lOMoARcPSD|52164003

CHN II RLE SAS - Tuon

Community Health Nursing 2 (Xavier University - Ateneo de Cagayan)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university

Downloaded by Dudai Unlock ([email protected])
 lOMoARcPSD|52164003

PHINMA EDUCATION NETWORK

College of Nursing

COMMUNITY HEALTH NURSING 2

(POPULATION GROUPS AND
COMMUNITY AS CLIENTS)

RLE Clinical Module, Clinical Instructor’s

Guide

BSN Level 3, 1st Semester

Clinical Instructor’s Guide 1

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

FLEXIBLE LEARNING RLE PROGRAM

Response to COVID-19 Pandemic

Course Name Community Health Nursing 2 (Population groups and Community as Clients)
Course This course focuses on the care of the population groups and community as
description clients utilizing concepts and principles in community health development. It
also describes problems, trends and issues in the Philippine and global health
care systems affecting community health nursing practice. The learners are
expected to participate in identifying the actual and potential problems in the
community utilizing the nursing process and applying COPAR as a strategy
towards community development.
Course At the end of the third year, given groups of clients (individual, families,
Outcomes population group and community) in any health care setting, the student
should be able to:
1. Apply knowledge of physical, social, natural, and health sciences, and
humanities in nutrition and diet therapy.
2. Provide safe, appropriate, and holistic care to individuals, families,
population group and community utilizing nutrition care process.
3. Apply guidelines and principles of evidence-based practice in nutrition
and diet therapy.
4. Practice nursing in accordance with existing laws, legal, ethical and
moral principles related to nutrition and diet therapy
5. Communicate effectively in speaking, writing, and presenting using
culturally appropriate language in nutrition and diet therapy.
6. Document client care in nutrition and diet therapy accurately and
comprehensively.
7. Work effectively in collaboration with inter-, intra-, and multidisciplinary
and multi-cultural teams in providing nutritional care.
8. Practice beginning management and leadership skills using a systems
approach in nutrition and dietary management of the client.
9. Engage in lifelong learning in to keep current with national and global
development in general, nursing and health development in particular.
10. Demonstrate responsible citizenship and pride of being a Filipino.
11. Apply techno-intelligent care systems and processes in nutrition and
diet therapy.
12. Adopt the nursing core values in the application of nutrition and diet
therapy.
13. Apply entrepreneurial skills in nutrition and diet therapy in the delivery
of nursing care.

Course credit Theory: 2 units (36 hours) RLE: - 1 unit (51 hours)
Contact hours 36 lecture hours, 51 RLE hours
Pre-requisite NUR 101/NUR 145
Placement Level III 1ST semester

Clinical Instructor’s Guide 2

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

COURSE RELATED LEARNING EXPERIENCE

ACTIVITIES

Module 1: COMMUNITY HEALTH NURSING

Module 2: COMMUNITY AND SOCIETY, COMMUNITY AND HEALTH
Module 3: CULTURE &HEALTH
Module 4: PUBLIC HEALTH NURSE
Module 5: LOCAL PUBLIC HEALTH SYSTEM

Face to Face/On-line activity Materials

Schedule Area (synchronous/asynchronous)/R Off-line activities needed at
emote Coaching home
Orientation to Related-Learning
ORIENTATION TO Experience, Rotational Plan,
COMMUNITY HEALTH Introduction Of RLE Groups And
NURSING 2 (POPULATION Assigned Clinical Instructors
GROUPS AND COMMUNITY
AS CLIENTS)
A. 1. Interview several
community health nurses
and clients regarding their
Interactive Discussion on: definitions of health. Share
the results with the class.
A. COMMUNITY HEALTH Do you agree with their
NURSING definitions? Why or why
not?
B. COMMUNITY AND 2. Interview several
SOCIETY, community health nurses Activity
Rotation regarding their opinions on
COMMUNITY AND Sheets
1 focus of community health
Community HEALTH
Weeks nursing. Improvised
1-3
C. CULTURE AND Materials
HEALTH The interview can be done
through a social media or any that
it is convenient to the interviewer
D. PUBLIC HEALTH and interviewee.
NURSE (The interview transcripts must be
encoded and properly
E. LOCAL PUBLIC documented. Interview transcripts:
HEALTH SYSTEM 8.5x11, single space, Times New
Roman Font Size 12)

B. Students will give possible

issues at present that
affects health and what are
the possible solutions that
may contribute as a
student nurse, as a

Clinical Instructor’s Guide 3

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

member of the community

and as a future worker.
⮚ Watch any video showing
Filipino culture and values
https://www.youtube.com/watch?v
=79xsa9zfA_U

C. Students will do an
interview to a nurse
working in a Public Health
Institution. The interview
can be done through a
social media or any that it
is convenient to the
interviewer and
interviewee.
(The interview transcripts must be
encoded and properly
documented. Interview transcripts:
8.5x11, single space, Times New
Roman Font Size 12)

***Students are to submit all their

output in the Google classroom
drive.

Module 6: PRINCIPLES OF COMMUNITY HEALTH CARE, CONDITIONS IN THE COMMUNITY

AFFECTING HEALTH &CHARACTERISTICS OF A HEALTHY COMMUNITY
Module 7: COMMUNITY HEALTH NURSING PROCESS: COMMUNITY ASSESSMENT
Module 8: COMMUNITY HEALTH NURSING PROCESS: COMMUNITY DIAGNOSIS
Module 9: COMMUNITY HEALTH NURSING PROCESS: PLANNING COMMUNITY HEALTH
INTERVENTION, FORMULATING GOALS AND OBJECTIVES DECIDING ON INTERVENTIONS,
IMPLEMENTATION AND EVALUATION

Face to Face/On-line activity Materials

Schedule Area (synchronous/asynchronous)/ Off-line activities needed at
Remote Coaching home

Interactive Discussion on:

A. PRINCIPLES OF
COMMUNITY
HEALTH CARE,
Activity
Rotation CONDITIONS IN THE
Sheets
2 COMMUNITY
Community
Weeks 4- AFFECTING HEALTH
Improvised
7 &CHARACTERISTICS
Materials
OF A HEALTHY
COMMUNITY
SCORING AND IDENTIFYING
HEALTH PROBLEM and PRIORITY
B. COMMUNITY
SETTING OF COMMUNITY
HEALTH NURSING
HEALTH NURSING PROBLEMS
PROCESS
Clinical Instructor’s Guide 4

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Students will follow the criteria and

steps in prioritizing health problems.
Refer to the video below
https://www.youtube.com/watch?v=
VmSy1Zok-c8
https://www.youtube.com/watch?v=-
rYyhzBgK2U
(The output must be computerized.
Times New Roman Font Size 12)
C. COMMUNITY
ASSESSMENT AND Students will do the steps in
DIAGNOSIS conducting a community diagnosis,
scoring and identifying health
problem, and steps in prioritizing
health problems.

D. COMMUNITY Community Assessment Forms and

HEALTH NURSING watch
PROCESS: https://www.youtube.com/watch?v=T
PLANNING Q640CZvNZg
COMMUNITY
HEALTH
INTERVENTION,
FORMULATING
GOALS AND
OBJECTIVES
DECIDING ON
INTERVENTIONS,
IMPLEMENTATION
AND EVALUATION

Module 10: (COPAR) COMMUNITY ORGANIZING part 1

Module 11: (COPAR) COMMUNITY ORGANIZING part 2 & COMMUNITY IMMERSION
Module 12: GUIDELINES IN MAKING OF THE COPAR DOCUMENTATION
Module 13: TABLES, GRAPHS AND ANALYSIS, ADDITIONAL GUIDELINES IN FILING UP OF
THECOMMUNITY HEALTH SURVEY FORM AND DOCUMENTATION
Module 14: COMMUNITY HEALTH SURVEY
Face to Face/On-line activity Materials
Schedule Area (synchronous/asynchronous)/ Off-line activities needed at
Remote Coaching home
Interactive Discussion on:
1.a. Identify a people’s
A. (COPAR)
organization within your Activity
Rotation COMMUNITY
community. Sheets
3 ORGANIZING &
Community b. Interview some of the officers
Weeks 8- COMMUNITY and members of the Improvised
10 IMMERSION organization. Materials

c. ask them the following:

Clinical Instructor’s Guide 5

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

-What is the name of the

organization?
-When was it organized?
-Why was it organized?
-What are the goals/objectives
of the organization?
-How was it organized?
-Where there any outside
institutions or organizers that
helped in the organizing
process?
What are the current
activities/projects of the
organization?
-What are the basic duties
and responsibilities of the
officers and members?
-Is the organization
registered? Is it accredited
by the LGU?
-What are the future plans
B. GUIDELINES IN of the organization?
MAKING OF THE
COPAR
DOCUMENTATION 2. Divide students into groups. They
will choose a barangay that will be
part of the Community Organizing
C. TABLES, GRAPHS
Participatory Action Research. The
AND ANALYSIS,
ADDITIONAL process can be done through a social
GUIDELINES IN media or any that it is convenient to
FILING UP OF the participants
THECOMMUNITY
3. Divide students into groups, find a
HEALTH SURVEY
family to do an interview and apply
FORM AND
the guidelines in filling out the
DOCUMENTATION
community health survey form.
The group must include a
D. COMMUNITY
documentation such as photos during
HEALTH SURVEY
the interview in their final output or
VIDEO RECORDED file.
FINAL OUTPUT must be in PDF.
Format: Font style; Times New
Roman, Font size:12Header

Module 15: PLANNING FOR COMMUNITY HEALTH NURSING PROGRAMS AND SERVICES
Module 16: COMMUNITY PROGRAM BASED HEALTH PLAN AND EVALUATION
Module 17: ENVIRONMENTAL HEALTH PART 1
Module 18: ENVIRONMENTAL HEALTH PART 2
Face to Face/On-line activity Materials
Schedule Area (synchronous/asynchronous)/ Off-line activities needed at
Remote Coaching home
Clinical Instructor’s Guide 6

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Interactive Discussion
on:

⮚ Structured problem solving –

A. PLANNING FOR
output Community based
COMMUNITY
health plan.
HEALTH NURSING
PROGRAMS AND
SERVICES ⮚ Class will be divided into
groups (RLE groupings). The
B. COMMUNITY students will be asked to
PROGRAM BASED prepare a community health-
HEALTH PLAN AND based plan
EVALUATION

C. ENVIRONMENTAL ⮚ Each student will prepare a

HEALTH poster (manual, no computer
Activity
Rotation assisted output) regarding
Sheets
4 environmental health.
Community
Weeks *Short bond paper will be used
Improvised
11-13 *colouring pens/crayons or any will be
Materials
accepted. Choose a pollutant and
propose a program
(Reflected in a free hand drawing) to
reduce its impact to the community.

Note: It should be accompanied by a

program proposal related to
environmental health.

⮚ Class will be divided into

groups (RLE groupings) and create a
short video maximum of 5 minutes
promoting environmental health. The
video should be creative, relevant and
unique and all members should be in
the video. Schedule a date for the
presentation of their outputs.

Module 19: CONTROL OF COMMUNICABLE DISEASES part 1

Module 20: CONTROL OF COMMUNICABLE DISEASES part 2
Module 21: NURSING CARE OF CLIENTS WITH NON-COMMUNICABLE DISEASES PART 1
Module 22: NURSING CARE OF CLIENTS WITH NON-COMMUNICABLE DISEASES PART 2
Module 23: HEALTH DEVELOPMENT PROGRAMS FOR ADULT AND OLDER PERSON
Face to Face/On-line activity Materials
Schedule Area (synchronous/asynchronous)/ Off-line activities needed at
Remote Coaching home

Clinical Instructor’s Guide 7

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Interactive Discussion Class must be divided into 5

on: groups and each group will be
assigned of a program; they will be
A. CONTROL OF advised to prepare a poster regarding
COMMUNICABLE the reading assignment.
DISEASES The output must be placed in a
cartolina.
1. Leprosy control The poster must be creatively
program written, informative and simple for non-
2. Malaria control healthcare professionals and non-
program professionals.
3. Schistosomiasis It should contain the etiology,
control program diagnostic tests, signs and symptoms,
4. Soil-transmitted complications and treatment.
helminthiasis control
program Concept Mapping
5. National Directions: The instructor prepares Activity
tuberculosis control draw lots concerning the 5 programs. Sheets
program She/he invites representative of each
6. COVID-19 group to pick other program other than Improvised
Rotation
their assignments. They will be asked Materials
5
Community to prepare a concept map.
Weeks
Short bond
14-16
B. NURSING CARE OF -Class must be divided into group. As a paper,
CLIENTS WITH NON- Public health nurse one of the roles is colouring
COMMUNICABLE to be a health educator so each group pens/cray
DISEASES PART will make a material to convey health ons
messages regarding healthy lifestyle in
C. HEALTH the community.
DEVELOPMENT Materials can be a poster, leaflet,
PROGRAMS FOR PowerPoint presentation etc. This will
ADULT AND OLDER be presented in the class.
PERSON
-for individual activity
1. What are the present action/s or
health programs of the government to
prevent and control non-communicable
diseases in the Philippines?

2.As nursing student what action/s can

you do to prevent and control non-
communicable disease in our country

Rotation
COPAR Presentation
6
Weeks
17-18

Clinical Instructor’s Guide 8

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Session 1
COMMUNITY HEALTH NURSING
Community Health Nursing: An Overview

What is a community?
⮚ a group of people with common characteristics or interests living together within a territory or
geographical boundary
⮚ place where people under usual conditions are found.
⮚ a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.

What is health?
⮚ Health-illness continuum
⮚ High-level wellness
⮚ Agent-host-environment
⮚ Health belief
⮚ Evolutionary-based
⮚ Health promotion
The definition of health is evolving. The early, classic definition of health by the World Health Organization
(WHO) set a trend toward describing health in social terms, rather than in medical terms. Indeed, the WHO
defined Health as “ a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity”. The definition has not been amended since 1948.
What is community health?
Part of paramedical and medical intervention/ approach which is concerned on the health of the whole
population, aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
The term “community health” refers to the health status of a defined group of people, or community, and the
actions and conditions that protect and improve the health of the community. Those individuals who make up a
community live in a somewhat localized area under the same general regulations, norms, values, and
organizations.
What is nursing? - assisting sick individuals to become healthy and healthy individuals achieve optimum
wellness
Public Health Nursing: the term used before for Community Health Nursing
According to Dr. C.E. Winslow, Public Health is a “science & art of 3 P’s
Prevention of Disease
Prolonging life
Promotion of health and efficiency through organized community effort for
1. Sanitation of the environment,
2. Control of communicable infections,
3. Education of the individual in personal hygiene,

Clinical Instructor’s Guide 9

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

4. Organization of medical and nursing services for the early diagnosis and preventive treatment of
disease, and
5. Development of the social machinery to ensure everyone a standard of living adequate the
maintenance of h, so organizing these benefits as to enable every citizen to realize his birthright
of health and longevity” (Halon, 1960, p.23)
A key phrase in this definition of public health is “through organized community effort”.
What is Community Health Nursing?
“The utilization of the nursing process in the different levels of clientele-individuals, families, population groups
and communities, concerned with the promotion of health, prevention of disease and disability and
rehabilitation.” – Maglaya, et al
COMMUNITY HEALTH NURSING (CHN):
● a specialized field of nursing practice
● a science of Public Health combined with Public Health Nursing Skills and Social Assistance with the
goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry
(Characteristic of CHN)

BASIC PRINCIPLES OF CHN

The community is the patient in CHN, the family is the unit of care and there are four levels of clientele:
individual, family, population group (those who share common characteristics, developmental stages and
common exposure to health problems – e.g., children, elderly), and the community. In CHN, the client is
considered as an ACTIVE partner NOT PASSIVE recipient of care
● CHN practice is affected by developments in health technology, in particular, changes in society, in
general.
● The goal of CHN is achieved through multi-sectorial efforts.
● CHN is a part of health care system and the larger human services system.
CLASSIFICATION OF COMMUNITY
● Urban – High density, a socially homogenous population and a complex structure, non-agricultural
occupation; something different from an area characterized by complex interpersonal social relations.
● Rural –Usually small and the occupation of the people is usually farming, fishing and food gathering. It
is peopled by simple folks characterized by primary group relation, well- knit and having high degree of
group feeling.
● Rurban –A combination of a rural and an urban community.
Activity:
1. Interview several community health nurses and clients regarding their definitions of health. Share the
results with the class. Do you agree with their definitions? Why or why not?

2. Interview several community health nurses regarding their opinions on focus of community health
nursing. Do you agree?
(The interview can be done through a social media or any that it is convenient to the interviewer and
interviewee.)
(The interview transcripts must be computerized and properly documented. Interview transcripts: 8.5x11, single
space, Times New Roman Font Size 12)

Clinical Instructor’s Guide 10

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Multiple Choice (10 points)

Answer the following questions carefully.
1. Which of the following are included in the three broad concept of community health nursing? Select all
that apply.
a. Health
b. Hospital
c. Nursing
d. Community
2. Community Health Nursing most concerns are the following, except:
a. Prevention of Health
b. Rehabilitation
c. Promotion of Health
d. Prevention of disease and disability
e. None of the above

3. The following are the CHARACTERISTICS OF Community Health Nursing. Select all that apply.
a. The nurse recognizes the impact of different factors on health and has a greater awareness of his/ her
client's lives and situations.
b. Community health nursing practice is comprehensive, general, continual and not episodic.
c. The nurse recognizes the impact of different factors on health and has a greater awareness of his/ her
client's lives and situations.
d. The nurse and the client have least control in making decisions related to health care and they
collaborate as equals

4. Farming and Fishing are the usual sources of livelihood is this type of community.
a. City
b. Rurban
c. Rural
d. Urban

5. It provides most frequently cited definition of Health

a. WHO
b. LGU
c. DOH
d. UNICEF

6. It is the goal of the health care delivery system and a basic human right:
a. Control
b. Wealth
c. Riches
d. Health

7. Factors affecting Health. Except.

a. Poverty and health
b. Culture and health
Clinical Instructor’s Guide 11

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

c. Environment and health

d. Wealth and resources

8. Dr. C. E Winslow define public health as “science and art of 3 P’s”. 3 P’s stands for which of the
following. Select all that apply.
a. Promotion of Health
b. Prevention of Disease
c. Perseverance in life
d. Prolonging of life

9. They are major source of financial, emotional, instrumental and social support, especially during crisis
situations.
a. Families and friends
b. Government
c. Schools and Barangays
d. Pets and neighbors

10. It includes many things like beliefs, values and customs or practices, how we socialize or interact with
others, how we relax and spend our time, the food that we or not eat, how we prepare our food, how we
treat and care for pregnant woman, how we deliver baby's and how we take care of newborns, how we
cope with our problems, how and when we seek help and many others.
a. Faith
b. Culture
c. Values
d. Community

Session 2
COMMUNITY AND SOCIETY, COMMUNITY AND HEALTH

Components of a Community
1. People- represents the core that makes up a community
2. 8 Sub-systems

8 Sub-systems
⮚ Housing
Types of Housing Materials
a. Concrete – made of hollow blocks and cement
b. Semi-concrete – made of hollow blocks and wood
c. Light materials – made of wood
d. Makeshift – made of available resources and other used materials like tarpaulin, plywood, sacks
and the like
⮚ Education
-Level of education (elementary graduate or elementary level)
⮚ Fire and Safety
- Availability of fire station and policemen
⮚ Politics and government
- Type of government
Clinical Instructor’s Guide 12

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

o Authoritarian
o Democracy

⮚ Health
- Availability, accessibility and affordability of health and health services
⮚ Communication
- Available way of communication
o Network signal
o Telephone and cellular phone signal

⮚ Economics
- Availability of trades
- Resources of the community
⮚ Recreation
- Public recreations like parks, available spaces for exercise and activities

The community is a social system, where an interaction among individual occurs.it is composes of subsystems
such as socio cultural, political, educational, environmental and religious. All these factors influence the health
of community.so within the community there is need to understand these subsystems to promote the health of
community.
THE COMMUNITY HAS THE FOLLOWING CHARACTERISTICS: group of people Common place Interaction
among members common culture common language same feeling common attitude more or less same type of
life style common values and interest.
CHARACTERISTICS OF COMMUNITY
1. Distinctiveness – Each community has defined as geographical boundaries having its beginning and end.
These boundaries are more remarkable in small communities than in larger communities.
2. Homogeneity- There is similarity in psychological characteristics of people living in the defined boundaries of
the community Example-similarity in language life style, customs, tradition etc.
3. Closeness- The people in the community have face to face interaction and free communication. The extent
of closeness varies. The community people frequently participate in common activities etc.
4. Sense of belongingness- The degree and intensity of this feeling may vary among members in the
community.
5. Sense of togetherness- There is unity and cohesiveness among the members in the community which is
based on their interactions and sense of belongingness to community.
6. Self-sufficiency- The community provides all such means and facilities which help in meeting the basic
needs of its people i.e.-space to live, education, protection and security etc.

COMMUNITY RESPONSIBILITIES
1. Vision for their community (principal responsibility)
2. Play an active role in involving all stakeholders
3. Educating the public about problems and opportunities
INDIVIDUAL’S RESPONSIBILITIES TO THE COMMUNITY
1. Cooperate – work jointly toward the same end

Clinical Instructor’s Guide 13

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2. Respect – regard to the vision of the community

3. Participate – to take part/involve to the community activities
Activities:
Question 1
What are the possible issues at present that affects health? Relate your answer to the concepts presented.
Possible answer: Divided political groups, emerging and re-emerging diseases, poverty, poor
healthcare accessibility
Question 2
What are the possible solutions that you may contribute as a student nurse? As a member of the community?
As future healthcare worker?

Possible answer: As a student nurse, I may do physical exercise and observe healthy diet and encourage my
family members to do it too. As member of the community, I should actively join environmental health and other
health programs. As a future healthcare worker, I will actively join community programs and other related
learning activities.

Multiple Choice (10 points)

Answer the following questions carefully.
1. As an individual we have our responsibilities in our own community. Which of the following are these
responsibilities?
a. Participate in community’s activities
b. Working together with other members for the development of the community
c. Respecting the vision of the community
d. All of the above
2. The following are the Goals of Health Education. Except.
a. Encourage client to participate in health decision making
b. Increased potentials of the client to not comply with health recommendations
c. Increased participation in continuing care for specific conditions
d. Improved client and family coping in their live situation in the community

3. It represents the core that makes up the community:

a. People
b. Sub-systems
c. Health
d. Social system

4. A sub-system that provides leisure to the people of the community:

a. Fire and Safety
b. Communication
c. Economics
d. Recreation

5. A sub-system component that protects the people and secure their psychological and physical safety:
a. Fire and Safety
b. Communication
Clinical Instructor’s Guide 14

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

c. Economics
d. Recreation

6. What is true to an individual in a social system? (Select all that apply)

a. He/she has one role to fulfill.
b. He/she may have several roles simultaneously.
c. He/she can be affected by the social system components.
d. He/she may serve as a part of several social systems.

7. This statement is true to the organizations within the social system:

a. Organizations in the social systems are formal.
b. Organizations that may have different functions form the community’s sub-system.
c. The bases of organizations are the interactions, patterns and communication that transpire in the
community.
d. Organizations are made mainly to maintain health among people.

8. Which of the following best describes the relationship of community to health?

a. If there are more businesses and commercial investments in the community, all positive health
outcomes will be expected.
b. If community members actively join civic activities, people in the community will have strong physical
health.
c. Presence of recreational areas will affect physical and mental health.
d. Lesser resources protect the environmental health.

9. Hospital becomes the substitute of the community for:

a. Health promotion
b. Disease prevention
c. Primary care
d. Restoration of health

10. Which among the following is NOT a responsibility of the hospital?

a. health restoration
b. disease treatment
c. heath promotion
d. community improvement

Session 3
CULTURE and HEALTH

CULTURE AND HEALTH

General influences
● Culture affects the way of life.
Specific influences
● Culture affects the manner in which people determine who is healthy or sick; what causes health or
illness; what healer(s) and intervention(s) are used to prevent and treat diseases and illnesses; how

Clinical Instructor’s Guide 15

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

long a person has an illness; what is appropriate role behavior in sickness; and when a person is
believed to have recovered from an illness.
● Culture also influences the way people receive health care information, exercise their rights and
protections, and express their symptoms and health-related concerns.

FILIPINO CULTURE AND VALUES

Positive
Family oriented - close family ties; married children stays with their parents
Joy and humour – smiles and laughs even having difficulty
Faith and religiosity – highly spiritual; celebrates patrons
Hard work and industriousness – works even not told
Hospitality – warmly receives surprise visitors
Pagkamalikhain - creativity
Malasakit- values for the common good
o Smooth interpersonal relationships are core values of Filipinos – personalism
✔ Sensitive to the needs of others; high regard to others; understanding and
considerate to others
Negative
Ningas kugon - Is a tendency among individuals to start a new venture or task with too much
enthusiasm and effort, but after some time will take a pause or will suddenly stop working, until such
time that they lose interest in the venture or task.
Filipino time - Tardiness
mañana habit - Procrastination; one of the most negative traits of some people. It means mamaya na in
Filipino or to do a certain thing in a later time.
Bahala na - Mean "whatever happens, happens," "things will turn out fine," or as
"I'll take care of things."

Impact to health
o Filipinos love celebrations and eating: obesity, cardiovascular problems
o Filipinos may take health symptoms lightly: late diagnosis – poor prognosis
o Filipinos are hardworking: self-neglect

Multiple Choice
Answer the following questions carefully.
1. Filipinos love to celebrate different occasions that include, among other occasions, the passing of a state
board examination of a member of the family, job promotions, "welcome back" celebrations (e.g. the arrival of
someone after working some time in another country) and love eating. What might be the negative impact of
this traditions to our health? Select all that apply.
a. Diabetes
b. Obesity
C. Cardiovascular diseases
d. None of the above

Clinical Instructor’s Guide 16

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2. Culture care Theory involves knowing and understanding different cultures concerning nursing and health-
illness caring practices, beliefs, and values to provide meaningful and efficacious nursing care services to
people’s cultural values health-illness context. This theory is created by?
a. Florence Nightingale
b. Dorothea Orem
c. Madeleine Leininger
d. Virginia Henderson

3.One of the negative values of Filipinos is to do a certain thing in a later time. They love to procrastinate. This
value is also known as?
a. Mañana habit
b. Padrino
c. Ningas kugon
d. bahala na

4. Culture does not influence the way people receive health care information, exercise their rights and
protections, and express their symptoms and health-related concerns.
a. True
b. False

5.Positive Filipino culture and values include. Select all that apply.
a. Faith and religiosity
b. Hospitality
c. Ningas kugon
d. Family oriented

Session 4
PUBLIC HEALTH NURSING

PUBLIC HEALTH NURSING

The World Health Organization (WHO) Expert
Committee of Nursing defined public health nursing as a “special field of nursing that combines the skills of
nursing, public health and some phases of social assistance and functions as part of the total public health
programme for the promotion of health and improvement of the conditions in the social and physical
environment, rehabilitation of illness and disability.”
a. advantages of public health nursing
● An opportunity of the nurse to improve the lives of the oppressed community
● An opportunity to make a social change
b. disadvantages of public health nursing
● Health resources can be scarce
● Geographical location can be challenging, thus, transportation will be
difficult (for remote areas)
● Environmental pollutants due to industrial or manufacturing companies can be challenging, causing
more health
problems (for urban areas)
c. qualities of a good public health nurse
● Professionally qualified and license to practice in the arena of public health

Clinical Instructor’s Guide 17

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● Personal qualities and people skills that would allow her practice to make a difference in the lives of
people
● Physically, mentally and emotionally strong
● Good leader
● Willing to work
● Resourceful, creative, honest and with integrity
● Resilient

Standards of Public Health Nursing Practice

Standards of care
Standard 1: Assessment The public health nurse collects comprehensive
data pertinent to the health status of population
Standard 2: Population diagnosis and priorities The public health nurse analyzes the
assessment data to determine the population
diagnoses and priorities.
Standard 3: Outcomes identification The public health nurse identifies expected
outcomes for a plan that is based on the
population diagnoses and priorities
Standard 4: Planning The public health nurse develops a plan that
reflects best practices by identifying strategies,
cation plans, and alternatives to attain expected
outcomes.
Standard 5: Implementation The public health nurse implements the
identified plan by partnering
with others.
a. Coordination Coordinates programs, services, and other
activities to implement the
identified plan.
b. Health education and health Employs multiple strategies to promote health,
promotion prevent disease, and
health promotion
ensure a safe environment for populations.
c. Consultation Provides consultation to various community
groups and officials to
facilitate the implementation of programs and
services.
d. Regulatory activities Identifies, interprets, and implements public
health laws, regulations,
and policies.
Standard 6. Evaluation The public health nurse evaluates the health
status of the population
Standards of professional performance
Standard 7. Quality of practice The public health nurse systematically
enhances the quality and
practice
effectiveness of nursing practice.
Standard 8. Education The public health nurse attains knowledge and
competency that
reflects current nursing and public health
practice.
Clinical Instructor’s Guide 18

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Standard 9. Professional The public health nurse evaluates one's own

practice evaluation nursing practice in
relation to professional practice standards and
guidelines, relevant
statutes, rules, and regulations.
Standard 10. Collegiality The public health nurse establishes collegial
and professional relationships partnerships while interacting with
representatives of the population, organizations,
and health and human services professionals,
and contributes to the professional development
of peers, students, colleagues, and others.
Standard 11. Collaboration The public health nurse collaborates with the
representatives of the population, organizations,
and health and human services professionals in
providing for and promoting the health of the
population.
Standard 12. Ethics The public health nurse integrates ethical
provisions in all areas of
practice.
Standard 13. Research The public health nurse integrates research
findings in practice.
Standard 14: Resource utilization population The public health nurse considers factors
related to safety, effectiveness, cost, and impact
on practice and in the planning and delivery of
nursing and public health programs, policies,
and services.
Standard 15. Leadership The public health nurse provides leadership in
nursing and public
health.

Activity:
Students will do an interview to a nurse working in a Public Health Institution. The interview can be done
through a social media or any that it is convenient to the interviewer and interviewee.
(The interview transcripts must be computerized and properly documented. Interview transcripts: 8.5x11,
single space, Times New Roman Font Size 12)

Matching type
Match column A with each appropriate description in column B. Select the letter of your best answer:
Standards of Public Health Nursing Practice

_____ 1. Collaboration A. The public health nurse collects comprehensive data pertinent to the
health status of population
_____ 2. Education B. The public health nurse integrates ethical provisions in all areas of
Practice.
_____ 3. Assessment C. The public health nurse collaborates with the representatives of the
population, organizations, and health and human services

Clinical Instructor’s Guide 19

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

professionals in providing for and promoting the health of the

population.
_____ 4. Ethics D. The public health nurse provides leadership in nursing and public
health.

_____ 5. Leadership E. The public health nurse attains knowledge and competency that
reflects current nursing and public health practice.

SESSION 5
LOCAL PUBLIC HEALTH SYSTEM
Review topics from your lecture...

FUNCTIONS OF MANAGEMENT

The functions of management are:

o Planning;
o Organizing;
o Staffing;
o Leading; and
o Controlling.

MANAGEMENT

o Good management “starts with a coordinated purposeful organization of people who, collectively on a
functional responsible for: setting objectives, planning strategy, setting goals-short-term
objectives, developing company philosophy, setting policies-the plan, planning the organization, providing
personnel, establishing procedures, providing facilities, providing capital, setting performance standards,
initiating management programs, developing management information
systems and activating people” (Meier, in Swansburg, 1993:19).

o Management can be evaluated in terms of the management structures in place (clear lines of authority and
relationships) and processes (plans and programs being implemented) and outcomes
(job satisfaction, client satisfaction and high quality products and services).

In big private health care organizations or those with

massive capital outlay and hundreds or thousands of
employees, the top management which includes aboard of trustees, president and senior vice-
presidents, is responsible for “steering the ship” towards its planned destination.

Top management determines where to go and how

to get there; supervisors take care of the detail of the
different requirements

MANAGEMENT IN PUBLIC HEALTH

The management function discussed in nursing management book (refer to Swansburg 1993, Marriner-
Tomey 1996)

Clinical Instructor’s Guide 20

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Seem to be premised on a distinct and autonomous nursing service in big hospitals, particularly in United
States. For many reasons, management in public health is different. The generic management functions are
the same but the way these are done differ from one setting
from another. Management in public health, particularly in the Philippines setting is unique undertaking given
the different macro and micro context of the local public health organization- government policies programs
of the national government, national and local health budgets, political dynamics in the local setting, and
Filipino culture.

THE LOCAL PUBLIC HEALTH ORGANIZATION

• The health department/office is one of the departments and offices in the local government unit.
• The size of the department depends on a number of factors such as population size, financial
capability of the LGU and the local leaders’ commitment to public health.
• Cities, particularly first-class cities have more health personnel (a few with more than a thousand)
and health centers.
• There are, however, poor municipalities that have only less than ten public health workers.
• These are doctor-less municipalities so the public health unit is headed by a nurse who is usually a
resident in the area.
• Big cities, demographically and financially speaking, have bigger health departments.
• These are a number of divisions, one of which is nursing service.
• A nursing service has a chief nurse, an assistant chief nurse, a number of supervisors (some are
assigned to different programs such as maternal and child health) and PHNs and midwives who are
assigned to the different health centers.
• These health centers are headed by physicians.
• The major programs are: maternal and child health, communicable disease prevention and control,
non-communicable disease prevention and control (including lifestyle diseases), nutrition and
environmental situation.
• Some health centers have other programs such as those for specific population groups such as older
people. Some of the health service provided are immunization.
• Prenatal, natal and postnatal care, treatment of common illnesses and referral to hospitals.
• The extent of services is primarily determined by the availability of financial resources.

THE NURSE AS A MANAGER AND SUPERVISOR

• The following discussion of management issues and concerns does not refer to a specific public
health organization. These are premised on the following realities and professional beliefs: (1) under
a developed set-up, the major decision-makers in health are the elected local officials whose term of
office is three years
• (a mayor may be re-elected twice); (2) most LGUs do not have adequate resources for health; (3)
there are LGUs with outstanding performance in health despite their meager resources; (4) nursing
care of/services to their clients- individuals, families and communities.
Planning
• These are different types of plans that a PHN is exposed to in public health system- strategic plan,
operational plan, program plan and nursing care plan. This session is just concerned with the first
two.
1. A strategic plan is a long-range plan which extends from three to five years.
2. An operational plan, on the other hand, is short- range plan that generally deals with the routine
activities of the organization.

Clinical Instructor’s Guide 21

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Preparation of budget
Public health nurses play an important role in preparing a budget for the health department/health centers.
They know how the health center operates and the demands for the health center’s services. In preparing a
budget, PHNs should consider the cost-effectiveness of their intervention.
All year round, they should assess the cost effectiveness of their activities or practices in the health center
and constantly explore on ways to improve their efficiency.

Policies, Standards and Procedures

-In health units, manuals of policies, standards and procedures are very important resources for health
personnel. These serve as a guide for their actions and decisions.
-A manual of personnel policies, standards and procedures should contain all pertinent policies emanating
from national agencies such as Civil Service Commission and those coming from local governments. It
should also contain professional

Organizing
• The organizing function of management entails the setting up of an organizational structure, staffing and
the development of job descriptions.
•There was a nursing service in big health departments who was headed by a chief nurse job description
and performance evaluation. Review of job description and performance standards, rewards system, etc.

Session 6
Principles of Community Health Care, Conditions in the Community Affecting
Health & Characteristics of a Healthy Community
Principles of Community Health Nursing
Adapted from the 8 Principles of Public Health by the American Nurses Association (2007)

1. Focus on the community as the unit of care.

2. Give priority to community needs.
3. Work with the community as an equal
partner of the health team.
4. In selecting appropriate activities, focus on
primary prevention.
5.Promote a healthful physical and
psychosocial environment.
6.Promote optimum use of resources.
7.Collaborate with others working in the
community.

Conditions in the Community Affecting Health

1.People
-include size, density, composition, rate of growth or decline, cultural characteristics, mobility, social class and
educational level

2.Location
-Including natural (i.e., geographic features, climate, flora & fauna) and man-made variables

2.Social System

Clinical Instructor’s Guide 22

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

-include the family, economic, educational, communication, political, legal, religious, recreational, and the
health systems (Allender,et al., 2009)

Characteristics of a Healthy Community

-A shared sense of being a community based on history and values
-A general feeling of empowerment and control over matters that affect the community as a whole
- Existing structures that allow subgroups to participate in decision-making in community matters
-The ability to cope with change, solve problems, and manage conflicts within acceptable means
-Open channels of communication and cooperation among the members of the community
- Equitable and efficient use of community resources, with the view towards sustaining natural resources.

A healthy community is in fact,

“The process of enabling people to increase
control over, and to improve, their health”.
-Ottawa Charter (WHO, 1986)

Multiple Choice
Answer the following questions carefully.
1. The community health nurse’s aim is to improve the health status of the community in general. For the care
in the community the nurse must bear in mind the principles adapted from the eight principles of public nursing.
These principles include? Select all that apply.
a. In selecting appropriate activities, focus on secondary prevention.
b. Focus on the community as the unit of care
c. promotes optimum use of resources
d. Collaborate with others working in the community

2.Treatment is a necessary component of programs that control prevalent communicable diseases, but
treatment by itself a measure to control the spread of the disease to others. This is termed as?
a. tertiary prevention treatment
b. handwashing
c. preventive treatment of disease
d. all of the above

3.Community has three features’ people, location and social system. Factors related to these three features
affect the health status of community. Example is the population size in an urban area that causes
overcrowding. What will be the negative effect of this factor to the community? Select all that apply.
a. easy spread of communicable diseases
b. resources will be enough for the community
c. overcrowded living condition
d. water, air and soil pollution

4. Social system is the patterned series of interrelationships existing between individuals, groups and institution
and forming a coherent whole. Social system components that affect health include the following, except?
a. family
b. communication
c. educational
Clinical Instructor’s Guide 23

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

d. political
e. weather

5.Which of the following describes a healthy community. Select all that apply.
a. The community that is able to manage conflict and cope with changes.
b. The community participates in identifying local solutions to local problems.
c. Cooperation among the members of the community is not observed.
d. Open channel of communication within the members of the community.

Session 7
COMMUNITY HEALTH NURSING PROCESS: COMMUNITY ASSESSMENT

Community Assessment
Collect data on the three categories of community health determinants: people, place, and social system
Planned Approach to Community Health (PATCH) is a community health planning model that builds on a set
of quantitative and qualitative data for profiling (Box 7-1)
Approaches:
Comprehensive needs assessment - broad – totality of the community
Problem-oriented assessment – focused - responds to a particular need
Tools for Community Assessment

Secondary Data
Primary Data Collection What is already known; Taken from existing data
Data that have not been gathered before and are sources
collected by the nurse

Observation Vital registries

• Ocular/ Windshield Survey
• Participant Observation

Survey Health records and reports – FHSIS from the

health centers (RHUs)

Informant Interview Disease registries – mortality, morbidity

Community Forum - assembly Publications

• Print & Electronic

Focus Group Discussion Census Data – birth, death, marriages,

migration

FIELD HEALTH SERVICES AND INFORMATION SYSTEM (FHSIS)

Clinical Instructor’s Guide 24

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Components:
1.Individual Tx Record
-Foundation of FHSIS
-Where the presenting s/s or chief complaint, Dx, Tx and Tx date are recorded
-Maintained as part of the system of records of the BHSs (city) or BHs (rural) or RHU or MHC
-If no Tx record in the facility, improvise with the following data
-Date of consultation
-Name of patient
-Address
-Chief complaint
-Medical Diagnosis

2.Target client List

Purposes:
- to plan and carry out patient care and services delivery
- to facilitate the monitoring and supervision of services
- to report services delivered
- to provide a facility-level database that can be accessed for other purposes, such as follow-ups
and record surveys
-TCLs should be maintained in RHUs and health centers:
-TCL for the EPI
-TCL for eligible population
-TCL of children 0-59 months (risk, under five)
-TLC for nutrition
-TCL for prenatal care
-TCL for postpartum care
-TCL for FP
-National Tuberculosis program (NTP)
- TB symptomatic
- TB cases under short course chemotherapy (SCC)
- TB cases under standard regimen (SR)
-National Leprosy Program (NLP)

3.Summary Table
12-column table (12 months of the year)
2 components:
- Health Program Accomplishment and Morbidity
- Diseases

4.Monthly Consolidation Table

-source document for the quarterly form and the output table of the RHU

FIELD HEALTH SERVICES AND INFORMATION SYSTEM (FHSIS)

Clinical Instructor’s Guide 25

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Pull-out of Record Based on the

Purpose of the client’s Visit Data is summarized in the
Client enters
Tally/Report Summary
the facility Individual Tx Record – clients who
come to the facility for Tx
Accomplished manually either
TCL – client who came to the facility
monthly/periodically
for health services where
target/client exists

Tally sheet/report form – clients

who came to the facility for routine
visits, e.g. prenatal visit

DOH CENTRAL OFFICE

Regional Hospital/Regional Health office/Medical Centers

Provincial Hospital/Provincial health Office/City Health Office

District Health Office

Rural Health Unit/Main Health Center

RHU/MHC report is not a consolidation of the BHS and RHU reports. It is a

report of the services rendered by the RHU-based personnel

BHSs/BHCs

Multiple Choice
Answer the following questions carefully.
1. Target Client List purposes are the following except?
Clinical Instructor’s Guide 26

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

a. To diagnose patient and refer to the hospital

b. to report services delivered
c. To facilitate the monitoring of services
d. None of the above

2. This type of data is taken from existing sources like vital registries, census, publication etc.?
a. Health data
b. Secondary data
c. Primary data collection
d. All of the above

3. FHSIS components includes? Select all that apply.

a. Monthly Consolidation Table
b. Table of content
c. Individual Tx Record
d. Summary Table

4. There are approaches when it comes to Planned Approach to Community Health. What approach focused
and responds to a particular need?
a. Comprehensive needs assessment
b. Problem-oriented assessment
c. Primary data collection
d. Secondary data

5. This is the source document of the nurse for the Quarterly Form?
a. Target client List
b. Summary Table
c. Individual Tx Record
d. Monthly Consolidation Table

Session 8
COMMUNITY HEALTH NURSING PROCESS: COMMUNITY DIAGNOSIS

Community Diagnosis

• As a finding: A quantitative and qualitative description of the health of citizens and the factors which
influence their health
• As a process: Determining a community’s
a. health status
b. resources, and
c. health action potential or the likelihood that the community will act to meet health needs or
resolve health problems

TYPES OF COMMUNITY DIAGNOSIS

A. Comprehensive Community Diagnosis

● This aims to obtain general information about the community. The elements of the comprehensive diagnosis
were discussed in the previous session.

B. Problem-Oriented Community Diagnosis

● A type of assessment that responds to a particular need.
● For example, a nurse is confronted with health and medical problems resulting from mine tailings being disposed
into the river systems by a mining company. Since a community diagnosis investigates the community, the nurse
will focus on the effects of mine tailings.
Clinical Instructor’s Guide 27

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

STEPS IN CONDUCTING A COMMUNITY DIAGNOSIS

1. Determining the objectives

● Determine the depth and scope of the data to be gathered
1. Defining the study population
● Identify the population to be included
● Entire population
● Focused on a specific population
2. Determining the data to be collected
● The objectives will determine what data will be collected.
1. Collecting the data
● Different methods can be utilized to generate health data.
● Records review – data may be obtained by reviewing those that have been compiled by health or non-
health agencies from the government or other sources.
● Surveys and observations – can be used to obtain both qualitative and quantitative data
● Interviews – can yield first-hand information
● Participant observation – is used to obtain qualitative data by allowing the nurse to actively participate in
the life of the community
1. Developing the instrument
● Instruments or tools facilitate the nurse’s data gathering activities
● Survey questionnaire
● Interview guide
● Observation checklist
1. Actual data gathering
● Before the actual data gathering, the nurse must meet the people who will be involved in the data collection
● Instruments must be discussed and analyzed
● Pre-testing of the instrument is highly recommended
● Data collectors must be oriented and trained (role-play can be conducted)
● During actual data gathering, the nurse supervises the data collectors by checking their filled-up instrument in
terms of completeness, accuracy and reliability
1. Data collation
● Numerical data – counted
● Descriptive data - described
1. Data presentation (see p. 140)
● Depend largely on the type of data obtained

Type of Graph Data Function

Line graph Shows trend data or changes with time or age with respect to some other
variable
Bar graph/pictograph For comparisons of absolute or relative counts and rates between categories
Histogram/frequency polygon Graphic presentation of frequency distribution or measurement

Proportional or component bar/pie Shows breakdown of a group or total where the number of categories is not too
chart many
Scattered diagram Correlation data for two variables

1. Data analysis
● Aims to establish trends and patterns in terms of health needs and problems of the community
● Allows comparison of data with standard values
● Determine the interrelationship of factors will help the nurse view significance of the problems and their
implications on the health status of the community
1. Identifying the community health nursing problems
● Health status problems
● They may be described in terms of increased or decreased morbidity, mortality, fertility or reduced
capability for wellness.
Clinical Instructor’s Guide 28

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● Health resources problems

● They may be described in terms of lack or absence of manpower, money, materials or institutions
necessary to solve health problems.
● Health-related problems
● They may be described in terms of existence of social, economic, environmental and political factors that
aggravate the illness-inducing situations in the community.
The Omaha System (refer to p.143-144)

Problem Classification Scheme

Environmental Areas of Concern under the 4 Identify Cluster of signs and symptoms that
Psychosocial domains if problem is: describe the problem
Physiological - Promotion
Health-related - Potential
behaviors - Actual
- Level of
clientele
Intervention Scheme

Problem Rating Scale for Outcomes

Environmental – income, sanitation, residence, safety (workplace/neighbourhood)

● Psychosocial – communication with community resources, social contact, role change, interpersonal relationship
spirituality, grief, mental health, sexuality, caretaking/parenting, neglect, abuse, growth and development
● Physiological – hearing, vision, speech and language, oral health, cognition, pain, consciousness, skin,
neuromuscuskeletal functions
● Health related – nutrition, sleep and rest patterns, physical activity, personal care, substance abuse, family planning,
health care supervision, medication regimen

Priority setting requires the joint effort of the community, the nurse, and other stakeholders, such as other
members of the health team.

Assigning criterion weight through nominal group technique

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Question: How important is the criterion in solving the problem?

Criterion Nurse J. Midwife BHW Mr. Mr. Average

Cruz B. Tan Dionisia Miranda Peralta Weight
Significance of the problem 8 10 7 10 6 8
Community awareness 8 8 5 5 5 6
Ability to reduce risk 10 10 10 10 10 10
Cost of reducing risk 8 8 8 8 8 8
Ability to identify target 4 5 6 5 6 5
population
Availability of resources 8 8 6 5 8 7

Criterion rating through nominal group technique

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Question: Can the group influence the situation in relation to the criteria?

Clinical Instructor’s Guide 29

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Criterion Nurse J. Midwife BHW Mr. Mr. Average

Cruz B. Tan Dionisia Miranda Peralta Weight

Significance of the problem 6 8 4 6 6 6

Community awareness 10 10 10 5 5 8

Ability to reduce risk 6 6 6 6 8 6

Cost of reducing risk 6 6 6 4 4 5

Ability to identify target 10 10 10 8 6 9

population

Availability of resources 4 4 3 2 2 3

Computation of problem priority score

Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Criterion Criterion weight Criterion rating Problem
(1-10) (1-10) (weight x rating)

Significance of the problem 8 6 48

Community awareness 6 8 48
Ability to reduce risk 10 6 60
Cost of reducing risk 8 5 40
Ability to identify target population 5 9 45
Availability of resources 7 3 21
Total Priority Score 262

SCORING AND IDENTIFYING HEALTH PROBLEM

Identification of community health nursing problems

● Health status problems – increased or decreased morbidity, mortality, fertility
e.g. 40% of the school-age children have ascariasis
● Health resources problems – lack or absence of manpower, money, materials, or institutions necessary to solve
health problems
e.g. 25% of the BHWs lack skills in vital-signs taking
Identification of community health nursing problems
● Health-related problems – existence of social, economic, environmental, and political factors that aggravate the
illness-inducing situations in the community
e.g. 30% of the households dump their garbage in the river

PRIORITY SETTING OF COMMUNITY HEALTH NURSING PROBLEMS

CRITERIA:
● NATURE OF THE PROBLEM PRESENTED – health status, health resources, or health-related problems

Clinical Instructor’s Guide 30

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● MAGNITUDE OF THE PROBLEM – severity of the problem and measured in terms of the proportion of the population
affected by the problem
● MODIFIABILITY OF THE PROBLEM – probability of reducing, controlling , or eradicating the problem
● PREVENTIVE POTENTIAL – probability of controlling or reducing the effects pose by the problem
● SOCIAL CONCERN – perception of the population/community as they are affected by the problem

CRITERIA SCORE WEIGHT

NATURE OF THE PROBLEM 3 1
● Health status 2
● Health resources 1
● Health-related
MAGNITUDE OF THE PROBLEM 4 3
75% - 100% affected 3
50% - 74% affected 2
25% - 49% affected 1
>25% affected

MODIFIABILITY OF THE PROBLEM 3 4

● High 2
● Moderate 1
● Low 0
● Not modifiable
PREVENTIVE POTENTIAL 3 1
● High 2
● Moderate 1
● Low

SOCIAL CONCERN 2 1
● Urgent community concern 1
● Recognized as a problem but not needing an urgent attention 0
● Not a com
unity concern

STEPS IN PRIORITIZING HEALTH PROBLEMS

1. Score each problem according to each criteria.

1. Divide the score by the highest possible score.
1. Multiply the answer by the weight of the criteria.
1. Add the final score for each criterion to get the total score for the problem. The highest possible score
is 10.
1. The problem with the highest score is given the priority by the nurse.
Given the situation:
Problem 1: After collating the data in the community diagnosis, the nurse learned that one of the community health
problems is that 40% of the school-age children have ascariasis. The mothers recognize this and are willing to have their
children undergo deworming. Majority of the mothers are so concerned that they asked the nurse about its cause and
ways on how to prevent it.
Problem 2: The other problem is the lack of skills of the BHWs in the barangay. For example, 25% of the BHWs lack skills
in vital signs-taking. The BHWs expressed their concern that they cannot perform their tasks because of this. All of them
verbalized their desire to attend health skills training in the future

Problem 1
Nature of the problem

Clinical Instructor’s Guide 31

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● (health status) - (3/3) x 1= 1

Magnitude of the problem
● (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
● (high) – (3/3) x 4 = 4
Preventive potential
● (high) – (3/3) x 1 = 1
Social concern
● (Urgent community concern) – (2/2) x 1 = 1
Total : 8 ½

Problem 2
Nature of the problem
● (health resources) - (2/3) x 1= 2/3
Magnitude of the problem
● (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
● (high) – (3/3) x 4 = 4
Preventive potential
● (high) – (3/3) x 1 = 1
Social concern
● (Urgent community concern) – (2/2) x 1 = 1
Total : 7 ¾

Multiple Choice
Answer the following questions carefully.

1. The following is NOT an environmental indicator:

a. Waste disposal
b. Water supply
c. Presence of air/water/land pollution
d. Types of industry present

2. This variable can indicate the poverty that exist and may reflect on health perception and utilization
pattern of the community:
a. Communication network
b. Poverty income level
c. Educational level
d. Housing conditions

3. This social indicator is necessary for disseminating health information or facilitating referral of clients to
the healthcare system:
a. Communication network
b. Transportation system
c. Educational level
d. All of the above

4. This is a vital element in achieving the goal of high-level wellness among the people:
a. Demographic variables
b. Socio-economic and cultural variable
c. Health and illness patterns
d. Political or leadership patterns

Clinical Instructor’s Guide 32

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

5. The following describes the political or leadership pattern of the community: (select all that apply)
a. Proportion of active earners in the community
b. Attitudes of the people towards authority
c. Existing manpower development
d. Practices in settling issues

Matching type
Options:
A. Environmental
B. Psychosocial
C. Physiological
D. Health related

6. Oral health
7. Workplace
8. Neglect
9. Role change
10. Sanitation

SESSION 9
COMMUNITY HEALTH NURSING PROCESS: Planning Community Health Interventions,
Formulating Goals and Objectives Deciding on Interventions, Implementation & Evaluation

Planning is a logical process of decision-making involving:

1. Priority setting
● Criteria
a. Significance of the problem
● Based on the number of people in the community affected by the problem or condition.
● If the concern is a:
● disease condition, this may be estimated in terms of its prevalence rate
● potential problem, its significance is determined by estimating the number of people at risk of
developing the condition
b. Level of community awareness
● And the priority its members give to the health concern is a major consideration
● When people are aware of the risk arising from a condition and resources are available, they are likely
to have motivation to deal with the condition and give it priority.
c. Ability to reduce risk
● Related to the availability of expertise among the health team and the community itself.
● Health team’s level of influence in decision making related to actions in resolving the community health
concern
d. Cost of reducing risk
● The nurse has to consider economic, social and ethical requisites and consequences of planned action.

Clinical Instructor’s Guide 33

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

e. Ability to identify the target population

● For the intervention is a matter of availability of data sources, such as FHSIS, census, survey reports
and or case-finding and screening tools
f. Availability of resources
● To intervene in the reduction of risk entails technological, financial, and other material resources of the
community, the nurse, and the health agency.
● Accessibility of outside resources and the link to these resources are taken into account
Priority setting requires the joint effort of the community, the nurse, and other stakeholders, such as other members of
the health team.

Formulating Goals and Objectives Deciding on Interventions

GOAL
desired outcome at the end of interventions
OBJECTIVE
short-term changes in the community that are observed
serve as instructions
must be SMART
CONSIDERATIONS
demographic, psychological, social, cultural, and economic characteristics of the target population VS. health
resources
Implementation
• Remember: process is intended to enhance the community’s capability in dealing with common
health conditions/problems

• Implementation entails:
o Facilitating the process
o Coordinating the plan with the community
o Collaboration with other sectors and agencies

Evaluation

• Structure
o manpower and physical resources
• Process
o activities undertaken (assessment, diagnosis, planning, implementation, and evaluation)
• Outcome
o degree of attainment of goals and objectives
• Standards
1. Utility 3. Propriety

Clinical Instructor’s Guide 34

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2. Feasibility 4. Accuracy

Multiple Choice
Answer the following questions carefully.
1.Which of the following are true about goals and objectives? Select all that apply.
a. Formulating goals and objectives should be SMART.
b. This is done during implementation to provide feedback on compliance to the plan as well as on need for
changes in the plan to improve the process and outcome intervention.
c. Goals are the desired outcomes at the end of interventions.
d. 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.

2. This is one of the bases of good evaluation where it answers the question of whether the plan for evaluation
is doable or not, considering available resources.
a. accuracy
b. feasibility
c. utility
d. propriety

3. This refers to the validity and reliability of the results of evaluation?

a. accuracy
b. feasibility
c. utility
d. propriety

4. Using the nursing process in dealing with community health needs requires that the nurse works with the
community as an equal partner.
a. True
b. False

5. Evaluation in the community that involves looking into the manpower and physical resources of the agency
responsible for community health intervention.
a. outcome evaluation
b. process evaluation
c. structure evaluation
d. ongoing evaluation

Session 10
(COPAR) COMMUNITY ORGANIZING part 1
*Recall the concept from your CHN2 Lecture.
Community Organizing as a process consists of steps or activities that instill and reinforce the people’s self-
confidence on their own collective strengths and capabilities (Manalili, 1990).
● It is the development of the community’s collective capacities to solve its own problems and aspire for
development through its own efforts. It entails harnessing and developing the community’s capacities to

Clinical Instructor’s Guide 35

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

recognize a community problem, identify and implement solutions, and monitor and evaluate the efforts
in resolving the problem.
● Is a continuous process of educating the community to develop its capacity to assess and analyze the
situation (which usually involves the process of consciousness raising), plan and implement
interventions mobilization), and evaluate them.
Basic values in community organizing
• Human Rights
• Social Justice
• Social Responsibility

Core Principles of Community Organizing

• People Centered
• Participative
• Democratic
• Developmental
• Process-Oriented

Phases of Community Organizing

1. Pre-entry
• Involves in Preparation and includes knowing the goals of the community organizing activity or
experience
• It may also be necessary to delineate criteria or guidelines for site selection.
• Making a list of sources of information and possible facility resources, both government and
private, is recommended.

• Skills in community organizing are developed on the job or through experiential approach.
• Novice community organizers, such as student nurses on their related learning experience, are
therefore not unusual.
• For novice organizers, preparation includes a study or review of the basic concepts of community
organizing.
• Although the affective domain is not easy to change, self-examination helps the organizer identify
attitudes – both positive and negative – that may influence effectiveness.

• Proper selection of the community is crucial.

• Identification of:
Possible barriers
Threats
Strengths
Opportunities at this stage is an important determinant of the over-all outcome of
community organizing

• Communities may be identified through different means:

Initial data during ocular survey
Review of records of a health facility
Review of barangay profile, and so on
Referrals from other communities or institutions
Through series of meetings
Consultation from local governments (LGUs) or private institutions
• Basic criteria
Geographically isolated and disadvantaged area
Clinical Instructor’s Guide 36

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Community perceives that they need assistance

Shows sign of willingness
No obvious threat for safety
No other organization working with same services
Partnership among other sectors is feasible

2. Entry into the community

• This phase formalizes the start of the organizing process.
• This is the stage where the organizer gets to know the community likewise gets to know the organizer.
• Courtesy calls to local formal leaders
• Visit informal leaders like elders, local health workers, traditional healers, church leaders and local
neighborhood association or other contact persons who may facilitate the subsequent phases of the
organizing process
Considerations in the entry phase
o Community organizers must clearly introduce themselves and their institution to the community

Clear explanation of the vision, mission, goals, programs and activities must be given in all initial
meetings and contacts with the community.
o Community organizer must have a basic understanding of the target community.
o Preparation for the initial visit includes
o Gathering basic information on socioeconomic conditions, traditions including practices,
overall physical environment, general health and illness patterns, and available resources.
o Informal meeting with contacts who have been to the area or some residents of the
community prior to entry will be useful.
o Avoid raising unrealistic expectations in the community.
o Goal: Build up the confidence and capacities of people
o 2 strategies in gaining entry into a community which can be COUNTERPRODUCTIVE
o Padrino or patron. When patron tries to boost the community organizer’s intended output to
the community, this will create false hopes
o Bongga entry. Easiest way to catch the attention and gain the approval of the community.
This strategy exploits the people’s weaknesses and usually involves dole-outs (free medicine,
food ant thers). This creates unreasonable expectations and contradicts the essence of
community organizing.

3. Community Integration
Community integration or pakikipamuhay is the phase when the organizer may actually live in the community in
an effort to understand the community better and imbibe community life. The establishment of rapport between
the organizer and the people indicates successful integration.
o Integration requires IMMERSION in a community life.
o Organizer’s conduct as well as manner of dressing must be in accordance with the norms of the
community
o Styles of integration
o “Guest” status
Visits the community as per schedule
“now you see, now you don’t”
o Boarder style
Rents a room or house in a village
Lives with his own lifestyle
Does not share life with the community
o “Elitist” style

Clinical Instructor’s Guide 37

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Lives with the barangay chairman or some other prominent person in the community
Frequently with the barangay officials

People-centered approach integration

o Community organizers enter into a community with a well-conceived plan.
o They establish contact with villagers and become THEIR ALLIES
o Organizers develop a deeper relationship through various techniques
o Pagbabahay-bahay or occasional home visit, observe house routines to avoid inconvenience
o Huntahan. Informal conversations in the village poso during laundry time, basketball court and
sari-sari store
o Participation in the production process
Participates in farming, fishing or any livelihood activities of the community
This practice allows the organizer to experience the life of the people in the community.
Hence, they will understand them better.

o Participation in social activities

Attending fiestas, weddings, baptismal celebrations, funeral wakes and other activities of
the community that carry social meaning and importance.
Community organizers should remain as role model, gambling and drinking alcoholic
beverages with them is prohibited.

4. Social Analysis
This is the process of gathering, collating and analyzing data to gain extensive understanding of community
conditions, help in the identification of problems of the community and determine the root cause of these
problems.
o Known also as social investigation, community study, community analysis, or community needs
assessment

o In nursing practice this is often called as community diagnosis with emphasis given to health and health-
related problems

o Comprehensive analysis

Demographic data
Sociocultural data
Economic data
Environmental data
Data on health patterns (morbidity, mortality, fertility) and
Data on health resources

5. Identifying Potential Leaders

Since organizing is not a job of one person, it is imperative that the organizer identifies partners and potential
leaders who will help lead the people.
Desirable characteristics of potential leaders
• Represent the target group/community
• E.g. farmer if it is a farmers group
• Possess or display leadership qualities
• They have the trust and confidence of the community
• Express belief in the need to change the current undesirable situation in the community, that change is
possible and that change must start with members of the community

Clinical Instructor’s Guide 38

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

• Willing to invest time and effort for community organizing

• Must have potential management skills
The community organizer must bear in mind that the prevailing culture or social structure in some communities
tends to make ordinary people shy away from leadership roles, and instead, prefer to work in self-effacing
supportive roles. Some community members may equate leadership ability with education or wealth. Thus, one
of
the challenges of community organizing is the training and preparation of the potential leaders. This requires
consistency and persistence in the training and thereby encouraging them and giving their opportunities
to assume various roles in community activities. The key is to allow time for them to develop and gradually
assume leadership role.
6. Core Group Formation
As the organizer works with potential community leaders, the membership of the group is expanded, as
necessary, by asking them to invite one or two of their neighborhood or friends. These new recruits must also
be
from the community sharing the same problems the group seeks to correct, while at the same time believing in
the same core values, principles and strategies the group is employing.
• Keep the group manageable, 8 and 12 members
• Initially forming a single group is suggested but as the community gets better organized, the first group
may have separate groups or committees
• Formation of a viable, functioning core group is the focal point of community organizing
o Requires series of training sessions to transfer the technology of organizing, enabling the core
group to take charge
o Essential component of core group formation: reinforcement of the social consciousness of the
members, particularly in terms of analysing the root causes of community problems
o The formation program may focus on self-awareness and development of community health
leaders
o Negative factor must be addressed so as not to affect the outcomes of the community organizing
efforts
7. Community Organization
Through various means of information dissemination, the core group, with the assistance of the organizer,
instills
awareness of common concerns among other members of the community. Subsequently, on the initiative of
the
core group, the community conducts an assembly or a series of assemblies, with the goals of arriving at a
common understanding of community concerns and formulating a plan of action in dealing with these
concerns.
Collective decision making must dictate what projects and strategy must be undertaken. The organizer must
remember that it is their project to be done in their community. The organizer must let them decide.
If the community decides to formalize the organization, it must have the following characteristics:
• An organizational name and structure
• A set of officers recognized by the members of the community
• Community and bylaws stating the vision, mission and goals (VMG) rules and regulations of the
organization and duties and responsibilities of its officers and members
The community may then decide to seek legal recognition by registering the organization with the appropriate
government agency, such as the Securities and Exchange Commission or the Cooperatives Development
Agency. Recognition by the LGU completes the process.
Gaining legal recognition paves the way for the organization’s participation in the Barangay, Municipal or City
Development Council as provided in the Local Government Council as provided in the Local Government Code
(RA 7160). The organization may also establish linkages and networks with other government agencies,
nongovernment organizations/agencies, or other people’s organizations that will further strengthen and expand

Clinical Instructor’s Guide 39

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

the organization, facilitating the attainment of its goals and objectives.

8. Action Phase
Also known as the MOBILIZATION phase, the action phase refers to the implementation of the community’s
planned projects and programs.
Important considerations during the mobilization phase are as follows:
1. Allow the community to determine the pace and scope of project implementation. The community may start
with simple barangay projects, such as Tapat Ko Linis Ko or clean and green. As the organization gains
experience and develops, it will move toward more complex programs, like coastal resource
management or a community material recovery facility.
2. The process is as important as the output. A project may fail but as long as the community gains
valuable experience and learns from the process, it is not failure in itself.
3. Regular monitoring and continuing community formation program are essential. Throughout the
mobilization, regular meetings must be conducted for monitoring and continuous training for
community leaders.
9. Evaluation
Evaluation is a systematic, critical analysis of the current state of the organization and or projects compared to
desired or planned goals or objectives. Ideally, evaluation is done periodically during mobilization (i.e.
formative
evaluation) to allow revision of strategies when needed and at the end of the prescribed project period (i.e.
summative evaluation).
In community organizing, there are two major areas of evaluation: program-based evaluation and
organizational
evaluation.

Area of evaluation General evaluation parameters

Program-based Were the goals and objectives of the program/project
achieved?
What strategies were implemented? What worked?
What did not?
What is the over-all impact of the project on the
community?
How were the resources of the organization and
community utilized?
Organizational Were the vision, mission and goals of the
organization achieved?
How are the organizational policies being
implemented?
What is the level of participation in the affairs of the
community
organization?
How were the resources of the organization utilized
and managed?
What type of interpersonal relationships is shared
among the members of
the organization, among leaders, and the members
of the community organization?

10. Exit and Expansion

From the start, the organizer must have a clear vision of the end with a general time frame in min. As
articulated

Clinical Instructor’s Guide 40

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

by Manalili (1990), “the best entry plan is an exit plan.” The time of exit should be mutually determined by the
organizer and community during a meeting for monitoring and evaluation.
Indications of readiness for exit by the community organizer should include:
• Attainment of the set goals of the community organizing efforts,
• Demonstration of the capacity of the people’s organization to lead the community in dealing with
common problems, and
• People empowerment as manifested by collective involvement in decision making and community
action on matters that impact their lives

During the exit phase:

• Organizer start exploring another community to organize

• While expanding to another area, the organizer stays in touch with the first community,
periodically visiting as friendly consultant

Multiple Choice (10 points)

Answer the following questions carefully.
1.COPAR is a vital part of public health nursing. COPAR stands for:
a. Community Organization Partly Active Review
b. Communication Organization Program At Risk
c. Community Organizing Participatory Action Research
d. Community Organization Participative Action Research

2. This is where the organizer gets to know the community. Trust building and establishing rapport phase.
a. Pre entry
b. Entry
c. Mobilization phase
d. Exit and expansion

3. One of the phases of community organizing is to identify a potential leader. The following are the desirable
characteristics except.
a. Willing to invest money for community organizing
b. Trusted and respected by the community
c. Display Leadership quality
d. Represents the target group

4. The following are the indications that the nurse is ready to leave the community, EXCEPT.
a. The people already developed self-reliance
b. People are empowered
c. People in the community do not involve in decision making and community action on matters that impact
their lives
d. The passive community turned active community

5 This phase is where we implement community's planned projects and programs.

a. Community integration
b. Social analysis
c. Mobilization phase
d. Community organization

Clinical Instructor’s Guide 41

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

SESSION 11
(COPAR) COMMUNITY ORGANIZING part 2 &
COMMUNITY IMMERSION

Goals of Community Organizing

1. People’s Empowerment
2. Building People’s Organizations
3. Improved quality of life

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 et al., 2008).

Community Organizing Participatory Action Research (COPAR)

• Is a community development approach that allows the community (participatory) to systematically analyze
the situation (research), plan solution, and implement projects/programs (action) utilizing the process of
community organizing. It is essentially a research project done by the community that leads to actions that
improve conditions in the community.

COPAR MODEL

COMPONENT PRACTICED COPAR IDEAL COPAR

Time frame/mode of Sometimes 8-16 hours/week for 2-4 3-6 weeks immersion
exposure weeks depending on the time allotted by 3-6 weeks duty, 8 hours duty; 5-6 days/week
the school
Methodology/Survey Use of ready-made survey from the school It will vary from the needs of the community
form Some use survey but just collect data from and the methodology is the surveying
previous study participants
Problem statement Misjudging complex problems as simple After the survey and analysis has been done
problems Problem will be coming from the survey form
Any problems too big should not be prioritized

Clinical Instructor’s Guide 42

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Not considering the result of the survey

form rather pay attention to the concern of
the few individuals
Implementation Fish effect Fishing rod effect
One day program Programs should not be a one-time affair
Evaluation Results are manipulated Reality acceptance
No re-implementation After evaluation, there must be re-
implementation if needed or program must be
revised depending on the result

COMMUNITY IMMERSION
• A related learning experience program requiring student nurses to live and work within a selected
remote community.
o Topics such as primary health care, epidemiology, environmental health, health promotion,
disease prevention and management, and individual, family, and population-centered nursing
will be covered.
• Community-based learning approach that has been further strengthened by the World Health
Organization, which defines the social accountability of medical schools as “the obligation to direct
education, research and service activities towards addressing priority health concerns of the
community”.
• Immersion of student nurses in the community raises awareness of future nurses of the health needs
of the community and of the psychosocial dimensions of any health problem. (Public health perspective
and an educational perspective)
GENERAL OBJECTIVES:
Prepare future nurses to be competent staff PHN
SPECIFIC OBJECTIVES:
-train future nurses to respond to the health problems of individuals in their complexity, and strengthens their
ability to work with the community;
-develop student nurses’ leadership capabilities;
-enhance their basic nursing skills and accountability to client care;
-strengthen their interpersonal skills;
-increase their commitment to the caring profession; and
-improve their management skills with a scientifically inquisitive research-oriented mind.
COMMUNITY SELECTION CRITERIA
1.Does the community meet the “GIDA” geographically isolated and disadvantaged area criterion of the
Department of Health?
2.Do the members of the community perceive the need for assistance?
3.Does the community show signs of willingness or hostility towards thE organizer or the organizing agency?
4.Is there no obvious threat to the safety of the community organizer?

Clinical Instructor’s Guide 43

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

5.Are there other individuals, groups, or agencies working in the area? If so, are they using the community
organizing approach? Will there be a duplication of services for the same target group?
6. Is the partnership among all potential stakeholders (the community, the LGU, and other external agencies)
possible and feasible?
Activity:
1. Identify a people’s organization within your community.
2. Interview some of the officers and members of the organization.
3. ask them the following:
• What is the name of the organization?
• When was it organized?
• Why was it organized?
• What are the goals/objectives of the organization?
• How was it organized?
Allow the respondents to relate their organizing experience. Note the different phases of the organizing
process discussed as related to the experience of the community.
• Where there any outside institutions or organizers that helped in the organizing process?
• What are the current activities/projects of the organization?
• What are the basic duties and responsibilities of the officers and members?
• Is the organization registered? Is it accredited by the LGU?
• What are the future plans of the organization?

Multiple Choice
Answer the following questions carefully.

Identify whether it is a Traditional research approach or COPAR

1. Decision-making – Bottom up

2. Emphasis – Nurse-driven process

3. Methodology – Methodologies are determined by the community

4. Roles – Data analyst is the nurse

5. Leadership and managerial skills are more likely being exercised during:
a. Community diagnosis
b. Community program implementation
c. Community assembly
d. Meeting with the barangay officials

6. Community Immersion Program is conducted to areas describe below, EXCEPT:

a. remote area
b. resistant people
c. more than 100-200 families
d. depressed community

Clinical Instructor’s Guide 44

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Session 12
GUIDELINES IN MAKING OF THE COPAR DOCUMENTATION

The suggested parts of the COPAR documentation are as follows:

1. Title Page
a. Title: All uppercase, centered at the top of the page. COMMUNITY ORGANIZING PARTICIPATORY
ACTION RESEARCH
b. Authors: Uppercase and lowercase, centered on the page. Enumerate name in alphabetical order
(Surname, First Name/s, Middle Initial); immediately followed on the next line by the authors’ affiliation
(Level, Block, and Group Number).
c. Submission Date: Month and year, with no comma in between. Uppercase and lowercase, centered
on the line of the page.
d. Pagination: While no pagination appears on the title page, this is considered as page i (lowercase of
letter i) and mentioned in the Table of Contents as such.
[Note: Pagination for the preliminary pages uses Roman Numerals in lowercase letters.]

2. Acknowledgement
i.Pagination: This document serves as page iii (depending on the number of Table of Contents’ pages)
placed at the bottom on the right edge of the paper.
ii.Heading: “Acknowledgement” (Uppercase and lowercase, centered on the first line below the running
head).
iii.Content: Briefly state names of mentors and other people with significant contribution to the research
study.

3. Table of Contents
a. Pagination: The table of contents follows the Dedication, with the corresponding lowercase
Roman numeral page numbering (and onwards) placed at the bottom on the right edge of the paper.
b. Heading: “Table of Contents” (Uppercase and lowercase, centered on the first line below the
running head).
c. Order of Subheadings: Starts on the second line after the main heading, flush left, and
sequentially on the succeeding lines. Across each is the corresponding page of it location on the
manuscript.
d. Preliminaries – Title page, Acknowledgement, Table of Contents, List of Tables, and List of
Figures.
e. Headings and subheadings (as they appear in chronological order in the body).
f. References, Appendices, and Curriculum Vitae.

4. Introduction
a. What is the study all about?
b. How it is related to Nursing?
c. Rationale of Community Health Nursing
d. Rationale of Community Organizing

5. Community Profile
A. Geographic identifiers
a. Historical Background – includes description of past population, location or proximity to
metropolitan area, organizational chart of barangay, relationship to surrounding communities and other
pertinent data.
b. Describe the location, boundaries, total population, physical features, climate (seasonal
change), medium of communication, and means of transportation and resource (e.g. Hospital, market.
School, health centers etc.) available in the community.
c. Create spot map with the following directions

Clinical Instructor’s Guide 45

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Note: The North always is located on the top. Legends and color coding are used to indicate
houses interviewed, and resources of the community such as Markets, Barangay hall, church,
communal water source, public toilets, health centers, stores and other landmarks.
d. Barangay Organizational Chart
e. Health Center Organizational Chart

B. Population Profile
a. Total Estimated Population of Barangay (based on NSO)
b. Population Density (PD)

PD= Total No. of Population x 1000

Total No. of Sq. meters

c. Total population of the area surveyed

a. Total of families surveyed
a. Total number of household surveyed

C. Socio-demographic Profile
a. Total Population of Families Surveyed
b. Total Population Surveyed
c. Total number of Households Surveyed
d. Age and Sex Distribution
e. Sex Ratio (SR)
SR= No. of Males x 100
No. of Females

f. Dependency of Ratio (DR)

DR= No. of pop. 0-14+ 65y.o and above

Population 15-64-year-old

g. Civil Status
h. Types of Families
i. Religious Distribution
j. Place of Origin
k. Length of Residency
D. Socio Economic Indicators
a. Educational Attainment
b. Literacy Rate
No. of population 8 years above whom can read and write
Literacy Rate=
Total No. of Population 8 years old and above

Clinical Instructor’s Guide 46

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

c. Occupation
d. Income
e. Housing Condition
f. Ventilation

E. Environmental Indicators
a. Water Supply
b. Excreta Disposal
c. Garbage Disposal
d. Others: Pet Ownership
Domestic Animals (Pig, Dog, Birds, Cats) per Family Surveyed

F. Health Profile
a. Food storage
b. Infant feeding practices
c. Immunization Status of Children (0-12 months old)
d. Community Facilities and Resources
e. Health seeking behaviours / Awareness of medical / dental
Utilized commonly used by the co munity people.

G. Communication resource
a. Source of Information
b. Family Planning

H. Morbidity and Mortality Data

a. Leading cause of Morbidity
b. Leading cause of Mortality
c. Leading cause of maternal Mortality

I. Analysis of Data
a. identification of health problems
b. Prioritized problems identified

J. Data on Community Development

K. Conclusion
L. Recommendations
Action Plan based on from the prioritized problem identified
a. Interventional Strategies
b. Review of related literature, if any regarding possible solutions to the health problems.
c. Specific activities to be done.
d. Gantt chart of activities to be done
e. Budget

6. References
7. Appendices

Multiple Choice
Answer the following questions carefully.
1. In COPAR Documentation, which of the following submission date is written correctly.
Clinical Instructor’s Guide 47

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

a. MAY 2021
b. May 1, 2021
c. May 2021
d. MAY 1, 2021

2.What part of the COPAR documentation follows the dedication?

a. Title page
b. Table of content
c. Acknowledgement
d. Introduction

3. In what part of the community profile we can include the organizational chart of the barangay?
a. Population Profile
b. Socio Economic Indicators
c. Geographic Profile
d. Socio-demographic Profile
Answer: c

4. Which of the following are included in the environmental indicator? SATA

a. Food storage
b. Pet Ownership
c. Garbage Disposal
d. Housing Condition
e. Excreta Disposal
f. Water Supply

5. Which of the following is not part of the title page?

a. Title
b. Author
c. Time
d. Submission date

SESSION 13
TABLES, GRAPHS AND ANALYSIS,
ADDITIONAL GUIDELINES IN FILING UP OF THECOMMUNITY HEALTH SURVEY FORM AND
DOCUMENTATION

Presentation of numerical variables:

Regardless of the form of presentation, total number of observations must be mentioned, whether in the title
or as part of the table or figure.

Table 1: Absolute relative frequencies of acne scar in 18-year-old adolescents

(n= 2,414.). Petolas,Brazil, 2010

Clinical Instructor’s Guide 48

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Appropriate legends should always be included, allowing for the proper identification of each of the categories
of the variable and including the type of information provided.

BASIC RULES FOR THE PREPARATION OF TABLES AND GRAPHS

Ideally, every table should:
o Be self-explanatory;
o Present values with the same number of decimal places in all its cells (standardization);
o Include a title informing what is being described and where, as well as the number of observations (N) and
when
data were collected;
o Have a structure formed by three horizontal lines, defining table heading and the end of the table at its lower
border;
o Not have vertical lines at its lateral borders;
o Provide additional information in table footer, when needed;

Clinical Instructor’s Guide 49

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

o Be inserted into a document only after being mentioned in the text; and
o Be numbered by Arabic numerals.
Similarly to tables, graphs should:
o Include, below the figure, a title providing all relevant information;
o Be referred to as figures in the text;
o Identify figure axes by the variables under analysis;
o Quote the source which provided the data, if required;
o Demonstrate the scale being used; and
o Be self-explanatory.
Interpretation and analysis:
Tables are the simplest way to represent data. A table compiles all data into columns and rows so that it can
be easily interpreted.

Table 6 Frequency and Percentage Distribution Based on Educational Attainment N=60

Educational attainment Frequency Percentage

Elementary Undergraduate 9 15.00%

Elementary Graduate 5 8.33%

High School Undergraduate 6 10.00%

High School Graduate 22 36.67%

College Undergraduate 6 10.00%

College Graduate 8 13.33%

No Formal Education 4 6.67%

Total 60 100.00%

Table 6 shows that 36.37% of the elderly are high school graduates. However, 6.67% of them did not
have formal education. Although, there are 13.33% of the elderly who are college graduates.
Nonetheless, the table may reflect the elderly’s knowledge and attitude in understanding health
related activities varies from one another. Basic education is a social determinant of health (Hahn &
Truman, 2015). Furthermore, the educational attainment mirrors that the socio-economic status may
vary widely. Hence, their ability to purchase health services and other basic needs are not the same.
Note: The description started from the highest then to the lowest. Implications were added, although the use
of words like
“may or possibly” and other words which denote uncertainty yet it may be true can be used to make the
interpretation and analysis not bias. Citing authors related to the implication can also help in the explanation.

Clinical Instructor’s Guide 50

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

ADDITIONAL GUIDELINES IN FILLING-UP THE SURVEY FORMS

Preparation before the survey interview:
1. Make sure all your materials are ready. (paper, pen/pencil and survey form)
2. You made rehearsal with a classmate or a friend. Be familiar to the parts of the survey form.
3. You did a mocked interview with your family members.
During the interview
1. Greet the family.
2. Introduce yourself and purpose.
3. Make sure they agree to be interviewed.
4. Engage in small talk first then move to the questions of the survey form.
5. Treat your survey like a conversation.
6. Keep your early set of questions light and straightforward, and then slowly move towards more personal
questions (often taking the form of demographic questions).
7. Don’t let your survey get too long.
8. Focus on using closed-ended questions.
9. Don’t ask leading questions. In other words, try not to put your own opinion into the question prompt.
Doing so
can influence the responses in a way that doesn’t reflect respondents’ true experiences. For example,
instead of
asking: “How helpful or unhelpful were our friendly customer service representatives?” Ask: “How helpful or
unhelpful were our customer service representatives?”
10. Stay away from asking double-barreled questions. Double-barreled questions are when you ask for
feedback on two separate things within a single question. Here’s an example: “How would you rate the
quality of the service and product?”

Non-verbal communication
o Non-verbal communication includes facial expressions, the tone and pitch of the voice, gestures displayed
through body language (kinesics) and the physical distance between the communicators (proxemics).
A. Material:
o White writing paper, letter size, 8.5” x 11” substance 20
B. Logos:
o The title page contains the colored logos of the (1) PHINMA University of Pangasinan on the left upper
margin, and the (2) College of Health Sciences or respective CHS department on the right upper margin.
The inclusion of logos in the rest of the pages of the manuscript is optional.

C. Margins:
o 1.5 inches or (3.81 cm) on the left, and 1 inch (or 2.54 cm) on the rest (top, bottom, and right).
D. Font Size and Type:
o Use 12- pt. Arial font for the text; use Tahoma for figures.
E. Line spacing:
o Double-spaced throughout the paper, including the title page, abstract, body of manuscript, references,

Clinical Instructor’s Guide 51

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

table headings, figures, and appendices. Single space may be used in certain areas where space is a
consideration (table entries, letters and questionnaire items).

F. Spacing after Punctuation:

o Space once after commas, colons, and semicolons within sentences. To increase readability, insert two
spaces after punctuation marks that end sentences.

G. Alignment:
o Left align.
H. Paragraph Indention:
o 5 spaces.
I. Pagination:
o The page number appears at the bottom on the right edge of the paper.
J. Style:
o Italics, underlining, and bolding should not be used except where prescribed.
K. Spelling:
o May be in either American or British English; whichever is chosen should be used consistently all
throughout the paper.

L. Approximations and Reporting Statistics:

o Use words to express approximations of days, months, and year (e.g., four years ago, nineteenth
century).
o Use a zero before the decimal point with numbers less than one when the statistics can be greater than
one (e.g., 0.56 kg).
o Do not use a zero before the decimal point when the number cannot be greater than one (e.g., r= .015).
o Use brackets to group together confidence interval limits in both the body text and tables.
Example: 95% CIs [-7.2, 4.3], [9.2, 12.4], and [-1.2, -0.5]
M. The Oral Examination:
o The researchers should provide the instructor/s, adviser, and each member of the Defense Panel a copy
of their final paper at least seven (7) working days before the scheduled oral examination.

Clinical Instructor’s Guide 52

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

N. The Final Output:

The approved final output should be paper-bound and with plastic cover. The color of the cover and binding
is a light green for Nursing. The cover of paper-bound copy contains the same entries as found o on the title
page; the spines contain the study title only. All prints on the cover and spine are printed in black (bold format).
O. Copies:
o Final Paper - Submit three (3) copies: one for the University Library and two for the CHS Library.
Additional copies may likewise be provided should the instructor and/or adviser request for one. The
original copy is submitted to the Faculty of the CHS. Unless prescribed by the research adviser
and/or instructor/s, clear photocopies for the two other final research papers are acceptable, provided
that the title page bears logos in color.

P. Order of Pages:
o Title page, Acknowledgement, Table of Contents, List of Tables, List of Figures, Body, References,
Tables, Figures, Appendices.
ACTIVITY: Form a group with 5 members, find a family to do an interview and apply the guidelines
mention in this session to fill out the community health survey in session 14.
Please include also your documentation such as photos during the interview in your final output or
VIDEO RECORDED file.
Kindly convert your FINAL OUTPUT to PDF. Format: Font style; Times New Roman, Font size:12Header

SESSION 14
COMMUNITY HEALTH SURVEY

COMMUNITY HEALTH ASSESSMENT FORM

Respondent: _________________________________________________
Age:_______________
Stage: _________________________________________________
Sex:_______________
Relation to Head ________________________________ (If not the Head of the Family)
I. Family Data
A. Head of the family: _____________________________ Age:
_____________
B. Name of Spouse: _____________________________ Age:
_____________
C. Address: _____________________________ Tel No.: _______________
D. Educational Attainment
i. Husband: _____________________________

Clinical Instructor’s Guide 53

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

ii. Wife: _____________________________

E. Length of Residency: _____________________________

F. Ethnic Origin : _____________________________
G. Family: _____________________________
Nuclear ( ) Extended ( )
H. Religion: _____________________________
I. No. of Children: _____________________________
J. Members of the Household: _____________________________
Name Age Sex Status Education Occupation
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
__________________________________________________________________________ __________
____________________________________________________________________________________
____________________________________________________________________________________
___________

II. Socio Economic Data

A. Source of Income
Occupation: _____________________________________
Husband: _______________________________________
Wife: ___________________________________________
Employed ( ) Unemployed ( ) Self–employed ( )
Monthly Income
Below ₱ 2,000 ( ) ₱ 2,000 - ₱ 5,000 ( )
₱ 5,001 - ₱ 8,000 ( ) more than ₱ 8,000 ( )
B. Family Expenditures

1. Food
Below ₱ 50 ( ) ₱ 50 – 75 ( )
More than ₱ 70 ( )

2. Clothing number of times of buying

Once a year ( ) Twice ( )
Thrice a year ( )
3. Housing
Water ( ) Electricity ( )
Telephone ( )
4. Schooling
Public ( ) Private ( )

5. Others _______________________________________________

C. Housing and Environmental Condition

A. Home
Type
Concrete ( ) Wood ( )
Mixed ( ) Makeshift ( )
Clinical Instructor’s Guide 54

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Others

Ventilation:
Poor ( ) Good ( )

Lighting:
Adequate ( ) Inadequate ( )

Surroundings:
Clean ( ) Dirty ( )

B. Source of Water Supply

Artesian well ( ) Deep well ( )
NAWASA ( ) Others:

C. Storage of Drinking Water

Refrigerated ( ) Covered ( )
Uncovered ( )
Containers used:
Plastic ( ) Clay jars ( ) Bottles ( ) Others:

D. Toilet Facilities
Sanitary:
Flush ( ) Pit privy ( )
Others Owned ( )
Shared ( )
Unsanitary:
“Ballot” system ( ) Others

E. Garbage Disposal
Collection ( ) Burning ( )
Burying ( ) Open dumping ( )
Garbage cans ( ) Others

F. Food Storage
Covered ( ) Uncovered ( )
Refrigerated ( )

G. Presence of Animals
Dogs ( ) Cats ( )
Pigs ( ) Others
H. Backyard Gardening
Vegetables ( ) Herbal ( )
Fruit-bearing ( ) Others

D. Community Resources
A. Health and Other Facilities
Health center ( ) Barangay hall ( )
School ( ) Church ( )
Park ( ) Market ( )
Health center ( ) Private clinic ( )
Clinical Instructor’s Guide 55

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Public hospital ( ) Private hospital ( )

B. Indigenous health workers

Trained “hilot ” ( ) BHW ( )
“Herbularyo” ( ) Untrained “hilot” ( )
Others:

C. Sources of health funds:

Government ( ) Private ( )
NGOs/POs ( ) Others:

E. Nutrition
A. Food preference
Fish ( ) Fruits/ vegetables ( )
Meat ( ) Mixed ( )

B. Common
Rice and egg ( ) Rice and sardines ( )
Rice and noodles ( ) Others:

C. Presence of Nutritional Disorder

1. Goiter
Enlargement of the neck ( ) Dysphagia ( )
Hoarseness ( ) Others:

2. Anemia
Pallor ( ) Easy fatigability ( )
Body weakness ( )

3. Vitamin A deficiency
Night blindness ( ) “Pilak sa mata” ( )
Others

4. Others:

F. Knowledge, Attitude and Practice

A. Do you utilize the health center: Yes ( ) No ( )

If no, why?
B. Reason:
Illness ( ) Prenatal ( )
Family planning ( ) Postnatal ( )
Dental ( ) Nutrition ( )

C. First Person consulted in times of illness:

M.D. ( ) Nurse ( )
Midwife ( ) “Hilot” ( )
“Herbularyo” ( ) BHW ( )

Others
Clinical Instructor’s Guide 56

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

D. Usual illness in the family

What do you do for this condition?

Self- medication ( ) Consultation ( ) Hospital ( ) Private clinics ( ) Nursing ( ) Others:

E. Others diseases
TB ( ) Leprosy ( )
Skin disease ( ) Hepatitis ( )
Others

F. Do you submit your children (0-12 months) for immunization?

Name of Child Birthday Immunization

BCG DPT OPV AM

G. Do you practice family planning? Yes ( ) No ( )

Method:
If no, why?

H. Method of infant feeding:

Breast ( ) bottle ( )
Mixed ( )

I. Subjects you want to learn in health education:

Drug abuse ( ) Nutrition ( )
Family planning ( ) Herbal plants ( )
First aid measure ( ) Others ____________

Interviewed by: _________________________

Date: __________________ Time: __________

Multiple Choice
Answer the following questions carefully.
1. The husband is self-employed. It means that:
a. He employed himself.
b. He is self-sufficient.
c. He is a freelancer.
Clinical Instructor’s Guide 57

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

d. He does not have work.

2.The student nurse noticed that house is too small for 12 persons. The mother mentioned they sleep together
inside. The family do not have sanitary toilet. When asked how they dispose their feces, the mother pointed to
the pile of plastic. The student nurse will record that the:
a. Family has good ventilation.
b. Family is very poor.
c. Toilet facility is unsanitary.
d. None of these

3.Herbularyo is a person who is: (select all that apply)

a. Known as witch doctors
b. Uses incantations or prayers when treating a person who is sick
c. May use different plants in treating
d. May use holy oil, amulets or religious objects during the treatment

4.Self-medication means that an individual may use: (select all that apply)
a. Over-the-counter medicines without prescription
b. Supplements as advertised
c. Treatment as advised by a family member
d. Maintenance medications as prescribed

5.The house of the family is made of light materials including tarpaulin and sacks. The house is:
a. Mixed type
b. Wood
c. Makeshift
d. Concrete

Module 15
PLANNING FOR COMMUNITY HEALTH NURSING PROGRAMS AND SERVICES

THE PLANNING CYCLE

As the community health nurse plans to meet the health problems and needs of the population, four basic questions are
asked (Mercado,1993):

● Where are we now?

● Where do we want to go?
● How do we get there?
● How do we are there?

Situational Analysis
● Gather health data
● Tabulate, Analyze and and interpret data
● Identify health problems
● Set priority

Evaluation
Goal and objective Setting
● Determine outcomes *Define program goals and
● Specify criteria and Standards objectives
*Assign priorities among
Clinical Instructor’s Guide objectives 58

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Strategy/Activity Setting
• Design CHN Programs
• Ascertain resources
• Analyze constraints and limitations

Situational Analysis
● Answering the question “Where are we now?” involves the process of collecting, synthesizing,
analysing and interpreting information in a manner that will provide a clear picture of the health status of
the community.
● It brings out the health problems of the community. In this phase of the planning cycle, the nurse
identifies and provides explanation to the problems.
● She may use the community diagnosis report as basis for the situational analysis.
● Problem identifies and explanations are facilitated if the nurse develops a problem tree. The problem
tree can lead her to the problem causes of the health status problem.

For example:
High incidence and prevalence of
intestinal parasitism among children

Poor personal Unsanitary waste Poor child Poor utilization

habits disposal system care of health

Lack of basic Preoccupation Negative attitude of

Low level of
health facilities with earning a health providers
education
living

poverty Lack of basic Job dissatisfaction

health
facilities

Government
neglect

Health is least priority in

terms of budget

Clinical Instructor’s Guide 59

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● One notices that the roots of the health status problem (high incidence and prevalence of parasitism) are related to
health resources and health-related problems like educational status, grinding poverty, government neglect and
quality of health care providers.
● Through explaining and analysing the problems using a problem tree, the nurse will have an idea what situation
needs to be changed or what can be done in order to effect a desired change.
● In summary, the situational analysis involves three activities. One, the nurse gathers data about the health status of
the community. Second, the nurse identifies and explains the problems and three, the nurse projects what situation
needs to be changed, developed or maintained.

Goal and Objective Setting

● “Where do we want to go?” refers to the process of formulating the goals and objectives of the health program and
nursing services in order to change the status quo.
● Goals and Objectives will serve as guide to the nurse’s efforts.
● A goal leads to a desired end.
● The desired end may be a total change, improvement or maintenance of a situation. It is directed towards solving
the health status problems which the nurse identified in the community diagnosis. It is generally broad and not
constrained by time or resources. It states the ultimate desired state. Objectives are more precise. They have to be
stated in specific and measurable terms.

For example:

Multiple Choice
Answer the following questions carefully.

1.When do nursing activities related to community nursing begin?

a. On the first contact with the patient
b. After the patient is admitted to the hospital
c. At the time referrals are made to community resources
d. When the primary health care provider writes discharge orders

2. Population-focused nursing practice requires which of the following processes?

a. Community organizing
b. Nursing process
c. Community diagnosis

Clinical Instructor’s Guide 60

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

3.In which step are plans formulated for solving community problems?
a. Mobilization
b. Community organization
c. Follow-up/extension
d. Core group formation

4. The public health nurse takes an active role in community participation. What is the primary goal of
community organizing?
a. To educate the people regarding community health problems
b. To mobilize the people to resolve community health problems
c. To maximize the community’s resources in dealing with health problems

5. A community/public health nurse employed by the local health department is told by the director to engage
in health planning. Which of the following actions will the nurse perform?
a. Collecting and analyzing data
b. Serving vulnerable populations
c. Planning for health care needs of individuals
d. Applying the nursing process to community-based care

Module 16
COMMUNITY PROGRAM BASED HEALTH PLAN AND EVALUATION

Note: Review the Community Health Nursing Process that was discussed in your CHN 2 lecture.
Example:
Situation:
Problem: Risk of Elderly Sickness leading to morbidity in Barangay Gueset.
Goal: To reduce morbidity rates among elderly from 1200/1000 to 800/1000
Objectives:
At the end of the year, the community of Barangay Gueset will:
1. Demonstrate the ability to participate in health-related activities of the barangay from 60% to 90%
1. Reduce the prevalence of communicable diseases from 18% to 8%
1. Reduce the prevalence of non-communicable diseases from 65% to 40%

Program Title: A title that may catch the attention of the community
Objectives: Pertains to the goals in relation to the situation presented
Activities: Plan of actions in order to achieve the objectives
Assign Person: For this sample plan, hypothetically assigning individuals’ work in relation to the health plan
Target Outcomes: Main purpose of the plan
Manpower: Refers to the people of the community that may help in the program
Materials: Supplies needed during the program
Budget: Projected expenses

Sample of Community Based Health Plan

Program Objectives Activities Assign Target Manpower Materials Budget

Title Person Outcomes

Clinical Instructor’s Guide 61

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

“Wastong At the end of the Short Short Elderly will Barangay Tables Refreshment
kalusugan activity, the elderly program program be able to Health Chair Php50 per
ay will be able to: Mini- – 10 acquire Workers – Sound head
kailangan a. Cite 3 or discussion students additional Registration system
upang more ways to knowledge Posters Token
sakit ay maintain health Hall of Hall of in Facility Extension Php20 per
b. Enumerate posters posters arrangement wires head
hindi maintaining
at least 3 or more – 20 – Barangay Foods
dapuan” health and
ways to prevent Healthy students Tanod and Drinks Certificate
diseases preventing Token
booths students Php5 per
diseases Certificates
Healthy head
Quiz booths – Sound
booths 6 system – c/o Miscellaneous
students Barangay Php15 per
head
Quiz
booths – Refreshment
9 – Mothers
students and Students

The Evaluation Plan

● The nurse poses the question “How do we know we are there?” in order to find out if the programs and services achieve
the purpose for which they were formulated. She determines whether the program is relevant, effective, efficient and
adequate.
● This entails determining the specific input, process and output/outcome indicators of the program stating the criteria
and standards of each.

Program evaluation includes the following steps:

1. Deciding what to evaluate in terms of relevance, progress, effectivity, impact and efficiency;
2. Designing the evaluation plan specifying the evaluation indicators, data needed, methods and tools for data
collection and data sources;
3. Collection of relevant data;
4. Making decisions;
5. Preparing report and providing decision-makers feedback on the program evaluation.

Examples:

Program being evaluated: “Hilot” Training Program

A. Evaluation of inputs/Resources – specifically on adequacy of manpower resources.

Criteria Evaluation: 1. Trainer- Hilot ratio

2. Qualification of trainer
Standards for Evaluation: 1. One trainer for every 10 hilots
2. Trainer nurse who attended a Trainer’s Course for Hilots.

B. Evaluation of Process – specifically on how the training program was conducted, i.e. the appropriateness and
adequacy of the training process.

Criteria for Evaluation: Application of basic concepts, principles and methods of educational science in the
training of hilots.

Standards for Evaluation: The following were done in the training of hilots:
Clinical Instructor’s Guide 62

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

i.Training needs of hilot - participants were assessed before the start of training, using valid and reliable methods;
ii.Training objectives set were based on the results of training – needs assessments;
iii.Training objectives were specified and stated in clear, specific, measurable and realistic terms;
iv.Training methods used were varied and appropriate to the participants’ level of comprehension, and
v.Appropriate, valid and reliable methods were used to evaluate learning and performance of trainees.

C. Evaluation of Outcome – specifically on some immediate and intermediate effects/results of the hilot training
program.

Criteria for Evaluation:

i.Incidence of postpartum infection and other preventable complications in the mother among births attended by trained hilots;
ii.Incidence of cord infection and other preventable complications in the newborn among births attended by trained hilots, and
iii.Reporting and registration of births attended by trained hilots.

Standards for Evaluation:

i.The incidences of postpartum infection and other preventable complications in the mother is significantly
lower among births attended by trained hilots compared to those attended by untrained hilots.
ii. The incidence of cord infection and other preventable complications in the newborn is significantly lower
among births attended by trained hilots compared to those attended by untrained hilots.
iii.Births attended by trained hilots are reported to the community health nurse or midwife and registered within
three weeks from the date of births.

Other example: Checklist

A CHECKLIST TO EVALUATE A PROGRAM PLAN

Instruction: Put a check mark (/) in the appropriate Yes or No column for each component of the Program Plan
evaluated according to the criteria and standards specified in the first column. You may write any pertinent
information or comments relating to your evaluation of specific item in the Remarks column.

Components/Items Evaluated Criteria Check if

and Standards for Evaluation Yes No Remarks

I.Title of the Program

1. Specifies that what, where and when the program
1. Appropriate and relevant to the problem situation

1. Manageable in scope
II. Introduction – contains:
1. General and specific background information relevant to the problem situation.

1. Relevant national policies and priorities.

III. The Problem Situation

A. Data Collection
1. Complete, i.e. no important data missed
1. Just enough i.e. no irrelevant data gathered

1. Correct, i.e. data gathered relevant to problem situation

1. Used valid and reliable sources

Clinical Instructor’s Guide 63

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

1. Used valid and reliable methods

1. Hypothetical values are realistic

B. Description of the Problem Situation
1. Complete, i.e. specified:
a. Nature and magnitude of the problem

b. People and geographic area involved

c. Primary and contributory causes
d. Past and present efforts to reduce or eliminate the problem

e. Resources available which can be used to reduce or eliminate the problem

f. Benefits of problem reduction or elimination

g. Forecast of the future if no intervention is done

Components/Items Evaluated Criteria Check if

and Standards for Evaluation Remarks
Yes No
IV. The Program
A. Goal
1. Appropriate to the problem situation
1. Clearly stated
B. Philosophy – Relevant to program Implementation
C. Objectives
1. Clearly stated; defines what, for whom and when of the change to be achieved

1. Measurable quantitatively or qualitatively

1. Realistic
1. Stated in terms of outcomes to be achieved

D. Strategy / Approach
1. Organizational structure for program implementation:
a. defined/specified
b. appropriate considering scope of the program
2. Policies, administrative rules and standard operating procedures to ensure
successful program implementation:
a. defined/ Specified

b. appropriate considering nature of the problem and program

3. Phases or major components of the program:

a. relevant to program or objectives
b. complete, i.e. no important component missed
4. Operational control and monitoring schemes:
a. defined (what, when and by whom)

Clinical Instructor’s Guide 64

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

b. appropriate and realistic

E. Activities
1. Appropriate to program objectives

1. Practical, can be implemented considering resources available

F. Resources Required
1. Complete, i.e. specified all major resources required to implement activities;
included:
a. manpower types and number

Components/Items Evaluated Criteria Check if

and Standards for Evaluation Remarks
Yes No
b. Facilities
c. Equipment – kinds and number
d. Furniture – kinds and number
e. Supplies – kinds and quantity, including drugs
f. Funds for capital expenditure
- recurrent expenditure
- contingency
- allowance for inflation

g. Time
1. Appropriate and correct considering program objectives and activities

1. Realistic, i.e. can be provided considering budget available and prevailing situation

G. Plan for Implementation

1. Program milestone or operational targets defined
1. Realistic, i.e. targets can be achieved
H. Plan for Evaluation
1. Purpose of evaluation defined

1. Specific objectives for evaluation defined

1. Scope of evaluation defined, specifically:
a. focus (Inputs, process or outcome)
b. dimensions/ aspects to be evaluated
1. Criteria to be used appropriate
1. Standards for evaluation:
a. defined for each criterion
b. realistic
1. Evaluation design / method briefly described and specified
1. Plan for collection of evaluative data:
a. data appropriate
b. data complete

Clinical Instructor’s Guide 65

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

c. use of valid and reliable sources

d. use of valid and reliable methods
1. Plan for data processing and analysis briefly described

1. Resources required to carry out evaluation plan identified

1. Users (i.e. persons, agencies, sectors) to whom evaluation report will be forwarded
identified

COMMON PITFALLS IN PROGRAM EVALUATION

The following are common pitfalls to avoid when evaluating health and /or nursing service programs:
1. When the emphasis of the evaluation is focused on the resources and facilities (inputs) provided, e.g. health centers
constructed, equipment provided, manpower deployed, etc. with the assumption that more inputs means good
health care. Experience and observation show that this is not always true, and that there is often plenty of waste of
resources.
2. When evaluation is limited to an enumeration of service activities which indicate that the health agency has been
quite busy, e.g. number of clinic consultations held, field visits made, or home visits made by the community health
nurse or midwife. In addition to volume or numbers, there is a need to assess and evaluate the results or outcomes
of these service activities. Many activities may be done as a matter of routine but may not be producing any
beneficial result.
3. Related to Pitfall No. 2 above, is a quantitative bias, i.e. accent or emphasis on the quantity of services or activities
done and disregard for measures of quality. Record keeping is often made just for counting purposes, not for
evaluation of quality of services.
4. Deficiencies in the method of evaluation, such as primary reliance on existing records as main source of evaluative
data, unqualified or incompetent service people doing the evaluation, and use of highly arbitrary and subjective
criteria.

Activity:
A. Class will be divided into groups (RLE groupings). The students will be asked to prepare a community
health-based plan

Multiple Choice
Answer the following questions carefully.
1. Primary health care is a total approach to community development. Which of the following is an indicator of
success in the use of the primary health care approach?
a. Health workers are able to provide care based on identified health needs of the people.
b. Health programs are sustained according to the level of development of the community.
c. Local officials are empowered as the major decision makers in matters of health.
d. Health services are provided free of charge to individuals and families
2. One of the participants in a hilot training class asked you to whom she should refer a patient in labor who
develops a complication. You will answer, to the;
a. Public health nurse
b. Rural health midwife
c. Municipal health officer
d. Any of these health professionals
3.Utilization of indigenous resources maximizes efforts of the Community Health Nurse. Which one of the
following Department of Health programs could you apply this principle?
a. Vegetable gardening
Clinical Instructor’s Guide 66

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

b. Training of Hilots
c. Herbal medicine
d. Nutrition of children

4. The following were done in the training of hilots, except.

a. Training needs of hilot - participants were assessed before the start of training, using valid and reliable
methods;
b. Training objectives set were based on the results of training – needs assessments;
c. Training objectives were specified and stated in clear, specific, measurable and realistic terms;
d. None of the above
e. All of the above

5.If nurses are busy, hilots can really be of help. What cases should be assigned to hilots?
a. Would dressing
b. Respiratory infection
c. Normal deliveries
d. Immunization

Clinical Instructor’s Guide 67

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Module 17
ENVIRONMENTAL HEALTH PART 1

***Recall and review the topics from your CHN 2 Lecture

Environmental Health
● The characteristics of environmental conditions affect the quality of health. It is the aspect of public health
that is concerned with those forms of life, substances, forces, and conditions in the surroundings or person
that may exert an influence on human health and well-being (PD 856).
● Environmental health comprises of those aspects of human health, including quality of life, that are
determined by physical, chemical, biological, social and psychosocial factors in the environment that can
potentially affect adversely the health of present and future generations (WHO, 1993).
● Environmental health is the component of the man’s well-being that is determined by
interactions with the physical, chemical, biological, social, and psychosocial factors external to
him.
● In the Philippines, maintenance of environmental health records is one of the responsibilities given to the
city, municipal, and provincial health nurses.

Objectives of the Environmental Sanitation (ES) Program

1. Expand and strengthen delivery of quality ES services
2. Institute supportive organizational, policy and management systems
3. Increase financing and investment in ES
4. Enforce regulation policy and standards
5. Establish performance accountability mechanism at all levels

Components
● Drinking-water supply
● Sanitation (e.g excreta, sewage and septage management)
● Zero Open Defecation Program (ZODP)
● Food Sanitation, Air Pollution (indoor and ambient)
● Chemical Safety, WASH in Emergency situations
● Climate Change for Health and Health Impact Assessment (HIA)

Eight environmental health indicators in the Field Health Service Information System (FHSIS):
1. Households with access to improved or safe water- stratified to Levels I, II, and III
2. Households with sanitary toilets
3. Households with satisfactory disposal of solid waste
4. Households with complete basic sanitation facilities
5. Food establishments
6. Food establishments with sanitary permit
7. Food handlers
8. Food handlers with health certificates

Solid Wastes

● Municipal Wastes
● Healthcare Wastes
● Infectious
● Pathological
● Pharmaceutical
● Chemical
● Sharps
● Radioactive
● Industrial Wastes

Clinical Instructor’s Guide 68

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● Hazardous Wastes

Solid waste management

“The discipline associated with the control of generation, storage, collection, transfer and transport, processing, and
disposal of solid wastes in a manner that is in accord with the best principles of public health, economics,
engineering, conservation, aesthetics, and other environmental considerations, and that is also responsive to public
attitudes”. –R.A. 9003
Solid waste stream

● Waste Generation
● Waste Reduction: Re-Use
● Waste Segregation
● Collection and Transportation
● Waste Recycling
● Waste Treatment and Processing
● Residual Waste Disposal

Waster segregation
● Black or colourless: non-hazardous and nonbiodegradable wastes
● Green: non-hazardous biodegradable wastes
● Yellow with biohazard symbol: pathological/anatomical wastes
● Yellow with black band: pharmaceutical, cytotoxic or chemical wastes (labelled separately)
● Orange with radioactive symbol: radioactive wastes

Prohibited on solid waste management

● Open burning of solid wastes
● Open dumping
● Burying in flood-prone areas
● Squatting in landfills
● Operation of landfills on any aquifer, groundwater reservoir or watershed
● Construction of any establishment within 200 meters from a dump or landfill

Environmental sanitation

Water supply and sanitation program

The lead agency on the determination of standards for quality of drinking water is the Department of Health (DOH).

The general requirements of safe drinking water include:

● Microbial quality tested through the parameters of total coliform, fecal coliform, and heterotrophic plate count.
● Chemical and physical quality tested through parameters of pH, chemical specific levels, color, odor, turbidity,
hardness and total dissolved solids.
● Radiological quality tested through the parameters of gross alpha activity, gross beta and radon.

Levels of Access to Safe Water

● Level I (Point Source) refers to protected well (shallow or deep well), improved dug well, developed spring or
rainwater cisterns with an outlet but without a distribution system.
● Level II (Communal Faucet System or Standpost) refers to a system composed of a source, reservoir, a piped
distribution network, and a communal faucet located not more than 25 meters from the farthest house.
● Level III (Waterworks System) refers to a system with a source transmission pipes, a reservoir, and a piped
distribution network for household taps.
- DOH FHSIS, 2008

Prohibitions of the Code of Sanitation on Water Supply

● Washing and bathing within a radius of 25 meters from any well or other source of drinking water

Clinical Instructor’s Guide 69

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● Construction of artesian, deep, or shallow well within 25 meters from any source of pollution (including septic tanks
and sewerage systems)
● Drilling a well within 50-meter distance from a cemetery
● Construction of dwellings within the catchment area of a protected spring water source

Emergency water treatments

● Pre-Treatment Processes
● Aeration
● Rapidly shake a container that is partially full of water for about 5 minutes
● Settlement
● Allowing water to be undisturbed in the dark for a day
● Filtration
● Utilizing filters to block particles
● Filters can be clean cloth, sand and ceramics
● Disinfection
● Boiling
● 1 minute rolling boil (at sea level)
● 3 minutes rolling boil (at higher altitude)
● Aeration after boiling to improve the taste of boiled water
● Chemical Disinfection
● Chlorine is most often use
● Solar Disinfection (SODIS)
● Filling transparent 1-2 liters of plastic container and exposing them to direct sunlight for about 5
hours
● Storage and Consumption

Air Purity

Two Major Sources of Air Pollution:

1. Mobile source – refers to any vehicle/machine propelled by or through oxidation or reduction reactions, including
combustion of carbon-based or other fuel, constructed and operated principally for the conveyance of persons or
other fuel, constructed and operated principally for the conveyance of persons or the transportation of property or
goods, that emit air pollutants as a reaction product.
2. Stationary source – refers to any building or fixed structure, facility or installation that emits or may emit any air
pollutant.

Table: Air Quality Indices

24-hour average total suspended particulates (TSP) (μg/m3)

Good 0-80
Fair 81-230
Unhealthy for sensitive groups 231-349
Very Unhealthy 350-599
Acutely Unhealthy 600-899
Emergency 900 and above

Particulate matter report results interpretation

● “Unhealthy for sensitive groups”: People with respiratory disease, such as asthma, should limit outdoor exertion.
● “Very unhealthy”: Pedestrians should avoid heavy traffic areas. People with heart or respiratory disease, such as
asthma, should stay indoors and rest as much as possible. Unnecessary trips should be postponed. People should
voluntarily restrict the use of vehicles.
● “Acutely unhealthy”: People should limit outdoor exertion. People with heart or respiratory disease, such as asthma,
should stay indoors and rest as much as possible. Unnecessary trips should be postponed. Motor vehicle use may
be restricted. Industrial activities may be curtailed.

Clinical Instructor’s Guide 70

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● “Emergency”: Everyone should remain indoors, (keeping windows and doors closed unless heat stress is possible).
Motor vehicle use should be prohibited except for emergency situations. Industrial activities, except that which is
vital for public safety and health, should be curtailed.

Prepare a poster (manual, no computer assisted output) regarding environmental health. Short bond paper will be
used, colouring pens/crayons or any will be accepted. Choose a pollutant and propose a program (reflected in a
free hand drawing) to reduce its impact to the community.

Note: It should be accompanied by a program proposal related to environmental health.

Sample of Community Based Health Plan

Program Title Objectives Activities Assign Person Target Outcomes Manpower Materials Budget

Multiple Choice
Answer the following questions carefully.
1.This refers to the actions of individuals, groups, and organizations, as well as their determinants, correlates,
and consequences, including social change, policy development, and implementation, improved coping skills,
and enhanced quality of life.

a. Health promotion
b. Multiple levels of influence
c. Health behavior
d. Ecological perspective

Clinical Instructor’s Guide 71

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2.What level of access to safe water that refers to a system composed of a source, reservoir, a piped
distribution network, and a communal faucet located not more than 25 meters from the farthest house.
a. Level I (Point Source).
b. Level II (Communal Faucet System or Standpost)
c. Level III (Waterworks System)
d. Level IV (Water System)

3.What level of access to safe water that refers to protected well (shallow or deep well), improved dug well,
developed spring or rainwater cisterns with an outlet but without a distribution system.
a. Level I (Point Source).
b. Level II (Communal Faucet System or Standpost)
c. Level III (Waterworks System)
d. Level IV (Water System)

4.A source of air pollution that refers to any building or fixed structure, facility or installation that emits or may
emit any air pollutant.
a. Mobile source
b. Building source
c. Stationary source
d. All of the above
5.Which of the following are parts of the Pre-Treatment processes of Emergency water treatments? Select all
that apply.
A. Aeration
B. Settlement
C. Boiling
D. Filtration
E. Disinfection

6. Which of the following are the general requirements of safe drinking water?
A. Microbial quality tested through the parameters of total coliform, fecal coliform, and heterotrophic
plate count.
B. Chemical and physical quality tested through parameters of pH, chemical specific levels, color, odor,
turbidity, hardness and total dissolved solids.
C. Radiological quality tested through the parameters of gross alpha activity, gross beta and radon.
D. None of the above
E. All of the above

7.It refers to any vehicle/machine propelled by or through oxidation or reduction reactions, including combustion
of carbon-based or other fuel, constructed and operated principally for the conveyance of persons or other fuel,
constructed and operated principally for the conveyance of persons or the transportation of property or goods,
that emit air pollutants as a reaction product.
a. Mobile source
b. Stationary source
c. Human Resource
d. All of the above

8.The following are the objectives of the Environmental Sanitation (ES) Program, except:
a. Expand and strengthen delivery of quality ES services
b. Institute supportive organizational, policy and management systems
c. Reduce financing and investment in ES
Clinical Instructor’s Guide 72

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

d. Enforce regulation policy and standards

e. Establish performance accountability mechanism at all levels

9. It is the component of the man’s well-being that is determined by interactions with the physical, chemical,
biological, social, and psychosocial factors external to him.
a. Personal Health
b. Healthy lifestyle
c. Environmental health
d. None of the above

Module 18
ENVIRONMENTAL HEALTH PART 2

Proper excreta and sewage disposal program

Sanitation
• “The hygienic and proper management, collection, disposal or reuse of human excreta (feces and urine) and
community liquid wastes to safeguard the health of individuals and communities.” –Philippine Sanitation
Sourcebook, 2005

6 F’s of Fecal-Oral Microbial Transmission

• Feces
• Fingers
• Fluids
• Flies
• Fields/ Floors
• Food

Sanitation Facilities
• Box-and-can privy – or bucket latrine, fecal matter is collected in a can or bucket, which is periodically
removed
for emptying and cleaning
• Pit-latrine – fecal matter is eliminated into a hole in the ground that leads to a dug pit. Generally, a latrine
refers to toilet facilities without a bowl. It can be equipped with either squatting plate or riser with a seat. The
pit reduces
the volume of its contents as the liquid infiltrates the surrounding soil
• Antipolo toilet – it is made up of an elevated pit privy that has a covered latrine. The elevation ensures that
the bottom of the pit is at least 1.5 meters
• Septic privy – fecal matter is collected into a built septic tank that is not connected to a sewerage system.
• Aqua privy - fecal matter is eliminated into a water-sealed drop pipe that leads to a latrine to a small water-
filled septic tank located directly below the squatting plate
• Overhung latrine – fecal matter is directly eliminated into a body of water such as flowing river that is
underneath the facility.
• VIP latrine – ventilated-improved pit, it is a pit latrine with a screened air vent installed directly over the pit.
• Concrete vault privy – fecal matter is collected in a pit privy lined with concrete in such a manner so as to
make it water tight.
• Chemical privy – fecal matter is collected into a tank that contains a caustic chemical solution, which in turn
controls and facilitates waste decomposition.

Clinical Instructor’s Guide 73

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

• Compost privy – fecal matter is collected in a pit with urine and anal cleansing materials with the addition of
organic garbage such as leaves and grass to allow biological decomposition and production of agricultural or
fishpond compost
• Pour-flush latrine – it has a bowl with a water-seal trap similar to the conventional tank flush toilet except that
it requires only a small volume of water for flushing
• Tank-flush latrine – feces are excreted into a bowl with a water-sealed trap
• UDDT- urine diversion dehydration toilet, it is water less toilet system that allows separate collection and on-
site storage or treatment of feces and urine

Sanitary Types of Toilet Facilities

1. Water sealed toilet connected to a sewer or septic tank, used exclusively by the household.
2. Water sealed toilet connected to other depository type, used exclusively by the household.
3. Closed pit used exclusively by the household.

Toxic and Hazardous Waste Control

Leading Causes of poisoning in the Philippines
• Jewelry cleaners (high in cyanide)
• Pesticides
• Button batteries
• Watusi firecracker
• Jathropha seeds
• Multi-vitamins

Food sanitation program

Food safety
• “The assurance that food will not cause harm to the consumer when it is prepared and eaten according to its
intended use.” -NEHAP, 2010

Rules in Food Safety

• The food establishment must have a sanitary permit from the city or municipality that has jurisdiction over the
business.
• No person shall be employed in any food establishment without a health certificate properly issued by the
city/municipal health officer.
• No person shall be allowed to work on food handling while he/she is afflicted with a communicable disease,
including boils, infected wounds, respiratory infections, diarrhea, and gastrointestinal upset.
After proper washing, the utensils are then subjected to one of the following bactericidal treatments:
• Immersion for at least half a minute in clean hot water (77°C)
• Immersion for at least one minute in lukewarm water containing 55-100 ppm of chlorine solution
• Exposure to steam for at least 15 minutes to 77°C, or for 5 minutes to at least 200°C

Vermin Abatement Methods

1. Environmental Sanitation
o Maintenance of cleanliness of the immediate premises and proper building construction and maintenance so
as to prevent access of pests into human dwellings
o Clean-up drives are aimed in altering or eliminating the breeding sites of the vectors.
2. Naturalistic Control
o Pest control method that utilizes nature and nature’s systems without disturbing the balance of nature
3. Biological and Genetic Control
o A method that utilizes living predators, parasites and other natural enemies of the pest species to reduce or to
eliminate the pest populations. It aimed at killing the larvae without polluting the environment.
4. Mechanical and Physical Control
o A method that utilizes mechanical devices such as rodent traps, fly traps, mosquito traps, air curtain and
Clinical Instructor’s Guide 74

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

ultraviolet light.
5. Chemical control
o A method that utilizes rodenticides, insecticides, larvicides and pesticides.
6. Integrated Control
o Control pests through the use of different methods and procedures that are used to complement each other.
These procedures may include the use of pesticides, environmental sanitation measures and natural, as well
as mechanical and biological control methods.

Minimum air-space in built environments

• School Rooms - 3.00 cu. meters with 1.00 sq. meter of floor area per person
• Workshop, Factories, and Offices - 12.00 cu. meters of air space per person
• Habitable Rooms - 14.00 cu. meters of air space per person

Minimum Window Sizes

• Rooms intended for any use, not provided with artificial ventilation system, shall be provided with a window or
windows with a total free area of openings equal to at least 10% of the floor area of the room, provided that such
opening shall be not less than 1.00 sq. meter.
• Toilet and bath rooms, laundry rooms and similar rooms shall be provided with window or windows with an area
not less than 1/20 of the floor area of such rooms, provided that such opening shall not be less than 240 sq.
millimeters.

Activity: Form a group with 5 members and create a short video maximum of 5 minutes promoting environmental
health. Be creative and unique and all members should be in the video. When you’re done you will share this to
the class.

Multiple Choice
Answer the following questions carefully.
1.Its main purpose is to provide a clean and sanitary environment for the handling of food products?
a. Environmental sanitation program
b. Proper waste and excreta program
c. Food sanitation program
d. None of the above

2.In Food establishments there are rules in food safety to assure that the food will not cause harm to
consumers. Among the following are the rules to food safety except:
a. The food establishment must have a sanitary permit from the city or municipality
b. A person shall be allowed to work on food handling even if he/she is suffering from diarrhea,
and gastrointestinal upset as long as he/she practice proper hygiene.
c. They cannot employ you on food establishment without a health certificate properly issued
by the city/municipal health officer
d. None of the above

3.Republic Act (RA) No. 10611 is also known as?

a. Food Safety Act of 2013
b. Food and Drug Administration Act
c. Ecological Solid Waste Management Act 0f 2000
d. Code on Sanitation of the Philippines

4.Prevention and control measure for fecal oral disease transmission are which of the following?
a. Frequent handwashing
b. Safe preparation and serving of food
c. Safe disposal of feces and other wastes
d. all of the above
e. none of the above
Clinical Instructor’s Guide 75

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

5.Which of the following best describe a urine diversion dehydration toilet?

a. fecal matter is collected into a tank that contains a caustic chemical solution, which in turn
controls and facilitates waste decomposition.
b. fecal matter is collected into a built septic tank that is not connected to a sewerage system.
c. it is water less toilet system that allows separate collection and on-site storage or treatment of
feces and urine.
d. it has a bowl with a water-seal trap similar to the conventional tank flush toilet except that it
requires only a small volume of water for flushing.

Module 19
CONTROL OF COMMUNICABLE DISEASES part 1

Nursing Care of clients with communicable diseases

B. General principles and techniques

● Communicable diseases are illnesses caused by an infectious agent or its toxic products that is
transmitted directly or indirectly to a person, animal or intermediary host or inanimate environment.
● Communicable diseases could either be a contagious or an infectious disease.
● Illness caused by an infectious agent or its toxic products that is transmitted directly or indirectly
to a person, animal, or intermediary host or inanimate environment.
● Contagion is transmitted by direct physical contact.
● Infectious disease is transmitted indirectly through contaminated food, body fluids, objects,
airborne inhalation or through vector organisms that would require a break or inoculation in the
skin or mucous membranes of individuals. Some infectious diseases are contagious but some
are not. For this reason, the term contagious disease is not popularly used.

Top 10 causes of Morbidity in the Philippines DOH 2010

RANK DISEASE Rate per

100,000

1 Acute Respiratory Infection 1,203

2 Acute lower respiratory tract 612.6
infection and pneumonia
3 Bronchitis 380.7
4 Hypertension 366.3
5 Acute watery diarrhea 354.5
6 Influenza 297.7
7 Urinary Tract Infection 91
8 Tuberculosis (Respiratory) 80.9
9 Accidents 54.9
10 Injuries 38.9

Epidemiologic Triangle Model

Three Major Components

1. Agent
Clinical Instructor’s Guide 76

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2. Host
3. Environment

Chain of infection

Activities:
Class must be divided into 5 groups and each group will be assigned of a program; they will be advised to
prepare a poster regarding the reading assignment.
The output must be placed in a cartolina.
The poster must be creatively written, informative and simple for non-healthcare professionals and non-
professionals.
It should contain the etiology, diagnostic tests, signs and symptoms, complications and treatment.

Multiple Choice
Answer the following questions carefully.
1.Which of the following is an epidemiologic function of the nurse during an epidemic?
a. Conducting assessment of suspected cases to detect the communicable diseases
b. Monitoring the condition of the cases affected by the communicable disease
c. Participating in the investigation to determine the source of epidemic
d. Teaching the community on preventive measures against the disease

Clinical Instructor’s Guide 77

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

2. The primary purpose of conducting an epidemiologic investigation is to;

a. Delineate the etiology of the epidemic
b. Encourage cooperation and support of the community
c. Identify groups who are at risk of contracting the disease
d. Identify geographical location of cases of the disease in the community

3. The number of cases of Dengue fever usually increases towards the end of the rainy season. This pattern of
occurrence of Dengue fever is best described as;
a. Epidemic occurrence
b. Cyclical variation
c. Sporadic occurrence
d. Secular occurrence
4. For prevention of Hepatitis A, you decided to conduct health education activities. Which of the following is
Irrelevant?

a. Use of sterile syringes and needles

b. Safe food preparation and food handling by vendors
c. Proper disposal of human excreta and personal hygiene
d. Immediate reporting of water pipe leaks and illegal water connections

5. Among the following diseases, which is airborne?

a. Viral conjunctivitis
b. Measles
c. Diphtheria
d. Acute poliomyelitis

6.The Chain of Infection is a model of:

a. How pathogenic microorganisms are transmitted from one person to another
b. How an infection affects the immune system
c. How infections can be prevented
d. How bacteria multiply. How microorganisms mutate to become pathogens

7.There are 6 links in the Chain of Infection. These include each of the following Select all that apply.
a. Susceptible host
b. Portal of entry
c. Mode of transmission
d. Personal protective device
e. Reservoir

8.In any healthcare setting, the Chain of Infection can be interrupted most readily at this step:
a. Portal of exit
b. Portal of entry
c. Mode of transmission
d. Causative agent
e. Susceptible host

9.Each of the following is true about Standard Precautions except:

a. Healthcare personnel caring for patients wear a gown and gloves for all interactions that may involve
contact with the patient or potentially contaminated areas in the patient's environment.
Clinical Instructor’s Guide 78

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

b. Standard Precautions involve hand hygiene; use of gloves, gown, mask, eye protection, or face shield,
depending on the anticipated exposure; and safe injection practices.
c. Implementation of Standard Precautions constitutes the primary strategy for the prevention of healthcare-
associated transmission of infectious agents among patients and healthcare personnel.
d. Standard Precautions are intended to protect patients by ensuring that healthcare personnel do not carry
infectious agents to patients on their hands or via equipment used during patient care.
e. Standard Precautions include a group of infection prevention practices that apply to all patients,
regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.

10.Transmission Based Precautions are a second level of precautions used when the route(s) of transmission
is (are) not completely interrupted using Standard Precautions alone. Each of the statements below is true
except:
a. Contact Precautions also apply where the presence of excessive wound drainage, fecal incontinence, or
other discharges from the body suggest an increased potential for extensive environmental contamination
and risk of transmission.
b. Healthcare personnel caring for patients on Contact Precautions wear a gown, gloves, and mask for all
interactions that may involve contact with the patient or potentially contaminated areas in the patient's
environment.
c. Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory
or mucous membrane contact with respiratory secretions.
d. In settings where Airborne Precautions cannot be implemented due to limited engineering resources
(e.g., physician offices), masking the patient, placing the patient in a private room (e.g., office examination
room) with the door closed, and providing intravenous antibiotics will reduce the likelihood of airborne
transmission until the patient is no longer in the facility.
e. Healthcare personnel caring for patients on Airborne Precautions wear a mask that is donned prior to
room entry.

Answer: d
Rationale: Antibiotic use is not included in Transmission Based Precautions.

Module 20
CONTROL OF COMMUNICABLE DISEASES part 2
1. Leprosy control program

Leprosy (Hansenosis, Hansen’s, Leontiasis)

Causative agent: Mycobacterium Leprae or Hansens bacillus
Mode of transmission: prolonged skin to skin contact, droplet infection
Incubation: 5 months – 5 years
Laboratory/Diagnostic test: Skin Slit test
Signs and Symptoms:
1. Early Signs – reddish or white change in skin color, loss of sensation on the skin lesion,
decrease/loss of sweating and hair growth over the lesion, thickened and or painful nerves,
Muscle weakness, pain or redness of the eye, nasal obstruction/bleeding, ulcers that do not
heal
1. Late Signs – Loss of eyebrow (madarosis), Inability to close eyelids (lagopthalmos), clawing
of fingers and toes, contractures, Sinking of the nose bridge, enlargement of the breast in males
(gynecomastia), chronic ulcers
Prevention:
Clinical Instructor’s Guide 79

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

1. BCG vaccination
1. Avoid prolong skin to skin contact
1.1 Good personal hygiene
1.2 Adequate nutrition
1.3 Health education

2. Malaria control program

Malaria (Marsh fever, Periodic fever, King of tropical diseases)

Causative agent: Plasmodium falciparum, vivax, ovale, malariae, knowlesi
Vector: Female anopheles mosquito
Symptoms: Recurrent fever preceded by chills and profuse sweating (triad signs), malaise, anemia
Laboratory/Diagnostic test:
1. History of having been in a malaria endemic area: Palawan and Mindoro
1. Blood smear
1. Rapid Diagnostic test (RDT)
Treatment:
1. Oral antimalarial drugs
a. Chloroquine phosphate 250mg – all species except P. malariae
b. Sulfadoxine 50 mg For resistant P. falciparum
c. Primaquine For relapse P. vivax and P. ovale
d. Pyrimethamine 25 mg/tab

e. Quinine sulfate 300 mg/tab

f. Tetracycline HCl 250mg/cap
g. Quinidine sulfate 200mg/durules
1. Parenteral
a. Quinine hydrochloride 300mg/mL, 2 mL
b. Quinidine gluconate 80 mg (50mg) 1 vial
Prevention and Control:
1. Mosquito control
1. Chemical method – use of insecticides
1. Biological methods – stream seeding
1. Zooprophylaxis – larvae-eating fish, farm animals should be kept near the house
1. Environmental methods – cleaning and irrigating canals
1. Screening of houses
1. Mechanical methods – use of fly swats or traps
1. Universal precaution
1. Screening of blood donors

3.Schistosomiasis control program

Schistosomiasis (Snail Fever, Bilharziasis)

Causative agent: Schistosoma japonicum, mansoni, haematobium
Intermediary host: Oncomelania quadrasi
Mode of transmission: vehicle (water), indirect (skin pores)
Diagnostic/Laboratory test: Cercum Ova Precipetin Test (COPT), Kato Katz Technique
Symptoms: Rash at the site of inoculation, enlargement of the abdomen, diarrhea, body weakness
Treatment: Praziquantel (Biltricide), Oxamniquine for S. mansoni and S. Haematobium
Prevention and control:

Clinical Instructor’s Guide 80

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

1. Proper disposal of feces

1. Proper irrigation of all stagnant bodies of water
1. Prevent exposure to contaminated water (wearing of rubber boots)
1. Eradication of breeding places of snails
1. Use of molluscicides

4. Soil-transmitted helminthiasis control program

● The Department in partnership with schools and local government units (LGUs) are distributing anti-helminthic
drugs during the National Deworming Month (NDM), a twice a year campaign held during the months of January
and July. The NDM is done by synchronizing the schedules of Mass Drug Administration for Soil Transmitted
Helminths (STH) in the schools and the community.
● NDM is being done because STH is a public health problem that has detrimental impact on children’s growth and
development. STH can cause anemia, malnutrition, weakness, impaired physical and cognitive development
resulting to poor growth and school performance in children.
● The two components of NDM are National School-Deworming Month (NSDM) and Community Based Deworming
Month (CBDM). The NSDM is a massive and simultaneous school-based effort to deworm school-aged children
ages 5-18 y/o enrolled in public schools every July, while the CBDM is deworming of pre-school children ages 1-4
y/o and school-aged children not enrolled in public schools in various health centers and rural health units under
the Local Government all over the country.

4. National tuberculosis control program

Tuberculosis (Phtisis, Consumption, Koch’s disease)

Causative Agent: gram (+) acid fast bacilli
Mycobacterium turberculosis (humans)
Mycobacterium africanum (humans)
Mycobacterium bovis (cattle)
Mycobacterium canettii
Mode of Transmission: Airborne/Droplet through inhalation of coughing, singing, or sneezing.
Incubation Period: 4-6 weeks
Signs and Symptoms: fever, low grade fever, loss of appetite, easy fatigability, night sweats, dry cough, later
productive with hemoptysis, chest pain.

Laboratory/Diagnostic test:

1. Direct sputum smear microscopy

Laboratory Diagnosis Result

Negative (-) No AFB seen in 100 fields

Positive (+) 1-9 AFB seen in 100 fields
1+ 10-99 AFB seen in 100 fields
2+ 1-10 AFB seen in at least 50 fields
3+ More than 10 AFB seen in at least 20 fields

1) Chest X-ray – useful in diagnosis TB patients who are asymptomatic, and those who cannot submit sputum
specimen but are suspected to have TB.

Category Type of patients Treatment regimen

1 New Smear (+) PTB Intensive – HRZE (2 months)
New Smear (-) PTB with extensive lesions Maintenance – HR (4 months)

Clinical Instructor’s Guide 81

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Extrapulmonary PTB
2 Treatment Failure (patient while on treatment, is sputum smear- Intensive – HRZES (2 months) + HRZE
positive at 5 months or later during the course of treatment) (1 month)
Relapse (patient previously treated for TB, who has been Maintenance – HR (5 months)
declared cured or treatment but with bacteriologically + TB)
Return after default (RAD) patient who returns to treatment with
positive bacteriology, following interruption of treatment for 2
months or more)
3 New Smear (-) PTB with minimal lesions on x-ray Intensive – HRZE (2 months)
Children Maintenance – HR (4 months)
4 Chronic (still smear + after supervised retreatment) Second line generation of antibiotics
based on results of culture and
sensitivity test

TB Treatment for Children

Types of TB Treatment Regimen

Intensive phase Maintenance phase
Pulmonary TB HRZ (2 months) HR (4 months)
Extrapulmonary TB HRZS (2 months) HR (10 months)

● H – Isoniazid
● R – Rifampicin
● E – Ethambutol
● S – Streptomycin

Prevention:
1. Bacillus Calmette-Guerin (BCG) - vaccination of newborn infants provides 50% protection against any TB disease
2. Health education
3. Environmental sanitation
4. Early diagnosis and treatment
5. Respiratory isolation

Roles and responsibilities of the nurse in the NTP (National TB Program) and DOTS (Direct Observed treatment,
short-course/ Tutok Gamutan) strategy
1. Administrator
2. Health educator
3. Case manager and coordinator
4. Community coordinator
5. Treatment partner
6. Advocate

Laws for Control of Communicable Diseases

● RA 3573 Reporting on Communicable Diseases

● Category I (Immediately Notifiable)
● Acute flaccid paralysis
● Adverse event following immunization
● Anthrax
● Human avian influenza
● Measles
● Meningococcal disease
● Neonatal tetanus
● Paralytic shellfish poisoning
● Rabies
Clinical Instructor’s Guide 82

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

● Severe Acute Respiratory Syndrome (SARS)

● Category II (Weekly Notifiable)
● Acute bloody diarrhea
● Acute encephalitis syndrome
● Acute hemorrhagic fever syndrome
● Acute viral hepatitis
● Bacterial meningitis
● Cholera
● Dengue
● Diptheria
● Influenza-like illness
● Leptospirosis
● Malaria
● Non-neonatal tetanus
● Pertussis
● Typhoid and paratyphoid fever
● RA 4073 An Act Liberalizing the Treatment of Leprosy
● No persons afflicted with leprosy shall be confined in a leprosarium provided that such person
shall be treated in any government skin clinic, rural health unit or by a duly licensed physician.
● RA 1136 TB Law of 1954
● Creation of the Division of TB under the appointed Director of the National Tuberculosis Center
of the Philippines (NTCP) established at the DOH compound.
● Memorandum Circular No. 98-155
● Pronounced the NTCP as the highest priority public health program of the LGUs
● AO No. 24 series of 1996
● The NTCP adopted DOTS in the management of TB.

Multiple Choice
Answer the following questions carefully.

1. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign
of leprosy?
a. Macular lesions
b. Inability to close eyelids
c. Thickened painful nerves
d. Sinking of the nose bridge

2. To improve compliance to treatment, what innovation is being implemented in DOTS?

a. Having the health worker follow up the client at home
b. Having the health worker or a responsible family member monitor drug intake
c. Having the patient come to the health center every month to get his medications
d. D. Having a target list to check on whether the patient has collected his monthly supply of drugs

3. Which clients are considered targets for DOTS category?

a. Sputum negative cavitary cases
b. Clients returning after default
c. Relapses and failures of previous PTB treatment regimens
d. Clients diagnosed for the first time through a positive sputum exam

4. Scotch tape swab is done to check for which intestinal parasite?

a. Ascaris
Clinical Instructor’s Guide 83

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

b. Pinworm
c. Hookworm
d. Schistosoma

5. Secondary prevention for malaria includes?

a. Planting of neem or eucalyptus trees
b. Residual spraying of insecticides at night
c. Determining whether a place is endemic or not
d. Growing larva-eating fish in mosquito breeding places

6. The following are strategies implemented by the DOH to prevent mosquito-borne diseases. Which of these is
most effective in the control of Dengue fever?
a. Stream seeding with larva-eating fish
b. Destroying breeding places of mosquitoes
c. Chemoprophylaxis of non-immune persons going to endemic areas
d. Teaching people in endemic areas to use chemically treated mosquito nets

7. A mother brought her 10-month-old infant for consultation because of fever which started 4 days prior to
consultation. To determine malaria risk, what will you do?
a. Do a tourniquet test
b. Ask where the family resides
c. Get a specimen for blood smear
d. Ask if the fever is present everyday

8. In the Philippines, which condition is the most frequent cause of death associated by schistosomiasis?
a. Liver cancer
b. Liver cirrhosis
c. Bladder cancer
d. Intestinal perforation

9. What is the most effective way of controlling schistosomiasis in an endemic area?

a. Use of molluscicides
b. Building of foot bridges
c. Proper use of sanitary toilets
d. Use of protective footwear, such as rubber boots

10. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based
on this fact?
a. Stream seeding
b. Stream clearing
c. Destruction of breeding places
d. Zooprophylaxis

Module 21
NURSING CARE OF CLIENTS WITH NON-COMMUNICABLE DISEASES PART 1

Non-communicable diseases (NCDs) include cardiovascular conditions (hypertension, stroke), diabetes

Clinical Instructor’s Guide 84

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

mellitus, lung/chronic respiratory diseases and a range of cancers which are the top causes of deaths
globally and locally. These diseases are considered as lifestyle related and is mostly the result of unhealthy
habits. Behavioral and modifiable risk factors like smoking, alcohol abuse, consuming too much fat, salt and
sugar and physical inactivity have sparked an epidemic of these NCDs which pose a public threat and
economic burden.

Prevalence
National Nutrition Survey – Food and Nutrition Research Institute (20years old and above):
Prevalence of Hypertension (2015): 23.9
Prevalence of High Fasting Glucose (2013): 5.6
Prevalence of High total Cholesterol: 18.6
Prevalence of Binge Drinking (2015): Males: 58.8, Female: 41.9
Prevalence of Insufficiently Physically Active Adults (2015): 42.5
Prevalence of Overweight and Obese and Adult (2013): Males: 27.6, Females: 34.4
- source, DOH

- To be effective in preventing and controlling NCDs, the public health nurse need to understand how NCDs
develop and the risk factors associated with each disease. The following is a brief primer on each of the five
major NCDs. For cardiovascular disease (diseases of the heart and blood vessels), the burden of illness is
mainly due to hypertension, coronary artery disease and stroke. Each one will be briefly discussed.

Goal of DOH: A Philippines free from the avoidable burden of NCDs

Risk Factor for Non-communicable diseases

1. Physical inactivity
o Less than 5 times of 30 minutes of moderate activity per week, or less than 3 times of 20 minutes of
vigorous activity per week, or equivalent
o Most important public health problem
o Key determinant of energy expenditure, fundamental to energy balance and weight control
o Contributes to weight loss, glycemic control, improved blood pressure and lipid profile and insulin
sensitivity

2. Cigarette smoking
o Causes lung cancer, cancer of the mouth, pharynx, larynx and esophagus
o Nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The
use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.

3. Unhealthy eating (obesogenic)

o One of the major risk factors responsible for global increase of cardiovascular disease, cancer, diabetes
and obesity
o Food and nutrition environments are contributors to obesity
o Risk for hypertension is two times greater among overweight/obese persons compared to people of
normal weight and three times more than of underweight persons.
o High salt intake. Salt may cause an elevation in blood volume, increase the sensitivity of cardiovascular
or renal mechanisms to adrenergic influences, or exert its effects through some other mechanisms such
as renin-angiotensin-aldosterone mechanism.
o Increased blood cholesterol is an important rick factor in the development of CAD. Reports have shown
that modest reduction in total cholesterol can significantly lessen CVD morbidity and mortality. High low
density lipoprotein (LDL) level is a risk factor of CAD. It is called as the bad cholesterol because it is the
main carrier of cholesterol and contributes to atherosclerosis.

4. Excessive alcohol drinking

o Lead to metabolic and physiological effects on all organ systems such as GI and cardiovascular
disturbances

Clinical Instructor’s Guide 85

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

o Causes malabsorption, inflammation of the GI tract, liver problems and cancer

o Cardiovascular disturbances; cardiac dysrhythmias, cardiomyopathy, hypertension and atherosclerosis
o Predict diabetes incidence by increasing glucose levels in the blood
o Growing concern to all age groups

5. Viruses
o Play role in the development of certain cancers
o Breaks the normal cell’s DNA causing mutation
o Human Papilloma Virus linked with cervical and vulvar cancer
o Epstein-barr virus is associated with nasopharyngeal and anal cancer
o Human t-lymphotrophic virus (HTLV-1) that is linked with non-Hodgkin lymphoma
o Hepatitis B virus (HBV) and hepatitis C virus are the most common causes of liver cancer
o Viruses causing cancer are known as oncoviruses
6. Radiation
o Energy emitted and transferred through matter and space
o 2 most common forms: ultraviolet (UV) and ionizing radiation
o UV radiation adversely affects the genes and cells enzymes causing DNA mutation
o Ionizing radiation causes tissue and cell damage by breaking the DNA molecule
o Solar radiation is the primary source of UV radiation and the major cause of skin cancer
o Ionizing radiation includes x-rays, gamma rays, and particulate radiation from nuclear accidents,
occupational exposure and treatments
o Cancer depends on the type, amount and length of radiation but evidence suggests that the risks tend to
be cumulative

7. Certain kinds of drug abuse

o Intravenous drug abuse carries a high risk of stroke from cerebral emboli. Cocaine use has been closely
related strokes, heart attacks and a variety of other cardiovascular complications. Some of them have
been fatal even in first time cocaine users.

8. Chemicals and Environmental agents

o Polycyclic hydrocarbons are found in chemical smoke, industrial agents or in food such as smoked foods.
Polycyclic hydrocarbons are also produced from animal fat in the process of broiling meats and are
present in smoked meat and fish.
o Aflatoxin is found in peanuts and peanut butter
o Others include benzopyrene, nitrosamines and a lot more
o Benzopyrene is produced when meat and fish are charcoal broiled or smoked (tinapa or smoked fish).
Avoid eating burned food or eat smoked foods in moderation. It is also produced when food is fried in fat
that has been reused repeatedly.
o Nitrosamines are powerful carcinogens used as preservatives in foods like tocino, longanisa, bacon and
hotdog. Formation of nitrosamines may be inhibited by the presence of antioxidants such as vitamin C in
the stomach. Limit eating preserved foods and eat more vegetables and fruits that are rich n dietary fiber.
Nursing functions and Responsibilities
The Role of Public Health Nurse in NCD Prevention and Control
Health Advocate
Public Health Nurse promotes active community participation in NCD prevention and control through
advocacy work. As a health advocate, the PHN helps the people towards optimal degree of independence in
decision-making and in asserting their right to safer and better community.

Health Educator
Health educator is an essential tool to achieve community health. A health educator is concerned with non-
communicable disease prevention and control, health education focuses on establishing or including
changes in personal and group attitudes and behaviour that promote healthier living. PHNs, as well as
educators and media personnel, should conduct health education in a variety of settings.
Clinical Instructor’s Guide 86

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Health Care Provider

The public Health Nurse is a care provider to individuals, families and communities rendering primary,
secondary and tertiary health care services in any setting including the community, school and workplace.

As a care provider, emphasis of care is on health promotion and disease prevention focusing on promotion
of rational diet and physical activity and cessation of smoking and alcohol drinking. In addition, actions is
directed towards the reduction of risk of non-communicable diseases. Primary prevention must be family-
oriented because the family members live and eat together and the roots of chronic diseases are related to
personal habits and lifestyle.

Although secondary level care is the domain of clinical medicine, it seeks to relive pain, arrest or cure the
disease and prevent disability and death. It also prevents the development of the secondary cases in the
community. This is where the guidelines for clinical management of obesity, diabetes, hypertension and
palliative care for cancer will come in.

Disability limitations and rehabilitation does not refer to prevention of disease per se but rather to prevention
of its potential consequences. The Public Health Nurse provides activities that will permit clients who have
suffered from consequences of non-communicable diseases to lead a socially and economically productive
life.
Community Organizer
As an organizer, the ultimate goal of the PHN is community health development and empowerment of the
people. This is achieved by:
• Raising the level of awareness of the community regarding non-communicable diseases, its causes,
prevention and control;
• Organizing and mobilizing the community in taking action for the reduction of risk factors;
• Influencing executive and legislative bodies to create and enforce policies that favor a healthy environment.

Health Trainer
The PHN provides technical assistance in the assessment of the skills of auxiliary health workers in NCD
prevention and
control; teaching and supervision on clinical management of non-communicable diseases and other
community-based
services and recording, reporting and utilization of health information related to non-communicable diseases.

Researchers
Researcher is an integral part of primary health care approach to non-communicable disease prevention and
control program. It is inextricably related to community health practice since it provides the theoretical bases
for developing appropriate and responsive intervention programs and strategies. Research provides valuable
information especially if it is

conducted using the participatory research approach. It prevents health workers from implementing irrelevant
interventions. If the interventions are grounded in community needs, NCD preventions and control programs
are likely to succeed. As health researchers, the PHN conducts community assessments, epidemiological
studies, and intervention studies.

Activity: Form a group with 5 members. One of the Roles of Public health nurse is health educator so
each group will make a material to convey health messages regarding healthy lifestyle in your
community. Materials can be a poster, leaflet, PowerPoint presentation etc. This will be presented in
the class.

Multiple Choice
Answer the following questions carefully.
Clinical Instructor’s Guide 87

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

1. One of the effective ways to reduce the major risk factors of non-communicable diseases is?
a. improper diet
b. regular physical activity
c. excessive drinking of alcohol
d. cigarette smoking

2) Empowering people in the community is best describe by what nursing function and responsibility?
a. Health advocate
b. Health Trainer
c. Researcher
d. Community Organizer

3) Community organizer’s ultimate goal of the PHN is community health development and empowerment
of the people. This is best achieved by? Select all that apply.
a. Organizing and mobilizing the community in taking action for the reduction of risk factors of NCD.
b. Increase the level of awareness of the community regarding the causes,
prevention and control of non-communicable diseases.
c. Focus on health education
d. None of the above

4) Which among the diseases below is not a non-communicable disease?

a. lung cancer
b. malaria
c. diabetes
d. coronary artery disease

5) Who among the following is at risk to having a non-communicable disease?

a. Ella loves eating ham, hotdogs, bacon and canned goods for breakfast.
b. Sonya loves to eat fruit and veggies.
c. Arthur loves brisk walking every morning.
d. Nala see to it that she works out 30 minutes every morning.

Module 22
NURSING CARE OF CLIENTS WITH NON-COMMUNICABLE DISEASES PART 2

1. Cardiovascular and Cerebrovascular Disease

• 33.8 % leading cause of death (NSO, 2009)
• Cardiovascular - also known as heart disease, diseases that involve the heart or blood vessels (arteries,
capillaries, and veins).
• Cerebrovascular – also known as stroke, a group of brain dysfunction related to disease of the blood
vessels supplying the brain.
• Atherosclerosis and hypertension is the most common cause of these two diseases.
• Atherosclerosis – disease of the blood vessels characterized by the deposition of fats and cholesterol
within the walls of the artery
• Hypertension or high blood pressure – systolic blood pressure equal to or above 140 mm Hg or diastolic
blood pressure equal or above 90 mm Hg.
• Screening – identification of an unrecognized disease by application of test, examination, or other
procedures that can be applied rapidly to help identify an individual’s chances of becoming ill (WHO,2011).
• Monitoring of BP 2x daily in the morning and the evening for several days
• Two consecutive measurements, a minute apart with the person seated

Clinical Instructor’s Guide 88

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

• Average value of all remaining measurements confirm the diagnosis of hypertension

Classification of blood pressure

CLASSIFICATION S/D BLOOD PRESSURE

Normal < 120/80
Pre Hypertension 120-139/80-89
Hypertension
Stage 1 140-159/90-99
Stage 2 160-179/100-109
Stage 3 > 180/110

Classification of LDL, Total and HDL Cholesterol (mg/dL)

VALUES INTERPRETATION
LDL Cholesterol
<100 Optimal
100-129 Above optimal
130-159 Borderline
160-189 High
>190 Very High
Total Cholesterol
<200 Desirable
200-239 Borderline
>240 High
HDL Cholesterol
<40 Low
>60 High

2. Cancer or Malignant Neoplasm

• 50,000 cases cancer cases in the Philippines
• A group of various diseases involving unregulated cell growth (Newton, 2009).
• Carcinogens – substances that cause some cells to undergo genetic mutation
• Women – Breast cancer, Men- Lung cancer
• Screening for cancer involves early detection of the warning signals of cancer

Clinical Instructor’s Guide 89

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

WARNING SIGNS OF CANCER Lifestyle related factors

C hange in bowel or bladder habits 1. Cigarette smoking
A sore that does not heal 2. Unhealthy diet
U nusual bleeding 3. Alcohol drinking
T hickening or lump in the breast 4. Physical inactivity
I ndigestion or difficulty of swallowing 5. Overweight/obesity
O bvious change in a wart or more
N agging cough or hoarseness
U nexplained anemia
S udden weight loss

3. Chronic Obstructive Pulmonary Disease (COPD)

• 4.7% cause of death in the Philippines
• Disease of the lungs in which the airways narrow over time.
• Example: Bronchitis, chronic asthma, and emphysema
• Smoking is a strong risk factor with 15% of smokers develop COPD
• Second hand smoke and pollution aggravates the problem

4. Diabetes
• Diabetes Mellitus is one of the leading causes of disability in persons over 45. More than half of diabetic
persons will die of coronary heart disease. CAD tends to occur at an earlier age and with greater severity in
persons with diabetes. It also increases the risk of dying of cardiovascular disease like heart attack or stroke
among women.
• Diabetes is not a single disease. It is genetically and clinically heterogeneous group of metabolic disorders
characterized by glucose intolerance, with hyperglycemia present at time of diagnosis.
o 18.1 per 100,000 deaths in the Philippines
o Group of metabolic disease in which an individual has high blood sugar because the pancreas does not
produce enough insulin or the cells do not respond to the insulin produced.
o Symptoms include increased frequency and amount of urination (polyuria), increased thirst (polydipsia),
constant hunger (polyphagia), weight loss, vision changes, and fatigue
o >7.0 mmol/L or 126mg/dL – fasting blood sugar (WHO, 2005) or >11.1 mmol/L or 200 mg/dL – 2 hour blood
sugar test

5. Chronic Obstructive Pulmonary Disease (COPD)

• It is a major cause of chronic morbidity and mortality throughout the world.
• It is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is
usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious
particles or gases. The lungs undergo permanent structural change which leads to varying degrees of
hypoxemia and hypercapnia. This explains the breathlessness and frequent cough associated with COPD.
• Causes and Risk factors: COPD is usually due to chronic bronchitis and emphysema, both of which are due
to cigarette smoking. Cigarette smoking is the primary cause of COPD.
• Complications: Respiratory failure and cardiovascular disease

Non-communicable diseases prevention

1. Promote physical activity and exercise
2. Promote healthy diet and nutrition
3. Promote a smoke free environment
4. Stress management

12 Stress Management Techniques

1. Spirituality
2. Self-awareness
Clinical Instructor’s Guide 90

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

3. Scheduling: Time Management

4. Siesta
5. Stretching
6. Sensation techniques
7. Sports
8. Socials
9. Sounds and songs
10. Speak to me
11. Stress debriefing
12. Smile

Activity: 1. What are the present action/s or health programs of the government to prevent and control
non-communicable diseases in the Philippines?
2.As nursing student what action/s can you do to prevent and control non-communicable
disease in our country.

Multiple Choice
Answer the following questions carefully.
1.Mang Peping a 45-year-old farmer has a family history of Hypertension. He went to their barangay health
center for his blood pressure to be check. The community nurse on duty got his blood pressure and the result
reads 140/90. How can we classify Mang Peping’s blood pressure?
a. Normal
b. Pre-hypertension
c. Stage I
d. Stage II
e. Stage III

2.The following are non- communicable disease except?

a. Cancer
b. Diabetes
c. Hypertension
d. measles

3.Cancer is a disease in which some of the body's cells grow uncontrollably and spread to other parts of the body.
The warning signs of cancer includes. Select all that apply.
a. Sudden weight gain
b. Unexplained anemia
c. Dry cough
d. A sore that heals
e. Unusual bleeding
f. Dysphagia/ Indigestion

4.A disease of the blood vessels characterized by the deposition of fats and cholesterol within the walls of the
artery.
a. Hypercalcemia
b. Hypertension
c. Atherosclerosis
d. Atelectasis

5.Which of the following lifestyle related factors can contribute to developing cancer? Select all that apply.
Clinical Instructor’s Guide 91

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

a. Unhealthy diet
b. Physical activity
c. Cigarette smoking
d. Excessive alcohol drinking

SESSION 23
HEALTH DEVELOPMENT PROGRAMS
FOR ADULT AND OLDER PERSON

HEALTH AND WELLNESS PROGRAM FOR SENIOR CITIZEN

• RA 9257 (The Expanded Senior Citizens Act of 2003) and the
• RA 9994 (Expanded Senior Citizen Act of 2010),
• Department of Health issued Administrative Orders for health implementors to undertake and promote
the health and wellness of senior citizens as well as to alleviate the conditions of older persons who
are encountering degenerative diseases.

Goal of Health and Wellness Program for Senior Citizen

• focused service delivery packages and integrated continuum of quality care,
• patient-centered and environment standard to ensure safety and accessibility for senior citizens,
• equitable health financing,
• capacitated health providers in the implementation of health programs for senior citizens,
• data base management, and
• strengthened coordination and collaboration with other stakeholders involved in the implementation of
programs for senior citizens.

Philippine Health Agenda (2017 - 2022),

centralize health services for care in all life stages, service delivery networks, and financial risk
protection, geriatric health is mentioned as an area of concern.
All senior citizens are mandatorily covered by the Philippine Health Insurance Corporation by virtue of
Republic Act No. 10642 “An act granting mandatory national health insurance program of PhilHealth
for all senior citizens”.

Vision
A country where all Filipino senior citizens are able to live an improved quality of life through a healthy
and productive aging.

Mission
Implementation of a well-designed program that shall promote the health and wellness of senior
citizens and improve their quality of life in partnership with other stakeholders and sectors.

Objectives
- To ensure better health for senior citizens through the provision of focused service delivery packages
and integrated continuum of quality care in various settings.
- To develop patient-centered and environment standards to ensure safety and accessibility of
all health facilities for the senior citizens.
- To achieve equitable health financing to develop, implement, sustain, monitor and continuously
improve quality health programs accessible to senior citizens.
- To enhance the capacity of health providers and other stakeholders including senior citizens group in
the implementation of health programs for senior citizens.
- To establish and maintain a database management system and conduct researches in the
development of evidence-based policies for senior citizens.

Clinical Instructor’s Guide 92

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

- To strengthen coordination and collaboration among government agencies, non-government

organizations, partner agencies and other stakeholders involved in the implementation of programs for
senior citizens.

Program Components
- The Policy, Standards and Regulation component shall develop a unified patient-centered and
supportive environment standards to ensure safety and accessibility of senior citizens to all health
facilities and to promote healthy ageing in order to prevent functional decline among senior citizens.
- The Health Financing component shall promote health financing schemes and other funding support
in all concerned government agencies and private stakeholders to provide programs that are
accessible to senior citizens.
- The Service Delivery component shall ensure access of senior citizens to essential geriatric health
services including preventive, promotive, treatment, and rehabilitation services from the national to the
local level.
- The Human Resources for Health component shall capacitate the health care providers in both
national and local government to be able to effectively provide technical assistance and implement the
program for senior citizens.
- The Health Information component shall establish an information management system and maintain a
repository of data.
- The Governance for Health component shall coordinate and collaborate with the local government
units and other stakeholders to ensure an effective and efficient delivery of health services at the
hospital and community level.

Policies and Laws

Madrid International Plan of Action on Aging
Regional Framework for Action on Aging and health in the Western Pacific 2014-2019
The 1987 Philippine Constitution
Aquino Health Agenda
Philippine Plan of Action for Senior Citizens (2012-2016)
Republic Act No. 9257 – “An Act Granting Additional Benefits and Privileges to Senior Citizens
amending for the purpose of Republic Act no. 7432, otherwise known as “An Act to Maximize the
Contribution of Senior Citizens to Nation Building, Grant benefits and Special Privileges and for Other
Purposes”
Republic Act No. 9994 – “An Act Granting Additional Benefits and Privileges to Senior Citizens,
Further Amending Republic Act no. 7432”

Strategies, action Points and Timeline

Participatory Governance for health through the life course
Strengthened Service Delivery for older populations
Advocacy and Promotion of healthy aging
Evidence-based Decision Making

Program Accomplishments/ Status

Provision of influenza and pneumococcal vaccine
Wellness camp for senior citizens
Elderly Filipino week (Walk for Life) Celebration

Calendar of Activities
• Presidential Proclamation No. 470, series of 1994 declares the First Week of October of every year as
Elderly Filipino Week (Linggong Katandaang Pilipino) Celebration

Statistics
• Populations around the world are aging rapidly. From 2000 to 2050, the proportion of the world’s
population aged 60 years and above will double from about 11% to 22%. The absolute number of

Clinical Instructor’s Guide 93

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

people aged 60 years or over is projected to increase from 900 million in 2015 to 1400 million by 2030
and 2100 million by 2050.(WHO)

Multiple Choice
Answer the following questions carefully.

1.Goals of Health and Wellness Program for Senior Citizen are which of the following.
a. equitable health financing
b. focused service delivery packages and integrated continuum of quality care
c. patient-centered and environment standard to ensure safety and accessibility for senior citizens
d. all of the above
e. none of the above

2.RA 9994 is also known as?

a. Expanded program for Senior citizen Act of 2003
b. Senior citizen law
c. Expanded program for Senior Citizen Act of 2010.
d. Aquino health agenda

3. Which of the following is not part of the Senior Citizen Act?

a. Senior citizens can avail of this special discount in sari-sari stores, cooperative stores, and wet markets.
b. Seniors can also get a 5% discount without VAT exemption on certain on groceries granted by the
Department of Trade and Industry and the Department of Agriculture.
c. Senior citizens are entitled to 20% discount and exemption from the value -added tax(VAT) on certain goods
and services for their exclusive use
d. Another privilege of senior citizens is the provision of express lanes for them in all commercial and
government establishments.

4. For the 60 and above citizens to enjoy benefits and privileges, they must apply their senior citizen I.D in
which agency.
a. DOTC
b. Dep Ed
c. OSCA
d. DOH

5.Expanded Senior Citizen Act of 2010 include beneficiaries of the Social Pension for Indigent Senior Citizens
will receive their 500 pesos.
a. True
b. False

Rubrics for the activities:

ASSESSMENT GUIDE

PRESENTATION ( 50%) GROUP:_____

Clarity ( 25%)

-Speaks clearly, smoothly, and coherently 10% ________________

- Showed Mastery and Confidence 10% ________________
- Observed time allotment ( 15-20 mins.) 5% _________________

Clinical Instructor’s Guide 94

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Visual Aids ( 25%)

Appropriate 10% ________________

Engaging 10%_________________
Aided in Understanding 5% _________________
CONTENT (30%)

-Concise 10%_________________
- Accurate 10% _________________
- Organized 10% _________________

CREATIVITY ( 20% )
- Originality 10% _________________
- Resourcefulness 10%__________________
TOTAL SCORE:_______________________

COMMENT:________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________

Evaluated by:_______________________________________

Rubric for COPAR Presentation

Poor (1) Fair (2) Good (3) Excellent (4)

Writer makes more Writer makes 5-6 Writer makes 3-4 Writer makes 1-2
Grammar & than 6 errors in errors in grammar errors in grammar errors in grammar
grammar or or spelling. or spelling. or spelling.
Spelling spelling.
Poor Fair Good Excellent

The script is NOT The script is slightly The script is The script is written
Written in written in script correct. Both Mostly correct. in the correct
format. margins and the Either the margin format. All lines
Script Format punctuation are not OR punctuation is have the correct
correct. incorrect. margin and
punctuation.
Poor Fair Good Excellent

There is little The story contains a The story contains a The story contains
evidence of few creative details few creative details many creative
creativity in the and/or descriptions, and/or descriptions details and/or
story. but they distract that contribute to descriptions that
from the story. contribute to the
Clinical Instructor’s Guide 95

Downloaded by Dudai Unlock ([email protected])

 lOMoARcPSD|52164003

Creativity The author does not the reader's reader's enjoyment.

seem to have used The author has tried enjoyment. The author has
much imagination. to use his really used his
imagination. The author has imagination.
used his
imagination.
Poor Fair Good Excellent

Script does NOT Script is difficult to Script has parts that Script is easy to
Easy to make sense. read and are confusing but understand and
Reader CANNOT understand. It does the overall intention follow. It flows and
Understand understand not flow. An attempt is clear. makes sense.
and Follow the intention or has been made.
where the script is
going.
Poor Fair Good Excellent
Specific
Meets few or no Meets some of the Meets all Extends all
Assignment requirements requirements requirements requirements
specified for this specified for this specified for this specified for this
Directions assignment. assignments. assignment. assignment.

References:
Textbook
Famorca, Z., Nies, M., McEwen, M. (2013). Nursing Care of the Community. Singapore: Elsevier.
Maglaya, A., (2009). Nursing Practice in the Community (5th edition). Philippines.
De Belen, R. & De Belen, D.V. (2008). A Praxis in Community Health Nursing. Quezon City, Philippines: C
& E Publishing, Inc
Cuevas, F. P., (2007). Public Health Nursing in the Philippines (10th edition). Manila, Philippines.

Website
https://www.doh.gov.ph/environmental-health-programs
https://www.encyclopedia.com/medicine/psychology/psychology-and-psychiatry/community-health

Clinical Instructor’s Guide 96

Downloaded by Dudai Unlock ([email protected])