Nursing Process in the Care of Population Groups and Community

Consisting of a systematic, purposeful set of interpersonal actions, the nursing process provides a
structure for change that remains a viable tool employed by the community health nurse.

The Nursing Process in the Care of the Community

➢ A community is a group of people who:
• Have a common interest or characteristics
• Interact with one another
• Have a sense of unity or belonging
• Function collectively within a defined social structure to address common concerns
➢ A community may be phenomenological (functional) or geopolitical (territorial)

Principles of Community Health Nursing

1. Community is the focus of care; nurse's responsibility is to the community as a whole.
2. Give priority to community needs.
3. Work with the community as an equal partner of the health team.
4. Focus on primary prevention for appropriate activities.
5. Promote a healthful physical and psychosocial environment.
6. Reach out to all who may benefit from a specific service.
7. Promote optimum use of resources.
8. Collaborate with others working in the community health.

Conditions in the community affecting health

• People
• Location
• Social system

Characteristics of a healthy community

• A shared sense of being a community based on history and values
• A general feeling of empowerment
• Existing structures that allow subgroups within the community to participate in decision making.
• The ability to cope with change, solve problems, and manage conflicts within the community through
acceptable means
• Open channels of communication
• Equitable and efficient use of community resources

Aims
1. Achieve a good quality of life
2. Create a health-supportive environment
3. Provide basic sanitation
4. Supply access to healthcare

Community Health Assessment

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1. The data needed to be collected depends on the objectives of community assessment.
2. In general, the nurse needs to collect data on the three categories of community health determinants: people,
place, and social system.
A. Community Health Assessment Tools

Field Health Services and Information System (FHSIS)

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)
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- TB symptomatic
- TB cases under short course chemotherapy (SCC)
- TB cases under standard regimen (SR)
-National Leprosy Program (NLP)
3.Summary Table
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

Characteristics of the assessment process:

(1) a participatory process among stakeholders to encourage information sharing and increase awareness of
health risks and problems in the community.

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(2) community health-care team building comprising representatives from the community or members of
stakeholder organizations.
(3) conducting the assessment process concurrently with other functions throughout the course of the
community healthcare interventions and programs.
(4) identifying community people’s healthcare demands (individuals, families, and groups in the community),
which lays a strong foundationfor other functions.
(5) collecting up-to-date information, representing both the people’s perspective/experiences and academic
perspective.

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
Approaches:
Comprehensive needs assessment - broad – totality of the community
Problem-oriented assessment – focused - responds to a particular need

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
1. Comprehensive Community Diagnosis
Aims to obtain general information about the community with the intent of determining not only prevalent
health conditions and risk factors (epidemiologic approach) but also the following factors, such as:
Socio-economic conditions
Lifestyle behaviors and attitudes that have effect on health
2. Problem-oriented Community Diagnosis
- The type of assessment that responds to a particular need of a target group.
For example, Health problems related to improper factory waste disposal
Steps in Conducting a Community Diagnosis
1. Determining the objectives
▪ In stating the objectives, the following questions should be answered:
✓ To describe the prevailing disease conditions and health needs of the target populations.
What is the present health condition of the people in the community?
✓ To explain the health behaviors or risk factors that give rise to the health problem.
Why are the people in the community in such condition?
✓ To provide the analyses related to the socio -economic, cultural, and environmental factors that sustain or
allow for the perpetuation of the health problems of the target population.
What are the roots of these problems?
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✓ To reflect possible solutions of the health problems based on the community’s capabilities and resources.
2. Defining the study population
▪ The defined objectives are the bases for determining the study population
▪ The nurse and the community diagnosis team identify the population group to be included in the study.
▪ May include the following:
- Entire population.
- Focused on a specific population group.
✓ Women of reproductive age-group (15-44 years old).
✓ Infants (0-12 months old).
✓ If a complete enumeration of the desired sample is not possible.
Sample or a subset of the target population.
▪ Example of objectives of the focused community diagnosis:
3. Determining the data to be collected.
▪ Developing a data collection plan.
- Data collection plan uses the objectives to guide the data
collectors to decide on the following:
✓ Data to be collected.
✓ Methods of data collection.
✓ Instruments/tools for data collection.
✓ Possible sources of these data.
▪ Categorizing data collected.
Primary Data – directly obtained by the nurse specifically to answer the community diagnosis objectives.
Secondary Data – existing data that were obtained by other people, which the nurse can use to answer the
community diagnosis objectives.

▪ The nurse considers the following characteristics of data collected.

✓ Timeliness of data. ✓ Precision
✓ Completeness ✓ Adequacy
✓ Accuracy ✓ Relevance

Data collation
● Numerical data – counted
● Descriptive data - described
Data presentation
● Depend largely on the type of data obtained

Data analysis
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● 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
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.
● 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.

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.

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
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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
● 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

Steps in prioritizing health problems

1. Score each problem according to each criteria.
2. Divide the score by the highest possible score.
3. Multiply the answer by the weight of the criteria.
4. Add the final score for each criterion to get the total score for the problem. The highest possible score is 10.
5. 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
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Nature of the problem
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

Planning
It is a logical process of decision making to determine which of the identified health concerns requires
more immediate consideration (priority setting & what action may be undertakes to achieve goals.

Criteria Priority Setting

1. Significance of the Problem- is based on the number of people in the community affected by the problem or
condition
2. The Level of Community Awareness- The priority its member give to the health concern is a major
consideration.

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- Related to the community gives to the health concern, Shuster & Geoppinger (2004)
- Community motivation to deal with condition
3. Ability to Reduce Risk
- Related to the availability of the expertise among the health team in the community itself
- This criterion involves the health team’s level of influence in decision making related to actions in resolving
the community health concern.
4. Determining cost of Reducing Risk
- The nurse has to consider economic, social & ethical requisites and consequences of planned action.
5. Ability to identify the target population
- For the intervention is a matter of availability of data resources such as FHSIS, census, survey reports or
case/screening finding.
6. Availability of Resources
- To intervene in the reduction of risk entails technological, financial & other material resources of the
community, the nurse, the health agency.
- Accessibility of outside resources & link are taken into account
7. Group. It is a flexible process using the nominal group technique wherein each group member has an equal
voice and decision-making, thereby avoiding control of the process by the more dominant members of the
group
Criteria:
■ From the scale of 1 to 10, 1 being the lowest, the members give each criterion
based on their perception of its degree of importance in solving the problem.
■ From a scale of 1 to 10, 1 being the lowest, each member rates the criteria in terms of likelihood of the group
being able to influence or change the situation.
■ Collate the weights (from step 1) and ratings (from step 2) made by the members of the group.
■ Compute the total priority score of the problem by multiplying collated weight and rating of each criterion.
■ The priority score of the problem is calculated by adding the production
obtained in step 4.

Formulating Goals and Objectives

● In family health nursing , goals are the desired outcomes at the end of interventions, whereas objectives are
the short term changes in the community that are observed as the health team & the community works towards
attainment of goals.
● Objectives serve as instructions, defining what should be detected in the community as interventions are
being implemented.

SMART Process:
For us to attain our goal and objective we must be smart
● Specific - be clear and specific to your goals that are easier to achieve. This would also help you to know how
and where to get started.
● Measurable - goal must be reached allowing you to see your progress. Tells you when your goals are
complete
● Attainable - your goal is realistic and you must have the tools or resources to attain it
● Relevant - realistic or relevant to avoid over well and unnecessary stress and frustration
● Time-Bound -a date help us stay focused and motivated, inspiring us and providing something to work
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Deciding on Community Interventions
● The group must analyze the reasons for people's health behavior and directs strategies to respond to the
underlying causes
● But if the reason is sociocultural, the planning team me opt to concentrate on providing opportunities for
skills development of traditional birth attendants or exerting more effort to gain trust and confidence of women
and families
● The group should take into consideration the demographic, physiological, social, cultural and economic
characteristic of the target population and one hand and the available health resources on the other hand.

Implementing the Community Health Interventions

● Referred to as the action phase
● Able to deal with recognize priority health concern
● To facilitate the process rather than directly implement the planned interventions

Importance of Partnership and Collaboration

● The problem are complicated and too many for the nurse and the people or their organization to handle
● They must work with other people or groups to increase the probability of accomplishing the goals that they
have set.
● The nurse must plan to establish and maintain valuable working relationships with people such as people's
organizations, health organizations, educational institutions, local government units , financial institutions,
religious groups, socio-civic organizations, and sectoral groups.
Activities involved in collaboration and advocacy environmental sanitation
● Proper excreta
● Disposal
● food safety
● Sanitation
● Vermin and vector control
● Built environment
Advocacy Work Involves:
● Informing the people about the rightness of a cause.
● Thoroughly discussing with the people the nature of alternatives, their content and possible consequences.
● Supporting people's right to make a choice and act on their choice
● Influencing public opinion.

Social Mobilization is an approach wherein the community participation is very essential. It uses deliberate
participating processes to involve local institutions, local leaders, community groups, and members of the
community to organize through concerted efforts toward a common purpose. Community mobilization is
characterized by respect for the community and its needs. What is Social Mobilization It is also defined as a
process of capability buildng of deprived community people to enable them to plan, manage and control over
their own development program. It emphasizes self-decision of the concerned community, self-initiated
development efforts as well as self-capacity building of the community, empowerment of the powerless,
organization of the unorganized, and awarenes of the unaware which are the major elements of the social
mobilization and are the concerns of the National Service Training Programs. (Abhiyan,2004)

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The following should be undertaken in social mobilization
Advocacy - element which is focused on various actors which could create the positive
environment for program or service delivery.
Information, Education and Communication (IEC) - a set of accurate and consistent information on the
programs and services as a timely response by those in direct contact with the communities.
Community Organizing - Individual and community groups are able to get a sense of what they can do among
themselves to improve their situation.
Capacity Building - Social mobilization can only be sustained if the network of the advocates and mobilizers
are continually expanded through Capacity - building (people) Institutional Development
(organization)

Community Organizing as a process consists of steps or activities that instill and reinforce the people’s
selfconfidence 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
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.
Importance of Community Organizing
Community Organizing is a participatory decision-making process that empowers communities to
improve health. It emphasizes active participation from the community in identifying key health issues and
strategies to address them. Communities focus on their strengths and collectively mobilize to develop
programs to achieve health goals.Power is the purpose of community organizing, and the issues, problems,
strategies and victories are means to the end of increased power for the organization and the
community.Empowerment processAt the heart of CO promotes participation of people, organizations and
communities toward the goals of increased individual and community control, political efficacy, improved
quality of community life, and social justice.Community organizationProcess by which the people organize
themselves to “take charge” of their situation and thus develop a sense of being a community together
Community organizing is a continuous and sustained process of:

1. Guiding people to understand the existing condition of their own community

2. Organizing people to work collectively and efficiently on their immediate and long term
problemMobilizing people to develop their capacity and readiness to respond and take action on
their immediate and long term needs
3. A middle ground where the healthcare worker and the people need to attain community organization
4. A liberal freedom of the community where the people are allowed to participate in the overallhealth
care status of their community
5. A transformation force, that enables the individuals, families and communities to be responsible for
their own health.

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 6. A phenomenon of interest goals and objectives at the health care works and the people in their way
to health citizenryImportance of Community Organizing.

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 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.
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• 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
- 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.
- Community organizer must have a basic understanding of the target community.
- Preparation for the initial visit includes
- Gathering basic information on socioeconomic conditions, traditions including practices, overall
physical environment, general health and illness patterns, and available resources.
- Informal meeting with contacts who have been to the area or some residents of the community prior to
entry will be useful.
- Avoid raising unrealistic expectations in the community.
- Goal: Build up the confidence and capacities of people
- 2 strategies in gaining entry into a community which can be Counteproductive
Padrino or patron. When patron tries to boost the community organizer’s intended output to the community,
this will create false hopes
Bongga entry. Easiest way to catch the attention and gain the approval of the community..
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.
- Integration requires IMMERSION in a community life.
- Organizer’s conduct as well as manner of dressing must be in accordance with the norms of the
community
- Styles of integration
- “Guest” status
People-centered approach integration
Community organizers enter into a community with a well-conceived plan.
They establish contact with villagers and become their allies
Organizers develop a deeper relationship through various techniques
Pagbabahay-bahay or occasional home visit, observe house routines to avoid inconvenience
Informal conversations in the village poso during laundry time, basketball court and sari-sari store
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.
Participation in social activities
Attending fiestas, weddings, baptismal celebrations, funeral wakes and other activities ofthe community
that carry social meaning and importance.
Community organizers should remain as role model, gambling and drinking alcoholic
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beverages with them is prohibited.

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