2. Introduction
• Primary concern of a community health
nurse is to improve the health of the
community.
• Before planning the interventions the
nurse must define the community.
• CHN must define the characteristics of
the community before applying the
community health nursing process.
3. Definition
• Refers to the systematic process of
knowing and exploring the defined
community for assessing its health
status and determining the possible
factors affecting the health of the
people in the community.
It is the first step of community health
nursing process.
4. Purposes
• Provides comprehensive knowledge
about the profile of the community.
• Provides oppurtunity for establishing
working relationship and gaining
acceptance in the community.
• Helps in making community diagnosis.
• It is instrumental to community health
planning
• It promotes community participation
5. Major categories of
information
• Geographical area
– It is important to study the topography of
any community.
– It includes the study of its location and
geographical boundaries, physical set up,
natural resources etc.
6. Major categories of
information
• Geographical area
– Geographical location/ boundary of the
community:
• It determines the climate, resources, health
threats and dangers.
• It serves as the basis for the measuring the
incidence and prevalence of various health
problems and for determining its spread.
• All the communities are demarcated by the
administrative, political, legislative and health
care point of view.
• It helps in making use of the health resources.
7. Major categories of
information
• Geographical area
– Physical set up
• Includes the pattern of the settlements,
arrangement of the houses, streets,
connecting roads, connecting landmarks etc.
• It influences the environment and lifestyle of
the people which have the impact on their
health status.
8. Major categories of
information
• Geographical area
– Natural resources
• Varies from community to community
• Includes climate, land area, forests, flora and
fauna, minerals, water etc.
• Climate determines the agricultural product,
which has important impact on the health
status.
9. Major categories of
information
• Geographical area
– Important landmarks and institutons
• Incudes: community centers, panchayat ghar,
schools, post office, anganwadi, relogious
centers, bank etc.
• It helps in locating houses.
10. Major categories of
information
• Geographical area
– Environmental sanitation
• Control of all those factors in man’s physical
environment which exercise or may exercise a
deleterious effect on his physical development,
health and survival.
• Includes control of housing, food, water, refuse
and excreta, waste water, air, vectors etc.
• CHN should identify strong and weak points of
environmental sanitation of community which
will form basis for community health actions.
11. Major categories of
information
• Population characteristics
– Health of the community is influenced by
the people living in the community.
– Demographic characteristics of the people
helps in identifying the health problems
and health needs of the community.
– CHN needs to explore the population
characteristics.
12. Major categories of
information
• Population characteristics
– Size
• Refers to total population.
• Smaller the size easier it is to identify the
cases, trace the resources of infection and
causes of infection and plan and provide the
services.
• Larger population causes overcrowding, slums,
insanitation, shortage of health and health
allied facilities which affects the health of the
people.
13. Major categories of
information
• Population characteristics
– Density
• Refers to number of people living per square
kilometre of area.
• Density is very high in towns and cities.
• Overcrowding and congestion affects the
community health.
• High density affects the allocation of
community resources.
14. Major categories of
information
• Population characteristics
– Composition
• Refers to the distribution of population by
age,sex, education and occupation etc.
• It helps in assessing health problems and
health needs of different age groups, sex etc.
• CHN needs to identify the stratification of the
community people.
15. Major categories of
information
• Population characteristics
– Vital events
• Vital events like: birth, deaths, population
growth, life expectancy and morbidity status
and pattern determines the health of the
community.
• Any significant change in the vital statistics
may affect the health of the community.
16. Major categories of
information
• Population characteristics
– Vulnerable/ High risk groups
• These groups form the target group for
providing health services.
• Helps in increasing the efficiency of the
services within the limits of the existing
resources.
• Includes: lactating mothers, chronically ill,
children below 1yr, handicapped, elderly,
people with presymptomatic conditions etc.
17. Major categories of
information
• Population characteristics
– Social Structure
• Refers to supporting framework of the society and is
concerned with mutual relations of human beings.
• It determines the psychosocial behaviour which affects
the personal, community health and health care
services.
• Includes: social stratification, social control system,
community organization and group dynamics,
leadership pattern etc.
• It help CHN in understanding the health attitude,
behaviour and competencies and ability to deal with the
health situations
18. Major categories of
information
• Population characteristics
– Social Structure
• Social stratification- refers to classification of
people. It is traditionally on the basis of caste
system. But people are also grouped on the
basis of income.
• It is important to know, as it determines the
types of problem in particular group.
19. Major categories of
information
• Population characteristics
– Social Structure
• Social control system- each community has
formal rules and regualtions which govern
human behaviour, maintain relationships,
control law and order situations.
• E.g. local self govt.- PRI in rural areas, MCD’s in
urban areas.
• It helps a CHN to carry out various programs in
the community.
20. Major categories of
information
• Population characteristics
– Social Structure
• Community organizations and group
dynamics- social health groups are based on
various factors such as: cultural beliefs, codes,
religion etc.
• Members of these groups work under a
leadership with some definite goals to achieve.
• CHN needs to identify these groups with their
integrating and disintegrating factors. It helps
in solving various community health problems.
21. Major categories of
information
• Population characteristics
– Social Structure
• Leadership pattern- community has leaders
who quite powerful, exert social pressures and
contribute in making community decisions..
• Local traditional leaders like: chowkidars,
landlords, priests,.
• Can be informal or formal.
• It is important to identify the leaders as they
help in many ways. They help in mobilising the
community resources.
22. Major categories of
information
• Population characteristics
– Social Structure
• Life style- refers to the way people live in the
community.
• It comprises of daily living activities,
behavioural and cultural practices including
customs and traditions.
• Life style is being found to be associated with
the health of the people.
• Many health related problems are associated
with harmful daily living activities like: rituals,
defective dietary pattern etc.
23. Major categories of
information
• Population characteristics
– Social Structure
• Communication system- refers to the process
of flow of information and dissemination of
knowledge, ideas, and thoughts among people
of the community.
• Ultimate aim is to socialize the members of the
community and inculcate a positive attitue
towards health and develop a behaviour which
is acceptable to the society.
• CHN needs to identify the channels of
communication in the community. Like:
meetings, festivals, religious gatherings etc.
24. Major categories of
information
• Social system
– Community is organized into the socio-political
system which is governed by the formal and
informal laws, rules and regulations.
– Community is influenced by th its social structure.
– It is devided into various soci0cultural, political
and administrative subsystems.
– The subsystems include- housing, education,
occupation, law and order, legal system etc.
25. SOURCES OF INFORMATION
• Sources of information for geographical aspects of
community are: Maps, municipal bodies, PRI, Block
development offices, meteorology department.
• Sources of information relevant to population
aspects: census, registration department of births
and deaths, annual reports, records and reports etc.
• Sources of information about social system: local
political and administrative bodies, local directory,
key informants of various systems
26. APPROACHES AND METHODS
• Community identification is done by the descriptive
survey approach.
• It provides broad range of data about all dimensions
of community and its health problems.
• It needs to be planned carefully.
• There are various methods to get information about
the community:
27. COMMUNITY FORUM METHOD
• Refers to holding a formal and informal meeting with
community people, leaders and organized groups which
may include panchayat members, school teachers, mahila
mandals etc.
• Initial meeting can be open discussion, for establishing the
interpersonal relationship.
• Later, the meetings can be planned properly with specific
objectives.
• It is useful and relatively less expensive method of
gathering the historical perspective, community social
structure, life style, social events and resources available
and also the problems encountered, actions need to be
taken etc.
28. OBSERVATION METHOD
• Basic method for collecting first hand information.
• It helps gaining the information regarding geographical
area, environmental conditions, population density, beliefs,
norms, power system and problem solving etc.
• Observation visits can be formal and informal
• Informal visits are done to get familiar with the area , the
set up, and to have a general view.
• Formal observation visits are done with specific objectives
and to attain specific data. E.g. mapping, natural resources.
• An observational checklist can be used as a tool to collect
the information.
29. QUESTIONING METHOD
• Refers to the method used to elicit the needed information
by asking relevant questions.
• Can be in form of informal conversation with people: face
to face interview of key informants, sample population etc.
• Provides information on: social structure, life style, health
problems, health services and allied services, demographic
information etc.
• Key informants can be formal and informal leaders.
• Interview of sample population is effective method of data
collection.
• Questioning method requires the use of planned interview
schedule and questionnaire to elicit information through
interviews and self answering questioning respectively.
30. RECORD REVIEW METHOD
• Information like: housing conditions, socio-economic
status, demographic information, vital events, morbidity
etc can be collected through records.
• A record review checklist can be used as a tool .
• A checklist can be developed on the basis of the
information to be obtained from the records.
31. CONVERSATION/ DISCUSSION
METHOD
• Conversation/ discussion with health personnel can
generate information on community problems in past,
present, services rendered, difficulties encountered etc.
• Discussions with other organizations can also be helpful in
attaining information regarding functioning of their
organization and about establishing working relationship
• Meetings need to be planned like community forum
method.
32. OTHER METHODS
• It includes:
• Physical examination,
• Clinical examination
• Investigations
• These methods involve the use of standard screening
instruments like B.P. app., Audiometers, weighing scale etc.
• Listening is another good method of data collection in
community.
33. STEPS OF DATA COLLECTION
• Define the community to be studied: name, address, level
of community: rural/ urban, etc.
• Determine the objectives for community identification:
state the purposes of community identification.
• Determine specific information: identify the sources from
where the information can be obtained.
• Identify population and sampling unit under the study:
people, key informants, records etc. Select the respondents
when the sampling unit is a family and household.
• Decide on the sample size and sampling method
34. STEPS OF DATA COLLECTION
• Decide on the methods and instruments of data
collection: it depends on the type of data to be collected.
• Develop the instrument decided: may include: interview
schedule, observation checklist, community forum
guidelines etc.
• Organize and conduct survey
35. TIPS IMPORTANT FROM
PRACTICAL POINT OF VIEW
• Before visiting, know about the customs expected by the visitors.
• Identify the leaders, greet them in traditional ways, introduce and
explain the purposes.
• Dress up appropriately in a manner acceptable by the local
people.
• Do not act as a stranger or superior. Empathies with them
• Mix up with the people, accept their hospitality.
• Watch and listen them attentively, answer their queries and
consider their point of view.
• Make only those commitments which can be fulfilled.
• Avoid unnecessary arguments, criticism and comments.
• Be neutral in any kind of disputes in the family or village
• Maintain confidentiality
36. DATA ANALYSIS
• Refers to putting all the information collected into an order,
compile, summarize according to variables studied.
• It helps in making data meaningful and understandable, to be able
to describe the community profile, identify the health problems
and their possible associated factors.
• Includes following steps:
– Coding, organizing and arrangement of the data for tallying and compiling.
– Presentation of the data into the tables and graphs for descriptive analysis.
– Statistical analysis for more specific and precise analysis.
– Interpretation of the data for determining possible associations, drawing
inferences and compare the findings with national data.
– Reporting of the findings: include the community profile, making
community diagnosis.
37. COMMUNITY PROFILE AND
DIAGNOSIS
• The community identification process helps to
determine community profile and help in drawing
conclusions or make diagnosis of its health needs and
health problems from interpretation of data collected.
• Community diagnosis is a written statement of
community’s health needs/health problems.
• Diagnosis focuses on wide range of factors influencing
health and wellness status of the community.
• Diagnosis may change overtime and need to be
evaluated and restated periodically.
38. COMMUNITY PROFILE AND
DIAGNOSIS
• According to WHO definition, it is “a quantitative and
qualitative description of the health of citizens and
the factors which influence their health. It identifies
problems, proposes areas for improvement and
stimulates action”.
• The process includes four stages: Initiation, Data
Collection and analysis, diagnosis and dissemination.
• It should preferably comprise three areas:
- health status of the community
- determinants of health in the community
- potential for healthy city development
39. COMMUNITY PROFILE AND
DIAGNOSIS
• The production of the community diagnosis report is
not an end in itself, efforts should be put into
communication to ensure that targeted actions are
taken.
• Framing the Community Nursing Dx
– Description of the problem, response, or state-come from the inferences
of community
– Identification of factors etiologically related-causes
– Signs and symptoms that characterize the problem/concern; they may
come from other subsystems.
– Nursing diagnosis is the final, summary statement: E.g. Increased fear of
crime related to young kids on crime sprees as evidenced by….supporting
data.
40. COMMUNITY PROFILE AND
DIAGNOSIS
• EXAMPLES OF COMMUNITY HEALTH NURSING DIAGNOSIS
• Incomplete immunization status of preschool children due to
limited access to immunization clinics/lack of knowledge of
importance of early immunizations as evidenced by
immunization completion rate of 37% based on survey data
• Inadequate family planning services due to clinic days twice a
month as evidenced by the crude birth rate 50% higher than city.
• Potential for disability and loss of productive years of life among
the residents of community related to lack of access to area
medical resources, inadequate financial resources for needed
medicines, and lack of knowledge regarding disease etiology as
evidenced by higher adult and infant mortality rates.
41. COMMUNITY HEALTH PLANNING
( PLANNING PHASE)
• Based on community diagnosis.
• It is a systematic process and involves logical decision
making at each step of its process.
• It includes four steps:
– Analyzing health needs/health problems
– Establishing priorities
– Setting goals and objectives
– Formulating community health action plan to achieve objectives.
42. COMMUNITY HEALTH PLANNING
( PLANNING PHASE)
• ANALYZING OF HEALTH PROBLEMS
• Clarify nature, extent and factors associated with the
problem.
• More specific information has to be gathered. Also
known as problem oriented assessment and its second
level of assessment.
• Also analyze the availability of the resources relevant to
resolve the problems.
• Helps in setting goals and objectives and also to
formulate action plan.
• Other sector personnel should also be involved in the
analyses.
43. ESTABLISHING PRIORITIES
• Refers to ranking of health problems identified by
determining their relative importance on the basis of
predetermined criteria.
• It is necessary because of limited resources available
and many problems to deal with.
• It requires consideration of the problems, impact, their
consequences, community readiness to solve it etc.
44. ESTABLISHING PRIORITIES
• TYPE OF HEALTH PROBLEM:
• Health deficits i.e. instances of ill health, failure to
thrive.
• Health threats i.e. factors that predispose or conducive
to diseases and accidents.
• Foreseeable crises or stress points i.e. anticipated
periods of unusual demands on the people in terms of
adjustments and resources.
45. ESTABLISHING PRIORITIES
• EXTENT OF PROBLEMS
• Refers to extent of prevalence of the problems.
• May range from high prevalence and low prevalence
depending upon the number of people affected, timing
of prevalence and seriousness of the problem.
• SEVERITY OF THE CONSEQUENCES OF THE PROBLEM
• Refers to nature and magnitude of the resultant
problems. i.e. impact of the problems.
• SALIENCE
• Refers to community’s perception and evaluation of
the problems in terms of seriousness and urgency of
the attention needed.
46. ESTABLISHING PRIORITIES
• PREVENTIVE POTENTIAL
• Whether the problem can be prevented, controlled and
eradicated.
• MODIFIABILITY OF THE PROBLEMS
• Refers to the possibility of resolving problems.
Depends upon the availability of resources relevant to
solve the problem.
47. S.No. CRITERIA RATING SCALE
1. TYPE OF PROBLEM
Health deficit
Health threats
Foreseeable crisis
3
2
1
2. EXTENT OF PROBLEM
High Prevalence
Moderate Prevalence
Low Prevalence
3
2
1
3. SEVERITY OF CONSEQUENCES
Very Severe
Moderately severe
Very less Severe
3
2
1
4. SALIENCE
Serious problem: immediate attention needed
Problem with no immediate attention needed
Not feeling it as a problem
3
2
1
5. PREVENTIVE POTENTIAL
High
Moderate
Low
3
2
1
48. S.No. CRITERIA RATING SCALE
6. MODIFIABLITY OF THE PROBLEM
Fully Modifiable
Partially Modifiable
Very little or not modifiable
3
2
1
49. SETTING GOALS AND OBJECTIVES
• Once priorities are set up, relevant goals and objectives
are made.
• Objectives are precise, specific statements determining
actions relevant to goal.
• Goals and objectives give directions and determine
relevant actions.
• Helps in evaluating the actions planned and
implemented.
• E.g. To identify and reduce the incidence and
prevalence of malnutrition in under five children in a
defined community in a period of one year.
50. SETTING GOALS AND OBJECTIVES
• Specific objectives of this goal could be:
– To assess g&d of all under fives
– To identify children at risk
– To medically examine all malnourished children
– To do regular supervision of the children
– To monitor nutritional status of all children
– To educate mothers regarding the nutrition.
51. FORMULATING HEALTH ACTION
PLANS
• Refers to the identification of the appropriate
community health and nursing actions and preparing
an operational plan to be implemented to achieve the
established goals.
• For any objective there can be possible plans of action
• Criteria:
– Agency policy
– Resources available
– Nature of problem
– Community’s interest and feasibility
– Competencies of health personnel
– Practicability and efficiency
52. ACTION PHASE
• Three types of nursing actions: (According to Ruth and
Freeman)
– Supplemental : doing things for families,
groups and individuals.
– Facilitative: removing barriers and obstacles
etc.
– Developmental: helping families, groups and
people at large to develop and improve
capacities.
53. EVALUATON
• Process of ascertaining the effectiveness of
something or some organized activities or
program in relation to some set standards and
criteria.
• Ongoing decision making process.
• It may be formative and summative.
• Can be compiled and computed the end of each
day, week, month and year.
