Community health diagnosis in nursing.

A review of the historical evolution of the concept of community health diagnosis in nursing identifies sources of ambiguity that have impeded making the goals and values of community health nursing operational. Refinements of meaning in the conceptualization of the community health diagnosis that focus upon the community as the primary level of analysis are suggested. Implications of this reconceptualization of the practice of community health nursing are considered in guidelines for developing community health diagnoses and in an example of the diagnosis of a Mien refugee community's responses to health problems. The basis of community health action must be an accurate assessment of the state of health of the community as a whole. For this reason, community health diagnosis is the keystone of community health practice (Freeman and Heinrich 1981, 314). That community health diagnosis is an essential precursor to community health nursing intervention is widely acknowledged (ANA 1980; APHA 1980). Is reconsideration of the community health diagnosis an exercise in tautology? I say not. Despite the chapters and texts that have been dedicated to community health nursing, we still have ambiguous definitions, unmeasurable goals, and a tenuous structure as guides for the construction and use of the community health diagnosis. The eclipse of community health diagAddress correspondence to: Marjorie A. Muecke, C.R.N., Ph.D., Department of Community Health Care Systems, School of Nursing SM-24, University of Washington, Seattle, WA 98195. Telephone (206) 545-0856. nosis theory in the literature is so complete that some texts even exclude diagnosis as a stage of the nursing process applied to the community, and some subsume it under the rubric of community assessment (Archer and Fleshman 1979; Freeman and Heinrich 1981; Helvie 1981; Leahy, Cobb, and Jones 1982).