NCM 113 Prefinals PDF

NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing COMMUNITY ASSESSMENT Assessment provides an estimate of the degree to which a family, group, or community...

NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing COMMUNITY ASSESSMENT Assessment provides an estimate of the degree to which a family, group, or community Considered to be the key stone of community is achieving the health possible for them, health nursing process (Freeman and Heinrich identifies specific deficiencies or guidance 1981; Muecke 1989) needed and estimates the possible effects of The nurse utilizes this assessment data to the nursing interventions derived to the community health nursing Three Important tools in identifying the diagnoses and become the bases for community’s health needs: developing and implementing community health nursing interventions and strategies ✓ Demography ✓ Vital statistics and This is the first part of community diagnostic ✓ Epidemiology process To recognize the health status of the community ASSESSMENT OF COMMUNITY HEALTH NEEDS these elements are to be considered: A community needs assessment provides community leaders with a snapshot of local policy, systems, and environmental change strategies currently in place and helps to identify areas for improvement. With this data, communities can map out a course for health improvement by creating strategies to make positive and sustainable changes in their communities. PRIMARY DATA COMPONENTS OF A NEEDS ASSESSMENT Directly obtained to answer the community Health status is an individual's relative level diagnosis objectives of wellness and illness, taking into account the Collecting Primary Data - may be obtained presence of biological or physiological either through observation or through direct dysfunction, symptoms, and functional communication with respondents in one form impairment. or another through personal interviews. Health resources include financial resources Primary data can be obtained in several ways. (health spending) and human resources. However, the most common techniques are Health spending measures the consumption observation, survey, and informant interview of health services and goods, including and community forum. Primary data outpatient care, hospital care, long-term care, collection is quite expensive and time pharmaceuticals and other medical goods, consuming compared to secondary data prevention and public health services, and collection. administration. A. Observation COMMUNITY HEALTH ASSESSMENT TOOLS This method provides an opportunity to check Tools in measuring and analyzing community the validity or truth of many verbal statements. health problems such as epidemiology and It is an important and useful method of biostatistics Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing collecting data when informants are unable to important issues affecting them, such as direct supply information. health problems in their neighborhood. In observation method, the information is This community discussion's primary purpose sought by way of investigator's own direct is to obtain input from a wide range of residents observation without asking the respondent. and stakeholders concerning their needs and identifying resources for addressing health B. Survey problems. A survey is defined as the act of examining a Focus Group Discussion process or questioning a selected sample of ✓ It is a very popular method appropriate individuals to obtain data about a service, in the community to elicit and explore product, or process. Data collection surveys the opinions of people, determine collect information from a targeted group of their attitudes and practices regarding people about their opinions, behavior, or a limited set of concepts knowledge. SECONDARY DATA SOURCES Ocular survey or windshield survey walking or driving through community appreciating what Data that are obtained by other people which can be seen and perceived as the people go can be used to answer the community along with their daily lives. diagnosis objectives. C. Informant Interview Data may be obtained by reviewing those that have been compiled by health or non-health It involves asking and answering questions agencies the government or other sources following a systematic procedure aimed at yielding first-hand information from the subject Secondary data means data that are already of inquiry. available i.e., they refer to the data which have In the personal interviews, the interviewer asks already been collected and analyzed by questions generally in a face-to-face contact. someone else. Through interview method more and reliable information may be obtained. Personal Records are written information that are kept information can be obtained easily under this in folders. method. However, it is a very expensive and ✓ Registry of Vital Events time-consuming method, especially when ✓ Health Records and Report large and widely spread geographical samples ✓ Disease Registries are taken. ✓ Census Data Interviews may be conducted through: A. Registry of Vital Events ✓ Face-to-face interview telephone A well-functioning civil registration and interview vital statistics (CRVS) system registers all ✓ Individual interview group births and deaths, issues birth and death ✓ Interview Structured certificates, and compiles and ✓ Interview Unstructured interview disseminates vital statistics, including D. Community Forum cause of death information. B. Health Records and Report A community forum is an open discussion A comprehensive compilation of where community residents gather to raise information traditionally placed in the medical record but also covering aspects Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing of the client’s physical, mental, and social To solicit broader support and participation in health that do not necessarily relate the community health process directly to the condition under treatment. C. Disease Registries To validate findings. A disease registry is a special database To allow a wider perspective in the analysis of that contains information about people data diagnosed with a specific type of disease. Most disease registries are either hospital- To provide a basis for better decision making based or population-based. A hospital- Data may be presented as text, in tables or in based registry contains data on all the pictorial form such as maps and graphs. patients with a specific type of disease diagnosed and treated at that hospital. A Maps - can be used to show differences or population-based registry contains similarities across geographic areas records for people diagnosed with a specific disease type who reside within a Bar Graph defined geographic region. For example, a Bar charts are one of the most commonly hospital can have a breast cancer registry used types of graph and are used to with records for all the women in their display and compare the number, breast cancer treatment program. The frequency or other measure (e.g. mean) for hospital-based registry would not include different discrete categories or groups. all the women with breast cancer in the Constructed such that the heights or community, since some women may go lengths of the different bars are elsewhere for treatment. proportional to the size of the category D. Census Data they represent. Information about the members of a given Since the X-axis (the horizontal axis) population collected from a government represents the different categories, it has census. no scale. The Y-axis (the vertical axis) does A census is a regularly occurring and have a scale, and this indicates the units of official count of a particular population. measurement. The bars can be drawn Census data provides more than just a either vertically or horizontally depending population count. Other variables include upon the categories and length or ethnicity breakdowns, income, and complexity of the category labels. housing values. A very flexible chart type Histogram METHODS TO PRESENT COMMUNITY DATA A special form of bar chart where the data represent continuous rather than discrete To inform the health team and members of the categories. community of existing health and health- For example, a histogram could be used to related conditions in the community in an present details of the average number of easily understandable manner. hours of exercise carried out by people of To make members of the community different ages because age is a continuous appreciate the significance and relevance of rather than a discrete category. However, health information to their lives because a continuous category may have many possible values the data are often Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing grouped to reduce the number of data detail or depth she should go into. A nurse may points. For example, instead of drawing a decide to assess a specific population group bar for each individual age between 0 and in a community, in which case, she may not 65, the data could be grouped into a series opt to conduct a comprehensive assessment of continuous age ranges such as 16-24, of that group and at the same time, focus on 25-34, 35-44, etc. the specific problems of that same group. It is Unlike a bar chart, in a histogram, both the important therefore, to decide on the x and y axes have a scale. This means that objectives of the community diagnosis, the it is the bar area that is proportional to the resources and time available to implement. size of the category represented and not TYPES OF COMMUNITY DIAGNOSIS just its height Pie Charts 1. Traditional/ Comprehensive Community A visual way of displaying how the total Diagnosis data are distributed between different A comprehensive community diagnosis categories. aims to obtain general information about Pie charts should only be used for the community. displaying nominal data (i.e. data that are 2. Participatory Action classed into different categories). They are Intentionally include the people and generally best for showing information groups who are most affected by an inquiry grouped into a small number of categories in the design and execution of the process. and are a graphical way of displaying data 3. Research (PAR) that might otherwise be presented as a Researchers and participants working simple table. together to understand a problematic Line Graph situation and change it for the better. Are usually used to show time series data, Participatory Action Research (PAR) is an that is how one or more variables vary over approach to enquiry which has been used a continuous period of time. Typical since the 1940s. It involves researchers examples of the types of data that can be and participants working together to presented using line graphs are monthly understand a problematic situation and rainfall and annual unemployment rates. change it for the better. There are many Scatter plots definitions of the approach, which share Are used to show the relationship between some common elements. PAR focuses on pairs of quantitative measurements made social change that promotes democracy for the same object or individual and challenges inequality; is context- For example, a scatter plot could be used specific, often targeted on the needs of a to present information about the particular group; is an iterative cycle of examination and coursework marks for research, action and reflection; and often each of the students in a class. In the seeks to ‘liberate’ participants to have a example here, the paired measurements greater awareness of their situation in are the age and height of children order to take action. PAR uses a range of different methods, COMMUNITY DIAGNOSIS both qualitative and quantitative. In the assessment of the community’s health Its fundamental principles are that the status, the nurse considers the degree of research subjects become involved as Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing partners in the process of the inquiry and It is also important to know whether there that their knowledge and capabilities are are population groups that need special respected and valued. Participatory attention such as indigenous people, research is ultimately about relationships internal refugees, and other socially and power. The key contacts are between dislocated groups as a result of disasters, the researcher and the researched, and calamities, and development programs. between local people and those actors 2. Socio-Economic and Cultural Variables they see as powerful and who affect their There are no limits as to the list of socio- lives. Participatory researchers act as economic and cultural factors that may facilitators and work towards attaining directly or indirectly affect the equality in these two relationships. Local community's health status. people involved in participatory research However, the nurse should consider the processes are often subordinate in their following essential information: own social context, while outside ✓ Social Indicators researchers are often perceived as experts ✓ Economic Indicators who impose their views. Transforming ✓ Environmental Indicators these dynamics is achieved by enabling ✓ Cultural Factors local people to articulate their views and 3. Political/ Leadership Patterns express their knowledge by describing and The process of community diagnosis consists analyzing their own situations and of collecting, organizing, synthesizing, problems. Many participatory research analyzing and interpreting health data. processes also have an action component Before the community health nurse collects that involves the participants in data, the objectives must be determined as successive cycles of analysis, reflection these will dictate the depth or the scope of the and action. community diagnosis. The nurse needs to resolve whether a comprehensive or a problem-oriented The following are the elements of a comprehensive community diagnosis will accomplish their community diagnosis: objectives 1. Demographic variables STEPS IN CONDUCTING COMMUNITY DIAGNOSIS The analysis of the community’s demographic characteristics should show 1. Determining the Objectives the size, composition and geographical In determining the objectives of the distribution of the population as indicated community diagnosis, the nurse by the following: decides on the depth and scope of the (1) Total population and geographical data she needs to gather. distribution including urban-rural 2. Defining the Study Population index and population density. Based on the objectives of the (2) Age and sex composition community diagnosis, the nurse (3) Selected vital indicators such as identifies the population group to be growth rate, crude birth rate, crude included in the study. death rate and life expectant at birth 3. Determining the Data to be Collected (4) Patterns of migration Whether the community diagnosis is (5) Population projections going to be comprehensive or focused Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing on specific problem, the objectives Data analysis in community diagnosis will guide the nurse in identifying the aims to established trends and specific data she will collect. patterns in terms of health needs and 4. Collecting the Data problems of the community. It also In conducting community diagnosis, allows for comparison of obtained different methods may be utilized to data with standard values. generate health data. In general, we 10. Identifying The Community Health Nursing use the methods such as records Problems review, surveys and observations, Community health nursing problems are interviews, and participant categorized as: observation. I. Health Status Problems 5. Developing the Instrument May be described in terms of Instruments or tools facilitate the increased or decreased morbidity, nurse’s data gathering activities. The mortality or fertility most common instruments are survey II. Health Resources Problem questionnaire, interview guide and They may be described in terms of lack observation checklist. of or absence of manpower, money, 6. Actual Data Gathering materials or institutions necessary to Before the actual data gathering, it is solve health problems suggested that the nurse meet the III. Health-Related Problems people who will involve in the data They may be described in terms of the collection. The data collectors must existence of social, economic, be given an orientation and training on environmental and political factors how they are going to use the that aggravate the illness-inducing instruments in data gathering. During situations in the community the actual data gathering, the nurse 11. Priority Setting supervises the data collectors by After the problems have been checking the filled-up instruments in identified, the next task is to prioritize terms of completeness, accuracy and which health problems can be reliability of the information collected. attended to considering the resources 7. Data Collation available at the moment. After data collection, the nurse is now In priority setting, the following ready to put together all information. criteria: There are two types of data that may be a. Nature of the condition/problem generated. They are either numerical presented data which can be counted or ✓ Problems are classified by the descriptive data which can be nurse as health status, health described. resources or health-related 8. Data Presentation problems. Data presentation will depend largely b. Magnitude of the problem on the type of data obtained. ✓ Refers to the severity of the Descriptive data are presented in problem which can be measured in narrative reports. terms of the proportion of the 9. Data analysis Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing population affected by the SCHEMES IN STATING COMMUNITY DIAGNOSIS problem. Diagnosis c. Modifiability of the problem After analyzing the data, the next step is to ✓ Refers to the probability of make a definitive statement (diagnosis) reducing, controlling or eradicating identifying what the problem is or the the problem. needs are. Nursing diagnoses for d. Preventive potential communities may be formulated regarding ✓ Refers to the probability of the following issues: controlling or reducing the effects 1. Inaccessible and unavailable services posed by the problem. 2. Mortality and morbidity rates e. Social concern 3. Communicable disease rates ✓ Refers to the perception of the 4. Specific populations at risk for physical population or the community as or emotional problems they are affected by the problem 5. Health-promotion needs for specific and their readiness to act on the populations problem. 6. Community dysfunction 7. Environmental hazards (ANA, 1986) The format of the problem statement varies, depending on the philosophy of the agency conducting the assessment. For example, problems or needs may be stated simply in epidemiological terms, such as a high rate of adolescent pregnancies, whereas in other instances you may be asked to state the problem or need as a nursing diagnostic statement Nursing diagnosis has evolved since 1973 because of the efforts of the North American Nursing Diagnosis Association (NANDA) (NANDA, 2009). The initial North American Nursing Diagnosis Association (NANDA) classification system of nursing diagnoses focused on the physical needs of individual clients but was not applicable to the family and community situations faced by community health nurses. Over the years, the NANDA classification system has expanded to include individuals and families' biological, psychological, and social needs. Because of ongoing refinement, the taxonomy of nursing diagnoses at present has 11 functional health patterns. Tools have been developed to assess the community Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing using the functional health pattern ✓ Respiration typology (Gikow & Kucharski, 1987; Wright, ✓ Vision 1985). Newer NANDA diagnoses may also ✓ Circulation apply to communities; examples include ✓ Speech and language the diagnosis of impaired home ✓ Oral health maintenance and impaired social ✓ Skin interaction. ✓ Pain North American Nursing Diagnosis ✓ Postpartum Association (NANDA) classification system of ✓ Neuromusculoskeletal function nursing diagnoses focused on the physical ✓ Digestion/hydration needs of individual clients but was not ✓ Bowel function applicable to the family and community ✓ Urinary function situations faced by community health nurses. ✓ Cognition ✓ Consciousness Omaha system ✓ Reproductive function Initially designed for clients in a ✓ Communicable/infectious condition community setting, it has been used (2) Health-related behaviors domain: as a framework for the case of Patterns of activity that maintain or individuals, families, and promote wellness, promote recovery, communities by nurses, nursing and decrease the risk of disease. educators, physicians, and other ✓ Nutrition health care providers. ✓ Sleep and rest patterns The system was designed by the ✓ Physical activity Personal care Omaha Visiting Nurse Association and ✓ Substance use has been used in home care, public ✓ Family planning health, and school health practice ✓ Health care supervision settings, among others. ✓ Medication regimen Client problems/needs/concerns are (3) Environmental Domain: organized into: Material resources and physical Four domains: surroundings both inside and outside ✓ Physiological the living area ✓ Psychosocial ✓ Neighborhood, and the broader ✓ Health-related behavior community. ✓ Environmental ✓ Income Each domain may involve actual or ✓ Residence potential problems or opportunities ✓ Sanitation for health promotion ✓ Neighborhood/workplace safety The Ohama System: Domains And (4) Psychosocial domain: Problems of The Problem ✓ Patterns of behavior Classification Scheme: ✓ Emotion (1) Physiological domain: ✓ Relationships, and development Functions and processes that maintain ✓ Mental health life. ✓ Communication with community ✓ Hearing resources Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing ✓ Caretaking/parenting and symptoms that are characteristic of the ✓ Social contact problem (Carpenito, 2000). ✓ Neglect A description of the problem, response, or ✓ Abuse state (risk, concern, issue, potential or actual) ✓ Growth and development ✓ Role change A statement of the aggregate, population, ✓ Interpersonal relationship community, or focus (boundaries). This differs ✓ Spirituality from the nursing diagnosis; the focus is added, ✓ Grief The system includes four categories of an identification of factors etiologically interventions: related to the problem(factors), and ✓ Teaching Those signs and symptoms (manifestations) ✓ Guidance, and counseling that are characteristic of the problem. ✓ Treatments and procedures ✓ Case management; and surveillance Sample of Community Diagnosis: Although originally developed for application Risk of maternal complications leading to with individuals or families, users are now maternal mortality among pregnant applying the problem domains and women in (community) r/t cost interventions with communities (Martin, inaccessibility of skilled birth attendance 2005). and the community members perception The Omaha System includes more that skilled birth attendance and facility- environmental and community factors that are based delivery are not necessary during considered in the NANDA system childbirth Because of the multiple nursing diagnostic and classification systems, the NNN Alliance PLANNING COMMUNITY HEALTH INTERVENTIONS has formed to develop a consistent classification system. The NNN Alliance is a Formulating Goals and Objectives collaboration of NANDA and the Center for Objectives planned end point of all activities Nursing Classification and Clinical and are concerned with the resolution of Effectiveness (CNC). The taxonomy developed health problem. they have to be stated in by the NNN Alliance has four domains specific and measurable terms. (Dochterman & Jones, 2003). The one relevant Goal is a desired end. It is directed towards to community health practice is the solving the health status problems that were environmental domain, with three subsets: identified in the community diagnosis. healthcare system, populations, and “Where do we want to go?” refers to aggregates. All three subgroups have formulating goals and objectives of the health diagnosis, outcome, and intervention arenas. program and nursing services to change the community’s status THE 4 PARTS OF COMMUNITY DIAGNOSIS A nursing diagnosis has 4 components: a descriptive statement of the problem, response, or state; identification of factors etiologically related to the problem; and signs Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing Goals and objectives will serve as guide to the your immediate needs - reducing youth nurse's efforts. A goal is a declaration of violence, e.g., but the assumptions behind purpose or intent that fives essential direction them - empowering the community to change to action. Objectives are stated in behavioral the root causes of youth violence and all but terms: specific, measurable, attainable, eliminate it over the long term. realistic, and time bounded. Determine what elements of a promising DECIDING ON COMMUNITY intervention will work in your community, and INTERVENTION/ACTION PLAN which ones need to be changed. In other words, change the intervention, or parts of it, “How do we get there?” defines the strategies so that it suits your community's needs. Not all and activities that the nurse sets to achieve to the pieces of an urban program will work in a realize the goals and objectives. rural area, for instance, where the realities of Conduct a community-based assessment and transportation, childcare, culture, and planning process to be sure that you're everyday life all may be totally different. The addressing the most appropriate and pressing community and the target population need to issues for the community. If your intervention make an adopted practice or intervention their is to work, it has to be aimed at the real issues own and work for them. If it's true that no two the community needs to address. An assets communities are exactly alike, it should be and needs assessment and planning process equally true that interventions that work for will help you identify those issues accurately them won't be exactly alike, either, though they and think about how to approach them most may have many common elements. effectively. IMPLEMENTING COMMUNITY HEALTH Decide whether you'll address the issue INTERVENTIONS directly or try to change the conditions that Community health needs and problems are make it possible. It may be that working on not solved by simply inducing changes in their causes will be more successful than personal and group attitudes and behavior. If coming at the issues themselves directly, and one expects a lasting and sustainable that could mean a totally different kind of solution, reforms have to be carried out within intervention. the health care delivery system and a larger Find (or create, if that's necessary) practices or socio-economic and political system. interventions that have successfully Community health nursing interventions must addressed the issue in the way you want to focus on providing health-related address it. It's important to realize that not interventions to improve the population's every successful program is successful in the health status and enhance the community's way that you're interested in. If your focus is capability to manage their own health. community empowerment, for instance, a top-down authoritarian program, no matter 1. Importance of Partnership and Collaboration how successful, isn't what you're looking for. If Partnership and collaboration aim to get you want to get at the root causes of a people to work together in order to address problem, a program that does a terrific job of problems or concerns that affect them. It treating the symptoms isn't a good fit for you. gives people the opportunity to learn skills Ensure that practice or intervention matches in-group relationships, interpersonal Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing relations, critical analysis, and, most Unlike those who promote more-consensual important of all, the decision-making community building, community organizers process in the context of democratic generally assume that social change leadership. necessarily involves conflict and social Health and health-related problems in the struggle in order to generate collective power community are varied. The problems are for the powerless. often complicated and too many for the Community organizing has as a core goal the nurse and the people or their organization generation of durable power for an to handle. They cannot solve the problems organization representing the community, alone. They must work with other people or allowing it to influence key decision-makers groups to increase the probability of on a range of issues over time. In the ideal, for accomplishing the goals that they have example, this can get community-organizing set. groups a place at the table before important decisions is made. Community organizers 2. Activities involved in collaboration and advocacy work with and develop new local leaders, Working together enables organizations to facilitating coalitions and assisting in accomplish their goals much quicker because developing campaigns. A central goal of of resources, skills, and views are pooled organizing is developing a robust, organized, together. local democracy bringing community Activities in Collaboration include: members together across differences to fight ✓ Networking together for the interests of the community. ✓ Coordination Community organizing is a process whereby ✓ Cooperation community members develop the capability ✓ Coalition to assess their health needs and problems, Advocacy work is one way the nurse can plan and implement actions to solve these promote active community participation. The problems, put up and sustain organizational nurse helps the people attain the optimal structures that will support and monitor degree of independence in decision making in implementation of health initiatives by the asserting their rights to a safe and better people. community. The World Organization defined social Advocacy work includes informing the people mobilization as the process of bringing about the rightness of the cause; thoroughly together all societal and personal influences discussing with the people the nature of the to raise awareness of and demand for health alternatives, their content and possible care, assist in the delivery of resources and consequences; supporting people's right to services, and cultivate sustainable individual make a choice and to act on their choice; and community involvement. In order to Influencing public opinion employ social mobilization, members of institutions, community partners and organizations, and others collaborate to reach 3. Community organizing and social mobilization specific groups of people for intentional Community organizing is a process where dialogue. Social mobilization aims to facilitate people who live in proximity to each other change through an interdisciplinary approach. come together into an organization that acts in Principles of community organizing include: their shared self-interest. Community development is a process; Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing Community development is a holistic ✓ To bring coordination between the approach for addressing the community's individuals, groups and organization to needs; Empowerment results from influence, focus their point and challenge their participation, and community education; objectives for fulfillment Development ensures environmental ✓ To launch necessary reforms in the stewardships; Development is tied to community for eradication of sustainability; Partnership provides access to community evils resources. ✓ To develop democratic leadership among people through their 4. Goals of Community Organizing participation in community programs A core goal of community organizing is to ✓ To develop the idea of ability and generate durable power for an organization better thinking to work for the representing the community, allowing it to betterment of the community influence key decision-makers on a range of ✓ To abolish the differences among issues over time. individuals, develop a spirit of Main objectives/aims: common interest and sacrifice, and ✓ To bring adjustment between the also participate collectively in resources available and felt needs of community programs the people ✓ To organize the people for the ✓ To get information about the resources promotion and progress of community and needs ✓ Removal of blocks to growth (in ✓ To arouse the people to work for the individuals, groups as well as in welfare of the community communities) ✓ To create sound ground for planning ✓ Release of full potentialities (in and action individuals, groups as well as in ✓ To create a sense of cooperation communities) integration and unity among people ✓ Full use of inner resources (in ✓ To motivate the people to take better individuals, groups as well as in participation in the developing communities) community program ✓ Development of capacity to manage ✓ To highlight the causes of various one's own (individual, group & problems affecting the community community) life and hinder the way of progress and ✓ Increasing the ability to function as an development integrated unit. ✓ To implement programs required for COMMUNITY ORGANIZING PARTICIPATORY the fulfillment of people basic RESEARCH (COPAR) ✓ To develop a better understanding among the people about the issues Is a vital part of public health nursing. and needs Aims to transform the apathetic, ✓ To mobilize the resources to create a individualistic, and voiceless poor into a suitable ground for the basic needs dynamic, participatory, and politically completion and eradication of responsive community. problems The following are the emphasis of COPAR: Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing ✓ Community working to solve its own 3. Mobilization or action problem. 4. Evaluation ✓ The direction is established internally 5. Reflection and externally. 6. Organization ✓ The development and implementation 4 PHASES OF COPAR of a specific project are less important than the development of the 1. Pre-Entry community's capacity to establish the 2. Entry Phase plan. 3. Organization-building Phase ✓ Consciousness-raising involves 4. Sustenance and Strengthening Phase perceiving health and medical care within the total structure of society. (1) Pre-Entry Phase The following are the importance of COPAR: Is the initial phase of the organizing process ✓ COPAR is an important tool for where the community organizer looks for community development, and people communities to serve and help. empowerment. Pre-Entry Activities: ✓ This helps the community workers For preparation: generate community participation in ✓ Train faculty and students in COPAR. development activities. ✓ Formulate plans for institutionalizing ✓ COPAR prepares people/clients to COPAR. eventually take over the management ✓ Revise/enrich curriculum and immersion of a development programs in the program—coordinate participants of future. other departments. ✓ COPAR maximizes community For Site Selection: participation and involvement; community resources are mobilized ✓ Initial networking with local government. for community services. ✓ Conduct preliminary special Principles of COPAR include: investigation. ✓ People, especially the most ✓ Make a long/short list of potential oppressed, exploited, and deprived communities. sectors are open to change, have the ✓ Do an ocular survey of listed capacity to change, and are able to communities. bring about change. Criteria for Initial Site Selection: ✓ COPAR should be based on the ✓ Must have a population of 100-200 interest of the poorest sector of the families. community. COPAR should lead to a ✓ Economically depressed. self-reliant community and society. ✓ No strong resistance from the The critical steps of COPAR are: community. i. Integration ✓ No serious peace and order problem. ii. Social Investigation ✓ No similar group or organization holding iii. Tentative program planning the same program. iv. Groundwork In identifying potential municipalities: v. Meeting ✓ Do the same process as in selecting 2. Role Play municipality. Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing ✓ Consult key informants and residents. ✓ Avoid raising the consciousness of the ✓ Coordinate with local government and community residents NGOs for future activities. ✓ Adopt a low-key profile. In choosing the final community: Activities in the Entry Phase: ✓ Conduct informal interviews with Integration community residents and key ✓ Establishing rapport with the people in informants. continuing effort to imbibe community ✓ Determine the need for the program in life, the community. ✓ living with the community, ✓ Take note of political development. ✓ seek out to converse with people ✓ Develop community profiles for where they usually congregate, secondary data. ✓ lend a hand in household chores, ✓ Develop survey tools. avoid gambling and drinking. ✓ Pay a courtesy call to community ✓ Deepening social leaders. Choose foster families based investigation/community study, on guidelines. ✓ verification, and enrichment of data In identifying Host Family: collected from the initial survey, ✓ House is strategically located in the ✓ conduct baseline survey by students, community. results relayed through community ✓ They should not belong to the rich assembly. segment. For Core Group Formation: ✓ Both formal and informal leaders respect them. ✓ Leader spotting through sociogram. ✓ Neighbors are not hesitant to enter the ✓ Key persons must be approachable by house. most people. ✓ No member of the host family should ✓ Must be an opinion leader. be moving out in the community. ✓ They are approached by key persons and never or hardly consulted. (2) Entry Phase/Social Preparation Phase (3) Organization-building Phase It is crucial in determining which strategies for In this phase, the formation of a more formal organizing would suit the chosen community. structure and the inclusion of more formal The success of the activities depends on how procedures of planning, implementing, and much the community organizers have evaluating community-wide activities. integrated with the community. At this phase, the organized leaders or groups Guidelines for Entry Phase: are being given training (formal, informal, OJT) ✓ Recognize local authorities' role by to develop their style in managing their own paying them visits to inform their concerns/programs. presence and activities. Key Activities: ✓ Her appearance, speech, behavior, ✓ Community Health Organization and lifestyle should be in keeping with (CHO) (preparation of legal those of the community residents requirements, guidelines in the without disregard of their being role organization of the CHO by the core models. group, election of officers). ✓ Research Team Committee. Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing ✓ Planning Committee. Level I: ✓ Health Committee Organization. ✓ Non-water carriage toilet facility ✓ Formation of by-laws by the CHO ✓ Toilet facilities requiring small amount (4) Sustenance and Strengthening Phase of water to wash the waste In this phase, the community organization has Level II: already been established, and the community members are already actively participating in ✓ On-site toilet facilities of the water community-wide undertakings. carriage type with water sealed and At this point, the different committees set up flush type with septic tank disposal in the organization-building phase are already facilities expected to be functioning by planning, implementing, and evaluating their own Level III: programs, with the overall guidance from the ✓ Water carriage types of toilet facilities community-wide organization. connected to septic tanks to Key Activities sewerage system to treatment plants. ✓ Include Training of CHO for monitoring and implementing of community Food Safety health programs. Fast food has become a staple diet for busy ✓ Identification of secondary leaders. people, especially when time is not enough for ✓ Linkaging and networking. food preparation. What could be worse than ✓ Conduct mobilization on health and sinking your teeth into your favorite food, development concerns. unperturbed to the fact that it is crawling with ✓ Implementation of livelihood projects. germs? You have already consumed and COMMUNITY ORGANIZING PARTICIPATORY digested your meal before discovering that RESEARCH there is an additional "ingredient," which is, without a doubt, a recipe for disaster. A person Proper Excreta Disposal will more likely choose to starve to death than Human excreta always contain large numbers eat contaminated food. There have been of germs, some of which may cause diarrhea. several complaints about food poisoning and When people become infected with cholera, unsafe food handling practices. While some typhoid and hepatitis A, their excreta will complainants are already well aware of the contain large amounts of the germs that cause steps to take, others still need guidance so the disease. When people defecate in the their complaints will not fall on deaf ears. open, flies will feed on the excreta and can The Republic Act No. 10611, otherwise known carry small amounts of the excreta away on as the "Food Safety Act of 2013," strengthens their bodies and feet. When they touch food, our country's food safety regulatory system. the excreta and the germs in the excreta are The law provides protection to consumers so passed onto the food, which may later be they will have access to local foods and food eaten by another person. Some germs can products that have undergone thorough and grow on food and in a few hours their numbers rigid inspection. can increase very quickly. Where there are Under Section 3 of the Republic Act, the germs there is always a risk of disease. objectives are as follows: Approved types of toilet facilities: ✓ Protect the public from food-borne and water-borne illnesses and Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing unsanitary, unwholesome, progress on a wide range of health and misbranded, or adulterated foods; economic development issues including Enhance industry and consumer universal health coverage and combatting confidence in the food regulatory antimicrobial resistance system, and Achieve economic Source: 1993 Philippine National Standard for growth and development by Drinking Water, Published by DOH promoting fair trade practices and Vermin and Vector Control sound regulatory foundation for domestic and international trade. Environmental management seeks to change ✓ The food safety regulatory system the environment in order to prevent or combines various processes to minimize vector propagation and human ensure that food safety standards are contact with the vector-pathogen by met. Food safety standards refer to destroying, altering, removing, or recycling the formal documents, which contain non-essential containers that provide larval the food requirements that the food habitats. Such actions should be the mainstay processors need to comply with such of dengue vector control. Three types of human health is safeguarded. These environmental management are defined: safety standards are implemented by Environmental modification – long-lasting law and authorities. Some of the physical transformations to reduce larval processes under the regulatory vector habitats, such as the installation of a system include inspection, testing, reliable piped water supply to communities, data collection, monitoring, and other including household connections. activities carried out by various food Environmental manipulation – temporary safety regulatory agencies. changes to vector habitats involving the management of "essential" containers, such Sanitation as frequent emptying and cleaning by The World Health Organization defined scrubbing of water- storage vessels, flower sanitation as the provision of facilities and vases, and desert room coolers; cleaning of services for the safe management of human gutters; sheltering stored tires from rainfall; excreta from the toilet to containment and recycling or proper disposal of discarded storage and treatment onsite or conveyance, containers and tires; management or removal treatment and eventual safe end use or from the vicinity of homes of plants such as disposal. ornamental or wild bromeliads that collect More broadly sanitation also included the safe water in the leaf axils. Changes to human management of solid waste and animal waste. habitation or behavior – actions to reduce Inadequate sanitation is a major cause of human – vector contact, such as installing infectious diseases such as cholera, typhoid mosquito screening on windows, doors, and and dysentery world-wide. It also contributes other entry points, and using mosquito nets to stunting and impaired cognitive function while sleeping during the daytime. and impacts on well-being through school Built Environment attendance, anxiety and safety with lifelong consequences, especially for women and A built environment is developed in order to girls. Improving sanitation in households, satisfy residents' requirements. Human needs health facilities and schools underpins can be physiological or social and are related Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing to security, respect, and self-expression. implementation phase, compares the actual People want their built environment to be progress (of the implementation of the aesthetically attractive and to be in an program) against what was planned. The accessible place with a well-developed purpose of monitoring is to identify deviations infrastructure, convenient communication or problems so that corrective actions or access, and good roads, and the dwelling interventions can be instituted immediately. should also be comparatively cheap, This implies reporting to appropriate persona comfortable, with low maintenance costs, and or offices at regular intervals. have sound and thermal insulation of walls. Types of Evaluation People are also interested in ecologically Planning Evaluation clean and almost noiseless environments, with sufficient relaxation options, shopping, ✓ same as program monitoring fast access to work or other destinations, and ✓ used to improve program performance good relationships with neighbors. by influencing immediate decisions about the activities, especially how MONITORING AND EVALUATING COMMUNITY they can be re-planned and/or HEALTH PROGRAMS improved. It enables the assessment Monitoring and evaluation are essential of: Who is being reached by the management tools that ensure that health program; What information is reaching activities are implemented as planned and them; Whether or not things are going assess whether desired results are being according to plan; The need for change achieved. Monitoring is done to provide Formative Evaluation concurrent feedback on the progress of activities, identify the problems in their ✓ initial assessment to develop implementation, and take corrective action. appropriate, effective programs. The Evaluation is done to assess whether the formative evaluation comprises of program's desired results have been achieved activities undertaken to furnish if not how it should be redesigned. information that will guide the design of health programs. ✓ enables us to assess: Who is most affected by the problem?; What knowledge, attitudes, and beliefs exist?; What is the level of access to services? ; What are the barriers to action?; What are the communication habits and preferences? Common sources of data are: Monitoring data; Existing epidemiologic and program reports; Interviews with program managers, stakeholders; Baseline survey data of intended audience; Media rating data; Service statistics; Monitoring and evaluation are closely related. Other program records Monitoring, which is done at the Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing Summative or Impact Evaluation data. Prior to actual data collection, data collection ✓ examines specific program outcomes methods and tools should be field- and accomplishments. tested, and data collectors should ✓ used to assess the program's success be trained. and judge its worth by assessing its 4. Analyze Data effectiveness in light of relevant Evaluators should assess the quality of the problems. It enables the assessment data before they start the analysis. of whether the appropriate behaviors ✓ What do the figures/ statistics were realized, and these changes can mean? be attributed to the intervention. ✓ What do qualitative data Steps in Program Evaluation reveal? 1. Decide what to evaluate. The WHO suggested five dimensions of Depending on the type of evaluation being program performance that could be conducted. The main questions that evaluated: should be asked are: ✓ Relevance ✓ Is the program relevant? ✓ Progress ✓ Is it progressing in accordance ✓ Effectiveness with the program plan? ✓ Impact ✓ Is it effective? ✓ Efficiency ✓ What are the lessons that To address these dimensions, the could be learned from the evaluator should review the program program? context and objectives. 5. Make Decisions ✓ If the intervention or program was 2. Design the Evaluation Plan effective and efficient, this could ✓ Designing an evaluation plan be continued and/or applied to means specifying data collection another client or group, given methods and tools and sources of similar circumstances. If the data. program is not relevant, the ✓ Records and reports can be evaluator should recommend its reviewed and analyzed. modification. ✓ Surveys can be conducted to 6. Report/ Give Feedback collect information on the client's ✓ The result of the program knowledge, attitudes, and evaluation should be submitted to practices local authorities such as mayor, chair of the Sangguniang Bayan committee on health, and to the Local Health Board. ✓ It should be noted that these are the key decision-makers in the 3. Collect Relevant Data local health system. An executive ✓ The evaluator's primary aim is the summary should be prepared for generation of accurate and reliable them. It should contain a brief Green text – PPT notes NCM 113 – PREFINALS Transcribed by: Jannah Isha Z. Jani BCI – College of Nursing description of the focus and Local Health Board. If the nurse procedures of the evaluation, will be asked to make a summary, and interpretation of presentation, you must prepare evaluation results, conclusions, good visual aids. A good written and recommendations. The nurse report and an impressive oral and other health workers must be presentation can influence prepared to make a presentation decision- makers positively. to the Sangguniang Bayan or to the NURSING PROCESS IN THE COMMUNITY DOCUMENTATION AND REPORTING Guidelines for Good Documentation and Reporting: Fact - information about clients and their care must be factual. A record should contain descriptive, objective information about what a nurse sees, hears, feels, and smells. Accuracy - information must be accurate so that health team members have confidence in it Completeness - the information within a record or a report should be complete, containing concise and thorough information about a client's care. Concise data are easy to understand. Currentness - ongoing decisions about care must be based on currently reported information. Organization - the nurse communicates in a logical format or order. Confidentiality - confidential communication is information given by one person to another with trust and confidence that such information will not be disclosed. Green text – PPT notes