1. proses chn ns.kumbo.pptx

7/27/2019 1. Proses CHN Ns.Kumbo.pptx

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The Community Health Nursing Process

Presented by:

Kumboyono

Sept 2008


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Setting for community health

nursing practice homes

ambulatory service settings

schools

occupational health setting

residential institutions the community at large


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Aggregate

Level

Individual or

Family Level

Community

Level

Example: Levels of community health nursing practice


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Meeting the Needs of

Community or Aggregates

Aggregates at risk across life span

Aggregates at vulnerable conditions


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Examples of Populations with

Population-Health IssuesElderly persons with ongoing chronic

conditions who need a broad range of

services to maintain their independencein the community

Persons who drink well water

All families with newborns

All children with asthmaSexually active teenagers

Persons who drink and drive


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Practice Focus

Staff

(Generalist/

Lower Manager)

(CHN

Specialist/Middle Manager)

(Administrator:

CHN Specialist/

Top Manager)

Individual and Family Focus

Community Focus


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Comparison of components of specialist and

generalist levels of practice

Components of Practice CHN Specialist Generalist

Focus of Practice Communities and

populations

Individuals and

families

Practice Models Advanced practice

Models

Comprehensive care

of individuals and

families

Processes Community

assessment, programplanning, program

implementation, and

program evaluation

Assessing,

diagnosing, planning,intervening, and

evaluating


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The CommunityHealth Process:

Using The Model

Figure 1. Community as Partner (Anderson & McFarlane, 2001)


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Community Health Assessment

Community as Partner Model:Assessment Wheel

Core :

- Demographics - Values- Beliefs - History

8 subsystems:

- Physical environment - Education

- Safety & transportation - Politics & government

- Health & social services - Communication

- Economics - Recreations


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Locating Sources of Data

Types of Data

Sources of Data for a Community Assessment


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Methods of Data Collections

Participants Observation

Winshield/Walking Survey

Focus groups Key informants

Surveys

Literature Review

etc


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Data Analysis

Cognitive process of ordering data to allowfor the higher-level function of synthesis(Ervin, 2002)

Data Synthesis

Combining data elements from severalsources to create a coherent whole or

new, complete picture of what is known or

not known (Burn & Groove, 2001)


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The Web of Causation

Concept that posits that effect never

depend on single isolated causes but

result from chains of causation in whichlink is the result of complex mix

antecedents (MacMahon & Pugh, 1970)


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Gambar 6. The Web of Causation Pemberdayan Masyarakat di Tingkat Komunitaspada Agregat Perokok di Kelurahan Depok Tahun 2008

Rendahnya Tingkat

Pendidikan Perokok

Ketergantungan

terhadap nikotin

Rendahnya

pengetahuan tentangdampak negatif

merokok

Rendahnya niat

berhenti merokok

Rendahnyadukungan keluarga

dan masyarakatuntuk kegiatan

berhenti merokok

Rendahnya kesiapan

berhenti merokok

Persepsi yang salah tentangmanfaat merokok

Buruknya persepsi terkena

dampak negatif merokok

Kebiasaan merokok

di sembarang tempat

Buruknya persepsi terhadap

dampak negatif merokok

Mudahnya akses

terhadap rokok

Kerterjangkaun

terhadap rokok

Pengaruh pergaulan

sesama perokok

Resiko terjadinyapenyakit akibat merokok

pada perokok

Resiko terjadinyapaparan asap rokok pada

perokok pasif

Resiko terjadinya

penyalahgunaan napza

pada kelompok perokok

Persepsi yang salahtentang cara mengatasi

stres pada perokok

Mekanisme koping tidakefektif pada kelompok

perokok

Ketidakmampuanperokok mengenal

diri sendiri

Harga diri rendah padakelompok perokok

Kebutuhan akan informasidampak negatif rokok

terhadap kesehatan

Potensial peningkatankesadaran anti rokok pada

siswa SMU Pelita I Depok


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Community Diagnosis

Stating the conclusions drawn from

synthesis of the data (Anderson &

Mcfarlane, 2000; Helvie, 1998; Mucke;

1984)

Statement of risk, condition, trend,

potential problem, strength, or latent

situation about a community or population

(Watson, 1984)


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Community Diagnosis

Community Diagnoses may be formulated about:

Health issues (e.g., infant mortality)

Housing conditions (e.g., high lead content in interiorpaint)

Economics conditions (e.g., 30% community residents

below poverty level)

Strengths (e.g., three community coalitions formed todeal with potential environmental hazards)

Trends (e.g., increasing employment opportunities)


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Formulating Community Diagnosis:

Comparison Approaches

Approach Conclusion Description of

community

Characteristics

of community

Indicators of

Conclusion

Muecke (1984) Risk of /

Presence of

Among Related to As demonstrated

in

Anderson &

McFarlane

(2000)

Potential /

actual health

problem orconcerns

Among Related to As demonstrated

by


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Example of a Community Diagnosis

Risk of death among infant born in the community related to:

12% of infants had low birth weight

24% of birth in 1998 were female 18 years ofage and younger

46% of women in 1998 had inadequateprenatal care

An infant mortality rate of 12 deaths per 1000live births in 1998

Etc.


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Planning

Community Diagnosis Goal/Objectives Interventions Evaluation Indicators

1. . Goal 1: .

Objectives :

1.1.

1.1.

Structure: ..

Process:

Output: ...

1.2.

1.2.

Structure: ..

Process:

Output: ...

1.3.

1.3.

Structure: ..

Process:

Output: ...


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Example of Objectives

Goal 1: to decrease deaths due to smokingamong community residents

Objective 1.1: to decrease the number ofsmokers in the worker population from 25%to 22% in two years by providing smokingcessation programs for all work sites in thecounty

Objective 1.2: to gain commitment from one-half of the work sites in the county tosponsor smoking cessation programs withinone year

C i l h i i


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Community Health Nursing Interventions


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CommunityHealth

NursingInterventions:

SystemsFocused


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CHN Interventions: Community Focused


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CHN

Interventions:IndividualFocused


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CHN Interventions

Example: Advocacy


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Implementing

Carry out plan to the community

Evaluating

Refers to evaluation indicators atplanning stage

1. proses chn ns.kumbo.pptx

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