Chapter 4: The Nursing Process Six Location Variables

The nursing process is a systematic approach Community boundaries: One must first
to evaluating a client's health, identifying issues, establish the boundaries of a community before
creating and implementing plans to address them, discussing it in any way. It serves as the
and assessing the plan's effectiveness in foundation for calculating the prevalence of health
promoting wellness and solving problems. It and illness and the spread of a disease.
applies to individuals, families, groups, or
Geographic features: Communities have
communities, guiding interactions and
been built in every suitable physical setting, and
interventions.
those environments can undoubtedly impact a
community's health. Floods, cyclones,
earthquakes, volcanoes, etc. can result in harm,
The nursing process commonly consists of
death, and damage.
five phases:
Climate: A community's health is directly
 Community assessment;
impacted by the climate, such as by extreme heat
 Community diagnosis;
and cold.
 Planning;
 Implementation and; Flora and Fauna: Animals that carry
 Evaluation. disease and poisonous plants can have an impact
on public health. Availability of plants that can be
used as therapeutic drugs can also affect the
Community as a Client
community. Currently, there are ten (10)
When the community is the client, nursing Philippine medicinal plant species approved for
services focus on addressing the community's therapeutic uses by the Food and Drug
health needs as a whole. This concept Administration (FDA) under the Department of
emphasizes treating the population broadly. Health (DOH) (see Table 4.1)
Community health nurses aim to (1) directly
Human made environment: Levels of
influence the health of individuals, families,
community wellbeing can be influenced by all
groups, or communities within the community, and
human influences on the environment (housing,
(2) provide essential healthcare services at the
dams, farming, types of industry, chemical
community level.
wastes, air pollution, etc.).
Table 4.1 Philippine medicinal plants (SANTA
Dimensions of the Community as Client LUBBY)

A community has three features: Lagundi  Cough and

(Vitexnegundo) asthma
 Location
 Population Sambong  Anti-urolithiasis
 Social system (Blumea balsamifera) (kidney stones)
Ampalaya  Lowering of
Use these characteristics of each community as a
(Momordicacharantia blood sugar and
general road map for determining needs or
L.) anti-diabetes
organizing the delivery of services. Garlic (Allium  Anti-cholesterol
sativum)

Location Guava  Oral/skin

(Psidiumguajava) antiseptic
Every physical community lives out its
everyday activities in a particular region. This Tsaang-guabat  Mouthwash
location's impact on a community's health (Carmona cetusa)
includes the placement of health services, Yerba-Buena  Analgesic or
geographical features, plants, and animals as well (Menthaarvensis) anti-pyretic
as the human made environment.
Niyug-niyogan  Anti-helminthic
(Quisaualisindica)
Acapulco  Antifungal Mobility: The population's mobility has an
(Cassia alata) impact on service accessibility and care
continuity. A community's health is directly
Ulsimang-bato  Anti-
(Peperomiapellucida) hyperuricemia impacted by mobility.
Social system: Every community has a
social structure, adding a third dimension to
Population location and population. Social system variables
Population includes all of the different individuals include health, family, economic, educational,
who reside within the community's bounds, not religious, welfare, legal, communication,
just a specialized aggregate. Any community's recreational, and political systems. These
population has a significant impact on its overall components interact and influence the
health. Various population characteristics indicate community. Community health nurses must
the demand for health care and serve as the consider and understand these systems'
foundation for health planning. interactions to promote community health
effectively.
Population variables
Size: The number and size of medical
facilities are influenced by the size of the
Phases of Nursing Process in the Community
population. Planning requires knowledge on the 1. Assessment: The first step in the nursing
size of the community. process is assessment, which involves
Density: Greater population density may gathering and analyzing data/information
raise stress. Similar to this, it may be challenging regarding the state of a community's health in
to provide healthcare when individuals are order to identify any current or projected
dispersed. needs that can serve as the foundation for
planning.
Composition: Types of health demands
are frequently determined by population Community Assessment
composition. A health community is one that fully This process involves looking for and verifying
considers and accommodates members' diversity pertinent community-based data using a
in age, sex, education, and occupation, all of predetermined methodology in order to
which may have an impact on health issues. understand how people, resources, and the
Finding out a community's makeup is a vital initial environment interact.
step in figuring out how healthy it is.
Community assessment includes:
Rate of growth or decline: Communities
that are expanding quickly could put heavy Collecting pertinent community data
demands on health services. A noticeable Analyzing and interpreting the collected data.
population decline could be a symptom of a
dysfunctional community.
Cultural difference: The needs of various Community Assessment
ethnic and subcultural groups may differ. Cultural
Community need assessment:- is the process
differences can lead to antagonism between
of determining the real or perceived needs of a
groups or conflicting or competing demands for
defined community of people.
resources and services.
Extensive community research may become the
Social class and educational levels:
top focus in various circumstances. In other
"Social class" denotes the ranking of different
cases, all that is required is a study of
social groups based on status, prestige,
organization (such as a women's association..) or
occupation, education, or a mix of these traits.
one system (such as a health system, educational
Educational attainment significantly influences
system, etc.).
health behaviors. Populations with the lowest
income and education levels require the most Major Aspects of Community Assessment (Eight
health promotion and preventive care. sub-system)
A. Physical Environment
1. Inspection foundation for a community-based solution is a
2. Auscultation community diagnosis.
3. Vital signs
4. System review A nursing diagnosis has three parts:
5. Laboratory studies
 Description of the problem (specific target
B. Health and social system or groups)
C. Economics
D. Safety and transportation  Identification of factors/etiology related to
E. Politics and government (r/t) the problem
F. Communication  The sign and symptoms (the
G. Education manifestations) that characteristics of the
H. Recreation problem.

Community core Example: Poor nutritional status of under five

Major components of community core: children in the community r/t knowledge deficit
regarding weaning diet as evidenced by growth
 History- history of that society monitoring chart.
 Demography- age, sex, ethnicity, marital
status Activities in planning:
 Vital statistics- birth, death, values, 1.Setting priorities involves:
beliefs, and religious practice of the  Assigning rank/importance to client's
people. needs

II. Community Analysis and Nursing  Determining the order in which the goal
diagnosis should be addressed. The goal can be
Community Analysis immediate, intermediate or long-range
goal.
The study and inspection of data constitute
analysis. Analysis is required to discover patterns
of health responses, trends in the use of 2. Establishing goal and objectives
healthcare, and community health needs and  Goal is a broad statement of desired end
strengths. Like so many of the processes we use, results.
community analysis may be thought of as a multi-
step process.  Objectives are specific statement of the
desired outcomes.
The phases of analysis include:
Characteristics of good objectives:
 Data categorization (demographic, ✓ Specific- target specific population
geographic, socioeconomic, health ✓ Measurable- when the results are stated
resource and services..etc) ✓ Achievable- within the capacity of the available
resources.
 Data summarization (rates, charts ✓ Relevant- fits with the general police
graphs...etc.) ✓Time bound- that is achieved within specified
time frame.
 Comparing data (with similar data,
identification of data gaps, Activities in planning:
incongruence..etc)
 Planned actions are specific activities or
 Draw inferences (draw logical conclusions methods of accomplishing the objectives
from the evidence) that lead to community or expected outcomes.
diagnosis.  Outcome measurements
- Is judging of the effectiveness of goal
Community nursing diagnosis attainment. How and when was each
objective met, why were they not met?
Community nursing diagnosis defines that of the  Recording the plan
community's health strengths, health issues, or
health hazards. A nursing diagnosis is an actual
Implementation
clinical conclusion or judgment about how people
react to actual or potential problems. The
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.

Evaluation

 It is a methodical, ongoing process of

contrasting the community's response with
the result as specified by the care plan. In
community health nursing, evaluating
interventions ultimately aims to ascertain
whether and to what extent clients' needs
were addressed by planned actions, and if
not, why not.

 Evaluation requires clear objectives,

explicit benchmarks and evaluation
criteria, as well as judgment abilities.