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Levels of Community Health Nursing Practice Klien
Asuhan Keperawatan Kom Komunitas unitas
Karakteristik
Pengkajian Kesehatan
Keterlibatan keperawatan
Kelompo Keinginan, masalah, k dankebutuhanumum
Dinamika kelompok Pencapaian tujuan
Anggota kelompokdan kelompokdan ketua
Kelompo Besar, kelompok tidak k terorgnisir dengan populasi keinginan, masalah, dankebutuhanumum
Pengkajian masalah, kebutuhandan statistik vital umum
Aplikasi proses keperawatan untuk kebutuhan yang teridentifikasi
Community Health Nursing Planning • Planning for community change Change Theory (Kurt Lewin) ▫
Unfreezing
Involves finding finding a method of making it possible for people To let go of an old pattern that was counterproductivee in some way counterproductiv
Keterlibatan keperawatan
Indi Indivi viduden dudengan gan berbagai kebutuhan
Kekuatan, masalah masalah dan kebutuhan individu
Interaksi klienperawat
Keluarga
Sistem keluarga keluarga •Sistem dengan kebutuhan individu individu dan keluarga • Interdependency
Kekuatan, masalah masalah dan kebutuhan individu& individu& keluarga
Interaksi dengan individudan individudan kelompok keluarga
Levels of Community Health Nursing Practice Klien
Klien
Pengkajian Kesehatan
Indi Indivi vidu du
Desy Indra Yani
Levels of Community Health Nursing Practice
Karakteristik
Karakteristik
Pengkajian Kesehatan
Organisasi Tempat Tempat kerja kerja Sekolah
Kelompok terorganisasipada kelompok umum dengan dengan penataan penataan dantujuan yang diberikan
Hubungan tujuan, struktur, komunikasi, pola organisasi dengan kekuatan, masalah masalah dan kebutuhan
Komunitas
Populasi ag agregat Analisis siste, padalokasi kekuatan, tertentu dengan krakteristik, sistem sistem sosial sosial yang masalah masalah dan terorganisasi kebutuhan
Keterlibatan keperawatan Konsultandan Konsultandan atauaplikasi kepegawaian proses keperawatan untuk kebutuhan yang teridentifikasi Ketua komunitas, partisipan, healthcare provider
Community Health Nursing Planning • Planning for community change Change Theory (Kurt Lewin) ▫
Moving to a new level or changing
Involves a process of change in t houghts, 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 change Change 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
Community Health Nursing Intervention
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: 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?
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?
Question 1 • Do the intervention activities fit the goals and objectives of the program? ▫
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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?
Question 3 • Are the activities based on an appropriate theory? ▫
Change within the participant ▫
Interpersonal?
Change between participants ▫
Community?
Change across groups of people
Question 3 • Level of influence ▫
Intrapersonal Theories Theory of Planned Behavior
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Health Belief Model TranstheoreticalModel
Interpersonal Theories Social Cognitive Theory
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SocialSupport/Networks
Community Theories Precede Proceed CommunityOrganization
Community Development
Question 5 • Are the necessary resources available to implement the intervention selection? ▫
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Have you considered whether or not you will charge a fee for the services rendered?
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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 4 • Is the intervention an appropr iate 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 6 • What types of intervention activities are known to be effective in dealing with the program focus? ▫
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What types of intervention activities ar e being done by the communities you visited? What types of intervention activities ar e 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
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
Question 7 • Would it be better to use an interv ention that consists of a single activity or one that is made up of multiple activities? ▫
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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 t he target population to embrace the concepts and make them more salient.
Intervention Strategies • • • •
Single action Phasing Collaboration & networks Coalitions
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
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 Nursing Types 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.
Evaluation Criteria • • • • •
Relevance (overall) Efficiency (activities, outputs) Effectiveness (outputs, outcome) Impact (outcome, impact) Sustainability (outcome, impact)
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
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
Steps in Evaluation • Plan the evaluation • Collect evaluation data • Analyze the data • Report the evaluation • Implement the results
Collect evaluation data • • • • •
Identify types of data need & sources of data Determine data collection methods Develop, validate, pilot instrument Identify samples & samp ling 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
Implement the results • Plan how the results w ill be implemented • Identify who will implement • Determine when the results will be implemented: develop the time line
Report the evaluation • Determine who will write & receive the rep ort • Determine the format • Writing the report • Distribute the report
Health Planning Model • Pengkajian ▫
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Karakteristik agregat Identifikasi dan prioritas kebutuhan/ masalah kesehatan
• Planning ▫
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Mutual goals and objectives Aternative levels of interventions (personal, group, enviornmental)
• Intervensi ▫
Interventions of at least one level
• Evaluasi ▫
Community Health Education Peran perawat • Advocate • Caregiver • Case manager • Collaborator • Community care agent • Counsultant • Counselor • Culture broker • Educator
Berdasarkan objektif, pere ncanaan dan outcomes (proses & product)
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 & s elf 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
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