Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 1
LESSON TITLE: COMMUNITY HEALTH NURSING
Materials:
LEARNING OUTCOMES:
Book, pen and notebook
At the end of the lesson, the nursing student can:
Cellular phone with internet
1. Discuss the principles of CHN.
LCD and power point presentation
2. Describe a healthy community.
References:
3. Classify different types of community.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier.
SUBJECT ORIENTATION (10 minutes)
The instructor will be starting to introduce himself/herself to the class and the assigned subject, Community Health
Nursing II. The course outline will be distributed and discussed accordingly. Listed below are the additional information
vital in orientation:
1.
2.
3.
4.
5.
6.
The calendar of activities for major examinations must be relayed.
Classroom rules and regulations will be informed per the instructor’s discretions.
Computation of grades specific for this subject must be thoroughly explained to students.
The essence and significance in grade computation of these modules must be introduced.
If this is the first subject of the class, the instructor must initiate an election for block officers.
Any other information that will be deemed necessary by the instructor must be properly coordinated to the class.
MAIN LESSON (25 minutes)
The teacher should discuss the following topics. Instruct students to take down notes and read their book about this
lesson
INTRODUCTION
x
x
The community health nurse’s aim is to improve
the health status of the community in general. Just
as in other fields of nursing practice, care of the
community is undertaken utilizing the nursing
process in a cyclical process of assessment,
diagnosis, planning, intervention, and evaluation.
To the nurse, the community is not just the setting
or the context for providing community health
nursing. It is the focus of nursing care. To the
community health nurse, understanding the
meaning of community is requisite.
x
x
To synthesize the definition in an earlier chapter, a
community is a group of people who:
o Have a common interest or characteristics
o Interact with one another
o Have a sense of unity or belonging
o Function collectively within a defined social
structure to address common concerns
A community may be phenomenological
(functional) or geopolitical (territorial). A school is
phenomenological, whereas a barangay is
geopolitical, with the latter being locality-based and
having a geographic boundary. This chapter
focuses mostly on the geopolitical community.
PRINCIPLES OF COMMUNITY
1. Focus on the community as the unit of care.
x The nurses’ responsibility is to the community
as a whole.
2. Give priority to community needs.
x The community health nurse has to “marry”
skills in the nursing process with populationfocused skills to produce the greatest benefit
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3. Promote a healthful physical and psychosocial
environment.
x The health team designs strategies to
concentrate on the environmental determinants
of health such as education, socioeconomic
status, physical environment, working
conditions, and social support networks.
5. Work with the community as an equal partner of
the health team.
x Team approach is most evident in community
health work, and, frequently, the nurse serves
as the liaison officer of the health team. It is
important to note that the community itself is a
member of the health team. It is important to
note that the community itself is a member of
the health team. An organized community
plays an important role in this process.
Partnership between health workers and the
community from assessment to evaluation is
more likely to produce effective and
sustainable results. As in family health care,
the principle of mutuality is also applied in
community health care.
7. Promote optimum use of resources.
x Limited health resources are best used for
strategies that will produce long-term effects,
taking ethical principles into consideration.
Results are studies on best practices in
community health should be disseminated and
utilized where applicable.
for the majority of the community. The nurse
uses assessment tools such as demographics
and vital statistics to determine the health
needs of the community as whole.
4. Focus on primary intervention.
x In selecting appropriate activities, focus on
primary prevention. Emphasis is given on
strategies to promote optimal health and
prevent disease and disability. Treatment is a
necessary component of programs that control
prevalent communicable diseases, but
treatment is by itself a measure to control the
spread of the disease to others. This is termed
preventive treatment of disease.
6. Reach out to all who may benefit from a
specific service.
x The community health nurse realizes that
members of the community who need
particular service are the least likely to actively
seek for appropriate help. For this reason, the
health team does not wait for people to come
to the health facility but goes on active casefinding and outreach activities.
8. Collaborate with others working in the
community.
x Health is a product of multiple determinants.
For this reason, the nurse has to work with a
variety of sectors, including the community
itself, in resolving issues that affect health. To
produce the greatest benefit, community health
efforts have the to be coordinated among the
members of the health team but also with other
disciplines, like teachers, social workers,
finance, and marketing experts, involved in
community development.
CHARACTERISTICS OF A HEALTHY COMMUNITY
A healthy organism has all its body parts contributing to
in all aspects. Certain observable traits allow health
the well-being by carrying out their specific functions. In
workers to ascertain whether an individual or a family is
the same manner, all systems of a community need to
healthy. A community likewise, may be observed for
function effectively and work together to maintain the
evidence traits that indicate its health.
health of the community. A healthy community has
mechanisms that assure all citizens a decent way of life
1. A shared sense of being a community based on history and values. Despite the presence of subgroups,
members of the community have a feeling of belonging and that they make up one community.
Recognition and respect for these subgroups make this possible.
2. A general feeling of empowerment and control over matters that affect the community as a whole.
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3. Existing structures that allow subgroups within the community to participate in decision making in
community matters.
4. The ability to cope with change, solve problems and manage conflicts within the community through
acceptable means.
5. Open channels of communication and cooperation among members of the community.
6. Equitable and efficient
7. Use of community resources with the view towards sustaining resources.
x
x
A healthy community is, in fact, the context of health
promotion defined in the Ottawa Charter (WHO,
1986) as “the process of enabling people to increase
control over, and to improve their health.” Further,
the Charter states, “To reach a state of complete
physical, mental and social well-being, an individual
or group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope
with the environment.” Health is, therefore, seen as
a resource for everyday life, not the objective of
living. Health is a positive concept emphasizing
social and personal resources, as well as physical
capacities. Therefore, health promotion is not just
the responsibility of the health sector, but goes
beyond healthy life-styles to well-being.”
A healthy city is one that is continually creating and
improving those physical and social environments
and expanding those community resources that
enable people to mutually support each other in
performing all the functions of life and developing to
x
x
their maximum potential. It aims to (1) achieve a
good quality of life, (2) create a health-supportive
environment, (3) provide basic sanitation and
hygiene needs, and (4) supply access to health care.
Being a healthy city does not depend on existing
structures, but a commitment to improve the city
environment and create the necessary networks for
health. The Philippines is a member nation of the
WHO Western Pacific Region, which has advocated
for the Healthy Cities and Healthy Islands
movement, especially because of rapic economic,
environmental, and social changes.
Health is affected by many factors that cannot be
controlled by individuals all by themselves.
Effectively functioning systems within the community
go a long way toward health promotion, disease
prevention, and access to resources needed for
health. Knowing that a healthy community is
essential to health promotion gives the community
health nurses further motivation in their work.
CLASSIFICATION OF COMMUNITY
Urban
x
Rural
x
Rurban
x
High density, a socially homogenous population and a complex structure, non-agricultural
occupation; something different from an area characterized by complex interpersonal social
relations.
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.
A combination of a rural and an urban community.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the ten (10) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. The PHNs’ responsibility of care is the:
A. Client
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B. Family
C. Community
D. All of these
Answer: D
Rationale: The nurses’ responsibility is to the community as a whole.
2. The focus of the PHNs’ activities is:
A. Primary prevention
B. Curative
C. Rehabilitative
D. all of these
Answer: A
Rationale: Emphasis is given on strategies to promote optimal health and prevent disease and disability.
3. Greatest benefit requires coordination among:
A. health care disciplines
B. other disciplines
C. community
D. all of these
Answer: D
Rationale: Health is a product of multiple determinants. For this reason, nurse must work with other disciplines,
aside from the health care team and community.
4. Which of the following describes a rural community?
A. Highly dense in population
B. People are well- knit and having high degree of group feeling
C. Complex interpersonal relationship
D. Non-agricultural occupation
Answer: B
Rationale: All options except B describes an urban community
5. In order to promote optimum use of resources, the PHN must promote:
A. Best practices that are products of studies.
B. Best practices are the applied by the community.
C. Health practices based from community survey
D. Community health practice that is acceptable.
Answer: A
Rationale: Promote optimum use of resources that are results of studies on best practices in community health.
Option B, not all practices applied by the community is evidence-based. Option C and D, practices based from
what is common and acceptable are not scientifically based.
6. These are the tools necessary to determine the needs of the community as a whole:
A. Blood pressure apparatus
B. Thermometer
C. Vital statistics
D. Weighing scale
Answer: C
Rationale: Option C and demographic profiles are tools necessary to determine the needs of the community as a
whole. Options A, B and D are accessory tools in order to determine data like blood pressure, temperature and
weight to aid in assessing individual.
7. It is a type of community that has high density of people and has both agriculture and manufacturing
industry:
A. Rural
B. Urban
C. Rurban
Answer: C
Rationale: Option C, rurban is a combination of the characteristics of rural and urban community. Option A, rural
can be an agricultural or fishery area and with people who are closely knit together. Option B, Urban areas are
highly industrialized countries and highly populated areas.
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8. Which among the following describes an urban community? (select all that apply)
A. agricultural occupation
B. complex interpersonal social relations
C. primary group relation
D. not well- knit
Answer: B and D
Rationale: Options B and D are descriptions of an urban community in which the relationships of people in the
community are not well-knit and social relation is complicated. Most of them value work and own family rather
than others. Option A and C describes a rural community.
9. A healthy community:
1. have a feeling of superiority
2. recognizes and respects other subgroups
3. feels empowered and control over matters that affect the community as a whole
4. participate in decision making in community matters
Choices:
A. 1, 2, 3 and 4
B. 2, 3 and 4
C. 3 and 4
D. 2 and 4
Answer: B
Rationale: Despite the presence of subgroups, members of the community have a feeling of belonging and
that they make up one community. There must be no feeling of superiority but rather equality.
10. A healthy city is one that: (select all that apply)
A. Maintains the community’s sanitation
B. Supplies health care needs
C. Doles out the need of the people in the community
D. Provides recreational activities for the people
Answer: A, B and D
Rationale: A healthy city is one that is continually provides basic sanitation and hygiene needs, access to health
care and creates health supportive environment through recreational activities. Option C disables people develop
to their maximum potential.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Effective Questioning
Situation: Community Health Nurse Ana is a newly-hired nurse of Dagupan City. Let us help her understand her
work as a Community Health Nurse by answering the following:
1. Why partnership with the community will ensure success?
_______________________________________________________________________
2. How will you reach people in the community that are aloof in the CH services?
________________________________________________________________________
3. Aside from building partnership with the community, how are you going to ensure a healthy community
considering that health is a product of multiple determinants?
________________________________________________________________________
4. In your barangay, what are the conditions that may affect the health of the community? How?
________________________________________________________________________
(Reading assignment: Chapter 7 of Famorca et al., 2013; Community and Society)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 2
LESSON TITLE: COMMUNITY AND SOCIETY, COMMUNITY
AND HEALTH
Materials:Book, pen and notebook
LEARNING OUTCOMES:
LCD and power point presentation
White board marker
At the end of the lesson, the nursing student can:
References:
1.
2.
3.
4.
5.
Analyze issues affecting health.
Formulate possible solutions.
Describe the relationship of community to health.
Enumerate the role of community to health.
Enumerate the responsibility of the community to the
health care delivery system.
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
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will advise the students to answer the following:
Modified True or False
1.The nurses’ responsible of care is the family.
Answer: False, Community
2. The priority needs of the community are based from the nurses’ assessment.
Answer: True
3. The community is the equal partner of the nurse.
Answer: True, there is mutuality in the partnership
4.A healthy community allows people to participate in decision-making regarding community matters.
Answer: True
5. People in a healthy community have a sense of belongingness.
Answer: True
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson:
DEVELOPMENT OF COMMUNITY AND SOCIETY
Components of a Community
1. People- represents the core that makes up a community
2. 8 Sub-systems
8 Sub-systems
1. Housing
Types of Housing Materials
a. Concrete – made of hollow blocks and cement
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2.
3.
4.
5.
6.
7.
8.
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
a. Level of education (elementary graduate or elementary level)
Fire and Safety
- Availability of fire station and policemen
Politics and government
- Type of government
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
SOCIAL SYSTEM
x
A social system is the patterned series of interrelationships existing between individuals, groups, and institutions
and forming a coherent whole. Social system components that affect health include the family, economic,
educational, communication, political, legal, religious, recreational, and health systems.
x
While carrying out several roles simultaneously, an individual serves as a part of several social system
components at the same time. One may be a son or a daughter in the family, a nurse employed in a hospital, a
church member, a member of a neighbourhood basketball team, and a citizen all at one time.
x
As in other systems, the composite parts of the social system of the community affect and interact with one
another. During these interactions, patterns and communications transpire, which form the basis of organizations.
Organizations within the social system can be formal or informal. A government agency, a bank, and a school are
examples of formal organizations, whereas neighbourhood friends and volunteers in a barangay clean up drive
are examples of informal organizations. Organizations that have interactions and linkages and that carry out
similar functions form community system or subsystems. For example health centres, private clinics, hospitals,
health laboratories, and drugstores are elements of the health system of a community.
x
Because of the multifactorial nature of health, all the components of the social system of a community influence
its health. In providing care to a community, the nurse has to take into account the totality of its social system. The
health care delivery system, however, is considered of central importance precisely because of its social role in
community health promotion and maintenance and risk reduction. In fact, the nurse is a part of this system.
DEVELOPMENT OF COMMUNITY AND SOCIETY
a.
b.
c.
d.
e.
f.
g.
Every human community has institution for socialization of its members
Development of community requires sanction of a group members
A community or a group is a reflection of all functional relationships that occur among its members
A community or a group can change because of conflict among members
Family is the primary group
Peer group
Group membership
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h. Type of leadership in a group
i. Types and role assumed by members of the group
j. Community is a social organization that is considered the individual’s secondary group
This session is not exactly found in your reference material. Hence, you are encouraged to read the concepts below.
COMMUNITY AND HEALTH
a. role of the
community
o
o
o
o
o
b. health
agency as a
social
institution
c. delivery of
health
services :
responsibilit
y of the
community
o
d. hospital as a
substitute of
the
community
o
o
o
o
o
o
o
plays an influential role in individual growth and maturation
partners in health and wellness
influences others’ health choices
Consumers of health services
Health is intrinsic to social and economic development – as a determinant, a measure of
progress and an outcome.
Health Institution means an institution (other than a hospital) by or at which health
services or health support services are provided
Either public or private
Healthy communities are those that have well-integrated, interdependent sectors that
share responsibility to resolve problems and enhance the well-being of the community.
Hence, for a community to successfully receive the health services, the community subsystems must be well-integrated. Collaboration and coordination must be observed from
the multiple community sectors.
o Community must
ƒ avail the health services provided
ƒ give feedback of the services
ƒ report any health-related concern
ƒ be responsible in the equitable use of services
ƒ efficiently use health services
once a sick individual needs remedies that is beyond the capacity of the
community, hospital takes charge until the sick individual recovers
health restoration
disease treatment
rehabilitation
RELATIONSHIP BETWEEN COMMUNITY DEVELOPMENT AND HEALTH
Economic development
o
Infrastructure
o
Community organizing
o
Resources
o
Business and commercial investment can improve the stability of local
economies through job creation and enhanced access to goods and
services. This stability increases household income and positive health
outcomes.
The physical attributes of the community like streets, parks and other
recreational areas influences physical activities, social interactions and
sense of safety. Therefore, presence of these attributes affect health
outcome physically (cardiovascular health) and psychologically (mental
health).
Mobilizing people with shared values and concerns to influence
institutions, policies, and government decision making can facilitate
health promoting changes in the community. Civic participation and
strengthen relationships among residents can affect range of health
outcomes including mental health substance abuse and cancer.
Services and support to meet individual and family needs affect the
quality of life and health outcomes. Services and support like job training,
child care and counselling as well as transportation, open space, health
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care and quality schools can improve the lives of people.
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 RESPONSIBILTIES TO THE COMMUNITY
1. Cooperate – work jointly toward the same end
2. Respect – regard to the vision of the community
3. Participate – to take part/involve to the community activities
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. It is the patterned series of interrelationships existing between individuals, groups, and institutions and
forming a coherent whole.
A. Community
B. Sub-systems
C. Health
D. Social system
Answer: D
Rationale: A social system is the patterned series of interrelationships existing between individuals, groups, and
institutions and forming a coherent whole. Social system components that affect health include the family,
economic, educational, communication, political, legal, religious, recreational, and health systems.
2. A sub-system component that affects health due lack of understanding is:
A. Economic
B. Educational
C. Communication
D. Political
Answer: B
Rationale: The educational status of the community affects how they perceive and act on health.
3. It is part of the social system and considered of central importance because of its role in health
promotion and maintenance and risk reduction:
A. Family
B. Economic
C. Educational
D. Health
Answer: D
Rationale: Option D, the health care delivery system is the one responsible in maintaining health and protecting
the people from diseases. Although health is multifactorial in nature, it is the health care delivery system that is
responsible and accountable. Option A, family is the component of the society. Option B, economy influences the
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community its socio-economic status. Option C, educational possibly affects economic status and health
practices.
4. To determine the root cause of deaths in the community, the PHN must assess the:
A. Location of the barangay
B. Socio-economic status of the community
C. Health care system
D. Political system
Answer: C
Rationale: Option C, determining the root cause of deaths in the community requires assessment how well the
health system is functioning. Option A, location can be a contributory factor, however, there are programs of
health requiring house to house. Thus, this is not an issue. Option B, although the socio-economic status of the
community contributes to the access of health services, there are health services that are free of charge. Option
D, the political system influences how organizations in the community will be ran. However, health care system
must not be inherently affected by political concerns.
5. The primary group in a society:
A. Client
B. Family
C. Community
D. Population group
Answer: B
Rationale: Family is the primary group
6. As partners in health, community must:
A. Consume the services provided
B. Avail health services
C. Influence others
D. Work hand in hand with the community health workers
Answer: D
Rationale: Working together towards a common goal ensures strong partnership.
7. What is the role of health in the community? (select all that apply)
A. Social development
B. Economic development
C. Projects progress or regress
D. Policy implementation
Answer: A, B and C
Rationale: Health is intrinsic to social and economic development. It determines and projects the progress or
regress of a community. Option D, policies affect health, policy plays a big role in the health of the community.
The making of policies can be affected by the health status. However, health has no role in policy implementation.
8. In order to improve community services, people in the community must:
A. Influence others to avail the services
B. Provide feedback
C. Efficiently use services
D. Report any health-related concern
Answer: B
Rationale: Feedback system will improve and enhance best practices
9. People in the community shows cooperation when they:
A. actively join in the community’s activities
B. regard community’s programs essential in their growth
C. take part in the community’s goals
D. work towards to the community’s vision
Answer: D
Rationale: Cooperation can be shown through working jointly towards the same end
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10. Community in terms of health acts as center of: (select all that apply)
A. Disease prevention
B. Health promotion
C. Critical care
D. Continuity of care
Answer: A, B and D
Rationale: Options A and B are primary levels of care which is offered by the community. Additionally, Option C
is a function of the community after the client is discharge from the hospital. Option C, cannot be rendered by the
community but rather in a hospital with critical care system.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Brainstorming
The instructor will ask the students to answer the following:
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.
Special assignment: Watch any video showing Filipino culture and values
https://www.youtube.com/watch?v=79xsa9zfA_U
(Reading assignment: Public Health Nursing)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 3
LESSON TITLE: CULTURE, HEALTH AND PUBLIC
HEALTH NURSE
LEARNING OUTCOMES:
Book, pen and notebook
LCD and laptop
At the end of the lesson, the nursing student can:
1.
2.
3.
4.
Materials:
Describe the Filipino culture.
Identify different Filipino culture.
Describe the influence of culture to health.
Describe the good qualities of a public health nurse.
References:
Cuevas, F. P., (2007). Public Health Nursing
inthe Philippines (10th edition). Manila,
Philippines.
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will advise the students to answer the following:
1. Cite one role of the community to health and explain.
Possible answer:
o Partners in health
Community works hand in hand with the community health workers. Community decides
for own self.
o Consumers of health services
Community avail the health services offered. These health services will enhance their
health.
o Influences others’ health choices
People in the community influence one another. Lifestyle and even accessing health
service is affected by each other’s’ opinions
2. Enumerate responsibilities of the community to the health care delivery system.
Possible answer:
o avail the health services provided
o give feedback of the services
o report any health-related concern
o be responsible in the equitable use of services
o efficiently use health services
o
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to read notes in their SAS regarding
the concepts for today’s lesson:
CHARACTERISTICS OF CULTURE
• A shared pattern of communication
• Similarities in dietary preferences and food preparation
• Common patterns of clothing
• Predictable socialization patterns
• A shared sense of beliefs
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o
o
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The term culture refers to the learned and
shared beliefs, values, and life ways of a
group that are generally transmitted from one
generation to the next and influence people’s
thoughts and actions.
An integral part of daily living, culture has
many hidden and built-in directives and rules
of behavior, beliefs, rituals, and moral–ethical
decisions that give meaning and purpose to
life (Leininger & McFarland, 2006).
Community/public health nurses’ knowledge
of
culture
and
skill
in
conducting
comprehensive cultural assessments guide
o
them in providing culturally competent care to
people from diverse cultures.
It should be noted that there are nonethnic
cultures such as those based on occupation
or profession (e.g., culture of nursing,
medicine, or the military); socioeconomic
background (e.g., culture of poverty or culture
of affluence); sexual orientation (gay, lesbian,
or transgendered cultures); age (e.g.,
adolescent culture or culture of older adults);
and ability/disability (e.g., culture of the
deaf/hearing impaired or culture of the
blind/visually impaired).
CULTURE AND HEALTH
a. General influences
b. Specific influences
Ɣ Culture affects the way of life.
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 long a person has an illness; what is
appropriate role behaviour in sickness; and when a person is believed to have
recovered from an illness.
ƒ Culture also influences the way people receive health care information,
exercise their rights and protections, and express their symptoms and healthrelated concerns.
FILIPINO CULTURE AND VALUES
Positive
Family oriented
Joy and humour
Faith and religiosity
Hard work and industriousness
Hospitality
Pagkamalikhain
Malasakit
Ɣ
Ɣ
Ɣ
Ɣ
Ɣ
Ɣ
Ɣ
close family ties; married children stays with their parents
smiles and laughs even having difficulty
highly spiritual; celebrates patrons
works even not told
warmly receives surprise visitors
creativity
values for the common good
o Smooth interpersonal relationships are core values of Filipinos –
personalism
ƒ Sensitive to the needs of others; high regard to others;
understanding and considerate to others
Ningas kugon
Ɣ
Filipino time
mañana habit
Ɣ
Ɣ
Bahala na
Ɣ
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.
Tardiness
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.
Mean "whatever happens, happens," "things will turn out fine," or as "I'll take
care of things."
Negative
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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
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
o An opportunity of the nurse to improve
the lives of the oppressed community
o An opportunity to make a social change
b. disadvantages of public health nursing
o Health resources can be scarce
o 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
o Professionally qualified and license to
practice in the arena of public health
o Personal qualities and people skills that
would allow her practice to make a
difference in the lives of people
o Physically, mentally and
emotionally strong
o Good leader
o Willing to work
o Resourceful, creative, honest
and with integrity
o Resilient
o
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be
recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for the
correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must
emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to
discuss among themselves.
Multiple Choice:
1. Which among the following describes culture? (select all that apply)
A. Culture is shared beliefs, values and life ways.
B. It predicts social patterns among group of people.
C. It can be shared life experiences.
D. Culture directs behavior and moral-ethical decisions.
Answer: A, B and D
Rationale: Community may share the same culture. Hence, people living together may have
similarities in their ways of life. Although people in one community may have also differences and
this is influence by life’s experiences. These life experiences together with the pattern of beliefs
direct the behavior and moral-ethical decisions. In turn, these actions reflect the culture of a
community.
2. Obesity among Filipinos is common and highly attributed to: (select all that apply)
A. Hospitality
B. Faith and religiosity
C. Hardwork and industriousness
D. Malasakit
Answer: A and B
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Rationale: Filipinos love eating foods with friends and relatives. When visiting families, foods are
being served most of the time. Filipinos love to celebrate their patrons (fiestas), and culminating
activities includes plenty of foods to eat. Option C is reflected by Filipinos dedication to work.
Option D is depicted by Filipinos’ caring attitude to others.
3. Filipinos tend delay to see a doctor if they are not feeling well. This kind of attitude is
highly influence by what culture: (select all that apply)
A. Bahala na
B. Faith and religiosity
C. Ningas kugon
D. Malasakit
Answer: A and B
Rationale: Filipinos’ belief from a Supreme being that God is in control. Option C is an attitude
that is reflected by having inability to maintain industry or the like. Option D, is the caring attitude
of Filipinos
4. Filipino Nurses are known for their resilience. Resiliency is shown by:
A. Their caring attitude to the client
B. Hardworking even underpaid
C. Staying with client
D. Doing what is right even no one sees you
Answer: B
Rationale: Filipino nurses during difficult times continue to work even they are not receiving the
right treatment.
5. One of the challenges among PHNs is the geographical location of the community they
serve. Nonetheless, they work willingly with the people. This attitude is highly related to
what Filipino culture?
A. Malasakit
B. Family oriented
C. Joy and humour
D. Hard work and industriousness
Answer: A and D
Rationale: Filipino nurses genuinely cares and values work as they value other people.
6. Filipinos express their minds through arts:
A. Pagkamalikhain
B. Malasakit
C. Joy and humour
D. Hospitality
Answer: A
Rationale: Option A reflects the creativity of Filipinos. Option B pertains to caring attitude. Option
C is reflected by Filipinos’ attitude towards problem. Option D is the caring attitude of Filipinos to
visitors.
7. Most of the Filipino families are extended type. This best explains by what culture:
A. Family oriented
B. Joy and humour
C. Malasakit
D. Hospitality
Answer: A
Rationale: Filipinos are closely knit. Thus, this explains even children they have their own family,
they prefer to have their parents with them and vice versa. Option B is reflected by smiling and
laughing even in a difficult situation. Option C is the caring attitude of Filipinos to visitors. Option
D refers to the Filipinos’ way of warm welcome to visitors and even surprise visitors.
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8. Shiela slipped on the stage. However, she exclaimed loudly “Kaya ninyo ‘yon?” (Can you
do it?) The audience clapped their hands for her gesture. This kind of culture is reflected
by:
A. Creativity
B. Hard work
C. Joy and humour
D. Faith
Answer: C
Rationale: Joy and humour is best express not only by smiling and laughing but ability to turn
negative into positive just like what Shiela did. Option A is best expressed through Filipinos’ ability
to make arts and useful materials out from garbage and indigenous materials. Option B can be
shown by doing one’s best and trying hard to achieve one’s goals. Option D is hoping for
something that is not yet seen but believing that it exists.
9. Filipinos are known for their piyestas (feasts). Each place in the Philippines celebrates
their town feasts in relation to their patrons. Moreover, even strangers visiting their places
are being fed and warmly accepted. This culture is known as:
A. Family oriented
B. Religiosity
C. Hospitality
D. Malasakit
Answer: C
Rationale: Option C refers to the Filipinos’ attitude in welcoming visitors and even surprise
visitors. Option A is the culture of being closely-knit to family members. Option B is the spiritual
belief of Filipinos. It can be practices or beliefs. Option D is the caring attitude of Filipinos to
visitors.
10. Which among the following poses great danger to the PHN?
A. Location is geographical far from the main health center
B. Areas are infested with insects
C. Place is visited by leftists
D. Area is being claimed by several rebels
Answer: D
Rationale: When an area is being claimed, it is more likely that there are threats of danger.
Option A, geographically far from the main center will pose a challenge but not as dangerous to
areas where there are conflicts. Option B, presence of insects may impose danger to health but
not immediate danger. Option C poses also danger. However, not as dangerous to areas where
there are conflicts of territory.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to
help students track how much work they have accomplished and how much work there is left to do. This
tracker will be part of the student activity sheet.
Minute paper
The instructor will advise the students to complete the statement posted on the board.
If I will work as a public health nurse (PHN), I should be
______________________________.
If I will work as a public health nurse (PHN), I know that
______________________________.
Assignment: Management in the local Public Health System
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Interview 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 should answer the following:
Describe the Public Health Organization (PHO): Organizational chart
Ɣ Who are included in the PHO organizational chart?
Ɣ Who is the head of the PHNs?
What are the roles of nurses in public health in terms of the following?
Ɣ Planning
Ɣ Organizing
Ɣ Leading /directing
Ɣ Controlling
Ɣ Evaluation of personnel
Directions: The interview transcripts must be computerized and properly documented. Interview
transcripts: 8.5x11, single space, Times New Roman Font Size 12
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 4
Materials:
LESSON TITLE: LOCAL PUBLIC HEALTH SYSTEM
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Identify the different function of a public health nurse
manager.
2. Differentiate the principles of organization.
3. Describe the ethical considerations in nursing
management.
Book, pen and notebook
LCD and laptop
References:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
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
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will present pictures asked the students what culture is reflected.
Figure 1: Answer - Family oriented
Follow up Question: If Filipinos are family oriented, what possible problems that may arise?
Answer: Bigger family – more mouth to feed, needs may not be met
Figure 2: Answer - Joy and humor
Question: If Filipinos love to celebrate…and eat a lot…What possible health problems that may arise?
Answer: Diabetes; Obesity; Cardiovascular problems
MAIN LESSON (30 minutes)
The concepts about this session are from other references:
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FUNCTIONS OF MANAGEMENT
The functions of management are:
o Planning;
o Organizing;
o Staffing;
x
Planning
Organizing
Staffing
Leading
x
Leading; and
Controlling.
In the first level management, planning involves determining how to achieve the mandate
or work of the unit.
Above the first level of management, planning includes forecasting or estimating the
future; defining organizational philosophy and objectives establishing policies, standards
and procedures; developing strategies, programs and projects; and, preparing the budget.
x
x
x
It entails distributing and arranging the work to ensure that the unit functions smoothly.
Organizing means designing the organization.
It includes the developing an organizational structure based on work activities and
functions, and spelling out the lines of authority and communications among the different
units or sub-units within the organization.
x
x
Staffing is concerned with getting and developing people for the jobs in the unit.
Staffing includes selection of personnel, staff development, scheduling and giving
assignments. (Note: staffing may be included under the function of organizing.)
x
x
Leading is directed and motivating people to do their share in the unit’s work.
Leading (or directing) is the process of ensuring that the personnel do what they are
supposed to do to accomplish the goals of the organization.
It includes processes such as leadership, motivation and communication.
In addition, top management communicates with, and exerts influence to people outside
their organization.
x
x
x
Controlling
o
o
x
x
Controlling which is the last step in the management process, involves the setting of
standards, comparing actual performance with these standards, reporting the results of
assessments or evaluation, and taking corrective actions.
Controlling is determining the actual performance compared with the desired output and
taking the necessary corrective action/s (Rue and Byars, 1996:6).
It ensures that the organization is on track as far as its vision, missions, goals, objectives
and standards are concerned.
MANAGEMENT
o
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).
Management can be evaluated in terms of the
management structures in place (clear lines of
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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 a
board of trustees, president and senior vicepresidents, 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 of the journey.
MIDDLE MANAGEMENT SERVES AS A LINK BETWEEN THE CONCERNS OF TOP AND FIRST LEVEL
MANAGEMENT
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o
In small organizations such as local public health
organization, the distinction between top
management and middle management and between
middle management and supervisory level is at
times blurred. In fact, there may just be two:
o Levels: top and first level. The ‘higher’
management functions reside in the owners
(private organizations) or top local officials
(local public health organizations); and
o the operative or day-to-day concerns are
with the supervisors.
9
It is the same management functions that the
different managers do planning, organizing, staffing,
leading and controlling. However, they differ in the
scope of their functions.
Top management, understandably performs
functions and makes decisions that have greater
impact on the organization.
Although first level management is also important,
the consequences of supervisors ‘action or inaction
are generally less serious and could be remedied
more easily that those of top management.
While top managements spend almost the same
amount of time for the five functions, supervisors
spend most of their time in leading and controlling
(Rue and Byars, p. 7).
That is, they are focused on directly motivating their
supervisees to meet targets on time. Because they
are the closest to the operations of the organizationproduction line or service delivery- they are the first
to notice deviations or problems. They are,
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therefore, expected to address these immediately to
minimize the damage done and prevent their
recurrence.
™ To be able to perform their functions well,
supervisors should possess four types of skillstechnical, human relations, administrative, and
decision- making/ problem-solving.
o Technical skills refer to both knowledge and
skills related to the products and services of
the unit- processes, methods, and
equipment or machines, among others. In
service delivery unit, a supervisor knows the
job of his/her supervisees and can take their
place in emergency situations.
o Human relations skills refer to a supervisor’s
ability to work with individual employees,
he/she should also be able to foster
harmonious relationship among her
supervisees.
o Administrative skills refer to the supervisor’s
ability to planning, organizing and controlling
functions of first level management.
o Decision-making/ problem solving skills refer
to his/her ability to critically analyze
information and problems and make
appropriate decisions.
Higher level managers, in addition to human
relations skills, administrative skills, decision-making
and problem-solving skills, should have very good
leadership and communication skills, and political
savvy.
MANAGEMENT IN PUBLIC HEALTH
The management function discussed in nursing
management book (refer to Swansburg 1993, MarrinerTomey 1996)
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
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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
9 Big cities, demographically and financially speaking,
departments and offices in the local government
have bigger health departments.
unit.
9 These are a number of divisions, one of which is
The size of the department depends on a number of
nursing service.
factors such as population size, financial capability
9 A nursing service has a chief nurse, an assistant
of the LGU and the local leaders’ commitment to
chief nurse, a number of supervisors (some are
public health.
assigned to different programs such as maternal and
Cities, particularly first class cities have more health
child health) and PHNs and midwives who are
personnel (a few with more than a thousand) and
assigned to the different health centers.
health centers.
9 These health centers are headed by physicians.
There are, however, poor municipalities that have
9 The major programs are: maternal and child health,
only less than ten public health workers.
communicable disease prevention and control, nonThese are doctor-less municipalities so the public
communicable disease prevention and control
health unit is headed by a nurse who is usually a
(including lifestyle diseases), nutrition and
resident in the area.
environmental situation.
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9
Some health centers have other programs such as
those for specific population groups such as older
people. Some of the health services provided are
immunization.
Context of the local public health organization
o The capability of the public health system is
influenced by decisions made by the local chief
executive and council, especially those on budgetary
allocation.
o How the budget is determined and the degree of
participation of the health center staff in the
preparation of the health budget varies from one
LGU to another.
o Some health centers are consulted, other are not.
o The latter are just given their supplies, and many of
the health center managers do not know their
supplies, and many of the health center managers
do not know their actual budget. It is, therefore, not
uncommon for supplies to be depleted before the
next delivery supplies.
o Purchases of medical supplies and medicines are
done by another office.
o Although this is a standard practice, what is
unfortunate is that the end users are sometimes not
consulted about the specifications of the goods to be
purchased.
o Some of the contentious issues in a number of
health centers is the appointment, promotion and
movement of health personnel.
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o
o
o
o
o
o
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.
There are many cases where qualification standards
and established procedures are not followed. These
are cases where a nurse or a midwife is reporting for
work with his/her signed appointment papers without
having undergone adequate screening procedures.
There are other factors that affect the delivery of
health services and implementation of public health
programs.
Since health centers are usually located in the town
proper, the residents of far-flung barangays find it
difficult to go to town for consultation. travel time is
long and transportation cost is high.
Although there are barangay health centers, the
needed medicines and supplies are not always
available.
To make things worse, there is no efficient
communication system that link the health centers to
the barangay health stations and far-flung catchment
(coverage) areas.
These factors, in addition to client-related factors
pose as threats or as challenge to the public health
system.
THE NURSE AS A MANAGER AND SUPERVISOR
The following discussion of management issues and
(a mayor may be re-elected twice); (2) most LGUs do
concerns does not refer to a specific public health
not have adequate resources fir health; (3) there are
organization. These are premised on the following
LGUs with outstanding performance in health despite
realities and professional beliefs: (1) under a developed
their meager resources; (4) nursing care of/services to
set-up, the major decision-makers in health are the
their clients- individuals, families and communities.
elected local officials whose term of office is three years
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.
o In the strategic planning
managers review the
organization’s strengths,
weakness, opportunities and
threats (SWOT); and its, beliefs,
missions, vision and goal.
o Although strategic planning is a
function and responsibility of all
managers in an organization, in
strategic planning is a function
and responsibility of all managers
in an organization, the initiative
usually comes from top
management.
o In a public health organization, the
initiative usually comes from top
management.
o In a public health organization, the
chief nurse (or equivalent
position) should participate in
strategic planning so that the
aspirations of nurses and their
unique contribution could be
adequately articulated.
2. An operational plan, on the other hand, is shortrange plan that generally deals with the routine
activities of the organization.
o In a health center, for example, an
operational plan addresses the
requirements for delivering health
services. It may include the
training of health center staff,
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purchase of instruments and
equipment, introduction of a new
system in queuing of clients, and
a new system of recording,
among others.
A nursing service should have a plan that
addresses the specific needs and concerns of
nurses. While the general (for the whole health
department) operational services plan is
primarily for health care delivery, the nursing
service plan focuses on those that impact on
how nurse’s performance evaluation, review of
Preparation of budget
o Public health nurses play an important role in
preparing a budget for the health department/health
centers.
o They know how the health center operates and the
demands for the health center’s services. In
preparing a budget, PHNs should consider the costeffectiveness of their intervention/.
o All year round, they should assess the costeffectiveness of their activities or practices in the
health center and constantly explore on ways to
improve their efficiency.
Policies, Standards and Procedures
x 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.
x 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
x The organizing function of management entails the
setting up of an organizational structure, staffing and
the development of job descriptions.
x 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.
These plans should be realistic and should be
acceptable to the decision-makers. Any plan
program, particularly if it would require a
significant amount of financial resources should
have the support of the local council and the
mayor. The Local Health Board may also be
able to help in advocating for the nurse service
plan.
o
x
A sound budget is based on carefully identified
requirements: drugs and medical supplies,
instruments and equipment (based in the number of
clients- procedures done, medicines, dispensed,
etc., on the previous years, the adjustments due to
projected population increase and additional health
programs); and, necessary financial support for
personnel (salaries, GSIS, PhilHealth contributions,
retirement benefits, ravel allowance, Magna Carta
benefits, staff development); and repairs and
maintenance of the health center and ambulance,
etc.
standards prepared by the Department of Health,
Professional Regulation Commission and the
Philippine Nurses Association.
A nurse manager or supervisor should ensure that
these important documents are available to all PHNs
so that they are informed of their rights and
responsibilities as health workers and duties as
government employees.
(Nurse VII or Nurse VI). Understandably, there have
been and there will be structural changes in health
makers view health care delivery. There is, of
course, no one best way in structuring a public
health organization.
Principles of Organization
1. Division of work.
o
o
o
This is also called specialization or departmentation. How will the work (health
services) be divided? Is the division of work according to client groups (children,
women, elderly), or program (maternal and child, Communicable diseases, noncommunicable diseases)?
In big organizations, services can be organized into clusters or teams. This means that
a group or team of service providers (physician, nurse, midwife and others) are
assigned to a specific program or service. However, in a small health centers, probably
the only division of work that could be done is the one based on position (or
profession).
What are the duties and responsibilities of the physician, nurse and midwife?
Sometimes the distinction of these professional responsibilities is not clear. If there are
no doctors, nurses and midwives perform what are strictly (legally) considered as
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2. Coordination
o
3. Unity of command
o
4. Authority and
responsibility
o
5. Span of control.
o
o
o
medical functions.
Proper coordination results in harmonious relationship among the different groups
within the organization. There are functions common to all programs/services that
these should be well coordinated, among which are training and information, education
and communication (IEC). There should be established mechanism to coordinate
efforts in these areas. Usually, there are people assigned as coordinators for special
concerns. This assignment is in addition to the person’s regular functions.
This principle means that an employee should be responsible to, and receive orders
from, only one superior. In some health organizations, this may not be tenable. For
example, PHNs who are assigned to health centers may be responsible to, and receive
orders from two people- the chief nurse (who is usually based at the health department
office) and the head of the health center. To prevent confusion and ill feelings among
the staff, the areas of concern and responsibilities of the two heads should be
adequately delineated.
Authority means superior’s right to command and exact obedience from his/her
subordinates. If a person is given responsibility in the organization, he/she should also
be granted corresponding authority.
Span of control means “the number of subordinates reporting directly to a superior”
(Rankich, Longest, and O’Donovan, p. 149).
In the public health setting, the span of control for a PHN who is supposed to supervise
midwives, is determined by a number of factors, some of which are: subordinates are
from each other and from the superior and the level of difficulty at their work.
There are, however, no fixed rules in determining the subordinate-superior ratio. If
nurse supervisors are adequately recording their supervisory activities, it may be easier
to establish span of control in their respective areas.
Nursing in the organizational structure
x Given the changing landscape of health care
delivery, we have to confront these questions: how
should nursing (nurses) be reflected in the overall
organizational structure? Should there be a separate
nursing service or unit in the local health
department? What roles and functions should be
assigned to PHNs? There is no single answer to
each of these questions. Nurses should actively
participate in configuring the organization.
Job description
x A job description defines the responsibility and authority of a position.
x In writing the job description for the different health personnel, we should first list all the work/ effectively.
Staffing
x Staffing means determining the number of personnel
that an organization needs to meet its objectives and
demands of its clients, and assigning the right
(qualified) people to the different positions. One of
the problems of the LGUs is the inadequacy of
health personnel which is mostly due to inadequate
health budget.
x
Caragay and tobias (2001) studied the staffing
pattern of the rural health unit by looking into the
Leading (directing)
x To lead means “to show, mark the way, guide the
course” (Marriner –Tomey, 268). Leading, therefore,
is the process of ensuring that personnel do what
functions and responsibilities of the different RHU
unit by looking into the functions and responsibilities
of the different RHU personnel, the activity
standards and standards work load. Probably
because of the differences in the circumstances of
RHUs, activity standards vary from one place to
another. A manual came out of the study and this
can be used as reference in determining the staffing
requirements of RHUs.
they are supposed to do in order to accomplish the
goals of the organization. It involves process such as
leadership, motivation and communication.
Leadership
x The essence of leadership is influencing others). According Frunzi and Savini, leadership is characterized by five key
behavioral functions: coaching, counseling, evaluating, delegating and rewarding (p. 174). Leadership, therefore, is an
important component of good management.
x
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x
The challenge for nurse managers and supervisors is how to influence their subordinates to pursue the goals of the
organization. Specifically, in public health, leadership is influencing the staff to: (1) behave respectfully towards their
clients; (2) provide quality service; (3) meet program and/or service targets; (4) observe cost containment measures;
and, (5) observe organizational values such as honesty, cooperation and punctuality.
x
What is the “best” style of leadership in a public health setting? Literature discusses the different theories of
leadership- great man theory, charismatic theory, trait theory, situational theory, contingency theory, path-goal theory,
situational leadership theory, and transformational leadership theory- and their strengths and weaknesses. With their
different emphases, there is a need for an “integrative leadership model” (Marriner- Tomey, pp. 267-279).
Communication
x Communication is the most pervasive activity with an
organization. While working or while they are not
doing anything people communicate something.
However, the communication that is of great interest
to nurse managers is one that moves people to
action. The flow of their communication is vertical
(upwards and downward) and horizontal.
x Nurse managers communicate to their subordinates
about a number of things: policies, standards,
procedures and the work that need to be done;
pertinent discussions and decisions made by the
local chief executive and the local council; and,
feedback on important personnel issues and
concerns. In addition, they convey their concern for
their subordinates’ (and their families’) well-being.
x They also communicate upwards- to the head of
health department/ unit and to the local official. They
communicate to inform, give feedback and to
Controlling
x Controlling was defined by Fayol as “verifying
whether everything occurs in conformity with the
plan adopted, the instructions issued, and principles
established/ it has for its object to point out
weaknesses and error in order to rectify them and
prevent recurrence” (Swansburg, p.367). this
definition, together with many others, have four
major components: (1) plan, instructions, principles
and standards; (2) observation, measurements and
comparing “what is” with “what should be”; (3)
identification of weaknesses, problems, or errors;
and, (4) correcting, rectifying or doing something
about them.
x
x
influence. Their communication to the LGU’s
decision makers should be properly planned,
particularly the content and medium, if the purpose
is to influence, then, managers should have a good
presentation- written and/or oral. In addition to those
‘formal’ approaches, managers should also be able
to communicate in a style that is culturally
appropriate.
Nurse managers also communicate with their peers
from the other offices (e.g. personnel, purchasing,
supply, accounting, etc.) to enlist their support or
assistance. Maintaining an open communication line
with heads of other offices/ units can facilitate the
flow of papers and goods for the health
department/office. In small organizations,
communication with peers is more informal. In the
Philippines, our interactions within the organization,
particularly among peers are very personal.
Managers introduce controls within the organization.
Controls are important in improving services delivery
because they serve as reminders if there are
deviations from targets and standards. There are a
number of control that could be introduced into the
public health unit, some of which are: statistical
report, records (e.g., medicines, FP supplies) audit,
Gantt chart or schedule of activities, client feedback
and incident reports. Analyses of these, together
with personal observations give the manager an idea
on how things are going in the unit.
Evaluation of personnel
x These are many reasons why nurse managers should evaluate their staff. Marriner-Tomey (1996:382) identified ten
purposes of performance evaluation: “(1) to determine job competence: (2) to enhance staff development and
motivate personnel toward higher achievement; (3) to discover the employee’s aspirations and to recognize
accomplishments; (4) to improve communications between managers and staff associates and to reach an
understanding about the objectives of the job and agency; (5) to improve performance by examining and encouraging
better relationships among nurses; (6) to aid the manager’s coaching and counselling; (7) to determine training and
developmental needs of nurses;
x (8) to make inventories of talent within the organization and reassess assignments; (9) to select qualified nurses for
advancement and salary increases; and (10) to identify unsatisfactory employees”.
x
In the Philippines, the evaluation of the performance of government employees is mandated by the Civil Service
Commission, although there are many possible uses of performance evaluation, the most prominent are termination
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of “non-performing assets” and promotion of competent and model employees. From time to time, there are
opportunities for step increases in salaries
Guide in preparing a performance evaluation tool
1. Identify the major groups/categories of the PHN’s
functions (e.g. assessment, planning,
implementation, evaluation).
2. For each, formulate specific desired behaviors.
Make sure that your list adequately captures what
the PHN should be doing.
3. A PHN’s actual performance will be judged whether
it is outstanding (5), very satisfactory (3),
unsatisfactory (2), or needs improvement (1). Each
of these descriptive/numerical rating should be
operationally defined so that the evaluator and the
one being evaluated will have a common
understanding of them.
4. Identifying desirable work behaviour and/or
professional values that the organization deems to
be important (e.g., attendance, punctuality, courtesy,
honesty and working relationship with other staff of
the health center).
5. Operationally define the descriptive/ numerical rating
for each item (same as number 3).
Guide in concluding performance evaluation
1. Performance appraisal should be done jointly by the
PHN and his/her supervisor.
2. The appraisal interview should be conducted in nonthreatening way at the office of the supervisor. The
supervisor should ensure the confidentiality of what
transpired during the interview.
3. The supervisor should use available records and
reports to support his/her rating of the PHN.
4. The result of the evaluation should be thoroughly
discussed and the goals for the next evaluation
period should be identified.
5. Both the supervisor (rater) and PHN (rate) should
sign the accomplished evaluation form.
6. Supervisees who do not agree with their supervisor’s
final rating should be informed of their right to appeal
to a grievance within the LGU.
Ethical considerations in nursing management
x
x
x
x
One of the major challenges in nursing management
is the provision of an environment and mechanisms
to encourage nursing personnel to engage in ethical
practice. Ethical practice means providing quality
care to clients regardless of their social class and
beliefs (political and religious), respecting the rights
of clients and maintaining confidentiality of
information, it also includes behaving in a manner
consistent with the values and norms of the
community, professional codes of ethics (such as
the PNA Code for Nurses) and laws such the Civil
Science Law (PD 807) and Code of Conduct for
Government Employees (RA 6713).
PD 807 and RA 6713 provide a list of grave, less
grave and light offenses for government employees.
Some of the grave offenses are: dishonesty, gross
neglect of duty, grave misconduct, being notoriously
undesirable, conviction of a crime, falsification of
official documents. physical and mental incapacity or
disability due to vicious habits, engaging directly and
indirectly in partisan
political activities, contracting loans from persons
with whom the office of the employee has business
relations, disloyalty to the Republic and to the
Filipino people, oppression, disgraceful and immoral
conduct, inefficiency and incompetence in the
performance of official duties, frequent unauthorized
absences or tardiness, refusal to perform official
duty and gross insubordination.
Some of the less grave offenses are: simple neglect
of duty, simple misconduct, and gross discourtesy in
x
x
x
the course of official duties, insubordination, habitual
drunkenness, nepotism, and unfair discrimination in
rendering public service due to party affiliation or
preference.
Light offense include the following: neglect of duty;
discourtesy in the course of official duties; improper
or unauthorized solicitation of contributions from
subordinate employees; violation of reasonable
office rules and regulations; gambling prohibit by
law; refusal to render overtime service; borrowing
money from subordinates; lending money at
usurious rates of interest; pursuit of private business,
vocation of profession without permission required
by the Civil Service rules and regulations; and,
promoting the sale of tickets in behalf of private
enterprises that are not intended for charitable or
public welfare purposes.
Ethical practices should be discussed during
orientation and training programs and emphasized
during supervisory visits. It is very important that it
should be the overarching value in performance
standards and evaluation. In other words, it should
be incorporated into the performance standards and
criteria.
Nurse managers/supervisors should be the role
model in ethical public service. It is easier for them
to enforce the rules if they what they expect their
subordinates to observe. If managers expect ethical
practices from their staff, they should also practice
ethical management.
CHECK FOR UNDERSTANDING (20 minutes)
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The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. Which among the statements below describes span of control as an organizing principle?
A. This is called specialization which delineates work according to specific programs or to client groups.
B. It refers to conscious activity of assembling and synchronizing differentiated work efforts so that they function
harmoniously in the attainment of organization objectives.
C. This principle means that an employee should be responsible to, and receive orders from, only one superior
D. This principle means “the number of subordinates reporting directly to a superior”.
Answer: D
Rationale: Option A pertains to division of work. Option B refers to coordination. Option C depicts unity of
command.
2. Which among the following are reasons why nurse managers should evaluate their staff? (select all that
apply)
A. determine job competence
B. enhance staff development
C. aid the employee’s coaching and counselling
D. determine training and developmental needs of nurses
Answer: A, B and D
Rationale: Options A, B and D are correct. Option C, evaluation aid the nurse manager’s coaching and
counselling. It is not the employee who will coach and counsel but it is the nurse manager.
3. These are example of grave offense: (select all that apply)
A. falsification of official documents
B. physical and mental incapacity or disability due to sickness
C. engaging directly and indirectly in partisan political activities
D. frequent unauthorized absences or tardiness
Answer: A and D
Rationale: Options A and D are example of grave offense. Option B, when sickness or disability is due to vicious
habits, then it becomes a grave offense. Being sick or disable because of sickness is not an offense. Option C is
an example of less grave offense.
Matching Type
Function of Management
Choices:
A. Planning
B. Organizing
C. Staffing
D. Leading
E. Controlling
4. Designing the organization
Answer: B
5. Motivating people to do their share
Answer: D
6. Setting the standards
Answer: E
7. Getting and developing people for the unit
Answer: C
Rationale: Option A, planning involves determining how to achieve the mandate or work of the unit. Option B,
organizing entails distributing and arranging the work to ensure that the unit functions smoothly. It means
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designing the organization. Option C, staffing is concerned with getting and developing people for the jobs in the
unit. Staffing includes selection of personnel, staff development, scheduling and giving assignments. Option D,
leading is directed and motivating people to do their share in the unit’s work. It is the process of ensuring that the
personnel do what they are supposed to do to accomplish the goals of the organization. It includes processes
such as leadership, motivation and communication. Option E, controlling is the last step in the management
process, involves the setting of standards, comparing actual performance with these standards, reporting the
results of assessments or evaluation, and taking corrective actions. Controlling is determining the actual
performance compared with the desired output and taking the necessary corrective action/s. It ensures that the
organization is on track as far as its vision, missions, goals, objectives and standards are concerned.
Matching Type
Options
A. Grave offense
B. Less grave offense
C. Light offense
8. Pursuit of private business
Answer: C
9. Refusal to render overtime
Answer: C
10. Falsification of documents
Answer: A
Rationale: Some of the grave offenses are: dishonesty, gross neglect of duty, grave misconduct, being
notoriously undesirable, conviction of a crime, falsification of official documents. physical and mental incapacity or
disability due to vicious habits, engaging directly and indirectly in partisan political activities, contracting loans
from persons with whom the office of the employee has business relations, disloyalty to the Republic and to the
Filipino people, oppression, disgraceful and immoral conduct, inefficiency and incompetence in the performance
of official duties, frequent unauthorized absences or tardiness, refusal to perform official duty and gross
insubordination.Some of the less grave offenses are: simple neglect of duty, simple misconduct, and gross
discourtesy in the course of official duties, insubordination, habitual drunkenness, nepotism, and unfair
discrimination in rendering public service due to party affiliation or preference. Light offense include the following:
neglect of duty; discourtesy in the course of official duties; improper or unauthorized solicitation of contributions
from subordinate employees; violation of reasonable office rules and regulations; gambling prohibit by law; refusal
to render overtime service; borrowing money from subordinates; lending money at usurious rates of interest;
pursuit of private business, vocation of profession without permission required by the Civil Service rules and
regulations; and, promoting the sale of tickets in behalf of private enterprises that are not intended for charitable
or public welfare purposes.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Success criteria
The teacher will instruct the students to complete the statement:
I know that a manager and a supervisor PHN, he/she is responsible of ___________________.
(Reading Assignment: Evaluation in Community Health Nursing Practice)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 5
Materials:
LESSON TITLE: EVALUATION IN COMMUNITY HEALTH
NURSING PRACTICE
Book, pen and notebook
LCD and laptop
LEARNING OUTCOMES:
References:
At the end of the lesson, the nursing student can:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
1. Describe the evaluation process.
2. Develop an evaluation criteria.
LESSON REVIEW/ PREVIEW GUIDED AND HOOK ACTIVITY (5 minutes)
The teacher will ask to answer and rationalize the following questions:
1. The evaluation of the performance of government employees is mandated by the:
A. City Health Office
B. Department of Health
C. Civil Service Commission
D. Nursing Service Office
Answer: C
Rationale: In the Philippines, the evaluation of the performance of government employees is mandated by the
Civil Service Commission.
2. The following are example of less grave offense, EXCEPT:
A. simple neglect of duty
B. simple misconduct
C. habitual drunkenness
D. gross neglect duty
Answer: D
Rationale: Options A, B and C are example of less grave offense. Option D, gross neglect of duty is a grave
offense
MAIN LESSON (30 minutes)
The instructor should discuss the following topics.
EVALUATION IN COMMUNITY HEALTH NUSRING PRACTICE
o
o
o
Evaluation in community health nursing practice the
worth of nursing interventions/actions and public
health programs.
Evaluation of public health programs, performance
of health facilities/human resources and nursing
care given to clients (i.e., individuals, family,
population groups) provided very critical information
to decision makers at different levels.
As major function of public health nurses (PHN),
evaluation should be reflected in their job
description.
o
o
o
o
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PHNs are primarily responsible for evaluating the
nursing care rendered to clients.
While the evaluation of local health programs is the
primary responsibility of the head of the unit who is
most of the time, a physician, the PHNs participate
in evaluating these programs.
In some cases, a person external to the
organization is tasked to do program evaluation.
The participation of the PHN and other health
workers may just be as key informants, resource
persons and facilitators.
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o
o
Even if they are not the evaluators, PHNS should
have a working knowledge on program evaluation.
This will enable them to understand what the
external evaluator is doing and the bases of his/her
conclusions and recommendations.
o
o
As the immediate supervisors of midwives, the PHN
evaluates their performance and submits his/her
recommendations to the head of the unit.
He/she should, therefore, be knowledgeable about
the Civil Service policies and process of
performance.
EVALUATION OF NURSING CARE
o
As Alfaro-LeFevre (2002: 191) succinctly explains, evaluating nursing care given to individuals and families
includes analyzing, evaluating nursing care given to individuals and families includes analyzing nursing in puts in
each step of the nursing process. She illustrates this is in the following diagram:
o
As shown above, evaluation is a distinct process. However, it is related with primarily based objectives of nursing
care formulated during the planning phase. It is comparing “what actually is” with “what should be”. Evaluation
process can be initiative at the planning stage where objectives and criteria are specified.
Objectives and criteria
x
x
Objectives should be:
o client-centered; and
o outcome-focused
Evaluation focuses on how the client responds to the
planned process.
Objectives could be further elaborated by using
more specific criteria.
o In the examples given below, the objectives
“to be able to administer insulin correctly’,
“to be able to collect good sputum sample”,
o
and, “to be able to take care of a family
member”, will have to be operationally
defined.
Criteria are objective, measurable, relevant
and flexible indicators related to
performance, behavior, circumstances, or
clinical status (ICN.1989). This definition
implies that there are two or more criteria for
every objective or standard.
Examples:
Objective:
After two sessions, Mr. Santos will be able to administer insulin correctly.
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Criteria:
Mr. Santos: (1) washes his hands before preparing his injection; (2) uses insulin syringe
which corresponds to the concentration of available insulin; (3) prepares the prescribed
(correct) dose; (4) prepares insulin at room temperature; (5) disinfects the site of injection
with an alcohol swab; (6) injects the insulin subcutaneously; (7) does not inject insulin if he
missed his meals; (8) rotates the site of injection systematically (Luckman and Sorensen,
1980: 1556-9).
Outcomes
x
x
In other settings (such as the US), the evaluation of
health care given to clients focuses on the
outcomes. It must be noted that objectives are
statements of patient (client) outcomes. Whether to
use “objectives” or “outcomes” is really just a matter
of policy or preference.
For example, the clinical pathways (critical path)
seems to be the official guide in the care of patients
for purposes of reimbursement (third party payers). It
contains basically four items – assessment
parameters, nursing diagnosis, nursing interventions
and patient outcomes.
Outcome 1:
Criteria:
Outcome 2:
Criteria:
x
The focus on outcomes has a number of
advantages. It can easily pinpoint nursing
interventions that are effective and those that are
not. It can show the value of nursing care/service.
That is why the desired outcomes of care have been
incorporated into reimbursement schemes.
If we adopt the use of client outcomes, there is still a
need to identify a number of criteria to facilitate
evaluation. The following outcomes and criteria are
based on the family’s health task:
The family is able to recognize interruptions of health or development.
The family is able to: (a) identify deviations from normal functioning among its
members; and (b) identify abnormal manifestations among its members.
The family is able to seek appropriate health care.
The family is able to: (a) decide to seek the assistance of an appropriate health
personnel; (b) select the appropriate facility of health worker; and, (c) avail of
appropriate health care on time.
Designing and Implementing the Evaluation Plan
x In designing an evaluation plan, the PHN should
specify the criteria and corresponding evaluation tool
for each objective. Table 9 serves as a guide to
ensure that the evaluation plan does not miss on
important points.
x
x
There are different tools or instruments for
evaluating outcomes of nursing interventionsthermometer, blood pressure apparatus, weighing
scale, tape measure or ruler, checklist and interview
guide. If the expected outcomes are related to the
client’s condition, then he/she can be observed and
interviewed. For a post-CVA patient, an observation
checklist can be used to determine his response to
nursing interventions. If the patient’s level of
consciousness or orientation is altered, the
immediate members of the family can be
interviewed.
Table 9. Sample Form in Designing an Evaluation Plan
OBJECTIVE
CRITERIA FOR EVALUATION
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EVALUATION TOOL
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x
A checklist is a good evaluation tool if there are a number of criteria for an objective. For example, if the PHN is
going to evaluate the response of the family client to the community’s Malaria Prevention and Control Program,
he/she should prepare a checklist similar to the one shown in Table 10.
Table 10. Sample Evaluation Checklist
Direction: Put a check mark on the appropriate column and write significant explanatory notes on the Remarks
column.
Check if Observed
Criteria
YES
NO
Remarks
1. The client takes prescribed anti-malarial drugs
correctly.
2. Each family members sleeps under a mosquito net.
3. The family eliminates the breeding and resting sites
of the mosquito vector.
4. The family takes care of the family member with
malaria correctly.
x
If the evaluator would like to measure the knowledge of the client, relevant question should be asked. If the
objective of the nursing intervention is to increase the knowledge of the mother on nutrition of children, then the
questions that will be asked should be specific to the identified criterion. In preparing a list of questions to be
asked, the evaluator should make sure that the questions are clear and easy to understand.
For example:
x
x
Criterion:
The mother will be able to identify the
consequences of vitamin A deficiency.
Question:
“Misis, puwede mo bang sabihin ang lahat
ng alam mo na maaaraing mangyari sa
batang kulang sa Vitamin A?”
Criterion:
The mother will be able to identify food
sources of Vitamin A.
Question:
“ Misis, maaari bang magbigay ng limang
pagkain na mayaman sa BItamina A?”
If the skills are the focus of the evaluation, the client
can be asked to demonstrate the specific skills that
he/she learned or observed for specific health
practices or behaviors. Because of the limitations of
the evaluator’s observations (he/she is not there all
the time), he/she can ask the significant others for
their observations.
Attitude can be assessed through qualitative, semistructured or unstructured interviews. In our
kwentuhan with our clients, when they are more
relaxed and not threatened with our presence, they
tend to be more open with their feelings. Through
x
x
informal talks, it is easier to assess our client’s
attitudes.
After the collection and analysis of data/information,
the nurse should give his/her clients feedback on the
results of evaluation. Giving feedbacks serves many
purposes, among which are: motivates and
reinforces positive behaviors, enhances client’s selfimage and increases client’s awareness of the need
to improve their repertoire of coping behaviors.
Feedback sessions provide an opportunity for clients
to articulate their thoughts regarding the tasks on
hand. The result of the evaluation and feedback
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sessions should be properly documented. The family
health record and other pertinent client records
should be updated regularly.
PROGRAM EVALUATION
Planning
>>> Implementation>>> Monitoring >>> Evaluation
x
x
range from thousands to millions of pesos. Since
health resources, both of the national and local
governments are very limited, health care providers
should ensure their proper utilization. This could be
done by monitoring and evaluation of health
programs.
Public health programs are conceived to address the
country’s or community’s major health problems.
The decision to put up a public health program is a
recognition of the magnitude and preventability of
the health problem and the possibility of preventing
unnecessary deaths, disability, pain and suffering.
The programs differ in scope and magnitude implies
that their also vary. The budget of programs can
Monitoring and Evaluation
x
x
x
Monitoring and evaluation are closely related.
Monitoring which is done at the implementation
phases compares the actual progress (of the
implementation of the program) against what was
planned. The purpose of monitoring is to identify
deviations or problems so that corrective actions or
interventions cab be instituted immediately. This
implies reporting to appropriate persons or offices at
regular intervals.
It is defined as the “process for determining
systematically and objectively the relevance,
efficiency and effectiveness and impact of activities
in the light of their objectives” (UN, 1978).
In other words, evaluation could help prevent costly
mistakes and improve program planning and
implementation in the future.
x
There are three types of evaluation: ongoing,
terminal and ex post evaluation.
o Ongoing evaluation is the “analysis during
the implementation of the activity, of its
continuing relevance, efficiency and
effectiveness and present and likely, future
outputs, effects and impact”.
o Terminal evaluation is undertaken from 6-12
months after the project completion”. It is
also a substitute for an ex post evaluation of
projects with short duration.
o Ex post evaluation is undertaken some
years after project completion when full
program/project benefits and impact are
expected to have been realized (UN, 1978).
Focus of Evaluation
x There are three major foci of program evaluation- inputs, processes and results or outcomes- and these should be
viewed within this context (Figure 9).
Figure 9: framework for Program Evaluation
x
There program results-output, effect and impact- correspond of the three levels of program objectives: short-term,
intermediate or medium-term and long-term.
o Outputs are the specific products or services which an activity is expected to produce from its inputs to
achieve its objectives (short-term).
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o
o
Effects are the outcomes of the use of project outputs (intermediate).
Impact it the outcome of program effects and is an expression of broader, long range program objectives.
x
Ongoing program evaluation focuses on the appropriateness and adequacy of inputs needed and the
appropriateness, adequacy and timeliness of processes or inactivities. Addressing concerns related to program
results- output, effect and impact.
x
Terminal and ex post evaluation have two purposes:
(1) to assess the achievement of overall results of the program; in terms of efficiency, outputs, effects and
impacts; and,
(2) to learn lessons for future planning.
x
x
x
After one year, the evaluator can collect and analyze data on a program’s outputs such as: number of fully
immunized children, number of sanitary toilets constructed and the number of patients who completed their shortcourse chemotherapy. The effects of these could be measured a few years later. With high programs outputs, it is
expected that the incidence of tuberculosis, poliomyelitis, measles, diphtheria, pertussis, tetanus, hepatitis B and
diarrheal diseases will be reduced significantly. A program’s long-term effect of impact such as increase in the
average life expectancy and improvement in the quality of life will manifest a longer period of time.
A good understanding of the context can lead to a better appreciation of the interactions of the three major foci of
program evaluation- inputs, processes and results. The context does not only serve as a background for the
implementation of programs and the operation and management of the health facility. It is a major consideration in
the identification of indicators and the actual conduct of the evaluation.
For examples, if the management of a company will evaluate an Employee Health Promotion Program, evaluators
will also include indicators on productivity, benefit costs (e.g. health insurance costs and compensation claims)
and image of the organization in addition to health promoting behaviors of employees, morbidity rate and rate of
absenteeism.
Indicators
An objective is a desired result while an indicator is a
performance measure.
o It is specific and objectively verifiable measure of
changes or results brought about by an activity.
Indicators are used as markers of progress
towards the attainment of program objectives;
these are not numerical targets in themselves.
o
o
For examples: percentage (%) of leprosy
patients who completed the multi-drug therapy
(MDT).
An indicator should be valid, reliable, objective,
sensitive, specific, cost-effective and timely.
x
An indicator is valid it actually reflects what it is intended to reflect or if it measures what is supposed to measure;
x
x
reliable, if it lends itself to measurement with minimum error;
objective, if it is not influenced by personal biases or if the answers are the same, if measured by different people
in similar circumstances;
sensitive, if changes in the indicator in fact reflect changes in the situation or phenomenon;
specific, if it is sensitive to the given situation or phenomenon only;
cost-effective, if the results are worth the time and money. It cost to apply them; and
timely, if it is possible to collect data reasonably quickly.
x
x
x
x
Examples:
Input indicators:
(1) Number of 200,000 I.U, vitamin A capsules procured; (2) number and type of nutrition
information and education materials developed and reproduced; (3) number of seeds and
seedlings and garden tools procured; and (4) percentage of targets trained on the
prevention and control of vitamin A deficiency by type of personnel.
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Process indicators:
(1) Percentage of 200,000 I.U vitamin A capsules distributed to field offices; (2) percentage of
nutrition information and education materials actually distributed to field offices; and, (3)
percentage of seeds and seedlings and garden tools procured actually distributed to field
offices.
Output indicators:
(1) Number of preschoolers who were weighed; (2) number of TB symptomatic examined; (3)
number of elementary school children whose stools were examined; and, (4) number of
pregnant women who received tetanus toxoid.
Effect indicators:
(1) Number of preschoolers who increased weight; (2) number of children whose stools are
negative for ova; and, (3) number of babies with tetanus neonatorum.
Impact indicators:
(1) Mortality rate; (2) average life expectancy; and, (3) quality of life.
x
Effectiveness refers to the extent to which the
program’s objectives have been achieved. To
evaluate the effectiveness of a community’s
maternal and child health program, these indicators
may be used: (1) infant mortality rate; (2) maternal
mortality rate; (3) percentages of infants who were
exclusively breastfed for 4-6 months; (4) coverage of
antenatal, delivery and post-natal care by trained
personnel; (5) percentage of couples using modern
contraceptive methods; (6) percentage of fully
immunized children; and, (7) knowledge, attitudes
and practice lifestyle. These are some of indicators
identified by the WHO (1995). The evaluator’s
decision to use specific indicators depends on many
factors such as the program components or
services, availability of data and ease in data
collection.
Steps in program Evaluation
x
There are sic steps in program evaluation: deciding what to evaluate, designing the evaluation plan, collecting
relevant data, analyzing data, making decisions and reporting/giving feedback.
1. Designing What to Evaluate
2. Designing the Evaluation Plan
The WHO suggested five dimensions of program performance that could be
the evaluated: relevance, progress, effectiveness, impact and efficiency. To
address these dimensions, the evaluator should review the program context
and objectives. The questions that need to be answered at this point are:
what should be evaluated? What indicators should be used?
Designing an evaluation plan means specifying data collection methods and
tools and sources of data. Records and reposts can be reviewed and
analyzed. Surveys can be conducted to collect information on client’s
knowledge, attitudes practices. Local officials, community leaders and
program implementers can also be interviewed. Data collection tools
included questionnaires or interview schedules and checklists (table 11).
Qualitative interviews or focus group discussions can be conducted among a
much smaller number of participants to have more in-depth understanding of
the program outcomes from the perspective of the beneficiaries. Qualitative
data complements quantitative survey data.
What to Evaluate
and Evaluation
Indicators
Table 11. Sample Evaluation Plan Format
Data/Information
Data Collection
Needed
Methods/Tools
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3. Collect Relevant Data
4. Analyze Data
5. Make Decisions
The evaluator’s primary aim is the generation of accurate and reliable data.
Prior to actual data collection, data collection method and tools should be
filed-tested and data collectors should be trained.
Evaluators are sometimes faced with poor quality of available data. Poor
quality means incomplete, inaccurate, inconsistent or simply unbelievable.
This problem can be prevented, or at least minimized, if this concern is
addressed during the program planning stage.
Evaluators should assess the quality of data before they start their analysis.
What to do the figures/statistics mean? What to do the qualitative data
reveal? Depending on the type of evaluation being conducted (ongoing,
terminal or ex post evaluation), the main questions that should be asked are:
Is the program relevant? Is it progressing in accordance with the program
plan? Is it effective? Is it efficient? Did it make a significant impact on the
beneficiaries and the community Do the benefits outweigh the problems
created (if there are)? What are the lessons that could be learned from the
program?
If the intervention program was effective and efficient, this could be
continued and/or applied to another client group, given similar
circumstances. This is, of course, with the recognition that there is no one
best way to implement and intervention program.
If there is still another phase of the program, then the positive evaluation
results serve as a go-signal to start the next phase. Based on the lesson
learned from the earlier phase, the implementation of the next phase will
have to be guided, modified or improved.
6. Report/Give Feedback
If the program is not relevant, the evaluator should recommend its
modification or termination.
The result of the program evaluation should be submitted to local authorities
such as the mayor, chair of the Sangguniang Bayan committee on health,
and the Local Health Board. It should be noted that these are the key
decision makers in the local health system.
An executive summary should be prepared for them. It should contain a brief
description of the focus and procedures of the evaluation, summary and
interpretation of evaluation results, conclusions and recommendation. The
nurse and other health workers must be prepared to make a presentation to
the Sangguniang Bayan or to the Local Health Board.
If the nurse will be asked to make a presentation, he/she should prepare
good visual aids. He/She should rehearse and prepare for the questions that
may be asked. A good written report and an impressive oral presentation can
influence decision makes positively.
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CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. PHN Grace is designing the program evaluation. She included the five dimensions. To address the
dimensions, Grace must ask the following questions EXCEPT:
A. What indicators should be used?
B. What should be evaluated?
C. What are the program objectives?
D. What are the responses of the people in the community to the program?
Answer: D
Rationale: The WHO suggested five dimensions of program performance that could be the evaluated: relevance,
progress, effectiveness, impact and efficiency. To address these dimensions, the evaluator should review the
program context and objectives. The questions that need to be answered at this point are: what should be
evaluated? What indicators should be used? Option D aims to collect the data which is the third step of Program
evaluation.
2. The program evaluated was found to be effective. What should be the recommendations?
A. The program must be terminated.
B. The program must be modified.
C. The lesson learned will serve as a guide in modifying the program.
D. The program can be applied to another group with same characteristics.
Answer: D
Rationale: Once the program is found to be effective it should be continued and/or applied to another client
group, given similar circumstances. Options A, B and C are the recommendations if there program is found to be
irrelevant.
Multiple Response
3. Evaluators sometimes faced poor quality of available data. In order to minimized if not prevented, the
PHN must:
A. Tools should be filed-tested
B. Data collectors should be trained
C. Data collection must be filed tested
D. Poor quality data must be addressed during the program planning stage.
Answer: A, B, C and D
Rationale: To generate accurate and reliable data. It is important to do file testing to the data collection method
and tools and data collectors must be trained. Addressing the concern of poor quality data must be done during
the planning stage to lessen if not prevented.
4. An indicator that reflects what is to be achieved:
A. Valid
B. Reliable
C. Objective
D. Specific
Answer: A
Rationale: Option A, an indicator is valid if it actually reflects what it is intended to reflect or if it measures what is
supposed to measure. Option B, reliability is present if it lends itself to measurement with minimum error. Option
C, objectivity is met when it is not influenced by personal biases. Option D, if it is sensitive to the given situation.
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5. Which among the following objective is properly constructed?
A. Eighty-five percent (85%) of leprosy patients will complete the multi-drug therapy (MDT).
B. After two sessions, Mr. S will be able to check his blood sugar accurately.
C. Mr. S will wash his hands before pricking his finger for blood extraction,
D. Mr. S’s family will accompany him to diabetes clinic.
Answer: B
Rationale: The only statement which is SMART. Option A lacks time frame. Option C and D are examples of
criteria. The following items 1-3, test your knowledge in formulating criteria based from the outcome. Select all
possible criteria in relation to the outcome.
6. Outcome: The family is able to provide nursing care to the sick member of the family. The family is able
to:
A. correctly perform appropriate interventions in caring for the sick member of the family
B. identify signs and symptoms indicative of improvement or worsening of condition
C. refer the member to appropriate health facility or health worker on time
D. give alternative treatment even without health workers’ advise
Answer: A, B and C
Rationale: Options A, B and C are correct, geared towards the outcome. Option D, all treatments to be rendered
must be appropriate and approved by the healthcare worker to avoid further problems.
7. Outcome: The family is able to maintain an environment conductive to good health and personal
development.
A. provide physical and social environment that promotes the members’ health and well-being
B. identify factors that can adversely affect the members’ health and well-being
C. mitigate the effects of non-modifiable factors
D. modify/eliminate/control the factors that adversely impact on the members’ health and well-being
Answer: A, B, C and D
Rationale: All options will help achieve the outcome
8. Outcome: The family is able to maintain reciprocal relationship with the community and health
institutions. The family is able to:
A. participate in health and health related activities in the community
B. share resources with other members of the community
C. provide feedback to health personnel/institutions regarding health policies, programs, projects and activities
D. join community activities upon request
Answer: A, B and C
Rationale: Options A, B and C are criteria that are geared towards the outcome. Option D is incorrect, family
must join activities even without request
The following items 9-10, test your knowledge in formulating criteria based from the objective. Select all
possible criteria in relation to the objective.
9. Objective: After one month, the family will be able to take care of the malnourished child. The family will
be able to:
A. allocate resources to meet the nutritional needs of the malnourished member
B. identify readily available and affordable nutritious food for the child
C. feed the child based on readily available
D. bring the child to the RHU for weight monitoring regularly
Answer: A, B and D
Rationale: Options A, B and D are correct. Option C, the food to be given must be based on agreed-upon quality
and quantity of food and not is what readily available.
10. Objective: During home visit, Mr. Jaime will be able to collect a good sputum sample for microscopy. Mr.
Jaime collects the sputum specimen as instructed:
A. breathes air deeply
B. coughs strongly at the height of inspiration
C. spits the sputum into sterile container
D. submit the sterile container uncovered
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Answer: A B and C
Rationale: Options A, B and C will result to a good sputum sample collection. However, it must be placed in
covered sterile container, thus Option D is incorrect.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
CAT 3-2-1
The instructor will advise the students to write their answers on the space provided in their SAS.
Q1. Enumerate at least three words related to Evaluation.
Answers: Outcome; objective; criteria
Q2. List at least two outcomes for a family with TB
Answers: O1 - The family is able to provide nursing care to the sick member of the family.
O2 - The family is able to prevent transmission of TB within their home.
Q3. Give at least one criterion to achieve the outcome: (choose one outcome only)
Answers: O1 – The family correctly perform appropriate interventions in caring for the sick member of the family.
Identify signs and symptoms indicative of improvement or worsening of condition.
Refer the member to appropriate health facility or health worker on time.
Answers: O2 – The client maintains to use mask until sputum examination is negative.
The family observes frequent handwashing.
The family maintains appropriate nutritional status to boost immune system.
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 6
LESSON TITLE: COMMUNITY HEALTH NURSING
PROCESS
Materials:
LEARNING OUTCOMES:
Book, pen and notebook
At the end of the lesson, the nursing student can:
White boardmarker
1. Differentiate the elements of community diagnosis.
2. Assess a community using five (5) elements of
community diagnosis.
3. Discuss the steps in nursing diagnosis
4. Identify problems to be prioritized.
5. Utilize nursing process in managing community health
concerns.
LCD and laptop
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will show the following slide and instruct the students and ask them to arrange the steps in
evaluation.
o
o
o
o
o
o
Analyze data
Make decisions
Design the evaluation plan
Collect relevant data
Report/give Feedback
Decide what to evaluate
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 7 Famorca et al., 2013 ):
COMMUNITY HEALTH 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
ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS
1. Demographic profile
The analysis of the community’s demographic
characteristic should show the size, composition and
geographical distribution of the population as indicated
by the following:
x total population and geographical distribution
including urban-rural index and population
density
x
x
x
x
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age and sex composition
selected vital indicators such as growth rate,
crude birth rate, crude death rate and life
expectancy at birth
patterns of migration
population projections
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It is also important to know whether there are population
groups that need special attention such as indigenous
people, internal refugees and other socially dislocated
2. Socio-economic and cultural profile
There are no limits as to the list of socio-economic and
cultural factors that may directly or indirectly affect the
health status of the community. However, the nurse
should consider the following as essential information:
A. Social indicators
a. Communication network (whether formal or
informal channels) necessary for disseminating
health information or facilitating referral of clients
to the health care system
b. Transportation system including road networks
necessary for accessibility of the people to
health care delivery system
c. Educational level which may be indicative of
poverty and may reflect on health perception
and utilization pattern of the community
d. Housing conditions which may suggest health
hazards (congestion, fire, exposure to elements)
B. Economic indicators
a. Poverty level income
b. Unemployment and underemployment rates
c. Proportion of salaried and wage earners to total
economically active population
d. Types of industry present in the community
e. Occupation common in the community
C. Environmental indicators
a. Physical/geographical/topographical
characteristics of the community
- Land areas that contribute to vector
problems
groups as a result of disasters, calamities and
development programs.
Terrain characteristics that contribute to
accidents or pose as geohazard sones
- Land usage in industry
- Climate/season
b. Water supply
- % population with access to safe, adequate
water supply
- Source of water supply
c. Waste disposal
- % population served by daily garbage
collection system
- % population with safe excreta disposal
system
- Types of waste disposal and garbage
disposal system
d. Air, water and land pollution
- Industries within the community having
health hazards associated with it
- Air and water pollution index
D. Cultural factors
a. Variables that may break up the people into
groups within the community such as:
- Ethnicity
- Social class
- Language
- Religion race
- Political orientation
b. Cultural beliefs and practices that affect health
c. Concepts about health and illness
3. Health and illness patterns
x In analysing the health and illness patterns, the
nurse may collect primary data about the leading
causes of illness and deaths and their respective
rates of occurrence. If she has access to recent and
reliable secondary data, then she can also make use
of these.
4. Health resources
The health resources that are available in the
community is an important element of the community
diagnosis mainly because they are the essential
elements in the delivery of basic health care
services. The nurse needs to determine manpower,
institutional and material resources provided not only
by state but those which are contributed by the
private sector and other non-government
organizations.
a. Manpower resources
- Categories of health manpower
available
- Geographical distribution of health
manpower
- Manpower- population ratio
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-
a.
b.
c.
d.
e.
Leading causes of mortality
Leading causes of morbidity
Leading causes of infant mortality
Leading causes of maternal mortality
Leading cause of hospital admission
-
-
Distribution of health manpower
according to health facilities (hospitals,
rural health units, etc)
Distribution of health manpower
according to type of organization
(government, non-government, health
units, private)
Quality of health manpower
Existing manpower
development/policies
b. Material resources
- Health budget expenditures
- Sources of health funding
- Categories of health institutions
available in the community
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-
Hospital bed-population ratio
5. Political /leadership patterns
The political and leadership pattern is a vital element
in achieving the goal of high level wellness among
the people. It reflects the action potential of the state
and its people to address the health needs and
problems of the community. It also mirrors the
sensitivity of the government to the people’s struggle
for better lives.
In assessing the community, the nurse describes the
following:
-
Categories of health services available
1. power structure in the community
(formal/informal)
2. attitudes of the people toward authority
3. conditions/events/issues that cause social
conflict/upheavals or that lead to social bonding
or unification
4. practices/approaches that are effective in
settling issues and concerns within the
community
SOURCES OF DATA IN THE CONDUCT OF COMMUNITY DIAGNOSIS
1. Primary source
- Adult family member who can
answer the queries
2. Secondary source
- Health center’s data
- Hospital data
TYPES OF COMMUNITY DIAGNOSIS
A. Comprehensive Community Diagnosis
B. Problem-Oriented Community Diagnosis
- This aims to obtain general information about
- A type of assessment that responds to a
the community. The elements of the
particular need.
comprehensive diagnosis were discussed in the
- For example, a nurse is confronted with health
previous session.
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.
STEPS IN CONDUCTING A COMMUNITY DIAGNOSIS
1. Determining the objectives
- Determine the depth and scope of the data to be
gathered
2. Defining the study population
- Identify the population to be included
o Entire population
o Focused on a specific population
3. Determining the data to be collected
- The objectives will determine what data will be
collected.
4. Collecting the data
- Different methods can be utilized to generate
health data.
o 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.
o Surveys and observations – can be
used to obtain both qualitative and
quantitative data
o 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
5. Developing the instrument
- Instruments or tools facilitate the nurse’s data
gathering activities
o Survey questionnaire
o Interview guide
o Observation checklist
6. 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 analysed
- Pre-testing of the instrument is highly
recommended
- Data collectors must be oriented and trained
(role-play can be conducted)
o
-
During actual data gathering, the nurse
supervises the data collectors by checking their
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filled-up instrument in terms of completeness,
accuracy and reliability
7. Data collation
- Numerical data – counted
- Descriptive data - described
8. 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
For comparisons of absolute or relative counts and rates between categories
Graphic presentation of frequency distribution or measurement
Bar graph/pictograph
Histogram/frequency polygon
Proportional or component
chart
Scattered diagram
bar/pie
Shows breakdown of a group or total where the number of categories is not
too many
Correlation data for two variables
9. 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
10. Identifying the community health nursing problems
- Health status problems
o They may be described in terms of
increased or decreased morbidity,
mortality, fertility or reduced capability
for wellness.
-
-
Health resources problems
o They may be described in terms of lack
or absence of manpower, money,
materials or institutions necessary to
solve health problems.
Health-related problems
o 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
Psychosocial
Physiological
Health-related
behaviors
Areas
of
Concern under
the 4 domains
Identify
if problem is:
- Promotion
- Potential
- Actual
- Level of clientele
Cluster of signs and
symptoms
that
describe the problem
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
11. Priority setting
- Criteria
a. Significance of the problem
b. Level of community awareness
c. Ability to reduce risk
d. Cost of reducing risk
o The nurse has to consider economic,
social and ethical requisites and
consequences of planned action.
e. Ability to identify the target population
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For the intervention is a matter of
availability of data sources, such as
FHSIS, census, survey reports and or
case-finding and screening tools
Availability of resources
o
f.
o
May include 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.
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.
Cruz
Midwife
B. Tan
BHW
Dionisia
Mr.
Miranda
Mr.
Peralta
Average
Weight
Significance of the problem
Community awareness
8
8
10
8
7
5
10
5
6
5
8
6
Ability to reduce risk
Cost of reducing risk
10
8
10
8
10
8
10
8
10
8
10
8
Ability to identify target population
4
5
6
5
6
5
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?
Criterion
Midwife
B. Tan
BHW
Dionisia
Mr. Miranda
Mr. Peralta
Average
Weight
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
population
10
10
10
8
6
9
Availability of resources
4
4
3
2
2
3
Significance
problem
Nurse
Cruz
of
the
J.
Computation of problem priority score
Problem: Risk of maternal complications leading to maternal mortality in Brgy. Bagong Silang
Criterion
Criterion
Criterion
Problem
weight
rating
(weight x rating)
(1-10)
(1-10)
Significance of the problem
8
6
48
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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
Identification of community health nursing problems
9 Health status problems – increased or
9 Health-related problems – existence of social,
decreased morbidity, mortality, fertility
economic, environmental, and political factors
e.g. 40% of the school-age children have ascariasis
that aggravate the illness-inducing situations in
9 Health resources problems – lack or absence of
the community
manpower, money, materials, or institutions
e.g. 30% of the households dump their garbage in the
necessary to solve health problems
river
e.g. 25% of the BHWs lack skills in vital-signs taking
PRIORITY SETTING OF COMMUNITY HEALTH NURSING PROBLEMS
CRITERIA:
ƒ MODIFIABILITY OF THE PROBLEM – probability of
ƒ NATURE OF THE PROBLEM PRESENTED –
reducing, controlling , or eradicating the problem
health status, health resources, or health-related
ƒ PREVENTIVE POTENTIAL – probability of
problems
controlling or reducing the effects pose by the
ƒ MAGNITUDE OF THE PROBLEM – severity of the
problem
problem and measured in terms of the proportion of
ƒ SOCIAL CONCERN – perception of the
the population affected by the problem
population/community as they are affected by the
problem
CRITERIA
SCORE
WEIGHT
NATURE OF THE PROBLEM
- Health status
- Health resources
- Health-related
3
2
1
1
MAGNITUDE OF THE PROBLEM
75% - 100% affected
50% - 74% affected
25% - 49% affected
!25% affected
4
3
2
1
3
MODIFIABILITY OF THE PROBLEM
- High
- Moderate
- Low
- Not modifiable
PREVENTIVE POTENTIAL
- High
- Moderate
- Low
3
2
1
0
4
3
2
1
1
SOCIAL CONCERN
- Urgent community concern
- Recognized as a problem but not needing an
urgent attention
- Not a community concern
2
1
0
1
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STEPS IN PRIORITIZING HEALTH PROBLEMS
1.
2.
3.
4.
Score each problem according to each criteria.
Divide the score by the highest possible score.
Multiply the answer by the weight of the criteria.
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
Nature of the problem
x (health status) - (3/3) x 1= 1
Magnitude of the problem
x (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
x (high) – (3/3) x 4 = 4
Preventive potential
x (high) – (3/3) x 1 = 1
Social concern
x (Urgent community concern) – (2/2) x 1 = 1
Total : 8 ½
Problem 2
Nature of the problem
x (health resources) - (2/3) x 1= 2/3
Magnitude of the problem
x (25%-49% affected) – (2/4) x 3 = 1 ½
Modifiability of the problem
x (high) – (3/3) x 4 = 4
Preventive potential
x (high) – (3/3) x 1 = 1
Social concern
x (Urgent community concern) – (2/2) x 1 = 1
Total : 7 3/4
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. The health status of the community is a product of the various interacting elements such as:
A. Population
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B. Physical and topographical characteristics
C. Socio-economic and cultural factors
D. Power structure within the community
Answer: A, B, C and D
Rationale: All options affect/determine the health status of the community.
2. This shows the size, composition and geographical distribution of the population:
A. Demographic variables
B. Socio-economic and cultural variable
C. Health and illness patterns
D. Political or leadership patterns
Answer: A
Rationale: Option A describes the demographic profile. Option B pertains to social, economic and cultural
indicators. Option C indicates the causes of illness and deaths in the community. Option D mirrors the sensitivity
of the government to the people’s struggle.
3. The following are indicative of the social status of the community: (select all that apply)
A. Communication network
B. Poverty income level
C. Educational level
D. Housing conditions
Answer: A, C and D
Rationale: Option B is an economic indicator. Social status pertains to the community’s communication network,
transportation system and housing conditions.
4. These variables help determine the delivery of health services: (select all that apply)
A. Communication network
B. Manpower population ratio
C. Categories of health services available
D. Power structures in the community
Answer: B and C
Rationale: Option A pertains to social indicators. Option D determines political/leadership patterns
5. These are variables that may break up people into groups within the community:
A. Social indicators
B. Economic indicators
C. Environmental indicators
D. Cultural indicators
Answer: A, B and D
Rationale: Classes or groups among people are influence by social indicators (educational level), economic
status and culture. Although people’s environment is influence by their social classes, some people may live in
one community and share similar physical characteristics of the community.
6. The nurse is about to prepare a data presentation. Knowing there are only three categories and she
wanted to show the breakdown, she will likely use what type of graph?
A. Bar graph
B. Pie chart
C. Scattered diagram
D. Histogram
Answer: B
Rationale: Option B, pie chart or proportional or component bar graph shows breakdown of a group or total where the
number of categories is not too many. Option A, bar graph shows trend data or changes with time or age with respect
to some other variable. Option C, scattered diagram presents correlation data for two variables. Option D, histogram is
a graphic presentation of frequency distribution or measurement.
Situation: After collating the data in the community diagnosis, the nurse learned that one of the community
health problems is that 70% 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.
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7. What is the nature of the problem?
A. Health status
B. Health resources
C. Health related
Answer: A
Rationale: Option A, health status may be described in terms of increased or decreased morbidity, mortality, fertility
or reduced capability for wellness. A 70% of school-age have ascariasis depicts increased morbidity. Option B, health
resources problems refers to lack or absence of manpower, money, materials or institutions necessary to solve health
problems. Option C, health related pertains to the existence of social, economic, environmental and political factors
that aggravate the illness-inducing situations in the community.
8. The score to be given if the nature of the problem is a health resource is:
A. 3
B. 2
C. 1
D. 0
Answer: B
Rationale: Option B, health resources scores 2. Nature of the problem can be Option A, health status and the score is
3. Option C, health-related scores 1. Option D, there is no score of zero (0) given to the nature of the problem.
9. The perception and readiness of the population to act to the problem:
A. Magnitude of the problem
B. Modifiability of the problem
C. Preventive potential
D. Social concern
Answer: D
Rationale: Option D, social concern reflects how people in the community perceive and act regarding a problem.
Option A, magnitude of the problem refers to severity of the problem and measured in terms of the proportion of the
population affected by the problem. Option C, preventive potential pertains to the probability of controlling or reducing
the effects pose by the problem.
10. Among the criteria in priority setting, this criterion weighs the highest:
A. Nature of the problem
B. Magnitude of the problem
C. Modifiability of the problem
D. Preventive potential
E. Social concern
Answer: C
Rationale: Option C weighs 4, Option A weighs 1, Option B weighs 3, Option D weighs 1 and Option S weighs 1.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Sharing Learning Targets and Success Criteria
I learn that _______________________.
I will show that I can do this by ________________________________.
I will look for ___________________________________.
(Reading assignment: Submit an assessment output, to include at least three (3) families using the five (5)
elements of comprehensive diagnosis discussed.)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 7
LESSON TITLE: PUBLIC HEALTH TOOLS
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Apply public health tools in assessing the health status
of the community.
Materials:
Book, pen and notebook
Calculator
White board marker
LCD and laptop
References:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will ask the students to answer the following.
Identify the nature of the problem: Health Status; health resource; health related
1. Tuberculosis
Answer: health status, actual problem
2. No work opportunity
Answer: health related, work provides income for the family. A family with no income will affect the family’s ability
to purchase needs and health services.
3. The probability of reducing, controlling , or eradicating the problem:
A. Preventive potential
B. Modifiability of the problem
C. Nature of the problem
D. Magnitude of the problem
Answer: A
Outcome: The family will be able to care for a post-stroke client.
Give at least two (2) criteria. The family will be able to:
Answers:
4. Assist the client in his/her activities of daily living.
5. Allocate resources for the needs of the client
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 8 Famorca et al., 2013):
APPLICATION OF PUBLIC HEALTH TOOLS IN COMMUNITY HEALTH NURSING
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Tools in measuring and analyzing community health problems:
1. Epidemiology
2. Biostatistics
Tools in identifying community needs:
1. Demography
2. Vital statistics
3. Epidemiology
Demography
o It is the science which deals with the study of
human population’s size, composition and
distribution in space.
o Population size refers to the number of people in
a given place or area at a given time.
o Population composition pertains to certain
variables like age, sex, occupation or
educational level.
Sources of Demographic Data
- Censuses
- Sample surveys
- Registration systems
Census
- Defined as an official and periodic enumeration
of population.
2 ways of assigning people when census is
taken
o de jure method – people are assigned to
the place where they
usually live
regardless of where they are at the time
of census
o de facto method – people are assigned
to the place where they are physically
present at the time of the census
regardless of their usual place of
residence
Population Size (births and deaths)
1.
Natural increase = Number of births – Number of deaths
(specified year)
(specified year)
(specified year)
2. a
Rate of Natural increase = Crude birth rate – Crude death rate
(specified year)
(specified year)
(specified year)
Population Size (two census periods)
1. Absolute increase per year measures the number of people that are added to the population per year.
Absolute increase per year = Pt – P0
t
Where: Pt = population size at a later time
P0 = population size at an earlier time
t = number of years between 0 and t
2. Relative increase is the actual difference between the two census counts expressed in percent relative to the
population size made during an earlier census.
Relative increase = Pt – P0
P0
t
Where: Pt = population size at a later time
P0 = population size at an earlier time
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Population composition
- A composition of the population commonly described in terms of age and sex.
1. Sex composition
o Sex ratio – number of males to the number of females
2. Age composition
a. Median age – divides the population into two equal parts. So, if the median age is said to be 19 years old. It
means half of the population belongs to 19 years and above, while the other half belongs to ages below 19
years old.
b. Dependency ratio – compares the number of economically dependent with the economic productive group in
the population. The economically dependent are those that belong to the 0-14 and 65 above age groups.
Considered to be economically productive are those within the 15 - 64 age group. The dependency ratio
represents the number of economically dependent for every 100 economically productive.
3. Age and Sex composition – age and sex composition of the population can be described at the same time using
population pyramid. It is a graphical presentation of the age and sex composition of the population.
Population distribution
1. Urban-rural distribution
Simply illustrates the proportion of the people living in urban compared to rural
areas
2. Crowding index
Describe the ease by which a communicable disease will be transmitted from one
host to another susceptible host. This is described by dividing the number of
persons in a household with the number of rooms used by the family for sleeping.
3. Population density
Determine how congested a place is. It can be computed by dividing the number of
people living in a given land area.
Vital statistics
- It estimates the extent or magnitude of health needs
and problems in the community.
- Vital Statistics refers to the systematics study of vital
events such as births, illnesses, marriages, divorce,
separation and deaths.
x
Statistics of disease (morbidity) and death (mortality)
indicate the state of health of a community and the
success or failure of health work.
Use of Vital Statistics:
x
x
x
x
Statistic on population and the characteristics such
as age and sex, distribution are obtained from the
National Statistics Office (NSO).
Births and Deaths are registered in the Office of the
Local Civil Registrar of the municipality or city. In
cities, births and deaths are registered at the City
Health Department.
Indicates of the health and illness status of a community
Serves as bases of planning, implementing, monitoring and evaluating community health nursing
programs and services
Sources of Data:
x
Population census
x Registration of Vital data
x Health Survey
x Studies and researches
x
Rates and Ratios:
Rate
Shows the relationship between a vital event and those persons exposed to the occurrence of
said event, within a given area and during a specified u it of time, it is evident that the person
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experiencing the event (Numerator) must come from the total population exposed to the risk of
same event (Denominator).
Ratio
Is used to describe the relationship between two (2) numerical quantities or measures of events
without taking particular considerations to the time or place. These qualities need not necessarily
represent the same entities, although the unit of measures must be the same for both numerator
and denominator of the ratio.
Crude or General
Rates
Referred to the total living population. It must be presumed that the total population was exposed
to the risk of the occurrence of the event.
Specific Rate
The relationship for a specific population class or group. It limits the occurrence of the event to
the portion of the population definitely exposed to it.
Crude Birth Rate
(CBR)
Crude Death Rate
(CDR)
A measure of one characteristics of the natural growth or increase of population.
A measure of one mortality from all causes which may result in a decrease of population
Infant Mortality Rate
(IMR)
Measures the risk of dying during the 1st year of life. It is a good index of the general health
conditions of a community since it reflects the changes in the environmental and medical
condition of a community.
Maternal Mortality
Rate (MMR)
Measures the risk of dying from causes related to pregnancy, childbirth and puerperium. It is an
index of the obstetrical care needed and received by women in a community.
Fetal Death Rate
(FDR)
Measures pregnancy wastage. Death of the product of conception occurs prior to its complete
expulsion, irrespective of duration of pregnancy.
Neonatal Death Rate
(NDR)
Describes more accurately the risk of exposure of certain classes or groups to particular
diseases. To understand the forces of mortality, the rates should be made specific provided the
data are available for both the population and the event in their specifications. Specific rates
render more comparable and thus reveal problem of public health.
Specific Death Rate
(SDR)
Describes more accurately the risk of exposure of certain classes or groups to particular
diseases. To understand the forces of mortality, the rates should be made specific provided the
data are available for both the population and the event in their specifications. Specific rates
render more comparable and thus reveal the problem of public health.
Incidence Rate (IR)
Measures frequency of occurrence of the phenomenon during a given period of time
Prevalence Rate
(PR)
Measures the proportion of the population which exhibits a particular disease at a particular time.
This can only be determined following a survey of the population concerned, deals with total (new
and old) number of cases.
Attack Rate (AR)
A more accurate measure of the risk of exposure.
Proportionate
Mortality (Death
Ratios)
Shows the numerical relationship between deaths from all causes (or group old causes), age (or
group of age) etc., and the total no. of deaths from all causes in all ages taken together.
Case of Fatality
Ratio (CFR)
Index of a killing power of a disease and is influenced by incomplete reporting and poor morbidity
data.
VITAL STATISTICS
Crude Birth Rate (CBR)
Total No. of live births registered in a given calendar year
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CBR=
---------------------------------------------------------------------------------------- x 1,000
Estimated population as of July 1 same of year
CDR=
IMR=
Crude Death Rate (CDR)
Total No. of deaths registered in a given calendar year
--------------------------------------------------------------------------------------- x 1,000
Estimated population as of July 1 same year
Infant Mortality Rate (IMR)
Total No. of death under 1 year of age
registered in a given calendar year
--------------------------------------------------------------------------------------- x 1,000
Total No. of registered live births of same calendar year
MMR=
FDR=
NDR=
Maternal Mortality Rate (MMR)
Total No. of deaths from maternal causes
registered for a given year
------------------------------------------------------------------------------ x 1,000
Total No. of live birth registered of same year
Fetal Death Rate (FDR)
Total no. of fetal deaths registered in a
Given calendar year
----------------------------------------------------------------------------- -- x 1,000
Total No. of live births registered of same year
Neonatal Death Rate (NDR)
No. of Deaths under 28 days of age registered
In a given calendar year
------------------------------------------------------------------------------- x 1,000
No. of live births registered of same year
Specific Death Rate (SDR)
Deaths in specific class/ group registered in a given year
Specific Death Rate=
--------------------------------------------------------------------------------x 100,000
Estimated population as of July 1 in same
specified class/ group of said year
Cause Specific Death Rate
No. of death from specific cause registered in a given year
Cause Specific Death Rate= ------------------------------------------------------------------------------------- x 100, 000
Estimated population as of July 1st of same year
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Age Specific Death Rate
No. of death in a particular age group registered
in a given calendar year
Age Specific Death Rate=
-------------------------------------------------------------------------- x 100,000
Estimated population as of July 1st
in same age group of same year
Sex Specific Death Rate
No. of deaths of a certain sex registered
in a given calendar year
Sex Specific Death Rate= --------------------------------------------------------------- x 100,000
Estimated population as of July 1
in same sex fro same year
Incidence Rate (IR)
No. of new cases of a particular disease registered
during a specified period of time
Incidence Rate= ------------------------------------------------------------------------------------------- x 100,000
Population at Risk
Prevalence Rate (PR)
No. of new and old of a certain disease
Registered at a given time
Prevalence Rate= --------------------------------------------------------------------------------------------- x 100
Total No. of persons examined at the same given time
Attack Rate=
Attack Rate (AR)
No. of persons acquiring a disease registered
in a given year
---------------------------------------------------------------------------------------- x 100
No. of exposed to same disease in the same year
Proportionate Mortality (PM)
No. of registered deaths from specific cause or age
for a given calendar year
Proportionate Mortality=
-------------------------------------------------------------------------------------- x 100
No. of registration deaths from all causes,
all ages in same year
CPR=
Case Fatality Ratio (CFR)
No. of registered deaths from same specific
disease in same year.
----------------------------------------------------------------------------------------------- x 100
No. of registered cases from same specific disease in same year
EPIDEMIOLOGY
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x
x
x
It is defined as the study of the occurrence and
distribution of health conditions such as disease,
death, deformities or disabilities on human
population. It is also concerned with the study of
probable factors that influence the development of
these health conditions.
It is used to analyse the different factors that
contribute to the disease development.
x
Two important Concepts
1. Multiple Causation Theory
Three models that explain the multiple causation
theory
- The wheel
- The web
- The ecologic triad
x Ecologic triad is the most helpful
(Ecologic triad will be discussed in other
session)
Herd immunity – is the probability of a group or
community
developing
an
epidemic
upon
introduction of an infectious agent.
2. Levels of Prevention of Health Problems
A. Primary Prevention
x It aims to strengthen host resistance,
inactivate the agent or interrupt the
chain of infection through environmental
manipulation.
x
Prevention of emergence of risk factors
(primordial prevention)
Removal of risk factors or reduction of
their levels (specific protection)
o E.g.
Personal
surveillance,
quarantine,
segregation
or
isolation, proper nutrition, safe
water supply and water disposal
system,
vector
control,
promotion of healthy lifestyle
and good personal habits
Specific measures: immunization and
prophylaxis
B. Secondary Prevention
x It aims to identify and treat existing
problems at the earliest possible time.
o E.g. Screening, casefinding,
disease surveillance, prompt
and appropriate treatment
C. Tertiary Prevention
x It aims to limit disability progression. It
attempts to reduce the magnitude or
severity of the residual effects of
communicable or non-communicable
diseases.
o E.g. Rehabilitation – drug
abuse; Workshops – Person
with disability
The Epidemiological Approach
Phases of Epidemiologic Approach
Descriptive Epidemiology - concerned with disease distribution and
frequency
Analytical Epidemiology - attempts to analyze the causes and
determinants of disease through hypothesis testing
Intervention or experimental Epidemiolgy - answers questions about
the effectiveness of new methods for controlling diseases or improving
underlying conditions
Evaluation Epidemiology - attempts to measure the effectiveness of
different health services and programmes
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
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Data:
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Province of Tarlac as of 1st July 2019
Total no. of Population - 2, 381, 000
Total no. of death (all causes) - 43, 000
Total no. Births - 340, 000
CDR = 18.06
CBR = 142.80
Male = 1023450
Female = 1357550
Province of Tarlac as of 1st July 2018
Total no. of Population - 1, 167, 000
Total no. of death (all causes) - 23, 000
Total no. Births - 940, 000
CDR = 19.71
CBR = 805.48
Compute the following: Formula must be written. (For formula please refer to Concept Notes)
1. Natural increase (2019)
Answer:
Natural Increase =
Natural increase =
340000 - 43000
297000
2. Rate of natural increase (2019)
Answer:
Rate of natural increase =
Rate of natural increase =
142.8 - 18.06
124.74
3. Absolute increase per year (2018 and 2019)
Answer:
Absolute increase per year =
2381000
1167000
___________________________
1
Absolute increase per year =
1214000
1
Absolute increase per year =
1214000
4. Relative increase
Answer:
Relative Increase =
2381000 1167000
___________________________
2381000
1214000
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2381000
Relative increase =
0.509869803
5. Sex composition
Answer:
Sex ratio =
1023450
x
100
0.753895 x
100
1357550
Sex ratio = 75.38949
Computation
x
x
x
x
x
x
x
x
Data:
Province of Tarlac as of 1st July 2019
Total no. of Population - 1, 867, 000
Total no. of death (all causes) - 43, 000
Total no. Births - 340, 000
Total no. of reported dengue cases: 73, 636
Total no. of population exposed to dengue: 134,000
Total no. death (dengue) - 940
Total of maternal deaths - 850
Answer the following:
6. What is the Crude Birth Rate?
Answer (182.11)
7. Measure the possibility in the decrease of the population per 1000
Answer (23.03)
8. What is the index killing power of dengue cases?
Answer (1.28)
9. What is the risk of exposure of the population to dengue?
Answer (54.95)
10. What is the index of the obstetrical care needed and received by women in a community?
Answer (2.5)
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
The teacher instructs the students to answer the following:
Guided Discovery
The teacher advises the students to answer the following:
“You are about to determine the effects of prenatal care and OB management of the newborn. What formula are
you going to use?”
After a minute, the instructor will ask them to show their answer:
Answer: Neonatal Death Rate (NDR)
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Then, the instructor shows the following data and let them compute the NDR:
Data:
x
x
x
x
No. of deaths under 28 days of age = 28
No. of live births registered at the same year = 345
Estimated number of population = 1, 245
Compute the NDR
NDR =
28
345
x
1000
0.081159 x
1000
NDR =
81.16
Remind the students regarding the following:
1. Coverage of Exam
2. Permit
3. Calculator (The instructor will emphasize that borrowing of calculator during the examination proper is strictly
prohibited).
Key answer
.
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 8
LESSON TITLE: COMMUNITY ORGANIZING, COMMUNITY
IMMERSION
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Outline the steps to be taken in applying the
community organizing.
2. Differentiate traditional research approach or
community organizing participatory action research.
3. Differentiate practiced community organizing
participatory action research to the ideal.
4. Discuss the concept of Community Immersion Nursing
Program.
5. Acknowledge the importance of Community Nursing
Program in their growth as future nurses.
Materials:
Book, pen and notebook
LCD and laptop
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will ask the students to answer the following.
Compute for the index killing power of CoVID-19.
Data:
Death (CoVID-19) – 921
Cases - 15,588
Total Population – 108, 000, 000
Answer:
CFR =
921
15588
0.059
CFR =
x
x
100
100
5.91
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to read their book about this lesson (Chapter 4
Famorca et al., 2013, page 61-75):
x
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).
x 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.
Community Organizing
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x
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:
ƒ Possible barriers
ƒ Threats
ƒ Strengths
ƒ Opportunities at this stage is an important determinant of the over-all outcome of
community organizing
• Communities may be identified through different means:
ƒ Initial data during ocular survey
ƒ Review of records of a health facility
ƒ Review of barangay profile, and so on
ƒ Referrals from other communities or institutions
ƒ Through series of meetings
ƒ Consultation from local governments (LGUs) or private institutions
• Basic criteria
ƒ Geographically isolated and disadvantaged area
ƒ Community perceives that they need assistance
ƒ Shows sign of willingness
ƒ No obvious threat for safety
ƒ No other organization working with same services
ƒ 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
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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
ƒ Visits the community as per schedule
ƒ “now you see, now you don’t”
o Boarder style
ƒ Rents a room or house in a village
ƒ Lives with his own lifestyle
ƒ Does not share life with the community
o “Elitist” style
ƒ Lives with the barangay chairman or some other prominent person in the community
ƒ 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
ƒ Participates in farming, fishing or any livelihood activities of the community
ƒ 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
ƒ Attending fiestas, weddings, baptismal celebrations, funeral wakes and other activities of
the community that carry social meaning and importance.
ƒ 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 healthrelated problems
o Comprehensive analysis
o
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ƒ Demographic data
ƒ Sociocultural data
ƒ Economic data
ƒ Environmental data
ƒ Data on health patterns (morbidity, mortality, fertility) and
ƒ 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
• 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.
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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
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.
Areas of evaluation and general evaluation parameters
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
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
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Goals of Community Organizing
1. People’s Empowerment
2. Building People’s Organizations
3. Improved quality of life
Participatory action research (PAR)
x 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)
x
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
Comparison of traditional research approach and COPAR
Points of Comparison
Decision making
Emphasis
Roles
Methodology
Output
Traditional research approach
Topdown
Expert/nurse driven process
Much premium is placed on the data
and output
Nurse as researchers; the community
members are subject or objects of
research, usually respondents of the
research instrument.
Data analysis is done by the nurse,
and then presented to the community.
Research tools and methodologies are
predetermined/prepackaged by the
nurse-organizer.
Upon completion, the study is
packaged and submitted to the
agency, and published.
Recommendations are made by the
researcher based on the findings of
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COPAR
Bottom-up
Community-driven process
Community members as researchers;
the nurse is a facilitator and recorder.
Data analysis is done collectively by
the community.
Research tools and methodologies are
identified and developed by the
community.
Conclusions and recommendations
are made by the community. These
will lead to agreed community
actions/projects, The whole research
cycle continues until it becomes part of
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the study.
community life, leading towards
community development. Community
members formulate the
recommendations.
Comparison of Practiced and Ideal COPAR
COMPONENT
Time frame/mode of exposure
Methodology/Survey form
Problem statement
PRACTICED COPAR
Sometimes 8-16 hours/week for 2-4
weeks depending on the time allotted by
the school
Use of ready-made survey from the
school
Some use survey but just collect data
from previous study
Misjudging complex problems as simple
problems
Not considering the result of the survey
form rather pay attention to the concern
of the few individuals
Implementation
Fish effect
One day program
Evaluation
Results are manipulated
No re-implementation
IDEAL COPAR
3-6 weeks immersion
3-6 weeks duty, 8 hours duty; 5-6
days/week
It will vary from the needs of the
community and the methodology is the
surveying participants
After the survey and analysis has been
done
Problem will be coming from the
survey form
Any problems too big should not be
prioritized
Fishing rod effect
Programs should not be a one-time
affair
Reality acceptance
After evaluation, there must be reimplementation if needed or program
must be revised depending on the
result
Community Immersion
x Community immersion (CI) is a related learning experience program requiring student nurses to live and work
within a selected remote community. Students learn about nursing care for diverse populations in the
community settings during this two-week clinical immersion experience. 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. Furthermore, students learn about rural public health
systems, the role of a public health nurse, as well as the wide range of programs and issues present in
remote community.
x The CI program is a 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”.
x From both a public health perspective and an educational perspective, 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. Student nurses who experienced living within the remote community have
been reported to have a positive impact on their future community engagement, giving them the opportunity of
an early experience.
General objectives
The general aim of the community immersion program is to prepare future nurses to be competent staff PHN
Specific Objectives
The community immersion program aims to:
1. train future nurses to respond to the health problems of individuals in their complexity, and strengthens their
ability to work with the community;
2. develop student nurses’ leadership capabilities;
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3.
4.
5.
6.
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.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
SITUATION: A group of researchers were recently assigned to Barangay Pugo to conduct Community Organizing
Participatory Action Research (COPAR). It is very vital to Public Health Nursing. It aims to transform the voiceless poor
people into dynamic, active and responsive community. Nurse Rashan is one of the members of this group who aims to
develop a self-reliant community.
1. In the Pre-entry phase of the COPAR process, a preliminary social investigation is conducted to aid in the
selection of the site. Nurse Rashan helped in identifying the community for COPAR. Which of the following is not
a criterion to be used when selecting an area for COPAR?
A. Area must have no serious peace and order problem
B. Must have a population of 100-200 families
C. Economically not depressed
D. No similar groups holding the same program
E. No strong resistance from the community
Answer: C
Rationalization: Not economically depressed means they can afford healthcare
2. In Pre-entry Phase, which of the following activities should be done in choosing the final community?
A. Determining the outcome of the program in the community
B. Developing programs with the community
C. Community decides to formalize organization
D. Take note of political development
E. Conducting formal interviews with community residents and key informants
Answer: D
Rationalization: Determining the outcome of the program in the community-action phase; developing programs with
the community-community organization; Community decides to formalize organization- community organization;
Conducting formal interviews with community residents and key informants-social analysis
3. As part of the Pre-entry phase of COPAR, which of the following implies that the potential host family is not
good to live-in?
A. House is strategically located in the community
B. Neighbours are hesitant to enter the house
C. No member of the host family should be moving out in the community
D. Should not belong to elite/rich segment
E. None of these
Answer: B
Rationalization: If neighbours are hesitant to enter the house, other families could not easily communicate to the
nurse
4. Nurse Natasha is in the Social Analysis phase of COPAR if she is doing which of the following activities?
A. Setting up linkages and network referrals
B. Training of CHO workers
C. SALT (self-awareness leadership training)
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D. Implementation of livelihood projects
E. Conduct community diagnosis
Answer: E
Rationalization: Setting up linkages and network referrals-community organization; Training of CHO workers-core
group formation; SALT (self-awareness leadership training)-core group formation; Implementation of livelihood
projects-action phase
5. Evaluation is a systematic, critical analysis of the current state of the organization and/or projects compared
to desired or planned goals or objectives. In evaluation, there are two areas of evaluation, one of which is
program-based evaluation. The following are the evaluation parameters for program-based, except:
A. Were the goals and objectives of the program/project achieved?
B. What strategies were implemented? What worked? What did not?
C. What is the level of participation in the affairs of the community organization?
D. What is the overall impact of the project on the community?
E. None of these
Answer: C
Rationale: The level of participation is an organizational evaluation
Identify whether it is a Traditional research approach or COPAR
6. Methodology – Methodologies are determined by the community
Answer: COPAR
7. Roles – Data analyst is the nurse
Answer: Traditional research approach
8. Which among the following best describes community immersion program (CIP)?
A. CIP refers to hands-on experience in a community nearby.
B. It is a related learning experience program which requires student nurses to live and work in the community.
C. Student nurses implement public health programs.
D. Student nurses assume the role of a public health nurse to a selected population.
Answer: B
Rationale: CIP in an RLE program which requires student nurses to live and work in the community. CIP is a
hands-on experience in a remote community not nearby. Student nurses helps in the implementation of the
program not as implementer. Student nurses assume the role of a public health nurse to all members of the
community and not to a selected population.
9. The main aim of conducting an immersion program to a remote area is:
A. For the students to learn
B. For the students to apply their basic skills
C. Bring the health programs to people who cannot access it
D. To give to the people what they need
Answer: C
Rationale: Although the aim of the CIP is for students to learn and apply their basic skills, bringing programs to a
remote area is a social accountability of health care workers and future health workers. Giving what people need is
against from the principle of community organizing.
10. Community Immersion program aims student nurses to develop their:
1. Competency in basic nursing skills
2. Interpersonal skills
3. Understanding regarding their social accountability
4. Leadership skills
Choices:
A. 1, 2, 3 and 4
B. 1, 3 and 4
C. 2, 3 and 4
D. 1, 2 and 4
Answer: A
Rationale: All of the options given are specific objectives of the CIP
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LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
The teacher instructs the students to answer the following:
CAT 3-2-1
The instructor will advise the students to write their answers in a ½ sheet of paper.
Q1. Enumerate at least three words related to Community Immersion.
Q2. List at least two outcomes of the immersion program?
x Develop their human skills relation
x Practice basic nursing skills
x Develop their communication skills
Q3. Why do you think nurses must undergo the community immersion program?
Since it is focus:
• Is to address the oppressed, economically deprived, and marginalized people who greatly in dire for change;
• On the best interests of the poorest sectors of the society;
• It will lead to a self- reliant community.
Student nurses will be able to exercise appropriate application of knowledge learned and develop correct attitude from this
first-hand experience.
(Reading assignment: Community Organizing Participatory Action Research)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 9
LESSON TITLE: GUIDELINES IN MAKING OF THE COPAR
DOCUMENTATION AND COMMUNITY HEALTH SURVEY
FORM
Materials:
Book, pen and notebook
LCD and laptop
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Identify the different parts of COPAR documentation.
2. Demonstrate how to do the COPAR documentation.
3. Identify the different parts of the community health
survey form.
4. Demonstrate how to use the community health survey
form properly.
Reference:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
LESSON REVIEW /PREVIEW (5 minutes)
Review Test
The instructor will show these questions and ask the class in unison to choose the correct letter of choice:
1. Which among the following best describes community immersion program (CIP)?
A. CIP refers to hands-on experience in a community nearby.
B. Student nurses implement public health programs.
C. It is a related learning experience program which requires student nurses to live and work in the community.
D. Student nurses assume the role of a public health nurse to a selected population.
Answer: C
Rationale: CIP in an RLE program which requires student nurses to live and work in the community. CIP is a
hands-on experience in a remote community not nearby. Student nurses helps in the implementation of the
program not as implementer. Student nurses assume the role of a public health nurse to all members of the
community and not to a selected population.
2. The main aim of conducting an immersion program to a remote area is:
A. For the students to learn
B. For the students to apply their basic skills
C. Make health programs accessible to the people
D. To give to the people what they need
Answer: C
Rationale: Although the aim of the CIP is for students to learn and apply their basic skills, bringing programs to a
remote area is a social accountability of health care workers and future health workers. Giving what people need is
against from the principle of community organizing.
MAIN LESSON (30 minutes)
The instructor should discuss the parts 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
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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
a. 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.
b. Heading: “Acknowledgement” (Uppercase and lowercase, centered on the first line below the running head).
c. 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
d.
e.
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.
Barangay Organizational Chart
Health Center Organizational Chart
B. Population Profile
a. Total Estimated Population of Barangay (based on NSO)
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b. Population Density (PD)
PD= Total No. of Population
Total No. of Sq. meters
x 1000
c. Total population of the area surveyed
d. Total of families surveyed
e. 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.
h.
i.
j.
k.
Civil Status
Types of Families
Religious Distribution
Place of Origin
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
c.
d.
e.
f.
Occupation
Income
Housing Condition
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
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a.
b.
c.
d.
e.
Food storage
Infant feeding practices
Immunization Status of Children (0-12 months old)
Community Facilities and Resources
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
Steps in Community Health Survey
1. Preparation
a. Identify the barangay to survey or required by the health center.
b. Ocular survey
1. Courtesy call on the barangay captain; kagawad for health
2. Identification key to leaders and barangay health workers;
3. Conduct ocular survey of a few households.
4. Start preparing the spot map.
c.
2.
Community assembly
1. Inform people of purpose of presence in the barangay.
2. Disseminate initial findings specially presence of infectious disease in the area: explaining its mode of
transmission; sign and symptoms.
Conduct of survey using the format/ survey form.
a. Random Sampling or saturation
- Random sampling, 10% of population; employ one group
- Saturation-house to house survey; to check total population and determine true picture of barangay; employ
several groups.
b. Guidelines in filling survey form.
1. Use pencil during the actual survey
2. Clean and clear documentation
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3. Families are not allowed to write on the health assessment form.
4. There are items that can be answered through ocular 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: _____________________________
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
%HORZࡇ ࡇ- ࡇ ( )
ࡇ 5,001 - ࡇ PRUHWKDQࡇ B. Family Expenditures
1. Food
%HORZࡇ ࡇ– 75
0RUHWKDQࡇ ( )
2. Clothing number of times of buying
Once a year
( )
Thrice a year
( )
Twice
( )
Electricity
( )
3. Housing
Water
( )
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Telephone
( )
4. Schooling
Public
( )
Private
( )
Wood
Makeshift
( )
( )
5. Others
C. Housing and Environmental Condition
A. Home
Type
Concrete
( )
Mixed
( )
Others
Ventilation:
Poor
( )
Good
( )
Lighting:
Adequate
( )
Inadequate
( )
Surroundings:
Clean
( )
Dirty
( )
( )
( )
Deep well
Others:
( )
( )
( )
Covered
( )
( )
( )
Clay jars
Others:
( )
( )
Pit privy
Owned
( )
( )
B. Source of Water Supply
Artesian well
NAWASA
C. Storage of Drinking Water
Refrigerated
Uncovered
Containers used:
Plastic
Bottles
D. Toilet Facilities
Sanitary:
Flush
Others
Shared
Unsanitary:
“Ballot” system
( )
( )
Others
E. Garbage Disposal
Collection
Burying
Garbage cans
( )
( )
( )
Burning
Open dumping
Others
( )
( )
F. Food Storage
Covered
Refrigerated
( )
( )
Uncovered
( )
G. Presence of Animals
Dogs
Pigs
( )
( )
Cats
Others
( )
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H. Backyard Gardening
Vegetables
Fruit-bearing
( )
( )
Herbal
Others
D. Community Resources
A. Health and Other Facilities
Health center
School
Park
Health center
Public hospital
(
(
(
(
(
)
)
)
)
)
Barangay hall
Church
Market
Private clinic
Private hospital
( )
( )
( )
( )
( )
( )
( )
BHW
Untrained “hilot”
( )
( )
C. Sources of health funds:
Government
NGOs/POs
( )
( )
Private
Others:
( )
E. Nutrition
A. Food preference
Fish
Meat
( )
( )
Fruits/ vegetables
Mixed
( )
( )
B. Common
Rice and egg
Rice and noodles
( )
( )
Rice and sardines
Others:
( )
B. Indigenous health workers
Trained “hilot ”
“Herbularyo”
Others:
C. Presence of Nutritional Disorder
1. Goiter
Enlargement of the neck ( )
Hoarseness
( )
2. Anemia
Pallor
Body weakness
3. Vitamin A deficiency
Night blindness
Others
( )
Dysphagia
Others:
( )
( )
( )
Easy fatigability
( )
( )
“Pilak sa mata”
( )
4. Others:
F. Knowledge, Attitude and Practice
A. Do you utilize the health center: Yes
If no, why?
B. Reason:
Illness
Family planning
(
)
( )
( )
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(
)
Prenatal
Postnatal
( )
( )
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Dental
( )
C. First Person consulted in times of illness:
M.D.
( )
Midwife
( )
“Herbularyo”
( )
Nutrition
( )
Nurse
“Hilot”
BHW
( )
( )
( )
Others
D. Usual illness in the family
What do you do for this condition?
Self- medication
( )
Hospital
( )
Nursing
( )
E. Others diseases
TB
Skin disease
Others
Consultation
Private clinics
Others:
( )
( )
Leprosy
Hepatitis
( )
( )
Immunization
DPT
OPV
AM
( )
( )
F. Do you submit your children (0-12 months) for immunization?
Name of Child
Birthday
BCG
G. Do you practice family planning?
Method:
If no, why?
H. Method of infant feeding:
Breast
Mixed
I.
Yes
( )
( )
Subjects you want to learn in health education:
Drug abuse
( )
Family planning
( )
First aid measure
( )
(
)
No
( )
bottle
( )
Nutrition
Herbal plants
Others
( )
( )
Interviewed by: _________________________
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Date: __________________ Time: __________
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the ten (10) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
1. Which among the following is included in the Title Page? (select all that apply)
A. Name of the authors
B. Name of the adviser
C. Submission date
D. Page
Answer: A and C
Rationale: Option A and C are included in the title page. Option B, name of adviser is not included. Option D, no
pagination appears on the title page although it is considered as page i.
2. This page briefly explains what is the paper all about?
A. Acknowledgement
B. Introduction
C. Table of Contents
D. Title page
Answer: B
Rationale: Option B, Introduction tells about what is the paper all about. Option A, acknowledgement contains
brief statements about mentors or people who made contribution to the research study. Option C, Table of
Contents will guide the readers regarding the content and its corresponding page.
3. Briefly state names of mentors and other people with significant contribution to the research study:
A. Acknowledgement
B. Introduction
C. Table of Contents
D. Title page
Answer: A
Rationale: Option B, Introduction tells about what is the paper all about. Option C, Table of Contents will guide
the readers regarding the content and its corresponding page. Option D, pertains to the title of the study
4. It contains pictures and documents that are related to the study:
A. Reference
B. Appendices
C. Community profile
D. Recommendations
Answer: B
Rationale: Option B, Appendices contain pictures, letters and other documents related to the study. Option A,
books and other related materials cited in the study will be documented in the reference. Option C, community
profile contains data about the community. Option D, recommendations are the proposal plans to solve the
problems and concerns of the community.
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5. Geographic identifiers include: (select all that apply)
A. Historical background
B. Spot map
C. Vicinity map
D. Organizational chart
Answer: A, B. C and D
Rationale: All options will help in determining the geographical identity of the community.
6. Who are included in determining the literacy rate of a community:
A. 8 years old and above
B. 8 years old and below
C. 14 years old and below
D. None of the above
Answer: A
Rationale: Only 8 years old and above are included in determining the literacy rate. It is being considered that 8
years old can read and write. The literacy rate is computed by dividing the total number of 8 years old and above
who can read and write over total number of population of 8 years old and above.
7. It is a record of names of authors cited in the study
A. Reference
B. Appendices
C. Community profile
D. Recommendations
Answer: A
Rationale: Option A, books and other related materials cited in the study will be documented in the reference.
Option B, Appendices contain pictures, letters and other documents related to the study. Option C, community
profile contains data about the community. Option D, recommendations are the proposal plans to solve the
problems and concerns of the community.
8. The health profile of the community is reflected by: (select all that apply)
A. Excreta Disposal
B. Food storage
C. Infant feeding practices
D. Community Facilities and Resources
Answer: B, C and D
Rationale: Option A, excreta disposal reflects the environmental profile of the community. Options B, C and D
depict the community’s health profile.
9. Who are not included in computing the dependency rate of the community?
A. 60 years old and above
B. 18 years old and below
C. 14 years old and below
D. None of the above
Answer: D
Rationale: In computing the dependency rate, the population of 0-14 years old and 65 years old above is divided
to the total population of 15-64 years old.
10. Population density is computed by dividing the total population to the:
A. Total lot area in cubic meter
B. Total lot area in square meter
C. Total community area in meters
D. Total number of houses
Answer: B
Rationale: The formula in computing PD is equals to total number of population divided by total area in square
meters multiply to 1000.
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11. 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
Answer: C
Rationale: Feces using the “ballot” system is unsanitary. Option A, the family does not have a good ventilation.
Option C, although it appears that the family is poor, it will be after the analysis of all the data.
12. 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
Answer: A, B, C and D
Rationale: All of the options describe the herbularyo.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
The muddiest point
The instructor will ask the students to bring a ¼ sheet of paper and advises to write what is not clear to them. The papers
will serve as their exit pass.
Reading assignment: Community Assessment Forms and watch https://www.youtube.com/watch?v=TQ640CZvNZg
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 10
Materials:
LESSON TITLE: TABLES, GRAPHS AND ANALYSIS,
ADDITIONAL GUIDELINES IN FILING UP OF THE
COMMUNITY HEALTH SURVEY FORM AND
DOCUMENTATION
Book, pen and notebook
LCD and laptop
White board marker
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1.
2.
3.
4.
5.
References:
Prepare tables and graphs based from the data.
Describe tables and graphs accurately.
Analyze tables and graphs appropriately.
Identify appropriate gestures during the interview.
Identify appropriate communication techniques.
Duquia RP, Bastos JL, Bonamigo RR,
González-Chica
DA,
Martínez-Mesa
J.
Presenting data in tables and charts. An Bras
Dermatol. 2014;89 (2):280-5.
LESSON REVIEW/PREVIEW (5 minutes)
The instructor will present the questions below via PowerPoint presentation. The students will be randomly called to
answer.
The instructor will ask the students to react to the following:
Public Health Nurse – “What type of toilet facility do you have?”
Client – “Flush toilet”
Answer: It will be better to check the toilet facilities by asking to use their toilet facility.
The instructor presents the graph below and asks, “What is the meaning of this Figure?” The instructor may call a
volunteer to share his/her answer. Then, the instructor presents the learning outcomes of today’s session.
Sex
Male
Female
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to read their book about this lesson. For this session
the instructor will demonstrate the use of MS excel in preparing graphs and tables. To aid the demonstration this
https://www.youtube.com/watch?v=JWcusqZDfZs link will help.
After the demonstration and video presentation the following concepts will be discussed.
Presentation of numerical variables:
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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
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
o
o
o
o
o
o
o
Be self-explanatory;
Present values with the same number of decimal places in all its cells (standardization);
Include a title informing what is being described and where, as well as the number of observations (N) and when
data were collected;
Have a structure formed by three horizontal lines, defining table heading and the end of the table at its lower
border;
Not have vertical lines at its lateral borders;
Provide additional information in table footer, when needed;
Be inserted into a document only after being mentioned in the text; and
Be numbered by Arabic numerals.
Similarly to tables, graphs should:
o
o
o
o
o
o
Include, below the figure, a title providing all relevant information;
Be referred to as figures in the text;
Identify figure axes by the variables under analysis;
Quote the source which provided the data, if required;
Demonstrate the scale being used; and
Be self-explanatory.
Interpretation and analysis:
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o
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
Elementary Graduate
High School Undergraduate
High School Graduate
College Undergraduate
College Graduate
No Formal Education
Total
9
5
6
22
6
8
4
60
15.00%
8.33%
10.00%
36.67%
10.00%
13.33%
6.67%
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.
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.
2.
3.
4.
5.
6.
Greet the family.
Introduce yourself and purpose.
Make sure they agree to be interviewed.
Engage in small talk first then move to the questions of the survey form.
Treat your survey like a conversation.
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?”
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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,
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]
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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.
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.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Figure 12 Graphical Presentation on Health
Resources Used by the Elderly
Health Center
Private Medical Clinic
Private Hospital
Public Hospital
5%
22%
60%
13%
1. What is the figure all about?
A. Elderly and their usage of health resources
B. Elderly with their health problems
C. Elderly without sickness
D. None of the above
Answer: A
Rationale: The figure does not represent any sickness or health problems but rather facilities which are being
used for health needs.
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2. Which among the health resources is least visited?
A. Health center
B. Private medical clinic
C. Private hospital
D. Public hospital
Answer: A
Rationale: The percentage of using the health center is 5% which is the lowest among the four health
facilities.
3. Which among the health resources is most visited?
A. Health center
B. Private medical clinic
C. Private hospital
D. Public hospital
Answer: D
Rationale: The percentage of using the public hospital is 60% which is the highest among the four health
facilities.
4. Which statement is true in relation to the Figure?
A. Elderly visits more the public hospital for health resources than health center, private clinic and private
hospital combined.
B. Elderly visits less the public hospital for health resources than health center, private clinic and private
hospital combined.
C. Elderly visits as much the public hospital for health resources as health center, private clinic and private
hospital combined.
D. None of the above
Answer: A
Rationale: The figure shows that combining the percentage of the health center, private clinic and private
hospital, the percentage is 40% comparing to the 60% usage of hospital.
5. What does the figure may imply?
A. Health problems felt by the elderly
B. Socio-economic status of the elderly
C. Confidence to the health facility
D. All of these
Answer: D
Rationale: The health concerns of any individual will affect his/her choice of health facility. Furthermore, the
ability to pay such services will also be a deciding factor. This is reflected by the elderly’s socio-economic
status. Furthermore, the trust and confidence to the health facility will also affect choices and decisions.
6. Which of the following question coming from the interviewer is correct?
A. What is the nature of your work?
B. Do you use contraceptives?
C. Are the healthcare workers and services effective?
D. Do you eat balanced diet?
Answer: B
Rationale: Option B, is direct and closed ended question. Option A, the question is vague. Instead, ask the person
what is his work. Option C, it is a double-barreled question. Option D, it is a leading question.
7. Who is the best resource person when the caregiver of the family is not around?
A. Grandmother who knows the family.
B. A neighbor who is a friend of the family.
C. A sane adult living with the family.
D. Anyone who is present.
Answer: C
Rationale: A sane adult who lives with the family will know better than a grandmother/friend who is not living with the
family. Option D, any adult who is present not anyone.
8. An example of correct use of speech and volume:
A. Giving the right information, speaking at the right volume and articulating your words properly.
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B. Keep eye contact, speaking loudly and using the right language
C. Speaking softly, use long pauses and positive facial expressions
D. Hold your head high, yet all your words and keep your eyes closed
Answer: A
Rationale: Speech and volume pertains to right information and speaking in a right volume. Option B, speaking loudly
may convey that he/she is angry. Option C, use of long pauses may bore the listener. Option D, keeping eyes closed
during conversation is disrespectful; eye contact conveys enthusiasm and sincerity.
9. One of the best way to show that you are listening is:
A. Talking to the person next to you
B. Appropriate amount of eye contact
C. Frowning at the person
D. Asking to repeat what they said
Answer: B
Rationale: Maintaining eye contact denotes that you are listening to the person you are conversing. Option A, simply
denotes that you are interested to listen to others. Option C, frowning means that you do not like what was said and
may mean that you are not paying attention to what was said. Option D, it means you are listening that is why you are
asking to repeat again what was said.
10. When you speak, your listener gets messages from: (select all that apply)
A. What you say
B. Your accent
C. How you look
D. How you act
Answer: A, C and D
Rationale: Messages will come from the words (verbal communication) and how you look and act (non-verbal
communication). Accent may affect how thy will understand the messages, although accent will not affect the
message.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Minute paper
The instructor will advise the students to complete the statement posted on the board. Their answers must be written in a
¼ sheet of paper and will serve as their exit pass. The instructor will call at least 2-3 students to share their answers.
If I will interview a family, I should be ______________________________.
During the interview, I know that ______________________________.
(Reading Assignment: Planning for Community Health Nursing Programs and Services)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 11
LESSON TITLE: PLANNING FOR COMMUNITY HEALTH
Materials:
NURSING PROGRAMS AND SERVICES
Book, pen and notebook
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Define planning.
2. Discuss the planning cycle.
3. Identify the different steps of the planning cycle.
White board marker
LCD and laptop
References:
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
LESSON REVIEW/PREVIEW (5 minutes)
The instructor will ask three students to share what they have learned last meeting regarding COPAR documentation.
Present a picture of a chaotic scenario.
Ask the students the following:
1. What do you see?
2. If you are in this place, how will you feel?
3. What will you do to make it organize?
4.
MAIN LESSON (30 minutes)
The instructor should introduce the following concepts.
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):
x
Where are we now?
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x
x
x
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
Determine
outcomes
Specify criteria
and Standards
Goal and objective Setting
•
Define program goals
and objectives
•
Assign priorities among
objectives
Strategy/Activity Setting
•
Design CHN Programs
•
Ascertain resources
•
Analyze constraints
and limitations
Situational Analysis
x 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.
x 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.
x She may use the community diagnosis report as basis for the situational analysis.
x 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
habits
Unsanitary waste
disposal system
Poor child
care
Poor utilization
of health
Low level of
education
Lack of basic
health facilities
Preoccupation
with earning a
living
Negative attitude
of health providers
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poverty
Lack of basic health
facilities
Job
dissatisfaction
Government
neglect
Health is least priority
in terms of budget
x
x
x
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
x “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.
x Goals and Objectives will serve as guide to the nurse’s efforts.
x A goal leads to a desired end.
x 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:
HEALTH PROBLEM
High incidence and prevalence of intestinal parasitism among children
GOAL
To reduce the incidence and prevalence of intestinal parasitism
among children of Sitio Cam chile
OBJECTIVES
75% of children below 6 years old will test negative for parasites after one year
80% of households will have access to safe waste disposal system within six months
80% of households will have access to safe and adequate water supply within
six months
75% of children under 6 years old will have regular clinic visits
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CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves
Multiple Choice:
1. Which among the following defines planning appropriately?
A. Planning is a systematic process that provides structured actions to address concerns of the community.
B. Planning is a continuous and change-oriented which desire to improve the future state of the community.
C. Planning is a formulation of steps to be undertaken in the future in order to achieve a desired end.
D. All of the above
Answer: C
Rationale: Planning is a systematic process that provides structured but flexible actions to address concerns of
the community, not just structured actions. Planning is continuous and change-oriented which desire to improve
the present state of the community not future. Although it is futuristic, the steps are futuristic but it desires to
improve current state.
2. Plans for priority goals depends on the availability of the resources:
A. True, constraints and limitations are considered
B. False, the nurse pursues the objective based from wellness
Answer: A
Rationale: Prioritization is highly affected by the availability of resources. Absence of resources makes it
impossible to solve problems. Although the nurse pursues objectives/goals based from wellness, availability or
resources is always considered.
3. To answer the question,” Where are we now? “, the nurse should:
A. Define the program goals
B. Design CHN programs
C. Gather health data
D. Specify criteria and standards
Answer: C
Rationale: Define program goals – Goal and objective setting; Design CHN programs – Strategy/activity setting;
specify standards and criteria – Evaluation
4. To analyze the situation, the following actions must be performed:
A. Set priority
B. Assign priority
C. Ascertain resources
D. Determine outcomes
Answer: A
Rationale: Answering the question where are we now (situational analysis) involves the process of collecting,
synthesizing, analyzing and interpreting information in manner that will provide a clear picture of the health status
of the community. Assign priority is part of the Goal and Objective setting. Ascertain resources are part of the
Strategy/activity setting. Determine outcomes is part of the Evaluation
5. Identifying the problem of the community involves:
A. Situational analysis
B. Nurse identifies and explains the problem
C. Nurse projects what situation needs to be changed developed or maintained.
D. All of the above
Answer: D
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Rationale: In order to determine the problem of the community, the current situation must be analyzed.
Situational analysis involves the process of collecting, synthesizing, analyzing and interpreting information in
manner that will provide a clear picture of the health status of the community.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Success criteria (Cold call, three students will be called to complete the sentence).
I know that planning involves ___________________.
Possible answers:
x Assessment
x Community Involvement
x Clear objectives
(Reading Assignment: Evaluation and Community Based Health Plan)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 12
Materials:
LESSON TITLE: COMMUNITY PROGRAM BASED HEALTH
PLAN AND EVALUATION
Book, pen and notebook
White board marker
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Develop a Community Program Based Health Plan.
2. Describe the Evaluation Process in Community Health
Nursing Practice.
Long bond paper
LCD and laptop
References:
De Belen, R. & De Belen, D. V., (2008). A Praxis
in Community Health Nursing. 1672 Quezon
Avenue South Triangle, Quezon City.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines
LESSON REVIEW/ PREVIEW (5 minutes)
Ask three students to answer the following:
1. The following describes planning accurately, EXCEPT:
A. Planning is a systematic process that provides structured but flexible actions to address concerns of the
community.
B. Planning is a continuous and change-oriented which desire to improve the current state of the community.
C. Planning is a formulation of steps to be undertaken in the future in order to achieve a desired end.
D. None of the above
Answer: D
Rationale: All of the options given are true to Planning
2. To answer the question,” Where do we want to go? “, the nurse should:
A. Define the program goals
B. Design CHN programs
C. Gather health data
D. Specify criteria and standards
Answer: A
Rationale: Design CHN programs – Strategy/activity setting; gather health data – situational analysis; specify
standards and criteria – Evaluation
3. To analyze the situation, the following actions must be performed:
A. Set priority
B. Assign priority
C. Ascertain resources
D. Determine outcomes
Answer: A
Rationale: Answering the question where are we now (situational analysis) involves the process of collecting,
synthesizing, analyzing and interpreting information in manner that will provide a clear picture of the health status
of the community. Assign priority is part of the Goal and Objective setting. Ascertain resources are part of the
Strategy/activity setting. Determine outcomes is part of the Evaluation
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The instructor will show a slide containing the following questions:
x “So, what now?; You know what is happening…;
x You have plans…What is your next step?”
The instructor will ask 2-3 students to answer, and then presents the learning outcome of today’s lesson.
MAIN LESSON (30 minutes)
The instructor presents the following.
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%
2. Reduce the prevalence of communicable diseases from 18% to 8%
3. 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
Title
“Wastong
kalusugan
ay
kailangan
upang
sakit
ay
hindi
dapuan”
Objectives
Activities
At the end of the
activity, the elderly will
be able to:
a. Cite 3 or more
ways
to
maintain
health
b. Enumerate at
least 3 or more
ways
to
prevent
diseases
Short
program
Minidiscussion
Hall of
posters
Healthy
booths
Quiz
booths
Assign
Person
Short
program
– 10
students
Hall of
posters
– 20
students
Target
Outcomes
Elderly will
be able to
acquire
additional
knowledge
in
maintaining
health and
preventing
diseases
Healthy
booths –
6
students
Quiz
booths –
9
students
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Manpower
Materials
Budget
Barangay
Health
Workers –
Registration
Tables
Chair
Sound
system
Posters
Extension
wires
Foods
Drinks
Token
Certificates
Refreshment
Php50 per
head
Facility
arrangement
– Barangay
Tanod and
students
Sound
system – c/o
Barangay
Token
Php20 per
head
Certificate
Php5 per
head
Miscellaneous
Php15 per
head
Refreshment
– Mothers
and
Students
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The Evaluation Plan
x 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.
x 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:
Standards for Evaluation:
1. Trainer- Hilot ratio
2. Qualification of trainer
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:
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.
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ii.
iii.
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.
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
and Standards for Evaluation
I.
Check if
Yes No
Remarks
Title of the Program
1. Specifies that what, where and when the program
2. Appropriate and relevant to the problem situation
3. Manageable in scope
II.
Introduction – contains:
1. General and specific background information relevant to the
problem situation.
2. Relevant national policies and priorities.
III.
The Problem Situation
A. Data Collection
1. Complete, i.e. no important data missed
2. Just enough i.e. no irrelevant data gathered
3. Correct, i.e. data gathered relevant to problem situation
4. Used valid and reliable sources
5. Used valid and reliable methods
6. 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
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Components/Items Evaluated Criteria
and Standards for Evaluation
IV.
Check if
Yes
No
Remarks
The Program
A. Goal
1. Appropriate to the problem situation
2. 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
2. Measurable quantitatively or qualitatively
3. Realistic
4. 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)
b. appropriate and realistic
E. Activities
1. Appropriate to program objectives
2. 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
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Components/Items Evaluated Criteria
Check if
and Standards for Evaluation
Yes
No
Remarks
b. Facilities
c.
d.
e.
f.
Equipment – kinds and number
Furniture – kinds and number
Supplies – kinds and quantity, including drugs
Funds for capital expenditure
- recurrent expenditure
- contingency
- allowance for inflation
g. Time
2. Appropriate and correct considering program objectives
and activities
3. Realistic, i.e. can be provided considering budget
available and prevailing situation
G. Plan for Implementation
1. Program milestone or operational targets defined
2. Realistic, i.e. targets can be achieved
H. Plan for Evaluation
1. Purpose of evaluation defined
2. Specific objectives for evaluation defined
3. Scope of evaluation defined, specifically:
a. focus (Inputs, process or outcome)
b. dimensions/ aspects to be evaluated
4. Criteria to be used appropriate
5. Standards for evaluation:
a. defined for each criterion
b. realistic
6. Evaluation design / method briefly described and
specified
7. Plan for collection of evaluative data:
a. data appropriate
b. data complete
c. use of valid and reliable sources
d. use of valid and reliable methods
8. Plan for data processing and analysis briefly described
9. Resources required to carry out evaluation plan
identified
10. Users (i.e. persons, agencies, sectors) to whom
evaluation report will be forwarded identified
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COMMON PITFALS 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.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple choice:
1. The PHN wants to determine the appropriateness and adequacy of the Infection Training Module. The PHN
evaluates the:
A. Manpower
B. Resources
C. Process
D. Outcome
Answer: C
Rationale: Option C, Process, evaluates specifically on how the training program was conducted, i.e. the
appropriateness and adequacy of the training process. Option A and B, inputs and resources, evaluates the adequacy
of manpower resources. Option D, Option D, Outcome, evaluates the immediate and intermediate effects/results of
the hilot training program.
2. Which among the following is NOT a criterion in evaluation an outcome of deworming program?
A. Training methods used were varied and appropriate to the participants’ level of comprehension.
B. Reports of parasitic infection are accurate
C. Incidence of ascariasis infection
D. Incidence of anemia related to hookworm infection
Answer: A
Rationale: B, C and D are all criteria to evaluate the outcome of the deworming program.
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3. Which among the following is true to Evaluation? (select all that apply)
A. It is assumed that the more resources used in a program; it means good health care.
B. Unqualified service people doing an evaluation may result to an insufficient evaluation.
C. Evaluation is a plant that entails determining the specific input, process and output/outcome indicators of the
program stating the criteria and standards of each.
D. Record keeping is a part of the evaluation.
Answer: B, C and D
Rationale: Options B, C and D are true to evaluation. Option A, it is not always true that if plenty of resources used, it
means good health care, it reported that there is often plenty of waste of resources.
4. Program evaluation includes the following steps:
A. Deciding on what to evaluate in terms of relevance, progress, effectivity, impact and efficiency
B. Specifying the evaluation indicators
C. Collection of method
D. Making decisions
Answer: A, B and D
Rationale: All options except C, collection of data not methods.
5. The primary purpose of program evaluation is:
A. To determine its effectiveness
B. To assess its outcome
C. To improve future program
D. To distribute report to the relevant groups
Answer: C
Rationale: Option C is the primary purpose of program evaluation. The findings of the evaluation can be used to
modify activities of future program.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Success criteria (Cold call, three students will be called to complete the sentence).
I know that program title can be written in a manner that is ________________. It can be written in a
_______________________.
In writing the objectives of the program, I have to observe __________.
Activities must be _________________. These activities must be _______________________.
Answer: I know that program title can be written in a manner that is simple. It can be written in a language of the people
of the community.
In writing the objectives of the program, I have to observe SMART.
Activities must be related to the objectives. These activities must be exciting to the community.
(Reading Assignment: Environmental Sanitation Programs)
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Suggestion for RLE Activity
AL: Structured problem solving – output Community based health plan
Class will be divided into groups (RLE groupings). The students will be asked to prepare a community health based plan
Situation:
Problem: Oral health problems among school-age children
Goal: To reduce oral health problems among school-age children from 320/100 to 80/100
Objectives:
At the end of the year, the community of Barangay Gueset will:
1. Demonstrate the ability to participate in oral health related activities of the barangay from 50% to 80%
2. Reduce the prevalence of oral health problem among school age from 58% to 28%
Sample of Community Based Health Plan
Program
Title
Objectives
Activities
Assign
Person
“Malinis na
bibig
tungo
sa
kalusugan
”
At the end of the activity,
the school-age children
will be able to:
a. Demonstrate
proper way of
brushing
their
teeth
b. Enumerate
at
least 3 food to
ensure healthy
gums and teeth
Short
program
- Minidiscussio
n
Short
program
– 10
students
Hall
of
posters
Healthy
booths
Quiz
booths
Hall of
posters –
20
students
Target
Outcom
es
Schoolage
children
will have
health
gums
and
teeth
Healthy
booths –
6
students
Quiz
booths –
9
students
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Education (Department of Nursing)
Manpower
Materials
Budget
Barangay
Health
Workers –
Registration
Tables
Chair
Sound
system
Posters
Extension
wires
Foods
Drinks
Token
Certificate
s
Refreshment
Php40 per
head
Facility
arrangemen
t
–
Barangay
Tanod and
students
Sound
system – c/o
Barangay
Token
Php20 per
head
Certificate
Php5 per
head
Miscellaneou
s
Php10 per
head
Refreshmen
t – Students
9 of 9
Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 13
LESSON TITLE: ENVIRONMENTAL HEALTH PART I
Materials:
LEARNING OUTCOMES:
Book, pen and notebook
At the end of the lesson, the nursing student can:
White board marker
1. Describe Environmental Health.
2. Identify environmental problems.
3. List down environmental health problems each
pollutant would cause.
4. Create a pilot program proposal to prevent pollution
with the environmental health problems that go with it.
Bond paper
LCD and laptop
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
Think, Pair and Share
The table below will be shown. The students will be instructed to formulate evaluation outcome and after 2 minutes, they
will show their answer to the one beside them. Then, ask 2-3 students to share their answer and call the attention of the
class to react to the answers that will be given. Answer will be presented thereafter.
Write the Evaluation Outcome based from the Objective
Objective
Evaluation Outcome
After one month, the family will be able to take care
of a weak elderly.
Answer:
The family will be able to: (1) identify the factors that contributed to the weakening of the elderly; (2) allocate resources to
meet the needs of the elderly; (4) identify signs of deterioration and (5) bring the elderly to the RHU for further
assessment.
The instructor will show a picture of a dirty environment.
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The instructor will ask the students what are the possible effects if this is the kind of environment. The instructor calls for
2-3 students to answer. The instructor relates their answers to the learning outcomes.
MAIN LESSON (30 minutes)
The instructor should discuss the following topics (Famorca et al., 2013, page 305-324).
Environmental Health
x 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).
x 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.
x
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
x
x
x
x
x
x
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
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
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•
•
•
•
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
• 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
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•
•
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) (ʅg/m3)
Good
0-80
Fair
81-230
Unhealthy
for
groups
Very Unhealthy
sensitive
231-349
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.
• “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.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
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1. Which among the following best describe Environmental Health (EH)? (select all that apply)
A. EH refers to the characteristics of environmental conditions that affect the man’s well-being.
B. EH is the aspect of private 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.
C. EH 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 past generations.
D. EH 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.
Answer: A and D
Rationale: A and D define EH. Option B, EH is the aspect of public health not private. Option C, …that can
potentially affect adversely the health present and current generations, not past generation.
2. Nurse Brent is to dispose used intravenous lines, he will place this in a:
A. Black bin
B. Green bin
C. Yellow with biohazard symbol bin
D. Yellow with black band symbol bin
E. Orange bin
Answer: C
Rationale: Used IV line is a pathological waste and in should be in yellow with biohazard symbol bin. Black or
colourless: non-hazardous and nonbiodegradable wastes; Green: non-hazardous biodegradable wastes; Yellow
with black band: pharmaceutical, cytotoxic or chemical wastes (labelled separately); Orange with radioactive
symbol: radioactive wastes
3. On the other hand, needleless syringes used with cytotoxic drugs, must be placed in a:
A. Black bin
B. Green bin
C. Yellow with biohazard symbol bin
D. Yellow with black band symbol bin
E. Orange bin
Answer: D
Rationale: Cytotoxic waste must be placed in a yellow with black band symbol bin. Black or colorless: nonhazardous 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
4. Which among the following is strictly prohibited in solid waste management? (select all that apply)
A. Garbage composting
B. Squatting in landfills
C. Dumping garbage anywhere
D. Re-use materials as long as possible
Answer: B and C
Rationale: Squatting in landfills is strictly prohibited. Families who live within the landfills will suffer of health
problems.Dumping anywhere is similarly to open dumping and this is prohibited practice. Garbage composting is
encouraged. The end output serves as fertilizer. “Re-use” is also a practice encourage in managing solid waste.
This practice lessens waste present in the environment.
5. This level of water system is common to remote areas. It can be shallow or deep but without distribution
system:
A. Point system
B. Standpost
C. Water works system
D. Communal faucet
Answer: A
Rationale: Points system is Level I which either shallow or deep and without distribution systems. Option B,
standpost and Option D, communal faucet are Level II, this level 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
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house. Level III (Waterworks System) refers to a system with a source transmission pipes, a reservoir, and a
piped distribution network for household taps.
6. A PHN came to visit a remote area. The water being used for drinking came from the mountains. It is best
to advise the people to let the water boil for about:
A. 30 seconds
B. 1 minute
C. 2 minutes
D. 3 minutes
Answer: D
Rationale: Mountains are high in altitude and water from there should be boiled for 3 minutes. Option A and C is
not enough to disinfect the water. Option B, is for water at sea level.
7. A good air quality index is:
A. 60 ʅg/m3
B. 90 ʅg/m3
C. 190 ʅg/m3
D. 290 ʅg/m3
Answer: A
Rationale: 60 ʅg/m3 is within 0-80 ʅg/m3 good air quality index. Option B, 90 ʅg/m3 and Option C, 190 ʅg/m3 is
within 81-230 fair air quality index. Option D, 290 ʅg/m3 is considred unhealthy for sensitive people.
8. Which among the following indicates an acutely unhealthy air index?
A. 231-349 ʅg/m3
B. 350-599 ʅg/m3
C. 600-899 ʅg/m3
D. 900 and above
Answer: C
Rationale: Option A, 231-349 ʅg/m3 – unhealthy for sensitive groups; Option B, 350-599 ʅg/m3 – very unhealthy;
Option D, 900 and above – emergency
9. People with heart or respiratory disease, such as asthma, should stay indoors and rest as much as
possible if the air index starts with:
A. 231 ʅg/m3
B. 350 ʅg/m3
C. 600 ʅg/m3
D. 900 ʅg/m3
Answer: A
Rationale: Option A, indicates that the air is unhealthy and once it starts with 231 and above, all people with
respiratory and heart problems must remain indoor.
10. When the air index reaches 900 ʅg/m3, the following will be advised: (select all that apply)
A. People should limit outdoor exertion.
B. Keeping windows and doors closed unless heat stress is possible.
C. Everyone should remain indoors.
D. Motor vehicle use should be prohibited except for emergency situations.
Answer: B, C and D
Rationale: An air index of 900 ʅg/m3 is an emergency situation. All must remain indoors, keep windows and
doors closed and motor vehicles are prohibited except for emergency situations. People are prohibited out from
their homes.
LESSON WRAP-UP (5 minutes)
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Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Exit pass
Students will be asked to write their reflections what presently they can do as a future nurse to their environment. Twothree students will be called to share their answers.
(Reading Assignment: Laws and Policies affecting Environmental Health)
For RLE: 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 (5 minutes).
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
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Manpower
Materials
Budget
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / FIRST YEAR
Session # 14
LESSON TITLE: ENVIRONMENTAL HEALTH PART II
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Describe other environmental programs.
2. Synthesize the laws related to environmental health.
Materials:
Book, pen and notebook
LCD and laptop
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
https://www.doh.gov.ph/environmental-healthprograms
LESSON REVIEW/ PREVIEW (5 minutes)
We are going to begin our lecture by calling three (3) students to fill in the table.
Pollutant
Health Problems
Infectious waste
Sulfur
Chemical waste
The instructor will show this image and ask the students to make a meme in relation to environmental health laws.
Example: “Sa labas may batas, ‘di pwede ang dahas sa inang likas”
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 13 Famorca et al., 2013):
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
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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.
• 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.
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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
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.
Environmental health laws and policies
Policies and Laws
•
PD No. 856 – Code on Sanitation of the Philippines
•
EO No. 489 s. 1991 – The Inter-Agency Committee on Environmental Health (IACEH)
•
National Objectives for Health (NOH) 2011-2016
•
DOH A.O. 2010-0021 - Sustainable Sanitation as a National Policy and a National Priority Program
of the DOH
•
DOH A.O. 2014-0027 – National Policy on Water Safety Plan (WSP) for All Drinking-Water Service
Providers
•
DOH A.O. 2017-0006 – Guidelines for the Review and Approval of the Water Safety Plans of
Drinking-Water Service Providers
•
DOH A.O. 2017-0010 – Philippine National Standards for Drinking Water (PNSDW) of 2017
-
Source: DOH website
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•
RA 9003 – Ecological Solid Waste Management Act 0f 2000
o
It declares the adoption of a systematic, comprehensive, and ecological solid waste
management programs as a policy state of the State. Adopts a community-based
approach. Mandates waste diversion through composting and recycling.
•
PD 825 – Providing Penalty for improper Disposal of Garbage and other forms of uncleanliness
•
RA 6969 – Toxic Substances and hazardous and Nuclear Waste Control Act of 1990.
o
•
Regulating the importation, use, movement, treatment and disposal of toxic chemicals and
hazardous and nuclear wastes in the Philippines.
RA 9275 – Philippine Clean Water Act of 2004
o
This law aims to establish wastewater treatment facilities that will clean wastewater before
releasing into the bodies of water like the rivers and seas. Furthermore, it also requires
LGUs to form water management areas that will manage wastewater in their respective
areas.
•
RA 9711 – Food and Drug Administration Act
•
PD 1096 – National Building Code of the Philippines
•
RA 8749 – Clean Air Act of 1999
o
Provides a comprehensive air pollution management and control program to achieve and
maintain healthy air. Section 20 bans the use of incineration for municipal, bio-medical
and hazardous wastes but allows the traditional method of small scale burning.
o
Motor vehicles cause 70% of outdoor air pollution and measures are required to alleviate
air pollution due to motor vehicles, such as: all motor vehicles are required to pass the
smoke emission standards prior to registration; phasing out leaded gasoline in the end of
year 2000; automotive diesel fuel’s sulphur content should be lowered; and decrease the
aromatics and benzene levels in unleaded gasoline.
o
Furthermore, ban smoking in enclosed public places including public transport in order to
prevent indoor pollution due to second hand smoke.
•
DENR, 2000 AO No. 2000-81 – Implementing Rules and Regulations (IRR) for RA 8749
•
DOH 1995a IRR of Chapter II “Water Supply” of the Code on Sanitation of the Philippines
•
DOH 1995b IRR of Chapter III “Food Establishments” of the Code on Sanitation of the Philippines
•
DOH 1995c IRR of Chapter XVII “Sewage Collection and Disposal, Excreta Disposal and Drainage”
of the Code on Sanitation of the Philippines
•
DOH 1997 IRR of Chapter XVI “Vermin Control” of the Code on Sanitation of the Philippines
•
DOH 2007 AO No. 2007-0012 – Philippine National Standards for Drinking Water
CHECK FOR UNDERSTANDING (20 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
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Multiple Choice:
1. Upon interview, Aling Neneth mentioned that their toilet is known as Antipolo toilet. Antipolo toilet is best
describe as:
A. fecal matter is collected in a can or bucket, which is periodically removed for emptying and cleaning
B. fecal matter is eliminated into a hole in the ground that leads to a dug pit
C. As made up of an elevated pit privy that has a covered latrine.
D. Fecal matter is collected into a built septic tank that is not connected to a sewerage system.
Answer: C
Rationale: Antipolo toilet is made up of an elevated pit privy that has a covered latrine. Option A, describes
Box-and-can privy; Option B describes pit-latrine and Option D describes septic privy
2. On the other hand, Cora described their toilet as pit latrine with a screened air vent installed directly over
the pit. This is a:
A. Aqua privy
B. Overhung latrine
C. VIP latrine
D. Chemical privy
Answer: C
Rationale: A ventilated-improved pit is with screened air vent installed directly over the pit. Option A aqua
privy is a toilet in which fecal matter is eliminated into a water-sealed drop pipe that leads to a small waterfilled septic tank located directly below the squatting plate. Option B overhung latrine is a when fecal matter is
directly eliminated into a body of water such as flowing river that is underneath the facility. Option D chemical
privy is when the fecal matter is collected into a tank that contains a caustic chemical solution, which in turn
controls and facilitates waste decomposition.
3. The following are rules of food safety:(select all that apply)
A. A food establishment must have a sanitary permit
B. Person employed in any food establishment must have a health certificate from health officer
C. Must have no history of diarrhea
D. Person employed in a food establishment shall not be allowed to handle food when suffering of
gastrointestinal upset.
Answer: A, B and D
Rationale: Option A, B and D are rules in food safety. Option C, if the person is afflicted of diarrhea, he/she
will not be allowed but if he is recovered, he/she will be allowed to handle food.
4. After proper washing, the utensils must be subjected to bactericidal treatments such as: (select all that
apply)
A. Immersion for a least a minute in lukewarm water containing 55-100 ppm of chlorine solution
B. Exposure to steam at least half a minute to a 200 °C
C. Exposure to steam for at least 5 minutes to 77 °C
D. Immersion for a least half a minute in clean hot water (77°C)
Answer: A and D
Rationale: Options A and D are correct. Option B, exposure to steam of 200°C must be 5 minutes not half a
minute. Option C, exposure to steam with 77 °C must be 15 minutes, not 5 minutes.
5. It is a law that requires all motor vehicles to pass the smoke emission standards:
A. RA 6969
B. PD 856
C. RA 8749
D. RA 9275
Answer: C
Rationale: Option C (RA 8749) is known as Clean Air Act of 1999. Option A (RA 6969) is known as Toxic
Substances and Hazardous and Nuclear Waste Control Act of 1990. Option B (PD 856) is the Sanitation
Code of the Philippines. Option D (RA 9275) is otherwise known as the Clean Water Act of 2004.
6. This law declares the adoption of a systematic, comprehensive, and ecological solid waste management
programs as a policy state of the State. Adopts a community-based approach. Mandates waste diversion
through composting and recycling:
A. RA 6969
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B. RA 9003
C. RA 8749
D. RA 9275
Answer: B
Rationale: Option B (RA 9003) is the Ecological Solid Waste Management Act of 2000. Option A (RA 6969)
is known as Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990. Option C (RA 8749) is
known as Clean Air Act of 1999. Option D (RA 9275) is otherwise known as the Clean Water Act of 2004.
7. This law allows traditional small-scale burning but prohibits incineration of biomedical waste and
hazardous waste.
A. RA 6969
B. RA 9003
C. RA 8749
D. RA 9275
Answer: C
Rationale: Option C (RA 9003) is the Ecological Solid Waste Management Act of 2000. Option A (RA 6969)
is known as Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990. Option C (RA 8749) is
known as Clean Air Act of 1999. Option D (RA 9275) is otherwise known as the Clean Water Act of 2004.
8. This law regulates the importation, use, movement, treatment and disposal of toxic chemicals and
hazardous and nuclear wastes in the Philippines:
A. RA 6969
B. RA 9003
C. RA 8749
D. RA 9275
Answer: A
Rationale: Option A (RA 6969) is known as Toxic Substances and Hazardous and Nuclear Waste Control Act
of 1990. Option B (RA 8749) is the Ecological Solid Waste Management Act of 2000. Option C (RA 8749) is
known as Clean Air Act of 1999. Option D (RA 9275) is otherwise known as the Clean Water Act of 2004.
9. Which among the following method is friendly to nature in controlling vermin: (select all that apply)
A. Chemical control
B. Integrated control
C. Naturalistic control
D. Biological and genetic control
Answer: C and D
Rationale: Options C and D, are natural methods of controlling vermin without disturbing nature. Option A
(Chemical control) uses chemical agents that will kill vermin but it may affect nature. Option B (integrated
control) is a combination of different methods which may either use chemical or natural measures.
10. The minimum air space that shall be provided for school rooms must be:
A. School Rooms - 3.00 cu. meters with 1.00 sq. meter of floor area per person
B. Workshop, Factories, and Offices - 12.00 cu. meters of air space per person
C. Habitable Rooms - 14.00 cu. meters of air space per person
D. 12.00 sq. meters of floor area per person
Answer: A
Rationale: Option A describes the air space for school rooms. Option B describes the air space for workshop,
factories and offices. Option C for habitable rooms. Option D’s unit is incorrect for workshop, factories and
offices, it should be in cu. meters not sq. meters
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
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Success criteria
The students will be asked to cite one of the Environmental Health Laws. The students will be instructed to complete the
sentence below.
I learned that ___________(law) and this concerns about _________________________.
Please be reminded regarding the following:
1. Coverage of P2 exam
2. Permit
3. Calculator (The instructor will emphasize that borrowing of calculator during the examination proper is strictly
prohibited).
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 15
LESSON TITLE: CONTROL OF COMMUNICABLE
DISEASES PART I
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can be able to:
1. Differentiate contagious and infectious disease.
2. Explain the epidemiologic triangle disease model.
3. Describe the elements involved in the chain of infection.
Materials:
Book, pen and notebook
LCD and power point presentation
Pieces of paper
Marker
White board marker
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
REVIEW TEST
The instructor will advise the students to choose a partner and be seated together. The students will be advised to use 8
pcs of ¼ sheet of paper and a marker. Each question will be flashed and they will be given 1 minute to answer. The
instructor will say, “show your answer” and students will be raise their answer.
1. This law safeguards the safety and quality of processed foods, drugs, diagnostic reagents, medical devices,
cosmetics and household substances.
Answer: (RA 9711)
2. This law prohibits drilling wells 25 meters within septic tank.
Answer: (PD 856)
3. This law directs the DOH to be primarily responsible for the promulgation, revision, and enforcement of drinking
water quality standards.
Answer: (RA 9275)
4. This law regulates the controlled chemicals namely asbestos, cyanide, mercury, polychlorinated biphenyls, and
ozone-depleting substances.
Answer: (RA 6969)
5. This law defines solid waste management as the discipline associated with the control of generation, storage,
collection, transfer and transport, processing, and disposal of solid wastes in a manner that it is accordance with
the best principles of public health, economics, engineering, conservation, aesthetics and other environmental
considerations, and that is also responsive to public attitudes.
Answer: (RA 9003)
Show the picture below. Ask 2-3 students what does it depicts. Present the learning outcomes for today’s discussion.
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MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 12 Famorca et al., 2013):
Nursing Care of clients with communicable diseases
A. General principles and techniques
x 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.
x Communicable diseases could either be a contagious or an infectious disease.
o 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.
o Contagion is transmitted by direct physical contact.
o 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.
RANK
Top 10 causes of Morbidity in the Philippines DOH 2010
DISEASE
Rate per 100,000
1
Acute Respiratory Infection
1,203
2
Acute lower respiratory tract infection
and pneumonia
Bronchitis
Hypertension
Acute watery diarrhea
Influenza
Urinary Tract Infection
Tuberculosis (Respiratory)
Accidents
Injuries
612.6
3
4
5
6
7
8
9
10
380.7
366.3
354.5
297.7
91
80.9
54.9
38.9
Epidemiologic Triangle Model
Three Major Components
1. Agent
2. Host
3. Environment
Agent – organism involved in the development of disease.
o Agent must be present for an infection to occur
o Agents include bacteria (TB, pneumonia), viruses (influenza, CoVID-19), rickettsiae (Rocky mountain
spotted fever), fungi (ringworm), protozoa (malaria), helmiths (ascariasis) and arthropods (scabies).
o Although the agent must be present at all times, it must be capable of infecting a host.
Host – organism that harbors and provides nutrition for the agent.
o Humans are most often the host of infectious organisms
o Animals can be also considered host
o Factors influencing the ability of the host to fight the agent causing infection
o Age
o Gender
o Socio-economic status, ethnicity, nutritional and immune status, ethnicity, nutritional and
immune status, genetic make-up, hygiene and behaviour
Environment – Conditions in which the agent may exist, survive, or originate.
o It comprises of the following components:
o Physical – temperature; weather; soil; water and food sources
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o
o
Biological – animals; insects; flora and other human beings that act as reservoir or foster the
survival of organisms
Socioeconomic – behaviour, personality, attitudes, cultural characteristics of people,
occupation, and urbanization
Chain of infection
o Causative agent
o Causative agent is any organism capable of producing a disease. It includes bacteria, viruses,
rickettsiae, fungi, protozoa and helminths.
o
Reservoir
o
o
o
o
The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and
multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may
not be the source from which an agent is transferred to a host. For example, the reservoir
of Clostridium botulinum is soil, but the source of most botulism infections is improperly canned
food containing C. botulinum spores.
Human reservoirs. Many common infectious diseases have human reservoirs.
o Diseases that are transmitted from person to person without intermediaries include the
sexually transmitted diseases, measles, mumps, streptococcal infection, and many
respiratory pathogens.
o Human reservoirs may or may not show the effects of illness.
o As noted earlier, a carrier is a person with inapparent infection who is capable of
transmitting the pathogen to others.
ƒ Asymptomatic or passive or healthy carriers are those who never experience
symptoms despite being infected.
ƒ Incubatory carriers are those who can transmit the agent during the incubation
period before clinical illness begins.
ƒ Convalescent carriers are those who have recovered from their illness but remain
capable of transmitting to others.
ƒ Chronic carriers are those who continue to harbor a pathogen such as hepatitis B
virus or Salmonella Typhi, the causative agent of typhoid fever, for months or
even years after their initial infection.
ƒ Carriers commonly transmit disease because they do not realize they are
infected, and consequently take no special precautions to prevent transmission.
ƒ Symptomatic persons who are aware of their illness, on the other hand, may be
less likely to transmit infection because they are either too sick to be out and
about, take precautions to reduce transmission, or receive treatment that limits
the disease.
Animal reservoirs. Humans are also subject to diseases that have animal reservoirs.
o Many of these diseases are transmitted from animal to animal, with humans as incidental
hosts.
o The term zoonosis refers to an infectious disease that is transmissible under natural
conditions from vertebrate animals to humans.
ƒ Long recognized zoonotic diseases include brucellosis (cows and pigs), anthrax
(sheep), plague (rodents), trichinellosis/trichinosis (swine), tularemia (rabbits),
and rabies (bats, raccoons, dogs, and other mammals).
Environmental reservoirs. Plants, soil, and water in the environment are also reservoirs for
some infectious agents.
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o
o
Many fungal agents, such as those that cause histoplasmosis, live and multiply in the
soil.
Outbreaks of Legionnaires disease are often traced to water supplies in cooling towers
and evaporative condensers, reservoirs for the causative organism Legionella
pneumophila.
o
Portal of exit
o Portal of exit is the path by which a pathogen leaves its host.
o The portal of exit usually corresponds to the site where the pathogen is localized.
x For example, influenza viruses and Mycobacterium tuberculosis exit the respiratory tract,
schistosomes through urine, cholera vibrios in feces, Sarcoptes scabiei in scabies skin
lesions, and enterovirus , a cause of hemorrhagic conjunctivitis, in conjunctival
secretions.
x Some bloodborne agents can exit by crossing the placenta from mother to fetus (rubella,
syphilis, toxoplasmosis), while others exit through cuts or needles in the skin (hepatitis B)
or blood-sucking arthropods (malaria).
o
Modes of transmission
o An infectious agent may be transmitted from its natural reservoir to a susceptible host in different
ways. There are different classifications for modes of transmission. Here is one classification:
o Direct
ƒ Direct contact
x Direct contact occurs through skin-to-skin contact, kissing, and sexual
intercourse.
x Direct contact also refers to contact with soil or vegetation harboring
infectious organisms.
o Thus, infectious mononucleosis (“kissing disease”) and
gonorrhea are spread from person to person by direct contact.
Hookworm is spread by direct contact with contaminated soil.
ƒ Droplet spread
x Droplet spread refers to spray with relatively large, short-range aerosols
produced by sneezing, coughing, or even talking.
x Droplet spread is classified as direct because transmission is by direct
spray over a few feet, before the droplets fall to the ground.
o Pertussis and meningococcal infection are examples of diseases
transmitted from an infectious patient to a susceptible host by
droplet spread.
o Indirect
ƒ Airborne
x Airborne transmission occurs when infectious agents are carried by
dust or droplet nuclei suspended in air. Airborne dust includes material
that has settled on surfaces and become resuspended by air currents as
well as infectious particles blown from the soil by the wind. Droplet nuclei
are dried residue of less than 5 microns in size. In contrast to droplets
that fall to the ground within a few feet, droplet nuclei may remain
suspended in the air for long periods of time and may be blown over
great distances. Measles, for example, has occurred in children who
came into a physician’s office after a child with measles had left,
because the measles virus remained suspended in the air.
ƒ Vehicleborne
x Vehicles that may indirectly transmit an infectious agent include food,
water, biologic products (blood), and fomites (inanimate objects such as
handkerchiefs, bedding, or surgical scalpels). A vehicle may passively
carry a pathogen — as food or water may carry hepatitis A virus.
Alternatively, the vehicle may provide an environment in which the agent
grows, multiplies, or produces toxin — as improperly canned foods
provide an environment that supports production of botulinum toxin
by Clostridium botulinum.
ƒ Vectorborne (mechanical or biologic)
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x
o
o
Vectors such as mosquitoes, fleas, and ticks may carry an infectious
agent through purely mechanical means or may support growth or
changes in the agent. Examples of mechanical transmission are flies
carrying Shigella on their appendages and fleas carrying Yersinia pestis,
the causative agent of plague, in their gut. In contrast, in biologic
transmission, the causative agent of malaria or guinea worm disease
undergoes maturation in an intermediate host before it can be
transmitted to humans.
Portal of entry
o The portal of entry refers to the manner in which a pathogen enters a susceptible host.
o The portal of entry must provide access to tissues in which the pathogen can multiply or a toxin can
act.
o Often, infectious agents use the same portal to enter a new host that they used to exit the source
host.
ƒ For example, influenza virus exits the respiratory tract of the source host and enters the
respiratory tract of the new host.
ƒ In contrast, many pathogens that cause gastroenteritis follow a so-called “fecal-oral” route
because they exit the source host in feces, are carried on inadequately washed hands to a
vehicle such as food, water, or utensil, and enter a new host through the mouth.
ƒ Other portals of entry include the skin (hookworm), mucous membranes (syphilis), and blood
(hepatitis B, human immunodeficiency virus).
Host
o The final link in the chain of infection is a susceptible host.
o Susceptibility of a host depends on genetic or constitutional factors, specific immunity, and
nonspecific factors that affect an individual’s ability to resist infection or to limit pathogenicity.
o An individual’s genetic makeup may either increase or decrease susceptibility.
ƒ For example, persons with sickle cell trait seem to be at least partially protected from a
particular type of malaria.
o Specific immunity refers to protective antibodies that are directed against a specific agent.
ƒ Such antibodies may develop in response to infection, vaccine, or toxoid (toxin that has been
deactivated but retains its capacity to stimulate production of toxin antibodies) or may be
acquired by transplacental transfer from mother to fetus or by injection of antitoxin or immune
globulin.
ƒ Nonspecific factors that defend against infection include the skin, mucous membranes,
gastric acidity, cilia in the respiratory tract, the cough reflex, and nonspecific immune
response. Factors that may increase susceptibility to infection by disrupting host defenses
include malnutrition, alcoholism, and disease or therapy that impairs the nonspecific immune
response.
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CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice
1. Which among the following statement is true to communicable disease? (select all that apply)
A. An infectious disease can be contagious because the latter can be transmitted indirectly.
B. Communicable diseases could either be contagious or infectious.
C. An infectious disease is transmitted through indirect physical contact.
D. Contagious diseases are sometimes called as infectious diseases.
Answer: B and C
Rationale: Only Option B and C statements are correct. Option A, Infectious diseases can be contagious if it is
Option D, infectious diseases are usually not regarded as contagious.
2. In order for an agent to cause infection, it must be: (select all that apply)
A. present all that time
B. capable of infecting the host
C. a virus
D. a bacteria
Answer: A and B
Rationale: Options A and B are correct. Option C and D are incorrect, there are other forms of agent that can cause
infection not only virus.
3. Which among the following is NOT true to the epidemiologic triangle model?
A. As long as the balance is maintained or is tilted in favor of the host, disease does not occur.
B. Environmental elements can tilt the balance in favor of the agent.
C. The model suggests that the agent and the susceptible host interact freely in a common environment.
D. If the balance is tilted in favor of the agent, disease does not occur.
Answer: D
Rationale: Options A, B and C are correct, while Option D is not. Disease occurs when balance is tilted in favor of the
agent.
4. This refers to any organism capable of causing disease:
A. Causative agent
B. Reservoir
C. Portal of exit
D. Susceptible Host
Answer: A
Rationale: Option A, causative agent is any organism that is capable of causing disease. Option B, reservoir is the
habitat of organisms in which they survive and multiply. Option C, Portal of exit is the path by which an agent leaves
its reservoir. Option D, Susceptible host is the individual who may be vulnerable of the invasion and multiplication of
agents.
5. This refers to the manner in which a pathogen enters a susceptible host:
A. Causative agent
B. Reservoir
C. Portal of exit
D. Portal of entry
Answer: D
Rationale: Option D, portal of entry refers to the manner in which a pathogen enters a susceptible host. Option A
causative agent is any organism that is capable of causing disease. Option B, reservoir is the habitat of organisms in
which they survive and multiply. Option C, Portal of exit is the path by which an agent leaves its reservoir.
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6. This is the habitat of causative agents:
A. Reservoir
B. Portal of exit
C. Portal of entry
D. Susceptible Host
Answer: A
Rationale: Option A, reservoir is the habitat of organisms in which they survive and multiply. Option B, portal of exit is
the path by which an agent leaves its reservoir. Option C, portal of entry is the path by which an agent enters
to its host. Option D, susceptible host is an individual that cannot resist that pathogenicity of the agent.
7. Which among the following is a direct transmission of agents?
A. Droplet spread
B. Airborne transmission
C. Vehicleborne transmission
D. Vectorborne
Answer: A
Rationale: Options B. C and D are all example of indirect transmission
8. Which among the following statements made by the student denotes understood the concept of indirect
transmission?
A. “I will not eat street foods.”
B. “I should be wearing gloves when taking care of a patient with gonorrhea.”
C. “Unprotected sexual intercourse may result to sexual transmitted disease.”
D. “I will advise mothers not to let their children walk barefooted. “
Answer: A
Rationale: Option A, prevents the possibility of having disease though foodborne vehicle, which is an indirect disease
transmission. Options B, C and D are examples of preventing transmission of diseases via direct contact like skin to
skin and sexual activity. Option D, is an instruction to prevent hookworm infection. Hookworm penetrates directly
through foot that is not protected. This is an example of direct transmission
9. To prevent transmission of diseases, the best way is to:
A. Remove any elements to prevent the onset of a communicable disease
B. Enhance the immune system of the susceptible host
C. Immunize all people
D. Eradicate the causative agent
Answer: A
Rationale: Option A, removing any element of the chain of infection stops communicable disease spread. Option B,
enhancing immune system is not enough to prevent the transmission of disease. Option C, immunizing all people is
not a guarantee that they will not have a disease. Furthermore, vaccines for all diseases are not yet developed.
Option D, causative agent eradication is impossible at present. Moreover, an eradication of microorganisms may lead
to birth of other agents.
10. The student nurse knows that a host is susceptible to diseases because of: (select all that apply)
A. Malnutrition
B. Old age
C. Not alcoholic
D. Present existing disease (co-morbidity)
Answer: A, B and D
Rationale: Options A, B and D lessens the immune status of a host making him/her more susceptible to disease.
Option C, not alcoholic does not place an individual at risk of a disease. Alcoholism per se makes one prone to
disease.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
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Modified Cold call
The student will summarize what they have learned based from the Learning Targets. (Five students will be called using “I
have the power technique”) A student will be randomly called by the teacher and will start a one statement summary and
the student will call another one by his/her choice to continue and so on and so forth until all output of learning targets will
be mentioned.
Give reading assignment regarding the following:
1. Leprosy control program
2. Malaria control program
3. Schistosomiasis control program
4. Soil-transmitted helminthiasis control program
5. National tuberculosis control program
Directions:
o
o
o
o
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 nonprofessionals.
It should contain the etiology, diagnostic tests, signs and symptoms, complications and treatment.
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 16
LESSON TITLE: CONTROL OF COMMUNICABLE
DISEASES PART II
Materials:
LEARNING OUTCOMES:
Book, pen and notebook
At the end of the lesson, the nursing student can:
LCD and power point presentation
1. Discuss the etiology of leprosy, malaria,
schistosomiasis, helminthiasis, and tuberculosis.
2. Identify appropriate nursing responsibilities in relation
to the diseases.
3. Enumerate the different laws that affect the control of
communicable diseases in the community.
Poster as prepared by the students
Cartolina
White board marker
Masking tape
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
We will begin our lecture by reviewing the previous topic. The instructor will show the following questions one by one.
Students will be randomly called to answer the questions below.
Multiple Choice
1. Which among the following is true to the epidemiologic triangle model? (select all that apply)
A. As long as it is tilted in favor of the host, disease does not occur.
B. Environmental elements can tilt the balance in favor of the agent.
C. The model suggests that the environment and the susceptible host interact freely in a common agent.
D. If the balance is tilted in favor of the agent, disease does not occur.
Answer: A and B
Rationale: Options A and B are correct, while Option C and D is not. Option C, Host and agent interacts in an
environment. Disease occurs when balance is tilted in favor of the agent.
2. Which among the following is an indirect transmission of agents? (select all that apply)
A. Droplet spread
B. Airborne transmission
C. Vehicleborne transmission
D. Vectorborne
Answer: B, C and D
Rationale: Options A is an example of direct transmission
3. Which among the following statements made by the student denotes understood the concept of direct
transmission?
A. “I will not eat street foods.”
B. “I should be wearing gloves when taking care of a patient with diarrhea.”
C. “Protected sexual intercourse may result to sexual transmitted disease.”
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D. “I will advise mothers not to let their children walk barefooted. “
Answer: D
Rationale: Option D, is an instruction to prevent hookworm infection. Hookworm penetrates directly through foot
that is not protected. This is an example of direct transmission
DIRECTIONS: The instructor will ask the students to display the poster in the classroom and present the expectations and
their responsibilities for today’s activity. (The display of poster must be done before the start of the class; all posters must
be posted to an assigned area. The class mayor will be asked to facilitate the posting.
Expectations
o
All students must be able to present their work and others’ work
Responsibilities
o Each student will play the role of a student and teacher
o All posters must be visited
Teacher role-play
The instructor will ask 5 students to stand beside their poster and prepare one-minute discussion about the poster. Then,
the student teachers will go to the next poster and listen. Those who listen will act as teachers and so on and so forth. All
students must be able to rotate to all the posters and act as a teacher and student. (Time will be strictly followed. There
must be an official timer to help in the facilitation of movement.)
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to read their book about this lesson
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
2. 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:
1. BCG vaccination
2. Avoid prolong skin to skin contact
3. Good personal hygiene
4. Adequate nutrition
5. 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
2. Blood smear
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3. 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
2. Parenteral
a. Quinine hydrochloride 300mg/mL, 2 mL
b. Quinidine gluconate 80 mg (50mg) 1 vial
Prevention and Control:
1. Mosquito control
2. Chemical method – use of insecticides
3. Biological methods – stream seeding
4. Zooprophylaxis – larvae-eating fish, farm animals should be kept near the house
5. Environmental methods – cleaning and irrigating canals
6. Screening of houses
7. Mechanical methods – use of fly swats or traps
8. Universal precaution
9. 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:
1. Proper disposal of feces
2. Proper irrigation of all stagnant bodies of water
3. Prevent exposure to contaminated water (wearing of rubber boots)
4. Eradication of breeding places of snails
5. Use of molluscicides
4. Soil-transmitted helminthiasis control program
x
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.
x
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.
x
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
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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.
5. 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
2. 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
1
2
3
4
Type of patients
New Smear (+) PTB
New Smear (-) PTB with extensive
lesions
Extrapulmonary PTB
Treatment Failure (patient while on
treatment, is sputum smear-positive at
5 months or later during the course of
treatment)
Relapse (patient previously treated for
TB, who has been 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)
New Smear (-) PTB with minimal
lesions on x-ray
Children
Chronic (still smear + after supervised
retreatment)
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Treatment regimen
Intensive – HRZE (2 months)
Maintenance – HR (4 months)
Intensive – HRZES (2 months) +
HRZE (1 month)
Maintenance – HR (5 months)
Intensive – HRZE (2 months)
Maintenance – HR (4 months)
Second line generation of antibiotics
based on results of culture and
sensitivity test
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TB Treatment for Children
Types of TB
Pulmonary TB
Extrapulmonary TB
x
x
x
x
Intensive phase
HRZ (2 months)
HRZS (2 months)
Treatment Regimen
Maintenance phase
HR (4 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
o
RA 3573 Reporting on Communicable Diseases
o Category I (Immediately Notifiable)
ƒ Acute flaccid paralysis
ƒ Adverse event following immunization
ƒ Anthrax
ƒ Human avian influenza
ƒ Measles
ƒ Meningococcal disease
ƒ Neonatal tetanus
ƒ Paralytic shellfish poisoning
ƒ Rabies
ƒ Severe Acute Respiratory Syndrome (SARS)
o Category II (Weekly Notifiable)
ƒ Acute bloody diarrhea
ƒ Acute encephalitis syndrome
ƒ Acute hemorrhagic fever syndrome
ƒ Acute viral hepatitis
ƒ Bacterial meningitis
ƒ Cholera
ƒ Dengue
ƒ Diptheria
ƒ Influenza-like illness
ƒ Leptospirosis
ƒ Malaria
ƒ Non-neonatal tetanus
ƒ Pertussis
ƒ Typhoid and paratyphoid fever
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o
o
o
o
RA 4073 An Act Liberalizing the Treatment of Leprosy
o 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
o 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
o Pronounced the NTCP as the highest priority public health program of the LGUs
AO No. 24 series of 1996
o The NTCP adopted DOTS in the management of TB.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice
1. The incubation period of leprosy is:
A. 4-6 weeks
B. 5 months to 5 years
C. 7 – 30 days
D. 14-84 days
Answer: B
Rationale: Option A, incubation period of TB. Option C, incubation period of malaria. Option D, incubation period of
Schistosomiasis.
2. The causative agent of leprosy is:
A. Mycobacterium leprae
B. Mycobacterium tubercle
C. Mycobacterium
D. All of these
Answer: A
Rationale: The causative agent of leprosy is Mycobactrium leprae that belongs to the family of Mycobacteria and
related to the causative agent of Tuberculosis.
3. Select all early signs of leprosy:
A. Reddish or white change in skin color
B. gynecomastia
C. Loss of sweating
D. Madarosis
Answer: A and C
Rationale: Option B and D are late signs of leprosy.
Early signs include 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
4. The specific vector of malaria:
A. Female anopheles mosquito
B. Oncomelania quadrasi
C. Aedes aegypti
D. Plasmodium falciparum
Answer: A
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Rationale: Option B is the vector if Schistosomiasis. Option C is the vector of dengue. Option D is the agent causing
malaria.
5. Which among is the triad signs of malaria:
A. Chills, fever and cough
B. Profuse sweating, fever and abdominal pain
C. Fever, chills and profuse sweating
D. Fever, rash and abdominal pain
Answer: C
Rationale: Option C is the triad signs of malaria. Although there is rash and abdominal pain, these signs and
symptoms are less likely.
6. This oral malarial treatment is given to resistant case of P. falciparum:
A. Sulfadoxine 50 mg
B. Primaquine
C. Chloroquine phosphate 250mg
D. Quinine hydrochloride 300mg/mL, 2 mL
Answer: A
Rationale: Option B, Primaquine For relapse P. vivax and P. ovale . Option C, chloroquine phosphate 250mg is given
to all species except P. malariae Option D, is a parenteral medication for malaria.
7. The best way to control Schistosomiasis is:
A. Protect self from insect bites.
B. Do not swim in rivers and other bodies of water.
C. Do not walk barefooted.
D. Snails must be killed.
Answer: D
Rationale: Option A, the vector of Schistosomiasis is not an insect. Option B, swimming in rivers and other bodies of
water will prevent the possibility of ingesting the schistosoma. However, it is not the way to control Schistosomiasis.
Option C, walking barefooted is advised to prevent hookworm infection.
8. Which among the following can be a host of Mycobacterium?
A. Humans
B. Dogs
C. Cattles
D. Monkeys
Answer: A and C
Rationale: Mycobacterium canettii and tubercle are found in humans. While Mycobacterium bovis is in cattles. Option
B, dogs and monkeys are not reported as hosts of Mycoacterium.
9. A patient is receiving a treatment of Intensive – HRZE (2 months) Maintenance – HR (4 months). This patient
can be: (select all that apply)
A. Relapse
B. Return after default (RAD)
C. New Smear (-) PTB with extensive lesions
D. Extrapulmonary PTB
Answer: C and D
Rationale: Option A and B, are category 2 and it requires longer treatment. Option C and D are under Category 1 and
will receive a treatment of Intensive – HRZE (2 months) Maintenance – HR (4 months).
10. This act mandates that communicable diseases must be reported:
A. RA 3573
B. RA 4073
C. RA 1136
D. RA 9173
Answer: A
Rationale: Option B, RA 4073 is an Act Liberalizing the Treatment of Leprosy. Option C, RA 1136, is the TB Law of
1954. Option D, RA 9173 is the Philippine Nursing Act.
LESSON WRAP-UP (5 minutes)
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Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
CAT 3-2-1
Direction: The instructor will write instruct the students to write their answers in a ½ sheet of paper.
1. Enumerate at least three communicable diseases.
2. Present two health promotion and preventive activities.
3. Write any concept related to the topic that is not clear to you.
(Reading assignment: Control of Non-communicable diseases)
Suggestion for RLE:
Concept Mapping
Directions: The instructor prepares draw lots concerning the 5 programs. She/he invites representative of each group to
pick other program other than their assignments. They will be asked to prepare a concept map. Each group will be given
10 minutes to finish the task and 2 minutes each for the presentation.
Rubrics for Evaluation (Total Score: 20 points)
Criteria
Completeness
-definition
-signs and symptoms
-diagnostic tests
-treatments
Nursing, pharmacological and
medical
Prevention activities
Conciseness
Creativity
Clarity
Score
5
Less
1
Partially
3
Fully
5
5
5
5
1
1
1
3
3
3
5
5
5
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 17
LESSON TITLE: NURSING CARE OF CLIENTS WITH NONCOMMUNICABLE DISEASES PART I
LEARNING OUTCOMES:
At the end of the lesson, the nursing student will be able to:
1. Enumerate the five (5) major non-communicable
diseases (NCD).
2. State the goal of the Department of Health’s NCD
program in relation to the lesson.
3. Identify the role of the public health nurse in NCD
Prevention and Control.
Materials:
Book, pen and notebook
LCD and laptop
White board marker
References:
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
https://www.doh.gov.ph/lifestyle-related-diseases
LESSON REVIEW/ PREVIEW (5 minutes)
Oral review test
The instructor will ask the students to answer in unison.
Fill in the blanks
1. Early signs of leprosy includes ________, __________, and ___________.
Possible answer: 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
2. Leprosy prevention includes BCG vaccination.
3. Primaquine is given for relapse P. vivax and P. ovale.
4. The intermediary host of Schistosomiasis is Oncomelania quadrasi.
5. National Deworming Month (NDM) is conducted on January and July.
6. The focus of NDM are children ages 1-18 years old.
7. Direct sputum smear microscopy confirms the presence of acid fast bacilli in the sputum.
8. Clients under Category 1 will receive treatment of Intensive – HRZE (2 months) Maintenance – HR (4 months).
9. Enumerate the roles of nurses in the National TB Program.
Possible answer: 1. Administrator 2. Health educator 3. Case manager and coordinator 4. Community coordinator
4. Treatment partner 6. Advocate
10. Enumerate at least 2 specific laws (Act, EO, AO and its title) related to Disease Prevention and Control.
Possible Answer: RA 3573 Reporting on Communicable Diseases, RA 4073 An Act Liberalizing the Treatment of
Lepros, RA 1136 TB Law of 1954, Memorandum Circular No. 98-155, AO No. 24 series of 1996
The instructor presents a slide containing, 2013 – 76.2%. The instructor asks the students to guess what those numbers
could mean.
Answers: 76.2% of the deaths among Filipino are NCD.
The instructor presents the definition of NCD.
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x
Non-communicable diseases (NCDs) include cardiovascular conditions (hypertension, stroke), diabetes
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.
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to read their book about this lesson
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.
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4. Excessive alcohol drinking
o Lead to metabolic and physiological effects on all organ systems such as GI and cardiovascular
disturbances
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. This involves:
1. Informing the people about the rightness of the cause. It is important to convey the problem, show how it affects
people in the community and describe what possible actions to take.
2. Thoroughly discussing with the people the nature of the alternatives, their content and consequences. In this manner,
needs and demands of the people are amplified and eventually become framework for decision-making. In this
exchange process, the advocate and the people strive to understand meanings and in a common way and establish
accuracy and reality in order to select the most effective strategy and tactic in the solution of the problem.
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3. Supporting people’s right to make a choice and to act on the choice. The people must be assured that they have the
right and responsibility to make decisions and that they do not have to change their decisions because of other’s
objections.
4. Influencing public opinion. The advocate affirms the decision made by the people by getting powerful individuals or
groups to listen, support and eventually, make substantial changes to solve the problem.
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.
The health educator aims to:
1. Inform the people. Health education creates an awareness of health needs and problems which consequently make
the people become conscious of their own responsibilities towards their own health. Misconceptions and ignorance
will be corrected by disseminating scientific knowledge about causes, factors, prevention and control of noncommunicable diseases.
2. Motivate the people. Telling people about health is not enough. They should be motivated to make own choices and
decisions about habits and practices that are detrimental to health, such as cigarette smoking, indulgence in alcohol,
physical inactivity and fat and sugar-rich diet. In order to motivate them, health education focuses on providing
learning experiences on what health actions to take, how, when and under what conditions are they going to
undertake them.
3. Guide people into action. Oftentimes, people need to be supported in their effort to adopt or maintain healthy practices
and lifestyles. Support comes in the form of making essential health services affordable, available and accessible to
them. In our society. Legislative policies are also necessary to provide initial push for people to undertake measures
to improve their own health status and the communities they live in.
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:
x Raising the level of awareness of the community regarding non-communicable diseases, its causes,
prevention and control;
x Organizing and mobilizing the community in taking action for the reduction of risk factors;
x 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
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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.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Review Test
Students will be asked to answer individually the questions below: Answers should be written in a 1/2 crosswise sheet of
paper.
Enumerate the 5 major noncommunicable diseases (NCD)
Answers:
1. Cardiovascular disease
2. Cerebrovascular disease
3. Diabetes
4. Chronic obstructive pulmonary disease
5. Cancer
State the goal of the Department of Health’s NCD program in relation to the lesson
6. A Philippines free from the avoidable burden of NCDs
Identify the role of the public health nurse in NCD Prevention and Control. (For 7-20, match the following letters
to the correct items.
A.
B.
C.
D.
E.
F.
Health Advocate
Health Educator
Health Care Provider
Community Organizer
Health Trainer
Researchers
7. Motivate the people.(B)
8. Supporting people’s right to make a choice and to act on the choice. (A)
9. Promotes health and prevents diseases through rational diet and physical activity. (C)
10. Influencing public opinion. (A)
11. The Public Health Nurse provides activities that will permit clients who have suffered from consequences of noncommunicable diseases to lead a socially and economically productive life. (C)
12. Organizing and mobilizing the community in taking action for the reduction of risk factors (D)
13. Influencing executive and legislative bodies to create and enforce policies that favour a healthy environment. (D)
14. Guide people into action. (B)
15. The people must be assured that they have the right and responsibility to make decisions and that they do not
have to change their decisions because of other’s objections. (A)
16. Inform the people (B)
17. The PHN provides technical assistance in the assessment of the skills of auxiliary health workers in NCD
prevention and control. (E)
18. It prevents health workers from implementing irrelevant interventions.(F)
19. The PHN conducts community assessments, epidemiological studies, and intervention studies.(F)
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20. The PHN teaches and supervises on clinical management of non-communicable diseases and other communitybased services and recording, reporting and utilization of health information related to non-communicable
diseases. (E)
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Minute Paper
The instructor will advise the students to complete the statement
What was the most meaningful part of this session?
What question do you have?
(Before dismissing the students, the instructor will ask at least two students to share their answers.)
(Reading Assignment: Non-communicable diseases)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 18
LESSON TITLE: CONTROL OF NONCOMMUNICABLE
DISEASES PART II
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Identify the different lifestyle-related diseases.
2. Enumerate ways to prevent non-communicable
diseases.
3. State the different laws affecting control of noncommunicable diseases.
Materials:
Book, pen and notebook
LCD and laptop
White board marker
References:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
Review Test (cold call)
The instructor will ask the students to identify the MOST possible NCD related to the following:
1. Cigarette smoking
Answer: Cardiovascular disease, COPD and Cancer
2. Radiation
Answer: Cancer
3. Excessive alcohol intake
Answer: Cardiovascular disease and Cancer
4. High salt intake
Answer: Cardiovascular disease
5. Loves to eat fried foods
Answer: Cardiovascular disease and Cancer
The instructor show a slide which contains this statement, “Non-communicable diseases - leading cause of mortality
in the Philippines”.
Direction: Ask 2-3 students what are the non-communicable diseases. Let them answer and then present the definition of
non-communicable diseases and the figure below.
Non-communicable diseases
• Medical condition that is non-infectious and non-transmissible.
• Referred as chronic disease or lifestyle-related disease
• Examples: Cardiovascular disease, Cerebrovascular disease, Cancer, Chronic Obstructive Pulmonary Disease
(COPD), Diabetes
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MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to listen and refer to their book and SAS:
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
• 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
Hypertension
Stage 1
Stage 2
Stage 3
120-139/80-89
140-159/90-99
160-179/100-109
> 180/110
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Classification of LDL, Total and HDL Cholesterol (mg/dL)
VALUES
INTERPRETATION
LDL Cholesterol
<100
100-129
130-159
160-189
>190
Optimal
Above optimal
Borderline
High
Very High
Total Cholesterol
<200
200-239
>240
Desirable
Borderline
High
HDL Cholesterol
<40
>60
Low
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
•
•
•
•
•
•
•
•
•
WARNING SIGNS OF CANCER
C hange in bowel or bladder habits
A sore that does not heal
U nusual bleeding
T hickening or lump in the breast
I ndigestion or difficulty of swallowing
O bvious change in a wart or more
N agging cough or hoarseness
U nexplained anemia
S udden weight loss
Lifestyle related factors
1. Cigarette smoking
2.
3.
4.
5.
Unhealthy diet
Alcohol drinking
Physical inactivity
Overweight/obesity
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
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4. Diabetes
x 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.
x 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
Lifestyle related factors
1. Unhealthy diet
2. Overweight
3. Obesity
Screening for Diabetes Mellitus:
For adults 20 years and older:
o Family history of diabetes
o Symptoms of diabetes
o If at special risk for diabetes
o Hypertensive
o Overweight
o Women who have delivered a baby weighing over 9 lbs
o Women who have been diagnosed of gestational diabetes
5. Chronic Obstructive Pulmonary Disease (COPD)
x It is a major cause of chronic morbidity and mortality throughout the world.
x 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.
x 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.
x Complications: Respiratory failure and Cardiovascular disease
Non-communicable diseases prevention
1. Promote physical activity and exercise
Physical activity refers to any bodily movement produced by skeletal muscles that results in expenditure of energy
and includes occupational, leisure-time and routine daily activities
Exercise is a subcategory of physical activity that is planned, structured repetitive and aimed at improving or
maintaining physical fitness or health
Physical activity guidelines
Low levels of activity
Metabolic equivalents (METS) of each intensity
Low (less than 150 minutes/week)
Light (<3.0 METs)
Walking slowly around home, store, or office; sitting using
computer, working at desk, using light hand tools; standing,
performing light work such as making bed, washing dishes,
ironing, preparing food or doing store clerk tasks, doing arts
and crafts, playing cards
Medium (150-300 minutes of moderate intensity/week
Moderate (3.0-6.0 METs)
or 75-150 minutes of vigorous intensity of physical
Walking briskly, cleaning, sweeping floors, vacuuming
activity)
carpet, washing car, doing carpentry; playing badminton,
basketball shooting, bicycling on flat surfaces, ballroom
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High (Activity of more than 300 minutes of moderate
intensity a week)
dancing, fishing, playing golf, surfing, swimming leisurely,
playing table tennis, playing tennis doubles, playing
noncompetitive volleyball
Vigorous (>6.0 METs)
Running, hiking, jogging, shoveling sand, carrying heavy
loads, farming, digging ditches, participating in a basketball
game, playing soccer, playing tennis singles, playing
competitive volleyball at the gym or beach
2. Promote healthy diet and nutrition
Good nutrition is a primary determinant of good health in preventing NCDs
Strategies to promote healthy eating and physical activity
1. Choose sensible portions of foods lower in fat. Watch portion sizes.
2. Learn healthier ways to make favorite foods.
3. Learn to recognize and control environmental cues that make you want to eat.
4. Have a healthy snack an hour before social gathering
5. Engage in moderate-intensity physical activity for 30 minutes every day
6. Do not eat meals in front of the television
7. Keep records of your food intake and physical activity. Weight yourself weekly.
8. Pay attention to what you are eating.
International classification of overweight and obesity by BMI, waist circumference and associated
disease risk
Classification
BMI
Disease relative to weight and waist circumference
Waist circumference
Waist circumference
0HQ”LQ ”FP
0HQ•LQ •FP
:RPHQ”LQ ”FP
:RPHQ•LQ •FP
Underweight
Severe
Moderate
Mild
Normal
Overweight
Obese
Class I
Class II
Class III
<16
16.0-16.99
17-18.49
18.50-24.99
25.0-29.9
30.0-34.99
35.0-39.99
>40.0
-
-
Increased
High
High
Very high
Body Mass Index (or BMI) is calculated as your weight (in kilograms) divided by the square of your height (in
metres) or BMI = Kg/M2.
3. Promote a smoke free environment
Smoking is major risk factor for developing cardiovascular and cerebrovascular disease
Ask
Advise
Assess
Assist
Arrange follow-up
Quick reference guide for treating tobacco use and dependence
Systematically identify all tobacco users at every visit
Strongly urge all tobacco users to quit
Determine willingness to make a quit attempt
Aide the client in quitting
Ask clients if they still smoke. Compliment ex-smokers soon after the visit and
before the original quit day
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Stress management
12 Stress Management Techniques
1. Spirituality
2. Self-awareness
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
Laws affecting control of non-communicable diseases
•
•
•
•
•
•
•
•
•
•
EO 958 – National Healthy Lifestyle Advocacy campaign
RA 1054 – Free emergency medical and dental treatment for employees
RA 9211 – Tobacco Regulation Act of 2003
RA 6425 – Penalties for violations of the Dangerous Drug Act.
RA 9165 – Comprehensive Dangerous Drug Act
RA 8423 – Traditional and Alternative Medicine Act
AO 179 Series of 2004 – Guidelines for the implementation of the National Prevention of Blindness
Program
Department Personnel No. 2005-0547 – Creation of Program Management Committee for the National
Blindness Program
Proc. No. 40 – Declaring the month of August as Sight Saving Month
RA 7277 – Magna Carta for Disable Persons
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
1. The recorded blood pressure of Mr. J is 130/100. The PHN understands that he will be considered to have
hypertension if the average value of measurements of BP 2x daily in the morning and the evening for
several days is:
A. 140/90
B. 130/80
C. 120/70
D. 110/60
Answer: A
Rationale: Option A, 140/90 and above are classified as hypertension. Option B, 130/80 is a prehypertension
state. Option C and D belongs to normal category.
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2. The LDL cholesterol level is said to be at borderline level if it is:
A. More than 190
B. 90
C. 100-129
D. 130-159
Answer: D
Rationale Option A is classified as very high. Option B is optimal. Option C is above optimal.
3. Eric is monitoring the level of physical activity of Mang Tomas. Eric knows that Mang Tomas’s activity is
classified as low if he reported that he: (select all that apply)
A. Washes cars twice a week
B. Does arts and crafts every day for 10 minutes daily
C. Plays non-competitive volleyball for an hour 2x a week
D. Washes dishes daily
Answer: B and D
Rationale: Walking slowly around home, store, or office; sitting using computer, working at desk, using light hand
tools; standing, performing light work such as making bed, washing dishes, ironing, preparing food or doing store
clerk tasks, doing arts and crafts, playing cards are classified as low physical activity. Option A and C are medium
activities.
4. Eric suggested sstrategies to promote healthy eating and physical activity. Eric knows that Mang Tomas
understood the teachings when he reported that he: (select all that apply)
A. Watch his diet by eating foods low in fat.
B. Eat healthy snack before social gathering.
C. Eat in front of a television
D. Engage in a moderate intensity of physical activity for at least 10 minutes daily.
Answer: A and B
Rationale: Low fat decreases intake of bad cholesterol. Eating healthy snack before social gathering will prevent
him to eat a lot in a social gathering. Option C, eating in front of the television will likely result to eat more. Option
D, engage in moderate intensity of physical activity must be done at least 30 minutes not 10 minutes.
5. This law is known as the “National Healthy Lifestyle Advocacy Campaign”:
A. EO 958
B. RA 1054
C. RA 9211
D. RA 9165
Answer: A
Rationale: Option A, EO 958 – National Healthy Lifestyle Advocacy campaign. Option B, RA 1054 - Free
emergency medical and dental treatment for employees. Option C, RA 9211 – Tobacco Regulation Act of 2003
Option D, RA 9165 – Comprehensive Dangerous Drug Act.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
Minute Paper
The instructor will advise the students to answer the following in a sheet of paper for a minute. Then, 2-3 students will be
called to share their answers. The paper will be collected as an exit pass.
Healthy lifestyle includes ___________________________.
Unhealthy lifestyle like _____________ will result to _______________.
(Reading Assignment: Health Development program for Older Person and Prevention of Blindness)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / THIRD YEAR
Session # 19
Materials:
LESSON TITLE: HEALTH DEVELOPMENT PROGRAMS
FOR ADULT AND OLDER PERSON , PREVENTION OF
BLINDNESS
Marker and several sheets of ½ paper
White board marker and eraser
LEARNING OUTCOMES:
Book, pen and notebook
At the end of the lesson, the nursing student will be able to:
-
Describe the following different health
development programs for adult and older person:
Mental health;
Pinggang Pinoy; and
Health and Wellness for Senior Citizen.
State the DOH vision, mission and goal in
preventing blindness
Differentiate types of visual impairment
Identify PHN roles in relation to this program
Enumerate interventions and or strategies in the
implementation of the program
References:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
https://www.doh.gov.ph/Health-and-WellnessProgram-for-Senior-Citizen
https://www.doh.gov.ph/national-prevention-ofblindness-program
LESSON REVIEW/ PREVIEW (5 minutes)
The instructor will show the table below for 30 seconds. Then, the instructor will ask the class to answer in unison:
Review test
Classification
Underweight
Severe
Moderate
Mild
Normal
Overweight
Obese
Class I
Class II
Class III
BMI
<16
16.0-16.99
17-18.49
18.50-24.99
25.0-29.9
30.0-34.99
35.0-39.99
>40.0
Disease relative to weight and waist circumference
Waist circumference
Waist circumference
0HQ”LQ ”FP
0HQ•LQ •FP
:RPHQ”LQ ”FP
:RPHQ•LQ •FP
-
-
Increased
High
High
Very high
Identify whether the BMI presented is underweight; normal; overweight or obese:
1. 17
Answer: Mild underweight
2. 25
Answer: Overweight
3. 43
Answer: Obese Class III
4. 20
Answer: Normal
The instructor displays pictures of food, adult and elderly. Then, he/she asks the students what they want to eat when
they are adults and when they are elderly. Then, the instructor will ask them what kind of treatment they deserve as once
who serve the country. What could be their thoughts when they are old? Let 2-3 students answer respectively. Then,
relate it to the learning outcome.
MAIN LESSON (30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their SAS.
A. MENTAL HEALTH PROGRAM
Description:
x Mental health and well-being is a concern of all. Addressing concerns related to MNS contributes to the
attainment of the SDGs. Through a comprehensive mental health program that includes a wide range of
promotive, preventive, treatment and rehabilitative services; that is for all individuals across the life course
especially those at risk of and suffering from MNS disorders; integrated in various treatment settings from
community to facility that is implemented from the national to the barangay level; and backed with
institutional support mechanisms from different government agencies and CSOs, we hope to attain the
highest possible level of health for the nation because there is no Universal Health Care without mental
health.
Vision
x A society that promotes the well-being of all Filipinos, supported by transformative multi-sectoral
partnerships, comprehensive mental health policies and programs, and a responsive service delivery
network
Mission
x To promote over-all wellness of all Filipinos, prevent mental, psychosocial, and neurologic disorders,
substance abuse and other forms of addiction, and reduce burden of disease by improving access to
quality care and recovery in order to attain the highest possible level of health to participate fully in
society.
Objectives
1. To promote participatory governance and leadership in mental health
2. To strengthen coverage of mental health services through multi-sectoral partnership to provide
high quality service aiming at best patient experience in a responsive service delivery network
3. To harness capacities of LGUs and organized groups to implement promotive and preventive
interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services
Program Components
1. Wellness of Daily Living
x All health/social/poverty reduction/safety and security programs and the like are protective
factors in general for the entire population
x Promotion of Healthy Lifestyle, Prevention and Control of Diseases, Family wellness programs,
etc
x School and workplace health and wellness programs
2. Extreme Life Experience
x Provision of mental health and psychosocial support (MHPSS) during personal and community
wide disasters
3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
x Provision of services for mental, neurologic and substance use disorders at the primary level
from assessment, treatment and management to referral; and provision of psychotropic drugs
which are provided for free.
x Enhancement of mental health facilities under Health Facilities Enhancement Program (HFEP)
Policies and Laws
x DOH Administrative Order No. 8 series of 2001 The National Mental Health Policy
x DOH Administrative Order No. 2016-0039 Revised Operational Framework for a Comprehensive National
Mental Health Program
x
Republic Act No. 11036 Mental Health Act
Calendar of Activities
x September 10 - World Suicide Prevention Day
x October 10 -World Mental Health Day
x 2nd Week of October - National Mental Week
B. PINGGANG PINOY
x Pinggang Pinoy is a new, easy to understand food guide that uses a familiar food plate model to convey the
right food group proportions on a per-meal basis, to meet the body’s energy and nutrient needs of Filipino
adults.
x Pinggang Pinoy serves as visual tool to help Filipinos adopt healthy eating habits at meal times by delivering
effective dietary and healthy lifestyle messages.
x
x
x
The “Pinggang Pinoy” can be used side by side with the existing Daily Nutritional Guide (DNG) Pyramid for
Filipinos but it will not replace it. According to FNRI, Pinggang Pinoy is a quick and easy guide on how much
to eat per mealtime, while the DNG Pyramid shows at a glance the whole day food intake recommendation.
Both the “Pinggang Pinoy” and the DNG Pyramid for Filipinos are based on the latest science about how our
food, drink, and activity choices affect our health.
The DNG Pyramid is a simple, trustworthy guide in choosing a healthy diet. It builds from the base, showing
that should eat more foods from the bottom part of the pyramid like vegetables, whole grains and less from
the top such as red meat, sugar, fats and oils.
C. HEALTH AND WELLNESS PROGRAM FOR SENIOR CITIZEN
Description
x In support of the RA 9257 (The Expanded Senior Citizens Act of 2003) and the RA 9994 (Expanded
Senior Citizen Act of 2010), the 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.
x With the goal of Health and Wellness Program for Senior Citizen of promoting quality of life among older
persons and contribute to the nation building, the HWPSC intends to provide the following:
o focused service delivery packages and integrated continuum of quality care,
o patient-centered and environment standard to ensure safety and accessibility for senior
citizens,
o equitable health financing,
o capacitated health providers in the implementation of health programs for senior citizens,
o data base management, and
strengthened coordination and collaboration with other stakeholders involved in the
implementation of programs for senior citizens.
In the current Philippine Health Agenda (2017 - 2022), guarantees that 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”.
o
x
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
x To ensure better health for senior citizens through the provision of focused service delivery packages
and integrated continuum of quality care in various settings.
x To develop patient-centered and environment standards to ensure safety and accessibility of all health
facilities for the senior citizens.
x To achieve equitable health financing to develop, implement, sustain, monitor and continuously improve
quality health programs accessible to senior citizens.
x To enhance the capacity of health providers and other stakeholders including senior citizens group in the
implementation of health programs for senior citizens.
x To establish and maintain a database management system and conduct researches in the development
of evidence-based policies for senior citizens.
x 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
1. 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.
2. 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.
3. 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.
4. 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.
5. The Health Information component shall establish an information management system and maintain a
repository of data.
6. 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
x Madrid International Plan of Action on Aging
x Regional Framework for Action on Aging and health in the Western Pacific 2014-2019
x The 1987 Philippine Constitution
x Aquino Health Agenda
x Philippine Plan of Action for Senior Citizens (2012-2016)
x 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”
x 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
1.
2.
3.
4.
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
1. Provision of influenza and pneumococcal vaccine
2. Wellness camp for senior citizens
3. Elderly Filipino week (Walk for Life) Celebration
Calendar of Activities
o 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
x According to the World Health Organization, 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 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.
PREVENTION OF BLINDNESS PROGRAM
Government Mandates and Policies:
x
x
x
Administrative Order No. 179 s.2004: Guidelines for the Implementation of the National Prevention of Blindness
Program Department Personnel Order No. 2005-0547: Creation of Program Management Committee for the National
Prevention of Blindness Program
Subcommittees: Refractive Error/Low Vision, Childhood Blindness, Cataract
Proclamation No. 40 declaring the month of August every year as “Sight Saving Month”
Visual 20/20
Aim – develop a sustainable comprehensive health care system that will ensure the best possible vision for all, thus
improving their quality of life.
Vision:
All Filipinos enjoy the right to sight by year 2020
Mission: The DOH, Local Health Unit (LGU) partners and stakeholders commit to:
1. Strengthen partnership among and with stakeholder to eliminate avoidable blindness in the Philippines;
2. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness;
3. Provide access to quality eye care services for all; and
4. Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos.
Goal: Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care.
3 components: Cost effective disease control interventions, human resource development, and infrastructure
development
Visual Impairment
• Low vision – visual acuity of less than 6/18, but equal to or better than 3/60, or a corresponding visual field loss to
less than 20 degrees in the better eye with best possible correction
• Blindness – visual acuity of less than 3/60, or a corresponding visual field loss to less than 10 degrees in the
better eye with best possible correction.
Interventions/Strategies employed or Implementation by the DOH
1. Advocacy and Health Education
x
This includes patient information and education, public information and education and intersectoral collaboration
on eye health promotion and the nature and extent of visual impairments particularly its risk factors and
complications and the need/urgency of early diagnosis and management.
2.
x
Capability Building
This component shall focus on ensuring the capability of
national and local government health facilities in
delivering the appropriate eye health care services
especially to the indigent sector of the population.
Program shall provide training for coordinators at
regional and provincial levels; will ensure the availability
of and access to training programs by program
implementers.
3.
Information Management
x
The program shall develop an information
management system for purposes of reporting
and recording. As far as practicable, this system
shall consider and will build on any existing
4.
Networking, Partnership Building and Resource Mobilization
x
An important component of the program is
networking and partnership building to ensure
that services are available at the local level. This
shall include public-private and public-public
partnership aimed at building coalition and
networks for the delivery of appropriate eye
5.
Supervision, Monitoring and Evaluation
x
The Program shall be coordinated by a national
program coordinator from the Degenerative
Disease Office of the National Center for
Disease Prevention and Control (NCDPC),
Department of Health (DOH). The national
6.
Research and Development
x
The program shall encourage the conduct of
researches for purposes of developing local
competence in eye health care and for other
purposes that may be necessary. The
development and dissemination of clinical
practice guidelines for eye health shall form part
of the research agenda of the program.
7.
mechanism. The system shall be national in
scope, although the mechanism shall consider
the regional and local needs and capabilities.
health care services at affordable cost especially
to the indigent sector. This component shall also
focus on ensuring that the highest appropriate
quality services are made available and
accessible to the people.
program coordinator shall oversee the
implementation of program plans and activities
with the assistance of the regional coordinators
from the Centers for Health Development.
x
The program shall support researches/studies in
the clinical behavior (KAP) and epidemiological
(trends) areas. It also aims to acquire
information that is utilized for continuing public
health information and education, policy
formulation, planning and implementation.
Service Delivery
x
Service delivery for the prevention of Blindness Program shall be covered by the principle of best practice. In
collaboration with the local government units and stakeholders, the program shall develop systems and
procedures for the integration and provision of services at the community level. This means primary eye
prevention concentrating on health education, advocacy and primary eye interventions; Secondary prevention;
screening/early
detection/basic management/ counseling,
x Activities for the Vitamin A Deficiency Disorder,
referral and/or definitive care and tertiary
for practical purposes, shall be led by the Family
prevention: management of complications,
Health Office also of the NCDPC.
continuing care and follow up including
rehabilitation. The following areas will be the
x A Referral System shall form part of services
priority areas for services to be provided by the
delivered by the program. This is to ensure that
National Prevention of Blindness Program:
all patients receive quality eye health care at
a. Cataract Surgeries
appropriate levels of health care delivery
b. Errors of Refraction
system. All rural health units should be linked to
c. Childhood Blindness
an eye care referral center.
CATARACT
Cataract, the opacification of the normally clear lens of
the eye, is the most common cause of blindness
worldwide. It is the cause in 62% of all blindness in the
Philippines and is found mostly in the older age groups.
The only cure for cataract blindness is surgery. This is
available in almost all provinces of the country; however
there are barriers in accessing such services.
Interventions will therefore consist of increasing
awareness about cataract and cataract surgery; as well
as improving the delivery of cataract services. The
parameter used worldwide to monitor cataract service
delivery is the Cataract Surgical Rate.
ERRORS OF REFRACTION
Errors of refraction is the most common cause of visual
impairment in the country (prevalence is 2.06% in the
population). Errors of refraction are corrected either with
spectacle glasses, contact lenses or surgery. The
services to address the problem of EOR are provided
mainly by optometrists. However, the provision of the
eyeglasses or lenses (who should provide, how is it
provided, etc.) has to be addressed.
CHILDHOOD BLINDNESS
The prevalence of blindness among children (up to age
19) is 0.06% while the prevalence of visual impairment in
the same age group is 0.43%. The problem of childhood
blindness is the highly specialized services that are
needed to diagnose and treat it. However, screening of
children for any sign of visual impairment can be done
by pediatricians, school clinics and health workers.
FOOD FORTIFICATION IN RELATION TO VITAMIN A
o
o
o
Vitamin A, Vitamin A Deficiency (VAD) and its
Consequences
Vitamin A - an essential nutrient as retinol needed by
the body for normal sight, growth, reproduction and
immune competence
Vitamin A deficiency - a condition characterized by
depleted liver stores & low blood levels of vitamin A
o
due to prolonged insufficient dietary intake of Vit. A
followed by poor absorption or utilization of Vit. A in
the body
VAD affects children’s proper growth, resistance
to infection, and chances of survival (23 to 35%
increased child mortality), severe deficiency results
to blindness, night blindness and Bitot’s spot
UNIVERSAL HEALTH CARE AND EYESIGHT
o
o
In line with the Universal Health Care (UHC) Law, the Department of Health (DOH) is gearing toward providing
comprehensive eye care services, integrating eye care within local health systems, and responding to emerging eye
diseases such as diabetic retinopathy and glaucoma.
Primary care provider network that will be institutionalized under UHC
o Accessibility
o Referral to ophthalmic units, comprehensive eye centers, and national ophthalmic specialty centers.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. Which among the following is included in the program components of Mental Health? (select all that apply)
A. Wellness of Daily Living
B. Life Experience
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C. Rehabilitation Services
D.Neurologic Disorders
Answer: A and D
Rationale: Option A and D together with Substance Abuse and other Forms of Addiction, Mental Disorders and
Extreme Life Experiences are the program components. Option B, it should be extreme life experiences. Option C,
rehabilitation services is not part of Mental Health but in Health and lifestyle wellness for elderly.
2. Which among the following describes the “Pinggang Pinoy”? (select all that apply)
A. It builds from the base, showing that should eat more foods from the bottom part of the pyramid like vegetables,
whole grains and less from the top such as red meat, sugar, fats and oils.
B. It is a quick and easy guide on how much to eat per mealtime.
C. It is the similar to the DNG Pyramid for Filipinos that is based on the latest science about how our food, drink, and
activity choices affect our health.
D. It serves as visual tool to help Filipinos adopt healthy eating habits at meal times by delivering effective dietary
and healthy lifestyle messages.
Answer: B, C and D
Rationale: Options B, C and D describe Pinggang Pinoy. Option A describes the DNG Pyramid.
3. Health and wellness program for senior citizen is a support to the following laws:
A. RA 9257
B. Presidential Proclamation No. 470
C. Republic Act No. 11036
D. DOH Administrative Order No. 2016-0039
Answer: A
Rationale: Option A, together with RA 1994 are the laws to which the DOH issued the program to promote and
undertake health and wellness among senior citizens. Option B declares the First Week of October of every year as
Elderly Filipino Week (Linggong Katandaang Pilipino) Celebration. Option C is known as the Mental Health Act.
Option D is known as the Revised Operational Framework for a Comprehensive National Mental Health Program.
These are the accomplishments of the Health and Wellness program for senior citizen: (select all that apply)
E. HPV immunization
F. Flu vaccination
G. Pneumococcal immunization
H. Wellness camp for senior citizens
Answer: B, C and D
Rationale: Options B. C and D are the programs under health and wellness. Option A, is not part of the program for
elderly but it is given to women to protect them from cervical cancer.
4. All senior citizens are mandatorily covered by the Philippine Health Insurance Corporation by virtue of:
A. RA 9257
B. RA 10642
C. Republic Act No. 11036
D. RA 7432
Answer: B
Rationale: Option A, together with RA 9994 are the laws to which the DOH issued the program to promote and
undertake health and wellness among senior citizens. Option B is An act granting mandatory national health
insurance program of PhilHealth for all senior citizens. Option C is known as the Mental Health Act. Option D is an
act an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and
for other purposes.
5. The visual acuity of less than 6/18, but equal to or better than 3/60, or a corresponding visual field loss to less
than 20 degrees in the better eye with best possible correction:
A. Low vision
B. Blindness
C. Cataract
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D. Error in refraction
Answer: A
Rationale: Option B is describe as having visual acuity of less than 3/60, or a corresponding visual field loss to
less than 10 degrees in the better eye with best possible correction. Option C, pertains to the opacification of the
normally clear lens of the eye and it is the most common cause of blindness worldwide. Option D is the most
common cause of visual impairment in the country which is corrected either with spectacle glasses, contact
lenses or surgery.
6. Which among the following is true to errors of refraction?
A. Errors of refraction are cured only through surgery.
B. This eyesight problem can be addressed by optometrists.
C. Errors of refraction are corrected only through spectacle glasses.
D. Errors of refraction are found mostly in the older age groups.
Answer: B
Rationale: Optometrists can prescribe appropriate correction eye glasses. Option A, surgery is the only cure for
cataract. Errors of refraction can be corrected through eyeglasses, lenses and surgery, not surgery alone. Option
C, errors in refraction can be corrected through eyeglasses, lenses and surgery, not only spectacle glasses.
Option D, errors in refraction may affect all ages. Cataract is found mostly in the older age groups.
7. One of the interventions/strategies employed by the DOH is advocacy and health education. As a PHN, this
intervention requires her to:
A. Collaboration to other sectors to ensure health promotion.
B. Strengthening treatment capabilities of existing personnel.
C. Builds coalition and networks for the delivery of appropriate eye health care services to ensure best service.
D. Reviews the program as conducted.
Answer: A
Rationale: Option B is an example of capability building. Option C is an example of Networking, Partnership
Building and Resource Mobilization. Option D is an example of Supervision, Monitoring and Evaluation.
8. Vitamin A is given to prevent blindness and: (select all that apply)
A. Prevent malnutrition
B. Boost immunization
C. Increase child’s survival
D. Bitot’s spot
Answer: A, B C, and D
Rationale: Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth, reproduction
and immune competence.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
CAT Student response cards
The instructor will advise the students to answer the following in a sheet of paper for a minute. Then, 2-3 students will be
called to share their answers. The paper will be collected as an exit pass.
AL: CAT Student oral response
Students will be asked to state specific action of the nurse in preventing blindness. Five or more students will be called
1. (Reading assignment: Research in Community Health Nursing)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / FIRST YEAR
Session # 20
LESSON TITLE: RESEARCH IN COMMUNITY HEALTH
NURSING PART I
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Appreciate the importance of research in the
community
2. Differentiate conventional research and PAR
3. Describe PAR in community health nursing
4. Appraise a PAR in the community
Materials:
Book, pen and notebook
LCD and laptop
White board marker
Reference:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
Maglaya, A., (2004). Nursing Practice in the
Community (4th edition). Philippines.
Baum, F., MacDougall, C. & Smith, D. (2006).
Participatory Action Research. J Epidemiol
Community
Health
2006;60:854–857.
doi:
10.1136/jech.2004.028662
LESSON REVIEW/ PREVIEW (10 minutes)
AL: Visible Quiz
Students will need ¼ sheet of paper for scoring and must be given to the one on their back. The instructor will show the
answer and students will look at the answer of whom they will be checking, paying attention to what is written. Those who
will not adhere to the time given will receive no points even with correct answer written. All students must raise their cards
as instructed. For the answer, students will use pieces of ½ half crosswise and a marker. Students will be given 5
seconds to raise their paper for each question. Question will be shown for about 10 seconds and 30 seconds for
answering.
Question: What is the vision of Visual 20/20
Answer: All Filipinos enjoy the right to sight by year 2020
Question: A role of the nurse that includes patient information and education, public information and education
and intersectoral collaboration on eye health promotion and the nature and extent of visual impairments
particularly its risk factors and complications and the need/urgency of early diagnosis and management.
Answer: Advocate and health educator
The instructor will give the students to read the following PREFACE taken from Borenstein, M., Hedges, L., Higgins, J., &
Rothstein, H., (2009). Introduction to Meta-Analysis. United Kingdom:John Wiley & Sons, Ltd. and post this question on
the board, “ What if there is NO RESEARCH? Let the students think and tell them that as they go along with the
discussion they may write a word reflecting the importance of research to practice specially in the community.
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MAIN LESSON (20 minutes)
The instructor should discuss the following topics. Instruct students to read notes in their SAS regarding the concepts for
today’s lesson:
RESEARCH IN COMMUNITY HEALTH
o
o
o
Research is an important activity in public health but
it is misconceived to be primarily an activity of
professional researchers and academicians.
Although it is not commonly included in the PHN’s
statement of duties and responsibilities, research is
nonetheless included in the scope of functions of the
nurses as defined by the Nursing Law.
Research in community health serves a number of
purposes, among which are:
o (1) improve our understanding of clients and
their specific contexts;
o (2)provide data needed for program and policy
development and evaluation;
o (3)improve the delivery of health services and
implementation of existing programs;
o (4) improve cost-effectiveness of programs;
and,
o (5) project a good image of nurses.
- The PHN can initiate “small” researches on the
major concerns in health service delivery and in the
management of the health facility.
- Research topics that could be studied by the PHN by
himself/herself include among others, sociodemographic profile of those who utilize health
services, client waiting time, referral from and to the
health center, perception of clients to different
health or nursing interventions, supply management
and effects of specific health education activities.
- Research also contributes to what is called
evidence-based practice. The practices were
passed on and were considered as gospel truth in
the past should be examined and tested through
research.
- The challenge, not only to PHNs but to the major
decision makers in the local health system is to
integrate research into the management and
operation of the health facility.
PARTICIPATORY ACTION RESEARCH
Participatory action research (PAR) differs from
most other approaches to public health research
because it is based on:
o reflection,
o data collection, and
o action that aims to improve health and
reduce health inequities through
involving the people who, in turn, take
actions to improve their own health.
Definition of PAR
x It is a combination of participatory and action
research.
x Participatory
o
o
o
x
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Research team and community
members are equal partners
Involves selecting issues related to the
community: dependence; oppression;
other inequities that need evaluation
Action
o Reveals strategies that can address
social issues
o Community needs are evaluated and
action is taken with the purpose of social
change
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PAR seeks to understand and improve the world by
changing it. It is a collective, self-reflective inquiry that
researchers and participants undertake. Its purpose is to
understand and improve their practices. The reflective
process is directly linked to action, influenced by
understanding of history, culture, and local context and
embedded in social relationships. The process of PAR
aims to empower and lead to people increase control
over their lives.
Difference of PAR from conventional research
1. Purpose - enable
action
x
2. Attention - power
relationships
x
x
x
3. People – active
participants
x
x
Action is achieved through a reflective cycle
ƒ Participants collect and analyse data, then determine what action should
follow.
ƒ The resultant action is then further researched and an iterative reflective
cycle perpetuates data collection, reflection, and action as in a corkscrew
action.
Advocating for power to be deliberately shared between the researcher and the
researched.
The researched cease to be objects and become partners in the whole research
process: including selecting the research topic, data collection, and analysis and
deciding what action should happen as a result of the research findings.
PAR posits that the observer has an impact on the phenomena being observed
and brings to their inquiry a set of values that will exert influence on the study.
Most health research involves people, even if only as passive participants, as
‘‘subjects’’ or ‘‘respondents’’.
PAR advocates that those being researched should be involved in the process
actively.
o The degree to which this is possible in health research will differ as will
the willingness of people to be involved in research
Example:
An example of the application of PAR in a remote CAR region community is the work to support a women’s self-help
group to plan, implement, and evaluate their activities. With support from the research team community members are
acting as researchers exploring priority issues affecting their lives, recognizing their resources, producing knowledge, and
taking action to improve their situation. The ongoing PAR process of reflection and action, which incorporates participant
observation, informal discussions, in-depth interviews, and a ‘‘feedback box’’, is viewed by the participants as contributing
to their self-reported increased sense of self awareness, self-confidence, and hope for the future.
1. What is the purpose of PAR in this remote community?
Answer: To support a women’s self-help group to plan, implement, and evaluate their activities. (ACTION)
2. Who are the researchers?
Answer: Research team community members are acting as researchers
3. The involvement of the people in the community indicates that they are ________(ACTIVE) participants.
CHECK FOR UNDERSTANDING (15 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Case Scenario:
Barrio Mahilom is a remote area which believes in the use of herbal plants. The DOH team started to educate the people
in the proper use of those herbal plants. A PAR is to be conducted in Barrio Mahilom .
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1. The PHN understands that PAR is conducted and not a conventional research when: (select all that apply)
A. The central aim of the study is to determine the effectiveness of the Herbal Plant Use Education of the community
through inquiry from other party.
B. The research team members are experts of research.
C. It is a combination of a quantitative and qualitative data mining.
D. The research is conducted from planning until the evaluation of the program identified.
Answer: C and D
Rationale: Options C and D are true to PAR. Qualitative and quantitative data are gathered and part of the analysis.
Research is conducted from planning to evaluation of the program. Option A, the main aim of PAR is to improve
program through self-reflective inquiry by determining what action to follow and not merely to determine effectiveness.
Option B, the community members are the acting researchers with support of research team.
2. The main aim of conducting PAR in Brgy Mahilom is:
A. Use research findings to influence social change
B. To evaluate the community’s program
C. Disseminate change in the community
D. Educate people about the importance of participating in community programs
Answer: A
Rationale: The overall goal of PAR is to use research findings to influence social change. Option B pertains to
evaluative research. Option C, dissemination does not require research but rather educating and awareness
campaign. Option D can be done through campaigns/advertisements and not research.
3. The community members as researchers are experts in their role. They are experts because:
A. They are being guided by the research team.
B. They have unique perspective as influenced by their lived experience.
C. They have the knowledge and expertise in doing the research.
D. They participate in making collaborative decisions.
Answer: B
Rationale: The lived experience can only be shared by the community members thus making them expert to their role
as research participant. Option A does not suggest that they are experts. Option C refers to the researchers not the
community members. It is the research team who will guide the community in the process. Option D, power sharing
among team members is present in PAR but it does not explains that the community members are experts.
4. Who chooses the research question?
A. Research experts
B. Community
C. People who have the lived experience
D. Community leaders
Answer: C
Rationale: Having people with lived experience participate in choosing issues and research questions ensures the
relevance and reflection of the community.
5. Which among the following is a PAR example? (select all that apply)
A. Dissatisfied evaluation of Family Planning services, a team of 10 couples-user researchers interviewed 50
couples who use Family Planning services. The researchers asked about their lived experience using the Family
Planning services and its influence to them as couples and family. The researchers presented their findings as a
live performance and an academic report.
B. A group of adults interviewed 50 adults living in a rehabilitation center. The group presented their academic report
to the Department of Health through theatrical presentation.
C. A group of people interviewed people in the community regarding health services and service providers about
their definitions and understanding of recovery. Findings were documented and shared to encourage
collaboration among service recipients and providers.
D. Abused women were interviewed by strong independent women regarding their lived experience. Results and
recommendations were given to the Health Office.
Answer: A and C
Rationale: Community involvement and “expert” being experienced the phenomenon is essential in PAR. Likewise
the results must initiate social change through community dissemination. B and D lacks “expertise” in the phenomena
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mentioned, thus cannot be considered as PAR. For a community member to be a part of PAR, he/she must have the
lived experience of the said phenomenon.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
AL: POST IT
The instructor will now ask the students to post what is the importance of research using one word. The instructor will
synthesize the words that will be posted by the students.
(Reading Assignment: Field Health Service Information System)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / FIRST YEAR
Session # 21
LESSON TITLE: RESEARCH IN COMMUNITY HEALTH
NURSING PART II
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Describe the concepts of Field Health Service
Information System (FHSIS)
2. Differentiate the components of FHSIS
Materials:
Book, pen and notebook
LCD and laptop
White board marker
Reference:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5minutes)
The instructor will ask the students to identify if it is a Conventional Research or PAR. The class will be asked to
answer in unison.
1. The researcher is the expert in the research process. (Conventional Research)
2. The end outcome is to involve people to change. (PAR)
3. It aims to reduce health inequities. (PAR)
4. Community members are research participants. (PAR)
5. It empowers people and more control on their lives. (PAR)
The instructor will show the following words:
DATA
RECORD
REPORT
The instructor will ask the 2-3 students why reporting is important. The instructor will advise the class that the answer will
be given as part of the closure of the session. Then, he/she presents the learning outcome of today’s session.
MAIN LESSON (20 minutes)
The instructor should discuss the following topics. Instruct students to read notes in their SAS regarding the concepts for
today’s lesson:
FIELD HEALTH SERVICES AND INFORMATION SYSTEM (FHSIS)
Objectives:
x To provide summary of data on health services delivery and selected program accomplished indicators at the
barangay, municipality, district, provincial, regional and national levels.
x
x
x
x
To provide data which when combined with data from other sources, can be used for program monitoring and
evaluation purposes.
To provide a standardized, facility level data base that can be accessed for more in-depth studies.
To ensure that the data reported to the FHSIS are useful and accurate and are disseminated in a timely and easy to
use fashion.
To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient
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care and primitive activities.
Components
x Family Treatment Record
x Target Client List
x
x
Reporting Forms
Output Reports
Treatment Record
o The fundamental building block or foundation of the Field Health Service Information System is the Treatment Record.
o This is the document, form or pieces of paper upon which the presenting symptoms or complaints of the patient on
consultation and the diagnosis (If available), treatment and date of treatment is recorded.
o This recorded will be maintained as part of the system or records at each BHS/BHC/RHU/MHC, or hospital outpatient
by facility on all patients seen.
o The treatment record and its entire system filling may vary from program to program and place to place.
o In some case, the history of previous pregnancies will be contained in the OB/GYN record as part of the family folder.
o Likewise, immunization recording, weighing, etc., may be recorded on the child growth and development chart card
which is also part of the family record/folder.
o Other programs have their own resident treatment records such as Tuberculosis, Leprosy and Schistosomiasis.
o However, these records will be described later. If in the facility, there is no formal treatment record for individual
patient’s visits/ consultation, one must be created.
o This record may be simple as the following example prepared on plain bond paper.
Date
Name
Rx Record
Address
Complaint
Rx Diagnosis
(if available)
Note: Do not rely on records maintained by the client / patient. In areas where the home based maternal records is in use,
there must still be a treatment record available in the facility.
Target/Client Lists
The target/Client Lists constitute the second “building block” of the FHSIS and are intended to serve four purpose:
1. To plan and carry out patient care and service
delivery. Such lists will be of considerable value to
midwives/nurses in monitoring service delivery to
clients in general, and in particular to groups of
patients identified as “targets” or “eligible” for one
another program of the Department. The primary
advantage of maintaining the Target/Client List is the
midwives/nurse does not have to go back to
individual patient/family records as frequently in
order to monitor patient treatment or services to
beneficiaries. The contribution of efficient service
delivery is the main consideration in determining
which of the previous “Master Lists” can be retained
in the revised FHSIS as Target/Client Lists. There
are no Target/Client Lists in the revised FHSIS
solely for reporting purposes.
2. To facilitate the monitoring and supervision for
services.
3. To provide a clinic-level data base which accessed
for further studies, e.g. follow up and special
prospective studies, record surveys, etc. the
introduction of standardized Target/Client Lists
maintained in hard-bound cover is designed to result
in permanent records of facility health care delivery
activities which can be served as a facility level data
base. The complete set of Target/Client Lists will be
collected periodically at the end of each year of
every two years and stored in a central location
(such as the Provincial Health Office) to facilitate the
maintenance of such a data base. The Target/Client
Lists in the revised FHSIS will be cross-reference
through the use of unique specific treatment records
in order to enhance the value of the Target/Client
Lists or as data source for further students.
For service activities which do not have target client lists,
space is provided in reporting forms to tally such
activities. If reporting units tally their service activities on
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a daily basis, the length of the time required to complete
the monthly/quarterly reporting forms will be reduced
significantly. At the end of each monthly/quarterly
reporting forms will be reduced significantly. At the end
of each month, count the number of ticks and write down
the number in the corresponding box.
Example:
One important difference between the Target/Client Lists in the revised FHSIS and the “Master Lists” utilized previously is
that the Target/Client List will no longer be transmitted from the clinic. Data from the Target/Client Lists will be transmitted
monthly/quarterly through the use of FHSIS Reporting Forms, but the Lists from one facility to another will be discontinued
in the FHSIS.
The target/Client Lists to be maintained in the revised FHSIS are as follows:
x Target client lists for Expanded Program on Immunization
x
x
x
x
x
x
x
x
x
x
Target Group List for Eligible Population
Target/Client Lists of Children 0 to 59 months (Risk, Under-Five Children)
Target/Client Lists of Nutrition
Clients Lists for Pre-Natal Care
Client Lists Postpartum Care
Client Lists for Family Planning (Non-Surgical Methods)
Lists for TB Symptomatic
Client Lists for TB Cases under Short Course Chemotherapy
Client Lists for TB Cases under Standard Regimen (SR)
Client List for Leprosy Cases
Tally/Reporting Forms
FHSIS Reports constitute the only mechanism through
which data are routinely transmitted from one facility to
another in the revised FHSIS. The majority of FHSIS
reports are prepared and submitted either monthly or
quarterly. One report is prepared weekly, several
annually, and in some instance, every few minutes as
relevant events occur, e.g. maternal and neonatal
deaths. The full sequence of FHSIS Reports is listed in
Table 1.
In the FHSIS, reports are prepared and submitted by the
unit/person responsible for the service/activity being
provided and sent directly to the Provincial Health Office.
The bulk of data reported from the RHU/MCH/BHS/BHC
level are activities which are undertaken or are the
responsibility of midwives/nurses within the facility will be
“kinked up” with the data reported by others during the
data processing phase of the operation.
Another significant change in the revised FHSIS involves
the flow of reports. Under the previous system, reports
were passed up to the next level higher level facility in
the DOH system for review and consolidation. Under the
current system, however, all report will be transmitted to
the PHO (or alternate data processing location in the
province as the case may be) without intermediate levels
of data handling. With the introduction of at least one (1)
microcomputer per province of entering and processing
of FHSIS data, it is anticipated that the computerized
“feedback” reports reach the PHO and DOH levels under
the revised FHSIS data flow scheme approximately the
same length of time s it took to move consolidation
BHS/BHC/HU/NHC data to the DHO/CHO level under
the data flow scheme in the previous system.
List of FHSIS Reports and Forms
Report/Form No.
Upon Occurrence of Events
FHSIS/E-1
FHSIS/E-2
FHSIS/E-3
Weekly
FHSIS/M-1
Title
Reporting Responsibility
Notification of Death Form
Maternal Death Report
Perinatal Death Report
BHS/BHC/RHU/MHC
BHS/BHC/RHU/MHC
DH/CH
Weekly Report of Notifiable Diseases
BHS/BHC/RHU/MHC
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Monthly
FSHSIS/M-1
FSHSIS/M-2
FSHSIS/M-3
FSHSIS/M-4
FSHSIS/M-5
FSHSIS/M-6
FSHSIS/M-7
Quarterly
FSHSIS/Q-1
FSHSIS/Q-2
FSHSIS/Q-3
FSHSIS/Q-4
FSHSIS/Q-5
FSHSIS/Q-6
Annual
FSHSIS/A-1
FSHSIS/A-2
FSHSIS/A-2A
FSHSIS/A-3
FSHSIS/A-3A
FSHSIS/A-4
Monthly Field Health
Services Activity Report
Monthly Natality Health
Monthly Mortality Report
Monthly Laboratory Report
Monthly Dental Health
Service Report
Family Planning Subsidized
Surgical Procedure Report
Monthly Social Hygiene
Clinic Activity Report
BHS/BHC/RHU/MHC
DH/CH/PH/CHO/RH
BHS/BHC/RHU/MHC
RHU/MHC
RHU/MHC/DH
RHU/MHC/DH
CH/PH/CHO/RH
RHU/MHC/DH
CH/PH/CHO/RH
STD/Clinic
Quarterly Field Health
Service Activity Report
Quarterly Dental Facility
Inspection Report
Quarterly Report of
Environmental Health Activities
Quarterly Reports of Malaria
Control of Activities
Drugs and Supplies
Quarterly Status Report
Laboratory Supplies
Quarterly Status Report
BHS/BHC/RHU/NMHC
DH/CH/PH/CHO/RH
DH/CH
Annual Catchment Area
Tally Sheet and Summary Report
Annual Catchment Area
Population Summary Report
Annual Catchment Area
OPT Form
Annual Household
Environmental Sanitation
Annual environmental
Household Survey Form
Annual Nutrition Report
Food Supplement
OPT/BHS/BHC/RHUMHC
Output Reports
o Output Reports or Table will be produced at the
PHO (or alternate date processing site in the
province) from the data reported in the RHU/MHC
and up through the DOH system to the Regional
Health Office.
RHU/MHC/DHO
DHO/CHO/PHO
RHU/MHC
RHU/MHC/DH/CH
PH/CHO
o
BHS/BHC/RHU/MHC
BHS/BHC/RHU/MHC
RHU-SI/MHC-SI
RHU/MHC/DHO
BHS/BHC/RHU/MHC
DH/CH/PH/CHO/RH
The objective in designing the output formats is to
make the reports useful for monitoring/
management purposes at each level of DOH
Management.
Figure 10 – FHSIS components
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Records, Reports and Patient Flow
o The use of the system or records and reports is
relatively simple.
o All information related to the client/patients history,
complaint, diagnosis, services and/or treatment is
contained in three documents or records:
o (1) The individual treatment record.
o (2) The Target/Client List (TCL) for the
several public health programs, and
o (3) The tally sheet/report forms which have a
dual purpose that is totally events as they
occur and the purpose of reporting
periodically to higher levels.
o The process of use to these documents as the
exclusive set of records in the BHS/RHU is as
follows:
x As a client enters the clinic/facility, their individual
treatment record is pulled out from the file. If the
client/patient has come to the clinic for program
service for which there is a Target/Client List, an
appropriate entry is made in the TCL and an entry in
the treatment record to show what the finding or
urine test results are. If the visit is usual, prenatal
visit, a tick would be made on the appropriate block
on the Tally Sheet/Report Form. No other recording
of information such as entries in a logbook or daily
services record is required.
x A further example of the relationship between the
treatment records and Target/Client Lists or Tally
Sheet/Record Forms is in the area of diarrheal
disease. Use the example of mother bringing a child
Geographic Coding
The FHSIS Report forms are to be submitted by the
reporting units identified in the upper portion of the page
of each Report Form.
A reporting unit is defined as any DOH Health care
facility that renders/delivers public care-related services
to targeted beneficiaries.
x
x
to the clinic after experiencing 3-4 days of water
bowel movements. The information as to the child’s
name, address, age and symptoms would be
recorded in the treatment record. The treatment of
Oral Rehydration Solution (ORS) or the notation of
degree of dehydration and referral would likewise be
noted if warranted. There is no Target/ Client List for
diarrheal disease. However, a tick is required in the
Tally Sheet Report Form M-1 in the diarrheal section
for an event and that oresol was given and the
referral if accomplished.
If it were noted while making the entry in the
treatment record for this encounter with diarrhea,
that the child has had another two episodes of
diarrhea, in the past month, an entry should be
made on events of diarrhea. If the child had not been
previously entered on the UNDER FIVE TCL, the
child would become a new addition to the list.
The monthly (or other period) report is then
simplified in preparation by a combination of adding
up ticks on the Tally/report Summary itself, or
consulting certain services or events directly from
the entries on the Target/Client Lists and entering
them on the Tally Report Form. In non cases, it will
be necessary to go the individual or family (or
program) treatment record or any other source of
information for the requirements. If you find you
need to refer to any other source for completing the
monthly, or quarterly reports, you are using the
records system incorrectly.
The lowest level of reporting unit is the Barangay Health
Station (BHS), where it expected to report health
services provided to its defined catchment area. A BHS
can be considered a reporting unit if the following
conditions are satisfied:
x It renders/delivers health services to a defined
catchment area which may be composed of one or
more barangays.
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x
x
x
x
A midwife renders regular services to the area. In
cases where the midwife of the area is in prolonged
leave of absence or refined but a replacement is
expected, the BHS still remains a reporting unit. The
reports will be expected to be submitted by the
nurse(s) or midwife(s) who took over the servicing of
the area.
Health services may be provided for any physical
structure designated for the purposes i.e. a BHS
building, a barangay hall or a place of residence.
The catchment area served is not a service area of
any RHU. For instance, Poblacion in most cases is
the catchment area served by the RHU. Thus,
Poblacion BHS cannot be considered a reporting
unit. The reports of this BHS should be prepared and
submitted by the RHU.
It should not include satellite BHS which are visited
by the midwife but part of the catchment of the
“Mother BHS”.
BHS/BHC RHU/MHC PH/CH RH -
The next level of reporting unit is the Rural Health Unit
(RHU) or Main Health Center (MHC) where it is expected
to report health services provided to the RHU or MHC
catchment area which is usually the Poblacion and
nearby barangays. The RHU/MHC report is not
consolidation of the BHS and RHU reports. It is a report
of services rendered by the RHU-based personnel.
Outpatient department of hospital provide public health
related services e.g. immunization, pre-natal care, etc.
As such, these hospitals are expected to submit FHSIS
reports. For example, District Hospitals may provide
prenatal and post-partum care services
As summary, the following are considered reporting units
and are expected to submit FHSIS reports in cases
where public health related services are provided.
Barangay Health Station/Barangay Health Centers
(City counterpart of BHS)
Rural Health Unit/Main Health Center
Provincial Hospital/City Health Office
(some CHO directly provides to city residents)
Regional Hospital. This category includes/Medical Centers providing public-health related services.
As all report forms submitted to the PHO will be entered
and processed using a microcomputer, it is important
that reporting units be properly identified on the FHSIS
Report Forms and the proper codes indicated. In this
connection, all possible reporting health units- Barangay
Health Station (BHSs) up to Regional Medical center
were assigned corresponding codes.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple Choice:
1. It is the building block of FHSIS:
A. Family Treatment Record
B. Target/Client List
C. Reporting Forms
D. Output Reports
Answer: A
Rationale: Option A, family treatment record is maintained as part of the system or records at each
BHS/BHC/RHU/MHC, or hospital outpatient by facility on all patients seen and serve as the fundamental unit of
FHSIS. Option B target/Client Lists constitute the second “building block” of the FHSIS. Option C, reporting forms
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which are bulk of data “kinked up” with the data reported by others. Option D, output reports are useful for monitoring/
management purposes at each level of DOH Management.
2. This will be produced at the PHO (or alternate date processing site in the province) from the data reported in
the RHU/MHC and up through the DOH system to the Regional Health Office:
A. Geographic coding
B. Output Reports or Table
C. Reporting forms
D. Target/client list
Answer: B
Rationale: Option B, output reports are useful for monitoring/ management purposes at each level of DOH
Management. It is produced at the PHO from the data reported from RHU/MHC. Option A, geographic recording
refers to the reporting units identified in the upper portion of the page of each Report Form. Option C, reporting forms
which are bulk of data “kinked up” with the data reported by others. Option D, target/Client Lists constitute the second
“building block” of the FHSIS
3. Which among the following requires reporting as it happens?
A. Notifiable diseases like dengue
B. Maternal death
C. Natality health
D. Dental health
Answer: B
Rationale: Option B, maternal death, perinatal death are required to be reported as it happened. Option A, notifiable
diseases are reported weekly. Option C and D, natality and dental health are reported monthly.
4. FHSIS intends to provide:
A. Data that can be used for program monitoring and evaluation purposes.
B. A standardized, facility level data base that can be accessed for more in-depth studies.
C. More time for patient care and primitive activities.
D. Useful and accurate data that can be disseminated in a timely and easy to use fashion.
Answer: A, B, C and D
Rationale: All options are the objectives of FHSIS.
5. The BHS can be a reporting area if:
A. It is a satellite BHS
B. The midwife renders service occasionally to the area.
C. It delivers health services to one or more barangays.
D. It is a service area of an RHU.
Answer: C
Rationale: For a BHS can be considered a reporting unit it must renders/delivers health services to a defined
catchment area which may be composed of one or more barangays. Option A, must not be a satellite BHS but rather
the mother BHS. Option B, the midwife must regularly serve the area and not occasionally. Option D, it must not be a
service area of an RHU. If it is an RHU service area, it is the RHU that will prepare the report.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
AL: Minute paper
The instructor will again ask the question posted at the beginning of the lesson. “Why do we need to report?” The
instructor will call at least 1-2 students to share their answers. The paper will serve as an exit pass. The instructor will
synthesize their answers.
- Reporting is not only to finish the job but rather it is way to evaluate if the programs are effective or not.
- Reporting will determine if there is a need to continue, revise or create another program.
(Reading assignment: Laws affecting Community/Public Health Nursing)
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mentioned, thus cannot be considered as PAR. For a community member to be a part of PAR, he/she must have the
lived experience of the said phenomenon.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
AL: POST IT
The instructor will now ask the students to post what is the importance of research using one word. The instructor will
synthesize the words that will be posted by the students.
(Reading Assignment: Field Health Service Information System)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / FIRST YEAR
Session # 22
LESSON TITLE: LAWS AFFECTING THE PUBLIC HEALTH
AND PRACTICE OF COMMUNITY HEALTH NURSING PART
I
LEARNING OUTCOMES:
Materials:
Book, pen and notebook
LCD and power point presentation
White board marker
At the end of the lesson, the nursing student can:
References:
1. Interpret RA 7305 and RA 9173
2. Evaluate actions that are align to RA 7305 and RA
9173
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (5 minutes)
Students will be asked to write their answers in a paper using a marker. They will be asked to raise their paper upon each
item. Once they incurred mistake, they will not allow to continue but will serve as checker for those who continuously got a
correct answer. Incentive will be given for those who will have perfect score. (additional 2 points for quiz)
Determine when to report…
1. Family Planning (monthly)
2. CoViD-19 case (upon occurrence)
3. Environmental health activities (quarterly)
4. Death because of delivery (upon occurrence)
5. Measles (weekly)
MAIN LESSON (25 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson:
RA 7305
SECTION 1. Title. - This Act shall be known as the "Magna Carta of Public Health Workers."
SEC. 2. Declaration of the Policy. - The State shall instill health consciousness among our people to effectively carry out
the health programs and projects to the government essential for the growth and health of the nation. Towards this end,
this Act aims:
(a) to promote and improve the social and economic well-being of the health workers, their living and working
conditions and terms of employment;
(b) to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver
health projects and programs; and
(c) to encourage those with proper qualifications and excellent abilities to join and remain in government service.
SEC. 3. Definition. - For purposes of this Act, "health workers" shall mean all persons who are engaged in health and
health-related work, and all persons employed in all hospitals, sanitaria, health infirmaries, health centers, rural health
units, barangay health stations, clinics and other health-related establishments owned and operated by the Government
or its political subdivisions with original charters and shall include medical, allied health professional, administrative and
support personnel employed regardless of their employment status.
SEC. 4. Recruitment and Qualification. - Recruitment policy and minimum requirements with respect to the selection
and appointment of a public worker shall be developed and implemented by the appropriate government agencies
concerned in accordance with policies and standards of the Civil Service Commission: Provided, That in the absence of
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appropriate eligible and it becomes necessary in the public interest to fill a vacancy, a temporary appointment shall be
issued to the person who meets all the requirements for the position to which he/she is being appointed except the
appropriate civil service eligibility: Provided, further, That such temporary appointment shall not exceed twelve (12)
months nor be less than three (3) months renewal thereafter but that the appointee may be replaced sooner if (a) qualified
civil service eligible becomes available, or (b) the appointee is found wanting in performance or conduct befitting a
government employee.
SEC. 5. Performance Evaluation a Merit Promotion. - The Secretary of Health, upon consultation with the proper
government agency concerned and the Management-Health Workers’ Consultative Councils, as established under
Section 33 of this Act, shall prepare a uniform career and personnel development plan applicable to all public health
personnel. Such career and personnel development plan shall include provisions on merit promotion, performance
evaluation, in-service training grants, job rotation, suggestions and incentive award system.
The performance evaluation plan shall consider foremost the improvement of individual employee efficiency and
organizational effectiveness: Provided, that each employee shall be informed regularly by his/her supervisor of his/her
performance evaluation.
The merit promotion plan shall be in consonance with the rules of the Civil Service Commission.
SEC. 6. Transfer or Geographical Reassignment of Public health Workers.
(a) a transfer is a movement from one position to another which is of equivalent rank, level or salary without break in
service;
(b) a geographical reassignment, hereinafter referred to as "reassignment," is a movement from one geographical
location to another; and
(c) a public health worker shall not be transferred and or reassigned, except when made in the interest of public
service, in which case, the employee concerned shall be informed of the reasons therefore in writing. If the public health
worker believes that there is no justification for the transfer and/or reassignment, he/she may appeal his/her case to the
Civil Service Commission, which shall cause his/her reassignment to be held in abeyance; Provided, That no transfer
and/or reassignment whatsoever shall be made three (3) months before any local or national elections: Provided, further,
That the necessary expenses of the transfer and/or reassignment of the public health worker and his/her immediate family
shall be paid for the Government.
SEC. 7. Married Public Health Workers. - Whenever possible, the proper authorities shall take steps to enable married
couples, both of whom are public health workers, to be employed or assigned in the same municipality, but not in the
same office.
SEC. 8. Security of Tenure. - In case of regular employment of public health workers, their services shall not be
terminated except for cause provided by law and after due process: Provided, That if a public health workers is found by
the Civil Service Commission to be unjustly dismissed from work, he/she shall be entitled to reinstatement without loss of
seniority rights and to his/her back wages with twelve percent (12%) interest computed from the time his/her
compensation was withheld from his/her up to time of reinstatement.
SEC. 9. Discrimination Prohibited. - A public worker shall not be discriminated against with regard to gender, civil
status, civil status, creed, religious or political beliefs and ethnic groupings in the exercise of his/her profession.
SEC. 10. No Understaffing/Overloading of Health Staff. - There shall be no understaffing or overloading of public
health workers. The ratio of health staff to patient load shall be such as to reasonably effect a sustained delivery of quality
health care at all times without overworking the public health worker and over extending his/her duty and service. Health
students and apprentices shall be allowed only for purposes of training and education.
In line with the above policy, substitute officers or employees shall be provided in place of officers or employees who are
on leave for over three (3) months. Likewise, the Secretary of Health or the proper government official shall assign a
medico-legal officer in every province.
In places where there is no such medico-legal officer, rural physicians who are required to render medico-legal services
shall be entitled to additional honorarium and allowances.
SEC. 11. Administration Charges. - Administrative charges against a public health worker shall be heard by a
committee composed of the provincial health officer of the province where the public health worker belongs, as
chairperson, a representative of any existing national or provincial public health workers’ organization or in its absence its
local counterfeit and a supervisor of the district, the last two (2) to be designated by the provincial health officer mentioned
above. The committee shall submit its findings and recommendations to the Secretary of Health within thirty (30) days
from the termination of the hearings. Where the provincial health officer is an interested party, all the members of the
committee shall be appointed by the Secretary of Health.
SEC. 12. Safeguards in Disciplinary Procedures - In every disciplinary proceeding, the public health worker shall have;
(a) the right to be informed, in writing, of the charges;
(b) the right to full access to the evidence in the case;
(c) the right to defend himself/herself and to be defended by a representative of his/her choice and/or by his/her
organization, adequate time being given to the public health worker for the preparation of his/her defense;
(d) the right to confront witnesses presented against him/her and summon witnesses in his/her behalf;
(e) the right to appeal to designated authorities;
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(f) the right to reimbursement of reasonable expenses incurred in his/her defense in case of exoneration or dismissal
of the charges; and
(g) such other rights as will ensure fairness and impartiality during proceedings.
SEC. 13. Duties and Obligations. - The public health workers shall:
(a) discharge his/her duty humanely wit conscience and dignity;
(b) perform his/her duty with utmost respect for life; and race, gender, religion, nationality, party policies, social
standing or capacity to pay.
SEC. 14. Code of Conduct. - Within six (6) months from the approval of this Act, the Secretary of Health, upon
consultation with other appropriate agencies, professional and health workers’ organization, shall formulate and prepare a
Code of Conduct for Public Health Workers, which shall be disseminated as widely as possible.
SEC. 15. Normal Hours of Work. - The normal of wok of any public health worker shall not exceed eight (8) hours a day
or forty (40) hours a week. Hours worked shall include:
(a) all the time during which a public health worker is required to be on active duty or to be at a prescribed workplace; and
(b) all the time during which a public health worker is suffered or permitted to work. Provided, That the time when the
public health worker is place on "On Call" status shall not be considered as hours worked but shall entitled the public
health worker to an "On Call" pay equivalent to fifty percent (50%) of his/her regular wage. "On Call" status refers to a
condition when public health workers are called upon to respond to urgent or immediate need for health/medical
assistance or relief work during emergencies such that he/she cannot devote the time for his/her own use.
SEC. 16. Overtime Work. - Where the exigencies of the service so require, any public health worker may be required t
render, service beyond the normal eight (8) hours a day. In such a case, the workers shall be paid an additional
compensation in accordance with existing laws and prevailing practices.
SEC. 17. Work During Rest Day. (a) Where a public health worker is made to work on his/her schedule rest day, he/she shall be paid an additional
compensation in accordance with existing laws; and
(b) Where a public health worker is made to worm on any special holiday he/she shall be paid an additional
compensation in accordance with existing laws. Where such holiday work falls on the workers’ scheduled rest day, he/she
shall be entitled to an additional compensation as may be provided by existing laws.
SEC. 18. Night-Shift Differential. (a) Every public health worker shall be paid night-shift differential of ten percent (10%) of his/her regular wage for each
hour of work performed during the night-shifts customarily adopted by hospitals.
(b) Every health worker required to work on the period covered after his/her regular schedule shall be entitled to
his/her regular wage plus the regular overtime rate and an additional amount of ten percent (10%) of such overtime rate
for each hour of work performed between ten (10) o’clock in the evening to six (6) o’clock in the morning.
SEC. 19. Salaries. - In the determination of the salary scale of public health workers, the provisions of Republic Act No.
6758 shall govern, except that the benchmark for Rural Health Physicians shall be upgraded to Grade 24.
(a) Salary Scale - Salary Scales of public health workers shall be provided progression: Provided, That the
progression from the minimum to maximum of the salary scale shall not extend over a period of ten (10) years: Provided,
further, That the efficiency rating of the public health worker concerned is at least satisfactory.
(b) Equality in Salary Scale - The salary scales of public health workers whose salaries are appropriated by a city,
municipality, district, or provincial government shall not be less than those provided for public health workers of the
National Government: Provided, That the National Government shall subsidize the amount necessary to pay the
difference between that received by nationally-paid and locally-paid health workers of equivalent positions.
(c) Salaries to be Paid in Legal Tender. - Salaries of public health workers shall be paid in legal tender of the
Philippines or the equivalent in checks or treasury warrants: Provided, however, that such checks or treasury warrants
shall be convertible to cash in any national, provincial, city or municipal treasurer’s office or any banking institution
operating under the laws of the Republic of the Philippines.
(d) Deductions Prohibited - No person shall make any deduction whatsoever from the salaries or public health
workers except under specific provision of law authorizing such deductions: Provided, however, That upon written
authority executed by the public health worker concerned, (a) lawful dues or fees owing to any organization/association
where such public health worker is an officer or member, and (b) premium properly due all insurance policies, retirement
and medicare shall be considered deductible.
SEC. 20. Additional Compensation. - Notwithstanding Section 12 of Republic Act No. 6758, public workers shall
received the following allowances: hazard allowance, subsistence allowance, longevity pay, laundry allowance and
remote assignment allowance.
SEC. 21. Hazard Allowance. - Public health worker in hospitals, sanitaria, rural health units, main centers, health
infirmaries, barangay health stations, clinics and other health-related establishments located in difficult areas, strife-torn or
embattled areas, distresses or isolated stations, prisons camps, mental hospitals, radiation-exposed clinics, laboratories
or disease-infested areas or in areas declared under state of calamity or emergency for the duration thereof which expose
them to great danger, contagion, radiation, volcanic activity/eruption occupational risks or perils to life as determined by
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the Secretary of Health or the Head of the unit with the approval of the Secretary of Health, shall be compensated hazard
allowance equivalent to at least twenty-five percent (25%) of the monthly basic salary of health workers receiving salary
grade 19 and below, and five percent (5%) for health workers with salary grade 20 and above.
SEC. 22. Subsistence Allowance. - Public health workers who are required to render service within the premises of
hospitals, sanitaria, health infirmaries, main health centers, rural health units and barangay health stations, or clinics, and
other health-related establishments in order to make their services available at any and all times, shall be entitled to full
subsistence allowance of three (3) meals which may be computed in accordance with prevailing circumstances as
determined by the Secretary of Health in consultation with the Management Health Workers’ Consultative Councils, as
established under Section 33 of this Act: Provided, That representation and travel allowance shall be given to rural health
physicians as enjoyed by municipal agriculturists, municipal planning and development officers and budget officers.
SEC.23. Longevity Pay. - A monthly longevity pay equivalent to five percent (5%) of the monthly basic pay shall be paid
to a health worker for every five (5) years of continuous, efficient and meritorious services rendered as certified by the
chief of office concerned commencing with the service after the approval of this Act.
SEC. 24. Laundry Allowance. - All public health workers who are required to wear uniforms regularly shall be entitled to
laundry allowance equivalent to one hundred twenty-five pesos (P125.00) per month: Provided, that this rate shall be
reviewed periodically and increased accordingly by the Secretary of Health in consultation with the appropriate
government agencies concerned taking into account existing laws and prevailing practices.
SEC. 25. Remote Assignment Allowance. - Doctors, dentists, nurses, and midwives who accept assignments as such in
remote areas or isolated stations, which for reasons of far distance or hard accessibility such positions had not been filed
for the last two (2) years prior to the approval of this Act, shall be entitled to an incentive bonus in the form of remote
assignment allowance equivalent to fifty percent (50%) of their basic pay, and shall be entitled to reimbursement of the
cost of reasonable transportation to and from and during official trips.
In addition to the above, such doctors, dentists, nurses, and midwives mentioned in the preceding paragraph shall be
given priority in promotion or assignment to better areas. Their tour of duties in the remote areas shall not exceed two (2)
years, except when there are no positions for their transfer or they prefer to start in such posts in excess of two (2) years.
SEC. 26. Housing. - All public health workers who are in tour of duty and those who, because of unavoidable
circumstances are forces to stay in the hospital, sanitaria or health infirmary premises, shall entitles to free living quarters
within the hospital, sanitarium or health infirmary or if such quarters are not available, shall receive quarters allowance as
may be determined by the Secretary of Health and other appropriate government agencies concerned: Provided, That this
rate shall be reviewed periodically and increased accordingly by the Secretary of Health in consultation with the
appropriate government agencies concerned.
For purposes of this Section, the Department of Health is authorized to develop housing projects in its own lands, not
otherwise devoted for other uses, for public health workers, in coordination with appropriate government agencies.
SEC. 27. Medical Examination. - Compulsory medical examination shall be provided free of charge to all public health
workers before entering the service in the Government or its subdivisions and shall be repeated once a year during the
tenure of employment of all public health workers: Provided, That where medical examination shows that medical
treatment and/or hospitalization is necessary for those already in government service, the treatment and/or hospitalization
including medicines shall be provided free either in a government or a private hospital by the government entity paying the
salary of the health worker: Provided, further, That the cost of such medical examination and treatment shall be included
as automatic appropriation in said entity’s annual budget.
SEC. 28. Compensation of Injuries. - Public health workers shall be protected against the consequences of employment
injuries in accordance with existing laws. Injuries incurred while doing overtime work shall be presumed work-connected.
SEC. 29. Leave Benefits for Public Health Workers. - Public health workers are entitled to such vacation and sick
leaves as provided by existing laws and prevailing practices: Provided, That in addition to the leave privilege now enjoyed
by public health, women health workers are entitled to such maternity leaves provided by existing laws and prevailing
practices: Provided, further, That upon separation of the public health workers from services, they shall be entitled to all
accumulated leave credits with pay.
SEC. 30. Highest Basic Salary Upon Retirement - Three (3) prior to the compulsory retirement, the public health worker
shall automatically be granted one (1) salary range or grade higher than his/her basic salary and his/her retirement
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benefits thereafter, computed on the basis of his/her highest salary: Provided, That he/she has reached the age and
fulfilled service requirements under existing laws.
SEC. 31. Right to Self-Organization. - Public health workers shall have the right to freely from, join or assist
organizations or unions for purposes not contrary to law in order to defend and protect their mutual interests and to obtain
redness of their grievances through peaceful concerned activities.
However, meanwhile the State recognizes the right of public health workers to organize or join organization, public health
workers on-duty cannot declare, stage or join any strike or cessation of their service to patients in the interest of public
health, safety or survival of patients.
SEC. 32. Freedom from Interference or Coercion. - It shall be unlawful for any person to commit any of the following
acts of interference or coercion:
(a) to require as a condition of employment that a public health worker shall not join a health workers’ organization or
union or shall relinquish membership therein;
(b) to discriminate in regard to hiring or tenure of employment or any item or condition of employment in order to
encourage or discourage membership in any health workers’ organization or union;
(c) to prevent a health worker from carrying out duties laid upon him/her by his/her position in the organization or
union, or to penalize him/her for the action undertaken in such capacity;
(d) to harness or interfere with the discharge of the functions of the health worker when these are calculated to
intimidate or to prevent the performance of his/her duties and responsibilities; and
(e) to otherwise interfere in the establishment, functioning, or administration of health workers organization or unions
through acts designed to place such organization or union under the control of government authority.
SEC. 33. Consultation With Health Worker’s Organization. - In the formulation of national policies governing the social
security of public health workers, professional and health workers, organizations or unions as well as other appropriate
government agencies concerned shall be consulted by the Secretary of Health. For this purpose, Management Health
Worker’s Consultative Councils for national, regional and other appropriate levels shall be established and
operationalized.
SEC. 34. Health Human Resource Development/Management Study. - The Department of Health shall conduct a
periodic health human resource development/management study into, among others, the following areas;
(a) adequacy of facilities and supplies to render quality health care to patients and other client population;
(b) opportunity for health workers to grow and develop their potentials and experience a sense of worth and dignity in
their work. Public health workers who undertake postgraduate studies in a degree course shall be entitled to an upgrading
in their position or raise in pay: Provided, That it shall not be more than every two (2) years;
(c) mechanisms for democratic consultation in government health institutions;
(d) staffing patterns and standard or health care to ensure that the people receive-quality care. Existing
recommendations on staffing and standards of health care shall be immediately and strictly enforced;
(e) ways and means of enabling the rank-and-file workers to avail of education opportunities for personal growth and
development;
(f) upgrading of working conditions, reclassification positions and salaries of public health workers to correct disparity
vis-a-vis other professions such that positions requiring longer study to upgrade and given corresponding pay scale; and
(g) assessment of the national policy on exportation of skilled health human resource to focus on how these resources
could instead be utilized productivity for the country’s needs.
There is hereby created a Congressional Commission on Health (HEALTHCOM) to review and assess health human
resource development, particularly on continuing professional education and training and the other areas described
above. The Commission shall be composed of five (5) members of the House of Representatives and five (5) members of
the Senate. It shall be co-chaired by the chairperson of the Committee on health of both houses. It shall render a report
and recommendation to Congress which shall be the basis for policy legislation in the field of health. Such a congressional
review shall be undertaken once every five (5) years.
SEC. 35. Rules and Regulations. - The Secretary of Health after consultation with appropriate agencies of the
Government as well as professional and health workers’ organizations or unions, shall formulate and prepare the
necessary rules and regulations to implement the provisions of this Act. Rules and regulations issued pursuant to this
section shall take effect thirty (30) days after publication in a newspaper of general circulation.
SEC. 36. Prohibition Against Double Recovery of Benefits. - Whenever other laws provide for the same benefits
covered by this Act, the public health worker shall have the option to choose which benefits will be paid to him/her.
However, in the event that the benefits chosen are less than that provided under this Act, the worker shall be paid only the
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difference.
SEC. 37. Prohibition Against Elimination and/or Diminution. - Nothing in this law shall be construed to eliminate or in
any way diminish benefits being enjoyed by public health workers at the time of the effectivity of this Act.
SEC. 38. Budgetary Estimates. - The Secretary of health shall submit annually the necessary budgetary estimates to
implement the provisions of this Act in staggered basis of implementation of the proposes benefits until the total of Nine
hundred forty-six million six hundred sixty-four thousand pesos (P964,664,000.00) is estimated within five (5) years.
Budgetary estimates for the succeeding years should be reviewed and increased accordingly by the Secretary of Health in
consultation with the Department of Budget and Management and the Congressional Commission on Health
(HEALTHCOM).
SEC. 39. Penal Provision. - Any person shall willfully interfere with, restrain or coerce any public health worker in the
exercise of his/her rights or shall in any manner any act in violation of any of the provisions of this Act, upon conviction,
shall be punished by a fine of not less than Twenty thousand pesos (P20,000.00) but not more than one (1) year or both
at the discretion of the court.
If the offender is a public official, the court, in addition to the penalties provided in the preceding paragraph, may impose
the additional penalty of disqualification from office.
SEC. 40. Separability Clause. - If any provision of this Act is declared invalid, the remainder of this Act or any provision
not affected thereby shall remain in force and effect.
SEC. 41. Repealing Clause. - All laws, presidential decrees, executive orders and their implementing rules, inconsistent
with the provisions of this act are hereby repealed, amended or modified accordingly.
SEC. 42. Effectivity. - This Act shall take effect fifteen (15) days after its publication in at least two (2) national
newspapers of general circulation.
Approved: March 26, 1992.
RA 9173
The focus of the discussion for this law are the following parts of RA 9173:
Article III- organization of the Board of Nursing
Article IV- Nursing Education
Article V- Nursing Practice
Article VI- Health Human resource development production and utilization
Article VII- Penal and Miscellaneous
RA 9173 - An act providing for a more responsive nursing profession, repealing for the purpose RA 7164 known as
the “Phil. Nursing Act of 1991 and for other purposes. This act shall be known as the “Phil. Nursing Act of 2002”
ARTICLE I
TITLE
SECTION 1. Title. — This Act shall be known as the “Philippine Nursing Act of 2002.”
ARTICLE II
DECLARATION OF POLICY
SEC. 2. Declaration of Policy. — It is hereby declared the policy of the State to assume responsibility for the protection
and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane
working conditions, better career prospects and a dignified existence for our nurses.
The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system
throughout the country.
ARTICLE III
ORGANIZATION OF THE BOARD OF NURSING
SEC. 3. Creation and Composition of the Board. — There shall be created a Professional Regulatory Board of Nursing,
hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by
the President of the Republic of the Philippines from among two (2) recommendees, per vacancy, of the Professional
Regulation Commission, hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees,
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per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications
prescribed in Section 4 of this Act.
SEC. 4. Qualifications of the Chairperson and Members of the Board. — The Chairperson and Members of the Board
shall, at the time of their appointment, possess the following qualifications:
(a) Be a natural born citizen and resident of the Philippines;
(b) Be a member of good standing of the accredited professional organization of nurses;
(c) Be a registered nurse and holder of a master’s degree in nursing, education or other allied medical profession
conferred by a college or university duly recognized by the Government: Provided, That the majority of the Members of
the Board shall be holders of a master’s degree in nursing: Provided, further, That the Chairperson shall be a holder of a
master’s degree in nursing;
(d) Have at least ten (10) years of continuous practice of the profession prior to appointment: Provided, however, That the
last five (5) years of which shall be in the Philippines; and
(e) Not have been convicted of any offense involving moral turpitude;
Provided, That the membership to the Board shall represent the three (3) areas of nursing, namely: nursing education,
nursing service and community health nursing.
SEC. 5. Requirements Upon Qualification as Member of the Board of Nursing. — Any person appointed as Chairperson
or Member of the Board shall immediately resign from any teaching position in any school, college, university or institution
offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or
employment in the government or any subdivision, agency or instrumentality thereof, including government-owned or
controlled corporations or their subsidiaries as well as those employed in the private sector. He/she shall not have any
pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including
review classes.
SEC. 6. Term of Office. — The Chairperson and Members of the Board shall hold office for a term of three (3) years and
until their successors shall have been appointed and qualified: Provided, That the Chairperson and Members of the Board
may be reappointed for another term.
Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired portion of the term only.
Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties.
The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under
Republic Act No. 7164 until their replacements have been appointed by the President and shall have been duly qualified.
SEC. 7. Compensation of Board Members. — The Chairperson and Members of the Board shall receive compensation
and allowances comparable to the compensation and allowances received by the Chairperson and members of other
professional regulatory boards.
SEC. 8. Administrative Supervision of the Board, Custodian of its Records, Secretariat and Support Services. —
The Board shall be under the administrative supervision of the Commission. All records of the Board, including
applications for examinations, administrative and other investigative cases conducted by the Board shall be under the
custody of the Commission. The Commission shall designate the Secretary of the Board and shall provide the secretariat
and other support services to implement the provisions of this Act.
SEC. 9. Powers and Duties of the Board. — The Board shall supervise and regulate the practice of the nursing
profession and shall have the following powers, duties and functions:
(a) Conduct the licensure examination for nurses;
(b) Issue, suspend or revoke certificates of registration for the practice of nursing;
(c) Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to
ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing
taking into account the health needs of the nation;
(d) Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or
departments of nursing education and those seeking permission to open nursing courses to ensure that standards of
nursing education are properly complied with and maintained at all times. The authority to open and close colleges of
nursing and/or nursing education programs shall be vested on the Commission on Higher Education upon the written
recommendation of the Board;
(e) Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional
conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad
testificandum and subpoena duces tecum to secure the appearance of respondents, and witnesses and the production of
documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such
proceedings, upon application with the court;
(f) Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses
within one (1) year from the effectivity of this Act;
(g) Recognize nursing specialty organizations in coordination with the accredited professional organization; and
(h) Prescribe, adopt, issue and promulgate guidelines, regulations, measures and decisions as may be necessary for the
improvement of the nursing practice, advancement of the profession and for the proper and full enforcement of this Act
subject to the review and approval by the Commission.
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SEC. 10. Annual Report. — The Board shall at the close of its calendar year submit an annual report to the President of
the Philippines through the Commission giving a detailed account of its proceedings and the accomplishments during the
year and making recommendations for the adoption of measures that will upgrade and improve the conditions affecting
the practice of the nursing profession.
SEC. 11. Removal or Suspension of Board Members. — The President may remove or suspend any member of the
Board after having been given the opportunity to defend himself/herself in a proper administrative investigation, on the
following grounds:
(a) Continued neglect of duty or incompetence;
(b) Commission or toleration of irregularities in the licensure examination; and
(c) Unprofessional, immoral or dishonorable conduct.
ARTICLE IV
EXAMINATION AND REGISTRATION
SEC. 12. Licensure Examination. — All applicants for license to practice nursing shall be required to pass a written
examination, which shall be given by the Board in such places and dates as may be designated by the
Commission: Provided, That it shall be in accordance with Republic Act No. 8981, otherwise known as the “PRC
Modernization Act of 2000.”
SEC. 13. Qualifications for Admission to the Licensure Examination. — In order to be admitted to the examination for
nurses, an applicant must, at the time of filing his/her application, establish to the satisfaction of the Board that:
(a) He/she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within
its territorial limits on the same basis as the subject or citizen of such country: Provided, That the requirements for the
registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;
(b) He/she is of good moral character; and
(c) He/she is a holder of a Bachelor’s Degree in Nursing from a college or university that complies with the standards of
nursing education duly recognized by the proper government agency.
SEC. 14. Scope of Examination. — The scope of the examination for the practice of nursing in the Philippines shall be
determined by the Board. The Board shall take into consideration the objectives of the nursing curriculum, the broad areas
of nursing, and other related disciplines and competencies in determining the subjects of examinations.
SEC. 15. Ratings. — In order to pass the examination, an examinee must obtain a general average of at least seventyfive percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average
rating of seventy-five percent (75%) or higher but gets a rating below sixty percent (60%) in any subject must take the
examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). In order to pass the
succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject or
subjects repeated.
SEC. 16. Oath. — All successful candidates in the examination shall be required to take an oath of profession before the
Board or any government official authorized to administer oaths prior to entering upon the nursing practice.
SEC. 17. Issuance of Certificate of Registration/Professional License and Professional Identification Card. — A
certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon
payment of the prescribed fees. Every certificate of registration/professional license shall show the full name of the
registrant, the serial number, the signature of the Chairperson of the Commission and of the Members of the Board, and
the official seal of the Commission.
A professional identification card, duly signed by the Chairperson of the Commission, bearing the date of registration,
license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment
of the required fees.
SEC. 18. Fees for Examination and Registration. — Applicants for licensure and for registration shall pay the
prescribed fees set by Commission.
SEC. 19. Automatic Registration of Nurses. — All nurses whose names appear at the roster of nurses shall be
automatically or ipso facto registered as nurses under this Act upon its effectivity.
SEC. 20. Registration by Reciprocity. — A certificate of registration/professional license may be issued without
examination to nurses registered under the laws of a foreign state or country: Provided, That the requirements for
registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided,
further, That the laws of such state or country grant the same privileges to registered nurses of the Philippines on the
same basis as the subjects or citizens of such foreign state or country.
SEC. 21. Practice Through Special/Temporary Permit. — A special/temporary permit may be issued by the Board to
the following persons subject to the approval of the Commission and upon payment of the prescribed fees:
(a) Licensed nurses from foreign countries/states whose service are either for a fee or free if they are internationally wellknown specialists or outstanding experts in any branch or specialty of nursing;
(b) Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital,
center or clinic; and
(c) Licensed nurses from foreign countries/states employed by schools/colleges of nursing as exchange professors in a
branch or specialty of nursing;
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Provided, however, That the special/temporary permit shall be effective only for the duration of the project, medical
mission or employment contract.
SEC. 22. Non-registration and Non-issuance of Certificates of Registration/Professional License or
Special/Temporary Permit. — No person convicted by final judgment of any criminal offense involving moral turpitude or
any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be
registered and be issued a certificate of registration/professional license or a special/temporary permit.
The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be
incorporated in the records of the Board.
SEC. 23. Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of
Special/Temporary Permit. — The Board shall have the power to revoke or suspend the certificate of
registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds:
(a) For any of the causes mentioned in the preceding section;
(b) For unprofessional and unethical conduct;
(c) For gross incompetence or serious ignorance;
(d) For malpractice or negligence in the practice of nursing;
(e) For the use of fraud, deceit, or false statements in obtaining a certificate of registration/professional license or a
temporary/special permit;
(f) For violation of this Act, the rules and regulations, Code of Ethics for nurses and technical standards for nursing
practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the
temporary/special permit; or
(g) For practicing his/her profession during his/her suspension from such practice;
Provided, however, That the suspension of the certificate of registration/professional license shall be for a period not to
exceed four (4) years.
SEC. 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates. — The Board may, after the
expiration of a maximum of four (4) years from the date of revocation of a certificate, for reasons of equity and justice and
when the cause for revocation has disappeared or has been cured and corrected, upon proper application therefor and
the payment of the required fees, issue another copy of the certificate of registration/professional license.
A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated
may be issued, subject to the rules of the Board.
ARTICLE V
NURSING EDUCATION
SEC. 25. Nursing Education Program. — The nursing education program shall provide sound general and professional
foundation for the practice of nursing.
The learning experiences shall adhere strictly to specific requirements embodied in the prescribed curriculum as
promulgated by the Commission on Higher Education’s policies and standards of nursing education.
SEC. 26. Requirement for Inactive Nurses Returning to Practice. — Nurses who have not actively practiced the profession
for five (5) consecutive years are required to undergo one (1) month of didactic training and three (3) months of practicum.
The Board shall accredit hospitals to conduct the said training program.
SEC. 27. Qualifications of the Faculty. — A member of the faculty in a college of nursing teaching professional courses
must:
(a) Be a registered nurse in the Philippines;
(b) Have at least one (1) year of clinical practice in a field of specialization;
(c) Be a member of good standing in the accredited professional organization of nurses; and
(d) Be a holder of a master’s degree in nursing, education, or other allied medical and health sciences conferred by a
college or university duly recognized by the Government of the Republic of the Philippines.
In addition to the aforementioned qualifications, the dean of a college must have a master’s degree in nursing. He/she
must have at least five (5) years of experience in nursing.
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will ask the students to answer and rationalize the ten (10) questions below. This will be recorded as their
quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationale. Superimpositions or
erasures in their answer/ratio are not allowed. The instructor must emphasize the time allotment for this activity.
(For 1-10 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Multiple choice:
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1. In order to pass the examination, an examinee must obtain: (select all that apply)
A. General average of at least seventy-five percent (75%)
B. General average of at least sixty percent (60%)
C. A rating of not below sixty percent (60%) in any subject
D. A rating of not below seventy-five percent (75%) in any subject
Answer: A and C
Rationale: In order to pass the examination, an examinee must obtain a general average of at least seventy-five
percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average
rating of seventy-five percent (75%) or higher but gets a rating below sixty percent (60%) in any subject must take the
examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). In order to
pass the succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the
subject or subjects repeated.
2. Who will appoint the Chairperson and six (6) members of the BON?
A. Accredited professional organization of nurses
B. Professional regulation Commission Chairman
C. President of the Republic of the Philippines
D. Professional Regulatory Board of Nursing
Answer: C
Rationale: SEC. 3. Creation and Composition of the Board. — There shall be created a Professional Regulatory
Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They
shall be appointed by the President of the Republic of the Philippines from among two (2) recommendees, per
vacancy, of the Professional Regulation Commission, hereinafter referred to as the Commission, chosen and ranked
from a list of three (3) nominees, per vacancy, of the accredited professional organization of nurses in the Philippines
who possess the qualifications prescribed in Section 4 of this Act.
3. Belinda passed the Nurse’s Licensure Examination and a caregiver in Israel for fifteen (15) years and wishes
to go back to nursing practice. She should be advised to: (select all that apply)
A. Retake the board exam
B. Undergo three (3) months practicum
C. Undergo one (1) month training
D. Undergo refresher course
Answer: B and C
Rationale: SEC. 26. Requirement for Inactive Nurses Returning to Practice. — Nurses who have not actively
practiced the profession for five (5) consecutive years are required to undergo one (1) month of didactic training and
three (3) months of practicum. The Board shall accredit hospitals to conduct the said training program.
Option A, an NLE passer does not need to retake the Board Exam. Option D, refresher course is not even mentioned
in RA 9173 for retakers.
4. Who among the following is liable to the law?
A. Mark a registered nurse is practicing in the community.
B. Matthew who renews his license using the online PRC renewal.
C. Luke who uses his PRC ID for special lane in the grocery during the CoViD-19 pandemic.
D. Philip who append his name the letters BSN who is a graduate of General Nursing
Answer: D
Rationale: SEC. 35. Prohibitions in the Practice of Nursing. — A fine of not less than Fifty thousand pesos
(P50,000,00) nor more than One hundred thousand pesos (P100,000.00) or imprisonment of not less than one (1)
year nor more than six (6) years, or both, upon the discretion of the court, shall be imposed upon a person who
appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered Nurse) or any similar appendage to his/her name
without having been conferred said degree or registration. Option A, Mark is an RN and community practice is legal.
Option B, it is required to renew license and online renewal is accepted. Option C, special lanes are given to
healthcare workers provided they have updated PRC license.
5. It shall be the duty of the nurse to:
A. Administer treatment
B. Suture perineal lacerations
C. Supervise student nurses
D. Perform internal examination during antenatal bleeding
Answer: C
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Rationale: Option C it is the duty of the nurse to teach, guide and supervise students in nursing education programs
including the administration of nursing services in varied settings such as hospitals and clinics (Sec.28 [d]). Option A,
nurse may administer treatment if it is prescribed. Option B, suturing perineal lacerations can be performed provided
the nurse has special training. Option D, internal examination can be performed if there is no antenatal bleeding.
6. The Magna Carta of Public Health Workers applies to: (select all that apply)
A. Barangay Health Nurse
B. Barangay Health Workers
C. Barangay Tanod
D. Liaison officer of an RHU
Answer: A, B and D
Rationale: SEC. 3. Definition. - For purposes of this Act, "health workers" shall mean all persons who are engaged in
health and health-related work, and all persons employed in all hospitals, sanitaria, health infirmaries, health centers,
rural health units, barangay health stations, clinics and other health-related establishments owned and operated by
the Government or its political subdivisions with original charters and shall include medical, allied health professional,
administrative and support personnel employed regardless of their employment status. Therefore, whether it is
medical or non-medical as long as they work in a health care facility owned by the government, they are under the
Magna Carta of Public Health Workers. Option C, are not considered to be part of the law. Barangay tanod are under
the jurisdiction of the Barangay Administration.
7. A health care worker is entitled of hazard allowance if: (select all that apply)
A. There is pandemic
B. The place is declared in a state of calamity
C. He/she works in a prisons camp
D. He/she works in a busy city
Answer: A, B and C
Rationale: SEC. 21. Hazard Allowance. - Public health worker in hospitals, sanitaria, rural health units, main centers,
health infirmaries, barangay health stations, clinics and other health-related establishments located in difficult areas,
strife-torn or embattled areas, distresses or isolated stations, prisons camps, mental hospitals, radiation-exposed
clinics, laboratories or disease-infested areas or in areas declared under state of calamity or emergency for the
duration thereof which expose them to great danger, contagion, radiation, volcanic activity/eruption occupational risks
or perils to life. Option D, is not included in the areas that may cause danger.
8. Doctors, dentists, nurses, and midwives who accept assignments as such in remote areas or isolated
stations shall be entitled of an incentive bonus in the form of remote assignment allowance equivalent to
______of the monthly basic salary:
A. Fifty percent (50%)
B. Twenty-five percent (25%)
C. Five percent (5%)
D. Ten percent (10%)
Answer: A
Rationale: Option A, (Remote Assignment Allowance) a health worker shall be entitled to an incentive bonus in the
form of remote assignment allowance equivalent to fifty percent (50%) of their basic pay, and shall be entitled to
reimbursement of the cost of reasonable transportation to and from and during official trips. Option B, 25%, of the
basic salary of health workers receiving salary grade 19 and below is given as hazard pay. Option C, five percent
(5%) for health workers with salary grade 20 and above is given as hazard pay. Option D, ten percent (10%) regular
wage for each hour of work performed during the night-shifts customarily adopted by hospitals.
9. John works at 10pm to 6am as a nurse in a Public Lying –in Clinic. He shall be paid additional of:
A. Fifty percent (50%)
B. Twenty-five percent (25%)
C. Five percent (5%)
D. Ten percent (10%)
Answer: D
Rationale: Option D, a night-shift differential of ten percent (10%) of regular wage for each hour of work performed
during the night-shifts customarily adopted by hospitals will be given to John. Option A, 50% of basic salary is a
remote assignment allowance given additionally. Option B, 25% of basic salary is the hazard pay for Grade 19 and
below as addition to the monthly salary. Option C, 5% of the basic salary is the additional pay for Grade 20 and
above.
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10. A longevity pay is given to:
A. Mark who is on his third year in Public Health
B. Harry who worked hard during the Pandemic
C. Ramir who just came back to Public Health
D. Dennis who is on his 6th year in Public Health
Answer: D
Rationale: Option D, SEC.23. Longevity Pay. - A monthly longevity pay equivalent to five percent (5%) of the monthly
basic pay shall be paid to a health worker for every five (5) years of continuous, efficient and meritorious services
rendered as certified by the chief of office concerned commencing with the service after the approval of this Act.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
AL: Success criteria (Cold call, the instructor will call three students to complete the sentence).
For me to practice Nursing in the Philippines, I must ____________________________.
As a nurse, my scope of practice includes ____________________________________.
As A PHN I am entitled of benefits like ________________ if I ______________________________.
(Reading assignment: Continue to read regarding laws related to Public Health and Community Health Nursing
Practice.)
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Community Health Nursing II
INSTRUCTOR’S GUIDE
BS NURSING / FIRST YEAR
Session # 23
LESSON TITLE: LAWS AFFECTING THE PUBLIC HEALTH
AND PRACTICE OF COMMUNITY HEALTH NURSING PART
II
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Describe the different laws affecting Public and
Practice of Community Health Nursing
2. Appreciate the laws affecting the Public and Practice
of Community Health Nursing
Materials:
Book, pen and notebook
LCD and power point presentation
White board marker
References:
Cuevas, F. P., (2007). Public Health Nursing in
the Philippines (10th edition). Manila, Philippines.
Famorca, Z., Nies, M., McEwen, M. (2013).
Nursing Care of the Community. Singapore:
Elsevier
LESSON REVIEW/ PREVIEW (10 minutes)
Multiple choice
1. Who among the following are NOT liable to the law?
A. Mark a BSN graduate practicing in the community.
B. Matthew who renews his license using the online PRC renewal.
C. Luke who uses his PRC ID for special lane in the grocery during the CoViD-19 pandemic.
D. Philip who append his name the letters BSN who is a graduate of General Nursing
Answer: B and C
Rationale: Appending BSN or RN to the name without having been conferred said degree or registration is unlawful.
Likewise, when one is practicing without a license.
2. It shall be the duty of the nurse to: (select all that apply)
A. Administer prescribed treatment
B. Suture perineal lacerations
C. Supervise student nurses
D. Perform internal examination during antenatal bleeding
Answer: A and C
Rationale: Option C it is the duty of the nurse to teach, guide and supervise students in nursing education programs
including the administration of nursing services in varied settings such as hospitals and clinics (Sec.28 [d]). Option A,
nurse may administer treatment if it is prescribed.
3. A health care worker is entitled of hazard allowance if: (select all that apply)
A. There is epidemic
B. The place is declared in a state of calamity
C. He/she works in a prisons camp
D. He/she works in a remote area
Answer: A, B and C
Rationale: SEC. 21. Hazard Allowance. - Public health worker in hospitals, sanitaria, rural health units, main centers,
health infirmaries, barangay health stations, clinics and other health-related establishments located in difficult areas,
strife-torn or embattled areas, distresses or isolated stations, prisons camps, mental hospitals, radiation-exposed
clinics, laboratories or disease-infested areas or in areas declared under state of calamity or emergency for the
duration thereof which expose them to great danger, contagion, radiation, volcanic activity/eruption occupational risks
or perils to life.
The instructor will show the following image. The instructor will say, “This image has something to do with our discussion
today. I would like you take a picture of it and try to figure out its implications to our discussion.”
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MAIN LESSON (25 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their SAS.
ARTICLE VI
NURSING PRACTICE
SEC. 28. Scope of Nursing. — A person shall be deemed to be practicing nursing within the meaning of this Act when
he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and
communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery,
infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age. As independent practitioners,
nurses are primarily responsible for the promotion of health and prevention of illness. As members of the health team,
nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care,
restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the
duty of the nurse to:
(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional
and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary
health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral,
topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In
case of suturing of perineal laceration, special training shall be provided according to protocol established;
(b) Establish linkages with community resources and coordination with the health team;
(c) Provide health education to individuals, families and communities;
(d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in
varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the
utilization of knowledge and decision-making skills of a registered nurse; and
(e) Undertake nursing and health human resource development training and research, which shall include, but not limited
to, the development of advance nursing practice;
Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision
of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe
the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain
competence by continual learning through continuing professional education to be provided by the accredited professional
organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the
continuing professional education shall be submitted to and approved by the Board.
SEC. 29. Qualifications of Nursing Service Administrators. — A person occupying supervisory or managerial positions
requiring knowledge of nursing must:
(a) Be a registered nurse in the Philippines;
(b) Have at least two (2) years experience in general nursing service administration;
(c) Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in management and administration
courses at the graduate level; and
(d) Be a member of good standing of the accredited professional organization of nurses;
Provided, That a person occupying the position of chief nurse or director of nursing service shall, in addition to the
foregoing qualifications, possess:
(1) At least five (5) years of experience in a supervisory or managerial position in nursing; and
(2) A master’s degree major in nursing;
Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief nurse shall
be as specified in subsections (a), (b), and (c) of this section: Provided, furthermore, That for chief nurses in the public
health agencies, those who have a master’s degree in public health/community health nursing shall be given
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priority. Provided, even further, That for chief nurses in military hospitals, priority shall be given to those who have finished
a master’s degree in nursing and the completion of the General Staff Course (GSC): Provided, finally, That those
occupying such positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify.
ARTICLE VII
HEALTH HUMAN RESOURCE
PRODUCTION, UTILIZATION AND DEVELOPMENT
SEC. 30. Studies for Nursing Manpower Needs, Production, Utilization and Development. — The Board, in coordination
with the accredited professional organization and appropriate government or private agencies shall initiate, undertake and
conduct studies on health human resource production, utilization and development.
SEC. 31. Comprehensive Nursing Specialty Program. — Within ninety (90) days from the effectivity of this Act, the Board
in coordination with the accredited professional organization, recognized specialty organizations and the Department of
Health is hereby mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the
level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the areas of critical
care, oncology, renal and such other areas as may be determined by the Board.
The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least two (2) years of
continuous service.
SEC. 32. Salary. — In order to enhance the general welfare, commitment to service and professionalism of nurses, the
minimum base pay of nurses working in the public health institutions shall not be lower than salary grade 15 prescribed
under Republic Act No. 6758, otherwise known as the “Compensation and Classification Act of 1989”: Provided, That for
nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said
law.
SEC. 33. Funding for the Comprehensive Nursing Specialty Program. — The annual financial requirement needed to train
at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the
income of the Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation, which shall
equally share in the costs and shall be released to the Department of Health subject to accounting and auditing
procedures: Provided, That the Department of Health shall set the criteria for the availment of this program.
SEC. 34. Incentives and Benefits. — The Board of Nursing, in coordination with the Department of Health and other
concerned government agencies, association of hospitals and the accredited professional organization shall establish an
incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and
other non-cash benefits. The government and private hospitals are hereby mandated to maintain the standard nursepatient ratio set by the Department of Health.
ARTICLE VIII
PENAL AND MISCELLANEOUS PROVISIONS
SEC. 35. Prohibitions in the Practice of Nursing. — A fine of not less than Fifty thousand pesos (P50,000,00) nor more
than One hundred thousand pesos (P100,000.00) or imprisonment of not less than one (1) year nor more than six (6)
years, or both, upon the discretion of the court, shall be imposed upon:
(a) any person practicing nursing in the Philippines within the meaning of this Act:
(1) without a certificate of registration/professional license and professional identification card or special temporary permit
or without having been declared exempt from examination in accordance with the provision of this Act; or
(2) who uses as his/her own certificates of registration/professional license and professional identification card or special
temporary permit of another; or
(3) who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of
registration/professional license, or an expired or cancelled special/temporary permit; or
(4) who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a
professional identification card or special permit; or
(5) who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the
impression that he/she is a registered and licensed nurse; or
(6) who appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered Nurse) or any similar appendage to his/her
name without having been conferred said degree or registration; or
(7) who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to
practice nursing.
(b) any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who
conducts review classes for both local and foreign examination without permit/clearance from the Board and the
Commission; or
(c) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that
should be accorded them as specified in Sections 32 and 34; or
(d) any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and
regulations.
ARTICLE IX
FINAL PROVISIONS
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SEC. 36. Enforcement of this Act. — It shall be the primary duty of the Commission and the Board to effectively
implement this Act. Any duly law enforcement agencies and officers of national, provincial, city or municipal governments
shall, upon the call or request of the Commission or the Board, render assistance in enforcing the provisions of this Act
and to prosecute any persons violating the same.
SEC. 37. Appropriations. — The Chairperson of the Professional Regulation Commission shall immediately include in its
program and issue such rules and regulations to implement the provisions of this Act, the funding of which shall be
included in the Annual General Appropriations Act.
SEC. 38. Rules and Regulations. — Within ninety (90) days after the effectivity of this Act, the Board and the Commission,
in coordination with the accredited professional organization, the Department of Health, the Department of Budget and
Management and other concerned government agencies, shall formulate such rules and regulations necessary to carry
out the provisions of this Act. The implementing rules and regulations shall be published in the Official Gazette or in any
newspaper of general circulation.
SEC. 39. Separability Clause. — If any part of this Act is declared unconstitutional, the remaining parts not affected
thereby shall continue to be valid and operational.
SEC. 40. Repealing Clause. — Republic Act No. 7164, otherwise known as the “Philippine Nursing Act of 1991” is hereby
repealed. All other laws, decrees, orders, circulars, issuances, rules and regulations and parts thereof which are
inconsistent with this Act are hereby repealed; amended or modified accordingly.
SEC. 41. Effectivity. — This Act shall take effect fifteen (15) days upon its publication in the Official Gazette or in any two
(2) newspapers of general circulation in the Philippines.
Approved: OCT 21 2002
LAWS AFFECTING THE PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING
R.A. 7160 – or the Local
Government Code
ƒ
R.A. 2382 – Philippine
Medical Act.
R.A. 1082 – Rural Health Act.
x
This act defines the practice of medicine in the country.
x
x
It created the 1st 81 Rural Health Units.
amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary
inspectors will live in the rural areas where they are assigned in order to raise the
health conditions of barrio people ,hence help decrease the high incidence of
preventable diseases
This involves the devolution of powers, functions and responsibilities to the local
government both rural & urban. The Code aims to transform local government units
into self-reliant communities and active partners in the attainment of national goals
thru’ a more responsive and accountable local government structure instituted thru’
a system of decentralization. Hence, each province, city and municipality has a
LOCAL HEALTH BOARD (LHB) which is mandated to propose annual budgetary
allocations for the operation and maintenance of their own health facilities.
ƒ Composition of Local Health Board (LHB)
o Provincial Level
ƒ Governor- chair
ƒ Provincial Health Officer – vice chairman
ƒ Chairman, Committee on Health of Sangguniang Panlalawigan
ƒ DOH representative
ƒ NGO representative
City and Municipal Level
ƒ Mayor – chair
ƒ MHO – vice chair
ƒ Chairman, Committee on Health of Sangguniang Bayan
ƒ DOH representative
ƒ NGO representative
Effective Local Health System Depends on:
o The LGU’s financial capability
o A dynamic and responsive political leadership
o Community empowerment
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R.A. 6425 – Dangerous Drugs
Act
R.A. 9165
x
P.D. No. 651
x
Requires that all health workers shall identify and encourage the registration of all
births within 30 days following delivery.
P.D. No. 996
x
Requires the compulsory immunization of all children below 8 yrs. of age against
the 6 childhood immunizable diseases.
P.D. No. 825
x
Provides penalty for improper disposal of garbage
R.A. 8749
x
Clean Air Act of 2000
P.D. No. 856
x
x
Code on Sanitation
It provides for the control of all factors in man’s environment that affect health
including the quality of water, food, milk, insects, animal carriers, transmitters of
disease, sanitary and recreation facilities, noise, pollution and control of nuisance
R.A 6758
R.A. 6675 – Generics Act of
1988
x
x
Standardizes the salary of government employees including the nursing personnel.
Which promotes, requires and ensures the production of an adequate supply,
distribution, use and acceptance of drugs and medicines identified by their generic
name.
R.A. 6713 – Code of Conduct
and Ethical Standards of
Public Officials and
Employees
x
R.A. 8423
x
It is the policy of the state to promote high standards of ethics in public office.
Public officials and employees shall at all times be accountable to the people and
shall discharges their duties with utmost responsibility, integrity, competence and
loyalty, act with patriotism and justice, lead modest lives uphold public interest over
personal interest.
Created the Philippine Institute of Traditional and Alternative Health Care
P.D. No. 965
x
P.D. NO. 79
RA 4073
Letter of Instruction No. 949
x
x
x
x
x
x
It stipulates that the sale, administration, delivery, distribution and transportation of
prohibited drugs is punishable by law.
The new Dangerous Drug Act of 2000
Ministry Circular No. 2 of
1986
R.A. 7875
x
Requires applicants for marriage license to receive instructions on family planning
and responsible parenthood.
Defines, objectives, duties and functions of POPCOM
Advocates home treatment for leprosy
Legal basis of PHC dated OCT. 19, 1979
promotes development of health programs on the community level
Requires reporting of all cases of communicable diseases and administration of
prophylaxis
Includes AIDS as notifiable disease
x
National Health Insurance Act
R.A. 7432
x
Senior Citizens Act
R.A. 7876
x
x
Senior Citizens Center Act
With recreational, educational, health and social programs and facilities designed
for the full enjoyment and benefit of the senior citizens in the city or municipality
accredited by the DSWD
R.A. 9994
x
An act granting additional benefits and privileges to senior citizens, further
amending republic act no. 7432, as amended, otherwise known as “an act to
maximize the contribution of senior citizens to nation building, grant benefits and
special privileges and for other purposes”
R. A. 7719
x
National Blood Services Act
R.A. 8172
x
Salt Iodization Act (ASIN LAW)
RA 3573
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R.A. 7277
x
x
Magna Carta for PWD’s
provides their rehabilitation, self-development and self-reliance and integration into
the mainstream of society
A.O. No. 2005-0014
x
x
National Policies on Infant and Young Child Feeding:
All newborns be breastfeed within 1 hr after birth
E.O. 51
x
x
x
x
Infants be exclusively breastfeed for 6 months.
Infants be given timely, adequate and safe complementary foods
Breastfeeding be continued up to 2 years and beyond
Phil. Code of Marketing of Breast milk Substitutes
R.A. 10028
x
Expanded Breastfeeding Promotion Act
R.A. 11148
x
An act scaling up the national and local health and nutrition programs through a
strengthened integrated strategy for maternal, neonatal, child health and nutrition
in the first one thousand (1,000) days of life, appropriating funds therefore and for
other purposes
R.A. 7600
x
Rooming In and Breastfeeding Act of 1992
R.A. 8976
x
Food Fortification Law
R.A. 8980
x
Promulgates a comprehensive policy and a national system for Early Childhood
Care and Development (ECCD)
A.O. No. 2006- 0015
R.A. 7846
x
x
R.A. 2029
A.O. No. 2006-0012
x
x
RA 3573
x
Defines the Implementing guidelines on Hepatitis B Immunization for Infants
Mandates Compulsory Hepatitis B Immunization among infants and children less
than 8 yrs old
Mandates Liver Cancer and Hepatitis B Awareness Month Act (February)
Specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk
Code, Relevant International Agreements, Penalizing Violations thereof and for
other purposes
Requires reporting of all cases of communicable diseases and administration of
prophylaxis
CHECK FOR UNDERSTANDING (20 minutes)
The instructor will instruct the students to find their partner to answer the five (5) questions and rationalize among
themselves. This will be recorded as their quiz. One (1) point will be given to correct answer and another one (1) point for
the correct rationale. Superimpositions or erasures in their answer/ratio are not allowed. The instructor must emphasize
the time allotment for this activity. (For 1-5 items, please refer to the questions in the Guided / Rationalization Activity)
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will then rationalize the answers to the students. Encourage them to ask questions and to discuss among
themselves.
Matching Type
Column A
1. Milk code of the Philippines
2. Food Fortification Law
3. Expanded Breastfeeding Promotion Act
4. National Blood Services Act
5. Created the Philippine Institute of Traditional
and Alternative Health Care
6. Magna Carta for PWD’s
7. The New Dangerous Drug Act of 2002
8. National Health Insurance Act
Column B
A. R.A. 8172
B. R. A. 7876
C. R.A. 10028
D. E.O. 51
E. R.A. 8976
F. R. A. 7719
G. R.A. 8423
H. R.A. 3573
I. R.A. 7277
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9. ASIN law
10. Home Treatment for Leprosy
J. R.A. 9165
K. R.A. 4073
Answer:
1. Milk code of the Philippines – E.O. 51
2. Food Fortification Law – R.A. 8976
3. Expanded Breastfeeding Promotion Act – R.A. 10028
4. National Blood Services Act – R.A. 7719
5. Created the Philippine Institute of Traditional and Alternative Health Care - R.A. 8423
6. Magna Carta for PWD’s - R.A. 7277
7. The New Dangerous Drug Act of 2002 – R.A. 9165
8. National Health Insurance Act - R. A. 7876
9. ASIN law - R.A. 8172
10. Home Treatment for Leprosy – R.A. 4073
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
The instructor will call 2-3 students to relate the image to the lesson.
Answer: Laws protect the rights of the people of the community.
Without law, there will be social disturbance.
(Reminders: Coverage of P3 and Comprehensive Examination)
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