BALSARZA, KRISHNA B. BSN-4 October 4, 2013

N107A QUIZ

A. Discuss the comprehensive community diagnosisA comprehensive community diagnosis aims to obtain general

information about the community with the intent of determining not only prevalent health conditions and risk factors (epidemiologic approach) but also the socio-economic conditions (socio-economic approach) and lifestyle behaviours and attitudes that have effect on health (behavioral approach).

The following are elements of a comprehensive community diagnosis and the basic data that are needed to characterize each variable:

A. Demographic VariablesThe analysis of the community’s demographic characteristics should show the size, composition and geographical distribution of the population as indicated by the following:

1. Total population and geographical distribution including urban-rural index and population density

2. Age and sex composition3. Household size4. Selected vital indicators such as growth rate, crude death

rate and life expectancy at birth5. Patterns of migration6. Population projections

It is also important to know whether there are population groups that need special attention such as indigenous people, internal refugees and other socially dislocated groups as a consequence of disasters, calamities and development programs.

B. Socio-Economic and Cultural VariablesThere are no limits as to the list of socio-economic and cultural factors that may directly or indirectly affect the health status of the community. However, the nurse should consider the following as essential information:

1. SOCIAL INDICATORSa) Educational level which may be indicative of poverty

and may reflect on health perception and utilization pattern of the community

b) Housing conditions which may suggest health hazards (congestion, fire, exposure to elements)

c) Social classes or groupings

2. ECONOMIC INDICATORSa) Poverty level income

b) Unemployment and unemployment ratesc) Proportion of salaried and wage earners to total

economically active populationd) Types of industry present in the communitye) Occupation common in the communityf) Communication network (whether formal or informal

channels) necessary for disseminating health information or facilitating referral of clients to the health care systems

g) Transportation system including road networks necessary for accessibility of the people to the health care delivery system

3. ENVIRONMENTAL INDICATORS

a) Physical/ geographical/ topographical characteristics of the community

Land areas that contribute to vector problems Terrain characteristics that contribute to

accidents or pose as geohazard zones Land usage in industry Climate/ season

b) Water supply %population with access to safe, adequate

water supply Source of water supply

c) Waste disposal %population served by daily garbage collection

system %population with safe excreta disposal system Types of waste disposal and garbage disposal

systemd) Air, water and lad pollution

Industries within the community having health hazards associated with it

Air and water pollution index

4. CULTURAL FACTORSa) Variables that may break up the population into

groups within the community such as: Ethnicity Social class Language Religion Race Political orientation

b) Cultural beliefs and practices that affect health

c) Concepts about health and illness

C. Health and Illness PatternsIn analyzing the health and illness patterns, the nurse may collect primary data about the leading causes of illness and deaths and their respective rates of occurrence. If she has access to recent and reliable secondary data, then she can also make use of these:

1. Leading causes of mortality2. Leading causes of morbidity3. Leading causes of infant and child mortality4. Leading causes of infant and child mortality5. Leading causes of maternal mortality6. Leading causes of hospital admission7. Leading causes of clinic consultation8. Nutritional status

D. Health ResourcesThe health resources that are available in the community are an important element of the community diagnosis mainly because they are the essential ingredients in the delivery of basic health services. The nurse needs to determine manpower, institutional and material resources provided not only by the state but those which are contributed by the private sector and other non-government organizations.

1. Manpower resources Categories of health manpower available Geographical distribution of health manpower Manpower-population ratio Distribution of health manpower according to type of

organization (government, non-government, health units, private)

Quality of health manpower Existing manpower development/policies

2. Material resources Health budget and expenditures Sources of health funding Categories of health institutions available in the community Hospital bed-population ratio Categories of health services available

E. Political/Leadership PatternsThe political and leadership pattern is a vital element in achieving the goal of high level wellness among the people. It reflects the action potential of the state high level wellness among the people. It reflects the action potential of the state and its people to address the health needs and problems of the

community. It also mirrors the sensitivity of the government to the people’s struggle for better lives.

In assessing the community, the nurse describes the following:1. Power structures in the community (formal or informal)2. Attitudes of the people toward authority3. Conditions/ events/ issues that cause social conflict/ upheavals or that

lead to social bonding or unification.4. Practices/ approaches effective in setting issues and concerns within

the community.

B. What are the phases of community diagnosis? Explain each

1. InitiationIn order to initiate a community diagnosis project, a dedicated committee or working group should be set up to manage and coordinate the project. The committee should involve relevant parties such as government departments, health professionals and non-governmental organisations.

At an early stage, it is important to identify the available budget and resources to determine the scope of the diagnosis. Some of the common areas to be studied may include health status, lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure, inequalities, as well as public health services and policies.Once the scope is defined, a working schedule to conduct the community diagnosis, production and dissemination of report should be set.

2. Data collection and analysisThe project should collect both quantitative and qualitative data. Moreover, Population Census and statistical data e.g. population size, sex and age structure, medical services, public health, social services, education, housing, public security and transportation, etc. can provide background of the district. As for the community data, it can be collected by conducting surveys through self-administered questionnaires, face to face interviews, focus groups and telephone interviews.

In order to ensure reliability of the findings, an experienced organisation such as an academic institute can be employed for conducting the study. The sampling method should be carefully designed and the sample size should be large enough to provide sufficient data to draw reliable conclusions. Therefore, study results derived can truly review the local community.

Collected data can then be analysed and interpreted by experts. Here are some practical tips on data analysis and presentation:

- statistical information is best presented as rates or ratios for comparison

- trends and projections are useful for monitoring changes over a time period for future planning

- local district data can be compared with other districts or the whole population

- graphical presentation is preferred for easy understanding

3. DiagnosisDiagnosis of the community is reached from conclusions drawn from

the data analysis. It should preferably comprise three areas:- health status of the community- determinants of health in the community- potential for healthy city development

4. DisseminationThe production of the community diagnosis report is not an end in itself, efforts should be put into communication to ensure that targeted actions are taken. The target audience for the community diagnosis includes policy-makers, health professionals and the general public in the community.

The report can be disseminated through the following channels:- presentations at meetings of the health boards and committees, or forums organised for voluntary organisations, local community groups and the general public- press release- thematic events (such as health fairs and other health promotion programmes)

C. Differentiate health problem with nursing problem. Give one example each.

Health Problem – refers to health deficits (diagnosed or not), health threats or foreseeable crisis identified during the assessment process

Example: threat of cross infection from a communicable disease; malnutrition, pregnancy.

Nursing Problem- Relate to the family’s inability to assume one or more health task with respect to a particular health problem. For each health problem, write the nursing problem, specifying the major and contributory causes. NURSING PROBLEM

Inability to recognize the presence of malnutrition in a preschool

member due to ignorance about the facts of the condition

HEALTH PROBLEM

MALNUTRITION

D. Using the criteria in identifying problem and prioritizing compute 3rd degree malnutrition

SCALE RANKING HEALTH CONDITIONS AND PROBLEM ACCORDING TO PRIORITIES

Problem: 3rd degree malnutrition

FORMULA: (score/highest score) x weight

CRITERIA COMPUTATION TOTAL SCORE JUSTIFICATIONNature of the condition or Problem presented

2/3x1 2/3It is a health threat

Modifiability of the condition or problem ½ x2

1

They can provide somehow but still lack

Preventive potential 2/3x1 2/3It can be prevented somehow but resources are limited.

Salience of the problem

2/2x1 1

The family sees it as a problem that requires immediate attention

TOTAL: 3 1/3 E. Discuss the phases of community organizing

A. Pre-entry Phase - This phase is also known as project site selection. The conduct of preliminary social analysis of the community is needed to be able to plan the most effective way of entering the community.

1. Preparation of criteria and guidelines for area selection

Criteria for selectiona. Local leaders and community are receptive/supportive - this is most important for sustainability b. Community organizing can serve as a model for our SELECTED PROGRAMS - this is important for replication by others

c. Area must have relatively high prevalence of diseases but not necessarily the highest - this is important for optimum use of limited resources

Phases in guidelines preparationa. Piloting - standardization of basic activities and tools based on small-scale implementation of project - identifying contacts - core group formation - start-up activities

b. Implementation of activities - standardization of comprehensive line of activities for large scale implementation - KAP surveys - development of advocacy/IEC materials (workshop/trimedia/production) - community organizing - training of health workers - building of family competencies - mass treatment - monitoring and evaluation

2. Identification of target area - the possible target area must be able to provide information relevant to the criteria provided.

3. Assessment of target area - conduct community profile to have an initial impression of the barangay based on the criteria set. It will also serve as a means to get to know other people in the area and to identify contacts.

B. Entry Phase - This is also known as social preparation of the community. It is considered crucial because the success of later activities depend largely on the community organizer's (CO) extent of integration with the people, her/his understanding of the events in the community, and how she/he is identified by the people.

1. Establishment of links with leaders and agencies - give formal recognition of the role of local authorities by paying them a visit to inform them of the activities to be done.

2. Immersion

Selecting a host family In general, a CO is more effective if she/he lives with the people in the project site. By living there, the CO acquires a deeper knowledge of the objective conditions of the community, and integration is facilitated.

There are 4 main activities that are interrelated and simultaneously carried out to be totally immersed in the community.

Integration with the community

Community integration is the process of establishing rapport with the people in a continuing effort to imbibe community life by living with them and undergoing the same experiences, and sharing their hopes, aspirations, and hardships toward building mutual trust and cooperation.

Community integration involves:• Participating in community activities• Conducting house to house visits or social calls• Conversing with people in places where they usually converge

b. Identification of potential leadersPotential leaders are considered future community organizers and managers of community-based programs. They are the people who will also be the foundations of the community organization.

c. Information campaign on SELECTED PROGRAMS• Discussions during house to house visits• Small group discussions/focus group discussions• Purok meetings and community assembliesd. Provision of basic health services• Responding to immediate health-related needs • Problems of the community may already be identified

3. Agreement - A partnership agreement is sealed by the members of the community to develop their own initiative and dynamism. 4. Direction setting - it involves the preparation of specific plans, schedules, and working arrangements with the community regarding SELECTED PROGRAMS. This activity takes the form of a community assembly attended by the Proponent, the LGU representatives, the RHU based on the project site, and the members of the community.

C. Helping Phase - This is also known as community involvement. This covers gathering data and encouraging people to identify and analyze their needs and problems.

Community profiling and analysisThere are four major activities in developing an accurate profile and analysis of the community.

a. Collection of primary data through surveys • Accessibility - access to and from the town proper • Socio-economic characteristics - means of livelihood, peace and order situation, and population of indigenous groups • Facilities and infrastructures - types of facilities and infrastructures, the presence of electricity and communication facilities, when and how these were established, their users, and problems encountered

• Access to service - groups and agencies that are providing service, and the type and frequency of the service they provide • Community organizations - organizations in the barangay, their projects, activities, and organizational set-up • Health status - common and endemic diseases, causes and management, maternal and child-care practices, sources of water, waste and disposal, as well as dietary patterns • Participation of women in development activities

b. Walk-through of the community - To familiarize with their area's physical features. A spot map is the output of the activity.

c. Collection of secondary data through interviews/review of records • Background data and map

• Barangay population by sex and age• Household size• Health status

• Health manpower• Health facilities

• Educational institutions• School enrollment

d. Data analysis

• Problem identification- distinguishing problem from cause or need

- distinguishing effect of the problem- distinguishing need from "want" • Prioritizing the problem

- urgency of the problem- severity or seriousness of the problem- percentage of the population affected

· Problem analysis- cause and effect of the main problem

• Strategizing - cause are translated to strategies or means to deal with the problem

SWOT AnalysisStrengths: like human/material resources

Weaknesses: like lack of trained manpowerOpportunities: like support from LGUs, NGOs, GOs

Threats: like implementation problem

2. Core group formation - Formation of groups who will organize the community, develop and sustain planned activities after phase out

3. Community planning - Formulation of measures to address the problem in a systematic and sequential process (Please refer to chapter IV for more details on community health plan)

4. Implementation - Series of activities designed to address concerns that affect the health and lives of the people in a community; this is consistent with the community health plan

5. Monitoring and evaluation - It is needed not only to improve particular actions for specific settings but also to gain knowledge for expanded action. It also requires innovative use or reformulation of existing methods and tools not previously given much attention.

D. Phase out - This phase could mean that a program is already community- managed. Facilitators (or outsiders) withdraw from self-reliant groups who will now continue to implement the cycle of direction setting, organizing, planning, implementation, and review for the benefit of the community members.

Determining factors to ensure sustainability1. Structure. It refers to the organizational structures both in the partnerships and in the communities. The capability of the people and the viability of the organization as a whole will greatly influence sustainability.2. Skills development and technology transfer. The skills required to carry out the project activities must be fully developed and integrated in the partnership before the end of the project life. This should be preserved in the memory of the organization which eventually will help sustainability.

3. Systems. It includes the systems and procedures needed to formulate policies, plan, and make decisions on the day-to-day operation of the system. Consensus among the members and their responsiveness to the changing times will determine the prospects of sustainability.

4. Commitment. Participation in planning and decision making fosters greater commitment in the community. This is because it gives community members a true sense of ownership of the program as well as a sense of self-respect that flows from self-governance.

When to phase out1. When the objectives have been attained 2. When the impact of the project has become visible or change has been made 3. When the members of the community can take over the planning, implementation, monitoring, and evaluation of the project 4. When the community resources can already be maximized by the people 5. When a viable community-based organization has been established

Phase out strategy1. Conduct of an impact assessment 2. Preparation of a comprehensive phase out action plan 3. Gradual pull-out of intervention 4. Institutionalization of the community organization with other agencies who provide support 5. Provision of consultancy services

Steps in phase out1. Determine factors to ensure sustainability 2. Determine when to phase out 3. Identify which strategy plans to phase out

F. What are the importance of community participation?

When people are involved and participate in an activity, they develop a sense of ownership and responsibility, which helps to sustain initiatives, activities and programmes. It also has the following benefits:

Increased availability of resources as community members willingly contribute time and resources to what they consider to be their own initiatives and activities.

A sense of unity among community members.

Increasing confidence as the successes of their contributions are registered.

People are empowered to exercise their skills, talents and develop their potential.

Behaviour change will be quicker and easier.

Controlling harmful traditional practices becomes easier.

G. Explain the basic health services offered by the government in the community

A.) COMPREHENSIVE MATERNAL AND CHILD CARE PROGRAMS

OBJECTIVES:

To improve the well-being of mothers andchildren through thedelivery of Comprehensive maternal and child related services utilizing the Primary Health Care (PHC) approach.

Reduction of maternal mortality & infant mortality.

1) Maternal Care/Safe MotherhoodProgram•Target Clients– pregnant women- safety of the mother and the child. Services during the Pre-natal visits:

Physical examination- Laboratory examination (urinalysis &hemoglobin det.)Giving of iron or ferrous sulfateTetanus Toxoid ImmunizationCounseling on proper nutrition, prenatal &neonatal care, proper hygiene, breastfeeding, Earlypsycho-social stimulation of the baby, etc

Schedule of Pre-natal visits in thehealth centers1st to 7 th month  – once a month8th month  – twice a month9th month - weekly

2) Family Planning/Reproductive Health Program•Target clients –women of reproductive age (WRAs) aged 15-49 years old.

Helping couples achieved their desired family size in the context of responsible parenthood.Health intervention program of DOH to promote overall health of women &childrenContributes to the reduction of maternal &infant deaths in the country

Services:-FP counseling-Physical examination-Provision of FP methods usingcafeteria approach.

O FP Methods-Permanent ( Vasectomy and BilateralTubal Ligation)- Temporary ( pill, iud,dmpa/injectables, condom, fertilityawareness- based methods)

3) BREASTFEEDINGPROGRAMPROMOTION OF EXCLUSIVEBREASTFEEDINGSTRENGTHENED THE MILK CODE(Executive Order No. 51

4) Expanded Program on Immunization(EPI)OBJECTIVE: To reduce morbidity & mortality among infants and children

caused by the 7 childhood immunizable diseases:diptheriapertussismeasles

hepatitis Btetanus

tuberculosispolio

A Fully Immunized Child (FIC) in EPIshall mean a child who has 1 BCG,3DPT,3 OPV,3 Hepa B & 1 MV given atthe right intervals by the time hereaches 12 months old (revised in1996)Wednesday is International Immunization Day.

5)Under Five Care Program Package of care services given to 0-71months old children. (0-5 years

old)Services:Newborn screeningImmunization

 Vitamin A Supplementation100,000 IU Dental check-upStrategies:

Use of mosquito netsResidual sprayingScreening of housesUse of  protective clothing amongplantation workers elimination of mosquito

breeding places.Mass Treatment

Strategies:Use of mosquito netsResidual sprayingScreening of housesUse of  protective clothing amongplantation workers elimination of mosquito

breeding places.

Mass TreatmentTarget Clients: 0-71 months old children, pregnant andlactating

mothers.OBJECTIVE:Decrease the prevalence of malnutrition among our children

&pregnant/lactating mothers.Classification of Nutritional Status based on InternationalReference Standard (IRS) :

Very Low Below Normal8) Control of Diarrheal Diseases (CDD)

Diarrhea– is the passing out of loose or watery stool 3 or more times aday. It is mainly caused by germs that enter the body through themouth. 7 out 10 cases are caused by a virus, therefore no drugs andantibiotics are necessary.

Prevention of Dehydration: 3 FsFluids (Oresol/Home Mad Feeding (  continue breastfeeding)Fast Referrals (health facilities)

A CHILD HAS SIGNS OF DEHYDRATION IF HE HAS ANY 2OF THE FOLLOWING:- passes out stools 3 or more times a day.- very thirsty- has sunken eyes/no tears when crying- fever- the skinfold remains raised for a few seconds when pinched- sleepy and irritable- has blood in stool

B ) C O M M U N I C A B L E   & NON-COMMUNICABLEDISEASES

9) NATIONAL TUBERCULOSISCONTROL PROGRAMInfectious disease usually affecting the lungs caused by Mycobacterium

tuberculosis.

Transmitted from TB patients through coughing. Most common sign is cough lasting for 2weeks or more.

Diagnosed through sputum examination (microscopy)

Strategy: Directly Observed TreatmentShort Course Chemotheraphy(TB-DOTS)WhatDOTScan do?

Will cure TB patients (high cure rate as high as 95%)Prevents new infections among children& adultsPrevents resistance to Anti-TB DrugsNo hospitalization requiredSaves money

10) LEPROSY CONTROL PROGRAMDisease affecting the skin caused byMycobacterium Laprae or Leprosy Bacilli.

Treatment & Management of Leprosy

 Multi-Drug Therapy 

Benefits of Early Treatment:1.Cured within a shorter period2.Will not be able to infect other susceptible membersof the household3.Prevent the progress of skin lesions in the body.4.Prevent nerve damage leading to deformities.5.Prevent relapse & resistance to drugs11) Cardio-Vascular Disease ControlProgram

Healthy Life-Style Practices among Filipinosthru the promotion of the following:

Anti-SmokingProper DietRegular ExerciseIwas StressActivities:- Case finding –BP Taking- Referral

12) Cancer Control ProgramOBJECTIVE: Morbidity and mortality rates from cancer are reduced. Cancer largely considered a lifestyledisease.

Males –lungs, liver and prostateFemales- breast, cervix and lungsChildren- leukemias, lymphomas

Services:Counselling patient on:- tobacco use

cessation- diet modification & moderatealcohol consumptionCancer screeningBreast ExaminationPap smear screeningHepa B vaccination among infantsEstablish support care program for cancerpatients.

13) Renal Disease Control Program About 6500 yearly deaths in the countrysecondary to various kidney diseases.Risk Reduction Objectives:1.Increase awareness of preventing renal diseases:adequate water intake, healthy lifestylepractices, BP check-up, yearly urinalysis.2.Increase awareness of the signs & symptoms of kidney disease3.Increase the proportion of schoolchildren,adolescents, young adults routinely screened forUTI, diabetes and kidney disease.

Strategies & Services1)Increase referral of abnormalurinary findings to nephrologist forearly & adequate management &monitoring.2)Counseling of patients3)Upgrade capabilities of hospitals to cater to kidneypatients. 14) Diabetes Control Program

Diabetes- condition where there is pooractivity or decrease production of ahormone called insulin resulting in anincrease in blood sugar.-4 out of 100 Filipinos are diabetics-Higher in urban than in rural areas-63% are unaware that they had diabetes-No known cure for diabetes.

15) STI/HIV & AIDSServices;1 ) C a s e   F i n d i n g / C o n s u l t a t i o n2 ) R e f e r r a l3 ) H e a l t h E d u c a t i o n4 ) C o n t a c t T r a c i n g5 ) T r e a t m e n t

16) Rabies ControlProgram

Services:1) Massive Campaign onResponsible Pet Ownership2) Referral to Animal Bites Center3) Provision of Anti-rabies vaccines( 3 –5 doses)4) Health Education

C ) T R O P I C A L   D I S E A S E CONTROL PROGRAM

17) Dengue Control ProgramDengue - a viral infection characterized by suddenonset of fever which would last for 2 - 7 days.Types of dengue:1.dengue fever2.dengue hemorrhagic fever3.undifferentiated fever

Carriers:1) Aedes Aegypti - primary vector of the disease- prefers to breed indoor inartificial container.2) Aedes Albopictus - most common in ruralareas- secondary vector of dengue- prefers to breed outside

PREVENTION AND CONTROL:1.Environmental Management2.Biological control3.Chemical control4.Personal protection5.Space spray applications

18) Schistosomiasis Control ProgramSchistosomiasis is a tropicalparasitic disease caused by ablood fluke known as schistosoma japonicum

Prevention & Control:

Treatment of casesEnvironmental SanitationSnail ControlHealth Education

19)Malaria Control ProgramMalaria is a disease caused byprotozoa of genus plasmodium.Most of those affected are the upland farmers, miners, forest related

workers, IPs, soldiers

Activities/Strategies:1) PROMOTIVE

community health education2) PREVENTIVEtreated mosquito netsindoor residual sprayingseeding of streamsclearing of streamsother personal protection measures3) CURATIVEEarly diagnosis & prompt treatment4)  SUPPORT MECHANISMSSurveillanceEpidemiological Investigation

20) Filariasis ControlProgramFilariasis is a parasitic infection transmitted by a mosquito.

Two species of the  parasitethat cause filariasis:wuchereria & brugia malayi 

Strategies:Use of mosquito netsResidual sprayingScreening of housesUse of  protective clothing among plantation workers elimination of mosquito

breeding places.Mass Treatment