Unit 4: Nursing Process in the Care of Population Groups and Community

(Continuation: 2nd Part)

4 Implementing Health Care Interventions
4.1 Concepts on Community Organizing and Social Mobilization
Definition of CO
Community organizing as a process consists of activities that instill and reinforce the people’s confidence on their
own collective strengths and capabilities to solve its own problems and aspirations for development through their
own efforts. It is also a process of educating and mobilizing members of the community to enable them to resolve
community problems.
Common goals for CO and CHN practice
Community organizing and CHN practice have common goals: empowerment, development of a self-reliant

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community, and improved quality of life (UST-NSTP, 2012).
Three basic values of CO
1. Human rights
2. Social justice
3. Social responsibility
Core Principles of CO
1. CO is people-centered
2. CO is participative
3. CO is democratic
4. CO is developmental
5. CO is process-oriented
Phases of CO
1. Pre-entry
2. Entry into the community
Two strategies for gaining entry according to Manalili (1990)
 Padrino entry
 Bongga entry
3. Community integration
Styles of Integration
 Now you see, now you don’t style
 Boarder style
 Elitist style
Techniques approaches recommended that will guarantee success of organizing the work as suggested by Manalili (1990)
that facilitate community integration
 Pagbabahay-bahay or occasional home visits
 Huntahan
 Participation in the production process
 Participation in social activities
4. Social analysis
Social analysis is the process of gathering, collating, and analyzing data to gain extensive understanding of
community conditions, help in identification of problems of the community, and determine the root causes of
these problems.
5. Identifying potential leaders
Desirable characteristics of a potential leader?
 Represent the target group in the community
 They possess or display leadership qualities.
 They have the trust and confidence of the community
 They express belief in the need to change the current undesirable situation in the community that change
is possible and that change must begin with members of the community.
 They are willing to invest time and effort for CO work
 They must have potential management skills

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 6. Core group formation
7. Action phase
8. Evaluation – is a systematic, critical analysis of the current state of organization and or projects compare
to desired or planned goals or objectives. Ideally done periodically
Two major areas of evaluation in CO?
a. Program-based evaluation
b. Organizational evaluation
9. Exit and expansion
Goals of CO
1. Peoples empowerment – people learn to overcome their powerlessness
2. Building relatively permanent structures and people’s organizations – localized experiences become the
building blocks
3. Improved quality of life – short and long term improvements fulfilling basic needs and create a conducive

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environment for human creativity.

4.2 COPAR
COPAR or Community Organizing Participatory Action Research is a vital part of public health nursing. COPAR aims
to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive
community.
Definition
COPAR stands for Community Organizing Participatory Action Research
It is a community development approach that allows the community to systematically analyze the situation, plan a
solution and implement projects/programs utilizing the process of community organizing.
A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic,
participatory and politically responsive community.

Importance
1. COPAR is an important tool for community development and people empowerment as this helps the
community workers to generate community participation in development activities.
2. COPAR prepares people/clients to eventually take over the management of a development programs in the
future.
3. COPAR maximizes community participation and involvement; community resources are mobilized for
community services.

Principles
1. People especially the most oppressed, exploited and deprived sectors are open to change, have the capacity
to change and are able to bring about change.
2. COPAR should be based on the interest of the poorest sector of the community.
3. COPAR should lead to a self-reliant community and society.

Critical Steps/Activities in COPAR

1. Integration
2. Social Investigation
3. Tentative program planning – choose one issue to work on in order to begin organizing the people
4. Groundwork – going around and motivating the people on a one-to-one basis to do something on the issue
that has been chosen
5. Meeting – gives the people collective power and confidence
6. Role Play – acting out the meeting between the leaders of the people and the government representatives
to anticipate what will happen and prepare them for such eventuality
7. Mobilization or action – actual experience of the people in confronting the powerful and the actual exercise
of people power
8. Evaluation – measuring the outcome of the activities versus its objectives
9. Reflection – dealing with deeper, ongoing concern to look at the positive values the CO is trying to build in
the organization
10. Organization

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Phases of COPAR
COPAR has four phases namely: Pre-Entry Phase, Entry Phase, Organization-building phase, and sustenance and
strengthening phase.
1. Pre-Entry Phase
Is the initial phase of the organizing process where the community organizer looks for communities to serve and
helped. Activities include:
Preparation of the Institution
 Train faculty and students in COPAR.
 Formulate plans for institutionalizing COPAR.
 Revise/enrich curriculum and immersion program.
 Coordinate participants of other departments.
Site Selection
 Initial networking with local government.

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 Conduct preliminary special investigation.
 Make long/short list of potential communities.
 Do ocular survey of listed communities.
Criteria for Initial Site Selection
 Must have a population of 100-200 families.
 Economically depressed. No strong resistance from the community.
 No serious peace and order problem.
 No similar group or organization holding the same program.
Identifying Potential Municipalities
 Make long/short list of potential municipalities
Identifying Potential Community
 Do the same process as in selecting municipality.
 Consult key informants and residents.
 Coordinate with local government and NGOs for future activities.
Choosing Final Community
 Conduct informal interviews with community residents and key informants.
 Determine the need of the program in the community.
 Take note of political development.
 Develop community profiles for secondary data.
 Develop survey tools.
 Pay courtesy call to community leaders.
 Choose foster families based on guidelines
Identifying Host Family
 House is strategically located in the community.
 Should not belong to the rich segment.
 Respected by both formal and informal leaders.
 Neighbors are not hesitant to enter the house.
 No member of the host family should be moving out in the community.
2. Entry Phase
Is sometimes called the social preparation phase. Is crucial in determining which strategies for organizing would
suit the chosen community. Success of the activities depend on how much the community organizers has integrated
with the community.

Guidelines for Entry

 Recognize the role of local authorities by paying them visits to inform their presence and activities.
 Her appearance, speech, behavior and lifestyle should be in keeping with those of the community
residents without disregard of their being role model.
 Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phase

Integration. Establishing rapport with the people in continuing effort to imbibe community life.
 living with the community
 seek out to converse with people where they usually congregate

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  lend a hand in household chores
 avoid gambling and drinking
Deepening social investigation/community study
 verification and enrichment of data collected from initial survey
 conduct baseline survey by students, results relayed through community assembly
Core Group Formation
 Leader spotting through sociogram.
o Key Persons. Approached by most people
o Opinion Leader. Approached by key persons
o Isolates. Never or hardly consulted
3. Organization-building Phase
Entails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing,
and evaluating community-wise activities. It is at this phase where the organized leaders or groups are being given
training (formal, informal, OJT) to develop their style in managing their own concerns/programs.

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Key Activities
 Community Health Organization (CHO)
o preparation of legal requirements
o guidelines in the organization of the CHO by the core group
o election of officers
 Research Team Committee
 Planning Committee
 Health Committee Organization
 Others
* Formation of by-laws by the CHO
4. Sustenance and Strengthening Phase
Occurs when the community organization has already been established and the community members are already
actively participating in community-wide undertakings. At this point, the different committees setup in the
organization-building phase are already expected to be functioning by way of planning, implementing and evaluating
their own programs, with the overall guidance from the community-wide organization.
Key Activities
 Training of CHO for monitoring and implementing of community health program.
 Identification of secondary leaders.
 Linkaging and networking.
 Conduct of mobilization on health and development concerns.
 Implementation of livelihood projects.

6 Documentation and Reporting

Documentation is anything written or printed that is relied on as a record of proof for authorized persons.
Documentation and reporting in nursing are needed for continuity of care it is also a legal requirement showing the
nursing care performed or not performed by a nurse.

Field Health Service Information System (FHSIS)

The FHSIS is an essential tool in monitoring the health status of the population at different levels. It is also a useful
tool in following-up clients and documenting the daily activities of the midwife and or community health nurse. It
composed of recording and reporting tools.

Records are facility-based that is, they are kept at the BHS or at the RHU or health center and contain day-to-day
account of activities of health workers. It serves as the basis of reports.
Report is an account or summary of the services rendered to the clients and rationalizes the continued existence
of the program. It consists of summary data that are transmitted or submitted monthly, quarterly, and annually to
a higher level, that is from the BHS to the RHU or health center, to the Provincial Health Office and finally to the
regional level (DOH-IMS, 2011).

Recording Tools
1. Individual Treatment Record – fundamental building block or foundation of the FHSIS
2. Target Client Lists – second building blocks of the FHSIS.
3. Summary Table – is a 12 column table in which columns corresponds to the 12 months of the year

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 4. Monthly Consolidation Table – is prepared by the nurse based on the summary table
Reporting forms enumerated in the FHSIS Manual Operations (DOH, 2011)
1. Monthly forms – regularly prepared by the midwife and submitted to the nurse to be used as data for the
Quarterly Forms
Two types of report
a. Program report (M1) – contains indicators categorized as maternal child, child care, FP, and disease
control
b. Morbidity report (M2) – contains all the list of all cases of disease by age and sex.
2. Quarterly forms – prepared by the nurse and usually submitted to the PHO
Two types of report
a. Program report (Q1) – contains the 3 month total indicators
b. Morbidity report (Q2) – is a 3 month consolidation of Morbidity Report (M2)
3. Annual forms

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Different annual forms
a. A-BHS – report by the midwife contains demographic, environmental and natality data
b. Annual Form 1 (A-1) – prepared by the nurse
c. Annual Form 2 (A-2) – prepared by the nurse is the yearly morbidity report by age and sex
d. Annual Form 3 (A-3) – prepared by the nurse is the yearly report of all deaths (mortality) by age and sex

Flow of Reports Table

Locus of Responsibility Recording REPORTING
Tools Forms Frequency Schedule of
Submission
to higher
level
Office Person
BHS Midwife ITR Monthly Form Monthly Every 2nd
TCL (M1 and M2) week of
succeeding
ST
month
A-BHS Form
Every 2nd
Annually week of
January
RHU PHN ST Quarterly Form Quarterly Every 3rd
MCT (Q1 and Q2) week of the
1st month of
the
succeeding
quarter

Annual Forms Every 3rd

A-1 Annually week of
A-2 January
A-3
PHO/C Provinci Quarterly Form Quarterly Every 4th
HO al/City (Q1 and Q2) week of the
Coordin first month of
ator the
succeeding
quarter

Annual Forms Every 4th

A-1 Annually week of
A-2 January
A-3
RHO Regional Quarterly Form Quarterly Every 2nd
FHSIS (Q1 and Q2) week of the
Coordin 2nd month of
ator the

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 succeeding
quarter
Annual Forms
Every 2nd
A-1
week of
A-2 Annually March
A-3
Source: Community Health Nursing and Community Health Development, 1st ed. 2012 by C. Estrada-Castro

Read
 Please read the following contents for further details and exploration of the topics presented above.
 Please read Chapter 4 Community Organizing: Ensuring Health in the Hands of the People on pages 61
to 71

Community Health Nursing II

 Please read principles of CO on pages 63-64
 Please read the Phases of Organizing on pages 65-71
 Please read People-centered approach in integration on page 67
 Please see Figure 4.1 for a CO with several core groups on page 6
 Please see Table 4.1 for areas of evaluation and general evaluation parameters on page 70
 Please read page 71 for the goals of community organizing
 Please read the concepts of COPAR on pages 71-74
 Please see Figure 4.2 for the Schematic presentation of the process in COPAR on page 72
 Read Family Health Records: Field Health Service Information System (FHSIS) on pages 138-139
 Please read the TCL’s maintained in RHUs and health centers on page 138

Readings and References

 Required Textbook: Nursing care of the community. (2013). Zenaida U. Famorca
 Community Health Nursing and Community Health Development: Text-Workbook (1st edition 2012).
Cecilia E. Castro
 The Basics of Community Health Nursing: A Study Guide for Nursing Students and Local Board
Examinees (2010). Monina H. Gesmundo
 Community Health Nursing Practice: The Basics of Practice (2006). Salvacion G. Baylon- Reyes
 Community Health Nursing Concepts and practice. (8th edn) 2001.Lippincott, 342-45. Allender J.N;
Spradely B.W.
 Community Health Nursing Promoting health of Aggregates, Families and individuals. (4th edition 2001).
Mosby, 265-80. Stanhope M; Lancaster J.

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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