THE NURSING PROCESS IN THE CARE OF THE COMMUNITY

The community health nurse's aim is to improve the health status of the community in general. Just as
in other fields of nursing practice, care of the community is undertaken utilizing the nursing process in
a cyclical process of assessment, diagnosis, planning, intervention, and evaluation.
To the nurse, the community is not just the setting or the context for providing community health
nursing, it is the focus of nursing care. To the community health nurse, understanding the meaning of
community is a requisite.
To synthesize the defınitions in an earlier chapter, a community is a group of people who:
• Have common interests or characteristics.
• Interact with one another.
• Have a sense of unity or belonging.
Function collectively within a defined social structure to address common concerns.
A community may be phenomenological (functional) or geopolitical (territorial). A school is
phenomenological, whereas a barangay is geopolitical, with the latter being locality-based and having
a geographic boundary. This chapter focuses mostly on the geopolitical community.

PRINCIPLES OF COMMUNITY HEALTH NURSING

For the care of the community, the nurse must bear in mind the following principles adapted from the
eight principles of public health nursing.
1. Focus on the community as the unit of care. The nurse's responsibility is to the community as a
whole.
2. Give priority to community needs. The community health nurse has to "marry" skills in the
nursing process with population-focused skills to produce the greatest benefit for the majority
of the community. The nurse uses assessment tools such as demographics and vital statistics to
determine the health needs of the community as a whole.
3. Work With the community as an equal partner of the health team. Team approach is most
evident in community health work, and, frequently, the nurse serves as the liaison officer of the
health team. It is important to note that the community itself is a member of the health team. An
organized community plays an important role in this process. Partnership between health
workers and the community from assessment to evaluation is more likely to produce effective
and sustainable results. As in family health care, the principle of mutuality is also applied in
community health care.
4. In selecting appropriate activities, focus on primary prevention. Emphasis is given on strategies
to promote optimal health and prevent disease and disability. Treatment is a necessary
component of programs that control prevalent communicable diseases, but treatment is by itself
a measure to control the spread of the disease to others. This is termed preventive treatment of
disease.
5. Promote a healthful physical and psychosocial environment. The health team designs strategies
to concentrate on the environmental determinants of health, such as education, socioeconomic
status, physical environment, working conditions, and social support networks.
6. Reach out to all who may benefit from a specific service. The community health nurse realizes
that members of the community who need a particular service are the least likely to actively
seek for appropriate help. For this reason, the health team does not wait for people to come to
the health facility but goes on active case-finding and outreach activities.
7. Promote optimum use of resources. Limited health resources are best used for strategies that
will produce long-term effects, taking ethical principles into consideration. Results of studies on
best practices in community health should be disseminated and utilized where applicable.
8. Collaborate with others working in the community. Health is a product of multiple determinants.
For this reason, the nurse has to work with a variety of sectors, including the community itself, in
resolving issues that affect health. To produce the greatest benefit, community health efforts
have to be coordinated not only among the members of the health team but also with other
disciplines, like teachers, social workers, finance, and marketing experts, involved in community
development.

CONDITIONS IN THE COMMUNITY AFFECTING HEALTH

A community has three features: people, location, and social system. Factors related to these features
affect the health status of the community.
People
Population variables that affect the health of the community include size, density, composition, rate of
growth or decline, cultural characteristics, mobility, social class, and educational level.
Population size and density influence the number and size of health care institutions. This explains the
concentration of health care institutions in urban areas. Negative effects of overcrowding include:
easy spread of communicable diseases; increased stress among members of the community; rapid
degradation of housing facilities, and water, air, and soil pollution. On the other hand, sparsely
populated areas, like rural areas, have limited resources, resulting in difficulty in providing health
services.
Health needs of communities vary because of differences in population composition by age, sex,
occupation, level of education, and other variables. For example, a community with a large number of
women of reproductive age and young children has different needs compared to a community with a
large number of elderly people. Likewise, a community of farmers may present health needs that are
not observable ina community composed largely of professionals.
Rapid growth or decline of a population affects the health of the community. Rapid population growth
usually results from migration of a large number of people into a community, as can be seen in
migration from rural areas to the city. This results in increased demand for services that existing health
care institutions may find hard to cope with. A rapid decline in population may result from
disturbances brought about by circumstances like disasters, political instability, or economic changes,
such as closure of an industrial area. Rapid population decline usually means a decrease in economic
activity in the community and lower government revenue. In turn, this results in a decrease in
resources accessible to the community.
Cultural characteristics of the community are mentioned here in reference to whether members of the
community belong to a similar cultural group (cultural homogeneity) or are multicultural. Feeling of
belongingness and participation in community action are more readily achieved ina culturally
homogeneous population, facilitating cohesive action in dealing with a health threat to the community.
Providing care to a multicultural community is more challenging, requiring cultural competence on the
part of the nurse and the other members of the health team.
People move from one place to another for various reasons, such as to start a family, to take a new job,
or to join another family member. Again, the feeling of belongingness and participation in community
action are less likely when a large segment of the community is composed of new or transient
residents.
The level of education and social class affect health status because of differences in living conditions
and degree of access to resources and opportunities. In addition, different social classes display
distinctive health problems.
Location
The health of the community is affected by both natural and man-made variables related to location.
Natural factors consist of geographic features, climate, flora, and fauna. Community boundaries,
whether the community is urban or rural, the presence of open spaces, the quality of the soil, air, and
water, and the location of health facilities are influenced by human decisions and behavior.
Geographic features consist of land and water forms that influence food sources and prevalent
occupations in the community. Geography plays an important role in disasters, such as earthquakes,
landslides, and floods.
The Philippines has a tropical and maritime climate. Temperature, humidity (i.e., the moisture content
of the atmosphere), and rainfall are the most important elements in the weather and climate of the
country. The mean temperature in the Philippines is 26.6°C, with January being the coolest month and
May the warmest. The country has a relatively high humidity due to the high ambient temperature and
the fact that the Philippines is surrounded by bodies of water. Although distribution varies from one
region to another, the country generally has an abundant rainfall. Based on rainfall distribution, the
Philippines has two seasons; the rainy season (tag-ulan) from June to November and the dry season
(tag-aravw) from December to May. The dry season is subdivided further into the cool dry season from
December to February and the hot dry season from March to May.
Climate change, however, has brought about temperature spikes. It has been observed that warming is
experienced most in the northern and southern regions of the country, while Metro Manila has
warmed less than most parts. In addition, the regions that have warmed the most (Northern Luzon and
Mindanao) have also dried up the most. Hot days and hot nights have become more frequent. Extreme
weather events have also occurred more frequently since 1980, including deadly and damaging
typhoons, floods, landslides, severe El Nino and La Nina events, drought, and forest fires.
The effects of climate change on human health are evidenced by seasonal diseases. The incidence of
diarrheal diseases, conjunctivitis (sore eyes), heat stroke, and skin conditions like prickly heat usually
goes up during the hot season. In contrast, the rainy season is accompanied bya rise in the number of
cases of respiratory and vector-borne infections.
Natural disasters are a frequent occurrence in the country. The geographic location of the Philippines
makes it vulnerable to natural hazards such as tropical cyclones called typhoons, extreme rainfall,
thunderstorms, and floods. Also, the country is within the so-called Ring of Fire, which encircles the
Pacific Ocean and is known for frequent earthquakes and volcanic eruptions.
Plant and animal populations have both positive and negative effects on the health of the community.
The Philippines is a rich habitat of plants with medicinal properties, and many plants and animals serve
as food sources. However, some plants may have ill effects as allergens and sources of toxic
substances. Animals may also serve as reservoirs and vectors of infectious diseases and parasites.
Describing a community is incomplete without delineating its boundaries. A clear demarcation of
community boundaries is necessary since they are the basis for determining the catchment area of
community health workers.
The National Statistical Coordination Board (NSCB) of the Philippines has redefined an urban area as
a barangay that has:
1.A population of 5,000 or more.
2. At least one business establishment with a minimum of 100 employees or 5 or more
establishments with a minimum of 10 employees.
3.5 or more facilities within the 2-km radius from the barangay hall.
All barangays in the National Capital Region are classified as urban. Factors that contribute to health
problems in urban communities include:a higher population density with the resulting congestion;
concentrated poverty and slum formation; and greater exposure to health risks and hazards leading to
violence, traffic injuries, and obesity.
The 2010 Census of Population and Housing showed a population density of 19,137 persons per
square kilometer at the National Capital Region, which is about 62 times the national average of 308
persons per square kilometer.
Rural areas are characterized by wide-open spaces and low population density, but inequities in
resources and economic opportunities hinder rural development. Health facilities and health workers
are concentrated mainly in urban areas. Also, poverty is more prevalent in rural areas, with almost
80% of the poor in the country residing in rural areas. This is backed up by other studies. For instance,
poverty incidence among children residing in rural areas is more than twice that of their urban
counterparts. Children living in poverty tend to be malnourished and are vulnerable to abuse.
Considerable government resources have been devoted to the delivery of services to the population
who do not have access to health services and education. However, there are still not enough roads in
rural areas, limiting access to health facilities.
Air, water, and soil pollution poses health hazards to the population. Outdoor air pollution is attributed
to transport and manufacturing activities, which occur in concentration in urban areas, especially the
National Capital Region. The use of solid fuel (wood, charcoal, and biomass residues like stalks, leaves,
and agricultural by-products), which leads to indoor pollution, is more prevalent among low-income
households in rural areas. A great portion of water pollution from domestic sources is contributed by
the National Capital Region and Region IV-A (CALABARZON). Soil pollution is mainly attributed to
mining, industries, farming, and household activities. The first three affect rural areas, whereas
household activities have a greater effect in urban areas.
Social System
A social system is the patterned series of interrelationships existing between individuals, groups, and
institutions and forming a coherent whole. Social system components that affect health include the
family, economic, educational, communication, political, legal, religious, recreational, and health
systems. While carrying out several roles simultaneously, an individual serves as a part of several
social system components at the same time. One may be a son or daughter in the family, a nurse
employed in a hospital, a church member, a member of a neighborhood basketball team, and a citizen
all at one time.

Social System
A social system is the patterned series of interrelationships existing between individuals, groups, and
institutions and forming a coherent whole. Social system components that affect health include the
family, economic, educational, communication, political, legal, religious, recreational, and health
systems. While carrying out several roles simultaneously, an individual serves as a part of several
social system components at the same time. One may be a son or daughter in the family, a nurse
employed in a hospital, a church member, a member of a neighborhood basketball team, and a citizen
all at one time.
As in other systems, the composite parts of the social system of the community affect and interact
with one another. During these interactions, patterns and communication transpire, which form the
basis of organizations. Organizations within the social system can be formal or informal. A government
agency, a bank, and a school are examples of formal organizations, whereas neighborhood friends and
volunteers in a barangay clean-up drive are examples of informal organizations. Organizations that
have interactions and linkages and that carry out similar functions form community systems or
subsystems. For example, health centers, private clinics, hospitals, health laboratories, and drugstores
are elements of the health system of a community.
Because of the multifactorial nature of health, all the components of the social system of a community
influence its health. In providing care to a community, the nurse has to take into account the totality of
its social system. The health care delivery system, however, is considered of central importance
precisely because of its role in community health promotion and maintenance and risk reduction. In
fact, the nurse is a part of this system. Community diagnosis requires a study of the health care
delivery system. For example, the infant mortality rate in a particular barangay is higher than the
national infant mortality rate. In addition to factors attributed to the characteristics of the people and
the location of the community, it is important that the nurse determines how well the health care
system is functioning in relation to the provision of maternal and child services, and to what degree
are services for maternal and child health promotion implemented by the health system at the
barangay level.

CHARACTERISTICS OF A HEALTHY COMMUNITY

A healthy organism has all its body parts contributing to its well-being by carrying out their specific
functions. In the same manner, all systems of a community need to function effectively and work
together to maintain the health of the community. A healthy community has mechanisms that assure
all citizens a decent way of life in all aspects. Certain observable trails allow health workers lo
ascertain whether an individual or a family is healthy. A community, likewise, may be observed for
evident trails that indicate its health.

A healthy community is, in fact, the context of health promotion defined in the Ottawa Charter as "the
process of enabling people to increase control over, and to improve, their health." Further, the Charter
states, "To reach a state of complete physical, mental and social well-being, an individual or group must
be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the
environment. Health is, therefore, seen as a resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health sector but goes beyond healthy
life-styles to well-being."
The Ottawa Charter was one of the documents that paved the way for the Healthy Settings
movement. Healthy Settings initiatives, such as the Healthy Cities movement, have been undertaken
in different parts of the world, A healthy city is one that is continually creating and improving those
physical and social environments and expanding those community resources that enable people to
mutually support each other in performing all the functions of life and developing to their maximum
potential. It aims to:
• Achieve a good quality of life.
Create a health-supportive environment.
• Provide basic sanitation and hygiene needs.
Supply access to health care. Being a healthy city does not depend on existing structures, but a
commitment to improve the city environment and create the necessary networks for health.
The Philippines is a member nation of the WHO Western Pacific Region, which has advocated for the
Healthy Cities and Healthy Islands movement, especially because of rapid economic, environmental,
and social changes.
Health is affected by many factors dial cannot be controlled by individuals all by themselves.
Effectively functioning systems within the community go a long way toward health promotion, disease
prevention, and access to resources needed for health. Knowing that a healthy community is essential
to health promotion gives the community health nurses further motivation in their work.

COMMUNITY ASSESSMENT
The data that need to be collected depend on the objectives of community assessment. In general, the
nurse needs to collect data on the three categories of community health determinants; people, place,
and social system.
The community database for Planned Approach to Community Health (PATCH), a community health
planning model based on Green's PRECEDE model, includes quantitative and qualitative data. Since
community participation is a premise of the PATCH process, the community profile is used to ensure
representation of all stakeholders in the building of the PATCH community team. In addition to
morbidity and mortality data, unique health events are also noted. A unique health event or activity in
the community is one that has a short- or long-term impact, which may be positive or negative, on the
health of the community. Behavioral data can help identify the risk factors and the specifc population
targeted for a particular activity. Exploring community opinion allows the health worker to appreciate
community perceptions of health and quality of life of the community.

There are several approaches in conducting community assessment. The nurse utilizes the approach
that is most appropriate to the community and the purpose of the assessment.
In a comprehensive needs assessment, the nurse gathers information about the entire community
using a systematic process where data is collected regarding all aspects of the community to be able to
identify actual and potential health problems. Although it requires much time and effort, information
gathered through a comprehensive needs assessment will be most useful, particularly when health
assessment of a community is being done for the first time. Periodic assessment and evaluation of
health programs may also require the application of this approach.
A problem-oriented assessment is focused on a particular aspect of health. In this approach, the nurse
collects information with a certain community problem in mind, and then proceeds to gather
information from the aggregate vulnerable to the problem. This approach is workable when the nurse
is familiar with the community such as when a comprehensive community assessment has been
previously done. For example, the nurse learns from a comprehensive assessment that the catchment
population has a large proportion of 0- to 5-year-old children. Knowing that children of this age are
susceptible to malnutrition, the nurse decides to conduct a nutritional assessment, focusing on feeding
and dietary patterns of the caregivers of infants and young children.
Deciding on a strategy for community assessment depends on the objective for data gathering, the
size and characteristics of the aggregate, and the resources available to the nurse.
Tools for community assessment
Data sources are generally grouped into primary and secondary data. In community health practice,
the community itself is the primary source of data. Primary data are data that have not been gathered
before and are collected by the nurse through observation (ocular/windshield survey and participant
observation), survey, informant interview, community forum, and focus group discussion. Secondary
data are taken from existing data sources. Going over secondary data first gives the nurse a picture of
what is already known about the population under study, which may facilitate collection of primary
data. Secondary data sources consist of vital registries, health records and reports, disease registries,
and publications. Publications include both print and electronic forms, such as those produced by the
Department of Health, Food and Nutrition Research Institute, and census data published by the
National Statistics Office.

The National Statistical Coordination Board (NSCB) of the Philippines has redefined an urban area as
a barangay that has:
1.A population of 5,000 or more.
2. At least one business establishment with a minimum of 100 employees or 5 or more
establishments with a minimum of 10 employees.
3.5 or more facilities within the 2-km radius from the barangay hall.
All barangays in the National Capital Region are classified as urban. Factors that contribute to health
problems in urban communities include: a higher population density with the resulting congestion;
concentrated poverty and slum formation; and greater exposure to health risks and hazards leading to
violence, traffic injuries, and obesity.
The 2010 Census of Population and Housing showed a population density of 19,137 persons per
square kilometer at the National Capital Region, which is about 62 times the national average of 308
persons per square kilometer.
Rural areas are characterized by wide-open spaces and low population density, but inequities in
resources and economic opportunities hinder rural development. Health facilities and health workers
are concentrated mainly in urban areas. Also, poverty is more prevalent in rural areas, with almost
80% of the poor in the country residing in rural areas. This is backed up by other studies. For instance,
poverty incidence among children residing in rural areas is more than twice that of their urban
counterparts. Children living in poverty tend to be malnourished and are vulnerable to abuse.
Considerable government resources have been devoted to the delivery of services to the population
who do not have access to health services and education. However, there are still not enough roads in
rural areas, limiting access to health facilities.
Air, water, and soil pollution poses health hazards to the population. Outdoor air pollution is attributed
to transport and manufacturing activities, which occur in concentration in urban areas, especially the
National Capital Region. The use of solid fuel (wood, charcoal, and biomass residues like stalks, leaves,
and agricultural by-products), which leads to indoor pollution, is more prevalent among low-income
households in rural areas. A great portion of water pollution from domestic sources is contributed by
the National Capital Region and Region IV-A (CALABARZON). Soil pollution is mainly attributed to
mining, industries, farming, and household activities. The first three affect rural areas, whereas
household activities have a greater effect in urban areas.
Social System
A social system is the patterned series of interrelationships existing between individuals, groups, and
institutions and forming a coherent whole. Social system components that affect health include the
family, economic, educational, communication, political, legal, religious, recreational, and health
systems. While carrying out several roles simultaneously, an individual serves as a part of several
social system components at the same time. One may be a son or daughter in the family, a nurse
employed in a hospital, a church member, a member of a neighborhood basketball team, and a citizen
all at one time.
As in other systems, the composite parts of the social system of the community affect and interact
with one another. During these interactions, patterns and communication transpire, which form the
basis of organizations. Organizations within the social system can be formal or informal. A government
agency, a bank, and a school are examples of formal organizations, whereas neighborhood friends and
volunteers in a barangay clean-up drive are examples of informal organizations. Organizations that
have interactions and linkages and that carry out similar functions form community systems or
subsystems. For example, health centers, private clinics, hospitals, health laboratories, and drugstores
are elements of the health system of a community.
Because of the multifactorial nature of health, all the components of the social system of a community
influence its health. In providing care to a community, the nurse has to take into account the totality of
its social system. The health care delivery system, however, is considered of central importance
precisely because of its role in community health promotion and maintenance and risk reduction. In
fact, the nurse is a part of this system. Community diagnosis requires a study of the health care
delivery system. For example, the infant mortality rate in a particular barangay is higher than the
national infant mortality rate. In addition to factors attributed to the characteristics of the people and
the location of the community, it is important that the nurse determines how well the health care
system is functioning in relation to the provision of maternal and child services, and to what degree
are services for maternal and child health promotion implemented by the health system at the
barangay level.

CHARACTERISTICS OF A HEALTHY COMMUNITY

A healthy organism has all its body parts contributing to its well-being by carrying out their specifhc functions. In
the same manner, all systems of a community need to
function effectively and work together to maintain the health of the community. A healthy community has
mechanisms that assure all citizens a decent way of life in all
aspects. Certain observable trails allow health workers lo ascertain whether an individual or a familyfis healthy. A
community, likewise, may be observed for evident
trails that indicate its health.

A healthy community is, in fact, the context of health promotion defined in the Ottawa Charter as "the
process of enabling people to increase control over, and to improve, their health." Further, the Charter
states, "To reach a state of complete physical, mental and social well-being, an individual or group must
be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the
environment. Health is, therefore, seen as a resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health sector but goes beyond healthy
life-styles to well-being."
The Ottawa Charter was one of the documents that paved the way for the Healthy Settings
movement. Healthy Settings initiatives, such as the Healthy Cities movement, have been undertaken
in different parts of the world, A healthy city is one that is continually creating and improving those
physical and social environments and expanding those community resources that enable people to
mutually support each other in performing all the functions of life and developing to their maximum
potential. It aims to:
• Achieve a good quality of life.
• Create a health-supportive environment.
• Provide basic sanitation and hygiene needs.
•Supply access to health care. Being a healthy city does not depend on existing structures, but a
commitment to improve the city environment and create the necessary networks for health.
The Philippines is a member nation of the WHO Western Pacific Region, which has advocated for the
Healthy Cities and Healthy lslands movement, especially because of rapid economic, environmental,
and social changes.
Health is affected by many factors dial cannot be controlled by individuals all by themselves.
Effectively functioning systems within the community go a long way toward health promotion, disease
prevention, and access to resources needed for health. Knowing that a healthy community is essential
to health promotion gives the community health nurses further motivation in their work.

COMMUNITY ASSESSMENT
The data that need to be collected depend on the objectives of community assessment. In general, the
nurse needs to collect data on the three categories of community health determinants; people, place,
and social system.
The community database for Planned Approach to Community Health (PATCH), a community health
planning model based on Green's PRECEDE model, includes quantitative and qualitative data. Since
community participation is a premise of the PATCH process, the community profile is used to ensure
representation of all stakeholders in the building of the PATCH community team. In addition to
morbidity and mortality data, unique health events are also noted. A unique health event or activity in
the community is one that has a short- or long-term impact, which may be positive or negative, on the
health of the community. Behavioral data can help identify the risk factors and the specific population
targeted for a particular activity. Exploring community opinion allows the health worker to appreciate
community perceptions of health and quality of life of the community.
There are several approaches in conducting community assessment. The nurse utilizes the approach
that is most appropriate to the community and the purpose of the assessment.
In a comprehensive needs assessment, the nurse gathers information about the entire community
using a systematic process where data is collected regarding all aspects of the community to be able to
identify actual and potential health problems. Although it requires much time and effort, information
gathered through a comprehensive needs assessment will be most useful, particularly when health
assessment of a community is being done for the first time. Periodic assessment and evaluation of
health programs may also require the application of this approach.
A problem-oriented assessment is focused on a particular aspect of health. In this approach, the nurse
collects information with a certain community problem in mind, and then proceeds to gather
information from the aggregate vulnerable to the problem. This approach is workable when the nurse
is familiar with the community such as when a comprehensive community assessment has been
previously done. For example, the nurse learns from a comprehensive assessment that the catchment
population has a large proportion of 0- to 5-year-old children. Knowing that children of this age are
susceptible to malnutrition, the nurse decides to conduct a nutritional assessment, focusing on feeding
and dietary patterns of the caregivers of infants and young children.
Deciding on a strategy for community assessment depends on the objective for data gathering, the
size and characteristics of the aggregate, and the resources available to the nurse.
Tools for community assessment
Data sources are generally grouped into primary and secondary data. In community health practice,
the community itself is the primary source of data. Primary data are data that have not been gathered
before and are collected by the nurse through observation (ocular/windshield survey and participant
observation), survey, informant interview, community forum, and focus group discussion. Secondary
data are taken from existing data sources. Going over secondary data first gives the nurse a picture of
what is already known about the population under study, which may facilitate collection of primary
data. Secondary data sources consist of vital registries, health records and reports, disease registries,
and publications. Publications include both print and electronic forms, such as those produced by the
Department of Health, Food and Nutrition Research Institute, and census data published by the
National Statistics Office.

Collecting primary data

Observation
Rapid observation of a community may be done through an ocular or windshield survey, either by
driving or riding a vehicle or walking through it. This gives the nurse the chance to observe people as
well as take note of environmental conditions and existing community facilities. When observing the
people, the nurse spots for vulnerable groups: the young, the elderly, and pregnant women, for
example. The nurse takes note of the general appearance of the people, if they appear healthy, well
nourished, or the opposite. Walking through a community allows the nurse to talk with people to find
out their perceptions of health and health services. Environmental conditions, like terrain, general
condition of homes and housing density, cleanliness, presence and type of vegetation, and presence of
street animals like cats and dogs, can be observed in an ocular/windshield survey. Community
resources, such as health facilities, barangay halls, schools, places of worship, open spaces like a plaza
and recreational areas like a basketball court, are easily discernible.
Participant observation is a purposeful observation of formal and informal community activities by
sharing, if possible, in the life of the community. This method helps the nurse in determining
community values, beliefs, norms, priorities, concerns, and power or influence structures. Examples of
formal community activities are barangay assemblies and school (parent-teacher) and church
meetings. Informal gatherings take place in a variety of settings in the community, as in sari-sari stores,
community recreational areas, or schools. Participant observation is a technique that suits community
organizing and participatory action research.
Survey
Although time consuming and expensive, a survey may be necessary when there is no available
information about the community or specific population group to be studied. A survey is made up of a
series of questions for systematic, collection of information from a sample of individuals or families in
a community, and may be written or oral. It is useful when, for example, the nurse needs information
about the municipality, but the existing information is about the entire province, or findings from a
comprehensive assessment show the need for nutritional assessment of the young children in a
particular community.
For a comprehensive needs assessment, data are collected about a random sample of the population.
Purposive sampling is indicated in a problem-oriented assessment where the sample population
consists of the population susceptible to the problem being studied. In nutritional assessment, for
example, families with young children are chosen as sources of information since they are most
susceptible to malnutrition.
In addition, a survey is also appropriate for determining community attitudes, knowledge, health
behaviors, and perceptions of health and health services. It is used by the nurse in identifying patterns
of utilization of health services (Maurer and Smith, 2009). A survey is also an opportunity for making
the members of the community more aware of community problems and their effects and more
conscious of their capacity to influence decision making about health policies and plans, giving them a
sense of empowerment.
Informant interview
Informant interviews are purposeful talks with either key informants or ordinary members of the
community. Key informants consist of formal and informal community leaders or persons of position
and influence, such as leaders in local government, schools, and business. The interview may be
structured where the nurse directs the talk based on an interview guide, or it may be unstructured
where the informant guides the talk. Used with skill, informant interviews can give the nurse valuable
information on community perceptions about health and health care.
Community forum
A community forum is an open meeting of the members of the community. Pulong-pulong sa barangay
is a good example of a community forum. It does not only give the nurse information on community
perceptions on needs, health, and health care, but it is also an effective tool in providing the people
with a medium for expressing their views and developing their capacity to influence decision makers. If
initiated by the nurse, the forum is set in coordination with the leaders of the community, such as the
barangay leaders or other informal leaders.
Besides data gathering, the community forum may also be used as a venue for informing the people
about secondary data, for data validation, and for getting feedback from the people themselves about
previously gathered data.

Focus group
A focus group differs from a community forum in the sense that the focus group is made up of a much
smaller group, usually 6-12 members only. Also, its membership is more homogeneous, that is, persons
with similar sociocultural or health conditions. If used properly, this method is effective in the
assessment of health needs of specific groups in the community. A good example is a focus group of
first-time pregnant women.
Secondary data sources
Registry of vital events
Act 3753 (Civil Registration Law, Philippine Legislature), enacted in 1930, established the civil registry
system in the Philippines and requires the registration of vital events, such as births, marriages, and
deaths. R.A. 7160 (Local Government Code) assigned the function of civil registration to local
governments and mandated the appointment of Local (city/ municipal) Civil Registrars. The NSO
serves as the central repository of civil registries and the NSO Administrator and the Civil Registrar
General of the Philippines.
Reliable civil registration and vital statistics provide a realistic basis for program planning and
implementation. The birth and death registries are of particular importance to the nurse, since they
are sources of fertility and mortality data. The need for information dissemination on registration,
especially among the Muslim population and indigenous cultural communities, has been noted. The
low compliance rate to registration requirements among certain Filipino populations has been
attributed to funeral rites, customs, and practices distinct to particular cultural groups. The nurse is in
a position to increase people's awareness on civil registration and guide them through the process.
In facility-based births, the facility administrator shall be responsible for the registration of the event.
The physician, nurse, midwife, or anybody who attended the delivery has the responsibility for
registering births that occur outside a facility. Either parent may also register the birth. The birth of a
child should be registered within 30 days from the occurrence of the birth at the Local Civil Registry
Office of city or municipality where the birth occurred.
Presidential Decree 856 (Sanitation Code-Office of the President, Republic of the Philippines, 1975)
requires a death certificate before burial of the deceased. The physician who last attended the
deceased shall be responsible for preparing the death certificate, certifying the cause of death, and
forwarding the death certificate to the health officer within 48 hours. If death occurred without
medical attention, the nearest relative or any person who has knowledge of the death shall report to
the health officer within 48 hours. The health officer then certifies the cause of the death and directs
its registration. In the absence of a health officer, the death should be reported to the mayor, municipal
secretary, or any member of the Sangguniang Bayan, who shall issue the death certificate for purposes
of burial. Registration of death shall be made within 30 days from the occurrence of death at the Local
Civil Registry Office of the city or municipality where the birth occurred. Fetal deaths are registered
following the same process.
Health records and reports
As specified by Executive Order No. 352 (Office of the President, Republic of the Philippines, 1996),
the Field Health Service Information System (FHSIS) is the official recording and reporting system of
the Department of Health and is used by the NSCB to generate health statistics. The FHSIS is an
essential tool in monitoring the health status of the population at different levels. It is therefore a basis
for (1) priority setting by local governments, (2) planning and decision making at different levels
(barangay, municipality, district, provincial, and national), and (3) monitoring and evaluating health
program implementation. Detection of unusual occurrence of disease is facilitated. It also provides a
standardized, facility-level database for more in-depth studies.
The FHSIS is composed of recording and reporting tools. Records are facility-based, that is, they are
kept at the Barangay Health Station (BUS) or at the Rural Health Unit (RHU) or health center and
contain a day-to-day account of the activities of health workers. Services delivered to clients are the
basis of the data entered in the records. Records serve as the basis of reports. Reports consist of
summary data that are transmitted or submitted monthly, quarterly, and annually to a higher level,
that is, from the BUS to the RHU or health center, to the Provincial Health Office, and finally to the
regional level.
The FHSIS Manual of Operations lists and describes the following recording tools:
• The Individual Treatment Record (UTR) is the building block of the FHSIS. The record contains
the date, name, address of patient, presenting symptoms or complaint of the patient on
consultation, and the diagnosis (if available), treatment, and date of treatment. ITRs are
maintained at the facility on all patients seen. Health workers are advised not to rely on client-
maintained records, like the home-based record.
Target Client Lists (TCLs) are the second building block of the FHSIS. These service records have
the following purposes:

a. service delivery since midwives and nurses use TCLs to monitor target or eligible
populations for particular health services.
b. To facilitate monitoring and supervision of service delivery activities.
c. To report services delivered, thus reducing the need to refer back to the ITRs to
accomplish reporting,
d. To provide a clinic-level database that can be accessed for further studies,
• The following are the TCLs maintained in RHUs and health centers:
a. TCL for Prenatal Care.
b. TCL for Postpartum Care.
c. TCL of Under 1-Year-Old Children.
d. TCL for Family Planning
e. TCL for Sick Children.
f. National Tuberculosis Program TB Register.
• The Summary Table is accomplished by the midwife. It isa 12-column table in which columns
correspond to the 12 months of the year. This record is kept at the BHS and has two
components: Health Program Accomplishment and Morbidity/ Diseases. 'The Summary Table' is
supposed to be updated on a monthly basis. The Health Program Accomplishment provides the
midwife with a tool for assessment of accomplishments and a ready source for reports. The
monthly summary of morbidity gives information on the monthly trend of diseases and serves as
a source for the 10 leading causes of morbidity in the municipality/city. The Summary Table is
also a source of data for any survey or research.
g. National Leprosy Control Program Central Registration Form.
The Monthly Consolidation Table (MCT) is accomplished by the nurse based on the Summary
Table. It serves as the source document for the Quarterly Form and the Output 'Fable of the
RHU or health center.
The reporting forms, as enumerated in the FHSIS Manual of Operations, are the following:
1. Monthly Forms are regularly prepared by the midwife and submitted to the nurse, who
then uses the data to prepare the Quarterly Forms.
a. Program Report (M1) contains indicators categorized as maternal care, child care,
family planning, and disease control. The midwife copies the data from the Summary
Table.
b. Morbidity Report (M2) contains a list of all cases of disease by age and sex.
sex
2. Quarterly Forms are usually prepared by the nurse. There should only be one Quarterly
Form for the municipality/city. In municipalities/cities with two or more RHUs or health
centers, consolidation is done under the direction of the Municipal/City Health Officer.
Quarterly Forms are submitted to the Proincial Health Office.
a. Program Report (Q1) contains the 3-month total of indicators categorized as
maternal care, family planning, child care, dental health, and disease control.
Disease registries
b. Morbidity Report (Q2) is a 3-month consolidation of Morbidity Report (M2).
3. Annual Forms
a. A-BHSis a report by the midwife that contains demographic, environmental, and
natality data.
b. Annual Form 1 (A-1) is prepared by the nurse and is the report of the RHU or health
center. It contains demographic and environmental data, and data on natality and
mortality for the entire year.
c. Annual Form 2(A-2), prepared by the nurse, is the yearly morbidity report by age and
d. Annual Form 3 A-3), also prepared by the nurse, is the yearly report of all deaths
(mortality) by age and sex.
A disease registry is a listing of persons diagnosed with a specific type of disease in a defined
population. Data collected through disease registries serve as basis for monitoring, decision making.
and program management. The Department of Health has developed and maintained registries for
HIV/AIDS and chronic noncommunicable diseases, particularly cancer, diabetes mellitus, chronic
obstructive pulmonary disease, and stroke. The Renal Disease Control Program manages the
Philippine Renal Disease Registry.

A census is a periodic governmental enumeration of the population. Batas Pambansa Blg. 72 provides
for a national census of population and other related data in the Philippines every 10 years.
The Philippine Statistical System (PSS) provides statistical information and services to the public. The
NSCB is the policy-making and coordinating body of the PSS, whereas the NSO is the PSS arm that
generates general-purpose statistics: population, employment, prices, and family
income/expenditures.
During a census, people may be assigned to a locality by de jure or de facto method. De jure
assignment is based on the legally established place of residence of people, whereas de facto is
according to the actual physical location of people.
The NSO conducts the national census using the de jure method. The census population consists of
Filipino nationals, to include those residing in and out of the Philippines, and nationals of other
countries having their usual residence in the Philippines. Demographic characteristics, household size,
and data on fertility and mortality are some of the census information that the nurse can utilize for
needs assessment.
Methods to present community data
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Community data are presented to the health team and the members of the community for the
following purposes:
• To inform the health team and members of the community of existing health and health-related
conditions in the community in an easily understandable manner.
To make members of the community appreciate the significance and relevance of health
information to their lives.
• To solicit broader support and participation in the community health process.
• To validate findings.
• To allow for a wider perspective in the analysis of data.
• To proide a basis for better decision making.
Depending on the context and the purpose of the presentation, community data may be presented as
text, in tables, or in pictorial form such as maps and graphs. Maps can be used to show differences or
similarities across geographic areas. For example, barangays may be color coded in a municipality map
to show immunization rates of infants. In contrast, numeric data are usually more clearly presented
through tables and graphs or charts.