3 | Community Health Nursing 2 1

UNIT 3
WORKING WITH GROUPS
TOWARDS COMMUNITY DEVELOPMENT

1.0 Intended Learning Outcomes

At the end of this chapter, the learners will be able to:

 Define and state the importance of community development.
 Apply conflict resolution skills to a given situation.
 Identify strategies or approaches in enhancing the capability of the community groups
in decision making and problem solving.

1.1 Introduction

As a nurse, can you think of ways in which you can contribute to the development of
a community? If there are any ways that you can, how will you be able to put these thoughts
into actions? Can these actions decrease the problems presently existing in the community?
How are you going to deliver these actions in the community?
These are some of the questions that nurses might ask themselves if they are to work
with families or groups in the communities. At present, there as so many problems faced by
the country and even in the smallest areas of the region, it is impossible for a nurse to deliver
some changes or improvements in the health status, much more so, if a nurse is to work alone
and with minimal support from the community itself.
Problems that are encountered in the community may have been existing for years
and may have coexisted with foundational problems or the root causes. That is why, it is
important to focus the resources, time, and energy of the nurses in addressing these problems
strategically. If they too can not influence community partners in a responsible and logical
manner nor persuade them to be involved, they will fail. These may only result to a waste of
the resources and may create new problems along the way.
This unit discusses the critical points in theory and practice in addressing the
problems of the community. This also tackles means and ways of empowering the population
groups, capacity building, and motivating them to work together in finding solutions to the
problems of their localities by utilizing strategies toward health promotion, disease
prevention, rehabilitation, and community development.

1.2 Topics/Discussion (with Assessment/Activities)

Community development is not new nor is outdated since up to this date they are
still being utilized by community nurses in terms of health promotion, disease prevention,
and health restoration and maintenance. However, it has been the role of nurses to think,
plan, and do for people the responsibilities in maintaining their health, when in fact with a
little motivation or stimulation they could eventually do these things for themselves.
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As the health care system is burdened by the aging population of the health care
workforce and broadened access to public health, the responsibility of which will be felt by
health workers at present. There are statistics that show fewer number of students graduate
from medicine-related courses.

In these trying times when there is increasing cost of health care and the shortage of
manpower in the health care field, nurses must now apply community development
approach in managing the needs of the community through proper planning and utilization
of the resources available. Community development was previously linked in the
improvement of socio-economic conditions of the country until in the fifties that it became a
process in improving the economic, social, cultural, and health conditions of the
communities. Community development process is…a progression of events that is planned by
the participants to serve goals they progressively choose. The events point to changes in a group and
in individuals that can be termed growth in social sensitivity and consciousness…a social process
by which human beings can become more competent to live with and gain some control over local
aspects of a frustrating and changing world (Biddle and Biddle, 1965).
Community development is characterized by the following:
 There is a constant negotiation between the community members and the agency.
 Problems are first identified by the involved community which is relayed to the
agency for shared interest.
 Longer in terms of duration of work.
 Outcomes usually targets increasing the community members’ capacity.
 The desired long term outcomes reflects positive changes in the community.

Activity #1
1. In your own words, differentiate COMMUNITY DEVELOPMENT from
COMMUNITY INVOLVEMENT?
2. As a future nurse, why is COMMUNITY DEVELOPMENT important?
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1.2.1. STAGES OF GROUP DEVELOPMENT

Creating a group with members aiming for the common goal or shared purpose will
be quite a challenge for any community nurse as it needs strategies to ensure that all members
stick to their roles and with thoughts set on that particular purpose. A team cannot readily
execute or perform specific functions from the moment a group is formed. It may require
time, patience, support, and efforts from and amongst members. They undergo stages as they
change from different individuals to a unified group aiming for a particular goal or purpose.
In 1965, psychologist Bruce Tuckman presented a model in developing a group which
starts from the time when individuals first meet and forms a group until the end of the
project.

•Manager is expected to •Begin understanding how

provide a high degree of team decisions are made
guidance for the members •The purpose is already
•Individuals are yet to clear, however, the
determine and identify relationship of the
their particular roles or members may still be
function blurry.
•The process are not yet
established in this stage

1. FORMING 2. STORMING

4. PERFORMING 3. NORMING

•Committed in performing •Well understood

well as a group relationships of the team
•Works strategically •Committed to a common
•Team works well with little goal
guidance •Begins to work to optimize
the process and achieve
goals.
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Forming Stage (Orientation)

 Time when group starts to come together and members may feel anxious and
uncertain about other individuals or members.
 Driven with the desire to be accepted by the group, individuals may show discreet
behaviour.
 Members of the group start to form impressions of each other, but conflicts, personal
issues, misunderstanding, and controversies are avoided.
 Achieve understanding of the group’s purpose or goals and determining individual’s
roles and responsibilities.
 Outlines group rules which includes when they will meet and identifying resources
available to use.
 At this stage, members start to learn what is expected of them, what to do, what is
acceptable, and how the group will operate in general.
 This stage focuses on the members rather than the work, it may not yet be productive
at this point.

Storming Stage (Power Struggle)

 Second stage where dispute and competition is at its greatest as they now have clear
knowledge and understanding of the work.
 Stage where dominating group members emerge while those who are less
confrontational stay safe in their comfort zone.
 Questions and issues arise regarding leadership, authority, rules, policies, norms,
responsibilities, evaluation criteria, and reward system during this stage which should
be addressed in order for the group to move forward to the next stage.

Norming Stage (Cooperation and Integration)

 Group becomes fun and enjoyable.
 Interaction between members are easier, more cooperative, and productive.
 There is a sense of mutual respect among members, give and take relationship, and
open communication bonding provides a feeling of belongingness.
 Appreciates knowledge and skills of each member and values their opinion.
 Dispute, conflicts, and issues at this stage is comparatively easy to resolve and allows
the group to get back to its track.
 Good leadership is always a key in attaining the perceived outcome, but at this stage,
the facilitator can step back and allow members to take initiative and work hand in
hand as a group.

Performing Stage (Synergy)

 At this stage, members of the group are confident and motivated about their team and
the project in general that they can operate with very minimal supervision.
 All members are on the same page, geared, and thriving to reach the final goal.
 This is the stage that all groups strive to reach. Some may not reach this stage for
reasons that they have failed to overcome the conflicts of the group and result to not
being able to work with the group in general.
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Adjourning Stage (Closure)

 This stage is reached when the project is finally completed. Once the project ends, the
group disbands.
 This may also be called as mourning phase as members have grown close to each other
and may feel a loss when the group disbands.

Activity #2: As a future nurse facilitator, in what ways can you ensure that
all members of the group continue to be motivated and involved?

HOW CAN YOU HELP A GROUP DEVELOP?

 Set a clear purpose or goal as to why the group was formed in the first place. Without
it, you are leading the group to nowhere.
 Set ground rules. Make sure that they are applied and followed.
 Allow other members of the group to act as leaders or facilitators.
 Resolve conflicts. Do not avoid it. It allows the group to grow.
 Remind the group members to listen and respect one’s insight, ideas, or opinions.
 End each meeting positively. Provide constructive feedback that can improve the
process.
 Everyone must contribute and participate. The point of forming a group is to work
together to achieve a common goal.

1.2.2. INTERVENTIONS TO FACILITATE GROUP GROWTH

Nurses are facilitators for changes and growth of groups in the community. They gear
the community with knowledge and skills toward addressing the existing problems and
achieving long term goals for the betterment of the community and its individuals. In order
for the groups to deliver and be successful in achieving the set goals or purpose, it takes time
to focus on the capacity of individuals and the assets of the community to make it all happen.
One must possess a facilitation skills to establish a good plan, keep the members
involved in all the processes, create leadership opportunities in the organization, and
develop skills of members of the groups. The more you know in keeping the members of the
group involved, running good leadership, and provide learning and planning process, the
more your members feel empowered and invested in the group while performing the roles
and responsibilities geared toward achieving the purpose and goals set by the group.
Facilitation focuses on the three principles:
1. The role of the facilitator is to the guide the group to move through a process by
drawing opinions, thoughts, or ideas from group members.
2. Facilitation is not just a question on what gets achieved but on how individual
members of the group will participate in the process of learning and planning.
3. A facilitator should never be biased. Should not take sides in terms of opinions and
conflicts.
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Orientation, Structure and Direction

Orientation is an important factor that will provide an impact and direction where the group
is headed. These are sessions that welcome individuals while giving them the chances to
know the other members of the community and its linkages. As a facilitator, it is important
to prepare ahead of time and this includes running through the orientation process. As part
of the process, create a checklist of the informations and tasks that needs to be completed.
Provide a chance for individuals to be acquainted with the rest of the members of the group.
Activities or games can be incorporated for members to work as team and be able to develop
as sense of cooperation and acknowledge each other’s opinion, ideas, and thoughts.

Structure provides the layout and is the combination of:

 Group roles – as part of a group, individuals have a specific role to play. These are set
of behaviour patterns associated to an individuals in a unit. Three types of roles people
play in a group
o Task roles
o Building and maintenance roles
o Self-centered roles
 Norms - or the standards set by the group that should be applied and followed. Every
group should contribute in setting the standards and this includes customs, values,
habits, and expectations. These direct how members should interact with the rest of
the group. This can help or block the group from achieving the intended goals set.
 Conformity – or the decisions and stand taken by the majority of the group. This can
also be called as “accommodating to group pressures” which is widely used to
indicate an agreement to majority position for reasons just to fit-in, desire to be correct,
or just to conform to a social role.
 Cohesiveness – this is the extent to which group members are attracted towards each
other which affects their decision to stay in the group. This acts as a glue that binds
the group in working together to achieve goals. The most influential factor may be
attributed is each member’s commitment towards the group’s performance goals and
norms.

Direction of the group towards achieving the desired goals or outcomes require a good
planning and leadership skills. When a group is equipped with a good plan, they will have
a greater chance of being effective and successful. A good plan consists of:
 The results desired (vision, goals, and objectives) – this will be the part that helps set
out the direction of the group. Doing this as a group is vital as it provides everyone
the chance to contribute and be committed not as individuals but members of a group
aiming towards common goal. This provides a clear picture as to what is the purpose
of the group in the community.
 Actions that will be taken
 The priorities or what needs to be done first
 Resources that are required
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 How resources will be provided and utilized

 Who will take which roles and responsibilities
 How coordination, communication, and decision-making will take place
 Timelines, and
 How progress will be monitored.

Process, Negotiate, and Resolve Conflicts

Process is how individual members of a group work together in order to get things done. If
the process is not well defined for the group, then most probably, the time and effort spent
in achieving the set goals will be for nothing. The most valuable resources of a group are the
members itself, therefore, needs of the members must be addressed. An effective group
should look at how members work together, the roles and responsibilities of each member,
and whether they contribute to the progress of the group. Utilizing a group process can be
an early intervention by the use of observation and analysis in identifying the problems and
addressing it to prevent a major problem as time progresses. Elements that influence a
process include communication, participation, decision-making, and organizational roles.

Negotiate to secure good process and outcome. Negotiations never come easy. The size of a
group may have a direct influence on how well members plan and how long they can settle
since it draws upon others perspectives and experience. Negotiating in a group may take
longer but it is needed if the group wants a better plan. Group leaders are responsible for
having and sharing negotiation strategies, ensuring team preparedness, assigning roles, and
motivating the team.

Resolve Conflicts if you want to maintain a healthy group environment. Conflicts are
unavoidable specially if people with different perspectives form in one single group. When
individuals’ differences arise, they create tension in a group. There are many responses that
people tend to adapt during conflicts, these include ignoring the situations, responding in a
passive aggressive actions, or tends to blame others involved. However, these may be an
unhealthy approach in resolving conflicts. When conflicts arise:
 Acknowledge the conflict – while most of the time this may feel unpleasant and may
affect your work at the moment, but acknowledging the issue can help prevent future
disputes.
 Stop and cool off – take a moment to breathe and think through the course of actions
which are appropriate in addressing the conflicts. Avoid pointing fingers, throwing
insults, building defensive attitudes or behaviours, complaining behind team mates
backs, and making assumptions of member’s behaviours.
 Clarify member’s position – allow members to voice out and be heard of their opinions
about the conflict. Allow them to explain and rationalize their opinions. As facilitator,
pay enough attention on the matter and refrain from jumping to any conclusion. This
way, it will prevent further miscommunication.
 List facts and assumptions – when every single members involved in the conflict, list
out the facts and assumptions that have been made and allow each other to reflect on
the statements given for the good of the group.
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 Break groups and separate existing alliances – members of the group may at times
agree with each other because of the fear of losing friendship, considering this may
cloud one’s judgment of certain issues in the group. This may be avoided when groups
are divided and factions are separated.
 Reconvene the group – when smaller groups have been allowed to discuss and resolve
conflicts, you can now reconvene the group. Sometimes, it is only a matter of
discussing issues and allowing individuals to exhaust all the negative emotions and
thoughts so that the group can move forward again.
 Celebrate the resolution as a team – appreciate and acknowledge the contributions of
each members of the group. It can be a simple congratulatory message, hand shake or
a simple gathering. Constructive conflict can bring groups together. Resolving conflict
when it arise in a quick and mannered approach can be beneficial for a group, thus,
maintaining a healthy relationship among its members.

Activity #3: At the SSU Clinic, there is a group of staff who speak Waray-
waray, which they often use to converse. Gia, an employee who doesn’t speak
the language, feels self-conscious and sometimes wonders if they are talking
about her. She frequently complains to her friends at work about other staff
not speaking English. One day Gia walks into a meeting room and several
staff are already there, speaking in Waray-waray. Gia walks in and says,
“Hello.” The other staff say “Hello” back and then resume their conversation,
which Gia does not totally understand. She rolls her eyes and sits down on
the other side of the room to wait for the meeting to start.

As a facilitator, point out the negative issues that surround this situation and
in what ways can you address or resolve these issues?

Awareness of the effects of behaviour

Behaviours and decision-making are somehow affected and influenced in the

presence of others, especially in a group. The influence can generate positive or negative
behaviours. There are three key phenomena how groups influence behaviours:
 Groupthink – is the desire for harmony and conformity within the group that may
result to an incorrect or non-standard decision-making outcomes which happens
when the members of the group are invested in maintaining a cohesive group,
avoiding conflicts, and lacks an impartial leader. The need to plan and appraise a
realistic course of action is override with the need for unanimity.
 Groupshift – is a phenomenon in which the initial position of members tend to be
more exaggerated or extreme, which means they tend to lean more towards the
direction they were already leaning. Therefore, they are likely to made riskier
decisions rather when they decide individually. This phenomenon allows members to
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feel that their position is correct and supported by like-minded members, thus making
them comfortable to take risks.
 Deindividuation – when members no longer act as individuals and becomes lost in
the group. They go with the flow. The larger the group, the higher the
deindividuation. It is important to distinguish deindividuation from obedience,
compliance, and conformity.

Application of new learning

Working in small groups provides the members with the opportunities to learn,
articulate ideas and understanding, uncover assumptions and misconceptions, and negotiate
with others to create plans and reach a consensus. As members undergo the group process,
they continue to develop skills and acquire new learning which will contribute and be
applied in reaching the goals and succeed as a whole. When members take hold of the
learnings they have acquired, they can potentially utilize it and be equipped when the time
comes that it may become handy.

1.3 References

Famorca, Z., Nies, M., Mcewen, M. (2013). Nursing Care of the Community. Elsevier
(Singapore) Pte. Ltd
https://citl.illinois.edu/citl-101/teaching-learning/resources/teaching-strategies/group-
learning
https://courses.lumenlearning.com/boundless-psychology/chapter/social-
influence/#:~:text=Individual%20behavior%20and%20decision%20making,by%20th
e%20presence%20of%20others.&text=However%2C%20the%20influence%20of%20g
roups,groupthink%2C%20groupshift%2C%20and%20deindividuation
https://ctb.ku.edu/en/table-of-contents/leadership/group-facilitation/facilitation-
skills/main
https://sustainingcommunity.wordpress.com/2017/07/12/community-engagement-
community-
development/#:~:text=Community%20development%2C%20however%2C%20invol
ves%20much,making%2C%20and%20in%20service%20delivery
https://toggl.com/track/stages-of-team-
development/#:~:text=In%201965%2C%20a%20psychologist%20named,meets%20u
ntil%20the%20project%20ends.&text=Each%20is%20aptly%20named%20and,buildin
g%20a%20high%2Dfunctioning%20team
https://www.doc.govt.nz/get-involved/run-a-project/community-project-guidelines/set-
your-direction/
https://www.karrass.com/en/blog/team-negotiations-lead-to-better-results
https://www.nursingworld.org/practice-
policy/workforce/#:~:text=The%20nursing%20shortage&text=With%20more%20th
an%20500%2C000%20seasoned,to%20avoid%20a%20nursing%20shortage
https://www.sandler.com/blog/professional-development-blog/ways-to-deal-with-team-
conflict-effectively/
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https://www.sdsmt.edu/uploadedFiles/Content/Campus_Life/Student_Activities/Orga
nizations/Understanding%20Group%20Process.pdf
https://www.tutorialspoint.com/individual_and_group_behavior/five_stage_model_gro
up_development.htm
https://www.tutorialspoint.com/individual_and_group_behavior/group_structure.htm
Kretzmann, J. & McKnight, J. (1993). Building the Communities from the Inside Out: A Path
Toward Finding and Mobilizing a Community’s Assets. Institute for Policy Research
(1993). Evanston, IL.
Lopez, D. & Jiao, C. (2020). Supplier of World’s Nurses Struggles to Fight Virus at Home.
Doi: https://www.bloomberg.com/news/articles/2020-04-23/philippines-sends-
nurses-around-the-world-but-lacks-them-at-
home#:~:text=There%20is%20an%20estimated%20shortage,work%20in%20the%20U
.S.%20alone
Woodward, V. (1981). Community development and the community nurse. Curationis, 4(3),
13-15. doi:https://doi.org/10.4102/curationis.v4i3.691

1.4 Acknowledgment
The images, tables, figures and information contained in this module were taken from
the references cited above.

DISCLAIMER: Any information, data, images, and contents provided in this learning packet are
based on books and other references cited by the instructors handling the subject. This is
intended for SSU-CONHS students’ learning information for the particular subject and not
suggested as replacement to standard references. Any inaccurate information found may be
communicated directly to the electronic mail provided. lawrencequiano@gmail.com
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ACTIVITY/ANSWER SHEET

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ACTIVITY/ANSWER SHEET

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UNIT 4
INFORMATION TECHNOLOGY AND COMMUNITY HEALTH

1.0 Intended Learning Outcomes

At the end of this chapter, the learners will be able to:
 Discuss the importance of information and communications technology (ICT) in
community health nursing.
 Identify and discuss some advantages and disadvantages of using ready-made
software and free and open source software (FOSS).
 Identify factors that affect the use of e-Health in the communities.
 Reflect on the current e-Health situation in the Philippines.

Pre-Assessment Activity!
Before you continue reading the Learning Packet 3, I would like to assess your
knowledge by answering the question below without scanning through the contents or
consulting any websites. Please be honest. Thank you!
In your own words, discuss the importance of Information and Communications
Technology (ICT) in terms of:
 Community health
 Health care delivery system
 Healthcare consumerism

1.1 Introduction

There had been so many improvement in the field of health in terms of information,
communication, and technology and health care professionals were able to apply these
advancements in their fields. Researches, present technologies, and sophisticated tools were
used in providing quality care for the clientele. With these advancements, more patients were
engaged in their health and care. Informations were readily available such as in the internet,
radio, and television. Communication between clients and providers was one of the issues
before especially in the Philippine setting where some areas are geographically inaccessible,
but now it had been made possible through the use of smart phones. Technologies are
becoming indispensable assets such as computers which are used in the storage, retrieval,
and process health data which provide health care professionals better decision making.

1.2 Topics/Discussion (with Assessment/Activities)

e-Health, what it is and how it is used

e-Health has been recognized as a cost-effective way of using information and

communications technology (ICT) in providing health care services, surveillance, health
 3 | Community Health Nursing 2 14

education and literature, and research purposes according to the World Health Assembly
(2005). The term serves to characterize everything that is related to computers and health.
This paved way in opening the endless possibilities of the Internet in the health care field as
new challenges and opportunities arise in what used to be a “traditional health care
information”. With the extensive capabilities of ICT, this has been considered as means of:
 Communication with patients through teleconference, e-mail, and short message
service (SMS).
 Recording, retrieving, and data mining in the electronic medical record (EMR).
 Providing learning to patients using the aid of electronic tools.
e-Health is an overall, umbrella term, which is often confused with telehealth or
telemedicine. This is not just a mere technological development or advancement but
encompasses three major areas:
 Delivery of information through the use of Internet and telecommunications to and
from health professionals and consumers.
 Improve public health services through education and training of health professionals
with the use of information technology and e-commerce.
 The use e-commerce and e-business practices in health systems and management.

The 10 E’s in “e-Health”

1. Efficiency – increases work productivity while decreasing health care costs through
enhanced communication between and among health care teams and establishments
(clinics, hospitals, and health units). This avoids duplicating works such as diagnostics
and therapeutic interventions.
2. Enhancing quality of care – when there is efficient work and lower health care cost,
this may result to an enhanced quality of care.
3. Evidenced-based – effectiveness and efficiency should not be solely based on pure
assumptions but on a proven scientific studies and evaluation.
4. Empowerment – accessibility of medical information and personal electronic records
of consumers over the Internet allows an opportunity for consumers of health care to
be empowered.
5. Encouragement – of relationship between the health care providers and consumers
based on trust, respect, and true partnership.
6. Education – provides opportunities for consumers to learn in terms of the health
promotion, disease prevention and health restoration and maintenance, and for health
care workers through online courses for professional development.
7. Enabling – in terms of communication and exchanges of information between health
care workers or professionals and establishments.
8. Extending – the scope of health care to the communities by enabling the consumers
located in geographical isolated areas to obtain health care services through online.
9. Ethics – poses challenges in provider-consumer interaction such as threats to issues of
online professional practice, consent, and privacy issues.
10. Equity – aims to provide health care for all. However, this poses a certain threats for
people who have no money and access to computers and Internet. This may prove
beneficial to those living in the urban areas, the rich, and the younger generations.
 3 | Community Health Nursing 2 15

Creative Thinking!!!
Browse the web or scan a dictionary and look for an “E” word that you can add
to the existing list of “E’s”on e-Health and make a brief description of it.

Storage – collection or recording of digital information in a storage medium. Such as when a

client visits a clinic for the very first time for a check-up, the nurse may have to gather
personal information about the clients and store in a medium for future use.

Retrieval – process of obtaining data from a database. It can mean identifying and extracting
data to display or to be used. An example would be, a client was instructed to come back to
the clinic for a follow-up and the nurse assigned to the client was on leave, the nurse can
easily retrieve the data by asking the client’s name and access it through the computer.

Transmittal – electronic exchange or transfer of data or information. This can be among the
offices in an institution or it can also be between hospitals, clinics, and other establishments.
An example of this is, when a client comes back to the clinic for a follow-up and the doctor
was not available, he referred the client to another specialist, transmittal of information from
one doctor to another is possible for the continued care.

Power of Data Information

Nurses are knowledge managers and are required to make fast, critical, and life-
impacting decisions, therefore, it is important for them to process raw data into a usable
information of clients to provide to deliver evidenced-based knowledge and individualized
interventions. Data can be considered as unanalysed facts that convey no meaning. However,
when meaning is attributed to data, processed and analysed it, then it becomes information.
(Ex. The number 37 can be anything in a sense that it has not been processed or analysed.
One may consider it to be a simple numerical figure, a person’s age, house number, or just
anything that one can think of. But when the nurse noticed it to be written in the field of
Respiration or Respiratory Rate, processing what seemed to be a senseless data will now
provide information to the nurse and give a whole new meaning to the number. It will be
clear to the nurse that patient is hyperventilating and will be able to provide a timely
intervention or report it to the physician).
As the health care system aims in accurate recording of obtained data, paper-based
methods may have brought about a degree of inconvenience in terms of interoperability of
services, information back-up, and data access. Some problems identified were:
1. Care stops in an event that records are misplaced. If a consumer suffers a chronic
health condition and supporting documents may no longer be accessed, it will be
waste of time and resources as consumer will need to recount the health conditions
and redo all the laboratory work-ups for every transfer of care.
2. Misinterpretation of data and large opportunities for errors associated with illegible
handwriting or incomplete prescriptions.
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3. Compromised privacy. The privacy of patient information may be vulnerable from

unauthorized people as they leave no audit trail of access, review, and use of charts.
4. Data are difficult to aggregate. When recording and tallying data manually, result in
a delay of interventions and programs. Information is not readily available which
compromises the delivery and monitoring of health care.
5. Patient care is limited. If data is not readily available, a big portion of time and effort
is spent in searching paper-based records rather than in the actual care.
When we talk about how well-managed consumer information system is, it provides
benefits to a certain extent, such as:
1. Data are readily mapped and available to health care professionals, thereby giving a
targeted and timely interventions and feedback. If the system is up-to-date and
provides accurate information about a community and individuals, then health care
professionals will be able to provide them with patient-centered care and
interventions. The facility can also receive real-time feedbacks which enable them to
comply with the standards and further improve the system. This also provides
information regarding the frequency and locale of diseases through the Geographic
Information System (GIS) which enables detailed maps and helps health care
providers with understanding of the distribution of diseases and the problems to
come up with better solutions.
2. Easy retrieval and recovery of data. Data are automatically backed-up in secured
servers from time to time and in cases of force majeure, retrieval or recovery will not
be a major problem.
3. Repetitive work is minimized. In terms of collecting consumers’ identifying
information (name, birthday, age, address, etc.), this needs to be done only once and
linked in a database, allowing better record management. Upon return to the clinic,
easy access of consumer’s information will be readily available.
4. Availability of clinical research data. Quality data stored in databases provides easy
access and reliable outputs which can be translated to health care innovations and
interventions.
5. Efficient use of resources. Patient information that is available in EMRs may require a
large amount of funding for purchasing equipment for the system but eventually
reduces the cost of future purchases. Studies have shown a reduced transcription costs
in documentation and other structured documentation procedures (Menachemi and
Collum, 2011).

e-Health Situation in the Philippines

Philippines is a developing country which suffers from inadequate health care

services or the lack of access thereof because of the geographical setup of the country.
However, despite the challenges, the country still aims to provide a quality health care for
all its citizens. There had been a steady increase in the number of population which have
access to the Internet from 2.5% in 2001 to 29% by 2011 (International telecommunications
Union, 2011). ICT has impacted Filipinos access to information and how the government has
utilized this to inform its citizenry. Now, health sectors have penetrated the ICT world to
improve and deliver its services. However, there are factors that impede the development of
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e-Health in the country especially in its rural and remote parts. Discussed below are the
limiting and advancing factors of e-Health.
 Limited health budget – allocation is relatively small when ICT requires a huge
amount of budget to push through.
 The emergence of free and open source software – there are ready-made software
available for use but there are some degree of limitations. They may not interface well
for data and exchange of information or interoperability and may require changes in
the source code. The bigger problem is that the source code is not available and is kept
a secret by the programmers and will require for the establishment to buy the source
which will entail additional and unplanned costs. The emerging and trending free and
open source software (FOSS) is open to the public which allows improvement of the
program and sharing these improvements with everyone.
 Decentralized government – R.A. 7160 or the Local Government Code of 1991,
provides autonomy for the LGUs to take control of their own basic health services and
its budget. In terms of control, LGUs may develop their own systems but the challenge
is how these different systems will be unified and interlinked into a one general
working system for the entire country. Although it is not impossible, but it will be
quite difficult.
 Target users are unfamiliar with technology – since e-Health is not only about
technology, it comes along with software development and hardware maintenance,
as well as staff training and system maintenance to ensure it effectiveness. One of the
pitfalls is because the institution is mainly focused on software development rather
than assessing the needs of the health professionals. Most are not familiar with the use
of computers or its system. The implementation of e-Health and to ensure its success
is highly dependent on the end-user’s willingness to learn and accepts the technology
and the changes in the system.

Activity #1. Identify and discuss at least two advantages and disadvantages of using
1. Ready-made software
2. Free and Open Source Software

Using e-Health in the Community

One of the major goal of Community Health Nursing is to preserve the health of the
community by focusing on health promotion and maintenance of individuals, families, and
groups. This section provides details on how e-Health will be beneficial for the community
nurses and the people in general towards the achievement of their goals.
 Universal Health Care and ICT – the archipelagic distribution of the country is
considered to be one of the challenges in the delivery of health care to its people,
together with the lack of financial health care coverage and mass migration of health
professionals. The Department of Health, through the Administrative Order No. 2010-
0036, outlined the policy directions of Universal Health Care (UHC) or Kalusugan
Pangkalahatan (KP) which prioritizes:
1. Financial risk protection through expansion in National Health Insurance
Program (NHIP) enrolment and benefit delivery.
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2. Improved access to quality hospital and health care facilities.

3. Attainment of the health-related Millennium Development Goals (MDGs)
One of the key instrument in attaining efficiency is the use of Health Information to
establish a modern information system that provides evidence for policy and program
development and support for immediate and efficient provision of health care and
management of province-wide health systems. The DOH also recognizes the valuable
purpose of ICT for health which led to the drafted National e-Health Strategic
Framework 2010-2016, with the vision of ICT supporting UHC to improve health care
access, quality, efficiency, and patient’s safety and satisfaction, reducing cost and
enabling policy makers, providers, individuals, and communities to make the best
possible health decisions.
 Electronic Medical Records – are patient records that are stored and accessed from a
computer or server. EMRs can easily be adapted in community health as they utilize
a standard process. However, this may be a problem in hospital interoperability when
one’s protocols and systems used may be totally different from other institutions. This
problem in implementation highlights the importance and need of creating standards.
EMRs are vital to community especially when records are more frequently used such
as for patients undergoing treatment for tuberculosis and children for regular health
services such as immunizations, deworming, and micronutrient supplementation.
And vital statistics indicators such as mortality and morbidity rates must come from
reliable sources of data from an accurate and thorough EMRs.
 Telemedicine – one of the strategic goals of the National e-Health Strategic
Framework is to capitalize on ICT. This it to reach and provide services for the
Geographically Isolated and Disadvantaged Areas (GIDAs) of the country through
Telemedicine and mobile health (mHealth). According to the World Health
Organization, telemedicine is “the delivery of health care services, where distance is a
critical factor, by all health professionals using information and communications
technologies for the exchange of valid information for diagnosis, treatment and
prevention of disease and injuries, research and evaluation and for the continuing of
education of health providers, all in the interests of advancing the health of
individuals and their communities”. There are four (4) elements that are specific to
telemedicine:
1. Its purpose is to provide clinical support.
2. It is intended to overcome geographical barriers, connecting users who are not
in the same physical location.
3. It involves the use of various types of ICT.
4. Its goal is to improve health outcomes.
Telemedicine has the capacity to bridge the gaps in the health referral system. This
may not be a universal solution but the goal of providing patients or consumers with
best possible care despite the distance or other unfavourable circumstances may be
achieved.
 e-Learning – or the use of electronic tools to aid in providing education to consumers.
This can useful in correcting misconceptions about health and health care and permits
access to reliable information. Learning can be interactive in a synchronous or
asynchronous environment or the use of instructional videos such as measures to
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combat and control diseases. Continuing professional development or education can

be availed through online and virtual seminars.

Activity #2. Identify at least three (3) factors that may affect the following:
1. Delivery of care using Telemedicine
2. e-Learning in the community

Roles of Community Health Nurse in e-Health

The advent of e-Health made nurses available to several consumers in diversified

roles, making the delivery of health care efficient. However, this can never be a replacement
for actual patient care. It is viewed as a powerful tool for nurses. The following are the major
roles of e-Health nurses in the community:
1. Data and records manager – records the trends of diseases in the community through
the use of EMR which allows provision of specific and related interventions for health
promotion, disease prevention, health maintenance and rehabilitation. Also maintains
quality data inputs such as the accuracy, completeness, consistency, correctness, and
currency through audits.
2. Change agent – is the one who works with the community and implementing the e-
Health with them. They do not force the technology and changes in the community,
but rather helping the community adapt to these changes by informing and guiding
them in selecting and applying appropriate ICT tools.
3. Educator – provides essential health information through the use of ICT tools. They
also engage in making e-Learning videos on diseases during their free time at health
centers. These videos may be installed in phones to be available at a convenient time
for the consumers.
4. Telepresenter – usually utilizes a teleconference application, nurse may function as
telepresenter when patients are needed to be referred to a remote medical specialist
through telemedicine. The nurse will present the patient’s case which includes
assessment, evaluation, and treatment to the medical specialist.
5. Client advocate – nurses as advocates must safeguard the patients’ records making
sure that privacy, confidentiality, and security are upheld. Clients must always be
informed about the benefits and challenges of e-Health. Nurses must also guarantee
that all interventions are performed in a safe and ethical manner.
6. Researcher – patient records can easily be retrieved and analysed retrospectively by
nurses when using e-Health tools. They are responsible for research and development
frameworks based on the data from the system. They also pursue continuing nursing
research informatics education with the goal of developing research framework
beneficial for the community.

Activity #3. Reflection!

What do you think about the current e-Health situation of the country? Provide strong
and weak points in your essay.
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1.3 References

Famorca, Z., Nies, M., Mcewen, M. (2013). Nursing Care of the Community. Elsevier
(Singapore) Pte. Ltd
Eysenbach G. (2001). What is e-health?. Journal of medical Internet research, 3(2), E20.
https://doi.org/10.2196/jmir.3.2.e20

1.4 Acknowledgment
The images, tables, figures and information contained in this module were taken from
the references cited above.

DISCLAIMER: Any information, data, images, and contents provided in this learning packet are
based on books and other references cited by the instructors handling the subject. This is
intended for SSU-CONHS students’ learning information for the particular subject and not
suggested as replacement to standard references. Any inaccurate information found may be
communicated directly to the electronic mail provided. lawrencequiano@gmail.com
 3 | Community Health Nursing 2 21

ACTIVITY/ANSWER SHEET

Name: _______________________________________________________ LP#: ______________

Instructor: ____________________________________________________

Pre-Assessment Activity - In your own words, discuss the importance of Information and
Communications Technology (ICT) in terms of:

 Community health
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 Health care delivery system
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 Healthcare consumerism
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Creative Thinking - Browse the web or scan a dictionary and look for an “E” word that you
can add to the existing list of “E’s”on e-Health and make a brief description of it.
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ACTIVITY/ANSWER SHEET

Name: _______________________________________________________ LP#: ______________

Instructor: ____________________________________________________
Activity #1. Identify and discuss at least two advantages and disadvantages of using
1. Ready-made software
2. Free and Open Source Software

Activity #2. Identify at least three (3) factors that may affect the following:
1. Delivery of care using Telemedicine
2. e-Learning in the community
 3 | Community Health Nursing 2 23

ACTIVITY/ANSWER SHEET

Name: _______________________________________________________ LP#: ______________

Instructor: ____________________________________________________
Activity #3. Reflection!
What do you think about the current e-Health situation of the country? Provide strong and
weak points in your essay.