Micro Teaching

Assessing Communty HealthBuelva, Lorraine

Bueno, MatetCarpena, Nivia

Intal, Ces

introduction

Community health nursing, the community is not simply a context of the existence of the families, groups, sub-populations or populations nor just a setting for our nursing interventions. Lest we forget, we regard the community as our primary client

Reasons why community is 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.

assessment

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.

diagnosis

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.

Health Status

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.

Types of Community Diagnosis

COMPREHENSIVE COMMUNITY DIAGNOSIS

PROBLEM-ORIENTED/FOCUSED

comprehensive community diagnosis

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

Demographic variableShows 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

Socio- economic & Cultural Variable 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.

A. social indicators B. economic indicators C. environmental indicators D. cultural factors

social indicators

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.

social indicators

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)

economic indicators

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

environmental indicators 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

environmental indicators 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

cultural factors 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

Health & Illness Patterns 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. Leading causes of mortality2. Leading causes of morbidity3. Leading causes of infant mortality4. Leading causes of maternal mortality5. Leading cause of hospital admission

Health Resources

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

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 organization (government, non-government, health units, private)

Quality of health manpower Existing manpower development/policies

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

Political / Leadership Patterns

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 people’s struggle for better lives.

In assessing the community, the nurse describes the following:

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

problem oriented / focused

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

PROCESS: Community Diagnosis

The process of community diagnosis consists of:

- Collecting- Organizing- Synthesizing- Analyzing- Interpreting health data

Steps in Conducting a Community Diagnosis

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, socio-economic and behavioral conditions important to disease control and wellness promotion (Dever 1980)

Steps in Conducting a Community Diagnosis

2. Defining the Study Population Based on objectives, the nurse identifies the

population group to be included in the study.

May include the entire population in the community or

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.

Steps in Conducting a Community Diagnosis

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?

Steps in Conducting a Community Diagnosis

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 people’s health beliefs

or review existing health records in the Rural Health Unit

methods of collecting data 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.

Steps in Conducting a Community Diagnosis

5. Developing the Instrument Instruments or tools facilitate the

nurse’s data gathering activities. The following are the most common instruments that the nurse uses in her data collection:

a. Survey questionnaireb. Interview guideC. Observation checklist

Steps in Conducting a Community Diagnosis

6. Actual Data Gathering 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

Steps in Conducting a Community Diagnosis

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

Steps in Conducting a Community Diagnosis

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 describedMust develop categories for classification of

responses making sure that the categories are mutually exclusive and exhaustive

Mutually exclusive choices do no overlap

Exhaustive categories anticipate all possible answers that a

respondent may give.

Summarize data.. Manually- by

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

Summarize data..

Responses given in numbers or codes when using a computer

Steps in Conducting a Community Diagnosis

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.

Types of graph & data function 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.

Steps in Conducting a Community Diagnosis

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

Steps in Conducting a Community Diagnosis

10. Identifying the Community Health Nursing Problems

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.

Steps in Conducting a Community Diagnosis

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

Steps in Conducting a Community Diagnosis

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.

DEMOGRAPHY Is the science which deals with the study

of the human population’s size, composition and distribution in space.

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

CENSUS defined as an official and

periodic enumeration of population.

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

WAYS OF ASSIGNING PEOPLE WHEN CENSUS IS BEING TAKEN..

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 registrar’s 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.

Population Composition-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

Population Distribution -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.