Wk 9- Community Development, Advocacy, Ethics, Assessment, Planning, Implementation, Analysis Flashcards
1
Q
Community (WHO, 1998).
A
A specific group of people often living in a defined geographic; area, who share common culture, values, and norms and are arranged in a social structure according to relationships which the community has developed over a period of time (WHO ‘98)
2
Q
3 Dimensions of community.
A
PEOPLE (defined by age, sex, SES, edu., occupation, etc), PLACE (geography and time), FUNCTION (aims and activities of the community or people in it)
3
Q
Function of Community.
A
- space, infrastructure for housing, schools, social services etc.
- employment, income, economics
- security
- participation, socialization
- linkage with other community systems
4
Q
Community function is demonstrated in what diagram?
A
community assessment wheel
5
Q
Healthy community.
A
A healthy community is one where people, organizations and local institutions work together to improve the social, economic and environmental conditions that make people healthy – the determinants of health
- continually creates and IMPROVES its physical and social ENVIRONMENTS
- EXPANDS the community RESOURCES
- mutually SUPPORTIVE for max. potential
6
Q
Community Development.
A
- community identifies concerns
- build capacity for change
- engaging community in work to improve the health of the community
- work with ppl, mobilize resources, develop plan to address problem that has been collectively identified
7
Q
A healthy community is one where people, organizations and local institutions work together to improve the social, economic and environmental conditions that make people healthy – the determinants of health
A
- individual activity involvement
2. collective activity involvement
8
Q
Community development results in…
A
- individual capacity building
- collective capacity building
- Improved health status of the community or target pop
9
Q
Factors that facilitate community development.
A
Community Mapping
10
Q
Community Mapping.
A
taking inventory of (MAPPING ASSETS) assets in a particular community
- these represent COMMUNITY CAPACITY
- Always BEGIN WITH STRENGTHS
11
Q
Community capacity building.
A
- identify and work with community strengths to PROMOTE POSITIVE VIEW of COMMUNITY
- STRENGTHEN community
- form STRONG FOUNDATION of support through PARTNERSHIP and COLLABORATION
12
Q
Empowerment.
A
- DISCOVERING own STRENGTHS
- able to STATE their HELATH REQUIREMENTS and be involved in and TAKE CHARGE of the strategies necessary to achieve IMPROVED HEALHT
- ACTIVE INVOLVEMENT PROCESS
- move toward increased individual and community CONTROL, improved QOL and SOCIAL JUSTICE
- involves participation, choice, support, negotiation and advocacy
- Results from COLLECTIVE AND INDIVIDUAL ACTION to influence and manage the effects of the DoH
13
Q
How does CHN empower communities?
A
inclusion and engagements strategies
14
Q
Inclusion and engagement strategies by CHN to Empower communities.
A
- process involving CITIZENS at various levels of PARTICIPATION based on INTERPERSONAL COMMUNICATION and TRUST and COMMON UNDERSTANDING and PURPOSE
- experience a SENSE OF BELONGING through involvement and feeling comfortable ACTIVELY PARTICIPATING in decisions which AFFECT HEALTH
15
Q
How we develop a sense inclusion and engagement…
A
- involvement in social networks and supports
- assisting in forming groups/private/public sector participation to identify to tackle health priorities (COALITION BUILDING and ADVOCACY)
- Joining a community organization to take action on a community issue
- engaging in advocacy for change
- engaging in political action
16
Q
Sustainability.
A
- maintenance and continuation of established community programs
- intent of sustainable is to heave the capacity to continue addressing the problem and to evolve strategies to math how the problem is changing
17
Q
Examples of sustainability.
A
Sustainability at the policy level occurs when a policy is established and enforcement strategies are used
Establishment of a recreational space and strategies developed to continue managing it on the financial and operational level
18
Q
Advocacy.
A
“Advocacy means acting on behalf of another person, speaking for person who cannot speak for themselves, or intervening to ensure that views are heard” (P&P)
19
Q
Health Advocacy.
A
“the processes by which the actions of individuals or groups attempt to bring about social and /or organizational change on behalf of a particular health goal, program, interest or pop.”
20
Q
Community Advocacy.
A
the process of TAKING ACTION, MOBILIZING COMMUNITIES to raise AWARENESS, CHANGE OPINIONS and INFLUENCE DECISIONS that affect them (Vollman, 2012)
The application of information and resources to effect systemic change that shapes the way people live in community (Christoffel, 2000)
21
Q
CNA advices all nurses advocate for clients by…
A
- PROTECTING THE CLIENTS RIGHT TO CHOICE BY PROVIDING INFORMATION
(protecting the right to dignity and minimizing suffering, promote health and social conditions) - OBTAINING INFORMED CONSENT FOR ALL NURSING CARE (protect p&c, follow policy)
- RESPECT CLIENTS DECISIONS (Advocating for the client’s expressed or written wishes, nurse as a communication bridge btw health team and pt)
22
Q
CHNC state main role of CHN is to ___
A
ADVOCATE for changes in the community and for individuals or groups in order to promote health and well being
23
Q
CHNs need to…
A
- use SUPPORTIVE and EMPOWERING strategies to move individuals and communities toward max. AUTONOMY
- support clients to develop SKILSS necessary TO ADVOCATE for themselves
- need to SUPPORT communities efforts to CHANGE POLICIES to improve HEALTH
24
Q
Community Advocacy consists of organized efforts and actions to:
A
- HIGHLIGHT CRITICAL ISSUES that have been ignored and submerged
- INFLUENCE PUBLIC ATTITUDES and decision makers in communities and government
- Support and implement LAWS and PUBLIC POLICY that PROMOTE HEALTH
25
Goal of advocacy.
improve community health as defined by the members of the community rather than as defined by the professional
26
Advocacy requires...
- strong AWARENESS of the CONTEXT
- UNDERSTAND the INFLUENCE of the POWER AND POLITICS
- Development of PARTNERSHIPS between CHNs, other professionals and community members to ENHANCE COMMUNITY SELF DETERMINATION
27
What do you need to change before you can empower?
attitudes and behaviours
28
Empower through...
advocacy, social planning, social action and consciousness raising
29
Empowerment is demonstrated by...
Individuals, groups, communities are able to STATE their HEALTH REQUIREMENTS and be INVOLVED in and take charge of the STRATEGIES necessary to IMPROVE HEALTH
30
What 3 things influence one another and summarize advocacy and empowerment
advocacy, empowerment, quality of health in the community
31
Barriers to advocacy.
- Person does not see himself as an activist
- Process takes too long, don’t have the time
- Too challenging to change peoples ideas, attitudes
- Feel there is a lack of knowledge of how to do advocacy work, do not know where to begin
- Feel it will not make a difference
- May impact their job
32
How do CHNs advocate.
1. ASSIT AND INVOLVE THE COMMUNITY TO PROBLEM SOLVE
(Engage the community)
2. COMMUNICATE/DISSEMINATE THE ISSUE (community participates)
3. INCORPORATE POLITICAL STRATEGIES
33
Benefits of advocacy.
Advocacy in nursing adds a level of humanity when dealing with the client.
Advocacy raises the voice of the person who cannot speak for themselves and ensures their views are heard
Advocacy benefits the client by protecting their right to choice and making an informed decision.
Protects client’s right to dignity by advocating for good health and social conditions so that a person can live and die with dignity.
34
Potential negative consequences of advocacy.
- become dependent on nurse
- nurse might be 'caught in the middle'
- nurse and pt moral differences
- nurse might face disinterest and apathy of the involved parties which might even question the motivation of the nurse
- creates frustration and discord (lack of agreement)
35
How can the CHN advocate through
1. Assist and involve the community in the problem.
Encourage active participation of community members to:
a. Identify issue
b. Develop goals & strategies to address the issue
c. Evaluate outcomes
d. Create a time line for project
36
How can the CHN advocate through
| 2. Communication/disseminate the issue.
a. SPEAK TO community organizations, businesses, schools, politicians in the community
b. Have COMMUNITY GATHERINGS, town hall meeting
c. Form COALITIONS in the community to ADDRESS HEALTH R/T ISSUES
d. USE MEDIA (web, news, etc.)
e. BULLETIN BOARDS (church, community, recreation centres, grocery stores etc)
F. WRITE LETTERS to campaign to government officials and news papers
G. LOBBY together to raise awareness
37
Disseminate
broadcast a message
38
How can the CHN advocate through 3. Incorporate political strategies.
a. Organize a group of citizens have meetings with municipal government (City Hall)
b. Provide the facts, research to defend current issue
c. Write articles, research, publish
d. Have people tell stories
e. Join coalitions who have a similar cause
f. Vote: get out an vote and encourage others to vote
g. Electioneering
h. Lobbying
i. Serve on a provincial/community board
j. Assume strategic positions in professional organizations, government and become involved in policy development (RNAO, CHNC, Interest groups of RNAO or organizations in communities
39
Lobbying.
contact your representative by phone, email, letter about a specific issue, or piece of legislation, meet with representative , build an ongoing relationship with representative
40
Electioneering.
Support or become a candidate (running for political office)
41
Ethics.
- include a body of knowledge about moral life; referee to values, norms, moral principles, virtues, and traditions that guide human conduct
42
Ethics address:
- How we behave
- What actions should I perform
- What kind of person I should be
- What are my obligations to myself and my fellow humans
43
Nursing Ethics.
- Examines ethical issues in health and health care through the lens of nursing practice and nursing theory
- Several nursing documents articulate the central ethical values and concepts used in all areas of nursing practice, including CHN
44
Everyday ethics.
How nurses attend to ethics in carrying out their daily interactions including how they approach their practice and reflect on their ethical commitment to the people they serve.
45
When do ethical dilemmas arise?
when 2 possible actions can be used in a situation; equally compelling (choosing one means that somethings else is relinquished or let go)
46
Process of ethical decision making.
focusing on the orderly process of how ethical decisions are made; consider ethical principles, client values and abilities, professional obligations; decisions are made using a FRAMEWORK
47
What are some ethical told for CHNs.
1. CHNC Standards of Practice
2. Regulatory Standards of the CNO
3. Legislation (Consent act, privacy legislation, freedom of information, etc)
4. CNA Code of ethics
5. Ethical Decision Making Frameworks
6 Ethical principles (do good, do no harm, respect others, tell the truth, keep promises) and Public health principles in CHN
48
Public Health Ethical Principles.
- focus on population
- work one on one or family, group, community
- main focus is about COLLECTIVE HEALTH of the population
- Community health is inextricably linked with health of its constituents
- attention to 'common good'
- focus on tension btw individual rights and the public health
49
Inextricably.
impossible to separate
50
Constituent.
being part of a whole
51
What are the 4 ethical principles of PHN (CNA, 2006).
1. Harm reduction
2. Least restrictive or coercive means
3. Reciprocity
4. Transparency
52
Ethical principle of HARM REDUCTION.
- do no harm/prevent harm to others
- protect the common good
- justification fro authority to restrict action of individuals or groups is preventing harm to others
53
Example of harm reduction.
CHN would only be justified in quarantining individuals who were exposed to communicable disease and could potentially spread it
54
Ethical Principle of LEAST RESTRICTIVE OR COERCIVE MEANS.
- more coercive methods should be applied only when less coercive means have failed
- should be education, negotiation, and discussion prior to taking someones decision making power away to take away individual autonomy
- PH also has a legal responsibility to protect people and have the legal power to take away individual autonomy
55
Ethical Principle of RECIPROCITY.
"society must be prepared to facilitate individuals and communities in efforts to discharge their duties"
- individuals who are isolated and quarantined may be burdened with time and money loss from work
- reciprocity principle demands compensation be given
- quarantined individuals should be compensated for lost income and additional expenses such as child care, and be sister with things such as food
56
Ethical Principles of TRANSPARENCY.
- referes to the way decisions should be made
- all stakeholders be involved in decisions
- all processes should be clear, accountable and free of political interference and coercion
57
Example of transparency.
Policy development for controlling infectious diseases such as SARS, requires all potential stakeholders be involved in the process ( public, health care professionals, hospital representatives, public health, government officials)
58
What is an ethical issue of CHN a combination of.
social, ethical (moral), legal aspects of nursing practice
59
What must he CHN reflect on?
Context of the issue
a. ethical context of an issue
b. social context of an issue
c. legal context of the issue
60
Ethical context of an issue.
refers to values, norms, moral principles, attitude towards issue (consider where this comes from)
61
Social context of an issue.
cultural script in which people live their lives
- society's experiences and responses to a particular issue
- context in which values, norms are experienced (racism, stigmatization, discrimination)
62
Legal context of the issue.
- provincial and federal legislating to protect population vs individual
- created to keep all people safe
- laws are created based on social norms, values, attitudes about particular issues whin a social context of the issue
- consequences for breaking laws
63
Harm reduction.
"Harm reduction" aims to keep people safe and minimize death, disease, and injury from high risk behaviour. Harm reduction involves a range of support services and strategies to enhance the knowledge, skills, resources, and supports for individuals, families and communities to be safer and healthier” (Health Link BC, 2010)
64
Strategies to reduce harm of illicit drugs.
- Needle exchange
- Heroin and methadone maintenance
- Distribution of safe crack kits
- Provision of information on safe injecting practices
- Supervised injection of illicit drugs in designated environments
- Safe sex products (condoms, lube)
- Drug policy reforms
65
Community Assessment.
- process of becoming familiar with the community (resources, strengths and weaknesses)
- ppl in community are partners in the process
- NEED TO KNOW:
WHAT info is required, WHERE information can be found, HOW it will be collected.
- use many methods of collecting data
66
Goal of Assessment.
Identify factors (positive and negative) affective health of the pop.
- develop strategies for health promotion
- improve the health of the community and or population
67
How many methods should you use for collecting data?
many
68
What is the first step in the CHN process?
assessment
69
Community Assessment includes:
- qualitative and quantitative appraisal of the community
- key questions which guide your assessment
- what SDOH are affected
- who, where and what are the characteristics of the community; are the characteristics of the population
- what info is needed? where do you get it?
- how to engage the community
- are there any constraints in completing the assessment
70
Reasons for Community assessment.
Needs to be EBP
1. Environmental scan
2. Needs assessment
3. Problem investigation
4. Resource evaluation
71
Components of Community Assessment.
a. COMMUNITY HX
b. PERCEPTION OF COMMUNITY (residents perceptions- strengths, concerns, your perceptions as health prof.)
c. POPULATION INFO/target pop./priority/vulnerable pop
(hx, genetics, biology, demographics, personal characteristics; values, space, time, communication, social roles, crime; HEALTH STATUS of comm., mortality, morbidity, density of pop.)
d. BOUNDARIES
e. COMMUNITY SUBSYSTEMS/SECTORS
72
a. History component of community assessment.
Understand the past and build on strengths, avoid repeating failures
73
b. Perceptions of community component of community assessment.
The Residents- how do they feel about their community? strengths/problems, concerns, services needed
Your perceptions- general assessment of “health” of community strengths?
actual or potential problems?
74
c. Population information/ target population/ priority/ vulnerable population component of community assessment.
- hx, genetic, biology
- demographics
- personal characteristics, health behaviours, biology, genetics
- values and beliefs, health practices, save, times, communication, social roles, relationships, crime rates
- health status of the community (mortality/morbidity, life expectancy, rate of growth or decline)
75
d. Boundaries component of community assessment.
- where the target pop lives, works, plays and learns
- Physical: geographic boundaries (lakes, rivers, roads)
- Artificial: political boundaries, situational boundaries (zoning for schools, traffic patterns, smoking area)
76
e. Community subsystems/sectors component of community health assessment.
- More information about the many aspects of community life
- Assess the resource /strengths in community ( assets)
- availability, accessibility
- Quality, quantity
- Gaps in services
77
What is a framework for community assessment.
Community Health Promotion Model.
78
Types of community data.
qualitative and quantitative data
79
Sources of community data.
PRIMARY. (data directly from the client or target pop. OR key informants who work with the pop.)
SECONDARY. (stats, texts, literature, previous surveys, government publications)
80
Methods of data collection.
observation
focus groups
community forum
81
Types of observations data collection.
Windshield surveys
| Participant observation
82
Windshield surveys.
systematic observation while driving or walking surveys
83
Participation observation.
deliberate sharing in the life of the community
84
Focus group discussion.
- obtain in-depth information on an issue from 8-12 people who are knowledgeable about issues
- use structures 4-6 open ended questions/pretested questions
- are formal with a moderator, recorder, prepared material
- provide opportunity for community to dialogue and openly exchange experiences and opinions
85
Community Forums.
- town hall meetings
- public meetings
- done in community centres, schools, serves club
- done when community is concerned about an issue
- provides opportunity to hear about and express views on the issue or proposed change
- forma (structured process, leadership, group participation
- often result in developing actions on specific issues
86
Surveys and questionnaires.
- collect data supplemental to other sources: satisfaction, beliefs, behaviours, hazards (sexual harassment)
- can be done via mail, internet, telephone or face to face
- provides a snap shot o the population being studied
87
Process of data interpretation/ analysis includes...
1. data collection
2. classification
3. summarization
4. interpretation
5. formation of health concern/diagnosis
88
1.Gathering data phase of analysis.
- information is gathered about population, community and perceptions of community
- use assessment tool
- toll has particular section and categories
89
2.Classifying data phases of analysis.
- put into categories based on the type of data
- demographic categories
- geographic characteristics
- socioeconomic characteristics
- health and social resources
- information about sectors in community
90
3. Summarize data.
Use statements made from data collected to summarize.
91
4. Interpret data.
- potential problems identified
- what are actual problems identified
- who are the ppl affected
- what factors contribute to the health concerns
- what are the strengths of the community
- what are the weaknesses
92
5. Formation of health concern/diagnosis.
Identification and formation of statement for community health concern or nursing diagnosis.
1. Specific gap or target pop
2. Actual or potential unhealthy or healthy response/situation that the nurse and partners can change
3. Cause for unhealthy or health response or situation
- Decision must be made to validate the problem list
- Important step in establishing and maintaining your partnership with your community
- Communities have a right to choose their own health needs and negotiate
93
Example of community nursing diagnosis.
Ex. Risk of LBW babies among teenage moms
Related to: inadequate income, tobacco use
Manifested by: High unemployment rates, high smoking rates, stats about lbw
94
Planning phase is..
a systematic process completed in partnership with the community
- involves community engagement; sharing experiences empowers ppl
- planning team may be different in membership than those who assessed and developed diagnoses
- team should bot be too big or small
Need to:
- prioritize issue
- designate who takes action
- set out time line and plan of how it is to be done
- how to evaluate the process and outcomes of actions
95
Planning for community health includes.
a. prioritize health concerns
b. clarify the ultimate goal and objectives
c. identifying interventions to accomplish objectives
d. identify and evaluate methods
96
What should the planning team have?
broad segments of community
- leaders with financial and legal authority for the problem
- ppl that will promote acceptance of the program (media, community leaders)
- those who will implement the program
- target pop
- those likely to offer resistance
- specialists to provide information and alternatives
- those with an awareness of planned change
97
What tools can assist community participation?
- Community Needs Matrix Tool
- Community Mapping
- Present Future Drawing
98
Community Needs Matrix tool to assist community participation
- use to discuss, identify, rate or explain what they perceive to be the most important health problems or most feasible interventions in the community
99
Community Mapping
| tools to assist community participation.
Schematic map of the community indicating the distribution and occurrence of illness, disease, and health; major resources; environmental conditions; accessibility and barriers to various services
100
Present-Future Drawing tool to assist community participation.
used to reflect upon present situation and why resources and constraints contributed to it, and visualize how the future might appear
- helps to see where the community wants to go and to formulate mutual interventions goals and objectives
101
What to consider when prioritizing an issue.
- Who decided the needs?
- Whose views have been shared? Not shared?
- What issue is the most important at this time?
- Why is it a priority
- Why does the issue exist
May divide community
Why?
- Short and long-term consequences
- resources, experts, additional training needed?
- cost effective
- how quickly and easily can the concern be solved
102
How does CHN assist the community to prioritize?
- In depth examination of problems may overwhelm community
- May need assistance in setting a priority
- Setting priority means that other issues may not be addressed
103
Principles used to decide priority community issue.
1. Buy-in
2. Transparency
3. Communication
104
Program.
- organized set of activities intended to meet specific goals and objectives (outcomes)
- need to ensure community involvement at all stages of the planning process
105
Goal.
- stated as a long-term future condition, situation or status of a particular pop group that clearly identifies why outcomes the intervention is designed to achieve or what change is expected in the target pop
- comes form nursing dx (general rationale)
- stated as expected change in pop
- statement of desired states in human condition and social environment
106
Examples of goals.
Goals:
1. Teenage moms will have healthy weight babies
2. Seniors will have less anxiety and fear of being victimized
3. Seniors will feel safe in their homes
107
Objectives.
- measurable step-by-step outcomes required to meet the goals
- what kinds of objectives (health, edu., skills)
- can be knowing, feeling, doing, discuss, appreciate, identify, state, decrease
- objectives should be SMART
108
SMART stands for.
```
Specific & unambiguous
Measurable
Achievable
Realistic
Time specific
```
109
Examples of objectives.
Goal: Teenage moms will have healthy weight babies
Objective: To increase the teenage moms’ knowledge of maternal child care by 50% in 4 weeks ( Feb. 2, 2015)
To increase knowledge and correct use of contraceptives among 75% of teenager in community ( January, 2015)
65% of the teenage girls will attend a smoking cessation program within 2 weeks (Jan, 16, 20150
110
Strategies used/interventions use for implementation.
```
Assertiveness training
Counseling
Self-help groups
Environmental changes
Organizational change
Enforcement of laws and policies
Planning and policy making
Positive action for under-served groups
Mass media campaigns
Lobbying and advocacy
Group work
Talks and lectures
Discussions and debates
Demonstrations/practice opportunities/skill building
Role-playing
Games
```
111
Identify resources to achieve goals, examples.
Resource people who can help you and the clients ( within community, outside community partners/colleagues, experts, leaders, professionals)
Existing facilities and services: staff, space, materials, technology, tables, chairs etc
112
Consider budgets, constraints.
How much expected money, when will it come,
| What are the barriers: time, money, space, people etc
113
What is the final step to community nursing process.
EVALUATION
Allows evaluation of the effectiveness of community interventions and the process of how the community worked together
Address:
Did we do what we said we would do?
What difference did we make?
Has the health concern been resolved or risk reduced
What did we learn about what worked and what did not work?
What could we have done differently?
How do we plan to use evaluation findings for continuous learning?
114
What are some methods of data collection (measures success of interventions)
- similar to those used to collect data in assessment
- group discussion
- surveys
- questionares
- cost effectiveness
- benefits info
- measure changes in demographic, SES, environmental factors, individual and community health status, use of health services
115
How often should you evaluate?
ONGOING basis
- have a TIMELINE
- engage stakeholders and ASSESS RESOURCES
- use those METHODS DETERMINED IN PLANNING
- collects and analyze DATA
- report and DISSEMINATE RESULTS
- make RECOMMENDATIONS for future action
116
Define evaluation.
a systematic examination & assessment of features of a program or other interventions in order to produce knowledge that different stakeholders can use for variety of purposes
117
What are the 2 main components of evaluation?
1. Summative (reflection on the outcomes)
| 2. Formative (reflection on the process towed achievement of the goal
