Saint Louis University

School of Nursing
Community Health Nursing
Summary Report Per Clinical Group
Semester/Term/Schoolyear: _______________
Community Area: ________________________

I. Family Nursing
A. Promotive/Preventive Activities
1. Health Promotion Campaigns Conducted
Health Advocacy Topics

No. of Family
Recipients

Sitio

Smoking cessation
Alcohol cessation
Nutrition
Exercise
Environmental sanitation
Hygiene
Waste management
Stress management
(add here other promotive
programs
2. Health Screening ( list of names of clients is attached)
Screening Activities
BP taking: Low BP
Normal BP
High BP
Weight Monitoring:
Below normal weight
Normal weight
Above normal weight
Physical examination
Breast Examination
( add other screening activities
eg. sputum exam, benedicts
tests, etc)

No. of Individuals

Sitio

3. Sitio Class/ Mothers Class on Disease Prevention and

Management
Topic

Description of
Participants
( mothers, etc.)

No. of
Participants

Date and Place

4. Maternal and Child Services ( list of names of clients is

attached)
Services
Number of Clients
Remarks
Antepartal care
Post partum care
Newborn care
Family planning acceptors
Follow-up of family planning
users
5. Immunization Services ( list of names of clients is attached)
Immunizations
BCG
Hepatitis
OPV
DPT
TT

No. of Clients

Remarks

B. Curative Activities ( may also include rehabilitative or

palliative services, if any)
1. Cases Handled ( list of names of clients is attached)
Cases
a. Communicabl
e diseases
Pulmonary
tuberculosis
( add other
diseases here)
b. Noncommunicabl
e diseases
Hypertension
( add other
diseases here)

Number of Clients

Sitio

Remarks

2. Referrals (Use the two-way referral system of SON)

Name of Client/
Age/Address

Chief
Complaint

Where/With
Whom
Referred

II. Community Development Activities

A. Community Activities/Projects Involvement

Results of
Referral/Remarks

Community Activity

Nature of
Involvement

Results of
Activity/Partners

B. Linkages and Networking

Agency/ Contact
Person

Purpose of
Coordination/Linka
ge

Results of
Coordination
/Remarks/Resources
Involved

III. COPAR Phases/Critical Activities ( Please check

activities performed)
Phases and Critical Activities
PRE-ENTRY PHASE
Initial consultations with community key leaders
Formal communications
Courtesy calls: municipal level
Utilize secondary data for preliminary social
investigation
Agency orientation conducted
ENTRY PHASE
Courtesy call in barangay level
Ocular survey
Community awareness of the immersion program
Community integration: specify methods of
integration done
Sociogramming
Core group formation/existing core group
identified
Groundworking of core group members
Tentative planning with community core group
members for research
Identifying research group from the core group
and other interested community members
Training of research core group
Deepening social investigation with research core
group
Completed community diagnosis report
Presentation of research data to the community
Community development plan formulation with
community
First set of ARAS with community leaders/core
group

Check if
perform
ed by
the grp

Remarks

ORGANIZATIONAL BUILDING PHASE

Developing/strengthening organizational
structures
Capability building activities/ training:
Core group
Health committees/BHWs
Other interest groups: Specify
Community integration: specify methods of
integration done
ARAS with community conducted as needed
CONSOLIDATION, STRENGTHENING AND
SUSTENANCE PHASE
Organizational diagnosis
Continuing training/capability building of peoples
organizations (PO)/groups
Networks, linkages and alliance building
POs/groups planning and implementing
development projects/programs
Community integration: specify methods of
integration done
Regular ARAS conducted
Identifying/developing second liners
Income generating projects and other sustaining
mechanisms developed
PHASE OUT
Impact evaluation for phase out
Endorsements: Barangay level
Municipal level
Monitoring of community activities
Disengagement
Prepared by: _______________________________
Printed Name and Signature of Faculty
Date Submitted: ____________________________