Community Nursing Process

Community Health Nursing Process

An, orderly, systematic and rational method of assessing the health problems and needs, planning and implementation of nursing care for the prevention of disease and promotion of health in the community. Scientific method of assessing and solving the health problems of a community. Helps to identify the client's health care needs, determine priorities, establish goals and expected outcomes of care, establish and communicate plan of care and provide nursing interventions designed to meet client outcomes and goals.

Community Assessment Phase

process of searching for and validating relevant community-based data according to a specified method, to learn about the interaction among the people, resources and environment

Community Need Assessment

the process of determining the real or perceived needs of a defined community or people

Comprehensive Needs Assessment.

nurse gathers all relevant information about the entire community using a systematic process form where data are collected regarding all aspects of the community to be able to identify actual and potential problems

Problem-oriented Assessment

Focused on a particular aspect of health. The nurse collects information with a certain community problem in mind and then proceeds to gather information from the aggregate vulnerable to the problem

Community Diagnosis Phase

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

The health risk or specific problem to which the community is exposed

The specific aggregate or community

Related factors that influence how the community will respond

three part statement of Community Diagnosis

Omaha System

Initially designed for clients in the community setting. It has been used as a framework for the care of individuals, families and communities by nurses, nursing educator, physicians and other health care services.

•Environmental Domain

•Psychosocial Domain

•Physiological Domain

•Health related behaviors Domain

Domains and Problem Classification Scheme

Social Diagnosis:

Represents the impact of the health problem in terms of the overall quality of life of the people in the community.

Drug abuse

Teenage pregnancy

Illegitimacy

School dropout

Out of school youth

Traffic congestions

Transportation crisis

Absenteeism

Overcrowding

Children in conflict with the law

Indicators of extent of social problems present

Planning Phase

logical process of decision making to determine which of the identified health concerns require more immediate consideration and what actions maybe undertaken to achieve goals and objectives.

• Setting priorities

•Establishing Goals and Objectives

•Planned actions

•Outcome Measurements

•Recording the plan

Activities in Planning

implementing Phase

Collaboration with other sectors such as the local government and other agencies may also be necessary. Often referred to as the action phase.

Evaluation Phase

the systematic continuous process of comparing the community's response with the outcomes as defined the plan of care. To determine whether planned actions met clients needs.

Universal Health Care Act (UHC) Act

Republic Act 11223 signed into law by then President Rodrigo R. Duterte on February 20, 2019

Francisco T. Duque Ill on October 10, 2019

UHC Act implementing Rules and Regulations was signed by

1. Adopts an integrated and comprehensive approach to ensuring health literacy, healthy living, and protection from hazards and risks.

2. Develops a health care model that provides comprehensive health services without causing financial hardships to citizens, specifically the poor and marginalized members of society

3. Pursues a whole-of-system, whole-of government and whole-of-society approach in developing healthcare policies

4. Adheres to a people-oriented approach centered towards people's health needs and well-being

Four Key Principles of the UHC Act

Individual-based health services

Health interventions that can be accessed within a health facility or remotely; can be definitely traced back to one recipient; have limited effect at a population level; and do not alter the underlying cause of illness

Population-based health services

Health interventions which have population groups as recipients, such that services cannot be specifically traced back to a single person or beneficiary

(1) primary care provider network;

(2) epidemiological and disease surveillance system:

(3) health promotion programs and campaigns;

(4) effective preparedness and response to public health emergencies and disasters.

P/CWHS are required to institute the following minimum components:

Primary Care Worker (PCW)

Expected to provide comprehensive primary care, or a wide range of health services that meet common needs across life stages. screening, diagnostic, therapeutic, and preventive measures within the scope of profession

promoting health and implementing public/population health

Competencies for population-based services

Promoting Health

identifying, describing, and implementing programs, policies, and other health promotion interventions that are empowering, participatory, holistic, inter-sectoral, equitable, sustainable, and multi-strategic in nature

Local Health Board

Monitor and evaluate the implementation of health promotion in P/CHWS. Submit periodic reports to the DOH and Department of Interior and Government detailing the progress impact of the health promotion

RA 7875

Created PhilHealth National Health Insurance

RA 10351

Sin Tax Law

RA 9994

Senior Citizens Automatic Phil Health coverage

RA 11228

Mandatory PhilHealth coverage for all PWDs.

RA 7160

Local Government Code of 1991

RA 11467

An Act on Increasing the excise tax on Sugar-Sweetened Beverages

Goals

the desired outcomes at the end of interventions

Objectives

Short-term changes in the community that are observed as the health team and the community work towards attainment of goals. Serve as instructions, defining what should be detected in the community as intervention are being implemented.

Planning Strategy

disciplined process aimed at producing fundamental decisions and actions that will shape and guide what an organization is. Enhance community access to healthcare in order to improve productivity and thus reduce poverty.

Structure Evaluation

Involves looking into the manpower and physical resources of the agency responsible for community health interventions.

Process Evaluation

Examining the manner by which assessment, diagnosis, planning, implementation and evaluation were undertaken

Outcome Evaluation

Determining the degree of attainment of goals and objectives.

Utility, feasibility, propriety, accuracy

basis for a good evaluation

Utility

value of the evaluation in terms of usefulness of results

Feasibility

Whether the plan for evaluation is doable or not, considering available resources which include facilities, time, and expertise for conducting the evaluation

Propriety

Involves ethical and legal matters. Respect for the worth and dignity of the participants in data collection should be given due considerations.

Accuracy

Validity and reliability of the results of evaluation. Begins with accurate documentation while the community health process is ongoing

Direct Contributors

Refer to those who have the capacity to pay premiums, are gainfully employed and are bound by an employer-employee relationship, or are self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members.

Indirect Contributors

Refer to all others not included as direct contributors, as well as their qualified dependents, whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws.

Revenue from Sin Tax Reform

50% of PAGCOR income

40% of PCSO charity fund

10% from DOH funding

Premium contributions

Source of Funding for UHC

ocular or windshield survey

Rapid observation of a community may be done through

Primary data

data that have not been gathered before and are collected by the nurse through observations, survey, informant interview. community forum, and focus group discussions. The community itself is an example of this

Secondary Data

taken from existing data sources. Gives the nurse a picture of what is already known about the population, which may facilitate collection of primary data. Consists of vital registries, health records and reports, disease registries, and publications.

Participant observation

purposeful observation of formal and informal community activities by sharing in the life of the community

Survey

time consuming and expensive, may be necessary when there is no available information about the community. A series of questions for systematic collection of information from a sample.

Random sampling

Type of sample that is indicated for comprehensive needs assessment

Purposive sampling

Type of sample that is indicated for problem-oriented assessment

Informant Interviews

Purposeful talks with either key informants or ordinary members of the community.

Community forum

an open meeting at which all members of a community affected by a potential program are invited to come and participate. Used as a venue for informing the people about secondary data

Focus group

A small group, usually 6-12 members, who meet under the direction of a discussion leader to communicate their opinions about an organization, its products, or other given issues.

RA 3753

Civil Registry Law

RA 10625

Philippine Statistical Act of 2013

PD 856 Sanitation Code of the Philippines

Requires a death certificate before burial of the deceased

Disease Registry

A listing of persons diagnosed with a specific type of disease in a defined population.

Census data

a periodic governmental enumeration of population done every 5 years using the de jure method

De Jure

assignment is based on the legally established place of residence of people

De Facto

Actual physical location of people

Aggregate

Community composed of people who have similar demographics

1:5000; 1 per BHS

Ratio of midwives to families

1:10000

Ratio of nurses to families

1 BHS: 4 Barangays

Ratio of BHS to barangays

People, location, Social System

According to Allender, a community has 3 features

size, density, composition, rate of growth or decline, cultural characteristics, social class and educational level, mobility

Population variables that affect the health of the community include

Population size and density.

Influence the number and size of health care institution

Social System

Patterned series of interrelationships existing between individuals, groups, and institutions, and forming a coherent whole

Shared sense of belonging

Feeling of empowerment and control

Existing structures that allow subgroups

Ability to cope with change, solve problems, and manage conflicts

Open channels of communication and cooperation

Equitable and efficient use of community resources

Characteristics of a Health Community

ocular or windshield survey

Rapid observation of a community may be done through