a. Nursing Process in the care of Population, Groups, and Community.

Community health purposes and goals are realized through the application
of a series of steps that lead to desired results. The nursing process is central to
all nursing actions; it is the very essence of nursing, applicable in any setting, in
any frame of reference, and within any philosophy. Its uniqueness will depend on
the best application of nursing and public health skills to family and community
problems.
The nursing process is a systematic, scientific, dynamic, on-going
interpersonal process in which the nurses and the clients are viewed as a system
with each affecting the other and both being affected by the factors within the
behavior. The process is a series of actions that lead toward a particular result.
This process of decision-making results in the optimal health care for the clients
to whom the nurse applies the process.
A. ASSESSMENT
Assessment provides an estimate of the degree to which a family, group
or community is achieving the level of health possible for them, identifies
specific deficiencies or guidance needed and estimates the possible effects of
the nursing interventions
The assessment process involves the following steps which are taken with
the active participation of the client/s especially in decisions made:
A. Collection of Data
Relevant data are collected on the health status of the family, groups and
community: demographic data, vital health statistics, community dynamics
including power structure, studies of disease surveillance, economic,
cultural and environmental characteristics, utilization of health services by
the population; and on individuals and families; health status, education,
socio-cultural, religious and occupational background, family dynamics,
environment and patterns of coping.
Various methods are employed to collect data: community surveys;
interview of individuals, families, groups and significant others; observation
of health-related behaviors of individuals, family groups and environmental
factors; review of statistics; epidemiological and relevant studies; individual
and family health records; laboratory and screening tests and physical
examinations of individuals.

These data are collected systematically and continuously, then are recorded
in appropriate forms and kept systematically so that retrieval of information
is facilitated. Collected data are treated confidentially
B. Categories of Health Problems
Health deficits, health threats and foreseeable crisis or stress points are
categories of health problems. The community health nurse analyzes the
 data in accordance with the nurse's conception of the source of the client's
problems and needs that can be met through nursing intervention. The
nursing diagnoses are interpreted and validated with individuals, members of
the community and family groups concerned. Their capabilities and
limitations to cope are identified.
 A health deficit occurs when there is a gap between actual and
achievable health status. Exploration and evaluation of possible
precursors of health deficits such as history of repeated infections or
miscarriages are noted. No regular health check-up is another example.
 Health threats are conditions that promote disease or injury and prevent
people from realizing their health potential. An example of a health threat
is when the population is inadequately immunized against preventable
diseases.
 Foreseeable crisis includes stressful occurrences such as death or
illness of a family member.
 A health need exists when there is a health problem that can be
alleviated with medical or social technology.
 A health problem is a situation in which there is a demonstrated health
need combined with actual or potential resources to apply remedial
measures and a commitment to act on the part of the provider or the
client.

The process of assessment in community health nursing includes: intensive

fact finding, the application of professional judgment in estimating the
meaning and importance of these facts to the family and the community, the
availability of nursing resources that can be provided, and the degree of
change which nursing intervention can be expected to effect.

B. PLANNING NURSING ACTIONS / CARE

The plan for nursing action or care is based on the actual and potential
problems that were identified and prioritized. Planning nursing actions include
the following steps:

I. Goal Setting

A goal is a declaration of purpose or intent that gives essential direction to

action. Specific objectives of care are made with the individual/family in
terms of activities of daily living and adaptive functioning based on remaining
capabilities resulting from this condition and capability to cope with stress
associated with his/her disease condition or environment. These objectives
 are stated in behavioral terms: specific, measurable, attainable, realistic and
time bounded. The nurse prioritizes these objectives.

II. Constructing a Plan of Action

The planning phase of community health nursing process is concerned with

choosing from among the possible courses of action, selecting the
appropriate types of nursing intervention, identifying appropriate and
available resources for care and developing an operational plan.

The courses of action may have positive and/or negative effects. The
positive consequences must be weighed against those with negative
aspects. The ability of the family to cope or solve its own problems and make
decisions on health matters should be considered.

The most appropriate action is selected such as those that the clients could
not perform themselves, those that facilitate actions that remove barriers to
care and those that improve the capacity of the clients to act in their behalf.

The appropriate resources are identified which include the family, the
neighborhood, the schools, the industrial population: the whole medical
system – the hospitals, clinics, public and private practitioners of medicine,
health units of welfare departments, voluntary health agencies, and other
health related agencies: non-health facilities such as social, educational, and
counseling agencies.

III. Developing an Operational Plan

To develop an operational plan, the community help nurse must establish

priorities, phase and coordinate activities.

Plans of care are prioritized in order of urgency to determine those that need
the earliest action or attention such as those that actually threaten the health
of the client (individual, family or community). These plans are broken down
to manageable units and properly sequenced. Periodic evaluation and
modification of the plan is necessary. The plan and activities should be
coordinated with the various services so that it would synchronize with the
total health program of the community.

Development of evaluation parameters is done in the planning stage od

based on standards set by the nursing services, problems identified, goals
 and priorities as reflected in the plan or program of nursing care for the
clients.

C. IMPLEMENTATION OF PLANNED CARE

In community health nursing, implementation involves various nursing

interventions which have been determined by the goals/objectives which
have been previously set. The community health nurses carry out nursing
procedures which are consistent with the nursing care plan, are adopted to
present situations which promote a safe and therapeutic environment.

Community health nurses involve the patient and his/her family in the care
provided in order to motivate them to assume responsibility for his/their care,
and to be able to teach and maintain a desired level of function, explaining
and answering questions to clarify doubts, to maximize the client's
confidence and ability to care for himself/themselves. Thus, the role of the
community health nurse shifts from direct care giver to that of a teacher.

To maintain his/her optimum level of functioning, the client needs the support
of his own knowledge and that of those around him/her. The utilization of a
support system provides a harmonious, orderly care to ale client to function
optimally. Through coordination initiated by the community health nurses, the
client is offered planned assistance.

He/she becomes his/her own best to get services for help. Friends,
neighbors, church members, community agencies, organization both
government and private are various resources that can be tapped.

The community health nurses monitor the health services provided, make
proper referrals as necessary and supervise midwives and barangay health
workers. The knowledge and skills of the midwives and barangay health
workers are continuously updated through planned education programs

Documentation is an important function of the community health nurses. This

provides data which is needed to plan the client's care and ensure its
continuity; serves as an important communication tool for various team
members; furnishes written evidence of the quality of care and the clients
received and their response to it; whether revisions were made in his/her
plan of care and whether such has been effective. They are legal records to
protect the agency and the health care providers or the client himself/herself.
They also provide data for research and education.

D. EVALUATION OF CARE AND SERVICES PROVIDED

Evaluation is interwoven in every nursing activity and every step of the
community health nurses. There are three classic frameworks from which
nursing care is delivered. An improvement in any one of these three tends to
produce favorable change in the other two.

Structural elements include the physical settings, instrumentalities and

conditions through which nursing care is given such as philosophy,
objectives, building, organizational structure, financial resources such as
budget, equipment and staff.

Process elements include the steps of the nursing process itself – assessing,
planning, implementing and evaluating; such as taking the family health data
base; performing physical examination; making nursing diagnosis;
determining nursing goals; writing a nursing care plan; performing the
necessary nursing interventions and coordination of services and measuring
success of nursing actions.

Outcome elements are changes in the client's health status that result
intervention. These changes include modification of symptoms, signs,
knowledge, attitudes, satisfaction, skill level and compliance with treatment
regimen.

Each of these frameworks permits more than one approach to quality

assurance. For example, structure can be examined from the standpoint of
agencies from which he/she receives his/her care. Process can be examined
by focusing on the actions and decisions of the community health nurse in
providing care. Outcome elements refer to the results of care provided and
the clients served, changes in the knowledge, skills and attitudes and
satisfaction of those served/including members of the nursing and health
team.

Quality assurance efforts now recommend that evaluation of structure

process and outcomes criteria be made. This will evaluate the effectiveness
of nursing care needs or changes in behavior, condition, or compliance

Evaluation based on professional practice include conformity with accepted

community and public health standards of practice, continued refinement and
enhancement of nursing skills through continued field experience and a
program of continuing education.

Evaluation of structure include cost-benefit ratio, qualifications and number

of members of the health team especially nurses in proportion to the
 populations served and the material resources in terms of quantity and
quality

Evaluation based on information gathered is utilized to improve community

health nursing services as part of the total community health services.

b. Community Health  Assessment tools

 Collecting Primary Data
 Secondary Data
c. Community Health Diagnosis