Lesson 3: Community Health Nursing Process in turn, increases the level of satisfaction in

individuals who receive care.

• Is a systematic, scientific, dynamic, on-
going interpersonal process in which the Nature or Concept of Community Health
nurses/midwife and the clients are viewed Nursing Process: There are different key
as a system with each affecting one and concepts of which are mentioned below:
another and both being affected by the
factors within the behaviour. • The nursing process provides a framework
• The community health nursing process for the practice of nursing. It involves both
is a systematic, rational method and art and science.
providing nursing care for the prevention • The nursing process refers to a series of
of disease and promotion of health of the planned steps and actions directed at
community. meeting the needs and solving the
• It is an orderly systematic manner of problems of patients.
determining the patient's problem, making • The nursing process is a deliberative
plans to solve them, initiating the plan or problem-solving approach that requires
assigning others to implement it, and cognitive, technical and interpersonal skills
evaluating the extent to which the plan was and is directed to meeting the needs of the
effective in resolving the problems patient.
identified.( Yura and Walsh, 1978). • The nursing process is a goal-oriented
humanistic and systemic plan of
PHN in CHN Process individualized care that is both effective
and efficient.
• Includes the promotion of health, • The nursing process is a problem-solving
prevention of illness, and the care of ill, process that addresses community health
disabled, and dying people. Advocacy, problems at all aggregate levels and aims
promotion of a safe environment, research, to prevent illness.
participation in shaping health policy and
• The nursing process is a deliberate
in patient and health systems
intellectual activity whereby the practice of
management, and education.
nursing is approached in a dynamic,
• The primary role of community health systematic manner to patient care in a
nurses/midwife is to provide treatment to dynamic, continuous method to assist the
patients. Additionally, community health patient to achieve and maintain health.
nurses/midwife offer education to
• The nursing process is dynamic and
community members about maintaining
continuous. It provides blueprint care and
their health so that they can decrease the
responds to the client's needs in a timely
occurrence of diseases and deaths such as
and reasonable manner to improve or
infectious and sexually transmitted
maintain the client's level of health.
diseases and obesity.
Characteristics of Community Health Nursing
The Nursing Process
Process:
functions as a systematic guide to client-centered
• The nursing process provides a framework
care with 5 sequential asteps. These are
or structure upon which community health
assessment, diagnosis, planning, implementation,
nursing/midwifery actions are based. The
and evaluation.
application of the process varies with each
Benefits of CHN Process situation, but the nature of the process
remains the same. Certain elements are
In addition, it promotes critical thinking, creativity, important for community health nurses to
problem solving, and decision making skills in emphasize in their practice.
clinical practice. Providing care via the use of 1. The process is deliberative
nursing process increases the quality of care and (Weidenbach, 1964):
 o That is purposefully, rationally and health care common goals in all areas of
carefully throughout the care. This community health. The nursing process which is
requires judgment. The situation otherwise known as the problem- solving approach
demands independent thinking and is a tool or guide for the provision of quality nursing
difficult decision making. care. A community health nurse/midwife provides
2. The process is adaptable (Lewis, 1988): skilled nursing care by making professional
o This dynamic nature enables the judgments and renders good nursing care to the
community health nurse/midwife family and the community.
to adjust appropriately to each
situation to be flexible in applying As a nurse, your primary duty is to ensure that your
the process to the individual needs. patients uphold quality standards while providing
The nurse adapts individual service care. Nurses can care for patients in a range of
to each community client. different healthcare settings with continuity of
3. The process is cyclical (Henlay, 1986): care for each patient. The nursing process
o The actions are in constant provides a framework of practice for the
progression. The nurse/midwife in nurse/midwife to follow to guarantee that the
any given situation engages patient has their needs met.
continual interaction, data
5 Steps in the Nursing Process
collection, analysis, intervention,
and evaluation. Steps are repeated 1. Assessment – Gather information about
over and over in the nurse- client the client’s condition
relationship continuously. 2. Nursing Diagnosis – identify the client’s
4. Client-focused (Hooper, 1986): problems
o Nurses/midwife use this process to 3. Planning – set goals of care and desired
help clients, directly or indirectly to outcomes and identify appropriate nursing
achieve and maintain health. actions
5. The process is interactive (Yura and 4. Implementing – Perform the nursing
Walsh, 1973) actions identified in planning
o Nurses/midwife and clients are 5. Evaluating – determine if goals met and
engaged in the process of ongoing outcomes achieved
interpersonal communication.
Giving and receiving accurate Assessment
information is necessary to promote
• Assessment is the first step and involves
understanding between
critical thinking skills and data collection;
nurse/midwife and client and foster
subjective and objective. Subjective data
effective use of the nursing
involves verbal statements from the patient
process. The client-nurse/midwife
or caregiver. Objective data is measurable,
relationship can and should be a
tangible data such as vital signs, intake and
partnership called "peer practice".
output, and height and weight.
6. Need-oriented (Steps, 1976):
• Data may come from the patient directly or
o Application of this nursing process
from primary caregivers who may or may
in the community health to the
not be direct relation family members.
anticipation of needs and
Friends can play a role in data collection.
prevention of problems assumes
Electronic health records may populate
additional significance. This focus
data in and assist in assessment.
is needed if we are to realize the
• Critical thinking skills are essential to
goals of community health to
assessment, thus the need for concept-
protect promote and restore
based curriculum changes.
people's health.
• Provides an estimated of the degree to
In every discipline, the nursing process is used to which a family, groups or community is
their professional practice differently using various achieving the level of health possible for
names, prevention of illness and maintenance of them, identifies specific deficiencies or
 guidance needed and estimates the Diagnosis
possible effects of the interventions.
• The formulation of a nursing diagnosis by
The assessment process involves the main steps employing clinical judgment assists in the
which are taken with the active participation of the planning and implementation of patient
clients especially in decisions made. care.
• The North American Nursing Diagnosis
A. Data Gathering: these are relevant data for
Association (NANDA) provides nurses with
determining community needs which can be
an up to date list of nursing diagnoses. A
collected through the following methods:
nursing diagnosis, according to NANDA, is
1. Interview defined as a clinical judgment about
2. Observation responses to actual or potential health
3. Survey problems on the part of the patient, family
4. Census or community,
5. Review of facts about the community • A nursing diagnosis encompasses
Maslow's Hierarchy of Needs and helps to
Types of Data: prioritize and plan care based on patient-
centered outcomes. In 1943, Abraham
1. Covert
Maslow developed a hierarchy based on
2. Overt
basic fundamental needs innate for all
Sources of Data individuals. Basic physiological needs/gls
must be met before higher needs/goals can
1. Primary be achieved such as self-esteem and self-
2. Secondary actualization. Physiological and safety
needs provide the basis for the
Health Need implementation of nursing care and nursing
1. Health Problem interventions. Thus, they are at the base of
2. and its categories Maslow's pyramid. laying the foundation for
physical and emotional health.

Nursing Diagnosis Community Assessment is a process of collecting

and processing data or information about the
• A Nursing Diagnosis may be part of the client.
nursing process and is a clinical judgment
Steps:
about individual, family, or community
experiences/responses to actual or 1. Initiate contact
potential health problems/life processes. 2. Demonstrate caring attitudes
Nursing diagnoses are developed based 3. Develop mutual trust and confidence
on data obtained during the nursing 4. Collect data from all possible resources
assessment. An actual nursing diagnosis 5. Identify problems
presents a problem response present at 6. Analyze and interpret data
time of assessment.
Planning
Community nursing diagnosis
• The planning stage is where goals and
• This is a statement that defines the health outcomes are formulated that directly
strength, health problems or health risks of impact patient care based from the
the community. Nursing diagnosis is a real guidelines set. These patient-specific goals
clinical judgment or conclusions about and the attainment of such assist in
human response to actual or potential ensuring a positive outcome. Nursing care
problems (ANA). A community diagnosis plans are essential in this phase of goal
forms the basis for community based setting. Care plans provide a course of
intervention. direction for personalized care tailored to
 an individual's unique needs. Overall evaluate to ensure the desired outcome
condition and comorbid conditions play a has been met. Reassessment may
role in the construction of a care plan. Care frequently be needed depending upon
plans enhance communication. overall patient condition. The plan of care
documentation. reimbursement, and may be adapted based on new assessment
continuity of care across the healthcare data.
continuum. • Process of making judgements as to the
extent the objective are met
Goals should be:
• It is a systematic comparison of client's
1. Specific health status with the outcomes.
2. Measurable or Meaningful
(Process and Outcome Evaluation)
3. Attainable or Action-Oriented
4. Realistic or Results-Oriented • An outcome evaluation tells you whether a
5. Timely or Time-Oriented program achieved its goals. A process
evaluation tells you how and why. A
Formulation of steps to be undertaken to achieve
process evaluation describes a program's
desired end.
services. activities, policies, and
Steps: procedures.... An outcome evaluation
measures a program's results and
1. Prioritize needs determines whether intended outcomes
2. Established goals based on needs and were achieved.
capabilities
3. Construct action and operation plan Possible decision based on evaluative findings
4. Devise evaluation parameters
• Intervention effective and objectives were
5. Revise plan as needed
met
Implementation • Objectives were not met and
• another approach should be tried No make
• Implementation is the step which involves change in quality of performance
action or doing and the actual carrying out
of nursing interventions outlined in the plan Steps
of care. This phase requires nursing
1. Care outcomes
interventions such as applying a cardiac
2. Performance appraisal
monitor or oxygen, direct or indirect care,
3. Estimate cost benefits ratio
medication administration. standard
4. Assessment problems
treatment protocols and EDP standards.
5. Identify needed alterations
• Translation of care plan into action
6. Revise plan as necessary
Steps:
• Documentation help ensure consent and
1. Put nursing plan into action expectations. It helps to tell the narrative for
2. Coordinate care/services decisions made, and how yourself or the client
3. Utilize community resources responded to different situations. In this same
4. Delegate and supervise manor, it is important to record Information that
5. Monitor health services provided can help support the proper treatment plan and
6. Provide health education and training the reasoning for such services.
7. Document responses to nursing action • Documentation is the record of nursing care
that is planned and delivered to individual
Evaluation
clients by qualified nurses/midwife or other
• This final step of the process is vital to a caregivers under the direction of a qualified
positive patient outcome. Whenever a nurse/midwire. It contains information in
healthcare provider intervenes or accordance with the steps of the nursing
implements care, they must reassess or process.
• Nursing Documentation is essential for good
clinical communication. Appropriate
documentation provides an accurate reflection
of assessments, changes in clinical state, care
provided and pertinent patient information to
support the multidisciplinary team to deliver
great care.

Note: CARE not WRITTEN is CARE NOT DONE

REPORTS

• Refers to periodic summaries of the

services or activities of an organization/unit
or the analysis of a certain phase of its
work.

RECORDS

• Refers to forms on which information's of

the pertaining to client is noted

Note: Effective and accurate Recording and

Reporting systems, whether paper-based or
electronic, are essential to ensure high-quality
care of clients and to ensure accurate sharing of
information.