Community Health Care Nursing Process: Community Care Plan

Identification of community health nursing problems

Data analysis will help in the identification of health problems in the community. Defining the community health nursing
problems will help the nurse and the team to decide with the people what action will effectively address and improve
community health.

A. Categories of health problems:

[Link] status problems: Increase or decrease fertility, morbidity, mortality or reduced capability for wellness,
2. Health resource problems: Lack of or absence of manpower, money, materials, or institutions necessary to solve
health problems
3. Health related problems: Describe in terms of existence of social, economic, environmental and political factors that
aggravate the illness- inducing situations in the community.

Community Diagnosis
 Identified health problems are stated in the form of community health diagnosis.
 This is a statement that defines the health strength, health problems or health risks of the community.

Health Problems / cues Community Nursing Diagnosis

Health Status Problem: Risk of incidence of bleeding, complications and
Presence of confirmed and suspected dengue untimely death due to dengue infection
cases
Health related problem: Risk of incidence of diarrhea and other gastrointestinal
Poor water sanitation. Water for drinking have diseases related to unsanitary water source for drinking
not been subjected or examined for bacterial
and other chemical contents and contaminants
Health resource problem: Inability of the people to make use of barangay health
Lack of health personnel in the barangay health station or/ RHU for care due to lack or no health
station: No permanent midwife on duty personnel available

Health related problem: 50% of dogs in the Risk of the population in acquiring rabies from
community have not been immunized unimmunized dogs

Health status problem: Increase risk of developing coronary artery disease

60% of the population of the older age group or
50 and above are hypertensive
Increase proportion of the population is at risk of
10% are not aware that they have high BP cardiovascular disease.

30% of 50 years old and over were diagnosed of

coronary heart disease and heart failure
10% of the children 0 – 1 year old were not able Increase risk of developing immunizable diseases among
to complete their immunization 0 to 1 year old children.

….and so many other health problems and community diagnosis

B. Planning for community action with the organizer and the people in the community
Planning: It is a logical, decision making process of design an orderly, detailed programs of action to accomplish specific
goals and objectives based on assessment of the community and the nursing diagnosis formulated.

[Link] Priorities for Action

Once the need assessment is complete and the issues requiring attention is identified, identification of priorities for action
is the next important step.

Criteria for priority setting:

1. Nature of the condition / problem presented

Criteria and Scoring System

Criteria: Scoring system
Score Weight
Classification of Health problems
a. health status problem 3
b. health resource problem 2 1
c. health related problems 1
2. Magnitude of the problem: refers to the severity of the problems which can be measured in terms of the proportion
of the population affected by the problem.
Criteria: Scoring system Weight
Affect 75 - 100% of the population 4

Affect 50-74% of the population 3 3

Affect 25-49% of the population 2
Affect Less than 25% of the population 1

[Link] of the problem: refers to the probability of reducing, controlling or eradicating the problem

Criteria: Scoring system

Score Weight
Highly modifiable 3
Moderately modifiable 2 4.
Low modifiability 1
Not modifiable 0

4. Preventive potential: refers to the probability of controlling or reducing the effects posed by the problem.

Criteria: Scoring system

Score Weight
High 3
Moderate 2 1
Low 1

5. Social concern: refers to the perception of the population or the community as they are affected by the problem and
their readiness to act on the problem.

Criteria: Scoring system

Score Weight
Urgent community concern; expressed readiness 2
for action 1.
Recognized as a problem but not needing 1
immediate action
Not a community concern 0
Source: UP College of Nursing Community Specialty Group. 1989.

Sample computation:

Criteria Health problem / community Community Score /HS Score Justification

diagnosis Nursing Diagnosis X W eight
( based on the data gathered)
1. Nature of Presence of confirmed and Risk of incidence 3/3 x 1 1
the problem: suspected dengue cases of bleeding,
2. Magnitude 65 % of the people in the complications and ¾ x3
of the problem community are affected by untimely death 2¼
dengue due to dengue
infection
3. Dengue is moderately
Modifiability modifiable ( based on the
of the problem assessment of the nurse)
4. Preventive Moderate due to some
potential stagnant water in the irrigated
ditches( sample only)
5. Social Is it an urgent community
concern concern; expressed readiness
for action based on the
verbalization of people affected
and the Barangay officials ( you
describe here the perceived
social concern of the people as
expressed)
Total Score
Continue computing…..
Compute for another health problems based on the criteria for prioritizing health problems
Another health problems….
Another….
Another…

Rank health problems according to priorities hypothetical only) . This is now the consolidation of all health problems
and rank them according to priorities. In the convenience of time due to limited community exposure, the people
together with the PHN/ health worker / organizer will now decide how many health problems can be realistically be
considered for planning for action.
All identified health problems shall be considered for computation and included in the ranking.

Rank Health Problems Community Nursing Diagnosis Score

1 Health status problem Risk of incidence of bleeding, complications and 6 5/6
Presence of dengue in the untimely death due to dengue infection
community
2 Health related problem Risk of incidence of diarrhea and other 5 ½
Poor water sanitation. Water gastrointestinal diseases related to unsanitary water
has not been examined for source for drinking
bacterial and other chemical ( hypothetical)
contents and contaminants
3 Health resource problem Inability of the people to make use of barangay 4¾
health station or/ RHU for care due to lack or no
Lack of health personnel in health personnel available
the barangay health station:
No permanent midwife on
duty
And so on and so forth 3½
This is a hypothetical entry just to give you a vivid
example

2. Goal and objective setting:

Once problems are prioritized, goals and objectives are set.
 Goal is a desired end. It is stated in a broad terms. It is the ultimate desired state.
 Objective: It is more precise and specific and stated in behavioral measurable terms.

Goal Objective
After 6 weeks of community health care At the end of one week of community exposure, the
activities, the community will have reduce community will
reported incidence of dengue fever a. implement sanitary measures to eradicate breeding
places of mosquitoes

Note: refer to Anderson and Krathwohl taxonomy of objectives to make a behavioral objectives

B. Plan of Action
Goal Objective Plan of Action
After 6 weeks of community At the end of one week of 1. Implement clean -up campaign
health care activities, the community exposure, the of stagnant water
community will have reduced community will
reported incidence of dengue a. implement sanitary measures 2. Remove bushes and rubber
fever to eradicate breeding places of tires, coconut husk ( Operation “
mosquitoes Kaya Kulob”

3. Observe the 4:0’clock habit by

all the households / families
Developing an evaluation plan:
This is the phase of the planning process that determines whether program is relevant, effective, efficient and adequate

Goal Objective Plan of Action Indicator

( Plan for evaluation)
After 6 weeks At the end of one 1. Implement clean -up campaign
of community week of community of stagnant water 85% of the household in the
health care exposure, the community will participate
activities, the community will 2. Remove bushes and rubber in the clean-up campaign.
community will a. implement tires, coconut husk ( Operation “
have reduce sanitary measures Kaya Kulob” 90% of the identified bushes
reported to eradicate and rubber tires, coconut
incidence of breeding places of 3. Observe the 4:0’clock habit by husks will be removed
dengue fever mosquitoes all the households / families

Majority of the population /

household will participate in
the 3 o’clock habit.

C. Implementation: 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. Community interventions are
the therapeutic actions designed to promote and protect the community

D. Evaluation It is systematic, continuous process of comparing the community’s response with the outcome as defined
by the plan of care. The ultimate purpose of evaluating interventions in community health nursing is to determine
whether planned actions met client needs, if so how well they were met, and if not why not. Evaluation requires a stated
purpose, specific standards and criteria by which to judge and judgment skills

Types of evaluation:
Process evaluation- measures the activities of the program, its quality and who it is reaching out.
Impact evaluation – measures the immediate effects of the program and determine whether the objectives of the
programs were met.
Outcome evaluation – measures the long term effects of the programs and determine if it meets the goals of the program

Community Action Plan Format:

Com. Com Nursing Goals of Objectives Plan of Target Person Responsible Budget/ Resources Evaluation
Health Problem / Care of care Action date ( Indicators)
proble Community
ms / Diagnosis
cues

Moving On:

LO. Given a data the learner will prioritize health problems using the scoring system

Given a hypothetical situation computes for prioritizing problems using the scale and scoring system provided,

Scenario: The following data were noted in one of the community in the northern part of Iloilo.
Community X health problems were the following:
1. 55% of the population are affected by poor environmental sanitation manifested by refuse and garbage are scattering
around in the community. The people are not mindful of the situation because other concerns are their priority.

2. 70% of the families are complaining of the presence of resting/ breeding places of mosquito. The families expressed
frustration because of their being poor, they will focus more on finding solution to their basic needs to sustain life rather
than cleaning their surroundings

3. 80 % of the people are affected by inaccessibility of transportation secondary to poor road construction. This problem
seemed so hard because they believed that the politicians are responsible to it.

4. 30% of the population were identified to be positive or active TB cases. TB of the member of the affected family has
been there for a long time and it does not bother them at all.

Direction: Based on the data stated above:

1. Set priorities among the list of health problems by using the criteria / computation given.
2. Rank health problems according to priorities. You can follow the template given
3. As regards to modifiability of the problem, it is you to decide based on your knowledge of the existing situations; Use
the template below
4, Choose the highest priority problem and make Community action plan.

Criteria Health problem / cues Community Nursing Score /HS Score Justification
Diagnosis X W eight
1. Nature of 3/3 x 1 1
the problem:
2. Magnitude
of the problem
3.
Modifiability
of the problem
4. Preventive
potential
5. Social
concern
Total Score

Formula to compute; Score / highest score X Weight

Ranking health problems according to priorities ( Rank 5 health problems as computed, being with 1 as the most highly
considered to be with great problem and 5 being the least )

Rank Health Problems / Community Nursing Score

cues Diagnosis
1
2
3
4
5

Note: How to rate your modifiability…. Take a look at your knowledge of modifiability: are there existing means,
treatment modalities to help prevent or control the condition. The decision is yours by your knowledge

Magnitude… social concern: it is given in the data.

Community Action Plan Format:

Com. Com Nursing Goal Objectives Plan Targ Person Budget/ Evaluation
Health Problem / of of care of et Respons Resourc ( Indicators)
proble Community Care Action date ible es
ms Diagnosis

Use landscape for this action plan

Note: I am not asking you to send back answers; rather practice first. You have the responsibility to read web search
resources to understand.
Application will be in the RLE component

Do some research on how to state community nursing diagnosis