The Community Health Nursing Process

Presented by: Kumboyono

Sept 2008

Setting for community health nursing practice

homes ambulatory service settings schools occupational health setting residential institutions the community at large

Community Level

Aggregate Level

Individual or Family Level

Example: Levels of community health nursing practice

Meeting the Needs of Community or Aggregates Aggregates at risk across life span
Aggregates at vulnerable conditions

Examples of Populations with Population-Health Issues

Elderly persons with ongoing chronic conditions who need a broad range of services to maintain their independence in the community Persons who drink well water All families with newborns All children with asthma Sexually active teenagers Persons who drink and drive

(Administrator: CHN Specialist/ Top Manager)

Community Focus

(CHN Specialist/ Middle Manager)

Staff (Generalist/ Lower Manager)

Individual and Family Focus

Practice Focus

Comparison of components of specialist and generalist levels of practice

Components of Practice Focus of Practice CHN Specialist Communities and populations Advanced practice Models Community assessment, program planning, program implementation, and program evaluation Generalist Individuals and families Comprehensive care of individuals and families Assessing, diagnosing, planning, intervening, and evaluating

Practice Models

Processes

The Community Health Process: Using The Model

Figure 1. Community as Partner (Anderson & McFarlane, 2001)

Community Health Assessment

Community as Partner Model: Assessment Wheel Core :
- Demographics - Beliefs - Values - History

8 subsystems:
- Physical environment
- Safety & transportation - Health & social services - Economics - Education - Politics & government - Communication - Recreations

Locating Sources of Data

Types of Data
Sources of Data for a Community Assessment

Methods of Data Collections

Participants Observation Winshield/Walking Survey Focus groups Key informants Surveys Literature Review etc

Data Analysis
Cognitive process of ordering data to allow for the higher-level function of synthesis (Ervin, 2002)

Data Synthesis
Combining data elements from several sources to create a coherent whole or new, complete picture of what is known or not known (Burn & Groove, 2001)

The Web of Causation

Concept that posits that effect never depend on single isolated causes but result from chains of causation in which link is the result of complex mix antecedents (MacMahon & Pugh, 1970)

Potensial peningkatan kesadaran anti rokok pada siswa SMU Pelita I Depok

Ketidakmampuan perokok mengenal diri sendiri

Harga diri rendah pada kelompok perokok

Kebutuhan akan informasi dampak negatif rokok terhadap kesehatan

Rendahnya Tingkat Pendidikan Perokok

Persepsi yang salah tentang cara mengatasi stres pada perokok

Buruknya persepsi terhadap dampak negatif merokok

Rendahnya pengetahuan tentang dampak negatif merokok

Mekanisme koping tidak efektif pada kelompok perokok

Buruknya persepsi terkena dampak negatif merokok

Ketergantungan terhadap nikotin

Resiko terjadinya penyalahgunaan napza pada kelompok perokok Rendahnya kesiapan berhenti merokok

Persepsi yang salah tentang manfaat merokok

Rendahnya niat berhenti merokok

Pengaruh pergaulan sesama perokok Mudahnya akses terhadap rokok Kerterjangkaun terhadap rokok Kebiasaan merokok di sembarang tempat

Resiko terjadinya penyakit akibat merokok pada perokok

Rendahnya dukungan keluarga dan masyarakat untuk kegiatan berhenti merokok

Resiko terjadinya paparan asap rokok pada perokok pasif

Gambar 6. The Web of Causation Pemberdayan Masyarakat di Tingkat Komunitas pada Agregat Perokok di Kelurahan Depok Tahun 2008

Community Diagnosis
Stating the conclusions drawn from synthesis of the data (Anderson & Mcfarlane, 2000; Helvie, 1998; Mucke; 1984) Statement of risk, condition, trend, potential problem, strength, or latent situation about a community or population (Watson, 1984)

Community Diagnosis
Community Diagnoses may be formulated about:
Health issues (e.g., infant mortality) Housing conditions (e.g., high lead content in interior paint) Economics conditions (e.g., 30% community residents below poverty level) Strengths (e.g., three community coalitions formed to deal with potential environmental hazards) Trends (e.g., increasing employment opportunities)

Formulating Community Diagnosis: Comparison Approaches

Approach Conclusion Description of community Characteristics of community Indicators of Conclusion

Muecke (1984)

Risk of / Presence of

Among

Related to

As demonstrated in

Anderson & McFarlane (2000)

Potential / actual health problem or concerns

Among

Related to

As demonstrated by

Example of a Community Diagnosis

Risk of death among infant born in the community related to:
12% of infants had low birth weight 24% of birth in 1998 were female 18 years of age and younger 46% of women in 1998 had inadequate prenatal care An infant mortality rate of 12 deaths per 1000 live births in 1998 Etc.

Planning
Community Diagnosis Goal/Objectives Interventions Evaluation Indicators

1. .

Goal 1: .
Objectives : 1.1. 1.2. 1.3.

1.1. 1.2. 1.3.

Structure: .. Process: Output: ... Structure: .. Process: Output: ... Structure: .. Process: Output: ...

Example of Objectives
Goal 1: to decrease deaths due to smoking among community residents Objective 1.1: to decrease the number of smokers in the worker population from 25% to 22% in two years by providing smoking cessation programs for all work sites in the county Objective 1.2: to gain commitment from onehalf of the work sites in the county to sponsor smoking cessation programs within one year

Community Health Nursing Interventions

Community Health Nursing Interventions: Systems Focused

CHN Interventions: Community Focused

CHN Interventions: Individual Focused

CHN Interventions

Example: Advocacy

Implementing
Carry out plan to the community

Evaluating
Refers to evaluation indicators at planning stage