The Community Health

Nursing Process

Assessment of Community
Health Needs

Ajpelongco RN, MN
 An Introduction

• Community – “Primary client” of

the CHNurse
• 2 important reasons WHY?
1. It has a direct influence on the
health of the individual, families
and the sub-populations
2. It is at this level that most health
service provision occurs
Community Health Nurses will
also deal with these
community characteristics in
planning and developing
specific programs and in
ensuring the delivery of
effective health services
• CHNurses - COMMUNITY
ASSESSMENT as part of
public health function
• Nursing students-
COMMUNITY ASSESSMENT
as a compulsory requirement of
the Nursing curriculum
• CHNurses and Nursing students
-assess the data;analyze and
interpret the data and diagnose
the health status of the
community
• The data from the eight
subsystems are useless
and meaningless – they
have to be useful to the
people
• They must be used in the
Nursing Process for the
benefit of the community
• Best persons to assess the
community’s health condition and
status are the CHNurses and
Nursing students who interact
with them and observe their social
environment
• The Nurses’ assessment & diagnosis
serve as the basis of rural health
unit or health office for community
health planning because they
provide information on the
community health concerns, needs
and priorities
• All these information
obtained from the
community are very
useful in community
nursing in particular
and community health
development in general.
• They are very useful in improving
the health status of the community
through strategic and operational
planning in community health.
• Thus, Community Health
assessment is a fundamental tool
of CHNurses
 Assessment

• Process of collecting, organizing,

processing, and analyzing data or
information obtained from the client
and other sources
Community Health Assessment
• A process by which community
members gain an understanding
of the health, concerns, and
health care systems of the
community by identifying,
collecting, analyzing, and
disseminating information on
community assets, strengths,
resources and needs
Community Diagnosis
• Diagnosis – process of
identification of the client’s
needs and problems based on
the analysis of data and or
information gathered
“they are just the same”
• Community Assessment
• Community Diagnosis
• Situational Analysis
Components of Community Health
Needs Assessment
• Health status – health condition,
health illness pattern and trend
(causes of morbidity/mortality);
health knowledge, attitudes, practice
• Health resources – RHU, BHS,
hospitals & specialty clinics,
equipment & facilities; manpower
resources, financial resources)
• Health action potential – health
implementation and services
Types of Community
Assessment/Diagnosis
• Comprehensive Diagnosis –
aims to obtain a general
information about the
community
• Problem-Oriented or
Focused Diagnosis – specific
problem in the community
Elements of Comprehensive
Diagnosis:
• A. Demographic Variables –
size, composition and geographical
distribution of the population
1. total population
2. Age and sex composition
3. Selected vital indicators –
growth rate, life expectancy at birth,
crude birth rate, crude death rate
 4. Patterns of migration
5. Population Projection

B. Socio-Economic & Cultural Variables

1. Social Indicators:
* Communication Network
– disseminate health info

* Transportation System –
accessibility of
people to HCDS
* Educational Level – indicative of
poverty & may reflect on health
perception
* Housing Conditions – which may
suggest health hazards
2. Economic Indicators –
* Poverty level income
* Unemployment & underemployment
* Monthly income vs. monthly expenses
* types of industry present
* occupation common in the
community
3. Environmental Indicators
a)
Physical/geographical/topographical
characteristics of the
community

 land areas
 terrain characteristics
 land usage in industry
 climate/season
 b) Water Supply –
 Sources of water
 % population w/ access to
safe & adequate water
supply
c) Waste disposal-
 % of population served by
daily garbage collection
system
 % population with safe
excreta disposal system
 types of waste disposal &
garbage disposal system
 d) Air, Water, and Land Pollution

4. Cultural Factors
 Variables that may break up
people into groups in the
community– social class, language,
religion, race, political orientation
 Cultural beliefs and practices
that affect health
 Concepts about health and illness
C. Health and Illness Patterns
 Leading cause of mortality
 Leading cause of
morbidity
 Leading cause of infant
mortality
 Leading cause of maternal
mortality
 Leading cause of hospital
admission
D. Health Resources –
 essential ingredients in the
delivery of basic health services
 Manpower Resources &
Material Resources
E. Political/Leadership Patterns
reflects action potential of the
government to address the health
needs & problems of the
community
Process of Community Diagnosis:
• Collecting
• Organizing
• Synthesizing
• Analyzing
• Interpreting
Steps in Conducting Community
Diagnosis:
1. DETERMINING OBJECTIVES
Nurse decides on the depth and
scope of the data she needs to
gather
2. DEFINING THE STUDY
POPULATION
Nurse identifies the population
group to be included in the study
3. DETERMINING THE DATA TO BE
COLLECTED
Objectives will guide the nurse in
identifying the specific data she will
gather
she decides on the sources of these
data
4. COLLECTING THE DATA
different methods:
Records Review- from health &
nonhealth agencies
Surveys & Observations
Interviews
Participant Observation – nurse
actively participate in the life of the
community “immersion”
5. DEVELOPING THE INSTRUMENT
Or TOOLS to facilitate the
nurse’s data gathering activities
Most common instruments:
• Survey Questionnaire
• Interview Guide
• Observation Checklist
6. ACTUAL DATA GATHERING
7. DATA COLLATION
2 types of data:
Numerical data which can be
counted
Descriptive data which can be
described
8. DATA PRESENTATION
Narrative reports or presented
into table or graphs
9. DATA ANALYSIS
• for comparison of obtained
data with standard values
• nurse view the significance
of the problems and their
implication on the health
status of the community
10. IDENTIFYING THE COMMUNITY
HEALTH NURSING PROBLEMS
Community health problems – are
conditions or situations that
intervene with the community’s
capability to achieve wellness.
Categories of CHNsg. Problems:
1. Health status problems
― increased or decreased morbidity,
mortality, fertility
― reduced capability for wellness
2. Health resource problems
― Lack of or absence of manpower, money,
materials or institutions necessary to solve
health problems
3. Health-related problems
― social, economic, environmental and
political factors that aggravate the illness
producing situations in the community
11. PRIORITY SETTING
Criteria:
a) Nature of Condition/problem
presented
Classification:
• Health status
• Health resources
• Health- related
problems
b) Magnitude of the problem – severity of
the problem that can be measured in
terms of the proportion of the population
affected by the problem
c) Modifiability of the Problem –
probability of reducing, controlling or
eradicating the problem
d) Preventive Potential – probability of
controlling, reducing the effects posed
by the problem
e) Social Concern – perception of the
population/community as they are
affected by the problem and their
readiness to act on the problem
 Criteria Weight
Nature of the problem 1
health status 3
health resources 2
health-related 1
Magnitude of the problem 3
75% - 100% affected 4
50% - 74% affected 3
25% - 49% affected 2
<25 % affected 1
Modifiability of the problem 4
High 3
Moderate 2
Low 1
Not modifiable 0
Preventive potential 1
High 3
Moderate 2
Low 1
Social Concern 1
urgent community concern; expressed readiness 2
recognized as a problem but not needing urgent
attention 1
TOOLS USED IN COMMUNITY
DIAGNOSIS
1. DEMOGRAPHY
Science which deals with the
study of the human :
population’s size
Composition
and distribution in space
Population Size – number of people
in a given place or area at a given
time
Composition – characterized by sex,
age, occupation or educational
level
Distribution in space – describes
how people are distributed in a
specific geographic location
 Population Size
• Not only know how large or small the
population is
• But to make comparisons between
population changes in time
• And helps rationalize types of health
programs or interventions that will be
provided in the community
 Population Composition
Commonly described in terms of
age and sex

Nurse uses this data to decide who

among the population group
merits attention in terms of
health services and programs
Calculations:
1. Sex Composition –
computes for sex ratio
( compares # of males to # of
females in the population)
Sex Ratio = # of males x 100
# of females
sex ratio represents the # of males
for every 100 females in the
population
2. Age Composition

a) Median Age – divides the

population into two equal parts
ex: if median age is said to be 19
years old, it means half of the
population belongs to 19 years and
above, while the other half belongs
to ages below 19 years old
b) Dependency Ratio – compares the
number of economically dependent with
the economically productive group in the
population
Economically dependent – 0-14 & 65
and above age groups
Economically independent – 15 to 64
years old

Dependency ratio represents the

number of economically dependent for
every 100 economically productive
 Population in Space
1. Urban-rural distribution – illustrates
proportion of the people living in urban
compared to rural areas
2. Crowding Index – describes the ease by
which a communicable disease will be
transmitted from one host to another
susceptible host
3. Population Density – how
congested the place is and has
implications in terms of the
adequacy of basic health services
present in the community
 16.. Evaluating Process of
Action Community Diagnosis

15. Action 1. Exposure/Immersion

14.Planning action & 2. Establish working

Health Program Relationship w/ com.
(HPP) leaders

13. Feedback to relevant

3. Specifying what can
Groups & work w/
Be investigated & where
Them on implications/
(objectives)
options

4. Planning the data collection

12. Preparation of Methods & tools
Report (survey &
Questionnaires)

5. Training interviewers
11.Analysis of data & 6. Pretesting
Determining implications 7. Reworking data
collection./instruments
8. Determining
9. Data Collection &
Sampling
10. collation
procedures