Community Health Nursing II

INSTRUCTOR’S GUIDE BS NURSING / THIRD YEAR

Session # 6

LESSON TITLE: COMMUNITY HEALTH NURSING

PROCESS Materials:
LEARNING OUTCOMES: Book, pen and notebook
At the end of the lesson, the nursing student can: White boardmarker
1. Differentiate the elements of community diagnosis. LCD and laptop
2. Assess a community using five (5) elements of
community diagnosis. References:
3. Discuss the steps in nursing diagnosis
4. Identify problems to be prioritized. Famorca, Z., Nies, M., McEwen, M. (2013).
5. Utilize nursing process in managing community health Nursing Care of the Community. Singapore:
concerns. Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.

LESSON REVIEW/ PREVIEW (5 minutes)

The instructor will show the following slide and instruct the students and ask them to arrange the steps in
evaluation.

o Analyze data
o Make decisions
o Design the evaluation plan
o Collect relevant data
o Report/give Feedback
o Decide what to evaluate

MAIN LESSON (30 minutes)

The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 7 Famorca et al., 2013 ):

COMMUNITY HEALTH DIAGNOSIS

As a finding: A quantitative and qualitative description of the health of citizens and the factors which influence their health
As a process: Determining a community’s
a. health status
b. resources, and
c. health action potential or the likelihood that the community will act to meet health needs or resolve health problems

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS

1. Demographic profile
The analysis of the community’s demographic • age and sex composition
characteristic should show the size, composition and • selected vital indicators such as growth rate,
geographical distribution of the population as indicated crude birth rate, crude death rate and life
by the following: expectancy at birth
• total population and geographical distribution • patterns of migration
including urban-rural index and population • population projections
density

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It is also important to know whether there are population groups as a result of disasters, calamities and
groups that need special attention such as indigenous development programs.
people, internal refugees and other socially dislocated

2. Socio-economic and cultural profile

There are no limits as to the list of socio-economic and - Terrain characteristics that contribute to
cultural factors that may directly or indirectly affect the accidents or pose as geohazard sones
health status of the community. However, the nurse - Land usage in industry
should consider the following as essential information: - Climate/season
A. Social indicators b. Water supply
a. Communication network (whether formal or - % population with access to safe, adequate
informal channels) necessary for disseminating water supply
health information or facilitating referral of clients - Source of water supply
to the health care system c. Waste disposal
b. Transportation system including road networks - % population served by daily garbage
necessary for accessibility of the people to collection system
health care delivery system - % population with safe excreta disposal
c. Educational level which may be indicative of system
poverty and may reflect on health perception - Types of waste disposal and garbage
and utilization pattern of the community disposal system
d. Housing conditions which may suggest health d. Air, water and land pollution
hazards (congestion, fire, exposure to elements) - Industries within the community having
B. Economic indicators health hazards associated with it
a. Poverty level income - Air and water pollution index
b. Unemployment and underemployment rates D. Cultural factors
c. Proportion of salaried and wage earners to total a. Variables that may break up the people into
economically active population groups within the community such as:
d. Types of industry present in the community - Ethnicity
e. Occupation common in the community - Social class
C. Environmental indicators - Language
a. Physical/geographical/topographical - Religion race
characteristics of the community - Political orientation
- Land areas that contribute to vector b. Cultural beliefs and practices that affect health
problems c. Concepts about health and illness

3. Health and illness patterns

• In analysing the health and illness patterns, the a. Leading causes of mortality
nurse may collect primary data about the leading b. Leading causes of morbidity
causes of illness and deaths and their respective c. Leading causes of infant mortality
rates of occurrence. If she has access to recent and d. Leading causes of maternal mortality
reliable secondary data, then she can also make use e. Leading cause of hospital admission
of these.

4. Health resources
The health resources that are available in the - Distribution of health manpower
community is an important element of the community according to health facilities (hospitals,
diagnosis mainly because they are the essential rural health units, etc)
elements in the delivery of basic health care - Distribution of health manpower
services. The nurse needs to determine manpower, according to type of organization
institutional and material resources provided not only (government, non-government, health
by state but those which are contributed by the units, private)
private sector and other non-government - Quality of health manpower
organizations. - Existing manpower
a. Manpower resources development/policies
- Categories of health manpower
available b. Material resources
- Geographical distribution of health - Health budget expenditures
manpower - Sources of health funding
- Manpower- population ratio - Categories of health institutions
available in the community

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 - Hospital bed-population ratio - Categories of health services available

5. Political /leadership patterns

The political and leadership pattern is a vital element
in achieving the goal of high level wellness among
the people. It reflects the action potential of the state
and its people to address the health needs and
problems of the community. It also mirrors the
sensitivity of the government to the people’s struggle
for better lives.
In assessing the community, the nurse describes the
following:
1. power structure in the community
(formal/informal)
2. attitudes of the people toward authority
3. conditions/events/issues that cause social
conflict/upheavals or that lead to social bonding
or unification
4. practices/approaches that are effective in
settling issues and concerns within the
community

SOURCES OF DATA IN THE CONDUCT OF COMMUNITY DIAGNOSIS

1. Primary source
- Adult family member who can 2. Secondary source
answer the queries - Health center’s data
- Hospital data

TYPES OF COMMUNITY DIAGNOSIS

A. Comprehensive Community Diagnosis
- This aims to obtain general information about
the community. The elements of the
comprehensive diagnosis were discussed in the
previous session.
B. Problem-Oriented Community Diagnosis
- A type of assessment that responds to a
particular need.
- For example, a nurse is confronted with health
and medical problems resulting from mine
tailings being disposed into the river systems by
a mining company. Since a community diagnosis
investigates the community, the nurse will focus
on the effects of mine tailings.

STEPS IN CONDUCTING A COMMUNITY DIAGNOSIS

1. Determining the objectives o Participant observation – is used to

- Determine the depth and scope of the data to be
gathered
2. Defining the study population
- Identify the population to be included
o Entire population
o Focused on a specific population
3. Determining the data to be collected
- The objectives will determine what data will be
collected.
4. Collecting the data
- Different methods can be utilized to generate
health data.
o Records review – data may be obtained
by reviewing those that have been
compiled by health or non-health
agencies from the government or other
sources.
o Surveys and observations – can be
used to obtain both qualitative and
quantitative data
o Interviews – can yield first-hand
information
obtain qualitative data by allowing the
nurse to actively participate in the life of
the community
5. Developing the instrument
- Instruments or tools facilitate the nurse’s data
gathering activities
o Survey questionnaire
o Interview guide
o Observation checklist
6. Actual data gathering
- Before the actual data gathering, the nurse must
meet the people who will be involved in the data
collection
- Instruments must be discussed and analysed
- Pre-testing of the instrument is highly
recommended
- Data collectors must be oriented and trained
(role-play can be conducted)
- During actual data gathering, the nurse
supervises the data collectors by checking their

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 filled-up instrument in terms of completeness, - Descriptive data - described
accuracy and reliability 8. Data presentation (see p. 140)
7. Data collation - Depend largely on the type of data obtained
- Numerical data – counted

Type of Graph Data Function

Line graph Shows trend data or changes with time or age with respect to some other
variable
Bar graph/pictograph For comparisons of absolute or relative counts and rates between categories
Histogram/frequency polygon Graphic presentation of frequency distribution or measurement

Proportional or component bar/pie Shows breakdown of a group or total where the number of categories is not
chart too many
Scattered diagram Correlation data for two variables

9. Data analysis - Health resources problems

- Aims to establish trends and patterns in terms of o They may be described in terms of lack
health needs and problems of the community or absence of manpower, money,
- Allows comparison of data with standard values materials or institutions necessary to
- Determine the interrelationship of factors will solve health problems.
help the nurse view significance of the problems - Health-related problems
and their implications on the health status of the o They may be described in terms of
community existence of social, economic,
10. Identifying the community health nursing problems environmental and political factors that
- Health status problems aggravate the illness-inducing situations
o They may be described in terms of in the community.
increased or decreased morbidity,
mortality, fertility or reduced capability The Omaha System (refer to p.143-144)
for wellness.

Problem Classification Scheme

Environmental Areas of Identify Cluster of signs and

Psychosocial Concern under if problem is: symptoms that
Physiological the 4 domains - Promotion describe the problem
Health-related - Potential
behaviors - Actual
- Level of clientele

Intervention Scheme

Problem Rating Scale for Outcomes

• Environmental – income, sanitation, residence, 11. Priority setting

safety (workplace/neighbourhood) - Criteria
• Psychosocial – communication with community a. Significance of the problem
resources, social contact, role change, interpersonal b. Level of community awareness
relationship spirituality, grief, mental health, c. Ability to reduce risk
sexuality, caretaking/parenting, neglect, abuse, d. Cost of reducing risk
growth and development o The nurse has to consider economic,
• Physiological – hearing, vision, speech and social and ethical requisites and
language, oral health, cognition, pain, consequences of planned action.
consciousness, skin, neuromuscuskeletal functions e. Ability to identify the target population

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 o For the intervention is a matter of
availability of data sources, such as
FHSIS, census, survey reports and or
case-finding and screening tools
f. Availability of resources
o May include Accessibility of outside
resources and the link to these
resources are taken into account
Priority setting requires the joint effort of the
community, the nurse, and other stakeholders,
such as other members of the health team.

Assigning criterion weight through nominal group technique

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Question: How important is the criterion in solving the problem?

Criterion Nurse J. Midwife BHW Mr. Mr. Average

Cruz B. Tan Dionisia Miranda Peralta Weight
Significance of the problem 8 10 7 10 6 8
Community awareness 8 8 5 5 5 6
Ability to reduce risk 10 10 10 10 10 10
Cost of reducing risk 8 8 8 8 8 8
Ability to identify target population 4 5 6 5 6 5

Availability of resources 8 8 6 5 8 7

Criterion rating through nominal group technique

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Question: Can the group influence the situation in relation to the criteria?

Criterion Nurse J. Midwife BHW Mr. Miranda Mr. Peralta Average

Cruz B. Tan Dionisia Weight

Significance of the 6 8 4 6 6 6
problem

Community awareness 10 10 10 5 5 8

Ability to reduce risk 6 6 6 6 8 6

Cost of reducing risk 6 6 6 4 4 5

Ability to identify target 10 10 10 8 6 9

population

Availability of resources 4 4 3 2 2 3

Computation of problem priority score

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Criterion Criterion Criterion Problem
weight rating (weight x rating)
(1-10) (1-10)
Significance of the problem 8 6 48

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 Community awareness 6 8 48
Ability to reduce risk 10 6 60
Cost of reducing risk 8 5 40
Ability to identify target population 5 9 45
Availability of resources 7 3 21
Total Priority Score 262

SCORING AND IDENTIFYING HEALTH PROBLEM

Identification of community health nursing problems
 Health status problems – increased or
decreased morbidity, mortality, fertility
e.g. 40% of the school-age children have ascariasis
 Health resources problems – lack or absence of
manpower, money, materials, or institutions
necessary to solve health problems
e.g. 25% of the BHWs lack skills in vital-signs taking
Identification of community health nursing problems
 Health-related problems – existence of social,
economic, environmental, and political factors
that aggravate the illness-inducing situations in
the community
e.g. 30% of the households dump their garbage in the
river

PRIORITY SETTING OF COMMUNITY HEALTH NURSING PROBLEMS

CRITERIA:  MODIFIABILITY OF THE PROBLEM – probability of
 NATURE OF THE PROBLEM PRESENTED – reducing, controlling , or eradicating the problem
health status, health resources, or health-related  PREVENTIVE POTENTIAL – probability of
problems controlling or reducing the effects pose by the
 MAGNITUDE OF THE PROBLEM – severity of the problem
problem and measured in terms of the proportion of  SOCIAL CONCERN – perception of the
the population affected by the problem population/community as they are affected by the
problem

CRITERIA SCORE WEIGHT

NATURE OF THE PROBLEM 3 1
- Health status 2
- Health resources 1
- Health-related
MAGNITUDE OF THE PROBLEM 4 3
75% - 100% affected 3
50% - 74% affected 2
25% - 49% affected 1
>25% affected

MODIFIABILITY OF THE PROBLEM 3 4

- High 2
- Moderate 1
- Low 0
- Not modifiable
PREVENTIVE POTENTIAL 3 1
- High 2
- Moderate 1
- Low

SOCIAL CONCERN 2 1
- Urgent community concern 1
- Recognized as a problem but not needing an 0
urgent attention
- Not a community concern

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 STEPS IN PRIORITIZING HEALTH PROBLEMS

1. Score each problem according to each criteria.

2. Divide the score by the highest possible score.
3. Multiply the answer by the weight of the criteria.
4. Add the final score for each criterion to get the total score for the problem. The highest possible score is
10.
5. The problem with the highest score is given the priority by the nurse.
Given the situation:

Problem 1: After collating the data in the community diagnosis, the nurse learned that one of the community health
problems is that 40% of the school-age children have ascariasis. The mothers recognize this and are willing to have their
children undergo deworming. Majority of the mothers are so concerned that they asked the nurse about its cause and
ways on how to prevent it.

Problem 2: The other problem is the lack of skills of the BHWs in the barangay. For example, 25% of the BHWs lack skills
in vital signs-taking. The BHWs expressed their concern that they cannot perform their tasks because of this. All of them
verbalized their desire to attend health skills training in the future

Problem 1
Nature of the problem
• (health status) - (3/3) x 1= 1
Magnitude of the problem
• (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
• (high) – (3/3) x 4 = 4
Preventive potential
• (high) – (3/3) x 1 = 1
Social concern
• (Urgent community concern) – (2/2) x 1 = 1
Total : 8 ½

Problem 2
Nature of the problem
• (health resources) - (2/3) x 1= 2/3
Magnitude of the problem
• (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
• (high) – (3/3) x 4 = 4
Preventive potential
• (high) – (3/3) x 1 = 1
Social concern
• (Urgent community concern) – (2/2) x 1 = 1
Total : 7 3/4

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:

1. The health status of the community is a product of the various interacting elements such as:
A. Population

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 B. Physical and topographical characteristics
C. Socio-economic and cultural factors
D. Power structure within the community
Answer: A, B, C and D
Rationale: All options affect/determine the health status of the community.

2. This shows the size, composition and geographical distribution of the population:
A. Demographic variables
B. Socio-economic and cultural variable
C. Health and illness patterns
D. Political or leadership patterns
Answer: A
Rationale: Option A describes the demographic profile. Option B pertains to social, economic and cultural
indicators. Option C indicates the causes of illness and deaths in the community. Option D mirrors the sensitivity
of the government to the people’s struggle.

3. The following are indicative of the social status of the community: (select all that apply)
A. Communication network
B. Poverty income level
C. Educational level
D. Housing conditions
Answer: A, C and D
Rationale: Option B is an economic indicator. Social status pertains to the community’s communication network,
transportation system and housing conditions.

4. These variables help determine the delivery of health services: (select all that apply)
A. Communication network
B. Manpower population ratio
C. Categories of health services available
D. Power structures in the community
Answer: B and C
Rationale: Option A pertains to social indicators. Option D determines political/leadership patterns

5. These are variables that may break up people into groups within the community:
A. Social indicators
B. Economic indicators
C. Environmental indicators
D. Cultural indicators
Answer: A, B and D
Rationale: Classes or groups among people are influence by social indicators (educational level), economic
status and culture. Although people’s environment is influence by their social classes, some people may live in
one community and share similar physical characteristics of the community.

6. The nurse is about to prepare a data presentation. Knowing there are only three categories and she
wanted to show the breakdown, she will likely use what type of graph?
A. Bar graph
B. Pie chart
C. Scattered diagram
D. Histogram
Answer: B
Rationale: Option B, pie chart or proportional or component bar graph shows breakdown of a group or total where the
number of categories is not too many. Option A, bar graph shows trend data or changes with time or age with respect
to some other variable. Option C, scattered diagram presents correlation data for two variables. Option D, histogram is
a graphic presentation of frequency distribution or measurement.

Situation: After collating the data in the community diagnosis, the nurse learned that one of the community
health problems is that 70% of the school-age children have ascariasis. The mothers recognize this and are
willing to have their children undergo deworming. Majority of the mothers are so concerned that they asked the
nurse about its cause and ways on how to prevent it.

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 7. What is the nature of the problem?
A. Health status
B. Health resources
C. Health related
Answer: A
Rationale: Option A, health status may be described in terms of increased or decreased morbidity, mortality, fertility
or reduced capability for wellness. A 70% of school-age have ascariasis depicts increased morbidity. Option B, health
resources problems refers to lack or absence of manpower, money, materials or institutions necessary to solve health
problems. Option C, health related pertains to the existence of social, economic, environmental and political factors
that aggravate the illness-inducing situations in the community.

8. The score to be given if the nature of the problem is a health resource is:
A. 3
B. 2
C. 1
D. 0
Answer: B
Rationale: Option B, health resources scores 2. Nature of the problem can be Option A, health status and the score is
3. Option C, health-related scores 1. Option D, there is no score of zero (0) given to the nature of the problem.

9. The perception and readiness of the population to act to the problem:

A. Magnitude of the problem
B. Modifiability of the problem
C. Preventive potential
D. Social concern
Answer: D
Rationale: Option D, social concern reflects how people in the community perceive and act regarding a problem.
Option A, magnitude of the problem refers to severity of the problem and measured in terms of the proportion of the
population affected by the problem. Option C, preventive potential pertains to the probability of controlling or reducing
the effects pose by the problem.

10. Among the criteria in priority setting, this criterion weighs the highest:
A. Nature of the problem
B. Magnitude of the problem
C. Modifiability of the problem
D. Preventive potential
E. Social concern
Answer: C
Rationale: Option C weighs 4, Option A weighs 1, Option B weighs 3, Option D weighs 1 and Option S weighs 1.

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.

Sharing Learning Targets and Success Criteria

I learn that _______________________.
I will show that I can do this by ________________________________.
I will look for ___________________________________.

(Reading assignment: Submit an assessment output, to include at least three (3) families using the five (5)
elements of comprehensive diagnosis discussed.)

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