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Levels of Community Health Nursing Practice

Klien Karakteristik Individu dengan berbagai kebutuhan

Asuhan Keperawatan Komunitas

Desy Indra Yani

Individu

Pengkajian Keterlibatan Kesehatan keperawatan Kekuatan, Interaksi klienmasalah dan perawat kebutuhan individu Kekuatan, masalah dan kebutuhan individu & keluarga Interaksi dengan individu dan kelompok keluarga

Keluarga Sistem keluarga dengan kebutuhan individu dan keluarga Interdependency

Levels of Community Health Nursing Practice

Klien Karakteristik Pengkajian Kesehatan Dinamika kelompok Pencapaian tujuan Pengkajian masalah, kebutuhan dan statistik vital umum Keterlibatan keperawatan Anggota kelompok dan ketua Aplikasi proses keperawatan untuk kebutuhan yang teridentifikasi Kelompo Keinginan, masalah, k dan kebutuhan umum

Levels of Community Health Nursing Practice

Klien Organisasi Tempat kerja Sekolah Karakteristik Kelompok terorganisasi pada kelompok umum dengan penataan dan tujuan yang diberikan Pengkajian Kesehatan Hubungan tujuan, struktur, komunikasi, pola organisasi dengan kekuatan, masalah dan kebutuhan Analisis siste, kekuatan, krakteristik, masalah dan kebutuhan Keterlibatan keperawatan Konsultan dan atau aplikasi kepegawaian proses keperawatan untuk kebutuhan yang teridentifikasi Ketua komunitas, partisipan, healthcare provider

Kelompo Besar, kelompok tidak k terorgnisir dengan populasi keinginan, masalah, dan kebutuhan umum

Komunitas

Populasi agregat pada lokasi tertentu dengan sistem sosial yang terorganisasi

Community Health Nursing Planning

Planning for community change Change Theory (Kurt Lewin)
Unfreezing
Involves finding a method of making it possible for people To let go of an old pattern that was counterproductive in some way

Community Health Nursing Planning

Planning for community change Change Theory (Kurt Lewin)
Moving to a new level or changing
Involves a process of change in thoughts, feeling, behavior, or all three That is in some way more liberating or more productive

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Community Health Nursing Planning

Planning for community change Change Theory (Kurt Lewin)
refreezing
Is establishing the change as a new habit, so that it now becomes the standard operating procedure. Without this stage of refreezing, it is easy to backslide into the old ways.

Steps of Program Planning

Identify target group Identify planning group Establishing program goals Identify possible solutions Identify alternative solutions Identify resources

Steps of Program Planning

Selection of best intervention strategies Set specific objectives Set intervention work plan Evaluation tool development Planning for monitoring & program evaluation

Community Health Nursing Intervention

7 questions to consider:
1. Do the intervention activities fit the goals and objectives of the program? 2. At what level(s) of influence will the intervention be focused? 3. Are the activities based on an appropriate theory? 4. Is the intervention an appropriate fit for the target population?

Community Health Nursing Intervention

7 questions to consider:
5. Are the necessary resources available to implement the intervention selected? 6. What types of intervention activities are known to be effective in dealing with the program focus? 7. What conclusions should be made about selecting a program intervention?

Question 1
Do the intervention activities fit the goals and objectives of the program?
Be clear about your level of intervention Is your goal to increase awareness? Is your goal to change behavior? What is it you are trying to change?

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Question 2
At what level(s) of influence will the intervention be focused?
Intrapersonal?

Question 3
Are the activities based on an appropriate theory?
Does your intervention include sound learning and educational theories and models that are grounded in social science research? Have you selected empirical research that is related to your topic that uses the same theory? Level of Influence

Change within the participant

Interpersonal?

Change between participants

Community?

Change across groups of people

Question 3
Level of influence
Intrapersonal Theories Theory of Planned Behavior

Question 4
Is the intervention an appropriate fit for the target population? Does it address the unique characteristics of the target population?
Age, ethnicity, emotional status, physical status

Health Belief Model Transtheoretical Model

Interpersonal Theories Social Cognitive Theory

Social Support/Networks
Community Theories Precede Proceed Community Organization

Does it fit the special needs of the target population?

Abilities, location

Community Development

Question 5
Are the necessary resources available to implement the intervention selection?
Have you considered whether or not you will charge a fee for the services rendered?

Question 6
What types of intervention activities are known to be effective in dealing with the program focus?
What types of intervention activities are being done by the communities you visited? What types of intervention activities are mentioned in your empirical literature?

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Types of intervention:
Health education program Screening program Health service establishment Policy setting & implementation Self-help initiatives Balancing power relations among disadvantages

Intervention Strategies
Single action Phasing Collaboration & networks Coalitions

Activity Examples
1. Education & awareness
Classes, posters, guest speakers

Activity Examples
5. Opportunity to practice
Projects, mentoring

2. Personal assessment
Surveys, journals, interviews

6. Relapse prevention
Support groups, hotlines, peer partners

3. Setting expectations
Guidelines, personal interviews, goal setting

7. Monitoring progress
Personal interviews, surveys, follow-up meetings

4. Knowledge & skill building

Projects, demonstrations, group work

8. Redefining expectations
Panel discussions, exit interviews, posttests

Question 7
Would it be better to use an intervention that consists of a single activity or one that is made up of multiple activities?
One shot interventions are not generally effective in changing attitudes and behaviors. Multiple activity interventions have been shown to be more effective. This may be due to being able to tap into the varying learning styles of the target population. Repeating the intended message can help the target population to embrace the concepts and make them more salient.

Remember!!!
It is important for you to recognize what level your participants are at and be realistic about how far they can progress. Make your goals and objectives attainable and have enough of them to make a significant impact

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Evaluation of Community Health Nursing

Types of evaluation Formative evaluation: Process evaluation focus on how well the program is operated and being implemented. It occurs during program ongoing Summative evaluation: Measure community response to nursing care, interpret the degree to which planned goals are met.

Possible Evaluation Outcomes

Knowledge, attitudes, behaviors & skills Health status (Epidemiological data) Well-being & quality of life Presence of health care system services & components Satisfaction of program implementation Presence of policy, regulation, funding

Evaluation Criteria
Relevance (overall) Efficiency (activities, outputs) Effectiveness (outputs, outcome) Impact (outcome, impact) Sustainability (outcome, impact)

Steps in Evaluation
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results

Plan the evaluation

Review goals & objectives Meet stakeholders Identify framework, expected outcomes, method of evaluation: What & How Design evaluation: when by whom Determine the budget

Collect evaluation data

Identify types of data need & sources of data Determine data collection methods Develop, validate, pilot instrument Identify samples & sampling method Collect data

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Analyze the data

Determine data analyzing method Identify who will analyzed data Analyze data, interpret and present the results

Report the evaluation

Determine who will write & receive the report Determine the format Writing the report Distribute the report

Implement the results

Plan how the results will be implemented Identify who will implement Determine when the results will be implemented: develop the time line

Health Planning Model

Pengkajian
Karakteristik agregat Identifikasi dan prioritas kebutuhan/ masalah kesehatan

Planning
Mutual goals and objectives Aternative levels of interventions (personal, group, enviornmental)

Intervensi
Interventions of at least one level

Evaluasi
Berdasarkan objektif, perencanaan dan outcomes (proses & product)

Community Health Education

Peran perawat Advocate Caregiver Case manager Collaborator Community care agent Counsultant Counselor Culture broker Educator

Community Health Education

Facilitating of health promoting behaviors Information agent & broker Innovator Liaison Mediator Negotiator Policy analyst, policy maker or change agent Promoter of collaborative partnerships Promoter of self-care & self efficacy

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Community Health Education

Referral resources Recognize dimensions of health choices Reseacher Sensitizer Social activist

Community Empowerment
Community development Community organizing Community mobilization Community building Community empowerment Community competence Community capacity