150 Chapter 7 ASSESSING COMMUNITY HEALTH NEEDS Luz Barbara P. Dones INTRODUCTION In community health nursing, the community is not simply a context of the existence of the nurse's clients nor is it just a setting for 01Lr nursing interventio ns. Spradley (1990) emphasizes that the community is the primary client for nvo main 1·easons. First, the communi ty has a direct influence o·u the health of the individual, families and sub-populations. Second, it is at this level th. at most health service provision occurs. 111e hallmark of community health nursing :is the fact that it is population-focu sed (Clark, 2003) and thal the pr:imary client and recipient of care of the nurse fo a group of people in the community. The community heal U1 nurse gets to work w:ith differenttypes of client in her practice. She may be involved with families, populutio ns or sub-grou ps, each has distinguish ing characteristics that the nurse must recognize in order to direct her nursing involvement. Clark (2003) makes the following distinction: Population refers to the general public or society or a collection of communities and generally do not display social action among its members (Kuss et al, 1997). Within the population are smaller subgroups oftea referred to as aggregate, neighborhood, and community. Aggregates are defined by their common characteristics and concerns but similar 10 populations, I hey may not interacl: or work together to address these concerns. Aggregates are often seen as populatio n having high risk for certain health conditions. (Helvie, 1998) Some examples of aggregat es include the children under five years old, the school-aged children, the adolescents and the eldel"ly. Matteso n (2000) describes a neighborhood as more homogeneous as a consequence of having common langua!!,e or cultural traclil:ion but may not have specific physical or geogn1ph ic bounduries. This is especially true in the Philippines when people from the rural arc. as migrate into the metropolis but are drawn together \Vitl, other people whom they sl1are dialect or traditions with to form a neighbor hood. As different neighborhoods converge and expand, the need to institute a system of governance becomes crucial. This give rise to communities that Sanders (1958) and Cassells {1993) define as a collection of people, a place and social system. Community health nurses need to know the defining characteristics of a community (see Chapter 1) because these "set" the stage in understanding the different aspeds that directly or indirecl'ly influence the health status of the community. The community health nurse,viii also deal with these community characteristics in planning and developi ng specific programs and in ensuring the delivery of effective healtl1 services. THE COMMUNITY DIAGNOSIS Caring for the community as client starts with detem,ining its health status. 