CHN ADPIE CONCEPT

Community

Community

Primary client" of the Community Health Nurse

1. It has a direct influence on the health of the individual, families and the sub-populations.

2. It is at this level that most health service provision occurs.

Significance of Community in the healthcare system

Assessment

Process of collecting, organizing, processing, and analyzing data or information obtained from the client and other sources.

1 - understanding of the health, concerns, and health care systems

2 - identifying, collecting, analyzing and disseminating information

3 - community assets, strength, resources and needs.

A process by which community members gain an (1) of the community by (2) on (3)

de Belen, 2008

- A process by which community members gain an understanding of the health, concerns, and health care systems of the community by identifying, collecting, analyzing and disseminating information on community assets, strength, resources and needs.

Community Health Assessment

the keystone of community health nursing process

CHN Nurses and Nursing students

Best persons to assess the community's health condition and status are the community health nurses and Nursing students who interact with them and observe their social environment.

1. Collecting primary data
2. Secondary data source

Tools for community assessment

1. Observation
2. Survey
3. Informant interview
4. Community forum
5. Focus group

Primary data sources

Observation

done through ocular or windshield observation

Allows the nurse to take note of the environmental conditions and existing community facilities

Observation allows

Utilize participant observation (PO)

Observation utilizes what kind of observation

participant observation (PO)

a technique or purposeful observation of formal and informal community activities

community values, beliefs, norms, priorities, concerns and power or influence structures

PO helps the nurse determine the

Survey

is made up of a series of questions for systematic collection of information from a sample of individuals or families in a community.

Survey (1)

Necessary when there is no available information about the community or specific population group

determining community attitudes, knowledge, health behaviors and perceptions of health and health services

Survey is appropriate for

making the members of the community more aware of community problems and their effects.

Survey is an opportunity for

Informant interviews

purposeful talks with either key informants or ordinary members of the community

Key informants

consist of formal and informal community leaders or persons of position and influence

the nurse valuable information on community perceptions about health and health care.

Informant interview provides

Community Forum

an open meeting of the members of the community

Pulong-pulong sa barangay

Another term for community forum

An effective tool in providing the people with a medium for expressing their views and developing their capacity to influence decision makers.

Community forum is an effective tool in?

informing the people about secondary data, for data validation and for getting feedback from the people.

Community forum may be a venue for

Focus group (6-12 members)

made up of a much smaller group

assessment of health needs of specific groups in the community

FOcus group is effective in

- Act 3753 - Civil Registration Law
- RA 7160 - Local Government Code
- PD 856 - Sanitation Code - requiring a death certificate before a burial (death should be reported with 48 hours)

Registry of vital events include

1. To inform the health team and members of the community of existing health and related conditions in the community
2. To make members of the community appreciate the significance and relevance of health information to their lives
3. To solicit broader support and participation in the community health process
4. To validate findings
5. To provide a basis for better decision making

Purpose of presenting community data

Health status
Health resources
Health action potential

Components of community health needs assessment

Health status

health condition, health illness pattern and trend (causes of morbidity/ mortality); health knowledge, attitudes, practice

Health resources

RHU, BHS, hospitals & specialty clinics, equipment & facilities; manpower resources, financial resources)

Health action potential

health implementation and services

Diagosis

process of identification of the client's needs and problems based on the analysis of data and or information gathered

Community diagnosis

the process of determining the health status of the community and the factors responsible for it.

Community diagnosis (1)

a quantitative and qualitative description of the health of the citizens and factors affecting their health

Community Diagnosis (2)

allows the identification of problems and areas of improvement, thereby stimulating action

1. NANDA
2. Shuster and Goeppinger
3. Omaha system

Schemes in stating the diagnosises

NANDA

- nursing diagnostic labels
- more focused on the individual

Shuster and Goepingger

- a format of nursing diagnosis for population groups
- utilizes a 3-part statement:

a. The health risk or specific problem to which the community is exposed (Risk)

b. The specific aggregate or community with whom the nurse will be working to deal with the risk or problem (Among)

c. Related factors (strength and weaknesses) that influence how the community will respond to the health risk or problem (Related)

3 part statement of shuster and goepingger

Omaha system

- a framework for care of individuals, families and communities by nurses, nursing educators and physicians and other health care providers

Omaha system (2)

- a comprehensive and research based classification system for client problems that exists in the public domain.

1. The health status of the community including the population's level of vulnerability
2. Community health capability or the ability of the community to deal with its health problems.
3. Community action potential or the patterns in which the community is likely to work on its health problems.

3 conditions in formulating a nursing diagnosis

1. Comprehensive community diagnosis
2. Problem oriented community diagnosis

Types of community diagnosis

Comprehensive Community Design

aims to obtain a general information about the community using demographic variables, socio-economic &cultural variables, health & illness patterns, health resources, & political/leadership patterns

Problem oriented community diagnosis

- type of assessment that responds to a particular need of a target group

Determining the objectives
Defining the Study Population
Determining the Data to be collected
Collecting the data
Developing the instrument
Actual data gathering
Data Collection
Data Presentation - will depend largely on the type of data obtained.
Descriptive data - narrative report.
Numerical data - may be presented into tables or graphs. Making it easier to show comparisons including patterns & trends.
Data Analysis
Identifying the community health nursing problems
Priority Setting.

Steps in conducting community diagnosis

1. health status problems
2. health resource problems
3. health related problems

Categories of CH Nursing problems

Health status problems

-increased or decreased morbidity, mortality, fertility
-reduced capability for wellness

Health resource problems

-Lack of or absence of manpower, money, materials or institutions necessary to solve health problems

Health related problems

-social, economic, environmental and political factors that aggravate the illness producing situations in the community

Magnitude of the problem

- severity of the problem that can be measured in terms of the proportion of the population affected by the problem

Modifiability of the problem

- refers to the probability of reducing, controlling or eradicating the problem

Preventive potential

- probability of controlling, reducing the effects posed by the problem

Social concern

- perception of the population/community as they are affected by the problem and their readiness to act on the problem

Planning

A logical step-by-step process in designing a plan of action to accomplish specific goals and objectives (desired outcomes)

Planning (2)

It refers to the process of constructing a program, formula or alternative model that will be used as a basis for a course of action or decision

Planning (3)

A logical process of decision making to determine which of the identified health concerns requires more immediate consideration (Priority Setting) and what actions maybe undertaken to achieve goals and objectives

Forecasting

the essence of planning to determine whether the plan is short-term or long term.

Priority Setting

provide the nurse and the health team a logical means of prioritizing concerns/problems among the health concerns/problems identified.

1. Significance of the problem
2. Level of community awareness
3. Ability to reduce risk
4. Cost of reducing risk
5. Ability to identify the target population
6. Availability of resources

Criteria by the WHO

should be base on the number of people in the community affected

consider the prevalence rate for disease conditions

If a potential problem, estimate people at risk for developing the condition

Significance of the problem criteria

degree of concern given by the community and its members

motivation of the community to deal with the condition/concerns

Level of community awareness

availability of an expert (from the health team or community)

may require the health team' influence in decision making related to the actions to be taken

Ability to reduce risk

the nurse has to consider the economic, social and ethical requisites and consequences of the planned action

Cost of reducing risk

information coming from the FHSIS, census, surveys or case finding can determine the intended population

Ability to identify target population

Requires technological, financial and other resources of the nurse, health agency and the community

may require the accessibility to external resources

Availability of resources

Goal

the desired outcomes at the end of interventions; long term

Objectives

the short term changes in the community as the health team and the community work towards the attainment of goals; serve as instructions; more specific

Specific - manifest a particular behavior

Measurable - quantifiable indications of the achievement

Attainable - in conformity with the community's resources

Relevant - realistic, appropriate to the need or problem of the community

Time-bounded - has specified target time or date

SMART OBJECTIVES

community has participated in the process of identifying and formulating and has mutual (the nurse and the community) agreement

Attainment of goals and objectives is more likely to occur when

Each community has it own unique characteristics, appropriate interventions should match the particular need of the community.

Consider the demographic, psychological, social, cultural and economic characteristics of the community and also the available resources.

Identify reasons for the people's behavior in the community to identify strategies to address these behaviors

Deciding on community interventions

Planning provides more rational decision making instead of gut-feel decisions or vested interest considerations.

Planning utilizes available resources properly.

Planning facilitates the determination of common goals, objectives and strategies.

Planning brings about positive change and growth in the community

Reasons for planning

Futuristic
Flexible
Change oriented
Continuous and dynamic process
Systematic process

Characteristics of Planning

Community Organizing

A process consists of steps and activities that instill and reinforce the people's self-confidence on their own collective strengths and capabilities.

Community Organizing (1)

A process of educating and mobilizing members of the community to enable them to resolve community problems.

Community Organizing (2)

A process that promotes the development of people's autonomy and self-reliance leading to people empowerment.

Human rights
Social justice
Social responsibility

3 Values where CO is based

Community organizing is
1. People centered
2. Participative
3. Democratic
4. Developmental
5. Process oriented

Core principles of community organizing

any community organizing endeavor views the people as the means and end of development
the people serve as the instruments in their own development

"CO is people centered" meaning?

the participation of the community is ensured in the entire process.
decision-making and responsibility is in the hands of the people
community participation is a critical condition for success

"CO is participative" meaning?

the decision should reflect the will of the whole especially the common people and the leaders and the "elite"

"CO is democratic" meaning?

should be directed towards changing current undesirable conditions.
CO promotes empowerment of the community by gaining insights, honing their capabilities and development of confidence.

"CO is developmental" meaning?

CO allows organizers to follow a process of change.
Monitoring and periodic review of plans is important.

"CO is process oriented" meaning?

1. People's Empowerment
2. Building relatively permanent structures and people's organizations
3. Improved Quality of Life

Goals of Community Organizing

CO is aimed at achieving effective power for the people

CO allows the people to overcome their powerlessness

CO develops the community's capacity to maximize their control over the situation

Explain people's empowerment as a goal of CO

CO aims to establish and sustain permanent organizational structures that best serve the needs and aspirations of the people.

Structures ensure people's maximum participation and provide a venue which allows linkages to other groups and sectors.

Explain building relative permanent structures and people's organizations as a goal of CO

Structures

ensure people's maximum participation and provide a venue which allows linkages to other groups and sectors.

CO seeks to secure short-term and long term improvements in the quality of life of the people

CO facilitates the fulfillment of basic needs for food, clothing, shelter, education and HEALTH.

Explain improved QOL as a goal of CO

basic needs for food, clothing, shelter, education and HEALTH

CO facilitates the fulfillment of

Participatory Action Research (PAR)

An approach to research that aims at promoting change among the participants.

1 - partners
2 - all

In PAR, members of the group being studied participate as (1) in (2) phases of the research

Introduced around mid-90s as useful tool in community organizing

PAR was introduced when?

COPAR

A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

COPAR acc to ROSS, 1967

A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community

1 - community (participatory)
2 - situation (research)
3 - implement projects/programs (action)

COPAR is a community development approach that allows the (1) to systematically analyze the (2)), plan a solution and (3) utilizing the process of community organizing.

Pre entry phase
Entry phase
Community Study/Community Diagnosis (Research Phase)
Community Organization and Capacity Building
Community Action
Sustenance and Strengthening Phase
Termination Phase

7 phases of COPAR

Evaluation

A process that systematically and objectively assesses compliance to the design of the program, the performance, relevance and success of a project or program, the extent to which a project accomplishes its intended results (outcomes) and achieves measurable impacts.

effectiveness of actions implemented.

Evaluation of interventions determines the