Untitled

• Community health nurses work with clients at individual, family, group, subpopulation, population, and community levels.
• Addressing a community-wide group of people as a whole is defined as community as client.

Common Health Indicators

• Common health indicators include those related to birth and death.
• Life expectancy is the number of years a person can expect to live.
• Premature mortality is the years of potential life lost
• Age-specific death rates can include infants and teens
• Cause-specific deaths such as lung or cervical cancer.
• Births to teens are health indicators
• Very low birth weight is a health indicator
• Adequacy of prenatal care is a health indicator
• Social characteristics of parents, such as maternal educational attainment, can be health indicators

Morbidity/Health Status

• Morbiditiy/Health status includes health-related quality of life factors.
• Poor health days impacts health status.
• Self-rated health status impacts health status.
• Obesity impacts health status with body mass index based on self-reported height and weight
• Diabetes, asthma, and other chronic diseases affect health status.

Health Behaviors

• Health behaviors include not smoking
• Participating in regular physical activity
• Maintaining a diet and well nutrition
• Not drinking, or not using drugs

Access to Healthcare

• Healthcare access includes insurance coverage
• Access to regular source of care
• Avoidance of hospitalizations
• Receipt of preventative services

Healthy Communities

• Healthy Cities and Healthy Communities is a movement to help community members bring about positive health changes.
• Interconnectedness between public and private sectors is essential to make community health changes.
• Ways a community collaborates:
• Identifying community needs and problems
• Achieving a consensus on goals and priorities.
• Agreeing on ways and implementing agreed-upon goals.
• Taking action, and collaborating effectively

Dimensions of a Community as a Client

• Community features:
• Location
• Population
• Social system
• Every physical community exists in a specific geographic location.
• The health of a community is affected by its location of health services
• Climate
• Plants and animals
• The humanmade environment
• Assessing a community's health requires information on location-specific variables.

Location Variables

• Community boundaries act as a basis for measuring wellness, illness, and spread of disease.
• Health service use depends on availability and accessibility.
• Injury, death, and destruction may be caused by floods, earthquakes, volcanoes, tornadoes, or hurricanes.
• Extremes of heat and cold affect health and illness, and may tax a community's coping ability.
• Poisonous plants and disease carrying animals can affect community health.
• Human influences on the environment (housing, industry, waste, pollution, etc.) can influence community wellness.

Population

• Total community population examines health dimensions.
• Community Health Nurses understand variables like size, density, composition, rate of growth/decline, cultural traits, social class structure, and mobility.
• The number of people influences the number and size of health institutions.
• Increased density may increase stress and affects health availability.
• Population composition often determines the type of health needs.
• Rapidly growing communities can place excessive health service demands.
• Declining populations can signal a poorly functioning community.
• Health needs and health service utilization varies with culture and health practices.
• Social class impacts health service utilization and cost of public health services.
• Population mobility affects continuity of care and the availability of service.

Social Systems

• The parts of a community’s social system that interact and influence the system are called social system variables.
• Community Health Nurses need to understand the community as a social system.
• The various parts of a community's social system are called social system variables.
• Social system variables include:
• Health, family, economic, educational, religious, welfare, political, recreational, legal and communication systems.
• Social systems such as local government, families, and hospitals, are linked together and influence each other.

Community Needs Assessment

• Types of Community Needs Assessments:
  • Needs Assessment: Collecting and evaluating community health information to discover existing or potential needs.
  • This helps nurses with planning and taking future actions with public health
  • Assessment involves data collection, analysis, and interpretation.
• Community needs assessment determines perceived needs from a defined community.

Types of Community Needs Assessments

• Comprehensive Assessment: -Discovers relevant community health information. begins with existing reviews. -Expensive and seldom done.
• Familiarization Assessment/"Windshield Survey": -Gathers data to gain working knowledge and understanding of the community. -Nurses drive (or walk) around the area to introduce themselves and explain the work being done within the community. -Needed when a nurse works with families, groups, organizations, or populations.
• Problem-oriented assessment: -Assesses the community in terms of single problems that aren't sufficient or comprehensive. -Responsive to specific needs that are useful in any kind of planning for a community response.
• Community subsystem assessment: -Focuses on a single dimension of community life, that is useful for a solid community assessment. -An example of that would be surveying religious organizations to discover their needs around their community. Community Assets Assessment: -Focuses on the strengths and skills of community members to multiply association effectivenesses. -Provides tools to perform a complete functional assessment and acts as a guide for the nurse.

Assessments Methods

• Surveys: A series of questions is used to collect data for analysis of specific areas.
• Descriptive Epidemiologic Study: Examines amount/distribution of disease in a population.
• Community Forums or Town Hall Meetings: A qualitative assessment to obtain community opinions.
• Focus groups: The members are organized by invitation/selection to represent segments, usually 5-15 people involved with an issue, they are homogenous with respect to demographic variables.

Sources of Community Data

• Data sources can be primary or secondary, and they can be from international, national, state, or local sources.
• Primary sources: Talking to community members provide primary data.
• Secondary sources: -People who know the community well. -Records created while people perform their jobs
  • Health statistics, Census Bureau data, reference books, research reports, and community health nurses. -WHO publishes annual activity reports -International statistics can be found online.

Nursing Process

• Applying the nursing process can work on the community as a client.
• The nursing process is a problem solving process that's a management process.
• Characteristics that support the use of the nursing process in community health nursing:
  • Addresses community health problems at every aggregate level with the goals of preventing illness and promoting public health. -Requires situational analysis, decision-making, planning,organization and control of services and outcome evaluation.
• Community assessment parameters include: -Geography, population, environment, industry, education, recreation, religion,communication, transportation, public services, social problems,, disaster programs, health professional organizations, health statistics.
• Steps In a needs assessment Process
  • Identify assessment aggregate
  • Identify required information
  • Select a method of data gathering
  • Develop interview questions/questionnaires/
  • Training data collectors
  • Conducting needs assessment, and analyzing it to develop a plan.

Data Analysis and Diagnosis

• Data analysis and diagnosis includes validation of data and interpretation.

Community Health Diagnosis Format

• Increased risk of (disability, disease, etc.). , among (community or population), related to (etiological statement) as demonstrated in (health indicators).

Evaluating an Implemented Community Health Plan

• Includes measuring or judging effectiveness of goal of outcome attainment
• Types of community health plan evaluations:
  • Formative: focus on process during actual interventions; development of performance standards
  • Summative: focus on the outcomes of interventions; effect; impact