Chapter 1 Health: A Community View Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Community/Public Health Nursing …     … is the synthesis of nursing practice and public health practice. … has the major goal to preserve the health of the community and surrounding populations. … focuses on health promotion and health maintenance. … is associated with health and identification of populations at risk rather than an episodic response to patient demand. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 The mission of public health is …  … social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible. http://www.health.gov/phfunctions/public.htm Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 How Do We Define Health?  A state of complete well-being, physical, social, and mental, and not merely the absence of disease or infirmity. – World Health Organization, 1958  The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, and physical capacities. – World Health Organization, 1986 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Community …  … a group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and/or goals. Nies and McEwen, 2013 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Figure 1-2 From U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Federal Interagency Workgroup: The vision, mission, and goals of Healthy People 2020. http://www.healthypeople.gov/2020/Consortium/HP2020Framework.pdf. Accessed July 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Healthy People 2020 Leading Health Indicators      Access to Health Services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant, and Child Health        Mental Health Nutrition, Physical Activity, and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco Use Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Public and Community Health  Public health is the Science and Art of … (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort… C.E. Winslow…  Community health extends the realm of public health … …to include organized health efforts at the community level through both government and private efforts. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Core Public Health Functions    Assessment: Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community. Policy development: Use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies. Assurance: Focuses on the availability of necessary heath services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations and the capacity to respond to critical situations and emergencies. – Institute of Medicine (1988) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 10 Essential Services  Assessment ➢ ➢ ➢ Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 10 Essential Services (Cont.)  Policy Development ➢ ➢ ➢ ➢ Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 10 Essential Services (Cont.)  Assurance ➢ ➢ ➢ ➢ ➢ Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable. Ensure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 The Three Levels of Prevention  Primary prevention ➢ ➢  Secondary prevention ➢ ➢  Prevention of problems before they occur Health promotion and health protection Early detection and intervention Early diagnosis and treatment Tertiary prevention ➢ ➢ Correction and prevention of deterioration of a disease state Limitation of disability and rehabilitation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 The Three Levels of Prevention (Cont.) Figure 1-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Level of Prevention—Individual Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Level of Prevention—Family Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Level of Prevention—Group Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Level of Prevention—Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Healthy People 2020  Vision ➢  A society in which all people live long, healthy lives. Overarching Goals ➢ ➢ ➢ ➢ Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Healthy People 2020 (Cont.)  HP2020 has 42 focus areas ➢ The objectives and related information and materials can help guide health promotion activities and can be used to aid in communitywide initiatives. (USDHHS, 2013) ➢ All health care practitioners… • should focus on the relevant areas in their practice • incorporate objectives into programs, events, and publications whenever possible • use them as a framework to promote healthy cities and communities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Healthy People 2020 Topic Areas 1. 2. 3. 4. 5. 6. 7. 8. Access to Quality Health Services Adolescent Health New Arthritis, Osteoporosis and Chronic Back Conditions Blood Disorders and Blood Safety New Cancer Chronic Kidney Disease Dementias, including Alzheimer’s Disease New Diabetes 9. 10. 11. 12. 13. 14. 15. 16. Disability and Secondary Conditions Early and Middle Childhood Educational and Community-based Programs Environmental Health Family Planning Food Safety Genomics New Global Health New Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Healthy People 2020 Topic Areas (Cont.) 17. Health Communication and 18. 19. 20. 21. Health Information Technology Healthcare-Associated Infections New Health-Related Quality of Life and Well-Being New Hearing and Other Sensory or Communication Disorders Heart Disease and Stroke 22. HIV 23. Immunization and Infectious 24. 25. 26. 27. 28. Diseases Injury and Violence Prevention Lesbian, Gay, Bisexual, and Transgender Health New Maternal, Infant, and Child Health Medical Product Safety Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Healthy People 2020 Topic Areas (Cont.) 29. Mental Health and Mental 30. 31. 32. 33. 34. 35. 36. 37. Disorders Nutrition and Weight Status Occupational Safety and Health Older Health New Oral Health Physical Activity Preparedness New Public Health Infrastructure Respiratory Disease 38. Sexually Transmitted 39. 40. 41. 42. 43. Diseases Sleep Health New Social Determinants of Health New Substance Abuse Tobacco Use Vision Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Public Health Nursing  ANA definition (2007) ➢ ➢ ➢ The practice of promoting and protecting the health of populations Uses knowledge from nursing, as well as social and public health sciences, to promote and protect the health of populations. Is population focused, with the goals of promoting health and preventing disease and disability for all people Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Community Health Nursing  ANA definition (1980) ➢ Synthesis of nursing practice and public health to promote and preserve the health of populations ➢ Care is directed to individuals, families, groups ➢ Contributes to health of the total population *The terms Public Health Nursing and Community Health Nursing are used interchangeably in Nies and McEwen, 6th edition. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Community-Based Nursing  “Application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system” –McEwen and Pullis, 2009   Setting-specific Emphasis is on acute and chronic care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Community and Public Health Nursing Practice     Nurses practice disease prevention and health promotion Practice is collaborative Practice is based on research and theory Applies the nursing process to the care of… ➢ Individuals ➢ Families ➢ Aggregates ➢ The community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Population-Focused Nursing      Focuses on the entire population Is based on assessment of the population’s health status Considers the broad determinants of health Emphasizes all levels of prevention Intervenes with communities, systems, individuals, and families – Minnesota Department of Health, 2003 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 PHN Intervention Wheel ✓ Is population based ✓ Contains three levels of practice (individual, community, and system) ✓ Identifies 17 public health interventions Figure 1-3 Illustration from Minnesota Dept. of Health Center for Public Health Nursing. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Public Health Interventions (purple section)   Surveillance: Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions. Disease and other health event investigation: Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Public Health Interventions (purple section) (Cont.)    Outreach: Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Screening: Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations. Case finding: Locates individuals and families with identified risk factors and connects them with resources. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Public Health Interventions (green section)    Referral and follow-up: Helps individuals, families, groups, organizations, and/or communities identify and access necessary resources to prevent or resolve problems or concerns. Case management: Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Delegated functions: Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Public Health Interventions (blue section)    Health teaching: Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. Counseling: Establishes an interpersonal relationship intended to increase or enhance capacity for selfcare and coping with a community, system, and family or individual. Consultation: Seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, and family or individual. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Public Health Interventions (red section)    Collaboration: Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Coalition building: Promotes and develops alliances among organizations or constituencies for a common purpose. Community organizing: Helps community groups identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Public Health Interventions (yellow section)    Advocacy: Plead someone’s cause or act on someone’s behalf, with focus on developing the capacity of the community, system, and individual or family to plead their own cause or act on their own behalf. Social marketing: Uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Policy development and enforcement: Places health issues on decision-makers’ agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Providing population-based care… a shift in thinking Populations are not homogeneous; must address the needs of special subpopulations. 2. High-risk and vulnerable subpopulations must be identified early in the care delivery cycle. 3. Nonusers of services often become high-cost users; essential to develop outreach strategies. 4. Quality and cost of all health care services are linked together across the health care continuum. 1. (Kaiser Family Foundation, 2013) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Chapter 2 Historical Factors: Community Health Nursing in Context Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Stages* in the Disease History of Humankind      Hunting and gathering (before 10,000 B.C.) Settled villages (10,000 to 6000 B.C.) Preindustrial cities (6000 B.C. to 1800 A.D.) Industrial cities (1700 to 1800 A.D.) Present period (1900 to 2000 A.D.) *Stages overlap and time periods are widely debated in the field of anthropology. Some form of each stage remains evident in the world today. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Aggregate Impact on Health    Increased population Increased population density Imbalanced human ecology ➢ Resulted in changes in cultural adaptation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Evolution of Early Public Health Efforts  Prerecorded historic times (before 5000 B.C.) ➢ ➢ Practices based on superstition or sanitation Health practices evolved to ensure survival Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Evolution of Early Public Health Efforts (Cont.)  Classical times (3000 to 200 B.C.) ➢ Devised ways to flush water; constructed drainage systems ➢ Developed pharmaceutical preparations ➢ Embalmed the dead ➢ Dealt with pollution ➢ Hygienic code to protect food and water ➢ Greek and Roman impact public health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Evolution of Early Public Health Efforts (Cont.)  Greeks ➢ Literature contains accounts of communicable diseases • Endemic, epidemic, and pandemic ➢ Hippocratic book on Airs, Waters and Places ➢ Hygeia, goddess of health, or good living ➢ Panacea, goddess of curative medicine ➢ Balance of human life with environmental demands Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Disease Definitions Disease Definitions Endemic Diseases that are always present in a population (e.g., colds and pneumonia). Epidemic Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles). Pandemic The existence of disease in a large proportion of the population—a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Evolution of Early Public Health Efforts (Cont.)  Romans ➢ Surpassed Greek engineering • Massive aqueducts, bathhouses, and sewer systems ➢ Addressed occupational health threats ➢ Priests mediated diseases and dispensed medicine ➢ Public physicians worked in designated towns • Worked in groups much like today’s HMOs • Eared money to care for the poor ➢ Hospital for sick poor established by Fabiola, a Christian woman Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Evolution of Early Public Health Efforts (Cont.)  Middle Ages (500 to 1500 A.D.) ➢ Monasteries promoted collective activity to protect public health. ➢ Churches enforced hygienic codes. ➢ A pandemic ravaged the world in the 14th century. ➢ Modern public health practices (e.g., isolation, disinfection, quarantines) emerged. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Evolution of Early Public Health Efforts (Cont.)  Renaissance (15th, 16th, 17th centuries) ➢ ➢ ➢ A theory about the cause of infection evolved. Leeuwenhoek described microscopic organisms. Elizabethan Poor Laws were enacted. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Evolution of Early Public Health Efforts (Cont.)  18th century ➢ The Industrial Revolution occurred. ➢ Poor children were forced into labor. ➢ Vaccination was discovered by Edward Jenner. ➢ Sanitary Revolution’s public health reforms were taking place. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Evolution of Early Public Health Efforts (Cont.)  19th century ➢ ➢ ➢ Communicable diseases ravaged the population that lived in unsanitary conditions. Edwin Chadwick examined death rates by occupation and class in England. The General Board of Health for England was established in 1848. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Evolution of Early Public Health Efforts (Cont.)  19th century (Cont.) ➢ ➢ Public health laws were enacted in 1849: • Healthy mental and physical development of citizens • Prevention of all dangers to health • Control of disease John Snow demonstrated the transmission of cholera via the public water source. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Evolution of Early Public Health Efforts (Cont.)  19th century (Cont.) ➢ Waves of epidemics occurred in the United States. ➢ Lemuel Shattuck published vital statistics in Massachusetts; he called for child health reform. ➢ The first Board of Health was formed in response. ➢ The AMA was asked to collected vital statistics. ➢ Efforts focused on determinants of health. ➢ The advent of “modern” health care occurred. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Florence Nightingale (1820-1910)       Credited with establishing “modern nursing” Concern for environmental determinants of health Emphasis on sanitation, community assessment, and analysis Use of graphically depicted statistics and comparable census data Political advocate Education reform for nurses Figure 2-2 Public domain; courtesy University of Chicago Library. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Impact of Important Scientists  Louis Pasteur ➢ ➢  Robert Koch ➢  Theory of existence of germs Discovered immunizations in 1881 and the rabies vaccine in 1885 Discovered causative agent for cholera and the tubercle bacillus in 1882 Joseph Lister ➢ Surgical success with wound care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 “Modern” Medical Care     Emergence of germ theory focused diagnosis and treatment on individual organism and individual disease. Community outcry for social reforms forced governments to take action. Boards of health and health departments began in 1866. TB surveillance began in 1889. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 “Modern” Medical Care (Cont.)    Flexner Report (1910) outlined shortcomings of U.S. medical schools. Philanthropic foundations influenced health care efforts. 1916: Rockefeller Foundation established first school of public health at Johns Hopkins. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Community Caregiver     Traditional healer common in non-Western, ancient, and primitive societies. Societies retain folk practices because of their success. Folk healing practices are socially cohesive and involve support systems. Although often overlooked, cultural practices affect health. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Establishment of Public Health Nursing  In England ➢ District Nursing in England, 1850s ➢ Rathbone worked with Nightingale to educate “health nurses,” 1859 ➢ Health Visiting in Manchester, England, 1862  In the United States ➢ ➢ Visiting Nurses, 1877 Henry Street Settlement, 1893 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Lillian Wald (1867-1940)     Established Henry Street Settlement in 1893 (along with Mary Brewster) Played an important role in establishing public health nursing in the United States—later called “Visiting Nurses Association of NYC” Role of Henry Street Settlement was “one of helping people to help themselves” (Wald, 1871) The Children’s Bureau and the Social Security Act Legislation formed as a result of these efforts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Other Key Dates in the Establishment of PH Nursing      First School Nurse, Linda Rogers, 1902 Metropolitan Life Insurance Company provided home nurses for policyholders, 1909 Department of Nursing and Health at Teachers’ College of Columbia University in NYC, 1910 National Organization of Public Health Nurses formed, 1912 (Lillian Wald was first president) Public Health Service appointed its first public health nurse, 1913 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Changing Perspectives on Mortality in the 20th Century and Beyond       Change from infectious diseases to chronic conditions Modern medical advances (vaccination programs and antibiotics) Holistic approach to health Better sanitation and nutrition Grecian Hygeia (i.e., healthful living) vs. Panacea (i.e., cure) dichotomy Multi-causal, not uni-causal, view of disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Challenges for Community Health Nursing      Promote the health of populations Need a broadened focus on the multiple causes of morbidity and mortality Aware of increased technological advances Understand the community need for a focus on prevention, health promotion, and home care Focus on holistic care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Challenges for Community Health Nursing (Cont.)  Emphasis on population-based focus nursing ➢ ➢ ➢ ➢ ➢ ➢ Work on behalf of aggregates Understand social determinants of health Gather information and statistics to make decisions Be part of the solution to find ways to solve persistent health problems Emphasize society’s responsibility for health Empower people to help themselves Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Chapter 6 Community Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Defining the Community  Aggregate of people ➢ ➢  Location in space and time ➢ ➢  The “who” Share personal characteristics and risks The “where” and “when” Physical location frequently delineated by boundaries and influenced by the passage of time Social system ➢ ➢ The “why” and “how” Interrelationships of aggregates fulfilling community functions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Diagram of Assessment Parameters Figure 6-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Community Assessment Parameters          Geography Population Environment Industry Education Recreations Religion Communication Transportation          Public services Political organization Community development or planning Disaster programs Health statistics Social problems Health manpower Health professional organizations Community services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Healthy Communities    A movement to help community members bring about positive health changes Interconnectedness between people and the public and private sectors is essential to make changes. Each community has its unique perspective. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Assessing the Community  Windshield survey ➢ ➢ ➢ Gain an understanding of environmental layout Locate possible areas of environmental concern through “sight, sense, and sound” Gives nurse an opportunity to observe people and their role in the community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Windshield Survey    Community vitality Indicators of social and economic conditions Health resources    Environmental conditions related to health Social functioning Attitudes toward health and health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Assessing the Community (Cont.)  Sources of data: ➢ Census data and other census reports ➢ Vital statistics ➢ NCHS survey data ➢ Local, regional, and state government reports ➢ Locally generated data collection  Analysis of demographic information provides descriptive information about the population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Assessing the Community (Cont.)  Needs assessment Used to understand the community’s perspective ➢ Interview key community informants ➢ Use community forums, focus groups, or surveys ➢ 12 Steps in a Needs Assessment ➢ Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Steps in the Needs Assessment Process 1. 2. 3. 4. 5. 6. Identify aggregate for assessment Engage the community in planning the assessment Identify required information Select method of data gathering Develop questionnaires or interview questions Develop procedures for data collection Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in the Needs Assessment Process (Cont.) 7. Train data collectors 8. Arrange for a sample representative of the aggregate 9. Conduct needs assessment 10. Tabulate and analyze data 11. Identify needs suggested by data 12. Develop an action plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Nursing Process ● The nursing process can be applied to the community as a client. ➢ Needs assessment ➢ Diagnosing health

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problems (actual and potential) ➢ Planning ➢ Intervention ➢ Evaluation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Format for Community Health Diagnosis Figure 6-3 Redrawn from Muecke MA: Community health diagnosis in nursing, Public Health Nurs 1:23-35, 1984. Used with permission of Blackwell Scientific Publications. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Epidemiological Studies Used Throughout the Nursing Process      Support planning by establishing effectiveness of certain interventions in specific aggregates Construct benchmarks to gauge achievement of program objectives Compare data with other rates Identify objectives of successful programs Document effectiveness with epidemiological data Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14
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