Unit 4: Nursing Process in the Care of Population Groups and Community

Topic Outline
1. Community Health Assessment Tools
1.1 Approaches in Conducting Community Assessment
1.1.1 Comprehensive Need Assessment
1.1.2 Problem-Oriented Assessment
1.2 Tools for Community Health Assessment
1.2.1 Sources of Data
1.2.1.1 Primary Data
1.2.1.2 Secondary Data

Community Health Nursing II

1.2.2 Collecting Primary Data
1.2.2.1 Observation
1.2.2.2 Survey
1.2.2.3 Informant interview
1.2.2.4 Community forum
1.2.3 Collecting Secondary Source of Data
1.2.3.1 Registry of Vital Events
1.2.3.2 Health Records and Reports
1.2.3.3 Disease Registries
1.2.3.4 Census Data
1.2.4 Method to Present Community Data
2. Community Diagnosis
2.1 Types
2.1.1 Comprehensive community diagnosis
2.1.2 Problem-oriented community diagnosis
2.2 Schemes in Stating Community Diagnosis
2.2.1 NANDA
2.2.2 Shuster and Goeppinger
2.2.3 Omaha System
3. Planning Community Health Interventions
3.1 Priority Setting
3.1.1 WHO Special Consideration
3.2 Formulating Goals and Objectives
3.3 Deciding Community Interventions/Action Plan
4. Implementing Community Health Interventions
4.1 Community Organizing and Social Mobilization
4.2 COPAR
5. Monitoring and Evaluating Community Health interventions
5.1 Monitoring
5.2 Evaluation
5.3 Types of Evaluation
5.4 Steps of Program Evaluation
5.5 Standards of Evaluation
6. Documentation and Reporting
6.1 Family Health Records
6.2 Community Profile

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 Learning Objectives
After studying this unit, you will be able to:
 Utilize the nursing process in managing community health concerns.
 Choose from several schemes appropriate in stating community diagnoses.
 Apply skills in recording and reporting system of DOH in monitoring the health status of the population
at different levels.

Introduction
Greetings my dear students!

The community health nurse aim is to improve the health status of the community in general. Just as in
other fields nursing practice, care of the community is undertaken utilizing the nursing process in a cyclical process

Community Health Nursing II

of assessment, diagnosis, planning, intervention and evaluation. To the nurse, the community is not just providing
community health nursing but it is the focus of nursing care.
Community health nurse is responsible to provide general and comprehensive public health and nursing
services to the people at large in a defined community. She is vested with the responsibility of rendering people to
solve their health and nursing care problems in their place of living and work. This process of rendering care can be
done by making use of nursing process and principles applicable in the community settings.

Activating Prior Knowledge

Answer the following question in the discussion forum
What is nursing process? What is one way nurses use critical thinking in regard to the nursing process?

1.1 Overview of Community Health Nursing

Community Health Nursing Process is a systematic, scientific, dynamic, ongoing interpersonal process in
which the nurses and the clients are viewed as a system with each affecting one and another and both being affected
by the factors within the behavior. It is a process which refers to systematic series of steps which are followed by
public health nurse in community health and nursing problems using community approaches and resources. Its
process is an effective tool to help people solve their problems and meet their health and nursing needs.

1 Community Health Assessment Tools

The data that need to be collected depend on the objectives of community assessment. The nurse needs to collect
data on the three categories of community health determinants.
1. People
2. Place and
3. Social system
Planned Approach to Community Health (PATCH)
Data collected for the PATCH process for health planning
1. Community profile
2. Morbidity and mortality data
3. Behavioral data focusing on behavioral risk factors
4. Opinion data from community leaders
1.1 Approaches in Conducting Community Assessment
1. Comprehensive Need Assessment – information about the entire community
2. Problems-Oriented Assessment – information with a certain community problem in mind
Strategy on for community assessment depends on
1. Objective for data gathering
2. Size and characteristics of the aggregate
3. Resources available to the nurse

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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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1.2 Tools for Community Assessment
1.2.1 Sources of Data
1. Primary Data – data that have been gathered before and are collected by the nurse observation, survey,
informant interview, community forum and focus group discussion
2. Secondary Data – data taken from existing data consists of vital registries, health records and reports,
disease registries and publications for example census
1.2.2 Collecting Primary Data
1. Observation – through an ocular or windshield survey, either by driving or riding a vehicle or walking through
it
 Participant observation is a purposeful observation of the formal and informal community activities. A
technique used in COPAR.
2. Survey – a series of questions may be oral or written
3. Informant interview – purposeful talks with either key informants or ordinary members of the community
4. Community forum – an open meeting initiated by the nurse in coordination with the leaders of the

Community Health Nursing II

community
5. Focus group – made of smaller group usually 6-12 members only and this method is effective in the
assessment of the health needs of specific groups in the community.
1.2.3 Collecting of Secondary Source of Data
1. Registry of Vital Events
 Act 3753 aka Civil Registration Law
 RA 7160 aka Local Government Code
 PSA
 The Administrator
 The physician, nurse or midwife or anybody who attended the delivery either or the parents may also
register the birth.
 A child should be registered within the 30 days from the occurrence of the birth.
 Where? At the LCR office of city or municipality where the birth occurred.
 PD 856 aka Sanitation Code
 The health officer within 48 hours
 The nearest relative or any person who has knowledge of the death shall report to the health officer
within 48 hours.
 To the mayor, municipal secretary, or any member of the Sangguniang Bayan who shall issue the death
certificate for purposes of burial.
 It shall be made within 30 days from occurrence of death at the LCR office of the city/municipality where
the birth occurred.
2. Health records and reports
Field Health Service Information System (FHSIS) – the official recording and reporting system of the DOH to
generate health statistics. (This will be discussed under the documentation and reporting topic.)
3. Disease registries – listing of persons diagnosed with specific type of disease in a defined population for
example HIV-AIDS and chronic NCD’s particularly CA, DM, COPD and stroke
4. Census data – a periodic governmental enumeration of the population.
 Batas Pambansa Blg. 72
 Every 10 years
Two ways of allocating census based on the assign locality in the Philippines
1. De Jure
2. De facto
1.2.4 Methods to Present Community Data
Community data is presented to the health team and the members of the community. Depending on the context
and purpose of the presentation the community data is presented as text, in tables, or in pictorial form such a maps
or graphs.

2 Community Diagnosis
Is the process of determining health status of the community and the factors responsible for it; it allows identification
of problems and areas of improvement, thereby stimulating action. (WHO, 1994).
Community health action potential which is essential for a healthy community is to be attained and maintained.

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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2.1 Types of community diagnosis
1. Comprehensive community diagnosis
2. Problem-oriented diagnosis
2.2 Schemes in Stating Community Diagnosis
1. Shuster and Goeppinger – proposed practical application of a format of nursing diagnoses for population
groups previously presented as three part statement: health risk, specific aggregate and related factors.
2. Omaha System – is comprehensive and research-based classification system for client problems that exists
in the public domain not under copyright.
Three components of the Omaha classification system that are to be used together
1. Problem classification scheme – which serves as a guide in collecting, classifying, analyzing, documenting
and communicating health and health-related needs and strengths.
Four Levels of Classification of identified problems or areas of concern:
 First level – has 4 domain
 Second level – consists of problems or areas of concern under the four domains

Community Health Nursing II

 Third level – the problem area is classified according to two sets of qualifiers
Categories
First – the area of concern is categorized into health promotion, potential problem or actual problem
then
Second – the level of clientele involved is identified.
 Fourth level – is made up of clusters of S/S that describe actual problems (Omaha System, 2011b)
2. An intervention scheme
3. Problem rating scale for outcomes

3 Planning Community Health Interventions

3.1 Priority Setting
The step that provides the nurse and the health team with a logical means of establishing priority among the
identified health concerns.
WHO criteria for community intervention
1. Significance of the problem
2. Community awareness
3. Ability to reduce risk
4. Cost or reducing risk
5. Ability to identify the target population
6. Availability of resources
For a realistic and useful outcome the “group” – community, nurse and other stakeholders and other members of
the health care team defines guidelines for discussion particularly on the manner of reconciling difference of opinion.
The technique suggested by Shuster and Goeppinger is nominal group technique which is appropriate for
brainstorming and ranking ideas and when concensus-building is desired over making a choice-based on the opinion
of majority.

The steps carried out in the identified problems

After repeating the process on all identified health problems, compare the total priority scores of the problems. The
problem with the highest total priority score is assigned top priority, the next highest is assigned second priority
and so on.

3.2 Formulating Goals and Objectives

Goal is the desired outcomes at the end of interventions, whereas objective is the short-term changes in the
community that are observed towards attainment of goals.

3.3 Deciding on Community Interventions/Plan

Considerations in the process of developing a plan
In the process of developing a plan, the group takes into consideration the demographic, psychological, social,
cultural, and economic characteristics of the target population on one hand and the available health resources on
the other hand.

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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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4 Implementing Community Health Interventions
Often referred to as the action phase and is the most exciting phase for most health workers. This requires a
common understanding of the goals, objectives and planned interventions among the members of the implementing
group. Collaboration with other sectors and other agencies is necessary.

5 Monitoring and Evaluating Community Health Programs

Approaches in the evaluation process
1. Structure evaluation
2. Process evaluation
3. Outcome evaluation
4. Ongoing evaluation or monitoring
The standards of evaluation
1. Utility

Community Health Nursing II

2. Feasibility
3. Propriety
4. Accuracy

Read
Read Approaches in Conducting Community Assessment on pages 134-135
Read Tools for Community Assessment on pages 135-139
Read Data collected for the PATCH process for health planning see Box 7.1 on page 134
Please read the approaches in conducting community assessment on page 134-135
Read Deciding strategy for community assessment on page 135
Read Box 7.2 Methods to present community data on page 140
Read page 142 for Community diagnosis
Read Schemes in stating community diagnosis on page 142-144
First Level Please see Box 7.4 for the four domains on page 144
Read Community Health Interventions on page 145
WHO criteria for community intervention on page 145
Please read the Steps suggested by Shuster and Goeppinger on page 146
Please see Tables 7.1 and 7.2 for an illustration of the process of collation using the nominal group technique
on pages 146-147
Please see Table 7.3 for a sample computation problem priority
Read Formulating goals and objectives on page 148
Please see Box 7.5 for sample statements of goals and objectives of a community health plan on page 148
Read Community Health Interventions on page 149
Deciding on Community Interventions/Plan (Please read page 148)
Read Monitoring and Evaluation Community Health Programs on pages 149-150
Please read the standards of evaluation on page 149

Summary

1.1 Overview of Community Health Nursing Process

In every discipline, the nursing process is used to their professional practice differently using various names,
prevention of illness and maintenance of health care common goals in all areas of community health. The nursing
process which is otherwise known as the problem-solving approach is a tool or guide for the provision of quality
nursing care. A community health nurse provides skilled nursing care by making professional judgments and renders
good nursing care to the family and the community.

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Readings and References
 Required Textbook: Nursing care of the community. (2013). Zenaida U. Famorca
 Community Health Nursing and Community Health Development: Text-Workbook (1st edition 2012).
Cecilia E. Castro
 The Basics of Community Health Nursing: A Study Guide for Nursing Students and Local Board
Examinees (2010). Monina H. Gesmundo
 Community Health Nursing Practice: The Basics of Practice (2006). Salvacion G. Baylon- Reyes
 Community Health Nursing Concepts and practice. (8th edn) 2001.Lippincott, 342-45. Allender J.N;
Spradely B.W.
 Community Health Nursing Promoting health of Aggregates, Families and individuals. (4th edition 2001).
Mosby, 265-80. Stanhope M; Lancaster J.

Community Health Nursing II

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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