CHNN312 Midterms 2024 PDF

CHNN312 LECTURE BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Bachelor of Science in Nursing 3-YA Professor: Professor Raymart Denaga...

CHNN312 LECTURE BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Bachelor of Science in Nursing 3-YA Professor: Professor Raymart Denaga 7 COMMUNITY HEALTH ASSESSMENT - Reveals a particular health problem Discussed by: Mr. Raymart Denaga - Written:  Which tools / methodology to use o Comprehensive needs = “random sampling”  “HEALTH IS LIKE LIBERTY” o Problem-oriented = “purposive sampling” - Offer free health services (constitutional right)  more aware of community problems  effects of a problem  conscious of their capacity to influence  a sense of Community Assessment empowerment  Comprehensive Process that Identify: - Strengths D. Informant Interview / purposeful talk o Including weaknesses  Anyone w/ influence - Resources  Key informant o Specifically health resources = ACTIONS - Assets E. Community Forum - Needs o Health needs/issues  More participants (e.g. purok)  Community Assessment  Open discussion - “act of getting acquainted in the community” - Future projects o Trying to collect data and to know the community - General assembly - Accomplishments of the community Primary Data Resources  Nurse  Collecting data directly from the people - community perceptions on needs, health and health care  People - expressing their views A. Ocular Survey / Windshield survey - influence decision makers  Rapid observation - Walking F. Focus Groups - Driving / riding (US – nurses observe the community  Fewer participants through driving)  Smaller (6-10 members)  Most initial/practical way of gathering info - Each sector of the community will be represented by their  Observes: president - People - Environment Secondary Data Resources - Existing Facility Registry of Vital Events (1) o Location of health centers RA 3753 B. Participant Observation  Civil Registration Law, Philippine Legistature - Enacted in 1930  Purposeful observation of both formal and informal - Established civil registry system in Philippines community activities by sharing/participating in the life of the - Required registration of vital events such as births, community marriages and deaths - Formal: “pagpasok sa trabaho” “ADLs” - May mali sa birth. Cert. = local civil registry o barangay assemblies, school-parent-teacher meeting, church meeting - Informal: “chimisan” RA 7160 o Sari-sari store, community recreation area or  Local Government Code schools - assigned the function of civil registration to local - Sharing: joining/integrating yourself in the activites of the governments people (e.g. jobs) - mandated the appointment of Local (city / municipal) Civil  Immersion Registrars - Immersing yourself to the day to day activities - decentralization of power from national government to  FOR: local government unit - Community Organizing Participatory Action Research - Mayor (COPAR) Live Birth C. Survey  COMPLETE EXPULSION/EXTRACTION from mother of a  Necessary when: product of conception, regardless of duration of pregnancy; after such separation, breathes or with evidence of life, ex. - No available information beating of heart, pulsation of umbilical cord, or movement of - Needs to collect data from a particular community Jhameel - Page 1 of 4  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 voluntary muscles, whether or not umbilical cord been cut or  To minimize the recording and reporting burden at the placenta is attached service delivery level in order to allow more time for patient  Who will register? care and promote activities. - Facility based births - Copied the US version of FHSIS and launched it in the o facility administrator Philippines - Births that occur outside a facility  To provide data which when combined with data from other o Physician, nurse, midwife, or anyone who attended sources, can be used for program monitoring and evaluation purposes. Death Data summary PD 856 Program Monitoring  PERMANENT disappearance of all evidence of life at any time Standardized Data base after live birth has taken place (postnatal cessation of vital Accurate and Timely Data functions without capability of resuscitation.) Minimize recording and recording  Reported w/in 48 hrs to the health officer - Absence of health officer FHSIS is composed of Recording and o Reported to the mayor, municipal secretary or any member of the Sangguniang Bayan, who shall Reporting Tools issue the death certificate for the purposes of  Records are facility-based. burial  Kept at the Barangay Health Station or at Rural Health Unit or  Death cert filing = w/in 30 days health center.  Presidential Decree 856 – Sanitation Code - BHS = midwife - Required death certificate before burial of deceased - RHU = nurse  Death occurred w/o medical attention  With day-to-day account of activities of health workers, service delivered to clients are basis of data entered in the records. - Nearest relative or any person who has knowledge of the  A basis of reports. deaths Components of FHSIS Guidelines in the Classification of Data 1. Reckoning of Vital Events  All vital events are registered and reported by place of occurrence, not by place of residence. 2. Reckoning of Age  Recorded as of last birthday 1. Individual Treatment Record (ITR) Health Records and Reports (2)  Family # / card EO 352 (FHSIS)  ITR = individual  Field Health Service Information System  FTR = family - Fully computerized or manual  Record contains the date, name, address of patient, presenting - Official recording and reporting system of the NSCB symptoms or complain of the patient on consultation and the (national statistical coordination board) / DOH to generate diagnosis (if available), treatment and date of treatment Health statistics  FUNDAMENTAL BUILDING BLOCK OF FHSIS. - Also involves the services available in the community  ITR IS MAINTAINED AT THE FACILITY. o E.g. family planning  HEALTH WORKERS ARE ADVISED NOT TO RELY ON - Morbidity, mortality, CBR and other important health CLIENT-MAINTAINED RECORDS LIKE THE HOME-BASED statistics MOTHERS RECORD.  Basis for: - priority setting by local governments 2. Target Client List (TCL) o e.g. ↑ cases of dengue fever = priority should be  Special population/aggregates w/ special needs directed towards controlling dengue  SECOND BUILDING BLOCK o priority health programs depending on the needs of  Every week  health services the community - planning and decision making at different levels  Not all patient are included - monitoring & evaluating health program  “vulnerable group only” o national and local level  Plan and carry out patient care o TCL = will allow monitoring of the health  Monitor target/eligible population and particular health services programs/services  Who are included? - TCL FOR PRENATAL CARE - TCL for Postpartum Care Goals / Objective - TCL of Under1-Year Child Children (IMCI)  To provide summary data on health service delivered - TCL for Family Planning selected program accomplishment indicators levels. - TCL for Sick Children  To provide a standardized, facility-level data base that can - National Tuberculosis Program TB Registrar = for be accessed for more in-depth studies. compliance o TB DOTS = 6 months tx program for TB cases = to control Jhameel - Page 2 of 4  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 o Monitor compliance - Submitted to the Provincial Health Office - National Leprosy Control Program Central Registration  Program Report (Q1) Form  Usually prepared by the nurse o Same medication w/ TB (multi-drug)  3- month total of indicators categorized as: o “Lion-face” w/ presence of nodules (1) Maternal care (2) Family planning 3. Summary Table (Reporting Forms) (3) Child care  This is accomplished by the Midwife. (4) Dental health  It is a 12-column table in which correspond to the 12 months (5) Disease control of the year.  Morbidity Report (Q2)  This record is kept at the BHS  3 month consolidation of Morbidity Report  From ITR and TCL (M2)  Transmitted from facility to facility C. Annual Forms  Has two components: Health Program Accomplishment and  A-BHS (Midwife) Morbidity / Disease.  Annual Form 1 (A-1) - Nurse  Summary Table is supposed to be updated on a monthly  Annual Form 2 (A-2) - Nurse basis.  Annual Form 3 (A-3) – nurse  The Health Program Accomplishment provides the midwife D. Upon Occurrence with: E. Weeks a. tool for assessment of accomplishments - Weekly report for Notifiable Diseases (Communicable b. ready source for reports Diseases)  The monthly summary of morbidity information on: o E.g. Measles - monthly trend of disease - serves as a source for the 10 leading cases of morbidity Recording Frequenc Sched. Of in the municipality/city Office Person Tools Forms y submission  The Summary Table is also a source of data for any survey or research. M1 and Monthly q 2nd wk of M2 the ITR succeeding 4. The Monthly Consolidation Table (MCT) BHS Midwife TCL month  Accomplished by the nurse based on the Summary Table. SL A-BHS q 2nd wk of  Quarterly Form Annually January  It serves as: - the source document for the Quarterly Form and q 3rd week of - the Output Table of the RHU or health center Q1 and the 1st month Q2 of the Quarterly succeeding Forwarded report from RHU to PHO = OUTPUT TABLE/REPORT ST RHU PHN year MCT Forms transmitted from one facility to another = REPORTING/TALLY FORMS Annual Forms q 3rd week of January Reporting Forms A. Monthly Forms (Midwife) - Are regularly prepared by the midwife and submitted to the nurse who then uses the data to prepare the Quarterly Form - are:  Program Report (M1) – health programs accomplished  contains indicators categorized as: (1) maternal care (2) child care (3) family planning (4) disease control  The midwife copies the data from the Summary Table  Morbidity Report (M2)  Contains a list of all cases of disease by: (1) Age (2) Sex B. Quarterly Forms (Nurse) - There should only be one Quarterly Form for the municipalities / cities with two or more RHUs or health centers - consolidation done under the direction of Municipality / City Health Officer - Data comes from the M1 and M2 Jhameel - Page 3 of 4  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Jhameel - Page 4 of 4  CHNN312 LECTURE BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Bachelor of Science in Nursing 3-YA Professor: Professor Raymart Denaga 8 COMMUNITY DIAGNOSIS  Incidence (new cases) and Prevalence (old and new) Discussed by: Mr. Raymart Denaga What is a Community Diagnosis? D. Health Resources  It is a quantitative and qualitative description of the health  # of health centers of citizens and the factors which influences their health. It  1 midwife = 5,000 identifies problems, proposes areas of improvement and stimulates action. (WHO and Famorca) - Quantitative = numerical data, has to be described using E. Political/Leadership Pattern graphs  Project by Brgy. Captain and mayor o Majority of information from IDB are quantitative o IDB = family members, salary, educ. attainment, 11 Steps in Community Diagnosis etc. 1. Determine Objectives - Qualitative = descriptive data, described using paragraph Comprehensive Community Diagnosis: or words To know the general/overall health status of the community o E.g. Health beliefs  Gather complete profile of the community  is a comprehensive assessment of health status of the - Demographic information of the Community community in relation to its social, physical and biological - Health status of the community environment - Physical/Geographical Characteristics of the community - Mayor - Socioeconomic o A community diagnosis must be done first before - Cultural Data of the community launching a health program - Environmental  It should be the first stage in planning health programs for  Survey: RANDOM PROBABILITY SAMPLING the betterment and the improvement of the community Problem-Oriented Community Diagnosis Purpose of Community Diagnosis  Identify specific need in community/barangay  The purpose of community diagnosis is to define existing problems, determine available resources, and set priorities - Ex. tumataas ang COVID → Then you conduct problem oriented Community Diagnosis for planning, implementing and evaluating, health action by and for the community. 2. Define the population  Similar to ADPIE  Which is included? Men, Women, Children, Geria, or all of  2-3 problems them?  In choosing a community for community diagnosis: - Depressed 3. Determine the Data to be collected - Oppressed  Go to the community and determine what is the problem by - Poor collecting data - Exploited - Safe  w/c information to be collected to meet the objectives 4. Collecting Data Elements of Community Diagnosis  Research A. Demographic Variables  Primary  Population size a. Ocular/ Windshield survey = most important / primary  Population composition b. Participant Observation = immersion  CBR and CDR c. Survey d. Informant Interview = formal leader B. Socio-economic and Cultural Variables e. Community Forum/Focus Group  Poverty rate  Unemployment Rate 5. Develop Instrument  Predominant Religion  Instrument: Questionnaire  Languages Used in communication  E.g. Participant Observation  Majority Race/Ethnicity - Instrument = observation checklist  Environmental Factors 6. Actual Data Gathering - Geolocation - Waste and Disposal Management  Under COPAR → Collection of data should be collected by the people [self-reliance & empowered] C. Health and Illness Pattern  Community Organizing Participatory Action Research  Morbidity Rate - Majority of tasks, the people are the one to conduct Jhameel - Page 1 of 3  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 - The nurse is to assist the people (facilitator/supervisor) Histogram o To provide self-reliance and compliant  Group of Data/ Data sets  Distribution of frequency (# of occurrence) 7. Data Collation - Group: Frequency  Everyone is gathered in the barangay hall and then all - In your group - There is frequency (1-10 -5; 11-20-10; 21- information gathered are TALLIED (Tally) 30) 8. Data Presentation  Put the data on graphs/charts Pie Chart / Area Diagram  Shows the different distribution of group  For a few variables → Gender, Employed vs. Unemployed 9. Data Analysis  Analyzing all the collected data  UNDER COPAR: Community assembly → Talk about the problem  Always done together with the people 10. Identify Community Problems  Together w/ the people, you identify the problem Bar Graph Categories of Community Problems  Distribution of groups 1. HEALTH STATUS  For MANY variables → Occupation (Farmer, Worker, etc)  Has something to do with morbidity [disease] & mortality [deaths] o Ex. Increased hypertension cases 2. HEALTH RESOURCES  Manpower, Money & Material o Ex. No BP apparatus 3. HEALTH-RELATED  Socioeconomic, Cultural, Environmental, Political o Ex. A lot of people are poor that 4 Categories of the Problem 1. Wellness State: Health 2. Health Deficit: (+) Deficit; (+) Disability Line Graph - All about health alteration, abnormality, disability,  Distribution over time deformity, deficiency, residual of a condition  Shows the time trends (Stock market) o E.g. stroke patient having speech difficulty  Employed and unemployed during the decade 3. Health Threat  Inflation rate over years - any condition or situation will be conducive to health alteration 4. Foreseeable Crisis/Stress Points - Any life events - E.g. pregnancies, puberty, retirement 11. Prioritization of Community Problems Jhameel - Page 2 of 3  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Jhameel - Page 3 of 3  CHNN312 LECTURE BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Bachelor of Science in Nursing 3-YA Professor: Prof. Raymart Denaga 9 PLANNING COMMUNITY HEALTH INTERVENTIONS - Ex. Therapeutic regimen Management, Ineffective Discussed by: Mr. Raymart Denaga - Ex. Therapeutic Regimen Management, Effective 4 Criteria for Prioritization (Source. NANDA Diagnoses, 2003 -2004 version) 1. Nature of the Problem - Health resources / health related B. Shuster and Goepinnger proposed format 2. Modifiability of the problem  In 2004, Shuster and Goeppinger proposed format of nursing - Resolving the problem using available resources diagnoses for population group. 3. Preventive Potential  Three-part statement consists of: - Chances of recurrence - Health risk or specific problem  “ano ang problema” 4. Salience / Social concern - Specific aggregates or community  “sino ang affected” - “subjective” - Related factors - Consulting/asking the people about their perception o influence how the community will respond to the health risk or problem Community Health Problems  E.g. Proposed format  conditions or situations that intervene with the community's - Risk for Infection leading to mortality (health risk) among capability to achieve wellness pregnant women in Sitio X (specific aggregates) related to  These are Health Status, Resources, Health-Related unavailability of skilled birth worker and community Problems perception (related factors) that skilled birth worker is not  Diagnosis Continuation necessary during childbirth. Health Status C. Omaha System  Morbidity, mortality, diseases / disease complication  Taxonomical (w/ levels from top to bottom)  Problem Classification Scheme consists of four levels of abstraction. Four domains appear at the first or most general Health Resources level.  3M (manpower, money, materials)  These are Environmental Domain, Psychosocial Domain, Physiological Domain, Health-related Behaviors Domain Health-Related Problems  Forty-two client problems or areas of concern are at the  Factors second level; by definition, problems are neutral, not negative.  Socio-economic  The third level consists of two sets of problem modifiers: - Poverty-rate health promotion, potential, and actual as well as individual, - Unemployment rate family, and community.  Socio-cultural - L1: identify w/c domain - Health practices - L2: 42 client problems = 4 domains  Environmental - L3: Modifiers = potential and actual (1); IFC (2) - Sanitation, garbage disposal - L4: s/s identified  Clusters of signs and symptoms that describe actual problems Schemes in stating community Diagnosis (Famorca, 2013) are at the fourth or most specific level.  What is a Problem Classification Scheme?  Using the Problem Classification Scheme with the Intervention - provides structure, terms, & system of cues & clues for a Scheme and Problem Rating Scale for Outcomes creates a standardized assessment of individuals, families, & comprehensive problem-solving model for practice, education, communities (Omaha System) and research. - It helps practitioners collect, sort, document, classify, analyze, retrieve, and communicate health- related needs 1. Environmental Domain and strengths.  Material resources and.physical surroundings both inside and outside the living area, neighborhood, and broader community. A. NANDA - Income  Now known as NANDA, International - Sanitation  NANDA International (NANDA-I) NANDA- International earlier - Residence known as the North American Nursing Diagnosis - Neighborhood/workplace safety Association (NANDA) is the principal organization for defining, distribution and integration of standardized nursing 2. Psychosocial Domain diagnoses worldwide  Patterns of behavior, emotion, communication, relationships,  Recent versions included nursing diagnostic labels for and development. community labels - Communication with community resources - Ex. Coping: Community, Ineffective - Social contact - Ex. Coping: community, Readiness for Enhanced Jhameel - Page 1 of 4  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 - Role change Planning - Grief  Planning is a process which involves steps that would be taken - Abuse in the future to attain desired end. It is performed to source out - Interpersonal relationship and allocate resources. - Spirituality  Planning Phase - involves priority setting, formulating goals - Mental health and objectives, and deciding on community interventions - Neglect (Famorca 2013). - Caretaking/parenting - Growth and development 1. Priority Setting - Sexuality  WHO SPECIAL CONSIDERATION (FAMORCA, 2013)  Significance of the Problem 3. Physiological Domain - based on the number of people in the community affected  Functions and processes that maintain life.  Level of Community Awareness - Hearing - members health concern - Vision  Ability to Reduce Risk - Speech and language - related to the availability of Expertise - Oral health  Cost of Reducing Risk - Cognition - PHN considers economic, social & ethical requisites & - Pain consequences of planned action. - Consciousness  Ability to identify the target population - Skin - intervention is a matter of availability of data resources - Respiration  Availability of Resources - Neuro-musculo-skeletal function - intervene in the reduction of risk, financial &other material - Circulation resources of the community, nurse & health agency - Digestion-hydration - Bowel function A. The concept of planning are as follows: - Urinary function  Futuristic - Reproductive function  change-oriented - Pregnancy  continuous - Postpartum - Communicable/infectious cond.  dynamic process  flexible  systemic process 4. Health-related Behaviors Domain  Patterns of activity that maintain or promote wellness, promote IMPORTANCE OF PLANNING IN COMMUNITY HEALTH recovery, and decrease the risk of disease. PRACTICE (GESMUNDO, 2010) - Nutrition 1. Basis of decision-making instead of guts-feeling, vested - Physical activity interest or political considerations - Substance use 2. Allows utilization of available community resources - Given - Health care supervision multiple needs of people and scarce community resources - Sleep & rest pattern 3. Assist in the determination of common goals, objectives and - Personal care strategies. - Family planning 4. Positive change & growth is feasible with planning - Medication regime PARTICIPATORY PLANNING FOR COMMUNITY Health  Primary Health Care Approach. - Emphasizes the need to "work with people" as equal partners towards the goals of increased individual & community control, political efficacy, improved quality of community life & social justice. Category Of Planning Based On Source Of Plan Comprehensive Plan  includes public and private sector alike Partial Plan  includes either a public or a private entity only Category Of Planning Based On Time Span Of The Plan Long Term Plan  which covers a minimum period of 8 years (>8 years) Jhameel - Page 2 of 4  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024  Such as National Health Plan or National Development Plan. - Include list of manpower. Material and financial resources  An example is the Australia 10-year Primary Health Care Plan that are needed 6. Assessing Effects of the Program Short - Term Plan - Develop an evaluation scheme  consist of one or two- year plan such as a yearly budgetary Elements of program Planning health plan  Name which identifies with a health policy objective, or disease condition it is addressing Category Of Planning Based On Authoritativeness  Brief Statement / report of priority disease/ condition it Compulsary proposes to improve or program status Indicative Planning  Objectives  when it is used only as a guide but not binding  Disease condition target that specifies quantified changes from existing level of recurrence Prescriptive Planning  Activity / Service Targets which show percentage coverage a  when it is accepted and implemented as approved by the given eligible population organization.  Approach which designates the course of actions to followed, such as manner of implementation, program tactios, field unit Types of Plan responsible for the delivery of services and principal Strategic Plan constraints that need to be overcome  This is a long - term plan that extends about 3 to 5 years. This  Linkages is usually accomplished by managers of an organization after  Program Budget a review their SWOT analysis (Strength, Weakness,  Need for technical cooperation from external agencies Opportunities, Threats, mission, mission and goals)  Evaluation Indicators Operational Plan  A short range plan that is usually less than 3 years. It usually deals with the routine activities of an organizations. Ex. A system of recording ITR in the FHSIS Program Planning  Program deals with the design of a strategy, for the achievement of given health policy, objective It is a type of plan that is concerned with courses of actions for the resolution o improvement of a specific health problems  Program is also synonyms to a "very Big Project." In the composite of one big project (Gesmundo, 2010). Program Planning 1. Situational Analysis TYPES OF PROGRAM  Answers question, "where are we now?" Involves process of  Program for Direction, Coordination and Management collecting, synthesizing, analyzing and interpreting information - This refers to program to formulate policies, programs and in a manner that provides a clear picture of the health status of projects to direct. the community. - Coordinate and control activities and to provide  It brings out the health problem of the community. informational and administrative support i.e., personnel, finance and logistics, legal service. 2. Formulating goals And Objectives  Program For Health System Infrastructure  Goal is the desired outcome at the end of intervention whereas - Comprises of program for planning and development of a objectives are short – term changes in the community basic health facility network, health manpower, policies and training, health education and public information  These two are more likely if mutually agreed upon &  Technology Program Program community must participated in process. - providing functional support like infrastructure development, human resources development, health 3. Implementing Community Health interventions information, accounting and budgeting  Entire process is directed to enhanced community's capabilities in dealing with health problems. PHN role is to Steps in Program Planning facilitate process & not directly implement planned intervention 1. Organizing a planning group  Requires common understanding of set goal & objective - Five to 10 people but not more than 12 with specific task  Entails coordination of intervention with community & health 2. Formulating goals teams as well with other sectors 3. Identification of Strategies 4. Determining Activities 4. Structure Evaluation 5. Estimating Resources  INVOLVES LOOKING INTO THE MANPOWER Jhameel - Page 3 of 4  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 - and physical resources of the agency responsible for  Outcome community health interventions. - Measures the long-term effects of the program &  Process Evaluation determines if it meets the goal of the program. - EXAMINING THE MANNER BY WHICH assessment, diagnosis, planning, implementation and evaluation wer undertaken  Outcome Evaluation - Determining the degree of attainment of goals and objectives Ongoing Evaluation or Monitoring  Done during implementation to provide teedback on compliance to the plan as well as on need for changes in the plan  To improve process and outcome of evaluation STANDARDS OF EVALUATION The basis of good evaluation are:  UTILITY - Value of evaluation in terms of usefulness of results. - gives insights about strengths, weaknesses of plan and manner of its implementation. - Evaluation may result in policy change such as budgetary allocations - basis using same community health process for other community health concern. End- beneficiary of evaluation is community - Dissemination of evaluation results allows community to identify barriers & allow to think of strategies to overcome / mitigate in future build community experience, confidence in dealing with own community concern.  FEASIBILITY - Determine if plan for evaluation is doable or not - Resources include facilities, time, expertise for conducting evaluation - Data gathering during evaluation should bring minimal disruptions of everyday activity.  PROPRIETY - involves ethical, legal matters. respect for worth and dignity of participants in data collection should be given due consideration - Result should be truthfully reported to give credit where it is due & show strength, weakness. Strength for further growth; weakness for remedial action if possible. For financial matters, transparency, accountability should be observed  ACCURACY - validity and reliability of the results of evaluation - begins with accurate documentation while health process is ongoing. - Right evaluation tool yields high reliability, validity - Review of data gathered during evaluation accompanied by corrective measures when errors occurs Increases level of accuracy THREE ASPECTS OF A PROGRAM THAT EVALUATION LOOK INSPOORE: (MAGLAYA)  Process - measures the activities, effects of the program & quality and who it is reaching out.  Impact - Measures the immediate effect of the program & determines if objectives were met. Jhameel - Page 4 of 4  CHNN312 LECTURE BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 Bachelor of Science in Nursing 3-YA 10 & 11 Professor: Professor Raymart Denaga COMMUNITY ORGANIZING PARTICIPATORY ACTION - Main researcher: Nurse RESEARCH (COPAR) - Co-researchers: People of the community Dicussed by: Mr. Raymart Denaga Approaches in Community Organizing 4 Principles of COPAR Community Organizing 1. Do people have the capacity to change? - Strategy, methodology to strengthen a community - Should embrace and accept change - To transform or change a community to a better one - COPAR will not be successful if the people has no COPAR – one methodology of community organizing capacity to change 2. Do people possess the ability to bring change? 1. Social Welfare/Dole-out - Do the people have the ability? - The intermediate and/or spontaneous response to 3. Base interest on poorest sectors? ameliorate the manifestation of poverty, especially on the - INTEREST!! personal level 4. Lead to development of self-reliant community? - People believe that poverty if given by the Lord - Intentions are good but don’t teach people how to be COPAR Method and Process independent  A progressive cycle of action-reflection-action which with - E.g. Willie Revillame – willingly hand out money to the small, local and concrete issues identified by the people and poor the evaluation and the reflection of and on the action taken by - E.g. Punta si SK or Mayor na mamimigay ng pera them. 2. Modernization/Project Development - ARAS - Considered a national strategy which adopts the o Community will identify the problems western mode of technological development o Provide solution 3. Participatory Action Approach o Evaluate and reflect - The process of empowering/ transforming the poor - METACOGNITION: highest form of learning - COPAR itself o If the people was able to realize their needs, it is considered a highest form of learning Definition of COPAR  Consciousness raising through experiential learning  A social development approach that aims to transform the central to the COPAR process because it places emphasis on apathetic, individualistic and into dynamic, participatory and learning that emerges from concrete action. politically responsive community.  COPAR is participatory and mass-based.  A collective, participatory, transformative, liberative,  COPAR is group-centered and not leader-oriented. Leaders sustained and systematic process building people's are identified, emerge and are tested through action rather organizations by mobilizing and enhancing the capabilities and than appointed or selected by some external force or entity. resources of the people for the resolution of their issues (1994 - Dapat majority will agree National Rural Conference)  To develop a self-reliant community Objectives of COPAR - A community that can identify their own needs and Patterns to be followed: problems 1. Organize people - Has the confidence to resolve problems w/in the available 2. Mobilize people resources 3. Work with people  A process by which a community identifies its needs, and 4. Educate people objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and  It is done to educate the people and develop their critical collaborative attitudes and practices in the community (Ross awareness of their present condition 1967).  It helps the community to develop and enhances its resources  (COPAR) is a community development approach that allows to the fullest thus making the community self-reliant. the community (participatory) to systematically analyze the  To help people understand their own situations and develop situation (research), plan solution, and implement projects/ awareness (process of action reflection-action) programs (action) utilizing the process of community organizing. It is essentially a research project done by the Important Concepts community that leads to actions that improve conditions in the 1. Change = Development community (Famorca, 2013) 2. Poor - E.g. Gina Lopez 3. People-centered o Targets the poor sectors and launch a livelihood 4. Participative project to help that community 5. Democratic - Action research 6. Developmental o A methodology used in social science 7. Process-oriented Jhameel - Page 1 of 5  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 8. Self-reliance Criteria of Potential Site (SIPRANA)  Socio-economically depressed Critical Steps (Activities in COPAR)  Inaccessible health services *COPAR IS GOOD FOR 5 YEARS (RENEWABLE)  Poor community health status 1. Integration - Immersion  Relative peace and order situation 2. Social Investigation - collection of data  Acceptance of the program by the community - Primary  Not currently served by similar agencies/ organizations - Secondary  At least 100-200 families o Preliminary social investigation (PSI) - CHPP PHASE 2: ENTRY PHASE o Deepening Social Investigation  Social mobilization o Community Research  Entry: the 1st thing to do upon entering the community is to 3. Tentative Program Planning have a courtesy call with the Barangay - Community organizer or people will choose 1 issue in order to begin 4. Groundworking - solicit the participation - Going around and motivate the people 5. The Meeting - People will agree what they have decided - To give power and confidence to the people 6. Role Play - “Acting out the meeting that took place between the leader and people of the community” - Way of training the people to anticipate what will happen - Practice session / Dry Run 7. Mobilization or Action - action phase  Integration/ Immersion 8. Evaluation - Immersion is imbibing the life situation/ condition of the 9. Reflection community by living, eating & sleeping with the family to - ARAS be able to understand their situation 10. Organization - It requires 2 Qualities of PHN: - Community is already self-reliant o Empathy o Sympathy (Integration) Phases of COPAR (PEOSP) - Integration/Immersion/Sensitization of the community/ 1. Pre-entry/Preparatory - Designing a Plan Information Campaigns 2. Entry/Integration/Immersion - Actual entry o Establish rapport and assess the needs of the - Social preparation phase community - Foundation of COPAS - Deepening Social Investigation 3. Organizing and Capacity Building/Activity - formal structure o Verification and enrichment of data, results - Launching the program (pinakamabigat na part ng relayed thru community assembly. COPAR) - Actual implementation Guidelines in Integration: 4. Sustenance and Stregthening/Maintenace  Recognize local authorities - Courtesy Call 5. Phase Out  Adapt the lifestyle of the community - EXIT  Choose a modest dwelling  Avoid expectation from the people  Be clear with your objectives & limitation PHASE 1: PREPARATORY PHASE  Participate in the production process 1. Area of Selection  Participate in social activities - It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new criteria for community  Social Investigations: organization Profiling/Community survey - "Old Criteria" → it must be a virgin community=meaning a. Subjective - Interview or Participatory Observation no agency has gone there. b. Objective - Community Survey Tool - This is a dangerous situation that's why RA 7305: Magna Carta for Public Workers was provided-  Community Diagnosis/Research/Analysis o a PHN is to receive a hazard pay of 20-25% of - Makes use of the Nursing Process/Problem Solving monthly salary Approach 2. Community Profiling - Prioritized which among the problems identified is to be - provides overview of: demographics, community health- attended related services & facilities o Bar - for comparison 3. Preliminary Social Investigation o Pie - Percentage distribution - Secondary data o Line – Trend 4. Collect data through secondary sources o Scatter - correlate variables Jhameel - Page 2 of 5  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024 given training to develop their style in managing their own concerns and programs PHASE 4: SUSTENANCE AND STRENGTHENING/MAINTENANCE  Evaluation/ Reassessment - Criteria: Effectivity, Efficiency, Appropriateness, Adequacy  Indicators of Health Status/Condition: - ARAS - Fertility: 1 CBR=community is overpopulated=HS  3 Types of Evaluation - Morbidity: IR (new cases) & PR (old cases)=HS - Process - Mortality: Deaths like children dying of pneumonia-HS o evaluate how the program was implemented  Health Resource(s): - Impact - 5 M's-Manpower/Man, money, machinery, material & o how the program affects the people in the methods (+) available facilities-Hospital/ Clinic, mode of community transportation, market, school & movie houses for recreation - Outcome  Health Related o evaluate if the lives of the community members - Categories according to 5 Aspects of Man=PEMSS improved o Physical, Physiological, Psychological  Linkaging / Establishing partnership: o E motional - Networking o M ental - Coordination o S ocial - Cooperation o S piritual - Collaboration - Coalition  Community Assembly: - Attend the assembly of the family/families PHASE 5: PHASE OUT - Families in the community should be represented, any  Community gradually shoulder greater responsibility in family members can represent his/her family as long as managing health care needs. he/ she is a RESPONSIBLE (one who also can  Nurse gradually prepares the turnover of work, develop plan of comprehend) member of that family. monitoring, follow-up of activity until full disengagement and - Barangay Captain/Chairman need not necessary be the phase-out leader. He can recommend.  Documentation - Start of Core Group Formation - identify potential leaders  Follow-up/Expansion (Must be done once a year). PHASE 3: ORGANIZING-BUILDING PHASE ENVIROMENTAL SANITATION  PROJECT MANAGEMENT Discussed by: Mr. Raymart Denaga  Criteria for Selection of Potential Leaders: Environmental Sanitation A. Belong to the poor sectors and classes and is directly  refers to all factors available in environment affecting the engaged in production health of the individual or population B. Well respected by members of the community and has  regulated by PD 856: Comprehensive Sanitation Code of the relatively wide influence Philippines C. Desirous of change and is willing to work for change  E.0 489: establishment of Inter-agency Committee on o Most IMPORTANT Environmental Health. D. Must be able to communicate effectively  Chairperson: Secretary of DOH  Key Activities: Sanitation related doses: A. Core group formation – SALT (ENTRY PHASE) 1. Diarrhea o Self-Awareness and Leadership Training 2. Intestinal parasitism Program) 3. Schistosomiasis o Min of 5 – 10 (max) - Snail Fever B. Formation of Organization/ Committee – - Rampant in agricultural areas o Community Health Org (highest) 4. Malaria C. Planning/Designing Phase (SMART). 5. infectious hepatitis o 5 Areas of Community Life (HELPS) 6. Filariasis  Health 7. DHF  Education 8. TB  Livelihood 9. Pneumonia  Physical Environment  Socio-spiritual ENVIRONMENTAL HEALTH SERVICE (EHS) OF DOH D. Mobilization/Implementation/Action IS RESPONSIBLE FOR: o Training potential leaders - It is at this phase  Promotion of healthy environmental conditions & prevention of where the organized leaders or groups are being environmental related diseases through appropriate sanitation strategies Jhameel - Page 3 of 5  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024  Promotion & implementation of sanitation programs through o A system composed of a source, a reservoir, a the Department of Health Field Health Units piped distribution network and communal  Conceptualization of new programs/projects to contend with faucets, located at not more than 25 meters from emerging environmentally related health problems the farthest house in rural areas where houses are clustered densely. Components 3. Level III - Waterworks system or individual house  Water Supply Sanitation Program connections  Proper Excreta and Sewage Disposal o A system with a source, a reservoir, a piped  Program distributor network and household taps that is  Insect and Rodent Control suited for densely populated urban areas.  Food and Sanitation Program o E.g. NAWASA  Hospital Waste Management Program B. TOILET FACILITIES A. Water Supply Sanitation Program 1. LEVEL 1 - Non-water carriage toilet facility:  POTABLE – “naiinom” o Pit latrines  free from any particles that might cause illness to an individual o Reed Odorless Earth Closet  WAYS TO MAKE WATER POTABLE: o Bored-hole - Boiling: o Compost o minimum of 3 minutes to maximum of 10 minutes - Toilets requiring small amount of water to wash waste for drinking into receiving space - Sterilization: o Pour flush o 30 minutes after the water starts to boil o Aqua privies - Filtration:  Pit latrines o makes use of filter paper or cotton cloth to - most commonly observed in rural area separate solid particle from liquid if water comes - has three components: the pit, a squatting from river plate and the super-structure - Coagulation/flocculation: - types of pit include o Uses aluminum crystal (tawas) that collects or - "Antipolo type", a pit type of toilet provided absorbs particles from liquid part & becomes with concrete floor and an elevated seat with slimy a cover o In 1 gallon of water, drop tawas (the size of magi - Ventilated Improved Pit or VIP, pit with a cubes) & allow to stand for 6-8 hours vent pipe o initially, water appears to be cloudy then after 6- - Reed Odourless Earth Closet or ROEC, a 8 hours of standing, the water becomes clear pit completely displaced from the - Chlorination: superstructure and connected to the squatting plate by a curved chute. o Uses 100% concentrated chlorine b from botika  Bored Hole Latrine or given free by health centers - consists of relatively deep holes bored into the o To prepare stock solution (ss): in 1 liter drinking earth by mechanical or manual earth-boring water, add 1 tablespoon of concentrated chlorine equipment which is potent for 3-4 months - holes are about 10-18 inches in diameter and o To prepare the chlorinated water: in 2 ½ gallons usually 15-35 feet deep. The hole is provided of drinking water (10,000 ml=10 liters), add 1 to facilitate squatting. Two types of bored-hole tablespoon from the prepared stock solution & let latrines are: it stand for 30 minutes to react with water o Wet Type - when the hole - Fluoridation: penetrates ground water table or o adding fluoride to prevent dental caries (primary other strata. significance) & whitens enamel of teeth ( 2nd o Dry Type - when he hole does not significance) reach ground water table; fills up at a - Aeration: faster rate then than the wet type. o exposing drinking water in air to strengthen taste 2. LEVEL 2 within 24 hours which is usually used in uphill - On site toilet facilities of the water carriage type with water areas where there's less or no pollution sealed and flushed type with septic vault/tank disposal  3 TYPES OF APPROVED WATER SUPPLY AND facilities. FACILITIES 1. Level I - Point Source 3. LEVEL 3 o A protected well or a developed spring with an - Water carriage types of toilet facilities connected to septic outlet but without a distribution system for rural tanks an/ or to sewerage system to treatment plant. areas where houses are thinly scattered. o Rural Houses thinly scattered (15-25 Families) THINGS TO CONSIDER IN CONSTRUCTING A o Protected Well - deep/shallow well, improved TOILET FACILITY: dug well  At least 25 meters away from water sources at a lower 2. Level Il - Communal faucet system or stand posts elevation Jhameel - Page 4 of 5  CHNN 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER MIDTERMS 2024  It should be within your financial capability Community  It should be approved by the local health authorities - Sanitary landfill or controlled tipping o Excavation of soil deposition of refuse and CARE AND MAINTENANCE OF YOUR TOILET FACILITY: compacting with a solid cover of 2 feet  Water must be provided at all times. - Incineration  Use toilet paper o Ecological Solid Waste Management: RA  Use lysol once a month for odor removal 9003- the use of incinerator approved in 2000 but  Clean the bowl by muriatic acid to remove the stains. was implemented in 2003 because of lack of  Avoid depositing solid objects on the bowl to prevent funding to purchase clogging  Always check your toilet if it's clean D. FOOD SANITATION PROGRAM  Use plunger when clogging occurs. Don't use sticks or rods  POLICIES: to avoid the breakage of the trap or the bowl. - Food establishment are subject to inspection (approved of all food sources containers and transport vehicles) C. PROPER SOLID WASTE MANAGEMENT - Comply with sanitary permit requirement  refers to satisfactory methods of storage, collection and final - Comply with updated health certificates for food handlers, disposal of solid wastes helpers, cooks  SOURCES OF SOLID WASTE - All ambulant vendors must submit a health determine - Household Waste present of intestinal parasite certificate to and bacterial o these are wastes generated in or discharged infection from household including shops but excluding commercial activities  3 POINTS OF COTAMINATION: - Commercial Waste - Place of production processing and source of supply o restaurants, stationery shops, grocery shops or - Transportation and storage any commercial activity are the main sources of - Retail and distribution points commercial waste - Market Waste FOUR RIGHTS TO FOOD SAFETY o only refers to waste generated in or discharged 1. RIGHT SOURCE from markets both for whole sale and retailing - FRESH - Institutional Waste 2. RIGHT PREPARATION o these are wastes generated in government, state - Raw food & cooked foods enterprise and private firm office - Wash hands/vegetable / pasteurized - Street Sweeping Waste 3. RIGHT COOKING o these are wastes generated by the street - 70 DEGREE C sweeping cleansing service 4. RIGHT STORAGE - River Waste - Room temperature - not more than 2 hrs - Hot environment - above 60 deg. C. o includes all the wastes generated by the river - Cold - below or equal to 10 deg. C. and creek cleansing Rule in food safety: - Medical Waste - "when in doubt, throw it out" o these are wastes generated in hospitals. E. HOSPITAL WASTE MANAGEMENT  SANITARY WAYS OF TREATING GARBAGE: - Segregation  RA 4226-Hospital Licensure Act o separating biodegradable from non- - monitors the hospital license & proper management of biodegradable wastes as well as renewal of license to operate - Collection  GOAL: o adherence to the proper collection time the City - To prevent the risk of contraction contracting nosocomial of Manila coordinates with Leonel Waste infection from type disposal of infectious, pathological and Management (a private firm which collects other wastes from hospital garbage) where the truck driver coordinates with the Barangay Chairman on the time they will  COLOR CODING OF BIN TO KEEP WASTE collect garbage so don't bring out garbage before - Green: wet waste the collection time - Black: dry waste - Yellow: infectious/ pathological waste like blood, sputum,  WAYS OF DISPOSAL urine, feces & gauze Household - Orange: toxic/hazardous waste - Burial o Deposited in 1m x 1m deep pits covered with soil, located 25 m. away from water supply - Open burning - Animal feeding - Composting - Grinding and disposal sewer Jhameel - Page 5 of 5