INTRODUCTION Community health nursing is one of the two major fields of our course academic, as holistic approach that

both enhances and profound our professional health skills and knowledge to implement feasible and practical interventions. But what is community health nursing? According to the Nurses Association, community health nursing is mainly a practice that promotes and preserves the health of the population by integrating the skills and knowledge relevant to both nursing and public health that partners the individuals, families and community geared to a common goal. This is always been the guideline of our nursing community education that brings about comprehensive practice, general care and continual preventive measures which are the core nature of our nursing practice. Significantly focused on the said nursing practice, supervised by our professor and equipped with health knowledge and skills, we are opted to promote and carry on our objectives that will have optimal nursing care output from our chosen community that may show also and employ our qualities and capabilities as registered nurses. Through the end of this case study material, that we, students of Graduate Studies Group No.___, may be able to present ourselves and persuade our panels that we have progressed after our community exposure and activities last January 21, 24, 25 and January 27 2012 in Barangay San Roque, Tarlac City specifically Block 2 under the supervision of our Professor Mr. Apollo Facun. Furthermore, uphold the core nature and essence of community health nursing.

GOALS AND OBJECTIVES

GOALS: To assess the communitys current health status To recognize possible relationships/ trends that may affect the communitys health condition To render appropriate health care services for health promotion and disease prevention

OBJECTIVES: 1. To gather and update the health data of the residents through a comprehensive community survey, and prepare an initial data base per household containing data on family structure, characteristics, and dynamics; socio-economic and cultural characteristics; home and environment conditions; health status of each member; and health beliefs, practices, and values. 2. To assess the health needs of the household/community and render basic health services such as health education programs (health teachings), as the situation calls for. 3. To recognize present and possible health threats in the community, through observation and data interpretation/correlation. 4. To assist all sectors involved, especially the family, in organizing a plan of action, possibly through the utilization of available community health resources, which will address recognized health problems in the community.

TARGET COMMUNITY PROFILE Barangay San Roque is one of the nine barangays enclosed in the Metro District Division of Barangays in Tarlac City. It is bounded by Barangay San Vicente on the West, Barangay Ligtasan on the East, Barangay San Sebastian on the South, and Barangay Cut-Cut 1st on the North. Barangay San Roque is classified as Urban Barangay, it has a total population of eight thousand one hundred forty-six (8,146) as of December 2011, and an estimated household population of 1,800.

HISTORICAL BACKGROUND Barangay San Roque serves as the Southern porter to the political, religious and economic hub or center of the City and Government of Tarlac. It is one of Tarlac Citys biggest barangays with a population of 7,487 as of May 1, 2000 Statistics. An account of 1849 City that Tarlac grew into 13 Barrios, though there was not yet the San Roque toponym also it became part of the history where the Guardia Civil executed Col. Francisco Taedo in January 1898 during the Spanish regime. The same year, San Roque was already mentioned in documents as one of the center of operations of General Francisco Macabulos against Spaniards. Barrio San Roque named after San Roque or Saint Rock who is the Powerful Patron of the Sick and the suffering. During the 30 th century, it said that many people who were afflicted with dreaded diseases healed through his intercession. It was March 07, 1969 when a kind couple gave hope for the rise of San Roque Parish. It was through the generosity of the Dr. Ernesto G. Cruz and Mrs. Ursula Magat that the 692 Square meter lot intended for the site of a Chapel for the Roman Catholic Church of Barrio San Roque. Barangay San Roque celebrates their feast Day every August 16 as a thanksgiving to their Patron Saint Roch (San Roque). The Socio-Economic and Physical profile is produced to provide baseline and benchmark in terms of livelihood, health and sanitation, peace and order, education, shelter, basic utilities and people's participation among others. This shall hopefully assist decision maker in the barangay to the highest level of government and nongovernment organizations by providing insight programs and projects for the development of the barangay.

GEOGRAPHIC PROFILE Barangay San Roque has nine (9) blocks, namely: Block 1, Block 2, and Block 3 to Block 9. It is approximately 1.0 kilometer away from city proper. It has a total land area of 96.51 hectares. Mostly the whole parts of this area designated to business establishments and residential area.

PHYSICAL AND NATURAL CHARACTERISTICS 1. Climate- the barangay has a temperate climate. It has two (2) distinct seasons: wet and dry. The months of November to April are generally dry while the rest of the year is the rainy season. It receives its continuous rainfall during the southwest monsoon period from June to November, which corresponds with the wet season. The northeast monsoon period from the months of November to May with the dry season. 2. Topography and Slope- the topography is characterized predominantly level to gently sloping (0-3% slope gradient) covers 90.84% or 38, 633.44 hectares which is suitable for urban expansion and settlements development. This slope ranges has lower susceptibility to erosion. 3. Soil Type- Tarlac Clay Loam, Gravelly Phase, this type of soil occurs as areas of lighter soils, with reddish brown to red, gravelly and concretion filled profile. 4. Water Bodies- the city of Tarlac has various communal bodies of water. The main tributary is Tarlac River, which is more or less 16 miles long located

COMMUNITY FACILITIES

Waiting Shed Health Center Barangay Hall Cell Site Schools Apartments Boarding House Jeepneys and Tricycles Business firms Government Offices

ORGANIZATIONAL CHART
HON. GELACIO MANALANG Municipal Mayor

HAZEL MIEMEE B. LEGASPI Barangay Chairwoman Peace and Order and Beautification

JULIET F. NUNAG Barangay Secretary

ALETHEA M. ALFONSO Barangay Treasurer

JERJOHN V. VIRAY Ways and Means and Education

YOLANDA B. PUNO Health and Environment

ALLAN M. BAUTISTA Appropriation and Public Works

CONSTANTE S. NAVARRO Peace and Order and Ways and Means and Education

ROMMEL B. SORIANO Peace and Order and Beautification

ROLANDO S. SANTIAGO Health and Environment

DANILO P. SALVADOR Appropriation and Public Works

CHRISTIAN ROMAR D. QUIROZ Sangguniang Kabataan Chairman

HEALTH CENTER PROFILE

VISION and MISSION

VISSION: To render quality and effective service in the community with dedication and commitment, uplifting the guidelines embodied on the nutrition program this producing healthy and productive Tarlaquenos

MISSION: That malnutrition will no longer be a problem in the city - a MALNOURISHED FREE CITY

PROGRAMS and SERVICES A. Maternal/ Womens Health Care Pre-natal/ Post natal check-up Family planning services Counseling Home visit Morbid (sick)

B. Under Five Children (UFC) Immunization Well baby check-up Nutrition services (weight monitoring, nutrition counseling, deworming, micro-nutrient supplementation, iodine- testing of salt)

C. Environmental Services Sanitary toilet facilities Garbage disposal (solid waste management) Others: community clean- up drive

D. Referral of Cases

E. IEC- Info, Education, Communication Individual teaching/ Bench Conferences

 Mothers/ Fathers Class Barangay/ Community Assembly Program for Tuberculosis OPT Program

CLINIC SCHEDULE PERSON IN-CHARGE Nurse I Casual Nurse Nurse I Casual Nurse Midwife I Nurse I Casual Nurse Health Workers Health Workers

DAY MONDAYS

VENUE
Barangay Health Center

ACTIVITY Clinic Day

TUESDAYS

Barangay Health Center

Araw ng mga Buntis

WEDNESDAYS THURSDAYS FRIDAYS

Barangay Health Center Block 1 5 Block 6 9

Immunization Day Home Visit Home Visit

CITY HEALTH CENTER I ORGANIZATIONAL CHART

DR. SHIERLY I. TIGLAO City Health Physician

ANICETA D. LOPEZ

Nurse II

SALVE D. CAPIAN Nurse I

ADORME S. MERGAS Nurse I

SHIELA MAIE C. ASUNCION Casual Nurse

SIR RUBEN C. TIMBOL Casual Nurse

JEANY ROSE G. JUNIO Casual Nurse

NEMIA L. LUMIBAO Midwife III

ESPERANZA C. BALIGAD Midwife II

DULCE B. CATLI Midwife II

MERCEDEZ G. ROLDAN Midwife I

AILEEN C. SOLIMAN Midwife I

NANCY C. JUNIO Midwife I

ELIZABETH R. ESTEBAN Midwife I

MELITA B. SANCHEZ BHW

TERESITA M. APOSTOL BHW

ESPERANZA D. SEREZO BHW

COMMUNITY ASSESSMENT POPULATION PROFILE Total Estimated Population of Barangay (2011): 8, 146 Total Population of Area Surveyed: 297 Total Number of Families Surveyed: 63 Total Number of Households Surveyed: 48

SOCIO-DEMOGRAPHIC PROFILE

Table I. Distribution of Population according to Gender

Male Female Total Frequency 138 159 297 Percentage (%) 46.46 53.54 100%

GENDER DISTRIBUTION

Males Females

Based on the table above, majority of the population residing in Block 2 compose of females. Along with the table on top is the pie graph that shows the percentage of males and females with 46% and 54% respectively. Meanwhile the sex ratio of males for every 100 females in the population is 86.79 for the area that was catered.

Table II. Distribution of Population according to Age

0 5 years old 6 10 years old 11 20 years old 21 30 years old 31 40 years old 41 50 years old 51 60 years old 61 70 years old Total Frequency 30 36 60 78 36 18 27 12 297 Percentage (%) 10.10 12.12 20.20 26.26 12.12 6.06 9.09 4 100%

AGE DISTRIBUTION
30% 25% 20% 15% 10% 5% 0%

0 - 5 years old 6 - 10 years old 11 - 20 years old 21 - 30 years old 31 - 40 years old 41 - 50 years old 51 - 60 years old 61 - 70 years old

Since the majority belongs to the 21 years old and above age group, this suggests that the community is economically productive yet at a relatively high risk for health problems brought about by work, social and family responsibilities, and age. The number of dependents that need to be supported by every 100 individuals in the economically active group is 35.61. Frequency 1-29 days 2 months 1 year old (Infancy) 2 4 years old (Toddler) 5 6 years old (Pre-school Age) 7 11 years old (School Age) 12 18 years old (Adolescence) 19 34 years old (Young Adulthood) 35 50 years old (Middle Adulthood) 50 years old and above (Old Adulthood) Total Table III. Distribution of Population according to Civil Status
Child (0 12 years old) Single Married Widow Widower Frequency ? 186 102 6 2 Percentage (%) ? 62.62 34.34 2.02 0.67

Percentage (%)

10

Separated Total

1 297

0.33 100%

CIVIL STATUS DISTRIBUTION

70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Child (0 - 18 years old) Single Married Widow Widower Separated

I&a

Table IV. Distribution according to Religion

Roman Catholic Iglesia Ni Cristo Born Again Christian Others Total Frequency 27 12 3 6 48 Percentage (%) 56.25 25 6.25 12.5 100%

RELIGION DISTRIBUTION

Others Born AgainOthers Iglesia ni Cristo Roman Catholic

0%

20%

40%

60%

80%

100%

Health is directly related to the religious endeavors of an individual. His/her religion somehow influences the decisions one makes, even those that are health-related. Since

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majority is Roman Catholics, this may place them at a higher risk for health problems due to the openness of the religion to its believers practices.

Table V. Distribution according to Ethnicity

Kapampangan Ilocano Kapampangan & Ilocano Others Total Frequency 27 3 9 9 48 Percentage (%) 56.25 6.25 18.75 18.75 100%

ETHNICITY DISTRIBUTION

Kapampangan Ilocano Kapampangan & Ilocano Others

The large number of Kapampangan in the community implies that prevalent health beliefs and practices in the community are from their groups culture. This also suggests that the most common medium of communication is the Kapampangan dialect. Both of which may affect the acceptance and channeling of health information.

Table VI. Distribution according to Family Type

Nuclear Extended Total Frequency 18 30 48 Percentage (%) 37.5 62.5 100%

FAMILY TYPE
100% 80% 60% 40% 20% 0% Nuclear Extended

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An extended family type is predominant in the area which represents 62.5% in the graph. It points out that the dependency ratio is significantly high based on the percentage shown on the graph and supported with the dependency ratio of 35.61 as mentioned on Table II.

Table VII. Distribution of Families according to Length of Residency

Frequency Below 6 months 6-11 months 1 year 2 years 3 years 4 years 5 years and above Total 100 Percentage (%)

LENGTH OF RESIDENCY
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Below 6 months 6 - 11 months 1 year 2 years 3 years 4 years 5 years and above

I&a

SOCIO-ECONOMIC INDICATORS

Table VIII. Distribution of Population according to Educational Attainment

Nursery Kinder Preparatory Elementary Graduate Elementary Level Highschool Graduate Highschool Level College Graduate Frequency 3 0 3 3 51 36 60 66 Percentage (%) 0.5 0 0.5 1 17.17 12.12 20.20 22.22

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College Level Vocational Not Applicable (babies) Total

54 0 21 297

18.18 0 7.07 100%

100%

EDUCATIONAL ATTAINMENT
90% 80% Nursery 70% 60% 50% 40% 30% 20% 10% 0% Kinder Preparatory Elemntary Graduate Elementary Level Highschool Graduate Highschool Level College Graduate College Level Vocational Not Applicable

The high percentage of college graduates entails a possibly high level of awareness and better comprehension especially of health issues and practices. It also increases the productivity level of the community since there is a higher chance of employment among college graduates.

Table IX. Distribution according to Employment

Employed Unemployed Self employed Total Frequency 33 3 12 48 Percentage (%) 68.75 6.25 25 100%

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EMPLOYMENT

Self-employed

Employed Unemployed Unemployed Self-employed

Employed

0%

20%

40%

60%

80%

100%

The above data reflects the high productivity level of the community which in turn provides more income for the communitys health needs; however the engagement of most of the population to work also increases the risk for the development of health problems brought about by the nature of their job and the demands of their working environment.

Table X. Distribution according to Monthly Income

Less than Php 2,000 Php 2,000 5,000 Php 5,000 8,000 More than Php 8,000 Total Frequency 9 15 9 15 48 Percentage (%) 18.75 31.25 18.75 31.25 100%

MONTHLY INCOME

Less than 2,000 2,000 - 5,000 5,000 - 8,000 More than 8,000

I&a

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Table XI. Distribution according to Type of Dwelling

Concrete Mixed Wood Total Frequency 21 15 12 48 Percentage (%) 43.75 31.25 25 100%

50.00% 45.00% 40.00% 35.00% 30.00% Concrete 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% TYPE OF DWELLING Mixed Wood

I&A

Table XII. Distribution according to Ventilation

Poor Good Total Frequency 15 33 48 Percentage (%) 31.25 68.75 100%

Table XII. Distribution according to Lightning

Adequate Inadequate Total Frequency 42 6 48 Percentage (%) 87.5 12.5 100%

ENVIRONMENTAL INDICATORS

Table XIII. Distribution according to Surroundings

Clean Dirty Total Frequency 36 12 48 Percentage (%) 75 25 100%

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Table XIV. Distribution of Households according to Source of Water

Artesian well NAWASA Deep well Others Frequency 0 72 4 0 Percentage (%) 0 87.5 12.5 0

Table XV. Distribution of Households according to Toilet Facilities

Flush Pit privy Owned Total Frequency 18 3 27 48 Percentage 37.5 6.25 56.25 100%

Table XVI. Distribution according to Garbage Disposal

Collection Burning Garbage cans Burying Open dumping Others Total Frequency 48 Percentage (%) 100

48

100%

Table XVII. Distribution according to Presence on Animals

Dogs Pigs Cats Others None Frequency 18 0 9 9 18 Percentage (%) 33.33% 0% 16.67% 16.67% 33.33%

HEALTH PROFILE

Table XVIII. Distribution according to Food Storage

Covered Refrigerated Uncovered Total Frequency 30 15 3 48 Percentage (%) 62.50 31.25 6.25 100%

Table XIX. Distribution according to Storage of Water

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Refrigerated Uncovered Covered Total

Frequency 18 0 30 48

Percentage (%) 37.5 0 62.5 100%

Table XX. Distribution according to Containers of Water Plastic Bottles Total Frequency 45 12 48 Percentage (%) 78.95 21.05 100%

Table XXI. Distribution according to Backyard Gardening

Vegetables Fruit bearing Herbal None Frequency 3 3 9 36 Percentage (%) 5.88% 5.88% 17.65 70.59%

Table XXII. Distribution according to Food Preference

Fish Meat Fruits/vegetables Mixed Total Frequency 6 0 6 36 48 Percentage (%) 12.5 0 12.5 75 100%

Table XXIII. Distribution according to Utilizing Health Center

Frequency 9 21 33 63 Percentage (%)

a. Goes for check-up b. Goes only when sick c. Does not go for check-up Total

100%

With majority of the respondents does not go for check-up even when they are sick, there is therefore a generally increased risk of developing diseases especially asymptomatic and chronic types. Another possible implication is a decreased level of awareness of the residents about health conditions and issues.

On the other hand, failure of most respondents to have regular check-ups were claimed to be due to lack of time, financial constraints, and the notion the absence of signs/symptoms means the absence of an illness.

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Table XXIV. Distribution according to Immunization

Complete Not Complete Not Applicable Frequency 15 6 27 Percentage (%) 31.25 12.5 56.25

Table XXV. Distribution of Couples based on Perception/Usage of Family Planning

Acceptor Non-Acceptor Total Frequency 12 36 48 Percentage (%) 25 75 100%

Since majority of the couples opt not to use any family planning method, it may be implied that the communitys population may increase in the near future; however, it can also be inferred that the couples may have already opted to practice natural birth spacing methods.

Table XXVI. Distribution according to Infant Feeding

Breast Mixed Bottle Frequency 0 21 9 Percentage (%) 0 70 30

MORBIDITY DISEASE Acute Upper Respiratory Infection Hypertension Urinary tract infection Abscess Bronchopneumonia Acute Gastro Enteritis Acute Tonsilitis Conjunctivitis Allergic Rhinitis Infected Wound No. of Cases 75 15 14 5 5 4 3 3 3 2

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IDENTIFICATION OF HEALTH PROBLEMS A. Present Illnesses >

B. Environmental Problems > Poor home/environmental sanitation specifically improper garbage disposal > Open drainage system > Presence of breeding sites for insects, mosquitoes and rodents > Pet ownership responsibilities > Usage of Family Planning > Presence of accident prone zone > Inaccessibility to Health Care Center > Inadequate Monthly Income

PRIORITIZATION OF IDENTIFIED HEALTH PROBLEMS A. Present Illnesses PRESENT ILLNESS FREQUENCY RANK

The identified present health problems were ranked based on the number of cases - the more persons affected with the illness, the higher the rank, the more it is prioritized.

B. Environmental Problems

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1.
Criteria Score Weight Highest score Computation Total Justification

1. Nature of the problem > 2.Modifiability of the problem > 3. Preventive potential > 4.Salience > Total:

2.
Criteria Score Weight Highest score Computation Total Justification

1. Nature of the problem > 2.Modifiability of the problem > 3. Preventive potential > 4.Salience > Total:

3.
Criteria Score Weight Highest score Computation Total Justification

1. Nature of the problem > 2.Modifiability of the problem

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> 3. Preventive potential > 4.Salience > Total:

4.
Criteria Score Weight Highest score Computation Total Justification

1. Nature of the problem > 2.Modifiability of the problem > 3. Preventive potential > 4.Salience > Total:

5.
Criteria Score Weight Highest score Computation Total Justification

1. Nature of the problem > 2.Modifiability of the problem > 3. Preventive potential > 4.Salience > Total:

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CURRENT PROGRAMS IN THE COMMUNITY PROGRAMS PROGRESS TIME FRAME

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