NURSING PROCESS - High infant mortality r/t inadequate

ANC, maternal nutrition, and

COMMUNITY DIAGNOSIS unhygienic delivery practice as
1. Definition evidenced by IMR 75 /1000 live
- This is a statement that defines the births.
health strength, health problems or 3. Schemes in Stating Community
health risks of the community. Diagnoses
- Nursing diagnosis is a real clinical
judgment or conclusions about human  NANDA nursing diagnostic labels
response to actual or potential problems have included diagnoses at the
(ANA). community level in more recent
- A community diagnosis forms the basis versions.
for community based intervention.The  Shuster and Goeppinger (2204)
process of determining the health status proposed a practical adaptation of a
of the community and the factors format of nursing diagnoses for
responsible for it. population groups previously
- It is a quantitative and qualitative presented by Green and Slade
description of the health of citizens and (2001)
the factors that influence their health.
The three-part statement consists of:
- Allows identification of problems and
areas of improvement, thereby 1. The health risk or specific problem to
stimulating action (WHO, 1994). which the community is exposed
2. A Nursing Diagnosis has Three (3) 2. The specific aggregate or community
Parts with whom the nurse will be working to
deal with the risk or problem
a. Description of the problem
(specific target or groups) 3. Related factors that influence how the
community will respond to the health risk
b. Identification of factors/etiology
or problem
related to (r/t) the problem
 The Omaha System
c. The sign and symptoms (the
- A comprehensive and research-based
manifestations) that characteristics
clarification system for client
of the problem.
problem that exists in the public
Examples: domain.
- Inadequate ANC r/t inadequate 4. The Omaha System
health information or service
3 components:
accessibility as evidenced by 70%
of female delivering at hospital a. Problem classification scheme
with no antenatal care.
- Poor nutritional status of under five b. Intervention scheme
children in the community r/t c. Problem rating scale for
knowledge deficit regarding outcomes
weaning diet as evidenced by
growth monitoring chart. (Omaha System, 2011a)

KAGP
4.1. First Component: A Problem PLANNING, IMPLEMENTATION,
Classification Scheme EVALUATION
 Problem Classification Scheme 1. Planning
- serves as a guide in collecting, - Based on findings during assessment and
classifying, analyzing, documenting, and formulated nursing diagnoses.
communicating health and health-related
- A logical process of decision making to
needs and strengths.
determine which of the identified health
- provides a model of practice, education, concerns requires more immediate
and research. consideration (priority setting) and what
actions may be undertaken to achieve
Areas of concern are classified in four levels: goals and objectives.
1.1 First and most general level of Planning involves:
classification is composed of four domains:
 priority setting
(1) environmental
 formulating goals and objectives
(2) psychosocial  deciding on community
interventions
(3) physiological
(4) health - related behaviors - It is a logical, decision making process
of design an orderly, detailed programs
1.2 Problems or areas of concern under the four
of action to accomplish specific goals
domains
and objectives based on assessment of
1.3 Two sets of qualifiers in the problem or the community and the nursing
area of concern diagnosis formulated.

(1) health promotion, potential problem - Provides the nurse and the health team
or actual problem with a logical means of establishing
(2) level of clientele (individual, family, priority among the identified health
or community) involved is identified concerns.

1.4 The fourth and most specific level is made The World Health Organization (WHO)
up of clusters of signs and symptoms that has suggested the following criteria to
describe actual problems (Omaha System, decide on a community health concern for
2011b) intervention:
 Significance of the problem
 Community awareness
 Availability to reduce risk
 Cost of reducing risk
 Ability to identify the target
population
 Availability of resources

KAGP
1.1. Setting priorities involves: - Community interventions are the
therapeutic actions designed to promote
- Assigning rank/importance to
and protect the community health, treat
client’s needs
and remediate community health
- Determining the order in which
problems and support the community as
the goal should be addressed.
it changes over time.
- The goal can be immediate, intermediate
or long range goal. 2.1. Key areas of nursing intervention in
the community are
1.2. Establishing goal and objectives
 link the community members with the
- Goal is a broad statement of desired end
available resources
results.
 pulls together information and
- Objectives are specific statement of the resources to assist community in
desired outcomes. addressing its health concern and
problems
Characteristics of good objectives:
 marinating its strength through
Specific- target specific population facilitation, education, organization,
consultation and direct care
Measurable- when the results are stated
3. Evaluation
Achievable- within the capacity of the
available resources. - It is systematic, continuous process of
comparing the community’s response
Relevant- fits with the general police
with the outcome as defined by the plan
Time bound- that is achieved within of care. The ultimate purpose of
specified time frame. evaluating interventions in community
health nursing is to determine whether
1.3. Planned actions
planned actions met client needs, if so
- Planned actions are specific activities or how well they were met, and if not why
methods of accomplishing the objectives not.
or expected outcomes.
- Evaluation requires a stated purpose,
- Outcome measurements is judging of the specific standards and criteria by which
effectiveness of goal attainment. How and to judge and judgment skills.
when was each objective met, why not?
- Recording the plan
2. Implementation
- Group analyzes the reasons for people's
health behavior and directs strategies to
respond to the underlying causes.
- Implementation is putting the plan into
actions and actually carrying out the
activities delineated in the plan, either by
nurse or other professionals. It is the
action phase of the nursing process.

KAGP