"PRESENTATION TO THE MAX_"
Community Health Nursing (CHN) is one of the two major nursing fields in the Philippines. Nursing practice in the community means different things to different nurses. Many, if not most of us, emphasize the setting of practice; that is, community health nursing is nursing practice outside the hospital. Not a few nurses choose community health nursing because they do not want to go on afternoon and night shifts. They simply prefer the pace of work in the community. The practice of community health nursing is enhanced by the bodies of knowledge of other academic disciplines such as the social sciences. Concepts like, the sociology, psychology, anthropology, economics and political science help nurses understand the health care delivery system and their clients, and thus perform their roles and functions better. In biological terms, a community is a group of interacting organisms sharing an environment. In human communities, intent, belief, resources, preferences, needs, risks, and a number of other conditions may be present and common, affecting the identity of the participants and their degree of cohesiveness. In sociology, the concept of community has caused infinite debate, and sociologists are yet to reach agreement on a definition of the term. There were ninety-four discrete definitions of the term by the mid-1950s. Traditionally a community has been defined as a group of interacting people living in a common location. The word is often used to refer to a group that is organized around common values and social cohesion within a shared geographical location, generally in social units larger than a household. The word can also refer to the national community or global community. Communis comes from a combination of the Latin prefix com- (which means “together”) and the word munis probably originally derived from the Etruscan word munis- (meaning “to have the charge of”). Since the advent of the Internet, the concept of community no longer has geographical limitations, as people can now virtually gather in an online community and share common interests regardless of physical location. In The Different Drum: Community-Making and Peace, Scott Peck argues that the almost accidental sense of community that exists at times of crisis can be consciously built. Peck believes that conscious community building is a process of deliberate design based on the knowledge and application of certain rules. He states that this process goes through four stages: 1. Pseudo-community: Where participants are “nice with each other”, playing-safe, and presenting what they feel is the most favorable sides of their personalities. 2. Chaos: When people move beyond the inauthenticity of pseudo-community and feel safe enough to present their “shadow” selves. This stage places great demands upon the facilitator for greater leadership and organization, but Peck believes that “organizations are not communities” and this pressure should be resisted. 3. 4. Emptiness: This stage moves beyond the attempts to fix, heal and convert of the chaos stage, when all people become capable of acknowledging their own woundedness and brokenness, common to us all as human beings. True community: The process of deep respect and true listening for the needs of the other people in this community. This stage Peck believes can only be described as “glory” and reflects a deep yearning in every human soul for compassionate understanding from one's fellows. More recently Peck remarked that building a sense of community is easy but maintaining this sense of community is difficult in the modern world. Community building can use a wide variety of practices, ranging from simple events such as potlucks and small book clubs to larger–scale efforts such as mass festivals and construction projects that involve local participants rather than outside contractors. Community building that is geared toward citizen action is usually termed “community organizing”. In these cases, organized community groups seek accountability from elected officials and increased direct representation within decision-making bodies. Where good-faith negotiations fail, these constituency-led organizations seek to pressure the decisionmakers through a variety of means, including picketing, boycotting, sit-ins, petitioning, and electoral politics. Community organizing is sometimes focused on more than just resolving specific issues. Organizing often means building a widely accessible power structure; often with the end goal of distributing power equally throughout the community. Community organizers generally seek to build groups that are open and democratic in governance. Such groups facilitate and encourage consensus decision-making with a focus on the general health of the community rather than a specific interest group. The three basic types of community organizing are grassroots organizing, coalition building, and “institution-based community organizing”, (also called “broad-based community organizing”, an example of which is faith-based community organizing or “congregation-based community organizing”). GEOGRAPHICAL BACKGROUND The two barangay, Ayusan Sur and Ayusan Norte, are bounded on the north by the Barraca ti Ili (now Solid West); on the east by Tamag, Paoa, and Pagburnayan; on the west by a tributary of the Abra River (more popularly called the Mindoro River); and on the south by Bulala. For the purpose of this study, the two Barangays are studied as one for the reason that there was only one barangay of Ayusan during the Spanish time. The place was sparsely populated during the early part of the Spanish period. It was only a place where flood water found its way to a river flowing to the China Sea. Many houses that were washed away during the typhoons and flood drifted to the river banks near Ayusan. It was for this reason that people of the other villages called the place “Ayusan” and Ilocano word which refers to a place where water flows. The old barangay of Ayusan is at present divided into two: Ayusan Norte and Ayusan Sur are more economically progressive as it is the home of rice and corn traders. Ayusan Sur is the home of pot makers, market vendors, and carpenters. Besides, it is the source of clay which is used in making earthen ware. CONGESTION Ayusan Sur has a total population of approximately 680. The eastern part of the barangay is less populated that the western part. On the total population of the community, there are 180 households with 220 numbers of families. The community is male-dominated and most of them are single. As a residential area, the houses in the barangay are built according to the needs and the household status of living. As observed, the eastern part of the community is richer than that of the other side. Almost all their houses were built in concrete cement and most of them have descent works or source of income. VULNERABILITY “There can be no vulnerability without risk; there can be no community without vulnerability; there can be no peace, and ultimately no life, without community.” Poverty is still the reigning problem of the society today. Moreover, it seems that it’s getting worse everyday as evidenced by continuous crisis that the people are experiencing. The causes of poverty include poor people's lack of resources, an extremely unequal income distribution, conflict, and hunger itself. By causing poor health, low levels of energy, and even mental impairment, hunger can lead to even greater poverty by reducing people's ability to work and learn. “Libreng Pakain” is a program of the government that will help the malnourished people, especially the children because they are the most visible victims of under nutrition. Infectious diseases continue to blight the lives of the poor people. But, so far, the government provides means on decreasing the burdens of the people by implementing programs like the “Cheaper Medicine Bill”, “Medical Mission”. “Libreng Bakuna”. In a way, this will help the people to have a greater chance of treating their sicknesses or illnesses and for them to improve their health status. Furthermore, the government had provided the “Botika ni Gloria” to help the less fortunate communities to lessen their expenses in buying medicines or drugs. SOCIAL ORGANIZATION Effective communication practices in group and organizational settings are important to the formation and maintenance of communities. In the community’s social aspect, there are organizations identified. These organizations were made for the people to be socially active. Socialization is influenced primarily by the family, through which children first learn community norms. SiSa, a religious organization was made to uplift the people’s spiritual well-being. This religious organization is essential, for alone our vision is too narrow to see all that must be seen. As one community, their vision will be widened and their strength will be renewed. The main organization of the community is BALIKATAN, which is being led by Mrs. Milagros Paz. This organization has an income-generating program; wherein, they help the low-income families through “pautang” (e.g. self-employed pottery making; sari-sari store). Community service is usually performed in connection with a non-profit organization, but it may also be undertaken under the auspices of government, one or more businesses, or by individuals. It is typically unpaid and voluntary. Social welfare assistance is also extended to families financially incapable to defray their medical needs especially serious illness. Another active organization is the United Neighbor’s Association led by Mrs. Alberta Alcartado. Other organizations that are partially active in the community are: KALIPI (Mrs. Estrelita Atalin), Senior Citizen (Mrs. Maxima de Peralta), Timpuyog ti Agdadamili (Mrs. Maxima Frando), RIC (Mrs. Delia Quebral) and Fisherman’s Organization (Mr. George Amano). Political Aspect Barangay Ayusan Sur General Organizational Structure Efren Rabago (Brgy. Chairman) Jason del Castillo (S.K. Chairman) Pedro Rabe Hipolito Arista Cynthia Alconis Estrelita Atalin Anastacia Arista Gerald Amano (Brgy. Kagawads) Marites Ladines (Brgy. Treasurer) SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS A community is simply defined as a group of people sharing common geographical boundaries, common values and interests. A community’s socio-economic and cultural characteristics define their way of living and contribute in molding the personality of every individual in the society. Life within a society is on its social aspect. It is composed of leisure, pious or serious activities that let people get new acquaintances. Organizations train its members to be more productive for the benefit of a greater humanity like a sharpener to a pencil. On the spiritual aspect, people are guided and enlightened through their religion which is their faith itself. Religion is the center of spirituality. Hence, people live with their faith (religion). 86.98% of the total population is Roman Catholic. The remaining 13.02% is distributed evenly to Born Again, Pentecost, Iglesia Ni Cristo, Mormons, Seventh Day Adventist and Protestant. As what the student nurses have observed, religion is not a barrier on the community. To support this fact in Ayusan Sur, there are followers or devotees of different religion that live in just one house and religion has never been a problem to them. Most of the people in Ayusan Sur are employees and laborers yet there are still some who depend in selling, farming, tailoring, fishing, and baking and pottery industry. There is a bakery and a junkshop on the eastern part alongside the road in Ayusan Sur and there are also stores which provide people the things they need. It was noted when the student nurses conducted the survey that the ASIAN Beer Corporation's storage located east of the barangay road creates flood when heavy rain strikes. The rain water from the said storage flows into the yards of the community people that will cause flood due to the lack of drainage. Some depend on vegetable gardens, piggery, poultry, fruit trees and fishery, which are used for family purposes and subtle in selling, but there are also residents who are unemployed. When it comes to decision-making, both of the father and mother conspires and decides about issues that should be faced and talked about. But as shown in the survey, women dominate men in such matters. There are so many active organizations on the community; among which are SISA, SARANAY, RIC, BALIKATAN, BNJ, BHW, BPC, COYA, SK, Kalipi, Fisherman’s Organization, Potable Water Organization, Tanod and the Barangay Council. Economic aspects which concerns the management of money, industry and trade together with social and spiritual aspects makes Ayusan Sur. CULTURAL ASPECTS Barangay Ayusan Sur considered as depressed, oppressed, poor and exploited community has people who strive hard just to survive and finance their everyday needs. In terms of food consumption, most of the members of each family consume all the food blessings that are served. But there are also some factors that affect the kinds of food that they eat. One is Religion. Aside from Roman Catholic, followers of other religious organizations such as Iglesia Ni Cristo, Pentecost, Born Again, Protestant, Seventh Day Adventist and Mormons exist in the community. VALUES AND Members of those religions don’t include “dinardaraan” in their diet because it is written in their bible. This implies that religion serves as a barrier in eating some kinds of foods. Another factor is the health status of an individual. People who are hypertensive do not consume fatty foods as well as those which are high in salt because it may worsen their situation. It is also the same scenario for other people suffering from other diseases because they are also advised to minimize the consumption of other kinds of foods depending on their ailment. Regardless of those factors, still, the majority of the residents are not choosy in their food intakes. In terms of child-feeding, most parents are well-oriented about the contributions of innutritious and innutritious food to their children. They avoid feeding them with junk foods and soft drinks. They usually prepare vegetables, fish, and meat to their siblings. The result shows that most children (86%) were breastfed while some (14%) were not, they introduced formula milk instead. According to the survey that has been conducted, it was concluded that most of them knows the essence of trusting one's self in a healthcare provider like doctors or physicians when they have health problems. The citizens verbalized that if their disease is not that too severe like colds, fever, cough, headache, stomach ache, they just buy an over the counter drugs that is appropriate to the said disease. Some of these drugs are Paracetamol, Neozep, Kremil-S and Biogesic. They also verbalized that they buy the same drugs that had been prescribed by their physician before. For an instance, people with high blood pressure take their maintenance drug. But during the house to house visits, it was found out that some tend to change the frequency and that their doctor had advised. Some of the hypertensive folks believe that if their blood pressure is within normal, they would skip the supposedly dose. On the other hand, if they feel signs or symptoms of their current illness that’s the time that they take their medicines. The researchers also found out that some families still recognize the significance of herbal medicine in treating discomforts. HOME AND ENVIRONMENT Housing: Majority of the residents in Barangay Ayusan Sur confirmed that they do not own the lot where their houses are built. The most common type of house construction they have at the eastern side is usually the medium-type of house, composed of concrete walls and floor. Most houses contain 4 rooms, a living room, a kitchen, a bedroom and a toilet, respectively. The type of toilet facility a large amount of residents use is the watersealed. At the west side of Ayusan Sur, most of the houses especially near the fish ponds are composed of light materials of mixed materials (e.g. nipa roof but with wooden walls and floor). Most of the houses contain 2 rooms, a living room, their kitchens are located outside their houses, some of them do not have toilet of their own. Nearly all houses have the open draining system; water wastes flow to the open canal beside the houses. Breeding sites for mosquitoes, flies, cockroaches, and rodents are to be anticipated due to the open drainage system that serves as reservoir for those vectors. When it comes to garbage disposal and management, it is not that pretty good because most families do not practice the proper and correct way to segregate their garbage and wastes; they usually burn those garbage disposed. Other options are burying and open dumping elsewhere. The dumping site is located few meters away from the residential houses. So far, the condition is not yet too shocking to cause a mass disease distribution in the community. There is also an area where an active river is located. It is situated near the houses which can be a good breeding site for vectors. However, some members of the community use insecticides, katol and mosquito nets to lessen their risk for vector-borne diseases. When it comes to their supply of electricity, a good number of houses are connected. Appliances like television, electric fan, radio, and the like play a very important role for every family’s leisure time and relaxation in this community. Most of the families own and domesticate animals which roam around their surroundings, specifically dogs, cats and the like. Some stray animals are also located in the national road. There is water supply in the barangay; the source of the water they drink is NAWASA and also, the potable water located at their barangay plaza. They usually place it on covered water jugs; others put it on water pitchers, while others choose to place it on drinking bottles for refrigeration. No other treatments such as chlorination and boiling are prepared or done on the water they drink; they just drink it straight from the source. Their food, on the other hand, is stored in baskets while a few choose to store the food through covered dishware or plates; others prefer to place it in their refrigerator but some families just leave them in their table and left uncovered. Accident hazards are not always absent in a home and community environment but can be minimized with precautions. For the most part of the barangay, the student nurses have observed that a large amount of families residing there have poor environmental sanitation as evidenced by the location of their houses just along the national road that makes them exposed to air and noise pollution and that of the open drainage system that contributes to the chances for insects, rodents or vectors to breed and proliferate in large amount that can bring about to probability of developing diseases in the community. Other factors which may contribute to the risk of accidents include the existence of pointed and sharp objects in some households. Poisonous chemicals and some drugs are not properly kept away from children being observed in some family households. The student-nurses also observed the absence of street lights which might contribute to vehicular accidents in the area. Kind of Neighborhood: The point on which the houses, located in the western part of the barangay, are established is too congested. The spacing between houses situated there is approximately one meter to two meters apart which results to crowding; while the spacing of the houses in the eastern part is approximately two to three meters apart. The population density on the western part is obviously more maximal compared to that of the eastern part. Social and Health Facilities Available: The families share with other residents in using available social facilities. One of these facilities is the Barangay Plaza which caters to the needs of all the residents of Barangay Ayusan Sur especially the men because a basketball court is situated just inside the plaza. The plaza aims to serve the residents in terms of social gatherings and social activities. The basketball court, a very important sport facility serves as a training ground for sports enthusiasts, and also serves as training ground for the sport development of the youth. The Barangay Chapel, which stands at the center of the plaza, is the site of religious activities. The location of the chapel speaks for itself that God should be in a clear and holy place. Some meetings, social and cultural gatherings also take place there when the plaza is unavailable for unexpected cause. There is also a Day Care Center located at the right side of the plaza. Just beside it is the Barangay Health Station that offers health facilities and services for the whole barangay. Communication Facilities: and Transportation Tricycle, one transportation facility which is very valuable for the development of the community, motorcycles and other vehicles roam around as their means of transportation. Tricycles bridge the gap between Barangay Ayusan Sur to the city proper. Tricycles also provide a fast transport of agricultural products and many more directly to the market. Communication facilities such as telephones are so apparent due to the fast evolution of technology; wireless communication such as cell phones is so rampant. Bakery and sari-sari stores are also visible within the vicinity. AND PRACTICES ON HEALTH PROMOTION / MAINTENANCE AND DISEASE PREVENTION The residents believe heavily on “quack doctors” or the so-called “albularyo”. Most of the families have stocks of medicines that are used for controlling hypertension, which is their major health problem and causes 26 numbers of cases in the said barangay (as of 2008), yet some of them still don’t have any stock medicines that can be use in case of emergency. Many of them never visit the doctor for a check-up until the case or illness is not yet severe because most of them believe in herbal medicine. The families with high status in life go to the district Hospital whenever a member of the family got sick. VALUES Diet among the community people is also a factor that needs more nutritional teachings. Some of them are fond of eating foods high in sugar, salt, carbohydrates, fats, so with those foods containing high cholesterol because of these eating habits, they are prone to different illnesses such as genitourinary tract and circulatory disorders. The most predominant case is hypertension as evidenced by elevated blood pressures taken during the house-to-house visits. Since it was obtained during survey and interview that the barangay on the brighter side prefer to eat vegetables and fish, and drink water. Pregnancies are often dominated by women ages 21-26 rather than those who are in the earlier and latter stage. According to the result of the data gathered during the interview, student nurses obtained that 69.74% of infants’ ages 0 – 5 years old were breastfed and 30.26% were fed of formula milk. The student nurses found out that many of those infants who are breastfed were also given formula milk. The Barangay Nutrition Scholar, Mrs. Estrelita Alconis, R.M. and the Barangay Midwife, Marilyn Arista facilitate the Immunization Activities of the barangay scheduled during Fridays. During the said schedule, people especially the pregnant and postpartum mothers visit for check-up, and so with the infants. Adult are being monitored through BP taking, vaccination and check-ups to achieve optimum health. With regards to lifestyle, the student nurses found out during series of interview that a number of residents engage in alcohol drinking and cigarette smoking that they even started it during their teenage life and some ended it only during their adulthood. This scenario escalates the possibility of acquiring hypertensive and other respiratory related disorders, which are dangerous and fatal. Some of them said during the interview that smoking is already a part of their daily routine or habit that they can’t get rid of and if they do, it might just cause their death. Activity and rest among the community people do not differ. They wake up early in the morning- some go to work and some go to school for learning. Exercise is not a problem to them for many of the residents considered their work as their exercise. Aside from their hectic schedules, they also have their recreational activities when they get tired. Watching TV and listening to radio are their relaxation after their work and studies. When they feel stressed they just take a nap to regain their strength. At night, most of the families sleep late – about 10 P.M. to12 midnight but then they would wake up the following morning around 4am to 6am and would do the same routine again. AGE 90 80 70 60 50 40 30 20 10 0 0 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 35 36 to 40 41 to 45 46 to 50 51 to 55 56 to 60 61 and above As of year 2008, notice that the age rate of the residents of Brgy. Ayusan Sur, Vigan City is dominated with age-group of 16 – 20 years old, followed by infants aged 0 – 5 years old while the age group of 56 – 60 years old ranked the lowest rate. EDUCATIONAL ATTAINMENT 100 80 60 40 20 0 No schooling Pre-school Elementary Level Elementary High School High School Graduate Level Graduate College Level College Graduate Vocational Grduate This table shows the distribution of the community people of Ayusan Sur in relation to their educational attainment. Eight members of the population never entered in any school institute to gain further knowledge. However, thirty five community people are still studying as pre-schoolers. Moreover, eighty one out of the total population studies as elementary pupils while thirty five from the total population are elementary graduates. From the total population, ninety members are studying as high school students while seventy members are secondary level graduates. In tertiary level, seventy two out of the total population are pursuing their studies. Meanwhile, seventy two members already received college diplomas. On the last bar, it shows that two among the total population received vocational certificates. CIVIL STATUS 2% 0% 10% 30% Married Single Widowed Seperated 58% Child As of 2008, 58% of the people of Brgy. Ayusan Sur is single, 30% is married, 20% is widowed, 1% is separated and 10% of the population is children. GENDER Male 53% 47% Female Notice that male residents dominate the female residents of Brgy. Ayusan Sur, Vigan City. OCCUPATION 10% 30% 25% Professional Skilled 35% Unskilled Student Notice the occupation of the residents, majority of the residents of Brgy. Ayusan Sur is unskilled. Second to it are students then third are skilled people. Lastly, there is a good number of professional people residing there. TOILET FACILITY 76% Flush Water-sealed 18% 6% None The illustration shows that 18% of the residents use flush-type of toilet, 76% use water-sealed type while 6% do not have such type of toilet facility. Therefore, the most common type of toilet facility use in Brgy. Ayusan Sur is the water-sealed. DRAINAGE SYSTEM 16% Open 84% Blind Majority of the houses there at Brgy. Ayusan Sur practice the open drainage system. Notice that 84% of the residents prefer the open drainage system. Meanwhile, the remaining 16% of the residents is in favor of the blind drainage system. RECEPTACLES 6% Open 10% Covered 84% None Notice that majority of the residents in Ayusan Sur prefer to use covered receptacles (84%) rather than using an open receptacle (10%). Meanwhile, 6% of the residents do not use receptacles as their way of storing their wastes. GARBAGE DISPOSAL 19% 10% 4% Composting Burning Burying Open Dumping 67% At Ayusan Sur, the major way of disposing their garbage is by means of burning comprising 67%, 10% of the family practices burying while open dumping is 14% and lastly, there are only 4% who practices composting as their means of garbage disposal. WATER CONTAINER Water Jug 30% 35% Galloon Pitcher 5% Water Dispenser Drum Pail 3% 1% 13% 13% Bottle Majority of the residents in the community place the water they drink in water jugs (35%). Others place the water in bottles (30%), pitcher (13%), water dispenser (13%), galloon (5%), pail (3%) and drum (1%), respectively. WATER SUPPLY 6% 10% 4% NAWASA Water Pump 44% Deep Well Mineral / Purified Water Potable water 36% The illustration shows the number of people using different sources of water. 36% of the residents use water pump, 44% of the residents use NAWASA, and 10% prefer to drink mineral or purified water. Meanwhile, 4% of the residents choose to drink from the potable water. Lastly, deep well serves as a water supply for remaining 6% of the residents of the said barangay. 5% 22% 53% Chlorinate Boiling Filter 20% None The table shows how the people in Ayusan Sur prepared their water to drink. It shows that the 20% of them drink the water directly, 53% are boiling it first, 20% of them chlorinate the water, and lastly, 5% of the people filter the water first before they will drink it. FOOD STORAGE Cabinet 13% 2% 17% 38% Refrigerator Basket 30% Others Covered Plate Most of the community people use covered plates as their food storage with the percentage of 38% followed by refrigerator (30%), basket (17%) and cabinet (13%), and the remaining 2% prefer to use any food storage. ANIMALS 36% 33% YES NO Bulos 25% 6% Nakapupok Most of the animals like dogs, cats and the like in the community are not properly kept, so they go astray in the streets. FOOD PREFERENCES 2% 16% Any Vegetables 38% Chicken / Poultry 21% Seafoods Meat 15% None 8% Notice that about 38% of the residents of Brgy. Ayusan Sur eat vegetables, 21% eat meat, 16% eat sea foods, 15% choose to eat any, 8% eat what is available or no food choice and the lastly, 2% eat chicken or poultry. 3% None 82% 15% Any Breastfed / Bottle In this graph, it shows that 82% of mothers in Ayusan Sur prefer to give anything for their child. 15% of mothers give nothing to their child and the remaining 3% of mothers prefer breastfeeding or giving milk to their child. Presence of Health Threat Good quality environment is very much needed in developing a better community. This element serves as a protection and dwelling place of the community people. It is where good communication pattern develops; a pattern which is vital in the survival of the community. But how will a community works if they do not have this quality environment. For an ordinary citizen, a regular community set-up is considered harmless, but to a health care professional, it is a risk for physiologic damages. Prior to observations, a normal set-up in the community has this idea of a health threat. Presence of accident hazards is being observed. This is evidenced by the presence of stray animals along the national road. The presence of this may cause accidents to passing vehicles and may risk the life of passengers and drivers. Aside from that, another factor is the presence of pointed and sharp objects in some family households. Poisonous chemicals and drugs are not kept away from children. Due to these factors, there will be greater risk for poisoning not only to children but as well as adults. Still in connection to the political government of Ayusan, the absence of street lights is being observed. Street lights are great help to motorists especially at night. Consider a place where street lights are absent. How could motorists entrust their safety in that particular place? Absence of street lights may cause vehicular accidents. Every family should practice environmental sanitation in order to lessen the risk for physiologic alterations- a way far different to community members of Ayusan. Poor environmental sanitation is considered to be a health threat. Community people of Ayusan practices dumping and burning system in terms of garbage disposal. The dumping area is located few meters away from the residential houses. This might cause pulmonary diseases. Several houses in the community are congested with an approximately one to two meters away from each other. With regards to this set-up, this can be the element which results to spread of communicable diseases. Furthermore, they are also prone to pulmonary diseases due to air pollution. This is because the family household are near the national highway. Vehicles emit toxic gaseous substances which may affect the health of the people. Most families just leave left over foods in their table and left uncovered. This might result to growth of bacteria. Presence of stress provoking factors is also observed. Conflicts in the family are normal, but it can cause physical damage in the long run. Some members in the community have conflicts, disagreements and misunderstandings. Presence of breeding sites of possible vectors such as mosquitoes can be a health threat. Improper waste disposal contributes in the development of these breeding sites. Open drainage system can also be the factor. Another big factor is the presence of an active river beside the houses. Summing up these cues, these can be good reservoir for certain vectors. Presence of Health Deficit Health deficits are instances of failure in the health maintenance. It has been said that as of 2008, there are already 26 number of hypertension cases- most leading cause of morbidity. Hypertension is believed to be the number one complaint of the people. This is being evidenced by the elevated BP of the people during the house visits. The main root of this illness is believed to be the effect of negative eating habits of the community people. Some of them are fond of eating foods high in salt and fats. Their habit increases their risk in developing circulatory alterations. Problems and Cues Health Deficit 1. PRESENCE OF ILLNESS Cues: Most of the are people in Second Level Assessment Inability to provide adequate nursing the care to the sick, disabled, dependent, from or vulnerable risk member of the family community suffering hypertension. As of 2008, there are due to inadequate knowledge about 26 number of cases of hypertension the disease / health condition. – most leading causes of morbidity in the community. During the home visits, the student nurses observed that most of the people in the as community manifested are by hypertensive elevated blood pressure obtained. 2. POOR ENVIRONMENTAL SANITATION Cues: Dumping and burning of garbage are being practiced by the people in the community. Several houses in the community are slightly congested with a distance of approximately 1–2 meters away from each other. Almost all of the people in the community do not have proper food storage. The location of the community is just along the national road so they are exposed to air and noise pollution. Inability to provide a home environment which is conducive to health maintenance and personal development due to lack of skill in carrying out measures to improve home environment. 3. PRESENCE OF BREEDING SITES Cues: Inability to provide an environment is conducive and due to to health Open drainage system nearby which houses that serves as breeding maintenance sites of vectors such as development personal limited mosquitoes, flies and so on. Improper waste disposal that turn out to be a favorable reservoir for certain vectors. physical resources. 4. PRESENCE OF ACCIDENT HAZARDS Cues: Inability to provide an environment is conducive and to health Stray animals along the national which road. Pointed or sharp maintenance personal objects, development due to insufficient poisons and medicines are not knowledge on ways of preventive properly kept. Burning of their garbage close to their houses. measures. Absence of street lights that may lead to vehicular accidents. 5. PRESENCE OF STRESS – PROVOKING FACTORS Cues: Inability to provide an environment Some members of the family in which is conducive to personal the community have conflicts, development due to insufficient disagreements, misunderstandings. and supportive relationship among family members. Problem 1: Presence of Illness CRITERIA Nature of the Problem JUSTIFICATION It is a health deficit because it is a disease that occurs within COMPUTATION 3/3x1 SCORE 1 the community or a symptom secondary to a specific illness. Modifiability of the Problem There are available resources of health worker by giving them advice on how to prevent the said illness, there is also the 1.5/2x2 1.5 presence of family resources for they take medications prescribed by their physician and the presence of current information obtained from teachings by the health worker. Preventive Potential of the Problem The disease state is already present in the community for years. It is also a severe problem due to the number of cases being recorded. It already caused harm in the life of community people. Due to this disease state, some members of the community use anti-hypertensive drugs prescribed by their physician. Some uses herbal meds to treat discomforts. The community people verbalized hypertension as a problem for its ability to take one’s life in just a split of a second. Because of this, the community people suffering from this state take up antihypertensive drugs prescribed by their physician. 1/3x1 .33 Salience of the Problem 2/2x1 1 TOTAL SCORE: 3.83 RANK 1 PROBLEM Presence of stress- SCORE 4.67 provoking factors 2 3 Presence of breeding sites Poor environmental 3.34 3 sanitation 4 Presence hazards 5 Presence of illness 2.42 of accident 2.99 HOUSE TO HOUSE VISIT AT AYUSAN SUR Have you ever wondered how big the treasures of Barron Hilton are? Have you ever find a clue on how the Royal family of England shares their wealth to the poor? Aren’t you amazed with the way on how the Ayalas, Tans, Sys, Lopezes, Cojuancos and even the Levisters put up charity foundations designed primarily to the poor? Well then, large amount of money is involved; Hundreds and thousands of dollars and pesos. But think this way: Aren’t you amazed with the way on how Florence Nightingale rendered her whole life to the sick? Charity on money or charity with physical strength? Through the exposure we had in Ayusan, we have become better nurses. We have been equipped with lots of experiences because not all the knowledge needed is spoon-fed in school. We have to practice what our dear teachers have taught us in order to master each principle – From the proper approach to the family, sharing our knowledge, blood pressure taking, up to the presentation of the assessment findings. Living with the community people for almost two months is an achievement. Rendering simple health teachings which they could use in the future keeps the goal fulfilling. The innate care and nursing abilities, the student nurses feel the real essence of being a nurse. This is a practice which is really worth it. Doing the home visits, made the whole activity in its highest level. Rendering blood pressure taking is the most “mobile” among the nursing services. Long days are over. Community Health Nursing is thought to be- “learning the basics to learning to life”. Community people learn from the student nurses, and in return, the student nurses learn from the community people. At the end of the day, the goal of both parties is achieved. Foundation of physical strength is main source of charity. And the student-nurses made it to the last point. That’s the real essence of being a nurse, not just being a health practitioner but being a good health practitioner.