CHN - UNIT 5

COMMUNITY ASSESSMENT

collecting data in the community which serve as a guide in determining the actual and potential health problems.

Community Diagnosis

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

Community Diagnosis

It is a quantitative and qualitative description of the health of citizens and the factors that influence their health.

Bar Graph

to compare values across different categories of data

Line Graph

to have a visual image of trends in data over time or age.

Pie Chart

to show percentage distribution or composition of a variable, such as population or households. A pie chart is an effective tool in highlighting the value of a group in relation to the whole population.

Scatter plot/diagram

to show the correlation between two variables. The values of both variables in subjects are plotted in a graph with an xaxis and a y-axis.

Traditional Research

a method of research that follows a systematic or scientific procedure in which a question is asked and a hypothesis is proposed in which it is either proved or disproved.

Traditional Research

Related to the investigation or experimentation aimed at the discovery and interpretation of facts or revision of accepted theories or laws in the light of new facts

Participatory Action Research (PAR)

an approach to research that aims at promoting change among the participants. Members of the group being studied participate as partners in all phases of the research, including design, data collection, analysis and dissemination.

COPAR

In ______, in the Decision making Emphasis, it is

• Bottom-up

• Community-driven process

• Premium is placed on the process

COPAR

In ______, in the Roles , it is

• Community members as researchers:

• the nurse is a facilitator and recorder.

• Data analysis is done collectively by the community.

COPAR

In ______, in the Methodology , it is

• Research tools and methodologies are identified and developed by the community.

COPAR

In ______, in the Output , it is

• Conclusions and recommendations are made by the community. These will lead to agreed community actions/projects. The whole research cycle continues until it becomes part of community life, leading towards community development. Community members formulate the recommendations.

Traditional research approach

In ______, in the Roles, it is

• Nurse as researcher:

• The community members are subjects or objects of research, usually respondents of the research instrument.

• Data analysis is done by the nurse, and then presented to the community.

Traditional research approach

In ______, in the Decision making Emphasis, it is

• Top-down

• Expert/Nurse-driven process

• Much premium is placed on the data and output

Traditional research approach

In ______, in the Methodology, it is

• Research tools and methodologies are predetermined/prepackaged by the nurse-organizer.

• NANDA

• Shuster and Goeppinger

• The Omaha System

Schemes in stating Community Diagnosis

NANDA

focused more on individual but in the recent versions, it has included diagnoses in the community level

Shuster and Goeppinger

proposed a practical adaptation of a format of nursing diagnoses for population groups.

The Omaha System

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

• Problem classification scheme (client assessment)

• Intervention scheme

• Problem rating scale for outcomes

The Omaha System Components

Problem Classification Scheme

Organize assessment (needs and strengths) for individuals, families, and communities

Intervention Scheme

Organize multidisciplinary practitioners’ care plans and the services they deliver

Problem Rating Scale for Outcomes

Evaluate individual, family, or community change over time

Problem classification scheme

serves as a guide in collecting, classifying, analyzing, documenting and communicating health-related needs and strengths.

➢ Environmental

➢ Psychosocial

➢ Physiological

➢ Health-related behaviors

First and most general level of classification is composed of 4 domains:

Environmental domain

(material resources and physical surroundings both inside and outside the living area, neighborhood, and broader community)

Psychosocial domain

(patterns of behavior, emotion, communication, relationships, and development)

Physiological domain

(functions and processes that maintain life)

Health-related behaviors domain

(patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease)

➢ Area of concern is categorized into health promotion, potential problem

➢ Level of clientele (individual, family or community)

Third level presents the problem or area of concern classified according to 2 sets of qualifiers

Intervention Scheme

is designed to describe and communicate multidisciplinary practice, practice that is intended to prevent illness, improve or restore health, decrease deterioration, and/or provide comfort before death.

• Teaching, Guidance, and Counseling

• Treatments and Procedures

• Case Management

• Surveillance

Intervention Scheme Categories

Teaching, Guidance, and Counseling

Activities designed to provide information and materials, encourage action and responsibility for self-care and coping, and assist the individual/family/community to make decisions and solve problems.

Treatments and Procedures

Technical activities such as wound care, specimen collection, resistive exercises, and medication prescriptions that are designed to prevent, decrease, or alleviate signs and symptoms of the individual/family/community.

Case Management

Activities such as coordination, advocacy, and referral that facilitate service delivery, improve communication among health and human service providers, promote assertiveness, and guide the individual/family/community toward use of appropriate resources.

Surveillance

Activities such as detection, measurement, critical analysis, and monitoring intended to identify the individual/family/community's status in relation to a given condition or phenomenon.

Problem Rating Scale for Outcomes

is a method to evaluate client progress throughout the period of service. It consists of three five-point, Likert-type scales to measure the entire range of severity for the concepts of Knowledge, Behavior, and Status.

Knowledge

is defined as what the client knows

Behavior

as what the client does

Status

as the number and severity of the client’s signs and symptoms or predicament.

Health Status Problems

described in terms of increased or decreased morbidity, mortality, fertility or reduced capability for wellness

Health Resources Problems

described in terms of lack or absence of manpower, money, materials or institutions necessary to solve health problems

Health-Related Problems

described in terms of existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community

Nature of the condition/problem presented

problems are classified as health status, health resources or health-related problems

Magnitude of the problem

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

refers to the probability of controlling or reducing the effects posed by the problem

Social concern

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

a. Establish stakeholders

b. Describe the program

c. Select evaluation design

d. Collect data

e. Generate conclusions

f. State findings and provide recommendations

Steps of Program Evaluation

community partnership

is a collaborative relationship between willing entities formed to address shared objectives.

Collaboration

s a process of participation through which people, groups, and organizations work together to achieve desired results.

Monitoring

refers to an organized process of overseeing and checking the activities undertaken in a project, to ascertain whether it is capable of achieving the planned results or not.

Evaluation

• the process by which we judge the worth or value of something.

• is a scientific process that gauges the success of the project or program in meeting the objectives

Qualitative methods of evaluation

determine the meaning and experience of the program for the people involved; and interprets the effects that may be observed.

Quantitative methods

measure and score changes occurring as a result of the program.

Process evaluation

measures the activities of the program, its quality and who is reaching out

Impact evaluation

measures the immediate effects of the program and determines whether the objectives of the program were met

Outcome evaluation

measures the long-term effects of the program and determines if it meets the goal of the program

• Formative

• Process

• Outcomes

• Impact

• Summative

Types of Evaluation

Formative

▪ Evaluates a program during development in order to make early improvements

▪ Helps to refine or improve a program

Summative

▪ Provides information on program effectiveness

▪ Is conducted after the completion of the program design

Process

▪ Focuses on program implementation

▪ Determines whether specific program strategies were implemented as planned

Outcomes

▪ Focuses on the changes in comprehension, attitudes, behaviors, and practices that result from program activities

▪ Can include both short- and long-term results

Impact

▪ Focuses on long-term, sustained changes as a result of program activities, both positive and negative and intended and unintended

The Stage of Orientation

Personal relations are characterized by dependence. Group members rely on safe, patterned behavior and look to the group leader for guidance and direction. Group members have a desire for acceptance by the group and a need to know that the group is safe. They set about gathering impressions and data about the similarities and differences among them and forming preferences for future subgrouping. Rules of behavior seem to be to keep things simple and to avoid controversy. Serious topics and feelings are avoided.

The Stage of Conflict

• -This stage is characterized by the group’s concern over dominance, control and power.

• Opposition between characters of forces in a work of dram or friction, especially opposition that motivates or shapes the action of the plot.

1) Inability to control self and others

2) Respect between parties.

3) Limited resources

4) Frustrations.

Causes of conflict:

Intra-sender

Conflicts originates in the sender who gives conflict instructions.

Inter-sender

Arises when a person receives conflicting messages from one or more sources.

Inter-role

Occurs when a person belongs to more than one group.

Person-role

Result of a discrepancies between internal and external role.

Intragroup

Occurs when a group faces new problem, when new values are imposed on the group from outside, or when one’s extra-group role conflicts with one’s intragroup role.

Inter-person

Between people whose positions require with other persons who fill various roles in the same organization or other organizations

Intergroup

Common when two groups have different goals and can only achieve their goals at the other’s expense

Role-ambiguity.

Individual do not know what is expected of them

Role-oriented

Individuals cannot meet the expectations placed on them

Latent conflict

• Phase of anticipation

• It exists whenever individuals, groups, organization or nations have

• differences that bother one or the other but those differences are not great enough to cause one side to act to alter the situation.

Perceived conflict

• Indicates cognitive awareness of stressful situation.

• It exists when there is a cognitive awareness on the part of at least one party that events have occurred or that conditions exist favorable to creating overt conflict.

• Group recognizes that a conflict is emerging and starts to look for possible explanation.

Felt conflict

• Presence of affective states such as stress, tension, anxiety, anger, hostility.

• Organization, groups or individual become more internally cohesive.

• Other group in the organization are viewed with suspicion as outsider.

Manifest conflict

• Overt behavior resulting from the above three stages.

• At this stage the conflicting parties are actively engaging in conflict behavior which is usually very apparent to non-involved parties.

• Feeling of conflict are now translated into actions and words which could either be constructive to problem solving process.

The Stage of Orientation

The major task functions also concern orientation. Members attempt to become oriented to the tasks as well as to one another. Discussion centers around defining the scope of the task, how to approach it, and similar concerns. To grow from this stage to the next, each member must relinquish the comfort of non-threatening topics and risk the possibility of conflict.

The Stage of Orientation

2 Task:

a) Determine a way of achieving their primary tasks- the purpose for which they joined the group

b) Find a place for themselves in the group, one that will not only provide the comfort necessary to attain their primary task, but will also result in additional gratification from the pleasure of group membership.

Stage of Cohesiveness

Interpersonal relations are characterized by cohesion. Group members are engaged in active acknowledgment of all members’ contributions, community building and maintenance, and solving of group issues. Members are willing to change their preconceived ideas or opinions on the basis of facts presented by other members, and they actively ask questions of one another. Leadership is shared, and cliques dissolve. When members begin to know-and identify with-one another, the level of trust in their personal relations contributes to the development of group cohesion. It is during this stage of development (assuming the group gets this far) that people begin to experience a sense of group belonging and a feeling of relief as a result of resolving interpersonal conflicts

Stage of Cohesiveness

The major task function of this stage is the data flow between group members: They share feelings and ideas, solicit and give feedback to one another, and explore actions related to the task. Creativity is high. If this stage of data flow and cohesion is attained by the group members, their interactions are characterized by openness and sharing of information on both a personal and task level. They feel good about being part of an effective group.

The Work Group Stage

If group members are able to evolve to this stage their capacity, range, and depth of personal relations expand to true interdependence. In this stage, people can work independently, in subgroups, or as a total unit with equal facility. Their roles and authorities dynamically adjust to the changing needs of the group and individuals. Stage four is marked by interdependence in personal relations and problem solving in the realm of task functions. By now, the group should be most productive. Individual members have become self-assuring, and the need for group approval is past. Members are both highly task oriented and highly people oriented. There is unity: group identity is complete, group morale is high, and group loyalty is intense. The task function becomes genuine problem solving, leading toward optimal solutions and optimum group development. There is support for experimentation in solving problems and an emphasis on achievement. The overall goal is productivity through problem solving and work.

The Termination Stage

Involves the termination of task behaviors and disengagement from relationships. A planned conclusion usually includes recognition for participation and achievement and an opportunity for members to say personal goodbyes. Concluding a group can create some apprehension - in effect, a minor crisis. The termination of the group is a regressive movement from giving up control to giving up inclusion in the group. The most effective interventions in this stage are those that facilitate task termination and the disengagement process.

The Termination Stage

Tasks of the group at this stage:  Finishing the agenda  Establishing key decisions and completing the group product  Trying up loose ends  Writing oft unfinished business.