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COMMUNITY HEALTH NURSING PROCESS INTRODUCTION: The CHNurse gets to work with different types of client in her practice

(fams, grps, subgrps or popa/communities). Each has different characteristics that the nurse must recognize. However in CHN, community is not only merely an existence of families or populations. The community is our primary client reasons: 1. It has a direct influence on the health of the indvidual, families, grps and populations 2. It is in this level that most health service provision occurs CHNurse must know the defining characteristics of a community this set the stage in understanding the different aspects that directly/indirectly affect/influence the health status of the community THE COMMUNITY DIAGNOSIS Introduction: Caring for the community starts with determining its health status. The nurse collects data in order to identify the different factors that may influence the health of the population. Then she proceeds to analyze and seek explanations for the occurrence of health needs and problems of the community. Community diagnoses are then derived and will become the bases for developing and implementing interventions and strategies. This process is called community diagnosis, community assessment or situational analysis. The health status of a cmmty is a product of the various elements population, physical/topographical characteristics, socio-economic, cultural factors, basic health services and power structure. TYPES OF COMMUNITY DIAGNOSIS Introduction: In assessment, the nurse considers the degree of detail or depth she should go into. There are times when situation calls for comprhensive assessment (general info abt the cmmnty). Oftentimes, the nurse is confronted with with specific problem (disaster) problem-oriented assessment will have to be conducted. Sometimes, she can conduct both (specific pop-comprehensive; problem -problem-oriented). It is important to decide on objectives, resources and time to implement it. I. COMPREHENSIVE COMMUNITY DIAGNOSIS aims to obtain a general information about the community. The following are the elements: A. Demogrphic Variables size, composition and geographical distribution of the population as indicated by the following; 1. Total population, geographical distribution (urban-rural), density 2. Age and sex composition 3. Vital indicators growth rate, CBR, CDR, life expectancy 4. Patterns of migration 5. Population projections

- also impt to know population grps that need special attention (indigenous people, refugees, dislocated people/evacuees) B. Socio-Ecocnomic and Cultural Variables there are no limits as to the list of socio-economic and cultural factors thath may effect the health status of the community. 1. Social indicators a. Communication network formal or informal; necessary for disseminating health info or facilitating referral of clients b. Transporitation system - road networks, accesibilty of of the people to health facilities c. Educational level may be indicative of poverty, may reflect on health perception and utilization patterns d. Housing conditions which may suggest health hazards 2. Economic indicators a, Poverty level income b. Unemployment and uneremployment c. Proportion of salaried and wage earners to total economically active populations d. Types of industries present e. Occupations common 3. Environmental indicators a. Physical/geographical/topographical characteristics: - land areas that contribute to vector problems; terrains accidents/hazards - land usage on industry; climate/season b. Water supply - % population with access to safe, adequate water supply; source c. Waste disposal -% served by daily garbage collection; % population with safe ecreta disposal system; types of disposal system d. Air, Water, Land pollution - industries with hazards 4. Cultural factors a. Variables that may break up peple into groups (ethnecity, class, language, religion, race, political orientation) b. Cultural beliefs and practices that affect health c. Concepts on health and illness C. Health and Illness patterns - nurse may collect primary data about leading causes of illness and deaths with rates of occurrence - secondary data may also be used; mortality, morbidity, infant/maternal mortality, hospital admission D. Health Resources - important element essential ingredients in DBHS; manpower, money, machineries, material 1. Manpower resources - categories, distribution, population ratio, distriburionj accdg to facilities/organization (gov't, NGO, private); polcies 2. Material resources - budget and expenditures, fundings, institutions, bed ratio, services

E. Political/leadership Patterns - vital element in achieving high level of wellness among the people. It reflects the people's potential to address health needs and problems. It also mirrors the sensitivity of the government. - power structures, attitudes of the people, conditions/events/issues that cause conflict or unification

II. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS - type of assessment that responds to particular need. The nurse proceeds with the identification of the population who were affected by the hazards/problems. Then the nurse proceeds on to characetrize the factors which are relevant to the specific problem being investigated. COMMUNITY DIAGNOSIS: THE PROCESS collecting, organizing, synthesizing, analyzing and interpreting health data before data gathering, the nurse must formulate objectives this will dictate the scope or depth of the diagnosis. STEPS IN COMMUNITY DIAGNOSIS in order to generate a broad range of useful data, cmmty dx must be carried out in an organized and systmatic manner community should take an active part in identifying community needs and problems 1. Determining the objectives - CHNurse decides on the depth and scope of the data she needs to gather - the nurse must determine the occurrence and distribution of selected conditions important to disease control and wellness promotion 2. Defining the study population nurse identifies the population group to be included in the study either entire population or specific 3. Determining the data to be collected - objectives will guide the in identifying the specific data needed, sources ( 4. Collecting the data - different methods are used depends on type of data - example: ocular survey physical/topographical characteristics; interview people health beliefs; review records a. Records review reviewing data compiled by health or non-health agencies b. Surveys and observation qualitative and quantitative c. Interviews first hand information d. Participant observation qualitative data, allowing the nurse to actively participate 5. Developing the instrument - tools - survey questionnaire, interview guide, observation checklist 6. Actual data gathering - before the actual data gathering, thenurse must meet the people instruments are discussed and analyze. It can be modified or simplified (not to overburden the

people -education or time to finish) pre-testing is highly recommended data collectors must be given orientation and trainings how to use (can do role-play) during actual data gathering nurse supervises by checking the instruments (completeness, accuracy, reliability) 7. Data collation -after collection, the data is put together. Two types of data my be generated numerical (counted) or descriptive (described) - categorize or classify data exclusive (choices do not overlap) or exhaustive (anticipate all possible answers may be given) - in fixed response questions, choices must be provided - after categorizing, the responses will be to summarize the data (manually or by computer) 8. Data presentation - depend on the type of data obtained; descriptive data narrative reports - numerical table or graph 9. Data analysis - aims to establish trends and patterns in terms of health needs and problems of the community; allows comparison of obtained data with standard values. - determining the interrelationship of factors will help the nurse view the significance of the problems and their implications on health status of the community 10. Identifuing the CHN problems - CHN problems are categorized as: a. health status problems they may be described in terms of increased/decreased morbidity, mortality or fertility b. health resources problems lack of 4 M's c. health-related problems factors that aggravate the illness-inducing situations 11. Priority-setting -after problems have been identified, next is to prioritize which health problems can be attended to considering the resources available at the moment Criteria: a. nature of the problem presented classified as health status, health resources, healthrelated problems b. magnitude of the problem severity of the problem c. modifiability of the problem this 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 or community as they are affected by the problem CRITERIA NATURE OF THE PROBLEM Health status Health resources Health-related 3 2 1 WEIGHT 1

MAGNITUDE OF THE PROBLEM 75%-100% effected 4 50%-74% affected 3 25%-49% affected 2 <25% affected 1 MODIFIABILITY OF THE PROBLEM High 3 Moderate 2 Low 1 Not modifiable 0 PREVENTIVE POTENTIAL High Moderate Low SOCIAL CONCERN Urgent community concern Recognized as problem but not needing urgent attention Not a community concern 3 2 1

1 2 1 0

Each problem will be scored according to each criteria and divided by the highest possible score multiplied by the weight. Then the final score for each criteria will be added to give the total score for the problem. The problem with the highest total score is given hihg priority.