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

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

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)

Three Dimensions of Community Location variables include community boundaries, location of health services, geographic features, climate, flora and fauna, and the human-made environment Population variables 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 system variables include the health system, family systems, economic system, educational system, religious system, welfare system, political system, recreational system, legal system, and communication system

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

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

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

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

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

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

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