Community Health Nursing

1. Community Health Nursing Community as Client: Applying the Nursing Process Chapter 15

2. Introduction • Community health nurses work with clients at several levels: as individuals, families, • The care of communities is vital to promoting health and prevention • Community as client: refer to a group or population of people as the focus of nursing services .

3. What is healthy community • Just as health for individual is relative and will change, all communities exist in relative state of health. • a key vision for healthy communities is presented in health people 2010, the national health promotion and disease prevention agenda • 1- to increase quality and years of healthy life and • 2- to eliminate health disparities

4. DIMENSIONS OF THE COMMUNITY AS CLIENT • The health of a community can be characterized through a number of perspectives. • One perspective is examining three dimensions • Other perspective is A competent community and • Another perspective identified three features

5. DIMENSIONS OF THE COMMUNITY AS CLIENT • threedimensions— • Status- morbidity, mortality data identifying the physical, emotional, and social determinants of health • Structure- refer to it services and resources • process- reflect the community’s ability to function effectively

6. DIMENSIONS OF THE COMMUNITY AS CLIENT • A competent community • Collaborate effectively • Working consensus on goals • Agree and implement the goal • Collaborate effectively to take action

7. DIMENSIONS OF THE COMMUNITY AS CLIENT • community having three features: • (1) a location • (2) a population • (3) a social system

8. Community profile inventory: Location Perspective

9. Community profile inventory: Location Perspective

10. Community profile inventory: Location Perspective

11. Community profile inventory: Location Perspective

12. Community profile inventory: Location Perspective

13. Community profile inventory: population Perspective

14. Community profile inventory: population Perspective

15. Community profile inventory: population Perspective

16. Community profile inventory: population Perspective

17. The concept of a social system • Is an abstract concept and can be more reality understood by first considering the people who make up the community’s pop. • The various community system have a profound influence on one another.

18. Community profile inventory: social system Perspective

19. The Nursing Process For The Community As Client • Consisting of a systematic, purposeful set of interpersonal actions,

20. Nursing Process Characteristics Applied to Community As A Client • First: the nursing process is a problem-solving process • Second: it is a management process that requires situational analysis, decision-making, planning, organization, direction, and control of services, as well as outcome evaluation. • Third: it is a process for implementing changes that improve the function of various health-related systems and the ways that people behave within those system

21. Nursing Process Characteristics Applied to Community As A Client • Deliberative ( planned and calculated) • Adaptable • Cyclic • Client-focused • Interactive • Need-oriented • Interacting with the community • - need for communication • - aggregate application • Forming partnerships and Building coalitions

22. TYPES OF COMMUNITY NEEDSASSESSMENT Community needs assessment • is the process of determining the real or perceived needs of a defined community.

23. Familiarization or “WindshieldSurvey” • is a common starting place in evaluation of a community. • Familiarizationassessment involves studying data already available on a community, and gathering certain amount of firsthand data, to gain a working knowledge of the community

24. Familiarization or “WindshieldSurvey” • Windshield survey-- is used by nursing students in community health courses and by new staff members in community health agencies. • It provides a knowledge of the context in which these aggregates live and may enable the nurse to better connect clients with community resources.

25. Familiarization or “WindshieldSurvey” • Nurses drive (or walk) around the community; find health, social, and governmental services • obtain literature; introduce themselves and explain that they are working in the area; and generally become familiar with the community

26. Familiarization or “WindshieldSurvey” • This type of assessment is • needed whenever the community health nurse works with families, groups, organizations, or populations.

27. Problem-Oriented Assessment • assessment, begins with a single problem and assesses the community in terms of that problem. • E.g. deaf children • problem-oriented assessment is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive. This type of assessment is responsive to a particular need. • The data collected will be useful in any kind of planning for a community response to the problem

28. Community Subsystem Assessment • Community health nurse focuses on a single dimension of community life. • For example, the nurse might decide to survey churches and religious organizations to discover their roles in the community.

29. Community Subsystem Assessment • Community subsystem assessment can be a useful way for a team to conduct a more thorough community assessment.

30. Comprehensive assessment • Comprehensive assessment seeks to discover all relevant community health information. • It begins with a review of existing studies and all the data presently available on the community • Key informants are interviewed in every major system—education, health, religious, economic, and others.

31. Comprehensive assessment • Because the assessment is an expensive, time-consuming process, it is not often performed.

32. Community Assets Assessment • It is The final form of assessment • Which focus on the strength and capacities of a community rather than its problems.

33. Community Assets Assessment Assets assessment has three levels: 1- specific skills, talents, interests, and experiences 2- local citizen associations, organizations, and institutions controlled largely by the community such as libraries. 3- Local institutions originating outside the community controlled largely outside the community such as welfare and public capital expenditures

34. COMMUNITY ASSESSMENT METHODS • 1- survey • is an assessment method in which a series ofquestions is used to collect data for analysis of a specific group or area. • Surveys are commonly used to provide a broadrange of data that will be helpful when used in conjunction with other sources or if other sources are not available.

35. COMMUNITY ASSESSMENTMETHODS The nurse may choose to conduct a survey to determine such things as health care patterns and needs, immunization levels, The survey method involves three phases • 1. Planning Phase • 2. Data Collection Phase • 3. Data Analysis and Presentation Phase

36. COMMUNITY ASSESSMENTMETHODS • 2- descriptive epidemiologic study • which examines the amount and distribution of a disease or health condition in a population by: • Person (Who is affected?) • place (Where does the condition occur?) • time (When do the cases occur?).

37. COMMUNITY ASSESSMENT METHODS • 3- Community Forums or Town Hall Meetings • is a qualitative assessment method designed to obtain community opinions. • It takes place in the neighborhood of the people involved, perhaps in a school exercise room or an hall • The participants are selected to participate by invitation from the group organizing the forum. • For instance if a community is contemplating ( planning) building a swimming pool, the people invited to the community forum might include potential users of the pool

38. COMMUNITY ASSESSMENTMETHODS • 4- focus groups • is similar to the community forum or town hall meeting in that it is designed to obtain grassroots opinion. • it has some differences • First, there is only a small group of participants, • usually 5 to 15 people The members chosen for the group are with homogeneous respect to specific demographic variables. Ex. Women in first pregnancy

39. SOURCES OF COMMUNITY DATA • Data sources can be • primary – talking to people (directly) • Secondary – client record, community health statistics • and they can be from • international, • national, • state, or • local sources.

40. SOURCES OF COMMUNITY DATA • International Sources • data are collected by several agencies, including • (WHO) and its six regional offices and health organizations,

41. SOURCES OF COMMUNITY DATA • National SourcesThere are official and nonofficial sources • Official sources develop documents based on data compiled by the government E.g. Jordan department of statistics

42. SOURCES OF COMMUNITY DATA • State and local Sources • State sources • The most significant state source of assessment data comes from the state health department. This official agency is responsible for collecting state vital statistics and morbidity data. • Example from Jordan: Ministry oh health

43. SOURCES OF COMMUNITY DATA • Local Sources • health department, hospitals, social service agencies • school districts, universities or colleges, libraries, Example from Jordan:data from the governorates in the cities (Irbid health governorate), from JUST

44. DATA ANALYSIS AND DIAGNOSIS • analysis of the information gathered • inferences or conclusions may be made about its meaning • Such inferences must be validated to determine their accuracy

45. The Analysis Process • First, the data must be validated : • (1) data can be rechecked by the community assessment team, • (2) data can be rechecked by others, • (3) subjective and objective data can be compared, • (4) community members can consider the findings and verify them

46. The Analysis Process Second, each category is examined to determine it significance. Data collection, data interpretation, and nursing diagnosis are sequential activities, with validation serving as the bridges between them.

47. Community Diagnosis Formation • “Community diagnoses clarify who gets the care (the community as opposed to the individual), • provide a statement identifying problems faced by who is getting care and identify the factors contributing to the identified problem”

48. Community Diagnosis Formation • Some authors define nursing diagnosis is: • The statement of a [client’s] response which is actually or potentially unhealthful and which nursing intervention can help to change in the direction of health. • It should also identify essential factors related to the unhealthful response

49. Community Diagnosis Formation • Neufeld and Harrison work to form a wellnessdiagnosis by using the phrase healthful response instead of unhealthful response. The definition of wellness is: • The statement of a client’s [community’s] healthful response which nursing intervention can support or strengthen. • It should also identify the essential factors related to healthful response.

50. Community Diagnoses • refer to nursing diagnoses about a community’s ineffective coping ability and potential for enhanced coping.