The Community as a Client: Assessment and Diagnosis

1. The Community asa Client: Assessment andDiagnosis

2. Community health nurses work with clients at severallevels: • as individuals, • families, • groups, • subpopulations, • populations, • and communities.

3. First, the community directlyinfluences thehealth of individuals, families, groups,subpopulations,and populations who are a partof it • Second, provision of most health services occurs at the communitylevel. Community agencies helpdevelop specifichealth programsand disseminate health information to manytypes of groups and populations

4. Myths Perpetuated by anIndividualistic Focus • Location Myth • Skills Myth • Client Myth

5. a community • (1)a location, • (2) a population, and • (3) a social system • (Lynd,1939)

6. Community Profile Inventory: Location Perspective • Community Boundaries • Location of Health Services • Geographic Features • Climate • Flora and Fauna • Human-Made Environment • Population

7. Community Profile Inventory: Population Perspective • Size • Density • Composition • Rate of Growth or Decline • Cultural Characteristics • Social Class and Educational Level • Mobility

8. Community Profile Inventory: Social System Perspective • Health system • Family system • Economic system • Educational system • Religious system • Welfare system • Political system • Recreational system • Legal system • Communication system

10. Three factors in particular affect community dynamics: • (1) citizen participation in community health programs, • (2) the power and decision-making structure, and • (3)collaborative efforts of the community (Lynd, 1939).

12. TYPES OF COMMUNITY NEEDSASSESSMENT • Familiarization or “WindshieldSurvey” (involves studying data already available on a community, and gathering a certain amount of firsthand data, to gain a working knowledge of the community) • Problem-Oriented Assessment • Community Subsystem Assessment • Comprehensive Assessment • Community Assets Assessment (which focuses on the strengths and capacities of a community rather than its problems)

13. Community Assets Assessment • (1) specific skills,talents, interests, andexperiences of individual communitymembers; • (2) local citizen associations andorganizations;and • (3) local institutions

14. COMMUNITY ASSESSMENTMETHODS

15. Surveys 1. Planning Phase a. Determine what information is needed and why. b. Determine precise data to be collected. c. Select population to be surveyed (eg, individuals, ahousehold, a city block). d. Select survey method or instrument to be used (eg, interviews,telephone calls, questionnaires). e. Determine sampling size (eg, a percentage of the totalpopulation in question). 2. Data Collection Phase a. Identify and train data collectors (eg, interviewers). b. Pretest and adjust instrument. c. Supervise actual collection, including plans for nonresponsesor refusals. 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; provide feedback to thepopulation surveyed through a community forum (discussedlater).

16. Descriptive Epidemiologic Studies • examines the amount and distribution ofa disease or health condition in a population • byperson(Who is affected?), • by place (Where does the condition occur?), • and by time (When do the cases occur?)

17. Community Forums or Town HallMeetings • is a qualitativeassessment method designed to obtain community opinions

18. Focus Groups • First, there is only a small group of articipants,usually 5 to 15 people • Usually the group meets for 1 to 3 hours, and there maybe a series of meetings. • Major advantages of focus groups are their efficiency andlow cost, similar to thecommunity forum or town hall meetingformat.

19. SOURCES OF COMMUNITY DATA • Primary and Secondary Sources • International Sources • National Sources • State Sources • Local Sources

20. DATA ANALYSIS AND DIAGNOSIS

21. The Process of Analysis • (1) data can be recheckedby the community assessment team, • (2) data can be recheckedby others, • (3) subjective and objective data can be compared,or • (4) community members can consider the findings and verifythem.

22. Community Diagnosis Formation

23. WHAT IS A HEALTHYCOMMUNITY? • 1. Collaborate effectively in identifying community needsand problems • 2. Achieve a working consensus on goals and priorities • 3. Agree on ways and means to implement the agreed-upongoals • 4. Collaborate effectively to take the required actions

24. Planning, Intervention, andEvaluation of Health Care inCommunities

25. Three characteristics support the use of the nursingprocess in community health nursing. • the nursingprocess is a problem-solvingprocess that addresses communityhealthproblems at every aggregate level with thegoalsof preventing illness and promotingpublic health. • Itis a management process that requires situationalanalysis,decision-making,planning, organization, direction and controlof services, and outcome evaluation • it is a process for implementing changes that improvethe function of various health-related systems and thewaysthat people behave within those systems.

26. Interacting With the Community • Need for Communication

27. Forming Partnerships and BuildingCoalitions • Partnerships are agreements between people (and agencies)that support a joint purpose. • A coalition is an alliance of individuals or groups thatwork together to influenceoutcomes of a specific problem(Green, Daniel, & Novick, 2001)

30. Types of Evaluations • Structure-Process Evaluation • Outcomes Evaluation

33. The end Thank you !