THE PUBLIC/COMMUNITY HEALTH NURSING PROCESS.

BY

RITA O. AGYEI

22019592
Learning Objectives

At the end of the presentation, students will be able to;

1. Define Public Health Nursing Process

2. State the steps involved in the process

3. Know how to implement each step

4. Understand how the OMAHA system is used in the process

5. Understand the principles of PHNP guiding the community health nurse in discharge of his or her duties

6. Understand how each affects the outcome of treatment and problem solving in the community.
INTRODUCTION

Nursing has an organized structure that helps nurses to efficiently apply their
intellectual, psychomotor, and interpersonal skills. This structure is the nursing
process. ‘’it is an orderly systematic manner of determining the patient’s problem,
making plans to solve them, initiating the plan or assigning others to implement it,
and evaluating the extent to which the plan was effective in resolving the problems
identified’’.( Yura and Walsh, 1978).
 DEFINITION

Community Health Nursing Process is a systematic, scientific, dynamic, on-going

interpersonal process in which nurses and clients are viewed as a system with each
affecting one another and both being affected by the factors within the behaviour.

Simply, it refers to systematic series of steps which are followed by public health
nurse in the community by solving nursing problems using community approaches
and resources.

https://health.mo.gov/living/lpha/phnursing/definition.php
ADVANTAGE

Public Health Nursing process is an effective tool to help people solve

their health problems and meet their health and nursing needs.
ESTABILISHIBG & MAINTAINING WORKING RELATIONSHIP •

 Public health Nursing process is helping community people and families

identify their health problems and develop competencies to solve their
health problems and meet their health and nursing needs.

 This is enabled when the community health nurse establishes a good

working relationship with the families and communities.

 Working relationship is productive in nature.

 In “working relationship” between community health nurse and the
community people/families, there is a free dialoguing and an attitude
of trust and confidence in the integrity and capabilities of each other
to meet health and nursing goals.

 A working relationship between a nurse and the community is

initiated and maintained by the following means:
 Knowing the client (community).
 Communicating intensions and nature of help and assistance that would be
extended.
 Attentive listening and responding in between.
 Answering heir queries.
 Considering their views.
 Appreciating what is worthwhile.
 Empathetic attitude.
 Meeting their immediate needs and needs which are considered important by
them.
1. ASSESSMENT OF HEALTH NEEDS & HEALTH PROBLEMS

 The community health nurse comes to know the health needs and problems of the community
as she explores the community.

The problems could be;

 A large family size

 Malnutrition in children

 Incomplete immunization

 Anaemia in pregnant and nursing mothers

 Several morbidity conditons-TB, malaria, diarrhoea etc.

After obtaining the list of health needs and problems, the community health nurse needs
to prioritize the problems, as all the problems cannot be dealt with simultaneously.

The priority is determined on the basis of underlying criteria:

1. The nature of the problem, its prevalence, impact and prognosis.

2. Community’s perception of the problem i.e., whether the problem is felt by the
community and considers serious.

3. Preventive potential i.e., whether the problem can be prevented or not.

2. SETTING OBJECTIVES & DIAGNOSIS

The nursing diagnosis is “a clinical judgment about an individual,

family or community response to actual or potential health problem/
life process”

North American Nursing Diagnosis Association (NANDA, 1990)

 Once the problems are prioritized, it is
very important to set up objectives
relevant to each of the problems
identified.
E.g. Malnutrition
 To assess the growth and development of
all the under five children in a defined
community to find out malnourished
children.
3. PLANNING

 To get the medical examination done for all the malnourished children.
 To carry out prescribed treatment and provide care to all malnourished children.

 To do a regular monitoring of nutrition status of all children.

 To enroll all children with kwashiorkor and marasmus for availing food supplements.
 To educate mothers and population in general about the dangers of malnutrition and
importance of nutritious diet.
4. IMPLEMENTATION OF INTERVENTIONS

This is otherwise called the ACTION PLAN.

Once the objectives are formulated and planned it is necessary to identify
interventions to be implemented to achieve the objectives.
Various actions are decided and implemented as being most effective in order to
solve particular problems e.g., problem of malnutrition among under 5s.
As the action is implemented, the community health nurse gives direct nursing care.
She also helps the community to develop their own resources that can help easy
their burden on disease.
5. EVALUATION OF ACTION PLAN

Evaluation of interventions determines the effectiveness of actions

implemented. That is whether the desired results intended are achieved or not.

Evaluation also helps in finding out the reasons for not achieving the desired
goal.

This helps in making further improvement feedback and re plan, re implement

and re-evaluate.
 The effectiveness of intervention depends upon its objectives and is determined
on the basis of the following criteria:

1. Population coverage

2. Utilization of services provided.

3. Outcomes in terms of reduction in morbidity rates (increase in life expectancy).

4. Change in knowledge, attitude and practice, degree of independence.

Evaluation thus made is both Qualitative And Quantitative.

An effective evaluation strategy has the following characteristics:

i. Well defined measurable objectives.

ii. Well defined action plan.

iii. Has a base line statistical information for comparison

iv. Observe changes in health knowledge, attitudes and practices.

v. Analyse and interpret the facts (data) observed and recorded.

PRINCIPLES OF COMMUNITY HEALTH NURSING PROCESS

Principles are rules for community health practice or actions.

Theses provide guidelines to function in the community effectively &

efficiently.
1. Community health nurse must explore and know various aspects of a
defined community to be able to plan and implement health services.

2. Community health nurse must make a map of the community

showing the geographical boundaries, important roads, streets,
housing networks, church, temple, mosque, school, post office. This
helps in plotting the house for care.
3. Community health nurse must establish good working relationship as it helps in
providing need based care.

4. Community health nurse must know the health care delivery system, health policies,
health goals, health actions, national health care programmes while rendering health
services.

5. The community health nurse should provide realistic health services ( in terms of
available resources, funds)
6. Community health nurse must organize health services at large for the community
and render the services to the family which is the unit of community.

7. Community health nurse must continuously keep in touch with the community
and provide wellness oriented comprehensive services continuously.

8. Community health nurse must work in collaboration with other team members…
therefore she needs to know the roles and responsibilities of the other team members
9. Community health nurse educates in giving care to individual, family and
community. The health education should aim at providing a comprehensive health
knowledge to the community.

10. Community health nurse must maintain proper health records, registers . (These are
legal documents) These records help in planning and evaluation of the services.

11. The community health nurse must evaluate her services to find out achievement.
Eg.population covered, actions planned and recorded
 12. The community health nurse must provide services to all without any
discrimination of age, gender, colour, caste, nationality, political affiliation, religion,
as every individual has a right to optimum health.

 13. The community health nurse must not interfere with people’s religious, political
beliefs, but respect every one without any prejudice.

 14. Community health nurse should work in close consultation with employing
authority (Govt, public trust, NGO)
 15. Community health nurse should develop and maintain professional relationship with health
and health allies agencies (Block Development Office, Panchayats, Voluntary Organizations).

 16. Community health nurse must never accept any bribe or gift against professional ethics.

 17. The community health nurse must have an active participation with the community people
in taking care of their own needs and health problems. (This can be done by mass awareness
campaign)
 18. The community health nurse must be aware and closely coordinate with the local formal
and informal leaders.
NURSING PROCESS IN PUBLIC HEALTH
APPLICATIONS
ASSESSMENT

 Data collection
 Data validation
 Data analysis
DIAGNOSIS

 Data analysis
 Identify nursing diagnosis/problem
OUTCOME DEVELOPMENT

 Establish priorities
 Set outcome goals with the patient
PLANNING

 Select interventions to correct, minimize or prevent each problem and achieve the
outcome goals.
 Make records on your plan of care
IMPLEMENTATION

 Carry out the plan interventions

 Make documentation on care given
EVALUATION

 Have the outcome goals been achieved?

FUNCTIONAL HEALTH PATTERN ASSESSMENT TOOL
ASSESSMENT

 DATA COLLECTION METHODS.

 1. Observation
 2. Interviewing
 3. Physical examination
 4. Intuition
TYPES OF DATA

 Subjective
 Objective

SOURCES OF DATA

Primary
Secondary
ASKING QUESTIONS IN DATA COLLECTION

 Close vs open ended questions

 Biased, leading or loaded question

NON VERBAL COMMUNICATION
BEING A GOOD LISTENER IN DATA COLLECTION

 1. Focus on what the other person is saying

 2. Paraphrase
 3. Avoid making quick judgments
 4. Don’t rush the speaker
 5. Learn to talk less
DATA VALIDATION

 1. Identification of cues
 2. Make inferences about cues
 3. Validate cues and inferences
WHAT TO DO
1. Compare cues to knowledge base of normal function
2. Refer to textbooks, journal, research and reports.
3. Check consistency of cues
4. Clarify client statements
5. Seek consensus with peers and colleagues about inferences
DATA ORGANIZATION

 1. Record data in an orderly fashion

 2. You can use the FHP (functional health pattern assessment tool)
 3. You can do head to toe organization
DIAGNOSIS

 Definition: a clinical judgment about

individual, family or community responses to
actual or potential health/life processes.
 It provides the basis for selection of nursing
interventions to achieve outcomes for which
the nurse is accountable. (NANDA, 2005)
FORMAT FOR DIAGNOSIS (PES)

 PROBLEM
 Diagnostic Level
 Human Response
 ETIOLOGY
 Related Factors
 Risk Factors
 SIGNS AND SYMPTOMS
 Defining Characteristics
 Clinical Manifestations
LINKING WORDS OF PES
GUIDELINES AND CAUTIONS

1. Avoid value judgment

2. Avoid medical diagnosis
3. Be concise
4. Use legally advisable terms
OUTCOME IDENTIFICATION
USING MASLOWS HIERARCHY OF
NEEDS
HIGH PRIORITY REQUIRES IMMEDIATE ACTION

1. Life threatening situations

Eg. Haemorrhage or respiratory distress
2. Something needing immediate attention
Eg. Preparation for surgery or medical test
3. Something of great importance to the client
E.Gc anxiety or pain
MEDIUM PRIORITY

 These are problems that might result in unhealthy consequences but are not life
threatening.
 E.g. Stress incontinence
 Fatigue
 Dysfunctional grieving

LOW PRIORITY

1. Problems that can be resolved easily with minimal intervention

2. Problems that have little potential to cause significant dysfunction E.g. Washing a
clients hair to promote self esteem.
OUTCOME GUIDELINES

1. Outcomes are derived from the nursing diagnosis

2. Outcomes are documented as measurable goals
a. Subject
b. Verb
c. Condition
d. Performance Criteria
e. Time Frame
BEHAVIORAL VERBS USED
IN CLIENT GOALS
3. Whenever possible goals should be manually formulated between the patient and the nurse.
4. Outcomes are realistic in relation to patients presence and potential capabilities.
5. Outcome should be attainable in relation to available resources.
OUTCOMES ARE SMART

 Specific
 Measurable
 Appropriate
 Realistic
 Timely
PLANNING

NURSING INTERVENTIONS.
1. They are specific strategies designed to assist the patient to achieve outcomes.
2. It is based on scientific rational
3. The use of Nursing Intervention Classification (NIC)
NURSING CARE PLAN.
 The nursing plan of care must be accurately and completely documented.
 The care plan serves as a guide for many nurse to follow.
IMPLEMENTATION
 It refers to the action phase of the nursing process
 It is the actual initiation of the plan and recording of nursing actions.
 Its purpose is to provide technical and therapeutic nursing care to help clients achieve an
optimal level of health.
SKILLS SET IN IMPLEMENTATION

1. Technical competence
2. Intellectual ability
3. Interpersonal skills
IMPLEMENTATION ACTIVITIES

 Reassess the situation

 Sets priorities
 Perform nursing interventions (Independent nursing interventions
Collaborative/dependant nursing interventions)
 Record actions
EVALUATION

 It is a systematic and ongoing process

 The judgments of the effectiveness of the nursing care to meet clients goals.
 The effectiveness of interventions is evaluated in relation to outcomes.
QUESTIONS TO ASK DURING
EVALUATION

1. WAS THE OUTCOME GOAL ACHIEVED?

 Goal completely met
 Goal partially met
 Goal completely unmet
2. IF NOT WERE THE OUTCOMES APPROPRIATE?
3. WERE THE INTERVENTIONS APPROPRIATE?
EVALUATION DIAGRAM
INTRODUCING THE OMAHA SYSTEM
TO THE PUBLIC HEALTH NURSING
PROCESS
 WHAT IS OMAHA SYSTEM?
 It is a system that measures the effectiveness of nursing interventions.
 It categorizes information for easy retrieval for example the PHN chats about the client
problems along with what he/she did.
 This means that you are recording each problem and intervention to the problem.
PROBLEM SET FOUNDATION OF
OMAHA

 THIS INVOLVES 3 MAIN STEPS

1. Problem Classification – What problems did you assess?
2. Intervention – What action did you take?
3. Problem Rating Scale – Rating the client on what they know, what they do and how
they are.
PROBLEM CLASSIFICATION

 Problems are issues that are assessed in the client.

 The OMAHA systems categorizes problems, organized from broad to specific. (Just like
a hierarchy or taxonomy)
DOMAINS OF PROBLEM CLASSIFICATION

a. Environmental (income, sanitation, residence, neighbourhood/workplace

safety).
b. Psychosocial (communication with community resources, social contact, role
change, interpersonal relationships, spirituality, grief, mental health, sexuality,
care taking parenting, neglect, abuse, growth and development)
c. Physiological (hearing, vision, speech and language, oral health, cognition, pain,
skin, consciousness, respiration, circulation, bowel function, urinary function,
reproductive, pregnancy, postpartum, communicable and infectious diseases.)
d. Health Related Behaviour (nutrition, sleep and rest patterns, physical activity,
personal care, substance use, family planning, education regime)
MODIFIERS OF PROBLEM
CLASSIFICATION

This describes two things:

1. Who has the problem/or affected (individual, family or community).
Individual: client is experiencing astma
Family: problem with housing
Community: problem with clean water
2. Type of problem (actual, potential or health promotion)
Actual: patient is experiencing signs and
symptoms(wheezing/toxicity)
Potential: no signs or symptoms but may lead to problems eg
mother smoking cigarette around infants.
Health Promotion: anticipatory guidance or what client
requests eg childcare information
PROBLEM CLASSIFICATION SIGNS AND SYMPTOMS

 High priority
 Low priority
INTERVENTION

These are organized from broad to specifics.

4 BROAD CATEGORIES
1. Teaching, guidance and counselling.
2. Treatment and procedures.
3. Case Management
4. Surveillance
CONTINUATION

SPECIFICS
 These are actions or activities done which goes in greater detail of the category you just
chose.
 Meaning list of various targets can attach to any category of intervention.
 Also additional clients specific information can be added.
PROBLEM RATING SCALE

 This rates the clients knowledge, behaviour and status of the problem.
1. Knowledge: What client knows about the problem.
2. Behaviour: What client does about the problem.
3. Status of the problem: How client is dew to the problem.
HIGH PRIORITY PROBLEM

 The scale is rated 1 – 5

 The scale is rated prior to initial intervention then periodically until client shows
improvement.
CONTINUATION
SUMMARY:

 In every discipline, the nursing process is used to their professional practice differently
using various names, prevention of illness, and maintenance of health care common
goals in all areas of community health. The nursing process which is otherwise known
as the problem-solving approach is a tool or guide for the provision of quality nursing
care. A community health nurse provides skilled nursing care by making professional
judgments and renders good nursing care to the family and the community. In PHN it is
important to incorporate OMAHA and NANDA to the PHNP for better care delivery
THANK YOU
References:

1. http://nursingexercise.com/community-health-nursing-process-characteristics/
2. https://health.mo.gov/living/lpha/phnursing/definition.php
3. Kamalam. S (2012). Essentials in Community Health Nursing Practice (2nd Edition).
New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.
4. Clement. I (2009). Basic Concepts of Community Health Nursing (2nd Edition).
New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.
5. https://www.youtube.com/watch?v=ZpgPtQ5sQmQ
6. https://www.youtube.com/watch?v=C3yDJhveawU
7. https://www.youtube.com/watch?v=9PQm5flNluA
8. https://www.youtube.com/watch?v=beFcE2v3iQw