Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 15 Community As Client: Applying the Nursing Process

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Most health services occur at the individual level.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False –Most health services are provided at the community level.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Community Assessment Methods Surveys Descriptive epidemiologic studies Community forums/town hall meetings Focus groups

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Data Analysis and Diagnosis Validation of data  data interpretation Diagnosis

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? An epidemiologic study is one type of community assessment.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False –An epidemiologic study is a method for completing a community assessment.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A formative evaluation focuses on the outcomes of the interventions.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False –A formative evaluation focuses on the process during the actual interventions.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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: