MODULE 4

Community Health Assessment

 Nursing Process in the Care of Population Groups and Community

Nursing Process in Community Health

1. Assessment
2. Diagnosis
3. Planning and outcome identification
4. Implementation
5. Evaluation

Scientific Method

 Select/define a problem
 Formulate research question/hypothesis
 Collect data
 Analyze data
 Report results

Community as Client
 A community-wide group of people as the focus of nursing service.
 The community directly influences the health of individuals, families,
groups, subpopulations, and populations who are a part of it.
 Provision of most health services occurs at the community level.
Nursing Process in Community Health Nursing

 The nursing process directs the CHNs in providing care to meet a clients’ health
needs, whether the client is an individual, a family, group or community.
 Description of Nursing Process as an efficient method of organizing thought
process for clinical decision making and problem solving

Nursing Process Characteristics & Community

 Problem-solving process; management process; process for implementing

change
 Characteristics:
 Deliberative; adaptable; cyclic; sequential
 Client-focused; need-oriented; goal-oriented
 Interaction with community (communication, reciprocal interaction, paving
way for helping relationship, aggregate application)
 Forming of partnerships and building of coalitions

Community Assessment

 Prior to nursing action, client is assessed to determine his/ her health status and
the need for nursing intervention.
 Assessment is “the act of reviewing a human situation from a data base in order
to affirm the wellness state and diagnose potential client problems; to affirm an
illness state, diagnosing the client’s prevailing problems, determining the
potential for problems and identifying the wellness aspects of the ill client”.
 The definition of assessment indicated: -
 Determination of a client’s health problem
 Identification of strengths and weaknesses and the clients state of health
 Types of data:
 Subjective or objective
 Current or historical
 Data collection methods:
 Interviews
 Physical examination
 Review of records
 Diagnostic reports
 Collaboration with colleagues
 CHNs collect wider array of data than nurses in other specialty areas
 They gather data on groups of people as well as individuals and families

Community Assessment and Analysis

 It is a technique that may be used to determine the health status, resources, or

needs of a group of population, through it CHN :
 Determines how a community influence health
  Explores the relationship between a variety of community variables and
the health of its occupants

Dimensions of Community Assessment

 Population - Analyzing the characteristics of people in the community

 Size, density, composition, rate of growth or decline, cultural
characteristics, social class and educational level, mobility, morbidity
and mortality rates.

 Place - Where the community is located and its boundaries

 Community boundaries, location of health services, geographic
features, climate, flora, fauna, human- made environment

 Social systems
 Economic, educational, religious, political and legal systems.
 Human services, opportunity for recreation, common power systems,
official and voluntary health agencies, stores and industries, safety and
communication dynamics.

Additional Dimensions in Community Assessment

 Socioeconomic patterns
 The high indicates available health facilities

 Environmental factors
 Condition of houses
 Crowding index
 Presence or absence of electricity
 Ventilation
 Sanitation
 Water supply
 Presence of safety measure

 The cultural patterns

 How values and beliefs and attitudes influence the health patterns

 Data about channels of communication

 Data related to vital statistics

 Basic to the development and evaluation of community health programs

 Data related to health patterns and health facilities

 Most common diseases, vaccination programs, and health education
programs
Methods of Data Collection in Community Assessment

 Windshield survey
 Equivalent to a simple head –to-toe assessment
 Observer drives through a chosen neighborhood and uses the five senses
and observation to assess the neighborhood
 Common characteristics about the way people live
 Where do they live
 Type of housing

 Informants interviews
 Interviewing community residents: -
 Key informants: Individuals in power position, such as leaders in local
government, schools, religion…… etc.
 General public: random residents in the community.
- Random telephone or face to face
- Street interviews
 Interviews might be structured or unstructured

 Participants observation
 The CHN observe formal and informal communities to determines signs or
events
 Formal community: Local government, school, board meeting
 Informal community: Coffee shop, street
 Effective to assess: -
 Values, norms and concerns of community
 Power system and how decisions are made

 Secondary analysis of existing data

 Assessing existing data sources: -
 Records, documents and other previously collected information
 Data bases from official and non-official facilities

 Constructed surveys
 A set of prepared specific questions given to a random sample in the
community
 It is time consuming and expensive

Nursing Diagnosis

 Diagnosing client health status

 The nurse identifies the client’s health status and formulates nursing
diagnosis.
 The nursing diagnosis is “a clinical judgment about an individual, family or
community response to actual or potential health problem/ life process” (NANDA,
1990)
 Nursing diagnosis includes
 Classification into specific categories
 Socioeconomic health status
 Physiological
 Psychological …………….etc.

 Interpretations
 Involves comparison of client-specific data with known norms and
standard
 Make inferences based on data (Hypothesis evaluation) which is possible
explanation of client’s condition

 Validation (Hypothesis evaluation)

 Tested by collecting additional data
 Verify or disconfirm

 Formulating nursing diagnosis

 Diagnostic statement that may reflect positive status of health as well as
health problems

 NANDA identified three types of diagnosis

 Actual
 High risk (Potential)
 Wellness

 Structure of nursing diagnosis

 Client’s state: Problem label
 Etiology: The actual or the risk factors for potential problems
 Defining characteristics

 The structure of wellness

 Only descriptive statement
 Enabling factors and strengths

 Nursing diagnosis and Community Health Nursing

 CHNs develop broader range of nursing diagnosis
 Individuals
 Family
 Group
 Community
 The probable cause of the problem or etiology provides direction for
problem solution
 The factors identified as contributors to positive health state indicate areas
for support and reinforcement by CHNs
Planning

 Planning is defined as collaboration, orderly, cyclic process to attain a mutually

agreed on desired future goals”.
 It includes primary, secondary, tertiary preventive actions
 Planning consists of 6 basic tasks
1. Prioritizing nursing interventions
 Clients usually with multiple health needs
 Priority according:
 Degree of threat to health (Maslow hierarchy)
 Clients’ concerns
 Ease of solution
 Problem contribution to other problems
2. Developing goals and objectives
3. Establish criteria to achieve goals
 Alternative actions to achieve goals
4. Selecting appropriate means to achieve goal
5. Designing nursing interventions
 Specific statement of actions
 Nurse client collaboration is needed
6. Planning evaluation
 Plan how to evaluate outcomes, what data, how to collect

Implementation

 Organizing and carrying out the plan of care

 Tasks 4-6
 Intervention scheme: it is four categories of nursing interventions to direct the
development of nursing care plan: -
 Health teaching
 Guidance
 Counselling
 Surveillance

 Implementing nursing care

 Identifying requested knowledge and skills needed to implement the plan
and identify the most appropriate person to implement a segment of the
plan
 Designating responsibility for implementation
 Assign those responsible for carrying out the planned interventions
 They should have the authority to perform activities
o Delegation
o Referrals
 Recognizing impediments to implementation
 Constraints that may impede (Modify or eliminate them)
 Communicating the plan
  Providing an environment for implementation
 Resources (time, personnel and equipment)
 Comfort (physical and psychological)
 Client’s safety
 Carrying out the planned activities

Evaluation of nursing care

 It is “systematic comparison of clients’ health status with the outcomes”.

 Outcome evaluation
 Process evaluation
 Activities involved are: -
 Selection of observable criteria related to the desired goals of clients’
 Collection of relevant information
 Comparison of the information collected with the selected criteria
 Judgment and decision making
 Feedback and modification of nursing care plan
 Possible decisions based on evaluative findings: -
 Interventions effective and objectives were met
 Objectives were not met and another approach should be tried
 No make change in quality of performance

Documentation of nursing process Remember Care not written is Care NOT DONE

https://www.slideshare.net/ManalHaija/community-nursing-process