Community

Health Nursing
Process
Raymund C. Ramos, RN
Instructor
Definition
systematic, scientific, dynamic, on-
going interpersonal process in which
the nurses & the clients are viewed as
a system with each affecting the other
and both being affeccted by the
factors within the behavior.
a series of action that lead toward a
particular result and that is the
optimal health care for the clients.
 The
Nature of
COMMUNITY
A. Aggregate of people
B. Location in space & Time
C. Social System
 Healthy
Communities
Determinants
of Healthy
Community Low Crime rate
Good place to bring up
children
Good schools
Strong family life
Good environmental quality
Healthy economy
Provides an estimate of the degree to
which a family, group or community is
achieving the level of health possible for
them, identifies specific deficiencies or
guidance needed and estimates the
possible effects of the nursing
intervention.
Steps
Data Gathering

Consolidation or Collection

Validation
Data Gathering

OOLS
INTERVIEW
OBSERVATION
QUESTIONNAIRES
RECORDS AND REPORTS AVAILABLE
Consolidation or Collection

collecting back the questionnaires, tabulate and

summarize.
Validation
using statistical approaches
1. Central Tendencies: 3 M's
Mean
Median
Mode
2. Standard Deviation: Used if there are too many
variables to be treated
3. Percentile (%) method: Most commonly used in
CHN by adding all cores and multiply by 100.
 Initial Data base (IDB)
1. Family Structure
Nuclear - Father, Children, Mother
Extended (3rd generation) - Relatives staying in the family
Multi-generational extended - "Apo sa tuhod" or " Apo sa
talampkan"
Dyad - Husband & Wife only
Blended - Widow married another widow and have children
Gay - same sex living together
Matriarchal - Mother is the decision maker
Patriarchal - Father is the decision maker
Communal - Different families forming a community
Cont...
2. Socio-economic
poverty level
educational attainment
nature of occupation
3. Socio-cultural
Different nature of religion
4. Home environment
Environmental Sanitation
Treatment of garbage
Preparation for food
Availability of toilet
Water & food sanitation
Sources of diseases
Cont...
5. Medical history
history of certain diseases
family member with diseases
6. Resources
5 Generalized M's
Man/ Manpower
Money
Machine
Materials
Methods
Categories of Health Problems
a. Health Deficit - If identified problem is an
abnormality, illness or disease, there's a
gap/difference between normal status and actual
status.
b. Health Threats - conditions that promote
disease or injury & prevent people from realizing
their health potential.
c. Foreseeable crisis - includes stressful
occurances
 Diagnosing Health Problems
this specifies the nature & cause of an actual or
potential community health problem & direct
the community health nurse plans to resolve
the problem.
4 Components;
identification of the health problem or risk
the affected aggregate or community
the etiological or causal statement
the evidence or support for the diagnosis
Format of Community Diagnosis
Increased risk of (disability, disease, etc.) among
(community on population) related to (etiological
statement) as demonstrated in (health indicators)
Types of Community Diagnosis
a. Comprehensive Community Diagnosis
aims to obtain a general information about the
community
b. Problem-Oriented Community Diagnosis
type of assessment that responds to a
particular need
 Steps in Conducting Community
Diagnosis
a. Determining the Objectives
nurse decides on the depth & scope of the data needed to gather
whether it leads to a comprehensive or a problem-oriented
community diagnosis.
b. Define the study population
it may include the entire population in the community or focussed
on a specific population group such as woman in the reproductive
age-group or the infants & young children.
c. Determining the Data to be collected
the objectives will guide the nurse in identifying the specific data to
collect.
Cont.....
d. Collecting the Data
different methods may be utilized to generate health data.
Types of Data to be generated
Records review
Surveys & observations
Interviews
Participant Observation
e. Developing the instrument
instruments or tools facilitate the nurse's data-gathering activities.
Common instruments
Survey Questionnaires
Interview guide
Observation checklist
Cont.....
f. Actual Data Gathering
before the actual data gathering, nurse must meet the people who will
be involved in data collection
data collectors must be given orientation & training
during the actual data gathering, nurse supervises the data collectors.
g. Data Collection
the nurse will put together all the information
Types of Data
Numerical data
Descriptive data
to facilitate data collection, the nurse must develop categories for
classification of responses making sure that categories are mutually
exclusive & exhaustive.
Cont.....
1. Mutually Exclusive 2. Exhaustive
Cont.....
Sample: Open ended
question
Cont.....
Summarizing colected
data
Cont.....
h. Data Presentation
Descriptive data - presented in
narrative reports
Numerical data - presented into
table and graphs
Cont.....
i. Data Analysis
aims to establish trends & patterns in terms of health needs &
problems of the community.

j. Identifying the Community Health Nursing Problems

Health Status Problems
Health Resources Problems
Health-related Problems

k. Priority setting
prioritize which health problems can be attended to considering the
resources available at the moment.
Cont.....

Priority setting criteria

1. Nature of the condition/problem presented

2. Magnitude of the problem
3. Modifiability of the problem
4. Preventive potential
5. Social concern
 Tools in
Community
Health Nursing
DEMOGRAPHY
is the science which deals with the study
of the human population size,
composition & distribution in space.

Sources of Demographic data

Census
Sample surveys
Registration system
Demography
CENSUS
cont...
official and periodic enumeration of
population
2 ways
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 census
de facto - method is used if 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.
Demography
cont... SAMPLE SURVEY
demographic information collected from a
sample of a given population.

REGISTRATION SYSTEMS
information collected by the civil registrar's
office deal with recording of vital events in the
community.
births
deaths
marriage
divorce
 Methods in
POPULATION SIZE
computing 1ST METHOD
Population SIze, Natural Increase
= # of Births - # of Deaths (specified
Composition &
year)
Distribution Rate of Natural Increase
= CBR - CDR (specified year)
2ND METHOD
Absolute increase/year Pt - Po
______________
t
Relative increase/yr Pt - Po
______________
Po
 Methods in POPULATION COMPOSITION
Sex Composition
computing
Sex Ratio
Population SIze, # of Males
___________________
X 100
Composition & # of Females
Age composition
Distribution Median Age
Dependency ratio
0-14 & 65 and above age group -
economically dependent
15-64 age group - economically
productive
Age & Sex composition - can be described at the
same time using a population pyramid.
Samples
 Methods in
computing
Population SIze,
Composition & POPULATION DISTRIBUTION
Urban-rural distribution - simply illustrates
Distribution proportion of the people living in urban
compared to the rural areas.
Crowding index - described by dividing the
number of persons in a household with the
member of rooms used by the family for
sleeping.
Population density - computed by dividing the
number of people living in a given land area.
 VITAL
STATISTICS

a tool in estimating the extent or magnitude

of health & problems in the community.
through this, the nurse is able to describe
the health status of the people which
serves as the basis for developing,
implementing & evaluating programs &
intervention strategies.
COMMON VITAL
STATISTICAL
INDICATORS
COMMON VITAL
STATISTICAL
INDICATORS
COMMON VITAL
STATISTICAL
INDICATORS
EPIDEMIOLOGY

study of the occurrence & distribution of

health conditions such as disease, death,
deformities on human population.
study of probable factors that influence
the development of these health
conditions.
used to aanalyze the different factors that
contribute to disease development.
2 Important Concepts
1. Mutiple causation Theory
Person - Place - Time Model
Person - "WHO"
Place - "WHERE"
Time - "WHEN"
2. Levels of Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
 Mutiple causation Theory
1. Epidemiological Triangle
examines the interrelationships
between host & environmental
characteristics and uses an
organized method of inquiry to
derive an explanation of
disease.
Mutiple causation Theory
2. Wheel Model
stress the multiplicity of host
and environmental interactions
have developed &
understanding of disease has
progressed.
Mutiple causation Theory
3. Web of Causation Model
illustrates the
complexity of
relationships among
causal variables.
1. Agent
is any element, substance or force, either animate ir
inanimate, the presence or absence of which may serve
as stimulus to initiate or perpetuate a disease process.
Biological - virus, bacteria, fungus, parasite
Chemical - lead, mercury, insecticide
Mechanical - stab, trauma
Nutritive - iron or iodine deficiency, cholesterol
Physical - humidity, atmospheric pressure, radiation
2. Host
is any organism that harbors & provides nourishment
for another organism.
susceptibility & resistance depends on the
characteristics of the host
specific resistance
non-specific resistance
3. Environment
is the total of all external cconditions & influences that
affect the life and development of an organism.
3 Components:
1. Physical environment - composed of the inanimate
surroundings such as the geophysical conditions or the
climate.
2. Biological environment - makes up the living things
around us such as plant and animal life.
3. Socio-economic environment - may be in a form of
level of economic development of the community,
presence of social disruptions & the like.
 Levels of
PREVENTION
Epidemiological
APPROACH