Community Nursing Health Process PDF

UNIVERSIDAD DE ZAMBOANGA MAIN CAMPUS, DON TORIBIO ST., TETUAN, ZAMBOANGA CITY CONCEPT III THE COMMUNITY HEALTH NURSING PROCESS Assessment of Community Health Needs Needs Assessment  A...

UNIVERSIDAD DE ZAMBOANGA MAIN CAMPUS, DON TORIBIO ST., TETUAN, ZAMBOANGA CITY CONCEPT III THE COMMUNITY HEALTH NURSING PROCESS Assessment of Community Health Needs Needs Assessment  A process of looking at many kinds of information about a target group or community.  It includes a review of demographics/ census data, surveys and interview of the population. Health Needs Assessment  A process of systematically collecting information to enable the practitioner, team and policy makers to identify, analyze, prioritize and meet the health needs of an individual, family or population. Community Health Needs Assessment  A community needs assessment identifies the strengths and resources available in the community to meet the needs of children, youth, and families. The assessment focuses on the capabilities of the community, including its citizens, agencies, and organizations. It provides a framework for developing and identifying  A process that describes the state of health of local people, enables the identification of the major risk factors and causes of ill health and identification of the actions or interventions to be needed.  A Community Health Needs Assessment is a way of using information to plan health care and public health programs in the future. Components Community Health Needs Assessment 1. Health Status 2. Health resources 3. Health action Potential 1. Health status is the health standing of the population as indicated by the morbidity, mortality and fertility rates.  Factors such as social, economic, physical environmental factors = poverty, air pollution, racism, inadequate housing and income inequalities play a significant role in determining health status of a community. 2. Health resources- are assets, means strengths and skills that are contributory to the promotion of health and well-being that exist within communities to meet the needs of the individuals, families or social groups.  These resources may be: (it is important to assess the extent of both types of resources as part of the profile information.) Formal services-  Can be provided at a variety of levels and by many agencies including both health services and those provided by other sectors that have an impact on health.  Educational resources in a community are an important resource for health (Rifkin, 1990).  Many political and religious organizations also have resources that communities use to provide economic assistance and health and social care. Informal resources or networks- families deliver the greatest part of all care services in the community.  Burden of care normally falls primarily on women can have significant effects on their health status.  Government, private and voluntary systems of care supplement the family or fill in where no family network exist. 3. Health action potential  Action planning is a complex activity and should be undertaken where the more local people are involve in action planning, the more likely that the plans will be accepted and implemented.  There must also be collaboration with others like groups of health care professionals, workers from other agencies and local people who can serve as potential partners in health planning.  Approaches in Conducting Community Assessment: 1. Comprehensive needs assessment  The nurse gathers information about the entire community using a systematic process where data is collected regarding all aspects of the community to be able to identify actual and potential health problems.  Requires much time and effort  Information gathered will be most useful particularly when the health assessment of the community is being done for the first time.  Periodic assessment and evaluation of health programs may also require the application of this approach. 2. Problem oriented assessment  Focused on a particular aspect of health.  The nurse collects information with a certain community problem in mind, and then proceeds to gather information from the aggregate vulnerable to the problem.  Workable when the nurse is familiar with the community, such as when comprehensive needs assessment has been previously done. Tools for Community Assessment: 1. Collecting Primary Data  Observation ▪ Rapid observation - done through ocular or windshield survey  Driving or riding vehicle – gives a nurse the chance to observe people as well as take note of environmental conditions and existing community facilities.  Walking through – allows the nurse to talk to people to find out their perceptions of health and health services ▪ Participant observation – a purposeful observation of informal and formal communities by sharing, if possible in the life of the community.  Helps the nurse determine community values, beliefs, norms, priorities, concerns and power or influence structures.  Survey – necessary when there is no available information about the community or specific population group to be studied.  Informant interview – purposeful talks with either key informants or ordinary members of the community. Key informants are either consist of formal and informal community leaders or persons of position or influence.  Community forum – an open meeting of the members of the community. Example: Pulong-pulong sa barangay.  Focus group – made up of smaller group usually 6 – 12 members only. 2. Secondary Data Sources  Registry of vital events – Local Civil Registrar (LCR), Philippine Statistics Authority (PSA)  Health records and events – Field Health Service Information System (FHSIS) the official recording and reporting system of the Department of Health  Disease registry – listing of persons diagnosed with a specific type of disease in a defined population. Data collected through disease registries serve as basis for monitoring , decision making and program management.  Census data - a periodic governmental enumeration of the population. 3. Methods to Present Community Data Purposes:  To inform the health team and members of the community of existing health-related conditions in the community in an easily understandable manner.  To make members of the community appreciate the significance and relevance of health information to their lives.   To solicit broader support and participation in the community health process.  To validate findings.  To allow for a wider perspective in the analysis of data.  To provide a basis for better decision making. Graphs for Presenting Community Data and their Uses:  Bar graph: To compare values across different categories of data. For example: a population pyramid is made up of two horizontal bar graphs representing the age structure of the male and female population  Line graph: To have a visual image of trends in data over time and age. This is appropriate for time series. For example, the trend of the total fertility rate or average number of children per woman in the Philippines from 1960 -2017.  Pie chart: To show percentage distribution or composition of a variable, such as population or households. A pie chart is an effective tool in highlighting the value of a group in relation to the whole population. But it can illustrate only a small number of categories, usually not more than six. As an example, a pie chart may be used to visually represent the percentage distribution of households based on environmental variables, such as water source, method of refuse, and excreta disposal. Another example is the distribution of 0-5 year old children by nutritional status based on operation timbang.  A scatter plot or diagram: To show correlation between two variables. The values of both variables in subjects are plotted in a graph with an x-axis and a y-axis. For example, a positive correlation between body mass index and waist circumference among men and women, that is, a high waist circumference is associated with high body mass index. COMMUNITY DIAGNOSIS  A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies. 2 Types of Community Diagnosis Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis ▪ aims to obtain general information about the ▪ type of assessment responds to a particular community need Elements of a Comprehensive Community Diagnosis A. Demographic Variables  The analysis of the community’s demographic characteristics should show the size, composition and geographical distribution of the population. B. Socio-Economic and Cultural Variables  The nurse should consider the following as essential information: 1. Social indicators a. Communication network necessary for disseminating health information or facilitating referral to clients to the health care system. b. Transportation system including road networks necessary for accessibility of the people to health care delivery system. c. Educational level which may be indicative of poverty and may reflect on health perception and utilization pattern of the community. 2. Economic indicators a. Poverty level income b. Unemployment and underemployment rates c. Proportion of salaries and wage earners to total economically active population d. Types of industry present in the community e. Occupation common in the community 3. Environmental indicators a. Physical/geographical/topographical characteristics of the community b. Water supply c. Waste disposal d. Air, water and land pollution  4. Cultural factors a. Variables that may break up the people into groups within the community such as ethnicity, social class, language, religion, race and political orientation. b. Cultural beliefs and practices that affect health c. Concepts about health and illness C. Health and Illness Patterns  In analyzing the health and illness patterns, the nurse may collect primary data about the leading causes of illness and deaths and their respective rates of occurrence. D. Health Resources  The nurse needs to determine 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. E. Political/Leadership Patterns  It reflects the action potential of the state and its people to address the health needs and problems of the community. It also mirrors the sensitivity of the government to the people’s struggle for better lives. Problem-Oriented Community Diagnosis Type of assessment that responds to a particular need of a target group. Since a community diagnosis investigates the community-meaning the people and its environment the nurse proceeds with the identification of the population who are affected. COMMUNITY DIAGNOSIS: THE PROCESS  The process of community diagnosis consists of: ▪ Collecting ▪ Organizing ▪ Synthesizing ▪ Analyzing ▪ Interpreting health data STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 1. DETERMINING THE OBJECTIVES ▪ The nurse decides on the depth and scope of the data she needs to gather. 2. DEFINING THE STUDY POPULATION ▪ The nurse identifies the population group to be included in the study. 3. DETERMINING THE DATA TO BE COLLECTED ▪ The objectives will guide the nurse in identifying the specific data she will collect, and will also decide on the sources of these data. 4. COLLECTING THE DATA ▪ The nurse decides on the specific methods depending on the type of data to be generated. 5. DEVELOPING THE INSTRUMENT ▪ Instruments / tools facilitate the nurse’s data-gathering activities. ▪ Most common instruments:  Survey questionnaire  Interview guide  Observation checklist 6. 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. 7. DATA COLLATION ▪ The nurse is now ready to put together all the information. 8. DATA PRESENTATION ▪ Will depend largely on the type of data obtained. (descriptive & numerical data) 9. DATA ANALYSIS – ▪ Aims to establish trends and patterns in terms of health needs and problems of the community. 10. IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS ▪ Health status problems – increased or decreased morbidity, mortality, fertility or reduced capability for wellness. ▪ Health resources problems – lack of or absence of manpower, money, materials or institutions necessary to solve health problems.  ▪ Health-related problems – existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community. 11. PRIORITY-SETTING ▪ Prioritize which health problems can be attended to considering the resources available at the moment. ▪ 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 act on the problem. TOOLS USED IN COMMUNITY DIAGNOSIS The health disciplines of demography, vital statistics and epidemiology are three important tools that help the nurse in identifying the community’s health needs. (Please refer to our previous lecture on Health Statistics and Demography)  Demography  Vital Statistics  Epidemiology Shuster and Geoppinger  Has three-part system: ▪ The health risk or specific problem to which the community is exposed. ▪ The specific aggregate or community with whom the nurse will be working to deal with the risk or problem. ▪ Related factors that influence how the community will respond to the health risk or problem. The Omaha System  Use as a framework for the care of individuals, families and communities by nurses, nursing educators, physicians and other health care providers  It is a comprehensive and research-based classification system for client problems that exists in the public domain  Classification system has three components that are to be used together; a problem classification scheme, an intervention scheme and a problem rating scale for outcomes ▪ First component of the Omaha classification system is a problem classification scheme (client assessment) which serves as a guide in collecting, classifying, analyzing, documenting and communicating health and health-related needs and strengths  The scheme provides a model for practice, education & research.  The identified problems or areas of concern are classified in four levels: four domains: ✓ Environmental ✓ Psychosocial ✓ Physiological ✓ Health-related behaviors ▪ Second-level consists of problems/areas of concern under the four domains ▪ In the third level, the problem or area of concern is classified according to two sets of qualifiers. First, the area of concern is categorized into health promotion, potential problem, or actual problem. The level of clientele (individual, family or community) involved is identified ▪ The fourth and most specific level is made up of clusters of signs and symptoms that describe actual problems PLANNING OF COMMUNITY HEALTH NURSING SERVICES Planning and implementation for groups, populations, and communities involve the application of the nursing process. Factors that may affect the planning process include:  Existing policies and legislation  Level of technology in the area  Economic resources  Having programs and institutions that are in conflict  Working with other members and sectors with different orientation and strategies PLANNING  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 as well as constraints and limitations that may affect planning decisions.  In general, planning is done in our desire to improve the present state of affairs.  Mercado (1993) summarizes the Concepts of Planning: 1. Planning is futuristic. 2. Planning is change-oriented. 3. Planning is a continuous and dynamic process. 4. Planning is flexible. 5. Planning is a systematic process.  Planning in community health nursing involves the orderly process of assessing the health problems and needs of the community.  Priority goals are set according to availability of resources. Interventions are carefully thought of considering constraints or limitations as they may hamper the realization of set goals. BASES FOR DEVELOPING A COMMUNITY HEALTH PLAN Community health problems are conditions or situations that intervene with the community’s capability to achieve wellness. They are generally categorized as health status problems, health resources and health-related problems.  Health status problems ▪ increased or decreased morbidity, mortality, fertility or reduced capability for wellness.  Health resources problems ▪ lack of or absence of manpower, money, materials or institutions necessary to solve health problems.  Health-related problems ▪ existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community. Steps in making a plan: THE PLANNING CYCLE As the community health nurse plans to meet the health problems and needs of the population, four basic questions are asked: 1. Where are we now? 2. Where do we want to go? 3. How do we get there? 4. How do we know we are there? Situational Analysis Gather health data Tabulate, analyze and interpret data Identify health problems Set priority Evaluation Goal and Objective Setting Determine outcomes Define program goals and Specify criteria and standards objectives Assign priorities among objectives Strategy/ Activity Setting Design CHN Programs Ascertain resources Analyze constraints and limitations THE PLANNING CYCLE 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 clear picture of the health status of the community. It brings out the health problems of the community. It involves three activities: 1. The nurse gathers data about the health status of the community. 2. The nurse identifies and explains the problems 3. The nurse projects what situation needs to be changed developed or maintained. Goal and Objective Setting “Where do we want to go?” refers to the process of formulating the goals and objectives of the health program and nursing services in order to change the status quo. Goals and objectives will serve as guide to the nurse’s efforts. Goal leads to a desired end. The desired end may be a total change, improvement or maintenance of a situation. It is directed towards solving the health status problems which the nurse identified in the community diagnosis. Objectives are considered as planned end point of all activities. Objectives are concerned with the resolution of the health problem itself. They have to be stated in specific and measurable terms. Strategy and Activity Setting “How do we get there?” defines the strategies and the activities that the nurse sets to achieve in order to realize the goals and objectives. It implies the identification of resources- manpower, money, materials, technology, time and institutions—needed to implement a program. This particular phase of the planning cycle involves three activities: 1. Designing the health programs and services 2. Budgeting 3. Making a time plan or schedule The 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 are formulated. She determines whether the program is relevant, effective, efficient and adequate. This entails determining the specific input, process and output/ outcome indicators of the program stating the criteria and standards of each. Program evaluation includes the following steps: 1. Deciding what to evaluate in terms of relevance, progress, effectivity, impact and efficiency. 2. Designing the evaluation plan specifying the evaluation indicators, data needed, methods and tools for data collection and data sources 3. Collection of relevant data 4. Analyzing data 5. Making decisions 6. Preparing report and providing decision-makers feedback on the program evaluation. Implementation  All the previous phases of the nursing process are integrated.  While giving actual care, you must continue to assess, validate concerns, modify the plan and identify priorities.  Components of program Implementation ▪ Coordinating the health program ▪ Monitoring health programs ▪ Supervising the program staff Evaluation  Final, on-going phase of the nursing process that tries to find out both the patient responses  Evaluation approaches: ▪ Structured evaluation- involves looking into the manpower of the agency responsible for community health interventions ▪ Process evaluation- examining the manner by which the assessment, diagnosis, planning, implementation and evaluation were undertaken ▪ Outcome evaluation- determining the degree of attainment of goals and objectives ▪ Ongoing evaluation- monitoring is done during implementation to provide feedback on compliance to the plan as well as on need for changes in the plan to improve the process & outcomes of interventions  Standards of evaluation: ▪ Utility- value of the evaluation in terms of usefulness of result. ▪ Feasibility- answers the question of whether the plan for evaluation is doable or not, considering available resources. ▪ Propriety- involves ethical and legal matters. Respect for the worth and dignity of the participants in the data collection should be given due consideration. The results should be truthfully reported to give credit where it is due and to show the strengths and weaknesses for remedial action. Results should be furnished to everyone entitled to them, especially the community. Finally, transparency and accountability should be observed in all financial matters related to the community health action. ▪ Accuracy- refers to validity and reliability of the results of evaluation. Accurate evaluation begins with accurate documentation while the community health process is ongoing. A high degree of validity and reliability can be achieved by choosing and properly utilizing the evaluation tools. Prepared By: ELLA B. ALBURO, RN, MN Instructor