Nursing process in community health

1. Nursing Process in Community
Health

2. Nursing Process
 Assessment
 Diagnosis
 Planning and outcome identification
 Implementation
 Evaluation

3. Scientific Method
 Select/define a problem
 Formulate research question/hypothesis
 Collect data
 Analyze data
 Report results

4. 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.

5. 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

6. 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

7. 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”.

8. Community Assessment
 The definition of assessment indicated: -
 Determination of a client’s health problem
 Identification of strengths and weaknesses
and the clients state of health

9. Community Assessment
 Types of data: -
 Subjective or objective
 Current or historical

10. Community Assessment
 Data collection methods: -
 Interviews
 Physical examination
 Review of records
 Diagnostic reports
 Collaboration with colleagues

11. Community Assessment
 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

12. 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

13. Dimensions of Community Assessment
 Population
 Place
 Social systems

14. 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.

15. Dimensions of Community Assessment
 Place
 Where the community is located and its
boundaries
 Community boundaries, location of health services,
geographic features, climate, flora, fauna, human-
made environment

16. Dimensions of Community Assessment
 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.

17. 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

18. Additional Dimensions in Community
Assessment
 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

19. Methods of Data Collection in Community
Assessment
 Windshield survey
 Informants interviews
 Participants observation
 Secondary analysis of existing data
 Constructed surveys

20. 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

21. Methods of Data Collection in Community
Assessment
 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

22. Methods of Data Collection in Community
Assessment
 Participant 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

23. Methods of Data Collection in Community
Assessment
 Secondary Data
 Assessing existing data sources: -
 Records, documents and other previously collected
information
 Data bases from official and non official facilities

24. Methods of Data Collection in Community
Assessment
 Constructed survey
 A set of prepared specific questions given to a
random sample in the community
 It is time consuming and expensive

25. Nursing Diagnosis
 Diagnosing client health status
 The nurse identifies the client’s health status and
formulate 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)

26. Nursing Diagnosis
 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

27. Nursing Diagnosis
 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

28. Nursing Diagnosis
 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

29. Nursing Diagnosis
 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

30. Planning
 Planning is defined as “a collaboration, orderly,
cyclic process to attain a mutually agreed on desired
future goals”.
 It includes primary, secondary, tertiary preventive
actions

31. Planning
 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

32. Planning
2. Developing goals and objectives
3. Establish criteria to achieve goals
 Alternative actions to achieve goals
2. Selecting appropriate means to achieve goal
3. Designing nursing interventions
 Specific statement of actions
 Nurse client collaboration is needed
2. Planning evaluation
 Plan how to evaluate outcomes, what data, how to collect

33. 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
 Counseling
 Surveillance

34. Implementation
 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
 Delegation
 Referrals

35. Implementation
 Implementing nursing care
 Recognizing impediments to implementation
 Constraints that may impede (Modify or eliminate
them)
 Communicating the plan
 Providing an environment for implementation
 Resources (time, personnel and equipments)
 Comfort (physical and psychological)
 Client’s safety
 Carrying out the planned activities

36. Evaluation of nursing care
 It is “systematic comparison of clients’ health
status with the outcomes”.
 Outcome evaluation
 Process evaluation

37. Evaluation of nursing care
 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

38. Evaluation of nursing care
 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

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