Chapter 15 Community As Client: Applying the Nursing Process

Community As Client A community-wide group of people as the focus of nursing service The community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it. Provision of most health services occurs at the community level.

Dimensions of Community As Client One perspective: Status: morbidity & mortality data identifying physical, emotional, and social determinants of health Structure: services and resources Process: ability to function effectively

Dimensions of Community As a Client (cont.) Another perspective: Location (community boundaries, location of health services, geographic features, climate,, human-made environment) Population (size, density, composition, rate of growth or decline, cultural characteristics, social class and educational level, mobility) Social system (variables, health care delivery system)

Question Is the following statement true or false? Most health services occur at the individual level.

Answer False Most health services are provided at the community level.

Nursing Process Characteristics & Community Problem-solving process; management process; process for implementing change Characteristics: Deliberative; adaptable; cyclic Client-focused; need-oriented Interaction with community (communication, reciprocal interaction, paving way for helping relationship, aggregate application) Forming of partnerships and building of coalitions

Community Needs Assessment Process of determining real or perceived needs of a defined community Types Windshield survey (familiarization assessment) Problem-oriented assessment Community subsystem assessment Comprehensive assessment (key informants) Community assets assessment Windshield surveys are systematic observations made from a moving vehicle. Windshield and walking surveys can be used to assess general community needs Our definition is broad. A community asset (or community resource, a very similar term) is anything that can be used to improve the quality of community life

Community Assessment Methods Surveys Descriptive epidemiologic studies Community forums/town hall meetings Focus groups

Sources of Community Data Primary: gathered by talking to the people Secondary: records produced by people who know the community well International National State Local

Data Analysis and Diagnosis Validation of data  data interpretation Diagnosis

Question Is the following statement true or false? An epidemiologic study is one type of community assessment.

Answer False An epidemiologic study is a method for completing a community assessment.

Community Diagnoses Portray a community focus Include community response and related factors that have potential for change via CHN; logically consistent; response and factors logically linked Include statements narrow enough to guide interventions Use a community response instead of a risk, goal, or need statement Include factors within the domain of community health nursing intervention Deficit and wellness diagnoses (include maintenance or potential change responses due to growth and development) when no deficit is present

Planning to Meet Community Health Needs; Implementing Plans Tools for assistance: operational definitions of objectives and activities, conceptual frameworks and models; systematic approach Health planning process Implementing Preparation Activities or actions

Evaluating Implemented Community Health Plan Measuring or judging effectiveness of goal or outcome attainment Types of evaluation Formative: focus on process during actual interventions; development of performance standards Summative: focus on the outcomes of interventions; effect; impact

Community Development Theory Outcome of effective community-level nursing practice Collaboration with community members to assess collective needs and desires for positive change and address these needs through problem solving, use of community experts, and resource development Presumption that all community members participate in all aspects of change Agent of change (nurse) considered a partner, not authority figure responsible for community’s health Outcomes benchmarked against those of other groups

Question Is the following statement true or false? A formative evaluation focuses on the outcomes of the interventions.

Answer False A formative evaluation focuses on the process during the actual interventions.

Internet Resources Agency for Toxic Substances and Disease Registry: http://www.atsdr.cdc.gov National Health Information Center: http://health.gov/nhic National Institute of Environmental Health Sciences: http://www.niehs.nih.gov National Institutes of Health: http://www.nih.gov National Safety Council: http://www.nsc.org Office of Disease Prevention: http://www.odphp.osophs.dhhs.gov