Chapter 7: Community Health Planning, Implementation, and Evaluation

Question 1

Health planning for and with the community is an essential component of community health nursing practice
Health planning varies at the different aggregate levels

Answer 1

Introduction

Question 2

Individual or family
Group level
Community

Answer 2

Health planning varies at the different aggregate levels

Question 3

goal is to focus on direct care needs or self-care responsibilities

Answer 3

Individual or family

Question 4

primary goal may be health education

Answer 4

Group level

Question 5

health planning involves population disease prevention or environmental hazard control

Answer 5

Community –

Question 6

Not new
Lillian Wald’s work exemplified concept with poor immigrants; when focusing on indiv/fam - nurses must remember that these clients member of larger pop group/community; influenced by community and environment around them

Answer 6

The community as client

Question 7

Improve aggregate health and apply the nursing process
Apply to larger aggregate within systems framework
Nursing process steps and listing within boxes what each step does
Assessment - Going through community what dealing with; health and conditions directly impacted by environment and community - true if indiv or if group of indivs - impacted by environment and things going on in community; gathering info
Planning - goals and objectives; work with info have to try to develop what goal/obj might be but work with clients/aggregates to make sure what they think need/want; establishing goals and objectives
Interventions - based on goals and objectives; needs be convo with client/aggregate so on same pg so still follow through
Eval - look over how effective intervention

Answer 7

Health planning model

Question 8

First step in model
First Establish a professional relationship - good communication skills essential to making a good first impression
Then Meet with group leaders to clarify mutual expectations and available meeting times
Do data collection to Determine sociodemographic characteristics: distribution age, sex, race
Gather information from a variety of sources and will interview a key informant(s) (formal/informal leader in community who provides data informed from personal knowledge and experience with community)
Consider both positive and negative factors - working well and not well for community
Complete literature review where Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Then Prioritize the health problems and needs to create an effective plan

Answer 8

Assessment

Question 9

Assess needs of clients and obtain input; interventions not successful unless client has input in determination of need, priority, and appropriateness of intervention
Expressed needs
Normative needs
Perceived needs
Relative needs

Answer 9

4 types of needs to assess

Question 10

Demand for services and the market behavior of the targeted population

Answer 10

Expressed needs

Question 11

Lack, deficit, or inadequacy as determined by expert health professionals

Answer 11

Normative needs

Question 12

Population’s wants and preferences

Answer 12

Perceived needs

Question 13

Gap showing health disparities between the advantaged and disadvantaged populations

Answer 13

Relative needs

Question 14

The aggregate’s preferences
Number of individuals in the aggregate affected by the health problem
Severity of the health need or problem
Availability of potential solutions to the problem
Practical considerations such as individual skills, time limitations, and available resources
Refine the priorities by applying a framework such as Maslow’s hierarchy of needs or Leavell and Clark’s levels of prevention - basic needs have to take priority

Answer 14

Factors when determining priorities include:

Question 15

The nurse is responsible for advocating for client empowerment throughout the health planning model process: assessment, planning, implementation, and evaluation steps of the process; essential component of health planning is to have strong level of community involvement
Successful health programs rely on empowering citizens to make decisions about individual and community health
Empowering citizens causes power to shift from health providers to community members in addressing health priorities

Answer 15

Community involvement is essential

Question 16

Plan interventions for each level of prevention
Determine the intervention levels
Plan interventions for each system level
Validate the practicality of the planned interventions according to available resources
Coordinate the planned interventions with the aggregate’s input to maximize participation

Answer 16

Planning

Question 17

Subsystem, aggregate system, and/or suprasystem

Answer 17

Determine the intervention levels

Question 18

Primary, secondary, or tertiary levels of prevention

Answer 18

Plan interventions for each system level

Question 19

Personal, aggregate, and suprasystem

Answer 19

Validate the practicality of the planned interventions according to available resources

Question 20

Also in planning phase
Develop mutual goals and objectives
Goals - where the nurse wants to be
Objectives - steps needed to get there

Answer 20

Development of goals and obj

Question 21

Measurable objectives are the specific measures used to determine whether the nurse is successful in achieving the goal
Objectives are instructions about what the nurse wants the population to be able to do – use verbs and include specific conditions (how well or how many)
Used to measure outcome – describes observable behavior rather than knowledge
May also be referred to as behavioral objectives or outcomes

Answer 21

Objectives - steps needed to get there

Question 22

Often the most enjoyable stage for the nurse and the clients
Implementation should follow the initial plan
Prepare for unexpected problems
If the intervention is not able to be completed, analyze the reasons for failure
Should include a range of strategies

Answer 22

Interventions

Question 23

Imp component for determining success/failure of a project and understanding the factors that contributed to its success/failure
Include the participant’s verbal or written feedback and the nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s strengths and weaknesses (process or formative)
Reflect on whether or not the desired outcomes were achieved (product or summative)
Communicate follow-up recommendations

Answer 23

Evaluation

Question 24

Each step of nursing process imp in health planning projects
Project failure often from probs in 1+ steps of nursing process; have people cont on in absence
Aggregate assessments must be thorough
The nurse must complete careful planning and set goals that the nurse and the aggregate accept
Interventions must include aggregate participation and must meet the mutual goals
Evaluation must include process and product evaluation and aggregate input

Answer 24

Importance of each step in the nursing process

Question 25

Should elicit answers to key questions about the aggregate’s health and demographic profile
Should compare this information with similar aggregates presented in the literature

Answer 25

Aggregate assessments must be thorough

Question 26

Mutual planning is very important

Answer 26

The nurse must complete careful planning and set goals that the nurse and the aggregate accept

Question 27

Passed health planning efforts
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources Development Act of 1974 combine strengths of others listed above and forged new sys of single state and area wide health planning agencies; goals: increase accessibility, continuity, quality, control costs and prevent duplication, addressed needs of underserved; legislation failed to affect major change and costs cont to rise

Answer 27

Health planning federal legislation

Question 28

Health legislation sig influenced by politics and admin in power; no universal care
Comprehensive health reform
National health insurance program
Object: Reduced premium costs for people and fed covt through Medicare
Capped out-of-pocket expenses - seemed great initially; good for lot people; no life-time limits
Required preventative care to be fully covered without any out-of-pocket expense - well-visits, vaccinations covered 100%; preventative testing is covered
Coverage of an adult child up to age of 26 required most indivs to have insurance or have penalty: Initially coverage for 26 yrs; covers them until 26 years so can cover themselves - mandate gone
Insurance cannot drop policyholder if get ill
Set clear rules for insurance companies
Prohibited insurance companies from denying coverage because of a person’s preexisting medical conditions - charge lot more money or decline cover if have preexisting med conditions
Put some protections in place and kept people of US in line rather than companies
Impacts what insurance covers today

Answer 28

Affordable care act (ACA) of 2010

Question 29

Health planning always impacted nurses and prac
Follow healthcare legislation at state and national level; be informed voter; contact state/Senate representatives when need; participate in events; look upstream
Must work collaboratively with health planners to improve aggregate health
Can influence health planning by fusing technology with their knowledge of health care needs and skills
May become directly involved in the planning process
Engage in aggregate-level projects and by tracking health care legislation and contacting their legislators about important issues

Answer 29

Nursing implications