Saint Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences
COLLEGE OF NURSING

THE QUALITIES OF A
COMMUNITY HEALTH NURSE
GUIDELINES FOR THE INSTRUCTOR:

1. Discuss with the students Community Assessment Tool, Community Diagnosis and Community Organizing
Participatory Action Research. Please see PPT uploaded in the channel.

2. At the end of the didactics, let the students reflect and imbibe the importance of these topics to become an effective and
efficient nurse in the community.

3. Inform the class that as part of their skills laboratory for CHN – II, they will have to use the community assessment tool
using the given baseline data survey form.

4. Divide the class into four (4) groups or you may follow the CHN RLE 2 groupings uploaded in our channel.

5. Instruct them to meet as a group and instead of doing this individually and finding a minimum of five households to
conduct an interview using the baseline data form. They are to answer this as a group using their own household details.

6. To ensure the safety of the students because of the surge of cases. Instruct the students to answer the form and they are
to collate their answers and present it using the different methods in presenting data.

7. Set a deadline for the group as to when they will send you their collated gata.

8. You may meet the whole class to critique their gathered and collated data using data presentation and analysis.

8. During the conduct of data gathering advise them to always follow minimum health protocols, even within their own
household. Photo documentation should also be done.

9. Instruct the students to make their data presentation and analysis simple, direct and creative

10. Remind the students that the answered baseline data survey form will still be submitted. They can scan or take a
picture of the answered form and to be included in the presentation.

11. You may meet the students again to give a synthesis of the activity, highlighting the lessons they have learned while
conduct of the activity

12. The conduct of the activity will be used using the following rubrics

13. See Attached Community Baseline Data Survey.

Saint Paul University Philippines

Tuguegarao City, Cagayan 3500
School of Nursing and Allied Health Sciences
COLLEGE OF NURSING
 THE QUALITIES OF A
COMMUNITY HEALTH NURSE

GUIDELINES FOR STUDENTS:

1. Review the Community Assessment Tool, Community Diagnosis and Community Organizing Participatory Action
Research. Please see PPT uploaded in the channel.

2. At the end of the didactics, let the students reflect and imbibe the importance of these topics to become an effective and
efficient nurse in the community.

3. As part of your skills laboratory for CHN – II, you will have to conduct an interview with a Public Health Nurse using a
questionnaire, and that questionnaire should be generated by you.

4. Your class will be divided into four (4) groups or your instructor may opt to follow the original CHN RLE 2 groupings.

5. You will meet as a group and instead of doing this individually and finding a minimum of five households to conduct
an interview using the baseline data form. Answer this as a group using your own household details.

6. This is to ensure your safety because of the surge of Covid 19 cases. Answer the form and as a group collate your
answers and present it using the different methods in presenting data.

7. Your instructor will meet the whole class to critique your gathered and collated data using data presentation and
analysis.

8. During the conduct of data gathering strictly always follow minimum health protocols, even within your own
household. Photo documentation should also be done.

9. Make your data presentation and analysis simple, direct and creative.

10. The answered baseline data survey form will still be submitted. Scan or take a picture of the answered form and to be
included in the presentation.

11. To culminate the activity, your instructor will meet you to synthesize the activity ighlighting the lessons they have
learned while conduct of the activity

12. Your activity will be graded using the instructors set rubrics.

Saint Paul University Philippines

Tuguegarao City, Cagayan Valley 3500

DATA BASELINE SURVEY FORM

Zone: Household No:
Date of Assessment: __________________________
Name of Assessor: ____________________________
Head of the Family: ___________________________

A. Family Size:
Number of Adults: ___ Male ___ Female
Number of Children: ___ Male ___ Female

B. Marital Status:
• Single: ___ Male ___ Female
• Married: ___
• Widow: ___ • Widower: ___
• Separated: ___
•

C. Educational Attainment:
• Elementary Undergraduate: ___ Male ___ Female
• Elementary Graduate: ___ Male ___ Female
• Highschool Undergraduate: ___ Male ___ Female
• Highschool Graduate: ___ Male ___ Female
• College Undergraduate: ___ Male ___ Female
• College Graduate: ___ Male ___ Female
• TechVoc Course Graduate: ___ Male ___ Female

D. Occupation:
• Farmer: ____ • Carpenter: ____ • Housewife: ____ • Driver: ____ • OFW: ____
• Others, specify: _________________
_________________
_________________

E. Religion:
• Roman Catholic: ____ • Baptist: _____
• Born Again: ____ • Others, specify __________

F. Types of Family:
• Dyad • Nuclear • Extended
• Blended • Single Parent

G. Authority:
a. Decision Making:
• Patriarchal • Matriarchal • Egalitarian
b. Child Discipline:
• Patriarchal • Matriarchal • Egalitarian
c. Healthcare Decisions:
• Patriarchal • Matriarchal • Egalitarian
d. Financial Management:
• Patriarchal • Matriarchal • Egalitarian
H. Signs and Symptoms:
• Head ache: ___ • Colds: ___ • Cough: ___ • Fever: ___ • Others, specify: __________
• Hypertension: ___ • TB: ___ • DM: ___
• Others, specify: __________ __________
• Diagnosed by a practitioner? • Yes: ___ • No: ___

I. Number of Pregnant Women:

● AGE <15
• Age 15 – 19: ___ • Age 20 – 24: ____
• Age 25 – 29: ___ • Age 30 – above: ____
• Others, specify: ______

J. Housing:
• Age of House:
0-5 6-10 11-15
* Materials used:
• Concrete • Wood • Bamboo • Mixed
* Number of floors:
• One • Two • Three • Four
* Lighting Facility:
• Electric Bulb • Candles • Gas Lamps
* General State of Repair:
• Roof • Floor • Walls • Ladder • Window • Door
• Foundation • Roof Braces • Rooms • Sink
• Kitchen • Toilet • Others: __________________

K. Hangouts:
• Store • Waiting Shade • Court • Yards • House •Others: __________________

L. Animals:
• Dogs: ___ • Cats: ___ • Pig: ___ • Chicken: ___
• Duck: ___ • Bird: ___ • Goat: ___ • Carabao: ___
• Cow: ___ • Others: _________

M. Water (drinking):
* Source: • Faucet • Deep Well • Pump Well
• Others, specify: ______________
* Ownership: • owned• shared
* Storage: • Refrigerated • Not refrigerated
• Covered • Not covered
M. Water (general usage):
* Source: • Faucet • Deep Well • Pump Well
• Others, specify: ______________
• Drum • Jags • Bottles • Pail • Jar
* Storage: • Refrigerated • Not refrigerated
• Covered • Not covered
• Drum • Jags • Bottles • Pail • Jar
* Usage: • Bathing • Cooking • Laundry
N. Food:
* Cooking facility: • Firewood • Gas stove • Charcoal
• Electric Stove • Others: ________
* Storage: • Refrigerated • Not refrigerated
• Covered • Not covered
* Usual Number of Meals per day: _______
* Usual Composition:
• Vegetable • Fish • Chicken • Meat • Fruits • Rice
•pork •beef •others

O. Exercise:
• Yes: ____ • No: _____
* Types:
• Jogging: ___ • Walking: ___ • Work: ___
• Biking: ___ • Stretching: ___ • Others: __________

P. Vices:
• Smoking: ______
• Drinking Alcohol: ______

Q. Leisure and Recreation:

• Chatting: ___ • Listening to radio: ___ • Sports: ___
• Sleeping: ___ • Walking: ___ • Watching TV: ___
• Playing cards: ___ • Others: _________________

R. Toilet:
* Ownership: • owned • shared
* Type: • Flush • Pail system
• Open pit • Close pit • Water sealed
* Distance: • 2 – 3M • 4 – 5M • 6 – 7M
• 8 – 9M • 9 – 10M • 11 – above

S. Garbage:
* Container used: • Trashcan • Plastic • Sack
• Box • Pail • Hole
* Method: • Burning • Composting • Open dumping
* Waste Segregation: • Yes • No

T. Drainage System:
* Type of Drainage: • Open • Close
* Household drainage: • Open • Close • None

U. Transportation:
• Jeepney • Truck • Motorcycle • Tractor
• Tricycle • Van • Other: _____________

V. Income:
* Who earns? • Mother • Father • Both Parents
• Children • All
* Source: • Farming • Self- employment
• Pensions • Others: _____________________
* Monthly income: • 0 – 500 • 501 – 1000
• 1001 – 2000 • 2001 – 3000
• 3001 – 4000 • 4001 – 5000 • 5001 – above
* Expenditure: • Clothing • Education • Food • Farm
• Housing • Medicine • Others: ______________
* Products: • Rice • Corn • Vegetables
• Poultry • Others: ____________
* Land ownership: • Tenant • Owned

W. Other Information:
* Protective Services Available:
• Police • Army • Tanod •security guard

* Security Facilities Available:

• Streetlights • Road humps • CCTV • Others: __________

* Social Facilities Available:

• Courts • Waiting shades • Others: ____________

* Healthcare Facilities Available:

• Botika • Health Center • Others: ____________

* Healthcare Providers Present:

• Nurse • Doctors • Midwives
• Trained Hilot • Albularyo • Others: ____________

* Health Services Offered:

• Immunization • Health Education • Check – ups
• Others: ________________________________

* Level of Satisfaction:
• Very Satisfied • Satisfied • Not Satisfied

* Frequency of Visiting Healthcare Facilities:

• Once • Twice • Thrice • As needed

* Name of Healthcare Provider/s:

1. _______________________________________
2. _______________________________________
3. _______________________________________

* Reasons for Visiting Health Centers:

• Health Education • Check – up • Medicine
• Feeding Program • Others: _________________
* Name of Organizations:
1. _______________________________________
2. _______________________________________
3. _______________________________________

NOTES:
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Saint Paul University Philippines

Tuguegarao City, Cagayan 3500
School of Nursing and Allied Health Sciences
COLLEGE OF NURSING

GRADING RUBRIC THE CONDUCT AND USE OF THE COMMUNITY

ASSESSMENT TOOL
STUDENTS NAME: ____________________________________________ TOTAL SCORE: ________________________
SECTION AND RLE GROUP: ___________________________________

CRITERIA SCORING
5 4 3 2 1
IDEAS The narrative is clear This paper is The writer is Topic is not well- As yet, the paper has no clear
and focused. It holds the mostly focused, beginning to define defined and/or there sense of purpose or central
reader's attention. and has some the topic, even are too many topics. theme. To extract meaning
Relevant details enrich good details. though development from the text, the reader must
the central theme. is still basic or make inferences based on
general. sketchy or missing details.
ORGANIZATIO The organization Paper (and The organizational Sentences within The writing lacks a clear sense
N enhances and showcases paragraphs) are structure is strong paragraphs make of direction. Ideas, details, or
the central idea or mostly enough to move the sense, but the order events seem strung together in
theme. The order, organized, in reader through the of paragraphs does a loose or random fashion;
structure of information order, and text without too not. there is no identifiable internal
is compelling and makes sense to much confusion. structure.
moves the reader the reader.
through the text.
SENTENCE The writing has an easy The writing The text hums along The text seems The reader has to practice
FLUENCY flow, rhythm, and mostly flows, with a steady beat, choppy and is not quite a bit in order to give this
cadence. Sentences are and usually but tends to be more easy to read orally. paper a fair interpretive
well built, with strong invites oral businesslike than reading.
and varied structure that reading. musical, more
invites expressive oral mechanical than
reading. fluid.
CONVENTION The writer demonstrates The write The writer shows The writer seems to Errors in spelling,
a good grasp of understands reasonable control have made little punctuation, capitalization,
standard writing good writing over a limited range effort to use usage, and grammar and/or
conventions (e.g., conventions and of standard writing conventions: paragraphing repeatedly
spelling, punctuation, usually uses conventions. spelling, distract the reader and make
capitalization, grammar, them correctly. Conventions are punctuation, the text difficult to read.
usage, paragraphing) Paper is easily sometimes handled capitalization,
and uses conventions read and errors well and enhance usage, grammar
effectively to enhance are rare; minor readability; at other and/or paragraphing
readability. touch-ups times, errors are have multiple
would get this distracting and errors.
piece ready to impair readability.
publish.
PRESENTATIO The form and The format only The writer's The writer's The reader receives a garbled
N presentation of the text has a few message is message is only message due to problems
enhances the ability for mistakes and is understandable in understandable relating to the presentation of
the reader to understand generally easy this format. occasionally, and the text, and is not typed.
and connect with the to read and paper is messily
message. It is pleasing pleasing to the written.
to the eye. eye.

Adopted from: https://www.uen.org/rubric/previewrubric.html?id=20123