The Royal and Pontifical Catholic University of the Philippines

UNIVERSITY OF SANTO TOMAS COLLEGE OF NURSING

FORMAT OF DOCUMENTATION FOR COMMUNITY ORGANIZING

Title page and Cover Page

The Royal and Pontifical Catholic University of the Philippines

UNIVERSITY OF SANTO TOMAS

Espana, Manila

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

IN (Name of Community)

Presented to the

COLLEGE OF NURSING

In partial fulfillment of the requirements in

COMMUNITY HEALTH NURSING

By

Group 1 Section 1 Class 2020

(Name of Students)

Submitted to

(Name of Clinical Instructor)

(month, day,year of shifting)

Title Page

Abstract

Table of ContentsPage

Chapter 1: Introduction

A. Background

B. Statement of Objectives

C. Scope and Limitations

Chapter 2: Research Method

A. Action Research

B. Population

C. Instruments

D. Data Collection

E. Ethical Considerations

Chapter 3: Community Diagnosis

A. Setting of the Community

1. Description

2. Spot Map

3. Organizational Structure of the Community

B. Demographic Indices

1. Total population

2. Total families

3. Age and Gender

4. Civil Status

C. Socio-Cultural Indices

1. Educational Attainment

2. Religion

3. Place of Origin

4. Length of Residency

D. Economic Indices

1. Dependency Ratio

2. Sources of Income

3. Occupation

4. Monthly Income

5. Business Establishments

E. Health Indices

1. Medical Conditions

1.1 Pregnant and Post Partum women

1.1.1 Pregnant women without pre-natal check-up

1.1.2 Reasons of pregnant women without pre-natal check-up

1.1.3 Pregnant women without Tetanus Toxoid immunization

1.1.4 Pregnant women without Iron supplementation

1.1.5 Pregnant women without Vitamin A supplementation

1.1.6 Post-partum women with post-partum follow up

1.1.7 Reasons of post-partum women without post-partum follow up

1.1.8 Post-partum women without Tetanus Toxoid immunization

1.1.9 Post-partum women without Iron supplementation

1.1.10 Post-partum women without Vitamin A supplementation

1.2 Past Illness

1.2.1 Past illness without medical attendance

1.2.2 Reasons of families with past illness without medical attendance

1.2.3 Causes of Morbidity

1.3 Present Illness

1.3.1 Present illness without medical attendance

1.3.2 Reasons of families with present illness without medical attendance

1.3.3 Point Prevalence of Present Illness

1.4 Deaths

1.4.1 Deaths without medical attendance

1.4.2 Reasons of death without medical attendance

1.4.3 Causes of Mortality

1.4.4 Swaroops Index

1.4.5 Cause of death among Elderly

1.4.6 Cause of death among adult

1.4.7 Cause of death among 0-5 y/o

2. Family Planning Practices

3. Health Seeking Behavior

4. Primary Sources of Health Information

5. Infant Feeding Practices

6. Nutrition Status of Children aged 0-12 y/o

7. Deworming Status of Children aged 1 -12 y/o

8. Vitamin A Supplementation Status of Children aged 6 months-6 y/o

9. Immunization Status of Children 0- 15 months

F. Environmental Indices

1. House Ownership

2. Lot Ownership

3. Ventilation

4. Type of Housing

5. Electricity

6. Privacy

7. Food Storage

8. Water Supply

9. Excreta Disposal

10. Refuse Disposal

11. Insect and Vermin Control

12. Domestic Animals

G. Summary

H. Problem Identification and Analysis

1. Health Status

2. Health Resources

3. Health Related

I. Problem Prioritization

Chapter 4: Community Development Plan

A. HELPS Community Action Plan

1. Health

2. Education

3. Livelihood

4. Physical Environment

5. Socio-Cultural/Spiritual

B. Community Project Plan

C. Community Budget Plan

D. Health Education Plan

E. Organizational Structure of the Community Development Team

F. Committees and Functions of the Community Development Team

G. Minute Meeting of the Community Development Team

Chapter 5. Community Project Evaluation

A. Overview of the Project

B. Activities Done

C. List of Participants

D. Project Expense Report

E. Project Evaluation

1. Participants Evaluation

2. Community Development Team Evaluation

Chapter 6. Public Health Nursing Activities

A. Health Service Profile

Chapter 7. Conclusion and Recommendation

A. Conclusion

B. Recommendation

1. Community

2. Community Development Team

C. Students learning experiences, insights, or realization

Appendix

A. Communication Letters

B. Instruments

C. Financial Report

D. Photo Documentation

E. Gantt Chart of Activities

Curriculum Vitae

Chapter 1. Introduction:

A. Background (describe clearly community health nursing practice in the field of community organizing and substantiate the significant role of the nurse in building healthy communities using participatory action research)

B. Statement of Objectives of PAR

1. General Objectives (statement of the general outcome)

2. Specific Objectives (statement of the task or what are to be accomplished)

C. Scope and Limitation

(Describe the limitations or research barriers that exist in reference to the participants of research and population groups participated in the program, area of research, time of the study or implementation of the program that came across in the study. The limitation must be substantial, and may be methodological, practical, or ethical)

Chapter 2. Research Method

A. Action Research (describe what is Action Research)

B. Population (describe the characteristics of the participants involved in the action program e.g. children, elderly)

C. Instruments (specify and describe the instruments used in data gathering such as survey questionnaires, interview protocol, weighing scale, etc.)

D. Data Collection (describe how data is gathered in the community such as house to house survey, focus group discussion, scheduled interview as basis for planning program)

E. Ethical Considerations

Chapter 3. Community Diagnosis

A. Setting of the community

1. Description (describes the geographic boundaries from north to south and west to east direction; distance from manila, total population of municipality or barangay; type of neighborhood whether urban or rural, subdivision or slum area, residential or commercial; physical facilities like schools, church/chapel, health center or hospital, recreation, police station, communication facilities, public market, commercial establishments; climate; traffic patterns; means of transportation, natural resources available in the community; sources of pollution; energy and water sources)

2. Spot Map (construct a map of the barangay with the geographic boundaries following north, south, west, and east directions. Indicate in the map the houses surveyed, and the location of the facilities in the barangay such as the barangay hall, health center/RHU/ BHS/hospital, school, market, church, public faucet, police station, park, and other natural resources visible in the barangay)

3. Organizational Structure of the Community (make an organizational chart, indicate the name, position, and the photo of the members)

B. Demographic Indices

1. Total population

2. Total families

3. Age and Gender Distribution

(Table Title:)

AGE IN YEARS

M

%

F

%

N

%

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

TOTAL

3.1 Sex Ratio= Total of number of Males/Total number of Females x 100

Analysis:

3.2 Age Distribution

Analysis:

For the ANALYSIS of each category, explain the reason for the existence of the data, its implication to the community, advantages/disadvantages, and relationship with other data. Analysis should be in narrative form.

Indicate the Title of the Table at the top of each table: Percentage Distribution of Category, at Sitio (Name), Bgy. (Name), (Area) as of (Month), (Year).

3.3 Age and Sex Pyramid (Figure 1- Make a Population Pyramid)

(use color legend: male-blue, female-red)

(Graph Title)

Analysis: (describe the population pyramid in the barangay)

4. Civil Status (based on the number of population aged 15 y/o and above)

Table Title

CIVIL STATUS

N

%

Single

Married

Widowed

Separated

Live-In

TOTAL

Analysis:

C. Socio-Cultural Indices

1. Educational Attainment (based on the total number population aged 7 y/o and above)

Table Title

EDUCATIONAL ATTAINMENT

N

%

No Formal Education

Elementary Level

Elementary Graduate

High School Level

High School Graduate

Vocational

College Level

College Graduate

TOTAL

Analysis:

1.1 Literacy Rate= Number of Population who can read and write x 100

Total number of Population

Analysis:

2. Religion (based on the total number of father and mother)

Table Title

RELIGION

N

%

(ex. Catholic)

TOTAL

Analysis:

3. Place of Origin (based on the total number of father & mother)

Table Title

PLACE OF ORIGIN

N

%

(ex. NCR)

TOTAL

Analysis:

4. Length of Residency (based on the total number of father & mother)

Table Title

LENGTH OF RESIDENCY

N

%

(ex. less than a year)

(ex. 1-5 years)

TOTAL

Analysis:

D. Economic Indices

1. Dependency Ratio

Table Title

AGE OF DEPENDENTS

N

%

0-14 y/o

65 y/o and above

TOTAL

Dependency Ratio (DR) % = Total # of Population 0-14 yrs. Old + 65 yrs. Old and above x 100

Total # of Population 15 to 64 years old

Analysis:

2. Source of Income

Table Title

SOURCES OF INCOME

N

%

Employed

Self-Employed

TOTAL

Analysis:

3. Occupation

Table Title

OCCUPATION

N

%

(eg. Factory Worker)

TOTAL

Analysis:

4. Monthly Income

Table Title

MONTHLY INCOME IN PESOS

N

%

(eg. Less than 5,OOO)

TOTAL

Analysis:

5. Business Establishment

Table Title

BUSINESS ESTABLISHMENTS

N

%

(eg. Sari-Sari Store)

(eg. Canteen)

TOTAL

Analysis:

E. Health Indices

1. Medical Conditions

1.1 Pregnant and Post Partum Women

1.1.1 Pregnant women with and without Pre-natal check-up

Table Title

PREGNANT WOMEN

N

N

%

1ST

TRI

2ND

TRI

3RD

TRI

With Pre-Natal check-up

Without Pre-Natal check-up

TOTAL

Analysis:

1.1.2 Reasons of pregnant women without pre-natal check-up

Table Title

REASONS

N

%

(eg. Financial constraint)

(eg. Inaccessible health facility)

TOTAL

Analysis:

1.1.3 Pregnant women with and without Tetanus Toxoid (TT) immunization

Table Title

PREGNANT WOMEN

N

%

With Tetanus Toxoid immunization

Without Tetanus Toxoid Immunization

TOTAL

Analysis:

1.1.4 Pregnant women with and without Iron supplements (starting on 1st-3rd Tri)

Table Title

PREGNANT WOMEN

N

%

Taking Iron Supplements

Not Taking Iron Supplements

TOTAL

Analysis:

1.1.5 Pregnant women with and without Vitamin A Supplementation (within 2nd-3rd tri)

Table Title

PREGNANT WOMEN

N

%

Taking Vitamin A Supplements

Not Taking Vitamin A Supplements

TOTAL

Analysis:

1.1.6 Post-partum women with and without post-partum follow-up

Table Title

POST-PARTUM WOMEN

N

%

With post-partum follow up

Without post-partum follow up

TOTAL

Analysis:

1.1.7 Reasons of post-partum women without Post-Partum follow up

Table Title

REASONS

N

%

(eg. Financial constraint)

(eg. Inaccessible health facility)

TOTAL

Analysis:

1.1.8 Post-partum women with Tetanus Toxoid (TT) immunization

Table Title

PREGNANT WOMEN

N

%

With Tetanus Toxoid immunization

Without Tetanus Toxoid Immunization

TOTAL

Analysis:

1.1.9 Post-partum women taking Iron supplements (within 3 months)

Table Title

PREGNANT WOMEN

N

%

Taking Iron Supplements

Not Taking Iron Supplements

TOTAL

Analysis:

1.1.10 Post-partum women received Vitamin A supplements (within a month)

Table Title

PREGNANT WOMEN

N

%

Received Vitamin A Supplements

Did not received Vitamin A Supplements

TOTAL

Analysis:

1.2 Past Illnesses

1.2.1 Past Illnesses with and without medical attendance (for the last 5 years)

Table Title

DISEASES

WITH MEDICAL ATTENDANCE

WITHOUT MEDICAL ATTENDANCE

N

%

N

%

(eg. Hypertension)

(eg. Diarrhea)

TOTAL

Analysis:

1.2.2 Reasons of families with past illness without medical attendance

Table Title

REASONS

N

%

(eg. Financial constraint)

(eg. Inaccessible health facility)

TOTAL

Analysis:

1.2.3 Causes of Morbidity (identify the top ten causes of morbidity based on the number of history of past illness)

Table Title

DISEASES

N

%

1. (eg. Hypertension)

2. (eg. Diarrhea)

TOTAL

Analysis:

1.3 Present Illnesses

1.3.1 Present Illness with and without medical attendance

Table Title

DISEASES

WITH MEDICAL ATTENDANCE

WITHOUT MEDICAL ATTENDANCE

N

%

N

%

(eg. Hypertension)

(eg. Diarrhea)

TOTAL

Analysis:

1.3.2 Reasons of Families with present illness without medical attendance

Table Title

REASONS

N

%

(eg. Financial constraint)

(eg. Inaccessible health facility)

TOTAL

Analysis:

1.3.3 Point Prevalence (PP) % = Number of existing cases of disease at a particular point in time / Number of population at that point of time x 100 (Compute for the PP of the top 10 causes of morbidity based on Present Illness)

Table Title

DISEASES

N

PP (%)

1. (eg. Hypertension)

2. (eg. Diarrhea)

TOTAL

1.4.Deaths

1.4.1 Deaths with and without medical attendance (for the last 5 years)

Table Title

DISEASES

WITH MEDICAL ATTENDANCE

WITHOUT MEDICAL ATTENDANCE

N

%

N

%

(eg. Hypertension)

(eg. Diarrhea)

TOTAL

Analysis:

1.4.2 Reasons of Death Without Medical Attendance (for the last 5 years)

Table Title

REASONS

N

%

(eg. Lack of financial resources)

TOTAL

Analysis:

1.4.3 Cause of Death Rate (CDR) % = Total # of deaths due to a specific cause for the last 5 yrs./ Total number of population surveyed x 100 (Compute for the CDR of the top 10 causes of death in the barangay)

Table Title

DISEASES

N

CDR (%)

1. (eg. HPN)

(eg.12)

(eg. 35.1%)

TOTAL

Analysis:

1.4.4 Swaroops Index (SI) % = Total # of deaths age 50 y/o and above for the last 5 years / Total number of deaths for the last 5 years x 100

Analysis:

1.4.5 Causes of death among Elderly

Table Title

CAUSE OF DEATH

N

%

1. (eg. HPN)

(eg.12)

(eg. 35.1%)

TOTAL

Analysis:

1.4.6 Causes of death among adult

Table Title

CAUSE OF DEATH

N

%

1. (eg. HPN)

(eg.12)

(eg. 35.1%)

TOTAL

Analysis:

1.4.7 Causes of death among 0-5 y/o (age 0-5 y/o)

Table Title

CAUSES OF DEATH

N

%

1. (eg. Diarrhea)

(eg.12)

(eg. 35.1%)

TOTAL

Analysis:

2. Family Planning Practices (based on the number married females age 15-45 y/o)

2.1 Family Planning Acceptors

Table Title

FAMILY PLANNING

N

%

Acceptor

Non-Acceptor

TOTAL

Analysis:

2.2 Methods Used by Acceptor

Table Title

METHODS OF FAMILY PLANNING

N

%

(eg. Calendar)

TOTAL

Analysis:

2.3 Reasons of Non-Acceptor

Table Title

REASONS OF NON-ACCEPTOR

N

%

(eg. Decrease sexual satisfaction)

TOTAL

Analysis:

2.4 Reasons of Drop-Out

Table Title

REASONS OF DROP-OUT

N

%

(eg. Not effective)

TOTAL

Analysis:

2.5 Methods Used by Failure

Table Title

METHODS USED BY FAILURE

N

%

(eg. Condom)

TOTAL

Analysis:

3. Health Seeking Behavior of families (based on the number of families)

Table Title

HEALTH SEEKING BEHAVIOR

N

%

Traditional Healers

Health Center/RHU/BHS

Private Clinic

Public Hospital

Private Hospital

TOTAL

Analysis:

4. Primary source of health Information of families (based on the number of families)

Table Title

PRIMARY SOURCE OF HEALTH INFORMATION

N

%

Professional Health Workers

Non-Professional Health Workers

Family Members

Friends/Relatives

Mass Media

TOTAL

Analysis:

5. Infant feeding practices (for 0-1 y/o)

TYPE OF INFANT FEEDING

N

%

Breastfeeding

Bottle feeding

Mixed

TOTAL

Analysis:

6. Nutritional Status of Children (for 0-12 y/o)

Table Title

AGE

NUTRITIONAL STATUS BASED ON WT (Kg)

OVERWEIGHT

NORMAL

1st

2nd

3rd

N

%

N

%

N

%

N

%

N

%

N

%

Below 0-11 months

1-3 y/o

3-5 y/o

6-12 y/o

TOTAL

Analysis:

7. Deworming Status of Children for the last 6 months (for 1-12 y/o)

Table Title

AGE

WITH

WITHOUT

N

%

N

%

1-3 y/o

3-5 y/o

6-12 y/o

TOTAL

Analysis:

8. Vitamin A supplements received by Children for the last 6 months (for 6 months-6 y/o)

Table Title

AGE

WITH

WITHOUT

N

%

N

%

6 months 1 y/o

1-3 y/o

3-6 y/o

TOTAL

Analysis

9. Immunization Status of Children (for 0-15 months)

Table Title

VACCINES

DOSES

WITH

WITHOUT

1

2

3

N

%

1

2

3

N

%

N

%

N

%

N

%

N

%

N

%

N

%

BCG

DPT

OPV

Hepa B

Hib

Rotavirus

AMV

MMR

TOTAL

Analysis:

F. Environmental Indices

1. Home Ownership

Table Title

HOME OWNERSHIP

N

%

Owned

Rented

Free

TOTAL

Analysis:

2. Lot Ownership

Table Title

LOT OWNERSHIP

N

%

Owned

Rented

Free

TOTAL

Analysis:

3. Ventilation

Table Title

VENTILATION

N

%

Satisfactory

Fair

Poor

TOTAL

Analysis:

4. Overcrowding

Table Title

OVERCROWDING

N

%

With

Without

TOTAL

Analysis:

5. Type of Housing

Table Title

TYPE OF HOUSE

N

%

Concrete

Light

Mixed

Makeshift

TOTAL

Analysis:

6. Electricity

Table Title

ELECTRICITY

N

%

With

Without

TOTAL

Analysis:

7. Privacy

Table Title

PRIVACY

N

%

With

Without

TOTAL

Analysis:

8. Food Storage

Table Title

FOOD STORAGE

N

%

Refrigerated

Not Refrigerated

TOTAL

Analysis:

9. Water Supply

Table Title

TYPE OF WATER SUPPLY

SHARED

OWNED

N

%

N

%

N

%

Level 1

Level 2

Level 3

TOTAL

Analysis:

10. Excreta Disposal

Table Title

TYPE OF EXCRETA DISPOSAL

SHARED

OWNED

N

%

N

%

N

%

Level 1

Level 2

Level 3

TOTAL

Analysis:

11. Refuse Disposal

Table Title

REFUSE DISPOSAL

N

%

Collected

Incineration

Open Dumping

Estero

Burial

TOTAL

Analysis:

12. Insect and Vermin Control

Table Title

INSECT AND VERMIN CONTROL

N

%

Mechanical

Chemical

Biological

TOTAL

Analysis:

13. Domestic Animals with and without pens

Table Title

DOMESTIC ANIMALS

With Pens

Without Pens

N

%

N

%

N

%

TOTAL

Analysis:

G. Summary (based on the information gathered from the community in terms of demography, socio-cultural, economic, health, and environment written in narrative form)

H. Problems Identification and Analysis (identify at least 5 community problems for each type)

A. Health Status

Problem Analysis

1. (eg. 80% of the mortality cases are due to TB)

(eg. TB is highly communicable and may cause death if left untreated)

B. Health Resources

1.

C. Health Related

1.

I. Prioritization of Identified Problems (Prioritize the identified community problems. Show the score for each type of problem)

Criteria

Actual / Highest

Score

Rationale for Actual Score

Weight

Criteria Score

1. Nature

2.Magnitude

3.Modifiability

4. Preventive Potential

5. Social Concern

Total

Chapter 4. Community Development Plan

A. HELPS Community Action Plan (CAP) (Construct an action plan following the format below for all of the problems identified and group them accordingly to category of: H- ealth, E- ducation, L- ivelihood, P- hysical Environment, S-ocio-Spiritual/Cultural).

PROBLEM AREA

(ex. Environment)

TITLE

(Formulate a title for each program based on the problem identified)

GENERAL OBJECTIVE

COMMUNITY PROBLEM

SPECIFIC

OBJECTIVES

POSSIBLE

ACTIVITIES

TIME FRAME

LOCUS OF RESPONSIBILITY

(persons responsible for the activity)

RESOURCE REQUIREMENTS

(ex. 80% of the houses has poor ventilation

(ex. 1 week)

(ex. BHW)

B. Community Project Plan (CPP)

1. Project Title

2. Target Sitio & Barangay and Number of Beneficiaries

3. Project Duration

4. Project Rationale and Description (briefly describe the community and outline of the problems and needs of the community and briefly describe how the project intends to address the problems)

5. Project Objectives

a. General Objective (State the over-all direction/long-term objective)

b. Specific Objectives (must be specific, measurable, attainable, realistic, and time-bound)

6. Project Phase (Narrative)

a. Preparatory Phase (explain briefly how was the project conceptualized and planned)

b. Implementation Phase (explain briefly how the project will be implemented, the roles of each group, partner community, and how it will be monitored)

c. Post- Implementation Phase (explain briefly how it will be evaluated and documented)

7. Community Participation (Describe what will be the participation of the community members, local officials, traditional leaders, local organizations, parish, and others)

8. Sustainability (state the over-all success, contributions, impact of the project to the integral development of the community, and how it can be sustain in the community)

9. Project Plan Matrix (written in bullet form)

PHASES

ACTIVITIES

TIME FRAME

EXPECTED OUTPUT

RESOURCE

REQUIREMENTS

PROJECT COST

UST

Counterpart

Community Counterpart

A. Preparatory

B. Implementation

C. Evaluation

Total Cost:

C. Community Budget Plan (indicate unit, quantity, cost, amount of resource requirements)

Total Cost of the Project:

Amount of UST counterpart: Php

Amount of community counterpart: Php

D. Health Education Plan (HEP)

TITLE

TARGET LEARNERS

(ex. mothers, preschool children, toddlers, etc.)

GENERAL OBJECTIVE

SPECIFIC OBJECTIVES

(use blooms taxonomy of objectives for knowledge, skill, or attitude)

CONTENT

(outline)

METHOD

(ex. Lecture, etc.)

TIME FRAME

(minutes)

RESOURCE

REQUIREMENTS

(ex. chalk, etc.)

METHOD OF

EVALUATION

(ex. Q/A,etc.)

After (duration) of (method), the (learners) will be able to:

1.

2.

3.

E. Organizational Structure of the Community Development Team

F. Committees and Functions of the Community Development Team

G. Minute Meeting of the Community Development Team (follow the format below)

MINUTE MEETING OF THE COMMUNITY DEVELOPMENT TEAM

Meeting Date

Meeting Location

Meeting Start

Meeting End

Attendance

(list all members that attended meeting)

Meeting Apologies

(list all members that did not attend the meeting)

Recorded by

Business/Agenda Items

Discussion

(summary of the discussion in the meeting)

Action

(list any decisions made or action to be taken by whom and by when)

1. Leader Report (reading of the agenda for the meeting and facilitate the approval of the minutes of the previous meeting)

2. Committee Report (based on the committee created by the group)

3. Old Business (unfinished business from previous meeting)

4. New Business (new business agenda)

Announcement

(list any special announcement made)

Future Agenda

(list any suggested agenda items that are to be tabled for the next meeting)

Next Meeting

(list date/time/location of the next meeting)

Chapter 5. Community Project Evaluation (CPE)

A. Overview (title, objectives, duration, area)

B. Activities Done (what are the activities implemented before, during, after)

C. List of Participants (list of community members participated the project)

D. Project Expense Report (summary of expenses incurred for the project)

E. Project Evaluation

1. Participants Evaluation (summary evaluation from the participants in the community)

PAGTATASA NG GAWAIN PANG PAMAYANAN

Tagapangasiwa ng Proyekto: (Year, Section, RLE Group #)

Pamagat ng Gawain:

Petsa: Lugar:

Panuto: Ipinakikiusap na ating tasahin ang gawain ayon sa katangian nito. Lagyan ng tsek ang naayon na kahon base sa inyong sagot.

BAHAGI NG GAWAIN

NAPAKAHUSAY

5

SOBRANG HUSAY

4

MAHUSAY

3

KATAMTAMAN

2

MAHINA

1

1. Programa

2. Tagapagsalita

3. Daloy ng Programa

4. Kahalagahan ng gawain

5. Lugar

6. Tagapag-organisa

7. Pamamahala ng Oras

8. Pamamahala ng kalinisan

Mungkahi or komento para sa ikauunlad ng programa:

2. Students Evaluation (examine the result of the project based on effectiveness, efficiency, appropriateness, and adequacy; examine the participation of the community in the project)

Chapter 6. Public Health Nursing Activities (done in the BHS/HC/RHU/Lying-In/Satellite Clinic)

A. Health Service Profile

PATIENTS NAME

AGE

SITIO/PUROK, BRGY

HEALTH PROBLEM

INTERVENTION

1.

2.

3.

Chapter 7. Conclusion, and Recommendations

A. Conclusion (based on the overall COPAR activities)

B. Recommendations

1. Community (interview the community)

2. Community Development Team (students)

C. Reflection on the learning experiences, insights, or realization (in narrative form per student)

Appendices

A. Communication Letters

B. Instruments (Community Survey Form, Interview Guide)

C. Financial Report (Summary of all expenses incurred for all of the activities, project implemented, transportation, food, accommodation)

D. Photo Documentation of Activities

E. Gantt Chart of the Activity (timeline of activities)

Curriculum Vitae (individual members with a 2x2picture for each)

NB:

To be submitted computerized in short bond paper with red hard bound using Arial font 12, Single space. Attached a CD containing a soft copy of the documentation, including the pictures for the whole duration of the activity.

* Compile in a ring bind and submit the survey form of the families surveyed in a long bond paper using Arial font 12, single space. Include the type written survey in the CD.

COMMUNITY HEALTH NURSING

FORMAT OF DOCUMENTATION FOR FAMILY HEALTH NURSING

Title page and Cover Page

The Royal and Pontifical Catholic University of the Philippines

UNIVERSITY OF SANTO TOMAS

Espana, Manila

FAMILY HEALTH NURSING

Presented to the

COLLEGE OF NURSING

In partial fulfillment of the requirements in

COMMUNITY HEALTH NURSING

By

Group 1 Section 1 Class 2020

(Name of Students)

Submitted to

(Name of Clinical Instructor)

(month, day,year of shifting)

Title Page

Abstract

Table of ContentsPage

Chapter 1: Introduction

A. Background

B. Statement of Objectives

C. Scope and Limitations

Chapter 2: Family Health Plan

A. Home Visit Plan

B. Family Data Base

C. Family Coping Index

D. Family Identification of Problem

E. Prioritization of Family Problems

F. Family Nursing Care Plan

Chapter 3: Conclusion, and Recommendation

A. Conclusion (based on the overall activities done during the home visit)

B. Recommendations

C. Learning experiences, insights, or realization (in narrative form per student)

Appendices

A. Photo Documentation of Activities

Curriculum Vitae

Chapter 1. Introduction:

A. Background (describe clearly community health nursing practice in the field of family health nursing and substantiate the significant role of the nurse in the care of the family)

B. Statement of Objectives of Family Health Nursing

1. General Objectives (statement of the general outcome)

2. Specific Objectives (statement of the task or what are to be accomplished)

C. Scope and Limitation

(Describe the limitations that exist in reference to the participants or population groups participated in the program, time or implementation of the program. The limitation must be substantial, and may be methodological, practical, or ethical)

Chapter 2. Family Health Plan (compiled together per family)

A. Home Visit Plan

PREPARATORY PHASE

ACTUAL HOME VISIT

POST VISIT

1.

1.

1.

2.

2.

2.

3.

3.

3.

B. Family Data Base

C. Family Coping Index

D. Identification of Family Problems

FIRST LEVEL ASSESSMENT

SECOND LEVEL ASSESSMENT

A. Health Deficit

Family Health Task Not Done

1.

B. Wellness Condition

1.

C. Health Threat

1.

D. Forseeable Crisis/Stress

1.

E. Prioritization of Family Health Problems

FAMILY PROBLEMS

CRITERIA

NATURE

MODIFIABILITY

PREVENTIVE

POTENTIAL

SALIENCE

TOTAL SCORE

SCORE

REASON

SCORE

REASON

SCORE

REASON

SCORE

REASON

1.

2.

3.

F. Family Nursing Care Plan

FAMILY PROBLEM

FAMILY NURSING DIAGNOSIS

GOALS

OBJECTIVES

INTERVENTION

TYPE OF FAMILY NURSE CONTACT

RESOURCE REQUIREMENTS

OUTCOME

Chapter 3. Conclusion, Recommendations

A. Conclusion (based on the overall activities done during the home visit)

B. Recommendations

C. Reflection on the learning experiences, insights, or realization (in narrative form per student)

Appendix : Photo Documentation of Activities

Curriculum Vitae (individual members with a 2x2picture for each)

NB:

To be submitted computerized in short bond paper with green soft bound using Arial font 12, Single space. Attached a CD containing a soft copy of the documentation, including the pictures for the whole duration of the activity.

1

Community Health Nursing- Related Learning Experience