COMMUNITY HEALTH NURSING

NURSING PROCESS

PRESENTED BY,
SHINI
NURSING TUTOR
PNS
 STEPS OF NURSING PROCESS
1.COMMUNITY IDENTIFICATION;-
I) PLACE OR SPACE
It includes following components:-
 Geographical areas: Size, census blocks, climate, name of area, location tec.
 Geopolitical boundaries: politics in our country has important effect on the geographical
areas & administration of community.
 Means of transportation: Foot, bullock cart, bus, boat, train, air etc.
 Physical environment: Land use patterns, housing condition etc.
II) PERSON OR PEOPLE
 It includes demographic & social characteristics of the community.
 It is a well established fact that without people, there is no meaning of community.
 For the identification of community, demographic setup of community should be
properly identified.
III) FUNCTION
• Maintenance of social control.
• Employment/unemployment/partial/seasonal employment status of the community.
• Socialization of the new members.
• Production, distribution system & consumption of goods & services.
• Adaptation of ongoing & expected changes.
• Provision of mutual aid, co-operation.
• Description of functions related to cast or religion etc.
 POPULATION COMPOSITION

It implies all the basis information about the residents of identified community. It includes
the following social & demographic structure of the community;-
• Size or no. of density of the population.
• Structural characteristics such as age, sex, socio economic, racial & caste distribution.
• Rural & urban character & dependency ratio of population.
• Formal groups such as families, schools, temples, mosque, churches, gurudwaras,
industries, business, governmental bodies, NGOs, voluntary, social health & welfare
agencies etc.
• Informal group such as community, clubs, labour centres, fans, associations, friendship
networks, workers club etc.
• Demographic structure of vulnerable groups (mother, child, handicapped etc.)
 HEALTH & ALLIED

For the successful achievement of the community health nursing process, community health nurse should
have the information about the following resources.
• I) HEALTH RESOURCES
• a) Health institutions
• Health facilities such as hospitals, teaching hospitals, dispensaries, FRUs, CHCs, PHCs, ESI hospitals,
nursing homes, maternity or other special hospitals (in government or private sectors) or health
institutions.
• School or industrial health services.
• Voluntary health association.
• National health programmes.
• Health related planning & working groups.
• Health manpower such as physician, nurses, epidemiologist, dentists, sanitary workers, social worker
etc.
• Health care delivery system & utilization pattern to compare the desired outcome & available resources.
• AYUSH.
• b) Health service resources
• Health services for reproductive & child health care.
• Health services elderly, workers, handicapped etc.
• Health counselling services etc.
• II) ALLIED RESOURCES
• Natural resources: - Water, land & soil, electricity etc.
• Financial aid services:-Health insurance, LIC, mediclaim, insurance services, religious financial aid services
etc.
• International financial support & schemes.
• Voluntary agencies working in the field of community welfare (orphans, ashrams tec.)
• Transportation resources.
• Information, education & communication resources (mass media resources).
• Nutritional services.
• Employment services.
• Institutional resources, educational, welfare agencies.
• Legal resources:- Existing public health laws such as environmental protection act, child labour act, MTP &
PC-PNDTA etc. along with the laws, legal aid or help forums should be find out, which can be helpful in
implementing the C.H.N. process.
• Counselling services other than health available in the community.
• Professional resources: - Journals, associations etc.
 APPLYING NURSING PROCESS
Five phases of nursing process are applied in community health setting or community as a patient.
I)C.H.N. ASSESSMENT:-
C.H.N. assessment is an organised & systematic method of assessing the identified community for
i) Determining the health status.
ii) Identifying potential risk factors which may cause ill-effect on health.
iii) Finding the existing health problems in the community.
• Data collection & interpretation:-
• Information of the community & its health.
• Data gathering:-
• -These include demographic data (age, sex, socio-economic, cast, racial, information tec.)
• -Vital statistics (IMR, MMR, life expectancy & other morbidity, & mortality data).
• Data generation:-
• These data involves values & rituals, traditions & customs, goals & needs, community which knowledge &
belief, norms, problem solving process.
• Data interpretation:-
• A complies data-base (data gathered+ data generated) is interpreted & community health
problems & strengths are indentified.
• Analysing, synthesizing, and identifying C.H. problems strength & available resources.

2. Tools of data assessment & interpretation:-

• Informative interviews:-
• Direct conversation with the selected members of community about community group, members
& events.
• Participation observation;-
• Is the conscious & systematic sharing in the activities & occasion for collecting data.
• Secondary analysis of existing data:-
• It refers to use previously gathered data such as minutes from community meetings. These are
valuable, economical & efficient also.
• Surveys:-
• It is conducted from the selected groups of persons, such as sample surveys groups of
persons, such as sample surveys provides data about community & its health status.
• Major surveys like demographic survey, geographic surveys, environmental mental
survey, nutritional survey etc. can be also used for the assessment.
• Windshield:-
• It is equivalent to simple observation in which community life & environment can be
carefully observed through an automobile windshield.
• i.e. housing quality, common sanitary habits, community gathering places, geographic &
geopolitical dimension etc.
II)COMMUNITY DIAGOSIS:-
• Community diagnosis is the scope of disciplines, epidemiology & nursing both try to
identify the health problems of community & establish the priorities of health needs of
the community.
• C.H.N. diagnosis is formulated on the basis of problems present in the community.
• Problems which are directly related health & its various components: - low birth baby,
infant malnutrition, malaria etc.
• Problems of health service system: - lack of health care agencies, lack health personnel &
resources, uneven distribution of health institution, poor referred services etc.
• Problems related IEC: - lack of awareness & information, poor medical management,
improper communication, inappropriate health education, poor transportation facilities
etc.
• General problems affecting health:- low education status, unemployment, overcrowded
community, discomfort zones, population of sound air, water etc. poor disposal
management, natural calamities, poverty, lack of sex child & women abuse, education,
inadequate water supply etc.
III)PLANNING:-
• Problem analysis & establishing priorities: - analysis of problem clarifies the nature of the
problem.
• Establishing gaols & objectives: - after the problem prioritization relevant goals & objectives are
established. Establishing goals & objectives involves collaboration between the nurse &
representatives of the community group which care are related problems & proposed
intervention.
• Identifying intervention: - interventions describe & clarify what is to be done & in what way it is
to be done.
IV)IMPLEMENTATION(conducting community health nursing care services): -
• Implementation is the fourth stage of nursing process which aims at the nursing action or
work activities.
• Implementation may be made by the person or group, who established the goals &
objectives or they may be shared or if necessary even they can be delegated to others.
• Factors affecting implementation: -
• Nurse’s role: - She may content expert, counsellor, health educator etc. which affects the
C.H.N. care implementation.
• Selection of the type of the health problem.
• Communities’ readiness to participate in problem resolution.
• The characteristics of the social change.
• Methods of intervention (Implementation mechanism): -
• Implementation mechanism are as following: -
• Small interacting groups:-
• Both formal (families, legislatives bodies, health care providers, health care recipients etc.) &
informal (social groups, neighbourhoods etc.) group have the common tie.
• Lay advisors:-
• They have higher position in the community. The village panch & sarpanch, religious persons,
ward members, key informants, and old famous lady of village. This much useful in the
community oriented intervention.
• Mass media or means of communication: -
• Mass media are effective aids in intervention. The impact of TV, computer, CDs, videos, mobiles,
internets, newspapers, journals etc.
• Health policy & public health laws: -
• The main of health policy & laws is to protect & address to collective human needs & to constrain
collective human needs & to constrain collective individual choice for the wellness of general
public.
• e.g. MTP act regulates the illegal abortions in the community.
V) EVALUATION:-
• Evaluation of the community of the C.H.N. process mainly involves two aspects: -
• i)Evaluation of the nurse performance.
• ii)Evaluation of the behavioural changes in the community.
• Nurses should evaluate whether the objectives were achieved & whether the intervention
activities used were effective.
 NURSING PROCESS

Assessment
Assessment

Evaluation Diagnosis
Evaluation Diagnosis

Implementati Goal/outcom
Implementati Goal/outcom
on e
on e

Planning
Planning
THANK YOU