Community Nursing Diagnosis

Community Nursing Diagnosis

Creating a community assessment composite database will result in a list of community health problems. Each problem needs to be identified clearly and stated as a community health diagnosis. The statement of the problem in a community health diagnosis format is the third phase of the community-as-client process. Developing the community health diagnosis in this phase of the process helps clarify the problem and is an important first step to planning. In the planning phase, where each diagnosis is analyzed, priorities are established and community-focused interventions are identified. Community diagnoses clarify who receives the care (the community as opposed to an individual), provide a statement identifying problems faced by who is receiving the care (i.e., the community), and identify the factors contributing to the identified problem.

Although the North American Nursing Diagnosis Association International (NANDA-I) provides a taxonomy of nursing diagnoses familiar to most students, NANDA-I’s focus has been on the individual rather than the community level. However, more recent NANDA-I work has also developed community-level diagnoses such as ineffective community coping. Furthermore, ongoing work with Nursing-sensitive Outcomes Classification (NOC) is an effort to produce a standard language across health care settings, including the community. NANDA-I is only one accepted system of nursing diagnosis; for example, home-health nurses are familiar with the Omaha System classification system of nursing diagnosis. In, a version of the nursing diagnosis format presented by Newfield et al three parts are used:
• Risk of
• Among
• Related to

“Risk of” identifies a specific problem or health risk faced by the community. “Among” identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. “Related to” describes characteristics of the community, including motivation, knowledge, and skills of the community and its environment. Environmental characteristics include physical, cultural, psychosocial, and political characteristics. These data were identified in the composite database of the assessment phase and provide the basis for the community-level nursing diagnosis. Each community has its own unique characteristics. Some of these characteristics are strengths that the nurse can build on, but other characteristics contribute to the problem identified in the community health diagnosis. The characteristics, or factors, related to the identified problem are listed after the “related to” statement as the third part of the community health diagnosis.

Community nursing diagnosis language must describe at the aggregate level—in other words, the community level—responses to actual and potential illnesses and life processes. This also means that the defining characteristics for community diagnoses must be observable and measurable at the aggregate level. To do this, community-level data must be used. Epidemiological data or community survey data are two examples of community-level data. The comparison of local data with state, regional, or national data, as rates and across multiple years, is one key means of identifying community-level problems, as well as patterns and trends. Newfield et al. provided a detailed example about their community-level diagnoses involving “ineffective community coping” and “risk for adverse human health effects” that were related to violence in the local community. The example being used for this illustration is infant malnutrition. On the basis of assessment data, the community diagnosis for infant malnutrition using this format would be the following:
• Risk of infant malnutrition

• Among families in your County

• Related to lack of regular developmental screening; lack of an outreach program to identify at-risk infants; knowledge deficit among families about infant-related nutrition and about WIC (special supplemental nutrition program for women, infants, and children); and confusion among families about WIC program enrollment criteria

Frequently, a number of community health diagnoses are made on the basis of the different problems identified during the assessment phase. The problems are stated in a community-focused nursing diagnosis format. In the next phase, planning for community health, weighting is done and priorities are established among these problems.
Marcia, Stanhope,, Lancaster, Jeanette. Public Health Nursing – Revised Reprint: Population-Centered Health Care in the Community, 8th Edition. Mosby, 03/2014. VitalBook file.