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C. Social System
Whether assessing a communitys health, developing new services for the mentally ill within
the community, or promoting the health of the elderly, the community health nurse needs to
understand the community as a social system.
The various parts of a communitys social system that interact and influence the system are
called social system variables.
Social system variables includes:
1. Health system
2. Family system
3. Economic system
4. Educational system
5. Welfare system
6. Political system
7. Legal system
8. Communication system
Assessment for nurses means collecting and evaluating information about a communitys
health status to discover existing or potential needs as a basis for planning future action
Assessment involves two major activities: the first is collection of pertinent data, and the
second is analysis and interpretation of data. These actions overlap and are repeated
constantly throughout the assessment. While assessing a communitys ability to enhance its
health, the nurse may simultaneously collect data on community lifestyle behaviors and
interpret previously collected data on morbidity and mortality.
Community needs assessment: is the process of determining the real or perceived needs of
a defined community.
The type of assessment depends on variables such as:
a. the needs that exist,
b. the goals to be achieved, and
c. the resources available for carrying out the study.
Although it is difficult to determine the type of assessment needed in advance, the decision
will be facilitated by understanding several different types of community assessment.
Types of community assessment includes:
1. Familiarization or windshield survey
Familiarization assessment involves studying data already available on a community,
and probably gathering a certain amount of firsthand data, to gain a working
knowledge and general understanding of the community.
Such an approach, sometimes called a windshield survey, is used by nursing
students in community assessment courses and by new staff members in community
health agencies.
Nurses drive (or walk) around the community; find health, social, and governmental
services; obtain literature; introduce themselves and explain that they are working in
the area; and generally become familiar with the community.
This type of assessment is needed whenever the community health nurse works with
families, groups, organizations, or populations.
Familiarization provides a knowledge of the context in which these aggregates exist
and may enable the nurse to connect clients with community resource.
2. Problem oriented assessment
A second type of community assessment, problem-oriented assessment, begins with a
single problem and assesses the community in terms of that problem.
The problem-oriented assessment is commonly used when familiarization is not
sufficient and a comprehensive assessment is too expensive.
This type of assessment is responsive to a particular need. The data collected will be
useful in any kind of planning for a community response to the problem.
3. Community subsystem assessment
In Community subsystem assessment, the community health nurse focuses on a single
dimension of community life.
Community subsystem assessment can be a useful way for a team to conduct a more
thorough community assessment. They could share their findings and create a more
comprehensive picture of community and its needs
4. Comprehensive assessment
Seeks to discover all relevant community health information.
A survey compiles all the demographic information on the population, such as its
size, density, and composition.
It begins with a review of existing studies and all the data presently available on the
community.
It is seldom performed because it is an expensive, time-consuming process
5. Community assets assessment
The final form of assessment presented here is assets assessment, which focuses on
the strengths and capacities of a community rather than its problems.
The assets assessment begins with what is present in the community. The capacities
and skills of community members are identified, with a focus on creating or
rebuilding relationships among local residents, associations, and institutions to
multiply power and effectiveness.
It helps to access the group of underprivileged people who are unable to use the available
facilities due to poverty, prevailing discriminations or other reasons.
It helps to find the real problems of the community people which might not have perceived
by them as problems.
It helps to impart knowledge and attitudes to turnover peoples problems towards the light of
solution.
Community analysis is the process of examining data to define needs strengths, barriers,
opportunities, readiness, and resources. The product of analysis is the community profile.
To analyze assessment data is helpful to categorize the data. This may be done as following:
Demographic
Environmental
Socioeconomic
Health resources and services
Health policies
Study of target groups.
Community Diagnosis is done using a tool called "Health Indicators" which are the variables
used for the assessment of community health. Indicators must be valid, reliable, sensitive,
specific, feasible and relevant.
Health indicators can be classified as:
1
Mortality indicators
2
Morbidity indicators
3
Disability rates
4
Nutritional status indicators
5
Health care delivery indicators
6
Utilization rates
7
Indicators of social and mental health
8
Environmental indicators
9
Socio-economic indicators
10
Health policy indicators
11
Indicators of quality of life
12
Other indicators
SOURCES of data in the conduct of community diagnosis:
1. PRIMARY DATA---source would be the community people through
Surveys
Interviews
Focused group discussions
Observations
Actual minutes of community meetings
2. SECONDARY DATA
Organizational records of the program
Health center records
Other public records
How to conduct community diagnosis?
The process of community diagnosis involves four stages:
1. Initiation
2. Data collection and analysis
3. Diagnosis
4. Dissemination
I.
II.
Initiation
In order to initiate a community diagnosis project, a dedicated committee or working
group should be set up to manage and coordinate the project. The committee should
involve relevant parties such as government departments, health professionals and nongovernmental organisations.
At an early stage, it is important to identify the available budget and resources to
determine the scope of the diagnosis. Some of the common areas to be studied may
include health status, lifestyles, living conditions, socioeconomic conditions, physical and
social infrastructure, inequalities, as well as public health services and policies.
Once the scope is defined, a working schedule to conduct the community diagnosis,
production and dissemination of report should be set.
Data collection and analysis
The project should collect both quantitative and qualitative data. Moreover, Population
Census and statistical data e.g. population size, sex and age structure, medical services,
public health, social services, education, housing, public security and transportation, etc.
can provide background of the district. As for the community data, it can be collected by
conducting surveys through self-administered questionnaires, face to face interviews,
focus groups and telephone interviews.
In order to ensure reliability of the findings, an experienced organisation such as an
academic institute can be employed for conducting the study. The sampling method
should be carefully designed and the sample size should be large enough to provide
sufficient data to draw reliable conclusions. Therefore, study results derived can truly
review the local community.
Collected data can then be analysed and interpreted by experts. Here are some practical
tips on data analysis and presentation:
- statistical information is best presented as rates or ratios for comparison
- trends and projections are useful for monitoring changes over a time period for future
planning
- local district data can be compared with other districts or the whole population
- graphical presentation is preferred for easy understanding
III.
Diagnosis
Diagnosis of the community is reached from conclusions drawn from the data analysis. It
should preferably comprise three areas:
- health status of the community
- determinants of health in the community
- potential for healthy city development
IV.
Dissemination
The production of the community diagnosis report is not an end in itself, efforts should be put
into communication to ensure that targeted actions are taken. The target audience for the
community diagnosis includes policy-makers, health professionals and the general public in
the community.
The report can be disseminated through the following channels:
- presentations at meetings of the health boards and committees, or forums organised for
voluntary organisations, local community groups and the general public
- press release
- thematic events (such as health fairs and other health promotion programmes)