Community As Client : Assessment and Diagnosis

Community As Client : Assessment and Diagnosis
Allender & Spradley 6th Edition Community As Client : Assessment and Diagnosis © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Allender & Spradley 6th Edition
Introduction:: Understanding the concept of the community as client is a prerequisite for effective service at every level of community nursing practice. Community health nurses work with clients at several levels: as individuals, families, groups, subpopulations, populations, and communities. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Community As Client working with communities is a primary mission of CHN for two important reasons: The community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it. 2. Provision of most health services occurs at the community level. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Dimensions of Community As Client:
Allender & Spradley 6th Edition Dimensions of Community As Client: Physical location Resources & threats Population Suggest health needs & basis for health planning Social system Formal and informal © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

1. Physical location: The health of a community is affected by location, because placement of health services, geographic features, climate, plants, animals, and the human-made environment are intrinsic to geographic location. The healthy community is one that makes wise use of its resources and is prepared to meet threats and dangers. In assessing the health of any community, it is necessary to collect information not only about variables specific to location but also about relationships between the community and its location. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Variables of Physical Location:
Allender & Spradley 6th Edition Variables of Physical Location: Community boundaries: Example: Some communities are distinctly separate, such as an isolated rural town, whereas others are closely situated to one another. 2. Location of health services Example: if the hospital is far away from village. village far away from fire protection 3. Geographic features Example: people who live in high altitude area may be more susceptible to pnemuthorax. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… Climate Example: people who live in sunshine area always risk for sun strike, eye disorder and skin cancer but less susceptible to osteoporosis. 5. Flora and Fauna The community health nurse needs to know about the major sources of danger from plants and animals affecting the community under study. 6. Human-made environment. Example: Agricultural activity can alter the environment through chemical fertilizers and pesticide applications. industry that produce smoke, worm, and toxic wastes. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

2. Population: Population consists not of a specialized aggregate but of all the diverse people who live within the boundaries of the community. The health of any community is greatly influenced by the attributes of its population. Various features of the population suggest health needs and provide a basis for health planning. Community health nurses can better understand any community by knowing about its population variables: size, density, composition, rate of growth or decline, cultural characteristics, social class structure, and mobility. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Population Variables:
Allender & Spradley 6th Edition Population Variables: Size Ex, tracing the source of contamination in a large city might involve a long and complicated search. 2. Density Ex, absence of stress from crowding may have contributed to their reduced rate of coronary artery disease 3. Composition (Age, sex, education, occupation, etc) Ex, A city with a large number of women in their childbearing years will have a set of concerns. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… 4. Rate of growth or decline Ex, populations may experience a decline because of economic change. 5. Cultural characteristics Ex, some cultures may have believes that have adverse affect on its people health. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… 6. Social class structure Social class refers to the ranking of groups within society by income, education, occupation, prestige, or a combination of these factors. Educational level, which is closely associated with social class, is a powerful determinant of health-related behavior. 7. Mobility Ex. fluctuations in the number of migrant farm workers, tourists, or college students can affect a community. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

3. Social System: A social system is an abstract concept and can be more readily understood by first considering the people who make up the community’s population. The patterns and interactions that emerge from these interactions among roles form the basis of organizations.( formal and informal). Social system variables. include the following systems: health, family, economic, educational, religious, welfare, political, recreational, legal, and communication. Although community health nurses must examine all the systems in a community and must understand how they interact. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Community Dynamics The discussion to this point may have suggested that the community is a rigid structure composed of a geographic location, a population, and a social system. Yet every community has a dynamic or changing quality. Three factors in particular affect community dynamics: (1) citizen participation in community health programs (2) the power and decision-making structure (3) collaborative efforts of the community © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

1. Citizen Participation in Community Health Programs
Allender & Spradley 6th Edition 1. Citizen Participation in Community Health Programs In some communities, citizens show little concern about public health issues and rely on health officials to take the entire responsibility. Community health nurses need to promote community education and awareness. One goal of a community nurse when working with families or groups is to encourage people to participate and take responsibility for their own health care. Such a commitment includes responsible involvement in assessing, planning, conducting, and evaluating programs to meet community needs. Community self-care is community health nursing’s goal. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

2. The power and Decision-Making Structure
Allender & Spradley 6th Edition 2. The power and Decision-Making Structure the power and decision-making structure of a community, is a central concern to anyone who wishes to bring about change. The description of the community as a social system may suggest that power and decision- making reside primarily in the political system, but this is not the case. We need to understand that: (1) every community has an identifiable power clique (2) that if you get the members on your side, all of your problems will be solved” © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

3. Collaborative Efforts of the Community
Allender & Spradley 6th Edition 3. Collaborative Efforts of the Community Each person has a different level of power and influence within each of their roles. The community health nurse keeps in mind that each person has many roles within a community and uses this information to enhance collaboration when working toward a community health goal. Community collaboration refers to the ability of the community to work together as a team of citizens professionals and lay people alike to meet an identified need in the community. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

TYPES OF COMMUNITY NEEDS ASSESSMENT
Allender & Spradley 6th Edition TYPES OF COMMUNITY NEEDS ASSESSMENT - Community Needs Assessment is the process of determining the real or perceived needs of a defined community The type of assessment depends on variables such as the needs that exist, the goals to be achieved, and the resources available for carrying out the study. the decision will be facilitated by understanding several different types of community assessment. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

1. Familiarization or Windshield Survey
Allender & Spradley 6th Edition 1. Familiarization or Windshield Survey The most necessary evaluation of a community. Involves studying data already available on a community, and gathering a certain amount of firsthand data, to gain a working knowledge of the community. Is used by nursing students in community assessment courses and by new staff members in community health agencies. Nurses drive (or walk) around the community; find health, social, and governmental services. obtain literature; introduce themselves and explain that they are working in the area; and generally become familiar with the community. Familiarization provides a knowledge of the context in which these aggregates exist and may enable the nurse to connect clients with community resources © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

2. Problem-Oriented Assessment:
Allender & Spradley 6th Edition 2. Problem-Oriented Assessment: Assessment, begins with a single problem and assesses the community in terms of that problem. The problem-oriented assessment is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive. This type of assessment is responsive to a particular need. The data collected will be useful in any kind of planning for a community response to the problem. Example: assessment regarding industry pollution that lead to multi respiratory disease in such community. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

3. Community Subsystem Assessment
Allender & Spradley 6th Edition 3. Community Subsystem Assessment The community health nurse focuses on a single dimension of community life. Can be a useful way for a team to conduct a more thorough community assessment. Example: when community students divide up the ten systems in the community and each group do an assessment of two systems, they could then share their findings to create a more comprehensive picture of the community and its needs. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

4. Comprehensive Assessment
Allender & Spradley 6th Edition 4. Comprehensive Assessment Seeks to discover all relevant community health information. It begins with a review of existing studies and all the data presently available on the community. A survey compiles all the demographic information on the population, such as its size, density, and composition. Key informants are interviewed in every major system—education, health, religious, economic, and others. Comprehensive assessment is an expensive, time-consuming process, a waste of resources and might repeat, in part, other studies. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

5. Community Assets Assessment
Allender & Spradley 6th Edition 5. Community Assets Assessment Focuses on the strengths and capacities of a community rather than its problems. Provides tools with which to conduct a complete functional community assessment and serves as a guide to the community for the nurse. This approach requires that the assessor look for the positive, or see the glass as “half full.” The nurse can then become a partner in community intervention efforts, rather than merely a provider of services. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… Assets assessment has three levels:
(1) specific skills, talents, interests, and experiences of individual community members. (2) local citizen associations and organizations. (3) local institutions. - The key, however, is linking these assets together to enhance the community from within.

Community Assessment Methods
Allender & Spradley 6th Edition Community Assessment Methods Community health needs may be assessed by a variety of methods. Regardless of the assessment method used, data must be collected. Data collection in community health requires the exercise of sound professional judgment, effective communication techniques, and special investigative skills. Four important methods are discussed here: surveys, descriptive epidemiologic studies, community forums or town meetings, and focus groups. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

1. Surveys A survey is an assessment method in which a series of questions is used to collect data for analysis of a specific group or area. Surveys are commonly used to provide a broad range of data that will be helpful when used in conjunction with other sources or if other sources are not available. The nurse may choose to conduct a survey to determine such things as health care use patterns and needs, immunization levels, demographic characteristics, or health beliefs and practices. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Phases of Survey: Example: Survey on Osteoporosis
Allender & Spradley 6th Edition Phases of Survey: Example: Survey on Osteoporosis 1. Planning Phase a. Determine what information is needed and why. b. Determine precise data to be collected. c. Select population to be surveyed. d. Select survey method or instrument to be used. e. Determine sampling size. 2. Data Collection Phase a. Identify and train data collectors. b. Pretest and adjust instrument. c. Supervise actual collection, including plans for nonresponses or refusals. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

cont… 3. Data Analysis and Presentation Phase a. Organize data for tabulation and analysis. b. Apply appropriate statistical methods. c. Determine relationships and significance of analysis. d. Report results, including implications, recommendations, and next steps needed © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

2. Descriptive Epidemiologic Studies
Allender & Spradley 6th Edition 2. Descriptive Epidemiologic Studies A second assessment method is a descriptive epidemiologic study, which examines the amount and distribution of a disease or health condition in a population. Person (Who is affected?) Place (Where does the condition occur?) Time (When do the cases occur?) Example: studying incidence of osteoporosis within menopuse women, and it’s prevalence. . © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… Theoretical Bases of Assessment:
Community assessment varies according to the theoretical framework or philosophical approach through which the nurse views the community. In other words, the community health nurse’s theoretical basis for approaching community assessment influences the purposes for conducting the assessment and the selection of methodology. For example, Neuman’s health care systems model forms the basis for the “community-as-partner” assessment model developed by Anderson and McFarlane (2004).

Cont… In addition to their value in assessing the health status of a population, descriptive epidemiologic studies are useful for suggesting which individuals are at greatest risk and where and when the condition might occur. They are also useful for health planning purposes and for suggesting hypotheses concerning disease etiology © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

3. Community Forums/Town Hall Meetings
Allender & Spradley 6th Edition 3. Community Forums/Town Hall Meetings A qualitative assessment method designed to obtain community opinions. It takes place in the neighborhood of the people involved, perhaps in a school gymnasium or an auditorium. Members come from within the community and represent all segments of the community that are involved with the issue. Example: the people invited to the community forum to discuss issue of building new industry inside the city. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

4. Focus Groups Similar to the community forum in that it is designed to obtain grassroots opinion. But it different in: First, there is only a small group of participants, usually 5 to 15 people Second, The members chosen for the group are homogeneous with respect to specific demographic variables. advantages of focus: efficiency and low cost, organized, capture contingents or interest. Example, a focus group may consist of female community health nurses, young women in their first pregnancy, or retired businessmen. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Sources of Community Data
Allender & Spradley 6th Edition Sources of Community Data Primary Gathered by talking to the people Secondary Records produced by people who know the community well International (Ex. WHO, CDC, USAD) National (Ex. MOH, MOE) Local ( Ex. local organization) © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Data Analysis and Diagnosis
Allender & Spradley 6th Edition Data Analysis and Diagnosis This stage of assessment requires analysis of the information gathered, so that inferences or conclusions may be made about its meaning. Such inferences must be validated to determine their accuracy, after which a nursing diagnosis can be formed. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

The Process of Analysis:
Allender & Spradley 6th Edition The Process of Analysis: First, validation Several validation procedures may be used: (1) data can be rechecked by the community assessment team (2) data can be rechecked by others (3) subjective and objective data can be compared (4) community members can consider the findings and verify them © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Validation Data Then separated into categories such as physical, social, and environmental data. Each category is examined to determine its significance. Some time we may be a need to search for additional information to clarify the meaning of the data. There are computer programs designed to analyze community assessment data. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Interpretation Data: A critical phase of the process. Interpretation, there is an ever-present danger of making inaccurate assumptions and diagnoses. Data collection, data interpretation, and nursing diagnosis are sequential activities, with validation serving as the bridges between them © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Formation of Community Diagnoses
Allender & Spradley 6th Edition Formation of Community Diagnoses Neufeld & Harrison (1994), proposed the use of nursing diagnoses in the community by substituting the term client, family, group, or aggregate for the word patient. Their definition of a nursing diagnosis is the following: - The statement of a [client’s] response which is actually or potentially unhealthful and which nursing intervention can help to change in the direction of health. It should also identify essential factors related to the unhealthful response. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Cont… Neufeld and Harrison built on this work to form a wellness diagnosis by using the phrase healthful response instead of unhealthful response. Their definition of a wellness diagnosis is the following: - The statement of a client’s [community’s] healthful response which nursing intervention can support or strengthen. It should also identify the essential factors related to the healthful response.

Nursing Diagnosis: By substituting the term community for client, family, group, or aggregate, the nursing or wellness diagnosis can be applied to the community as a whole. In community health, nurses do not limit their focus to problems; they consider the community as a total system and look for evidence of all kinds of responses that may influence the community’s level of wellness. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Formation of Community Diagnoses
Allender & Spradley 6th Edition Formation of Community Diagnoses Community nursing diagnoses must also: Include statements that are narrow enough to guide interventions. Have logical linkages between community responses (clause 1) and related factors (clause 2) Use a community response instead of a risk, goal, or need statement Include factors within the domain of community health nursing intervention © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Examples Wellness Community Nursing Diagnosis:
Allender & Spradley 6th Edition Examples Wellness Community Nursing Diagnosis: The senior residents of an assisted living center have the potential for achieving optimal functioning related to (host factors) their expressed interest in exercise, diet, and meaningful activities and to (environment factors) their access to exercise opportunities, nutritional information, and social outlets. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Example on Deficit Community Nursing Diagnosis:
Allender & Spradley 6th Edition Example on Deficit Community Nursing Diagnosis: The Mothers and children in Mogair AL-Sarahan are at risk for health disturbance related to ( environment factors) lake of family planning methods, ( host factors) lake of community awareness. The student’s in AL. Za’atree Village are at risk for traffic injury related to ( host factors) absent of traffic awareness, ( enviroment factors) closeness of school for main street. © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

Competent Community Four important characteristics of a competent or healthy community were outlined by Cottrell (1976) and are still relevant today. A competent community can: 1. Collaborate effectively in identifying community needs and problems. 2. Achieve a working consensus on goals and priorities 3. Agree on ways and means to implement the agreed-upon goals. 4. Collaborate effectively to take the required actions.

Characteristics of a Healthy Community:
Allender & Spradley 6th Edition Characteristics of a Healthy Community: High degree of awareness of being a community Use and conserve resources Participation of sub-groups Prepared to meet crises Problem-solving processes Open channels of communication Resources available to all members Effective ways to settle disputes. Maximum citizen participation Promotes high level of wellness for all members © 2005 by Lippincott Williams & Wilkins All Rights Reserved.

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