Community Health and Diagnosis Notes

Community Diagnosis

  • Definition: Process of determining the health status of a community and the factors contributing to it.
  • Purpose: Identify problems and areas for improvement to stimulate action.
  • Judgment Process: Health workers assess the community’s health status, available resources, and the potential for health action.

Role of Community Organizer

  • Definition: Individuals involved in community organization, including nurses, social workers, teachers, or volunteers.
  • Roles:
    • Enabler: Enhance human resources through education and training.
    • Advocate: Represent community views, ensuring voices are heard.
    • Facilitator: Foster relationships and linkages among people and agencies.
    • Change Agent: Influence community decision-making and future shaping.

Traditional Research vs. Participatory Action Research

  • Decision Making:
    • Traditional: Top-down approach driven by experts.
    • Participatory: Bottom-up approach driven by community input.
  • Roles:
    • Traditional: Nurse-expert driven.
    • Participatory: Community-driven process.
  • Methodology:
    • Traditional: Pre-determined tools and methodologies.
    • Participatory: Tools developed by the community itself.
  • Output:
    • Traditional: Study packaged and submitted for publication with researcher recommendations.
    • Participatory: Conclusions and recommendations made by the community lead to agreed actions/projects, forming part of community life.

Stating Community Diagnoses

1. NANDA International Diagnostic Labels
  • Focus on individual responses, with more recent versions including community-level diagnoses.
2. Shuster and Goeppinger
  • Proposed adaptations of nursing diagnoses for population groups.
3. Omaha System
  • Framework for care involving nursing and other health care providers with three components:
    1. Problem Classification Scheme: Guides data collection and classification of health needs.
    2. Intervention Scheme: Directs the focus of care interventions.
    3. Problem Rating Scale for Outcomes: Evaluates the effectiveness of interventions.
Problem Classification Levels:**
  • Level I: Four domains:
    • Environmental
    • Psychosocial
    • Physiological
    • Health-related behaviors
  • Level II-IV: More specific classifications based on qualifiers and clustering of signs/symptoms.

Planning Community Health Interventions

  • Basis: Derived from assessment findings and formulated nursing diagnoses.
  • Involvement: Active participation from the community is crucial; representation is facilitated through prior organization.
Priority Setting
  • Provides nurses and health teams with a logical method to prioritize health concerns.
  • WHO Criteria for Intervention Selection:
    1. Significance of Problem: Number of people affected.
    2. Community Awareness: Level of priority given by community members.
    3. Ability to Reduce Risk: Availability of expertise and resources.
    4. Cost of Reducing Risk: Economic and ethical considerations.
    5. Target Population Identification: Access to reliable data sources.
    6. Availability of Resources: Financial and material resources for interventions.
Steps in Priority Setting:
  1. Rate each criterion's importance (scale of 1-10).
  2. Rate the group's ability to influence each criterion (scale of 1-10).
  3. Collate weights and ratings from group members.
  4. Compute total priority scores by multiplying weights and ratings.
  5. Determine the highest priority based on total scores.

Goals and Objectives Formulation

  • Goals: Desired outcomes after interventions.
  • Objectives: Short-term changes observed during interventions.
  • SMART Objectives: Ensure specific, measurable, achievable, relevant, and time-bound outcomes.
Sample Goal:

Problem: Risk of maternal complications leading to maternal mortality.
Goal: Reduce maternal mortality rate from 132/100,000 to 80/100,000 by 2015.
Objectives: Increase facility-based births, reduce untrained-TBA attended births, lower nutritional risks among pregnant women.

Deciding on Community Interventions

  • Analysis: Evaluate health behaviors and direct strategies to address underlying causes.
  • Example: Preference for home delivery over facility-based delivery due to cost and lack of services. Strategies include improving facility-based services.
  • Considerations: Demographic, psychological, social, cultural, and economic characteristics of the target population must be assessed alongside available resources.