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THE COMMUNITY DIAGNOSIS Caring for the community as client starts with determining its health status.

Community health diagnosis in nursing consists of two important parts (Muecke 1989). The nurse collects data about the community in order to identify the different factors that may directly or indirectly influence the health of the population. Then, she proceeds to analyse and seek explanations for the occurrence of health needs and of the community. This is the first part of the community diagnostic process called the community of community health nursing process. (Freeman and Heinrich 1981; Muecke 1989) The nurse utilizes these assessment data to derive the community health nursing diagnoses and become the bases for developing and implementing community health nursing interventions and strategies. This process completes the community diagnosis.

Types of Community Diagnosis In the assessment of the communitys health status, the nurse considers the degree of detail or depth of inquiry. Comprehensive assessment is normally done when the nurse has not had opportunity of working with the community and its people. The nurse needs information to help her understand the community and facilitate its enabling process. Oftentimes, the nurse is confronted with a specific problem area like a disaster situation or an outbreak of disease. In these instances, a problem-oriented assessment will have to be conducted. A nurse may decide to assess a specific population group in the community, in which case, she may opt to conduct a comprehensive assessment of that group and at the same time, focus on the specific problems of that same group. It is important, therefore, to decide on the objectives of the community diagnosis, the resources and time available to implement it.

Comprehensive Community Diagnosis A comprehensive community diagnosis aims to obtain general information about the community with the intent of determining not only prevalent health conditions and risk factors (epidemiologic approach) but also the socio-economic

conditions (socio-economic approach) and lifestyle behaviors and attitudes that have effect on health (behavioral approach). The following are elements of a comprehensive community diagnosis and the basic data are needed to characterize each variable: A. Demographic Variables The analysis of the communitys demographic characteristics should show the size, composition and geographical distribution of the population as indicated by the following: 1. Total population and geographical distribution including urban-rural index and population density 2. Age and sex composition 3. Household size 4. Selected vital indicators such as growth rate, crude birth rate, crude death rate and life expectancy at birth 5. Patterns of migration 6. Population projections It is also important to know whether there are population groups that need special attention such as indigenous people, internal refugees and other socially dislocated groups as a consequence of disasters, calamities and development programs. B. Socio-Economic and Cultural Variables There are no limits as to the list of socio-economic and cultural factors that may directly or indirectly affect the health status of the community. However, the nurse should consider the following as essential information: 1. Social indicators a. Educational level which may be indicative of poverty and may reflect on health perception and utilization pattern of the community b. Housing conditions which may suggest health hazards (congestion, fire, exposure to elements) c. Social classes or groupings 2. Economic indicators a. Poverty level income b. Unemployment and underemployment rates c. Proportion of salaried and wage earners to total economically active population d. Types of industry present in the community e. Occupation common in the community

f. Communication network (whether formal or informal channels) necessary for disseminating health information or facilitating referral of clients to the health care system g. Transportation system including road networks necessary for accessibility of the people to health care delivery system 3. Environmental indicators a. Physical/geographical/topographical characteristics of the community land areas that contribute to vector problems terrain characteristics that contribute to accidents or pose as geohazard zones land usage in industry climate/season b. Water supply % population with access to safe, adequate water supply source of water supply c. Waste disposal % population served by daily garbage collection system % population with safe excreta disposal system Types of waste disposal and garbage disposal system d. Air, water and land pollution industries within the community having health hazards associated with it air and water pollution index 4. Cultural factors a. Variables that may break up the people into groups within the community such as: ethnicity social class language religion race political orientation b. Cultural beliefs and practices that affect health c. Concepts about health and illness C. Health and Illness Patterns

In analysing the health and illness patterns, the nurse may collect primary data about the leading causes of illness and deaths and their respective rates of occurrence. If she has access to recent and reliable secondary data, then she can also make use of these. 1. Leading cause of mortality 2. Leading cause of morbidity 3. Leading cause of infant and child mortality 4. Leading cause of maternal mortality 5. Leading cause of hospital admission 6. Leading cause of clinic consultation 7. Nutritional status D. Health Resources The health resources that are available in the community are an important element of the community diagnosis mainly because they are the essential ingredients in the delivery of basic health services. The nurse needs to determine manpower, institutional and material resources provided not only by the state but those which are contributed by the private sector and other nongovernment organizations. 1. Manpower resources categories of health manpower available geographical distribution of health manpower manpower-population ratio distribution of health manpower according to health facilities (hospitals, rural health units, etc) distribution of health manpower according to type of organizations (government, non-government, health units, private) quality of health manpower existing manpower development/policies 2. Material resources health budget and expenditures sources of health funding categories of health institutions available in the community hospital bed-population ratio categories of health services available

E. Political/Leadership Patterns The political and leadership pattern is a vital element in achieving the goal of high level wellness among the people. It reflects the action potential of the state and its people to address the health needs and problems of the community. It also mirrors the sensitivity of the government to the peoples struggle for better lives. In assessing the community, the nurse describes the following: 1. Power structures in the community (formal or informal) 2. Attitudes of the people toward authority 3. Conditions/events/issues that cause social conflict/ upheavals or that lead to social bonding or unification. 4. Practices/approaches effective in settling issues and concerns within the community. Problem-Oriented Community Diagnosis The problem-oriented community diagnosis is the type of assessment that responds to a particular need of a target group. (Spradley, 1990; Clark 2003) For example, a nurse is confronted with health and medical problems resulting from mine tailings being disposed into the river systems by a mining company. Since a community diagnosis investigates the community-meaning, the people and its environment the nurse proceeds with the identification of the population who were affected by the hazards posed by mine tailings. Then she goes on to characterize the biophysical, psychological, physical environmental, socio-cultural and behavioral as well as health system factors relevant to the specific problem being investigated.