CHN-MIDTERMS

Module 4: Nursing Process in Community Health Nursing Process

the Care of Population Groups  Is a systematic, scientific, dynamic, on-going
interpersonal process in which the nurses and the
and Community clients are viewed as a system with each
affecting one and another and both being affected
Public Health Nursing by the factors within the behavior.
 the term used before for Community  Refers to systematic series of steps which are
Health Nursing followed by public health nurse in community
health and nursing problems using
According to Dr. C.E. Winslow, Public Health is a community
science and art of 3 P’s approaches and resources
 Prevention of Disease
 Prolonging Life
Community Assessment
 Promotion of health and efficiency  Is the process of identifying the strengths,
through organized community effort assets, needs and challenges of a specified
community.
 Seeks to empower community members by
Nursing Process
allowing them to take ownership in affecting
 Is the means by which nurses address the the health of their community instead of
health needs and problems of their clients. providing
 It is a logical and systematic way of them with a perception of what their community
processing information gathered from different needs.
sources and translating intentions into Components of Community Assessment
meaningful actions or intervention
 People
 Place
 Social Systems
Assessment Data
Individual
 Signs and Symptoms
 Medications/Nursing History
 Knowledge, attitudes and practices
 Ability to cope
 Lifestyle
 Help-seeking behavior
 Utilization health services
Family
 Family structure and characteristics
 Socioeconomic and cultural factors
 Environmental factors
 Health Assessment of each member
 Value placed on the prevention of disease
 Competencies on family health care
Community
Basic Phases Elaboration of the Nursing  Population characteristics
of the Nursing Process  Physical characteristics
Process  Environmental factors
ASSESSMENT  Establishing a working  Health/illness data
relationship  Knowledge, attitudes and practices
 Assessment  Community resources
 Diagnosis  Leadership and communication
INTERVENTION  Planning outcomes  Culture
 Planning interventions  Socioeconomic stratification
 Implementation of plan of care  People’s participation in health programs
EVALUATION  Evaluation of
intervention outcomes

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A. Community Health Assessment
Tools
1. Collecting Primary Data:
 the nurse decides on the specific methods
depending on the type of data to be
generated.
 the nurse also may interview people about
their health beliefs
Windshield Survey
 is the motorized equivalent of a simple head-to-toe
assessment
 the observer drives through a chose
neighborhood and uses the five senses and
powers of observation to conduct a general
assessment of that neighborhood. Conclusions
from a windshield survey show common
characteristics about the way people live, where
they live, and the type of housing that exists in a
given neighborhood.
 In the Philippines, considering the standard of
living, the nurse may not have a vehicle for the
windshield survey. In practice, the nurse
conducts a walk-through survey or ocular survey
of the community.
Informant Interviews
 Involve community residents who are either
key informant of members of the general
public.
 Key informants are individuals in positions of
power or influence in the community, such
as leaders in local government, schools and
the religious or business community
 General public interviews may include random
telephone technique or person-on-the street
interviews. Interviews are typically unstructured
and are conducted to collect general information,
Participants Observations
 The nurse observes formal and informal
community activities to determine significant
events and occurrences, leading to
conclusions about what is happening in
selected settings
 Formal gatherings would include local council
meetings, or school board meetings. Informal
gatherings occur at the local coffee shop of
sari- sari store, barber shop, local market, or
school.
 This type of assessment can be effective in
determining values, norms, and concerns of a
community. It may also be an opportunity to
identify the power systems within the
community
 Recognizing how power is distributed
throughout the community social system and
how decisions are made provides important
insights into how
change occurs in a community
1.a. Observation
 This method of data collection is done through the
use of the sensory capacities (sight, hearing, smell
1.b. Survey
 can be used to obtain both qualitative and
quantitative data (survey questionnaire or
survey checklist)
1.c. Interview
 can yield first hand information. wich
include health history, health status, health
of family members, etc)
1.d. Community Forum
 Its immediate purpose is to get feedback or
opinion from the residents in the community
about a problem or an issue.
1.e. Physical Examination
 significant data about health status of individual
family members which can be obtained through
direct IPPA.
2. Secondary Data Sources:
 Secondary data are data collected by
someone other than the user. These include
records, documents, and other previously
collected information
 Secondary data analysis can save time that
would otherwise be spent collecting data.
Particularly in the case of quantitative data,
these can provide larger and higher-quality
databases
that would be unfeasible for any individual to
collect on their own.
a. Registry of Vital Events
 are records of life events kept under
governmental authority, including birth
certificates, marriage licenses (or
marriage certificates), and death
certificates
b. Health Records and Reports
 is the principal repository (storage place) for
data and information about the healthcare
services provided to an individual patient. It
documents the who, what, when, where,
why, and how of patient care.
c. Disease Registries
 Disease or patient registries are collections of
secondary data related to patients with a
specific diagnosis, condition, and procedure.
d. 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.
3. Methods to Present Community Data
 data presentation will depend largely on the
type of data obtained.
 Descriptive data are presented in a narrative
reports. Ex. Geographic data, history of a place
or beliefs regarding illness and death.
 Numerical data may be presented into table or
graphs. Tables and graphs are useful in
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choice of graphs will depend on the type of data
being presented.
a. Line graph
 is primarily intended to portray trends, and
for
changes indicating population growth, birth
rates, morbidity and mortality rates.
 Shows trend data or changes with time or age
with respect to some other variables.
b. Bar graph/Pictograph
 is used to portray absolute or relative frequencies,
population, races or other numerical
measurements across the categories of
qualitative variable or discrete quantitative
(discontinuous) variables
 used for comparisons of absolute or
relative counts and rates between
categories
 A Simple vertical bar graph is best when you
have to compare between two or more
independent variables. Each variable will relate
to a fixed value. The values are positive and
therefore, can be fixed to the horizontal value.
c. Pie chart
 is used to show how the whole is divided into its
component parts through the use of wedge of
slice proportional to the relative contribution of the
component to the whole pie.
d. Descriptive data
 presented
programinplanning
narrative reports
b) To clearly describe the strengths and
B. Community
weaknesses of the community
c) To lead to theDiagnosis
outcomes and strategies to
address and improve the identified health problem
Community
d) To increase Diagnosis
the likelihood that the problem will
be solved
 The bases for developing and
implementing community health nursing
interventions and strategies.
 Community diagnosis or other may call it
community assessment or situational
analysis
 Is the process of determining the health status
of the community and the factors responsible for
it. The term is applied to both the process of
determination and to its findings.
 The nurse collects the data about the
community in order to identify the
different factors that may directly or
indirectly influence the health of the
population
 Then she proceeds to analyze and seek
explanations for the occurrence of health
needs and problems of the community. The
community health nursing diagnoses are
then derived and will become the bases for
developing and implementing community
health nursing interventions and strategies.
This process is called community
diagnosis. Others call it community
assessment or
situational analysis.
A. What is the purpose of writing a community
Types of Community Diagnosis:
1. Comprehensive Community Diagnosis
 Aims to obtain a general information about
the community.
Elements:
a) Demographic variables
b) Socio-Economic and Cultural Variables
c) Health and Illness Pattern
d) Health Resources
e) Political/Leadership Patterns
2. Problem-Oriented Community Diagnosis:
 deals with assessment/problems to a particular
need that are readily seen and should be
acted upon immediately.
Example: A nurse is confronted with health and medical
problems brought about by mining, she then conducts
investigation and identification of the population who are
affected by the hazard posed by mining. Then she goes
on to characterize the environmental factors along with
the other elements which are relevant to the specific
problem being investigated.
The Process/Steps of Community
Diagnosis:
1. Determining the Objectives:
 the nurse decides on the depth and scope of
the data she needs to gather
 the nurse must determine the occurrence and
distribution of selected environmental, socio-
economic and behavioral conditions important
to disease control and wellness promotion.
2. Defining the Study Population:
 the nurse identifies the population group to
be included in the study
 it may include the entire population in the
community or a specific population group such
as women in the reproductive age, infants or
male populations.
3. Determining the data to be collected:
 the objectives guides the nurse in identifying
the specific data she will collect.
 She also decides on the sources of data
whether these data are available from the
records of agencies or from the people
themselves.
4. Collecting the Data:
 the nurse decides on the specific methods
depending on the type of data to be
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 ex. Through an ocular survey the nurse is able
to determine the physical and topographical
characteristics of the community.
 the nurse also may interview people about
their health beliefs
 the nurse can also review existing health
records in the rural health unit
5. Developing the Instrument:
 Instrument or tools facilitate the nurse's data-
gathering activities. The following are the
most common instruments that the nurse use
in her data collection:
a) Survey questionnaire
b) Interview guide
c) Observation checklist
6. Actual data Gathering:
 Before the actual data gathering, it is
suggested that the nurse meet the people who
will be involved in the data collection
 The instruments are discussed and analyzed
 If necessary, the instruments may be modified
or simplified in order not to overburden the
people who may have limitations in terms of
educational preparation or available time to
finish data collection
 Pre-testing is highly recommended
 The data collectors must be given an
orientation and training on how they are going
to use the instruments in data gathering.
 The nurse can ask the data collectors to role
play an interview scene so that they can place
themselves in an actual interview situation
 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 gathered/collected.
7. Data Collation:
 After data collection, the nurse is now ready
to put together all the information.
 There are two types of data that may be
generated: numerical data which can be
counted and descriptive data which can be
described.
 To facilitate data collation, the nurse must
developed categories for classification of
responses making sure that the categories
are mutually exclusive and exhaustive.
 After data collation, summarized the data
8. Data Presentation:
 data presentation will depend largely on the
type of data obtained.
 Descriptive data are presented in a narrative
reports. Ex. Geographic data, history of a
place or beliefs regarding illness and death.
 Numerical data may be presented into table or
graphs. Tables and graphs are useful in
showing key information making it easier to
comparisons including patterns and trends. The
choice of graphs will depend on the type of
data being presented.
9. Data Analysis:
 aims to establish 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 the Community Health
Nursing Problems:
Categories of Community Health Nursing Problems:
a) Health Status Problems – They may be
described in terms of increased or decreased
morbidity, mortality, fertility or reduced capability
for wellness.
b) Health Resources Problems – They may be
described in terms of lack of or absence of
manpower, money, materials or institutions
necessary to solve health problems.
c) Health-Related Problems – They may be
described in terms of existence of social,
economic, environmental and political factors
that aggravate the illness-including situations
in the community.
11. Priority Setting:
 Prioritize which health problems can be attend
to considering the resources available at the
moment
Criteria use in priority setting:
a) Nature of the condition/problem presented –
the problems are classified by the nurse as
health status, health resources or health -
related problems.
b) Magnitude of the problem – this refers to the
severity of the problem which can be
measured in terms of the proportion of the
population affected by the problem
c) Modifiability of the problem – this refers to
the probability of reducing, controlling or
eradicating the problem
d) Preventive potential – this refers to the
probability of controlling or reducing the
effects posed by the problem.
e) Social concern – this 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 1
 health status 3
 health resources 2
 health related 1
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Magnitude of the problem 3 problem is determined by the people who believe

 75- 100% affected 4 and feel that the problem is really a problem in
 50-74% affected 3 the local setting and the solution to the problem is
 25-49% 2 within the same setting without intention of
 <25% affected 1 generalizing its results
Modifiable of the problem 4 Characteristics of Participatory Action
 High 3 Researched
 Moderate 2 1. People-oriented
 Low 1 2. Community involvement
 Not modifiable 0 3. Group-research
4. Big crowd
Preventive potential 1 5. Political involvement
 High 3
 Moderate 2 Cyclical mode of PAR
 Low 1
Social concern 1
 Urgent community concern
/expressed readiness 2
 Recognized as a problem
nut not needing urgent attention 1
 Not a community concern 0
TOTAL SCORE 10

Example: PROBLEM: Rising case of Dengue H.

Fever

Criteria Computati Actual Score Justifi Framework of Participatory

on cation
Action Research
Nature of the 3/3 x 1 (3/3)x1=1 1. Identification of the problem and community
problem 2. Statement of the goals/objectives
3. Identification of participant
Magnitude of the 3/4x3 (3/4) x3 =2.25 4. Organization of the research team
problem 5. Establishment of timetable
Modifiability of the 1/2 x 4 (1/2)x4=2 6. Conduct of the participatory action
problem research project
7. Evaluation of results
3/3 x 1 (3/3)x1=1 8. Interpretation of the findings
Preventive
9. Implications/recommendations
Potential
10. Implementation
Social concern 1/2x 1 (1/2)x1=.5
Advantages of PAR
TOTAL SCORE 6.75 1. Research participants increases their knowledge
and ideas as well as valid analysis of social
reality, thus, more relevant solutions are achieved
2. Both researchers and subjects of the study
Participatory Action Research gain more from the research process when the
researchers attain greater sensitivity and self-
(PAR) awareness of the problems
3. The subject of the study gain trust and self-
Participatory Action Research confidence at their own rate and resources
to improve their conditions
 Is a form of action research in which
4. Good relationship can be developed among the
professional social researchers operate as full
research team, research participants, and
collaborators with members of organizations in
people in the community
studying and transforming those organizations
5. Humanistic approach is enhanced
 It is an ongoing organizational learning process,
through involvement of everyone in
a research approach that emphasizes co-
solving social problems
learning, participation and organizational
transformation. (Greenwood et al, 1993)
 Is an attribute of action research in which the
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b. Health Resources Problems – They may

described in terms of lack of or absence of
Disadvantages of PAR manpower, money, materials or
institutions necessary to solve health
1. It is time consuming because it takes time to problems.
involve many people in conducting c. Health-Related Problems – They may be
research described in terms of existence of social,
2. It is difficult to gather people and manage to economic, environmental and political factors
attend the general assembly due to large number that
of people involved aggravate the illness-including situations in the
3. When the research team back-out while the community.
research process is going on, a new team is
created therefore you have to start all over
again Planning Cycle:
4. The research team may use their power to
personal needs and most of the benefits go to
them Situational analysis:
5. Politicians who get involved in the research Where are we now?
process may use traditional techniques and the  Gather health data
said technique may prevail  Tabulate, analyze and
6. Abuse of discretion by research team may be interpret
practiced due to too much trust and confidence by  Identify health problems
the research participants and subjects of the  Set priority
study to them and they do not check and balance
their activities
7. With full people’s participation, factors such as
experiences, educational qualifications, socio-
economic status, knowledge, abilities and skills
will affect the benefit of participants. The less
Evaluation:
experiences, knowledge, abilities and skills one Goal and Objective Setting:
How do we know we
Where do we want to go?
are there?
 Determine outcomes  Define program
C. Planning: Planning of Community  Specify criteria
goals and objectives
Health Interventions  Assign priorities among
and standards
objectives

Planning
 Planning is a process that entails formulation
of steps to be undertaken in the future in order
Strategy/Activity Setting:
to achieve Howend.
a desired do we get there?
 Design CHN programs
 Planning takes place in order to efficiently
allocate available resources.  Ascertain resources
 In general, planning is done in our desire  Analyze constraints
to improve the present state of affairs. and limitations
 Planning in community health nursing involves
the orderly process of assessing the health
problems and needs of the community.
 Priority goals are set according to availability 1. Priority setting/Situational Analysis
of resources.
 Interventions are carefully thought of considering
constraints or limitations as they may hamper
the
realization of set goals.
Concepts of Planning:
 Planning is futuristic
 Planning is changed-oriented
 Planning is a continuous and dynamic process
 Planning is flexible
 Planning is a systematic process
Bases For Developing A Community Health
Plan
a. Health Status Problems – They may be Abby
described in terms of increased or decreased
morbidity, mortality, fertility or reduced capability
CHN-MIDTERMS

 Answers the question “Where are we now”?

 Involves the process of collecting,
synthesizing, analyzing and interpreting
information in the community
 It brings out the health problems of the community
 in this phase, the nurse provides explanation
to the problems
 The nurse use CDX report as basis for
the situational analysis

Activities of the CHN:

A. Gathers data about health status of
the community
B. Identifies and explains the problems
C. Projects what situation needs to be
changed, developed or maintained

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2. Formulating Goals and Objectives

 “Where do we want to go”? refers to the process
of formulating goals and objectives of the health
program.
 Goals and Objectives serves as guide to
the nurse’s efforts.
 A goal leads to a desired end which may be a
total change, improvement or a maintenance of a
situation
 Directed towards solving a problem which
the nurse identified in the community
diagnosis
Goals Should Be Realistic or Attainable
a  It should be at reasonable level
 Too high the goal may frustrate the Community
 Objectives – refers to more specific statements of
the desired results or outcomes of care.
 Objectives – are the milestones to reach the
destination
disease
Goals-
andtell where the community is going
threat.
 Short term or immediate objective:
 All members of the community will use self-
protection measures at night till early
morning when biting time at malaria vector
is expected.
 Medium term or intermediate objective:
 All members of the community will
have medical check-up and laboratory
confirmation (Example blood smear) to
diagnosed malaria.
3. Strategy and Activity Setting
 Long-term or ultimate objective:  Answers the question “How do we get there?”
 All members of the community will carry  Strategies and the activities that the nurse sets to
out mosquito vector control measures. achieve in order to realize the goals and
objectives
SMARTer Objectives  It implies identification of resources-
manpower, money, materials, technology, time
Element Synonyms Challenge yourself and institutions-needed to implement the
program
Specific Significant, Are you being precise Activities involves:
Stretching about what you want to
 Designing the health program or services
Simple achieve?
 Budgeting
Measurable Meaningful, Have you quantified your
 Formulation of a time plan or schedule
Motivational objectives?
Manageable 4. The Evaluation Plan
Attainable Appropriate, Are you attempting to  Answers the question “How do we know we
Kinds of Objectives
Achievable According
achieveto Time
too much?Span: are there?”
Agreed,
1. Short-term or immediate objectives  Find out if he programs and services achieve
Assignable
 are formulated for problem situations which D. the purpose for which Community
Implementing they were formulated
 Determine whether the program is
Health
Relevant Realistic, attention,
require immediate Doandyou results
have resources
can be
Resourced to make
observed in a relatively short period the
ofobjective
time.
Interventions
relevant, effective, efficient and adequate
Rewarding withhappen?
Can be accomplished a few nurse patient
Time- contacts.Timely, Time- Have you stated by 1. Importance
Steps: of partnership
The Evaluation Plan and collaboration:
Relatively require fewer resources.
Long-term Specific,
bound
2. when the objective
or ultimate objectives  A.TheDeciding what to evaluate
aim of partnership in terms of is to
and collaboration
Trackable
 require several encounters,should be achieved?
an investment of relevance, progress, effectivity,
get people to work together in order impact and
to address
Evaluation efficiency
more resources. Requires time toon
Are we track to
demonstrate. problems or concerns that affect them
3. Medium-term or intermediate achieve the goal?
objectives  B.It gives
Designing heopportunity
people evaluation plan specifying
to learn skills inthe
Review Do we need to re-define evaluation indicators,
group relationship. data needed, methods
 are those which are not immediately achieved
the objective? and tools for data collection
 The community health nurse must plan toand data sources
and are required to attain the long-term ones
C.establish
Collection
andofmaintain
relevantvaluable
data working
D.relationships
Analyzing the withdata
people such as POs,
Example:
E.health
Making decisions
Nursing Goal: The Community will manage Dengue as
organizations, educational institutions, the LGUs,
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financial institutions, religious groups, socio-civic
organizations, NGOs and sectoral groups.
Terms:
A. Networking - relationship among
organizations that consists of exchanging
information about each other’s goals and
objectives, services or facilities.
B. Coordination - relationship where
organization modify their activities in order to
provide better service to the target beneficiary.
C. Cooperation - relationship where organization
share information and resources and make
adjustments in one’s own agenda to
accommodate the other organization’s
agenda.
D. Collaboration – level of organizational
relationship where organizations help each
other enhance their capacities in performing
their task as well as in the provision of services.
E. Coalition or Multi-sector Collaboration – level
of relationship where organizations and citizens
for a partnership. All parties give priority to the
community.
F. Advocacy – Helps empower the people to make
decisions and carry out actions that have
the potential to better their lives.
2. Activities involved in collaboration and
advocacy
A. Collaboration – level of organizational
relationship where organizations help each other
enhance their capacities in performing their task as
well as in the provision of services.
Activities in Collaboration involves:
1) It is imperative for the nurse to involve all
the stakeholders in the process of forgoing
partnership
And collaboration with the community
2) In working together, the nurse and the community
face risks together. It is important therefore, that
they need to know and trust each other.
3) Determine how each organization views the
problem, how it proposes to solve the problem
and how it perceives an organizational
relationship can help solve the problem
4) Organizations should agree on the kind or level
of relationship that will help best accomplish the
group goals considering needs and available
resources
5) Formulate ground rules that will become the
bases for decision-making. The following are the
most important points:
a. Listen to what each has to say
b. Take time to listen to people who voice
different opinions or concerns. Keep
an open mind.
c. Don’t force organizations to give up their
identities. Remember, organizations
work together for a common good.
B. Advocacy – Helps empower the people to make
decisions and carry out actions that have the potential
better their lives. This involves:
1) Informing the people about the rightness of
the cause
2) Thoroughly discussing with the people the
nature of the alternatives, their content and
possible consequences
3) Supporting people’s right to make a choice and
to act on their choice
4) Influencing public opinion
Advocacy
 The act or process of supporting a cause
or proposal
 Community health advocacy entails advocacy by a
community around issues related to health,
however that community is defined or formed.
Levels of Advocacy (Lynda L. West, Stephanie
Corbey, Arden Boyer-Stephens, and Bonnie Jones, et
al. (1999)
 Self-Advocacy – I can speak up for myself
 Individual Advocacy – I can speak up on
behalf of another
 Systematic Advocacy – we speak on behalf of
those who can’t speak for themselves
3. Community organizing and social
mobilization
Community Organizing
 A social development methodology is utilized to
facilitate the process of forming and sustaining
self-reliant and self-determining communities.
 Is a process whereby the community members
develop the capability to assess their health
needs and problems, plan and implement actions
to
solve these problems.
Phases of Community Organizing
A. Preparatory Phase
 includes area selection, community profiling,
entry in the community and integration with the
people.
Area Selection – guided with the following
questions;
1. Is the community in need of assistance?
2. Do the community members feel the need to
work together to overcome a specific
problems?
3. Are there concerned groups and
organizations that the nurse can possibly work
with?
4. What will be the counterpart of the community
in terms of community support, commitment
and human resource?
Community Profiling (Community Profile)
 Provides an overview of demographic
characteristics, community related services
and activities.
 once selected, a community member will
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 It will serve as an initial database of the
community and provide the basis for planning
and programming of organizing activities
Entry in the Community and Integration with the
people:
 Before entry in the community, know first
the cultural practices and lifestyle of the
people
 Establish rapport and integrate with the
people and understand or imbibe their
community life.
 Living the people and undergoing their hardship
and problems and sharing their hopes and
aspirations help build mutual trust and
cooperation
Guidelines in conducting integration work:
1. Recognize the role and position of
local authorities
2. Adapt a lifestyle in keeping with that of
the community
3. Choose a model dwelling which the people,
especially the economically disadvantaged
will not hesitate to enter
4. Avoid raising expectations of the people.
Be clear with your objectives and limitations
5. Participate directly in production process
6. Make house calls and seek out people
where they usually gather
7. Participate in some social activities
B. Organizational Phase
Consists of activities leading to the formation of a
people’s organization
1) Social preparation – learn more about the
conditions of the community, the nurse
deepens and strengthens her ties with the
people
2) Spotting and developing potential leaders
– gain the trust and respect of the community
members. Provide opportunities and test the
commitment to the community’s well being.
Nurse provide learning experiences that will
prepare them as future leaders of the
community.
3) Core group formation – identify potential
leaders who will be tasked with laying down
the foundation of a strong people’s
organization
4) Setting up the community organization – this
organization will participate in a wider
participation and collective action on
community problems.
C. Education and Training Phase
 this is to strengthen the organization and
develop its capability and attend to community’s
basic health-care needs.
1. Conducting community diagnosis
2. Training of community health workers
D.
Intersectoral Collaboration Phase
 Facilitate and coordinate with
institutions, agencies and other key
people.
E. Phase-out
 Turn over of works to the community
organization and develop monitoring and follow-
up activities.
Social mobilization
 is 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.
 Mobilization- a Military terminology
 To Mobilize- to prepare forces for action
 A process of motivating communities to organize
in a cohesive group for an active participation
towards their own development
 An integrative process where stakeholders are
stimulated to become active participants in
social change, using diverse strategies o meet
shared goals
 A comprehensive planning approach
that emphasizes
 Political coalition building
 Community action
 The process is concerned with mobilizing
human and financial resources through five
main approaches:
1. Political Mobilization
2. Community Mobilization
3. Government Mobilization
4. Corporate Mobilization
5. Beneficiary Mobilization
Community Mobilization
 Aims at informing and gaining the commitment
of community leaders as well as local
government agencies, Nongovernmental
organizations (NGOs), women’s groups and
cooperatives
Tips on Community Mobilization
1. Know your community well, and understand
their problems and their needs
2. Be aware of existing health beliefs and
practices that exist in the community
3. Always listen to community members carefully
4. Do not rapidly introduce new interventions that
are different from existing practices and beliefs.
Take gradual steps to introduce such practices
5. Try to analyze community dynamics and adjust
to each situation
6. Involve the entire community in the program
right from the beginning.
7. Give respect and importance to negative
experiences of the community, if any, and try to
minimize the negative feelings verbally and in
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Key Elements of Social Mobilization
1) Partnership building and networking
2) Community participation
3) Media and special events to raise
public awareness
4) Advocacy to mobilize resources and effect
policy change
4. Core Principles in Community Organizing
 People, especially the most depressed,
oppressed, poor and exploited (DOPE) sectors
are open to change, have the capacity to change
and are able to bring about change.
 Should be based on the interest of the
poorest sectors of society
 Should lead to a self-reliant community
and society
 Planning groups needs to represent all
people concerned and discussion must
include organization and group discussion
 Technique of asking questions is often important
in developing community organization and
group discussion
 Major discussion should be made by he
entire group
 Local factors and available personnel should be
asked in determining what types of organization
is desirable and practicable
 Functions of an agencies and members must
be defined
 A good organization plan can succeed only when
the people who operate it will see its values
which are compatible personally and not
antagonistic
professionally
Principles of CHN
E- ducation as primary tool and responsibility
M- ade available to all regardless of race, creed
and socio-economic status
P- olicies and objectives of the agency is fully
understood by the nurse
O- rganizing for health, with the family as the unit
of service
W- orks as a member of the health team (PHN)
E- xisting active organizations are utilized
R- ecording and reporting are accurate
M-onitoring and evaluation of services is periodically
done
E- xisting indigenous resources of the community
is used
N- eeds of clienteles is recognized and serves as
basis for CHN
T- raining and development as opportunities for
continuing staff education programs
5. Goals of community organizing
Aims /Goals of Community Organizing (Apuan 1988)
1. to achieve effective power for the people so they
can determine their own development and
shape their own future;
2. to establish and sustain relatively permanent
organizational structures, which best serve
people’s needs; and
3. to build or join alliances that are useful to the
people. She explains that the first goal of
empowerment enables people to overcome the
dehumanizing effects of powerlessness and
become human beings with dignity, assertive of
their rights, and able to determine their destiny.
Community Organizing Participatory Action
Research (COPAR)
 as been a strategy used by Health Resource
Distribution Program(HRDP 111) in implementing
the Primary Health Care delivery in depressed
and underserved communities to become self -
reliant.
 is a social development approach that aims to
transform the apathetic, individualistic and
voiceless poor into dynamic , participatory and
politically responsive community.
COPAR PROCESS
1. Pre-entry Phase
 Community consultation/dialogues
 Setting of issues/considerations related to
site selection
 Development of criteria for the selection
 Site selection
 Preliminary Social Investigation (PSI)
 Networking the local government units
(LGUs), NGOs, and other departments
2. Entry Phase
 Integration with the community
 Sensitization of the
community/information campaigns
 Continuing social investigation
 Core group (CG) formation
 Development of criteria for selection of CG
members
 Defining the roles/functions/tasks of the CG
 Coordination/Dialogue/Consultation with other
community organizations
 Self- Awareness and Leadership Training (SALT)
Action planning
3. Community Study/Diagnosis Phase
(Research Phase)
 Selection of the research team
 Training on data collection methods
and techniques/capability building
 Planning for the actual gathering of data
 Data gathering
 Training of data validation (include tabulation
and preliminary analysis of data)
 Community validation
 Presentation of the community
study/diagnosis and recommendations
 Prioritization of community needs/problems
for action
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CHN-MIDTERMS
4. Community Organization and Capability –Building
Phase
 Community meetings to draw up guidelines for
the organization of the Health Organization
Community (CHO)
 Election of officers
 Development of management systems and
procedures, including delineation of the roles,
functions and tasks of officers and members of the
CHO
 Team building/Action-Reflection-Action (ARA)
 Organization of working committees/task
groups (e.g. education and training)
 Training of the CHO officers/community leaders
5. Community Action Phase
 Organization and training of community
health workers
 Development of criteria for the selection
of Community Health Workers (CHWs)
Selection of CHWs
 Training of CHWs
 Setting up of linkages/network referral system
 PIME of health services/intervention schemes
and community development projects
 Initial identification and implementation
 Resource mobilization schemes
6. Sustenance and Strengthening Phase
 Formulation and ratification of constitution and by-
laws
 Identification and development of
“secondary” leaders
 Setting up and institutionalization or financing
scheme for community health
programs/activities
 Formalizing and institutionalization of
linkages, networks and referral systems
 Development and implementation of
viable management systems and
procedures, committees, continuing
education/
 COPAR process training of leaders, CHWs,
community residents
 Continuing education and upgrading of
community leaders, CHWs, and CHO members
 Development of medium/long term community
health development plan
E. Monitoring and Evaluating
Community Health Programs
Implemented
1. Designing and implementing evaluation Plan
 Public Health Nurse should specify the criteria
and corresponding evaluation tool for each
objective.
 Example of Different Tool or Instrument:
Thermometer, BP, weighing scale, tape
measure, checklist or interview guide.
 If the expected outcomes are related to the
client’s condition, then he/she can be observed
and interviewed
 If a post-CVA patient, an observation checklist
can be used to determine his/her response to
nursing intervention
 If the level of consciousness or orientation is
altered, the immediate members of the family can
be interviewed.
SAMPLE FORM IN DESIGNING AND EVALUATION PLAN
OBJECTIVE CRITERIA FOR EVALUATION TOOL
EVLAUATION
A checklist is a good evaluation tool if there are a
number of criteria for an objective. Example, if the
PHN is going to evaluate the response of the family
client to the community’s malaria prevention and
control program, she/he should prepare a checklist
similar to this
SAMPLE EVALUATION CHECKLIST
DIrection: Put a check mark on the appropriate column and write signific
ant explanatory notes on the Remarks column
CRITERIA Check if observe Remarks
d
YES NO
The client takes prescribed anti-
malarial drugs correctly
Each family member sleeps under a
mosquito net
The family eliminates the breeding and
resting sites of the mosquito vector
The family takes care of the family
member with malaria correctly
 If the evaluator would like to measure the
knowledge of the client, relevant questions
should be asked
 In preparing a list of questions o be asked, the
evaluator should make sure that the questions
are clear and easy to understand.
 Example:
 Criterion: The mother will be able to
identify the consequences of vitamin A
deficiency
 Question: “Misis, pwedi mo bang sabihin
ang lahat ng alam mo na maaaring
mangyari sa batang kulang sa Bitamina
A?”
 Criterion: The mother will be able to identify
food sources of vitamin A
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CHN-MIDTERMS
ng limang pagkain na mayaman sa Bitamina
A?”
 If SKILLS are the focus of the evaluation, the
client can be asked to demonstrate the specific
skills that she/he learned or observed for
specific health practices or behaviors
 ATTITUDE can be assessed through qualitative,
semi-structured or unstructured interviews. In
our “KWENTOHAN” with our clients, when they
are more relaxed and not theatened with our
presence, they tend to be more open with their
feelings. Through informal talks, it is easier to
assess our clients’ attitude.
 After collection and analysis of data/information,
the nurse should give his/her clients feedback on
the results of evaluation
Purposes of giving feedback:
 Motivates and reinforces positive behaviors
 Enhances client’s self-image and increases
client’s awareness of the need to improve
their repertoire of coping behaviors.
 Provide opportunity for clients to articulate
their thoughts regarding the task on hand
 The result of the feedback sessions should
be properly documented
 The family health record and other
pertinent records should be updated
regularly
Monitoring
 UN defined monitoring as the “continuous or
periodic review and surveillance by management
at every level of the hierarchy of the
implementation of an activity to ensure that input
deliveries, work schedules, targeted outputs and
other required actions are proceeding according
to plan.
 Monitoring is closely related to evaluation.
Monitoring which is done ate the implementation
phase compares the actual progress 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
requires reporting to appropriate persons or
offices
at regular intervals
Evaluation
 is the analysis of the effectiveness, quality, scope
and timeliness of services given. - Define as the
process for determining systematically and
objectively the relevance, efficiency and
effectiveness and impact of activities in the light
of their objectives
 According to UN, evaluation simply is the
collection and analysis of information to determine
program performance.
Aims of Evaluation:
 Discover how well the objectives are fulfilled
 Determine the reasons for specific successes
 To uncover principles underlying a
successful program
 Prevent costly mistakes and improve
program planning and implementation in the
future
2. Types of Evaluation
A. Ongoing Evaluation
 is the analysis during the implementation of
the activity, of its continuing relevance,
efficiency and effectiveness and present and
likely future outputs, effects and impact.
 focuses on the appropriateness, adequacy
and timeliness of processes or activities
B. Terminal Evaluation
 is undertaken from 6-12 months after the
project completion
 it is a substitute for an Ex post evaluation of
projects with short duration
C. Ex post Evaluation
 is undertaken some years after the project
completion when full program/project benefits
and impact are expected to have been
realized
2 Purposes of Terminal and Ex post Evaluation
A. To assess the achievement of overall results
of the program, in terms of efficiency, outputs,
effects and impact
B. To learn lessons for future planning
Formative vs Summative Evaluation
A formative evaluation
 (sometimes referred to as internal) is a method
for judging the worth of a program while the
program activities are forming (in progress). They
can be conducted during any phase of the
Analysis Design Development Implementation
and Evaluation (ADDIE) process. This part of the
evaluation focuses on the process.
A summative evaluation
 (sometimes referred to as external) is a method
of judging the worth of a program at the end of
the program activities (summation). The focus is
on
the outcome.
FOCUS OF EVALUATION
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Three Major Foci of Program Evaluation:

1) Inputs
2) Process
3) Outcome/Result

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).

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CHN-MIDTERMS
 Effects are the outcomes of the use
project outputs (intermediate).
 Impact is the output of program effects and is
an expression of broader, long-range program
objectives.
Indicators
 It is a specific and objectively verifiable measure
of changes or results brought about by an activity
 Used as marker of progress towards
the attainment of program objectives
 Indicators should be valid, reliable,
objective, sensitive, specific, cost-effective
and timely
Valid
 measures what is supposed to measure
Reliable
 if it lends itself to measurement with
minimum error
Objective
 It is not influenced by personal biases or if he
answers are the same if measured by
different people in similar circumstances
Sensitive
 if changes in the indicator in fact reflect changes
in the situation or phenomenon
Specific
 if it is sensitive to the given situation
or phenomenon only
Cost-effective
 if the results are worth the time and money it
costs to apply them
Timely
 if it is possible to collect data reasonably quickly
3. Steps of Program Evaluation
A. Decide what to Evaluate
 The WHO suggested five dimensions of
program performance that could be then
evaluated: relevance, progress, effectiveness,
impact and efficiency
 the evaluator should review the program
context and objectives
 questions that need to be answered at this point
are: What should be evaluated? What
indicators should be used?
B. Design the Evaluation Plan
 Specifying data collection methods and tools
and sources of data
 Records and reports should be analyzed
 Surveys can be conducted to collect information
on clients’ knowledge, attitudes and practices
 Local officials, community leaders and
program implementers can also be interviewed
 Data collection tools include questionnaires
or interview schedules and checklists
 Qualitative interviews or focus group discussions
can be conducted among a smaller number of
participants to have more in-depth
understanding of the program outcomes from the
perspective of
the beneficiaries.
C. Collect Relevant Data
 The evaluator’s primary aim is the generation
of accurate and reliable data
 Prior to actual data collection, data collection
method and tools should be field-tested and data
collectors should trained
D. Analyze Data
 Evaluators should assess the quality of the
data before they start their analysis
The following are questions that the evaluator
should reflect:
1) What do the figures/statistics mean?
2) What do the qualitative data reveal?
3) Is the program relevant?
4) Is it progressing in accordance with the
program plan?
5) Is it effective?
6) Is it efficient?
7) Did it make a significant impact on
the beneficiaries and the community?
8) Do the benefits outweigh the problems created?
9) What are the lessons that could be learned
from the program?
E. 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 there is still another phase of the program,
then positive evaluation results should serve as
a go- signal to start the next phase
 Based on the lessons learned from the earlier
phase, the implementation of the next phase
will have to be guided, modified or improved
 if the program is not relevant, the evaluator
should recommend its modification or termination.
F. Report/Give Feedback
 The result of the program evaluation should be
submitted to the local authorities such as
mayors, chair of the SB committee on health,
and the Local Health Board
 It must be noted that they are the key
decision makers in the Local Health System
 An executive summary should be prepared for
them and should contain a brief description of the
focus and procedures of the evaluation, summary
and interpretation of results, conclusions and
recommendations
 the nurse and other health workers must be
prepared to make a presentation to the SB
or
Local Health Board
Key for a better presentation:
1) Prepared a good visual aids
2) Rehearse and prepare for the questions that may
be asked
3) A good written report and an impressive oral
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CHN-MIDTERMS
presentation can influence decision makers
positively
F. Documentation and
Reporting
Documentation
 Serves as a permanent record of client information
and care.
Reporting
 Takes place when two or more person share
information about client care, either face to face
or
by telephone
Purposes of Client’s/family Record:
1) Communication – sharing of information
about the client
2) Legal documentation – use as evidence in court
3) Research – provides health data for research
4) Statistics – provides statistical information for
planning
5) Education – tool for students
6) Audit and Quality assurance – monitor quality
of care received by client
7) Planning client care – data are used by
healthcare team members for continued
client care
8) Reimbursement -
1. FIELD HEALTH SERVICES AND
INFORMATION SYSTEM (FHSIS)
Composed of recording and reporting tools.
 Records are facility based, that is they are kept
at the BHS or at the RHU, and contain a day to
day account of the activities of health workers.
Services delivered to the clients are the basis of
the data entered in the records.
 Records serve as the basis of report.
 Reports consists of summary data that are
transmitted or submitted monthly, quarterly,
and annually to a higher level.
The recording tools:
1) Individual Treatment Record (ITR)- is the
building block of the FHSIS .
2) Target Client List – (TCL) the second building
block of the FHSIS . The following purposes of
the TCL:
a. To plan and carry out patient care
and services; to monitor target.
b. To facilitate monitoring and supervision
of service activities.
c. To report services delivered.
d. To provide a clinic level database that
can be accessed for further studies.
The following are TCLs maintained at the RHUs and
Health Centers
a. TCL for Prenatal Care
b. TCL for Postpartum Care
c. TCL of Under 1-year old children
d. TCL for family planning
e. TCL for sick children
f. National Tuberculosis Program register
g. National Leprosy Control Program
3) Summary Table – the monthly summary
table serves as a source for the 10 leading
causes of morbidity in the municipality/city.
4) Monthly Consolidation Table (MCT) –
accomplished by the nurse based on the summary
table
The following forms:
1. Monthly forms –prepared by the midwife
and submitted to the nurse.
a. Program report (M1)
b. Morbidity report (M2) contains a list of
all cases of disease by age and sex.
2. Quarterly forms are usually prepared by
the nurse.
a. Program report (Q1)
b. Morbidity report (Q2)
3. Annual forms
a. A BHS report of the midwife that contains
Demographic, environmental , and natality
data
b. Annual form 1 (A-1) prepared by the nurse
and is the report of the RHU or health
center
c. Annual form 2 (A-2) yearly report
morbidity by age and sex
d. Annual form e(A-3) yearly report of
all deaths (mortality) by age and sex.
2. Community Profile
 Is a summary of baseline conditions and trends
in a community and study area. It establishes the
context for assessing potential impacts and for
project decision-making.
 Is a data sheet that records information on a
broad range of factors (such as
environmental/natural features and management,
sociodemographic characteristics, political and
economic structures, local institutions, economic
activities and livelihoods, basic household and
community facilities
 The purpose of a community profile is to enable
mission members to develop a sufficient
understanding of the community as a whole to
be able to: ... understand the context in which
households and local institutions operate so that
they can identify linkages.
Community profiling
 is used to identify the strengths, weaknesses,
needs and problems of a community, to make
decisions about health services and to justify
the allocation of resources.
The community profile provides:
 an overview of demographic characteristics
 community and health related services
and facilities
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 serves as an initial database of the community Vital

 provide basis for planning and programming of  events records: birth and death records
activities  General information records; individual
 Help determine the appropriate approach and records, family, village, map of community
method of organizing specific population  Other records:
group  Antenatal records
or sectors.  Medicine records
Steps on How to Conduct Community  Monthly/yearly records
Profiling:  Consumable stock register
These steps and methods can be combined in To be kept with the Patient
various ways, depending on the context. Kept under supervision of community health nurse:
These are:
Step 1: Identify Research Issues and Set Objectives.  Health record of school going children
Step 2: Select and Sequence Tools.  Infant health card
Step 3: Record the Data.  Maternal card
Step 4: Validate the Findings.  TB patient card
Records and Reports at Community  Individual health card
 Birth and death record
Level  Inpatient and outpatient record
Records  Eligible couple records
 Health records refers to the forms on  Movement register
which information about an individual or  Medicine stock register
family is recorded
Reports Important Health Records
 These are account or statement describing in 1. Daily diary: daily activities of community health nurse
detail an event, situation, or like, usually as the 2. Village record: it consist of
result of observation, inquiry, etc. a formal or  Name of village
official presentation of facts.
 distance from health center
Types of Records  total no. of families
 total population
1. PERIODICAL  religious beliefs
 Permanent records (cumulative)  no. of women under different age group
 Temporary records (casual/daily records)
2. UNIT BASED RECORDS Cumulative records
 Individual (individual health cards)  cumulative means gradual increasing in
 Related to family (family folders) amount by one adding after another
 Related to community (community folders)  it is continuing record procedure
 National (national health programs records)  time saving, economical, review total history
3. SUBJECT BASED of individual
 Economical (financial structure of family, village)  evaluate progress for longer period
 Social (records of social structure) (nursing students clinical record)
 Political
 Medical and nursing (treatment and Family folder
medicine records)  condition and address of residence
4. COLLECTION PLACE BASED  name of head of family
 Collected at institutions (records of  religion and cast
hospitals/ health centers)  name of family member
 Records to be kept with the  education, occupation, economic status,
individual (immunization cards, diet, eligible couple, environment
disease cards) Reports
 Account or statement describing in detail an
Records to be kept under health centers event, situation or like usually as the result of
1. Family folders observation, inquiry etc.
 MCH cards  A formal or official presentation of facts
 Antenatal card/postnatal cards  Reports means fact findings
 Infant card  Reports can be oral or written
 Pre-school child card  Can be daily, monthly, quarterly, half yearly
 Medicine distribution card include records of and annual
iron and folic acid distribution cards  Analytical aspect of a subject or services
 Family welfare records: eligible couple, mtp, is presented in a report
family planning
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Types of Reports

2 Types:
1) Verbal report
2) Written report

In hospital important reports are:

 24hrs reports
 Night and day report
 Supervision report
 Patient census report
 Accident report

In Community:
 Anecdotal reports
 Monthly, quarterly, yearly or annually reports
 Evaluatory report

Importance of Records and Reports

 Assess health level of community
 Helps in collecting data
 Assessment and evaluation of work
 Basis for formulating plans
 Tool or medium for health education
 Determine needs of resources
 Legal documentation
 Means of communication
 Provide information of good nursing
 Conduct training and research work
 Assess health problems

Maintenance of Records and Reports

 Filling of records: Alphabetically, numerically
and geographically

Guidelines:
 Clear, appropriate and readable
 Real or based on facts
 Abbribation and short forms should be of standard
 Sentences should be short and clear
 Signature of person filled records

Precautions
1) Kept carefully
2) Protected against termites and insects
3) Good filling system
4) Easily available on time
5) Kept at definite place
6) Confidential

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