10/17/2013 1 COMMUNITY NURSING DIAGNOSIS AND PLANNING COMMUNITY HEALTH NURSING DEPARTMENT FACULTY OF NURSING UNIVERSITAS PADJADJARAN Nursing Processs Assessment Planning implementation Evaluation
Nov 29, 2015
10/17/2013
1
COMMUNITY NURSING DIAGNOSIS AND PLANNING
COMMUNITY HEALTH NURSING DEPARTMENT
FACULTY OF NURSINGUNIVERSITAS PADJADJARAN
Nursing Processs
Assessment
Planning
implementation
Evaluation
10/17/2013
2
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
10/17/2013
3
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.
10/17/2013
4
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
10/17/2013
5
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”
10/17/2013
6
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?
10/17/2013
7
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.
10/17/2013
8
• Community is diagnosed using:
Health Indicators
Indicators of health are variables used for the assessment of community health.
10/17/2013
9
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
10/17/2013
10
Mortality IndicatorsMortality 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 IndicatorsMorbidity 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
10/17/2013
11
Disability IndicatorsDisability 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 IndicatorsNutritional 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
10/17/2013
12
Health Care Delivery IndicatorsHealth 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 IndicatorsUtilization Indicators
Health care utilization Health care utilization RatesRates
-- Extent of use of health servicesExtent of use of health services-- Proportion of people in need of service Proportion of people in need of service
who actually receive it in a given who actually receive it in a given periodperiod
Proportion of infants who are Proportion of infants who are fully immunized in the 1fully immunized in the 1stst year year of life. of life. i.e..immunization coverage.i.e..immunization coverage.
Proportion of pregnant women Proportion of pregnant women who receive ANC.who receive ANC.
HospitalHospital--Beds occupancy rate.Beds occupancy rate. HospitalHospital--Beds turnBeds turn--over ratioover ratio
10/17/2013
13
Social/Mental Health IndicatorsSocial/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 IndicatorsEnvironmental 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
10/17/2013
14
SocioSocio--economic Indicatorseconomic 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 IndicatorsHealth 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
10/17/2013
15
Other IndicatorsOther 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.
10/17/2013
16
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 community’s 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.
10/17/2013
17
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
10/17/2013
18
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 Community as patient
I Desire for help ‘what is diagnosis?’ Recognition of need
II Superficial observation of patient Actual visit and observation of the
community served
III Opinion of the patient What does community think or feel it
needs?
I
V
Examination of record, in office, clinic
and hospital
Vital statistics and other records
V History and physical examination Routine studies, questions, observations,
examinations,
Tentative diagnosis preliminary to a
complete work-up
Tentative status and chief problems
10/17/2013
19
Steps in Community Health Diagnosis
Individual as patient Community as patient
VII Specific studies, and test, lab investigation Specific studies felt pertinent and necessary
VII
I
Written diagnosis commitment This is your problem in writing with publicity
IX Prognosis and priorities, patient must be
consulted and informed
Community involvement, community
prognosis with alternatives
X Prescribed treatment, patient
understanding, co-operation, and
participation
Plan, procedure and program, community
understand, cooperation and participation
X Follow-up and evaluation of treatment,
patient involvement
Follow-up and evaluation of programs,
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 people’s practices in relation to health
10/17/2013
20
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 community’s 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 HealthyCommunity?
• 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
10/17/2013
21
What is a HealthyCommunity?
• 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 communityhealth 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.
10/17/2013
22
Community HealthPriority 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 HealthPriority 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.
10/17/2013
23
Community HealthPriority 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 forPriority 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.
10/17/2013
24
Community HealthNursing Planning
• Planning for community change: Kurt
• Lewin Change Theory– Steps of program planning
– Traditional program plan
– Logical frame program plan
Kurt Lewin’s Change Theory
• Consists of three distinct and vital stages:– “Unfreezing”
– “Moving to a new level or Changing”
– “Refreezing”
10/17/2013
25
“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
10/17/2013
26
“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