 hospital bed-popu lation ratio categories of health services available E, Po Utical/Leadership Patterns The political and leadership pattern is a vital element in achfoving the goal of high level wellness among the people. It reflects the action potential of the state and its people to address the health needs and problems of the community. It also mirrors the sensitivity of the government to the people's struggle for better lives. In assessing the commun ity, the nurse describes the following: 1. Power structures in the community (formal or informal) 2. Attitudes of the people toward authority 3. Conditions/events/is sues that cause social conflict/ upheavals or that lead to soci. al bonding or unification. 4. Practices/ap proaches effective in settling issues and concerns within the community. Problem-Oriented Community Diagnosis The problem-oriented community diagnosis is the type of assessment that responds to a particula r need of a target group. (Spradley, 1990; Clark, 2003) For example, a nurse is confronted with health and medical problem s resulting from mine tailings being disposed into the river systems by a mining company. Since a community diagnosis investigates the community-mean ing, the people and its environment the nurse proceeds with the identification of the population who were affected by the hazards. posed by mine tai. lings. Then she goes on to characterize the biophysical, psychological, physical environmental, socio-cultural and behavioral as well as health system factors relevant to the specmc problem being investigated. COMMUNITY DIAGNOSIS : THE PROCESS Community diagnosis consists of collecting, organizing, synthesizing, analyzing and interpreting health data. Before data are collected, the community diagnosis objectives must be determi ned as these will direct the depth or the scope of the community assessment. It is fundamental to resolve whether a comprehensiv e or a problem­ oriented community diagnosis will accomplish the objectives. The community health nursing process emphasizes the active involvement of the clients in its care. The community is an active partner not a passive recipient of care. The nurse works with and not for the communi ty. People tend to believe that their participa tion is only required when it is time to implement program activities. In working with a community in a diagnostic exercise, the nurse needs to be conscious about the appropriate participatorym. ethods for mobilizing community participation. The nurse does not operate like an e. xternal assessor of community needs, but as the faci Utator working in a team composed of community members and leaders. Figure 7. 1 sumrnacizes a model of community diagnosis process adapted from F. J. Bennett (1979). The community's involvement starts early during the assessment phase to create awareness of their health needs and problems. Their participation in the community diagnosis develops their commitment and enthusiasm to carry on with the planning and implementation of health programs that address their needs and problems. The nurse must ensure the community's input in the communjty diagnosis considering th. eir capacities and limitations but with enough room to develop their potential s. 155 