UNIVERSITY OF LA SALETTE, INC.

COLLEGE OF NURSING, PUBLIC HEALTH & MIDWIFERY

SANTIAGO CITY

COMMUNITY NURSING PROCESS MODULE

PREPARED BY: MELISSA D. SARMIENTO, RN, RM, MSN

CHARACTERISTICS OF A HEALTHY COMMUNITY

 A shared sense of being a community based on history, and values.
- despite the presence of subgroups, members of the community have a feeling of belonging and
that they make up one community
- recognition and respect for this subgroups make this possible
 A general feeling of empowerment and control over matters that affect the community as a
whole.
 Existing structures that allow subgroups within the community to participate in decision making
in community matters.
 The ability to cope with change, solve problems, and manage conflicts within the community
through acceptable means.
 Open channels of communication and cooperation among the members of the community.
 Equitable and efficient use of community resources with the view towards sustaining natural
resources.

THE COMMUNITY NURSING PROCESS

I. COMMUNITY ASSESSMENT - ASSESSING COMMUNITY HEALTH

 is an essential process for understanding the community, identifying its needs or weaknesses,
and assets or strengths that is useful to achieve healthy communities
 termed as “Community Health Needs Assessment”

Community Health Needs Assessment

 a health assessment that identifies key health needs and issue through systematic,
comprehensive data collection and analysis.
 results can help in developing community health plan

WAYS OF CONDUCTING COMMUNITY ASSESSMENT

1. COMPREHENSIVE NEEDS ASSESSMENT
 nurse gathers information about the entire community using a systematic process where data
are collected regarding all aspects of the community to be able to identify actual and potential
health problems
 most useful especially when health assessment of a community is being done for the first time.
2. A PROBLEM-ORIENTED ASSESSMENT
 is focused on a particular aspect of health
 the nurse collects information with a certain community problem in mind, and then proceeds to
gather information from the aggregate vulnerable to the problem
 workable when the nurse is familiar with the community such as when a comprehensive
community assessment has been previously done.

TOOLS FOR COMMUNITY ASSESSMENT

PRIMARY DATA
 the community itself is the primary source of data
 are data that have not been gathered before and are collected by the nurse through:
A. Observation
o rapid observation may be done through an ocular or windshield survey, either by driving or
riding a vehicle or walking through it
o gives the nurse the chance to observe people as well as take note of environmental conditions
and existing community facilities.
When observing the community:
 1. the nurse spots for vulnerable groups; the young, the elderly and pregnant women
2. the nurse takes note of the general appearance of the people (healthy, well nourished or the
opposite)
3. it allows the nurse to talk with people to find out their perceptions of health and health
services
4. it allows the nurse to observe environmental condition

PARTICIPANT OBSERVATION
 Is a purposeful observation of formal and informal community activities by sharing, if possible,
in the life of the community
 helps the nurse in determining community values, beliefs, norms, priorities, concerns. and
power or influence structures
 suits community organizing and participatory action research
B. Survey
 time consuming and expensive
 necessary when there is no available information about the community or specific population
group to be studied
 made up of a series of questions for systematic collection of information from a sample of
individuals or families in a community and may be written or oral
 appropriate for determining community attitudes, knowledge, health behaviors, and
perceptions of health and health services
 used by the nurse in identifying patterns of utilization of health services
 also an opportunity for making the members of the community more aware of community
problems and their capacity to influence decision making about health policies and plans, giving
them a sense of empowerment
C. Informant Interview
 are purposeful talks with either key informants or ordinary members of the community
 Key Informants consist of formal and informal community leaders or persons of position and
influence (leaders in local government, schools and business)
 give valuable information on community perceptions about health and health care
1. Structured Interview
- the nurse directs the talk based on an interview guide
2. Unstructured Interview
- the informant guide the talk
D. Community Forum
 is an open meeting of the members of the community
 “Pulong-pulong sa barangay” is a good example
 it does not only gives the nurse information on community perceptions on needs, health, and
health care but it is also an effective tool in providing the people with a medium for expressing
their views and developing their capacity to influence decision makers
 set in coordination with the leaders in the community
 may also be a venue for informing the people about secondary data, for data validation, and for
getting feedback from the people themselves about previously gathered data
E. Focus Group
 is made up of a much smaller group, usually 6 – 12 members only
 its membership is more homogenous, that is, persons with similar sociocultural or health
conditions
 effective in the assessment of health needs of specific groups in the community

SECONDARY DATA
 taken from existing data sources
A. Registry of Vital Events
o under the PSA by virtue of RA 10625 “Philippine Statistical Act of 2013”
o sources of fertility and mortality data
B. Health Records and Reports
o FHSIS is the official recording and reporting system of the DOH and is used by the PSA to
generate health statistics
  FHSIS is an essential tool in monitoring the health status of the population at different levels and
serves as basis for:
1. priority setting by local governments
2. planning and decision making at different levels
3. monitoring and evaluating health program implementation
C. Disease Registries
 is a listing of persons diagnosed with a specific type of disease in a defined population
 data collected serve as basis for monitoring, decision making and program management
D. Census Data
 is a periodic governmental enumeration of the population
 to ensure updated information is used by both government and private organizations in
planning and decision making

EIGHT STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT

1. Identify and engage stakeholders
 the nurse and the community health needs assessment team identify the population group to
be included in the study.
 will it be the total population or a specific population group
2. Define the Community
 is it rural or urban/
 If it is rural, is it semirural where environmental sanitation is a problem?
 If it is an urban, is it semi-urban where over congestion is overlooked?
3. Collect and Analyze Data
 What are the appropriate data to be collected?
 Are these data primary or secondary
 The nurse and the team decides on the timeliness of data, accuracy, precision, relevance, and
adequacy.
 After data collection, analysis is done by sorting, classifying or grouping data in terms of
relatedness and interpreted for any significance.
4. Select priority community health issues
 the team determines which problem is of importance to the community, level of awareness,
ability to reduce risk, and how much will it costs, ability to identify the target population and
availability of resources
5. Document and communicate
 this step is done through community assembly where all community health concerns are
presented and how they will act on those concerns
6. plan improvement strategies
 the team encourages all active community members to come together and identify strategies to
reduce/solve their health concerns.
7. Implement improvement plans
 All community members, as much as possible must be involved headed by their active members.
The team facilitates the implementation.
8. Evaluate progress
 The team and the community as well determine whether the objective sets were implemented
as planned. How much resources (time, money, effort, facilities) were utilized for the execution
of the plan.

DOCUMENTATION OF ASSESSMENT DATA

 Indicate subjective information by quotation marks
 Avoid generalization like good, normal and fair
 Record data completely, objectively and concisely observing correct grammar and spelling
 Write or print legibly using ink

DATA TO BE INCLUDED IN THE ASSESSMENT

 Characteristics of the population
 Geography
 Numbers
 Age and gender distribution
  Ethnicity and religion
 Population trends
 Language and literacy
 Health status of the population
 Mortality and morbidity rates
 Communicable diseases
 Low birth weights
 Breastfeeding and immunization rates
 Health behaviors
 Health service use

 Local factors affecting health

 Work and employment
 Poverty and income
 Environment
 Social cohesion/social support
 Destabilizing factors
 Resources (formal and informal)

COMPONENTS OF COMMUNITY HEALTH NEEDS ASSESSMENT

 HEALTH STATUS
- Is the health standing or condition of the population as indicated by the morbidity, mortality
and fertility rates (MMF)
 HEALTH RESOURCES
- Are assets, means, strengths and skills that are contributory to the promotion of health and
well-being that exist within communities to meet the needs of individual, families or
social groups
 HEALTH ACTION POTENTIAL
- Action planning is a complex activity and should be undertaken where the local people are
involved in actual planning, the more likely the plans will be accepted and implemented

STAGES OF ACTION PLANNING

 Preparation stage
 Agreeing to the aims set by the group
 Describing the objectives of the program or project
 Detailing the activities needed to meet the objectives
 Evaluation of the outcomes

II. COMMUNITY DIAGNOSIS

 is the process of determining the health status of the community and the factors responsible for
it
 the health worker makes a judgment about the community’s health status, resources, and
health potential.

Types of community diagnosis

1. Comprehensive
- General information about the community
2. Problem-oriented or Focused Diagnosis
- Made to responds to a particular need of a target group

Steps in conducting community diagnosis

 Determine the objective
 Define the study population
 Determine the data to be gathered
 Collect the data
 Develop the instrument
 Actual data gathering
  Data collation
 Data presentation
 Data analysis
 Problem identification
 Prioritization of health problems

Prioritizing health problems

 HEALTH PROBLEM
- A situation where there is a demonstrated health need combined with actual or potential
resources to apply remedial measures and commitment to act on the part of the
provider or the client
 After nursing diagnoses have been identified, they must be ranked in order of priority which is
done ideally in consultation with the client

Nature of the Condition/ problem presented

o HEALTH STATUS PROBLEMS
- Increased/morbidity, mortality, fertility, or reduced wellness capability
o HEALTH RESOURCES PROBLEMS
- lack / absence of manpower, money, materials, institutions necessary to solve health
problem
o HEALTH RELATED PROBLEMS
- with social, economic, environmental & political factor that aggravate the illness-inducing
situations

PRIORITY SETTINGS
1. Nature or categories of health problems
CATEGORIES
Health Status - 3 points
Health Resources - 2 points
Health Related Problem - 1 point

WEIGHT: 1

2. Magnitude of the problem

 Percentage of the population that has been affected
CATEGORIES
75 – 100% affected - 4 points
50 74% affected - 3 points
25 – 49% affected - 2 points
Less than 25% affected - 1 point

WEIGHT : 3

3. Modifiability of the problem

 Refers to the probability of success in minimizing, alleviating or totally eradicating the problem
through interventions
CATEGORIES
High - 3 points
Moderate - 2 points
Low - 1 point
Not Modifiable - 0 point

WEIGHT: 4

4. Preventive potential
 Probability of controlling or reducing the effects posed by the problem
CATEGORIES
 High - 3 points
Moderate - 2 points
Low - 1 point

WEIGHT: 1

5. Social concern
 Refers to the community’s perception and evaluation of the problem in terms of seriousness
and urgency of attention needed
CATEGORIES
Urgent Community Concern - 2 points
Recognized problem, but does not need urgent attention - 1 point
Not a community concern - 0 point

WEIGHT: 1

DEMOGRAPHICS
DEMOGRAPHY
o Is the science of vital and social statistics like Marriages, Births and Deaths of the population
o Statistical study of the population specifically with reference to size, destiny and distribution

DEMOGRAPHIC DATA
o Demographic Features
 Population
 Population density
 Source of power/power supply
 Communication services
 Land use
o Physical Infrastructure
 Roadworks
 Transportation
 Water supply
o Social Features
 Health status
 Health facilities and services
 Toilet facilities
 Garbage collection and disposal
 education

SOURCES OF DEMOGRAPHIC DATA

 Survey
a. Census
1. De Jure – data from place of origin
2. De Facto – registration where it happened or the person is registered in the place where
he/she is located or staying when the census was taken
b. Sample Survey
 Continuing Population Registers
 Other records and registration systems
 Vital Registration Records - Civil Registry Law (RA 3753)
 Weekly reports from field health personnel based on RA 3573 (law on reporting of notifiable
diseases)
 Population census
 Individual health record/family records
 Publications
 CRITERIA SCORE HIGHEST WEIGHT ACTUAL SCORE
POSSIBLE
SCORE
Nature of the Problem
Health status 3
Health resources 2 3 1
Health Related 1
Problems
Magnitude of the Problem
75-100% affected 4
50-74% affected 3 4 3
25-49% affected 2
Less than 25% 1
affected
Modifiability of the problem
High 3
Moderate 2 3 4
low 1
Not modifiable 0
Preventive Potential
High 3 3 1
Moderate 2
Low 1
Social Concern
Urgent
Community 2
Concern
Recognized
problem but does 1 2 1
not need urgent
attention
Not a community 0
concern

TABLE 1. HEALTH PROBLEM PRIORITIZATION

CRITERIA SCORE: ________SCORE____________ X Weight = Score

Highest possible score