MODULE

5.9
CLIENT CARE

Levels of Clientele in Community Health

Nursing Practice: Family, Specific
Population Groups and Community
SALVACION G. BAILON-REYES, BSN/RN, MPH, M.Ed.

NOTICE
Most of the content of this module were excerpted from the Author’s (Salvacion G. Bailon-Reyes)
book on Community Health Nursing --- The Basics of Practice, published by the National Book
Store in 2006.
This Self-instructional Module is an intellectual property of the Author, and all parts of it are reserved.
The Module may not be reproduced by any means and in any form whatsoever, nor distributed to
others, except by those authorized to do so in writing by the Author.

INTRODUCTION

1. MAJOR FIELDS OF NURSING PRACTICE

Nursing practice is broadly categorized into two major fields based on setting or place of work:
Hospital Nursing and Community Health Nursing (CHN). Hospital nurses, as the name implies,
work in various units of the hospital, from the Emergency Room and Outpatient Clinics to such
specialized units as the Intensive Care Unit (ICU) and Dialysis Unit. They care for sick people in
various stages of illness --- from the mild cases to the terminally ill. The main functions of hospitals
are to diagnose and treat disease/pathology. Hence, hospital nurses’ objective in the care of patients
is to help patients to recover from their illness.

Community Health Nursing, on the other hand, is a field of nursing practice where services are
delivered outside of purely curative institutions (i.e. hospitals) but in community settings such as the
home, the school, places of work, in health centers/clinics, or in public places in the community where
a client/patient* may be situated, or where health services may be delivered. Community health
nurses serve people in various stages of health and illness --- from the optimally well to the dying.
The objective of care is to achieve the highest possible level of health by developing and enhancing
the capabilities of the client/patient to take care of their own health and effectively cope with health
problems.

2. HOSPITAL NURSING VS. COMMUNITY HEALTH NURSING: AREAS OF DIFFERENCES

Community Health Nursing, as a field of nursing practice, may be better understood by comparing
it with the more familiar Hospital Nursing. In a nutshell, Table 5.9.1 on the next page presents this
comparison, showing six (6) areas of differences.
*The terms “client” and “patient”, as used in this Module, refer to the recipient of health/nursing services, be it an individual, a family, a specific
population group, or the community as a whole. The term “client” is used to denote a recipient of care on the wellness side of the health continuum,
while “patient” refers to one on the illness side.

165
 166 CLIENT CARE

Comparison Between Community Health Nursing and Hospital/Clinical

Table 5.9.1 Nursing
AREA OF DIFFERENCE HOSPITAL/CLINICAL NURSING COMMUNITY HEALTH NURSING

1. Setting/Place of Hospital wards, special clinical units Outside of hospital, in the

Practice and Activities in hospital community – home, school, health
center, place of work (industrial
establishments, farms, markets,
etc.), outpatient clinics

2. Types of Patients Mostly sick people; maybe limited to Varied patients, representing total
Seen one group of patients, e.g. maternity health spectrum – from the healthy
cases, depending on clinical area of sick recovering from
practice disease terminally ill
dying

3. Scope of Concern/ Mostly curative and rehabilitative Total care, whole range of
Range of Services care services – health promotion,
Provided disease prevention, curative care,
rehabilitative care, development of
self-reliance, capabilities in health
care

4. Priority Concern Comfort and care during illness, Promotion and maintenance of
recovery from disease health, prevention of disease

5. Unit or Focus of Care Individual patient The family population groups

whole community

6. Ultimate Goal Maximum comfort, patient Effective coping and self-reliance for
independence (self-care), recovery families and the whole community in
from disease, peaceful/dignified health care
death for terminal cases

INTENDED LEARNERS

1. First/Second year midwifery/nursing students taking their beginning course in Family Health
Nursing;
2. Community Health Nurses working in Rural Health Units, clinics, health centers and dispen-
saries;
3. Nurse Supervisors of community health nurses/midwives, as a form of continuing education
for them, and
4. Nurse educators/trainers in the field of Community Health Nursing, as a form of continuing educa-
tion for them.
 MODULE 5.9 167

APPROXIMATE TIME NECESSARY TO COMPLETE THE MODULE

Two hours to go through the content of the module

MODULE OBJECTIVES

This Self-instructional Module (SIM) aims to improve the practice of Community Health Nursing (CHN) at
each level of clientele in CHN practice, through a clear understanding of the basic concepts, principles and
processes that serve as bases for competent practice. More specifically, the learner is expected to be able
to do the following after a study of this SIM:

1. Differentiate the two major fields of nursing practice --- Hospital Nursing and Community Health
Nursing;
2. Identify, distinguish, briefly describe and differentiate the four levels of clientele in CHN practice;
3. Be able to apply the nursing process in the care of individual clients/patients, families, specific
population groups, and the whole community. More specifically, be able to:
a. Make an accurate initial assessment of the condition/situation of each client/patient in four levels
of clientele in CHN practice;
b. Identify the possible health/nursing needs and problems of each client/patient based on an
analysis of initial data gathered;
c. Define and state the objectives of nursing care in clear, concise and measurable terms in each
of the four levels of clientele, based on the health/nursing needs/problems identified;
d. Identify specific appropriate nursing interventions for each level of clientele based on the
objectives of nursing care, and
e. Make a plan to evaluate the outcomes of nursing care at each level of clientele with the use of
appropriate sources, methods and tools for data collection.

The above module objectives are covered by the following competencies.

Table 5.9.2 NNCCS on the Beginning Nurse’s Role on Client Care

Responsibility 2 Utilizes the Nursing Process in the Interdisciplinary Care of Clients that
Empowers the Clients and Promotes Safe and Quality Care
COMPETENCIES PERFORMANCE INDICATORS

2.4.9. Implements participatory 1. Determines participatory and empowerment strategies

and empowerment strategies related to promotion of health, healthy lifestyle/adaptation,
related to promotion of wellness, disease management, environmental sanitation
health, healthy lifestyle/ and protection and health resource generation, use or
adaptation, wellness, disease access.
management, environmental 2. Creates opportunities to develop client’s competence for
sanitation, environment promotion of health, healthy lifestyle/adaptation, wellness,
protection and health resource disease management, environmental sanitation,
generation, use or access environment protection and health resource generation,
within the context of Primary use or access.
Health Care. 3. Executes appropriate participatory and empowerment
strategies.
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COMPETENCIES PERFORMANCE INDICATORS

2.4.9.1. Enhances family 1. Develops the competence of the family to recognize

competence on health opportunities for wellness, healthy lifestyle/adaptation,
promotion, wellness, health promotion, disease/problem management and
healthy lifestyle, health environmental sanitation and protection by:
care, health resource • Analyzing the factors affecting health, human
access or use and safe response, the environment and its resources/realities
environment conducive to • Determining the relationships among these factors
health maintenance among • Specifying the health and related conditions/problems
its members. which need to be addressed.
2. Carries out strategies/interventions to help the family
decide to take appropriate action on each health
condition/problem identified.
3. Implements competency-building intervention options to
help family provide appropriate care to the dependent, at-
risk, vulnerable, sick, and/or disabled member/s.
4. Develops the competence of the family to provide a home
environment conducive to health maintenance and
personal development.
5. Carries out participatory and empowerment strategies to
enhance the family’s competence to use community
resources for health care and health maintenance.

2.4.9.2. Implements 1. Carries out empowerment strategies to enhance

strategies/interventions to competence for health promotion, healthy lifestyle/
ensure healthy population/s adaptation, wellness, disease and accident prevention/
in the school and work management among population groups in the school and
settings. work setting.
2. Performs counterparting strategies to help population
groups in the school and work setting carry out activities
or measures in support of environment protection and
maintain a safe environment.

2.4.9.3. Enhances the 1. Develops the competence of specific population groups/

competencies of specific support systems to analyze the relationship of factors or
population groups to patterns, home and community realities affecting health,
ensure wellness, healthy human response, and the environment.
lifestyle/adaptation, disease 2. Implements effective strategies to develop/enhance the
prevention, management, competence of specific population groups/support
rehabilitation and system/s for decision making on appropriate action/s
vulnerability reduction or for healthy lifestyle/adaptation, disease prevention,
prevention. management and rehabilitation.
3. Carries out empowerment strategies to develop the
competencies of specific population groups and support
system for health care, healthy lifestyle/adaptation, use of
health service and health resource access or use.
 MODULE 5.9 169

COMPETENCIES PERFORMANCE INDICATORS

2.4.9.4. Implements participa- 1. Develops the competence of community work groups to:
tory and empowerment a) analyze population and environmental factors/
strategies for community community patterns/realities which generate need to
competence to identify and address specific health conditions/situations/patterns
collaborate effectively in b) articulate commitment and opportunities for community
addressing needs and improvement on health resource availability access/
problems related with use, environmental sanitation and protection, and
health resource availa- safety/security.
bility, access or use, c) handle/address issues and conflicts as creative options
environmental sanitation, for collaboration and shared responsibility for
environment protection, decision-making by generating new ways of analyzing
safety and security. situations/problems for multiple possibilities/effective
solutions.
2. Carries out participatory and empowerment opportunities
to increase community’s competence for interaction,
decision-making, effective implementation of actions and
management of community’s relationship with the larger
society for environmental sanitation and environmental
protection, safety, security and for creating or using
appropriate and/or supplementary resources especially
for the marginalized or the vulnerable risk groups.

2.4.10. Implements interventions 1. Specifies the bases for choice of interventions carried out
guided by prescribed context within existing policies and procedures or protocols of
of specific health programs/ specific health programs and services.
services. 2. Performs the appropriate interventions.

2.4.11. Implements appropriate care 1. Participates in the prevention and mitigation of adverse
to individuals, families, effects of a disaster.
vulnerable groups and 2. Performs preparedness activities as a member of the
communities during three multi-disciplinary team.
phases of disaster situations, 3. Executes appropriate nursing interventions in
such as: 1) Pre-incident collaboration with disaster response team.
phase, 2) Incident phase, and 4. Provides care and support to those injured with chronic
3) Post incident phase. disease, maladaptive patterns of behaviour and
disabilities during recovery/reconstruction/rehabilitation
period.

2.4.12. Implements appropriate 1. Utilizes appropriate technique of communication when

nursing interventions to help identifying needs of client for spiritual care.
clients and support system 2. Provides the client with appropriate environment and
address spiritual needs. materials for praying.
3. Offers opportunities for performance of religious activities
based on client’s religion.
4. Refer to an appropriate religious agency for further
spiritual support.
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COMPETENCIES PERFORMANCE INDICATORS

2.4.13. Manages client load to ensure 1. Conducts case detection, tracking, tracing and monitoring
health program/service surveillance.
coverage. 2. Conducts health programs and services in the home,
clinic, school, and work settings.
3. Carries out strategies to ensure health program/service
coverage based on health programs objectives/targets,
through health resource availability, access, and/or use,
especially among marginalized/vulnerable risk groups.
4. Determines adequacy of health program/service
coverage based on updated caseload registries by type
of client, health program or health problem (e.g. Client
Lists for Prenatal/Postpartum Care, Client List for At-risk
Children, Family Registry of Priority Cases)
5. Carries out interventions for effective and efficient care
of clients in the caseload based on assigned geographical
coverage.
6. Adheres to institutional safety policies and protocols to
prevent injuries/accidents and infection.
7. Refers client for appropriate management and assistance
for health and medical-related benefits.
8. Reports notifiable/reportable disease based on protocol.

2.5. Provides health education using

selected planning models to
targeted clientele (individuals,
family, population group or
community).

2.5.1. Determines the health 1. Specifies the characteristics of each health education
education planning models planning model.
appropriate to target clientele/ 2. Selects appropriate health education planning model.
expected objectives and
outcomes.

2.5.2. Utilizes health education 1. Assesses the needs of the target population.
process to accomplish the 2. Prioritizes the learning needs/problems in partnership
plan to meet identified client’s with client partner.
learning needs. 3. Formulates appropriate goals and objectives
4. Designs a comprehensive health education plan.
5. Implements the health education plan utilizing appropriate
teaching strategies
6. Evaluates the results of client’s learning experiences
using the evaluation parameters identified in the health
education plan.
 MODULE 5.9 171

COMPETENCIES PERFORMANCE INDICATORS

2.6. Evaluates with the client the 1. Utilizes participatory approach in evaluating outcomes of
health status/competence and/or care.
process/expected outcomes of 2. Specifies nature and magnitude of change in terms of
nurse-client working relationship. client’s health status/competence/processes and
outcomes of nurse-client working relationship.
3. Monitors consistently client’s progress and response
to nursing and health interventions based on standard
protocols using appropriate methods and tools (e.g.
critical pathway, nurse sensitive indicators, quality
indicators, client competency indicators, hospital and
community scorecard) in collaboration and consultation
with the client.
4. Revises nursing care plan based on outcomes and
standards considering optimization of available
resources.

2.7. Documents client’s response/ 1. Accomplishes appropriate documentation forms using

nursing care services rendered standard protocols.
and processes/outcomes of the 2. Adopts appropriate methods and tools to ensure
nurse client working relationship. accuracy, confidentiality, completeness and timelines of
documentation.
3. Utilizes acceptable and appropriate terminology
according to standards.

TOPIC OUTLINE

This Module covers the following topics:

I. Module Content
I.1. Levels of Clientele in CHN Practice
I.2. An Individual as the Client/Patient
I.3. The Family as the Client/Patient
III.3.1. Basic Functions of a Family
III.3.2. Health Tasks of the Family
I.4. A Population Group as the Client/Patient
I.5. The Community as the Client/Patient
I.6. Prioritizing Health/Nursing Care at Various Levels of Clientele Through the Risk Approach
II. Methodology for Providing Nursing Care --- The Nursing Process Applied to Various Levels of
Clientele
II.1. What Is The Nursing Process?
II.2. Major Steps in the Nursing Process
II.2.1. Assessment of Health/Nursing Needs and Problems at Various Levels of Clientele
II.2.2. Nursing Interventions at Various Levels of Clientele
II.2.3. Evaluation of Nursing Care at Various Levels of Clientele
III. Summary
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TEACHING/LEARNING ACTIVITIES

1. Lecture discussion on the topics under Content conducted by a nurse educator or nurse trainer, or
self-study of the Module by the Learner.
2. A two-week affiliation with a Rural Health Unit (RHU) where the Learner goes through the following
experiences:
a. Participation in the conduct of a Clinic in the health center and providing nursing services at the
individual level of clientele;
b. Following up a priority client/patient in his/her home and providing services at the family level of
clientele;
c. Identifying a priority population group in the community, making an initial assessment of the
group, defining possible health/nursing needs and/or problems, and making a plan of care, and
d. Identifying a community-wide health problem, and planning a community project problem with the
whole RHU team.

EVALUATION OF STUDENT LEARNING

1. Administration of a written test --- a Short-Question, Short-Answer type --- before and after study
of the Module i.e. as a Pretest and Post-Test, and comparing the two scores obtained by the
student. An increase in the Post-Test score of 20 percent or more represents an acceptable gain
in learning.
2. Review and evaluation of the student’s Nursing Care Study Report on either an Individual client/
patient, a family, or a specific population group, or the Report on A Plan for a Community Health
Project. Among the items to be evaluated are:
- Completeness of identifying information on the client/patient;
- Completeness, adequacy and accuracy of initial assessment data collected;
- Clarity and accuracy of health/nursing needs/problems identified based on assessment data
gathered;
- Clarity, appropriateness and feasibility of achievement of nursing objectives set;
- Appropriateness of intervention measures(planned or executed) to achieve the nursing objectives
set, and
- Appropriateness and adequacy of plan to evaluate nursing care planned or implemented.

PRE ASSESSMEENT

INSTRUCTIONS TO THE LEARNER --- Before you proceed to the study of the Module, please take the
Pretest below. The purpose of the Pretest is simply to find out how much you already know about the
content material to be presented in the Module. Write your answers in a separate sheet of paper. Do not
write anything on the Pretest/Question Sheet.

PRETEST

INSTRUCTION: Read carefully each of the following questions, and write your answers in a separate sheet
of paper.
1. Identify five (5) areas of difference between Hospital Nursing and Community Health Nursing (CHN).
For each area, indicate the difference between the two major fields of nursing practice.
2. Identify the four (4) levels of clientele in CHN practice. Briefly describe each level and differentiate
one from the others.
 MODULE 5.9 173

3. For each of the four (4) levels of clientele in CHN practice, identify the five (5) initial data to collect
to have some idea on possible health/nursing needs/problems.
4. Enumerate five (5) basic functions of a family.
5. Enumerate five (5) health tasks of a family.
6. In no more than two (2) sentences, define the risk approach to health/nursing care.
7. For each of the four (4) levels of clientele in CHN practice, identify three (3) kinds of clients/patients
to whom you will give priority attention based on the risk approach to health/nursing care.
8. In no more than two (2) sentences, define Nursing Process.
9. Enumerate the three (3) major steps in the nursing process.
10. Identify three (3) possible general objectives of nursing practice.
11. Enumerate five (5) kinds of nursing interventions in CHN practice.
12. Identify three (3) specific items to evaluate under Structure/Resources/Inputs, three (3) items under
Process and three (3) items under Outcomes of nursing care.

CHECKING AND SCORING YOUR ANSWERS

1. Check your answers against the Key to Correction.

2. Score your answers according to the number of points given to each correct answer.
3. Add up your total correct answers. The Perfect Total Score is 95 points.
4. Indicate your Total Score on the upper right hand corner of your Answer Sheet.
5. Interpreting Your Score: If your total score is 80 points or higher, you are pretty knowledgeable
about the subject/topics to be studied and may not need to study this Module. However, if you
scored below 71 points (75%), please proceed and carefully read the succeeding text.

KEY TO CORRECTION

INSTRUCTION: Check your answers against the following correct answers. Give the stated number of
points per question for every correct answer.

1. Five (5) areas of difference between Hospital Nursing (HN) and Community Health Nursing (CHN),
and difference between the two major fields of nursing practice --- Any five (5) of the following:
a. Setting/Place of Practice and Activities
HN – Hospital wards and special clinical units of the hospital
CHN – Outside of hospitals, in community settings such as the home, school, place of work,
health center, outpatient clinic, in the farm, market and other public places where the client/patient
may be situated.
b. Type of Clients/Patients Seen
HN – Mostly sick people at various stages of illness.
CHN – Varied clients/patients representing the total health spectrum --- from the well/healthy to
the sick, the terminally ill and the dying.
c. Range of Services Provided
HN – Mostly curative and rehabilitative care.
CHN – Total care and whole range of health services --- health promotion, disease prevention,
curative and rehabilitative care, and development of self-reliance and capabilities in health care.
d. Priority Concern
HN – Comfort and care during illness, recovery from disease.
CHN – Promotion and maintenance of health, prevention of disease.
e. Unit and Focus of Care
HN – Individual patient
CHN – The family, specific population groups and the whole community.
 174 CLIENT CARE

f. Ultimate Goal
HN – Maximum comfort, patient independence in self-care, recovery from disease, and a peaceful,
dignified death for terminal cases.
CHN – Effective coping and self-reliance in health care for families and the whole community.
Scoring: Give two (2) points for every correct answer. Perfect Score is ten (10) points.

2. Four (4) levels of clientele in CHN practice, and brief description of each one.
a. Individual Client/Patient – The focus of care are individual persons from varying age groups and
states of health and illness.
b. The family as a totally functioning unit, i.e. two or more individuals joined by ties of blood, marriage
or adoption who share a single household.
c. Specific Population Group – Groups of people in the community who share common and unique
health needs, are at risk of developing or have already developed certain defined health problems.
d. Community – A unit or section of a community, e.g. a “barangay”, a barrio/village or the whole
municipality or city; a group of people who share common needs, interests, ethnic or cultural ties,
such as the Christian community in Mindanao, or the squatter community in Metro-Manila.
Scoring: Give two (2) points for each correct answer. Perfect Score is eight (8) points.

3. Five (5) initial data to collect for each level of clientele in CHN practice in order to have some idea of
possible health needs/problems
a. Individual Client/Patient – Any five (5) of the following:
i. Identifying Information – name, position in the family, relationship to the head of the family
ii. Sociodemographic Characteristics – age, sex, marital status, education, occupation, income,
religion
iii. Physical Condition – Appearance, build, nutritional status, weight, height, body mass index
(BMI), vital signs, state of orientation or consciousness
iv. Psychological Condition – General mood, mental/emotional state, ability to express needs,
thoughts and feelings, body language, mannerisms, “abnormal” behaviour
v. Ability to perform activities of daily living
vi. Signs and symptoms of disease, injury, disability or developmental deficit, history of disease
condition, if any.
vii. Disease condition, injury, disability or developmental deficit diagnosed by a legitimate medical
practitioner, history of condition and current treatment, if any.
b. Family – Any five (5) of the following:
i. Family size and composition – Size of household, names of members and relationship to the
head of the family
ii. Sociodemographic Characteristics – Age, sex, marital status, education, occupation, income,
religion of members
iii. Health status of members:
- Members of the family with signs and symptoms of disease, injury, disability, developmental
delays/deficits which need to be diagnosed and treated; history of each condition, if any.
- Members with disease condition, injury, disability, and/or developmental deficit which have
been diagnosed by a legitimate medical practitioner; history of condition, past and current
treatment, if any.
iv. Family health habits and lifestyle – Eating/nutrition, personal hygiene, exercise and leisure/
recreation of the family as a unit, any smoking, alcohol-drinking or drug use of member(s).
v. Family Relationship – Quality of interaction, characteristic communication pattern and relation-
ship among members of household, presence of conflict between family members.
vi. Decision-makers in the family, particularly in health matters.
vii. Quality of housing, facilities and immediate surroundings and environment.
- Housing – Type and ownership of house/dwelling; adequacy of living space, bedrooms/
 MODULE 5.9 175

sleeping quarters and sleeping arrangement; lighting and cooking facilities.

- Water Supply – Source, potability, storage
- Food storage facility
- Toilet – Type, sanitary condition
- Garbage/Refuse disposal – Type, sanitary condition
- Drainage system – Type, adequacy
- Presence of insects and rodents
- Presence of accident hazards in the home and immediate surroundings
viii. Quality of neighborhood/community where family is residing
- Kind and socioeconomic class of neighbourhood/community
- Communication and transportation facilities available
- Support systems, welfare and health care facilities and resources available, and services
provided.
ix. Ability to provide for basic needs of members – food, clothing, shelter and education
x. Ability to provide nursing care to its dependent, sick or disabled members
xi. Family utilization of available community health resources and related social and welfare ser-
vices, preventive care services, curative care services, material/financial and psychosocial
support systems.
xii. Family relationship with the community and participation in community activities
c. Specific Population Group – Any five (5) of the following:
i. Size, location and composition of the group
- Number of members
- Place of domicile, work, study and common place where group congregates
- Sociodemographic characteristics of members – age, sex, marital status, education,
occupation, income, religion
ii. Nature of health threats, hazards or risks, disease condition, disability or developmental deficit
faced by the group
iii. Relevant health statistics for the group – morbidity and mortality rates, causes of illness and
deaths.
iv. Community health and health-related resources available to the group, including psychosocial,
material and financial support systems from government, semi-government, private and non-
government agencies/institutions.
v. Group’s utilization of available community health and health-related resources.
d. Community - Any five (5) of the following:
i. Size and Type of Community
- Land area
- Geographic units (e.g. “barangays”, barrios/villages), number, size, any special
distinguishing characteristics
- Type of community, e.g. rural/urban, agricultural, industrial, shanty town, etc.
- Socioeconomic class
- Topography and climate/weather conditions
- Natural resources – e.g. forest, river, lake, volcano, mountain, tourist attractions/spots
ii. Demographic data
- Total population; population density
- Sex ratio
- Age structure
- Marital status – Number/proportion of single, married, widowed and divorced/separated
among population
- Total number of families/households; average family size
- Religious and ethnic groups – types, number and proportion
iii. Socioeconomic data
 176 CLIENT CARE

- Main occupations/industries
- Average family income or GNP
- Unemployment rate
- Percentage of the population below the poverty level
- Education – percentage of the population who completed the elementary, high school,
college and graduate education levels, and those with no schooling
- Literacy rate
iv. Environmental health facilities
- Water supply – Sources, type of distribution, quality of water
- Waste disposal system – Types, sanitary condition
- Refuse/Garbage disposal system - Types of collection and disposal
- Housing – Types, condition
- Presence of pollution – Air, water, noise, land
v. Public health statistics and related information
- Fertility/natality rate
- Morbidity – rate, leading causes, endemic diseases, past epidemics
- Mortality – rates and leading causes
- Life expectancy at birth
- Reports of studies on health and related matters
vi. Health care resources – Government, private; nature, scope and quality of services provided
- Hospitals – Location, type, bed capacity, facilities, occupancy rate
- Health centers, dispensaries – Number, location, service programs, personnel, utilization
by public
- Private medical clinics – Number, location
- Dental clinics – Number, location
- X-ray and laboratories
- Traditional health care providers
• Traditional healers – Number and type, location
• Traditional birth attendants (“Hilots”) – Number, location, number trained, percent of
births attended
vii. Other community resources
- Schools – Type, number, location, number of students
- Public transportation – Types, condition of roads and bridges
- Communication – Types, location
- Leisure/recreation facilities – Types, number, location
- Electricity – Coverage
- Public markets, commercial centers/malls, stores
- Police/security system – Peace and order situation, crime rate and nature of crimes
committed
viii. Government and community leadership
- Government officials, formal community leaders
- Informal community leaders
- Influential citizens and groups who participate in decision-making process as well as in the
planning, implementation and evaluation of community health and related programs
Scoring: Give one (1) point each for every correct answer. Perfect Score is twenty (20) points.

4. Five (5) basic functions of a family – Any five (5) of the following:
a. Procreation, rearing and care of children.
b. Provision of food, clothing, shelter and other essentials of living.
c. Provision of education to the young.
d. Satisfying the family members’ psychosocial needs for love, acceptance, sense of belonging, self-
 MODULE 5.9 177

esteem, etc.
e. Assigning roles, tasks and responsibilities to family members.
f. Allocation and management of family resources.
g. Maintenance of order and discipline, establishing standards of communication, interaction,
relationship and behaviour.
h. Socialization of family members, i.e. introduction to the norms, beliefs, customs, values, traditions
and culture of the family and the community.
i. Placement of members in the larger society, fitting them into the community and its social insti-
tutions, e.g. school, church, etc.
j. Development of a sense of family loyalty and maintenance of the family as a cohesive unit.
k. Promoting and ensuring the well-being and overall development of the members and the family
as a whole.
Scoring: Give two (2) points for every correct answer. Perfect score is ten (10) points.

5. Five (5) health tasks of a family – Any five (5) of the following:
a. To recognize interruptions in health development, or the presence of a health problem.
b. To make decisions about taking appropriate health action.
c. To provide nursing care to the sick, disabled and/or dependent members of the family.
d. To deal effectively with health and non-health crises.
e. To maintain a home environment conducive to health maintenance and personal development.
f. To maintain a reciprocal relationship with the community and its health institutions, including
effective utilization of available resources for health care.
Scoring: Give two (2) points for every correct answer. Perfect score is ten (10) points.

6. The risk approach to health/nursing care refers to the early recognition of risk factors associated
with adverse or undesirable unwanted outcomes (e.g. illness, disability or death) in individuals, families,
specific population groups or community, and taking the necessary anticipatory or compensatory
measures to reduce, totally eliminate or cope with the probability of occurrence of the adverse or
undesirable unwanted outcome.
Scoring: Give one (1) point for the correct answer. Perfect score is one (1) point.

7. For each of the four levels of clientele in CHN practice, three (3) clients/patients to give priority atten-
tion based on the risk approach to health/nursing care.
a. Individual Client/Patient – Any three (3) of the following:
i. Individuals with strong genetic/hereditary predisposition to certain diseases.
ii. Individuals with unhealthful lifestyle, e.g. heavy smokers, alcohol drinkers, drug users.
iii. Individuals manifesting some signs and symptoms of disease which require proper diagnosis
and treatment.
iv. Individuals with specific diagnosed disease/illness, including communicable and non-
communicable diseases which require monitoring and supervision.
b. Families – Any three (3) of the following:
i. The very poor families.
ii. Families residing in hazardous/unhealthy environment, e.g. shanties, squatter areas, etc.
iii. Families who are unable to cope with certain health threats, illness states or foreseeable crisis
situations within the family.
c. Specific Population Groups – Any three (3) of the following:
i. The very young and the very old in the population – infants, children and the elderly.
ii. Childbearing women
iii. Specific groups living or working in hazardous/unhealthful environment such as the homeless,
street children, factory workers, prostitutes.
iv. Specific groups suffering from chronic/long-term diseases, e.g. hypertensives, diabetics, heart
 178 CLIENT CARE

disease requiring monitoring/supervision.

v. Specific groups suffering from communicable diseases who require treatment and follow-up,
and prevention of spread to others.
vi. The physically and mentally disabled who require monitoring, follow-up and supervision.
d. Communities – Any three (3) of the following:
i. The very poor communities lacking in such basic facilities as potable water, sanitation and
primary health care.
ii. Communities with relatively high fertility, morbidity and mortality rates.
iii. Communities with high incidence and prevalence of endemic diseases, epidemics, accidental
injuries, communicable and non-communicable diseases.
Scoring: Give one (1) point for every correct answer. Perfect score is twelve (12) points.

8. Nursing Process is a logical, systematic and organized method of providing care to clients/patients
based on the scientific problem-solving approach. It consists of three major steps --- assessment,
intervention and evaluation.
Scoring: Give one (1) point for the correct answer. Perfect score is one (1) point.

9. Three major steps in the Nursing Process:

a. Assessment
b. Intervention
c. Evaluation
Scoring: Give one (1) point for the correct answer. Perfect score is three (3) points.

10. Three (3) possible objectives of nursing care – Any three (3) of the following:
a. Promotion and maintenance of good health
b. Prevention of disease and accidental injuries
c. Change of lifestyle or unhealthful behaviour
d. Improved condition of the environment, i.e. to a more healthful one
e. Improved ability to do activities of daily living
f. Improved physical health, e.g. nutritional status, blood pressure, etc.
g. Improved psychological/emotional state
h. Early diagnosis and treatment of disease
i. Relief of symptoms
j. Improved compliance with prescribed treatment and/or rehabilitation measures
k. Prevention of spread of a communicable disease
l. Prevention of complications of an existing disease or condition (e.g. pregnancy)
m. Rehabilitation – physical, psychosocial, occupational
n. Prolong life
o. Comfort, freedom from pain
p. A peaceful, dignified death for the terminally ill
q. Increased competence in dealing with common and simple illnesses and accidental injuries
r. Increased utilization of available health care and related resources
s. Increased ability to perform one or more health tasks and achieve self-reliance in health care
matters
t. Reduced incidence and prevalence of illness/diseases
u. Reduced mortality from a given illness/disease
Scoring: Give two (2) points for every correct answer. Perfect score is six (6) points.

11. Five (5) kinds of intervention in CHN practice – Any five (5) of the following:
a. Administration of medical treatments
b. Direct nursing care/ministration
 MODULE 5.9 179

c. Indirect nursing care/ministration

d. Observational measures
e. Anticipatory guidance
f. Health teaching/education
g. Counseling
h. Motivation, support, development of support system/groups/network
i. Environmental manipulation, modification and/or improvement
j. Referral
k. Advocacy
l. Community organization and development
Scoring: Give one (1) point for every correct answer. Perfect score is five (5) points.

12. Three (3) specific items to evaluate under Structure/Resources/Inputs, three (3) under Process, and
three (3) under Outcomes of nursing care.
a. Structure/Resources/Inputs – Any three (3) of the following:
i. Resources of the nurse – e.g. competence (knowledge, skills, attitudes), transport facility,
equipment, etc.
ii. Resources of the client/patient – Human/manpower resources (e.g. adult/employed members
of a family)
iii. Resources of the community – e.g. health manpower, health care facilities
iv. The Nursing Care Plan (NCP) – Assessment done, objectives set, activities and intervention
measures planned to be done, resources used and plan for evaluating care.
b. Process – The implementation of the NCP. Any three (3) of the following:
i. Quantity of activities implemented and services provided
ii. Estimated quality of services rendered
iii. Quality of the nurse’s performance, including involvement and participation of the client/patient
in the implementation of the NCP
c. Outcome/Output – Any three (3) of the following:
i. Change in the physical/mental health status of individual clients/patients, families or specific
population groups
ii. Change in fertility, morbidity and/or mortality patterns in groups and in the whole community
iii. Prevention of unwanted results or negative outcomes
iv. Change in communication, interaction and relationship patterns, or in the assumption of roles
and functions, and/or overall functioning
v. Change in health behaviour and lifestyle
vi. Change in the quality of the environment
vii. Change in level of competence (knowledge, skills, attitudes) in matters relating to health and
health care
viii. Satisfaction or dissatisfaction with nursing services received
Scoring: Give one (1) point for every correct answer. Perfect score is nine (9) points.

Total Perfect Score: 95 points

MODULE CONTENT

1. LEVELS OF CLIENTELE IN COMMUNITY HEALTH NURSING PRACTICE

The practice of CHN covers four levels of clientele --- an individual client/patient, a family, a specific
population group, or a community. The nurse sees and serves individual clients/patients in the clinic/
health center, at home during a home visit, in the work place and other community settings where a client/
 180 CLIENT CARE

patient may be situated. Families are usually seen during home visits. Specific population groups and the
community at large are served in the process of implementing special programs directed at certain groups
or the community as a whole.

This Module focuses on basic concepts, principles and methodology of providing nursing care to the various
levels of clientele in CHN practice.

2. AN INDIVIDUAL AS THE CLIENT/PATIENT

At the individual level of care the focus is a person, and the objective of nursing care is either promotion
and maintenance of health, prevention of disease, early diagnosis and treatment of a suspected ailment,
recovery and/or rehabilitation from illness, eventual self-reliance in personal care, or a peaceful, dignified
death.

Individual clients/patients served are in various conditions of health and illness --- from the healthy/well to
the dying --- and all age groups from birth to senescence. The nurse provides professional nursing services
based on the client’s/patient’s needs which were previously assessed, and in various community settings
--- in the clinic/health center, at home, in the school, in the work place, or anywhere where a client/patient
may be situated at the time the nurse is called for help, e.g. at the roadside to a victim of vehicular accident,
or by a river bank to a drowning accident victim, or in the market to a woman who suddenly fainted. The
scope of service varies from simple first-aid, to basic, and to comprehensive nursing care.

An individual client/patient, however, is not viewed in isolation, but within the context of the family, group or
community to which he/she belongs. Assessment of the client’s/patient’s needs and problems, therefore,
includes an assessment of his/her family, group and community situation, as continuing care, if needed, will
be based on, among others, capabilities and resources available to implement the prescribed measures.

3. THE FAMILY AS THE CLIENT/PATIENT

The family is the basic unit, the primary social group and the fundamental institution of human society
that provides the physical and psychosocial environment for the natural development and fulfillment of all
its members. As the basic unit of society the family is part of a larger system encompassing community
and cultures. A family is a member of a community, an ethnic group, a culture and a race. It is the primary
mediating agent between the individual and his society, through its teachings, examples and sanctions. The
young are socialized into the habits, customs, beliefs, values and traditions of the culture.

The family is the unit of care in CHN practice. At this level of care, the focus is the family as a total functioning
unit which is more than the sum of its parts. Individual members with certain defined or medically-diagnosed
health problems are seen as features or part of the situation in a given family.

A family refers to two or more individuals joined or related by ties of blood, marriage or adoption, and who
constitute a single household, interact with each other in their respective familial roles, and who create and
maintain a common culture.

The basic traditional family unit is the conjugal or nuclear family which is comprised of the husband and
wife and children. An extended family is formed when a nuclear family shares living quarters with relatives
or friends. Various types of family structures are found in different societies and cultures. In recent times,
there is an emergence of quasi-family forms, among them the communal or “group” family, the single-parent
family, homosexual marriages and consensual unions without the benefit of marriage.

The family, like an individual, has a natural history and undergoes a life cycle of formation (starts with
 MODULE 5.9 181

marriage and ends with the birth of the first child), growth (begins with the birth of the first child and ends
with the birth of the last child), contraction (starts when the first child leaves home and ends with the
departure of the last child), and dissolution (starts when the first spouse dies and ends with the death of
the surviving spouse).

3.1. Basic Functions of a Family

The family undertakes certain basic functions in all social classes and cultures through changing times and
throughout the family life cycle. These functions, which are carried out by the roles family members play in
interaction, include the following:
1. Procreation, rearing and care of children until they are mature and ready to start lives of their own;
2. Provision of food, clothing, shelter, health care and other essentials of living;
3. Provision of education to the young, including religious instruction;
4. Satisfying the family members’ psychosocial needs for love, acceptance and belonging, self-
esteem, encouragement, motivation and morale, self-fulfillment or self-actualization, resolving
personal and family crises and problems;
5. Assigning roles, tasks and responsibilities to family members to ensure effective operation of the
household and the well-being of the members;
6. Allocation and management of family resources to meet family needs, care and maintenance of
family possessions;
7. Maintenance of order and discipline, establishing standards of communication, interaction, relation-
ships and behaviour, regulating behaviour of members and administering sanctions for infraction of
rules and norms of conduct;
8. Socialization of family members, i.e. introduction of children to the norms, customs, beliefs, values
and tradition of the culture to which the family belongs, and transmitting the culture across family
generations;
9. Placement of members in the larger society, fitting them into the community and its social institutions
such as the school, church, social, political and economic organizations, and protecting family
members from undesirable influences;
10. Development of a sense of family loyalty and maintenance of the family as a cohesive unit through
family activities and rituals, and
11. Promoting and ensuring the well-being and over-all development of the members and the family as
a whole.

3.2. Health Tasks of the Family

Ruth B. Freeman* identified tasks in the area of health care which a family must be able to perform in order
to effectively cope with health problems. These tasks are the following:

1. To recognize interruptions in health development, or the presence of a health problem;

2. To make decisions about taking appropriate health action;
3. To provide nursing care to the sick, disabled and/or dependent members of the family;
4. To deal effectively with health and non-health crises;
5. To maintain a home environment conducive to health maintenance and personal development, and
6. To maintain a reciprocal relationship with the community and its health institutions, including
effective utilization of available resources for health care.

At the family level of care, the fundamental function of the community health nurse is to develop or
strengthen the ability of families to effectively perform the above health tasks.

Family health nursing is the basic and core component of CHN practice. Care to individual clients/
*Freeman, Ruth B. (1970). Community Health Nursing Practice. Philadelphia, Toronto, London: W.B. Saunders Co., 115-117.
 182 CLIENT CARE

patients is provided within the context, maximum involvement and participation of the family.

4. A POPULATION GROUP AS THE CLIENT/PATIENT

At this third level of care, community health nurses direct and focus their activities to certain population
groups with common unique health needs, are at risk of developing or have already developed certain
defined health problems, and to whom the nurse delivers health-promotive, preventive, curative or
rehabilitative nursing services. Examples of population groups given priority attention in public health work
are childbearing women, infants and pre-school age children, school children and workers in industrial
establishments. Midwifery/Maternal and Child Health, School Health Nursing and Occupational Health
Nursing are subspecialties in CHN practice. Other population groups with particular health needs and
problems include the elderly population, out-of-school youths and street children, communicable disease
cases (e.g. patients with tuberculosis or HIV/AIDS), chronic disease cases (e.g. diabetes, heart disease),
and the disabled, e.g. the blind, paraplegics, and the physically or mentally retarded.

In the care of specific population groups the nurse utilizes the group approach, identifying the common
health and nursing needs/problems of the members and addressing them for the whole group. For
example, the nurse may organize and conduct a Meal Planning Workshop for Diabetics, a Mother’s Class
for Primigravidas, or a rehabilitation program for stroke victims.

5. THE COMMUNITY AS THE CLIENT/PATIENT

Collections of families constitute a community. The term “community” has both geographic and socio-
cultural connotations. On the basis of geography, a community can be viewed as a place with spatial
boundaries, physical and environmental characteristics, and natural and man-made resources. In this
context, a community can be a “barangay”, a village/barrio, a town/municipality, a city, a district, a province,
a region, or the whole country. A community can also refer to a group of people who share common
needs, interests, ethnic or cultural ties, and are committed to the group’s well-being. Examples of these
are the squatter community in Metro-Manila, the Chinese community in the Philippines and the Christian
community in Mindanao. The world is a “community of nations”, sharing the same aspirations of peace,
development and progress, and working together to achieve these goals.

Communities, like individuals and families, are different from each other. Each community has its own
physical individuality, distinctive cultural characteristics, peculiarities, problems and needs which may
change through time, as well as its own set of values, relationships and ways of behaving that may
have significant effects on its own state of health. And communities, like individuals and families, also go
through stages of growth and development towards “maturity”. Thus, we have “primitive” and “progressive”
communities, communities which are underdeveloped, developing or fully developed, as well as healthy
and unhealthy/sick communities.

As with individuals and families and specific population groups, the health of a community is influenced by
many factors --- physical, biological, social, cultural, economic and political factors. Mortality and morbidity
statistics are broad indicators of a community’s state of health.

A community health nurse assigned in a particular community, such as a town or municipality, has the
whole community as her client/patient. While many of the services are delivered to individuals, families
and specific population groups, the health needs and problems of such individuals, families and groups are
seen collectively, including their import and impact on total community health. When establishing priorities
for care in the face of limited resources, the nurse maintains the perspective of and orientation to the health
of the total population or the community as a whole, the greatest good for the greatest number and impact
on community health rather than solely the needs of an individual patient, a family or group. To use an
 MODULE 5.9 183

analogy, the nurse views the whole forest instead of a few individual trees.

When a particular condition or situation poses a risk or hazard to total community health, or when a disease
threatens or actually afflicts a significant number of a community’s population, such situation, condition
or disease becomes a community health problem that calls for community-wide intervention measures.
Examples of these are epidemics of communicable diseases, problems in the environment such as air
pollution, contaminated water supply, unhygienic condition and dirty food handling practices in the public
markets and eating establishments. Corrective intervention measures to community-wide health problems
come in the form of specific programs or special projects which are implemented with the participation of
various members of the health team, including the community health nurse.

Figure 5.9.1 below schematically presents the levels of clientele in CHN practice, each level viewed as
part of and in relation to the next higher level. Healthy individual members make up a healthy family or
population group, and healthy families make up a healthy community. A community health nurse maintains
this perspective and never loses sight of the broader and ultimate goal of community health development.

Community
Group
Family

Individual

Figure 5.9.1 Levels of Clientele in CHN Practice

Source: Bailon-Reyes, Salvacion G. Community Health Nursing --- The Basics of Practice.
National Book Store, 2006, p. 10.

6. PRIORITIZING HEALTH/NURSING CARE SERVICES IN VARIOUS LEVELS OF

CLIENTELE THROUGH THE RISK APPROACH

It is not possible for a community health nurse to serve every individual, family or group in the community.
The needs and demands for health/nursing services are almost always greater than the resources available.
In view of this, there has to be some prioritization to ensure that services are delivered to those who need
them most in order to have some impact on total community health. The risk approach to health care
is one way of establishing priorities in the care of individual clients/patients, families, specific population
groups and communities.

The risk approach to health care refers to the early recognition of risk factors associated with adverse or
undesirable unwanted outcomes in individuals, families, specific population groups or communities, and
taking the necessary anticipatory or compensatory measures to reduce, totally eliminate or cope with the
probability of occurrence of the adverse or undesirable unwanted outcome.
 184 CLIENT CARE

The adverse or undesirable unwanted outcome can be any of the following: death, disability, disease/
illness, accidental injury, decline in quality of life, natural or man-made disaster, or negative effects on
human relationships, family, group or community health and health-related problems of individuals, families,
specific population groups or the community at large.

The risk approach is applicable to the care of individual clients/patients, families, specific population groups
and communities at large. Given a specific problem, risk factors at these various levels of care can be
identified. It requires identifying and concentrating care on those who are at greatest risk in relation to a
particular unwanted outcome or problem. For example, to control an increasing incidence of diabetes,
obese people are those at greatest risk of developing the disease; for the HIV/AIDS pandemic, drug users
and prostitutes are the groups most vulnerable to acquire the disease.

Certain common defining factors make up for corresponding risks to health. Table 5.9.3 shows these factors,
the ensuing vulnerable or high-risk population groups and the health programs which are addressed to
reduce the chance of undesirable unwanted outcomes to occur.

Vulnerable/High-risk Groups According to Certain Common Defining

Table 5.9.3Factors and Corresponding Health and Health-Related Programs to Meet
Their Health Needs
COMMON DEFINING VULNERABLE/HIGH-RISK HEALTH PROGRAMS
FACTOR POPULATION GROUPS
A. Age 1. Infants (0 - 1 year) Child Health Program
2. Pre-School Children (1 – 6 years)
3. School-age children (7 – 14 years) School Health Program
4. The elderly (60 years and over) Geriatric Program
B. Sex/Biological Child bearing women/ women in their Maternal and Child (MCH) Program
Function reproductive years
C. Socioeconomic 1. Squatters/residents of shanty town Health promotive and preventive
status 2. The homeless programs, rehabilitative and welfare
3. Street children programs
4. Beggars
5. Orphans
6. Out-of-school youth
D. Unhealthful 1. Cigarette smokers Health education, health promotive,
behaviour or lifestyle 2. Alcohol/drug users preventive and rehabilitative
3. Homosexuals programs
4. Prostitutes
5. Overweight/obese people
E. Disease/Illness state 1. Tuberculosis patients Communicable Disease Control
a. Communicable 2. People with sexually transmitted Program
diseases diseases, including HIV/AIDS
3. Malaria patients
4. Lepers
5. Polio patients/victims
 MODULE 5.9 185

Table 5.9.3 Continued:

COMMON DEFINING VULNERABLE/HIGH-RISK HEALTH PROGRAMS
FACTOR POPULATION GROUPS

b. Chronic non- 1. Hypertensives Follow-up and monitoring program

communicable 2. Diabetics to prevent complications and
disease 3. Heart disease patients premature death
4. Cancer patients
F. Disability/ 1. Physically handicapped/disabled – Rehabilitation, follow-up and
Developmental blind, deaf, lame, post-polio and monitoring program
Deficit post-stroke patients
2. Mentally retarded
G. Hazardous 1. Jeepney, bus and truck drivers Occupational Health Program
Occupation 2. Factory workers

The risk approach is in accord and consistent with the principles of equity and need-based care in primary
health care, the same care for all but more to those with greater need. The greater risk, the more need for
care. Risk screening increases coverage as it identifies individuals, families, specific population groups and
communities who require health/nursing services.

Table 5.9.4 presents, in general, the clients at each level of care who are at risk of developing health
problems and should receive priority for health/nursing services.

Table 5.9.4 Clients At Risk Who Should Receive Priority for Nursing Care
INDIVIDUALS FAMILIES SPECIFIC
POPULATION GROUPS COMMUNITIES

1. Individuals with 1. The very poor 1. The very young and 1. The very poor
strong genetic/ families. the very old in the communities
hereditary 2. Families residing in population – infants, lacking in such
predisposition to hazardous/unhealthy children, the elderly. basic facilities as
certain diseases, environment, e.g. 2. Childbearing women potable water,
e.g. breast cancer, shanties, squatter 3. Specific groups living sanitation and
diabetes. areas. or working in primary health
2. Individuals with 3. Families who are hazardous/unhealthful care.
unhealthful lifestyle, unable to cope (i.e. environment, e.g. 2. Communities with
e.g. heavy smokers, perform the family the homeless, street relatively high
alcohol drinkers, health tasks) with children, factory fertility, morbidity
drug users. respect to certain workers. and mortality rates.
3. Individuals health threats, illness 4. Specific groups 3. Communities with
manifesting some states or foreseeable suffering from chronic/ high incidence
signs and symptoms crisis situations within long-term diseases and prevalence of
of disease which the family due to: (e.g. hypertensives, endemic diseases,
require proper a. Lack of or diabetics, heart epidemics,
diagnosis and inadequate will, disease cases) accidental injuries,
treatment. knowledge and/or requiring monitoring communicable and
skills; and follow-up. non-communicable
diseases.
 186 CLIENT CARE

Table 5.9.4 Continued:

INDIVIDUALS FAMILIES SPECIFIC COMMUNITIES

POPULATION GROUPS

4. Individuals with b. Lack of or 5. Specific groups

specific diagnosed inadequate suffering from a
disease/illness resources; communicable
(includes c. Negative beliefs disease who require
communicable/ and/or attitudes, treatment and follow-
non-communicable e.g. fear, denial, up, and prevention of
diseases, acute complacency, lack spread to others.
as well as chronic of trust/confidence 6. The physically and
or long-term in health mentally disabled who
conditions) requiring professionals and/ require monitoring,
monitoring and or health care follow-up and health
follow-up. system. supervision.

METHODOLOGY FOR PROVIDING NURSING CARE --- THE NURSING PROCESS

APPLIED TO VARIOUS LEVELS OF CLIENTELE

1. WHAT IS THE NURSING PROCESS?

The nursing process is a logical, systematic, organized and dynamic method of providing care to clients,
whether the client/patient is an individual, family, a specific population group or a whole community. It is a
methodical and orderly approach to the planning and delivery of nursing care that is utilized to systematize
the helping process and standardize the nurse’s approach to her clients/patients in an attempt to effect
improvement in the latter’s health status, as well as increase his capabilities to cope with health problems.

The nursing process is basically the application of the scientific problem-solving to nursing care, and is used
to identify client/patient problems, to systematically plan and implement nursing care and to evaluate the
results of that care. It is action-oriented but requires a great deal of judgment as the nurse makes decisions
based on a consideration of a number of factors and variables, and from a synthesis of knowledge, ideas,
principles, methodologies and techniques from nursing and related disciplines. In its totality, the nursing
process is an integration of the intellectual, interpersonal and technical skills of the nurse.

2. MAJOR STEPS IN THE NURSING PROCESS

The nursing process consists of the following steps:

1. Assessment of the health/nursing needs of a client/patient, be it an individual, a family, a specific
population group or the community as a whole;
2. Intervention – the identification and implementation of appropriate intervention measures to meet
the nursing needs and/or solve the health problems which were determined during the assessment
phase, and
3. Evaluation of goal achievement – the process of determining whether the intervention measures
done were effective in meeting the nursing needs and resolving the health problems identified.
Based on the results of the evaluation, the nurse conducts a reassessment of the client’s/patient’s
condition through continuous data collection and analysis.

The above major steps of the nursing process must be viewed as a continuing circular process as shown
 MODULE 5.9 187

in Figure 5.9.2 below.

Assessment

Evaluation Intervention

Figure 5.9.2 Major Steps in the Nursing Process

Source: Bailon-Reyes, Salvacion G. Community Health Nursing --- The Basics of Practice.
National Book Store, 2006, p. 96.

2.1. Assessment of Health and Nursing Needs and Problems at Various Levels of Clientele

Assessment is the first step in the nursing process. It is a crucial step as it determines the accuracy of
the nursing diagnosis and the appropriateness of the ensuing nursing intervention. Adequate assessment
involves the collection of relevant and significant data that alert the nurse and the whole health team
to the early warning signs of trouble, data that clarify problems, contribute to the development of insight
regarding what needs to be done, as well as provide some direction or bases for action. There is also a
need to be discriminating and to be able to verify the veracity and validity of the sources, and the accuracy
of the data collected.

The types of data to collect, their sources, the methods and tools for data collection vary according to the
level of clientele, i.e. whether the client/patient is an individual, a family, a specific population group, or the
whole community. Table 5.9.5 presents the initial data to collect, their sources, the methods and tools for
data collection when assessing an individual client/patient, Table 5.9.6 for a family, Table 5.9.7 for a specific
population group and Table 5.9.8 for a community.
 188 CLIENT CARE

Assessment at the Individual Level of Care – Data to Collect, Sources of Data,

Table 5.9.5
Methods of and Tools for Data Collection
DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA
COLLECTION COLLECTION
1. Name, position in 1. Client/Patient 1. Physical examination 1. Physical
the family, 2. Responsible family of the client/patient: examination tools –
relationship to the member a. Inspection thermometer, blood
head of the family. 3. Friends/Neighbors b. Palpation pressure apparatus,
2. Sociodemographic 4. Medical records and c. Auscultation stethoscope, tape
characteristics – reports d. Vital signs, measure, weighing
Age, sex, marital 5. Verbal or written weight, height scale, height sale.
status, education, reports of other measurements. 2. Clinical history
occupation, income, members of 2. Direct observation record forms
religion. the health and of verbal and 3. Interview schedule
3. Physical condition intersectoral teams nonverbal or questionnaire
– appearance, build, who have had communication style,
nutritional status, previous contact mannerisms and
weight, height, with and/or provided behaviour of client/
body mass index service to the client/ patient
(BMI), vital signs patient 3. Interview of client/
(temperature, pulse, patient
respiration, blood 4. History-taking of a
pressure), state health or health-
of orientation and related problem
consciousness. 5. Interview of
4. Psychological responsible family
condition – general member
mood, mental/ 6. Review of health
emotional state, agency records
ability to express and reports,
needs, thoughts including laboratory
and feelings, examination results
body language, and radiological exam
mannerisms, results.
“abnormal” 7. Interview of relevant
behaviour. members of
5. Ability to perform the health and
activities of daily intersectoral teams
living. 8. Interview of relevant
6. Signs and and close friends
symptoms of and/or neighbors
disease, injury,
disability, and/
or developmental
deficit; history of
condition, if any.
 MODULE 5.9 189

Table 5.9.5 Continued:

METHODS OF DATA TOOLS FOR DATA
DATA TO COLLECT SOURCES OF DATA
COLLECTION COLLECTION

7. Disease condition,
injury, disability and/
or developmental
deficit diagnosed by
a legitimate medical
practitioner; history
of condition and
current treatment,
if any.
8. Personal health
habits and lifestyle
– eating/nutrition,
exercise, personal
hygiene, leisure/
recreation, smoking,
drinking alcohol,
drug use.
9. Personal and family
resources available,
including support
system.
10. Utilization of
available community
health resources for:
a. Preventive care/
services
b. Curative care/
services.
 190 CLIENT CARE

Assessment at the Family Level of Care – Data to Collect, Sources of Data,

Table 5.9.6
Methods of and Tools for Data Collection
METHODS OF DATA TOOLS FOR DATA
DATA TO COLLECT SOURCES OF DATA
COLLECTION COLLECTION

1. Family size and 1. Head of family/ 1. Interview of the health 1. Physical

composition – size household and of the family, examination tools
of household, names other responsible the spouse and – thermometer,
of members and family members other responsible blood pressure
relationship to the head 2. Close and relevant members. apparatus,
of the family. friends and 2. Physical examination stethoscope, tape
2. Sociodemographic neighbors of members of the measure, weighing
characteristics of 3. Other members family. scale, height scale.
members – Age, of the health and/or 3. Direct observation of 2. Clinical history/
sex, marital status, intersectoral teams family interaction and record forms
education, occupation, who have had relationship. 3. Interview schedule
income, religion. previous contact or 4. Inspection of home or questionnaire
3. Health status of provided services to environment 4. Observation
members: the family. and surrounding schedule
a. Member(s) of 4. Health agency premises.
the family with signs records and reports 5. Interview of close and
and symptoms of 5. Community leaders relevant relatives,
disease of illness, – formal and friends and/or
injury, disability, informal neighbors
developmental 6. Review of health
delays/deficits agency records and
which need to be reports
diagnosed and 7. Interview of relevant
treated; history of members of
each condition, if the health and
any. intersectoral teams
b. Member(s) with 8. Interview of relevant
disease condition, formal and informal
injury, disability and/ community leaders
or developmental
deficit which have
been diagnosed
by a legitimate
medical practitioner;
history of condition,
past and current
treatment, if any.
4. Family health habits
and lifestyle – Eating/
nutrition, personal
hygiene, exercise and
leisure/recreation of
family as a unit; any
smoking, alcohol-
drinking or drug use of
member(s).
 MODULE 5.9 191

Table 5.9.6 Continued:

DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA

COLLECTION COLLECTION

5. Family relationship
– Quality of interaction,
characteristic
communication pattern
and relationship of
members of household;
presence of conflict
between family
members.
6. Decision-makers in
the family, particularly in
health matters.
7. Quality of housing,
facilities and immediate
surroundings/
environment
a. Housing – Type
and ownership of
house/dwelling;
adequacy of living
space, bedrooms/
sleeping quarters
and sleeping
arrangement; lighting
facility, cooking
facility
b. Water supply –
source, potability
and storage
c. Food storage
facility
d. Toilet – type,
sanitary condition
e. Garbage/refuse
disposal – type,
sanitary condition
f. Drainage system –
type, adequacy
g. Presence of
insects and rodents
h. Presence of
accident hazards
in the home
and immediate
surroundings
 192 CLIENT CARE

Table 5.9.6 Continued:

SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA

DATA TO COLLECT
COLLECTION COLLECTION

i. State of
cleanliness and order
in the home and yard/
surroundings.
8. Quality of neighborhood/
community where family is
residing
a. Kind and socioeconomic
class of neighbourhood/
community
b. Communication and
transportation facilities
available
c. Support systems, welfare
and health care facilities
and resources available;
services provided
i. Government
ii. Semi-government
iii. Non-government
9. Ability to provide for basic
needs of members – food,
clothing, shelter and
education
10. Ability to provide nursing
care to its dependent, sick
or disabled members
11. Family’s utilization
of available community
health resources and
related social and welfare
services; preventive care
services, curative care
services, material/financial
and psychosocial support
systems
12. Family’s relationship with
the community and partici-
pation in community
activities
 MODULE 5.9 193

Assessment at the Group Level of Care – Data to Collect, Sources of Data,

Table 5.9.7
Methods of and Tools for Data Collection
DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA
COLLECTION COLLECTION

1. Size, location and 1. Leaders and/or 1. Survey of whole group. 1. Survey forms
composition of group responsible 2. Physical examination 2. Physical
a. Number of members members of the or health screening of examination
b. Place of domicile, group members of the group. and/or health
work, study and/or 2. Individual group 3. Interview of group’s screening tools
common place where members leader(s) or responsible 3. Interview
group congregates 3. Health agency members. schedule or
c. Sociodemographic records and 4. Direct inspection of questionnaire
characteristics of reports group’s common 4. Health record
members – age, 4. Other members environment (domicile, forms
sex, marital status, of the health work, study, recreation 5. Community map
education, occupation, and/or inter- or place of congregation) to pinpoint
income, religion sectoral teams 5. Review of health group’s location
2. Nature of health threats, who have agency’s records and or spatial
hazards or risks, disease knowledge and/ reports, including public distribution
condition, disability or or experience health statistics relevant 6. Observation
developmental deficit with the group. to the group. schedule
faced by group. 5. Formal and 6. Interview of relevant
3. Relevant health statistics informal members of the health
for the group – morbidity community and/or intersectoral
and mortality rates, and leaders. teams
causes of illness and 7. Interview of relevant
deaths. formal and informal
4. Community health and community leaders.
health-related resources
available to the group,
including psychosocial,
material and financial
support systems.
a. Government
b. Semi-government
c. Non-government/
private
5. Group’s utilization
of available community
health and health-related
resources.
 194 CLIENT CARE

Assessment at the Community Level of Care – Data to Collect, Sources of

Table 5.9.8
Data, Methods of and Tools for Data Collection
DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA
COLLECTION COLLECTION
1. Size, and type of community 1. Bureau of Census 1. Review/study and 1. Map of the com-
a. Land area and Statistics analysis of existing munity
b. Geographic units (e.g. 2. Municipal and/or data from records 2. Interview schedule,
barrios/vilages, provincial and reports of questionnaire
“puroks”, “barangays”) government government 3. Survey forms
– number, size, any office – relevant and private
special distinguishing or appropriate agencies, heath
characteristics. officials, records and intersectoral
c. Type of community – e.g. and reports agencies,
rural/urban, agricultural/ 3. Informal including census
industrial, shanty town, community data, public health
etc. leaders statistics and
d. Socioeconomic class (In 4. Officers and research study
the Philippines, ranges staff of relevant reports.
from Class I to VI) intersectoral 2. Interview
e. Topography and climate/ agencies, their of appropriate
weather conditions records and government
f. Natural resources – reports officials,
e.g. forests, rivers, lakes, 5. Health agency community
volcano, mountains, records and leaders, citizens,
tourist spots, etc. reports, health care
2. Demographic Data government and providers and
a. Total Population private relevant staff
b. Population density 6. Private medical of intersectoral
c. Sex ratio and other health agencies
d. Age structure – percen- professionals, 3. Tour of the com-
tage of population: traditional care munity – direct
i. 0-1 year (Infants) providers inspection of the
ii. 1-6 years (Preschool) 7. Published article environment,
iii. 7-16 years (Elemen- on the community facilities, natural
tary and high school and reports of resources, health
age) studies, if any. care and related
iv. 17-21 years (college resources
age group) 4. Survey of the
v. 22-60 years (working whole community
group) 5. Review of
vi. 61 and over (elderly) publications
e. Marital status with articles/
i. Single reports about the
ii. Married community, if any.
iii. Widow/widower
iv. Divorce/separated
f. Total number of families/
households ; average
family size
 MODULE 5.9 195

Table 5.9.8 Continued:

DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA

COLLECTION COLLECTION

a. Religious/ethnic groups
– Types, number and
proportion
b. Socioeconomic data
i. Main occupations/
industries
ii. Average family
income or GNP
iii. Unemployment rate
iv. Percentage of popu-
lation who are below
the poverty level
v. Education – Percen-
tage of population
who completed:
• Elementary school
• High school
• College
• Graduate education
• No schooling
vi. Literacy rate
3. Environmental Health
Facilities
a. Water supply – sources,
type of distribution,
quality of water
b. Waste disposal system –
types, sanitary condition
c. Refuse/Garbage dispo-
sal systems – types of
collection and disposal
d. Housing – types and
condition
e. Presence of pollution
i. Air – quality in
general
ii. Water – condition of
rivers
iii. Noise
iv. Land – uncollected
refuse/garbage in
public places
4. Public Health Statistics and
Related Information/
Literature
a. Fertility/Natality Rates
 196 CLIENT CARE

Table 5.9.8 Continued:

DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA

COLLECTION COLLECTION

a. Mobidity – rates and

leading causes, endemic
diseases, past epidemics
b. Mortality – rates and
leading causes
c. Life expectancy at birth
d. Reports of studies on
health and health-related
matters
5. Health Care Resources –
Government and private,
nature, scope and quality of
service provided
a. Hospitals – location, type,
bed capacity, facilities,
occupancy rate
b. Health centers/dispen-
saries – number, location,
service programs,
personnel, utilization by
public
c. Private medical clinics –
number, location
d. Dental clinics – number,
location
e. X-ray and Laboratories
f. Traditional health care
providers
i. traditional healers –
number and type;
location
ii. traditional birth atten-
dants – number and
location; number
trained; percent of
births attended
6. Other Community Resources
a. Schools – type, number,
location, number of
students
b. Public transportation –
types; condition of roads
and bridges
c. Communication – types,
location
 MODULE 5.9 197

Table 5.9.8 Continued:

DATA TO COLLECT SOURCES OF DATA METHODS OF DATA TOOLS FOR DATA

COLLECTION COLLECTION

d. Leisure/Recreation facili-
ties – types, number and
location
e. Electricity – coverage
f. Public markets, commer-
cial centers/malls, stores
g. Police/security system –
peace and order situation,
crime rate and nature of
crimes committed
7. Government and Community
Leadership
a. Government officials/
formal community leaders
b. Informal community
leaders
c. Influential citizens and
groups who participate in
decision-making process
as well as in the planning,
implementation and
evaluation of community
health and related
programs

A nursing diagnosis is the end result of the assessment process, which refers to a clear, concise and
definitive statement of the client’s/patient’s health needs and problems that can be modified through nursing
intervention. Health and health-related needs and problems which are not within the nurse’s ability or
resources to resolve are referred to other members of the health team or intersectoral teams.

From the final list of defined health needs and problems of a client/patient, the community health nurse and
the client/patient identify and decide on the priorities for nursing intervention. These priority needs/problems
become the bases for formulating the objectives for nursing care.

Nursing objectives can be immediate, intermediate or ultimate/long-term in relation to the time frame
for their expected achievement. Table 5.9.9 presents general objectives of nursing care in CHN practice,
and the level(s) of clientele to which each objective may apply.
 198 CLIENT CARE

Table 5.9.9 General Objectives of Nursing Care in CHN Practice

LEVEL OF CLIENTELE WHERE APPLICABLE
GENERAL NURSING OBJECTIVES
INDIVIDUAL FAMILY GROUP COMMUNITY
1. Promotion and maintenance of good
health
2. Prevention of disease and accidental
injuries
3. Change of lifestyle or unhealthful
behavior
4. Improved condition of the environment,
i.e. to a more healthful one
5. Improved ability to do activities of daily
living
6. Improved physical health, e.g. nutritional
status, normal blood pressure, etc.
7. Improved psychological/emotional state
8. Early diagnosis and treatment of disease
9. Relief of symptoms
10. Improved compliance with prescribed
treatment or rehabilitation measures
11. Prevention of spread of a communicable
disease
12. Prevention of complications of an
existing disease/illness or condition (e.g.
pregnancy)
13. Rehabilitation – physical, psychosocial,
occupational
14. Prolonging life
15. Comfort, freedom from pain for the
terminally ill and a peaceful, dignified
death
16. Increased competence in dealing with
common and simple illnesses and
accidental injuries
17. Increased utilization of available health
care and related resources
18. Increased ability to perform one or more
health tasks and achieve self-reliance in
health care matters
19. Reduced incidence and prevalence of
illness/diseases
20. Reduced mortality from a given illness/
disease
 MODULE 5.9 199

2.2. Nursing Interventions at Various Levels of Clientele

Nursing interventions are actions or measures taken by the nurse to achieve certain predetermined
objectives of care. Such actions are in accord with the current or prevailing scope and standards of nursing
practice and the nurse’s defined roles and functions. They are aimed at reducing or totally eliminating the
risk of occurrence of any adverse unwanted outcome related to health, or for the client/patient to effectively
cope with the adverse unwanted outcome if it was not prevented from happening.

Table 5.9.10 shows 12 types of nursing interventions in CHN practice and the levels of clientele to which
each type is applicable. These interventions are complementary and may be used in combination to deal
with a particular health/nursing problem at various levels of clientele. Various ramifications of each type
need to be identified, described, tried, tested, evaluated and documented if nursing science is to grow and
develop. The typology is an open system. Every CHN practitioner has the challenge to discover new and
more effective intervention measures to help clients/patients achieve the ultimate goal of effective coping
in the face of health problems, and self-reliance in health care. An inquiring mind, creativity, imagination
and experimentation on the part of every community health nurse will pave the way towards expanding the
armamentarium of nursing interventions in CHN practice.

Types of Nursing Interventions in CHN Practice and the Levels of Clientele

Table 5.9.10
To Which Each Type of Intervention is Applicable
LEVEL OF CLIENTELE WHERE APPLICABLE
TYPES OF NURSING INTERVENTIONS
INDIVIDUAL FAMILY GROUP COMMUNITY

1. Administration of Medical Treatments

2. Direct Nursing Care/Ministration
3. Indirect Nursing Care/ Ministration
4. Observational Measures
5. Anticipatory Guidance
6. Health Teaching/Education
7. Counselling
8. Motivation, Support, Development of
Support System/Groups/Network
9. Environmental Manipulation, Modification
and/or Improvement
10. Referral
11. Advocacy
12. Community Organization and
Development

2.3. Evaluating Nursing Care at Various Levels of Clientele

As the last step in the nursing process, evaluation is that phase which is concerned with ascertaining
whether the objectives of care were achieved. In its broadest sense, evaluation of care involves the
analysis of the appropriateness, adequacy, effectiveness and efficiency of care, based on systematic
documentation, monitoring and observations in relation to:
1. the accuracy, completeness and regularity of assessment;
2 degree of client/patient participation;
 200 CLIENT CARE

3. the quality, scope and timeliness of care provided, and

4. the outcomes of care and the interpretation of differences between observed and expected changes
in client/patient condition.

Evaluation relates to objectives, and the manner in which objectives are stated affects the ease or difficulty
of evaluation. Well-stated objectives specify the outcome(s) expected of nursing care activities, whether in
terms of physical, mental or emotional state and/or behavioural outcomes. Nursing care objectives stated in
terms of expected outcomes and in clear, specific and measurable manner make evaluation relatively easy.

Evaluation may focus on structure, resources or inputs, on the process of providing care, and/or
outcomes of care. Table 5.9.11 shows the specific items to evaluate under the levels of structure/resources/
inputs, process and outcomes, and these are applicable to all levels of clientele in CHN practice.

Specific Items to Evaluate Under the Levels of Structure/Resources, Process

Table 5.9.11 and Outcome, Dimensions of Evaluation to Which Evaluative Questions are
Addressed and Sample Evaluative Questions
LEVEL OF SPECIFIC ITEMS TO EVALUATE DIMENSIONS OF SAMPLE EVALUATIVE
EVALUATION EVALUATION QUESTIONS

I. Structure/ A. Resources of the nurse adequacy; Does the nurse have the
Resources/ 1. Competencies: appropriateness requisite knowledge, skills
Inputs knowledge, and attitudes to deal with the
skills, attitudes multiple problems presented
2. Material resources: adequacy; by the client/patient? Does
equip- appropriateness; she have adequate support in
ment, supplies, transport efficiency terms of material resources?
facility, etc. Were the resources allocated,
including time and effort,
3. Time and effort adequacy;
appropriate and adequate?
efficiency
Were they efficiently utilized?
B. Resources of the client/ appropriateness; Are the present human and
patient adequacy material resources of the
1. Human manpower client/patient appropriate and
resources, e.g. adult/ adequate to deal with the
employed members multiple problems at hand? Is
2. Material resources: adequacy; the client’s/patient’s level of
equipment, materials, appropriateness; competence in health matters
funds efficiency adequate? Were actions taken
in the past during episodes of
3. Competence in health adequacy; illness appropriate?
care: knowledge, skills, appropriateness
attitudes Did the client/patient expend
4. Time and effort adequacy; the necessary time and
efficiency effort in the resolution of the
problems identified?
 MODULE 5.9 201

Table 5.9.11 Continued:

LEVEL OF SPECIFIC ITEMS TO DIMENSIONS OF SAMPLE EVALUATIVE
EVALUATION EVALUATE EVALUATION QUESTIONS
C. Resources of the com- adequacy; Does the community have
munity effectiveness; appropriate and adequate health
1. Health manpower – efficiency; manpower, health care facilities
modern and traditional appropriateness and health-relevant organizations
2. Health care facilities appropriateness; that could provide support to the
3. Institutions relevant to adequacy; implementation of the nursing care
health, government and effectiveness; plan? Are these resources effective
non-government, and efficiency and efficient in their operations?
programs run
D. The nursing care plan adequacy; To what extent is the care plan
1. Assessment done appropriateness; likely to solve or reduce the health
which served as basis effectiveness; problems of the client/patient? Was
for plan efficiency assessment done appropriate and
2. Objectives set appropriateness; adequate to serve as sound basis
adequacy for objectives set? Are the nursing
objectives appropriate, adequate
and realistic? Are there important
objectives which were left out? Were
the activities/intervention measures
3. Activities/interventions appropriateness; and resources selected appear to be
planned to be done adequacy; adequate, appropriate, efficient and
effectiveness; effective to realize the objectives?
efficiency; Is a health teaching plan included?
impact Is a plan for evaluation included in
4. Resources to be used appropriateness; the nursing care plan? If so, does it
adequacy; appear to be appropriate, adequate,
efficiency effective and efficient? What was
5. Plan for evaluation of appropriateness; the cost in terms of resources of the
care adequacy; activities done? What is the cost-
effectiveness; benefit ratio?
efficiency
II. Process The implementation of the appropriateness; Were all nursing activities carried
nursing care plan, specifically adequacy; out as planned? What were the
the following: progress constraints faced in implementation
1. Quantity of services/ of planned activities? Was the
activities actually care provided comprehensive,
implemented coordinated and continuous? Did it
2. Estimated quality of effectiveness; consider and meet both the physical
services/care rendered efficiency; and psychosocial needs of the client/
3. Quality of nurse’s appropriateness; patient? What was the quality of the
performance including adequacy nurse’s performance of the activities/
involvement and partici- interventions done? Were correct
pation of the family in techniques and standard operational
the implementation of procedures and guidelines observed
the care plan in the performance of nursing
activities?
 202 CLIENT CARE

Table 5.9.11 Continued:

LEVEL OF SPECIFIC ITEMS TO EVALUATE DIMENSIONS OF SAMPLE EVALUATIVE
EVALUATION EVALUATION QUESTIONS

To what extent and in what

ways was the client/patient
involved in the implementation
of the nursing care plan?
III. Outcome/ 1. Change in physical/mental appropriateness; Did the intended results or
Output health status of individual adequacy; impact; changes occur? What is the
clients/patients, families; progress magnitude of change? At
change in fertility, morbidity what cost were the desired
and mortality patterns in results achieved? Was there
groups and in the whole any unintended or harmful
community. outcome? Was there any
2. Prevention of unwanted negative outcome prevented?
results or negative outcomes Are the outcomes significant
3. Change in communication, and likely to lead to the
interaction and relationship achievement of the ultimate
patterns, in assumption of objective?
roles and functions and in
overall functioning.
4. Change in health behaviour
and lifestyle.
5. Change in the quality of the
environment.
6. Change in level of compe-
tence (knowledge, skills,
attitudes) in matters relating
to health and health care.
7. Satisfaction or dissatisfac- adequacy To what extent was the client/
tion with nursing services patient satisfied with the care
received. received from the nurse? What
are their specific complaints, if
any?

Evaluation also involves determination of criteria and standards. Criteria refer to the signs which indicate
that the objective has been realized or achieved. Criteria are free from any value judgment and are not
attached to a time frame. When a value judgment is applied to a criterion, it becomes a standard. A standard
refers to the yardstick against which results of assessment will be compared in order to make a judgment.
It represents the desired condition, situation, state of affairs or level of performance corresponding with a
criterion against which the actual condition, situation, state of affairs or level of performance is compared.
Applied to the evaluation of nursing care, standards tell us what the client’s/patient’s situation, behavior,
level of performance or capability should be for us to say that nursing intervention was successful, or that
the objective of nursing care was achieved. Standards are established by authority, custom or general
consent as a model or rule of measurement. They reflect the development of an art, science or service and
are usually the product of detailed scientific investigation and professional judgment. Standards can be
low, moderate or high; they can also be realistic or unrealistic. Standards also relate directly to the criteria,
i.e. for every criterion, there has to be a standard. An adequate statement of objectives specifies both the
 MODULE 5.9 203

criterion and standard of evaluation.

Figure 5.9.3 on the next page schematically presents the steps in evaluating nursing care. Again, they apply
to the evaluation of care of individual clients/patients, families, specific population groups and communities.
Methods of data collection and sources of evaluative data can range from direct observation, to records
and reports review, verbal reports, interviews or questionnaire administration, oral and/or written tests,
simulation exercises, and feedback from the recipients of care. While clients/patients may not be aware
or knowledgeable about the technical elements of good care, it is necessary and useful to ascertain the
client’s/patient’s satisfaction with health care in general and nursing care in particular. Such satisfaction
affects the development and maintenance of a good working relationship between the nurse and the
client/patient. Clients’/patients’ feedback is particularly useful for evaluating the humanistic, ethical and
psychosocial aspects of care, courtesy, respect, sympathy, compassion, kindness, sensitivity and concern
expressed by the nurse in the process of providing care. The latter pertain to the affective component of
nursing competence which are extremely important in clients’/patients’ perception of “good” care.

Evaluation is the last phase of the nursing process but it is not the end. It continues and goes back to
reassessment of the client’s/patient’s condition and situation, and to the nursing care plan.

SUMMARY

This Self-Instructional Module defines, describes and explains the basic concepts, features and
characteristics of the four levels of clientele in CHN practice: the individual, the family, specific population
groups and the community as a whole. It briefly explains the nursing process --- the basic methodology for
providing professional nursing care, and it illustrates the application of each step in the nursing process at
each level of clientele, from assessment of health/nursing needs and problems, to evaluation of nursing
care.

POST ASSESSMENT

Please turn to Page 205 and take your Post-Test. Write your answers in a separate sheet of paper. Do not
write anything in the Question Sheet.
 204 CLIENT CARE

1. Review client’s/patient’s health/

problem situation prior to
nursing intervention

2. Review nursing care plan,

particularly objectives of
nursing care

3. Decide on type of evaluation to

be done and specific dimen-
10. Identify possible causes of full sions to assess
achievement, partial
achievement or non-
achievement of nursing care
objectives 4. Decide on what to evaluate

5. Define criteria and standards

for evaluation

9. Draw conclusions
6. Decide on sources of evaluative
data and method(s) of data
collection; construct and pretest
data collection tool(s)

8. Analyze data gathered; com-

pare client/patient situation
before and after, nursing care 5. Gather data
based on criteria and standards
for evaluation

Figure 5.9.3. Steps in Evaluating Nursing Care

Source: Bailon-Reyes, Salvacion G. Community Health Nursing --- The Basics of Practice. National
Book Store, 2006, p. 178.
 MODULE 5.9 205

POST-TEST

INSTRUCTION: Read carefully each of the following questions, and write your answers in a separate sheet
of paper.
1. Identify five (5) areas of difference between Hospital Nursing and Community Health Nursing
(CHN). For each area, indicate the difference between the two major fields of nursing practice.

2. Identify the four (4) levels of clientele in CHN practice. Briefly describe each level and differentiate
one from the others.

3. For each of the four (4) levels of clientele in CHN practice, identify five (5) initial data to collect to
have some idea on possible health/nursing needs/problems.

4. Enumerate five (5) basic functions of a family.

5. Enumerate five (5) health tasks of a family.

6. In no more than two sentences, define the risk approach to health/nursing care.

7. For each of the four levels of clientele in CHN practice, identify three (3) kinds of clients/patients to
whom you will give priority attention based on the risk approach to health/nursing care.

8. In no more than two (2) sentences, define Nursing Process.

9. Enumerate the three (3) major steps in the nursing process.

10. Identify three (3) possible general objectives of the nursing care.

11. Enumerate five (5) kinds of nursing interventions in CHN practice.

12. Identify three (3) specific items to evaluate under Structure/Resources/Inputs, three (3) items under
Process, and three (3) under Outcomes of nursing care.

CHECKING AND SCORING YOUR ANSWERS

1. Check your answers against the Key to Correction on Pages 173 to 179 of the Module.
2. Score your answers according to the number of points given to each correct answer for every item
in the Test.
3. Add up your score for all your correct answers. The Perfect Total Score is 95 points.
4. Indicate your Total Score on the upper right hand corner of your Answer Sheet.
5. Now, compare your Pretest Score with your Post-test Score. An increase in your Post-test Score
over your Pretest Score represents your gain in learning. For example, your Pretest Score was 20
points and your Post-test Score was 80 points, you have a learning gain of 60 points (equivalent
to 63.1% gain in learning). However, if your Pretest Score was higher than your Post-test Score,
something went wrong somewhere --- you have to reread/restudy the Module.

If your Post-test Score is lower than 71 points (75%), the Passing Mark, please reread/restudy the Module.
 206 CLIENT CARE

REFERENCE

Bailon-Reyes, Salvacion G. Community Health Nursing --- The Basics of Practice. National Book Store,
2006.