NURSING PROCESS IN THE CARE OF 1.

Total population and geographical

POPILATION GROUPS AND THE COMMUNITY: distribution including urban-rural index
COMMUNITY HEALTH ASSESSMENT and population density.
(COMMUNITY DIAGNOSIS) 2. Age and sex composition
3. Household size
 Caring for the community as client starts with 4. Selected vital indicators such as growth
determining the health needs. rate, crude birth rate, crude death rate
 The nurse collects data about the community in and life expectancy at birth
order to identify the different factors that may 5. Patterns of migration
directly or indirectly influence the health of the 6. Population projections
population. Then she proceeds to analyze and
seek explanations to the occurrence of Health B. SOCIO-ECONOMIC AND CULTURAL
needs and problems in the community. VARIABLES
 The community health nursing diagnosis are  There are no limits as to the list of socio-
then derived and will become the basis for economic and cultural factors that may
developing and implementing the community directly affect or indirectly affect the health
health nursing intervention and strategies. in status of the economy.
such a way that programs can be implemented  However, the nurse should consider the
through interventions and strategies. following as essential information:
 It is important that Community Health diagnosis
or Community Health assessment or situational 1. Social Indicators
analysis has to be done by the nurse. a. Educational level which may be
indicative of poverty and may
COMMUNITY HEALTH ASSESSMENT reflect on health perception and
utilization pattern of the
Community Diagnosis community.
 It is regarded to as a profile. b. Housing conditions which may
 It is a description of the communities’ state of suggest health hazard
health as determined by the: (1) physical, (2) (congestion, fire, exposure to
emotional, (3) political and (4) social factors. elements)
These factors are intertwined. In such a way, c. Social classes or groupings
that the health situation of the community will be
determined. 2. Economic indicators
PURPOSE: a. Poverty level income
 To be able to obtain a quick picture of the b. Unemployment and
community which is as accurate as possible. underemployment rates
 A community profile could summarize c. Proportion of salaried and wage
information which could be useful for planning earners to total economically
and monitoring. active population
d. types of industry present in the
Community Profile community
A community profile should: e. Occupation common in the
1. Summarize information community
2. Present results and figures clearly f. Communication network
3. Be useful for planning and monitoring necessary for disseminating
health information or facilitating
TYPES OF COMMUNITY DIAGNOSIS: referral of clients to the health
1. Comprehensive Community Diagnosis care system
 A comprehensive community diagnosis g. Transportation system including
aims to obtain general information about the road networks necessary for
community with the intent of determining not accessibility of the people to
only prevalent health conditions and risk health care delivery system.
factors (epidemiological approach) but also
the socio-economic conditions (socio- 3. Environmental indicators
economic approach) and lifestyle behaviors a. Physical /geographical
and attitudes that have effect on health /topographical characteristics of
(behavioral approach). the community
 The following are elements of a b. Water supply
comprehensive community diagnosis c. Water disposal
and the basic data that are needed to d. Air, water and land pollution
characterize each variable:
4. Cultural factors
A. DEMOGRAPHIC VARIABLES a. Variables that may break up
 The analysis of the community’s people into groups within the
demographic characteristics should show community such as:
the size, composition and geographical o Ethnicity
distribution of the population as indicated by o Social class
the following: o Language
 o Religion
o Race
o Political orientation
b. Cultural beliefs and practices
that affect health
c. Concepts about health and
illness
C. HEALTH AND ILLNESS PATTERN
 In analyzing the health and illness patterns,
the nurse may collect primary data about
the leading causes of illness and deaths
and their respective rates of occurrence.
 If she has access to recent and reliable
secondary data, then she can also make
use of these:
1. Leading causes of morbidity
2. Leading causes of mortality
3. leading causes of infant and child
mortality
4. Leading causes of maternal mortality
5. Leading causes of hospital admission
6. Leading causes of clinic consultation
7. Nutritional status
 So, for this data take note that the
information that are being gathered are
classified as secondary data sources.
 A secondary data source that is different
from other secondary data sources we have
the registry of vital events. In the registry of
vital events, we have the Civil Registration
Law.
 Civil Registration Law known as Republic
act 3753 and it requires registration of vital
events such as birth marriages and deaths.
 The Republic act 7160 which is the Local
Government Code. Assigned the function of
the Civil registration to the Local
government and mandated the appointment
of the local. Families will register so there
are civil registers in both cities as well as
municipalities.
 Moreover, the NSO serves as the central
repository of civil registries, and the end ISO
administrator and the Civil Register General
on the data regarding the illness and illness
pattern, leading causes of mortality
morbidity in infant mortality can be
accessed. You can get the information from
the Philippine Statistics Authority.
 So aside from the registry of vital events, we
have the health records and reports
coming from the Department of Health. It is
stated in the Executive Order No. 352,
which is an executive order that was issued
by the Office of the President, Republic of
the Philippines.
 In the executive order, it mentioned that the
Field Health Service Information System
(FHSIS) is the official recording and
reporting system of the Department of
Health and is used by the NSCB to
generate health statistics.
D. HEALTH RESOURCES
 The health resources that are available in
the community are an important element of
the community diagnosis mainly because
they are the essential ingredients in the
delivery of basic health services.
 The nurse needs to determine manpower,
institutional and material resources provided
not only by the state but those which are
contributed by the private sector and other
non-government organizations.
1. Manpower Resources
a. Categories of health manpower
available
b. Geographical distribution of health
manpower
c. Manpower-population ratio
d. Distribution of health manpower
according to health facilities (hospitals,
rural health units, etc.)
e. Distribution of health manpower
according to type of organization
(government, non-government, health
units, private)
f. Quality of health manpower
g. Existing manpower
development/policies
2. Material Resources
a. Health budget and expenditures
b. Sources of health funding
c. Categories of health institutions
available in the community
d. Hospital bed-population ratio
e. Categories of health services available
E. POLITICAL/LEADERSHIP PATTERNS
 The political and leadership pattern is a vital
element in achieving the goal of high-level
wellness among people.
 It reflects the action potential of the state and its
people to address the health needs and
problems of the community.
 It also mirrors the sensitivity of the government
to the people’s struggle for better lives.
 In assessing the community, the nurse
describes the following:
a. Power structures in the community
(formal or informal)
 We have the barangay officials,
selected Municipal officials and
the city officials, then we also
have informal leaders. Key
leaders that are found in the
community.
b. Attitudes of the people towards authority
c. Conditions/events/ issues that cause
social inflict or upheavals or that lead to
social bonding or unification
d. Practices of approaches effective in
settling issues and concerns within the
community.
2. Problem-oriented Community Diagnosis
 The problem-oriented community diagnosis
is the type of assessment that responds to a
particular need of a target group.

ECOLOGIC APPROACH TO COMMUNITY
DIAGNOSIS
 The ecologic approach to community
health diagnosis recognizes the fact that the
health status of the community is a product
of the various interacting elements such as
population, the physical and topographical
characteristics, socio-economic and cultural
factors, health and basic social services and
the power structure within the community.
 Community health problems are often
viewed as technical problems that need
technical solutions without regard to the
interrelatedness of all factors and forces
that are bearing down on community health.
 According to Freeman and Heinrich
(1981), community health diagnosis is
based on the three independent,
interacting and constantly changing
conditions:
1. The health status of the community,
including the population level of
vulnerability
o An estimate of the health status
relates the characteristics of two
factors, namely (1) the people and
(2) the environment.
o Person variables include
demographic characteristics such as
age, sex, ethnic group, occupation,
income or educational attainment
may explain population growth
trends, death and illness
experiences as well as identification
of vulnerable or special risk groups
in the population.
o Environmental factors include not
only the physical environment (e.g.
air, water, housing, and climate) but
those of biologic environment (e.g.
plant and animal life) and social
environment (e.g. presence of war or
armed conflict, poverty) associated
with disease development.
2. Community health capability or the
ability of the community to deal with its
health problems
o The community’s capacity to
promote or sustain health depends
on the extent of its economic,
institutional and human resources.
o The mere presence or availability of
such resources does not necessarily
guarantee people’s health. People
need to make out how these
resources can be optimally used to
their advantage.
3. Community action potential or the
patterns in which the community is likely
to work on its health problems
o Freeman and Heinrich (1981),
describes the following important
aspects of community health action:
a. Value people give to their health over
their needs in life that provide the
forward motion of health action – Is the
health problem perceived to be
important to the people? Is it perceived
to need immediate attention? Are there
other concerns in the community that
take priority?
b. Community’s relationship with the
political system and the government
institutions that support health actions –
How responsive is the government to
the health needs and problems of the
community? To what extent does the
political system or government
institutions for people’s organization’s
participation in the decision-making
about planning and implementation of
health actions?
c. Habits that the community has
developed for dealing with common
problems – Is there genuine partnership
among all stakeholders to push the
agenda of promoting and sustaining
health in the community? What are the
different approaches or strategies that
they have developed and implemented?
TOOLS FOR COMMUNITY ASSESSMENT:
A. COLLECTING PRIMARY DATA
1. Observation
 Rapid observation of a community may be
done through an ocular or windshield
survey, either by driving or riding a vehicle
or walking through it.
2. Survey
 Although time-consuming and expensive, a
survey may be necessary when there is no
available information about the community
or specific population group to be studied.
3. Community Forum
 A community forum is an open meeting of
the members.
 “Pulong-pulong sa baranagay” is a good
example of a community forum.
 It does not give the nurse information on
community perceptions on needs, health,
and health care, but it is also an effective
tool in providing the people with a medium
for expressing their views and developing
their capacity to influence decision makers.
4. Focus Group Discussion
 A focus group differs from a community
forum in the sense that the focus group is
made up of a much smaller group, usually
6-12 members only.
 A good example is a focus group of first-
time pregnant mothers.
B. SECONDARY DATA SOURCES
1. Registry of Vital Events
 Act 3753 (Civil Registration Law,
Philippine Legislature) enacted in 1930,
established the civil registry system in the
Philippines and requires the registration of
vital events such as birth, marriages and
deaths.
  Republic Act 7160 (Local Government
Code) assigned the function of the civil
registration to the local governments and
mandated the appointment Local Civil
Registrars.
 The NSO serves as the central repository of
civil registries and the NSO Administrators
and the Civil Registrar General of the
Philippines.
 Presidential Decree 856 (Sanitation
Code; Office of the President, Republic
of the Philippines) requires a death
certificate before burial of the deceased.
The physician who last attended the
deceased shall be responsible for preparing
the death certificate, certifying the cause of
death, and forwarding the death certificate
to the health officer within 48 hours.
2. Health Records and Reports
 As specified in the Executive Order No.
352 (Office of the President, Republic of
the Philippines 1996) the Field Health
Service Information System (FHSIS) is
the official recording and reporting
system of the Department of Health and
is used by the NSCB to generate health
statistics.
 The FHSIS is an essential tool in
monitoring the health status of the
population at different levels.
 It is therefore a basis for (1) priority
setting by local governments, (2)
planning and decision making at
different levels (barangay, municipality,
district, provincial, and national), and (3)
monitoring and evacuating health
program implementation.
THE FHSIS MANUAL OF OPERATIONS (DOH-
IMS, 2011) LISTS AND DESCRIBES THE
FOLLOWING RECORDING TOOLS:
A. INDIVIDUAL TREATMENT RECORD
 It is the building block of the FHSIS.
 The record contains the date, name,
address of patient, presenting symptoms
or complaint of the patient on
consultation, and the diagnosis (if
available).
B. TARGET CLIENT LISTS
 Are the second building block of the
FHSIS. These service records have the
following purpose:
a. To plan and carry out patient care
and service delivery since midwives
and nurses use TCLs to monitor
target or eligible population for
particular health services.
b. To facilitate monitoring and
supervision of service delivery
activities.
c. To report services delivered, thus
reducing the need to refer back to
the ITRs to accomplish reporting.
d. To provide a clinic-level database
that can be accessed for further
studies.
The following are the TCLs maintained
in the RHUs and health centers:
a. TCL for Prenatal Care
b. TCL Postpartum Care
c. TCL for Under-1 Year Old Children
d. TCL for Family Planning
e. TCL for Sick Children
f. National Tuberculosis Program TB
Register
g. National Leprosy Control Program
Central Registration Forms
C. SUMMARY TABLE
 It is accomplished by the midwife.
 It is a 12-column table in which columns
correspond to the12 months of the year.
 This record is kept at the BHS and has 2
components: (1) Health Program
Accomplishment and (2) Morbidity/
Diseases.
4. MONTHLY CONSOLIDATION TABLE
 It is accomplished by the nurse based
on the summary table.
 It serves as the source document for the
Quarterly Form and Output Table of the
RHU or health center.

THE REPORTING FORMS, AS ENUMERATED IN
THE FHSIS MANUAL OF OPERATIONS, ARE
THE FOLLOWING:
A. MONTHLY FORMS
 Are regularly prepared by the midwife
and submitted to the nurse, who then
uses the data to prepare the Quarterly
Forms.
a. Program Report (MI) – contains
indicators categorized as maternal
care, child care, family planning and
disease control. The midwife copies
the data from the Summary Table.
b. Morbidity Report (M2) – contains a
list of all cases of disease by age
and sex.
B. QUARTERLY FORMS
 Are usually prepared by the nurse.
 There should only be one Quarterly
Form for the municipality/city.
 Quarterly Forms are submitted to the
Provincial Health Office.
a. Program Report (Q1) – contains
the 3-month total of indicators
categorized as maternal care, family
planning, child care, dental health,
and disease control.
b. Morbidity Report (Q2) – is a 3-
month consolidation of Morbidity
Report (M2).
C. ANNUAL FORMS
a. A-BHS – is a report by the midwife
that contains demographic,
environmental and natality data.
b. Annual Form 1 (A-1) – is prepared
by the nurse and is the report of the
RHU or the health center. It contains
demographic and environmental
data, and data and natality and
mortality for the entire year.
 c. Annual Form 2 (A-2) – prepared by
the nurse, is the yearly morbidity
report by age and sex.
d. Annual Form 3 (A-3) – also
prepared by the nurse, is the yearly
reports of all deaths (mortality) by
age and sex.

3. Disease Registries
 A disease registry is a listing of persons
diagnosed with a specific type of disease in
a defined population.
 Data collected through disease registries
serve as basis for monitoring, decision-
making and program management.
 The Department of Health has developed
and maintained registries for HIV/AIDS and
chronic noncommunicable diseases,
particularly cancer, diabetes mellitus, COPD
and stroke.

4. Census Data
 A census is a periodic governmental
enumeration of the population.
 Batas Pambansa Blg. 72, provides for a
national census of population and other
related data in the Philippines every 10
years.