Nursing Process in the Care of Population Groups and Community

A. Community Health Assessment Tools

Collecting Primary Data

1. Rapid observation of a community may be done through an ocular or windshield survey,

either by driving or riding a vehicle or walking through it.
This gives the nurse the chance to observe people as well as take note of environmental conditions
and existing community facilities. Participant observation is a technique that suits community
organizing and participatory action research.

2. Survey is necessary when there is no available information about the community or specific
population group to be studied. It is made up of a series of questions for systematic collection of
information from a sample of individuals or families in a community and maybe written or oral. –
--

3. Informant interview are purposeful talks with either key informants or ordinary members of the
community.
Key informants consist of formal or informal community leaders or persons of position and influence,
such as leaders in local government, schools or business.

3. Community forum is an open meeting of the members of the community.

4. Focus group differs from community forum in the sense that the focus group is made up of a much
smaller group, usually 6-12 members only.

Secondary Data-

• Are taken from existing data sources. Sources consist of vital registries, health records and
reports, disease registries and publications.

Secondary data sources

1. Registry of vital events

- Act 3753 established the civil registry system in the Philippines and requires the registration of
civil events, such as births, marriages and deaths.
- RA 7160 (Local Government Code) assigned the function of civil registration to local
governments and mandated the appointment of Local Civil Registrars. The National
Statistics Office (NSO) serves as the central repository of civil registries and the NSO
Administrators and the Civil
- Registrar General of the Philippines before 2014. All these functions are now under the
Philippines Statistics Authority (PSA) by virtue of RA 10625 otherwise known as the “Philippine
Statistical Act of 2013
2. Health Records and Reports
 - As specified by EO No. 352, the FHSIS is the official recording and reporting system of the
Department of Health and is used by the Philippine Statistics Authority to generate health
statistics. The FHSIS is an essential tool in monitoring the health status of the population at
different levels.

Recording Tools in FHSIS

a. Individual treatment record
b. Target client list
c. Summary table
d. Monthly Consolidation table

Reporting Forms in FHSIS

a. The monthly form (Program Report, Morbidity Report)

b. The quarterly form (Program Report, Morbidity Report)
c. The annual form
3. Disease registries
- A disease registry is a listing of persons diagnosed with a specific type of disease in a defined
population. Data collected through disease registries serve as basis for monitoring, decision
making and program management (DOH, 2011).

4. Census data
- A census is a periodic governmental enumeration of the population

B. Community Diagnosis

Eight Steps to Community Health Needs Assessment

1. Identify and engage in stakeholders.
2. Define the community.
3. Collect and analyse data.
4. Select community priority health issues.
5. Document and communicate.
6. Plan improvement strategies.
7. Implement improvement plans.
8. Evaluate progress.

Basic Values in Community Organizing

1. Human rights
2. Social Justice
3. Social Responsibility
Participatory Action Research (PAR)

- is an approach to research that aims at promoting change among the participants. Members of
the group being studied participate as partners in all phases of the research, including
design, data collection, analysis and dissemination (Brown, 2008).

Community Organizing (CO) is a process of educating and mobilizing members of the community to
enable them to resolve community problems. The emphasis of community organizing in primary
health care are the following:
1. People from the community working together to solve their own problems
2. Internal organizational consolidation as a prerequisite to external expansion
3. Social movement first before technical change.
4. Health reforms occurring within the context of broader social transformation.

Comparison of Traditional Research Approach and COPAR

Points of Comparison Traditional Approach Research COPAR

Decision making Emphasis Top-down Expert/nurse-driven Bottom-up Community-driven

process Much premium is process Premium is placed on the
placed on the data and output. process

Roles Nurses as researcher; Community members as

the community members
are subjects or objects of
research
Data analysis is done by
the nurse, and then
presented to the
community
researchers: the nurse is
a facilitator and recorder
Data analysis is done
collectively by the
community

Methodology Research tools and Research tools and

methodologies are pre
determined/ prepackaged
by the nurse-organizer
Output Upon completion, the
study is packaged,
submitted to the agency
and published.
Recommendations are
made by the researcher
based on the findings of
the study.
methodologies are
identified and developed
by the community
Conclusions and recommendations
are made by the community.
These will lead to agreed
Community actions/projects. The
whole research cycle continues
until it becomes part of community
life, leading towards community
development.
Community members formulate
the recommendations.
SCHEMES IN STATING THE COMMUNITY DIAGNOSIS

Community Diagnosis

- Community diagnosis is the process determining the health status of the community and the
factors responsible for it.

1. NANDA
- nursing diagnostic labels focused more on individual rather than the community responses to
health conditions, have included diagnosis at the community level

2. Shuster and Goppingen

- Proposed a practical adaptation of a format of nursing diagnosis for population groups
previously presented by Green and Slade (2001).
- The three part consists of:
a. The health risk or specific problem to which the community is exposed.
b. The specific aggregate or community with whom the nurse will be working to deal with the
risk or problem.
c. Related factors that influence how the community will respond to the health risk or
problem.

3. OMAHA System
- is the framework for the care of individuals, families and communities by nurses,
nursing educators, physicians and other health care provider. (pls see OMAHA System
Website)
- Domains and Problems of the Problem Classification Scheme
a. environmental domain
b. psychosocial domain
c. physiological domain
d. health-related domain

D. Planning Community Health Interventions

- As in other fields of nursing practice, planning for community health interventions is based on
findings during assessment and formulated nursing diagnosis.
- Planning is a logical process of decision making to determine which of the identified health
concerns requires more immediate consideration and what actions may be undertaken to
achieve goals and objectives.
I. Priority Setting

WHO Special Considerations:

a. Significance of the problem

b. Community awareness
c. Ability to reduce risk
d. Cost of reducing risk
e. Ability to identify the target population
f. Availability of resources

Steps in Priority Setting

1. From a scale of 1 to 10, 1 being the lowest, the members give each criterion a weight based on
their perception of its degree of importance in solving the problem. For example, each member
assigns a weight to the significance of the problem in response to the question, “How important is
significance of the problem to its solution?”

2. From a scale of 1 to 10, 1 being the lowest, each member rates the criteria in terms of the
likelihood of the group being able to influence or change the situation.
For example, each member rates significance of the problem in response to the question, “Can the
group influence the significance of this problem?”

3. Collate the weighs (from step 1) and ratings (from step 2) made by the members of the
group.
4. Compute the total priority score of the problem by multiplying collated weight and rating of
each criterion.

II. Formulating Goals and Objectives

- As in family health nursing, goals are the desired outcomes at the end of interventions,
whereas objectives are the short-term changes in the community that are observed as the
health team and the community work towards the attainment of goals. Objectives serve as
instructions, defining what should be detected in the community as interventions are being
implemented. It should be specific, measurable, and attainable and time bound.

III. Deciding on Community Interventions/ Action Plan

- Because of their inherent differences, what may work for one community may not be effective
in another? The group analyzes the reasons for people’s health behaviour and directs strategies
to respond to the underlying causes.
- For example, reasons for preference of home delivery over facility-based delivery should be
identified. If the majority of the women would choose to have a home delivery because of cost
or lack of access of birthing facilities, strategies should then be focused on improving facility-
based services