COMMUNITY

HEALTH NURSING
PROCESS
Prepared by:
Mr. JOMER V. MANALANG, RN,MAN
THE NURSING PROCESS is a
systematic, scientific, dynamic, on-going
interpersonal process in which the nurses
and the clients are viewed as a system
with each affecting the other and both
being affected by the factors within the
behavior.

The process is a series of action that

results in the optimal health care for the
clients.
 COMMUNITY HEALTH
NURSING PROCESS STEPS

1. Assessment
2. Planning
3. Implementation of Planned care
4. Evaluation of Care and Services
rendered.
 ASSESSMENT
1. Assessment provides an estimate of the degree
to which a family or community achieve the level
of health, identifies specific deficiencies or
guidance needed and estimates the possible
effects of the nursing intervention.

It involves COLLECTION OF DATA like:

 surveys, interviews, observation, review of
statistics, epidemiologic studies, physical
examinations of individuals.

Collected data are treated confidentially.

 Process of Assessment:
Initiate contact
Demonstrate caring attitude
Mutual trust/ confidence
Collect data from all sources
Identify health problem
Assess coping abilities
Analyze and interprets data
 Categories of health problem
Health Deficit occurs when there is a gap between
actual and achievable health status.

Health Threats are conditions that promote

disease or injury and prevent people from
realizing their health potential.

Foreseeable Crisis includes stressful occurrence

such as death or illness of a family member.
Health Need exists when there is a health
problem that can be alleviated with
medical or social technology.

Health Problem is a situation in which

there is a demonstrated health need
combined with actual or potential
resources to apply remedial measures and
a commitment to act on the part of the
provider or the client.
COMMUNITY –our primary client since
it has a direct influence on the health of
the individual, families and
sub-populations.

COMMUNITY DIAGNOSIS
It is the process of determining the
community health status to meet their
needs through utilizing the nursing
process.
TYPES OF COMMUNITY DIAGNOSIS
A. COMPREHENSIVE
It aims to obtain general information about
the community.

B. PROBLEM ORIENTED/ FOCUSED

It is as a type of assessment that responds
to a particular need
 Elements of a Comprehensive
Community Diagnosis:
A. DEMOGRAPHIC VARIABLES

It pertains to the size, composition and geographical

distribution of the population density as indicated by the
following:

1. Total population and geographical distribution including

urban-rural index and population density
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth
rate, crude death rate and life expectancy at birth
4. Patterns of migration
5. Population projections
B. SOCIO-ECONOMIC AND CULTURAL
VARIABLES

1. Social indicators:

a. Communication Network (whether formal or informal

channels) necessary for disseminating health information or
facilitating referral of clients to the health care system.

b. Transportation system – including road networks

c. Educational Level which maybe indicative of poverty and may

reflect on health perception and utilization pattern of the
community.

d. Housing conditions which may suggest health hazards

(congestion, fire, exposure to elements)
 2. Economic indicators:

a. Poverty level income

b. Unemployment and underemployment rates
c. Proportion of salaried and wage earners to
total economically active population
d. Type of industry present in the community.
e. Occupation common in the community
 3. Environmental indicators:

a. Physical / geographical/ topographical characteristics of

the community
- Land areas that contribute to vector problems
- Terrain characteristics that contribute to accidents or pose
as geohazard zones
- Land usage of industry
 Climate or season

b. Water Supply
- % population with access to safe, adequate water supply
 Source of water supply

c. Waste disposal
- % population served by daily garbage collection system
- % population with safe excreta disposal system
- Types of water disposal and garbage disposal system
d. Air, water and land pollution
- Industries within the community having health
hazards associated with it.
- Air and water pollution index

4. Cultural factors:

a. Variables that may break-up People into Groups

within the community such as: Ethnicity, Social
Class, Language, Religion, Race, Political
Orientation

b. Cultural beliefs and practices that effect health

c. Concepts about health and Illness

C. HEALTH AND ILLNESS PATTERNS

1. Leading causes of mortality

2. Leading causes of morbidity
3. Leading causes of infant mortality
4. Leading causes of maternal mortality
5. Leading cause of hospital admission
D. HEALTH RESOURCES

 They are important determinants of the delivery of care

that the nurse needs to determine the following:

1. 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
 2. 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.
E. POLITICAL/ LEADERSHIP PATTERNS

In assessing the community, describe the following:

1. Power structures in the community (formal or

informal)

2. Attitudes of the people toward authority

3. Conditions/events/issues that cause social

conflict/upheavals or that lead to social bonding or
unification

4. Practices/approaches that are effective in setting

issues and concerns within the community.
B. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS
The process of community diagnosis consists of:

1. Collecting
2. Organizing
3. Synthesizing
4. Analyzing
5. Interpreting Health Data

Before the nurse collects data she needs to determine the

objectives as these will dictate the depth or the scope of the
community diagnosis. She needs to resolve whether a
comprehensive or a problem-oriented community diagnosis
will accomplish her goals.
Steps in Conducting Community Diagnosis:
1. Determining the objectives- takes into
consideration the occurrence and distribution of
selected environmental, socio-economic, and
behavioral conditions important to disease
control and wellness promotion.

2. Defining the study population – identifies the

population group to be included in the study.

3. Determining the data to be collected – with

the objectives as guide, identifies the specific
data to be collected and where are these
available
4. Collecting the data

Methods:
a. Records review
b. Surveys and observations – for qualitative and
quantitative data
c. Interviews –first hand information
d. Participant observation – involves active participation
in the life of the community

5. Developing the instrument

a. Survey questionnaire
b. Interview guide
c. Observation checklist
6. Actual data gathering

- Before the actual data gathering, pre-testing of

the instruments is highly recommended.

- Data collectors must be given an orientation

and training on how they are going to use the
instruments in data gathering.

- During the actual data gathering, the nurse

supervises the data collectors by checking the
filled-up instruments in terms of completeness,
accuracy and reliability of the information
collected.
7. Data collation

- Putting together all the information.

- Data may either be numerical or

descriptive.

- Develop categories for classification of

responses making sure that the categories
are mutually exclusive (choices do not
overlap) and exhaustive. (all possible
answers are anticipated)
8. Data presentation
Descriptive data – are presented in
narrative reports
Example : geographic data, history of a
place or beliefs regarding illness and death

Numerical data – may be presented into

tables and graphs

9. Data Analysis
Aims to establish trends and patterns in terms of
health needs and problems of the community.
It allows for comparison of obtained data with
standards values
10. Identifying the community health nursing
problems

Categories of nursing problems:

Health status problems- may be described in terms of

increased or decreased morbidity, mortality, fertility or
reduced capability for wellness

Health resources problems- may be describes in terms

of lack of or absence of manpower, money, materials
or institutions necessary to solve health problems

Health related problems- may be described in terms of

existence of social, economic, environmental, and
political factors that aggravate the illness-inducing
situations in the community
 11. Priority setting
Criteria:
a. Nature of the condition/problem presented – problems
are classified as health status, health resources or health-related
problems

b. 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

C. Modifiability of the problem – refers to the probability of

reducing, controlling or eradicating the problem

D. Preventive potential – refers to the probability of

controlling or reducing the effects posed by the problems

E. Social concern – refers to the perception of the population

or the community as they are affected by the problem and their
readiness to act on the problem
Criteria weight

Nature of the problem 1

Health status 3
2
Health resources
1
Health- related
Magnitude of the problem 3
75-100% affected 4
3
50-74% affected
2
25-49% affected 1
<25% affected
Modifiability of the problem 4
High 3
2
Moderate
1
Low 0
Not modifiable
Preventive potential 1
High 3
2
Moderate
1
Low
Social Concern 1
Urgent community concern 2

Expressed readiness
Recognized as a problem 1
But not needing urgent attention
Not a community concern 0
Score/criteria x weight = Final
score for each criterion
Each problem will be scored according to
each criterion and divided by the highest
possible score multiplied by the weight.
Then the final score for each criterion will
be added to give the total score for the
problem. The problem with the highest
total score is given high priority by the
nurse.
TOOLS USED IN COMMUNITY DIAGNOSIS

DEMOGRAPHY

VITAL STATISTICS

EPIDEMIOLOGY.
 1. DEMOGRAPHY
is the science which deals with the study of the
human population’s size, composition and distribution
in space

Population – refers to the number of people in a given

place or area at a given time

Population composition – characteristics of the

population in relation to certain variables such as age,
sex, occupation or educational level

People are distributed in a specific geographic

location
SOURCES OF DEMOGRAPHIC DATA
Census
Sample survey
Registration system

Census – an official and periodic

enumeration of population.
Demographic, economic and
social data are collected from a
specified population group.
Two ways of assigning people
de facto method – the people are
assigned to the place where they are
physically present at the time of the
census regardless of their usual place
of residence

de jure method – is done when people

are assigned to the place where they
usually live regardless of where they
are at the time of the census
Sample survey – demographic
information is collected from a sample of a
given population. Results can be
generalized for the whole population.

Registration system – collected by the

civil registrar’s office deal with recording of
vital events in the community. (births,
deaths, marriages, divorces and the like).
Population Distribution

– this can be describes in terms of urban-

rural distribution, population density and
crowding index for proper allocation of
resources based on concentration of
population in a certain place

a. Urban-rural distribution – illustrates the

proportion of the people living in urban
compared to the rural areas
b. Crowding index – describe the ease by which
a communicable disease will be transmitted from
one host to another susceptible host. This is
describes by dividing the number of persons in a
household with the number of rooms used by
the family for sleeping

c. Population density – determine how

congested a place is and has implications in
terms of the adequacy of basic health services
present in the community
2. VITAL and HEALTH STATISTIC
- a tool in estimating the extent or magnitude of
health needs and problems in the community
STATISTICS
- it refers to a systematic approach of obtaining,
organizing and analyzing numerical facts so tat
conclusion may be drawn from them.

VITAL STATISTICS

refers to the systematic study of vital events such as births,

illnesses, marriages, divorce, separation and deaths
USE OF VITAL STATISTICS

- Indices of the health and illness status of a

community.
- Serves as bases for planning, implementing,
monitoring and evaluating community health
nursing programs and services.

SOURCES OF DATA

1. Population census
2. Registration of vital data
3. Health survey
4. Studies and researches
RATES AND RATIOS

Rate – shows the relationship between a vital event and

those persons exposed to the occurrence of said event,
with a given area and during a specified unit of time.

Ratio – is used to describe the relationship between 2

numerical quantities or measures of events without
taking particular considerations to the time or place.

CRUDE OR GENERAL RATES –referred to the total

living population. It must be presumed that the total
population was exposed to the risk of the occurrence of
the event.

SPECIFIC RATE –the relationship is for a specific

population class or group. It limits the occurrence of the
event to the portion of the population definitely exposed
to it.
INFANT MORTALITY RATE – measures the risk
of dying during the 1st year of life. It is a good
index of the general health of a community since
it reflects the changes in the environment and
medical condition of the community.

MATERNAL MORTALITY RATE- measures the

risk of dying from causes related to pregnancy,
childbirth and puerperium. It is an index of the
obstetrical care needed and received by women
in a community.

FETAL DEATH RATE – measures pregnancy

wastage. Death of the product of conception
occurs prior to its complete expulsion,
irrespective of duration of pregnancy.
NEONATAL DEATH RATE – measures the risk
of dying the 1st month of life. It serves as an
index of the effects of prenatal care and
obstetrical management of the newborn.

INCIDENCE RATE – measures the frequency of

occurrence of the phenomena during a given
period of time.

PREVALENCE RATE – measures the proportion

of the population which exhibits a particular
disease at a particular time. This can only be
determined following a survey of the population
concerned, deals with total number of cases.
FUNCTIONS OF THE NURSE

Collects data
Tabulates analyzes and interprets data
Evaluates data
Recommends redirection and/ or
strengthening of specific areas of health
programs as needed.
 3. Epidemiology
it is the study of occurrences and
distribution of diseases as well as
distribution and determinants of health
states or events in specified population,
and the application of this study to the
control of health problems.
USES OF EPIDEMIOLOGY:

According to Morris, epidemiology is used to:

1. Study the history of the health population and

the rise and fall of diseases and changes in their
character.

2. Diagnose the health of the community and the

condition of people to measure the distribution
and dimension of illness in terms of incidence,
prevalence, disability and mortality, to set health
problems in perspective and to define their
relative importance and to identify groups
needing special attention.
3. Study the work of health services with a
view of improving them. Operational
research shows how community
expectations can result in the actual
provisions of service.

4. Estimate the risk of disease, accident,

defects and the chances of avoiding them.

5. Complete the clinical picture of chronic

disease and describe their natural history.
6. Identify syndromes by describing the
distribution and association of clinical
phenomena in the population.

7. Search for causes of health and disease

by comparing the experience of groups
that are clearly defined by their
composition, inheritance, experience,
behavior and environments.
 THE EPIDEMIOLOGIC TRIANGLE

HOST – Is any organism that harbors and provides nourishment

for another organism.
- Are related to lower resistance as a result of exposure to the
elements during floods or disasters.

AGENT – The intrinsic property of microorganism to survive and

multiply in the environment to produce disease.
- The result of the introduction of new disease agents into the
population.

ENVIRONMENT – The sum total of all external condition and

influences that affects the development of an organism which
can be biological, social, and physical. The environment affects
both the agents and host.
- Changes in the physical environment; temperature, humidity,
rainfall may directly or indirectly influence equilibrium of agent
and host
 The Epidemiologic
Triangle consists of three
component – the host,
environment and agent.
host
The model implies that
each must be analyzed
and understood for
comprehensions and
prediction of patterns of
a disease. A change in
any of the component
will alter an existing
equilibrium to increase agent environment

or decrease the
frequency of the disease.
THREE COMPONENTS OF THE ENVIRONMENT

1. PHYSICAL ENVIRONMENT – is composed of

the inanimate surroundings such as the
geophysical conditions of the climate.

2. BIOLOGICAL ENVIRONMENT – makes up

the living things around us such as plants and
animal life.

3. SOCIO-ECONOMIC ENVIRONMENT- may

be in the form of level of economic development
of the community, presence of social disruptions
and the like.
DISEASE DISTRIBUTION

The method and technique of epidemiology are desired

to detect the cause of a disease in relation to the
characteristic of the person who has it or to a factor
present in his environment. These variables are studied
since they determine the individuals and populations at
greatest risks of acquiring particular disease, and
knowledge of these associations may have predictive
value.

Time- refers to the period during which the cases of the

disease being studied were exposed to the source of
infection and the period during which the illness
occurred. This analysis of cases by time enables the
formulation of hypotheses concerning time and source of
infection, mode of transmission, and causative agent.
Epidemic period: a period during which the
reported number of cases of a disease exceed
the expected, or usual number for that period.

Year: For many diseases the incidence (Frequency of

occurrence) is not uniform during each of 12 consecutive
months. Instead, the frequency is greater in one season
than any of the others. This seasonal variations is
associated with variations in the risk of exposure of
susceptible to the source of infection.

Period of Consecutive years: recording the reported

cases of a disease over a period of years-by weeks,
months or year of occurrence – useful in predicting the
probable future incidence of the disease and in
planning appropriate prevention and control programs.
THREE COMPONENTS OF THE ENVIRONMENT

1. PHYSICAL ENVIRONMENT – is composed of

the inanimate surroundings such as the
geophysical conditions of the climate.

2. BIOLOGICAL ENVIRONMENT – makes up

the living things around us such as plants and
animal life.

3. SOCIO-ECONOMIC ENVIRONMENT- may

be in the form of level of economic development
of the community, presence of social disruptions
and the like.
Thank You