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CHAPTER I

PROBLEM AND ITS SETTING

Community Health Nursing is a nursing practice outside the hospital which emphases on

the rural and far-off areas. A steadfast legacy observed by the College of Nursing of Ateneo de

Zamboanga University is the commitment in service of others. As a matter of fact, its vision

specifies that of “forming Men and Women for others who will bring about peace and

development by addressing the health needs of people in the city, the region, the nation and the

world.“(Ateneo de Zamboanga College of Nursing Policy Handbook, p. 7). Moreover, its

mission highlights on establishing in the said mentalities or beliefs of nursing students the

prominence of service to God and others through values such as spirituality and citizenship. With

the use of the expertise and capacities in which the students have, they will be able to succeed

excellence through focus, determination and their willpower to accomplish the goal that they are

up to.

During the 2nd week of duty, one of the researchers in Dona Maria Isabel C. Climaco

Health Center, it was observed that there a lot of old people who came by the health center to

have sputum examinations on the TB DOTS Center of the Health facility. It was observed then

that Mothers are bringing children during consultation with chief complaints of colds and

coughs. After that, the researcher noticed that there is a critical pathway on the health center

regarding the National Tuberculosis Program of the DOH. However, the critical pathway of the

NTP is not being utilized by the health center. Also, the system of the health center on how to

entertain clients is not okay even if there are flow charts that are visible on the health center

regarding the system on how to entertain clients.

Thus, in a local health center, Total Quality Management (TQM) must be practiced at all

times. It describes a management approach to long-term success through customer satisfaction.

In a TQM effort, all members of an organization participate in improving processes, products,

services, and the culture in which they work. TQM is considered a customer-focused process and

aims for continual improvement of business operations. It strives to ensure all associated

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a clearly specified list of problems is the most suitable basis for identifying potential solutions. This is also done to determine the usage of the different quality improvement tools that can be utilized to identify and analyze problems in the health center. 2 . and it may be easier for members of the public to understand a strategy based on clearly identified problems. but does still need to be checked against the full list of objectives. As a requirement in Total Quality Management. High levels of organizational communication are encouraged. objectives are often rather abstract. Although a good number of quality tools specific are available for certain domains. fields and practices. some of the quality tools can be used across such domains.employees work toward the common goals of improving product or service quality. Problems can be identified. using performance metrics to monitor progress. Special emphasis is put on fact-based decision making. Most organizations use quality tools for various purposes related to controlling and assuring quality. for the purpose of maintaining employee involvement and morale. as well as improving the procedures that are in place for production. These quality tools are quite generic and can be applied to any condition. 1. the conduct of problem identification and analysis is part of the approach of the Ateneo de Zamboanga University College of Nursing in committing to the service of God and Country. However.1 Purpose/Rationale As explicated. both now and in the future. as evidence that objectives are not being achieved. The Seven Basic Tools of Quality is a designation given to a fixed set of graphical techniques identified as being most helpful in troubleshooting issues related to quality. This problem-oriented approach to strategy formulation is an alternative to starting with objectives. They are called basic because they are suitable for people with little formal training in statistics and because they can be used to solve the vast majority of quality-related issues.

2 Review of the Related Literature “Community” here refers to a group of people with a shared interest. and efficient and effective practices. business management. social and economic interests. healthcare providers and entities must demonstrate quality outcomes. safety issues. and substantial fines. The central feature of community organizing is that it is a process and strategy designed to build political power” (p. which starts at your vocal chords 3 . and social justice . Noncompliance with regulatory standards can lead to a disruption in operations. fiscal responsibility. but can also affect other parts of the body. It can also affect just your lower respiratory system. political efficacy. preventing infections. which starts at your sinuses and ends at your vocal chords. Tuberculosis generally affects the lungs. poor quality of care. . improved quality of life. Our customers tell us they need to focus on delivering high quality patient care. Tuberculosis (TB) is a potentially serious infectious disease that mainly affects your lungs. Orr (2007) defines community organizing as “the process that engages people. Sullivan (2013) says that Healthcare organizations are continually battling conflicting priorities. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes. Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). including spatial. As the healthcare delivery system is held to greater accountability. and ensuring patient safety – all with extremely stretched resources. political. . 2).1. Acute respiratory infection is an infection that may interfere with normal breathing. Duquesne University emphasizes that Health Management Systems is an integration of healthcare. At the same time. Most infections do not have symptoms. and information systems. maintaining hospital security. in which case it is known as latent tuberculosis. as energy demand rises. many countries are requiring healthcare facilities to reduce carbon output and meet mandates for energy reductions. and communities toward the goals of increased individual and community control. organizations. It can affect just your upper respiratory system.

it pushes blood through your arteries to the rest of your body. and eyes. and the lower number signifies the pressure between the heartbeats. Your blood pressure may be different at different times of the day. (2014). National Library of Medicine stresses that high blood pressure. This may lead to stroke. When the blood pushes harder against the walls of your arteries. However. Having higher blood pressure for short amounts of time is normal. Other parts of the body. It happens when the force of the blood pumping through your arteries is too strong. Which problems should be ranked. a reading of 140/90 may require treatment. What are the actions and arrangements to implement to resolve the corresponding problems? 4 . When your heart beats.” is a serious medical condition. What are the problems of the said health center that need attention? 2. However. U. heart disease.This infection is particularly dangerous for children. It is usually higher when you first wake up. 1. also may suffer damage. According to the American Heart Association (AHA).S.and ends at your lungs. your blood pressure goes up. and people with immune system disorders. prioritized and addressed accordingly? 3. over time. older adults. also called “hypertension. when your blood pressure stays high for most of the time. after you exercise. which can interfere with blood flow throughout the body. it causes progressive damage to arteries and veins. or when you are under stress. The top number signifies the pressure in the arteries. including the kidneys. limbs.3 Statement of the Problem This paper specifically aims to answer the following questions: 1. and heart failure. High blood pressure doesn’t always produce obvious symptoms. it can cause serious health problems (2017).

The researchers first brainstormed on the possible problems that the health center currently faces.1. bar graphs. and pie charts. A Problem Tree diagram was used to identify the root cause and its effects for the different problems that were discussed. Afterwards. the researchers went to plan out on the different things to do for the identification of the problems and analysis. The data gathered from the Assessment Database Base were gathered and organized to statistically characterize the whole community of Farmers Drive in terms of the aspects involved in ADB. Selection of families was done randomly which definitely refers to selecting respondents without any exact order or manner (random sampling). After the thorough research on the different quality tools.4 Methodology Before venturing into health centers. (3) hypertension and (4) Pulmonary Tuberculosis. Affinity diagram was used to identify common ideas of the researchers regarding the possible problems and solutions they have thought during brainstorming. socio-economic and health related data regarding the families. These critical pathways are adapted from the different hospitals and health centers in the country. three concerns were identified by the community these are as follows: (1) poor management system (2) acute respiratory infection. the data that were collected were transcribed into line graphs. The main research instrument used to achieve this is an Assessment Database (ADB) which covers demographic. Also. The researchers have thought of to develop a critical pathway through flowcharts for the cases of tuberculosis which causes high morbidity rates in the health center. 5 . Collection of data was initialized by going to the health center and asking for the vital statistics for the year 2017. The use of the control pathways will make an impact for the faster processing and for the initial system of the health center. Next step taken was the ocular survey of Farmers Drive through home visit done by one of the researchers of 20 families. After the gathering of the data.

tuberculosis. radar chart. It is said that brainstorming is a group creativity technique by which 6 .6 Problem Identification There are four tools that can be used to identify problems in the clinical setting. we have utilized the Affinity Diagram. Brain Storming. Other quality improvement tools are used to determine the problems and analyze more the solutions to be used such as the histogram. With the brainstorming conducted. and the Poor Management System of the community.5 Limitation of the Study The paper is limited to Dona Maria Isabel Climaco Health Center and to the 20 families of Farmers Drive. acute respiratory infection and hypertension. During the brainstorming activity of the researchers. issues) and organizes them into groupings based on their natural relationships. In which. Maria. Increasing cases of Increasing Cases of Poor Management Increasing cases of PTB Acute Respiratory Hypertension System Infection •Poor usage of critical •Poor Home •High number of Old •"Palakasan" System pathways Management (IMCI) Age people in the •Not following the •Poor implementation •Common in Barangay Flowcharts that are of DOH programs Squattered Areas due •Sedentary Lifestyle displayed in the health •Poor early diagnosis to congestion •No "Bantay Presyon center and prompt treatment •Common in children Program" in the •Lack of staff members of PTB Barangay •Low salience of the •Poor prompt problem treatment for Hypertension Figure 1. 1. The Affinity process is often used to group ideas generated by Brainstorming. Sta. an Affinity Diagram is a tool that gathers large amounts of language data (ideas.1 shows the affinity diagram of the topics that were discussed during the Brainstorming Activity.1 Figure 1. opinions. we have found out that we should focus on the problems such as the incidence of cases such as Tuberculosis. 1. This paper is limited only to identify and analyze the problems by utilizing the different quality improvement tools in Total Quality Management. It precisely focuses on the problems identified by the researchers which are the poor management system. scatter plot diagram and etc. Hypertension. Flowchart and Nominal Group Technique. Affinity Diagram. Acute Respiratory Infection.

workflow or process.2 shows the flowchart series of the paper. The researchers thought of the process that they should follow in order to identify the problems and make solutions on the identified problems with a followed step-by-step process. Like other types of diagrams. This diagrammatic representation illustrates a solution model to a given problem. Flowcharts are used in designing and documenting simple processes or programs. and perhaps also find less-obvious features within the process. like flaws and bottlenecks. designing. With the four major problems that were identified.2 Figure 1. tools to be used. they help visualize what is going on and thereby help understand a process. Flowcharts are used in analyzing. the four major concerns were discussed and the causes were identified. documenting or managing a process or program in various fields.efforts are made to find a conclusion for a specific problem by gathering a list of ideas spontaneously contributed by its members. priority ranking and solutions to be made. The Affinity diagram shows the cause-effect relationship. we have utilized another tool to see the flow of the problem identification. and their order by connecting the boxes with arrows. Flowchart is Is a type of diagram that represents an algorithm. The flowchart shows the steps as boxes of various kinds. 7 . Problems of the Health Center Gather data regarding the Problems of the Health Center Analyze the data and Prioritze the problems accordingly Make solutions based on the given problems of the community Figure 1. Hence.

solution generation. First. 3rd. and the members proceed to rank the solutions. It can be used in groups of many sizes. 1st. Then. However. Problem Tally ARI 1 Tuberculosis 3 Poor Management System 1 Hypertension 0 Figure 1. the problems that were noticed are the focus of the paper and the data that were gathered throughout the period of time. and decision making. the group found out that based on their votes. They focused the increasing cases of tuberculosis as the main problem of the research paper since that there is a need to address the problem with Tuberculosis. where only the largest group is considered). with a short explanation. and so on.3 Based on the NGT.The method of tallying is the difference. With the given flowchart of the paper. Hence. 2nd. they also thought of solving the poor management system of the health center to further solve the other problems concerning all the levels of clientele in the community. Nominal Group Technique is a group process involving problem identification. every member of the group gives their view of the solution. but want everyone's opinions taken into account (as opposed to traditional voting. 4th. as by a vote. 8 . duplicate solutions are eliminated from the list of all solutions. who want to make their decision quickly. the researchers thought of using the nominal group technique.