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The Community Health Nursing Process Setting for community health nursing practice

homes ambulatory service settings schools occupational health setting residential institutions the community at large

Community Level

Aggregate Level

Individual or Family Level

Example: Levels of community health nursing practice

Meeting the Needs of Community or Aggregates Aggregates at risk across life span Aggregates at vulnerable conditions Examples of Populations with Population-Health Issues  Elderly persons with ongoing chronic conditions who need a broad range of services to maintain their independence in the community  Persons who drink well water  All families with newborns  All children with asthma  Sexually active teenagers  Persons who drink and drive .

(Administrator: CHN Specialist/ Top Manager) Community Focus (CHN Specialist/ Middle Manager) Staff (Generalist/ Lower Manager) Individual and Family Focus Practice Focus .

program implementation. planning. program planning.Comparison of components of specialist and generalist levels of practice Components of Practice Focus of Practice CHN Specialist Communities and populations Advanced practice Models Community assessment. and program evaluation Generalist Individuals and families Practice Models Comprehensive care of individuals and families Assessing. intervening. diagnosing. and evaluating Processes .

The Community Health Process: Using The Model Figure 1. Community as Partner (Anderson & McFarlane. 2001) .

Community Health Assessment Community as Partner Model: Assessment Wheel • Core : .Education .History • 8 subsystems: .Economics .Demographics .Physical environment .Values .Health & social services .Recreations .Politics & government .Safety & transportation .Beliefs .Communication .

Methods of Data Collections Types of Data Sources of Data for a Community Assessment Methods of Data Collections • Participants Observation • Winshield/Walking Survey • Focus groups • Key informants • Surveys • Literature Review • etc .

complete picture of what is known or not known (Burn & Groove.Data Analysis • Cognitive process of ordering data to allow for the higher-level function of synthesis (Ervin. 2002) Data Synthesis • Combining data elements from several sources to create a coherent whole or new. 2001) .

1970) .The Web of Causation • Concept that posits that effect never depend on single isolated causes but result from chains of causation in which link is the result of complex mix antecedents (MacMahon & Pugh.

The Web of Causation Pemberdayan Masyarakat di Tingkat Komunitas pada Agregat Perokok di Kelurahan Depok Tahun 2008 .Potensial peningkatan kesadaran anti rokok pada siswa SMU Pelita I Depok Ketidakmampuan perokok mengenal diri sendiri Harga diri rendah pada kelompok perokok Kebutuhan akan informasi dampak negatif rokok terhadap kesehatan Rendahnya Tingkat Pendidikan Perokok Persepsi yang salah tentang cara mengatasi stres pada perokok Buruknya persepsi terhadap dampak negatif merokok Rendahnya pengetahuan tentang dampak negatif merokok Mekanisme koping tidak efektif pada kelompok perokok Buruknya persepsi terkena dampak negatif merokok Ketergantungan terhadap nikotin Resiko terjadinya penyalahgunaan napza pada kelompok perokok Rendahnya kesiapan berhenti merokok Persepsi yang salah tentang manfaat merokok Rendahnya niat berhenti merokok Pengaruh pergaulan sesama perokok Mudahnya akses terhadap rokok Kerterjangkaun terhadap rokok Kebiasaan merokok di sembarang tempat Resiko terjadinya penyakit akibat merokok pada perokok Rendahnya dukungan keluarga dan masyarakat untuk kegiatan berhenti merokok Resiko terjadinya paparan asap rokok pada perokok pasif Gambar 6.

trend. Helvie.Community Diagnosis • Stating the conclusions drawn from synthesis of the data (Anderson & Mcfarlane. 1984) . 1984) • Statement of risk. Mucke. or latent situation about a community or population (Watson. condition. potential problem. 1998. 2000. strength.

g. three community coalitions formed to deal with potential environmental hazards) – Trends (e...g.Community Diagnosis • Community Diagnoses may be formulated about: – Health issues (e..g..g.. 30% community residents below poverty level) – Strengths (e.g. increasing employment opportunities) . infant mortality) – Housing conditions (e. high lead content in interior paint) – Economics conditions (e.

Formulating Community Diagnosis: Comparison Approaches Approach Conclusion Description of community Characteristics of community Indicators of Conclusion Muecke (1984) Risk of / Presence of Among Related to As demonstrated in Anderson & McFarlane (2000) Potential / actual health problem or concerns Among Related to As demonstrated by .

.Example of a Community Diagnosis • Risk of death among infant born in the …… community related to: – 12% of infants had low birth weight – 24% of birth in 1998 were female 18 years of age and younger – 46% of women in 1998 had inadequate prenatal care – An infant mortality rate of 12 deaths per 1000 live births in 1998 – Etc.

. ……………………… ……………………… ……………………… 1.. Goal 1: …………………. …………………… …………………… …………………… 1. .3.1. Structure: ……………. Objectives : 1. Process: ……………… Output: ………………. Structure: ……………. …………………… …………………… …………………… Structure: …………….1... ……………………… ……………………… ……………………… 1.3..Planning Community Diagnosis Goal/Objectives Interventions Evaluation Indicators 1..2.. Process: ……………… Output: ………………. …………………… …………………… …………………… 1.2.. ……………………… ……………………… ……………………… 1. …………………….. Process: ……………… Output: ……………….

1: to decrease the number of smokers in the worker population from 25% to 22% in two years by providing smoking cessation programs for all work sites in the county • Objective 1.2: to gain commitment from one-half of the work sites in the county to sponsor smoking cessation programs within one year .Example of Objectives • Goal 1: to decrease deaths due to smoking among community residents • Objective 1.

Community Health Nursing Interventions .

Community Health Nursing Interventions: Systems Focused .

CHN Interventions: Community Focused .

CHN Interventions: Individual Focused .

CHN Interventions Example: Advocacy .

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Implementing • Carry out plan to the community Evaluating • Refers to evaluation indicators at planning stage .