Community Health Nursing Process PDF

**Community Health Nursing Process: Planning Community Health Interventions, Formulating Goals and Objectives Deciding on Interventions, Implementation & Evaluation** **Planning** It is a logical process of decision making to determine which of the identified health concerns requires more immediat...

**Community Health Nursing Process: Planning Community Health Interventions, Formulating Goals and Objectives Deciding on Interventions, Implementation & Evaluation** **Planning** It is a logical process of decision making to determine which of the identified health concerns requires more immediate consideration (priority setting & what action may be undertakes to achieve goals. **Criteria Priority Setting** 1\. Significance of the Problem- is based on the number of people in the community affected by the problem or condition 2\. The Level of Community Awareness- The priority its member give to the health concern is a major consideration. \- Related to the community gives to the health concern, Shuster & Geoppinger (2004) \- Community motivation to deal with condition 3\. Ability to Reduce Risk \- Related to the availability of the expertise among the health team in the community itself \- This criterion involves the health team's level of influence in decision making related to actions in resolving the community health concern. 4\. Determining cost of Reducing Risk \- The nurse has to consider economic, social & ethical requisites and consequences of planned action. 5\. Ability to identify the target population \- For the intervention is a matter of availability of data resources such as FHSIS, census, survey reports or case/screening finding. 6\. Availability of Resources \- To intervene in the reduction of risk entails technological, financial & other material resources of the community, the nurse, the health agency. \- Accessibility of outside resources & link are taken into account 7\. Group. It is a flexible process using the nominal group technique wherein each group member has an equal voice and decision-making, thereby avoiding control of the process by the more dominant members of the group **Formulating Goals and Objectives** In family health nursing , goals are the desired outcomes at the end of interventions, whereas objectives are the short term changes in the community that are observed as the health team & the community works towards attainment of goals. Objectives serve as instructions, defining what should be detected in the community as interventions are being implemented. **SMART** Process: For us to attain our goal and objective we must be smart Specific - be clear and specific to your goals that are easier to achieve. This would also help you to know how and where to get started. Measurable - goal must be reached allowing you to see your progress. Tells you when your goals are complete Attainable - your goal is realistic and you must have the tools or resources to attain it Relevant - realistic or relevant to avoid over well and unnecessary stress and frustration Time-Bound -a date help us stay focused and motivated, inspiring us and providing something to work **Deciding on Community Interventions** The group must analyze the reasons for people\'s health behavior and directs strategies to respond to the underlying causes But if the reason is sociocultural, the planning team me opt to concentrate on providing opportunities for skills development of traditional birth attendants or exerting more effort to gain trust and confidence of women and families The group should take into consideration the demographic, physiological, social, cultural and economic characteristic of the target population and one hand and the available health resources on the other hand. **Implementing the Community Health Interventions** Referred to as the action phase Able to deal with recognize priority health concern To facilitate the process rather than directly implement the planned interventions **Importance of Partnership and Collaboration** The problem are complicated and too many for the nurse and the people or their organization to handle They must work with other people or groups to increase the probability of accomplishing the goals that they have set. The nurse must plan to establish and maintain valuable working relationships with people such as people\'s organizations, health organizations, educational institutions, local government units , financial institutions, religious groups, socio-civic organizations, and sectoral groups. **Activities involved in collaboration and advocacy environmental sanitation** Proper excreta Disposal food safety Sanitation Vermin and vector control Built environment **Advocacy Work Involves:** Informing the people about the rightness of a cause. Thoroughly discussing with the people the nature of alternatives, their content and possible consequences. Supporting people\'s right to make a choice and act on their choice Influencing public opinion. **Community Organizing and Social Mobilization**. [**Social Mobilization **](https://www.slideshare.net/slideshow/social-mobilization-group-2-1pptx/252906831#3)is an approach wherein the community participation is very essential. It uses deliberate participating processes to involve local institutions, local leaders, community groups, and members of the community to organize through concerted efforts toward a common purpose. Community mobilization is characterized by respect for the community and its needs. What is Social Mobilization It is also defined as a process of capability buildng of deprived community people to enable them to plan, manage and control over their own development program. It emphasizes self-decision of the concerned community, self-initiated development efforts as well as self-capacity building of the community, empowerment of the powerless, organization of the unorganized, and awarenes of the unaware which are the major elements of the social mobilization and are the concerns of the National Service Training Programs. (Abhiyan,2004) **The following should be undertaken in social mobilization** **Advocacy** - element which is focused on various actors which could create the positive environment for program or service delivery. **Information, Education and Communication (IEC)** - a set of accurate and consistent information on the programs and services as a timely response by those in direct contact with the communities. **Community Organizing** - Individual and community groups are able to get a sense of what they can do among themselves to improve their situation. **Capacity Building** - Social mobilization can only be sustained if the network of the advocates and mobilizers are continually expanded through Capacity - building (people) Institutional Development (organization) **Community Organizing** as a process consists of steps or activities that instill and reinforce the people's selfconfidence on their own collective strengths and capabilities (Manalili, 1990). It is the development of the community's collective capacities to solve its own problems and aspire for development through its own efforts. It entails harnessing and developing the community's capacities to recognize a community problem, identify and implement solutions, and monitor and evaluate the efforts in resolving the problem. Is a continuous process of educating the community to develop its capacity to assess and analyze the situation (which usually involves the process of consciousness raising), plan and implement interventions mobilization), and evaluate them. **Importance of Community Organizing** Community Organizing is a participatory decision-making process that empowers communities to improve health. It emphasizes active participation from the community in identifying key health issues and strategies to address them. Communities focus on their strengths and collectively mobilize to develop programs to achieve health goals.Power is the purpose of community organizing, and the issues, problems, strategies and victories are means to the end of increased power for the organization and the community.Empowerment processAt the heart of CO promotes participation of people, organizations and communities toward the goals of increased individual and community control, political efficacy, improved quality of community life, and social justice.Community organizationProcess by which the people organize themselves to "take charge" of their situation and thus develop a sense of being a community together Community organizing is a continuous and sustained process of: 1. Guiding people to understand the existing condition of their own community 2. Organizing people to work collectively and efficiently on their immediate and long term problemMobilizing people to develop their capacity and readiness to respond and take action on their immediate and long term needs 3. A middle ground where the healthcare worker and the people need to attain community organization 4. A liberal freedom of the community where the people are allowed to participate in the overallhealth care status of their community 5. A transformation force, that enables the individuals, families and communities to be responsible for their own health. 6. A phenomenon of interest goals and objectives at the health care works and the people in their way to health citizenryImportance of Community Organizing. **Basic values in community organizing** Human Rights Social Justice Social Responsibility **Core Principles of Community Organizing** People Centered Participative Democratic Developmental Process-Oriented **Phases of Community Organizing** **1. Pre-entry** Involves in Preparation and includes knowing the goals of the community organizing activity or experience It may also be necessary to delineate criteria or guidelines for site selection. Making a list of sources of information and possible facility resources, both government and private, is recommended. Skills in community organizing are developed on the job or through experiential approach. Novice community organizers, such as student nurses on their related learning experience, are therefore not unusual. For novice organizers, preparation includes a study or review of the basic concepts of community organizing. Although the affective domain is not easy to change, self-examination helps the organizer identify attitudes -- both positive and negative -- that may influence effectiveness. Proper selection of the community is crucial. Identification of: Possible barriers, Threats, Strengths Opportunities at this stage is an important determinant of the over-all outcome of community organizing Communities may be identified through different means: Initial data during ocular survey Review of records of a health facility Review of barangay profile, and so on Referrals from other communities or institutions Through series of meetings Consultation from local governments (LGUs) or private institutions Basic criteria Geographically isolated and disadvantaged area Community perceives that they need assistance. Shows sign of willingness No obvious threat for safety No other organization working with same services Partnership among other sectors is feasible **2. Entry into the community** This phase formalizes the start of the organizing process. This is the stage where the organizer gets to know the community likewise gets to know the organizer. Courtesy calls to local formal leaders Visit informal leaders like elders, local health workers, traditional healers, church leaders and local neighborhood association or other contact persons who may facilitate the subsequent phases of the organizing process Considerations in the entry phase - Community organizers must clearly introduce themselves and their institution to the community. Clear explanation of the vision, mission, goals, programs and activities must be given in all initial meetings and contacts with the community. - Community organizer must have a basic understanding of the target community. - Preparation for the initial visit includes - Gathering basic information on socioeconomic conditions, traditions including practices, overall physical environment, general health and illness patterns, and available resources. - Informal meeting with contacts who have been to the area or some residents of the community prior to entry will be useful. - Avoid raising unrealistic expectations in the community. - Goal: Build up the confidence and capacities of people - 2 strategies in gaining entry into a community which can be **Counteproductive** *Padrino or patron*. When patron tries to boost the community organizer's intended output to the community, this will create false hopes *Bongga entry*. Easiest way to catch the attention and gain the approval of the community. This strategy exploits the people's weaknesses and usually involves dole-outs (free medicine, food ant thers). This creates unreasonable expectations and contradicts the essence of community organizing. **3. Community Integration** Community integration or pakikipamuhay is the phase when the organizer may actually live in the community in an effort to understand the community better and imbibe community life. The establishment of rapport between the organizer and the people indicates successful integration. - Integration requires IMMERSION in a community life. - Organizer's conduct as well as manner of dressing must be in accordance with the norms of the community - Styles of integration - "Guest" status Visits the community as per schedule "now you see, now you don't" Boarder style Rents a room or house in a village Lives with his own lifestyle Does not share life with the community "Elitist" style Frequently with the barangay officials People-centered approach integration Community organizers enter into a community with a well-conceived plan. They establish contact with villagers and become *their allies* Organizers develop a deeper relationship through various techniques Pagbabahay-bahay or occasional home visit, observe house routines to avoid inconvenience Huntahan. Informal conversations in the village poso during laundry time, basketball court and sari-sari store Participation in the production process Participates in farming, fishing or any livelihood activities of the community This practice allows the organizer to experience the life of the people in the community. Hence, they will understand them better. **Participation in social activities** Attending fiestas, weddings, baptismal celebrations, funeral wakes and other activities ofthe community that carry social meaning and importance. Community organizers should remain as role model, gambling and drinking alcoholic beverages with them is prohibited. **4. Social Analysis** This is the process of gathering, collating and analyzing data to gain extensive understanding of community conditions, help in the identification of problems of the community and determine the root cause of these problems. - Known also as social investigation, community study, community analysis, or community needs assessment - In nursing practice this is often called as community diagnosis with emphasis given to health and healthrelated problems - Comprehensive analysis Demographic data Sociocultural data Economic data Environmental data Data on health patterns (morbidity, mortality, fertility) and Data on health resources 5\. **Identifying Potential Leaders** Since organizing is not a job of one person, it is imperative that the organizer identifies partners and potential leaders who will help lead the people. Desirable characteristics of potential leaders Represent the target group/community E.g. farmer if it is a farmers group Possess or display leadership qualities They have the trust and confidence of the community Express belief in the need to change the current undesirable situation in the community, that change is possible and that change must start with members of the community Willing to invest time and effort for community organizing Must have potential management skills The community organizer must bear in mind that the prevailing culture or social structure in some communities tends to make ordinary people shy away from leadership roles, and instead, prefer to work in self-effacing supportive roles. Some community members may equate leadership ability with education or wealth. Thus, one of the challenges of community organizing is the training and preparation of the potential leaders. This requires consistency and persistence in the training and thereby encouraging them and giving their opportunities to assume various roles in community activities. The key is to allow time for them to develop and gradually assume leadership role. 6**. Core Group Formation** As the organizer works with potential community leaders, the membership of the group is expanded, as necessary, by asking them to invite one or two of their neighborhood or friends. These new recruits must also be from the community sharing the same problems the group seeks to correct, while at the same time believing in the same core values, principles and strategies the group is employing. Keep the group manageable, 8 and 12 members Initially forming a single group is suggested but as the community gets better organized, the first group may have separate groups or committees Formation of a viable, functioning core group is the focal point of community organizing. -Requires series of training sessions to transfer the technology of organizing, enabling the core group to take charge -Essential component of core group formation: reinforcement of the social consciousness of the members, particularly in terms of analysing the root causes of community problems -The formation program may focus on self-awareness and development of community health leaders -Negative factor must be addressed so as not to affect the outcomes of the community organizing efforts **7. Community Organization** Through various means of information dissemination, the core group, with the assistance of the organizer, instills awareness of common concerns among other members of the community. Subsequently, on the initiative of the core group, the community conducts an assembly or a series of assemblies, with the goals of arriving at a common understanding of community concerns and formulating a plan of action in dealing with these concerns. *Collective decision making* must dictate what projects and strategy must be undertaken. The organizer must remember that it is their project to be done in their community. The organizer must let them decide. If the community decides to formalize the organization, it must have the following characteristics: An organizational name and structure A set of officers recognized by the members of the community Community and by laws stating the vision, mission and goals (VMG) rules and regulations of the organization and duties and responsibilities of its officers and members The community may then decide to seek legal recognition by registering the organization with the appropriate government agency, such as the Securities and Exchange Commission or the Cooperatives Development Agency. Recognition by the LGU completes the process. Gaining legal recognition paves the way for the organization's participation in the Barangay, Municipal or City Development Council as provided in the Local Government Council as provided in the Local Government Code (RA 7160). The organization may also establish linkages and networks with other government agencies, nongovernment organizations/agencies, or other people's organizations that will further strengthen and expand the organization, facilitating the attainment of its goals and objectives. **8. Action Phase** Also known as the MOBILIZATION phase, the action phase refers to the implementation of the community's planned projects and programs. **Important considerations during the mobilization phase are as follows:** 1\. Allow the community to determine the pace and scope of project implementation. The community may start with simple barangay projects, such as Tapat Ko Linis Ko or clean and green. As the organization gains experience and develops, it will move toward more complex programs, like coastal resource management or a community material recovery facility. 2\. The process is as important as the output. A project may fail but as long as the community gains valuable experience and learns from the process, it is not failure in itself. 3\. Regular monitoring and continuing community formation program are essential. Throughout the mobilization, regular meetings must be conducted for monitoring and continuous training for community leaders. **9. Evaluation** Evaluation is a systematic, critical analysis of the current state of the organization and or projects compared to desired or planned goals or objectives. Ideally, evaluation is done periodically during mobilization (i.e. Formative evaluation) to allow revision of strategies when needed and at the end of the prescribed project period (i.e. summative evaluation). In community organizing, there are two major areas of evaluation: program-based evaluation and organizational evaluation. +-----------------------------------+-----------------------------------+ | Area of evaluation | General evaluation parameters | +===================================+===================================+ | Program-based | Were the goals and objectives of | | | the program/project | | | | | | achieved? | | | | | | What strategies were implemented? | | | What worked? | | | | | | What did not? | | | | | | What is the over-all impact of | | | the project on the community? | | | | | | How were the resources of the | | | organization and community | | | utilized? | +-----------------------------------+-----------------------------------+ | Organizational | Were the vision, mission and | | | goals of the organization | | | achieved? | | | | | | How are the organizational | | | policies being implemented? | | | | | | What is the level of | | | participation in the affairs of | | | the community | | | | | | organization? | | | | | | How were the resources of the | | | organization utilized and | | | managed? | | | | | | What type of interpersonal | | | relationships is shared among the | | | members of | | | | | | the organization, among leaders, | | | and the members of the community | | | organization? | +-----------------------------------+-----------------------------------+ **10. Exit and Expansion** From the start, the organizer must have a clear vision of the end with a general time frame in min. As articulated by Manalili (1990), "the best entry plan is an exit plan." The time of exit should be mutually determined by the organizer and community during a meeting for monitoring and evaluation. Indications of readiness for exit by the community organizer should include: Attainment of the set goals of the community organizing efforts, Demonstration of the capacity of the people's organization to lead the community in dealing with common problems, and People empowerment as manifested by collective involvement in decision making and community action on matters that impact their lives. During the exit phase: Organizer start exploring another community to organize While expanding to another area, the organizer stays in touch with the first community, periodically visiting as friendly consultant. **(COPAR) COMMUNITY ORGANIZING** Goals of Community Organizing 1\. People's Empowerment 2\. Building People's Organizations 3\. Improved quality of life Participatory action research (PAR) Is an approach to research that aims at promoting change among the participants. Members of the group being studied participate as partners in all phases of the research, including design, data collection, analysis, and dissemination (Brown et al., 2008). **Community Organizing Participatory Action Research (COPAR)** It is a community development approach that allows the community (participatory) to systematically analyze the situation (research), plan solution, and implement projects/programs (action) utilizing the process of community organizing. It is essentially a research project done by the community that leads to actions that improve conditions in the community. **COPAR MODEL** +-----------------------+-----------------------+-----------------------+ | **COMPONENT** | **PRACTICED COPAR** | **IDEAL COPAR** | +=======================+=======================+=======================+ | **Time frame/mode | Sometimes 8-16 | 3-6 weeks immersion | | of** | hours/week for 2-4 | | | | | 3-6 weeks duty, 8 | | **exposure** | weeks depending on | hours duty; 5-6 | | | the time allotted by | days/week | | | | | | | the school | | +-----------------------+-----------------------+-----------------------+ | **Methodology/Survey* | Use of ready-made | It will vary from the | | * | survey from the | needs of the | | | school | community | | **form** | | | | | Some use survey but | and the methodology | | | just collect data | is the surveying | | | from | | | | | participants | | | previous study | | +-----------------------+-----------------------+-----------------------+ | **Problem statement** | -Misjudging complex | After the survey and | | | problems as simple | analysis has been | | | | done | | | Problems | | | | | Problem will be | | | -Not considering the | coming from the | | | result of the survey | survey form | | | | | | | form rather pay | Any problems too big | | | attention to the | should not be | | | concern of | prioritized | | | | | | | the few individuals | | +-----------------------+-----------------------+-----------------------+ | **Implementation** | Fish effect | Fishing rod effect | | | | | | | One day program | Programs should not | | | | be a one-time affair | +-----------------------+-----------------------+-----------------------+ | **Evaluation** | Results are | Reality acceptance | | | manipulated | | | | | After evaluation, | | | No re-implementation | there must be | | | | reimplementation | | | | | | | | if needed or program | | | | must be | | | | | | | | revised depending on | | | | the result | +-----------------------+-----------------------+-----------------------+ **IMMERSION** A related learning experience program requiring student nurses to live and work within a selected remote community. Topics such as primary health care, epidemiology, environmental health, health promotion, disease prevention and management, and individual, family, and population-centered nursing will be covered. Community-based learning approach that has been further strengthened by the World Health Organization, which defines the social accountability of medical schools as "the obligation to **direct** education, research and service activities towards addressing priority health concerns of the community". Immersion of student nurses in the community raises awareness of future nurses of the health needs of the community and of the psychosocial dimensions of any health problem. (Public health perspective and an educational perspective) **GENERAL OBJECTIVES:** Prepare future nurses to be competent staff PHN **SPECIFIC OBJECTIVES:** -train future nurses to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community; -develop student nurses' leadership capabilities; -enhance their basic nursing skills and accountability to client care; -strengthen their interpersonal skills; -increase their commitment to the caring profession; and -improve their management skills with a scientifically inquisitive research-oriented mind. **COMMUNITY SELECTION CRITERIA** 1.Does the community meet the "GIDA" geographically isolated and disadvantaged area criterion of the Department of Health? 2.Do the members of the community perceive the need for assistance? 3.Does the community show signs of willingness or hostility towards thE organizer or the organizing agency? 4.Is there no obvious threat to the safety of the community organizer? 5.Are there other individuals, groups, or agencies working in the area? If so, are they using the community organizing approach? Will there be a duplication of services for the same target group? 6\. Is the partnership among all potential stakeholders (the community, the LGU, and other external agencies) possible and feasible? **References** David, E. (2007) Community Health Nursing, An Approach to Families and Population Groups. Faahb, F. R. P. M. N. A., & Anef, M. M. P. R. C. (2018). Community/Public Health Nursing: Promoting the Health of Populations, 7e (7th ed.). Saunders. Faan, S. M. P. R., & Faan, L. J. P. R. (2017). Foundations for Population Health in Community/Public Health Nursing - Binder Ready (5th ed.). Mosby. Famorca, Z. (2013)Nursing Care of the Community, Elsevier Singapore. Maglaya , A. (2004). Nursing Practice in the Community, Argonaota Corporation. Rector, C. L. (2018). Community & Public Health Nursing. Wolters Kluwer. Salvacio G & Bailon-R.(2006)Community Health Nursing. The basics of Practice Stanhope, P. D. R. N. F., Lancaster, P. D. R. N. F., Marcia Stanhope, P. D. R. N. F., & Jeanette Lancaster, P. D. R. N. F. (2015). Public Health Nursing. Elsevier Gezondheidszorg