Unit 3:

Nursing Process in the Care of

Population Groups and Community
Learning Objectives:At the end of the
discussion, the students will be able to:

Define community.
Identify the three features of community.
Familiarize the community assessment and its
composition.
What is community?

is a group of people who have common

interest and characteristics (Allender et al.,
2009; Lundy and Janes, 2009; Clark,
2008)
Interact with one another (Allender et al.,
2009; Lundy and Janes, 2009; Clark, 2008)
Community has three features:

People
Location
Social system
People

 Size
 Composition
 Rate of growth
 Cultural characteristics
 Educational level
Location

Naturaland
man made variables
Social system
What is assessment?
Community Assessment

Is an essential process in understanding

the community, identifying its needs or
weaknesses and assets or strength that is
useful in achieving a healthy community.
Community Assessment

Comprehensive needs
assessment
Problem-oriented assessment
Comprehensive Assessment

The nurse gathers information about the entire

community using a systematic process where
data are collected regarding all aspects of the
community to identify actual or potential health
problems.
Requires much time and effort.
Most useful when health assessment
is being done for the first time.
Problem-oriented assessment
 Focused on a particular aspects of health (Maurer and
Smith, 2009)
 The nurse collects information with certain health
problems in mind.
 This approach is workable when the nurse is familiar with
the community such as when a comprehensive community
assessment has been previously done.
Tools for Community Assessment

Primary Data – are data that have not been

gathered before and are collected by the
nurse through the following:
Secondary Data-are taken from existing data
sources
Activity:
Group 1- Primary Data-
-Observation and Survey
 Group 2- Primary Data
 Informant interview and community forum
 Group 3- Primary Data
 Focus group
 Group 4- Secondary Data
- Registry of vital events
- Group 5- Secondary Data
- -Health records and reports
- Group 6-Secondary data
- -disease registries and census
Tools for Community Assessment

 Primary Data – are data that have not been

gathered before and are collected by the nurse
through the following:
 1. Observation – ocular/windshield survey and
participant observation
 2. Survey
 3. Informant Interview
4. Community Forum

 5. Focus group discussion

Secondary Data – are taken from
existing data sources.

1. Vital registries

 2. Health records and reports

3. Disease registries
Collecting Primary Data

Observation
Survey
 Informant interview
Community Forum
Focus group
Secondary Data Sources
Registry of vital events

Health Records and Reports

 Disease registries

Census Data
Registry of vital events

 Act 3753 (Civil Registration Law, Philippine

Legislature)
 Vital events:
- Births
- Marriages
- Deaths
Birth and death registries

In facility-based births- administrators shall

be responsible for the registration of event.
Outside facility- Physician, nurses and
midwife or anybody who attended the
delivery has the responsibility for registering
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
(NSO, 2010a)
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 health officer within 48 hours.
Health Records and Reports

 ExecutiveOrder no. 352 (Office of the President,

Republic of the Philippine, 1996). The Field Health
Service Information System (FHSIS) is the official
recording and reporting system of the DOH and is
used by the NSCB to generate health statistics.
F = Field; H = Health; S = Service;
I = Information; S = System
 Field Health Service Information System

 It is a network information.
 It is intended to address the short term needs of
DOH and LGU staff with managerial or supervisory
functions in facilities and program areas.
 It monitors health service delivery nationwide.
Ultimate Goal of a Health Information System

To enable various health system stakeholders

to make transparent and evidence-based
decisions.
 The FHSIS – is an essential tool in monitoring the health
status of the population at different levels.
 Basis:
 1. Priority setting by local governments
 2. Planning and decision making at different levels
(barangay, municipality, district, provincial, and national)
 3. Monitoring and evaluating health program and
implementation.
 FHSIS- is composed of recording and reporting tools. Records are
facility based, all records are kept at the Barangay Health Station or at
the Rural Health Unit or Health Center which contain the daily
activities of the health workers.
- Services rendered to the client should be documented in the records.
- Records serves as the basis of reports.
- Reports consist of the Summary data that are submitted monthly,
quarterly, and annually to a higher level.
- Submission of reports from the BHS to the RHU or health center, to
the Provincial Health Office/City Health Office, and finally to the
regional level.
Components of FHSIS
Recording Tools Reporting Forms
 Individual Treatment  Monthly Form
Record (ITR) - M1 – Program
• Target Client List - M2 – Morbidity
(TCL)  Quarterly Form
• Summary Table - Q1 – Program
> HPA - Q2 – Morbidity
> Morbidity Disease  Annual Forms
• Monthly - A-BHS
Consolidation - A1-Vital Statistics
Table (MCT) Envi/Demographic
- A2 – Morbidity
- A3 – Mortality
Difference of Recording & Reporting
Recording Reporting
Facility Based  Transmitted /Submitted
• Detailed Data  Summary Data
• Day – to – Day  Monthly/Quarterly Annual
• Source: Services  Source: Dependent on the
delivered to patients / records (Summary of Records)
clients
Uses & Importance of each Recording
Forms
 1. Individual Treatment Record (ITR)
 - Foundation/building block
 - Piece of paper
 - Patient consultation record
 a. Complaints/presenting symptoms
 b. Diagnosis
 c. Treatment given
 d. Date, name, address of patient, etc.
 2. Target Client List (TCL)

 - To plan and carry out patient care and service

delivery “Targets/Eligibles”
- Facilitate the monitoring and supervision of
service delivery activities
- Record services delivered

- Provide a clinic-level data base accessible for

further studies
 TCLs to be maintained are:

TCL for Prenatal, TCL for Post-partum

Care, TCL for Family Planning, TCL for
Under One year old children and TCL
for Sick Children
Summary Table – is accomplished by the midwife. It is a
12 column table in which columns correspond to the 12
months of the year.
 2 components:
 1. Health Program Accomplishment
 2. Morbidity/Diseases
 MonthlyConsolidation Table – is accomplished by
the nurse on the Summary Table. Serves as the
source document for the Quarterly Form and
Output Table of the RHU or health center.
Disease registries

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
(DOH, 2011a).
 The Department of Health has developed and maintained
registries for the following:
 HIV/AIDS
 Cancer
 Diabetes Mellitus
 COPD
 Stroke (DOH-NEC, 2012; DOH, 2011a)
Census Data

 A census is a periodic governmental enumeration of the population

(Merriam-Webster Online Dictionary, 2012a).
 Batas Pambansa - provides for a national census of population and other
related data in the Philippines every 10 years (Batasang Pambansa, 1980).
 Philippine Statistical System – provides statistical information and services
to the public.
 National Statistic Office – is the PSS arm that generates general purpose
statistics: population, employment, prices, and family
income/expenditures (Astrologo, 2011).
 RepublicAct No. 10625 (Philippine Statistical Act
of 2013) was signed into law by President Benigno
S. Aquino III on 12 September 2013. The law’s
Implementing Rules and Regulations took effect on
29 December 2013.
It merged the National Statistics Office
(NSO), National Statistical Coordination
Board (NSCB), Bureau of Labor and
Employment Statistics (BLES) and the
Bureau of Agricultural Statistics (BAS) into
the Philippine Statistics Authority (PSA).
PSA shall serve as the central statistical
authority of the Philippine Government. It
shall also administer the civil registration
functions provided under Act No. 3753 (Law
on Registry of Civil Status).
All civil registry documents (i.e.
birth certificate/ROB, marriage
certificate/ROM, death
certificate/ROD, CENOMAR) are
now issued by the PSA.
Unit 3:
Nursing Process in the Care of
Population Groups and Community
Learning objectives:

Utilizethe nursing process in managing

community health concerns.
Community Diagnosis
Community Diagnosis is the process of
determining the health status of the
community and factors responsible for it.
The three-part statement consists of:
Shuster and Geoppinger (2004)
1. The health risk or specific problem to which the
community is exposed.
2. The specific aggregate or community with whom
the nurse will be working to deal with the risk or
problem.
3. Related factors that influence how the community
will respond to the health risk or problem.
 All over the Philippines, FHSIS Annual Reports of 2007 and 2008 show that about 33%
and 38%, respectively, of deliveries were facility-based, that is, the delivery was in a
private or government hospital or clinic, and about 61% and 55%, respectively, were home
deliveries. In the same period, nationwide, about 3% of deliveries were attended by
untrained traditional birth attendants (TBAs) or hilots. Notably, provinces with higher
proportion of home deliveries and TBA-attended deliveries registered higher maternal
death rates ranging from 1 to 1.9 per 1,000 live births in comparison to the national average
of 0.6/1,000 live births. For instance, in Palawan where 89% of deliveries were home
deliveries and 20% of the deliveries were TBA-attended, the maternal mortality rate was
1.3 and 1.4 in 2007 and 2008, respectively. Studies conducted by Lavado(2010), Montagu
et al. (2011), and Tiataley et al. (2010) lokk on the reasons for preference for home
deliveries and TBA attendance. Reasons cited include cost, inaccessibility of skilled birth
attendance especially in rural areas, convenience, and sociocultural issues, such as trust in
TBAs who are usually looked upon as respected elders in the community. The perception
that childbirth is a natural process that does not require the services of a health professional
and health facilities also leads to the decision of having a home delivery attendant by an
untrained hilot.
Community Diagnosis
Risk for maternal complications leading to
maternal mortality among pregnant women in
(community) related to cost and
inaccessibility of skilled birth attendance and
the community members’ perception that
skilled birth attendance and facility–based
delivery are not necessary during childbirth.
The Omaha system

The Omaha System is used as a

framework for the care of individuals,
families, and communities by nurses,
nursing educators, physicians, and other
health care providers.
The classification system has three
components that are to be used
together:
1 . A problem classification scheme
2. An intervention scheme
3. A problem rating scale for outcomes (Omaha
System, 2011a)
A. A problem classification scheme
(client assessment)
is the first component of the Omaha
classification system, which serves as a guide
in collecting, classifying, analyzing,
documenting, and communicating health
and health-related needs and strengths. The
scheme provides a model for practice,
education, and research.
The identified problems or areas of
concern are classified into four levels:
The first and most general level of classification
is composed of four domains:
- Environmental
- Psychosocial
- Physiological
- Health-related behaviors
2. The second level consists of
problems or areas of concern under
the four domains.
3. The third level, the problem or area
of concern is classified according to
two sets of qualifiers.

-The area of concern is categorized into
health promotion, potential problem, or
actual problem.
- The level of clientele (individual, family, or
community) involved is identified.
4. The fourth and most specific level is
made up clusters of signs and
symptoms that describe actual
problems (Omaha System, 2011b).
Environmental domain: Materials resources
and physical surroundings both inside and
outside the living area, neighborhood, and
broader community.
Psychosocial domain: Patterns of
behavior, emotion, communication,
relationships, and development:
Psychological domain: Functions
and processes that maintain life.
Health-related behaviors domain:
Patterns of activity that maintain or
promote wellness, promote recovery,
and decrease the risk of disease.
Planning Community Health
Interventions
The planning phase involves priority
setting, formulating goals and
objectives, and deciding on
community interventions.
Priority setting:
Criteria
Significance of the problem

 Community Awareness

 Ability to reduce risk

 Cost of reducing risk

 Ability to identify the target population

 Availability of resources
Significance of the Problem

- Is based on the number of people in the community
affected by the problem or condition. If the concern is a
disease condition, this may be estimated in terms of its
prevalence rate. If the concern is a potential problem, its
significance is determined by estimating the number of
people at risk of developing the condition.
Community Awareness


- The level of community awareness
and the priority its members give to the
health concerns is a major consideration.
Ability to reduce risk

- Is related to the availability of expertise

(Shuster and Goeppinger, 2004) among
the health team and the community
itself.
Cost of reducing risk

- The nurse has to consider economic,

social, and ethical requisites and
consequences of planned action.
Ability to identify the target population

- The availability of data sources, such

as FHSIS, census, survey reports,
and /or case-finding or screening
tools.
Availability of resources

- To intervene in the reduction of risk entails

technological, financial, and other material
resources of the community, the nurse, and
the health agency.
Steps:
1. From a scale of 1 to 10, being the lowest, the members
give each criterion a weight based on their perception of its
degree of importance in solving the problem.

2. From a scale to 1 to 10, 1 being the lowest, each

members rates the criteria in terms of likelihood of the
group being able to influence or change the situation.
3. Collate the weights (from step 1) and ratings (from step 2)
made by the members of the group.

4. Compute the total priority score of the problem by

multiplying collated weight and rating of each criterion.

5. Priority score of the problem is calculated by adding the

products obtained in step 4.
Problem: Risk to maternal complications leading
to maternal mortality in (community)

Criterion Nurse 1 Midwife BHW Average weight

Significance of the problem 8 10 6

Community Awareness 8 8 5
Ability to reduce risk 10 10 10
Cost of reducing risk 8 8 8
Ability to identify target population 5 6 6
Availability of resources 8 8 7
Criterion Nurse Midwife BHW Average weight

Significance of the problem 6 8 6

Community Awareness 10 10 10

Ability to reduce risk 6 6 6

Cost of reducing risk 6 6 6

Ability to identify target population 10 10 10

Availability of resources 5 5 4
Computation of problem priority score

Criterion Criterion Criterion Problem score

Weight (1-10) rating (1-10) (Weight x rating)
Significance of the problem
Community Awareness
Ability to reduce risk
Cost of reducing risk
Ability to identify target
population
Availability of resources
Total priority score of problem
Formulating goals and objectives
 Goals – are the desired outcomes at the end of
interventions.
 Objectives- are the short-term changes in the community
that are observed as the health team and the community
work towards the attainment of goals.
 SMART- Specific, Measurable, Attainable, Relevant, and
Time-bound
Sample Goal and Objectives of a
Community Health Plan
Problem: Risk of maternal complications
leading to maternal mortality in Barangay
Bagong Silang
Goal: To reduce maternal mortality rate from
132/100,000 live births to 80/100,000 live
births by the year 2015.
 Objectives: At the end of the year, the community of Barangay Bagong
Silang will:
1. Demonstrate the ability to organize groups to participate in the
community health process from assessment to evaluation.
2. Increase the proportion of facility-based births from 10% to 15%.
3. Lower the proportion of untrained hilot-attended births from 20% to
10%.
4. Reduce the prevalence of nutritionally at-risk pregnant women by 20%
5. Reduce the prevalence of anemia among pregnant women by 20%.
Deciding on community interventions

 The group analyzes the reasons for people’s health

behavior and direct strategies to respond to the
underlying causes.
Implementing the community health
interventions
 Action phase
 Able to deal with the recognized priority health concerns,
the entire process is intended to enhance the community’s
capability in dealing with common health
conditions/problems.
 The role of the nurse is to facilitate the process rather than
directly implement the planned interventions.
 Implementation
entails coordination of the plan with the
community and other members of the health team.
 Requiresa common understanding of the goals,
objectives, and planned intervention among the members
of the implementing groups.
 Collaboration
with other sectors such as the local
government and other agencies may also be necessary.
Evaluation of community health
interventions
 Evaluation approaches may be directed towards structure, process and/or
outcome.
Structure evaluation- involves looking into the manpower and physical
resources of the agency responsible for community health interventions.
Process evaluation- is examining the manner by which assessment, diagnosis,
planning, implementation, and evaluation were undertaken.
Outcome evaluation- is determining the degree of attainment of goals and
objectives.
Community Organizing
Community Organizing

is a process that consists of steps or activities

that instill and reinforce the people’s self-
confidence on their own collective strengths and
capabilities (Manatili, 1990).
The basic values in community
organizing:

Human rights

Social justice

Social responsibility
Core Principles in Community
Organizing
1.Community organizing is people-centered

2. Community Organizing is participative

3. Community organizing is democratic

4. Community organizing is developmental

5. Community Organizing is process oriented

Goals of Community Organizing


1. People’s empowerment
2. Building relatively permanent
structures and people’s organizations
3. Improve quality of life