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The Community Health Nursing Process

Maureen A. Bawang, MPH, RN Faculty, College of Nursing

Community needs assessment

is the process of determining the real or perceived needs of a defined community.

One goal of a community nurse when working with

families or groups is to encourage people to participate and take responsibility for their own health care.
Community self-care is community health nursing's goal.

Components of Community Needs Assessment


1. Health Status Problem
-

Described in terms of increased and decreased morbidity, mortality, fertility or reduced capability for wellness.

2. Health Resources Problem - described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems. 3. Health-related Problems - described in terms of existence of social, economic, environmental and political factors that aggravate the illnessinducing situations in the community.

Community Diagnosis
Also called Community Assessment or Situational

Analysis. Consists of collecting, organizing, synthesizing, analyzing & interpreting health data.
Nurse Collects Data Community Health Nursing Diagnosis
Analyse/Seek explanations Bases for developing Community Health Nursing Interventions & Strategies

Types of Community Diagnosis


1. Familiarization or "Windshield Survey":
Familiarization assessment involves studying data already

available on a community, and gathering a certain amount of firsthand data, to gain a working knowledge of the community. Such an approach, sometimes called windshield survey is used 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.

2. Problem-Oriented Diagnosis:
begins with a single problem and assesses the community

in terms of that problem. Spradley (1990) described is as type of assessment that responds to a particular need. E.g. Health problems in the community resulting from mine
tailings being disposed into the river systems by a mining company. Nurse proceeds with identification of the population who were affected by the hazards.

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. Comprehensive Community Diagnosis:


Comprehensive assessment seeds to discover all relevant

community health information.


Aims to obtain a general information about the

community.
A survey compiles all the demographic information,

socio-economic cultural information, health & illness patterns, health resources, political and leadership patterns.

Key informants are interviewed in every major system

education, health, religious, economic, and others.


Then, more detailed surveys and intensive interviews are

performed to yield information on organizations and the various roles in each organization.

Because comprehensive assessment is an expensive, time-

consuming process, and waste of resources, it is seldom performed.


Performing a more focused study based on prior

knowledge of needs is often a better strategy.

STEPS IN CONDUCTING COMMUNITY DIAGNOSIS


1. Determining the Objectives
- nurse decides on the scope of the data she needs to gather.

2. Defining the Study Population


- nurse identifies the population group to be included in the study. 3. Determining the Data to be Collected - nurse identifies the specific data to collect. - Nurse decides on the sources of these data (data available from agency records, or from people themselves).

4. Collecting Data - different methods may be utilized to generate health data. Methods to Collect Data A. Record Review B. Survey and observations C. Interviews D. Participant observation - nurse actively participate in the life of the community.

5. Developing the Instrument - instruments or tools facilitate the nurses datagathering activities. Most Common Instruments a. Survey Questionnaire b. Interview guide c. Observation Checklist

6. Actual Data Gathering Guidelines: 1. Meet the people who will be involved in the data collection. 2. Instruments may be modified or simplified. 3. Data Collectors must be given an orientation and training on how to use the instruments in data gathering. 4. Nurse must supervise data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected.

7. Data Collation - putting together all the information. - either numerical data (counted) or descriptive data (described). E.G Common Illnesses N=150 Numerical Data
Respiratory Infections
Heart Disease Acute Gastritis Dengue Fever

105
5 15 25

Descriptive Data: Itogon, Benguet


Generally inhabited by Ibalois, Itogons main source of livelihood is mining. Secondary to mining is agriculture.

8. Data Presentation Descriptive data presented in narrative reports. e.g. geographic data, history of the community Numerical Data presented in a table or graphs. - easier to show comparisons including patterns and trends.

9. Data Analysis - determining the interrelationship of factors, significance of the problems and their implications on the health status of the community.
10. Identifying the Community Health Nursing Problem 11. Priority-Setting a) Nature of the problem classified by the nurse as health status, health resources, health-related problems. b) Magnitude of the problem refers to the severity of the problem which can be measured in terms of the population affected by the problem.

c) Modifiability of the Problem - refers to the probability of reducing, controlling or eradicating the problem. d) Preventive Potential - refers to the probability of controlling or reducing the effects posed by the problem. e)Social Concern - refers to the perception of the population to the problem or readiness to act on the problem.
Scoring: page 170 Nursing Practice in the Community by Arcelli Maglaya

Sources of Community Data


There are many places the community health nurse can

look for data to enhance and complete a community assessment. Data sources can be primary or secondary, and they can be from international, national, state, or local sources. Web sites for many primary and secondary data sources are included at the end of this chapter.

What is a Healthy Community?


The following descriptors can serve as a guide for assessing a healthy community. The healthy community:
1. 2.

Is one in which members have a high degree of awareness that "we are a community". Uses natural resources wisely while taking steps to conserve them for future generations.

3. Openly recognizes the existence of subgroups and

welcomes their participation in community affairs. 4. Is prepared to meet crises. 5. Is a problem-solving community; it identifies, analyzes, and organizes to meet its own needs.

6. Has open channels of communication that allow

7. 8. 9. 10.

information to flow among all subgroups of citizens in all directions. Seeks to make each of its systems' resources available to all members of the community. Has legitimate and effective ways to settle disputes that arise within the community. Encourages maximum citizen participation in decisionmaking Promotes a high level of wellness among all its members.