The Community as Client: Assessment and Diagnosis

1. The Community as Client: Assessment and Diagnosis Allender and Spradley - Chapter 18

2. Why Nurses Work with Communities • The community as client refers to the concept of a community-wide group of people as the focus of nursing service • The community directly influences the health of its constituents • Provision of most health services, like the development of specific health programs and dissemination of health information, occurs at the community level

3. Values and Myths • In the US, individualism is a core value that gives meaning to life and provides motivation for people • It is a myth that community health nursing is defined by its setting or location (location myth) • It is a myth that community health nurses employ only the skills of basic clinical nursing when working with community clients (skills myth) • It is a myth that the primary community health clients are individuals and families (client myth)

4. Three Dimensions of Community • Location variablesinclude community boundaries, location of health services, geographic features, climate, flora and fauna, and the human-made environment • Populationvariables include size, density, composition, rate of growth or decline, cultural characteristics, social class, and mobility of all the diverse people living within the boundaries • Social systemvariables include the health system, family systems, economic system, educational system, religious system, welfare system, political system, recreational system, legal system, and communication system

5. Factors in Community Dynamics • Citizen participation - ranges from apathy to widespread and may be uninformed or obstructive, with the goal being self-care • Power and decision-making structure - may reside in the political system or unevenly among organizational leaders • Collaboration efforts - refers to the ability of the community to work together as a team of citizens, professional and lay people to meet needs

6. Needs Assessments • Community needs assessment is the process of determining the real or perceived needs of a defined community of people • Activities overlap and are repeated constantly throughout the assessment • 1. collection of pertinent data, including lifestyle behaviors • 2. analysis and interpretation of data, including morbidity and mortality data

7. Types of Needs Assessments • Familiarization - studies available data, perhaps adding some firsthand data, to gain a general understanding of the community (windshield survey) • Problem-oriented - focuses on a single problem and studies the community in terms of that problem • Community subsystem - examines a single dimension of community life • Comprehensive - surveys the entire community in depth • Assets-focuses on the strengths and capacities of a community to change

8. Assessment Methods • Survey - a series of questions, used to collect data for analysis of a specific group or area • Descriptive epidemiologic study - examines the amount and distribution of a disease or health condition in a population by person, place, and time • Community forum/town hall meeting - qualitative method that obtains community opinions by selective invitation of participants • Focus group - obtains grassroots opinions via small group process with members being homogeneous in regards to demographic variables

9. Data Sources • Primary Data - talking with community members, including formal and informal leaders, and community inhabitants for accurate insights and comprehensive information • Secondary Data - includes health team information, client records, community health statistics, Census Bureau data, reference books, research reports, and community health nurses • Agencies - local (Chamber of Commerce, City Planners), state (Dept of Health), national (USPHS, Census, NIH), and international (WHO) • Maps and web sites

10. Analysis and Diagnosis Process • Analyze the information gathered by recording, tabulating, and synthesizing for patterns and trends • Draw inferences or conclusions about the data’s meaning • Validate the inferences by rechecking or comparing to determine their accuracy • Form a nursing diagnosis using standard format, substituting communtiy as client, relating factors within the community health domain

11. Characteristics of a Healthy Community • A sense of unity • The ability to collaborate and communicate effectively • A problem-solving orientation • The ability to use yet conserve resources • The ability to handle crises and conflict