Communities significantly shape the overall health and well-being of individuals. Factors like economic conditions, social structures, and political landscapes profoundly impact access to healthcare. These elements can be critical determinants of physical, emotional, and mental health outcomes, influencing both illness rates and mortality within a population.
Structural characteristics such as race, ethnicity, education level, gender, and income are strong indicators of community health. These variables highlight risk factors for chronic health issues and present opportunities for targeted, community-based interventions.
The Nursing Process in Community Health
Community-based nursing emphasizes both immediate and long-term care, encompassing various practice settings, including:
- Home health services
- School nursing programs
- Case management facilities
- Outpatient clinics and public health departments
Nursing practice in these settings prioritizes wellness promotion, disease prevention, health maintenance, and disease management. While healthcare has traditionally focused on managing acute and chronic illnesses, community health nursing recognizes the crucial role of prevention and education in improving health outcomes and reducing the overall burden and cost of healthcare.
Developing Nursing Care Plans for Community Health Needs
Once a nurse identifies community health nursing diagnoses, comprehensive nursing care plans are essential. These plans prioritize assessments and interventions to achieve both short-term and long-term health goals for the community. Below are examples of nursing care plans relevant to community health.
Addressing Deficient Knowledge in Community Health
Deficient Knowledge in the context of community health can stem from a lack of awareness regarding available resources, navigating the healthcare system, understanding health programs, and recognizing individual and community-wide health risks.
Nursing Diagnosis: Deficient Knowledge
Related Factors:
- Limited awareness of community support systems and resources
- Inadequate access to healthcare professionals and information
- Scarcity of financial and social resources
- Deficiencies in program budgeting, outcome data, or evaluation plans
- Inability of existing programs to effectively address pressing health concerns
Evidenced By:
- Community members expressing confusion or concern about health issues
- Noncompliance with recommended health programs or guidelines
- Frequent inquiries from community members about specific health topics
- Misconceptions prevalent among community members regarding health
- Worsening of health symptoms within the community
- Ineffectiveness of health programs in addressing identified health concerns
- Avoidable hospital readmissions within the community
- Increasing rates of physiological or psychological health conditions
Expected Outcomes:
- The community will demonstrate an understanding of the advantages and disadvantages of available programs in achieving community health objectives.
- The community will collaboratively develop a plan to address recognized health needs within the community.
- Community members will adopt and maintain behaviors and lifestyle changes that contribute to improved community health.
Nursing Assessments:
1. Evaluate healthcare providers’ understanding and application of community health knowledge.
Consistent knowledge and terminology among healthcare providers facilitate effective communication and collaboration within the community health network (CHN).
2. Identify current and potential health problems within the community.
Pinpointing specific health issues allows for the development of focused, population-based interventions, emphasizing primary prevention and proactive strategies.
3. Inventory available community resources.
Understanding the existing resources and how the community accesses them helps identify gaps in service. Resources might be inadequate for community needs, or community members may be unaware of their existence.
4. Document community members’ concerns and complaints.
Recording community feedback provides a realistic perspective on problem areas from those directly affected.
Nursing Interventions:
1. Foster a collaborative community environment while respecting individual and group uniqueness.
When individuals feel valued and respected, they are more likely to participate in creating and implementing plans for community health improvement.
2. Engage the community in selecting healthcare goals and priorities.
Community involvement in problem assessment, goal setting, and prioritizing health needs enhances collaboration and commitment to health initiatives.
3. Connect community members with relevant resources.
Facilitate access to essential healthcare services by providing information and support for transportation, utilizing 2-1-1 programs, and promoting free clinics to ensure optimal healthcare delivery.
4. Partner with the community to develop solutions.
Collaborative problem-solving empowers the community and fosters a sense of ownership, leading to more effective and sustainable solutions.
Addressing Ineffective Community Coping
Ineffective Community Coping arises when community efforts to adapt to and resolve problems fail to meet the community’s needs and desires.
Nursing Diagnosis: Ineffective Community Coping
Related Factors:
- Limited resources available for effective problem-solving
- Inadequate community infrastructure (emergency services, transportation systems)
- Deficient social support services within the community
Evidenced By:
- Community members expressing feelings of inadequate support or overwhelming stress
- Elevated rates of illness and disease within the community
- High incidence of crime, abuse, unemployment, and poverty
- Community members voicing feelings of powerlessness or hopelessness
Expected Outcomes:
- The community will demonstrate measurable improvements in coping mechanisms, such as reduced crime rates or increased employment.
- The community will identify and choose constructive alternatives to harmful activities for problem resolution and adaptation.
Nursing Assessments:
1. Evaluate the specific needs of the community.
A thorough needs assessment is crucial for pinpointing gaps that hinder the community from achieving its health-related objectives.
2. Review disaster preparedness plans and emergency response protocols.
Assess local and regional policies for handling epidemics, threats, terrorist events, and natural disasters to determine the level of community preparedness.
3. Determine the availability, accessibility, and utilization of community resources.
Even when resources are available, they may not be used effectively or to their full potential. Evaluate existing programs, referral processes, and follow-up systems.
4. Identify unmet expectations within the community.
Recognizing shortcomings is the initial step in addressing gaps. Open communication is essential to understand the community’s perspective.
Nursing Interventions:
1. Collaborate with community members to develop action plans.
Organize community interactions to manage needs and promote engagement. This fosters long-term participation and adherence to community initiatives.
2. Assist the community in building partnerships both internally and externally.
Establishing partnerships with external organizations and within the community supports sustained development and continuous improvement to address current and future challenges.
3. Educate the community on the benefits of available resources and activities.
Help the community understand how improvement efforts and community cohesion contribute to their safety, health, and overall well-being.
4. Ensure access to information at the community level.
Disseminate resource information through accessible channels such as TV, flyers, radio, and social media, tailoring the information to diverse educational and cultural backgrounds.
Fostering Readiness for Enhanced Community Coping
Recognizing and nurturing the community’s potential to improve adaptation and problem-solving through proactive engagement, effective management, and open communication.
Nursing Diagnosis: Readiness for Enhanced Community Coping
Related Factors:
- Strong community motivation to improve health and manage stress effectively
- Desire to promote positive social change within the community
- Openness to community transformation and growth
Evidenced By:
- Positive and effective communication channels among community groups
- Development and expansion of health-focused programs (nutrition, exercise, immunizations)
- Community-led planning and proactive initiatives
Expected Outcomes:
- The community will effectively utilize community resources to manage stressors.
- Community members will articulate and practice appropriate coping techniques.
Nursing Assessments:
1. Review the community’s existing plan for addressing challenges.
Analyzing the current plan helps identify areas for improvement based on the community’s evolving needs.
2. Assess the specific stressors impacting the community.
Accurate identification of unique community stressors is vital for tailoring relevant and effective interventions to enhance coping skills.
3. Evaluate the level of social support available to community members.
Community leaders and support networks play a critical role in promoting healthy coping mechanisms and facilitating community progress.
4. Analyze the community’s current coping strategies.
Understanding existing coping strategies helps identify negative patterns and determine which new techniques are needed to enhance community resilience.
Nursing Interventions:
1. Organize regular community meetings to discuss concerns.
Establish a platform for discussing current stressors and anticipating future concerns to enable proactive intervention and planning.
2. Practice active listening and reflective communication.
Actively listening to community members and reflecting on their perceptions of their situation provides valuable insights and data for developing accurate and relevant plans.
3. Develop diverse programs and outlets for community expression.
Enhance coping skills through creative outlets such as art, music, exercise, and meditation. Offer classes and stress-management programs to educate on healthy coping strategies.
4. Promote problem-solving skills and acceptance of limitations.
While problem-solving skills are essential, effective coping also includes recognizing and accepting situations that are beyond immediate control.
References
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Institute of Medicine (US) Committee. (1988). Public health as a problem-solving activity: Barriers to effective action – The future of public health – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK218227/
- Nies, M. A., & McEwen, M. (2019). Community/Public Health Nursing: Promoting the health of populations (7th ed.). Saunders.
- Rector, C. (2018). Community and Public Health Nursing : Promoting the Public’s Health (9th ed.). Wolters Kluwer Law & Business.
