NURSING PROCESS IN COMMUNITY

INTRODUCTION
The Nursing process is a systematic way of determining a client health status, isolating health
concern and problems, developing the plans to remediate them, initiating actions to implement
the plan, and finally evaluating the adequacy of the plan in promoting wellness and problem
resolution.

THE NURSING PROCESS COMMONLY CONSISTS OF FIVE

PHASES:
 Community assessment
 Community diagnosis
 Planning
 Implementation
 Evaluation

COMMUNITY AS CLIENT:
For community health nurses, working with communities has two important missions:
 The community directly influences the health of the individuals, families, groups and
populations who may be a part of it.
 Provision of the most important health services at the community level.

DIMENSIONS OF THE COMMUNITY AS CLIENT:

A community has three features:
1. Location
2. A population
3. A social system
It is useful to think of these dimensions of every community as a rough map to follow for
assessing needs or planning for service provision.

1. LOCATION:
Every physical community carries out daily existence in a specific geographic location.
The health of a community is affected by this location including the placement of health services,
the geographic features, plants, animals and the human made environment.
 Six Location Variables:
a. Community Boundaries:
To talk about community in any sense, one must first describe its boundaries. It serves as
basis for measuring incidence of wellness and illness and for determining spread of a
disease.

b. Location of Health Service:

When assessing a community, the community health nurse will want to identify the major
health centers and know they are located. Use of health services depends on availability
and accessibility.

c. Geographic Features:
Communities have been constructed in every suitable physical environment and that
environment certainly can affect the health of a community. Injury, health and destruction
may be caused by floods, cyclones, earthquakes, volcanoes etc. recreational activities at
lakes, seashores, mountains promotes health and wellness.

d. Climate:
Climate has a direct effect on health of a community e.g. extreme heat and cold.

e. Flora and Fauna:

Poisonous plants and disease carrying animals can affect community health.

f. Human Made Environment:

All human influences on environment (housing, dams, farming, types of industry,
chemical wastes, air pollution, etc.) can influence levels of community wellness.

2. POPULATION:
Population consist not only of a specialized aggregate, but also of the diverse people, who
live within the boundaries of the community. The health of any community is greatly influenced
by the population that lives in it. Different features of the population suggest the health needs
and provide bases for health planning.

 Population Variables
 Size: The size of a population influences the number and size of health care institutions.
Knowing community size provides important information for planning.
 Density: Increased population density may increase stress. Similarly when people
are spread out health care provision may become difficult.
  Composition: Composition of the population often determine type of health
needs. A health community is one that takes full account of and provides for differences
in age, sex, educational level, and occupation of its members, all of which may affect
health concerns. Determining a community composition is an important early step in
determining its level of health.
 Rate of Growth and Decline: Rapidly growing communities may place extensive
demands on health services. Marked decline in population may signal of poorly
functioning community.
 Cultural Difference: Health needs may vary among sub-cultural and ethnic
populations. Cultural differences can create conflicting or competing demands for
resources and services or create inter-group hostility.
 Social class and educational levels: Social class refers to the ranking of groups
within society by income, education occupation, prestige or a combination of these
factors. Educational level is a powerful determinant of health related behavior. Health
promotion and preventive health services are most needed for people with low income
and educational levels.
 Mobility: Mobility of the population affects continuity of care and availability of
services. Mobility has a direct effect on the health of a community.

3. SOCIAL SYSTEM:
In addition to location and population, every community has a third dimension, a social
system. The various parts of community social system that interact and influence the system are
called social system variables. These variables include the health, family, economic, educational,
religious, welfare, legal, communication, recreational and the political system. Although
community health nurses must examine all the systems in the community and how they interact,
the health system is of particular importance to promote the health of the community.

PHASES OF NURSING PROCESS IN THE

COMMUNITY:
Community Assessment
 This is the process of searching and validating relevant community based data
according to a specified method, to learn about the interaction among the people,
resources and environment.
 Community assessment includes:
o Collecting pertinent community data
o Analyzing and interpreting the collected data
Community Need Assessment:
Community Need Assessment is a process of determining the real or perceived needs of a
defined community of people.

MAJOR ASPECTS OF COMMUNITY ASSESSMENT

(EIGHT SUB-SYSTEMS)
A. PHYSICAL ENVIRONMENT:
Just as physical examination is important to individual patients, so is examination of the
community physical environment. Five senses are used in physical assessment:
o Inspection
o Auscultation
o Vital signs
o System review
o Laboratory studies

 Inspection:
Uses all sense organs and is done by walking survey in the community, or micro
assessment of housing, open spaces, boundaries, transportation service centers,
market places, meeting street people, signs of decay, ethnicity, religion, health
and morbidity, political media.

 Auscultation
Auscultation is listening to the community residents about the physical
environments.
 Vital Signs
Observes the climate, terrain, natural boundaries such as rivers and hills.
 Community Resources
Look for signs of life such as notices, posters, new housing and buildings.

 System Review
Hosing age, architecture, building materials used, signs of disrepair, running
water, plumbing, sanitation, windows (glasses) etc.

 Laboratory Studies
Census data or planning studies for community mapping.

B. HEALTH AND SOCIAL SYSTEM:

  Differentiate between facilities located within the community and those located outside.
Hospital, number of beds, staffing, budget, health center, clinics, or health posts, public
health services, private clinics, pharmacies, dental and other services. Signs of drugs and
substance abuse, alcoholism. Social service include counselling and support, clothing,
food, shelter and special needs as well as markets and shops.

C. ECONOMICS:
 Financial characteristics median house hold income, percentage of household living in
poverty less than 100 birr per month. Labor force characteristics, employment status of
the general population greater than 18 years of age. Occupational categories and
percentage of persons employed by government, farmers, skilled, unskilled, professional,
types of business / industry.

D. SAFETY AND TRANSPORTATION:

 Police, sanitation (water source, solid waste disposal, sewage and air quality) and fire
services. Primary means of transportation:
o Walking
o Mule
o Taxi
o Bus
o Train
o Private car and
o Air services
 Frequency and affordability of public / private transport and standard of roads.

E. POLITICS AND GOVERNMENT:

 Business alliances, religious groups, youth and women’s associations, professional
associations, ethical associations, political activism etc. describe the associations’
objectives and activities.

F. COMMUNICATION:
 Bulletin boards, posters, oral messages, radio, television, newspapers, postal services,
telephone. Look for TV aeries, telephone wires, magazines and satellite dishes.

G. EDUCATION:
 Types of schools, colleges and universities. Note languages used, grades, courses offered,
percentage of attendance (male, female) adequacy, accessibility, and acceptability of
education. Average number of years completed by people at school.

H. RECREATION:
  Note facilities such as stadium, recreational areas, volley ball’s court, playground, picnic
areas, museum, music/dancing, theatre/cinema. Who is going out about during the
evening and in the morning? Teenagers, mothers and children, the homeless?

COMMUNITY ASSESSMENT TOOL (QUESTIONNAIRES)

The following areas of nursing concerns when making community assessment that helps to reach
a community nursing diagnosis. The point under each sub-heading may be modified to meet the
need of individual practice. The questions are modified under the following sub-headings:

Location Perspectives
Population Perspectives
Social System Perspectives
Community Core
The definition of Core is “that which is essential, basic and enduring.” The core of a community
of its people – their history, characteristics, values and beliefs. The first stage of assessing a
community, then, is to about its people.

Major components of Community Core:

 History – history of that society.
 Demography – age, sex, ethnicity, marital status vital status – birth, death, values, beliefs
and religious practice of the people.

COMMUNITY ANALYSIS AND NURSING DIAGNOSIS

COMMUNITY ANALYSIS
Analysis is the study and examination of data. Analysis is necessary to determine community
health needs and strengths as well as to identify patterns of health responses and trends in health
care use. Community analysis like so many procedures we carry out, may be viewed as a process
with multiple steps.

The Phases of Analysis include:

 Data categorization (demographic, geographic, socio-economic, health resource and
services etc.)
 Data summarization (rates, charts graphs etc.)
 Comparing data (with similar data, identification of data gaps, incongruence etc.)
 Draw interferences (draw logical conclusions from the evidence) that lead to community
diagnosis.

Community Nursing Diagnosis:

This is the statement that defines the health strength, health problems or health risks of the
community. Nursing diagnosis is a real clinical judgement or conclusion about human response
to actual or potential problems (ANA). A community diagnosis forms the basis for community
based interventions.

A Nursing Diagnosis has Three Parts:

 Description of the problem (specific target or groups)
 Identification of factors/etiology related to (r/t) the problem.
 The sign and symptoms (the manifestations) the characteristics of the problem.
Examples:
 Inadequate ANC r/t inadequate health information or service accessibility as
evidence by 70% of female delivering at hospital with no antenatal care.
 Poor nutritional status of under five children in the community r/t knowledge
deficit regarding weaning diet as evidenced by growth monitoring chart.
 High infant mortality r/t inadequate ANC, maternal nutrition, and unhygienic
delivery practice as evidenced by IMR 75 / 1000 live births.

I. Planning:
 It is a logical, decision making process of design and orderly, detailed programs of action
to accomplish specific goals and objectives based on assessment of the community and
the nursing diagnosis formulated.

Activities in Planning:
 Setting priorities involved: Assigning ranks/importance to client’s needs
determining the order in which the goal should be addressed. The goal can
be immediate, intermediate or long range goal.
Establishing Goal and Objectives:
 Goal is a broad statement of desired and results. Objectives are specific statement of the
desired outcomes.
Characteristics of Good Objectives:
 Specific – target specific population
 Measurable – when the result are stated
 Achievable – within the capacity of the available resources
 Relevant – fits with general police
 Time bound – that is achieved within specified time frame
  Planned Actions
Planned actions are specified activities or methods of accomplishing the objectives or expected
outcomes.
 Outcome Measurements
Outcome measurements is judging of the effectiveness of goal attainment. How and when was
each objective met, why not?
 Recording the Plan

II. Implementation:
Implementation is putting the plan into actions and actually carrying out the activities delineated
in the plan, either by nurse or other professionals. It is the action phase of the nursing process.
Community interventions are the therapeutic actions designed to promote and protect the
community health, treat and remediate community health problems and support the community
as it changes over time.
Intervention in the community are:
 Link the community members with available resources
 Pulls together information and resources to assist community in addressing its health
concern and problems
 Marinating its strength through facilitation, education, organization, consultation and
direct care.

III. Evaluation:
 It is systematic, continues process of comparing the community’s response with the
outcome as defined by the plan of care. The ultimate purpose of evaluating interventions
in community health nursing is to determine whether planned actions met client needs, if
so how well they were met, and if not why not.
 Evaluation requires a stated purpose, specific standards and criteria by which to judge
and judgement skills.