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Assessing Communty HealthBuelva, Lorraine
Bueno, MatetCarpena, Nivia
Intal, Ces
introduction
Community health nursing, the community is not simply a context of the existence of the families, groups, sub-populations or populations nor just a setting for our nursing interventions. Lest we forget, we regard the community as our primary client
Reasons why community is our primary client…
The community has a direct influence on the health of the individual, families and sub-populations.
It is at this level that most health service provision occurs.
assessment
Caring for the community as client starts with determining its health status. The nurse collects data about the community in order to identify the different factors that may directly or indirectly influence the health of the population.
diagnosis
Proceed to analyze and seek explanations for the occurence of health needs and problems of the community. The community health nursing diagnoses are then derived and will become the bases for developing and implementing community health nursing interventions and strategies. This process is called community diagnosis.
Health Status
The health status of the community is the product of the following elements:
population physical & topographical
characterestics socio-economic and cultural factors health and basic social services power structure within the community.
Types of Community Diagnosis
COMPREHENSIVE COMMUNITY DIAGNOSIS
PROBLEM-ORIENTED/FOCUSED
comprehensive community diagnosis
Aims to obtain a general information about the community.
Has the following elements: 1. Demographic Variable 2.
Socio- economic & Cultural Variable 3. Health and Illness Patterns 4. Health Resources 5. Political/Leadership Patterns
Demographic variableShows the size, composition and geographical
distribution of the population.
TOTAL POPULATION and GEOGRAPHICAL DISTRIBUTION: urban-rural index and population density
AGE and SEX composition VIRAL INDICATORS: growth rate, crude birth
rate, crude death rate, life expectancy at birth
PATTERNS OF MIGRATION POPULATION PROJECTIONS
Socio- economic & Cultural Variable there are no limits as to the list of
socio-economic and cultural factors that may directly or indirectly affect the health status of the community.
A. social indicators B. economic indicators C. environmental indicators D. cultural factors
social indicators
Communication network - whether FORMAL or INFORMAL
CHANNELS -necessary for disseminating health
information or facilitating referral of clients to the health care system
Transportation system- road networks necessary for accesibility of the people to health care delivery system.
social indicators
Educational level- may be indicative for POVERTY and may reflect on health perception and utilization pattern of the community.
Housing conditions- may suggest health hazards ( congestion, fire, exposure to elements)
economic indicators
Poverty level income Unemployment and underemployment
rates Proportion of salaried and wage
earners to total economically active population
Types of industry present in the community
Occupation common in the community
environmental indicators Physical/geographical/topographical
characteristics of the community:› land areas that contribute to vector
problems› terrain characteristics that contribute to
accidents or pose as geo hazard zones› land usage in industry› climate/season (flood during rainy days)
Water supply› % population with access to safe, adequate
water supply› source of water supply
environmental indicators Waste disposal
› % population served by daily garbage collection system
› % population with safe excreta disposal system
› types of waste disposal and garbage disposal system
Air, water & land pollution› Industries in the community having
health hazards associated with it› Air and water index
cultural factors variables that may break up the
people into groups within the community such as:
ethnicity social class language religion race political orientation
cultural beliefs and practices that affect health
concepts about health and illness
Health & Illness Patterns may collect primary data about the
leading causes of illness and deaths and their respective rates of occurrence. If has access to recent and reliable secondary data, then make use of these:
1. Leading causes of mortality2. Leading causes of morbidity3. Leading causes of infant mortality4. Leading causes of maternal mortality5. Leading cause of hospital admission
Health Resources
health resources that are available in the community are important element of the community diagnosis mainly because they are the essential ingredients in the delivery of basic health services
May be classified as Manpower or Material
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
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
Political / Leadership Patterns
vital element in achieving the goal of high level wellness among the people. It reflects the action potential of the state and its people to address the health needs and problems of the community. It also mirrors the sensitivity of the government to the people’s struggle for better lives.
In assessing the community, the nurse describes the following:
power structures in the community (formal/informal)
attitudes of the people toward authority
conditions/events/issues that cause social conflict/ upheavals or that lead to social bonding or unification
practices/approaches that are effective in setting issues and concerns within the community
problem oriented / focused
type of assessment that responds to a particular need (Spradley 1990)
PROCESS: Community Diagnosis
The process of community diagnosis consists of:
- Collecting- Organizing- Synthesizing- Analyzing- Interpreting health data
Steps in Conducting a Community Diagnosis
1. Determining the Objectives decide on DEPTH and SCOPE of data that
needs to be gathered whether a problem-oriented or community
diagnosis, determine the occurrence and distribution of selected environmental, socio-economic and behavioral conditions important to disease control and wellness promotion (Dever 1980)
Steps in Conducting a Community Diagnosis
2. Defining the Study Population Based on objectives, the nurse identifies the
population group to be included in the study.
May include the entire population in the community or
Focused on a specific population group such as women in the reproductive age- group or infants and young children.
You may also collect data from a subset population-when a complete enumeration of the desired population is not possible.
Steps in Conducting a Community Diagnosis
3. Determining the Data to be Collected The objectives will guide you in
identifying the specific data that you have to collect.
Should decide on the sources of these data
Are these data available from record of agencies? Or from people themselves?
Steps in Conducting a Community Diagnosis
4. Collecting the Data Different method may be utilized to
generate health data. Decide on specific methods depending
on the type of data to be generated interview- about people’s health beliefs
or review existing health records in the Rural Health Unit
methods of collecting data Records view- data may be obtained by reviewing
those that have been complied by health or non-health agencies from the government or other sources.
Surveys and observations- used to obtain both qualitative and quantitative data.
Interviews- can yield first hand information
Participant Observation- used to obtain qualitative data by allowing the nurse to actively participate in the life of the community.
Steps in Conducting a Community Diagnosis
5. Developing the Instrument Instruments or tools facilitate the
nurse’s data gathering activities. The following are the most common instruments that the nurse uses in her data collection:
a. Survey questionnaireb. Interview guideC. Observation checklist
Steps in Conducting a Community Diagnosis
6. Actual Data Gathering Meet people before the actual data gathering
who will be involved in the data collection. Instruments are discussed and analyzed If necessary, instruments may be modified
or simplified in order- not to overburden the people who may have limitations in terms of educational preparation or available time to finish data collection
Steps in Conducting a Community Diagnosis
6. Actual Data Gathering Pre-testing of instruments- highly
recommended Data collectors- must be given an orientation
and training on how they are going to use the instruments
During the actual data gathering, the nurse supervises the data collectors by checking the filled-up instruments in terms of:› Completeness› Accuracy› Reliability
Steps in Conducting a Community Diagnosis
7. Data Collection Ready to put together all the
information. Two types of data that may be
generated:› NUMERICAL DATA- can be counted› DESCRIPTIVE DATA- can be describedMust develop categories for classification of
responses making sure that the categories are mutually exclusive and exhaustive
Mutually exclusive choices do no overlap
Exhaustive categories anticipate all possible answers that a
respondent may give.
Summarize data.. Manually- by
tallying the data or by using the computer. Tallying involves- entering responses into prepared tally sheets showing all possible responses.
Summarize data..
Responses given in numbers or codes when using a computer
Steps in Conducting a Community Diagnosis
8. Data Presentation› Depend largely on the type of data obtained.
Descriptive data- presented in narrative reports.
Numerical data- may be presented into table or graphs.
Table/graphs-useful in showing key information making it easier to show comparisons including patterns & trends.
Types of graph & data function LINE GRAPH- shows trend data or changes with
time or age with respect to some other variable. BAR GRAPH/PICTOGRAPH- for comparisons of
absolute or relative counts and rates between categories.
HISTOGRAM/FREQUENCY POLYGON- graphic presentation of frequency distribution or measurement.
PROPORTIONAL OR COMPONENT BAR/ GRAPH/ PIE CHART- shows breakdown of a group or total where the number of categories is not too many.
SCATTERED DIAGRAM- correlation data for two variables.
Steps in Conducting a Community Diagnosis
9. Data Analysis
Aims to establish trends and patterns in terms of health needs and problems of the community.
Allows for comparison of obtained data with standard values
Determining interrelationship of factors- helps view the significance of the problems and their implications on the health status of the community
Steps in Conducting a Community Diagnosis
10. Identifying the Community Health Nursing Problems
Categorized as:Health status problems- may be described in terms
of increased or decreased morbidity, mortality, fertility or reduced capability of wellness
Health resources problems- lack or absence of manpower, money, materials or institutions necessary to solve health problems.
Health-related problems- existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community.
Steps in Conducting a Community Diagnosis
11. Priority-setting
› Prioritize which health problems can be attended to considering the resources available at the moment.
› The following criteria is used: Nature of the condition/problem- presented
classified as health status, health resources or health related-problems
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
Steps in Conducting a Community Diagnosis
11. Priority-setting › The following criteria is used:
Modifiability of the problem- refers to the probability of reducing, controlling or eradicating the problem
Preventive potential- probability of controlling or reducing the effects posed by the problem.
Social concern- perception of the population or the community as they are affected by the problem and their readiness to act on the problem.
DEMOGRAPHY Is the science which deals with the study
of the human population’s size, composition and distribution in space.
SOURCES OF DEMOGRAPHIC DATA>censuses>sample surveys>registration systems
CENSUS defined as an official and
periodic enumeration of population.
demographic, economic and social data are collected from a specified population group.
WAYS OF ASSIGNING PEOPLE WHEN CENSUS IS BEING TAKEN..
The de jure method-people are assigned to the place where they usually live
The de facto method-people are assigned to the place where they are physically present at the time of the census
SAMPLE SURVEY-demographic information can still be
collected from a sample of a given population.
REGISTRATION SYSTEMS-collected by the civil registrar’s office
deal with recording of vital events in the community.
POPULATION SIZE-also helps her rationalize the types of
health programs or interventions which are going to be provided for the community.
One method of measuring the population size is by determining the increase in the population resulting from excess of births compared to deaths. This can be done in two ways:
Second method of measuring the population size is to determine the increase in the population using data obtained during two census periods.
Population Composition-commonly described in terms of its age and sex
SEX COMPOSITION SEX RATIO = number of males x100
number of females AGE COMPOSITION -Median Age divides the population into two equal
parts-Dependency Ratio compares the number of
economically dependent with the economically productive group in the population
AGE AND SEX COMPOSITION-described at the same time using a population pyramid
Population Distribution -urban-rural distribution, population density and
crowding index.
1.URBAN-RURAL DISTRIBUTION-simply illustrate the portion of the people living
in urban compared to the rural areas 2. CROWDING INDEX-will describe the ease by which a communicable
disease will transmitted from one host to another susceptible host
3.POPULATION DENSITY-will determine how congested a place is and has
implications in terms of the adequacy of basic health services present in the community.
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