HOW TO PRIORITIZE HEALTH PROBLEM

NOTE: ALL IDENTIFIED PROBLEM MUST BE SCALED INDIVIDUALLY AND ACCORDINGLY BASE ON
THE PROCESS BELOW.

A. By scaling using a criterion and then numerically ranking the health problem. The biggest number is
the topmost problem.

Procedure:

A.1 Scale the Health Problem you had identified using the criteria as shown by the table
below.

Criteria Weight
1. Nature of the problem
Wellness state 3
Health Deficit 3 1
Health Threat 2
Foreseeable Crisis 1
2. Modifiability of the Problem
Easily modifiable 2
Partially modifiable 1 2
Not modifiable 0
3. Preventive Potential
High 3
Moderate 2 1
Low 1
4. Salience
A condition or problem, needing 2
immediate attention 1
A condition or problem, not 1
needing immediate attention
Not Perceived as a problem or 0
condition needing change

A.2. The criteria are the Nature of the Problem, Modifiability of the Problem, Preventive
Potential of the problem, Salience of the Problem.

B. Under the NATURE OF THE PROBLEM are the sub-criteria or sub-classification. These are
Wellness state, Health deficit, health threat, and Foreseeable crisis.

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 Wellness State: a clinical nursing judgment about a client in transition from a specific level of
wellness or a capability to a higher level
 From the word wellness, it means the client’s present good condition going to
a higher level of healthy condition.
 If the client is not in good or healthy condition then this criterion is not
applicable.
 For example.
o Under the present wellness condition the client is aware of the importance
of good nutrition, diet, exercise/activity.
o But the client’s awareness may or may not be put into action or practice.
o Therefore, the client’s awareness on proper nutrition, good diet, exercise is
only a potential to enhance capability of wellness condition.
o However, when the client ACTUALLY PRACTICES what he/she know
regarding good nutrition, diet, exercise/activity and living a healthy lifestyle
then the client had achieved the Presence of Wellness Condition. The client
is ready or have the capability of going to a higher level of Wellness
Condition.
o Therefore, for this criterion two things must concur. The client’s potential
to enhance capability of wellness condition and the readiness capability of
going to a higher level of Wellness Condition/readiness to enhance the
potential.
o For this example, the client’s awareness of good nutrition, proper diet,
exercise/activity is a potential to enhance capability of wellness condition.
The client’s actual practice of healthy lifestyle is a readiness to enhance the
potential.

 Health Threats: Are conditions that are conducive to disease and accident, or may result to
failure to maintain wellness or realize health potential.
o Therefore, the client is still in good state but due to the presence of other existing condition, the
client may fail to maintain good/wellness state or condition.
o Example of conditions that may result to client’s failure to maintain wellness or realize health
potential.
 Presence of risk factor of specific diseases (e.g. lifestyle diseases - habitual drinking of
alcoholic beverages, frequent eating of foods containing sugar, sedentary lifestyle)
 Threat of cross infection from communicable disease case.
 Family size beyond what family resources can adequately provide.
 Accident hazards like.
o Broken stairs
o Pointed/sharp objects, poison and medicine improperly kept
o Fire hazards
o Fall hazards
 Stress-provoking factors:
o Strained marital relationship
o Strained parent-sibling relationship
o Interpersonal conflicts between family members

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 o Care-giving burden
 Poor home/environmental condition/sanitation.
o Inadequate living space
o Lack of food storage facilities
o Polluted water supply
o Presence of breeding or resting sites of vectors of disease.
o Improper garbage/refuse disposal
o Unsanitary waste disposal
o Improper drainage system
o Poor lighting and ventilation
o Noise pollution
o Air pollution
 Unsanitary food handling and preparation
 Unhealthy lifestyle and personal habits/practices.
o Alcohol drinking
o Cigarette/tobacco smoking
o Walking barefooted or inadequate footwear
o Eating raw meat of fish
o Poor personal hygiene
o Self-medication/substance abuse
o Sexual promiscuity
o Engaging in dangerous sports
o Inadequate rest or sleep
o Inadequate exercise/physical activity
o Lack of relaxation activities
o Non-use of self-protection measures (e.g. non-use of bed nets in malaria and
filariasis endemic areas).
 Inherent personal characteristics: e.g. poor impulse control
 Health history, which may participate/induce the occurrence of Health Deficit, e.g.
previous history of difficult labor.
 Inappropriate role assumption- e.g. child assuming mother’s role, father not assuming
his role.
 Lack of immunization/inadequate immunization status specifically of children
 Family dis-unity
o Self-oriented behavior of member(s)
o Unresolved conflicts of member(s)
o Intolerable disagreement
 Others.

 Health Deficit: Instances of failure in health maintenance; actual illness state

 Examples include:
o Illness state, regardless of whether it is diagnosed or undiagnosed by medical
practitioner

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 o Failure to thrive/develop according to normal rate
o Disability whether congenital or arising from illness; transient/temporary (e.g.
aphasia or temporary paralysis after CVA) or permanent (e.g. leg amputation
secondary to diabetes, blindness from measles, lameness from polio)

 Stress points/ Foreseeable Crisis: Anticipated period of unusual demand on the individual or
family in terms of adjustment/family resources.

 Example:
o Marriage
o Pregnancy, labor, puerperium
o Parenthood
o Additional member - e.g. newborn
o Abortion
o Entrance at school
o Adolescence
o Divorce or separation
o Menopause
o Loss of job
o Hospitalization of a family member
o Death of member
o Resettlement in a new community
o Illegitimacy

After the identification of the sub-criteria or sub-classification of the NATURE OF THE PROBLEM,
encircle the number that corresponds to the identified sub-criteria or sub-classification. Three (3) for the
Wellness State, Three (3) for Health Deficit, Two (2) for Health Threat, and One (1) Foreseeable Crisis.
After encircling the corresponding assigned number, divide that by the highest sub-criteria or sub-
classification assigned number, and multiply that by the constant weight assigned to all sub-criteria or
sub-classification of the NATURE OF THE PROBLEM, which is one (1).

Example: If the identified sub-criteria or sub-classification of the NATURE OF THE PROBLEM is Health
Deficit, number 3 will be encircled. Since 3 is the highest assigned number of all sub-criteria or sub-
classification in the Nature of the Problem, thus it’s 3/3. Multiply this by the constant weight 1.

Therefore it’s: 3/3 x 1 = 1

1 is the Actual Score for the NATURE OF THE PROBLEM

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C. MODIFIABILITY OF THE PROBLEM: Refers to the probability of success in minimizing, alleviating
or totally eradicating the problem through intervention. Under the MODIFIABILITY OF THE PROBLEM the
following are the sub-criteria or sub-classification: Easily Modifiable, Partially Modifiable, and Not
Modifiable.

o Easily Modifiable: For example: The problem can be easily minimized or eradicated because of
client’s interest of improving their family health hygiene. Or condition can be improved because
of the client’s interest on regular personal hygiene.
o Partially Modifiable: The client has slight chance of solving the problem, due to the client’s poor
interest in personal hygiene.
o Not Modifiable: cannot be changed at all

After the identification of the sub-criteria or sub-classification of the MODIFIABILITY OF THE

PROBLEM, encircle the number that corresponds to the identified sub-criteria or sub-classification. Two
(2) for the Easily Modifiable, One (1) for Partially Modifiable, Zero (0) for Not Modifiable. After
encircling the corresponding assigned number, divide that by the highest sub-criteria or sub-
classification assigned number, and multiply that by the constant weight assigned to all sub-criteria or
sub-classification of the MODIFIABILITY OF THE PROBLEM, which is two (2).

Example: If the identified sub-criteria or sub-classification of the MODIFIABILITY OF PROBLEM is Easily

Modifiable, number 2 will be encircled. Since 2 is the highest assigned number of all sub-criteria or sub-
classification in the MODIFIABILITY OF THE PROBLEM, thus it’s 2/2. Multiply this by the constant weight
2.

Therefore its: 2/2 x 2 = 2

2 is the Actual Score for the MODIFIABILITY OF THE PROBLEM

D. PREVENTIVE POTENTIAL: This refers to the nature and magnitude of the future problems that can
be minimized or totally prevented if intervention is done on the problem under consideration. The sub-
criteria or sub-classification under the PREVENTIVE POTENTIAL are the following: HIGH, MODERATE, and
LOW.

FACTORS AFFECTING THE PREVENTIVE POTENTIAL (High, Moderate, and Low)

o Gravity or Severity of the Problem: Refers to the progress of the disease/problem indicating
extent of damage on the patient/family; also indicates prognosis, reversibility of modifiability of

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 the problem. In general, the more severe the problem is, the lower the preventive potential of
the problem.
o Duration of the Problem: refers to the length of time the problem has existed. Generally
speaking, duration of the problem has direct relationship to gravity. The nature of the problem
is variable that may, however, alter this relationship. Because of this relationship to gravity of
the problem, duration has also a direct relationship to preventive potential.
o Current Management: Refers to the presence and appropriateness of intervention measures
instituted to enhance the wellness state or remedy the problem. The institution of appropriate
intervention increases condition’s preventive potential.
o Exposure of any Vulnerable or High Risk-Group: Increases the preventive potential of condition
or problem

After the identification of the sub-criteria or sub-classification of the PREVENTIVE POTENTIAL,

encircle the number that corresponds to the identified sub-criteria or sub-classification. Three (3) for
High, Two (2) for Moderate, One (1) for Low. After encircling the corresponding assigned number, divide
that by the highest sub-criteria or sub-classification assigned number, and multiply that by the
constant weight assigned to all sub-criteria or sub-classification of the PREVENTIVE POTENTIAL, which
is one (1).

Example: Example: If the identified sub-criteria or sub-classification of the PREVENTIVE POTENTIAL is

Moderate, number 2 will be encircled. Since 3 is the highest assigned number of all sub-criteria or sub-
classification in the PREVENTIVE POTENTIAL, thus it’s 2/3. Multiply this by the constant weight 1.

Therefore its: 2/3 x 1 = .66

.66 is the Actual Score for the PREVENTIVE POTENTIAL

E. SALIENCE: Refers to the client’s/family’s perception and evaluation of the condition of the
problem in terms of seriousness and urgency of attention needed or family readiness. The sub-criteria or
sub-classification under SALIENCE are the following: A condition or problem needing immediate
attention, A condition or problem not needing immediate attention, Not Perceived as a problem or
condition needing change.

Example:

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 o A Condition or problem needing Immediate Attention: The family recognize it as a
problem, and is seeking consultation to a health care facility. The family recognize the
need of intervention to cure and prevent the spread of scabies.
o A condition or problem not needing immediate attention: The family recognize it as a
problem but delay consultation and intervention because of the belief “that it is just
natural and they have some other important matters to attend to”.
o Not Perceived as problem or condition needing change: The family does not recognize
it as a problem. They refrained from seeking consultation to any health care facility and
did not utilize any intervention to cure and minimize the spread of scabies.

After the identification of the sub-criteria or sub-classification of SALIENCE, encircle the number
that corresponds to the identified sub-criteria or sub-classification. Two (2) for A condition or problem
needing immediate attention, one (1) for A condition or problem not needing immediate attention,
zero (0) for Not perceived as a problem or condition needing change. After encircling the corresponding
assigned number, divide that by the highest sub-criteria or sub-classification assigned number, and
multiply that by the constant weight assigned to all sub-criteria or sub-classification of the SALIENCE,
which is one (1).

Example: If the identified sub-criteria or sub-classification of the SALIENCE is Not perceived as a

problem or condition needing change, number (0) will be encircled. Since 2 is the highest assigned
number of all sub-criteria or sub-classification in SALIENCE, thus it’s 0/2. Multiply this by the constant
weight 1.

Therefore its: 0/2 x 1 = 0

0 is the Actual Score for SALIENCE

F. TOTAL ACTUAL SCORE OF THE IDENTIFIED PROBLEM: After undergoing the whole process, add all
the actual score of the Nature of the Problem, Modifiability of the Problem, Preventive Potential, and
Salience.

o In the examples given above:

Nature of the Problem: 1
Modifiability of the Problem 1
Preventive Potential .66

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 Salience 0

Total Actual Score of the Problem 2.66

G. ACTUAL TABLE OF THE IDENTIFIED PROBLEM:

Criteria Weight Computation Actual Justification
Score
1. Nature of
The problem
Wellness state 3
Health Deficit 3 1 3/3 x 1 1
Health Threat 2
Foreseeable Crisis 1
2. Modifiability of the
Problem
Easily modifiable 2 2/2 x 2 1
Partially modifiable 1 2
Not modifiable 0
3. Preventive
Potential
High 3
Moderate 2 1 2/3 x 1 .66
Low 1

4. Salience of
the Problem

A condition or problem, needing 2

immediate attention
A condition or problem, not 1 1 0/2 x 1 0
needing immediate attention
Not Perceived as a problem or 0
condition needing change

TOTAL ACTUAL SCORE 2.66

H. REPEAT THE SAME PROCESS TO OTHER IDENTIFIED PROBLEM

I. AFTER SCALING AND COMPUTING ALL THE IDENTIFIED PROBLEM, RANK THEM ACCORDING TO
THEIR TOTAL ACTUAL SCORE. THE HIGHEST TOTAL ACTUAL SCORE IS THE TOPMOST PRIORITY
PROBLEM AND SO ON.

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J. LASTLY, IDENTIFY AMONG THE GROUP MEMBERS WHICH OF THE INDIVIDUAL TOPMOST PROBLEM
HAVE THE HIGHEST SCORE. THAT WILL BE THE COMMUNITY PRIORITY HEALTH PROBLEM.

K. YOU ARE NOW READY FOR THE NEXT STEP, THE PLANNING, WHICH IS THE FORMULATION OF THE
NURSING CARE PLAN OF THE TOP COMMUNITY HEALTH PROBLEM.