GROUP-3-CHN-REPORTING PDF

COMMUNITY HEALTH NURSING MANIFESTING CHAPTER 6 RN 2026! NURSING PROCESS IN THE CARE OF THE COMMUNITY This presentation is prepared by Group 3. OBJECTIVES: Determine the tools for community assessment; Understand the methods for...

COMMUNITY HEALTH NURSING MANIFESTING CHAPTER 6 RN 2026! NURSING PROCESS IN THE CARE OF THE COMMUNITY This presentation is prepared by Group 3. OBJECTIVES: Determine the tools for community assessment; Understand the methods for presenting community data and its purposes; Keep in mind the importance of communicating community data; Utilize the nursing process in managing community health concerns; Enumerate approaches and tools in assessing community health status; and Identify models of planning for community health problems.  Assessing Community 1 Health 2 Community Diagnosis Planning Community 3 Health Interventions AGENDA 4 Planning Models in Community Health Interventions Implementing 5 Community Health Interventions ASSESSING COMMUNITY HEALTH Community assessment is an essential process for understanding the community, identifying its needs and weaknesses, and assets or strengths that are useful to achieve healthy communities. supports the actions of the community health nurse in planning and implementing interventions refers to a state, tribal, local, or barangay health assessment that identifies key health needs and iss  TOOLS FOR COMMUNITY ASSESSMENT Key point: In community health practice, the community itself is the primary source of data. PRIMARY DATA SECONDARY DATA Data that have not been gathered Data taken from existing data sources. before. This may facilitate collection of primary Collected by the nurse through: data. Observation This consists of the following: Ocular/Windshield survey vital registries Participant observation health records and reports Survey disease registries; and Informant interview publications Community forum Focus group discussion OBSERVATION 1 Ocular or Windshield survey Rapid observation of a community may be done. This gives the nurse the chance to observe: people, environmental conditions, and existing community facilities / resources. 2 Participant observation A purposeful observation of formal and informal community activities by sharing, if possible, in the life of the community. It helps the nurse in determining community values, beliefs norms, priorities, concerns, and power or influence structures (Hunt, 2009; Stanhope and Lancaster, 2010). community organizing participatory action research SURVEY CONS: Time consuming & expensive Necessary when there is no available information. This comprises a series of questions for systematic collection of information; may be written or oral (Maurer and Smith, 2009). For example: Findings from a comprehensive assessment show the need for nutritional assessment of the young children in a particular community. With this, the nurse conducted a survey through purposive sampling. Give-and-take type of data collection INFORMANT INTERVIEW This is a purposeful talk with either key informants or ordinary members of the community. The interview may be structured or unstructured. Used with skill, informant interviews can give the nurse valuable information (Lundy and Janes, 2009).  COMMUNITY FORUM It is an open meeting of the members of the community (Lundy and Janes, 2009). Pulong-pulong sa barangay It is an effective tool in providing the people with a medium for expressing their views and developing their capacity to influence decision makers. In setting this event, the nurse will serve as a coordinator. Besides data gathering, the community forum may also be used as a venue for informing the people about secondary data, for data validation, and for getting feedback.  SMALLER; SIMILAR; FOCUS SPECIFIC GROUP A focus group differs from a community forum; usually 6-12 members only (Maurer and Smith, 2009). Its membership is more homogenous. If used properly, this method is effective in the assessment of health needs of specific groups in the community (Lundy and Janes, 2009). VITAL REGISTRIES Act 3753 - established the civil registry system in the philippines and requires the registration of vital events such as births, marriage, and deaths. Republic Act 7160 (Local Government Code) - assigned the function of civil registration to local governments and mandated the appointment of Local (City/Municipality) Civil Registrars The National Statistics Office serves as the central repository of civil registries and the NSO Administrator and the Civil Registrar General of the Philippines before 2014 VITAL REGISTRIES Philippine Statistics Authority (PSA) by virtue of Republic Act 10625 otherwise known as "Philippine Statistical Act of 2013" the birth of a child and should be registered within 30 days registration of death shall be made within 30 days Presidential Decree 856 - requires death certificate before burial of the deceased  HEALTH RECORDS AND REPORTS Field Health Service Information System (FHSIS) - specified by Executive Order No. 352, is the official recording and reporting system of the Department of Health and is used by Philippine Statistics Authority to generate health statistics FHSIS records are kept in Barangay Health Station (BHS) or Rural Health Unit (RHU). Reports consist of summary data that are transmitted or submitted monthly, quarterly or annually  HEALTH RECORDS AND REPORTS The FHSIS is therefore a basis for (1) priority setting by local governments (2) planning and decision-making at different levels (barangay, municipality, district, provincial, and national) (3) monitoring and evaluating of health program implementation  DISEASE REGISTRIES Disease Registry is the listing of persons diagnosed with specific type of disease in a defined population The Department of Health has developed strategies for HIV/AIDS and chronic noncommunicable diseases, particularly cancer, diabetes mellitus, chronic obstructive pulmonary disease and stroke CENSUS DATA A Census is a periodic governmental enumeration of the population Batas Pambansa Blg. 72 provides national census of the population and other related data in the Philippines every 10 years. Executive Order No. 352, enumeration of the population through census has become every 5 years There are two methods : de jure - based on legally established place of residence of the people de facto - according to the physical location of the people METHODS TO PRESENT COMMUNITY DATA Depending on the context and the purpose of the presentation, community data may be presented as text, in tables, or in pictorial form such as maps and graphs. SHOW DIFFERENCES OR SIMILARITIES ACROSS GEOGRAPHIC AREAS (UNITED NATIONS ECONOMIC COMMISSION, 2009A). METHODS TO PRESENT COMMUNITY DATA Numeric data are usually more clearly presented through tables and graphs or charts. BAR GRAPH LINE GRAPH PIE CHART SCATTER PLOT OR DIAGRAM  GRAPHS FOR PRESENTING COMMUNITY DATA BAR GRAPH LINE GRAPH To compare values across different To have a visual image of trends in categories of data. data over time or age. For example, a population pyramid that AppropriateSECONDARY for time series. is made up of two horizontal bar For example, DATA the trend of the total graphs. fertility rate per woman in the Data taken from existing data sources. Philippines from 1978 to 2016. This may facilitate collection of primary data. This consists of the following: Vital registries Health records and reports Disease registries Publications  GRAPHS FOR PRESENTING COMMUNITY DATA PIE CHART SCATTER PLOT OR To show the percentage distribution DIAGRAM or composition of a variable. To show correlation between two variables; SECONDARY highlighting the value of a group in an x-axis and a y-axis. relation to the whole population; DATA usually not more than six categories. Data taken from existing data sources. This may facilitate collection of primary data. This consists of the following: Vital registries Health records and reports Disease registries Publications PURPOSES OF COMMUNICATING COMMUNITY DATA: Community data are presented to the health team and the members of the community for the following purposes: To inform the health team and members of the community of existing health and 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. PURPOSES OF COMMUNICATING COMMUNITY DATA: To validate findings. To allow for a wider perspective in analysis of data. To provide a basis for better decision making  8 STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT Step 1: Identify and engage Step 2: Define the community stakeholders. The nurse and the Is the community rural or urban? If it is community health needs assessment a rural community, is it semirural where team identify the population group to environmental sanitation is a problem? be included in the study. Will it be the If it is an urban community, is it total population in the community or semiurban where over congestion is focused on a specific population overlooked? group like 0 to 6 years old children? At this point in time, dengue is prevalent all over the country. Have this as a priority.  8 STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT Step 4: Select priority community Step 5: Document and health issues communicate This step is The team determines which problem done through community is of importance to the community, level of awareness, ability to reduce assembly where all community risks, and how much will it costs, health concerns are presented ability to identify the target and how they will act on those population and availability of concerns. resources.  8 STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT Step 3: Collect and analyze data What are the appropriate data to be collected? Are these data primary or secondary? The nurse and the community health needs assessment team decide based on the timeliness of data, completeness, accuracy, precision, relevance, and adequacy. After data collection, analysis is done by sorting, classifying or grouping data in terms of relatedness and interpreted for any significance. The urgency of the problems can be compared with standard values and norms.  8 STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT Step 6: Plan improvement Step 7: Implement strategies The team improvement plans encourages all active All community members, as community members to come much as possible, must be together and identify involved headed by their active strategies to reduce/solve members. The team facilitates the implementation. their health concerns.  8 STEPS TO COMMUNITY HEALTH NEEDS ASSESSMENT Step 8: Evaluate progress The team and the community as well determine whether the objective sets were implemented as planned. How much resources (time, money, effort, facilities) were utilized for the execution of the plan.  COMMUNITY DIAGNOSIS Community diagnosis is the process of determining the health status of the community and the factors responsible for it. The term is applied both to the process of determination and to its findings (WHO, 2004) It is a quantitative and qualitative description of the health of citizens and the factors that influence their health. Community diagnosis allows identification of problems and areas of improvement, thereby simulating action (WHO, 1994). COMMUNITY DIAGNOSIS Shuster and Goepingger (2004) proposed a practical adaptation of a format of nursing diagnoses for population groups previously presented by Green and Slade (2001). The three-part statement consists of: a.) the health risk or specific problem to which the community is exposed b.) the specific aggregate or community with whom the nurse will be working to deal with the risk or problem c.) related factors that influence how the community will respond to the health risk or problem COMMUNITY DIAGNOSIS  THE OMAHA SYSTEM A comprehensive and research- based classification system for client problems that exists in the public domain, meaning it is not held under copyright. It is has been used as a framework for the care of individuals, families, and communities by nurses, nursing educators, physicians, and other health care providers.  THE OMAHA SYSTEM The classification system has The first component of the Omaha three components that are to be classification system is a problem used together: classification scheme (client a problem classification assessment), which serves as a scheme guide in collecting, classifying, an intervention scheme analyzing, documenting, and communicating health and health- a problem rating scale for related needs and strengths. outcomes  THE OMAHA SYSTEM The identified problems or areas of concern are classified in four levels: 1. The first and most general 2. The second level consists of level of classification is problems or areas of concern composed of four domains: under the four domains. environmental, psychosocial, physiological, health-related behaviors  THE OMAHA SYSTEM The identified problems or areas of concern are classified in four levels: 3. In the third level, the problem or 4. The fourth and most specific area of concern is classified level is made up of clusters of according to two sets of qualifiers. signs and symptoms that describe First, the area of concern is actual problems. categorized into health promotion, potential problem, or actual problem. Then, the level of clientele (individual, family, or community) involved is identified.  SOCIAL DIAGNOSIS - represents the impact of the health problem in terms of the overall quality of life of the people in the community. Example of indicators of the extent of social problems present in a community or a population group include: Drug abuse Green and Kreuter (1980), Teenage pregnancy looks at quality of life as a Illegitimacy School dropouts subjectively defined problem Out of school youth of individuals or communities. Traffic congestions Transportation crisis Absenteeism Overcrowding Children in conflict with the law  SOCIAL DIAGNOSIS - represents the impact of the health problem in terms of the overall quality of life of the people in the community. Further, the social diagnosis is described as to the following: Prevalence of the problem-is the problem rampant in the community? In community and public health Population affected by the problem-is nursing practice, community the problem affecting the schoolers, diagnosis is more commonly used adolescents, or young adults? Prognosis of the problem-is the than the social diagnosis approach. problem serious that needs immediate attention? Implications due to the quality of life, economic, and healthcare costs.  PLANNING COMMUNITY HEALTH INTERVENTIONS It is based on the findings during assessment and formulated nursing diagnoses. Planning is a logical process of decision-making. It involves priority setting, formulating goals and objectives, and identifying community interventions. Dealing with community health concerns require active participation of the people. PRIORITY SETTING It provides logical means of establishing priority among the identified health concerns. THE WORLD HEALTH ORGANIZATION (WHO) SUGGESTED A CRITERIA TO DECIDE ON A COMMUNITY HEALTH CONCERN FOR INTERVENTION: Significance of the problem is based on the number of people affected by the problem or condition. The level of community awareness and the priority its members give to the health concern is also a major consideration. Ability to reduce risk is related to the availability of expertise among the health team and community itself. THE WORLD HEALTH ORGANIZATION (WHO) SUGGESTED A CRITERIA TO DECIDE ON A COMMUNITY HEALTH CONCERN FOR INTERVENTION: In determining the cost of reducing risk, the nurse has to consider economic, social, and ethical requisites and consequences of planned actions. Ability to identify the target population for the intervention is a matter of availability of data sources. Availability of resources to intervene in the reduction of risk entails technological, financial, and other material resources of the community, the nurse, and the health agency. Priority-setting process requires the joint effort of the community, the nurse, and other stakeholders. Shuster and Goeppinger (2004) suggested a flexible process using the nominal group technique wherein each group member has an equal voice in decision making, thereby avoiding control of the process by the more dominant member(s) of the group. This technique is appropriate for brainstorming and ranking ideas and making a choice based on the opinion of the majority. The group makes a list of the identified community health problems or conditions. Each of the identified problems is treated separately according to a set of criteria agreed upon by the group. For a scale of 1 to 10, 1 being the lowest, the members give each 1 criterion a weight based on their perception of its degree of importance in solving the problem. From a scale of 1 of 10, 1 being the lowest, each member rates the 2 criteria in terms of the likelihood of the group being able to influence or change the situation. Collate (collect and combine) the weighs (from step 1) and ratings 3 (from step 2) made by the members of the group.  Compute the total priority score of the problem by multiplying 4 collated weight and rating of each criterion. 5 The priority score of the problem is calculated by adding the products obtained in step 4. After repeating the process on all identified health problems, compare the total priority scores of the problems. The problem with the highest total priority score is assigned top priority FORMULATING GOALS AND OBJECTIVES Goals are the desired outcomes at the end of interventions, whereas objectives are the short-term changes in the community. Objectives serve as instructions, defining what should be detected in the community as interventions are being implemented. Objectives should be SMART (Specific, Measurable, Attainable, Relevant, and Time-bound). DECIDING ON COMMUNITY INTERVENTIONS What may work for one community may not be effective in another. The group analyzes the reasons for people’s health behavior and directs strategies to respond to the underlying causes. In the process of developing the plan, the group takes into consideration the demographic, psychological, social, cultural, and economic characteristics of the target population on one hand and the available health resources on the other hand. PLANNING MODELS IN COMMUNITY HEALTH INTERVENTIONS Many planning programs to address public health problems began as environmental planning of water and sewer systems. Population-based planning became necessary with the advent of immunizations. (Issel, 2014) PLANNING MODELS IN COMMUNITY HEALTH INTERVENTIONS Blum (1974) was the first to suggest how public health planning should be done. From systematic problem solving and an epidemiological approach to a social awareness approach. In mid-1980s CDC began to develop models for health planning in public health. PRECEDE-PROCEED MODEL provides structure for assessing health and quality needs assists in designing, implementing, and evaluating health promotion and public health programs to meet those needs PRECEDE-PROCEED MODEL PRECEDE (Predisposing, Reinforcing, and Enabling Constructs Educational Diagnosis and Evaluation) assesses diagnostic and planning process to assist in the development of focused public health programs. PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) guides the implementation and evaluation of the programs. (Greem & Kreuter, 2005) PRECEDE-PROCEED MODEL PRECEDE-PROCEED framework examines factors contributing to behavior change. They are: Predisposing factors: Knowlege, attitudes, behavior, beliefs, and values before intervention that affect willingness to change. Enabling factors: Environment or community of an individual that presents obstacles to change. Reinforcing factors: Positive or negative effects of adapting new behavior. (Greem & Kreuter, 2005)  PATCH MODEL The Planning Approach to Community Health This model encourages the idea that health promotion is a process that enables the population to have more control over it's own health. Community Participation - essential element of PATCH Model  Use of data to develop comprehensive health strategies.  PATCH The Planning Approach to Community Health model achieved this through: mobilizing the community collecting health data selecting health priorities developing a comprehensive intervention plan evaluating process (Issel, 2014)  APEX-PH PROGRAM The Assessment Protocol for Excellence in Public Health Voluntary process for organizational and community self- assessment, planned improvements and continuing evaluation and reassessment. It is a true self-assessment and is intended to be more of a public endeavor involving the community as well as the public organization (CDC, 2009) MAPP MODEL MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS - mobilize the community released by CDC and NACCHO health planning model that helps public health leaders facilitate - guide the community toward a share facilitate community priorities vision for long-range planning about health issues and identify - conduct the for assessments sources to address them. a. identifying community strengths b. local health systems c. health status d. forces of change within the population (NACCHO, 2017) PLANNING STRATEGIES FOR COMMUNITY HEALTH INTERVENTIONS Planning strategy is a discipline process aimed at producing fundamental decisions and actions that will shape and guide what an organization is, what it does, and why it does. (Public Health Accreditation Board) PLANNING STRATEGIES FOR COMMUNITY HEALTH INTERVENTIONS Its overall goal is to enhance community access to healthcare in order to improve productivity and thus reduce poverty, hunger, and child and maternal deaths; and to improve education performance across all stages of the life cycle. 5 STEPS STRATEGY TO PLANNING Determine Identify what is Define what you where you are. important. must achieve. Determine who Review. is accountable.  IMPLEMENTING COMMUNITY HEALTH INTERVENTIONS The entire process is intended to enhance the community's capability in dealing with common health conditions/problems. The nurse's role therefore may be to facilitate the process rather than directly implement the planned interventions. Implementation also entails coordination of the plan with the community and the other members of the health team. EVALUATION Structure evaluation involves looking into the manpower and physical resources of the agency responsible for community health interventions. Process evaluation is examining the manner by which assessment, diagnosis planning, implementation, and evaluation were undertaken. Outcome evaluation determining the degree of attainment of goals and objectives. Ongoing evaluation or 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 and outcomes of interventions.  STANDARD OF EVALUATION Utility is the value of the evaluation in Feasibility answers the question of terms of usefulness of results. The whether the plan for evaluation is evaluation of community health doable or not, considering available interventions will be of great use to the resources. Resources include community health group (the nurse, other facilities, time, and expertise for members of the health team, and the conducting the evaluation. Feasibility community representatives), as it helps entails anticipation of how the the group gain insight into strengths and weaknesses of the plan and the manner of results of the evaluation will be its implementation. This will provide a received by different groups and basis for utilizing the community health how to avoid possible misuse of the process in dealing with other community data derived from the process. concerns in the future. (Community Toolbox, 2013)  STANDARD OF EVALUATION Propriety involves ethical and legal Accuracy refers to the validity and matters. Respect for the worth and reliability of the results of evaluation. dignity of the participants in data Accurate evaluation begins with collection should be given due accurate documentation while the consideration. The results of community health process is evaluation should be truthfully ongoing.(Community Toolbox, 2013). reported to give credit where it is due and to show the strengths and weaknesses of the community. (Community Toolbox, 2013). CLINICAL EXAMPLE: Francis is a public health nurse from the Rural Health Unit 2 of the Municipality of Plaridel, in Bulacan. He was assigned to Barangay Sipat Health Station. During the first six months of his stay in the community, he noticed that animal bites among children are a common problem encountered weekly in the clinic. He checked the record for the past years and realized that it has been a perennial concern of the Barangay. CLINICAL EXAMPLE: Assessment-gathers information about the patient’s health status, including physical, psychological, and social factors. Identifies the patient’s needs and sets priorities for care. Planning-should be based on the patient’s health problems and needs, as well as the resources available. Implementation-After three months of coordinating with various agencies. After six months, a significant reduction in the number of cases of animal bites has been documented and people in the community showed compliance to the local ordinance on responsible pet ownership.  THANK YOU FOR LISTENING!