Community Health Nursing II

INSTRUCTOR’S GUIDE BS NURSING / THIRD YEAR

Session # 8

LESSON TITLE: COMMUNITY ORGANIZING, COMMUNITY

IMMERSION
LEARNING OUTCOMES:
Materials:
At the end of the lesson, the nursing student can:
Book, pen and notebook
1. Outline the steps to be taken in applying the
community organizing. LCD and laptop
2. Differentiate traditional research approach or
community organizing participatory action research.
3. Differentiate practiced community organizing
participatory action research to the ideal.
4. Discuss the concept of Community Immersion Nursing References:
Program. Famorca, Z., Nies, M., McEwen, M. (2013).
5. Acknowledge the importance of Community Nursing Nursing Care of the Community. Singapore:
Program in their growth as future nurses. Elsevier

LESSON REVIEW/ PREVIEW (5 minutes)

The instructor will ask the students to answer the following.

Compute for the index killing power of CoVID-19.

Data:

Death (CoVID-19) – 921

Cases - 15,588
Total Population – 108, 000, 000

Answer:
921
CFR = x 100
15588

0.059 x 100

CFR = 5.91

MAIN LESSON (30 minutes)

The instructor should discuss the following topics. Instruct students to read their book about this lesson (Chapter 4
Famorca et al., 2013, page 61-75):

•Community organizing as a process consists of steps or activities that instill and reinforce the people’s self-
confidence on their own collective strengths and capabilities (Manalili, 1990).
• It is the development of the community’s collective capacities to solve its own problems and aspire for
development through its own efforts. It entails harnessing and developing the community’s capacities to recognize
a community problem, identify and implement solutions, and monitor and evaluate the efforts in resolving the
problem.
Community Organizing

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 • Is a continuous process of educating the community to develop its capacity to assess and analyze the situation
(which usually involves the process of consciousness raising), plan and implement interventions mobilization),
and evaluate them.
Basic values in community organizing
• Human Rights
• Social Justice
• Social Responsibility
Core Principles of Community Organizing
• People Centered
• Participative
• Democratic
• Developmental
• Process-Oriented
Phases of Community Organizing
1. Pre-entry
• Involves in Preparation and includes knowing the goals of the community organizing activity or
experience
• It may also be necessary to delineate criteria or guidelines for site selection.
• Making a list of sources of information and possible facility resources, both government and
private, is recommended.
• Skills in community organizing are developed on the job or through experiential approach.
• Novice community organizers, such as student nurses on their related learning experience, are
therefore not unusual.
• For novice organizers, preparation includes a study or review of the basic concepts of community
organizing.
• Although the affective domain is not easy to change, self-examination helps the organizer identify
attitudes – both positive and negative – that may influence effectiveness.
• Proper selection of the community is crucial.
• Identification of:
 Possible barriers
 Threats
 Strengths
 Opportunities at this stage is an important determinant of the over-all outcome of
community organizing
• Communities may be identified through different means:
 Initial data during ocular survey
 Review of records of a health facility
 Review of barangay profile, and so on
 Referrals from other communities or institutions
 Through series of meetings
 Consultation from local governments (LGUs) or private institutions
• Basic criteria
 Geographically isolated and disadvantaged area
 Community perceives that they need assistance
 Shows sign of willingness
 No obvious threat for safety
 No other organization working with same services
 Partnership among other sectors is feasible
2. Entry into the community
• This phase formalizes the start of the organizing process.
• This is the stage where the organizer gets to know the community likewise gets to know the organizer.
• Courtesy calls to local formal leaders
• Visit informal leaders like elders, local health workers, traditional healers, church leaders and local
neighborhood association or other contact persons who may facilitate the subsequent phases of the
organizing process
Considerations in the entry phase
o Community organizers must clearly introduce themselves and their institution to the community

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 o Clear explanation of the vision, mission, goals, programs and activities must be given in all initial
meetings and contacts with the community.
o Community organizer must have a basic understanding of the target community.
o Preparation for the initial visit includes
o Gathering basic information on socioeconomic conditions, traditions including practices,
overall physical environment, general health and illness patterns, and available resources.
o Informal meeting with contacts who have been to the area or some residents of the
community prior to entry will be useful.
o Avoid raising unrealistic expectations in the community.
o Goal: Build up the confidence and capacities of people
o 2 strategies in gaining entry into a community which can be COUNTERPRODUCTIVE
o Padrino or patron. When patron tries to boost the community organizer’s intended output to
the community, this will create false hopes
o Bongga entry. Easiest way to catch the attention and gain the approval of the community.
This strategy exploits the people’s weaknesses and usually involves dole-outs (free medicine,
food ant thers). This creates unreasonable expectations and contradicts the essence of
community organizing.
3. Community Integration
Community integration or pakikipamuhay is the phase when the organizer may actually live in the community in
an effort to understand the community better and imbibe community life. The establishment of rapport between
the organizer and the people indicates successful integration.
o Integration requires IMMERSION in a community life.
o Organizer’s conduct as well as manner of dressing must be in accordance with the norms of the
community
o Styles of integration
o “Guest” status
 Visits the community as per schedule
 “now you see, now you don’t”
o Boarder style
 Rents a room or house in a village
 Lives with his own lifestyle
 Does not share life with the community
o “Elitist” style
 Lives with the barangay chairman or some other prominent person in the community
 Frequently with the barangay officials
People-centered approach integration
o Community organizers enter into a community with a well-conceived plan.
o They establish contact with villagers and become THEIR ALLIES
o Organizers develop a deeper relationship through various techniques
o Pagbabahay-bahay or occasional home visit, observe house routines to avoid inconvenience
o Huntahan. Informal conversations in the village poso during laundry time, basketball court and
sari-sari store
o Participation in the production process
 Participates in farming, fishing or any livelihood activities of the community
 This practice allows the organizer to experience the life of the people in the community.
Hence, they will understand them better.
o Participation in social activities
 Attending fiestas, weddings, baptismal celebrations, funeral wakes and other activities of
the community that carry social meaning and importance.
 Community organizers should remain as role model, gambling and drinking alcoholic
beverages with them is prohibited.
4. Social Analysis
This is the process of gathering, collating and analyzing data to gain extensive understanding of community
conditions, help in the identification of problems of the community and determine the root cause of these
problems.
o Known also as social investigation, community study, community analysis, or community needs
assessment
o In nursing practice this is often called as community diagnosis with emphasis given to health and health-
related problems
o Comprehensive analysis

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  Demographic data
 Sociocultural data
 Economic data
 Environmental data
 Data on health patterns (morbidity, mortality, fertility) and
 Data on health resources
5. Identifying Potential Leaders
Since organizing is not a job of one person, it is imperative that the organizer identifies partners and potential
leaders who will help lead the people.
Desirable characteristics of potential leaders
• Represent the target group/community
• E.g. farmer if it is a farmers group
• Possess or display leadership qualities
• They have the trust and confidence of the community
• Express belief in the need to change the current undesirable situation in the community, that change is
possible and that change must start with members of the community
• Willing to invest time and effort for community organizing
• Must have potential management skills
The community organizer must bear in mind that the prevailing culture or social structure in some communities
tends to make ordinary people shy away from leadership roles, and instead, prefer to work in self-effacing
supportive roles. Some community members may equate leadership ability with education or wealth. Thus, one of
the challenges of community organizing is the training and preparation of the potential leaders. This requires
consistency and persistence in the training and thereby encouraging them and giving their opportunities
to assume various roles in community activities. The key is to allow time for them to develop and gradually
assume leadership role.
6. Core Group Formation
As the organizer works with potential community leaders, the membership of the group is expanded, as
necessary, by asking them to invite one or two of their neighborhood or friends. These new recruits must also be
from the community sharing the same problems the group seeks to correct, while at the same time believing in
the same core values, principles and strategies the group is employing.
• Keep the group manageable, 8 and 12 members
• Initially forming a single group is suggested but as the community gets better organized, the first group
may have separate groups or committees
• Formation of a viable, functioning core group is the focal point of community organizing
o Requires series of training sessions to transfer the technology of organizing, enabling the core
group to take charge
o Essential component of core group formation: reinforcement of the social consciousness of the
members, particularly in terms of analysing the root causes of community problems
o The formation program may focus on self-awareness and development of community health
leaders
o Negative factor must be addressed so as not to affect the outcomes of the community organizing
efforts
7. Community Organization
Through various means of information dissemination, the core group, with the assistance of the organizer, instills
awareness of common concerns among other members of the community. Subsequently, on the initiative of the
core group, the community conducts an assembly or a series of assemblies, with the goals of arriving at a
common understanding of community concerns and formulating a plan of action in dealing with these concerns.
Collective decision making must dictate what projects and strategy must be undertaken. The organizer must
remember that it is their project to be done in their community. The organizer must let them decide.
If the community decides to formalize the organization, it must have the following characteristics:
• An organizational name and structure
• A set of officers recognized by the members of the community
• Community and bylaws stating the vision, mission and goals (VMG) rules and regulations of the
organization and duties and responsibilities of its officers and members
The community may then decide to seek legal recognition by registering the organization with the appropriate
government agency, such as the Securities and Exchange Commission or the Cooperatives Development
Agency. Recognition by the LGU completes the process.

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 Gaining legal recognition paves the way for the organization’s participation in the Barangay, Municipal or City
Development Council as provided in the Local Government Council as provided in the Local Government Code
(RA 7160). The organization may also establish linkages and networks with other government agencies,
nongovernment organizations/agencies, or other people’s organizations that will further strengthen and expand
the organization, facilitating the attainment of its goals and objectives.
8. Action Phase
Also known as the MOBILIZATION phase, the action phase refers to the implementation of the community’s
planned projects and programs.
Important considerations during the mobilization phase are as follows:
1. Allow the community to determine the pace and scope of project implementation. The community may start
with simple barangay projects, such as Tapat Ko Linis Ko or clean and green. As the organization gains
experience and develops, it will move toward more complex programs, like coastal resource
management or a community material recovery facility.
2. The process is as important as the output. A project may fail but as long as the community gains
valuable experience and learns from the process, it is not failure in itself.
3. Regular monitoring and continuing community formation program are essential. Throughout the
mobilization, regular meetings must be conducted for monitoring and continuous training for
community leaders.
9. Evaluation
Evaluation is a systematic, critical analysis of the current state of the organization and or projects compared to
desired or planned goals or objectives. Ideally, evaluation is done periodically during mobilization (i.e. formative
evaluation) to allow revision of strategies when needed and at the end of the prescribed project period (i.e.
summative evaluation).
In community organizing, there are two major areas of evaluation: program-based evaluation and organizational
evaluation.
Areas of evaluation and general evaluation parameters
Area of evaluation General evaluation parameters

Program-based Were the goals and objectives of the program/project achieved?

What strategies were implemented? What worked? What did not?
What is the over-all impact of the project on the community?
How were the resources of the organization and community utilized?

Organizational Were the vision, mission and goals of the organization achieved?
How are the organizational policies being implemented?
What is the level of participation in the affairs of the community
organization?
How were the resources of the organization utilized and managed?
What type of interpersonal relationships is shared among the members of
the organization, among leaders, and the members of the community organization?

10. Exit and Expansion

From the start, the organizer must have a clear vision of the end with a general time frame in min. As articulated
by Manalili (1990), “the best entry plan is an exit plan.” The time of exit should be mutually determined by the
organizer and community during a meeting for monitoring and evaluation.

Indications of readiness for exit by the community organizer should include:

• Attainment of the set goals of the community organizing efforts,
• Demonstration of the capacity of the people’s organization to lead the community in dealing with
common problems, and
• People empowerment as manifested by collective involvement in decision making and community
action on matters that impact their lives
During the exit phase:
• Organizer start exploring another community to organize
• While expanding to another area, the organizer stays in touch with the first community,
periodically visiting as friendly consultant

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Goals of Community Organizing
1. People’s Empowerment
2. Building People’s Organizations
3. Improved quality of life

Participatory action research (PAR)

• Is an approach to research that aims at promoting change among the participants. Members of the group being
studied participate as partners in all phases of the research, including design, data collection, analysis, and
dissemination (Brown et al., 2008).

Community Organizing Participatory Action Research (COPAR)

• Is a community development approach that allows the community (participatory) to systematically analyze the
situation (research), plan solution, and implement projects/programs (action) utilizing the process of community
organizing. It is essentially a research project done by the community that leads to actions that improve conditions
in the community.
COPAR MODEL

Comparison of traditional research approach and COPAR

Points of Comparison Traditional research approach COPAR

Decision making Topdown
Emphasis Expert/nurse driven process
Much premium is placed on the data
and output
Roles Nurse as researchers; the community
members are subject or objects of
research, usually respondents of the
research instrument.
Data analysis is done by the nurse,
and then presented to the community.
Methodology Research tools and methodologies are
predetermined/prepackaged by the
nurse-organizer.
Output Upon completion, the study is
packaged and submitted to the
agency, and published.
Recommendations are made by the
researcher based on the findings of
Bottom-up
Community-driven process
Community members as researchers;
the nurse is a facilitator and recorder.
Data analysis is done collectively by
the community.
Research tools and methodologies are
identified and developed by the
community.
Conclusions and recommendations
are made by the community. These
will lead to agreed community
actions/projects, The whole research
cycle continues until it becomes part of

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 the study. community life, leading towards
community development. Community
members formulate the
recommendations.

Comparison of Practiced and Ideal COPAR

COMPONENT PRACTICED COPAR IDEAL COPAR

Time frame/mode of exposure
Methodology/Survey form
Problem statement
Implementation
Evaluation
Sometimes 8-16 hours/week for 2-4
weeks depending on the time allotted by
the school
Use of ready-made survey from the
school
Some use survey but just collect data
from previous study
Misjudging complex problems as simple
problems
Not considering the result of the survey
form rather pay attention to the concern
of the few individuals
Fish effect
One day program
Results are manipulated
No re-implementation
3-6 weeks immersion
3-6 weeks duty, 8 hours duty; 5-6
days/week
It will vary from the needs of the
community and the methodology is the
surveying participants
After the survey and analysis has been
done
Problem will be coming from the
survey form
Any problems too big should not be
prioritized
Fishing rod effect
Programs should not be a one-time
affair
Reality acceptance
After evaluation, there must be re-
implementation if needed or program
must be revised depending on the
result

Community Immersion
• Community immersion (CI) is a related learning experience program requiring student nurses to live and work
within a selected remote community. Students learn about nursing care for diverse populations in the
community settings during this two-week clinical immersion experience. Topics such as primary health care,
epidemiology, environmental health, health promotion, disease prevention and management, and individual,
family, and population-centered nursing will be covered. Furthermore, students learn about rural public health
systems, the role of a public health nurse, as well as the wide range of programs and issues present in
remote community.
• The CI program is a community-based learning approach that has been further strengthened by the World
Health Organization, which defines the social accountability of medical schools as “the obligation to direct
education, research and service activities towards addressing priority health concerns of the community”.
• From both a public health perspective and an educational perspective, immersion of student nurses in the
community raises awareness of future nurses of the health needs of the community and of the psychosocial
dimensions of any health problem. Student nurses who experienced living within the remote community have
been reported to have a positive impact on their future community engagement, giving them the opportunity of
an early experience.

General objectives
The general aim of the community immersion program is to prepare future nurses to be competent staff PHN

Specific Objectives

The community immersion program aims to:

1. train future nurses to respond to the health problems of individuals in their complexity, and strengthens their
ability to work with the community;
2. develop student nurses’ leadership capabilities;

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 3. enhance their basic nursing skills and accountability to client care;
4. strengthen their interpersonal skills;
5. increase their commitment to the caring profession; and
6. improve their management skills with a scientifically inquisitive research-oriented mind.

CHECK FOR UNDERSTANDING (20 minutes)

The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.

Multiple Choice:

SITUATION: A group of researchers were recently assigned to Barangay Pugo to conduct Community Organizing
Participatory Action Research (COPAR). It is very vital to Public Health Nursing. It aims to transform the voiceless poor
people into dynamic, active and responsive community. Nurse Rashan is one of the members of this group who aims to
develop a self-reliant community.

1. In the Pre-entry phase of the COPAR process, a preliminary social investigation is conducted to aid in the
selection of the site. Nurse Rashan helped in identifying the community for COPAR. Which of the following is not
a criterion to be used when selecting an area for COPAR?
A. Area must have no serious peace and order problem
B. Must have a population of 100-200 families
C. Economically not depressed
D. No similar groups holding the same program
E. No strong resistance from the community
Answer: C
Rationalization: Not economically depressed means they can afford healthcare

2. In Pre-entry Phase, which of the following activities should be done in choosing the final community?
A. Determining the outcome of the program in the community
B. Developing programs with the community
C. Community decides to formalize organization
D. Take note of political development
E. Conducting formal interviews with community residents and key informants
Answer: D
Rationalization: Determining the outcome of the program in the community-action phase; developing programs with
the community-community organization; Community decides to formalize organization- community organization;
Conducting formal interviews with community residents and key informants-social analysis

3. As part of the Pre-entry phase of COPAR, which of the following implies that the potential host family is not
good to live-in?
A. House is strategically located in the community
B. Neighbours are hesitant to enter the house
C. No member of the host family should be moving out in the community
D. Should not belong to elite/rich segment
E. None of these
Answer: B
Rationalization: If neighbours are hesitant to enter the house, other families could not easily communicate to the
nurse

4. Nurse Natasha is in the Social Analysis phase of COPAR if she is doing which of the following activities?
A. Setting up linkages and network referrals
B. Training of CHO workers
C. SALT (self-awareness leadership training)

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 D. Implementation of livelihood projects
E. Conduct community diagnosis
Answer: E
Rationalization: Setting up linkages and network referrals-community organization; Training of CHO workers-core
group formation; SALT (self-awareness leadership training)-core group formation; Implementation of livelihood
projects-action phase

5. Evaluation is a systematic, critical analysis of the current state of the organization and/or projects compared
to desired or planned goals or objectives. In evaluation, there are two areas of evaluation, one of which is
program-based evaluation. The following are the evaluation parameters for program-based, except:
A. Were the goals and objectives of the program/project achieved?
B. What strategies were implemented? What worked? What did not?
C. What is the level of participation in the affairs of the community organization?
D. What is the overall impact of the project on the community?
E. None of these
Answer: C
Rationale: The level of participation is an organizational evaluation

Identify whether it is a Traditional research approach or COPAR

6. Methodology – Methodologies are determined by the community
Answer: COPAR
7. Roles – Data analyst is the nurse
Answer: Traditional research approach

8. Which among the following best describes community immersion program (CIP)?
A. CIP refers to hands-on experience in a community nearby.
B. It is a related learning experience program which requires student nurses to live and work in the community.
C. Student nurses implement public health programs.
D. Student nurses assume the role of a public health nurse to a selected population.
Answer: B
Rationale: CIP in an RLE program which requires student nurses to live and work in the community. CIP is a
hands-on experience in a remote community not nearby. Student nurses helps in the implementation of the
program not as implementer. Student nurses assume the role of a public health nurse to all members of the
community and not to a selected population.
9. The main aim of conducting an immersion program to a remote area is:
A. For the students to learn
B. For the students to apply their basic skills
C. Bring the health programs to people who cannot access it
D. To give to the people what they need
Answer: C
Rationale: Although the aim of the CIP is for students to learn and apply their basic skills, bringing programs to a
remote area is a social accountability of health care workers and future health workers. Giving what people need is
against from the principle of community organizing.

10. Community Immersion program aims student nurses to develop their:

1. Competency in basic nursing skills
2. Interpersonal skills
3. Understanding regarding their social accountability
4. Leadership skills
Choices:
A. 1, 2, 3 and 4
B. 1, 3 and 4
C. 2, 3 and 4
D. 1, 2 and 4
Answer: A
Rationale: All of the options given are specific objectives of the CIP

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LESSON WRAP-UP (5 minutes)

Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.

The teacher instructs the students to answer the following:

CAT 3-2-1
The instructor will advise the students to write their answers in a ½ sheet of paper.
Q1. Enumerate at least three words related to Community Immersion.

Q2. List at least two outcomes of the immersion program?

• Develop their human skills relation
• Practice basic nursing skills
• Develop their communication skills
Q3. Why do you think nurses must undergo the community immersion program?
Since it is focus:
• Is to address the oppressed, economically deprived, and marginalized people who greatly in dire for change;
• On the best interests of the poorest sectors of the society;
• It will lead to a self- reliant community.

Student nurses will be able to exercise appropriate application of knowledge learned and develop correct attitude from this
first-hand experience.

(Reading assignment: Community Organizing Participatory Action Research)

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