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The Community Health Nursing Process
Setting for community health nursingpractice
homes
ambulatory service settings
schools
occupational health setting
residential institutions the community at large
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Aggregate
Level
Individual or
Family Level
Community
Level
Example: Levels of community health nursing practice
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Meeting the Needs of
Community or Aggregates
Aggregates at risk across life span
Aggregates at vulnerable conditions
Examples of Populations withPopulation-Health Issues
Elderly persons with ongoing chronic conditions whoneed a broad range of services to maintain theirindependence in the community
Persons who drink well waterAll families with newbornsAll children with asthma Sexually active teenagers Persons who drink and drive
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Practice Focus
Staff
(Generalist/
Lower Manager)
(CHN
Specialist/Middle Manager)
(Administrator:
CHN Specialist/
Top Manager)
Individual and Family Focus
Community Focus
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Comparison of components of specialist and
generalist levels of practice
Components of Practice CHN Specialist Generalist
Focus of Practice Communities and
populations
Individuals and families
Practice Models Advanced practice
Models
Comprehensive care of
individuals and families
Processes Community
assessment, programplanning, program
implementation, and
program evaluation
Assessing, diagnosing,
planning, intervening,and evaluating
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The CommunityHealth Process:
Using The Model
Figure 1. Community as Partner (Anderson & McFarlane, 2001)
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Community Health Assessment
Community as Partner Model:Assessment Wheel
Core :
- Demographics - Values- Beliefs - History
8 subsystems:
- Physical environment - Education
- Safety & transportation - Politics & government
- Health & social services - Communication
- Economics - Recreations
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Methods of Data Collections
Types of Data
Sources of Data for a Community Assessment
Methods of Data Collections
Participants Observation
Winshield/Walking Survey
Focus groups
Key informants
Surveys
Literature Review
etc
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Data Analysis
Cognitive process of ordering data to allow forthe higher-level function of synthesis (Ervin,2002)
Data Synthesis
Combining data elements from severalsources to create a coherent whole or
new, complete picture of what is known or
not known (Burn & Groove, 2001)
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The Web of Causation
Concept that posits that effect never depend
on single isolated causes but result from
chains of causation in which link is the resultof complex mix antecedents (MacMahon &
Pugh, 1970)
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Gambar 6. The Web of Causation Pemberdayan Masyarakat di Tingkat Komunitaspada Agregat Perokok di Kelurahan Depok Tahun 2008
Rendahnya Tingkat
Pendidikan Perokok
Ketergantungan
terhadap nikotin
Rendahnya
pengetahuan tentangdampak negatif
merokok
Rendahnya niat
berhenti merokok
Rendahnyadukungan keluarga
dan masyarakatuntuk kegiatan
berhenti merokok
Rendahnya kesiapan
berhenti merokok
Persepsi yang salah tentangmanfaat merokok
Buruknya persepsi terkena
dampak negatif merokok
Kebiasaan merokok
di sembarang tempat
Buruknya persepsi terhadap
dampak negatif merokok
Mudahnya akses
terhadap rokok
Kerterjangkaun
terhadap rokok
Pengaruh pergaulan
sesama perokok
Resiko terjadinyapenyakit akibat merokok
pada perokok
Resiko terjadinyapaparan asap rokok pada
perokok pasif
Resiko terjadinya
penyalahgunaan napza
pada kelompok perokok
Persepsi yang salahtentang cara mengatasi
stres pada perokok
Mekanisme koping tidakefektif pada kelompok
perokok
Ketidakmampuanperokok mengenal
diri sendiri
Harga diri rendah padakelompok perokok
Kebutuhan akan informasidampak negatif rokok
terhadap kesehatan
Potensial peningkatankesadaran anti rokok pada
siswa SMU Pelita I Depok
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Community Diagnosis
Stating the conclusions drawn from synthesis
of the data (Anderson & Mcfarlane, 2000;
Helvie, 1998; Mucke; 1984)
Statement of risk, condition, trend, potential
problem, strength, or latent situation about a
community or population (Watson, 1984)
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Community Diagnosis
Community Diagnoses may be formulated about:
Health issues (e.g., infant mortality)
Housing conditions (e.g., high lead content in interior paint) Economics conditions (e.g., 30% community residents
below poverty level)
Strengths (e.g., three community coalitions formed to deal
with potential environmental hazards) Trends (e.g., increasing employment opportunities)
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Formulating Community Diagnosis: Comparison
Approaches
Approach Conclusion Description of
community
Characteristics
of community
Indicators of
Conclusion
Muecke (1984) Risk of /
Presence of
Among Related to As demonstrated
in
Anderson &
McFarlane(2000)
Potential /
actual healthproblem or
concerns
Among Related to As demonstrated
by
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Example of a Community Diagnosis
Risk of death among infant born in the community related to:
12% of infants had low birth weight
24% of birth in 1998 were female 18 years of ageand younger
46% of women in 1998 had inadequate prenatalcare
An infant mortality rate of 12 deaths per 1000 livebirths in 1998
Etc.
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Planning
Community Diagnosis Goal/Objectives Interventions Evaluation Indicators
1. . Goal 1: .
Objectives :
1.1.
1.1.
Structure: ..
Process:
Output: ...
1.2.
1.2.
Structure: ..
Process:
Output: ...
1.3.
1.3.
Structure: ..
Process:
Output: ...
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Example of Objectives
Goal 1: to decrease deaths due to smoking amongcommunity residents
Objective 1.1: to decrease the number of smokersin the worker population from 25% to 22% in twoyears by providing smoking cessation programs forall work sites in the county
Objective 1.2: to gain commitment from one-half of
the work sites in the county to sponsor smokingcessation programs within one year
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Community Health Nursing Interventions
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CHN Interventions: Community Focused
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CHN
Interventions:IndividualFocused
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CHN Interventions
Example: Advocacy
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Implementing
Carry out plan to the community
Evaluating
Refers to evaluation indicators atplanning stage