Community Health Nursing II

COPAR – Community Organizing Participatory Action Research

• As a tool for development.
• A social development approach
• Aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory,
and politically responsive community.
• A collective, participatory, transformative, liberative, sustained and systemic process of building
people’s organizations by mobilizing and enhancing the capabilities and resources of the people.
• For the resolution of their issues and concerns towards effective change in their existing
oppressive and exploitive conditions.
• A process by which a community identifies its needs and objectives, develops a confidence to
take action in respect to them and in doing so, extends and develops cooperative and
collaborative attitudes and practices in the community.
• A continuous and sustained process of educating the people to understand and develop their
critical awareness of their existing conditions, working with the people collectively and
efficiently on their immediate needs toward solving their long-term problems.

Importance of COPAR
✔ Helps the community workers to generate community participation.
✔ Prepares people to eventually take over the management of development program/s in the
future.
✔ Maximizes community participation and development.
✔ Mobilization of resources for health development services.

Principles of COPAR:
✔ People, especially the most sectors are open to change, have the capacity to change and are able
to bring about to change the following people:
1. DEPRIVED - people who are suffering a severe and damaging lack of basic material or cultural
benefits.

2. OPRESSED - someone to crush or burden by abuse of power or authority.

3. POOR - lacking sufficient money to live at a standard considered comfortable or normal in a

society.

4. EXPLOITED - someone was been treated unfairly in order to make money or taking them
for an advantage.

5. STRUGGLE - someone to use a lot of effort to defeat someone, prevent something or

achieve something.
✔ COPAR should be based on the interests of the poorest sectors of society.
✔ COPAR should lead to self-reliant community and society.

Processes used in COPAR:

• Progressive Cycle of Action-Reflection-Action:
- issues are identified by people and the evaluation and reflection of and on the action taken by
them.
 • Consciousness-Raising:
- through experiential learning.

• COPAR is Participatory and Mass-Based:

- primarily directed and based in favor of the poor, the powerless and the oppressed.

• COPAD is Group-Centered and Not Leader-Centered:

- leaders are not appointed but identified, emerge and are tested through action.

Community Organizing (CO) Process:

1. PRE-ENTRY PHASE
➢ Gathering important data in the community before entering it
➢ Knowing the people
➢ Conducting preliminary social analysis

Sources of Initial Data:

➢ Written community profile
➢ Vital statistics consolidated and updated at the RHC
➢ Reports from the Field Health Service and Information System (FHIS) of the covered barangay
➢ Descriptions of the barangay from RHU workers, barangay health workers and volunteer

2. ENTRY PHASE
➢ Do not create false hopes
➢ We should maintain a “Low Profile”
➢ Based on the information we have gathered, we must adapt our clothing and manners to the
people’s way of life
➢ We do not create the impression of becoming “Superstars” or “Saviours”

Courtesy Call:
✔ Visiting the leaders in the community to present our interactions and to come to an agreement
with the scope of our work
✔ Contact with the leaders will be continuous and often

3. SOCIAL INTEGRATION OR “PAKIKIPAMUHAY”

➢ Arranging period where we can live with them and experience what they do
➢ We must become family members, neighbors, co-workers, co-church members, and friends

We integrate specifically to achieve the following:

• EMPATHY – work because of “pang-unawa” (understanding) rather than “awa” (pity)
• TRUST – mutually gaining comfort and revealing reality
• TRUTH – people reveal their true sentiments, concerns and aspirations

Tips on how to integrate well in community:

(a) Live their lives
(b) Get out of your comfort zones
(c) Cultural exchanges
(d) Be one of the crowd

4. SOCIAL ANALYSIS/COMMUNITY DIAGNOSIS or “PAGSUSURING PAMPAMAYANAN”

 ➢ The usual participation of the people in the investigation of their situation through answering
survey questionnaires or interview questions
➢ People must have “kamalayan” or deeper understanding of their reality
➢ Community diagnosis must be done by the people
➢ People reflect on their present health conditions and identify individual and common problems
➢ Investigate on the readiness and willingness of the community to remove barriers to their health
and contribute for the improvement of their healthy systems

5. CORE GROUP FORMATION

➢ Core group is composed of individuals who possess abilities to lead the community in health
care.

Criteria for the core group:

• INDIGENOUS
• MULTISECTORAL
• SOCIAL AWARENESS
• COMMITMENT
• PEOPLE CHOSEN
➢ By creating a core group, the organization will not be leader-centered but people-centered
where all sectors will be represented

6. SETTING UP THE ORGANIZATION

• Readiness of the community to form organization
• Start of establishing their organization
• Election of officers
• Every sector should have seat in the organization leadership

7. STRENGTENING THE ORGANIZATION

• Investigate deeper into their situations and find possible solutions as a whole
• Formulation of mission, vision and goals
• Strengthen leadership and membership by training
SALT TRAINING: (team building)

>Self

>Awareness

>Leadership

>Training

Sustenance & Strengthening Phase

8 Important Keys:

1. Formulation & Raptification of constitution by laws - mga batas na sinusunod natin

para guidelines upang magbigay ng formal approach
 2. Identify secondary leaders - sino yung mga susunod sa position mo kapag nag phase out
kana

3. Setting up Financial Schemes - saan tayo kukuha ng mga pera o saan ginagamit yung
pera para malaman kung magkano at para mabayaran ang mga kailangan pang
kalusugan

4. Continuing Education & Training of Barangay Health Workers - ongoing parin ang
pag-tratrain sa kanila

5. Formalizing Linkages, Network and Referrals - gagawa tayo ng program na connected

sa ibang experts and professional para maging maayos at organize ang mga kailangan ng
community para maging maayos pa lalo ang community nila

• These two terms are really applied in working with other organization
Ex. Partnership na may ginawang bag, gawa sa organic ang bag na ito na galing sa basura
ginawa niyang bag, may communication outside the network

>INTRASECTORAL

• This is WITHIN THE COMMUNITY OF ex. PAMPANGA

• paloob

>INTERSECTORAL

• This is OUTSIDE THE BOUNDARY OF ex. PAMPANGA

• palabas

6. Negotiation of Barangay Health Workers - kailangan makipag-negotiate tayo sa mga

nakakaalam ng problema sa community at aalamin natin kung mag kano yung allowance
ng barangay nila para malaman natin kung ano na yung mga naayos or hindi pa naayos
ng community para magawan ng paraan dahil sa pagtatanong natin may nalalaman tayo
sa mga kalagayan nila

7. Development of Plan - ito yung pang long term plan na ginagawa natin para maging
independent ang mga citizen na yung program mag mamaintain na ginagawa parin ng
mga tao sa community to maintain their health, hindi siya nawawala yung program pero
nag eevolve siya

8. Registration to the Security and Exchange Commission - upang maging legal ang
pinapatupad na organization program upang mag sustain at mag develop pa lalo ang
community kapag kasi naka-register siya sa mga authoridad na magiging mas in demand
ang program kaya siya magiging lifetime kasi yun ang utos ng batas
8. WORKING WITH OTHER ORGANIZATION
• Involvement with higher level of health issues not only affecting their own community but their
municipality, province, region or even the country
• Need to be supported and support other organizations
• Joining not only an organization, but coalition or alliance, or later even network

CDX – Community Diagnosis

- Note social analysis community diagnosis, ginagawa natin we are diagnosis the community
problem and usual participation of the people in a investigation of situation tru answering
survey, to determine what is the priority problem of the certain community, para makita :ay
problema pala dto walang trabaho ang mga people”
- Community -> sila ang mas nakakaalam ano ang problema ng community.
- That is the community diagnosis/social diagnosis of the community

Participatory Action Research (PAR)

- Hindi mabubuo si COPAR ng walang application through evidence-based/action
• Community-Directed Process of gathering and analyzing information or issues for the process
of taking actions and making changes
ex. Pupunta ang group of students together with doc orte sa brgy isidro that time they determine
the problem alam na nila ang problems jan because they conduct community diagnosis, a tie
after they identify the issue: Improper grabage disposal.

• Guided and continuous process that will chart present and future directions
ex. formulating recommendation solution to that problem in short in other word gagawan natn
ng research in order to create better action, para ma solve natin ang problem ng meron ang
community currently which in top priority problem of the community, Someimes hindi tayo
mismo ang pipili ng top priority problems nila.
Note: di pwede, ikaw ang masusunod, kung ikaw eto alam ong mas malalapero sa community sabi ay
ito at sila mismo ang nakakaalam kung ano ang problema nila
• Involves research, education and action to empower the people

➢ FOCUS – generate knowledge to generate actions

GKGA – General Knowledge to General Action

-> Bago ka makagawa nga action you have to analyze dapat may knowledge dapat alam mo ang
problema ng community, alam mo ang background, alam mo ang hx, alam mo ung profile
-> Di ka gagawa ng action ng walang proper assessment of the community
-> Titignan mo kung ano ang status of the community, titignan mo ano ang kalagayan ng
community, you cannot create any action without proper assessment data

➢ DRIVING FORCE – positive social change

- Di ito magagawa kung sino at mga nurses lang ang gagawa, this is social participation
- It means kailangan lahat magtulong tulungan, means social envolvement
- Magkakaroon lang ng pagbabago sa isang community if mayroong participation of the social
people or community, dapat everyone are working in the community should be positive to
cooperate.
- Di magagawa ang change kung isa lang ang gagawa.
➢ ESSENTIAL ELEMENT OF PAR – participation
- May effect to the community if you not participate every family or group have a vital role in
the community by significant role
- Your are organizing in the COPAR di pwede na na si nurse lang yung gagawa take note
kailangan po si people at family individual to work with the COPAR
> GROUP CENTERED IS NOT LEADER CENTERED

➢ MAIN ACTORS IN THE RESEARCH PROCESS – people (beneficiaties)

➢ Activities:
- Investigate health conditions
Purpose: Para malaman ano ang problema.
- Determine the causes of the problem
Purpose: Nalaman mo ito ang problema nila, let the people to analyze, initiates what cause of
the problem.
- Analyze the problem
Purpose: Before to create a good one, attention to analyze pwedeng lumalala kung hindi
masolusyonan.
- Identify factors affecting their level of functioning
Purpose: Yung mga problemang maliit lamang, pwede ba itong maka apekto sa health.
Ex. Walang tubig, need to maligo
- Act by themselves in responding to their own problems
Purpose: To establish SR
--> Identify their strengths and weaknesses
--> Determine ways for improvement or changes in action

➢ Characteristics:
- Research seeks social transformation
• Dapat di lang char char ang research mo kailangan may pagbabago after you conduct action
research there will be a change, it means may change na magagawa, there will be
transformation to the community (may pagbabago bang nakikita sa community.)

- Problems are defined by the community members themselves

• Sila mismu ang gagawa sila mismu ang mag initiates kung ano ang problema ng kanilang
community, di mo pwede silang diktahan.

- The people (Community Groups) undertake the investigation from data collection to analysis
• Kumbaga they will be conducting a survey to all, ex. In one brgy ilang purok yan, 20 a purok
assuming then that a time they will be a investigate or collect the data, lahatng mga organizing
to conduct survey to each family household after that nakuha na nila ang survey, then after that
interview and survey they collecting the data, then mag tally, there will be a analysis, mattignan
na nila to prioritize kung ano talaga ang problema ng specific brgy na ito/community (di pwede
na they will be create a problem without data collection, dapat talaga mag data collection)

- The community formulates recommendation and an action plan based on research outcome
• Gagawa ka nang recommendation ex. The problem is malnulutrition, maraming malnutririon so
gagawa kanang recommendation or action plan, ex. You will be partnership with the Non-
government NGO, non-government organization, to conductfeeding program every wednesday,
you will be create that, to assess may proven (this is action plan effective to those malnourish
client, kailangan makikita ang research outcome)
PAR in the CO process:
• PAR is an integral part in community organizing
• Through PAR the organization is strengthened and continued
• PAR is the strategy used in social analysis

PAR Methods:
➢ REVIEW EXISTING DOCUMENTS
- Vital Statistics
> Study of vital event and state of the community
MORBIDITY – someone unhealthy or with illness
MORTILITY - death
> Titignan mo kung ilang family members per household, titignan mo ano ang common aid,
in short the vital statistic of the per family

➢ PARTICIPANTS OBSERVATION AS BASIS FOR SOCIAL ANALYSIS

> Sa pag collect ng facts or datas kinakailangan mo magaling pag socialize at pag observed
sa mga tao sa community paano nila nagagampanan ang function nila as residence sa
community.

➢ COMMUNITY MAPPING
- Analyze the relationships of the community’s resource
> Ex: You will be conduct investigation, survey in brgy garden, do pwede na lalagpas ka sa
bgry garden, you conduct community mapping within the bgry kung saan or hanggang saan
ang boundary nila

➢ CASE STUDIES AND STORIES

- Models for community actions
> Example: You found out that one family na naiiba talaga sya kumbaga naiiba lang sya, or
person with disability sya may apat sya apat syang anak with disability din at the same time
nabubuhay nya ng mag isa single mom sya, very rare condition in the community that’s
unique case na pwedeng gawin case study.

➢ SEEK THOSE WHO ARE EXPERTS ABOUT SPECIFIC ISSUES

- Knowledge and skills handed on by tradition have been long validated and cannot be
questioned
> Example: Maraming malnourish children dto, before mag conduct ng feeding program, mag
invite kayo ng doctor or expert (dietician) to introduce to the mother bakit ito parte ung
kalusugan ng mga bata.

➢ GROUP ENCOUNTERS
- Joining “Umpukans” with the community people
> Lahat ng community dIto na encounter nila na experience ay ang pagkawala ng trabaho
most residence sa brgy nila kumbaga extended family pa, majority of the family walang
trabaho sa mga extended family.

➢ TRANSECT WALKS
- Systematic walk with key informants while discussing significant information about the
community
 > It means we will be listening to the participants what are they trying to provide
information sayo, kumbaga para kang nag documentary sakanya
> Example: The client mentioned “alam mo during pandemic ganito kami
mahirap....naghihintay lang ng ayuda ganon kapag wala ibibigay ang mayor wala kaming
makakain.” so that you can apply transient a walk.

➢ SHARED PRESENTATION AND ANALYSIS

- Presentation, checking, correction and discussion of findings and data by local people at
community meetings
> Example: After you have the data collection, kailangan nyo na i-present to the brgy official sa
mga officers ng brgy, so you have the correction time frame to analyze all the data what kind of
seminar or activities ang kailangan isagawa to improve the life of their people.

PARTNERSHIP & COLLABORATION NETWORKING:

• Organizations exchange information about each other’s goal, objectives, services or facilities
- Dapat iisa lang ang layunin, one direction

• Results in the organizations’ awareness of each other’s worth and capabilities and how to
contribute to the accomplishment of the network’s goals and objectives
- You will ask yourself to have an awareness kung SMART ba sya

Specific – all data ay nakafocused lang parati sa specific goal na yung sa health
Measurable – lahat ng problems kailangan measure muna at mga factors nito
Attainable – may goals ka na kailangan ma-achieve kapag nag cocommunity duty ka
Realistic – makatotohanan ang research niyo sa community hindi gawa gawa lang
Time bounded – requires enough time, titignan ang pwedeng ma improve

• Requires small amount of time

- may time frame na sinusundan kapag nag coconstruct ng solution sa mga problema ng isang
community dahil hindi natin pwedeng hayaan na may maaksidente or may karamdaman na
nakakasama sa mga nakatira sa community na magiging dahilan na mawalan sila ng kaanak or
mahal sa buhay, mabilisan ang pag iisip ng solusyon dapat.

• Has great potential in terms of joint action

- teamwork para maging mas madaling ang process ng pag mamaintain ng health condition ng
nakakarami.

COORDINATION
- organizations modify their activities in order to provide better service to the target beneficiary
- becomes time consuming as it requires more involvement and trust from the committed organization

COOPERATION
- organizations share information and resources to make adjustments in one’s own agenda to
accommodate their organization’s agenda
- organizations share ownership of the success, rewards as well problems and hassles that go along with
working together

COLLABORATION
- organizations help each other enhance their capacities in performing their tasks as well as in the
provision of services
- people become partners rather than competitors
- entails a lot of work, but the potential for change can be great
- As a team walang lamangan, walang pagalingan

COALITION or MULTI-SECTORAL COLLABORATION

- organizations and citizens form a partnership
- all parties give priority to the good of the community
- requires great investment in terms of effort, time, trust and the will to make a change

ADVOCACY
- promotes community participation
- helps people attain optimal degree of independence in decision-making in asserting their rights to a
safe and better community
- places the client’s rights as priority
- helps empower the people to make decisions and carry out actions that have the potential to improve
their lives
- The community will benefit sa napiling community
- Gagawa tayo ng may direction at patutunguhan, ensure the safety of the community
- Tutulungan natin ang commuity, hindi natin kaaway ang community, unity is the key. (we are in a big
family in community)

CHN- According to Dr. Aracelli Maglaya

 Utilization of Nursing Process to the different level of clientele

I - Individual- Point of entry/ first receiving of intervention

F -Family- Center delivery of care/ focal point
G - Group- point of specific care/ Per group there is a different intervention
C - community- point of entire care/ Client of CHN

Concepts of CHN- EUROPE

E- Emphasis of CHN according to PAMORCA
 Health Promotion-
o tools (Health Education)- the focus of nurse
o In 1986 started the OTTAWA charter for health promotion
 International conference on health promotion
 focus process of enabling people to increase control over and improve
the health
 Disease Prevention

U-Ultimate Goal of CHN-

 Increase the level of health of citizenry
 Increase the wellness of the people

R- Read the Primary goal of CHN

  Enhance people’s capabilities

O- Objective of CHN
 PROCOPAR
o PRO- Provide Quality Services, Education and Research
o CO- Coordinate nursing services
o PAR- Participate, Development and Evaluation plan

PE- Pen- Philosophy of CHN according to Dr. Margarette Shetland

 Based on the worth and dignity of man

PHASE OUT PHASE

- After 5 years
- Pwede munang iwan ang community based sa ability nila na kaya na nila tulungan ang sarili nila
- Hindi pwedeng mawawala ka nasa community doon kapalang mag eendorse
- Kailangan every year gumagawa ka na ng Coradual Endorsement so that it can be measured
atsaka para ma-trained yung mga inspiring leaders ng community before ka umalis ng
community para ipagpatuloy yung program ng organization
- Transfer roles & responsibilities para ma-secure na accountable sila at the same time
responsible sila sa kanilang actions
- Time to time follow up!

When to phase out:

O - Objectives have been attained/achieved
I - Impact of the project has becomes visible
C - Community can take over the APIE (Assess, Plan, Implement & Evaluate)
C - Community resources can be utilize
S - Self Reliance

DOLE OUT APPROACH

– kailangan pang samahan kasi hindi pa nila kaya tumayo sa sarili nila

When to dole out approach:

D - Dependency
P - Passive
D – Decreased Self-esteem
P - Powerless

EPIDEMIOLOGY
– study of occurence and distribution of a disease or factors affecting the disease
- back bone of disease prevention

Patterns of Disease Prevention or Occurence:

E – Epidemic (Sudden increased, occurence and also known as Rapid Outbreak within the
community)
S – Sporadic (On or off, intermittent and irregular occurence)
P – Pandemic (Worldwide disease outbreak)
E – Endemic (Constant, regular or disease is always present in the community)
Field Health Service & Information Systems (FHSIS)
- ito yung mga recording and reporting of cases in the health center

Components of FHSIS:
1. Family Treatment Record (FTR)
- this is the fundamental building blocks of FHSIS
- ito yung mga forms and documents of presenting symptoms of the client/patient

2. Target Client List (TCL)

- secondary building blocks of FHSIS
- monitoring and reporting of cases
- ex: prenatal care and family planning

3. Tally/Reporting Forms
- ito yung mga naka-arrange daily
- mechanism through which data are rountinely transmitted (From one ability to another)
- ex: From the health center going to the Municipality Office and then goes to the Regional Sectoral
Office

4. Output Report
- dito yung papers or forms na galing sa provincial health office i-tratransfer sa DOH or the national
organization for health management, doon siya makakarating dahil may pake sila sa kung anong
kalagayan ng bawat tayo sa community gusto nilang maprevent ang mga cases ng diseases para
malaman ilang percent na ang may sakit or walang sakit sa country.

Source of Data:
1. De Jure --> inclusion of person based on where they live regardless of where they are during the
census
- yung data na pinag-combine ng buong population sa isang community na kung saan ka
- yun ang kung saan ka naka-residency, kunware pampanga, davao okaya naman sa manila doon ka
lang mag sasagawa ng census

2. De Facto --> inclusion of person based on where they at the time of census
- ito naman yung data combination ay naka based sa lugar kung nasaan ka man ngayon kunware nasa
mall okaya palengke counted parin siya kahit hindi siya doon nakatira sa paligid

Legal Basis:
R.A 7305 – Magna Carta for Public Health Workers
R.A 3573 – Reporting of Community Disease
R.A 9994 – Senior Citizen Act of 60 years old and above
R.A 9165 – Dangerous Drug Act
R.A 9275 – Clean Water Act
R.A 8749 - Clean Air Act
R.A 9003 – Ecological Solid Waste Management Act
R.A 6969 – Toxic Hazardous Nuclear Waste Control
R.A 7600 – Rooming in and Breastfeeding Act
R.A 8976 – Philippines Food Fortification Act
R.A 7160 – Local Goverment Unit Code
R.A 7846 - Compulsory HEPA B Immunization
E.O 84 – Declaring Rabies Awareness
E.O 51 – Milk Code
E.O 651 – Birth and Death Certification Law
P.D 825 - Anti Improper Garbage Disposal
P.D 856 – Sanitation Code
PROCLAMATION 1066 – Declaring National Neonatal Tetanus

Prelim Exam Questions:

The typology of family nursing problems is used in the statement of nursing diagnosis in the care
of families:

The youngest child of the De Los Reyes Family has been diagnosed as mentally retarded:
- Health Deficit

The Marcos couple have a 6 years old child entering school for the first time. Tha family has
- Foreseeable Crisis

Client in the CHN:

- Community

Unit of Service of CHN in delivery of care:

- Family

Point of Specific care in CHN

- Group

Hours of declaration of death in the Philippines:

- 24 Hours
Hours of issuance of death certificate in the Philippines:
- 48 Hours

Basic Concepts in CHN

- EUROPE

Ottawa charter for health promotion is 1986 knowns as:

- International Conference on Health Promotion

What is the advantage of a home visit?

- It provides an opportunity to do first hand appraisal of the home situation

The PHN bag is an important tool in providing nursing care during a home visit. The most
important principle of bag technique states it:
- Should minimize if not totally prevent the spread of infection

It is an essential part of the health system and serves as the first point of contract for many
around the world:
- Emergency Case

It is the step in community organizing involves training of potential leaders in the community:
- Core Group Formation

Long will it take to transition or phrase out:

- 5 years

As an epidemiologist. the nurse is responsible for reporting cases of notifiable diseases

- R.A 3573

Birth and Death Registration Law:

- P.D 9165
Milk Code
- E.O 51

Based on the community health process

focus in evaluation phase
- The Effect of the Nursing Intevention

Based on the community health process focus in assessment phase

- Identify health problems

Based on the community health process focus in planning phase

- Goal setting

Magna Carta for Public Health Workers known as

- R.A 7305

Ecological Solid Waste Management act known as:

- R.A 9003

Senior Citizen Act of 60 yrs old and above known as:

- R.A 9994

Philippine Board of Nursing Chairperson:

- Dr. Elsie A. Tee