Community Health

Nursing Week 1-2

TOPICS

MONITORING/EVALUATING COMMUNITY
HEALTH PROGRAMS

DOCUMENTATION/REPORTING IN CHN
DEVELOPING WORK GROUPS FOR COMMUNITY
HEALTH DEVELOPMENT

COMMUNITY HEALTH PROFILE

DELIVERY OF HEALTH CARE TO THE FILIPINO
PEOPLE
 MONITORING & EVALUATION OF
COMMUNITY HEALTH PROGRAMS
IMPLEMENTED
MONITORING
➢to watch and check a situation carefully for a period of time
In order to discover something about it:

➢to observe and check the progress or quality of (something)

over a period of time; keep under systematic review.

➢to maintain regular surveillance

MONITORING – (United Nations-1978)
> “the continuous or periodic review and surveillance by
management at every level of hierarchy of the
implementation or an activity to ensure that :
- input deliveries
- work schedules
- targeted outputs
- other required outputs are proceeding according to
plan
> Done during the implementation phase
Purpose of Monitoring:

➢ Identify deviations or problems so that

corrective measures/actions or
interventions can be instituted
immediately

➢ Implies reporting to appropriate

persons/offices at regular intervals
NURSING PROCESS IN CHN

I
1. Family A D P M E
S I L P V
S A A L A
2. Individual E G N E L
S N N M U
S O I E A
3. Population Group M S N N T
E I G T I
N S A O
4. Community T T N
I
O
N
EVALUATION
➢the making of a judgment about the amount, number,
or value of something;

➢In CHN, evaluation is specifying the worth of the

implemented
- health programs
- performance of health facilities/human resources
- nursing care given to clients
EVALUATION :
➢ Analysis of the effectiveness, quality, scope, and timeliness of
services given

➢ “the process for determining systematically and objectively the

relevance, efficiency, effectiveness, and impact of activities in
the light of their objectives (UN, 1978)

> Done during planning stage

PROGRAM EVALUATION aims to:

➢ discover how well the objectives are being fulfilled

➢ determine the reasons for specific successes and

failures

➢ Uncover principles underlying a successful program

EVALUATION :

➢ Help prevent costly mistakes

➢ Improve program planning/

implementation in the future
Responsible for evaluation
in CHN:
Head of the Unit(Physician)
- Local health programs

Community Health Nurse

- Nursing care rendered to clients/Midwives
performance

Midwife

- Assist in the evaluation of BHW

Steps in the Evaluation of Nursing
Care
Assessment Diagnosis Planning Implementation

Determine whether Determine if Determine if the Analyze how the plan

there are changes in problems requiring interventions are was implemented
health status nursing care are appropriate and
resolved, improved adequate to achieve
or controlled client outcome
Make sure that Consider if there are Specify client’s Determine what
assessment data are new problems status based on factors are related
accurate and expected outcomes with the success in
complete of care implementing the
plan
Specify what factors
created problems or
barriers to care
The steps will:

➢ guide the nurse in deciding whether to:

- continue
- modify
- terminate the nursing care plan

➢ Compare “what actually is” and “what should be”

➢ Specify Objectives and Criteria

OBJECTIVES(s)
something toward which
effort is directed : an aim,
goal, or end of action

should be:
➢ client-centered
➢ outcome-focused
CRITERIA: a standard by which something can be judged or
decided.

➢ Objective
➢ Measurable
➢ Relevant
➢ Flexible
EXAMPLES:
Objective: During home visit, Mr. Rodrigo will be able to
collect a good sputum sample for microscopy

Criteria: Mr. Jaime collects sptum specimen as instructed:

- breaths air deeply
- coughs strongly at the height of inspiration
- spits the sputum into a sterile container
(35ml/mucopurulent)
- covers the sputum cup
OUTCOMES:
➢ Evaluation of nursing care given to clients
focuses on outcomes

➢ Outcomes can easily pinpoint nursing

interventions that are effective and those
that are not

➢ Show value of care/services

Example: Mr. Jaime was able to collect

sputum specime for microscopy
correctly.
Designing and Implementing Evaluation
Plan and Monitoring Evaluation
Tools/Instruments for evaluating outcomes of nursing
interventions:
➢Thermometer
➢BP app/stethoscope
➢Weighing scale
➢Tape measure
➢Checklist – post CVA patient
➢Interview –related to client’s condition
Sample Form in Designing an
Evaluation Form

Objective Criteria for evaluation Evaluation tool

During the home visit, Mr. Mr. Jaime collects sputum - Sputum specimen in a
Jaime will be able to collect specimen as instructed: sterilized sputum cup
a good sputum sample for - breaths air deeply - interview
microscopy - coughs strongly at the
height of inspiration
- spits the sputum into a
sterile container(3-5ml
/mucopurulent)
- covers the sputum cup
 SAMPLE EVALUATION CHECKLIST
CRITERIA CHECK IF OBSERVED REMARKS
YES NO
1. The client takes prescribed Anti-TB / On his 3rd month of
drugs Anti-TB drugs
2. Each family member underwent / All members are
sputum microscopy sputum negative
3. The family properly disposes sputum / Health teaching
discharges done
4. The TB patient undergo sputum / Follow-up sputum
follow-up for microscopy with (-) result
5. The family takes care of the family / Wife take good
member with TB correctly care of her
husband
 SAMPLE EVALUATION INTERVIEW

Criterion:
- The mother will be able to identify the
consequence of Vit. A deficiency
Question:
- “Misis pwede mo ma sugid sa akon ang nabal
an mo kung ano matabo sa bata mo nga
kulang sya sa Bitamina A?
Criterion:
- The mother will be able to identify food sources
of Vit. A

Question:
- “Misis pwede ka kahatag sa akon lima ka
halimbawa sang pagka-on nga masustansya sa
Bitamina A?
• If skills are the focus of evaluation:

> let client demonstrate the specific skill

> can ask significant others for their observation

• Attitude:

> can be assessed through qualitative or structured interviews

> “Kwentuhan” –informal talks but will make client more relax, open
with their feelings and not threatened by the presence of the
evaluator
Feedback:
➢ serves many purposes:
- motivates and reinforces positive behavior
- enhances client’s self image
- increases client’s awareness of the need to improve their
behaviors
- provide client the opportunity to articulate their thoughts
regarding tasks on hand

➢ Should be properly documented

➢ Family health record should be updated regularly

 PROGRAM EVALUATION

PROGRAM :

➢ An organize set of activities, projects, processes or services

which aims for the realization of specific objectives

➢ Has a broader scope, magnitude, and diversity than a project

Focus of Evaluation
 Three types of program evaluation

1. Ongoing:

- analysis during implementation

of the activity
- of its continuing relevance,
efficiency, effectiveness
- present and like future outputs,
effects, impact
2. Terminal:
- undertaken from 6-12 months after the project completion
- a substitute for ex-post evaluation of the project with
short duration
- assess the achievement of overall results in terms of
efficiency, outputs, effect and impact
- learn lessons for future planning
3. Ex post :
- undertaken some years after project completion
- impact have been realized
Indicators:
➢ is a performance measure
➢ Indicator should be:
- valid
- reliable
- objective
- sensitive
- specific
- cost-effective
- timely

•
Examples of Indicators:

1. Input indicators

- number of Vit. A capsules procured

- number and type of education/information materials
developed/reproduced
- number of BHWs trained on the prevention of Vit. A
2. Process Indicator

- percentage (%) of Vit. A capsules distributed to field offices

- percentage (%) of education/information materials actually
distributed to field office
- percentage (%) of BHWs actually trained
3. Output Indicators:

- number of preschoolers weighed

- number of school children given Vit. A
- number of BHWs completed the training
4. Effect Indicators:

- number of preschoolers who increased weight

- number of school children having good eyesight
- number of trained BHWs doing health teaching
5. Impact Indicator:

- mortality rate : decreased by 10% in the number of

children with Vit. A deficiency

- BHWs manned the BHC during consultation

 Steps in Program Evaluation

1. Deciding what to evaluate:

-what should be evaluated?
* content
* objectives of the program/project
5 Dimensions of program performance for evaluation:

1. relevance
2. progress
3. effectiveness
4. impact
5. efficiency
2. Design the Evaluation : specifying
- data collection methods
- tools
* questionnaire
* interview
* checklist
- sources of data
* records/reports
* surveys
* interview
3. Collect relevant data (based on facts)
Why relevant data is important?
- indisputable
- creates strong strategies
- necessary for optimization
- builds better relationship
- strengthen internal team
- quantifies the purpose of work
- helps cover yourself
4. Analyze data:
what to analyze:
- is the program relevant?
- progressing according to program plan?
- is it effective?
- is it efficient?
- did it make an impact on beneficiaries/community?
- do benefits outweighs the problem created?
- lessons learned from the program/project?
5. Make decisions if:
- program is effective/efficient = continued or applied
to another program or group
- there is another phase of the program = positive
result serves as a go signal to start the next
phase (guided, modified, improved)
- not relevant = recommend modification or
termination
6. Report/Give Feedback
- should be submitted to:

* Local authorities (Mayor)

* Sanggunian Bayan Chair (Health)
* Local Health Board
 Sample Format for Evaluation Report

Executive Summary of Program Evaluation

Brief Description:
Focus/Coverage/Objectives

Summary and Interpretation of Results:

Conclusion:

Recommendation(s):
 Determining Focus of Evaluation:

• Basic Components of Focus of Evaluation:

• 1. For which audience is the evaluation being conducted?

Ex.: patient and families, groups, peers

• 2. For what purpose is the evaluation conducted?

• > answer the questions > why is the evaluation being conducted?
• 3. Which question will be asked in the evaluation?
> must be directly related to the purpose of the evaluation
> must be specific
> must be measurable

• 4. What is the scope of the evaluation

• > extent of what is being examined (mothers or entire population)
• > time frame
• 5. Which resources are available to conduct the evaluation?
• > time
• > expertise
• > personnel
• > materials
• > equipment
• > facilities
4 Levels of Program Evaluation:

1. Process (Formative) Evaluation

> make necessary adjustments to an activity as soon as they are
identified such as:
- personnel
- materials
- facilities
- methods
- objectives
- attitude
2. Content Evaluation
> determine whether learners have acquired knowledge or skills
during the learning experience

> focus on how the teaching-learning process affected

- immediate
- short term outcomes
> focus on collecting internal evidence to determine whether
objectives for a specific group of learners were met
3. Outcome (Summative) Evaluation
> determine the effects of teaching effort
> measures that changes that results from teaching efforts

4. Impact Evaluation
> determine the relative effects of education on the community
> obtain information that will help decide whether continuing
the activity is worth its cost (cost effective)
Barriers to Evaluation

1. Lack of clarity
> if focus of evaluation is unclear, unstated, or not well defined
= unknown result
2. Lack of ability – often results from lack of:
> knowledge
> interest
> confidence
> resources needed to carry out the evaluation process
3. Fear of punishment or loss of self esteem
> evaluation might be perceived as a judgment of someone’s
value or personal worth
> both teacher and learner may fear that anything less than
perfect will result to:
- criticism
- punishment
- being labeled as incompetent
 RECORDS IN FAMILY NURSING HEALTH
PRACTICE
HEALTH RECORDS – is a written document about a target client, whether:
- individual person,
- family,
- a group or
- a whole community

➢Relates an event pertinent to health care services:

- clinic - consultation
- hospitalization - home visit
- immunization - births/marriages/deaths
HEALTH REPORTS – account or summary of the services rendered to
the clients
and rationalizes the continued existence of the program

➢Gives a description and analysis of the problem(s) encountered

➢The measures or actions taken/implemented

➢The accomplishments and degree to which objectives are met and

the quality of service rendered
PURPOSES OF HEALTH RECORDS:

1. Patient care

2. Communication

3. Legal documentation

4. Billing and Reimbursement

5. Research and Quality Assurance

USES OF HEALTH RECORDS:

1. Empower health care professionals to treat patients to the best of their

ability.
2. Safety can be increased
3. Processes can be sped up
4. Claims processes and reimbursement can be improved
5. Effectiveness of treatments and therapies can be monitored and tracked
6. With growing amount of information, outcome predictions can be made
7. Liability is reduced as a result of oversight
8. With IT, loss of information, errors, and omission can be significantly
reduced
TIPS FOR RECORD KEEPING:

1. Always date and sign your name

2. Correction must be shown clearly as:
- alteration
- complete with date
- amendments
- name of nurse
3. Making good notes should become a routine
4. Document all:
- decisions made - clinical findings - referrals
- discussion - patient progress
- information given - results
- relevant history - investigation
5. DO NOT WRITE offensive or gratuitous comments

6. Patient can access to his/her record

7. Maintain best practice aiding clear communication

8. Essential for good medical practice and continuity of care

9. Appropriate record keeping is recognized as important to professional

standard
 Field Health Services Information System

FHSIS – is a network of information source developed by the Department of

Health.
- intended to address the short-term data needs of the DOH staff
with managerial and supervisory functions in the DOH facilities and in
each of the program areas
- aims to monitor national health service delivery system
- act as:
- source of referral - validation
- evaluation - delivery of quality patient care
- legal document in court cases
OBJECTIVES OF FHSIS: TO

1. Provide summary of data on health services and selected

program indicators
in all levels

2. Provide data for program monitoring and evaluation purposes

3. Ensure that data reported are useful, accurate, and easy to

understand

4. Minimize recording and reporting burden at the service

delivery level
IMPORTANCE OF FHSIS:

1. Helps local government to determine public health priorities

2. Basis for monitoring and evaluating health program

implementation

3. Basis for planning, budgeting, logistics, and decision-making

at all levels
4. Source of data for detecting unusual occurrence of illness

5. Helps in monitoring the health status of the community

6. Helps midwives/ CHN nurses in monitoring clients

7. Helps in documentation of RH Midwives/CHN Nurse day-to-day

activities
DOH Programs as Focus of FHSIS:

• Maternal and Child Health (MCH) - Maternal Care

• Expanded Program on Immunization (EPI)

• Control of Diarrheal Disease (CDD) - Tuberculosis/Malaria,

• Leprosy - Schistosomiasis
• Nutrition - Dental Health

• Family Planning - Environmental Health

COMPONENTS OF FHSIS:

A. Recording:
1. Individual Treatment/Family Treatment Record
- most basic record which must be kept in the facility
- fundamental building block of FHSIS
- it contains:
- client’s data: name, address, date of birth, religion,
weight
- chief complaints, vital signs, diagnosis, treatment(s)
- date of treatment, consultation
 FORMAT OF TREATMENT RECORD

Date Name Address Date of Sex Religion Occupation Complaint Diagnosis Treatment
Birth
11/20/22 Kim Pk. Love, 3/3/2015 F Catholic none Hard TB SCC
Lee Brgy. 99 productive For sputum
cough exam
Target/Client List:
a. constitute the second building block of the FHSIS
4 Purposes:

1. plan and carry out patient care and service delivery to prevent duplication or
redundancy

2. Facilitate monitoring and supervision

3. Report services delivered, information or tally sheets for easy reporting

4. Provide clinic-level data base for further studies

 b. Programs to be maintained in the
target/client list:
1. EPI
2. Eligible Population
3. Children 9-59 months (risk, Under 5 Children)
4. Nutrition
5. Pre-Natal Care
6. Post Partum Care
7. Family Planning
8. TB Symptomatic/TB Patients under SCC/TB Patients under
Standard Regimen
9. Leprosy/Malaria/Schistosomiasis Patients
3. SUMMARY TABLE

a. is a form with 12-month column retained at the Barangay Health Station (BHS)
- Midwives made relevant monthly report
b. parts of the summary table:
1. health program accomplishment
- midwives record all data found in the target client list (TCL)
- serves as source of data for reports prepared by midwives
- serves as data source for survey, study, or research
- serves as a tool for the midwife to assess her own accomplishment

4. MONTHLY CONSOLIDATION TABLE– show monthly trend of disease occurrence

B. REPORTING:
1. Tally/Reporting Forms- data are transmitted from one health facility to another
* weekly * monthly * quarterly * annually * or even few minutes

BHS/BHC
RHS/RHC
PHO DOH
“FEEDBACK”

2. Output Reports/Tables – produced at the PHO back to BHS/BHC to RHO

Thank You!
[email protected]