Community as Client: Applying Nursing Process

1. Chapter 15Community 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, flora, fauna, 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

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 • Planning • 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: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