COMMUNITY

HEALTH
NURSING
NCM 104

PROCESS
 Ensure a working relationship with the client and/or

LEARNING support system based on trust, respect and shared

decision-making using appropriate
communication/interpersonal techniques/strategies
OUTCOME
Apply management and leadership principles in
providing direction to manage a community / village –
based program.

Use appropriate strategies/approaches to plan

community health programs and nursing service.

Document client’s responses/ nursing care services

rendered and processes/ outcomes of the nurse client
working relationship.
CONTENT
A. Steps of Community Nursing Process
1. Assessing Community Health Needs
a. Types of Community Diagnosis
• Traditional/Comprehensive Community Diagnosis
• Participatory Action Research (PAR)
2. Steps in Conducting Community Diagnosis
3. Sources of data
a. Primary source
b. Secondary source
B. Planning Health Program for Community Development
1. Concepts of Planning
2. Activities of Planning Cycle
3. Priority Setting
4. Formulation of Action Plan
Community health
nurses need to know
the defining
characteristics of a
community because
these set the stage in
understanding the
different aspects that
directly or indirectly
influence the health
status of the
community.
COMMUNITY
IS SEEN AS THE
PRIMARY
CLIENT
COMMUNITY
DIAGNOSIS
• Or Community Assessment and or
Situational Analysis
• It will be derived and will become
the bases for developing and
implementing community health
nursing interventions and strategies.
COMMUNITY
DIAGNOSIS
• It consists of collecting,
organizing, synthesizing,
analyzing and interpreting
health data.
ASSESSING COMMUNITY HEALTH NEEDS

1 2 3
The nurse considers the There are times when Decide on the objectives,
degree of detail or depth situations call for a the resources and time
the nurse should go into. comprehensive available to implement it
assessment. the community diagnosis.
TYPES OF
COMMUNITY
DIAGNOSIS
TYPES OF
COMMUNITY • Traditional/Comprehensive
DIAGNOSIS
Community Diagnosis
• Participatory Action Research
(PAR)/Problem-Oriented
Community Diagnosis
TRADITIONAL/COMPREHENSIVE COMMUNITY
DIAGNOSIS
• Aims to obtain a general information about the community
• Elements:
A. Demographic Variables
B. Socio-Economic and Cultural Variables
1. Social Indicators
2. Economic Indicators
3. Environmental Indicators
4. Cultural Factors
C. Health and Illness Patterns
D. Health Resources
E. Political/Leadership Patterns
A. should show the size, composition and geographical
DEMOGRAPHIC distribution of the population as indicated by the following:
VARIABLES
• Total Population and geographical distribution
including urban-rural index and population density.
• Age and sex composition
• Selected vital indicators such as growth rate, crude
birth rate, crude death rate and life expectancy at
birth.
• Patterns of migration
• Population Projections
B. SOCIO- 1. Social Indicators
ECONOMIC AND
• Communication network necessary for disseminating health
CULTURAL
VARIABLES information
• Transportation system
• Education level
• Housing Conditions that suggest health hazards (congestion, fire,
exposure to elements)
B. SOCIO- 2. Economic Indicators
ECONOMIC
AND CULTURAL • Poverty Level
VARIABLES • Unemployment and underemployment rates
• Proportion of salaried and wage earners to
total economically active population
• Types of industry present in the community
• Occupation common in the community
B. SOCIO-ECONOMIC AND CULTURAL
VARIABLES

Air, water and

Physical/geographical/ Water Supply: source
topographical characteristics of water supply
Waste disposal: land pollution:
3. Environmental Types of disposal
of the community: land
air and water
Indicators areas, terrain characteristics,
and garbage
land usage in industry,
climate/season disposal system
pollution index
B. SOCIO- 4. Cultural Factors
ECONOMIC AND
CULTURAL • Variables that may break up the people
VARIABLES into groups within the community such
as:
• Ethnicity
• social class,
• Language
• Religion
• Race
• Political Orientation
C. HEALTH AND • The nurse may collect primary data about the leading causes of illness
ILLNESS and deaths and the rate of occurrence.
PATTERNS • If the nurse can access the secondary data, then make use of these.

• Leading Causes of Mortality

• Leading Causes of Morbidity
• Leading Causes of Infant Mortality
• Leading Causes of Maternal Mortality
• Leading Cause of Hospital Admission
D. HEALTH RESOURCES

• The health resources that are available in the community is an important element of the community
diagnosis because they are the essential ingredients in the delivery of the basic health services.
• The nurse needs to determine the manpower, institutional and material resources provided not only
by the state but those which are contributed by the private sector and other non-government
organizations.
D. HEALTH • Manpower resources
RESOURCE • Categories of help manpower available

S • Geographical distribution of health manpower

• Manpower-population ratio
• Distribution of health manpower according to health
facilities (hospitals, rural health units, etc.)
• Distribution of health manpower according to type of
organization (Government, non-government, health
units, private)
• Quality of health manpower
• Existing manpower development/policies
D. HEALTH
RESOURCES • Material resources
• Health budget and expenditures
• Sources of health funding
• Categories of health institution available
in the community
• Hospital bed-population ratio
• Categories of health services available
E. POLITICAL/LEADERSHIP PATTERNS

• The political and leadership pattern is a vital element in

achieving the goal of high-level wellness among the people.
• It reflects the action potential of the state and its people to
address the health needs and problems of the community.
PARTICIPATORY ACTION RESEARCH (PAR)/PROBLEM-
ORIENTED COMMUNITY DIAGNOSIS

• The type of assessment that responds to a particular need.

• For example, a nurse is confronted with health and medical problems resulting
from mine tailings being disposed into the river systems by a mining company.
Since community diagnosis investigates the community-mining, the people and
its environment the nurse proceeds with the identification of the population who
are affected by the hazards posed by mine tailings.
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS

• The process of community

diagnosis consists of
collecting, organizing,
synthesizing, analyzing and
interpreting health data.
STEPS IN • Before the data collection, the objectives

CONDUCTING must be determined, this will dictate the

depth or the scope of the community
COMMUNITY diagnosis.
DIAGNOSIS • The nurse needs to resolve whether a
comprehensive or a problem-oriented
community diagnosis will accomplish the
objectives.
STEPS IN • The community diagnosis must
CONDUCTING be carried out in an organized and
COMMUNITY systematic manner
DIAGNOSIS • Keeping in mind that the
community should take an active
part in identifying the community
needs and problems
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

1 2 3 4
Determining Defining the Determining Collecting the
the Objectives Study the data to be Data
Population Collected
DETERMINING THE
OBJECTIVES
• The nurse decides on the depth and scope
of the data she needs to gather.
• The nurse must determine the occurrence
and distribution of selected
environmental, social economic and
behavioral conditions important to disease
control and wellness promotion.
DEFINING THE STUDY POPULATION

It may include the entire

population in the community or
Based on the objectives of the
focused on a specific
community diagnosis, the nurse
population groups such as
identifies the population group
women in the reproductive age-
to be included in the study.
group or the infants and the
young children.
COLLECTING THE DATA
Different methods may be utilized to generate health data.

The nurse decides on the specific methods depending on the type of

data to be generated.

For example, through an ocular survey the nurse can determine the
physical and topographical characteristics of the community.
THE FOLLOWING METHODS TO COLLECT DATA:

• Records Review- reviewing those that have been compiled by health or non-health agencies from
the government or other sources.
• Surveys and Observations- Can be used to obtain both qualitative and quantitative data.
• Interviews- Can yield firsthand information
• Participant Observation- is used to obtain qualitative data by allowing the nurse to actively
participate in the life of the community
DEVELOPING THE INSTRUMENT

Instruments are tools The most common

facilitate the nurse’s data instruments use in data
gathering activities. collection:
• Survey questionnaire
• Interview Guide
• Observation Checklist
ACTUAL DATA GATHERING

• It is suggested that the nurse meet the

people who will be involved in the data
collection before the actual data gathering.
• The instruments are discussed and analyzed,
if necessary, then instruments may be
modified or simplified
ACTUAL DATA GATHERING
• Pre-testing of the instrument is highly recommended.
• The data collectors must be given an orientation and training on how they are going to use the
instruments in data gathering.
• The nurse can ask the data collectors to role play an interview scene so that they can place
themselves in an actual interview situation.
• During the actual data gathering, the nurse supervises the data collectors by checking the filled-up
instruments in terms of completeness, accuracy and reliability of the information collected.
DATA COLLATION
After data collection, the nurse is now ready to put together all the information.

There are two types of data that may be generated. They are either numerical data which
can be counted or descriptive data which can be described.

To facilitate data collation, the nurse must develop the categories for classification of
responses making sure that the categories are mutually exclusive and Exhaustive.
DATA PRESENTATION
Will depend largely on the type of data obtained.

Descriptive data are presented in narrative reports.

Numerical data may be presented into table or graphs. Tables or graphs are useful in showing key
information making it easier to show comparisons including patterns and trends. The choice of
graphs will depend on the types of data being presented.
 TYPE OF GRAPH DATA FUNCTION
Line Graph Shows trend data or changes with time or age with
respect to some other variable

Bar graph/pictograph For comparisons of absolute or relative counts and rates

between categories

Histogram/Frequency Polygon Graphic presentation of frequency distribution or

measurement

Proportional or component Bar Shows breakdown of a group or total where the number
graph/pie chart of the degrees is not too many

Scattered Diagram Correlation data for two variables

01 02 03
In community diagnosis It also allows for Determining the
aims to establish trends and comparison of obtain interrelationship of factors
patterns in terms of health will help the nurse view the
needs and problem of the data with standard significance of the
community. values. problems and their
implications on the health
status of the community.

DATA ANALYSIS
Identifying The Community Health Nursing Problems
Community health nursing problems are categorized as:

• Health Status Problems- they may be described in terms of increased or decreased morbidity,
mortality, fertility or reduced capability for wellness
• Health Resources Problems- they may be described in terms of lack of or absence of manpower,
money, materials or institutions necessary to solve health problems
• Health Related Problems - they may be described in terms of existence of social, economic,
environmental and political factors that aggravate the illness inducing situations in the community.
Priority Setting
In priority setting, the nurse makes use of the following criteria:

• Nature of the Condition/Problem presented- the problems are classified by the nurse as health status,
health resources or health-related problems.
• Magnitude of the Problem- this refers to the severity of the problem which can be measured in terms of the
proportion of the population affected by the problem
• Modifiability of the Problem- this refers to the probability of reducing, controlling or eradicating the
problem
• Preventive Potential- this refers to the probability of controlling or reducing the effects posed by the
problem
• Social Concern- This refers to the perception of the population or the community as they are affected by the
problem and their readiness to cope up on the problem
3. SOURCES OF DATA
a. Primary Source
• talking with community members, including formal and informal leaders, and
community inhabitants for accurate insights and comprehensive information

b. Secondary Source
• includes health team information, client records, community health statistics, census
bureau’s data, reference books, research reports, and community health nurses
PLANNING HEALTH PROGRAM FOR COMMUNITY DEVELOPMENT
CONCEPTS OF PLANNING

• Planning and implementation for groups, populations and communities involved the application of the
nursing process. The nurse will find herself working with other members of the health team with other
sectors you may have different orientation or strategies in terms of viewing solutions to community health
problems.
• Planning is a process that entails formulation of steps to be undertaken in the future in order to achieve a
desired end. Planning takes place in order to efficiently allocate available resources. This implies that the
planner assesses the nature and extent of the problems for which the program is being planned for us as well
as constraints and limitations that may affect planning decisions.
• Planning is done in our desire to improve the present state of affairs.
THE
CONCEPT OF • Planning is futuristic
PLANNING
(MERCADO, • Planning is change-oriented
1993):
• Planning g is a continuous and
dynamic process
• Planning is flexible
• Planning is a systematic process
ACTIVITIES OF
PLANNING CYCLE
AS THE
COMMUNITY
HEALTH NURSE
PLANS TO MEET THE
HEALTH PROBLEMS
AND NEEDS OF THE
POPULATION, FOUR
BASIC QUESTIONS
ARE ASKED:
SITUATIONAL ANALYSIS
Answering the question “Where are we now” involves the process of collecting,
synthesizing, analyzing and interpreting information in a manner that will provide a
clearer picture of the health status of the community.

In this phase of planning cycle, the nurse identifies and provides explanation to their
problems.

The nurse may use the community diagnosis report as a basis for the situational
analysis.
IN SITUATION ANALYSIS
INVOLVES THREE ACTIVITIES:

• The nurse gathers data about the

health status of the community.
• The nurse identifies and explains the
problems
• The nurse projects what situation
needs to be changed, developed or
maintained.
PRIORITY SETTING
GOAL AND OBJECTIVES SETTING

• Where do we want to go? Refers to the process of formulating the goals

and objectives of the health program.
• Goal and objectives will serve as guide with the nurse’s efforts.
• A goal leads to a desired end. The desired end maybe a total change,
improvement or a maintenance of a situation. It is directed towards
solving the health status problem which the nurse identified in a
community diagnosis.
• Objectives are more precise; they are considered as planned end point of
all activities. Objectives are concerned with the resolution of the health
problem itself.
GOAL AND OBJECTIVES SETTING

• Health Problem: High incidence and prevalence of intestinal parasitism among children.
• Goal: To reduce the incidence and prevalence of intestinal parasitism among children of Sitio Camachile
• Objectives: 75% of children below 6 years old will test negative for parasites after one year.

Objectives
• 80% of households will have access to safe waste disposal system within six months
• 80% of households will have access to safe and adequate water supply within six months
• 75% of children under 6 years old will have regular clinic visits
STRATEGY AND ACTIVITY SETTING

• How do we get there? Defines the strategies and activities that the nurse said to achieve and realize
the goals and objectives.
• It implies the identification of resources-manpower, money, materials, technology, time and
institutions-needed to implement a program.
• The nurse defines the strategy approach in a health program.
• Nurse assessed extent to which constraints or limitations affect planning decisions.
STRATEGY AND ACTIVITY SETTING

• Activities may provide direct healthcare services to the population such as immunizations, family
planning services, nutrition supplementation and the like.
• The activities are directed towards transferring knowledge and skills to specific group of people like
community health workers training and mother’s classes.
• The nurse must organize activities in such a way that time, money, and effort are not wasted.
EVALUATION PLAN
• The nurse poses the question “How do we
know we are there?” In order to find out if
the programs and services achieve the
purpose for which they were formulated.
• The nurse determines whether the
program is relevant, effective, efficient
and adequate.
 Deciding what to evaluate in terms of relevance, progress, effectivity,
PROGRAM impact and efficiency

EVALUATION Designing the evaluation plan specifying the evaluation indicators, data
needed, methods and tools for data collection and data sources
INCLUDES THE
FOLLOWING Collection of relevant data

STEPS: Analyzing data

Making decisions

Preparing report and providing decision-makers feedback on the

program evaluation.
END