Community Health Nursing Process PDF

COMMUNITY HEALTH NURSING PROCESS  Ensure a working relationship with the client and/or support system based on trust, LEARNING respect and shared decision-making using appropriate communication/interpersonal OUTCOME techniques/strategies...

COMMUNITY HEALTH NURSING PROCESS  Ensure a working relationship with the client and/or support system based on trust, LEARNING respect and shared decision-making using appropriate communication/interpersonal OUTCOME techniques/strategies Apply management and leadership principles in providing direction to manage a community / village –based program. Use appropriate strategies/approaches to plan community health programs and nursing service. Document client’s responses/ nursing care services rendered and processes/ outcomes of the nurse client working relationship. CONTENT A. Steps of Community Nursing Process 1. Assessing Community Health Needs a. Types of Community Diagnosis Traditional/Comprehensive Community Diagnosis Participatory Action Research (PAR) 2. Steps in Conducting Community Diagnosis 3. Sources of data a. Primary source b. Secondary source B. Planning Health Program for Community Development 1. Concepts of Planning 2. Activities of Planning Cycle 3. Priority Setting 4. Formulation of Action Plan Community health nurses need to know the defining characteristics of a community because these set the stage in understanding the different aspects that directly or indirectly influence the health status of the community. COMMUNITY IS SEEN AS THE PRIMARY CLIENT COMMUNITY DIAGNOSIS Or Community Assessment and or Situational Analysis It will be derived and will become the bases for developing and implementing community health nursing interventions and strategies. COMMUNITY DIAGNOSIS It consists of collecting, organizing, synthesizing, analyzing and interpreting health data. ASSESSING COMMUNITY HEALTH NEEDS 1 2 3 The nurse considers There are times Decide on the the degree of detail when situations call objectives, the or depth the nurse for a comprehensive resources and time should go into. assessment. available to implement it the community diagnosis. TYPES OF COMMUNITY DIAGNOSIS TYPES OF COMMUNIT Traditional/ Y DIAGNOSIS Comprehensive Community Diagnosis Participatory Action Research (PAR)/Problem-Oriented Community Diagnosis TRADITIONAL/COMPREHENSIVE COMMUNITY DIAGNOSIS Aims to obtain a general information about the community Elements: A. Demographic Variables B. Socio-Economic and Cultural Variables 1. Social Indicators 2. Economic Indicators 3. Environmental Indicators 4. Cultural Factors C. Health and Illness Patterns D. Health Resources E. Political/Leadership Patterns A. should show the size, composition and DEMOGRAPHIC geographical distribution of the population as VARIABLES indicated by the following: Total Population and geographical distribution including urban-rural index and population density. Age and sex composition Selected vital indicators such as growth rate, crude birth rate, crude death rate and life expectancy at birth. Patterns of migration Population Projections B. SOCIO- 1. Social Indicators ECONOMIC Communication network necessary for disseminating AND CULTURAL VARIABLES health information Transportation system Education level Housing Conditions that suggest health hazards (congestion, fire, exposure to elements) B. SOCIO- 2. Economic Indicators ECONOMIC Poverty Level AND CULTURAL Unemployment and underemployment VARIABLES rates Proportion of salaried and wage earners to total economically active population Types of industry present in the community Occupation common in the community B. SOCIO-ECONOMIC AND CULTURAL VARIABLES Air, water Physical/geographical/ Water Supply: topographical source of water Waste disposal: and land 3. Types of characteristics of the supply pollution: air Environment community: land areas, disposal and al Indicators terrain characteristics, land usage in industry, garbage and water climate/season disposal pollution system index B. SOCIO- 4. Cultural Factors ECONOMIC AND Variables that may break up the CULTURAL people into groups within the VARIABLES community such as: Ethnicity social class, Language Religion Race Political Orientation C. HEALTH The nurse may collect primary data about the leading causes of illness and deaths and the rate of occurrence. AND ILLNESS PATTERNS If the nurse can access the secondary data, then make use of these. Leading Causes of Mortality Leading Causes of Morbidity Leading Causes of Infant Mortality Leading Causes of Maternal Mortality Leading Cause of Hospital Admission D. HEALTH RESOURCES The health resources that are available in the community is an important element of the community diagnosis because they are the essential ingredients in the delivery of the basic health services. The nurse needs to determine the manpower, institutional and material resources provided not only by the state but those which are contributed by the private sector and other non-government organizations.  Manpower resources D. Categories of help manpower available HEALTH Geographical distribution of health RESOURC manpower ES Manpower-population ratio Distribution of health manpower according to health facilities (hospitals, rural health units, etc.) Distribution of health manpower according to type of organization (Government, non- government, health units, private) Quality of health manpower Existing manpower development/policies D. HEALTH RESOURCES Material resources Health budget and expenditures Sources of health funding Categories of health institution available in the community Hospital bed-population ratio Categories of health services available E. POLITICAL/LEADERSHIP PATTERNS The political and leadership pattern is a vital element in achieving the goal of high-level wellness among the people. It reflects the action potential of the state and its people to address the health needs and problems of the community. PARTICIPATORY ACTION RESEARCH (PAR)/PROBLEM- ORIENTED COMMUNITY DIAGNOSIS The type of assessment that responds to a particular need. For example, a nurse is confronted with health and medical problems resulting from mine tailings being disposed into the river systems by a mining company. Since community diagnosis investigates the community-mining, the people and its environment the nurse proceeds with the identification of the population who are affected by the hazards posed by mine tailings. STEPS IN CONDUCTING COMMUNITY DIAGNOSIS STEPS IN CONDUCTING COMMUNITY DIAGNOSIS The process of community diagnosis consists of collecting, organizing, synthesizing, analyzing and interpreting health data.  Before the data collection, the STEPS IN CONDUCTIN objectives must be determined, this will dictate the depth or the G scope of the community COMMUNIT diagnosis. Y The nurse needs to resolve DIAGNOSIS whether a comprehensive or a problem-oriented community diagnosis will accomplish the objectives. STEPS IN The community diagnosis CONDUCTIN must be carried out in an G organized and systematic COMMUNIT manner Y Keeping in mind that the DIAGNOSIS community should take an active part in identifying the community needs and problems STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 1 2 3 4 Determinin Defining Determinin Collecting g the the Study g the data the Data Objectives Population to be Collected DETERMINING THE OBJECTIVES The nurse decides on the depth and scope of the data she needs to gather. The nurse must determine the occurrence and distribution of selected environmental, social economic and behavioral conditions important to disease control and wellness promotion. DEFINING THE STUDY POPULATION It may include the entire Based on the objectives population in the of the community community or focused diagnosis, the nurse on a specific population identifies the population groups such as women group to be included in in the reproductive age- the study. group or the infants and the young children. COLLECTING THE DATA Different methods may be utilized to generate health data. The nurse decides on the specific methods depending on the type of data to be generated. For example, through an ocular survey the nurse can determine the physical and topographical characteristics of the community. THE FOLLOWING METHODS TO COLLECT DATA: Records Review- reviewing those that have been compiled by health or non- health agencies from the government or other sources. Surveys and Observations- Can be used to obtain both qualitative and quantitative data. Interviews- Can yield firsthand information Participant Observation- is used to obtain qualitative data by allowing the nurse to actively participate in the life of the community DEVELOPING THE INSTRUMENT Instruments are The most common tools facilitate the instruments use in nurse’s data data collection: gathering activities. Survey questionnaire Interview Guide Observation Checklist ACTUAL DATA GATHERING It is suggested that the nurse meet the people who will be involved in the data collection before the actual data gathering. The instruments are discussed and analyzed, if necessary, then instruments may be modified or simplified ACTUAL DATA GATHERING Pre-testing of the instrument is highly recommended. The data collectors must be given an orientation and training on how they are going to use the instruments in data gathering. The nurse can ask the data collectors to role play an interview scene so that they can place themselves in an actual interview situation. During the actual data gathering, the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected. DATA COLLATION After data collection, the nurse is now ready to put together all the information. There are two types of data that may be generated. They are either numerical data which can be counted or descriptive data which can be described. To facilitate data collation, the nurse must develop the categories for classification of responses making sure that the categories are mutually exclusive and Exhaustive. DATA PRESENTATION Will depend largely on the type of data obtained. Descriptive data are presented in narrative reports. Numerical data may be presented into table or graphs. Tables or graphs are useful in showing key information making it easier to show comparisons including patterns and trends. The choice of graphs will depend on the types of data being presented.  TYPE OF GRAPH DATA FUNCTION Line Graph Shows trend data or changes with time or age with respect to some other variable Bar graph/pictograph For comparisons of absolute or relative counts and rates between categories Histogram/Frequency Graphic presentation of frequency distribution or Polygon measurement Proportional or Shows breakdown of a group or total where the number component Bar of the degrees is not too many graph/pie chart Scattered Diagram Correlation data for two variables 01 02 03 In community It also allows for Determining the diagnosis aims to comparison of interrelationship of establish trends and factors will help the patterns in terms of obtain data with nurse view the health needs and standard values. significance of the problem of the problems and their community. implications on the health status of the community. DATA ANALYSIS Identifying The Community Health Nursing Problems Community health nursing problems are categorized as: Health Status Problems- they may be described in terms of increased or decreased morbidity, mortality, fertility or reduced capability for wellness Health Resources Problems- they may be described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems Health Related Problems - they may be described in terms of existence of social, economic, environmental and political factors that aggravate the illness inducing situations in the community. Priority Setting In priority setting, the nurse makes use of the following criteria: Nature of the Condition/Problem presented- the problems are classified by the nurse as health status, health resources or health-related problems. Magnitude of the Problem- this refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem Modifiability of the Problem- this refers to the probability of reducing, controlling or eradicating the problem Preventive Potential- this refers to the probability of controlling or reducing the effects posed by the problem Social Concern- This refers to the perception of the population or the community as they are affected by the problem and their readiness to cope up on the problem 3. SOURCES OF DATA a. Primary Source talking with community members, including formal and informal leaders, and community inhabitants for accurate insights and comprehensive information b. Secondary Source includes health team information, client records, community health statistics, census bureau’s data, reference books, research reports, and community health nurses PLANNING HEALTH PROGRAM FOR COMMUNITY DEVELOPMENT CONCEPTS OF PLANNING Planning and implementation for groups, populations and communities involved the application of the nursing process. The nurse will find herself working with other members of the health team with other sectors you may have different orientation or strategies in terms of viewing solutions to community health problems. Planning is a process that entails formulation of steps to be undertaken in the future in order to achieve a desired end. Planning takes place in order to efficiently allocate available resources. This implies that the planner assesses the nature and extent of the problems for which the program is being planned for us as well as constraints and limitations that may affect planning decisions. Planning is done in our desire to improve the present state of affairs. THE CONCEPT OF Planning is futuristic PLANNING (MERCADO, Planning is change-oriented 1993): Planning g is a continuous and dynamic process Planning is flexible Planning is a systematic process ACTIVITIES OF PLANNING CYCLE AS THE COMMUNITY HEALTH NURSE PLANS TO MEET THE HEALTH PROBLEMS AND NEEDS OF THE POPULATION, FOUR BASIC QUESTIONS ARE ASKED: SITUATIONAL ANALYSIS Answering the question “Where are we now” involves the process of collecting, synthesizing, analyzing and interpreting information in a manner that will provide a clearer picture of the health status of the community. In this phase of planning cycle, the nurse identifies and provides explanation to their problems. The nurse may use the community diagnosis report as a basis for the situational analysis. IN SITUATION ANALYSIS INVOLVES THREE ACTIVITIES: The nurse gathers data about the health status of the community. The nurse identifies and explains the problems The nurse projects what situation needs to be changed, developed or maintained. PRIORITY SETTING GOAL AND OBJECTIVES SETTING Where do we want to go? Refers to the process of formulating the goals and objectives of the health program. Goal and objectives will serve as guide with the nurse’s efforts. A goal leads to a desired end. The desired end maybe a total change, improvement or a maintenance of a situation. It is directed towards solving the health status problem which the nurse identified in a community diagnosis. Objectives are more precise; they are considered as planned end point of all activities. Objectives are concerned with the resolution of the health problem itself. GOAL AND OBJECTIVES SETTING Health Problem: High incidence and prevalence of intestinal parasitism among children. Goal: To reduce the incidence and prevalence of intestinal parasitism among children of Sitio Camachile Objectives: 75% of children below 6 years old will test negative for parasites after one year. Objectives 80% of households will have access to safe waste disposal system within six months 80% of households will have access to safe and adequate water supply within six months 75% of children under 6 years old will have regular clinic visits STRATEGY AND ACTIVITY SETTING How do we get there? Defines the strategies and activities that the nurse said to achieve and realize the goals and objectives. It implies the identification of resources-manpower, money, materials, technology, time and institutions-needed to implement a program. The nurse defines the strategy approach in a health program. Nurse assessed extent to which constraints or limitations affect planning decisions. STRATEGY AND ACTIVITY SETTING Activities may provide direct healthcare services to the population such as immunizations, family planning services, nutrition supplementation and the like. The activities are directed towards transferring knowledge and skills to specific group of people like community health workers training and mother’s classes. The nurse must organize activities in such a way that time, money, and effort are not wasted. EVALUATION PLAN The nurse poses the question “How do we know we are there?” In order to find out if the programs and services achieve the purpose for which they were formulated. The nurse determines whether the program is relevant, effective, efficient and adequate.  Deciding what to evaluate in terms of relevance, PROGRAM progress, effectivity, impact and efficiency EVALUATION Designing the evaluation plan specifying the evaluation indicators, data needed, methods and tools for data INCLUDES collection and data sources THE Collection of relevant data FOLLOWING STEPS: Analyzing data Making decisions Preparing report and providing decision-makers feedback on the program evaluation. END