NCM 113 – PREFINALS

Transcribed by: Jannah Isha Z. Jani

BCI – College of Nursing

COMMUNITY ASSESSMENT • Assessment provides an estimate of the

degree to which a family, group, or community
➢ Considered to be the key stone of community
is achieving the health possible for them,
health nursing process (Freeman and Heinrich
identifies specific deficiencies or guidance
1981; Muecke 1989)
needed and estimates the possible effects of
➢ The nurse utilizes this assessment data to the nursing interventions
derived to the community health nursing
Three Important tools in identifying the
diagnoses and become the bases for
community’s health needs:
developing and implementing community
health nursing interventions and strategies ✓ Demography
✓ Vital statistics and
➢ This is the first part of community diagnostic
✓ Epidemiology
process
To recognize the health status of the community
ASSESSMENT OF COMMUNITY HEALTH NEEDS
these elements are to be considered:
➢ A community needs assessment provides
community leaders with a snapshot of local
policy, systems, and environmental change
strategies currently in place and helps to
identify areas for improvement. With this data,
communities can map out a course for health
improvement by creating strategies to make
positive and sustainable changes in their
communities.
PRIMARY DATA
COMPONENTS OF A NEEDS ASSESSMENT
➢ Directly obtained to answer the community
• Health status is an individual's relative level diagnosis objectives
of wellness and illness, taking into account the ➢ Collecting Primary Data - may be obtained
presence of biological or physiological either through observation or through direct
dysfunction, symptoms, and functional communication with respondents in one form
impairment. or another through personal interviews.
• Health resources include financial resources ➢ Primary data can be obtained in several ways.
(health spending) and human resources. However, the most common techniques are
• Health spending measures the consumption observation, survey, and informant interview
of health services and goods, including and community forum. Primary data
outpatient care, hospital care, long-term care, collection is quite expensive and time
pharmaceuticals and other medical goods, consuming compared to secondary data
prevention and public health services, and collection.
administration.
A. Observation
COMMUNITY HEALTH ASSESSMENT TOOLS
➢ This method provides an opportunity to check
• Tools in measuring and analyzing community the validity or truth of many verbal statements.
health problems such as epidemiology and It is an important and useful method of
biostatistics
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NCM 113 – PREFINALS
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

collecting data when informants are unable to important issues affecting them, such as
direct supply information. health problems in their neighborhood.
➢ In observation method, the information is ➢ This community discussion's primary purpose
sought by way of investigator's own direct is to obtain input from a wide range of residents
observation without asking the respondent. and stakeholders concerning their needs and
identifying resources for addressing health
B. Survey
problems.
➢ A survey is defined as the act of examining a ➢ Focus Group Discussion
process or questioning a selected sample of ✓ It is a very popular method appropriate
individuals to obtain data about a service, in the community to elicit and explore
product, or process. Data collection surveys the opinions of people, determine
collect information from a targeted group of their attitudes and practices regarding
people about their opinions, behavior, or a limited set of concepts
knowledge.
SECONDARY DATA SOURCES
➢ Ocular survey or windshield survey walking or
driving through community appreciating what • Data that are obtained by other people which
can be seen and perceived as the people go can be used to answer the community
along with their daily lives. diagnosis objectives.
C. Informant Interview • Data may be obtained by reviewing those that
have been compiled by health or non-health
➢ It involves asking and answering questions
agencies the government or other sources
following a systematic procedure aimed at
yielding first-hand information from the subject • Secondary data means data that are already
of inquiry. available i.e., they refer to the data which have
➢ In the personal interviews, the interviewer asks already been collected and analyzed by
questions generally in a face-to-face contact. someone else.
Through interview method more and reliable
information may be obtained. Personal • Records are written information that are kept
information can be obtained easily under this in folders.
method. However, it is a very expensive and ✓ Registry of Vital Events
time-consuming method, especially when ✓ Health Records and Report
large and widely spread geographical samples ✓ Disease Registries
are taken. ✓ Census Data
➢ Interviews may be conducted through: A. Registry of Vital Events
✓ Face-to-face interview telephone ➢ A well-functioning civil registration and
interview vital statistics (CRVS) system registers all
✓ Individual interview group births and deaths, issues birth and death
✓ Interview Structured certificates, and compiles and
✓ Interview Unstructured interview disseminates vital statistics, including
D. Community Forum cause of death information.
B. Health Records and Report
➢ A community forum is an open discussion ➢ A comprehensive compilation of
where community residents gather to raise information traditionally placed in the
medical record but also covering aspects
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NCM 113 – PREFINALS
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

of the client’s physical, mental, and social • To solicit broader support and participation in
health that do not necessarily relate the community health process
directly to the condition under treatment.
C. Disease Registries • To validate findings.
➢ A disease registry is a special database • To allow a wider perspective in the analysis of
that contains information about people data
diagnosed with a specific type of disease.
➢ Most disease registries are either hospital- • To provide a basis for better decision making
based or population-based. A hospital-
• Data may be presented as text, in tables or in
based registry contains data on all the
pictorial form such as maps and graphs.
patients with a specific type of disease
diagnosed and treated at that hospital. A • Maps - can be used to show differences or
population-based registry contains similarities across geographic areas
records for people diagnosed with a
specific disease type who reside within a • Bar Graph
defined geographic region. For example, a ➢ Bar charts are one of the most commonly
hospital can have a breast cancer registry used types of graph and are used to
with records for all the women in their display and compare the number,
breast cancer treatment program. The frequency or other measure (e.g. mean) for
hospital-based registry would not include different discrete categories or groups.
all the women with breast cancer in the ➢ Constructed such that the heights or
community, since some women may go lengths of the different bars are
elsewhere for treatment. proportional to the size of the category
D. Census Data they represent.
➢ Information about the members of a given ➢ Since the X-axis (the horizontal axis)
population collected from a government represents the different categories, it has
census. no scale. The Y-axis (the vertical axis) does
➢ A census is a regularly occurring and have a scale, and this indicates the units of
official count of a particular population. measurement. The bars can be drawn
Census data provides more than just a either vertically or horizontally depending
population count. Other variables include upon the categories and length or
ethnicity breakdowns, income, and complexity of the category labels.
housing values. ➢ A very flexible chart type
• Histogram
METHODS TO PRESENT COMMUNITY DATA ➢ A special form of bar chart where the data
represent continuous rather than discrete
• To inform the health team and members of the
categories.
community of existing health and health-
➢ For example, a histogram could be used to
related conditions in the community in an
present details of the average number of
easily understandable manner.
hours of exercise carried out by people of
• To make members of the community different ages because age is a continuous
appreciate the significance and relevance of rather than a discrete category. However,
health information to their lives because a continuous category may have
many possible values the data are often

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NCM 113 – PREFINALS
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

grouped to reduce the number of data detail or depth she should go into. A nurse may
points. For example, instead of drawing a decide to assess a specific population group
bar for each individual age between 0 and in a community, in which case, she may not
65, the data could be grouped into a series opt to conduct a comprehensive assessment
of continuous age ranges such as 16-24, of that group and at the same time, focus on
25-34, 35-44, etc. the specific problems of that same group. It is
➢ Unlike a bar chart, in a histogram, both the important therefore, to decide on the
x and y axes have a scale. This means that objectives of the community diagnosis, the
it is the bar area that is proportional to the resources and time available to implement.
size of the category represented and not
TYPES OF COMMUNITY DIAGNOSIS
just its height
• Pie Charts 1. Traditional/ Comprehensive Community
➢ A visual way of displaying how the total Diagnosis
data are distributed between different ➢ A comprehensive community diagnosis
categories. aims to obtain general information about
➢ Pie charts should only be used for the community.
displaying nominal data (i.e. data that are 2. Participatory Action
classed into different categories). They are ➢ Intentionally include the people and
generally best for showing information groups who are most affected by an inquiry
grouped into a small number of categories in the design and execution of the process.
and are a graphical way of displaying data 3. Research (PAR)
that might otherwise be presented as a ➢ Researchers and participants working
simple table. together to understand a problematic
• Line Graph situation and change it for the better.
➢ Are usually used to show time series data, ➢ Participatory Action Research (PAR) is an
that is how one or more variables vary over approach to enquiry which has been used
a continuous period of time. Typical since the 1940s. It involves researchers
examples of the types of data that can be and participants working together to
presented using line graphs are monthly understand a problematic situation and
rainfall and annual unemployment rates. change it for the better. There are many
• Scatter plots definitions of the approach, which share
➢ Are used to show the relationship between some common elements. PAR focuses on
pairs of quantitative measurements made social change that promotes democracy
for the same object or individual and challenges inequality; is context-
➢ For example, a scatter plot could be used specific, often targeted on the needs of a
to present information about the particular group; is an iterative cycle of
examination and coursework marks for research, action and reflection; and often
each of the students in a class. In the seeks to ‘liberate’ participants to have a
example here, the paired measurements greater awareness of their situation in
are the age and height of children order to take action.
➢ PAR uses a range of different methods,
COMMUNITY DIAGNOSIS
both qualitative and quantitative.
➢ In the assessment of the community’s health ➢ Its fundamental principles are that the
status, the nurse considers the degree of research subjects become involved as
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NCM 113 – PREFINALS
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BCI – College of Nursing

partners in the process of the inquiry and ➢ It is also important to know whether there
that their knowledge and capabilities are are population groups that need special
respected and valued. Participatory attention such as indigenous people,
research is ultimately about relationships internal refugees, and other socially
and power. The key contacts are between dislocated groups as a result of disasters,
the researcher and the researched, and calamities, and development programs.
between local people and those actors 2. Socio-Economic and Cultural Variables
they see as powerful and who affect their ➢ There are no limits as to the list of socio-
lives. Participatory researchers act as economic and cultural factors that may
facilitators and work towards attaining directly or indirectly affect the
equality in these two relationships. Local community's health status.
people involved in participatory research ➢ However, the nurse should consider the
processes are often subordinate in their following essential information:
own social context, while outside ✓ Social Indicators
researchers are often perceived as experts ✓ Economic Indicators
who impose their views. Transforming ✓ Environmental Indicators
these dynamics is achieved by enabling ✓ Cultural Factors
local people to articulate their views and 3. Political/ Leadership Patterns
express their knowledge by describing and ➢ The process of community diagnosis consists
analyzing their own situations and of collecting, organizing, synthesizing,
problems. Many participatory research analyzing and interpreting health data.
processes also have an action component ➢ Before the community health nurse collects
that involves the participants in data, the objectives must be determined as
successive cycles of analysis, reflection these will dictate the depth or the scope of the
and action. community diagnosis.
➢ The nurse needs to resolve whether a
comprehensive or a problem-oriented
The following are the elements of a comprehensive
community diagnosis will accomplish their
community diagnosis:
objectives
1. Demographic variables
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
➢ The analysis of the community’s
demographic characteristics should show 1. Determining the Objectives
the size, composition and geographical ➢ In determining the objectives of the
distribution of the population as indicated community diagnosis, the nurse
by the following: decides on the depth and scope of the
(1) Total population and geographical data she needs to gather.
distribution including urban-rural 2. Defining the Study Population
index and population density. ➢ Based on the objectives of the
(2) Age and sex composition community diagnosis, the nurse
(3) Selected vital indicators such as identifies the population group to be
growth rate, crude birth rate, crude included in the study.
death rate and life expectant at birth 3. Determining the Data to be Collected
(4) Patterns of migration ➢ Whether the community diagnosis is
(5) Population projections going to be comprehensive or focused
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NCM 113 – PREFINALS
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

on specific problem, the objectives ➢ Data analysis in community diagnosis

will guide the nurse in identifying the aims to established trends and
specific data she will collect. patterns in terms of health needs and
4. Collecting the Data problems of the community. It also
➢ In conducting community diagnosis, allows for comparison of obtained
different methods may be utilized to data with standard values.
generate health data. In general, we 10. Identifying The Community Health Nursing
use the methods such as records Problems
review, surveys and observations, Community health nursing problems are
interviews, and participant categorized as:
observation. I. Health Status Problems
5. Developing the Instrument ➢ May be described in terms of
➢ Instruments or tools facilitate the increased or decreased morbidity,
nurse’s data gathering activities. The mortality or fertility
most common instruments are survey II. Health Resources Problem
questionnaire, interview guide and ➢ They may be described in terms of lack
observation checklist. of or absence of manpower, money,
6. Actual Data Gathering materials or institutions necessary to
➢ Before the actual data gathering, it is solve health problems
suggested that the nurse meet the III. Health-Related Problems
people who will involve in the data ➢ They may be described in terms of the
collection. The data collectors must existence of social, economic,
be given an orientation and training on environmental and political factors
how they are going to use the that aggravate the illness-inducing
instruments in data gathering. During situations in the community
the actual data gathering, the nurse 11. Priority Setting
supervises the data collectors by ➢ After the problems have been
checking the filled-up instruments in identified, the next task is to prioritize
terms of completeness, accuracy and which health problems can be
reliability of the information collected. attended to considering the resources
7. Data Collation available at the moment.
➢ After data collection, the nurse is now ➢ In priority setting, the following
ready to put together all information. criteria:
There are two types of data that may be a. Nature of the condition/problem
generated. They are either numerical presented
data which can be counted or ✓ Problems are classified by the
descriptive data which can be nurse as health status, health
described. resources or health-related
8. Data Presentation problems.
➢ Data presentation will depend largely b. Magnitude of the problem
on the type of data obtained. ✓ Refers to the severity of the
Descriptive data are presented in problem which can be measured in
narrative reports. terms of the proportion of the
9. Data analysis
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NCM 113 – PREFINALS
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

population affected by the SCHEMES IN STATING COMMUNITY DIAGNOSIS

problem.
• Diagnosis
c. Modifiability of the problem
➢ After analyzing the data, the next step is to
✓ Refers to the probability of
make a definitive statement (diagnosis)
reducing, controlling or eradicating
identifying what the problem is or the
the problem.
needs are. Nursing diagnoses for
d. Preventive potential
communities may be formulated regarding
✓ Refers to the probability of
the following issues:
controlling or reducing the effects
1. Inaccessible and unavailable services
posed by the problem.
2. Mortality and morbidity rates
e. Social concern
3. Communicable disease rates
✓ Refers to the perception of the
4. Specific populations at risk for physical
population or the community as
or emotional problems
they are affected by the problem
5. Health-promotion needs for specific
and their readiness to act on the
populations
problem.
6. Community dysfunction
7. Environmental hazards (ANA, 1986)
➢ The format of the problem statement
varies, depending on the philosophy of the
agency conducting the assessment.
➢ For example, problems or needs may be
stated simply in epidemiological terms,
such as a high rate of adolescent
pregnancies, whereas in other instances
you may be asked to state the problem or
need as a nursing diagnostic statement
➢ Nursing diagnosis has evolved since 1973
because of the efforts of the North
American Nursing Diagnosis Association
(NANDA) (NANDA, 2009). The initial North
American Nursing Diagnosis Association
(NANDA) classification system of nursing
diagnoses focused on the physical needs
of individual clients but was not applicable
to the family and community situations
faced by community health nurses. Over
the years, the NANDA classification
system has expanded to include
individuals and families' biological,
psychological, and social needs. Because
of ongoing refinement, the taxonomy of
nursing diagnoses at present has 11
functional health patterns. Tools have
been developed to assess the community
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BCI – College of Nursing

using the functional health pattern ✓ Respiration

typology (Gikow & Kucharski, 1987; Wright, ✓ Vision
1985). Newer NANDA diagnoses may also ✓ Circulation
apply to communities; examples include ✓ Speech and language
the diagnosis of impaired home ✓ Oral health
maintenance and impaired social ✓ Skin
interaction. ✓ Pain
• North American Nursing Diagnosis ✓ Postpartum
Association (NANDA) classification system of ✓ Neuromusculoskeletal function
nursing diagnoses focused on the physical ✓ Digestion/hydration
needs of individual clients but was not ✓ Bowel function
applicable to the family and community ✓ Urinary function
situations faced by community health nurses. ✓ Cognition
✓ Consciousness
Omaha system
✓ Reproductive function
➢ Initially designed for clients in a ✓ Communicable/infectious condition
community setting, it has been used (2) Health-related behaviors domain:
as a framework for the case of Patterns of activity that maintain or
individuals, families, and promote wellness, promote recovery,
communities by nurses, nursing and decrease the risk of disease.
educators, physicians, and other ✓ Nutrition
health care providers. ✓ Sleep and rest patterns
➢ The system was designed by the ✓ Physical activity Personal care
Omaha Visiting Nurse Association and ✓ Substance use
has been used in home care, public ✓ Family planning
health, and school health practice ✓ Health care supervision
settings, among others. ✓ Medication regimen
➢ Client problems/needs/concerns are (3) Environmental Domain:
organized into: Material resources and physical
Four domains: surroundings both inside and outside
✓ Physiological the living area
✓ Psychosocial ✓ Neighborhood, and the broader
✓ Health-related behavior community.
✓ Environmental ✓ Income
➢ Each domain may involve actual or ✓ Residence
potential problems or opportunities ✓ Sanitation
for health promotion ✓ Neighborhood/workplace safety
➢ The Ohama System: Domains And (4) Psychosocial domain:
Problems of The Problem ✓ Patterns of behavior
Classification Scheme: ✓ Emotion
(1) Physiological domain: ✓ Relationships, and development
Functions and processes that maintain ✓ Mental health
life. ✓ Communication with community
✓ Hearing resources
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NCM 113 – PREFINALS
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BCI – College of Nursing

✓ Caretaking/parenting and symptoms that are characteristic of the

✓ Social contact problem (Carpenito, 2000).
✓ Neglect
• A description of the problem, response, or
✓ Abuse
state (risk, concern, issue, potential or actual)
✓ Growth and development
✓ Role change • A statement of the aggregate, population,
✓ Interpersonal relationship community, or focus (boundaries). This differs
✓ Spirituality from the nursing diagnosis; the focus is added,
✓ Grief
➢ The system includes four categories of • an identification of factors etiologically
interventions: related to the problem(factors), and
✓ Teaching
• Those signs and symptoms (manifestations)
✓ Guidance, and counseling
that are characteristic of the problem.
✓ Treatments and procedures
✓ Case management; and surveillance • Sample of Community Diagnosis:
➢ Although originally developed for application
➢ Risk of maternal complications leading to
with individuals or families, users are now
maternal mortality among pregnant
applying the problem domains and
women in (community) r/t cost
interventions with communities (Martin,
inaccessibility of skilled birth attendance
2005).
and the community members perception
➢ The Omaha System includes more
that skilled birth attendance and facility-
environmental and community factors that are
based delivery are not necessary during
considered in the NANDA system
childbirth
➢ Because of the multiple nursing diagnostic
and classification systems, the NNN Alliance PLANNING COMMUNITY HEALTH INTERVENTIONS
has formed to develop a consistent
classification system. The NNN Alliance is a • Formulating Goals and Objectives
collaboration of NANDA and the Center for • Objectives planned end point of all activities
Nursing Classification and Clinical and are concerned with the resolution of
Effectiveness (CNC). The taxonomy developed health problem. they have to be stated in
by the NNN Alliance has four domains specific and measurable terms.
(Dochterman & Jones, 2003). The one relevant • Goal is a desired end. It is directed towards
to community health practice is the solving the health status problems that were
environmental domain, with three subsets: identified in the community diagnosis.
healthcare system, populations, and • “Where do we want to go?” refers to
aggregates. All three subgroups have formulating goals and objectives of the health
diagnosis, outcome, and intervention arenas. program and nursing services to change the
community’s status
THE 4 PARTS OF COMMUNITY DIAGNOSIS

• A nursing diagnosis has 4 components: a

descriptive statement of the problem,
response, or state; identification of factors
etiologically related to the problem; and signs

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NCM 113 – PREFINALS
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BCI – College of Nursing

• Goals and objectives will serve as guide to the your immediate needs - reducing youth
nurse's efforts. A goal is a declaration of violence, e.g., but the assumptions behind
purpose or intent that fives essential direction them - empowering the community to change
to action. Objectives are stated in behavioral the root causes of youth violence and all but
terms: specific, measurable, attainable, eliminate it over the long term.
realistic, and time bounded.
• Determine what elements of a promising
DECIDING ON COMMUNITY intervention will work in your community, and
INTERVENTION/ACTION PLAN which ones need to be changed. In other
words, change the intervention, or parts of it,
• “How do we get there?” defines the strategies
so that it suits your community's needs. Not all
and activities that the nurse sets to achieve to
the pieces of an urban program will work in a
realize the goals and objectives.
rural area, for instance, where the realities of
• Conduct a community-based assessment and transportation, childcare, culture, and
planning process to be sure that you're everyday life all may be totally different. The
addressing the most appropriate and pressing community and the target population need to
issues for the community. If your intervention make an adopted practice or intervention their
is to work, it has to be aimed at the real issues own and work for them. If it's true that no two
the community needs to address. An assets communities are exactly alike, it should be
and needs assessment and planning process equally true that interventions that work for
will help you identify those issues accurately them won't be exactly alike, either, though they
and think about how to approach them most may have many common elements.
effectively. IMPLEMENTING COMMUNITY HEALTH
• Decide whether you'll address the issue INTERVENTIONS
directly or try to change the conditions that • Community health needs and problems are
make it possible. It may be that working on not solved by simply inducing changes in
their causes will be more successful than personal and group attitudes and behavior. If
coming at the issues themselves directly, and one expects a lasting and sustainable
that could mean a totally different kind of solution, reforms have to be carried out within
intervention. the health care delivery system and a larger
• Find (or create, if that's necessary) practices or socio-economic and political system.
interventions that have successfully • Community health nursing interventions must
addressed the issue in the way you want to focus on providing health-related
address it. It's important to realize that not interventions to improve the population's
every successful program is successful in the health status and enhance the community's
way that you're interested in. If your focus is capability to manage their own health.
community empowerment, for instance, a
top-down authoritarian program, no matter 1. Importance of Partnership and Collaboration
how successful, isn't what you're looking for. If
➢ Partnership and collaboration aim to get
you want to get at the root causes of a
people to work together in order to address
problem, a program that does a terrific job of
problems or concerns that affect them. It
treating the symptoms isn't a good fit for you.
gives people the opportunity to learn skills
Ensure that practice or intervention matches
in-group relationships, interpersonal
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BCI – College of Nursing

relations, critical analysis, and, most ➢ Unlike those who promote more-consensual
important of all, the decision-making community building, community organizers
process in the context of democratic generally assume that social change
leadership. necessarily involves conflict and social
➢ Health and health-related problems in the struggle in order to generate collective power
community are varied. The problems are for the powerless.
often complicated and too many for the ➢ Community organizing has as a core goal the
nurse and the people or their organization generation of durable power for an
to handle. They cannot solve the problems organization representing the community,
alone. They must work with other people or allowing it to influence key decision-makers
groups to increase the probability of on a range of issues over time. In the ideal, for
accomplishing the goals that they have example, this can get community-organizing
set. groups a place at the table before important
decisions is made. Community organizers
2. Activities involved in collaboration and advocacy
work with and develop new local leaders,
➢ Working together enables organizations to facilitating coalitions and assisting in
accomplish their goals much quicker because developing campaigns. A central goal of
of resources, skills, and views are pooled organizing is developing a robust, organized,
together. local democracy bringing community
➢ Activities in Collaboration include: members together across differences to fight
✓ Networking together for the interests of the community.
✓ Coordination Community organizing is a process whereby
✓ Cooperation community members develop the capability
✓ Coalition to assess their health needs and problems,
➢ Advocacy work is one way the nurse can plan and implement actions to solve these
promote active community participation. The problems, put up and sustain organizational
nurse helps the people attain the optimal structures that will support and monitor
degree of independence in decision making in implementation of health initiatives by the
asserting their rights to a safe and better people.
community. ➢ The World Organization defined social
➢ Advocacy work includes informing the people mobilization as the process of bringing
about the rightness of the cause; thoroughly together all societal and personal influences
discussing with the people the nature of the to raise awareness of and demand for health
alternatives, their content and possible care, assist in the delivery of resources and
consequences; supporting people's right to services, and cultivate sustainable individual
make a choice and to act on their choice; and community involvement. In order to
Influencing public opinion employ social mobilization, members of
➢ institutions, community partners and
organizations, and others collaborate to reach
3. Community organizing and social mobilization specific groups of people for intentional
➢ Community organizing is a process where dialogue. Social mobilization aims to facilitate
people who live in proximity to each other change through an interdisciplinary approach.
come together into an organization that acts in ➢ Principles of community organizing include:
their shared self-interest. Community development is a process;
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BCI – College of Nursing

Community development is a holistic ✓ To bring coordination between the

approach for addressing the community's individuals, groups and organization to
needs; Empowerment results from influence, focus their point and challenge their
participation, and community education; objectives for fulfillment
Development ensures environmental ✓ To launch necessary reforms in the
stewardships; Development is tied to community for eradication of
sustainability; Partnership provides access to community evils
resources. ✓ To develop democratic leadership
among people through their
4. Goals of Community Organizing
participation in community programs
➢ A core goal of community organizing is to ✓ To develop the idea of ability and
generate durable power for an organization better thinking to work for the
representing the community, allowing it to betterment of the community
influence key decision-makers on a range of ✓ To abolish the differences among
issues over time. individuals, develop a spirit of
➢ Main objectives/aims: common interest and sacrifice, and
✓ To bring adjustment between the also participate collectively in
resources available and felt needs of community programs
the people ✓ To organize the people for the
✓ To get information about the resources promotion and progress of community
and needs ✓ Removal of blocks to growth (in
✓ To arouse the people to work for the individuals, groups as well as in
welfare of the community communities)
✓ To create sound ground for planning ✓ Release of full potentialities (in
and action individuals, groups as well as in
✓ To create a sense of cooperation communities)
integration and unity among people ✓ Full use of inner resources (in
✓ To motivate the people to take better individuals, groups as well as in
participation in the developing communities)
community program ✓ Development of capacity to manage
✓ To highlight the causes of various one's own (individual, group &
problems affecting the community community) life
and hinder the way of progress and ✓ Increasing the ability to function as an
development integrated unit.
✓ To implement programs required for
COMMUNITY ORGANIZING PARTICIPATORY
the fulfillment of people basic
RESEARCH (COPAR)
✓ To develop a better understanding
among the people about the issues • Is a vital part of public health nursing.
and needs • Aims to transform the apathetic,
✓ To mobilize the resources to create a individualistic, and voiceless poor into a
suitable ground for the basic needs dynamic, participatory, and politically
completion and eradication of responsive community.
problems • The following are the emphasis of COPAR:

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BCI – College of Nursing

✓ Community working to solve its own 3. Mobilization or action

problem. 4. Evaluation
✓ The direction is established internally 5. Reflection
and externally. 6. Organization
✓ The development and implementation
4 PHASES OF COPAR
of a specific project are less important
than the development of the 1. Pre-Entry
community's capacity to establish the 2. Entry Phase
plan. 3. Organization-building Phase
✓ Consciousness-raising involves 4. Sustenance and Strengthening Phase
perceiving health and medical care
within the total structure of society. (1) Pre-Entry Phase
• The following are the importance of COPAR: ➢ Is the initial phase of the organizing process
✓ COPAR is an important tool for where the community organizer looks for
community development, and people communities to serve and help.
empowerment. ➢ Pre-Entry Activities:
✓ This helps the community workers For preparation:
generate community participation in ✓ Train faculty and students in COPAR.
development activities. ✓ Formulate plans for institutionalizing
✓ COPAR prepares people/clients to COPAR.
eventually take over the management ✓ Revise/enrich curriculum and immersion
of a development programs in the program—coordinate participants of
future. other departments.
✓ COPAR maximizes community
For Site Selection:
participation and involvement;
community resources are mobilized ✓ Initial networking with local government.
for community services. ✓ Conduct preliminary special
• Principles of COPAR include: investigation.
✓ People, especially the most ✓ Make a long/short list of potential
oppressed, exploited, and deprived communities.
sectors are open to change, have the ✓ Do an ocular survey of listed
capacity to change, and are able to communities.
bring about change. ➢ Criteria for Initial Site Selection:
✓ COPAR should be based on the ✓ Must have a population of 100-200
interest of the poorest sector of the families.
community. COPAR should lead to a ✓ Economically depressed.
self-reliant community and society. ✓ No strong resistance from the
• The critical steps of COPAR are: community.
i. Integration ✓ No serious peace and order problem.
ii. Social Investigation ✓ No similar group or organization holding
iii. Tentative program planning the same program.
iv. Groundwork ➢ In identifying potential municipalities:
v. Meeting ✓ Do the same process as in selecting
2. Role Play municipality.
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BCI – College of Nursing

✓ Consult key informants and residents. ✓ Avoid raising the consciousness of the
✓ Coordinate with local government and community residents
NGOs for future activities. ✓ Adopt a low-key profile.
➢ In choosing the final community: ➢ Activities in the Entry Phase:
✓ Conduct informal interviews with Integration
community residents and key ✓ Establishing rapport with the people in
informants. continuing effort to imbibe community
✓ Determine the need for the program in life,
the community. ✓ living with the community,
✓ Take note of political development. ✓ seek out to converse with people
✓ Develop community profiles for where they usually congregate,
secondary data. ✓ lend a hand in household chores,
✓ Develop survey tools. avoid gambling and drinking.
✓ Pay a courtesy call to community ✓ Deepening social
leaders. Choose foster families based investigation/community study,
on guidelines. ✓ verification, and enrichment of data
➢ In identifying Host Family: collected from the initial survey,
✓ House is strategically located in the ✓ conduct baseline survey by students,
community. results relayed through community
✓ They should not belong to the rich assembly.
segment.
For Core Group Formation:
✓ Both formal and informal leaders
respect them. ✓ Leader spotting through sociogram.
✓ Neighbors are not hesitant to enter the ✓ Key persons must be approachable by
house. most people.
✓ No member of the host family should ✓ Must be an opinion leader.
be moving out in the community. ✓ They are approached by key persons
and never or hardly consulted.
(2) Entry Phase/Social Preparation Phase (3) Organization-building Phase
➢ It is crucial in determining which strategies for ➢ In this phase, the formation of a more formal
organizing would suit the chosen community. structure and the inclusion of more formal
➢ The success of the activities depends on how procedures of planning, implementing, and
much the community organizers have evaluating community-wide activities.
integrated with the community. ➢ At this phase, the organized leaders or groups
➢ Guidelines for Entry Phase: are being given training (formal, informal, OJT)
✓ Recognize local authorities' role by to develop their style in managing their own
paying them visits to inform their concerns/programs.
presence and activities. ➢ Key Activities:
✓ Her appearance, speech, behavior, ✓ Community Health Organization
and lifestyle should be in keeping with (CHO) (preparation of legal
those of the community residents requirements, guidelines in the
without disregard of their being role organization of the CHO by the core
models. group, election of officers).
✓ Research Team Committee.
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BCI – College of Nursing

✓ Planning Committee. Level I:

✓ Health Committee Organization. ✓ Non-water carriage toilet facility
✓ Formation of by-laws by the CHO ✓ Toilet facilities requiring small amount
(4) Sustenance and Strengthening Phase of water to wash the waste
➢ In this phase, the community organization has
Level II:
already been established, and the community
members are already actively participating in ✓ On-site toilet facilities of the water
community-wide undertakings. carriage type with water sealed and
➢ At this point, the different committees set up flush type with septic tank disposal
in the organization-building phase are already facilities
expected to be functioning by planning,
implementing, and evaluating their own Level III:
programs, with the overall guidance from the ✓ Water carriage types of toilet facilities
community-wide organization. connected to septic tanks to
➢ Key Activities sewerage system to treatment plants.
✓ Include Training of CHO for monitoring
and implementing of community Food Safety
health programs. ➢ Fast food has become a staple diet for busy
✓ Identification of secondary leaders. people, especially when time is not enough for
✓ Linkaging and networking. food preparation. What could be worse than
✓ Conduct mobilization on health and sinking your teeth into your favorite food,
development concerns. unperturbed to the fact that it is crawling with
✓ Implementation of livelihood projects. germs? You have already consumed and
COMMUNITY ORGANIZING PARTICIPATORY digested your meal before discovering that
RESEARCH there is an additional "ingredient," which is,
without a doubt, a recipe for disaster. A person
Proper Excreta Disposal will more likely choose to starve to death than
➢ Human excreta always contain large numbers eat contaminated food. There have been
of germs, some of which may cause diarrhea. several complaints about food poisoning and
When people become infected with cholera, unsafe food handling practices. While some
typhoid and hepatitis A, their excreta will complainants are already well aware of the
contain large amounts of the germs that cause steps to take, others still need guidance so
the disease. When people defecate in the their complaints will not fall on deaf ears.
open, flies will feed on the excreta and can ➢ The Republic Act No. 10611, otherwise known
carry small amounts of the excreta away on as the "Food Safety Act of 2013," strengthens
their bodies and feet. When they touch food, our country's food safety regulatory system.
the excreta and the germs in the excreta are The law provides protection to consumers so
passed onto the food, which may later be they will have access to local foods and food
eaten by another person. Some germs can products that have undergone thorough and
grow on food and in a few hours their numbers rigid inspection.
can increase very quickly. Where there are ➢ Under Section 3 of the Republic Act, the
germs there is always a risk of disease. objectives are as follows:
➢ Approved types of toilet facilities: ✓ Protect the public from food-borne
and water-borne illnesses and
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BCI – College of Nursing

unsanitary, unwholesome, progress on a wide range of health and

misbranded, or adulterated foods; economic development issues including
Enhance industry and consumer universal health coverage and combatting
confidence in the food regulatory antimicrobial resistance
system, and Achieve economic Source: 1993 Philippine National Standard for
growth and development by Drinking Water, Published by DOH
promoting fair trade practices and
Vermin and Vector Control
sound regulatory foundation for
domestic and international trade. ➢ Environmental management seeks to change
✓ The food safety regulatory system the environment in order to prevent or
combines various processes to minimize vector propagation and human
ensure that food safety standards are contact with the vector-pathogen by
met. Food safety standards refer to destroying, altering, removing, or recycling
the formal documents, which contain non-essential containers that provide larval
the food requirements that the food habitats. Such actions should be the mainstay
processors need to comply with such of dengue vector control. Three types of
human health is safeguarded. These environmental management are defined:
safety standards are implemented by ➢ Environmental modification – long-lasting
law and authorities. Some of the physical transformations to reduce larval
processes under the regulatory vector habitats, such as the installation of a
system include inspection, testing, reliable piped water supply to communities,
data collection, monitoring, and other including household connections.
activities carried out by various food ➢ Environmental manipulation – temporary
safety regulatory agencies. changes to vector habitats involving the
management of "essential" containers, such
Sanitation
as frequent emptying and cleaning by
➢ The World Health Organization defined scrubbing of water- storage vessels, flower
sanitation as the provision of facilities and vases, and desert room coolers; cleaning of
services for the safe management of human gutters; sheltering stored tires from rainfall;
excreta from the toilet to containment and recycling or proper disposal of discarded
storage and treatment onsite or conveyance, containers and tires; management or removal
treatment and eventual safe end use or from the vicinity of homes of plants such as
disposal. ornamental or wild bromeliads that collect
➢ More broadly sanitation also included the safe water in the leaf axils. Changes to human
management of solid waste and animal waste. habitation or behavior – actions to reduce
Inadequate sanitation is a major cause of human – vector contact, such as installing
infectious diseases such as cholera, typhoid mosquito screening on windows, doors, and
and dysentery world-wide. It also contributes other entry points, and using mosquito nets
to stunting and impaired cognitive function while sleeping during the daytime.
and impacts on well-being through school
Built Environment
attendance, anxiety and safety with lifelong
consequences, especially for women and ➢ A built environment is developed in order to
girls. Improving sanitation in households, satisfy residents' requirements. Human needs
health facilities and schools underpins can be physiological or social and are related
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BCI – College of Nursing

to security, respect, and self-expression. implementation phase, compares the actual

People want their built environment to be progress (of the implementation of the
aesthetically attractive and to be in an program) against what was planned. The
accessible place with a well-developed purpose of monitoring is to identify deviations
infrastructure, convenient communication or problems so that corrective actions or
access, and good roads, and the dwelling interventions can be instituted immediately.
should also be comparatively cheap, This implies reporting to appropriate persona
comfortable, with low maintenance costs, and or offices at regular intervals.
have sound and thermal insulation of walls. ➢ Types of Evaluation
People are also interested in ecologically
Planning Evaluation
clean and almost noiseless environments,
with sufficient relaxation options, shopping, ✓ same as program monitoring
fast access to work or other destinations, and ✓ used to improve program performance
good relationships with neighbors. by influencing immediate decisions
about the activities, especially how
MONITORING AND EVALUATING COMMUNITY
they can be re-planned and/or
HEALTH PROGRAMS
improved. It enables the assessment
➢ Monitoring and evaluation are essential of: Who is being reached by the
management tools that ensure that health program; What information is reaching
activities are implemented as planned and them; Whether or not things are going
assess whether desired results are being according to plan; The need for change
achieved. Monitoring is done to provide
Formative Evaluation
concurrent feedback on the progress of
activities, identify the problems in their ✓ initial assessment to develop
implementation, and take corrective action. appropriate, effective programs. The
Evaluation is done to assess whether the formative evaluation comprises of
program's desired results have been achieved activities undertaken to furnish
if not how it should be redesigned. information that will guide the design
of health programs.
✓ enables us to assess: Who is most
affected by the problem?; What
knowledge, attitudes, and beliefs
exist?; What is the level of access to
services? ; What are the barriers to
action?; What are the communication
habits and preferences? Common
sources of data are: Monitoring data;
Existing epidemiologic and program
reports; Interviews with program
managers, stakeholders; Baseline
survey data of intended audience;
Media rating data; Service statistics;
➢ Monitoring and evaluation are closely related.
Other program records
Monitoring, which is done at the

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BCI – College of Nursing

Summative or Impact Evaluation data. Prior to actual data

collection, data collection
✓ examines specific program outcomes
methods and tools should be field-
and accomplishments.
tested, and data collectors should
✓ used to assess the program's success
be trained.
and judge its worth by assessing its
4. Analyze Data
effectiveness in light of relevant
Evaluators should assess the quality of the
problems. It enables the assessment
data before they start the analysis.
of whether the appropriate behaviors
✓ What do the figures/ statistics
were realized, and these changes can
mean?
be attributed to the intervention.
✓ What do qualitative data
➢ Steps in Program Evaluation
reveal?
1. Decide what to evaluate.
The WHO suggested five dimensions of Depending on the type of evaluation being
program performance that could be conducted. The main questions that
evaluated: should be asked are:
✓ Relevance
✓ Is the program relevant?
✓ Progress
✓ Is it progressing in accordance
✓ Effectiveness
with the program plan?
✓ Impact
✓ Is it effective?
✓ Efficiency
✓ What are the lessons that
To address these dimensions, the could be learned from the
evaluator should review the program program?
context and objectives. 5. Make Decisions
✓ If the intervention or program was
2. Design the Evaluation Plan
effective and efficient, this could
✓ Designing an evaluation plan
be continued and/or applied to
means specifying data collection
another client or group, given
methods and tools and sources of
similar circumstances. If the
data.
program is not relevant, the
✓ Records and reports can be
evaluator should recommend its
reviewed and analyzed.
modification.
✓ Surveys can be conducted to
6. Report/ Give Feedback
collect information on the client's
✓ The result of the program
knowledge, attitudes, and
evaluation should be submitted to
practices
local authorities such as mayor,
chair of the Sangguniang Bayan
committee on health, and to the
Local Health Board.
✓ It should be noted that these are
the key decision-makers in the
3. Collect Relevant Data local health system. An executive
✓ The evaluator's primary aim is the summary should be prepared for
generation of accurate and reliable them. It should contain a brief
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BCI – College of Nursing

description of the focus and Local Health Board. If the nurse

procedures of the evaluation, will be asked to make a
summary, and interpretation of presentation, you must prepare
evaluation results, conclusions, good visual aids. A good written
and recommendations. The nurse report and an impressive oral
and other health workers must be presentation can influence
prepared to make a presentation decision- makers positively.
to the Sangguniang Bayan or to the

NURSING PROCESS IN THE COMMUNITY

DOCUMENTATION AND REPORTING

Guidelines for Good Documentation and Reporting:

➢ Fact - information about clients and their care must be factual. A record should contain descriptive,
objective information about what a nurse sees, hears, feels, and smells.

➢ Accuracy - information must be accurate so that health team members have confidence in it

➢ Completeness - the information within a record or a report should be complete, containing concise and
thorough information about a client's care. Concise data are easy to understand.

➢ Currentness - ongoing decisions about care must be based on currently reported information.

➢ Organization - the nurse communicates in a logical format or order.

➢ Confidentiality - confidential communication is information given by one person to another with trust and
confidence that such information will not be disclosed.

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