Community health nursing, the community is not simply a context of the existence of the families, groups, subpopulations or populations

nor just a setting for our nursing interventions. Lest we forget, we regard the community as our primary client

The community has a direct influence on the health of the individual, families and sub-populations. It is at this level that most health service provision occurs.

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

Proceed to analyze and seek explanations for the occurence of health needs and problems of the community. The community health nursing diagnoses are then derived and will become the bases for developing and implementing community health nursing interventions and strategies. This process is called community diagnosis.

The health status of the community is the product of the following elements: population physical & topographical characterestics socio-economic and cultural factors health and basic social services power structure within the community.

COMPREHENSIVE COMMUNITY DIAGNOSIS PROBLEM-ORIENTED/FOCUSED

Aims to obtain a general information about the community. Has the following elements: 1. Demographic Variable 2. Socio- economic & Cultural Variable 3. Health and Illness Patterns 4. Health Resources 5. Political/Leadership Patterns

Shows the size, composition and geographical distribution of the population.

TOTAL POPULATION and GEOGRAPHICAL DISTRIBUTION: urban-rural index and population density AGE and SEX composition VIRAL INDICATORS: growth rate, crude birth rate, crude death rate, life expectancy at birth PATTERNS OF MIGRATION POPULATION PROJECTIONS

there are no limits as to the list of socioeconomic and cultural factors that may directly or indirectly affect the health status of the community. A. social indicators B. economic indicators C. environmental indicators D. cultural factors

Communication network - whether FORMAL or INFORMAL CHANNELS -necessary for disseminating health information or facilitating referral of clients to the health care system Transportation system- road networks necessary for accesibility of the people to health care delivery system.

Educational level- may be indicative for POVERTY and may reflect on health perception and utilization pattern of the community. Housing conditions- may suggest health hazards ( congestion, fire, exposure to elements)

Poverty level income Unemployment and underemployment rates Proportion of salaried and wage earners to total economically active population Types of industry present in the community Occupation common in the community

Physical/geographical/topographical characteristics of the community:

land areas that contribute to vector

problems terrain characteristics that contribute to accidents or pose as geo hazard zones land usage in industry climate/season (flood during rainy days)

Water supply
% population with access to safe, adequate

water supply source of water supply

 Waste disposal % population served by daily garbage

collection system % population with safe excreta disposal system types of waste disposal and garbage disposal system

Air, water & land pollution Industries in the community having health

hazards associated with it Air and water index

 variables

that may break up the people into groups within the community such as:
ethnicity social class language religion race political orientation

cultural

beliefs and practices that affect health concepts about health and illness

may collect primary data about the leading causes of illness and deaths and their respective rates of occurrence. If has access to recent and reliable secondary data, then make use of these:
1. 2. 3. 4. 5. Leading causes of mortality Leading causes of morbidity Leading causes of infant mortality Leading causes of maternal mortality Leading cause of hospital admission

health resources that are available in the community are important element of the community diagnosis mainly because they are the essential ingredients in the delivery of basic health services May be classified as Manpower or Material

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 organization (government, nongovernment, health units, private) Quality of health manpower Existing manpower development/policies

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

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.

 power structures in the community (formal/informal) attitudes of the people toward authority conditions/events/issues that cause social conflict/ upheavals or that lead to social bonding or unification practices/approaches that are effective in setting issues and concerns within the community

type of assessment that responds to a particular need (Spradley 1990)

The process of community diagnosis consists of: - Collecting - Organizing - Synthesizing - Analyzing - Interpreting health data

1. Determining the Objectives

decide on DEPTH and SCOPE of data that needs to be gathered whether a problem-oriented or community diagnosis, determine the occurrence and distribution of selected environmental, socioeconomic and behavioral conditions important to disease control and wellness promotion (Dever 1980)

2. Defining the Study Population

Based on objectives, the nurse identifies the population group to be included in the study. May include the entire community or

population in the

Focused on a specific population group such as women in the reproductive age- group or infants and young children. You may also collect data from a subset population-when a complete enumeration of the desired population is not possible.

3. Determining the Data to be Collected

The objectives will guide you in identifying the specific data that you have to collect. Should decide on the sources of these data Are these data available from record of agencies? Or from people themselves?

4. Collecting the Data

Different method may be utilized to generate health data. Decide on specific methods depending on the type of data to be generated interview- about peoples health beliefs or review existing health records in the Rural Health Unit

Records view- data may be obtained by reviewing those that have been complied by health or non-health agencies from the government or other sources. Surveys and observations- used to obtain both qualitative and quantitative data. Interviews- can yield first hand information

Participant Observation- used to obtain qualitative data by allowing the nurse to actively participate in the life of the community.

5. Developing the Instrument

Instruments

or tools facilitate the nurses data gathering activities. The following are the most common instruments that the nurse uses in her data collection: a. Survey questionnaire b. Interview guide C. Observation checklist

Meet people before the actual data gathering who will be involved in the data collection. Instruments are discussed and analyzed If necessary, instruments may be modified or simplified in order- not to overburden the people who may have limitations in terms of educational preparation or available time to finish data collection

6. Actual Data Gathering

Pre-testing of instruments- highly recommended Data collectors- must be given an orientation and training on how they are going to use the instruments During the actual data gathering, the nurse supervises the data collectors by checking the filled-up instruments in terms of:
Completeness Accuracy Reliability

6. Actual Data Gathering

7. Data Collection
Ready

to put together all the information. Two types of data that may be generated:
NUMERICAL DATA- can be counted DESCRIPTIVE DATA- can be described Must develop categories for classification of responses making sure that the categories are mutually exclusive and exhaustive

choices do no overlap

anticipate all possible answers that a respondent may give.

Manually- by tallying the data or by using the computer. Tallying involvesentering responses into prepared tally sheets showing all possible responses.

Responses given in numbers or codes when using a computer

8. Data Presentation
Depend largely on the type of data

obtained.

Descriptive data- presented in narrative reports. Numerical data- may be presented into table or graphs. Table/graphs-useful in showing key information making it easier to show comparisons including patterns & trends.

LINE GRAPH- shows trend data or changes with time or age with respect to some other variable. BAR GRAPH/PICTOGRAPH- for comparisons of absolute or relative counts and rates between categories. HISTOGRAM/FREQUENCY POLYGON- graphic presentation of frequency distribution or measurement. PROPORTIONAL OR COMPONENT BAR/ GRAPH/ PIE CHART- shows breakdown of a group or total where the number of categories is not too many. SCATTERED DIAGRAM- correlation data for two variables.

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 Determining interrelationship of factors- helps view the significance of the problems and their implications on the health status of the community

Categorized as: Health status problems- may be described in terms of increased or decreased morbidity, mortality, fertility or reduced capability of wellness Health resources problems- lack or absence of manpower, money, materials or institutions necessary to solve health problems. Health-related problems- existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community.

10. Identifying the Community Health Nursing Problems

11. Priority-setting
Prioritize which health problems can be

attended to considering the resources available at the moment. The following criteria is used:

Nature of the condition/problem- presented classified as health status, health resources or health related-problems

Magnitude of the problem- refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem

11. Priority-setting
The following criteria is used:
Modifiability of the problem- refers to the probability of reducing, controlling or eradicating the problem Preventive potential- probability of controlling or reducing the effects posed by the problem. Social concern- perception of the population or the community as they are affected by the problem and their readiness to act on the problem.

Is the science which deals with the study of the human populations size, composition and distribution in space.

SOURCES OF DEMOGRAPHIC DATA >censuses >sample surveys >registration systems

 defined

as an official and periodic enumeration of population.

demographic,

economic and social data are collected from a specified population group.

The de jure method -people are assigned to the place where they usually live The de facto method -people are assigned to the place where they are physically present at the time of the census

SAMPLE SURVEY -demographic information can still be collected from a sample of a given population. REGISTRATION SYSTEMS -collected by the civil registrars office deal with recording of vital events in the community. POPULATION SIZE -also helps her rationalize the types of health programs or interventions which are going to be provided for the community.

One method of measuring the population size is by determining the increase in the population resulting from excess of births compared to deaths. This can be done in two ways:

Second method of measuring the population size is to determine the increase in the population using data obtained during two census periods.

-commonly described in terms of its age and sex

SEX COMPOSITION SEX RATIO = number of males x100 number of females

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

AGE AND SEX COMPOSITION -described at the same time using a population pyramid

-urban-rural distribution, population density and crowding index.

1.URBAN-RURAL DISTRIBUTION -simply illustrate the portion of the people living in urban compared to the rural areas 2. CROWDING INDEX -will describe the ease by which a communicable disease will transmitted from one host to another susceptible host 3.POPULATION DENSITY -will determine how congested a place is and has implications in terms of the adequacy of basic health services present in the community.