Features of CHN

UNIT 1: Community Health Nursing Concepts There are six essential characteristics of community nursing. These
are in the following:
1. It is a specialty field of nursing.
Overview 2. The practice combines public health with nursing.
Community nursing is one of the two significant fields of 3. It is population-based.
nursing in the Philippines. We generally use the term community 4. It emphasizes on wellness and other than disease or illness.
health nursing and public health nursing. Those who work in rural 5. It includes interdisciplinary collaboration.
health units (RHUs) or health centers are community health nurses 6. It amplifies the client's responsibility and self-care.
and are officially called public health nurses (PHN’s). Occupational
nurses and school health nurses are classified as a community health Theoretical Models / Approaches
nurse. The general systems theory is the first of the theories taken
up in this section, being the basis, in part, of several nursing theories
Community Health Nursing that the community health nurse may find useful. It is the framework of
In today's pandemic COVID-19, many of us are staying at the Community Assessment Tool developed by Maurer and Smith
home and doing less in social interactions and exercise. This can have (2009). Short explanations of Albert Banduria’s Social Learning
a negative effect on your physical and mental health. The role of Theory and models that community health nurses may use when
community health nurse has been emphasized to lead Barangay planning for health promotion and disease prevention includes Health
Health Emergency Response Team (BHERT) in monitoring COVID-19 Belief Model, Milio’s Framework for Prevention, Nola Pender’s Health
cases in their respective barangays. Promotion Model, Transtheoretical Model and Lawrence Green’s
The American Nurses Association wrote that: Community PRECEDE-PROCEED Model.
health nursing practice promotes and preserves populations' health by
integrating skills and knowledge relevant to both nursing and public General System’s Theory
health. The practice is comprehensive and general, and is not limited The general system theory is applicable to the different
to a particular age or diagnostic group; it is continual, and is not limited levels of the community health nurse’s clientele: individuals, families,
to episodic care… While community health nursing practice includes groups or aggregates, and communities. Viewed as open system, the
nursing directed to individuals, families and groups, the dominant client is considered as a set of interacting elements that exchange
responsibility is to the population (Clark, 2014:50) energy, matter, or information with the external environment to exist
The World Health Organization Expert Committee of (Katz and Khan, 1966) This concept is particularly useful when
Nursing defines public health nursing as a "special field of nursing that analyzing interrelationships of the elements within the client as well as
combines the skills of nursing, public health and some phases of social those of the client and the environment.
assistance and functions as part of the total public health program for
the promotion of health, the improvement of the conditions in the social Social Learning Theory
and the physical environment, rehabilitation of illness and disability." Social learning Theory is based on the belief that learnings
take place in a social context, that is people learn from one another
Philosophy and Principles and that learning is promoted by modeling or observing other people,
According to Dr. Margaret Shetland, the philosophy of It is anchored on the fact that persons are thinking beings with self-
Community Health Nursing is based on man's worth and dignity. regulatory capacities, capable of making decisions and acting
The following are Community Health Nursing principles that according to expected consequences of their behavior. The
were adapted from those formulated by Mary S. Gardner and by environment affects learning outcomes depend on the learner’s
Leahy, Cobb, and Jones: (1) Community Health Nursing is based on individual characteristics (Bandura, 1977).
recognized needs of communities, families, groups, and individuals.
(2)The community health nurse must fully understand the objectives Health Belief Model
and policies of the agency she represents. (3)In community health The Health Belief Model (HBM) was developed in the early
nursing, the family is the unit of service. (4)Community Health Nursing 1950s by social scientists at the U.S. Public Health Service to
must be available to all regardless of race, creed, and socioeconomic understand people's failure to adopt disease prevention strategies or
status. (5)Health teaching is a primary responsibility of the community screening tests for the early detection of disease. Later uses of HBM
health nurse. (6)The community health nurse works as a member of were for patients' responses to symptoms and compliance with
the health team (7). There must be a provision for periodic evaluation medical treatments. The HBM suggests that a person's belief in a
of Community Health Nursing Service (8) Opportunities for continuing personal threat of an illness or disease, together with a person's belief
staff education programs for nurses must be provided by the in the effectiveness of the recommended health behavior or action, will
community health nursing agency. The community health nurse also predict the likelihood the person will adopt the behavior.
has a responsibility for his/her professional growth. (9) The community The HBM derives from psychological and behavioral theory
health nurse makes use of available community health resources. with the foundation that the two components of health-related behavior
(10)The community health nurse utilizes the already existing are 1) the desire to avoid illness, or conversely get well if already ill;
organized groups in the community. (11) There must be provision for and, 2) the belief that a specific health action will prevent, or cure,
educative supervision in Community Health Nursing. (12) There illness. Ultimately, an individual's course of action often depends on
should be accurate recording and reporting in community Health the person's perceptions of the benefits and barriers to health
Nursing. behavior. There are six constructs of the HBM. The first four constructs
were developed as the original tenets of the HBM. The last two were
added as research about the HBM evolved.
 The Transtheoretical Model
The Transtheoretical Model(TTM) combines several
theories of intervention, thus the name transtheoretical. The TTM
assumes that the behavior change takes place over time, progressing
through a sequence of stages. It also assumes that each of the stages
is both stable and open to change. In other words, one may stop in
one stage, progress to the next page, or return to the previous stage.

DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

School Health Nursing

School nursing is a specialized nursing practice that
advances the well-being, academic success, and lifelong achievement
and health of students. Keeping children healthy, safe, and ready to
Milio’s Framework for Prevention learn should be a top priority for both healthcare and educational
Nancy Milio developed a framework for prevention that systems.
includes concepts of community – oriented, population- focused care. School nurses lead in developing policies, programs, and
Milio stated that behavioral patterns of the populations-and individuals procedures for the provision of school health services at an individual
who make up populations result from habitual selection from limited or district level (NASN, 2016a), relying on student-centered, evidence-
choices. She challenged the common notion that the main determinant based practice and performance data to inform care (Robert Wood
for unhealthful behavioral choice is lack of knowledge. Milio’s Johnson Foundation, 2009). Integrating ethical provisions into all
framework described a sometimes neglected role of community health areas of practice, the school nurse leads in delivering care that
nursing to examine the determinants of a community’s health and preserves and protects student and family autonomy, dignity, privacy,
attempt to influence those determinants through public policy. and other rights sensitive to diversity in the school setting (American
Nurses Association [ANA] & NASN, 2011).
Nola Pender’s Health Promotion
The Health Promotion Model was designed by Nola J. Occupational Health Nursing
Pender to be a "complementary counterpart to models of health The American Association of Occupational Health Nurses
protection." It defines health as a positive dynamic state rather than describes an occupational health nurse as someone who "provides for
merely the absence of disease. Health promotion is directed at and delivers health and safety programs and services to workers,
increasing a patient's level of well-being. The health promotion model worker populations, and community groups. The practice focuses on
describes persons' multidimensional nature as they interact within their promoting and restoration of health, prevention of illness and injury,
environment to pursue health. and protection from work-related and environmental hazards.
The Health Promotion Model makes four assumptions: (1) Occupational and environmental health nurses have a combined
Individuals seek to actively regulate their own behavior. (2) In all their knowledge of health and business that they blend with health care
biopsychosocial complexity, individuals interact with the environment, expertise to balance the requirement for a safe and healthful work
progressively transforming the environment as well as being environment with a 'healthy' bottom line."
transformed over time. (3)Health professionals, such as nurses,
constitute a part of the interpersonal environment, which influences Community Mental Health Nursing
people through their life span. (4) Self-initiated reconfiguration of the Community Mental Health Nurses are specialized Nurses
person-environment interactive patterns is essential to changing who provide holistic nursing services for people with mental health
behavior. issues in a community setting. We provide caring and confidential
supports for our clients, using the recovery model for care.
Lawrence Green’s Precede-Proceed Model The services provided by the Community Mental Health Nursing
The PRECEDE–PROCEED model is a cost–benefit Program include Treatment Planning, Medication Management,
evaluation framework proposed in 1974 by Lawrence W. Green that Assessment, Counseling, Family Support, Education, Group Support,
can help health program planners, policy makers and other evaluators Facilitate services with visiting Psychiatrists.
analyze situations and design health programs efficiently. It provides
a comprehensive structure for assessing health and quality of life POST-TEST
needs and designing, implementing, and evaluating health promotion 1. This term refers to a state of complete physical, mental, and
and other public health programs to meet those needs. social well-being and not merely the absence of disease or
The PRECEDE–PROCEED planning model consists of four infirmity.
planning phases, one implementation phase, and 3 evaluation phases. a. Social
b. Community
c. Health
d. Community health nursing

2. This term refers to a collection of people who interact with

one another and whose common interests or characteristics
form unity or belonging.
a. Social
b. Community
c. Health d. None of the above
d. Community health nursing
10. This framework is for prevention that includes concepts of
3. These communities are defined or created by both natural community – oriented, population- focused care.
and human made boundaries and include barangays, cities, a. PRECEDE–PROCEED model
provinces, regions, and nations. b. Health Promotion Model
a. Geopolitical communities c. Milio’s Framework for Prevention
b. Phenomenological communities d. None of the above
c. Rural community
d. Urban community 11. Which of the following are the two HBM components of
health-related behavior?
4. This type of community refers to relational, interactive a. The desire to avoid illness, or conversely get well if already
groups. The place or setting is more abstract, and people ill
share a group perspective or identity based on culture, b. The belief that a specific health action will prevent, or cure,
values, history, interests, and goals. illness.
a. Geopolitical communities c. Both a and c
b. Phenomenological communities d. None of the above
c. Rural community
d. Urban community 12. This refers to a person's subjective perception of the risk of
acquiring an illness or disease. There is wide variation in a
5. This term usually denotes a group of people having common person's feelings of personal vulnerability to an illness or
personal or environmental characteristics. disease.
a. Community a. Perceived susceptibility
b. Population b. Perceived severity
c. Group c. Perceived benefits
d. Family d. Perceived barriers

6. This term provides for and delivers health and safety 13. This refers to a person's feelings on the seriousness of
programs and services to workers, worker populations and contracting an illness or disease (or leaving the illness or
community groups. The practice focuses on promotion and disease untreated). There is wide variation in a person's
restoration of health, prevention of illness and injury, and feelings of severity, and often a person considers the
protection from work-related and environmental hazards. medical consequences (e.g., death, disability) and social
a. Community health nurse consequences (e.g., family life, social relationships) when
b. School Nurse evaluating the severity.
c. Occupational Health Nursing a. Perceived susceptibility
d. Mental Health Nursing b. Perceived severity
c. Perceived benefits
7. It is a specialized practice of nursing that advances the well- d. Perceived barriers
being, academic success, and lifelong achievement and
health of students. Keeping children healthy, safe, in school,
and ready to learn should be a top priority for both healthcare UNIT 2: Concepts of the Community
and educational systems.
a. Community health nurse
b. School Nurse Overview
c. Occupational Health Nursing The community you live in is part of who you are. Even if you don't see
d. Mental Health Nursing your neighbors every day, you recognize that your decisions impact
those around you. You're all in it together, and you wouldn't have it any
8. This model is complementary counterpart to models of other way! Improving your community and helping others is often at
health protection.” It defines health as a positive dynamic the top of your mind. So when the phrase "community health" crossed
state rather than simply the absence of disease. your radar, you had to know more. The Philippine government has
a. PRECEDE–PROCEED model imposed a strict community quarantine order amid the coronavirus
b. Health Promotion Model disease (COVID-19) outbreak in 2020. However, residents have
c. Milio’s Framework for Prevention concerns, as the guidelines require that everyone should as much as
d. None of the above possible, stay at home. What is community health? And how does it
affect the lives of those in your area?
9. This model is a cost–benefit evaluation framework proposed
in 1974 by Lawrence W. Green that can help health program Lesson Proper
planners, policy makers and other evaluators analyze The community is a group of people sharing common geographic
situations and design health programs efficiently. boundaries and common values and interests. It functions within a
a. PRECEDE–PROCEED model particular sociocultural context, which means that no two communities
b. Health Promotion Model are alike. The physical environment varies, and so with the people's
c. Milio’s Framework for Prevention
way of behaving and coping. The people are different from each other; clinician role involves specific emphasis different from basic nursing,
thus, the dynamics in one community differs from that of the other. i.e., Holism, health promotion, and skill expansion.
Educator Role: It is widely recognized that health teaching
Types of Community is a part of good nursing practice and one of the primary functions of
There are three classifications of community according to a community health nurse (Brown, 1988). Assesses the knowledge,
Untalan, Tuesca (2005) COPAR, first is Rural or the Open lands attitudes, values, beliefs, behaviors, practices, stage of change, and
usually places in the provincial areas where people make earn their skills of the community people and provides health education
living by agriculture and things of sort, mostly less dense and more according to knowledge level.
spacious. Urban or the City is a non-agricultural type of community, Advocate Role: The issue of clients' rights is essential in
the community is dense and mostly populating the whole community, health care today. Every patient or client has the right to receive just
the major source of income are the industrial products and technology. equal and human treatment. Community health nurse is an advocate
Suburban or the Capitals, it is usually the capital of the provinces of patient's rights about their care. They encourage the individuals to
where there is a mix of agriculture and industry, although technology take the right food for maintaining health, the right drugs for the
is not in its highest peak, technology is utilized to increase the treatment, and the right services at right place where ever needed.
productivity of both industrial and agriculture side. They provide sufficient information to make necessary health care
decision, promote community awareness of significant health
Characteristics of a Healthy Community problems.
A healthy community has the characteristics of: The Managerial Role: As a manager, the nurse exercises
members are aware of their own health and biologic status, members administrative direction towards accomplishing specified goals by
give credit to the governing authority, the natural and biological assessing clients' needs, planning, and organizing to meet those
resources are open for everybody, has a strong and reliable governing needs, directing and controlling and evaluating the progress to assure
body, people work together to attain independence, environmental and that goal are met.
physiologic needs are sustained by the community and families, Collaborator Role: Community health nurses seldom
parents and guardians serve as role models for the children, people practice in isolation. They must work with many people, including
are concerned with their health status, health needs are accessible clients, other nurses, physicians, social workers, community leaders,
and affordable to the public and free for indigent and everyone is therapists, nutritionists, occupational therapists, psychologists,
working to attain health citizenry. epidemiologists, biostatisticians, legislators, etc. the health team
(Fairly 1993, Williams, 1986).
Components of a Healthy Community Leader Role: Community health nurses are becoming
increasingly active in the leader role. As a leader, the nurse instructs
influences or persuades others to effect change that will positively
affect people's health. The leadership role's primary function is to use
health policy change based on community people's health; thus, the
community health nurse becomes an agent of change.
Research Role: In the researcher role, community health
nurses engage in systematic investigation, collection, and analysis of
data to solve problems and enhance community health nursing
practice. Based on the research result, community nurses improve
their service quality and improve community people's health.

POST-TEST

1. A healthy community has the following characteristics except:

a. Awareness that “we are community”
b. Conservation of natural resources
c. Recognition of, and respect for the existence of subgroups
d. none of the above
Factors Affecting Health of the Community
The factors that affect the community's health are physical factors, 2. A healthy community has the following characteristics except:
social/cultural factors, community organization, and individual a. Participation of subgroups in community affairs
behavior. b. Preparation to give crises
c. Ability to problem solved
Roles and Activities of Community Health Nurse d. Communication through open channels
Community health nursing involves several basic concepts,
including promoting healthy living, prevention of disease and health 3. This term provides for and delivers health and safety programs and
problems, medical treatment, rehabilitation, evaluation of community services to workers, worker populations and community groups. The
health nursing care delivery and prevention systems, and research to practice focuses on promotion and restoration of health, prevention of
further community health nursing and wellness. illness and injury, and protection from work-related and environmental
Clinician Role or Direct care provider: The clinician role hazards.
in the community health nurse means, the nurse ensures health care a. Community health nurse
services, not just to individuals and families but also to groups and b. School Nurse
population of the community. For community health nurses, the c. Occupational Health Nursing
d. Mental Health Nursing UNIT 3: Health Statistics and Epidemiology
4. It is a specialized practice of nursing that advances the well-being,
academic success, and lifelong achievement and health of students. Overview
Keeping children healthy, safe, in school, and ready to learn should be In journalism, students are taught that a good news story
a top priority for both healthcare and educational systems must include the 5 W's: what, who, where, when, and why (sometimes
a. Community health nurse cited as to why/how). The 5 W's are the essential components of a
b. School Nurse news story because if any of the five are missing, the story is
c. Occupational Health Nursing incomplete. The same is true in characterizing epidemiologic events,
d. Mental Health Nursing whether it be an outbreak of coronavirus among cruise ship
passengers or mammograms to detect early breast cancer. The
5. This model is complementary counterpart to models of health difference is that epidemiologists tend to use synonyms for the 5 W's:
protection.” It defines health as a positive dynamic state rather than diagnosis or health event (what), the person (who), place (where), time
simply the absence of disease. (when), and causes, risk factors, and modes of transmission
a. PRECEDE–PROCEED model (why/how).
b. Health Promotion Model
c. Milio’s Framework for Prevention Lesson Proper
d. None of the above The main concern of public health is preventing the disease,
prolonging life, and promoting physical health and efficiency through
6. This model is a cost–benefit evaluation framework proposed in 1974 organized community efforts. Epidemiology is concerned with studying
by Lawrence W. Green that can help health program planners, policy factors that influence the occurrence and distribution of diseases,
makers and other evaluators analyze situations and design health detects disability or death, which occur in groups aggregation of
programs efficiently individuals. It is the study of the spread of the disease in a group of
a. PRECEDE–PROCEED model individuals as in public health. On the other hand, health statistics, as
b. Health Promotion Model defined by the World Health Organization, refer to quantitative data
c. Milio’s Framework for Prevention and the classification of such data according to probability theory and
d. None of the above the application to them of methods such as hypothesis testing. Health
statistics include empirical data and estimates related to health, such
7. This framework is for prevention that includes concepts of as mortality, morbidity, risk factors, health service coverage, and
community – oriented, population- focused care. health systems. Epidemiology and health statistics, therefore, are the
a. PRECEDE–PROCEED model backbone of the prevention of disease.
b. Health Promotion Model
c. Milio’s Framework for Prevention Tools
d. None of the above Epidemiology is the study of the distribution and
determinants of health-related states or events in specified
8. Which of the following are the two HBM components of health- populations, and the application of this study to the prevention and
related behavior? control of health problems.
a. The desire to avoid illness, or conversely get well if already ill Demography is the science which deals with the study of the
b. The belief that a specific health action will prevent, or cure, illness. human population size, composition, and distribution in space.
c. Both a and c Population size simply refers to the number of people in each place or
d. None of the above are at a given time. When population is characterized in relation to
certain variables such as age, sex, occupation, or educational level,
9. This refers to a person's subjective perception of the risk of acquiring then the population composition is being described. The three events
an illness or disease. There is wide variation in a person's feelings of are affected depending on how fast or how slow people are added to
personal vulnerability to an illness or disease. the population as a result of births, deaths and migration occurring in
a. Perceived susceptibility the community.
b. Perceived severity
c. Perceived benefits SOURCES OF DEMOGRAPHIC DATA
d. Perceived barriers
1. Population Size
10. This refers to a person's feelings on the seriousness of contracting 2. Population Composition
an illness or disease (or leaving the illness or disease untreated). 3. Spatial Distribution
There is wide variation in a person's feelings of severity, and often a 4. Health Indicators
person considers the medical consequences (e.g., death, disability)
and social consequences (e.g., family life, social relationships) when Population Size
evaluating the severity. Population size of a place allows the nurse to make
a. Perceived susceptibility comparisons about population changes over time. It helps rationalize
b. Perceived severity the types of health programs or interventions which are going to be
c. Perceived benefits provided for the community.
d. Perceived barriers
 One method of measuring the population size is by 2. Age Composition: There are two ways to describe the age
determining the increase in the population resulting from excess of composition of the population.
births compared to deaths. This can be done in two ways: a. Median age divides the population into two equal parts. So,
1. Natural increase is simply the difference between the if the median age is said to be 19 years old, it means half of
number of births and the number of deaths occurring in a the population belongs to 19 years and above, while the
population in a specified period of time. other half belongs to ages below 19 years old.
b. Dependency ratio compares the number of economically
Natural increase = (Number of immigrants + Number of births) - dependent with the economically productive group in the
(Number of deaths + Number of emigrant) population. The economically dependent are those who
belong to 0-14 and 65 and above age groups. Considered
to be economically productive are those within the 15 to 64
2. Rate of Natural Increase is the difference between the Crude are group. The dependency ratio represents the number of
Birth Rate and the Crude Death Rate occurring in a economically productive.
population in a specified period of time.
3. Age and Sex Composition of the population can be
Rate Natural increase = (Crude Birth Rate) - (Crude Death described at the same time using population pyramid. It is a
Rate) graphical presentation of the age and sex composition of the
population.

The second method of measuring population size is to determine Spatial Distribution

the increase in the population using data obtained during two census The distribution of the population in space can be described in terms
periods. This implies that the increase in the size of the population is of urban-rural distributions, population density and crowding index.
not merely attributed to excess in births but also effect of migration. The measures help the nurse decide how meager resources can be
These are: justifiably allocated based on concentration of population in a certain
place
1. Absolute increase per year measures the number of people 1. Urban-rural distribution simply illustrates the proportion of
that are added to the population per year. the people living in urban compared to the rural areas.
2. Crowding index will describe the ease by which a
communicable disease will be transmitted from one host to
another susceptible host. This is described by dividing the
number of persons in a household with the number of rooms
used by the family for sleeping.
3. Population density will determine how congested a place is
and has implications in terms of the adequacy of basic health
services present in the community. It can be computed by
dividing the number of people living in a given land area
2. Relative increase is the actual difference between the two
census counts expresses in percent relative to the Health Indicators
population size made during an earlier census. The Global Reference List of 100 Core Health Indicators is
a standard set of 100 indicators prioritized by the global community to
provide concise information on the health situation and trends,
including responses at national and global levels. It will be reviewed
and updated periodically as global and country priorities evolve, and
measurement methods improve. This publication contains the 2015
version.

Population Composition A. Crude Birth Rate: a measure of one characteristics of the

The composition of the population is commonly described in natural growth or increase of a population.
terms of its age and sex. The nurse utilizes data on age and sex
composition to decide who among the population groups merits Total No. of live births registered in a given calendar year
attention in terms of health services and programs. CBR =
1. Sex composition: To describe the sex composition of the Estimated Population as of July 1 of same year x 1,000
population, the nurse computes for the sex ratio. The sex
ratio compares the number of females in the population, it B. Crude Death Rate: a measure of one mortality from all
represents the number of males for every 100 females in the causes that may decrease population
population.
Total No. of live deaths registered in a given calendar year
CDR =
Estimated Population as of July 1 of same year x 1,000
Infant Mortality Rate: measures the risk of dying during the 1sy year
of life. It is a useful index of a community's general health condition
since it reflects the changes in the environment and medical conditions
of a community.

Total No. of live deaths under 1 year of age in a given

calendar year
IMR =
Total No. of registered live births of the same calendar year
x 1,000

Rates Specific Rates of Mortality: measure the frequency of

occurrence of death in a defined population during a specified interval.
Morbidity and mortality measures are often the same mathematically;
it's just a matter of what you choose to measure, illness, or death. The Philippine Health Situation
formula for the mortality of a defined population, over a specified The Health Systems in Transition (HiT) profiles are country-
period. based reports that provide a detailed description of a health system
and reform and policy initiatives in progress or under development in
Deaths occurring during a given period a specific country. Each profile is produced by country experts in
Mortality = collaboration with two international editors. To facilitate comparisons
Size of the population among which the deaths occurred x 1,000 between countries, the patterns are based on a template, which is
revised periodically. The template provides detailed guidelines and
Leading Causes of Morbidity: refers to having a disease or a symptom specific questions, definitions, and examples needed to compile a
of disease, or to the amount of disease within a population. Morbidity profile.
also refers to medical problems caused by a treatment. The Philippines is an archipelago in the South-East Asia
Region, with a population of 104.9 million as of 2017. It is the thirteenth
most populous country in the world. The majority of Filipinos are
Christian Malays (92.2%), with Roman Catholics constituting 87.4% of
the Christian population. Muslim minority groups, comprising 5.6%,
are concentrated in Mindanao. The country has an adult literacy rate
of 96.5%. The Philippines is currently one of Asia's fastest-growing
economies, with a gross domestic product growth of 6.7% at the end
of 2017. Categorized as a newly industrialized country, it is
transitioning from one based on agriculture to one based more on
services and manufacturing. Filipinos tend to live longer now than in
previous decades, with life expectancy at birth increasing from 62.2
years in 1980 to 69.1 years in 2016.

Health Service Delivery System

Health service delivery Health is a basic human right
guaranteed by the Philippine Constitution of 1987. This is provided in
the Philippines through a dual health delivery system composed of the
public and private sectors. The public sector is largely financed
through a tax-based budgeting system, where government facilities
deliver health services under the national and local governments. The
Department of Health (DOH) supervises the government-corporate
hospitals, specialty, and regional hospitals, while the Department of
National Defense runs the military hospitals. At the local level, the
Leading Causes of Mortality refers to the number of deaths
provincial governments manage and operate district and provincial
in a given area or period, or from a particular cause.
hospitals, while municipal governments provide primary care,
The leading causes of death are diseases of the heart,
including preventive and promotive health services and other public
diseases of the vascular system, pneumonias, malignant
health programs through the rural health units, health centers, and
neoplasms/cancers, and all forms of tuberculosis, accidents, COPD
barangay health stations.
and allied conditions, diabetes mellitus, nephritis /nephritic syndrome
Highly urbanized and independent cities provide both
and other diseases of respiratory system. Among these diseases, six
hospital services and primary care services. The private sector,
are non-communicable and four are the major NCDs such as CVD,
consisting of for-profit and non-profit healthcare providers, is largely
cancers, COPD, and diabetes mellitus.
market oriented, where health care is generally paid for through user
Life Expectancy refers to the number of years a person can
fees at the point of service. The introduction of social health insurance
expect to live. By definition, life expectancy is based on an estimate of
administered by the Philippine Health Insurance Corporation
the average age that a particular population group will be when they
(PhilHealth) since 1995 aimed to provide financial risk protection for
die.
the Filipino people. The rapid expansion of its membership in the past
five years is considered a positive development as the government
pursues universal health coverage. In terms of physical infrastructure, the growing population, overprovision of physicians, underprovision of
the Philippine health sector has 1224 hospitals, 2587 city/rural health care, and poor physician adherence to clinical practice guidelines
centers, and 20 216 village health stations (2016 figures). contribute to low quality of care.

Health Financing Health Status

Total health expenditure (THE) has consistently increased Filipinos tend to live longer now than in previous decades,
since 2005 and compares well with neighbors like Indonesia. with life expectancy at birth increasing from 62 years in 1980 to 69
Government health expenditure has increased significantly in nominal years in 2016. Filipinas live longer (73 years) than their men
terms, but it has been eclipsed by private sector funding sources, counterparts (66 years). The life expectancy trend is reflective of
which have grown rapidly with the economy. Much of THE is for improving living conditions in recent years. Mortality rates declined
personal care, although the government has raised public health from 291 and 209 per 1000 men and women, in 1980 to 261 and 136,
spending since 2007. The three major flows of public health financing respectively, in 2016 (Table 1.3). The past is characterized by difficult
have overlapping coverage. The DOH funds regional and apex times with sporadic armed conflicts in the countryside, pervasive
hospitals, while local government units (LGUs) fund primary- and political unrest and mass protests in urban centers, widespread
secondary-level care. PhilHealth reimburses government as well as poverty and income inequality across the country, poor nutrition, and
private health facilities. It reportedly covers 92% of the population, 40% inadequate health care underprivileged majority.
of which is the poor population, and subsidized by the government for
premium payments. Covered services are focused on inpatient care
and inadequate outpatient care that only covers PhilHealth's poor
members. Financial protection is limited, resulting in a high level of
household out-of-pocket (OOP) payment.

Health Governance and Regulation

As the national technical authority on health, the DOH
provides national policy direction and strategic plans, regulatory
services, standards and guidelines for health, and highly specialized
and specific tertiary-level hospital services. It provides leadership,
While the country continues to combat pneumonia and TB
technical assistance, capacity building, linkages, and coordination with
as the leading cause of death among Filipinos, it faces an increasing
other national government agencies, LGUs, and private entities in
number of diseases of the heart, diseases of the vascular system,
implementing health policies. On the other hand, the LGUs, i.e.,
malignant neoplasms, and diabetes. Among external causes, road
provincial, city, and municipal governments, are responsible for
traffic accidents are also becoming a major cause of death. This
managing and implementing local health programs and services. A
essentially places the Philippines in epidemiological transition,
local health board chaired by the local chief executive (governor or
referred to as the triple burden of disease, in light of the observed rise
mayor) serves as an advisory body to the local chief executives and
in NCDs and the actual prevalence of infectious diseases, and the
the local legislative council members (sanggunian) on the local health
health impact of globalization and climate change. This disease
system. Simultaneously, the DOH Regional Health Office is
pattern indicates that even as degenerative diseases and other
represented by either a DOH representative or Development
lifestyle-related illnesses increase, communicable diseases are still
Management Officer under the DOH Provincial Health Team. In
widely prevalent. At the same time, road safety has become a severe
Mindanao, a distinct subnational entity called the Autonomous Region
public health problem.
in Muslim Mindanao (ARMM) was created by Republic Act No. 6734,
as amended by Republic Act No. 9054. ARMM consists of five
provinces and has its own regional Department of Health directly
responsible to the ARMM Regional Governor. It directly administers
the provincial, city and municipal health offices, and the provincial and
district hospitals within the autonomous region. Key health reforms are
articulated (or sometimes renamed) in every administration.

Health System Performance

The national objectives for health (NOH) have well-specified
targets, but local governments' progress towards these targets
remains highly uneven due to devolved health financing and service
delivery. While PhilHealth membership coverage has expanded, its
benefits coverage remains mainly for inpatient care, and it provides
only limited financial support. Access remains highly inequitable due
to the misdistribution of facilities, health staff, and specialists. While
deployment programs are easing these problems somewhat, these
strategies result in monitoring and sustainability problems. Patient
satisfaction and user experience of health services may show
improvements. Still, balance billing, i.e., service charges set by the
hospital, which are not covered by PhilHealth case rate payment, are
billed to the patient, and outside-hospital purchases continue to
impoverish patients. The limited number of health facilities relative to
Epidemiology and the Nurse 7. One of the most commonly used types of graph and are used to
A nurse epidemiologist investigates trends in groups or display and compare the number, frequency or other measure (e.g.
aggregates and studies the occurrence of diseases and injuries. The mean) for different discrete categories or groups. The graph is
information is gathered from census data, vital statistics, and constructed such that the heights or lengths of the different bars are
reportable disease records. Nurse epidemiologists identify people or proportional to the size of the category they represent.
populations at high risk; monitor the progress of diseases; specify a. Bar Graph
areas of health care need; determine priorities, size, and scope of b. Line Graph
programs; and evaluate their impact. They generally do not provide c. Pie Chart
direct patient care, but serve as a resource and plan educational d. Histogram
programs. They also publish results of studies and statistical analysis
of morbidity and mortality. 8. This is a special form of bar chart where the data represent
continuous rather than discrete categories. For example it could be
POST TEST used to present details of the average number of hours exercise
carried out by people of different ages because age is a continuous
1. It may be collected either through observation or through direct rather than a discrete category
communication with respondents in one form or another through a. Bar Graph
personal interviews/ b. Line Graph
a. Primary Data c. Pie Chart
b. Secondary Data d. Histogram
c. Both a and b
d. None of the above 9. These are a visual way of displaying how the total data are
distributed between different categories. The example here shows the
2. The information is sought by way of investigator’s own direct proportional distribution of visitors between different types of tourist
observation without asking from the respondent. attractions.
a. Observation a. Bar Graph
b. Survey b. Line Graph
c. Personal interview c. Pie Chart
d. Community Forum d. Histogram

3. It is an open discussion where community residents gather in order 10. These are usually used to show time series data – that is how one
to raise important issues affecting them, such as health problems in or more variables vary over a continuous period of time.
their neighborhood. a. Bar Graph
a. Observation b. Line Graph
b. Survey c. Pie Chart
c. Personal interview d. Histogram
d. Community Forum

4. In this method the nurse asks questions generally in a face to face UNIT 4: Nursing Process in the Care of Population
contact. This method obtained more and reliable information. Personal
information can be obtained easily under this method. Groups and Community
a. Observation
b. Survey
c. Personal interview Overview
d. Community Forum Community health purposes and goals are realized through
application of series of steps that lead to desired results. The nursing
5. It is defined as the act of examining a process or questioning a process is central to all nursing actions, it is the essence of nursing
selected sample of individuals to obtain data about a service, product, that is applicable in any setting. The nursing process is a systematic,
or process. scientific, dynamic, ongoing interpersonal process in which the nurses
a. Observation and the clients are viewed as a system with each affecting the other
b. Survey and both being affected by the factors within the behavior. In this unit
c. Personal interview you will learn nursing process in the care of population groups and
d. Community Forum community.

6. In this method data means data that are already available i.e., they Lesson Proper
refer to the data which have already been collected and analyzed by Assessment of Community Health Needs
someone else. A community needs assessment provides community
a. Primary Data leaders with a snapshot of local policy, systems, and environmental
b. Secondary Data change strategies currently in place and helps to identify areas for
c. Both a and b improvement. With this data, communities can map out a course for
d. None of the above health improvement by creating strategies to make positive and
sustainable changes in their communities.
Components of a Needs Assessment C. Disease Registries
Health status is an individual's relative level of wellness and A disease registry is a special database that contains
illness, taking into account the presence of biological or physiological information about people diagnosed with a specific type of disease.
dysfunction, symptoms, and functional impairment. Health resources Most disease registries are either hospital based or population based.
includes financial resources (health spending) and human resources. A hospital-based registry contains data on all the patients with a
Health spending measures the consumption of health services and specific type of disease diagnosed and treated at that hospital. A
goods, including outpatient care, hospital care, long-term care, population-based registry contains records for people diagnosed with
pharmaceuticals and other medical goods, prevention and public a specific disease type who reside within a defined geographic region.
health services, and administration. For example, a hospital can have a breast cancer registry with records
for all the women in their breast cancer treatment program. The
Community Assessment Tools hospital-based registry would not include all the women with breast
Assessment provides an estimate of the degree to which a cancer in the community, since some women may go elsewhere for
family, group or community is achieving the health possible for them, treatment.
identifies specific deficiencies or guidance needed and estimates the
possible effects of the nursing interventions. D. Census Data
Information about the members of a given population
Primary Data collected from a government census. A census is a regularly-occurring
Collecting Primary Data- it may be obtained either through and official count of a particular population. Census data provides
observation or through direct communication with respondents in one more than just a population count. Other variables include ethnicity
form or another through personal interviews. There are several ways breakdowns, income, and housing values.
of collecting pri-mary data. Primary data can be obtained in several
ways. However, the most common techniques are observation, Methods to present Community Data
survey, and informant interview and community forum. Primary data There are many ways in which you can present community
collection is quite expensive and time consuming compared to numerical data. There will likely be occasions when you have
secondary data collection. numerical information that you want to include in your assessment, for
In observation method, the information is sought by way of example figures and other statistics from secondary sources (such as
investi-gator's own direct observation without asking the respondent. registry of vital events, health records and reports, disease registry and
A survey is defined as the act of examining a process or questioning a census data); the results of survey; or data that you have collected and
selected sample of individuals to obtain data about a service, product, analyzed as a result of observation. Such information can be used to
or process. Data collection surveys collect information from a targeted illustrate an argument or concisely convey complex or detailed
group of people about their opinions, behavior, or knowledge. information.
In the personal interviews, the interviewer asks questions
gen-erally in a face to face contact. Through interview method more A. Bar Graph
and reliable information may be obtained. Personal information can be Bar charts are one of the most commonly used types of graph
obtained easily under this method. However, it is a very expensive and and are used to display and compare the number, frequency or other
time-consuming method, especially when large and widely spread measure (e.g. mean) for different discrete categories or groups. The
geographical samples are taken. graph is constructed such that the heights or lengths of the different
A community forum is an open discussion where community bars are proportional to the size of the category they represent. Since
residents gather to raise important issues affecting them, such as the x axis (the horizontal axis) represents the different categories it has
health problems in their neighborhood. This community discussion's no scale. The y-axis (the vertical axis) does have a scale and this
primary purpose is to obtain input from a wide range of residents and indicates the units of measurement. The bars can be drawn either
stakeholders concerning their needs and identifying resources for vertically or horizontally depending upon the categories and length or
addressing health problems. complexity of the category labels. There are various ways in which bar
charts can be constructed, making them a very flexible chart type.
Secondary Data Sources
Secondary data means data that are already available i.e., B. Histogram
they refer to the data which have already been collected and analyzed Histograms are a special form of bar chart where the data
by someone else. represent continuous rather than discrete categories. For example, a
histogram could be used to present details of the average number of
A. Registry of Vital Events hours exercise carried out by people of different ages because age is
a continuous rather than a discrete category. However, because a
A well-functioning civil registration and vital statistics
continuous category may have many possible values the data are
(CRVS) system registers all births and deaths, issues birth and death
often grouped to reduce the number of data points. For example,
certificates, and compiles and disseminates vital statistics, including instead of drawing a bar for each individual age between 0 and 65, the
cause of death information. data could be grouped into a series of continuous age ranges such as
16-24, 25-34, 35-44, etc. Unlike a bar chart, in a histogram both the x-
B. Health Records and Reports and y-axes have a scale. This means that it is the bar area that is
A comprehensive compilation of information traditionally proportional to the size of the category represented and not just its
placed in the medical record but also covering aspects of the client’s height.
physical, mental, and social health that do not necessarily relate
directly to the condition under treatment.
 C. Pie Charts information: Social Indicators, Economic Indicators, and
Pie charts are a visual way of displaying how the total data are Environmental Indicators, Cultural Factors.
distributed between different categories. The example here shows the
proportional distribution of visitors between different types of tourist C. Political/ Leadership Patterns
attractions. Similar uses of a pie chart would be to show the The process of community diagnosis consists of collecting,
percentage of the total votes received by each party in an election. Pie organizing, synthesizing, analyzing and interpreting health data.
charts should only be used for displaying nominal data (i.e. data that Before the community health nurse collects data, the objectives must
are classed into different categories). They are generally best for be determined as these will dictate the depth or the scope of the
showing information grouped into a small number of categories and community diagnosis. She needs to resolve whether a comprehensive
are a graphical way of displaying data that might otherwise be or a problem- oriented community diagnosis will accomplish her
presented as a simple table. objectives.

D. Line Graph Steps in Conducting Community Diagnosis

Line graphs are usually used to show time series data – that is In order to generate a broad range of useful data, the community
how one or more variables vary over a continuous period of time. diagnosis must be carried out in an organized and systematic manner
Typical examples of the types of data that can be presented using line keeping in mind that the community should take an active part in
graphs are monthly rainfall and annual unemployment rates. identifying community needs.
1. Determining the Objectives. In determining the objectives
E. Scatter Plots of the community diagnosis, the nurse decides on the depth
Scatter plots are used to show the relationship between pairs of and scope of the data she needs to gather.
quantitative measurements made for the same object or individual. For 2. Defining the Study Population. Based on the objectives of
example, a scatter plot could be used to present information about the the community diagnosis, the nurse identifies the population
examination and coursework marks for each of the students in a class. group to be included in the study.
In the example here, the paired measurements are the age and height 3. Determining the Data to be collected. Whether the
of children. community diagnosis is going to be comprehensive or
focused on specific problem, the objectives will guide the
Community Diagnosis nurse in identifying the specific data she will collect.
In the assessment of the community’s health status, the 4. Collecting the Data. In conducting community diagnosis,
nurse considers the degree of detail or depth she should go into. A different methods may be utilized to generate health data. In
nurse may decide to assess a specific population group in a general, we use the methods such as records review,
community, in which case, she may not opt to conduct comprehensive surveys and observations, interviews, and participant
assessment of that group and at the same time, focus on the specific observation.
problems of that same group. It is important therefore, to decide on the 5. Developing the Instrument. Instruments or tools facilitate
objectives of the community diagnosis, the resources and time the nurse’s data gathering activities. The most common
available to implement. instruments are survey questionnaire, interview guide and
observation checklist
Traditional/ Comprehensive Community Diagnosis 6. Actual Data Gathering. Before the actual data gathering, it
A comprehensive community diagnosis aims to obtain is suggested that the nurse meet the people who will involve
general information about the community. The following are the in the data collection. The data collectors must be given an
elements of a comprehensive community diagnosis: orientation and training on how they are going to use the
instruments in data gathering. During the actual data
A. Demographic variables gathering, the nurse supervises the data collectors by
The analysis of the community’s demographic characteristics checking the filled-up instruments in terms of completeness,
should show the size, composition and geographical distribution of the accuracy and reliability of the information collected.
population as indicated by the following: 7. Data Collation. After data collection, the nurse is now ready
1. Total population and geographical distribution including to put together all information. There are two types of data
urban-rural index and population density. that may be generated. They are either numerical data which
2. Age and sex composition. can be counted or descriptive data which can be described.
3. Selected vital indicators such as growth rate, crude birth 8. Data Presentation. Data presentation will depend largely
rate, crude death rate and life expectant at birth on the type of data obtained. Descriptive data are presented
4. Patterns of migration in narrative reports.
5. Population projections 9. Data analysis in community diagnosis aims to
established trends and patterns in terms of health needs and
It is also important to know whether there are population groups that problems of the community. It also allows for comparison of
need special attention such as indigenous people, internal refugees obtained data with standard values.
and other socially dislocated groups as a result of disasters, calamities 10. Identifying Community Health Nursing Problems.
and development programs. Community health nursing problems are categorized as:
a. Health status problems is described in terms of increased or
B. Socio-Economic and Cultural Variables decreased morbidity, mortality, fertility, or reduced capability
There are no limits as to the list of socio-economic and cultural for wellness.
factors that may directly or indirectly affect the community's health
status. However, the nurse should consider the following essential
 b. Health resources problems is described in terms of lack of Its fundamental principles are that the research subjects
or absence of manpower, money, materials, or institutions become involved as partners in the process of the inquiry and that their
necessary to solve health problems, knowledge and capabilities are respected and valued. Participatory
c. Health related problems is described in terms of existence research is ultimately about relationships and power. The key contacts
of social, economic, environmental, and political factors that are between the researcher and the researched, and between local
aggravate the illness-inducing situations in the community. people and those actors they see as powerful and who affect their
11. Priority Setting. After the problems have been identified, lives. Participatory researchers act as facilitators and work towards
the next task is to prioritize which health problems can be attaining equality in these two relationships. Local people involved in
attended to considering the resources available at the participatory research processes are often subordinate in their own
moment. In priority setting, the following criteria: social context, while outside researchers are often perceived as
a. Nature of the condition/problem presented- problems are experts who impose their views. Transforming these dynamics is
classified by the nurse as health status, health resources or achieved by enabling local people to articulate their views and express
health-related problems. their knowledge by describing and analyzing their own situations and
b. Magnitude of the problem-refers to the severity of the problems. Many participatory research processes also have an action
problem which can be measured in terms of the proportion component that involves the participants in successive cycles of
of the population affected by the problem. analysis, reflection and action.
c. Modifiability of the problem-refers to the probability of
reducing, controlling or eradicating the problem.
d. Preventive potential-refers to the probability of controlling or
reducing the effects posed by the problem.
e. Social concern-refers to the perception of the population or
the community as they are affected by the problem and their
readiness to act on the problem.

Schemes in Stating Community Diagnosis

After analyzing the data, the next step is to make a definitive
statement (diagnosis) identifying the problem or the needs. Nursing
diagnoses for communities may be formulated regarding the following
issues: Inaccessible and unavailable services, Mortality and morbidity
rates, Communicable disease rates, Specific populations at risk for
physical or emotional problems, Health-promotion needs for specific
populations, Community dysfunction, 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 as a result 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
Participatory Action Research
expanded to include individuals and families' biological, psychological,
Participatory Action Research (PAR) is an approach to
and social needs. Because of ongoing refinement, the taxonomy of
enquiry which has been used since the 1940s. It involves researchers
nursing diagnoses at present has 11 functional health patterns. Tools
and participants working together to understand a problematic
have been developed to assess the community using the functional
situation and change it for the better. There are many definitions of the
health pattern typology (Gikow & Kucharski, 1987; Wright, 1985).
approach, which share some common elements. PAR focuses on
Newer NANDA diagnoses may also apply to communities; examples
social change that promotes democracy and challenges inequality; is
include the diagnosis of impaired home maintenance and impaired
context-specific, often targeted on the needs of a particular group; is
social interaction.
an iterative cycle of research, action and reflection; and often seeks to
Other classification systems have been developed in an
‘liberate’ participants to have a greater awareness of their situation in
attempt to address the community. One example is the Omaha
order to take action. PAR uses a range of different methods, both
System, written by community/public health nurses for
qualitative and quantitative.
community/public health nursing practice (Martin, 2005). The system
was designed by the Omaha Visiting Nurse Association and has been
used in-home care, public health, and school health practice settings, In the context of health systems, priority-setting is about the
among others. Client problems/needs/concerns are organized into allocation of resources to innovative high-cost medicines or new
four domains: physiological, psychosocial, health-related behaviors, vaccines and its introduction in public health programs; prevention, or
and environmental. Each domain may involve actual or potential primary care; to training community workers or specialists; about
problems or opportunities for health promotion. The system includes deciding which population subgroups ought to receive subsidized
four categories of interventions: teaching, guidance, and counseling; care; even about complex policy interventions such as introducing pay-
treatments and procedures; case management; and surveillance. for-performance schemes for remunerating providers. As in the case
Although originally developed for application with individuals or of specific drugs or surgical procedures, establishing priorities
families, users are now applying the problem domains and concerning human resource capacity, infrastructure investment,
interventions with communities (Martin, 2005). The Omaha System provider payment, or premium setting for service delivery also requires
includes more environmental and community factors than are systematic consideration of available evidence. And while such
considered in the NANDA system. evidence may be more readily available in pharmaceuticals, policy-
Because of the multiple nursing diagnostic and classification makers still need to address the same two broad sets of issues when
systems, the NNN Alliance has formed to develop a consistent considering more complex service delivery and policy interventions.
classification system. The NNN Alliance is a collaboration of NANDA These are: first, the relative effectiveness of rival alternative
and the Center for Nursing Classification and Clinical Effectiveness interventions and, second, the value to be placed on the outcomes for
(CNC). The taxonomy developed by the NNN Alliance has four each alternative. Even in the absence of technical skills or data, a
domains (Dochterman & Jones, 2003). The one relevant to community structured approach setting out each option's costs and benefits can
health practice is the environmental domain, with three subsets: make trade-offs explicit, highlight assumptions and gaps in evidence,
healthcare system, populations, and aggregates. All three subgroups and reveal values underpinning decisions.
have diagnosis, outcome, and intervention arenas. This process can also help ensure engagement with clients
A nursing diagnosis has three components: a descriptive and stakeholders in collating, reviewing, and interpreting the evidence,
statement of the problem, response, or state; identification of factors making implementation and impact more likely. Decision-making
etiologically related to the problem; and signs and symptoms that are processes will inevitably reflect expert judgments when data for
characteristic of the problem (Carpenito, 2000). sophisticated modeling, or the local skills for analysis, are unavailable.
In such circumstances, it is important to interpret evidence from other
Planning Community Interventions settings and assess its relevance. Core principles for planning,
The World Health Organization's (1978) definition of health conduct, and reporting of economic evaluations have been suggested.
emphasizes not only the prevailing physical and mental conditions of Priority-setting is about making explicit choices about what
the people and community. It also considers the political, economic to fund and weighing the trade-offs between the various options. All
and social and cultural dimensions that affet their living conditions and health systems set priorities: these are reflected in the technologies
quality of life. The interventions of the nurse cannot be limited to and services paid for and the investments made in training and
actions geared towards the reduction of mortality and morbidity. infrastructure. Whether implicitly or explicitly, driven by local players or
global donors, priorities become established even in settings where
Priority Setting / Priority-setting for Achieving Universal Health the institutions, data, and technical expertise for doing so effectively
Coverage by WHO and fairly are weak or non-existent. Thus the question is not whether
Universal health coverage (UHC) has been defined as "the to set priorities – but how to improve priority-setting processes.
desired outcome of health system performance whereby all people In terms of protocol, priority-setting broadly involves four
who need health services receive them, without undue financial steps, which are: (i) identifying interventions or issues to be
hardship." However, most countries' scarce resources cannot ensure considered; (ii) finding evidence; (iii) making decisions and (iv) making
that everyone obtains every beneficial health service at an affordable appeals. While different stakeholders may have various capacities and
price. Therefore, priority setting is required to provide a therefore varying contributions at each stage of the process,
comprehensive range of key services, which are well aligned with experiences indicate that broad stakeholder participation, uniquely
other social goals, to which all people should have access. The engaging civil society, and the public, is important for the long-term
question then arises: how comprehensive is comprehensive? sustainability of the process.
Definitions and indicators of essential health services, as well as Priority-setting can be difficult if the evidence is not properly
financial protection, have recently been suggested to guide countries considered because stakeholders have different perspectives and
on implementing UHC. Policy-makers then need to make choices interests. Evidence can be considered in several ways depending on
about what health services to provide, for whom, at what price and at available resources and the principles identified, which can include
what quality. quantitative or qualitative, global or local, clinical, social, or economic
The configuration of UHC is country specific, since the and primary or secondary evidence. The groups responsible for
demography, epidemiology, culture and history, as well as spending generating the evidence should have academic integrity and limited
requirements and available resources are different for every country. conflicts of interest. It is also important that the evidence generated is
Many countries set priorities using waiting lists by compromising the comparable across interventions. In some countries with limited
quality of care by not providing certain services to some populations capacity, the government may allow the industry to provide evidence,
or geographic areas or charging user fees that only some can afford resulting in the need for mechanisms to ensure the evidence's
to pay. reliability and validity, for example, through the establishment of
Priority-setting in health care has been defined as: “the task methodological guidelines and independent review. In cases of limited
of determining the priority to be assigned to a service, a service capacity and infrastructure, there may be limitations in the availability
development or an individual patient at a given point in time. of local evidence; the attempt to generate relevant evidence can
Prioritization is needed because claims (whether needs or demands) thereby help build capacity for generating local data.
on healthcare resources are greater than the resources available.
Formulating Goals and Objectives improve the population's health status and enhance the community's
“Where do we want to go?" refers to formulating goals and capability to manage their own health.
objectives of the health program and nursing services to change the
community's status. Goals and objectives will serve as guide to the Partnership and Collaboration
nurse's efforts. A goal is a declaration of purpose or intent that fives Health and health-related problems in the community are
essential direction to action. Objectives are stated in behavioral terms: varied. The problems are often complicated and too many for the nurse
specific, measurable, attainable, realistic, and time-bounded. and the people or their organization to handle. They cannot solve the
problems alone. They must work with other people or groups to
increase the probability of accomplishing the goals that they have set.
Partnership and collaboration aim to get people to work together in
order to address problems or concerns that affect them. It gives people
the opportunity to learn skills in-group relationships, interpersonal
relations, critical analysis, and, most important of all, the decision-
making process in the context of democratic leadership.
Deciding on Community Intervention/ Action Plan
“How do we get there?” defines the strategies and activities Activities involved in collaboration and advocacy
that the nurse sets to achieve in order to realize the goals and Working together enables organizations to accomplish their
objectives. goals much quicker because of resources, skills, and views are pooled
Conduct a community-based assessment and planning together.
process to be sure that you're addressing the most appropriate and Activities in Collaboration includes: Networking,
pressing issues for the community. If your intervention is to work, it has Coordination, Cooperation, and Coalition.
to be aimed at the real issues the community needs to address. An Advocacy work is one way the nurse can promote active
assets and needs assessment and planning process will help you community participation. The nurse helps the people attain the optimal
identify those issues accurately and think about how to approach them degree of independence in decision making in asserting their rights to
most effectively. a safe and better community. Advocacy work includes: Informing the
Decide whether you'll address the issue directly or try to people about the rightness of the cause; thoroughly discussing with
change the conditions that make it possible. It may be that working on the people the nature of the alternatives, their content and possible
their causes will be more successful than coming at the issues consequences; supporting people's right to make a choice and to act
themselves directly, and that could mean a totally different kind of on their choice; influencing public opinion.
intervention.
Find (or create, if that's necessary) practices or interventions Community organizing and social mobilization
that have successfully addressed the issue in the way you want to Community organizing is a process where people who live
address it. It's important to realize that not every successful program in proximity to each other come together into an organization that acts
is successful in the way that you're interested in. If your focus is in their shared self-interest. Unlike those who promote more-
community empowerment, for instance, a top-down authoritarian consensual community building, community organizers generally
program, no matter how successful, isn't what you're looking for. If you assume that social change necessarily involves conflict and social
want to get at the root causes of a problem, a program that does a struggle in order to generate collective power for the powerless.
terrific job of treating the symptoms isn't a good fit for you. Ensure that Community organizing has as a core goal the generation of durable
practice or intervention matches your immediate needs - reducing power for an organization representing the community, allowing it to
youth violence, e.g., but the assumptions behind them - empowering influence key decision-makers on a range of issues over time. In the
the community to change the root causes of youth violence and all but ideal, for example, this can get community-organizing groups a place
eliminate it over the long term. at the table before important decisions are made. Community
Determine what elements of a promising intervention will organizers work with and develop new local leaders, facilitating
work in your community, and which ones need to be changed. In other coalitions and assisting in developing campaigns. A central goal of
words, change the intervention, or parts of it, so that it suits your organizing is developing a robust, organized, local democracy bringing
community's needs. Not all the pieces of an urban program will work community members together across differences to fight together for
in a rural area, for instance, where the realities of transportation, child the interests of the community. Community organizing is a process
care, culture, and everyday life all may be totally different. The whereby community members develop the capability to assess their
community and the target population need to make an adopted health needs and problems, plan and implement actions to solve these
practice or intervention their own and work for them. If it's true that no problems, put up and sustain organizational structures that will support
two communities are exactly alike, it should be equally true that and monitor implementation of health initiatives by the people.
interventions that work for them won't be exactly alike, either, though The World Organization defined social mobilization as the
they may have many common elements. process of bringing together all societal and personal influences to
raise awareness of and demand for health care, assist in the delivery
Implementing Community Health Interventions of resources and services, and cultivate sustainable individual and
Community health needs and problems are not solved by community involvement. In order to employ social mobilization,
simply inducing changes in personal and group attitudes and behavior. members of institutions, community partners and organizations, and
If one expects a lasting and sustainable solution, reforms have to be others collaborate to reach specific groups of people for intentional
carried out within the health care delivery system and a larger socio- dialogue. Social mobilization aims to facilitate change through an
economic and political system. Community health nursing interdisciplinary approach.
interventions must focus on providing health-related interventions to Principles of community organizing include: Community
development is a process; Community development is a holistic
approach for addressing the community's needs; Empowerment should be based on the interest of the poorest sector of the community.
results from influence, participation, and community education; COPAR should lead to a self-reliant community and society.
Development ensures environmental stewardships; Development is The critical steps of COPAR are: (1)Integration(2)Social
tied to sustainability; Partnership provides access to resources. Investigation(3)Tentative program
planning(4)Groundwork(5)Meeting(6) Role Play(7)Mobilization or
Goals of Community Organizing action(8)Evaluation(9)Reflection(10)Organization.
A core goal of community organizing is to generate durable
power for an organization representing the community, allowing it to Phases of COPAR
influence key decision-makers on a range of issues over time. In the COPAR has four phases, namely: Pre-Entry Phase, Entry
ideal, for example, this can get community organizing groups a place Phase, Organization-building phase, and sustenance and
at the table before important decisions are made. strengthening phase.
Their main objectives/aims are the following: to bring Pre-Entry Phase: Is the initial phase of the organizing
adjustment between the resources available and felt needs of the process where the community organizer looks for communities to
people; to get information about the resources and needs; To arouse serve and help. Activities include:
the people to work for the welfare of the community; To create sounds A. For preparation: Train faculty and students in COPAR.
ground for planning and action; To create a sense of cooperation Formulate plans for institutionalizing COPAR. Revise/enrich
integration and unity among people; To motivate the people to take curriculum and immersion program—coordinate participants
better participation in the developing community programs ; To of other departments.
highlight the causes of various problems affecting the community and B. For Site Selection: Initial networking with local government.
hinder the way of progress and development ;To implement programs Conduct preliminary special investigation. Make a long/short
required for the fulfillment of people basic; To develop better list of potential communities. Do an ocular survey of listed
understanding among the people about the issues and needs; To communities.
mobilize the resources to create a suitable ground for the basic needs C. Criteria for Initial Site Selection: Must have a population
completion and eradication of problems; To bring coordination of 100-200 families. Economically depressed. No strong
between the individuals, groups and organization to focus their point resistance from the community. No serious peace and order
and challenge their objectives for fulfillment; To launch necessary problem. No similar group or organization holding the same
reforms in the community for eradication of community evils; To program.
develop democratic leadership among people through their D. In identifying potential municipalities: Do the same
participation in community programs; To develop the idea of ability and process as in selecting municipality. Consult key informants
better thinking to work for the betterment of community; To abolish the and residents. Coordinate with local government and NGOs
differences among individuals, develop spirit of common interest and for future activities.
sacrifice and also participate collectively in community programs; To E. In choosing the final community: Conduct informal
organize the people for the promotion and progress of community; interviews with community residents and key informants.
Removal of blocks to growth (in individuals, groups as well as in Determine the need for the program in the community. Take
communities); Release of full potentialities (in individuals, groups as note of political development. Develop community profiles
well as in communities); Full use of inner resources (in individuals, for secondary data. Develop survey tools. Pay a courtesy
groups as well as in communities); Development of capacity to call to community leaders. Choose foster families based on
manage one's own (individual, group & community) life; Increasing the guidelines.
ability to function as an integrated unit. F. In identifying Host Family: House is strategically located
in the community. They should not belong to the rich
Community Organizing Participatory Research (COPAR) segment. Both formal and informal leaders respect them.
COPAR or Community Organizing Participatory Action Neighbors are not hesitant to enter the house. No member
Research is a vital part of public health nursing. COPAR aims to of the host family should be moving out in the community.
transform the apathetic, individualistic, and voiceless poor into a
dynamic, participatory, and politically responsive community. Entry Phase is sometimes called the social preparation phase. It
The following are the emphasis of COPAR: Community is crucial in determining which strategies for organizing would suit the
working to solve its own problem. The direction is established internally chosen community. The success of the activities depends on how
and externally. The development and implementation of a specific much the community organizers have integrated with the community.
project are less important than the development of the community's A. Guidelines for Entry: Recognize local authorities' role by
capacity to establish the plan. Consciousness-raising involves paying them visits to inform their presence and activities. Her
perceiving health and medical care within the total structure of society. appearance, speech, behavior, and lifestyle should be in
The following are the importance of COPAR: COPAR is an keeping with those of the community residents without
important tool for community development, and people empowerment. disregard of their being role model. Avoid raising the
This helps the community workers generate community participation consciousness of the community residents; adopt a low-key
in development activities. COPAR prepares people/clients to profile.
eventually take over the management of a development programs in B. Activities in the Entry Phase: Integration. Establishing
the future. COPAR maximizes community participation and rapport with the people in continuing effort to imbibe
involvement; community resources are mobilized for community community life, living with the community, seek out to
services. converse with people where they usually congregate, lend a
Principles of COPAR include: People, especially the most hand in household chores, avoid gambling and drinking.
oppressed, exploited, and deprived sectors are open to change, have Deepening social investigation/community study,
the capacity to change, and are able to bring about change. COPAR verification, and enrichment of data collected from the initial
 survey, conduct baseline survey by students, results relayed in the open, flies will feed on the excreta and can carry small amounts
through community assembly. of the excreta away on their bodies and feet. When they touch food,
C. For Core Group Formation: Leader spotting through the excreta and the germs in the excreta are passed onto the food,
sociogram. Key persons must be approachable by most which may later be eaten by another person. Some germs can grow
people. Must be an opinion leader. They are approached by on food and in a few hours their numbers can increase very quickly.
key persons and never or hardly consulted. Where there are germs there is always a risk of disease.
Approved types of toilet facilities:
Organization-building Phase. In this phase, the formation of a Level I:
more formal structure and the inclusion of more formal procedures of • Non-water carriage toilet facility
planning, implementing, and evaluating community-wide activities. At • Toilet facilities requiring small amount of water to wash the waste
this phase, the organized leaders or groups are being given training Level II:
(formal, informal, OJT) to develop their style in managing their own • On site toilet facilities of the water carriage type with water sealed
concerns/programs. and flush type with septic tank disposal facilities.
Key Activities include Community Health Organization (CHO) Level III:
(preparation of legal requirements, guidelines in the organization of the • Water carriage types of toilet facilities connected to septic tanks to
CHO by the core group, election of officers). Research Team sewerage system to treatment plants.
Committee. Planning Committee. Health Committee Organization.
Formation of by-laws by the CHO. Food Safety
Fast food has become a staple diet for busy people,
Sustenance and Strengthening Phase. In this phase, the especially when time is not enough for food preparation. What could
community organization has already been established, and the be worse than sinking your teeth into your favorite food, unperturbed
community members are already actively participating in community- to the fact that it is crawling with germs? You have already consumed
wide undertakings. At this point, the different committees set up in the and digested your meal before discovering that there is an additional
organization-building phase are already expected to be functioning by "ingredient," which is, without a doubt, a recipe for disaster. A person
planning, implementing, and evaluating their own programs, with the will more likely choose to starve to death than eat contaminated food.
overall guidance from the community-wide organization. There have been several complaints about food poisoning and unsafe
Key Activities include Training of CHO for monitoring and food handling practices. While some complainants are already well
implementing of community health programs. Identification of aware of the steps to take, others still need guidance so their
secondary leaders. Linkaging and networking. Conduct of mobilization complaints will not fall on deaf ears.
on health and development concerns. Implementation of livelihood The Republic Act No. 10611, otherwise known as the "Food
projects. Safety Act of 2013," strengthens our country's food safety regulatory
system. The law provides protection to consumers so they will have
Environmental Sanitation access to local foods and food products that have undergone thorough
Environmental Sanitation is still a health problem in the country. and rigid inspection.
Diarrheal disease ranked fifth in 2010 causes of morbidity among the
general population. The Department of Health, through the Under Section 3 of the Republic Act, the objectives are as follows:
Environment Health Services, has the authority to act on all issues and Protect the public from food-borne and water-borne illnesses
concerns in environment and health, including the Sanitation Code of and unsanitary, unwholesome, misbranded, or adulterated foods;
the Philippines (PD 856, 1978). The World Health Organization Enhance industry and consumer confidence in the food regulatory
defined Environmental Sanitation as the promotion of hygiene and the system, and Achieve economic growth and development by promoting
prevention of disease and other consequences of ill-health, relating to fair trade practices and sound regulatory foundation for domestic and
environmental factors. international trade.
The food safety regulatory system combines various
a. Environmental factors processes to ensure that food safety standards are met. Food safety
These are environmental factors which impact on the infectious agents standards refer to the formal documents, which contain the food
and transmission of disease. These include Disposal of human requirements that the food processors need to comply with such
excreta; Sewage; Household waste, and other waste likely to contain human health is safeguarded. These safety standards are
infectious agents; Water drainage; Domestic water supply; Housing. implemented by law and authorities. Some of the processes under the
regulatory system include inspection, testing, data collection,
b. Sanitation practices monitoring, and other activities carried out by various food safety
These are various hygienic practices of the communities, basic regulatory agencies.
knowledge, skills, human behaviors, and social and cultural factors
concerning health, lifestyles, and environmental awareness. These Sanitation
include: Personal hygiene (washing, dressing, eating); Household The World Health Organization defined sanitation as the provision of
cleanliness (kitchen, bathroom cleanliness); Community cleanliness facilities and services for the safe management of human excreta from
(waste collection, common places). the toilet to containment and storage and treatment onsite or
conveyance, treatment and eventual safe end use or disposal. More
Proper Excreta Disposal broadly sanitation also included the safe management of solid waste
Human excreta always contain large numbers of germs, and animal waste. Inadequate sanitation is a major cause of infectious
some of which may cause diarrhea. When people become infected diseases such as cholera, typhoid and dysentery world-wide. It also
with cholera, typhoid and hepatitis A, their excreta will contain large contributes to stunting and impaired cognitive function and impacts on
amounts of the germs that cause the disease. When people defecate well-being through school attendance, anxiety and safety with lifelong
consequences, especially for women and girls. Improving sanitation in urban environments extend beyond those of vector control, and
households, health facilities and schools underpins progress on a wide applying many of the basic principles can contribute substantially to
range of health and economic development issues including universal reducing the availability of Ae. aegypti larval habitats. Proper storage,
health coverage and combatting antimicrobial resistance. collection, and disposal of waste are essential for protecting public
health. The basic rule of "reduce, reuse, recycle" is highly applicable.
Vermin and Vector Control Efforts to reduce solid waste should be directed against discarded or
Environmental management seeks to change the environment in order non-essential containers, particularly if they have been identified in the
to prevent or minimize vector propagation and human contact with the community as important mosquito-producing containers.
vector-pathogen by destroying, altering, removing, or recycling non- Solid waste should be collected in plastic sacks and
essential containers that provide larval habitats. Such actions should disposed of regularly. The frequency of collection is important: twice
be the mainstay of dengue vector control. Three types of per week is recommended for houseflies and rodent control in warm
environmental management are defined: climates. Integration of Ae. aegypti control with waste management
1. Environmental modification – long-lasting physical services is possible and should be encouraged.
transformations to reduce larval vector habitats, such as the
installation of a reliable piped water supply to communities, Street cleansing
including household connections. A reliable and regular street cleansing system that removes
2. Environmental manipulation – temporary changes to discarded water bearing containers and cleans drains to ensure they
vector habitats involving the management of "essential" do not become stagnant and breed mosquitoes will both help to reduce
containers, such as frequent emptying and cleaning by larval habitats of Ae. aegypti and remove the origin of other urban
scrubbing of water storage vessels, flower vases, and desert pests.
room coolers; cleaning of gutters; sheltering stored tires
from rainfall; recycling or proper disposal of discarded Building structures
containers and tires; management or removal from the During the planning and construction of buildings and other
vicinity of homes of plants such as ornamental or wild infrastructure, including urban renewal schemes, and through
bromeliads that collect water in the leaf axils. legislation and regulation, opportunities arise to modify or reduce
3. Changes to human habitation or behavior – actions to potential larval habitats of urban disease vectors, including Ae.
reduce human – vector contact, such as installing mosquito aegypti, Culex quinquefasciatus, and An. stephensi. For example,
screening on windows, doors, and other entry points, and under revised legislation in Singapore, roof gutters are not permitted
using mosquito nets while sleeping during the daytime. on buildings in new developments because they are difficult to access
and maintain. Moreover, property owners are required to remove
Improvement of water supply and water-storage systems existing gutters on their premises if they are unable to maintain them
Improving water supplies is a fundamental method of satisfactorily.
controlling Aedes vectors, especially Ae. aegypti. Water piped to
households is preferable to water drawn from wells, communal Chemical control: larvicides
standpipes, rooftop catchments, and other water-storage systems. Although chemicals are widely used to treat Ae, aegypti
However, potable water must be supplied reliably so that water- larval habitats, larviciding should be considered as complementary to
storage containers that serve as larval habitats – such as drums, environmental management and – except in emergencies – should be
overhead or ground tanks, and concrete jars – are not necessary. In restricted to containers that cannot otherwise be eliminated or
urban areas, the use of cost-recovery mechanisms such as the managed. Larvicides may be impractical to apply in hard-to-reach
introduction of metered water may actually encourage household natural sites such as leaf axils and tree holes, which are common
collection and storage of roof catchment rainwater that can be habitats of Ae. albopictus, or in deep wells. The difficulty of accessing
harvested at no cost, resulting in the continued use of storage indoor larval habitats of Ae. aegypti (e.g. water-storage containers,
containers. plant vases, saucers) to apply larvicides is a major limitation in many
urban contexts.
Mosquito-proofing of water-storage containers
Water-storage containers can be designed to prevent Built Environment
access by mosquitoes for oviposition. Containers can be fitted with A built environment is developed in order to satisfy residents'
tight lids or if rain-filled, tightly-fitted mesh screens can allow for requirements. Human needs can be physiological or social and are
rainwater to be harvested from roofs while keeping mosquitoes out. related to security, respect, and self-expression. People want their built
Removable covers should be replaced every time water is removed environment to be aesthetically attractive and to be in an accessible
and should be well maintained to prevent damage that permits place with a well-developed infrastructure, convenient communication
mosquitoes to get in and out. access, and good roads, and the dwelling should also be
Expanded polystyrene beads used on the surface of water comparatively cheap, comfortable, with low maintenance costs, and
provide a physical barrier that inhibits oviposition in storage containers have sound and thermal insulation of walls. People are also interested
from which water is drawn from below via a pipe and from which there in ecologically clean and almost noiseless environments, with
is no risk of overflow. These beads can also be placed in septic tanks, sufficient relaxation options, shopping, fast access to work or other
which Ae. aegypti sometimes exploits. destinations, and good relationships with neighbors.

Solid waste management Monitoring and Evaluating Community Health Programs

In the context of dengue vector control, "solid waste" refers Monitoring and evaluation are essential management tools
mainly to non-biodegradable items of household, community, and that ensure that health activities are implemented as planned and
industrial waste. The benefits of reducing the amount of solid waste in assess whether desired results are being achieved. Monitoring is done
to provide concurrent feedback on the progress of activities, identify Types of Evaluation
the problems in their implementation, and take corrective action. There are three types of evaluation:
Evaluation is done to assess whether the program's desired results 1. Planning Evaluation: same as program monitoring.
have been achieved if not how it should be redesigned. Planning Evaluation programs are used to improve program
performance by influencing immediate decisions about the
activities, especially how they can be re-planned and/or
improved. It enables the assessment of: Who is being
reached by the program; what information is reaching them;
Whether or not things are going according to plan; The need
for change
2. Formative Evaluation: initial assessment in order to
develop appropriate, effective programs. The formative
evaluation comprises of activities undertaken to furnish
information that will guide the design of health programs.
Formative evaluation 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;
Monitoring and evaluation are closely related. Monitoring, which is
done at the implementation phase, compares the actual progress (of Baseline survey data of intended audience; Media rating
the implementation of the program) against what was planned. The data; Service statistics; other program records
purpose of monitoring is to identify deviations or problems so that 3. Summative or Impact Evaluation: examines specific
corrective actions or interventions can be instituted immediately. This program outcomes and accomplishments. This is used to
implies reporting to appropriate persona or offices at regular intervals. assess the program's success and judge its worth by
assessing its effectiveness in light of relevant problems. It
enables the assessment of whether the appropriate
behaviors were realized, and these changes can be
attributed to the intervention.

Steps in Program Evaluation

There are six steps in program evaluation: deciding what to
evaluate, designing the evaluation plan, collecting relevant data,
analyzing data, making decisions, and reporting/ giving feedback.
1. Decide what to evaluate. The WHO suggested five
dimensions of program performance that could be
evaluated: relevance, progress, effectiveness, impact, and
efficiency. To address these dimensions, the evaluator
should review the program context and objectives.
2. Design the Evaluation Plan. Designing an evaluation plan
Focus of Evaluation means specifying data collection methods and tools and
There are three major foci of program evaluation: inputs, sources of data. Records and reports can be reviewed and
processes, and results or outcomes, and these should be viewed
analyzed. Surveys can be conducted to collect information
within its context. The program results output, effect, and impact on the client's knowledge, attitudes, and practices.
correspond to the three levels of program objectives: short term,
intermediate or medium-term, and long term. Outputs are the specific
products or services which an activity is expected to produce from its
inputs to achieve its objectives (short term). The effects are the
outcomes of the use of project outputs (intermediate). The impact is
the outcome of program effects and is an expression of broader, long-
range program objectives. 3. Collect Relevant Data. The evaluator's primary aim is the
After one year, the evaluator can collect and analyze data generation of accurate and reliable data. Prior to actual data
on the program's outputs, such as: number of fully immunized children, collection, data collection methods and tools should be field-
the number of sanitary toilets constructed and the number of patients tested, and data collectors should be trained.
who completed their short-course chemotherapy. The effects of these 4. Analyze Data. Evaluators should assess the quality of the
could be measured a few years later. With high program outputs, it is data before they start the analysis. What do the figures/
expected that the incidence of tuberculosis, poliomyelitis, measles, statistics mean? What do qualitative data reveal?
diphtheria, pertussis, tetanus, hepatitis B, and diarrheal diseases will Depending on the type of evaluation being conducted. The
be reduced significantly. A program's long-term effect or impact, such main questions that should be asked are: Is the program
as an increase in the average life expectancy and improvement in life relevant? Is it progressing in accordance with the program
quality, will manifest after a longer period of time. plan? Is it effective? What are the lessons that could be
learned from the program?
5. Make Decisions. If the intervention or program was effective
and efficient, this could be continued and/or applied to
another client or group, given similar circumstances. If the
program is not relevant, the evaluator should recommend its
modification.
6. Report/ Give Feedback. The result of the program
evaluation should be submitted to 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 local health
system. An executive summary should be prepared for
them. It should contain a brief description of the focus and
procedures of the evaluation, summary, and interpretation of
evaluation results, conclusions, and recommendations. The
nurse and other health workers must be prepared to make a
presentation to the Sangguniang Bayan or to the Local
Health Board. If the nurse will be asked to make a
presentation, you must prepare good visual aids. A good
written report and an impressive oral presentation can
influence decision-makers positively.

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.