community health nursing II - unit IV

1. Community Health Nursing II
Unit IV
Approaches In Community Health Nursing
PREPAREDBY
KRUPAMATHEW.M,
ASSISTANTPROFESOR

2. APPROACHES
Community Health Nurses use various approaches to provide care in the community. Some of them
are
1. Epidemiological approach
2. Problem solving approach
3. Evidence based approach

3. EPIDEMIOLOGICAL APPROACH
• Epidemiology is the basic science of preventive and social medicine.
• It began with Adam and eve both tried to investigate the qualities of
“forbidden fruit”.
• The Greek physician Hippocrates father of epidemiology the first
person to have examined the relationship between the occurrence
disease and environmental influences. epidemiology
• epi means=among, demos= people, logos=study.

4. DEFINITION
The study of the distribution and determinants of health-related
states or events in specified population and the application of the study
to control of health problems
(J.M. LAST 1988)

5. AIMS OF EPIDEMIOLOGY
The ultimate aims of epidemiology can be concluded into two followings points
 To eliminate or reduce the health problem or its consequences
 To promote the health and wellbeing of society as a whole.

6. USES OF EPIDEMIOLOGY
 Investigation of causation of disease.
 Study of the natural history and prognosis of diseases.
 Description of the health status of the populations.
 It includes proportion with ill health, change over time, change with age etc
 Evaluation of the interventions.
 Planning health services, public policy and programs.

7. EPIDEMIOLOGICALAPPROACHES

8. ASKING QUESTIONS
Epidemiology has been defined as “a means of learning or asking
questions… and getting answers that lead to further questions”. for
example the following questions could be asked.
1. Related to Health Events
2. Related to Health Action

9. HEALTH EVENTS

10. HEALTH ACTIONS
What can be done to reduce this problem and its consequences?
How can it be prevented in the future?
What action should be taken by the community?
By the health services? By other sectors? Where and for whom these activities be carried
out?
What resources are required? How are the activities to be organized?
What difficulties may arise, and how might they be overcome?

11. MAKING COMPARISONS
This approach is to make comparisons and draw inferences.
This may be comparison of two (or more groups)- one group having the disease
(or exposed to risk factor) and the other groups not having the disease (or not
exposed to risk factor) or comparison between individuals.
By making comparisons, the epidemiologist tries to find out the crucial
differences in the host and environmental factors between those affected and not
affected.
Comparison may be made between different populations at a given time e.g.
rural with urban population, between sub group of population e.g. male with
female population, between various periods of observation e.g. different seasons

12. DEFINITION
 A systematic approach to defining the problem and creating a vast number of possible
solutions without judging these solution.
 “Problem solving is a cognitive processing directed at achieving a goal where no
solution method is obvious to the problem solver”
PROBLEM SOLVING APPROACH

13. PROBLEM-SOLVING PROCESS
Problem
Definition
Problem
Analysis
Generating
Problem
Solutions
Analyzing
The
Problem
Solution
Selecting
The Best
Solution
Implement
ing The
Solution
Evaluation
&
Revision

14. PROBLEM
DEFINITION
• In this first step, there is a need to write down what exactly the problem entails, which helps to identify
the real problem that is under study & needs an immediate solution.
PROBLEM
ANALYSIS
• To analysis how the problem affects the researcher & his or her current situation & other people involved
in the situation.
• The gravity of the problem & all the factors that are contributing to the problem are determined
GENERATING
PROBLEM
SOLUTIONS
• Focus must be on identifying & generating all possible solutions for a problem.
• Each potential idea for solution of a problem must be considered without discarding it through value
judgment

15. ANALYZING
THE
SOLUTIONS
• Various factors about each of the potential solutions are investigated, wherein all the positive & negative aspects of each
solution are analyzed
SELECTING
THE BEST
SOLUTIONS
• An attempt is made to compare the available solutions, & eventually the best solutions is selected based on the careful
judgment
IMPLEMENTI
NG THE
SOLUTION
• The final step of the problem-solving process is to practically solve the problem by implementing the selected solutions...
REVISION
AND
EVALUATION
• After implementation of the most potential solution, an evaluation is made to judge the effectiveness of the solution in
resolving the problem.
• It also helps to redefine the problem & revise the problem- solving process in case the initial solution fails to manage the
problem effectively.

16. EVIDENCE BASED PRACTICE APPROACH
DEFINITION
Evidence:
It is something that furnishes proof or testimony or something legally submitted
to ascertain in the truth of matter.
Evidence based practice:
It is systemic inter connecting of scientifically generated evidence with the tacit
knowledge of the expert practitioner to achieve a change in a particular practice for the
benefit of a well- defined client / patient group.
(French 1999).
Evidence based nursing:
It is a process by which nurses make clinical decisions using the best available
research evidence, their clinical expertise and patient preferences

17. NEED FOR EBP
1. For making sure that each client get the best possible services.
2. Update knowledge and is essential for lifelong learning.
3. Provide clinical judgement.
4. Improvement care provided and save lives.

18. GOAL OF EBP
1. Provide practicing nurse the evidence based data to deliver effective care.
2. Resolve problem in clinical setting.
3. Achieve excellence in care delivery.
4. Reduces the variations in nursing care and assist with efficient and effective
decision making

19. STEPS IN EBP
Many methods are used to conduct EBP in community health nursing one of the common
method is PICO method
P – Patient Population Of Interest
I – Intervention Of Interest
C – Comparison Of Interest
O – Outcome Of Interest
Step 1: Defining the patient (Population Of Interest)
Step 2: Identifying the intervention or process of interest
Step 3: Examining the comparison of interest
Step 4: Outcome of interest
Step 5: Time frame

20. Example:
Does the incidence of protein energy malnutrition among infants (P) of village A decrease (O)
WITH administration of nutrition balls ( I ) for 6 months compared to infants of village B (C)

21. ADVANTAGES OF EBP
1. Provide better information to practitioner
2. Enable consistency of care
3. Better patient outcome
4. Provide client focused care
5. Structured process
6. Increases confidence in decision-making
7. Generalize information
8. Contribute to science of nursing
9. Provide guidelines for further research
10. Helps nurses to provide high quality patient care

22. DISADVANTAGES OF EBP
1. Not enough evidence for EBP
2. Time consuming
3. Reduced client choice
4. Reduced professional judgement/ autonomy
5. Suppress creativity
6. Influence legal proceedings
7. Publication bias

23. THANK YOU