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NEEDS ASSESSMENT OF FAMILIES IN

BRGY. MAMALINGLING, DAGUPAN CITY,


A PRELIMINARY STUDY

JAN PATRICK S. ARRIETA, RN, RM


BRANDO V. SOLIS, RN, MaED, Ed.D.

A FACULTY RESEARCH
COLLEGE OF NURSING
COLEGIO DE DAGUPAN

October 2010
ABSTRACT
Jan Patrick S. Arrieta, RN, RM, and Dr. Brando V. Solis, RN, MAEd.

Satisfaction of a need is integral for survival. However, it has now been realized that certain needs require
fulfillment primarily before others. In the setting of a community, wherein there is a blend of different
perspectives and prioritizations of needs, there is a requisite for assessing what they are and who are the
people who demand them. In short a phrase, what is the profile and collective needs of Brgy.
Mamalingling. The researchers used a Community Survey form to acquire data from a representative
sample of 144 households. From there, the data are tabulated and computed using the UP Manila College of
Nursing matrix for prioritizing needs. The study reveals that the top five needs are (1) diarrhea, being the
most common illness or medical problem; (2) influenza as the leading cause of child mortality; (3) waste
management; (4) low academic profile; (5) and presence of breeding sites of rodents and pests.

ACKNOWLEDGEMENT
Gratitude is due to the following people, who in ways, minute or otherwise have imparted
something which has made an immense impact in the completion of this work.
To Colegio De Dagupan, for the opportunity to excel and prove oneself.
To the College of Nursing, for the shared laughter.
To our students, the reasons we go to work every day.
To them, who shall be the spring of love flowing evermore, the source of our inspiration.

JPSA and BVS

Contents
Page
Title Page
Abstract i
Acknowledgement ii
Contents iii
List of Tables iv
List of Figures vi
Chapter
1 INTRODUCTION 1
Background of the Study 1
Theoretical Framework 5
Conceptual Framework 9
Statement of the Problem 12
Assumptions 15
Significance of the Study 15
Scope and Limitations 18
Definition of Terms 19
2 REVIEW OF LITERATURE AND STUDIES 23
3 METHODOLOGY 33
Research Design 33
Sources of Data 34
Instrumentation 36
Tools for Data Analysis 37
4 DISCUSSION OF FINDINGS 40
5 SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summary
Conclusions
Recommendations
Bibliography/References
Appendices
A Community Survey Form
B Matrix for Scoring Community Health Problems/Health Needs from University
of the Philippines College of Nursing Community Health Nursing Specialty
C Organizational Chart of Brgy. Mamalingling
D Photographs
E Action Plan for Nursing Students in the Implementation of COPAR

Curriculum Vitae

List of Table

Table Title (Frequency and Percentage of…) Page


4.1 Age Group
4.2 Gender
4.3 Civil Status
4.4 Educational Attainment
4.5 Employment Status
4.6 Religion
4.7 Family Structure
4.8 Decision Maker
4.9 Income Profile
4.10 Housing Material
4.11 Ownership Status
4.12 Ownership Status of the Lot
4.13 Availability of Gardening Space
4.14 Source of Drinking Water
4.15 Drinking Water Storage
4.16 Food Storage
4.17 Drainage System
4.18 Type of Dwelling Unit Structure
4.19 Electric Supply
4.20 Cooking Fuel Source
4.21 Toilet Facility
4.22 Garbage Disposal
4.23 Use of Garbage Segregation
4.24 Animals or Pets
4.25 Breeding Sites for Insects, Rodents, or Pests
4.26 Stillbirth
4.27 Causes of Child Mortality
4.28 Common Illness in the Family
4.29 Family Planning Methods
4.30 Health Resources Availed
4.31 Computation Matrix for Academic pool of 14.43% who did not go to school and
high school graduates of 45.25%
4.32 Computation Matrix for Unemployment rate of 16.77% or about 126 people aged
18 and above who do not have/hold jobs currently
4.33 Computation Matrix for 63.89% of families have a family income below PhP
5,000.00
4.34 Computation Matrix for Waste management: 20.13% Burning; 8.33% Open
dumping; and 43.06% of not practicing garbage segregation
4.35 Computation Matrix for 47.92% of households have a breeding site for pests and
rodents
4.36 Computation Matrix for Stillbirth occurrence of 9 in 144 families
4.37 Computation Matrix for Influenza is the leading cause of child mortality in 5 out of
14 cases
4.38 Computation Matrix for Diarrhea is the most common illness in the family in 62
out of 192 cases
5.1 List of Health Needs Identified and their Total Scores

List of Figures

Figure Title Page


1.1 Maslow’s Hierarchy of Needs 6
1.2 Maslow’s Hierarchy of Needs as Adapted by R. Kalish 7
1.3 Paradigm of the Study 11
4.1 Age Group
4.2 Gender
4.3 Civil Status
4.4 Educational Attainment
4.5 Employment Status
4.6 Religion
4.7 Family Structure
4.8 Decision Maker
4.9 Income Profile
4.10 Housing Material
4.11 Ownership Status
4.12 Ownership Status of the Lot
4.13 Availability of Gardening Space
4.14 Source of Drinking Water
4.15 Drinking Water Storage
4.16 Food Storage
4.17 Drainage System
4.18 Type of Dwelling Unit Structure
4.19 Electric Supply
4.20 Cooking Fuel Source
4.21 Toilet Facility
4.22 Garbage Disposal
4.23 Use of Garbage Segregation
4.24 Animals or Pets
4.25 Breeding Sites for Insects, Rodents, or Pests
4.26 Stillbirth
4.27 Causes of Child Mortality
4.28 Common Illness in the Family
4.29 Family Planning Methods Used
4.30 Health Resources Availed

Chapter 1
INTRODUCTION
Background of the Study
Needs and wants are two entirely different things. One means it is of utmost importance that if
absent would not allow progression of life while the other is the expression to acquire more beyond what is
imperative. There are many needs of man and we necessitate identifying them, both individually and in a
community setting.
According to the famous writings of Abraham Maslow, needs could be arranged in a pyramidal
schema where the most basic needs are located at the bottom and that if they are not met, the person is not
able to reach higher level needs. All people have the same basic needs; however, each person’s needs and
reactions to those needs are influenced by the culture with which the person identifies. They could range
from bodily needs, independence, privacy, and professional achievement may be important in one
subculture but may not necessarily be of equal importance in another. Prioritization of these needs is based
on a complex set of learned and situational influences.
There are several characteristics of human needs. People meet their own needs relative to their
own priorities. This is exemplified by a poor mother who might give up her share of food so that her child
might have sufficient food to live. Although basic needs generally must be met, some needs can be
deferred. An example is when someone is waiting in line but feels the urge to urinate, may defer urination
to secure his place in the line. Another characteristic is that failure to meet needs results in one or more
homeostatic imbalances, which can eventually result in illness. Furthermore, a need can make itself known
by either external or internal stimuli. A person may experience hunger as a result of physiologic processes
(internal stimulation) or as a result of seeing a beautifully-decorated cake (external stimulation).
Another characteristic of a need is exemplified when a person who perceives a need can respond
in several ways to meet it. The choice of response is largely a result of learned experiences, lifestyle, and
the values of the culture. For example, many people’s food choices at mealtimes and snack times are based
on past experiences, lifestyle, and culture.
Needs are interrelated. Some needs cannot be met unless related needs are also met. The need to
main hydration or fluid balance can be influenced by the need to eliminate urine first.
And finally, needs can be satisfied in healthy and unhealthy ways. Ways of meeting basic needs
are considered healthy when they are not harmful to others or to self, conform to the individual’s
sociocultural values, and are within the law. Conversely, unhealthy behavior may be harmful to others or to
self, does not conform to the individual’s sociocultural values, or is not within the law. People who satisfy
their basic needs appropriately are healthier, happier, and more effective than those whose needs are
frustrated (Kozier, et. al. 2008).
According to Maglaya (2000), before the needs could be solved, they must be assessed. The
community health nurse is a product of, and interacts constantly with his/her physical, sociocultural,
economic and political environment. Although nursing seems to be universal, the nature, the practice of the
profession is primarily determined by its context. The clients’ health needs and problems are a major
determinant of the practice of community health nursing. The health care delivery system, particularly the
nursing profession, should be responsive to these needs.
In order to respond to these needs, community health nursing is the tool. It is the utilization of the
nursing process in the care of the different levels of clientele – individuals, families, population groups and
communities. Through community survey, we will be able to identify the health needs of the client. We
acknowledge that there are factors which change the needs of one family from another. Literacy is a
person’s ability to read and write. People with higher education have better health status than those who
spent lesser number of years in schools. They can take care of their health needs better than those who were
not able to finish significant number of years in school. This is easy to explain because those who were not
able to finish elementary or high school levels are the poor who could not afford the other basic
requirements of good health. Another major reason for health problems of our people is poverty. Most of
the leading causes of morbidity and mortality associated with factors could be attributed to poverty,
illiteracy, unfounded health beliefs, harmful practices, inadequate nutrition, poor environmental sanitation,
inadequate source of potable water, congested housing units, poor access to basic health services, and
inability to make decisions on matters which are important to health (Cruz, 2000).
It is therefore through careful assessment can we truly catalogue the needs of the people and as the
nursing process dictates, the data can reveal or diagnose these collective needs or problems which will be
managed through careful planning, ready for implementation. And this will lead to the final step of
evaluating the course of action if they are successful or otherwise.
Theoretical Framework
A variety of theoretical frameworks provide the nurse with a holistic overview of health
promotion for the individual and families across the life span. Two major theoretical frameworks that nurse
use in promoting health are Maslow’s Hierarchy of Needs and by adaption, Kalish’s Hierarchy of needs.
According to Maslow, there are five levels of needs arranged in an ascending manner. Physiologic
needs. Needs such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial
for survival. Safety and security needs. The need for safety has both physical and psychologic aspects. The
person needs to feel safe, both in the physical environment and in relationships. Love and belongingness
needs. The third level of needs includes giving and receiving affection, attaining a place in a group, and
maintaining the feeling of belonging. Self-esteem needs. The individual needs both self-esteem (i.e.,
feelings of independence, competence, and self-respect) and esteem from others (i.e., recognition, respect,
and appreciation). Self-actualization. When the need for self-esteem is satisfied, the individual strives for
self-actualization, the innate need to develop one’s maximum potential and realize one’s abilities and
qualities. (Kozier, et. al., 2008)

Figure. 1.1 Maslow’s Hierarchy of Needs


Also, in the work of Richard Kalish, he adapted Maslow’s hierarchy of needs into six levels rather
than five. He suggests an additional category between physiologic needs and the safety and security needs.
This category referred to as stimulation needs, includes sex, activity, exploration, manipulation, and
novelty. Kalish emphasizes that children need to explore and manipulate the environments to achieve
optimal growth and development. He notes that adults, too, often seek novel adventures or stimulating
experiences before considering their safety and security needs. (Kozier, et. al., 2008)
Self-actualization
Esteem Self-Esteem
Love Belonging Closeness
Safety Security Protection
Sex Activity Exploration Manipuation Novelty
Food Air Water Temperature Elimination Rest Pain Avoidance

Figure 1.2 Maslow’s Hierarchy of Needs, as adapted by Kalish


The nursing process is based on a nursing theory developed by Ida Jean Orlando. She developed
this theory in the late 1950's as she observed nurses in action. She saw "good" nursing and "bad" nursing.
From her observations she learned that the patient must be the central character; nursing care needs to be
directed at improving outcomes for the patient, not about nursing goals; and that the nursing process is an
essential part of the nursing care plan.
The purpose of the nursing process is to identify a client’s health status and actual or potential
health care problem or needs, to establish plans to meet the identified needs, and to deliver specific nursing
intervention to meet those needs. The client may be an individual, family or a group. (Kozier, et. al. 2008)
Giving rise to the importance of planning is Willes (2007) who believed that evaluation is the
process of making judgments that are to be used as a basis for planning. “The effectiveness and success of
any job of learning therefore is heightened by a valid and discriminating appraisal of all its aspects”. It
seems to be important to point out the centrality of evaluation in nursing too. The very essence of nursing
requires the nurse to evaluate constantly the clientele’s nursing needs as well as her own activities in
meeting these needs and guiding the clientele in his own evaluation of his health needs to maintain an
optimal level of health. If nurses are to improve their practices, change their attitudes or alter their
behavior, they must develop the habit of evaluating the outcomes/results of any programs implemented.
Thus, evaluation is an essential part of nursing just as it is a part of teaching and learning. The perception
focused on the health workers involves their awareness of the component thrusts of the program and the
extent of their involvement in the attainment of the program objectives along with the component thrusts.
Similarly, it focuses on the problems encountered by the health workers and their extent of seriousness, and
the recommendations offered for the improvement of the implementation of the community health
extension program. Nurses are part of a fast growing and changing community. They are affected by
change just as they are agents of change. The profession must seek the relevancy with the community they
serve. Nurses play a role in the community in the preservation and protection of public health. Nurses of
this country have a grave challenge to meet. With the pace of the development of a community, the need of
every member of the community is dynamic. As a representative of the institution where one is employed,
nurses have to be prepared in bringing out the most relevant plan of action in response to changing needs of
the community and at the same time, motivate them to develop a community based spirit that will lead to
the ultimate goal of the Department of Health empowerment through self-reliance.
It is through all these theories that the research is grounded. Theories that explain the different
needs and the way with which they are being prioritized is a baffling undertaking, and it is only with
another concept, Community Organizing and Participatory Action Research will we be able to make sense
of it all. All of these make a fine mesh of conglomeration that will aid us in our search for the needs of a
particular individual and extending it to the community level.
Conceptual Framework
The main concept that is necessitated in this issue is Community Organizing and Participatory
Action Research (COPAR). In the works of Maglaya (2000), this is integral in a community setting to
resolve the problems. It is from here that the nurse-researcher can see a clear picture of what factors are
lacking or that need attention. COPAR is a way for us to prioritize problems and that if we have a list of
problems, manners and methods to resolve them can be initiated.
In support of Maglaya, we have the writings of De Belen who says that when using primary health
care as an approach to health, the community health nurse conduct community organization and
participatory action research not only for the purpose of community health but also for community
development. He further states that is an important tool for community development and people
empowerment, as it helps the community health workers to generate community participation and to obtain
information for developing a community plan for health as a key to development. He also states that in the
two function of participatory action research, one is to obtain data for assessment and diagnosis of the
community and the preparation of a community nursing care plan.
With the theoretical and conceptual frameworks we can clearly see the importance of a careful
assessment in order for community health nurses and their ancillary partners to create a plan for furthering
the health condition of the people. Most importantly, this is a cyclical approach which aims to continue
seeking areas for improvement in the community setting, eyeing the family as the basic unit.
Paradigm of the Study
Figure 1 shows the schematic relationship of the Independent variables, Dependent Variables, and
the Moderator Variables. In the diagram, rooting from Needs Assessment and COPAR is a directional line
leading to the collective needs of Brgy. Mamalingling and the priority problems of the people. Here, Needs
Assessment is the process with COPAR as a concept to ground and guide the process of gauging the
community under study. The result of which will vary depending on the moderators of the assessment listed
as the Family Profile, Family Characteristics, Home and Environment, Health and Health Practices;
apropos by a straight solid line.
Statement of the Problem
Assessment starts the nursing process and therefore is of primary importance in the formulation of
a plan to tackle any problem.
Specially, this study seeks to answer the following questions:
• What is the demographic profile of the families/households in Brgy. Mamalingling, Dagupan
City in Pangasinan in terms of the following:
Part A. Family Member’s Chart
• Names
• Position in the Family
• Age
• Sex
• Civil Status
• Highest Level of Schooling Attended
• Current Employment Status
• Religion
Part B. Family Characteristics
• Type of Family Structure
• Family Decision Maker
• Family Income in a Month
Part C. Home and Environment
• Housing Material
• Ownership Status of the House
• Ownership Status of the Lot Which the House is Built
• Available Space for Gardening
• Source of Drinking Water
• Drinking Water Storage
• Food Storage
• Drainage System
• Type of Dwelling-Unit Structure
• Electric Supply
• Type of Cooking Fuel Source
• Toilet Facility
• Garbage Disposal
• Use of Garbage Segregation
• Animals or Pets Kept
• Breeding Sites for Insects, Rodents, or Pests
Part D. Health and Health Practices
• Stillbirth
• Causes of Child Mortality
• Common Illness in the Family
• Family Planning Methods
• Health Resources Availed Of
• What are the collective needs of the families in Brgy. Mamalingling, Dagupan City?
They may be:
• Health Status Problems
• Health Resource Problem
• Health-related Problems
• What are the top five priorities revealed in the Typology of Community Health Nursing
Problems?
Assumptions
• The needs of the members of Brgy. Mamalingling are multifaceted and highly variable.
• The assessment part of the Nursing process will direct the accurate collection of data to elicit
the needs of the barangay.
• The needs can be prioritized using the criteria in the Community Organizing Participatory
Action Research.

Significance of the Study


These findings of this study could be beneficial to the parties identified hereunder;
Nursing Research. The study is an asset in the field of nursing research this could be used as a
basis for future researches providing conglomerated data on a community level. This could also be the
springboard in formulating an instructional education campaign for the barangay with the data presented.
The proposed functional measures can be used by them as guidance in knowing the demographic profile of
the respondents, their status, their knowledge and awareness, access and utilization of health services by
household in Brgy. Mamalingling, Dagupan City and assess the facet relative to health care and how
professionals and the residents can be educated towards utilization of health care system, its benefits and
importance to health. This is beneficial to the educators, policymakers, and community leaders identify key
threats to sustainable development and explore possible approaches to addressing about issues on
utilization of health services by household in Brgy. Mamalingling, Dagupan City.
Nursing Practice. The study will aid in knowing what particular action to be adopted in such
cases and what action to be applied to educate the households about family care and promote health among
depressed areas of the Philippines. This would benefit the BHW, community nurses, doctors, midwives in
order for them to understand the need of promoting health care delivery system, with this study they would
be able to understand the households regarding the different contributors of poor health
Nursing Education. This will be valuable as this will provide the nurses, students and educators
with knowledge and essential concept towards the health care services. With a well-guided learning
experience, evaluation of their competence can be easily outlined. This will also serve as an opportunity to
initiate care at the very base of society, which should be emphasized in the curriculum. To consider also
could be a coordinated plan with affiliate communities and the college, which will manifest in black and
white to serve as an activity guide for a given academic year or postulated time frame.
Residents and Health Personnel. This makes them increase their awareness that promoting
health care is a dynamic and continuously evolving concept. Therefore, information sharing and
collaboration will be needed to ensure that the approaches developed and implemented are based on the
most recent and relevant information available and on the evolving experiences of those working in the
field.
City Planning Office. Government agencies can benefit from this research report because of the
information contained in it which will serve as an update regarding the situation facing Brgy.
Mamalingling. This will aid in the formulation of plans to address the people’s concerns, particularly in the
preparation of budget allocation. This research report may pave the way in giving Brgy. Mamalingling a
second glance and be considered as a priority.
City Health Office. As earlier stated, when needs are not met, it will result to illness. The City
Health Office will have the opportunity to look at the data presented here and may alert them regarding the
status of the people’s health. An ill nation is a poor nation, therefore, it is imperative that health be a
priority. Moreover, along with the City Planning Office, they could collaborate with one another in the
implementation of the programs the Department Health in whatever area that needs implementation.
Scopes and Limitations
The locale of the study will be conducted in Dagupan City and within the administrative locale of
Brgy. Mamalingling. The study will be concerned with assessing the needs of the families in Brgy.
Mamalingling, that is, they are residents within the boundaries of the barangay. The time (in years) on how
long they have resided in the barangay is difficult to allow exclusivity because of the turn-over in terms of
residence, moreover the data is encompassing because it would include even temporary residents such as
boarders or visitors during the time of data gathering. The variables under study are enumerated in the
Moderator Variables using the Community Survey Form. The study concerns these variables but is not
limited to them. Other pieces of information which would reveal needs and/or problems will be allowed a
test for prioritization. Data gathering will start from January 20, 2010 until February 10, 2010. From here,
data will be collated.
Data gathered from the community survey form and other pertinent data not found in the survey
form acquired from the Barangay Hall, School Records, and Midwives’ Records are the only sources of
data. It means that no other health needs can be identified if not revealed in the survey form or other data
sheets. Changes in the actual numbers of the population may not necessarily be up-to-date in that census
has been acquired in the year 2009 (for actual population). As for the School Records of enrolment, the
pupils of Brgy. Mamalingling may not necessarily be bound to Brgy. Mamalingling Elementary School in
that the school is located near the boundary of Brgy. Bolosan, where another school is located.
Definition of Terms
The following are define in order to provide additional information above the study:
Age. This is defined as the period of time that an individual has lived, usually expressed in years. To
differentiate the age division, it shall be delineated by one day beginning the stated year and ends
with one day before the next category assuming a 30 day/month calendar.
Age Divisions:
1 day to 11 months and 29 days
12 Months to 2 years and 11 months and 29 days
3 years to 5 years and 11 months and 29 days
6 years to 11 years and 11 months and 29 days
12 years to 17 years and 11 months and 29 days
18 years to 39 years and 11 months and 29 days
40 years to 64 years and 11 months and 29 days
65 years and beyond
Assessment. This is defined as the first phase of the Nursing Process comprising of collecting data,
validating data, organizing data, and documenting data.
Barangay. This is defined as the smallest administrative division in the Philippines.
BHW (barangay health workers). This is defined as the provider of health services in a barangay or health
workers working in a barangay.
Collective Needs. This is defined as the surveyed factors or things which require attention and treatment.
Community. This is defined as a collection of people who share some attribute of their lives.
Community Health Center. This is defined as the agency within a community or barangay which is
responsible for delivering primary level of care and is committed to improving the health of its
community.
Department of Health. This is defined as the national agency that focuses on promoting health and
wellness of the estate.
Family. This is defined as the basic unit of society; a fraction of the population comprising a single
household.
Family Decision Maker. This is defined as the family member who makes critical decision regarding the
best interest of the family. May be patriarchal (father is the decision maker), Matriarchal (mother
is the decision maker), or Combination, even extended from the first filial generation (the
grandfather or grandmother).
Family Type. This is defined as the conglomerated characteristics of a household.
• Nuclear – This family type is composed of a husband, wife, and children.
• Binuclear – This is a family type where two nuclear families (commonly two siblings) are
living together.
• Extended – This family type is also known as the multigenerational family; it includes
not only the nuclear family but also other family members such as grandmothers,
grandfathers, aunts, uncles, cousins, and grandchildren.
• Single Alliance
• Single Parent – A family type wherein there is only one parent who lives in the home.
• Blended – Also known as a remarriage or reconstituted family, are divorced or widowed
persons with children who marries someone who also has children.
• Cohabitation – A family type composed of heterosexual couples living together like a
nuclear family but remain unmarried.
• Communal – This is also known as communes which comprise groups of people who
have chosen to live together as an extended family, and their relationship to each other is
motivated by social or religious values.
• Foster Family – This family type is a temporary home placement for a child whose
parents can no longer care for them and is cared for by foster parents; foster parents may
not have children of their own.
Family Income. This is defined as the amount of money or its equivalent received during a period of time
in exchange for labor or services, from the sale of goods or property, or as profit from financial
investments.
Health. This is defined as a state of complete physical, mental and social wellbeing, not merely the absence
of disease or infirmity.
Health Status Problems. This is defined as a community health problem described in terms of increased or
decreased morbidity, mortality, or fertility.
Health Resource Problem. This is defined as a state of lack or absence of manpower, money, materials, or
institutions necessary to solve health problems.
Health-related Problems. This is defined as the existence of social, economic, environmental, and
political factors that aggravate the illness-inducing situations in the community.
Household. This is defined as a domestic unit consisting of the members of a family who live together
along with nonrelatives such as servants.
Illness. This is defined as the opposite of health or is a state of poor health
Literacy. This is defined as the cognitive ability to read and write.
Need. This is a condition necessitating supply or relief; a requirement for subsistence or for carrying out
some function or activity.
Needs Assessment. This is defined as a process employing varying methods of data acquisition within the
framework of Community Organizing and Participatory Action Research.
Priority Setting Criteria. This is defined as the factors considered in determining the rank or order of
community health problems relative to the unique requirement of the community area under study.
The following are the criterion with their descriptions:
• Nature of the problem presented – the problems are classified by the nurse-researcher as health
status, health resources or health-related problems
• Magnitude of the problem – this refers to the severity of the problem which can be measured in
terms of the proportion of the population affected by the problem
• Modifiability of the problem – this refers to the probability of reducing, controlling, or eradicating
the problem
• Preventive potential – this refers to the probability of controlling or reducing the effects of posed
by the problem
• Social concern – this refers to the perception of the population or the community as they are
affected by the population
Chapter 2
REVIEW OF LITERATURE AND STUDIES
Nursing Process Theory
Orlando's theory was developed in the late 1950s from observations she recorded between a nurse
and patient. Despite her efforts, she was only able to categorize the records as "good" or "bad" nursing. It
then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records.
From these observations she formulated the deliberative nursing process.
The role of the nurse is to find out and meet the patient's immediate need for help. The patient's
presenting behavior may be a plea for help, however, the help needed may not be what it appears to be.
Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered
from their thoughts to explore with patients the meaning of their behavior.
This process helps the nurse find out the nature of the distress and what help the patient needs.
Orlando's theory remains one the of the most effective practice theories available. The use of her theory
keeps the nurse's focus on the patient. The strength of the theory is that it is clear, concise, and easy to use.
While providing the overall framework for nursing, the use of her theory does not exclude nurses from
using other theories while caring for the patient (Tomey and Alligood, 2002).
The Nursing Process
The nursing process is a systematic, rational method of planning and providing nursing care. Its
purpose is to identify a client’s health care status, and actual or potential health problems, to establish plans
to meet the identified needs, and to deliver specific nursing interventions to address those needs. The
nursing process is cyclical; that is, its components follow a logical sequence but more than one component
may be involved at one time. At the end of the first cycle may continue with reassessment, or the plan of
care may be modified.
Assessing is the systematic and continuous collection, organization, validation, and documentation
of data. In effect, assessing is a continuous process. For example, in the evaluation phase, assessment is
done to determine the outcomes of the nursing strategies and to evaluate goal achievement. All phases of
the nursing process depends on the accurate and complete collection of data. A nursing assessment should
include the client’s perceived needs, health problems, related experience, health practices, values, and
lifestyles. To be most useful, the data collected should be relevant to a particular health problem. Therefore,
nurses should think critically about what to assess. The assessment process involves four closely related
activities: collecting data, organizing them; validation, and documentation of data (Orlando 1972).
In addition to the content of Orlando, George (2002) explains further that collection of data
includes only information relevant to identifying the patient’s need for help.
Wilkinson (2007) supports the statements aforementioned, saying assessment is the first phase in
the nursing process, is the systematic gathering of relevant and important patient data. And that in effect,
assessment is a continuous process carried out during all phases of the nursing process.
In the context of community nursing, De Belen (2008) says that the best persons to assess the
community’s health condition and status are the community health nurses or nursing students who interact
with the community member’s and observe their social environment. The nurses’ assessment and diagnosis
serve as the basis of rural health unit or health office for community health planning, because they provide
information on the community health concerns, needs and priorities. All these information obtained from
the community are useful in community nursing in particular and community health development in
general. They are also useful for improving the health status of the community through strategic and
operational planning in community health. Thus, community health assessment is a fundamental tool of
community health nurses.
Community Organizing and Participatory Action Research
COPAR is a social developmental approach and a systematic, continuing process of people
transforming themselves from their culture of silence to a collective voice and action through undergoing
continuous education or collective conscientization and awareness building about their existing situations,
identifying their own needs and formulating their own goals and objectives, developing their own
capabilities, readiness and political will to respond or take action on their immediate long or short term
needs or problems, and mobilizing their constituents to collectively take action on such needs or problems.
As applied to community health development, it is defined as an essential health care approach
based on practical, scientifically-sound, and socially-acceptable methods of technology made universally
accessible to individuals, families in the community through full participation at a cost that the community
can afford to maintain at every stage of development in the spirit of self-reliance and self-determination.
(Maglaya, 2000)
Along with this idea is needs assessment which is a process for determining and addressing needs,
or "gaps" between current conditions and desired conditions, often used for improvement projects in
education/training, organizations, or communities. In the context of community improvement, it is known
as community needs analysis. It involves identifying material problems/deficits/weaknesses and
advantages/opportunities/strengths, and evaluating possible solutions that take those qualities into
consideration (Gupta, 2007).
Community needs assessment involves assessing the needs that people have in order to live in:
• an ecologically sustainable environment
• a community that maintains and develops viable social capital
• a way that meets their own economic and financial requirements
• a manner that permits political participation in decisions that affect themselves
Once you have collected the data, the process moves on to analysis of the data to determine the
health status, the patient's coping mechanisms or lack thereof, his ability to use these mechanisms and to
identify his problems related to his health status. (Roudy and Kusy, 1995).
To deliver a more comprehensive approach to COPAR, we have an electronic source
By definition, Community Organizing Participatory Action Research (COPAR) is a continuous
and a sustained process of educating the people to understand and develop their critical consciousness. It is
involved in working with people, to work collectively and effectively on their immediate and long term
problems; and mobilizing with people, develop their capability and readiness to respond, take action on
their immediate needs towards solving the long term problems.
The process and structure through which members of a community are/or become organized for
participation in health care and community developmental activities.
COPAR emphasizes community working to solve its own problems; the direction is established
internally and externally; development and implementation of a specific project less important than the
development of the capacity of the community to establish the project; and that consciousness raising
involves perceiving health and medical care within the total structure of society
COPAR is important because it maximizes community participation and involvement; could be an
alternative in situations wherein health interventions in Public Health Care do not require direct
involvement of modern medical practitioners; it gets people actively involved in selection and support of
community health workers; and through COPAR, community resources are mobilized for selected health
services. Likewise, COPAR improves both projects effectiveness during implementation.
There are different phases in the COPAR process. The first is the Pre-Entry Phase which is the
initial phase of the organizing process where the community organizer looks for communities to serve and
help. Preparation of the institution is the first activity done in the Pre-Entry Phase. It is here that faculty
and students are trained in COPAR, plans are formulated to institutionalize COPAR, revisions or
enrichment of the curriculum and immersion program are done, and coordination with participants from
other departments is carried out.
Second activity is site selection to implement COPAR. Here, initial networking is done with the
local government, a special preliminary investigation is conducted, and ocular survey is done.
In order to select a site, the community must satisfy the following criteria: a population of 100 to
200 families; the community is economically depressed; there is no strong resistance from the community,
there is no serious peace and order problem; and that no similar group or organization holding the same
program.
The second phase of COPAR is known as Entry Phase. This is sometimes called the social
preparation phase. This phase is crucial in determining which strategies for organizing would suit the
chosen community. The success of the activities depends on how much the community organizers have
integrated with the community.
A key activity in the Entry Phase is called Integration, wherein rapport is established with the
people in continuing effort to imbibe community life. Integration is carried out by living with the
community; seeking out to converse with people where they usually congregate; and lending a hand in
household chores. After integration, the settled group may continue with deepening social
investigation/community study. During this time, the group verifies and enriches data collected from initial
survey. After that, a core group is to be formed composed of key persons, or those approached by most
people; and the opinion leader, or the one approached by the key persons. With this, isolates or those who
are hardly consulted are sought out.
The third phase is known as the Organization-building Phase. This entails the formation of more
formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating
community-wise activities. It is at this phase where the organized leaders or groups are being given training
(formal, informal, OJT) to develop their style in managing their own concerns/programs.
And finally, the last phase is known as Sustenance and Strengthening Phase. This 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 committee setups 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.
It was according to Jimenez (2005), she proposed six phases in community organizing and
participatory action research for community health nursing: Pre-entry phase, entry phase, community
study/diagnosis phase, community organization/capability building phase (research), community action
phase, and sustenance and strengthening phase. And that these phases can be simplified into the four
aforementioned phases. However, O’Brien has specified a structure of COPAR following Diagnosing,
Action Planning, Taking Action, Evaluating, Specifying Learning and back in a cyclical fashion.
Citing O’Brien (2001) and McNiff (2002), they said that action research involves utilizing a
systematic cyclical method of planning, taking action, observing, evaluating (including self-evaluation) and
critical reflecting before planning the next cycle. This is supplementary to the statements of Wadsworth
(1998), saying participatory action research is essentially research involving all relevant parties in actively
examining together current action (which they experience as problematic) in order to change and improve
it. They do this by critically geographical and other contexts which make sense of it. Furthermore, he says
that participatory action research is not just research which is hoped will be followed by action. It is an
action which is researched, changed and re-researched within the research process by participants. Nor is it
simply an exotic variant of consultation. Instead, it aims to be active co-research, by and people to get
another group of people to do what is thought best for them – whether that is to implement a central policy
a genuinely democratic or non-coercive process whereby those to be helped determine the purposes and
outcomes of their own inquiry.
Chapter 3
METHODOLOGY
Research Design
The descriptive design will be used in the study. It is a method which seeks to gather information
about existing conditions with an aim to describe the nature of a situation as it exists at the time of the study
and to explore the causes of a particular phenomenon (Sevilla, et. al. 2001). Polit and Beck (2004) presents
a more contemporary purpose in that It is a study which determines and reports the way things are and
measures what already exists. The descriptive research seeks to observe, describe, and document aspects of
a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis gathering or
theory development. This research portrays accurately the characteristics of persons, situations, or groups
and for the frequency with which certain phenomena occur.
With the intention to observe and identify the needs of the families, the use of the descriptive
research will enable the researchers to gather tangible information regarding their specific family needs,
which in turn, could be amassed to list the collective needs or problems. The design will help in assessing
the different needs as it is applied to the variable literacy and family income. This design will also dictate
the use of statistical methods in order to deal with the data gathered.

Sources of Data
The study would like to put under the microscope of scrutiny the needs of the families within the
confines of the barangay. The study will be conducted in the City of Dagupan, in Brgy. Mamalingling. The
barangay is located in the eastern part of Dagupan City in the province of Pangasinan. It is bounded by the
municipality of Mangaldan on the east and the barangay of Bolosan on the south, by barangay Tambac on
the west, and by barangay Bonuan-Boquig on the north. It is in this area occupied by about 1280 occupying
226 households (Barangay Report, Population Censal Year of 2009) covering a land area of 216.2 hectares.
This area was chosen because the area is easily accessible, about 3 kilometers away from City Hall using
public utility vehicles such as jeepneys that traverse through the national highway and local transport such
as tricycles and pedicabs. And with the stated indicators in the above section of Background of the study,
the tendency points to a myriad of needs in the barangay. This barangay is divided into 3 (three) puroks,
wherein there is one Barangay Health Worker assigned.
The respondents chosen for this research is any family who are permanent residents and currently
living in the barangay. Application of Slovin’s Formula gives rise to the sample size being aimed for in this
study. With a current population of 226 households and be using 5% margin of error equates to 144 needed
households as respondents. This will provide sufficient data to represent the collective needs or problems of
the barangays.
The purposive clustered sampling will be used to collect the needed 144 household. The purposive
sampling is needed because we have imposed characteristics that we are looking for in the
respondents/families, alongside cluster wherein we have preset the location of the families from which we
will gather data from.
After properly identifying the respondents for the study, the consent for participation will be
obtained. The anonymity of the residents and the confidentiality of the data will be ensured. The completed
questionnaires are kept under lock and key and will be known to the researchers and the family from which
the data are acquired from. After data gathering, the data will be tabulated and the frequency of the answers
are tallied and totaled. This study is designed in such a way that it does not pose any physical or
psychological harm to our respondents.
The 10 research assistants will be grouped into pairs and will be tasked to look for families.
Families shall serve as respondents if they have given their consent. Each household is given one
community survey form and the research assistant will fill it up as the family representative, the one who
could speak for the family, answers the guided questions. Then, the cycle is repeated until the 144 families
have been interviewed. Data gathering will start on the 20th of January for two weeks.
Instrumentation
The questionnaire is the main data gathering tool that will be utilized in the study. Employing
questionnaires has an advantage of uniformity of instructions to which the respondents are exposed to. The
developed community survey form is currently being used for surveying purposes as part of Related
Learning Experiences in the Community Setting. This has been modified by Dr. Brando Solis from the
former survey form and has blended with it updated entries from Araceli Maglaya’s Nursing Practice in
the Community.
The community survey form is divided into 5 parts. Part A inquires about the household
identification as to where the household is located. Part B asks about the family member’s names, position
in the family, age, gender, civil status, educational attainment, employment status, and religion. Part C
inquires about the family characteristics as to type, decision maker, and income. Part D asks about housing
material, ownership, space for gardening, source of drinking water, storage of water, food storage, drainage
system, unit structure, electricity supply, cooking fuel used, toilet facilities, garbage disposal and
segregation, pets, presence of breeding sites for pests or rodents. Part E is all about health and health
practices within the last 12 months; number of live children, stillbirth, deceased children, common illnesses
in the family, use of family planning or contraceptive methods, available health resources, and the
immunization status of children aged 0 to 5 years. The tool is no longer to undergo pilot study nor face
validity since it has been an established data gathering tool for community health nursing.

Tools for Data Analysis


Collected data will be tallied per category of data starting from the family member’s chart
particularly age, sex, civil status, educational attainment, employment status and religion.
Collated data are tallied into each of the appropriate tables and from them; the frequency with
which the situation occurs will reveal the most number. It is from here that the total answers per category
are acquired in order for the research team to calculate the percentages of each item in a category.
The tools for data analysis are the accumulation of responses per question or category and they
will be presented using frequency. The total score per category will reveal the frequency. And the
percentage of each item will also be computed to reveal partition of the variables.
Community health problems are categorized as:
• Health status problems
• Health resource problems
• Health-related problems
After the problems have been identified, the next task for the researcher and the community is to
prioritize which health problems can be attended to considering the resources available at the moment. In
priority setting, the researcher considers the following criteria:
• Nature of the problem presented
• Magnitude of the problem
• Modifiability of the problem
• Preventive potential
• Social concern
The problems will be scored using the scoring system from the University of the Philippines
College of Nursing Community Health Nursing Specialty (see Appendix D)
Each problem will be scored according to each criterion and divided by the highest possible score
multiplied by the weight. Then the final score for each criterion will be added to give the total score for the
problem. The problem with the highest score is given highest priority by the nurse-researcher.