Professional Documents
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Community Health Nursing is a nursing practice outside the hospital which emphases on
the rural and far-off areas. A steadfast legacy observed by the College of Nursing of Ateneo de
Zamboanga University is the commitment in service of others. As a matter of fact, its vision
specifies that of “forming Men and Women for others who will bring about peace and
development by addressing the health needs of people in the city, the region, the nation and the
mission highlights on establishing in the said mentalities or beliefs of nursing students the
prominence of service to God and others through values such as spirituality and citizenship. With
the use of the expertise and capacities in which the students have, they will be able to succeed
excellence through focus, determination and their willpower to accomplish the goal that they are
up to.
During the 2nd week of duty, one of the researchers in Dona Maria Isabel C. Climaco
Health Center, it was observed that there a lot of old people who came by the health center to
have sputum examinations on the TB DOTS Center of the Health facility. It was observed then
that Mothers are bringing children during consultation with chief complaints of colds and
coughs. After that, the researcher noticed that there is a critical pathway on the health center
regarding the National Tuberculosis Program of the DOH. However, the critical pathway of the
NTP is not being utilized by the health center. Also, the system of the health center on how to
entertain clients is not okay even if there are flow charts that are visible on the health center
Thus, in a local health center, Total Quality Management (TQM) must be practiced at all
services, and the culture in which they work. TQM is considered a customer-focused process and
aims for continual improvement of business operations. It strives to ensure all associated
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employees work toward the common goals of improving product or service quality, as well as
improving the procedures that are in place for production. Special emphasis is put on fact-based
decision making, using performance metrics to monitor progress. High levels of organizational
communication are encouraged, for the purpose of maintaining employee involvement and
morale.
most suitable basis for identifying potential solutions. Problems can be identified, both now and
in the future, as evidence that objectives are not being achieved. However, objectives are often
rather abstract, and it may be easier for members of the public to understand a strategy based on
alternative to starting with objectives, but does still need to be checked against the full list of
objectives.
1.1 Purpose/Rationale
As explicated, the conduct of problem identification and analysis is part of the approach
of the Ateneo de Zamboanga University College of Nursing in committing to the service of God
and Country. This is also done to determine the usage of the different quality improvement tools
that can be utilized to identify and analyze problems in the health center.
The Seven Basic Tools of Quality is a designation given to a fixed set of graphical
techniques identified as being most helpful in troubleshooting issues related to quality. They are
called basic because they are suitable for people with little formal training in statistics and
because they can be used to solve the vast majority of quality-related issues.
Most organizations use quality tools for various purposes related to controlling and
assuring quality. Although a good number of quality tools specific are available for certain
domains, fields and practices, some of the quality tools can be used across such domains. These
quality tools are quite generic and can be applied to any condition.
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1.2 Review of the Related Literature
“Community” here refers to a group of people with a shared interest, including spatial,
political, social and economic interests. Orr (2007) defines community organizing as “the
process that engages people, organizations, and communities toward the goals of increased
individual and community control, political efficacy, improved quality of life, and social justice .
. . The central feature of community organizing is that it is a process and strategy designed to
healthcare, business management, and information systems. As the healthcare delivery system is
held to greater accountability, healthcare providers and entities must demonstrate quality
Sullivan (2013) says that Healthcare organizations are continually battling conflicting
priorities. Our customers tell us they need to focus on delivering high quality patient care,
preventing infections, maintaining hospital security, and ensuring patient safety – all with
extremely stretched resources. Noncompliance with regulatory standards can lead to a disruption
in operations, poor quality of care, safety issues, and substantial fines. At the same time, as
energy demand rises, many countries are requiring healthcare facilities to reduce carbon output
Tuberculosis (TB) is a potentially serious infectious disease that mainly affects your
lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny
droplets released into the air via coughs and sneezes. Tuberculosis (TB) is an infectious disease
affects the lungs, but can also affect other parts of the body. Most infections do not have
Acute respiratory infection is an infection that may interfere with normal breathing. It can
affect just your upper respiratory system, which starts at your sinuses and ends at your vocal
chords. It can also affect just your lower respiratory system, which starts at your vocal chords
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and ends at your lungs.This infection is particularly dangerous for children, older adults, and
U.S. National Library of Medicine stresses that high blood pressure, also called
“hypertension,” is a serious medical condition. It happens when the force of the blood pumping
through your arteries is too strong. When your heart beats, it pushes blood through your arteries
to the rest of your body. When the blood pushes harder against the walls of your arteries, your
blood pressure goes up. Your blood pressure may be different at different times of the day. It is
usually higher when you first wake up, after you exercise, or when you are under stress. Having
higher blood pressure for short amounts of time is normal. However, when your blood pressure
stays high for most of the time, it can cause serious health problems (2017).
According to the American Heart Association (AHA), over time, a reading of 140/90
may require treatment. The top number signifies the pressure in the arteries, and the lower
number signifies the pressure between the heartbeats. High blood pressure doesn’t always
produce obvious symptoms. However, it causes progressive damage to arteries and veins, which
can interfere with blood flow throughout the body. This may lead to stroke, heart disease, and
heart failure. Other parts of the body, including the kidneys, limbs, and eyes, also may suffer
damage. (2014).
1. What are the problems of the said health center that need attention?
3. What are the actions and arrangements to implement to resolve the corresponding
problems?
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1.4 Methodology
Before venturing into health centers, the researchers went to plan out on the different
things to do for the identification of the problems and analysis. The researchers first
brainstormed on the possible problems that the health center currently faces.
After the thorough research on the different quality tools, Affinity diagram was used to
identify common ideas of the researchers regarding the possible problems and solutions they
Afterwards, Collection of data was initialized by going to the health center and asking for
the vital statistics for the year 2017. Also, the data that were collected were transcribed into line
Next step taken was the ocular survey of Farmers Drive through home visit done by one
of the researchers of 20 families. The main research instrument used to achieve this is an
Assessment Database (ADB) which covers demographic, socio-economic and health related data
regarding the families. Selection of families was done randomly which definitely refers to
selecting respondents without any exact order or manner (random sampling). The data gathered
from the Assessment Database Base were gathered and organized to statistically characterize the
After the gathering of the data, three concerns were identified by the community these are
as follows: (1) poor management system (2) acute respiratory infection, (3) hypertension and (4)
Pulmonary Tuberculosis. A Problem Tree diagram was used to identify the root cause and its
The researchers have thought of to develop a critical pathway through flowcharts for the
cases of tuberculosis which causes high morbidity rates in the health center. These critical
pathways are adapted from the different hospitals and health centers in the country. The use of
the control pathways will make an impact for the faster processing and for the initial system of
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Other quality improvement tools are used to determine the problems and analyze more
the solutions to be used such as the histogram, radar chart, scatter plot diagram and etc.
The paper is limited to Dona Maria Isabel Climaco Health Center and to the 20 families
of Farmers Drive, Sta. Maria. It precisely focuses on the problems identified by the researchers
which are the poor management system, tuberculosis, acute respiratory infection and
hypertension. This paper is limited only to identify and analyze the problems by utilizing the
There are four tools that can be used to identify problems in the clinical setting; Affinity
During the brainstorming activity of the researchers, we have found out that we should
focus on the problems such as the incidence of cases such as Tuberculosis, Acute Respiratory
Infection, Hypertension, and the Poor Management System of the community. With the
brainstorming conducted, we have utilized the Affinity Diagram. In which, an Affinity Diagram
is a tool that gathers large amounts of language data (ideas, opinions, issues) and organizes them
into groupings based on their natural relationships. The Affinity process is often used to group
Increasing cases of
Increasing Cases of Poor Management
Increasing cases of PTB Acute Respiratory
Hypertension System
Infection
•Poor usage of critical •Poor Home •High number of Old •"Palakasan" System
pathways Management (IMCI) Age people in the •Not following the
•Poor implementation •Common in Barangay Flowcharts that are
of DOH programs Squattered Areas due •Sedentary Lifestyle displayed in the health
•Poor early diagnosis to congestion •No "Bantay Presyon center
and prompt treatment •Common in children Program" in the •Lack of staff members
of PTB Barangay
•Low salience of the •Poor prompt
problem treatment for
Hypertension
Figure 1.1
Figure 1.1 shows the affinity diagram of the topics that were discussed during the
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efforts are made to find a conclusion for a specific problem by gathering a list of ideas
spontaneously contributed by its members. Hence, the four major concerns were discussed and
the causes were identified. The Affinity diagram shows the cause-effect relationship.
With the four major problems that were identified, we have utilized another tool to see
the flow of the problem identification, tools to be used, priority ranking and solutions to be
made. Flowchart is Is a type of diagram that represents an algorithm, workflow or process. The
flowchart shows the steps as boxes of various kinds, and their order by connecting the boxes
with arrows. This diagrammatic representation illustrates a solution model to a given problem.
various fields. Flowcharts are used in designing and documenting simple processes or programs.
Like other types of diagrams, they help visualize what is going on and thereby help understand a
process, and perhaps also find less-obvious features within the process, like flaws and
bottlenecks.
Figure 1.2
Figure 1.2 shows the flowchart series of the paper. The researchers thought of the process
that they should follow in order to identify the problems and make solutions on the identified
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With the given flowchart of the paper, the researchers thought of using the nominal group
solution generation, and decision making. It can be used in groups of many sizes, who want to
make their decision quickly, as by a vote, but want everyone's opinions taken into account (as
opposed to traditional voting, where only the largest group is considered).The method of tallying
is the difference. First, every member of the group gives their view of the solution, with a short
explanation. Then, duplicate solutions are eliminated from the list of all solutions, and the
members proceed to rank the solutions, 1st, 2nd, 3rd, 4th, and so on.
Problem Tally
ARI 1
Tuberculosis 3
Hypertension 0
Figure 1.3
Based on the NGT, the group found out that based on their votes. They focused the
increasing cases of tuberculosis as the main problem of the research paper since that there is a
need to address the problem with Tuberculosis. However, they also thought of solving the poor
management system of the health center to further solve the other problems concerning all the
Hence, the problems that were noticed are the focus of the paper and the data that were