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COMMUNITY NURSING DIAGNOSIS AND PLANNING

COMMUNITY HEALTH NURSING DEPARTMENT FACULTY OF NURSING UNIVERSITAS PADJADJARAN

Nursing Processs
Assessment

Planning

implementation

Evaluation

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Data Analysis and Diganosis

Data must be validated: Are they accurate? Data can be rechecked by the community assessment team Can be rechecked by others Subjective and objective data can be compared Community members can verify the findings Validated data are categorised in physical, social and environmental sectors Before making a diagnosis ALL assumptions must be validated!

Triangulation Methods

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Definition of a Community
A cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition) A group of people with a common characteristic or interest living together within a larger society

Community
A community is a whole entity that functions because of the interdependence of its parts or subsystems. Eight subsystems plus the community core are identified.

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Community Core
1. Community core: history, socio-demographic characteristics, vital statistics, values/beliefs/religions

Eight Subsystems
2. Eight subsystems:
Physical environment Education Safety and transportation Politics and government Health and social services Communication Economics recreation

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Definition of Community Diagnosis

Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.

The Community Diagnosis Process

A means of examining aggregate and social statistics in addition to the knowledge of the local situation, in order to determine the health needs of the community

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Goal
The mission of community diagnosis is to:
Analyze the health status of the community Evaluate the health resources, services, and systems of care within the community Assess attitudes toward community health services and issues Identify priorities, establish goals, and determine courses of action to improve the health status of the community Establish an epidemiologic baseline for measuring improvement over time.

How is the community diagnosed?

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Community Analysis
Community analysis is the process of examining data to define needs strengths, barriers, opportunities, readiness, and resources. The product of analysis is the community profile.

Community Analysis (cont.)

To analyze assessment data is helpful to categorize the data. This may be done as following:
Demographic Environmental Socioeconomic Health resources and services Health policies Study of target groups.

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Community is diagnosed using:

Health Indicators

Indicators of health are variables used for

the assessment of community health.

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Characteristics of Indicators:
should be valid, i.e., they should actually measure what they are supposed to measure; should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances; should be sensitive, i.e., they should be sensitive to changes in the situation concerned, should be specific, i.e., they should reflect changes only in the situation concerned, should be feasible, i.e., they should have the ability to obtain data needed, and; should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest.

Classification of health Indicators

Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators Utilization rates Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators

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Mortality Indicators

Mortality Rates
The traditional measures of health status. Widely used because of their ready availability.( death certificate is a legal requirement in many countries)

Crude death rates Specific death rates: age/disease Expectation of life Infant mortality rate Maternal mortality rate Proportionate mortality ratio Case Fatality rate

Morbidity Indicators

Morbidity rates

- Data on morbidity are preferable, although often difficult to obtain.

Incidence and prevalence Notification rates Attendance rates: out-patient clinics or health centers. Admission and discharge rates Hospital stay duration rates

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Disability Indicators

Disability rates

No. of days of restricted activity Bed disability days Work/School loss days within a specified period. Expectation of life free of disability

Nutritional Indicators

Nutritional Status Indicators

- It is an indicator of positive health

Anthropometrics measurements Height of children at school entry Prevalence of low birth weight Clinical surveys: Anaemia, Hypothyroidism, Nightblindness

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Health Care Delivery Indicators

Health Care Delivery Indicators

- Reflect the Equity / Provision of health care

Doctor / Population ratio Doctor / Nurse ratio Population / Bed ratio Population / per health center

Utilization Indicators

Health care utilization Rates

- Extent of use of health services

- Proportion of people in need of service who actually receive it in a given period

Proportion of infants who are fully immunized in the 1st year of life. i.e..immunization coverage. Proportion of pregnant women who receive ANC. HospitalHospital -Beds occupancy rate. HospitalHospital -Beds turnturn-over ratio

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Social/Mental Health Indicators

Indicators of Social and Mental Health

- Valid positive indicators does not often exist - Indirect measures are commonly used

Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse.

Environmental Indicators

Environmental health Indicators

- Reflect the quality of environment

Measures of Pollution The proportion of people having access to safe water and sanitation facilities Vectors density

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SocioSocio -economic Indicators

Socio-economic Indicators

- Is not a direct measure of health status. - For interpretation of health care indicators.

Rate of population increase Per capita GNP Level of unemployment Literacy rates - females Family size Housing condition e.g. No. of persons per room

Health Policy Indicators

Health Policy Indicators

- Allocation of adequate resources.

Proportion of GNP spent on health services. Proportion of GNP spent on health related activities. Proportion of total health resources devoted to primary health care

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Other Indicators

Other health indicators

Indicators of quality of life. Basic needs indicators. Health for all indicators.

Community Health diagnosis

Determining the pattern of health problems in a community, including factors which influence this pattern This community health diagnosis has the aspects of social medicine, which includes social anatomy, social physiology, social pathology, social diagnosis and social therapy.

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Social Anatomy
Human anatomy deals with the structure of body which has different organs The society has a structure (anatomy) and satisfaction of society may be according to:
Socioeconomic group: upper class, middle class, lower class, working class Professional groups: doctors, engineers, nurses, businessmen, professors Religions Rural and urban communities also differ in their life pattern

Contents of Community Health Diagnosis

Contents refers to the information required for making community health diagnosis This includes about:
present health and diseases information about potential for future and the community and communitys capacity for change, the health services being provided and how community feels about these services and the resources available or likely to be available in the future.

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Contents of Community Health Diagnosis

The information on present conditions may include demographic conditions
Mortality with cause of death Morbidity with frequency and type Disability of permanent nature

Contents of Community Health Diagnosis

The future potentials may be measured by:
Fertility-live births, still births, sterility, etc Susceptibility-blood test, skin test, etc Immunity natural, artificial Nutrition- nutritional level, deficiencies, symptoms, etc

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Contents of Community Health Diagnosis

The information on environment may include:
Internal health environment
Health services Sanitation Occupation All that affects health directly

External health environment

Socioeconomic factors which have bearing on health such education, food, housing, culture, behaviors, beliefs

Steps in Community Health Diagnosis

Individual as patient I Desire for help what is diagnosis? Community as patient Recognition of need Actual visit and observation of the community served III Opinion of the patient What does community think or feel it needs? I Examination of record, in office, clinic Vital statistics and other records II Superficial observation of patient

V and hospital V History and physical examination Routine studies, questions, observations, examinations, Tentative diagnosis preliminary to a Tentative status and chief problems complete work-up

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Steps in Community Health Diagnosis

Individual as patient Community as patient
VII Specific studies, and test, lab investigation VII Written diagnosis commitment I IX Prognosis and priorities, patient must be Community consulted and informed X Prescribed understanding, participation X Follow-up and evaluation of treatment, Follow-up patient involvement and evaluation of programs, treatment, co-operation, involvement, community Specific studies felt pertinent and necessary This is your problem in writing with publicity

prognosis with alternatives patient Plan, procedure and program, community and understand, cooperation and participation

community involvement

Possibility of failure to cure the sick community due to following reasons

Wrong inferences made from available data leading wrong actions Logically correct inferences but failure to act on the inferences Action taken but failure to change peoples practices in relation to health

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Community Health Diagnosis

Nursing diagnosis changes over time as it reflects the community health status, therefore they need to be periodically reevaluated and redefined Diagnosis include strengths, identifying sources of solutions, as well as communitys weaknesses or problem areas Diagnosis guide communities towards maximizing or improving their health, as they plan, implement and evaluate changes that will be measured by outcome criteria Outcome criteria are measurable standards community members will use to measure their success as they work towards improving the health of their community.

What is a Healthy Community?

Ten descriptors of a healthy community (Carlson 1997; Kang 1997)
healthy community is one where members have a high degree of awareness that we are a community healthy community uses its natural resources while taking steps to conserve them for future generations healthy community openly recognizes the existence of subgroups and welcomes their participation in community affairs A healthy community is prepared to meet crisis A healthy community is a problem-solving community

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What is a Healthy Community?

A healthy community has open channels of communication allowing information flow among all subgroups and in all directions healthy community seeks to make its systems resources available to all members of the community healthy community has legitimate and effective ways to settle disputes that arise healthy community encourages maximum citizen participation in decision-making healthy community promotes high level of wellness among all its members

Prioritization of community health issues

Priority setting for the selection of program content areas is one of the most important steps in the community assessment process, and one of the most neglected. Establish explicit criteria and process used by community benefit committee and staff to select priority program areas of focus.

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Community Health Priority Setting

Most high quality community assessments produce a relatively large number of health concerns that could be viewed as important, if not priorities. A more rational, deliberate, and evidence based approach is needed.

Community Health Priority Setting

The selection of priorities can be driven by factors ranging from who advocates most vigorously, or which stakeholders have more influence and resources to invest. This approach yields priorities, but they may not represent the most effective use of limited resources.

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Community Health Priority Setting

Priority setting should be based upon: a clearly articulated set of criteria areas where the needs are greatest where the potential for producing measurable outcomes is highest where community partners are most invested in positive results

Criteria and Process for Priority Setting

Develop a formal process and use explicit criteria to select program priorities. The process should include diverse community stakeholders, who should play a significant role in determining the selection criteria. Document the rationale for not addressing significant health issues identified in the community assessment.

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Community Health Nursing Planning

Planning for community change: Kurt Lewin Change Theory
Steps of program planning Traditional program plan Logical frame program plan

Kurt Lewins Change Theory

Consists of three distinct and vital stages:
Unfreezing Moving to a new level or Changing Refreezing

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Unfreezing
Involves finding a method of making it possible for people To let go of an old pattern that was counterproductive in some way

Moving to a new level

Involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive

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Refreezing
Is establishing the change as a new habit, so that it now becomes the standard operating procedure. Without this stage of refreezing, it is easy to backslide into the old ways.

Steps of program planning

Identify target group Identify planning group Establishing program goals Identify possible solutions Identify alternative solutions Identify resources

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Steps of program planning

Selection of best intervention strategies Set specific objectives Set intervention work plan Evaluation tool development Planning for monitoring & program evaluation

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