Care of Populations Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Community Health Nursing, 5/e Mary Jo Clark 15 CHAPTER

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Population Health Management Accountability and management of health of entire community Regardless of system membership or insurance status Health promotion Illness prevention strategies

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Population Health Assessment Benefits of including member of community –Ensures that their interests are considered –Accurate and comprehensive appraisal of health status –Aids in offsetting organizational or agency agendas that may arise –Assures a comprehensive/balanced picture of health

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Rapid Participatory Appraisal Addresses community structure, composition, interest, and capacity Collects data regarding community needs and assets Identifies available services Considers social policy as it affects capacity to meet population health needs

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Key Concepts Community Target group Community engagement

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Factors Affecting Population Health: Biophysical Considerations Annual birth rate Age dynamics Age-specific death rates Genetics Race/ethnicity Disease incidence and prevalence

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Psychological Considerations Community stressors Suicide and homicide rates Adequacy of law enforcement Communication patterns

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physical Environmental Considerations Geographical location Type and size of community Topographical features Climate

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physical Environmental Considerations (continued) Type and adequacy of housing Water supplies Disaster potentials

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Sociocultural Considerations Community government and leadership Language Income and education Employment levels and occupations

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Socioculutral Considerations (continued) Marital status/family composition Religion Transportation Availability of goods and services

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Behavioral Considerations Consumption patterns Nutritional levels Use of harmful substances Prevalent leisure activities

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Considerations Existing health services Level of health system performance Availability and adequacy of services Health care financing Community’s definition of health and illness

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Principles of Population Health Assessment Seek multiple sources of information Address needs of specific subgroups Involve all potential stakeholders Identify population assets, needs, and problems Use experts to conduct or direct assessment

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Components of a Population Nursing Diagnosis A potential adverse situation or risk Identification of the group or population at risk Group factors or characteristics contributing to the risk Indicators that support the conclusion that an increased risk is present

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Planning Collaborative, systematic process to attain a goal Collaboration through involving community and stakeholders Systematic process –Effective health systems respond to/are accountable to needs of population –Limited resources must be used to population’s greatest advantage –Health supersedes other economic or social ends

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Program Planning Utilizes five step process: –Define and prioritize issue to be addressed –Create the planning group –Analyze the issue –Develop the program –Set the stage for evaluation

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Define/Prioritize Issue to Be Addressed Severity of threat Degree of community’s concern

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Categories to Include When Creating a Planning Group Those in authority who approve program People with expertise related to issue Those who will implement program Those who will benefit from program Those who might resist program

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Analyze Issue Contributing factors Alternative solutions Determine level of prevention for problem resolution Determine costs, feasibility, and acceptability

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Analyze Issue (continued) Determine availability of necessary resources Determine efficiency Determine equity Identify political advantages

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Develop Program Outcome objectives –Immediate, intermediate, and ultimate outcomes Process objectives: –Designate level of expected staff performance

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Evaluation Criteria Determine evaluation criteria Types of collection data Means of collecting data Resources needed to conduct evaluation Identify who will evaluate the program

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Program Theory How elements of a program interact to produce outcomes Conceptual model of planned interventions and outcomes Graphically displayed interrelationships –Critical elements –Expected outcomes

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Theory Types Theory of cause and effect: –Links interventions with outcomes Theory of implementation –Describes strategies for program implementation

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Theory Types Partial Program Theory for a Smoking Cessation Program

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Levels of Acceptance Community policy makers Program implementers Members of target group: Potential resistors:

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Acceptance by Policy Makers May involve nurse as advocate

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Acceptance by Program Implementers May only involve making plan operational

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Acceptance by Members of Target Group May require marketing to that group

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Acceptance by Potential Resistors Critical to success or failure of program Early involvement can positively influence this group

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Program Evaluation Justify program continuation/expansion Improve quality of service Determine future courses of action Determine impact of program

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Program Evaluation (continued) Call attention to the program Assess personnel performance Assuage political expectations Make better programmatic decisions

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Considerations in Program Evaluation Purpose of the evaluation Who should conduct the evaluation Political considerations Ethical considerations Type of evaluation to be conducted –Prospective –Retrospective

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources Community Assessment & Collaboration This Washington State community site contains access information about the health and health concerns of a community, and offers tools to better reach out and to involve the community with these issues.Community Assessment & Collaboration

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources American Public Health Association Population, Family Planning and Reproductive Health Section. Section members work to improve the health of women, men and children by ensuring that population, family planning and reproductive health remain major domestic and international priorities.American Public Health Association

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources Texas Department of State Health Services, Children with Special Needs Site describes various programs developed for this special population. Their mission is to support family- centered, community-based strategies for improving the quality of life for children with special health care needs and their families.Texas Department of State Health Services, Children with Special Needs