UNIT IV: NURSING PROCESS IN THE CARE OF POPULATION

GROUPS AND COMMUNITY

Assessment of Community Health Needs
A community needs assessment provides community leaders with a snapshot of local
policy, systems, and environmental change strategies currently in place and helps to identify areas
for improvement. With this data, communities can map out a course for health improvement by
creating strategies to make positive and sustainable changes in their communities.

Components of a Needs Assessment

Health status is an individual's relative level of wellness and illness, taking into account
the presence of biological or physiological dysfunction, symptoms, and functional impairment.
Health resources includes financial resources (health spending) and human resources. Health
spending measures the consumption of health services and goods, including outpatient care,
hospital care, long-term care, pharmaceuticals and other medical goods, prevention and public
health services, and administration.

Community Assessment Tools

Assessment provides an estimate of the degree to which a family, group or
community is achieving the health possible for them, identifies specific deficiencies or
guidance needed and estimates the possible effects of the nursing interventions.

Primary Data
Collecting Primary Data- it may be obtained either through observation or through
direct communication with respondents in one form or another through personal
interviews. There are several ways of collecting pri-mary data. Primary data can be
obtained in several ways. However, the most common techniques are observation, survey,
and informant interview and community forum. Primary data collection is quite expensive
and time consuming compared to secondary data collection.

In observation method, the information is sought by way of investi-gator's own

direct observation without asking the respondent.

A survey is defined as the act of examining a process or questioning a selected

sample of individuals to obtain data about a service, product, or process. Data collection
surveys collect information from a targeted group of people about their opinions, behavior,
or knowledge.

In the personal interviews, the interviewer asks questions gen-erally in a face to

face contact. Through interview method more and reliable information may be obtained.
Personal information can be obtained easily under this method. However, it is a very
expensive and time-consuming method, especially when large and widely spread
geographical samples are taken.

A community forum is an open discussion where community residents gather to

raise important issues affecting them, such as health problems in their neighborhood. This
community discussion's primary purpose is to obtain input from a wide range of residents
and stakeholders concerning their needs and identifying resources for addressing health
problems.
Secondary Data Sources
Secondary data means data that are already available i.e., they refer to the data
which have already been collected and analyzed by someone else.

Registry of Vital Events

A well-functioning civil registration and vital statistics (CRVS) system registers all
births and deaths, issues birth and death certificates, and compiles and disseminates vital
statistics, including cause of death information.

Health Records and Reports

A comprehensive compilation of information traditionally placed in the medical
record but also covering aspects of the client’s physical, mental, and social health that do
not necessarily relate directly to the condition under treatment.

Disease Registries
A disease registry is a special database that contains information about people
diagnosed with a specific type of disease. Most disease registries are either hospital based
or population based. A hospital-based registry contains data on all the patients with a
specific type of disease diagnosed and treated at that hospital. A population-based registry
contains records for people diagnosed with a specific disease type who reside within a
defined geographic region. For example, a hospital can have a breast cancer registry with
records for all the women in their breast cancer treatment program. The hospital-based
registry would not include all the women with breast cancer in the community, since some
women may go elsewhere for treatment.

Census Data
Information about the members of a given population collected from a government
census. A census is a regularly-occurring and official count of a particular population.
Census data provides more than just a population count. Other variables include ethnicity
breakdowns, income, and housing values.

Methods to present Community Data

There are many ways in which you can present community numerical data. There
will likely be occasions when you have numerical information that you want to include in
your assessment, for example figures and other statistics from secondary sources (such as
registry of vital events, health records and reports, disease registry and census data); the
results of survey; or data that you have collected and analyzed as a result of observation.
Such information can be used to illustrate an argument or concisely convey complex or
detailed information.

Bar Graph
Bar charts are one of the most commonly used types of graph and are used to
display and compare the number, frequency or other measure (e.g. mean) for different
discrete categories or groups. The graph is constructed such that the heights or lengths of
the different bars are proportional to the size of the category they represent. Since the x-
axis (the horizontal axis) represents the different categories it has no scale. The y-axis (the
vertical axis) does have a scale and this indicates the units of measurement. The bars can be
drawn either vertically or horizontally depending upon the categories and length or
complexity of the category labels. There are various ways in which bar charts can be
constructed, making them a very flexible chart type.
Histogram
Histograms are a special form of bar chart where the data represent continuous
rather than discrete categories. For example, a histogram could be used to present details of
the average number of hours exercise carried out by people of different ages because age is
a continuous rather than a discrete category. However, because a continuous category may
have many possible values the data are often grouped to reduce the number of data points.
For example, instead of drawing a bar for each individual age between 0 and 65, the data
could be grouped into a series of continuous age ranges such as 16-24, 25-34, 35-44, etc.
Unlike a bar chart, in a histogram both the x- and y-axes have a scale. This means that it is
the bar area that is proportional to the size of the category represented and not just its
height.

Pie Charts
Pie charts are a visual way of displaying how the total data are distributed between
different categories. The example here shows the proportional distribution of visitors
between different types of tourist attractions. Similar uses of a pie chart would be to show
the percentage of the total votes received by each party in an election. Pie charts should
only be used for displaying nominal data (i.e. data that are classed into different categories).
They are generally best for showing information grouped into a small number of categories
and are a graphical way of displaying data that might otherwise be presented as a simple
table.

Line Graph
Line graphs are usually used to show time series data – that is how one or more
variables vary over a continuous period of time. Typical examples of the types of data that
can be presented using line graphs are monthly rainfall and annual unemployment rates.

Scatter Plots
Scatter plots are used to show the relationship between pairs of quantitative
measurements made for the same object or individual. For example, a scatter plot could be
used to present information about the examination and coursework marks for each of the
students in a class. In the example here, the paired measurements are the age and height of
children

Community Diagnosis
In the assessment of the community’s health status, the nurse considers the degree
of detail or depth she should go into. A nurse may decide to assess a specific population
group in a community, in which case, she may not opt to conduct 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
resources and time available to implement.

Traditional/ Comprehensive Community Diagnosis

A comprehensive community diagnosis aims to obtain general information about
the community. The following are the elements of a comprehensive community diagnosis:

Demographic variables
The analysis of the community’s demographic characteristics should show the size,
composition and geographical distribution of the population as indicated by the following:
 1. Total population and geographical distribution including urban-rural
index and population density.
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth rate, crude death
rate and life expectant at birth
4. Patterns of migration
5. Population projections

It is also important to know whether there are population groups that need special
attention such as indigenous people, internal refugees and other socially dislocated groups
as a result of disasters, calamities and development 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 community's health status. However, the nurse should
consider the following essential information: Social Indicators, Economic Indicators, and
Environmental Indicators, Cultural Factors

Political/ Leadership Patterns

The process of community diagnosis consists of collecting, organizing, synthesizing,
analyzing and interpreting health data. Before the community health nurse collects data, the
objectives must be determined 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.
1. Determining the Objectives. In determining the objectives of the community
diagnosis, the nurse decides on the depth and scope of the data she needs to gather.
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.
3. Determining the Data to be Collected. Whether the community diagnosis is going to
be comprehensive or focused on specific problem, the objectives will guide the
nurse in identifying the specific data she will collect.
4. Collecting the Data. In conducting community diagnosis, different methods may be
utilized to generate health data. In general, we use the methods such as records
review, surveys and observations, interviews, and participant observation.
5. Developing the Instrument. Instruments or tools facilitate the nurse’s data gathering
activities. The most common instruments are survey questionnaire, interview guide
and observation checklist
6. Actual Data Gathering. Before the actual data gathering, it is suggested that the
nurse meet the people who will involved in the data collection. The data collectors
must be given an orientation and training on how they are going to use the
instruments in data gathering. During the actual data gathering, the nurse
supervises the data collectors by checking the filled-up instruments in terms of
completeness, accuracy and reliability of the information collected.
7. Data Collation. After data collection, the nurse is now ready to put together all
information. There are two types of data that may be generated. They are either
numerical data which can be counted or descriptive data which can be described.
8. Data Presentation. Data presentation will depend largely on the type of data
obtained. Descriptive data are presented in narrative reports.
9. Data analysis in community diagnosis aims to established trends and patterns in
terms of health needs and problems of the community. It also allows for comparison
of obtained data with standard values.
10. Identifying Community Health Nursing Problems. Community health nursing
problems are categorized as:
a. Health status problems is described in terms of increased or decreased
morbidity, mortality, fertility, or reduced capability for wellness.
b. Health resources problems is described in terms of lack of or absence of
manpower, money, materials, or institutions necessary to solve health problems,
c. Health related problems is 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 is to
prioritize which health problems can be attended to considering the resources
available at the moment. In priority setting, the following criteria:
a. Nature of the condition/problem presented- problems are classified by the
nurse as health status, health resources or health-related problems.
b. Magnitude of the problem-refers to the severity of the problem which can be
measured in terms of the proportion of the population affected by the problem.
c. Modifiability of the problem-refers to the probability of reducing, controlling or
eradicating the problem.
d. Preventive potential-refers to the probability of controlling or reducing the
effects posed by the problem.
e. Social concern-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.
 Criteria Weight
Nature of the problem
Health status 3
Health resources 2 1
Health-related 1
Magnitude of the problem
75%-100% affected 4
50%-74% affected 3 3
25%-49% affected 2
<25% affected 1
Modifiability of the problem
High 3
Moderate 2 4
Low 1
Not modifiable 0
Preventive potential
High 3
Moderate 2 1
Low 1
Social Concern
Urgent community concern; express readiness 2
Recognized as a problem but not needing urgent 1 1
attention
Not a community concern 0

Figure 8: Nursing Process in

the Community Source:
Nursing Care of the
Community,(2013)

Participatory Action Research

Participatory Action Research (PAR) is an approach to enquiry
which has been used since the 1940s. It involves researchers and
participants working together to understand a problematic situation and
change it for the better. There are many definitions of the approach, which
share some common elements. PAR focuses on social change that
promotes democracy and challenges inequality; is context-specific, often
targeted on the needs of a particular group; is an iterative cycle of research,
action and reflection; and often seeks to ‘liberate’ participants to have a
greater awareness of their situation in order to take action. PAR uses a
range of different methods, both qualitative and quantitative.
Its fundamental principles are that the research subjects become
involved as partners in the process of the inquiry and that their knowledge
and capabilities are respected and valued. Participatory research is
ultimately about relationships and power. The key contacts are between
the researcher and the researched, and between local people
and those actors they see as powerful and who affect their lives.
Participatory researchers act as facilitators and work towards attaining
equality in these two relationships. Local people involved in participatory
research processes are often subordinate in their own social context, while
outside researchers are often perceived as experts who impose their views.
Transforming these dynamics is achieved by enabling local people to
articulate their views and express their knowledge by describing and
analyzing their own situations and problems. Many participatory research
processes also have an action component that involves the participants in
successive cycles of analysis, reflection and action.

Figure 7: Five Phases of PAR

source: Nursing Care of the Community,(2013)