COMMUNITY HEALTH NURSING II

NUR204

(Population Groups and Community as clients)

Prepared By:
Jo-ann M. Flores - Pasinabo MSN,RN
Objectives:

1. To be able to Apply knowledge of physical, social, natural, health sciences

and humanities in the care of population groups in the community setting.
2.Provide safe, appropriate and holistic care to population groups in the
community utilizing the nursing process.
3. Apply guidelines and principles of evidence-based practice in the delivery
of care to population groups in the community setting.
4. Practice nursing in the community setting in accordance with existing
laws, legal, ethical and moral principles.
5. Communicate effectively in speaking, writing, and presenting using
culturally- appropriate language in the community setting.
6. Document care of individual and family accurately and comprehensively.
7. Work effectively in collaboration with inter-, intra-, and multi-disciplinary
and multi-cultural teams in the care of population groups in the community.
8. Practice beginning management and leadership skills using systems
approach in the delivery of care to population groups and communities.
9. Conduct research with an experienced researcher in the care of
population groups in the community setting.
10. Engage in lifelong learning with a passion to keep current with national
and global development in the care of population groups in the community
setting,
11. Demonstrate responsible citizenship and pride of being a Filipino.
12. Apply techno-intelligent care systems and processes to perform safe and
efficient nursing activities for population groups in the community
13. Adopt the nursing core values in the delivery of care to population
groups.
14. Apply entrepreneurial skills in the delivery of nursing care to population
groups in the community setting.
TOPICS:
The Community Health Nursing Process
1. Assessment of Community Health Needs
2. Components (Health status, Health resources)
3. Community Diagnosis (Definition, Types, and Steps)
4. Tools Used (Demography, Vital and health statistics, Epidemiology)
5.Planning of Community Health Nursing Services
6. Principles in community health planning
7. Bases for developing a community health plan
8. Steps in making a plan: the planning cycle
9. Philippine health care delivery system
a. Executive Order 102 (The
Departmentof Health)
b. RA 7160 (Local Health Systems)
c. Levels of Health Care and
Referral System
10. Global health situation (Millennium Development Goals)
11. National health situation (FOURmula One)
12.Primary health care as an approach to health
13. COPAR
Pre-Test

Instruction: Write & Answer comprehensively the following questions in a 1

whole sheet of paper. Take a picture and pm me directly your answers once you
are done answering. (20 points)

1. What is the Importance of studying community Health Nursing in

community and population groups?

2. What is the role and responsibility of a community health nurse in the

development of community?

3. How do you apply your competency as a community health nurse in the

community? Cite an example

4. As nursing students how can you promote health in the community amidst
of the covid 19 pandemic?
The Community Health Nursing process – it is an efficient
method of organizing thought for clinical decision making and
problem solving. It directs the community health nurses in
providing care to meet a clients health needs whether it is an
individual, family, group or community.

Nursing Process in the Community:

1. Assessment

2. Diagnosis

3. Planning and outcome identification

4. Implementation

5. Evaluation
Community Nursing Process
ASSESSMENT OF COMMUNITY HEALTH NEEDS

- Assessment is the act of reviewing human situation from a data base in order to
affirm clients wellness state, diagnose & determine potential problem , affirm illness
state, and determining the wellness aspect of the ill client.
-Assessment is the Determination of client health problems. Identification of
strengths & weaknesses of the clients state of health.
-Prior to nursing action client is assess to determine health status and the need for
nursing intervention.

Community Assessment types of Data:

1. Subjective/ Objective -
2. Current/historical – belongs to the present time/ happening now
Concerning the past events. e.g ( large family size, health problems, early
pregnancy)

Data Collection Method : Interviews, PE, Review of records, Diagnostic reports,

collaboration with colleagues.
Determinants of Health

Health Status – A range of age-specific and condition specific mortality rates,

as well as derived indicators. Examples include infant mortality, life
expectancy, potential years of life lost, circulatory deaths, unintentional injury
deaths. It is also associated with environmental issues and cultural practices.

Health resources -Health resources includes financial resources (health

spending) and human resources. Health spending measures the consumption of
health services and goods, including outpatient care, hospital care, long-term
care, pharmaceuticals and other medical goods, prevention and public health
services, and administration.
Diagnosis - Community diagnosis is the identification and quantification of
health problems in a given population using health indicators to define
those at risk or those in need of care and the opportunities and resources
available to address these factors.
There are two types of Community Diagnosis. 
1. Comprehensive Community Diagnosis - It is more focused on obtaining
general information about the community. It takes the community as a
whole and gives emphasis on all of the aspects, strengths and
weaknesses. (demographical data, the socio-economic and cultural
variables affecting health, the economic status of the community, the status
of the community’s environment, the health and illness patterns, the health
resources including health manpower and material resources, and the
political and leadership patterns.) Ex. Alteration in community Health
status related to improper waste disposal sec. to a disease process.
2. The Problem-Oriented Community Diagnosis – Respond to a particular
need & deals with problems that are readily seen and should be acted upon
immediately. 
Steps in Community diagnosis:

1. Determine the Objective

2. Define the study Population
3. Determine the data to be collected
4. Collect the data – records review, survey, & observation,
interview/Participant interview
5. Developing the instruments – obs. Checklist, questionnaire,
interview guides
6. Actual data gathering
7. Data collection & summarization
8. Data presentation
9. Data Analysis
10. Problem Identification.
Tools used in diagnosing community problem

Demography – is the statistical study of human populations. Demography examines

the size, structure, and movements of populations over space and time. Demography
is useful for governments and private businesses as a means of analyzing and
predicting social, cultural, and economic trends related to population.

Vital & Health Statistics –  Vital statistics incorporates a number of some

significant vital events that take place in human life, for example, birth, death, fetal
death, marriage, divorce, judicial separation, adoption, legitimation, and recognition
that combinedly generate an excessive amount of data and can be analyze.

Epidemiology - the study of how often diseases occur in different groups of people
and why. Epidemiological information is used to plan and evaluate strategies to
prevent illness and as a guide to the management of patients in whom disease has
already developed.
Planning of Community Health Nursing Services
It is an essential component of health planning to have a strong level of
community involvement. The nurse is responsible for advocating client
empowerment throughout the assessment, planning, implementation, and
evaluation phase of the process. You have to consider :
Principles in community health planning

1.The recognized need of individuals, families and communities 

2. Knowledge and understanding of the objectives and policies of the agency

facilities goal achievement. 

3. CHN considers the family as the unit of service. 

4. Respect for the values, customs and beliefs 

5. CHN integrated health education and counseling as vital parts of functions. 

6. Collaborative work relationships with the co-workers and members of the

health team facilities accomplishments of goals.
7. Periodic and continuing evaluation provides the means for assessing the degree to
which CHN goals and objectives are being attained. 

8. Continuing staff education program quality services to client and are essential to
upgrade and maintain sound nursing practices in their setting. 

9. Utilization of indigenous and existing community resources maximizing the success of

the efforts of the Community Health Nurses. 

10. Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the CHN
programs. 

11. Supervision of nursing services by qualified by CHN personnel provides guidance and
direction to the work to be done. 

12. Accurate recording and reporting serve as the basis for evaluation of the progress of
planned programs and activities and as a guide for the future actions. 
Bases for developing a community health Plan

A community health improvement plan (or CHIP) is a long-term, systematic

effort to address public health problems based on the results of community
health assessment activities and the community health improvement process.

1. Analyze the Health Issue

2. Inventory Health Resources
3. Develop a Health Improvement Strategy
4.Establish Accountability for Health Improvement Activities
5.Develop a Set of Performance Indicators
6.Implement the Improvement Strategy
7. Monitor Process and Outcomes of the Improvement Strategy.
Steps in making a plan: The planning cycle
The Planning Cycle offers a framework for a research project up to a certain level of
complexity. It is an eight-step process that you can use as tool to plan and implement fully
considered, well-focused, practical, and cost-effective research project. It also helps you to
learn from any mistakes you make, and to feed this knowledge back into your future
planning and decision making.

Planning
Philippine health care delivery system
a. Executive Order 102 (The Departmentof Health)

The Department of Health (DOH) is mandated to be the over-all technical authority on health.
The major mandate of DOH is to provide national policy direction and develop national plans,
technical standards and guidelines on health. It is also a regulator of all health services and
products; and provider of special or tertiary health care services and of technical assistance to
other health providers specially to Local Government Units (LGU). With other health
providers and stakeholders, the DOH shall pursue and assure the following:
1. Promotion of the health and well-being for every Filipino;
2. Prevention and control of diseases among population at risk;
3. Protection of individuals, families and communities exposed to health hazards & risks;
and
4. Treatment, management and rehabilitation of individuals affected by diseases and disability.
5. Lead agency in articulating national objectives for health, to guide the development of local
health systems, programs and services;
6. Direct service provider for specific programs that affect large segments of the population,
tuberculosis, malaria, schistosomiasis, HIV-AIDS and other emerging infections and
micronutrient deficiencies;
7. Lead agency in health emergency response services, including referral and
networking systems for trauma, injuries and catastrophic events;
8. Technical authority in disease control and prevention;
9. Lead agency in ensuring equity, access and quality of health care services through
policy formulation, standards development and regulations;
10.Technical oversight agency in charge of monitoring and evaluating the
implementation of health programs, projects research, training and services;
11.Administrator of selected health facilities at sub-national levels that act as referral
centers for local health systems i.e., tertiary and special hospitals, reference
laboratories, training centers, centers for health promotion, center for disease control,
and prevention, regulatory offices among others;
12.Innovator of new strategies for responding to emerging needs;
13.Advocate for health promotion and healthy life styles for the general population;
14.Capacity-builder of LGUs, the private sector, non-governmental organizations,
peoples organizations, national government agencies in implementing health programs,
services, through technical collaborations, logistical support, provision of grants and
allocation and other partnership mechanism;
15.Lead agency health and medical research;
16.Lead agency in health emergency preparedness and response;
17.Protector of standards of excellence in the training and education of health care providers at all levels of the
health care system;
18.Implementer of the National Health Insurance Law; providing administrative and technical leadership in
health care financing; and
19.Expressing national objectives for health to lead the progress of local health systems, programs and services.
20.Formulate national policies and standards for health;
21.Prevent and control leading causes of death and disability;
22.Develop disease surveillance and health information systems;
23.Maintain national health facilities and hospitals with modern and advanced capabilities to support local
services;
24.Promote health and well-being through public information and to provide the public with timely and relevant
on health risks and hazards;
25.Develop and implement strategies to achieve appropriate expenditure patterns in health as recommended by
international agencies;
26.Develop sub-national centers and facilities for health promotion, disease control and prevention, standards,
regulations and technical assistance;
27.Promote and maintain international linkages for technical collaboration;
28.Create the environment for the development of a health industrial complex;
29.Assume leadership in health in times of emergencies, calamities, and disasters and system failures;
30.Ensure quality of training and health human resource development at all levels of the health care system;
31.Oversee financing of the health sector and ensure equity and accessibility to health services; and
32. Articulate the national health research agenda and ensure the provision of sufficient resources and logistics
to attain excellence in evidenced-based intervention for health.
b. RA 7160 (Local Health Systems)
c. Levels of Health Care and
Classification of Health Facilities (DOH AO- 0012A)

Outcome 1: Improved Financial Risk Reduction

The National Health Insurance Program (NHIP) which
is the Philhealth covered 92% or 93.45 million principal
members & dependents of the country’s 101.45 million
population.

Philhealth Benefits:
Expanded Z Benefit Package for Colon & Rectum
Cancers
Point of Care (POC) Enrolment Program

- Enhance Primary Care Package (Tsekap)

- Extended Dialysis Coverage
Outcome 2: Greater Access to Health Care Services
In 2015, DOH took steps to upgrade facilities to meet
licensure & Philhealth Accreditation requirements.
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Outcome 3: Public Health Development Goals (MDG’s) Achieved

1. MDG-4 Reduce Child Mortality – 83% of the targeted

Population was fully immunized
2. National School-based immunization Campaign
3. Micronutrients Supplementation
4. Mass Deworming
5. MDG-5 Improved Maternal Health
6. MDG 6 – Combat HIV/AIDs, Malaria and other diseases
7. Disease Free Zone Initiatives : Rabies, Malaria, Dengue,
Filariasis
8. Emerging and Re-emerging Disease
9. Disaster Preparedness and A Changing Climate
Outcome 4: Improved Health Governance

ISO Certification As of December 2015, 45 out of 70

Department of Health hospitals were ISO certified.
National Health Summit
Local Government Unit Awards
World Health Organization Executive Board Secretary
of Health Dr. Janette Loreto-Garin represented the
Philippines as a member of the WHO Executive Board.
Fifth Asia Pacific Economic Cooperation (APEC) High
Level Meeting 5 on Health and the Economic
National Barangay Health Workers Convention
On February 2019, President Rodrigo Duterte signed the Universal Health Care Bill
into law, ushering in massive reforms in the Philippine health sector. Among the salient
features of the UHC Law are the expansion of population, service, and financial
coverage through an array of health system amendments. Along with this is a planned
paradigm shift to primary care, which is the core and center of all health reforms under
the UHC.
With UHC, all Filipinos are guaranteed equitable access to quality and affordable
health care goods and services, and protected against financial risk. The UHC helps
ensure every Filipino is healthy, protected from health hazards and risks, and has
access to affordable, quality, and readily available health service that is suitable to their
needs.
 
 COMMUNITY NURSING CARE PLAN
Cues Health Family/community Planning/Goals Objectives Intervention Method of Resources
Problem diagnosis contact

S/O Improper Potential/ risk for After 2-5 days After 2-5 days of >Establish Home visit Material
Drainage community of home visit home visit and rapport with the Interview Resources:
-Open system acquired infection and interventions the community Observatio
drainage related to interventions community will be state the n >Visual aid,
improper drainage the community able to : purpose of the Survey flyers
-Presence system and will be able to action
of flies, inability of the decide and -Be Oriented with Assess the Human
rats, brgy. To provide demonstrate the problem and community resources
mosquito, an environment appropriate identify the willingness to
cockroach conducive to measures to importance of participate in Time &
in the health eliminate and or having a proper solving the effort of the
drainage maintenance and reduce problem drainage system. problem individual,
personal to improve Discuss to the family and
-Stagnant development due environmental - Enumerate the dis community the the whole
water at to lack of skill in sanitation. –advantages of present problem community
the end of improving improper drainage & allow them to
the health measures. system verbalize their Financial
drainage perception resources:
tube - Can cite vector- Encourage
-Offensive related illness that them to maintain >money ,
smell in the family can suitable food and
the acquire environment for transportati
drainage the community on
Case Scenario:

Rain is a newly hired DOH nurse assigned in brgy Makalisang. She noticed
everyday on her duty in the health center that most of the children in Brgy.
Makalisang were malnourished, have a low birth weight, their skin was dry and
pale. One day she visited a family and interviewed the parents of a 5 years old
girl in the said community. Rain found out that because of this pandemic, many
families in brgy. Makalisang cannot provide their families enough food to eat
everyday and other necessities at home because of the lockdown situation.
Furthermore, rain also identified that if some member of the family were sick
they usually managed it at home rather than going to the health center or in the
hospital because of the Covid 19 Pandemic.
On February 2019, President Rodrigo Duterte signed the Universal Health Care Bill
into law, ushering in massive reforms in the Philippine health sector. Among the salient
features of the UHC Law are the expansion of population, service, and financial
coverage through an array of health system amendments. Along with this is a planned
paradigm shift to primary care, which is the core and center of all health reforms under
the UHC.
With UHC, all Filipinos are guaranteed equitable access to quality and affordable
health care goods and services, and protected against financial risk. The UHC helps
ensure every Filipino is healthy, protected from health hazards and risks, and has
access to affordable, quality, and readily available health service that is suitable to their
needs.
 
Millennium Development Goals (MDGs)

The United Nations Millennium Development Goals are eight goals

that all 191 UN member states have agreed to try to achieve by the
year 2015. The United Nations Millennium Declaration, signed in
September 2000 commits world leaders to combat poverty, hunger,
disease, illiteracy, environmental degradation, and discrimination
against women. The MDGs are derived from this Declaration, and
all have specific targets and indicators.

The MDGs are inter-dependent; all the MDG influence health, and
health influences all the MDGs. For example, better health enables
children to learn and adults to earn. Gender equality is essential to
the achievement of better health. Reducing poverty, hunger and
environmental degradation positively influences, but also depends
on, better health.
SUSTAINABLE GOALS