Community Health Nursing Lecture

TITLE: COMMUNITY HEALTH NURSING I

INSTRUCTOR: MR. JOMER V. MANALANG, RN MAN
COURSE CODE: NCM 104
COURSE TITLE: NCM 104 COMMUNITY HEALTH NURSING 1 (LECTURE)
CREDIT UNITS: 2 Units Lecture (36 hours), 2 Units RLE,1 Unit Skills Laboratory(51hours)
and 1 Unit Clinical Skills (51 hours)

COURSE DESCRIPTION
This course deals with concepts, principles, theories and technique in the provision of
basic care in terms of health promotion, disease prevention, restoration and maintenance
and rehabilitation at the individual and family level. It includes the study of the
Philippine Health Care Delivery System, national health situation and the global context
of family as clients in community setting utilizing the nursing process.

COURSE OUTLINE
Unit 1 Overview of Community Health Nursing/Public Health Nursing in
Week 1,2
the Philippines
Week 3,4 Unit 2 The Health Care Delivery System
Unit 3 The Family & Filipino Cultures Values, and Practices in relation to
Week 5,6
Health Care of individual and Family
Week 7,8,9 Unit 4 Family Nursing Process
Week 10 MIDTERM EXAMINATION
Week 11 Unit 5 Community health Nursing Activities
Unit 6 Records in Family Health Nursing Practice & New Technologies Related
Week 12,13
to Public Health Electronic Information
Week 14,15 Unit 7 DOH Programs Related to Family Health
Week 16 Unit 8 Ethical Considerations in Community Health Nursing
Week 17 Unit 9 Health-Related Entrepreneurial Activities in the Community Setting
Week 18 FINAL EXAMINATION

Criteria of Grading (Course Assessment)

Attendance/ Attitude 15%
Reports/Assignment/
Journal / Class 20%
Participation
Quizzes 25%
Term Examination 40%
Total 100%

Community Health Nurse

 Unlike a nurse who works with patients one-on-one in other clinical settings,
community health nurses focus on communities.
 CH nurses can have various roles in a community setting such as:
 Health education.
 Community advocacy.
 Ensuring a safe and healthy environment.
 Abuse and neglect prevention.
 Policy reform
 Community development
 What they do depends on the communities they serve; lower income, school, and
culturally diverse communities all have different needs.

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Community Health Nursing
 Community health nursing (CHN), also called public health nursing or community
nursing, combines primary healthcare and nursing practice in a community setting.
Community health (CH) Nurses provide health services, preventive care, intervention
and health education to communities or populations.

Global, National and Local Health Situation

 The country is facing a health crisis at present due to COVID19 pandemic. Where large
number of the population is affected.
 The Philippines has presently recorded new increased cases and a daily additional
COVID-19 cases still reported.
 The Department of Health and the Local Government Units are working together to find
ways of controlling the spread of the disease.
 With their joint efforts national and local health facilities are involved in the
management of cases. There is a problem in the scarcity of health workers (Doctors,
Nurses, Medical Technologists).
 Several private hospitals across Metro Manila earlier said beds allocated for COVID-19
cases had reached full capacity following the easing of quarantine restrictions in a
bid to revive the economy.
 According to the DOH the current population of the country is estimated about
109,653,229 where the Philippines ranked 13th in the highest population rate.
 The Philippine population is considered young and for global population Increase is
1.05 % per year.
 According to the DOH top leading causes of MORBIDITY in the Philippines includes all
forms respiratory diseases, hypertension, kidney and urinary tract problems, all forms
of diarrheal diseases, and diabetes mellitus.
 For MORTALITY, it includes cardiovascular diseases, pneumonias, malignant
neoplasms/cancers, all forms of tuberculosis, accidents, COPD and allied conditions,
diabetes mellitus, nephritis/nephritic syndrome and other diseases of respiratory
system.
 Morbidity – refers to the cases of illness in a given population in a specified period
of time.
 Mortality – refers to the cases of deaths in a given population in a specified period
of time.

Health and Longevity as Birthrights

 HEALTH IS A BASIC HUMAN RIGHT FOR EVERY FILIPINO.
 LONGEVITY – average lifespan.
 The lifespan increases among Filipinos according to the DOH and varies per year.
 There is an increase every year which is closely related to the different DOH health
programs.
 Life expectancy in the country in 2010-2015 was 68.6 years.
 Life expectancy at birth male/female in 2016- 66/73.
 The life expectancy for the Philippines in 2017 was 70.87 years.
 The life expectancy for the Philippines in 2018 was 71.03 years, a 0.23% increase from
2017.
 The life expectancy for Philippines in 2019 was 71.16 years, a 0.18% increase from
2018.

DEFINITION AND FOCUS

COMMUNITY
 It is a group of people with common characteristics or interests living together
within a territory or geographical boundary.
 It is a place where people under usual conditions are found.
 It is derived from a latin word "comunicas" which means a group of people.
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Two specific types of a community
 Urban areas – can refer to towns, cities, and suburbs. An urban area includes the city
itself, as well as the surrounding areas.
 Rural areas – are the opposite of urban areas. Rural areas have low population density
and large amounts of undeveloped land (Barios).

HEALTH
 According to WHO Health is defined as a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity.
 The state of being free from illness or injury.
 The enjoyment of the highest attainable standard of health is one of the fundamental
rights of every human being without distinction of race, religion, political belief,
economic or social condition.
 The health of all peoples is fundamental to the attainment of peace and security and
is dependent on the fullest cooperation of individuals and States.
 The achievement of any state in the promotion and protection of health is of value to
all.

COMMUNITY HEALTH
 Community health refers to the health status of the members of the community, to the
problems affecting their health and to the totality of the health care provided for
the community.
 Community health is a branch of public health which focuses on people and their role
as determinants of their own and other people's health.

Aims of CHN
 To promote health and efficiency.
 To prevent and control of diseases and disabilities.
 To prolong life through need-based health care.

OTTAWA CHARTER FOR HEALTH PROMOTION

 The Ottawa Charter for Health Promotion is the name of an international agreement
signed at the First International Conference on Health Promotion, organized by the
World Health Organization (WHO) and held in Ottawa, Canada, in November 1986.
 It launched a series of actions ng international organizations, national governments
and local communities to achieve the goal of "Health for All" by the year 2000 and
beyond through better health promotion.
Five action areas for health promotion were identified in the charter:
1. Building healthy public policy.
2. Creating supportive environments.
3. Strengthening community action.
4. Developing personal skills.
5. Re-orienting health care services toward prevention of illness and promotion of
health.
The basic strategies for health promotion prioritized as:
 Advocate: Health is a resource for social and developmental means, thus the dimensions
that affect these factors must be changed to encourage health.
 Enable: Health equity must be reached where individuals must become empowered to
control the determinants that affect their health, such that they are able to reach
the highest attainable quality of life.
 Mediation: Health promotion cannot be achieved by the health sector alone; rather its
success will depend on the collaboration of all sectors of government (social,
economic, etc.) as well as independent organizations (media, industry, etc.).
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JAKARTA DECLARATION ON LEADING HEALTH PROMOTION INTO THE 21ST CENTURY
 The Fourth International Conference on Health Promotion: New Players for a New Era
- Leading Health Promotion into the 21st Century, Jakarta, Indonesia, 2125 July,
1997.
PRIORITIES FOR HEALTH PROMOTION IN THE 21ST CENTURY
 Promote social responsibility for health.
 Increase investments for health development.
 Consolidate and expand partnerships for health.
 Increase community capacity and empower the individual Jakarta Declaration on Leading
 Health Promotion into the 21st Century Investments for health should reflect the
needs of particular groups such as women, children, older people, and indigenous,
poor and marginalized populations.

Definition of COMMUNITY HEALTH NURSING

 It is a synthesis of nursing and public health practice applied to promoting and
preserving the health of the people.
 According to Maglaya, CHN is the utilization of the nursing process in the different
levels of clientele-individuals, families, population groups and communities,
concerned with the promotion of health, prevention of disease and disability and
rehabilitation.
 The goal of CHN as stated by Nisce, is to raise the level of citizenry by helping
communities and families to cope with the discontinuities in and threats to health in
such a way as to maximize their potential for high-level wellness.
 The definition of CHN by the WHO Committee on expert in nursing is a special field of
nursing that combines the skills of nursing, public health and some phases of social
assistance and functions as part of the total public health program for the promotion
of health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.
 From Jacobson point of view CHN is learned practice discipline with the ultimate goal
of contributing as individuals and in collaboration with others to the promotion of
the client's optimum level of functioning through teaching and delivery of care
(Jacobson).
 DR. Ruth B. Freeman: A service rendered by a professional nurse to IFCs, population
groups in health centers, clinics, schools, workplace for the promotion of health,
prevention of illness, care of the public health.

Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice

Philosophy of CHN
 According to Dr. M. Shetland the philosophy of CHN is based on the worth and dignity
of man.
 The community is the patient in CHN, the family is the unit of care and there are four
levels of clientele: individual, family, population group (those who share common
characteristics, developmental stages and common exposure to health problems - e.g.
children, elderly), and the community.
 In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care.
 CHN practice is affected by developments in health technology, in particular, changes
in society, in general.
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  The goal of CHN is achieved through multi-sectoral efforts CHN is a part of health
care system and the larger human services system.

Objectives of Public Health

C.O.D.E.S
 Control of Communicable Diseases
 Organization of Medical and Nursing Services
 Development of Social Machineries
 Education of IFC on personal Hygiene
 Health Education is the essential task of every health worker
 Sanitation of the environment

3 Elements in Health Education

1. Information: to share ideas to keep population group knowledgeable and aware.
2. Education: change within the individual.
3. Communication: interaction involving 2 or more persons or agencies.

12 Basic Principles of CHN

 Community Health Nursing (CHN) is a vital part of Public Health.
 The following are the 12 Principles of CHN:
1. The recognized need of individuals, families and communities provides the basis
for CHN practice. Its primary purpose is to further apply public health measures
within the framework of the total CHN effort.
2. Knowledge and understanding of the objectives and policies of the agency
facilities goal achievement.
3. CHN considers the family as the unit of service. Its level of functioning is
influenced by the degree to which it can deal with its own problems and effective
and available channel for the most of the CHN efforts.
4. Respect for the values, customs and beliefs of the clients contribute to the
effectiveness of care to the client. CHN services must be available sustainable
and affordable to all regardless of race, creed, color or socio-economic status.
5. CHN integrated health education and counseling as vital parts of functions. These
encourage and support community efforts in the discussion of issues to improve
the people's health.
6. Collaborative work relationships with the co-workers and members of the health
team facilities accomplishments of goals. Each member is helped to see how
his/her work benefits the whole enterprise.
7. Periodic and continuing evaluation provides the means for assessing the degree to
which CHN goals and objectives are being attained. Clients are involved in the
appraisal of their health program through consultations, observations and
accurate recording.
8. Continuing staff education program quality services to client and are essential
to upgrade and maintain sound nursing practices in their setting. Professional
interest and needs of Community Health Nurses are considered in planning staff
development programs of the agency.
9. Utilization of indigenous and existing community resources maximizing the success
of the efforts of the Community Health Nurses. The use of local available
ailments. Linkages with existing community resources, both public and private,
increase the awareness of what care they need what are entitled.
10. Active participation of the individual, family and community in planning and
making decisions for their health care needs, determine, to a large extent, the
success of the CHN programs. Organized community groups are encouraged to
participate in the activities that will meet community needs and interests.
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 11. Supervision of nursing services by qualified by CHN personnel provides guidance
and direction to the work to be done. Potentials of employees for effective and
efficient work are developed.
12. Accurate recording and reporting serve as the basis for evaluation of the
progress of planned programs and activities and as a guide for the future
actions. Maintenance of accurate records is a vital responsibility of community
as these are utilized in studies and researches and as legal documents.

Roles of The Public Health Nurse

 Clinician - who is a health care provider, taking care of the sick people at home or
in the RHU.
 Health Educator - who aims towards health promotion and illness prevention through
dissemination of correct information; educating people.
 Facilitator - who establishes multi-sectoral linkages by referral system.
 Supervisor - who monitors and supervises the performance of midwives.
 Health Advocate - who speaks on behalf of the client.
 Collaborator - who works with other health team members.
 In the event that the Municipal Health Officer (MHO) IS unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of
the MHO's responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and
Regulations of RA 9173 (Philippine Nursing Act of 2002) includes:
 Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies.
 Suturing lacerations in the absence of a physician.
 Provision of first aid measures and emergency care.
 Recommending herbal and symptomatic medicines.

Responsibilities of a Community Health Nurse

In the care of the families:
 Provision of primary health care services.
 Developmental/Utilization of family nursing care plan in the provision of care.
In the care of the communities:
 Community organizing mobilization, community development and people empowerment.
 Case finding and epidemiological investigation.
 Program planning, implementation and evaluation.
 Influencing executive and legislative individuals or bodies concerning health and
development.

Responsibilities of CHN
 Be a part in developing an overall health plan, its implementation and evaluation for
communities.
 Provide quality nursing services to the three levels of clientele.
 Maintain coordination/linkages with other health team members, NGO/government agencies
in the Provision of public health services.
 Conduct researches relevant to CHN services to improve provision of health care.
 Provide opportunities for professional growth and continuing education for staff
development.

EVOLUTION OF CHN WORLDWIDE AND IN THE PHILIPPINES

 INFLUENCES OF ANCIENT CULTURES ON PUBLIC HEALTH
EGYPTIAN CIVILIZATION (ca 3000 BC)
 Built irrigation canal and granaries for storage of food
 Practice of prophylaxis by the medicine man and high priest
 Emphasis on personal hygiene, cleanliness within & outside the body
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  Sanitation measures (removal of refuse and crude fumigation in times of epidemics)
HEBREWS (C.A. 1400 BC)
 Founders of public hygiene and Moses was regarded as "Father of Sanitation"
 Mosaic Health Code pertained to every aspect of individual, family & community
hygiene, included:
a. Principles of personal hygiene (rest, sleep, hours of work, cleanliness)
b. Environmental sanitation
1. Inspection of food
2. Methods of disposal of excreta
3. Detecting and reporting diseases
4. Practice of isolation, quarantine, fumigation, and disinfection.
5. Detailed instructions on the correct way of handwashing.
GREEKS (CA. 600 BC)
 Hippocrates - "Father of Medicine", exponent of the science of preventive medicine
and introduced the philosophy of the interrelationship between physical and mental
health ("A healthy mind dwells in a healthy body").
ROMANS (CA. 50 BC)
 Contributed to the field of sanitation (building of Aqueducts, purification of
water supply).
 Appointing of public health medical officers and establishment of hospitals which
emphasized both preventive and curative aspects of care.

 DEVELOPMENT OF PUBLIC HEALTH NURSING AS A WORLD MOVEMENT

EARLY CHRISTIAN PERIOD (1 ST CENTURY)
 Order of Deaconesses – called visiting nurses, forerunner of CHN and endeavored to
practice the corporal works of mercy (feeding the hungry, caring for the sick,
burying the dead).
 Phoebe a friend of St Paul and the first Deaconess and visiting nurse.
MIDDLE AGES (500-1500)
 Beguines of Flanders – worked as nursing sister in the hospital, but also gave care
to the sick in their homes, staying with the dying and consoling the families of
the bereaved.
RENAISSANCE (1500-1700)
 St Vincent De Paul – introduced modern principles of visiting nurse, social
services, taught that indiscriminate giving was harmful, emphasized the concept of
helping people.
 Maintained the family is the unit of the service and recognized the importance of
supervision of those who render service to the sick.
EARLY 19 TH CENTURY
 Pastor Theodor Fliedner – a German Lutheran pastor, went on tour to raise funds
when the main industry of his community failed, came back with money and ideas for
a program social work.
 Fredericka Munster Fliedner – wife of the pastor who organized women society for
visiting nursing the sick poor in their homes Couple recognized the need for
preparing the training those who care for the sick, organized a hospital school of
nursing in Germany (Kaiserswerth Institute for the training of Deaconesses).

Development of Modern PHN

Characterized by:
 Clean-up measures in the control of communicable disease.
 Removal of refuse Clean-up campaign of prison and asylums.
 Improvement of working conditions of women and children.
William Rathbone – Father of Modern District Nursing with the encouragement of Florence
Nightingale, organized a training school for nurses in the Liverpool Royal Infirmary

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which provided training for hospital nurses, private duty nurses, and the district
nurses.

STANDARDS IN CHN
 Theory
 Data Collection
 Diagnosis
 Planning
 Intervention
 Evaluation
 Quality Assurance and Professional Development
 Interdisciplinary Collaboration
 Research

Legal basis of CHN Practice

 Code of Ethics for Nurses R.A. # 9173 (Nursing Law of 2002) Competency Standards of
Nursing Practice in the Philippines

COMMUNITY HEALTH NURSE ROLES and FUNCTIONS

Qualifications
 Bachelor of Science in Nursing
 Registered Nurse of the Philippines
Planner/Programmer
 Identifies needs, priorities, and problems of individuals, families, and
communities.
 Formulates municipal health plan in the absence of a medical doctor.
 Interprets and implements nursing plan, program policies, memoranda, and circular
for the concerned staff personnel.
 Provides technical assistance to rural health midwives in health matters.
 Provider of Nursing Care
 Provides direct nursing care to sick or disabled in the home, clinic, school, and
workplace.
 Develops the family's capability to take care of the sick, disabled, or dependent
member
Community Organizer
 Motivates and enhances community participation in terms of planning, organizing,
implementing, and evaluating health services.
 Initiates and participates in community development activities.
Coordinator of Services
 Coordinates with individuals, families, and groups for health-related services
provided by various members of the health team.
 Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health.
Trainer/Health Educator
 Identifies and interprets training needs of the RHMs and Barangay Health Workers
(BHW).
 Conducts training for RHMs and BHW on promotion and disease prevention
 Conducts pre- and post-consultation conferences for clinic clients; acts as a
resource speaker on health and health related services.
 Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health
education purposes.
 Conducts pre-marital counseling
Health Monitor
 Detects deviation from health of individuals, families, groups, and communities
through contacts/visits with them.
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Role Model
 Provides good example of healthful living to the members of the community
Change Agent
 Motivates changes in health behavior in individuals, families, groups, and
communities that also include lifestyle in order to promote and maintain health.
Recorder/Reporter/Statistician
 Prepares and submits required reports and records.
 Maintain adequate, accurate, and complete recording and reporting.
 Reviews, validates, consolidates, analyzes, and interprets all records and reports.
 Prepares statistical data/chart and other data presentation.
Researcher
 Participates in the conduct of survey studies and researches on nursing and health-
related subjects Coordinates with government and non-government organization in the
implementation of studies/research.

NURSING CORE VALUES AS A COMMUNITY HEALTH NURSE

Mission
 The National League for Nursing promotes excellence in nursing education to build a
strong and diverse nursing workforce to advance the health of our nation and the
global community.
CORE VALUES
 CARING: promoting health, healing, and hope in response to the human condition
- A culture of caring, as a fundamental part of the nursing profession,
characterizes our concern and consideration for the whole person, our
commitment to the common good, and our outreach to those who are vulnerable.
 INTEGRITY: respecting the dignity and moral wholeness of every person without
conditions or limitation;
- A culture of integrity is evident when organizational principles of open
communication, ethical decision-making, and humility are encouraged,
expected, and demonstrated consistently.
 DIVERSITY: affirming the uniqueness of and differences among persons, ideas,
values, and ethnicities.
- A culture of inclusive excellence encompasses many identities, influenced by
the intersections of race, ethnicity, gender, sexual orientation, socio-
economic status, age, physical abilities, religious and political beliefs, or
other ideologies.
 EXCELLENCE: co-creating and implementing transformative strategies with daring
ingenuity.
- A culture of excellence reflects a commitment to continuous growth,
improvement, and understanding. It is a culture where transformation is
embraced, and the status quo and mediocrity are not tolerated.
 Community Health Nurses face daily challenges not experienced in a hospital setting,
and experience more autonomy than hospital-based nurses. Nursing ethics and
professional core values play a substantial role in the decision-making process
outside of the hospital setting.

THE HEALTH CARE DELIVERY SYSTEM

Health care delivery system is defined as the aggregate of institutions, organizations
and persons who enter the health care system, who has responsibility that include the
promotion of health, prevention of illness, detection and treatment of disease and
rehabilitation.

DEFINITION OF TERMS
HEALTH CARE DELIVERY SYSTEM (HCDS)

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 - It is the totality of all policies, facilities, equipment, products, human
resources and services which address the health needs, problems and concerns of the
people. It is large, complex, multi-level and multi-disciplinary. HCDS is often
used to describe the way in which health care is provided to the people.
- It is the network of health facilities and personnel which carries out the task of
rendering health care to the people. (Williams-Tungpalan, 1981)
HEALTH CARE SYSTEM (HCS)
- It is a complex set of organizations interacting to provide an array of health
services (Dizon, 1977).
- It is an organized plan of health services (Miller-Keane, 1987)
HEALTH CARE DELIVERY (HCD)
- It is rendering health care services to the people (Williams-Tungpalan, 1981).

HEALTH CARE DELIVERY SYSTEM

The primary objectives of any health delivery system are:
- To enable all citizens to receive health care services whenever needed.
- To deliver health services that are cost-effective and meet preestablished
standards of quality.
Three levels of health care & health care facility:
 Primary Level of care – Primary Level of Health care Facility
 Secondary Level of care – Secondary Level of Health care Facility
 Tertiary Level of care – Tertiary Level of Health care facility

PRIMARY LEVEL OF CARE

- This includes prevention of illness or promotion of health. It is the initial entry
point for clients of the health care delivery system which is directed towards the
promotion and maintenance of health, the prevention of disease, the management of
common specific illnesses and usually ambulatory or outpatient settings. Services
are offered by the Primary level of Health Care Facility.
 RHU/MHO
 Private Clinics
 Birthing/Lying in Centers

SECONDARY LEVEL OF CARE

- It centers on early diagnosis and treatment of diseases. This includes provision of
specialized medical services by physician or a hospital on a referral by the
primary care provider. Services are offered by Secondary Level of Health Care
facility.
 Community hospitals
 District and emergency hospitals

TERTIARY LEVEL OF CARE

- Rehabilitation is restoring health and aimed at lessening the pain and discomfort
of illness and helping clients live with disease and disability. It also includes
care of chronic ailment that requires long term care and prevention of
complications. Services are offered by Tertiary Level of Health Care facility.
 Provincial Hospitals
 Specialized hospitals

FACTORS AFFECTING THE DELIVERY OF HEALTH CARE SERVICES

 Socio-economic factor
 Technological advancement
 Access to health care facility
 High cost of hospitalization
 Health consumers
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  Unequal distribution of health services and health personnel
 Demographic changes

THE WORLD HEALTH ORGANIZATION (WHO)

- The World Health Organization is a specialized agency of the United Nations
responsible for international public health. The WHO Constitution, which
establishes the agency's governing structure and principles, states its main
objective as "the attainment by all peoples of the highest possible level of
health.
- The WHO was established by constitution on 7 April 1948, which is commemorated as
World Health Day.
- The WHO's broad mandate includes advocating for universal healthcare, monitoring
public health risks, coordinating responses to health emergencies, and promoting
human health and well-being.
- It provides technical assistance to countries, sets international health standards
and guidelines, and collects data on global health issues through the World Health
Survey.
- Its flagship publication, the World Health Report, provides expert assessments of
global health topics and health statistics on all nations.
- The WHO also serves as a forum for summits and discussions on health issues.

The WHO Eight Millennium Development Goals:

 To eradicate extreme poverty and hunger;
 To achieve universal primary education;
 To promote gender equality and empower women;
 To reduce child mortality;
 To improve maternal health;
 To combat HIV/AIDS, malaria, and other diseases;
 To ensure environmental sustainability, and
 To develop a global partnership for development

The WHO 17 sustainable development goals (SDGs) to transform our world:

 GOAL 1: No Poverty
 GOAL 2: Zero Hunger
 GOAL 3: Good Health and Well-being
 GOAL 4: Quality Education
 GOAL 5: Gender Equality
 GOAL 6: Clean Water and Sanitation
 GOAL 7: Affordable and Clean Energy
 GOAL 8: Decent Work and Economic Growth
 GOAL 9: Industry, Innovation and Infrastructure
 GOAL 10: Reduced Inequality
 GOAL 11: Sustainable Cities and Communities
 GOAL 12: Responsible Consumption and Production
 GOAL 13: Climate Action
 GOAL 14: Life Below Water
 GOAL 15: Life on Land
 GOAL 16: Peace and Justice Strong Institutions
 GOAL 17: Partnerships to achieve the Goal

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

It is a complex set of organizations between the public and the private sector to provide
health services.

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Department of Health (DOH)
- The Department of Health (DOH; Kagawaran ng Kalusugan) is the executive department
of the Government of the Philippines responsible for ensuring access to basic
public health services by all Filipinos through the provision of quality health
care and the regulation of all health services and products. It is the government's
overall technical authority on health.

THE DEPARTMENT OF HEALTH MANDATE:

The Department of Health shall be responsible for the following:
 Formulation and development of national health policies, guidelines, standards and
manual of operations for health services and programs;
 Issuance of rules and regulations, licenses and accreditations; promulgation of
national health standards, goals, priorities and indicators;
 Development of special health programs and projects and advocacy for legislation on
health policies and programs.
 The primary function of the Department of Health is the promotion, protection,
preservation or restoration of the health of the people through the provision and
delivery of health services and through the regulation and encouragement of providers
of health goods and services (E.O. No. 119, Sec. 3).

DEPARTMENT OF HEALTH (DOH)

VISION by 2030
- A global leader for attaining better health outcomes, competitive and responsive
health care system and equitable health financing.
MISSION
- To guarantee equitable, sustainable and quality health for every Filipinos leading
to the quest for excellence in health amongf the Filipino people.
- Health as a right. Health for All Filipinos.
- The mission of the DOH, in partnership with the people to ensure equity, quality
and access to health care:
 By making services available
 By arousing community awareness
 By mobilizing resources
 By promoting the means to better health
GOAL
- To enable the Filipino population to achieve a level of health which will allow
Filipino to lead a socially and economically productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability
through measures that will guarantee access of everyone to essential health care
OBJECTIVES
 To promote equity in health status among all segments of society.
 To address specific health problems of the population.

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  To upgrade the status and transform the HCDS into a responsive, dynamic and highly
efficient, and effective one in the provision of solutions to changing the health
needs of the population.
 To promote active and sustained people's participation in health care.

DOH Roles and Functions (EO 102)

 Leadership in Health
 Enable and Capacity Builder
 Administrator of Specific Services

The DOH is composed of:

 17 central offices
 16 Centers Health Development
 70 hospitals
 4 attached agencies

REFERRAL SYSTEM IN LEVELS OF THE HEALTH CARE: (Philippine Ratio)

 Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM)
 Rural Health Midwife 1:500 catchment population
 Rural Health Unit (RHU) is under the management or supervision of PHN
 Public Health Nurse (PHN) caters to 1:10,000 catchment population, acts as managers
in the implementation of the policies and activities of RHU, directly under the
supervision of MHO (who acts as administrator)
 Municipal Health Officer (MHO/Physician) 1:20,000 catchment population

FEATURES OF DOH REORGANIZATION

 1958- RA 1082
- 1st Rural Health Act which increases the number in the employment of more
physicians, dentists, nurses, midwives and sanitary inspectors assigned to RHU's
and 1st 81 rural health units were defined.
 1972- RA 5435
- Defined authorities of regional directors for more meaningful decentralization
and 13 regional health offices were created.
 1974
- RHCDS was implemented, RHM were sent to BHS to man BHS and Midwives were
trained and roles expanded.
 1982- EO 851
- Integrated public health and hospital systems with emphasis on importance of
putting together promotive, preventive, curative and rehabilitative components
of health care and utilization of BHW.
- Implementation of DOH impact programs, Role of Society in RHCDS and
participation in information drive of HCDS.
PHILIPPINE HEALTH AGENDA 2016 - 2022.
 With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system
with the values of Equity, Quality, Efficiency, Transparency, Accountability,
Sustainability, Resilience towards "Lahat Para sa kalusugan! Tungo sa kalusugan
Para sa Lahat”.

PRIMARY HEALTH CARE

- Primary Health Care (PHC) is an essential health care made universally acceptable
to individuals and families in the community by means acceptable to them through
their full participation and at a cost that the community and country can afford at
every stage of development. Primary Health Care (PHC) characterized by partnership
and empowerment of people shall permeate as core strategy in effective provision of
essential health services.
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 - Letter of Instruction (LOI) 849: signed on Oct. 19, 1979 by then Pres. Ferdinand E.
Marcos provides legal basis in the official adoption of PHC in the Philippines.

The following are the eight (8) essential elements of primary health care:
1. Education for Health
- This is one of the potent methodologies for information dissemination. It promotes
the partnership of both the family members and health workers in the promotion of
health as well as prevention of illness.
2. Locally Endemic Disease Control
- The control of endemic disease focuses on the prevention of its occurrence to
reduce morbidity rate. Example Malaria control and Schistosomiasis control.
3.Expanded Program on Immunization
- This program exists to control the occurrence of preventable illnesses especially
of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus,
diphtheria and other preventable disease are given for free by the government and
ongoing program of the DOH
4. Maternal and Child Health and Family Planning
- The mother and child are the most delicate members of the community. So, the
protection of the mother and child to illness and other risks would ensure good
health for the community. The goal of Family Planning includes spacing of children
and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
- Environmental Sanitation is defined as the study of all factors in the man's
environment, which exercise or may exercise deleterious effect on his well-being
and survival.
Water is a basic need for life and one factor in man's environment. Water is
necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is
necessary for basic promotion of health
6. Nutrition and Promotion of Adequate Food Supply
- One basic need of the family is food. And if food is properly prepared then one may
be assured healthy family. There are many food resources found in the communities
but because of faulty preparation and lack of knowledge regarding proper food
planning. Malnutrition is one of the problems that we have in the country.
7. Treatment of Communicable Diseases and Common Illness
- The diseases spread through direct contact pose a great risk to those who can be
infected. Tuberculosis is one of the communicable diseases continuously occupies
the top ten causes of death.
- Most communicable diseases are also preventable. The Government focuses on the
prevention, control and treatment of these illnesses
8. Supply of Essential Drugs
- This focuses on the information campaign on the utilization and acquisition of
drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted.

PRIMARY HEALTH CARE

Goal:
- Health for all Filipinos and Health in the hands of the people by the year 2020.
- The ultimate goal of primary health care is better health for all. WHO has
identified the following key elements to achieving that goal:
 Reducing exclusion and social disparities in health (universal coverage
reforms);
 Organizing health services around people's needs and expectations (service
delivery reforms);
 Integrating health into all sectors (public policy reforms);
 Pursuing collaborative models of policy dialogue (leadership reforms); and
 Increasing stakeholder participation
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Mission
- To strengthen the health care system by increasing opportunities and supporting
conditions wherein people will manage their own health care.

PRIMARY HEALTH CARE

Adopting primary health care has the following rationales:
 Magnitude of Health Problems.
 Inadequate and unequal distribution of health resources.
 Increasing cost of medical care.
 Isolation of health care activities from other development activities.
Objectives
 Improvement in the level of health care of the community.
 Favorable population growth structure.
 Reduction in the prevalence of preventable, communicable and other disease.
 Reduction in morbidity and mortality rates especially among infants and children.
 Extension of essential health services with priority given to the underserved
sectors.
 Improvement in basic sanitation.
 Development of the capability of the community aimed at self-reliance.
 Maximizing the contribution of the other sectors for the social and economic
development of the.
LEVELS OF PREVENTION
 Primary Prevention
- Health Promotion Practices and Specific Protection from specific Illnesses
 Secondary Prevention
- Practices on Early Diagnosis and Treatment of Diseases
 Tertiary Prevention
- Rehabilitation, Restoration and Maintenance of health and prevention of
complications and disability limitation

FOUR PILLARS OF PUBLIC HEALTH CARE

1. Active Community Participation.
2. Intra and Inter-sectoral linkages.
3. Use of appropriate technology.
4. Support mechanism made available.

LEARNING MODULE FOR UNIT III

The Family & Filipino Cultures Values, and Practices in relation to Health Care of
Individual and Family

I. INTRODUCTION
This topic will give the student knowledge about a family, how does it function, as a
client, as a system and its tasks, functions and roles. This concept deals with the
characteristic of a healthy family and the different Filipino cultures values, and
practices in relation to health care of individual and family.

II. LEARNING OUTCOMES

At the end of two weeks, the student will be able to:
 Describe a family.
 Distinguish the different types of a family.
 Determine how the family functions as a client and as a system.
 Discuss the various family health task.
 Explain how cultures, values, and practices affect he4alth care of a family.
 Relate the characteristics of a healthy family
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III. LEARNING OUTLINE
Unit 3
A. The Family
A. Family as Basic Unit of the Society
B. Type
1. Family as a Client
2. Family as a System
C. Functions Developmental Stages
D. Family Health Task
E. Characteristics of a Health Family
B. Filipino Cultures Values, and Practices in relation to Health Care of Individual and
Family
A. Family Solidarity
B. Filipino Family Values
1. Communication
2. Helping Others and Gratitude
3. Respect
4. Independence
5. Service
6. Trust

IV. LEARNING CONTENT

Family Health Nursing
 FAMILY: It is the basic unit of the society, and is shaped by all forces surround
it. Values, beliefs, and customs of society influence the role and function of the
family (invades every aspect of the life of the family)
 It is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective
familial roles and create and maintain a common culture.
 An open and developing system of interacting personalities with structure and
process enacted in relationships among the individual members regulated by
resources and stressors and existing within the larger community.
 Two or more people who live in the same household (usually), share a common
emotional bond, and perform certain interrelated social tasks.
 An organization or social institution with continuity (past, present, and future).
In which there are certain behaviors in common that affect each other.

THE FILIPINO FAMILY

 Based on the Philippine Constitution, Family Code with focus on religious, legal,
and cultural aspects of the definition of family. The state recognizes the Filipino
family as the foundation of the nation. Accordingly, it shall strengthen its
solidarity and actively promote its total development Marriage, as an
inviolable social institution, is the foundation of family and shall be protected
by the state.
 The state shall defend:
1. The right of spouses to found a family in accordance with their religious
convictions and the demands of responsible parenthood
2. The right of children to assistance including proper care and nutrition, and
special protection from all forms of neglect, abuse, cruelty, exploitation
and other conditions prejudicial to their development.
3. The right of the family to a family living wage income
4. The right of families or family associations to participate in the planning
and implementation of policies and programs of that affect them
5. The family has the duty to care for its elderly members but the state may
also do so through just programs of social security.
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THE FILIPINO FAMILY AND ITS CHARACTERISTICS
The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship is felt in
all segments of social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often includes the
third cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial ties. Filipino
marriage is not an individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions.
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also have to
learn to repress their repressive tendencies
9. The older siblings have something of authority of their parents.

TYPES OF FAMILY
 There are many types of family. They change overtime as a consequence of BIRTH,
DEATH, MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS.
Structure of Family:
1. NUCLEAR- a father, a mother with child/children living together but apart from both
sets of parents and other relatives.
2. EXTENDED- composed of two or more nuclear families economically and socially
related to each other. Multigenerational, including married brothers and sisters,
and the families.
3. SINGLE PARENT-divorced or separated, unmarried or widowed male or female with at
least one child
4. BLENDED/RECONSTITUTED-a combination of two families with children from both
families and sometimes children of the newly married couple. It is also a
remarriage with children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing resources COHABITING/LIVEIN-
unmarried couple living together
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and exchange support
who have no legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care for them

FUNCTIONAL TYPE:
1. FAMILY OF PROCREATION- refers to the family you yourself created.
2. FAMILY OF ORIENTATION-refers to the family where you came from.

Decisions in the family (Authority)

 PATRIARCHAL – full authority on the father or any male member of the family e.g.
eldest son, grandfather
 MATRIARCHAL – full authority of the mother or any female member of the family, e.g.
eldest sister, Grandmother.
 EGALITARIAN- husband and wife exercise a more or less amount of authority, father
and mother decide.
 DEMOCRATIC – everybody is involved in decision making
 AUTHOCRATIC- the father or the mother or eldest member of the family should be
followed with full authority
 LAISSEZ-FAIRE- “full autonomy”

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  MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father
is working overseas)
 PATRICENTIC- the father decides/ takes charge in absence of the mother

DECENT (cultural norms, which affiliate a person with a particular group of kinsman for
certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are related to him
though his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
RESIDENCE
 PATRILOCAL – family resides / stays with / near domicile of the parents of the
husband
 MATRILOCAL – live near the domicile of the parents of the wife

FUNCTION OF FAMILY ACCORDING TO ACKERMAN & DOODE

 Insuring the physical survival of the species/ REPRODUCTION/ BIOLOGICAL
 Physical functions of the family are met through parents providing food, clothing
and shelter, protection against danger provision for bodily repairs after fatigue
or illness, and through reproduction
 Transmitting the culture, thereby insuring man’s humanness
o Affectional function – the family is the primary unit in which his child test
his emotional reactions
o Social functions – include providing social togetherness, fostering self-
esteem and a personal identity tied to family identity, providing opportunity
for observing and learning social and sexual roles, accepting responsibility
for behavior and supporting individual creativity and initiative.

THE FAMILY AS A UNIT OF CARE

Rationale for Considering the Family as a Unit of Care:
1. The family is considered the natural and fundamental unit of society
2. The family as a group generates, prevents, tolerates and corrects health problems
within its membership
3. The health problems of the family members are interlocking
4. The family is the most frequent focus of health decisions and action in personal
care
5. The family is an effective and available channel for much of the effort of the
health worker.

THE FAMILY AS THE CLIENT

Characteristics of a Family as a Client
1. The family is a product of time and place- A family is different from other family
who lives in another location in many ways. A family who lived in the past is
different from another family who lives at present in many ways.
2. The family develops its own lifestyle, develop its own patterns of behavior, its
own style in life and develop their own power system which either be:
a. Balance-the parents and children have their own areas of decisions and
control.
b. Strongly Bias-one member gains dominance over the others.
3. The family operate as a group: A family is a unit in which the action of any member
may set of a whole series of reaction within a group, and entity whose inner
strength may be its greatest single supportive factor when one of its members is
stricken with illness or death.
4. The family accommodates the needs of the individual members. An individual is
unique human being who needs to assert his or herself in a way that allows him to
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 grow and develop. Sometimes, individual needs and group needs seem to find a
natural balance;
a. The need for self-expression does not over shadow consideration for others.
b. Power is equitably distributed.
c. Independence is permitted to flourish
5. The family relates to the community: Family develops a stance with respect to the
community:
a. The relationship between the families is wholesome and reciprocal; the family
utilizes the community resources and in turn, contributes to the improvement
of the community.
b. There are families who feel a sense of isolation from the community.
 Families who maintain proud, “We keep to ourselves” attitude
 Families who are entirely passive taking the benefits from the
community without either contributing to it or demanding changes to it.
6. The family has a growth cycle and passes developmental stages.

STAGES OF A FAMILY
According to MAGLAYA there are 7 developmental stages of a family:
STAGES TASKS
1. Beginning Establishing a mutually satisfying marriage
Family/Marriage & Planning to have or not to have children
Family Period of adjustment like routines in sleeping, eating,
chores, sexual and economic aspects
2. Child-bearing family Having and adjusting the infant
Supporting the needs of all three members Renegotiating
martial relationships
3. Family with a pre- Adjusting to cost a family life
school Children Adapting to the needs of pre-school children
Coping with parental loss of energy and privacy
Busy family children at this stage demand a great deal of
time related to growth and development needs and safety
considerations.
4. Family with school age Adjusting to the activity of the growing children
Children Promoting joint decisions between children and parents
Important responsibility of preparing their children to be
able to function in a complex world while at the same
time maintaining their own satisfying marriage relationship.
Encouraging and supporting children’s educational
achievements
5. Family with teenagers Maintaining open communication among members
and young adult Supporting ethical and moral values within the family
Balancing freedom with responsibility of teenagers
Releasing young adults with appropriate rituals and
assistance
Family allows the adolescents more freedom and prepare them
for their own life as technology advances gap between
generations increase
6. Post-parental family Strengthening martial relationships
Maintaining supportive home base Preparing for retirement
Children leave to set their own household-appears to
represent the breaking of the family returns to two partners
nuclear unit
Period from empty nest to retirement
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7. Aging Family Maintaining ties with younger and older generations
Adjusting for retirement
Adjusting to loss of spouse and closing family house

BEHAVIORS INDICATING A WELL FAMILY

1. Able to provide for physical emotional and spiritual needs of family members
2. Able to be sensitive to the needs of the family members
3. Able to communicate thought and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing relationship
6. Maintain and create constructive and responsible community relationships
7. Able to grow with and through children
8. Ability to perform family roles flexibly
9. Able to help oneself and to accept help when appropriate
10. Demonstrate mutual respect for the individuality of family members
11. Ability to use a crisis experience as a means of growth
12. Demonstrate concern of family unity, loyalty and interfamily cooperation

FAMILY HEALTH TASK

 Health task differ in degrees from family to family
 TASK- is a function, but with work or labor overtures assigned or demanded of the
person
 According to Maglaya there are 5 Family Health Tasks
1. Recognizing interruptions of health development
2. Making decisions about seeking health care/ to take action
3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health maintenance

EIGHT FAMILY FUNCTIONS.

1. Physical maintenance- provision of basic needs of the family like food, shelter,
clothing, and health care to its members being certain that a family has ample
resources to provide
2. Socialization of Family– preparation of children to live in the community and interact
with people outside the family.
3. Allocation of Resources- determines which family needs will be met and their order of
priority.
4. Maintenance of Order–opening an effective means of communication between family
members, integrating family values and enforcing common regulations for all family
members.
5. Division of Labor – who will fulfill certain roles e.g., family provider, home
manager, children’s caregiver
6. Reproduction/Procreation, Recruitment, and Release of family member
7. Placement of members into larger society –consists of selecting community activities
such as church, school, politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale– created when members serve as support people to
each other

FAMILY ROLES
 Nurturing figure– primary caregiver to children or any dependent member.
 Provider – provides the family’s basic needs.
 Decision maker– makes decisions particularly in areas such as finance, resolution, of
conflicts, use of leisure time etc.
 Problem-solver– resolves family problems to maintain unity and solidarity.

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  Health manager– monitors the health and ensures that members return to health
appointments. Gate keeper-determines what information will be released from the family
or what new information can be introduced.

CLASSIC FILIPINO TRAITS AND CHARACTERISTICS

 Hospitality. This is one of the most popular qualities of Filipinos.
 Respect. This is often observed not just by younger people but also by people of all
ages.
 Strong Family Ties and Religions
 Generosity
 Helpfulness
 Strong Work Ethic
 Love
 Caring

10 COMMENDABLE TRAITS AND CHARACTERISTICS OF A FILIPINO

1. Honest
2. Respectful
3. Calm and Collected
4. Resourceful
5. Hard-working
6. Cheerful
7. Active
8. Passionate
9. Jack of all Trades
10. Focused

LEARNING MODULE FOR UNIT IV

Family Nursing Process

I. INTRODUCTION
This concept will provide the student knowledge in the conduct of family health nursing
process. This will guide the student in dealing with families as clients in the community
by utilizing the different steps of family health nursing process, from assessment,
identification of family health problems, formulating family nursing diagnosis, planning,
implementation and evaluation. This will equip the student the different approach and
strategies to deal with identified family health problems.

II. LEARNING OUTCOMES

At the end of this unit, the student will be to
1. Know what is family health.
2. Define family health nursing process and its steps/phases
3. Identify and deal with the recognized health needs and problems of a family.
4. Formulate family nursing diagnosis
5. Design nursing strategies solve the health problems of the family.
6. Teach families develop abilities to work with their health needs and problems.
7. Evaluate nursing actions in solving health problems of a family.

LEARNING CONTENT
Review of the Nursing Process
 It is a scientific and systematized approach to health to care for individuals,
families, and illness prevention
 It is the means by which nurses address the health needs and problems of their
clients

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  It is a systematic, client-centered method or structuring the delivery of nursing
care
 Nursing process is a systematic, rational method of planning and providing
individualized nursing care.
The Purpose of Nursing Process
 To identify client’s health status, actual or potential healthcare problems or
need.
 To establish plans to meet the identified needs and to deliver specific
interventions to meet those needs.
 It provides a framework in which to practice nursing.
Characteristics of a nursing process:
 Dynamic and cyclic
 Patient centered
 Goal directed
 Open and Flexible
 Problem Oriented
 Planned
 Universally accepted
 Interpersonal and collaborative
 Holistic
 Systematic
Benefits of Nursing Process
1. Improves the quality of care that the client receives
2. Ensures a high level of client participation together with continuous evaluation
designed to meet the client’s unique needs
3. Enables nurses to use time and resources efficiently to both their own and their
client’s benefit
The steps of the Nursing Process
 Assessment
 Nursing Diagnosis
 Planning
 Implementation
 Evaluation

Nursing Assessment: The process of collecting, validating and recording data about a
client’s health status. It identifies patient’s strengths and limitations and is done
continuously throughout the nursing process.
Nursing Diagnosis: In this phase the nurse sort, clusters and analyzes data.
Nursing diagnoses are identified through actual and potential health problems or
responses to life processes.
Types of nursing diagnosis:
It can be ACTUAL, POTENTIAL or WELLNESS diagnosis:
1. ACTUAL – identifies an occurring health problem
2. POTENTIAL – identifies a high-risk health problem
3. WELLNESS‐ focused on promoting or enhancing a patient’s level of wellness.
Planning: Planning expected outcomes to resolve or minimize the identified problems of
the client. In collaboration with the client, the nurse develops specific nursing
intervention for each nursing diagnosis.
Implementation: Also called intervention; putting the nursing care plan into action to
achieve goals and outcomes as you implement your plan, you continue to assess your
patient’s responses and modify plan as needed. The doing phase of the nursing process.
Care done should always be documented.
Evaluation: Assessing the client’s response to nursing interventions and then comparing
the response to the goals or outcome criteria written in the planning phase

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FAMILY HEALTH
 The continuing ability to meet defined functions in interaction with other social,
political, economic and health system.
 Possessing the abilities and resources to accomplish family developmental tasks.
FAMILY HEALTH NURSING PROCESS
 Family nursing process is the same, whether the focus is the famiily as patient or
as environment. The goal is to help the family reach and maintain its maximum
health in a given situation.
PRINCIPLES OF FAMILY HEALTH CARE
1. Establishing good professional relationship with the family
2. Proper education and guidance should be provided
3. Gather all relevant information about family to identify problem and set priorities
4. Provide need-based support and services to the family to improve their health
status
5. Health care services should be provided to the family irrespective of their age,
sex, income, religion, etc.
6. Duplication of health services should be avoided
7. Proper health message to be communicated to family in every contact
STEPS OF FAMILY HEALTH NURSING PROCES
1. ASSESSMENT
2. FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS
3. PLANNING
4. IMPLEMENTATION
5. EVALUATION PHASE

I. ASSESSMENT
Family Health Nursing Assessment
 This involves a set of actions by which the nurse measures the status of the family
as a client, its ability to maintain itself as a system and functioning unit, and
its ability to maintain wellness, prevent control and resolve problems in order to
achieve health and well-being among its members.
 Data Collection Data Analysis Diagnosis

DATA COLLECTION
Two important things to ensure Effective and Efficient Data Collection in Family Nursing
Practice:
1. Identify the types of kinds of data needed
2. Specify the methods of data gathering and necessary tools for gathering data
DATA ANALYSIS – sorting out and classifying or grouping data by type of nature.

ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS

1. Criteria for analysis
2. Process for analysis
o sorting of data
o clustering of related cues
o distinguishing relevant from irrelevant cues
o identifying patterns
o comparing patterns
o interpreting results of comparison
o making inferences and drawing conclusions

NURSING DIAGNOSIS
 The end result of the secondary level assessment and a set of family nursing problems
for each health condition or problem
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  First major phase of nursing process in family health nursing
 It involves a set of action by which the nurse measures the status of the family as a
client. Its ability to maintain wellness, prevent, control or resolve problems in
order to achieve health and wellness among its members
 Data about present condition or status of the family are compared against the norms
and standards of personal, social, and environmental health, system integrity and
ability to resolve social problems. The norms and standards are derived from values,
beliefs, principles, rules or expectation.

TWO MAJOR TYPES OF ASSESSMENT:

1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or
problems of the family are determined (WS, HT, HD, SP or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family
encounters in performing health task with respect to given health condition or problem
and etiology or barriers to the family’s assumption of the task

DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD

OBSERVATION
 It is done through use of sensory capacities
 The nurse gathers information about the family’s state of being and behavioral
responses.
 The family’s health status can be inferred from the signs /symptoms of problem areas
within the following areas:
 communication and interaction patterns expected, used, and tolerated by family members
 role perception / task assumption by each member including decision making patterns
 conditions in the home and environment
 Data gathered though this method have the advantage of being subjected to validation
and reliability testing by other observers.
PHYSICAL EXAMINATION
 Health assessment of every member of the family, significant data about the health
status of individual members can be obtained through direct examination through IPPA,
measurement of specific body parts and reviewing the body systems.
 Data gathered form substantive part of first level assessment which may indicate
presence of health deficits (illness state)
INTERVIEW
 Productivity of interview process depends upon the use effective communication
techniques to elicit needed response.
 Problems encountered during interview:
 How to ascertain where the client is in terms of perception of health condition or
problems and the patterns of coping utilized to resolve them
 Tendency of community health worker to readily give out advice, health teachings or
solutions once they have identified the health condition or problems.
 Provisions of models for phrasing interview questions utilization of deliberately
chosen communication techniques for an adequate nursing assessment.
 Confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question that aim to
explore, validate, clarify, offer feedback, encourage verbalization of thought and
feelings.
RECORDS REVIEW
 Gather information through reviewing existing records and reports pertinent to the
client.
 Individual clinical records of the family members, laboratory and diagnostic reports,
immunization records about home and environmental conditions.
LABORATORY/ DIAGNOSTIC TEST

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  Laboratory examinations to confirm the diagnosis of the patient, such as Blood
test, urine test, radiological examination.

CONTENT OF FAMILY ASSESSMENT

1. INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
 Family Structure, characteristics and dynamics
 Socio-economic and cultural characteristics
 Home and environment
 Health status of each member
 Values and practices on health promotion/maintenance and disease prevention»
2. FAMILY STRUCTURE CHARACTERISTICS AND DYNAMIC
This includes the following:
 composition and demographic data of the members of the family/household
 their relationship to the head and place of residence
 the type of family
 family interaction/communication
 Decision making patterns and dynamics

3. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

This includes the following:
 Income and Expenses
 Occupation, place of work, and income of each working member
 Adequacy to meet basic necessities
 Who makes decisions about money and how it is spent
 Educational attainment of each family member
 Ethnic background and religious affiliations
 Significant others-roles they play in the family’s life
 Relationship of the family to the larger community (membership in organizations)
4. Home and Environment
a. Housing:
 Adequacy of living space
 Sleeping arrangement
 Food storage and cooking facilities
 Water supply, toilet facilities
 Presence of accident hazards
 Garbage disposal
b. Kind of neighborhood
c. Social and Health Facilities
d. Communication and transportation facilities available

5. Health status of each member

 Medical and nursing history indicating current and past significant illness or
beliefs and practices conductive to health and illness
 Nutritional and developmental status
 Developmental assessment of infants, toddlers and preschoolers
 Risk factor assessment
 Physical assessment findings
 Significant results of laboratory/diagnostic tests/screening procedures
 Decision making on which or whom to seek advice regarding health
6. Values and Practice on health promotion/maintenance and disease prevention
 Immunization status of the family members
 Healthy lifestyle practices
 Adequate of: rest/sleep, exercise/activities, use of protective measures,
relaxation and stress management
 Utilization of health care facilities
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FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS
Family profile and diagnosis
 Family profile implies brief description of family structure and characteristics,
family life cycle and culture, socio economic conditions environmental factors
health and medical history etc. Family health diagnosis is the written statement of
family health problems which are assessed from analysis of data collected.

FIRST LEVEL ASSESSMENT

Name or Categories of Health Problems
1. Presence of Wellness Condition
Stated as Potential or Readiness
o A clinical or nursing judgment about a client transition form a specific
level of wellness or capability to a higher level (NANDA, 2001)
Wellness Potential
o It is a nursing judgement on wellness state or performance current
competencies expression of client’s desire
 e.g. Potential for Enhanced Capability for parenting

2. Presence of Health Threats

Readiness for Enhanced Wellness State
o It is a nursing judgement on wellness state or condition based on client’s
current competencies or performance, clinical data and explicit expression of
desire to achieve higher level or function in a specific area on health
promotion and maintenance.
 e.g Readiness for Enhanced Capability for Healthy Lifestyle
3. Presence of Health Threats
These are conditions that are conducive to disease and accident, or may result to
failure to maintain wellness or realize health potential.
 e.g. Presence of Risk Factors of specific disease, accident hazards,
poor home/ environmental conditions, family history of hereditary
disease, threat of cross infection, faulty eating habits, poor
environmental sanitation, unhealthy lifestyle/personal habits
4. Presence of Health Deficits
These are instances of failure in health maintenance
 e.g. Illness states, diagnosed or undiagnosed by medical practitioner,
disability, transient (aphasia or temporary paralysis after a CVA),
permanent (leg amputation secondary to diabetes, lameness from polio)
5. Presence of Stress Points/Foreseeable Crisis
Anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources.
 e.g. marriage, pregnancy, parenthood, divorce, separation, loss of job,
menopause death

SECOND LEVEL ASSESSMENT

 Determining family’s ability to perform the Family Health Tasks on each health threat,
health deficit, foreseeable crisis on wellness potential.
 Family Health Condition - a statement of family’s capabilities to maintain health and
prevent illness
 Ability to recognize signs of health and development
 Ability to manage health and non-health crisis
 Ability to provide health care to its members
 Ability to provide home environment conducive to good health and personal
development Ability to utilize community resources for health care

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FAMILY NURSING PROBLEM
Five Main Types:
1. Inability to recognize the presence on the condition/problem due to…
2. Inability to make decisions with respect to taking appropriate health action due
to…
3. Inability to provide nursing care to the sick, disabled, or dependent member of the
family due to…
4. Inability to provides a home environment which is conducive to health maintenance
and personal development due to…
5. Failure to utilize community resources for health due to…

III. PLANNING PHASE (FAMILY HEALTH AND NURSING CARE PLAN FORMULATION)
 It is based on the analysis of diagnosed health problems and assessment of family’s
ability to resolve problems, establish priorities, setting goals and objectives,
formulating family health nursing care plan.
1. Analysis of diagnosed health problems and assessment of family’s ability to
resolve problems Family’s ability to resolve health problems can be assessed on
the basis of:
a. ability to recognize the presence of health problems
b. ability to make decisions for taking appropriate health action
c. ability to provide desired care to the sick disabled
d. ability to maintain environment conducive to health promotion maintenance and
personnel development
e. ability to utilize community for health care
2. Establish priorities -means rank ordering of the health problems.

Four Criteria for Determining Priorities:

Nature of the condition or problem
 These are categorized into wellness state/potential, health threat, health deficit
or foreseeable crisis.
 The biggest weight is given to the wellness state or potential because of the
premium on client’s effort or desire to sustain/maintain high level of wellness.
 The same weight is given to health deficit because of its sense of clinical
urgency, which may require immediate intervention.
 Foreseeable crisis is given the least weight because culture linked
variables/factors usually provide our families with adequate support to cope with
developmental or situational crisis.
Modifiability of the condition or problem
 This refers to the probability of success in enhancing the wellness state improving
the condition minimizing, alleviating or totally eradicating the problem through
intervention.
 This is possibility of resolving the problem through nursing intervention which
includes:
o Current knowledge, technology and interventions to enhance the wellness state
or manage the problem.
o Resources of the family
o Resources of the nurse
o Resources of the community
Preventive potential
 This refers to the nature and magnitude of future problem that can be minimized or
totally prevented if interventions are done on the condition or problem under
consideration.

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  It refers to the severity of the consequence of the problem and nature and
magnitude of the problem, interventions within available resources whether the
problem can be prevented, eradicated or controlled. These are:
o Gravity or severity of the problem
It refers to the progress of the disease/problem indicating extent of damage
on the patient/family; also indicates prognosis, reversibility or
modifiability of the problem. In general, the more severe the problem is, the
lower is the preventive potential of the problem.
o Duration of the problem
This refers to the length of time the problem has existed. Generally
speaking, duration of the problem has a direct relationship to gravity; the
nature of the problem is variable that may, however, alter this relationship.
Because of this relationship to gravity of the problem, duration has also a
direct relationship to preventive potential.
o Current management
refers to the presence and appropriateness of intervention measures
instituted to enhance the wellness state or remedy the problem. The
institution of appropriate intervention increases condition’s preventive
potential.
o Exposure of any vulnerable or high-risk group
Increases the preventive potential of condition or problem
o Salience
This refers to the family’s perception and evaluation of the condition or
problem in terms of seriousness and urgency of attention needed or family
readiness. It refers to the family’s perception about the seriousness of the
problem

Prioritization of Health Problem

Criteria Weight
Nature or conditions of the problem 1
Scale:
 wellness state (3)
 health deficit (3)
 health threat (2
 foreseeable crisis (1)
Modifiability of the problem 2
Scale:
 easily modifiable (2)
 partially modifiable (1)
 not modifiable (1)
Preventive potential 1
Scale:
 high (3)
 moderate (2)
 low (1)
Salience 1
Scale:
 needs immediate attention (2)
 does not need immediate attention (1)
 not perceived as a problem or condition needing change (0)
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SCORING:
1. Divide the score for each of the criteria
2. Divide the score by the highest possible score and multiply by the weight
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the
total weight

Setting goals and objectives

 Formulation of Goals and Objectives
 Formulating Goals and Objective for Health Promotion and Maintenance
 Goal is a general statement of the condition or the state to be brought about by
specific course of action

Parts of a Nursing Objective

1. Time frame and condition
2. Terminal behavior or expected outcome
3. Criteria of acceptable performance
Example: After 2-3 months of the family will be able to maintain ability to recognize
signs of health and development
 Objective refers to more specific statements of the desired results or outcomes of
care.
Example: At the end of 2-3 months the family will be able to:
1. Identify signs of health and development
2. Perform usual activities for health and development
 They specify the criteria by which the degree of effectiveness of care is to be
measured.
 A cardinal principle in goal setting states that goal must be set jointly with the
family. This ensures family commitment to realization. Basic to the establishment
of mutually acceptable goals is the family’s recognition and acceptance of existing
health needs and problems.
UNIT V – COMMUNITY HEALTH NURSING ACTIVITIES
COMMUNITY HEALTH NURSING INVOLVES THESE BASIC CONCEPTS:
 Promote healthy lifestyle
 Prevent disease and health problems
 Provide direct care
 Educate community about managing chronic conditions and making healthy choices
 Evaluate a community’s delivery of patient care and wellness projects
 Institute health and wellness programs
 Conduct research to improve healthcare
TOOLS OF PUBLIC HEALTH NURSE
 PHN Bag and Contents
 Principles and Techniques in the Use of PHN Bag
Types of Family Nurse Contact
 Clinical Visit
 Home Visit
 Group Conference
 Telephone Calls
 Written Communications

PHN BAG AND CONTENTS

The BAG TECHNIQUE is a tool by which the nurse, during her visit will enable her to perform a nursing
procedure with ease and deftness, to save time and effort with the end view of rendering effective nursing care
to clients.

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The PUBLIC HEALTH BAG is an essential and indispensable equipment of public health nurse which she has
to carry along during her home visits. It contains basic medication and articles which are necessary for giving
care.

Contents: Solutions of:

The ff are the contents of a Public Health Nurse Bag: •betadine
•Paper lining •70% alcohol
•Extra paper for making waste bag •Zephiran solution
•Plastic/linen lining •Hydrogen peroxide
•Apron •Spirit of ammonia
•Hand towel •Ophthalmic ointment
•Soap in a soap dish •Acetic acid
•Thermometers (oral and rectal) •Benedict’s solution
•2 pairs of scissors (surgical and bandage)
•2 pairs of forceps (curved and straight)
•Disposable syringes with needles
•Hypodermic needles
•Sterile dressing
•Cotton balls
•Cord clamp
•Micropore plaster
•Tape measure
•1 pair of sterile gloves
•Baby’s scale
•Alcohol lamp
•2 test tubes
•Test tubes holders
*BP apparatus and stethoscope are carried separately and are never placed the bag.

Points to consider PHN BAG

1. The bag should contain all the necessary articles, supplies and equipment that will be used to answer
the emergency needs.
2. The bag and its contents should be cleaned very often, the supplies replaced and ready for use
anytime.
3. The bag and its contents should be well protected from contact with any article in the patient’s home.
4. Consider the bag and its contents clean and sterile, while articles that belong to the patients as dirty
and contaminated.
5. The arrangement of the contents of the bag should be the one most convenient to the user, to facilitate
efficiency and avoid confusion.
PRINCIPLES OF BAG TECHNIQUE
 Performing the bag technique will minimize, if not, prevent the spread of any infection.
 It saves time and effort in the performance of nursing procedures.
 The bag technique can be performed in a variety of ways depending on the agency’s policy, the home
situation, or as long as principles of avoiding transfer of infection is always observed.
TYPES OF FAMILY NURSE CONTACT
 Clinical visit
 Home Visit
 Group Conference
 Telephone Calls
 Written Communications

UNIT VI RECORDS IN FAMILY HEALTH NURSING PRACTICE

RECORDS
 Records are necessary for the continuation of delivery pf family health care services and its evaluation
while evaluation of family health services is necessary to identify the new and continuing family health
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FAMILY RECORDS
Family records include information based on:
Factual events
 Observation results
 Measurements taken such as height, weight, body circumference
 Laboratory examinations carried out like hemoglobin, urine test, stool test and sputum examination
depending upon the problem of the family.
 These also includes records of Immunization, nutritional status, medical prescription and curative
procedures carried out.
 Demographic data and individual personal history are also included in the family folder.
HEALTH RECORDS
 Health records refer to forms on which information about an individual and family is noted.
 Information varies from socio-economic, psychological, environmental factors, etc.
 Records are a practical and indispensable aid to the doctor, nurse, and other health care workers in
giving best service to individual, family or community.
 Recorded facts have value and scientific accuracy and are guidelines for better administration of family
health services.
 Contributions of health team members are reflected in case records.
 Records are also a means of communication between a health worker and the families.
NEW TECHNOLOGIES RELATED TO PUBLIC HEALTH ELECTRONIC INFORMATION
 Technology is changing the world at warp speed.
 For many years, Nurses have dealt with technology first-hand with a rapid evolution in health care.
 These are some of the healthcare technologies that Nurses and healthcare providers deal with on a
daily basis using in the community:
o Electronic Records
o Medication Prescribing Tools
o Tele-health
o Online Appointment Scheduling
o Mobile Laboratories

UNIT 7: DOH PROGRAMS RELATED TO FAMILY HEALTH (BASIC HEALTH SERVICES AND
PROGRAMS)
2020 CALENDAR OF HEALTH EVENTS
Universal Health Care
Alamin mo, kasama ka dito.
JANUARY
 National Deworming Month
 Schistosomiasis Awareness & Mass Drug Administration Month
 Liver Cancer and Viral Hepatitis Awareness and Prevention Month
 ZERO Waste Month
 Autism Consciousness Week - 3rd Week
 Goiter Awareness Week - 4th Week
 World Leprosy Day - last Sunday
FEBRUARY
 National Cancer Awareness Month
 Philippine Heart Month
 Oral Health Month National Health
 Insurance Month
 National Down Syndrome Consciousness Month
 Mental Retardation Week - February 14 to 20
 National Awareness Week for the Prevention of Sexual Abuse and Exploitation - 2nd Week
 Leprosy Control Week - last week
 National Rare Disease Week - last week
 World Cancer Day - February 4
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  International Childhood Cancer Day - February 15
MARCH
 Colorectal Cancer Awareness Month
 Rabies Awareness Month
 Women's Week - 1st Week
 International Ear Care Day - March 3
 National Women's Day - March 8
 World TB Day - March 24
APRIL
 National Hemophilia Awareness Month
 World Health Worker's Week - 1st Week
 World Immunization Week - last week
 Head and Neck Consciousness Week - last week
 World Health Day - April 7
 World Malaria Day - April 25
MAY
 Cervical Cancer Awareness Month
 Hypertension Awareness Month
 Road Safety Month
 Health Worker's Day - May 7
 Safe Motherhood Week - 2nd Week
 International Thyroid Awareness Week - last week
 AIDS Candlelight Memorial Day - 3rd Sunday
 World Thyroid Day - May 25
 World No Tobacco Day - May 31
JUNE
 Prostate Cancer Awareness Month
 Cancer Survivor's Day
 Scoliosis Awareness Month
 Dengue Awareness Month
 National Kidney Month
 National No Smoking Month
 National Safe Kids Week - 3rd week
 National Poison Prevention Week - 4th Week
 World Blood Donor Day - June 14
 ASEAN Dengue Day - June 15
 DOH Anniversary - June 23
 International Day Against Drug Abuse and Illicit Trafficking - June 26
JULY
 National Deworming Month
 National Blood Donors Month
 Nutrition Month National Disaster Resilience Month
 Filariasis Mass Drug Administration Month
 National Cardiopulmonary Resuscitation (CPR) Day - July 17
 World Day Against Trafficking in Persons - July 30
 National Disability Prevention and Rehabilitation Week - 3rd Week
 National Allergy Day - July 8
 World Population Day - July 11
AUGUST
 Blood Cancer Awareness Month
 Family Planning Month
 ASEAN Month
 Sight Saving Month
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  National Lung Month
 National Adolescent Immunization Month
 National Breastfeeding Awareness Month
 Mother-Baby Friendly Hospital Initiative Week - 1st Week
 World Breastfeeding Week - Aug 1-7
 National Hospital Week - August 6-12
 Philippine National Research System Week - 2nd Week
 Asthma Week - 2nd Week
 Family Planning Day - August 1
 White Cane Day - August 1
 International Youth Day - August 12
 National TB Day - August 19
SEPTEMBER
 International Childhood Cancer Awareness Month
 World Leukemia Awareness Month
 Generics Awareness Month
 Blood Diseases Month
 National Thyroid Cancer Awareness Month
 National Epilepsy Awareness Week - 1st Week
 Obesity Prevention Awareness Week - 1st Week
 Alzheimer's Disease Awareness Week - 3rd Week
 World Suicide Prevention Day - September 10
 World Patient Safety Day - September 17
 Cerebral Palsy Awareness Week - Sept 16-22
 World Environmental Health Day - Sept. 26
 World Rabies Day - September 28
OCTOBER
 Breast Cancer Awareness Month
 National Hospice and Palliative Care Awareness Month
 National Newborn Screening Week - 1st Week
 Filipino Elderly Week - 1st Week
 National Mental Health Week - 2nd Week
 Bone and Joint Awareness Week - 3rd Week
 National Attention Deficit/ Hyperactivity Disorder Awareness Week - 3rd Week
 Health Education Week - 3rd Week
 Food Safety Awareness Week - last week
 World Sight Day - 2nd Thursday
 World Mental Health Day - October 10
 Global Handwashing Day - October 15
 World Psoriasis Day - October 29
NOVEMBER
 Lung Cancer Awareness Month
 National Children's Month
 Filariasis Awareness Month
 Traditional and Alternative Health Care Month
 Malaria Awareness Month
 National Skin Disease Detection and Prevention Week - 2nd Week
 Drug Abuse Prevention and Control Week - 3rd Week
 National Consciousness Week Against Counterfeit Medicine - 3rd Week
 National Biotechnology Week
 Population and Development Week - November 23-29
 National Food Fortification Day - November 7
 World Diabetes Day - November 14
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  World Prematurity Day - November 17
 World Toilet Day - November 19
 Chronic Obstructive Pulmonary Disease Awareness Day - 3rd Wednesday
 National Consciousness Day for the Elimination of VAWC - November 25
 18 Day Campaign to End Violence Against Women - Nov. 25 - Dec. 12
DECEMBER
 Firecrackers Injury Prevention Month
 Linggo ng Kabataan - 2nd week
 Ear, Nose and Throat Consciousness Week - December 3-9
 World AIDS Day - December 1
 International Day of Persons with Disabilities - December 3
 National Health Emergency Preparedness Day - December 6

UNIT 8: ETHICAL CONSIDERATIONS IN COMMUNITY HEALTH NURSING

RELEVANT ETHICO-LEGAL GUIDELINES IN CONDUCTING HEALTH ASSESSMENT
–INFORMED CONSENT
–PATIENT’S BILL OF RIGHTS
–DATA PRIVACY ACT
INFORMED CONSENT
 The process of informed consent occurs when communication between a patient and physician
results in the patient’s authorization or agreement to undergo a specific medical intervention.
 In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient
lacks decision-making capacity or declines to participate in making decisions), physicians
should:
o (a) Assess the patient’s ability to understand relevant medical information and the
implications of treatment alternatives and to make an independent, voluntary decision.
o (b) Present relevant information accurately and sensitively, in keeping with the patient’s
preferences for receiving medical information.
ETHICO-LEGAL CONSIDERATIONS
 Legal capacity (competency): The right and ability to manage one’s own affairs (bestowed at age 18 in
most states).
 Legal incapacity (incompetency): The inability to manage one’s own affairs because of injury or
disability, as determined by a legal proceeding.
 Clinical incapacity to make health care decisions: The inability to understand the significant benefits,
risks, and alternatives to proposed health care and to make and communicate a health- care decision,
as determined by a qualified doctor or other health care practitioner.
 MINORS, MENTALLY and/or PHYSICALLY INCAPACITATED
 Advance directives: Documents or other recordings such as a living will or a health care power of
attorney that communicates a person's wishes about health care decisions.
 Living will: A document, sometimes called a medical directive, that expresses a person’s wishes
regarding future medical interventions when the person no longer has the capacity to make health care
decisions.
 Health care power of attorney: A document that legally appoints someone else to make health care
decisions on a person's behalf in the event the person no longer has the capacity to make health care
decisions. The person appointed may be called a health care agent or proxy, health care
representative, or other name depending on the state.
THE PATIENT’S BILL OF RIGHTS
 Patient rights were developed with the expectation that hospitals and health care institutions would
support these rights in the interest of delivering effective patient care.
 The Patient’s Bill of Rights includes:
THE RIGHT TO RECEIVE PROPER MEDICAL CARE
 You have the right to receive professional and quality health care and to be treated with respect and
consideration, without any discrimination on grounds of religion, race, gender, nationality, country of
origin, sexual orientation and so on.
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  If you came to the emergency room, it is your right to be examined by a doctor.
IDENTITY OF CARE-PROVIDER
 You have the right to know the name and position of any healthcare team member providing your care,
and care- providers must identify themself, and carry clear identification tag.
CONSENT FOR MEDICAL TREATMENT
 You have the right to receive an appropriate and clear explanation about your medical condition, about
treatment options that are available for you and their alternatives, risks, prospects and potential side
effects, including those relating to refraining from treatment. It is important that you will provide the care
provider with information about your medical history, so that the diagnosis and treatment offered to you
will be appropriate.
 You have the right to refuse treatment to which you did not give consent (except for exceptional cases
prescribed by law).
 You have the right to appoint a proxy, who will have the authority to consent to medical treatment in the
event that you become unable to do so.
MAINTAINING THE DIGNITY AND PRIVACY
 You have the right that all care providers and all employees of the medical institution will retain your
dignity and privacy at all stages of treatment. In certain medical examinations, you have the right to
have additional person in the room, at your.
MEDICAL CONFIDENTIALITY
 You have the right to keep the confidentiality of your medical information, and care providers must
ensure the confidentiality of medical information relating to you and to your treatment which they
received due to their positions.
DISCLOSING OF MEDICAL INFORMATION
 You have the right that medical information about you will be disclosed only with your consent, or
where by law it is permitted or not required.
SECOND OPINION
 You have the right to initiate receiving a second medical opinion (from a care provider within or outside
the medical institution) about your condition and the recommended treatment. The medical staff at the
institution has the obligation to assist you.
CONTINUITY OF CARE
 In transition between care providers or between medical institutions, you have the right to request that
care providers and medical institutions will cooperate in order to ensure your continued proper medical
care.
RECEIVING VISITORS
 During hospitalization, you have the right to receive visitors during visiting hours designated to this
purpose by the hospital administration.
RECEIVING MEDICAL INFORMATION
 You have the right to receive from the care provider or medical institution, medical information
contained in your medical records, or a copy of the medical record (receiving a copy of the record may
be subject to a fee).
 At the time of your release, you have the right to receive a summary of the course of treatment or
hospitalization, in writing.
PUBLIC INQUIRIES
 You have the right to contact the person responsible for public inquiries and rights of patients at the
medical institution in any comment, complaint, question or recommendation.
 You have the right to receive findings and conclusions of the investigation of your complaint.
DATA PRIVACY ACT Republic Act. No. 10173
 In 2012 the Philippines passed the Data Privacy Act 2012, comprehensive and strict privacy legislation
“to protect the fundamental human right of privacy, of communication while ensuring free flow of
information to promote innovation and growth.”
 This comprehensive privacy law also established a National Privacy Commission that enforces and
oversees it and is endowed with rulemaking power.
 On September 9, 2016, the final implementing rules and regulations came into force, adding specificity
to the Privacy Act.
SCOPE AND APPLICATION OF DATA PRIVACY ACT
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  The Data Privacy Act is broadly applicable to individuals and legal entities that process personal
information.
 The law has extraterritorial application, applying not only to businesses with offices in the Philippines,
but when equipment based in the Philippines is used for processing.
 One exception in the act provides that the law does not apply to the processing of personal information
in the Philippines that was lawfully collected from residents of foreign jurisdictions.
SENSITIVE PERSONAL AND PRIVILEGED INFORMATION
 The law defines sensitive personal information as being:
 About an individual’s race, ethnic origin, marital status, age, color, and religious, philosophical or
political affiliations;
 About an individual’s health, education, genetic or sexual life of a person, or to any proceeding or any
offense committed or alleged to have committed;
 Issued by government agencies “peculiar” (unique) to an individual, such as social security number;
 Marked as classified by executive order or act of Congress.
ALL PROCESSING OF SENSITIVE AND PERSONAL INFORMATION IS PROHIBITED EXCEPT IN
CERTAIN CIRCUMSTANCES.
The exceptions are:
 Consent of the data subject;
 Pursuant to law that does not require consent;
 Necessity to protect life and health of a person;
 Necessity for medical treatment;
 Necessity to protect the lawful rights of data subjects in court proceedings, legal proceedings, or
regulation.
PERSONAL DATA BREACH
 A “personal data breach,” on the other hand, is a subset of a security breach that actually leads to
“accidental or unlawful destruction, loss, alteration, unauthorized disclosure of, or access to, personal
data transmitted, stored, or otherwise processed.
PENALTIES/SANCTION
 The law provides separate penalties for various violations, most of which also include imprisonment.
Separate counts exist for unauthorized processing, processing for unauthorized purposes, negligent
access, improper disposal, unauthorized access or intentional breach, concealment of breach involving
sensitive personal information, unauthorized disclosure, and malicious disclosure.
 The penalty of imprisonment ranging from one (1) year to three (3) years and a fine of not less than
Five hundred thousand pesos (Php500,000.00) but not more than Two million pesos (Php2,000,000.00)
shall be imposed on persons who knowingly and unlawfully, or violating data confidentiality and security
data systems
PENALTIES FOR FAILURE TO NOTIFY
 Persons having knowledge of a security breach involving sensitive personal information and of the
obligation to notify the commission of same, and who fail to do so, may be subject to penalty for
concealment, including imprisonment for 1 1/2 to five years of imprisonment, and a fine to pay.

CORE VALUES OF NURSING

FOUR MAIN GOALS OF NURSING
1. To promote health (state of optimal functioning or wellbeing with physical, social, spiritual, and mental
components)
2. To prevent illness (primary, secondary, and tertiary)
3. To treat human responses to health or illness
4. To advocate for individuals, families, communities, and populations
CORE VALUES OF NURSING IN CONDUCTING HEALTH ASSESSMENT and CHN ACTIVITIES
 CARING: promoting health, healing, and hope in response to the human condition
 INTEGRITY: respecting the dignity and moral wholeness of every person without conditions or
limitation;
 DIVERSITY: affirming the uniqueness of and differences among persons, ideas, values, and ethnicities.
 EXCELLENCE: co-creating and implementing transformative strategies with daring ingenuity.
CARING
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  A culture of caring, as a fundamental part of the nursing profession, characterizes our concern and
consideration for the whole person, our commitment to the common good, and our outreach to those
who are vulnerable. All organizational activities are managed in a participative and person-centered
way, demonstrating an ability to understand the needs of others and a commitment to act always in the
best interests of all stakeholders.
INTEGRITY
 A culture of integrity is evident when organizational principles of open communication, ethical
decision-making, and humility are encouraged, expected, and demonstrated consistently. Not only is
doing the right thing simply how we do business, but our actions reveal our commitment to truth telling
and to how we always see ourselves from the perspective of others in a larger community.
DIVERSITY
 A culture of inclusive excellence encompasses many identities, influenced by the intersections of race,
ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious and
political beliefs, or other ideologies. It also addresses behaviors across academic and health
enterprises. Differences affect innovation so we must work to understand both ourselves and one
another. And by acknowledging the legitimacy of us all, we move beyond tolerance to celebrating the
richness that differences bring forth.
EXCELLENCE
 A culture of excellence reflects a commitment to continuous growth, improvement, and understanding.
It is a culture where transformation is embraced, and the status quo and mediocrity are not tolerated.

UNIT 9: HEALTH-RELATED ENTREPRENEURIAL ACTIVITIES IN THE COMMUNITY SETTING

HEALTH-RELATED ENTREPRENEURIAL ACTIVITIES IN THE COMMUNITY SETTING

 Examples of HEALTH-RELATED ENTREPRENEURIAL ACTIVITIES IN THE COMMUNITY SETTING
include improving agricultural production and living conditions; generating entrepreneurial activity and
related employment; promoting family planning, involving making medicinal remedies from herbal
plants, and improving infrastructure.
 Research and policy have largely employed the adoption perspective, and infrastructure approach are
also evident.
Factors Affecting Entrepreneurship
1. Venture Capital Availability
2. Presence of Experienced Entrepreneur
3. technically Skilled Labor Force
4. Accessibility of Suppliers
5. Accessibility of Customers or New Markets
6. Favorable Governmental Policies
7. The Proximity of Universities and Research Institutions
8. Availability of Infrastructural Facilities
9. Accessibility of Transportation
10. Receptive Population
11. Availability of Supporting Services
12. Attractive Living Conditions
Types of Entrepreneurial Activities
 Retailing – the selling of merchandise and certain services to consumers. It ordinarily involves the
selling of individual units or small lots to large numbers of customers by a business set up for that
specific purpose.
 Wholesaling is the sale of merchandise in bulk to a retailer for repackaging and resale in smaller
quantities at a higher price. The buyer of wholesale merchandise sorts, reassembles, and repackages it
into smaller quantities for direct retail sale to consumers.
 Manufacturing – the making of articles on a large-scale using machinery; industrial production.
 Service – the action of helping or doing work for someone. a system supplying a public need such as
transport, communications, or utilities such as electricity and water. perform routine maintenance or
repair work on.
EXAMPLES OF HEALTH-RELATED ENTREPRENEURIAL ACTIVITIES IN THE COMMUNITY SETTING
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COMMUNITY HEALTH NURSING
Community health nursing (CHN), also called public health nursing or community nursing,
combines primary healthcare and nursing practice in a community setting.
Community health (CH) Nurses provide health services, preventive care, intervention and health education to
communities’ populations
Community Health Nurse
- Unlike a nurse who works with patients one-on-one in other clinical settings, community health nurses focus
on communities.
» CH nurses can have various roles in a community setting such as:

 Health education.
 Community advocacy.
 Ensuring a safe and healthy environment.
 Abuse and neglect prevention.
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  Policy reform.
 Community development.
What they do depends on the communities they serve; lower income, school, and culturally diverse
communities all have different needs.
GLOBAL, NATIONAL and LOCAL HEALTH SITUATION
- The country Is facing a health crisis at present due to COVID19 pandemic. Where large number of the
population is affected.
The Philippines has presently recorded new increased cases and a daily additional COVID-19 cases still
reported. - The Department of Health and the Local Government Units are working together to find ways of
controlling the spread of the disease.
- With their Joint efforts national and local health facilities are Involved in the management of cases. There is a
problem in the scarcity of health workers (Doctors, Nurses, Medical Technologists).
- Several private hospitals across Metro Manila earlier said beds allocated for COVID-19 cases had reached full
capacity following the easing of quarantine restrictions in a bid to revive the economy.
- According to the DOH the current population of the country is estimated about 109,653 229 where the
Philippines ranked 13th in the highest population rate. - The Philippine population is considered young and for
global population increase is 1.05 % per year
According to the DOH top leading causes of MORBIDITY in the Philippines includes all forms respiratory
diseases, hypertension, kidney and urinary tract problems, all forms of diarrheal diseases, and diabetes mellitus.
- For MORTALITY, it includes cardiovascular diseases, pneumonias, malignant neoplasms/cancers, all forms
of tuberculosis, accidents, COPD and allied conditions, diabetes mellitus, nephritis/nephritic syndrome and
other diseases of respiratory system.
- Morbidity-refers to the cases of illness in a given population in a specified period of time.
- Mortality-refers to the cases of deaths in a given population in a specified period of time

HEALTH AND LONGEVITY AS BIRTHRIGHTS

- HEALTH IS A BASIC HUMAN RIGHT FOR EVERY FILIPINO.
LONGEVITY- average lifespan
- The lifespan increases among Filipinos according to the DOH and varies per year.
- There is an increase every year which is closely related to the different DOH health programs
- Life expectancy in the country in 2010-2015 was 68.6 years.
- Life expectancy at birth male/female in 2016-66)73
The life expectancy for Philippines in 2017 was 70.87 years. The life expectancy for Philippines in 2018 was
71.03 years, a 0.23% increase from2017
The life expectancy for Philippines in 2019 was 71.16 years a 0.18% increase from 2018.
DEFINITION AND FOCUS dump
COMMUNITY
It is a group of people with common characteristics or interests living together within a territory or geographical
boundary
It is a place where people under usual conditions are found
It is derived from a latin word "comunicas" which means a group of people.
3 Elements of a community
1. Geographical Entity
2. Social Entity
3. Psycho-cultural Entity
Two specific types of a community
• Urban area " can refer to towns, cities, and suburbs. An urban area includes the city itself, as well as the
surrounding areas.
• Rural areas are the opposite of urban areas. Rural areas have low population density and large amounts of
undeveloped land (Barios),
HEALTH
- According to WHO Health is defined as a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
- The state of being free from illness or injury.
- The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human
being without distinction of race, religion, political belief economic or social condition.
- The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest
co-operation of individuals and States
- The achievement of any state in the promotion and protection of health is of value to all.
COMMUNITY HEALTH
- Community health refers to the health status of the members of the community, to the problems affecting their
health and to the totality of the health care provided for the community.
- Community health is a branch of public health which focuses on people and their role as determinants of their
own and other people's health
AIMS of CHN

 To promote health and efficiency.

 To prevent and control of diseases and disabilities.
 To prolong life through need-based health care.
The basic strategies for health promotion were prioritized as:
- Advocate: Health is a resource for social and developmental means, thus the dimensions that affect these
factors must be changed to encourage health.
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- Enable: Health equity must be reached where individuals must become empowered to control the
determinants that affect their health, such that they are able to reach the highest attainable quality of life.
- Mediation: Health promotion cannot be achieved by the health sector alone, rather its success will depend on
the collaboration of all sectors of government (social, economic, etc.) as well as independent organizations
(media industry, etc.).
Definition of COMMUNITY HEALTH NURSING
- It is a synthesis of nursing and public health practice applied to promoting and preserving the health of the
people.
- According to Maglaya, CHN is the utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the promotion of health, prevention
of disease and disability and rehabilitation.
- The goal of CHN as stated by Nisce is to raise the level of citizenry by helping communities and families to
cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level
wellness.
- The definition of CHN by the WHO Committee on expert in nursing is a special field of nursing that
combines the skills of nursing, public health and some phases of social assistance and functions as part of the
total public health program for the promotion of health, the improvement of the conditions in the social and
physical environment, rehabilitation of illness and disability
- From Jacobson point of view CHN is learned practice discipline with the ultimate goal of contributing as
individuals and in collaboration with others to the promotion of the client's optimum level of functioning thru'
teaching and delivery of care (Jacobson)
- DR. Ruth B. Freeman: A service rendered by a professional nurse IFCs, population groups in health centers,
clinics, schools, workplace for the promotion of health prevention of illness, care of the Public Health
Mission of CHN
- Health Promotion
- Health Protection
- Health Balance
- Disease prevention
- Social Justice
PHILOSOPHY OF CHN
- According to Dr. M. Shetland the philosophy of CHN is based on the worth and dignity on the worth and
dignity of man.
- The community is the patient in CHN, the family is the unit of care and there are four levels of clientele:
individual, family, population group(those who share common characteristics, developmental stages and
common exposure to health problems - e.g. children, elderly), and the community.
- In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care.
- CHN practice is affected by developments in health technology, in particular changes in society, in general
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- The goal CHN is achieved through multi-sectoral efforts - CHN is a part of health care system and the larger
human services system.
OBJECTIVES OF PUBLIC HEALTH
C.O.D.E.S
Control of Communicable Diseases
Organization of Medical and Nursing Services Development of Social Machineries
Education of IFC on personal Hygiene. Health Education is the essential task of every health worker
Sanitation of the environment
3 ELEMENTS IN HEALTH EDUCATION
1.Information: to share ideas to keep
population group knowledgeable and aware 2. Education: change within the individual
3.Communication: interaction involving 2 or more persons or agencies
ROLES OF THE PUBLIC HEALTH NURSE
Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
Health Educator - who aims towards health promotion and illness prevention through dissemination of correct
information; educating people
Facilitator - who establishes multi-sectoral linkages by referral system
Supervisor - who monitors and supervises the performance of midwives
Health Advocate - who speaks on behalf of the client
Collaborator - who working with other health team member
----
- In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or is not
available, the Public Health Nurse will take charge of the MHO's responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Regulations of RA 9173
(Philippine Nursing Act of 2002) includes:
- Supervision and care of women during pregnancy, labor and puerperium
- Performance of internal examination and delivery of babies
- Suturing lacerations in the absence of a physician
- Provision of first aid measures and emergency care
- Recommending herbal and symptomatic medicines
Responsibilities of CHN
- Be a part in developing an overall health plan, its implementation and evaluation for communities
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- Provide quality nursing services to the three levels of clientele
- Maintain coordination/linkages with other health team members, NGO/government agencies in the Provision
of public health services
-Conduct researches relevant to CHN services to improve provision of health care
- Provide opportunities for professional growth and continuing education for staff development
Responsibilities of a CH Nurse
In the care of the families:
- Provision of primary health care services
- Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
- Community organizing mobilization, community development and people empowerment
- Case finding and epidemiological investigation
- Program planning, implementation and evaluation
- Influencing executive and legislative individuals or bodies concerning health and development
Community = is a group of people sharing common geographic boundaries and/or common values and
interests.
Characteristics of Community:
1. It is defined by its geographic boundaries within certain identifiable characteristics.
2. It is made up of institutions organized into a social system with the institutions and organizations linked in a
complex network having a formal and informal power structure and a communication system
3. A common or shared interest that binds the members together exists
4. It has an area with fluid boundaries within which a problem can be identified and solved
5. it has a population aggregate concept
Health = (WHO) is a state of complete physical and social wellbeing, not merely an absence of disease or
infirmity.
Determinants of health:
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support networks
6. Culture
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7. Genetics
8. Personal behavior and coping skin
9. Health services
10 Gender
Right to, and responsibility for health
Health is a basic human right.
The Universal Declaration of Human Rights Article 25; Section 1
- States that "Everyone has the right to a standard of living adequate for the health and well-being of himself
and of his family, including food, clothing, housing and medical care and necessary social services, and the
right to security in the event of unemployment, sickness, disability widowhood, old age or other lack of
livelihood in circumstances beyond his control
According to American Nurses Association (ANA)
Community health nursing practice promotes and preserves the health populations by integrating the skills and
knowledge relevant to both nursing and public health. The practice is comprehensive and general and is not
limited to a particular age, diagnostic group, or episodic care.
CLIENTELE OF THE CHN
- Individual
- Family
Basis in identifying family nursing problems:
a. recognizing interruptions of health development
b. seeking health care
c. managing health and non-health crises
d. providing nursing care to the sick, disabled and dependent member of the family
e. maintaining a home environment conducive to good health and personal development
f. maintaining a reciprocal relationship with the community and health situations
Population group - is a group of people who share common characteristics, developmental stage or common
exposure to particular environmental factors and consequently common health problems:
e.g., children, men, women, farmers, factory workers, commercial workers, prisoners, military men, and elderly
Children are the first to suffer from socioeconomic difficulties and political upheavals in a country
CHARACTERISTICS OF A HEALTHY COMMUNITY
- Awareness that we are community
- Conservation of natural resources
- Recognition of, and respect for, the existence of subgroups
- Participation of subgroups in community affairs
- Preparation to meet crises
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 - Ability to problem solve
- Communication trough open channels
- Resources available to all
- Setting of disputes through legitimate mechanisms
- Participation by citizens in decision making Wellness of a high degree among its members
-
QUALIFICATIONS OF A CHN
. Bachelor of Science in Nursing
Registered Nurse
Master's Degree in Nursing or
Public Health with at least 5 years experiences as Public Health Nurse
2/18/2021
CONCEPT OF HEALTH PROMOTION
Health promotion strategies and programs should be adapted to the local needs and possibilities of individual
countries and regions to take into account differing social (standing in community), and economic systems.
(OTTAWA CHARTER)
Health Promotion Action Means:
• BUILDING HEALTHY PUBLIC POLICY
• Health promotion policy combines diverse but complementary approaches including legislation, fiscal
measures, taxation and organizational change.
• It is a coordinated action that leads to health, income and social policies that foster greater equity. Joint action
contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more
enjoyable environments.
• Health promotion policy requires the identification of obstacles. The aim must be to make the healthier choice
the easier choice for policy makers as well.
• CREATING SUPPORTIVE ENVIRONMENTS
• The links between people and their environment constitutes the basis for a socio-ecological approach to health.
• The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage
reciprocal maintenance - to take care of each other, our communities and our natural environment.
• The conservation of natural resources throughout the world should be emphasized as a global responsibility.
• The protection of the natural and built environments and the conservation of natural resources must be
addressed in any health promotion strategy.
• STRENGTHENING COMMUNITY ACTIONS
• Health promotion works through concrete and effective community action in setting priorities, making
decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the
empowerment of communities.

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• This requires full and continuous access to information, learning opportunities for health, as well as funding
support.
• DEVELOPING PERSONAL SKILLS
• Health promotion supports personal and social development through providing information, education for
health, and enhancing life skills.
• It increases the options available to people to exercise more control over their own health and over their
environments, and to make choices conducive to health.
• Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic
illness and injuries is essential.
• This has to be facilitated in school, home, work and community settings. Action is required through
educational, professional, commercial and voluntary bodies, and within the institutions themselves.
•REORIENTING HEALTH SERVICES
The responsibility for health promotion in health services is shared among individuals, community groups,
health professionals, health service institutions and governments.
• The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility
for providing clinical and curative services.
• Reorienting health services also requires stronger attention to health research as well as changes in
professional education and training. This must lead to a change of attitude and organization of health services
which refocuses on the total needs of the individual as a whole person.
• MOVING INTO THE FUTURE
• Health is created and lived by people within the settings of their everyday life; where they learn, work, play
and love. Health is created by caring for oneself and others, by being able to take decisions and have control
over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the
attainment of health by all its members.
Caring, holism and ecology are essential issues in developing strategies for health promotion.
Those involved should take as a guiding principle that, in each phase of planning, implementation and
evaluation of health promotion activities, women and men should become equal partners
THEORIES/MODELS OF HEALTH PROMOTION DIFFERENCE OF THEORY AND MODEL
NURSING THEORETICAL WORKS
A. Nursing Philosophies
1. Nightingales environmental theory
2. Watson’s theory of human caring
3. Benner Benner’s stages of nursing expertise Nursing Philosophies
4. Eriksson’s caritative Caring theory
B. Nursing Conceptual Model
1. Roger's Science of Unitary Human being dump
2.Orem's self care deficit model
3.Kings General System Framework Nursing conceptual model
4. Neumans System Model
5. Roy's Adaptation Model
6. Johnson's Behavioral System Model
C. Nursing Theories
1. Peplau's Theory of Interpersonal Relationship
2. Orlando's Theory of Deliberate Nursing process
3. Travelbee's Human to human relationship
4. Hall's CORE, CARE, CURE
5. Abdellah's 21 Nursing problem
6. Henderson's Need theory
7. Pender's Health prmotion model
8. Leininger Theory of Culture Care Diversity
9. Newmans theory of Health as Expanding Consciousness
10. Parse's Theory of Human Becoming
11. Watson's Theory of Human Caring
12. Orlando's Nursing Process
13. Locsin's Technological Competency as Caring
LOCAL THEORIES AND MODELS OF NURSING INTERVENTION (PHILIPPINE SETTING)
Locsin's Technological Nursing as Caring Model Agravante's CASAGRA Tranformative Leadership model
Divinagracias COMPOSURE Model Kuan's retirement and Role Discontinuity Model
Abaquin's Prepare Me Holistic Nursing intervention
Laurentes Theory of Nursing Practice career
Synchronicity in human space-Time A theory of Nursing Engagement in Global Community
THEORIES RELEVANT IN NURSING PRACTICE
- Maslow's Human Needs theory
- Sullivan;s Transactional Analysis
- Von Bertallanfy's General System theory a lewin's Change theory
- Erikson's Psychosocial Development "Kohlberg's Moral Development
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THEORY:
• An integrated set of propositions that serve as an explanation for a phenomenon.
• A systematic arrangement of fundamental principles that provide a basis for explaining certain happening of
life.
MODEL:
• A subclass of theory. It provides for investigating and or addressing a phenomenon.
• Does not attempt to explain the processes underlying learning, but only to represent them
• Provides the vehicle for applying the theories
BANDURA'S Social cognitive theory provides a framework for human behavior. The theory identifies human
behavior as an interaction of personal factors, behavior, and the environment
(Bandura 1977; Bandura 1986).
• Social cognitive theory is helpful for understanding and predicting both individual and group behavior and
identifying methods in which behavior can be modified or changed.
Social Cognitive Theory: B represents behavior, P represents personal factors in the form of cognitive,
affective, and biological events, and E represents the external environment.
• In the model, the interaction between the person and behavior involves the influences of a person's thoughts
and actions.
• The interaction between the person and the environment involves human beliefs and cognitive competencies
that are developed and modified by social influences and structures within the environment.
The third interaction, between the environment and behavior, involves a person's behavior determining the
aspects of their environment and in turn their behavior is modified by that environment.
GREEN: HEALTH PROMOTION/EDUCATION
• "Health promotion" can be defined as "any combination of educational and environmental supports for actions
and conditions of living conducive to health" (Green and Kreuter, 1999).
• Health education aims at learning experiences and voluntary actions people take, individually or collectively,
for their own health, the health of others, or the common good of the community.
• Health education as "any combination of learning experiences designed to facilitate voluntary actions
conducive to health" (Green and Kreuter, 1999) emphasizes the importance of multiple determinants of
behavior.
• The task for health promotion, beyond health education, is how to make more healthful choices easier choices.
• Health education provides the consciousness-raising, concern-arousing, and action-stimulating impetus for the
public involvement and commitment to social reform essential to its success in a democracy.
The most appropriate "center of gravity" for health promotion is the community.
• A "community" may be a town or county in sparsely populated areas; or it may be a neighborhood, worksite,
or school in more populous metropolitan areas.

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It can also apply to groups of people not. sharing a specific geographic association, but sharing social, cultural,
political, or economic interests that link them together.
COMMUNITY ORGANIZING TOWARDS COMMUNITY PARTICIPATION IN HEALTH
Community health promotion requires the participation of local leadership and social networks to facilitate the
transmission and uptake of interventions for the overall population.
EPIDEMIOLOGY
it is the study of occurrences and distribution of diseases as well as distribution and determinants of health states
or events in specified population, and the application of this study to the control of health problems.

USES OF EPIDEMIOLOGY
According to Morris, epidemiology is used to:

1. Study the history of the health population and the rise and fall of diseases and changes in their character.
2. Diagnose the health of the community and the condition of people to measure the distribution and dimension
of Illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to
define their relative importance and to identify groups needing special attention.
3. Study the work of health services with a view of improving them. Operational research shows how
community expectations can result In the actual provisions of service.
4. Estimate the risk of disease, accident, defects and the chances of avoiding them.
5. Complete the clinical picture of chronic disease and describe their natural history.
6. Identify syndromes by describing the distribution and association of clinical phenomena in the population.
7. Search for causes of health and disease by comparing the experience of groups that are clearly defined by
their composition, inheritance, experience, behavior and environments.

THE EPIDEMIOLOGIC TRIANGLE

HOST - Is any organism that harbors and provides nourishment for another organism.
- Are related to lower resistance as a result of exposure to the elements during floods or disasters.
AGENT - The intrinsic property of microorganism to survive and multiply in the environment to produce
disease. - The result of the introduction of new disease agents into the population.

ENVIRONMENT – The sum total of all external condition and influences that affects the development of an
organism which can be biological, social, and physical. The environment affects both the agents and host.
- Changes in the physical environment; temperature, humidity, rainfall may directly or indirectly influence
equilibrium of agent and host
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The Epidemiologic Triangle consists of three component – the host, environment and agent. The model implies
that each must be analyzed and understood for comprehensions and prediction of patterns of a disease. A
change in any of the component will alter an existing equilibrium to increase or decrease the frequency of the
disease.

THREE COMPONENTS OF THE ENVIRONMENT

1. PHYSICAL ENVIRONMENT – is composed of the inanimate surroundings such as the geophysical
conditions of the climate.
2. BIOLOGICAL ENVIRONMENT - makes up the living things around us such as plants and animal life.
3. SOCIO-ECONOMIC ENVIRONMENT- may be in the form of level of economic development of the
community, presence of social disruptions and the like.
DISEASE DISTRIBUTION
The method and technique of epidemiology are desired to detect the cause of a disease in relation to the
characteristic of the person who has it or to a factor present in his environment. These variables are studied
since they determine the individuals and populations at greatest risks of acquiring particular disease, and
knowledge of these associations may have predictive value
Time- refers to the period during which the cases of the disease being studied were exposed to the source of
infection and the period during which the illness occurred. This analysis of cases by time enables the
formulation of hypotheses concerning time and source of infection, mode of transmission, and causative agent.
Epidemic period: a period during which the reported number of cases of a disease exceed the expected, or usual
number for that period.
Year: For many diseases the incidence (Frequency of occurrence) is not uniform during each of 12 consecutive
months. Instead, the frequency is greater in one season than any of the others. This seasonal variation is
associated with variations in the risk of exposure of susceptible to the source of infection.

Period of Consecutive years: recording the reported cases of a disease over a period of years-by weeks, months
or year of occurrence - useful in predicting the probable future incidence of the disease and in planning
appropriate prevention and control programs.

PATTERNS OF OCCURRENCE AND DISTRIBUTION

1. SPORADIC OCCURRENCE
It is the intermittent occurrence of a few isolated and unrelated cases in a given locality.
The cases are few and scattered, so that there is no apparent relationship between them and they occur on and
off, intermittently, through a period of time.
2. ENDEMIC OCCURRENCE
It is the continuous occurrence throughout a period of time, of the usual number of cases in a given locality.
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The disease is therefore always occurring in the locality and the level of occurrence is more or less constant
throughout a period of time.
3. EPIDEMIC OCCURRENCE
It is of unusually large number of cases in a relatively short period of time.
There is a disproportionate relationship between the number of cases and the period of occurrence, the more
acute is the disproportion, the more urgent and serious of the problem.
4. PANDEMIC
It is the simultaneous occurrence of epidemic of the same disease in several countries. It is another occurrence
from an international perspective.

COMMUNITY HEALTH NURSING PROCESS

 THE NURSING PROCESS is a systematic, scientific, dynamic, on-going interpersonal process in which
the nurses and the clients are viewed as a system with each affecting the other and both being affected
by the factors within the behavior.
 The process is a series of action that results in the optimal health care for the clients.
COMMUNITY HEALTH NURSING PROCESS STEPS

 Assessment
 Planning
 Implementation of Planned care
 Evaluation of Care and Services rendered.
ASSESSMENT

 Assessment provides an estimate of the degree to which a family or community achieve the level of
health, identifies specific deficiencies or guidance needed and estimates the possible effects of the
nursing intervention.
 It involves COLLECTION OF DATA like:
o surveys, interviews, observation, review of statistics, epidemiologic studies, physical
examinations of individuals.
o collected data are treated confidentially
 Process of Assessment:
o Initiate contact
o Demonstrate caring attitude
o Mutual trust/ confidence
o Collect data from all sources
o Identify health problem
o Assess coping abilities
o Analyze and interprets data
Categories of Health Problem

 Health Deficit occurs when there is a gap between actual and achievable health status.
 Health Threats are conditions that promote disease or injury and prevent people from realizing their
health potential.
 Foreseeable Crisis includes stressful occurrence such as death or illness of a family member.
 Health Need exists when there is a health problem that can be alleviated with medical or social
technology.
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  Health Problem is a situation in which there is a demonstrated health need combined with actual or
potential resources to apply remedial measures and a commitment to act on the part of the provider or
the client.
COMMUNITY

 Our primary client since it has a direct influence on the health of the individual, families and sub-
populations.
COMMUNITY DIAGNOSIS

 It is the process of determining the community health status to meet their needs through utilizing the
nursing process.
TYPES OF COMMUNITY DIAGNOSIS

 COMPREHENSIVE
o It aims to obtain general information about the community.
 PROBLEM ORIENTED/ FOCUSED
o It is as a type of assessment that responds to a particular need
Elements of a Comprehensive Community Diagnosis:

A. DEMOGRAPHIC VARIABLES
o It pertains to the size, composition and geographical distribution of the population density as
indicated by the following:
1. Total population and geographical distribution including urban-rural index and population
density.
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth rate, crude death rate and life
expectancy at birth.
4. Patterns of migration
5. Population projections
B. SOCIO-ECONOMIC AND CULTURAL VARIABLES
o Social indicators:
a. Communication Network (whether formal or informal channels) necessary for
disseminating health information or facilitating referral of clients to the health care
system.
b. Transportation system – including road networks.
c. Educational Level which maybe indicative of poverty and may reflect on health
perception and utilization pattern of the community.
d. Housing conditions which may suggest health hazards (congestion, fire, exposure to
elements).
o Economic indicators:
a. Poverty level income
b. Unemployment and underemployment rates
c. Proportion of salaried and wage earners to total economically active population
d. Type of industry present in the community
e. Occupation common in the community
o Environmental indicators:
a. Physical / geographical/ topographical characteristics of the community
 Land areas that contribute to vector problems
 Terrain characteristics that contribute to accidents or pose as geohazard zones
 Land usage of industry
 Climate or season
b. Water Supply
 - % population with access to safe, adequate water supply
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  Source of water supply
c. Waste disposal
 % population served by daily garbage collection system % population with safe
excreta disposal system
 Types of water disposal and garbage disposal system
d. Air, water and land pollution
 Industries within the community having health hazards associated with it.
 Air and water pollution index
o Cultural factors:
a. Variables that may break-up People into Groups within the community such as:
Ethnicity, Social Class, Language, Religion, Race, Political Orientation
b. Cultural beliefs and practices that effect health
c. Concepts about health and Illness
C. HEALTH AND ILLNESS PATTERNS
o Leading causes of mortality
o Leading causes of morbidity
o Leading causes of infant mortality
o Leading causes of maternal mortality
o Leading cause of hospital admission
D. HEALTH RESOURCES
o They are important determinants of the delivery of care that the nurse needs to determine the
following:
a. Manpower resources:
 Categories of health manpower available
 Geographical distribution of health manpower
 Manpower population ratio
 Distribution of health manpower according to health facilities (hospitals, rural
health units, etc.)
 Distribution of health manpower according to type of organization (government,
non-government, health units, private)
 Quality of health manpower
 Existing manpower development/policies
b. Material resources:
 Health budget and expenditures
 Sources of health funding
 Categories of health institutions available in the community
 Hospital bed-population ratio
 Categories of health services available.
E. POLITICAL/ LEADERSHIP PATTERNS
o In assessing the community, describe the following:
 Power structures in the community (formal or informal)
 Attitudes of the people toward authority
 Conditions/events/issues that cause social conflict/upheavals or that lead to social
bonding or unification
 Practices/approaches that are effective in setting issues and concerns within the
community.
PROBLEM-ORIENTED COMMUNITY DIAGNOSIS

 The process of community diagnosis consists of:

1. Collecting
2. Organizing
3. Synthesizing
4. Analyzing
5. Interpreting Health Data
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  Before the nurse collects data she needs to determine the objectives as these will dictate the depth or
the scope of the community diagnosis. She needs to resolve whether a comprehensive or a problem-
oriented community diagnosis will accomplish her goals.
Steps in Conducting Community Diagnosis:

1. Determining the objectives- takes into consideration the occurrence and distribution of selected
environmental, socio-economic, and behavioral conditions important to disease control and wellness
promotion.
2. Defining the study population – identifies the population group to be included in the study.
3. Determining the data to be collected – with the objectives as guide, identifies the specific data to be
collected and where are these available
4. Collecting the data
o Methods:
a. Records review
b. Surveys and observations – for qualitative and quantitative data
c. Interviews –first hand information
d. Participant observation – involves active participation in the life of the community
5. Developing the instrument
o Survey questionnaire
o Interview guide
o Observation checklist
6. Actual data gathering
o Before the actual data gathering, pre-testing of the instruments is highly recommended.
o Data collectors must be given an orientation and training on how they are going to use the
instruments in data gathering.
o During the actual data gathering, the nurse supervises the data collectors by checking the filled-
up instruments in terms of completeness, accuracy and reliability of the information collected.
7. Data collation
o Putting together all the information.
o Data may either be numerical or descriptive.
o Develop categories for classification of responses making sure that the categories are mutually
exclusive (choices do not overlap) and exhaustive. (all possible answers are anticipated)
8. Data presentation
o Descriptive data – are presented in narrative reports.
a. Example: geographic data, history of a place or beliefs regarding illness and death.
o Numerical data – may be presented into tables and graphs 
9. Data Analysis
o Aims to establish trends and patterns in terms of health needs and problems of the community.
o It allows for comparison of obtained data with standards values.
10. Identifying the community health nursing problems
o Categories of nursing problems:
a. Health status problems- may be described in terms of increased or decreased morbidity,
mortality, fertility or reduced capability for wellness.
b. Health resources problems- may be describes in terms of lack of or absence of
manpower, money, materials or institutions necessary to solve health problems.
c. Health related problems- may be described in terms of existence of social, economic,
environmental, and political factors that aggravate the illness-inducing situations in the
community.
11. Priority setting
o Criteria:
a. Nature of the condition/problem presented – problems are classified as health status,
health resources or health-related problems.
b. Magnitude of the problem – refers to the severity of the problem which can be measured
in terms of the proportion of the population affected by the problem.
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 c. Modifiability of the problem – refers to the probability of reducing, controlling or
eradicating the problem.
d. Preventive potential – refers to the probability of controlling or reducing the effects posed
by the problems
e. Social concern – refers to the perception of the population or the community as they are
affected by the problem and their readiness to act on the problem.
 Score/criteria x weight = Final score for each criterion
 Each problem will be scored according to each criterion and divided by the
highest possible score multiplied by the weight. Then the final score for each
criterion will be added to give the total score for the problem. The problem with
the highest total score is given high priority by the nurse.
TOOLS USED IN COMMUNITY DIAGNOSIS

 DEMOGRAPHY
 VITAL STATISTICS
 EPIDEMIOLOGY

DEMOGRAPHY

 is the science which deals with the study of the human population’s size, composition and distribution in
space.
 Population – refers to the number of people in a given place or area at a given time
 Population composition – characteristics of the population in relation to certain variables such as age,
sex, occupation or educational level
 People are distributed in a specific geographic location
SOURCES OF DEMOGRAPHIC DATA

 Census
 Sample survey
 Registration system
Census – an official and periodic enumeration of population. Demographic, economic and social data are
collected from a specified population group.

Two ways of assigning people

 de facto method – the people are assigned to the place where they are physically present at the time of
the census regardless of their usual place of residence.
 de jure method – is done when people are assigned to the place where they usually live regardless of
where they are at the time of the census.
Sample survey – demographic information is collected from a sample of a given population. Results can be
generalized for the whole population.

Registration system – collected by the civil registrar’s office deal with recording of vital events in the
community. (births, deaths, marriages, divorces and the like).

Population Distribution

 this can be described in terms of urban-rural distribution, population density and crowding index for
proper allocation of resources based on concentration of population in a certain place.
o Urban-rural distribution – illustrates the proportion of the people living in urban compared to the
rural areas.
o Crowding index – describe the ease by which a communicable disease will be transmitted from
one host to another susceptible host. This is describes by dividing the number of persons in a
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 o Population density – determine how congested a place is and has implications in terms of the
adequacy of basic health services present in the community.
VITAL and HEALTH STATISTIC

 a tool in estimating the extent or magnitude of health needs and problems in the community
STATISTICS

 it refers to a systematic approach of obtaining, organizing and analyzing numerical facts so that
conclusion may be drawn from them.
VITAL STATISTICS

 refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation
and deaths
USE OF VITAL STATISTICS

 Indices of the health and illness status of a community.

 Serves as bases for planning, implementing, monitoring and evaluating community health nursing
programs and services.
SOURCES OF DATA

1. Population census
2. Registration of vital data
3. Health survey
4. Studies and researches
RATES AND RATIOS

 Rate – shows the relationship between a vital event and those persons exposed to the occurrence of
said event, with a given area and during a specified unit of time.
 Ratio – is used to describe the relationship between 2 numerical quantities or measures of events
without taking particular considerations to the time or place.
CRUDE OR GENERAL RATES –referred to the total living population. It must be presumed that the total
population was exposed to the risk of the occurrence of the event.

SPECIFIC RATE –the relationship is for a specific population class or group. It limits the occurrence of the
event to the portion of the population definitely exposed to it.

INFANT MORTALITY RATE – measures the risk of dying during the 1st year of life. It is a good index of the
general health of a community since it reflects the changes in the environment and medical condition of the
community.

MATERNAL MORTALITY RATE- measures the risk of dying from causes related to pregnancy, childbirth and
puerperium. It is an index of the obstetrical care needed and received by women in a community.

FETAL DEATH RATE – measures pregnancy wastage. Death of the product of conception occurs prior to its
complete expulsion, irrespective of duration of pregnancy.

NEONATAL DEATH RATE – measures the risk of dying the 1st month of life. It serves as an index of the
effects of prenatal care and obstetrical management of the newborn.

INCIDENCE RATE – measures the frequency of occurrence of the phenomena during a given period of time.

PREVALENCE RATE – measures the proportion of the population which exhibits a particular disease at a
particular time. This can only be determined following a survey of the population concerned, deals with total
number of cases.
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FUNCTIONS OF THE NURSE

 Collects data
 Tabulates analyzes and interprets data
 Evaluates data
 Recommends redirection and/ or strengthening of specific areas of health programs as needed.
EPIDEMIOLOGY

 it is the study of occurrences and distribution of diseases as well as distribution and determinants of
health states or events in specified population, and the application of this study to the control of health
problems.
USES OF EPIDEMIOLOGY:

According to Morris, epidemiology is used to:

1. Study the history of the health population and the rise and fall of diseases and changes in their
character.
2. Diagnose the health of the community and the condition of people to measure the distribution and
dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in
perspective and to define their relative importance and to identify groups needing special attention.
3. Study the work of health services with a view of improving them. Operational research shows how
community expectations can result in the actual provisions of service.
4. Estimate the risk of disease, accident, defects and the chances of avoiding them.
5. Complete the clinical picture of chronic disease and describe their natural history.
6. Identify syndromes by describing the distribution and association of clinical phenomena in the
population.
7. Search for causes of health and disease by comparing the experience of groups that are clearly defined
by their composition, inheritance, experience, behavior and environments.
THE EPIDEMIOLOGIC TRIANGLE

HOST

 Is any organism that harbors and provides nourishment for another organism.
 Are related to lower resistance as a result of exposure to the elements during floods or disasters.
AGENT

 The intrinsic property of microorganism to survive and multiply in the environment to produce disease.
 The result of the introduction of new disease agents into the population.
ENVIRONMENT

 The sum total of all external condition and influences that affects the development of an organism
which can be biological, social, and physical. The environment affects both the agents and host.
 Changes in the physical environment; temperature, humidity, rainfall may directly or indirectly influence
equilibrium of agent and host
The Epidemiologic Triangle consists of three component – the host, environment and agent. The model implies
that each must be analyzed and understood for comprehensions and prediction of patterns of a disease. A
change in any of the component will alter an existing equilibrium to increase or decrease the frequency of the
disease.

THREE COMPONENTS OF THE ENVIRONMENT

1. PHYSICAL ENVIRONMENT – is composed of the inanimate surroundings such as the geophysical

conditions of the climate.
2. BIOLOGICAL ENVIRONMENT – makes up the living things around us such as plants and animal life.
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 3. SOCIO-ECONOMIC ENVIRONMENT- may be in the form of level of economic development of the
community, presence of social disruptions and the like.
DISEASE DISTRIBUTION

 The method and technique of epidemiology are desired to detect the cause of a disease in relation to
the characteristic of the person who has it or to a factor present in his environment. These variables are
studied since they determine the individuals and populations at greatest risks of acquiring particular
disease, and knowledge of these associations may have predictive value.
 Time- refers to the period during which the cases of the disease being studied were exposed to the
source of infection and the period during which the illness occurred. This analysis of cases by time
enables the formulation of hypotheses concerning time and source of infection, mode of transmission,
and causative agent.
 Epidemic period: a period during which the reported number of cases of a disease exceed the
expected, or usual number for that period.
 Year: For many diseases the incidence (Frequency of occurrence) is not uniform during each of 12
consecutive months. Instead, the frequency is greater in one season than any of the others. This
seasonal variation is associated with variations in the risk of exposure of susceptible to the source of
infection.
 Period of Consecutive years: recording the reported cases of a disease over a period of years-by
weeks, months or year of occurrence – useful in predicting the probable future incidence of the disease
and in planning appropriate prevention and control programs.
PATTERNS OF OCCURRENCE AND DISTRIBUTION

 SPORADIC OCCURRENCE
o It is the intermittent occurrence of a few isolated and unrelated cases in a given locality.
o The cases are few and scattered, so that there is no apparent relationship between them and
they occur on and off, intermittently, through a period of time.
 ENDEMIC OCCURRENCE
o It is the continuous occurrence throughout a period of time, of the usual number of cases in a
given locality.
o The disease is therefore always occurring in the locality and the level of occurrence is more or
less constant throughout a period of time.
 EPIDEMIC OCCURRENCE
o It is of unusually large number of cases in a relatively short period of time.
o There is a disproportionate relationship between the number of cases and the period of
occurrence, the more acute is the disproportion, the more urgent and serious of the problem.
 PANDEMIC
o It is the simultaneous occurrence of epidemic of the same disease in several countries. It is
another occurrence from an international perspective
OUTLINE OF PLAN FOR EPIDEMIOLOGICAL INVESTIGATION

1. Establish fact of presence of epidemic

 Verify diagnosis – do clinical and laboratory studies to confirm the data
 Reporting – Is it reasonably complete
 Is there an unusual prevalence of the disease – past experience of a given community
2. Establish time and space relationship of the disease
 Are the cases limited to or concentrated in any particular geographical subdivision of the
affected community?
3. Relations to characteristics of the group of community
 Relation of cases to age, group, sex, color, occupation, school attendance, past immunization.
 Relation to sanitary facilities.
 Relation to milk and food supply.
 Relation of cases and known carriers if any.
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 4. Correlation of all data obtained
 Establish the source of the epidemic and the manner of the spread, if possible
PLANNING FOR COMMUNITY HEALTH NURSING PROGRAMS AND SERVICES

1. Prioritize needs
2. Establish goal based on needs and capabilities of staff
3. Construct action and operation plan
4. Develop evaluation parameters
5. Revise plan as needed
Planning

 It is a process that entails formulation of steps to be undertaken in the future in order to achieve a
desired end.
 Takes place in order to efficiently allocate available resources.
Concepts of Planning (Mercado, 1993)

 Planning is futuristic
 Planning is change-oriented
 Planning is a continuous and dynamic process
 Planning is flexible
 Planning is a systematic process
Planning in CHN involves:

 Orderly process of assessing the health problems and needs of the community
 Priority goals are set according to availability of resources
 Interventions are carefully thought of considering constraints or limitations as they may hamper the
realization of set goals
Community Health Problems – are conditions or situations that intervene with the community’s capability to
achieve wellness.

Categories of Community Health Problems

 Health status problems

 Health resources
 Health – related problems
THE PLANNING CYCLE

1. Situational Analysis
 Activities involved:
 The nurse gathers data about the health status of the community.
 The nurse identifies and explains the problems.
 The nurse projects what situation needs to be changed, developed, or maintained.
 Answering the question “where are we now?” Involves the process of collecting,
synthesizing, analyzing and interpreting information to have a clear picture of the health
status of the community.
 It brings out the health problems of the community.
 In this planning cycle, the nurse:
a. Identifies and provides explanation to the problems, by using the community
diagnosis report as basis for situational analysis.
b. Problem identification and explanation are facilitated if the nurse develops a
problem tree. The problem tree can lead her to the probable causes of the health
status problem.
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2. Goal and Objective Setting
 Define program goals and objectives
 Assign priorities among objectives
 “Where do we want to go?”
3. Strategy/Activity Setting
 Design CHN Programs
 Ascertain resources- it implies the identification of resources such as manpower, money,
materials, technology, time and institutions-needed to implement a program.
 This particular phase of the planning cycle involves three activities:
o Designing the health programs or services
o Budgeting
o Making a time plan or schedule

 Analyze constraints and limitations: “How do we get there?”

 Programs may be classified in terms of the focus of activities:
a. direct health care services to the population such as:
 immunizations
 family planning services
 nutrition supplementation
b. directed towards transferring knowledge and skills
4. The Evaluation Plan
 Determine outcomes
 Specify criteria and standards
The Evaluation Plan
 “How do we know we are there?”
 Program evaluation includes the following steps:
o Deciding what to evaluate in terms of relevance, progress, effectiveness, impact
and efficiency.
o Designing the evaluation plan specifying the evaluation indicators, data needed,
methods and tools for data collection and data sources.
o Collection of relevant data.
o Analyzing data
o Making decisions
o Preparing report and providing decision-makers feedback on the program
evaluation.
5. Implementation of Planned Care
 Involves various nursing intervention which have been determined by the goals and objectives
that have been previously set
 Involve the patient and the his/her family in the care
 Utilization of support system monitor the health services provided
 Make proper referrals
DOCUMENTATION - is necessary to provide data which is needed to plan the client’s care and ensure
its continuity, serve as an important communication tool for various team members, and serve as legal
records to protect the agency and the health care providers or himself / herself.

6. Evaluation of Care and Services Provided - classic frameworks from which nursing care is delivered.
 Structural elements – includes physical settings, instrumentalities and conditions through which
nursing care is given such as philosophy, objectives, building, organizational structure, financial
resources such as budget, equipment and staff
 Process elements – include the steps of the nursing process itself-assessing, planning,
implementing and evaluating such as:
o Taking the family health data base
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 o Performing physical examination
o Making nursing diagnosis
o Determining nursing goals
o Writing a nursing care plan
o Performing the necessary nursing interventions and coordination of services and
measuring success of nursing actions.
 Outcome elements – are changes in the client’s health status that result from nursing
intervention. These changes include modification of symptom, signs, knowledge, attitudes,
satisfaction, skill level and compliance with treatment regimen.
*Each of these frameworks permits more than one approach to quality assurance. (to evaluate the
effectiveness of nursing care done or changes in the behavior, condition or compliance)*.

COMMUNITY ORGANIZING TOWARDS COMMUNITY PARTICIPATION IN HEALTH

COMMUNITY ORGANIZING

o Community Organizing (CO) is a social development approach that aims to transform the apathetic,
individualistic and voiceless poor into a dynamic, participatory and politically responsive community.
o Community organizing is a continuous and sustained process of:
 Guiding people to understand the existing condition of their own community.
 Organizing people to work collectively and efficiently on their immediate and long-term
problems.
 Mobilizing people to develop their capacity and readiness to respond and take action on their
immediate and long-term needs.
GOAL OF COMMUNITY ORGANIZING

 Motivating, enhancing and seeking wider community participation in decision making and activities that
have the potential to impact positively on community health.
Importance of Community Organizing

 It provides the people with an opportunity to get involved and identify the common health problems of
their community.
 It guides the community in decision-making towards self-reliance.
 It guides people in analyzing the strengths and weaknesses of every possible solution offered by them.
STEPS IN COMMUNITY ORGANIZING

1. Fact finding – serves to identify needs for better adjustment for resources and need
2. Determination of needs – it helps to define community problems and action
3. Program Formation – develops a proposal containing objectives
4. Education and Interpretation – all the steps will lead to action that will benefit the community. It will
interpret and educate the public to support proposed programs.
STEPS/PHASES OF COMMUNITY ORGANIZING

A. Pre-entry Phase
o This phase is also known as project site selection. The conduct of preliminary social analysis of
the community is needed to be able to plan the most effective way of entering the community.
B. Entry Phase
o This is also known as social preparation of the community. It is considered crucial because the
success of later activities depend largely on the community organizer's (CO) extent of
integration with the people, her/his understanding of the events in the community, and how
she/he is identified by the people.
C. Helping Phase

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 o This is also known as community involvement. This cover gathering data and encouraging
people to identify and analyze their needs and problems.
D. Phase out
o This phase could mean that a program is already community- managed. Facilitators (or
outsiders) withdraw from self-reliant groups who will now continue to implement the cycle of
direction setting, organizing, planning, implementation, and review for the benefit of the
community members.
o When to phase out
 When the objectives have been attained.
 When the impact of the project has become visible or change has been made.
 When the members of the community can take over the planning, implementation,
monitoring, and evaluation of the project.
 When the community resources can already be maximized by the people.
 When a viable community-based organization has been established.

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