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COMMUNITY HEALTH NURSING REVIEWER

CO-PAR
 Community Organizing – Participatory Action Research

Community Organizing
 Process by which health services, agencies, and people and of the people of the community brought
together to:
o Identify/learn their own problem
o Plan activities
o Act on this basis
o Evaluate

COMMUNITY ORGANIZING EMPHASIZE

 Strengthening the community members capability in:
o Problem solving skills
And Necessary for self-reliant development
o Decision making skills

Community Organizing process has someone plays the role of a Community Organizer

Roles and Responsibilities of a Community Health Nurse

Manager
Guide
Advocate
Coordinator, Counselor, Change Agent
Health Care Provider
Nurse Trainer
Researcher
Organizer
Leader
Educator – Primary role, Primary responsibilities  promotion of health and prevention of illness
Supervisor

Community Organizer
 Person who mobilize:
Individual
Family Sick or Well
Community
To come together in unity and collectively address given:
Issues
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Needs
Problem
* assess by way of research

PARTICIPATORY ACTION RESEARCH

 Is an investigation on problems and issues of the community by way of research.
 Representatives of community participates in the actual research.
 Local Researcher
 Outside Researcher = Community Health Nurse
 Act as researchers themselves, doing research of their own problem.
 The essential element of Participatory Action Research is participation

Participatory Action Research Objectives:

o To encourage consciousness of the suffering
o To empower people to determine the cause of their own problem
o To analyze these problem
o To develop competence for changing their own situation
o To act by themselves in responding to their own problems

Ideal participatory research process involves the community in all research aspect
1. Identification of research problem
2. Formulation of research design
3. Data gathering
4. Validation of research
5. Data presentation
6. Recommendations
7. Action of activities

COPAR Phase/Process
According to (Sister Jimenez)

PRE ENTRY PHASE

 At the NGO level
o Formulation of institutional goals, objectives and targets for the program
o Revision of curriculum
o Training of faculty if CO-PAR
o Coordinate participation of other departments within the institution

 At the community level

o Community consultations/dialogues
o Setting of issues related to site selection
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o Development of criteria for site selection

Criteria in selecting community
 Site must be
Depressed and underserved
Oppressed
Poor
Exploited
Struggling
 Area must not have a serious peace and order problem
 Willingness to be organized
 Community needing health assistance
o Check vital health statistic  can determine general health status
o Malnutrition rate
o Lack of health facility/health care providers
 Counter-part of the community (support, commitment, resources)
 Accessible to transport and communication
o Site selection
o Preliminary Social Investigation (PSI)
 Identify contact person
 Gather “overview” of the demographic characteristics, health services and facilities of the
community
o Networking with LGU’s, NGO’s and other departments

ENTRY PHASE
 Integration with the community  main objective: Gain Trust
First task  courtesy call to the Brgy. Captain
Establish rapport
* house calls
* joining to social activities

Imbibe their lifestyle

Immerse yourself

Live with them

Reside on the area

* live in the center/modest dwelling
 Sensitization of the community  social preparation
 Information campaign on health services
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 Continuing/deep social investigation

Process of collecting, collating, analyzing data to draw the clear picture of
the community
 Core Group formation (CG)
o Consist of identified potential leaders
 Characteristics of a potential leaders
1. Respected community members
2. Responsible/committed
3. Willing to work for a desired change
4. Has good communication skills
5. Has wide “influence” to elite/poor community members
 Self-awareness and leadership training (SALT)
 Coordination with other community organization
o Representing different sectors of the community
COMMUNITY DIAGNOSIS/STUDY PHASE
(research phase)
 Selection of the research team
 Training on data collection
 Planning for the actual gathering of data
 Data gathering
 Training on data validation
 Community validation
 Presentation of the community study/diagnosis and recommendations
 Prioritization of community needs/problems for action

COMMUNITY ORGANIZATION/CAPABILITY BUILDING PHASE

 Community meetings to draw-up guidelines for the organization
 Election of officer
 Development of management systems:
(Delineation of the Roles, Function, and Task of Officers)
 Training of leaders
 Team building exercises  to enhance cohesiveness
 Action-Reflection-Action-Session

COMMUNITY ACTION PHASE

 Organization and training of BHW’sVillage or Grassroot Workers
 PIME of health services
Project Implementation/Monitoring and Evaluation (Project Management)
 Resource mobilization
5 M’S
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MANPOWER
MACHINE
MATERIAL
METHOD
MONEY
SPACE
 Setting up of linkages/network/referral system

SUSTENANCE AND STRENGTHENING PHASE

 Formulation and ratification of constitution and by-laws
 Identification and development of “secondary” leaders
 Setting up a financing scheme
 Continuing education and training of BHW’s
 Development of long term community health development plans
 Formalizing linkages, networks and referral system

TURNOVER/PHASE OUT
 Transfer of community organizer roles and responsibilities and documents
 subsequent follow-up
CO-PAR main goal is to attain COMMUNITY DEVELOPMENT  better quality life
* Basic needs are met
* Equal rights
* Self-reliance
* Active participation
COMMUNITY HEALTH NURSING
Definition:
WHO  Health – is a state of complete physical, mental and social well being
Modern Concept  Health – refers to optimum level of functioning of individual, family, community
OLOFis influence by the Eco System
Eco System Factors
Socio-economic status
 Education
 Employment
 Housing
Hereditary factor genetic
Health care delivery system
Activities and Behavior mag HL tayo
Manage Stress
Regular Exercise
Do not Smoke  Priority Message
Regular health check-up
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Eat healthy foods

Weight loss
Political factors
Environmental factors
WHO – special field of nursing that combines:
o Skills of nursing
o Public health
o Social assistance and functions

Dr. C. E. Winslow – public health is a science and art of 3 P’s

o Promotion of health
o Prevention of illness/hazards through organize community efforts
o Prolonging life
Statement: “every citizens has his BIRTHRIGHT of good health and longevity”

CHN according to Dr. Ruth Freeman

 A service rendered by a professional nurse
o To individuals, family, community and population groups
o At home
o Clinics
o Schools
o And workplace

CHN subspecialty
 School Health Nursing
 Occupational Health Nursing

CHN according to Dr. Maglaya

 The utilization of the nursing process in the different levels of clientele, individual, family, community
and population groups concerned with the
Promotion of health
Prevention of disease
And Disability and Rehabiliation

CHN as Field Of Nursing Practice

 Hallmark of CHN is that it is Population or Aggregate-Focused
 Emphasis on the importance of the “Greatest Good for the Greatest Number”
 “Goal of improving Community Health is realized through interdisciplinary/multi effort”

Philosophy of CHN  Dr. Shetland

 CHN is based on the Worth and Dignity of Man
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Ultimate Goal of CHN

 “To raise the level of health of the citizenry”

Principles of CHN
 Based on recognized needs of the community
 Understand the objectives and policies of the agency
 Family is the basic unit of service
 Always available to all regardless of Race, Creed and Socio-economic status
 Use available community health resource
- Indigenous resource
o Dried proteins
 Pounded Dilis
 Pounded Shrimp
 Pounded Monggo
 Record and report data accurately  research/legal
 Health teaching is primary responsibility
 Evaluation of programs
 Continuous professional growth

CONCEPTS OF COMMUNITY HEALTH NURSING

 Health promotion  primary responsibility
 Generalistnever Specialist
 Population is the main focus
 Individual, Family, Community including Population Group Pregnant, Newborn, Elderly, Youth

Population Group – those who share a common characteristics, developmental stages and common
exposure to health problems

 Community health nursing process is implicit in the practice of CHN

 Essence of nursing
 Dynamic and cyclic process
 Systemic approach

CHN PROCESS
1. Assessment
o Establishing rapport
 Greetings
 Introduce self
o Collection of data/facts/information
METHODS TO COLLECT DATA
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Interview
Records review  Family Health Record
Physical assessment
Observation
Diagnostic exam
o Diagnosis – identification of the client, families and community needs based on the gathered data
2. Planning
o Prioritizing needs
Ranking and Scaling
 Nature of problem
 Preventive potential
 Modifiability of the problem
 Salience – perception
o Stating goals and objective
o Goal setting
o Expected outcome
o Developing parameters  evaluation process

THEPLANNING CYCLE/PROCESS

Situational
Evalutaion
analysis

Strategy Goal/Objective
setting setting

1. Situational Analysis
 Where are we now?
o Gather, tabulate, analyze and interpret data
o Identify the problems/issues/needs

2. Goal and Objective Setting

 Where do you want to go?
o Define program goals and objectives
o Assign priorites among objectives
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3. Strategy and Activity Settings

 How do we get there?
o Design CHN programs
o Ascertain resources
o Analyze constraints and limitations

4. Evaluation
 How do we know we are there?
o Specify criteria and standards
o Determine outcomes

HOME VISIT (should always have: PURPOSE and OBJECTIVE)

Is a professional face to face contact done by the nurse to the family
 Factors Affecting Frequency of Home Visits
o Physical/psychological and educational needs
o Acceptance of the family (PRIORITY NEEDS)
o Policy of a given agency
 Steps during Home Visit
1. Greetings/Introduce Self
2. Stating purpose and objective
 Priorities during Home Visit
1. Newborn (FIRST)
2. Post-Partum
3. Pregnant mother
4. Morbid individual (LAST)

PUBLIC HEALTH BAG

 Is an essential and indispensable equipment of the Public Health Nurse used during home visit

BAG TECHNIQUE
 A tool making use of a Public Health Bag and which the Public Nurse can perform procedures during
home visits

 Rationale in the use of PHN BAG

o Technique during Home Visit:
 “It help render effective nursing care”
 Principle of Bag Technique
1. Minimize if not totally prevent the spread of infection
2. Save time and effort
3. Not to overshadow the concern of the client and family
 BP apparatus, stethoscope and umbrella are carried separately
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SPECIAL CONSIDERATIONS
Bag and its contents must be free from any contamination
Always do hand washing
Gather necessary equipment’s to render Nursing Care
 Place waste bag, paper lining outside

SOLUTION
1. Benedict solution  for sugar detection
2. Acetic acid solution  for albumin detection
3. Zephiram solution  soaking solution
4. Alcohol, Betadine
5. Ammonia

LEVELs of CLIENTELE
Individual, Family, Community, Population Group Sick or Well

LEVELS OF PRIMARY HEALTH FACILITY

PRIMARY – Client in Fair health and with early symptoms of illness
o Barangay Health Center (BHC), City Health Office (CHO), Municipal Health Office (MHO),
Lying-in Clinics, Puericulture Center, Community Hospitals
SECONDARY – Patient in symptomatic stage of an illness and requires moderately specialized
knowledge/facilities
o Provincial Hospitals, District Hospitals, Municipal Hospitals, Emergency Hospitals
TERTIARY – Patients seriously threaten and requires highly technical facilities and knowledge
o National Hospitals, Teaching/Training Hospitals, Regional Hospitals
(SPECIALTY HOSPITALS)

2 TYPES OF PRIMARY HEALTH CARE WORKERS

1. Village/Grassroot workers – Trained hilots
o Trained individuals
 BHW, TBA, Trained hilot, Trained Dentist, Trained Nutritionist
2. Intermediate Health Care Workers
o Professional Groups
 RH Physicians, RH Nurse, RH Midwife, RH Dentist, Medtech, Nutritionist, Sanitary
Inspector
 Ratio to Population
o 1 Physician = 20,000
o 1 Nurse = 20,000
o 1 Med Tech = 20,000
o 1 Sanitary Inspector = 20,000
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o 1 Dentist = 50,000
o 1 Midwife = 5,000

QUALIFICATIONS OF A COMMUNITY HEALTH NURSE

 BASIC REQUIREMENT
o BSN
Public Health Nurse 2
o RN
o MAN  with Positions
Positions
1. Chief Nurse
o BSN, RN, MAN
o 5yrs experience as Community Health Nurse
o 3yrs experience as Supervisor
2. Assistance Chief Nurse
o 5yrs experience as Community Health Nurse
o 2yrs experience as Supervisor
3. Regional Training Nurse
o BSN, RN, MAN
o 6yrs experience as Community Health Nurse
o 3yrs experience as Trainor /Educator
4. Regional Supervisor
o BSN, RN, MAN
o 5yrs experience as Community Health Nurse
o 2yrs experience as Supervisor
5. Provincial Supervisor
o BSN, RN, MAN
o 5yrs experience as Community Health Nurse
6. Nurse Instructor
o BSN, RN, MAN
o 3yrs experience as Community Health Nurse with teaching abilities
7. Nursing Program Supervisor
o BSN, RN, MAN
o 7yrs experience as Community Health Nurse with Training to DOH programs

PRIMARY HEALTH CARE

 Is an essential Health Care based on practical and socially acceptable methods and technology
 Made universally accessible to Individual, Family, Community
History of Public Health Care
WHAT: Alma Ata Conference
WHEN: September 6-12, 1978
WHERE: Alma Ata,USSR/Russia
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WHO: WHO/Unicef
WHO: Dr. Dizon/Dr. Villar
Legal Basis: LOI 949
 Signed by: Pres. Ferdinand Marcos on October 1979

GOAL OF PUBLIC HEALTH CARE

 Health for all Filipinos and health in the hands of the people by year 2020

MISSION
 Strengthening the health system wherein people will manage their own health care

KEY/CORE STRATEGY
“PARTNERSHIP”

PILLARS/CORNERSTONE OF PUBLIC HEALTH CARE

Support Mechanism mad available
Community Participation Active
Appropriate technology
Multi-Sectoral linkages

CHARACTERISTIC OF PUBLIC HEALTH CARE

Accessible/Available
Community Bases
Affordable
Sustainable
Integral/Important
Acceptable

VITAL HEALTH STATISTIC

 Is the study on vital events such as Birth-Fertility
Deaths – Mortality
Morbidity
 Main Objective: to determine general health status of the community