1. Chapter 15 Community As Client: Applying the Nursing Process

2. 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.

3. 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

4. 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)

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

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

7. 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

8. 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

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

10. 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

11. Data Analysis and Diagnosis
Validation of data  data interpretation
Diagnosis

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

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

15. 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

16. 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

17. 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

18. 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

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

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

21. Internet Resources
Agency for Toxic Substances and Disease Registry:
National Health Information Center:
National Institute of Environmental Health Sciences:
National Institutes of Health:
National Safety Council:
Office of Disease Prevention: