Community as Client: Assessment and Diagnosis PDF - Princess Nourah bint Abdulrahman University

Community as Client: Assessment and Diagnosis Lecture 6 College of Nursing, PNU 1 Learning Objectives Describe the meaning of community as client. Articulate specific considerations of each of the three dimensions of the community as client. Express the meaning an...

Community as Client: Assessment and Diagnosis Lecture 6 College of Nursing, PNU 1 Learning Objectives Describe the meaning of community as client. Articulate specific considerations of each of the three dimensions of the community as client. Express the meaning and significance of community dynamics. Compare and contrast five types of community needs assessment. Discuss community needs assessment methods. Describe four sources of community data. Discuss the significance of formation of community diagnoses. Explain the characteristics of a healthy community. 2 Introduction Community health nurses work with clients at several levels: as individuals, families, groups, subpopulations, populations, and communities. Community as a client refers to the concept of community-wide group of people as the focus of nursing services PROVISION OF MOST HEALTH SERVICES OCCURS AT THE COMMUNITY LEVEL. 3  COMMON HEALTH INDICATORS THE MOST COMMON HEALTH INDICATORS ARE THOSE RELATED TO BIRTH AND DEATH: life expectancy, the term “life expectancy” refers to the number of years a person can expect to live. premature mortality (e.g., years of potential life lost YPLLS) age-specific death rates (e.g., infants, teens) cause specific deaths (e.g., lung, cervical cancer) births to teens very/low birth weight adequacy of prenatal care social characteristics of parents (e.g, maternal educational. attainment). 4 COMMON HEALTH INDICATORS CONT. MORBIDITY/HEALTH STATUS Health-related quality of life: –Poor health days –Self-rated health status Obesity – Body mass index based on self- reported height and weight Diabetes, asthma, and other chronic diseases. 5  COMMON HEALTH INDICATORS CONT. Health behaviours: Not smoking Regular physical activity Diet and well nutrition No drinking, or not using drugs. Access to health care: Insurance coverage Regular source of care Avoidable hospitalizations Receipt of preventive services 6  HEALTHY CITIES AND HEALTHY COMMUNITIES A movement to help community members bring about positive health changes. Interconnectedness between public and private sectors is essential to make changes. 7  WHAT IS A HEALTHY COMMUNITY? 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 8 DIAGRAM OF ASSESSMENT PARAMETERS 9  DIMENSIONS OF THE COMMUNITY AS CLIENT Community as having three features: 1) location, 2) population, and 3) social system.  Location ❑Every physical community carries out its daily existence in a specific geographic location. The health of a community is affected by location of health services, geographic the features, climate, plants, animals, and the humanmade environment. ❑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. Location variables (1) Community boundaries Community boundaries serve as basis for measuring incidence of wellness and illness, and for determining spread of disease. Where is the community located? What is its boundary? Is it a part of a larger community? What smaller communities does it include?  (2) location of health services Use of health services depends on availability and accessibility. Where are the major health institutions located? What necessary health institutions are outside the community? Where are they? (3) geographic features, Injury, death, and destruction may be caused by floods, earthquakes, volcanoes, tornadoes, or hurricanes. What major landforms are in or near the community? What geographic features pose possible threats? (4) climate, Extremes of heat and cold affect health and illness. Extremes of temperature and precipitation may tax community’s coping ability. What are the average temperature and precipitation? What are the extremes? What climatic features affect health and fitness ? Is the community prepared to cope with emergencies? (5)flora and fauna, and Poisonous plants and disease- carrying animals can affect community health Plants and animals offer resources as well as dangers. What plants and animals pose possible threats to health (6) The human-made environment All human influences on environment (housing, dams, farming, type of industry, chemical waste, air pollution, and so forth) can influence levels of community wellness What are the major industries? How have air, land, and water been affected by humans? What is the quality of housing? State health department Do highways allow access to health institutions? II. Population ❑The total population of community is the second dimension to be examines. The health of any community is greatly influenced by the attributes of its population. ❑ A healthy community has leaders who are aware of the population’s characteristics, know its various needs, and respond to those needs. ❑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.  Population variables: (1)Population Size: The number of people influences number and size of health institutions. What is the population of the community? Census data Is it an urban, suburban, rural community? (2) Density Increased density may increase stress High and low density often affect the availability of health services What is the density of the population? (3) Composition Composition of the population often determines types of health needs. What is the age composition of the community? What is the sex composition of the community? What is the marital status of community members? (4) Rate of growth or decline Rapidly growing communities may place excessive demands on health services Marked decline in population may signal a poorly functioning community How has population size changed over the past two decades? What are the health implications of this change? (5) Cultural differences Health needs vary among sub-cultural and ethnic population Utilization of health services varies with culture. Health practices and extent of knowledge are affected by culture. ✓What is the ethnic breakdown of population? ✓What racial groups are represented? ✓What subcultural populations exist in the community? ✓Do any of the subcultural groups have unique health needs and practices? ✓Are different ethnic and cultural groups included in health planning? (6) Social class Class differences influence the utilization of health services Class composition influences cost of public health services. ✓What percentage of the population falls into each social class? ✓What do class differences suggest for health needs and services? (7) Mobility Mobility of the population affects continuity of care. Mobility affects availability of service to highly mobile populations ✓ How frequently do members move into and out of the community? ✓ How frequently do members move within the community? ✓ Are there any specific populations, such as migrant workers, that are highly mobile? ✓ How does the pattern of mobility affect the health of the community? ✓ Is the community organized to meet the health needs of mobile groups? III. Social System ❑The various parts of a community’s social system that interact and influence the system are called social system variables. ❑Whether assessing a community’s health, developing new services for the mentally ill within the community, or promoting the health of the elderly, the community health nurse needs to understand the community as a social system. ❑A community health nurse working in a small village in SA needs to grasp the social system of that village no less than a nurse working in Capital City. Social System variables include: ❑Health system ❑Family system ❑Economic system ❑Educational system ❑Religious system ❑Welfare system ❑Political system ❑Recreational system ❑Legal system ❑Communication system ❑The CHN needs to understand the community as a social system ❑ a social system consist of parts, such as the local government , families and hospitals that are linked together. The parts interact and influence each other ❑ each of the ten major systems of a community includes a number of subsystems that are made up of organizations. Member of the community occupy roles in these organizations  The Health Care Delivery System as Part of the Social System ❑Community health nurses must examine all the systems in a community and must understand how they interact, the health system is of particular importance. ❑Studying the health system in a community can be compared with assessing an individual client. ❑The major function of the health system is to promote the health of the community. Community assessment asks not merely whether, but also how well, the system is functioning. What is the level of health promotion carried out by the health system of a community?  ❑TYPES OF COMMUNITY NEEDS ASSESSMENT ❑The community health nurse is ready to determine the community’s needs. Assessment is the first step of the nursing process. ❑Assessment for nurses means collecting and evaluating information about a community’s health status to discover existing or potential needs as a basis for planning future action  ❑TYPES OF COMMUNITY NEEDS ASSESSMENT ❑Assessment involves two major activities. The first is collection of pertinent data, and the second is analysis and interpretation of data. These actions overlap and are repeated constantly throughout the assessment. While assessing a community’s ability to enhance its health, the nurse may simultaneously collect data on community lifestyle behaviors and interpret previously collected data on morbidity and mortality. 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: 1. the needs that exist, 2. the goals to be achieved, and 3. the resources available for carrying out the study. Although it is difficult to determine the type of assessment needed in advance, the decision will be facilitated by understanding several different types of community assessment (1) 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. ❑Because comprehensive assessment is an expensive, time-consuming process, it is seldom performed. (2) Familiarization or “Windshield Survey” ❑Familiarization assessment involves studying data already available on a community, and probably gathering a certain amount of firsthand data, to gain a working knowledge and general understanding of the community. ❑Such an approach, sometimes called a “windshield survey,” 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; introduce themselves and explain that they are working in the area; and generally become familiar with the community. (2) Familiarization or “Windshield Survey” cont…… ❑This type of assessment is needed whenever the community health nurse works with families, groups, organizations, or populations. ❑Familiarization provides a knowledge of the context in which these aggregates exist and may enable the nurse to connect clients with community resource (3) Problem-oriented assessment: ❑Begins with a single problem and assesses the community in terms of that problem. Assume that when you check around for services available for the deaf child you discover that there are none confronted with this problem, one family with one deaf child, you could make a problem-oriented community assessment. ❑First step would be to discover the incidence of childhood deafness, both in the community and in the state. ❑Second: You might begin interviewing officials its schools health institutions to find out what has been done in the past with such problems (3) Problem-oriented assessment: ❑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. (4) Community Subsystem Assessment ❑CHN focuses on a single dimension of community life ❑It can be a useful way for a team to conduct a more thorough community assessment. They could share their findings and create a more comprehensive picture of community and its needs For example, the nurse might decide to survey religious organizations to discover their roles in the community. What kinds of needs do the leaders in these organizations believe exist? What services do these organizations offer? To what extent are services coordinated within the religious system and between it and other systems in the community? (5) Community Assets Assessment ❑It focuses on the strengths and capacities of a community rather than the problems alone ❑The assets assessment begins with what is present in the community. The capacities and skills of community members are identified, with a focus on creating or rebuilding relationships among local residents, associations, and institutions to multiply power and effectiveness. ❑It provide tools to conduct a complete functional community assessment and serves as a guide to the community for the nurse  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. (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. 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 by person (Who is affected?), by place (Where does the condition occur?), and by time (When do the cases occur?). ❑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. Community Forums or Town Hall Meetings The community forum or town hall meeting is 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. The participants are selected to participate by invitation from the group organizing the forum. Members come from within the community and represent all segments of the community that are involved with the issue. Focus Groups This fourth assessment method, focus groups, is similar to the community forum or town hall meeting in that it is designed to obtain grassroots opinion. However, it has some differences. First, there is only a small group of participants, usually 5 to 15 people. The members chosen for the group are homogeneous with respect to specific demographic variables. For example, a focus group may consist of young women in their first pregnancy SOURCES OF COMMUNITY DATA There are many places the community health nurse can look for data to enhance and complete a community assessment. Data sources can be primary or secondary, and they can be from international, national, state, or local sources. Primary and Secondary Sources Community health nurses make use of many sources in data collection. Community members, including formal leaders, informal leaders, and community inhabitants, can frequently offer the most accurate insights and comprehensive information. Information gathered by talking to people provides primary data, because the data are obtained directly from the community. Secondary sources of data include people who know the community well and the records such people create in the performance of their jobs. Specific examples are health team members, client records, community health.  Primary and Secondary Sources Secondary sources of data include people who know the community well and the records such people create in the performance of their jobs. Specific examples are health team members, client records, community health statistics, Census Bureau data, reference books, research reports, and community health nurses. Because secondary data may not totally describe the community and do not necessarily reflect community self-perceptions, they may need augmentation or further validation International Sources International data are collected by several agencies, including the World Health Organization (WHO) and its regional offices and health organizations, such as the Pan- American Health Organization. In addition, the United Nations and global specialty organizations that focus on certain populations or health problems, such as the United Nations Children’s Fund, are major sources of international health-related data. WHO publishes an annual report of their activity (World Health Organization, 2003), and international statistics for diseases and illness trends can be found on the Internet. National Sources There are official and nonofficial sources of national data that community health nurses can access if needed. Official sources develop documents based on data compiled by the government. NURSING PROCESS 🗸NEEDS ASSESSMENT 🗸DIAGNOSING HEALTH PROBLEMS 🗸PLANNING 🗸INTERVENTION 🗸EVALUATION 50 Characteristics that support the use of the nursing process in community health nursing. The nursing process is a problem-solving process that addresses community health problems at every aggregate level with the goals of preventing illness and promoting public health. It is a management process that requires situational analysis, decision-making, planning, organization, direction and control of services, and outcome evaluation. 51 COMMUNITY ASSESSMENT PARAMETERS Geography Public services Population Political organization Environment Community development or Industry planning Education Disaster programs Recreations Health statistics Religion Social problems Communication Health manpower Transportation Health professional organizations Community services 52  STEPS IN THE NEEDS ASSESSMENT PROCESS Identify aggregate for assessment Identify required information Select method of data gathering Develop questionnaires or interview questions Develop procedures for data collection Train data collectors Arrange for a sample representative of the aggregate Conduct needs assessment Tabulate and analyze data Identify needs suggested by data Develop an action plan 24  SOURCES OF COMMUNITY DATA Primary (primary: gathered by talking to the people) Secondary sources (records produced by people who know the community well) International sources National sources Local sources 54  DATA ANALYSIS AND DIAGNOSIS Validation of data Data interpretation Diagnosis 55  FORMAT FOR COMMUNITY HEALTH DIAGNOSIS 56 PLANNING, INTERVENTION, AND EVALUATION OF HEALTH CARE IN COMMUNITIES 57  PLANNING TO MEET COMMUNITY HEALTH NEEDS; IMPLEMENTING PLANS Tools for assistance: Operational definitions of objectives and activities, conceptual frameworks and models; systematic approach Health planning process Implementing Preparation Activities or actions 58  EVALUATING IMPLEMENTED COMMUNITY HEALTH PLAN Measuring or judging effectiveness of goal or outcome attainment Types of evaluation Formative: focus on process during actual interventions; development of performance standards Summative: focus on the outcomes of interventions; effect; impact 59  QUESTION Is the following statement true or false? A formative evaluation focuses on the outcomes of the interventions. 60  ANSWER FALSE A formative evaluation focuses on the process during the actual interventions. 61