The Community asa Client: Assessment and

Diagnosis

Community health nurses work with clients at several levels: as individuals, families, groups, subpopulations, populations, and communities.

First, the community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it

Second, provision of most health services occurs at the community level. Community agencies help develop specific health programs and disseminate health information to many types of groups and populations

Myths Perpetuated by anIndividualistic Focus

Location Myth Skills Myth Client Myth

a community

(1) a location, (2) a population, and (3) a social system

(Lynd, 1939)

Community Profile Inventory: Location Perspective

Community Boundaries Location of Health Services Geographic Features Climate Flora and Fauna Human-Made Environment Population

Community Profile Inventory: Population Perspective

Size Density Composition Rate of Growth or Decline Cultural Characteristics Social Class and Educational Level Mobility

Community Profile Inventory: Social System Perspective

Health system Family system Economic system Educational system Religious system Welfare system Political system Recreational system Legal system Communication system

Three factors in particular affect community dynamics:

(1) citizen participation in community health programs,

(2) the power and decision-making structure, and

(3) collaborative efforts of the community (Lynd, 1939).

TYPES OF COMMUNITY NEEDSASSESSMENT

Familiarization or “Windshield Survey” (involves studying data already available on a community, and gathering a certain amount of firsthand data, to gain a working knowledge of the community)

Problem-Oriented Assessment Community Subsystem Assessment Comprehensive Assessment Community Assets Assessment (which focuses on the

strengths and capacities of a community rather than its problems)

Community Assets Assessment

(1) specific skills, talents, interests, and experiences of individual community members;

(2) local citizen associations and organizations; and

(3) local institutions

COMMUNITY ASSESSMENT

METHODS

Surveys1. Planning Phasea. Determine what information is needed and why.b. Determine precise data to be collected.c. Select population to be surveyed (eg, individuals, a household, a city block).d. Select survey method or instrument to be used (eg, interviews, telephone calls,

questionnaires).e. Determine sampling size (eg, a percentage of the total population in question).2. Data Collection Phasea. Identify and train data collectors (eg, interviewers).b. Pretest and adjust instrument.c. Supervise actual collection, including plans for nonresponses or refusals.3. Data Analysis and Presentation Phasea. Organize data for tabulation and analysis.b. Apply appropriate statistical methods.c. Determine relationships and significance of analysis.d. Report results, including implications, recommendations, and next steps needed;

provide feedback to the population surveyed through a community forum (discussed later).

Descriptive Epidemiologic Studies

examines the amount and distribution of a disease or health condition in a population by person (Who is affected?), by place (Where does the condition occur?), and by time (When do the cases occur?)

Community Forums or Town HallMeetings

is a qualitative assessment method designed to obtain community opinions

Focus Groups

First, there is only a small group of articipants, usually 5 to 15 people

Usually the group meets for 1 to 3 hours, and there may be a series of meetings.

Major advantages of focus groups are their efficiency and low cost, similar to the community forum or town hall meeting format.

SOURCES OF COMMUNITY DATA

Primary and Secondary Sources International Sources National Sources State Sources Local Sources

DATA ANALYSIS AND DIAGNOSIS

The Process of Analysis

(1) data can be rechecked by the community assessment team,

(2) data can be rechecked by others, (3) subjective and objective data can be

compared, or (4) community members can consider the

findings and verify them.

Community Diagnosis Formation

WHAT IS A HEALTHYCOMMUNITY?

1. Collaborate effectively in identifying community needs and problems

2. Achieve a working consensus on goals and priorities

3. Agree on ways and means to implement the agreed-upon goals

4. Collaborate effectively to take the required actions

Planning, Intervention, andEvaluation of Health Care in

Communities

Three characteristics support the use of the nursingprocess in community health nursing.

the nursing process is a problem-solving process that addresses community health problems at every aggregate level with the goalsof preventing illness and promoting public health.

It is a management process that requires situational analysis, decision-making, planning, organization, direction and control of services, and outcome evaluation

it is a process for implementing changes that improve the function of various health-related systems and the ways that people behave within those systems.

Interacting With the Community

Need for Communication

Forming Partnerships and BuildingCoalitions

Partnerships are agreements between people (and agencies) that support a joint purpose.

A coalition is an alliance of individuals or groups that work together to influence outcomes of a specific problem (Green, Daniel, & Novick, 2001)

Types of Evaluations

Structure-Process Evaluation Outcomes Evaluation

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