Nursing process in the care of population groups and
community Objective
Community assessment
 The nurse collects data on the three categories
of community health determinants:
people, place & social system.
 Data collection depends on the objectives of
community assessment.
 PLANNED APPROACH TO COMMUNITY HEALTH
(PATCH) - a community health planning model
based on Green’s PRECEDE model requires
qualitative and quantitative data.
The nurse utilizes the approach that is most appropriate
to the community and the purpose of assessment.
COMPREHENSIVE NEEDS ASSESSMENT
 Gathers information about the entire
community using a systematic process.
 Requires much time & effort
 Information gathered is most useful when
health assessment of the community is done for
the first time
PROBLEM-ORIENTED ASSESSMENT
 Focused on a particular aspect of health
 Information is collected when a certain
community problem is in mind.
 Workable when the nurse is familiar with the
community
Tools for community assessment-sources of data
PRIMARY DATA
 Community itself
 Data that have not been gathered before and
are collected through observation (ocular
/windshield survey & participant observation),
survey, informant interview, community forum
& focus group discussion.
SECONDARY DATA
 Taken from existing data sources
 Gives a picture of what is already known about
the population under study.
 Consist of vital registries, health records &
reports, disease registries, publications-print
electronic forms produced by DOH & FNRI, NSO.
A. Community health Assessment tool
1. Collecting primary data:
A. Observation method
- of Data Collecting is a method that employs vision as
its main means of data collection.
- It implies the use of eyes rather than of ears and the
voice.
- Observation is accurate watching and noting of
phenomena as they occur with regard to the cause and
effect or mutual relations
Observation based on comparison
 An observation based on facts
Fact- a piece of information that can strictly be defined
and prove true
Subjective
 An observation based on opinion
Opinion- a statement that expresses belief, values
or feeling
Two types of observation
1. Qualitative observation
 Involve characteristics that can be described
but cannot be measured or counted such as
color or texture e.g. Red flowers, smells
sweet, taste bitter
2. Quantitative observation
 Measurable and can be counted. It involves
numbers for counting
e.g. 3 meters long, 50kg weight, 35 degrees
Celsius
b. Survey
 A survey is a research method used for
collecting data from a predefined group of
respondents to gain information and insights
on various topics of interest.
 Survey can be used to investigate the
characteristics, behaviours, or opinions of a
group of people.
 These research tools can be used to ask
questions about demographic information
about characteristics such as sex, religion,
ethnicity, and income
Four modes of survey data collection
 Face-to-face surveys
 Self-administered paper and pencil
surveys
 Self-administered computer surveys
(typically, online)
 Telephone surveys
Types of survey question
 Multiple Choice: questions form the basis of
most research. They can be displayed as a
traditional list of choices or as a dropdown
menu, select box, etc.
 Multi-Select:  is used when you want
participants to select more than one answer
from a list.
 Text Entry: is used to gather open-ended
feedback from respondents. These responses
can be lengthy essays, standard form
information such as name and email address, or
anything in between
 Ranking Order: is used to determine each
respondent’s order of preference for a list of
items. These questions are best used to
 measure your respondents’ attitude toward
something.
 Rating Order: questions are being asked to
indicate their personal levels on things such as
agreement, satisfaction, or frequency
 Matrix Table: is used to collect multiple pieces
of information in one
 Slider: Sliders let respondents indicate their
level of preference with a bar rather that can be
drag than a traditional button or checkbox.
 Side by Side: Side by Side questions let you ask
multiple questions in one condensed table and
provides an effective way of shortening your
survey while gathering the same amount of
data.
NOTE:
- Avoid asking Personal info you don’t need
or already have
- Respondents want to give their opinions,
and not personal details.
- If you already have this information, don’t
ask it again. This respect’s the respondent’s
time and limit survey fatigue and
frustration.
- You’ll also want to make sure that the data
are secure
- If you are collecting sensitive data, make
sure you are complying with internal
policies, local laws
c. Informant interview
 Are qualitative in-depth interviews with people
who have the firsthand knowledge on what is
going on in the community.
 The purpose of informant interviews is to
collect information from a wide range of people
including community leaders, professionals, or
residents.
d. Community forum
 is like a public meeting, were members of the
community come together at a central location
to share their ideas, opinions and concerns.
 A forum is a way of consulting members of the
community and is part of the community
engagement process.
e. 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
Secondary data sources
Registry of vital events
 RA 3753 (Civil Registration Law, Philippines
Legislature) requires the registration of vital
events (such as birth, marriage, death etc)
 RA 7160 (Local Government Code) was enacted
into law, transferring control and responsibility
of delivering basic services to the hands of local
government units (LGU).
A.. Registry of vital events
 is a statewide data system responsible for
collecting information on Identity data of
person that occur in Philippines.
 The Vital Events Registry is part of the Vital
Statistics Program of the Philippine Statistics
authority.
 Through this program, It will ensure the
personal identity data of a person is as
complete, timely and accurate as possible
a. Live Birth Registration
 It is a permanent and official recording of a
child’s existence.
 As a legal document, a birth certificate serves
to define and protect a person’s human and
civil rights in society.
 Birth record or birth certificate is a source of
vital information and provides legal proof of the
identity of an individual.
b. Death Registration
 PD 856 (sanitation code of the Philippines,
1975), requires a death certificate before burial
of the deceased
 It is a permanent and official recording of a
person’s death.
 Before a death can be formally registered,
a doctor will need to issue a medical certificate
giving the cause of death.
 No human body shall be buried unless the
proper death certificate has been presented
and recorded in the Office of the Local civil
registry of the city, municipality
Health records and reports
As specified by EO 352
 The FHSIS- field health service information
system is the official recording and reporting
system of the DOH and is used by the NSCB
(national statistical coordination board) to
generate health statistics
FHSIS is an essential tool in monitoring the health status
of the population at different levels
It is therefore a basis for:
a. Priority setting by local government
b. Planning and decision making at different levels
(brgy, municipality, district, provincial and
national)
c. Monitoring and evaluating health program
implementation
FHSIS manual of operation list describes the ff recording
tools
a. The individual treatment record (ITR)
b. Target clients lists (TCL’s)
c. Summary Table
d. Monthly Consolation Table (MCT)
FHSIS manual of operation list describes the ff recording
tools
A. The individual treatment record (ITR)
- Contains name, date, address and presenting
symptoms or complaint of the patient
B. Target clients lists (TCL’s)
- Plan and carryout patient care
- To facilitate monitoring and supervision
- To report services delivered
C. Summary Table
- accomplished by a midwife
- it has a 12-column table which correspond to
months of the year
- this is kept ln BHS and has 2 components
- health programmed accomplishment
- morbidity disease
- updated on a monthly basis
D. Monthly Consolation Table (MCT)
- is accomplished by the nurse based on the
summary table
- serves as a document for the quarterly form and
output table of the RHU or HC
The reporting forms are on:
Monthly forms (prepared by midwifes and submit to the
nurse)
- Program report (M1)
- Morbidity report (M2)
Quarterly forms (usually prepare by the nurse,
municipality/cities - 1 quarterly report, quarterly forms
are submitted to the provincial health office)
- programs report (Q1)
- program report (Q2)
Annual forms (yearly reports)
- A-BHS
- Annual form 1 (A-1)
- Annual form 2 (A-2)
- Annual form 3 (A-3
Monthly forms
Program report (M1)
- contains indicators categorized as maternal care,
family planning and disease control
- midwives copies the data from the summary table
Morbidity report (M2)
- contains list of all cases of disease by age and sex
Quarterly forms
(Q1) - contains the 3 months total of indicators
categorized as maternal care, dental care
(Q2) - is a 3-month consolidation of morbidity
report (M2)
Annual forms
 A-BHS is a report by the midwife that contains
demographic, natality data that contains
demographic, natality data
 Annual form 1 (A-1) - prepared by the nurse,
report of the RHU contains demographic and
data on natality and mortality for the entire
year
 Annual form 2 (A-2) - also prepare by the nurse,
is a yearly morbidity report by age and sex
 Annual form 3 (A-3) - prepared by the nurse,
yearly report of all deaths by age and sex
B. Health records and reports
 A health record is a confidential compilation of
pertinent facts of an individual's health history,
including all past and present medical
conditions, illnesses and treatments, with
emphasis on the specific events affecting the
patient during the current episode of care
Purpose of medical record
 It serves as tools of communication between
health workers, the family and other health
personnel
 Supply data for essential medical planning and
evaluation
 To provide practitioner with data required for
the application of professional services for
improvement of patient or family health
 To avoid duplication of work
 Legal protection to the hospital doctors and
nurses and other health care provider.
Records are facility-based
That is why they are kept at the
BHS (barangay health station) or at the
RHU (rural health unit) or
HC (health center) and contain a day-to-day
account of the activities of health workers
Healthcare Report
 The purpose of report is to provide information
about the patients you cared for.
C. Disease registry
 Is a listing of persons diagnosed with a specific
type of disease in a defined population
 Registries can provide health care professionals
and researchers with first-hand information
about people with certain conditions, both
individually and as a group, and over time, to
increase our understanding of that condition.
D. Census data
 It provides Information about the members of a
given population collected from a government
census.
 provides more than just a population count but
other variables include ethnicity, income, and
housing values.
 Every five years the census gives us a complete
picture of the nation.
 Philippine statistic system (PSS) - provide statistical
information and services to the public
NSBC (national statistical coordination board) - is the
policy-making and coordinating body of the PSS
NSO - is the arm that generates general purpose
statistical population, employment etc
During census, people may be assigned to a locality by:
 de jure method or
- Assignment is based on the legally established
place of residence of people, they usually live regardless
of where they are at the time of census
 de facto method
- People were assigned to the place where they
are physically present at and at the time of census
regardless, of their usual place of residence
2. Methods to present community data
Presenting data involves the use of a variety of
different graphical techniques to visually show the
reader the relationship between different data sets, to
emphasize the nature of a particular aspect of the data
or appropriately on a map.
Purposes of presenting community data:
 To inform the health team and member of the
community of existing health and health related
condition in the community in an easily
understandable manner
 To appreciate the significance and relevance of
health information to their lives
 To provide basis for better decision making
Graphs for presenting data:
a. Bar graph
b. Pie chart
c. Line graph
d. Scatter plot or diagram
How to present the content of information effectively
a.Use real images.
a) Write short sentences and paragraphs.
b) Explain how you gather the data.
c) Come up with conclusions and then present
how they differ.
d) Make a list of your sources.
e) Avoid distorting the data.
f) Use bold fonts to make text information
engaging.
g) Show your Passion and focus on your
Audience’s Needs.
h) Keep it Simple: Concentrate on your Core
Message.
b. How to present information and recommendations
 Make your material readable.
 Don’t make promises you can’t keep.
 Know why you are recommending something.
 Ensure that you address all the parts of the
problem.
 Ensure you don’t try to solve a problem you
weren’t asked to.
 Be confident & positive.
Effective way of communication in presenting data
 Show your passion and connect with your data
 Show your interest
 Focus on your audience’s need
 Keep it simple; concentrate on your core
message
 Smile and make eye contact with your audience
 Start strongly
 Tell a story
 Use your voice effectively
B. Community diagnosis
o Is the process of determining the health
status of the community and the factors
responsible for it.
o It allows identification of problems and
areas of improvement thereby
stimulating
 Community diagnosis is a quantitative and
qualitative description of the health of citizens
and the factors which influence their health.
1. Types of community diagnosis
 Comprehensive Community Diagnosis
Aims to obtain general information about
the community
- Eg. Physical setting, geography
- Population
- Mortality
- morbidity
- Sanitation
 Problem-Oriented Community Diagnosis
Type of assessment responds to a particular
need
Eg. Measles outbreak
Parasitic infestation
Water supply
a. Traditional participatory action research (PAR
 Participatory action research (PAR) is
intended to study and change a
particular community, neighborhood,
school, organization or group
Purpose of participatory action research
1.To identify problems that the community faces
2. Empower community member to research and
create solutions to those problems
3. To improve condition in the community
 the capacity to change and are able to bring
Key principles of participatory action research
about change.
Commitme Respe Mutu Attentio Action  COPAR should be based on the interest of
nt to the ct of the al n to the to the poorest sector of the community.
participation knowledg learning needs of promote  COPAR should lead to a self-reliant
of ordinary e of all Amon marginalized social community and society.
people as co- participan g or justice for
researcher are t participan disempower those 4 PHASES OF COPAR
involved in ts ed groups marginaliz PRE-ENTRY PHASE,
every aspect of and people ed people ENTRY PHASE
the research and others ORGANIZATION-BUILDING PHASE, AND
like them SUSTENANCE AND STRENGTHENING PHASE.

Key goals of participatory action research Pre-Entry Phase

To produce To take action To be transformative  Is the initial phase of the organizing
practical knowledge and make the both social and for the process where the community organizer
knowledge individual who takes part looks for communities to serve and help.
available
Criteria for Initial Site Selection
 Must have a population of 100-200 families.
Five phases of PAR cycle  Economically depressed.
 No strong resistance from the community.
 No serious peace and order problem.
 No similar group or organization holding the
same program.

2. Entry Phase
 sometimes called the social preparation phase. Is
crucial in determining which strategies for
organizing would suit the chosen community.

Core Group Formation

 Leader spotting through sociogram.
 Key Persons. Approached by most people
 Opinion Leader. Approached by key persons
COPAR
3. Organization-building Phase
 is a vital part of public health nursing.
 It is at this phase where the organized leaders or
groups are being given training (formal,
 A social development approach that aims to informal, OJT) to develop their style in
transform the apathetic, individualistic and managing their own concerns/programs.
voiceless poor into dynamic, participatory and
politically responsive community. 4. Sustenance and Strengthening Phase
 Occurs when the community organization has
Process
already been established and the community
The sequence of steps whereby members of a
members are already actively participating in
community come together to critically assess to
community-wide undertakings.
evaluate community conditions and work together to
improve those conditions.
Key Activities
 Training of CHO for monitoring and
Structure
implementing of community health program.
Refers to a particular group of community members
 Linkaging and networking.
that work together for a common health and health
 Conduct of mobilization on health and
related goals
development concerns.
Importance of COPAR
 Implementation of livelihood projects
 is an important tool for community development
and people empowerment as this helps the
2.Scheme in stating community diagnosis
community workers to generate community
participation in development activities.
1. NANDA (North American Nursing Diagnosis
Association)
PRINCIPLES
 People especially the most oppressed, exploited
 NANDA International, originally known as the
and deprived sectors are open to change, have
North American Nursing Diagnosis Association,
 was founded in 1982.
 A nursing diagnosis is used to determine the
appropriate plan of care for the patient.
 The nursing diagnosis drives interventions and
patient outcomes, enabling the nurse
to develop the patient care plan.
2. Shuster and Goppingen
A format of nursing diagnosis for population groups
utilizes a 3-part statement
a. The health risk or specific problem to which
the community is expose
b. The specific aggregate or community with
whom the nurse will be working to deal with
the
risk or problem
c. Related factors (strength and weaknesses)
that influence how the community will respond
to the health risk or problem
 means a written, planned schedule of
action agreed upon by the program staff,
parents/primary caregivers, and qualified
professional resources
3. Problem rating scale for outcomes
 is a method to evaluate client progress
throughout the period of service.
 It consists of three five-point, Likert-type
scales to measure the entire range of
severity for the concepts of Knowledge,
Behavior, and Status.
 This is usually use in conducting research
survey

3. Omaha System
 Initially designed for clients in the community
settings
 a framework for care of individuals, families and
communities by nurses, nursing educators and
physicians and other health care providers

3 Components (Omaha System)

1. Problem classification scheme
2. Intervention scheme
3. Problem rating scale for outcomes

1. Problem classification scheme

 is a patient-centered assessment that engages
the patients and their families
 It Serves as a guide to collect, classify, analyze,
document, retrieve, and communicate health
and health related needs and strengths

Omaha system: Four domains

Environmental
Psychological
physiological,
and health- related behaviors

2. An intervention scheme
 Is a systematic plan for a course of action
and services