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    15 views20 pages

    Community Diagnosis

    Uploaded by

    Mary Sutingco

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    © All Rights Reserved
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    Chapter 6 Assessing C ommunity Health Needs Luz Barbara P. Dones INTRODUCTION ith different The community health nurse gets to work wit se aoe client in her practice. She may be involved wit 5 chiara cteristics that Populations or populations. Each has distinguishing ing. Involvernont the nurse must recognize in order to direct her nursing I : However, we are reminded that in community health nursing, the community is not simply a context of the existence of the families, groups, Sub-populations or populations nor just a setting for our nursing interventions. Lest we forget, we regard the community as our Primary client. The community is seen as the Primary client of the nurse for two important reasons. First, the community has a direct influence on the health of the individual, families and ‘sub-populations. Second, it is at this level that most health service provision occurs (Spradiey, 1990). Community health nurses need to know of a community (see Chapter 1) because these “set" th, 7 understanding the different aspects that directly or indirectly into his health status of the community. The community health nurse will also deal with these community characteristics in planning and developing eae ices, the defining characteristics programs and in ensuring the delivery of effective health servi THE COMMUNITY DIAGNOSIS Caring for the community as client starts with a status. The nurse collects data about the community forming its health the different factors that may directly or indirectly inf a "der to identify the population. Then, she proceeds to analyze and seek the health of the occurrence of health needs and problems of ®xplanations for community health nursing diagnoses are then deriveg ang unity. The bases for developing and implementing Community Will become the interventions and strategies. This process is called heatth 4 * ursii Others call it community assessment or situational analysig WY diagnosie 158 The health status of the coy ity i mmunity is a product of the various interacting clmments such as Population, the physical and topographical characteris! ics, ae and cultural factors, health and basic ee eae en ane power Structure within the community. The iterrelat elements will i il items Ga ihe Go nity, ll explain the health and illness Types of Community Diagnosis In the assessment of the community's health status, the nurse considers the degree of detail or depth she should go into. There are times when situations call for a comprehensive assessment. Oftentimes, the nurse is confronted with a specific problem area like a disaster situation or an outbreak of disease. In these instances, a problem-oriented assessment will have to be conducted. A nurse may decide to assess a specific population group in the community, in which case, she may opt to conduct a comprehensive assessment of that group and at the same time, focus on the specific problems of that same group. It is important, therefore, to decide on the objectives of the community diagnosis, the fesources and time available to implement it. Comprehensive Community Diagnosis A comprehensive community diagnosis aims to obtain a general information about the community. The following are elements of a comprehensive community diagnosis: A. Demographic Variables analysis of the community's demographic ved oe show the size, composition and geographical distribution of the population as indicated by the following; tion and geographical distribution Total oop rural index and population density Age and sex composition rowth rate, crude ital indicators such as g , cru Select se ide death rate and life expectancy at birth bit fi gration Patterns of migratis Population projections oP Py popul: i i whether there are It is also important to know 8 jation groups that need special attention such as i ind other social} indigenous people, internal refugees al 8 cislecatee groups as a result of disasters, calamities ang devel lopment programs. Socio-Economic and Cultural Variables There are no limits as to the list of socio-economic and cultural factors that may directly or indirectly affect the health status of the community. However, the nurse should consider the following as essential information: 1. Social indicators a. 2. E a. b. c. d e. . Educational level which Communication network (whether formal or informal channels) Necessary for disseminating health information or facilitating referral of clients to the health care system . Transportation system including road networks necessary for accessibility of the people to health care delivery system 1 may be indicative of Poverty and may ‘reflect on health Perception and utilization Pattern of the community - Housing conditions which ma suggest hazards (congestion, fi y pgest health re, exposure to elements) Conomic indicators Poverty level income Unemployment and underemployment tates Proportion of salaried and wage earn economically active Population 2 ers to total - Types of industry present } Sent in the community . Occupation common in the community 3. Environmental indicators a Physical/geographicalttopographicg) char A the community €Cteristicg of » land areas that contribute to vector roby > terrain characteristics that Contibure to pill or pose as geohazard zones Cidents » land usage in industry > climate/season b. Water supply >» % population with access to safe, adequate water supply > source of water supply c. Waste disposal > % population served by daily garbage collection system > % population with safe excreta disposal system > types of waste disposal and garbage disposal system d. Air, water and land pollution > industries within the community having health hazards associated with it >> air and water pollution index 4. Cultural factors a. Variables that may break up the people into groups within the community such as: ethnicity > social class > language > religion > race > political orientation b. Cultural beliefs and practices that affect health c. Concepts about health and illness Vv Health and Iliness Pat IS In analyzing the health and illness patterns, the nurse may collect primary data about the leading causes of iliness and deaths and their respective rates of occurrence. If she has access to recent and reliable secondary data, then she can also make use of these. Leading causes of mortality Leading causes of morbidity Leading causes of infant mortality Leading causes of maternal mortality Leading cause of hospital admission abon= Health Resources The health resources that are available in the community is an important element of the community diagnosis mainly because they are the essential ingredients in the delivery of basic health services. The nurse needs to determine manpower, institutional and material resources provided not only by the state but those which are contributed by the private sector and other non-government organizations. 1. Manpower resources > categories of health manpower available > geographical distribution of health manpower > manpower-population ratio > distribution of health manpower according to health facilities (hospitals, rural health units, etc) > distribution of health manpower according to type of organization (government, non-government, health units, private) quality of health manpower existing manpower development/policies jaterial resources health budget and expenditures sources of health funding categories of health institutions available in the community hospital bed-population ratio categories of health services available Political/Leadership Patterns The political and leadership Pattern is a vi in achieving the goal of high level wellness eemnent people. It reflects the action potential of the state ene people to address the health needs and problems of ie ity of the governme> VVOVYVE vv community. It also mirrors the sensitivi to the people's struggle for better lives. In assessing the community, the nurse describes the following: 1. Power structures in the community (formal or informal) 2. Attitudes of the people toward authority 3. Conditions/events/issues that cause social conflict/ upheavals or that lead to social bonding or unification. 4. Practices/approaches that are effective in settling issues and concerns within the community. Problem-Oriented Community Diagnosis Spradiey (1990) describes the problem-oriented community diagnosis as the type of assessment that responds to a particular need. For example, a nurse is confronted with health and medical problems resulting from mine tailings being disposed into the river systems by a mining company. Since a community diagnosis investigates the community-meaning, the people and its environment - the nurse proceeds with the identification of the population who were affected by the hazards posed by mine tailings. Then she goes on to characterize. the environmental factors along with the other elements which are relevant to the specific problem being investigated. Community Diagnosis: The Process The process of community diagnosis consists of collecting, organizing, synthesizing, analyzing and interpreting health data. Before she collects the data, the objectives must be determined by the nurse as these will dictate the depth or the scope of the community diagnosis. She needs to resolve whether a comprehensive or a problem-oriented community diagnosis will accomplish her objectives. Steps in Conducting Community Diagnosis In order to generate a broad range of useful data, the community diagnosis must be carried out in an organized and systematic manner keeping in mind that the community should take an. active part in identifying community needs and problems. 14. Determining the Objectives In determining the objectives of the ee the nurse decides on the depth and scope O' am eee needs to gather. But whether she undertakes a 7 ith Cn or a problem-oriented community diagnosis, evi » explains that the nurse must determine the occurrence an distribution of selected environmental, socio-economic and behavioral conditions important to disease control and wellness Promotion. 2. Defining the Study Population Based on the objectives of the community diagnosis, the nurse identifies the population group to be included in the study. It may include the entire population in the community or focused on @ specific population group such as women in the reproductive age-group or the infants and young children. There are situations, however, when a complete enumeration of the desired population is not possible. The nurse, then, may collect data from a subset of the population. 3. Determining the Data to be Collected Whether the community diagnosis comprehensive or focused on a specific will guide the nurse in identifying th collect. She also decides on the so these data available from records of thernselves? 4. Collecting the Data In conducting community diagnosis, different me: be utilized to generate health data. The Nurse degi, specific methods depending on the type fata t generated. For example, through an ocular Survey the 0 be able to determine the physical and topographical charactems® is of the community. She may also interview People abou stics health beliefs or she can review existing health Tecordg ; their Rural Health Unit. In general, we use the following 'n the collect data: Sthods to is going to be Problem, the Objectives © Specific data she will urces of these data. Are agencies? Or from People thods may ides on the Records review - data may be obtained by reviewing those that have been compiled by health or non-health agencies from the government or other sources. b. Surveys and observations - can be used to obtain both qualitative and quantitative data c. Interviews - can yield first hand information d. Participant observation - is used to obtain qualitative data by allowing the nurse to actively participate in the life of the community 5. Developing the Instrument Instruments or tools facilitate the nurse’s data-gathering activities. The following are the most common instruments that the nurse use in her data collection: a. Survey questionnaire b. Interview guide i c. Observation checklist 6. Actual Data Gathering | data gathering, it is suggested that the et m6 Sa wie will be involved in the data collection. The’ instruments are discussed and analyzed. if ecessary, the instruments may be modified or simplified in 3 not to overburden the people who may have limitations in re of educational preparation or available time to finish data collection. Pre-testing of the instruments is highly recommended. collectors must be given an orientation and training ae trey are going to use the instruments in data gathering. on urse can ask the data collectors to role-play an interview ab 0 that they can place themselves in an actual interview situation. During the actual data gathering, the nurse supervises the collectors by checking the filled-up instruments in terms of earnpleteness, accuracy and reliability of the information collected. 7. Data Collation After data collection, the nurse is NOW Ree {098th all the information. There are two ae see anich may be generated. They are either _numerical ee an be counted or descriptive data which can be de: To facilitate data collation, the er must deve| categories for classification of responses abst ee sure that the categories are mutually exclusive and exhaustive. Mutually exclusive choices do not overlap For example: To classify sex: MALE FEMALE To classify monthly income: Below Ps 500 Ps 501 Ps 1000 “Ps 1000 —Ps 1500 “Ps 1501 —-Ps 2000 Exhaustive categories mean that they anticipate all possible answers that a respondent may give. For example: Family planning methods: Lactational Amenorrhea Method Natural Basal body temperature Cervical Mucus Method Symptothermal Method Standard Days Method Others (specify): Artificial lUD Pills Injectables Condom Others (specify): Permanent Tubal ligation Vasectomy In collating fixed response questions, choices must be provided which will serve as categories for the respondent's answer. In some community diagnosis designs, data collectors use flashcards to help the respondent choose his answer. Open-ended questions do not provide choices or categories. But the nurse can still facilitate data collation by constructing categories from answers in randomly selected questionnaires. For example: Question: Bakit hindi kayo nagpapasuso ng inyong sanggol? Response 10: Bawal sa akin, sabi ng doktor Response 27: Nagtatrabaho ako Response 30: Ayaw ni mister Response 45: Masakit Response 59: Masisira ang figure ko Response 60: Medical reasons Response 62: May sakit ako Response 67: Modern at convenient ang bottlefeeding Response 75: Pagod na ako pagkagaling sa trabaho Response 77: Mas gusto ko ang magpasuso sa bote For these responses, possible categories are: Convenience - Responses 67, 77 “Medical reasons - Responses 10, 60, 62 Personal reasons - Responses 30, 45, 59 Economic/work reasons - Responses 27, 75 The next step after categorizing the responses will be to summarize the data. There are two ways to summarize data. One can do it manually by tallying the data or by using the computer. Tallying involves entering the responses into prepared tally sheets showing all possible responses. For example: Diseases Tally Mark Parasitism TATA Diarrhea MINNA Cough MUA AAA i mmarizin, to be used in sul 1g are going numbers or codes. For computers 5 When comp! es are given results, the respons example: Male Female Religion Catholic INK Methodist Aglipayan Data Presentation Data presentation will depend largely on the type of data obtained. Descriptive data are presented in narrative reports. Examples of data appropriate for descriptive presentation are geographic data, history of a place or beliefs regarding iliness and death. Numerical data may be presented into table or graphs. Tables or graphs are useful in showing key information making it easier to show comparisons including patterns and trends. The choice of graphs will.depend on the type of data being presented. TYPE OF GRAPH DATA FUNCTION Line graph shows trend data or changes with time or age with respect to some other variable Bar grapl/pictograph for comparisons of absolute or relative counts and rates between categories Histogram/frequency graphic presentation of frequency polygon distribution or measurement Proportional or Shows breakdown of a group or total component bar —_—_ where the number of categories is not graph / pie chart too many Correlation data for two variables 9. Data Analysis Data analysis in community diagnosis aims to establish trends and patterns in terms of health needs and problems of the community. It also allows for 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 the health status of the community. 10. — Identifying the Community Health Nursing Problems Community health nursing problems are categorized as: a. Health status problems - They may be described in terms of increased or decreased morbidity, mortality, fertility or reduced capability for wellness; b. Health resources problems - They may be described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems; c. Health-related problems - They may be described in terms of existence of social, economic, environmental and political factors that aggravate the illness- inducing situations in the community. 11. Priority-setting After the problems have been identified, the next task for the nurse and the community is to prioritize which health problems. can be attended to considering the resources available at.the moment. In priority-setting, the nurse makes use of the following criteria: a. Nature of the condition/problem presented - The problems are classified by the nurse as health status, health resources or health-related problems; b. Magnitude of the problem - This refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem; c. Modifial of the problem - This refers to the probability of reducing, controlling or eradicating the problem, d. Preventive potential - This refers to the probability of controlling or reducing the effects posed by the problem; e. Social concern - This refers to the perception of the population or the community as they are affected by the problem and their readiness to act on the problem. Below is the scoring system utilized by the nurse in deciding which of the problems need to be prioritized: Criteria Weight 1 Nature of the problem health status health resources health-related 2No Magnitude of the problem 3 75% - 100% affected 50% - 74% affected 25% - 49% affected <25% affected Modifiability of the problem 4 High Moderate Low Not modifiable Preventive potential 5 7 High Moderate Low Social Concern : 4S urgent community concern; expressed readiness 2 recognized as a problem but not needing urgent attention not a community concem nl Source: UP College of Nursing, Community Health Specialty Grou 1989. P, SNOR O=NH =-No on Each prob i divided ie het ae be scored according to each criterion and Then the final aha est possible score Multiplied by the weight. total score for the rocker ctaron Mil he added to give the score is given high priority by ie eee with the highest total APPLICATION OF PUB LIC HE, HEALTH NURSING ALTH TOOLS IN COMMUNITY __ Aside from the biophysical and social sciences, community health nursing also synthesizes in its practice the concepts, knowledge and skills derived from public health. The Population and wellness emphases of public health are the Same essential features of community health nursing. Tools in measuring and analyzing community health problems such as epidemiology and biostatistics were borrowed to form part of our assessment tools in the diagnosis of community health nursing problems. The health disciplines of demography, vital statistics and epidemiology are three important tools that help the nurse in identifying the community's health needs. Demography More than just. being aware of how large a population is in a community, the nurse also needs to comprehend the characteristics of the population that makes the people vulnerable to certain health conditions. She can determine the nature and magnitude of existing and potential community health nursing problems if she possesses knowledge — i population’s size, composition and distribution in space. Demograp! iShie science of population helps the nurse find'reasons or rationale ey

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