Chapter 3, Exam 2 Part 1 Flashcards
What is an ecological model?
an ecological model for population health can reused as guide to examine the determinants of health for a population, and for targeting interventions to multiple factors that affect health.
Components of ecological model
- individual traits (age, gender, biological, mental, and behavioral factors)
- social, family, and community relationships
- occupational and home environments
- overall conditions created by local, state, national, and worldwide forces and trends
What is community assessment
- it is a comprehensive approach that emphasizes the community as a client, with the goal of providing benefit to the people of the area as a whole, rather than to individuals
- community assessment and diagnosis are the foundation for community-specific program planning
Community Health Nurse Roles
Community Health Nurse is a key player in assessing the needs of the community
- interacting and establishing contracts with community partners serving the community at large
- witnessing the interaction between community programs and the response of the client to the services
- identifying future services based upon the visible needs of community members and population groups
Factors to consider when determining the health of a community
status, structure, process
Factors to consider when determining the health of a community: Status
epidemiological data, client satisfaction, mental health, crime rates
Factors to consider when determining the health of a community: Structure
presence of health care facilities, service types and patterns of use, demographic data
Factors to consider when determining the health of a community: Process
relationships, communication, commitment to and participation in health
Community Assessment Components
People, place or environment, social systems
Community Assessment Components: People
- demographic: distribution, mobility, density, census data
- biological factors: health and disease status, genetics, race, age, gender, causes of death
- social factors: occupation, activities, marital status, education, income, crime rates, recreation, industry
- cultural factors: ethnohistory, hierarchy and roles, language, religion, and spirituality, values, customs, norms
Community Assessment Components: Place or environment
- physical factors: geography, terrain, type of community, location of health services, housing, animal control
- environmental factors: geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants
Community Assessment Components: Social Systems
- health systems
- economic systems/factors
- education systems
- religious systems
- welfare systems
- political systems
- recreation systems/factors
- legal systems
- communication systems/factors
- transportation systems
- resources and services
What is data collection?
data collection is critical community health nursing function. To best identify the health needs of the local community, it is essential to combine several methods of data collection. Relying on only one or two key pieces can result in an incomplete assessment.
Informant interviews
direct discussion with community members for the purpose of obtaining ideas and opinions from key informants
Informant interview strengths
- minimal cost
- participants serving as future supporters
- offers insight into beliefs and attitudes of community members
- reading/writing of participants not required
- personal interaction can elicit more detailed responses
Informant interview limitations
- built in bias
- meeting time and place
Community forum
open public meeting
Community forum strengths
opportunity for community input and minimal costs
Community forum limitations
- difficulty finding a convenient time and place
- potential to drift from the issue
- challenging to get adequate participation
- possibility that a less vocal person can be reluctant to speak
What is secondary data?
- use of existing data (death, birth stats, census data, mortality, morbidity data, health records, minutes from meetings, prior health surveys) to assess problem
- the nurse must evaluate the reliability of secondary data obtained from the Web. Generally, websites with .edu, .org, and .gov URLs present reliable information
Secondary data strengths
- database of prior concerns/needs of population
- ability to trend health issues over time
Secondary data limitations
- possibility that data might not represent current situation
- can be time consuming
Participant observation
observation of formal or informal community activities
Participant observation Strengths
indication of community priorities, environmental profile, and identification of power structures
Participant observation limitations
- bias
- time-consuming
- inability to ask questions of participants
Focus groups
directed talk with a representative sample
Focus groups strengths
- possibility of participants being potential supporters
- provides insight into community support
- reading/writing of participants not required
Focus groups limitations
- possible discussion of irrelevant issues
- challenging to get participants
- requires strong facilitator
- difficult to ensure that sample is truly representative of the overall community
- time-consuming to transcribe discussion
Surveys
specific questions asked in written format
Surveys strengths
- data collected on client population and problems
- random sampling
- available as written or online format
- contact with participants not required
Survey limitations
- low response rate
- expensive
- time-consuming
- possibility of collection of superficial data
- requires reading/writing abilities of participants
Windshield survey
descriptive approach that assesses several community components by driving through a community
Windshield survey strengths
provides a descriptive overview of a community
Windshield survey limitations
- need for a driver so the nurse can visualize and document the community elements
- can be time consuming
- results based only on visualization and does not include input from community members
Windshield survey general components
people, place, housing, social systems
Data collection general types
informant interviews, community forum, secondary data, participant observation, focus groups, surveys, windshield survey
Analysis of community assessment data
-The community health nurse plays an active role in assessment, data interpretation, and problem identification.
Steps in analysis of community assessment data
- gathering collected data into a composite database
- assessing completeness of data
- identifying and generating missing data
- synthesizing data and identifying themes
- identifying community needs and problems
- identifying community strengths and resources
-problem analysis is completed for each identified problem. frequently, work groups are formed to examine individual problems and develop solutions.
Community Health Diagnoses
- problems identified by community assessments are often stated as community health diagnoses
- community nursing diagnoses incorporate information from he community assessment, general nursing knowledge, and epidemiological concepts (esp. the concept of risk in a population)
- community nursing diagnoses often are written in the following format….
RISK OF [specific problem or risk in the community] AMONG [the specific population that is affected by the problem or risk] RELATED TO [strengths and weaknesses in the community that influence the problem or risk]
Community Health Program Planning, Development, and management
nurses should consider literacy needs when developing interventions. An individual’s ability to understand basic health information and make decisions, or health literacy, can affect the ability or desire to take action
Community Health Program Planning, Development, and management: Preplanning
brainstorm ideas
- gain entry into community and establish trust
- obtain community awareness, support, and involvement
- coordinate collaborations that have similar interests in addressing identified problems
Community Health Program Planning, Development, and management: Assessment
Collect data about the community and its members
- complete a needs assessment and identify community strengths and weaknesses
- assess the availability of community resources
- list potential sources for program funding (charitable giving, fund-raising, grants)
- evaluate secondary health data
Community Health Program Planning, Development, and management: Diagnosis
Identify and prioritize health needs of the community
- analyze data to determine health needs
- work with community members, local health professionals and administrators to develop priorities and establish outcomes
- in setting priorities among identified community problems, consider the following…
1) community awareness of the problem
2) community readiness to acknowledge and address the problem
3) available expertise/fiscal resources
4) severity of the problem
5) amount of time needed for problem resolution
Community Health Program Planning, Development, and management: Planning
Develop interventions to meet identified outcomes
- determine possible solutions to meet the health need
- compare the resources and interventions required for each solution, and select the best option
- establish goals and objectives for the selected solution
- objectives are behaviorally stated, measurable, and include a target data for achievement
- select strategies/interventions to meet the objectives
- plan a logical sequence for interventions by establishing a timetable
- identify who will assume responsibility for each intervention
- determine available and needed resources to implement interventions
- assess the personnel needed and any special training required for screening or providing education
- determine funding opportunities for needed interventions and develop a budget
- plan for program evaluation
Community Health Program Planning, Development, and management: Implementation
Carry out the plan
- initiate the interventions to achieve goals and objectives according to program plan
- monitor the intervention process and the response of the community in terms of values, needs, and perceptions
Community Health Program Planning, Development, and management: Evaluation
Examine the success of the interventions
- evaluate strengths and weaknesses of the program
- determine achievement of desired outcomes
- examine the adequacy, efficiency, appropriateness, and cost benefit of the program
- recommend and implement modifications to better meet the needs of the community
- share findings and recommendations with community members and stakeholders
- ongoing evaluation is necessary in order to ensure program success (sustainability) and meet the changing needs of the community
Community Health Program Planning, Development, and management Steps
preplanning, assessment, diagnosis, planning, implementation, evaluation
Community Health Program Planning, Development, and management: Strategies and Barriers: Helpful Strategies
- thorough assessment
- accurate interpretation of data
- collaboration with community partners
- effective outreach and communication patterns
- sufficient resources
- logical planning
- skilled leadership
Community Health Program Planning, Development, and management: Strategies and Barriers: Barriers
- inadequate assessment
- inadequate or misconstrued data
- no involvement with community partners
- impaired communication
- inadequate resources
- lack of planning
- poor leadership
Windshield survey components: people
- Who is on the street?
- What is their general appearance (age, dress, well-nourished, obese, frail, unkempt)?
- What are they doing?
- What is the origin, ethnicity, or race of the people?
- How are the different groups (subgroups) residentially located?
- Is there any evidence of substance use, violence, disease, mental illness?
- Are there any animals or pets in the community?
Windshield survey components: Place general
boundaries, location of health services, natural environment, man-made environment
Windshield survey components: Place: boundaries
- Where is the community located?
- What are its boundaries?
- Are there natural boundaries?
- Are there man-made boundaries?
Windshield survey components: Place: Location of health services
- Where are the major health facilities located?
- What health care facilities are necessary for the community but are not within the community?
Windshield survey components: Place: Natural environment
- Are there geographic features that can harm the community?
- Are there plants or animals that could harm or threaten the health of the community?
Windshield survey components: Place: Man-made environment
- What industries are within the communities?
- Could the environment or industry pose a threat to the health of community workers or the community itself?
- Is there easy access to health care facilities?
- Are the roads adequate and marked well?
- What types of employment exist? Manufacturing? Retail? Small business? Military installation?
- Are there grocery stores which provide fresh produce, or is this a “food desert”?
- Where is garbage disposed? Is there evidence of trash, abandoned cars or houses?
Windshield survey components: Housing
- Is the housing of acceptable quality?
- How old are the homes?
- Are there single or multifamily dwellings?
- Is the housing in good repair or disrepair?
- Is there vacant housing?
Windshield survey components: Social Systems
- Are there social services, clinics, hospitals, dentists, and health care providers available within the community?
- Are there ample schools within the community? Are they in good repair or disrepair?
- Are there parks or areas for recreation?
- What places of worship are within the community?
- What services are provided by local religious groups, schools, community centers, and activity or recreation centers?
- Is there public transportation?
- What grocery stores or other stores are within the community?
- Is public protection evident (police, fire, emergency medical services, animal control)?
