Community Health Nursing II

NUR204
(Population Groups and Community as clients)

Prepared By:
Noemi Shiela V. Ausejo RN
Prelim Topics:
The Community Health Nursing Process
1. Principles of Community Health Nursing
2. Assessment of Community Health Needs
3. Components (Health status, Health resources)
4. Community Diagnosis (Definition, Types, and Steps, Tools Used (Demography,
Vital and health statistics, Epidemiology)
5. Planning of Community Health Nursing Services
6. Bases for developing a community health plan
7. Steps in making a plan: the planning cycle
8. Philippine health care delivery system
a. Executive Order 102 (The Department of Health)
b. RA 7160 (Local Health Systems)
c. Levels of Health Care and Referral System
10. Global health situation (Millennium Development Goals)
11. National health situation (FOURmula One)
12.Primary health care as an approach to health
13. COPAR: Community Organizing Participatory Action Research
Pre-Test

Instruction: Write legibly & Answer comprehensively the following questions in a your activity
notebook. Submit your activity notebook after answering. (30 points)
1. What is community? What is the focus of your community health nursing 2? What are the
important factors you had learn in your CHN 1 Subject?
2. What is the Importance of studying community Health Nursing in community and population
groups?
3. What is the role and responsibility of a community health nurse in the promoting, advocating &
health development in the community?
4. How do you apply your competency as a community health nurse in the community? Cite an
example
5. As nursing students how you can promote health in the community amidst of the covid 19
pandemic?
6. Identify and explain the principles of community health nursing.
 Principles Of Community
Health Nursing
1. Focus on the community as the unit of care.
2. Give priority to community needs. (use assessment tool to
determine health problems like demographics & vital statistics)
3. Work with the community as an equal partner of the health
team.
4. In selecting appropriate activities, focus on primary prevention.
5. Promote a healthful physical and psychosocial environment.
6. Reach out to all who may benefit from a specific service.
7. Promote optimum use of resources.
8. Collaborate with others working in the community.
 Assessment of community
Health needs

3 features affecting the health status of the community

1. People – includes the size, composition rate of growth, cultural characteristics,

mobility, social class and educational level.
2. Location – (Urban or rural) consider the quality of the soil, air water, and the
location of health facilities.
3. Social system – The patterned series of interrelationship between individuals.
The Community Health Nursing process – it is an efficient method
of organizing thought for clinical decision making and problem
solving. It directs the community health nurses in providing care to
meet a clients health needs whether it is an individual, family,
group or community.

Nursing Process in the Community:

1. Assessment
2. Diagnosis
3. Planning and outcome identification
4. Implementation
5. Evaluation
Community Nursing Process
Determinants of Health

Health Status – A range of age-specific and condition specific mortality rates, as

well as derived indicators. Examples include infant mortality, life expectancy,
potential years of life lost, circulatory deaths, unintentional injury deaths. It is
also associated with environmental issues and cultural practices.

Health resources -Health resources includes financial resources (health spending)

and human resources. Health spending measures the consumption of health
services and goods, including outpatient care, hospital care, long-term care,
pharmaceuticals and other medical goods, prevention and public health services,
and administration.
Diagnosis - Community diagnosis is the identification and quantification of health
problems in a given population using health indicators to define those at risk or those in
need of care and the opportunities and resources available to address these factors.
There are two types of Community Diagnosis.
1. Comprehensive Community Diagnosis - It is more focused on obtaining general
information about the community. It takes the community as a whole and gives
emphasis on all of the aspects, strengths and weaknesses. (demographical data, the
socio-economic and cultural variables affecting health, the economic status of the
community, the status of the community’s environment, the health and illness patterns,
the health resources including health manpower and material resources, and the
political and leadership patterns.) Ex. Alteration in community Health status related to
improper waste disposal sec. to a disease process.
2. The Problem-Oriented Community Diagnosis – Respond to a particular need & deals
with problems that are readily seen and should be acted upon immediately.
Steps in Community diagnosis:

1. Determine the Objective

2. Define the study Population
3. Determine the data to be collected
4. Collect the data – records review, survey, & observation,
interview/Participant interview
5. Developing the instruments – obs. Checklist, questionnaire,
interview guides
6. Actual data gathering
7. Data collection & summarization
8. Data presentation
9. Data Analysis
10. Problem Identification.
 Tools used in diagnosing community problem

Demography – is the statistical study of human populations. Demography examines

the size, structure, and movements of populations over space and time. Demography
is useful for governments and private businesses as a means of analyzing and
predicting social, cultural, and economic trends related to population.

Vital & Health Statistics – Vital statistics incorporates a number of some

significant vital events that take place in human life, for example, birth, death, fetal
death, marriage, divorce, judicial separation, adoption, legitimation, and recognition
that combinedly generate an excessive amount of data and can be analyze.

Epidemiology - the study of how often diseases occur in different groups of people
and why. Epidemiological information is used to plan and evaluate strategies to
prevent illness and as a guide to the management of patients in whom disease has
already developed.
Planning of Community Health Nursing Services
It is an essential component of health planning to have a strong
level of community involvement. The nurse is responsible for
advocating client empowerment throughout the assessment,
planning, implementation, and evaluation phase of the process.
You have to consider :
Principles in community health planning

1.The recognized need of individuals, families and communities

2. Knowledge and understanding of the objectives and policies of the agency

facilities goal achievement.

3. CHN considers the family as the unit of service.

4. Respect for the values, customs and beliefs

5. CHN integrated health education and counseling as vital parts of functions.

6. Collaborative work relationships with the co-workers and members of the

health team facilities accomplishments of goals.
7. Periodic and continuing evaluation provides the means for assessing the degree to which CHN
goals and objectives are being attained.

8. Continuing staff education program quality services to client and are essential to upgrade and
maintain sound nursing practices in their setting.

9. Utilization of indigenous and existing community resources maximizing the success of the
efforts of the Community Health Nurses.

10. Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the CHN
programs.

11. Supervision of nursing services by qualified by CHN personnel provides guidance and
direction to the work to be done.

12. Accurate recording and reporting serve as the basis for evaluation of the progress of planned
programs and activities and as a guide for the future actions.
 Bases for developing a community health Plan

A community health improvement plan (or CHIP) is a long-term,

systematic effort to address public health problems based on the
results of community health assessment activities and the community
health improvement process.

1. Analyze the Health Issue

2. Inventory Health Resources
3. Develop a Health Improvement Strategy
4.Establish Accountability for Health Improvement Activities
5.Develop a Set of Performance Indicators
6.Implement the Improvement Strategy
7. Monitor Process and Outcomes of the Improvement Strategy.
 Steps in making a plan: The planning cycle
The Planning Cycle offers a framework for a research project up to a certain
level of complexity. It is an eight-step process that you can use as tool to plan
and implement fully considered, well-focused, practical, and cost-effective
research project. It also helps you to learn from any mistakes you make, and to
feed this knowledge back into your future planning and decision making.

.
Analyze
the
Situation

Identify
Close the
the aim of
Plan
your plan

Evaluate
your plan Explore
& its your option
impact
Planning

Implement
your plan Select the
best option

Evaluate
your plan Detailed
& its planning
impact
 Community Health Nursing Care Plan
Cues Health Family/community Planning/Goals Objectives Intervention Method of Resources
Problem diagnosis contact

S/O Improper Potential/ risk After 2-5 days After 2-5 days of >Establish Home Material
Drainage for community of home visit home visit and rapport with visit Resources:
-Open system acquired and interventions the the community Interview
drainage infection interventions community will state the Observati >Visual
related to the be able to : purpose of the on aid, flyers
-Presence improper community action Survey
of flies, drainage system will be able to -Be Oriented with Assess the Human
rats, and inability of decide and the problem and community resources
mosquito, the brgy. To demonstrate identify the willingness to
cockroac provide an appropriate importance of participate in Time &
h in the environment measures to having a proper solving the effort of
drainage conducive to eliminate and drainage system. problem the
health or reduce Discuss to the individual,
-Stagnant maintenance problem to - Enumerate the community the family and
water at and personal improve dis –advantages present the whole
the end development environmental of improper problem & community
of the due to lack of sanitation. drainage system allow them to
drainage skill in verbalize their Financial
tube improving - Can cite vector- perception resources:
-Offensiv health related illness Encourage
e smell in measures. that the family them to >money ,
the can acquire maintain food and
drainage suitable transporta
environment tion
for the
community
 Case Scenario:

Rain is a newly hired DOH nurse assigned in brgy Makalisang. She

noticed everyday on her duty in the health center that most of the
children in Brgy. Makalisang were malnourished, have a low birth
weight, their skin was dry and pale. One day she visited a family and
interviewed the parents of Blossom a 5 years old girl living in the
community. Rain found out that because of the pandemic, many
families in brgy. Makalisang cannot provide their families enough food
to eat everyday and other necessities at home because of the
lockdown situation. Furthermore, rain also identified that if some
member of the family were sick they usually managed it at home
rather than going to the health center or in the hospital because of
the Covid 19 Pandemic.
 Activity quiz no.2

Instruction: Make a comprehensive Community health nursing care plan

base on the scenario given. Prioritize the community health nursing
problem base on your assessment. ( 30 points)
Philippine health care delivery system
a. Executive Order 102 (The Departmentof Health)

The Department of Health (DOH) is mandated to be the over-all technical authority on health.
The major mandate of DOH is to provide national policy direction and develop national plans,
technical standards and guidelines on health. It is also a regulator of all health services and
products; and provider of special or tertiary health care services and of technical assistance to
other health providers specially to Local Government Units (LGU). With other health providers
and stakeholders, the DOH shall pursue and assure the following:
1. Promotion of the health and well-being for every Filipino;
2. Prevention and control of diseases among population at risk;
3. Protection of individuals, families and communities exposed to health hazards & risks;
and
4. Treatment, management and rehabilitation of individuals affected by diseases and disability.
5. Lead agency in articulating national objectives for health, to guide the development of local
health systems, programs and services;
6. Direct service provider for specific programs that affect large segments of the population,
tuberculosis, malaria, schistosomiasis, HIV-AIDS and other emerging infections and
micronutrient deficiencies;
7. Lead agency in health emergency response services, including referral and networking systems
for trauma, injuries and catastrophic events;
8. Technical authority in disease control and prevention;
9. Lead agency in ensuring equity, access and quality of health care services through policy
formulation, standards development and regulations;
10.Technical oversight agency in charge of monitoring and evaluating the implementation of
health programs, projects research, training and services;
11.Administrator of selected health facilities at sub-national levels that act as referral centers for
local health systems i.e., tertiary and special hospitals, reference laboratories, training centers,
centers for health promotion, center for disease control, and prevention, regulatory offices among
others;
12.Innovator of new strategies for responding to emerging needs;
13.Advocate for health promotion and healthy life styles for the general population;
14.Capacity-builder of LGUs, the private sector, non-governmental organizations, peoples
organizations, national government agencies in implementing health programs, services, through
technical collaborations, logistical support, provision of grants and allocation and other
partnership mechanism;
15.Lead agency health and medical research;
16.Lead agency in health emergency preparedness and response;
17.Protector of standards of excellence in the training and education of health care
providers at all levels of the health care system;
18.Implementer of the National Health Insurance Law; providing administrative
and technical leadership in health care financing; and
19.Expressing national objectives for health to lead the progress of local health
systems, programs and services.
20.Formulate national policies and standards for health;
21.Prevent and control leading causes of death and disability;
22.Develop disease surveillance and health information systems;
23.Maintain national health facilities and hospitals with modern and advanced
capabilities to support local services;
24.Promote health and well-being through public information and to provide the
public with timely and relevant on health risks and hazards;
25.Develop and implement strategies to achieve appropriate expenditure
patterns in health as recommended by international agencies;
26.Develop sub-national centers and facilities for health promotion, disease
control and prevention, standards, regulations and technical assistance;
27.Promote and maintain international linkages for technical collaboration;
28.Create the environment for the development of a health industrial
complex;
29.Assume leadership in health in times of emergencies, calamities, and
disasters and system failures;
30.Ensure quality of training and health human resource development at all
levels of the health care system;
31.Oversee financing of the health sector and ensure equity and accessibility
to health services; and
32. Articulate the national health research agenda and ensure the provision
of sufficient resources and logistics to attain excellence in evidenced-based
intervention for health.
Classification of Health Facilities
(DOH AO- 0012A)

Outcome 1: Improved Financial Risk Reduction

The National Health Insurance Program (NHIP) which is the
Philhealth covered 92% or 93.45 million principal members &
dependents of the country’s 101.45 million population.

Philhealth Benefits:
-Expanded Z Benefit Package for Colon & Rectum Cancers
-Point of Care (POC) Enrolment Program
- Enhance Primary Care Package (Tsekap)
 Outcome 2: Greater Access to Health Care Services
In 2018, DOH took steps to upgrade facilities to meet
licensure & Philhealth Accreditation requirements.

• Received • Infrastructu 162 DOH

Essential re Projects: funded, fully
Equipment equipped
Items/Packages Mobile
• 685- LGU • 596- Brgy. Dental vans
Hospitals Hx Stations for Hx
• 70 DOH Hospitals • 138 – LGU Facilities
• Receive Tsekap 13 Drug Abuse
Hospitals
Equipment: & treatment
17,541 – Brgy. Hx • 207 – Rural Rehabilitation
Stations Hx Units/ Centers,
• 2459 – RHU’s & Hx Centers ongoing
Health Centers procurement/
Construction
Outcome 3: Public Health Development Goals (MDG’s)
Achieved
1. MDG-4 Reduce Child Mortality – 83% of the targeted
Population was fully immunized
2. National School-based immunization Campaign
3. Micronutrients Supplementation
4. Mass Deworming
5. MDG-5 Improved Maternal Health
6. MDG 6 – Combat HIV/AIDs, Malaria and other diseases
7. Disease Free Zone Initiatives : Rabies, Malaria, Dengue,
Filariasis
8. Emerging and Re-emerging Disease
 Outcome 4: Improved Health Governance

ISO Certification As of December 2015, 45 out of 70 Department

of Health hospitals were ISO certified.
National Health Summit
Local Government Unit Awards
World Health Organization Executive Board Secretary of Health
Dr. Janette Loreto-Garin represented the Philippines as a member
of the WHO Executive Board.
Fifth Asia Pacific Economic Cooperation (APEC) High Level
Meeting 5 on Health and the Economic
National Barangay Health Workers Convention
Global Health Suituation MDG’s & SG

Millennium Development Goals (MDGs)

The United Nations Millennium Development Goals are eight goals that all 191
UN member states have agreed to try to achieve by the year 2015. The United
Nations Millennium Declaration, signed in September 2000 commits world
leaders to combat poverty, hunger, disease, illiteracy, environmental degradation,
and discrimination against women. The MDGs are derived from this Declaration,
and all have specific targets and indicators.

The MDGs are inter-dependent; all the MDG influence health, and health
influences all the MDGs. For example, better health enables children to learn and
adults to earn. Gender equality is essential to the achievement of better health.
Reducing poverty, hunger and environmental degradation positively influences,
but also depends on, better health.
Millennium Development Goals
Sustainable Goals
b. RA 7160 (Local Health Systems/Local Gov’t Code) – was enacted to bring
genuine and meaningful local autonomy in order to:

1. Attain a fullest development of self reliant communities and make them a more
effective partners in the attainment of national health goals.
2. Mandates devolution of basic services from the national government to the
LGU’s
Devolution – refers to the act by which the national government confers power &
authority upon the Various LGUs to perform specific functions &
responsibilities.
3. Provided for the creation of The provincial health board or local health Boards
Headed by: Governor, Mayor, members of the local health boards and the private
sector or NGO involve in health services.
Functions of Local Health Boards

1. Proposing to the sanggunian annual budgetary allocations for the

operation and maintenance of health facilities and services within
the province, city, municipality
2. Serving as an advisory committee to the sanggunian on health
matters
3. Creating committees that shall advise local health agencies on
various matters related to health service operations

See page 247 on the Org. structure of the Dept. of Health.

 C. Levels of Health Care & Referral System (page 243)

DOH – issued AO 2012-0012 (Rules & regulations Governing the new

classification Hospital and other health facilities in the Philippines that
provides for a basic classification scheme of health facilities. Although the
levels of health care delivery have remained basically the same as Primary,
Secondary & Tertiary

Levels of Public Health care Delivery

1. Primary Level - The first contact between the community members &
other levels of health care. Like, Municipal health office, Rural Health
units, Health Centers, Barangay health stations
2. Secondary Level – Offers services to patients requires moderately
specialized knowledge & technical resources for adequate treatment like;
Provincial health office, District Hospitals, Emergency Hospitals,
Provincial Hospitals/Provincial Medical Centers
3. Tertiary Level –Highly specialized level of care. National Hospitals,
National Medical Centers & National Specialized Hospitals, regional
Hospitals/Regional Medical Center , Teaching and Training Hospitals
 Levels of Health Care facility
Category A – Primary Care facility - first contact health care facility that
offers basic services including emergency services & provision for normal
deliveries
Example:
1. without in patient beds like health centers, out patient clinics and dental
clinics
2. Short stay facility where the patients spends on the average of 1-2 days
before discharge. Like infirmaries and birthing clinics (lying in)
facilities.
Category B- Custodial Care facility – A health facility that provides
long term care, including basic services like food and shelter to
patients with chronic condition requiring on going health and
nursing care due to impairment & reduced degree of independence
in ADL & patients in need of rehabilitation.
Example:
Psychiatric facilities, substance/drug abuse treatment, rehab.
Centers & nursing Homes.
Cont.
Category C. Diagnostic and therapeutic Facility - a facility for
examination of a human body, specimens from human body for
diagnosis, sometimes treatment of disease. The test covers the pre
analytical phases of examination. This is classified into:
1. Laboratory facility – clinical laboratory, HIV testing lab, Blood
service facility, drug testing lab, NBS lab & lab for drinking water
analysis
2. Radiologic Facility – X-ray, CT scan, Mammography, MRI &
ultrasonography
3. Nuclear medicine facility – Regulated by the Philippine Nuclear
Research utilizing applications of radioactive materials in diagnosis &
treatment like radiation therapy.
Category D. Specialized Outpatient Facility – a facility that performs a
highly specialized procedures on an out patient basis. Example are,
dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic
clinic, physical medicine & rehabilitation center.
 National Health Situation

The Philippines has joined the bandwagon of pursuing the various reforms to
strengthen the local health care delivery and improve health outcomes of the
population this includes:
FOURMula One - started from 2005 to 2010, Kalusugan Pangkalahatan from 2010
to 2015 & the Duterte Health Agenda or Philippine Health Agenda in 2016. Formula
1 Plus (F1 Plus ) is the latest in the series.
F1 Plus – Is outlined the direction and provided the guidelines to help achieve the
universal healthcare in the Philippines. It centers on pursuing the 3 goals:
1. Better Health outcomes
2. A more responsive health system
3. A more equitable healthcare financing

The DOH shall organized health sector initiatives into (4) Pillars, namely;
Financing, Service Delivery, Regulation, Governance Plus a cross-cutting initiative
on Performance Accountability.
F1+ Strategy Map

Clear view on Page 256

 Primary Health Care as an
approach to health
Primary Health Care (PHC) – is defined as essential healthcare base on
practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individuals and families in the
community trough their full participation and at cost that the community &
country can afford to maintain at every stage of their Development in the
spirit of self-reliance and self determination WHO,2008).
It advocates for a health care system characterized by 5A’s namely:
Accessible, Available, Affordable, Acceptable and Appropriate

The core values of PHC :

Social Justice
Equity
Respect for Human Dignity & Human Rights
Solidarity
Self-reliance
 Principles of Primary
Health Care

Accessible healthcare

Intersectoral collaboration

Appropriate technology

Cultural sensitivity and safety

Community participation

Health promotion
 Essential Health Services of PHC

1. Health education
2. Immunization
3. Essential Medicine/Drugs
4. Mother & Child Health Services
5. Endemic Disease Control & Management
6. Nutrition
7. Treatment of simple conditions
8. Sanitation and access to safe water supply
 10 Essential Public Health
Services
1 . Monitor Health Status to identify and solve community health Problems
2. Diagnose & investigate health problems & health hazards in the
community
3. Inform, educate & empower people about health issues
4. Mobilize community partnerships & action to identify & solve health
problems
5. Develop policies & plans that supports individual & community health
efforts
6. Enforce laws & regulations that protect health & ensure safety
7. Link people to needed personal health services & assure the provision
of health care when otherwise unavailable
8. Assure competent public & personal health care workforce
9. Evaluate effectiveness, accessibility & quality of personal &
population-based health services
10. Research for new insights & innovative solutions to health problems
Three main Elements to define PHC

1. Primary Health care and essential public health

functions as the core of integrated services

2. Multi-sectoral Policy and action

3. Empowered people and communities

 Calendar of Health events of the
DOH

Figure 12.2 - From January to December Page 245