Chn2 Module 2nd Edition 2021

NCM 113 COMMUNITY HEALTH NURSING II
COMMUNITY HEALTH NURSING II
Course Code : NCM 113

Credit Unit/Course Credit : 2 units Lecture
Time Duration : 18weeks/36 hours ; 2Hours/Week
Pre-requisite :NCM 104
Course Description :This course deals with concept, principles, theories
and techniques in the care of population groups and communities utilizing community
organizing strategies toward health promotion, disease prevention, restoration and
maintenance, and rehabilitation and community development. The learners are expected to
provide safe, appropriate and holistic nursing care to clients utilizing the community health
nursing process.
This module is intended for third year students of Bachelor of Science in Nursing of
Nueva Ecija University of Science and Technology. To help students study even they are
staying at home. It will help them integrate principles and concepts of physical, social,
natural and health sciences and humanities in the care of population groups and
communities. Allow the students to assess the health status of the population groups and
communities as client. Prioritized community health needs and concerns and develop
community diagnosis
INSTRUCTIONS ON HOW TO DO THIS MODULE

1. Begin reading and studying the Module. This Module is designed for individualized
instruction and is outcomes-based. Read the information at your own pace or
according to the timelines established by your subject teacher. In most cases, the
student will be studying the modules independently.
2. Read the objectives of each chapter. These objectives specify what you are expected
to learn and what you will be expected to do as a result of studying this Module.
3. Stop when you come to a Motivational Activity section and complete the Activity
and Pretest questions. Your subject teacher will provide answers.
4. Start to read and study. After each unit, you have to complete all the Assessing
Learning section immediately. Check your answers against the discussion part of the
Module. If you have incorrect answers, re-read the appropriate section of the text in
the Module, and then write the correct answer(s). Then submit to your subject
teacher.
5. The Posttest measures your mastery of the units’ objectives. Thus, to prepare for the
Posttest, review the chapter objectives. Each Posttest question is directly related to
one of the chapter objectives.
6. You can now move onto the next unit in the Module. Continue to read and study the
Module—repeating steps 2, 3, 4, and 5 of these instructions—until you reach the
end of the Module.
7. From time to time follow-up conference between you and your subject teacher will
take place for feedback on what you have learned. Follow-up conference can be in
the form of text, personal message, call, and video call.
8. If you have any questions about the Community Health Nursing module, please
contact the subject teacher.
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All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
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institution. Unauthorized reproduction is punishable by law.
TABLE OF CONTENTS
UNIT I: Community Health Nursing Concepts 3

Definition 5
Philosophy and Principles 5
Features of CHN 5
Theoretical Models/ Approaches 5
Different Fields 8
UNIT II: Concepts of the Community 13

Types of communities 15
Characteristics of a Healthy Community 15
Components of Community 15
Factors Affecting Health of the Community 16
Roles and Activities of Community Health Nurse 16
UNIT III Health Statistics and Epidemiology 19

Tools 21
Demography 21
Health Indicators 25
Philippine Health Situation 28
Epidemiology and the Nurse 28
Epidemiological Process and Investigations
UNIT IV: Nursing Process in the Care of Population Groups 30

and Community
Community Health Assessment Tools 32
Collecting Primary Data 32
Secondary Data Sources 33
Methods to Present Community Data 33
Community Diagnosis 34
Traditional 34
Participatory Action Research (PAR) 37
Schemes in Stating Community Diagnosis 38
NANDA 38
Shuster and Goppingen
Omaha System 38
Planning Community Health Interventions 39
Implementing Community Health Interventions 41
Importance of Partnership and Collaboration 41
Activities Involved in Collaboration and Advocacy 42
Community Organizing and Social Mobilization 42
Core Principles in Community Organizing 43
Goals of Community Organizing 43
Community Organizing Participatory Research 44
Environmental Sanitation 45
Documentation and Reporting 53

UNIT V: Working with Groups Towards Community 56

Development
Stages of Group development 58
Interventions to Facilitate Group Growth 59
Collaboration and Partnership 61
UNIT VI: Information Technology and Community Health 126

Definition of e-health 64
Power of Data in Information 66
e-Health Situation in the Philippines 67
Using e-Health in the community 68
Roles of the Community Health Nurse in e-Health 71
UNIT VII Current Trends in Public Health: 74

Global and National
Role of a Community Health Nurse in 77
the National and Global
Health Care Delivery System. 77
UNIT VIII Delivery the Health Care to the 81

Filipino Family and Community
Filipino Culture 83
Filipino Customs and Traditions 85
Filipino Values, Traits and Beliefs 85
UNIT IX Positive Qualities and Values of a 87

Community Health Nurse
Personal Attributes 89
Professional Competencies 90
UNIT X Health Related Entrepreneurial Activities 92

Community Based Project 94
Wellness Clinics 94
Couse Plan Agreement Form 96

UNIT I. COMMUNITY HEALTH NURSING CONCEPTS

Overview
Community nursing is one of the two significant fields of nursing in the Philippines.
We generally use the term community health nursing and public health nursing. Those who
work in rural health units (RHUs) or health centers are community health nurses and are
officially called public health nurses (PHN’s). Occupational nurses and school health nurses
are classified as a community health nurse.
Learning Objectives______________________________________________________________________ _
Upon completion of this unit, I will be able to:
1. know major concepts in community health nursing;
2. define community health nursing;
3. enumerate the philosophy and principles of community health nursing;
4. enumerate the features of community health nursing; and
5. discuss the different theoretical Models and Approaches to CHN.
Motivation Activity
Name: Date:
Course/Year/Section:
Directions: The following grid contains terms associated with Community Health
Nursing (as enclosed in the box below). Find and encircle them. Look for them in all
directions, including backward and diagonally.
S X W P U B L I C H E A L T H
C Z H R I W P R O M O T I O N
H L F E F I F I M Z J K Z E W
O F W V Z F A I M H K Q J G D
O V L E G R Z G U Z J X U K X
L X K N H G I H N Q E R J H G
N J K T G I N D I V I D U A L
U F W I H R G K T D K M N K G
R V L O H S H W Y H W L Z W H
S X H Q W E R T N D F G J K B
E J W D S W V L U X L X L H B
Z T H E O R Y K R H J H Z W F
E X G J S Z V Z S Z F F F F S
A P P R O A C H E S F Z F H H
H Z L V K F V K F F A M I L Y

Pretest
Name: Date:
Directions: Encircle the correct answer
1. This term refers to a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.
a. Social
b. Community
c. Health
d. Community health nursing
2. This term refers to a collection of people who interact with one another and whose
common interests or characteristics form unity or belonging.
a. Social
b. Community
c. Health
3. These communities are defined or created by both natural and humanmade

boundaries and include barangays, cities, provinces, regions, and nations.
a. Geopolitical communities
b. Phenomenological communities
c. Rural community
d. Urban community
4. This type of community refers to relational, interactive groups. The place or setting is
more abstract, and people share a group perspective or identity based on culture, values,
history, interests, and goals.
c. Rural community
d. Urban community
5. This term usually denotes a group of people having common personal or

environmental characteristics.
a. Community
b. Population
c. Group
d. Family

Lesson Proper_______________________________________________________________________________
Community Health Nursing

In today's pandemic COVID-19, many of us are staying at home and doing less in
social interactions and exercise. This can have a negative effect on your physical and mental
health. The role of community health nurse has been emphasized to lead Barangay Health
Emergency Response Team (BHERT) in monitoring COVID-19 cases in their respective
barangays.
The American Nurses Association wrote that: Community health nursing practice
promotes and preserves populations' health by integrating skills and knowledge relevant to
both nursing and public health. The practice is comprehensive and general, and is not limited
to a particular age or diagnostic group; it is continual, and is not limited to episodic care…
While community health nursing practice includes nursing directed to individuals, families and
groups, the dominant responsibility is to the population (Clark,2014:50)
The World Health Organization Expert Committee of Nursing defines public health
nursing as a "special field of nursing that combines the skills of nursing, public health and
some phases of social assistance and functions as part of the total public health program for
the promotion of health, the improvement of the conditions in the social and the physical
environment, rehabilitation of illness and disability."
Philosophy and Principles

According to Dr. Margaret Shetland, the philosophy of Community Health Nursing is
based on man's worth and dignity.
The following are Community Health Nursing principles that were adapted from
those formulated by Mary S. Gardner and by Leahy, Cobb, and Jones: (1) Community Health
Nursing is based on recognized needs of communities, families, groups, and individuals.
(2)The community health nurse must fully understand the objectives and policies of the
agency she represents. (3)In community health nursing, the family is the unit of service.
(4)Community Health Nursing must be available to all regardless of race, creed, and
socioeconomic status. (5)Health teaching is a primary responsibility of the community
health nurse. (6)The community health nurse works as a member of the health team (7).
There must be a provision for periodic evaluation of Community Health Nursing
Service(8)Opportunities for continuing staff education programs for nurses must be
provided by the community health nursing agency. The community health nurse also has a
responsibility for his/her professional growth. (9) The community health nurse makes use
of available community health resources. (10)The community health nurse utilizes the
already existing organized groups in the community. (11) There must be provision for
educative supervision in Community Health Nursing. (12) There should be accurate
recording and reporting in community Health Nursing
Features of CHN
There are six essential characteristics of community nursing. These are in the
following:
It is a specialty field of nursing.
The practice combines public health with nursing.
It is population-based.
It emphasizes on wellness and other than disease or illness.
It includes interdisciplinary collaboration.
It amplifies the client's responsibility and self-care.

Theoretical Models/Approaches
The general systems theory is the first of the theories taken up in this section, being
the basis, in part, of several nursing theories that the community health nurse may find
useful. It is the framework of the Community Assessment Tool developed by Maurer and
Smith (2009). Short explanations of Albert Banduria’s Social Learning Theory and models
that community health nurses may use when planning for health promotion and disease
prevention includes Health Belief Model, Milio’s Framework for Prevention, Nola Pender’s
Health Promotion Model, Transtheoretical Model and Lawrence Green’s PRECEDE-
PROCEED Model.
General System s Theory

The general system theory is applicable to the different levels of the community
health nurse’s clientele: individuals, families, groups or aggregates, and communities.
Viewed as open system, the client is considered as a set of interacting elements that
exchange energy, matter, or information with the external environment to exist (Katz and
Khan,1966) This concept is particularly useful when analyzing interrelationships of the
elements within the client as well as those of the client and the environment.
Social Learning Theory

Social learning Theory is based on the belief that learnings take place in a social
context, that is people learn from one another and that learning is promoted by modeling or
observing other people, It is anchored on the fact that persons are thinking beings with self-
regulatory capacities, capable of making decisions and acting according to expected
consequences of their behavior. The environment affects learning outcomes depend on the
learner’s individual characteristics(Bandura,1977)
Health Belief Model

The Health Belief Model (HBM) was developed in the early 1950s by social scientists
at the U.S. Public Health Service to understand people's failure to adopt disease prevention
strategies or screening tests for the early detection of disease. Later uses of HBM were for
patients' responses to symptoms and compliance with medical treatments. The HBM
suggests that a person's belief in a personal threat of an illness or disease, together with a
person's belief in the effectiveness of the recommended health behavior or action, will
predict the likelihood the person will adopt the behavior.
The HBM derives from psychological and behavioral theory with the foundation that
the two components of health-related behavior are 1) the desire to avoid illness, or
conversely get well if already ill; and, 2) the belief that a specific health action will prevent,
or cure, illness. Ultimately, an individual's course of action often depends on the person's
perceptions of the benefits and barriers to health behavior. There are six constructs of the
HBM. The first four constructs were developed as the original tenets of the HBM. The last
two were added as research about the HBM evolved.

Figure 1: Health Belief model

source:en.wikepia.org
Milio’s Framework for Prevention

Nancy Milio developed a framework for prevention that includes concepts of
community – oriented, population- focused care. Milio stated that behavioral patterns of the
populations-and individuals who make up populations result from habitual selection from
limited choices. She challenged the common notion that the main determinant for
unhealthful behavioral choice is lack of knowledge. Milio’s framework described a
sometimes neglected role of community health nursing to examine the determinants of a
community’s health and attempt to influence those determinants through public policy.
Nola Pender’s Health Promotion

The Health Promotion Model was designed by Nola J. Pender to be a
"complementary counterpart to models of health protection." It defines health as a positive
dynamic state rather than merely the absence of disease. Health promotion is directed at
increasing a patient's level of well-being. The health promotion model describes persons'
multidimensional nature as they interact within their environment to pursue health.
The Health Promotion Model makes four assumptions: (1) Individuals seek to
actively regulate their own behavior. (2) In all their biopsychosocial complexity, individuals
interact with the environment, progressively transforming the environment as well as being
transformed over time. (3)Health professionals, such as nurses, constitute a part of the
interpersonal environment, which influences people through their life span. (4) Self-
initiated reconfiguration of the person-environment interactive patterns is essential to
changing behavior.
Lawrence Green’s Precede-Proceed Model

The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in
1974 by Lawrence W. Green that can help health program planners, policy makers and
other evaluators analyze situations and design health programs efficiently. It provides a

comprehensive structure for assessing health and quality of life needs and designing,
implementing, and evaluating health promotion and other public health programs to meet
those needs.
The PRECEDE–PROCEED planning model consists of four planning phases, one
implementation phase, and 3 evaluation phases.
PRECEDE phases PROCEED phases

Phase 1 – Social Diagnosis Phase 5 – Implementation
Phase 2 – Epidemiological, Behavioral &
Phase 6 – Process Evaluation
Environmental Diagnosis
Phase 3 – Educational & Ecological Diagnosis Phase 7 – Impact Evaluation
Phase 4 – Administrative & Policy Diagnosis Phase 8 – Outcome Evaluation
Table 1: Precede-Proceed phase
source: wikepedia
The Transtheoretical Model
The Transtheoretical Model(TTM) combines several theories of intervention, thus
the name transtheoretical. The TTM assumes that the behavior change takes place over
time, progressing through a sequence of stages. It also assumes that each of the stages is
both stable and open to change. In other words, one may stop in one stage, progress to the
next page, or return to the previous stage.
Different fields of Community Health Nursing
School Health Nursing

School nursing is a specialized nursing practice that advances the well-being,
academic success, and lifelong achievement and health of students. Keeping children
healthy, safe, and ready to learn should be a top priority for both healthcare and educational
systems.
School nurses lead in developing policies, programs, and procedures for the
provision of school health services at an individual or district level (NASN, 2016a), relying
on student-centered, evidence-based practice and performance data to inform care (Robert
Wood Johnson Foundation, 2009). Integrating ethical provisions into all areas of practice,
the school nurse leads in delivering care that preserves and protects student and family
autonomy, dignity, privacy, and other rights sensitive to diversity in the school setting
(American Nurses Association [ANA] & NASN, 2011).
Occupational Health Nursing

The American Association of Occupational Health Nurses describes an occupational
health nurse as someone who "provides for and delivers health and safety programs and
services to workers, worker populations, and community groups. The practice focuses on
promoting and restoration of health, prevention of illness and injury, and protection from
work-related and environmental hazards. Occupational and environmental health nurses
have a combined knowledge of health and business that they blend with health care
expertise to balance the requirement for a safe and healthful work environment with a
'healthy' bottom line."

Community Mental Health Nursing

Community Mental Health Nurses are specialized Nurses who provide holistic
nursing services for people with mental health issues in a community setting. We provide
caring and confidential supports for our clients, using the recovery model for care.
The services provided by the Community Mental Health Nursing Program include
Treatment Planning, Medication Management, Assessment, Counseling, Family Support,
Education, Group Support, Facilitate services with visiting Psychiatrists.
References___________________________________________________________________________________
Famorca, Zenaida U, Nies, Mary A., McEwan, Melanie,(2013) Nursing Care of the
Community: A Comprehensive Text on Community and Public Health Nursing
Maglaya, Arceli S. ( 2004) Nursing Practice in the Community 5th Edition
https://sphweb.bumc.bu.edu/otlt/MPH-
Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories2.html
http://currentnursing.com/nursing_theory/models_prevention.html
https://nursing-theory.org/theories-and-models/pender-health-promotion-model.php
en.wikepedia.org https://en.wikipedia.org/wiki/PRECEDE%E2%80%93PROCEED_model
https://www.nasn.org/advocacy/professional-practice-documents/position-
statements/ps-role
Assessing Learning_________________________________________________________________________
a. Reflection
Activity 1
Name: Score:
Course/Year/Section: Date:
In today's pandemic Covid-19, how community health nursing helps your present
community? Write your answer in the space provided. (100 words)

b. Post Test
Activity 2
Name: Date:
Course/Year/Section: Score:
1. This term refers to a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.
a. Social
b. Community
c. Health
common interests or characteristics form the basis of unity or belonging.
a. Social
b. Community
c. Health
3. This term provides for and delivers health and safety programs and services to
workers, worker populations, and community groups. The practice focuses on the
promotion and restoration of health, prevention of illness and injury, and protection
from work-related and environmental hazards
a. Community health nurse
b. School Nurse
c. Occupational Health Nursing
d. Mental Health Nursing
4. It is a specialized practice of nursing that advances the well-being, academic success,

and lifelong achievement and health of students. Keeping children healthy, safe, in
school, and ready to learn should be a top priority for both healthcare and educational
systems.
a. Community health nurse
b. School Health Nursing
c. Occupational Health Nursing
d. Mental Health Nursing
5. This model is a complementary counterpart to models of health protection." It defines

health as a positive dynamic state rather than merely the absence of disease.
a. PRECEDE–PROCEED model
b. Health Promotion Model
c. Milio’s Framework for Prevention
d. None of the above

6. This model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W.

Green that can help health program planners, policy makers and other evaluators
analyze situations and design health programs efficiently
7. This framework is for prevention that includes concepts of community – oriented,

population- focused care.
8. Which of the following are the two HBM components of health-related behavior?
a. The desire to avoid illness, or conversely get well if already ill
b. The belief that a specific health action will prevent, or cure, illness.
c. Both a and c
9. This refers to a person's subjective perception of the risk of acquiring an illness or

disease. There is wide variation in a person's feelings of personal vulnerability to an
illness or disease.
a. Perceived susceptibility
b. Perceived severity
c. Perceived benefits
d. Perceived barriers
10. This refers to a person's feelings on the seriousness of contracting an illness or

disease (or leaving the illness or disease untreated). There is wide variation in a
person's feelings of severity, and often a person considers the medical consequences
(e.g., death, disability) and social consequences (e.g., family life, social relationships)
when evaluating the severity.
a. Perceived susceptibility
b. Perceived severity
c. Perceived benefits
d. Perceived barriers

Activity 3
Name: Date:
Directions: Write your answer in the space provided.
1. Select a theory or conceptual model. Evaluate its potential for understanding health in
individuals, families, 400 children in an elementary school, a community of 20,000
residents, and 500 workers within a corporate setting.
2. Apply HBM and Penders HPM in the following situation: Cecille for prenatal 30 years
old, G2P0 came to the health center for a prenatal consultation. For her first pregnancy,
she availed a traditional birth attendant (hilot) that ended in stillbirth. However, she
wants a healthy baby, the reason for an early consultation.

UNIT II CONCEPT OF THE COMMUNITY

Overview
The community you live in is part of who you are. Even if you don't see your
neighbors every day, you recognize that your decisions impact those around you. You're all
in it together, and you wouldn't have it any other way! Improving your community and
helping others is often at the top of your mind. So when the phrase "community health"
crossed your radar, you had to know more. The Philippine government has imposed a strict
community quarantine order amid the coronavirus disease (COVID-19) outbreak in 2020.
However, residents have concerns, as the guidelines require that everyone should as much
as possible, stay at home. What is community health? And how does it affect the lives of
those in your area?
Learning Objectives________________________________________________________________________
Upon completion of this unit, I am able to:
1. enumerate and explain the different types of community;

2. discuss the characteristics of a healthy community;
3. know the components of a community;
4. explain the factors affecting health of the community; and
5. enumerate and explain the roles and activities of community health nurse.
Motivational Activity
Name: Date:
Direction: Write ten words in the space provided that will describe the picture below.

Pretest
Name: Date:
common interests or characteristics form the basis of unity or belonging.
a. Social
b. Community
c. Health
2. This term refers to areas that are settled places outside towns and cities.
a. Rural
b. Suburban
c. Urban
3. This type of communities is defined or formed by both natural and manmade

boundaries and include barangays, cities, provinces, regions and nations.
c. Rural community
d. Urban community
4. This type of community refer to relational, interactive groups, in which the place or
setting is more abstract, and people share a group perspective or identity based on
culture, values, history, interests and goals.
c. Rural community
d. Urban community
5. This term usually denotes a group of people having common personal or

environmental characteristics.
a. Community
b. Population
c. Group
d. Family

Lesson Proper______________________________________________________________________________
The community is a group of people sharing common geographic boundaries and

common values and interests. It functions within a particular sociocultural context, which
means that no two communities are alike. The physical environment varies, and so with the
people's way of behaving and coping. The people are different from each other; thus, the
dynamics in one community differs from that of the other.
Types of Community
There are three classifications of community according to Untalan, Tuesca (2005)
COPAR, first is Rural or the Open lands usually places in the provincial areas where people
make earn their living by agriculture and things of sort, mostly less dense and more
spacious. Urban or the City is a non-agricultural type of community, the community is dense
and mostly populating the whole community, the major source of income are the industrial
products and technology. Suburban or the Capitals, it is usually the capital of the provinces
where there is a mix of agriculture and industry, although technology is not in its highest
peak, technology is utilized to increase the productivity of both industrial and agriculture
side.
Characteristics of a Healthy Community

A healthy community has the characteristics of: The members are aware of their
own health and biologic status, members give credit to the governing authority, the natural
and biological resources are open for everybody, has a strong and reliable governing body,
people work together to attain independence, environmental and physiologic needs are
sustained by the community and families, parents and guardians serve as role models for
the children, people are concerned with their health status, health needs are accessible and
affordable to the public and free for indigent and everyone is working to attain health
citizenry.
Components of a Community
Figure 2: components of community

source: rideshark.com tlewinson

Factors Affecting Health of the Community

The factors that affect the community's health are physical factors, social/cultural
factors, community organization, and individual behavior.
Roles and Activities of Community Health Nurse

Community health nursing involves several basic concepts, including promoting
healthy living, prevention of disease and health problems, medical treatment, rehabilitation,
evaluation of community health nursing care delivery and prevention systems, and research
to further community health nursing and wellness.
Clinician Role or Direct care provider: The clinician role in the community health
nurse means, the nurse ensures health care services, not just to individuals and families but
also to groups and population of the community. For community health nurses, the clinician
role involves specific emphasis different from basic nursing, i.e., Holism, health promotion,
and skill expansion.
Educator Role: It is widely recognized that health teaching is a part of good nursing
practice and one of the primary functions of a community health nurse (Brown, 1988).
Assesses the knowledge, attitudes, values, beliefs, behaviors, practices, stage of change, and
skills of the community people and provides health education according to knowledge level.
Advocate Role: The issue of clients' rights is essential in health care today. Every
patient or client has the right to receive just equal and human treatment. Community health
nurse is an advocate of patient's rights about their care. They encourage the individuals to
take the right food for maintaining health, the right drugs for the treatment, and the right
services at right place where ever needed. They provide sufficient information to make
necessary health care decision, promote community awareness of significant health
problems.
Managerial Role: As a manager, the nurse exercises administrative direction
towards accomplishing specified goals by assessing clients' needs, planning, and organizing
to meet those needs, directing and controlling and evaluating the progress to assure that
goal are met.
Collaborator Role: Community health nurses seldom practice in isolation. They must
work with many people, including clients, other nurses, physicians, social workers,
community leaders, therapists, nutritionists, occupational therapists, psychologists,
epidemiologists, biostatisticians, legislators, etc. the health team (Fairly 1993, Williams,
1986).
Leader Role: Community health nurses are becoming increasingly active in the
leader role. As a leader, the nurse instructs influences or persuades others to effect change
that will positively affect people's health. The leadership role's primary function is to use
health policy change based on community people's health; thus, the community health
nurse becomes an agent of change.
Research Role: In the researcher role, community health nurses engage in
systematic investigation, collection, and analysis of data to solve problems and enhance
community health nursing practice. Based on the research result, community nurses
improve their service quality and improve community people's health.
References
Famorca, Zenaida U, Nies, Mary A., McEwan, Melanie,(2013) Nursing Care of the
Community: A Comprehensive Text on Community and Public Health Nursing
Maglaya, Arceli S. ( 2004) Nursing Practice in the Community 5th Edition
https://en.wikipedia.org/wiki/Developed_environments
https://www.rideshark.com/2017/07/19/sustainablecommunities/

http://nursingexercise.com/community-health-nursing-overview/
Assessing Learning_________________________________________________________________________
a. Reflection
Activity 4
Name: Score:
Interview at least two community health nurses regarding their opinions on the focus of
community health nursing. Do you agree? (100 words)
b. Post Test
Activity 5
Name: Date:
1. A healthy community has the following characteristics except:

a. Awareness that "we are a community."
b. Conservation of natural resources
c. Recognition of and respect for the existence of subgroups
2. A healthy community has the following characteristics except:

a. Participation of subgroups in community affairs
b. Preparation to give crises
c. Ability to problem solved
d. Communication through open channels
3. The following are the factors that affect the health of the community except:
a. physical factor
b. social/cultural factor
c. community organization
d. individual capability
4. The nurse's role in the community means he/she ensures health care services, not just
to individuals and families but also to groups and population of the community
a. Clinician Role
b. Educator Role
c. Advocate Role
d. Managerial Role

5. It is widely recognized that health teaching is a part of good nursing practice and one
of the primary functions of a community health nurse (Brown, 1988). Assesses the
knowledge, attitudes, values, beliefs, behaviors, practices, stage of change, and skills of
the community people and provide health education according to knowledge level.
a. Clinician Role c. Advocate Role
b. Educator Role d. Managerial Role
6. The issue of clients’ rights is important in health care today. Every patient or client has
the right to receive just equal and human treatment.
7. The nurse exercises administrative direction towards the accomplishment of specified

goals by assessing clients’ needs, planning and organizing to meet those needs, directing
and controlling and evaluating the progress to assure that goals are met.
8. Community health nurses seldom practice in isolation. They must work with many
people including clients, other nurses, physicians, social workers and community
leaders, therapists, nutritionists, occupational therapists, psychologists, epidemiologists,
biostaticians, legislators, etc. as a member of the health team.
a. Collaborator Role
b. Leader Role
c. Researcher Role
9. The nurse instructs, influences, or persuades others to effect change that positively
affects people's health. Its primary function is to useful change of health policy based on
community people health; thus, the community health nurse becomes an agent of
change.
b. Leader Role
c. Researcher Role
10. In this role the community health nurses engage in systematic investigation,
collection and analysis of data to solve problems and enhance community health nursing
practice. Based on the research result, community nurses improve their service quality
and improve community people's health.
b. Leader Role
c. Researcher Role

UNIT III: HEALTH STATISTICS AND EPIDEMIOLOGY

Overview
In journalism, students are taught that a good news story must include the 5 W's:
what, who, where, when, and why (sometimes cited as to why/how). The 5 W's are the
essential components of a news story because if any of the five are missing, the story is
incomplete. The same is true in characterizing epidemiologic events, whether it be an
outbreak of coronavirus among cruise ship passengers or mammograms to detect early
breast cancer. The difference is that epidemiologists tend to use synonyms for the 5 W's:
diagnosis or health event (what), the person (who), place (where), time (when), and causes,
risk factors, and modes of transmission (why/how).
Learning Objectives_______________________________________________________________________ _
1. enumerate and explain the tools used in health statistics and epidemiology;
2. discuss the demography;
3. know and apply calculation of different health indicators;
4. know the Philippine health situation; and
5. explain the epidemiology in the field of nursing
Motivational Activity
Pretest
Name: Date:
Direction: Write at least five words from the picture below and explain it on tour
own words.

Name: Date:
1. The following are the epidemiology fundamental assumptions except:

a. The occurrence of the disease is not random
b. The study of populations enables the identification of the causes and
preventive factors associated with the disease.
c. Both a and b
2. This term refers to the statistical study of populations, especially human

beings.
a. Demography
b. Composition
c. Distribution
d. Mortality
3. This term is generally based on the disease specific incidence or prevalence for
the common and severe disease.
a. Morbidity Indicators
b. Incidence
c. Cohort
4. This term measures the number of new cases, episodes, or events occurring
over a specified period of time, commonly a year, within a specified population at
risk.
b. Incidence
c. Cohort
5. This term refers to a group of people who share common defining

characteristics.
b. Incidence
c. Cohort

Lesson Proper_____________________________________________________________________________
The main concern of public health is preventing the disease, prolonging life, and
promoting physical health and efficiency through organized community efforts.
Epidemiology is concerned with studying factors that influence the occurrence and
distribution of diseases, detects disability or death, which occur in groups aggregation of
individuals. It is the study of the spread of the disease in a group of individuals as in public
health. On the other hand, health statistics, as defined by the World Health Organization,
refer to quantitative data and the classification of such data according to probability theory
and the application to them of methods such as hypothesis testing. Health statistics include
empirical data and estimates related to health, such as mortality, morbidity, risk factors,
health service coverage, and health systems. Epidemiology and health statistics, therefore,
are the backbone of the prevention of disease.
Tools
Epidemiology is the study of the distribution and determinants of health-related
states or events in specified populations, and the application of this study to the prevention
and control of health problems.
Demography is the science which deals with the study of the human population size,
composition, and distribution in space. Population size simply refers to the number of
people in each place or are at a given time. When population is characterized in relation to
certain variables such as age, sex, occupation, or educational level, then the population
composition is being described. The three events are affected depending on how fast or how
slow people are added to the population as a result of births, deaths and migration
occurring in the community.
Sources of Demographic Data

Demographic information can be obtained from a variety of sources but most
common come from censuses, sample surveys and registration systems
Population Size
Population size of a place allows the nurse to make comparisons about population
changes over time. It helps rationalize the types of health programs or interventions which
are going to be provided for the community.
One method of measuring the population size is by determining the increase in the
population resulting from excess of births compared to deaths. This can be done in two
ways:
1. Natural increase is simply the difference between the number of births and the
number of deaths occurring in a population in a specified period of time.
Natural increase = Number of births - Number of deaths

(specified year) (specified year) (specified year)
2. Rate of Natural Increase is the difference between the Crude Birth Rate and the
Crude Death Rate occurring in a population in a specified period of time.
Rate of Natural increase = Crude Birth Rate - Crude Death Rate

(specified year) (specified year) (specified year)

The second method of measuring population size is to determine the increase in the
population using data obtained during two census periods. This implies that the increase in
the size of the population is not merely attributed to excess in births but also effect of
migration. These are:
1. Absolute increase per year measures the number of people that are added to the
population per year.
Absolute increase per year = Pt – Po

t
where:
Pt = population size at a later time
Po = population size at an earlier time
t = number of years between time 0 and time t
2. Relative increase is the actual difference between the two census counts
expresses in percent relative to the population size made during an earlier
census.
relative increase = Pt – Po
Po
where:
Pt = population size at a later time
Po = population size at an earlier time
Population Composition
The composition of the population is commonly described in terms of its age and
sex. The nurse utilizes data on age and sex composition to decide who among the
population groups merits attention in terms of health services and programs.
1. Sex Composition. To describe the sex composition of the population, the nurse
computes for the sex ratio. The sex ratio compares the number of females in the
population, it represents the number of males for every 100 females in the
population.
Sex ratio = number of males X 100

number of females
2. Age Composition. There are two ways to describe the age composition of the
population.

a. Median age divides the population into two equal parts. So, if the median age
is said to be 19 years old, it means half of the population belongs to 19 years
and above, while the other half belongs to ages below 19 years old.
b. Dependency ratio compares the number of economically dependent with the
economically productive group in the population. The economically
dependent are those who belong to 0-14 and 65 and above age groups.
Considered to be economically productive are those within the 15 to 64 are
group. The dependency ratio represents the number of economically
productive
3. Age and Sex Composition of the population can be described at the same time
using population pyramid. It is a graphical presentation of the age and sex
composition of the population
Spatial Distribution
The distribution of the population in space can be described in terms of urban-rural
distributions, population density and crowding index. The measures help the nurse decide
how meager resources can be justifiably allocated based on concentration of population in a
certain place
1. Urban-rural distribution simply illustrates the proportion of the people living in
urban compared to the rural areas.
2. Crowding index will describe the ease by which a communicable disease will be
transmitted from one host to another susceptible host. This is described by dividing
the number of persons in a household with the number of rooms used by the family
for sleeping.
3. Population density will determine how congested a place is and has implications in
terms of the adequacy of basic health services present in the community. It can be
computed by dividing the number of people living in a given land area.
Health Indicators
The Global Reference List of 100 Core Health Indicators is a standard set of 100
indicators prioritized by the global community to provide concise information on the health
situation and trends, including responses at national and global levels. It will be reviewed
and updated periodically as global and country priorities evolve, and measurement
methods improve. This publication contains the 2015 version.
Crude Birth Rate- a measure of one characteristic of the natural growth or increase
of a population
Total No. of live births registered in a given calendar year

CBR= Estimated Population as of July 1 of same year X 1,000
Crude Death Rate- a measure of one mortality from all causes that may decrease
population
Total No. of live deaths registered in a given calendar year

CDR= Estimated Population as of July 1 of same year X 1,000
Infant Mortality Rate measures the risk of dying during the 1sy year of life. It is a
useful index of a community's general health condition since it reflects the changes
in the environment and medical conditions of a community.

Total No. of live deaths under one year of age in a given calendar year
IMR= Total No. of registered live births of the same calendar year X 1,000
Rates Specific Rates of Mortality measure the frequency of occurrence of death in a

defined population during a specified interval. Morbidity and mortality measures are often
the same mathematically; it's just a matter of what you choose to measure, illness, or death.
The formula for the mortality of a defined population, over a specified period
Deaths occurring during a given period ____

Mortality= size of the population among which the deaths occurred X1,000
Leading Causes of Morbidity- refers to having a disease or a symptom of disease, or

to the amount of disease within a population. Morbidity also refers to medical problems
caused by a treatment.
Morbidity: 10 leading causes
2010*
Diseases
Number Rate
1. Acute Respiratory Infection ** 1,289,168 1371.3

2. Acute Lower Respiratory Tract Infection
586,186 623.5
and Pneumonia
3. Bronchitis/Bronchiolitis 351,126 373.5
4. Hypertension 345,412 367.4
5. Acute Watery Diarrhea 326,551 347.3
6. Influenza 272,001 289.3
7. Urinary Tract Infection** 83,569 88.9
8. TB Respiratory 72,516 77.1
9. Injuries 51,201 54.5
10. Disease of the Heart 37,589 40.0
Table2: Philippines Morbidity 2010

Source: DOH
Leading Causes of Mortality refers to the number of deaths in a given area or period,
or from a particular cause.
The leading causes of death are diseases of the heart, diseases of the vascular
system, pneumonias, malignant neoplasms/cancers, and all forms of tuberculosis, accidents,

COPD and allied conditions, diabetes mellitus, nephritis /nephritic syndrome and other
diseases of respiratory system. Among these diseases, six are non-communicable and four
are the major NCDs such as CVD, cancers, COPD, and diabetes mellitus.
Life Expectancy refers to the number of years a person can expect to live. By
definition, life expectancy is based on an estimate of the average age that a particular
population group will be when they die.
Figure 3: Philippines Life Expectancy 2017

Source: World Bank
Philippine Health Situation

The Health Systems in Transition (HiT) profiles are country-based reports that
provide a detailed description of a health system and reform and policy initiatives in
progress or under development in a specific country. Each profile is produced by country
experts in collaboration with two international editors. To facilitate comparisons between
countries, the patterns are based on a template, which is revised periodically. The template
provides detailed guidelines and specific questions, definitions, and examples needed to
compile a profile.
The Philippines is an archipelago in the South-East Asia Region, with a population of
104.9 million as of 2017. It is the thirteenth most populous country in the world. The
majority of Filipinos are Christian Malays (92.2%), with Roman Catholics constituting
87.4% of the Christian population. Muslim minority groups, comprising 5.6%, are
concentrated in Mindanao. The country has an adult literacy rate of 96.5%. The Philippines
is currently one of Asia's fastest-growing economies, with a gross domestic product growth
of 6.7% at the end of 2017. Categorized as a newly industrialized country, it is transitioning
from one based on agriculture to one based more on services and manufacturing. Filipinos
tend to live longer now than in previous decades, with life expectancy at birth increasing
from 62.2 years in 1980 to 69.1 years in 2016.
Health Service Delivery System

Health service delivery Health is a basic human right guaranteed by the Philippine
Constitution of 1987. This is provided in the Philippines through a dual health delivery
system composed of the public and private sectors. The public sector is largely financed
through a tax-based budgeting system, where government facilities deliver health services
under the national and local governments. The Department of Health (DOH) supervises the
government-corporate hospitals, specialty, and regional hospitals, while the Department of
National Defense runs the military hospitals. At the local level, the provincial governments
manage and operate district and provincial hospitals, while municipal governments provide
primary care, including preventive and promotive health services and other public health
programs through the rural health units, health centers, and barangay health stations.

Highly urbanized and independent cities provide both hospital services and primary care
services. The private sector, consisting of for-profit and non-profit healthcare providers, is
largely market oriented, where health care is generally paid for through user fees at the
point of service. The introduction of social health insurance administered by the Philippine
Health Insurance Corporation (PhilHealth) since 1995 aimed to provide financial risk
protection for the Filipino people. The rapid expansion of its membership in the past five
years is considered a positive development as the government pursues universal health
coverage. In terms of physical infrastructure, the Philippine health sector has 1224
hospitals, 2587 city/rural health centers, and 20 216 village health stations (2016 figures).
Health Financing
Total health expenditure (THE) has consistently increased since 2005 and compares
well with neighbors like Indonesia. Government health expenditure has increased
significantly in nominal terms, but it has been eclipsed by private sector funding sources,
which have grown rapidly with the economy. Much of THE is for personal care, although the
government has raised public health spending since 2007. The three major flows of public
health financing have overlapping coverage. The DOH funds regional and apex hospitals,
while local government units (LGUs) fund primary- and secondary-level care. PhilHealth
reimburses government as well as private health facilities. It reportedly covers 92% of the
population, 40% of which is the poor population, and subsidized by the government for
premium payments. Covered services are focused on inpatient care and inadequate
outpatient care that only covers PhilHealth's poor members. Financial protection is limited,
resulting in a high level of household out-of-pocket (OOP) payment.
Health Governance and Regulation

As the national technical authority on health, the DOH provides national policy
direction and strategic plans, regulatory services, standards and guidelines for health, and
highly specialized and specific tertiary-level hospital services. It provides leadership,
technical assistance, capacity building, linkages, and coordination with other national
government agencies, LGUs, and private entities in implementing health policies. On the
other hand, the LGUs, i.e., provincial, city, and municipal governments, are responsible for
managing and implementing local health programs and services. A local health board
chaired by the local chief executive (governor or mayor) serves as an advisory body to the
local chief executives and the local legislative council members (sanggunian) on the local
health system. Simultaneously, the DOH Regional Health Office is represented by either a
DOH representative or Development Management Officer under the DOH Provincial Health
Team. In Mindanao, a distinct subnational entity called the Autonomous Region in Muslim
Mindanao (ARMM) was created by Republic Act No. 6734, as amended by Republic Act No.
9054. ARMM consists of five provinces and has its own regional Department of Health
directly responsible to the ARMM Regional Governor. It directly administers the provincial,
city and municipal health offices, and the provincial and district hospitals within the
autonomous region. Key health reforms are articulated (or sometimes renamed) in every
administration.
Health System Performance

The national objectives for health (NOH) have well-specified targets, but local
governments' progress towards these targets remains highly uneven due to devolved health
financing and service delivery. While PhilHealth membership coverage has expanded, its
benefits coverage remains mainly for inpatient care, and it provides only limited financial
support. Access remains highly inequitable due to the misdistribution of facilities, health

staff, and specialists. While deployment programs are easing these problems somewhat,
these strategies result in monitoring and sustainability problems. Patient satisfaction and
user experience of health services may show improvements. Still, balance billing, i.e., service
charges set by the hospital, which are not covered by PhilHealth case rate payment, are
billed to the patient, and outside-hospital purchases continue to impoverish patients. The
limited number of health facilities relative to the growing population, overprovision of
physicians, underprovision of care, and poor physician adherence to clinical practice
guidelines contribute to low quality of care.
Health Status
Filipinos tend to live longer now than in previous decades, with life expectancy at
birth increasing from 62 years in 1980 to 69 years in 2016. Filipinas live longer (73 years)
than their men counterparts (66 years). The life expectancy trend is reflective of improving
living conditions in recent years. Mortality rates declined from 291 and 209 per 1000 men
and women, in 1980 to 261 and 136, respectively, in 2016 (Table 1.3). The past is
characterized by difficult times with sporadic armed conflicts in the countryside, pervasive
political unrest and mass protests in urban centers, widespread poverty and income
inequality across the country, poor nutrition, and inadequate health care underprivileged
majority.
Table 2: Mortality and health indicators, 1980–2016
While the country continues to combat pneumonia and TB as the leading cause of
death among Filipinos, it faces an increasing number of diseases of the heart, diseases of the
vascular system, malignant neoplasms, and diabetes. Among external causes, road traffic
accidents are also becoming a major cause of death. This essentially places the Philippines
in epidemiological transition, referred to as the triple burden of disease, in light of the
observed rise in NCDs and the actual prevalence of infectious diseases, and the health
impact of globalization and climate change. This disease pattern indicates that even as
degenerative diseases and other lifestyle-related illnesses increase, communicable diseases
are still widely prevalent. At the same time, road safety has become a severe public health
problem.

Table 3: Main Cause of Death 1980-2014
Epidemiology and the Nurse

A nurse epidemiologist investigates trends in groups or aggregates and studies the
occurrence of diseases and injuries. The information is gathered from census data, vital
statistics, and reportable disease records. Nurse epidemiologists identify people or
populations at high risk; monitor the progress of diseases; specify areas of health care need;
determine priorities, size, and scope of programs; and evaluate their impact. They generally
do not provide direct patient care, but serve as a resource and plan educational programs.
They also publish results of studies and statistical analysis of morbidity and mortality.
References
Zenaida U. Famorca, Mary A. Nieves, Melanie McEwen (2013).Nursing Care of the
Community. Elsevier Singapore
Araceli S. Maglaya (2004). Nursing Practice in the Community. 4thEdition. Argonauta
Corporation Philippines

Frances Prescilla l. Cuevas (2007). Public Health Nursing in the Philippines 10th edition.
National League of Philippine Government Nurses, Incorporated. Philippines
https://www.who.int/topics/statistics/en/
https://www.britannica.com/science/epidemiology/Basic-concepts-and-tools
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/community-
assessment/
Assessing Learning__________________________________________________________________________________
a. Reflection
Activity 6
Name: Score:
Examine a recent publication (whether hard or e-copy) by any agency that gathers data
to serve as a secondary source of information for public health practitioners. Choose one
data point and discussed how a public health worker could utilize this in the
performance of his/her function.
b. Post Test
Activity 7
Name: Date:
Directions: Calculate the relevant health indicator for each of the following, show your
computation, add a necessary sheet of paper if necessary
1. Borja conducted a study to estimate bacteriology's prevalence confirmed
pulmonary tuberculosis (PTB) among inmates and jail guards in seven prisons in
the Philippines. They defined PTB through direct sputum smear microscopy
(DSSM) and sputum culture. A respondent was considered a case of PTB if at
least two out of three DSSM results were positive or if the culture is positive. Out
of the 1,433 male inmates included in the study, 42 were bacteriology confirmed
cases of PTB. Compute and interpret the prevalence of active PTB among male
inmates in the seven prisons included in the study.
2. In 2008, there were 1,917,693 live births in the Philippines and 17, 835 infant
deaths. Suppose 2,675 of the infant deaths occurred during the neonatal period,
whereas 15, 160, during the postneonatal period. Given this data, calculate the
neonatal, postneonatal, and IMR's.

UNIT IV: NURSING PROCESS IN THE CARE OF POPULATION GROUPS

AND COMMUNITY
Overview
Community health purposes and goals are realized through application of series of
steps that lead to desired results. The nursing process is central to all nursing actions, it is
the essence of nursing that is applicable in any setting. The nursing process is a systematic,
scientific, dynamic, ongoing interpersonal process in which the nurses and the clients are
viewed as a system with each affecting the other and both being affected by the factors
within the behavior. In this unit you will learn nursing process in the care of population
groups and community.
Learning Objectives__________________________________
1. enumerate and explain the community health assessment tools;

2. discuss and apply community diagnosis;
3. know how to apply the planned community health interventions;
4. discuss the implementing community health interventions;
5. enumerate and explain different environmental sanitation;.
6. know how to evaluate and monitor the community health programs implemented;
and
7. know the proper documentation and reporting.
MOTIVATIONAL ACTIVITY
Name: Date:
Directions: The following grid contain terms associated with Community Health Nursing
(as enclosed in the box below). Find and encircle them. Look for them in all directions
including backwards and diagonally.
C X W O B S E R V A T I O N H
O Z H R L A N O I T I D A R T
P L F E F R F I M Z J K Z E W
A F W V Z V A I M H K Q J G D
R V L E C E N S U S J X U K X
N X K N H Y I H N Q E R J H G
A J K T G D I A G N O S I S F
N F W I H R G K T D K M N K G
D V L O M A H A S Y S T E M H

Pretest
Name: Date:
1. It is defined as the act of examining a process or questioning a selected sample of

individuals to obtain data about a service, product, or process.
a. Observation
b. Survey
c. Personal interview
d. Community Forum
2. The information is sought by way of investigator’s own direct observation without
asking from the respondent.
a. Observation
b. Survey
d. Community Forum
3. This term is generally based on the disease specific incidence or prevalence for
the common and severe disease.
b. Incidence
c. Cohort
4. One of the most commonly used types of graphs is used to display and
compare the number, frequency or other measure (e.g. mean) for different
discrete categories or groups. The graph is constructed so that the different bars'
heights or lengths are proportional to the size of the category they represent.
a. Bar Graph
b. Line Graph
c. Pie Chart
d. Histogram
5. In this method data means data that are already available i.e., they refer to the
data which have already been collected and analyzed by someone else
a. Primary Data
b. Secondary Data
c. Both a and b

Lesson Proper_______________________________________
Assessment of Community Health Needs
A community needs assessment provides community leaders with a snapshot of local
policy, systems, and environmental change strategies currently in place and helps to identify areas
for improvement. With this data, communities can map out a course for health improvement by
creating strategies to make positive and sustainable changes in their communities.
Components of a Needs Assessment

Health status is an individual's relative level of wellness and illness, taking into account
the presence of biological or physiological dysfunction, symptoms, and functional impairment.
Health resources includes financial resources (health spending) and human resources. Health
spending measures the consumption of health services and goods, including outpatient care,
hospital care, long-term care, pharmaceuticals and other medical goods, prevention and public
health services, and administration.
Community Assessment Tools

Assessment provides an estimate of the degree to which a family, group or
community is achieving the health possible for them, identifies specific deficiencies or
guidance needed and estimates the possible effects of the nursing interventions.
Primary Data
Collecting Primary Data- it may be obtained either through observation or through
direct communication with respondents in one form or another through personal
interviews. There are several ways of collecting pri-mary data. Primary data can be
obtained in several ways. However, the most common techniques are observation, survey,
and informant interview and community forum. Primary data collection is quite expensive
and time consuming compared to secondary data collection.
In observation method, the information is sought by way of investi-gator's own

direct observation without asking the respondent.
A survey is defined as the act of examining a process or questioning a selected

sample of individuals to obtain data about a service, product, or process. Data collection
surveys collect information from a targeted group of people about their opinions, behavior,
or knowledge.
In the personal interviews, the interviewer asks questions gen-erally in a face to face
contact. Through interview method more and reliable information may be obtained.
Personal information can be obtained easily under this method. However, it is a very
expensive and time-consuming method, especially when large and widely spread
geographical samples are taken.
A community forum is an open discussion where community residents gather to

raise important issues affecting them, such as health problems in their neighborhood. This
community discussion's primary purpose is to obtain input from a wide range of residents
and stakeholders concerning their needs and identifying resources for addressing health
problems.

Secondary Data Sources

Secondary data means data that are already available i.e., they refer to the data
which have already been collected and analyzed by someone else.
Registry of Vital Events

A well-functioning civil registration and vital statistics (CRVS) system registers all
births and deaths, issues birth and death certificates, and compiles and disseminates vital
statistics, including cause of death information.
Health Records and Reports

A comprehensive compilation of information traditionally placed in the medical
record but also covering aspects of the client’s physical, mental, and social health that do
not necessarily relate directly to the condition under treatment.
Disease Registries
A disease registry is a special database that contains information about people
diagnosed with a specific type of disease. Most disease registries are either hospital based
or population based. A hospital-based registry contains data on all the patients with a
specific type of disease diagnosed and treated at that hospital. A population-based registry
contains records for people diagnosed with a specific disease type who reside within a
defined geographic region. For example, a hospital can have a breast cancer registry with
records for all the women in their breast cancer treatment program. The hospital-based
registry would not include all the women with breast cancer in the community, since some
women may go elsewhere for treatment.
Census Data
Information about the members of a given population collected from a government
census. A census is a regularly-occurring and official count of a particular population.
Census data provides more than just a population count. Other variables include ethnicity
breakdowns, income, and housing values.
Methods to present Community Data

There are many ways in which you can present community numerical data. There
will likely be occasions when you have numerical information that you want to include in
your assessment, for example figures and other statistics from secondary sources (such as
registry of vital events, health records and reports, disease registry and census data); the
results of survey; or data that you have collected and analyzed as a result of observation.
Such information can be used to illustrate an argument or concisely convey complex or
detailed information.
Bar Graph
Bar charts are one of the most commonly used types of graph and are used to
display and compare the number, frequency or other measure (e.g. mean) for different
discrete categories or groups. The graph is constructed such that the heights or lengths of
the different bars are proportional to the size of the category they represent. Since the x-
axis (the horizontal axis) represents the different categories it has no scale. The y-axis (the
vertical axis) does have a scale and this indicates the units of measurement. The bars can be
drawn either vertically or horizontally depending upon the categories and length or
complexity of the category labels. There are various ways in which bar charts can be
constructed, making them a very flexible chart type.

Histogram
Histograms are a special form of bar chart where the data represent continuous
rather than discrete categories. For example, a histogram could be used to present details of
the average number of hours exercise carried out by people of different ages because age is
a continuous rather than a discrete category. However, because a continuous category may
have many possible values the data are often grouped to reduce the number of data points.
For example, instead of drawing a bar for each individual age between 0 and 65, the data
could be grouped into a series of continuous age ranges such as 16-24, 25-34, 35-44, etc.
Unlike a bar chart, in a histogram both the x- and y-axes have a scale. This means that it is
the bar area that is proportional to the size of the category represented and not just its
height.
Pie Charts
Pie charts are a visual way of displaying how the total data are distributed between
different categories. The example here shows the proportional distribution of visitors
between different types of tourist attractions. Similar uses of a pie chart would be to show
the percentage of the total votes received by each party in an election. Pie charts should
only be used for displaying nominal data (i.e. data that are classed into different categories).
They are generally best for showing information grouped into a small number of categories
and are a graphical way of displaying data that might otherwise be presented as a simple
table.
Line Graph
Line graphs are usually used to show time series data – that is how one or more
variables vary over a continuous period of time. Typical examples of the types of data that
can be presented using line graphs are monthly rainfall and annual unemployment rates.
Scatter Plots
Scatter plots are used to show the relationship between pairs of quantitative
measurements made for the same object or individual. For example, a scatter plot could be
used to present information about the examination and coursework marks for each of the
students in a class. In the example here, the paired measurements are the age and height of
children
Community Diagnosis
In the assessment of the community’s health status, the nurse considers the degree
of detail or depth she should go into. A nurse may decide to assess a specific population
group in a community, in which case, she may not opt to conduct comprehensive
assessment of that group and at the same time, focus on the specific problems of that same
group. It is important therefore, to decide on the objectives of the community diagnosis, the
resources and time available to implement.
Traditional/ Comprehensive Community Diagnosis

A comprehensive community diagnosis aims to obtain general information about
the community. The following are the elements of a comprehensive community diagnosis:
Demographic variables
The analysis of the community’s demographic characteristics should show the size,
composition and geographical distribution of the population as indicated by the following:

1. Total population and geographical distribution including urban-rural

index and population density.
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth rate, crude death
rate and life expectant at birth
4. Patterns of migration
5. Population projections
It is also important to know whether there are population groups that need special
attention such as indigenous people, internal refugees and other socially dislocated groups
as a result of disasters, calamities and development programs.
Socio-Economic and Cultural Variables

There are no limits as to the list of socio-economic and cultural factors that may
directly or indirectly affect the community's health status. However, the nurse should
consider the following essential information: Social Indicators, Economic Indicators, and
Environmental Indicators, Cultural Factors
Political/ Leadership Patterns

The process of community diagnosis consists of collecting, organizing, synthesizing,
analyzing and interpreting health data. Before the community health nurse collects data, the
objectives must be determined as these will dictate the depth or the scope of the community
diagnosis. She needs to resolve whether a comprehensive or a problem- oriented
community diagnosis will accomplish her objectives.
Steps in Conducting Community Diagnosis

In order to generate a broad range of useful data, the community diagnosis must be
carried out in an organized and systematic manner keeping in mind that the community
should take an active part in identifying community needs.
1. Determining the Objectives. In determining the objectives of the community
diagnosis, the nurse decides on the depth and scope of the data she needs to gather.
2. Defining the Study Population. Based on the objectives of the community diagnosis,
the nurse identifies the population group to be included in the study.
3. Determining the Data to be Collected. Whether the community diagnosis is going to
be comprehensive or focused on specific problem, the objectives will guide the
nurse in identifying the specific data she will collect.
4. Collecting the Data. In conducting community diagnosis, different methods may be
utilized to generate health data. In general, we use the methods such as records
review, surveys and observations, interviews, and participant observation.
5. Developing the Instrument. Instruments or tools facilitate the nurse’s data gathering
activities. The most common instruments are survey questionnaire, interview guide
and observation checklist
6. Actual Data Gathering. Before the actual data gathering, it is suggested that the
nurse meet the people who will involved in the data collection. The data collectors
must be given an orientation and training on how they are going to use the
instruments in data gathering. During the actual data gathering, the nurse
supervises the data collectors by checking the filled-up instruments in terms of
completeness, accuracy and reliability of the information collected.

7. Data Collation. After data collection, the nurse is now ready to put together all
information. There are two types of data that may be generated. They are either
numerical data which can be counted or descriptive data which can be described.
8. Data Presentation. Data presentation will depend largely on the type of data
obtained. Descriptive data are presented in narrative reports.
9. Data analysis in community diagnosis aims to established trends and patterns in
terms of health needs and problems of the community. It also allows for comparison
of obtained data with standard values.
10. Identifying Community Health Nursing Problems. Community health nursing
problems are categorized as:
a. Health status problems is described in terms of increased or decreased
morbidity, mortality, fertility, or reduced capability for wellness.
b. Health resources problems is described in terms of lack of or absence of
manpower, money, materials, or institutions necessary to solve health problems,
c. Health related problems is described in terms of existence of social, economic,
environmental, and political factors that aggravate the illness-inducing
situations in the community
11. Priority Setting. After the problems have been identified, the next task is to
prioritize which health problems can be attended to considering the resources
available at the moment. In priority setting, the following criteria:
a. Nature of the condition/problem presented- problems are classified by the
nurse as health status, health resources or health-related problems.
b. Magnitude of the problem-refers to the severity of the problem which can be
measured in terms of the proportion of the population affected by the problem.
c. Modifiability of the problem-refers to the probability of reducing, controlling or
eradicating the problem.
d. Preventive potential-refers to the probability of controlling or reducing the
effects posed by the problem.
e. Social concern-refers to the perception of the population or the community as
they are affected by the problem and their readiness to act on the problem.

Criteria Weight
Nature of the problem
Health status 3
Health resources 2 1
Health-related 1
Magnitude of the problem
75%-100% affected 4
50%-74% affected 3 3
25%-49% affected 2
<25% affected 1
Modifiability of the problem
High 3
Moderate 2 4
Low 1
Not modifiable 0
Preventive potential
High 3
Moderate 2 1
Low 1
Social Concern
Urgent community concern; express readiness 2
Recognized as a problem but not needing urgent 1 1
attention
Not a community concern 0
Figure 8: Nursing Process in the Community

Source: Nursing Care of the Community,(2013)
Participatory Action Research

Participatory Action Research (PAR) is an approach to enquiry which has been used
since the 1940s. It involves researchers and participants working together to understand a
problematic situation and change it for the better. There are many definitions of the
approach, which share some common elements. PAR focuses on social change that
promotes democracy and challenges inequality; is context-specific, often targeted on the
needs of a particular group; is an iterative cycle of research, action and reflection; and often
seeks to ‘liberate’ participants to have a greater awareness of their situation in order to take
action. PAR uses a range of different methods, both qualitative and quantitative.
Its fundamental principles are that the research subjects become involved as
partners in the process of the inquiry and that their knowledge and capabilities are
respected and valued. Participatory research is ultimately about relationships and power.
The key contacts are between the researcher and the researched, and between local people

and those actors they see as powerful and who affect their lives. Participatory researchers
act as facilitators and work towards attaining equality in these two relationships. Local
people involved in participatory research processes are often subordinate in their own
social context, while outside researchers are often perceived as experts who impose their
views. Transforming these dynamics is achieved by enabling local people to articulate their
views and express their knowledge by describing and analyzing their own situations and
problems. Many participatory research processes also have an action component that
involves the participants in successive cycles of analysis, reflection and action.
Figure 7: Five Phases of PAR

source: Nursing Care of the Community,(2013)
Schemes in Stating Community Diagnosis

After analyzing the data, the next step is to make a definitive statement (diagnosis)
identifying the problem or the needs. Nursing diagnoses for communities may be
formulated regarding the following issues: Inaccessible and unavailable services, Mortality
and morbidity rates, Communicable disease rates, Specific populations at risk for physical
or emotional problems, Health-promotion needs for specific populations, Community
dysfunction, Environmental hazards (ANA, 1986)
The format of the problem statement varies, depending on the philosophy of the
agency conducting the assessment. For example, problems or needs may be stated simply in
epidemiological terms, such as a high rate of adolescent pregnancies, whereas in other
instances you may be asked to state the problem or need as a nursing diagnostic statement.
Nursing diagnosis has evolved since 1973 as a result of the efforts of the North
American Nursing Diagnosis Association (NANDA) (NANDA, 2009). The initial North
American Nursing Diagnosis Association (NANDA) classification system of nursing
diagnoses focused on the physical needs of individual clients but was not applicable to the
family and community situations faced by community health nurses. Over the years, the
NANDA classification system has expanded to include individuals and families' biological,
psychological, and social needs. Because of ongoing refinement, the taxonomy of nursing
diagnoses at present has 11 functional health patterns. Tools have been developed to assess
the community using the functional health pattern typology (Gikow & Kucharski, 1987;
Wright, 1985). Newer NANDA diagnoses may also apply to communities; examples include
the diagnosis of impaired home maintenance and impaired social interaction.

Other classification systems have been developed in an attempt to address the

community. One example is the Omaha System, written by community/public health
nurses for community/public health nursing practice (Martin, 2005). The system was
designed by the Omaha Visiting Nurse Association and has been used in-home care, public
health, and school health practice settings, among others. Client problems/needs/concerns
are organized into four domains: physiological, psychosocial, health-related behaviors, and
environmental. Each domain may involve actual or potential problems or opportunities for
health promotion. The system includes four categories of interventions: teaching, guidance,
and counseling; treatments and procedures; case management; and surveillance. Although
originally developed for application with individuals or families, users are now applying the
problem domains and interventions with communities (Martin, 2005). The Omaha System
includes more environmental and community factors than are considered in the NANDA
system.
Because of the multiple nursing diagnostic and classification systems, the NNN
Alliance has formed to develop a consistent classification system. The NNN Alliance is a
collaboration of NANDA and the Center for Nursing Classification and Clinical Effectiveness
(CNC). The taxonomy developed by the NNN Alliance has four domains (Dochterman &
Jones, 2003). The one relevant to community health practice is the environmental domain,
with three subsets: healthcare system, populations, and aggregates. All three subgroups
have diagnosis, outcome, and intervention arenas.
A nursing diagnosis has three components: a descriptive statement of the problem,
response, or state; identification of factors etiologically related to the problem; and signs
and symptoms that are characteristic of the problem (Carpenito, 2000).
Planning Community Interventions

The World Health Organization's (1978) definition of health emphasizes not only
the prevailing physical and mental conditions of the people and community. It also
considers the political, economic and social and cultural dimensions that affet their living
conditions and quality of life. The interventions of the nurse cannot be limited to actions
geared towards the reduction of mortality and morbidity.
Priority Setting / Priority-setting for Achieving Universal Health Coverage by WHO

Universal health coverage (UHC) has been defined as "the desired outcome of health
system performance whereby all people who need health services receive them, without
undue financial hardship." However, most countries' scarce resources cannot ensure that
everyone obtains every beneficial health service at an affordable price. Therefore, priority-
setting is required to provide a comprehensive range of key services, which are well aligned
with other social goals, to which all people should have access. The question then arises:
how comprehensive is comprehensive? Definitions and indicators of essential health
services, as well as financial protection, have recently been suggested to guide countries on
implementing UHC. Policy-makers then need to make choices about what health services to
provide, for whom, at what price and at what quality.
The configuration of UHC is country specific, since the demography, epidemiology,
culture and history, as well as spending requirements and available resources are different
for every country. Many countries set priorities using waiting lists by compromising the
quality of care by not providing certain services to some populations or geographic areas or
charging user fees that only some can afford to pay.
Priority-setting in health care has been defined as: “the task of determining the
priority to be assigned to a service, a service development or an individual patient at a given

point in time. Prioritization is needed because claims (whether needs or demands) on

healthcare resources are greater than the resources available.
In the context of health systems, priority-setting is about the allocation of resources
to innovative high-cost medicines or new vaccines and its introduction in public health
programs; prevention, or primary care; to training community workers or specialists; about
deciding which population subgroups ought to receive subsidized care; even about complex
policy interventions such as introducing pay-for-performance schemes for remunerating
providers. As in the case of specific drugs or surgical procedures, establishing priorities
concerning human resource capacity, infrastructure investment, provider payment, or
premium setting for service delivery also requires systematic consideration of available
evidence. And while such evidence may be more readily available in pharmaceuticals,
policy-makers still need to address the same two broad sets of issues when considering
more complex service delivery and policy interventions. These are: first, the relative
effectiveness of rival alternative interventions and, second, the value to be placed on the
outcomes for each alternative. Even in the absence of technical skills or data, a structured
approach setting out each option's costs and benefits can make trade-offs explicit, highlight
assumptions and gaps in evidence, and reveal values underpinning decisions.
This process can also help ensure engagement with clients and stakeholders in
collating, reviewing, and interpreting the evidence, making implementation and impact
more likely. Decision-making processes will inevitably reflect expert judgments when data
for sophisticated modeling, or the local skills for analysis, are unavailable. In such
circumstances, it is important to interpret evidence from other settings and assess its
relevance. Core principles for planning, conduct, and reporting of economic evaluations
have been suggested.
Priority-setting is about making explicit choices about what to fund and weighing
the trade-offs between the various options. All health systems set priorities: these are
reflected in the technologies and services paid for and the investments made in training and
infrastructure. Whether implicitly or explicitly, driven by local players or global donors,
priorities become established even in settings where the institutions, data, and technical
expertise for doing so effectively and fairly are weak or non-existent. Thus the question is
not whether to set priorities – but how to improve priority-setting processes.
In terms of protocol, priority-setting broadly involves four steps, which are: (i)
identifying interventions or issues to be considered; (ii) finding evidence; (iii) making
decisions and (iv) making appeals. While different stakeholders may have various capacities
and therefore varying contributions at each stage of the process, experiences indicate that
broad stakeholder participation, uniquely engaging civil society, and the public, is important
for the long-term sustainability of the process.
Priority-setting can be difficult if the evidence is not properly considered because
stakeholders have different perspectives and interests. Evidence can be considered in
several ways depending on available resources and the principles identified, which can
include quantitative or qualitative, global or local, clinical, social, or economic and primary
or secondary evidence. The groups responsible for generating the evidence should have
academic integrity and limited conflicts of interest. It is also important that the evidence
generated is comparable across interventions. In some countries with limited capacity, the
government may allow the industry to provide evidence, resulting in the need for
mechanisms to ensure the evidence's reliability and validity, for example, through the
establishment of methodological guidelines and independent review. In cases of limited
capacity and infrastructure, there may be limitations in the availability of local evidence; the
attempt to generate relevant evidence can thereby help build capacity for generating local
data.

Formulating Goals and Objectives

“Where do we want to go?" refers to formulating goals and objectives of the health
program and nursing services to change the community's status. Goals and objectives will
serve as guide to the nurse's efforts. A goal is a declaration of purpose or intent that fives
essential direction to action. Objectives are stated in behavioral terms: specific, measurable,
attainable, realistic, and time-bounded.
Example:
Health Problem High incidence and prevalence of intestinal parasitism among children
Goal To reduce the incidence and prevalence of intestinal parasitism among
children of Sitio A.
Objectives 75% of children below six years old will test negative for parasites after
one year
Deciding on Community Intervention/ Action Plan

“How do we get there?” defines the strategies and activities that the nurse sets to
achieve in order to realize the goals and objectives.
Conduct a community-based assessment and planning process to be sure that you're
addressing the most appropriate and pressing issues for the community. If your
intervention is to work, it has to be aimed at the real issues the community needs to
address. An assets and needs assessment and planning process will help you identify those
issues accurately and think about how to approach them most effectively.
Decide whether you'll address the issue directly or try to change the conditions that
make it possible. It may be that working on their causes will be more successful than
coming at the issues themselves directly, and that could mean a totally different kind of
intervention.
Find (or create, if that's necessary) practices or interventions that have successfully
addressed the issue in the way you want to address it. It's important to realize that not
every successful program is successful in the way that you're interested in. If your focus is
community empowerment, for instance, a top-down authoritarian program, no matter how
successful, isn't what you're looking for. If you want to get at the root causes of a problem, a
program that does a terrific job of treating the symptoms isn't a good fit for you. Ensure that
practice or intervention matches your immediate needs - reducing youth violence, e.g., but
the assumptions behind them - empowering the community to change the root causes of
youth violence and all but eliminate it over the long term.
Determine what elements of a promising intervention will work in your community,
and which ones need to be changed. In other words, change the intervention, or parts of it,
so that it suits your community's needs. Not all the pieces of an urban program will work in
a rural area, for instance, where the realities of transportation, child care, culture, and
everyday life all may be totally different. The community and the target population need to
make an adopted practice or intervention their own and work for them. If it's true that no
two communities are exactly alike, it should be equally true that interventions that work for
them won't be exactly alike, either, though they may have many common elements.

Implementing Community Health Interventions

Community health needs and problems are not solved by simply inducing changes
in personal and group attitudes and behavior. If one expects a lasting and sustainable
solution, reforms have to be carried out within the health care delivery system and a larger
socio-economic and political system. Community health nursing interventions must focus
on providing health-related interventions to improve the population's health status and
enhance the community's capability to manage their own health.
Partnership and Collaboration
Health and health-related problems in the community are varied. The problems are
often complicated and too many for the nurse and the people or their organization to
handle. They cannot solve the problems alone. They must work with other people or groups
to increase the probability of accomplishing the goals that they have set. Partnership and
collaboration aim to get people to work together in order to address problems or concerns
that affect them. It gives people the opportunity to learn skills in-group relationships,
interpersonal relations, critical analysis, and, most important of all, the decision-making
process in the context of democratic leadership.
Activities involved in collaboration and advocacy

Working together enables organizations to accomplish their goals much quicker
because of resources, skills, and views are pooled together.
Activities in Collaboration includes: Networking, Coordination, Cooperation,
Coalition
Advocacy work is one way the nurse can promote active community participation.
The nurse helps the people attain the optimal degree of independence in decision making in
asserting their rights to a safe and better community. Advocacy work includes: Informing
the people about the rightness of the cause; thoroughly discussing with the people the
nature of the alternatives, their content and possible consequences; supporting people's
right to make a choice and to act on their choice; Influencing public opinion
Community organizing and social mobilization

Community organizing is a process where people who live in proximity to each
other come together into an organization that acts in their shared self-interest. Unlike those
who promote more-consensual community building, community organizers generally
assume that social change necessarily involves conflict and social struggle in order to
generate collective power for the powerless. Community organizing has as a core goal the
generation of durable power for an organization representing the community, allowing it to
influence key decision-makers on a range of issues over time. In the ideal, for example, this
can get community-organizing groups a place at the table before important decisions are
made. Community organizers work with and develop new local leaders, facilitating
coalitions and assisting in developing campaigns. A central goal of organizing is developing
a robust, organized, local democracy bringing community members together across
differences to fight together for the interests of the community. Community organizing is a
process whereby community members develop the capability to assess their health needs
and problems, plan and implement actions to solve these problems, put up and sustain
organizational structures that will support and monitor implementation of health initiatives
by the people.
The World Organization defined social mobilization as the process of bringing
together all societal and personal influences to raise awareness of and demand for health
care, assist in the delivery of resources and services, and cultivate sustainable individual
and community involvement. In order to employ social mobilization, members of

institutions, community partners and organizations, and others collaborate to reach specific
groups of people for intentional dialogue. Social mobilization aims to facilitate change
through an interdisciplinary approach.
Principles of community organizing include: Community development is a process;
Community development is a holistic approach for addressing the community's needs;
Empowerment results from influence, participation, and community education;
Development ensures environmental stewardships; Development is tied to sustainability;
Partnership provides access to resources.
Goals of Community Organizing

A core goal of community organizing is to generate durable power for an
organization representing the community, allowing it to influence key decision-makers on a
range of issues over time. In the ideal, for example, this can get community organizing
groups a place at the table before important decisions are made.
Their main objectives/aims are the following: to bring adjustment between the
resources available and felt needs of the people; to get information about the resources and
needs; To arouse the people to work for the welfare of the community; To create sounds
ground for planning and action; To create a sense of cooperation integration and unity
among people; To motivate the people to take better participation in the developing
community programs ; To highlight the causes of various problems affecting the community
and hinder the way of progress and development ;To implement programs required for the
fulfillment of people basic; To develop better understanding among the people about the
issues and needs; To mobilize the resources to create a suitable ground for the basic needs
completion and eradication of problems; To bring coordination between the individuals,
groups and organization to focus their point and challenge their objectives for fulfillment;
To launch necessary reforms in the community for eradication of community evils; To
develop democratic leadership among people through their participation in community
programs; To develop the idea of ability and better thinking to work for the betterment of
community; To abolish the differences among individuals, develop spirit of common
interest and sacrifice and also participate collectively in community programs; To organize
the people for the promotion and progress of community; Removal of blocks to growth (in
individuals, groups as well as in communities); Release of full potentialities (in individuals,
groups as well as in communities); Full use of inner resources (in individuals, groups as well
as in communities); Development of capacity to manage one's own (individual, group &
community) life; Increasing the ability to function as an integrated unit.
Community Organizing Participatory Research (COPAR)

COPAR or Community Organizing Participatory Action Research is a vital part of
public health nursing. COPAR aims to transform the apathetic, individualistic, and voiceless
poor into a dynamic, participatory, and politically responsive community.
The following are the emphasis of COPAR: Community working to solve its own
problem. The direction is established internally and externally. The development and
implementation of a specific project are less important than the development of the
community's capacity to establish the plan. Consciousness-raising involves perceiving
health and medical care within the total structure of society.
The following are the importance of COPAR: COPAR is an important tool for community
development, and people empowerment. This helps the community workers generate
community participation in development activities. COPAR prepares people/clients to

eventually take over the management of a development programs in the future. COPAR
maximizes community participation and involvement; community resources are mobilized
for community services.
Principles of COPAR include: People, especially the most oppressed, exploited, and
deprived sectors are open to change, have the capacity to change, and are able to bring
about change. COPAR should be based on the interest of the poorest sector of the
community. COPAR should lead to a self-reliant community and society.
The critical steps of COPAR are: (1)Integration(2)Social Investigation(3)Tentative

program planning(4)Groundwork(5)Meeting(6)Role Play(7)Mobilization or
action(8)Evaluation(9)Reflection(10)Organization
Phases of COPAR
COPAR has four phases, namely: Pre-Entry Phase, Entry Phase, Organization-
building phase, and sustenance and strengthening phase.
Pre-Entry Phase-Is the initial phase of the organizing process where the community
organizer looks for communities to serve and help. Activities include:
For preparation: Train faculty and students in COPAR. Formulate plans for
institutionalizing COPAR. Revise/enrich curriculum and immersion program—coordinate
participants of other departments.
For Site Selection: Initial networking with local government. Conduct preliminary
special investigation. Make a long/short list of potential communities. Do an ocular survey
of listed communities.
Criteria for Initial Site Selection: Must have a population of 100-200 families.
Economically depressed. No strong resistance from the community. No serious peace and
order problem. No similar group or organization holding the same program.
In identifying potential municipalities: Do the same process as in selecting

municipality. Consult key informants and residents. Coordinate with local government and
NGOs for future activities.
In choosing the final community: Conduct informal interviews with community

residents and key informants. Determine the need for the program in the community. Take
note of political development. Develop community profiles for secondary data. Develop
survey tools. Pay a courtesy call to community leaders. Choose foster families based on
guidelines.
In identifying Host Family: House is strategically located in the community. They

should not belong to the rich segment. Both formal and informal leaders respect them.
Neighbors are not hesitant to enter the house. No member of the host family should be
moving out in the community.
Entry Phase is sometimes called the social preparation phase. It 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.
Guidelines for Entry: Recognize local authorities' role by paying them visits to
inform their presence and activities. Her appearance, speech, behavior, and lifestyle should
be in keeping with those of the community residents without disregard of their being role
model. Avoid raising the consciousness of the community residents; adopt a low-key profile.
Activities in the Entry Phase: Integration. Establishing rapport with the people in
continuing effort to imbibe community life, living with the community, seek out to converse
with people where they usually congregate, lend a hand in household chores, avoid
gambling and drinking. Deepening social investigation/community study, verification, and
enrichment of data collected from the initial survey, conduct baseline survey by students,
results relayed through community assembly.
For Core Group Formation: Leader spotting through sociogram. Key persons must
be approachable by most people. Must be an opinion leader. They are approached by key
persons and never or hardly consulted.
Organization-building Phase. In this phase, the formation of a more formal structure

and the inclusion of more formal procedures of planning, implementing, and evaluating
community-wide activities. At this phase, the organized leaders or groups are being given
training (formal, informal, OJT) to develop their style in managing their own
concerns/programs.
Key Activities include Community Health Organization (CHO) (preparation of legal
requirements, guidelines in the organization of the CHO by the core group, election of
officers). Research Team Committee. Planning Committee. Health Committee Organization.
Formation of by-laws by the CHO
Sustenance and Strengthening Phase. In this phase, the community organization has
already been established, and the community members are already actively participating in
community-wide undertakings. At this point, the different committees set up in the
organization-building phase are already expected to be functioning by planning,
implementing, and evaluating their own programs, with the overall guidance from the
community-wide organization.
Key Activities include Training of CHO for monitoring and implementing of
community health programs. Identification of secondary leaders. Linkaging and networking.
Conduct of mobilization on health and development concerns. Implementation of livelihood
projects.
Environmental Sanitation
Environmental Sanitation is still a health problem in the country. Diarrheal disease
ranked fifth in 2010 causes of morbidity among the general population. The Department of
Health, through the Environment Health Services, has the authority to act on all issues and
concerns in environment and health, including the Sanitation Code of the Philippines (PD
856, 1978). The World Health Organization defined Environmental Sanitation as the
promotion of hygiene and the prevention of disease and other consequences of ill-health,
relating to environmental factors.

Environmental factors
These are environmental factors which impact on the infectious agents and
transmission of disease. These include Disposal of human excreta; Sewage; Household
waste, and other waste likely to contain infectious agents; Water drainage; Domestic water
supply; Housing.
Sanitation practices
These are various hygienic practices of the communities, basic knowledge, skills,
human behaviors, and social and cultural factors concerning health, lifestyles, and
environmental awareness. These include: Personal hygiene (washing, dressing, eating);
Household cleanliness (kitchen, bathroom cleanliness); Community cleanliness (waste
collection, common places)
Proper Excreta Disposal

Human excreta always contain large numbers of germs, some of which may cause
diarrhea. When people become infected with cholera, typhoid and hepatitis A, their excreta
will contain large amounts of the germs that cause the disease. When people defecate in the
open, flies will feed on the excreta and can carry small amounts of the excreta away on their
bodies and feet. When they touch food, the excreta and the germs in the excreta are passed
onto the food, which may later be eaten by another person. Some germs can grow on food
and in a few hours their numbers can increase very quickly. Where there are germs there is
always a risk of disease.
Approved types of toilet facilities:
Level I:
• Non-water carriage toilet facility
• Toilet facilities requiring small amount of water to wash the waste
Level II:
• On site toilet facilities of the water carriage type with water sealed and flush
type with septic tank disposal facilities
Level III:
• Water carriage types of toilet facilities connected to septic tanks to sewerage
system to treatment plants.
Food Safety
Fast food has become a staple diet for busy people, especially when time is not
enough for food preparation. What could be worse than sinking your teeth into your
favorite food, unperturbed to the fact that it is crawling with germs? You have already
consumed and digested your meal before discovering that there is an additional
"ingredient," which is, without a doubt, a recipe for disaster. A person will more likely
choose to starve to death than eat contaminated food. There have been several complaints
about food poisoning and unsafe food handling practices. While some complainants are
already well aware of the steps to take, others still need guidance so their complaints will
not fall on deaf ears.
The Republic Act No. 10611, otherwise known as the "Food Safety Act of 2013,"
strengthens our country's food safety regulatory system. The law provides protection to
consumers so they will have access to local foods and food products that have undergone
thorough and rigid inspection.

Under Section 3 of the Republic Act, the objectives are as follows:
Protect the public from food-borne and water-borne illnesses and unsanitary,
unwholesome, misbranded, or adulterated foods; Enhance industry and consumer
confidence in the food regulatory system, and Achieve economic growth and development
by promoting fair trade practices and sound regulatory foundation for domestic and
international trade.
The food safety regulatory system combines various processes to ensure that food
safety standards are met. Food safety standards refer to the formal documents, which
contain the food requirements that the food processors need to comply with such human
health is safeguarded. These safety standards are implemented by law and authorities.
Some of the processes under the regulatory system include inspection, testing, data
collection, monitoring, and other activities carried out by various food safety regulatory
agencies.
Sanitation
The World Health Organization defined sanitation as the provision of facilities and
services for the safe management of human excreta from the toilet to containment and
storage and treatment onsite or conveyance, treatment and eventual safe end use or
disposal. More broadly sanitation also included the safe management of solid waste and
animal waste. Inadequate sanitation is a major cause of infectious diseases such as cholera,
typhoid and dysentery world-wide. It also contributes to stunting and impaired cognitive
function and impacts on well-being through school attendance, anxiety and safety with
lifelong consequences, especially for women and girls. Improving sanitation in households,
health facilities and schools underpins progress on a wide range of health and economic
development issues including universal health coverage and combatting antimicrobial
resistance
Source: 1993 Philippine National Standard for Drinking Water, Published by DOH
Vermin and Vector Control

Environmental management seeks to change the environment in order to prevent or
minimize vector propagation and human contact with the vector-pathogen by destroying,
altering, removing, or recycling non-essential containers that provide larval habitats. Such
actions should be the mainstay of dengue vector control. Three types of environmental
management are defined: Environmental modification – long-lasting physical
transformations to reduce larval vector habitats, such as the installation of a reliable piped
water supply to communities, including household connections. Environmental
manipulation – temporary changes to vector habitats involving the management of
"essential" containers, such as frequent emptying and cleaning by scrubbing of water-
storage vessels, flower vases, and desert room coolers; cleaning of gutters; sheltering stored
tires from rainfall; recycling or proper disposal of discarded containers and tires;
management or removal from the vicinity of homes of plants such as ornamental or wild
bromeliads that collect water in the leaf axils.Changes to human habitation or behavior –
actions to reduce human – vector contact, such as installing mosquito screening on
windows, doors, and other entry points, and using mosquito nets while sleeping during the
daytime.

Improvement of water supply and water-storage systems

Improving water supplies is a fundamental method of controlling Aedes vectors,
especially Ae. aegypti. Water piped to households is preferable to water drawn from wells,
communal standpipes, rooftop catchments, and other water-storage systems.
However, potable water must be supplied reliably so that water-storage containers
that serve as larval habitats – such as drums, overhead or ground tanks, and concrete jars –
are not necessary. In urban areas, the use of cost-recovery mechanisms such as the
introduction of metered water may actually encourage household collection and storage of
roof catchment rainwater that can be harvested at no cost, resulting in the continued use of
storage containers.
Mosquito-proofing of water-storage containers

Water-storage containers can be designed to prevent access by mosquitoes for
oviposition. Containers can be fitted with tight lids or if rain-filled, tightly-fitted mesh
screens can allow for rainwater to be harvested from roofs while keeping mosquitoes out.
Removable covers should be replaced every time water is removed and should be well
maintained to prevent damage that permits mosquitoes to get in and out.
Expanded polystyrene beads used on the surface of water provide a physical barrier
that inhibits oviposition in storage containers from which water is drawn from below via a
pipe and from which there is no risk of overflow. These beads can also be placed in septic
tanks, which Ae. aegypti sometimes exploits.
Solid waste management

In the context of dengue vector control, "solid waste" refers mainly to non-
biodegradable items of household, community, and industrial waste. The benefits of
reducing the amount of solid waste in urban environments extend beyond those of vector
control, and applying many of the basic principles can contribute substantially to reducing
the availability of Ae. aegypti larval habitats. Proper storage, collection, and disposal of
waste are essential for protecting public health. The basic rule of "reduce, reuse, recycle" is
highly applicable. Efforts to reduce solid waste should be directed against discarded or non-
essential containers, particularly if they have been identified in the community as important
mosquito-producing containers.
Solid waste should be collected in plastic sacks and disposed of regularly. The
frequency of collection is important: twice per week is recommended for houseflies and
rodent control in warm climates. Integration of Ae. aegypti control with waste management
services is possible and should be encouraged.
Street cleansing
A reliable and regular street cleansing system that removes discarded water-
bearing containers and cleans drains to ensure they do not become stagnant and breed
mosquitoes will both help to reduce larval habitats of Ae. aegypti and remove the origin of
other urban pests.
Building structures
During the planning and construction of buildings and other infrastructure,
including urban renewal schemes, and through legislation and regulation, opportunities
arise to modify or reduce potential larval habitats of urban disease vectors, including Ae.
aegypti, Culex quinquefasciatus, and An. stephensi. For example, under revised legislation in
Singapore, roof gutters are not permitted on buildings in new developments because they

are difficult to access and maintain. Moreover, property owners are required to remove
existing gutters on their premises if they are unable to maintain them satisfactorily.
Chemical control: larvicides

Although chemicals are widely used to treat Ae, aegypti larval habitats, larviciding
should be considered as complementary to environmental management and – except in
emergencies – should be restricted to containers that cannot otherwise be eliminated or
managed. Larvicides may be impractical to apply in hard-to-reach natural sites such as leaf
axils and tree holes, which are common habitats of Ae. albopictus, or in deep wells. The
difficulty of accessing indoor larval habitats of Ae. aegypti (e.g. water-storage containers,
plant vases, saucers) to apply larvicides is a major limitation in many urban contexts.
Built Environment
A built environment is developed in order to satisfy residents' requirements. Human
needs can be physiological or social and are related to security, respect, and self-expression.
People want their built environment to be aesthetically attractive and to be in an accessible
place with a well-developed infrastructure, convenient communication access, and good
roads, and the dwelling should also be comparatively cheap, comfortable, with low
maintenance costs, and have sound and thermal insulation of walls. People are also
interested in ecologically clean and almost noiseless environments, with sufficient
relaxation options, shopping, fast access to work or other destinations, and good
relationships with neighbors.
Monitoring and Evaluating Community Health Programs

Monitoring and evaluation are essential management tools that ensure that health
activities are implemented as planned and assess whether desired results are being
achieved. Monitoring is done to provide concurrent feedback on the progress of activities,
identify the problems in their implementation, and take corrective action. Evaluation is
done to assess whether the program's desired results have been achieved if not how it
should be redesigned.
Figure 9: Programme Management Cycle

Monitoring and evaluation are closely related. Monitoring, which is done at the
implementation phase, compares the actual progress (of the implementation of the
program) against what was planned. The purpose of monitoring is to identify deviations or
problems so that corrective actions or interventions can be instituted immediately. This
implies reporting to appropriate persona or offices at regular intervals.
Table 4: Comparison between Monitoring and Evaluation

source: https://ctb.ku.edu/en/table-of-contents/analyze/choose-and-adapt-community-
interventions/criteria-for-choosing/main
Focus of Evaluation
There are three major foci of program evaluation: inputs, processes, and results or
outcomes, and these should be viewed within its context.
The program results output, effect, and impact correspond to the three levels of program
objectives: short term, intermediate or medium-term, and long term. Outputs are the
specific products or services which an activity is expected to produce from its inputs to
achieve its objectives (short term). The effects are the outcomes of the use of project
outputs (intermediate). The impact is the outcome of program effects and is an expression
of broader, long-range program objectives.
After one year, the evaluator can collect and analyze data on the program's outputs,
such as: number of fully immunized children, the number of sanitary toilets constructed and
the number of patients who completed their short-course chemotherapy. The effects of
these could be measured a few years later. With high program outputs, it is expected that
the incidence of tuberculosis, poliomyelitis, measles, diphtheria, pertussis, tetanus, hepatitis
B, and diarrheal diseases will be reduced significantly. A program's long-term effect or
impact, such as an increase in the average life expectancy and improvement in life quality,
will manifest after a longer period of time.

Types of Evaluation
There are three types of evaluation:
Planning Evaluation: same as program monitoring. Planning Evaluation programs
are used to improve program performance by influencing immediate decisions about the
activities, especially how they can be re-planned and/or improved. It enables the
assessment of: Who is being reached by the program; What information is reaching them;
Whether or not things are going according to plan; The need for change
Formative Evaluation: initial assessment in order to develop appropriate, effective
programs. The formative evaluation comprises of activities undertaken to furnish
information that will guide the design of health programs. Formative evaluation enables us
to assess: Who is most affected by the problem? ; What knowledge, attitudes, and beliefs
exist?; What is the level of access to services? ; What are the barriers to action?; What are
the communication habits and preferences? Common sources of data are: Monitoring data;
Existing epidemiologic and program reports; Interviews with program managers,
stakeholders; Baseline survey data of intended audience; Media rating data ; Service
statistics; Other program records
Summative or Impact Evaluation: examines specific program outcomes and
accomplishments. This is used to assess the program's success and judge its worth by
assessing its effectiveness in light of relevant problems. It enables the assessment of
whether the appropriate behaviors were realized, and these changes can be attributed to
the intervention.
Steps in Program Evaluation

There are six steps in program evaluation: deciding what to evaluate, designing the
evaluation plan, collecting relevant data, analyzing data, making decisions, and reporting/
giving feedback.
1. Decide what to evaluate. The WHO suggested five dimensions of program
performance that could be evaluated: relevance, progress, effectiveness, impact, and
efficiency. To address these dimensions, the evaluator should review the program
context and objectives.
2. Design the Evaluation Plan. Designing an evaluation plan means specifying data
collection methods and tools and sources of data. Records and reports can be
reviewed and analyzed. Surveys can be conducted to collect information on the
client's knowledge, attitudes, and practices
Example:
Sample Evaluation Plan Format
What to Evaluate Data/Information Data collection Sources of Data/
and Evaluation Needed Methods/Tools Information
Indicators
3. Collect Relevant Data. The evaluator's primary aim is the generation of accurate
and reliable data. Prior to actual data collection, data collection methods and tools
should be field-tested, and data collectors should be trained.

4. Analyze Data. Evaluators should assess the quality of the data before they start
the analysis. What do the figures/ statistics mean? What do qualitative data reveal?
Depending on the type of evaluation being conducted. The main questions that
should be asked are: Is the program relevant? Is it progressing in accordance with
the program plan? Is it effective? What are the lessons that could be learned from
the program?
5. Make Decisions. If the intervention or program was effective and efficient, this
could be continued and/or applied to another client or group, given similar
circumstances. If the program is not relevant, the evaluator should recommend its
modification.
6. Report/ Give Feedback. The result of the program evaluation should be submitted
to local authorities such as mayor, chair of the Sangguniang Bayan committee on
health, and to the Local Health Board. It should be noted that these are the key
decision-makers in the local health system. An executive summary should be
prepared for them. It should contain a brief description of the focus and procedures
of the evaluation, summary, and interpretation of evaluation results, conclusions,
and recommendations. The nurse and other health workers must be prepared to
make a presentation to the Sangguniang Bayan or to the Local Health Board. If the
nurse will be asked to make a presentation, you must prepare good visual aids. A
good written report and an impressive oral presentation can influence decision-
makers positively.
Example:
Sample Format
Executive Summary of Program Evaluation
Brief Description:
Focus/Coverage/Objectives:
Procedures:
Summary and Interpretation of Results:
Conclusions:
Recommendations:

Documentation and Reporting
Guidelines for Good Documentation and Reporting
Fact – information about clients and their care must be factual. A record should
contain descriptive, objective information about what a nurse sees, hears, feels, and smells.
Accuracy – information must be accurate so that health team members have confidence in it
Completeness – the information within a record or a report should be complete, containing
concise and thorough information about a client's care. Concise data are easy to understand.
Currentness – ongoing decisions about care must be based on currently reported
information. Organization – the nurse communicates in a logical format or order.
Confidentiality – confidential communication is information given by one person to another
with trust and confidence that such information will not be disclosed.
References
https://www.yourarticlelibrary.com/agriculture/different-ways-of-collecting-primary-
data/44384
https://www.yourarticlelibrary.com/agriculture/different-ways-of-collecting-primary-
data/44384
Assessing Learning_______________________________________
a. Reflection
Activity 10
Name: Score:
Directions: Collect data on population, location, and social systems on your own
barangay. Present it using methods you have learned in this unit. Use another sheet of
paper if necessary.

b. Post Test
Activity 11
Name: Date:
1. It may be collected either through observation or through direct

communication with respondents in one form or another through personal
interviews
a. Primary Data
b. Secondary Data
c. Both a and b
2. The information is sought by way of investigator’s own direct observation without

asking from the respondent.
a. Observation
b. Survey
d. Community Forum
3. It is an open discussion where community residents gather in order to raise important

issues affecting them, such as health problems in their neighborhood.
a. Observation
b. Survey
d. Community Forum
4. In this method, the nurse asks questions gen-erally in a face to face contact. This
method obtained more and reliable information. Personal information can be obtained
easily under this method.
a. Observation
b. Survey
d. Community Forum
5. It is defined as the act of examining a process or questioning a selected sample of

individuals to obtain data about a service, product, or process.
a. Observation
b. Survey
d. Community Forum

6. In this method data means data that are already available i.e., they refer to the
data which have already been collected and analyzed by someone else
a. Primary Data
b. Secondary Data
c. Both a and b
7. One of the most commonly used types of graph and are used to display and
compare the number, frequency or other measure (e.g. mean) for different
discrete categories or groups. The graph is constructed such that the heights or
lengths of the different bars are proportional to the size of the category they
represent.
a. Bar Graph
b. Line Graph
c. Pie Chart
d. Histogram
8. This is a special form of bar chart where the data represent continuous rather
than discrete categories. For example, it could be used to present details of the
average number of hours exercise carried out by people of different ages because
age is a continuous rather than a discrete category
a. Bar Graph
b. Line Graph
c. Pie Chart
d. Histogram
9. These are a visual way of displaying how the total data are distributed between
different categories. The example here shows the proportional distribution of
visitors between different types of tourist attractions.
a. Bar Graph
b. Line Graph
c. Pie Chart
d. Histogram
10. These are usually used to show time series data – that is how one or more
variables vary over a continuous period of time
a. Bar Graph
b. Line Graph
c. Pie Chart
d. Histogram

UNIT V: WORKING WITH GROUPS TOWARDS COMMUNITY

DEVELOPMENT
Overview
The primary role of community health nurses is to provide treatment to patients.
Additionally, community health nurses offer education to community members about
maintaining their health to decrease the occurrence of diseases and deaths. They plan
educational assemblies, hand-out flyers, conduct health screenings, dispense medications
and administer immunizations. In the heath development process, the Alma Ata Declaration
(1978) stresses two important concerns in addressing community health issues. The first
concern is the need for an integrated approach in solving health problems. The second is the
need for the enhanced capability for greater participation and involvement of the people in
health efforts, including policymaking and influencing decisions.
1. enumerate and explain the stages of group development;

2. discuss and apply interventions to facilitate group growth; and
3. know the principles of collaboration and partnership.
Name: Score:
Directions: Write a least five sentences that describe the pictures below.

Pretest
Name: Date:
1. It is a lot like orientation day at college or a new job. You could even compare it
to going out on a first date. The team has just been introduced, and everyone is
overly polite and pleasant.
a. Forming stage
b. Storming Stage
c. Norming Stage
2. At this point, members become aware of a person's characteristics, and they

frustrate or annoy you each other.
a. Forming stage
b. Storming Stage
c. Norming Stage
3. In this stage, members start to notice and appreciate their team members'
strengths. Groups begin to settle into a groove. Everyone is contributing and
working as a cohesive unit.
a. Forming stage
b. Storming Stage
c. Norming Stage
4. In this stage, members are confident, motivated, and familiar enough with the
project and their team that they can operate without supervision. Everyone is on
the same page and driving full-speed ahead towards the final goal.
a. Forming stage
b. Storming Stage
c. Norming Stage
5. This phase is sometimes known as mourning because members have grown

close and feel a loss now that the experience is over.
a. Forming stage
b. Storming Stage
c. Norming Stage

Lesson Proper_____________________________________
Stages of Development
In 1965, a psychologist named Bruce Tuckman said that teams go through 5 stages
of development: forming, storming, norming, performing and adjourning. The stages start
from the time that a group first meets until the project ends.
The first stage of team development is forming, which is a lot like orientation day at
college or a new job. You could even compare it to going out on a first date. The team has
just been introduced, and everyone is overly polite and pleasant. Most are excited to start
something new and get to know the other team members at the start.
During this stage, you may discuss member's skills, background, and interests;
Project goals; Timeline; Ground rules; Individual roles.
As the group starts to familiarize themselves, roles and responsibilities will begin to
form. Team members need to develop relationships and understand what part each person
plays. But, because this stage focuses more on the people than on the work, your team
probably won't be very productive.
The next stage is storming. Have you ever reached the point in a relationship where
you become aware of a person's characteristics, and they frustrate or annoy you? Perhaps
they squeeze the toothpaste from the top of the tube instead of the bottom? Eat with their
mouth open? Or they listen to the same Drake song 15 times in a row?
Well, congrats, you've entered the storming stage. Being in a team is like being in a
relationship. At first, you may think someone is perfect and flawless. But then you realize
that they aren't. Once you're aware of their flaws, you either learn to embrace them or end
quickly. In the storming stage, the reality and weight of completing the task at hand have
now hit everyone. The initial feelings of excitement and the need to be polite have likely
worn off. Personalities may clash. Members might disagree over how to complete a task or
voice their concerns if they feel that someone isn't pulling their weight. They may even
question the authority or guidance of group leaders. But, it is important to remember that
most teams experience conflict. If you are the leader, remind members that disagreements
are normal. Some teams skip over the storming stage or try to avoid conflict at whatever
cost. Avoidance usually makes the problem grow until it blows up. So, recognize conflicts
and resolve them early on.
During the norming stage, people start to notice and appreciate their team
members' strengths. Groups begin to settle into a groove. Everyone is contributing and
working as a cohesive unit. Of course, you may still think that your tech guy's choice in
music is obnoxious. But, you also admire his knowledge of web design and coding skills, and
value his opinions on anything tech-related. Storming sometimes overlaps with norming. As
new tasks arise, groups may still experience a few conflicts. If you've already dealt with
disagreement before, it will probably be more comfortable to address this time.
If you've reached the fourth stage, pat yourself on the back. You're on your way to
success. In the performing stage, members are confident, motivated, and familiar enough
with the project and their team that they can operate without supervision. Everyone is on
the same page and driving full-speed ahead towards the final goal. The fourth stage is the
one that all groups strive to reach. Yet, some do not make it. They usually fail to overcome
conflict and can't work together.

In 1977, Tuckman added a fifth stage called adjourning. (Sadly, not a perfect rhyme.)
Once a project ends, the team disbands. This phase is sometimes known as mourning
because members have grown close and feel a loss now that the experience is over.
Intervention to Facilitate Group Growth
Orientation, Structure, Direction

During the stage of orientation and dependence, the level of anxiety can be
decreased by helping provide the necessary orientation, structure, and direction to the
group. In instances when the group members do not know each other, the preliminaries of
introductions should be made. There would be a great positive impact on group members if
they got introduced by the leader facilitator. They can also be encouraged to get know to
know one another by making them introduce a co-member.
Specific structured learning exercises on group decision-making and consensus may
be utilized to help group members experience performing the various tasks and group
building for maintenance functions necessary for effective group work. These exercises also
provide opportunities to release, through a game, the energy generated by anxiety.
Process, Negotiate, and Resolve Conflicts

The work group's dynamism characteristics are maintained if the group's hostility
and conflict are permitted to develop. However, in the face of turbulence, stability cannot be
sustained unless group members have the necessary attitude towards conflicts and the
competencies required to handle or manage them. Specific interventions focus on
developing the member's competencies to handle conflict constructively: Help members
understand the nature of conflicts; Help members go through the coping process of conflict
resolution using the problem-solving approach.; Help members generate new ways of
looking at the situation or problem.; Help members analyze her and now experience.
Any conflict can be handled constructively by the group when the following aspects
are considered: Members should develop specific group norms or rules to create an
atmosphere conducive to healthy conflict management. Conflicts are managed effectively by
encouraging group cooperation and by using the problem-solving approach.
Helping members analyze the here and now experiences. The third intervention to
keep group analyze, negotiate, and resolve conflicts is to focus on the members' feelings and
experiences in the present moment, in the here and now. Essentially this intervention helps
members recognized, examine, and understand the "how" and "why" of interactions or
behavior soon after the group members experience them. Sample communications
techniques that shall help the facilitator initiate or utilize the here-and-now process
illumination include:
a) “Is there anything you can feel/say about how we are going through this
group experience?”
b) “Can we describe what’s happening to our group for the last few minutes?”
c) “What do you think are the reasons why we feel we are on a dead-end since
a few minutes ago?”
d) “How have we been discussing the issues? What re the feeling generated in
us by this group experience? Why do we feel this way?”
e) What insights can we derive from this experience? What are the implications
of our insights to help us identify alternatives?”
The facilitator can utilize structured exercises to help members experience conflict
and analyze the here-and-now event it brings. Instead of just task serving roles can be

incorporated, any number of the following self-serving roles can be added to the structured
exercise (Wilson and Kneisi 1979, p444)
Aggressor: Deflates status of others by expressing disapproval of their values, acts,

or feelings by attacking the group or the problem it is working on, or by joking aggressively.
Blocker: Tends to be negative and stubbornly resistant. Attempts to maintain or
bring back issues after the group has rejected or by passed them.
Recognition seeker: Calls attention to self through boasting, reporting on personal
achievements, acting unusual ways, or struggling to prevent being placed in an inferior
position.
Self-confessor: Uses group as an audience for expression of personal, non group-
oriented feelings, insights, or ideology.
Playboy: Displays look of involvement in group horseplay and other more or less
studied forms of irrelevant behavior,
Nominator: Tries to assert authority or superiority by engaging in flattery, claiming
superiority status or right to attention, giving directions, authoritatively, and interrupting
contributions of others.
Help seeker: Attempts to evoke sympathy response from other group members or
from the whole group, through expressions of insecurity, personal confusion, or self-
depreciation beyond reason.
Special interest pleader: Speaks for some underdog- the small business person or
the community's grass roots, usually cloaking own prejudice or biases in stereotypes that
best fit their own individual needs.
Figure 11: Conflict Resolution Model
Awareness of the Effects of Behavior

As the facilitator or coordinator of group discussion, the nurse exerts an influence
on group members' behavior and experience. Members look up to the facilitator or leader
for approval of certain behavior, response, or actions. The facilitator becomes the model of
the group as regards behavior that is expected or acceptable. This exemplified by such
experiences as being on time for meetings, keeping appointments, and promises. Therefore,
the facilitator must become aware of her own behavior and its effects on the group.
Otherwise, her behavior may potentiate or mitigate such experiences and expressions of
aggression, passivity, rebellion, etc. When these are allowed to happen and are not handled

effectively, the group may not be allowed to grow from the earlier stages or eventually
undergo dissolution.
Application of New Learning

Group experiences provide varied learning opportunities for members. More often,
the basic concepts and principles for effective group life are re-lived in various group
experiences. Members gain more depth in understanding the group process as they realized
that the concepts and principles previously learned in handling a particular issue can be
applied in another situation dealing with a different issue. This particular intervention is
also helpful when the facilitator helps the group undergo successfully the stage of
termination.
Collaborative and Partnership

Health and health related problems in the community are varied. The problems are
often complicated and too many for the nurse and the people or their organization to
handle. They cannot solve the problem alone. They must work with other people or groups
to increase the probability of accomplishing the goals that they have set. As they go, there is
strength in numbers. The nurse must plan to establish and maintain valuable working
relationships with people such as people's organizations, educational institutions, the local
government units, financial institutions, religious groups, socio-civic organizations, sectorial
group, and the like. The aim of partnership and collaboration is to get people to work
together to address problems or concerns that affect them. It gives people the opportunity
to learn skills in group relationships, interpersonal relations, critical analysis, and most
importantly, decision-making process in the context of democratic leadership. Working
together enables organizations to accomplish their goals much quicker because resources,
skills, and views are pooled together. Organizations can commit and work together in
different ways (ICHSP, 2000). Networking is a relationship among organizations that
consists of exchanging information about each other goals and objectives, services, or
facilities. Coordination is a relationship where organizations modify their activities in order
to provide better service to the target beneficiary. Cooperation is a relationship where
organizations share information and resources and make adjustments in one's own agenda
to accommodate the other organization's agenda. Collaboration is the level of organizational
relationship where organizations help each other enhance their capacities in performing
their tasks as well as in the provision of services. Coalition or Multi-sector Collaboration is
the level of relationship where organizations and citizens from a partnership.
The following are the nurse's general ideas on how to get started in partnership and
collaboration to work: The nurse must involve all the stakeholders in the process of forging
partnership and cooperation with the community. In working together, the nurse and the
community face risks together. It is important, therefore, that they need to know and trust
each other. Determine how each organization views the problem, how it is proposed to
solve the problem and how it perceives an organizational relationship can solve the
problem. Organizations should agree on the kind or level of relationship and formulate
ground rules that will become the basis for decision-making. The following are the most
important points: Listen to what each has to say. Points of agreement can only be reached if
there is an exchange of information. Take time to listen to people who voice different
opinions or concerns. Keep an open mind. Try to identify points of unity from diverse
opinions. Don't force organizations to give up their identities. Remember, organizations
work together for the common good. They do not work together just so they can outdo each
other.

References
https://toggl.com/stages-of-team-development/
Assessing Learning___________________________________
a. Reflection
Activity 13
Name: Score:
Directions: In your experience working in a group or class write the

characteristics or behavioral patterns demonstrated by members or classmates
as they go through the group experience. What are the blocks or barriers to group
or class growth for productive discussion? How can you help for the group
growth? (100 words)
b. Post Test
Activity 14
Name: Date:
1. In this stage members are confident, motivated and familiar enough with the
project and their team that they can operate without supervision. Everyone is on
the same page and driving full-speed ahead towards the final goal.
a. Forming stage c. Norming Stage
b. Storming Stage d. None of the above
2. This phase is sometimes known as mourning because members have grown
close and feel a loss now that the experience is over.
a. Forming stage c. Norming Stage
b. Storming Stage d. None of the above

3. All of the following statements about conflict are correct except:

a. Conflict is desirable and extremely valuable for several reasons
according to Johnson and Johnson
b. It encourages inquiry, promotes objectivity and sharpens analysis
c. Conflict stimulates interest and curiosity, and increases the motivation
and energy of group members
d. Conflicts do not bring information to members about where they are.
4. Role reversal is another way to help group members understand each other’s
position and frame reference. This statement is:
a. True
b. False
c. Neither
d. I don’t know the answer
5. Deflates others' status by expressing disapproval of their values, acts, or
feelings by attacking the group or the problem it is working on, or by joking
aggressively.
a. Aggressor c. Recognition Seeker
b. Blocker d. Self-Confessor
6. Tends to be negative and stubbornly resistant. Attempts to maintain or bring
back issues after the group has rejected or by passed them.
7. Calls attention to self through boasting, reporting on personal achievements,
acting unusual ways, or struggling to prevent being placed in an inferior position.
8. Uses group as audience for expression of personal, non-group-oriented
feelings, insights, or ideology.
9. Tries to assert authority or superiority by engaging in flattery, claiming
superiority status or right to attention, giving directions, authoritatively, and
interrupting others' contributions
a. Playboy
b. Nominator
c. Help seeker

UNIT VI: INFORMATION TECHNOLOGY AND COMMUNITY HEALTH

Overview
Innovations in health care are continuously introduced. Health care providers apply
best practices from the latest research and use appropriate tools to enhance healthcare
delivery quality. Patients appear to be become more engaged in their care through
information available on the internet, radio, and television. Communication problems
between patients and healthcare providers, brought about the geographical disparity, are
easily solved by mobile phones. Computers are used to store, retrieve, and process
important health data for better decision making. Information technology is becoming
indispensable tools in addressing some challenges in healthcare.
1. know the definition of e-health;

2. know the power of data in information;
3. know the current e-health situation in the Philippines;
4. know how to use e-health in the community;
5. enumerate and explain the roles of community health nurse in e-health; and
6. identify the importance of information technology in community health nursing.
Name: Score:
Directions: Write at least five sentences that describe the picture below.

Pretest
Name: Date:
1. It is the use of information and communication technologies for health.

a. e-Health
b. Assessments
c. Nursing Diagnosis
d. Intervention
2. All of the following statements about e-Health are correct except:

a. It supports the delivery of health services and health systems
management to become more efficient and effective
b. It is the use of information and communication technologies for health
c. The application of information and communication technologies in
health

a. Data are readily mapped, enabling more targeted interventions and
feedback.
b. Data can be easily retrieved and recovered
c. Redundancy of data is minimized.
d. Resources are not used efficiently.
4. Data must have the following characteristics except:

a. Accuracy
b. Accessibility
c. Comprehensiveness
5. Factors affecting e-Health in the country includes all of the following except:
a. Limited health budget
b. The emergence of free and open source software
c. Decentralized government

Lesson Proper______________________________________
E-Health
The World Health Organization defines eHealth as the use of information and
communication technologies for health. It supports the delivery of health services and
management of health systems to become more efficient and effective. eHealth is described
also as a means to ensure that "the right health information is provided to the right person
at the right place and time in a secure, electronic form to optimize the quality and efficiency
of health care delivery, research, education and knowledge. The application of information
and communication technologies in health has rapidly increased for the past years and
gained significance not only in the Department of Health but in the entire health sector. The
DOH has continuously addressed the challenges and demands to improve health care
service deliveries and outcomes further. Many countries have recognized the importance of
adopting information and communication technology in health, also called eHealth, to
optimize processes and improve data collection, processing, and analysis. The adoption of
ICT has provided a concrete foundation for health investments and innovations. Countries
have formulated their own eHealth agenda to establish direction and plan the necessary
steps to achieve their intended vision, mission, and goals.
Storage, Retrieval and Transmittal

An important consideration in the process of developing electronic health records is
to plan for the long-term preservation and storage of these records. The field will need to
come to a consensus on the length of time to store EHRs, methods to ensure the future
accessibility and compatibility of archived data with yet-to-be developed retrieval systems,
and how to ensure the physical and virtual security of the archives. Additionally,
considerations about long-term storage of electronic health records are complicated by the
possibility that the records might one day be used longitudinally and integrated across sites
of care. Records have the potential to be created, used, edited, and viewed by multiple
independent entities. These entities include, but are not limited to, primary care physicians,
hospitals, insurance companies, and patients.
According to WHO, e-health encompasses three main areas: (1) The delivery of
health information, for health professionals and health consumers, through the internet and
telecommunications. (2)Using the power of information technology and e-commerce to
improve public health services. (3)The use of e-commerce and e-business practices in
health systems management.
Nurses are knowledge managers. They constantly process raw patient data into
valuable information to deliver evidence-based and individualized interventions. The
healthcare system builds heavily on accurate recording of obtained data. Paper-based
methods may bring inconvenience, especially when it comes to interoperability of health
services, information back up, and instant data access. A number of bigger problems may
also emerge. Continuity and interoperability of care stops in the unlikely event that a record
gets misplaced. Illegible handwriting poses misinterpretation. Patient privacy is
compromised. Data are difficult to aggregate. Actual time for patient care gets limited
In contrast, having a well-managed patient information system can have the

following benefits: Data are readily mapped, enabling more targeted interventions and
feedback. Data can be easily retrieved and recovered. Redundancy of data is minimized.
Data for clinical research becomes more available. Resources are used efficiently.

The nursing process begins with obtaining data through assessing the patient's
signs and symptoms. In order for the information to be valuable, data must have the
following characteristics (Abdelhak et al.,2012). Accuracy-this ensures that documentation
reflects the event as it happens. Accessibility- This data characteristic that ascertains data
availability should be the patient or any member of the healthcare staff's needs.
Comprehensiveness-data inputted should be complete. Consistency/ Reliability-having, no
discrepancies in data recorded, makes it consistent. Currency-all data must be up-to-date
and timely. Definition-data should be properly labeled and clearly defined.
e-Health Situation in the Philippines
The DOH has learned from the results of experimentation and early adoption phase
since 1988, the start of developing software for Field Health Services and Information
System, and has continuously developed or built other applications or information systems.
The use of ICTs in the DOH has remarkably supported and improved some of the
Department's functions. ICTs have been used in the areas of innovative technological
changes, networking, and infrastructure, office automation, development, and
implementation of computer-based systems. From the limited resources in terms of ICT
personnel and funds, the DOH Management has augmented the budget on ICT to accomplish
and support the ICT strategic goals and direction fully. Existing information systems and
data sources are being integrated or harmonized to eventually address other challenges like
establishing the DOH data warehouse, quality database, and establishing a more responsive
information system and access to and sharing knowledge products. For remote and
underserved areas and vulnerable populations, the DOH has implemented telemedicine in
selected pilot areas through the National Telehealth Center, National Institute for Health,
University of the Philippines, Manila. The DOH has also developed and implemented mobile
technology solutions in reporting cases through the Health Emergency Management Staff's -
Surveillance in Post Extreme Emergencies and Disasters (SPEED) with WHO support. There
are several mobile technology applications developed and for implementation, e.g. Text TB
for reporting inventory of tuberculosis drugs, maternal and neonatal death reporting, and
routine health data reporting.
By 2020 eHealth will enable widespread access to health care services, health
information, and securely share and exchange patients’ information in support to a safer,
quality health care, more equitable and responsive health system for all the Filipino people
by transforming the way information is used to plan, manage, deliver and monitor health
services.

Figure 12: Strategic Vision of Philippine Health System

Source:WHO
Factors affecting e-Health in the country includes: Limited health budget. The
emergence of free and open source software. Decentralized government. Target users are
unfamiliar with the technology. Surplus of “digital native” registered nurse
Using e-Health in the community

Twenty-first-century methods of communication are changing. Technology and the
way it is used have the potential to revolutionize health care. In the same way information
technology (IT) has had a massive impact on commerce and industry; it also has a
substantial impact on the practice of community nurses and how care is delivered. In order
for the impact of IT to be a positive one, community nurses and other health professionals
will have to learn and develop a range of new skills. Nurses can and should be directing and
becoming involved in the ways in which the IT revolution unfolds. Nurses working with
systems development teams also need to make known their needs making clear what
information the various IT systems have to contain and how these will fit in with their
nursing practice.
Universal healthcare and ICT

In the Philippines, making health care accessible to all remains a great challenge.
Lack of financial health care coverage leads to high out-of-pocket expenses. A series of
health reforms have been implemented. The DOH through Administrative Order No. 2010-
0036. Outlined the policy directions of Universal Health Care. Also known as Kalusugan
Pangkalahatan, this reform has three priority health directions: (1) Financial risk
protection through expansion in the National Health Insurance Program enrolment and
benefit delivery. (2) Improved access to quality hospitals and healthcare facilities. (3)
Attainment of health related Millenium Development Goas(MDG's)
Electronic Medical Records

EMR's are basically comprehensive patient records that are stored and accessed
from a computer or server. Community health centers have the capacity to rapidly adapt
MR's because they utilize a standard process nationwide. One of the most widely used
community based EMR in the country is CHITS, which begun in 2004 and was funded by the
International Development Research Centre (IDRC). It was created by Dr. Herman Tolentino

of the University of the Philippines-Medical Informatics Unit (UP-MIU) and is currently

being implemented at health centers in Pasay, Navotas, Quezon City and several other
municipalities.
eLearning
Health education, which is essential in health promotion and maintenance, can be facilitated
by ICT. eLearning is basically the use of electronic tools to aid in teaching. It can be done
synchronously, asynchronously, or in a combination of both. This can be in the form of
simple instructional videos and information text blast to social network help groups and
interactive simulations.
Examples of eHealth projects in the community
Name Type Key information

BuddyWors Telemedicine and -Implemented in 2004 by the University of
elearning the Philippines Manila-National Telehealth
Center (UPM-NTHC) through the
eGovernment Fund of the Commission on
Information and Communication
Technology (CICT)
-Allowed RHU physicians in GIDAs to send
telereferrals to a medical specialist at the
Philippine General Hospital (PGH) via short
message service(SMS) and e-mail
CJITS (Community Electrical medical -Developed in 2004 by Dr. Herman
Health record Tolentino of the UPM College of Medicine-
Information Medical Informatics Unit (MIU). The project
Tracking System) initially began in Pasay health centers and
has been implemented in more than 48
health centers since then
-Program is divided into different modules
based on existing DOH programs (EPI,
NTP,etc.) and is Free and Open Source
Software (FOSS)
A demo of CHITS can be accessed online at
https//demo2010.chit.ph (username: user,
password user0(UPM, NTHC 2010)
Health Information -An online version of FHIS developed by the
eFHSIS ( system and electronic DOH where you can upload FHSIS data
Electronic Field reporting
Health Service
Information
System
eIMCI (Electronic eLearning -Developed in 2009 by the Ateneo
Integrated Innovation Center
Management of -An electronic version of IMCI accessible to
Childhood Illness) mobile devices
NTHC eLearning eLearning -Funded by the United States Agency for

videos International Development (USAID) and

developed by UOM-NTHC
-Created eLearning videos on tuberculosis,
stroke, bird flu, and child poisoning.
RxBox Telemedicine -Funded by the DOST-PCHRD and
developed through the collaborative efforts
of the University of the Philippines Manila-
Electrical and Electronics Engineering
Institute (UPM-EEEI), University of the
Philippines Manila-National Institute of
Physics (UPM-NIP) and UPM-NTHC
-It is a mobile computer connected with
medical devices such as ECG, pulse
oximeter, and electronic blood pressure
and heart rate monitors that are intended
for mobile deployment to rural centers
SEGRIS(Segworks Electronic medical -An electronic medical record created for
Rural Health record rural health units.
Information -Developed by Segworks, a local software
System) company based in Davao.
SHINE (Secure Electronic medical -An electronic medical record developed by
Health record and SMS Smart Communications
Information reporting
Network
Exchange)
SPASMs SMS alert system -Add on to WAH (Wireless Access for
(Synchronized Health), SPASMS is an SMS reminder
Patient Alert via system for patients who are due for follow
SMS) up
SPEED Disaster management -A project of the World Health Organization
(Surveillance in and SMS reporting and the Department of Health- Health
Post Extreme Emergency Management Staff (DOH-HEMS)
Emergencies and -Allows community health nurses to submit
Disasters) daily reports of prevalent diseases
immediately after disasters via SMS, e-mail,
and other information and communication
technologies.
-SPEED also sends immediate notification
alerts (INAs) to community health nurses
for possible outbreaks based on available
data.
WAH Health information -Implemented in 2010 in the Tarlac
system and electronic province through the Public-Private
medical record Partnership (PPP) of Qualcomm, UP-NTHC,
USAID, Smart, DOH-IMS, Center for the
Health Development (CHD) Region III, RTI
International, National Epidemiological
Center(NEC), Tarlac State University and
the local government.

-WAH augmented the existing CHITS by

connecting health centers through
broadband Internet access.
Table 4: eHealth projects in the Philippines
source: Nursing Care of the Community 2013
Roles of Community Health Nurse in e-Health

The following are the major roles of an eHealth nurse in the Philippine community
setting: Data and records manager, change agent, educator, telepresenter, client advocate,
and researcher.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761894/
http://ehealth.doh.gov.ph/#openModal11
a. Reflection
Activity 16
Name: Score:
Directions: Write your answers in the space provided. You may use an extra sheet
of paper if necessary.
If you were to initiate ICT projects that can improve community health, what
features would be installed? What community health problems would it address?
How can you ensure that the target end users would use this technology? (100
words)

b. Post Test
Activity 17
Name: Date:
1. Kalusugan Pangkalahatan reform has the following priority health directions

except:
a. Financial risk protection through expansion in the National Health
Insurance Program enrolment and benefit delivery.
b. Improved access to quality hospitals and healthcare facilities.
c. Attainment of health related Millenium Development Goas(MDG’s)
2. Factors affecting e-Health in the country includes all of the following except:
3. All of the following statements about telemedicines are correct except:

a. Its purpose is to provide clinical support.
b. It involves the use of various types of ICT
c. Its goal is to improve health outcomes.
d. It is intended not to overcome geographical barriers.
4. This is the nurse's role in eHealth wherein he/she monitors the trends of
disease through EMR, maintaining the quality of data inputted.
a. Data and records manager
b. Change agent
c. Educator
d. Client’s advocate
5. Data must have the following characteristics except:

a. Accuracy
b. Accessibility
c. Comprehensiveness

6. This is the nurse's role in eHealth, wherein he/she provides health education
to individuals and families through ICT tools.
a. Data and records manager
b. Change agent
c. Educator
d. Client’s advocate
7. This is the nurse's role in eHealth wherein he/she present the patient's case to
a remote medical specialist, noting salient points for case assessment, evaluation,
and treatment.
a. Client’s advocate
b. Educator
c. Telepresenter
d. Researcher
8. This is the nurse's role in eHealth wherein he/she safeguard the patient's
records, ensuring the security, and confidentiality and privacy of all patient
information are being upheld.
b. Educator
c. Telepresenter
d. Researcher
9. This is the nurse's role in eHealth wherein he/she is responsible for identifying
possible points for research and developing a framework based on the data
aggregated by the system.
b. Educator
c. Telepresenter
d. Researcher
a. Data are readily mapped, enabling more targeted interventions and
feedback.
b. Data can be easily retrieved and recovered
c. Redundancy of data is minimized.
d. Resources are not used efficiently.

UNIT VII: CURRENT TRENDS IN PUBLIC HEALTH: GLOBAL AND

NATIONAL
Overview
The Philippines is a part of the Association of Southeast Asian Nations (ASEAN)
community and one of the fastest-growing healthcare markets. Concerning healthcare, the
Philippine Government has been looking at ways to achieve 100% enrollment to PhilHealth
by 2020. One of the means is by mandating all Filipinos to enroll in PhilHealth. Currently,
PhilHealth's coverage is at about 92%.
1. enumerate and explain a community health nurse's role in the national and global
health care delivery system.
Name: Score:
Directions: Write at least five sentences that relate to the picture below.

Pretest
Name: Date:
1. Nine out of ten people breathe polluted air every day. This statement is:
a. Correct
b. Incorrect
c. Neither
d. Don’t know the answer
2. The primary cause of air pollution (burning fossil fuels) is also a major
contributor to climate change. This statement is:
a. Correct
b. Incorrect
c. Neither
3. In October 2018, WHO held its first ever Global Conference on Air Pollution
and Health in Geneva. This statement is:
a. Correct
b. Incorrect
c. Neither
4. WHO will work with governments to help them meet the global target of
reducing physical inactivity by 15% by 2030 – through such actions as
implementing the ACTIVE policy toolkit to help get more people being active
every day. This statement is:
a. Correct
b. Incorrect
c. Neither
5. Every year, WHO recommends which strains, should be included in the flu
vaccine to protect people from seasonal flu. This statement is:
a. Correct
b. Incorrect
c. Neither


Lesson Proper_______________________________________
Trends in National Public Health

An aging population, urbanization, and the rising middle class have led to an
increasing demand for healthcare services, as more people can afford quality healthcare.
Due to the huge gap in the Philippines' healthcare delivery system, abundant opportunities
are available for key private participants to invest in the healthcare sector. Private hospitals,
pharmaceutical producers, and healthcare IT companies are expanding into the Philippines
market, partially owing to the recently launched AEC. Lack of infrastructure and human
resources is putting a strain on the healthcare delivery system in the Philippines. The bed-
to-population ratio is quite low and there is still a huge gap in the number of doctors and
nurses required to cater to the growing population's needs.
The Philippines' healthcare delivery system is dominated by the public sector
(regional, provincial, municipal, and barangay level) while being supported by private
healthcare service providers. The implementation of Universal Health Care (UHC) is already
driving the demand across all healthcare sectors. However, the Philippines still requires a
strong focus on infrastructure and skilled manpower. The shortage of qualified personnel is
a huge problem, especially in high-skill fields such as radiology. The private sector is playing
a huge role in helping the government address the gaps in healthcare services. Generics is
evolving into a huge market due to the demand for low-cost medicine and strong
government support. Production of raw materials for medicines is now 100% open to
foreign ownership, creating an opportunity for the Philippines to emerge as a regional raw
materials manufacturing hub. Areas such as healthcare technology and diagnostics that can
improve access to health information for making better healthcare choices are growing
faster.
This year has been very eventful for public health in the Philippines. In February,
amid much fanfare and anticipation, the Universal Health Care Act (Republic Act No. 11223)
was passed — a culmination of a series of health-related legislative measures over the past
several years, from the sin tax law (RA 10351) to the new HIV/AIDS law (RA 11166), that
many hope would transform the health care system. We also saw health figures in the 2019
elections as part of several candidates' campaign platforms, with varying degrees of depth
and substance.
Yet if 2019 saw a lot of attention toward health, it also served to illustrate the
serious challenges that need to be hurdled if “health for all Filipinos” — and not just
universal insurance coverage—is to be achieved. As we face a new year, it is a timely
exercise to enumerate some of these challenges:
Vaccine-preventable diseases. Early this year, a measles outbreak claimed the lives
of over 560 Filipinos; several months later, polio's re-emergence—a disease that has been
documented in the country for decades—was announced. What the two diseases have in
common is that they are preventable through vaccines. The same can be said of chickenpox,
mumps, pertussis, for which doctors are also sounding the alarm.
To its credit, the Department of Health has strengthened its immunization efforts,
including awareness campaigns. In a reversal of what happened during the dengue vaccine
scandal, I have seen families lining up in rural health centers to get their children vaccinated
in the wake of the measles outbreak. Still, if 2020 is any different from 2019, families should
be motivated not by fear but by knowledge and trust. Crucially, supply-chain issues should
be addressed, and public officials should be held accountable both for vaccine-related
corruption and misinformation.
Dengue, and tuberculosis. This year, the dengue season was particularly devastating
with, as of last month, over 350,000 cases and 1,300 deaths, prompting the declaration of a

"national dengue epidemic." Receiving far less attention but no less significant,
tuberculosis—the "boring emergency"—continues to plague the country, with an estimated
591,000 cases and 26,000 deaths last year alone, earning for the country the unwelcome
distinction of ranking fourth globally in terms of TB incidence.
While much of the public’s attention concerned the dengue vaccine, the nature of the
disease means that it will require various actions from the personal to the national level
toward primary and secondary prevention—that is, mosquito control as well as access to
quality outpatient, emergency and inpatient care.
As for tuberculosis, Health Secretary Francisco Duque’s call for “not business as
usual” last year at the United Nations must be renewed, with particular attention given to
strengthening the role of primary care (including barangay health workers) in following up
patients, rethinking the “directly observed treatment, short-course” program, and
enhancing coordination between public and private health care providers.
HIV/AIDS. Despite increased public attention and the welcome visibility of people
living with HIV (PLHIV), the infection remains on the rise, even as efforts toward promoting
condom use and increasing testing remain inadequate. In absolute terms, HIV incidence
remains low, with the UNAIDS estimating a country total of 77,000 cases. However, the rate
of increase—174 percent over the past decade is among the world's highest. Moreover,
while the national incidence is relatively low, it is much higher in certain populations.
Unfortunately, buried in the stigma and lack of information is the fact that HIV is
both preventable and manageable. But we need to remove cultural, economic, bureaucratic,
and physical barriers to enable access to comprehensive education, confidential testing,
antiretrovirals, and pre-exposure prophylaxis—including for minors. RA 11166 addresses
these concerns, but the government should strive for their full implementation if we are to
arrest this trend.
Global Health
The world is facing multiple health challenges. These range from outbreaks of
vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-
resistant pathogens, growing rates of obesity and physical inactivity to the health impacts
of environmental pollution and climate change and multiple humanitarian crises.
To address these and other threats, 2019 sees the start of the World Health
Organization's new 5-year strategic plan – the 13th General Programme of Work. This plan
focuses on a triple billion target: ensuring 1 billion more people benefit from access to
universal health coverage, 1 billion more people are protected from health emergencies,
and 1 billion more people enjoy better health and well-being. Reaching this goal will require
addressing the threats to health from a variety of angles.
Here are 10 of the many issues that will demand attention from WHO and health
partners in 2019:
Air Pollution and Climate Change

Nine out of ten people breathe polluted air every day. In 2019, air pollution was
considered by the WHO as the greatest environmental risk to health. In the air, microscopic
pollutants can penetrate respiratory and circulatory systems, damaging the lungs, heart,
and brain, killing 7 million people prematurely every year from diseases such as cancer,
stroke, heart and lung disease. Around 90% of these deaths are in low- and middle-income
countries, with high volumes of emissions from industry, transport, agriculture, and dirty
cookstoves and fuels in homes.
Non Communicable Diseases

Noncommunicable diseases, such as diabetes, cancer, and heart disease, are

collectively responsible for over 70% of all deaths worldwide, or 41 million people. This
includes 15 million people dying prematurely, aged between 30 and 69.
Global Pandemic Influenza

The world will face another influenza pandemic – the only thing we don't know is
when it will hit and how severe it will be. Global defenses are only as effective as the
weakest link in any country’s health emergency preparedness and response system.
Fragile and Vulnerable Settings

More than 1.6 billion people (22% of the global population) live in places where
protracted crises (through a combination of challenges such as drought, famine, conflict,
and population displacement) and weak health services leave them without access to basic
care. Fragile settings exist in almost all regions of the world. Half of the key targets in the
sustainable development goals, including on child and maternal health, remain unmet.WHO
will continue to work in these countries to strengthen health systems so that they are better
prepared to detect and respond to outbreaks, as well as able to deliver high-quality health
services, including immunization.
Anti Microbial Resistance

The development of antibiotics, antivirals, and antimalarials are some of modern
medicine's greatest successes. Now, time with these drugs is running out. Antimicrobial
resistance – the ability of bacteria, parasites, viruses, and fungi to resist these medicines –
threatens to send us back to a time when we were unable to easily treat infections such as
pneumonia, tuberculosis, gonorrhea, and salmonellosis. The inability to prevent infections
could seriously compromise surgery and procedures such as chemotherapy.
Ebola and Other High Threat Pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks,
both of which spread to cities of more than 1 million people. One of the affected provinces is
also in an active conflict zone. This shows that the context in which an epidemic of a high-
threat pathogen like Ebola erupts is critical – what happened in rural outbreaks in the past
doesn’t always apply to densely populated urban areas or conflict-affected areas.
Weak Primary Health Care

Primary health care is usually the first point of contact people have with their health
care system, and ideally, should provide comprehensive, affordable, community-based care
throughout life. Primary health care can meet the majority of a person’s health needs of the
course of their life. Health systems with strong primary health care are needed to achieve
universal health coverage.
Vaccine Hesitancy
Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of
vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases.
Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents
2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of
vaccinations improved. Measles, for example, has seen a 30% increase in cases globally.
The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy.
However, some countries that were close to eliminating the disease have seen a resurgence.

Dengue
Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal
and kill up to 20% of those with severe dengue, has been a growing threat for decades. A
high number of cases occur in the rainy seasons of countries such as Bangladesh and India.
Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the
highest number of deaths in almost two decades), and the disease is spreading to less
tropical and more temperate countries such as Nepal, that have not traditionally seen the
disease. An estimated 40% of the world is at risk of dengue fever, and there are around 390
million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by
2020.
HIV
The progress made against HIV has been enormous in terms of getting people
tested, providing them with antiretrovirals (22 million are on treatment), and providing
access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when
people at risk of HIV take antiretrovirals to prevent infection). However, the epidemic
continues to rage with nearly a million people every year dying of HIV/AIDS. Since the
beginning of the epidemic, more than 70 million people have acquired the infection, and
about 35 million people have died. Today, around 37 million worldwide live with HIV.
Reaching people like sex workers, people in prison, men who have sex with men, or
transgender people is hugely challenging. Often these groups are excluded from health
services. A group increasingly affected by HIV are young girls and women (aged 15–24),
who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa
despite being only 10% of the population.
References
https://www.businesswire.com/news/home/20170511005884/en/Philippines-
Transformational-Healthcare-Insights-2016-Current-Trends
https://opinion.inquirer.net/125981/public-health-challenges-for-2020-part-
i#ixzz6T7aISJDk
https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019

a. Reflection
Activity 19
Name: Score:
Directions: Write tour answers in the space provided. You may use an extra sheet
As a community health nurse student, how can you help your community in the
present health situation? (100 words)
b. Post Test
Activity 20
Name: Date:
Directions: Write True if the statement is correct and False if the statement is incorrect,
then encircle the word/ words that make the statement incorrect.
_____________1. Despite increased public attention and the welcome visibility of people
living with HIV (PLHIV), the infection remains on the rise, even as efforts toward
promoting condom use and increasing testing remain inadequate.
_____________2. The healthcare delivery system in the Philippines is dominated by the
public sector (regional, provincial, municipal, and barangay level) while being supported
by private healthcare service providers.
____________3. The private sector is playing a huge role in helping the government address
the gaps in healthcare services.
___________4. Republic Act No. 11223 is also known as the Universal Health Care Act
__________5. In 2019 a measles outbreak claimed the lives of over 560 Filipinos; several
months later, the re-emergence of polio—a disease that has been documented in the
country for decades—was announced.
__________6. Nine out of ten people breathe polluted air every day.
__________7. The primary cause of air pollution (burning fossil fuels) is also a major
contributor to climate change
_________8. Noncommunicable diseases, such as diabetes, cancer, and heart disease, are
collectively responsible for over 70% of all deaths worldwide, or 41 million people.
__________9. Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease
that causes around 10 million people to fall ill, and 1.6 million to die every year.
_________10. Primary health care is usually the first point of contact people have with
their health care system, and ideally should provide comprehensive, affordable,
community-based care throughout life.

UNIT VIII: DELIVERY OF HEALTH CARE TO THE FILIPINO FAMILY

AND COMMUNITY
Overview
Filipino older adults tend to cope with illness with the help of family and friends and
by faith in God. Complete cure or even the slightest improvement in a malady or illness is
viewed as a miracle. Filipino families greatly influence patients' decisions about health care.
Patients subjugate personal needs and tend to go along with the demands of a more
authoritative family figure in order to maintain group harmony. Before seeking professional
help, Filipino older adults tend to manage their illnesses by self-monitoring of symptoms,
ascertaining possible causes, determining the severity and threat to functional capacity, and
considering the financial and emotional burden to the family.
Upon completion of this chapter, I am able to:
1. know and explain the Filipino culture, customs, traditions, values, traits, and beliefs
that will affect the delivery of health care to the community
Name: Score:

Pretest
Name: Date:
1. The ability to tolerate uncertain situations

a. Tiyaga
b. Lakas ng loob
c. Tatawanan ang problema
d. Bahala na
2. Filipino coping style being respectful and honest with oneself.

a. Tiyaga
b. Lakas ng loob
d. Bahala na
3. The capacity to laugh at oneself in times of adversity

a. Tiyaga
b. Lakas ng loob
d. Bahala na
4. The view that illness and suffering are the unavoidable and predestined will of
God, in which the patient, family members, and even the physician should not
interfere
a. Tiyaga
b. Lakas ng loob
d. Bahala na
5. Conceding to the wishes of the collective to maintain group harmony

a. Tiyaga
b. Lakas ng loob
d. Pakikisama

b. The emergence
©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND ofTECHNOLOGY
free and open source software 82
Lesson Proper______________________________________
Coping Styles
Coping styles common among elderly Filipino in times of illness or crisis include:
Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations; Flexibility
(Lakas ng Loob): being respectful and honest with oneself; Humor (Tatawanan ang
problema): the capacity to laugh at oneself in times of adversity; Fatalistic Resignation
(Bahala Na): the view that illness and suffering are the unavoidable and predestined will of
God, in which the patient, family members and even the physician should not interfere;
Conceding to the wishes of the collective (Pakikisama) to maintain group harmony.
Indigenous traits common among elderly Filipino when faced with illness related to
mental conditions such as devastating shame (Hiya) and sensitivity to criticism (Amor
Propio)
Common Perceptions of Filipinos about Mental Illness includes: Unwillingness to

accept having a mental illness, which leads to the avoidance of needed mental health
services due to fear of being ridiculed; Involvement of other coping resources such as
reliance on family and friends or indigenous healers, and dependence on religion which can
diminish the need for mental health services; Prioritizing of financial and environmental
needs which preclude the need for mental health services; Limited awareness of mental
health services resulting in limiting access; Difficulty in utilizing mental health services
during usual hours because of the unavailability of working adult family members; Mental
illness connotes a weak spirit, and may be attributed to divine retribution as a consequence
of personal and ancestral transgression; Lack of culturally oriented mental health services.
Though such coping mechanisms, perceptions and traits may help elderly Filipino
adjust initially to their illnesses, these tactics also pose barriers and impede implementation
of necessary treatment intervention in a timely fashion.
Health Beliefs and Behaviors: Indigenous Health Beliefs
Concept of Balance (Timbang)

This concept is central to Filipino self-care practices and is applied to all social
relationships and encounters. According to this principle, health is thought to be a result of
balance, while illness due to humoral pathology and stress is usually the result of some
imbalance. Rapid shifts from “hot” to “cold” cause illness and disorder. Illustrated are a
range of humoral balances that influence Filipino health perceptions: Rapid shifts from
“hot” to “cold” lead to illness; “Warm” environment is essential for maintaining optimal
health; Cold drinks or cooling foods should be avoided in the morning; An overheated body
is vulnerable to disease; a heated body can get “shocked”; When cooled quickly, it can cause
illness; A layer of fat maintains warmth, protecting the body’s vital energy; Imbalance from
worry and overwork create stress and illness; Emotional restraint is a key element in
restoring balance; A sense of balance imparts increased body awareness (Adapted from
Becker, 2003).

Health Beliefs and Behaviors: Theories of Illness

Physical and mental health and illness are viewed holistically as an equilibrium
model. In contrast, other explanatory models may include mystical, personalistic and
naturalistic causes of illness or disease (Anderson, 1983; Tan, 1987; Tompar-Tiu &
Sustento-Seneriches, 1995).
Mystical Causes. Mystical causes are often attributed to experiences or behaviors
such as ancestral retribution for unfinished tasks or obligations. Some believe that the soul
goes out from the body and wanders, a phenomenon known as Bangungot, or that having
nightmares after a heavy meal may result in death.
Personalistic Causes. Personalistic causes are associated with social punishment or
retribution from supernatural forces such as evil spirit, witch (Manga ga mud) or sorcerer
(mangkukulam). The forces cast these spells on people if they are jealous or feel disliked.
Witch doctors (Herbularyo) or priests are asked to counteract and cast out these evil forces
through the use of prayers, incantations, medicinal herbs, and plants. For protection, the
healer may recommend using holy oils, or wearing religious objects, amulets, or talismans
(anting-anting).
Naturalistic Causes. Naturalistic causes include a host of factors ranging from
natural forces (thunder, lightning, drafts, etc.) to excessive stress, food, and drug
incompatibility, infection, or familial susceptibility.
References
https://nursing-theory.org/theories-and-models/pender-health-promotion-model.php
en.wikepedia.org https://en.wikipedia.org/wiki/PRECEDE%E2%80%93PROCEED_model
https://www.nasn.org/advocacy/professional-practice-documents/position-
statements/ps-role
a. Reflection
Activity 22
Name: Score:
Directions: Write tour answers in the space provided. You may use an extra sheet
What are the Filipino culture, traditions, customs and values, traits and beliefs
that your family members follow and how it affects the family's health (100
words)

b. Post Test
Activity 23
Name: Date:
1. The following are the Filipinos health beliefs and behaviors and theories of
illness except:
a. Mystical cause
b. Personalistic cause
c. Naturalistic cause
2. These are often attributed to experiences or behaviors such as ancestral

retribution for unfinished tasks or obligations.
a. Mystical cause
3. These are associated with social punishment or retribution from supernatural

forces such as evil spirit, witch (Manga ga mud) or sorcerer (mangkukulam).
a. Mystical cause
4. It includes a host of factors ranging from natural forces (thunder, lightning,

drafts, etc.) to excessive stress, food, and drug incompatibility, infection, or
familial susceptibility.
a. Mystical cause
5. Filipino coping style being respectful and honest with oneself.

a. Tiyaga
b. Lakas ng loob
d. Bahala na

6. The view that illness and suffering are the unavoidable and predestined will of
God, in which the patient, family members and even the physician should not
interfere
a. Tiyaga
b. Lakas ng loob
d. Bahala na
7. One of the Filipino perceptions on mental illness is the unwillingness to accept

having a mental illness, which leads to the avoidance of needed mental health
services due to fear of being ridiculed. The statement is:
a. Correct
b. Incorrect
c. Neither
8. One of the Filipino perceptions on Mental illness is that it connotes a weak

spirit, and may be attributed to divine retribution as a consequence of personal
and ancestral transgression
a. Correct
b. Incorrect
c. Neither
9. Indigenous traits common among elderly Filipino when faced with illness
related to mental conditions such as devastating shame (Hiya) and sensitivity to
criticism (Amor Propio)
a. Correct
b. Incorrect
c. Neither
10. This concept is central to Filipino self-care practices and is applied to all
social relationships and encounters. According to this principle, health is thought
to be a result of balance, while illness due to humoral pathology and stress is
usually the result of some imbalance.
a. Mystical cause
d. Concept of balance (timbang)

UNIT IX: POSITIVE QUALITIES AND VALUES OF A COMMUNITY

HEALTH NURSE
Overview
Community health Nursing is the synthesis of nursing and public health practice
applied to promote and protect the health of the population. It combines all the basic
elements of professional, clinical nursing with public health and community practice. As
nurses of the 21st century, we have duties and responsibilities to keep a dynamic balance
with the ever-changing needs of the health of our society. This unit will explain the positive
qualities and values of a Community Health Nurse.
1. identify and explain the personal attributes of a community health nurse; and
2. explain the professional competencies of a community health nurse.
Name: Score:

Pretest
Name: Date:
1. The following are the personal attributes of a community health nurse except:
a. Good communication skills
b. Emotional Stability
c. Emphatic
d. Sympathic
2. These attributes include speaking and listening. Based on team and patient
feedback, they can problem-solve and effectively communicate with patients and
families.
c. Emphatic
d. Sympathic
3. This attribute is the ability to accept suffering and death without letting it get
personal.
c. Emphatic
d. Sympathic
4. In this attribute, nurses can feel compassion and provide comfort. But be
prepared for the occasional bout of compassion fatigue; it happens to the
greatest of nurses.
c. Emphatic
d. Sympathic
5. Nurses are often required to work long periods of overtime, late or overnight
shifts, and weekends.
c. Emphatic
d. Flexibility


Lesson Proper_______________________________________
Personal Attributes
A community health nurse should have good communication skills. Solid
communication skills are a basic foundation for any career. But for nurses, it's one of the
most important aspects of the job. A great nurse has excellent communication skills,
especially when it comes to speaking and listening. Based on team and patient feedback,
they can problem-solve and effectively communicate with patients and families. Nurses
always need to be on top of their game and make sure that their patients are clearly
understood by everyone else. A truly stellar nurse can advocate for her patients and
anticipate their needs.
A community health nurse should have emotional stability. Nursing is a stressful job
where traumatic situations are common. The ability to accept suffering and death without
letting it get personal is crucial. Some days can seem like non-stop gloom and doom. That's
not to say that there aren't heartwarming moments in nursing. Helping a patient recover,
reuniting families, or bonding with fellow nurses are special benefits of the job. A great
nurse can manage the stress of sad situations but also draws strength from the wonderful
outcomes that can and do happen.
A community health nurse should have empathy. Great nurses have empathy for the
pain and suffering of patients. They can feel compassion and provide comfort. But be
prepared for the occasional bout of compassion fatigue; it happens to the greatest of nurses.
Learn how to recognize the symptoms and deal with them efficiently. Patients look to
nurses as their advocates — the softer side of hospital bureaucracy. Being sympathetic to
the patient's hospital experience can go a long way in terms of improving patient care.
Sometimes, an empathetic nurse is all patients have to look forward to.
A community health nurse should be flexible. Being flexible and rolling with the
punches is a staple of any career, but it’s especially important for nurses. A great nurse is
flexible with regards to working hours and responsibilities. Nurses, like doctors, are often
required to work long periods of overtime, late or overnight shifts, and weekends. Know
that it comes with the territory.
A community health nurse should pay attention to detail. Every step in the medical
field is one that can have far-reaching consequences. A great nurse pays excellent attention
to detail and is careful not to skip steps or make errors. From reading a patient’s chart
correctly to remembering the nuances of a delicate case, there’ s nothing that should be left
to chance in nursing. When a simple mistake can spell tragedy for another’s life, attention to
detail can literally be the difference between life and death.
A community health nurse should have interpersonal skills. Nurses are the link
between doctors and patients. A great nurse has excellent interpersonal skills and works
well in a variety of situations with different people. They work well with other nurses,
doctors, and other members of the staff. Nurses are the glue that holds the hospital together.
Patients see nurses as a friendly face and doctors depend on nurses to keep them on their
toes.
A community health nurse should have physical endurance. Frequent physical tasks,
standing for long periods of time, lifting heavy objects (or people), and performing a
number of taxing maneuvers on a daily basis are staples of nursing life. It’s definitely not a
desk job. Always on the go, a great nurse maintains her energy throughout her shift,
whether she’s in a surgery or checking in on a patient. Staying strong, eating right, and
having a healthy lifestyle outside of nursing is important too!
A community health nurse should have problem solving skills. A great nurse can
think quickly and address problems as — or before — they arise.

A community health nurse should have a quick response. Nurses need to be ready to
respond quickly to emergencies and other situations that arise. Quite often, health care
work is simply the response to sudden incidences, and nurses must always be prepared for
the unexpected. Staying on their feet, keeping their head cool in a crisis, and a calm attitude
are great qualities in a nurse.
A community health nurse should be respectful. Respect goes a long way. Great
nurses respect people and rules. They remain impartial at all times and are mindful of
confidentiality requirements and different cultures and traditions.
Professional Competencies
The professional nurse, including the community health nurse, must demonstrate
competence in 11 key areas of responsibility as determined by the Committee on Core
Competency Standards Development for the Board of Nursing of the Philippines and the
Commission on Higher Education Technical Committee on Nursing Education (2005). The
Nursing Core Competency Standards were revised in 2012, building on the same set of key
areas of responsibility. The following are the key areas of responsibility: (1) Safe and quality
nursing knowledge, a nurse must have knowledge of health and illness status of the client,
sound decision making, safety, comfort and privacy of the client, priority setting based on
client's needs, administration of medications and health therapeutics, and use of the nursing
process. (2) Management of resources and environment, organizational workload, use of
financial resources for client care, the mechanism to ensure the proper functioning of
equipment, and maintenance of a safe environment. (3) Health Education, assessment of
client's learning needs, development of health education plan and learning materials, and
implementation and evaluation of the health education plan. (4) Legal responsibility,
adherence to the nursing law, and other relevant laws. (5) Ethicomoral responsibility,
respect for the rights of the client, responsibility, and accountability for own decisions and
actions, and adherence to the international and national code of ethics for nurses. (6)
Personal and professional development, identification of own learning needs; pursuit of
continuing education, involvement in professional and civic activities. (7) Quality
improvement, data gathering for quality improvement, participation in nursing audits, and
rounds. (8) Research, research-based formulation of a solution to problems in client care
and dissemination and application of research findings. (9) Records management, accurate
updated documentation of client care while observing legal imperatives in record keeping.
(10) Communication, during interactions with clients and co-workers, uses therapeutic
communication techniques for the establishment of rapport, identifies verbal and nonverbal
cues, and responds to clients' needs. (11) Collaboration and teamwork, the establishment of
a collaborative relationship with colleagues and other members of the healthcare team.
References

a. Reflection
Activity 25
Name: Score:
Directions: Write tour answers in the space provided. You may use an extra sheet of
paper if necessary.
What are your personal attributes that will contribute to you working as a community
health nurse? Explain. (100 words)
b. Post Test
Activity 26
Name: Date:
Directions: Write True if the statement is correct and False if the statement is incorrect
and encircle the word/words that make the statement incorrect. The following are the
key areas of responsibility based on the Nursing Core Competency Standard.
___________1. Safe and quality nursing knowledge, a nurse must have knowledge of the
health and illness status of the client, sound decision making, safety.
___________2.Management of resources and environment, organizational workload, use of
financial resources for client care, a mechanism to ensure the proper functioning of
equipment, and maintenance of a safe environment.
___________3.Health Education, assessment of client’s learning needs, development of
health education plan and learning materials, and implementation and evaluation of the
health education plan.
____________4. Legal responsibility, adherence to the nursing law and other relevant laws.
____________5. Ethicomoral responsibility, respect for the rights of the client, responsibility
and accountability for own decisions and actions and adherence to the international and
national code of ethics for nurses
____________6. Personal and professional development, identification of own learning
needs; pursuit of continuing education, involvement in professional and civic activities.
___________7. Records management, accurate updated documentation of client care while
observing legal imperatives in record keeping
__________8. Uses therapeutic communication techniques for establishment of rapport,
identifies verbal and non-verbal cues and responds to clients’ needs.
___________9. Collaboration and teamwork, the establishment of a collaborative
relationship with colleagues and other members of the healthcare team.
__________10. Research-based formulation of solution to problems in client care and
dissemination and application of research findings.

UNIT X: HEALTH RELATED ENTREPRENEURIAL ACTIVITIES
Overview
Community-based entrepreneurship is considered to be an important instrument
for the realization of potential among marginal and deprived communities isolated from the
mainstream economy and is important in bringing social upliftment. Cultural values, shared
resources, linkages, and mutual trust work for the community, nurtured through close
personal relations for the functioning of economic activities. Entrepreneurial activities
creating local public goods for a community have a comparative advantage over the
absolute market-oriented activities
Learning Objectives_________________________________
1. identify and explain possible community- based projects; and

2. define wellness clinics.
Name: Score:

Pretest
Name: Date:
1. This covers a wide variety of different areas within a community or a group of

networking entities and refers to any project within the community.
a. Community-based project
b. Community entrepreneurship
c. Emph
d. Sympathic
2. Projects can cover almost anything, including the most obvious section of
concern to any community, the welfare element. This statement is:
a. Correct
b. Incorrect
c. Neither
3. Most economic community projects are designed at creating some sort of

economic autonomy. This statement is:
a. Correct
b. Incorrect
c. Neither
4. Community based projects begin when a small collection of motivated

individuals within a community come together with a shared concern. This
statement is:
a. Correct
b. Incorrect
c. Neither
5. Community based projects cover a wide variety of different areas within a

community or a group of networking entities and refer to any project within the
community
a. Correct
b. Incorrect
c. Neither


Lesson Proper_______________________________________
To alleviate poverty, development agencies and multinational organizations have
been greatly involved in interventions in the developing world for many decades. It has
been observed that the most widely adopted approaches have often been paternalistic, even
if unintentionally, while ignoring the strength of local institutions (Davis 1993). Most of the
poverty alleviation programs have degenerated into "charity" rather than building the local
and durable self-reliance (Burkey, 1993). It is evident that the real effect of developmental
interventions has been compromising with respect to community development and
eventually contributes to the creation of real poverty rather than alleviation (Cornwall
1998; Crewe, and Harrison 1998; Sachs 1992).
Community-based Project
A community project is a term applied to any community-based project. This covers
a wide variety of different areas within a community or a group of network entities. Projects
can cover almost anything, including the most obvious section of concern to any
community, the welfare element. Welfare community projects would for example be, a
locally run and locally funded orphanage; a Christmas dinner kitchen for the homeless.
Another important sector of importance to the community would be charity. Charitable
projects in the community can include but are not limited to, ecological charities concerned
with either the maintenance of green spaces, or in some cases, the prevention of the
reduction/removal of green spaces.. Most economic community projects are designed at
creating some sort of economic autonomy. It begins when a small collection of motivated
individuals within a community come together with a shared concern: how can our
community respond to the challenges, and opportunities, of peak oil and climate change.
Wellness Clinics
The term wellness refers to the well-being of the person. It is not, therefore,
exclusively linked to aesthetic treatments but also to a new way of approaching the life of
each client. It is a joint effort, both by the clinic that offers its services and by the person
who requires them.
An establishment focused on holistic wellness will provide you with: (1) Specific
treatments to suit your needs. The first step is to visit a specialist to assess your physical
condition and, specifically, what you need. You may prefer to control your weight and to
eliminate accumulated toxins, to better control your stress, to rejuvenate or to simply
recover after a long period of activity. (2)Total integration with the method, diet, exercises,
and programmed activities are always tailored to respect the needs and conditions of each
person. The method includes a more balanced diet, an exercise program, and continuous
check-ups with our doctors and complementary activities such as visits of specialists. (3)
Preventive medicine. It is essential to anticipate a disease and to avoid it. The use of an up to
date and efficient medication prepare your body ready so that your stay in the clinic can be
revulsive that will enable you to face a new stage in your life. (4)Necessary concentric
aspects, the services of these clinics make up a large circle of which other concentric circles
take part. We are referring to genetic medicine to delay aging, aesthetic medicine, internal
balance, the changing of habits, natural therapies, improving your nutrition, cognitive
stimulation, or fitness. (5)The quest for physical and mental balance, it is, possibly, the pillar
of this type of establishments. Physical ailments are the reflection of some mental problems
and vice versa. The choice of treatments and disciplines to achieve your own balance is
essential in achieving success.

References
https://shawellnessclinic.com/en/shamagazine/wellness-clinic-what-is-it/
a. Reflection
Activity 28
Name: Score:
Directions: Write tour answers in the space provided. You may use an extra sheet of
paper if necessary.
Think of an entrepreneurial project that can be applied to your barangay that will solve a
certain health problem. What are the objectives of your project? How are you going to
sustain the project?
b Post Test
Activity 29
Name: Date:
Directions: Write True if the statement is correct and False if the statement is incorrect
and encircle the word/words that make the statement incorrect. The following are the
key areas of responsibility based on the Nursing Core Competency Standard.
_______________1. Community based projects cover a wide variety of different areas within
a community or a group of networking entities and refer to any project within the
community.
_______________2. Community based projects begins when a small collection of motivated
individuals within a community come together with a shared concern.
_______________3. Most economic community projects are designed at creating some sort of
economic autonomy.
_______________ 4. Wellness clinics are a joint effort, both by the clinic that offers its
services and by the person who requires them.
_______________5. An establishment focused on holistic wellness will provide you with
specific treatments to suit your needs.
______________6. An establishment focused on holistic wellness will provide you total
integration with the method, diet, exercises, and programmed activities that are always
tailored to respect the needs and conditions of each person.
_____________7. An establishment focused on holistic wellness will provide you preventive
medicines, it is essential to anticipate a disease and to avoid it.
____________8. An establishment focused on holistic wellness will provide you quest for
physical and mental balance.
___________9. Community based projects can cover almost anything, including the most
obvious section of concern to any community, the welfare element.
__________10. The choice of treatments and disciplines to achieve your own balance is
essential in achieving success.

COURSE PLAN AGREEMENT FORM
I acknowledge that I received the course plan for NCM 113 COMMUNITY HEALTH
NURSING II
I have read the course plan and I understand the remote learning policies, instructions,
expectations and rules (e.g. online submission of requirements, downloading of digital
references, attendance, and attitude and grading system) as stated in the course plan of this
course.
If I have any questions or concerns, I will contact and consult my instructors for further
explanation.
I understand that I am responsible to complete the online assignments, assigned class
presentations, skills performance via video, quizzes and outputs by the due dates.
I agree to be prepared for and attend class on each scheduled meeting.
PRINTED NAME: _____________________________ SIGNATURE: ______________

DATE: _________________ CONTACT NO: _____________________
Email address: (Please write exactly and eligibly) ____________________________
NAME OF PARENT/GUARDIAN with signature: _______________________________

RELATIONSHIP: ____________________________ CONTACT NO: _____________
COMPLETE ADDRESS: __________________________________________________

COURSE DESCRIPTION:
This course deals with concept, principles, theories and techniques in the care of
population groups and communities utilizing community organizing strategies toward
health promotion, disease prevention, restoration and maintenance, and rehabilitation and
community development. The learners are expected to provide safe, appropriate and
holistic nursing care to clients utilizing the community health nursing process..
COURSE CREDIT: 2 units Lecture /18 weeks/ 36 hours; 2 Hours/Week
SEMESTER SCHEDULE: Additional readings will be assigned as necessary. This schedule
may be modified or change to fit the needs of the class.
WEEK LECTURE TOPIC OUTLINE

•Orientation to the NEUST vision, mission, core values and tagline; CON
goals and objectives; and course content
•Leveling of expectations and discussion of the intended learning
1st week outcomes and shift to OBE approach for the course
1.Independent study
2.Attire in the classroom/laboratory
3.Assessment, evaluation and grading system
Students ethics
Community Health Nursing Concepts
A.Definition
B.Philosophy and Principles
C.Features of CHN
D.Theoretical Models/ Approaches
1.Health Belief Models (HBM)
2.Milo’s Framework for Prevention
3.Nola Pender’s Health Promotion
4.Lawrence Green’s PRECEDE-PROCEED MODEL
2nd week (PRECEDE=Predisposing, Reinforcing, Enabling Constructs in
Educational Diagnosis and Evaluation
5.(PROCEED=Policy, Regulatory and Organizational and
Environmental Development.
E . Different Fields
1.School Health Nursing
2.Occpational Health Nursing
3.Community Mental Health Nursing
Concepts of the Community

A. Types of communities
3rd week
B. Characteristics of a Healthy Community
C. Components of Community

D. Factors Affecting Health of the Community

1. Characteristics of the Population
2. Location of the Community
3. Social Systems within the Community
Roles and Activities of Community Health Nurse
Health Statistics and Epidemiology
A. Tools
1. Demography
a. Definition and uses
b. Components
c. Population size
d. Population composition
e. Spatial distribution
f. Sources of Data
g. Population Size
4th week h. Composition
i. Distribution
2. Health Indicators
- Crude Birth Rate
- Crude Death Rate
- Infant Mortality Rate
- Maternal Mortality Rate
- Rate Specific Rates of Mortality
- Leading Causes of Morbidity
- Leading Cause of Mortality
Life Expectancy
B. Philippine Health Situation
1. Demographic Profile
2. Health Profile
5th week
C. Epidemiology and the Nurse
1. Definitions and Related Terms
2. Natural Life History of Disease
Epidemiological Process and Investigations
Nursing Process in the Care of Population Groups and Community
A. Assessment of community health needs.
1. Components of community needs assessment;
- Health status
- Health resource
- Health action potential
B. Community Health Assessment Tools
1. Collecting Primary Data
6th week
a. Observation
b. Survey
c. Informant Interview
d. Community Forum
2. Secondary Data Sources
a. Registry of Vital
b. Events
c. Health Records and Reports

d. Disease Registries
e. Census Data
Methods to Present Community Data
C. Community Diagnosis
- Definition
- Types
- Steps in conducting community diagnosis
1. Types
a. Traditional
b. Participatory Action
c. Research (PAR)
2. Schemes in Stating Community Diagnosis
a. NANDA
7th- 8th week b. Shuster and Goppingen
c. Omaha System
D. Planning Community Health Interventions

1. Priority Setting
a. WHO Special Considerations
2. Formulate Goals and Objectives
3. Deciding on Community Interventions/ Action Plan
E. Implementing Community Health Interventions
1. Importance of Partnership and Collaboration
2. Activities Involved in Collaboration and Advocacy
9th week MIDTERM EXAMINATION
Define the following:
a. Community
b. Health
c. Development
d. Community development
- Aim
- Characteristics
2. Community organizing towards community participation in health
and social mobilization
a. Definition of community
organizing
b. Objectives
10th -12th week c. Phases of community
organizing
- Preparatory
- Organizational Phase
- Educational/ Training Phase
d. Importance of Community organizing
3. Core Principles of Community Organizing
4. Goals of Community Organizing
5. Community Organizing Participatory Action Research Process
6. Capacity Building for sustainable community health development
towards community competence.
a. Qualities of health worker in the communities.
b. Types of Primary Health Worker

c. Levels of Primary Health

workers
d. Community Health Worker
- -definition
- -qualities
- -function
F. Environmental Sanitation
1. Health and Sanitation
2. Water and Supply Sanitation
3. Proper Excreta
4. Disposal
5. Food and Safety
6. Vermin and Vector Control
7. Built Environment
G. Documentation and Reporting
13th week 1. Family Health records
2. Community Profile
Working with Groups Towards Community Development
A. Stages of Group development

B. Interventions to Facilitate Group Growth
1. Orientation, Structure, Direction
2. Process, Negotiate and Resolve Conflicts
14th week
3. Awareness of the Effects of Behavior
4. Application of New Learning
Collaboration and Partnership

Information Technology and Community Health
A. Definition of e-health
- Storage
- Retrieval
15th week
- Transmittal
B. Power of Data in Information
C. e-Health Situation in the Philippines
D. Using e-Health in the community
Roles of the Community Health Nurse in e-Health
Current Trends in Public Health: Global and National
Role of a Community Health Nurse in the National and Global Health Care
Delivery System
16th week
Delivery the Health Care to the Filipino Family and Community
A. Filipino Culture
B. Filipino Customs and Traditions
C. Filipino Values, Traits and Beliefs
17th week Positive Qualities and Values of a Community Health Nurse

A. Personal Attributes
Professional Competencies
Health Related Entrepreneurial Activities

A. Community Based Project
B. Wellness Clinics
18st week FINAL EXAMINATION
FINAL COURSE OUTPUT:

The student is required to do and submit the following at the end of the course:
1. Submission of the all activities as stated in the module and other means of online
platform.
2. Compliance to the Online Learning Management System or any platform designated
like Activities/Online Quizzes.
CLASS POLICIES:
1. Attendance will be subjected to the guideline and protocols of the IATF and DOH, as
well as CHED.
2. Maximum participation is expected in all activities.
3. At all instances, respect for classmates and instructors are expected. Observe proper
decorum even as a netizen.
4. It is expected that all outputs be submitted on time on the designated dates.
5. Anyone violating these policies will be subjected to the Guidance Office for
disciplinary action.
6. All general policies of the College of Nursing and the University will also be
implemented as part of the policies for this course.
GRADING SYSTEM:
DESCRIPTION MIDTERM DESCRIPTION FINAL

Media Assignment 20% Media Assignment 20%
Post Test 25% Portfolio 25%
Community Health Plan 25% Post Test 25%
Midterm Exam 25% Final Exam 25%
Attendance/Attitude 5% Attendance/Attitude 5%
Total 100% 100%

Prepared by: Noted: Approved:
GIRLIE DL TAYAO,MAN, RN
ZUZETTE B. CATABONA, MAN, RN DR. JEAN N. GUILLASPER, RN
CECILLE L. ALDAY, MAN, RN,LPT
Subject Teacher Academic Unit Head Dean, College of Nursing

Date Signed: Date Signed: Date Signed:


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NCM 113 COMMUNITY HEALTH NURSING II

COMMUNITY HEALTH NURSING II

Course Code : NCM 113

INSTRUCTIONS ON HOW TO DO THIS MODULE

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UNIT I: Community Health Nursing Concepts 3

UNIT II: Concepts of the Community 13

UNIT III Health Statistics and Epidemiology 19

UNIT IV: Nursing Process in the Care of Population Groups 30

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UNIT V: Working with Groups Towards Community 56

UNIT VI: Information Technology and Community Health 126

UNIT VII Current Trends in Public Health: 74

UNIT VIII Delivery the Health Care to the 81

UNIT IX Positive Qualities and Values of a 87

UNIT X Health Related Entrepreneurial Activities 92

Couse Plan Agreement Form 96

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UNIT I. COMMUNITY HEALTH NURSING CONCEPTS

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Directions: Encircle the correct answer

3. These communities are defined or created by both natural and humanmade

5. This term usually denotes a group of people having common personal or

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Community Health Nursing

Philosophy and Principles

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General System s Theory

Social Learning Theory

Health Belief Model

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Figure 1: Health Belief model

Milio’s Framework for Prevention

Nola Pender’s Health Promotion

Lawrence Green’s Precede-Proceed Model

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PRECEDE phases PROCEED phases

Different fields of Community Health Nursing

School Health Nursing

Occupational Health Nursing

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Community Mental Health Nursing

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Directions: Encircle the correct answer

4. It is a specialized practice of nursing that advances the well-being, academic success,

5. This model is a complementary counterpart to models of health protection." It defines

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6. This model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W.

7. This framework is for prevention that includes concepts of community – oriented,

9. This refers to a person's subjective perception of the risk of acquiring an illness or

10. This refers to a person's feelings on the seriousness of contracting an illness or

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Directions: Write your answer in the space provided.

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UNIT II CONCEPT OF THE COMMUNITY

1. enumerate and explain the different types of community;

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Directions: Encircle the correct answer

3. This type of communities is defined or formed by both natural and manmade

5. This term usually denotes a group of people having common personal or

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The community is a group of people sharing common geographic boundaries and

Characteristics of a Healthy Community