104 2F

CHN Process
- Definition: Nursing Process (assessment, diagnosis, planning, intervention,
evaluation) applied to the community

- Condition sin the community affecting health

• People:
- core of the community
- population variables, growth and decline of a population, cultural characteristics of
a community, migration

• Location:
- presence of both natural (geographic feature, climate, flora and fauna) and man-
made variable (community boundaries [urban or rural])

• Social System:
- the patterned series of interrelationships existing between individuals, groups,
and institutions and forming a coherent whole
- Describe a healthy community:
• a shared sense of being in community based on history and values (Hunt,1997;
Dunl, 2002)

• a general feeling of empowerment and control over matter that affect the community
as a whole
- empowerment: the process by which people gain control over the factors and
decisions that shape their lives (WHO,2019)

• existing structure within the community to participate in decision making community

matters

• the ability o cope with change, solve problems, and manage conflicts within the
community through acceptable means

• open channels of communication among the members of the community

• conservation for multiple future generations
• equitable and efficient use of community resources with the view towards sustaining
natural resources
- Assessment phase
• nursing assessment
• first major phase in the CHN practice
• involves a set of actions by which the nurse measures the status of the family as a
client, functioning unit to prevent/control problems

- Tools of community assessments:

• Primary data
- data that have not been gathered before and are collected by the nurse through
observation, survey, informant, interview, community forum, and focus group
discussion

• Secondary data
- taken from existing data sources (vital registries, health records, and reports,
disease registries, and publications [print/electronic]) Gives the nurse a picture of
what is already known about the population under study

RA. 3753: civil registration law

- requires death certificate before burial

• Data gathering:
- tools or instruments during survey
• Interview:
- structural (questionnaires) / unstructured (lengthy conversation)
1. interview

2. observations

3. questionaries

4. available health records and reports

5. publications

survey - forms, questionnaires

interview - structured, unstructured

community forum - >12 members

focus group - less or more specific people (6-12 pax)

- Methods to present community data

• to inform the health team and members of the community of existing health and
health related conditions in the community in an understandable manner

• to validate findings
• to provide a basis for better decision making. These can be prevented in test,
tabular and pictorial forms such as maps and/or graphs
- Formulates plan of care in the community setting
• community diagnosis: the process of determining the health status of the community
and factors responsible for it. Applied both to the process of determination and to its
findings.

• the ____ system: a comprehensive and _____-based classification system for client
problems that exist in public domain. Used as a framework for the care of
individuals, families, and communities by nurses, nursing education, physicians, and
other health care providers. The classification has three components:

1. a problems classification scheme

2. an intervention scheme

3. problem rating scale for outcomes

- PATCH process phases:
1. participation/mobilizing the community

2. collecting and organizing the data

3. choosing health priorities

4. developing a comprehensive intervention plan (eg tentative program plan)

5. evaluating PATCH process

- developed by the COC?
- help local coordinators facilitate the PATCH process.
• Goal: Increase capacity of the community to plan, implement, and evaluate
comprehensive community-based health promotion programs
Phase 1 - Mobilizing
- defining the community and gaining commitment and support from the citizen
- profile of the community (total population, age distribution, marital status, education)
- identify and coordinate community resources
Location Factor

- physical determinants:
1. natural environment

2. transportation

3. housing

4. worksites, schools, recreations settings

5. exposure to toxic substances

6. access to healthcare

Phase 2 - Collecting & Organizing data

- Begins when the community groups form working groups
- makes use of the data sheet/ select health priorities
- obtain mortality, morbidity, and behavioral data
- compare data
Phase 3 - Setting / choosing health priorities
- develop visit of health problems
- assess the community’s capacity to address the health problems
- identify existing community programs and policies for health problem
Phase 4 - Developing a comprehensive intervention plan
- ascertain that community groups and partners re committed to address the health
problems
- involving the target group to ensure that interventions are appropriate and culturally
sensitive
- determine the intervention group (people who will work ____?)
Appropriate corrective action
- planning community health interventions. A logical process of decision making to
determine which of the identified health concerns requires more immediate
consideration and what action may be undertaken to achieve goals and objectives.
Planning is based on finding during assessment and formulated nursing diagnoses.

- Priority setting: provides the nurse and the health team with a logical means of
establishing priority among the identified health concerns. The WHO has suggested
the following criteria to decide on a community health concern for intervention:

• significance of the problems

• community awareness
• ability to reduce risk
• cost of reducing risk
• ability to identify the target population
• availability of resources
- formulating goals and objectives:
• goal: desired outcomes at the end of interventions
• objectives: short-term changes in the community that area observed as the health
team and the community work towards the attainment of goals
- deciding on community interventions: analyzes the reason for peoples health behavior
and direct strategist to respond tot he underlying causes behind them

- implementing the community health interventions: referred to as the action phase.

Intended to enhance the community’s capabilities in dealing with common health
conditions or problems

• requires a common understanding of the goals, objectives, and planned

interventions among the members of the implementing group

• collaboration with other sectors such as local government and other agencies may
be necessary
- Evaluation of the community health interventions: evaluation approaches may be
directed towards: process, structure, outcome and ongoing evaluation or monitoring is
done during the implementation to provide feedback on compliance on need for
changes in the plan
- Standars fo evaluation (CDC,2011)
 • utility
• feasibility
• propriety
• accuracy
- Omaha:
• environmental
• psychosocial
• physiological
• health-related behaviors

Discussion notes: (their dis not ours)

- CHN process: a logical and systematic way of gathering/processing information
gathered from different sources to have meaningful action or interventions
- means by which the nurse addresses the health needs and problems of the client
- rapport establisment

Assessment phase:
- first major phase in the nursing process
- involves actions by which the nurse measures the status of the family as a client
Types of Data:

- Primary: haven't been gathered

• observation
• survey
• interview
• forum
• focus group
- Secondary: data for validation
• registry of vital events
 - RA. 3753: civil registration law
- PD 856: requires death cert. before burial
• health records and reports
• diseases registries (cancer, diabetes, hypertension..etc)
• census data

Social System
- greater support from families, friends, and communities lead to better outcomes.
- social interactions among older adults have decreases cardiovascular diseases,
keeping them mentally and physically healthy (Yale Medical Group)

- Linkages are needed to build and develop programs

Health Community
- groups must be able to change/cope with the environment

Assessment:
- comprehensive: 1st visit
- problem-oriented: after comprehensive assessment is done

Assessment Phase:

analyzing and interpreting data

utilize tales and charts to visualize date and results

Community data presentation

- to inform the health team and community members of existing conditions
- to make the community member appreciate relevance of health information to the their
lives
- to ___ br___ support and participation
- to validate the findings
Diagnoses Phase:
- the process of determining the community health status and sectors responsible for i
- knowing the cause allows the nurse and the community to identify which areas to
improve

Omana / Omaha System:

- problem classification scheme

• environmental
• psychosocial
• physiological
• health-related behavior
- intervention scheme:
• an orderly and comprehensive scheme
• teaching guidance and counseling
• activities designed to provide information and materials

Treatments and Procedures

- technical activities
- wound care, specimen collection
- case management
• activities that require co-ordination, to facilitate service delivery
• guides towards use of appropriate resources
Problem rating scale for outcomes
- a method to evaluate client progress
- concepts:
• knowledge
• behaviors
• _____
Planning phase
- prioritize health problems
- formulate foals and objectives
- create plan of intentions
- set evaluative? care