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Asuhan Keperawatan KomunitasDesy Indra Yani

Levels of Community Health Nursing PracticeKlien Karakteristik Pengkajian

KesehatanKeterlibatankeperawatan

Individu Individu denganberbagaikebutuhan

Kekuatan, masalah dankebutuhanindividu

Interaksi klien-perawat

Keluarga •Sistem keluargadengan kebutuhanindividu dankeluarga•Interdependency

Kekuatan, masalah dankebutuhanindividu & keluarga

Interaksidenganindividu dankelompokkeluarga

Levels of Community Health Nursing Practice

Klien Karakteristik PengkajianKesehatan

Keterlibatankeperawatan

Kelompok

Keinginan, masalah, dan kebutuhan umum

DinamikakelompokPencapaiantujuan

Anggotakelompok danketua

Kelompokpopulasi

Besar, kelompok tidakterorgnisir dengankeinginan, masalah, dan kebutuhan umum

Pengkajianmasalah, kebutuhan danstatistik vital umum

Aplikasi proseskeperawatanuntukkebutuhan yang teridentifikasi

Levels of Community Health Nursing Practice

Klien Karakteristik PengkajianKesehatan

Keterlibatankeperawatan

OrganisasiTempat kerjaSekolah

Kelompokterorganisasi padakelompok umumdengan penataandan tujuan yang diberikan

Hubungan tujuan, struktur, komunikasi, polaorganisasi dengankekuatan,masalah dankebutuhan

Konsultan danatau aplikasikepegawaianproseskeperawatanuntuk kebutuhanyang teridentifikasi

Komunitas Populasi agregatpada lokasitertentu dengansistem sosial yang terorganisasi

Analisis siste, kekuatan,krakteristik, masalah dankebutuhan

Ketua komunitas, partisipan,healthcare provider

Community Health Nursing Planning

• Planning for community changeChange Theory (Kurt Lewin)▫ Unfreezing Involves finding a method of making it possible for

people To let go of an old pattern that was

counterproductive in some way

Community Health Nursing Planning

• Planning for community changeChange Theory (Kurt Lewin)▫ Moving to a new level or changing Involves a process of change in thoughts, feeling,

behavior, or all three That is in some way more liberating or more

productive

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Community Health Nursing Planning

• Planning for community changeChange Theory (Kurt Lewin)▫ refreezing Is establishing the change as a new habit, so that it

now becomes the “standard operating procedure.” Without this stage of refreezing, it is easy to

backslide into the old ways.

Steps of Program Planning

• Identify target group• Identify planning group• Establishing program goals• Identify possible solutions• Identify alternative solutions• Identify resources

Steps of Program Planning

• Selection of best intervention strategies• Set specific objectives• Set intervention work plan• Evaluation tool development• Planning for monitoring & program evaluation

Community Health Nursing Intervention

7 questions to consider:1. Do the intervention activities fit the goals and

objectives of the program?2. At what level(s) of influence will the intervention

be focused?3. Are the activities based on an appropriate

theory?4. Is the intervention an appropriate fit for the

target population?

Community Health Nursing Intervention

7 questions to consider:5. Are the necessary resources available to

implement the intervention selected?6. What types of intervention activities are known

to be effective in dealing with the program focus?

7. What conclusions should be made about selecting a program intervention?

Question 1

• Do the intervention activities fit the goals and objectives of the program?▫ Be clear about your level of intervention…▫ Is your goal to increase awareness?▫ Is your goal to change behavior?▫ What is it you are trying to change?

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Question 2

• At what level(s) of influence will the intervention be focused?▫ Intrapersonal?

Change within the participant▫ Interpersonal?

Change between participants▫ Community?

Change across groups of people

Question 3

• Are the activities based on an appropriate theory?▫ Does your intervention include sound learning

and educational theories and models that are grounded in social science research?

▫ Have you selected empirical research that is related to your topic that uses the same theory?

▫ Level of Influence

Question 3

• Level of influence▫ Intrapersonal Theories

Theory of Planned Behavior Health Belief Model Transtheoretical Model

▫ Interpersonal Theories Social Cognitive Theory Social Support/Networks

▫ Community Theories Precede Proceed Community Organization Community Development

Question 4

• Is the intervention an appropriate fit for the target population?

• Does it address the unique characteristics of the target population?▫ Age, ethnicity, emotional status, physical status

• Does it fit the special needs of the target population?▫ Abilities, location

Question 5

• Are the necessary resources available to implement the intervention selection?▫ Have you considered whether or not you will

charge a fee for the services rendered?

Question 6

• What types of intervention activities are known to be effective in dealing with the program focus?▫ What types of intervention activities are being

done by the communities you visited?▫ What types of intervention activities are

mentioned in your empirical literature?

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Types of intervention:

• Health education program• Screening program• Health service establishment• Policy setting & implementation• Self-help initiatives• Balancing power relations among disadvantages

Intervention Strategies

• Single action• Phasing• Collaboration & networks• Coalitions

Activity Examples

1. Education & awareness Classes, posters, guest speakers

2. Personal assessment Surveys, journals, interviews

3. Setting expectations Guidelines, personal interviews, goal setting

4. Knowledge & skill building Projects, demonstrations, group work

Activity Examples

5. Opportunity to practice Projects, mentoring

6. Relapse prevention Support groups, hotlines, peer partners

7. Monitoring progress Personal interviews, surveys, follow-up meetings

8. Redefining expectations Panel discussions, exit interviews, posttests

Question 7• Would it be better to use an intervention that

consists of a single activity or one that is made up of multiple activities?▫ One shot interventions are not generally effective in

changing attitudes and behaviors.▫ Multiple activity interventions have been shown to be

more effective.▫ This may be due to being able to “tap into” the varying

learning styles of the target population.▫ Repeating the intended message can help the target

population to embrace the concepts and make them more salient.

Remember!!!

• It is important for you to recognize what level your participants are at and be realistic about how far they can progress.

• Make your goals and objectives attainable and have enough of them to make a significant impact

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Evaluation of Community Health NursingTypes of evaluation• Formative evaluation: Process evaluation focus

on how well the program is operated and being implemented. It occurs during program ongoing

• Summative evaluation: Measure community response to nursing care, interpret the degree to which planned goals are met.

Possible Evaluation Outcomes

• Knowledge, attitudes, behaviors & skills• Health status (Epidemiological data)• Well-being & quality of life• Presence of health care system services &

components• Satisfaction of program implementation• Presence of policy, regulation, funding

Evaluation Criteria

• Relevance (overall)• Efficiency (activities, outputs)• Effectiveness (outputs, outcome)• Impact (outcome, impact)• Sustainability (outcome, impact)

Steps in Evaluation• Plan the evaluation• Collect evaluation data• Analyze the data• Report the evaluation• Implement the results

Plan the evaluation

• Review goals & objectives• Meet stakeholders• Identify framework, expected outcomes, method

of evaluation: What & How• Design evaluation: when by whom• Determine the budget

Collect evaluation data

• Identify types of data need & sources of data• Determine data collection methods• Develop, validate, pilot instrument• Identify samples & sampling method• Collect data

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Analyze the data

• Determine data analyzing method• Identify who will analyzed data• Analyze data, interpret and present the results

Report the evaluation

• Determine who will write & receive the report• Determine the format• Writing the report• Distribute the report

Implement the results

• Plan how the results will be implemented• Identify who will implement• Determine when the results will be

implemented: develop the time line

Health Planning Model• Pengkajian▫ Karakteristik agregat▫ Identifikasi dan prioritas kebutuhan/ masalah kesehatan

• Planning▫ Mutual goals and objectives▫ Aternative levels of interventions (personal, group,

enviornmental)• Intervensi▫ Interventions of at least one level

• Evaluasi▫ Berdasarkan objektif, perencanaan dan outcomes (proses &

product)

Community Health EducationPeran perawat• Advocate• Caregiver• Case manager• Collaborator• Community care agent• Counsultant• Counselor• Culture broker • Educator

Community Health Education

• Facilitating of health promoting behaviors• Information agent & broker• Innovator• Liaison• Mediator• Negotiator• Policy analyst, policy maker or change agent• Promoter of collaborative partnerships• Promoter of self-care & self efficacy

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Community Health Education

• Referral resources• Recognize dimensions of health choices• Reseacher• Sensitizer• Social activist

Community Empowerment

• Community development• Community organizing• Community mobilization• Community building

• Community empowerment

• Community competence• Community capacity