Community Health Nursing Process PDF

MODULE 4 - UNIT IV COMMUNITY HEALTH NURSING PROCESS mmmvsosing  UNIT IV COMMUNITY HEALTH NURSING PROCESS mmmvsosing  UNIT IV. A COMMUNITY HEALTH ASSESSMENT  ASESSING COMMUNITY HEALTH NEEDS The CHN needs to get to know the defining characteristi...

MODULE 4 - UNIT IV COMMUNITY HEALTH NURSING PROCESS mmmvsosing  UNIT IV COMMUNITY HEALTH NURSING PROCESS mmmvsosing  UNIT IV. A COMMUNITY HEALTH ASSESSMENT  ASESSING COMMUNITY HEALTH NEEDS The CHN needs to get to know the defining characteristics of a community in order to have a clear picture of the community The CHN needs to understand the different aspects that directly & indirectly influence the health status of the community. These community characteristics are used for planning & developing specific programs & in ensuring the effective delivery of health care services. COMMUNITY HEALTH ASSESSMENT TOOLS  COMMUNITY HEALTH ASSESSMENT TOOLS 1. COLLECTING PRIMARY DATA A. Observation B. Survey C. Informant interview D. Community forum / Focused group discussion COLLECTING PRIMARY DATA 1. Observation – ocular or windshield survey. - Observe people – state of health of vulnerable groups (young, elderly, pregnant) - Observe environmental condition – terrain, housing density, cleanliness, vegetation, street animals - Observe community resources – health facilities and other subsystems of the community - Participant observation – observation of formal/informal community activities by sharing in the life of the community to determine community values, beliefs, norms, priorities, concerns, & power structures - E.g. formal - community assemblies, school, church meetings. informal – community gatherings in sari - sari store, water wells, plaza, recreational facilities. 2. Survey – systematic collection of information through made up series of questions from a sample of individuals, families or communities that may be written or oral. - Ideal for comprehensive assessment - Purposive sampling is indicated in a problem – oriented assessment where the sample population consists of the population susceptible to the problem being studied. - Survey is also suitable for determining community attitudes, knowledge, health behaviors, & perceptions of health & health services. - Survey provides opportunity for making community members become more aware of community problems and their effects and what can they do about it. 3. Informant interview – purposeful talks with either key informants or ordinary members of the community Key informants – consists of formal & informal community leaders or persons of position and influence. 4. Community forum – open meeting of the members of the community. E.g. pulong – pulong sa barangay 5. Focus group discussion (FGD) – consists of smaller group of 6 – 12 members with similar socio-cultural or health conditions. E.g. group of first – time mothers 2. COLLECTING SECONDARY DATA A. Registry of Vital Events B. Health Records & Reports C. Disease Registries D. Census Data  COLLECTING SECONDARY DATA 1. Registry of vital events – ( lists of births, marriages, and deaths) NSO/PSA Local Civil Registrar 2. Health records and reports Field Health Service Information System (FHSIS) – official recording & reporting system of DOH. – used to generate health statistics - Used to generate health status of people at diff. levels - It is the basis for : a. Priority setting by local governments. b. Planning & decision – making at diff. levels (Brgy., municipality, dist., provincial, & nat’l.) c. Monitoring & evaluating health program implementation. FHSIS – composed of recording & reporting tools. Records are facility based. Kept at BHS or RHU. Contain day – to – day account of activities of Health workers & Services delivered to clients. Records are basis of Reports Reports consists of summary data that are transmitted or submitted monthly, quarterly, or annually to higher level. From BHS to RHU to Provincial Health Office to Regional Health Office.  The FHSIS Manual of Operations lists of recording tools: 1. The Individual ttt record (ITR)– 1st building block of FHSIS. Contains the date, patient’s name, address, presenting symptoms, diagnosis, date & name of ttt. 2. Target Client List (TCL) -2nd building block of FHSIS. It serves to: a. plan & carry out patient care & service delivery to monitor target or eligible popn. for particular health service. b. facilitate monitoring & supervision of service delivery activities. c. report delivered services d. provide a clinic – level database for further studies  TCL s maintained in RHUs & Health Centers 1. TCL Prenatal Care 2. TCL Postpartum Care 3. TCL Under 1 year old children 4. TCL Family Planning 5. TCL Sick Children 6. National Tuberculosis Program TB Register 7. National Leprosy Control Program Central Registration Form 3. The Summary Table - accomplished by midwives. Kept at BHS. Has 12 columns to correspond the 12 mos. of the year. 2 components: 1. Health Program Accomplishment - a tool for assessment os accomplishments & a ready source of reports 2. Monthly summary of Morbidity /Diseases – gives information on monthly trend of diseases & source of 10 leading causes of morbidity in the municipality The Summary Table – is also a source for any survey or research. 4. The Monthly Consolidation Table (MCT) – done by the Nurse based on the Summary Table. Serves as the source document for the Quarterly Form & the Output Table of the RHU.  The FHSIS Manual of Operations lists of reporting forms: 1. Monthly Forms – prepared by midwife & submitted to the Nurse a. Program Report (M1) contains indicators categorized as maternal care, child care, family planning, & disease control. The midwife copies the data from the Summary Table. b. Morbidity Report (M2) contains a list of all cases of disease by age & sex. 2. Quarterly Forms – prepared by the Nurse. There should only be one quarterly form for the municipality or city. Consolidation must be done if there are more than 1 RHU Quarterly Form components: a. Program Report (Q1) – contains 3 month total of indicators categorized as maternal care, family planning, child care, dental health , & disease control. b. Morbidity Report (Q2) – 3 month consolidation of Morbidity Report (M2) Annual Forms: c. A – BHS – report done by midwife that contains demographic, environmental, & natality data. d. Annual Form 1 (A – 1) done by the Nurse. Report of the RHU or health center. Contains demographic & environmental data, & data on natality & mortality for the entire year. c. Annual Form 2 (A – 2) – prepared by the nurse, the yearly morbidity report y age and sex. d. Annual Form 3 (A – 3) – prepared by the nurse, the yearly report of all deaths (mortality) by age and sex. 3. Disease Registries – DOH registries for HIV/AIDS & Chronic non - communicable diseases (Ca; DM; COPD; & stroke) the Renal Disease Control Program manages the Philippine Renal Disease Registry by NKTI. 4. Census Data Census – periodic governmental enumeration of the population. Batas Pambansa Blg. 12 (1980)provides for a national census of population & other related data in the Philippines every 10 yrs. The Philippine Statistical System (PSS) provides statistical information & services to the public. The NSO/PSA generates general purpose statistics: population, employment, prices, and family income & expenditures. Census data is accessible at then NSO/PSA website http://www.census.gv.ph PRESENTING COMMUNITY DATA PURPOSES OF PRESENTING COMMUNITY DATA To inform the health team & community members of existing health & health related problems in the community in an easily understandable manner. To make members of the community appreciate the significance & relevance of health information in their lives. To solicit broader support & 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. METHODS USED TO PRESENT COMMUNITY DATA Community data may be presented as texts, Tables, Pictorial forms – maps & graphs Maps are used to show similarities or differences across geographic areas. Numeric data are clearly presented through tables, graphs, charts. GRAPHS & USES FOR PRESENTING COMMUNITY DATA BAR GRAPH – to compare values across different categories of data. E.g. population pyramid is made up of 2 horizontal bar graphs representing the age structure of male & female population. LINE GRAPH – to have a visual image of trends in data over time or age. This is appropriate for time series. E.g. trend of total fertility rate or average number of children per woman in the Philippines from 1973 - 2010  PIE CHART – to show percentage distribution or composite of a variable such as population or household. 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 of not more than six (6) E.g. a pie chart to visually represent the percentage distribution of household based on environmental variables like water source, methods of refuse disposal, SCATTER PLOT OR DIAGRAM – to show correlation between 2 variables. The values of both variables in subject are plotted in a graph with an X – axis & Y – axis. E.g. a positive correlation between body mass index & waist circumference among men aged 18 years and above. Thank you