This document discusses the nursing process in community health and its application to community assessment. [1] It outlines the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation - and how they guide community health nurses. [2] Through assessment, nurses collect data on the health of communities to identify problems and strengths. [3] They then diagnose actual or potential issues and prioritize planning and interventions.
This document discusses the nursing process in community health and its application to community assessment. [1] It outlines the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation - and how they guide community health nurses. [2] Through assessment, nurses collect data on the health of communities to identify problems and strengths. [3] They then diagnose actual or potential issues and prioritize planning and interventions.
This document discusses the nursing process in community health and its application to community assessment. [1] It outlines the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation - and how they guide community health nurses. [2] Through assessment, nurses collect data on the health of communities to identify problems and strengths. [3] They then diagnose actual or potential issues and prioritize planning and interventions.
This document discusses the nursing process in community health and its application to community assessment. [1] It outlines the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation - and how they guide community health nurses. [2] Through assessment, nurses collect data on the health of communities to identify problems and strengths. [3] They then diagnose actual or potential issues and prioritize planning and interventions.
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
