Table. 1. 2 presents the basic data/information that need lo be collected by type of c Hen t-parh1er. Ln a:ssessing populatio n groups, other data shollld be added, parlicul. u:ly ou lbeir context. For exainple, assessment of workers sbou Jd also foc1,1s on f:ictors snch as nature of their work, imrnediotc physical and social environ ment, exposure lo occupational health ha7. ards and hcnlt J1 resources. Assessment lndlvldual Famlly Community Health Status Family structure, l:)emographic, c;ultural and Knowledge, attitudes charac:ter,stlcs. ind soc:loeconomlc: variables and practices (KAP) dynal7'ias Snvironmlc'rrtal factors Adaptation Propess Socioeconomic and cu,ltural 1-1<. >alth nnd lllh CS!\ patterns Pattern characterlst1cs Commun1ty resources Lifestyle Environmental fac~ors Community competence Help-seeking behavior He;:ilth stc1tus of each Examples: l J till:z:ation of health n1ember Parrticlpal ion services Values and practices on Mechlnery for health promotion/ focllltatlng Interaction mafntenanc.. and disease and dec;islo,,-maklng prcv-enbon Articulateness Compelenctes on famlly Conflict management he,3lth care Reasons for the failure of p>ast health programs. Table 1. 2 Assessme nt data for lndlvlduals, famllles and communities Diagnosis Diagnosis is the identification of the client's welness stl'ltus or needs and problems based on an analysis of the data/infonnu tion gat11ered. A CHN formulates a nursing diagnosis. Nursing diagnosis was defined in the 121" North American Nursing Diagnosis Association (NANDA) Conference in 1996 as "a clinical judgment about individual, family or commun ity responses to actual or potential healtl1 pi:oblerns/life process es" There were 165 NANDA nursing <liagnoses in 2003-2004 (Daniels, 2005:221. ; 1513-1514). NANDA·s focus, however has been at the indi,vidual ralhe,-than co1nmunrty level of diagnosis. Refer to the Typology of Nm·sing Problems in Fa1nily Nursing Practice (Chapter 2) and the three categories of community health nursing p1·oblems­ health status problems, health l'esources problems and health-related problems, jn Chapter 7. Planning of outcomes and interventions Planning is a logical step-by-step process in designing a plan of action to accomplish specifo. : goals and objectives (Allender and Spradley, 378). Desfred outcomes could be in terms of a person's health, knowledge, attitudes and practice s, and ability to cope,-vith problems. (Refer to Chapter 3 for developing family nursing care plan and Chapter 8 for planning for community heal th nu rsiug programs and services. ) Objectives of care which reflect the desired outcomes, should be specific, measurable, attainab le, realistic and bave specific time frame (SMART). The presence of SMART 35 