LEARNING GUIDE

SUBJECT Primary Health Care 2

COURSE/YEAR LEVEL Midwifery/ Second Year

TOPIC 1 : COMMUNITY HEALTH CARE DEVELOPMENT PROCESS

Introduction
Health can be defined in many ways by different people. In its simplest form, health has been
defined as merely the absence of disease and disability. Although this definition of health has been used
historically, the World Health Organization has established a more useful and broader definition of health
that highlights the connection of health and community. 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 or economic and social condition. A person’s health and that of the community is said to be the
product of the social environment and the choices that the individual makes as members of the community.
The health of a community is dependent not only upon the characteristics of its residents, but also upon the
environment within which those individuals live. It is very important for people to know that the health of our
communities is critical to the growth and development of our country. Many factors influence health and
well-being in a community, and many entities and individuals in the community have a role to play in
responding to community health needs. Unhealthy communities lead to chronic disease, such as cancers,
diabetes, and heart disease.

Hence, to achieve healthy and progressive communities, people need to come together to take
collective action and generate solutions to common problems. This process is called community
development. Community development seeks to improve quality of life. Effective community development
results in mutual benefit and shared responsibility among community members. It ranges from small
initiatives within a small group to large initiatives that involve the broader community. Community
development is a grassroots process by which communities become more responsible, organize and plan
together, develop healthy lifestyle options, empower themselves, reduce poverty and suffering, create
employment and economic opportunities, achieve social, economic, cultural and environmental goals.

OBJEECTIVE: At the end of the semester, the learner should be able to synthesize the different phases
and activities of COPAR and its influence/role in health development.t

Community
- a social group determined by geographical boundaries and/ or common values and interests
(WHO).
Health
- complete state of physical, mental, and social well-being and not merely the absence of disease
or infirmity (WHO).

Development
- a change, a process of unfolding from an un- manifested condition to more advanced or effective
condition. In these process the qualities reveals possibilities, capabilities emerge, and potentials
are realized.
- multi-dimensional process involving major changes in social structures, population, attitudes
and national institutions, as well as the acceleration of economic growth, reduction of inequality
and eradication of absolute poverty. ▪The goal of development is to have a better life. (Teodoro,
1978)
- development includes consumption of basic goods and services such as health and education
and the generation of more productive employment and reduction of inequalities in income and
access (NEDA).

COMMUNITY DEVELOPMENT
- is a process designed to create a condition of economic and social progress for the whole
community with its active participation and fullest possible reliance on the community initiatives
This is achieved through:
▪Democratic procedures
▪Voluntary cooperation
▪Self-help
▪Development of indigenous leadership
▪Education

How can we say that the community is developed?

◦ the people are working together
◦ have the vision
◦ know how
◦ capabilities and experience to confront and solve problems of under development
Community development principle is committed to the services of the people to become self-reliant.
- therefore, the health of the community depends on its ability to work toward common health goals
and upon adequate distribution of health resources to all members. Furthermore, organized
community effort to prevent disease and promote health is valuable and effective.
- group of people in a community reaching a decision to initiate a social action process (planned
intervention) to change their economic, social, cultural, or environmental situation.
- advocates “self-help”, voluntary participation and cooperation of the people.

Approaches to Community Development

1. Welfare Approach - this is an immediate and/ or spontaneous response to ameliorate the manifestation
of poverty, especially on the personal level.
- assumes that poverty is caused by bad luck, natural disasters and certain circumstances,
which are beyond the control of the people.
2. Modernization Approach - this is also referred to as the project development approach.
- introduces whatever resources are lacking in a given community.
- also considered a national strategy, which adopts the western mode of technological
development.
- assumes that development consists of abandoning the traditional methods of doing things and
must adopt the technology of industrial countries.
- believes that poverty is due to lack of education, lack of resources such as capital and
technology.
3. Transformatory/ Participatory Approach - this is the process of empowering/ transforming the poor and
the oppressed sectors of society so that they can pursue a more just and humane society.
- believes that poverty is caused by prevalence of exploitation, oppression, domination and
other unjust structure.

Health Resource Development Program (HRDP) Community Health Organizing Utilizing COPAR
Model (Inspire, Innovate, Impact)

Health Resource Development Program (HRDP) was developed and sponsored by the Philippine Center
for Population and Development (PCPD). Philippine Center for Population and Development
(PCPD) is a non-stock, non-profit institution, which serves as a resource center assisting
institutions and agencies through programs and projects geared toward the social human
development of rural and urban communities
- formerly known as The Population Center Foundation
- to make health services available and accessible to depressed and underserved communities
in the Philippines

History of HRDP:
- community organizing as the main strategy to be employed in preparing the communities to develop
their community health care systems and the establishment of community health organization to
manage the community health programs.
- organizing work in the communities were done in 3 phases.
- PAR as fascinating strategy for maximum community involvement through collective identification and
analysis of community health problems and collective health action.
- available funds to finance community initiated projects.
HRDP I
- trained the faculty, medical/ nursing students to provide health care services to the far flung
barrios because of lack of manpower for health services at the same time that similar activities
fulfilled the curricular requirements of the students for public health.
- the PCPD provides seed money for the income generating projects.
- short-term service.

HRDP II
- the 2nd cycle uses the same strategy but the program could not be sustained by the schools or
hospitals and the income- generating projects eventually become the hindrance to the goal of
 achieving the health program because the people tend to be more interested in the income
generated by the projects.
- both HRDP I and HRDP II have brought about some changes in the community life of the people
- established basic health infrastructure; basic health services were increased; there were trained
workers and organized health groups to take care of the needs of the community.

HRDP III
- PCPD refined the program and resulted to what is now called HRDP III, which has these unique
features:
- comprehensive training of the staff and faculty of the participating agency in which the community
work was initiated
- periodic training program and regular assistance to the participating agency were provided to
strengthen the health outreach program to become community oriented
- PHC as the approach with which all nursing/ medical students, their CI’s and indigenous health
workers are trained for community health work and around which all other project inputs will
revolve.

Community Organizing Participatory Action Research (COPAR)

- a social development approach that aims to transform the apathetic, individualistic, and voiceless
poor into a dynamic, participatory and politically responsive community.
- a collective, participatory, transformative, liberated, sustained and systematic process of building
people organizations by mobilizing and enhancing the capabilities and resources of the people for
the resolution of their issues and concerns towards affecting change in their existing oppressive and
exploitative conditions.
- a process by which community identifies its need and objective. Develops confidence to take action
in respect to them and in doing so extends and develops cooperative attitudes and practices in the
community (Rose, 1967).
- a continuous and sustained process of educating the people to understand and develop their critical
awareness of their existing condition, working with the people, collectively and efficiently on their
immediate and long term problems, and mobilizing to pursue to develop their capability and
readiness to respond and take action on their immediate needs toward solving their long term
problems.
- a collective, participatory, transformative, liberative, sustained, and systematic process of building
people’s organizations by mobilizing and enhancing the capabilities and resources of the people for
the resolution of their exploitative conditions (National Rural CO Conference, 1994)
Community Organizing - a continuous process of awareness building, organizing and mobilizing community
members towards community development
Importance of COPAR:
1. COPAR – is an important tool for community development and people empowerment, as this helps
the community workers to generate community participation and development activities.
 2. COPAR – prepares people/clients to eventually take over the management of development
programs in the future.
3. COPAR – maximizes community participation and involvement; community resources are
mobilized for health development services.
Principles of COPAR:
1. People especially the most oppressed, exploited and deprived sectors are open to change, have
the capacity to change, and able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of the society.
3. COPAR should lead to self-reliant community and society.
Process and Methods used in COPAR:
1. Action-Reflection- Action - which begins with small, local, and concrete issues identified by the
people and the evaluation and reflection of actions taken by them.
2. Consciousness Raising - through experiential learning
- is central to the COPAR process because it places emphasis on learning that emerges from
concrete action and which enriches succeeding action.
3. Participatory & Mass- based - it is primarily DIRECTED TOWARDS AND BASED IN FAVOR OF
THE POOR, the powerless and the oppressed
4. Group centered & not leader oriented - leaders are identified, emerge and are tested through
action rather than appointed or selected by some external force or entity
Phases of COPAR:
1. PRE-ENTRY PHASE - called the Social Preparation Phase
- the initial phase of the organizing process where the community organizer looks for
communities to serve or help.
- it is considered the simplest phase in terms of actual outputs, activities and strategies and
time spent for it.
2. ENTRY PHASE - the IMMERSION Phase
- this includes the synthesis of the people on the critical events in their life, motivating them to
share their dreams and ideas on how to manage their concerns and eventually mobilizing
them to make collective action on these.
- this phase signals the actual entry of the community worker/ organizer into the community.
- he/she must be guided by the following:
▪ Integration with the community
▪ Conduct of courtesy calls
▪ Conduct of information campaigns about the community health development programs
▪ Conduct of the community study and social investigation
▪ Provision of health and health related services
▪ Identification of potential leaders

Entry in the Community and Integration with the People:

- before actual entry into the community, basic information about the area in relation to the
cultural practices and lifestyles of the people must be known
 - establishing rapport and integrating with them will be much easier if one is able to understand,
accept or imbibe their community life
- living with the people, undergoing their hardships and problems and sharing their hopes and
aspirations help build mutual trust and cooperation
- recognize the role of local authorities by paying them visits to inform them of their presence
and activities.
- health worker appearance, speech, behavior and lifestyle should be kept in low profile and
health workers should always serve as a role model.
- avoid raising the consciousness of the community residents
- work always with community member to identify potential leaders

Guidelines in Conducting Integration Work:

a. recognize the role and position of local authorities
b. adapt a lifestyle in keeping with that of the community
c. choose a modest dwelling which the people , especially the economically disadvantaged will not
hesitate to enter
d. avoid raising expectations of the people; be clear with your objectives and limitations
e. participate directly in production process
f. make house calls and seek out people where they usually gather
g. participate in some social activities

3. CORE GROUP FORMATION PHASE - once the community health nurse identifies the potential
leaders, they are formed into a core group.
- the core group will be given the role of community organizer.
- integration with the core group members
- deepening social investigation
- training and education
- mobilizing the core group

4. ORGANIZATION- BUILDING PHASE- entails the formation of more formal structures and the inclusion
of more formal procedures of planning, implementing, and evaluating community- wide activities.
- it is at this phase where the organized leaders or groups are being given trainings to develop
their KSA (knowledge, skills and attitude,) in managing their own concerns/ programs.
- other community members are encourage to join and form a community organization
 Pre-organization building activities
 Organizing the barrio health committee
 Setting up community organization
- training and education for the organization

5. SUSTENANCE and STRENGTHENING PHASE – occur when the community organization has already
been established and the community-wide undertakings.
 - at this point, the different committees set-up in the organization-building phase are already
expected to be functioning by way of planning, implementing and evaluating their own
programs, with the overall guidance from the community-wide- organization.
Strategies used:
▪ Education and training
▪ Networking and linking
▪ Conduct of mobilization on health and development concerns
▪ Implementation of livelihood projects
▪ Developing secondary leaders.

6. PHASE-OUT - the phase when the health care workers leave the community to stand alone
- this phase should be stated during the entry phase so that the people will be ready for this
phase
- the organizations built should be ready to sustain the test of the community itself because the
real evaluation will be done by the residents of the community itself
Activities of the COPAR Process:
1. PRE-ENTRY PHASE
Preparation of the staff:
a. Statement of objectives and realization of COPAR guidelines
b. Development of criteria for site selection
c. Site selection
d. Setting of issues/ considerations related to site selection
e. Preliminary Social Investigation (PSI)
f. Community consultations/ dialogues
g. Networking with LGU’s, NGO’s and other departments

Criteria for Site Selection:

a. Is the community in need of assistance?
b. Do the community members feel need to work together to overcome a specific health problem?
c. Are there concerned groups and organizations that the nurse can possibly work with?
d. What will be the counterpart of the community in terms of community support, commitment and
human resources?

2. ENTRY PHASE
a. Courtesy call to mayor, or the local government leader of the selected site.
b. Courtesy call to the barangay level.
c. Meeting with the “will be” foster parents of health care students.
d. Appreciating the environment.
e. Coordination/ dialogue/ consultation with other community organizations
f. Self-awareness and Leadership training (SALT), action, planning
g. General assembly.
h. Preparation of survey forms.
 i. Actual survey.
j. Analysis of the data gathered.

3. ORGANIZATION -BUILDING PHASE

a. Identifying problems.
b. Spreading awareness and soliciting solution or suggestion
c. Analysis of the presented solution
d. Planning of the activities
e. Organizing the people to build their own organization
f. Registration of the organization
g. Implementing of the said activities
h. Evaluation

4. SUSTENANCE & STRENGTHENING PHASE

a. Meeting with the organizational leaders.
b. Evaluation of the programs.
c. Re-implementing of the programs. (For unmet goals)
d. Education and training.
e. Networking and linking.
f. Implementation of livelihood projects.
g. Developing secondary leaders

5. PHASE-OUT
a. Leaving the immersion site
b. Documentation

Critical Steps/Activities in Building People’s Organization

1. INTEGRATION - a community organizer becoming one with the people in order to:
• immerse himself in the poor community
• understand deeply the culture, economy, leaders, history, rhythms and lifestyle of the
community.
Methods of Integration includes:
a. Participation in direct production activities of the people
b. Conduct of house visits
c. Participation in activities like birthdays, fiestas, wakes, etc
d. Conversing with people where they usually gather such as stores, water, walls, washing
streams, or churchyards
e. Helping out in the household chores like cooking, washing the dishes, etc

2. SOCIAL INVESTIGATION – a systematic process of collecting, collating, analyzing data to draw a

clear picture of the community.
 - also known as community study.
Pointers for the conduct of Social Investigation:
a. Use of survey or questionnaires is discouraged
b. Community leaders can be trained to initially assist the community worker/organizer in SI
c. Data can be more effectively and efficiently collected through informal methods-house visits,
participating in conversations in jeepneys and others
d. Secondary data should be thoroughly examined because much of the information might already
be available
e. SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of
the people
f. Confirmation and validation of community data should be done regularly
g. SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of
the people
h. Confirmation and validation of community data should be done regularly
i. A systematic process of collecting, collating, analyzing data to draw a clear picture of the
community
j. Also known as the COMMUNITY STUDY

3. TENTATIVE PROGRAM PLANNING - community organizer to choose one issue to work on in order to
begin organizing the people.

4. GROUNDWORK - going around and motivating the people on something or an issues.

- time to spot and develop potential leader.
- the entry phase or sometimes called the social preparation phase.

5. MEETING - core group formation.

- people collectively ratifying what they have already decided individually.
- the meeting gives the people the collective power and confidence.
- problems and issues are discussed.

6. ROLE PLAYING - to act out the meeting that will take place between the leaders of the people and the
government representatives.
- It is a way of training the people to participate what will happen and prepare themselves for
such eventually

7. MOBILIZATION OF ACTIONS - actual experience of the people in confronting the powerful and the
actual exercise power.

8. EVALUATION - determines whether the goal is met or not

- the people reviews steps 1-7 to determine whether they were successful or not in their
objectives.
9. REFLECTION - dealing with deeper, on-going concerns to look at the positive values CO is trying to
build in the organization
- it gives the people time to reflect on the stark reality of life compared to the ideal.

10. ORGANIZATION - the result of many successive and similar actions of the people.
- occurs when the community organization has already been established and the community
members are already participating in a community wide undertaking.

TEACHER INTERVENTION
If you have any questions or clarifications about the topics/concepts presented earlier, you can call or text
09651747812 or email at [email protected]

ASSESSMENT ACTIVITY 1 (ESSAY)

Situational Analysis: Think of the community that you are presently living as an example. Identify 2
needs/problems that may affect the health of your community. Using the COPAR
process discussed earlier as a guide, discuss how you can improve the health of
your community based on the assessed needs and problems.

NAME:

ANSWER:

NOTE: IF THIS GUIDE IS MAILED TO YOU, WRITE YOUR ANSWER ON A SEPARATE SHEET OF
PAPER AND LABEL AS PRACTICE ACTIVITY 1 THEN SEND BACK THE WHOLE DOCUMENT.
BUT IF YOU RECEIVED THIS GUIDE THROUGH EMAIL, ANSWER DIRECTLY ON THE SPACE
PROVIDED (IN BLACK COLORED TEXT) AND EMAIL BACK THE WHOLE DOCUMENT TO THE
EMAIL ADDRESS GIVEN ABOVE).
TOPIC 2 : CARE ENHANCEMENT QUALITIES OF HEALTH WORKERS IN THE COMMUNITY SETTING

OBJECTIVES: At the end of the semester, the learners shall be able to:
1. Internalize the care enhancement qualities and functions of health workers in the community
setting
2. Analyze the importance of conflict management in community development

Community Health Worker - is one who provides basic community health care services for the promotion of
health, prevention of illness, simple treatment and rehabilitation. The service utilizes the philosophy,
content, method and skills of a public health care.
Qualities of Health Worker:
1. Open –accept need for joint planning and decision relative to health care in a particular situation; not
resistant to change
2. Tactful - one who presides over an assembly, meeting or discussion in a subtle manner, does not
embarrass but gives constructive criticisms.
3. Coordinator – brings into consonance or harmony the community’s health care activity.
4. Objective – unbiased and fair in decision-making
5. Good listener – always attentive and available for the participant to voice out their sentiments and needs.
6. Efficient – knowledgeable about everything relevant to his practice; has the necessary skills
expected of him; produces the expected output with consideration to cost and time
7. Flexible – able to cope with different situations; adapts easily and makes necessary adjustment
appropriately
8. Critical thinker – decides on what has been analyzed.

Functions of a Health Worker:

1. Community health service provider- carries out health services contributing to the promotion of health,
prevention of illness, early treatment of illness and rehabilitation.
- appraises health needs and hazards ( existing or potential).
2. Facilitator - helps plan a comprehensive health program with the people
- continuing guidance and supervisory assistance
3. Health counselor- giving appropriate advice and broadening the client’s insight about a problem so that
appropriate decisions are made which can lead to positive resolution of the problem.
- provides health counseling including emotional support to individuals, family, group and
community.
4. Co-Researcher - provides the community with stimulation necessary for a wider or more complex study
of problems.
- enforce community to do prompt and intelligent reporting of epidemiologic investigation of
diseases.
- suggest areas that need research ( by creating dissatisfaction)
 - participate in planning for the study and in formulating procedures
- assist in the collection of data.
- help interpret findings collectively.
- acts on the result of the research
- plan and conduct of nursing and related studies that contribute to the improvement of
nursing and health services, either alone or independently, or in collaboration of other
members of the health and intersect oral teams.
5. Member of a team - in operating within the team, one must be willing to listen as well as to contribute, to
teach as well as to learn, to lead as well as to follow, to share authority as well as to
work under it.
- helps make multiple services which the family receives in the course of health care,
coordinated and comprehensive as possible.
- consults with and refers to appropriate personnel for any other community services.
6. Health Educator - health education is an accepted activity at all levels of public work. A health educator
is the one who improves the health of the people by employing various methods or
scientific procedures to stimulate, arouse and guide people to healthful ways of living.
She takes into consideration these aspects of health education.
a. Information - provision of knowledge
b. Education- change in knowledge, attitude and skills
c. Communication - exchange of information
7. Change Agent

Traits and Qualities of Health Educator:

1. Efficient - plans with the people, organizes, conducts, directs health education activities according to the
needs of the community.
2. Good communicator - provides participants with clear and relevant information
3. Good listener - hears what’s being said and what’s behind the words
4. Keen observer - keeps eye on the proceedings, processes and participants’ behavior.
5. Systematic - knows how to put in sequence or logical order the parts of the session
6. Creative/Resourceful - uses available resources, involves participants
7. Analytical - critical thinker
8. Tactful - brings about issues in smooth, subtle manner
9. Knowledgeable - able to impart relevant, updated and sufficient input
10. Open - invites ideas, suggestions, criticisms; involves people in decision making
11. With sense of humor - knows how to place a touch of humor to keep audience alive
12. Change agent - involves participants actively in assuming the responsibility for his own learning

The Community Health Worker as a Documenter/Reporter:

▪ the community health worker keeps a written account of services rendered, observations, condition,
needs, problems and attitude of the client in community activities, accomplishments made etc.
▪ community workers takes responsibility to disseminate pertinent information to appropriate authorities,
agencies, and most especially to the client
▪ at the same time, the community worker develops the people’s capabilities to keep/ maintain their
recording and reporting system

Guidelines on How to Become an Effective Health Educator in terms of:

A) Teaching methodologies/strategies ( selection and use) - in making decisions about methodologies, the
health educator has to choose specific methods that will bring about the desired output. The
methods should also correspond to the objectives. A technique/ method should:
1. Generate active participation of the learner
2. Provide quick feedback
3. Facilitate transfer of learning to on the job situation
4. Develop desirable behavior pattern
5. Motivate participants to improve their level of performance in class and on the job
6. Allow opportunity to learn at individual and group leaders.
B. Preparations of Materials - are the training aids available?( black board, chalk, pad papers, pentel pens,
kraft paper, masking tape)
- are the hand - outs well package?

C. Uses of a Teaching Plan - a teaching plan is a list of steps and activities and equipment needed in
health education sessions. A lesson should be planned by having an outline of what is to be
taught and the methods to be used. Time allocation for the various activities should also be
included.

Conflict Management
Conflict – a state of disharmony between incompatible or antithetical persons, ideas, or interests; a clash. -
opposition between characters or forces in a work of drama or fiction, especially opposition that
motivates or shapes the action of the plot.
- a psychic struggle between opposing or incompatible impulses, desires, or tendencies.

Causes of Conflict:
1. Security
2. Inability to control self and others
3. Respect between parties
4. Limited Resources
5. Frustrations

Types of Conflict:
1. Intra-sender - conflict originates in the sender who gives conflicting instructions
2. Inter-sender - arises when a person receives conflicting messages from one or more sources
3. Inter-role - occurs when a person belongs to more than one group
4. Person-role - result of a discrepancies between internal and external role
5. Inter-person - between people whose positions require interaction with other persons who fill various
roles in the same organization or other organizations
6. Intragroup - occurs when a group faces new problem, when new values are imposed on the group from
outside, or when one’s extra group role conflicts with one’s intragroup role
7. Intergroup - common when two groups have different goals and can only achieve their goals at the
other’s expense
8. Role-ambiguity - condition where an individual do not know what is expected of them
9. Role-oriented - individuals cannot meet the expectations placed on them
Stages of Conflict:
1. Latent Conflict - phase of anticipation
- it exists whenever individual, groups, organization or nations have differences that bother one
or the other but those differences are not great enough to cause one side to act to alter the
situation.
- there is not yet an outright conflict present but a number of factors exist that create the
conditions that could result in a conflict.
2. Perceived Conflict - indicates cognitive awareness of stressful situation
- it exists when there is a cognitive awareness on the part of at least one party that events have
occurred or that conditions exist favorable to creating overt conflict.
- groups recognizes that a conflict is emerging and starts to look for possible explanation.
3. Felt Conflict - presence of affective states such as stress, tensions, anxiety, anger, hostility
- organization, groups or individual become more internally cohesive.
- other group in the organization are viewed with suspicion as outsider.
- us versus them mentality begins to really take hold.
4. Manifest Conflict - overt behavior resulting from the above three stages
- at this stage the conflicting parties are actively engaging in conflict behavior which is usually
very apparent to non-involved parties.
- feelings of conflict are now translated into actions and words which could either be
constructive obstructive to problem solving process.

Approaches to Conflict Resolution:

1. Accommodating - the person neglects personal concerns to satisfy the concerns of others
- It is cooperative but unassertive.
2. Compromising - the individual attempts to find mutually acceptable solutions that partially satisfy both
parties in reflects assertiveness and cooperation
3. Collaborating - the individual attempts to work with others toward solutions that satisfy the work of both
parties it is both assertive and cooperative
4. Competing - the person pursues personal concerns at another’s expense
- it is a power oriented mode that is assertive but uncooperative.
- the competition is aggressive and pursues one’s own goals at another’s expense.

Conflict Management:
1. Negotiation - is a strategic process used to move conflicting parties toward an outcome.

2. Collaboration - is achieved through a developmental process. It is sequential yet reciprocal and

characterized by seven strategies and activities:

TEACHER INTERVENTION
If you have any questions or clarifications about the topics/concepts presented earlier, you can call or text
09651747812 or email at [email protected]

ASSESSMENT ACTIVITY 2
Question: Considering the functions and traits of a midwife as a community health worker, how will you
pacify or manage conflicts in the community?

NAME:

ANSWER:

NOTE: IF THIS GUIDE IS MAILED TO YOU, WRITE YOUR ANSWER ON A SEPARATE SHEET OF
PAPER AND LABEL AS PRACTICE ACTIVITY 2 THEN SEND BACK THE WHOLE DOCUMENT.
BUT IF YOU RECEIVED THIS GUIDE THROUGH EMAIL, ANSWER DIRECTLY ON THE SPACE
PROVIDED (IN BLACK COLORED TEXT) AND EMAIL BACK THE WHOLE DOCUMENT TO THE
EMAIL ADDRESS GIVEN ABOVE).

TOPIC 3 : NURSING PROCESS IN THE COMMUNITY

OBJECTIVES: at the end of the semester, the learners shall be able to:
1. Internalize the steps in the community health care process
2. Utilize appropriate tools for community health assessment
3. Articulate appropriate community diagnosis, plans and interventions and evaluation parameters
based on identified community health problems
 The nursing process is a systematic way of determining a client health status, isolating health
concern and problems, developing the plans to remediate them, initiating actions to implement the plan,
and finally evaluating the adequacy of the plan in promoting wellness and problem resolution.
The nursing process commonly consists of five phases:
1. Community assessment;
2. Community diagnosis;
3. Planning;
4. Implementation and;
5. Evaluation.
For community health nurses, working with communities has two important missions:
a. The community directly influences the health of the individuals; families, groups, and
populations who may be a part of it,
b. Provision of the most important health services at the community level.
A community has three features:
1. Location - Every physical community carries out daily existence in a specific geographic location.
The health of a community is affected by this location including the placement of health services,
the geographic features, plants, animals and animals and the human made environment
Six Location Variables:
1. Community boundaries - to talk about community in any sense, one must first describe
its boundaries. It serves as basis for measuring incidence of wellness and illness and
for determining spread of a disease
2. Location of health services - when assessing a community, the community health
nurse will want to identify the major health centers and know they are located. Use of
health services depends on availability and accessibility
3. Geographic features - communities have been constructed in every suitable physical
environment and that environment certainly can affect the health of a community.
Injury, death, and destruction may be caused by floods, cyclones, earthquakes
volcanoes…etc. recreational activities at lakes, seashores, mountains promote health
and wellness
4. Climate - this has a direct effect on health of a community e.g., extreme heat and cold
5. Flora and Fauna - poisonous plants and disease carrying animals can affect
community health
6. Human made environment - all human influences on environment (housing, dams,
farming, types of industry, chemical wastes, air pollution…etc.) can influence levels of
community wellness
2. A population - consists not only of a specialized aggregate, but also of all the diverse people, who
live within the boundaries of the community. The health of any community is greatly influenced by
the population that lives in it. Different features of the population suggest the health needs and
provide bases for health planning
 Population variables
1. Size: the size of a population influences the number and size of health care institutions.
Knowing community size provides important information for planning.
2. Density: increased population density may increase stress. Similarly when people are spread
out health care provision may become difficult.
3. Composition: composition of the population often determines types of health needs. A health
community is one that takes full account of and provides for differences in age, sex,
educational level, and occupation of its members, all of which may affect health concerns.
Determining a community composition is an important early step in determining its level of
health.
4. Rate of growth or decline: rapidly growing communities may place extensive demands on
health services. Marked decline in population may signal of poorly functioning community.
5. Cultural difference: health needs may vary among sub-cultural and ethnic populations. Cultural
difference can create conflicting or competing demands for resources and services or create
inter-group hostility.
6. Social class and educational levels: social class refers to the ranking of groups within society
by income, education, occupation, prestige or a combination of these factors. Educational level
is a powerful determinant of health related behavior. Health promotion and preventive health
services are most needed for people with low income and educational levels.
7. Mobility: mobility of the population affects continuity of care and availability of services. Mobility
has a direct effect on the health of a community.

3. A social system - the various parts of community social system that interact and influence the system
are called social system variables. These variables include the health, family, economic,
educational, religious, welfare, legal, communication, recreational, and the political systems.
Although community health nurses must examine all the systems in the community and how
they interact, the health system is of particular importance to promote the health of the
community.
- It is useful to think of these dimensions of every community as a rough map to follow for assessing needs
or planning for service provision.

Phases of Nursing Process in the Community

1. COMMUNITY ASSESSMENT – this is the process of searching for and validating relevant community
based data according to a specified method, to learn about the interaction among the people,
resources and environment.
- community assessment includes; Collecting pertinent community data
- analyzing and interpreting the collected data.
Community needs assessment - is the process of determining the real or perceived needs of a
defined community of people.
 Major Aspects of Community Assessment (Eight sub-systems)
a. Physical Environment - just as physical examination is important to individual patients, so is
examination of the community physical environment. Five senses are used in physical
assessment: inspection, auscultation, vital signs, system review, and laboratory studies.
b. Health and social system - differentiate between facilities located within the community and those
located outside. Hospital: number of beds, staffing, budget, health center, clinics, or health
posts, public health services, private clinics, pharmacies, dental and other services. Signs of
drugs or substance abuse, alcoholism. Social services include counseling and support, clothing,
food, shelter and special needs as well as markets and shops.
c. Economics - financial characteristics median household income, percentage of households living
in poverty. Labor force characteristics, employment status of the general population greater
than 18 years of age. Occupational categories and percentage of persons employed by
government, farmers, skilled, unskilled, professional, types of business/industry.
d. Safety and transportation - police, sanitation (water source, solid waste disposal, sewage and air
quality) and fire services. Primary means of transportation; walking, mule, taxi, bus, train,
private car, and air services.
– frequency and affordability of public/private transport, and standard of roads.

e. Politics and government - business alliances, religious groups, youth and women’s associations,
professional associations, ethical associations, political activism…etc. describe the
associations’ objectives and activities.
f. Communication - bulletin boards, posters, oral messages, radio, television, newspapers, postal
services, telephone/ cellular phone.
g. Education - types of schools, colleges and universities. Note languages used, grades, courses
offered, percentage of attendants (male, female), adequacy, accessibility, and acceptability of
education. Average number of years completed by people at school.
h. Recreation - note facilities such as stadium, recreational areas, volley ball's court, playground,
picnic areas, museum, music/dancing, theatre/cinema. Who is going out about during the
evening and in the morning? Teenagers, mothers and children, the homeless?
2. COMMUNITY ANALYSIS AND NURSING DIAGNOSIS - to determine community health needs and
strength as well as to identify patterns of health responses and trends in health care use.
Community analysis, like so many procedures we carry out, may be viewed as a process with
multiple steps. A community diagnosis forms the basis for community based intervention.
3. PLANNING - it is a logical, decision making process of design an orderly, detailed programs of action to
accomplish specific goals and objectives based on assessment of the community and the
nursing diagnosis formulated. This also includes setting priorities.
4. IMPLEMENTATION – this is putting the plan into actions and actually carrying out the activities
delineated in the plan, either by nurse or other professionals. It is the action phase of the nursing
 process. Community interventions are the therapeutic actions designed to promote and protect the
community health, treat and remediate community health problems and support the community as it
changes over time.

5. EVALUATION - it is systematic, continuous process of comparing the community’s response with the
outcome as defined by the plan of care. The ultimate purpose of evaluating interventions in community
health nursing is to determine whether planned actions met client needs, if so how well they were met,
and if not why not.
- evaluation requires a stated purpose, specific standards and criteria by which to judge and
judgment skills.

Community Health Management

Focus: facilitating community empowerment to act on community health problems by using the community
health process and the philosophy of Community Health Nursing

Ultimate goal: to improve the quality of health of the citizenry. It is geared to help communities and families
cope with health problems and have them assent to health services
1.Establishing a good working relationship. Initial attempts to communicate the intention to
help members of the community and inform them of its nature are vital to the success

a. Identifying key community officials Community health manager must possess the ability to
effectively influence and negotiate with people from both ends of the social spectrum
-the most important activities of the community health manager : Directly influencing
executive and legislative officials and governing agencies for health and development
-first step in initiating a smooth relationship: to learn the correct full name and designation
of key community officials
b. Establish a good working relationship with the community. Using COPAR: the client assumes
the role of partner in both health related activities and health development
-frequent consultation with the client is required to arrive at a decision that is desirable to
both and advantageous to working with partners
-initiating contact through home or official visits to the community leaders or attending
official meetings of community leaders could be a way of establishing a working
relationship with them

TEACHER INTERVENTION

If you have any questions or clarifications about the topics/concepts presented earlier, you can call or text
09651747812 or email at [email protected]
ASSESSMENT ACTIVITY 3
Question: Discuss in your own words the steps/phases in the community nursing process and give
examples.

NAME:

ANSWER:

NOTE: IF THIS GUIDE IS MAILED TO YOU, WRITE YOUR ANSWER ON A SEPARATE SHEET OF
PAPER AND LABEL AS PRACTICE ACTIVITY 3 THEN SEND BACK THE WHOLE DOCUMENT.
BUT IF YOU RECEIVED THIS GUIDE THROUGH EMAIL, ANSWER DIRECTLY ON THE SPACE
PROVIDED (IN BLACK COLORED TEXT) AND EMAIL BACK THE WHOLE DOCUMENT TO THE
EMAIL ADDRESS GIVEN ABOVE).

References:
Eric, J. (2017). Care Enhancement Qualities of Health Workers in Community Setting. Retrieved from
http://001122m.com/download/care-enhancement-qualities-of-health-workers-in-community-
setting_pdf

Nagar K. (2018). Nursing Process Community. Retrieved from

https://www.slideshare.net/krishnagar90/nursing-process-community
Rocha, M.A. (2018). Community Health Care Development Process. Retrieved from
https://www.slideshare.net/mamirich12/community-health-care-development-process

Udtujan, J.F.C. (2016). Care Enhancement Qualities of Health Workers in the Community Setting.
Retrieved from https://vdocuments.site/care-enhancement-qualities-of-health-care-workers.html

What is community development (n.d.). Retrieved from http://www.peernetbc.com/what-is-

community-development

UNLV, The Lincy Institute (2012). What is a healthy community. Building healthy communities in
southern Nevada. Retrieved from https://www.unlv.edu/sites/default/files/24/Health-
Community-January2012.pdf

“I know this may look difficult at first but don’t be afraid to try, this is just an exercise. Nobody is perfect so
learn from your mistakes. Believe in yourself, coz I know you can do it.”
GOOD LUCK AND STAY SAFE!