Community Assessment

Question 1

Nursing/Care Management Process in Community

Answer 1

Assessment – Data Collection
Diagnosis – Identifying Strengths and Problems
Planning – Program Development
Implementation
Evaluation – Program Outcomes
•The community is the client

Question 2

Assessment (Data Collection) is the _______ step in the Nursing Process/Care Management Process.

Answer 2

FIRST!
Just as you assess your individual patients before you intervene, we assess a community before we plan community programming.

Question 3

Community Assessment

Answer 3

• Process of data collection about a community
• Describes the health of the community
• Guides nursing diagnoses
• Becomes the basis for program planning and development
• Remember Assessment is one of the Core Functions of PH

We do assessment in the community for the exact same reasons we do assessment with individual clients.

Question 4

Types of Community Health Assessments

Answer 4

Comprehensive Assessment
Population-focused
Setting-specific
Problem-based or Health-issue based
Health Impact Assessment
Rapid Needs Assessment

Question 5

Comprehensive Assessment

Answer 5

Collection of data about populations living in a community

• Look at assets, unmet needs, and opportunities for improvement
• Use of community statistics: Health status, Health needs, Epidemiological studies
• Mandate for conducting comprehensive assessments
• IOM directed 1988
• Affordable Care Act: Nonprofit hospitals must conduct community health assessments

Question 6

Population-focused

Answer 6

Considers a larger group or aggregate – remember, members may or may not interact with one another, but they shares at least one similar characteristic/issue

• Can focus on a specific age group, gender, or health issue (Community Assessment for Homeless in Charlotte)

Question 7

Setting-specific

Answer 7

must have clear understanding of purpose

• Considers: strengths/weaknesses of: An organization, policies/procedures, programs.
• Identify indicators specific to setting
• Treats the setting as the community
• People within a specific setting
• Data specific to the setting

Question 8

Problem-Based or Health-Issue Based

Answer 8

Focus on specific problem or health issue, analysis of data determines who is at risk

• Promote understanding of: Policies, practices, and the environment
• Determines who is at risk? (Obesity)

Question 9

Health Impact Assessment

Answer 9

Provides advice to community on optimizing its health by identifying the:
• Potential effects on the health of a population and the distribution of those effects within the population.
• Combination of policies and methods used to judge programs/projects
• Associated with: the environment and social influences on populations

Question 10

Rapid Needs Assessment

Answer 10

Measures present and potential public health impact of an emergency
• Effective use of limited resources
• Comprised of: Existing information, visual inspection, interviewing key people, rapid surveys (Haiti following earthquake)

Question 11

Kinds of data

Answer 11

Quantitative
Qualitative

Question 12

Quantitative data examples

Answer 12

• Census figures
• Local agencies
• Community surveys
• Observations

Question 13

Qualitative data examples

Answer 13

• Community surveys
• Key informant interviews
• Resident interviews
• Observation

Question 14

Refresher: what are the determinants of health?

Answer 14

Biology and genetics
Personal behavior/Lifestyle
Health services
Policymaking
Social factors

Question 15

Refresher: what are the SOCIAL determinants of health?

Answer 15

Education access and quality
Healthcare access and quality
Economic stability
Neighborhood and build environment
Social and community context

Question 16

Remember, that the data (to use for PH) that we want is _______ scope.

Answer 16

BROAD
We are going to consider all of the DETERMINANTS OF HEALTH.

Question 17

So, we not only want to consider the ________ health status of a community – the rate of heart disease in the population. We must also consider the determinants of health in the community – considering heart disease again, we need to consider the number of fast food outlets or the rate of smoking. What other factors would we want to assess?

Answer 17

Physical

Availability to healthy food options in the area
Education on healthy eating/heart disease prevention
Access to preventable HC for those at risk

Question 18

Data Collection Methods

Answer 18

Use existing data when possible
• Public information (US census, CDC, local health department)
• Other existing data (hospital statistics, other local agencies)
Gather new data as necessary
• Windshield survey
• Informant interviews
• Participant observation
• Surveys
• Focus groups

What data do we have? What data do we need? How can we get the data we need?

Question 19

10 things to know about Health

Answer 19

1. Health is more than HC
2. Health is tied to the distribution of resources
3. Racism imposes an added health burden
4. The choices we make are shaped by the choices we have
5. High demand + Low control = Chronic Stress
6. Chronic Stress can be TOXIC
7. Inequality - economic and political - is bad for our health
8. Social policy IS Health policy
9. Health inequalities are NOT nature
10. We ALL pay the price for poor health

Question 20

10 things to know about Health - Health is more than health care.

Answer 20

Doctors treat us when we’re ill, but what makes us healthy or sick in the first place? Research shows that social conditions – the jobs we do, the money we’re paid, the schools we attend, the neighborhoods we live in – are as important to our health as our genes, our behaviors and even our medical care.

Question 21

10 things to know about Health - Health is tied to the distribution of resources.

Answer 21

The single strongest predictor of our health is our position on the class pyramid. Whether measured by income, schooling, or occupation, those at the top have the most power and resources and on average live longer and healthier lives. Those at the bottom are most disempowered and get sicker and die younger. The rest of us fall somewhere in between. On average, people in the middle are almost twice as likely to die an early death compared to those at the top; those on the bottom, four times as likely. Even among people who smoke, poor smokers have a greater risk of dying than rich smokers.

Question 22

10 things to know about Health - Racism imposes an added health burden.

Answer 22

Past and present discrimination in housing, jobs and education means that today people of color are more likely to be lower on the class ladder. But even at the same rung, African Americans typically have worse health and die sooner than their white counterparts. In many cases, so do other populations of color. Segregation, social exclusion, encounters with prejudice, the degree of hope and optimism people have, differential access and treatment by the health care system – all of these can impact health.

Question 23

10 things to know about Health - The choices we make are shaped by the choices we have.

Answer 23

Individual behaviors – smoking, diet, drinking, and exercise – matter for health. But making healthy choices isn’t just about self- discipline. Some neighborhoods have easy access to fresh, affordable produce; others have only fast food joints and liquor and convenience stores. Some have nice homes; clean parks; safe places to walk, jog, bike or play; and well-financed schools offering gym, art, music and after-school programs; and some don’t. What government and corporate practices can better ensure healthy spaces and places for everyone?

Question 24

10 things to know about Health - High demand + low control = chronic stress.

Answer 24

It’s not CEOs who are dying of heart attacks, it’s their subordinates. People at the top certainly face pressure but they are more likely to have the power and resources to manage those pressures. The lower in the pecking order we are, the greater our exposure to forces that can upset our lives – insecure and low-paying jobs, uncontrolled debt, capricious supervisors, unreliable transportation, poor childcare, no healthcare, noisy and violent living conditions – and the less access we have to the money, power, knowledge and social connections that can help us cope and gain control over those forces.

Question 25

10 things to know about Health - Chronic stress can be toxic.

Answer 25

Exposure to fear and uncertainty triggers a stress response. Our bodies go on alert: the heart beats faster, blood pressure rises, glucose floods the bloodstream – all so we can hit harder or run faster until the threat passes. But when threats are constant and unrelenting our physiological systems don’t return to normal. Like gunning the engine of a car, this constant state of arousal, even if low-level, wears us down over time, increasing our risk for disease.

Question 26

10 things to know about Health - Inequality – economic and political – is bad for our health.

Answer 26

The United States has by far the most inequality in the industrialized world – and the worst health. The top 1% now owns as much wealth as the bottom 90%. Tax breaks for the rich, deregulation, the decline of unions, racism and segregation, outsourcing and globalization, and cuts in social programs destabilize communities and channel wealth and power – and health – to the few at the expense of the many. Economic inequality in the U.S. is now greater than at any time since the 1920s.

Question 27

10 things to know about Health - Social policy is health policy.

Answer 27

Average life expectancy in the U.S. improved by 30 years during the 20th century. Researchers attribute much of that increase not to drugs or medical technologies but to social changes – for example, improved wage and work standards, universal schooling, improved sanitation and housing and civil rights laws. Social measures like living wage jobs, paid sick and family leave, guaranteed vacations, universal preschool and access to college, and universal health care can further extend our lives by improving our lives. These are as much health issues as diet, smoking and exercise.

Question 28

10 things to know about Health - Health inequalities are not natural.

Answer 28

Health differences that arise from our racial and class inequities result from decisions we as a society have made – and can make differently. Other rich nations already have, in two important ways: they make sure inequality is less (e.g., Sweden’s relative child poverty rate after transfers is 4%, compared to our 22%), and they try to ensure that everyone has access to health promoting resources regardless of their personal wealth (e.g., good schools and health care are available to everyone, not just the affluent). They live healthier, longer lives than we do.

Question 29

10 things to know about Health - We all pay the price for poor health.

Answer 29

It’s not only the poor but also the middle classes whose health is suffering. We already spend $2 trillion a year to patch up our bodies, more than twice per person than the average rich country spends, and our health care system is strained to the breaking point. Yet our life expectancy is 29th in the world, infant mortality 30th, and lost productivity due to illness costs businesses more than $1 trillion a year. As a society, we face a choice: invest in the conditions that can improve health today, or pay to repair the bodies tomorrow.