern, etc.

o Cultural – Values, Beliefs people uphold, Norms, Cultural groups, etc. o Environmental – Physical Structures, Sanitary Conditions, etc.
o Health Care Delivery System

b. Plan the process of data gathering.  Determine data gathering methods.

 Interview – Is a conversation between two individuals in which
one seeks information and the other providers it.

 Observation – Process of obtaining data through visual means.  Review of Secondary Data – Process of going over recorded
information.  Community Survey c. Plan the data gathering activity.    Who will gather the data? How will the data be gathered? Tool to be used? Who and how will the data be collated? Analyzed?

d. Actual data gathering. e. Preparing a report based on the gathered data.  Include here the list of prioritized problems.

COPAR Principles and Strategies that could be applied in this phase: (NOTE: Faculty is encouraged to review these concepts by referring to module on COPAR)  Integration  Social Investigation  Ground working  People Participation 2. PLANNING FOR A PROGRAM OF ACTION / PROJECT  Includes the following:

a. Determining objectives for care / action  Identify what is to be done and what outcomes might be expected from the program / project / services implemented / rendered.

 They should be realistically achievable.


 Are within the competence of the implementor / community / care
provider; are accepted and understood by them; are within the available potential time and resources.  Should be specifically stated.  Indicates what should be done, who should do it, when / where / how / how often should they these be done, etc.

 Should be flexible enough to allow for change.
 Allows for modification / substitution / revision of plans / activities / strategies depending on what happens or are needed during the time of implementation.

 Should be closely related to the problems and needs identified and
felt by the client.  Should be closely coordinated with those of the entire health care team.

b. Select activities and methods / strategies for achieving the

 There are a variety of activities that may be employed to meet the
objectives:       Home visits Conferences / Demonstrations Health Service Delivery Group discussion / Education Information Dissemination

Consider the following in selecting activities:  Consider need / Capabilities of the client  Identify target clientele  Review traditional activities and select only those not detrimental to health / life / limb.  Bear in mind that a balanced program is far more effective than in those which are unbalanced or biased.

c. Estimate time needed.  Determine how much time is needed to accomplish each activity / program / project.

d. Identify the persons responsible.   Who will take the lead or participate in the implementation of the program plan. Remember to involve the people / clientele in the planning / implementation / monitoring / evaluation of the plan / program.

e. Develop monitoring and evaluation scheme.

 Determine methods / tools / strategies for M & E.
       Self – evaluation Peer evaluation Evaluation by superior Analysis of statistical reports Use of standards Records of tests Case discussion


 Action – Reflection – Action Session (ARAS? ARFA)
3. PROGRAM IMPLEMENTATION      Essential is the active participation of the people. Accompanied by utilization of resources. Refers to the actual carrying out of the plan. Refers to the mobilization of resources to meet objectives. Must include active participation of the people; from groups to expedite

4. PROGRAM MONITORING AND EVALUATION Evaluation - A process design to show the relationship. Monitoring - Improvement and development of the community. - An internal program care activity concerned to assess whether the resources is being used as intended.     Are vital elements community health care process. They are interrelated. Is an essential component of planning and should be built in as the plan of services if constructed. Is a process that is designed to show the relationship between services rendered and the objectives or purpose of the services / unit / care provider. Not a record nor count of what was done but of what DIFFERENCE the doing made. Is mainly used to help in the selection and design of future plans / programs / projects.

 

Fertility  Refers to the ability of the body to reproduce, to create and sustain new life.


It involves a cognitive decisions and behavioral practices that enable a woman to have a wanted pregnancy and avoid an unwanted pregnancy

Family Planning  Is a the conscious effort of individuals and couples of reproductive age to regulate / limit their fertility through the use of the medically and legally accepted methods of contraception (natural and artificial) according to their beliefs, religious, economic and health circumstances. The ability to conceive and bear children and one’s views towards planning the number and spacing of children are associated with many social, religious and cultural values for both men and women. According to World Health Organization (WHO), it is the uses of a range of fertility regulation to help individuals or couples attain certain objectives such as avoid unwanted birth produce a change in the number of children born, regulate the intervals between pregnancies and control time at which birth occurs.

COMPREHENSIVE FAMILY PLANNING PROGRAM  Should provide: 1. Contraceptive Education 2. Genetic Counseling 3. Infertility Counseling 4. Methods of Fertility Enhancement 5. Information regarding Alternatives (assisted) Birth Technologies and Adoption Assistance


1. Is to reduce the number of unintended pregnancy (Unwanted or earlier the
planned). 2. Decreases the number of unintended pregnancy, decreases the rate of abortion. 3. Parent should consciously decide of whether to have children and which contraceptive method, if any will be used their decision should be accordance with their personal, social, and religious values, and beliefs. ROLES AND FUNCTIONS OF THE NURSE IN FAMILY PLANNING 1. Identifying, Counseling and when appropriate making referral for clients who are in need of information. About Family Planning and its services. 2. Provide and interpreting Family Planning instructions, information and resources. 3. Contributing to the development of new methods, services and programs as well as evaluating existing ones. NURSE’S ROLE IN CONTRACEPTIVE EDUCATION 1. Provide accurate, unbiased information about their various contraceptive methods and correcting misinformation. 2. Help the client with the risks and benefits of each method and determine which method will best fit his / her lifestyle, how will each method prevents pregnancy. 3. Contraceptive Education should include whether these methods protects against HIV / STD’s both patterns should be included during the teaching. THREE MAIN CATEGORIES  Contraceptive methods that are used temporarily to prevents conception. 1. Those that prevent fertilization. 2. Those that prevent ovulation. 3. Those that prevent implantation. METHODS THAT PREVENT FERTILIZATION


1. Abstinence – refraining 2. Coitus interuptus – withdrawal
3. Periodic Abstinence FOUR BASIC METHODS

1. Calendar Method
2. Basal Body Temperature (BBT) 3. Cervical Mucus Method 4. Symptothermal Method ADVANTAGES OF FAMILY PLANNING 1. Usually acceptable to these who had religious objectives to other methods of contraception. 2. Woman who uses these methods became more knowledgeable about their bodies. DISADVANTAGES OF FAMILY PLANNING 1. These require extended periods of abstinence during each ovulation and require considerable commitment on the part of the couple. 2. None of these methods provides protection from STD’s or HIV. WITHDRAWAL  Is also called Coitus Interuptus.  The man with draws his penis from a woman’s vagina before he ejaculates so that the sperm released from his penis does not enter her vagina.  There are problems with using withdrawal as a contraceptives method. First, a man may release sperm before he has an orgasm. LOCAL BARRIERS  Barriers methods of contraception are methods that prevent sperm entering the reproductive system spermicides that immobilize and kill sperm, used in conjunction with barrier methods, provide enhanced protection against STD’s and increase protection against pregnancy. 1. Male Condom  Most widely used birth control device in the UN and in the world.  Shaped like a finger the condom is inserted over the erect penis before intercourse.  This can be done by with man by woman.  A half – inch space or the pocket should be left at the end to collect the ejaculate and to prevent the condom from tearing during ejaculation.  To prevent spilling sperm into the vagina after intercourse the man should hold onto the condom as the penis is carefully with drawn.  Do not use petroleum gel. ADVANTAGES:     Safe readily available Easy to use Inexperience Prevent transmission of STD’s and HIV.

DISADVANTAGES:  Decreased sensation the interruption of sexual foreplay.  To apply the condom and the need to quickly remove the penis from the vagina after ejaculation


 MOST PROTECTIVE CONDOM – are those inside of latex. 2. Female Condom  A combination of a diaphragm.  It is soft relubricated. ADVANTAGES: Women can be in control of contraception. Pleasurable (Men and Women) with the presence of the sheath. Available on the counter. Because it is made of polyurethane, it is less likely to tear than the rod condoms.  It is an alternative for those who are allergic latex.     DISADVANTAGES:  If the woman is uncomfortable with contraceptive method require touching herself.  She may not like this method. 3. Diaphragm  An ordinary spring  A flat or Wide – Seal spring  Coil spring 4. Cervical Caps ADVANTAGES:     Easy to use Inexpensive Do not dull sexual sensation and help prevent STD Diaphragm and Caps however, must be fitted by a physician or technician are available only by prescription.


 Should not be used during menses or when a vaginal discharge is 
noted. Douching after intercourse is not recommended. (If woman does, douches, she should wait for at least 6 hours to avoid washing away spermicides.)

SAFETY:  Not all women can be fitted satisfactorily; they may need to be refitted after pregnancy because of changes is cervical size.  To health Care Provider should check the woman’s ability to insert and remove these devices correctly.  Prescriptions should be limited to woman without pap smear. 5. Vaginal Spermicides ADVANTAGES:  Spemicides are readily available and relatively inexpensive.  Provide vaginal lubrication.  25% more effective and provide much better protection from STD’s and HIV, if used in conjunction with one of the other barrier method.  Kills organism that cause gonorrhea, genital herpes, trichomoniasis and syphilis. DISADVANTAGES:  Intravaginal spermicidal / barrier agents sometimes caused local irritation.


 Also associated with an increased incidence of candidiasis.  Couples feel uneasy. DOUNCHES  Vaginal irrigations are not a reliable means of contraception, even when spermicides are used in the douching solution.  Sperm may enter the cervix as soon as 15 seconds after ejaculation.  As a Nurse what Genetic Counseling will you advise to couples who have unwanted pregnancy is abnormal. RESPONSIBLE PARENTHOOD

 Promote the basic needs of his / her family morally, spiritually, financially,
  and emotionally. Involves adequate performance of parents. Adjust and adapt where they are living.

GENETIC COUNSELING  Consists of one or more encounters with the problems and their families with the objective or providing information about their genetic disease.


a. Counselor must work with grief and anticipatory grief issues with the
knowledge of a potentially negative outcome a amount of hope and denial usually prevails until the birth of the affected child brings family back to reality. b. Prevents knowledge that they are biologically responsible for their child condition is a burden often too.  Genetic Counseling will start when the physician have the diagnoses about the condition of the baby. BEST APPROACH IN GENETIC COUNSELING TEAM APPROACH o o o o o A Physician Geneticist Nurse Psychologist Medical Specialist Consist of one or more encounter with the family with objectives of providing information about them genetic disease.

PROBAND  Clinically identified person who person who displays the characteristics or features of the disease in question.

The Following Information includes: a. The risk of figure, options, provide and framework for a course of action taken by the individual, family and psychosocial family dynamics. b. The information includes risk figure, options, and provides a framework disease in question. c. Typically Genetic Counseling process begins when a clinician refer a family with a genetic disease has been identified its heavy to carry without emotional damage. INFERTILITY  It is inability to conceive after 1 year of any contraceptive method.


Two Types:

a. 1st Degree of Infertility
The couple has never conceived despite of unprotected intercourse after 12 months. nd 2 Degree of Infertility   The couple has previously conceived regardless of outcomes that are subsequently unable to conceive unprotected intercourse after 12 months.


40% = Woman 40% = Men 10% = Both 10% = Undetermined


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