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COMMUNITY DIAGNOSIS -PROFILE of local health situation: BASIS for health programs and services to be delivered to the community

-Starts with determining the health status of the community Types of Community Diagnosis Comprehensive community diagnosis Aims to obtain general information about the community Problem Oriented community diagnosis Responds to a particular need ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS DEMOGRAPHIC VARIABLES Total population & Geographical distribution including Urban-Rural index & Population Density Age & Sex composition Selected vital indicators e.q. Growth rate, CBR, CDR & Life expectancy rate Patterns of migration Population projection Note: **Population groups that need special attentions: Indigenous people Internal refugees Socially dislocated groups as a result of disasters, calamities & development programs 2. Socio-economic & Cultural variables Social indicators Communication network Transportation system Educational level Housing conditions Economic indicators Poverty level income Employment rate Types of industry present in the community Occupation common in the community Environmental indicators 1. Physical/geographical/topographical characteristics 2. Water supply 3. Waste disposal 4. Air, Water and Land pollution Cultural factors Variables that may break up people into groups within the community Ethnicity Social class Language Religion Race Political orientation Cultural beliefs and practices that affect health Concepts about Health and Illness 3. Health & illness patterns Leading cause of mortality Leading cause of morbidity Leading cause of infant mortality Leading cause of maternal mortality Leading cause of hospital admission 4. Health resources Manpower resources Material resources 5. Political/Leadership patterns Reflects the action potential of the state and its people to address the health needs and problems of the community Mirrors the sensitivity of the government to the peoples struggle for better lives STEPS 1. Determine the objectives Nurse decides on the depth or scope of the data she needs to gather 2. Define the study population Entire population Specific population groups 3. Determine the data to be collected Nurse decides on the sources of data 1. Records of agencies 2. People themselves 4. Collecting the data Records review Surveys & Observations Interviews

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Participant observation 5. Developing the instruments Survey questionnaires Interview guides Observation checklist 6. Actual data gathering Before actual data gathering 1. Nurse meet people who will be involved in data collection 2. Nurse supervises the data collectors by checking of filled-up instruments in terms of; 1. Completeness Accuracy Reliability 7. Data collation putting up all gathered information altogether Two types of data that may be generated Numerical Descriptive To facilitate data collation Nurse must develop categories for classification of responses Mutually exclusive Exhaustive categories The next step after categorizing is; Summarizing the data Manual tallying Encoding by the use of computers 8. Data presentation Depend largely on the type of data obtained Descriptive data are presented in narrative reports Geographic data History of a place Beliefs regarding death and illness Numerical data are presented into table or graph Line graph Bar graph/Pictograph Histogram/Frequency polygon Proportional or Component bar graph/Pie chart Scattered diagram 9. Data analysis Aims to establish trends and patterns in terms of health needs and problems of the community Allows for comparison of obtained data with standard values 10. Identifying Community Health Nursing Problems Health Status Problems 1. Increased/decreased morbidity, mortality fertility or reduced capability for wellness Health Resources Problems 1. Lack of or absence of manpower, money, materials or institutions necessary to solve health problems Health Related Problems 1. Existence of social, economic, environmental and political factors that aggravate the illnessinducing situations in the community 11. Priority-setting Nature of the condition/problem presented Classified as health status, health resources or health related problems Magnitude of the problem 1. Severity of the problem which can be measured in terms of the proportion of the population affected by the problem Modifiability of the problem Probability of reducing, controlling or eradicating the problem Preventive potential Probability of controlling or reducing the effects posed by the problem Social concern 1. Perception of the population or the community as they are affected by the problem and their readiness to act on the problem APPLICATION OF PUBLICHEALTH TOOLS IN COMMUNITY HEALTH NURSING Three important tools that help the nurse in identifying the communitys health needs The health disciplines of Demography Vital statistics Epidemiology DEMOGRAPHY. Science which deals with the study of the human populations Size Composition

Distribution in space Sources of Demographic Data: Can be obtained from a variety of sources Censuses Sample surveys Registration systems Two ways of assigning people when the census is being taken De jure: Done when people are assigned to the place where they usually live regardless of where they are at the time of the census De facto: People are assigned to the place where they are physically present at the time of the census regardless of their usual place or residence SAMPLE SURVEY: Data comes from a small number of population proportionate to the total population REGISTRATION SYSTEMS Collected by the Civil Registrars Office Deal with the recording of vital events in the community VITAL EVENTS Births Deaths Marriages Divorces POPULATION SIZE Refers to the number of people in a given place or area at a given time TWO METHODS IN DETERMINING POPULATION SIZE METHOD 1

Refers to the systematic study of vital events such as births, illnesses, marriages, divorces/separations and deaths Tool in estimating the extent or magnitude of health needs and problems in the community 3 HEALTH INDICATORS FERTILITY -CRUDE BIRTH RATE -GENERAL FERTILITY RATE MORBIDITY -INCIDENCE RATE -PREVALENCE RATE MORTALITY -CRUDE DEATH RATE -SPECIFIC MORTALITY RATE -INFANT MORTALITY RATE -MATERNAL MORTALITY RATE -SWAROOPS INDEX -CAUSE OF DEATH RATE -PROPORTIONATE MORTALITY RATE -CASE FATALITY RATE CRITERIA Nature of the Problem H. Status H. Resources H. Related Magnitude of the Problem 75-100% affected 50-74% affected 34-49% affected <25% affected Modifiabiltiy of the Problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social Concern Urgent community concern expressed readiness Recognized as problem but not needing urgent attention Not a community concern 3 2 1 4 3 2 1 3 2 1 0 3 2 1 2 1 0 WEIG HT 1

BIRTHS DEATHS NATURAL INCREASE RATE OF NATURAL INCREASE METHOD 2 BIRTHS + MIGRANTS - DEATHS ABSOLUTE INCREASE PER YEAR RELATIVE INCREASE POPULATION COMPOSITION Pertaining to population sizes variables such as: Age Sex Occupation Educational level SEX COMPOSITION To describe the sex composition of the population, the nurse computes for the SEX RATIO AGE COMPOSITION MEDIAN AGE Divides the population into two equal parts. DEPENDENCY RATIO Compares the number of economically dependent with the economically productive group in the population.

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Economically dependent: 0-14, 65 and

Economically productive: within 15-64 age group AGE AND SEX COMPOSITION Can be described at the same time using a population pyramid Population pyramid: Graphical presentation of the age and sex composition of the population POPULATION DISTRIBUTION

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Urban-Rural distribution: Simply illustrates the proportion of the people living in urban compared to the rural areas Crowding Index: Described by dividing the number of persons in a household with the number of rooms used by the family for sleeping (# of persons/# of rooms) Population Density: Will determine how congested a place and has implications in terms of the adequacy of basic health services present in the community (#of people/TLA) VITAL STATISTICS