Community Health Nursing Module 4 PDF

COMMUNITY HEALTH NURSING MODULE 4: NURSING PROCESS IN THE o Health records and reports Births  Field Health Service Information (FHSIS) CARE OF POPULATION GROUPS AND...

COMMUNITY HEALTH NURSING MODULE 4: NURSING PROCESS IN THE o Health records and reports Births  Field Health Service Information (FHSIS) CARE OF POPULATION GROUPS AND recording and reporting tools COMMUNITY ❖ FHSIS is as basis for PART 1: 1. priority setting by local governments 2. planning and decision making at different COMMUNITY ASSESSMENT levels(barangay, municipality, district,  The data needed to be collected depend on the provincial, and national) objectives of community assessment. 3. monitoring and evaluating health  In general, the nurse needs to collect data on three program implementation categories of community health.  Determinants: people, place and social system. The FHSIS manual of operations RECORDING FORMS DATA COLLECTED FOR THE HEALTH for 1. Individual Treatment Record (ITR) (building block of P.A.T.C.H (planed approach to community health) FHSIS) - health workers are advised not to rely on process for health planning client-maintained 1. Community profile: demographic educational and economic data 2. Morbidity and mortality data, including unique health events (e.g., completion of barangay health station, a typhoon that caused flooding of residential areas) 3. Behavioral data focusing on behavioral risk factors, such as smoking, drinking and leading a sedentary life style, and prevailing good health practices in the community, such as breast feeding and getting regular exercise 2. TARGENT CLIENT LIST 4. Opinion data from community leaders, such as what a. TCL for prenatal care they think about the main health problems of the b. TCL for postpartum care community their causes, measures that may alleviate c. TCL of under 1-year-old children or correct them d. TCL for family planning e. TCL for sick children PROBLEM ORIENTED ASSESMENT f. National tuberculosis program registry. - *problem oriented assessment is focused on a g. national leprosy control program central particular aspect of health: focusing on what’s problem the community have in mind registration form 3. Summary table (accomplished by midwife)- tool for TOOLS IN COMMUNITY ASSESSMENT assessment of accomplishment and a ready data source for report  Collecting primary data: 4. Monthly consolidation table (MTC) – serves as source o Observation- ocular survey/ windshield survey document for the quarterly Form and output table of o Survey RHU or Health Center  Informant interview:  talks to the community REPORTING FORMS people 1. Monthly forms (regularly prepared by the midwife  key informants: consist of formal and informal and summited to the nurse) community leaders or a. Program report(m1) contains indicators persons of position and categorized as maternal care, child care, family influence planning  Community forum: b. Morbidity report (m2) contains list of all cases of  pulong – pulong sa barangay disease by age and sex.  focus group 2. Quarterly forms (prepared by the nurse)  Secondary data source a. PROGRAM REPORT (Q1) 3-month total indicators o Registry of Vital events (Civil registrar & NSO) categorized as maternal care, family planning child  Births care, dental health and disease control  Deaths b. MORBIDITY (Q2)  Marriage 3. Annual forms a. A-BHS – contains demographic, environmental, and natality data  b. Annual form 1 (a-1) prepared by the nurse and is  NANDA- individual diagnosis the report of the RHU or health center. It  Shuster and Goeppinger (2004) - consist of 3 parts contains demographic and environmental data 1. The health risk or specific problem to which the and data on natality and mortality for the entire community is exposed. year 2. The specific aggregate or community with whom c. Annual form 2 (a-2) prepared by the nurse, is the nurse will be working to deal with the risk or the yearly morbidity report by age and sex problem. d. Annual for 3( a-3) prepared by the nurse, yearly 3. Related factors that influence how the community report of all mortality by age and sex will respond to the health risk or problem application of this nursing diagnosis  DISEASE REGISTRY - a listing of persons diagnosed with specific type of disease in a defined population e.g. HIV/AIDs, non- communicable diseases  CENSUS DATA - demographic characteristics, household size, and data on fertility and mortality that can be utilized by the nurse Methods to Present Community Data *Community Data are presented to the health team and the members of the community for the following purposes:  The Omaha System  To inform the health team and members of - The identified problems or areas of concern are the community of existing health and health classified in 4 levels related conditions in the community in an 1. The first and most general level of classification easily understandable manner. is composed of four domains: (1)  To make members of the community environmental, (2) psychological, (3) appreciate the significance and relevance of physiological, and (4) health-related behaviors. health information to their lives 2. 2nd level consists of the problems or concern  To solicit broader support and participation under these four domains. Box 4.1 has the list in the community health process. of problems or areas of concern under the four  To validate findings domains. This is not an exhaustive list of  To allow for wider perspective in the analysis problems. It is possible that the user of this of data. system may encounter a client who presents an  To provide a basis for better decision unlisted problem. making. *depending on the context and purpose of the presentation, community data may be presented as text, in tables or in pictorial forms such as maps and graphs.  Maps can be used to show differences or similarities across geographic areas  Bar graph is used to compare values across different categories of data  Pie chart is used to show percentage distribution or composition of a variable, such as population or households.  Scatter plot or diagram is used to show 3. Third level, the problem or area of concern is correlation between two variables classified according to two sets of qualifiers. COMMUNITY DIAGNOSIS First, the area of concern is categorized into  Community diagnosis is the process of health promotion, potential problem, or actual determining the health status of the community problem. Then, the level of clientele (individual, and the factors responsible for it. family, or community) involved is identified.  In this phase the, the health workers make a 4. The fourth and most specific level is made up of judgement about the community’s health status, clusters of signs and symptoms that describe resources and health action potential or likely actual problems. hood that the community will act to meet health PLANNING COMMUNITY HEALTH INTERVENTIONS needs to resolve health problems.  As in other fields of nursing practice, planning for  There are several schemes that the nurse may community health interventions is based on findings choose from in stating community diagnoses during assessment and formulated nursing diagnosis.  Participatory action research (PAR)  PLANNING phase – involves priority setting, differs from most other approaches to formulating goals and objectives, and deciding on public health research because it is community interventions. based on reflection, data collection, and  Active participation of the people action that aims to improve health and  To foster participation, the community reduce health inequities through should have genuine representation in the involving the people who, in turn, take planning group. actions to improve their own health.  Deciding on community representatives will be facilitated if the community has been organized earlier.   PRIORITY SETTING - Provides the nurse and the health After repeating the process on all identified health team with a logical means of establishing priority problems, compare the total priority scores of the among the identified health concerns. problems. The problem with the highest total priority score Criteria’s to decide on a community health concern for is assigned top priority, the next highest is assigned to intervention according to The World Health Organization second, and so on. (WHO): 1. Significance of the problem- is based on the number of people in the community affected by the problem or condition.  If the concerns are: ✔ DISEASE CONDITION – this may be estimated in terms of its prevalence rate. ✔ POTENTIAL PROBLEM – its significance is determined by estimating the number of people at risk of developing the condition. 2. The level of community awareness and the priority its members give to the health concern is a MAJOR consideration. Related to the priority that the community gives to the health concern, Shuster and Goeppinger (2004) also mention community motivation to deal with the condition. 3. Ability to reduce risk ✔ is related to the availability of expertise among the health team and the community itself. ✔ Involves the health team’s level of influence in decision making related to actions in resolving the community health concern For a realistic and useful outcome, the priority-setting process requires the joint effort of the community, the nurse, and other stakeholders, such as the other members of the DECIDING ON COMMUNITY INTERVENTIONS health team.  The group analyzed the reasons for the people’s health behavior and directs strategies to respond to  The group defines guidelines for discussion, the underlying causes. For example, reasons for particularly on the manner of reconciling differences preference of home delivery over facility-based of opinion. delivery should be identified. If the majority of the  Shuster and Goeppinger (2004) suggested a flexible women would choose to have a home delivery process using the nominal group technique wherein because of cost or lack of access of birthing each group member has an equal voice in decision facilities, strategies should then be focused on making, thereby avoiding control of the process by the improving facility-based services. But if the primary more dominant members of the group. reason is sociocultural, the planning team may opt  This technique is appropriate for brainstorming and to concentrate on providing opportunities for skills ranking ideas, when consensus-building is desired development of traditional birth attendants and/or over making a choice based on the opinion of the exerting effort to gain the trust and confidence of majority. the women and their families.  The group makes a list of the identified community  In the process of developing the plan, the group health problems or conditions. Each of the identified takes into consideration the demographic, problems is treated separately according to a set of psychological, social, cultural, and economic criteria agreed upon by the group such as those characteristics of the target population on one suggested by the WHO. hand and the available health resources on the *As suggested by Shuster and Goeppinger (2004), the other hand. following steps are carried out: Formulating Goals and Objectives  GOALS are the desired outcomes at the end of 1. From a scale of 1 to 10, being the lowest, the members interventions, whereas objectives are the short- give each criterion a weight based on their perception term changes in the community that are observed of a weight based on their perception of its degree of as the health team and the community work importance in solving the problem. towards the attainment of goals. 2. From a scale of 1 to 10, being the lowest, each  OBJECTIVES serve as instructions, defining what member rates the criteria in terms of the likelihood of should be detected in the community as the group being able to influence or change the interventions are being implemented. situation. Specific, measurable, attainable, relevant, and 3. Collate the weights (from step 1) and ratings (from time-bound (SMART) objectives provide a solid basis for step 2) made by the members of the group. monitoring and evaluation. 4. Compute the total priority score of the problem by multiplying collated weight and rating of each criterion. 5. The priority score of the problem is calculated by adding the products obtained in step  ∙ Community organizing and community health nursing practice have common goals: People empowerment, development of self-reliant community, and improved quality of life. ∙ As a result, they become the health care professionals’ partners in health care delivery and overall community development. SOCIAL MOBILIZATION DECIDING ON COMMUNITY INTERVENTIONS ∙ Social mobilization is the process of o The group analyzed the reasons for the people’s health behavior bringing together all societal and personal and directs strategies to respond to the underlying causes. influences to raise awareness of and demand for health care, assist in the For example, reasons for preference of home delivery over delivery of resources and services, and facility-based delivery should be identified. If the majority of the cultivate sustainable individual and women would choose to have a home delivery because of cost or community involvement. lack of access of birthing facilities, strategies should then be ∙In order to employ social mobilization, focused on improving facility-based services. members of institutions, community partners and organizations, and others But if the primary reason is sociocultural, the planning team collaborate to reach specific groups of may opt to concentrate on providing opportunities for skills people for intentional dialogue. Social development of traditional birth attendants and/or exerting mobilization aims to facilitate change effort to gain the trust and confidence of the women and through an interdisciplinary approach their families. (WHO) COMMUNITY ORGANIZING  Community organizing is a value-based In the process of developing the plan, the group takes into process, tracing its roots to three basic consideration the demographic, psychological, social, cultural, values: human rights, social justice, and and economic characteristics of the target population on one social responsibility (LOCOA, 2005). hand and the available health resources on the other hand. 1. Human rights – are based on the worth and dignity inherent to all human beings: the right to life, the Implementing Community Health Interventions right to development as persons and o Often referred to as the action phase, implementation is the most as a community, and the freedom to exciting phase for most health workers. Aside from being able to make decisions for oneself. deal with the recognized priority health concern, the entire process 2. Social justice- entails fairness in the is intended to enhance the community’s capability in dealing with distribution of resources to satisfy common health conditions/problems. basic needs and to maintain dignity as o The nurses role therefore may be to facilitate the process rather human beings. than directly implement the process rather than directly 3. Social responsibility- is an offshoot of implement the planned interventions. the ethical principle of solidarity, o Implementation also entails coordination of the plan with the which points to people being part of community and the other members of the health team. This one community and is reflected requires a common understanding of the goals, objectives and planned interventions among the members of the implementing CORE PRINCIPLES IN COMMUNITY ORGANIZING group. * Anchored on the basic values of human rights, o Collaboration with the other sectors such as the local government social justice, and social responsibility, the and other agencies may also be necessary. following are the core principles and grounds for the practice of community organizing: COMMUNITY ORGANIZING: Ensuring Health in the Hands of the People  Community organizing is people-centered  Community organizing is participative DEFINITION:  Community organizing is democratic ∙ Community organizing as a process consists of steps or activities  Community organizing is developmental that instill and reinforce the people’s self-confidence on their own  Community organizing is process- collective strengths and capabilities (Manalili, 1990). It is the oriented development of the community’s collective capacities to solve its COMMUNITY ORGANIZING IS PEOPLE-CENTERD: own problems and aspire for development through its own efforts. ∙ The basic premise of any community ∙ Community organizing is a continuous process of educating the organizing endeavor is that the people are community to develop its capacity to assess and analyze the the means and ends of development, and situation (which usually involves the process of consciousness community empowerment is the process raising), plan and implement interventions (mobilization), and and the outcome (Felix, 1998). It is evaluate them. people-centered (Brown, 1985) in the sense that the process of critical inquiry is ∙ Community Organizing is a process of educating and mobilizing informed by and responds to experiences members of the community to enable them to resolve and needs of the marginalized community problems. It is a means to build the community’s sectors/people. capacity to work for the common good in general and health goals.  ∙ Community organizing is a people-centered  It was around the mid-1990s when PAR was first strategy, with emphasis on the development of introduced. It is a utilized mostly in social psychology human resources necessitating education. The that encourage researches and those who will benefit educational processes are interactive, from the research (families, providers, policy makers) to empowering both the learners (the members of work together as full partners in all phases of the the community) and the teacher (the nurse), research. leading to decision making that plays a part in  Community Organizing Participatory Action Research human development (Brown, 1985). (COPAR) is a community development that allows the COMMUNITY ORGANIZING IS PARTICIPATIVE: community (participatory) to systematically analyze the situation, and implement projects/programs (action) ∙ The participation of the community in the entire utilizing the process of community organizing. It is process -assessment, planning, implementation, essentially a research project done by the community and evaluation-should be ensured. The that leads to actions to improve conditions in the community is considered as the prime mover and community. determinant, rather than beneficiaries and  Both COPAR and traditional research approach in nursing recipients, of development efforts, including endeavor using methods of scientific inquiry; however, health care. they differ in certain ways. ∙ For people empowerment, community  For COPAR to succeed, the nurse-researcher must be participation is a critical condition for success able to adopt methodologies that are creative (Reid, 2000). In community participation decision interesting and easy to apply at the community level. making and responsibility are in the hands of Strategies that are informal, provide fun, utilize local ordinary people, not just the elite. Distinction is resources, and create excitement among the people are not made among different groups and different plus factors. personalities (Reid, 2000).  The major role of the nurse in COPAR is to facilitate and COMMUNITY ORGANIZING IS DEMOCRATIC: guide the community in the critical assessment of the ∙ Community organizing should empower the situation. disadvantage population. It is a process that allows the majority of people to recognize and Process in COPAR critically analyze their difficulties and articulate their aspiration. Hence, their decision must reflect the will of the whole, more so the will of the common people, than that of the leaders and the elite. ∙ Conflicts are inevitable in group dynamics. They are to be expected in organizing work. Thus, the organizer and community leaders require skills to effectively process and manage these conflicts. ∙ Effort must be exerted to achieve a consensus. This requires a participative and consultative approach. COMMUNITY ORGANIZING IS DEVELOPMENT: Monitoring and Evaluating Community Health ∙ Community organizing should be directed Programs Implemented towards changing current undesirable conditions. EVALUATION: The organizer desires changes for the betterment  To evaluate is to determine or fix the value. of the community and believes that the  Formative evaluation – judgment made about community shares these aspirations and that effectiveness of nursing interventions as they are these changes can be achieved. implemented. ∙ Beyond health or economic improvement,  Summative evaluation – determining the end results of community organizing seeks authentic human family nursing care and usually involves measuring development. outcomes or the degree to which goals have been COMMUNITY ORGANIZING IS PROCESS-ORIENTED: achieved.  Aspects of evaluation: ∙ The community organizing goals of - Effectiveness – determination of whether goals empowerment and development are achieved and objectives were attained. through a process of change. - Appropriateness – suitability of the ∙ Community organizing is dynamic. With the goals/objectives and interventions evolving community situation, monitoring and - Adequacy – degree of sufficiency of periodic review of plans are necessary. Through goals/objectives and interventions efforts of community members to identify and - Efficiency – relationship of resources used to deal with other problems leads to sustenance of attain the desired outcomes the community organizing efforts. COPAR-Community Organizing Participatory Action Research  Participatory action research (PAR) is an approach to research that aims at promoting change among the participants. Members of the group being studied participate as partners in all phase of the research, including design, data collection, analysis and dissemination.  Documentation and Reporting MODULE 5: WORKING WITH THE GROUPS FAMILY HEALTHE RECORDS  include information based on factual events, TOWARDS COMMUNITY DEVELOPMENT observation results or measurements taken such as INTRODUCTION: height, weight, body circumference or laboratory  One of the beginning nurse’s roles is the development of examinations carried out like hemoglobin, urine the competencies on establishing a collaborative test, stool test and sputum examination depending relationship with colleagues and other members of the upon the problem of the family. health team to enhance nursing and other health care  These also include records of immunization, services provided to an individual, family, population nutritional status, medical prescription and group, and community. curative procedures carried out. Demographic data and individual personal history are also included in  This module deals with group developmental stages and the family folders how the leaders and members of the community can COMMUNITY PROFLING improve the ways their partnership works together. This  the collection of relevant information that will module also helps the learners understand how inform the nurse about the state of health and expectations about the groups' progress and members' health needs of the population interactions can be managed. Overall, this material will enlighten the learners on how the community is  analysis of this information to identify the major established and how they could remain focus on the health issues. groups' purpose and goal. STAGES OF TEAM DEVELOPMENT TUCKMAN proposed the Forming – Storming – Norming – Performing model of group development. According to him, all these stages are important and inevitable for a team to grow, face challenges and difficulties effectively and deliver positive results. 1. FORMING - The forming stage involves a period of orientation and getting acquainted. Uncertainty is high during this stage, and people are looking for leadership and authority. A member who asserts authority or is knowledgeable may be looked to take control. Team members are asking such questions as “What does the team offer me?” “What is expected of me?” “Will I fit in?” Most interactions are social as members get to know each other. 2. STORMING - The storming stage is the most difficult and critical stage to pass through. It is a period marked by conflict and competition as individual personalities emerge. Team performance may actually decrease in this stage because energy is put into unproductive activities. Members may disagree on team goals, and subgroups and cliques may form around strong personalities or areas of agreement. To get through this stage, members must work to overcome obstacles, to accept individual differences, and to work through conflicting ideas on team tasks and goals. Teams can get bogged down in this stage. Failure to address conflicts may result in long-term problems.  3. NORMING - If teams get through the storming GROUP TASK ROLES stage, conflict is resolved and some degree of unity  The first type of roles that individuals can take-on emerges. In the norming stage, consensus develops within a group are all centered around the tasks that around who the leader or leaders are, and the group needs to accomplish. These roles are all pro- individual member’s roles. Interpersonal social and help the group strive towards achieving the differences begin to be resolved, and a sense of group or team’s goal. Benne and Sheats identified cohesion and unity emerges. Team performance twelve different task roles that group members could increases during this stage as members learn to take on. Remember, in smaller groups or teams cooperate and begin to focus on team goals. individuals could take on multiple roles and it’s entirely However, the harmony is precarious, and if possible that multiple group members take on the disagreements re-emerge the team can slide back same roles as well. into storming. INITIATOR-CONTRIBUTOR 4. PERFORMING - In the performing stage, consensus  The initiator-contributor is all about providing new and and cooperation have been well-established and keen insight and ideas to the group. This person may the team is mature, organized, and well- help the group brainstorm new and novel ways to go functioning. There is a clear and stable structure about understanding or looking at a particular and members are committed to the team’s mission. problem. Problems and conflicts still emerge, but they are INFORMATION SEEKER dealt with constructively. The team is focused on  The information seeker focuses on ensuring that the problem solving and meeting team goals. group ha accurate and relevant information as it goes 5. ADJOURNING - In the adjourning stage, most of the about problem solving. This person asks to see relevant team’s goals have been accomplished. The data to ensure the accuracy of the information the emphasis is on wrapping up final tasks and group uses while attempting to problem solve. documenting the effort and results. As the work OPINION SEKEER load is diminished, individual members may be  The opinion seeker is not concerned with the accuracy reassigned to other teams, and the team disbands. of information, but is more interested in understanding There may be regret as the team ends, so a the group’s values. What are the group’s values and ceremonial acknowledgement of the work and how are the used to solve problems? When a potential success of the team can be helpful. If the team is a solution to a problem is solved, the opinion seeker will standing committee with ongoing responsibility, ask for clarification of whether the solution is in sync members may be replaced by new people and the with the group’s purported values. team can go back to a forming or storming stage INFORMATION GIVER and repeat the development process.  The information giver is someone within a group that has some kind of authoritative understanding or INTERVENTION TO FACILITATE GROUP specific expertise that can help inform a group’s decision making process. This person ca often use her GROWTH or his own knowledge or personal experiences to help * Working together does not necessarily produce effective inform a group’s decision making process. teamwork. Here is a simple outline made by Kenneth OPINION GIVER Benne and Paul Sheats that will guide in the understanding  The opinion giver, like the opinion seeker, is concerned of the process of developing health care teamwork. Analysis less with the facts surrounding a specific problem, but of informal roles provides another useful tool for is more concerned with ensuring the group sticks to its understanding the team process. There are three (3) broad values. This person will offer suggestions and insight on sets of informal roles: how the group can employ its values while making Group task roles Group building Individual roles specific decisions. and ELABORATOR maintenance  The elaborator takes the ideas that other people have roles had within a group and tries to flesh out the ideas in a Participant roles here Group building and Individual roles. This meaningful way. The evaluator can also help a group are related to the maintenance roles. category does not task which the group The roles in this classify member- understand specific rationales for the decisions it has is deciding to category are roles as such, since made, or think through how the implementation of a undertake or has oriented toward the the participations specific decision would practically work. undertaken. Their functioning of the denoted here are COORDINATOR purpose is to group as a group. directed toward the facilitate and They are designed to satisfaction of the  The coordinator tries to find the common links coordinate group alter or maintain the participants between the various ideas that group members have effort in the selection group way of individual needs. and combine them in some kind of succinct package. and definition of a working, to Their purpose is Furthermore, the coordinator tries to coordinate the common problem strengthen, regulate some individual goal various activities that the group or team must and in the solution of and perpetuate the which is not relevant that problem. group as a group. either to the group accomplish along the way. task or to the ORIENTER functioning of the  The orienter is akin to a group or team’s mapmaker. group as a group. This person’s role is to show where the group has been Such participations are, of course, highly in an effort to understand where the group is right relevant to the now. Furthermore, this person will point out when the problem of group group has gotten completely off topic and try to training, insofar as refocus the group back to the decision at hand. such training is directed toward improving group maturity or group task efficiency. EVALUATOR-CRITIC GATEKEEPER  The evaluator-critic’s job is to help assess the actual  In a group or team setting, the gatekeeper’s job is to functionality of t group and the decisions that it ensure that all participants are freely and openly makes. This individual ensures that the group is involved in the group’s decision-making. The meeting predetermined standard levels and not just gatekeeper will encourage people who are on tangents “getting by” with quick and easy solutions to to bring it back to the decision at hand while complex problems. This person really seeks out to encouraging those who are more reticent in their hold the group to a clear standard of excellence by communication to actively participate in the decision- evaluating or questioning “practicality,” the “logic,” making. the “facts” or the “procedure” of a suggestion or of STANDARD SETTER some unit of group discussion.”  The standard setter or ego sets out to ensure that the ENERGIZER group or team’s decision-making processes meet a  Often groups get worn down by the decision making certain quality level. This role is similar to the opinion process because some decisions may take months giver under the task roles, but this role is specifically or years to come to fruition. Th energizer’s primary focused on how the group goes about making decisions role is to help pull groups out of a rut and and then holds the groups to those standards. encourage them to make decisions or take action. GROUP-OBSERVER and COMMENTATOR Like the evaluator-critic, the energizer also attempts  The group-observer and commentator watch how the to help groups reach a higher quality of decision group goes about completing its purpose. This making. individual will take notes about the group’s functioning PROCEDURAL-TECHNICIAN and then periodically inform the group about how well  All groups have simple tasks that someone needs to it is working as a group or team. This person’s focuses take care of. on ensuring the group or teams’ processes for decision  Whether it’s rearranging a room into a circle or making do not leave out minority voices, prevent poor photocopying the agenda brainstorming, or jump to decisions too quickly.  and minutes from the previous meeting, the FOLLOWER procedural-technician ensures  The follower is an individual who attempts to not rock  that the routine tasks of the group get the boat for the group. This person is often passive and accomplished just observes the group’s decision processes. Instead of GROUP/TEAM BUILDING or MAINTENACE being an active participant in the group’s decision- ROLES making, he or she will serve as an audience for the  Group/team building roles are roles that help decision-making process during group discussions. build a group-centered identity for the members, while maintenance roles are roles SELF-CENTERED ROLES/INDIVIDUAL ROLES that help keep that group-centered identity  The final category of group roles identified by Benne over the lifecycle of the group or team. and Sheats are generally very destructive and can harm ENCOURAGER the group decision-making process. Benne and Sheats  The encourager is functionally the group or team’s called these roles self-centered because the roles focus cheerleader. This person encourages people to on the individual desires of group members and not come up with new ideas and then praises group or necessarily on what is best for the group or its team members for the ideas they generate. This decisions. According to Benne and Sheats, when self- person also encourages the group to seek out centered roles are noticed by group members, it’s very alternative ways of seeing a problem and fosters an important to quickly diagnose why these roles are environment where alternative ideas and appearing within the group suggestions are welcomed. AGGRESSOR HARMONIZER  The aggressor tends to be an individual who feels the  The harmonizer’s job is to ensure that the group need to improve her or his own standing within the effectively handles conflict. All groups will group by taking others down. Aggressors can enact a eventually have conflict. In fact, conflict can actually number of behaviors that ultimately impact group be very important for groups to survive and thrive. morale and the basic functioning of the group itself. However, when conflict becomes person-focused Some of the behaviors identified by Benne and Sheats instead of task-focused, the harmonizer will help are, “deflating the status of others, expressing alleviate the tension of the group and help conflict disapproval of the values, acts or feelings of others, parties solve their conflicts pro-socially. attacking the group or the problem it is working on, COMPROMISER joking aggressively, showing envy toward another's  The compromiser is someone who realizes that her contribution by trying to take credit for it, etc.” or his ideas are in conflict with another person or BLOCKER faction of the group or team. Instead of holding her  The blocker is someone who simply either hates or his ground refusing to budge one inch in her or everything the group is doing and rejects everything his ideas, the compromiser tries to seek out a the group recommends or he or she keeps rehashing compromise between her or himself and the group or team decisions that have been long since conflict parties. Compromising does not mean this decided. This person may simply say “no” to anything individual is a doormat, but rather compromising is the group likes and is often a giant stumbling block for a strategy to help groups build better, more groups. informed decisions. RECOGNITION-SEEKER - It is assumed that the contribution of each  The recognition-seeker seeker is all about showing how participant is based on knowledge or expertise he or she is such a vital person in the group by brought to the practice rather than the traditional trumpeting her or his achievements (whether relevant employer/employee relationship. or not). Often this person acts in this fashion for fear  The interdisciplinary health care team work that the group or team will see her or him as irrelevant. together as an identified unit or system whose So instead of becoming a relic of the group, he or she members consistently collaborate to the health care feels it is necessary to show how vitale he or she is to team is a group of professionals with different the group by wasting the group’s time while seeking competencies, roles and responsibilities who need recognition. each other’s contribution to achieve effectiveness SELF-CONFESSOR and quality patient care. The interdisciplinary health  The self-confessor sees the group or team as the setting care team work together as an identified unit or to air her or his own feelings, ideology, insight, or system whose members consistently collaborate to values. This person sees the group or team as her or his provide solutions to health care problems of the own therapy session and has no problem self-disclosing clients in hospital or in community settings, which inappropriate information to group or team members may be too complicated to be solved by one during meetings. discipline. PLAYBOY/PLAYGIRL  The multidisciplinary team involves or combines  The playboy or playgirl clearly could care less about the several academic or professional disciplines, formal group or team and its goals. In fact, this person is or informal groups that meet to accomplish a generally quite vocal in her or his lack of caring. He or specific purpose. Team structure can be seen as, in she may simply become overly cycnical of the a hospital setting, for example, an attending group/team and it’s decision-making or actively disrupt physician requests the assistance of other the decision-making process through horseplay or other professionals who communicate by writing reports nonchalant behavior. and with informal conversation. On multidisciplinary DOMINATOR teams, members practice independently of one  The dominator is someone who tries to control the another, each member being guided by his/her own group/team and dominate the group’s discussion and professional standards but the leadership is decision-making processes. This individual is often highly determined by a profession hierarchy, usually the manipulative and will attempt to coerce those in staff physician. In an inter-disciplinary team, subordinate status positions to her or his stance within members with a variety of expertise contribute, but the group. Often these people will see their own on another hand, they view the health care services position within the group or team as more superior than provided in a different focus. other group members and will make this very clear while  The interdisciplinary and multidisciplinary team asserting that her or his ideas are more superior collaboration involves contribution of different because of her or his elevated position within an departments of their services and sharing of organization’s hierarchy. professional expertise of the different disciplines to HELP-SEEKER achieve optimum health of the patient. The role of  The help-seeker tries to get the group to be sympathetic the nurse is to coordinate, communicate and by stressing that he or she is insecure or confused. The document services provided by the team, as shown goal of the help-seeker is to downplay her or his own in the illustration: ability to contribute to the group by making other group/team members care for her or him. SPECIAL INTEREST PLEADER  The special interest pleader is someone who always has a secondary agenda within a group. According to Benne and Sheats, a special interest pleader pleads on behalf of a specific group (e.g., small businesses, labor, gender, race, etc...), but is “usually cloaking [her or] his own prejudices or biases in the stereotype which best fits [her or] his individual need” COLLABORATION AND PARTNERSHIP - In a community setting, the Intra-agency, Inter-  The ability to collaborate and interact with the health agency, multidisciplinary and sectoral collaborate care team may be difficult and challenging, but is are important in the effective and efficient delivery essential to become more effective and efficient in the of health services to the individuals, families, delivery of quality health care to the clients. population groups and the community. The nurse is  Katzenbach and Smith (1993) describe the team as a responsible in maintaining harmonious relationship small number of people with complimentary skills who within the health unit (intra-agency) and are committed to a common purpose, performance coordinating activities of the members of the health goals and approach for which they held themselves team (multidisciplinary) to ensure achievement of accountable. group goals. Collaboration with other government  Collaboration is defined as a joint communication and and non-government agencies (Inter-agency/ decision-making process with the goal of satisfying the sectoral) contributes to t availability of needed health care needs of a target population. The basis of resources, facilities and services provided to the collaboration is the belief that quality patient care is community served. achieved by the contribution of all care providers. A true collaborative practice has no hierarchy.  Good data qualities  The nursing process begins with obtaining data through assessing the patient's sign and symptoms. These data are interpreted by the health care professional into useful information and a diagnosis. This is then followed by necessary interventions and again ends with gathering new data from evaluating the results. Without data, il will be difficult for a health professional to assist the patient. Human error, viruses, bugs, and hardware issues pose a great threat to the integrity of data. ICT can help decrease these errors by putting safeguards in place, such as MODULE 6: INFORMATION TECHNOLOGY backing up files on a routine basis and error AND COMMUNITY HEALTH detection (McGonigle and Mastriæ-, 2009). Introduction  In order for information to be valuable, data  Innovations in health care are continuously introduced. must have the following characteristics Health care providers apply best practices from latest (Abdelhak et al., 2012): researches and use appropriate tools to enhance the 1. Accuracy. This ensures that quality of health care delivered. Patients appear to documentation reflects the event as it become more engaged in their care, through information happened. All values should be correct available on the Internet, radio, and television. and valid. In a computerized system, a Communication problems between patients and health computer can be instructed to check care providers, brought about by geographical disparity, specific fields for validity and alert the are easily solved by mobile phones. Computers are used to user to a potential data collection error store, retrieve, and process important health data for (WHO, 2003). In electronic systems, better decision making. Information and communications format requirements must be followed technologies (ICTs) are becoming indispensable tools in (e.g., if date required is mm-dd-yyyy, then addressing some challenges in health care.ICTs are defined it should be presented as 03-24-1989). as, diverse set of technological tools and resources used 2. Accessibility. This is a data characteristic to communicate, and to create, disseminate, store, and which ascertains data availability should manage information." These technologies include the patient or any member of the health computers, the Internet, broadcasting technologies (radio care staff needs it. An example is readily and television), and telephony (Blunon, 2002). available reports or statistics when  This chapter explores the actual and potential applications needed by decision makers. of ICTs geared toward improving people's access and 3. Comprehensiveness. Data inputted utilization of health care in the Philippine community should be complete. This is done by health setting. making sure that all required fields in the EHeaIth patient's record are properly filled up.  eHealth is the use of ICT for health (World Health 4. Consistency/Reliability. Having no Organization, 2012). On May 25, 2005, during the Fifty- discrepancies in data recorded makes it Eighth World Health Assembly (WHA)/ a resolution was consistent. This means that when John adopted by the World Health Organization (WHO) member Lloyd Dela Cruz is written on the first page states recognizing eHealth as the cost-effective way of of the patient record, it should not be using ICE in health care services, health surveillance, health John Lloyd Dela Cruz in the next. This literature, health education, and research (WHA, 2005). potential error is reduced through error detection and alerts by the computer.  Given the extensive capabilities of ICT e-health can be 5. Currency. All data must be up-to-date and considered in any of, but not limited to, the following: timely. This is exemplified when the  Communicating with a patient through a community health nurse records data at teleconference, electronic mail (e-mail), short the point-of-care or when it happened. message service (SMS). 6. Definition. Data should be properly  Recording, retrieving, and mining data in an labeled and clearly defined. For example, electronic medical record (EMR). 36 is just an ordinary number unless it is  Providing patient teachings with the aid of labeled as an age of a person. electronic tools such as radio, television, computers, smartphone, and tablets. eHEALTH SITUATION IN THE PHILIPPINES  eHealth, often confused with telehealth or telemedicine, is  The developing world suffers from inadequate the overall, umbrella term. According to the WHO, eHealth health care and medical services. Lack of health encompasses three main areas: care professionals and infrastructure contributes  The delivery of health information, for health to this problem, making it more difficult to deliver professionals and health consumers, through the health care to people in rural and remote Internet and telecommunications. communities of the developing world (IDRC,  Using the power of information technology (IT) 2009). and e-commerce to improve public health services, for example, through the education and training of health workers.  The use of e-commerce and e-business practices in health systems management.   The ubiquity of mobile technologies and availability of Telemedicine Internet services in the Philippines create a promising  A specific example of how telemedicine was ground for eHealth access. In 2001, roughly 2.5% of the applied in the community was the discovery of a country's population had Internet access. In the span of rare skin disease called tinea imbricata in a tribe 10 years, this rate steadily increased to 29% from Kiamba, Saranggani in Mindanao. The (International Telecommunications Union, 2011). The Municipal Health Office of Kiamba, Saranooani Philippines has also a mobile phone penetration rate of referred multiple cases of strange, ring-like 80%, with 73 million subscribers as of 2009 formations on a patient's skin. Images were sent to  In addition, the country is ranked first in terms of short the UPM-NTHC telehealth nurse and were referred messaging services (SMS) usage in the entire world to a dermatology specialist at the Philippine (BusinessWire, 2010). ICT has changed how Filipinos General Hospital, who gave the initial diagnosis of access information and how the government has utilized tinea imbricata—which has only been reported in this to inform its citizenry. Examples of these include the Philippines three times since 1789. The regular updates of traffic conditions, current events, and recommended treatment was effective. Case critical weather reports through various social media. finding for patients with a similar condition sought. The health sector has also begun utilizing ICT to improve its This eventually led to a medical mission by the services. The DOH has introduced a number of health dermatology specialist and her fellow information systems that aim to improve the access of health dermatologists in cooperation with the local data, such as the Electronic Field Health Service Information government of Kiamba to help the patients System (DOH, 2012b), Online National Electronic Injury affected by the disease. Surveillance System (DOH, 2012c), the Philippine Health Atlas, E-learning and the Unified Health Management Information System  Health education is essential in health promotion (DOH, 2012d). and maintenance can be facilitated by ICT. Formula plus one and ICT eLearning is basically the use of electronic tools to  Guide by the Philippines eHelath Strategic Plan for aid in teaching. It can be done synchronously, Universal Health care as embodied in the DOH Strategic asynchronously, or in a combination of both. This Framework and Policy, “Formula 1 Plus: Boosting can be in the form of simple instructional videos Universal Heath Care” one of the identified policy and and information text blasts to social network help strategic activities to help drive timely, evidence- groups and interactive simulations. eLearning can informed, data-driven decision is through the be especially useful in correcting misconceptions implementation of the National eHealth Electronic about health and health care. Health Record System Validation (NEHEHRSV). Electronic medical records  EMRs are basically comprehensive patient records that are stored and accessed from a computer or server. Community health centers have the capacity to rapidly adapt EMRs because they utilize a standard process nationwide. For example, the workflow with a patient at a health center in Quezon City is basically the same as that of a health center at Batanes.  EMR systems also allow computerized processing of indicators, making it easier for nurses to focus on other important aspects of health care. One of the most widely used community- based EMR in the country is CHITS, which began in 2004 and was funded by the International Development Research Centre (IDRC). Telemedicine  This in order to reach and provide better health services to geographically isolated and disadvantaged areas (GIDAs)  The WHO defines telemedicine as, "the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for ROLES OF COMMUNITY HEALTH NURSES IN ehealth the continuing education of health care providers, all in  Community health nurses' roles are significantly the interests of advancing the health of individuals and diversified by eHealth. With the advent of eHealth, their communities nurses are made available to several clients at a  WHO further underscores four elements that are single time, making health care delivery more specific to telemedicine: efficient. The following are the major roles of an 1. Its purpose is to provide clinical support eHealth nurse in the Philippine community setting: 2. It is intended to overcome geographical barriers, connecting users who are not in the same physical location. 3. It involves the use of various types of ICE. 4. Its goal is to improve health outcomes.  Data and records manager: MODULE 7 CURRENT TRENDS IN PUBLIC HEALTH - As data and records managers, community (GLOBAL AND NATIONAL) health nurses monitor the trends of diseases through the EMR, allowing for targeted Introduction: interventions for health promotion, disease A. Role of a Community Health Nurse in the National and prevention, curative services, or rehabilitation. Global Health Care Delivery System Nurses also maintain the quality of data inputs in the EMRs, making sure that information is GLOBAL accurate, complete, consistent, correct, and o With a total of approximately 3 million registered current. Nurses also participate in regular data nurses (RNs) in the United States, these professionals audits. play a prominent role in healthcare throughout the  Change agent country. - Nurses act as change agents by working closely o They factor even more significantly into healthcare with the community and implementing eHealth delivery throughout the world, with an extremely with them and not for them. Change agents do significant number of about 32 million nurses across not force technology on the community, but the planet. inform and guide the community in selecting o Nurses provide about 90 percent of healthcare services and applying appropriate ICT tools. in the world, and for that, they deserve intense - Change agents also collaborate with health appreciation. With those statistics in mind, here is a leaders, policy makers, stakeholders, and other look at global nursing as it currently stands. community health professionals to determine The Nurse's Worldwide Role their knowledge and awareness on eHealth and appropriate ICT tools. Nurses then build on the o A world without nurses is almost impossible to imagine. baseline eHealth knowledge and help develop Everywhere you turn, nurses are there to provide appropriate eHealth tools for the community. leading-edge treatments to patients from all walks of  Educator life. - Nurses provide health education to individuals o Nurses work in various settings, including wellness and families through ICT tools. They may also clinics, hospitals, schools, churches and businesses, and participate in in making eLearning videos on they work with people throughout the lifespan. specific diseases (e.g diabetes mellitus, Why Nurses Matter in Global Health tuberculosis), which the patient can watch  In the United States, nurses have a rather clearly during their waiting time at health centers. defined role. However, in many locations throughout  Telepresenter the world, there are not enough doctors available to - In the event that a patient needs to be provide the care that people need. referred to a remote medical specialist through  Luckily, there are nurses, and if it were not for them telemedicine, nurses may function as a these individuals would not receive any healthcare telepresenter. This means that the nurse may services at all. need to present the patient's case to a remote  Nurses make a major contribution by addressing medical specialist, noting salient points for case various health issues. Here is a short list of service assessment, evaluation, and treatment. This situations or issues nurses might face: usually occurs via a teleconference. a. Birth and Delivery: In various remote areas  Client advocate such as in rural Africa, there is not enough - As client advocates, community health money to pay a doctor who can set up a safeguard patient records, ensuring security, practice. Or there may be other obstacles to confidentiality, and privacy of all patient having a local doctor. Fortunately, nurse- information are being upheld. midwives are excellent in the role of caring for  Researcher mothers before, during and after childbirth. - Using eHealth tools (e.g., EMRs), patient b. Primary Care: Also in rural, remote or records can easily be retrieved and analyzed poverty-stricken areas, physicians may not be retrospectively by community eHealth nurses. available to provide primary care services, and They are responsible for identifying possible nurses are there to deliver many of those points for research and developing a services. One challenge these areas face is that framework, based on data aggregated by the the health conditions people have are often system. more complex and difficult to treat. c. Cholera: Illnesses and diseases we rarely encounter in the U.S. can be problems in certain other areas of the world. For example, cholera is an issue in Haiti, so nurses there get the chance to help numerous people with that disease. d. Tuberculosis: Nurses in Peru have been able to develop a program with the world's highest cure rates for drug-resistant tuberculosis.  Partnerships and Collaboration Why is it important for health care workers, especially nurses, to have education and training in  It is wonderful to see medical centers in various areas disaster preparedness and emergency response? of the world collaborate. Here are two examples of  As nurses comprise the largest component of the innovative and resourceful partnerships: health care workforce, should a disaster occur, it is o The Dana-Farber Cancer Institute in the U.S. is working inevitable that nurses will be caring for those to create a nursing oncology partnership with an victims and patients. It is important that they are organization in Rwanda. Oncology nurses from the U.S. trained and have the knowledge and skills to will work directly with Rwandan doctors and nurses to respond, whether they are caring for someone on share knowledge. the front lines of the disaster or in a hospital. o Regis College in the U.S. is working with the Haitian What can they do to protect themselves against Ministry of Health and PIH to address the shortage of risk? nursing education in that country. The end result will  One of the first things is having enough proper PPE be a three-year master's program for Haitian nurses. to use while working. Health care workers are Nurses are leaders who make a positive difference by implementing other strategies to help protect advocating for health and providing healthcare throughout the themselves against risk, including changing out of world. In many instances, despite their incredibly huge and their work attire before entering their homes, generous contribution across the globe, nurses are treated showering as soon as they get home, and many almost as though they are invisible. They deserve to have a health care providers are also isolating themselves prominent voice when world leaders get together to address into a separate room of their home, away from health issues and develop national and international policies. other family members to try to protect their family They also need more resources, such as for mentorships, members as best they can. And of course, leadership and nurse education. One way of receiving meticulous handwashing! additional education and preparation is through online programs, and an online RN to BSN program is ideal for CHAPTER 8: FILIPINO CULTURE, receiving high-quality education in an efficient way. VALUES AND PRACTICES IN RELATION People who believe in the value of nursing should remind as TO HEALTH CARE OF INDIVIDUAL AND many people as possible, as often as possible, about the value FAMILY that nurses bring to the world. We need to advocate for nurses having a greater voice on the world stage. Their contributions COPING STYLES to healthcare are already spectacular, but when they have a Coping styles common among elderly Filipino in times of bigger platform, who knows how far they can go? illness or crisis include: 1. Patience and Endurance (Tiyaga): the ability to NATIONAL tolerate uncertain situations The role of nurses in the COVID-19 pandemic: 2. Flexibility (Lakas ng Loob): being respectful and What roles do nurses play in mitigating the spread of honest with oneself infectious diseases? Why and how are they important in 3. Humor (Tatawanan ang problema): the managing a health crisis such as a pandemic? capacity to laugh at oneself in times of adversity  Nurses are important in managing a health crisis 4. Fatalistic Resignation (Bahala Na): the view because they are a vital link between the patient and that illness and suffering are the unavoidable the rest of the health care team. and predestined will of God, in which the  They are with their patients for their whole shift, and patient, family members and even the through assessment and critical thinking are able to physician should not interfere notice subtle changes in their patients that could indicate they are decompensating or getting worse, or “Seeking medical advice from family members or friends getting better. who are health professionals is also a common practice  They are able to determine the human response to the among Filipino older adults and their family members, medical problem. Nurses relay their assessment especially if severe somatic symptoms arise.” findings to providers, they are able to determine if respiratory therapy needs to be called, they are able to Health Beliefs and Behaviors: Indigenous Health assess the patient’s response to medical treatments, Beliefs and they educate the patients, along with providing a  This concept is central to Filipino self-care practices listening ear or a calming touch. and is applied to all social relationships and encounters. What have you heard from your fellow nurses working  Health is thought to be a result of balance, while in hospitals about their workload and expectations? illness due to humoral pathology and stress is usually the result of some imbalance.  The patients they are seeing are sick, very, very sick.  Rapid shifts from “hot” to “cold” cause illness and This virus is impacting everyone. Many of the disorder. patients they are caring for are younger patients and they are just as sick, requiring ICU care and intubation.  HUMORAL BALANCES THAT INFLUENCE FILIPINO HEALTH PERCEPTIONS Health Promotion/Treatment Concepts  Rapid shifts from “hot” to “cold” lead to illness  “Warm” environment is essential for maintaining  FLUSHING: The body is thought to be a vessel or optimal health container that collects and eliminates impurities  Cold drinks or cooling foods should be avoided in the through physiological processes such as sweating, morning vomiting, expelling gas, or having an appropriate  An overheated body is vulnerable to disease; a heated volume of menstrual bleeding. body can get “shocked”  HEATING: Adapts the concept of balanced between  When cooled quickly, it can cause illness “hot” and “cold” to prevent occurrence of illness and  A layer of fat maintains warmth, protecting the body’s disorders. vital energy  PROTECTION: Safeguards the body’s boundaries  Imbalance from worry and overwork create stress and from outside influences such as supernatural and illness natural force  Emotional restraint is a key element in restoring  RESPONSE TO ILLNESS balance - Filipino older adults tend to cope with illness with  A sense of balance imparts increased body awareness the help of family and friends, and by faith in God. (Adapted from Becker, 2003 - Complete cure or even the slightest improvement in a malady or illness is viewed as a miracle. - Filipino families greatly influence patients’ HEALTH BELIEFS AND BEHAVIORS: THEORIES OF decisions about health care. ILLNESS - Patients subjugate personal needs and tend to go  Mystical Causes: Mystical causes are often attributed along with the demands of a more authoritative to experiences or behaviors such as ancestral family figure in order to maintain group harmony. retribution for unfinished tasks or obligations. Some believe that the soul goes out from the body and Health Superstitions wanders, a phenomenon known as Bangungot, or that ✔ Get rid of a hiccup by placing a short thread wet having nightmares after a heavy meal may result in with saliva on the forehead. death.  Several factors can cause hiccups, including  Naturalistic Causes: Naturalistic causes include a host swallowing air and eating or drinking too much or of factors ranging from natural forces (thunder, too fast. lightning, drafts, etc.) to excessive stress, food and  Bite on a slice of lemon, slowly sip ice-cold water drug incompatibility, infection, or familial while placing gentle pressure on your nose as you susceptibility. swallow, or hold your breath for a short time  Personalistic Causes ✔ By showing fondness or affection when meeting a - Personalistic causes are associated with social baby for the first time, you may cause the baby to punishment or retribution from supernatural feel uneasy or make the baby cry non-stop which is forces such as evil spirit, witch (Manga ga mud) or commonly referred to as "na-usog." sorcerer (mangkukulam).  To avoid passing the negative energy and cure - The forces cast these spells on people if they are the infant of usog, superstition practice says jealous or feel disliked. Witch doctors (Herbularyo) you must dab your saliva on the baby’s or priests are asked to counteract and cast out forehead or abdomen. Often, most people these evil forces through the use of prayers, would also greet the child by saying “pwera incantations, medicinal herbs and plants. usog” meaning for protection from the hex. - For protection the healer may recommend using ✔ Hitting the sack right after a shower is believed to holy oils, or wearing religious objects, amulets or cause blindness and insanity. talismans (anting anting).  Rubbing wet hair against your pillow can cause hair damage o breakage. The friction Filipino families greatly influence patients’ decisions about will also lead to you having to deal with a bad health care. Patients subjugate personal needs and tend to go hair day the next morning along with the demands of a more authoritative family figure ✔ Washing sweat hands can lead to spasmodic hands in order to maintain group harmony. or pasma. Before seeking professional help, Filipino older adults tend to  Hand tremors, sweaty hand numbness, and manage their illnesses by self-monitor