Determine sociodemographic characteristics
Chapter 7
Community Health Planning, Implementation, and Evaluation
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The Community as Client
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Figure 7-1
Levels of Community Health Nursing Practice
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| Client | Example | Characteristics | Health Assessment | Nursing Involvement |
| Individual | Lisa McDonald | Individual with various needs | Individual strengths, problems, and needs | Client-nurse interaction |
| Family | Moniz family | Family system with individual and group needs | Individual and family strengths, problems, and needs | Interactions with individuals and the family group |
| Group | Boy Scout troop Alzheimer’s support group | Common interests, problems, and needs Interdependency | Group dynamics Fulfillment of goals | Group member and leader |
| Population group | AIDS patients in a given state Pregnant adolescents in a school district | Large, unorganized group with common interests, problems, and needs | Assessment of common problems, needs, and vital statistics | Application of nursing process to identified needs |
| Organization | A workplace A school | Organized group in a common location with shared governance and goals | Relationship of goals, structure, communication, patterns of organization to its strengths, problems and needs | Consultant and/or employee application of nursing process to identified needs |
| Community | Italian neighborhood Anytown, USA | An aggregate of people in a common location with organized social systems | Analysis of systems, strengths, characteristics, problems, and needs | Community leader, participant, and health care provider |
Health Planning Model
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Figure 7-2
Hogue (1985)
Steps in the Health Planning Model
Assessment
Meet with group leaders of aggregate to clarify mutual expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the identified problems and needs to create an effective plan
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Four Types of Needs to Assess
Expressed needs
Demand for services and the market behavior of the targeted population
Normative needs
Lack, deficit, or inadequacy of services determined by health professionals
Perceived needs
Wants and desires expressed by audience
Relative needs
Gap showing health disparities between advantaged and disadvantaged population
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Factors for Determining Priorities
Aggregates preferences
Number of individuals affected by the health problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time, and available resources
May use Maslow’s hierarchy of needs or levels of prevention to further refine priorities
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Community Involvement Is Essential
“Start where the people are!”
Five spheres of empowerment
Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
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Steps in the Health Planning Model (Cont.)
Planning
Determine the intervention levels
Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned interventions according to available resources
Personal, aggregate, and suprasystem
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Development of Goals and Objectives
Goals—where we want to be
Objectives—steps needed to get there
Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
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Steps in the Health Planning Model (Cont.)
Intervention
Often the most enjoyable stage for the nurse and the clients
Implementation should follow the initial plan
Should include a variety of strategies
Prepare for unexpected problems
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Interventions by Type of Aggregate and System Level
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| Project | Type of Aggregate | System Level for Intervention |
| Rehabilitation group | Group | Subsystem and aggregate system |
| Textile industry | Organization | Aggregate system and suprasystem |
| Crime watch | Group, organization, and population group | Aggregate system and suprasystem |
| Bilingual students (case study) | Community | Aggregate system and suprasystem |
Steps in the Health Planning Model (Cont.)
Evaluation
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
Evaluate both formative (process) and summative (product/outcome) aspects
Communicate follow-up recommendations
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Importance of Each Step in the Nursing Process
Aggregate assessments must be thorough.
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
The nurse must complete careful planning and set goals that the nurse and the aggregate accept.
Mutual planning is very important.
Interventions must include aggregate participation and must meet the mutual goals.
Evaluation must include process and product evaluation and aggregate input.
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PRECEDE-PROCEED Model
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Federal Legislation Affecting Health Planning
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources Development Act
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Comprehensive Health Reform
Patient Protection and Affordable Care Act (2010)
Preventive services based on evidence-based recommendations
National strategy to improve the nation’s health
CMMS innovation center
National quality improvement strategy for services and population health
Improved access to care
Reduction in the growth of Medicare spending
National workforce strategy
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Nurses’ Role
Work collaboratively with health planners to improve aggregate health
Fuse technology with knowledge of health care needs and skills
Become directly involved in the planning process
Engage in aggregate-level projects
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