Subject:- Community
Health Nursing
Topic:- NURSING PROCESS IN
THE
COMMUNITY
PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD
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.
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The nursing process commonly
consists of five phases:
• Community assessment;
• Community diagnosis;
• Planning;
• Implementation and;
• Evaluation.
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Community as a 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.
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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.
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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 animals and the human made environment.
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Six Location Variables
1. 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.
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2. Location of health services
• 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.
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3. Geographic features
• Communities have been constructed in
every suitable physical environment and
that environment certainly can affect the
health of a community. Injury, death, and
destruction may be caused by floods,
cyclones, earthquakes volcanoes…etc.
recreational activities at lakes, seashores,
mountains promote health and wellness.
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4. Climate
• Climate has a direct effect on health of a
community e.g., extreme heat and cold).
5. Flora and Fauna
• Poisonous plants and disease carrying
animals can affect community health.
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6. 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.
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2. Population
• Population consists not only of a specialized
aggregate, but also of all 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
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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
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• Composition: composition of the
population often determines types 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
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early step in determining its level of health.
• Rate of growth or 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 difference can create conflicting or
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competing demands for resources and
• 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
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• Mobility: mobility of the population affects
continuity of care and availability of services.
Mobility has a direct effect on the health of a
community.
• 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
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variables.
• These variables include the health, family,
economic, educational, religious, welfare,
legal, communication, recreational, and the
political systems. 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
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community.
Phases of Nursing Process in the Community
Community Assessment
• This is the process of searching for 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; Collecting
pertinent community data
• Analyzing and interpreting the collected
data.
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Community need assessment
• is the process of determining the real or
perceived needs of a defined community
of people.
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Just as physical examination is important to
individual patients, so is examination of the
community physical environment. Five
senses are used in physical assessment:
inspection, auscultation, vital signs, system
review, and laboratory studies.
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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, markets places, meeting street
people, signs of decay, ethnicity, religion,
health and morbidity, political media.
Auscultation: is listening to the community
residents about the physical environment.
Vital signs: observe the climate, terrain,
natural boundaries such as rivers and hills.
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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.
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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 or substance abuse, alcoholism.
Social services include counseling and
support, clothing, food, shelter and
special needs as well as markets and
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C. Economics
• Financial characteristics median
household income, percentage of
households 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
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D. safety and transportation
• Police, sanitation (water source, solid
waste disposal, sewage and air quality)
and fire services. Primary means of
transportation; walking, mule, taxi,
bus, train, private car, and air services.
• Frequency and affordability of
public/private transport, and standard
of roads.
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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.
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F. Communication
• Bulletin boards, posters, oral
messages, radio, television,
newspapers, postal services,
telephone. Look for TV aeries,
telephone wires, magazines, and
satellite dishes.
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G. Education
• Types of schools, colleges and
universities. Note languages used,
grades, courses offered, percentage of
attendants (male, female), adequacy,
accessibility, and acceptability of
education. Average number of years
completed by people at school.
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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?
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Community Assessment Tool (Questionnaires)
• The following areas are 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.
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• 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 is
its people- their history, characteristics, values
and beliefs. The first stage of assessing a
community, then, is to about its people.
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Major components of community core
• History- history of that society
• Demography- age, sex, ethnicity,
marital status Vital statistics- birth,
death, values beliefs, and religious
practice of the people
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Community Analysis and Nursing
diagnosis Community Analysis
Analysis is the study and examination of data.
Analysis is necessary to determine community
health needs and strength 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.
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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 inferences (draw logical conclusions from
the evidence) that lead to community diagnosis.
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Community nursing diagnosis
• This is a statement that defines the health
strength, health problems or health risks of
the community. Nursing diagnosis is a real
clinical judgment or conclusions about
human response to actual or potential
problems (ANA). A community diagnosis
forms the basis for community based
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intervention.
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) that characteristics of
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Examples;
Inadequate ANC r/t inadequate health information or
service accessibility as evidenced 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.
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Planning
• It is a logical, decision making process
of design an orderly, detailed
programs of action to accomplish
specific goals and objectives base d on
assessment of the community and the
nursing diagnosis formulated.
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Activities in planning:
• Setting priorities involves:
Assigning rank/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.
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Establishing goal and objectives
• Goal is a broad statement of desired end
results. Objectives are specific statement of
the desired outcomes. Characteristics of good
objectives
• Specific- target specific population
• Measurable- when the results are stated
• Achievable- within the capacity of the
available resources.
• Relevant- fits with the general police
• Time bound- that is achieved within
specified time frame.
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• Planed actions
are specific activities or methods of
accomplishing the objectives or expected
outcomes.
• Outcome measurements
• Is judging of the effectiveness of goal
attainment. How and when was each
objective met, why not?
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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
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Key areas of nursing intervention in the community are:
– link the community members with the
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.
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Evaluation
• It is systematic, continuous 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 and45
Monday, July 05, 2021
Thank You
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