NCM 104 (RLE1)

COMMUNITY HEALTH NURSING

COMMUNITY ASSESSMENT AND DIAGNOSIS

Family Health Nursing Practice
- Nursing Assessment is the major face of nursing process
- Nurse’s Role
1) Measures status of family as client
2) Ability to maintain itself as a system and functioning unit.
3) Ability to maintain wellness, prevent, control or resolve problems
- To achieve health and well-being among family members.
Nursing Assessment CAP
- Three major steps in nursing assessment as applied to family nursing practice
1) Data Collection
 To ensure effective and efficient data collection in family nursing
practice
 To specify the methods of data gathering and the necessary tools to
collect such data
2) Data Analysis or Interpretation
 Utilizing the data generated from the tool on initial data base in family
nursing practice. The nurse goes through the data analysis, she
searched out and classifies or groups data by type or nature such as:
switch our wellness states, threats, deficits, or stress points
3) Problem definition or nursing diagnosis
 The end result of two types of assessment
Diagnosis
- End product of first level assessment
- The identification of the client’s needs and problems based on an analysis of the
data/information gathered.
- Specify a hierarchy of two sets of data and their analysis, they reflect depth of the
data gathering and analysis and what health conditions or problem exists
- End result of 2 major types of Nursing assessment in family nursing practice:
1) First level Assessment
 Health conditions and problem of family
 Categorized as: WDTF
1. Wellness state
2. health deficit
 3. health threats
4. foreseeable crisis/stress points situations
2) Second level Assessment
 Define the Family Nursing Diagnosis or Problems
 The family encounters in performing the health tasks with respect to a
given health condition or problem
 Provide a home environment conducive to health maintenance and
personal development
 Ex. Family’s Inability to Perform Health Tasks on each health
condition and reasons.
First Level Assessment
- Wellness state (stated as Potential or Readiness problem)
1) a nursing judgement on wellness state or condition based on client’s
performance, current competencies or clinical data but no explicit expression
of patient’s desire.
 Readiness - a nursing judgement on wellness state or condition based
on client’s performance, current competencies or clinical data and
explicit expression of desire to achieve a higher level of state or
function on health promotion and maintenance.
- Health Deficit (short)
1) Instances of failure in health maintenance
 Illness states - regardless of whether it is diagnosed or undiagnosed
by medical practitioner
 Failure to thrive or develop according to normal rate
 Disability – whether congenital or arising from illness, transient.
 Temporary such as aphasia
 temporary analysis after a stroke
 permanent, such as leg amputation
 secondary to diabetes
 blindness for measles
 lameness from polio
- Heath Threats
1) Conditions that are conducive to disease and accident, or may result to failure
to maintain wellness or realize health potential.
 Lifestyle diseases; Metabolic syndrome
 Cross infection from a communicable disease case
 - Foreseeable Crisis (Presence of stress points)
1) Anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources.
 Marriage
 Pregnancy
 Labor
 Parenthood – additional members
Second Level Assessment
- Family’s perception of the problem
- Decisions made and appropriateness, if none, reasons
- Actions taken and results, if none, reasons
- Effects of decisions and actions on other family members.
ASSESSMENT
- How will data be collected? What method and tools to use? Is it valid? reliable?
adequate?
1) Observation
2) Physical EXAMS
3) Interview
4) Review of records
5) Laboratory/Diagnostic Tests
- How will data be processed and presented? Determines patterns or reoccurring
themes among the data then she’ll compare the data’s
1) Summarize
2) Quantify
3) Do data analysis- sorts out, classify or groups data by type or nature
4) Compares data and patterns with norms or standards.
- What to do after the end of assessment phase?
1) If focus is on individual: Formulate a nursing diagnosis
2) If focus about community: Formulate a community diagnosis (mortality and
morbidity rates and ratios and identification of their correlates for the purpose
of defining those at risk or those in need of health care)
2ND LEVEL OF ANALYSIS:
- Nursing Diagnosis in Family nursing problems
1) each wellness state must be analyzed in terms of how the family handles the
problem.
2) A wellness condition is a nursing judgement related with the client’s capability
for wellness. It becomes a nursing problem when it is stated as the family’s
 failure to perform adequately specific health tasks to enhance the wellness
state)
- What do we use to define Family Nursing Problems?
1) Typology of Nursing Problems in Family Health Care (1970)
 Presence of Health Threats: Presence of Risk Factors of specific
diseases (lifestyle disease, metabolic syndrome etc.)
Community Diagnosis (aka community assessment/situational analysis)
- The identification and quantification of health problems in a community as a whole in
terms of mortality and morbidity rates and ratios.
- Correlates for the purpose of defining those at risk or in need of health care
- Role of the Nurse
1) Determines health status
2) Collects data about community (to identify the different factors that may
directly or indirectly influence the health of the population)
3) Analyze and seek explanations for the occurrence of health needs and
problems of the community
4) Community Health Nursing Diagnosis are derived. (become the basis in
developing and implementing community health nursing interventions and
strategies)
- TYPES
1) Comprehensive Community Diagnosis
 Aims to obtain a general information about the community.
 ELEMENTS OF A COMPREHENSIVE COMMUNITY DIAGNOSIS
 Demographic Variables – size, composition and geographical
distribution of the population
 Socio-economic and Cultural Variables (no limits)
o Social Indicators – communication network
o Economic Indicators – poverty level income,
unemployment, industry, occupation common
o Environmental – physical, geographical, topographical;
water supply, waste disposal, air, water, land pollution
o Cultural – groups within the community; ethnicity and
religion
 Health and Illness Patterns – leading causes of illness and
deaths and respective rates of occurrence
  Health Resources – essential ingredients in the liberty of basic
health services
o Manpower
o Material
 e. Political/Leadership – mirrors the sensitivity of the
government to the people’s struggle for better lives
2) Problem Oriented Community Diagnosis (disaster or outbreak of disease)
 Spradley (1990) describes the problem-oriented community diagnosis
as the type of assessment that responds to a particular need.
 Mine tailings being exposed into the river system by a mining
company. Identify who were infected by the hazards posed by
mine tailings then she goes one to characterize the
environmental factors.
- What are the processes of Community Diagnosis?
1) Collecting
2) Organizing
3) Analyzing
4) Interpreting health data
5) Identify objectives and type of diagnosis to use.
 This will dictate the depth of the scope of the community diagnosis.
- STEPS IN CONDUCTING CD?
1) Determine the objectives – depth and scope of data
2) Define the study population – based on the objectives, population group in the
community; can be specific – women in reproductive age group or infants and
young children
3) Determine the data to be collected – objectives will guide you
4) Collect the data – based on specific methods depending on the data to be
generated
5) Develop the instrument – meet the people first
 Survey questionnaire
 Interview guide
 Observation checklist
6) Actual data gathering – checking the field of instruments in terms of
completeness, accuracy and reliability of the information needed
7) Data Collation – categories for classification of responses making sure that
the categories are exclusive
8) Data Presentation – will depend on the type of data obtained
 Descriptive data – presented in narrative reports
 Demographic
 History of place or beliefs regarding illness and death.
 Numerical Data – presented into tables and graphs (show
comparisons and patterns and trends). The choice of graphs will
depend on type of data being presented.
 TYPES OF GRAPHS
o Line graph – changes in time
o Bar graph or pictograph – comparisons of absolute or
relative counts and rates between categories
o Histogram or frequency polygon
o Proportional or component bar graph or pie chart –
breakdown of a total where the number of categories is
not too many
o Scattered – correlation data for two variables
9) Data Analysis
 Aims to establish trends and patterns in terms of health needs and
problems of the community. It also allows comparison of obtained
data.
 Allows nurse to view its significance and implications on the health
status of the community.
10) Identifying the community health nursing problems
 Categorized as:
 Health status problems – described in terms of increased or
decreased morbidity, mortality, fertility or reduced capability of
wellness.
 Health resource problems – described in terms of lack of or
absence of manpower, money, materials or institutions
necessary to solve health problems.
 Health Related problems – described in terms of existence of
social, economic, environmental and political factors that
aggravate the illness-inducing situations in the community.
11) Priority-setting
 Nature of the condition/problem presented. Classified as: health
status, health resources or health related problems.
 Magnitude of the problem – severity of the problem which can be
measured in terms of the population
 Modifiability of the problem – probability of reducing, controlling or
eradicating the problem
 Preventing potential – reducing and controlling the effects posed by
the problem
 Social concern – perception of community as they are affected by the
problem.