COMMUNITY

HEALTH NURSING
RELATED LEARNING EXPERIENCE
MANUAL FOR NURSING STUDENTS

Student’s Name: ____________________________________

Course & Year: ____________________________________
Area: ____________________________________

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 COMMUNITY IMMERSION
Introduction to the Course

This course compromises the application component of the Community Health Care
Course. It is primarily focused on the use of the health process on families’ and communities’
health care management.
Health care I and II Theory Courses should be given prior to or taken along with
module.
Students taking this course will be performing activities that require the application of
family and community health care concepts and principles to their actual areas of assignment.
This course aims to compliment, if not enhance, the capability of the student dispensing
comprehensive health care service.
The immediate supervisor is strongly encouraged to get involved with facilitating and
evaluating student performance. However, written approval from the agency head is required
prior to the start of the course.

FAMILY HEALTH MANAGEMENT

Part 1 of this book consists of the following module.

Module 1: Establishing A Good Working Relationship
Module 2: Family Assessment
Module 3: Family Health Care Planning
Module 4: Family Health Care Implementation
Module 5: Family Health Care Evaluations

GENERAL OBJECTIVES

Content of this module will enable to:

1. Establish good working relationships.
2. Comprehensively assess client families;
3. Involve client families in preparing health care plans
4. Assist client families in implementing family health care plan;
5. Evaluate health care conducted on the client family

INTRODUCTION

This Community Exposure Manual is a guide to the application component of the

Community Health Nursing 1 course. It is primarily focused on the use of the health process on
families and high-risk clients.

In Community Health Nursing 1 the health process was discussed as the operational
framework employed to systematize service extended to clients.

It includes a set of deliberately chosen actions that standardizes the approach to effect
improvement the client’s health status and increase capabilities in coping with health problems.
The health process uses the scientific method of exploring and analyzing data to arrive at
conclusions.

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 SPOT MAP

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 BARANGAY OFFICIALS

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 RHU STAFF

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 Module 1
ESTABLISHING A GOOD WORKING RELATIONSHIP

SCOPE OF THE MODULE

This module consists of the following lessons:

1.1 Establishing Good Working Relationships with Families
1.2 Conducting A Home Visit
1.3 Other Means Of Contact with Clients/Families

MODULE OBJECTIVES

Content mastery of the module will enable students to:

1. Establish a good working relationship with client families;
2. Properly conduct home visits
3. Determine other means of communicating with client families whenever a home visit is
not possible.

INTRODUCTION

The family is the basic unit of service of Community Health Care. As the client, the family
needs to be sought and seen in its natural environment – the community. As the community
health worker, it is your responsibility to ensure that a harmonious working relationship is
established with the client family. However, before any relationship can be established, report
with one or two members of the target family must first be achieved. This is the first step
towards gaining their cooperation/collaboration in becoming health educated members of the
community.

Foremost in this kind of relationship is an attitude of partnership and equality of both the
nurse and the client. It includes trust and confidence in the integrity and capability of each
partner and a desire to help boost the other’s strength and overcome weaknesses. This is only
possible if both parties keep communication free and open. It is also important that the
community health worker and the client family have the space time they need functions as
separate entities and as single unit.

Lesson 1.1__________________________________________________

ESTABLISHING GOOD WORKING RELATIONSHIPS WITH FAMILIES

Lesson Objective
Using the guide form, establish good working relationships with families in a community.

INTRODUCTION
Initial attempts to communicate the intention to help and the nature of the assistance that
can be extended to the clients are vital access in the use of the health process. The Community
Healthcare Nurse (CHN) must first establish good working relationships with his/her clients
before he/she can hope to gain their cooperation in educating them on the health process.

Basic to this kind of relationships is an attitude of trust and confidence on the integrity
and capabilities of each partner to improve clients’ health status. Developing and nurturing this
type of relationship becomes the foundation for all subsequent health actions.

Direction
Asses level of accomplishment in establishing a good working relationship with each
other client family by truthfully filling up the required form. The first one is done for you.

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 Establishing a Working Relationship with the Client Family ______________________
Name of Family Head

Criteria Check if done

(Indicate date)
1. Initiate contact through home visit.
2. Introduce yourself and your agency.
3. Communicate interest in family welfare.
4. Maintain a two-way communication with the family.
5. Show willingness to help with expressed needs.

Lesson 1.2__________________________________________________

CONDUCTING A HOME VISIT

Lesson Objective
Using the guide form, perform the duties and responsibilities of a CHN during home
visits to families.

INTRODUCTION
A home visit is a professional face to face contact made by a nurse to the patient or the
family to provide necessary health care activities and the further attain an objective of the
agencies. (CHN Services in the Philippines, 2000)

Direction
Conducting home visits (HV) require accomplishing a specific form. The form below
serves as your guidance/example.
Upon earning the family’s trust and confidence, succeeding HVs should include a
detailed inspection of household surrounding and a thorough examination of other health
problem concerns.

___________________ ______________
Name of Family Head Date Of Visit

STEPS IN HOME VISIT Check if done

(Indicate date)

1. Greets clients or household member and introduce yourself.

2. Explain purpose of home visit.
3. Inquire about health and welfare of client/patient and other
family members. Ask about any health and health related
problems.
4. Perform physical examination (PE). Administer nursing care. If
more than one member has to be health supervised/cared for,
start with the well member to avoid transfer of infection.
5. Give necessary health advice or teach basic health care based
on clients needs and condition. If patient is weak or is
diagnosed with illness during a visit, give health instructions to
a responsible well member of the family.
6. Wash hands.
7. Record health status of family members and care administered.
8. Make an appointment for next visit either at the clinic or other
home visit.

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 Module 2
FAMILY ASSESMENT

SCOPE OF THE MODULE

This module consists of the following lessons.

1.1 Conducting Family Health Assessment
1.2 Identifying Family Health Problems
1.3 Determining Priorities and High-Risk Groups

MODULE OBJECTIVES

Content mastery of the module will enable students to:

1. Efficiently conduct family health assessment;
2. Accurately identify family health problems; and
3. Determine priorities and high-risk groups.

INTRODUCTION

The health status of the community is the primary concern of the Community Health
Manager. He/she is tasked with improving the health condition of the families under his/her care
by applying the operational framework to systematize service extended client families.

The health process includes a deliberately chosen set of actions that standardizes the
approach to effect improvement in the client’s health status and increase his/her ability to cope
and overcome health problems.

This process uses the scientific method of gathering and analyzing data to arrive at
conclusions and solutions to health problems.

Lesson 2.1__________________________________________________

CONDUCTING FAMILY HEALTH ASSSESSMENT

Lesson Objective
Using the family assessment guide forms, students should be able to comprehensively
assess families’
- Demographic data;
- Home and home environment details;
- Health and health practices; and
- Awareness community resources and organizations.

ASSESSMENT PHASE

The family health process involves conducting an initial assessment to determine

the presence of any health problem.

The assessment phase includes the collection and analysis of relevant factual
information regarding the client’s current health problems and present environment.

The following are the three sources of data reflecting the family health status:
1. Health status of family members – shows whether there are deviations in the health
condition of individual members.
2. Ability and willingness of the family to promote wellness among its members –
shows the nature and the extent of the family’s performance of specific tasks to meet the
physical, social and emotional needs of its members.

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 3. Family environment – defines the conditions in the home and environment that
interfere with the promotion and/or maintenance of the family members’ health and
recovery from illness.
Module 2
FAMILY ASSESSMENT

SCOPE OF THE MODULE

This module consists of the following lessons.

1.1 Conducting Family Health Assessment
1.2 Identifying Family Health Problems
1.3 Determining Priorities and High-Risk Groups

MODULE OBJECTIVES

Content mastery of the module will enable students to:

1. Efficiently conduct family health assessments;
2. Accurately identify family health problems; and
3. Determine priorities and high-risk groups

INTRODUCTION

The health status of the community is the primary concern of the Community Health
Manager. He/she is tasked with improving the health condition of the families under his/her care
by applying the operational framework to systematize service extended to client families.

The health process includes a deliberately chosen set of actions that standardizes the
approach to effect improvement in the clients health status and increase his/her ability to cope
and overcome health problems.

This process uses the scientific method of gathering and analyzing data to arrive
conclusions and solutions to health problems.

Direction
Within three days, visit and interview families in the community and fill up the family
assessment guide forms. The accomplished form below will serve as your guide.

FAMILY ASSESSMENT GUIDE

Family Name: _____________ Address: ________________________________

I- Demographic Data

Household No: ______ Barangay House No: ______

II- Family Data

Length of residency: ___________________________

Place of origin: ___________________________
___________________________
Family Size: ___________________________
Religion: ___________________________
___________________________

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Family Member’s Chart

FAMILY Age Sex CIVIL POSITION RELATIONSHIP EDUCATIONAL OCCUPATION

MEMBERS STATUS TO FAMILY ATTAINMENT
HEAD

III- Family Characteristics

Type of Family Structure

A. Extended ______ B. Nuclear ______

A. Matriarchal ______ B. Patriarchal ______ C. Both _____
Dominant Family Member ______

General Family Relationship/Dynamics

Criteria Status Additional Information

Observation conflicts between
family members
Characteristics of Communication

Interaction patterns among

members

Family Dietary Habits

What did you eat yesterday? (24 hours dietary recall)

Breakfast: _____________________________________
Lunch: _____________________________________
Supper: _____________________________________

Monthly Family Income Source

Husband ______ Wife ______ Others ______

Monthly Family Income

Total (Check bracket)

Below P 5,000.00 ______
Above P 5,000.00 – P 10,000.00 ______
Above P 10,000.00 – P 15,000.00 ______
Above P 15,000.00 – P 20,000.00 ______
Above P 20,000.00 – P 30,000.00 ______
Above P 40,000.00 – P 50,000.00 ______
More than P 50,000.00 ______

Family Health Status/Health History

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Father: _____________________________________
Mother: _____________________________________
Children: _____________________________________

Felt Family Needs (Identify and rank according to priority)

1. _____________________________________
2. _____________________________________
3. _____________________________________
4. _____________________________________
5. _____________________________________

IV- Home and Environment

A. Is your lot owned? Yes ______ No ______

B. Is your house owned? Yes ______ No ______

C. Type of housing materials Wood ______ Mixed ______

Concrete ______ makeshift ______
Others, specify ______

D. Is the Living space adequate? Yes ______ No ______

E. What are the appliances owned by the family?

Radio, kerosene stove, plantsa__________

F. Type of garbage disposal

______ Collected ______Burning
______ Waste segregation ______Burying
______ Fed to animals ______Throw in the river/sewer
______ Open dumping

G. Type of waste disposal

______ Flush ______ Water- sealed
______ Wrap and throw ______ Pit privy
Others, specify: ______

H. Type of drainage system ______ Open ______ Closed

I. Source of water supply

_____ Owned ______ shared
_____ Bought Others, specify: ______

J. Drinking water storage

______ Refrigerated
______ Uncovered ______ Covered

K. Containers used
______ Plastic Pitchers ______ jars, clay, pots
______ Bottles Others, specify: ______

L. Food storage/cooking facilities

______ Covered ______ Uncovered ______stove
______ Refrigerator ______ cabinet ______ pots, pans

M. Common household pests found at the home

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 _______________________________________

N. Are these breeding sites of insects, rodents, etc. present?

Yes ______ No ______

O. Pets/animals kept in the yard/home

_________________________________________

P. Are there accident hazard present?

Yes __X____ No ______

V- Health and Health Practices

A. Common illness encountered for the last 6 months and the treatment applied.
_____________________________________

B. Whom do you consult for health-related problems?

______ Manghihilot ______ albularyo
______ Midwife ______ nurse
______ Doctor ______ Health care
______ Barangay Health Worker Others, specify: ______

C. For problems other than health, whom do you consult?

______ Family members ______ relatives
______ Friends ______ Barangay officials
______ Priest Others, specify: ______

D. Immunization status of family members

_____________________________________

E. Have you had adequate?

1. Rest and sleep? Yes ______ No ______
2. Exercise? Yes ______ No ______
3. Relaxation Activities? Yes ______ No ______
4. Stress management activities? Yes ______ No ______

VI- Environment

1. Kind of Neighborhood
2. Social and health facilities available
3. Communication and Transportation facilities

VII- Awareness of community organization

A. Are you aware of existing organizations in the community?

Yes ______ No ______

B. Name all the organization/s you know

_____________________________________

C. Are you a member of any of these organizations?

Yes ______ No ______

D. Are you aware of its activities and projects?

Yes ______ No ______

E. How are you involved in its activities?

______ Attend meetings ______ give donations
______ Planning ______ evaluation
______ Implementation others, specify not involved ______

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 F. Name 5 formal and non-formal leaders of the community whom do you think can lead
the people.
1.
2.
3.
4.
5.

EVIDENCE (MUST BE SHOWN THROUGH PICTURES)

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Lesson 2.2__________________________________________________

IDENTIFYING FAMILY HEALTH PROBLEMS

Lesson Objective
Using the for identifying and ranking health problems, students should be able to:
1. List down the health problems recognized in each family.
2. Categorize each health problem into health threat, health deficit or foreseeable crisis.
3. Prioritize health problems according to nature, modifiability, preventive potential and
salience to the family.
4. Justify the scores given to each problem; and
5. Rank health problems according to priorities.

After collecting the data, these will be analyzed, sorted out and grouped. The synthesized
information will be compared to the norm to determine the nature and source of the data
gathered.
From the inference made, conclusions are formed. Hence, diagnoses are formulated and
priorities set.

FACTORS AFFECTING PRIORITY STATUS

Greater weight is assigned to health deficit over health threat because the former usually
demands more immediate intervention than the latter. On the other hand, foreseeable crisis is
given the least attention because culture-linked factors usually provide adequate support to
cope with developmental/situational crises.

The community health manager must consider some important factors in defining
modifiability of a health problem - or probability of success in minimizing, alleviating, or totally
eradicating the problem through health intervention. These are:
1. Current knowledge, technology and intervention to manage the problem.
2. Resources of the family (physical, financial and manpower.)
3. Resources of the community (facilities and community organization.)
4. Resources of the community health manager (knowledge, skill and time.)

To decide on the appropriate score for the preventive potential of the health problem – or the
nature and magnitude of future problems that can be minimized or prevented if intervention is
done, the following factors are considered.
1. Severity of the problem – the more severe or advanced the problem, the lower the
preventive potential.
2. Duration of the problem – the longer the problem has existed, the lower the preventive
potential.
3. Current management – application of appropriate intervention increases the problem’s
preventive potential.

To determine the silence score, evaluate the family’s perception and evaluation of the
problem in terms of seriousness and urgency of attention needed. The family’s concern and felt
needs require priority attention.

After the score for each criterion has been finalized, the sum of all scores is determined. The
highest possible total score is 5. Priority problems are those with scores nearer 5. The higher
the score of the problem, the higher it’s rank.

COMPUTING AND JUSTIFYING SCORES OF HEALTH PROBLEMS

Identified Health Problem
1.
2.
3.

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Direction
Encircle the actual standards scores and the scores that apply to the family’s problems.
Justify the scores you gave in the indicated column. Compute for the sum of all the actual
scores you have encircled and write them on the space provided. See example below.

Family Name:

Problem: ______________________________

Criteria Standard Score Weight Actual Justification

Score
1. Nature of the Health Deficit 3 1
problem
Health threat 2

Foreseeable 1
Crisis
2.Modifiability of Removable 2 2
the problem
Partially Modifiable 1

Not Modified 0
3.Preventive High 3 1
potential
Moderate 2

Low 1
4. Salience of the Needs immediate 2 1
problem attention

Does not need 1

immediate
attention
0
Not a problem
TOTAL SCORE: ___________

Family Name: _____________________________

Problem: _____________________

Criteria Standard Score Weight Actual Justification

Score
1. Nature of the Health Deficit 3 1
problem
Health threat 2

Foreseeable 1
Crisis
2.Modifiability of Removable 2 2
the problem
Partially Modifiable 1

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 Not Modified 0
3.Preventive High 3 1
potential
Moderate 2

Low 1
4. Salience of the Needs immediate 2 1
problem attention

Does not need 1

immediate
attention
0
Not a problem
TOTAL SCORE: ___________

Family Name: _____________________________

Problem: _____________________

Criteria Standard Score Weight Actual Justification

Score
1. Nature of the Health Deficit 3 1
problem
Health threat 2

Foreseeable 1
Crisis
2.Modifiability of Removable 2 2
the problem
Partially Modifiable 1

Not Modified 0
3.Preventive High 3 1
potential
Moderate 2

Low 1
4. Salience of the Needs immediate 2 1
problem attention

Does not need 1

immediate
attention
0
Not a problem
TOTAL SCORE: ___________

RANKING HEALTH PROBLEMS ACCORDING TO PRIORITY

Direction
Rank the health problems of each family. Priority 1 has the highest score; Priority 2 has
the second highest. Priority 3, the next highest, and so on. The first one has been done for you.

Ranking Health Problems of Family _______________________

PRIORITY PROBLEM SCORE
1
2
3

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Lesson 2.3__________________________________________________

FAMILY HEALTH CARE PLANNING

SCOPE OF THE MODULE

This module consists of the following lessons:

1.4 Identifying Priority Families for Follow-up
1.5 Determining Family Nursing Problems
1.6 Preparing Family Health Care Plans for Priority Families
1.7 Working Out Details of the Plan Together with the Families Concerned

MODULE OBJECTIVES

Completion of the forms in this module will enable student to:

1. List the top three priority families requiring follow-up;
2. Prepare family health care plans for the top three priority families.
3. Work out details of the family health care plan with the families concerned; and
4. Make a contract with the families for the implementation of the family health care plan.

INTRODUCTION

A community health manager should be cognizant of the health level of the different
families under his/her care. It is his/her task to identify the high risk families who will be the
focus of his/her services. A family health care plan must be prepared together with the
cooperation of the responsible members of each of the family. A family health care plan is
designed upon completion of the assessment, analyses and diagnoses of the health of the
families concerned. The purpose of the plan is to elicit and sustain behavioral change in the
family that will promote better health and prevent illness. It is crucial that family members
actively participate in the planning phase because its success depends on their participation.
This participation will largely affect behavioral changes that are expected to take place.

PREPARING FAMILY HEALTH CARE PLANS FOR PRIORITY FAMILIES

Lesson Objective
Using the forms for preparing a family health care plan, students and the priority families
concerned should be able to:
1. Identify the family health problems;
2. Formulate the goals and objectives of health care
3. Discuss and list planned intervention for identified problems and
4. Agree on the standards/criteria for evaluation of family health care.

A plan intervention is designed up on completion of the assessment, and the analysis

and health diagnosis of the family, the purpose of the plan is to elicit behavioral change in
the family that will promote health and/or prevent dysfunction. The family is expected to be
an active participant in the planning process. The success of the planned behavioral
changes depends largely on the degree of responsibility that the family concerned is willing
to assure. The planning process involves to following steps:

1. Determining the order of priority of existing or potential problems

2. Identifying problems that can be handled by the community health nurse and the family
and those that may be referred\d to others for assistance.
3. Setting goals and objectives to resolve the problems
4. Predicting actions and expected outcomes.,

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 Choices of family health care intervention should focus on what help lessen or eliminate
possible reasons for the family’s inability to do health tasks. Health education and training,
or simply health teaching, enhances the family’s inability to recognize health problems,
decide on appropriate health actions to take and develop the ability to provide care for its
members. The maximum use of available resources through coordination and collaboration
via an effective referral and conduction system is one important tool of intervention. Also
included as intervention tools are the bag, thermometer and isolation techniques and
dispensing home health care.

Direction
Prepare, together with the families concerned, family health care plans for the Priority 3
families you have assessed.

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Family Name: _____________________________

Problem: _____________________
Priority Number: ________________
Health Problems Family Nursing Goals Objectives Intervention Method of Resources Evaluation
Problems Methods Nursing Family Required
Contact

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Family Name: _____________________________

Problem: _____________________
Priority Number: ________________
Health Problems Family Nursing Goals Objectives Intervention Method of Resources Evaluation
Problems Methods Nursing Family Required
Contact

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Family Name: _____________________________

Problem: _____________________
Priority Number: ________________
Health Problems Family Nursing Goals Objectives Intervention Method of Resources Evaluation
Problems Methods Nursing Family Required
Contact

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Lesson 5.2__________________________________________________
SELF-EVALUATION

Lesson Objective
Using the forms for Family Health Evaluation, students should be able to:
1. Evaluate performance in home health care visit
2. Compute their scores and identify their own weaknesses and strengths.

Self-evaluation is assessment of one’s own performance. Some supervising health workers find this idea worrisome because
they fell that the students or new workers are not yet ready for the said undertaking; they are either not responsible enough or their
knowledge is lacking. This is probably true in the beginning. However, many community health managers will be working with
minimum supervision after they have qualified; therefore on the job, they must learn to accurately assess themselves. It is ideal to
undergo self-assessment during training. It provides a greater sense of responsibility and ultimately saves time. In regarding the
standards to use and an accurate idea of the task he/she can compare his/her work with to determine his/her level of[performance.
Note that the primary purpose of self-assessment is not to score points such as the case in supervisor or client evaluation.
Supervisor evaluation employs external examiners to determine the strengths and weaknesses of the CHM and his/her
performance.

Direction
Rate your performance in home health care visits using the forms.

FAMILY HEALTH CARE EVALUATION FORM

Sa pagdalaw ko sa pamilya _____________________ (pangalan ng pamilya)

Mga Batayan (lagyan ng tsek ang angkop na sagot) Oo Oo Oo Hindi
Palagi Madalas Minsan (3)
(10) (8) (5)
1. Ipinakilala ko ang aking sarili
2. Ipinakilala ko ang aking kasama
3. Ako ay gumamit ng tamang pananalita sa pakikipagusap
4. Ako ay nagpakita ng katapatan sa pagtulong
5. Madali kong nakapalagayang loob ang mga miyembro ng pamilya
6. Ako ay nagpakita ng ugaling madaling pakitunguhan
7. Ginamit ko ang pagkakataon upang magtuor ng kaalamang pangkalusugan
8. Tinitiyak ko na naiintindihan ang aking tinuturo
9. Ipinaliwanag ko ang mga salitang medical
10. Ako ay nagging maayos at mabilis sa paggawa
Total:
Iba pang masasabi:

________________________
Pangalan ng student nurse at Lagda

Lesson 5.3__________________________________________________

CLIENT FAMILY EVALUATION

Lesson Objective
Using the forms for client family evaluation, you should be able to:
1. Let a family member evaluate home visit performance
2. Explain to the family how to use the form and
3. Compute the score and identify strengths and weaknesses

Client evaluation serves as feedback to the service provider regarding services rendered to the client family. It determines their
performance level and reflects how much they have learned in the course of their training/immersion.

Direction
Within the day, have member of each priority family where you rendered services rate your performance in home visits
using the forms found in the succeeding pages.
FAMILY HEALTH CARE EVALUATION FORM

Sa pagdalaw ko sa pamilya ni Mr/Ms. ______________________________ (pangalan ng estudyante)

Mga Batayan (lagyan ng tsek ang angkop na sagot) Oo Oo Oo Hindi
Palagi Madalas Minsan (3)
(10) (8) (5)
1. Nagpakilala ng sarili
2. Nagpakilala ng kasama
3. Gumamit ng tamang pananalita sa pakikipagusap
4. Nagpakita ng katapatan sa pagtulong
5. Madaling nakapalagayang loob ang mga miyembro ng pamilya
6. Nagpakita ng ugaling madaling pakitunguhan
7. Gumamit ng pagkakataon upang magturo ng kaalamang
pangkalusugan
8. Naniniguro na naiintindihan ang tinuturo
9. Nagpaliwanag ng mga salitang medical
10. Naging maayos at mabilis sa paggawa
Total:

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Iba pang masasabi:
________________________
Pangalan ng sumagot at Lagda

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