Community health Nursing

Facilitators :
Module Leader : Agathe Uwitonze MSCN
UR-College of Medicine and Health Sciences
Rwamagana Campus
Mob : +250 0788651179
E-mail: agathe.uwitonze@gmail.com
Kigali/Rwanda

November, 2017
Definition
 A community is a group of people in defined
geographical area with common goal and
objective and the potential for interacting with one
another

 Community health Nursing

It is defined as the synthesis of nursing and public
health practice applied to promoting and
protecting the health of population. It focuses on
the health needs of communities, aggregates,
and in particular vulnerable populations.
Features of a community
 A community has three features, location, population
and social system.
 Location: every physical community carries out
its daily existence in a specific geographical location.
The health of the community is affected by this
location, including the placement of the service, the
geographical features…
 Population: consists of specialized aggregates,
but all of the diverse people who live with in the
boundary of the community.
 Social system: the various parts of communities’
social system that interact and include the heath
system, family system, economic system and
educational system.
Characteristics of Community Health
Nursing
 It is a field of nursing
 It combines public health and nursing
 It focus in population and environment factors that
may impact to people’s health
 It emphasize in health promotion, illness prevention,
and wellness
 It promotes client responsibility and self-care
 It uses aggregate measurement and analysis
 It use principle of organizational theory
 It involves inter-professional collaboration.
Community settings nursing care
 Community health nursing takes place in a
wide variety of settings which includes
promoting health, preventing illness,
maintaining health, restoration, coordination,
management and evaluation of care of
individuals, families, and aggregates,
including communities.
 In the community settings, care focuses on
maximizing individual potential for self-care
regardless of any injury or illness.
 The client assumes responsibility for health
care divisions and care provision
 Community Health Practice

Health Promotion

1. Increase the 2. Reduce health 3. Achieve access to

span of healthy disparities among preventive services
life for all citizens population groups for everyone.
Roles of Community Health Nurses

Clinician

Researcher Educator

Nurses
Leadership Advocate

Collaborator Manager
Health Prevention

Tertiary Prevention

Secondary Prevention

Primary Prevention
Primary Prevention for Health
Promotion

 Health Education
 Adequate Nutrition
 Individual Development
 Adequate working environment and recreation,
resting
 Pre-marriage counseling and education
 Genetic Counseling
 Regular Physical Examination
Secondary Prevention

 Identify cases in the community

 Screen and test
 Conduct special physical examination
 Treat and prevent the progress of illness
 Avoid the spreading of disease
 Reduce the disability time
Tertiary Prevention

 Treat and stop the disease progress and

avoid complication and side effect

 Limit the chance for disability

 Provide rehabilitation for physical and

psychological well-being, occupational
therapy, availability of long-term care
Health and wellness

Health
 Each person has a personal perception
of health.
 Some people describe their state of
health as good even though they may
actually have one or more diagnosed
illness (es).
 That is because each person perceives
health in relation to personal
expectations and values
Wellness
Wellness is a life – style aimed at
achieving physical, emotional,
intellectual, spiritual and environmental
well-being.

The use of wellness measures can

increase stamina, energy and self –
esteem, then enhance quality of life.
Unit 1 : Assessment of community health
needs

Community Health needs assessment (CHNA) is a systematic

method for reviewing the health issues facing a population,
leading to agreed priorities and resource allocation that
will improve health and reduce inequalities.
• CHNA is a process that:
• describes the state of health of local people;
• enables the identification of the major risk factors and
causes of ill health; and
• enables the identification of the actions needed to
address these.
Continues,….
Types
• Familiarization or Windshield Survey : study the data
already available in the community
• Problem- oriented assessment : Presence of a problem
and the study of the community in terms of that problem
• Community subsystem assessment : focus on single
dimension of community life. Ex : survey of churches (their
role in the community)
Continues,…
• Comprehensive assessment : all relevant community
health information. Start with the existing data and then
the survey.
• Assets assessment : focus on the strengths and capacities
of the community rather than the problem.
CHNA methods
A. Survey : a series of questions to get the data for
analysis; it involves 3 phases :
• 1. Planning phase
• 2. data collection phase
• 3. Data analysis phase
Continues,..
B. Descriptive epidemiologic studies : Amount of
distribution of a health problem in the community by a
person (who, when, where, how,..)
C. Community forum/Town hall meetings : A
qualitative method designed to get the community’s
opinions. Ex: in school auditorium,..
D. Focus groups : Grassroots opinions, but small group
(5 to 15), meet 1 to 3 h and have same characteristics.
Continues,….
Sources of community data :
a. Primary and secondary sources : primary it is
from community members directly and
secondary from people who know the
community well
b. International sources : from several agencies
such as WHO
c. National sources : Official and non official
d. Local sources : from local level such as health
department of institution,...
Continues,…
The steps of CHNA
 Profiling : the collection of relevant information
about the state of health and health needs of the
population; and analysis this information to
identify the major health issues
 Deciding on priorities for action
 Planning public health and health care
programmes to address the priority issues
 Implementing the planned activities
 Evaluation of health outcomes
Continues,..
 Why CHNA is done ?
 HNA will enable to:
 plan and deliver the most effective care to those in
greatest need;
 apply the principles of equity and social justice in
practice;
 ensure that scarce resources are allocated where
they can give maximum health benefit;
The HNA to be successful must involve the
community as well as other professionals and
agencies
 Continues,….
Community diagnosis
It is one used to assess the health needs of the community

According to WHO definition, it is “a quantitative and qualitative

description of the health of citizens and the factors which
influence their health. It identifies problems, proposed areas for
improvement and stimulates action”.

Other definitions :

Community diagnosis is a comprehensive assessment of health

status of the community in relation to its social, physical and
biological environment. The purpose of community diagnosis is to
define existing problems, determine available resources and set
priorities for planning, implementing and evaluating health action,
by and for the community.
 Continues,….
The practical relevance of community diagnosis includes:
• - To act as a data reference for the district
• - To provide an overall picture of the local community and the
residents’ concerns
• - To suggest priority areas for intervention and the feasible
solutions
• - To indicate the resource allocation and the direction of work
plans
• - To create opportunities for intersectoral collaboration and
media involvement
 Continues,….
• To form basis of setting indicators for health community
evaluation
• -To find the common problems or diseases, which are
troublesome to the people and are easily preventable in
the community.
• -To access the group of underprivileged people who are
unable to use the available facilities due to poverty,
prevailing discriminations or other reasons.
• -To find the real problems of the community people
which might not have perceived by them as problems.
• -To impart knowledge and attitudes to turnover people’s
problems towards the light of solution.
 Continues,..
• Types of Community Diagnosis
• Comprehensive Community Diagnosis : aims to obtain
general information about the community
• Problem-Oriented Community Diagnosis : type of
assessment responds to a particular need
• How to conduct a community diagnosis?

• The process of CD involves four stages

• 1. Initiation
• 2. Data collection and analysis
• 3. Diagnosis
• 4. Dissemination
 Continues,..
Initiation :
In order to initiate a community diagnosis project, a dedicated committee
to manage and coordinate the project is necessary . It should involve
relevant parties such as government departments, health professionals
and non-governmental organizations.

At an early stage, it is important to identify the available budget and

resources to determine the scope of the diagnosis. Some of the common
areas to be studied may include health status, lifestyles, living conditions,
socioeconomic conditions, physical and social infrastructure,
inequalities, as well as public health services and policies.

Once the scope is defined, a working schedule to conduct the community

diagnosis, production and dissemination of report should be set.
 Continues,….
 Data collection and analysis
In data collection, both quantitative and qualitative data
should be used as data collection approaches.
Moreover, Population Census and statistical data e.g.
population size, sex and age structure, medical services,
public health, social services, education, housing, public
security and transportation, etc. can provide
background of the population.
Also the community data can be collected by conducting
surveys through self-administered questionnaires, face
to face interviews, focus groups and telephone
interviews.
 Continues,…
The data collection in Community Diagnosis is done using a tool
called "Health Indicators" which are the variables used for the
assessment of community health. Indicators must be valid,
reliable, sensitive, specific, feasible and relevant.

 Health indicators can be classified as:

 Mortality indicators
 Morbidity indicators
 Disability rates
 Nutritional status indicators
 Health care delivery indicators
 Utilization rates
 Continues,…..
• Indicators of social and mental health
• Environmental indicators
• Socio-economic indicators
• Health policy indicators
• Indicators of quality of life

Collected data can then be analyzed and interpreted by experts.

Here are some practical tips on data analysis and presentation:
• - statistical information is best presented as rates or ratios for
comparison
• - local district data can be compared with other districts or the
whole population
• - graphical presentation is preferred for easy understanding
 Continues,…
 Diagnosis
Diagnosis of the community is reached from conclusions
drawn from the data analysis. It should preferably
comprise three areas:
 - Health status of the community
 - Determinants of health in the community
 - Potential for healthy development in the community
 Continues,…
Dissemination

Efforts should be put into communication to ensure that targeted

actions are taken. The target audience for the community
diagnosis includes policy-makers, health professionals and the
general public in the community.
The report can be disseminated through the following channels:
• - Presentations at meetings of the health boards and
committees, or forums organized for voluntary organizations,
local community groups and the general public
• - Press release
• It is important to realize that CD is not a one-off Project, but is
part of a dynamic process leading to health promotion in the
community. Therefore community diagnosis should be
conducted at regular
Tumusiime Alex intervals.
& Mulamba Museme Kabile December 4, 2018