COMMUNITY HEALTH NURSING 2 (POPULATION GROUPS AND COMMUNITY AS CLIENTS)
LESSON 1:
NURSING PROCESS IN THE CARE OF POPULATION
GROUPS AND COMMUNITY
HALLMARK OF COMMUNITY HEALTH NURSING
 Population-focused
- “the primary client and recipient of care
of the nurse is a group of people in the
community”.
 The nurse works with families, population
/sub-groups.
COMMUNITY HEALTH NURSING PROCESS
POPULATION
Community Health Nursing Process
 The total of individuals occupying an area or
making up a whole.
 Within a population are smaller subgroup
called aggregates–defined by their common
characteristics and concerns, often seen as
population having high-risk for certain health
conditions.
 Children under 5 years old, school-aged
children, adolescents, and the elderly.
COMMUNITY
 A cluster of people with at least one common
characteristic (geographic, location,
occupation, ethnicity, housing condition)
 A group of people with a common
I.
characteristic or interest living together in a
larger society.
POPULATION-BASED CARE: Plans for the Group or
Individual
 Approach allows one to assess the health
status and health needs of a target
population, implement and evaluate
interventions that are designed to improve
the health of that population, and efficiently
and effectively provide care for members of
that population in a way that is consistent
with the community’s cultural, policy and
health resource values.
COMMUNITY-BASED CARE: Plans for the community
 Approach allows one to assess the health
status and health needs of a target
community, implement and evaluate
interventions that are designed to improve
the health of the people living in the
MIDTERM
community, and efficiently and effectively
provide care for members of that in a way
that is consistent with the community’s
cultural, policy and health resource values.
 A multi-sector and multi-disciplinary
collaborative enterprise that uses public
health science, evidence-based strategies, and
other approaches to engage and work with
communities, in a culturally appropriate
manner, to optimize the health and quality of
life of all persons who live, work, or are
otherwise active in a defined community or
communities.
 Is a systematic, scientific, dynamic on-going
interpersonal process in which the nurses
and the clients are viewed as a system with
each affecting one and another and both
being affected by the factors within the
behavior.
 An effective tool to help people solve their
health problems and meet their health and
nursing needs.
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
Assessment of Community Health Needs
Health Needs Assessment:
 A process of systematically collecting
information to enable the health
practitioner, team, and policy makers
identify, analyze, prioritize and meet
the health needs of an individual,
family or population.
Community Health needs Assessment:
 A process that describes the state of
health of local people, enables the
identification of the major risk factors
and causes of illness and
identification of the actions or
interventions needed.
Purposes of Community Health Needs
assessment
1. Will enable the health practitioners,
NGO’s, civic-oriented group, and
policy makers to identify the
members of the population who need
the health care services, and
 resources the most, b. Poverty & income
c. Environment
2. To ensure that these resources are d. Social cohesion / social support
used following the rule of equity. e. Destabilizing factors
f. Resources formal & informal
3. Important in health care planning
to identify the priority health needs,
utilize the internal and external
resources of the community and COMPONENTS OF COMMUNITY HEALTH NEEDS
develop community participation and
ASSESSMENT
involvement.
1. Health Status
2. Health Resources
Community Health Nursing Process Assessment tools: 3. Health Action Potential

PRIMARY DATA
Health Needs Assessment
OBSERVATION SURVEY INFORMANT
HEALTH STATUS

INTERVIEW COMMUNITY FORUM  Health standing or condition of the

SECONDARY DATA
 Registry of vital events
 Health records
 Disease registry
 Census data
SOURCES OF ASSESSMENT INFORMATION
 The client
 The family or significant others
 Medical records/nurses’ notes
 Other members of health team
 Other sources
DATA TO BE COLLECTED
1. CHARACTERISTICS OF THE POPULATION
a. Geography
b. Numbers
c. Age distribution & gender
d. distribution
e. Ethnicity & religion
f. Population trends
g. Language and literacy
2. HEALTH STATUS OF THE POPULATION
a. Mortality & morbidity rates
b. Communicable diseases
c. Low birth weights
d. Breast feeding rates & immunization
rates
e. Health behaviors such as smoking
f. Health service use
3. LOCAL FACTORS AFFECTING
(strengths and weaknesses)
a. Work & employment
population as indicated by the morbidity,
mortality, and fertility rates (MMF).
1. MORTALITY DATA- describes patterns
of death in relation to age, gender, and
cause of death.
2. MORBIDITY DATA – information is on
the types of illness and disability,
their incidence and prevalence.
3. Behavior measures – indicators of
health (like: smoking, or any activity
proven to cause illness.
4. Quality of life measures – means
assessing physical health, functional
ability, & psychological being.
5. Use of service information –
Information gives an account of the
morbidity status of the community,
the hospital admissions and use of
preventive services like immunization
& screening programs.
6. Health inequalities – most disease and
illness patterns are closely associated
to economic circumstances where
there is high rate of death and illness
among poor sectors of society.
HEALTH RESOURCES
 Are assets, means, strengths, and skills that
are contributory to the population of health &
well-being that exits within communities to
meet the needs of individuals, families or
social groups.
1. Informal resources – families deliver
the greatest part of all care services in
the community.
2. Formal resources- can be provided at
a variety of levels & by many agencies
including both health services & those
HEALTH
provided by sectors that have an
impact on health.
 KINDS OF COMMUNITY RESOURCES
 Knowledge & skills in caring
for & promoting health
 Health careers (family &
friends)
 Social support networks;
community-based
organizations
 Resources (money, shops,
food, transport)
 The ability to cope in often
very difficult circumstances
(like: supportive
interpersonal relationships)
HEALTH ACTION POTENTIAL
 Action planning is a complex activity and
should be undertaken where the more local
people are involved in action planning
 There must be collaboration with other
groups
Stages of Action Planning
Preparation stage
Agreeing to the aims set by the group
Describing the objectives of the program or project
Detailing the activities needed to meet the objectives
Evaluation of the outcomes
SUMMARY
 Assessment is a continuing and dynamic
process which must be undertaken to
validate whether the nursing diagnosis is
correct, and to find out if the client is on the
way to achieving the expected outcomes.
 Community health needs assessment is the
same process as carrying out a holistic
assessment of an individual or family but
covers a larger population instead of just an
individual or a family.
 The client is the whole community and
involves more people.
 Community health needs assessment
identifies problems and needs and, also
assesses the strengths and resources of the
community members.
LESSON 2:
NURSING PROCESS IN THE CARE OF POPULATION
GROUPS AND COMMUNITY
NURSING DIAGNOSIS
 Is the statement of the client’s current health
status and concerns which were obtained
from the assessment data and can be resolved
or minimized through nursing intervention.
- Clinical judgment about individual, family,
or community responses to actual or
potential health problems/life processes
- Provides the basis for selection of nursing
interventions to achieve outcomes for
which the nurse is accountable
IMPORTANCE OF THE NURSING DIAGNOSIS
1. Nursing Diagnosis allows nurse to develop
individualized plan of care.
2. Nursing diagnosis distinguishes the role of
the nurse from the physician and the medical
diagnosis as the nursing diagnoses focus on
the human responses and alterations in the
client’s ability to function as an independent
human being.
Review:
Elements of a Nursing Diagnosis Statement
 Actual nursing diagnosis
 Etiology
 Defining characteristics
 Wellness
 Actual
 Risk
 Potential
COMMUNITY DIAGNOSIS
 Is a statement of the health and health-
related problems of the community or which
have a high risk of developing, and the
possible causes or causative organisms and
the contributory factors.
 It is the end-result of data collection and
analysis
TYPES OF COMMUNITY DIAGNOSIS
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 3. MODIFIABILITY OF THE PROBLEM –the
probability of success in reducing, controlling
1. Determine the objective or eradicating the problem through
2. Define the study population interventions
3. Determine the data to be gathered 4. PREVENTIVE POTENTIAL –the nature &
4. Collect the data magnitude of future problems that can be
5. Develop the instrument minimized, controlled, or totally prevented if
6. Actual data gathering intervention is done.
7. Data collation 5. SOCIAL CONCERN –the community’s
8. Data presentation perception & evaluation of the problem in
9. Data analysis & interpretation terms of seriousness & urgency of attention
10. Problem identification needed.
11. Health status –mortality, morbidity, fertility
12. Health resources-money, manpower,
material, institution
13. Health related –environment, culture, HEALTH PROBLEM PRIORITIZATION
economic, political
14. Prioritization of HEALTH PROBLEMS

PRIORITIZING HEALTH PROBLEMS

Which one needs the most attention or is most

critical

The most urgent or immediate needs of the

client/clients
HEALTH PROBLEM PRIORITIZATION CRITERIA
Priorities can either becritical
physical or psychological in SCORE
nature

Which one needs the most attention or is most

critical
PROBLEM IDENTIFICATION

A. HEALTH STATUS PROBLEM –described in EXAMPLE: COMMUNITY DIAGNOSIS STATEMENT

terms of increased/ decreased morbidity,
mortality, fertility or reduced capability for  Deficient Knowledge associated with
wellness. community health can be caused by
B. HEALTH RESOURCES PROBLEM-described in inadequate knowledge of resources, access to
terms of lack of or absence of manpower, the healthcare system and programs, and an
money, materials or institutions necessary to understanding of individual and community
solve health problems. health risks.
C. HEALTH-RELATED PROBLEMS –described in
terms of existence of social, economic, Nursing Diagnosis: Deficient Knowledge
environmental & political factors that
Related to:
aggravate the illnessinducing situations in
the community.  Inadequate knowledge of community
support and resources
 Inadequate access to healthcare
PRIORITY SETTING professionals
 Lack of financial and social resources
1. NATURE OF THE CONDITION/PROBLEM  Program budget, outcome information, or
PRESENTED evaluation plan deficiencies
a) health status  Inability of existing programs to address
b) health resources health concerns
c) health-related
2. MAGNITUDE OF THE PROBLEM-the severity Nursing Diagnosis: Deficient Knowledge
of the problem which can be measured in
As evidenced by:
terms of the proportion of the population
affected by the problem  Community members’ verbalization of
confusion/concern
  Community members’ noncompliance with
the health program
 Community members’ inquiries about a
certain topic
 Community members’ misconceptions
 Community members’ exacerbation of health
symptoms
 Health program’s inability to address the
health concern
 Preventable hospital readmissions
 Increased incidence of physiological or
psychological conditions
DEFICIENT KNOWLEDGE ASSESSMENT
1. Assess healthcare providers’ knowledge and
practices related to the community’s health.
 Having the same knowledge and
using the same knowledge makes it
easier for those working in the
community to recognize one another
and communicate ideas more
effectively.
2. Assess the community’s existing and potential
health problems.
 By identifying particular issues,
population-based treatments can
focus on the existing problem that
may be solved by primary prevention
and proactive intervention.
3. Assess the community’s resources.
 Knowing what resources are
currently accessible and how the
community accesses them helps to
identify potential gaps. Resources
may not be meeting the needs of the
community or the community may
not be aware they exist
4. Note the community members’ complaints/
concerns.
 Taking note of the members’
concerns presents a realistic image of
issue areas through feedback from
those who are affected most.
EXAMPLE: COMMUNITY DIAGNOSIS STATEMENT
 Ineffective community coping can be caused
by unsatisfactory community efforts to adapt
and solve problems in a way that satisfies
community desires or needs.
Nursing Diagnosis: Ineffective Community Coping
Related to:
 Insufficient resources for problem-solving
 Inadequate community resources
(emergency services, transportation)
 Lack of social support services
Nursing Diagnosis: Ineffective Community Coping
As evidenced by:
 Community members’ expression of lack of
support or excessive stress
 Higher rates of illness
 High rates of crime, abuse, unemployment,
and poverty
 Community members’ expression of
powerlessness or hopelessness
INEFFECTIVE COMMUNITY COPING ASSESSMENT
1. Assess the community’s needs.
 A needs assessment is essential to
identify the gaps preventing it from
achieving its targeted objectives.
2. Assess disaster plans and response to
emergencies.
 Evaluate the policies of local and
regional efforts in the face of
epidemics, threats, terrorist attacks,
and natural catastrophes to assess
preparedness.
3. Identify the availability, accessibility, and
usage of community resources.
 Even when resources are accessible,
they are not always utilized properly
or to their full potential. Evaluate
programs and resources available,
referral processes, and follow-up
measures.
4. Identify unmet community expectations.
 Establishing shortcomings is the first
step in overcoming gaps.
Communication is crucial to
understanding the perspective of the
community.